Chapter 4: Cornelius Gemma with the Review Summary of the Earlier Chapters

[below is a summary of the chapters 1, 2 and 4 of Medical Humanism by Hiro Hirai. I chose these 3 chapters because of the thematic similarities they share, leaving out the chapter 3 on Schegk as somewhat distinct from the others.]

The chapters 1, 2 and 4 of this book examine the interpretations of the formative powers by various thinkers in the history of embryology. The humanist physician, Leoniceno gives his commentaries on commentators of Galen and offers his own interpretation of the issue. First of Galen, although he believed that there must be a supreme intelligence in the formation of the fetuses, he left it open whether it was to be equated with any kind of soul and did not speculate its origin. This led many commentators to hypothesize what this formative power could mean, and the identification or the explanation was in demand, as to what it is that is doing the formation of the fetuses, as opposed to merely nourishing the animal bodies. This is because the nourishing the bodies, which is the proper office of vegetative soul, does not necessarily require a forming principle.

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          Just as Hippocrates taught that the body’s natural heat is nothing but the mixture of the four elemental qualities (i.e. temperament), and just as Galen called the vegetative soul the animal’s natural heat, Leoniceno justifies his use of the term ‘temperament’ to mean both the body’s natural heat and the vegetative soul. Synthesizing Hippocrates and Galen, Leoniceno equated 1) body’s natural heat with 2) temperament and 3) vegetative soul. Hence, all these things are terrestrial origin and congenial to the animal’s birth. This in turn is termed as “inbred heat”. Here, Leoniceno did what Galen did not – although Galen believed the natural heat to be the vegetative soul, he believed it is of divine origin and did not think that it is the mixture of the terrestrial elemental qualities.

However, Aristotle recognized two different formative powers, according to Galen. One is formative power of homogeneous parts such as flesh and bones, while the other is the organization of heterogeneous parts such as hands and eyes. The former is mutative, for it forms organs and alters the shapes for fitting ones, while the latter is the formative cause proper as it forms particular hands and eyes proper to the species. For instance, formation of flesh and bones are universal to all animals, but what kinds of eyes or hands these animals have differ from species to species, and they become the distinct characteristics of particular animals. So Aristotle invoked a higher intelligence to this formative cause proper, and wondered if there can be a supreme intelligence of a creator, i.e. celestial cause. Leoniceno disagrees with the later commentators of Aristotle that Aristotle here was in fact invoking a celestial cause, and insists that it remains an analogy, for Aristotle says that this “inbred” heat is not fire and is the foam-like principle in the breath, i.e. spirit. Leoniceno is content that this vital/inbred heat is contained in the seed or the spirit, which is a certain vehicle, a subtle body, that carries the immaterial foam-like heat principle. Is Leoniceno then saying that this formative power is devoid of reason? No. Along with Simplicius, Leoniceno argues that this formative power is not irrational but rather co-responsible with the immediate causes of things that are generated and corrupted. What this means is that the formative power, although itself not of celestial origin, is subordinate or auxiliary to the celestial and intellectual causes, and this formative power is the concause with the celestial cause.

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              Of course, as was mentioned earlier, this is not what Galen held – for although he professed that he did not know the cause of this formative principle, he did believe that it must be of a divine origin, i.e. celestial cause. Jean Fernel picks out Galen’s view and tried to reconcile Aristotle (via Galen) with Plato, drawing upon the works of Marcilio Ficino. Fernel’s position on this would be that the vegetative soul (or natural heat) is essentially divine and that there is divine presence in natural and medical philosophy. Fernel indeed advances his argument as if Galen would have agreed with him, and to that extent, his argument is an elaboration of Galen’s view.

Fernel first argues that the form partakes in the divinity as opposed to the matter, which is nothing but the composite of the corruptible elements. The form thus equated with the divinity has more power than the four terrestrial elements, but precisely because it partakes in divinity, we cannot know the specifics of this power or where it originates. These hidden powers are called occult properties. Since these powers exceed the limits of natural philosophy, they are called divine and belong to the realm of the divinity. In this way, while Galen remained agnostic about the origin of the soul, Fernel attributed the notion of divine force to the natural beings on earth. Such divine force is wise and powerful, and responsible for the formation of living beings. This form is of necessity immortal, since it is not simply a congenial heat or a temperament (in which case, the soul/form would not be immortal because it would be nothing but a mixture of the four elemental qualities, and everything made out of these qualities are corruptible) but partakes in divinity. Such divine force must have the primary or the ultimate cause as the divine Creator, and neither whose substance nor his way of operation can be grasped by the human mind.

