ZUR DISKUSSION

Galen as (Mis)informant about the Views

of his Predecessors
A Discussion of R. J. Hankinson (ed.),
Galen on Antecedent Causes (Cambridge, 1998)

by J am es Al le n (Pittsburgh)

The De causis procatarctis (CP) is one of a number of Galen’s works that survive
only in medieval Latin translations by Niccolò da Reggio. A version edited and
equipped with a Rückübersetzung by Kurt Bardong appeared in the Corpus medi-
corum graecorum in 1937 (Supp. vol. II). For his edition R. J. Hankinson (RJH)
has examined some of the manuscripts afresh, including one that Bardong seems
not to have known about (52 ff.). He provides an English translation instead of
his predecessor’s Rückübersetzung, and has supplied his edition with an extensive
introduction, a detailed commentary, indices, bibliographies and a comparative glos-
sary of Greek and Latin terms, which will help make the work available to a broader
audience while enhancing its usefulness to all its readers.
It emerges from Galen’s argument that something functions as a procatarctic
cause when, by acting on a body, it produces, or more typically sets in train a
sequence of causes and effects that produce, the condition of the body whose proca-
tarctic cause it is. Such causes precede their effects and may have ceased to act long
before the effects of which they are procatarctic causes come about. They cannot
bring about their effects alone, but depend on the cooperation of other factors; in
particular, the body on which they act must be predisposed to be so affected. Indeed
because the procatarctic cause does not bring the effect at issue about directly, it
may discharge its function in relation to a suitably disposed body and still fail to
bring about the effect of which it is the procatarctic cause if further necessary condi-
tions are not satisfied or timely preventive action is taken. And because so much
depends on the condition of the body acted upon and the cooperation of other causal
factors, the intensity of the effect, when it does come about, need not correspond to
the intensity of the influence exerted by the procatarctic cause. Galen’s favorite ex-
amples are the way in which, as he believes, heating, chilling and the like can give
rise to fevers.
I spoke of this account ‘emerging’ because Galen’s CP is not a treatise in which
procatarctic causation and related notions are systematically expounded, but is
rather an angry polemic. The objects of Galen’s ire are those physicians and philo-

Archiv f. Gesch. d. Philosophie 83. Bd., S. 81⫺89

쑔 Walter de Gruyter 2000
ISSN 0003-9101

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82 Zur Diskussion

sophers who, as he sees it, impose illegitimate constraints on what is to count as a

cause: according to them, he alleges, a cause ⫺ or the type to which it belongs ⫺
must always bring about its effect, cannot depend on the cooperation of other
factors for the production of that effect and must give rise to effects whose intensity
varies in proportion to the intensity with which the cause acts on the body affected.
Only by legislating the procatarctic cause out of existence in this way, Galen main-
tains, are his opponents able to ignore the influence exerted by procatarctic causes
⫺ to the detriment of both scientific knowledge and effective medical practice (cf.
XII, 166). What is more, he insists, this mistake is not due to simple ignorance;
rather, it is a deliberate piece of sophistical trickery, used by his opponents in order
to protect their theories from the evidence which ⫺ as everyone not blinded by
sophistry can plainly see ⫺ refutes them. Without his theory, according to Galen,
Erasistratus, who is his principal and only named opponent in the CP, would have
to give up his claim to originality and acknowledge that the true account of matters
had been set out in all essential points long ago by Hippocrates ⫺ something that
he is most unwilling to do (XII, 159; cf. 155; I 2; VIII, 104; X, 132). Indeed Galen
goes so far as to accuse Erasistratus and his followers of neglecting therapies they
know to be effective because cures accomplished with their aid would confirm the
truth of a theory other than Erasistratus’ own (X, 138).
These are very serious charges. But if I may describe a personal reaction, which
I suspect is not all that uncommon, the effect of Galen’s polemical fervor is some-
times the opposite of what he intends: the suspicion grows that he is being unfair;
one begins to sympathize with the figures against whom he inveighs so fiercely and
to wonder what can be said on their behalf. In what follows, I should like to pursue
the question of Galen’s fairness a little further. RJH expresses some reservations
himself, but in the end, I believe, gives Galen’s account of his opponents, especially
Erasistratus, more credence than it deserves.
There are two parts to Galen’s polemic. In the first he attacks unnamed oppo-
nents who, he maintains, resort to sophistry in order to win the reputation which
they have no chance of gaining by legitimate means (I, 2⫺3). Their argument con-
cerning procatarctic causes ⫺ only one of many they employ to this end according
to Galen ⫺ works, as we have already noted, by employing an excessively restrictive
concept of causation. Galen demolishes these arguments, in the process developing
his own central theme, viz. that no effect comes about without the cooperation of
a number of factors, no single one of which is the cause. In his own words: “there
is no such thing as a cause complete and perfect in itself” (XIII, 165; cf. RJH 225).
The arguments are handled with considerable flair by Galen, and the explanatory
framework he advocates, with its distinctions between different kinds of causal
factors that enter into the production of an effect, is plainly a very sophisticated
instrument.
But for all the interest of Galen’s treatment and the skill he displays in argument,
the question remains whether and to what extent his adversaries are real rather than
notional. At the beginning of the first section, directed against those philosophers
and physicians who, Galen maintains, invented sophisms to win a reputation for
originality, he also mentions others who, unable to refute these sophisms, either

