Professional Documents
Culture Documents
SEMINARI
E CONVEGNI
Universals in
Ancient Philosophy
edited by
Riccardo Chiaradonna
Gabriele Galluzzo
Table of contents
Introduction
Riccardo Chiaradonna, Gabriele Galluzzo
23
41
87
113
185
209
255
299
329
353
381
425
Bibliography
471
Index locorum
509
Index of names
537
Here I will not focus on Plato, for his numerous discussions of medicine do not
really consider the role played by universals in it (unless indeed one reads universals
into Platos famous account of Hippocrates method in Pl., Phdr. 270cd, but this would
be controversial to say the least). his speciic issue is irst tackled by Aristotle and, as I
aim to show in this contribution, Aristotles discussion provides the framework for the
subsequent debates on universals and medicine. For a full account of Platos views on
medicine and its epistemic status, see Hutchinson 1988; Allen J. 1994.
1355b10-14; see also Top., 3, 101b5-10)2. (iii) Like rhetoric, and all
other arts, medicine does not focus on individual cases as such, but on
universals:
[] None of the arts theorizes about what is individual [
]. Medicine, for instance, does not theorize about what will help to
cure Socrates or Callias, but only about what will help to cure a patient of a
certain kind or patients of a certain kind [ ]: this alone
is subject to art what is individual is indeterminate and cannot be known [
] (Arist., Rh., 2, 1356b30-33,
trans. Rhys Roberts, with some changes).
Medicine is an art and as such includes a body of theoretical knowledge. his knowledge, however, does not focus on the treatment of
each individual patient qua individual, since according to Aristotle
particular cases are indeterminate and cannot rationally be known
in their singularity (more on this below). Rather, medicine theorizes
about what helps to cure patients of a certain kind, patients who
happen to be in given conditions that are knowable and deinable
universally (e.g., as Aristotle argues in the Metaphysics, doctors theorize about what can treat a certain illness in all patients with a certain
physical disposition). he last-mentioned feature is extremely interesting for our discussion. hat arts focus on universals is famously stated
in the opening chapter of Aristotles Metaphysics, where medicine is
taken as a case example illustrating the distinction between experience
and art; however, Aristotles view in the Metaphysics is more nuanced
than what we ind in the Rhetoric3. Aristotle presents experience as a
knowledge of particulars, which originates from repeated perception
and memory and may be seen as an organized set of data derived from
perception and retained in memory (Met., 1, 980b28-981a1; APo.,
19, 100a5-6). Since experience does not involve reason as a cognitive
power distinct from perception and memory, experience is not exclusively proper to human beings: some irrational animals also partake in
it, albeit in a limited way (Met., 1, 980b25-27). Art is diferent, since
it involves reason as a cognitive power distinct from perception and
2
See on this Schiefsky 2005, p. 369. I will come back to this issue below.
On medicine in Met. 1, see Frede M. 1990; Schiefsky 2005, pp. 350-3; Hankinson 2004; on the epistemic status of medicine according to Aristotle, see also Frede
M. 2011.
3
memory that is only proper to human beings. Reason has the speciic
function of grasping universals, i.e. recurrent items that are such as
to be predicated of many4, furthermore, rational knowledge not only
knows that something is the case (to hoti, 981a29), but also why it is
so (dioti). Universal items are the proper object of rational knowledge
and cannot be grasped as such by experience: experience is knowledge [gnsis] of particulars [tn kath hekaston], whereas art is knowledge of universals [tn katholou] (Met., 1, 981a15-16, trans. Ross).
his famous schematic distinction, however, is subject to further
qualiication. First, experience and rational technical knowledge are
not simply opposed to one another (as was the case in Platos Gorgias).
Aristotle rather suggests that technical knowledge originates from experience, while not being identical to it. Consequently, at 981a4-5, he
cites Polus words experience made art, but inexperience luck without rejecting his view5. Of course Aristotles position does not coincide
with that of Polus, since he regards art as the result of experience in beings who, in addition to that, also possess intellectual or rational cognitive power. Experience, however, has a crucial (though somewhat
diicult to determine) position in Aristotles account of the formation
of general concepts, both in Met. 1 and APo. 19, and both texts
suggest that we could not rationally grasp universals without experience and memory.
Experience and art are not mutually connected simply because art
cannot arise without experience. What Aristotle also suggests is that
experience and technical knowledge may be equally efective in practice. His example is signiicantly taken from medicine. An empirical
practitioner can successfully heal his patients through mere associative
learning based on experience, without grasping universals and without
having any rational explanation to ofer for treatments administered:
For to have a judgement [echein hupolpsin] that when Callias was ill
of this disease this did him good, and similarly in the case of Socrates
and in many individual cases, is a matter of experience (Met., 1,
981a6-8, trans. Ross). It has been noted (rightly in my opinion) that
this view of medical empirical practice involves some power of gener4
his is indeed a very sketchy characterisation and I will not dwell on the
deinition(s) of universal in Aristotle: see the remarks in Mariani, Castelli and
Galluzzo, this volume.
5
On Aristotles reference to Polus and its anti-Platonic character, see Auffret
2011.
alization, even if this empirical generalization difers from generalization proper, which implies the rational grasp of explanatory universals. As R.J. Hankinson puts it, one may well assume that the empirical
healer does not recognize the universal as such (he is not committed to
the view that a certain treatment is beneicial to everyone in a particular condition); nonetheless, the empirical healer too acts in a certain
way because the universal is true6.
