galen and astrology r&s

Galen and Astrology: A Match Made in the Heavens? Glen M. Cooper (Submitted to journal: Early Science and Medicine) The author examines the question of Galens affinity with astrology, in view of Galens extended astrological discussion in the De diebus decretoriis (Critical Days). The critical passages from Galen are examined, and shown to be superficial in understanding. He performs a lexical sounding of Galens corpus, using key terms with astrological valences drawn from the Critical Days, and assesses their absence in Galens other works. He compares Galens astrology with the astrology of Ptolemys Tetrabiblos, and evaluates their respective strategies of scientific reasoning. Three types of inference are introduced and applied to Galens astrology. Finally, he concludes that the empirical side of Galens science does not depend upon astrological methods or concepts, but that these were introduced for their rhetorical power in presenting his new medical methodology. It is suggested that continued attention to Galens astrology has obscured the truly important empirical scientific method that Galen developed. Introduction Galens use of astrology in the De diebus decretoriis1 (hereafter Critical Days) has provoked both admiration and revulsion since his death 1900 years ago. For many of his followers and imitators, Galens astrology represented the epitome of empiricism in medicine. For his critics, however, beginning with Nicole Oresme (d. 1382) and culminating in the 16th debates over the validity of the critical days in medicine, Galen completely misunderstood the ancient Art. Some critics, such as Oresme, urged that astrology be eliminated from his medicine, since the critical days could be used as a prognostic tool in medical practice without astrology, and others, such as Girolamo Cardano (d. 1576), wanted to reject Galenic medicine entirely, replacing it with an amalgam of Hippocratic medicine, which he considered superior, and the more successful Ptolemaic astrology.2 Clearly, the status of Galens astrology is problematic. What neither the admirers nor the critics have realized, however, is that by focusing on astrology, they missed the real point of Galens empirically based theory of crises and critical days. Indeed, as I shall try to show, Galens use of astrology is superficial, and does not cohere

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Galen, De diebus decretoriis libri iii. C. G. Khn (Ed.) 1825. Claudii Galeni opera omnia. vol. 9. Leipzig: Knobloch (reprint: Hildesheim: G. Olms 1964-1965), 769-941. 2 Grafton, Anthony. Cardanos Cosmos: The Worlds and Works of a Renaissance Astrologer. Cambridge, MA: Harvard University Press, 1999, 127-155; and N. Siraisi 1997. Siraisi, Nancy. The Clock and the Mirror: Girolamo Cardano and Renaissance Medicine. Princeton: Princeton Univ. Press, 1997, 140-41. See also Grafton, Anthony, and Nancy Siraisi. Between the Election and My Hopes: Girolamo Cardano and Medical Astrology. In Secrets of Nature: Astrology and Alchemy in Early Modern Europe, edited by William R. Newman and Anthony Grafton, 69-131. Cambridge: MIT Press, 2001, 86 seq.

Galen and Astrology, Glen M. Cooper

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with the rest of his medical science, except in an almost meaninglessly general wayespecially with his theory of the crises. It is this theory that is most interesting, in my view, from the perspective of the development of scientific thinking. Once the astrology has been removed, we can begin to see clearly, perhaps for the first time, the true ingenuity of Galens approach to data and natural phenomena. Yet, if astrology is so foreign to Galens scientific method, then why did he include such a detailed discussion of it in the Critical Days at all? The answer, I think, is for its persuasive value: the Critical Days was one of several treatises written at about the same time (c. 175 A.D.), among which also was the De crisibus (hereafter, Crises). These treatises were intended to advance Galens new theories or his versions of ideas and methods found originally in the Hippocratic writings. His point was not to present a fully usable astrological method, but to show how the critical days could fit within the commonly accepted astrological cosmology. He no doubt hoped thereby to increase his clientele, especially among the wealthier and more powerful Romans. One clue to this motivation is that the only astrological authority that Galen cites in the Critical Days is the popular author, Aratus (discussed below), whose poetic rendering of Eudoxan astronomy can hardly be considered scientific, but whose writings were a staple of an aristocratic Roman education. To my knowledge, Galens astrology has not been scrutinized this carefully since the late Middle Ages and Renaissance, although recently there have been a few insightful studies of Galens thought and practice.3 (See below.) These observations of the present article are based on the authors intense study of the Critical Days and the Crises, as I have prepared editions and studies of these texts for publication, in both Greek and Arabic.4 As I compiled the commentary to my edition of the Critical Days, I initially tried to explain Galens astrology as an integral part of his scientific worldview. Yet, when considering the empirical methods of the Crises and the Critical Days taken as a whole, I was forced to conclude that the astrology is not organic to Galens scientific method at all, but has been tacked on for rather different purposes, mainly rhetorical.

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Among the best of these is: Barton, Tamsyn S. Power and Knowledge: Astrology, Physiognomics, and Medicine under the Roman Empire. Ann Arbor, Michigan: The University of Michigan Press, 1994. 4 The Critical Days will appear in two volumes, one Arabic, one Greek, from Ashgate; the Crises will appear from Brill.


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Important Conceptual Distinctions One of the difficulties in understanding Galens text is created by the fact that he employs, indiscriminately, arguments and techniques from at least two disparate astrological disciplines, i.e. natural and judicial astrology. So, our first task is to sort them out. It is useful, therefore, to draw some distinctions. Although the astrological worldview was pervasive in Galens day, not all astrological practices would have counted as scientific for Galen. Galen would have excluded all magical and divinatory practices. Galen emphasizes repeatedly that his ability to predict the future is based on rational procedures, not prophecy.5 Most pre-Modern thinkers seem to have admitted the idea of celestial influences of a general nature, such as would affect the weather or the environment of a patient, and thus his chances of healing. This kind of astrology might be termed natural astrology.6 Part of the Hippocratic worldview, via the influence of stars on atmospheric conditions, and thought to be significant in the patients recovery, natural astrology was accepted by most thinkers until modern times. On the other hand, the practices of casting star charts, determining horoscopes and reading the future therefrom belong to the general category of judicial astrology, and aim to determine the particular effects of the stellar influences on a specific person, with a view toward forecasting the future. It was possible for a person to subscribe to the first view, and not the second. A. A. Long makes another useful distinction, between hard and soft astrology.7 Hard astrology is tied to a kind of determinism; soft astrology admits the operability of human agency, and the idea that the stars indicate probable futures that can be altered by human action. Judicial astrology tends to be hard, and natural astrology tends to be soft. Ancient astrology was not monolithicunder its rubric were numerous and varied practices, not all of which were mutually consistent, nor would all have been recognized as authentic by all practitionersranging from using the stars or zodiac signs as talismans, to a full blown natural philosophy requiring years of university education to understand.

