... Galen discusses the opinions of Aristotle, Plato and the Stoics on the relationship between nature, soul, vital breath and innate heat. Some physicians, perhaps the Pneumatists, were interested in finding the Stoic view already articulated by Hippocrates, particularly in a work called On Sevens, and in Epidemics 6, which is being discussed here. I've added paragraph breaks to make the text easier to read. This is a continuation from part i...

In fact, some of those who wrote commentaries on the book under discussion say the word 'born' was written in the sense of 'becomes better'. They suppose it [sc. the soul] becomes better over time for those who are concerned about science and wisdom. This discussion, however, is neither medical nor is it consistent with what comes next, for it is clear from the following quotation that 'produced' is said about the substance of [the soul]: "when it is inflamed together with disease, the soul also consumes the body." The word 'inflamed' would seem to indicate Hippocrates thinks the substance of the soul is the innate heat, which he uses as a cause of natural activities in many other places.

On this point, there is also a great difference of opinion among philosophers. Some believe the substance of the soul and of nature are identical, some of these ones positing its existence in pneuma, others in a specific quality of the body. Certain people think it is not one substance, but claim each of them is distinct and differ not just in a small way in species, but wholly in kind. In this case, they think that the substance of nature is perishable, while that of the soul is imperishable.

Now, Aristotle and Plato introduce both capacities using one word, not only calling that by which we think and remember 'soul', but also the capacity in plants by which they are nourished, increased and preserved until they dry out over time. For the Stoics, on the other hand, it is customary to refer 'nature' to that by which plants are governed, 'soul' that by which animals are. They posit that the substance of both is the co-natural pneuma, and they think these differ from each other by quality: the pneuma of the soul is drier, that of nature more moist, but both require not only food in order to persist, but also air.

Whoever thinks the person who introduced this opinion is Hippocrates, according to what was mentioned in On Sevens, say the word 'born' is mentioned concerning the production in them of additional stuff from both substances, of food and air, since it is clearly observable and we know the usefulness of each of them. For it has been proven that respiration preserves the balance of the innate heat, while ingestion of food replenishes the flowing-out of bodily substance. Moreover, if the soul is a kind of form of the body, it would be appropriate to say that 'it is born until death.'

Now, if there is some other substance, then concerning the one called 'nature', which Aristotle calls 'threptic', Plato 'epithumetic', what was said would be true; but it would not be true in the case of the 'dianoetic' soul. Certainly, that the innate heat, to which Hippocrates very often refers bodily functions, is inflamed, not only when it is no longer able to complete its previous activities or nourish us —which is its most important function—but also when it destroys and consumes like fire does, this is clear to us when we look carefully at the text and when we see the colliquesence of the body produced by excessively hot fevers.

Left out of the whole discussion is the third 'soul' or 'capacity' or whatever you might want to call it, which Plato called 'spirited'. It is good to mention this so that nothing is left out of our discussion about the soul. One kind of innate warmth, by which blood is produced, is contained in the liver. But a different, greater warmth has been received by the heart for the production of emotion. For if there is some use for it, as it has been pointed out in On the Opinions of Hippocrates and Plato, the one warmth needs respiration, the other transpiration. For thus it is customary for doctors to call what occurs through the artery along its whole body a 'double-activity', sending out residues at systole, drawing in outside air at diastole.

τῶν μέντοι γραψάντων ὑπομνήματα τοῦ προκειμένου βιβλίου τινὲς ἀντὶ τοῦ βελτίων γίνεται τὸ «φύεταί» φασιν εἰρῆσθαι. γίνεσθαι δ' αὐτὴν ἐν τῷ χρόνῳ βελτίονα νομίζουσι τοῖς προνοουμένοις ἐπιστήμης τε καὶ σοφίας, ἀλλ' οὔτε ἰατρικὸς ὁ λόγος οὔθ' ὁμολογῶν τοῖς ἐπιφερομένοις. ὅτι γὰρ ἐπὶ τῆς οὐσίας αὐτῆς εἴρηται τὸ «φύεται», δῆλον ἐκ τοῦ φάναι· «ἢν δ' ἐκπυρωθῇ, ἅμα τῇ νούσῳ καὶ ἡ ψυχὴ <καὶ> τὸ σῶμα φέρβεται». καὶ δόξειε δ' ἂν ἐνδείκνυσθαι τὸ «ἐκπυρωθῇ» ῥῆμα τὴν οὐσίαν τῆς ψυχῆς ἡγεῖσθαι τὸν Ἱπποκράτην τὸ ἔμφυτον εἶναι θερμὸν, ὃ καὶ τῶν φυσικῶν ἔργων αἰτιᾶται πολλαχόθι.

