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3 33 SEMINARI E CONVEGNI

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5 Universals in Ancient Philosophy edited by Riccardo Chiaradonna Gabriele Galluzzo

6 2013 Scuola Normale Superiore Pisa isbn

7 Table of contents Introduction Riccardo Chiaradonna, Gabriele Galluzzo 1 Universals before Universals: Some Remarks on Plato in His Context Mauro Bonazzi 23 Plato s Conception of the Forms: Some Remarks Francesco Ademollo 41 Plato s Five Worlds Hypothesis (Ti. 55cd), Mathematics and Universals Marwan Rashed 87 Plato and the One-over-Many Principle David Sedley 113 Universals, Particulars and Aristotle s Criticism of Plato s Forms Laura M. Castelli 139 Universals in Aristotle s Logical Works Mauro Mariani 185 Universals in Aristotle s Metaphysics Gabriele Galluzzo 209 Epicureans and Stoics on Universals Ada Bronowski 255 Alexander, Boethus and the Other Peripatetics: The Theory of Universals in the Aristotelian Commentators Riccardo Chiaradonna 299

8 One of a Kind: Plotinus and Porphyry on Unique Instantiation Peter Adamson 329 Universals, Education, and Philosophical Methodology in Later Neoplatonism Michael Griffin 353 Universals in Ancient Medicine Riccardo Chiaradonna 381 Universals in the Greek Church Fathers Johannes Zachhuber 425 Bibliography 471 Index locorum 509 Index of names 537

9 Universals in Ancient Medicine 1. Universals and particulars in Aristotle s account of medicine Plato and Aristotle famously use medicine as the standard example of an art (technê). Both Plato and Aristotle compare medicine and rhetoric. In Plato s Gorgias Socrates argues that arts, such as medicine, can give a rational account (logos) of both their subject matter and the cause of the things they do. Unlike arts (but just like pastry baking), rhetoric cannot provide any such rational account, for it is merely based on experience or the rule of thumb (501a3-b1; see also 462b10- c3; 465a6-7; etc.) 1. The same parallel between medicine and rhetoric also comes up in Aristotle, who compares the two in the opening chapters of his Rhetoric. Aristotle draws attention to some analogies between medicine and rhetoric, and this is obviously of great importance for assessing his views on rhetoric and how they differ from those of Plato (especially in the Gorgias). I will only recall three main features of medicine that emerge in Aristotle s Rhetoric. (i) Unlike rhetoric, medicine can instruct and persuade about its own particular subject matter (i.e. what is healthy or unhealthy: see Rh., Α 2, 1355b27). (ii) Like rhetoric, medicine allows for imprecision, so that complete mastery over the art is no guarantee of reaching any successful result. Still, according to Aristotle, this should not prevent us from regarding medicine as an art, since the competent practitioner does everything in his power to achieve a good result, even if he may fail in his goal (Rh., Α 1, 1 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 Plato s famous account of Hippocrates method in Pl., Phdr. 270cd, but this would be controversial to say the least). This specific issue is first tackled by Aristotle and, as I aim to show in this contribution, Aristotle s discussion provides the framework for the subsequent debates on universals and medicine. For a full account of Plato s views on medicine and its epistemic status, see Hutchinson 1988; Allen J

10 382 Riccardo Chiaradonna 1355b10-14; see also Top., Α 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 [σκοπεῖ τὸ καθ ἕκαστον]. 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 [τῷ τοιῷδε ἢ τοῖς τοιοῖσδε]: this alone is subject to art what is individual is indeterminate and cannot be known [τὸ δὲ καθ ἕκαστον ἄπειρον καὶ οὐκ ἐπιστητόν] (Arist., Rh., Α 2, 1356b30-33, trans. Rhys Roberts, with some changes). Medicine is an art and as such includes a body of theoretical knowledge. This 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 definable 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). The last-mentioned feature is extremely interesting for our discussion. That arts focus on universals is famously stated in the opening chapter of Aristotle s Metaphysics, where medicine is taken as a case example illustrating the distinction between experience and art; however, Aristotle s view in the Metaphysics is more nuanced than what we find in the Rhetoric 3. 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., Α 1, 980b28-981a1; APo., Β 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., Α 1, 980b25-27). Art is different, since it involves reason as a cognitive power distinct from perception and 2 See on this Schiefsky 2005, p I will come back to this issue below. 3 On medicine in Met. Α 1, see Frede M. 1990; Schiefsky 2005, pp ; Hankinson 2004; on the epistemic status of medicine according to Aristotle, see also Frede M

11 383 Universals in Ancient Medicine memory that is only proper to human beings. Reason has the specific function of grasping universals, i.e. recurrent items that are such as to be predicated of many 4, 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 [gnôsis] of particulars [tôn kath hekaston], whereas art is knowledge of universals [tôn katholou]» (Met., Α 1, 981a15-16, trans. Ross). This famous schematic distinction, however, is subject to further qualification. First, experience and rational technical knowledge are not simply opposed to one another (as was the case in Plato s 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 view 5. Of course Aristotle s 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 difficult to determine) position in Aristotle s account of the formation of general concepts, both in Met. Α 1 and APo. Β 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 effective in practice. His example is significantly 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 offer for treatments administered: «For to have a judgement [echein hupolêpsin] 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., Α 1, 981a6-8, trans. Ross). It has been noted (rightly in my opinion) that this view of medical empirical practice involves some power of gener- 4 This is indeed a very sketchy characterisation and I will not dwell on the definition(s) of universal in Aristotle: see the remarks in Mariani, Castelli and Galluzzo, this volume. 5 On Aristotle s reference to Polus and its anti-platonic character, see Auffret 2011.

12 384 Riccardo Chiaradonna alization, even if this empirical generalization differs 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 beneficial to everyone in a particular condition); nonetheless, the empirical healer too acts in a certain way because the universal is true 6. 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. These 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., Α 1, 981a10-30: [ ] to judge that it has done good to all persons of a certain constitution, marked off in one kind [πᾶσι τοῖς τοιοῖσδε κατ εἶδος ἓν ἀφορισθεῖσι], 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). The 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 Aristotle s case example for illustrating this complex situation: [ ] we even see men of experience succeeding more than those who have theory without experience. The 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 See Hankinson 2004, p. 5.

13 385 Universals in Ancient Medicine will often fail to cure; for it is the individual that is to be cured (Arist., Met., Α 1, 981a14-24, trans. Ross). These remarks are immediately followed at 981a24 by the words ἀλλ ὅμως [ ] γε ( and yet ), which introduce Aristotle s emphatic statement that knowledge and understanding belong to art rather than experience. The line of this argument is complicated to say the least and may reflect a certain tension in Aristotle s views on the status of technical knowledge (and of medicine in particular). On the one side, Aristotle argues that experience and art are hierarchically ordered in such a way that art alone belongs to knowledge or understanding in the proper sense, which involves generalization and causal reasoning. Nonetheless, medicine provides a powerful case example for illustrating the potential weaknesses of technical knowledge when confronted with individual situations. From this perspective, experience may not only be as effective as art, but even more effective. As Aristotle argues, the reason for this is that doctors do not cure the general kind human being, but Callias or Socrates or some other individual, who happens to be a human being (ᾧ συμβέβηκεν ἀνθρώπῳ εἶναι, Met., Α 1, 981a20). This is apparently disconcerting: how can the species human being be an accident of Socrates or Callias? Strange as it may seem, Aristotle s position can actually be explained with reasonable clarity. He suggests that each individual human being is not cured insofar as he/she is a mere instantiation of a general kind, but insofar as he/she is that single individual, in his/her irreducible particularity. Both in the Rhetoric and the Metaphysics Aristotle argues that medicine includes a body of technical knowledge that as such deals with universal items. For example, a trained physician will know that a substance of a certain kind (say, camomile) can heal in virtue of its defining properties human beings who instantiate a certain constitution from a disease that is definable (say, stomach-ache). Unlike the empirical healer, the rational doctor knows more than merely the fact based on previous individual observations that administering a particular remedy to a particular patient heals particular symptoms. In his case, proper generalization rationally accounts for the repeatability of therapy in all particulars of the same kind. Thus, one could conclude that the trained doctor heals individual patients just like the empirical healer, but attains this result in a different way: for the rational doctor does not heal the individual patient as an individual, but insofar as he/she is the individual bearer of a disease that is universally defined and may also be found among other individuals of the same kind. An

