Galen and, foremost, discusses the final cause that the ancient physician considers as a teleology of function of an organ or of the body as a whole. The doctrine of teleology, along with and inseparable from the principle of balance of the three tetrads and the principle of homoiomereia, are the main grounds for Galen’s rejection of the explanation of the ancient Methodists regarding the causes of disease. The assertion of the Methodist physicians, who have adopted the ontology of ancient atomism that the general pathology is due to clogged pores in a certain part of the human body, is unacceptable to him. He is a follower of Plato and Aristotle and the mechanics of the atomism does not correspond to the teleology of function, inherent in the body in the states of health and disease alike. Balalykin explains that the principle of teleology should not be confused with the Stoic determinism of physicians from the Empiric school that is set by blind fate and is completely beyond any rational control. Thus, the author unambiguously shows: the philosophical preconditions at the level of ontology preset Galen's position on medical causality. Furthermore, he clarifies that the mechanisms of diseases, pathogenesis, depend on the same ontological arguments.
According to Balalykin the respective central concepts of Plato’s and Aristotle’s ontology and epistemology, eidos and entelechia, become decisive for the formation of the apodictic method in Galen. The creation and functioning of the sensory world after a model of the non-sensory eidos that guarantees realization in the sensory world of certain patterns, perceptible by the human mind, gives Galen the opportunity to follow in the medical theory and practice a method based on a cognizable necessity. The feasibility of apodictic method is reinforced by the Aristotelian entelechia, which justifies teleological changes both in healthy and diseased persons, and also the state of a person between health and disease. The author points out why Empirics, criticized by Galen, following the Stoic view of lekton adhere to the situational understanding of diseases and cannot perceive the apodictic method that yields the necessary conclusions. Instead, they are forced to rely on a dialectical method that provides nothing more than probabilistic conclusions. Stoic lekton has no ontological status of necessity, unlike eidos and entelechia, because it is not material in character, and for the Stoics this is equivalent to a lack of reality. This means that disease observations—diagnosis of the disease, as well as its treatment decisions—are lektons with probabilistic value. The non-acceptance in principle of the theory leads to the underestimation of medical causality and disinterest in the mechanisms of diseases among physicians from the Empiric school. Moreover, these philosophical reasons limit the diagnostic and therapeutic actions of Empirics to addressing pathological symptoms using their own experience gained in similar situations or the experience of their counterparts, applied depending on the available pharmacological and dietary agents that have proven their effects in such symptomatology. Here, the author is a very shrewd observer when he perceives an essential dialectical feature (‘dialectical’ not in the sense of the ancient dialectic, but of Georg Hegel’s speculative dialectic) according to which the Empirics, by denying the possibility of knowing general principles, are not able to apply individualized treatment and are inevitably entangled in repetitive patterns. Balalykin intuitively and completely justifiably perceives that this paradoxical situation expresses the fact of the transformation of one-sided rational statements into their opposites. The Empirics, following dogmatic one-sided constructions of Stoicism and insisting on the significance of only a singular disease situation, allow an insurmountable gulf between the singular and the universal, thus falling into the lifeless generalization of oversimplification. Galen’s approach, based on Plato’s and Aristotelian philosophical views, freely overcomes the rational one-sidedness and rises up to the level of rational speculative dialectic by perceiving the unity between singular, particular, and universal. The singular symptoms of a patient manifest themselves in an inseparable and individualized unity with the universal and indispensable features of the given disease (according to the modern terminology of the “nosological unit”) and thus form the particular type of a specific patient’s disease. The interpretation of schematization during treatment by the Empirics proves that the assumption and knowledge of universal features of diseases and their treatment does not prevent, but on the contrary supports the application of an individual approach to diagnosis and treatment.
In studying Galen’s apodictics, Balalykin addresses a purely logical problem. He points out that Galen holds on to making necessary conclusions through categorical syllogism, which provides true knowledge, while physicians from the Empiric school, in conformity with their understanding of probable and solely plausible knowledge, use hypothetical syllogism. The author is quite right that in both forms of hypothetical syllogism, pure hypothetical syllogism and hypothetical categorical syllogism, there is an element of hypothesis that gives some probability to the conclusion reached. Nevertheless, it should be taken into consideration that the very inferences of these types of syllogism produce necessary conclusions. The two forms of the inference are known as modus ponens and modus tollens, which are accepted as valid both by traditional formal logic and by its modern symbolic version. Furthermore, the categoricalness of the strict categorical syllogism’s premises is not necessarily identical with their truthfulness and leaves room for a certain dose of probability. There is Aristotle’s well-known claim about the middle term of the categorical syllogism being identified by dialectical means of the art of topics. The truthfulness of categorical syllogism (not just logical validity) is borne not only by the formal laws of this type of inference, but by the overall context in which it takes place. Similarly, the probability of a hypothetical syllogism (again, not just logical validity) depends on the context of its application. We should not neglect the practical reliability of the negative modus of the hypothetical categorical syllogism modus tollens in clinical practice. During the differential diagnostics procedure diseases with similar symptoms are excluded in order to determine the real disease(s). The exclusion is done by the modus tollens rule whereby the absence of a necessary symptom or sign leads to an absence of the corresponding disease. In terms of logical validity, this is a completely necessary and correct conclusion. In medical practice, it excels the positive modus ponens, where the inference is driven from the presence of the cause of a disease to the disease itself, because even the presence of the necessary cause of a disease cannot lead to the disease in the case that the sufficient cause is not also present. However, when discussing the necessary validity of the eliminating modus tollens, we should not forget that it is a common situation in diagnostic practice when the absence of a symptom or sign (in the case it is not a pathognomonic symptom or sign) does not guarantee the absence of the disease we are looking for. This means that the decision to reject or affirm the presence of a disease goes beyond logical necessity, but that does not at all mean, as the author clearly demonstrates, that the decision is not subject to the apodictic method.
It would be entirely justified to state that Galen on Apodictics masterfully demonstrates the philosophical impetus in the formation of the apodictic method in Galen’s clinical practice and theoretical treatises and outlines this method as “an expression of a new type of rationality in the field of medicine” during the Roman Empire. No doubt, Balalykin’s book is a significant and valuable contribution to studies in the field of philosophical analysis of Galen’s works on an international scale and deserves excited and committed readers.
Introduction
Modern academic literature generally accept the existence of a unified branch of science—the “history and philosophy of science”. Unfortunately, historians concerned with separate areas of natural science have very little interest in philosophical methodology: they are often concerned with specifics and do not seek to generalise and identify common patterns in the development of the subject under investigation.
The history of medicine is dominated by a tendency for narrowly specialised analysis, which is generally typical for the history of natural sciences. Among medical professionals studying history, priority interest is payed to the events directly influencing the modern image of medical science and practice. There are extensive studies in historiography devoted to the history of surgery, cardiology, immunology, the establishment of medical education, etc.1 By virtue of mental inertia, their chronological