μέγιστον δ' ἐνταῦθα κινεῖται δόγμα διαπεφωνημένον καὶ αὐτοῖς τοῖς φιλοσόφοις. ἔνιοι μὲν ἡγοῦνται μίαν οὐσίαν εἶναι ψυχῆς τε καὶ φύσεως, οἱ μὲν ἐν τῷ πνεύματι τιθέμενοι τὴν ὕπαρξιν αὐτῶν, οἱ δ' ἐν τῇ τοῦ σώματος ἰδιότητι. τινὲς δὲ οὐ μίαν, ἀλλ' ἰδίαν ἑκατέρᾳ τὴν οὐσίαν εἶναί φασι καὶ οὐ σμικρῷ γ' <εἴδει> τινὶ διαφερούσας, ἀλλ' ὅλῳ τῷ γένει, ὅπου γε καὶ τὴν μὲν τῆς φύσεως φθαρτὴν εἶναι ἡγοῦνται, τὴν δὲ τῆς ψυχῆς ἄφθαρτον.

Ἀριστοτέλης μὲν οὖν καὶ Πλάτων ὑπὸ μίαν προσηγορίαν ἀμφοτέρας ἄγουσι τὰς δυνάμεις, οὐ μόνον ᾗ λογιζόμεθα καὶ μεμνήμεθα ψυχὴν καλοῦντες, ἀλλὰ καὶ τὴν ἐν τοῖς φυτοῖς, ᾗ τρέφεταί τε καὶ αὔξεται καὶ διασῴζεται, μέχρι περ ἂν ἐν τῷ χρόνῳ ξηρανθῇ. τοῖς Στωϊκοῖς δ' ἔθος ἐστὶ φύσιν μὲν ὀνομάζειν, ᾗ τὰ φυτὰ διοικεῖται, ψυχὴν δὲ ᾗ τὰ ζῷα, τὴν οὐσίαν ἀμφοτέρων μὲν τίθενται τὸ σύμφυτον πνεῦμα καὶ διαφέρειν ἀλλήλων οἴονται ποιότητι. ξηρότερον μὲν γὰρ πνεῦμα τὸ τῆς ψυχῆς, ὑγρότερον δὲ τὸ τῆς φύσεως εἶναι, δεῖσθαι δ' ἄμφω πρὸς διαμονὴν οὐ τροφῆς μόνον, ἀλλὰ καὶ ἀέρος.

καὶ ὅσοι γε τοῦ δόγματος τούτου νομίζουσιν ἡγεμόνα τὸν Ἱπποκράτην γεγονέναι, καθάπερ ἐν τῷ Περὶ ἑβδομάδων εἴρηται, τὸ «φύεσθαι» λέγουσιν εἰρῆσθαι κατὰ τῆς γινομένης ἐν αὐτοῖς προσθέσεως ἐξ ἀμφοτέρων τῶν οὐσιῶν, τῆς τε <τροφῆς καὶ> τοῦ ἀέρος, <ὡς> ἐναργῶς φαίνεται καὶ τὴν ἑκατέρου χρείαν ἐπιστάμεθα (δέδεικται γὰρ ἡ μὲν ἀναπνοὴ τὴν συμμετρίαν τῆς ἐμφύτου θερμασίας φυλάττειν, ἡ δὲ τῶν σιτίων προσφορὰ τὸ διαρρέον τῆς σωματικῆς οὐσίας ἀναπληροῦν) καὶ, εἴπερ εἶδός τι τοῦ σώματός ἐστιν ἡ ψυχή, προσηκόντως ἂν λέγοιτο «φύεσθαι μέχρι τοῦ θανάτου».

εἰ δ' ἐστὶν ἑτέρα τις αὐτῆς <ἡ> οὐσία, <περὶ ταύτης> τῆς φύσεως, ἣν Ἀριστοτέλης μὲν ὀνομάζει θρεπτικὴν, ἐπιθυμητικὴν δὲ Πλάτων, ἀληθὲς ἂν εἴη τὸ εἰρημένον, οὐκ ἀληθὲς δὲ ἐπὶ τῆς διανοητικῆς ψυχῆς. ὅτι μέντοι τὸ ἔμφυτον θερμόν, ᾧ μάλιστα ἀναφέρει τὰ σωματικὰ τῶν ἔργων ὁ Ἱπποκράτης, ἐκπυρωθὲν οὐ μόνον οὐκέτι δύναται τὰς ἔμπροσθεν ἐνεργείας ἐπιτελεῖν οὐδὲ τρέφειν ἡμᾶς, ὅπερ ἦν ἔργον αὐτῷ κυριώτατον, ἀλλὰ διαφθείρει τε καὶ τήκει καθάπερ τὸ πῦρ, εὔδηλόν ἐστι τῷ λόγῳ σκοπουμένοις ἡμῖν καὶ τὰς <γινομένας> ὑπὸ τῶν διακαῶν πυρετῶν συντήξεις τοῦ σώματος ἐναργῶς ὁρῶσι.

