Dmitry A. Balalykin. Galen on Apodictics, Studies
in Medical Philosophy, no. 7. Stuttgart: ibidem-Verlag, 2020, 340 pp., €39.90,
ISBN 978-3-8382-1406-1.
Quod optimus medicus sit quoque
philosophus
Dimka Gicheva-Gocheva (Sofia University)
published in Sofia Philosophical Review, vol. XIV, No1, 2021, p. 22-34
http://sphr-bg.org/14/18/52.html
If I am to express with a single
sentence the merits and the moral of the book by Dmitry Alekseevich Balalykin, Galen on Apodictics, it would be this
one: The best doctor is also a
philosopher. This is the title of one of the most popular writings of the eminent
Roman philosopher and physician Galen, the successful personal doctor of three
emperors: Marcus Aurelius, Commodus and Caracalla. The book is the seventh
volume in the series Studies in Medical
Philosophy and includes an elucidating Foreword written by Alexander L.
Gungov. The scope of the book is much
larger than its title suggests. In fact, this is an excellent and comprehensive
history of the philosophy of medicine in antiquity from the Hippocratic
tradition to Galen, including a narrative of the main developments both in the
theoretical field and the practical application of the art of healing.
In the Introduction, Balalykin imparts to readers the
meaning implied in a range of terms and concepts having a general
epistemological character. For instance, his “simplified definition” of
“science” is “an organised collection of verifiable paradoxes and corrected
errors”.[1] Another
important clarification concerns the term “protoscience.” According to
Balalykin, the latter embraces certain works by ancient scholars, whose ideas
are ontologically very close to modern ideas and are partially commensurable
with them. Ancient medicine is in a better position than many other branches of
knowledge, with it being engendered and fully elaborated in the Greek and Roman
worlds. To begin with, the number of the texts in the Hippocratic corpus is impressive, and Balalykin reminds us that
nothing similar is at the disposal of researchers studying the birth of other
disciplines. Galen was an astonishingly prolific author, leaving 500 writings
of which 111 have reached us. Fewer than half of them have been translated into
English, 30 into Russian, and an even smaller number into Bulgarian.
This paucity is a consequence of
many ungrounded prejudices, unquestioned assumptions and bad educational
practices, rooted in decades-old university curricula: students and academics,
concerned with philosophy, should study only
the ancient thinkers; students and academics, focused on history, should
read the historiographers of the past, but not other prose texts; the
departments of classics should concentrate on the great masterpieces of the
literary heritage, but are free to ignore the sources of the exact sciences,
etc. Such established routines distort the knowledge of the past. The most
enjoyable part of the book was the historical outline: the views of
Hippocrates, Empedocles, Democritus, Plato, Aristotle, the Epicureans, many of
the Stoics, and above all Galen are analyzed. All of them were philosophers,
and the greatest practitioners and scientists among them attained the peaks of
the knowledge of their time because of the theoretical foundations of their
endeavors. Concerning Galen, Balalykin’s book is irrefutably convincing as he
explains the phenomena of medical theory and practice in the language of
philosophy.
What is health? disease? body? soul?
What is the soul’s connection to the body of man? How many parts and/or
functions, or powers, does the human soul possess? What is a cause? an effect?
a purpose? a sign? To these and many other important questions, Galen not only
provides answers, but builds these answers into an imposing theoretical system,
founded on the most powerful abstract philosophical concepts, and, at the same
time, given successful expression in his own therapeutic practice. This is why
Galenism remained dominant for more than a millennium. Balalykin stresses that
it is a minor matter to debate whether it took 50 or 150 years for this
philosophy-and-practice to triumph. What matters is that it dominated till the
seventeenth century and was regarded as relevant until the early nineteenth
century.
