Ancient Concepts of the Hippocratic: Papers Presented at the XIIIth International Hippocrates Colloquium, Austin, Texas, August 2008 900430701X, 9789004307018

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Ancient Concepts of the Hippocratic

Studies in Ancient Medicine Edited by John Scarborough Philip J. van der Eijk Ann Ellis Hanson Joseph Ziegler

VOLUME 46

The titles published in this series are listed at brill.com/sam

Ancient Concepts of the Hippocratic Papers Presented at the XIIIth International Hippocrates Colloquium Austin, Texas, August 2008 Edited by

Lesley Dean-Jones and Ralph M. Rosen

LEIDEN | BOSTON

Cover illustration: Four ancient busts of Hippocrates. Clockwise starting from the top left: ‒ Arboreo Mella Milan, found on a site called Ryanmuseum ‒ Cast from the Pushkin museum. Photo credit: Shakko ‒ Museo di Ostia Antica. Photo credit: Lalupa ‒ Photo credit: Vima. Library of Congress Cataloging-in-Publication Data International Hippocrates Colloquium (13th : 2008 : Austin, Tex.), author.  Ancient concepts of the Hippocratic : papers presented at the XIIIth International Hippocrates Colloquium, Austin, Texas, August 2008 / edited by Lesley Dean-Jones and Ralph M. Rosen.   p. ; cm. — (Studies in ancient medicine, ISSN 0925-1421 ; volume 46)  Includes bibliographical references and index.  In English; two papers in French.  ISBN 978-90-04-30701-8 (hardback : alk. paper) — ISBN 978-90-04-30740-7 (e-book)  I. Dean-Jones, Lesley, editor. II. Rosen, Ralph Mark, editor. III. Title. IV. Series: Studies in ancient medicine ; v. 46. 0925-1421  [DNLM: 1. Hippocrates. Works. 2. Philosophy, Medical—history—Congresses. 3. Greek World— Congresses. 4. History, Ancient—Congresses. W1 ST918K v.46 2016 / W 61]  R723  610.1—dc23

2015032016

This publication has been typeset in the multilingual “Brill” typeface. With over 5,100 characters covering Latin, IPA, Greek, and Cyrillic, this typeface is especially suitable for use in the humanities. For more information, please see www.brill.com/brill-typeface. issn 0925-1421 isbn 978-90-04-30701-8 (hardback) isbn 978-90-04-30740-7 (e-book) Copyright 2016 by Koninklijke Brill nv, Leiden, The Netherlands. Koninklijke Brill NV incorporates the imprints Brill, Brill Hes & De Graaf, Brill Nijhoff, Brill Rodopi and Hotei Publishing. All rights reserved. No part of this publication may be reproduced, translated, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission from the publisher. Authorization to photocopy items for internal or personal use is granted by Koninklijke Brill nv provided that the appropriate fees are paid directly to The Copyright Clearance Center, 222 Rosewood Drive, Suite 910, Danvers, ma 01923, usa. Fees are subject to change. This book is printed on acid-free paper.

Contents Acknowledgements ix Abbreviations x Introduction: Identifying the Hippocratic 1 Lesley Dean-Jones

Part 1 Formation of the Hippocratic Corpus 1 On ‘Hippocratic’ and ‘Non-Hippocratic’ Medical Writings 17 Philip van der Eijk 2 The Hippocratic Aphorisms in Ptolemaic and Roman Times 48 Ann Ellis Hanson 3 Remarques sur le tableau de la médecine et d’Hippocrate chez Platon 61 Paul Demont 4 The Treatise Affections in the Context of the Hippocratic Corpus 83 Pilar Pérez Cañizares 5 The Peripatetic Hippocrates and Other Monists in the Anonymus Londiniensis 99 Susan Prince 6 Tracking the Hippocratic Woozle: Pseudepigrapha and the Formation of the Corpus 117 Eric Nelson

Part 2 Hippocratic Concepts 7 Is There a ‘Hippocratic’ Response to the Attack on Medicine? 143 Joel E. Mann

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8 Perceiving the Coherence of the Perceiving Body: Is There Such a Thing as a ‘Hippocratic’ View on Sense Perception and Cognition? 163 Roberto Lo Presti 9 [Hippocrates] On Glands 195 Elizabeth Craik 10 Regimen in the Hippocratic Corpus: Diaita and Its Problems 209 Jacques Jouanna 11 Towards a Hippocratic Anthropology: On Ancient Medicine and the Origins of Humans 242 Ralph M. Rosen 12 On Regimen and the Question of Medical Dreams in the Hippocratic Corpus 258 Maithe Hulskamp

Part 3 Hippocratic Topics in Cultural Contexts 13 Teeth in the Hippocratic Corpus 273 Patrick Macfarlane 14 Hippocratic and Aristophanic Recipes: A Comparative Study 292 Laurence Totelin 15 Hippocratic and Non-Hippocratic Approaches to Lovesickness 308 Leanne McNamara

Part 4 Galen’s Hippocratism 16

‘According to both Hippocrates and the Truth’: Hippocrates as Witness to the Truth, from Apollonius of Citium to Galen 331 Amneris Roselli

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Bodily Features in the Corpus Hippocraticum: On the Classification of Individuals into Groups 345 Robert Alessi

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Ce qu’ ‘hippocratique’ (ἱπποκράτειος) veut dire: la réponse de Galien 378 Véronique Boudon-Millot

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Author, Argument and Exegesis: A Rhetorical Analysis of Galen’s In Hippocratis de natura hominis commentaria tria 399 Todd Curtis

20 Galen on Hippocratic Physics 421 R.J. Hankinson General Index 445 Index Locorum 455

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Acknowledgements This volume results from the XIIIth International Hippocrates Colloquium that was held 11th–13th August 2008 at The University of Texas at Austin. The Colloquium received generous support from the College of Liberal Arts, Department of Classics, Department of Philosophy and the Vice Provost for Health, all of The University of Texas at Austin, the National Science Foundation, the Society for Ancient Medicine, the Seton Family of Hospitals and the Texas Medical Association. We are grateful to all these entities for their sponsorship. We would like to thank Jim Hankinson for assistance with editing (and in once case, translation) of the chapters written in French. We thank Heather Elomaa Galante for editorial assistance in the early stages of preparing the manuscript for publication, Sarah Scullin for compiling the general index and Margaret Clark for compiling the index locorum. Philip van der Eijk, Tessel Jonquière and Tessa Schild provided valuable support and direction in preparing the copy for publication by Brill. Beth Chichester assembled and modified the images for the cover design and provided technical support in many other ways. Our greatest thanks goes to the contributors of this volume, for the chapters themselves, their patience with the protracted editing process and their willingness to respond to requests at short notice. I would particularly like to thank my co-editor, Ralph Rosen, for all his hard work and support in the later stages of producing this volume. Without his help it would have taken even longer to see the light of day. Austin, Texas, September 2015

Abbreviations The Latin abbreviations of Hippocratic titles, and of ancient authors generally, follow those of LSJ, those of Galenic titles the abbreviations suggested in R.J. Hankinson (ed.), The Cambridge Companion to Galen, Cambridge, 2008, 391–397. CH CMG CML CUF DELG DK FGH GMP IG K Kw L LSJ M-P3 OLD TLG vdE

Corpus Hippocraticum Corpus Medicorum Graecorum Corpus Medicorum Latinorum Collection des Universités de France Dictionnaire étymologique de la langue grecque Diels, H. and Kranz W. (eds.), Die Fragmente der Vorsokratiker Fragmente der Griechischen Historiker Greek Medical Papyri Inscriptiones Graecae Kühn, C.G. (ed.), Claudii Galeni Opera Omnia, 22 vols. Leipzig, 1821– 1833, repr. Hildesheim, 1964–1965 Kühlewein, H. (ed.), Hippocratis Opera Omnia, 2 vols. Leipzig, 1902 Littré, E. (ed.), Oeuvres complètes d’Hippocrate, 10 vols. Paris, 1839– 1861, repr. Amsterdam, 1961–1963 Liddell, H.G., Scott, R. and Jones, H.S. (eds.), A Greek-English Lexicon, Oxford 19963 (with revised supplement) Marganne, M.-H. and Mertens, P. (eds.), ‘Medici et Medica, 2e édition’, in: I. Andorlini (ed.), Specimina per il Corpus dei papiri Greci di Medicina. Florence, 1997, 3–71. Oxford Latin Dictionary Thesaurus Linguae Graecae van der Eijk, P.J. (ed.), Diocles of Carystus, 2 vols. Leiden, 2000–2001.

Introduction

Identifying the Hippocratic Lesley Dean-Jones Since 1972, scholars interested in the works collected under the name Hippocrates in the Corpus Hippocraticum (CH) have met triennially in the Colloque Hippocratique/Hippocratic Colloquium to discuss various issues relevant to the CH. In 2008 the Colloque was held at The University of Texas at Austin and the theme was ‘What is Hippocratic about the Hippocratics?’ All the papers collected in this volume were presented at that meeting and all address in some way or other the question of what led 60–70 medical treatises, clearly written over more than a century, by a number of different authors, from different parts of the Greek world, with different styles, who subscribed to different—sometimes contradictory—medical theories, to be collected under one name. This is not an attempt to locate the works of the original Hippocrates, but to identify what it is that the Hippocratic treatises have in common that caused them to become associated with one another. The first chapter in the collection, that of Philip van der Eijk, in addition to making its own argument, acts as an admirable introduction to the problems of finding any unifying theory, theme or element among all the works in the CH which is not so broad as to be shared with all the medical texts from the same time period which were not included in the CH, so I will not rehearse this material here myself. In this Introduction I confine myself to outlining the argument of each chapter and explaining what I see as the connections between chapters or groups of chapters. In the first section the chapters deal directly with the formation of the Corpus. In the very first chapter, Philip van der Eijk argues for the ‘dismemberment of the Corpus’ on the grounds that any characteristics which all the texts share are very general ones and can also be found in medical writings outside the Corpus. He argues that continuing to treat the treatises gathered together in the CH as forming some sort of unity, however much the general dissonance within the Corpus is acknowledged, has led to the comparative neglect of other medical material from the same period and hampered our understanding of the medical thought of ancient Greece. One cannot deny that non-Hippocratic medicine of the 5th and 4th c. BCE has received short shrift from scholars, and that more comparisons between this material and the treatises of the CH are profoundly to be wished. One aim of this collection is to provide more varied parameters along which the coherence of the treatises among themselves

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and their divergence, if any, from other medical material of the period can be gauged. Papyrus fragments offer external evidence of the evolution of the CH. Ann Hanson explains in her chapter that the structure, format and content of many unascribed medical fragments are hard to distinguish from those of treatises included in the CH. Although these adespota are written in Koine Greek, she argues that dialect alone cannot have been the reason they were excluded from the Corpus, because the papyrus fragments of recognized Hippocratic texts themselves exhibit Attic forms as often as Ionic, as is the case of the papyrus fragments of Herodotus, who, like the Hippocratics, has been transmitted in the manuscript tradition as a highly ionicized author. Many of these adespota papyri were copied between Erotian’s edition of roughly 30 Hippocratic treatises in the 1st c. CE and the much larger collections of the Byzantine era and so were possibly available for inclusion in the later collections. While in the case of unrelated adespota fragments we cannot tell if they derive from the same treatise, we can identify fragments that belong to one and the same Hippocratic treatise, and of these, fragments of Aphorisms, of which we have 7, outnumber those of any other treatise at least 2 to 1. Three of these contain marginal notations, which reflects the fact that many more commentaries were written on the Aphorisms than any other treatise. Although we know the names of many of the commentators it is impossible to identify the marginal notations on the papyri as belonging to any one of them specifically. Aphorisms was, of course, already identified as a Hippocratic treatise very early in the tradition, so it is not surprising that it should survive as a subject for exegesis into later centuries. But if we flip the causal chain it may be worth investigating whether it was having commentaries written on them that led to the greater survival rate of some treatises over others, regardless of their supposed authorship. Paul Demont investigates the role Plato may have played in helping to determine which treatises would earn the designation ‘Hippocratic’. He demonstrates that Plato, despite noting differences in medical practice in different geographical locales, acknowledging the development of the medical art over time and apparently reversing himself on the value of dietetics in medicine (all of which can be seen as resulting from the valorization of medicine for the soul over medicine for the body), throughout his dialogues conceives of the medical art as unified around definitions and descriptions that are, for the most part, compatible with the texts of the CH as we have it. The medical τέχνη is usually discussed as the province of unnamed doctors, past and present, but the two times Hippocrates is cited in the Platonic corpus he appears as the paradigm exponent of this art. Several dialogues make it clear that medical writings were widely available to the general public in Plato’s time, but also that it was

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generally conceded that one could not become a doctor oneself simply by reading the treatises. Demont suggests that they served the purpose of a rubric by which a layperson could gauge whether or not any given physician was competent. As Plato was the author that had raised the problem of assessing the worth of a physician and also put forward criteria of ‘true’ medicine, it was initially treatises that cohered with his concept of medicine that were accepted as exhibiting the medicine of the paradigmatic doctor—Hippocrates. Demont underscores the authority Plato had for later ancient historians of medicine by tracing the Nachleben of his comparison between the medicine seen in the Homeric poems and that of his own day. This intriguing suggestion provides a raison d’être for the nucleus of the collection while allowing for divergence in specific treatments, etc., among the treatises. It could also explain the deliberate removal of the names of the real authors of the treatises. Of course, later accretions to the CH need not have been made with Platonic criteria in mind. Pilar Pérez Cañizares focuses on one particular treatise, Affections, which, she argues, may offer some idea of the criteria by which medical texts were collected into the CH, but which has not received much attention from scholars ancient or modern. It is first referred to by Galen, who cites it as an authoritative text written either by Hippocrates himself or by his son-in-law Polybus, though he also finds the style if not the content inferior to other works he considers genuinely Hippocratic. From the general purpose the author states in the first chapter, Cañizares characterizes Affections as an assemblage of material taken from previously existing sources and put together for a lay audience. Some material coincides with that in Diseases 2 and Internal Affections, vocabulary is less consistent than in some other treatises and although the pathology of the treatise is based almost entirely on bile and phlegm, on one occasion the author refers to a theory of four humors, including black bile and hydrops. Like the authors of Articulations and Prorrhetic 2, the author of Affections refers to other medical works which he has written (γράφω). Cañizares believes that these also would have been written for a lay audience, and that the assumption that there was such an educated lay audience with ready access to written texts places the composition of the treatise in the second quarter of the 4th c. BCE, somewhat later than is usually assumed. Although Affections itself did not make it into either Bacchius’ or Erotian’s lists, it may be used as an early indication of what was considered Hippocratic, or at least authoritative, in medicine written by the early 4th c. One testimony which might have been expected to go a long way towards identifying the Hippocratic is a papyrus, referred to as Anonymus Londiniensis, probably composed in the 1st c. CE but not discovered and published till 1893. It summarizes and comments upon an account of medical theories from the

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5th and 4th c. BCE drawn up by Menon, a student of Aristotle. Menon, then, would have been writing about half a century after the death of Hippocrates. Unfortunately the discovery of the papyrus only served to complicate matters because the type of pluralistic theory evident in most of the treatises of the CH, i.e., that health results from the balance between opposing constituents of the body (whatever and however many those constituents may be), Menon attributed to only one physician, Menecrates, while the theory he attributed to Hippocrates most closely resembles the monistic theory found in the treatise Breaths, a treatise included in Erotian’s glossary but regarded by almost every scholar as an outlier. Susan Prince argues that this discrepancy developed because Menon wanted to attach the name of Hippocrates to the medical theory that most closely approximated the Peripatetic material monism. Anonymus, she argues, himself realized the bias in Menon’s account and corrects it in the papyrus. If this argument is correct, we can see that while in Plato’s works Hippocrates is seen as a prominent example of an excellent physician, practicing a τέχνη shared by others, about half a century later the discussion about medicine centered not so much on good and bad doctors but on good and bad medical practices, and the surest way to validate the medical practice one thought best was to label it ‘Hippocratic’. That any names attached to medical treatises as authors were paid scant attention is suggested by the fact that the theory Menon attributes to Menecrates, of all the treatises in the CH, most closely resembles On the Nature of Man, which Aristotle had attributed to Polybus, Hippocrates’ son-in-law. That there was a cavalier approach to historical authorship in the 4th and 3rd c. BCE is also a central argument in Eric Nelson’s chapter. He argues that the deliberate attribution of treatises to Hippocrates—in the knowledge sometimes that he was not the author—was begun by Bacchius to bring the designation ‘Hippocratic’, which by his era had come to be generally associated with the best in medicine, in line with the theories of the medical sect he favored, the Herophileans. Nelson’s argument, though, takes off, surprisingly, from texts that are general acknowledged as apocryphal—the orations Presbeutikos (Speech of the Envoy) and Epibomios (Speech from the Altar). The evidence from Erotian suggests that these were among the treatises which Bacchius included in his Lexeis as ‘Hippocratic’. However, as Nelson points out, these are a long way from supporting Hippocrates as a prolific medical author or authority. The Presbeutikos, ‘spoken’ by his son Thessalus, presents him as a highly respected physician and teacher, but one in a long line of Asclepiads who had performed service for Greece, a service which is being continued by Thessalus himself, who if anything is presented as even more accomplished. The Epibomios is downright unflattering, a whining complaint from Hippocrates’ lips about the

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confiscation of some land, ‘more like an embarrassing picture of one’s parent that, with all due respect, ought to be discarded from the family photo album’, in Nelson’s words. It is almost certain that there were pseudepigrapha about Hippocrates in circulation to which Bacchius had access which would have served better to support his authority as the fount of true medicine. Why, then, did Bacchius choose these texts about Hippocrates to include with the selection of texts he presented as being written by Hippocrates? Nelson’s answer is that they were chosen deliberately to present the medicine attributed to Hippocrates as a tradition emanating from a group of physicians associated in an οἴκησις, just as the Herophileans were a medical sect associated in an οἰκία. They also served to divorce this tradition from its connection to the island of Cos, seen in Bacchius’ time as the locus of Empiricism, a competing sect. If this was the nature of ‘Hippocratic’ medicine, Bacchius was free to choose treatises for his Hippocratic Lexeis which he felt cohered with Herophileanism even if he knew they were not written by Hippocrates himself, and even if it were clear they were not by the same author. The same process, argues Nelson, the desire of ‘discourse communities’ to construct ‘Hippocrates’ in their own image accounts for additions and removals from corpora of ‘Hippocratic’ treatises until it becomes more or less fixed by Dioscorides and Artemidorus. The chapters in the second section identify shared fundamental concepts among Hippocratic treatises, some of which are usually seen as agonistic towards one another. The well-known group of ‘polemical’ treatises, Ancient Medicine, Nature of Man, and Regimen in Acute Diseases are often cited as evidence of theoretical divisions within the CH. However, Joel Mann argues that although they present different aetiologies and therapies for disease and are ostensibly attacking different targets, they are united in their concept of the fundamental quality of nature and are also counterattacking the same claim, that ‘medicine is not’. They share the view that prognosis and knowledge of human nature are possible and constitute both means and end in medicine. They all also, as Mann phrases it, ‘absorb’ the criticism that many who claim to be doctors disagree with each other and make mistakes, but they answer this by the methodological claim that disagreement with their own particular (correct) aetiology naturally entails mistakes. They then all give an outline of their preferred aetiology and therapy, which would put an end to disagreements and mistakes if adopted by all doctors. On the Art, on the other hand, while it agrees in saying that prognosis and knowledge of human nature are possible, minimizes disagreements among doctors and the frequency with which they make mistakes. The author does not give an overview of the aetiology and therapeutics that would constitute true medicine. This, Mann argues, is because he is not aiming at the exclusion or promotion of any specific

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methodology. Those self-proclaimed physicians which the treatise does criticize are blamed for taking on patients who are too far gone in their disease to be able to be saved, not because of any beliefs about causation and treatment of disease. So, in identifying medicine as that which seeks to treat patients by identifying causes of their illness, uses knowledge gained from past cases both for this and for treatment, and looks to matter voided from the body as evidence of the interior, On the Art can be seen as giving a defense of ‘generic’ Hippocratic medicine. This in turn explains the frequently noted dearth of medical specifics in the treatise. Just as Mann picks out a shared concept of medicine from what are normally considered competing polemics, Roberto Lo Presti sees a shared view of the perceiving subject in the CH even in treatises which are usually thought to be at odds with one another, such as On the Sacred Disease and On Regimen which posit different seats of consciousness (the brain and blood respectively). Lo Presti recognizes that the germ of the Hippocratic concepts about cognition and perception was inherited from the Presocratics, but argues that even when Hippocratic treatises have been influenced by different Presocratic philosophers (as On Regimen is influenced by Empedocles and On the Sacred Disease by Diogenes) there was a distinction between purely philosophical theories and those developed in the service of medicine. The earlier Presocratic theories treat the different senses as distinct mechanisms in the body each of which interacts with the external environment separately, making the body a ‘multiplicity’. The Hippocratics see consciousness in all its forms as the manifestation of a ‘perceiving body’ attributable to a ψυχή which operates as part of a body. This concept allows the ψυχή to be both individuating—its quality in various respects determined by the composition of a particular body—and a coherent whole in a differentiated body—one individual may be more adept at handicrafts than another, or more musical, but this results from the makeup of their whole ψυχή, not from having more ψυχή material in the hands or ears. Furthermore, the Hippocratic authors make the seat of cognition both continuous with and disjointed from both the external and internal environment, allowing it to perceive and interpret both in some way or other. Because of their concept of the ψυχή as a bodily part which connected the individual to the external world, unlike the Presocratics the Hippocratics were interested in the occasions when this link became disordered, even if only in one sense, because it served as a significant piece of evidence of the disruption taking place within the diseased body. Lo Presti suggests that although there is no single theory of cognition shared by the Hippocratic treatises, this view of the individual as a discrete and integrated psycho-somatic entity functioned as

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one of the key criteria in selecting medical treatises for inclusion in a single Corpus. On the other hand, Elizabeth Craik discusses a group of treatises which have so much in common that she argues for a single author: On Glands, On Generation/Nature of the Child, Diseases 4, the sections of Diseases of Women 1 & 2 attributed to ‘Author C’ and Diseases of Young Girls. These treatises have a shared vocabulary, such as the constant use of σημεῖον and μαρτύριον and a fondness for α-privatives, duals and diminutives, as well as similar tendencies in style, such as rather long-winded transitional passages. Several topics adumbrated in On Glands are treated more fully in the other works, but they all share the same assumptions on the general character of glands and fluxes round the body relating to pressure and space. Craik also argues that many of these theories seem to underlie other treatises which allude to glandular function—even if they do not mention glands themselves—but which do not share the stylistic traits of the Glands group, e.g., Places in Man, Articulations, Fractures and Regimen. These treatises comprise a considerable number of core texts in the CH and their shared conceptions could perhaps serve as a basis for a fundamental anatomy in the CH. The last three chapters in this section focus on the aspect of medicine in antiquity that many people feel has the best claim to being uniquely Hippocratic: dietetics and regimen. Jacques Jouanna first emphasizes the evidence of the lexical tradition which demonstrates the importance that δίαιτα had for the medical writers and the resultant increase in the appearance of the term in non-medical literature. He then explores the scope of the term in the Hippocratic treatises. In some cases the term is restricted to matters of food and drink, but it also frequently includes exercise, and sometimes activities such as bathing, sleep and sex. All these areas can become part of therapy and are distinguished from drug-therapy by the Hippocratics. Jouanna argues that this twofold organization of therapeutics is one of the earliest divisions of a subfield within medicine, perhaps indicating its originality. He then considers the connection of the medical sense of δίαιτα to its other technical use in legal contexts, where it means ‘judgment’. He locates it in the earliest attested meaning of the verb διαιτᾶν, to ‘rule’ or ‘direct’ a city and its people. The connection then, and fundamental meaning of δίαιτα, is rule or regulation. The fact that Greek doctors realized that the δίαιτα of sick individuals had to be regulated constituted, for the Hippocratics, the discovery of medicine and placed the Greek race further along the path of progress than barbarians. Various Hippocratic authors recognize the difficulties inherent in prescribing regimen for different individuals, and the need to take into account the changes

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of seasons and other environmental factors when doing so. The most important constant in this type of therapy is that change be implemented gradually. Jouanna observes that Diocles of Carystus, who is not included in the Corpus, gives much the same advice, but in language so close to that of Nature of Man that he wonders whether Diocles is paraphrasing the Hippocratic text. Ralph Rosen focuses on the treatise that most completely instantiates the view of δίαιτα as the essence of medicine, On Ancient Medicine. He argues that while the anthropological foray into an imagined prehistory to explain the origins of medicine is not reflected elsewhere in the Corpus, the assumptions underlying this account are, i.e., that the human φύσις is inherently weak, tending to disease rather than health, but that the human condition is getting progressively better because of advances in the medical τέχνη. Other Hippocratic treatises assume that this is the case. On Ancient Medicine argues for why this is the case, beginning the account in a world constituted of humans, animals and foodstuffs as they are today but without the medical τέχνη. Rosen acknowledges that there were other accounts of the progress of humans from bestiality to civilization put forward in the 5th c. BCE, but he notes that On Ancient Medicine is unique in single-mindedly attributing the bestial nature of human origins to their inability to deal with raw foods and the improvement in their lot to refinements in their diet. Other doctors might realize that a patient cannot tolerate certain foodstuffs; a Hippocratic doctor would argue that the foodstuffs, or the way they were prepared, caused the illness because, uniquely among animals, humans were not formed by Nature to deal with the world as it presented itself. Rosen argues that certain passages in Galen indicate that he shared this view of the relationship between human φύσις and the medical τέχνη and would have considered it a Hippocratic belief. In relation to another treatise with a focus largely on diet and regimen, On Regimen, Maithe Hulskamp investigates the use of dreams in book 4 of the treatise as a diagnostic tool to help a doctor prescribe the regimen a patient should follow before any physical signs of a disease have manifested themselves openly. The author believes this is possible because in sleep the ψυχή is able to pay attention to the inner environment of the body and represent it symbolically in dreams. It has been assumed that this diagnostic use of dreams was peculiar to the author of On Regimen, but Hulskamp argues that it can be discerned in other Hippocratic treatises, notably Epidemics 6.8.9–10. She argues on both semantic and lexical grounds that the two chapters are better understood as one. As chapter 9 ends with a reference to sleep and dreams and chapter 10 opens with a reference to γνώμη, Hulskamp argues that this passage shows the same relationship between the body’s consciousness of its inner state in sleep and its representation of it in dreams as that of On Regimen.

