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Universals in
Ancient Philosophy
edited by
Riccardo Chiaradonna
Gabriele Galluzzo

2013 Scuola Normale Superiore Pisa

isbn 978-88-7642-484-7

Table of contents

Riccardo Chiaradonna, Gabriele Galluzzo

Universals before Universals: Some Remarks on Plato

in His Context
Mauro Bonazzi


Platos Conception of the Forms: Some Remarks

Francesco Ademollo


Platos Five Worlds Hypothesis (Ti. 55cd),

Mathematics and Universals
Marwan Rashed


Plato and the One-over-Many Principle

David Sedley


Universals, Particulars and Aristotles Criticism of Platos Forms

Laura M. Castelli
Universals in Aristotles Logical Works
Mauro Mariani


Universals in Aristotles Metaphysics

Gabriele Galluzzo


Epicureans and Stoics on Universals

Ada Bronowski


Alexander, Boethus and the Other Peripatetics: The Theory of

Universals in the Aristotelian Commentators
Riccardo Chiaradonna


One of a Kind: Plotinus and Porphyry on Unique Instantiation

Peter Adamson


Universals, Education, and Philosophical Methodology

in Later Neoplatonism
Michael Griffin


Universals in Ancient Medicine

Riccardo Chiaradonna


Universals in the Greek Church Fathers

Johannes Zachhuber




Index locorum


Index of names


Universals in Ancient Medicine

1. Universals and particulars in Aristotles account of medicine

Plato and Aristotle famously use medicine as the standard example
of an art (techn). Both Plato and Aristotle compare medicine and
rhetoric. In Platos 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 462b10c3; 465a6-7; etc.)1. he 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 difer from those of
Plato (especially in the Gorgias). I will only recall three main features of
medicine that emerge in Aristotles Rhetoric. (i) Unlike rhetoric, medicine can instruct and persuade about its own particular subject matter (i.e. what is healthy or unhealthy: see Rh., 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., 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 Platos famous account of Hippocrates method in Pl., Phdr. 270cd, but this would
be controversial to say the least). his speciic issue is irst tackled by Aristotle and, as I
aim to show in this contribution, Aristotles discussion provides the framework for the
subsequent debates on universals and medicine. For a full account of Platos views on
medicine and its epistemic status, see Hutchinson 1988; Allen J. 1994.

382 Riccardo Chiaradonna

1355b10-14; see also Top., 3, 101b5-10)2. (iii) Like rhetoric, and all
other arts, medicine does not focus on individual cases as such, but on
[] None of the arts theorizes about what is individual [
]. 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 [ ]: this alone
is subject to art what is individual is indeterminate and cannot be known [
] (Arist., Rh., 2, 1356b30-33,
trans. Rhys Roberts, with some changes).

Medicine is an art and as such includes a body of theoretical knowledge. his 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 deinable
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). he last-mentioned feature is extremely interesting for our discussion. hat arts focus on universals is famously stated
in the opening chapter of Aristotles Metaphysics, where medicine is
taken as a case example illustrating the distinction between experience
and art; however, Aristotles view in the Metaphysics is more nuanced
than what we ind in the Rhetoric3. 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., 1, 980b28-981a1; APo.,
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., 1, 980b25-27). Art is diferent, since
it involves reason as a cognitive power distinct from perception and

See on this Schiefsky 2005, p. 369. I will come back to this issue below.
On medicine in Met. 1, see Frede M. 1990; Schiefsky 2005, pp. 350-3; Hankinson 2004; on the epistemic status of medicine according to Aristotle, see also Frede
M. 2011.

383 Universals in Ancient Medicine

memory that is only proper to human beings. Reason has the speciic
function of grasping universals, i.e. recurrent items that are such as
to be predicated of many4, 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 [gnsis] of particulars [tn kath hekaston], whereas art is knowledge of universals [tn katholou] (Met., 1, 981a15-16, trans. Ross).
his famous schematic distinction, however, is subject to further
qualiication. First, experience and rational technical knowledge are
not simply opposed to one another (as was the case in Platos 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 view5. Of course Aristotles 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
diicult to determine) position in Aristotles account of the formation
of general concepts, both in Met. 1 and APo. 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 efective in practice. His example is signiicantly 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 ofer for treatments administered:
For to have a judgement [echein hupolpsin] 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., 1,
981a6-8, trans. Ross). It has been noted (rightly in my opinion) that
this view of medical empirical practice involves some power of gener4

his is indeed a very sketchy characterisation and I will not dwell on the
deinition(s) of universal in Aristotle: see the remarks in Mariani, Castelli and
Galluzzo, this volume.
On Aristotles reference to Polus and its anti-Platonic character, see Auffret

384 Riccardo Chiaradonna

alization, even if this empirical generalization difers 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 beneicial to everyone in a particular condition); nonetheless, the empirical healer too acts in a certain
way because the universal is true6.
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. hese 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., 1, 981a10-30:
[] to judge that it has done good to all persons of a certain constitution,
marked of in one kind [ ], 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).

he 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 Aristotles case
example for illustrating this complex situation:
[] we even see men of experience succeeding more than those who have
theory without experience. he 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

See Hankinson 2004, p. 5.

385 Universals in Ancient Medicine

will oten fail to cure; for it is the individual that is to be cured (Arist., Met.,
1, 981a14-24, trans. Ross).

hese remarks are immediately followed at 981a24 by the words

[] (and yet), which introduce Aristotles emphatic statement that knowledge and understanding belong to art rather than
experience. he line of this argument is complicated to say the least
and may relect a certain tension in Aristotles 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 efective as art, but even more efective. 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 ( , Met., 1,
981a20). his is apparently disconcerting: how can the species human
being be an accident of Socrates or Callias? Strange as it may seem,
Aristotles 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
deining properties human beings who instantiate a certain constitution from a disease that is deinable (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. hus, one could conclude
that the trained doctor heals individual patients just like the empirical
healer, but attains this result in a diferent 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 deined
and may also be found among other individuals of the same kind. An

386 Riccardo Chiaradonna

argument such as this, however, does not hold without qualiication.