Aristotle acknowledges that a treatment merely based on memory
and experience is as successfully repeatable as a treatment based on
rational knowledge, although empirical practice is not able to provide
any universal and rational explanation for this fact. hese remarks suggest that the relation between experience and technical knowledge is,
so to say, a foundational one: both experience and technical knowledge
can ensure successful practice, but technical knowledge alone provides
an adequate understanding of the reasons for success, whereas experience is unable to provide anything of the sort. Aristotle himself seems
to suggest this conclusion at Met., 1, 981a10-30:
[] to judge that it has done good to all persons of a certain constitution,
marked of in one kind [ ], when
they were ill of this disease, e.g. to phlegmatic or bilious people when burning
with fever, this is a matter of art []. For men of experience know that the
thing is so, but do not know why, while the others know the why and the
cause (trans. Ross, with some slight changes).
he above distinction could not be any clearer; yet the lines replaced
by [] provide some further remarks, which at least partially meaning, as far as practice is concerned qualify the hierarchy subsisting
between experience and art. Again, medicine provides Aristotles case
example for illustrating this complex situation:
[] we even see men of experience succeeding more than those who have
theory without experience. he reason is that experience is knowledge of individuals, art of universals, and actions and productions are all concerned with
the individual; for the physician does not cure a man, except in an incidental
way, but Callias or Socrates or some other called by some such individual
name, who happens to be a man. If, then, one has theory without experience,
and knows the universal but does not know the individual included in this, he
6
will oten fail to cure; for it is the individual that is to be cured (Arist., Met.,
1, 981a14-24, trans. Ross).
sense. Medicine cannot in any way remove such factors from its focus,
for it is intrinsically directed to the treatment of individuals.
Problems such as these were tackled from the age of Hippocrates
onwards, and the ancient physicians emphasized that ideally not only
the nature of the human being in general should be considered, but
the peculiar nature of each individual (see e.g. Vict. 2). his overall approach is set out in the famous methodological chapter in Hippocrates
Epidemics (Epid. I.23), where we ind the view that doctors should take
account of the individual nature of each person and of a large number
of additional factors in order to do justice to particular cases:
he following were the circumstances attending the diseases, from which
I framed my judgments, learning from the common nature of all and the
particular nature of the individual [
], from the disease, the patient, the regimen prescribed and the
prescriber for these make a diagnosis more favourable or less from the
constitution, both as a whole and with respect to the parts, of the weather
and of each region; from the custom, mode of life, practices and ages of each
patient [] (trans. Jones).
his passage with great clarity displays a line of thought that repeatedly comes up in the Hippocratic treatises, where the doctor is supposed to understand the individuality of the patient in order to give
him advice and heal him (e.g. VM 20)7. his view is sometimes connected to the idea that individuals contain blends (krsis) deriving
from the humoural composition of the body, so that each human being may be seen to embody one distinctive mixture (see VM 14.4)8. An
approach such as this is obviously at odds with what Aristotle argues
in the Rhetoric, where he asserts that medicine is an art that does not
theorize on individuals as such, but only on what heals individuals of a
certain kind. Instead, the remarks in the Hippocratic corpus are closer
to Met. 1, where Aristotle argues that it is the individual that is to be
7
For further details, see Schiefsky 2005, pp. 293-8 and pp. 315-24.
On this, see the overview in Sassi 2005, pp. 148-160; Schiefsky 2005, pp. 233 f.
and pp. 248 f. he view set out in VM 14.4 is so described by Schiefsky 2005, p. 233:
[E]ach individual contains a distinctive blend of humors present in diferent amounts
and degrees of concentration; the particular amounts and concentrations of the various humors determine the distinctive capacities of the individual to assimilate certain
foods and to be afected by others.
8
cured, e.g. Socrates or Callias. We might be led to infer from this that
Aristotles views in the Rhetoric and the Metaphysics are mutually contradictory, yet this would certainly be the wrong conclusion. In both
treatises, Aristotle maintains that medical technical knowledge deals
with universals. His remarks on individuals in Met. 1 concern not
the understanding, but the practice of medicine: as noted above, it is
experience, not technical knowledge, that is responsible for this practice. he separation between the theory and the practice of medicine
clearly emerges in a passage from Aristotles On Sensation:
It also belongs to the natural philosopher to obtain a clear view of the irst
principles of health and disease, inasmuch as neither health nor disease can
exist in lifeless things. Indeed we may say of most physical inquirers and of
those physicians who pursue their art more philosophically, that while the
former end by discussing medical matters, the latter start from a discussion
of nature (Arist., Sens. 436a17-b1, trans. Beare, with slight modiications).
his passage reveals at least two facts. First, that for Aristotle medicine and natural philosophy are two separate and well-deined ields:
his problem is to explain how they are related9. Second, that this relation is close, as far as the theoretical or philosophical aspect of medicine is concerned, to that which subsists between two hierarchically ordered sciences according to Aristotles view of subalternation (see APo.
7), since philosophical medicine draws its principles from natural
philosophy and applies them to a more speciic and well-deined ield
(the knowledge of health and disease). he relation between medicine
and natural philosophy is thus similar to that between harmonics and
arithmetic or between optics and geometry. It has been noted that this
position, which implies a strict subordination of medicine to natural
philosophy, is similar to that rejected in the Hippocratic treatise On
Ancient Medicine (De vetere medicina)10. his remark is certainly correct, but needs qualiication. Aristotles overall view seems to be based
on the distinction between philosophically oriented and practically or
empirically oriented physicians (see also Platos similar distinction in
Lg., IV, 720ac and IX, 857cd). While what he says about philosophical medicine in On Sensation actually recalls the position rejected in
On Ancient Medicine, his remarks about the practice of medicine in
9
10
Met. 1 are much closer to what can be found in treatises such as the
Epidemics or On Ancient Medicine, since Aristotle shares the idea that
treatments should be geared towards individual patients. However, a
crucial diference subsists: according to the authors of Epidemics and
On Ancient Medicine, it is medicine as such that is concerned with
individuals there is no distinction drawn here between a theoretical
aspect of medicine (dealing with generalities) and a practical or empirical one (aimed at treating individuals). his, by contrast, is the view
which can be attributed to Aristotle, although Aristotle never explicitly
presents it.
he above distinction between the theory and practice of medicine
is open to several objections. In a sense, it paved the way for the later
radical distinction, in the Hellenistic Age, between the conjectural
parts of medicine (e.g. diagnosis and therapy) on the one hand and its
scientiic ones on the other (e.g. aetiology and physiology: see Erasistratus ap. [Gal.], Int. XIV.684 K.)11. However, it would no doubt be
grossly misleading to ascribe an anti-empiricist view to Aristotle, even
if Jaegers celebrated idea that Aristotle should be regarded as the philosophical inspirer of Diocles of Carystus methodological empiricism
in medicine has repeatedly been rejected12. Aristotles position is rather
that experience is necessary to adapt a corpus of technical universal
knowledge to individual given situations, as far as this is possible. his
empirical adaptation, however, is doomed to be imperfect and remain
outside the boundaries of science proper.