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Although Diseases 2.72 and Internal Affections 48 deal with mental derangement during an illness rather than dreams prior to falling ill, Hulskamp demonstrates the close similarities between the two passages and chapters 92 and 93 of On Regimen 4 which discuss the significance of dreams about the dead, fear and fighting. Hulskamp’s analysis suggests that the medical approach to dreams of On Regimen 4 may be more widespread among Hippocratic authors than has been recognized. The third section considers other specific topics on which Hippocratic treatises can be seen as sharing a similar approach not only with each other but also with non-Hippocratic texts. Patrick Macfarlane focuses on comments about teeth in the CH. He shows there are no contradictions between Hippocratic treatises on the nature of teeth (they are a form of bone), the age at which they appear (seven months for first dentition, seven years for second), the problems associated with teething (including convulsions and spasms), the ailments that afflict the teeth (grinding, being ‘set on edge’ (αἱμαδέω) by perceptions of sight and sound, pain and decay), or the treatment (application of various materia medica, extraction). This would all be very encouraging for a shared Hippocratic conception of teeth, except that these views are also shared by a variety of non-Hippocratic philosophical writers, notably Aristotle. In showing how coherent ideas about the teeth were among medical and philosophical writers Macfarlane identifies an interesting area for further study, but not one likely to shed much light on anything distinctive about the Hippocratics. Laurence Totelin compares three medical recipes found in Aristophanes to the 1551 recipes she identifies in the CH as a whole, 80% of them in the gynecology. One of the Aristophanic recipes is a remedy concocted for a wife’s supposed bellyache by a cuckolded husband. Totelin suggests that the joke, which the audience would have appreciated, was that the ingredients were used in a gynecological context in the CH for a condition for which coitus was frequently recommended as a cure. We have to assume, not that the audience had read that particular text, but that the gynecological application of the ingredients was generally known. The other two Aristophanic recipes were for eye ailments. These include five ingredients, only one of which, garlic, was used for eye ailments in the CH. However, three of the four other ingredients suggested by Aristophanes do appear in remedies for eye ailments in later medical authors. All the ingredients would cause the eyes to sting quite fiercely and thus to water, procuring a purge. The joke here relies on the last ingredient in one recipe, spurge, which would be an even greater irritant than the others and is not found in any medical eye remedy, and in the fact that unlike the real medical remedies the other recipe is applied to the inside of the eyelid,

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which again ratchets up the irritant effect considerably. The implication is that these remedies would harm rather than heal. For the audience to be in on the joke, however, these types of remedies would have to be circulating more freely than the meager correlations we find with the CH. Totelin accepts Elizabeth Craik’s argument that there were several pharmacological books circulating in the classical Greek world, and that the contents of these books would have aligned with what we see in the CH and later medical texts so that the audience would have understood what Aristophanes was parodying in his comedies. As with Macfarlane’s chapter this suggests that on this issue at least the authors of the CH were reflecting widely shared medical beliefs rather than something peculiar to one type of medicine. Rather than discussing a common issue present in the CH, Leanne McNamara considers a common avoidance: the interesting absence of lovesickness from the CH. She demonstrates that this is commonly considered a νόσος in non-medical literature of the period and she assembles a recurring symptomology (fever, sweating, pallor, insomnia, etc.) from sources in lyric, tragedy, oratory, philosophy, curse tablets, magic spells and non-Hippocratic medical texts. She also points out that later doctors, including Galen, recognized and treated love-sickness. Although in these sources love-sickness is not always gendered, when it is it is seen predominantly as a female affliction. McNamara argues that at least one Hippocratic author recognized an attenuated version of the ailment in the treatise Diseases of Young Girls, reflecting not only the gendered aspect of love-sickness and its symptomology, but also the identification of the seat of the disease as the ψυχή and its frequent resolution in suicide. Further, she suggests that case histories of young girls who are said to suffer around the time of menarche throughout the CH could also be assimilated to this attenuated version of love-sickness. She argues that this tacit agreement to avoid the topic of love-sickness shows that the Hippocratics shared a desire to distance themselves from the recognition of an ailment that was often attributed to divine causation and dealt with by folk remedies and magical intervention, but at the same time, as with the ‘Sacred Disease’ sought a way to redefine it as a natural physical ailment that could be brought into their domain. In later eras when ‘rational’ medicine was more securely established there was less need for doctors to hold themselves so aloof. The final section consists of five examinations of what Galen considers truly Hippocratic. And, as Amneris Roselli shows, what Galen considers truly Hippocratic he also considers true simpliciter, deploying the phrase ‘according to Hippocrates and according to the truth’ to illustrate the coincidence of these two concepts. Galen was not the first to call Hippocrates a ‘lover of truth’, but in his writings the epithet takes on a somewhat different emphasis than it had in

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writers such as Apollonius of Citium. Prior to Galen, Hippocrates’ love of truth was thought to be manifest in a lack of reticence on any piece of knowledge he had collected, in particular anything he had learned through his own failures in diagnosis and treatment, several of which are described in treatises of the CH. This view of Hippocrates is so pronounced that it allows Apollonius to assert that Hippocrates must have been successful in permanently reducing a dislocated femur, even though this issue is addressed nowhere in the CH, because if he had failed he would have said so. Although there are references to disagreements among physicians in the CH there is very little indication that any writer felt he had to combat outright deceit. When a verb indicating ‘deceit’ is used it usually designates a doctor falling into error as a result of being deceived by appearances. Galen, on the other hand, accuses many of his rival physicians of deliberately deceiving students and patients purely for the sake of setting themselves apart from Hippocratic medicine. In Galen’s view, Hippocrates is a lover of truth because he had no need to record anything but what presented itself in his investigations due to the fact that there were no opposing sects to argue against. Admitting to mistakes is not part of the love of truth which Galen attributes to Hippocrates because in Galen’s eyes Hippocrates did not make mistakes. Robert Alessi explores one aspect of medicine that is referred to in treatises Galen considers authentically Hippocratic which we might have expected him to label as mistaken: physiognomy. This is usually taken to mean the prediction of an individual’s character from observable bodily features. However, Galen explicitly denies that this is possible at various points in his corpus. Using several texts that have survived only in Arabic translations, Alessi demonstrates that Galen interprets various ‘physiognomic’ statements in the CH to have nosological import. That is, Galen believes that Hippocrates attached words such as ἐσθλός and πονηρός as predicates to physical descriptions not to indicate the quality of a person’s soul but to show whether they would tolerate certain conditions well or badly. This reading can be derived from the Greek texts once we accept that sometimes the author wrote very abbreviated notes to which he would add further defining physical descriptions for the predicate as an afterthought. Galen states that it is only the overall bodily constitution which could serve to predict how well or badly an individual would tolerate any particular ailment, not discrete body parts, but he seems to allow that a constellation of body parts could indicate the underlying constitution. Having discussed ‘physiognomic’ lemmata from the Epidemics upon which Galen had commented, Alessi demonstrates that this grouping of patients by ‘physiognomics’ is seen as having medical application in other treatises of the CH and so could be considered a mark of Hippocratic medicine.

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The last three chapters focus on another aspect of Galenic medicine which seems at odds with what is said, or not said, in the CH and yet is fundamental to Galen’s whole system: the idea that the four elements, earth, air, fire and water, are the basic constituents of the body. Véronique Boudon-Millot begins her examination of what Galen encompasses in the term ‘Hippocratic’ by considering the occasions on which he uses it of other physicians. There was a group identifying as ‘Hippocratics’ in Rome in the 2nd c. CE, which, BoudonMillot notes, Galen usually refers to as ‘those calling themselves Hippocratics’ and about which he never has anything positive to say. In fact, he usually criticizes their commentaries on Hippocratic treatises more harshly than he does those of other medical sects because whereas other sects are clear on what Hippocrates says and simply disagree with him (wrongly as Galen thinks), those who claim to be followers of Hippocrates do not even understand him to begin with. Boudon-Millot argues that this is because whereas Galen portrays Hippocrates as infallible, members of the Hippocratean αἵρεσις in Rome were probably critical of certain aspects of the Hippocratic treatises they were commenting on. In Galen’s eyes, anybody who disagrees with anything Hippocrates says cannot be a Hippocratic because nothing the genuine Hippocrates said needs correcting. According to Galen the most important fundamental beliefs of Hippocrates are the existence of two different heats in the body, one the innate heat needed for conception and another which is involved in fever, and the formation of the body from the four elements earth, air, fire and water. The fact that these fundamental beliefs are not very easy to find in the treatises of the CH is reflected in the fact that Galen wrote no less than six treatises expounding upon Hippocrates’ theories about them, and dismisses as spurious any treatise that cannot be squared with this vision of Hippocrates’ doctrine. He argues that when Hippocrates appeals to the qualities hot, cold, wet and dry he is actually appealing to the elements. In fact, Boudon-Millot argues, these fundamental beliefs reflect positions in medical debates contemporary with Galen, not Hippocrates. Because this is what Galen identifies as fundamentally Hippocratic and believes he is the only one who has understood this aspect of the original Hippocrates he considers himself the only true Hippocratic, though he never uses the term of himself. The rhetoric by which Galen was able to convince himself, and presumably others, that Hippocrates did hold the same position as himself on this contemporary debate is documented by Todd Curtis in his analysis of Galen’s commentary on On the Nature of Man and On Regimen in Health. In Galen’s time these treatises were viewed as a single treatise On the Nature of Man but Galen broke it up into three parts, the first, he argued, penned by Hippocrates himself, the third part (On Regimen in Health) by his disciple Polybus and the middle

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section, the second half of On the Nature of Man, by a complete medical imposter. Curtis demonstrates that three practices of ancient commentary enabled Galen to propagate this view. The first was that Galen provided so much of the text that he presented a source text within his own commentary, to a great extent masking some of the problems he had with the received text. Then, he interposed his comments contextualizing lemmata at junctures in the text which disrupted the author’s actual argument. Finally, ancient commentators saw their job as not only explicating abstruse words or untangling dense arguments but also supplementing written material with unwritten concepts they attributed to the author’s γνώμη. Because Galen believes the author of the first section was Hippocrates himself, he believes nothing in that text can be stated incorrectly. His understanding of Hippocrates’ γνώμη allows him to expand upon anything that seems unclear or at odds with his own view of medicine to bring Hippocrates’ statements in line with the truth as he sees it. He extends this generosity to Polybus, but not to the author of the middle section. Both authors, for example, make reference in similar terms to the heat of the young compared to the cold of the aged. In the case of Polybus this calls forth from Galen a gentle acknowledgement that he has missed out two other stages of life which should have been included in his argument and then an explanation of how the two missing stages could be seen as assumed in Polybus’ argument. By contrast Galen pours scathing mockery on the ‘imposter’ for failing to specifically identify the heat he is discussing as innate, ἔμφυτον, though it would have been even easier to have explained this lack of precision than Polybus’ omission. It is by arguments such as these, Curtis argues, that Galen convinced many later physicians that his elemental theory of the constitution of the body was genuinely Hippocratic. R.J. Hankinson undertakes to exonerate Galen from complete ‘anachronistic phantasm’ in his attribution of a belief in the four elements to Hippocrates. He first establishes that the argument in On the Nature of Man is aimed squarely at Monists, not at the existence of any fundamental but unperceived substrate. He shows that the author of On the Nature of Man used what can be represented as a formal demonstration to argue that a complex body has to be made of more than one thing. From this we can assume that for this author blood, phlegm, yellow bile and black bile are different things. Hankinson then addresses the problem that the author’s definition of an element, i.e., something that cannot change in form or power, seems diametrically opposed to Galen’s concept of the elements as intertransmutable. However, Hankinson argues that for the author of On the Nature of Man, the qualities of hot, cold, wet and dry are causal forces that bring about a transmutation of an underlying unnamed substance. The elements of the body cannot change in the sense

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of taking on different qualities yet remaining the same fluid. Phlegm cannot assume the quality warm and remain phlegm. It is the qualities which are fundamental for the author. But, argues Hankinson, the four humors are only the purest carriers of the qualities in the body. Outside the body there are even more fundamental materials, earth, air, fire and water, which can transmute into everything, including the fluids of the body, and are the fullest and purest bearers of the qualities. Because the qualities are the most significant causal factor in On the Nature of Man’s humoral theory, Hankinson argues, Galen has some warrant for attributing the theory of the four elements to the author of On the Nature of Man, who Galen believes is Hippocrates. Hankinson admits that Galen goes beyond what the author himself says, and perhaps even what he implies, but he absolves him of a completely unfounded attribution of his own views to Hippocrates. Although this collection provides no conclusive answer to ‘What is Hippocratic about the Hippocratics?’, it does suggest a variety of criteria that could account at least for an initial collection of treatises which could each have been seen to have further connections with other treatises, causing the CH to grow by accretion along several disparate lines, more like an octopus than a snowball. This would still leave unanswered the question posed at the beginning of the collection by Philip van der Eijk: why were other medical texts which seem to share the same elements not collected into the CH? It is undoubtedly true that we need to consider all the medical texts written in the 5th and 4th c. BCE when looking for commonalities between treatises, but in this study, for the time being at least, it seems prudent to remember that some medical treatises were seen by the ancients themselves as suitable for inclusion in a collection associated with a single name and others were not.

part 1 Formation of the Hippocratic Corpus

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CHAPTER 1

On ‘Hippocratic’ and ‘Non-Hippocratic’ Medical Writings Philip van der Eijk 1

Introduction: The Concept of the ‘Hippocratic Corpus’

While most scholars have by now given up the hope of ever being able to identify the genuine writings of the historical Hippocrates, many still speak of ‘Hippocratic writings’, or of ‘Hippocratic medicine’. And while it is now generally accepted that there is great diversity in doctrine, style and methodology between these Hippocratic writings, which cannot be the product of one single author, there still is, even within scholarship on ancient medicine, a tendency to treat the Hippocratic writings as a ‘corpus’ or a ‘collection’ that can be distinguished, as a group, from other medical and scientific literature of the same period, and within which sub-groups can further be distinguished.1 * I am grateful to the Wellcome Trust and the Alexander von Humboldt Foundation for their support to the research project from which this chapter has arisen. 1  Two quotations from one of the world’s most eminent Hippocratic scholars may suffice to illustrate this attitude: ‘The some sixty treatises that have come down to us under the name of Hippocrates surely could not all have been written by the great physician himself, nor even by his disciples of the school of Cos; some of these treatises plainly come from other sources, or are to be dated to later periods. But the main part of this work is prior to that of Aristotle, and it forms, despite certain undeniable discrepancies, an ancient and globally coherent core that can be seen as constituting a distinctly Hippocratic style of thought’ (Jouanna 1999, xii), and ‘But beyond the differences and contradictions to be found among the various writings that make up the Hippocratic Collection, a certain unity yet manages to emerge, with respect to both medical practice and to the rational approach to disease and treatment they advocate. And without wishing to ignore these differences and contradictions, we may speak from now on of the ‘Hippocratic physician’ in the broad sense of the phrase—indeed, for the sake of convenience, of ‘Hippocrates’—without thereby prejudging the question of authorship. The name Hippocrates signifies in fact two things. It signifies, first of all, Hippocrates the historical figure. But it also stands for the work that has been bequeathed to us under his name. For as long as this collection of medical manuscripts has been known, this ambiguity in the use of the name has been constant. It cannot really be gotten away from. The essential thing is that we are aware of it’ (Jouanna 1999, 71). The habit of contextualising individual ‘Hippocratic’ writings by considering their ‘place within the Hippocratic Corpus’ separately

© koninklijke brill nv, leiden, ���6 | doi ��.��63/9789004307407_003

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Admittedly, views have differed on the positioning, dating and classification of individual treatises within this corpus, on the criteria for sub-division and on the demarcation lines between groupings of treatises, subject as these are to changing patterns and developments in historical scholarship. One may think here, for example, of the classification of the Hippocratic writings by the 1st c. CE medical lexicographer Erotian into ‘semiotic’ works, ‘physical and aetiological’ works, writings ‘relating to the art’, ‘therapeutic’ treatises and ‘mixed’ works; or one may think of Galen’s division between Coan vs. Cnidian treatises, revived in the mid 20th c., but now largely abandoned; or one may think of modern divisions, such as Jouanna’s distinction between a ‘core’ of works from within the ‘school’ of Hippocrates and more peripheral, mostly later works (see n. 18). Yet for all these differences, scholarship seems to have been in tacit agreement that such sub-divisions are to be made within the boundaries of the ‘distinct’ body that is the CH. In this chapter, I shall be challenging this practice and raise a number of ­questions about the legitimacy of treating the writings transmitted under the name of Hippocrates as a corpus, and consider its implications for the study of Greek medicine in the 5th and 4th c. BCE. In so doing, I am developing, and slightly qualifying, views presented on earlier occasions in a paper provocatively called ‘Is there such a thing as Hippocratic medicine?’2 My conclusions in that earlier paper were rather sceptical, and especially my suggestion to scrap the word ‘Hippocratic’ and to replace it by less appealing but more precise phrases such as ‘Classical Greek medicine’, or ‘5th and 4th c. Greek medicine’ was considered too radical by many members of the audience. Yet the question is a serious one, and not only for academic but also for what one may call cultural or even ideological reasons related to the public image of Hippocrates and the impact of the study of the Hippocratic writings among wider audiences, particularly in the medical profession. For some would argue that, especially in the discourse of what is nowadays referred to as Medical Humanities, from their place within broader frameworks of medical and philosophical texts ‘outside the Corpus’ is a manifestation of this tendency and can be found in many editions of Hippocratic writings, e.g., in Craik 2006, Grensemann 1968, Jouanna 1996. 2  Delivered at a conference organized in Leiden in honor of Wesley Smith in December 2004, as a guest lecture at the University of Melbourne in March 2006, and at a conference on Hippocrates and his Legacy held at Columbia University in December 2006. I am grateful to the audiences on these occasions for their comments. A more recent version of the present chapter was presented in a ‘Text and Translation’ seminar at the Wellcome Trust Centre for the History of Medicine at University College London in March 2009, and at a seminar at the Humboldt Universität zu Berlin in April 2011. I am grateful to the audiences on these occasions for their feedback.

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it would be undesirable, counter-productive or even damaging to deprive the writings that have been so formative for the development of Western medicine of the illustrious name of Hippocrates. After all, in the medical world Hippocrates has often been regarded as the respectable hero to whom many physicians turn and trace their pedigree, the icon of a special type of medicine that can command universal acclaim and of which Western medicine has often claimed to be the legitimate heir. And for classicists, Hippocrates has long been the man incorporating the medical component of le miracle grec or of Greek paideia, so suitable as a symbol for the lasting humanising influence of Classical Greece on Western civilisation. Yet the counter-case can also be made, viz. that stripping these writings from their Hippocratic label, apart from academic reasons, can have ideological advantages as well. Indeed it has been made by Vivian Nutton, in a review of one of the volumes of Anastassiou’s and Irmer’s Testimonien zum Corpus Hippocraticum: The Hippocratic Corpus of this volume, as recent scholarship has shown, is a renaissance construct. It encompasses what a renaissance publisher found and selected for publication (. . .) As a grouping of writings it is extremely varied (. . .) Over the last thirty years this variety has been welcomed as a leading feature of Greek medicine in the 5th and 4th c. BC, and many scholars, myself included, have used ‘Hippocratic’ as a shorthand description of medicine in that period. But there is still a tendency to consider medical material that falls outside the 1526 Corpus as irrelevant or inferior, and to resume the search for treatises that were written by the Father of Medicine himself. It is to avoid this confusion that some sceptics wish to go further and abandon all reference to ‘Hippocratic’ medicine and to talk instead of ‘medicine in Classical Greece’, or some such formulation. This avoids giving the impression of a coherent body of writing and doctrine or, still worse, suggesting that anything can be traced back to Hippocrates himself. This is a tempting abnegation, not least when faced, particularly in the modern medical press, with statements that are attributed, usually with an ethical or deontological intent, to the historical Hippocrates, and thus are intended to carry greater weight precisely because of that association.3 No doubt many examples could be given where the association of Hippocrates with a particular recent medical practice, tradition or ideology is not only 3  Nutton 2008, 174–75 (italics mine). See also Nutton 2004, 60 and 156 for a similar point.

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questionable on academic grounds but also undesirable for other, ethical or political or cultural reasons. Without indulging in scepticism, there is therefore good reason not to use the term ‘Hippocratic’ so uncritically or indiscriminately as has often happened or to maintain the habit of using it simply out of tradition and convenience. More importantly, one should go further and argue that our views on the origins and early history of Western medicine can only be enriched by including the contributions from what one could call ‘nonHippocratic’ medical and scientific writers—the ‘medical material that falls outside the 1526 Corpus’, as Nutton puts it—and by taking account of the diverse, pluralist nature of Greek thinking and practice regarding health and disease. Before going further, there are three things I should like to make clear from the outset in order to avoid misunderstanding.4 First, to say that the CH as we have it is a Renaissance construct is, of course, a bit of an overstatement, for the Renaissance editors were, in all likelihood, compiling their collections of Hippocratic works on the basis of what the manuscript tradition(s) handed down to them as being ‘by Hippocrates’.5 How far back into antiquity those traditions can be traced and what credentials they have is another matter; but there is considerable evidence for the work of Hellenistic lexicographers and commentators who as early as the 3rd c. BCE seem to have been dealing with collections, or at least groups, of writings attributed to Hippocrates.6 The 4  I am addressing criticisms here made of the earlier paper, in particular by Jacques Jouanna and Heinrich von Staden; I am grateful to them for their comments. 5  This is conceded by Nutton 2004, 60. Yet as Nutton goes on to point out, none of the manuscripts on which these editors drew contains all the works included in their editions (Nutton 2004, 60 with n. 29; Jones 1923, lvii–lxvi). How editors such as Jean François d’Asola (the editor of the 1526 Aldina) went about collecting, selecting, including, or excluding works in their editions and translations, or whether they simply included anything they found in the manuscripts they could get hold of (or which they deemed most authoritative), is by no means easy to answer. Nor were the Renaissance editors unanimous in what they included. Thus Theodor Zwinger’s 1579 Basle edition contains only 22 writings, while Cratander’s 1526 Basle collection of Latin translations by Calvo, Copo, Leoniceno, and Brenta includes ‘Hippocratic’ works not contained in the Greek Aldina. On the work of the Renaissance editors see Fortuna 2006; Potter 1998, 243–244 with further references; Rivier 1962, 150–153; Jouanna 2004, esp. 3–5; and the contributions to Boudon-Millot, Cobolet, and Jouanna 2012. On Calvo’s translation activities see Rütten 2008, 259–262. I am grateful to Pilar Pérez Cañizáres for her advice on the issues discussed here and in the following footnotes. 6  Collected and discussed by Smith 1979/2002; Roselli 2000; von Staden 2006; Anastassiou and Irmer 2006, 509–510; Manetti 2014; see also Pöppel 1959, 4–12. Even if scholars today no longer accept Wellmann’s claim (1901) that Diocles of Carystus was the first to have created a ‘Hippocratic Corpus’, or Gossen’s claim (1913, col. 1808) that a version of the ‘Hippocratic Corpus’ already existed prior to Aristotle, there is still a question to what extent the words

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history of these early collections is complicated and largely obscure, and the fragmentary evidence makes it very difficult, if not impossible, to trace in detail when, by whom, for what purposes and on what grounds, particular writings were added to or excluded from what one may call the canon (or canons) of Hippocratic writings (for we should realise that what we are reading today as the CH is the product of a long process of canonization).7 Yet it seems indisputable that collections of writings attributed to Hippocrates were already ‘corpus’ or ‘collection’ can be applied to the (at least) 18 works attributed to Hippocrates that an early lexicographer such as Bacchius of Tanagra had at his disposal. If one takes ‘corpus’ in the strict sense of ‘Schriften . . . die . . . nach kritischer Sichtung zusammengefaßt als Einheit auftreten . . . Gesammeltes, Geordnetes und auch Begrenztes’ (Pöppel 1959, 4ff.), one has to concede that there is no evidence that such collections already existed (cf. Roselli 2000, 177). Yet it is also clear that early in the 3rd c. BCE a sizeable number of treatises already circulated under the name of Hippocrates and were considered worthy of lexicographical explanation en bloc. I am grateful to Heinrich von Staden for permission to draw on material presented (but hitherto unpublished) in a paper ‘The Hellenistic Hippocrates’, delivered at the December 2006 Hippocrates conference at Columbia (see n. 2 above), and in a paper ‘Authority, agon and exegesis’, delivered in Cambridge in March 2008. See now also von Staden 2009, 153–155. 7  On canon formation in antiquity in relation to the Hippocratic writings see Roselli 2000; Alexander 2007; Pöppel 1959; and Beccaria 1959, 1961, and 1974. As literary and Biblical studies in the phenomenon of canonization have shown, canonization is, of course, a very complex process and its manifestations can be manifold (see Sanders 1984; Luhrmann 2004; von Campenhausen 1972; Aragione, Junod, and Norelli 2005; Finkelberg and Stroumsa 2003; Markschies 2007, 215–236; Rippl and Winko 2013). Some points that are relevant here: (1) canons usually are the products of interpretive traditions and/or communities; (2) canonization of (collections of) texts often takes place in relation to questions of authenticity (as is clearly the case with the early history of the Hippocratic canon, which started off in the context of ‘Echtheitskritik’, see Pöppel 1959, 10), or to questions of authority and orthodoxy, or in contexts where there is competition for intellectual or ideological power; (3) for texts to become canonical usually requires a considerable amount of time, even after formal decision by an authoritative body like a Church Council or professional body of experts; (4) canons are not static but are subject to change and development; (5) there can be canonical pluralism (as there was in the Netherlands in 2009 about the institution of a canon of Dutch history in secondary education); (6) canons often live on for a long time after they have been established without the members of the relevant interpretive communities being fully aware of their exact contents or foundations; (7) canonization does not preclude the continued circulation, use, and influence of writings declared ‘apocryphal’ or ‘deuterocanonical’, nor does it preclude the new emergence, or re-emergence, of texts previously excluded from the canon (one may compare the recent revival of the Gnostic ‘Gospel of Judas’, which had been known for several decades, but which enjoyed a new surge of interest because it seemed to suit certain theological agendas). There are, of course, differences as well as similarities between the role of canons in religious, literary, and medical contexts, and certainly from very early onwards in classical antiquity the recognized authority of Hippocrates

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in circulation in the early Hellenistic period and that such collections grew over time (as testified by later authors such as Erotian and Galen) and gradually fed into the transmission of Hippocratic works in late antiquity and the Middle Ages.8 Admittedly, these Hellenistic versions may have varied among one another, and they will, again to a varying extent, have been much smaller in size than the collection of the 1526 Aldine edition,9 which in turn served as the basis for subsequent editions of the ‘complete’ Hippocratic writings.10 did not preclude medical writers from departing from what was perceived to be his teaching; yet that teaching was considered valuable even in strictly medical matters until the late 19th century. In today’s medicine, the perceived authority of Hippocrates is largely confined to issues of medical ethics and to philosophical aspects of medicine (where the question of the representativeness of the Oath for the practices recommended in other Hippocratic writings is sometimes conveniently ignored), although Hippocrates is still invoked in certain strands of complementary, or alternative medicine. Canons of course also have a powerful influence on scholarship, and Classics and History of Medicine as academic disciplines are no exception to this, as is demonstrated by the long neglect of Hellenistic and Imperial literature in the study of classical literature; yet just as these canons have been challenged and given way to a renewed and more appreciative study of Hellenistic and Imperial literature and thought, likewise the study of ancient medicine has moved ‘beyond Hippocrates’ (see van der Eijk 2005a, 21–29) and ‘beyond Galen’ (see Nutton 2004, 1–17). 8   A rare testimony to collections of numbered books of Hippocratic writings is found in the treatise On the Seed by the so-called Anonymus Bruxellensis (also known as PseudoVindicianus, ed. Wellmann 1901), who in chs. 5, 14 and 44 refers to the works On Eighth Month’s Child, On the Nature of the Child and the Epidemics as occupying positions ‘38’, ‘49’, and ‘11’ respectively. See Roselli 2000, 188–189. 9   For a discussion of what the more extensive Hippocratic ‘Collections’ of Erotian, Artemidorus, and Dioscorides in the first century CE may have looked like see Roselli 2000, 182; Manetti–Roselli 1994, 1617–1629. 10  The claim of ‘completeness’, too, has an early Hellenistic pedigree, for as Galen tells us on two occasions, Zeuxis the Empiricist (late 3rd–early 2nd c. BCE) wrote commentaries on ‘all (ἅπαντα) the books of Hippocrates’ (In Hp. De off. med. comm., Proem. [18B.631–632 K] and In Hp. Prorrh. I comm. 2.23 [p. 73, 8–20 Heeg, 16.636 K]), although what exactly ‘all’ means here is open to various interpretations (see von Staden 2006, 30; 2009, 152– 154). From the Early Modern period onwards, the claim to completeness (opera omnia, œuvres complètes) seems meaningful only in the practical sense of ‘comprising all extant works that are known to have, at some stage of their transmission, been attributed to or associated with Hippocrates’, and as such it seems to be used in the editions of Ermerins (Hippocratis et aliorum medicorum veterum reliquiae) and Littré (Oeuvres complètes d’Hippocrate) and in the list of ‘The Treatises of the Hippocratic Collection’ as printed in Jouanna’s 1992/1999 book on Hippocrates (Appendix 3). It should be noted here (a) that there are some extant works attributed to Hippocrates (such as the Testamentum and some of the Letters) which Littré and most other editors left out and (b) that the label ‘Hippocratic’ is sometimes also used in relation to works that do not survive, such

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Nevertheless, the existence of these early collections makes it hard to believe that the attribution of the works they contained to Hippocrates was entirely a matter of fabrication by Alexandrian (and other) philologists, as the radically as the famous Cnidian Sentences referred to in Regimen in Acute Diseases (and sometimes attributed to Euryphon), or the Pharmakitis mentioned by the author of On Affections, or the work Wounds and Traits known to Erotian, or some of the works mentioned in the Brussels Vita of Hippocrates (see Schöne 1903) or in the pinakes of the oldest medieval manuscripts (see Roselli 2000, 186–193; Irigoin 1999, 274). The largest collection of (titles of) Hippocratic treatises is probably Gerhard Fichtner’s Corpus Hippocraticum, which lists a substantial number of texts (in many cases based on records in Diels’ Handschriften der antiken Ärzte or Kibre’s Hippocrates Latinus) as ‘nicht bei Littré’, for some of these Fichtner cites the incipits, while in other cases no incipit is given and it is not clear whether he (or Diels) actually saw the manuscript. Fichtner’s collection has as subtitle ‘Verzeichnis der hippokratischen und pseudo-hippokratischen Schriften’, and his preface says that his work ‘verzeichnet die Schriften des Corpus Hippocraticum und ihre alten Übersetzungen’. Apparently, ‘Corpus Hippocraticum’ here is, again, to be understood in the unhistorical sense of the total sum of works (in this case both extant and lost) that, at some stage of their transmission, were attributed by Hippocrates, regardless of when, by whom, on what grounds and with what justification, these attributions were made. Yet Fichtner does not explain how his collection was arrived at and why some works attributed to Hippocrates in the medieval pinakes or in some of the Renaissance collections (such as De re venerea, De telorum extractione, De lavationibus) seem not to have been included, although it is possible that some of these texts are identical to material preserved under a different title or as part of a different work (on Fichtner’s Corpus Hippocraticum see van der Eijk 2012, 89–90 and n. 30, where I quote from private correspondence with Gerhard Fichtner about the principles of his collection). In this regard, it is worth referring to works like the ‘pseudo-Hippocratic’ treatise On the Generation of Man and the Seed edited by Ideler (1841) and recently re-edited by Jouanna (2008), and which is clearly of late antique (if not early Byzantine) date. Although the work, like many others, is attributed in the MS to Hippocrates, Jouanna nevertheless does not consider it part of the ‘Collection hippocratique canonique’ (2008, 23, n. 20; the same expression on p. 25). Regarding these late antique works attributed to Hippocrates (another example being the treatise On the Formation of Man, also edited by Jouanna in the same article, or the work On the Pulse and the Human Temperament), Jouanna (2008, 31) goes on to make the following interesting remark: ‘Ces traités, se réclamant d’Hippocrate, peuvent se diviser en deux classes. D’une part ceux qui sont dérivés directement ou indirectement de l’Hippocrate qui sera mis au jour à la Renaissance . . . D’autre part ceux qui, tout en se rattachant à la théorie des humeurs inaugurée par le traité hippocratique de la Nature de l’homme, fonctionnent d’une façon totalement indépendante de cette source première . . . Cette médecine va, dans une large mesure, à l’encontre de ce que l’on a tendance à dire sur la survie d’Hippocrate dans l’Antiquité tardive, à savoir qu’elle s’opérait essentiellement par l’intermédiaire de l’œuvre de Galien . . . Il reste que tous ces traités sont les représentants d’une médecine rationnelle. C’est peut-être là que réside, en définitive, l’héritage d’Hippocrate, même quand son œuvre est oubliée’.

