Galen: On Diseases and Symptoms

by Galen

Overview

Galen's treatises on the classification and causation of diseases and symptoms are an important component of his prodigious oeuvre, forming a bridge between his theoretical works and his practical, clinical writings. As such, they remained an integral component of the medical teaching curriculum well into the second millennium. This edition was originally published in 2006. In these four treatises (only one of which had been previously translated into English), Galen not only provides a framework for the exhaustive classification of diseases and their symptoms as a prelude to his analysis of their causation, but he also attempts to establish precise definitions of all the key terms involved. Unlike other of his works, these treatises are notably moderate in tone, taking into account different views on structure and causation in a relatively even-handed way. Nonetheless, they are a clear statement of the Dogmatic position on the theoretical foundations of medicine in his time.

Product Details

ISBN-13:	9780521865883
Publisher:	Cambridge University Press
Publication date:	11/09/2006
Edition description:	First Edition
Pages:	346
Product dimensions:	5.98(w) x 9.02(h) x 0.83(d)

About the Author

IAN JOHNSTON was born at Collaroy, NSW in 1939. An eminent neurosurgeon, he was appointed a member of the Order of Australia (AM) in 2000 for services to medicine. Throughout his medical career Ian also pursued a life-long passion for ancient languages, completing degrees in Greek and Latin, and in classical Chinese at the Universities of New England and Sydney. His translations of Chinese poetry have been performed at arts festivals and exhibitions and he has made several radio and television appearances to discuss aspects of translation.

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Cambridge University Press
978-0-521-86588-3 - Galen: on diseases and symptoms - by Ian Johnston
Index

CHAPTER 1.1

General introduction

Galen remains indisputably one of the major figures in the history of medicine, both occidental and oriental. Whilst his name may not evoke the undiluted reverence accorded to Hippocrates, he is a much more identifiable historical figure with a very substantial surviving body of work accepted as being from his own hand. In terms of influence, particularly in Western Europe, his position in medicine is somewhat akin to that of Aristotle in philosophy, characterized as it is by a dominance extending to the mid-point of the second post-Christian millennium. Unlike both Hippocrates and Aristotle, however, he has always had his share of detractors, in part a consequence of his combative and self-aggrandizing style of writing, in part because of his perceived arrogance, in part because during his lifetime he was a weighty participant in a continuing debate between conflicting schools on the theoretical bases of medicine, and in part subsequently because of the supposed stultifying effect of his ideas, seen by some as hindering further developments in medicine.

   The merits of these and other criticisms are debatable. What is incontrovertible is that his writings were not only extensive in amount, but also wide-ranging in scope, embracing all aspects of theoretical and practical medicine and many areas of philosophy aswell. Changing concepts of physiology and pathology may have vitiated many of his concepts and practices, but in their more theoretical aspects, his medical writings, and arguably his philosophical writings too, remain relevant. Nevertheless, only a relatively small part of his corpus has been translated into any of the modern European languages. Thus those who wish to experience the full scope of his writing must turn to the nineteenth-century edition compiled under the editorship of Karl Gottlob Kühn, which provides the Greek text and a Latin translation for most of his surviving works.

   The central purpose of the present work is to provide translations of the four related treatises, De morborum differentiis, De causis morborum, De symptomatum differentiis and De symptomatum causis, the last comprising three books. These translations are the first into a modern language of these six books apart from a recent translation of De causis morborum in a collection of tracts related to food and diet. Each translation is preceded by a short synopsis of the translated treatise. Among the secondary purposes may be mentioned the following:

   (i) The attempt to examine Galen’s ideas on definition, classification and causation of disease.

   (ii) An analysis of his concept of the composition and structure of the body in relation to his ideas about pathology.

   (iii) A consideration of Galen’s place in the theoretical debate referred to, particularly with regard to causation, which defined the rival schools before and during his own time.

   (vi) An evaluation of the relevance of his ideas to modern thinking on the classification and causation of diseases and symptoms.

The four treatises under examination, thought to have been written during the very prolific period after his return to Rome in AD 169,3 form a bridge between his more theoretical and his obviously practical medical writings – between, for example, De elementis secundum Hippocratem and De methodo medendi. Galen himself, who listed them among his works of anatomical science,⁴ saw them as following both Hippocrates and Aristotle in intent as well as in methodology. Thus, he wrote in the opening book of De methodo medendi:

Furthermore, concerning the differentiae of diseases, how many there are and of what kind, and likewise concerning symptoms, and in addition concerning the causes related to each, Hippocrates appears to be the first of all those we know to have made a beginning correctly, whilst after him Aristotle showed the way to the greatest degree.

