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What Factors Influence Galen's Development of a Theory of Black What factors influence Galen’s development of a theory of black bile for his explanation of health and disease in the body? Submitted by Keith Andrew Stewart to the University of Exeter as a thesis for the degree of Doctor of Philosophy in Classics in July 2016 This thesis is available for Library use on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. I certify that all material in this thesis which is not my own work has been identified and that no material has previously been submitted and approved for the award of a degree by this or any other University. Signature: ………………………………………………………….. Abstract Galen’s theory of black bile is strongly influenced by his aim to bring together a wide range of material from the work of different physicians and philosophers that begins with Hippocrates. This has caused there to be a large amount of inconsistencies in his writing on black bile. There has been a tendency in modern scholarship either to try to resolve these inconsistencies or to ignore them completely. In many cases there has been an emphasis on the definition of black bile in the Hippocratic On the Nature of Man as the most important basis for understanding Galen’s characterisation of black bile. My analysis will challenge this assumption concerning the dominance of On the Nature of Man for Galen’s use of black bile in his explanation of health and disease in the body. I shall show that an investigation of the way that Galen characterises the physical properties and function of black bile reveals that it is better to understand his use of this humour in terms of his attempt to bring material from a wide range of authorities together to support the arguments that he presents in his treatises. Galen defines black bile as three distinct types of substance that differ in physical properties in order to account for the different ways that this humour is characterised and defined in the various medical sources that he draws upon. However, he is unable to produce a theory of black bile without inconsistencies relating to a number of issues that include such factors as his naming of the different forms of black bile and his concept of authenticity of texts in the Hippocratic Corpus. Galen’s strategy is to make his audience believe that there is a comprehensive and well-defined theory of black bile that originates in the work of Hippocrates and was followed by certain physicians and philosophers afterwards. But in reality this is just a facade and Galen defines and uses black bile in many different and inconsistent ways for his arguments and refutations that cannot always be reconciled with the content of his sources. 2 Table of Contents Abstract 2 Acknowledgements 6 Research Question 7 1 Introduction 10 1.1 Structure of the thesis 10 1.2 Review of literature on Galen and black bile 16 1.3 Galen and humoral theory 21 1.3.1 Humoral theory in ancient medicine 21 1.3.2 The origins of black bile in ancient medicine 23 1.3.3 Black bile as the cause of health and disease 25 1.3.4 Galen’s classification of physicians and philosophers as humoral 29 theorists 1.3.5 Galen’s polemic against those he considers to be opposed to 43 humoral theory 1.4 Summary 46 2 Galen’s strategy for his portrayal of Hippocrates as a 48 philosopher 2.1 Introduction 48 2.2 Galen and the importance of philosophy for medicine 49 2.3 Galen’s reliance on Plato for his concept of the tripartite system of 53 the soul 2.4 Galen’s element theory 57 2.4.1 Galen’s argument for the Hippocratic origins of element theory 60 2.4.2 The concept of ‘mixture’ in Galen’s element theory 65 2.5 Galen’s teleological theory 71 2.5.1 Galen and Platonic teleology 72 2.5.2 Galen and Aristotelian teleology 75 2.5.3 Galen’s view of ‘Hippocrates the teleologist’ 79 2.6 Summary 81 3 Galen’s opinion on the authenticity of the individual treatises 86 in the Hippocratic Corpus 3.1 Introduction 86 3 3.2 Category 1: Texts from the Hippocratic Corpus that Galen 100 considered to be written by Hippocrates 3.2.1 On the Nature of Man and On Regimen in Health 101 3.2.2 Prognostic 106 3.2.3 Aphorisms 108 3.2.4 Epidemics I and III 110 3.2.5 On Regimen in Acute Diseases 112 3.2.6 Airs, Waters and Places 114 3.2.7 On the Sacred Disease 116 3.2.8 On Humours 117 3.2.9 On Diseases of Women I, II and III 118 3.2.10 Koan