14 386 Riccardo Chiaradonna argument such as this, however, does not hold without qualification. Certainly, Aristotle links medical art to universal explanatory knowledge: medicine is an art and arts as such do not theorize on individuals. Yet individuals cannot be removed from the practice of a given art, and this holds paradigmatically for medicine, since as Aristotle argues in Met. Α 1 doctors do not cure the universal species human being, represented by its individual instantiations; rather, they cure the individual Socrates or Callias, who happens to be a human being. In its practice medicine should then be set in relation to individual patients and situations; and relating the knowledge of generalities to particular situations is not a straightforward exercise. Technical knowledge alone thus appears incapable of ensuring unvaryingly successful practice in medicine, since practice entails being confronted with particular situations that are indeterminate and outside the domain of technical knowledge (see Met. Ε 2). A well-trained doctor, for example, may know the universal definition of a disease and be capable of explaining its symptoms in causal terms, but still fail his diagnosis when treating an individual patient. Hence Aristotle s crucial remark that experience (i.e. a kind of knowledge intrinsically directed to individuals) is essential in the practice of medicine, since if someone has the theory without the experience, and recognizes the universal but does not know the individual it includes, he will often fail to cure his patient (Met., Α 1, 981a20-23). To sum up: experience is necessary in order to relate and successfully adapt a body of technical universal knowledge to the particular situations that are the object of clinical practice. A further crucial problem subsists, which has even deeper consequences on the generalization problem in medicine. Let us assume that a combined use of reason and experience ensures the correct application of a given medical theory that good doctors will reach a diagnosis and administer the appropriate treatment for a disease in a given case. Even so, no certainty exists that the therapy chosen will prove successful: different individual human beings affected by the same disease may react in different ways to the same treatment, so that a given treatment will sometimes prove effective and sometimes fail. Therapy is not repeatable for individuals of the same kind without further qualification, since no one patient is perfectly similar to others and this lack of precise similarity can affect the outcome of a therapy. Furthermore, a large number of factors related to an individual patient can affect the outcome of a therapy, and at least some of these factors lie outside the domain of universal technical knowledge in the proper

15 387 Universals in Ancient Medicine 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). This overall approach is set out in the famous methodological chapter in Hippocrates Epidemics (Epid. I.23), where we find 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: The 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 [ἐκ τῆς κοινῆς φύσεως ἁπάντων καὶ τῆς ἰδίης ἑκάστου], 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). This 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. This view is sometimes connected to the idea that individuals contain «blends» (krêsis) 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. Α 1, where Aristotle argues that it is the individual that is to be 7 For further details, see Schiefsky 2005, pp and pp On this, see the overview in Sassi 2005, pp ; Schiefsky 2005, pp. 233 f. and pp. 248 f. The 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 different 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 affected by others».

16 388 Riccardo Chiaradonna cured, e.g. Socrates or Callias. We might be led to infer from this that Aristotle s 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. Α 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. The separation between the theory and the practice of medicine clearly emerges in a passage from Aristotle s On Sensation: It also belongs to the natural philosopher to obtain a clear view of the first 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 modifications). This passage reveals at least two facts. First, that for Aristotle medicine and natural philosophy are two separate and well-defined fields: his problem is to explain how they are related 9. 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 Aristotle s view of subalternation (see APo. Α 7), since philosophical medicine draws its principles from natural philosophy and applies them to a more specific and well-defined field (the knowledge of health and disease). The 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. This remark is certainly correct, but needs qualification. Aristotle s overall view seems to be based on the distinction between philosophically oriented and practically or empirically oriented physicians (see also Plato s 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 See the remarks in Schiefsky 2005, p. 301 f. 10 Schiefsky 2005, p. 302.

17 389 Universals in Ancient Medicine Met. Α 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 difference 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). This, by contrast, is the view which can be attributed to Aristotle, although Aristotle never explicitly presents it. The 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 scientific 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 Jaeger s celebrated idea that Aristotle should be regarded as the philosophical inspirer of Diocles of Carystus methodological empiricism in medicine has repeatedly been rejected 12. Aristotle s 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. This 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» (hôs 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. Ε 2). Things 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 Galen s works are given in Roman (volume) and Arabic (page) numerals according to Kühn s edition (with the exception of course of those works not included in Kühn). Μore recent editions, such as those of CMG and Les Belles Lettres, also indicate Kühn s pagination. For the list of the abbreviations used for Galen s works, see Hankinson 2008a, pp See van der Eijk 1996 and Frede M

18 390 Riccardo Chiaradonna not only with what is «for the most part», but with what is individual and accidental. Under such premises, the completely successful and scientific 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., Α 1, 1355b10-14). Remarks such as these, however, confirm 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 difficult to isolate theory from practice in medicine (nor do Aristotle s remarks in Met. Α 1 invite us to do so). All this helps explain why Aristotle sometimes regards the scientific status of medicine as intrinsically feeble. Significantly, 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 Aristotle s emphasis on the unavoidably imprecise character of medical knowledge (see EN, Γ 3,1112b1 ff.) 13. The potential separation between the theory and the practice of medicine is deeply rooted in Aristotle s views on knowledge. A cursory reference to Met. Ζ 15 may be appropriate here. This 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 Galluzzo s analysis and recall the overall conclusion which emerges from Aristotle s text namely, that particulars can well be objects of definition, but their definition is always de iure applicable to multiple objects, even when there is de facto only one particular which satisfies it. No definition exclusively picks out a particular object to the exclusion of others of the same kind, since each definition is a conjunction of predicates and predicates are always (at least de iure) applicable to a plurality of objects (see Met., Ζ 15, 1040a8-14 and a27-b2). Particulars are situated outside the domain of definitions and there is no room for de iure 13 See the classical article by Jaeger 1957.

19 391 Universals in Ancient Medicine non-recurrent individual natures in Aristotle s world of knowledge 14. Particulars can only rationally be known insofar as they represent some general kind. As noted above, what we find in the Hippocratic corpus is instead the thesis according to which cures should be individualized in order to effectively treat particular human beings, who are never exactly similar to one another. Epidemics I.23 obviously does not dwell on the ontological and epistemological aspects of this position, but the author s view that doctors should consider the nature of each individual is potentially laden with consequences. A view such as this suggests possible philosophical developments, whereby individual unrepeatable natures would be seen as objects of rational knowledge. It is more than plausible that this medical approach to particulars blended with the later Hellenistic (and in particular Stoic) theses on ontology and epistemology. As we shall see below, Galen s views on the knowledge of particulars are radically different from those of Aristotle and provide a full philosophical explanation of the Hippocratic notion of individual nature. 2. Empiricist generalizations and Methodist generalities This long preamble on Aristotle was necessary to set the later medical theories against their philosophical background. As I aimed to show, Aristotle s remarks are significant in that they opened up a range of possible approaches to the status of universals in medicine; each of these approaches was actually pursued by Hellenistic and post-hellenistic doctors (obviously I do not intend to suggest that later doctors always referred to Aristotle, but simply wish to draw a doctrinal parallel). Here I will not provide any overall account of the history of medical epistemology in the five centuries dividing Aristotle and Ga- 14 Indeed, according to the reading developed by Frede M., Patzig 1988, Aristotle s theory of individual substantial forms in Met. Ζ might be potentially at odds with this conclusion. The issue is however very controversial and Frede and Patzig s interpretation faces a number of difficulties: see Galluzzo, this volume. Furthermore, even according to Frede and Patzig s 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-specific and do not differ in nature from each other precisely as forms: see Frede M., Patzig 1988, 1, pp. 55 f.; Frede M., Patzig 1988, 2, p. 148.

20 392 Riccardo Chiaradonna len 15. Instead, I will focus on a very limited set of problems or theories that are particularly important for any attempt to assess the views on universals and particulars. Aristotle s complex view of the roles played by reason and experience paved the way for three different developments, which coincide grosso modo with the epistemological positions held (i) by Rationalist doctors, (ii) Empiricist doctors, and (iii) Galen. Aristotle s idea that medicine has a theoretical aspect the science of what is healthy and unhealthy which aims to rationally explain investigated objects in causal terms foreshadows the distinction between the scientific and conjectural parts of medicine drawn by Hellenistic Rationalist doctors. Rationalist doctors, however, tended to marginalize experience in a way that is alien to Aristotle. Despite significant differences among their views (there were actually several distinct types of Rationalist doctors), they generally argued that reason should be sufficient to determine the nature of a disease, ascertain its internal causes and, consequently, discover the appropriate treatment capable of removing these causes (see e.g. Gal., Sect. Int. I K.). It is theoretical knowledge, then, that according to these doctors should enable the physician to account for his practice. Indeed, this approach runs the risk of not doing justice to actual clinical practice (with all its failures), and de facto ending in abstract speculation (significantly, Galen reports that Erasistratus stopped practising medicine to entirely devote himself to the study of the art: see PHP V.602 K.). It was probably this impasse of rational medicine that prompted the reaction of Empiricist doctors from the third century BCE onwards 16. As noted above, Aristotle can in no way be regarded as a mere forerunner of Rationalist medicine, and his views on the cognitive value of experience actually point to a different possible development. Aristotle regards experience as something necessary to adapt and qualify medical theory in its actual practice, where technical knowledge must be applied to individual and variable situations. Furthermore, he claims that experience, and experience alone, is capable of accounting for successful (but non-technical) medical practice, without in any way referring to reasoning about causes or universal entities. A 15 This 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 ff.; Frede M The classical work on the Empiricist school remains Deichgräber 1930.