The first chapter of the book
presents Galen as a historian of philosophy, of the theory and practice of the
art of medicine. Indeed, everything starts with Hippocrates and his associates
and co-authors, whose writings are included in the Corpus. Some of these authors claimed that medicine should not be
built on theoretical concepts about human nature, a view initially expressed by
natural philosophers. Others believed that the human body consists of a single
element. Galen holds the opposite view: the body is a mixture of the four
elements (earth, air, fire and water) and the balance of the four liquids
(blood, phlegm, yellow and black bile). The purpose of medicine, according to
Hippocrates, is “to do away with the sufferings of the sick, to lessen the
violence of their diseases, and to refuse to treat those who are overmastered
by their diseases, realizing that in such cases medicine is powerless.”[2]
Balalykin rightfully qualifies this goal and the definition of health, which
follows from it, as apophatic: “health is the absence of suffering”.[3]
At the same time, from the Hippocratic tradition, Galen borrows one of his
definitions of health, which is cataphatic: health is due to the good balance
or the good mixture of the three tetrads. Balalykin highlights the most useful
conceptual tool formulated by the authors of the Hippocratic circle and
Alcmaeon of Croton:
Galen subsequently employs the concept
of the “good mixture” to describe health. Consequently, “disease” is defined as
the antithesis of health, i.e. as the suffering of the human body through the
disruption of the dynamic equilibrium of the three tetrads (elements, liquids,
essences). Here we see the continuity of Hippocrates’ idea and the preceding
rationalistic theories about health and disease. According to Alcmaeon of
Croton (the first in the history of medicine to attempt to construct a rational
theory of general pathology), “isonomy” (ἰσότητα, i.e. “equilibrium” of the
properties wet, dry, cold, hot, etc.) is indicative of “health”, whereas
“monarchy”( μοναρχία, i.e. the “dominance” of one of these properties) shifts
the equilibrium and, as a result, leads to disease.[4]
Other key notions of the Hippocratic
medical school to which Balalykin draws attention are: the opposite of balance,
change, “transition” (μετάβαση); the influence of external factors such as
climate, diet, etc.; timely detection of the first symptoms; the relativistic
view of health (“health can be more or less”[5]); the
proper start of treatment (“[i]f disease and treatment start together, the
disease will not win the race”[6]);
the fundamental principle of curing the “opposite with the opposite”[7]
– the elimination of the excess of one and deficiency of the other.
Balalykin also points to the humble
Hippocratic recognition of the limits of medicine and the confession of the
“relativity of recovery”:[8]
Full recovery from sickness is not always
possible. To summarize, this part of the book elucidates the theoretical
framework of the Hippocratic art of healing and its empirical method. This
stage led to two types of generalization: ideas about the anatomy, physiology
and general pathology of the human being as a whole and, secondly, the
understanding of the individual peculiarities in the progression of any
disease.
The next section of the first
chapter of the book discusses the impact of the doctrines of Plato and
Aristotle. One of Galen’s principal treatises is entitled On the Doctrines of Hippocrates and Plato, in which he focuses upon
the dialogue Timaeus – Plato’s
encyclopedia of the philosophy of nature. Cosmogony, cosmology, the creation of
the four elements out of perfect triangles, anthropogony, embryology, anatomy
and physiology, all are covered in the speech of the Pythagorean of Locri. A
certain part of this speech could be read as a lecture by Plato on the
generalities of medicine. According to the summary given by Balalykin, Plato
suggests that there are three types of diseases. The first group is defined by
the disruption of the equilibrium of the four primary elements – earth, air,
fire and water. The second group is associated with disturbances in the
nourishment of some parts of the body. Diseases of the third group are due to
the imbalance of humors and primarily arise from the disturbance of the
breathing process.
Balalykin points out two significant
components of Platonic physics and philosophy of nature: 1. the primary
elements are transformable into each other; 2. the description of their
properties is given in the language of mathematics, through geometry and
stereometry. He also pays attention to the influence of the Pythagoreans and
Empedocles on the formation of Plato’s cosmology, and the crucial role played
by the Demiurge in the construction of the beautiful and eternal cosmos. He
also stresses that Plato disagrees with Empedocles: the center of rational
activity, the higher control of the functions of the body, according to Timaeus,
lies in the brain. Balalykin notes the fundamental concept of the mutual
influence of the spiritual and the corporeal. Nowadays this is called the
psychosomatic integrity of the human body. He insists on the congruence between
the views of Plato and the authors of the Hippocratic
Corpus because, in his opinion, the right approach to the essence of
medicine is its treatment as a theoretico-practical system that progresses on
the path of the accumulation of knowledge and its generalization. Balalykin praises
Galen for advancing Plato’s fundamental ideas further, especially the
explanation of the process of breathing, the topography of the human body, and
above all the idea of the tripartition of the human soul. Balalykin quotes
Galen, who states in his Commentary on
the Timaeus:
Reason resides in the brain, from
which it controls the nerves and movements, as well as the five senses. The
appetitive part of the soul is located in the liver and is responsible for the
blood, veins, and also has the ability to differentiate substances necessary
for the nourishment of the body. The spirited source, which is located in the
heart, monitors the arteries, the natural temperature, pulsation of the blood,
as well as the animal part of the soul.[9]
Balalykin’s next interpretive task
is perhaps the most difficult, because when writing on Plato’s natural
philosophy, on his ideas of the body and soul of the cosmos, and their
interrelations, imitated by every living creature, it is possible to concentrate
on just one dialogue; the Timaeus.