Regularity devoid of all exceptions is nowhere to be found in the
sublunary region, for here nature displays no complete regularity, but
only regularity of the sort that allows for exceptions and hence holds
for the most part (hs epi to polu). As a matter of fact, according to
Aristotle this is the status of all rational knowledge focusing on the
sublunary physical region (Met. 2). hings vary from case to case,
however, and the epistemic status of medicine cannot straightforwardly be compared to that of sciences such as zoology or botany, since
medicine involves a practical aspect that is unavoidably confronted
11
References to Galens works are given in Roman (volume) and Arabic (page)
numerals according to Khns edition (with the exception of course of those works
not included in Khn). ore recent editions, such as those of CMG and Les Belles Lettres, also indicate Khns pagination. For the list of the abbreviations used for Galens
works, see Hankinson 2008a, pp. 391-7.
12
See van der Eijk 1996 and Frede M. 2011..
not only with what is for the most part, but with what is individual
and accidental. Under such premises, the completely successful and
scientiic practice of medicine is de iure impossible to attain. Indeed,
as Aristotle argues in his Rhetoric, this should not prevent us from
regarding medicine as an art, even if its practice does not allow for
repeatability without exceptions and thus cannot escape occasional
failures: the competent practitioner will do everything in his power
to attain a successful result, even if he may fail in his goal (Rh., 1,
1355b10-14). Remarks such as these, however, conirm that the theory
and practice of medicine remain somewhat removed from one another: medical theory shares the epistemic status of the natural sciences
(i.e. sciences which focus on what is for the most part), while medical practice is doomed to be at least partly empirical and removed from
science proper; at the same time, it seems somewhat diicult to isolate
theory from practice in medicine (nor do Aristotles remarks in Met.
1 invite us to do so). All this helps explain why Aristotle sometimes
regards the scientiic status of medicine as intrinsically feeble. Signiicantly, he makes extensive use of medical analogies in his ethical writings: his comparisons rest on the fact that both the art of the physician
and that of the ethical philosopher deal with individual situations and
practical actions that contain accidental features and thus exceed the
boundaries of science in its proper and true sense; hence Aristotles
emphasis on the unavoidably imprecise character of medical knowledge (see EN, 3,1112b1 f.)13.
he potential separation between the theory and the practice of
medicine is deeply rooted in Aristotles views on knowledge. A cursory reference to Met. 15 may be appropriate here. his chapter is the
focus of an in-depth discussion by Gabriele Galluzzo in this volume
and I will not dwell on it. I will limit myself to following Galluzzos
analysis and recall the overall conclusion which emerges from Aristotles text namely, that particulars can well be objects of deinition, but
their deinition is always de iure applicable to multiple objects, even
when there is de facto only one particular which satisies it. No deinition exclusively picks out a particular object to the exclusion of others
of the same kind, since each deinition is a conjunction of predicates
and predicates are always (at least de iure) applicable to a plurality of
objects (see Met., 15, 1040a8-14 and a27-b2). Particulars are situated outside the domain of deinitions and there is no room for de iure
13
Indeed, according to the reading developed by Frede M., Patzig 1988, Aristotles theory of individual substantial forms in Met. might be potentially at odds
with this conclusion. he issue is however very controversial and Frede and Patzigs
interpretation faces a number of diiculties: see Galluzzo, this volume. Furthermore,
even according to Frede and Patzigs reading individual forms should not be conceived of as individual unrepeatable quasi-Leibnizean natures (the individual essence
of Socrates as Socrates), for they are co-speciic and do not difer in nature from each
other precisely as forms: see Frede M., Patzig 1988, 1, pp. 55 f.; Frede M., Patzig
1988, 2, p. 148.
his task largely exceeds the limits of the present discussion, so I will simply refer
here to some excellent studies devoted to the subject: Frede M. 1982; Frede M. 1985,
pp. ix-xxxvi; Frede M. 1987c; Frede M. 1990; Vegetti 1994; Allen J. 1994; Allen J.
2001, pp. 87 f.; Frede M. 2011.
16
he classical work on the Empiricist school remains Deichgrber 1930.
