Another interesting speculation on the origins of the empiricist physicians comes from Michael Frede. Frede has suggested that from a reference in Plato's Laws a-c; c-d that there was a two-tired medical system with physicians for the wealthy who employed theoretical principles and physicians for the slaves who relied merely upon trial-and-error experience. If this speculation is correct, then the burden of proof for the empiricists is to show that the theoretical "book learning" of upper class doctors could be reduced to mere experience.
In other words, experience, itself, could generate competence. The result would be an elevation of the second-level physician. If Frede is correct on this, then perhaps social situation is partially responsible for the rise of the medical empiricists. Sextus Empiricus circa set out a loosely woven doctrine of "consideration" or skepsis.
Sextus is a key source of our knowledge of Pyrrhonism and is also said to have been a physician though his writings on medicine have not survived. It is not clear whether Sextus was an original thinker or merely a reflection of his era. However, at the very least, one can garner background information of what might have influenced the empiricists through the doctrine of skepsis. Under this doctrine the theoretical structures of the philosophers Dogmatists would be held in abeyance neither accepted nor rejected.
What would rule the day would be the case before the physician right now. The case and the physician's experience would dictate the treatment. Against the Empiricists, on the other hand, were the philosophers Dogmatists. In one important way the Dogmatists are not a "school" as such.
They are often depicted by their detractors, such as the Empiricists, rather than being self-identifying. This may relate to the social class dynamics noted earlier. Thus, one should keep in mind that the group is not so much a school of practitioners but a depiction of a group by objectors to those who profess a foundation in medical theory. Perhaps the best way to characterize the Dogmatists would be on the issue of aetiology.
The Empiricists attacked the Dogmatists for asserting that there might be hidden causes of disease, and that these hidden causes might be grasped via ratiocination. This was because under this characterization the Dogmatists were advocating reasoning and conjecture over experience.
To the Empiricists, this was akin to creating a priori science. Detractors said that the Dogmatists honored theory over observation and experience. Of course, from the point of view of the philosophical schools, rational theories create a critical structure that aid in the interpretation and explanation of nature.
The sense of explanation here harkens back to Aristotle , who distinguished knowing the fact hoti and the reasoned fact dioti, APo II, i. It may not be enough to know that if I as a physician do x, then y will result anecdotal correlation of two events. The reason for this is that when circumstances alter slightly, how is the practitioner to know whether this alteration is significant unless he also has an appreciation of the mechanism that underlies the process?
For example, anecdotal correlation might in a non-medical modern example suggest that every time I wash my car, it will rain. My personal experience may be almost perfect, but that does not mean that such a causal connection actually exists. The reluctance to embrace a non-observable causal mechanism leaves this dilemma to those who profess an aversion to theory in favor of experience.
Somewhat in the middle of these two schools were the Methodists. Aside from Soranus there are no surviving texts of the Methodists. Therefore most of what we have comes from the descriptions of Galen and pseudo-Galen on these writers. There is some controversy about the characterization and origins of this school but many relate it to Themison of Laodicea a pupil of Asclepiades of Bithynia. However this attribution is disputed by Celsus and Soranus who state that Themison is not the first but merely a representative of Methodism.
At any rate, the Methodists paid attention in contrast to the Dogmatists and Empiricists to the disease alone as opposed to the situation of the individual patient, that is, his medical history and personal situation. Thus, the physician does not have to have anatomical or physiological knowledge of the body. Instead, he observes the body in a holistic manner koinotetes. The three principle conditions of a body viewed in this way are: a the body's dryness, b the body's fluidity, and c the mixture of the two.
The "method" to be followed was to follow the phenomena. Underlying this assumption was the notion about the status of pores in the mechanism of the body's common balance. The body's pores allowed atoms to enter and exit the body. When the atoms came and went freely health was the result.
When there was a disruption, then sickness was the result. When the pores were either too small constriction or too large dilatation then an imbalance occurred in the normal atomic flow. Atoms are invisible to the naked eye. Pores are visible, but their subtle alterations are often not visibly detectable. Thus, on the face of it, the Methodists seem to be contra-Empiricist. However, the atomist tradition upon which this theory rests was taken to be Empiricist. In principle, one could view an entirely physical event-if it were possible to witness it. Thus, the Methodists seem to have affinities to both.
Disease was depicted as a community of constriction or dilatation or some combination of the two that, in principle, was observable even though, in practice, it couldn't be observed except through its effects, namely, the disease. Thus, though the intent of the Methodists was probably to lean toward the Empiricists, the actual practice put them more in-between. Galen often characterizes himself as an eclectic belonging to no school. It is true that Galen was an innovator in observation, for example he gave the first depiction of the four-chambered human heart.
