In this essay I will strive to show the extent upon which Galenic medicine was incorporated in to the predominantly Aristotelian world view, concluding that Aristotelian philosophies underpinned the majority of Galenic theories and concepts. To achieve this I will primarily demonstrate the perceived link between medicine and natural philosophy that existed at the time. I will continue with a description of the Aristotelian Form, Matter and Substance theories, which formed the basis for the Aristotelian world view.
After considering the concepts that formed the Aristotelian philosophy, form, matter and substance, I will take a closer look at the Galenic theories. I aim to display how these Galenic principles relied on Aristotelian concepts and further how they were integrated into the broader world view. There was integration between medicine and natural philosophy from the earliest history of Greek science. [1] It was important for all medical students to study natural philosophy, as ‘logic provided the would-be-medical student with the major tool of medical scientific enquiry.
’[2] From Hippocrates the term ‘Philosophical Physician’ developed and Galen suggested that ‘the best physician is also a philosopher’[3]. Physicians had to advise patients on how to live in harmony with nature. This was key to health, as both body and nature sought to balance together. The job of physicians within the Renaissance was as much to maintain the health of a patient in order to prevent illness, as it was to treat disease. This maintenance of health was achieved through regulations in diet, exercise, rest, balanced environmental conditions and the patients overall physiological well being.
[4] This idea of balancing the body originally came from Hippocrates, who believed that everything could be cured by the application of reasoned remedies, drugs, surgery or dietary regulation. This balance between health and illness was predominantly between the two humours of bile and phlegm. The balance was believed to be achieved in one of two ways; either there was a flux that had to stay within a certain region to maintain health, almost like scales, if it tipped then the patient would become ill. Or, the body remained balanced until an internal or external factor changed this.
[5] Galen refined this theory, believing that all disease was the result of irregular or unbalanced humours. It was from these ideas and the philosophical concepts of both Aristotle and Plato that Galenic Medicine originated. Aristotelian philosophy had its roots in logical and reasoned thinking and formed the dominant knowledge of the Renaissance. Galenic medicine was reliant on the Aristotelian concepts of form, matter and substance, which were adapted from Plato, and formed the structural frame for the Aristotelian worldview.
‘Substance’ was the composite of form and matter; it was the identification of whether something was truly real or had ultimate existence. Individual objects could be considered as truly real according to Aristotle, as they all represent ‘substance’. A grammatical definition would be that ‘substance’ was that which could serve as the subject, but never as a predicate, thus a table is truly real. [6] An alternative meaning for ‘substance’ concerned descriptions of reality. In Aristotelian philosophy, objects have various properties, those that are ‘essential’ and those that are ‘accidental’.
The universal essence or the ‘substance’ of all tables is ‘tableness’, the property of the table being in the kitchen is ‘accidental’, as if the table were moved it would no longer be a property. The ‘substance’ or ‘essence’ of a table is something that the table maintains consistently and without exception. ‘Accidental’ properties then refer to the quantity, quality or place of an object, without affecting its essence. ‘Substantial Form’, defined the characteristics of a thing which makes it what it is. [7] The ‘Form’ of an object was due to the qualities it held, which were responsible for its appearance and specificity.
The ‘form’ carries or provides qualities and bestowed them on objects to make them what they were. Certain forms were subordinate to others and this created a hierarchy of forms which resulted in a controlling or a noble form. [8] Matter is the thing which takes on form. All change in the universe is the result of opposition between contraries, in this case between the three primary principles of, ‘privation, form and matter’. The theme of opposition between contraries ran through many Aristotelian theories, such as the primary qualities.
Matter lacked form and was suitable to receiving all forms. Privation was simply the absence of form and the potentiality of acquiring new form. [9] Through this process of privation, form and matter, elements had the ability to transform in to each other, within Aristotle’s elemental matter theory. Form and matter cannot exist separately, although in thought they can be considered as two separate things. The function of form was to, ‘inform matter and determine a particular kind, giving specificity and distinction from other kinds; and finally to furnish and bring about all activities.
’[10] Matter, form and substance are exemplified in the Aristotelian theory of elements, which was the basis of the Galenic humoral theory. Aristotle believed all bodies and objects in the sub-lunar world, or the world beneath the moon, were made up of four elements or simple bodies; Earth, Water, Fire and Air. The sub-lunar world was considered imperfect, which resulted in the imbalance of nature. These four elements therefore have natural movement, as they are tried to rebalance and return to perfection, or, their original place in the world.
