Since you are knowledgable in that matter, could you comment on the following narrative (I have heard it several times, but can't point to a specific source).
Before the Renaissance, there was a very strong scientific tradition in Europe (especially in catholic church, which hosted most of European science in these days) that you were supposed follow the ancient sages like Aristotle. You were allowed to re-interpret them, but not to extend past their knowledge/understanding, and you were supposed to not question them.
With Renaissance (and even more, with enlightenment), a lot of people started seeing this as a bug, not a feature. They began to question the ancient authorities. One of their methods (perhaps as part of a cultural war? I don't know) was to make up really bad stories about everything associated with the old tradition that preceded Renaissance . This included in particular old science (Galen?), the middle ages (the name "Dark Ages" switched its meaning to "intellectual darkness" about that time), and the catholic church.
So they invented a lot of stories that were either plainly wrong ("There was no technical advancement in the middle ages") or so distorted that they sounded horrible ("Galilei had a brilliant scientific insight, but Catholic church opposed science and suppressed him"). Since they were the winners, the stories maintained, and except for knowledgable historians, they became Common Knowledge.
I am inclined to believe the narrative, but I am not sure. It's probably quite simplified. But then I share your impression that a lot of Things We All Know about middle ages in Europe are wrong, and this wrongness seems to go quite systematically into the same direction (middle ages were horrible, Church was Evil). I am sure that there are a lot of wrong Things We All Know about other topics, but I don't have the feeling that it's so systematic or runs so deep.
There's a few significantly different issues around here.
The people we now call the "Renaissance" (mainly Tuscan humanists of the 15th century) had some revolutions in art and philosophy, as well as beginning the translation and study of Ancient humanist texts, but they often erase the "Renaissance of the 12th Century" in which Ancient scientific texts were revived: https://en.wikipedia.org/wiki/Renaissance_of_the_12th_century
Rene Descartes criticizes the Scholastic philosophers of the 16th century as just doing epicycles on Aristotle, while he is the first person to think truly new thoughts - and his work was influential enough that the history of philosophy is often taught that way. (Students are required to take a class on "Ancient philosophy" and a class on "Modern philosophy", which usually means Descartes to Kant, as well as contemporary philosophy, but Medieval is usually purely optional.)
The "Dark Ages" refers most specifically to the period from the 5th to 8th century in Europe, when Germanic kingdoms took over the various parts of western Roman territory, but the ruling class didn't keep written records of things until Charlemagne. There's not much evidence that this period was that much worse for people in any way - just worse for historians who like written records.
So there's a lot more complexity to these rules - the Renaissance thinkers were actually much more into hero worship of the Ancients than the people that preceded them. But there's also usually a lot more continuity between each period and its immediate predecessors and successors than the self-told stories really make clear.
I see. So it's probably not true that medieval scholars focused more on tradition and ancient texts than Renaissance. In some sense, this should be obvious, it's in the very name "Renaissance". Nevertheless, I have heard this claim several times, so I still wonder where it comes from.
As far as I get it, the "Renaissance of the 12th Century" was in fact only one of several medieval Renaissances. It seems more like it went in and outside of fashion several times, and the standard "Renaissance" was only one such wave.
For the term "Dark Ages", I disagree. I do agree that among historians, it means "period with few record". But that is not how the general public uses it, and I would claim that even non-historian intellectuals don't use it that way. According to wikipedia https://en.wikipedia.org/wiki/Dark_Ages_(historiography), the idea of intellectually "Dark Middle Ages" became popular during Enlightenment (though it existed earlier), and the idea remained so strong over centuries that historians eventually stopped using the term because readers kept on misunderstanding it. (Also, by the same source the restriction of the term to Early Middle Ages came much later, in 19th and 20th century.)
Renaissance scholars tended to hero worship the ancients such as Plato (thus we refer to scholarship as "research" rather than "search" because the assumption was that the ancients knew it all and we just have to recover their learning) and criticize medieval scribes who made less that wholly faithful copies of the ancient originals.
During the Renaissance (perhaps especially after the invention of the printing press in the 1450s), scholars noticed that they often had more than one version of ancient texts due to imperfect copying by subsequent scribes. Critical methods had to be invented to figure out what the original text most likely said. From there, criticism continued to expand as a habit of mind. This growing critical spirit is noteworthy in distinguishing the last 600 years in the West from the intellectual framework of other times and places.
There's an old SSC post where Scott looks at this issue and rejects both the thesis that the Medieval Era was an undifferentiated time when everyone in Europe had the plague and spent their whole lives covered in mud, and the antithesis that the end of Antiquity was barely noticed by anyone outside of a small literati.
When did Galen finally go out of fashion? Wikipedia says humorism fell out of fashion in the 1850s:
"Humourism began to fall out of favor in the 1850s with the advent of Germ theory which was able to show that many diseases previously thought to be humoural were in fact caused by pathogens."
> Nature takes on the exact same role in his arguments that evolution would take on in ours:
> “Your school of medicine says that the ureters don’t do anything? Then why are they there? We know that this animal was created by Nature, why would she include these structures if they were truly useless?”
I mean, you could also substitute in "God" here. Saying that Nature wouldn't be wasteful isn't any more of an explanation than that would be; I don't think it's worth giving any credit for this. (And of course, on occasion, nature *is* wasteful...)
Fair enough, but I suppose my point was vestigial things in general, for example how some humans are born with "throwback" tails or an extra finger. I just get a little white knuckle about the "intelligent design" implication here.
There are definitely "intelligent design" vibes, but it doesn't strike me as all that wrong to think this way from an evolutionary perspective. Nature *isn't* wasteful--it's just not efficient. People evolved fingers for a reason, and having an extra one is just an indication that the formation process went a bit awry. "Divine creation" proponents historically had more trouble explaining such things in themselves, preferring to say "God gives us our burdens to bear, to teach us humility," etc.
Galen probably didn't know about the appendix, since pigs don't have them, and Wikipedia says the first recorded appendectomy was in the 18th century CE
It's an argument that experience shows to be worth *something*, but which, taken as an absolute, rests on the Aristotelian teleological framework, which showed itself ultimately fallacious. Another reason why Galen got "cancelled" in Cartesian times (... and then of course later developments showed that nature sometimes does behave, in some specific ways and contexts, *as if it had* a purpose; natural selection here, law of least action there (but one has to be careful not to overstate the extent to which this can be true)).
<i>It's an argument that experience shows to be worth *something*, but which, taken as an absolute, rests on the Aristotelian teleological framework, which showed itself ultimately fallacious.</i>
Though I can't help but notice that claims of Aristotle's fallaciousness are generally very similar to claims of Galen's stupidity -- in both cases, people don't show more than an extremely shallow acquaintance with the original sources (if they show any acquaintance at all), nor do they stop to consider how such an alleged idiot was able to amass the kind of following he did.
Well, Aristotle's views were reasonable enough; why expect a mechanistic world-view to impose itself in an era before machines? Everyday intuition came from interactions with living beings, many of which clearly have a sense of purpose.
I read a very interesting paper by a physicist which examined Aristotle's actual theories and concluded that they were a fairly good, nonintuitive description of motion in fluids. I think that this link is it:
Teleology is an inescapable feature of the world; the question is whether you want to locate it in objects themselves, like Aristotle thought, or whether you think it's imposed on them by God, like the mechanists did.
Like I said, "An extremely shallow acquaintance with the original sources". To take but one example, "All natural bodies and magnitudes we hold to be, as such, capable of locomotion" doesn't, despite the fisker's bluster, contradict "the geometric description of motion is accidental, not essential". It's the ability to move (or be moved) which Aristotle thinks belongs to natural bodies and magnitudes by nature, not the precise form which this movement takes.
Aristotle does think the precise form must be a combination of linear & circular, and it's THAT which Dutch insists is "accidental" rather than essential.
So he does, my bad. Though since he also says that "Yes, you can describe all motion as a compound of linear and circular motion", I'm not sure why he thinks Aristotle made a massive howler in saying exactly the same thing.
My impression is that either Aristotle was not as great of a prose stylist as Plato was (whose dialogues remain highly readable after 2400 years), or that much of what we have of Aristotle's are lecture notes written up by his students from their notes. Also, whatever Aristotle wrote in dialogue form hasn't come down to us, which is an unfortunate loss because dialogues tend to be more fun to read.
I'd frame this as: yes, teleology as applied to the products of evolution is an imperfect heuristic. But relative to the state of medical science in Galen's time it was pretty darn powerful and accurate, and it sounds like he got a lot of mileage out of it. One can say "modern science shouldn't operate on teleological heuristics" without faulting him for his approach.
> I mean, you could also substitute in "God" here. Saying that Nature wouldn't be wasteful isn't any more of an explanation than that would be; I don't think it's worth giving any credit for this. (And of course, on occasion, nature *is* wasteful...)
It's not really an explanation; it's something far more valuable: a belief that (relatively) consistently pays rent in valid predictions. It's predictions are (as you say) wrong on occasion, but they're far more often right.
This is especially true on the organ scale, which is all Galen had access to confirm its predictions. Organs are enormously expensive to evolve, and so are literally never evolved without a purpose (and very rarely lose that purpose without being coopted for something useful anyhow.)
Indeed, Galen's principle here was generally more accurate in its predictions than pre-1950s evolutionary theory. The recognition of the possibility of vestigial organs led to far more erroneous predictions of vestigiality than correct ones.
It is an explanation though. It's not a good one compared to the explanations we have available today, but it's a theory that distinguishes the world we live in (where most parts of most living things have some purpose) from a very large number of worlds we don't live in (where it's normal for living things to have lots of pointless organs).
A great review. One comment: Bacon was writing during the time when William Harvey was trying to disprove Galen's model of circulation and encountering a lot of resistance. Maybe Galen got cancelled by Harvey partisans, or just acquired a bad reputation for being on the wrong side of this argument?
> “Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.
I don't know whether it was the earliest, but I know of an earlier thinker who basically invented survival of the fittest way before Darwin (okay, admittedly without all the details): Empedocles (a Pre-Socratic philosopher)
"He knew that there is sex in plants, and he had a theory (somewhat fantastic, it must be admitted)
of evolution and the survival of the fittest. Originally, "countless tribes of mortal creatures were
scattered abroad endowed with all manner of forms, a wonder to behold." There were heads
without necks, arms without shoulders, eyes without foreheads, solitary limbs seeking for union.
These things joined together as each might chance; there were shambling creatures with countless
hands, creatures with faces and breasts looking in different directions, creatures with the bodies of
oxen and the faces of men, and others with the faces of oxen and the bodies of men. There were
hermaphrodites combining the natures of men and women, but sterile. In the end, only certain
forms survived. "
(Bertrand Russell: A History of Western Philosophy)
Super interesting, easy to read, humorous (heh heh) -- and not an idea I would have had, to review a book by an ancient author and compare what he actually said with what it's often claimed he did.
I wasn't interested in reading the reviews at all -- "no one ever picks books I'd be interested in, and few have the touch that makes a review enlightening *and* entertaining; hmph", thought I -- but this changed my mind. Thanks for this, anonymous reviewer!
Hm, do you think Scott's book reviews make your cut? For consistent enlightertainment (making that word up) I think his reviews are rarely surpassed; usually it's one or the other: https://slatestarcodex.com/tag/book-review/
I find book reports a hard sell when I tell people about SSC/ASX, but frankly I think this aspect is one of the freshest and most interesting things the Internet has to offer in <current year>.
I really enjoyed this. It was lively, engaging, thoughtful and intelligently written. Quite Scott-esque at times.
I read it too fast because I wanted to get to the end so I could comment, but I'll read it again at a more leisurely pace and I'm already looking forward to the prospect.
I understand that in Galen's time, Alexandria was the place to go to learn medicine, because they didn't mind cutting up dead bodies at the med school there.
For a similar reasons, it is surmised that Galen took a job doctoring up gladiators because it gave him a more...hands on insight into human anatomy and how it worked.
Of course, Aristotle was way off on a lot of things, but he was considered an authority for longer than Galen was.
Really good book review. Make me aware of a book I should be interested in, tell me where you're going with this and why you're reviewing it, then make good on all those promises. I feel like I know a lot more than I did before. I also really appreciate going back and reading a foundational text rather than just something new and modern and trendy (not that there's anything wrong with the latter, just that we don't get enough of the former).
"All who drink of this treatment recover in a short time, except those whom it does not help, who all die. It is obvious, therefore, that it fails only in incurable cases.”
Without context, the above can easily be interpreted as mockably fallacious. But Galen was talking - whether he was right or wrong - about a specific medicine, not proposing a logical syllogism. There is a factor which is potentially empirically relevant, i.e. the short recovery time after drinking.
Consider, for example, the Heimlich manoeuvre. Surely that operates in just such a fashion? Those who can be helped by it are helped immediately. Those who cannot will die. Defibrillation is another example. There is no reason in principle why it should not be the case for a drug also.
One can quibble about the details - yes, for example, a tracheostomy might work, but might not be a practical solution if medical professionals are not present. And perhaps use of the word 'obvious' is too strong. My point is that the criticisms of Galen's wording are implicitly attributing to him a major, not minor, fallacy - and there is no strong reason to believe this major fallacy was present.
I guess it just still seems like a fallacy to me. There's a big difference between "either it cures you quickly or you die" and "if this doesn't cure you, you're incurable". You can say the first thing of the Heimlich manoeuvre, or defibrillation, and plausibly you can say it of this medicine. I don't think you can say the second thing of any of the three, and if you wanted to try you'd need to bring in some reason to think it.
I guess if you tried to translate the first thing into a logical proposition "for all person, (sick(person) and given-medicine(person)) => (cured-quickly(person) or dies-quickly(person))", it implies the second thing, but... I dunno, "you're going to die soon" feels like it has an implied "given our current knowledge and abilities", where "you're incurable" feels like it explicitly denies that extra clause.
(Clarifying here that there seems to be no particular reason to think Galen ever made this mistake, and this is an epistemological point rather than a point in favor or against Galen. Not accusing you of thinking otherwise, just seems worth being explicit to help avoid readers losing track of context.)
Um, but it now occurs to me that trying to read such implications across thousands of years and at least one translator seems... risky. So I guess my previous comments need to be tempered in that light.
I laughed with our Author's admission that this juicy word choice made them "very uncomfortable". I then noticed that they simply gave us the straight, even unremarkable, phenomenologic truth. We all feel the discomfort. So why laugh?
"It's funny because it's true" - this explains a lot of Rationalist humor - which I admire, to be clear. A lot of humor, if not all, also elucidates, e.g. draws to a punchline, a contradiction. Perhaps this kind of frankness is funny because it is true, and because it reminds us that we live in a world of degraded discourse where writers so often obfuscate, lie, hide the simple truth. The contradiction instantly elucidated, then, is this Comedic Situation: a humble truth-teller in a loud lying world.
Outstanding! 5/5 in style, I would believe this was written by Scott, maybe just a bit more succinct. I think you steelman Galen a bit too much however, the "evolution" section was a bit too laughable. Don't give the guy points for sounding like he knows what he's talking about, stick to praising his empirical heuristics.
Meh – I think it's perfectly fair (and better overall) to "give the guy points for sounding like he knows what he's talking about".
The detailed history of the development of the theory of natural selection, or any major scientific theory, sure makes it seem like a long period of people "sounding like [they know] what [they're] talking about" before the final recognizable theory is described (and then, often much later, confirmed).
And a lot of scientific theorizing would similarly seem like 'giving people points for sounding like they know what they're talking about' based on your implied standards – take special relativity as another example. Others had, e.g. already derived the relevant mathematics, before Einstein wrapped it all up in an explanation that we all now agree is palatable.
The history of mathematics, physics, chemistry, is _riddled_ with people 'sounding like they know what they're talking about'. Yes, they mostly weren't producing 'good' scientific theories, for all kinds of reasons, but I think of that as the (probably inevitable) manner in which people 'locate a hypothesis in hypothesis space'.
This is pretty inconsequential, but I have an interesting thought about this anyway:
"reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Actually, this seems plausible to me. Earthen jars tend to be somewhat porous and they were probably not glazed, so water being stored in them will slowly evaporate over the course of weeks or months. By "corn" he was surely not referring to the yellow vegetable you eat off the cob, because corn is native to Central America and was not introduced into Europe until the Colombian Exchange. I am not totally sure, but I think the antiquated meaning of "corn" was closer to that of "cereal" or "flour". And it seems plausible to me that flour can absorb water vapor out of humid air.
So if you store a bunch of water and flour next to each other inside non-watertight earthen jars in your basement, the water will evaporate out of the water jars and some will absorb into the flour, making it heaver.
> When Europeans say “corn”, it’s a general term for any grain or cereal crop, including wheat, barley, millet, sorghum, oats and rye. These are native to the Old World, and the Romans would have cultivated or at least known about them.
"Corn" in European context refers to wheat (mostly), oats, barley and other cereals. When maize was introduced from the New World, it was known as "Indian corn" or "yellow meal" when ground.
Purchased as an emergency food supply during the Famine, it became known as "Peel's Brimstone" because of its yellow colour, and due to people not knowing how to mill and cook it properly:
"Confronted by widespread crop failure in November 1845, the Prime Minister, Sir Robert Peel, purchased £100,000 worth of maize and cornmeal secretly from America with Baring Brothers initially acting as his agents. The government hoped that they would not "stifle private enterprise" and that their actions would not act as a disincentive to local relief efforts. Due to poor weather conditions, the first shipment did not arrive in Ireland until the beginning of February 1846. The initial shipments were of unground dried kernels, but the few Irish mills in operation were not equipped for milling maize and a long and complicated milling process had to be adopted before the meal could be distributed. In addition, before the cornmeal could be consumed, it had to be "very much" cooked again, or eating it could result in severe bowel complaints. Due to its yellow colour, and initial unpopularity, it became known as "Peel's brimstone"."