παραλελειμμένης δὲ κατὰ τὸν εἰρημένον λόγον ἅπαντα τῆς τρίτης ψυχῆς ἢ δυνάμεως ἢ ὅπως ἂν ἐθέλῃς ὀνομάζειν αὐτήν, ἣν ὁ Πλάτων ἐκάλει θυμοειδῆ, καὶ περὶ ταύτης ἄμεινόν ἐστιν εἰπεῖν ἕνεκα τοῦ μηδὲν ἔτι ὑπολείπεσθαι κατὰ τὸν περὶ ψυχῆς λόγον. θερμασία μέν τις ἔμφυτος ἐν ἥπατι περιέχεται, καθ' ἣν αἷμα γεννᾶται· θερμασία δὲ ἑτέρα πλείων ἐστὶ κατὰ τὴν καρδίαν εἰς θυμοῦ γένεσιν ἡμῖν δοθεῖσα. καὶ γὰρ <εἰ> χρεία τούτου τίς ἐστιν, ὡς ἐν τοῖς Περὶ τῶν Ἱπποκράτους καὶ Πλάτωνος δογμάτων ἐπιδέδεικται, δεῖται μὲν αὕτη ἡ θερμασία τῆς ἀναπνοῆς, ἡ δ' ἑτέρα τῆς διαπνοῆς. οὕτω γὰρ ὀνομάζειν ἔθος ἐστὶ τοῖς ἰατροῖς τὴν διὰ τῶν ἀρτηριῶν γινομένην καθ' ὅλον τὸ σῶμα διττὴν ἐνέργειαν, ἐκπεμπουσῶν αἰθαλῶδες περίττωμα κατὰ τὴν συστολὴν, ἑλκουσῶν δὲ τὸν πέριξ ἀέρα κατὰ τὴν διαστολήν.

Galen, Commentary on Hippocrates' Epidemics 6, 5.5 (272,10-274,11 Wenkebach = XVIIB 249-253 Kühn)

(edit: the sequel can be found here)

While I've been collecting the fragments of Athenaeus of Attalia, I've also been tracking down texts about the Pneumatist school of medicine. They are pretty elusive, and this makes me wonder whether it was a medical 'school' in the normal sense (like the 'Rationalists' , Empiricists', or 'Methodists'). I'm also curious about the idea of 'belonging to a school' and how what it meant to doctors changed during the first and second centuries.

Galen's commentary on Epidemics 6 is a good place to go to with these questions. It contains lots of discussions of people Galen disagrees with, and some of them sound pretty close to people he calls "Pneumatikoi" in other places. He never names them in the commentary, which means I need to file them away as possible testimonies. Still, whether or not the "τινές" – the "some people" – Galen talks about here are Pneumatists, this passage is further evidence that Epidemics 6 and its interpretation was an important locus for the revival of Hippocratean medicine, and for bringing medicine, natural philosophy and ethics closer together.

I'll post this comment on Epidemics 6.5.2 in two parts. The first part deals with medical views on the soul and its relation to pneuma (or spirit), as well as Galen's thoughts on the soul's importance for medicine. The second records the views of Platonists, Aristotelians and Stoics on the soul.

Lemma: A person's soul is ever born until death, but when the soul is inflamed with disease, it consumes the body.

Ἀνθρώπου ψυχὴ αἰεὶ φύεται μέχρι θανάτου· ἢν δὲ ἐκπυρωθῇ ἅμα τῇ νούσῳ καὶ ἡ ψυχὴ, τὸ σῶμα φέρβεται.

'Hippocrates', Epidemics 6.5.2 (V 314,14-15 Littré)

Galen's Commentary: One needs the power of prophecy more than any method, if one is going to figure out what the person who wrote [the word] "born" intended it to mean. One can take it in the sense of "begotten", like Asclepiades later understood it; or one can take it in the sense of "increased"; or, one can take it, as some people did, in the sense of "preserved", since we engage in nutrition and respiration—for all those who consider the soul to be pneuma say it is preserved by an exhalation of the blood and the air drawn through the trachea into the body during inspiration. Obviously, it is impossible for us to maintain that any of these claims are true, without first having identified the substance of the soul precisely. If, therefore, as in the case of On Sevens, in which the book's author clearly stated his opinion about the substance of the soul, it was likewise mentioned in some of the other books which are agreed to be the genuine works of Hippocrates, then I would have to say something about the word "born". Since, however, Hippocrates nowhere in the genuine books states his opinion clearly [...Wenkebach marks a lacuna...] whatever the word "produced" means.

