> Nature takes on the exact same role in his arguments that evolution would take on in ours:
> “Your school of medicine says that the ureters don’t do anything? Then why are they there? We know that this animal was created by Nature, why would she include these structures if they were truly useless?”
I mean, you could also substitute in "God" here. Saying that Nature wouldn't be wasteful isn't any more of an explanation than that would be; I don't think it's worth giving any credit for this. (And of course, on occasion, nature *is* wasteful...)
A great review. One comment: Bacon was writing during the time when William Harvey was trying to disprove Galen's model of circulation and encountering a lot of resistance. Maybe Galen got cancelled by Harvey partisans, or just acquired a bad reputation for being on the wrong side of this argument?
> “Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.
I don't know whether it was the earliest, but I know of an earlier thinker who basically invented survival of the fittest way before Darwin (okay, admittedly without all the details): Empedocles (a Pre-Socratic philosopher)
"He knew that there is sex in plants, and he had a theory (somewhat fantastic, it must be admitted)
of evolution and the survival of the fittest. Originally, "countless tribes of mortal creatures were
scattered abroad endowed with all manner of forms, a wonder to behold." There were heads
without necks, arms without shoulders, eyes without foreheads, solitary limbs seeking for union.
These things joined together as each might chance; there were shambling creatures with countless
hands, creatures with faces and breasts looking in different directions, creatures with the bodies of
oxen and the faces of men, and others with the faces of oxen and the bodies of men. There were
hermaphrodites combining the natures of men and women, but sterile. In the end, only certain
forms survived. "
(Bertrand Russell: A History of Western Philosophy)
Super interesting, easy to read, humorous (heh heh) -- and not an idea I would have had, to review a book by an ancient author and compare what he actually said with what it's often claimed he did.
I wasn't interested in reading the reviews at all -- "no one ever picks books I'd be interested in, and few have the touch that makes a review enlightening *and* entertaining; hmph", thought I -- but this changed my mind. Thanks for this, anonymous reviewer!
I really enjoyed this. It was lively, engaging, thoughtful and intelligently written. Quite Scott-esque at times.
I read it too fast because I wanted to get to the end so I could comment, but I'll read it again at a more leisurely pace and I'm already looking forward to the prospect.
I understand that in Galen's time, Alexandria was the place to go to learn medicine, because they didn't mind cutting up dead bodies at the med school there.
For a similar reasons, it is surmised that Galen took a job doctoring up gladiators because it gave him a more...hands on insight into human anatomy and how it worked.
Of course, Aristotle was way off on a lot of things, but he was considered an authority for longer than Galen was.
Really good book review. Make me aware of a book I should be interested in, tell me where you're going with this and why you're reviewing it, then make good on all those promises. I feel like I know a lot more than I did before. I also really appreciate going back and reading a foundational text rather than just something new and modern and trendy (not that there's anything wrong with the latter, just that we don't get enough of the former).
"All who drink of this treatment recover in a short time, except those whom it does not help, who all die. It is obvious, therefore, that it fails only in incurable cases.”
Without context, the above can easily be interpreted as mockably fallacious. But Galen was talking - whether he was right or wrong - about a specific medicine, not proposing a logical syllogism. There is a factor which is potentially empirically relevant, i.e. the short recovery time after drinking.
Consider, for example, the Heimlich manoeuvre. Surely that operates in just such a fashion? Those who can be helped by it are helped immediately. Those who cannot will die. Defibrillation is another example. There is no reason in principle why it should not be the case for a drug also.
Outstanding! 5/5 in style, I would believe this was written by Scott, maybe just a bit more succinct. I think you steelman Galen a bit too much however, the "evolution" section was a bit too laughable. Don't give the guy points for sounding like he knows what he's talking about, stick to praising his empirical heuristics.
This is pretty inconsequential, but I have an interesting thought about this anyway:
"reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Actually, this seems plausible to me. Earthen jars tend to be somewhat porous and they were probably not glazed, so water being stored in them will slowly evaporate over the course of weeks or months. By "corn" he was surely not referring to the yellow vegetable you eat off the cob, because corn is native to Central America and was not introduced into Europe until the Colombian Exchange. I am not totally sure, but I think the antiquated meaning of "corn" was closer to that of "cereal" or "flour". And it seems plausible to me that flour can absorb water vapor out of humid air.
So if you store a bunch of water and flour next to each other inside non-watertight earthen jars in your basement, the water will evaporate out of the water jars and some will absorb into the flour, making it heaver.
Fantastic. Finalist #2 has done an impressive job of capturing Scott's book review style, and I can't pay a much higher compliment than that.
I think touches like doing the extra legwork to research the historical context of the writer and not just the work itself are what really push it over the edge into exceptional. One signature move of Scott's is to relay some amusing, often absurd-sounding anecdote found in the writing of the piece, and the bit on Galen having to write a dedicated piece to combat the various imitators and servants pawning off his letters is EXACTLY that. It adds humor to the piece, depth and context to the work's author, and really underscores the depth of research put into the review.
Of course, the overall review itself is also written in a super readable style and the flow is very logical and smoothly laid out. This is going to be a really high bar to clear given how well it manages to match our host's style. Then again, in true transhumanist fashion, we should hope for and demand Super Scott from one of the remaining 12 entries, perhaps?
> "You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…"
Am I just being really dense, and is this obvious to everyone? I was thinking Maimonides, but maybe it is Locke, or Schweitzer. Or is he talking about Fauci?
> "If that which is white becomes black, or what is black becomes white, it undergoes motion in respect to colour..."