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sceptic view holds.11 For if that were the case, one would have to assume either that these writings, before being put together in a collection, were anonymous, or that the names of their real authors were lost, forgotten, or even actively suppressed, in the later tradition.12 The latter is not inconceivable, as is shown by the example of Polybus, the author of On the Nature of Man; but it is still quite something to imagine Alexandrian philologists systematically depriving thirty or forty works of their original author’s label, and one would be hard pressed to cite parallel evidence for such activity from Greco-Roman antiquity. One thing that the discussion about the so-called Hippocratic question has made clear is that comparison of the CH to the Corpus Platonicum, the Corpus Aristotelicum or the Corpus Galenicum is problematic, hence questions of canonization and pseud­ epigraphy are somewhat different here. Contrary to the latter three,13 there is, in the Hippocratic writings as we know them, not a single work, let alone one clear ‘core’ of works that can be demonstrated to have been written by Hippocrates, or even by a group of like-minded authors. It is of course true that some ancient readers of the Hippocratic writings believed that such authenticity was capable of being ascertained for a number of writings. Even so, that core would have been relatively small and one would still have to assume that a substantial number of further medical writings of the 5th and 4th c. were anonymized and subsequently attributed to Hippocrates in the later tradition.14 Yet the alternative scenario, viz. that these writings were anonymous from the beginning, possibly even deliberately anonymous, e.g., because they were the work of more than one author, is perhaps even more unlikely, considering that anonymity, at least in the Greek world (as opposed to Near-Eastern literature) was by no means common. One only needs to think of the confidence with which authors such as Herodotus and Thucydides put their names at the beginning of their works. And whereas anonymity might be conceivable for seemingly collective works such as the Epidemics or the Coan Prognoses, it is less easy to imagine why strong personalities like the authors of On the Sacred 11  According to the sceptical view, the epithet ‘Hippocratic’, rather than being some kind of essentialist notion covering the intrinsic nature of a specific body of medical literature with an identity of its own, just stands for all anonymous 5th and 4th c. medical literature that happens to survive, possibly for the very reason that it was associated, at some stage of its reception, with Hippocrates and his school. 12  See the discussion by Littré 1839, 265. 13  Nor is the case of Pythagoras and his followers a close parallel since even in the case of Pythagorean writings (most of which are, of course, lost), we do have lists of names of other authors. 14  Cf. Littré 1839, 263.

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Disease or On Regimen or Prorrhetic 2 would wish to conceal or suppress their identity (although it remains the case that these works do not mention the names of their authors at the beginning). Furthermore, as we shall see in a moment, many medical writers of the 5th and 4th c. BCE are known to us by name, and in a number of these cases we know the titles of works they are reported to have authored; thus anonymity was by no means the standard for medical writing of the 5th and 4th c. BCE. My second preliminary point is that it is clear from passages in Plato, Aristotle, and Anonymus Londiniensis that already in the 4th c., Hippocrates was a well-known figure, that his name stood for a particular brand of medicine and that he had a number of disciples practising and promulgating his teaching.15 Moreover, some of the works that have come to be known as Hippocratic can be shown to have been in circulation and used already in this early timeframe,16 although it is uncertain whether these works were regarded as being written by Hippocrates by those who used them (e.g. Diocles using Joints or Epidemics I), and one gets the impression that disagreement or confusion about the precise teaching of Hippocrates also existed already in the 4th c.17 Thus, and this is my third point, the hypothesis of a unifying ‘core’ of treatises,18 which was recognised and agreed by a sufficiently large or 15  The well-known passages are: Plato, Phaedrus 270c; Protagoras 311b–c; Aristotle, Politics 1326a15–17; Anonymus Londiniensis 5.35–6.18 (reporting Aristotle’s view of Hippocrates’ theory of the causes of disease). 16  The evidence for each treatise is collected by Anastassiou and Irmer 2006. 17  See Diocles’ paraphrase of a passage in On Joints (frs. 162 and 163 vdE) with the comments in van der Eijk 2001, 302–304, and Diocles’ ‘theoretical’ objection to a passage in Epidemics I (fr. 57 vdE with the comments in van der Eijk 2001, 126–127 [where on p. 127, for ‘Epidemics 2’ read ‘Epidemics 1’]). Both passages strongly suggest that Diocles was familiar with the works concerned, but do not necessarily prove that Diocles perceived them as being written by Hippocrates. The explicit address of ‘Hippocrates’ in Diocles’ fr. 55b vdE is very likely to be a later doxographical construction and cannot be used as evidence that Diocles was familiar with Hippocrates or regarded Aphorism 2.34 as ‘Hippocratic’ (see van der Eijk 2001, 121–122). 18  For a statement of this hypothesis see Jouanna 1999, 65: ‘One set of treatises forms the original core of the collection and is due to the school of Hippocrates, known as the school of Cos. This was the state of the corpus during the Hellenistic period, at the time of Bacchius in the third century BC. Other treatises then came to be added to this core, issuing notably from the Cnidian branch of the Asclepiads, known as the school of Cnidus. Erotian’s list, drawn up during Nero’s reign in the first century AD, corresponds to this intermediate stage in the development of the corpus. Finally, still other treatises of unknown provenance were subsequently added to this secondary body of Hippo­ cratic works, yielding the Hippocratic Collection as it was transmitted by the medieval

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authoritative group of people (doctors? textual scholars?) from the beginning or at least from very early onwards as being written by Hippocrates and which somehow (how?) managed to dictate the subsequent process of its reception and canonisation, and hence preservation,19 has something to be said for it. And that hypothesis should not too easily be discarded in favour of the more sceptical, radical hypothesis according to which the ‘Hippocratic Corpus’ was just a later construction by Hellenistic and Imperial philological scholarship motivated by the desire to impose unity and authority on a disparate number of texts that had little else in common except that they were concerned with medicine and written in the Ionic dialect. For one could argue that (many of) these works, for all their diversity, do have more in common than just the epithet ‘Hippocratic’. Indeed, the demonstration of this commonality is the very purpose of the present volume. Even if it may be hard (if not impossible) to spell out the distinctiveness of ‘Hippocratic medicine’ compared to other medical literature of the same period, it is still worth asking on what grounds, or on the strength of what criteria, particular (possibly anonymous) works managed to get the name of Hippocrates attached to them, and hence secured survival, as opposed to the many other medical texts which had, and kept, an author’s

manuscripts we now possess’. One may broadly agree with the gist of this summary even if the actual process of canonization of individual works is more complicated and varied (for there may have been variation between the different collections; see n. 6 above) and even if one may have reservations about the use of terms such as ‘school of Cos’ and ‘school of Cnidus’; on the latter point see now Jouanna’s revised position in Jouanna 2009, 679–697. 19  It is certainly striking, and perhaps significant, that no strictly medical texts from the 5th and 4th c. survive beyond the ‘Hippocratic writings’ (but see below on 4th c. material). Why these writings, and not others, had the good fatum of being attributed to Hippocrates is a question to which the answer may (and in some cases is known to) have varied from one treatise to another; and varying reasons may (and in some cases are known to) have been given even for one and the same treatise. Yet while the ancient history of the Hippocratic question—i.e. perceptions in classical antiquity itself on the question which ‘Hippocratic’ works counted as genuine or spurious—has received considerable attention in scholarship (see Smith 2002; Anastassiou and Irmer 2006), there is the further question to what extent, and in what terms, the Hippocratic writings as we know them today were perceived in antiquity as constituting a group distinct from other medical, scientific and philosophical literature of the 5th and 4th c. The Hellenistic and early Imperial editions of the Hippocratic writings seem to have been smaller than the collection as we know it today (which, as pointed out above, goes back to the Aldine edition of 1526), but this begs the question in what terms the treatises not included in these early collections may have been perceived.

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name different from Hippocrates, and which did not survive, possibly for this very reason. In the present chapter I therefore wish to pursue what I hope will be welcomed as a more constructive approach to these issues and raise a question that to me seems of central importance to the present volume but which has, to my knowledge, received rather little attention: to what extent are the Hippocratic writings as we have them bound together by any intrinsic characteristic(s) that distinguish(es) them as a group from other medical literature and thought of the same period? This is an important question, for if the answer is negative, the justification for treating the Hippocratic writings as a corpus or collection will collapse, and we will end up with a situation not so different from the present, pluralist state of scholarship on what used to be called ‘Presocratic philosophy’: a state in which the Hippocratic treatises are regarded as individual pieces of evidence whose context is not primarily constituted by other treatises of the CH but which may equally well, and in some cases perhaps even better, be associated with other, ‘non-Hippocratic’ medical and scientific literature of the same period. In order to answer this question, I will consider, as far as the fragmentary state of the material allows, whether the very substantial amount of this ‘nonHippocratic’ medical literature that was written in the 5th and 4th c. BCE can lay at least equal claim to some of the features with which ‘Hippocratic medicine’ is usually credited. 2

Greek Authors and Writings on Medicine, Human Physiology and Related Subjects from the Period 450–300 Bce outside the Hippocratic Corpus

To this end, let us take stock of what this ‘non-Hippocratic’ medical writing in the 5th and 4th c. BCE comprised.20 Abas (or Aias) Acron of Agrigentum Aegimius of Elis (περὶ παλμῶν) 20  The following survey is based on that printed in van der Eijk 2005b, 74–78, though with some additions and corrections, and I am grateful to Ashgate for permission to use it here. Surviving works are marked with an asterisk. Prosopographical details about the authors mentioned can be found in the relevant entries in Pauly-Wissowa’s Realencyclopädie or in Der neue Pauly.

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Alcamenes of Abydos Alexias (pupil of Thrasyas of Mantinea) Alcmaeon of Croton Anaxagoras of Clazomenae Apollonides Archidamus Aresas of Lucania Aristo Chrysippus of Cnidus Ctesias of Cnidus Democedes of Croton Democritus of Abdera περὶ φύσεως ἀνθρώπου ἢ περὶ σαρκῶν (‘On the Nature of Man’ or ‘On Fleshes’) περὶ χυμῶν (‘On Humours’) περὶ λοιμῶν (‘On Epidemic Diseases’) περὶ αἰτιῶν τῶν ζῴων (‘On Causes of Animals’) προγνωστικόν (‘On Prognosis’) περὶ διαίτης (‘On Regimen’) περὶ πυρετοῦ (‘On Fever’) περὶ ἐλεφαντιάσεως (‘On Elephantiasis’). Dexippus of Cos Dieuches Diogenes of Apollonia Diotimus the gymnastics trainer Diphilus of Siphnus Empedocles Epicharmus Epigenes Eudemus Euryphon of Cnidus Evenor Herodicus of Cnidus Herodicus of Selymbria Hippo of Croton Iccos of Tarentum Leophanes Menecrates (ἰατρική) Monas

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Ninyas the Egyptian Petron of Aegina Phaon Phasitas of Tenedos Philetas Philistion of Locri Philolaus of Croton Philotimus (or: Phylotimus) Pleistonicus Polybus Syennesis of Cyprus Thessalus Thrasyas of Mantinea Thrasymachus of Sardis Timotheus of Metapontus Xenophon (pupil of Praxagoras) Diocles of Carystus ἀνατομικόν or ἀνατομαί (‘On Anatomy’, or ‘On Dissection(s)’) Ἀρχίδαμος (‘Archidamus’, dealing i.a. with the use of olive oil in personal hygiene) ἐπιστολὴ προφυλακτικὴ πρὸς Ἀντίγονον (‘Letter on the Prevention of Disease, addressed to Antigonus’) ὀψαρτυτικά (‘Cookery’) πάθος αἰτία θεραπεία (‘Affection, Cause, Treatment’) περὶ ἀφροδισίων (‘On Sexual Activity’) περὶ γυναικείων, or γυναικεῖα (‘Matters Related to Women’, at least three books) περὶ ἐκκενώσεων (‘On Evacuations’, quoted in Latin as De egestionibus) περὶ ἐπιδέσμων (‘On Bandages’) περὶ θανασίμων φαρμάκων (‘On Lethal Drugs’) περὶ θεραπειῶν, or θεραπεῖαι, or θεραπευτικά (‘On Treatments’, at least four books, quoted in Latin as De curationibus) περὶ κατάρρων (‘On Catarrhs’) περὶ λαχάνων (‘On Vegetables’) περὶ πέψεως (‘On Digestion’) περὶ πυρετῶν (‘On Fevers’, quoted in Latin as De febribus) περὶ τῶν ἔξωθεν θεραπειῶν, or περὶ τῶν ἔξωθεν παθῶν (‘On External Remedies’, title quoted in Arabic source) περὶ τῶν κατ’ ἰατρεῖον, or κατ’ ἰατρεῖον (‘On Things in the Surgery’) προγνωστικόν (‘On Prognosis’, referred to in Latin as liber prognosticus)

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ῥιζοτομικόν (‘On Rootcutting’) ὑγιεινὰ πρὸς Πλείσταρχον (‘Matters of Health addressed to Pleistarchus’) Praxagoras of Cos ἀνατομή (‘Dissection’, or ‘Anatomy’) φυσικά (‘Matters related to Nature’) αἰτίαι, πάθη, θεραπεῖα (‘Affections, Causes, Treatments’, quoted in Latin as De causis atque passionibus et curationibus) περὶ νούσων (‘On Diseases’, at least three books, quoted in Latin as De morbis) διαφοραὶ τῶν ὀξέων (‘Different Kinds of Acute Diseases’) νοῦσοι ἀλλότριοι (‘Foreign Diseases’, at least two books, quoted in Latin as Passiones peregrinae) περὶ ἐπιγινομένων (‘On Things Supervening [on Diseases]’) περὶ συνεδρευόντων (‘On Things Accompanying [Diseases]’, at least two books) θεραπεῖαι (‘Treatments’, at least four books, quoted in Latin as Curationes) Mnesitheus of Athens παθολογικός (‘Account on Affections’) περὶ τῶν ἐδεσμάτων, or περὶ ἐδεστῶν (‘On Foods’) ἐπιστολὴ πρὸς Λύσικον περὶ παιδίου τροφῆς (‘Letter to Lyciscus on the Rearing of the Child’) περὶ κωθωνισμοῦ (‘On Tippling’) περὶ τῶν περιττωμάτων (‘On Residues’) περὶ στεφάνων (‘On Garlands’, quoted in Latin as De coronis) Plato *Timaeus (esp. 72dff.) Speusippus ὅμοια (‘Similars’) Aristotle and Ps. Aristotle *τῶν περὶ τὰ ζῷα ἱστοριῶν ζ’ (‘History of Animals’ book 7, 602b12–605b21, on animal diseases) περὶ ὑγιείας καὶ νόσου (‘On Health and Disease’) ἀνατομαί (‘Dissections’) ἰατρικά (‘Medical [issues]’, in two books) περὶ ἰατρικῆς (‘On the medical art’, in seven books) *(?) ὑπὲρ τοῦ μὴ γεννᾶν (‘On Failure to Generate Offspring’, possibly identical with the extant ‘History of Animals book 10’) περὶ βοηθημάτων (‘On Remedies’—quoted in a Latin source as De adiutoriis)

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*περὶ πνεύματος (‘On Breath’) προβλήματα (‘Problems’, i.e. the lost Problemata to which Aristotle often refers, as distinct from the preserved but presumably post-Aristotelian collection known as Problemata physica, for which see below) Ἰατρικὴ ϲυναγωγὴ or Μενώνεια, (‘Medical Collection’ or ‘Menoneia’, perhaps identical with the lost ‘Aristotelian’ doxography on the causes of disease reported in the Anonymus Londiniensis Heracleides of Pontus (αἰτίαι) περὶ νόσων (‘(Explanations) concerning Diseases’) Theophrastus *περὶ ἰλλίγγων καὶ σκοτώσεων (‘On Vertigo and Dizziness’) περὶ λειποψυχίας (‘On Fainting’) περὶ πνιγμοῦ (‘On Choking’) περὶ παραλύσεως (‘On Paralysis’) περὶ ἐπιλήψεως (‘On Epilepsy’) περὶ λοιμῶν (‘On Plagues’) περὶ μελαγχολίας (‘On Melancholy’) περὶ παραφροσύνης (‘On Derangement’) περὶ ἐνθουσιασμοῦ (‘On Inspiration’) *περὶ κόπων (‘On Fatigues’) περὶ ὕπνου καὶ ἐνυπνίων (‘On Sleep and Dreams’) *περὶ ἱδρώτων (‘On Sweats’) περὶ τριχῶν (‘On Hairs’) περὶ ἐκκρίσεως (‘On Excretion’) περὶ πνευμάτων (‘On Breaths’) περὶ γήρως (‘On Old Age’) *περὶ φυτῶν ἱστορία θ’ (‘Inquiry into Plants’, book 9) Strato περὶ τοῦ πνεύματος (‘On Breath’) περὶ φύσεως ἀνθρωπίνης (‘On Human Nature’) περὶ ζωογονίας (‘On Generation of Living Beings’) περὶ ὕπνου (‘On Sleep’) περὶ ἐνυπνίων (‘On Dreams’) περὶ νόσων (‘On Diseases’) περὶ κρίσεων (‘On Crises’) περὶ δυνάμεων (‘On Faculties’) περὶ λιμοῦ (ἰλίγγου Reiske) καὶ σκοτώσεων (‘On Hunger (or: Vertigo) and Dizziness’) περὶ κούφου καὶ βάρεος (‘On Sense of Lightness or Heaviness’)

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περὶ ἐνθουσιασμοῦ (‘On Inspiration’) περὶ τροφῆς καὶ αὐξήσεως (‘On Nutrition and Growth’) Clearchus περὶ ὕπνου (‘On Sleep’) *Problemata Physica (i.e. the extant early Peripatetic Collection Attributed to Aristotle) *1. ὅσα ἰατρικά (‘Problems concerned with medical matters’) *2. ὅσα περὶ ἱδρῶτα (‘Problems concerned with sweat’) *3. ὅσα περὶ οἰνοποσίαν καὶ μέθην (‘Problems concerned with wine-drinking and drunkenness’) *4. ὅσα περὶ ἀφροδίσια (‘Problems concerned with sexual activity’) *5. ὅσα ἀπὸ κόπου (‘Problems concerned with the effects of fatigue’) *6. ὅσα ἐκ τοῦ πως κεῖσθαι καὶ ἐσχημάτισθαι συμβαίνει (‘Problems concerned with the effects of lying down and taking up positions’) *7. ὅσα ἐκ συμπαθείας (‘Problems concerned with the effects of sympathetic reaction’) *8. ὅσα ἐκ ῥίγους καὶ φρίκης (‘Problems concerned with chill and shivering’) *9. ὅσα περὶ ὑπώπια καὶ οὔλας καὶ μώλωπας (‘Problems concerned with bruises, scars and weals’) *10. ἐπιτομὴ φυσικῶν (‘Summary of physical problems’) *11. ὅσα περὶ φωνῆς (‘Problems concerned with the voice’) *31. ὅσα περὶ ὀφθαλμούς (‘Problems concerned with the eyes’) *32. ὅσα περὶ ὦτα (‘Problems concerned with the ears’) *33. ὅσα περὶ μυκτῆρα (‘Problems concerned with the nose’) *34. ὅσα περὶ τὸ στόμα καὶ τὰ ἐν αὐτῷ (‘Problems concerned with the mouth and what is in it’) *35. ὅσα περὶ τὰ ὑπὸ τὴν ἀφήν (‘Problems concerned with the effects of touch’) *36. ὅσα περὶ πρόσωπον (‘Problems concerned with the face’) *37. ὅσα περὶ ὅλον τὸ σῶμα (‘Problems concerned with the whole of the body’) *38. ὅσα περὶ χρόαν (‘Problems concerned with complexion’).

This survey, though laying no claim to completeness,21 offers a substantial list of names and works. Much of the material is fragmentary, and in many cases we have little more than names and in some cases titles of works, which are

21  Not included here, for example, are epigraphic and archaeological sources on temple medicine; see Perilli 2009.

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not always reliable.22 However, for some authors, such as Diocles, Praxagoras, Mnesitheus and Dieuches, the evidence is substantial, not to mention the extant works of Plato and Aristotle and the early Peripatetics. As I have argued extensively elsewhere,23 there is no reason to dismiss as irrelevant some of these works for being ‘non-medical’ or ‘philosophical’, for the boundaries between medicine and philosophy were fluid, certainly in this period; and if the criterion is whether an author was a practising doctor, a number of socalled Hippocratic writings may also have to be discarded.24 In fact, the survey gives us some idea of the volume of activity in the area of medical and physiological thinking and writing in the late 5th, 4th and early 3rd c. BCE, of the number of authors known by name to have written on medicine outside the CH,25 of what was on the agenda(s) of these authors in this period, and of the very substantial extent to which the agendas of thinkers normally thought of as philosophers present overlap with those of authors usually regarded as medical writers in the stricter, canonical sense. There is a wealth of material here, long and largely ignored or neglected by historians of medicine, partly because of the fragmentary nature of the evidence, partly because some of it was considered not medicine but philosophy or science. Yet the history of medicine in the 5th and 4th c. BCE is not complete without an account of the achievements of these authors and their relationship to the Hippocratic texts. This balance is now beginning to be redressed, not least by the contributors to this volume—and, one may add, to the proceedings of the Newcastle

22  I am thinking of the example of Democritus, who is credited with a sizeable number of works on medical topics, such as fevers, humors, the nature of man or fleshes, respiration, prognosis, plagues, although recently, Perilli has emphasized the extent of Democritus’ interests in physiology and medicine; see Perilli 2007. 23  Van der Eijk 2005a, 8–21; 2005b, 78–86. 24  I have made this point in connection with the use of the word ‘Medicorum’ in the Corpus Medicorum Graecorum and the question of inclusion and exclusion of medical texts in/ from this Corpus; see van der Eijk and Francis 2009, 219 with notes pp. 26–28. 25  It is, of course, possible that some of the medical writers included in the list were actually the authors of treatises preserved among the ‘Hippocratic’ writings, as testified by the case of Polybus (whom both Aristotle and Anonymus Londiniensis cite as author of On the Nature of Man) and Synennesis (a quotation from whose work cited in Aristotle’s Historia animalium 511b24–30 is identical to a passage in the Hippocratic treatise On the Nature of Bones 8 [9.174 L]). As to the latter, however, see Althoff 1999, 68, who suggests that Syennesis may have been the common source for both the author of On the Nature of Bones and Aristotle.

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Hippocrates conference in 2002,26 collectors of fragments, and by scholars crossing the disciplinary boundaries between medicine and philosophy.27 Yet, paradoxically, the realization of the importance of this material already dates to the early 19th c., when M.S. Houdart wrote his Etudes historiques et critiques sur la vie et la doctrine d’Hippocrate et sur l’état de la médecine avant lui (Paris, 1840) and his Histoire de la médecine grecque depuis Esculape jusqu’à Hippocrate exclusivement (Paris, 1856). Right at the moment when Emile Littré started publishing his ten volumes of Oeuvres complètes d’Hippocrate, and long before the discovery of the Anonymus Londiniensis, Houdart already discussed much of the evidence listed in our survey above; he also considered works referred to by the authors of the Hippocratic writings but which have not survived in the Corpus (such as the Cnidian Sentences and the Pharmakitis), thereby challenging Littré’s concept of ‘completeness’ and his suggestion that everything started with Hippocrates.28 Today, Houdart is a forgotten name, whereas Littré’s edition still, and rightly so, underlies Hippocratic scholarship. Yet for all its eminence, Littré’s claim to ‘completeness’ has, perhaps unintentionally, marginalized the works of other medical authors mentioned in our survey. 3

The Question of the Distinctiveness of the ‘Hippocratic’ Writings

Let us now turn to our second question, viz. to what extent some of the attributes or characteristics with which ‘Hippocratic medicine’ is usually credited are the exclusive property of the Hippocratic writings or common also to this body of non-Hippocratic medical literature. Obviously, this is a wide-ranging question that requires detailed examination and comparison of individual 26  See van der Eijk 2005c, section 3. 27  See for example Perilli 2007; Tuplin 2004. 28  Two quotations from Houdart’s work (1856, 299) may suffice: ‘Combien est erronée l’opinion de ceux qui regardent Hippocrate comme le créateur de la médecine grecque (. . .) cette science, au contraire, était constituée et en voie de progrès lors de son avènement dans le monde (. . .) le public médical était nombreux ainsi que les ouvrages écrits sur cet art’ (1840, 271), and: ‘Les ouvrages sur la médecine étaient déjà fort nombreux au siècle d’Hippocrate; et c’est même, nous devons en faire la remarque, une circonstance sur laquelle n’ont pas assez réfléchi ceux qui veulent que le divin viellard ait tout tiré de son propre génie’. By contrast, Littré (1839, 3), in the first volume of his edition of the works of Hippocrates, claims: ‘le premier corps de doctrine que l’on rencontre est la collection d’écrits connue sous le nom d’Hippocrate. La science remonte directement à cette origine et s’y arrête’.