The natural movement for air and fire was seen as upward, and for earth and water downwards. The four elements had four primary qualities that maintained their form. These qualities follow the discourse of contraries, with opposites of hot and cold, wet and dry. All secondary qualities are derived from these primary four. Galen deduced from this that there were four humours in the body, all created with the four primary qualities in their form and each linked to one of the four elements. These humours of Galen’s, like those of Hippocrates, consisted of phlegm and bile.
However in Galen’s theory, bile was split in to two kinds, yellow and black. Blood, although mentioned in Hippocratic Corpus, was also added as a cause of illness. Black Bile linked with Earth which had the qualities cold and dry, Phlegm linked with Water and had the qualities cold and wet. Blood linked to Air and had the qualities of hot and wet, yellow bile linked to Fire and had the qualities of hot and dry. Galenic medicine further linked this theory to the concept of temperament, implying that each body had a noble humour, which all other humours were subordinate to.
This humour determined a person’s temperament, characteristics and complexion. Aristotle’s work on blood was important to this theory as he first identified blood as a vehicle of complexion. [11] Knowing each person’s noble humour helped to identify the unbalance which was causing illness and aided the process of rebalancing the contrary qualities. For example, a dominant humour of blood resulted in a sanguine or muscular temperament, giving a ruddy complexion, a muscular build, normally quite wary yet social disposition. These people were seen to have positive attitudes and undertook a lot of physical exercise.
The belief that certain forms could have had an accidental relationship to an object rather than an essential relationship was important for determining causes and treatments. It led Galen to suggest that disease may affect the ‘total substance’ of the body in some illnesses, rather than just the temperaments. [12] The unbalance of the humours could be due to a number of causes, air, exercise and rest, sleeping and walking, food and drink, repletion and excretion, and accidents of the soul which refers to passion and emotion.
[13] This method of ascertaining the causes of various regimes became known as ‘humoralism’ and sought an understanding of how a person’s temperament should to be balanced within natures’ natural scheme. [14] Galenic ideas mainly focused on digestion as the cause of irregularity or unbalance. All four of the humours were believed to arouse at the site of the liver, in quantity or predominance to the nature of foods eaten and the degree and completion of their digestion. The primary qualities were also used to explain the actions of food and determine which foods produced which humours.
Diet was often controlled, to help maintain the humoral balance. [15] These ideas of balancing diet and regime all relate back to Hippocratic concepts, but Galenic medicine advanced this further by linking each humour with a season; yellow bile with summer, phlegm with winter, black bile with autumn and blood with spring. This allowed Physicians to predict what illnesses and imbalances would be predominant at different times of the year and helped with the regulation of diet, through knowledge of which foods should be avoided at different seasons.
Galenists later incorporated the four fevers in to the same system. [16] The linking of the elemental matter theory, with the humoral theory and the seasons, helped medicine to become a unified body of knowledge. Other treatments based on the idea of rebalancing the humours were, bloodletting and purging, which were used to rid the body of any humour it contained too much of. Uroscopy, a practice that continued until the 17th century, was also used as a diagnostic. The Aristotelian doctrine of opposites provided the basis for the Galenic treatment of opposites.
This treatment used the counter qualities of an illness or humour as a cure, for instance; if a patient had a fever, the physician would attempt to cool the patient. This highlights Galenic medicine working within the frames of Aristotelian philosophy. Aristotle believed in teleology and sought an explanation for bodily parts in terms of their purpose or teleology. The concept of teleology was based on the Aristotelian opinion that everything in nature had a purpose. [17] Galenists followed this through their explanations and beliefs in anatomy.
Anatomical phenomena were explained in terms of purpose and Galenists believed that physicians should know what organs did, their afflictions and their main qualities including their ‘substance’. Teleology was linked with the humoral system which suggested that each action of the body had a function that operated only when its basic elements were correct. A change in the organisation, mixture, or combination of these elements led to loss of function, injury, or disease. Aristotelian philosophy indicated a hierarchy of forms on earth.
At the bottom of this hierarchy was matter and at the top was God. The hierarchy of forms placed living things, with souls, higher up than those without. Plants were believed to have a basic, vegetative or nutritive soul and were at the bottom of the hierarchy for living things. Animals were believed to be adaptive to their environment and sense situations; therefore they had a sensitive soul. Man was believed to be the most perfect form on earth and possessed not only the vegetative and sensitive souls of the plants and animals, but also a rational soul.