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 Zur Diskussion 83

believed them or judged it best to remain in doubt (I, 2⫺3). 1 This sounds very much
like Pyrrhonian suspension of judgement. As is well known, medical Empiricism had
close ties with Pyrrhonism, and Galen ascribes precisely this attitude to the medical
Empiricists later in the CP (XIII, 162). But who, then, originally put forward the
arguments branded sophisms by Galen? If the Pyrrhonists were the philosophical
counterparts of the Empiricists, they will have been required to suspend judgment
by their inability to refute arguments put to them by others. Or is it the Pyrrhonists
who have misled the Empiricists, perhaps including Empiricists philosophizing as
Pyrrhonists who have misled themselves? Certainly some of the arguments men-
tioned by Galen resemble those we find in Sextus Empiricus. But the motive Galen
ascribes to their authors ⫺ to win renown by overthrowing traditional and correct
views and replacing them with their own novel but false views ⫺ hardly agrees with
what we know of Pyrrhonism or Galen’s view of it. 2
Later in the CP Herophilus is said to have put forward arguments against causes
very much like those we find in Sextus Empiricus (XVI, 197 ff.; cf. RJH 272 ff.). This
passage throws valuable light on possible medical influences on early Pyrrhonism,
but Herophilus can hardly be one of the villains of the first section. For according
to Galen, Herophilus argues in this way to cast doubt on causes, but then goes on
to use causes all the same because most people think there are causes. To be sure,
Galen, who dismisses this as a feeble excuse, fails to understand the rather subtle
position which Herophilus takes here, which permits appeal to causes ‘ex supposi-
tione’, but does not pretend that the causes it uses enjoy the incontrovertible support
of reason (cf. RJH 271). It is a pity that Galen is prevented by incomprehension
from saying more about this extremely interesting position. Nonetheless it is plain
that neither Herophilus’ real position nor the timidity of which Galen accuses him
can be reconciled with the motive Galen ascribes to the unnamed opponents of the
first section.
In the second polemical section, Galen directs his fire against ‘another species of
sophist who act shamelessly toward the procatarctic cause’, whose chief is Erasistra-
tus (VIII, 96 ff.; 102). We are in a better position to assess the merits of Galen’s
charges this time not only because he names his opponent but because he puts in
evidence a quotation and a paraphrase from Erasistratus.
It is not entirely clear what Galen means by shameful treatment of the procatarc-
tic cause. Elsewhere he says that Erasistratus argues against such causes or wants to
do away with them as falsely believed in (IX, 123; XIII, 162; cf. 169), but he fails to
distinguish between different kinds of argument with different objects that might be
fairly described as ‘against the procatartic cause’.
(a) Arguments that items exerting the kind of influence specified in the account
of the procatarctic cause cannot be causes because they lack features that are
essential to causes properly so called.

1 ‘a$porei&n’ is RJH’s very plausible suggestion for ‘dubitare’ (154).