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. 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. 2). A well-trained
doctor, for example, may know the universal deinition of a disease
and be capable of explaining its symptoms in causal terms, but still
fail his diagnosis when treating an individual patient. Hence Aristotles
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 oten
fail to cure his patient (Met., 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: diferent individual human beings afected by the
same disease may react in diferent ways to the same treatment, so that
a given treatment will sometimes prove efective and sometimes fail.
herapy is not repeatable for individuals of the same kind without further qualiication, since no one patient is perfectly similar to others
and this lack of precise similarity can afect the outcome of a therapy.
Furthermore, a large number of factors related to an individual patient
can afect the outcome of a therapy, and at least some of these factors
lie outside the domain of universal technical knowledge in the proper

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). his overall approach is set out in the famous methodological chapter in Hippocrates
Epidemics (Epid. I.23), where we ind 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:
he 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 [
], 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).

his 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. his view is sometimes connected to the idea that individuals contain blends (krsis) 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. 1, where Aristotle argues that it is the individual that is to be

For further details, see Schiefsky 2005, pp. 293-8 and pp. 315-24.
On this, see the overview in Sassi 2005, pp. 148-160; Schiefsky 2005, pp. 233 f.
and pp. 248 f. he 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 diferent 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 afected by others.

388 Riccardo Chiaradonna

cured, e.g. Socrates or Callias. We might be led to infer from this that
Aristotles 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. 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. he separation between the theory and the practice of medicine
clearly emerges in a passage from Aristotles On Sensation:
It also belongs to the natural philosopher to obtain a clear view of the irst
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 modiications).

his passage reveals at least two facts. First, that for Aristotle medicine and natural philosophy are two separate and well-deined ields:
his problem is to explain how they are related9. 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 Aristotles view of subalternation (see APo.
7), since philosophical medicine draws its principles from natural
philosophy and applies them to a more speciic and well-deined ield
(the knowledge of health and disease). he 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. his remark is certainly correct, but needs qualiication. Aristotles overall view seems to be based
on the distinction between philosophically oriented and practically or
empirically oriented physicians (see also Platos 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

See the remarks in Schiefsky 2005, p. 301 f.

Schiefsky 2005, p. 302.

389 Universals in Ancient Medicine

Met. 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 diference 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). his, by contrast, is the view
which can be attributed to Aristotle, although Aristotle never explicitly
presents it.
he 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
scientiic 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 Jaegers celebrated idea that Aristotle should be regarded as the philosophical inspirer of Diocles of Carystus methodological empiricism
in medicine has repeatedly been rejected12. Aristotles 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. his
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 (hs 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. 2). hings 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

References to Galens works are given in Roman (volume) and Arabic (page)
numerals according to Khns edition (with the exception of course of those works
not included in Khn). ore recent editions, such as those of CMG and Les Belles Lettres, also indicate Khns pagination. For the list of the abbreviations used for Galens
works, see Hankinson 2008a, pp. 391-7.
See van der Eijk 1996 and Frede M. 2011..

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
scientiic 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., 1,
1355b10-14). Remarks such as these, however, conirm 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 diicult to isolate
theory from practice in medicine (nor do Aristotles remarks in Met.
1 invite us to do so). All this helps explain why Aristotle sometimes
regards the scientiic status of medicine as intrinsically feeble. Signiicantly, 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 Aristotles
emphasis on the unavoidably imprecise character of medical knowledge (see EN, 3,1112b1 f.)13.
he potential separation between the theory and the practice of
medicine is deeply rooted in Aristotles views on knowledge. A cursory reference to Met. 15 may be appropriate here. his 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 Galluzzos
analysis and recall the overall conclusion which emerges from Aristotles text namely, that particulars can well be objects of deinition, but
their deinition is always de iure applicable to multiple objects, even
when there is de facto only one particular which satisies it. No deinition exclusively picks out a particular object to the exclusion of others
of the same kind, since each deinition is a conjunction of predicates
and predicates are always (at least de iure) applicable to a plurality of
objects (see Met., 15, 1040a8-14 and a27-b2). Particulars are situated outside the domain of deinitions and there is no room for de iure

See the classical article by Jaeger 1957.

391 Universals in Ancient Medicine

non-recurrent individual natures in Aristotles world of knowledge14.

Particulars can only rationally be known insofar as they represent
some general kind. As noted above, what we ind in the Hippocratic
corpus is instead the thesis according to which cures should be individualized in order to efectively 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 authors 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, Galens views on
the knowledge of particulars are radically diferent from those of Aristotle and provide a full philosophical explanation of the Hippocratic
notion of individual nature.

2. Empiricist generalizations and Methodist generalities

his long preamble on Aristotle was necessary to set the later medical
theories against their philosophical background. As I aimed to show,
Aristotles remarks are signiicant 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 ive centuries dividing Aristotle and Ga14

Indeed, according to the reading developed by Frede M., Patzig 1988, Aristotles theory of individual substantial forms in Met. might be potentially at odds
with this conclusion. he issue is however very controversial and Frede and Patzigs
interpretation faces a number of diiculties: see Galluzzo, this volume. Furthermore,
even according to Frede and Patzigs 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-speciic and do not difer in nature from each
other precisely as forms: see Frede M., Patzig 1988, 1, pp. 55 f.; Frede M., Patzig
1988, 2, p. 148.

392 Riccardo Chiaradonna

len15. 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.
Aristotles complex view of the roles played by reason and experience
paved the way for three diferent developments, which coincide grosso
modo with the epistemological positions held (i) by Rationalist doctors,
(ii) Empiricist doctors, and (iii) Galen. Aristotles 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 scientiic 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 signiicant diferences among their views
(there were actually several distinct types of Rationalist doctors), they
generally argued that reason should be suicient 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.69-72 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 (signiicantly, 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 onwards16. 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 diferent 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

his 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 f.; Frede M. 2011.
he classical work on the Empiricist school remains Deichgrber 1930.