"As chairman, Routh worked hard to counter the initial resistance to Indian corn, derisively dubbed ‘Peel’s brimstone’ because of its sulphurous yellow colour. The hard, unpalatable grain was far removed from the diet of potatoes to which the rural poor had become accustomed and, if not boiled for long enough, the alien foodstuff could cause painful indigestion and, in some cases, dysentery.
Routh become a public advocate of its use and benefits, overseeing the publication of thousands of instructional handbills and a popular pamphlet with instructions for its preparation. The resistance, however, was short-lived. In the words of the unfortunately-named commissary general, Sir Edward Pine-Coffin, in a letter to Trevelyan on 30 March 1846, the Indian meal was ‘much too good a thing to be long rejected by starving people’.
In practice, the Relief Commission was hindered by internal disagreements and Trevelyan’s rigorous oversight and the public works schemes were beset by bureaucratic delays and inefficiencies. Nonetheless, the relief measures devised by Peel succeeded in averting many deaths.
As Isaac Butt pronounced in the Dublin University Magazine in April 1847, ‘the timely precaution [of importing Indian corn] and the subsequent judicious distribution of this store had the effect of bringing the people through the winter that closed the year 1845.’"
Fantastic. Finalist #2 has done an impressive job of capturing Scott's book review style, and I can't pay a much higher compliment than that.
I think touches like doing the extra legwork to research the historical context of the writer and not just the work itself are what really push it over the edge into exceptional. One signature move of Scott's is to relay some amusing, often absurd-sounding anecdote found in the writing of the piece, and the bit on Galen having to write a dedicated piece to combat the various imitators and servants pawning off his letters is EXACTLY that. It adds humor to the piece, depth and context to the work's author, and really underscores the depth of research put into the review.
Of course, the overall review itself is also written in a super readable style and the flow is very logical and smoothly laid out. This is going to be a really high bar to clear given how well it manages to match our host's style. Then again, in true transhumanist fashion, we should hope for and demand Super Scott from one of the remaining 12 entries, perhaps?
> "You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…"
Am I just being really dense, and is this obvious to everyone? I was thinking Maimonides, but maybe it is Locke, or Schweitzer. Or is he talking about Fauci?
> "If that which is white becomes black, or what is black becomes white, it undergoes motion in respect to colour..."
I've noticed this before in ancient Greek works, but it's still striking that to them—at least if the translations are apt—change was considered a type of motion, while in our culture we more usually consider motion a type of change (a change in place).
And I wonder when this changed, and whether there is a particular reason that it had to.
(A lot of the apparent weirdness in Greek philosophy is mostly from just having conventional translations that have different connotations, so it might just be a thing that didn't leave the Greek language, but I don't know how it is in modern Greek.)
To me, change as motion implies smooth, gradual change through intermediate states, just like motion in space. As opposed to a sharp, qualitative 'step' change.
So for example, any two colors can be connected by a gradient of color change. And when objects change color over time, e.g. ripening fruit, they display some intermediate colors.
On the other hand, when water boils into steam, there's no apparent intermediate state between the two.
Our senses are finite and imprecise, and before modern instruments and modern physics, one could make an argument that either kind of change of fundamental and the other one arises from it.
So maybe all change is gradual, and water-into-steam is just so fast that the quantity of matter in the hypothetical state between water and steam is very small and short-lived, and we can't observe it directly because of all the bubbling.
Or maybe all change is qualitative, and when an apple seems to go from green to red over time, it's really a mix of very many very small pieces of matter which individually transition from pure green to pure red, but we only perceive the overall color of the mix as the proportion of green to red pieces changes.
> On the other hand, when water boils into steam, there's no apparent intermediate state between the two.
Having observed some boiling water – and maybe being a contrarian mood! – I'm not sure what this means.
I recognize that this is the accepted 'cartoon physics', and phase transitions _are_ a thing, but it also doesn't really match observations!
At the macroscopic human scale from which most people ever have or will observe water boiling, there sure seem to be LOTs of 'apparent intermediate states' between non-boiling water and boiling water. One reason being that there are many varieties, or intermediate states, of 'boiling'!
The closets thing to "no apparent intermediate state", for boiling water, that I think could be observed (by a person, with their unaided senses) is something like boiling (distilled) water in a microwave (e.g. "superheated exploding water"). All of the other more typical means of boiling water (most of which is NOT distilled) look very much like they involved a whole continuum of intermediate states.
And I would bet that these ancient intellectuals could easily understand 'phase transitions'. For one, I'd expect most of them to know about routs in battle and that's pretty obviously a phenomena where small intermediate states, at one level, result in a drastic and sudden qualitative change at a higher one (i.e. larger scale).
When the water is partially boiled, it isn't in a semi-steam state; rather some of it is still water and some of it is steam. You can clearly see bubbles of steam within the liquid.
Yes, I understand that. That's the modern understanding!
My point is that, if you (yourself) observe, e.g. a pot of boiling water, it isn't obvious that "partially boiled" isn't an intermediate state. We can't observe the individual water molecules with our eyes. But even if we could, we couldn't _perfectly_ separate all of the water molecules into 'water' or 'steam'.
Part of the 'problem' is that 'liquid' and 'gas' don't make sense as descriptions of individual molecules. They're both (necessarily) applicable only to (fairly large) ensembles or collections of molecules.
And, even in water at thermal equilibrium with its surroundings, some (tiny) amount of the liquid water is 'boiling' off of its surface. And, similarly, some (tiny) amount of steam condenses back into liquid water too, even during boiling.
There _is_ a 'sharp' phase transition, but it doesn't occur at an obviously visible scale. And I think the 'modern understanding' obfuscates a lot of the (interesting) details of what's going on in what we can observe ourselves with our own faculties. When you boil a pot of water on your stove, only a very small portion of the volume 'boils'. So the volume of water – the visible thing we can observe with our eyes over the span of seconds, minutes, and hours – doesn't itself, as a whole, undergo a rapid phase transition. The phase transition happens at much smaller scales, e.g. the bubbles of steam visible in the pot of water. That seems to me like a much more interesting, and complicated, phenomena than _strictly_ emphasizing the 'phase transition' between liquid and gas.
I disagree that the sharp phase transition isn't obvious. I can't see individual molecules, but as you note liquid and gas are descriptions of collections of molecules. And those I can see!
I think I'm thinking of this as what's reasonable to _expect_ for people that don't already have our modern understanding of the states of matter and the relevant phase transitions among them.
But I think it's hard to appreciate how non-obvious something like 'bubbles in boiling water are pockets of gaseous water inside the larger volume of liquid'.
When you pour boiling (or near boiling) water on coffee grounds, you'll observe bubbles, but the grounds aren't being sublimated, or melted and then boiled – there is pre-existing gas escaping.
And I'm struggling to think how someone could figure out the difference between the two without most of our modern understanding.
A big general problem is that, for any ontology, Nature is perfectly content 'crossing levels' (or ontologies).
Any intuitions we have about mundane boiling of pots of water is inextricably complicated by small details, e.g. the drastic difference in the behavior of boiling ('impure') water in a pot on a stove versus superheating distilled water in a microwave.
Most people, with whatever (partial) understanding modern scientific theories have provided them, consider the messy 'real world' examples, whereas the scientific theories much more accurately describe 'contrived' experiments like the superheated exploding microwave water. The latter is a much better macroscopic example of a phase transition!
<i>“Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.</i>
I don't know who originated the argument, but Aristotle was fond of saying that "nature does nothing in vain".
I suspect this idea of nature is a lot like other pre-scientific principles – and it seems like this was also a (mostly) necessary ingredient in developing what we now think of as 'scientific theories'.
Relativity – the general pre-scientific principle that Einstein kinda just _assumed_ for the sake of his argument for Special Relativity – always seemed like a similarly philosophical or metaphysical stance that wasn't (and couldn't have been) 'scientific'.
This was an unexpectedly enjoyable piece about a topic I knew absolutely nothing about, props to the author! But... if I had one nit to pick it's that they seem a little more credulous of Galen's perspective vis-a-vis his critics than is maybe wise. Anyone who adopts a beleaguered, surrounded-by-fools stance in describing their critics raises the question of "is this guy a lone voice of sanity in the wilderness, or is he just setting up strawmen to knock down?" Given that we don't have writings from his contemporaries to cross-check against, it seems like we're potentially committing the same error against them--trusting someone who says "check out this idiot, how can anyone believe something so stupid!"--as we were originally against Galen.
I totally agree. I read the first entry and was amazed by the review, and thought that this might be my winner. After the second one, I already have no idea how to decide because both are amazing in their own way. Awesome work!
I always thought that Moliere's satirical line about how a sleeping medicine worked due to its dormitive virtue seemed a little harsh: the term "dormitive virtue" can be seen as a placeholder for some precise mechanism that will be discovered in the future. Perhaps 17th Century France, however, didn't have much sense of scientific progress, so my reaction that "well of course scientists will eventually figure out how this medicine's dormitive virtue works" would not have been natural to Moliere.
> As much as modern authors like to describe the humors as imaginary, Galen routinely talks about them as if he were actually collecting and measuring them!
I think it's not so much that the humors themselves are imaginary—they were referring to actual bodily fluids—but the way they classified them does not match any way that we classify bodily fluids today, and accordingly the properties ascribed to those groupings aren't necessarily going to correspond to anything we would recognize.
If I call several unrelated fluids 'phlegm' my ideas of how 'phlegm' works as a category can be anywhere from inaccurate to magical.
I read something many years ago, and unfortunately I have no idea how to find it again.
There was a doctor in the early 20th century who had some blood in a sealed test tube. After a while the components of the blood settled out, forming four distinct layers. The doctor understood what had happened in modern terms, but he also figured he had discovered what the ancients were looking at when they talked out the four humors.
This makes me wonder about something else: if what we call blood is actually mix of all four humors, how is bloodletting supposed to correct an imbalance?
> This makes me wonder about something else: if what we call blood is actually mix of all four humors, how is bloodletting supposed to correct an imbalance?
Blood being a mix of all four humors wouldn't require it to be an _equal_ mix of all four humors. If there's disproportionately more of some humor, it would reduce that humor's proportion accordingly.
If my blood is uniformly 26% phlegm, and you draw some of my blood, both your sample and my remaining blood will remain 26% phlegm. Maybe they thought it wasn't uniform, though? Maybe different parts of the body had different proportions?
The proportion within your blood would be unchanged, yes, but it would affect the amount in your body considered as a sum.
(I suppose I am taking it as assumed that the imbalance in question is one in the body as a whole, and that bloodletting was thus used for issues that weren't necessarily in the blood per se; I admit I don't know offhand if this is actually how the theory would be applied.)
As far as I know, it is true (at least in the opinion of the original physician):
"Robin Fåhræus (1921), a Swedish physician who devised the erythrocyte sedimentation rate, suggested that the four humours were based upon the observation of blood clotting in a transparent container. When blood is drawn in a glass container and left undisturbed for about an hour, four different layers can be seen. A dark clot forms at the bottom (the 'black bile'). Above the clot is a layer of red blood cells (the 'blood'). Above this is a whitish layer of white blood cells (the 'phlegm'). The top layer is clear yellow serum (the 'yellow bile')."
Fåhræus goes on to point out that the relative amounts of the four 'fluids' differ in samples from a healthy person and a person with bacterial pneumonia. From this sort of observation, he argues, you can see why Galen might have found humorism convincing.
"Today phlebotomy therapy is primarily used in Western medicine for a few conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda.
Hemochromatosis is a genetic disorder of iron metabolism leading to abnormal iron accumulation in liver, pancreas, heart, pituitary, joints, and skin. It is treated with periodic phlebotomy to maintain ferritin levels at a reasonable level so as to minimize further iron deposition.
Polycythemia vera is a stem cell bone marrow disorder leading to overproduction of red blood cells and variable overproduction of white blood cells and platelets. Its treatment includes phlebotomy to reduce the red blood cell mass and decrease the chance of dangerous clots.
Porphyria cutanea tarda is a group of disorders of heme metabolism with an associated abnormality in iron metabolism. Phlebotomy is also used to decrease iron levels and prevent accumulation in various organs."
I think like many other things that were done by trial-and-error, bloodletting worked well in some instances, so it was adopted as a panacea. It would seem to be a lot easier to draw off blood rather than the other humours, and possibly at times when drawing off blood it also allowed the escape of pus and infected matter, thus clearing out wounds and sites of infection. So when you don't have a lot of effective tools, the authorities all tell you this is the prescribed treatment, and sometimes it really does help your patient, why not continue to do it?
Charles Darwin's father Robert, a well-to-do doctor, told his son that he tried to bleed his patients less than the norm of the time insisted, but (IIRC) patients often demanded he bleed them like a respectable doctor ought.
This is related to what they did with the "four elements". Earth/Air/Fire/Water were still considered a pretty good elemental division up until the 18th century, but they had figured that "fire" wasn't quite right and it was this substance "phlogiston" that was released in burning. They also noticed, after centuries of trying to transmute metals, that each metal had an associated earth, and so they suspected that there might actually be multiple "earths" and not just one, with each metal being a compound of that earth and phlogiston. Similarly, Priestley had figured out two separate airs. The big innovation of Lavoisier was to realize that the metals are all *lighter* than the corresponding earths, and he suggested that one of Priestley's airs was actually compounding with the metals to produce an earth. Suddenly, we had about 18 of the modern elements, with just one conceptual shift from the earth/air/fire/water theory, and it was only a few years later that Davy proved that water was itself a compound of two airs.
I'd always considered that the classical elements might be better translated as states of matter (solid/liquid/etc.) than substances or chemical elements. (Though of course we've learned a lot about those since then as well and would still disagree with them on particulars.)
I believe that's true of the Chinese elements, but not the Greek. In the Greek system elements cannot transform into other elements; steam may look like air, but it's still water.
"and reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Terracotta is porous and liquid will slowly seep out, given time. (This makes it a great material for plant pots in the garden, not so amazing for storing water, but it is much, much, much cheaper than other forms of pottery, and romans used earthenware amphorae for many staples.) Dried grain likes to absorb water and will sprout or spoil in higher humidity.
So while generally I wouldn't expect this to happen, and certainly not quickly, if we were doing a Mythbusters-style experiment, there might be a conceivable set of circumstances where over a few weeks or something, some water would evaporate from the porous pots, and grain in close proximity might sprout or swell slightly - especially in a cellar or other environment where humidity might be able to build up.
This was my thought as well, but without the causality. He, or someone who talked to him, probably by chance happened to have corn and a pot of water near each other, and noticed the level of water went down and the corn seemed to swell. He either drew conclusions from this, or more likely performed an experiment that carefully weighed both of them at the beginning and after some period of time, and noticed the change. But without the notion of a control group: having a pot of water that wasn't near corn, and corn that wasn't near water, he lacked a full notion and assumed causality where there wasn't one. Water in a pot will evaporate regardless of corn, and dried corn will probably swell from ambient moisture regardless of whether or not there's a pot of water near it or not.
In a certain sense, he was right, if we disregard that the evaporation and absorption are likely to be mostly different water molecules, the net effect is kind of like absorption.
Under certain circumstances, there can definitely be causality. You put a bunch of water inside a closed shed, it'll evaporate a little and then stop because the air reaches 100% humidity. You put a bunch of grain inside a closed shed, it'll absorb a little and then stop because the humidity gets low enough that the water activity balances. You put both in the same shed, the process will continue until one of them is exhausted (either all the water evaporates, or all the grain has swelled up).
Desiccators exploit this principle, and raw grain/flour actually is a reasonable desiccant.
Great review but I would've liked to seen more research and or speculation into why someone with such apparent focus on empiricism got it so wrong. I think that's the most interesting question Galen's life and work presents, but I don't feel I have much of an understanding of how his well-intentioned experiments produced confirmations of theories so utterly and completely false. When he reported extracting phlegm, and observing protuberances and motions of the humors, what exactly was he extracting, and what was he seeing? I can't seem to wrap my head around a somewhat scientifically minded person looking into a cut open gladiator and thinking "yep, there are those humors Hippocrates was always on about".
Sometimes but I expect I'd find it more difficult to relate to people from Galen's day. Overall I think that line of thinking isn't that useful though, and reminds me too much of the main character from A Confederacy of Dunces.
Very engaging and entertaining stuff! The writing style is an impressive approximation of Scott's though a bit more casual and untutored. Great choice of topic and a nice brisk pace. It made for an effective introduction to the tone of Galen's work, though not quite so much to its content or significance. Humorism may be clear to the reviewer but it wasn't especially clear to me; I gather the "humors" are actual bodily fluids which Galen treats as having inherent properties? Also, I find the reviewer's first explanation for Galen's bad rep quite obvious and intuitive; the problem wasn't Galen, it was that there wasn't any other medical scientist with similar influence for another 1000+ years. Much of the review was like that: fun, accurate, and informative as to facts, but more vague and less insightful than I'd have liked, especially when it comes to the medical content itself. Still, that's understandable given it's a non-expert's book review, and overall I enjoyed it a lot.
"a Hippocrates stan" - translation, please. Is 'stan' American slang for 'fan'? The reviewer is a little too colloquial for my taste, but it is an excellent and engaging review.