2 Cf. Subfiguratio empirica, 82, 20 ff.; 84, 30 ff. Deichgräber.

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84 Zur Diskussion

(b) Arguments that there are no items exerting this kind of influence regardless
of whether it would be right to style them causes if there were.
(c) Arguments that the items commonly supposed or alleged by a theory to exert
procatarctic causal influence do not in fact do so.
Galen had little patience with arguments of the first kind. Witness his attitude
toward those people who, he maintains, do not deny that cold, heat, overeating and
the like harm, only that they are causes of harm (VI, 46; cf. I, 10). As he never tires
of observing, it is not words that matter, but what they mean; if some people, for
whatever perverse reasons, prefer to withhold the term ‘cause’ from procatarctic
causes, he is willing to accommodate them so long as they acknowledge the fact of
procatarctic causation, however designated. And arguments of type (a) do not com-
mit one either to denying that there are items exerting the kind of influence ascribed
to the procatarctic cause ⫺ falsely so called ⫺ or to rejecting any particular view
about what they might be.
The burden of Galen’s argument ⫺ though he nowhere puts the matter so clear-
ly ⫺ is that Erasistratus advances considerations that would, at best, support an
argument of the first kind as if they entitle him to a conclusion of the second or
third type. This, I take it, is what he means by his charge that Erasistratus’ writings
against procatarctic causes, (as he ⫺ Galen ⫺ describes them) owe their plausibility
to an alteration in the meaning of words (XIII, 166; cf. 172, 175). Thus in order to
evaluate the justice of Galen’s charges we must answer two questions.
(i) Did Erasistratus deny, either implicitly or explicitly, the legitimacy of a con-
cept of procatarctic causation and restrict the use of the term ‘cause’ accord-
ingly?
(ii) If he did, did he use this restriction to evade the substantive question whether
so-called procatarctic causes, including those favored by Galen, play the part
they are alleged to play in the origin of disease?
The first quotation from Erasistratus begins (VIII, 102):
Most people both now and earlier have sought the causes of fevers by wishing to
hear (audire) and learn (discere) from the ill whether their illness had its origin
in being chilled or exhausted or in repletion or some other cause of this kind, in
this way neither truly (vere) nor profitably (conferenter) investigating the causes
of disease.
I have departed from RJH’s translation at two points in particular. First, I have
rendered ‘audire’ as ‘hear’ rather than ‘ascertain’. That Galen understands the pas-
sage in this way is strongly suggested by his later remark that, when recounting their
own experiences, lay people remember that labor, heat and that sort of thing are
accustomed to ignite (accendere) fevers (XI, 143). In other words, Galen believes
that lay people are often capable of identifying the causes of their own fevers. Indeed,
as we shall see, Galen believes that the causal influence exerted by some procatarctic
causes is manifestly evident. Secondly, I have also preferred a more literal rendering
of the last phrase in the above citation to RJH’s: “but this type of inquiry yields

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 Zur Diskussion 85

results that are neither true nor useful” 3. I take it that Erasistratus means to say
that this is not the correct method of investigating causes or the right way to look
for an explanation.
If we pause here, there seems to be nothing especially shameless about this. But
the best evidence for Galen’s charge is furnished by the remark Erasistratus immedi-
ately goes on to make (103):
For if cold were a cause of fever, 4 then those who have been chilled the more
would suffer the greater fever. But this is not what happens: rather there are some
who have faced extreme danger from freezing, and when rescued have remained
unaffected by fever. The same thing happens in regard to exhaustion and reple-
tion: many people who experience far worse exhaustion and repletion than when
some people have come down with a fever 5 none the less escape the illness. 6
To proponents of procatarctic causation like Galen this must seem to beg the
question. They never claimed as much for the items mentioned here, yet they main-
tain that they have a part to play in bringing about fever all the same and are, for
that reason, properly styled ‘causes’, a position which seems to be left untouched by
Erasistratus’ remarks.
But we do not know the immediate context of this quotation, and it is not hard
to imagine one that would support a more charitable reading than Galen’s. If, as I
have suggested, Erasistratus is principally concerned to complain about a defective
method of explanation, it may be enough to suppose that Erasistratus thinks the
people about whom he is complaining fail to explain why fevers arise when they do
and exhibit the variations that they do. If we suppose that these people are not
proponents of a sophisticated causal theory of the kind espoused by Galen, but
physicians who he ⫺ Erasistratus ⫺ thinks ⫺ rely on lay testimony about fevers and
are content to leave matters at that, there are a number of points he could be making
in this way. In the context I have imagined, it may even be that Erasistratus meant
that it was as if the people he criticizes make heating and chilling the sole causes or
complete explanation of the fevers alleged to result from them because they say
nothing that would explain why causes of this sort, e. g., chilling, sometimes result
in fever and sometimes do not and why the fevers that result are sometimes stronger
sometimes weaker. His point would then be very similar to the one that Galen thinks
he is scoring against Erasistratus with his charge that his ⫺ Erasistratus’ ⫺ argu-