I've noticed this before in ancient Greek works, but it's still striking that to them—at least if the translations are apt—change was considered a type of motion, while in our culture we more usually consider motion a type of change (a change in place).
And I wonder when this changed, and whether there is a particular reason that it had to.
<i>“Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.</i>
I don't know who originated the argument, but Aristotle was fond of saying that "nature does nothing in vain".
This was an unexpectedly enjoyable piece about a topic I knew absolutely nothing about, props to the author! But... if I had one nit to pick it's that they seem a little more credulous of Galen's perspective vis-a-vis his critics than is maybe wise. Anyone who adopts a beleaguered, surrounded-by-fools stance in describing their critics raises the question of "is this guy a lone voice of sanity in the wilderness, or is he just setting up strawmen to knock down?" Given that we don't have writings from his contemporaries to cross-check against, it seems like we're potentially committing the same error against them--trusting someone who says "check out this idiot, how can anyone believe something so stupid!"--as we were originally against Galen.
> As much as modern authors like to describe the humors as imaginary, Galen routinely talks about them as if he were actually collecting and measuring them!
I think it's not so much that the humors themselves are imaginary—they were referring to actual bodily fluids—but the way they classified them does not match any way that we classify bodily fluids today, and accordingly the properties ascribed to those groupings aren't necessarily going to correspond to anything we would recognize.
If I call several unrelated fluids 'phlegm' my ideas of how 'phlegm' works as a category can be anywhere from inaccurate to magical.
"and reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Terracotta is porous and liquid will slowly seep out, given time. (This makes it a great material for plant pots in the garden, not so amazing for storing water, but it is much, much, much cheaper than other forms of pottery, and romans used earthenware amphorae for many staples.) Dried grain likes to absorb water and will sprout or spoil in higher humidity.
So while generally I wouldn't expect this to happen, and certainly not quickly, if we were doing a Mythbusters-style experiment, there might be a conceivable set of circumstances where over a few weeks or something, some water would evaporate from the porous pots, and grain in close proximity might sprout or swell slightly - especially in a cellar or other environment where humidity might be able to build up.
Great review but I would've liked to seen more research and or speculation into why someone with such apparent focus on empiricism got it so wrong. I think that's the most interesting question Galen's life and work presents, but I don't feel I have much of an understanding of how his well-intentioned experiments produced confirmations of theories so utterly and completely false. When he reported extracting phlegm, and observing protuberances and motions of the humors, what exactly was he extracting, and what was he seeing? I can't seem to wrap my head around a somewhat scientifically minded person looking into a cut open gladiator and thinking "yep, there are those humors Hippocrates was always on about".
Very engaging and entertaining stuff! The writing style is an impressive approximation of Scott's though a bit more casual and untutored. Great choice of topic and a nice brisk pace. It made for an effective introduction to the tone of Galen's work, though not quite so much to its content or significance. Humorism may be clear to the reviewer but it wasn't especially clear to me; I gather the "humors" are actual bodily fluids which Galen treats as having inherent properties? Also, I find the reviewer's first explanation for Galen's bad rep quite obvious and intuitive; the problem wasn't Galen, it was that there wasn't any other medical scientist with similar influence for another 1000+ years. Much of the review was like that: fun, accurate, and informative as to facts, but more vague and less insightful than I'd have liked, especially when it comes to the medical content itself. Still, that's understandable given it's a non-expert's book review, and overall I enjoyed it a lot.
"a Hippocrates stan" - translation, please. Is 'stan' American slang for 'fan'? The reviewer is a little too colloquial for my taste, but it is an excellent and engaging review.
<i>I see two possibilities. The first is that Galen’s followers may have really been as bad as people say. To take one example: Jacobus Sylvius, in the 16th century, was a huge supporter of Galen. When his student Vesalius called into question Galen’s knowledge of anatomy, by performing his own dissections, Sylvius rushed to Galen’s defense. Despite being the first professor to teach anatomy of the human corpse in France, Sylvius said that Galen had not erred, but “probably the human body had changed since then.” Further, he said that advance beyond Galen’s understanding was impossible.</i>
Are we sure that these sorts of stories are actually true? We've already established that this kind of "Huh huh, people before the present were a bunch of morons" sneering is false in the case of Galen himself, so it seems like we should be sceptical about it in the case of Galen's later followers.
"Nature (always capitalized)" - that is in the English translation. Galen's manuscript would have made no distinction between capitals and small letters, because that distinction did not yet exist in his time. I think the capitalisation is to distinguish the use of the Greek φύσις as a general organising principle rather than as the quality of an individual.
> To Galen, biology is all about these faculties shuffling, transforming, and combining different humors.
That sounds fairly tangible to me; it's an interesting contrast with the atoms-versus-forces dichotomy drawn later in the review.
I might also note that this would be an accurate description of our modern understanding of biology, if we called the humors "carbon", "hydrogen", "oxygen", and "nitrogen".
> Nature (always capitalized)
It seems unlikely that Galen made any orthographic distinction of this kind.
> I was going to suggest that maybe this quote might somehow be a mistaken bastardization of the “dormitive potency” line from Molière’s The Hypochondriac, since that’s what it reminds me of. But I looked and I actually wasn’t able to find that line in the play, so…
> electromagnetic fields, which look a lot more like one of Galen’s natural faculties (a tendency for mutual attraction over distance)
No, it's the other way around. Electromagnetic fields are local, that's what Maxwell's equations are about. That's how we get light. One can derive equations that describe attraction over distance from local equations given suitable assumptions about the medium, boundary conditions etc.
