Galen on Apodictics. Dmitry A. Balalykin

on practical observations, and medicine of Hippocrates. It is in the context of the analysis of its history in the special literature that the discussion of the problem of the apodictic method of knowledge begins. In the 1960s, G. Lloyd6 for the first time very pointedly and reasonably raised the question of the separation of mystical and occult chiliastic practices from the development of ancient Greek rational medicine. And here it becomes clear that it is precisely the development of medicine that historians and philosophers can judge most reliably in view of the quality of the source base: nothing like Hippocratic Corpus is at the disposal of scientists studying the birth of other disciplines. Thus, it turned out that the historically accurate picture of the history of medicine has the best background. Further, G. Lloyd raised the question of the apodictic method of knowledge in the rational medicine of antiquity. It also dealt with the absolute opposition of a clear, structured logical proof to sophistic tricks. Ideally, the apodictic method in medicine should, according to the degree of evidence of the proof, approach the mathematical method. In this sense, the application of the “apodictic” concept to medicine can be regarded as a rather free extrapolation of the concept from the mathematical science vocabulary. However, the Hippocratic Corpus has already shown obvious evidence, with which to argue is as difficult as with a mathematical formula—an anatomical autopsy has become such. G. Lloyd, in fact, was the first who absolutely clearly defined the dissection as a medical apodictic. In addition, a significant number of arguments by G. Lloyd, based on a thorough analysis of sources, relate to the principles of analysis and reflection on clinical experience.

      J. Longrigg asserted the incomprehensible differences, comparing medical schools of antiquity. He linked only very definite theories with later history of medicine. In the last decades of 20th century the concept of “ancient Greek rational medicine”, which denoted precisely this direction, was firmly established in historiography.

It means a clear separation of Alkmeon and Hippocrates medicine, which is based on a completely clear natural-philosophical theory, from temple healing, ritual incubation, invoking spirits and other non-rational chiliastic practices. Apodictic (in the understanding of G. Lloyd) cautiously and not quite consistently begins to recognize the basis of the methodology of rational medicine of antiquity. The reason for this caution, I think, is the difficulty with a clear classification of practical knowledge. However, after J. Jouanna was able to describe the basic principles of the clinical practice of Hippocrates7 these difficulties can be considered overcome. I suggest to use the term “clinical systematics”: this is how we can describe the principle of understanding the whole set of practical knowledge about diseases and its treatment, specific to the Hippocratic school. Its development is underway, Galen only emphasizes the hierarchical, logically built and striving to match the particular and the general (that is, “systematic”) nature of the comprehension of practical experience.

The works of V. Nutton have an outstanding meaning in the development of the study of the history and methods of ancient medicine. Due to decades of hard work of V. Nutton, his co-authors, students and followers, the problem of historically reliable reconstruction of the main events of almost a thousand-year-old history of ancient medicine was, in general, solved.8

      The availability of sources that allow making an impression about the development of ancient medicine after Hippocrates leaves much to be desired. It is with this that I associate the fact that in modern scholarly literature there is a tendency to consider hippocratics-rationalists and, for example, doctors-empiricist, equivalent historical phenomena. The connection between clinical practice and philosophical theory in the teachings of various medical schools is often misunderstood, their mutual exclusivity is sometimes underestimated. The main sources containing information about antiquity medicine from the 3rd century BC and later, are the works of Galen: 111 out of more than 500 reached us. However, fewer than half were translated into English, fewer than 30 texts into Russian.

Speaking of underlying methodological problems arising when studying the medical texts of Galen, above all, the conceptual framework of the 2nd century doctor has to be compared with the professional “world view” of the modern-day doctor. This pertains to the problem T. Kuhn9 called the “incommensurability” of scientific knowledge, identifying it as key when working on translations and interpretation of sources. The question of “incommensurability” of theoretical conceptions arising in different epochs caught the attention of leading scientists in the last quarter of the 20th century.10 In my opinion, the question of the effect of change of scientific theory on the meaning of special terms bears particular significance. When Galen spoke of “inflammation”, did he mean that which modern pathophysiologists and doctors understand as inflammation? What is the relationship (if at all) between “cancer” in a patient observed by Galen and “cancer” as understood by an oncologist in the 21st century? The fact that the overwhelming majority of terms used by Galen remain in the vocabulary of the modern doctor stands out. However, in what sense were they used in the 2nd century and what do they mean today? In this case comparability of meanings indicates the ontological commonality of our thinking and the world view of the rationalist doctor, which belongs to the Hippocratic tradition. Considering the importance of this issue and its crudity in local academic literature, I think serious attention should be paid to the assessment of the problem of the “incommensurability” of the theory by T. Kuhn himself.

      T. Kuhn notes that the concept of “incommensurability” in respect to the theory of science should be interpreted metaphorically. This means that “no common measure” should mean “no common language”, which essentially does not entail incomparability as well. Most of the terms and concepts can be interpreted in the same manner in “old” and “new” theories, i.e., their original meaning is retained. It is only for a very small group of terms that the problem of translation arises, and all of this, to my point of view, can be considered “partial commensurability”.

We will try to illustrate the foregoing with a specific example—the term “apoplexy” used by Galen. In literature, this concept is often associated with the modern-day nosological entity of “stroke”. Such an interpretation has the right to exist, it is certainly logical from a clinical point of view.11 However, broadly speaking, Galen’s “apoplexy” should not be considered exactly the same as the modern term “stroke”.12

      What did Galen mean by the term “a fit of apoplexy”? In one of his works, he defined apoplexy as a state when there is simultaneous loss of sensation and motor functions. The definitions and descriptions of this disease may differ in his various works, but this difference can be reduced to a common denominator. Apoplexy is characterised by the following symptoms: abrupt manifestation of disease, comatose state, violation of motor functions of the entire body, simultaneous loss of sensation, shallow breath, weak, slow pulse, violation of speech function, chronic disease progression. This often has a fatal outcome. The addition of fever to the above-described symptoms may have led to the condition Galen referred to as “lethargos”, i.e., loss of mobility and sensation of a certain side of the body. The concept which corresponds to its description in today’s medical vocabulary is “paralysis”. On the other hand, Galen’s understanding of the term “apoplexia” (“fit of apoplexy”) was broader than today’s. The modern-day doctor may associate a case of sudden, simultaneous, complete loss of mobility and sensation, including with impairment of consciousness and breathlessness with the manifestation of several diseases, starting with brain trauma, heart attack or pulmonary embolism with loss of consciousness and ending with acute toxic response. The equation of the meaning of a fit of apoplexy in Galen’s work with the modern-day concept of stroke, which, at first sight, seems obvious, may lead the medical historian to the wrong interpretation of the text of the source.

      For ancient doctors, the correct prediction of the course and outcome of a disease