3 “neque vere neque conferenter querentes causas egritudinum”. Cf. Bardong’s

Rückübersetzung, 25.
4 The Latin could correspond to Greek that could be rendered “the cause of (a)
fever”.
5 “quam quando aliqui februerunt”; RJH: goes too far by rendering “than that
which coincides with fever in some others” if he means to suggest the relation is
purely accidental, since as he notes himself: “Erasistratus accepts (as does Galen)
that over-eating and exhaustion play a part in the onset of disease” (33).
6 “These words”, says Galen, “come from the first book of Erasistratus’ “On Fe-
vers” ” (VIII, 104).

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86 Zur Diskussion

ments work by illicitly importing the requirement that to be a cause of an affection

something must be its sole cause (XIII, 167⫺8). But while Galen believes that Era-
sistratus is himself committed to this requirement, on my suggestion, Erasistratus is
complaining about physicians who, on his view, put forward an item ⫺ one of the
so called procatarctic causes ⫺ as if it furnished a complete explanation when it
manifestly fails to do so.
Erasistratus could also believe that there is an especially important factor in the
explanation of fevers which deserves to be privileged as the cause because it explains,
or plays the principal part in explaining, why fevers arise when and as they do,
something that his opponents’ causes signally fail to do. It is a commonplace that
we tend to single out one item as the cause of something that we are attempting to
explain even though a full account of what is responsible for the outcome in question
would require reference to many other factors as well. Which item is privileged of
favored in this way will depend on the assumptions and interests we bring to the
case at issue. We expect something different from an explanation, e. g., when our
aim is to establish moral responsibility than when our inquiry has another object.
But to focus on one factor in this way and to employ a sense of ‘cause’ applying to
it is not to deny the part played by other items in bringing about the effect, and it
need not even put the application of ‘cause’ to other factors out of bounds. We
should have no difficulty, e. g., in understanding someone who said ‘X is not the
cause of Y, it is the cause of W, which is the cause of Y’. Nor should we be terribly
surprised if the same person went on to ascribe to X a part in the causation of Y or
even to describe X as a cause of Y ⫺ although this may suggest the advantages of
a technically regimented vocabulary of the kind employed by Galen. Erasistratus’
decision to favor one factor in this way may owe more to the explanatory require-
ments of the particular situation than to a theory of causation or a view about the
meaning of the word ‘cause’. It may, e. g., be important that Erasistratus, unlike
some physicians, seems to have held that fever is not, properly speaking, the disease
itself, but rather a symptom supervening on it, which might account for the emphasis
on explaining variations in the intensity of the fever (ps.-Galen, Medicus XIV, 729
Kühn).
Erasistratus may also have been moved by the not unreasonable thought that
without a deeper understanding of the aetiology of fevers we shall not be in a posi-
tion to evaluate claims made on behalf of heating, chilling, repletion and the like. If
so, his complaint may have applied also to physicians whose theoretical inquiries
are unduly constrained by the excessive faith they place in lay testimony. And it is
important to note that Galen was vulnerable on this score himself. For he seems to
have believed that one can sense procatarctic causes at work producing their effects,
e. g., excessive exertion giving rise to a fever (XII, 155⫺56). 7 Thus when Galen ac-
cuses Erasistratus of resorting to sophistry to argue against the phenomena
(XII, 160; 169; XI, 139⫺41), the phenomena that he has in mind are not that people

7 “Galen seems to believe that one can actually feel causal connections as opposed
to inferring them” (RJH 251).