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See De diebus decretoriis K 833.6-12 for a sarcastic comparison of the diviners with the rational physician. And yet the people demand more of Galen than they do of prophets! 6 Campion, Nicholas. The Dawn of Astrology: A Cultural History of Western Astrology. Volume 1: The Ancient and Classical Worlds. London: Continuum, 2008, 278; 284. This distinction was clarified during the Middle Ages: Campion, Nicholas. A History of Western Astrology. Volume 2: The Medieval and Modern Worlds. London: Continuum, 2009, 13-14; 33-34. 7 Long, A. A. Astrology : Arguments Pro and Contra. In Science and Speculation : Studies in Hellenistic Theory and Practice, edited by J. Barnes, J. Brunschwig, M. Burnyeat and M. Schofield, 165-92. Cambridge: CUP, 1982, esp. 170, n.19.


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The present article advances a two-fold thesis. I maintain that 1) while Galens medicine is consistent with natural astrology, it is not so with judicial astrology, and his attempt to present his theory of the critical days in terms of judicial astrology is a practical failure, if a rhetorical success. And, 2) Again, while Galens medicine is consistent with natural astrology, that is truly secondary in his thought. Galens rhetorical emphasis is on the order and design of the cosmos, which he claims can be observed at the lowest level. When in Book III of the Critical Days he introduced the heavenly bodies, I shall argue that this was an afterthought with mainly rhetorical value. To conclude, I shall sketch Galens mundane approach to sciencei.e. what remains when the astrology has been removedin terms that I believe others have not addressed. Galen was certainly a product of his time, yet I believe that some aspects of his scientific method have either been misunderstood or ignored. In the case of astrology, he has been exploited or condemned, while his followers and detractors both have generally missed the real point of his scientific approach. The present study focuses on his actual empirical approach. As will become clear, Galens thought was at home in a natural astrological world, and he invokes the celestial bodies as causes, but only after all of the essential empirical reasoning has been accomplished. Astrology and Medicine Astrology and medicine have been closely associated for most of the history of medicine, since both were closely tied to a cosmology within which prognoses were thought to be possible. For astrology and other more overt forms of divination a cosmic sympathy between disparate elements, such as that taught by the Stoics, were believed to make predictions (and magic) possible. Even for a more natural scientific medicine, Aristotles notions of causation and the regularity of nature suggested that knowledge of present causes and factors could produce reasonable predictions about future states. Recent Scholarship There has not been much scholarship that addresses Galens astrology, yet the more recent work is quite excellent. At the beginning of the last century, Karl Sudhoff, one of the founders of the discipline of medical history, published an historical survey of the critical days concept in


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medicine.8 Although excellent in all other ways, since it is a survey, the analysis of specific points is not sufficiently deep for my purposes. Another article, from a generation ago, presents a general survey of basic conceptual distinctions and a discussion of important passages from Galen and other authors. In spite of its promising title,9 however, this article turns out to be something of a disappointment, for reasons that call for brief discussion. The author makes a similar basic distinction as I do between Galens use of a Hippocratic (natural) astrology, and the divinatory astrology of many of his contemporaries.10 However, his analysis is not penetrating enough for my purpose, and the discussion is marred by racist remarks, attributing the irrational elements of astrology and numerology (which Galen sought to refute in the Critical Days) to the Egyptians, as well as to the Semitic tendency (!) to exaggerate the significance of numerical symbolism.11 The pseudo-Galenic treatise De decubitu12 he calls a product of the irrational Egyptian-Mesopotamian strand in astrology, which blatantly opposes the higher Hippocratic rational astrology. Nevertheless, even the great Galen could not escape this pernicious influencehence the absurd astrology in an otherwise intelligent scientistsince, Puma observes, he was born in Asia!13 An article by the historian of astronomy, G. J. Toomer, is more responsible.14 The title is somewhat misleading, however, leading us to expect an unambiguous statement from Galen about astronomers and astrologers. Instead, in the chapter presented, extracted from a much longer work that survives only in Arabic, Galen condemns horoscope-casters (the Arabic ukkmul-mawld judges of nativities15 refers to practitioners of judicial astrology) for their ignorance of astronomy and geometry. We conclude then (though not with Toomer) that Galen disparages an astrology that lacks solid grounding in the natural and mathematical sciences. This stance is similar to his condemnation of contemporary physicians for their lack of knowledge of

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Sudhoff, Karl. Zur Geschichte der Lehre von den kritischen Tagen im Krankheitsverlaufe. Sudhoffs Archiv fr Geschichte der Medizin 21, no. 1-4 (1929): 1-22. 9 Puma, Alfredo. Galeno y la Astrologia. Revista de la sociedad venezolana de Historia de la Medicina 12/13, (1964-5): 21-34. 10 Ibid., 27. 11 Ibid., 33. 12 Prognostica de decubitu ex mathematica scientia. Khn, vol.19, 529-73.13 14

Puma, 31. Toomer, G. J. Galen on the astronomers and astrologers. Archive for History of Exact Sciences 32, no. 3-4 (1985): 193206. 15 Ibid., 196.