But his epistemology was grounded in his philosophical training. In this way his practice is closest to Aristotelian critical empiricism that requires careful observation and a comprehensive theory that will make those observations meaningful. Because of Galen's pluralistic method, it is appropriate that for the most part his own method draws upon his predecessors with additions and corrections. For example, Galen employed the four-element theory earth, air, fire, and water as well as the theories of the contraries hot, cold, wet, and dry.
Though Aristotle interrelated these two descriptive accounts in his work Generation and Corruption, it is Galen who attempts to create a more gradated form by making quasi-quantitative categories of the contraries to describe the material composition of the mixtures On Mixtures.
Galen on the brain: anatomical knowledge and physiological speculation in the second century AD.
From the perspective of modern science, this is an advancement upon Aristotle. This work on mixtures is also used to account for the properties of drugs On Simples. Drugs were supposed to counteract the disposition of the body. Thus, if a patient were suffering from cold and wet upper respiratory infection , then the appropriate drug would be one that is hot and dry such as certain molds and fungi-does this remind you of penicillin? The use of broad-reaching natural principles enhanced the explanatory power of Galen's theory of biological science.
Galen speaks at length about the philosophers Plato from whom he accepts the tri-partite soul and Aristotle whose biological works are well known to him. In medicine, he is also greatly influenced by historical figures such as Hippocrates who he describes as a single individual opposed to our modern understanding of a group of writers-even though Galen was aware of the Hippocratic Question , Herophilus, and especially Erasistratus. In his avowed work on biological theory, On the Natural Faculties, Galen goes to great lengths to refute the principles of Erasistratus and his followers.
Contemporary figures are also discussed such as Aclepiades, and the Methodists Themison and Thessalus. This thorough use of the context of medicine allows Galen to consider, for example, Eristrates' theory of mechanical digestion via a vacuum principle and to supplant it with his own theory of attraction holke. Galen's theory of attraction may have had its roots in the theory of natural place that always lacked a material force to implement it.
At any rate, when the mechanisms are inscrutable, it was important for Galen to offer an account that fits into other parts of his theory such as the mixture of the contraries in the composition of the elements. One of the most influential aspects of Galenic practice was his implementation of or invention of-as per Wesley Smith the Hippocratic theory of the four humours phlegm, blood, black bile, and yellow bile.
These points of focus relate to a theory of health as balance. Each of these four humours is related to the three principal points of the body: head phlegm , heart blood , black bile liver and yellow bile the liver's complement, the gall bladder. The three principal points of the body are also loosely linked to the Platonic tripartite soul: head sophia, reason , heart thumos, emotion or spiritedness , liver epithumos, desire.
Thus, the sort of just balance of the soul that Plato argues for in the Republic is also the ground of natural health.
The physician's job is to assist the patient in maintaining balance. If a person is too full of uncontrollable emotion or spiritedness, for example, then he is suffering from too much blood. The obvious answer is to engage in bloodletting guaranteed to calm a person down. As in the case of pharmacology and the contraries, the four humours provide a comprehensive account of what it means to obtain and maintain health via the balancing of various primary principles.
One of the striking features of ancient medicine is the extent that very limited observations had to be interpreted in order to explain natural function.
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For example, given that blood was considered to be nourishment, trophe, it seemed reasonable following Aristotle that the blood would be entirely consumed by the body's tissue. Thus, the blood would be manufactured in the liver and heart and then would flow to the rest of the body and be consumed. The flow of blood went one-way. However, there was a problem: there were two sorts of blood vessels veins and arteries. These were structurally distinct. This was known through dissection of primates. Then it is assumed that Nature does nothing in vain discussed at length in On the Use of the Parts as a key biomedical explanatory principle.
This means that the veins and arteries have different functions. But they cannot be too disparate. The answer to this dilemma for Galen is that the arteries carry blood mixed with aer or pneuma that acts as a vital force whereas the venous blood is ordinary-though Galen held correctly that the two systems were connected by tiny almost invisible vessels capillaries. Thus Galen began with a problem and a number of observations and sought to make sense of the seeming anomalies via his overarching biomedical principles.
In this way, Galen was acting according to the mathematical training from his father and a desire to create a unified quasi-axiomatic explanatory system. Without observation, this could have led to a priori or "armchair" science. But when combined with careful observation, it leads to critical empiricism. Another example of this mixture of observation and inference is in the area of conception theory. Galen says in his treatise, On Seed,.