21 393 Universals in Ancient Medicine 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 sufficient 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 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. Α 1, according to which experience is a sufficient basis to establish an art 17. The Empiricists, therefore, rejected the overall Rationalist idea that doctors should grasp the basic nature of both the human body and unhealthy affections in order to decide on the appropriate treatment. All that doctors need to know, they argued, is what is harmful and what is beneficial 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 physician s own direct observation (autopsia) and drawing on the previous observations of earlier reliable practitioners (historia) is fully sufficient in itself to establish medical knowledge 18. As we shall see below, Galen s 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, Galen s views on experience differ 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 See Frede M This is just a very sketchy account. For further details (with numerous references), see the studies by M. Frede, Vegetti and Allen mentioned above, note 15. The controversial issue of whether there was an evolution in the ancient Empiricist school need not occupy us here: for further details, see the contrasting discussions in Frede M. 1987c; Machuca On the Empiricist kind of reasoning (epilogismos) and its difference from the Rationalist one (analogismos), see Allen J. 2001, p. 113 ff.

22 394 Riccardo Chiaradonna This sketchy account of medical views on knowledge after 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 modified 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. These 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 school 19. 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. The Methodist theory of generalities (koinotêtes) 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 Galen s Platonic-Aristotelian account of division and universals, which he chiefly developed as a critical reaction against Methodist medicine. Both Empiricist and Methodist doctors held distinctive views on universals and particulars. Their views are different toto caelo from each other and an account of them is necessary to understand Galen s approach to the universal generalization problem 21. As noted above, Aristotle qualifies experience as the knowledge of individuals and thus separates experience from art, which is the knowledge of universals. This position is not exempt from possible objections, since experience too seems to involve some power of generalization. Aristotle s answer to this objection would probably be that empirical generalizations cannot be seen as generalizations in the true and full sense. Indeed, the 19 See the collection of sources in Tecusan See Frede M. 1982, p This will be a cursory account, since the issues in question have already been made the focus of a series of important contributions: see above, note 15.

23 395 Universals in Ancient Medicine 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. The 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 ff. Deichgräber), the recommended treatment of which is always the same 22. Significantly, 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 recollect» 23 ; thus they treated technical knowledge as basically a matter of acquiring the disposition to be reminded of certain things by certain observations. This view may appear suspect and indeed be criticized for obscuring the difference 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 different 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. The 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). The way in which repeated experience can account for the formation of general knowledge is obviously radically different from the way in which reason can account for it: By experience we mean the knowledge of those things which have become apparent so often 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, Deichgräber, trans. M. Frede). 22 See Allen J. 1994, pp. 103 f. 23 Allen J. 2001, p Allen J

24 396 Riccardo Chiaradonna Let us return for a moment to Aristotle s Rationalist account of technical knowledge. According to Aristotle, the trained doctor is capable of finding the correct treatment since he knows that a certain remedy heals all individuals of a certain kind from a certain disease (Met., Α 1, 981a10-12). Since, then, the doctor grasps the properties that define 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. The 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. The 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.). Their 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; significantly, 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 patient s age and gender, the observable qualities of his/her flesh, 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 emerged 25. For example, a general theorem concerning the therapeutic power of a remedy will merely 25 See Frede M. 1990, p. 246; Allen J. 1994, pp. 100 f.

25 397 Universals in Ancient Medicine result from the repeated experience that a substance effectively treats a certain pattern of symptoms in patients with certain observable characters (see for example Galen s remarks on their treatment of wounds in MM X K.). Experience, however, allows for exceptions. The Empiricist distinguished four levels of frequency in the connection between phenomena: always, for the most part, half the time and rarely (see Subf. Emp. 45, 25-30; 58,15 ff. Deichgräber; Exp. Med. 95, 112 Walzer; [Gal.], Def. Med. XIX.354 K.). Accordingly medical theorems will include an explicit specification of the frequency of the connections they report. As noted by J. Allen, this view on generalization may well be linked to the idea that the theorems that comprise medical knowledge are themselves stochastic and thus cannot attain true universality and stability (see [Gal.] Opt.Sect. I.114 K.) 26. Alexander of Aphrodisias also held this view while arguing that medicine falls short of the criteria that qualify true sciences, whose theorems are universal and necessary (more on this below). As we shall see, generality is no unqualified good according to Galen. Many of his polemical remarks in the treatise On the Method of Healing (De methodo medendi) are addressed against a view of medicine that allows for indiscriminate generalization, i.e. the Methodist theory of generalities or common conditions (koinotêtes) as probably developed by the Methodist doctor Thessalus of Tralles, who was active in the age of Nero and is Galen s favourite polemical target in MM. Here I will only recall the fact that the Methodist school was traditionally taken to be inspired by the corpuscular theory held by the Rationalist doctor (and strenuous opponent of the Empiricist school) Asclepiades of Bythinia (first century BCE) another of Galen s pet hates 27. While probably not endorsing Asclepiades Rationalist physiology, according to which the body is formed by atoms and invisible pores (with illnesses depending on either the constriction of these invisible pores or an excessive flow through them), the Methodists developed his general ideas in a distinctive way. They assumed (i) that all diseases are just a matter of constriction, relaxation (stegnôsis; rhusis) or a combination of both; and (ii) that constriction and relaxation are not hidden states, but manifest phenomena and common conditions. It is by grasping these manifest general conditions, then, that the Methodists claimed they could find indications as to the appropriate treatment to 26 See Allen J. 1994, p See Allen J. 2001, pp and p. 143.

26 398 Riccardo Chiaradonna be adopted in each case. All training, in their view, was simply geared to make common medical conditions evident to physicians with sufficient clarity; hence the Methodist claim that six months were sufficient to apprehend medicine (see Sect. Int. I.83 K.; MM X.5 K.). There was actually some debate in antiquity as to whether the Methodist believed that koinotêtes could be perceived or not; their attitude to reason is also a matter of debate 28. 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 K.). However, neither were koinotêtês 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 different from that of the Rationalists. It is worth quoting M. Frede s account of the Methodist position in full: They refuse to attribute to reason any obscure powers which we would have not dreamed of in ordinary life. They 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 obvious 29. Accordingly, the Methodist notion of indication differs 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. The Methodists famously adopted an outrageously critical attitude to Hippocratic medicine (Thessalus wrote a letter to Nero against the harmful precepts of Hippocrates and proclaiming the virtues of the 28 See Frede M. 1982, p Frede M. 1982, p. 266.

27 399 Universals in Ancient Medicine Methodist sect: see MM X.7-8 K.) 30. In fact, their theory of common conditions may be seen as a radical overthrowing of the Hippocratic principle according to which individual patients are the proper object of therapy. While the Empiricist doctors did not endorse the Hippocratic humoural theory, their method was nonetheless based on the direct observation and careful recording of individual cases; and as a consequence of this, they could still be seen as following the overall pattern of Hippocratic medicine. The attitude of the Methodists is completely different, since they emphatically claimed that individualizing features (such as gender, causes, the knowledge of affected parts, the age and constitution of the patient, etc.) are irrelevant for any attempt to discover the appropriate treatment (see Sect. Int. I.79 K.) 31. On their view, grasping the common condition was perfectly sufficient for attaining this purpose; we should not worry, then, about individuals and how to know them. Hence, Galens polemical remark (MM X.206 K.): the Methodists talk as if they were applying their therapies to the generic human being instead of individuals. In a sense, the Methodists may be taken to have developed one of the criteria set out by Aristotle for assessing artistic knowledge, i.e. generality. Indeed, their view on generalities is not based on any ontological theory about causes and essences: the author of Opt. Sect. (I K.) informs us that the Methodists talk about generalities was based on our ordinary talk about similarities (homoiotês tis en pleiosin). Thus they compared their generalities to humanity, a feature (eidos) that we grasp in all human beings on the basis of their mutual similarity. It would probably be misleading to search for a precise ontology of generalities here. Rather, it seems that the Methodists (here as elsewhere see what has been noted above about their conception of reason and indication ) used logical or ontological notions in a distinctively non-committal way. As we shall see below, Galen s criticism of the Methodists aims to reverse their position. Galen is perfectly happy to admit that we should take the ordinary meaning of a term as the starting point for scientific research. This is the case because ordinary language mirrors our pre-scientific knowledge of the world, that of our common conceptions ; the job of scientific investigation is to analyse these notions, thus unveiling their underlying essences. Without an agreement on common conceptions, it is impossible to discover the substance of the 30 See Tecusan 2004, p Frede M. 1982, p. 268.