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the same in the Quod optimus medicus sit quoque philosophus (That the Best Physician is also a Philosopher)16 Therefore, Galens astrologywhatever it may beis of the very learned kind, as I have stated, that overlaps with meteorology and natural science. His disparaging attitude toward the judicial astrologers here makes his use of some of their technical apparatus in Book III of the Critical Days all the more curious. Most recently there have appeared articles by I. Garofalo17 and C. Pennuto18 on the critical days that are more useful for my purposes. The excellent article by I. Garofalo is the only one Ive found that engages in any depth with Galens text of the Critical Days, including consideration of the Arabic tradition. He discusses several issues of an astronomical interest that I also cover in my commentary, such as Galens derivation of the medical month. C. Pennuto presents an insightful summary of the critical days doctrine, as it was mediated via the Latin tradition, as well as a penetrating discussion of the critical days in the medical debates of the 16th C. It was while reading her survey of Galens doctrine of the critical days that the possibility that Galens astrology could be conceptually removed from his science occurred to me, leaving the empirical science more clearly to be observed. Crises and Critical Days: Basic Concepts To appreciate the subtle conceptual distinctions that I shall make later, I must first set the groundwork of Galens critical theory. One of the foundations of Galens therapeutic approach was the concept of crisis. Greek physicians had noticed that some febrile illnesses show periodic patterns of intense symptoms (crises), whether copious sweating and shivering, increased vomiting, or diarrhea.19 These crises marked significant turning points in the illness, after which the patient recovered or died. The crisis was connected with a process of expelling diseasecausing substances, usually putrefied humors, from the body. The evidence of successful16

Quod optimus medicus sit quoque philosophus, Khn vol.1, 53-63. Translation in: Brain, P. Galen on the Ideal of the Physician. South African Medical Journal 51, (1977): 936-38. See also Galien: Que lexcellent mdecin est aussi philosophe, ed. V. Boudon-Millot, in: Galen. Galien: Introduction Gnrale; Sur lordre de ses propres Livres; Sur ses propres Livres; Que lexcellent Mdecin est aussi Philosophe. edited by V Boudon-Millot. Paris: Les Belles Lettres, 2007. 17 Garofalo, Ivan. Note sui giorni critici in Galeno. Paper presented at the Rationnel et irrationnel dans la medecine ancienne et medievale : aspects historiques, scientifiques et culturels : [actes du colloque international organise par le centre Jean Palerne a` lUniversite Jean Monnet de Saint-tienne les 14 et 15 novemb, 2003. 18 Pennuto, Concetta. The Debate on Critical Days in Renaissance Italy. In Astro-Medicine: Astrology and Medicine, East and West, edited by Anna Akasoy, Charles Burnett and Ronit Yoeli-Tlalim. Florence: Sismel - Edizione del Galluzzo, 2008. 19 (Some of these symptoms are observed in connection with malaria, which has led some modern scholars to posit that at least some of these illnesses were malarial in origin.)


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expulsion was sought in the bodys major secreta and excreta: coalescence of nasal mucosal discharges; sediment in the urine; or excess biles in the stools. The periodicity of these illnesses, namely, peaks of intensity in the febrile symptoms called paroxysms, led to the identification of specific days, counted from the onset of the illness, on which one could expect to observe a crisis, which usually occurred in conjunction with a paroxysm. Most prominent were days: 7, 14, and 20, with secondary days on 4, 11, and 17. The latter were indicator days, on which one could find clues from the patients condition as to the character of the crisis expected to occur on the next major critical day. The crises and critical days are the subjects of the two Galenic treatises, Crises and Critical Days, already mentioned. Galens model was a development of the ancient humoral theory of illness, according to which perspective illness is the result of humoral imbalance, and the physicians task is to restore the balance, through therapy. The expulsion of the putrefied humor was absolutely necessary for a restored balance. The planets, however, have little directly to do with the situation, which requires much careful observation over time, and subtle adjustments in regimen. The critical day concept also influenced therapy: Through the physicians skilled intervention, via diet and regimen, the patients body could be manipulated to produce a better crisis, which both expels as much of the diseased humors as possible, while minimizing damage to the patient (through its traumatic symptoms). The Structure of Galens Theory of Crises and Critical Days Next, for my argument it is crucial to understand the structure of Galens treatises about the crises and critical days. The Crises discusses crises: how to identify their symptoms, how to use their features to infer the interior states of the patients bodies, how to classify them, etc. The first two books of the Critical Days concern the identification of critical days and their use in treatment, as Galen sifts through data to derive a scientifically sound list of critical days with their principal properties.20 Thus, five of the six books of these two treatises concern mundane issues. Book III of the Critical Days, however, is altogether different. There, Galen presents a causal astrological explanation for the critical days, based on a roughly Aristotelian cosmology, one that we would classify as a natural astrological outlook.20

This procedure was analyzed in detail in: Cooper, Glen M. Numbers, Prognosis, and Healing: Galen on Medical Theory. Journal of the Washington Academy of Sciences 90, no. 2 (2004): 45-60.


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Cosmology and Astrology in the Critical Days Galen opens Book III with a cosmological description of the physician-patient scenario, with distinctly Aristotelian elements, especially the superlunary / sublunary realms. The sublunary realm is the world of change and has an inherent tendency to disorder. The superlunary realm, however, is the unchanging, stabilizing power in the cosmos, and it is through its influence that there is any rational order at all to anything in the sublunary world. Galens mention of the imperfection due to the material element of the sublunary world (K 9.901.8-13) is also a superficial nod to cosmology, since he already explained in Book II in detail the types of factors that knock the crisis off the ideal pattern, and most, if not all, of these factors derive either from human agency or from environmental circumstances. In fact, it seems that, according to Galens cosmology, part of the imperfection and uncertainty of the sublunary realm of our world is due to the existence of agency here, and, furthermore, the perfection of the upper realms derive from their invariability and lack of agency. Whatever Galens true attitude toward astrology, it is definitely not hard astrology in Longs sense,21 since his whole medical philosophy is that the patient and physician can alter probable outcomes through choices, whether via a change of lifestyle before illness strikes, or via choosing to follow Galens therapeutic directions. As Galen acknowledges at the start of Book III (K 9.900.1-3), a physician could use the critical days successfully in treatment without understanding their underlying causes. For that purpose the first two books are sufficient. But in Book III, through artful calculations, Galen connects the periodicity of the critical days with the lunar phases, and derives a medical month that combines the effects of the two lunar periods, and which is supposed to be responsible for the periodicity of the critical days. This is an average of the sidereal month (27 1/3 days) and the (adjusted) synodic month (26 days). The result is a medical week of 6 35/48 days (K 9.932.5-933.7).22 He offers a superficial but explicit connection between medical prognosis and the traditions of judicial astrology, which, however, provides too little information to be useful for applied medical astrology.