However, in the Aristotelian Corpus,
one third of the treatises, or better, one third of the notes for and from his
lectures in the Lyceum, are engaged with ontological and physical principles
and causes, the structuring of the cosmos as a whole and of all the living
organisms in it. It is almost impossible to decide what to select and what to
skip. In the panoramic survey of the ideas of Galen’s predecessors, inherited
and enriched by him, Balalykin chooses several Aristotelian tenets: the four
primary elements and their natural places in the eternal, imperishable and
uncreated world, and the problem of coming-to-be and passing-away, treated
differently in three texts. One solution to this problem is found in the two books
bearing the same title (On Coming t0-Be
and Passing-Away and Book Alpha and
Beta); a second is in his biological writings; and a third is in Physics. Also important here is the reduction of the contrarieties in
his explanation of living creatures. This matters, because in the four
cosmological books of On the Heavens
there are three constitutive couples of contrarieties (heavy and light; hot and
cold; moist and dry). Balalykin stresses the fact that in the explanation of
ensouled creatures, Aristotle excludes the couple heavy-and-light because they
are neither active nor susceptible.[10]
The
great difference between Plato and Aristotle concerning the identification of
the most important organ in the human body preoccupied Galen. Is it the heart
or the brain? Balalykin comments that Aristotle followed Empedocles and
believed the most important to be the heart. This question provoked ardent
debates through the centuries, and was recorded mostly in the text On the Doctrines of Hippocrates and Plato,
which discussed the views of Hippocrates, Empedocles, Plato and Aristotle.
Galen’s criticism gradually increased and reached its utmost height in the
polemic against the Stoic Chrysippus of Soli. Balalykin summarizes the result
of Galen’s survey of the Roman philosopher and physician: “Galen points to the
extremely speculative nature of the ideas of the Stoics and Aristotle,
attributing that to their ‘ignorance of anatomy’. He proves that the centre of
the motive power is in the brain and this energy is transmitted to the whole
body through the spinal cord and nerves.”[11] Balalykin
also emphasizes the difference between the Aristotelian History of Animals and the treatise On Fleshes by Galen concerning cardiac anatomy. At the same time,
he correctly clarifies that, for Aristotle, there is a considerable difference
between the cardiovascular system of mammals and the anatomy of the animal and
human heart. This is evident in the Aristotelian texts On the Parts of Animals and Historia
Animalium.
After this historical outline of the
main conceptions of the greatest antecedent Greek philosophers and physicians
from different schools of thought, Balalykin analyzes the doctrine of homoiomereia as the foundation of
Galen’s view of the microstructure of tissue. The term and the notion of homoiomereia was coined by Anaxagoras of
Clazomenae (500-428 B. C.), and literally means “particles similar to other
particles.” These particles are ontologically responsible for the birth and
evolution of the material cosmos and are ruled and governed by the immaterial
divine Nous. Aristotle makes great use of the concept in his biological
writings and Galen further implements it, enriching its compass. This part of
the book is extremely dense, including the testimonies from various ancient
thinkers alongside the work of many contemporary scholars. He sums up the main
points of “The Art of Medicine” with the obvious positive conclusion that the
human body consists of various organs and tissues, observed by the physician
during surgical intervention. In the discourse on the pathological processes,
which are the real challenge for the art of healing, Galen, according to
Balalykin, insists mainly on the following: 1. The mechanisms of development of
a disease may be realized at the level of homoiomereia;
2. It is particularly at the level of homoiomereia
that pathological states associated with the imbalance of essences may manifest
themselves; 3. The classification of the states of the human body along the
scale of the “normal and pathological” begins at the level of the particles
similar to others; 4. Galen defines specific tissues as a collection of
homogenous homoiomereia and the
spaces between them.