28 400 Riccardo Chiaradonna matter at issue (see MM X.40 K.). Yet, according to Galen, adopting this procedure correctly shows that Methodist generalities in no way share the status of the species human being, since koinotêtes are just arbitrary and artificial constructions not based on the real structure of the world. Hence, as we shall see below, Galen s emphasis on diairesis and his idea that differentiae must be appropriate to each genus and not transgress its limits. As I aimed to show, Aristotle s remarks in Met. A 1 set out with paradigmatic clarity what I would call the structural dilemma of medical knowledge. On the one hand, medicine is an art and as such is based on a body of general knowledge; on the other hand, medicine is such that generalization cannot hold without substantial qualifications and the experience of individual unrepeatable cases plays a fundamental role within it. The Methodist and the Empiricist approaches may be seen as radicalizations of the two poles of this dichotomy. The Methodist view on generalities at least as described by Galen develops the quest for universality to such an extent that it regards individuals as irrelevant. The Empiricists, by contrast, regard generalization as the mere result of individual repeated observations, so that medical theorems should include an explicit specification of the relative frequency of observed facts. 3. Galen on universals and definitions Galen s monumental treatise On the Method of Healing contains a detailed critical discussion of both the Empiricist and the Methodist view. The first two books of this work are particularly interesting, since they make up a sort of general methodological premise to therapeutics, in which the theory of universals has a prominent position. Galen often refers to his (now lost) treatise On Demonstration and it is more than plausible that in this work he fully developed those theories which he somewhat cursorily mentions in MM 32. Galen s philosophical train- 32 On the chronology of Galen s MM, see Hankinson 2008b, p. 19. The literature on this work is rather abundant (though unfortunately a critical edition is still missing). I will especially refer to Hankinson 1991; Barnes 1991; van der Eijk A French and an English translation of this work have recently been published: see Boulogne 2009; Johnston, Horsley On Galen s On Demonstration, see the seminal work by Müller 1895; more recently, Chiaradonna 2009a; Havrda 2011,

29 401 Universals in Ancient Medicine ing was famously very extensive and rather unique for its day: he was extremely well acquainted with Plato, Aristotle and Theophrastus, with the Hellenistic traditions, and with works by Platonist and Aristotelian philosophers and commentators. This fact explains the distinctive character of Galen s 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 specific medical purposes of Galen s approach to logic and philosophy (this is paradigmatically the case with the theory of definition and specific differentia). 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 striking 33. 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 [ἑνὸς καὶ ταὐτοῦ μεθέξει], in the same way as do human being, cow, and each other living being. For there is some thing unique in all human beings [ἓν γὰρ καὶ ταὐτὸν ἐν ἅπασι τοῖς ἀνθρώποις ἐστί]. 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 modifications). This 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.). This may appear disappointing, especially if we compare Galen s approach to that of professional philosophers such as Alexander of Aphrodisias or Porphyry, whose discussion of imwho interestingly suggests that Galen s DD is in the background of Clem. Al., Strom. VIII. 33 See Hankinson 1991, p. 218.

30 402 Riccardo Chiaradonna manent natures is highly sophisticated 34. Yet an adequate assessment of Galen s view should take account of his specific purpose, which is a medical one. Here as elsewhere, Galen draws from logic and philosophy only inasmuch as this is necessary for him to address medical matters appropriately; on his view, logical and philosophical technicalities should not be pursued in themselves. In fact, Galen s account of division in MM is part of his Rationalist account of therapy: in brief, what he argues is that the principal indication of the appropriate therapy comes from the scientific understanding of the essence (ousia) of each disease (MM X.128; X K.; Fac. Nat. II.127 K.). Diseases are organized in genera and species and each specific disease further determines its summum genus: generally speaking, disease involves the impairment of some natural function or activity and can appropriately be defined as the disposition (diathesis) that impedes this activity: see MM X.41; X.81 K.; Sympt. Diff. VII.43; K. Galen s division of diseases is actually rather problematic and its details should not keep us here 35. Here it is sufficient to remark that Galen regards the division of the genus disease down to its infimae species (see MM X.25 K.), as well as the definition of each of these species, as the rational basis of treatment. An understanding of the specific essence of a disease will provide the principal indication for its appropriate treatment, whose aim is to remove the pathological disposition of the patient, thus restoring the affected body to its healthy and natural condition. All individual instances of disease, then, share in a unique specific thing, just as all particular human beings or dogs or horses do: an appropriate knowledge of this specific real nature is the first basis of therapy according to Galen s method. Galen often points to the philosophical background of this overall doctrine and presents Plato, Aristotle and Theophrastus as his chief authorities regarding logical methods of division and definition (see MM X.22 and X.26 K.). Galen mentions Plato s Philebus, Sophist and Statesman, as well as Aristotle s On the Parts of Animals, «since Aristotle tries in that book to enumerate all the differentiae of animals»; a quotation from Plato s Phaedrus is predictably added some lines below (Phdr. 237bc: see MM X.27 K.). Galen s list of auctoritates may indeed strike us as somewhat surprising, since Plato s dialogues on division are followed by Aristotle s PA, which famously includes in its first book a scathing criticism of dichotomic division. Yet things become 34 See for further details Chiaradonna 2007a. 35 See Barnes 1991, pp. 95-8; Hankinson 1991, p. 201.

31 403 Universals in Ancient Medicine clearer as soon as we realize two facts, namely: (i) that for all their differences, Plato, Aristotle and Theophrastus, according to Galen, form a unique philosophical front, that of the logical method, to be addressed against Thessalus theory of koinotêtes; (ii) that while drawing his overall inspiration from Plato, Aristotle and Theophrastus, Galen does not simply report their theories; rather, his theory of division and definition presents some peculiar features, which can only properly be understood against the background of Galen s own epistemology. Just after mentioning his philosophical authorities, Galen overtly opposes them to Thessalus: Yet the outrageous Thessalus 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 don t you reveal it to us? (Gal., MM X 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 ff.): 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) differentia (see MM X.23 K.). What is a species-forming differentia? As R.J. Hankinson puts it, «A differentia D is species-forming with respect to some genus G if and only if either (a) the conjunction of G and D is sufficient to identify a species, or (b) the conjunction of G, D, and some further set of differentiae is sufficient non-redundantly to identify a species» 36. For example, as Galen argues (MM X K.), one should not divide the genus animal on the basis of differentiae such as soft 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. This view finds a couple of interesting parallels in writings attributed to Alexander of Aphrodisias. In Mant., 21, 169, Bruns, we find a sketchy account of division and differentiae which is similar to that of Galen and has rightly been compared to it 37 : 36 See Hankinson 1991, p See Barnes 2003, p. 182.

32 404 Riccardo Chiaradonna For the proper differentiae that divide something [αἱ οἰκεῖαί τινος διαιρετικαὶ διαφοραί] do not extend beyond that which they divide; for example, none of the differentiae that divide animal occurs outside animal or belongs to anything which is not an animal. For the differentiae that properly dissect something must be contained within what is dissected by them [περιέχεσθαι [ ] ἐν τῷ τεμνομένῳ] (Alex. Aphr., Mant., 169, 11-15, trans. Sharples, with slight modifications). This 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 Alexander s lost commentary on Met. I (the term oikeios occurs in this chapter from the Metaphysics too, where it designates male and female as oikeia pathê of the genus animal: see Met., I 9, 1058b22) 38. There are actually several complicated questions surrounding these lines from Mantissa, in particular regarding the view that (a) dividing (diairetikai) differentiae should be contained in the genus they divide (if X is a differentia that divides Y, Y is predicated of X) 39 and (b) dividing differentiae should not extend wider than the divided genus. Certainly, these problems were extensively debated among commentators and divergent solutions were proposed 40. Alexander s texts On Differentia, preserved in Arabic, contain an extremely complex set of discussions of these issues, whose relation with the passage from the Mantissa is somewhat difficult to determine 41. Actually, the Arabic Diff. I criticizes the view according to which dividing differentiae should not extend beyond the divided genus; however, the contradiction with Mant. 21 is perhaps not to be overemphasized 42. In Diff. I [7] Alexander also deals with the ap- 38 See Sharples 2008b, p See Barnes 2003, p See the discussion in Luna 2001, pp ; Barnes 2003, pp Further evidence is now provided by the rediscovered commentary on Aristotle s Categories preserved in the Archimedes Palimpsest most probably, a part of Porphyry s big commentary Ad Gedalium: see Chiaradonna, Rashed, Sedley Diff. I and II according to Rashed s classification: see Rashed 2007, pp. 54 ff. and pp. 104 ff. 42 The peculiar dialectical context of Mant. 21 should probably be taken into account (here Alexander cursorily discusses the theses about genus and differentia only inasmuch as it serves to explain why male and female are not dividing differentiae).