> You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…
This piece of flattery ought to have been removed by the editor. Scott, you're better than this.
Interesting review and approach! I felt like it was less of a straight book review and more of a "debunking" of what Galen said against what he actually said.
I am curious to know what Galen wrote about pregnancy in the text. I read parts of a different text of his, "On the Usefullness of the Different Parts of the Body" and found the description of why male and female bodies just reiterating the sexism of the time, and reminiscent of Aristotle's description of the female as "mutilated" man. Here's a section from the text:
"In fact, just as the mole has imperfect eyes, though certainly not so imperfect as they are in those animals that do not have any trace of them at all, so too the woman is less perfect than the man in respect of the generative parts…”
“… though making the animal itself that was being formed less perfect than one that is complete in all respects, provided no small advantage for the race; for there needs to be a female. Indeed, you ought not to think that our creator would purposefully make half the whole race imperfect and, as it were, mutilated, unless there were some great advantage in it.”
"[Galen] refers to different types of blood and suggests that there is a 'sweet' phlegm and a 'bitter or salty' phlegm, the former useful to health and the latter dangerous." I only skimmed the review, so maybe I missed it – but was Galen in the habit of tasting bodily fluids? Was that a "thing" during his era? If so, yuck.
Something Scott wrote previously gave the example that if you wanted to convince an 11th century bishop of something we now hold to be common knowledge, you would have to explain every single assumption that the two of you don't share for you to even begin to make sense to him. A common claim that follows from this is if you talked to a medieval commoner, you'd have so little common ground that it'd be like talking to an extraterrestrial.
The fact that we have writings from almost 1900 years in the past that show us a shockingly relatable academic mindset makes me really hopeful that the essential human experience is more constant over the centuries than I previously thought. I don't know why, but it makes me happy to know that I could have a real conversation with someone born more than a milennium previously. Maybe it means that humans of the future might not end up being too different from us either.
Back in 2016, I tried to track down the "fails in incurable cases" quote (I remember I was set off by some mention of Galen in SSC, but I couldn't find it now). I found a cluster of citations significantly earlier than 1998, with the most prominent one in this article by Hans Eysenck from 1960: https://archive.org/details/handbookofabnorm029075mbp/page/n709/mode/2up?view=theater (on the first page of the article). The earliest mention I found was from 1941 (but I didn't retain the reference).
Earlier quotes typically mention specifically "Samian clay" as the substance, and by looking over Galan's work, I convinced myself that if there's a chance of his actual texts containing it, it has to be in Galen 12,178, inside Book IX of "De simplicium medicamentorum...". This has not been translated (AFAIK) and while the original text can easily be found on Google Books, I couldn't easily read it, and abandoned the task back then.
I enjoyed the review of the text, but take issue with the framing device of defending Galen from his detractors. Was he really the "whipping boy of all doctors"? The one quote from Bacon and the line from Tetlock seem slim evidence, especially since Galen is *the* doctor of the ancient and medieval world. My impression of Galen's reception had been that he was and is pretty universally recognized a genius and a kind of Aristotle of medicine. Is there a tradition of criticizing Galen in the Rennaissance? Or is he a popular target for rationalists in particular?
What does modern academia say about Galen? Surely there's a historian of science/historian of medicine somewhere who knows all this and has written about it.
(Formatting note: If I'm reading it right, each quoted paragraphs in section IV (which is incorrectly labelled section VI) are from different parts of the book, but as formatted they look like they're contiguous. I think there should be line breaks between them, with the blue indentation bar on the left broken up into five smaller bars.)
This was a very interesting and enjoyable review. Thank you.
But I went to read the wikipedia, and then did some googling and I'm not immediately finding this negativity towards Galen that is alleged, although I expect that I won't find negativity towards Aristotle in this way either, and it definitely exists (I've encountered it in college classes).
Thanks for this review, it was really interesting!
I can totally imagine servants stealing Scott's emails and publishing them.
A lot of the direct quotes resonated with me as eerily similar to Maimonides (the Rambam) writing in "Guide to the Perplexed", written about 1000 years after Galen (originally in Arabic). He is also a doctor, discussed philosophy, and follows Aristotle everywhere he can without contradicting his beliefs [Jewish orthodoxy a-la 1000 AD].
The paragraph about white-black motion could have been a direct quote from "Guide to the Preplexed" - maybe they are both quoting Aristotle? If they're both paraphrasing, their styles are almost identical.
Maimonides also does the exact same thing when arguing with different sects in his book, dissing them and complaining about how foolish their ideas are, and yet that he must refute them in the text.
Anyway the parallels just seemed stark enough that I though I'd mention them.
The supposedly apocryphal “It is obvious, therefore, that it [medicine] fails only in incurable cases” quotation may be a boiled-down or adapted version of this, from Galen's <em>Ars Medicinalis</em> 1:3: "Medicine is an art that cures the sick, or lessens their pains, and which has nothing to do with incurable diseases".
Later in the same section he says: "it appears that medicine has an appropriate means of discovering the mode of cure, or at least of assuaging the sufferings of disease; and that it is not deficient in substantial reasons, for declining those that are incurable, or at any rate, of overthrowing the unjust reproaches made against physicians when unsuccessful in such cases."
But did Galen’s treatments actually work? What did his empiricism accomplish? I have a vague impression that most pre-modern medicine was worse than nothing.
I see a lot of comments about the contest writer's style being similar to Scott's. I realize that these comments are meant as compliments, but they are a bit patronizing. This writer had very much his/her own voice and style. There are infinite ways to combine humor, insight, and coherence.