In brief, in the first chapter, the
reader encounters Balalykin’s interpretation of the critical reception in
Galen’s writings of the ideas expressed mainly by the famous pre-Socratics and
the two giants of classical Greek thought; Plato and Aristotle. The second
chapter turns to a discussion of Galen’s clinical experience and apodeixis,
starting with a theoretico-philosophical consideration of the semiotics of
diseases. Several complex conceptual problems are debated here. Obviously, the
first is the thematic circle around the questions: What is a sign? What is a
signifier? What is a signified? What constitutes medical and pathological
semiotics? The most intriguing answers to these questions were proposed in the
logic of the Stoics and the writings of some of the later Skeptics, but there
are few authentic fragments from the oldest Stoics and also from the Skeptics
prior to Sextus Empiricus. Moreover, Galen dislikes and criticizes the
doctrines of the Stoics in almost all their ramifications, and also opposes the
negative skeptical attitude.
Before properly dealing with the
polemic between the representatives of the Hellenistic schools and Galen,
Balalykin opens this chapter with Galen’s contemplation of the education most
necessary and required for any person who wishes to become a good physician.
Geometry, as the best branch of mathematics, astronomy, “and particularly
logic, which have been created by human genius, help us to find sources of
harmony and consistency in nature and to discover its ideal beauty.”[12] Galen’s
fundamental educational and didactic credo is expressed by his high appraisal
of the study of philosophy. Even the title of his writing-manifesto is telling:
The Best Doctor is also a Philosopher.
With respect to the problematic
circle of the nature of the sign, Balalykin demonstrates Galen’s pragmatic
approach:
Galen’s teachings on “the external
signs” combine philosophical investigations and practical observations. The
very term “sign” in Galen is highly individualised. The symptoms (or signs) of
a disease and features (or signs) of the patient’s unhealthy condition and
behaviour make it possible to draw a conclusion pointing to a particular
diagnosis and methods of treatment.[13]
At the same time, he again underlines the philosophical and
logical dimensions of the concept of the sign in Galen’s theory:
For Galen, the identification and
analysis of the signs of an illness is a process of establishing a logical
relationship or inference (the one follows from the other in line with a
certain rational principle). Usually, there is a cause-and-effect relationship
between the internal changes in the body and the external sign of the disease
(the one is a prerequisite of the other). Galen looks for the causes of the
disease using logical constructs, by analysing external signs. Only after doing
this and determining the cause can one find the correct remedy.
A sign being observed exists in
itself, without being studied, but needs to be studied when the relation
between the evident and the non-evident can be established.[14]
Balalykin’s conclusions are grounded in his understanding of
Galen’s treatise On the Sects for
Beginners.
Another key thematic field discussed
in the book is Galen’s etiology, i.e. his philosophical theory of causality,
applied to the art of medicine. Balalykin notes that “‘aetiology’ in Galen’s system means teachings on disease in
general. Today ‘aetiology’ refers to a combination of ideas about specific
conditions under which disease arise in particular nosological forms.”[15] Galen’s reasoning in this aspect is far
from the crude, hopeless and merciless Stoic determinism, and more akin to the
teleology of Aristotle. Balalykin says that “cause” for him is rather a
combination of external factors that are “healthy” or “unhealthy.”[16]
From this follows his definition of “disease” : some condition contrary to
nature and harming function.[17]
In turn, this leads to the concept of a “disease symptom” as an observable
phenomenon.
Galen’s ambition was to be the best
possible doctor. To achieve this he attempted to construct a universal system,
by considering the nature of functional impediments. The human body in its
normal state performs the functions of the soul and the functions of nature. As
Balalykin recalls, the most important ingredient, inherited from Plato, is the
tripartite structure of the human soul. The functions of the soul, writes
Galen, can be divided into the sensory, the motor and the authoritative. The
sensory function of the soul is manifested through the five senses; sight,
smell, taste, hearing and touch. The motor function has one instrument and one
mode of movement, diversified in the various organs, a job performed by the
muscles. The authoritative function is manifested through imagination, memory
and reason.[18]
All these considerations are
included in “The Art of Medicine” but a new ingredient is added to them – a
polemic against the Methodic doctors, who fancied that there are eternal
chaotically moving indivisible particles, or atoms, existing in the form of a
“healthy” essence. According to this curious theory, the status of the body is
determined by the proportions and combination of “good” and “bad” atoms,
“health-bearing” and “disease-bearing” atoms, and these are randomly connected.