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works and passages, examples of which can be found elsewhere in this volume. Yet in this chapter I would like to take a more general, tentative approach by considering the extent to which some of the more salient and universally agreed features of Hippocratic medicine can be found also in other medical and philosophical works of the same period. A convenient statement of such features is provided by the following quotation: It [i.e. rhetoric about the Hippocratic Oath] is often accompanied by a list of good things which mark off Hippocratic medicine from other types of medicine, and which link it with the aspirations of the modern teacher. Hippocratic medicine opposes superstition, although it is religious; it is scientific; it respects the vis medicatrix naturae; it avoids extremes; it is aware of the environment; it reports failures as well as triumphs; it demands moral standards and good communication; and its practitioner is a philosopher, a teacher, and an honest man, whose motivation is the well-being of patients, not money.29 Admittedly, it may be disputed whether this is an adequate representation of the core virtues of Hippocratic medicine, for no doubt things could be put differently, or other things could be added; and from a historical point of view, there is no reason to restrict such features to the virtues only. Even so, it is worth examining, if only exempli gratia, to what extent these characteristics are found in non-Hippocratic medical writers as well. I will draw especially on the fragments of the ‘younger Hippocrates’, Diocles of Carystus, but also on material derived from other authors. First of all, attitude to superstition and religion, or in other words, the well-known ‘rational’ outlook of Hippocratic medicine, so well illustrated in a treatise such as On the Sacred Disease.30 For all one’s reservations about the use of the term ‘rational’ in relation to Greek medicine,31 it needs to be said that examples of this rational outlook can equally well be found in most of the other medical authors on our list, and in most Presocratic philosophers for that matter. Thus a fragment of Diocles (150 vdE) rationalises the effect of charms or incantations by reference to the effect of the voice of the speaking 29  Nutton 1996, 48, quoting common opinion. 30  This is what Jouanna (1999, 64) defines as the main constituent of the ‘undeniable unity of this set of treatises, which stems from the rational spirit of a medicine freed from all traces of magic’, see also Longrigg 1993. 31  On the use of the concept of ‘rationality’ in relation to Greek medicine see van der Eijk 2004, 3–9.

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person on the pneuma of the patient subsequently bringing the bleeding of a wound to a halt. In a comment on a passage from Odyssey 19.457 ‘[they caused] the blood [to stop flowing] with a charm’, Diocles is reported to have handed down that [it was] a charm [that acted as] the assuagement. For [he said that] this brings the bleeding to a halt, whenever the breath of the wounded [person] is connected and as it were fixed to the person assuaging, just as it says in a different passage ‘But a servant soothed you’.32 Even if there are doubts as to the reliability of this report, Diocles’ other fragments testify to the same ‘naturalistic’ or ‘rational’ outlook as the Hippocratic writings, and there is no evidence of ‘magical’ or ‘religious’ healing practices.33 A further example of ‘rationalism’ one could cite is Aristotle’s rejection of the belief that dreams are sent by the gods and, very similar to what we find in On Regimen, his explanation of the medical significance of dreams in a purely physiological way: dreams, he argues, are not sent by the gods, nor do they exist for the purpose of divination; they are products of human nature, and they can be signs of things happening in the bodily sphere and thus reveal the beginnings of illnesses.34 Other examples would be Theophrastus’ ironic account of deisidaimonia, and his (presumably physiological) explanation of enthousiasmos.35 At the same time, there is no reason to question the religiosity of any of these medical and philosophical writers; indeed, positive evidence for the belief in gods and divine powers, and for the apparent compatibility of these religious beliefs with their ‘rational’ or ‘naturalistic’ outlook, is abundantly available in Plato’s Republic (e.g. book 2) and Timaeus and in Aristotle’s Eudemian Ethics (e.g. chs. 8.2 and 8.3). Thus the ‘rational cum religious’ outlook of ‘Hippocratic medicine’ is found elsewhere too and not unique to the writings attributed to Hippocrates. 32  Diocles of Carystus, fr. 150 vdE: ἐπαοιδῇ δ’ αἷμα] Διοκλῆς ἐπαοιδὴν παρέδωκε τὴν παρηγορίαν. ἴσχαιμον γὰρ εἶναι ταύτην, ὅταν τὸ πνεῦμα τοῦ τετρωμένου προσεχὲς ᾖ, καὶ ὥσπερ προσηρτημένον τῷ παρηγοροῦντι, ὡς καί δι’ ἑτέρων ἀλλὰ σὲ μὲν θεράπων ποτιτέρπετο. It is, however, not certain that the Diocles mentioned here is identical to the Carystian physician. See the discussion in van der Eijk 2001, 285–287. 33  See the account of Diocles’ medical outlook in van der Eijk 2001, xxii–xxxviii. 34  Aristotle, On Divination in Sleep 462b20–22; 463a3–21; 463a12–18; 464a19–24; On Dreams 461a28–462a12. See the discussion in van der Eijk 1994, ad loc., and 2005a, 169–205. 35  Theophrastus, Characters 16; fr. 328 FHSG. Strictly speaking, we have no information on the contents of Theophrastus’ explanation of enthousiasmos, but it is likely to have been cast in physiological terms along the lines of Aristotle’s discussion of katharsis in the Politics (1342a6; cf. Eudemian Ethics 1225a28).

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The question of the ‘scientific’ nature of these medical writers depends, of course, on what one regards as scientific and on the extent to which this term is deemed applicable to the ancient world. Yet when adopting criteria such as the use of observation and empirical evidence, the development of systematic empirical research, the use of causal explanation, the articulation of rules, methods and epistemological procedures, and the critical reflection on the conditions of use and on the appropriateness of these procedures, one will find that authors such as Diocles, Praxagoras, and Mnesitheus, and Democritus— not to mention Plato and Aristotle—fulfill these criteria at least as much as the writers of the Hippocratic treatises. For example, we see the use of classification and diairesis; the use of inferential reasoning and analogismos; the use of and reflection on causal explanation; and the development of empirical research.36 4th c. ‘non-Hippocratic’ medicine, as I have argued elsewhere, presents powerful examples of what the Greeks themselves later called ‘rationalist’ or ‘dogmatist’ medicine, i.e., medicine based on a theoretical foundation and equipped with a sophisticated methodology.37 At the same time, it provides strong evidence for the increasingly systematic pursuit of empirical evidence. The belief in the healing power of nature can be paralleled by a passage in Aristotle’s Parts of Animals (665a8), which speaks of nature’s restoration of a situation in the body that might otherwise have led to disease: ‘Nature has contrived it so as to remedy the unsatisfactory position of the windpipe in front of the oesophagus’.38 Aristotle also in the Posterior Analytics discusses the different degrees within the self-healing power of wounds, arguing that circular wounds heal more slowly than straight ones (79a14–16).

36  Cf. the use of classification and diairesis by Mnesitheus (frs. 10–11 Bertier), Anonymus Londiniensis (in the second, ‘Aristotelian’ section), Praxagoras (frs. 21–22 Steckerl) and Diocles (fr. 183a) and Plato on disease (Tim. 86a); the use of inferential reasoning and analogismos in Praxagoras (frs. 84–85 Steckerl) and Diocles (frs. 22 and 24 vdE); the use of and reflection on causal explanation in Diocles (frs. 176 and 178 vdE); and the development of empirical research in Mnesitheus (frs. 17 and 52 Bertier), Diocles (frs. 17–24 vdE) and Praxagoras (frs. 11, 12, 67 Steckerl). 37  See van der Eijk 2005b. 38  Δι’ ἣν μὲν οὖν αἰτίαν τὰ μὲν ἔχει τῶν ζῴων τὰ δ’ οὐκ ἔχει, ταῦτ’ εἰρήσθω, καὶ διότι τῆς ἀρτηρίας τὴν φαυλότητα τῆς θέσεως ἰάτρευκεν ἡ φύσις, μηχανησαμένη τὴν καλουμένην ἐπιγλωττίδα. I am grateful to Hynek Bartos (Prague) for sharing with me his paper on ‘Aristotle and his precursors on health and natural teleology’ (delivered at the Approaches to Ancient Medicine conference in Reading in 2008) in which he discusses this and related passages (although I should add that we differ in the evaluation of these passages for the more general question to what extent Aristotle took the self-healing power of nature seriously).

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As to the ‘avoidance of extremes’, this can, again, be paralleled in Diocles’ frequent insistence on what he calls the ‘appropriate’ (to harmotton, to oikeion) and ‘moderate’ (to meson);39 and again, as Theodore Tracy has argued, one could point to Plato’s and Aristotle’s use of the concept of the mean (­mesotés) in physiological as well as ethical contexts.40 Furthermore, consideration of the environment can likewise be found in the fragments of Diocles and is clearly present also in Praxagoras’ interest in ‘Foreign Diseases’ (to which he devoted a separate treatise);41 and Aristotle discusses the influence of climate and season on the constitution and character of different people (Politics 7.6) and on reproduction and embryonic development (Generation of Animals 767a28–35). Perhaps the most difficult point to find parallels for in other sources is the admission of medical failure. Yet one important potential reason why this is so is that we do not have preserved for other authors the kind of documents (case histories) similar to the Hippocratic Epidemics in which authors admit their mistakes. However, we do find abundant evidence in 5th and 4th c. literature of discussions of medical failure, and not just in polemical contexts where one author is criticizing others for their mistakes,42 something which one of course also finds in the Hippocratic writings; nor is this just restricted to passages in which the blame for medical error is put on factors beyond the doctor’s control, such as the patient’s disobedience (and again, there are such passages in the Hippocratic writings as well). In addition, we also find contexts, especially in Plato and Aristotle, which suggest that doctors and philosophers reflected in a non-accusatory way upon the nature of error and failure in medical practice.43 39  Cf. Diocles, fr. 182.202 vdE: δῆλον ὡς μέση δίαιτα τῶν εἰρημένων μάλιστα ἁρμόττει. ‘It is clear that a regimen that steers a middle course between those mentioned is most appropriate’. Cf. also fr. 182.69, fr. 187.34, fr. 153.3–4. 40  Tracy 1969. 41  Diocles, fr. 52, 53, 55a and 55b vdE; Mnesitheus, fr. 9; Praxagoras, fr. 63 Steckerl. 42  A case in point is Diocles fr. 176 (especially the use of diamartanein in lines 23 and 30) and ff. 183a.64. 43  Cf. Aristotle, Eudemian Ethics 1226a34ff.: διὸ καὶ ἀπορήσειεν ἄν τις, τί δή ποθ’ οἱ μὲν ἰατροὶ βουλεύονται περὶ ὧν ἔχουσι τὴν ἐπιστήμην, οἱ δὲ γραμματικοὶ οὔ; αἴτιον δ’ ὅτι διχῇ γινομένης τῆς ἁμαρτίας (ἢ γὰρ λογιζόμενοι ἁμαρτάνομεν ἢ κατὰ τὴν αἴσθησιν αὐτὸ δρῶντες) ἐν μὲν τῇ ἰατρικῇ ἀμφοτέρως ἐνδέχεται ἁμαρτεῖν, ἐν δὲ τῇ γραμματικῇ κατὰ τὴν αἴσθησιν καὶ πρᾶξιν, περὶ ἧς ἂν σκοπῶσιν, εἰς ἄπειρον ἥξουσιν. ‘Hence one might also raise the question, why is it exactly that, whereas doctors deliberate about things in their field of science, scholars do not? The reason is that since error occurs in two ways (for we err either in reasoning, or in perception when actually doing the thing), in medicine it is possible to err in both ways, but in grammar error only occurs in our perception and action, to investigate which

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Doctors did recognize that they sometimes failed, and they were interested in the nature and causes of such failure.44 As to moral integrity and lack of financial interest, we cannot, of course, be sure whether this can be predicated even of the historical Hippocrates, if we may believe the report in Plato’s Protagoras about Hippocrates’ practice of charging a fee for his tuition. Suffice it to say, however, that similar ethical claims are attested for Diocles (fr. 5);45 and there are also, again, a number of passages in Plato and Aristotle to this effect.46 would be an endless undertaking’ (tr. H. Rackham); and Aristotle, Politics 1331b34ff.: ἐνίοτε γὰρ ὁ μὲν σκοπὸς ἔκκειται καλῶς, ἐν δὲ τῷ πράττειν τοῦ τυχεῖν αὐτοῦ διαμαρτάνουσιν, ἐνίοτε δὲ τῶν μὲν πρὸς τὸ τέλος πάντων ἐπιτυγχάνουσιν, ἀλλὰ τὸ τέλος ἔθεντο φαῦλον, ὁτὲ δὲ ἑκατέρου διαμαρτάνουσιν, οἷον περὶ ἰατρικήν• οὔτε γὰρ ποῖόν τι δεῖ τὸ ὑγιαῖνον εἶναι σῶμα κρίνουσιν ἐνίοτε καλῶς, οὔτε πρὸς τὸν ὑποκείμενον αὐτοῖς ὅρον τυγχάνουσι τῶν ποιητικῶν• δεῖ δ’ ἐν ταῖς τέχναις καὶ ἐπιστήμαις ταῦτα ἀμφότερα κρατεῖσθαι, τὸ τέλος καὶ τὰς εἰς τὸ τέλος πράξεις. ‘Sometimes the aim has been correctly proposed, but people fail to achieve it in action, sometimes they achieve all the means successfully but the end that they posited was a bad one, and sometimes they err as to both—for instance, in medicine practitioners are sometimes both wrong in their judgement of what qualities a healthy body ought to possess and unsuccessful in hitting on effective means to produce the distinctive aim that they have set before them; whereas in the arts and sciences both these things have to be secured, the end and the practical means to the end’ (tr. H. Rackham). 44  Cf. also Topics 1.3, 101b5–10: ‘Neither will the rhetorician seek to persuade nor the physician to heal by every expedient; but if he omits none of the available means, we shall say that he possesses the science in an adequate degree’ (tr. Forster). 45  Diocles of Carystus, fr. 5 vdE: οὔκουν τοῖς ἰατροῖς τὸ τέλος ἐστὶν ὡς ἰατροῖς ἔνδοξον ἢ πόριμον, ὡς Μηνόδοτος ἐμπειρικὸς ἔγραψεν, ἀλλὰ Μηνοδότῳ μὲν τοῦτο, Διοκλεῖ δ’ οὐ τοῦτο, καθάπερ οὐδὲ Ἱπποκράτει καὶ Ἐμπεδοκλεῖ οὐδ’ ἄλλοις τῶν παλαιῶν οὐκ ὀλίγοις ὅσοι διὰ φιλανθρωπίαν ἐθεράπευον τοὺς ἀνθρώπους. ‘Hence the aim for doctors, in so far as they are doctors, is not fame or money, as Menodotus the Empiricist wrote, but for Menodotus it is this, for Diocles it is not this, just as it is not this for Hippocrates too, or Empedocles or many other ancients too who treated humans because of their love of human kind’. 46  For Plato, see e.g. Republic 340c–347a. Aristotle, on the whole, portrays doctors as motivated by the desire to heal rather than reap financial benefits. He notes that they practice for their own good as well as that of the patient (Pol. 1278b30ff.); the doctor does not deliberate about whether to cure, just how to do it (EN 1112b12ff.; EE 1227b25ff); the art of medicine involves care and φρόνησις (EN 1180b27–8). On the other hand, there are those who pretend to have medical knowledge for profit (EN 1127b20). At Pol. 1287a32ff, Aristotle, in discussing the use of medical books, says that doctors do not go against their principles out of friendship but earn their reward from healing the sick, in contrast to the political leader who does things out of favor etc. (1287a35–8); however, Aristotle concedes at 38–41 that there are cases where people treat themselves from books if they think that their enemies have persuaded their doctors to harm them. See also EN 1148b8—a bad

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Finally, as to communication, several passages in Plato testify to an awareness of the importance of good communication between doctors and their patients: You are also aware that, as the sick folk in the cities comprise both slaves and free men, the slaves are usually doctored by slaves, who either run round the town or wait in their surgeries; and not one of these doctors either gives or receives any account of the several ailments of the various domestics, but prescribes for each what he deems right from experience, just as though he had exact knowledge, and with the assurance of an autocrat; then up he jumps and off he rushes to another sick domestic, and thus he relieves his master in his attendance on the sick. But the free-born doctor is mainly engaged in visiting and treating the ailments of free men, and he does so by investigating them from the commencement and according to the course of nature; he talks with the patient himself and with his friends, and thus both learns himself from the sufferers and imparts instruction to them, so far as possible; and he gives no prescription until he has gained the patient’s consent, and only then, while securing the patient’s continued docility by means of persuasion does he attempt to complete the task of restoring him to health.47 And a passage in the Politicus (295b–d) refers to written instructions from a doctor to his patients in the form of a letter: Let us suppose that a physician or a gymnastic trainer is going away and expects to be a long time absent from his patients or pupils; if he thinks doctor is not morally bad, just bad as a doctor. (I am grateful to Sarah Francis for her assistance with the collection and interpretation of passages in Aristotle representing medical practice.) 47  Plato, Laws 720b–e: Ἆρ’ οὖν καὶ συννοεῖς ὅτι, δούλων καὶ ἐλευθέρων ὄντων τῶν καμνόντων ἐν ταῖς πόλεσι, τοὺς μὲν δούλους σχεδόν τι οἱ δοῦλοι τὰ πολλὰ ἰατρεύουσιν περιτρέχοντες καὶ ἐν τοῖς ἰατρείοις περιμένοντες, καὶ οὔτε τινὰ λόγον ἑκάστου πέρι νοσήματος ἑκάστου τῶν οἰκετῶν οὐδεὶς τῶν τοιούτων ἰατρῶν δίδωσιν οὐδ’ ἀποδέχεται, προστάξας δ’ αὐτῷ τὰ δόξαντα ἐξ ἐμπειρίας, ὡς ἀκριβῶς εἰδώς, καθάπερ τύραννος αὐθαδῶς, οἴχεται ἀποπηδήσας πρὸς ἄλλον κάμνοντα οἰκέτην, καὶ ῥᾳστώνην οὕτω τῷ δεσπότῃ παρασκευάζει τῶν καμνόντων τῆς ἐπιμελείας• ὁ δὲ ἐλεύθερος ὡς ἐπὶ τὸ πλεῖστον τὰ τῶν ἐλευθέρων νοσήματα θεραπεύει τε καὶ ἐπισκοπεῖ, καὶ ταῦτα ἐξετάζων ἀπ’ ἀρχῆς καὶ κατὰ φύσιν, τῷ κάμνοντι κοινούμενος αὐτῷ τε καὶ τοῖς φίλοις, ἅμα μὲν αὐτὸς μανθάνει τι παρὰ τῶν νοσούντων, ἅμα δὲ καὶ καθ’ ὅσον οἷός τέ ἐστιν, διδάσκει τὸν ἀσθενοῦντα αὐτόν, καὶ οὐ πρότερον ἐπέταξεν πρὶν ἄν πῃ συμπείσῃ, τότε δὲ μετὰ πειθοῦς ἡμερούμενον ἀεὶ παρασκευάζων τὸν κάμνοντα, εἰς τὴν ὑγίειαν ἄγων, ἀποτελεῖν πειρᾶται; (tr. R.G. Bury). On communication between doctors and patients see Langholf 1996.

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they will not remember his instructions, he would want to write them down, would he not?—Sure.—What if he should come back again after a briefer absence than he expected? Would he not venture to substitute other rules for those written instructions if others happened to be better for his patients, because the winds or something else had, by act of God, changed unexpectedly from their usual course? Would he persist in the opinion that no one must transgress the old laws, neither he himself by enacting new ones nor his patient by venturing to do anything contrary to the written rules, under the conviction that these laws were medicinal and healthful and anything else was unhealthful and unscientific?’48 More broadly speaking, when it comes to the doctor’s writing skills, one can point to the remarkable care given by authors such as Diocles and Mnesitheus to the style and genre of their writings.49 It is clear that ‘non-Hippocratic’ medical writers, too, made major efforts to communicate as effectively as possible with their patients and audiences, writing popularising documents in the form of letters and poems about matters of health. 4

Conclusions: Diversity and Unity

We may tentatively conclude that none of the allegedly typical attributes mentioned above are unique to the Hippocratic writings as a whole and are also found in ‘non-Hippocratic’ authors of the same time frame. One could object here by saying that what I have been doing is just picking and choosing from a wide variety of authors: if Diocles does not supply evidence, let us turn to Plato, and if that does not help, let us move on to Aristotle. But perhaps one could respond to this by saying that this is not so different from the habit of arbitrarily picking and choosing from the CH those passages that 48  Plato, Politicus 295b–d: εἴπωμεν γὰρ δὴ πρός γε ἡμᾶς αὐτοὺς ἰατρὸν μέλλοντα ἢ καί τινα γυμναστικὸν ἀποδημεῖν καὶ ἀπέσεσθαι τῶν θεραπευομένων συχνόν, ὡς οἴοιτο, χρόνον, μὴ μνημονεύσειν οἰηθέντα τὰ προσταχθέντα τοὺς γυμναζομένους ἢ τοὺς κάμνοντας, ὑπομνήματα γράφειν ἂν ἐθέλειν αὐτοῖς, ἢ πῶς; Οὕτως. Τί δ’ εἰ παρὰ δόξαν ἐλάττω χρόνον ἀποδημήσας ἔλθοι πάλιν; ἆρ’ οὐκ ἂν παρ’ ἐκεῖνα τὰ γράμματα τολμήσειεν ἄλλ’ ὑποθέσθαι, συμβαινόντων ἄλλων βελτιόνων τοῖς κάμνουσι διὰ πνεύματα ἤ τι καὶ ἄλλο παρὰ τὴν ἐλπίδα τῶν ἐκ Διὸς ἑτέρως πως τῶν εἰωθότων γενόμενα, καρτερῶν δ’ ἂν ἡγοῖτο δεῖν μὴ ἐκβαίνειν τἀρχαῖά ποτε νομοθετηθέντα μήτε αὐτὸν προστάττοντα ἄλλα μήτε τὸν κάμνοντα ἕτερα τολμῶντα παρὰ τὰ γραφέντα δρᾶν, ὡς ταῦτα ὄντα ἰατρικὰ καὶ ὑγιεινά, τὰ δὲ ἑτέρως γιγνόμενα νοσώδη τε καὶ οὐκ ἔντεχνα (tr. H.N. Fowler). 49  On Diocles’ style and modes of expression see van der Eijk 2001, xxiv–xxv; on Mnesitheus see Bertier 1972; van der Eijk 2005b, 101–102.

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provide answers to questions or that best fit one’s preconceived ideas about what constitutes ‘Hippocratic’ medicine. And it would be equally question-begging to assume that all these other authors got their ideas from Hippocrates. Rather, we must think of Greek medicine in the 5th and 4th c. as constituting a large reservoir of ideas, some of which were more common, others more peculiar to specific treatises or authors. But we must take the whole ‘body’ of evidence into account, both the extant works and the fragmentary material and both the treatises preserved under the name of Hippocrates and those—both extant and fragmentary—preserved under different names. As I noted at the beginning, everyone nowadays accepts the great diversity among the Hippocratic writings. Indeed, this acceptance is so universal now that the editors of this volume have rightly decided that it is time to see whether it really is that great or whether the time has come for the pendulum to swing back in the direction of stressing convergence. It is, after all, possible to exaggerate the diversity between the Hippocratic writings,50 just as it is possible to exaggerate the differences between the Presocratic philosophers or, for that matter, between the accounts of the life of Jesus in the four Gospels included in the New Testament. That latter example is meant to remind us of the fact that stressing diversity or consonance can be a strategy arising from a particular agenda, be it an intellectual, or a political, ideological, or religious agenda. Such agendas have existed, and will continue to exist, also in the field of medicine where, as I mentioned earlier on, the name of Hippocrates has often been used to lend credibility and authority to a wide variety of medical and ethical beliefs, alternative therapies, etc., and where stressing diversity has sometimes been a counter-strategy aimed at depriving certain strands and ways of thinking in today’s medicine from a historical pedigree.51 Yet my point here is primarily a historical one, viz. that one should not a priori assume that the diversity between the Hippocratic writings is less great than that between some Hippocratic and some non-Hippocratic writings, or to put it differently: one should not uncritically assume that the coherence between the Hippocratic writings is greater than that between the Hippocratic and the non-Hippocratic writings. For that is the assumption underlying the continuing treatment of the Hippocratic writings as a Corpus, the continuing practice of explaining one Hippocratic work by reference to another and the continuing habit, when it comes to situating a Hippocratic text in its context,

50  This is the charge that has often been levied against the sceptic position advocated by Edelstein 1939; Lloyd 1975/1991. 51  An example is Godderis 2005, on which see van der Eijk 2006.

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of regarding other Hippocratic writings as the first, most natural port of call. It is also that assumption that has long underpinned the disregard and negligence of the wealth of medical ideas contained in the writings and fragments of other authors, such as those of the so-called ‘second Hippocrates’, Diocles of Carystus, and other authors such as Praxagoras of Cos, or Mnesitheus of Athens, Plato, Aristotle, Theophrastus, etc. It is this assumption, and the often implicit and almost automatic interpretive practice resulting from it, that needs to be examined critically. Rather than continuing to refer to the ‘Hippocratic Corpus’, I would argue that the Hippocratic body needs to be dismembered in order for the individual texts to be properly contextualized and historicized and, eventually, regrouped in new mappings. That, I suggest, is one of the major challenges facing current Hippocratic scholarship or, as I would prefer to call it, the study of Greek medical thought and writing in the 5th and 4th c. BCE. Bibliography Alexander, L.C.A., ‘Canon and exegesis in the medical schools of antiquity’, in: P.S. Alexander and J.-D. Kaestli (eds.), The Canon of Scripture in Jewish and Christian Tradition. Lausanne, 2007, 115–153. Althoff, J., ‘Aristoteles als Medizindoxograph’, in: P.J. van der Eijk (ed.), Ancient Histories of Medicine. Leiden, 1999, 57–94. Anastassiou, A. and Irmer, D., Testimonien zum Corpus Hippocraticum, 4 Bde, Göttingen, 1997–2012. Aragione, G., Junod E. and Norelli E. (eds.), Le canon du Nouveau Testament. Regards nouveaux sur l’histoire de sa formation. Geneva, 2005. Beccaria, A., ‘Sulle tracce di un antico canone latino di Ippocrate e di Galeno’, Italia Medioevale e Umanistica 2, 1959, 1–56; 4, 1961, 1–75; 14, 1974, 1–23. Bertier, J., Mnésithée et Dieuchès. Leiden, 1972. Boudon-Millot, V., Cobolet G. and Jouanna J. (eds.), René Chartier (1572–1654), éditeur et traducteur d’Hippocrate et Galien. Paris, 2012. Campenhausen, H. von, The Formation of the Christian Bible. Philadelphia, 1972. Craik, E., Two Hippocratic Treatises On Sight and On Anatomy. Leiden, 2006. Diels, H., Handschriften der antiken Ärzte, I: Hippokrates und Galenos. Berlin, 1905–6. Edelstein, L., ‘The Genuine Works of Hippocrates’, Bulletin of the History of Medicine 7 (1939), 236–248 (reprinted in: O. and C.L. Temkin (eds.), L. Edelstein, Ancient Medicine. Baltimore, 1967, 133–144). Eijk, P.J. van der, Aristoteles. De insomniis. De divinatione per somnum. Berlin, 1994. ———, ‘Towards a rhetoric of ancient scientific discourse: Some formal characteristics of Greek medical and philosophical texts (Hippocratic Corpus, Aristotle)’, in:

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E.J. Bakker (ed.), Grammar as Interpretation. Greek Literature in its Linguistic Contexts. Leiden, 1997, 77–129. ———, Diocles of Carystus, 2 Vols. Leiden, 2000–2001. ———, ‘Introduction’ and ‘Divination, prognosis, prophylaxis: the Hippocratic work ‘On Dreams’ (De victu 4) and its Near Eastern background’, in: H.F.J. Horstmanshoff and M. Stol (eds.), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine. Leiden, 2004, 1–10 and 187–218. ———, Medicine and Philosophy in Classical Antiquity. Cambridge, 2005a. ———, ‘Between the Hippocratics and the Alexandrians: Medicine, science and philosophy in the fourth century BCE’, in: R.W. Sharples (ed.), Philosophy and the Sciences in Antiquity. Aldershot, 2005b, 72–109. Eijk, P.J. van der (ed.), Hippocrates in Context. Leiden, 2005c. Eijk, P.J. van der, Review of Godderis (2005) in: Nederlands Tijdschrift voor Geneeskunde 150 (2006), 2118–2119. Eijk, P.J. van der and S.R. Francis, ‘Aristoteles, Aristotelismus und antike Medizin. Zur Physiologie und Therapie der akrasia’, in: C. Brockmann, W. Brunschön and O. Overwien (eds.), Antike Medizin im Schnittpunkt von Natur- und Geisteswissen­ schaften. Berlin, 2009, 213–234. Eijk, P.J. van der, ‘Le rôle de Chartier dans la constitution des canons des traités hippocratiques et galéniques’, in: Boudon-Millot, Cobolet and Jouanna 2012, 81–96. Fichtner, G., Corpus Hippocraticum. Verzeichnis der hippokratischen und pseudohippokratischen Schriften, Tübingen, 2013 (now regularly updated on the CMG website at http://cmg.bbaw.de/online-publikationen/hippokrates-und-galenbiblio graphie-fichtner). Finkelberg, M. and Stroumsa G.G. (eds.), Homer, the Bible and Beyond. Literary and Religious Canons in the Ancient World. Leiden, 2003. Fortenbaugh, W.W. and Wöhrle G. (eds.), On the Opuscula of Theophrastus. Stuttgart, 2002. Fortenbaugh, W.W., Sharples R.W. and Sollenberger M. (eds.), Theophrastus of Eresus on Sweat, On Dizziness and On Fatigue. Leiden, 2003. Fortuna, S., ‘Nicolò Leoniceno e le edizioni Aldini dei medici greci (con un appendice sulle traduzioni latine)’, in: V. Boudon-Millot, A. Garzya, J. Jouanna and A. Roselli (eds.), Ecdotica e ricezione dei testi medici greci. Naples, 2006, 443–464. Garofalo, I., Erasistrati fragmenta. Pisa, 1988. Godderis, J., Eed van Hippocrates. Historische beschouwingen inzake de opdracht en de begrenzingen van het medisch handelen. Apeldoorn, 2005. Gossen, H., ‘Hippokrates’, RE 8.2 (1913), 1801–1852. Grensemann, H., Die hippokratische Schrift Über die heilige Krankheit. Berlin, 1968. Houdart, M.S., Etudes historiques et critiques sur la vie et la doctrine d’Hippocrate et sur l’état de la médecine avant lui. Paris, 1840.