much more radical version of this view can actually lead to the position
of Empiricist doctors, who famously criticized the Rationalist approach
to medicine: rejecting all talk of hidden causes, they argued that experience is a suicient basis for the art of medicine, without ever referring to any faculty of reasoning distinct from perception and memory
(see e.g. Sect. Int. I.72-74 K.). However, I do not intend to suggest that
Aristotle and the Empiricist doctors held the same views about experience: rather, the Empiricist view is close to that of Polus, as reported in
Met. 1, according to which experience is a suicient basis to establish an art17. he Empiricists, therefore, rejected the overall Rationalist
idea that doctors should grasp the basic nature of both the human body
and unhealthy afections in order to decide on the appropriate treatment. All that doctors need to know, they argued, is what is harmful
and what is beneicial to a patient: on their view, there is no need for
any theory to attain this knowledge, which can instead be grounded
on pure observation. While Rationalist medicine grounded therapy in
physiology and pathology, according to Empiricist doctors experience
based on a physicians own direct observation (autopsia) and drawing
on the previous observations of earlier reliable practitioners (historia) is fully suicient in itself to establish medical knowledge18. As we
shall see below, Galens position may in a way be seen as a synthesis
between these two approaches and thus be compared to the view held
by Aristotle, who regarded medicine as a rational art that in practice
relies on experience. In fact, although Galen is certainly a Rationalist
and maintains that causal knowledge provides the basis for appropriate
therapy, he vehemently criticizes bad Rationalist doctors and speculative philosophers for neglecting experience and indulging in groundless theories. Nonetheless, Galens views on experience difer considerably from those of the Empiricist doctors (but also Aristotle), since he
suggests that experience can be treated rationally and so to speak
reduced to reason. Furthermore, he argues that reason can at least
approach to the knowledge of particulars as such (see below, Part 4).
17
his sketchy account of medical views on knowledge ater Aristotle would be a very partial one indeed if no reference were made to
at least two additional factors. First, the Hellenistic and post-Hellenistic philosophical traditions, which profoundly modiied the doctrinal background of the fourth century and interacted extensively with
medicine. Specialists have repeatedly focused on the relation between
Stoicism and Rationalist doctors (in particular with respect to the theory of inferences from signs), as well as that between Empiricist doctors and Neopyrrhonism. In the present paper, instead, I will especially
focus on the theory of individuals as formulated by some Hellenistic
and post-Hellenistic doctors most notably Galen. hese physicians
developed the ancient Hippocratic view that medicine should consider individual natures by taking account of Stoic ideas on the nature
and knowledge of individuals (see below, Part 4). Another essential
aspect of post-Hellenistic medicine is the epistemology of the so-called
Methodist school19. Medicine, according to Methodists, is nothing but
a knowledge of manifest generalities, or as M. Frede has put it of
certain general, recurrent features whose presence or absence can be
determined by inspection (see Gal., Sect. Int. I.80 K. and I.93 K.; MM
X.206 K.; [Gal.], Opt.Sect. I.175 K. and 182 K)20. he Methodist theory
of generalities (koinottes) may be seen as a radical overthrowing of
the Hippocratic approach to individuality; this theory is both of philosophical interest in itself and crucial to an understanding of Galens
Platonic-Aristotelian account of division and universals, which he
chiely developed as a critical reaction against Methodist medicine.
Both Empiricist and Methodist doctors held distinctive views on
universals and particulars. heir views are diferent toto caelo from
each other and an account of them is necessary to understand Galens
approach to the universal generalization problem21. As noted above,
Aristotle qualiies experience as the knowledge of individuals and thus
separates experience from art, which is the knowledge of universals.
his position is not exempt from possible objections, since experience
too seems to involve some power of generalization. Aristotles answer
to this objection would probably be that empirical generalizations cannot be seen as generalizations in the true and full sense. Indeed, the
19
empirical healer acts in a certain way because universals are true, but
he does not recognize universals as such he is not committed to the
view that a certain treatment heals all human beings in a given condition from a certain disease. Reason, and reason alone, can grasp universals as such. he Empiricist doctors, however, did not assign any
position to reason in establishing medical knowledge. Unlike Aristotle
and Rationalist doctors, they rejected all talk of causes or natures
that can only be grasped through reason; accordingly, they replaced
reasoning about illnesses and their causes with the observation and
recording of manifest symptoms or clusters (sundromai) of symptoms
(see Gal., Subf. Emp., 57, 2 f. Deichgrber), the recommended treatment of which is always the same22. Signiicantly, Empiricists regarded
apparent instances of inferential reasoning in medicine (e.g. the transition from symptoms to a suggested therapy) as cases of being induced to recollect23; thus they treated technical knowledge as basically
a matter of acquiring the disposition to be reminded of certain things
by certain observations. his view may appear suspect and indeed be
criticized for obscuring the diference between being reminded and
coming to know. A defence of it could also be provided, but I will not
dwell on the matter 24.
What I will focus on is instead a diferent aspect of the question.
Unlike Aristotle, the Empiricists overtly ascribe a capacity of generalization to experience. Yet this capacity cannot be grounded on the
intellectual grasping of any universal recurrent feature, nor can reason
provide guidance for experience. he Empiricist view is rather that
knowledge of medical theorems is merely based on repeated unassisted observation, either direct (autopsia) or recorded by previous
reliable practitioners (historia). he way in which repeated experience
can account for the formation of general knowledge is obviously radically diferent from the way in which reason can account for it:
By experience we mean the knowledge of those things which have become
apparent so oten that they already can be formulated as theorems, i.e., when
it is known whether they always have turned out this way, or only for the most
part, or half of the time, or rarely (Gal., Subf. Emp., 45, 24-30 Deichgrber,
trans. M. Frede).
22
23
24
Let us return for a moment to Aristotles Rationalist account of technical knowledge. According to Aristotle, the trained doctor is capable
of inding the correct treatment since he knows that a certain remedy
heals all individuals of a certain kind from a certain disease (Met.,
1, 981a10-12). Since, then, the doctor grasps the properties that deine a remedy, a certain illness and all individuals of a certain kind, he
universally knows that administering the remedy in question will heal
those individuals from their illness. he Empiricist account of generalization can best be understood in opposition to this Rationalist account of technical generalization.
According to the Empiricists, general propositions of the kind All
As are F are actually nothing but the result of the repeated observation of individual cases. he Empiricists avoid all reference to nonobservable natures to be grasped intellectually; hence their refusal to
adopt the Hippocratic humoural theory (and the consequent criticism
addressed by Galen against them: see MM X.207 K.). heir emphasis
on direct observation and on the careful recording of individual cases,
however, can still be seen as being connected to the Hippocratic method of the Epidemics; signiicantly, it was favourably regarded by Galen.