The atomistic substratum of this view is beyond doubt. Balalykin demonstrates
Galen’s struggles against this physical theory as the basis for medicine in his
treatise On Hippocrates’ On the Nature of
Man. In the latter, he establishes three main states of the body: healthy,
sick and neutral. In contrast to the atomistic theory, Galen holds that the
material structure of a specific part of the body is a combination of
homogenous homoiomeres and the space
between them.
In this context, Galen defines
medicine as the “knowledge of those things that are healthy, those that are
diseased, and those that are neither”.[19]
In the paragraphs of this excellent epitome of the synergy between
philosophical theory and medical practice, a synergy for which every decent
physician should strive, there is one more idea: the hierarchy of the parts of
the body. According to Galen, there are four parts: 1. The principals (brain,
heart, liver and testicles); 2. The parts that grow out of the principals
(nerves, spinal cord, arteries, veins and spermatic ducts), but do not engender
others; 3. The parts that do not grow out of others, but have functions
inseparable from the other organs (cartilage, bones, ligaments, membranes,
glands, fat and simple flesh); 4. Those that are both related to others and
grow out of others (everything else). In a quick comment here, we may say that
the influence of Aristotle’s philosophy is undeniable in this doctrine of the
principals in the body and everything else is dependent on them. There is one
huge difference: for Aristotle, the brain is a kind of a refrigerator (sic) and its task is to cool the
excessive heat coming from the intense work of the heart. On the contrary,
Galen states that the brain is the most important arche in the human body.
The final part of the second chapter
raises again the issue of the unity of mind and body, this being substantial
and essential according to Galen. In his reasoning on this eternal problem, he
combines notions from Plato and Aristotle, and, exceptionally, the Stoic demand
to lead a virtuous life. Balalykin clearly presents the Platonic ideas of the
two spheres of being: the visible and the invisible, or the upper level of the
unchangeable and eternal (essences and ideas), and the realm of change and
flux. It is clear to which the soul belongs and in which the body is destined
to abide. Nevertheless, Galen is not a dualist. In his philosophy, the
statements about harmony and interaction are much more numerous than those
depicting an irreconcilable struggle between the two sides of human nature.
After
this, Balalykin moves to the topic that stood at the head of all philosophical
concern and inquiry for all Hellenistic schools and thinkers in late antiquity:
ethical teaching about what is good and bad, which are the principal virtues
and which are the worst vices. As in many other cases, Galen is much closer to
Plato and Aristotle, and opposes the Stoics and the atomists. A curious note
here, but not ungrounded, is the parallel which Balalykin draws between some of
Galen’s convictions and the pious exhortations of several early Christian
apologists.
The third chapter is entitled
“Anatomical dissections as evidence in a philosophical polemic” and begins with
an analysis of Galen’s method of investigation. This chapter deals with the
same authors, philosophers and physicians, and often the same texts discussed
in the first and the second chapters, but here the focus and the perspective
are different. How do all previous questions look when they are posited in the
realm of the history of medicine, in the context of the history and methodology
of science? Balalykin’s overall ambition is to defend the value of the ancient
medical-and-philosophical authorities, and to oppose some contemporary
derogations of the ancient knowledge and protoscience.
In this chapter, the focus is on the
intersection of three important writings by Galen: again On the Doctrines of Hippocrates and Plato, the self-reflective On my own opinions, and the polemical survey
On the Sects for Beginners. Serious
statements emerge from tackling the problem: were there real scientific experiments in medical
practice from Hippocrates to Galen, or were there mainly pure and simple descriptive observations? Balalykin
studies the history of the art of healing in these centuries, as perceived and
assessed by Galen, through the lens of the logic and methodology of science.