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 suicient 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.72-74 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. 1, according to which experience is a suicient basis to establish an art17. he Empiricists, therefore, rejected the overall Rationalist
idea that doctors should grasp the basic nature of both the human body
and unhealthy afections in order to decide on the appropriate treatment. All that doctors need to know, they argued, is what is harmful
and what is beneicial 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 physicians own direct observation (autopsia) and drawing
on the previous observations of earlier reliable practitioners (historia) is fully suicient in itself to establish medical knowledge18. As we
shall see below, Galens 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, Galens views on experience difer 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).

See Frede M. 1990.

his 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. he
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 2008. On the Empiricist kind of reasoning (epilogismos) and its
diference from the Rationalist one (analogismos), see Allen J. 2001, p. 113 f.

394 Riccardo Chiaradonna

his sketchy account of medical views on knowledge ater 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 modiied 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. hese 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 school19. 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. he Methodist theory
of generalities (koinottes) 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 Galens
Platonic-Aristotelian account of division and universals, which he
chiely developed as a critical reaction against Methodist medicine.
Both Empiricist and Methodist doctors held distinctive views on
universals and particulars. heir views are diferent toto caelo from
each other and an account of them is necessary to understand Galens
approach to the universal generalization problem21. As noted above,
Aristotle qualiies experience as the knowledge of individuals and thus
separates experience from art, which is the knowledge of universals.
his position is not exempt from possible objections, since experience
too seems to involve some power of generalization. Aristotles answer
to this objection would probably be that empirical generalizations cannot be seen as generalizations in the true and full sense. Indeed, the

See the collection of sources in Tecusan 2004.

See Frede M. 1982, p. 262.
his 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.

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. he 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 f. Deichgrber), the recommended treatment of which is always the same22. Signiicantly, 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 recollect23; thus they treated technical knowledge as basically
a matter of acquiring the disposition to be reminded of certain things
by certain observations. his view may appear suspect and indeed be
criticized for obscuring the diference 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 diferent 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. he 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). he way in which repeated experience
can account for the formation of general knowledge is obviously radically diferent from the way in which reason can account for it:
By experience we mean the knowledge of those things which have become
apparent so oten 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, 24-30 Deichgrber,
trans. M. Frede).


See Allen J. 1994, pp. 103 f.

Allen J. 2001, p. 111.
Allen J. 2001.

396 Riccardo Chiaradonna

Let us return for a moment to Aristotles Rationalist account of technical knowledge. According to Aristotle, the trained doctor is capable
of inding the correct treatment since he knows that a certain remedy
heals all individuals of a certain kind from a certain disease (Met.,
1, 981a10-12). Since, then, the doctor grasps the properties that deine 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. he 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. he 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.). heir 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; signiicantly, 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 patients age and gender, the observable
qualities of his/her lesh, 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 emerged25. For example, a general
theorem concerning the therapeutic power of a remedy will merely

See Frede M. 1990, p. 246; Allen J. 1994, pp. 100 f.

397 Universals in Ancient Medicine

result from the repeated experience that a substance efectively treats a

certain pattern of symptoms in patients with certain observable characters (see for example Galens remarks on their treatment of wounds
in MM X.182-184 K.). Experience, however, allows for exceptions.
he 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 f. Deichgrber; Exp. Med. 95,
112 Walzer; [Gal.], Def. Med. XIX.354 K.). Accordingly medical theorems will include an explicit speciication 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 unqualiied 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 (koinottes) as probably developed by the Methodist doctor hessalus of Tralles, who was active
in the age of Nero and is Galens 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 (irst century BCE) another of Galens pet hates27.
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 low through them), the Methodists developed
his general ideas in a distinctive way. hey assumed (i) that all diseases
are just a matter of constriction, relaxation (stegnsis; 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 ind indications as to the appropriate treatment to

See Allen J. 1994, p. 100.

See Allen J. 2001, pp. 92-4 and p. 143.

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 suicient clarity; hence the Methodist claim that six months were suicient
to apprehend medicine (see Sect. Int. I.83 K.; MM X.5 K.). here was
actually some debate in antiquity as to whether the Methodist believed
that koinottes could be perceived or not; their attitude to reason is also
a matter of debate28. 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.81-82 K.). However,
neither were koinotts 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 diferent from that of the Rationalists. It is worth
quoting M. Fredes account of the Methodist position in full:
hey refuse to attribute to reason any obscure powers which we would have not
dreamed of in ordinary life. hey 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 obvious29.

Accordingly, the Methodist notion of indication difers 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
he Methodists famously adopted an outrageously critical attitude
to Hippocratic medicine (hessalus wrote a letter to Nero against the
harmful precepts of Hippocrates and proclaiming the virtues of the

See Frede M. 1982, p. 269.

Frede M. 1982, p. 266.

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. he attitude of the Methodists is completely diferent, since they emphatically claimed that individualizing
features (such as gender, causes, the knowledge of afected 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 suicient 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.190-191 K.) informs us that
the Methodists talk about generalities was based on our ordinary talk
about similarities (homoiots tis en pleiosin). hus 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, Galens 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 scientiic research. his is the case because ordinary language mirrors our
pre-scientiic knowledge of the world, that of our common conceptions; the job of scientiic 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

See Tecusan 2004, p. 15.

Frede M. 1982, p. 268.

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 koinottes are just
arbitrary and artiicial constructions not based on the real structure of
the world. Hence, as we shall see below, Galens emphasis on diairesis
and his idea that diferentiae must be appropriate to each genus and
not transgress its limits.
As I aimed to show, Aristotles 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 qualiications and
the experience of individual unrepeatable cases plays a fundamental
role within it. he Methodist and the Empiricist approaches may be
seen as radicalizations of the two poles of this dichotomy. he 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. he Empiricists, by contrast, regard generalization as the
mere result of individual repeated observations, so that medical theorems should include an explicit speciication of the relative frequency
of observed facts.

