Bryn Mawr Classical Review

Bryn Mawr Classical Review 1999.08.14

R. J. Hankinson, Galen: On Antecedent Causes.   Cambridge:  Cambridge University Press, 1998.  Pp. xv, 349.  ISBN 0-521-62250-6.  $80.00.  



Reviewed by Rebecca Flemming, Wellcome Institute for the History of Medicine, University College London (r.flemming@wellcome.ac.uk)
Word count: 1591 words

It is estimated that the great imperial physician Galen contributes about ten percent of all surviving classical Greek literature, and there is still more. A number of his treatises are preserved only in Arabic and/or Latin, and thus spill over the more narrowly Greek edges of the most complete edition of his works, that produced by Karl Gottlob Kühn in the 1820s. Since the beginning of this century, however, steady progress has been made in the publication of these additional, but none the less interesting and valuable, parts of Galen's extant oeuvre, and this book may be counted as the most recent of such endeavours. Though the Latin text of On Antecedent Causes (De Causis Procatarticis), translated from the Greek by Niccolò da Reggio sometime between 1308 and 1345, was initially edited by Kurt Bardong, and published as a supplementary volume of the Corpus Medicorum Graecorum series in 1937, Hankinson here offers the first translation of a somewhat reworked text, together with an extensive commentary. This commentary focuses on the philosophical aspects of Galen's treatise, and, in particular, on the way it illuminates the epistemological and aetiological debates which raged in both philosophy and medicine from the Hellenistic period onwards; for this, to Hankinson's mind, is where the wider interest of the work primarily lies.

This emphasis is evident from the opening lines of the introduction onwards, and Hankinson's preliminary remarks cover Galen's life, literary career, and social context much more briefly than ancient notions of causation and the ways in which they intersect with debates and developments in medical thinking. There is, of course, considerable justification for this approach. The treatise is, after all, about a particular kind of cause -- the antecedent kind, that is causes which are both prior and external to what is caused (as distinct from 'preceding/προηγούμενα' causes, which are internally prior to their effect -- and about its medical importance. More particularly it is an argument that there are such things as antecedent causes, and that, contrary to those physicians (especially Erasistratus and his followers) who deny it, they need to be considered in treating the sick. The point may be illustrated, as Galen does, by the case of the orator Menander who, after a day spent watching contests in a sunny stadium, developed a headache and fever. For Galen the sun's heat is thus an antecedent cause of the fever and must be taken into account in prescribing for the stricken Menander, but the other doctors called to the sick-bed disagree. In attacking opponents of this kind Galen must deal both with the general matter of what constitutes a cause, in order to show that the antecedent kind thus qualifies, and with the more specific question of disease causation, and what it is about a disease which determines the appropriate therapeutic response. He need not, however, approach these issues directly, but only obliquely, as they relate to his particular line of reasoning, and he can assume in his audience (or at least the Gorgias to whom the treatise is addressed) considerable familiarity with the basic contours of the debate. Hankinson, on the other hand, needs to provide this background so that the text, and the contribution it makes to broader classical discussions of causation, can be fully understood.

However, for those who wish to read Galen in a less single-mindedly philosophical fashion -- who take, for example, as much sociological as aetiological interest in the orator Menander and his day at the theatre, in the disagreements which ensue at his bed-side and the manner of their adjudication -- such a focus is bound to disappoint. The commentary does pick up on some of the wider themes, but they remain clearly subordinate and underdeveloped. To explain, for instance, the popularity of the theatre as a potentially pathological venue in Galen's illustrations by reference only to its exemplary functionality, to the way it ensures that a large (and otherwise diverse) group of people are exposed to the same causal influence, is to miss plenty of other possible cultural connections that might be made. The sick-bed disputations and Menander's decision in Galen's favour, thus revealing the soundness of his learning and judgement, receive fuller discussion, but still of a somewhat uneven character. A degree of sloppiness is also evident in parts of the introductory account, both in the general construction of some of the summary descriptions provided, and in some of the concrete assertions made (for example, that Erasistratus' famous diagnosis of love-sickness was made in respect to a woman, rather than a Hellenistic prince, thus confusing Galen's reworking of the feat with its earlier renderings).