One example of Galen’s implementation of his theory’s logical toolkit will
suffice, as it relates to his descriptive anatomy. In the meticulous reasoning
on the obsessive problem about the priority of the heart or the brain as the most
important organ in the human body, Galen does not reprimand, but understands
and explains to readers whence comes the mistake made by Aristotle, whose other
ideas he shares almost entirely:
In my opinion Aristotle
here used two correct premises, the first, that some considerable strength is
needed for voluntary actions, and the second, that the brain does not possess
any such strength. But when he adds to these as a third, taken from
sense-perception, the large number of nerve-like ligament in the heart, he no
longer had the patience to concern himself with the particulars of anatomy and
to inquire how a nerve proceeds from the heart to each part of the body; he
asserts it as if it were directly entailed in the passage that I cited … So I
think that Aristotle was also misled when he posited two true premises and a
third plausibly close to the truth.[20]
As stated before, Balalykin proves
that Galen rightly considered himself to be a follower of Hippocrates, Plato
and Aristotle, which made him a good example of the late antique heterogeneous
eclectic in the best sense of the term “eclecticism.” When he had to choose
between two mutually exclusive solutions to a fundamental problem, he just
skipped it. For example, he confesses that he will not state anywhere whether
he believes the soul to be immortal or not. He reaches almost impossible levels
in his mingling of Platonic and Aristotelian ideas, and critically approaches
the views of the three major Hellenistic schools, especially their notions of
nature and human cognition, which have laid the philosophical foundations of
the other medical schools: the Empiricist physicians, the Methodic physicians
and the Pneumatic physicians, to whom he was more lenient. Balalykin is
convinced that, for anyone interested in the history of the methodological
debates between the medical schools and their pertinent philosophical
affiliations, Galen’s On the Sects for
Beginners is indispensable. Balalykin devotes a considerable part of his
survey to the analysis of the Empirical school as an opponent of the
Hippocratic tradition, mainly due to the fact that “the Empiricist doctors
provided theoretical substantiation of the pointlessness of studying anatomy”.[21]
Here, a controversial issue comes to the fore: were these physicians entirely
Stoics or forerunners of the Skeptics? Balalykin’s selection and interpretation
of passages from Galen is more inclined to the first option.
A key section of the book is the one
that discusses apodictics. The history of the application of the method of
dissection and vivisection begins with the authors of the Hippocratic corpus, more precisely with the treatise The Sacred Disease, in which the
features of the pathologic damage in the brains of cattle and goats, suffering
from epilepsy, are paralleled to the ones in human patients. From these remote
times to the practice of Galen the method progressed gradually, facing
resistance mainly from the doctors of the Empiricist creed. Balalykin
substantiates the narrative with a profound analysis of Stoic tenets,
responsible for their antipathy: the nature of lekton and pneuma, the cataleptike phantasia, the four
ontological concepts, the hypothetical syllogism, their inclination to use
emotional literary quotations rather than anatomical observations and research.
The last two sections of the book summarize the most
valuable ideas expressed by Galen in his numerous writings and are supported by
his experience of anatomical investigations and surgical practice. On many
occasions, Balalykin stresses the teleological principle not only as the basis
of Galen’s apodictics, but as a holistic understanding of the organic body’s
vital functions, resulting in health or disease. Here, this conception is
reinforced and exemplified by references to the embryology and gastroenterology
of the great Roman physician, and by many respectful links to the champion of
teleological reasoning in the philosophy of life; Aristotle. In the concluding
part, focus turns to Galen’s clinical work and the physiological experiments. Noteworthy
is the importance of Rufus of Ephesus, convincingly depicted by Balalykin as a
leading figure in the diagnosis and treatment of diseases, traumas, animal
bites, etc.
I have only one serious
terminological disagreement with the author. In several places, when mentioning
the three principal tetrads, whose balance results in a healthy condition,
Balalykin labels the pairs cold-hot and moist-dry “essences” or “substances”;
rather, they are properties or contrarieties. Some other hesitations
arose in me concerning the predominance of the Stoics as tutors of the
Empiricist doctors, but these became an occasion to look more attentively into
the ancient sources and into the commentaries on them made in the last few
decades.
The synoptic impression of the book
is delightful: this is a precious study, which builds bridges over abysses.
These abysses do not belong to the ancient world of knowledge and cognition.
They were excavated and deepened in the last two centuries by the
ever-increasing distance between the natural sciences and the humanities, and
by the compartmentalization of academic education and research. Dmitry
Balalykin’s Galen on Apodictics,
rewards the careful reader longing for real acquaintance with the history,
philosophy and logic of medicine in the European past.
Dmitry A. Balalykin, Galen on Apodictics (Stuttgart: ibidem-Verlag 2020), 14.
Hippocrates, “The
Art” in Hippocrates
Volume II (Massachusetts: Harvard University
Press, 1923), 211.