3. Galen on universals and deinitions

Galens monumental treatise On the Method of Healing contains a
detailed critical discussion of both the Empiricist and the Methodist
view. he irst 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
oten 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 MM32. Galens philosophical train32

On the chronology of Galens MM, see Hankinson 2008b, p. 19. he 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 2008.
A French and an English translation of this work have recently been published: see
Boulogne 2009; Johnston, Horsley 2011. On Galens On Demonstration, see the
seminal work by Mller 1895; more recently, Chiaradonna 2009a; Havrda 2011,

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 heophrastus,
with the Hellenistic traditions, and with works by Platonist and Aristotelian philosophers and commentators. his fact explains the distinctive character of Galens 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 speciic medical purposes of Galens approach to logic and philosophy (this is paradigmatically the
case with the theory of deinition and speciic diferentia).
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 striking33. 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 [ ], in the same way as do human
being, cow, and each other living being. For there is some thing unique in
all human beings [ ]. 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 modiications).

his 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.). his may appear disappointing, especially
if we compare Galens approach to that of professional philosophers
such as Alexander of Aphrodisias or Porphyry, whose discussion of im-

who interestingly suggests that Galens DD is in the background of Clem. Al., Strom.
See Hankinson 1991, p. 218.

402 Riccardo Chiaradonna

manent natures is highly sophisticated34. Yet an adequate assessment

of Galens view should take account of his speciic 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, Galens 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 scientiic understanding of the essence (ousia) of each disease
(MM X.128; X.157-159 K.; Fac. Nat. II.127 K.). Diseases are organized
in genera and species and each speciic disease further determines its
summum genus: generally speaking, disease involves the impairment of
some natural function or activity and can appropriately be deined as
the disposition (diathesis) that impedes this activity: see MM X.41; X.81
K.; Sympt. Dif. VII.43; 50-51 K. Galens division of diseases is actually
rather problematic and its details should not keep us here35. Here it is
suicient to remark that Galen regards the division of the genus disease down to its inimae species (see MM X.25 K.), as well as the deinition of each of these species, as the rational basis of treatment. An understanding of the speciic 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 afected body
to its healthy and natural condition. All individual instances of disease,
then, share in a unique speciic thing, just as all particular human beings or dogs or horses do: an appropriate knowledge of this speciic real
nature is the irst basis of therapy according to Galens method.
Galen oten points to the philosophical background of this overall
doctrine and presents Plato, Aristotle and heophrastus as his chief
authorities regarding logical methods of division and deinition (see
MM X.22 and X.26 K.). Galen mentions Platos Philebus, Sophist and
Statesman, as well as Aristotles On the Parts of Animals, since Aristotle tries in that book to enumerate all the diferentiae of animals; a
quotation from Platos Phaedrus is predictably added some lines below
(Phdr. 237bc: see MM X.27 K.). Galens list of auctoritates may indeed
strike us as somewhat surprising, since Platos dialogues on division
are followed by Aristotles PA, which famously includes in its irst
book a scathing criticism of dichotomic division. Yet things become

See for further details Chiaradonna 2007a.

See Barnes 1991, pp. 95-8; Hankinson 1991, p. 201.

403 Universals in Ancient Medicine

clearer as soon as we realize two facts, namely: (i) that for all their differences, Plato, Aristotle and heophrastus, according to Galen, form
a unique philosophical front, that of the logical method, to be addressed against hessalus theory of koinottes; (ii) that while drawing
his overall inspiration from Plato, Aristotle and heophrastus, Galen
does not simply report their theories; rather, his theory of division and
deinition presents some peculiar features, which can only properly be
understood against the background of Galens own epistemology.
Just ater mentioning his philosophical authorities, Galen overtly
opposes them to hessalus:
Yet the outrageous hessalus 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
dont you reveal it to us? (Gal., MM X.26-27 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 f.): 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) diferentia (see MM X.23 K.). What is a
species-forming diferentia? As R.J. Hankinson puts it, A diferentia
D is species-forming with respect to some genus G if and only if either
(a) the conjunction of G and D is suicient to identify a species, or (b)
the conjunction of G, D, and some further set of diferentiae is suficient non-redundantly to identify a species36. For example, as Galen
argues (MM X.23-24 K.), one should not divide the genus animal on
the basis of diferentiae such as sot 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.
his view inds a couple of interesting parallels in writings attributed
to Alexander of Aphrodisias. In Mant., 21, 169, 11-13 Bruns, we ind
a sketchy account of division and diferentiae which is similar to that
of Galen and has rightly been compared to it37:


See Hankinson 1991, p. 102.

See Barnes 2003, p. 182.

404 Riccardo Chiaradonna

For the proper diferentiae that divide something [

] do not extend beyond that which they divide; for example, none
of the diferentiae that divide animal occurs outside animal or belongs to
anything which is not an animal. For the diferentiae that properly dissect
something must be contained within what is dissected by them [
[] ] (Alex. Aphr., Mant., 169, 11-15, trans. Sharples, with
slight modiications).

his 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 Alexanders lost commentary on
Met. I (the term oikeios occurs in this chapter from the Metaphysics
too, where it designates male and female as oikeia path of the genus
animal: see Met., I 9, 1058b22)38. here are actually several complicated questions surrounding these lines from Mantissa, in particular
regarding the view that (a) dividing (diairetikai) diferentiae should
be contained in the genus they divide (if X is a diferentia that divides
Y, Y is predicated of X)39 and (b) dividing diferentiae should not extend wider than the divided genus. Certainly, these problems were extensively debated among commentators and divergent solutions were
proposed40. Alexanders texts On Diferentia, preserved in Arabic,
contain an extremely complex set of discussions of these issues, whose
relation with the passage from the Mantissa is somewhat diicult to
determine41. Actually, the Arabic Dif. I criticizes the view according
to which dividing diferentiae should not extend beyond the divided
genus; however, the contradiction with Mant. 21 is perhaps not to
be overemphasized42. In Dif. I [7] Alexander also deals with the ap38

See Sharples 2008b, p. 224.