What is the essence of this soul/form? Fernel argues, according to the authority of Galen, that the soul is a completely simple, uniform and incorporeal substance. And in order for such incorporeal substance to have an effect on corporeal substance, it must be through some sort of semi-corporeal instrument, which is called pneuma. Notice that this is the breath or the spirit, a vehicle, discussed earlier by Leoniceno. Having argued that the soul is even more excellent than this pneuma, Fernel explains that pneuma is corporeal and essentially belongs to the body, whereas the soul is free of body and can subsist by itself. Further, upon the departure of pneuma, life ceases to function and life is restored when pneuma returns to the soul. So the soul does need this pneuma in order to function, although it can survive by itself. But at the same time, since the soul does not belong to the body and can subsist by itself, it is not a property of bodily substance (it can subsist by itself) or simply an incorporeal substance (it needs corporeal pneuma to function). It is somewhat half way between being a substance and being a property. What this means is that the soul is both incorporeal and subject to the needs of the body. It needs the body as its house to function, so it is not a substance in a complete sense.

How can the soul be both free and in need of body to function? If it is constrained by the body, it is not independent of body, and further, it runs the risk that the soul may be damaged when the host body becomes ill or poisoned. Fernel responds to this rather ingeniously that the soul does not suffer even when the host is damaged, but instead what is damaged is the chain of bonds that connects the soul with the body. So if a body suffers poison, then this union gets loosened, and when the union is broken, the soul flees itself, as if it had been freed from a chain tied to the body. This chain of bond is nothing but the pneuma, innate heat or spiritus. In this way, Fernel shows that the soul is not tied to the body in such a way that it needs the body’s constant aid.

Fernel then goes onto describe what power (dunamis) is, and explains that it is a potency of action and something the substance of a thing uses as a principle of action. In other words, it is in the thing but is different from the thing itself. It is that which emanates from the substance itself. Because this formative power/soul arises out of the substance from the very beginning, but is distinct from the substance itself, the vegetative soul must possess divinity as well. Although there are apparently two distinct powers in the tripartite soul, i.e. formation of the fetuses and the governance of the body, Fernels concludes with Galen that what molds the body also possess the ability to function each part of the formed body.

So the seed gives rise to this celestial mind and divinity, which is what the soul possessed. But if, as Galen argued, the soul possesses the force from the seed, such power cannot be of the celestial origin, and further it seems to suggest that the matter is actually an active principle itself, rather than the vehicle that carries such power. To the first worry, Fernel responds that Galen was speaking analogously to mean simply that this formative power is in the seed, and he was not actually saying that the force comes from the seed. Further, Fernel makes a careful point that the seed/matter is not identical with the formative power, but the celestial mind is placed in the seed. This also follows from the fact that Galen was speaking analogously about the relation between the force and the matter that emanates this force.

What exactly is then this spiritus/breath/pneuma? As has been said, it is close to incorporeal beings by virtue of being invisible. It is a means and instrument used by any substance devoid of body and hidden to human senses to communicate its force to the body. This is the way in which God communicates his power as well, through the use of the animus mundi, the World-Soul. The spiritus is said to be the basis of the soul and its forces, and in it lies the innate heat. The nature (or God) and the soul’s forces are enclosed in the spiritus, and this nature uses the spiritus and innate heat to form the living beings. So when the spiritus and the innate heat are lost, the chain of bond between the soul and the body disappears, and the life ceases to be. This nature being divine, it corresponds and shares with the element of the stars, i.e. the fifth element and aether. For Fernel, then, this aether provides the soul’s powers and implants the spiritus in natural beings, determining their form. While the composition and mixture of the elements can be the force of nature, the formation of specific organs and heterogeneous parts exceeds the capacity attributed to nature. Hence, there needs some other extraneous principle to guide through the formation of fetuses and living beings. In this way, Fernel attributed the cause of concoction to celestial heat, and not merely to the mixture of elements and their moderate heat. Without the celestial aid, concoction is noxious and destructive.

Such a conclusion has a medical significance, for it supposes a new etiology of diseases, because it is no longer just the imbalance of the four elements/humours that causes the diseases, but the elemental heat itself is conceived as something that is potentially bad for the body. The very idea that the formative power is endowed with a rational principle prevents Fernel from concluding that the spiritus is made up of the terrestrial elements. As the spiritus cannot come from the simple mixture of the four elements, it must be implanted into the natural beings at the time of generation, from then onwards directing the fetal formation and taking charge of the nourishment of the body. To this extent, then, the spiritus is said to be governed by and closely united with the World Soul.