21 22

Long 1982, 172. See also Garofalo 2003, 52-53.


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When discussing Galens astrology, it is useful to compare it with that of his near contemporary, the Alexandrian Ptolemy, who is famed as the ancient master of the mathematical sciences, as they were then understood, including harmonics, optics, and astrology. Two of his most famous works were the Almagest,23 his magisterial treatise on mathematical astronomy, and the Tetrabiblos,24 his influential manual on astrological interpretation. His mathematical astronomy and astrology form an organic whole, as he explains in the Introduction to the Tetrabiblos. Ptolemys astrology thus was so systematic and detailed, that, whenever Galens and Ptolemys astrology have been available, it is not surprising that most have favored Ptolemys version. Analysis of Galens Astrology in Book III At the beginning of the overtly astrological passage of Book III (K 9.910.7-13), Galen observes that, whereas the sun is the cause of changes that occur in the scale of the year, an idea that is expressed in Aristotles On Generation and Corruption25, the moon is the cause of changes that occur within the scale of the month. The moon is most powerful when it is halved or full, i.e. when it is approximately seven or fourteen days into its cycle. He then introduces a sketchy birth chart, or hints at one (K 9.911.18-912.3), since the example he gives is not a complete chart. He doesnt even take a stand on the ancient issue of whether the stellar influences are imprinted on the child at conception or at birth, leaving the option open. This non-committal attitude is further support that hes not serious about judicial astrology. Galen states in a general way, that if somethinga life or a process, he is not specific begins when the moon is in Taurus, then we can expect a major change in it when the moon has traversed three or six signs, which are a quarter and a half of the cycle. He gives the three signs in quartile with Taurus: Leo, Scorpio, and Aquarius. In discussing these four signs, he seems oblivious to the significance placed by astrologers on the quartile configuration, namely, that it intensifies the influence of the planets in it, whether good or ill.26 The result is not even a real23 24

Ptolemy. Ptolemys Almagest. Translated by G. J. Toomer. Princeton, NJ: Princeton University Press, 1998. Ptolemy. Tetrabiblos. Translated by F. E. Robbins. Edited by G. P. Goold. Vol. 435, Loeb Classical Library. Cambridge: Harvard University Press, 1940. Reprint, 1980. 25 De generatione et corruptione 336b17ff (= On Generation and Corruption. transl. H. H. Joachim: 1984: 551-552). See commentary in his edition of this text, by Williams 1982: 190-196. 26 Ptolemy, Tetrabiblos, I.13, 75; 82.


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birth chart, but the Signs are used merely as a coordinate system to mark the progress of the moon through its course. In another attempt at a birth chart at K 9.912.3-16, Galen takes his cue from the Egyptian astrologers, who taught that the moon could be used to infer the patients condition (K 9.911.1418). This statement accords with Ptolemys statement that the Egyptians had united medicine with astronomical prediction, which he calls iatromathematics (the healing mathematical science).27 Galen mentions temperate and intemperate planets, and beneficent and maleficent planets, concepts that all appear in Ptolemy28, except that, curiously, Ptolemy omits dyskratos, expressing the notion as the negation of eukratos. When Galen discusses the second birth chart (K 9.912.316), this time he chooses to discuss the moment of birth as significant rather than the moment of conception. The hypothetical patient is assumed to have been born when the beneficent planets were in Aries and the maleficent in Taurus. Then, when the moon is in Aries or any of the signs in quartile with it, he will experience good fortune. But, when the moon is in Taurus or the signs in quartile with it, he will fare badly. Galen then specifically observes that, if an illness begins when the moon is in Taurus, his illness will be very difficult, but the opposite will happen if the illness begins when the moon is in a favorable sign. What this means in terms of the crisis theory is this: the character of the crisis that occurs when the moon is in a specific sign can be, at least partly, inferred from whether that sign is favorable or unfavorable, based on where the moon was when the illness began. Of course, that would be only one clue for the physician; far more important are the empirical considerations discussed at length in the empirical portions of the Crises and the Critical Days. After this rudimentary example, Galen swiftly moves away from judicial astrology, back into the realm of natural astrology, as he discusses seasonal and weather variations and their influence on the course of illnesses (K 9.913.7 seq.). There are significant features missing from Galens astrology, which one would expect of an ancient astrologer, that should be noted. First, of all the planets only the moon is specifically mentioned. The others are grouped together as either well- or poorly-tempered, or either beneficent or maleficent. The sun and moon, of course, are the primary factors in natural27 28

Tetrabiblos, I.3, 31-33. Also, Bouch-Leclercq, A. Lastrologie Grecque. Paris: 1899, 517-520. In the Tetrabiblos, temperate: I.4, 37; intemperate: I.11, 67; beneficent: I.17, 81; maleficent: I.21, 103.