Prognoses 119 3.2.11 On Breaths 120 3.2.12 On the Nature of Bones 121 3.3 Category 2: Texts from the Hippocratic Corpus that Galen 122 considered to be Hippocratic treatises 3.3.1 Epidemics II, IV and VI 122 3.3.2 On Internal Affections 124 3.4 Category 3: Texts from the Hippocratic Corpus that Galen 126 considered to be inauthentic 3.4.1 Epidemics V, and VII 126 3.4.2 On Diseases I-III 127 3.4.3 On Diseases IV 128 3.4.4 On Places in Man 130 3.4.5 Ancient Medicine 132 3.5 Summary 133 4 Galen’s characterisation and physical description of the 137 black bile humour 4.1 Galen’s qualitative and structural characterisation of black bile 137 4.2 Galen’s development of different types of black bile 155 4.3 A question of consistency in Galen’s qualitative characterisation 166 of black bile 4.4 Galen’s explanation of why black bile can be so harmful to the 175 body 4.5 Summary 185 5 The cleansing of excess or harmful black bile from the body 191 5.1 The importance of the liver for the origin of black bile in the body 191 4 5.2 The relationship between the structure of the spleen and its 194 function 5.3 Galen’s attack on Asclepiades and Erasistratus on the function of 201 the spleen to cleanse the body of black bile 5.4 Diseases of the spleen in relation to the harmful nature of black 210 bile 5.5 Summary 217 6 The diseases caused by black bile 222 6.1 Melancholy, the black bile disease 222 6.2 Quartan fever, the black bile fever 229 6.3 Cases where the presence of black bile indicates a terminal 238 disease 6.4 The identification of black bile in urine for correct diagnosis and 242 prognosis 6.5 Summary 249 Conclusion 255 Bibliography 264 5 Acknowledgements I would like to thank my supervisors John Wilkins and David Leith for their advice and feedback on my work on this thesis. I would like also to thank both David Braund and Matthew Wright for their support as supervisors at the beginning and end of the PhD. I am very grateful to the Arts and Humanities Research Council for their funding of three years for the PhD, without this funding I would not have been able to undertake this research. Finally, I want to thank my wife Katherine for her continued love and support to me while I worked on the thesis, which also coincided with the birth of our first child, Alexander. 6 Research Question The concept of black bile as a substance responsible for health and disease is an interesting topic in ancient medicine. The origin of black bile appears to have begun towards the end of the fifth century BCE, when it was defined as a fundamental substance in the body, alongside blood, phlegm and yellow bile in the Hippocratic On the Nature of Man. But, apart from this one treatise, black bile was regarded mostly as a residue, waste product or was completely ignored in the medical theories of many physicians and philosophers. Black bile might have remained a fairly insignificant substance in medical writing, if it was not for Galen’s reference to the superiority of the four-humour system of On the Nature of Man, which raised the status of black bile as an important substance for the explanation of health and disease in the body. It is easy to understand why Galen would use blood, phlegm and yellow bile as fundamental substances in his theory of health and disease, as all three were considered by many physicians and philosophers to be essential in the understanding of how health and disease occur in the body. However, black bile did not seem to be as highly regarded in medicine and so required Galen to defend the use of this humour in his medical writing. Therefore, out of the four humours, black bile represents the greatest challenge for Galen, as he attempts to explain how this substance can be both an essential humour that keeps the body healthy, but also is the cause of the most deadly diseases. In addition, Galen’s justification of the very existence of black bile provides an excellent insight into his polemical strategy for the refutation of the theories of his rivals, such as Erasistratus and Asclepiades. There has been relatively little work done on the analysis of Galen’s use of black bile across the large number of extant texts in the corpus. Most of the discussion in modern scholarship relates to Galen’s characterisation of black bile in terms of his adoption and development of the four-humour system of On the Nature of Man.
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