<i>I see two possibilities. The first is that Galen’s followers may have really been as bad as people say. To take one example: Jacobus Sylvius, in the 16th century, was a huge supporter of Galen. When his student Vesalius called into question Galen’s knowledge of anatomy, by performing his own dissections, Sylvius rushed to Galen’s defense. Despite being the first professor to teach anatomy of the human corpse in France, Sylvius said that Galen had not erred, but “probably the human body had changed since then.” Further, he said that advance beyond Galen’s understanding was impossible.</i>
Are we sure that these sorts of stories are actually true? We've already established that this kind of "Huh huh, people before the present were a bunch of morons" sneering is false in the case of Galen himself, so it seems like we should be sceptical about it in the case of Galen's later followers.
"Nature (always capitalized)" - that is in the English translation. Galen's manuscript would have made no distinction between capitals and small letters, because that distinction did not yet exist in his time. I think the capitalisation is to distinguish the use of the Greek φύσις as a general organising principle rather than as the quality of an individual.
> To Galen, biology is all about these faculties shuffling, transforming, and combining different humors.
That sounds fairly tangible to me; it's an interesting contrast with the atoms-versus-forces dichotomy drawn later in the review.
I might also note that this would be an accurate description of our modern understanding of biology, if we called the humors "carbon", "hydrogen", "oxygen", and "nitrogen".
> Nature (always capitalized)
It seems unlikely that Galen made any orthographic distinction of this kind.
> I was going to suggest that maybe this quote might somehow be a mistaken bastardization of the “dormitive potency” line from Molière’s The Hypochondriac, since that’s what it reminds me of. But I looked and I actually wasn’t able to find that line in the play, so…
> electromagnetic fields, which look a lot more like one of Galen’s natural faculties (a tendency for mutual attraction over distance)
No, it's the other way around. Electromagnetic fields are local, that's what Maxwell's equations are about. That's how we get light. One can derive equations that describe attraction over distance from local equations given suitable assumptions about the medium, boundary conditions etc.
> You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…
This piece of flattery ought to have been removed by the editor. Scott, you're better than this.
Locality is different from the condition the atomists were after - at least some of them (particular Descartes) thought everything was mechanical, so that it always results from one material object displacing another through its motion, rather than allowing any sort of local interaction that involves attraction or twisting or the like.
Assuming that the fundamental forces all have 'carrier' particles (which I think is still the dominant intuition), the atomists don't seem wrong exactly.
My understanding is that at least some of the fundamental forces can have attractive interactions rather than just repulsive ones, but I don't exactly know how the carrier particles mediate that. There's probably some extra philosophical complexity here.
Oh, yes. Gravity is strictly attractive as far as we know. Electromagnetism is _both_ attractive and repulsive, depending on electric charges (which can be positive or negative), and is the only (potentially) repulsive force. I'm pretty sure the two nuclear forces (one of which, the 'weak' one, we're sure is 'fundamentally the same' as electromagnetism) are both attractive.
But I'm lost too on grasping how carrier particles mediate any of the forces! I don't _think_ there's a good 'gears level' explanation of how that works exactly. I get the sense that this is one of those 'that's how the equations' work kind of things modern physicists mostly just accept as-is.
The dominant picture, yes, but a poor description of the physics. It's still more similar to field-stuff interacting with other field-stuff than particles bouncing off each other.
Meh – there's so many formalisms, mostly for different 'levels', and thus a bunch of seemingly fundamental ontologies, which can't all simultaneously be 'true', but I'm not sure it's obviously really anything. 'Obviously', people exist, are real, it's 'true' that they're 'a thing'. But – from the perspective of 'fundamental physics' – they're 'just' a REALLY large number (relative to our current computational powers)of whatever, e.g. particles, field patterns.
'Particles' seem to emerge from the "field-stuff" – yes, they're not really much like our billiard ball intuitions, at least not in specific circumstances, but it's still a pretty powerful (e.g. useful) intuition.
But I agree that, fundamentally, all is "field-stuff" – or, I think more likely, whatever 'pixels' there are underneath the fields from which the fields emerge. (I think the field-stuff is obviously 'not real' just because of the mathematics.)
The electromagnetic field is local in a very technical way, so it doesn't seem (entirely) wrong to describe it as an 'attraction [or repulsion] over distance'.
We don't know which reviews they wrote. We don't even know if their reviews made the cut - Scott posted the list of reviews that did, in the previous open thread I think, so they might know if their reviews made the cut. But we don't know if they saw that list.
I looked through the last open thread and didn’t see a list of finalists. Did I just miss it?
I’ve also assumed my review didn’t make the cut, and as you say, I’m not in any way linking my name to my review.
Further, it seems to me the anon thing isn’t an absolute hard and fast rule. I’m sure that any half decent amateur sleuth could work out the identity of a fair number of reviewers. So what? It annoyed me slightly that there were commenters shouting that the first reviewers identity could be ascertained through the footnotes thereby creating a problem that didn’t exist before they started alerting everyone to the possibility. I think a healthy norm for the whole process would be ‘Don’t worry about anonymity, don’t look for it and don’t mention it’ I know, some people will find that difficult.
Thanks for that. I’m a little bit surprised that he only published that info for paying subscribers. Are we plebs not worthy of such info? Perhaps all the finalists are subscribers but my guess is that that’s unlikely and also doesn’t address the problem of only putting subscribers out of their misery..
But my prediction was correct! So my review will be in the repéchage with all the other also-fans.
Interesting review and approach! I felt like it was less of a straight book review and more of a "debunking" of what Galen said against what he actually said.
I am curious to know what Galen wrote about pregnancy in the text. I read parts of a different text of his, "On the Usefullness of the Different Parts of the Body" and found the description of why male and female bodies just reiterating the sexism of the time, and reminiscent of Aristotle's description of the female as "mutilated" man. Here's a section from the text:
"In fact, just as the mole has imperfect eyes, though certainly not so imperfect as they are in those animals that do not have any trace of them at all, so too the woman is less perfect than the man in respect of the generative parts…”
“… though making the animal itself that was being formed less perfect than one that is complete in all respects, provided no small advantage for the race; for there needs to be a female. Indeed, you ought not to think that our creator would purposefully make half the whole race imperfect and, as it were, mutilated, unless there were some great advantage in it.”
Not the reviewer (but I am a woman, for whatever that's worth.) I'm sure Galen's views of women were far from enlightened, but it wouldn't surprise me if this is majorly exacerbated by translation issues. For example, the word "mutilated" may have harsher connotations than the original used by Galen, especially if it was translated several times. And "perfect" was often used to mean "fully developed," with imperfect meaning "partially developed" or "in the process of development," which is somewhat different than defective or flawed. I found a slightly more complete version of the quote:
"Now just as mankind is the most perfect of all animals, so within mankind the man is more perfect than the woman, and the reason for his perfection is his excess of heat, for heat is Nature's primary instrument. Hence in those animals that have less of it, her workmanship is necessarily more imperfect, and so it is no wonder that the female is less perfect than the male by as much as she is colder than he. In fact, just as the mole has imperfect eyes..."
It's hard to tell without more context, but based on my experience reading older books, I would interpret it more like this:
"Humans are the most highly developed animals (in terms of capacities), and men naturally have more energy (physical strength/stamina) than women. As life expresses itself through the energy to act, an animal with more energy is more developed (it can give fuller expression to its capacities). Women are physically weaker, but that is because they are designed for a complementary biological role that prioritizes other things." (I assume he then discusses childbearing, but I can't find more of the quote).
Pretty sure he was just making the point that women are usually physically weaker than men, something that was more relevant when the main tasks of life were more physical. This was a pretty common framing (energy being the most important, and men having more of it, because women were optimized childbearing instead of constant heavy physical action) until the mid-19th century.
In looking for the quote, I came across several analyses focused on sexism, and they include some other comments that easily can be connected to sexist assumptions. That said, much of the actual analysis fails because it assumes that Galen should know certain biological facts that were not then obvious, and doesn't fully understand the paradigms in which he was working.
Basically, Galen noted that some of the reproductive organs of males and females were similar (as far as he could tell, given limited knowledge of how they worked). He believed the female ones were partially developed versions of the male ones (I'm guessing in the same way that male breasts would be partially developed female breasts). It seems like part of his sexist interpretation here likely resulted from the fact that he could not examine the female reproductive system very well, as it is mostly internal.
One source confirms the Greek word he used for "imperfect" is better translated as "unfinished," and also notes that Galen was essentially correct to define ovaries as female testicles--that this was an advance over Aristotle. But he thought they were "unfinished" because they "cannot emerge to the outside because their whole nature is weaker." This suggests he thought they *should* have been external, like men's, for some reason, and extrapolated from that that development was missing.
This assumption that women should have the same parts as men is seen as sexist presumptuousness, but it seems to have been a reasonable interpretation of what he thought he was seeing. He believed ovaries produced semen, not eggs, and this is also held against him, because why would a woman need a man to conceive if this were so? For a long time, one paradigm was that both men and women produced *different* types of semen, and it was their combination that resulted in conception! Galen believed that female semen was a "congenial nutriment for the male semen." The article keeps talking about how ridiculous it was to refer to "female semen," but it's only ridiculous from a modern perspective in which we define it as containing the uniquely male contribution of sperm cells. At the time, it was only understood to consist of some "energy."
It took a while to understand the release, fertilization, and implantation of the egg, because you can't easily see it happen. Because of this, they were also really confused about the purpose of menstruation--well into the 19th century, some paradigms did not connect it to the release of an egg--the 19th century theory was that it was essentially the release of a placenta prepared for a pregnancy that did not happen, and that this depleted a woman's intellectual energy, which was a rationale for not encouraging too many intellectual activities for women.
Aristotle thought humans used energy to turn their blood into semen, and that, as women had less energy, this was not successful, and somehow resulted in menstruation. Galen doesn't seem to have believed this, because he literally thought men and women had the same organs, with the female ones being inverted and unfinished. Turns out he did make a note that this was the opposite of the case for breasts, which he could not explain (though the reason should be pretty obvious). I don't know what Galen thought menstruation was, but the article notes that da Vinci believed that the reason it ceased during pregnancy and breastfeeding was because it was converted into breastmilk! Sorry for the long response, but thought it was pretty interesting.
He may have never properly examined *human* female reproductive organs, but I would think from his work on animals he had a good understanding of how everything looked.
Semen means seed in Latin, and the ovaries do produce seeds that combine with seeds from the testicles to produce children. It sounds to me that he got remarkably close to the truth for someone without access to a microscope.
"Semen means seed in Latin"---thanks for adding that---should have looked it up. "and the ovaries do produce seeds that combine with seeds from the testicles to produce children." Yeah, to me, this is the exact same thought process as "male and female DNA combine to produce an embryo"--modern have better information as to the specifics, but there's no reason to think they are capable of a higher level of understanding than Galen was. I'm sure that if we were able to bring him here via time machine and explain what we've discovered, he'd be able to understand it pretty quickly.
"It sounds to me that he got remarkably close to the truth for someone without access to a microscope." I agree--seems like he thought it out as well as was permitted by the available knowledge at that time. The feminist critiques mostly revolve around his failure to appreciate the unique reproductive role of the woman (as in, thinking of functions she might possess independent of male ones.) But even though he suggests women were basically "incubators" in which the "seeds" could develop, with the uterus and ovaries not having much complexity to them, "incubation" is a pretty important non-male function! And he must have been aware that mothers had genetic influence on their offspring.
They're basically expecting him to have a modern concept of DNA or hormones, but these are very recent discoveries--a semi-detailed understanding didn't exist until the 1930s, or at least that's the impression I get. Without this knowledge, the idea of hyper-specialized functions makes less sense. Some later doctors were far more deserving of such criticism, clearly influenced more by social assumptions than any honest attempt to figure out medical reality. (Many of them also made ridiculous medical assumptions about men, though--there weren't really any winners in pre-modern medicine!)
> But he thought they were "unfinished" because they "cannot emerge to the outside because their whole nature is weaker." This suggests he thought they should have been external, like men's, for some reason, and extrapolated from that that development was missing.
Note that testicles actually start inside the body, and then drop into the scrotum (sometimes after birth!). I’m pretty sure most animals are similar; he might have noticed that, which would be a pretty good reason to think that “this is what they should do, women’s didn’t finish the journey”.
In the absence of sex hormones (e.g. in a fetus before they've had a chance to work, or in an androgen-insensitive XY female) you get genitals and body plan which read to us as female - albeit of course infertile, possibly lacking secondary sex characterise such as breasts, etc.
Misinterpreting this as a natural progression towards the "perfect form" of man, which is then interrupted in women, is very Greek.
"[Galen] refers to different types of blood and suggests that there is a 'sweet' phlegm and a 'bitter or salty' phlegm, the former useful to health and the latter dangerous." I only skimmed the review, so maybe I missed it – but was Galen in the habit of tasting bodily fluids? Was that a "thing" during his era? If so, yuck.
To state it outright "mellitus" is from μέλι (meli), the Greek word for honey. Ancient physicians *definitely* tasted bodily fluids.
There's another kind of diabetes mentioned in medical textbooks: diabetes insipidus. Called that because the urine tastes bad aka isn't sweetened by excess glucose as it's unrelated to insulin.
Something Scott wrote previously gave the example that if you wanted to convince an 11th century bishop of something we now hold to be common knowledge, you would have to explain every single assumption that the two of you don't share for you to even begin to make sense to him. A common claim that follows from this is if you talked to a medieval commoner, you'd have so little common ground that it'd be like talking to an extraterrestrial.
The fact that we have writings from almost 1900 years in the past that show us a shockingly relatable academic mindset makes me really hopeful that the essential human experience is more constant over the centuries than I previously thought. I don't know why, but it makes me happy to know that I could have a real conversation with someone born more than a milennium previously. Maybe it means that humans of the future might not end up being too different from us either.
"Something Scott wrote previously gave the example that if you wanted to convince an 11th century bishop of something we now hold to be common knowledge, you would have to explain every single assumption that the two of you don't share for you to even begin to make sense to him." I remember reading that, and, if I remember correctly, I was impressed that it was true in the specific example, because so often that kind of claim is dubious or false.
I definitely think the human experience is more constant over centuries than is generally thought to be the case in intellectual circles. Someone like Galen is an exceptional person in any age, but, at least since we've had writing, we have evidence there were always some people like that around. I read mostly 19th century American stuff, which I know is pretty recent, but I see the full range of modern human thought in play back then. In particular, every shade of annoying human behavior was catalogued *very* early on, because that's what most people complain about. Galen references what the proverb says about madmen--the Bible is full of rants about that, and about people who pray loudly in the streets to show off, etc. People weren't incapable of reflection and skepticism.
In any era with a literate culture, some small number of people will always independently arrive at insights that allow them to experience the general range of human thought, even if they express them in a way that is hard to recognize or don't have the tools or reasons to fully develop them. (I'm not saying cultures that are not literate cannot produce people who do the same, but the evidence is obviously harder to come by, and there's less reason to produce elaborate explanations for general audiences).
Back in 2016, I tried to track down the "fails in incurable cases" quote (I remember I was set off by some mention of Galen in SSC, but I couldn't find it now). I found a cluster of citations significantly earlier than 1998, with the most prominent one in this article by Hans Eysenck from 1960: https://archive.org/details/handbookofabnorm029075mbp/page/n709/mode/2up?view=theater (on the first page of the article). The earliest mention I found was from 1941 (but I didn't retain the reference).
Earlier quotes typically mention specifically "Samian clay" as the substance, and by looking over Galan's work, I convinced myself that if there's a chance of his actual texts containing it, it has to be in Galen 12,178, inside Book IX of "De simplicium medicamentorum...". This has not been translated (AFAIK) and while the original text can easily be found on Google Books, I couldn't easily read it, and abandoned the task back then.
I enjoyed the review of the text, but take issue with the framing device of defending Galen from his detractors. Was he really the "whipping boy of all doctors"? The one quote from Bacon and the line from Tetlock seem slim evidence, especially since Galen is *the* doctor of the ancient and medieval world. My impression of Galen's reception had been that he was and is pretty universally recognized a genius and a kind of Aristotle of medicine. Is there a tradition of criticizing Galen in the Rennaissance? Or is he a popular target for rationalists in particular?
Thanks for raising this question. I blindly believed the reviewer and was rooting for "Galen the Underdog" from the get-go. Definitely a clever literary approach by the reviewer, if somewhat misleading.
What does modern academia say about Galen? Surely there's a historian of science/historian of medicine somewhere who knows all this and has written about it.
"Surely there's a historian of science/historian of medicine somewhere who knows all this and has written about it." There may well be one, but in my own historical research, I've found it's not safe to assume that's "surely" the case. There are just huge gaps in scholarship due to people parroting secondary sources without ever bothering much with the primary sources.
There are various factors that make it more or less likely for a given person/topic, but many scholars really do assume that people in the past had no idea what was going on, so they don't really become curious about dismissive remarks. The best scholars tend to be the ones who think like the author of this review--they notice a portrayal doesn't quite and add up, and end up doing a "search and rescue" mission. I do historical research as a hobby, not professionally, but my technique is pretty similar to what is described here, and it's crazy how many people or concepts have been the victim of "hit jobs," with few realizing it. And I was stunned to find how easy it was, after some effort, to follow the thinking of people from earlier eras, compared to what I'd been led to believe. In fact, as this author said at one point, they often explained their own views much more clearly than modern summaries did.