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———, Histoire de la médecine grecque depuis Esculape jusqu’à Hippocrate exclusivement. Paris, 1856. Ideler, I.L., Physici et medici graeci minores, Vol. 1. Berlin, 1841. Irigoin, J., ‘Le manuscrit V d’Hippocrate (Vaticanus Graecus 276). Étude codicologique et philologique’, in: A. Garzya and J. Jouanna (eds.), I testi medici greci. Tradizione ed ecdotica. Naples, 1999, 269–283. Jones, W.H.S., Hippocrates, vol. 2. Cambridge Mass. – London (Loeb Classical Library), 1923. Jouanna, J., Hippocrate. Airs, Eaux, Lieux. Paris, 1996. ———, Hippocrates. Baltimore and London, 1999 (English tr. of Hippocrate, Paris 1992). ———, ‘Foes éditeur d’Hippocrate: deux énigmes résolus’, in: V. Boudon-Millot and G. Cobolet (eds.), Lire les médecins grecs à la renaissance. Paris, 2004, 1–25. ———, ‘La postérité de l’embryologie d’Hippocrate dans deux traités pseudohippocratiques de la médecine tardive: Sur la formation de l’homme et Sur la génération de l’homme et de la sémence’, in: L. Brisson, M.-H. Congourdeau and J.-L. Solère (eds.), L’embryon. Formation et animation. Paris, 2008, 15–41. ———, Hippocrate. Pour une archéologie de l’école de Cnide, 2me edition augmentée d’un article (2004) et d’une Postface (2009), Paris. Jouanna, J. and Grmek M.D., Hippocrate. Epidémies V et VII. Paris, 2000. Kibre, P., Hippocrates Latinus. New York, 1985. Langholf, V., ‘Nachrichten bei Platon über die Kommunikation zwischen Ärzten und Patienten’, in: R. Wittern and P. Pellegrin (eds.), Hippokratische Medizin und antike Philosophie. Hildesheim, 1996, 113–142. Leven, K.-H., Antike Medizin. Ein Lexikon. Munich, 2005. Littré, E., Oeuvres complètes d’Hippocrate, Tome 1. Paris, 1839. Lloyd, G.E.R., ‘The Hippocratic Question’, The Classical Quarterly 25 (1975), 171–192 [reprinted with postscript in: G.E.R. Lloyd, Methods and Problems in Greek Science, Cambridge 1991, 194–223]. ———, ‘Le pluralisme de la vie intellectuelle avant Platon’, in: A. Laks and C. Louguet (eds.), Qu’est-ce que la philosophie présocratique? Villeneuve d’Asq, 2002, 39–54. Longrigg, J., Greek Rational Medicine. London, 1993. Lührmann, D., Die apokryph gewordenen Evangelien. Leiden, 2004. Manetti, D., ‘Alle origini dell’ippocratismo: fra IV e III sec.’, in: J. Jouanna and M. Zink (eds.), Hippocrate et les hippocratismes. Paris 2014, 231–251. ——— and Roselli, A., ‘Galeno commentatore di Ippocrate’, ANRW 2.37.2 (1994), 1531– 1635 and 2071–2080. Mansfeld, J., ‘Plato and the method of Hippocrates’, Greek, Roman and Byzantine Studies 21 (1980), 341–362.

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Markschies, C., Kaiserzeitliche christliche Theologie und ihre Institutionen. Tübingen, 2007. Mewaldt, J., ‘Galenos über echte und unechte Hippocratica’, Hermes 44 (1909), 111–134. Nutton, V., ‘Hippocratic morality and modern medicine’, in: H. Flashar and J. Jouanna (eds.), Médecine et morale dans l’antiquité (Entretiens sur l’antiquité classique 43). Vandœuvres – Geneva, 1996, 31–63. ———, Ancient Medicine. London, 2004. ———, Review of A. Anastassiou and D. Irmer, Testimonien zum Corpus Hippocraticum, Teil I, Gnomon 80 (2008), 173–175 Perilli, L., ‘Democritus, zoology and the physicians’, in: A. Brancacci and P.-M. Morel (eds.), Democritus: Science, the Arts and the Care of the Soul. Leiden, 2007a, 143–179. ———, ‘Conservazione dei testi e circolazione della conoscenza in Grecia’, in: A.M. Andrisano (ed.), Biblioteche del mondo antico. Rome, 2007b, 36–71. ———, ‘Scrivere la medicina. La registrazione dei miracoli di Asclepio e le opere di Ippocrate’, in: C. Brockmann, W. Brunschön and O. Overwien (eds.), Antike Medizin im Schnittpunkt von Geistes- und Naturwissenschaften. Berlin, 2009. Pöppel, O., Die hippokratische Schrift Koakai Prognoseis und ihre Überlieferung. Diss. Kiel, 1959. Potter, P., ‘The editiones principes of Galen and Hippocrates and their relationship’, in: K.–D. Fischer, D. Nickel and P. Potter (eds.), Text and Tradition. Leiden, 1998, 243–261. Ripple, G. and Winko, S. (eds.), Handbuch Kanon und Wirtung. Theorien, Instanzen, Geschichte. Darmstadt, 2013. Rivier, A., Recherches sur la tradition manuscrite du traité hippocratique ‘De morbo sacro’. Berne, 1962. Roselli, A., ‘Un corpo che prende forma: L’ordine di successione dei trattati ippocratici dall’età ellenistica fino all’età Byzantina’, in: G. Cerri (ed.), La letteratura pseudepigrafa nella cultura greca e romana. Naples, 2000, 167–195. Rütten, T., ‘Rufus’ legacy in the psychopathological literature of the (Early) Modern Period’, in: P.P. Pormann (ed.), Rufus on Melancholy. Tübingen, 2008, 245–262. Sanders, J., ‘Canonical criticism: an introduction’, in: Le canon de l’ancient testament. Sa formation et son histoire. Geneva, 1984, 341–362. Schöne, H., ‘Bruchstücke einer neuen Hippokratesvita’, Rheinisches Museum, N.F. 58 (1903), 56–66. Smith, W.D., ‘Notes on ancient medical historiography’, Bulletin of the History of Medicine 63 (1989), 73–103. ———, Hippocrates. Pseudepigraphic Writings. Letters, Embassy, Speech from the Altar, Decree (Studies in Ancient Medicine 2). Leiden, 1990. ———, ‘The genuine Hippocrates and his theory of therapy’, in: I. Garofalo et al. (eds.), Aspetti della terapia nel Corpus Hippocraticum. Florence, 1999, 107–118.

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———, The Hippocratic Tradition, http://www.bium.univ-paris5.fr/amn/docu.htm. Ithaca – London, 2002 (revised edition of first edition 1979). Staden, H. von, Herophilus. Cambridge, 1989. ———, ‘Interpreting ‘Hippokrates’ in the 3rd and 2nd centuries BC’, in: C.W. Müller, C. Brockmann and C.W. Brunschön (eds.), Ärzte und ihre Interpreten. Leipzig, 2006, 15–47. ———, ‘Staging the past, staging oneself: Galen on Hellenistic exegetical strategies’, in: C. Gill, T. Whitmarsh and J. Wilkins (eds.), Galen and the World of Knowledge. Cambridge, 2009, 132–156. Steckerl, F., The Fragments of Praxagoras and His School. Leiden, 1958. Tracy, T.J., Physiological Theory and the Doctrine of the Mean in Plato and Aristotle. The Hague – Paris, 1969. Tuplin, C., ‘Doctoring the Persians: Ctesias of Cnidus, physician and historian’, Klio 86 (2004), 305–347. Wellmann, M., Die Fragmente der sikelischen Ärzte Akron, Philistion und des Diokles von Karystos. Berlin, 1901.

CHAPTER 2

The Hippocratic Aphorisms in Ptolemaic and Roman Times Ann Ellis Hanson The theme of the 13th Hippocratic Colloquium, What’s Hippocratic about the Hippocratics? can, of course, be answered tautologically—‘being included in a copy of the Corpus makes a text Hippocratic’. Nonetheless, underneath the tautology lies a myriad of modern questions and assumptions regarding the circumstances under which a Hippocratic collection came into being and the means by which earlier evidence for the existence of a collection subsequently expanded into what we now know in the large Byzantine manuscripts such as the Marcianus in Venice and the Vaticanus in Rome. Papyrus finds do proffer fragments from medical treatises that are not part of our CH, yet many could be, since they display considerable affinity with the style, content, and vocabulary of Hippocratic treatises. For example, P.Köln 9.356, a roll with three columns copied in the 2nd c. CE, presents short discussions of symptoms and therapy for three diseases of the spleen and one disease of the kidneys in a manner similar to the Hippocratic Diseases 1–3 of our CH, as well as the now largely-lost treatise Galen entitled Cnidian Sentences.1 It presents a ‘parallel version’, if you will, of material also appearing in the Hippocratic Internal Affections with ἄλλη νόσος introducing the discussion of each disease.2 The Greek dialect employed in the papyrus is for the most part Koine, but that detail is only to be expected, since Hippocratic papyri display Attic forms at least as frequently as Ionic ones. The level of ionicisms in papyri of Herodotus is similar. Another example of a papyrus text that resembles items in the CH is 1  P.Köln 9.356 = MP3 2357.14. The hand which copies the papyrus is dated to the 2nd c. CE, but the medical text itself was most likely written years, or even centuries previous. The original editor noted parallels he found between the papyrus and the Hippocratic Int. affect. 14–16 and 30–31. In addition to the publication reference, P.Köln 9.356, the MP3 number affixed to a papyrus with literary or subliterary content, signals where in the online database MertensPack3 the references to the literary papyrus are to be found and the data that have been accumulating on the papyrus since its original publication in the ninth volume of papyri housed in Cologne. 2  Jouanna 2004, 221–236.

© koninklijke brill nv, leiden, ���6 | doi ��.��63/9789004307407_004

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GMP 2.2, a roll with at least four columns copied in the late 1st or early 2nd c. CE.3 The papyrus contains a didactic manual and was unearthed at the Fayum village of Tebtunis by the Oxford papyrologists B.P. Grenfell and A.S. Hunt over a century ago; they describe the roll as ‘seven fragments of a medical work’, but displayed little interest in its medical contents, and preferred to devote their time to fragments of high literature. The roll had to wait a century for full publication of its Greek and detailed explication of its contents; the preserved sections teach students the symptoms of respiratory ailments, such as catarrah and cough, as well as the prognoses to be deduced from the symptoms. The structure, format, and content are those of the Hippocratic Prognostic 14–15 and Coan Prenotions 383–87, either in paraphrase or copied more or less verbatim. Both the roll in Cologne, which lacks provenance, and that in Berkeley are classified in the online database MP3 among medical adespota, and languish there still, even though they are similar to texts in our CH. The many medical adespota, papyri of medical content for which no author is known, do, however, give us a sense of how much medical writing from antiquity has been lost. Those that survive to modern times only as fragments beg to be set into meaningful relationship with what is already known from treatises passed down through the manuscript traditions and from all the fragments described and published for our perusal. This obligation is placed on those who edit papyri of medical content in the hope of discovering new connections. In this chapter I examine papyrus copies of the Hippocratic Aphorisms and attempt to assess the popularity this treatise apparently enjoyed in Egypt during Roman and Byzantine times. A different type of information about the CH in antiquity comes from glossaries, for what survives even as fragments testifies to the fact that the Hippocratic collection was increasing in size over time, embracing more and more of the treatises we now know in our CH. The earliest Hippocratic glossator was Bacchius of Tanagra, working in Alexandria in the 3rd c. BCE and said by Galen to be a follower of Herophilus; the words to be explained in his Hippocratic glossary were drawn from perhaps as many as twenty treatises.4 Although Bacchius’ glossary is lost, we know some of its glosses through 3  G MP 2.2 = P.Tebt. 2.678 descriptum = MP3 2368. Now at Berkeley, which houses papyri excavated from Tebtunis during the winter of 1899/1900. 4  I follow the dates assigned for Bacchius and Zeuxis by von Staden 2006, especially 16–20 and 30–40. See also von Staden 1992. Efforts to count the number of treatises embraced in any Hippocratic collection begin and end with Erotian’s list, for which, see Nachmanson 1917, especially 257–259 and the fourth chapter, 268–456; on the perils associated with this kind of counting, see von Staden 1989, 490–492.

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Erotian, who quoted from Bacchius when he was writing his own glossary in Rome at the middle of the 1st c. CE. Not only did Erotian include extensive quotations from Bacchius, but his preface listed by title some thirty-one to thirtyeight treatises he was covering; the precise number depends on how you count items such as the seven books of Epidemics or the seven sections of Aphorisms. An increase in the number of early medical treatises being subsumed under a ‘Hippocratic’ rubric occurred during the three hundred years separating the two glossators. The alphabetical dictionary associated with Galen also survives to our time and was probably written out during the later decades of the 2nd c. CE. Erotian not only listed by title the treatises for which he was providing glosses, but his list indicated the ordering in which treatises were to be glossed. Whether scribes copied Erotian’s glosses onto a papyrus roll separate from the roll bearing the Hippocratic text, or whether they placed his glosses in the margins of a single roll adjacent to the Hippocratic text being glossed, Erotian’s list was functional and the positioning of his glosses on a roll was flexible, even though the ordering of treatises and glosses was fixed so that the two proceeded in tandem. At some point Erotian’s glosses were alphabetized, and this severed the connection between his glossary and editions of the CH ranged with the same ordering for treatises and glosses. Although Erotian’s original arrangement is occasionally visible within the glosses to a single letter of the alphabet, his list of treatises to be glossed does afford a means to estimate the size of the Hippocratic collection at Rome around the middle of the 1st c. CE. The Galenic dictionary needed no list, for it was alphabetic from the start, and its definitions serviced multiple editions of the CH without concern that ordering of treatises and glosses were in harmony. The major concern in Galen’s introduction was the fact that words change meaning over time and the words that go out of use mystify latter-day readers when they come across them in old treatises. Galen worried about restoring intelligibility to Hippocratic texts, and a first step in the process was to restore old meanings for the old words. An alphabetized dictionary obviated the need for a list of treatises to indicate the order in which glosses were proceeding, and such a list was never written. The ancient tradition of commentary on the CH seems to have begun more or less contemporaneous with the glossographic one, and Bacchius of Tanagra may have been the first to compose in that tradition as well, followed a decade or so later by the Empiric Zeuxis, also working in Alexandria. While glossators consider the entire CH as it is known to them, commentators concentrate on a specific treatise and draw upon techniques developed by scholars in the Alexandrian Museum for their commentaries to Homeric epics, giving close scrutiny to difficult passages, emending or otherwise explaining the text, and adducing parallels from elsewhere in the author’s oeuvre to elucidate

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his thinking.5 In his own commentary on Aphorisms 7.70 Galen explains the way in which earlier commentators confronted the gnômê, naming in one breath Bacchius the Herophilean, and the Empiricists Zeuxis and Heracleides of Tarentum.6 Over a dozen Hippocratic commentaries (hypomnêmata) from the hand of Galen give us a view of the varying ways in which he explicates Hippocratic texts, and how his methods and interests evolved over the years. The number of commentaries he and others produced throughout antiquity not only suggests something about the interest a particular Hippocratic treatise continued to arouse, and thus its overall popularity among ancient readers, but also about a treatise’s didactic efficiency for teaching medical students generation after generation. The various groupings of physicians into sects (αἱρέσεις) characterize medicine in the Hellenistic and earlier Roman worlds, and among the exegetes we encounter Empiricists, Hippocrateans, Herophileans, Erasistrateans, and Methodists, for composing a commentary on a Hippocratic treatise permitted the medical writer to lay claim to the treatise, to colonize and possess it. Explaining what ‘Hippocrates really means’ refashioned the Father of Medicine into an authority figure in the present among the doctors the commentator was addressing. Exegesis was as likely to be a personal activity and a means for presentation of self, as it was an interpretation in harmony with the tenets of a particular medical collectivity. Not only do we have more commentaries mentioned for the seven sections of Aphorisms than for any other treatise,7 but considerably more examples of Aphorisms on papyrus or 5  E.g., Galen, De dign. puls. 4, 8.958.6–7 K, and De com. sec. Hipp. 1.5, CMG 5.9.2, 182.22–26 Mewaldt; cf. also Hanson 1998. ‘Hippocrates’ was used to explain ‘Hippocrates’, as ‘Homer’ explained ‘Homer’. 6  In Hipp. Aph. Comment. 7.70, 18A 186.9–187.4 K. For textual problems, see now von Staden 2006, 16 and n.6, 38 and n.95; his remarks are based on collations by Dr. Caroline Magdalaine. For less detailed, but still useful presentations of Galen on Aph. 7.70, see von Staden 1989, 75–76 and 83 (T34), and Guardasole 1997, 295–296 (fr. 95). 7  For Hippocratic commentaries to Aph., see Ihm 2002, arranged alphabetically by author of each commentary. An approximate chronological listing for those who are said to have written commentary to Aph., or whose commentary to Aph. survives in toto or fragments, follows below, and a question mark after the name of the commentator signals that scholarly doubt exists as to the existence of the commentary: no. 33 Bacchius of Tanagra (Herophilean), Ihm, 77; no. 264 Zeuxis (Empiricist), Ihm, 219; no. 26 Asclepiades of Bithynia, Ihm, 72; no. 115 Heracleides of Tarentum (Empiricist), Ihm, 130; no. 258 Thessalus of Tralles? (Methodist), Ihm, 216; no. 211 Rufus of Ephesus?, Ihm, 189; no. 204 Quintus, Ihm, 186; no. 234 Soranus of Ephesus (Methodist), Ihm, 199–200; no. 44 Dionysius, Ihm, 83; no. 159 Lycus of Macedon (Erasistratean?), Ihm, 158; no. 45 Dioscorides (also said to be editor of the Hippocratic Corpus in the reign of Hadrian), Ihm, 83–84; no. 221 Sabinus (Hippocratean),

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parchment copied between the 1st and 6th c. CE survive to our time than they do for any other ‘Hippocratic’ treatise.8 An indication, I argue, of Aphorisms’ popularity during antiquity, as well as confirmation that its gnômai remained difficult to understand and continually begging for exegetes to explicate their meaning. From the seven discrete copies of Aphorisms listed in n. 8 three codices are of particular interest here, either because they contain marginal glosses,9 or brief online commentary (MP3 543.4, antea MP3 2338 = CPF I 2.18.24T). Two codices with marginal annotations were found at Antinoopolis in Upper Egypt, the city reestablished by the Emperor Hadrian in CE 130 to commemorate the drowning in the Nile of Antinoos.10 The date assigned for the copying of MP3 543 (P.Ant. 1.28), now a tattered parchment leaf from a codex, varies from late in the 3rd to the 5th c. CE. On the front side are the final thirty lines of the Hippocratic Prognostic and on the back side the author and title (Ἱπποκρά[τους ἀφορ]ισμοί, followed by the first three gnômai at the beginning of the first Ihm, 194; no. 170 Marinus of Alexandria, Ihm, 163–164; no. 180 Numesianus, Ihm, 169; no. 196 Pelops, Ihm, 181; no. 154 Julianus Alexandrinus (Methodist), Ihm, 155–156; no. 60 Galen, Ihm, 94–95; no. 274 Anonymus of the 3rd/4th c. CE, Ihm, 224; no. 275 Anonymus of the 6th c. CE, Ihm, 224–225. For a summary of views about no. 124 Herophilus, who did not produce a formal commentary to Aph., Ihm, 124–125. For no. 17 Archibius (MP3 2354), also problematic, see below, n. 8. For specific commentators, see e.g. von Staden 2002, especially 109–123; Guardasole 1997, 265–298. For Rufus of Ephesus, Sabinus, and Galen, see Manetti and Roselli 1994; Mansfeld 1994; Smith 1979, 63–74 and 245–246. 8   CPF (Corpus dei papiri filosofici greci e latini) 1.2, ‘section 18’ contains ‘papyri of or involving Hippocrates’. The copies of Hipp., Aph. are: (1.) MP3 543 = CPF 1.2, 18.1. (2.) MP3 543.1 = CPF 1.2, 18.2. (3) MP3 543.2 = CPF 1.2, 18.3. (4.) MP3 543.3 = CPF 1.2, 18.4. (5.) MP3 543.4, antea MP3 2338 = CPF 1.2, 18.24T. (6.) MP3 544 = CPF 1.2, 18.5. And subsequent to the publication of the CPF and not yet registered in Mertens-Pack3, the small fragment of a papyrus codex, P.Oxy. 80.5219, with Aph. 5.35–37, 6.5–7 and assigned a date in the late 3rd/4th c. CE. In addition to the seven copies of Aph., two other papyri offer testimony about the text at the beginning of Aph. 1.1: MP3 2354 (= CPF I 2, 18.22T, distancing itself from the commentary suggested as possible for no. 17 Archibius?, Ihm, 67); and MP3 2380.1 (= CPF 1.2, 18.23T). 9   For ameliorations to the Greek text of MP3 543 (= CPF 1.2, 18.1) and MP3 543.3 (= CPF 1.2, 18.4), as well as discussion, see Andorlini 2003, especially 20–26. See also Andorlini’s reedition of MP3 543.3 for CPF 1.2, 18.4. English translations for some marginalia in McNamee 2007, 261–264. 10  That is, P.Ant. 1.28 (= MP3 543 = CPF 1.2, 18.1 = no. 274 Ihm); and P.Ant. 3.183 (= MP3 543.3 = CPF 1.2, 18.4 = no. 275 Ihm). Another papyrus codex copied in the 6th–7th c. CE was also excavated at Antinoopolis: P.Ant. 2.86 (= MP3 544 = CPF 1.2, 18.5). For evidence suggesting the existence of a medical library in late antique Antinoopolis, see Marganne 1984.

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section of Aphorisms. Thus two treatises deemed essential for students to master are circulating together in a single codex, albeit the sequence of Prognostic before Aphorisms is opposite to that exhibited in Byzantine manuscripts. Four paragraphoi, plus blank spaces in the line of text mark pauses, the second of which coincides with the end of Aphorisms 1.1 in our CH (pap. line 7 = 4.458.1–4 L) and the fourth coincides with the end of 1.2 (pap. line 18 = 4.458.10 L). Galen is aware of a division of Aphorism 1.1 into two parts, and the manner in which gnomic utterances are divided does influence their meaning.11 The first marginal notation in this papyrus (P.Ant. 1.28 = MP3 543) explains that Aphorisms 1.2 is ‘about spontaneous evacuation of the stomach’, and by glossing koilia with gastêr the commentator aligns himself with those who interpret this aphorism as digestive in intent. Galen, in his commentary to this gnômê, insists that Hippocrates is looking at the quality of the stomach’s evacuations, not quantity, as other exegetes have claimed. The second marginal note interprets Aphorisms 1.3 as referring to ‘the release of excess weight and purgation during gymnastic exercises’.12 The other codex from Antinoopolis with marginal notations (P.Ant. 3.183 = MP3 543.3, fourth among those listed in n.8) is copied in the 6th c. CE and contains the only example in the papyri to date of the word σχό(λιον), serving here pleonastically as a title to the note to Aphorisms 3.24: ‘The most revered Hippocrates, having finished his explanation about the seasons and constitutions (that is, Aphorisms 3.1–23), now begins the section about people’s ages’. The remaining marginal notes, especially those on the back of the papyrus leaf are difficult to read, yet it seems clear that fragment B↓ completes the commentary to Aphorisms 3.31 and also continues on to Aphorisms 4.1, certainly by the time the note reaches the adjective ‘four-month old’ (τετράμη[ν]) and perhaps several lines previous. The Greek in both the Hippocratic Aphorisms 4.1 and in Galen’s commentary to it speaks only of ‘fourth to seventh months’, that is, both give individual mention to the two months that bound the middle portion in a pregnancy of term. By contrast, a Latin commentary to this first 11  Gal., In Hipp. Aph. comment. 1.2, 17B 346.1–3 K. A conspicuous example exists in a late Ptolemaic papyrus displaying the text of an aphoristic passage from Epid. 2.6.7–22 (= MP3 537.1). The division into discrete aphoristic utterances, separated by blank spaces, differs considerably from that in the Galen commentary, preserved only in Arabic (In Hipp. Epidemiarum librum secundum commentaria, CMG 5.10.1 Pfaff) and from modern printed editions of the CH, such as Epid. 2.6.7–22 in the Loeb Hippocrates 7.82–87 (Cambridge MA, 1994 Smith): see Hanson and Gagos 1997, 120–140. 12  For Aph. 1.2, see Gal., In Hipp. Aph. I 2 comment., 17B 356–61 K; for Aph. 1.3, Gal., In Hipp. Aph. 1.2 comment., 17B 363–64 K. For the marginal notes, see Andorlini 2003, 20–26.