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 Zur Diskussion 87

are chilled and that some of them later come down with a fever, but that, on certain
occasions, chilling causes people to come down with a fever. But of course it is far
from clear that facts like these are as evident as Galen maintains, and there are real
dangers in postulating underlying dispositions that would save allegedly phenomenal
procatarctic causes by explaining variations in their effects. 8
We shall have to see whether the remaining evidence supports these suggestions.
But even if they are too charitable and Galen was right to attribute a restrictive
conception of cause to Erasistratus (questions i), if his charges are to be vindicated
it must still be established that Erasistratus denied causal influence, under whatever
name, to the so-called procatarctic causes and did so by altering the meaning of the
word ‘cause’ (question ii). And the evidence for this charge is still weaker.
After all the abuse heaped upon Erasistratus’ disgraceful behavior toward proca-
tarctic causes, it comes as a surprise to find Soranus crediting Erasistratus with the
view that plethora is a procatarctic cause of disease (Gyn. 3.4). Of course, this need
not mean that Erasistratus used the term ‘procatarctic cause’, only that he ascribed
the kind of causal influence to plethora that entitles it to be called a procatarctic
cause and that would lead those familiar with the term to call it a procatarctic cause
(cf. RJH 47). What is more, Galen himself seems to accept as much in his paraphrase
of another passage from Erasistratus (XIV, 174).
For he says something along these lines: ‘This much, namely that there would
not be a proximate cause of disease had something first not brought about some-
thing else, and then that something else again, no one disputes. Congestion in the
veins must therefore follow repletion from things that have been eaten and drunk
and paremptosis (i. e. falling to the arteries) occurs because of this … and because
of this the heart changes the pneuma more powerfully and rapidly, which invaria-
bly propels the displaced blood and forces it to the edges of the arteries, where it
is compressed and forms an inflammation. So it is clear that paremptosis occurs
by way of plethora, and then compression occurs.
It is clear from this that Erasistratus does find a place for repletion as a necessary
condition for, though not the proximate cause of, disease; the part of proximate
cause is reserved for paremptosis, the displacement of blood from the veins, where
it belongs, into the arteries, which according to Erasistratean physiology are vessels
for the pneuma. The context seems to be one in which Erasistratus was concerned
to emphasize the importance of proximate causes. And it may be that paremptosis
satisfied the requirements that Galen takes Erasistratus to be imposing on causes in
the first quotation. Soranus, in the passage already cited, maintains that Erasistratus
makes paremptosis the containing cause of disease. The containing cause was origi-
nally a Stoic notion, but once introduced into medicine by Athenaueus of Attaleia,
the founder of the pneumatic school, it led an independent life there (cf.
RJH 43⫺45). And at least in its medical version, the containing cause did behave in
something like the required way. Thus the evidence does suggest that Erasistratus

8 Cf. RJH 228⫺9.

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88 Zur Diskussion

granted a privileged position to paremptosis, the proximate cause, in the explanation