I think that, most of the time, the reasons for this tend to be kind of random and related to structural incentives, like the speculations given in this piece. The ease of doing deep and comparative research, due to searchable online databases and other such things, has recently caused a major shift in the incentives, so I expect to see more of these high-quality "setting the record straight" pieces. I've already seen quite a few during the pandemic, as people have had more time to dive in.
I have thought about it, but I'm much better at writing than I am at doing video or podcasts. Maybe I should look into it more. Or find a collaborator who is good at those things. Thanks very much for suggesting the links!
Gianna Pomata's chapter, "Observation rising : birth of an epistemic genre, ca. 1500-1650" in Lorraine Daston & Elizabeth Lunbeck (eds.), Histories of Scientific Observation gives a very interesting account of the influence of Galen's empirical practice on very early scientific culture. Despite many gaps in the written record, it's possible see hints of a continuous empirical tradition in medical practice in late antiquity and the medieval period that influenced the formation of early scientific culture in Europe. The route goes by way of Islamic medicine in the lands that had been part of the Byzantine empire, and then, via European cities with ties to the Islamic world, into Italy, where medical empiricism (observation and reporting of details individual cases) mixed with astronomical practice to produce changes in how early science conceived of the role of evidence in supporting theories. From Pomata I learned that [in 1551 the Jewish physician Amatus Lusitanus, teaching anatomy at Ferrara, began publishing his _Centuriae curationum_ introducing to scientific culture the genre of the medical case narrative, an enterprise that he carried through seven volumes]. (The part within the brackets is more or less a quote, but may not be exact.) Definitely worth reading the entire Daston and Lunbeck volume if you want to plunge into the history of empiricism in science.
(Formatting note: If I'm reading it right, each quoted paragraphs in section IV (which is incorrectly labelled section VI) are from different parts of the book, but as formatted they look like they're contiguous. I think there should be line breaks between them, with the blue indentation bar on the left broken up into five smaller bars.)
This was a very interesting and enjoyable review. Thank you.
But I went to read the wikipedia, and then did some googling and I'm not immediately finding this negativity towards Galen that is alleged, although I expect that I won't find negativity towards Aristotle in this way either, and it definitely exists (I've encountered it in college classes).
Thanks for this review, it was really interesting!
I can totally imagine servants stealing Scott's emails and publishing them.
A lot of the direct quotes resonated with me as eerily similar to Maimonides (the Rambam) writing in "Guide to the Perplexed", written about 1000 years after Galen (originally in Arabic). He is also a doctor, discussed philosophy, and follows Aristotle everywhere he can without contradicting his beliefs [Jewish orthodoxy a-la 1000 AD].
The paragraph about white-black motion could have been a direct quote from "Guide to the Preplexed" - maybe they are both quoting Aristotle? If they're both paraphrasing, their styles are almost identical.
Maimonides also does the exact same thing when arguing with different sects in his book, dissing them and complaining about how foolish their ideas are, and yet that he must refute them in the text.
Anyway the parallels just seemed stark enough that I though I'd mention them.
I don't think you have to suppose they're linked indirectly via Aristotle. Maimonedes himself seems to have written a Book Review of Galen, titled 'The Art of Cure - Extracts from Galen'.
The supposedly apocryphal “It is obvious, therefore, that it [medicine] fails only in incurable cases” quotation may be a boiled-down or adapted version of this, from Galen's <em>Ars Medicinalis</em> 1:3: "Medicine is an art that cures the sick, or lessens their pains, and which has nothing to do with incurable diseases".
Later in the same section he says: "it appears that medicine has an appropriate means of discovering the mode of cure, or at least of assuaging the sufferings of disease; and that it is not deficient in substantial reasons, for declining those that are incurable, or at any rate, of overthrowing the unjust reproaches made against physicians when unsuccessful in such cases."
But did Galen’s treatments actually work? What did his empiricism accomplish? I have a vague impression that most pre-modern medicine was worse than nothing.
Pre-antibiotics medicine wasn't very effective; surgery was a bit better but you still had problems there with blood loss and infection. Before we had effective treatments to kill disease-causing agents, what you had was painkillers, things to reduce fever, and basically 'wait and see' - the old jokes about "nature provides the cure, the doctor takes the fee". Some of Galen's treatments doubtless worked on an empirical basis, some did not, but he did the best he could with the knowledge at the time and tried to advance it. That was a worthy effort.
I see a lot of comments about the contest writer's style being similar to Scott's. I realize that these comments are meant as compliments, but they are a bit patronizing. This writer had very much his/her own voice and style. There are infinite ways to combine humor, insight, and coherence.
This was a very good review! I very much enjoyed the quotations from Galen, and as I find so frequently the people from the past are be intelligent, empirical, and rational. The most important difference between them and us is we have been somewhat better at not creating hero worship of previous scholars. The dark side of the current system, which incentivizes novelty and departing from tradition, is that we rarely return to old works to find the new insights and ways of reconceiving and questioning current paradigms.
There are a few mistakes about Aristotle in this article which I want to clear up. Galen's discussion of the faculties derives primarily from Book 2 of Aristotle's De Anima. In that book Aristotle describes all of the major sensing faculties of human and animal organisms, and tries to give an account of how each of these faculties operates. Aristotle's conception of the soul, by which he means the living organism, is as a bundle of faculties or capacities. Galen's taxonomy further divides and subdivides these faculties, carrying on the work that Aristotle had started.
Aristotle also discusses and argues against atomism at length throughout his corpus. And most of all of his works Aristotle begins by discussing the theories of all the previous philosophers and natural scientists have come before him. This always includes the atomists whose accounts he gives reasons for rejecting. In De Anima book 1, for example, he says the atomists hold that animation is a quantity or a number, and he then objects that it impossible to derive from a number observed facts like reason, sensation, pleasure, and pain.
Aristotle is far less essentialist than most people assume. Reading him reminds me of reading an intelligent and structured blogger trying to work out some of the big questions. Like Galen, we should just read him, and then decide what we think. Instead of relying on hearsay.
Is it just me, or does Galen sound like a sort of Scott Alexander of his time, if Scott had bad AD&D and was the celebrity Surgeon General to an Imperial Presidency?
I don't think Aristotle on medicine is read much either. Some folks use the four humours as personality types, which is fun, but that has more to do with Jungian classification than Hippocrates. Notice that the Hippocratic oath has not waned with the passage of time. This implies that chronological advance does not entirely replace even ancient insights. We should remember that Aristotle conducted one of the first great experiments - observation of a natural process; in his study of how chick embryos develop.
Greg Cochran likes to point out that medicine was a thriving profession which people sought out for thousands of years... even though it made people worse off on average (Nassim Taleb theorizes that religion provided a benefit by redirecting people away from doctors). So even the best of ancient doctors might have better spent his time as an architect.
The geologist Steve Dutch points out some basic conceptual problems in Aristotle's science here:
As always (the entire POINT of this review) how was this claim “made people worse off on average” arrived at? What possible evidence is there to prove for, say, Rome in 150 CE?
I think it's based on looking on how the actual techniques of the past have been analyzed with more modern rigor. Bloodletting is only helpful in extremely rare situations, but believers in medicine based on "humors" used it frequently.
We have no idea what the default strategies were for various diseases, or how precisely they were implemented. All we know is a few cases (recorded because they were conventional? Or recorded because they were exceptional?)
If Galen is doing a substantially better job with the gladiators than his predecessor, then "better" is clearly possible. At which point one needs to distinguish between something like "the best known medicine" vs "what's done by lousy practitioners".
Extrapolating from "bloodletting is usually not helpful" to "medicine made people worse off on average" seems a hell of a stretch, including, for example, an assumption that bloodletting was the primary tool reached for in any and all disease situations. Toothache? Cataracts? Diarrhea? Snake bite?
I'd much rather we simply admit "we don't know! don't know much about the medicine, don't know much about the treatments, don't know much about the outcomes, don't now much about the expectations" than the faux-certainty that's implicit in a statement like “made people worse off on average”.
It's not just that bloodletting is usually "not helpful", most doctors nowadays would expect to make it worse. It was fairly central to medicine under the theory of "humors", and continued to be used not only for the ancient Greeks but also Charles II & George Washington:
It's noted in the post up top that the same doctor blinded both Bach & Handel.
If Galen is doing a better job than his predecessor, then perhaps his predecessor was astonishingly worse than doing nothing. We know from Semmelweiss that lots of doctors killed women giving birth while poorer women reliant on midwives fared better. And it seems doctors during the Civil War also made their patients more likely to die:
But you're falling into the same pitfall as the concept that triggered this review, the assumption that people in the past were idiots.
I agree that people fall into multiple delusions about things with complicated causality. And that people have a "do something, anything" bias in certain situations. Even so, the causality between "person about to die" and "person now dead" is frequently not one of those difficult cases.
Or, to put it differently, I don't understand how we're simultaneously supposed to believe that metis is so awesome, able to figure out the right way to cook cassava, or how to balance beans, corn, and lye, yet also believe that people are going to continue engaging in practices that have a significant, observable, effect on fitness generation after generation.
Once again, I ask you to consider the difference between "medicine" and "an ignorant dick". John Taylor seems to be the equivalent of (and thought of as such) someone like Dr Oz -- a charlatan who has the combination of charisma and shamelessness to persuade the rich and famous to believe whatever he says.
Ignorant dicks will always be with us. But they are not the whole of humanity, or of any profession.
The whole of the profession effectively did turn against Semmelweis. He died in an insane asylum while the doctors he accused of killing mothers continued killing mothers.
Now to reconcile that with metis: the people with metis were the midwives. Doctors had only gotten involved in birthing recently, and only for wealthier women. In the past science wasn't good enough to determine much that actually made people healthier, there was essentially just regression to the mean (a concept nobody knew about prior to Galton) and bodies naturally healing. But there were still some people wealthy enough to pay for doctors even though they didn't do any good.
I forgot about the vivisection. I probably wouldn't have asked if I remembered.
That said, I don't know enough psychology to identify whether it's a true trigger. As I understand it, a "trigger" is something that sets off someone's mental health problems. The examples I've seen are all reminders of awful things that have happened to the person in question, so I don't know if an awful thing happening to an animal would qualify.
Does it sound like Galen was something like a modern scientist who constantly publishes his findings and theories and his reasons for believing them, whereas most medical experts before recent centuries tended to see their ideas as something like trade secrets to pass down to their trusting apprentices.?(You can see this trade secret tendency in Newton keeping his invention of calculus his personal secret until Leibniz happened upon the same great advance.)
If so, then subsequent medical experts seemed to adopt Galen as their master who supplied them with a huge framework of quasi-trade secrets that, perhaps, were protected from too much competition by the volume and disorganization of Galen's writings. (Or, alternatively, there was a good living to be made by developing a reputation as a medical sage by publishing easier to read summaries of Galen's work.)
It seems as if the problem with Galen was less that he was a dogmatist (he was, by the standards of his time, less dogmatic than many of his rivals) than that subsequent generations for 1500 years wanted dogma. So we ended up getting Galen elevated to the supreme authority, when what we really needed were one, two, many Galens arguing it out.
How much was the problem with medicine until about, oh, 1880 being that doctors and patients were made uncomfortable by medical controversy? Everybody felt better when doctors talked as if all of their ideas were incontrovertible -- as Dr. Fauci and President Biden like to say: "Follow the Science!" -- rather than admit that these were preliminary speculations, which might be falsified in the future. Over the last 14 months, I've noticed that lots of people want to believe that whatever The Science tells them at the moment -- coronavirus is spread by touching surfaces, ventilators are our only hope, or whatever -- is the only possible truth, while other people want to reject all knowledge. Trying to stay in the middle between credulity and nihilism has been a lot of work and been rather discouraging, as many of my preliminary hypotheses have been proven wrong by subsequent events.
Maybe doubt and humility is not what people look for in the personality of doctors?
In recent times, we've largely separated the roles of medical researcher and medical practitioner. E.g., nobody expects medical practitioners to be innovators on mRNA. (The big exception are surgeons: e.g., surgeon Frank Jobe invented Tommy John surgery in 1974.)
But in the past, the two roles were conjoined. So, a lot of the personality traits we prefer in doctors (self-confidence, decisiveness, etc.) were found in medical theorists as well, since they were one and the same.
I also once tried to find the line about "dormative properties" in Molière's Hypochondriac (or The Imaginary Invalid). I found it in a scene which is entirely in Latin, and which is left out of English translations. Perhaps the jokes don't translate well into Germanic languages.
Great review - incisive and humorous 😉 I had heard of Galen, but knew very little about his life, work or status as enlightenment whipping-boy. Inspired to open up some animals now...
Since you are knowledgable in that matter, could you comment on the following narrative (I have heard it several times, but can't point to a specific source).
Before the Renaissance, there was a very strong scientific tradition in Europe (especially in catholic church, which hosted most of European science in these days) that you were supposed follow the ancient sages like Aristotle. You were allowed to re-interpret them, but not to extend past their knowledge/understanding, and you were supposed to not question them.
With Renaissance (and even more, with enlightenment), a lot of people started seeing this as a bug, not a feature. They began to question the ancient authorities. One of their methods (perhaps as part of a cultural war? I don't know) was to make up really bad stories about everything associated with the old tradition that preceded Renaissance . This included in particular old science (Galen?), the middle ages (the name "Dark Ages" switched its meaning to "intellectual darkness" about that time), and the catholic church.
So they invented a lot of stories that were either plainly wrong ("There was no technical advancement in the middle ages") or so distorted that they sounded horrible ("Galilei had a brilliant scientific insight, but Catholic church opposed science and suppressed him"). Since they were the winners, the stories maintained, and except for knowledgable historians, they became Common Knowledge.
I am inclined to believe the narrative, but I am not sure. It's probably quite simplified. But then I share your impression that a lot of Things We All Know about middle ages in Europe are wrong, and this wrongness seems to go quite systematically into the same direction (middle ages were horrible, Church was Evil). I am sure that there are a lot of wrong Things We All Know about other topics, but I don't have the feeling that it's so systematic or runs so deep.
There's a few significantly different issues around here.
The people we now call the "Renaissance" (mainly Tuscan humanists of the 15th century) had some revolutions in art and philosophy, as well as beginning the translation and study of Ancient humanist texts, but they often erase the "Renaissance of the 12th Century" in which Ancient scientific texts were revived: https://en.wikipedia.org/wiki/Renaissance_of_the_12th_century
Rene Descartes criticizes the Scholastic philosophers of the 16th century as just doing epicycles on Aristotle, while he is the first person to think truly new thoughts - and his work was influential enough that the history of philosophy is often taught that way. (Students are required to take a class on "Ancient philosophy" and a class on "Modern philosophy", which usually means Descartes to Kant, as well as contemporary philosophy, but Medieval is usually purely optional.)
The "Dark Ages" refers most specifically to the period from the 5th to 8th century in Europe, when Germanic kingdoms took over the various parts of western Roman territory, but the ruling class didn't keep written records of things until Charlemagne. There's not much evidence that this period was that much worse for people in any way - just worse for historians who like written records.
So there's a lot more complexity to these rules - the Renaissance thinkers were actually much more into hero worship of the Ancients than the people that preceded them. But there's also usually a lot more continuity between each period and its immediate predecessors and successors than the self-told stories really make clear.
I see. So it's probably not true that medieval scholars focused more on tradition and ancient texts than Renaissance. In some sense, this should be obvious, it's in the very name "Renaissance". Nevertheless, I have heard this claim several times, so I still wonder where it comes from.
As far as I get it, the "Renaissance of the 12th Century" was in fact only one of several medieval Renaissances. It seems more like it went in and outside of fashion several times, and the standard "Renaissance" was only one such wave.
For the term "Dark Ages", I disagree. I do agree that among historians, it means "period with few record". But that is not how the general public uses it, and I would claim that even non-historian intellectuals don't use it that way. According to wikipedia https://en.wikipedia.org/wiki/Dark_Ages_(historiography), the idea of intellectually "Dark Middle Ages" became popular during Enlightenment (though it existed earlier), and the idea remained so strong over centuries that historians eventually stopped using the term because readers kept on misunderstanding it. (Also, by the same source the restriction of the term to Early Middle Ages came much later, in 19th and 20th century.)
Renaissance scholars tended to hero worship the ancients such as Plato (thus we refer to scholarship as "research" rather than "search" because the assumption was that the ancients knew it all and we just have to recover their learning) and criticize medieval scribes who made less that wholly faithful copies of the ancient originals.
During the Renaissance (perhaps especially after the invention of the printing press in the 1450s), scholars noticed that they often had more than one version of ancient texts due to imperfect copying by subsequent scribes. Critical methods had to be invented to figure out what the original text most likely said. From there, criticism continued to expand as a habit of mind. This growing critical spirit is noteworthy in distinguishing the last 600 years in the West from the intellectual framework of other times and places.
https://slatestarcodex.com/2017/10/15/were-there-dark-ages/
There's an old SSC post where Scott looks at this issue and rejects both the thesis that the Medieval Era was an undifferentiated time when everyone in Europe had the plague and spent their whole lives covered in mud, and the antithesis that the end of Antiquity was barely noticed by anyone outside of a small literati.
Cool, thanks! And the comments on that old post are even better than the article! Lots of expertise. :-)
When did Galen finally go out of fashion? Wikipedia says humorism fell out of fashion in the 1850s:
"Humourism began to fall out of favor in the 1850s with the advent of Germ theory which was able to show that many diseases previously thought to be humoural were in fact caused by pathogens."
https://en.wikipedia.org/wiki/Humorism#Western_Medicine
https://slatestarcodex.com/2015/08/09/contrarians-crackpots-and-consensus/
Also the black boxes in https://slatestarcodex.com/2019/02/26/rule-genius-in-not-out/
A very clear review and one palatable to my tastes due to the subject, thank you for this!