See Barnes 2003, p. 348.
See the discussion in Luna 2001, pp. 486-95; Barnes 2003, pp. 348-50. Further
evidence is now provided by the rediscovered commentary on Aristotles Categories
preserved in the Archimedes Palimpsest most probably, a part of Porphyrys big
commentary Ad Gedalium: see Chiaradonna, Rashed, Sedley 2013.
Dif. I and II according to Rasheds classiication: see Rashed 2007, pp. 54 f. and
pp. 104 f.
he peculiar dialectical context of Mant. 21 should probably be taken into account (here Alexander cursorily discusses the theses about genus and diferentia only
inasmuch as it serves to explain why male and female are not dividing diferentiae).

405 Universals in Ancient Medicine

propriate genera which should be taken into account while deining a

species43. Here we ind the remark that the diferentia which makes up
the deined species is a diferentia that belongs to the genus (une
difrence appartenant ce genre, trans. Rashed).
here are close family resemblances between MM X.23 f. K. and
these passages from Alexander. Grosso modo, all of these texts emphasize that diferentiae should not be arbitrary or stipulatively attached
to the genus in order to make up the species; the connection between
genus and diferentia in deinitions should instead be an intrinsic one
and relect the real essence that we aim to deine; hence the emphasis
on the appropriate character of the diferentia. Both Alexander and
Galen reject the idea that deinition 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 diferentiae 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.23-24 K.
in full:
For in the irst place not every diferentia that is conjoined with the genus contributes something towards the creation of the species, but only that from the
appropriate division of the genus [ [] ].
Only these are species-forming diferentiae: all the others are superluous [].
Hence it is impossible to discover the species-forming diferentiae of anything
without irst having accurately circumscribed its deinition, or the formula of
its substance [
] (trans. Hankinson, with slight changes).

Species-forming diferentiae are here regarded as resulting from the

appropriate division of the genus. he diference from the view held in
Mant. 21 is signiicant, for according to Alexander a genus should be
divided by its appropriate dividing diferentiae; instead, Galen argues
that diferentiae come from the appropriate division of the genre. his
overall view is even more strikingly asserted at the end of the passage,
where Galen argues that circumscribing the deinition of a substance
is a preliminary requirement for discovering its speciic diferentiae.
For variations in Alexanders views on diferentia, see Rashed 2007, p. 54 note 169, p.
122 and pp. 154 f.
See Rashed 2007, p. 108.

406 Riccardo Chiaradonna

he use of Aristotelian notions here is very evident (logos ts ousias

is an obvious reminiscence of Cat., 1, 1a1-4 and Top., 2, 130b26);
however, Galen thesis that the grasping of essential deinitions should
precede the discovery of speciic diferentia 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 Galens On Demonstration, Iwan von Mller
rightly talks about die Notwendigkeit, erst eine vollstndig Deinition
zu gewinnen, ehe an die Division gegangen werden kann44.
Before proceeding any further, it is worth discussing a possible interpretation of the lines quoted above. In his Isagoge Porphyry codiies 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 diferentiae or, rather, between the dividing and the species-forming or constitutive function that diferentiae can play (since
the same diferentiae can under diferent respects be both dividing
and species-forming: see Isag., 10, 3 f. Busse). Without focusing too
much on the details45, we may simply recall that diferentiae are taken
to be dividing insofar as they divide a genus into its subordinate species (hence rational and irrational are dividing diferentiae of the genus animal), since exactly one of the dividing diferentiae is predicated
diferentially of everything which the genus is predicated of generally;
instead, diferentiae are taken to be species-forming or constitutive insofar as together with the genus they make up the deinition of the
divided species (rational is therefore a constitutive diferentia of the
species man, whose deinition is rational animal). Alexander (Mant.
21) talks about dividing diferentiae, whereas Galen talks about species-forming diferentiae: hence, one may conclude, the distinction of
their views. his explanation is tempting, but some remarks may be
addressed against it.
To the best of my knowledge, the distinction between dividing and
speciies-forming diferentiae does not come up in Galen and certainly
is not hinted at in the lines quoted above. he Greek text runs as follows:


Mller 1895, p. 448.

See the in-depth discussion in Barnes 2003, pp. 178 f.

407 Universals in Ancient Medicine

, .

Galen is focusing here on the deinition of species: this deinition

is made up of a (set of) diferentia(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
diferentiae, insofar as they are appropriate dividing diferentiae of the
genus (and not constitutive diferentiae of the species). his is well possible, but Galen does not suggest anything of the sort. Rather, he merely argues that, say, rational and mortal are appropriate diferentiae 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
deinition of man) by conjoining footed and biped with rational animal (MM X.24 K.). Such divisions are indeed diferent 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 deinition 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. he 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 diferentiae
and a wrong number of cuts entails that the deinition of the species
has not been circumscribed correctly. To sum up: the lack of mention
of dividing diferentiae at MM X.23-24 K. may not be haphazard, since
Galen does not claim that we come to deine the species by dividing
the genus through its appropriate (dividing) diferentiae. What Galens
discussion rather implies is that the deinition of the species in ques46

See on this and what follows Hankinson 1991, p. 102. Rashed 2007, p. 155
argues that the choice between rational and biped as species-forming diferentiae of
human being raises some questions concerning Alexanders hylomorphic ontology.
As far as I can judge, Galens overall approach does not share this kind of concerns.