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aphorism in the fourth book names the entire series of nine months, beginning with the first, second, and third months, when the fetus is weak and liable to flow out, and counting out the later months one by one.13 This Hippocrates Latinus is one who eschews cathartics in the first trimester, but safely prescribes them in the fourth and fifth months of pregnancy because the fetus is now solidified. As for the sixth, seventh, eighth, and ninth months, the size and weight of the fetus are contraindications for purging, because weakness characterizes the last months of pregnancy, just as it did the first months. In fragment C↓ of MP3 543.3 are notes to Aphorisms 4.4–5, and it is perhaps worth noting that here a Latin commentary seems to parallel two of the phrases in the Greek marginal notations: compare C↓ 4 ἐν δ]ὲ χειμῶνι τὴν κάτω γαστέ[ρα with hieme uero inferiorem uentrum purgare dicit, both appearing near the end of the comment to Aphorisms 4.4.14 And although fragmentary, cf. C↓ 6 . . . φύσεως with hic grandis erit labor natur(a)e. The third papyrus of interest here, P.Ryl. 3.530 (= MP3 543.4 = CPF I 2, 18.24T), has a more complicated publication history, due to conclusions drawn by its original editor back in 1938. As a result the papyrus leaf was designated as ‘2338’ among medical adespota in the two repertories of literary papyri assembled by R.A. Pack (1952 and an update in 1967). Its contents were described as ‘medical aphorisms, [s]ome are from the aphorisms of Hippocrates, but in a different order’. R. Luiselli and D. Manetti rearranged the fragments and prepared a new edition of the Rylands for publication in CPF 1.2, 18 (Hippocrates); the 13  Prof. Dr. Klaus-Dietrich Fischer kindly put at my disposal his transcripts of Latin versions of Aph. accompanied by Latin commentary, and his generosity has been much appreciated. The most useful Latin mss. for the passages considered in this chapter have proved to be MS Bern 232, s.10, and MS Londiniensis Latinus Regius 12 E. xx, s.12. I seem to see reflections of the fragmentary Greek comments in the far less lacunose Latin versions, especially in the case of P.Ant. 3.183 (= MP3 543.3 = CPF 1.2, 18.4). Dr. Caroline Magdelaine has also generously made available to me her unpublished work on the Latin translations of Aph., and I thank her for her help.  The Hippocratic Aph. were apparently twice translated directly from Greek into Latin, and both translations antedate Isidore of Seville (d. CE 636, Fischer per litteram). For the Latin text of Aph. without commentary based on 6 manuscripts, see Müller-Rohlfsen 1980. The Latin Aph. also knows two distinct commentaries, ‘A’ and ‘B’, appended to this same Latin translation of Aph. without commentary; these versions of Aph. 1.1 all read uita breuis ars autem prolixa (not longa). 14  Ad Aph. 4.4 and 4.5, MS Bern 232, fol. 21v–22r and MS Lond. Lat. Reg. 12 E. xx, fol. 12. Other Latin mss. prove lacunose in the parts of Aph. examined here, and no evidence is available from either MS Bibliothecae Cathedralis Lincoloniensis Lat. 220, or MS Auxerre Bibliothèque munic. 22.

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re-edition, however, properly bears the title ‘MP3 543.4, antea MP3 2338’ only in the online database, the electronically-searchable replacement for Pack’s two printed catalogs. In CPF 1.2, 18, however, the papyrus is still placed among the testimony about Hippocratic Aphorisms (‘MP3 543.24T’), despite emphatic statements to the contrary from Luiselli and Manetti that this is a copy of Aphorisms plus jejune commentary. The revised labeling for the papyrus in the online database as ‘MP3 543.4, antea MP3 2338’, reinforces the papyrus’ identity as another copy of Hippocratic Aphorisms: on the front, Aphorisms 5.7–14, on the back Aphorisms 5.16–22, and only Aphorisms 5.15 is totally lost in lacuna. A newly-discovered fragment (‘Z’) extends the coverage back to Aphorisms 4.77–79. The brief commentary is separated off from the Aphorisms text by online forked paragraphoi, also known as the diplai obelismenai (>—).15 The papyrus is seriously damaged, and the Greek text of Aphorisms as we know it fits only occasionally into the lines in which many letters are unreadable or missing.16 At the moment the brief commentary remains beyond our grasp.17 The date assigned for the copying of the Rylands papyrus is 3rd or 4th c. CE, and so Galen’s commentary to Aphorisms is the important comparandum, while the commentary by Stephanus the Athenian was composed several centuries subsequent to MP3 543.4, and gives no hint of ever having circulated in Egypt.18 Luiselli and Manetti likewise listed ancient commentators known to have produced exegetical works on the Hippocratic Aphorisms, both prior to Galen and subsequent (183–184). Their list overlaps to some degree that in Ihm’s Clavis commentariorum (see above, n. 7). According to Galen, our major source for information about Hippocratic exegetes, commentaries from the hand of the Empiricist physician Zeuxis are no longer in demand by the later 2nd c. CE and have accordingly become scarce.19 The shelf-life for many a Hippocratic commentary may have been rather short in Roman or Byzantine times, considering how many were produced. By the time Galen was writing On the order of my 15  The diplê obelismenê rarely occurs in prose papyri, but for a few examples see Lundon and Matthaios 2005, especially 99 and n.17. P.Ryl. 3.530 remains among testimonia for the Corpus in Anastassiou and Irmer 2006, 87, underscoring how difficult it is for an adespoton to emerge from the status ‘author unknown’. Anastassiou and Irmer also repeat the Greek of the editio princeps. 16  Sometimes Attic forms provide more convincing restorations than Ionic ones. 17  An image of the two major fragments of MP3 543.3, A and B, in proper order, is reproduced as no. 146, in CPF Parte 4.2, Tavole. 18  Stephanus’ commentary is usually dated to the 6th/7th c. CE. See Westerink 1985–1995. P.Ant. 3.183 (= MP3 543.3 = no. 275, Ihm 224–25), is similarly dated to the 6th c. CE, and the jejune marginal glosses it provides to Aph. 3.24 and 4.4–5 are examined above. 19  Gal., In Hipp. Epid. 3, 2.4, CMG 5.10.2.1, 78–80 Wenkebach.

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own books in the later years of his life, probably during the decade CE 195–205, he argues that those who want to understand important Hippocratic works should read Hippocrates together with the commentary he has already written on the treatise, or with one he yet intends to write, should he live so long.20 In the absence of his own commentaries to particular Hippocratic works, his next suggestion is to read his own major treatises, for these provide lucid instruction about Hippocratic medicine. Galen has one more suggestion to offer— that one could also profit by choosing ‘from previous medical writers, such as the works of my teacher Pelops, or of Numesianus, although few copies of their works now survive, or of Sabinus and Rufus of Ephesus’. He returns to Sabinus and Rufus again at the end of the passage, underscoring that this pair has produced students with a better understanding of Hippocrates than have other commentators. ‘Anyone who knows the writings of Galen’, he concludes confidently, ‘will be able to spot errors in Sabinus and Rufus and proceed to correct them’. Galen’s attitude toward his medical predecessors who write on Hippocrates is admittedly complex, and this is certainly true of his evaluations of Sabinus and Rufus. Nonetheless, Galen seems unlikely to have recommended the Hippocratic exegesis that Rufus and Sabinus produced nearly a century earlier were their commentaries no long available. Galen’s reference does not guarantee, however, that Rufus produced a commentary to Aphorisms, only that Rufus did write Hippocratic commentary. Galen mentions Rufus’ commentaries to Epidemics 2 and 6, as well as to the Hippocratic Prorrhetic, and cited Rufus frequently in his own commentary to Epidemics 6, because like Galen Rufus was often preoccupied with the medical sense of a passage and was willing to emend the Greek, when he found it corrupt and deficient in meaning.21 Sabinus, however, did compose a commentary to Aphorisms, and Galen’s polemic work Against Julianus represents something of a counterthrust in 20  Gal., De ord. libr. suor. 3.6–12, 1.98–99 Boudon-Millot. The earlier editions (Müller 1891, Kühn 1830, etc.) lack chapter 3.1–3.4 (middle) and only the edition by Boudon-Millot 2007 provides the more complete text of Galen’s De ordine librorum suorum recoverable from the newly-rediscovered MS Vlatadon 14, also the source of Galen’s Avoidance of grief, previously thought lost. 21  A commentary to Aph. by Rufus is mentioned in the prologue to Stephanus of Athens’ own commentary, CMG 11.1.3.1, 30.11–12 and 30.27–29 Westerink, but apparently not elsewhere. In the first passage Stephanus names Rufus together with Sabinus, Soranus, Pelops, and Galen—all of whom consider Aph. ‘a genuine work of Hippocrates’; in the second passage Soranus is said to have divided Aph. into three parts, Rufus into four, and Galen into seven. For Rufus as an exegete and medical predecessor for Galen, see Manetti and Roselli 1994, 1600–1606.

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defense of Sabinus, whose commentary Galen may not have considered firstrate, but it was better than what Julianus composed. Sabinus himself gets mentioned by name only when Galen is making fun of Julianus’ title and verbosity—Against the Aphorisms of Hippocrates in 48 books, ‘as people say’! In Galen’s opinion a more apt title would be Against the interpretations of Sabinus.22 Galen had failed to mention Sabinus in his own commentary to Aphorisms, seemingly the first commentary Galen wrote, although we learn something about the principles Sabinus followed in his commentaries to Epidemics 2, 3, and 6, because Galen’s own commentary to Epid. 6 repeatedly points to Sabinus’ deficiencies when explicating Hippocratic text. Even so, Galen and his circle at Rome read commentaries to Epidemics by Sabinus at the end of the 2nd c. CE, and Aulus Gellius in Athens was reading the Hippocratic Nutriment 42 on fetal development with Sabinus’ commentary to hand.23 No one tells us much about Sabinus’ commentary to Aphorisms; perhaps it was still popular in the latter years of the 2nd c. CE, and while it might have had brief interaction with the jejune commentary preserved in the Rylands papyrus, there is no sign that it did. Progress has been made in that the Rylands papyrus now occupies its proper place in the online database MP3 as one of the seven, discrete ancient copies of Hippocrates’ Aphorisms surviving to our time. The primacy that Aphorisms holds with its seven papyrus copies known is double that of other Hippocratic treatises.24 Even so, the exegete who composed the commentary for MP3 543.4 remains unknown.

22  Gal., Adv. Julian. 1 and 3, CMG 5.1.3, 33–70, especially 34 and 39 Wenkebach. For the conflicted role assigned to Sabinus by Galen, see Manetti and Roselli 1994, 1538 and 1607–1614; Smith 1979, 64–73, 148–155 and 162–63. 23  Gellius, Noct. Attic. 3.16.7–8 and 20. 24  Therapeutics dominate the Hippocratic papyri, with the exception of the pseudepigraphic Epist., and perhaps give us some sense as to why Hippocratic texts were still popular among the readers of medical literature even in late Rome and Byzantine Egypt. At the same time several treatises popular in modern times— Aër., Morb. Sacr., VM— are conspicuous for their absence, although examples of these on papyrus may yet be uncovered. Treatises in our CH represented by three or more papyri each: Epid.: (1.) MP3 537.1 (= Epid. 2.6.7–22), (2.) MP3 538 (= Epid. 3.1.9–12), (3.) MP3 538.01 (= Epid. 7.80), (4.) P.Oxy. 80 5222 (= Epid. 1, case 11). Fract.-Artic.: (1.) MP3 538.02 (= Fract. 1), (2.) MP3 538.03, antea 2352 (= Fract. 37), (3.) MP3 538.04, antea 538.03 (= Artic. 57–58, 60). Epist.: (1.) MP3 540 (= Epist. 3–6), (2.) MP3 541 (= Epist. 3–5, 11), (3.) MP3 542 (= Epist. 4–5, 11). One may add from the gynecologies: (1.) MP3 545.1 (= Superf. 32–33–34. 38–39, 41–42, and Mul. 1.1–2, 25; 2.32–33, 174–175, 180, 182, 205), (2.) MP3 545.11 (= Mul. 1.1), and (3.) a copy of Mul., found at Oxyrhynchus, P.Oxy. 80 5221.

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Bibliography

Editions and Collections of Papyri



Books and Articles

Accademia toscana di scienze e lettere ‘La Colombaria’, Corpus dei papiri filosofici greci e latini. Testi e lessico nei papiri di cultura greca e latina. Parte I 2. Cultura e filosofia, Galenus-Isocrates (= CPF I 2), Florence: Olschki 2008. ——— Parte IV 2. Tavole, Galenus-Isocrates (= CPF IV 2), Florence, 2008. Antinoopolis Papyri. Part I (= P.Ant. 1), ed. C.H. Roberts, London: Egypt Exploration Society, 1950. Antinoopolis Papyri. Part II (= P.Ant. 2), ed. J.W.B. Barns and H. Zilliacus, London: Egypt Exploration Society, 1960. Antinoopolis Papyri. Part III (= P.Ant. 3), ed. J.W.B. Barns and H. Zilliacus, London: Egypt Exploration Society, 1967. Catalogue of the Greek and Latin Papyri in the John Rylands Library, Manchester, Volume III (= P.Ryl. 3), Theological and Literary Texts, ed. C.H. Robert, Manchester, 1938. Greek Medical Papyri I (= GMP 1), ed. I. Andorlini, Florence, 2001. Greek Medical Papyri II (= GMP 2), ed. I. Andorlini, Florence, 2009. Kölner Papyri (P.Köln 9, Pap.Colon. VII/9), ed. M. Gronewald et al., Opladen, 2001. ‘Specimina’ per il Corpus dei Papiri Greci di Medicina. Atti dell’Incontro di studio. Firenze, 28–29 Marzo 1996, ed. I. Andorlini, Florence, 1997. Tebtunis Papyri II (= P.Tebt. 2), ed. B.P. Grenfell et al., London, 1907. Testi medici su papiro, ed. I. Andorlini, Florence, 2004.

Anastassiou, A., and Irmer, D. (eds.), Testimonien zum Corpus Hippocraticum. Teil I: Nachleben der hippokratischen Schriften bis zum 3. Jahrhundert n. Chr. Göttingen, 2006. Andorlini, I., ‘L’esegesi del libro tecnico: papiri di medicina con scoli et commenti’, Papiri filosofici. Miscellanea di studi 4 (2003), 9–29. ——— GMP 2.2. Florence, 2009, 15–33. Galen, De ordine librorum suororum, in: V. Boudon-Millot (ed.), Galien I. Paris, 2007, 3–127. Galen, Adversus Julianum, in: E. Wenkebach, (ed.), Galeni adversus Lycum et adversus Iulianum libelli CMG 5.1.3. Berlin, 1951, 33–70. Gibson, R.K., and Kraus, C.S. (eds.), Classical Commentary: Histories, Practices, Theory. Leiden, 2002. Guardasole, A., Eraclide di Taranto. Frammenti, testo critico, introduzione, traduzione, e commentario. Naples, 1997. Haase, W., (ed.), Aufstieg und Niedergang der römischen Welt 2.37.2. Berlin, 1994.

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Hanson, A.E., ‘Galen: Author and Critic’, in: G. Most (ed.), Editing Texts/Texte edieren, Aporemata 2. Göttingen, 1998, 22–53. ——— and Gagos, T., ‘Well Articulated Spaces: Hippocrates, Epidemics II 6.7–22’, in: I. Andorlini (ed.), ‘Specimina’ per il Corpus dei Papiri Greci di Medicina. Atti dell’Incontro di studio. Firenze, 28–29 Marzo 1996. Florence, 1997, 117–40. Hippocrates 4: Aphorisms 1–7, W.H.S. Jones, ed. Cambridge, MA, 1931, 98–221. Ihm, S., Clavis commentariorum der antiken medizinischen Texte. Leiden, 2002. Jouanna, J., ‘L’archéologie de l’École de Cnide et le nouveau témoignage du PKöln 356 (Inv. 6067)’, in: I. Andorlini (ed.), Testi medici su papiro. Florence, 2004, 221–36. López Férez, J.A., (ed.), Tratados Hipocráticos. Estudios acerca de su contenido, forma, e influencia. Actas del viie Colloque international Hippocratique, Madrid, 24–29 septiembre de 1990. Madrid, 1992. Lundon, J., and Matthaios, S., ‘Nominal accidents by question and answer: two fragments of a Τέχνη γραμματική, one new’, ZPE 154 (2005), 97–116. Manetti, D., and Roselli, A., ‘Galeno commentatore di Ippocrate’, in: W. Haase (ed.), Aufstieg und Niedergang der Römischen Welt 2.37.2. Berlin, 1994, 1529–1635. Mansfeld, J., Prolegomena: Questions to be settled before the study of an author or a text. Leiden, 1994. Marganne, M.-H., ‘La ‘Collection médicale’ d’Antinoopolis’, ZPE 56 (1984), 117–21. McNamee, K. Annotations in Greek and Latin Texts from Egypt. Cincinnati, 2007. Mertens-Pack, 3rd edition (= MP3), M.-H. Marganne (ed.), Centre de Documentation de Papyrologie Littéraire http://www2.ulg.ac.be/facphl/services/cedopal/. Continuation of R.A. Pack, The Greek & Latin Literary Texts from Greco-Roman Egypt (= P2). Ann Arbor, 1967. Most, G.W. (ed.), Editing Texts/Texte edieren, Aporemata 2, Göttingen, 1998. Müller, C.W., et al. (eds.), Ärzte und ihre Interpreten. Medizinische Fachtexte der antike als Forschungsgegenstand der klassischen Philologie. Beiträge zur Altertumskunde 238, Munich, 2006. Müller-Rohlfsen, I. (ed.), Die lateinische ravennatische Übersetzung der hippokratischen Aphorismen aus den 5./6. Jahrhundert n. Chr. Textkonstitution auf der Basis der Übersetzungscodices. Hamburg, 1980. Smith, W.D., The Hippocratic Tradition. Ithaca, 1979. Staden, H. von, Herophilus: The Art of Medicine in Early Alexandria. Cambridge, 1989. ———, ‘Lexicography in the Third Century BC. Bacchius of Tanagra, Erotian, and Hippocrates’, in: J.A. López Férez (ed.), Tratados Hipocráticos. Estudios acerca de su contenido, forma, e influencia. Actas del viie Colloque international Hippocratique, Madrid, 24–29 septiembre de 1990. Madrid, 1992, 549–69. ———, ‘A Woman does not become Ambidextrous: Galen and the Culture of Scientific Commentary’, in: R. Gibson and C.S. Kraus (eds.), Classical Commentary. Leiden, 2002, 109–39.

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———, ‘Interpreting “Hippokrates” in the 3rd and 2nd Centuries BC’, in: C.W. Müller et al. (eds.), Ärzte und ihre Interpreten. Medizinische Fachtexte der Antike als Forschungsgegenstand der Klassischen Philologie. Munich, 2006, 15–47. Westerink, L.G. (ed.), Stephanus of Athens. Commentary on Hippocrates’ Aphorisms: Text and Translation, CMG 11.1.3.1–3. Berlin, 1985–1995.

CHAPTER 3

Remarques sur le tableau de la médecine et d’Hippocrate chez Platon Paul Demont Les hypothèses que l’on peut faire sur les rapports entre Platon, Hippocrate et les textes médicaux du cinquième et du quatrième siècles sont, on le sait, fragiles. Une comparaison suffira à souligner ce point : Platon ne mentionne qu’une fois Isocrate, d’une façon énigmatique. Il serait impossible de reconstruire à partir du seul Platon une image d’Isocrate qui corresponde à ce que nous connaissons par ailleurs. Pourtant, dans ses discussions sur la ‘rhétorique’, la connaissance des œuvres d’Isocrate permet de penser que Platon débat au moins autant avec son rival Isocrate qu’avec d’autres, qu’il met en scène abondamment, comme Gorgias1. Le cas d’Hippocrate est plus complexe encore. Les deux mentions d’Hippocrate par Platon, l’une très générale, l’autre énigmatique, ne permettent pas de reconstruire la spécificité hippocratique. De plus, en l’absence d’œuvre dont on soit certain qu’Hippocrate en soit l’auteur, il est impossible de repérer à coup sûr chez Platon ce qui peut être ‘hippocratique’2. Enfin, tout comme quand Platon traite de rhétorique, il peut viser Isocrate à travers Gorgias, de même, quand il traite de médecine, il peut faire référence à ses contemporains immédiats plutôt qu’à Hippocrate, qui était de trente ans son aîné. Ces précautions prises, la tentation de définir à partir de Platon ce que peut être une médecine ‘hippocratique’ reste grande : Platon est, sur Hippocrate (né vers 460), notre seul témoin extérieur contemporain, par le biais du témoignage qu’il attribue à Socrate (né en 469) ou à ses interlocuteurs. Mario Vegetti, dans une série d’études des années 1966-1969 est peut-être celui qui a le plus complètement tenté de renouveler cette perspective dans la période 1  Indications sur ce point dans Demont (à paraître). 2  L’adjectif semble rarement employé en grec. Le Thesaurus Linguae Graecae mentionne μέρος τῆς Ἱπποκρατικῆς (Theophilus Protospatharius, Commentaires aux Aphorismes d’Hippocrate, éd. F.R. Dietz, 2.239, 27), à propos des différentes parties de ‘[scil. L’art] hippocratique’. Mais l’adjectif hippocraticus est attesté chez le poète latin Prudence. Sur ῾Ιπποκράτειος ‘Hippocratéen’, et son emploi chez Galien, voir dans ce volume la communication de V. Boudon-Millot, ch. 18.

© koninklijke brill nv, leiden, ���6 | doi ��.��63/9789004307407_005

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récente3. Pour lui, le groupe des ‘bons médecins’ de la Grèce dont le Charmide (156b) fait l’éloge a une valeur spécifique et réfère à l’école ‘hippocratique’. Le Gorgias, loin de polémiquer contre la conception de la médecine qu’on trouve dans l’Ancienne Médecine, prolonge les analyses de ce traité, qu’il juge hippocratique au sens fort du terme. L’Eryximaque du Banquet, mis en scène par Platon parce qu’il fait partie, comme son père Acoumène, des compagnons de Socrate, réunit aussi divers aspects de la médecine d’Hippocrate lui-même, joints à d’autres emprunts. Comme le Phèdre, dans un passage aussi célèbre que controversé, identifie explicitement, dans des termes qui évoquent le Charmide, une spécificité doctrinale d’Hippocrate, on pourrait donc réunir tout cet ensemble dans une présentation platonicienne de cette médecine hippocratique comme ‘modèle de savoir’ transposable en philosophie. Par la suite, dans la République, Platon, de plus en plus marqué par le modèle des sciences mathématiques, modèle qui remplacerait plus ou moins le modèle médical, prendrait ses distances avec les développements post-hippocratiques de la médecine diététique, à la fois dans ‘l’école de Cos post-hippocratique’ (celle dont seraient issus les livres les plus récents des Epidémies) et surtout chez Hérodicos de Sélymbrie, et il critiquerait en même temps les innovations des médecins cnidiens, tout en conservant le cadre général, ‘hippocratique’ au sens restreint, de sa présentation de la médecine. La perspective de Mario Vegetti se distinguait explicitement des études antérieures sur ‘la’ médecine (conçue de façon unitaire) et Platon, par l’insertion de la problématique des écoles médicales et par un parallélisme entre le développement de l’œuvre de Platon et l’évolution de l’Ecole de Cos. Et il pourrait sembler que la question mise au coeur du colloque d’Austin (‘What is Hippocratic about the Hippocratics?’) invite à suivre à nouveau cette direction. Mais la mise en cause de la notion même d’école médicale au cours des années qui ont suivi les articles de Mario Vegetti enlève, comme il le signale lui-même dès 1995 dans l’introduction au volume qui réunit ses études, une partie de leur pertinence aux conclusions que je viens de résumer de façon un peu brutale, même si les rapprochements entre les traités médicaux et l’œuvre de Platon qu’il a repris, approfondis ou proposés, restent très instructifs. Une perspective très différente a été souvent adoptée4. A partir du fait historique des visites de Platon en Sicile, de la probabilité, étayée, qu’elle soit authentique ou non, par la Lettre 7 (314d), qu’il ait rencontré Philistion, et de rapprochements indubitables, elle consiste à souligner les liens entre les idées 3  Etudes réunies dans Vegetti 1995, avec une introduction nouvelle. Je renvoie à ce livre pour la biliographie antérieure, qui est considérable. 4  Longrigg 1993 (ch. 5: ‘Post-Hippocratic Medicine I. Medicine and the Academy’).

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biologiques et médicales de Platon et les écoles médicales d’Italie du sud depuis Empédocle, notamment en ce qui concerne la reprise de la théorie des quatre éléments dans le Timée. On a pu aussi, en un tout autre sens, et néanmoins de façon tout à fait convaincante aussi, étudier les rapports étroits entre la pensée politique de Platon (ou d’autres penseurs) et des thématiques médicales bien attestées dans la Collection hippocratique sur la notion de changement5. Mon objectif aujourd’hui est limité. Il consiste à souligner d’abord, indépendamment des théories de Platon sur le corps humain et ses maladies, le caractère dans l’ensemble unifié du tableau de la médecine chez Platon. Bien sûr, cette unification laisse la place à des distinctions, qui seront brièvement évoquées dans une seconde partie. Enfin, la description de la méthode attribuée à Hippocrate dans le Phèdre sera examinée du point de vue, souvent négligé, du passage, dans la narration du dialogue, du médecin Eryximaque au médecin Hippocrate. L’ensemble suggère une explication, compatible avec beaucoup d’autres, qui sont certainement plus décisives, à la réunion, qui reste assez énigmatique, d’une collection d’écrits médicaux divers des cinquième et quatrième siècles sous le nom d’Hippocrate6. La première observation est qu’un tableau de la médecine chez Platon est possible, car Platon se réfère en règle générale à la médecine comme s’il n’y avait pas d’autres différences entre les médecins qu’une plus ou moins grande maîtrise d’un même savoir médical, ce qu’il appelle avec des formules différentes selon les dialogues, mais toujours compatibles entre elles, et qu’on peut résumer par : ‘la connaissance du soin des malades’, selon la formule générale du Protagoras (ἡ τῶν καμνόντων τῆς θηραπείας μάθησις, 345a, cf. République 1, 341c), permettant le retour à l’état de santé (Lois 12, 962a). Ce point va de soi pour les spécialistes de Platon, mais il surprend les spécialistes de la Collection hippocratique ou de la médecine antique, car il semble peu compatible avec les divergences considérables qu’on y observe entre les théories sur le pronostic et l’étiologie, ou entre les méthodes thérapeutiques. Voici deux exemples, parmi des dizaines d’autres, de cette approche unifiante de la médecine et du ou des médecins. Sur la médecine : ‘Bien diagnostiquer si Homère a raison de dire cela, est-ce le fait de la médecine ou de l’art du rhapsode?’ (πότερον ἰατρικῆς ἐστιν διαγνῶναι καλῶς ἢ ῥαψωδικῆς, Ion 538c) ou pour le médecin : ‘Réaliser tous leurs désirs, par exemple, quand ils ont faim, manger, ou quand ils ont soif, boire autant qu’ils le veulent, les médecins (οἱ ἰατροί) ne le permettent pas, le plus souvent, aux gens en santé, mais, quand on est malade, ils interdisent 5  Voir en particulier Jouanna 1978, 1980a, 1980b, et, sur la question du rapport d’Ancienne Médecine avec le Protagoras de Platon, Demont 2013. 6  Cf. Roselli 2000.

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pratiquement toujours de se gaver de tout ce dont on a envie’ (Gorgias 505a). Le Politique (267e) emploie même la formule : τὸ τῶν ἰατρῶν γένος, ‘la famille des médecins’. Dans cette perspective, la médecine se caractérise, du point de vue des traitements proposés aux malades, par des constantes. On peut résumer ‘les traitements des médecins’: ‘par cautérisation, incision, purgatif ou jeûne’ (τὰς ὑπὸ τῶν ἰατρῶν θεραπείας τὰς διὰ καύσεών τε καὶ τομῶν καὶ φαρμακείων καὶ λιμοκτονιῶν γιγνομένας, Protagoras 354a). Ce résumé se retrouve sous une forme ou sous une autre dans le Gorgias (456 b-c, 479a, 480c), où, en particulier, dans la scène finale du médecin jugé par un tribunal d’enfants, sont évoqués : couper, brûler, dessécher, faire suffoquer, faire boire des remèdes amers, faire jeûner (521e). Le cas du Gorgias est à cet égard particulièrement éloquent. C’est le dialogue où les aspects violents de la thérapeutique médicale antique sont peut-être le plus soulignés, comme on vient de le voir. Mais c’est aussi celui qui, dans la comparaison faite par Socrate devant Polos, aux paragraphes 464-466, met en parallèle la médecine et la cuisine, ce qui suppose que la diététique (les ‘aliments utiles et nuisibles’, περὶ τῶν χρηστῶν σιτίων καὶ πονηρῶν, 464d) est une composante évidente et essentielle de la compétence du médecin7. A ce niveau de généralité, on retrouve donc les principaux types de traitement des traités hippocratiques, sans hiérarchie : médecine dite chirurgicale, médecine pharmaceutique, médecine diététique sont évoquées sur le même plan. La notion d’évacuation, de purge, ou de purification est fréquente, et particulièment thématisée dans le Sophiste (230c). On trouve une fois une référence générale aux deux principales humeurs nocives des traités hippocratiques, ‘le phlegme et la bile’, dont ‘le bon médecin’ (en général) doit éviter l’apparition et, si elles apparaissent, qu’il doit évacuer, au besoin par incision, immédiatement (République 8, 564b-c). Le danger des remèdes évacuants, qui nécessite la maîtrise de la ‘science’ médicale, est souligné dans la législation des Lois (11, 933b-d) sur les drogues. Cette perspective unifiante est partagée par les interlocuteurs de Socrate. Lorsque Platon reconstruit, dans le Théétète, l’apologie que Protagoras aurait pu prononcer en face de Socrate, il lui fait aussi attribuer aux médecins en général, sur la question des humeurs, des positions très proches de celles qu’on lit dans l’Ancienne Médecine et ailleurs sur l’utilisation du ‘changement’ (μεταβολή) en thérapeutique pour résoudre le ‘changement’ introduit par la maladie (166e-167a). Ailleurs, le même Protagoras déclare sans susciter de contestation : ‘Tous les médecins (οἱ ἰατροὶ πάντες, on remarque à nouveau la généralisation) défendent aux malades de mettre de l’huile dans ce qu’ils vont 7  Voir sur ce point la contribution de Jacques Jouanna dans ce volume, ch. 7.

