van der Eijk: Medicina e Filosofia na Antiguidade

[...] ‘nature, soul, health and disease’ indicates some of the more prominent areas in which such interaction between ‘philosophers’ and medical writers was most clearly visible. It is no coincidence that Aristotle  ’s comments on the overlap between ‘students of nature’ and ‘doctors’ are made in his own Parva naturalia, a series of works on a range of psycho-physiological topics — sense-perception, memory, sleep, dreams, longevity, youth and old age, respiration, life and death, health and disease — that became the common ground of medical writers and philosophers alike. And, not surprisingly, Aristotle makes similar remarks in his zoological works concerning questions of anatomy, such as the parts of the body and structures like the vascular system, and embryology, especially the question of the origins of life, the mechanisms of reproduction and the ways in which inherited features are passed on from one generation to another, the question of the male and female contribution to the reproductive process, the origin of the semen, questions of fertility and infertility (see chapter 9), stages of embryonic development, the way the embryo is nourished, twins and triplets, and suchlike. This whole area was referred to in later antiquity as ‘the nature of man’, particularly man’s physical make-up, ranging from the lowest, most basic level of ‘principles’ (archai) or ‘elements’ (stoicheia) of organic substances through anatomical structures such as bones and the vascular system, fluids such as humours, qualities such as hot and cold, and physiological proportions and ‘blendings’ (kraseis) right through to the most sophisticated psycho-physical functions such as soul, sense-perception, thinking and reproduction. We perceive this ‘agenda’ in texts as early as the Hippocratic works On Fleshes, On the Nature of Man and On Regimen, or in such later works as Nemesius’ On the Nature of Man, Vindicianus’ On the Nature of the Human Race and in the treatise On the Seed, preserved in a Brussels manuscript and attributed to Vindicianus, and there are similar points of overlap in the doxographical tradition. Even a philosopher like Plato, who seems to have had very little reason to be interested in mundane matters like disease or bodily waste products, deals at surprising length and in very considerable detail with the human body and what may go wrong with it, using an elaborate classification of bodily fluids and types of disease (physical as well as mental) according to their physiological causes. Plato was of course not a doctor, but he was clearly aware ofthe medical doctrines ofhis time and took them sufficiently seriously to incorporate them into this account of the nature of the world and the human body as set out in the Timaeus  .

Yet interaction was not confined to matters of content, but also took place in the field of methodology and epistemology. As early as the Hippocratic medical writers, one finds conceptualisations and terminological distinctions relating to such notions as ‘nature’ (phusis), ‘cause’ (aitia, prophasis), ‘sign’ (semeion), ‘indication’ (tekmerion), ‘proof’ (pistis), ‘faculty’ (dunamis), or theoretical reflection on epistemological issues such as causal explanation, observation, analogy and experimentation. This is continued in fourth-century medicine, with writers such as Diocles of Carystus and Mnesitheus ofAthens, in whose works we find striking examples ofthe use ofdefinition, explanation, division and classification according to genus and species relations, and theoretical reflection on the modalities and the appropriateness ofthese epistemological procedures, on the requirements that have to be fulfilled in order to make them work. In Hellenistic medicine, authors such as Herophilus and Erasistratus made important theoretical points about causation, teleological versus mechanical explanation, and horror vacui, and in the ‘sectarian’ debates between Empiricists, Dogmatists and Methodists major theoretical issues were raised about the nature of knowledge and science. Subsequently, in the Imperial period, we can observe the application and further development of logic and philosophy of science in writers such as Galen   (chapter 10) and Caelius Aurelianus (chapter 11). And again, it is by no means the case that the medical writers were exclusively on the receiving end: theories about causation or inference from signs constitute good examples of areas in which major theoretical and conceptual distinctions were first formulated in medical discourse and subsequently incorporated in philosophical discussions. [1]

It would therefore be quite wrong to regard Aristotle’s and Galen’s perceptions of the overlap between medicine and philosophy as anachronistic distortions or projections of their own preoccupations, or to believe that, when ‘philosophers’ had medical interests, these were nothing more than eccentric curiosity. To the Greek thinkers, areas such as those mentioned above represented aspects of natural and human reality just as interesting and significant as the movements ofthe celestial bodies, the origins ofearth-quakes or the growth of plants and trees, and at least equally revealing of the underlying universal principles of stability and change. Nor were their interests in the medical area limited to theoretical study or the pursuit of knowledge for its own sake without extending to ‘clinical’ or ‘therapeutic’ practice. Some are known to have put their ideas into practice, such as Empedocles  , who seems to have been engaged in considerable therapeutic activity, or Democritus  , who is reported to have carried out anatomical research on a significant scale, or, to take a later example, Sextus Empiricus  , who combined his authorship of philosophical writings on Scepticism with medical practice.

Such connections between theory and practical application, and such combinations of apparently separate activities, may still strike us as remarkable. Nevertheless we should bear in mind, first, that especially in the period up to about 400 bce (the time in which most of the better-known Hippocratic writings are believed to have been produced), ‘philosophy’ was hardly ever pursued entirely for its own sake and was deemed of considerable practical relevance, be it in the field of ethics and politics, in the technical mastery of natural things and processes, or in the provision of health and healing. Secondly, the idea of a ‘division of labour’ which, sometimes implicitly, underlies such a sense of surprise is in fact anachronistic. We may rightly feel hesitant to call people such as Empedocles, Democritus, Pythagoras   and Alcmaeon ‘doctors’, but this is largely because that term conjures up associations with a type of professional organisation and specialisation that developed only later, but which are inappropriate to the actual practice of the care for the human body in the archaic and classical period. The evidence for ‘specialisation’ in this period is scanty, for doctors as well as mathematicians and other ‘scientists’, and there is good reason to believe that disciplinary boundaries, if they existed at all, were fluid and flexible. As we get to the Hellenistic and Imperial periods, the evidence of specialisation is stronger, but this still did not prevent more ambitious thinkers such as Galen or John Philoponus   from crossing boundaries and being engaged in a number of distinct intellectual activities such as logic, linguistics and grammar, medicine and meteorology.