The chief element or controlling form in any living thing was called the ‘anima’, in Galenic concepts this was often considered to be the spirit. Galenic medicine following this system believed that the organs heated and mixed materials at different stages of digestion, infusing them with spirits. [18] A ‘nutritive spirit’ was produced in the stomach and liver by the digestion of food. An ‘animal spirit’ was produced in the brain and was responsible for sensation, motion and mental activity. There was also a ‘vital spirit’ which was produced at the heart and lungs.
[19] This vital spirit was responsible for the pulse throughout the body. Galen enunciated the work of Herophilus on the pulse and conducting much further work in to how the pulse or the vital spirit could determine disease. [20] The nature of these human souls, was determined by an individual’s complexion of the humours and their moral qualities. It is clear to see the Aristotelian influence behind these Galenic processes and how this hierarchy of forms could have shaped Galenic thinking regarding the suggestion of a noble or ruling humour in the body.
Aristotelian cosmology was based on the sub lunar and super lunar divide, which in turn meant that there were two principles of physics, those that work below the moon and those that work above it. The earth, below the moon, was imperfect and consisted of the four primary elements, earth and water that have gravity, and air and fire which have levity. The super lunar world was made of a fifth element, aether, which operated differently to the earths’ four elements.
In the sublunar world, elements operated in straight lines, whereas the super lunar world operated in perfect geometrical circles. Naturally the movement of circles led to thoughts on spheres; stars and planets were believed to be part of their own fixed spheres that circled the earth. Earth was the centre of the universe, as all ‘earthy’ elements were dragged to the centre of the earth, in a downward motion. The initial motions of these spheres, that circled the earth, were caused by the ‘prime mover’ and beyond the edge of the spheres was a spiritual realm.
Aristotelians did not place too much emphasis on the super lunar world and had more interest in the rational causes of nature. During the Renaissance as the philosophies of Plato grew in following, so did beliefs in astronomy and magic. Platonism highlighted the direct effect that the super lunar world had on the earth and people. A greater emphasis was placed on the qualities of the planets. Saturn was considered to be sluggish, with the primary qualities of cold and dry; Mars was seen as sanguine, active and warlike with the primary qualities of hot and wet.
Platonism also led to the development of microcosm and macrocosm, the belief that man was a replica of the cosmos at large. The seven superlunar plants ruled the seven organs of the body; Jupiter related to corruption of the blood, Venus to phlegm and coughs, while Mars ruled fevers and choler. Galenists accepted the phenomena of astronomy, in that the movements of the heavens could impose changes in the sub lunar world, through environmental conditions and the weather, which could alter an individuals humoral patterns and cause disease.
[21] Galen also developed a dietetic physic based on the links between astronomy and physiology[22]. Horoscopes were seen as an aid in determining a person’s temperament and the ‘medicinal month’ was often used to determine treatments and causes. The ‘medicinal month’ was used to form calculations between when a patient took ill, and the days on which different phenomena of the disease occurred, from the onset of illness. From these calculations it was possible to astronomically and mathematically link the occurrences to the properties of numbers and calendar dates.
This ‘medicinal month’ was dependant on the movements of the moon and postulated critical days. Critical days were the days upon which a turn for the better or the worse in an illness could take place. The idea was that a heavy sweat, diarrhoea, or vomiting could be a sign that the body was naturally rebalancing, or a sign that the illness was getting worse. The interpretation of these phenomena was then dependant on the critical day and how the phenomenon was astronomically and numerically linked to for the patient.
This idea continued to play a role in medicine until the sixteenth century. [23] The Aristotelian world view as well as having little room for astronomy, had little belief in the occult or magic. Ideas of magic were not reasoned as logical in Aristotelian philosophy. The Aristotelian doctrine of opposites provided the base for the primary qualities, which was adapted by Galenists. The form of an object acts through its qualities and for this reason Galenists believed in two types of qualities, manifest qualities and occult qualities.
Manifest qualities were those immediately identifiable by the senses and occult qualities were those qualities not immediately known but appreciated only by their effects. [24] The four primary qualities were therefore all manifest qualities and Galenists attributed unseen qualities to ‘idiotes arretoi’ or ‘propriertates occultae’. [25] This was useful in explaining the inexplicable, but was inconsistent with typical Aristotelian views. Aristotelians taught that the heart was the source of heat and life and overall was the main authority in the body.