33 405 Universals in Ancient Medicine propriate genera which should be taken into account while defining a species 43. Here we find the remark that the differentia which makes up the defined species is a differentia that «belongs to the genus» («une différence appartenant à ce genre», trans. Rashed). There are close family resemblances between MM X.23 ff. K. and these passages from Alexander. Grosso modo, all of these texts emphasize that differentiae should not be arbitrary or stipulatively attached to the genus in order to make up the species; the connection between genus and differentia in definitions should instead be an intrinsic one and reflect the real essence that we aim to define; hence the emphasis on the appropriate character of the differentia. Both Alexander and Galen reject the idea that definition is a merely stipulative or formal procedure that combines concepts without doing justice to the real structure of the world. A division of species and differentiae should «cut them at the joints» (MM X.123 K., clearly echoing Phdr. 265 e). So far so good; but things become much more complex when we come to examine the details. Let us quote some lines from MM X K. in full: For in the first place not every differentia that is conjoined with the genus contributes something towards the creation of the species, but only that from the appropriate division of the genus [ἐκ τῆς τοῦ γένους [ ] οἰκείας διαιρέσεως]. Only these are species-forming differentiae: all the others are superfluous [ ]. Hence it is impossible to discover the species-forming differentiae of anything without first having accurately circumscribed its definition, or the formula of its substance [ἄνευ τοῦ τὸν ὁρισμὸν ἢ τὸν λόγον τῆς οὐσίας ἀκριβῶς αὐτοῦ περιγράψασθαι] (trans. Hankinson, with slight changes). Species-forming differentiae are here regarded as resulting from the appropriate division of the genus. The difference from the view held in Mant. 21 is significant, for according to Alexander a genus should be divided by its appropriate dividing differentiae; instead, Galen argues that differentiae come from the appropriate division of the genre. This overall view is even more strikingly asserted at the end of the passage, where Galen argues that «circumscribing» the definition of a substance is a preliminary requirement for discovering its specific differentiae. For variations in Alexander s views on differentia, see Rashed 2007, p. 54 note 169, p. 122 and pp. 154 f. 43 See Rashed 2007, p. 108.

34 406 Riccardo Chiaradonna The use of Aristotelian notions here is very evident (logos tês ousias is an obvious reminiscence of Cat., 1, 1a1-4 and Top., Ε 2, 130b26); however, Galen thesis that the grasping of essential definitions should precede the discovery of specific differentia appears somewhat peculiar and is repeatedly asserted in MM (see X.27; X.40; X.115 K.). Hence, division seems to be regarded by Galen as a mean of systematically presenting something the essence of which one has already come to know. In his classic work on Galen s On Demonstration, Iwan von Müller rightly talks about «die Notwendigkeit, erst eine vollständig Definition zu gewinnen, ehe an die Division gegangen werden kann» 44. Before proceeding any further, it is worth discussing a possible interpretation of the lines quoted above. In his Isagoge Porphyry codifies a well known distinction, which was certainly familiar to previous commentators and may be thought to be of some help for interpreting these passages, namely the distinction between dividing and speciesforming differentiae or, rather, between the dividing and the species-forming or constitutive function that differentiae can play (since the same differentiae can under different respects be both dividing and species-forming: see Isag., 10, 3 ff. Busse). Without focusing too much on the details 45, we may simply recall that differentiae are taken to be dividing insofar as they divide a genus into its subordinate species (hence rational and irrational are dividing differentiae of the genus animal), since exactly one of the dividing differentiae is predicated differentially of everything which the genus is predicated of generally; instead, differentiae are taken to be species-forming or constitutive insofar as together with the genus they make up the definition of the divided species (rational is therefore a constitutive differentia of the species man, whose definition is rational animal ). Alexander (Mant. 21) talks about dividing differentiae, whereas Galen talks about species-forming differentiae: hence, one may conclude, the distinction of their views. This explanation is tempting, but some remarks may be addressed against it. To the best of my knowledge, the distinction between dividing and specifies-forming differentiae does not come up in Galen and certainly is not hinted at in the lines quoted above. The Greek text runs as follows: 44 Müller 1895, p See the in-depth discussion in Barnes 2003, pp. 178 ff.

35 407 Universals in Ancient Medicine οὐδὲ πᾶσα διαφορὰ προστιθεμένη τῷ γένει συντελεῖ τι πρὸς τὴν τοῦ εἶδους γένεσιν, ἀλλ ἥτις ἂν ἐκ τῆς τοῦ γένους οἰκείας ᾖ διαιρέσεως αὗται γάρ εἰσιν εἰδοποιοὶ μόναι τῶν διαφορῶν, αἱ δ ἄλλαι πᾶσαι περιτταί. ζῴου μὲν γὰρ διαφοραὶ τὸ θνητὸν καὶ ἀθάνατον κτλ. Galen is focusing here on the definition of species: this definition is made up of a (set of) differentia(e) conjoined with a genus. Galen remarks that in order to really be constituents of the species, these differentiae should come from the «appropriate division of the genus». How can this division be accomplished? One might say: via the same differentiae, insofar as they are appropriate dividing differentiae of the genus (and not constitutive differentiae of the species). This is well possible, but Galen does not suggest anything of the sort. Rather, he merely argues that, say, rational and mortal are appropriate differentiae of the genus animal since they can make up a species (that of man) when conjoined with that genus. One may well reach the same result (the definition of man) by conjoining footed and biped with rational animal (MM X.24 K.). Such divisions are indeed different and the order of cuts may change (as a matter of fact, the cuts rational/irrational and mortal/immortal can come in either order, whereas footed has clearly a greater extension than biped) 46. However, the actual end result does not change, since in either way we have a definition of the species human being and in MM X.24 K. Galen overtly states that there is more than one way of arriving at the species in question. The order of cuts does not really matter and at PHP V.763 K. Galen does not consider making the right number of cuts in the wrong places a way in which division can go wrong: what really matters is that the cuts be neither too few nor too many (see also MMG XI.4 K.); the reason is simple, since cuts in the diairesis correspond to species-forming differentiae and a wrong number of cuts entails that the definition of the species has not been circumscribed correctly. To sum up: the lack of mention of dividing differentiae at MM X K. may not be haphazard, since Galen does not claim that we come to define the species by dividing the genus through its appropriate (dividing) differentiae. What Galen s discussion rather implies is that the definition of the species in ques- 46 See on this and what follows Hankinson 1991, p Rashed 2007, p. 155 argues that the choice between rational and biped as species-forming differentiae of human being raises some questions concerning Alexander s hylomorphic ontology. As far as I can judge, Galen s overall approach does not share this kind of concerns.

36 408 Riccardo Chiaradonna tion should somehow already be known from the start and act as a guide for finding the species-forming differentiae 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 ff. Kalbfleisch that Herminus, while interpreting Cat., 3, 1b16-17, argued that differentiae that occur in different parallel genera which fall not one under the other, but rather all under the same genus (e.g. the differentiae 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 differentiae of the superior genus that includes the parallel genera (i.e. of the genus animal) 47. This view is obviously open to the objection that animal would thus be both biped and quadruped: we find a remark of this sort in Alexander s text Diff. I, preserved in Arabic (see Diff. I [3i]) 48. In this work, Alexander reacts against an adversary whose position is actually extremely close to that of Herminus 49. Galen s view that rational/irrational, mortal/immortal, tame/wild, are all differentiae of the genus animal may actually recall Herminus view that biped and quadruped are primarily differentiae of the genus animal. However, Herminus view is certainly connected to his refusal to admit species-forming differentiae: on his view, differentiae are just dividing differentiae (see Simpl. In Cat., 55, Kalbfleisch). This remark does not solve all problems, but can at least serve to dismiss the objection that the genus animal would be equally determined by differentiae such as biped and quadruped: Herminus merely argues that these differentiae are primarily dividing differentiae 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 fixing the correct order of cuts in divisions that start from the highest genus (see Alex. Aphr., In APr., 47 Further crucial evidence on Herminus theory of the differentia is given by the newly rediscovered part of Porphyry s Ad Gedalium (see above, note 40). I will not dwell on this. Porphyry s account supplements that of Simplicius, but is not at odds with it. For an overall account of Herminus, see Moraux 1984, pp See Rashed 2007, p See Rashed 2007, p. 111 and pp. 121 ff.