of disease, perhaps going so far as to confine the term ‘cause’ to proximate causes,
though the evidence does not make it certain that he took this step. 9 But regardless
of whether Erasistratus insisted on a terminological restriction of this kind, since he
clearly concedes causal influence to factors other than paremptosis and since Galen
insists that terminology is not the issue, why then does he say of the view set out in
the paraphrase: “this shamelessness is worse than the others. Repletion causes pleth-
ora which causes … paremptosis, [which] causes inflammation; yet he will not agree
that repletion is in any way the cause of inflammation” (XIV, 176)? This hardly
seems a fair summary of this passage. Indeed, if this passage belongs to the work
from which the first quotation was drawn, it might almost seem to have been in-
tended to forestall that impression.
I take it that Galen sees a contradiction between the account of repletion here
and the position he takes Erasistratus to have argued for in the first quotation.
Behind his fury, I suspect, lies a view something like this: Because of the self evident
causal influence exerted by heating and chilling, Erasistratus had no choice but to
use sophistical arguments based on an arbitrary change in the meaning of the word
‘cause’ to deny heating, chilling, repletion and other items a part in the aetiology of
febrile diseases. This is the object of the argument of the first quotation. And from
this point of view it must seem that Erasistratus makes a completely unprincipled
exception on behalf of repletion simply because it agrees with his theory. Herein lies
the outrage. But once we reject the dubious view that heating and chilling are self
evident causes of disease, favoring repletion because it has a part to play in the
causal mechanisms postulated by a theory need not be in principle illegitimate. To
be sure, the fact that a proposed cause agrees with a theory furnishes a reason for
accepting it that is only as good as the theory. And Erasistratus’ theory is false, as
Galen had excellent reasons to believe, because of his experiments demonstrating
that the arteries contain blood (cf. RJH 32). But this is another issue.
Erasistratus rejects the claims of heating and chilling to play a part in the genera-
tion of fevers not, as Galen supposes, by a change in the meaning of words, but on
grounds drawn from his pathology. The object of the argument in the first quotation,
where Galen claims to find this sophistical trick is not to deny the items any part in
the production of fevers, but rather to show that a method relying on lay testimony
will be unable to supply the correct explanation for diseases. But from this it does
not follow that none of the items mentioned by lay people have a part to play in
the explanation of diseases, only that they do not supply a complete explanation
and cannot owe their place in the correct explanation, when they have one, to lay
testimony alone, but must be supported by scientific aetiology. Thus there is nothing
shameless about the fact that repletion appears in the list of causes proposed by lay
people, which, according to Erasistratus, cannot explain disease, and as part of his
preferred explanation for disease in which paremptosis plays the principal part.
RJH acknowledges that Erasistratus has grounds drawn from his physiology and
pathology for denying any pathogenic influence to hot and cold, but insists that

9 Contra RJH 47.

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 Zur Diskussion 89

“Erasistratus further holds that heat and cold cannot be causes of illness”, I take it
because they do not satisfy the conditions that Erasistratus is alleged to impose on
causes in the first quotation (33). He remarks that Erasistratus wins a purely hollow
verbal victory by means of arguments based on those conditions (256). He describes
“as of the Erasistratean type” the parodic courtroom argument constructed by Ga-
len, in which a prizefighter argues that he is not the cause of an old woman’s death
because the blow he dealt her was no stronger than many blows he had received and
dealt out in the ring without death ensuing (247). And he describes the Erasistratean
approach as untenable because it sidesteps issues of assigning causal responsibility
by stipulation (265). According to RJH, the CP demolishes the ‘conceptual basis’
for the rejection of procatarctic causes (48).
As should be plain by now, I do not believe that Erasistratus’ views had a concep-
tual basis of the kind alleged. He rejects the procatarctic causes favored by Galen
on substantive grounds that have everything to do with his preferred pathology and
little or nothing to do with a theory of causation or a view about the meaning of
the word ‘cause’. Everything Erasistratus says about causes can be explained by
reference to his substantive views and facts about the ordinary use of the term
‘cause’. If this is right, the CP is an example, though far from the only one, of
Galen’s unfairness as a reader of others’ works. 10 We have good reasons to be very
cautious about relying on Galen’s testimony. In particular, I suspect, we have very
little reason to suppose that the kind of sophistical logic chopping with which the
CP is concerned played a significant part in Erasistratean medicine.
The alternative interpretation that I have defended here is of course very heavily
indebted to RJH’s presentation of the evidence in his extremely helpful volume, for
which students of ancient philosophy and medicine should be very grateful.

10 Cf. J. Cooper, “Posidonius on the Emotions” in idem, Reason and Emotion

(Princeton, 1999), 449⫺484, where Cooper convincingly argues that the Posidon-
ius’ alleged return to a Platonic moral psychology is a polemically motivated
misreading on Galen’s part. To be sure, by his own lights, Galen is doing Posi-
donius a favor, but his ultimate aim is to use his Platonizing Posidonius as an-
other stick with which to beat Chrysippus, and this leads him seriously to distort
Posidonius’ more subtle but less radical revision of the Stoic position.

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