Galen reproaches Empiricist physicians for focusing only on observable characters (in order to discover what the correct treatment might
be, as criteria they adopt the patients age and gender, the observable
qualities of his/her lesh, etc.), while neglecting the true criterion for
determining the individual nature of each patient, namely the balance
of his/her elemental constitution. Nonetheless, their practice does justice to the crucial fact that medicine aims to heal individuals; consequently Galen is moderately favourable to the Empiricist view, at least
insofar as it is opposed to that of the Methodists, which he notoriously
regards as hopelessly false and misleading, for it subverts the practice
of the art (Sect. Int. I.79 K.).
As noted above, the Empiricist practice of medicine depends on the
careful observation and recording of individual cases, whereby general medical theorems are merely based on the relative frequency of
the observed facts. Generalization is thus intrinsically connected to
frequency of observation: it is precisely in this context that a recognizable (albeit rudimentary and non-mathemathized) notion of probability and degrees of probability emerged25. For example, a general
theorem concerning the therapeutic power of a remedy will merely
25
be adopted in each case. All training, in their view, was simply geared
to make common medical conditions evident to physicians with suicient clarity; hence the Methodist claim that six months were suicient
to apprehend medicine (see Sect. Int. I.83 K.; MM X.5 K.). here was
actually some debate in antiquity as to whether the Methodist believed
that koinottes could be perceived or not; their attitude to reason is also
a matter of debate28. Certainly, their generalities were not meant to be
made the object of inferential reasoning like the non-manifest states
whose knowledge, according to the Rationalist doctors, accounted for
the choice of the correct treatment (see Sect. Int. I.81-82 K.). However,
neither were koinotts meant to be grasped through repeated experience, nor, according to the Methodists views, was the indication of
the appropriate treatment to be grasped through observation and experience. As M. Frede has put it, that a state of constriction requires
relaxation and a state of relaxation requires replenishment is seen by
the Methodists as truths of reason. Unlike the Empiricists, they thus
grant that reason has a constitutive position in medical knowledge;
however, their conception of reason is a non-committal one and as
such is radically diferent from that of the Rationalists. It is worth
quoting M. Fredes account of the Methodist position in full:
hey refuse to attribute to reason any obscure powers which we would have not
dreamed of in ordinary life. hey are just noting, in this and in other contexts,
[] that there certain things that are obvious to rational creatures, though
it does not seem to be by observation or experience that they are obvious29.
Accordingly, the Methodist notion of indication difers considerably from that of the Rationalist doctors. Methodist indication does
not refer to any knowledge of hidden pathological states; rather, the
Methodists claim that each disease is indicative of its treatment, since,
once one is aware of the disease in the appropriate way (i.e. once the
common condition of constriction or relaxation has become manifest to a physician), it will also be obvious how the disease should be
treated.
he Methodists famously adopted an outrageously critical attitude
to Hippocratic medicine (hessalus wrote a letter to Nero against the
harmful precepts of Hippocrates and proclaiming the virtues of the
28
29
ing was famously very extensive and rather unique for its day: he was
extremely well acquainted with Plato, Aristotle and heophrastus,
with the Hellenistic traditions, and with works by Platonist and Aristotelian philosophers and commentators. his fact explains the distinctive character of Galens approach. As I aim to show, the relation
between medicine and philosophy is a reciprocal one in Galen since
(i) he discusses and recasts the distinctive epistemological problems of
the medical tradition by making extensive use of technical and philosophical theories (in particular, but not exclusively, Platonic and Aristotelian ones); (ii) in doing so, he comes to develop a highly distinctive
version of these philosophical doctrines, which can only properly be
understood by taking account of the speciic medical purposes of Galens approach to logic and philosophy (this is paradigmatically the
case with the theory of deinition and speciic diferentia).
In the second book of MM Galen repeatedly argues in favour of a
theory of immanent recurrent natures whose Aristotelian character is
as evident as it is striking33. It is worth quoting some lines in full:
It is necessary for all diseases to be called diseases because they share in one
and the same thing [ ], in the same way as do human
being, cow, and each other living being. For there is some thing unique in
all human beings [ ]. For this
reason all human beings are in fact called by the same name. Similarly there
is some one thing unique to all dogs, which we attend to when we wish to
have an understanding of dogs. Equally, in horses there is some single unique
thing in virtue of which they are called horses (Gal., MM X.128 K., trans.
Hankinson, with slight modiications).
his view on universal immanent things involves a rudimentary realist ontology, of the kind that Galen (to the best of my knowledge) never
developed in any detail (for example, he does not explain what the ontic
status of immanent recurrent features is, or the way in which they are
related to particulars, etc.). his may appear disappointing, especially
if we compare Galens approach to that of professional philosophers
such as Alexander of Aphrodisias or Porphyry, whose discussion of im-
who interestingly suggests that Galens DD is in the background of Clem. Al., Strom.
VIII.
33
See Hankinson 1991, p. 218.
clearer as soon as we realize two facts, namely: (i) that for all their differences, Plato, Aristotle and heophrastus, according to Galen, form
a unique philosophical front, that of the logical method, to be addressed against hessalus theory of koinottes; (ii) that while drawing
his overall inspiration from Plato, Aristotle and heophrastus, Galen
does not simply report their theories; rather, his theory of division and
deinition presents some peculiar features, which can only properly be
understood against the background of Galens own epistemology.
Just ater mentioning his philosophical authorities, Galen overtly
opposes them to hessalus:
Yet the outrageous hessalus thinks he is worthy of credence when he simply
asserts that there are only two kinds of disease in the sphere of regimen. []
And if you have discovered these things by some method, as you boast, why
dont you reveal it to us? (Gal., MM X.26-27 K., trans. Hankinson).