37 409 Universals in Ancient Medicine 72, 26 ff. Wallies) 50. Despite some similarities between the two authors (which might not be due to sheer chance: for the connection between Herminus and Galen is attested in a piece of writing by Alexander preserved in Arabic, in which he criticizes Galen for attacking Aristotle s views on motion in an essay he sent Herminus) 51, Galen s use of eidopoios at MM X K. points to a different view. According to Galen, rational and irrational are both appropriate differentiae of animal since we know preliminarily and not by dividing the genus that these differentiae constitute the species under animal. While Herminus rejects the very notion of specific differentia, Galen seems to pass over in silence that of dividing differentia. In fact, rather than establishing a rigid and hierarchically ordered taxonomy, Galen s aim seems to be that of correctly grasping the specific differentiae that (conjoined with the genus) make up the species and correspond to the natural cuts of the genus. As a Rationalist doctor, Galen grounds therapy on pathology and pathology requires division, since illnesses come in genera and species; indications for therapy come from the essence of defined diseases. Since all diseases are kinds of unnatural physical dispositions, the indication of the appropriate treatment should start from a correct essential definition of the disposition in question via its appropriate differentiae (e.g. MM X K., where these principles are applied to the treatment of wounds). As noted above, what is crucial for Galen is not so much to create a well-ordered tree à la Porphyry, but to take account of all the differentiae which determine the disease in question, so that its definition will not be too general and the indication of therapy will prove adequate (divisions then should be neither wrong nor defective, like those practiced by bad doctors: see MMG XI.4 K.). It is not difficult to see the anti-methodist aim behind this overall view. As noted above, immediately after praising Plato, Aristotle and Theophrastus for their work on division (MM X.27 K.), Galen vehemently attacks Thessalus koinotêtes. The Methodist use of koinotêtes is Galen s paradigmatic example of a misleading generalization, ignorant of logical methods and blind to the appropriate divisions of reality (see MM X K.). Galen s emphasis on natural or appropriate division, while consciously rooted by him in the previous medical and philosophical traditions (starting from Plato and Hippocrates), only 50 On this see now Griffin forthcoming. 51 See Rescher, Marmura 1965, pp. 57 ff.

38 410 Riccardo Chiaradonna acquires full meaning when interpreted as a reaction against Methodist therapeutical principles. What Galen is doing is reproaching Thessalus for his practice of drawing therapeutic indications from hypergeneral differentiae that lack any real informative value for treatment. Galen does not deny that the Methodist costive/fluid differentiae may be attached to diseases (just like rare/dense, hard/soft, taut/relaxed: see MM X.23 K.); what he denies is that enumerating differentiae such as these may in any way suffice to adequately determine the species of diseases (such as inflammation, tumour or oedema), thus establishing a pathology, which (in his view) is the only adequate ground for therapy. Hence Galen s irony (MM X K.) directed against Thessalus view that a concave wound in a fleshy part of the body should be treated by administering a remedy that generates flesh (embalontes [ ] to sarkôtikon pharmakon), thus replenishing the wound. This is obviously true, but one should determine precisely how this remedy should be prepared, and this, according to Galen, requires (MM X.169 ff. K.) detailed particular indications (about pharmacology, the elemental composition of the wounded flesh, etc.: see MM X K.), as well as rationality (logos) and logical methods. Yet, while Galen s polemical strategy clearly emerges from the text, his own views on division and definition still appear somewhat vague. As I aimed to show, his emphasis on «appropriate differentiae» and the necessity of adequately determining species can be seen as a reaction against the Methodists. Galen s peculiar view that one should first grasp a species in order to discover its differentiae can also be understood as part of his anti-methodist approach. Thus we return to the problem mentioned above: how can one be capable of grasping the essential definition of a species accurately, if this awareness is a necessary condition for finding the differentiae 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 Thras. V.812 K.) 52, so another explanation should be found. Actually, Galen himself provides an answer to this question at MM X.40 Κ.: [ ] we must now I suppose explain what a disease actually is in its definition, so that we may thus attempt a proper division of it. How then do we find this out correctly and methodically? How else than by the means specified in On 52 Further references in Barnes 1991, p. 76.

39 411 Universals in Ancient Medicine Demonstration? First of all the common conception must be agreed upon [τῆς ἐννοίας πρότερον ὁμολογηθείσης]: without it it is impossible to discover the substance of the matter at issue (trans. Hankinson). The Stoicizing reference to the «common conception» points to a distinctive theory by Galen. He sees the ordinary use of (the Greek) language as mirroring a pre-theoretical knowledge of the world, which scientific enquiry should take as its basis and criterion for discovering essential or scientific definitions by scientific enquiry according to logical methods (see MM X.42 K.) 53. Scientifically understanding the essence of something is thus presented, in a famous passage from Diff. Puls. (VIII.708 K.; see 704 ff. K. for the whole account), as a transition from «notional» to «essential» definition (ennoêmatikos horos; ousiôdês horos) (e.g. that of pulse). It is crucial to note that notional accounts are by no means merely conceptual; nor are they the object of merely linguistic analysis: rather, they reflect a pre-scientific, not adequately unfolded, and yet perfectly real, acquaintance with the world, which should be the basis of all scientific accounts 54. Cutting «at the joints», then, entails respecting the distinctions expressed by our linguistic awareness of the world (hence Galen s criticism against those physicians who do not respect these distinctions and, accordingly, provide arbitrary definitions: see Diff. Puls. VIII.704 K.; see also Galen s polemic against Archigenes artificial use of language in Loc. Aff. VIII K.) 55. The question of how to correctly divide can 53 For further details, see Brittain 2005; Chiaradonna 2007b. 54 The status of notional accounts is closely parallel to that of Galen s dialectical premises in PHP: see Chiaradonna 2007b, p According to Galen, language is a necessary condition for establishing correct classifications, but not a sufficient one, for Galen recognizes the existence of «ineffable» differentiae, i.e. differentiae that can be perceived and are relevant for medical knowledge, but for which there is no corresponding word. This happens, e.g., with certain types of pain (Loc. Aff. VIII.117 K.), with certain types of pulse (Diff. Puls. VIII.517 K.) or discolourations of the skin (Loc. Aff. VIII.355K.). Galen acknowledges that many perceptual experiences cannot be expressed in words (Dign. Puls. VIII K.). Furthermore, he also seems to recognize the existence of a subset of unsayable properties that can only be perceived in a way which does not make them fully and consciously available to us (Loc. Aff. VIII K.). On this, see the enlightening discussion in Reinhardt It is however extremely important that Galen s emphasis on unsayable properties does not lead him to disqualify language as a mean for

40 412 Riccardo Chiaradonna now receive the following preliminary answer: by respecting the distinctions of ordinary language that reflect 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 reflected in language should be regarded as a criterion for scientific enquiry. Again, Galen s 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. The ultimate basis for Galen s 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 Theophrastus (see S.E., M. VII, ): 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 K.). These, 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 attacks 56. 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 K.). Galen s excursus on how donkeys are able to distinguish specific and numerical unity may appear as merely a picturesque detail, yet things change as soon as we realize that Galen s rivals actually denied this distinction. The Empiricist theory of sundromai (i.e. combinations of symptoms which are individual features of a case: see Subf. Emp. 56, 4 ff. Deichgräber) 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 times 57. 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 Galen s views on approximation, see the last part of this contribution. 56 See Hankinson Galen condemns Empiricist doctors for asserting this view at MM X.136 K.; see Hankinson 1991, p. 217.

41 413 Universals in Ancient Medicine Certainly, an accurate scientific account can in no way be compared to either the awareness of specific unity that (according to Galen) can be found in donkeys, or the awareness reflected in ordinary language. In Diff. Puls. VII K. Galen shows how we can reach a scientific definition (that of pulse) by starting from the ordinary account of the thing in question, i.e. the «conceptual account» that reflects our elementary awareness of the perceptible accidents of the investigated phenomenon. According to the present reconstruction of Galen s views, a full division which starts from the summum genus and ends with the species by enumerating all of its constitutive differentiae should then be seen as the final result of the enquiry which unfolds from our preliminary awareness of the investigated thing. This ordinary and preliminary awareness provides a sketchy but in no way arbitrary or stipulative map of reality, thus acting as a basic criterion for division. Accordingly, we do not accomplish division by starting from a summum genus and then dividing it according to differentiae; rather, we set off from a preliminary grasping of the investigated thing and proceed by unfolding this account according to a methodical use of our cognitive capacities (reason and experience). It is this procedure (and not a formal procedure of division) which allows us to discover species-forming differentiae. As R.J. Hankinson aptly remarks, «what the scientific taxonomist does is to make clear and rigorously defined distinctions which everybody (indeed, every animal) already knows in some sense of know» Galen on particulars In the first two books of MM Galen emphasizes the scientific 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 find in hard sciences such as mathematics. That medicine as such deals with universals is actually also asserted at the beginning of the Ars medica. The author of this treatise (probably Galen, although the issue is debated) follows Herophilus in defining medical science (epistêmê) as «the knowledge of health-re- 58 Hankinson 1991, p. 105.