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manger, sauf une toute petite portion, pour effacer, dans les nourritures et les boissons, le désagrément lié aux perceptions olfactives’ (Protagoras 334c) – une phrase dont on ne peut guère trouver de confirmation précise dans les nombreux traités ‘hippocratiques’. Ce dernier cas montre que la médecine chez Platon englobe évidemment plus que la Collection hippocratique telle que nous l’avons conservée8. L’unification de la médecine chez Platon repose enfin, et surtout, sur une série de définitions abstraites, le plus souvent dans la perspective de la définition de la techne en général, à partir de la techne qui s’occupe du corps humain, dans la mesure où celui-ci, par nature, peut tomber malade, ce qui a conduit à la ‘découverte’, maintenant réalisée, de la médecine (διὰ ταῦτα καὶ ἡ τέχνη ἐστὶν ἡ ἰατρικὴ νῦν ηὑρημένη, ὅτι σῶμά ἐστιν πονηρὸν καὶ οὐκ ἐξαρκεῖ αὐτῷ τοιούτῳ εἶναι, ‘La techne médicale est maintenant découverte pour la raison que le corps est en mauvais état et ne peut se suffire de rester en tel état’, République 1, 341e). Pour connaître la nature du bon état du corps, il faut lire la description de la sphère initiale du Timée, avec son harmonie parfaite entre les quatre éléments, qui interdit toute prédominance du chaud ou de froid, et donc toute maladie, et inversement la description du corps humain malade dans le même dialogue (32e-33a, 82a-b). Le savoir ‘du médecin’ est défini comme ‘la connaissance de l’état de santé et de l’état de maladie’ (τὸ ὑγιεινὸν. . .καὶ τὸ νοσῶδες, Lachès 195c). La médecine est l’art qui nous débarrasse de la maladie (Gorgias 477e). L’étiologie, la sémiologie et le pronostic relèvent d’une seule et même médecine : ‘Concernant l’état de santé, ce ne sont pas des médecines différentes qui surveillent ce qui arrive, ce qui a eu lieu et la façon dont arrivera ce qui arrivera, car la médecine est unique’ (οἷον περὶ τὸ ὑγιεινὸν εἰς ἅπαντας τοὺς χρόνους οὐκ ἄλλη τις ἢ ἰατρική, μία οὖσα, ἐφορᾷ καὶ γιγνόμενα καὶ γεγονότα καὶ γενησόμενα ὅπῃ γενήσεται, Lachès 198d). Une définition du Gorgias met particulièrement l’accent sur le caractère rationnel de la médecine, qui la conduit à analyser la physis de ce qu’elle soigne, à donner l’aitia de ses recommandations et pouvoir donner un logos de tout ce qu’elle fait : à la différence de la cuisine, dit 8  Le traitement médical par la cendre mentionné dans le Lysis (210a) a en revanche un parallèle en Epidémies 2.5.28. Si Platon nie toute spécificité de la santé de la femme par rapport à celle de l’homme (Ménon 72d-e), cela n’est pas du tout contradictoire avec les traités hippocratiques, qui, à l’exception des traités gynécologiques, envisagent le plus souvent de façon indifférenciée hommes et femmes (cf. e.g., à propos du Pronostic, Jouanna 2013, 29). La gynécologie intéresse Platon sous l’aspect de la procréation et de la formation des nouveaux-nés, dans les Lois – une perspective qui est générale dans la médecine antique aussi. Signalons au passage qu’aux yeux de Platon, il existe des femmes naturellement douées pour la médecine (République 4, 455e).

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Socrate, ‘la médecine est une techne, à mon avis, ai-je dit, en mentionnant le fait que la médecine, elle, examine complètement la nature de ce à quoi elle donne ses soins et la cause de ce qu’elle fait, et qu’elle est capable de rendre raison de chacune de ses démarches’ (λέγων ὅτι ἡ μὲν τούτου οὗ θεραπεύει καὶ τὴν ́ τούτων ἑκάστου δοῦναι, ἡ φύσιν ἔσκεπται καὶ τὴν αἰτίαν ὧν πράττει, καὶ λόγον ἔ�χει ἰατρική, 501a). Pour Platon, il n’y a, ici du moins, qu’une seule médecine, et elle est rationnelle9. Cette unité de la médecine est liée à la conception platonicienne de la techne: en médecine comme ailleurs, il y a une techne et une seule, dont le spécialiste est le seul véritable connaisseur et dont le savoir s’impose au profane (Théétète 178c), parce que la techne fournit la raison pour laquelle une pratique est efficace. Thrasymaque lui-même dit, dans le premier livre de la République, que le médecin, en tant que médecin, ne se trompe pas, même si on dit couramment que le médecin s’est trompé, car l’art suppose la connaissance exacte de son objet (Rép. 1, 340d-e). Glaucon, plus tard, reprend cette affirmation d’une autre façon, en disant que le bon médecin est capable de corriger ses erreurs éventuelles, et en ajoutant le refus de soin dans les cas incurables comme preuve de sa compétence : ‘Un pilote, un médecin éminents (οἷον κυβερνήτης ἄκρος ἢ ἰατρός), discernent dans leur art ce qui est impossible et ce qui est possible ; à celui-ci ils entreprennent de travailler, ils renoncent à l’autre ; bien plus, s'il leur arrive de faire une erreur, ils sont capables d’opérer le redressement voulu’ (2, 360e-361a). Il peut y avoir des médecins meilleurs que d’autres, mais à l’intérieur d’un art unique de la médecine. Ainsi, quand Socrate, au début du Protagoras, évoque devant le jeune Hippocrate l’idée de suivre l’enseignement de son homonyme le grand Hippocrate de Cos, de la famille des Asclépiades, pour devenir médecin, il ne peut s’agir que de devenir médecin au sens le plus général du mot, indépendamment de toute spécificité que nous appellerions hippocratique (Prot. 311b-c). Hippocrate n’est, dans ce passage bien connu, que le prototype du maître de médecine, ‘le représentant paradigmatique de l’art médical’10. C’est ce que montre la reprise du même argument, mais sous une forme générale, sans la mention d’Hippocrate, dans le Ménon: ‘Si nous voulions que Ménon ici présent 9   Le contraste est évidemment éclatant avec les distinctions du commentaire d’Olympiodore (2, 3: Jackson et al., 1998): ‘For just as a rationalist doctor knows that wet diets help people with fevers, so too do the empirical doctors. And just as the rationalist doctor knows that the eye-sufferer needs to drink wine neat of needs washing or a vapour-bath, so too does the empirical doctor. But the rationalist and crafstmanlike doctor also supplies causes, whereas the empirical doctor does not know them’. 10  Jouanna 1992, 16.

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devienne un bon médecin, auprès de quels maîtres devrions-nous l’envoyer? Ne sera-ce pas auprès des médecins (παρὰ τοὺς ἰατρούς)?’, c’est-à-dire, en général, ‘des gens qui revendiquent pour eux-mêmes la connaissance de l’art (τοὺς ἀντιποιουμένους τε τῆς τέχνης)’ (90b-d). À la question posée, on répond donc, selon le dialogue, ou bien : ‘Hippocrate’, ou bien : ‘les médecins’. Cette constatation de la tendance générale à l’uniformisation de la techne iatrike doit naturellement être corrigée. Platon établit des distinctions et des hiérarchies, par le biais d’oppositions géographiques, par la reconstruction d’évolutions historiques, par des incertitudes sur les frontières de la médecine, et même sur la valeur de l’art médical. Une distinction renforce toutefois en fait le tableau unifié de la médecine qui vient d’être présenté, en y ajoutant un élément, son caractère ‘grec’. Platon oppose ‘les médecins grecs’ aux ‘médecins thraces de Zalmoxis’ dans le Charmide (156d). Si, en Grèce, ‘les bons médecins’ (τῶν ἀγαθῶν ἰατρῶν, 156b) savent qu’il est nécessaire de ne pas soigner les yeux sans la tête, ni la tête sans le corps, et, en conséquence, ‘tentent de soigner et de guérir la partie en même temps que le tout, en se tournant vers l’ensemble du corps au moyen des régimes’ (διαίταις ἐπὶ πᾶν τὸ σῶμα τρεπόμενοι μετὰ τοῦ ὅλου τὸ μέρος ἐπιχειροῦσιν θεραπεύειν τε καὶ ἰᾶσθαι, 156c), Socrate a appris à l’armée (à Potidée, en 432-429) auprès de ‘l’un des médecins thraces de Zalmoxis, dont on dit qu’ils donnent l’immortalité’, que ces médecins grecs, si bons qu’ils soient, omettent de soigner l’âme, et, dit ce médecin, ‘c’est la raison pour laquelle la plupart des maladies échappent aux médecins grecs : ils négligent la totalité dont il faut avoir le souci et dont le mauvais état rend impossible le bon état de la partie’ (τοῦ ὅλου ἀμελοῖεν οὗ δέοι τὴν ἐπιμέλειαν ποιεῖσθαι, οὗ μὴ καλῶς ἔχοντος ἀδύνατον εἴη τὸ μέρος εὖ ἔχειν, 156e). Cette distinction entre bons médecins grecs (ou bien, notons-le une fois encore, sans spécification, les médecins grecs, le bon médecin étant le prototype du médecin en général) et médecins thraces fait certes partie de la stratégie déployée par Socrate pour s’approcher du tout jeune et beau Charmide, qui a mal à la tête, et qu’il veut persuader de discuter avec lui : pour pouvoir lui parler, il tient à introduire la notion de la guérison par des ‘incantations’ (καὶ τὰς ἐπῳδάς) s’adressant à l’âme, et non pas seulement par un ‘remède’ (τό τε φάρμακον, 157b) soignant le corps. Le médecin thrace lui aurait dit : ‘Attention à ce que personne ne te persuade de le soigner avec le remède sans t’avoir donné d’abord son âme à soigner par l’incantation’ (ὅπως τῷ φαρμάκῳ τούτῳ μηδείς σε πείσει τὴν αὑτοῦ κεφαλὴν θεραπεύειν, ὃς ἂν μὴ τὴν ψυχὴν πρῶτον παράσχῃ τῇ ἐπῳδῇ ὑπὸ σοῦ θεραπευθῆναι, 157b). Mais, indépendamment du contexte, ce passage complète sur deux points les analyses précédentes. La bonne médecine grecque, prise de façon générale, n’est pas, pour Socrate, une médecine spécialisée, en ce sens qu’elle ne soigne pas une partie du corps sans

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envisager l’ensemble du corps (τὸ ὅλον, bis), et c’est une médecine du ‘corps’, ce n’est pas une médecine de ‘l’âme’11. De plus, le Socrate de Platon considère que la bonne médecine grecque de son temps n’utilise pas les incantations de type magique : un passage de la République, qui semble bien distinguer d’un côté ‘drogues, cautérisations et incisions’, et de l’autre ‘incantations, amulettes et ce genre de chose’, va probablement dans le même sens (contre une vie de débauche, ‘ni les drogues, ni les cautérisations, ni les incisions, ni d’un autre côté les incantations, les amulettes ou ce genre de chose ne seront d’aucune utilité’, οὔτε φάρμακα οὔτε καύσεις οὔτε τομαὶ οὐδ᾿ αὖ ἐπῳδαὶ αὐτὸν οὐδὲ περίαπτα οὐδὲ ἄλλο τῶν τοιούτων οὐδὲν ὀνήσει, République 4, 426b). Non pas que Platon, d’ailleurs, refuse l’existence d’un art des incantations, dans d’autres contextes, par exemple dans l’Euthydème (290a), pour le soin des morsures et des maladies, sans toutefois parler de iatrike; dans le Cratyle, il mentionne même la médecine religieuse d’Apollon, en faisant un parallèle explicite entre médecine et mantique (405a : utilisation du soufre pour la purification, pratique du bain) qui peut faire écho au second genre de ‘folie’ signalé dans le Phèdre (244d-e); dans le Politique, il évoque ‘les antidotes divins et humains’ (ἀλεξιφάρμακα καὶ θεῖα καὶ ἀνθρώπινα, 279c), dont certains relèvent de ‘l’art de la magie’ (280d). Surtout, Socrate est déclaré connaître, en quelque sorte par filiation maternelle, l’art des incantations, qu’utilisait déjà sa mère Phénarétè la sage-femme, capable d’accélérer, de ralentir ou de provoquer l’accouchement par des drogues ou des incantations (Théétète 148a, 149c-d, cf. 157d). Les incantations sont aussi mentionnées dans les soins corrects à donner aux enfants nouveaux-nés (Lois 7, 790e), où elles sont comparées aux ‘moyens de guérir les transports bacchiques’. Mais, en tout cela, Platon est-il si éloigné du médecin de Maladie sacrée, qui, lui aussi, reconnaît le rôle des purifications assurées par la divinité dans les sanctuaires ‘en cas de souillure ou d’affections venant d’ailleurs’ (6.364.12 L, Jouanna 9)? Il n’y a pas incompatibilité entre la médecine humaine et la médecine d’Apollon12. Platon évoque aussi un autre pays, l’Egypte, qui est réputé aux origines de la médecine. Elle y est, comme dans les cas précédents, liée à la mantique, mais, dans ce pays des origines, d’une façon explicite et fondamentale. La phrase du prêtre de Saïs à Solon d’Athènes dans le Timée est difficile et comprise de 11  Bien sûr, cette médecine du corps est, chez les médecins, le fait de l’âme ; les médecins ont aussi l’expérience de nombreuses natures de malades et peuvent eux-mêmes avoir été malades, et souvent, dit Socrate (République 2, 408d-e) d’une façon qui semble par avance indiquer que le cas d’Hérodicos de Sélymbrie, dont nous parlerons dans un instant, est exceptionnel, et ne peut servir de règle pour juger tous les médecins. 12  Cf. notamment van der Eijk, 1990, 87-119.

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diverses façons, mais ne laisse aucun doute sur ce lien : ‘Pour ce qui relève de la réflexion (τὸ δ ̓ αὖ περὶ τῆς φρονήσεως), tu vois bien quelle grande attention ici la loi lui a portée dès le commencement, en découvrant, en relation avec l’ordre du monde (περί τε τὸν κόσμον), toutes choses, jusqu’à la mantique et la médecine, pour la santé, à partir de tout cela, qui est divin, jusqu’à ce qui est humain, et en acquérant tous les savoirs qui découlent de ceux-ci’ (Timée, 24c). A cette géographie historique, Platon ajoute une histoire interne de la médecine grecque, en Grèce même, aux livres 2 et 3 de la République, ce qui lui permet d’opposer la médecine de la cité malade actuelle à la médecine des temps héroïques13. Dans la cité actuelle, la médecine tient nécessairement une place excessive : la cité étant devenue ‘inflammatoire’ (φλεγμαίνουσαν, 2, 372e), ‘nous aurons, dit Socrate, beaucoup plus besoin de médecins, avec un tel régime, qu’auparavant’ (2, 373d). ‘Beaucoup de tribunaux et de cabinets médicaux (ἰατρεῖα πολλά) ouvrent et la médecine comme la judicature sont en grand honneur’ (3, 405a, cf. 5, 489b). Car les médecins ne soignent plus seulement les ‘blessures’ et les ‘maladies saisonnières’, mais aussi mille maladies auxquelles les ‘Asclépiades raffinés’, bien éloignés de leur ancêtre Asclépios et de ses enfants, donnent les noms (incroyables, aux yeux de Socrate et de ses interlocuteurs, mais, on le sait, bien attestés dans la Collection hippocratique) de ‘vents’ et de ‘catarrhes’ (405d)14. Je ne ferai que deux remarques sur ce texte célèbre, avant d’y revenir dans ma conclusion. Platon discute le remède donné à Eurypyle pendant la guerre de Troie, selon Homère (11.639), dans un passage qui est aussi évoqué dans l’Ion avec un texte différent, dont le texte exact est donc encore mouvant à l’époque de Platon, ce qui correspond peut-être à une controverse médico-poétique : ‘Les fils d’Asclépios, à Troie, ne firent aucun reproche à celle qui donna à boire à Eurypyle blessé ‘du vin de Pramnos avec force farine et fromage râpé’, préparation qui passe pour être inflammatoire (φλεγματώδη εἶναι). – Et pourtant c’est vraiment une boisson absurde (ἄτοπόν γε τὸ πῶμα) pour quelqu’un dans son état !’ (3, 405e-406a). Le commentaire socratique de la citation homérique et la réaction de ses interlocuteurs supposent la connaissance partagée, par des non-médecins, à la fois du texte homérique, de la nature ‘inflammatoire’ (c’est probablement le sens de l’adjectif ici) du remède mentionné dans ce texte, et de son caractère inapproprié en cas de blessure, et cela suppose aussi que le lecteur a cette connaissance. Un remède de ce genre intervient à plusieurs reprises dans les traités gynécologiques et nosologiques de la Collection 13  Cf. Jouanna 2003 et Demont 2009. 14  Il vaut peut-être la peine de noter ici que, selon le Phédon (118a), Socrate, au moment de mourir, pense à régler ses dettes avec . . . Asclépios.

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hippocratique. Il est vrai qu’il ne s’agit pas alors de blessure ni de ‘catarrhe’, mais de ‘flux’ (ῥόος) – vomissements ou diarrhées, notamment chez une femme qui vient d’accoucher, dans Nature de la femme 51, 1 (7.394 L, 65 Bourbon), où le remède est ainsi composé : ‘De la présure de jeune chèvre, délayée dans du vin de couleur noire, avec du fromage de chèvre râpé par dessus et en y jetant de la farine de blé grillée’. Un remède comparable, dans le même traité, est décrit comme évacuant. La nature inflammatoire n’est pas mentionnée. Cependant, un passage bien connu de l’Ancienne Médecine (20, 1.620-624 L, 145-148 Jouanna) discute longuement des dangers du vin et du fromage (séparés), et on doit en conclure que seul le médecin peut décider de leur emploi en fonction de sa connaissance du patient particulier qu’il soigne. La question de l’Ion à propos du même passage homérique suggère aussi que la condamnation péremptoire de la République ne doit pas être prise trop au sérieux : ‘Bien diagnostiquer si Homère a raison de dire cela, est-ce le fait de la médecine ou de l’art du rhapsode? – De la médecine’. (Ion 538c). C’est le fait de la médecine, donc, et non pas des interlocuteurs de la République! Un passage des Lois (1, 638c) va dans le même sens15. Cette première remarque renvoie à notre première partie : il y a bien une médecine à laquelle même les profanes avertis, c’est-à-dire une partie du public des traités médicaux, y compris Socrate et ses interlocuteurs, doivent se référer. La seconde remarque tient au rôle attribué à Hérodicos de Sélymbrie dans l’évolution que condamne Socrate : il en serait le principal responsable (406a), pour des raisons personnelles, en tant que ‘pédotribe’ tombé malade lui-même et ayant donc dû unir la ‘gymnastique’ et la ‘médecine’. La distinction entre les deux arts est fermement posée dans le Gorgias, on le sait, mais ici, elle semble s’effacer. La gymnastique suppose l’entraînement régulier du corps en santé ; bien menée, elle rend inutile la médecine (410b)16; la médecine diététique, en revanche, désormais propose un entraînement régulier du corps malade, qui entretient, non plus la santé, mais la maladie, une nosotrophia (νοσοτροφία, 407b). On connaît une autre version platonicienne, un peu différente, du régime de ‘promenades’ prescrit par Hérodicos, dans le Phèdre (aller à pied jusqu’à Mégare et revenir par les Longs Murs, 227d!), version ironique qui, plus que le passage de la République, trouve, on le sait, un écho direct dans un passage inhabituellement polémique des Epidémies 6.3.18 (5.302 L, 69-69?? Manetti-Roselli) où un Hérodicos (le même homme, probablement) est accusé de tuer les fébricitants à coups, notamment, de ‘promenades’. Dans 15  Il a été corrigé depuis Cornarius pour harmoniser plus encore ce passage avec le traité hippocratique (cf. Jouanna 1990, ad loc. et Schiefsky 2005, 316-317). 16  Opinion similaire dans Lieux dans l’homme 35.

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la République, la critique est certes différente : loin de tuer, Hérodicos empêche de mourir et prolonge vainement la maladie. Mais les deux textes veulent combattre ce qui est présenté d’abord comme une déviation de la gymnastique : la description platonicienne n’est pas incompatible avec les positions de certains médecins ‘hippocratiques’ eux-mêmes. Avec le cas d’Hérodicos, nous passons de l’histoire de la médecine à la question de la frontière de la médecine. Le rapport entre médecine et gymnastique est étroit chez Platon. Dans le Gorgias même, qui les distingue le plus nettement, elles sont appariées, comme étant les deux technai relatives au soin du corps. Et on les trouve associées bien souvent. Dans le Sophiste, en tant que purgeant17 l’intérieur du corps (226e-227a), puis en tant que corrigeant respectivement la laideur et la maladie (‘N’y a-t-il pas pour le corps ces deux arts jumeaux concernant ces deux affections jumelles? – Lesquels? – Concernant la laideur, la gymnastique, concernant la maladie, la médecine’, 228d-229a). Dans le Protagoras, le spécialiste de la gymnastique et le médecin (γυμναστικὸς ἢ ἰατρός) sont évoqués ensemble par Socrate en tant que seuls connaisseurs des effets du régime alimentaire sur le corps (313d). Cette association se retrouve, avec l’agriculture, dans le Banquet (187a), les Lois (889d), et, avec d’autres arts encore, y compris la cuisine(!), dans le Politique (289a). De la même façon, le médecin et le ‘gymnaste’ sont évoqués ensemble bien souvent, par exemple dans le Sophiste (267e, 295c), ou dans les Lois (684c, 720e, 916a). Un point commun aux deux arts est à l’occasion spécifié : ils corrigent avec rudesse et non sans douleur (Phédon 94d, Sophiste 227a, Lois 1, 646c). Ils agissent en accord avec la nature (Lois 10, 889d). Les deux métiers de médecin et de spécialiste des gymnases sont enfin rapprochés de façon très étroite dans la législation sur les ventes d’esclaves malades (Lois 11, 916a-b). La supériorité, pour l’entretien du corps, de la gymnastique sur les traitements médicaux est rappelée encore dans le Timée: la gymnastique est la règle, la médecine l’exception, et cela correspond naturellement à la place attribuée chez Platon à la santé18.

17  La notion de purge ou de purification ne renvoie bien sûr pas nécessairement à la religion ni au pythagorisme. Notons que la pensée ‘religiös-kathartischen’ (Wehrli 1951, 60) du Phédon, qui, elle, est en relation avec la pythagorisme, n’est pas présentée par Platon en rapport avec l’art de la médecine. 18  Une place bien mise en valeur dans la conclusion du chapitre de W. Jaeger sur ‘Greek Medicine as Paideia’ (Jaeger 1943, 3-45). En revanche, il y a, semble-t-il, moins d’étude sur la ‘gymnastique’ chez Platon que sur la médecine chez Platon, peut-être en raison du moindre prestige social actuel de l’une par rapport à l’autre, et surtout en l’absence de traités conservés de ‘gymnastique’.

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Le Timée mérite une mention particulière. En effet, outre la théorie des maladies par excès ou défaut des quatre éléments, que j’ai rappelée plus haut, il analyse en détail la formation des maladies par la production de ‘biles, ichors et phlegmes de toutes sortes’ (χολὰς καὶ ἰχῶρας καὶ φλέγματα παντοῖα, 82e), en se référant évidemment à la nomenclature médicale que nous connaissons comme hippocratique, tout en prenant ses distances à son égard. Pour ‘l’amertume’ (πικρότης) appelée ‘bile’, il réserve peut-être un rôle particulier à un médecin dialecticien : ‘Le nom commun à tous ces éléments, ‘bile’, ou bien ce sont certains médecins qui l’ont trouvé, ou bien un homme doué de la capacité de considérer des éléments divers et dissemblables tout en observant en eux la présence d’un type générique méritant une appellation commune. Quant au nom des différentes espèces de bile, chacune a le sien en fonction de la couleur’ (83b). On se souvient de la formule très proche par laquelle l’auteur de l’Ancienne Médecine signale son rôle et celui de ses collègues dans la dénomination de la ‘bile jaune’: ‘une certaine amertume que nous, nous appelons bile jaune’ (19, 1.618.5 Littré, 144 Jouanna). Pour les ichors et les phlegmes, le Timée cite des appellations hippocratiques : ‘Un tel mal est appelé phlegme aigu’ (ὀξὺ φλέγμα, 83c, cf. Maladies des femmes 128, ὀξυφλεγμασίη Maladies des jeunes filles 1), ‘Nous disons que c’est un phlegme blanc’ (λευκὸν φλέγμα, 83d, cf. Maladies 2, passim): la formule employée montre l’accord donné à la nomenclature médicale que nous connaissons. Il est ensuite question de ‘sphacèle’ (84b). Dans la division ultérieure des maladies, sont mentionnées en outre ‘tétanos et opisthotonos’ (dus au souffle, 84e), maladies à catarrhe (dues au phlegme), maladies inflammatoires dues à la bile (85b) comme ‘diarrhées, dysenteries et tout ce genre de maladies’ (85e) et fièvres continues, tierces, quotidiennes ou quartes selon l’élément en excès (86a). Plus loin, il est question, de façon unique chez Platon, mais de façon tout à fait cohérente avec la Collection hippocratique, des maladies des femmes, dues à la matrice (90c). Tout ce vocabulaire est présenté sans distinction de provenance, comme quelque chose de connu, même s’il apparaît curieux, nouveau ou contestable, et, quelle que soit l’origine des doctrines biologiques de Platon, il est compatible avec les textes hippocratiques. Pour ne mentionner encore que deux aspects en rapport avec notre exposé, on retrouve dans le Timée la thématique du soin de l’âme, rappelée juste après l’exposé des maladies corporelles, non sans une critique ironique d’une certaine médecine du corps qui peut faire penser au Charmide: un manque d’harmonie entre une âme trop forte et un corps trop faible peut ‘tromper la plupart de ceux qu’on appelle médecins’ (88a), incapables d’identifier cette source psychique des fièvres et des flux. En second lieu, Platon accepte ce que Socrate refusait énergiquement dans la République, le soin des maladies de

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longue durée par le régime, pour lesquelles il faut, dit-il, éviter le plus possible les ‘drogues’: ‘Il faut conduire (παιδαγωγεῖν, à comparer à la νοσοτροφία de la République) tout ce genre de maladies avec des régimes, pour autant qu’on en ait le loisir, au lieu de les irriter par des drogues pour en faire un mal difficile’ (89c-d). Le Philèbe (55e-56b) indique, d’une façon remarquable, que la médecine fait partie des arts, comme l’aulétique, l’agriculture, l’art du pilote, l’art du stratège, qui n’ont qu’un rapport médiocre avec la mesure et qu’on atteint ‘par expérience, à force d’en user, en se servant des capacités de l’art de la prévision que beaucoup de gens appellent technai, qui tiennent leur efficacité de l’entraînement et de l’effort’ (ἐμπειρίᾳ καί τινι τριβῇ, ταῖς τῆς στοχαστικῆς προσχρωμένους δυνά�́μεσιν ἃς πολλοὶ τέχνας ἐπονομάζουσι, μελέτῃ καὶ πόνῳ τὴν ῥώμην ἀπειργασμένας). Cela nuance le rôle de modèle que joue la médecine dans la philosophie platonicienne, et montre que même après le Gorgias, et malgré le Gorgias, Platon peut considérer la médecine comme une techne reposant sur l’expérience (empeiria): même à l’intérieur de l’œuvre de Platon, ce dialogue ne constitue donc pas une rupture décisive et définitive après laquelle on devrait désormais distinguer entre techne et simple empeiria19. Signalons ici qu’une définition de l’Epinomis pseudo-platonicienne (976a) prolonge l’analyse du Philèbe, avec le même contexte de l’art du stratège, de celui du pilote mais ajoute, en plus, en oubliant complètement le Gorgias, l’art rhétorique(!). Selon une autre nouveauté, Platon décrit même, au livre 4 des Lois, une distinction entre ‘deux espèces de ceux qu’on appelle les médecins’ (δύο γένη τῶν καλουμένων ἰατρῶν), selon qu’il sont esclaves, ayant appris l’art par expérience et non par nature (κατ ̓ἐμπειρίαν . . ., κατὰ φύσιν δὲ μή), ou libres, le tenant de leurs parents (720b, cf. 9, 857c). Alors que la médecine acquise des esclaves procède par contrainte, de façon ‘tyrannique’ (cf. aussi 722e), la médecine héréditaire libre procède par dialogue avec le malade, où le médecin s’informe auprès de lui, et où il explique au malade son traitement afin de le persuader de le mettre en œuvre, comme on le ferait avec des enfants (720a). Cette distinction est valable d’ailleurs aussi pour les maîtres de gymnastique, dit-il. Mais lorsque 19  Contra Wehrli 1951b, qui reconstitue la pensée platonicienne sur la médecine en voyant dans le Gorgias un point d’aboutissement. Selon moi (Demont 2013, 116 n.12), ce dialogue ne constitue pas non plus, a fortiori, une rupture définitive dans l’histoire de la pensée, que tous les penseurs devaient connaître, notamment l’auteur du traité de l’Ancienne Médecine (selon un argumentaire souvent utilisé dans la détermination de la date de ce traité : cf. Jouanna 1990, 77 et 85 et, de façon moins assurés, Schiefsky 2005, 63 (voir aussi 354, où il est observé avec raison que ‘Aristotle, like Plato, often treats techne and empeiria as virtual synonyms in non-specialized contexts’.