Basically, Galen builds on a general principle which he could easily draw from both Plato (see Phdr. 265e) and Aristotle (see PA, A 2,
642b10 f.): the division of natural kinds should correspond to the appropriate joints of reality. Dividing correctly, then, is no arbitrary or
stipulative procedure: for it entails that one conjoin the genus to the
species-forming (eidopoios) diferentia (see MM X.23 K.). What is a
species-forming diferentia? As R.J. Hankinson puts it, A diferentia
D is species-forming with respect to some genus G if and only if either
(a) the conjunction of G and D is suicient to identify a species, or (b)
the conjunction of G, D, and some further set of diferentiae is suficient non-redundantly to identify a species36. For example, as Galen
argues (MM X.23-24 K.), one should not divide the genus animal on
the basis of diferentiae such as sot and hard, heavy and light, which
are appropriate not for animal, but for substance; the appropriate differentiae (oikeiai diaphorai) of the genus animal are instead mortal
and immortal, rational and irrational, tame and wild, etc.
his view inds a couple of interesting parallels in writings attributed
to Alexander of Aphrodisias. In Mant., 21, 169, 11-13 Bruns, we ind
a sketchy account of division and diferentiae which is similar to that
of Galen and has rightly been compared to it37:
36
37
his quaestio is designed to show that male and female are not different in species: the topic is closely connected to Met. I 9 and it is
possible (but not provable with any certainty) that this text from the
Mantissa ultimately derives from Alexanders lost commentary on
Met. I (the term oikeios occurs in this chapter from the Metaphysics
too, where it designates male and female as oikeia path of the genus
animal: see Met., I 9, 1058b22)38. here are actually several complicated questions surrounding these lines from Mantissa, in particular
regarding the view that (a) dividing (diairetikai) diferentiae should
be contained in the genus they divide (if X is a diferentia that divides
Y, Y is predicated of X)39 and (b) dividing diferentiae should not extend wider than the divided genus. Certainly, these problems were extensively debated among commentators and divergent solutions were
proposed40. Alexanders texts On Diferentia, preserved in Arabic,
contain an extremely complex set of discussions of these issues, whose
relation with the passage from the Mantissa is somewhat diicult to
determine41. Actually, the Arabic Dif. I criticizes the view according
to which dividing diferentiae should not extend beyond the divided
genus; however, the contradiction with Mant. 21 is perhaps not to
be overemphasized42. In Dif. I [7] Alexander also deals with the ap38
44
45
,
, .
.
See on this and what follows Hankinson 1991, p. 102. Rashed 2007, p. 155
argues that the choice between rational and biped as species-forming diferentiae of
human being raises some questions concerning Alexanders hylomorphic ontology.
As far as I can judge, Galens overall approach does not share this kind of concerns.
tion should somehow already be known from the start and act as a
guide for inding the species-forming diferentiae which are appropriate to the genus (i.e. which make up its subordinate species). But how
can this be possible?
Before attempting to answer this question, it is worth discussing
a further parallel with the commentators. We know from Simpl., In
Cat., 57, 22 f. Kalbleisch that Herminus, while interpreting Cat., 3,
1b16-17, argued that diferentiae that occur in diferent parallel genera which fall not one under the other, but rather all under the same
genus (e.g. the diferentiae biped and quadruped that occur both in
the genus terrestrial and in the genus winged, including mythological
creatures such as the sphinx or the gryphon, which both fall under
the genus animal) are primarily diferentiae of the superior genus that
includes the parallel genera (i.e. of the genus animal)47. his view is
obviously open to the objection that animal would thus be both biped
and quadruped: we ind a remark of this sort in Alexanders text Dif.
I, preserved in Arabic (see Dif. I [3i])48. In this work, Alexander reacts
against an adversary whose position is actually extremely close to that
of Herminus49. Galens view that rational/irrational, mortal/immortal,
tame/wild, are all diferentiae of the genus animal may actually recall
Herminus view that biped and quadruped are primarily diferentiae
of the genus animal. However, Herminus view is certainly connected
to his refusal to admit species-forming diferentiae: on his view, differentiae are just dividing diferentiae (see Simpl. In Cat., 55, 22-23
Kalbleisch). his remark does not solve all problems, but can at least
serve to dismiss the objection that the genus animal would be equally
determined by diferentiae such as biped and quadruped: Herminus
merely argues that these diferentiae are primarily dividing diferentiae
of the genus animal. Furthermore, what we know about his views on
how major and minor terms should be determined in syllogistic shows
that Herminus was very interested in ixing the correct order of cuts in
divisions that start from the highest genus (see Alex. Aphr., In APr.,
47
acquires full meaning when interpreted as a reaction against Methodist therapeutical principles. What Galen is doing is reproaching hessalus for his practice of drawing therapeutic indications from hypergeneral diferentiae that lack any real informative value for treatment.
Galen does not deny that the Methodist costive/luid diferentiae may
be attached to diseases (just like rare/dense, hard/sot, taut/relaxed: see
MM X.23 K.); what he denies is that enumerating diferentiae such as
these may in any way suice to adequately determine the species of
diseases (such as inlammation, tumour or oedema), thus establishing
a pathology, which (in his view) is the only adequate ground for therapy. Hence Galens irony (MM X.162-163 K.) directed against hessalus view that a concave wound in a leshy part of the body should
be treated by administering a remedy that generates lesh (embalontes
[] to sarktikon pharmakon), thus replenishing the wound. his
is obviously true, but one should determine precisely how this remedy should be prepared, and this, according to Galen, requires (MM
X.169 f. K.) detailed particular indications (about pharmacology, the
elemental composition of the wounded lesh, etc.: see MM X.176-177
K.), as well as rationality (logos) and logical methods.
Yet, while Galens polemical strategy clearly emerges from the text,
his own views on division and deinition still appear somewhat vague.