These things have been said by me because of some of the philosophers who call themselves Aristotelians and Peripatetics. I, at least, would not address these men so, they being so greatly ignorant of the opinion of Aristotle that they think it is pleasing to him that the sperm of the male being cast into the uterus of the female places the principle of motion in the katamenia the female seed and, after this is expelled, the principle of motion in the katamenia and, after it is expelled, does not any part become the corporeal substance of the fetus.
They have been deceived by the first book of the Generation of Animals that alone of the five they seem to have read. These things are written there, "As we said, of the generation of the principles we may say that chiefly there are the male principle and the female principle. These are not far after the beginning: in still later parts of the tract he writes as well, "But this may be well concluded that the male provides the form and the principle of motion and the female provides the body and the matter just as the example of curding milk.
The biological accounts of human reproduction in the ancient world offer excellent examples of the interaction between observation and inference. There are a number of issues involved in this issue that pre-dates even the Hippocratic writers. The one that is mentioned here is the issue of whether there is one seed the male's only or two the male's and the female's.
Books Galen on the Brain: Anatomical Knowledge and Physiological Speculation in the Second Century
In the above example Galen seems to be saying that the first reading of Aristotle in which the male provides the efficient cause and the female provides the material cause, simpliciter, is a misreading of Aristotle. Instead, the event conception is depicted as a more involved process in which principles of both parents come into play. These principles revolve around the empirically observable facts that children as often as not resemble the mother as much as the father. The "one seed" theory in which the father's seed, alone, fashions the child can only account for such an outcome by calling it a sort of mutation agone, para physin.
But regularity counts for something. This turns the entire idea of mutation a statistical anomaly on its head. Galen approaches the issue with a balanced approach beginning with anatomical observations. Galen did some of the most extensive work in the ancient world on the study of the female anatomy albeit mostly upon apes, On Anatomical Procedures, I. However, in the midst of this mistake he was on the right track in viewing the ovaries as analogous to the male testes. Michael Boylan Email: michael. Galen — C. Life Galen of Pergamum was a physician who was born in Pergamum was a bustling and vibrant city at the time and was particularly famous for its statue of Asclepius, a god of healing.
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- Greek anatomist herophilus: the father of anatomy?
Hellenistic Schools of Medicine During the end of the fourth century BCE and throughout the third century BCE there were enormous advances in medicine revolving around the principal practitioners: Diocles, Praxagoras, Herophilus, and Erasistratus. Method Because of Galen's pluralistic method, it is appropriate that for the most part his own method draws upon his predecessors with additions and corrections.
Galen's Critical Empiricism One of the striking features of ancient medicine is the extent that very limited observations had to be interpreted in order to explain natural function. Galen says in his treatise, On Seed, These things have been said by me because of some of the philosophers who call themselves Aristotelians and Peripatetics.
Basel: Par'Andrea to Kratandro, Galeni Opera Omnia. Leipzig: C. Cnobloch, , rpt. Hildesheim, This is still the standard edition though it is very gradually being supplanted by the Corpus Medicorum Graecorum Leipzig, present. Translated and notes by Vincent Barras. Paris: Les Belle Lettres, Galen on Antecedent Causes. Edited and translated with introduction and commentary by R. Cambridge: Cambridge University Press, Galen on Bloodletting. Translated by Peter Brain.
Galen on Food and Diet. Translated and notes by Mark Grant. London: Routledge, Galen's Institutio logica. A founder of the principles of observations in science, and an exponent of measurements in medicine, his accurate dissections resulted in original anatomical discoveries.
He distinguished nerves that produce voluntary motion from blood vessels, and motor from sensory nerves; the nerves of the spinal cord were directly linked to the brain. He identified at least seven pairs of cranial nerves. Herophilus demonstrated the meninges, and ventricles, regarding the fourth as most important. His name is perpetuated by his accounts of the calamus scriptorius and the confluence of venous sinuses the torcular Herophili. Alexandria, founded by Alexander the Great BC and established by the Ptolemaic Pharaohs, was the seat of learning for many famous Greek physicians.
Its teachers had access to a library of some 7, scrolls, probably the largest collection of any country. Hellenistic Alexandria's renowned scholars included Erasistratus, and Herophilus ca.
From Fotolia. Unfortunately, Herophilus's treatises were lost in the fire of AD in the Alexandrian Library [ 5 ] where they were housed. Our main sources are treatises by Galen [ 6 ].
However, the fragility of theories founded on disparate historical records [ 7 ] and on possible errors in translation must prompt caution. This account of the neurological advances of Herophilus is based on research in translated primary sources that allows a limited evaluation of his work in a historical context. Outstanding amongst them is the exhaustive scholarship of Von Staden [ 8 ]. Born in Chalcedon, Asia Minor, little is known Herophilus's early life. With his younger contemporary Erasistratus of Ceos ca.