This was a very good review! I very much enjoyed the quotations from Galen, and as I find so frequently the people from the past are be intelligent, empirical, and rational. The most important difference between them and us is we have been somewhat better at not creating hero worship of previous scholars. The dark side of the current system, which incentivizes novelty and departing from tradition, is that we rarely return to old works to find the new insights and ways of reconceiving and questioning current paradigms.
There are a few mistakes about Aristotle in this article which I want to clear up. Galen's discussion of the faculties derives primarily from Book 2 of Aristotle's De Anima. In that book Aristotle describes all of the major sensing faculties of human and animal organisms, and tries to give an account of how each of these faculties operates. Aristotle's conception of the soul, by which he means the living organism, is as a bundle of faculties or capacities. Galen's taxonomy further divides and subdivides these faculties, carrying on the work that Aristotle had started.
Aristotle also discusses and argues against atomism at length throughout his corpus. And most of all of his works Aristotle begins by discussing the theories of all the previous philosophers and natural scientists have come before him. This always includes the atomists whose accounts he gives reasons for rejecting. In De Anima book 1, for example, he says the atomists hold that animation is a quantity or a number, and he then objects that it impossible to derive from a number observed facts like reason, sensation, pleasure, and pain.
Aristotle is far less essentialist than most people assume. Reading him reminds me of reading an intelligent and structured blogger trying to work out some of the big questions. Like Galen, we should just read him, and then decide what we think. Instead of relying on hearsay.
Is it just me, or does Galen sound like a sort of Scott Alexander of his time, if Scott had bad AD&D and was the celebrity Surgeon General to an Imperial Presidency?
I don't think Aristotle on medicine is read much either. Some folks use the four humours as personality types, which is fun, but that has more to do with Jungian classification than Hippocrates. Notice that the Hippocratic oath has not waned with the passage of time. This implies that chronological advance does not entirely replace even ancient insights. We should remember that Aristotle conducted one of the first great experiments - observation of a natural process; in his study of how chick embryos develop.
Greg Cochran likes to point out that medicine was a thriving profession which people sought out for thousands of years... even though it made people worse off on average (Nassim Taleb theorizes that religion provided a benefit by redirecting people away from doctors). So even the best of ancient doctors might have better spent his time as an architect.
The geologist Steve Dutch points out some basic conceptual problems in Aristotle's science here:
Does it sound like Galen was something like a modern scientist who constantly publishes his findings and theories and his reasons for believing them, whereas most medical experts before recent centuries tended to see their ideas as something like trade secrets to pass down to their trusting apprentices.?(You can see this trade secret tendency in Newton keeping his invention of calculus his personal secret until Leibniz happened upon the same great advance.)
If so, then subsequent medical experts seemed to adopt Galen as their master who supplied them with a huge framework of quasi-trade secrets that, perhaps, were protected from too much competition by the volume and disorganization of Galen's writings. (Or, alternatively, there was a good living to be made by developing a reputation as a medical sage by publishing easier to read summaries of Galen's work.)
It seems as if the problem with Galen was less that he was a dogmatist (he was, by the standards of his time, less dogmatic than many of his rivals) than that subsequent generations for 1500 years wanted dogma. So we ended up getting Galen elevated to the supreme authority, when what we really needed were one, two, many Galens arguing it out.
How much was the problem with medicine until about, oh, 1880 being that doctors and patients were made uncomfortable by medical controversy? Everybody felt better when doctors talked as if all of their ideas were incontrovertible -- as Dr. Fauci and President Biden like to say: "Follow the Science!" -- rather than admit that these were preliminary speculations, which might be falsified in the future. Over the last 14 months, I've noticed that lots of people want to believe that whatever The Science tells them at the moment -- coronavirus is spread by touching surfaces, ventilators are our only hope, or whatever -- is the only possible truth, while other people want to reject all knowledge. Trying to stay in the middle between credulity and nihilism has been a lot of work and been rather discouraging, as many of my preliminary hypotheses have been proven wrong by subsequent events.
Maybe doubt and humility is not what people look for in the personality of doctors?
I also once tried to find the line about "dormative properties" in Molière's Hypochondriac (or The Imaginary Invalid). I found it in a scene which is entirely in Latin, and which is left out of English translations. Perhaps the jokes don't translate well into Germanic languages.
Great review - incisive and humorous 😉 I had heard of Galen, but knew very little about his life, work or status as enlightenment whipping-boy. Inspired to open up some animals now...
https://slatestarcodex.com/2015/08/09/contrarians-crackpots-and-consensus/
A very clear review and one palatable to my tastes due to the subject, thank you for this!
I thought this was an excellent book review on an interesting subject. Thank you!
If this has inspired anyone to want to know more about Galen, NYU recently launched a very nice online exhibition about him: https://galen.nyu.yourcultureconnect.com/e/home
> Nature takes on the exact same role in his arguments that evolution would take on in ours:
> “Your school of medicine says that the ureters don’t do anything? Then why are they there? We know that this animal was created by Nature, why would she include these structures if they were truly useless?”
I mean, you could also substitute in "God" here. Saying that Nature wouldn't be wasteful isn't any more of an explanation than that would be; I don't think it's worth giving any credit for this. (And of course, on occasion, nature *is* wasteful...)
A great review. One comment: Bacon was writing during the time when William Harvey was trying to disprove Galen's model of circulation and encountering a lot of resistance. Maybe Galen got cancelled by Harvey partisans, or just acquired a bad reputation for being on the wrong side of this argument?
https://pubmed.ncbi.nlm.nih.gov/21781247/
> “Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.