I thought this was an excellent book review on an interesting subject. Thank you!
If this has inspired anyone to want to know more about Galen, NYU recently launched a very nice online exhibition about him: https://galen.nyu.yourcultureconnect.com/e/home
> Nature takes on the exact same role in his arguments that evolution would take on in ours:
> “Your school of medicine says that the ureters don’t do anything? Then why are they there? We know that this animal was created by Nature, why would she include these structures if they were truly useless?”
I mean, you could also substitute in "God" here. Saying that Nature wouldn't be wasteful isn't any more of an explanation than that would be; I don't think it's worth giving any credit for this. (And of course, on occasion, nature *is* wasteful...)
Am I the only one who saw that line and immediately went "wait but what about the appendix?" heh
Interestingly though, the appendix may have some purpose in maintaining gut bacteria and repopulating it after infections.
Fair enough, but I suppose my point was vestigial things in general, for example how some humans are born with "throwback" tails or an extra finger. I just get a little white knuckle about the "intelligent design" implication here.
There are definitely "intelligent design" vibes, but it doesn't strike me as all that wrong to think this way from an evolutionary perspective. Nature *isn't* wasteful--it's just not efficient. People evolved fingers for a reason, and having an extra one is just an indication that the formation process went a bit awry. "Divine creation" proponents historically had more trouble explaining such things in themselves, preferring to say "God gives us our burdens to bear, to teach us humility," etc.
Galen probably didn't know about the appendix, since pigs don't have them, and Wikipedia says the first recorded appendectomy was in the 18th century CE
It's an argument that experience shows to be worth *something*, but which, taken as an absolute, rests on the Aristotelian teleological framework, which showed itself ultimately fallacious. Another reason why Galen got "cancelled" in Cartesian times (... and then of course later developments showed that nature sometimes does behave, in some specific ways and contexts, *as if it had* a purpose; natural selection here, law of least action there (but one has to be careful not to overstate the extent to which this can be true)).
<i>It's an argument that experience shows to be worth *something*, but which, taken as an absolute, rests on the Aristotelian teleological framework, which showed itself ultimately fallacious.</i>
Though I can't help but notice that claims of Aristotle's fallaciousness are generally very similar to claims of Galen's stupidity -- in both cases, people don't show more than an extremely shallow acquaintance with the original sources (if they show any acquaintance at all), nor do they stop to consider how such an alleged idiot was able to amass the kind of following he did.
Well, Aristotle's views were reasonable enough; why expect a mechanistic world-view to impose itself in an era before machines? Everyday intuition came from interactions with living beings, many of which clearly have a sense of purpose.
I read a very interesting paper by a physicist which examined Aristotle's actual theories and concluded that they were a fairly good, nonintuitive description of motion in fluids. I think that this link is it:
http://faculty.poly.edu/~jbain/mms/texts/15Rovelli_Aristotle.pdf
Teleology is an inescapable feature of the world; the question is whether you want to locate it in objects themselves, like Aristotle thought, or whether you think it's imposed on them by God, like the mechanists did.
Armand Marie Leroi's 2015 <a href=https://www.amazon.com/Lagoon-How-Aristotle-Invented-Science/dp/0143127985/ref=sr_1_1?crid=IGNGS584OZ4O&dchild=1&keywords=the+lagoon+how+aristotle+invented+science&qid=1618322177&s=books&sprefix=Aristotle+lagoon%2Cstripbooks%2C153&sr=1-1>The Lagoon: How Aristotle Invented Science</a> is an interesting and remarkably sympathetic attempt to set forth exactly what Aristotle believed and why he believed it. Leroi does for Aristotle what this reviewer did for Galen. With the major diffrence that he could read everything Aristotle wrote (well, everything that survived).
https://scienceblogs.com/evolvingthoughts/2008/09/16/aristotle-on-the-mayfly
Here's someone fisking Aristotle's actual writing (or at least an English translation of it): http://stevedutch.net/pseudosc/greekswrong.htm
Like I said, "An extremely shallow acquaintance with the original sources". To take but one example, "All natural bodies and magnitudes we hold to be, as such, capable of locomotion" doesn't, despite the fisker's bluster, contradict "the geometric description of motion is accidental, not essential". It's the ability to move (or be moved) which Aristotle thinks belongs to natural bodies and magnitudes by nature, not the precise form which this movement takes.
Aristotle does think the precise form must be a combination of linear & circular, and it's THAT which Dutch insists is "accidental" rather than essential.
So he does, my bad. Though since he also says that "Yes, you can describe all motion as a compound of linear and circular motion", I'm not sure why he thinks Aristotle made a massive howler in saying exactly the same thing.
My impression is that either Aristotle was not as great of a prose stylist as Plato was (whose dialogues remain highly readable after 2400 years), or that much of what we have of Aristotle's are lecture notes written up by his students from their notes. Also, whatever Aristotle wrote in dialogue form hasn't come down to us, which is an unfortunate loss because dialogues tend to be more fun to read.
For what it's worth, Cicero at least considered Aristotle's dialogues to read "like a river of gold" due to their eloquence.
I'd frame this as: yes, teleology as applied to the products of evolution is an imperfect heuristic. But relative to the state of medical science in Galen's time it was pretty darn powerful and accurate, and it sounds like he got a lot of mileage out of it. One can say "modern science shouldn't operate on teleological heuristics" without faulting him for his approach.
> I mean, you could also substitute in "God" here. Saying that Nature wouldn't be wasteful isn't any more of an explanation than that would be; I don't think it's worth giving any credit for this. (And of course, on occasion, nature *is* wasteful...)
It's not really an explanation; it's something far more valuable: a belief that (relatively) consistently pays rent in valid predictions. It's predictions are (as you say) wrong on occasion, but they're far more often right.
This is especially true on the organ scale, which is all Galen had access to confirm its predictions. Organs are enormously expensive to evolve, and so are literally never evolved without a purpose (and very rarely lose that purpose without being coopted for something useful anyhow.)
Indeed, Galen's principle here was generally more accurate in its predictions than pre-1950s evolutionary theory. The recognition of the possibility of vestigial organs led to far more erroneous predictions of vestigiality than correct ones.
It is an explanation though. It's not a good one compared to the explanations we have available today, but it's a theory that distinguishes the world we live in (where most parts of most living things have some purpose) from a very large number of worlds we don't live in (where it's normal for living things to have lots of pointless organs).
A great review. One comment: Bacon was writing during the time when William Harvey was trying to disprove Galen's model of circulation and encountering a lot of resistance. Maybe Galen got cancelled by Harvey partisans, or just acquired a bad reputation for being on the wrong side of this argument?
https://pubmed.ncbi.nlm.nih.gov/21781247/
> “Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.
I don't know whether it was the earliest, but I know of an earlier thinker who basically invented survival of the fittest way before Darwin (okay, admittedly without all the details): Empedocles (a Pre-Socratic philosopher)
"He knew that there is sex in plants, and he had a theory (somewhat fantastic, it must be admitted)
of evolution and the survival of the fittest. Originally, "countless tribes of mortal creatures were
scattered abroad endowed with all manner of forms, a wonder to behold." There were heads
without necks, arms without shoulders, eyes without foreheads, solitary limbs seeking for union.
These things joined together as each might chance; there were shambling creatures with countless
hands, creatures with faces and breasts looking in different directions, creatures with the bodies of
oxen and the faces of men, and others with the faces of oxen and the bodies of men. There were
hermaphrodites combining the natures of men and women, but sterile. In the end, only certain
forms survived. "
(Bertrand Russell: A History of Western Philosophy)
Great quote. I do wonder what's going on with the weird double spacing though.
> He knew that there is sex in plants
Everyone in the ancient world knew this; it's important to anyone who wants to grow fruit.
Super interesting, easy to read, humorous (heh heh) -- and not an idea I would have had, to review a book by an ancient author and compare what he actually said with what it's often claimed he did.
I wasn't interested in reading the reviews at all -- "no one ever picks books I'd be interested in, and few have the touch that makes a review enlightening *and* entertaining; hmph", thought I -- but this changed my mind. Thanks for this, anonymous reviewer!
Hm, do you think Scott's book reviews make your cut? For consistent enlightertainment (making that word up) I think his reviews are rarely surpassed; usually it's one or the other: https://slatestarcodex.com/tag/book-review/
I find book reports a hard sell when I tell people about SSC/ASX, but frankly I think this aspect is one of the freshest and most interesting things the Internet has to offer in <current year>.
I really enjoyed this. It was lively, engaging, thoughtful and intelligently written. Quite Scott-esque at times.
I read it too fast because I wanted to get to the end so I could comment, but I'll read it again at a more leisurely pace and I'm already looking forward to the prospect.
Excellent stuff.
I understand that in Galen's time, Alexandria was the place to go to learn medicine, because they didn't mind cutting up dead bodies at the med school there.
For a similar reasons, it is surmised that Galen took a job doctoring up gladiators because it gave him a more...hands on insight into human anatomy and how it worked.
Of course, Aristotle was way off on a lot of things, but he was considered an authority for longer than Galen was.
Really good book review. Make me aware of a book I should be interested in, tell me where you're going with this and why you're reviewing it, then make good on all those promises. I feel like I know a lot more than I did before. I also really appreciate going back and reading a foundational text rather than just something new and modern and trendy (not that there's anything wrong with the latter, just that we don't get enough of the former).
"All who drink of this treatment recover in a short time, except those whom it does not help, who all die. It is obvious, therefore, that it fails only in incurable cases.”
Without context, the above can easily be interpreted as mockably fallacious. But Galen was talking - whether he was right or wrong - about a specific medicine, not proposing a logical syllogism. There is a factor which is potentially empirically relevant, i.e. the short recovery time after drinking.
Consider, for example, the Heimlich manoeuvre. Surely that operates in just such a fashion? Those who can be helped by it are helped immediately. Those who cannot will die. Defibrillation is another example. There is no reason in principle why it should not be the case for a drug also.
It's certainly not *obvious* that someone who can't be helped by the Heimlich manoeuvre or by defibrillation is incurable.
One can quibble about the details - yes, for example, a tracheostomy might work, but might not be a practical solution if medical professionals are not present. And perhaps use of the word 'obvious' is too strong. My point is that the criticisms of Galen's wording are implicitly attributing to him a major, not minor, fallacy - and there is no strong reason to believe this major fallacy was present.
I guess it just still seems like a fallacy to me. There's a big difference between "either it cures you quickly or you die" and "if this doesn't cure you, you're incurable". You can say the first thing of the Heimlich manoeuvre, or defibrillation, and plausibly you can say it of this medicine. I don't think you can say the second thing of any of the three, and if you wanted to try you'd need to bring in some reason to think it.
I guess if you tried to translate the first thing into a logical proposition "for all person, (sick(person) and given-medicine(person)) => (cured-quickly(person) or dies-quickly(person))", it implies the second thing, but... I dunno, "you're going to die soon" feels like it has an implied "given our current knowledge and abilities", where "you're incurable" feels like it explicitly denies that extra clause.
(Clarifying here that there seems to be no particular reason to think Galen ever made this mistake, and this is an epistemological point rather than a point in favor or against Galen. Not accusing you of thinking otherwise, just seems worth being explicit to help avoid readers losing track of context.)
Um, but it now occurs to me that trying to read such implications across thousands of years and at least one translator seems... risky. So I guess my previous comments need to be tempered in that light.
> But Galen was talking
Was he? The review seems to come down on the side of the quote being apocryphal.
This was a great idea, and a very informative piece. Kudos to the author.
>Though the translator often insists on translating “humor” as “juice”
I openly cackled when I read this, and I love it. It seems to be a much more accurate translation and much better describes what a "humor" is.
In German, it's literally called Säftelehre (juice-teaching).
I laughed with our Author's admission that this juicy word choice made them "very uncomfortable". I then noticed that they simply gave us the straight, even unremarkable, phenomenologic truth. We all feel the discomfort. So why laugh?
"It's funny because it's true" - this explains a lot of Rationalist humor - which I admire, to be clear. A lot of humor, if not all, also elucidates, e.g. draws to a punchline, a contradiction. Perhaps this kind of frankness is funny because it is true, and because it reminds us that we live in a world of degraded discourse where writers so often obfuscate, lie, hide the simple truth. The contradiction instantly elucidated, then, is this Comedic Situation: a humble truth-teller in a loud lying world.
Outstanding! 5/5 in style, I would believe this was written by Scott, maybe just a bit more succinct. I think you steelman Galen a bit too much however, the "evolution" section was a bit too laughable. Don't give the guy points for sounding like he knows what he's talking about, stick to praising his empirical heuristics.
Meh – I think it's perfectly fair (and better overall) to "give the guy points for sounding like he knows what he's talking about".
The detailed history of the development of the theory of natural selection, or any major scientific theory, sure makes it seem like a long period of people "sounding like [they know] what [they're] talking about" before the final recognizable theory is described (and then, often much later, confirmed).
And a lot of scientific theorizing would similarly seem like 'giving people points for sounding like they know what they're talking about' based on your implied standards – take special relativity as another example. Others had, e.g. already derived the relevant mathematics, before Einstein wrapped it all up in an explanation that we all now agree is palatable.
The history of mathematics, physics, chemistry, is _riddled_ with people 'sounding like they know what they're talking about'. Yes, they mostly weren't producing 'good' scientific theories, for all kinds of reasons, but I think of that as the (probably inevitable) manner in which people 'locate a hypothesis in hypothesis space'.
This is pretty inconsequential, but I have an interesting thought about this anyway:
"reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Actually, this seems plausible to me. Earthen jars tend to be somewhat porous and they were probably not glazed, so water being stored in them will slowly evaporate over the course of weeks or months. By "corn" he was surely not referring to the yellow vegetable you eat off the cob, because corn is native to Central America and was not introduced into Europe until the Colombian Exchange. I am not totally sure, but I think the antiquated meaning of "corn" was closer to that of "cereal" or "flour". And it seems plausible to me that flour can absorb water vapor out of humid air.
So if you store a bunch of water and flour next to each other inside non-watertight earthen jars in your basement, the water will evaporate out of the water jars and some will absorb into the flour, making it heaver.
According to quora (https://www.quora.com/Did-Ancient-Romans-have-corn):
> When Europeans say “corn”, it’s a general term for any grain or cereal crop, including wheat, barley, millet, sorghum, oats and rye. These are native to the Old World, and the Romans would have cultivated or at least known about them.
I wasn't aware of this usage for "corn".
Yup. Maize was known as "Indian Corn" and over time the adjective just dropped off.
We still call it Sweet Corn in the UK, to distinguish from generic corn which is what you make bread dough from.
Cobden & Bright weren't railing against protectionism for maize in the "Corn Law".
I also suspect Galen meant jars the grain was stored in and translation telephone turned that into "nearby".
"Corn" in European context refers to wheat (mostly), oats, barley and other cereals. When maize was introduced from the New World, it was known as "Indian corn" or "yellow meal" when ground.
Purchased as an emergency food supply during the Famine, it became known as "Peel's Brimstone" because of its yellow colour, and due to people not knowing how to mill and cook it properly:
https://en.wikipedia.org/wiki/Great_Famine_(Ireland)#Government_response
"Confronted by widespread crop failure in November 1845, the Prime Minister, Sir Robert Peel, purchased £100,000 worth of maize and cornmeal secretly from America with Baring Brothers initially acting as his agents. The government hoped that they would not "stifle private enterprise" and that their actions would not act as a disincentive to local relief efforts. Due to poor weather conditions, the first shipment did not arrive in Ireland until the beginning of February 1846. The initial shipments were of unground dried kernels, but the few Irish mills in operation were not equipped for milling maize and a long and complicated milling process had to be adopted before the meal could be distributed. In addition, before the cornmeal could be consumed, it had to be "very much" cooked again, or eating it could result in severe bowel complaints. Due to its yellow colour, and initial unpopularity, it became known as "Peel's brimstone"."
https://www.rte.ie/history/the-great-irish-famine/2020/1117/1178730-the-temporary-relief-commission/
"As chairman, Routh worked hard to counter the initial resistance to Indian corn, derisively dubbed ‘Peel’s brimstone’ because of its sulphurous yellow colour. The hard, unpalatable grain was far removed from the diet of potatoes to which the rural poor had become accustomed and, if not boiled for long enough, the alien foodstuff could cause painful indigestion and, in some cases, dysentery.
Routh become a public advocate of its use and benefits, overseeing the publication of thousands of instructional handbills and a popular pamphlet with instructions for its preparation. The resistance, however, was short-lived. In the words of the unfortunately-named commissary general, Sir Edward Pine-Coffin, in a letter to Trevelyan on 30 March 1846, the Indian meal was ‘much too good a thing to be long rejected by starving people’.
In practice, the Relief Commission was hindered by internal disagreements and Trevelyan’s rigorous oversight and the public works schemes were beset by bureaucratic delays and inefficiencies. Nonetheless, the relief measures devised by Peel succeeded in averting many deaths.
As Isaac Butt pronounced in the Dublin University Magazine in April 1847, ‘the timely precaution [of importing Indian corn] and the subsequent judicious distribution of this store had the effect of bringing the people through the winter that closed the year 1845.’"
It is used now to make cornflour, used as a thickening agent for soups and gravies: https://en.wikipedia.org/wiki/Corn_starch
Fantastic. Finalist #2 has done an impressive job of capturing Scott's book review style, and I can't pay a much higher compliment than that.