An almost heroic devotion to the teachings of Hippocrates, which he sought to validate, appears to many scholars significant in his investigations [ 8 , 15 ]. Corpses were generally considered sources of both physical and God-inflicted pollution stoutly denied by Hippocrates , hence the traditional Greek taboo that banned human dissection [ 10 ]. However, for a period of 40 years, Ptolemaic royal patronage permitted dissection of condemned criminals probably to expand understanding of disease and hence the repute of Alexandria as the foremost site of scholarship.
After Alcmaeon 6th century BC , Herophilus was probably the first person to dissect human cadavers, numbering about [ 5 , 11 , 12 ]. Soon after Herophilus and Erasistratus, dissection was abandoned [ 2 ] until the midth century. There was therefore little anatomical advance until Vesalius's De humani corporis fabrica , At Oxford University, human anatomy was not taught until The Murder Act of in England finally allowed dissection, but only of executed criminals on public display.
Ethical arguments about vivisection performed by Herophilus and Erasistratus [ 10 ] were provided by Tertullian ca. However, it is unclear whether Herophilus was culpable, for some authorities doubt the authenticity of Celsus' claims because vivisection by Herophilus is not mentioned in Galen's often critical writings [ 13 , 14 ]. Herophilus's aim was to demonstrate anatomy and explore the nature of disease by dissections. Galen frequently shows respect for Herophilus's anatomical descriptions, but these had to wait until the revival of human dissection in the Renaissance for explicit recognition of his anatomical accuracy [[ 8 ], pp.
He believed the primary parts of the human body should be perceptible to the senses, following the principles of the Hippocratic school On the Nature of Man , probably the work of Polybus, Hippocrates' son-in-law. His original well-documented [ 2 , 8 , 9 , 15 ] depictions of the duodenum, liver, salivary glands, uterus, cardiac chambers are not repeated here. Praxagoras, his teacher, from the school of Cos was renowned for his studies of the pulse. Herophilus supported him, maintaining that pulsation was involuntary and the result of the contraction and dilatation of the arteries caused by contraction and dilatation of the heart [ 14 ] VIII, K.
Herophilus stated that the brain not the heart was the seat of the soul. It explains why Herophilus emphasised that the brain related to the physical body [ 15 ] through motor and sensory nerves. Underlying much of his philosophy can be seen a separation between faculties of the soul and faculties he attributed to nature, the latter was seen as the domain of the physical body, as distinct from the soul: an issue expounded by Imai [ 16 ]. The prevailing notion was that diseases resulted from an imbalance or excess of one of the four humours which impeded the pneuma from reaching the brain.
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The brain for Herophilus was the seat of intelligence, motion and sensation, and not just a cooling chamber as propounded by Aristotle [ 5 ]. This was a revolutionary idea, derived from tentative indications in the Hippocratic corpus and from Praxagoras. Pneuma, the air or spirit, entered the body and was pumped as the spiritus vitalis by the heart in arteries which he observed to have thicker coats than veins to the cerebral ventricles and converted into psychic pneuma or spiritus animalis, which was responsible for producing motion, sensation and thought.
Herophilus considered the ventricles, especially the fourth, to be the seat of both soul and mental functions whereas Galen later favoured the brain substance itself. Since the brain was the centre of the nervous system, there must be a passage from it, via the ventricles, into the cerebellum, for the spiritus animalis. The concept at this time was of three mental functions: the sensus communis, i. Herophilus, who introduced the term, correctly found no rete mirabile in human subjects [[ 18 ], pp.
Whereas Galen, who performed no human dissections, concluded from ungulates that the basal network of vessels, the rete mirabile, changed the spiritus vitalis into the spiritus animalis which mediated the brain's functions. Herophilus identified at least seven pairs of cranial nerves [[ 8 ], p.
Herophilus named the layered meninges that he described as chorioid owing to its resemblance to the chorion surrounding the foetus. He gave an account of the cerebral ventricles and of the arachnoid membrane lining the ventricles [ 19 ]. Herophilus also dissected the eye, describing its four coats and the optic poros nerve.
Herophilus mentioned the different parts of the eye, including the vitreous glass-like humour. The layer at the back of the eye seemed to him rather like a spider's web. Hence he named it the amphiblestroides latin retina. His dissections also demonstrated the oculomotor, and also trigeminal, facial, vestibulocochlear and hypoglossal nerves [ 5 , 8 ]. On the crown of the head the doublings of the meninges meet, converging and conveying the blood to an empty space like a cistern, which he called the wine press Latin, torcular.
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