I don't know whether it was the earliest, but I know of an earlier thinker who basically invented survival of the fittest way before Darwin (okay, admittedly without all the details): Empedocles (a Pre-Socratic philosopher)
"He knew that there is sex in plants, and he had a theory (somewhat fantastic, it must be admitted)
of evolution and the survival of the fittest. Originally, "countless tribes of mortal creatures were
scattered abroad endowed with all manner of forms, a wonder to behold." There were heads
without necks, arms without shoulders, eyes without foreheads, solitary limbs seeking for union.
These things joined together as each might chance; there were shambling creatures with countless
hands, creatures with faces and breasts looking in different directions, creatures with the bodies of
oxen and the faces of men, and others with the faces of oxen and the bodies of men. There were
hermaphrodites combining the natures of men and women, but sterile. In the end, only certain
forms survived. "
(Bertrand Russell: A History of Western Philosophy)
Super interesting, easy to read, humorous (heh heh) -- and not an idea I would have had, to review a book by an ancient author and compare what he actually said with what it's often claimed he did.
I wasn't interested in reading the reviews at all -- "no one ever picks books I'd be interested in, and few have the touch that makes a review enlightening *and* entertaining; hmph", thought I -- but this changed my mind. Thanks for this, anonymous reviewer!
I really enjoyed this. It was lively, engaging, thoughtful and intelligently written. Quite Scott-esque at times.
I read it too fast because I wanted to get to the end so I could comment, but I'll read it again at a more leisurely pace and I'm already looking forward to the prospect.
Excellent stuff.
I understand that in Galen's time, Alexandria was the place to go to learn medicine, because they didn't mind cutting up dead bodies at the med school there.
For a similar reasons, it is surmised that Galen took a job doctoring up gladiators because it gave him a more...hands on insight into human anatomy and how it worked.
Of course, Aristotle was way off on a lot of things, but he was considered an authority for longer than Galen was.
Really good book review. Make me aware of a book I should be interested in, tell me where you're going with this and why you're reviewing it, then make good on all those promises. I feel like I know a lot more than I did before. I also really appreciate going back and reading a foundational text rather than just something new and modern and trendy (not that there's anything wrong with the latter, just that we don't get enough of the former).
"All who drink of this treatment recover in a short time, except those whom it does not help, who all die. It is obvious, therefore, that it fails only in incurable cases.”
Without context, the above can easily be interpreted as mockably fallacious. But Galen was talking - whether he was right or wrong - about a specific medicine, not proposing a logical syllogism. There is a factor which is potentially empirically relevant, i.e. the short recovery time after drinking.
Consider, for example, the Heimlich manoeuvre. Surely that operates in just such a fashion? Those who can be helped by it are helped immediately. Those who cannot will die. Defibrillation is another example. There is no reason in principle why it should not be the case for a drug also.
This was a great idea, and a very informative piece. Kudos to the author.
>Though the translator often insists on translating “humor” as “juice”
I openly cackled when I read this, and I love it. It seems to be a much more accurate translation and much better describes what a "humor" is.
Outstanding! 5/5 in style, I would believe this was written by Scott, maybe just a bit more succinct. I think you steelman Galen a bit too much however, the "evolution" section was a bit too laughable. Don't give the guy points for sounding like he knows what he's talking about, stick to praising his empirical heuristics.
This is pretty inconsequential, but I have an interesting thought about this anyway:
"reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Actually, this seems plausible to me. Earthen jars tend to be somewhat porous and they were probably not glazed, so water being stored in them will slowly evaporate over the course of weeks or months. By "corn" he was surely not referring to the yellow vegetable you eat off the cob, because corn is native to Central America and was not introduced into Europe until the Colombian Exchange. I am not totally sure, but I think the antiquated meaning of "corn" was closer to that of "cereal" or "flour". And it seems plausible to me that flour can absorb water vapor out of humid air.
So if you store a bunch of water and flour next to each other inside non-watertight earthen jars in your basement, the water will evaporate out of the water jars and some will absorb into the flour, making it heaver.
Fantastic. Finalist #2 has done an impressive job of capturing Scott's book review style, and I can't pay a much higher compliment than that.
I think touches like doing the extra legwork to research the historical context of the writer and not just the work itself are what really push it over the edge into exceptional. One signature move of Scott's is to relay some amusing, often absurd-sounding anecdote found in the writing of the piece, and the bit on Galen having to write a dedicated piece to combat the various imitators and servants pawning off his letters is EXACTLY that. It adds humor to the piece, depth and context to the work's author, and really underscores the depth of research put into the review.
Of course, the overall review itself is also written in a super readable style and the flow is very logical and smoothly laid out. This is going to be a really high bar to clear given how well it manages to match our host's style. Then again, in true transhumanist fashion, we should hope for and demand Super Scott from one of the remaining 12 entries, perhaps?
> "You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…"
Am I just being really dense, and is this obvious to everyone? I was thinking Maimonides, but maybe it is Locke, or Schweitzer. Or is he talking about Fauci?
> "If that which is white becomes black, or what is black becomes white, it undergoes motion in respect to colour..."
I've noticed this before in ancient Greek works, but it's still striking that to them—at least if the translations are apt—change was considered a type of motion, while in our culture we more usually consider motion a type of change (a change in place).
And I wonder when this changed, and whether there is a particular reason that it had to.
Great review!
<i>“Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.</i>
I don't know who originated the argument, but Aristotle was fond of saying that "nature does nothing in vain".