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astrology and meteorology, which seems to be Galens chief concern. Second, of all the possible aspects of planetary configurationstrine, quartile, sextile, etc.only conjunction and opposition seem to matter to Galen here. Furthermore, there is no mention of the Ascendant (horoskopos), namely, the Sign rising over the eastern horizon at the moment of the patients birth, a highly significant parameter for the ancient astrologer.29 This Ascendant changes swiftly for any given location, and varies with ones position on the earth. It seems odd that Galen, who has been minutely concerned with the temporal details of the patients unfolding critical illness, and has even expressed in this passage his confidence in the powers of the Signs to transmit positive or negative influences to the patient, ignores the Ascendant. There are several other features missing from Galens account, about which one can read in any good history of astrology. All of this suggests that Galen was not really concerned with astrology, except in the most general terms, and for its persuasive value. The Phaenomena of Aratus of Soli In support of my contention that Galen is merely trying to appeal to his educated audience is the fact that he quotes lines from one of the most popular poems of antiquity, the Phaenomena of Aratus of Soli (c.315-240/239 B.C.).30 A versification of two scientific treatises, one on astronomy by Eudoxus of Cnidus (d. c.347 B.C.), and the second on weather signs, by the great Theophrastus (d. c.287 B.C.), the poem skips over technical astronomy, especially the part describing the wandering planets, and contains many parts that show the poets fuzzy grasp of his subject. Nevertheless, this poem represented the limits of astronomical knowledge for most educated Romans in Galens day.31 The poets purposea rather Stoic onewas to demonstrate how the cosmos is governed by a divine monarch, Zeus, who maintains universal harmony and justice.32 This cosmology fit well with the then current imperial ideology, especially under that most Stoic of emperors, Marcus Aurelius (r.161-180 AD)

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Ptolemy, Tetrabiblos, I.12, 69-71. Also, Barton, Tamsyn. Ancient Astrology. Edited by Roger French, Sciences of Antiquity. London / New York: Routledge, 1994, 46-7; 122-23; 129-30. 30 Aratus of Soli. Phaenomena. Edited by G. R. Mair, Callimachus, Hymns and Epigrams. Lycophron. Aratus, Loeb Classical Library Volume 129. London: William Heinemann, 1921. 31 Barton 1994, 37. The poem was translated into Latin several times, by Cicero, Germanicus, and others. 32 Green, Peter. Alexander to Actium: The Historical Evolution of the Hellenistic Age. Berkeley Los Angeles: University of California Press, 1990, 183-6.


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Galen quotes the poem at K 909.3-6 and 909.8-13, passages that illustrate how the moon may be used for weather forecasting.33 He does this to support his argument that the moon has a powerful influence over conditions on the earth, and, moreover, that lunar cause and effect are connected in such as way that reason can be used to infer the latter from the former. Galens citation (K 911.14-18) of the Egyptian astronomers doctrine that the moon can be used to infer the patients condition makes the connection to medicine explicit. But these passages are meteorological, and thus belong to the tradition of natural astrology. Given that Galen was such a prolific writer, it would be surprising if astrology were absent from his works. It does appear, but only in specific and narrow contexts. A better question might be: why isnt there more of it? If Galen were a true advocate of astrology in medicine, then we should expect to find astrological methods referred to in his therapeutic works, especially in the De methodo medendi, his lengthy treatise on therapy. However, this is not the case. Astrological Contexts in Galen Several representative words were chosen that could provide unambiguously astrological contexts, and then the whole of Galens corpus was search on the TLG.34 The results support my position, that astrology is of very little scientific importance in Galens writings. The word forms searched were: -, -, -, -, and -. These are the results, with commentary: Only two contexts, both of which cite the astrologers for their astronomical knowledge. The more interesting, from De naturalibus facultatibus K 2.29, l.9, occurs within a passage where Galen refutes the views of the Atomists, who not only deny that there is innate knowledge and that we have natures, but also despise the activities of the diviners, oracles, and the whole of astrology. I assume that what the Atomists dont like is the belief that anything in nature is connected at all, in order to make such activities possible. Although Galen seems sympathetic to these practices in this passage, it is impossible to infer anything unambiguously about his attitude here.33

Aratus, Phaenomena I.794-797 (= transl. Mair 1921): 442-443, and I.805-810 (= transl. Mair 1921): 442-443, respectively. 34 Thesaurus Linguae Graecae, Irvine: University of California (http://www.tlg.uci.edu/).


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Most references (10 out of 11), as expected, are from the Critical Days. The outlier, from In Hippocratis prognosticum commentaria iii, K 18b.247, l.13, in discussing the sequence of the critical days, describes a cosmology, and notes that the planets always keep to the region of the Zodiac (i.e. near the ecliptic). There are only two contexts, neither of which seems to refer to the astrological Ascendant. The closer of the two, at Institutio Logica, Ch.12, sect. 4, l.2, ( ) seems to be some form of solar clock used to measure the length of the year. Most contexts (of 39) refer to the discipline or the practitioners of astronomy, grouped with other disciplinesarithmetic, architecture, geometry, etc., to make some point about them collectively, usually how they are essential to the practice of medicine. At K 5.69, l.3 (De animi cuiuslibet peccatorum dignotione et curatione), however, Galen describes astronomy as a discipline in which its data is obvious to everyone, and can be cross-checked simply by looking. At K 17a. 20, l.19, 17a 21, l.1, and 17a.23, l.13, all from In Hippocratis librum primum epidemiarum commentarii iii, it is mentioned in the context of a discussion about how astronomy is necessary to be able to determine the lengths of months and how the general atmospheric conditions affect the patient: Hipparchus is mentioned in the last one. In the same work, at 17a.90, l.12, Galen notes that astronomers demarcate the heavens as a region beginning with the lunar sphere. Finally, in the De septimestri partu, a working discussing the relationship between the moon and human gestation, at l.36 the specific findings of the astronomers about the lengths of the months are mentioned. Most of the 19 contexts refer to fevers, which are described as chaotic i.e. wandering (like the planets), they have irregular paroxysms. One context actually makes the chaotic feverplanet simile explicit (K 9.445, l.11 of Synopsis librorum suorum de pulsibus). At K 5.69, l.6 (De