408 Riccardo Chiaradonna

tion should somehow already be known from the start and act as a
guide for inding the species-forming diferentiae 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 f. Kalbleisch that Herminus, while interpreting Cat., 3,
1b16-17, argued that diferentiae that occur in diferent parallel genera which fall not one under the other, but rather all under the same
genus (e.g. the diferentiae 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 diferentiae of the superior genus that
includes the parallel genera (i.e. of the genus animal)47. his view is
obviously open to the objection that animal would thus be both biped
and quadruped: we ind a remark of this sort in Alexanders text Dif.
I, preserved in Arabic (see Dif. I [3i])48. In this work, Alexander reacts
against an adversary whose position is actually extremely close to that
of Herminus49. Galens view that rational/irrational, mortal/immortal,
tame/wild, are all diferentiae of the genus animal may actually recall
Herminus view that biped and quadruped are primarily diferentiae
of the genus animal. However, Herminus view is certainly connected
to his refusal to admit species-forming diferentiae: on his view, differentiae are just dividing diferentiae (see Simpl. In Cat., 55, 22-23
Kalbleisch). his remark does not solve all problems, but can at least
serve to dismiss the objection that the genus animal would be equally
determined by diferentiae such as biped and quadruped: Herminus
merely argues that these diferentiae are primarily dividing diferentiae
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 ixing the correct order of cuts in
divisions that start from the highest genus (see Alex. Aphr., In APr.,


Further crucial evidence on Herminus theory of the diferentia is given by the

newly rediscovered part of Porphyrys Ad Gedalium (see above, note 40). I will not
dwell on this. Porphyrys account supplements that of Simplicius, but is not at odds
with it. For an overall account of Herminus, see Moraux 1984, pp. 361-98.
See Rashed 2007, p. 106
See Rashed 2007, p. 111 and pp. 121 f.

409 Universals in Ancient Medicine

72, 26 f. 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 Aristotles
views on motion in an essay he sent Herminus)51, Galens use of eidopoios at MM X.23-24 K. points to a diferent view. According to Galen,
rational and irrational are both appropriate diferentiae of animal since
we know preliminarily and not by dividing the genus that these
diferentiae constitute the species under animal. While Herminus rejects the very notion of speciic diferentia, Galen seems to pass over
in silence that of dividing diferentia. In fact, rather than establishing
a rigid and hierarchically ordered taxonomy, Galens aim seems to be
that of correctly grasping the speciic diferentiae 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 deined diseases. Since all diseases are kinds of unnatural physical dispositions,
the indication of the appropriate treatment should start from a correct
essential deinition of the disposition in question via its appropriate
diferentiae (e.g. MM X.226-227 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 la Porphyry, but to take
account of all the diferentiae which determine the disease in question, so that its deinition 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 diicult to see the anti-Methodist aim behind this overall view.
As noted above, immediately ater praising Plato, Aristotle and heophrastus for their work on division (MM X.27 K.), Galen vehemently
attacks hessalus koinottes. he Methodist use of koinottes is Galens paradigmatic example of a misleading generalization, ignorant of
logical methods and blind to the appropriate divisions of reality (see
MM X.141-142 K.). Galens emphasis on natural or appropriate division, while consciously rooted by him in the previous medical and
philosophical traditions (starting from Plato and Hippocrates), only

On this see now Griffin forthcoming.

See Rescher, Marmura 1965, pp. 57 f.

410 Riccardo Chiaradonna

acquires full meaning when interpreted as a reaction against Methodist therapeutical principles. What Galen is doing is reproaching hessalus for his practice of drawing therapeutic indications from hypergeneral diferentiae that lack any real informative value for treatment.
Galen does not deny that the Methodist costive/luid diferentiae may
be attached to diseases (just like rare/dense, hard/sot, taut/relaxed: see
MM X.23 K.); what he denies is that enumerating diferentiae such as
these may in any way suice to adequately determine the species of
diseases (such as inlammation, tumour or oedema), thus establishing
a pathology, which (in his view) is the only adequate ground for therapy. Hence Galens irony (MM X.162-163 K.) directed against hessalus view that a concave wound in a leshy part of the body should
be treated by administering a remedy that generates lesh (embalontes
[] to sarktikon pharmakon), thus replenishing the wound. his
is obviously true, but one should determine precisely how this remedy should be prepared, and this, according to Galen, requires (MM
X.169 f. K.) detailed particular indications (about pharmacology, the
elemental composition of the wounded lesh, etc.: see MM X.176-177
K.), as well as rationality (logos) and logical methods.
Yet, while Galens polemical strategy clearly emerges from the text,
his own views on division and deinition still appear somewhat vague.
As I aimed to show, his emphasis on appropriate diferentiae and the
necessity of adequately determining species can be seen as a reaction
against the Methodists. Galens peculiar view that one should irst grasp
a species in order to discover its diferentiae can also be understood as
part of his anti-Methodist approach. hus we return to the problem
mentioned above: how can one be capable of grasping the essential
deinition of a species accurately, if this awareness is a necessary condition for inding the diferentiae 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 hras. V.812 K.)52, so another explanation should be found. Actually, Galen himself provides an answer to this question at MM X.40 .:
[] we must now I suppose explain what a disease actually is in its deinition,
so that we may thus attempt a proper division of it. How then do we ind this
out correctly and methodically? How else than by the means speciied in On


Further references in Barnes 1991, p. 76.

411 Universals in Ancient Medicine

Demonstration? First of all the common conception must be agreed upon [

]: without it it is impossible to discover the
substance of the matter at issue (trans. Hankinson).

he 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
scientiic enquiry should take as its basis and criterion for discovering essential or scientiic deinitions by scientiic enquiry according
to logical methods (see MM X.42 K.)53. Scientiically understanding
the essence of something is thus presented, in a famous passage from
Dif. Puls. (VIII.708 K.; see 704 f. K. for the whole account), as a transition from notional to essential deinition (ennomatikos horos;
ousids 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 relect a pre-scientiic, not
adequately unfolded, and yet perfectly real, acquaintance with the
world, which should be the basis of all scientiic accounts54. Cutting
at the joints, then, entails respecting the distinctions expressed by
our linguistic awareness of the world (hence Galens criticism against
those physicians who do not respect these distinctions and, accordingly, provide arbitrary deinitions: see Dif. Puls. VIII.704 K.; see also
Galens polemic against Archigenes artiicial use of language in Loc.
Af. VIII.115-117 K.)55. he question of how to correctly divide can


For further details, see Brittain 2005; Chiaradonna 2007b.