This was an unexpectedly enjoyable piece about a topic I knew absolutely nothing about, props to the author! But... if I had one nit to pick it's that they seem a little more credulous of Galen's perspective vis-a-vis his critics than is maybe wise. Anyone who adopts a beleaguered, surrounded-by-fools stance in describing their critics raises the question of "is this guy a lone voice of sanity in the wilderness, or is he just setting up strawmen to knock down?" Given that we don't have writings from his contemporaries to cross-check against, it seems like we're potentially committing the same error against them--trusting someone who says "check out this idiot, how can anyone believe something so stupid!"--as we were originally against Galen.
Wow, the quality of these reviews has been really high.
The lines in Moliere that I found on Google books are "Quia est in eo Virtus dormitiva, Cujus est natura Sensus assoupire."
One translation is: "Because it contains a dormitive virtue, Whose nature is to put the senses to sleep."
> As much as modern authors like to describe the humors as imaginary, Galen routinely talks about them as if he were actually collecting and measuring them!
I think it's not so much that the humors themselves are imaginary—they were referring to actual bodily fluids—but the way they classified them does not match any way that we classify bodily fluids today, and accordingly the properties ascribed to those groupings aren't necessarily going to correspond to anything we would recognize.
If I call several unrelated fluids 'phlegm' my ideas of how 'phlegm' works as a category can be anywhere from inaccurate to magical.
"and reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Terracotta is porous and liquid will slowly seep out, given time. (This makes it a great material for plant pots in the garden, not so amazing for storing water, but it is much, much, much cheaper than other forms of pottery, and romans used earthenware amphorae for many staples.) Dried grain likes to absorb water and will sprout or spoil in higher humidity.
So while generally I wouldn't expect this to happen, and certainly not quickly, if we were doing a Mythbusters-style experiment, there might be a conceivable set of circumstances where over a few weeks or something, some water would evaporate from the porous pots, and grain in close proximity might sprout or swell slightly - especially in a cellar or other environment where humidity might be able to build up.
Great review but I would've liked to seen more research and or speculation into why someone with such apparent focus on empiricism got it so wrong. I think that's the most interesting question Galen's life and work presents, but I don't feel I have much of an understanding of how his well-intentioned experiments produced confirmations of theories so utterly and completely false. When he reported extracting phlegm, and observing protuberances and motions of the humors, what exactly was he extracting, and what was he seeing? I can't seem to wrap my head around a somewhat scientifically minded person looking into a cut open gladiator and thinking "yep, there are those humors Hippocrates was always on about".
Your review put me in good humors.
Brief review-of-the-review:
Very engaging and entertaining stuff! The writing style is an impressive approximation of Scott's though a bit more casual and untutored. Great choice of topic and a nice brisk pace. It made for an effective introduction to the tone of Galen's work, though not quite so much to its content or significance. Humorism may be clear to the reviewer but it wasn't especially clear to me; I gather the "humors" are actual bodily fluids which Galen treats as having inherent properties? Also, I find the reviewer's first explanation for Galen's bad rep quite obvious and intuitive; the problem wasn't Galen, it was that there wasn't any other medical scientist with similar influence for another 1000+ years. Much of the review was like that: fun, accurate, and informative as to facts, but more vague and less insightful than I'd have liked, especially when it comes to the medical content itself. Still, that's understandable given it's a non-expert's book review, and overall I enjoyed it a lot.
As your local friendly classical history nerd, I feel the need to point out: Marcus Aurelius died in 180 CE, not 170 CE.
"a Hippocrates stan" - translation, please. Is 'stan' American slang for 'fan'? The reviewer is a little too colloquial for my taste, but it is an excellent and engaging review.
<i>I see two possibilities. The first is that Galen’s followers may have really been as bad as people say. To take one example: Jacobus Sylvius, in the 16th century, was a huge supporter of Galen. When his student Vesalius called into question Galen’s knowledge of anatomy, by performing his own dissections, Sylvius rushed to Galen’s defense. Despite being the first professor to teach anatomy of the human corpse in France, Sylvius said that Galen had not erred, but “probably the human body had changed since then.” Further, he said that advance beyond Galen’s understanding was impossible.</i>
Are we sure that these sorts of stories are actually true? We've already established that this kind of "Huh huh, people before the present were a bunch of morons" sneering is false in the case of Galen himself, so it seems like we should be sceptical about it in the case of Galen's later followers.
"Nature (always capitalized)" - that is in the English translation. Galen's manuscript would have made no distinction between capitals and small letters, because that distinction did not yet exist in his time. I think the capitalisation is to distinguish the use of the Greek φύσις as a general organising principle rather than as the quality of an individual.
> To Galen, biology is all about these faculties shuffling, transforming, and combining different humors.
That sounds fairly tangible to me; it's an interesting contrast with the atoms-versus-forces dichotomy drawn later in the review.
I might also note that this would be an accurate description of our modern understanding of biology, if we called the humors "carbon", "hydrogen", "oxygen", and "nitrogen".
> Nature (always capitalized)
It seems unlikely that Galen made any orthographic distinction of this kind.
> I was going to suggest that maybe this quote might somehow be a mistaken bastardization of the “dormitive potency” line from Molière’s The Hypochondriac, since that’s what it reminds me of. But I looked and I actually wasn’t able to find that line in the play, so…
https://www.gutenberg.org/files/9070/9070-h/9070-h.htm has it in the "THIRD INTERLUDE", spoken by "Bachelierus". ("Vertus dormitiva".)
> electromagnetic fields, which look a lot more like one of Galen’s natural faculties (a tendency for mutual attraction over distance)
No, it's the other way around. Electromagnetic fields are local, that's what Maxwell's equations are about. That's how we get light. One can derive equations that describe attraction over distance from local equations given suitable assumptions about the medium, boundary conditions etc.