In addition to my ignorance about this, I myself am not convinced that I can know the substance of the soul with any certainty. That the brain controls perception and voluntary movement for all the parts of an animal, I have demonstrated in The Opinions of Hippocrates and Plato. I am convinced, moreover, that the pneuma in the ventricles [of the brain] is a primary kind of psychic instrument, which it would be rather rash for me to claim is the substance of the soul. Whether the whole nature of the brain arose out of the mixture of the four elements to form some specific quality of the substance, because of which it becomes the primary source of perception and voluntary movement in animals (and obviously also of imagination, memory and thought), or whether some further incorporeal capacity is fastened to us at the brain by a craftsman and then separated again from us when we are dying, I have no sound demonstration. But I also think that those who have an opinion about this have a larger share than mine of rashness rather than wisdom.

And in fact, I think it is superfluous for doctors to know the substance of the soul. For those who practice the art of medicine in a rational way, it is enough to know that as long as the natural mixture of the brain itself and the pneuma in its ventricles is preserved, then the animal is able to live. When the pneuma in the ventricles is completely destroyed, or is diverted a good deal from its natural mixture along with the substance in the brain, then either psychic disease or death necessarily follow. When the doctor knows these things, he will provide for their good-mixture and for the subsistence <of the pneuma>, always according to the methods we mentioned in the notes on Matters of Health (De sanitate tuenda) and The Therapeutic Method (Methodus medendi), all of which I showed Hippocrates had discovered first.

For this reason, then, I think the present passage is not genuine, but was written by someone, as it were, not too far removed, perhaps even his son Thessalus. They say he strung together his father's writings, which he found written on papyrus, parchment and writing-tablets, and inserted passages like these ones along with them.

Μαντείας δεῖ μᾶλλον ἤ τινος μεθόδου, καθ' ἣν εὑρήσει τις, ὅ τί ποτε σημαίνειν βουληθεὶς ἔγραψε τὸ «φύεται». δύναται μὲν γὰρ ἀκούεσθαι καὶ <ἀντὶ> τοῦ "γεννᾶται", καθάπερ ὁ Ἀσκληπιάδης ὕστερον ὑπέλαβε, δύναται δὲ καὶ <ἀντὶ> τοῦ "αὐξάνεται", δύναται δ', ὥσπερ τινὲς ἤκουσαν, ἀντὶ τοῦ "διασῴζεται", τροφῇ καὶ ἀναπνοῇ χρωμένων ἡμῶν· ὅσοι γὰρ οἴονται τὴν <ψυχὴν> εἶναι πνεῦμα, διασῴζεσθαι λέγουσιν αὐτὴν ἔκ τε τῆς ἀναθυμιάσεως τοῦ αἵματος καὶ τοῦ κατὰ τὴν εἰσπνοὴν <ἀέρος> ἑλκομένου διὰ τῆς τραχείας ἀρτηρίας εἴσω τοῦ σώματος. οὐκ ἄδηλον δ' ἐστὶ καὶ ὡς οὐδὲν ὧν εἶπον ἀποφήνασθαι δυνατὸν ἡμῖν ἐστι διατεινομένοις, ὡς ἀληθὲς εἴη, μὴ πρότερον οὐσίαν ψυχῆς ἀκριβῶς ἐξευροῦσιν. εἰ μὲν οὖν, ὥσπερ ἐν τῷ Περὶ ἑβδομάδων ὁ γράψας τὸ βιβλίον ἐκεῖνο σαφῶς ἀπεφήνατο περὶ ψυχῆς οὐσίας, οὕτως καὶ κατ' ἄλλο τι τῶν ὁμολογουμένων γνησίων Ἱπποκράτους συγγραμμάτων ἦν εἰρημένον, εἶχον ἄν τι κἀγὼ λέγειν περὶ τοῦ «φύεται» ῥήματος. ἐπεὶ δ' οὐδαμόθι τῶν γνησίων βιβλίων Ἱπποκράτης ἀπεφήνατο σαφῶς ***, ὅ τί ποτε σημαίνει τὸ «φύεται» ῥῆμα.