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animi cuiuslibet peccatorum dignotione et curatione), however, the same context as above, discussing the planets as something that everyone can observe. Searching on these terms suggests that, apart from the De diebus decretoriis Book III, Galen never refers to astrology in any more than a superficial way, especially not in the De methodo medendi, where any use of these words is strictly metaphorical. It is possible here only to do a representative search, a sounding of possible words from the Galenic corpus. But the evidence strongly indicates that Galen has more mundane concerns in medicine than astrology. The Harmonic Structure of Galens Cosmos Nevertheless, the Critical Days does suggest a serious interest in natural astrology. So, consistent with Galens interest in that is his use of harmonic symbolism in the theory of the crises. The presence of music theory in Galen may seem surprising. But Galen was unusually well-educated, and a good education in his day touched upon all the sciences, however superficially. Ptolemy was also interested in cosmic harmony, for in his influential Harmonics, he refers to planetary connections with the various harmonic modes, comparing the musical system he had just derived to the harmony and influences from the Zodiac.35 Galens musical allusions are subtle, mainly at the level of terminology and word-image; yet, their presence reveals, I believe, intrinsic features of Galens medical cosmology that have gone unnoticed. Galen repeatedly uses (to make a mistake) in referring to errors in treatment, a word with distinct musical associations, meaning literally to play a wrong note in music.36 However, it is generally used metaphorically by other Greek authors to mean an error in taste or judgment. Galens medical contexts, however, revive the musical sense of what was a dead metaphor in the Greek of Galens time. Galen uses a related word, (mistake, error), in a manner similar to Plato at Apology 22d when he criticizes the skilled craftsmen ( ) for claiming knowledge outside their area of expertise. The context of the complete treatise Critical Days, and Galens theory of medicine as a whole, i.e. the relationship between physician, patient, and nature, is one of cosmic harmony, and this suggests

35

Harmonics, III.8-end, translation: Solomon, Jon. Ptolemy Harmonics: Translation and Commentary. Leiden, Boston, Kln: Brill, 2000, 152-66. 36 LSJ, 1418-9.


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that when a physician makes a mistake in treating a patient, he does more than merely err: he upsets this harmony, frustrating natures efforts on behalf of the patient. The word and its cognates appear in eight other contexts in the Critical Days, all in passages that describe how the physicians error upsets the patients delicate harmonic relationship with nature, and causes the crisis either to be delayed, or to come prematurely.37 In either case, the result is to harm the patient and to corrupt the critical cycles, thus frustrating prognosis. The very possibility of prognosis depends on the properly functioning harmonic relationship between physician, nature, and patient. Of all the authors in the Greek corpus known to have used some form of the word , Galen was the most prolific.38 It is noteworthy that this word does not appear in Ptolemy, nor in any other true ancient harmonicist. Thus, according to Galen, proper and successful treatment requires the intervention of a physician, such as Galen, who understands the subtle connections between natural and external factors and the healing program, who can discern the destabilizing effects of certain factors and compensate for them. To be this sort of physician, he must also become a natural philosopher, and grasp the interconnectedness of all natural factors. Comparison of Galen and Ptolemy Galens use of astrology in the Critical Days, in spite of his great medical authority, was clearly inadequate. But Ptolemys treatment of astronomy in the Almagest as a demonstrative science set an example that all other sciences, including medicine, could aspire to or approximate. It would be helpful to compare their respective scientific methodologies. Ptolemy tidily divided his astronomical project into two parts, which roughly parallels the modern distinction between astronomy and astrology.39 The first was treated in the Almagest, which dealt with planetary positions, developing functional mathematical models for generating ephemeris tables. As Ptolemy argues in the Tetrabiblos, the second part of this astrology system, the heavenly influences come from above, and change the material dispositions of things in the

37 38

K 789.10; 822.17; 825.9; 826.9; 827.7; 827.13; 828.5; 829.12; 869.4; 916.7. 133 citations for Galen, as compared with 87 in the Septuagint, 66 in Plutarch, 33 in Plato, and 6 in Aristotle. These figures derive from a search of the TLG Corpus. 39 Of course, that distinction did not exist until relatively recent times, and the terms astronomia and astrologia were used interchangeably.


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sublunary realm. This provides a much more organic conception of astrology than is found in Galen. One first calculates the positions of the planets, then determines their probable influences. The basic inferential direction is opposite in the two cases, Ptolemy reasons from the heavens above, to infer influences on earth; but Galen other starts on earth, develops the science from the data, and only then tacks on superlunary factors. In Galen, on the other hand, all of the empirical data and arguments are in place before the planets or heavens are referred to in any detail. The most we hear about them before Book III of the Critical Days is that they are the model of perfection in the cosmos, and the underlying pattern of the critical days depends on their order and influence (in a vague, general sort of way).40 This use of the heavens is in line with a general, cosmological sense of heavenly influence (i.e. natural astrology), which one can accept without accepting all the details of fullblown astrology. It thus corresponds to Longs soft astrology.41 From this analysis, it seems that the astrology is tacked on after all the theoretical details of the critical days have been worked out. When we consider their respective views on error, or variability in a natural system, their differences appear even more stark. For Ptolemy, the error lies in the uncertainty of interpretation, after the planetary positions have been determined with mathematical certainty. For Galen, however, errors are what knock the (mundane) system off its ideal pattern. For Ptolemy, the pattern of the heavens is determined via mathematical demonstration, and is there for all to see and agree upon. The interpretation, however, introduces variation, since we dont have all the facts, i.e. not enough empirical data has been gathered yet, on the basis of which to make a completely sound inference. But, in principle, as time goes on and more astrologers pool their (correct) inferences, we approach a more perfect knowledge of the connections between heavenly patterns and earthly outcomes, minimizing error. There is nothing like this in Galen: error is not a matter of interpretation, but of introducing factors that perturb the ideal natural situation. That ideal is what the physician ought to strive after. Therefore, the way to minimize error or variability is for the physician to have a knowledge4041

K 9.844.12-15. Long 1982, 170, n.19.


