doi:10.1093/brain/awt253
Brain 2013: 136; 3809–3811
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BRAIN
A JOURNAL OF NEUROLOGY
BOOK REVIEW
Galen Recovered: Ancient explorations of bodily
movement
It has been a good decade or so for the great classical physician
Galen (AD 128–c.210). His long career and copious writings have
been scrutinized as never before, not just for his many medical
contributions, but also his philosophy and culture, and his politics
and values. His experience and outlook as a Greek doctor from
Pergamum in Asia Minor (Bergama in modern Turkey), who journeyed around the eastern Mediterranean in pursuit of the best
medical education he could find, and eventually settled in the
imperial metropolis—Rome—has proven a rich resource for those
interested in a whole range of historical topics (e.g. Gill et al.,
2009). Galen lived and worked, practiced and taught, constructed,
promulgated and defended his system of medicine right at the
heart of a flourishing Roman Empire. He consorted with senators
and emperors, curing and educating them and their families; he
publically tangled with his rivals, always demonstrating the correctness of his own doctrines and therapies; and he recorded
much of his activity, his life and thoughts, for posterity.
It is not just that new approaches to Galen’s oeuvre have been
adopted, that there is greater vigour and excitement about in the
study of ancient medicine than before, but also, and perhaps more
surprisingly given that almost two millennia have passed since
Galen stopped writing, new material has emerged. As of today
we have more of Galen than we had 10 years ago, or, at least, we
are cognizant of more, and the trend is likely to continue. It is not
just fragments that are being recovered, but whole treatises, in
both their original Greek and the languages of their late antique
and medieval translation—primarily Arabic and Latin, but also
Syriac, Hebrew and Armenian. A Greek manuscript (re)discovered
in the Vlatadon monastery in Thessaloniki in 2005 contains a distinctive set of Galen’s more personal literary productions
(Pietrobelli, 2010). These include fuller versions of his tracts On
my own books, and On the order of my own books (that is the
order in which they should be read) than hitherto, a first full Greek
text of On my own opinions, and a new treatise in any language—On the avoidance of distress—which describes how
Galen managed not to be devastated when most of his library
and many other prized possessions were destroyed in a huge
fire at Rome (Boudon-Millot and Pietrobelli, 2005; BoudonMillot, 2007; Boudon-Millot and Jouanna, 2010; Singer et al.,
2013). Publication of the Arabic translation of Galen’s massive
GALEN: ON
PROBLEMATICAL
MOVEMENTS
By Vivian Nutton and Gerrit
Bos Eds. 2011.
Cambridge: Cambridge
University Press
ISBN 9780521115490
Price: £88.00/$146.00
commentary on the key Hippocratic work Airs waters places,
which is lost in Greek but preserved in a single Arabic manuscript
in Cairo, is eagerly awaited; and a team has recently been working
on an edition, and English translation, of the Arabic versions of his
commentaries on Books One to Three of another set of canonical
Hippocratic texts—Epidemics (see Pormann, 2012). The commentary on Epidemics Book Two again survives only in Arabic, which
has not been published, though we have a translation in German.
The treatise On problematical movements was more forgotten
than lost; having endured a particularly complex (but illuminating)
textual journey from its Greek origins in imperial Rome to the
global bookshelves of today. As Vivian Nutton outlines in his
new modern edition, though only one fragment survives in
Greek, both an Arabic translation and two Latin versions are preserved. This illustrates the multiple paths along which classical
medical learning travelled in the Medieval successor states to
Rome’s empire, the manifold places of cultural exchange, where
old ideas were picked up and variously passed on and reworked:
sometimes further expanded and developed, sometimes compressed and summarized. In particular it is the paths East from
Rome to Byzantium, Persia and the cultural matrices of the
Islamic Caliphates and then back West into the kingdoms of
Christendom, that are here displayed.
Received August 19, 2013. Accepted August 19, 2013
ß The Author (2013). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.
For Permissions, please email: [email protected]
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| Brain 2013: 136; 3809–3811
So, the Arabic rendition was made by the most prominent figure
of the translation movement initiated by the new Abbasid Caliphs
around the middle of the ninth century AD—Hunayn ibn Ishaq
(AD 809—875)—who worked in Baghdad, the recently founded
capital of their Islamic empire, converting up to 129 Galenic
works, amongst other Greek philosophical and scientific writings,
from Greek into Arabic (and Syriac), as a valuable resource themselves and the basis for more original developments in the same
disciplines. It was from the Arabic that the earliest Latin version of
On problematical movements was produced by Mark of Toledo,
operating as his name suggests as part of the translation centre
which flourished in Toledo in the first centuries following its conquest by Christian forces and incorporation into the Kingdom of
Castile. Made around AD 1200, Mark’s Latin text circulated
widely in the Medieval West, contributing to the formation of
the ‘new Galen’ which was increasingly taught in European universities; and which is extant in over 30 manuscripts. The second,
later, translation was produced by Niccolò da Reggio in the early
14th century AD, this time from a Greek manuscript perhaps
newly arrived in Southern Italy from the Byzantine East. Though
his work seems to have had less contemporary impact, since only
a single manuscript survives, its direct contact with the Greek
original and Niccolò’s word-for-word approach to the task of
translation make this an invaluable source for those interested in
recovering what Galen actually wrote.