I think touches like doing the extra legwork to research the historical context of the writer and not just the work itself are what really push it over the edge into exceptional. One signature move of Scott's is to relay some amusing, often absurd-sounding anecdote found in the writing of the piece, and the bit on Galen having to write a dedicated piece to combat the various imitators and servants pawning off his letters is EXACTLY that. It adds humor to the piece, depth and context to the work's author, and really underscores the depth of research put into the review.
Of course, the overall review itself is also written in a super readable style and the flow is very logical and smoothly laid out. This is going to be a really high bar to clear given how well it manages to match our host's style. Then again, in true transhumanist fashion, we should hope for and demand Super Scott from one of the remaining 12 entries, perhaps?
In turn, this is a great review of the review!
> "You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…"
Am I just being really dense, and is this obvious to everyone? I was thinking Maimonides, but maybe it is Locke, or Schweitzer. Or is he talking about Fauci?
I assumed he meant Scott.
Wow. I am way too tired to be reading these reviews :)
I mean it is kind of an oblique description.
It's Scott. Maybe you've just had a long day / haven't had your morning coffee yet :)
Did Scott train all around the world? The rest lined up, obviously, but that bit kept me looking for a better fit.
He did med school in Ireland I believe.
"All around the world" is a bit of a stretch, but he did graduate from a medical school in Ireland.
Which isn't his homeland, but it's still only one place.
Hence 'a bit of a stretch'.
He also had formative experiences in Haiti and Japan. Okay, the latter as an English teacher, not a doctor... but still, it was a training :)
> "If that which is white becomes black, or what is black becomes white, it undergoes motion in respect to colour..."
I've noticed this before in ancient Greek works, but it's still striking that to them—at least if the translations are apt—change was considered a type of motion, while in our culture we more usually consider motion a type of change (a change in place).
And I wonder when this changed, and whether there is a particular reason that it had to.
(A lot of the apparent weirdness in Greek philosophy is mostly from just having conventional translations that have different connotations, so it might just be a thing that didn't leave the Greek language, but I don't know how it is in modern Greek.)
Seeing change as motion has kind of had a comeback with physics-adjacent types, though?https://en.m.wikipedia.org/wiki/Dynamical_system
To me, change as motion implies smooth, gradual change through intermediate states, just like motion in space. As opposed to a sharp, qualitative 'step' change.
So for example, any two colors can be connected by a gradient of color change. And when objects change color over time, e.g. ripening fruit, they display some intermediate colors.
On the other hand, when water boils into steam, there's no apparent intermediate state between the two.
Our senses are finite and imprecise, and before modern instruments and modern physics, one could make an argument that either kind of change of fundamental and the other one arises from it.
So maybe all change is gradual, and water-into-steam is just so fast that the quantity of matter in the hypothetical state between water and steam is very small and short-lived, and we can't observe it directly because of all the bubbling.
Or maybe all change is qualitative, and when an apple seems to go from green to red over time, it's really a mix of very many very small pieces of matter which individually transition from pure green to pure red, but we only perceive the overall color of the mix as the proportion of green to red pieces changes.
> On the other hand, when water boils into steam, there's no apparent intermediate state between the two.
Having observed some boiling water – and maybe being a contrarian mood! – I'm not sure what this means.
I recognize that this is the accepted 'cartoon physics', and phase transitions _are_ a thing, but it also doesn't really match observations!
At the macroscopic human scale from which most people ever have or will observe water boiling, there sure seem to be LOTs of 'apparent intermediate states' between non-boiling water and boiling water. One reason being that there are many varieties, or intermediate states, of 'boiling'!
The closets thing to "no apparent intermediate state", for boiling water, that I think could be observed (by a person, with their unaided senses) is something like boiling (distilled) water in a microwave (e.g. "superheated exploding water"). All of the other more typical means of boiling water (most of which is NOT distilled) look very much like they involved a whole continuum of intermediate states.
And I would bet that these ancient intellectuals could easily understand 'phase transitions'. For one, I'd expect most of them to know about routs in battle and that's pretty obviously a phenomena where small intermediate states, at one level, result in a drastic and sudden qualitative change at a higher one (i.e. larger scale).
When the water is partially boiled, it isn't in a semi-steam state; rather some of it is still water and some of it is steam. You can clearly see bubbles of steam within the liquid.
Yes, I understand that. That's the modern understanding!
My point is that, if you (yourself) observe, e.g. a pot of boiling water, it isn't obvious that "partially boiled" isn't an intermediate state. We can't observe the individual water molecules with our eyes. But even if we could, we couldn't _perfectly_ separate all of the water molecules into 'water' or 'steam'.
Part of the 'problem' is that 'liquid' and 'gas' don't make sense as descriptions of individual molecules. They're both (necessarily) applicable only to (fairly large) ensembles or collections of molecules.
And, even in water at thermal equilibrium with its surroundings, some (tiny) amount of the liquid water is 'boiling' off of its surface. And, similarly, some (tiny) amount of steam condenses back into liquid water too, even during boiling.
There _is_ a 'sharp' phase transition, but it doesn't occur at an obviously visible scale. And I think the 'modern understanding' obfuscates a lot of the (interesting) details of what's going on in what we can observe ourselves with our own faculties. When you boil a pot of water on your stove, only a very small portion of the volume 'boils'. So the volume of water – the visible thing we can observe with our eyes over the span of seconds, minutes, and hours – doesn't itself, as a whole, undergo a rapid phase transition. The phase transition happens at much smaller scales, e.g. the bubbles of steam visible in the pot of water. That seems to me like a much more interesting, and complicated, phenomena than _strictly_ emphasizing the 'phase transition' between liquid and gas.
I disagree that the sharp phase transition isn't obvious. I can't see individual molecules, but as you note liquid and gas are descriptions of collections of molecules. And those I can see!
That's a good point!
I think I'm thinking of this as what's reasonable to _expect_ for people that don't already have our modern understanding of the states of matter and the relevant phase transitions among them.
But I think it's hard to appreciate how non-obvious something like 'bubbles in boiling water are pockets of gaseous water inside the larger volume of liquid'.
When you pour boiling (or near boiling) water on coffee grounds, you'll observe bubbles, but the grounds aren't being sublimated, or melted and then boiled – there is pre-existing gas escaping.
And I'm struggling to think how someone could figure out the difference between the two without most of our modern understanding.
A big general problem is that, for any ontology, Nature is perfectly content 'crossing levels' (or ontologies).
Any intuitions we have about mundane boiling of pots of water is inextricably complicated by small details, e.g. the drastic difference in the behavior of boiling ('impure') water in a pot on a stove versus superheating distilled water in a microwave.
Most people, with whatever (partial) understanding modern scientific theories have provided them, consider the messy 'real world' examples, whereas the scientific theories much more accurately describe 'contrived' experiments like the superheated exploding microwave water. The latter is a much better macroscopic example of a phase transition!
Great review!
<i>“Nature”, described in this way, ends up sounding a lot like evolution. Of course, Galen had no concept of evolution, but it’s very interesting to see that he was using a functionally equivalent concept hundreds of years before Darwin. It’s not clear if this is a concept he developed himself or if he inherited it from some earlier thinker, but clearly someone, in looking at biology, noticed that the principle “everything exists for a purpose” was a pretty good starting place for making arguments that turned out to be true.</i>
I don't know who originated the argument, but Aristotle was fond of saying that "nature does nothing in vain".
I suspect this idea of nature is a lot like other pre-scientific principles – and it seems like this was also a (mostly) necessary ingredient in developing what we now think of as 'scientific theories'.
Relativity – the general pre-scientific principle that Einstein kinda just _assumed_ for the sake of his argument for Special Relativity – always seemed like a similarly philosophical or metaphysical stance that wasn't (and couldn't have been) 'scientific'.
This was an unexpectedly enjoyable piece about a topic I knew absolutely nothing about, props to the author! But... if I had one nit to pick it's that they seem a little more credulous of Galen's perspective vis-a-vis his critics than is maybe wise. Anyone who adopts a beleaguered, surrounded-by-fools stance in describing their critics raises the question of "is this guy a lone voice of sanity in the wilderness, or is he just setting up strawmen to knock down?" Given that we don't have writings from his contemporaries to cross-check against, it seems like we're potentially committing the same error against them--trusting someone who says "check out this idiot, how can anyone believe something so stupid!"--as we were originally against Galen.
Wow, the quality of these reviews has been really high.
I totally agree. I read the first entry and was amazed by the review, and thought that this might be my winner. After the second one, I already have no idea how to decide because both are amazing in their own way. Awesome work!
The lines in Moliere that I found on Google books are "Quia est in eo Virtus dormitiva, Cujus est natura Sensus assoupire."
One translation is: "Because it contains a dormitive virtue, Whose nature is to put the senses to sleep."
I always thought that Moliere's satirical line about how a sleeping medicine worked due to its dormitive virtue seemed a little harsh: the term "dormitive virtue" can be seen as a placeholder for some precise mechanism that will be discovered in the future. Perhaps 17th Century France, however, didn't have much sense of scientific progress, so my reaction that "well of course scientists will eventually figure out how this medicine's dormitive virtue works" would not have been natural to Moliere.
> As much as modern authors like to describe the humors as imaginary, Galen routinely talks about them as if he were actually collecting and measuring them!
I think it's not so much that the humors themselves are imaginary—they were referring to actual bodily fluids—but the way they classified them does not match any way that we classify bodily fluids today, and accordingly the properties ascribed to those groupings aren't necessarily going to correspond to anything we would recognize.
If I call several unrelated fluids 'phlegm' my ideas of how 'phlegm' works as a category can be anywhere from inaccurate to magical.
I read something many years ago, and unfortunately I have no idea how to find it again.
There was a doctor in the early 20th century who had some blood in a sealed test tube. After a while the components of the blood settled out, forming four distinct layers. The doctor understood what had happened in modern terms, but he also figured he had discovered what the ancients were looking at when they talked out the four humors.
This makes me wonder about something else: if what we call blood is actually mix of all four humors, how is bloodletting supposed to correct an imbalance?
> This makes me wonder about something else: if what we call blood is actually mix of all four humors, how is bloodletting supposed to correct an imbalance?
Blood being a mix of all four humors wouldn't require it to be an _equal_ mix of all four humors. If there's disproportionately more of some humor, it would reduce that humor's proportion accordingly.
If my blood is uniformly 26% phlegm, and you draw some of my blood, both your sample and my remaining blood will remain 26% phlegm. Maybe they thought it wasn't uniform, though? Maybe different parts of the body had different proportions?
The proportion within your blood would be unchanged, yes, but it would affect the amount in your body considered as a sum.
(I suppose I am taking it as assumed that the imbalance in question is one in the body as a whole, and that bloodletting was thus used for issues that weren't necessarily in the blood per se; I admit I don't know offhand if this is actually how the theory would be applied.)
That's a really cool idea except that AFAIK blood in a test tube separates into three layers, not four.
Any chance that would be impacted by what the vessel is made of or any impurities?
That's because humanity has degenerated since Galen's time.
Ha!
As far as I know, it is true (at least in the opinion of the original physician):
"Robin Fåhræus (1921), a Swedish physician who devised the erythrocyte sedimentation rate, suggested that the four humours were based upon the observation of blood clotting in a transparent container. When blood is drawn in a glass container and left undisturbed for about an hour, four different layers can be seen. A dark clot forms at the bottom (the 'black bile'). Above the clot is a layer of red blood cells (the 'blood'). Above this is a whitish layer of white blood cells (the 'phlegm'). The top layer is clear yellow serum (the 'yellow bile')."
Fåhræus goes on to point out that the relative amounts of the four 'fluids' differ in samples from a healthy person and a person with bacterial pneumonia. From this sort of observation, he argues, you can see why Galen might have found humorism convincing.
Was it this? https://www.researchgate.net/profile/Irving-Kushner/publication/232812185_The_4_Humors_and_Erythrocyte_Sedimentation_The_Most_Influential_Observation_in_Medical_History/links/5a63eca40f7e9b6b8fd89a85/The-4-Humors-and-Erythrocyte-Sedimentation-The-Most-Influential-Observation-in-Medical-History.pdf?origin=publication_detail
I think it was probably a different article about Dr. Fåhraeus. Thank you!
Well, in 1915, somebody was writing a book on the benefits of bloodletting: https://jamanetwork.com/journals/jama/article-abstract/436486
There are diseases where you do need to draw off blood: https://bcmj.org/premise/history-bloodletting
"Today phlebotomy therapy is primarily used in Western medicine for a few conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda.
Hemochromatosis is a genetic disorder of iron metabolism leading to abnormal iron accumulation in liver, pancreas, heart, pituitary, joints, and skin. It is treated with periodic phlebotomy to maintain ferritin levels at a reasonable level so as to minimize further iron deposition.
Polycythemia vera is a stem cell bone marrow disorder leading to overproduction of red blood cells and variable overproduction of white blood cells and platelets. Its treatment includes phlebotomy to reduce the red blood cell mass and decrease the chance of dangerous clots.
Porphyria cutanea tarda is a group of disorders of heme metabolism with an associated abnormality in iron metabolism. Phlebotomy is also used to decrease iron levels and prevent accumulation in various organs."
I think like many other things that were done by trial-and-error, bloodletting worked well in some instances, so it was adopted as a panacea. It would seem to be a lot easier to draw off blood rather than the other humours, and possibly at times when drawing off blood it also allowed the escape of pus and infected matter, thus clearing out wounds and sites of infection. So when you don't have a lot of effective tools, the authorities all tell you this is the prescribed treatment, and sometimes it really does help your patient, why not continue to do it?
Charles Darwin's father Robert, a well-to-do doctor, told his son that he tried to bleed his patients less than the norm of the time insisted, but (IIRC) patients often demanded he bleed them like a respectable doctor ought.
This is related to what they did with the "four elements". Earth/Air/Fire/Water were still considered a pretty good elemental division up until the 18th century, but they had figured that "fire" wasn't quite right and it was this substance "phlogiston" that was released in burning. They also noticed, after centuries of trying to transmute metals, that each metal had an associated earth, and so they suspected that there might actually be multiple "earths" and not just one, with each metal being a compound of that earth and phlogiston. Similarly, Priestley had figured out two separate airs. The big innovation of Lavoisier was to realize that the metals are all *lighter* than the corresponding earths, and he suggested that one of Priestley's airs was actually compounding with the metals to produce an earth. Suddenly, we had about 18 of the modern elements, with just one conceptual shift from the earth/air/fire/water theory, and it was only a few years later that Davy proved that water was itself a compound of two airs.
I'd always considered that the classical elements might be better translated as states of matter (solid/liquid/etc.) than substances or chemical elements. (Though of course we've learned a lot about those since then as well and would still disagree with them on particulars.)
I believe that's true of the Chinese elements, but not the Greek. In the Greek system elements cannot transform into other elements; steam may look like air, but it's still water.
While the Chinese elements do transform into one another they don't really correspond to the states of matter.
"and reports that corn will spontaneously draw water out of nearby earthen jars and increase in weight, which I’m pretty sure is not true."
Terracotta is porous and liquid will slowly seep out, given time. (This makes it a great material for plant pots in the garden, not so amazing for storing water, but it is much, much, much cheaper than other forms of pottery, and romans used earthenware amphorae for many staples.) Dried grain likes to absorb water and will sprout or spoil in higher humidity.
So while generally I wouldn't expect this to happen, and certainly not quickly, if we were doing a Mythbusters-style experiment, there might be a conceivable set of circumstances where over a few weeks or something, some water would evaporate from the porous pots, and grain in close proximity might sprout or swell slightly - especially in a cellar or other environment where humidity might be able to build up.
This was my thought as well, but without the causality. He, or someone who talked to him, probably by chance happened to have corn and a pot of water near each other, and noticed the level of water went down and the corn seemed to swell. He either drew conclusions from this, or more likely performed an experiment that carefully weighed both of them at the beginning and after some period of time, and noticed the change. But without the notion of a control group: having a pot of water that wasn't near corn, and corn that wasn't near water, he lacked a full notion and assumed causality where there wasn't one. Water in a pot will evaporate regardless of corn, and dried corn will probably swell from ambient moisture regardless of whether or not there's a pot of water near it or not.
In a certain sense, he was right, if we disregard that the evaporation and absorption are likely to be mostly different water molecules, the net effect is kind of like absorption.
Under certain circumstances, there can definitely be causality. You put a bunch of water inside a closed shed, it'll evaporate a little and then stop because the air reaches 100% humidity. You put a bunch of grain inside a closed shed, it'll absorb a little and then stop because the humidity gets low enough that the water activity balances. You put both in the same shed, the process will continue until one of them is exhausted (either all the water evaporates, or all the grain has swelled up).
Desiccators exploit this principle, and raw grain/flour actually is a reasonable desiccant.
Great review but I would've liked to seen more research and or speculation into why someone with such apparent focus on empiricism got it so wrong. I think that's the most interesting question Galen's life and work presents, but I don't feel I have much of an understanding of how his well-intentioned experiments produced confirmations of theories so utterly and completely false. When he reported extracting phlegm, and observing protuberances and motions of the humors, what exactly was he extracting, and what was he seeing? I can't seem to wrap my head around a somewhat scientifically minded person looking into a cut open gladiator and thinking "yep, there are those humors Hippocrates was always on about".
Just out of curiosity, do you find it difficult to relate to people who live in the present age?