As I aimed to show, his emphasis on appropriate diferentiae and the
necessity of adequately determining species can be seen as a reaction
against the Methodists. Galens peculiar view that one should irst grasp
a species in order to discover its diferentiae can also be understood as
part of his anti-Methodist approach. hus we return to the problem
mentioned above: how can one be capable of grasping the essential
deinition of a species accurately, if this awareness is a necessary condition for inding the diferentiae that account for appropriate division?
We may suppose that one comes to grasp species by inductive reasoning: by division, each species will subsequently be ordered under its genus. Yet Galen dismisses induction as inappropriate for demonstration
(see hras. V.812 K.)52, so another explanation should be found. Actually, Galen himself provides an answer to this question at MM X.40 .:
[] we must now I suppose explain what a disease actually is in its deinition,
so that we may thus attempt a proper division of it. How then do we ind this
out correctly and methodically? How else than by the means speciied in On
52
53
now receive the following preliminary answer: by respecting the distinctions of ordinary language that relect our awareness of the real
distinctions of the world around us. But this obviously leads to a further question, namely why these distinctions are appropriate and why
our awareness of the world relected in language should be regarded as
a criterion for scientiic enquiry.
Again, Galens answer to this question runs along familiar Stoicizing lines: we are naturally built in such a way that we come to grasp
how the world around us is objectively structured. he ultimate basis
for Galens views on division and universals, then, is his theory of the
criterion. Galen adopts a widely shared view in post-Hellenistic philosophy, which possibly dates back to heophrastus (see S.E., M. VII,
217-218): he regards both senses in their normal conditions and
reason as criteria of truth (see MM X.36 and 38 K.; PHP V.723 K.; Opt.
Doc. I.48-49 K.). hese, he argues, are natural physical and physiological capacities that account for our awareness of the world and whose
reliability should be thought to resist sceptic attacks56. Galen sees the
distinction between things which are one in species and those which
are one in number as a most elementary feature of our acquaintance
with the world; so elementary, in fact, that it is also shared by donkeys,
by common consent the stupidest creatures (MM X.133-134 K.).
Galens excursus on how donkeys are able to distinguish speciic and
numerical unity may appear as merely a picturesque detail, yet things
change as soon as we realize that Galens rivals actually denied this
distinction. he Empiricist theory of sundromai (i.e. combinations of
symptoms which are individual features of a case: see Subf. Emp. 56,
4 f. Deichgrber) led them to suppress the distinction between being
one in species and being one in number (see MM X.141 K.); so much
so, that according to them individuals of the same kind (several relevantly similar sundromai) are in fact the same individual seen many
times57. On the other hand, the Methodist theory of generalities suppressed all natural distinctions among things by replacing them with
general dispositions, which make individuals irrelevant.
understanding reality. Rather, he suggests that an approximate linguistic description
can successfully be applied even when complete precision is impossible (Dign. Puls.
VIII.774 K.). On Galens views on approximation, see the last part of this contribution.
56
See Hankinson 1997.
57
Galen condemns Empiricist doctors for asserting this view at MM X.136 K.; see
Hankinson 1991, p. 217.
4. Galen on particulars
In the irst two books of MM Galen emphasizes the scientiic character of therapeutics and links division to the kind of rational understanding pursued by medicine. All this obviously tends to present
medicine as a body of general knowledge which (according to Galen)
can attain the same status that we ind in hard sciences such as mathematics. hat medicine as such deals with universals is actually also
asserted at the beginning of the Ars medica. he author of this treatise
(probably Galen, although the issue is debated) follows Herophilus in
deining medical science (epistm) as the knowledge of health-re-
58
lated, disease-related, and neutral things (I.307 K.)59. he author further explains (I.309 K.) that this deinition may be taken to mean that
medicine is a science (a) of all of these things taken as particulars, (b) of
some of these things taken as particulars, and (c) of things of such and
such a kind60. Both (a) and (b) are rejected: medicine cannot focus on
all individuals, since these are ininitely many; but on the other hand
it cannot focus only on some individuals, since in this case it would
be incomplete and would not be an art. Instead, medicine focuses on
kinds of individuals. Focusing on kinds of individuals both belongs
to the science and is adequate to all the particulars of the science
(trans. von Staden). J. Barnes rightly qualiies this view as thoroughly
Aristotelian61 and, indeed, Galens use of hopoin is similar to Aristotles use of toiide/toioisde at Rh., 2, 1356a30-32 and of toioisde at
Met., 1, 981a10. In all of these passages, medicine is regarded as an
art to the extent that it is based on a corpus of general knowledge62. As
I aim to show, however, this is not Galens last word on this issue.
As noted above, this view is potentially aporetic, since general medical knowledge cannot account for clinical practice, which is unavoidably confronted with individual and variable situations. Still, a body of
general scientiic knowledge should in principle account for unqualiied repeatability (for example, a geometrical demonstration can unqualiiedly be repeated for all particular geometrical objects that satisfy
certain conditions established ex hypothesi) and medicine falls short of
this criterion63. Just ater Galen, Alexander of Aphrodisias (see In APr.,
39, 19-40, 4 Wallies) drew all consequence from the aporetic status
of medical knowledge and overtly denied that medicine (like all stochastic arts) could be regarded as being rigorously scientiic, since it
deals with contingent objects and its syllogisms (unlike those of true
sciences) are not apodeictic but problematic. Certainly, Galen did not
hold anything of the sort: he repeatedly argued that medicine is a fully
demonstrative and certain form of knowledge comparable to that possessed by arithmeticians and geometers (see PHP V.213 K.; MM X.34
59
K.). If this is the case, however, one should address the familiar problem of how this certain general body of knowledge is to be applied
to clinical practice, which does not allow for unqualiied repeatability.