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              Influenced by the Renaissance Platonism of Marcilio Ficino and his contemporary leading physicians, Fernel and Cardano, the royal professor of medicine at the Univeristy of Louvain, Cornelius Gemma (1535-1578) promotes Hippocrates as the leading figure amongst the “ancient theologians” along with Philo and Moses. This chapter gives the first analysis of the historical and intellectual context of Gemma’s Hippocratism based on the prisca theologica, or the ancient theology.

The followers of Galen tended gnerally to give a naturalistic account of Galen’s medicine, i.e. humoural imbalance within the terrestrial elements. Fernel, Cardano and Gemma, however, also adapted Ficinian Platonism on the basis of Hippocratic writings. Among the key notions in Hippocratic corpus, Fernel picked out the word “divine” used by Hippocrates to refer to something lying beyond the sphere of the four traditional elements. Because what is divine is not transient or destructible but supra-elemental, it must be something celestial. Fernel, as we have seen, tried to establish the consistent theme of Platonism both in Hippocrates and in Galen, but Cardano, as well as Gemma, rejects the Galenic medicine and leans heavily towards the medical corpus of Hippocrates.

Contrary to Fernel, Cardano was particularly interested in the Hippocratic writings that dealt with the celestial and atmospheric phenomena. In his book, On Subtley (De Subtilitate), he argues to establish a synthesis of two eminent ideas, i.e. the soul is nothing but a celestial heat (Hippocrates), since the heat of spiritus is analogous to the element of the stars (Aristotle). Arguing that the heat is the soul’s first instrument, Cardano explains that there must be the soul wherever this kind of heat is found, and wherever there is this celestial heat, one necessarily finds soul and life. This cosmic heat, for Cardano, is animate and endowed with intelligence. And because the World Soul is all pervading, the soul is said to be omnipotent in the entire universe. In this way, Cardano emphasized the celestial origin of the soul, arguing that the soul is immortal and cannot be corrupted, in accordance with Hippocrates, since nothing is corrupted but is only separated or dispersed. So for Cardano, Hippocrates figures as an ancient sage who knew and taught the very secret of the original constitution of the world and of the soul.

Similarly, Cornelius Gemma also calls upon the authority of Hippocrates by interpreting the notion of “something divine” in the manner of Fernel and argues that “the spiritus does not really differ from innate heat, just as the spiritus of the world does not differ from the element of the stars… [and] is the first instrument of a future form or soul. It connects the form to bodies as the spiritus is tied to these bodies by a carrier quality which intervenes. It is the same spiritus as that which perfects, connects, sees and understands all according to Hippocrates.” Gemma then divides the medical art into three parts:

① that which shows the actual state of things before our eyes (diagnosis)

② that which works through prognostication or prediction (prognosis)

③ that which deals with the hidden causes of actions in natural things (practice)

He continues to argue that the first two are inseparably tied together, for the medicine is intricately connected with prophecy, just as Hippocrates said that Apollo is the shared father of both medicine and prophecy. The one concerning the hidden causes of actions is explained by the “seven degrees of divinity” – the first of which is in the matter and the second is in the form of mixed bodies, whereas the third degree is found in the spiritus either through the Idea conceived in the soul as in the case of the formation of the fetus or through the action of celestial rays as are the works of innate heat).

[Q: what are the other degrees of divinity? What does it mean for a degree of divinity to reside in a matter or a form?]

For Gemma, the notion of spiritus as a universal knot of all natural things is an indispensable pillar in the structure of the universe as well as of human beings.

Cardano quoted in Hiro Hirai, Medical Humanism, 111. “[i]t is evident that Hippocrates correctly said: the soul is nothing but that celestial heat. This also corresponds well to the opinion of Aristotle since he wants the heat of spiritus to have a certain analogy with the element of the stars. Indeed whether the heat is the soul or its first instrument, wherever there is this [kind of] heat, it is evident that the soul itself should be present; therefore [there should be] life too. For life is nothing but the work of the soul.”

Gemma quoted in Hiro Hiral, Medical Humanism, 116.

Ibid., 118. “Indeed the spiritus is the knot and tie of opposites and, by the kinship of its nature, looks at both sides to the same degree. So it is not surprising if it connects the soul to the body in a human being, celestial force with sublunary things in the exterior sphere, corporeal faculties with incorporeal faculties in both realms. And [it is not surprising either] if it mixes up among them the seminal reasons of all things which act and are acted on. Since [the spiritus] belongs to all, draws all through all, composing very different things into one species by the perpetual change of contrary movements (that is, attraction, repulsion or self-rotation), Hippocrates, more than divine, attributes this triple motion to the [spiritus] by really subtle signs in the first book of On Regimen and in the book On Dreams.”