They also believed that the heart ruled motion and sensation. Galenists believed that it was in fact the three principle members of the heart, liver and brain which governed the body each ruling over a group of separate organs,[26] and that the brain and spinal cord were responsible for controlling motion and sensation. Such disagreements hardly resulted in Galenic medicine being found to be inconsistent with the beliefs of Aristotle. This was possibly due to an attempt among writers to reconcile the two views.
Therefore even when evidence from paralysis patients suggested that Galenic opinion was correct, a hierarchical concept was employed to suggest that the spinal cord and the brain did control motion and sensation, but overall the heart controlled everything in the body. Work from writers in this way, helped to keep Galenic medicine as part of the overall Aristotelian world view, rather than to induce confrontation between the two philosophies. Galenists and Aristotelians also disagreed over the role of the female parent in conception.
Aristotle believed that the male alone contributed sperm containing an active principle to contraception. Galenists however believed that the male and female contributed, so that the child had traits of both parents, this they believed was done through vaginal segregation. Unfortunately, anatomical observation could not rectify this. Although a tendency to avoid practical subjects in preference of theory was reinforced by Aristotle’s teachings on how natural philosophy should be conducted, Galenists gave high value to personal observation[27]and experience, which was increasingly taken to mean experiments.
[28] Galen advised all practitioners, ‘to become expert in all matters of plants, animals and metals… by personally inspecting them, not once, or twice, but often’. [29] Even though learning was dependent on the writings of ancient authorities and used little individual exploration, this was a fundamental difference between the processes of Aristotelians and Galenists. Aristotle rejected the use of mathematics in natural philosophy, suggesting that it did not explain phenomena in terms of physical causes. Despite this, arithmetical expertise was involved in determining drug temperaments within Galenic medicine.
The temperaments were worked out according to the dominant qualities, active and passive qualities and the four primary qualities. The use of dominant qualities in these calculations, show the Aristotelian influence of hierarchy upon Galenic thinking, however maths did not comply with the broader world view. Quantative information and mathematical analysis began to offer more reliable knowledge than the qualitative and philosophical knowledge in Aristotelian philosophy. [30] It seems clear that Galenic medicine drew on the works of Aristotle and that philosophical ideas underlay many Galenic concepts.
The elemental matter theory and humoral theory are good examples of this. The Aristotelian doctrine of Opposites provided a basis for Galenic treatments and the hierarchy of forms aided the concepts and reasoning behind the temperament theory of dominant and noble humours. The Galenic ideas of spirits were greatly influenced by Aristotle’s theory of souls and teleology provided an outline for Galenists in the conduct and assessment of anatomy. Aristotelian philosophy on form and matter were central to all of the Galenist principles and Aristotelian logic and reason seem at the heart of all Galenic ideas.
To this extent, Galenic medicine was undoubtedly a part of the broader Aristotelian world view. There are however a number of discrepancies between the Galenists and Aristotelians, from the role of the heart to the role of females in conception. Unlike Aristotelians, Galenists did not reject mathematics, astronomy or experience and many historians have considered this to be due to the philosophical influence of Plato. [31] There is evidence that Renaissance writers tried to reconcile the medical views of both Aristotelians and Galenists, but this often concluded with hierarchical resolutions which were not efficient or well reasoned.
Some historians like Nancy Sirasi, suggest that although Galenic medicine provided a more richly detailed account of the human body than Aristotelian philosophy, the authority of Aristotle was as powerful in medicine, as it was other doctrines. [32] Other historians believe that Aristotle was the leading authority in natural philosophy and Galen was his equal in medicine. This is highlighted in Debus when he suggests an, ‘Aristotelian-Galenic system’. [33] Kristeller even suggests that Galenists reinforced the authority of the Aristotelian world view, through their use of Aristotelian concepts.
[34] I believe that because Aristotle and Galen formed the basis for traditional university education, at Padua in the late sixteenth century, [35] this identified the authority of Galenic medicine and its integration to the broader world view, at an academic level. Even when Galen was dropped, as the leading knowledge in medicine, treatments based on the four humours, digestion and uroscopy continued until the nineteenth century, although they were related to different principles.
[36] The incorporation of Galenic medicine in to a unified body of knowledge that involved Aristotelian theories of form and matter, the elemental matter theory, the hierarchy of beings, and cosmology, represented the integration of Galenic medicine in to the overall Aristotelian world view.