42 414 Riccardo Chiaradonna lated, disease-related, and neutral things» (I.307 K.) 59. The author further explains (I.309 K.) that this definition 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 kind 60. Both (a) and (b) are rejected: medicine cannot focus on all individuals, since these are infinitely 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 qualifies this view as «thoroughly Aristotelian» 61 and, indeed, Galen s use of hopoiôn is similar to Aristotle s use of toiôide/toioisde at Rh., Α 2, 1356a30-32 and of toioisde at Met., Α 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 knowledge 62. As I aim to show, however, this is not Galen s 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 scientific knowledge should in principle account for unqualified repeatability (for example, a geometrical demonstration can unqualifiedly be repeated for all particular geometrical objects that satisfy certain conditions established ex hypothesi) and medicine falls short of this criterion 63. Just after 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 scientific, 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 See von Staden 1989, pp. 103 ff. 60 σημαίνεται δὲ καὶ τὸ πάντων τῶν κατὰ μέρος, σημαίνεται δὲ καὶ τό τινων, σημαίνεται δὲ καὶ τὸ ὁποίων. Text after Boudon-Millot s edition: see Boudon-Millot 2000, pp. 277, , See the contribution on Barnes in Boudon-Millot 2003 (Discussion). 62 For further parallels, see García-Ballester 1994, pp f. 63 I develop this point in Chiaradonna 2011b.

43 415 Universals in Ancient Medicine 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 unqualified 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 K.). This treatise is spurious; yet some scholars are inclined to assume that it represents Galen s final answer to the problem of the scientific status of medicine 64. I agree that the view voiced in the treatises finds significant parallels in Galen: a passage such as Ars Med. I.309 K., for example, equates genuine knowledge with the knowledge of universals. This Aristotelizing idea certainly found a prominent place in Galen s epistemology, but I would be hesitant to claim that this was Galen s final answer to the problem of the scientific 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 scientific 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, Galen s 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 scientifically and according to logical methods 65. Throughout MM, Galen argues that demonstrative medical skill as such is capable of curing individual human beings. Galen does not confine 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 Therapeutic 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 See Ierodiakonou 1995, pp See on this Barnes 1991, pp. 52 f.

44 416 Riccardo Chiaradonna (idian) to each one. This is obviously consistent with Galen s overall Hippocratic programme, which he emphatically reaffirms (e.g.) in the passage mentioned above (MM X.206 K.), where he criticizes Methodists for talking as if they were applying their therapies to the generic human being rather than individuals. As Galen emphatically argues, it is not the generic human being that is cured, but each one of us (hêmôn hekastos). True medicine, according to Galen, should take account (conjecturally, as we shall see below) of the nature of (each individual) patient (MM X.209 K.): ἡ ὄντως ἰατρικὴ τῆς τοῦ κάμνοντος ἐστόχασται φύσεως. The words τῆς τοῦ κάμνοντος [ ] φύσεως as such may not necessarily refer to an individual unrepeatable nature. Galen could simply be claiming that medicine should consider recurrent natures instantiated by individual patients. Yet this is certainly not the case, since Galen immediately goes on to explain that «most doctors» call this nature «idiosyncrasy» and that they all agree that it cannot be grasped (akatalêpton). The term «idiosyncrasy» (idiosunkrasia) occurs several times in Galen (San. Tu VI.283 K.; MM X.169 K.; X.209 [with X.206] K.; Dign. Puls. VIII.774 K.; Di. Dec. IX.932 K.) and elsewhere (see S.E., PH I 79, 81 and 89). This notion has an important place not only in medicine, but also in another conjectural art which raises similar epistemological problems, namely astrology (see Ptol., Tetr. I ) 66. In MM X.169 K. Galen informs his readers that «idiosyncrasy» is part of the Empiricist terminology (and Sextus use provides obvious confirmation for this). Grosso modo, the notion of idiosyncrasy denotes the individual unrepeatable nature or constitution of each patient. Galen s remark (MM X.209 K.) that «most doctors» made use of this notion suggests that both Empiricist and Rationalist doctors mentioned idiosyncrasies. Further passages suggest that both schools agreed that such individual natures cannot as such be the subject of any adequate account (see also MM X K. = 151, 19 ff. Deichgräber). Significantly, both Empiricists and Rationalists argued that since it is impossible to rationally grasp individual natures with complete precision, therapy is bound to be conjectural (MM X.182 K.) 67. Certainly, Empiricists and Rationalists conceived of individual natures differently. In MM X.207 K. Galen criticizes Empiricists for taking only account of observable characters such as the 66 See Sassi 2005, pp On the history of this notion in ancient medicine, see Hall Barnes 1991, p. 63 note 46 (with further references).

45 417 Universals in Ancient Medicine patient s age and gender, without considering the proportion of his/ her elemental composition. Building on this passage, one may draw a distinction between the Empiricist and the Rationalist account of idiosyncrasy, the former referring to the observable features of each patient, the latter to his/her unique blend of humoural qualities (ὅπως ὑγρότητος ἢ ξηρότητος ἔχει τὸ σῶμα: MM X.207 K.) 68. Yet for all of their differences, it is noteworthy that both schools agreed that therapy should consider the unique and unrepeatable constitution of each patient. This overall conclusion can be seen as simply a reinstatement of what we find in Met. Α 1: the idea that medicine is an art with a body of general knowledge which needs experience in order to be adapted to individual variable situations. Yet, at least as far as Galen is concerned, things are somewhat different. Like Aristotle, Galen maintains that we cannot attain precise knowledge of any individual in his/her singularity. However, he develops this idea in a highly distinctive way, since he regards both the unrepeatable blends proper to each human being and the particular situations that affect each individual as perfectly knowable de iure, although we are de facto incapable of attaining any precise knowledge of them. In a very important passage, Galen clearly states the individuum ineffabile principle (see MM X.206 K.: τὸ τῆς ἑκάστου φύσεως ἴδιον ἄρρητόν ἐστι) 69. This principle, however, is only valid inasmuch as it refers to our limited knowledge and should definitely not be taken to mean that individuals as such cannot in any way be the object of scientific and precise knowledge. Suppose that a doctor precisely knows the unique individual blend that identifies each patient as well as all the other circumstances that may affect the treatment. Suppose, moreover, that this doctor has complete mastery over both his discipline and logical methods. A doctor such as this would not only possess a precise body of general medical knowledge, but would also be capable of exactly and unvaryingly applying his knowledge to particular situations without any residual imprecision. As such, he would always be successful. As Galen remarks (MM X.207 and 209 K.), this is the case with the god Asclepius, who is able precisely (akribôs) to determine the individual nature of each patient and is therefore an infallible healer. In his commentary on Hippocrates, Epidemics I.23, Galen (Hipp. Epid. XVIIA.205 K.) overtly treats the knowledge of universal natures in di- 68 See Allen J. 1994, p On this, see Reinhardt 2011, p. 309; Deichgräber 1957, pp

46 418 Riccardo Chiaradonna 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. Ε 2). Galen s distinction between the human and the divine knowledge of an individual would hardly make any sense within an Aristotelian philosophical framework. Here the difference between Galen and Aristotle emerges quite clearly, since as J. Allen has noted Galen s version of rationalism represents a fusion of Platonic-Aristotelian views on the knowledge of universals «with the very different 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 reason» 70. Interestingly, Galen s 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, Kalbfleisch = 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 idiotêtôn) within an overall Platonic-Aristotelian account of universals and predication 71. Galen s views are certainly different from those of Porphyry and while Galen focuses on the epistemological problems raised by the knowledge of the individual, Porphyry s 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 Allen J. 1994, p See Chiaradonna Reinhardt 2011 provides a detailed parallel between Galen s views on individual properties and the Stoic theory. As Reinhardt notes, «[i]t has not been explored in detail what Galen s notion of the phusis of individuals owes to Aristotelian Einzelformen and Stoic peculiar properties» (Reinhardt 2011, p. 309 note 21). The present contribution aims to at least partially fill this gap.