Despite this continued interest, these repeated efforts at wider
transmission and circulation, doubts about the text’s authenticity
rapidly emerged as Galen scholarship became a more serious
matter. From the Renaissance onwards much energy was devoted
to distinguishing the genuine works from the many others that
circulated under the Pergamene’s famous name, and On problematical movements was categorized as spurious in an important,
new and ‘complete’ edition printed in 1541–42. Debate continued, but rescue could not be effected until the Greek excerpt had
been identified, and all the translations—Arabic and Latin—studied
and assessed, collated and compared; this is therefore the first
publication of the treatise as Galen’s since the 16th century AD;
but in a rather different style than before. Nutton has produced a
critical edition of the Latin, based on Niccolò’s word-for-word rendering of the Greek, bringing in the other traditions where useful,
together with an English translation of this text. In addition, as
well as the introduction and commentary, this volume includes an
edition of the Arabic translation by Gerrit Bos, side-by-side with
Mark of Toledo’s Latin.
It is, however, not just its participation in the wider and longer
patterns of historical cultural exchange and knowledge transfer
involving the medical writings of antiquity that make this text
worthy of attention. Its contents are also of interest. It presents
to modern readers a new and intriguing discussion by an ancient
physician of issues that continue to perplex and challenge. The
title On problematical movements may be somewhat opaque,
but, as Galen explains in the opening lines: this discussion is of
bodily movements that are problematic in the sense of being not
fully understood in anatomical terms, since, either the part of the
body that produces them, or the means of their production, are
not known. The basic somatic sequence involved in such activities
is well comprehended. The systematic human dissection (and
Book Review
vivisection) practised in the first couple of decades of the third
century BC in Alexandria established that movements of the
limbs involve bones, muscles, nerves and brain. The muscles act
to move the bones, having been provided with the power to move
by the nerves, transmitted there by the brain. Thus as Galen
states: ‘The brain is the principal and prime mover of voluntary
movement in every part of the animal’ (2.17). ‘Voluntary’ movement, it subsequently emerges, is contrasted to ‘natural’, movement that occurs without the participation of muscles (or brain),
but through other somatic systems, and the innate powers of the
organs themselves, such as in the case of the pulsation of the
arteries and heart.
The distinction between ‘voluntary’ and ‘natural’ movements is
a common one, inherited not only from the Alexandrian anatomists, but also established in philosophical debates, though terminology and definitions varied. It is, however, problematic, in the
terms Galen is here discussing, particularly as the division is
meant to cover a package including not just the presence or
absence of conscious action, an action of the main part of the
soul located in the brain, but also of specific anatomical correlates—especially muscles. What does ‘voluntary’ really mean if
even very young children can immediately move any part of
their body, using all the right muscles, despite having no idea
which these might be: how can this be conscious or deliberate?
And what about the complicated business of breathing, which
definitely involves muscles, but which some argue is ‘natural’,
since it continues in sleep or stupor, or is it a combination of
voluntary and involuntary? One of Galen’s favourite anatomical
demonstrations has him showing that, by ligating various nerves
coming down from the neck, he can prevent an animal from
moving its thorax and thus breathing without actually entering
the chest cavity itself, supporting a voluntary classification,
but without resolving all the issues, and leaving some counterindications untouched.
There are, to Galen’s mind, also two clear cases of ‘voluntary’
movements made without the aid of muscles. These are sticking
out the tongue and the rapid erection of a young man’s penis
when he sees, or just thinks about, the object of his desire. Both
are willed and involve brain and soul: erection of the penis
through imagining intercourse proving the point that the process
involves the ruling part of the soul but neither the extension forwards or lengthwise of the tongue, nor the upwards and outwards
movement and increase in length and girth of the penis, involve
any muscles that are in the vicinity of either organ. Rather, these
processes are essentially pneumatic. ‘Pneuma’—air elaborated in
the lungs and heart and integrated into the somatic economy—fills
pipe-like structures in the tongue and penis to cause the requisite
effect, brought to the area, with blood, in the arteries (though
Galen is a little vague on the details of the supply).
Then there are the men who can easily and intentionally vomit
up what they have just drunk, without using their fingers or a
feather or any artificial assistance; who have, as it were, adapted
themselves to this Roman habit. Most throwing up is, of course,
involuntary, and the mechanics involved align themselves with a
‘natural’ reading of this activity too. There has been a debate
about whether the oesophagus or stomach is the part responsible
for vomiting, but Galen thinks he has resolved this problem with
Book Review
his investigations into the two tunics of the gullet. He holds that
the inner tunic takes the lead in relation to swallowing and the
outer in relation to its regurgitative opposite, the latter action
being driven by the expulsive power of the stomach. This is an
innate power of this organ, essential to its general functioning and
operating without any reference to the brain, so definitely counting as ‘natural’, not to mention that there are no muscles implicated. Nonetheless, throwing up can be intended, ‘voluntary’, as
well as ‘natural’, and there is no suggestion that the mechanisms
are different, the same parts carry out the same activities, but
under alternate rubrics, alternate auspices or principal powers.