Sometimes but I expect I'd find it more difficult to relate to people from Galen's day. Overall I think that line of thinking isn't that useful though, and reminds me too much of the main character from A Confederacy of Dunces.
> why someone with such apparent focus on empiricism got it so wrong.
Ummm – because Nature is terribly complicated and not 'designed' to be easily understood by us?
It's actually really hard to learn a lot of things empirically!
Your review put me in good humors.
Brief review-of-the-review:
Very engaging and entertaining stuff! The writing style is an impressive approximation of Scott's though a bit more casual and untutored. Great choice of topic and a nice brisk pace. It made for an effective introduction to the tone of Galen's work, though not quite so much to its content or significance. Humorism may be clear to the reviewer but it wasn't especially clear to me; I gather the "humors" are actual bodily fluids which Galen treats as having inherent properties? Also, I find the reviewer's first explanation for Galen's bad rep quite obvious and intuitive; the problem wasn't Galen, it was that there wasn't any other medical scientist with similar influence for another 1000+ years. Much of the review was like that: fun, accurate, and informative as to facts, but more vague and less insightful than I'd have liked, especially when it comes to the medical content itself. Still, that's understandable given it's a non-expert's book review, and overall I enjoyed it a lot.
As your local friendly classical history nerd, I feel the need to point out: Marcus Aurelius died in 180 CE, not 170 CE.
"a Hippocrates stan" - translation, please. Is 'stan' American slang for 'fan'? The reviewer is a little too colloquial for my taste, but it is an excellent and engaging review.
Closer to "obsessive fan". https://www.urbandictionary.com/define.php?term=Stan
Fan already meant obsessive fan - it's short for fanatic. I guess this is an example of a euphemism treadmill.
Fan already meant obsessive fan - it's short for fanatic. I guess this is an example of a euphemism treadmill.
Thanks for that. I had just assumed "stan" was a typo for "fan."
<i>I see two possibilities. The first is that Galen’s followers may have really been as bad as people say. To take one example: Jacobus Sylvius, in the 16th century, was a huge supporter of Galen. When his student Vesalius called into question Galen’s knowledge of anatomy, by performing his own dissections, Sylvius rushed to Galen’s defense. Despite being the first professor to teach anatomy of the human corpse in France, Sylvius said that Galen had not erred, but “probably the human body had changed since then.” Further, he said that advance beyond Galen’s understanding was impossible.</i>
Are we sure that these sorts of stories are actually true? We've already established that this kind of "Huh huh, people before the present were a bunch of morons" sneering is false in the case of Galen himself, so it seems like we should be sceptical about it in the case of Galen's later followers.
"Nature (always capitalized)" - that is in the English translation. Galen's manuscript would have made no distinction between capitals and small letters, because that distinction did not yet exist in his time. I think the capitalisation is to distinguish the use of the Greek φύσις as a general organising principle rather than as the quality of an individual.
> To Galen, biology is all about these faculties shuffling, transforming, and combining different humors.
That sounds fairly tangible to me; it's an interesting contrast with the atoms-versus-forces dichotomy drawn later in the review.
I might also note that this would be an accurate description of our modern understanding of biology, if we called the humors "carbon", "hydrogen", "oxygen", and "nitrogen".
> Nature (always capitalized)
It seems unlikely that Galen made any orthographic distinction of this kind.
> I was going to suggest that maybe this quote might somehow be a mistaken bastardization of the “dormitive potency” line from Molière’s The Hypochondriac, since that’s what it reminds me of. But I looked and I actually wasn’t able to find that line in the play, so…
https://www.gutenberg.org/files/9070/9070-h/9070-h.htm has it in the "THIRD INTERLUDE", spoken by "Bachelierus". ("Vertus dormitiva".)
> electromagnetic fields, which look a lot more like one of Galen’s natural faculties (a tendency for mutual attraction over distance)
No, it's the other way around. Electromagnetic fields are local, that's what Maxwell's equations are about. That's how we get light. One can derive equations that describe attraction over distance from local equations given suitable assumptions about the medium, boundary conditions etc.
> You know, reading about Galen reminded me of someone… a physician… trained all around the world… a prolific writer… constantly drawn into disputes about philosophy and empirical practice… who am I thinking of…
This piece of flattery ought to have been removed by the editor. Scott, you're better than this.
Locality is different from the condition the atomists were after - at least some of them (particular Descartes) thought everything was mechanical, so that it always results from one material object displacing another through its motion, rather than allowing any sort of local interaction that involves attraction or twisting or the like.
Assuming that the fundamental forces all have 'carrier' particles (which I think is still the dominant intuition), the atomists don't seem wrong exactly.
My understanding is that at least some of the fundamental forces can have attractive interactions rather than just repulsive ones, but I don't exactly know how the carrier particles mediate that. There's probably some extra philosophical complexity here.
Oh, yes. Gravity is strictly attractive as far as we know. Electromagnetism is _both_ attractive and repulsive, depending on electric charges (which can be positive or negative), and is the only (potentially) repulsive force. I'm pretty sure the two nuclear forces (one of which, the 'weak' one, we're sure is 'fundamentally the same' as electromagnetism) are both attractive.
But I'm lost too on grasping how carrier particles mediate any of the forces! I don't _think_ there's a good 'gears level' explanation of how that works exactly. I get the sense that this is one of those 'that's how the equations' work kind of things modern physicists mostly just accept as-is.
The dominant picture, yes, but a poor description of the physics. It's still more similar to field-stuff interacting with other field-stuff than particles bouncing off each other.
Meh – there's so many formalisms, mostly for different 'levels', and thus a bunch of seemingly fundamental ontologies, which can't all simultaneously be 'true', but I'm not sure it's obviously really anything. 'Obviously', people exist, are real, it's 'true' that they're 'a thing'. But – from the perspective of 'fundamental physics' – they're 'just' a REALLY large number (relative to our current computational powers)of whatever, e.g. particles, field patterns.
'Particles' seem to emerge from the "field-stuff" – yes, they're not really much like our billiard ball intuitions, at least not in specific circumstances, but it's still a pretty powerful (e.g. useful) intuition.
But I agree that, fundamentally, all is "field-stuff" – or, I think more likely, whatever 'pixels' there are underneath the fields from which the fields emerge. (I think the field-stuff is obviously 'not real' just because of the mathematics.)
The electromagnetic field is local in a very technical way, so it doesn't seem (entirely) wrong to describe it as an 'attraction [or repulsion] over distance'.
Dammit, this is better than mine. *angry upvote*
I thought it was better than mine, too. Weirdly and surprisingly, I was quite happy about it. No idea why - nice feeling, tho'.
We don't know which reviews they wrote. We don't even know if their reviews made the cut - Scott posted the list of reviews that did, in the previous open thread I think, so they might know if their reviews made the cut. But we don't know if they saw that list.
I looked through the last open thread and didn’t see a list of finalists. Did I just miss it?
I’ve also assumed my review didn’t make the cut, and as you say, I’m not in any way linking my name to my review.
Further, it seems to me the anon thing isn’t an absolute hard and fast rule. I’m sure that any half decent amateur sleuth could work out the identity of a fair number of reviewers. So what? It annoyed me slightly that there were commenters shouting that the first reviewers identity could be ascertained through the footnotes thereby creating a problem that didn’t exist before they started alerting everyone to the possibility. I think a healthy norm for the whole process would be ‘Don’t worry about anonymity, don’t look for it and don’t mention it’ I know, some people will find that difficult.
My mistake, it was the last hidden open thread. His comment follows (I predict he'd be fine with me sharing it):
I was hoping to keep everyone in suspense, but upon thinking about it that has no advantages beyond annoying people, so:
1. On The Natural Faculties
2. Progress And Poverty
3. Double Fold
4. The Wizard And The Prophet
5. The Years Of Lyndon Johnson
6. The Accidental Superpower
7. Why Buddhism Is True
8. Are We Smart Enough To Know How Smart Animals Are
9. The Collapse Of Complex Societies
10. Order Without Law
11. Addiction By Design
12. Through The Eye Of A Needle
13. Humankind
14. Where's My Flying Car? (be careful, several people reviewed this, so even if you reviewed it doesn't mean you are a finalist)
Thanks for that. I’m a little bit surprised that he only published that info for paying subscribers. Are we plebs not worthy of such info? Perhaps all the finalists are subscribers but my guess is that that’s unlikely and also doesn’t address the problem of only putting subscribers out of their misery..
But my prediction was correct! So my review will be in the repéchage with all the other also-fans.
“Vote For Anonymous Anteros!!”
Interesting review and approach! I felt like it was less of a straight book review and more of a "debunking" of what Galen said against what he actually said.
I am curious to know what Galen wrote about pregnancy in the text. I read parts of a different text of his, "On the Usefullness of the Different Parts of the Body" and found the description of why male and female bodies just reiterating the sexism of the time, and reminiscent of Aristotle's description of the female as "mutilated" man. Here's a section from the text:
"In fact, just as the mole has imperfect eyes, though certainly not so imperfect as they are in those animals that do not have any trace of them at all, so too the woman is less perfect than the man in respect of the generative parts…”
“… though making the animal itself that was being formed less perfect than one that is complete in all respects, provided no small advantage for the race; for there needs to be a female. Indeed, you ought not to think that our creator would purposefully make half the whole race imperfect and, as it were, mutilated, unless there were some great advantage in it.”
Not the reviewer (but I am a woman, for whatever that's worth.) I'm sure Galen's views of women were far from enlightened, but it wouldn't surprise me if this is majorly exacerbated by translation issues. For example, the word "mutilated" may have harsher connotations than the original used by Galen, especially if it was translated several times. And "perfect" was often used to mean "fully developed," with imperfect meaning "partially developed" or "in the process of development," which is somewhat different than defective or flawed. I found a slightly more complete version of the quote:
"Now just as mankind is the most perfect of all animals, so within mankind the man is more perfect than the woman, and the reason for his perfection is his excess of heat, for heat is Nature's primary instrument. Hence in those animals that have less of it, her workmanship is necessarily more imperfect, and so it is no wonder that the female is less perfect than the male by as much as she is colder than he. In fact, just as the mole has imperfect eyes..."
It's hard to tell without more context, but based on my experience reading older books, I would interpret it more like this:
"Humans are the most highly developed animals (in terms of capacities), and men naturally have more energy (physical strength/stamina) than women. As life expresses itself through the energy to act, an animal with more energy is more developed (it can give fuller expression to its capacities). Women are physically weaker, but that is because they are designed for a complementary biological role that prioritizes other things." (I assume he then discusses childbearing, but I can't find more of the quote).
Pretty sure he was just making the point that women are usually physically weaker than men, something that was more relevant when the main tasks of life were more physical. This was a pretty common framing (energy being the most important, and men having more of it, because women were optimized childbearing instead of constant heavy physical action) until the mid-19th century.
In looking for the quote, I came across several analyses focused on sexism, and they include some other comments that easily can be connected to sexist assumptions. That said, much of the actual analysis fails because it assumes that Galen should know certain biological facts that were not then obvious, and doesn't fully understand the paradigms in which he was working.
Basically, Galen noted that some of the reproductive organs of males and females were similar (as far as he could tell, given limited knowledge of how they worked). He believed the female ones were partially developed versions of the male ones (I'm guessing in the same way that male breasts would be partially developed female breasts). It seems like part of his sexist interpretation here likely resulted from the fact that he could not examine the female reproductive system very well, as it is mostly internal.
One source confirms the Greek word he used for "imperfect" is better translated as "unfinished," and also notes that Galen was essentially correct to define ovaries as female testicles--that this was an advance over Aristotle. But he thought they were "unfinished" because they "cannot emerge to the outside because their whole nature is weaker." This suggests he thought they *should* have been external, like men's, for some reason, and extrapolated from that that development was missing.
This assumption that women should have the same parts as men is seen as sexist presumptuousness, but it seems to have been a reasonable interpretation of what he thought he was seeing. He believed ovaries produced semen, not eggs, and this is also held against him, because why would a woman need a man to conceive if this were so? For a long time, one paradigm was that both men and women produced *different* types of semen, and it was their combination that resulted in conception! Galen believed that female semen was a "congenial nutriment for the male semen." The article keeps talking about how ridiculous it was to refer to "female semen," but it's only ridiculous from a modern perspective in which we define it as containing the uniquely male contribution of sperm cells. At the time, it was only understood to consist of some "energy."
It took a while to understand the release, fertilization, and implantation of the egg, because you can't easily see it happen. Because of this, they were also really confused about the purpose of menstruation--well into the 19th century, some paradigms did not connect it to the release of an egg--the 19th century theory was that it was essentially the release of a placenta prepared for a pregnancy that did not happen, and that this depleted a woman's intellectual energy, which was a rationale for not encouraging too many intellectual activities for women.
Aristotle thought humans used energy to turn their blood into semen, and that, as women had less energy, this was not successful, and somehow resulted in menstruation. Galen doesn't seem to have believed this, because he literally thought men and women had the same organs, with the female ones being inverted and unfinished. Turns out he did make a note that this was the opposite of the case for breasts, which he could not explain (though the reason should be pretty obvious). I don't know what Galen thought menstruation was, but the article notes that da Vinci believed that the reason it ceased during pregnancy and breastfeeding was because it was converted into breastmilk! Sorry for the long response, but thought it was pretty interesting.
Glad to hear it!
Thank you!
A couple of things I'd like to note:
He may have never properly examined *human* female reproductive organs, but I would think from his work on animals he had a good understanding of how everything looked.
Semen means seed in Latin, and the ovaries do produce seeds that combine with seeds from the testicles to produce children. It sounds to me that he got remarkably close to the truth for someone without access to a microscope.
"Semen means seed in Latin"---thanks for adding that---should have looked it up. "and the ovaries do produce seeds that combine with seeds from the testicles to produce children." Yeah, to me, this is the exact same thought process as "male and female DNA combine to produce an embryo"--modern have better information as to the specifics, but there's no reason to think they are capable of a higher level of understanding than Galen was. I'm sure that if we were able to bring him here via time machine and explain what we've discovered, he'd be able to understand it pretty quickly.
"It sounds to me that he got remarkably close to the truth for someone without access to a microscope." I agree--seems like he thought it out as well as was permitted by the available knowledge at that time. The feminist critiques mostly revolve around his failure to appreciate the unique reproductive role of the woman (as in, thinking of functions she might possess independent of male ones.) But even though he suggests women were basically "incubators" in which the "seeds" could develop, with the uterus and ovaries not having much complexity to them, "incubation" is a pretty important non-male function! And he must have been aware that mothers had genetic influence on their offspring.
They're basically expecting him to have a modern concept of DNA or hormones, but these are very recent discoveries--a semi-detailed understanding didn't exist until the 1930s, or at least that's the impression I get. Without this knowledge, the idea of hyper-specialized functions makes less sense. Some later doctors were far more deserving of such criticism, clearly influenced more by social assumptions than any honest attempt to figure out medical reality. (Many of them also made ridiculous medical assumptions about men, though--there weren't really any winners in pre-modern medicine!)
KE, great series of comments.
Thanks!
> But he thought they were "unfinished" because they "cannot emerge to the outside because their whole nature is weaker." This suggests he thought they should have been external, like men's, for some reason, and extrapolated from that that development was missing.
Note that testicles actually start inside the body, and then drop into the scrotum (sometimes after birth!). I’m pretty sure most animals are similar; he might have noticed that, which would be a pretty good reason to think that “this is what they should do, women’s didn’t finish the journey”.
In the absence of sex hormones (e.g. in a fetus before they've had a chance to work, or in an androgen-insensitive XY female) you get genitals and body plan which read to us as female - albeit of course infertile, possibly lacking secondary sex characterise such as breasts, etc.
Misinterpreting this as a natural progression towards the "perfect form" of man, which is then interrupted in women, is very Greek.
"[Galen] refers to different types of blood and suggests that there is a 'sweet' phlegm and a 'bitter or salty' phlegm, the former useful to health and the latter dangerous." I only skimmed the review, so maybe I missed it – but was Galen in the habit of tasting bodily fluids? Was that a "thing" during his era? If so, yuck.
> maybe I missed it – but was Galen in the habit of tasting bodily fluids? Was that a "thing" during his era? If so, yuck.
You do know that diabetes mellitus is named for its impact on the flavor of urine?
To state it outright "mellitus" is from μέλι (meli), the Greek word for honey. Ancient physicians *definitely* tasted bodily fluids.
There's another kind of diabetes mentioned in medical textbooks: diabetes insipidus. Called that because the urine tastes bad aka isn't sweetened by excess glucose as it's unrelated to insulin.
Typo-spotting: the paragraph at the end of section VII is duplicated.
No, the first sentence is exactly the same, but there's a Nature <-> natural selection swap between the two.
Whoops, you're right!
Something Scott wrote previously gave the example that if you wanted to convince an 11th century bishop of something we now hold to be common knowledge, you would have to explain every single assumption that the two of you don't share for you to even begin to make sense to him. A common claim that follows from this is if you talked to a medieval commoner, you'd have so little common ground that it'd be like talking to an extraterrestrial.
The fact that we have writings from almost 1900 years in the past that show us a shockingly relatable academic mindset makes me really hopeful that the essential human experience is more constant over the centuries than I previously thought. I don't know why, but it makes me happy to know that I could have a real conversation with someone born more than a milennium previously. Maybe it means that humans of the future might not end up being too different from us either.
"Something Scott wrote previously gave the example that if you wanted to convince an 11th century bishop of something we now hold to be common knowledge, you would have to explain every single assumption that the two of you don't share for you to even begin to make sense to him." I remember reading that, and, if I remember correctly, I was impressed that it was true in the specific example, because so often that kind of claim is dubious or false.