Bibliography Debus. (1978) Man and Nature in the Renaissance Cambridge University Press Genest. J. Elemental Theory and the Realm of Forms, http://www. durenmar. de/articles/eltheory. html, accessed 10th March 2007 Henry. J (1997) The Scientific Revolution and the Origins of Modern Science. Macmillan King and Lester.
(1978) The Philosophy of Medicine Cambridge MA: Harvard University Press Kristeller. (1961) Renaissance Thought: the classic, scholastic and humanist strains NY: Harper and Row Kristeller. (1968) Humanism and Culture of Renaissance Europe. NY: Harper and Row Lindberg and Western. (1990) Reappraisals of the Scientific Revolution. Cambridge University Press Nutton. V (1995) The Western Medical Tradition Cambridge University Press Pumfrey. S (1991) Science, Culture and Popular Belief in Renaissance Europe. UK: Manchester University Press Shapin. S (1966) The Scientific Revolution University of Chicago.
Schmitt. (1984) The Aristotelian Tradition and Renaissance Universities London: Variorum Reprints Schmitt and Skinner (1988) The Cambridge History of Renaissance Philosophy. Cambridge University Press Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press Temkin. O (1973) Galenism. Rise and Decline of A Medical Philosophy. Ithaca NY: Cornell University Press The Theory of Humours in Uani Traditional Medicine, http://www. unani. com/humours. htm, accessed 10th March 2007 Wear. A (1985) Medical Renaissance of the sixteenth century Cambridge University press Webster.
C (1979) Health, Medicine and Morality in the sixteenth century Cambridge University Press ———————– [1] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [2] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [3] Temkin. O (1973) Galenism. Rise and Decline of A Medical Philosophy. Ithaca NY: Cornell University Press [4] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [5] Nutton. V (1995) The Western Medical Tradition Cambridge University Press [6] King and Lester.
(1978) The Philosophy of Medicine Cambridge MA: Harvard University Press [7] Genest. J. Elemental Theory and the Realm of Forms, http://www. durenmar. de/articles/eltheory. html, accessed 10th March 2007 [8] King and Lester. (1978) The Philosophy of Medicine Cambridge MA: Harvard University Press [9] King and Lester. (1978) The Philosophy of Medicine Cambridge MA: Harvard University Press [10] Ibid In King and Lester. (1978) The Philosophy of Medicine Cambridge MA: Harvard University Press [11] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [12] Sirasi. N (1990) Medieval and Early Renaissance Medicine.
University of Chicago Press [13] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [14] Cook. H In Lindberg and Western. (1990) Reappraisals of the Scientific Revolution. Cambridge University Press [15] The Theory of Humours in Uani Traditional Medicine, http://www. unani. com/humours. htm, accessed 10th March 2007 [16] Nutton. V (1995) The Western Medical Tradition Cambridge University Press [17] Nutton. V (1995) The Western Medical Tradition Cambridge University Press [18] Cook. H In Lindberg and Western. (1990) Reappraisals of the Scientific Revolution.
Cambridge University Press [19] Debus. (1978) Man and Nature in the Renaissance Cambridge University Press [20] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [21] Nutton. V (1995) The Western Medical Tradition Cambridge University Press [22] Cook. H In Lindberg and Western. (1990) Reappraisals of the Scientific Revolution. Cambridge University Press [23] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [24] Wear. A (1985) Medical Renaissance of the sixteenth century Cambridge University press [25] Copenhaver In Lindberg and Western.
(1990) Reappraisals of the Scientific Revolution. Cambridge University Press [26] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [27] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [28] Cook. H In Lindberg and Western. (1990) Reappraisals of the Scientific Revolution. Cambridge University Press [29] Galen. In Shapin. S (1966) The Scientific Revolution University of Chicago [30] Nutton. V (1995) The Western Medical Tradition Cambridge University Press [31] Sirasi.
N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [32] Sirasi. N (1990) Medieval and Early Renaissance Medicine. University of Chicago Press [33] Debus. (1978) Man and Nature in the Renaissance Cambridge University Press [34] Kristeller. (1961) Renaissance Thought: the classic, scholastic and humanist strains NY: Harper and Row [35] Schmitt. (1984) The Aristotelian Tradition and Renaissance Universities London: Variorum Reprints [36] Cook. H In Lindberg and Western. (1990) Reappraisals of the Scientific Revolution. Cambridge University Press.