In this regard the books are identified as an essential prerequisite for an understanding of this, his major practical medical text of somewhat uncertain date of composition, in which he also writes:

. . . it is then necessary for one who desires to establish the truth in every way to get away from a further concern with names, to pass to the actual substance of the matters and to reflect on and seek this – however many diseases and symptoms there are altogether and, in addition, the proegoumenic causes of these. Therefore, we did this in other treatises, of which there is one concerning the number of diseases, which has set out the differentiae of diseases, and another about the differentiae of symptoms. And in this way we tried to discover the causes of these, each individually, those of all diseases and those of all the symptoms, so that there remains nothing further, but everything is ready and prepared for the matter now lying before us. Accordingly, I do not advise knowing the things said in what follows before being conversant with these [works], for in this way someone would misunderstand many theories and would not himself be helped, taking issue with what has been stated correctly.

Summaria Alexandria), both for Arabic medical teaching and for that in medieval Europe.

   What Galen sets out to do in these four treatises is, first, to establish certain definitions and to clarify the terminology involved in them. Secondly, he attempts to formulate a classification of diseases and symptoms. Thirdly, he endeavours to provide a detailed, and largely practical, account of causation in respect to both diseases and symptoms. These several aims, and the extent to which they are achieved, will be considered in detail in what follows. In summary, the definitions of central importance are those of health, disease, symptom and affection, whilst the terms of particular concern are those involved in these definitions. In providing a classification, and in examining causation, Galen recognizes the two competing theories of basic and bodily structure of the time. The first, a continuum theory based on the idea of four primary elements or qualities and involving humours, is the theory he himself espouses. The second, an atomic theory based on the idea of all matter as consisting of particles and void, is considered mainly with emphasis on Asclepiades’ version of this, and is the theory Galen opposes. What is striking in the books being considered here is the relatively even-handed way in which Galen treats these two groups of theories compared to his dismissive, indeed often vituperative, ad hominem arguments common elsewhere.

   In part I, following these general introductory remarks, brief consideration is given to Galen’s life and works, his important antecedents both medical and philosophical, and issues of terminology, disease classification and disease causation. With regard to the translations in part II, some general remarks may be apposite here. A particular aim has been to remain close to the original, avoiding paraphrase and glossing. It is to be hoped that this has been achieved without too great a cost in terms of the fluency of the English. Where, however, there has been an apparently unresolvable conflict between accuracy and readability, the latter has regrettably borne the sacrifice. Comments on the basis of the translations, and the use and availability of other manuscripts, are to be found in the introduction to the translations (chapter II.0), but this is, in effect, a translation from the oft-criticized Kühn text. The present work is, then, intended as a translation of these texts and an analysis of the ideas contained therein. It is not intended as a philological study. The focus is on accuracy of translation from the text as it is, and on the nature and relevance of the ideas expressed in relation to theories of medicine both then and now.

   Before proceeding, I would like to foreshadow briefly some of the conclusions drawn from the translations and analyses. Firstly, the treatises studied are predominantly practical in intent and content. Whilst Galen does provide theoretical discussion of definitions and of causation, and, to a lesser extent, of classification, his considerations are obviously preliminary to the main purpose of the treatises, and particularly in the case of causation are somewhat peripheral to his presentation. On the matter of definitions, he does succeed in providing workable definitions of health, disease, symptom and affection although difficulties undoubtedly remain, both in the terms used in the definitions and in the overlap between them. The second problem, at least, Galen clearly recognizes. His classes of diseases and symptoms are comprehensive, perhaps even exhaustive, but are open to criticism on several grounds, as will be discussed. Causation is an issue of considerable concern to Galen. Both in these and in other works he does attempt to grapple with problems of mechanism and terminology. In the treatises here examined, there is, however, a failure to effect a systematic connection between the theoretical and the practical, and a failure also to achieve a consistent use of causal terminology. Nevertheless, the theoretical issues he raises do not depend on now outmoded concepts of anatomy, physiology and pathology. One timeless lesson, then, which might be learned from these treatises is that Galen’s emphasis on the importance of the link between medicine and philosophy bears an enduring relevance.

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Table of Contents

Part I. Introduction: 1. General introduction; 2. Galen's life and works; 3. Galen's philosophical and medical antecedents; 4. Definitions and terminology: i. Definitions; ii. Causal terms; iii. General terms; iv. Diseases and symptoms; v. Conclusions; 5. The classification of diseases and symptoms: i. Introduction; ii. Diseases (de morborum differentiis); iii. Symptoms (de symptomatum differentiis); iv. Conclusions; 6. Causation in diseases and symptoms: i. Introduction; ii. Theories of disease causation prior to Galen; iii. Galen on causation; iv. Conclusions; Part II. Translation: Introduction; 1. On the differentiae of diseases; 2. On the causes of diseases; 3. On the differentiae of symptoms; 4. On the causes of symptoms I; 5. On the causes of symptoms II; 6. On the causes of symptoms III; Part III. Conclusions; Bibliography.