he status of notional accounts is closely parallel to that of Galens dialectical
premises in PHP: see Chiaradonna 2007b, p. 219.
According to Galen, language is a necessary condition for establishing correct
classiications, but not a suicient one, for Galen recognizes the existence of ineffable diferentiae, i.e. diferentiae that can be perceived and are relevant for medical
knowledge, but for which there is no corresponding word. his happens, e.g., with certain types of pain (Loc. Af. VIII.117 K.), with certain types of pulse (Dif. Puls. VIII.517
K.) or discolourations of the skin (Loc. Af. VIII.355K.). Galen acknowledges that
many perceptual experiences cannot be expressed in words (Dign. Puls. VIII.773-774
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. Af. VIII.339-340 K.). On this, see the enlightening
discussion in Reinhardt 2011. It is however extremely important that Galens emphasis on unsayable properties does not lead him to disqualify language as a mean for

412 Riccardo Chiaradonna

now receive the following preliminary answer: by respecting the distinctions of ordinary language that relect 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 relected in language should be regarded as
a criterion for scientiic enquiry.
Again, Galens 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. he ultimate basis
for Galens 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 heophrastus (see S.E., M. VII,
217-218): 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.48-49 K.). hese, 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 attacks56. 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.133-134 K.).
Galens excursus on how donkeys are able to distinguish speciic and
numerical unity may appear as merely a picturesque detail, yet things
change as soon as we realize that Galens rivals actually denied this
distinction. he Empiricist theory of sundromai (i.e. combinations of
symptoms which are individual features of a case: see Subf. Emp. 56,
4 f. Deichgrber) 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
times57. 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 Galens views on approximation, see the last part of this contribution.
See Hankinson 1997.
Galen condemns Empiricist doctors for asserting this view at MM X.136 K.; see
Hankinson 1991, p. 217.

413 Universals in Ancient Medicine

Certainly, an accurate scientiic account can in no way be compared

to either the awareness of speciic unity that (according to Galen) can
be found in donkeys, or the awareness relected in ordinary language.
In Dif. Puls. VII.705-708 K. Galen shows how we can reach a scientiic deinition (that of pulse) by starting from the ordinary account
of the thing in question, i.e. the conceptual account that relects
our elementary awareness of the perceptible accidents of the investigated phenomenon. According to the present reconstruction of Galens views, a full division which starts from the summum genus and
ends with the species by enumerating all of its constitutive diferentiae
should then be seen as the inal result of the enquiry which unfolds
from our preliminary awareness of the investigated thing. his 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 diferentiae; rather,
we set of 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 diferentiae. As R.J. Hankinson aptly remarks, what
the scientiic taxonomist does is to make clear and rigorously deined
distinctions which everybody (indeed, every animal) already knows in
some sense of know58.

4. Galen on particulars
In the irst two books of MM Galen emphasizes the scientiic 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 ind in hard sciences such as mathematics. hat medicine as such deals with universals is actually also
asserted at the beginning of the Ars medica. he author of this treatise
(probably Galen, although the issue is debated) follows Herophilus in
deining medical science (epistm) as the knowledge of health-re-


Hankinson 1991, p. 105.

414 Riccardo Chiaradonna

lated, disease-related, and neutral things (I.307 K.)59. he author further explains (I.309 K.) that this deinition 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 kind60. Both (a) and (b) are rejected: medicine cannot focus on
all individuals, since these are ininitely 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 qualiies this view as thoroughly
Aristotelian61 and, indeed, Galens use of hopoin is similar to Aristotles use of toiide/toioisde at Rh., 2, 1356a30-32 and of toioisde at
Met., 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 knowledge62. As
I aim to show, however, this is not Galens 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 scientiic knowledge should in principle account for unqualiied repeatability (for example, a geometrical demonstration can unqualiiedly be repeated for all particular geometrical objects that satisfy
certain conditions established ex hypothesi) and medicine falls short of
this criterion63. Just ater 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 scientiic, 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.34

See von Staden 1989, pp. 103 f.

, ,
. Text ater Boudon-Millots edition: see Boudon-Millot
2000, pp. 277, 22-278, 1.
See the contribution on Barnes in Boudon-Millot 2003 (Discussion).
For further parallels, see Garca-Ballester 1994, pp. 1644 f.
I develop this point in Chiaradonna 2011b.

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 unqualiied 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.114-115 K.). his
treatise is spurious; yet some scholars are inclined to assume that it
represents Galens inal answer to the problem of the scientiic status
of medicine64. I agree that the view voiced in the treatises inds signiicant parallels in Galen: a passage such as Ars Med. I.309 K., for example, equates genuine knowledge with the knowledge of universals.
his Aristotelizing idea certainly found a prominent place in Galens
epistemology, but I would be hesitant to claim that this was Galens
inal answer to the problem of the scientiic 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
scientiic 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, Galens 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 scientiically and according
to logical methods65.
hroughout MM, Galen argues that demonstrative medical skill as
such is capable of curing individual human beings. Galen does not conine 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 herapeutic 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

See Ierodiakonou 1995, pp. 481-3.

See on this Barnes 1991, pp. 52 f.

416 Riccardo Chiaradonna

(idian) to each one. his is obviously consistent with Galens overall

Hippocratic programme, which he emphatically reairms (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
(hmn 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.):
. he words [] 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 (akatalpton). he 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). his 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 1-2.11)66. In MM X.169 K. Galen informs his readers that
idiosyncrasy is part of the Empiricist terminology (and Sextus use
provides obvious conirmation for this). Grosso modo, the notion of
idiosyncrasy denotes the individual unrepeatable nature or constitution of each patient. Galens 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.181-182 K. =
151, 19 f. Deichgrber). Signiicantly, 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 diferently. In MM X.207 K. Galen criticizes Empiricists for taking only account of observable characters such as the

See Sassi 2005, pp. 177-9. On the history of this notion in ancient medicine, see
Hall 1974.
Barnes 1991, p. 63 note 46 (with further references).

417 Universals in Ancient Medicine

patients 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 (
: MM X.207 K.)68. Yet for all of
their diferences, it is noteworthy that both schools agreed that therapy
should consider the unique and unrepeatable constitution of each patient. his overall conclusion can be seen as simply a reinstatement of
what we ind in Met. 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 diferent.
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
afect 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 inefabile
principle (see MM X.206 K.:
)69. his principle, however, is only valid inasmuch as it refers to
our limited knowledge and should deinitely not be taken to mean that
individuals as such cannot in any way be the object of scientiic and
precise knowledge. Suppose that a doctor precisely knows the unique
individual blend that identiies each patient as well as all the other circumstances that may afect 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 (akribs) 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 di68

See Allen J. 1994, p. 96.