47 419 Universals in Ancient Medicine matters 72. When Galen talks about the conjectural or empirical aspects of treatment, then, one should not forget that conjecture and experience can and should, in his view, be treated scientifically and methodically. As he notes at MM X.206 K. the best doctor will have acquired a method (methodon tina porisamenos) which allows him to diagnose the nature of each individual patient and to conjecture the remedies suited to it. Technical conjecture is no doubt a second best when compared to Asclepius precise knowledge. Galen, however, does not emphasize this aspect very much: he rather points out that technical conjecture should be regarded as something extremely positive, since it makes the good doctor capable of approximating precise knowledge as far as this is possible (see Cris. IX.583 K.: ἐγγυτάτη τῆς ἀληθείας; see also Hipp. Off. Med. XVIIIB.861 K.; Hipp. Aph. XVIIB.382 K.), thus minimizing the probability of errors on his part in the treatment of individual patients. This is the reason why, according to Galen, medical conjectural thinking should carefully be distinguished both from divination and from philosophical hypotheses concerning issues such as the nature of the soul or the generation of the world. Philosophical hypotheses such as these are impossible to verify and can at most be regarded as subjectively persuasive (pithanon) 73. Medical conjectures, instead, are not merely persuasive: they are probable to a very high degree and can be tested against experience. Galen maintains that the good doctor (unlike the Empiricist, who does not treat experience methodically) will be capable of conjecturing in a precise way (stochasetai akribôs: see MM X.195 K.). How can a technical conjecture be formulated? When conjecturing, doctors cannot simply derive conclusions from already known premises: instead, they must come up with hypotheses that can account for a given problem (i.e. the diagnosis, prognosis and therapy of the individual patient). Let us (very cursorily) outline what happens in diagnosis and therapy 74. In some rare and extremely favourable situations, the good doctor may immediately and without any uncertainty know that a given symptom corresponds to a certain disease: this is the case when a symptom exclusively corresponds to a specific disease and is unvary- 72 On Galen s views on technical conjecture, see Boudon-Millot 2003; Fortuna See Chiaradonna forthcoming. 74 For an in-depth discussion (with detailed references), see García-Ballester 1994; Fortuna 2001; Fortuna, Orilia 2000; van der Eijk 2008.

48 420 Riccardo Chiaradonna ingly and identically present in all patients affected by the disease in other words, when x has the disease D iff it presents the symptom S 75. This situation, however, is extremely rare; in the vast majority of cases (especially when diagnosing internal diseases: see Galen s Loc. Aff.) doctors are forced to come up with a hypothesis. According to Galen, the formulation of diagnostic hypotheses involves several aspects and throughout this whole process the good doctor should be guided by his background knowledge of diseases and symptoms, as well as by complete mastery over logical methods. When formulating a diagnostic hypothesis, for example, a doctor should know all the symptoms caused by the hypothesized disease and should very carefully explore their presence in the investigated patient (Loc. Aff. VIII.366 K.). While a single symptom may well correspond to different diseases, a cluster of several symptoms is likely to correspond to one disease alone; according to Galen, some symptoms (e.g. pulse) have a privileged status and the good doctor should therefore be extremely well trained in exploring them. Furthermore, direct exploration may not suffice. In order to minimize the probability of erring, the good doctor should also collect all the available information concerning the patient he is treating: accordingly, the patient should describe his present and past symptoms and should also inform the doctor about what happened in the days prior to his visit. This verbal information is essential for any attempt to formulate a correct diagnostic hypothesis (Loc. Aff. VI- II K.; see also VIII.335 K., etc.) 76. Finally, the doctor may begin a course of treatment and test its effectiveness (Loc. Aff. VIII K.). If the doctor acts in this way, and is helped by his patient, who answers correctly all of his questions, he can then minimize the probability of erring to the point that it becomes negligible. Even if well-trained doctors cannot attain precise knowledge of the individual nature of each patient, they can nevertheless successfully approximate such knowledge by elaborating a detailed classification of all kinds of individual mixtures (see Galen s Temp. and Prop. Plac. 5). Furthermore, they will carefully explore all factors which may affect their therapeutical strategy in particular situations. As noted above, division is presented in MM 1 as a systematic way of arranging information concerning a specific disease, the essential definition of which provides the principal indication for treatment. This indication alone, 75 See Fortuna, Orilia 2000, p. 103 and p See on this Mattern 2008.

49 421 Universals in Ancient Medicine however, is by no means sufficient for successful treatment, which needs to be qualified (this is the function of diorismos in Galen s therapeutical method) according to factors which pertain to each particular investigated case 77. Very interestingly, division also has the function of systematically presenting our approximated technical knowledge of those particular factors: If someone uses this method [sc. of division] on everything that is normal and everything that is abnormal, and derives flawless indications from all that results from this division, he alone would be free from errors in healing as far as is humanly possible, he would deal with patients whom he knows better than others, and even patients he does not know he would heal to the best of his ability, as well as those he does know. For if one divided first according to the difference in age, then according to the temperaments and capacities and all the other factors that pertain to human beings I mean colour, heat, physical disposition, movement of the arteries, habit, profession, and the character of the soul and if to these he were to add the difference of male and female and whatever else must be divided in terms of place and seasons of the year and the other conditions of the air surrounding us, he would come close to an idea of the nature of the patient (Gal., MMG XI.4-5 K, trans. Dickson) 78. Experience certainly has an important role to play: Galen regards it as a source of certain knowledge and as a fundamental component of the medical art 79. Still, he often (especially, but non exclusively, in pharmacological contexts) argues that experience should be qualified (diôrismenê peira), i.e. methodically interpreted according to a set of factors 80. Accordingly, experience is not the mere result of several repeated perceptions mutually associated via memory. Rather, the association of several perceptions is selected on the basis of factors that the good doctor knows in virtue of his skill and which he regards as relevant. Galen s position may well be considered an over-optimistic one. For instance, he seems to assume that the hypotheses which the good doc- 77 See van der Eijk p See van der Eijk 2008, pp. 290 ff. Galen was certainly not the first physician to have an interest in division. He mentions in particular the fourth-century doctor Mnesitheus of Athens for his skilful use of division in medicine: see Gal., MMG XI.3 K.; Adv. Lyc. XVIIIA.209 K. See van der Eijk 2008, p See the remarks in Frede M. 1981, p See van der Eijk 1997.

50 422 Riccardo Chiaradonna tor may consider are always limited in number and, in any case, all preliminarily and exactly known 81. Scientific conjectural reasoning in diagnosis and therapy makes it possible for good doctors to approximate the precise scientific knowledge of Asclepius even when treating individuals, and Galen is notoriously eager to present himself as an infallible physician 82. As noted above, Galen s view on the knowledge of individuals points to an overall conception according to which nothing is intrinsically accidental or indeterminate. Indeed, even within Galen s 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 individual s distinctive nature corresponds to an irrational infinite ratio which Asclepius knows as such (i.e. as infinite), while human doctors only know it in an approximate way. Galen, however, never suggests this idea 83. The view he outlines at MM X 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 infinite. Furthermore, some interesting testimonia preserved by the Arab tradition suggest that Galen did not posit any real distinction between necessary and contingent events 84. In his Short Treatise on Aristotle s 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 one s 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 differ 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 See Fortuna 2001, p See García-Ballester 1994, p Apart from this, Galen s idiosyncrasy (i.e. the unique ratio of humoural qualities characterizing each single human being) is obviously different from Leibniz s individual form, which contains all the predicates of the subject. However, in MMG XI.4 K. Galen suggests that the nature proper to the patient (ἡ ἰδία τοῦ κάμνοντος φύσις) comprises not only his/her distinctive mixture, but all the factors that pertain to him/ her as an individual. This position has a certain Leibnizean flavour. 84 For further details, see Chiaradonna forthcoming.

51 423 Universals in Ancient Medicine provisional formulae such as «For the most part, x s are F» with «All x s, given condition C, are F», where condition C is clearly and independently specifiable 85. Galen s vindication of the scientific status of medicine, then, ultimately leads to an overthrowing of the philosophical picture that emerges from Aristotle s Metaphysics: accidental features tend to be removed from Galen s account of knowledge and reality, so that not only universals but also individuals as such can (with appropriate qualifications) be made the object of rational knowledge 86. Riccardo Chiaradonna 85 Hankinson 1988, p. 6. See also Zimmermann 1991, p. lxxxii. 86 Drafts of this paper were discussed at the Pisa Workshop and at the seminar on ancient medicine coordinated by Philip van der Eijk (Humboldt University, Berlin). I would like to thank the participants for their valuable comments.

52

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