> You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…
This piece of flattery ought to have been removed by the editor. Scott, you're better than this.
Dammit, this is better than mine. *angry upvote*
Interesting review and approach! I felt like it was less of a straight book review and more of a "debunking" of what Galen said against what he actually said.
I am curious to know what Galen wrote about pregnancy in the text. I read parts of a different text of his, "On the Usefullness of the Different Parts of the Body" and found the description of why male and female bodies just reiterating the sexism of the time, and reminiscent of Aristotle's description of the female as "mutilated" man. Here's a section from the text:
"In fact, just as the mole has imperfect eyes, though certainly not so imperfect as they are in those animals that do not have any trace of them at all, so too the woman is less perfect than the man in respect of the generative parts…”
“… though making the animal itself that was being formed less perfect than one that is complete in all respects, provided no small advantage for the race; for there needs to be a female. Indeed, you ought not to think that our creator would purposefully make half the whole race imperfect and, as it were, mutilated, unless there were some great advantage in it.”
"[Galen] refers to different types of blood and suggests that there is a 'sweet' phlegm and a 'bitter or salty' phlegm, the former useful to health and the latter dangerous." I only skimmed the review, so maybe I missed it – but was Galen in the habit of tasting bodily fluids? Was that a "thing" during his era? If so, yuck.
Typo-spotting: the paragraph at the end of section VII is duplicated.
Something Scott wrote previously gave the example that if you wanted to convince an 11th century bishop of something we now hold to be common knowledge, you would have to explain every single assumption that the two of you don't share for you to even begin to make sense to him. A common claim that follows from this is if you talked to a medieval commoner, you'd have so little common ground that it'd be like talking to an extraterrestrial.
The fact that we have writings from almost 1900 years in the past that show us a shockingly relatable academic mindset makes me really hopeful that the essential human experience is more constant over the centuries than I previously thought. I don't know why, but it makes me happy to know that I could have a real conversation with someone born more than a milennium previously. Maybe it means that humans of the future might not end up being too different from us either.
Back in 2016, I tried to track down the "fails in incurable cases" quote (I remember I was set off by some mention of Galen in SSC, but I couldn't find it now). I found a cluster of citations significantly earlier than 1998, with the most prominent one in this article by Hans Eysenck from 1960: https://archive.org/details/handbookofabnorm029075mbp/page/n709/mode/2up?view=theater (on the first page of the article). The earliest mention I found was from 1941 (but I didn't retain the reference).
Earlier quotes typically mention specifically "Samian clay" as the substance, and by looking over Galan's work, I convinced myself that if there's a chance of his actual texts containing it, it has to be in Galen 12,178, inside Book IX of "De simplicium medicamentorum...". This has not been translated (AFAIK) and while the original text can easily be found on Google Books, I couldn't easily read it, and abandoned the task back then.
Just want to say I'm really impressed with these reviews so far. They're not just good book reviews, they're *good ACX posts*.
I enjoyed the review of the text, but take issue with the framing device of defending Galen from his detractors. Was he really the "whipping boy of all doctors"? The one quote from Bacon and the line from Tetlock seem slim evidence, especially since Galen is *the* doctor of the ancient and medieval world. My impression of Galen's reception had been that he was and is pretty universally recognized a genius and a kind of Aristotle of medicine. Is there a tradition of criticizing Galen in the Rennaissance? Or is he a popular target for rationalists in particular?
What does modern academia say about Galen? Surely there's a historian of science/historian of medicine somewhere who knows all this and has written about it.
(Formatting note: If I'm reading it right, each quoted paragraphs in section IV (which is incorrectly labelled section VI) are from different parts of the book, but as formatted they look like they're contiguous. I think there should be line breaks between them, with the blue indentation bar on the left broken up into five smaller bars.)
This was a very interesting and enjoyable review. Thank you.
But I went to read the wikipedia, and then did some googling and I'm not immediately finding this negativity towards Galen that is alleged, although I expect that I won't find negativity towards Aristotle in this way either, and it definitely exists (I've encountered it in college classes).
There seems to be an error about the age of Victor Frankenstein - he should be 22 or 23, not 19, when he created the creature. See: https://www.quora.com/How-old-was-Dr-Frankenstein-in-the-novel/answer/Chris-Pollard-28
Thanks for this review, it was really interesting!
I can totally imagine servants stealing Scott's emails and publishing them.
A lot of the direct quotes resonated with me as eerily similar to Maimonides (the Rambam) writing in "Guide to the Perplexed", written about 1000 years after Galen (originally in Arabic). He is also a doctor, discussed philosophy, and follows Aristotle everywhere he can without contradicting his beliefs [Jewish orthodoxy a-la 1000 AD].
The paragraph about white-black motion could have been a direct quote from "Guide to the Preplexed" - maybe they are both quoting Aristotle? If they're both paraphrasing, their styles are almost identical.
Maimonides also does the exact same thing when arguing with different sects in his book, dissing them and complaining about how foolish their ideas are, and yet that he must refute them in the text.
Anyway the parallels just seemed stark enough that I though I'd mention them.
The supposedly apocryphal “It is obvious, therefore, that it [medicine] fails only in incurable cases” quotation may be a boiled-down or adapted version of this, from Galen's <em>Ars Medicinalis</em> 1:3: "Medicine is an art that cures the sick, or lessens their pains, and which has nothing to do with incurable diseases".