On this, see Reinhardt 2011, p. 309; Deichgrber 1957, pp. 36-9.

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. 2). Galens distinction between the human and
the divine knowledge of an individual would hardly make any sense
within an Aristotelian philosophical framework. Here the diference
between Galen and Aristotle emerges quite clearly, since as J. Allen
has noted Galens version of rationalism represents a fusion of Platonic-Aristotelian views on the knowledge of universals with the very
diferent 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 reason70. Interestingly, Galens 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, 11-15 Kalbleisch = 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 idiottn) within an overall Platonic-Aristotelian account
of universals and predication71. Galens views are certainly diferent
from those of Porphyry and while Galen focuses on the epistemological problems raised by the knowledge of the individual, Porphyrys
theory is part of his logical and ontological account of substance and
predication. Still, it is worth noting the overall similarity between their
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

Allen J. 1994, p. 97.

See Chiaradonna 2000. Reinhardt 2011 provides a detailed parallel between
Galens views on individual properties and the Stoic theory. As Reinhardt notes, [i]t
has not been explored in detail what Galens notion of the phusis of individuals owes
to Aristotelian Einzelformen and Stoic peculiar properties (Reinhardt 2011, p. 309
note 21). he present contribution aims to at least partially ill this gap.

419 Universals in Ancient Medicine

matters72. 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 scientiically 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.: ; see
also Hipp. Of. Med. XVIIIB.861 K.; Hipp. Aph. XVIIB.382 K.), thus
minimizing the probability of errors on his part in the treatment of
individual patients. his 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
akribs: 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 therapy74. 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 speciic disease and is unvary72

On Galens views on technical conjecture, see Boudon-Millot 2003; Fortuna

See Chiaradonna forthcoming.
For an in-depth discussion (with detailed references), see Garca-Ballester
1994; Fortuna 2001; Fortuna, Orilia 2000; van der Eijk 2008.

420 Riccardo Chiaradonna

ingly and identically present in all patients afected by the disease in

other words, when x has the disease D if it presents the symptom S75.
his situation, however, is extremely rare; in the vast majority of cases
(especially when diagnosing internal diseases: see Galens Loc. Af.)
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. Af. VIII.366 K.). While
a single symptom may well correspond to diferent 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 suice. 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. his verbal information is essential for
any attempt to formulate a correct diagnostic hypothesis (Loc. Af. VIII.265-266 K.; see also VIII.335 K., etc.)76. Finally, the doctor may begin
a course of treatment and test its efectiveness (Loc. Af. VIII.40-41 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 classiication of
all kinds of individual mixtures (see Galens Temp. and Prop. Plac. 5).
Furthermore, they will carefully explore all factors which may afect
their therapeutical strategy in particular situations. As noted above,
division is presented in MM 1 as a systematic way of arranging information concerning a speciic disease, the essential deinition of which
provides the principal indication for treatment. his indication alone,

See Fortuna, Orilia 2000, p. 103 and p. 114.

See on this Mattern 2008.

421 Universals in Ancient Medicine

however, is by no means suicient for successful treatment, which

needs to be qualiied (this is the function of diorismos in Galens therapeutical method) according to factors which pertain to each particular
investigated case77. 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 lawless 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 irst according to
the diference 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 diference 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 art79. Still, he oten (especially, but non exclusively, in
pharmacological contexts) argues that experience should be qualiied
(dirismen peira), i.e. methodically interpreted according to a set of
factors80. 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.
Galens position may well be considered an over-optimistic one. For
instance, he seems to assume that the hypotheses which the good doc77

See van der Eijk 2008. p. 289.

See van der Eijk 2008, pp. 290 f. Galen was certainly not the irst 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. 289.
See the remarks in Frede M. 1981, p. 295.
See van der Eijk 1997.

422 Riccardo Chiaradonna

tor may consider are always limited in number and, in any case, all
preliminarily and exactly known81. Scientiic conjectural reasoning in
diagnosis and therapy makes it possible for good doctors to approximate the precise scientiic knowledge of Asclepius even when treating individuals, and Galen is notoriously eager to present himself as
an infallible physician82. As noted above, Galens view on the knowledge of individuals points to an overall conception according to which
nothing is intrinsically accidental or indeterminate. Indeed, even
within Galens 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 individuals distinctive nature corresponds to an irrational ininite ratio which Asclepius
knows as such (i.e. as ininite), while human doctors only know it in an
approximate way. Galen, however, never suggests this idea83. he view
he outlines at MM X.206-209 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 ininite. Furthermore, some interesting testimonia preserved by the Arab tradition suggest that Galen did not posit any real
distinction between necessary and contingent events84. In his Short
Treatise on Aristotles 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 ones
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 difer 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

See Fortuna 2001, p. 296.

See Garca-Ballester 1994, p. 1646.
Apart from this, Galens idiosyncrasy (i.e. the unique ratio of humoural qualities
characterizing each single human being) is obviously diferent from Leibnizs 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 ( )
comprises not only his/her distinctive mixture, but all the factors that pertain to him/
her as an individual. his position has a certain Leibnizean lavour.
For further details, see Chiaradonna forthcoming.

423 Universals in Ancient Medicine

provisional formulae such as For the most part, xs are F with All
xs, given condition C, are F, where condition C is clearly and independently speciiable85. Galens vindication of the scientiic status of
medicine, then, ultimately leads to an overthrowing of the philosophical picture that emerges from Aristotles Metaphysics: accidental features tend to be removed from Galens account of knowledge and reality, so that not only universals but also individuals as such can (with
appropriate qualiications) be made the object of rational knowledge86.
Riccardo Chiaradonna


Hankinson 1988, p. 6. See also Zimmermann 1991, p. lxxxii.

Drats 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.


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