πρὸς δὲ τῷ τοῦτ' ἀγνοεῖν οὐδ' αὐτὸς ἐμαυτὸν πέπεικα ψυχῆς οὐσίαν ἐπίστασθαι βεβαίως. ὅτι μὲν γὰρ ὁ ἐγκέφαλος αἰσθήσεώς τε καὶ κινήσεως τῆς καθ' ὁρμὴν ἡγεμών ἐστι τοῖς τοῦ ζῴου μορίοις ἅπασιν, ἐν τοῖς Περὶ τῶν Ἱπποκράτους καὶ Πλάτωνος δογμάτων ἀποδέδειγμαι. πέπεισμαι <δὲ> καὶ πρός γε τούτῳ τὸ κατὰ τὰς κοιλίας αὐτοῦ πνεῦμα πρῶτόν τι τῶν ὀργάνων εἶναι τῶν ψυχικῶν, ὅπερ ἦν μοι προπετέστερον ἀποφηναμένῳ ψυχῆς οὐσίαν εἰπεῖν. εἴτε δὲ ἡ ὅλη τοῦ ἐγκεφάλου φύσις ἐκ τῆς τῶν τεττάρων στοιχείων κράσεως εἰς τοιαύτην <τῆς> οὐσίας ἦλθεν [ἢ] ἰδιότητα, καθ' ἣν αἰσθήσεώς τε καὶ κινήσεως τῆς καθ' ὁρμὴν ἀρχηγὸς ἔσται τῷ ζῴῳ καὶ δηλονότι <καὶ φαντασίας> καὶ μνήμης τε καὶ νοήσεως, εἴτε τις ἄλλη δύναμις ἀσώματος ὑπὸ τοῦ δημιουργήσαντος ἡμᾶς ἐνδεῖταί τε τῷ ἐγκεφάλῳ καὶ χωρίζεται πάλιν ἀποθνῃσκόντων, οὐδεμίαν ἔχω ἀπόδειξιν βεβαίαν, ἀλλὰ καὶ τοὺς ἀποφηναμένους περὶ τούτων ἡγοῦμαι πλεονεκτεῖν ἐμοῦ προπετείᾳ μᾶλλον ἢ σοφίᾳ.

καὶ μέντοι καὶ περιττὸν εἶναι νομίζω τοῖς ἰατροῖς ἐπίστασθαι ψυχῆς οὐσίαν. ἀρκεῖ γὰρ γινώσκεσθαι τοῖς τὴν ἰατρικὴν τέχνην λογικῶς μεταχειριζομένοις, ὡς, ἡ κατὰ φύσιν κρᾶσις αὐτοῦ τοῦ ἐγκεφάλου καὶ τοῦ κατὰ τὰς κοιλίας αὐτοῦ πνεύματος ἄχρι περ ἂν διασῴζηται, ζῆν δυνάμενον τὸ ζῷον. ἐὰν δὲ ἤτοι τὸ κατὰ τὰς κοιλίας πνεῦμα διαφθαρῇ παντάπασιν ἢ τῆς κατὰ φύσιν κράσεως ἐπὶ πλεῖστον ἐκτραπῇ, μετὰ τῆς κατὰ τὸν ἐγκέφαλον <οὐσίας ἀναγκαῖον αὐτῇ ἢ ψυχικὴν νόσον ἢ θάνατον> ἀκολουθῆσαι. ταῦτα γὰρ γινώσκων ὁ ἰατρὸς τῆς τ' εὐκρασίας αὐτῶν καὶ τῆς ὑπάρξεως προνοήσεται <τοῦ πνεύματος> ἀεὶ κατὰ τὰς εἰρημένας μεθόδους ὑφ' ἡμῶν ἔν τε τοῖς Ὑγιεινοῖς καὶ τοῖς Θεραπευτικοῖς ὑπομνήμασιν, ἃς ἔδειξα πάσας Ἱπποκράτην πρῶτον εὑρηκότα.

διὰ τοῦτ' οὖν οὐδὲ γνησίαν νομίζω τὴν προκειμένην ῥῆσιν εἶναι, παρεγγεγράφθαι δ' ὑπό τινος ὥσπερ καὶ ἄλλας οὐκ ὀλίγας, ἴσως δὲ καὶ τὸν υἱὸν αὐτοῦ Θεσσαλόν, <ὃν> ἀθροῖσαί φασι τὰς ὑπογραφὰς τοῦ πατρὸς εὑρόντα γεγραμμένας ἐν χάρταις τε καὶ διφθέραις καὶ δέλτοις, καὶ τοιαύτας τινὰς παρεντεθεικέναι ῥήσεις.

Galen, Commentary on Hippocrates' Epidemics 6, 5.5 (270,21-272,9 Wenkebach = XVIIB 246-249 Kühn)

"When the soul is inflamed", part II

"When the soul is inflamed", part I