A possible solution is sketchily presented in a famous passage from
the pseudo-Galenic On the Best Sect (De optima secta). Unlike Alexander of Aphrodisias, the author of this treatise regards general medical
theorems as being certain and precise in nature; what is neither certain
nor precise he argues but merely conjectural, is their practical and
empirical application to individual cases (Opt. Sect. I.114-115 K.). his
treatise is spurious; yet some scholars are inclined to assume that it
represents Galens inal answer to the problem of the scientiic status
of medicine64. I agree that the view voiced in the treatises inds signiicant parallels in Galen: a passage such as Ars Med. I.309 K., for example, equates genuine knowledge with the knowledge of universals.
his Aristotelizing idea certainly found a prominent place in Galens
epistemology, but I would be hesitant to claim that this was Galens
inal answer to the problem of the scientiic status of medicine. As
noted above, this answer is only apparently convincing: in itself it is
actually aporetic, unless one adopts the radical strategy of insulating
scientiic theoretical medicine from clinical conjectural practice that
was familiar to some Hellenistic doctors. Otherwise so long as clinical practice is taken to be an integral part of medicine claiming that
medicine is a science since its general theorems are necessary, while
their particular applications are merely conjectural or empirical, does
not really solve any problem. Certainly, Galens intention in MM is
not to separate a body of general theoretical knowledge from clinical
practice based on experience. Quite on the contrary, his work aims to
show that clinical practice can be treated scientiically and according
to logical methods65.
hroughout MM, Galen argues that demonstrative medical skill as
such is capable of curing individual human beings. Galen does not conine medical practice which involves the treatment of each individual
outside the domain of medical knowledge in its proper and full sense.
At the very beginning of his short therapeutical work To Glauco on
the herapeutic Method (De methodo medendi ad Glauconen) (MMG
XI.1 K.), Galen argues that doctors should know (epistasthai) not only
the common nature of all human beings, but also the nature proper
64
65
See Sassi 2005, pp. 177-9. On the history of this notion in ancient medicine, see
Hall 1974.
67
Barnes 1991, p. 63 note 46 (with further references).
agnostics and prognosis as a second best when compared to the precise knowledge of individual natures.
Aristotle would probably counter that particular objects and situations can in no way (neither de facto nor de iure) be the object of
exact knowledge, since they contain accidental features which are intrinsically impossible to determine precisely and are thus irreducible
to science (see Met. 2). Galens distinction between the human and
the divine knowledge of an individual would hardly make any sense
within an Aristotelian philosophical framework. Here the diference
between Galen and Aristotle emerges quite clearly, since as J. Allen
has noted Galens version of rationalism represents a fusion of Platonic-Aristotelian views on the knowledge of universals with the very
diferent outlook championed by the Stoa, according to which there
is nothing imperfect or irregular about the nature of the individual or
the particular processes in which it participates; they are completely
determinate and rationally explicable, at least to divine reason70. Interestingly, Galens approach is similar to that of Porphyry in his discussion of individuals (see Isag., 7, 22 Busse; In Cat., 129, 10 Busse
and ap. Simpl., In Cat., 48, 11-15 Kalbleisch = 55F Smith): like Galen,
Porphyry inserts a markedly Stoicizing view of individuals (which he
conceives of as consisting of a unique assemblage of proper features
athroisma idiottn) within an overall Platonic-Aristotelian account
of universals and predication71. Galens views are certainly diferent
from those of Porphyry and while Galen focuses on the epistemological problems raised by the knowledge of the individual, Porphyrys
theory is part of his logical and ontological account of substance and
predication. Still, it is worth noting the overall similarity between their
approaches.
According to Galen, no human doctor can completely attain the divine level of precision. However, Galen argues that such precise knowledge can at least be approximated by the use of what he repeatedly calls
technical conjecture (technikos stochasmos), i.e. conjectural reasoning which applies medical knowledge and logical methods to empirical
70
tor may consider are always limited in number and, in any case, all
preliminarily and exactly known81. Scientiic conjectural reasoning in
diagnosis and therapy makes it possible for good doctors to approximate the precise scientiic knowledge of Asclepius even when treating individuals, and Galen is notoriously eager to present himself as
an infallible physician82. As noted above, Galens view on the knowledge of individuals points to an overall conception according to which
nothing is intrinsically accidental or indeterminate. Indeed, even
within Galens epistemological framework one may adopt a roughly
Leibnizean line of argument in order to preserve the existence of contingency. It may for example be argued that each individuals distinctive nature corresponds to an irrational ininite ratio which Asclepius
knows as such (i.e. as ininite), while human doctors only know it in an
approximate way. Galen, however, never suggests this idea83. he view
he outlines at MM X.206-209 K. seems to be much simpler and merely
entails that Asclepius has a precise knowledge of individual natures,
which is far more complex than that which human beings can attain,
but in no way ininite. Furthermore, some interesting testimonia preserved by the Arab tradition suggest that Galen did not posit any real
distinction between necessary and contingent events84. In his Short
Treatise on Aristotles Int., al-Farabi informs us that Galen claimed in
his On Demonstration that what is possible by nature is the same as
what is possible to our minds, i.e. unknown to us (Treatise 82, trans.
Zimmermann). To call an event contingent, then, is but to state ones
ignorance of the factors involved in bringing it about. In principle,
however, it should always be possible to specify these factors, which
make the assertions of medicine certain. Accordingly, what is for the
most part does not ultimately difer from what is necessary: medicine
is not stochastic because it refers to indeterminate objects, but for mere
epistemic reasons. In principle, it should always be possible to replace
81
provisional formulae such as For the most part, xs are F with All
xs, given condition C, are F, where condition C is clearly and independently speciiable85. Galens vindication of the scientiic status of
medicine, then, ultimately leads to an overthrowing of the philosophical picture that emerges from Aristotles Metaphysics: accidental features tend to be removed from Galens account of knowledge and reality, so that not only universals but also individuals as such can (with
appropriate qualiications) be made the object of rational knowledge86.
Riccardo Chiaradonna
85
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