It requires practice to vomit at will, but it certainly can be done,
and Galen does indirectly discuss how this might work. He repeatedly refers to the physical effects that certain mental states, activities of the soul, can have: fear causes pallor and shaking, for
example, thinking about sex causes an erection, and so forth.
Imagining vomiting could therefore have an impact on the stomach, could trigger the expulsive power and the appropriate action
of the outer tunic of the oesophagus. Indeed, the argument could
have been strengthened if Galen had included throwing up on his
list of cross-over ‘voluntary’/‘natural’ (or ‘involuntary’) activities,
which if seen generate an imitative response, along with urinating,
defecating, stretching and yawning. Again the point is that sensation or perception—processed in the brain—can have a bodily
effect, which replicates the whole somatic sequence involved in
the movements observed, or, at least begins the process of such
replication, for the will may intervene to prevent completion, at
least in some cases: for example that of urination, though children
usually cannot manage these inhibitions. There is a sense, then, in
which bodies, organs and organic combinations, come close to
having their own intentions, with aims, purposes and their own
powers of realization, so that, to return to the complicated matters
of breathing and speech, which Galen finds deeply fascinating, the
brain, the controlling part of the soul in the brain, does not need
to know exactly which muscles have to be activated, in what
sequence, in inhaling, exhaling or speaking. It simply needs to
communicate its wants and the tongue, mouth, throat and parts
of the respiratory system will do the rest.
The treatise concludes with a lengthy and intricate discussion of
the anatomy of these processes as they also relate to swallowing.
Galen describes in considerable detail dissections of the throat and
neck (in animals) and how these reveal the various parts and their
inter-relationships. Before he reaches this point, he adds an extra
pair of movements which trouble the ‘voluntary’/‘natural’ distinction in association with breathing, and which occupy some of the
same somatic space and share the same processes. That is, coughing and sneezing, which can be voluntary or involuntary (in
respect to timing at least), with the same combination of parts
responsible as for breathing. Although some explanations are possible here, and coughing and sneezing, like yawning, serve certain
physiological purposes; the most baffling case of all is laughter,
Brain 2013: 136; 3809–3811
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which also involves the same organic package. The problems here
are manifold. Why does being tickled produce the same effect as
seeing or hearing something ridiculous? Why do ridiculous things
make us laugh anyway, even if we try not to? How do bones,
muscles, nerves and brain, the innate capacities of the relevant
organs, work together to produce these outcomes? These issues
remain open today.
As this—somewhat selective—survey shows, this is a treatise
with as many questions as answers in it, and one that does not
proceed in an entirely systematic or orderly way. It is the product
of system, however, the result of Galen’s examining and explaining, in as comprehensive a way as possible, the functioning of the
human being, how it all works and why. In investigating somatic
movements he found that some were straightforward—in terms of
the parts responsible, and their mechanics—but others were not;
and he discovered that the traditional, and organizationally useful,
distinction between ‘voluntary’ and ‘natural’ movements, as they
map onto anatomy, also has its limits. A set of problems emerged,
and needed tackling, within the same overall framework of understanding. They were not all soluble, they do not even all neatly fall
into one class of problem or the other; they are, like the human
body itself messy and complicated, but Galen’s desire to get to
grips with them all, his insatiable curiosity and drive to explication
come through clearly. He definitely had the workings of nerves
and brain fully in his sights, and there will be further revelations
about his ideas in these areas as new material continues to
emerge.
Rebecca Flemming
Jesus College, Cambridge
Advance Access publication September 24, 2013
References
Boudon-Millot V (editor, trans. and comm.). Galien: introduction générale; Sur L’Ordre de ses propres Livres; Sur ses propres Livres; Que
l’excellent Médecin et aussi Philosophe. Paris: Les Belles Lettres; 2007.
Boudon-Millot V, Jouanna J (editors and trans.). Galien: ne pas se chagriner. Paris: Les Belles Lettres; 2010.
Boudon-Millot V, Pietrobelli A. Galien ressuscité: édition princeps du
texte Grec du De Propriis Placitis. Revue des Études Grecques 2005;
118: 168–213.
Gill C, Whitmarsh T, Wilkins J, editors. Galen and the world of knowledge. Cambridge: Cambridge University Press; 2009.
Pietrobelli A. Variation autour du Thessalonicensis Vlatadon 14. Revue
des Études Byzantines 2010; 68: 95–126.
Pormann P, editor. Epidemics in context: Greek commentaries on hippocrates in the Arabic tradition. Berlin: de Gruyter; 2012.
Singer P, Nutton V, Davies D. (trans.). Galen: psychological writings.
Avoiding distress, character traits, the diagnosis and treatment of the
affections and errors peculiar to each person’s soul, the capacities of
the soul depend on the mixtures of the body. Cambridge: Cambridge
University Press; forthcoming 2013.