Ibid,
37, clarifying Hippocrates, On the Nature of Man.
Ibid,
52, Balalykin here quotes Galen’s “Commentary on the Timaeus” (Comm. Tim. 76e7-77c5)
Galen, “On
the Differentia of Diseases” in On
Diseases and Symptons (Cambridge: Cambridge University of Press, 2006),
131-156.
Galen, “The Art of Medicine,”
in On the Constitution of the Art of
Medicine. The Art of Medicine. A Method of Medicine to Glaucon
(Massachusetts: Harvard University Press, 2016), 223.
Quoted
in
Balalykin, Galen on Apodictics, 175.
Ibid, 188.
През миналото лято писах рецензия за книгата на Дмитрий Балаликин "Гален за аподиктиката". Защитена е като дисертация в англоезичната докторска програма по философия във ФФ. Повечето от текстовете в нея са варианти на негови встъпителни студии към руски преводи на Гален.
В областта на античната философия на медицината бях почти невежа, но понеже в книгата на Балаликин става дума и за антични философи изобщо, приех да направя това, и от колегиалност към колегите, които направиха много успешна докторска, магистърска и прохождаща бакалавърска програма по философия с преподаване на английски, и от егоизъм, разбира се: за да прочета колкото се може повече от и за големите авторитети на медицинското изкуство в древността покрай писането на рецензията.
У нас Гален е познат благодарение на чудесните издания с превод и коментар на
Ирена Станкова.
От многото, което прочетох и което не ме направи знаеща, но поне малко по-информирана, разбрах: големите лечители на миналото са били и големи философи, както е озаглавен и един от най-концептуалните трактати на Гален. "Добрият лекар е също така и философ". В трактатите на големите лечители на миналото има априоризъм – не може някой да е лекар и да пише трактати по медицина, без да има светоглед и философия. Трябва да има изяснени и обяснени с понятия и дефиниции свои схващания за това какво е тяло, какво е душа, какво е здраве и болест, но и какво е междинното състояние между болестта и здравето, в което пребивават повечето хора през по-голямата част от времето.
Големите са останали големи през хилядолетията, защото са имали своите a priori светогледни и философски убедености.
Но те са били и хора на опита, на дисекциите и вивисекциите, нутриолози, фармаколози, фитотерапевти, хирурзи, всичко, което е запазено и в някои от клоновете на модерната медицина.
Но разбира се, те са били големи и в емпирията, в практиката, в опита.
Техните изисквания за апостериорния опит на всеки, който иска да е голям в теорията и практиката на лечителското изкуство на моменти е стряскащ. Медицината на опита и доказателствата не допуска превземки.
Който е много гнуслив и чувствителен, да не чете нататък.
Ето ви един пример от съветите и дидактиката на Хипократ и Гален към бъдещите медици, които наистина искат да станат наистина добри.
При всички заразни болести, както според Хипократ, така и според Гален, добрият лекар, този, който наистина е добър и мисли доброто на пациента си, трябва не само да гледа, не само да помирисва, но и да вкусва – да, да вкусва! – частички от урината и feces на своите пациенти.
Иначе няма да постави точна диагноза и да лекува добре.
Това го написвам нарочно, защото на всички лекари от античността до днес, на санитарите и медицинските сестри им се случва да виждат, помирисват и/или почистват и отпадъците от човешкото тяло.
И когато някакъв високоплатен лаборант в някаква чуждоземна клиника подстрекава и насъсква българските граждани в топящата ни страна да започнат да доносничат срещу нашите лекари, защото не се водят по акъла на високоплатените фарматърговци, които обаче не са лекували никога хора у нас--- е-е-е – тази самонадеяност, наглост и високомерие няма как да не предизвикат гняв!
Това са новите ченгета – по-гнусни и от предишните.
Да доносничим срещу онези, които са лекували всички в семействата ни години, десетилетия наред?!?
Този от швейцарската лаборатория да продължи да си тъпче гушата с швейцарските си франкове и да престане с ченгесарските си номера.
Поклон пред лекарите, медицинските сестри, фелдшерите и санитарите, работили и работещи у нас, останали при нас въпреки мизерните си доходи, въпреки неблагодарността на обществото и излекуваните от тях, въпреки опасността да бъдат изправени до стената и обвинени за всичко, което не се е случило, въпреки техния десетилетен труд!