I definitely think the human experience is more constant over centuries than is generally thought to be the case in intellectual circles. Someone like Galen is an exceptional person in any age, but, at least since we've had writing, we have evidence there were always some people like that around. I read mostly 19th century American stuff, which I know is pretty recent, but I see the full range of modern human thought in play back then. In particular, every shade of annoying human behavior was catalogued *very* early on, because that's what most people complain about. Galen references what the proverb says about madmen--the Bible is full of rants about that, and about people who pray loudly in the streets to show off, etc. People weren't incapable of reflection and skepticism.
In any era with a literate culture, some small number of people will always independently arrive at insights that allow them to experience the general range of human thought, even if they express them in a way that is hard to recognize or don't have the tools or reasons to fully develop them. (I'm not saying cultures that are not literate cannot produce people who do the same, but the evidence is obviously harder to come by, and there's less reason to produce elaborate explanations for general audiences).
Back in 2016, I tried to track down the "fails in incurable cases" quote (I remember I was set off by some mention of Galen in SSC, but I couldn't find it now). I found a cluster of citations significantly earlier than 1998, with the most prominent one in this article by Hans Eysenck from 1960: https://archive.org/details/handbookofabnorm029075mbp/page/n709/mode/2up?view=theater (on the first page of the article). The earliest mention I found was from 1941 (but I didn't retain the reference).
Earlier quotes typically mention specifically "Samian clay" as the substance, and by looking over Galan's work, I convinced myself that if there's a chance of his actual texts containing it, it has to be in Galen 12,178, inside Book IX of "De simplicium medicamentorum...". This has not been translated (AFAIK) and while the original text can easily be found on Google Books, I couldn't easily read it, and abandoned the task back then.
Just want to say I'm really impressed with these reviews so far. They're not just good book reviews, they're *good ACX posts*.
I enjoyed the review of the text, but take issue with the framing device of defending Galen from his detractors. Was he really the "whipping boy of all doctors"? The one quote from Bacon and the line from Tetlock seem slim evidence, especially since Galen is *the* doctor of the ancient and medieval world. My impression of Galen's reception had been that he was and is pretty universally recognized a genius and a kind of Aristotle of medicine. Is there a tradition of criticizing Galen in the Rennaissance? Or is he a popular target for rationalists in particular?
Thanks for raising this question. I blindly believed the reviewer and was rooting for "Galen the Underdog" from the get-go. Definitely a clever literary approach by the reviewer, if somewhat misleading.
Last week, a friend told me, "Galen was always wrong."
What does modern academia say about Galen? Surely there's a historian of science/historian of medicine somewhere who knows all this and has written about it.
"Surely there's a historian of science/historian of medicine somewhere who knows all this and has written about it." There may well be one, but in my own historical research, I've found it's not safe to assume that's "surely" the case. There are just huge gaps in scholarship due to people parroting secondary sources without ever bothering much with the primary sources.
There are various factors that make it more or less likely for a given person/topic, but many scholars really do assume that people in the past had no idea what was going on, so they don't really become curious about dismissive remarks. The best scholars tend to be the ones who think like the author of this review--they notice a portrayal doesn't quite and add up, and end up doing a "search and rescue" mission. I do historical research as a hobby, not professionally, but my technique is pretty similar to what is described here, and it's crazy how many people or concepts have been the victim of "hit jobs," with few realizing it. And I was stunned to find how easy it was, after some effort, to follow the thinking of people from earlier eras, compared to what I'd been led to believe. In fact, as this author said at one point, they often explained their own views much more clearly than modern summaries did.
I think that, most of the time, the reasons for this tend to be kind of random and related to structural incentives, like the speculations given in this piece. The ease of doing deep and comparative research, due to searchable online databases and other such things, has recently caused a major shift in the incentives, so I expect to see more of these high-quality "setting the record straight" pieces. I've already seen quite a few during the pandemic, as people have had more time to dive in.
I have thought about it, but I'm much better at writing than I am at doing video or podcasts. Maybe I should look into it more. Or find a collaborator who is good at those things. Thanks very much for suggesting the links!
Is there somewhere on line where you posted writings?
Oh, now I see "Mary Lincolniana".
Gianna Pomata's chapter, "Observation rising : birth of an epistemic genre, ca. 1500-1650" in Lorraine Daston & Elizabeth Lunbeck (eds.), Histories of Scientific Observation gives a very interesting account of the influence of Galen's empirical practice on very early scientific culture. Despite many gaps in the written record, it's possible see hints of a continuous empirical tradition in medical practice in late antiquity and the medieval period that influenced the formation of early scientific culture in Europe. The route goes by way of Islamic medicine in the lands that had been part of the Byzantine empire, and then, via European cities with ties to the Islamic world, into Italy, where medical empiricism (observation and reporting of details individual cases) mixed with astronomical practice to produce changes in how early science conceived of the role of evidence in supporting theories. From Pomata I learned that [in 1551 the Jewish physician Amatus Lusitanus, teaching anatomy at Ferrara, began publishing his _Centuriae curationum_ introducing to scientific culture the genre of the medical case narrative, an enterprise that he carried through seven volumes]. (The part within the brackets is more or less a quote, but may not be exact.) Definitely worth reading the entire Daston and Lunbeck volume if you want to plunge into the history of empiricism in science.
(Formatting note: If I'm reading it right, each quoted paragraphs in section IV (which is incorrectly labelled section VI) are from different parts of the book, but as formatted they look like they're contiguous. I think there should be line breaks between them, with the blue indentation bar on the left broken up into five smaller bars.)
This was a very interesting and enjoyable review. Thank you.
But I went to read the wikipedia, and then did some googling and I'm not immediately finding this negativity towards Galen that is alleged, although I expect that I won't find negativity towards Aristotle in this way either, and it definitely exists (I've encountered it in college classes).
There seems to be an error about the age of Victor Frankenstein - he should be 22 or 23, not 19, when he created the creature. See: https://www.quora.com/How-old-was-Dr-Frankenstein-in-the-novel/answer/Chris-Pollard-28
Thanks for this review, it was really interesting!
I can totally imagine servants stealing Scott's emails and publishing them.
A lot of the direct quotes resonated with me as eerily similar to Maimonides (the Rambam) writing in "Guide to the Perplexed", written about 1000 years after Galen (originally in Arabic). He is also a doctor, discussed philosophy, and follows Aristotle everywhere he can without contradicting his beliefs [Jewish orthodoxy a-la 1000 AD].
The paragraph about white-black motion could have been a direct quote from "Guide to the Preplexed" - maybe they are both quoting Aristotle? If they're both paraphrasing, their styles are almost identical.
Maimonides also does the exact same thing when arguing with different sects in his book, dissing them and complaining about how foolish their ideas are, and yet that he must refute them in the text.
Anyway the parallels just seemed stark enough that I though I'd mention them.
I don't think you have to suppose they're linked indirectly via Aristotle. Maimonedes himself seems to have written a Book Review of Galen, titled 'The Art of Cure - Extracts from Galen'.
Very interesting, I was not aware of that!
So he could have been quoting directly, or perhaps adopted his style somewhat.
The supposedly apocryphal “It is obvious, therefore, that it [medicine] fails only in incurable cases” quotation may be a boiled-down or adapted version of this, from Galen's <em>Ars Medicinalis</em> 1:3: "Medicine is an art that cures the sick, or lessens their pains, and which has nothing to do with incurable diseases".
Later in the same section he says: "it appears that medicine has an appropriate means of discovering the mode of cure, or at least of assuaging the sufferings of disease; and that it is not deficient in substantial reasons, for declining those that are incurable, or at any rate, of overthrowing the unjust reproaches made against physicians when unsuccessful in such cases."
But did Galen’s treatments actually work? What did his empiricism accomplish? I have a vague impression that most pre-modern medicine was worse than nothing.
Pre-antibiotics medicine wasn't very effective; surgery was a bit better but you still had problems there with blood loss and infection. Before we had effective treatments to kill disease-causing agents, what you had was painkillers, things to reduce fever, and basically 'wait and see' - the old jokes about "nature provides the cure, the doctor takes the fee". Some of Galen's treatments doubtless worked on an empirical basis, some did not, but he did the best he could with the knowledge at the time and tried to advance it. That was a worthy effort.
I see a lot of comments about the contest writer's style being similar to Scott's. I realize that these comments are meant as compliments, but they are a bit patronizing. This writer had very much his/her own voice and style. There are infinite ways to combine humor, insight, and coherence.
Yep. Fair point.
This was a very good review! I very much enjoyed the quotations from Galen, and as I find so frequently the people from the past are be intelligent, empirical, and rational. The most important difference between them and us is we have been somewhat better at not creating hero worship of previous scholars. The dark side of the current system, which incentivizes novelty and departing from tradition, is that we rarely return to old works to find the new insights and ways of reconceiving and questioning current paradigms.
There are a few mistakes about Aristotle in this article which I want to clear up. Galen's discussion of the faculties derives primarily from Book 2 of Aristotle's De Anima. In that book Aristotle describes all of the major sensing faculties of human and animal organisms, and tries to give an account of how each of these faculties operates. Aristotle's conception of the soul, by which he means the living organism, is as a bundle of faculties or capacities. Galen's taxonomy further divides and subdivides these faculties, carrying on the work that Aristotle had started.
Aristotle also discusses and argues against atomism at length throughout his corpus. And most of all of his works Aristotle begins by discussing the theories of all the previous philosophers and natural scientists have come before him. This always includes the atomists whose accounts he gives reasons for rejecting. In De Anima book 1, for example, he says the atomists hold that animation is a quantity or a number, and he then objects that it impossible to derive from a number observed facts like reason, sensation, pleasure, and pain.
Aristotle is far less essentialist than most people assume. Reading him reminds me of reading an intelligent and structured blogger trying to work out some of the big questions. Like Galen, we should just read him, and then decide what we think. Instead of relying on hearsay.
Is it just me, or does Galen sound like a sort of Scott Alexander of his time, if Scott had bad AD&D and was the celebrity Surgeon General to an Imperial Presidency?
I don't think Aristotle on medicine is read much either. Some folks use the four humours as personality types, which is fun, but that has more to do with Jungian classification than Hippocrates. Notice that the Hippocratic oath has not waned with the passage of time. This implies that chronological advance does not entirely replace even ancient insights. We should remember that Aristotle conducted one of the first great experiments - observation of a natural process; in his study of how chick embryos develop.
Isn't the "dormitive potency" line from a Gilbert & Sullivan play?
This was a fantastic essay, and it made me rethink my attitude towards past civilisations. Thanks for writing this!
I really enjoyed this and it’s going to be hard to beat!
Greg Cochran likes to point out that medicine was a thriving profession which people sought out for thousands of years... even though it made people worse off on average (Nassim Taleb theorizes that religion provided a benefit by redirecting people away from doctors). So even the best of ancient doctors might have better spent his time as an architect.
The geologist Steve Dutch points out some basic conceptual problems in Aristotle's science here:
http://stevedutch.net/pseudosc/greekswrong.htm
As always (the entire POINT of this review) how was this claim “made people worse off on average” arrived at? What possible evidence is there to prove for, say, Rome in 150 CE?
I think it's based on looking on how the actual techniques of the past have been analyzed with more modern rigor. Bloodletting is only helpful in extremely rare situations, but believers in medicine based on "humors" used it frequently.
We have no idea what the default strategies were for various diseases, or how precisely they were implemented. All we know is a few cases (recorded because they were conventional? Or recorded because they were exceptional?)
If Galen is doing a substantially better job with the gladiators than his predecessor, then "better" is clearly possible. At which point one needs to distinguish between something like "the best known medicine" vs "what's done by lousy practitioners".
Extrapolating from "bloodletting is usually not helpful" to "medicine made people worse off on average" seems a hell of a stretch, including, for example, an assumption that bloodletting was the primary tool reached for in any and all disease situations. Toothache? Cataracts? Diarrhea? Snake bite?
I'd much rather we simply admit "we don't know! don't know much about the medicine, don't know much about the treatments, don't know much about the outcomes, don't now much about the expectations" than the faux-certainty that's implicit in a statement like “made people worse off on average”.
It's not just that bloodletting is usually "not helpful", most doctors nowadays would expect to make it worse. It was fairly central to medicine under the theory of "humors", and continued to be used not only for the ancient Greeks but also Charles II & George Washington:
https://westhunt.wordpress.com/2016/03/31/medicine-as-a-pseudoscience/#comment-77709
It's noted in the post up top that the same doctor blinded both Bach & Handel.
If Galen is doing a better job than his predecessor, then perhaps his predecessor was astonishingly worse than doing nothing. We know from Semmelweiss that lots of doctors killed women giving birth while poorer women reliant on midwives fared better. And it seems doctors during the Civil War also made their patients more likely to die:
https://westhunt.wordpress.com/2018/01/22/dalys-per-doctor/
But you're falling into the same pitfall as the concept that triggered this review, the assumption that people in the past were idiots.
I agree that people fall into multiple delusions about things with complicated causality. And that people have a "do something, anything" bias in certain situations. Even so, the causality between "person about to die" and "person now dead" is frequently not one of those difficult cases.
Or, to put it differently, I don't understand how we're simultaneously supposed to believe that metis is so awesome, able to figure out the right way to cook cassava, or how to balance beans, corn, and lye, yet also believe that people are going to continue engaging in practices that have a significant, observable, effect on fitness generation after generation.
Once again, I ask you to consider the difference between "medicine" and "an ignorant dick". John Taylor seems to be the equivalent of (and thought of as such) someone like Dr Oz -- a charlatan who has the combination of charisma and shamelessness to persuade the rich and famous to believe whatever he says.
Ignorant dicks will always be with us. But they are not the whole of humanity, or of any profession.
The whole of the profession effectively did turn against Semmelweis. He died in an insane asylum while the doctors he accused of killing mothers continued killing mothers.
Now to reconcile that with metis: the people with metis were the midwives. Doctors had only gotten involved in birthing recently, and only for wealthier women. In the past science wasn't good enough to determine much that actually made people healthier, there was essentially just regression to the mean (a concept nobody knew about prior to Galton) and bodies naturally healing. But there were still some people wealthy enough to pay for doctors even though they didn't do any good.
I don't think that all texts need trigger warnings, but this one could benefit from having one.
What part of it calls for a trigger warning?
The "many disturbing vivisection experiments". But maybe I am misunderstanding what trigger warnings should be about.
I forgot about the vivisection. I probably wouldn't have asked if I remembered.
That said, I don't know enough psychology to identify whether it's a true trigger. As I understand it, a "trigger" is something that sets off someone's mental health problems. The examples I've seen are all reminders of awful things that have happened to the person in question, so I don't know if an awful thing happening to an animal would qualify.
Thanks.
Does it sound like Galen was something like a modern scientist who constantly publishes his findings and theories and his reasons for believing them, whereas most medical experts before recent centuries tended to see their ideas as something like trade secrets to pass down to their trusting apprentices.?(You can see this trade secret tendency in Newton keeping his invention of calculus his personal secret until Leibniz happened upon the same great advance.)
If so, then subsequent medical experts seemed to adopt Galen as their master who supplied them with a huge framework of quasi-trade secrets that, perhaps, were protected from too much competition by the volume and disorganization of Galen's writings. (Or, alternatively, there was a good living to be made by developing a reputation as a medical sage by publishing easier to read summaries of Galen's work.)
It seems as if the problem with Galen was less that he was a dogmatist (he was, by the standards of his time, less dogmatic than many of his rivals) than that subsequent generations for 1500 years wanted dogma. So we ended up getting Galen elevated to the supreme authority, when what we really needed were one, two, many Galens arguing it out.
How much was the problem with medicine until about, oh, 1880 being that doctors and patients were made uncomfortable by medical controversy? Everybody felt better when doctors talked as if all of their ideas were incontrovertible -- as Dr. Fauci and President Biden like to say: "Follow the Science!" -- rather than admit that these were preliminary speculations, which might be falsified in the future. Over the last 14 months, I've noticed that lots of people want to believe that whatever The Science tells them at the moment -- coronavirus is spread by touching surfaces, ventilators are our only hope, or whatever -- is the only possible truth, while other people want to reject all knowledge. Trying to stay in the middle between credulity and nihilism has been a lot of work and been rather discouraging, as many of my preliminary hypotheses have been proven wrong by subsequent events.
Maybe doubt and humility is not what people look for in the personality of doctors?
In recent times, we've largely separated the roles of medical researcher and medical practitioner. E.g., nobody expects medical practitioners to be innovators on mRNA. (The big exception are surgeons: e.g., surgeon Frank Jobe invented Tommy John surgery in 1974.)
But in the past, the two roles were conjoined. So, a lot of the personality traits we prefer in doctors (self-confidence, decisiveness, etc.) were found in medical theorists as well, since they were one and the same.
These are good comments.
I also once tried to find the line about "dormative properties" in Molière's Hypochondriac (or The Imaginary Invalid). I found it in a scene which is entirely in Latin, and which is left out of English translations. Perhaps the jokes don't translate well into Germanic languages.
Great review - incisive and humorous 😉 I had heard of Galen, but knew very little about his life, work or status as enlightenment whipping-boy. Inspired to open up some animals now...
I really enjoyed this one.
Link on Thomas Kuhn is broken, wayback link is here: https://web.archive.org/web/20210506033648/https://www.units.miamioh.edu/technologyandhumanities/kuhn.htm