Later in the same section he says: "it appears that medicine has an appropriate means of discovering the mode of cure, or at least of assuaging the sufferings of disease; and that it is not deficient in substantial reasons, for declining those that are incurable, or at any rate, of overthrowing the unjust reproaches made against physicians when unsuccessful in such cases."
But did Galen’s treatments actually work? What did his empiricism accomplish? I have a vague impression that most pre-modern medicine was worse than nothing.
I see a lot of comments about the contest writer's style being similar to Scott's. I realize that these comments are meant as compliments, but they are a bit patronizing. This writer had very much his/her own voice and style. There are infinite ways to combine humor, insight, and coherence.
This was a very good review! I very much enjoyed the quotations from Galen, and as I find so frequently the people from the past are be intelligent, empirical, and rational. The most important difference between them and us is we have been somewhat better at not creating hero worship of previous scholars. The dark side of the current system, which incentivizes novelty and departing from tradition, is that we rarely return to old works to find the new insights and ways of reconceiving and questioning current paradigms.
There are a few mistakes about Aristotle in this article which I want to clear up. Galen's discussion of the faculties derives primarily from Book 2 of Aristotle's De Anima. In that book Aristotle describes all of the major sensing faculties of human and animal organisms, and tries to give an account of how each of these faculties operates. Aristotle's conception of the soul, by which he means the living organism, is as a bundle of faculties or capacities. Galen's taxonomy further divides and subdivides these faculties, carrying on the work that Aristotle had started.
Aristotle also discusses and argues against atomism at length throughout his corpus. And most of all of his works Aristotle begins by discussing the theories of all the previous philosophers and natural scientists have come before him. This always includes the atomists whose accounts he gives reasons for rejecting. In De Anima book 1, for example, he says the atomists hold that animation is a quantity or a number, and he then objects that it impossible to derive from a number observed facts like reason, sensation, pleasure, and pain.
Aristotle is far less essentialist than most people assume. Reading him reminds me of reading an intelligent and structured blogger trying to work out some of the big questions. Like Galen, we should just read him, and then decide what we think. Instead of relying on hearsay.
Is it just me, or does Galen sound like a sort of Scott Alexander of his time, if Scott had bad AD&D and was the celebrity Surgeon General to an Imperial Presidency?
I don't think Aristotle on medicine is read much either. Some folks use the four humours as personality types, which is fun, but that has more to do with Jungian classification than Hippocrates. Notice that the Hippocratic oath has not waned with the passage of time. This implies that chronological advance does not entirely replace even ancient insights. We should remember that Aristotle conducted one of the first great experiments - observation of a natural process; in his study of how chick embryos develop.
Isn't the "dormitive potency" line from a Gilbert & Sullivan play?
This was a fantastic essay, and it made me rethink my attitude towards past civilisations. Thanks for writing this!
I really enjoyed this and it’s going to be hard to beat!
Greg Cochran likes to point out that medicine was a thriving profession which people sought out for thousands of years... even though it made people worse off on average (Nassim Taleb theorizes that religion provided a benefit by redirecting people away from doctors). So even the best of ancient doctors might have better spent his time as an architect.
The geologist Steve Dutch points out some basic conceptual problems in Aristotle's science here:
http://stevedutch.net/pseudosc/greekswrong.htm
I don't think that all texts need trigger warnings, but this one could benefit from having one.
Thanks.
Does it sound like Galen was something like a modern scientist who constantly publishes his findings and theories and his reasons for believing them, whereas most medical experts before recent centuries tended to see their ideas as something like trade secrets to pass down to their trusting apprentices.?(You can see this trade secret tendency in Newton keeping his invention of calculus his personal secret until Leibniz happened upon the same great advance.)
If so, then subsequent medical experts seemed to adopt Galen as their master who supplied them with a huge framework of quasi-trade secrets that, perhaps, were protected from too much competition by the volume and disorganization of Galen's writings. (Or, alternatively, there was a good living to be made by developing a reputation as a medical sage by publishing easier to read summaries of Galen's work.)
It seems as if the problem with Galen was less that he was a dogmatist (he was, by the standards of his time, less dogmatic than many of his rivals) than that subsequent generations for 1500 years wanted dogma. So we ended up getting Galen elevated to the supreme authority, when what we really needed were one, two, many Galens arguing it out.
How much was the problem with medicine until about, oh, 1880 being that doctors and patients were made uncomfortable by medical controversy? Everybody felt better when doctors talked as if all of their ideas were incontrovertible -- as Dr. Fauci and President Biden like to say: "Follow the Science!" -- rather than admit that these were preliminary speculations, which might be falsified in the future. Over the last 14 months, I've noticed that lots of people want to believe that whatever The Science tells them at the moment -- coronavirus is spread by touching surfaces, ventilators are our only hope, or whatever -- is the only possible truth, while other people want to reject all knowledge. Trying to stay in the middle between credulity and nihilism has been a lot of work and been rather discouraging, as many of my preliminary hypotheses have been proven wrong by subsequent events.
Maybe doubt and humility is not what people look for in the personality of doctors?
I also once tried to find the line about "dormative properties" in Molière's Hypochondriac (or The Imaginary Invalid). I found it in a scene which is entirely in Latin, and which is left out of English translations. Perhaps the jokes don't translate well into Germanic languages.
Great review - incisive and humorous 😉 I had heard of Galen, but knew very little about his life, work or status as enlightenment whipping-boy. Inspired to open up some animals now...
I really enjoyed this one.
Link on Thomas Kuhn is broken, wayback link is here: https://web.archive.org/web/20210506033648/https://www.units.miamioh.edu/technologyandhumanities/kuhn.htm