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of medicine equal to Galens, and to restrict the factors from outside the system that ruin the ideal natural pattern. Galens Handling of Data and His Empirical Reasoning In the Critical Days, Galen employs two kinds of scientific reasoning that must be carefully distinguished, and must be grasped in order to appreciate where Galens empirical reasoning ends and his metaphysical theorizing begins. Once this is understood, then it should become clearer how Galens use of astrology is distinct from his scientific method. In scientific method, there are three kinds of inferences commonly employed: induction, deduction, and abduction. The first two are, perhaps, the more familiar, and the third really wasnt clarified until the work of C. S. Peirce (1839-1914), the American pragmatic philosopher, although there are hints of it in Aristotle.42 Each involves a direction of inference and a stance toward the data. To briefly summarize, induction is analyzing data to infer a pattern or general rule for practice (I.e. All human beings of whom we have any record in the past have died; therefore, All human beings are mortal); deduction is applying a general rule to infer characteristics of particular entities (I.e. All men are mortal; Socrates is a man; Therefore, Socrates is a mortal). These two inferential methods differ in their direction of reasoning: the first is from particular to general, and the second, from general to particular. Both require an empirical stance. In Galens case, he has sifted through the crisis data from the Epidemics and his own experience in Book II, and derived, through induction, what he takes to be a canonical series of critical days, which requires the assumption of secondary factors that perturb the natural system. Deduction is then used to decide whether a given day counts as a critical day for the purposes of therapy. Abduction (which Peirce sometimes called retroduction, a better term in my view), however, takes a metaphysical stance, in the sense that it tries to arrive at the background theory that must be assumed in order for the data and the general rules about the data to be such as they are. This inference is by nature more speculative, since there could be multiple theories that explain the data (i.e. Save the appearances) equally well. For example, within the limits of observational error, both the Ptolemaic and Copernican planetary models explained the apparent42

Barton, Power and Knowledge, 1994, 134-37; and Fann, K. T. Peirces Theory of Abduction. The Hague: Martinus Nijhoff, 1970.


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motions of the planets equally well. Deciding between them required other metaphysical considerations. Galen employs a form of abductive reasoning in Book III of the Critical Days, as he outlines a basically Aristotelian cosmology, including natural astrology, within which the crisis theory could securely fitalthough he probably would not have described it that way. However, it is important to realize that the crises and critical days could be equally well at home within a paradigm that ignores celestial influences or metaphysical speculation completely, and focuses instead on a disease pathology such as of malarial parasites that cause periodic fevers with occasional critical symptoms, interior to the patients body. This is another way of saying that the crisis theory can be used without reference to astrology at all, a perspective similar to that of Nicole Oresme. Since abductive reasoning is metaphysical, it can often serve a persuasive purpose, as it does here, by placing a theoretical or practical procedure within a wider, generally accepted perspective. A modern example might be: such is the dominant cosmology in the United States that, if a physicians lobby is trying to get a new medical approach approved for government funding, say, it would be prudent not to couch the proposal in a Marxist or atheistic metaphysics. Perturbations: An Ideal Model Adjusted to Fit a Complex Reality To better appreciate the scientific modeling accomplished by Ptolemy and Galen, its useful to consider a technique from modern mathematical physics, namely, perturbation. The idea is that physical reality is more complex than can be simply modeled, whether by mathematics or otherwise. Therefore, one adopts a simple model as a basis and then considers variations brought about by secondary factors. In modern mathematics and physics, these appear as additional terms in the equations. Where does Galen get his base ideal model, to serve as a first approximation? From the data he sifts through in Book II, the base pattern is derived via induction, as I have explained. Then, by abduction, the theoretical framework and natural laws that must be in place for the observations and patterns of data to be as they are is posited. Ptolemys planetary models, as found in the Almagest, say nothing about influences, only about positions. Once the positions are known from the methods of the Almagest and cast into a chart, their influences can be determined from the Tetrabiblos.


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Galen, however, sought to understand a complex natural entityi.e. the sick patientin the sublunary world, with many influences. Some of the factors affecting the patient are: the planets, nature, the physician, the patients attendants, well-meaning but medically incompetent loved-ones, and other external factors, such as stress-producing environmental factors, for example barking dogs, noisy neighbors, and leaking or collapsing roofs.43 In an ideal situation, only the heavens (sc. atmospheric conditions), nature, and the philosopher-physician would affect the patient, and their combined effect would be toward recovery of health. The physician is necessary, because although nature tends to heal a sick body, it usually requires the skilled guidance of a physician. Nature as an entity is not intelligent in the rational or human senseit is more like an Aristotelian plant soul, that tends to grow continually. In this ideal case, the illness would follow a predictable course, and the critical days could be determined precisely and marked on a timeline. However, rarely does such a set of ideal conditions obtainunless of course Galen alone is at the helm!44 In reality, other perturbing factors come into play, and disturb the natural unfolding of the illness. The job of the physician, according to Galen, is to determine which additional factors are operating, and to estimate their perturbing effect on the prognosis and the natural course of the illness. A skilled physician can do this and adjust treatment to compensate for their disturbance to the natural system. The modeling approaches of Ptolemy and Galen also differ significantly. For Ptolemy, each planet moves independently of all the others. Galens approach requires the assessment of multiple variables, and estimating their affect on an ideal natural system. The ideal natural situation is found here within the sublunary world, instead of beyond the moon, as in Ptolemy. The subject in Galens system can be affected by the actions of other factors, human or not, in this world, whereas the planets are imperturbable. Furthermore, Ptolemy has a two step process: prediction, then inferring influences. Galen first determines the critical day sequence, and what factors are required to assist the patient; second, what factors must be avoided, and third, what factors, already having done their damage, must be compensated for. Galen is thus not directly concerned with the planets, but with a host of empirical, sublunary factors. These perturbing factors Galen describes as external or from outside (), meaning external to the43 44

See K 9.825.14-826.10. K 9.833.18-834.4.