Hankinson also provides a discussion of the text and its transmission in his introduction, alongside a statement of the principles adopted in producing his edition and translation. Bardong worked from two manuscripts, as well as making use of the first printed edition of the work (published in 1490), and since then one further manuscript has been identified and considerably more work has been done on various paths of Galenic transmission, some of which (primarily by Vivian Nutton) has a direct bearing on the manuscript tradition of On Antecedent Causes. However, though Hankinson has put this subsequent find and scholarship to good use, he has only consulted one of the manuscripts Bardong employed, despite stating that the second, Dresden, manuscript, survived the bombing of that city much better than had once been thought. This seems a somewhat odd decision, though it probably would not have made much difference in the end, and, in general, Hankinson's text does not substantially differ from Bardong's. Some improvements have been made, and, since the original version appeared at a time when international distribution was becoming increasingly problematic, and is not as easily accessible as it might be, the inclusion of text and apparatus in this book is certainly to be welcomed.

Bardong placed a back-translation into the Greek he thought Galen had written alongside the surviving Latin, a precedent Hankinson does not follow. None the less, while he has tried to produce a Latin text that is as close to Niccolò's as possible (even as it follows mistakes in its exemplar), Hankinson too is, of course, concerned with the formulations of the Greek original. Thus, he offers a translation that tries to 'get as close as possible to the meaning of Galen's original Greek', that uses Niccolò's careful Latin as the means to achieve that closeness rather than treating it necessarily as what is being translated in itself. This is backed up by detailed discussion in the commentary of the relationship between the Latin and the Greek, of places where they are likely to have diverged, of other problems and uncertainties, and further supported by a glossary of lexical equivalences. This strategy is, I think, largely successful, and the translation is rendered more readable and comprehensible as a result.

Apart from these points of meaning and interpretation, the bulk of the commentary is by way of philosophical explication and evaluation of the particular arguments Galen is making in the treatise, how they fit into his thinking more broadly, and where they stand in relation to other classical theories of causation. Hankinson is concerned both to explain the lines of reasoning Galen is proposing, and to assess their effectiveness, to investigate their logical structure and internal consistency, and also whether they do actually counter or refute the arguments of his opponents. For many of the reasons already outlined, this does undoubtedly clarify matters. Sometimes I feel that the analysis is overdone, particularly in its more evaluative modes, but Hankinson is most adept at using other parts of Galen's monumental oeuvre to elucidate arguments that otherwise appear knotted and obscure. There are too, as has also already been alluded to, areas that are distinctly underdone. Another set of illustrations Galen provides are drawn from judicial scenarios. Surely, he exclaims, Orestes is the cause of Clytemnestra's death, not, as a sophistical Erasistratean would no doubt claim, his sword, or even the outflow of blood. And why did a stepmother condemned for poisoning her stepson, together with the slave who had purchased the poison, the slave who had offered it to the victim, and the doctor who supplied it, not adopt an Erasistratean line of defence, and assert that none of them, but the poison itself, was the cause of death? Hankinson may well be right to say that the second case adds little of substance to the first, but it would surely be worth saying something about the wicked stepmother topos and its deployment here, where the case is presented as a real one, in contrast to the previous one drawn from tragedy. It may contribute little to logical construction of Galen's specific polemic, but it has rather more to contribute to wider understanding of Galen's world.

Much of this is, of course, to say little more than that Hankinson has written a different kind of commentary than I would have, and he is certainly as entitled to his interests as I am to mine. Moreover, he is also entitled to thanks for making this work of Galen's so much more accessible than it has been, for helping bring it in from the outer margins of surviving classical literature. So, much of this review might be taken less as criticism than as encouragement to those who find themselves less well served by this edition of On Antecedent Causes than classical philosophers will, to read this text, and others by Galen, none the less. He has something to offer everyone.

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