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system of Nature.45 This reflects the beginning of the sophisticated notion of a closed scientific system. Sometimes these factors are called accidents, which also suggests a variation from an ideal situation. The physicians skill is measured by his ability to size up these corrupting factors and to estimate the effect they have on the whole system, so as to adjust his prognosis. Therefore, the astral bodies dont really figure into Galens account, for, in the actual practice of medicine, they play no role. Astrological medicine is actually a later development, although it cites the authority of Galen. The Arabic Response The Arabic authors seem to have rejected Galens astrology, since except for the initial translation by unaynibnIsq (d. 873 A.D.), Book III of the Critical Days does not seem to figure in Arabic accounts of medicine. For example, QusibnLq (d. 912/3 A.D.), one of the early translators, prepared a catechism of the Critical Days, possibly to attract a patron who would pay him to translate the entire treatise.46 However, Qusomits all reference to the material of Book III from his catechism. This suggests two things: 1) he didnt find Galens astrology useful for medical practice and 2) Qusknew the Greek text of the Critical Days well enough (he was a native Greek speaker, as both his nameConstantine son of Loukasand his originshe was from Baalbek in the former Byzantine province of Syriaindicate, as well as the dominant trends in astrology in his place and time to draw this conclusion. The influential physician and philosopher, Ibn Sn (d.1037 A.D.), although he describes the critical days in the fourth book of the Canon,47 and his list is identical to that of Galens, he omits discussion of their astrology altogether, as far as I can determine, focusing instead on their usefulness for prognosis. Ibn Sn had well-defined views about astrology, for he wrote antiastrological tracts (against judicial astrology).48 However, since natural astrology was embedded45

K 9.820.15-821.7 Discussed in its historical context in the Introduction to my Arabic edition of the Critical Days. Text found in: Ms. Tehran, Malik Library no. 6188, 11th C. See Sezgin, Fuat. Geschichte des Arabischen Schrifttums: Medizin Pharmazie; Zoologie - Tierheilkunde bis ca. 430 H. Vol. 3. Leiden: Brill, 1970: 273, no.49, dating to 11th C.H., i.e. c.17th C. A.D. 47 Qanun, Rome: Typographia Medicea, 1593, Book 4, Sect. 2, pp. 41-62. 48 Ullmann, Manfred. Islamic Medicine. Edinburgh: Edinburgh University Press, 1978, 114, n. 22, and August Ferdinand Mehren, Vues dAvicenna sur lastrologie Muson, 111 (1884), 383-403. See also Ibn Sina. Avicenne: Rfutation de lastrologie. Edition et Traduction du Texte Arabe, Introduction, Notes et Lexique par Yahya Michot. Prface dElizabeth Teissier. Beirut-Paris: Albouraq, 2006.46


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within the cosmos that lay at the background of all ancient science, elements of it appear throughout his philosophical system. Conclusion Galens attempts at (judicial) astrology do not fit well with the rest of his empirical science, and was tacked on to the Critical Days to make the theory more appealing to students or other intelligent readers (potential clients). Yet, it has been difficult to disentangle astrology from Galenism. For example, so much did the astrologically-inclined physicians of the Middle Ages want to believe that Galen had endorsed astrology that they readily accepted the (false) attribution of the overtly astrological treatise, the De decubitu49 to Galen. Whereas Galens association of astrology with medicine in the Critical Days has been found wanting, that of this pseudo-Galenic text is explicit. Its actual author has been shown to have been one Imbrasios of Ephesus (c. 1st C. AD)50, who essentially picked up where Galen had left off in the Critical Days, explaining how to use the moons position in the various signs of the Zodiac to prognosticate the course of the patients illness. To recapitulate, astrology is discordant within Galens science for the following reasons. As mentioned, the popular author, Aratus, is cited by Galen as his best astrological authority. Given that Aratus was a poet, not an astronomer, and that his poem contains many astronomical errors, this does not inspire much confidence. Furthermore, as later critics pointed out and as I have shown, Galens hypothetical birth chart in Book III of the Critical Days is sketchy. Yet, it seems that Galen only meant to show in a general way that the critical day theory is consistent with astrology as it was generally understood, in order to make the new methods more acceptable, not to show how to cast or use a birth chart. It is also evident that Galen either does not understand judicial astrology, or does not really care to present it in any detail, since the astrology, as is apparent from his example, is just a show. From other contexts, as I have elaborated, Galen appears to have believed in a natural

49 50

Prognostica de decubitu ex mathematica scientia. Cumont, F. Les Prognostica De Decubitu attribus Galien. Bull. Inst. Hist. Belge Rome xv, (1935): 119-31. Weinstock, S. The Author of Ps.-Galens Prognostica de Decubitu. Classical Quarterly 42, (1948): 41-43.


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astrology, but the examples in the Critical Days do not inspire confidence that he understood how to cast a chart. As the medieval inclination to supply Galen with a practical medical astrology suggests, theres not enough information in the Critical Days to be able to use astrology with the critical days. In fact, in contrast to the detailed empirical arguments of the first two books, this section is highly theoretical. One might also cite the long list of Galens critics, through the Middle Ages and Renaissance, who found fault with his astrology.51 Among these critics, perhaps the Arabic authors were the earliest. Another critic, on the other hand, G. Cardano, wanted to reject Galen completely, replacing his thought with an amalgam of Hippocrates and Ptolemaic astrology. Finally, as I have tried to show, the astrology is non-integral to the medical theory of the critical days. It is, rather, an add-on that has no real bearing on the use of the crises or critical days in treatment, which can be practiced without reference to it at all. Even Galens natural astrology has little bearing on the practical aspects of his therapy. To use a modern analogy, invoking the stars or planets when treating a patient would be like a physician today referring to the Big Bang or sunspot activity as relevant factors in treating an ulcer. The empirical aspects of Galens therapeutic method deserve to be examined in their own right, unobscured by his apparent astrological cosmology, which, as I have argued, is mainly there for rhetorical effect.

51

C. Pennuto 2008 provides such a list.


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galen and astrology r&s

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