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cette distinction est explicitement reprise au livre 9, la médecine libérale y apparaît presque ridicule, car elle transforme le soin des malades en cours de médecine pour apprentis-médecins, à force de remonter à ‘la nature entière des corps’ (περὶ φύσεως πάσης ἐπανιόντα τῆς τῶν σωμάτων, 857d – l’expression est remarquable), selon une orientation didactique qu’on doit introduire dans la législation mais qui n’a guère sa place, estime Clinias, en médecine20. Ainsi, malgré l’unité générale de la présentation platonicienne de la médecine grecque, Platon prend parti de différentes façons, principalement, et de façon constante, pour revendiquer la supériorité de la médecine de l’âme (ce qu’est pour lui la philosophie) sur la médecine du corps, en second lieu pour privilégier la gymnastique par rapport à la médecine ; la pertinence du développement chronologique depuis un modèle pratique jusqu’à une priorité donnée aux sciences exactes semble aussi assurée ; enfin, on observe dans son œuvre une évolution en faveur de la médecine diététique et en faveur aussi, non sans un sourire, d’une médecine libérale qui cherche à gagner la confiance de ses malades ou de ses futurs malades, au point d’en faire de quasi-élèves en médecine – ce qui pose la question de l’écriture et de la diffusion de traités médicaux. De ce point de vue, examinons le rapport, chez Platon, entre Eryximaque, fils d’Acoumène, le seul médecin qui soit mis en scène par Platon (dans le Banquet), et Hippocrate de Cos, l’Asclépiade, dans le passage fameux du Phèdre sur la méthode hippocratique, un dialogue partiellement consacré à la question de l’écriture21, et qui se réfère aussi à l’Egypte. Ce passage est précédé par une première comparaison médicale de Socrate. Socrate suppose que quelqu’un vienne trouver Eryximaque, l’ami de Phèdre, ou son père Acoumène, et leur déclare : ‘Je sais administrer au corps de quoi l’échauffer ou le refroidir à volonté, le faire vomir si je veux ou, inversement, évacuer par en bas, etc. et donc, puisque je sais cela, je suis apte à la médecine et à y rendre apte tout homme à qui je donnerai cette science’ (Ἐγὼ ἐπίσταμαι τοιαῦτ᾿ ἄττα σώμασι προσφέρειν, ὥστε θερμαίνειν τ᾿ ἐὰν βούλωμαι καὶ ψύχειν, καὶ ἐὰν μὲν δόξῃ μοι, ἐμεῖν ποιεῖν, ἐὰν δ᾿ αὖ, κάτω διαχωρεῖν, καὶ ἄλλα πάμπολλα τοιαῦτα· καὶ ἐπιστάμενος αὐτὰ ἀξιῶ ἰατρικὸς εἶναι καὶ ἄλλον ποιεῖν ᾧ ἂν τὴν τούτων 20  Les réflexions de Joly 1969 (réfutant Kudlien 1958, selon qui la distinction de Platon ne correspond à aucune réalité historique) méritent toujours d’être lues avec attention. 21  La bibliographie sur le passage concernant la méthode d’Hippocrate est considérable (voir notamment, sur les rapports avec l’Ancienne Médecine, Schiefsky 2005, 67-71, qui adopte une position proche de celle de J. Jouanna, et où on trouvera, pp. 77-81, un résumé précieux des thèses en présence), mais elle n’examine que rarement le rapport de ce passage avec la mention initiale d’Eryximaque.

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ἐπιστήμην παραδῷ, 268a-b). Que leur répondront, demande Socrate, nos médecins? Evidemment, dit Phèdre, ils leur demanderont ‘s’il sait aussi à qui appliquer ces traitements, quand il faut pratiquer chacun d’entre eux et jusqu’à quel point’ (εἰ προσεπίσταται καὶ οὕστινας δεῖ καὶ ὁπότε ἕκαστα τούτων ποιεῖν, καὶ μέχρι ὁπόσου;). La personne en question dira alors qu’elle ne le sait absolument pas, mais que ses disciples, instruits par elle, le sauront. Les médecins estimeront naturellement ‘qu’un tel individu est fou, et qu’il croit être devenu médecin pour avoir lu quelque livre ou être tombé sur des drogues, alors qu’il n’entend rien à la techne’ (μαίνεται ἅνθρωπος, καὶ ἐκ βιβλίου ποθὲν ἀκούσας ἢ περιτυχὼν φαρμακίοις ἰατρὸς οἴεται γεγονέναι, οὐδὲν ἐπαΐων τῆς τέχνης, 268c). L’art médical suppose qu’on ne connaisse pas seulement des recettes apprises, directement ou indirectement, dans des livres, mais qu’on soit capable de connaître aussi et la nature du corps des malades, et leur environnement temporel (c’est-à-dire vraisemblablement les différents aspects de la constitution de la maladie), et le rapport entre les deux, qui seul peut fixer la mesure du traitement, dans une perspective comparable à celle du chapitre 20 de l’Ancienne Médecine évoqué plus haut. Ensuite, Socrate développe la même analyse sur un autre exemple, l’art de la tragédie. Phèdre ajoute alors quelques mots supplémentaires. Sophocle et Euripide, dit-il, se moqueraient d’un individu qui croirait être spécialiste de l’art tragique pour avoir seulement appris toute une série de techniques de rédaction : ‘Eux aussi se moqueraient, je pense, Socrate, de quiconque croit que la tragédie est autre chose que l’organisation de tous les éléments, une organisation qui les adapte les uns aux autres et qui soit adaptée à la totalité’ (τὴν τούτων σύστασιν πρέπουσαν ἀλλήλοις τε καὶ τῷ ὅλῳ συνισταμένην, 268d). Un tel homme ne saurait en fait que ‘ce qui précède la tragédie, et non la tragédie’, tout comme, dirait Acoumène, l’homme, dans le cas précédent, sait ‘ce qui est préalable à la médecine, et non la médecine’ (τὰ πρὸ ἰατρικῆς ἀλλ᾿ οὐ τὰ ἰατρικά, 269a). Socrate reprend encore la conclusion une fois, en la mettant cette fois dans la bouche de . . . Périclès : il ne suffit pas de posséder ‘les connaissances indispensables qui sont préalables à la techne’, mais il faut aussi avoir la capacité d’employer chacune d’elles d’une façon persuasive et de réunir le tout’ (τὸ δὲ ἕκαστα τούτων πιθανῶς λέγειν τε καὶ τὸ ὅλον συνίστασθαι, 269c). Cette comparaison avec la médecine d’Eryximaque et d’Acoumène suppose l’existence d’un corpus de textes médicaux mis à la disposition de tous, médecins et non médecins, mais dont les médecins revendiquaient la seule utilisation véritablement efficace, en raison de leur aptitude à mettre en rapport les traitements avec la nature du malade et de la maladie (y compris sa constitution, évoquée notamment par la question du moment opportun pour les soins, ce qui implique la connaissance des saisons et de leurs variations selon les

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lieux et les années), c’est-à-dire avec une ‘totalité’ que ne peuvent atteindre seuls les livres de médecine22. Nous retrouvons, mais développé et explicité, un aspect que nous avons rencontré dans nos remarques sur la citation homérique dans le livre 3 de la République. La critique de l’écriture médicale est beaucoup développée, et nuancée à la fois, dans le Politique. Socrate y part du principe que le médecin est reconnu comme tel s’il assure le salut de ses patients : ‘Les médecins, tout particulièrement, nous considérons que, qu’ils nous guérissent de notre plein gré ou malgré nous, par des incisions ou des cautérisations, ou en nous imposant toute autre souffrance, qu’ils le fassent d’après des écrits ou sans écrits (κατὰ γράμματα ἢ χωρὶς γραμμάτων), qu’ils soient riches ou pauvres, nous disons qu’ils sont tout autant médecins, tant qu'ils exercent leur autorité par leur science, en purgeant, en réduisant d’une autre façon, ou aussi en accroissant, pourvu qu’ils le fassent pour le bien du corps, en améliorant son état, tous ceux qui appliquent leurs traitements pour nous sauver’ (293a-b). Il imagine alors qu’un médecin, ou un spécialiste de la gymnastique qui va partir en voyage et être éloigné, pense-t-il, de ces patients un bon moment, pensera que les praticiens du gymnase ou les malades ne se souviendront plus de ses prescriptions, et voudra sûrement leur écrire des aide-mémoire’ (ὑπομνήματα γράφειν, 295c). Le livre médical est ici destiné au malade. Mais, ajoute Socrate, si le médecin revient plus tôt que prévu et constate un changement dans les conditions générales (‘si l’environnement des malades s’est amélioré en raison des vents ou de toute autre phénomène inattendu relevant de Zeus’), évidemment il modifiera ses prescriptions écrites pour les adapter à la situation nouvelle, et le malade fera de même (295d). Il agira en homme de l’art si, ‘sans user de persuasion à l’égard de son patient, mais parce qu’il connaît correctement son art, il force un enfant, un homme ou une femme à faire ce qui vaut mieux, contrairement à ce qui est écrit’ (296b-c). La polémique du Phèdre contre l’écriture trouve ici son prolongement le plus net. D’un autre côté, le risque existe d’un médecin qui impose mille souffrances au malade uniquement pour gagner de l’argent, lui et ses aides (298a). Il vaudrait mieux, dans ce cas, comme solution de rechange, refuser tout usage autoritaire de la médecine, ‘permettre aux profanes ou aux spécialistes d’autres arts de formuler un avis sur les maladies, sur ce qu’il convient d’utiliser envers les malades en fait de drogues ou d’instruments médicaux’ (298c) et porter par écrit les résolutions, qui seraient valables une fois pour toutes (298d) au point qu’on pourrait accuser un médecin de ne pas les avoir respectées dans le soin 22  Jim Hankinson me fait observer que ‘Galien, en tant que porte-parole de la médecine ‘Hippocratique’ condamne régulièrement les logiatroi’.

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des malades (299a). Ne faudra-t-il pas punir toutes les infractions aux règles écrites (παρὰ τὰ γράμματα), y compris ‘dans les recherches relatives aux vents, au chaud et au froid, concernant la santé et la vérité de la médecine’ et traiter qui s’y adonne de ‘spécialiste des hauteurs et de savant bavard’ (μετεωρολόγον, ἀδολέσχην τινὰ σοφιστήν, 299b)? Mais ce serait alors la ruine complète de tous les arts (299e). Laissons de côté ici l’objectif platonicien du Politique, qui concerne la science politique. Ce texte explicite une tension qui était perceptible dès les discussions de l’Ion et de la République23: le profane qui est informé de traités médicaux et de questions médicales peut-il donner son avis en médecine? Le risque de la diffusion des connaissances et des livres est la disparition de la recherche médicale véritable, semble dire Platon. L’écho avec le texte du Phèdre est perceptible aussi dans les mots qui qualifient le spécialiste, le savant, qui entreprend de dépasser traités et réglements écrits. Revenons maintenant à ce dialogue. La mention d’Hippocrate se situe dans la continuité de ce qui précède. La transition avec l’évocation de la médecine et de la tragédie est assurée par le personnage de Périclès, et par la reprise du vocabulaire de la ‘totalité’ qu’il faut prendre en compte pour être véritablement un spécialiste efficace de la techne. Si Périclès fut un si grand orateur, c’est qu’outre ses qualités naturelles, il a su apprendre des éléments du ‘bavardage et de la connaissance des hauteurs, au sujet de la nature’ (ἀδολεσχίας καὶ μετεωρολογίας φύσεως περί, 269e). Et en particulier, auprès d’Anaxagore, ‘la nature de l’Esprit et de l’absence d’Esprit’, dans l’ensemble du monde, en vertu des théories d’Anaxagore sur le rôle de l’Esprit dans le monde que Socrate expose de façon si ironique dans le Phédon. C’est ce qui a permis à Périclès de connaître ‘la nature de l’âme’, à partir de la ‘nature de la totalité’. De même, selon Socrate, pour Hippocrate, du genos des Asclépiades, pour la nature du corps. La description de l’analyse de la ‘nature de l’âme’: simple ou complexe, avec les propriétés actives et passives afférentes ou bien à cette simplicité ou bien à chacun des composants (270c-d) développe et raffine, dans la perspective de l’analyse de l’âme, l’objection qu’Eryximaque et Acoumène avaient faite plus tôt au simple lecteur des traités médicaux, qui est, lui, incapable de saisir la totalité permettant de mettre en rapport les traitements avec la nature du malade et la constitution de la maladie. Le sens exact de cette totalité de la compréhension du corps reste assez énigmatique. Le concept de totalité comme fin, ici simplement esquissé, est l’objet chez Platon d’analyses multiples et ardues, notamment dans le Parménide, qu’il faudrait faire intervenir, et il est encore repris dans les Lois 10, 903c, à 23  Voir aussi Théét. 178c.

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propos de la médecine. Dans la perspective ici adoptée, ce n’est pas l’essentiel. Observons seulement que les médecins Eryximaque et Acoumène sont présentés par Socrate comme proposant une conception de la médecine dont ensuite Hippocrate apparaît comme le garant et le fondateur, et qui s’impose à tout utilisateur des traités médicaux écrits, sous peine d’incompétence. Au total, Platon, malgré les oppositions qu’il construit notamment entre médecine de l’âme et médecine du corps, et entre médecine diététique moderne et médecine véritablement utile, propose une conception dans l’ensemble unifiée de l’art médical autour de définitions et de descriptions qui sont le plus souvent compatibles avec les textes de la Collection hippocratique que nous connaissons. De plus, non seulement il fait d’Hippocrate le modèle du maître de médecine, mais, quand Socrate présente l’opinion personnelle de deux médecins de ses amis, Eryximaque et Acoumène, sur la nature de la médecine, il ne peut mieux faire que développer cette opinion en exposant ce qu’il dit être la méthode d’Hippocrate lui-même, manifestement présentée dans la continuité de la leur, comme prototypique de la médecine. Cette méthode est présentée comme dépassant le savoir que l’on peut tirer, qu’on soit ou non spécialiste de la médecine, des livres de médecine, livres qui peuvent néanmoins représenter pour les profanes une sorte de garde-fou contre le risque de l’arbitraire médical. La conclusion que l’on peut tirer de ces quelques observations n’a rien de révolutionnaire : le nom d’Hippocrate, dès le début du quatrième siècle, est employé chez Platon de telle façon qu’il réunit l’ensemble du domaine de la médecine. De plus, les collections d’écrits médicaux relevant de ce champ, dans le Phèdre, réclament son autorité pour permettre la formation de véritables médecins : le Phèdre semble indiquer qu’on ne peut les lire ni les utiliser à bon escient sans passer, de toute façon, par Hippocrate et par sa méthode. L’œuvre de Platon a ainsi pu contribuer, dès le quatrième siècle, à une définition normative comme ‘hippocratique’ d’un corpus de traités médicaux variés qu’on a jugés de bonne qualité et dignes de confiance, y compris, dans une certaine mesure, pour de non-médecins, et cette contribution du tableau platonicien, par son influence sur les milieux lettrés, s’est naturellement prolongée dans les siècles suivants. On peut proposer pour finir un exemple de la diffusion ultérieure de cette influence platonicienne sur la constitution d’une vulgate hippocratique, dans le cas du livre 3 de la République. Comme le dit M. Grmek, ‘Plutarque et tant d’autres moralistes reprendront l’argumentation platonicienne sur les maladies comme effet d’une civilisation corruptrice’24. Fabio Stok a montré25 que 24  Grmek 1983, 18. 25  Stok 1985, 123-126.

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les scholies anciennes d’Homère, elles aussi, commentent le texte de l’Iliade 11.624 (cf. pp. 240-241 Erbse) que cite Platon au moyen du commentaire platonicien de la République. S’étonnant, comme Socrate et comme l’interlocuteur de Socrate, du remède que l’on fait boire, le scholiaste offre en effet immédiatement une explication qui rappelle celle de Platon : ‘Ce sont des substances inflammatoires et ennemies des blessures : tout d’abord, nous disons qu’ils ignoraient le régime et que leurs corps étaient plus solides et capables de lutter contre les blessures, ensuite que c’est le propre d’un excellent médecin de soigner sans modifier le régime habituel’. Dans une autre scholie (ad 11.515, p. 222 Erbse), on lit aussi : ‘Les uns disent que ce sont la médecine chirurgicale et la médecine pharmaceutique qui avaient été découvertes par les anciens, car c’est Hérodicos qui commença la médecine diététique, puis Hippocrate, Praxagoras et Chrysippe qui la complétèrent’. Au second siècle de notre ère, Maxime de Tyr paraphrase les vers 515 et 829-830 du chant 11 de l’Iliade en examinant la différence entre la ‘première médecine’ et la ‘nouvelle médecine’: à la différence d’autres arts qui, répondant toujours aux mêmes besoins, n’évoluent pas, la médecine, traitant des constitutions physiques qui changent en fonction du régime individuel et collectif, doit changer. Il donne même la parole à Asclépios, qui explique que ses deux fils, Machaon et Podalire, les deux Asclépiades de l’Iliade, n’étaient nullement inférieurs aux médecins actuels : ‘A cette époque l’art (médical) était en contact avec des constitutions physiques qui n’étaient pas échauffantes ni compliquées ni complètement relâchées, et donc les traitait facilement, et son activité consistait simplement à entailler et à extraire les flèches et à ‘répandre de douces drogues’, mais maintenant, il a fini par se compliquer considérablement parce que les constitutions physiques sont tombées peu à peu dans un régime plus compliqué et un tempérament mauvais, et, de sa simplicité première, il est passé à un état très diversifié’ (4.2). Galien, dans le Thrasybule26 reprend lui aussi l’explication historisante d’Homère que l’on trouve chez Platon, mais sans prendre entièrement parti pour lui et sans y joindre les considérations morales qui y sont si importantes : ‘Quant à savoir si la troisième partie du traitement médical qu’est la diététique existait à l’époque d’Homère, je ne peux pour ma part l’évaluer, mais Platon, qui est à la fois bien plus ancien que moi et dont il est bien plus vraisemblable qu’il connaisse la situation des Grecs, dit que les anciens Asclépiades n’avaient absolument pas recours à cette partie de l’art’ (5.868-869 K). On pouvait donc lire les vers d’Homère en fonction des analyses historiographiques de Platon.

26  Signalé par Mudry 1982, 54 (sans rapprochement avec Platon), mais non, sauf erreur, par Stok.

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Ce contexte intervient aussi, comme le note Fabio Stok, en signalant que M. Grmek l’avait lui aussi signalé comme une sorte d’évidence ne demandant pas de démonstration, pour distinguer Hippocrate de la médecine des origines, au début de l’histoire de la médecine dans la préface du De medicina de Celse, dont voici un extrait, dans la traduction de Philippe Mudry : ‘Podalirius et Machaon (. . .) ne prodiguèrent d’aide ni lors de la peste ni dans les divers cas de maladies, mais ils ne faisaient que soigner les blessures par le fer et les médicaments. Il ressort de là que seules ces parties de la médecine ont été pratiquées par eux et qu’elles sont les plus anciennes. La même source nous apprend qu’à cette époque les maladies étaient attribuées au ressentiment des dieux immortels et que c’est à eux d’ordinaire qu’on demandait de l’aide. Il est probable que, en l’absence de tout remède contre la maladie, la santé générale était néanmoins bonne grâce à des mœurs saines que l’oisiveté ni le luxe n’avaient corrompues, tant il est vrai que ce sont là les deux causes qui ont terrassé les organismes d’abord en Grèce, puis chez nous. C’est pourquoi cette médecine complexe, dont la nécessité n’a existé ni dans le passé ni chez d’autres peuples, amène à peine quelques-uns d’entre nous au seuil de la vieillesse’ (Pr. 3-5). Philippe Mudry montre que la notion de ‘maladie’ (morbus) est liée intrinsèquement chez Celse à celle de médecine diététique, l’une des trois grandes divisions de la médecine pour lui27. Le texte de Celse a été excellemment commenté par Philippe Mudry, puis par Heinrich von Staden28, qui en souligne le côté ‘romain’, tout en signalant en note le ‘background’ que fournit l’article de Fabio Stok. ‘Arrière-plan’ ou élément déterminant, il paraît difficile de penser que Celse commente Homère sans connaître les commentaires platonisants d’Homère. Sa réutilisation, dans le nouveau contexte romain, renforce l’assimilation entre Hippocrate et la médecine de la Grèce classique.

27  Ibid. p. 68. 28  ‘In Rome, as in all nations, ‘folk’ medicine, presumably of the kind practised by the paterfamilias and endorsed by Cato, Pliny the Elder, and others, had sufficed until Roman culture became infected by Greek culture. Without Greek decadence there would have been neither (a) Greek scientific medicina nor (b) Roman physical degeneracy, and with­ out (a) and (b) there would be no Latin text by Celsus, and no need for it’ (von Staden 1999).

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Bibliographie Demont, P., ‘L’ancienneté de la médecine hippocratique : un essai de bilan’, in : A. Attia and G. Buisson (eds.), Advances in Mesopotamian Medicine from Hamurabi to Hippocrates. Leiden, 2009, 129-149. ———, ‘L’efficacité en politique selon le Protagoras de Platon’, in : J.M. Van Ophuijsen, M. Van Raalte and P. Storke (eds.), Protagoras of Abdera: The Man, His Measure. Leiden, 2013, 113-138. ———, ‘La théorie du logos dans le Sur l’échange d’Isocrate’, in : B. Cassin (ed.), La rhétorique au miroir de la philosophie. Définitions philosophiques et définitions rhétoriques de la rhétorique. Paris, (à paraître), 69-91. Eijk, P.J. van der, ‘The Theology of the Hippocratic Treatise On the Sacred Disease’, Apeiron 23 (1990), 87-119. Grmek, M.D., Les maladies à l’aube de la civilisation occidentale. Paris, 1983. Hippocrate, De l’ancienne médecine, Texte établi et traduit par Jacques Jouanna. Paris, 1990. ———, On Ancient Medicine, transl. with intr. and comm. by Mark J. Schiefsky. Leiden, 2005. ———, Pronostic, Texte établi, traduit et annoté par Jacques Jouanna, avec la collaboration d’Anargyros Anastassiou et Caroline Magdelaine. Paris, 2013. Jaeger, W., Paideia. The Ideals of Greek Culture, transl. G. Highet, vol. III, ‘The Conflict of Cultural Ideals in the Age of Plato’. Oxford, 1943. Joly, R., ‘Esclaves et médecins dans la Grèce antique’, Sudhoffs Archiv 53 (1969), 1-14. Jouanna, J., ‘Le médecin modèle du législateur dans les Lois de Platon’, Ktema 3 (1978), 77-91. ———, ‘Médecine et politique dans la Politique d’Aristote (II, 1268b25-1269a28)’, Ktema 5 (1980), 257-266. [1980a] ———, ‘Politique et médecine. La problématique du changement dans le Régime des maladies aiguës et chez Thucydide (livre VI)’, in : M. Grmek and F. Robert (eds.), Hippocratica. Actes du Colloque hippocratique de Paris, 4-9 septembre 1978. Paris, 1980, 299-319. [1980b] ———, Hippocrate. Paris, 1992. ———, ‘La naissance de l’histoire de la médecine en Grèce à l’époque classique’, Histoire des sciences médicales 37 (2003), 319-329. Kudlien, F., Die Sklaven in der griechischen Medizin der klassischen und hellenistischen Zeit. Wiesbaden, 1958. Longrigg, J., Greek Rational Medicine. Philosophy and Medicine from Alcmeon to the Alexandrians. London, 1993. Mudry, P., La préface du De Medicina de Celse, Texte, traduction et commentaire. Lausanne, 1982.

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Olympiodorus, Commentary on Plato’s Gorgias, transl. with full notes by R. Jackson, K. Lycos and H. Tarrant. Leiden, 1998. Roselli, A., ‘Un corpo che prende forma : l’ordine di successione dei trattati ippocratici dall’eta ellenistica fino all’eta bizantina’, in : G. Cerri (ed.), La letteratura pseudoepigrafica nella cultura greca e romana. Napoli, 2000, 167-195. Staden, H. von, ‘Celsus as Historian’, in: P.J. van der Eijk (ed.) Ancient Histories of Medicine. Essays in Medical Doxography and Historiography in Classical Antiquity. Leiden-Boston-Köln, 1999, 251-294. Stok, F., ‘Un topos platonico nel De medicina di Celso’, in : I. Mazzini and F. Fusco (eds.), I testi di medicina latini antiqui. Problemi filologici e storici. Rome, 1985. Vegetti, M., La medicina in Platone. Venezia, 1995. Wehrli, F., ‘Ethik und Medizin’, Museum Helveticum 8 (1951), 36-62. [1951a] ———, ‘Der Artzvergleich bei Platon’, Museum Helveticum 8 (1951), 177-184. [1951b].

CHAPTER 4

The Treatise Affections in the Context of the Hippocratic Corpus Pilar Pérez Cañizares When and why the treatise Affections1 was included in the CH remains unclear, but it is significant that Erotian did not use it in his Hippocratic Glossary.2 Whether this was due to the concern to distinguish authentic from nonauthentic Hippocratic treatises that already existed in his time, or whether the version of the CH Erotian used did not include Affections yet, cannot be established with the extant evidence.3 There was considerable scholarly activity on the Hippocratic works between Erotian and Galen, including the editions of the CH produced in the age of Hadrian by Dioscorides and Artemidorus Capito, which are considered to be the origin of the collection transmitted by the medieval manuscripts of the CH and may have contained Affections.4 Nevertheless, as is the case for earlier 1  Hippocrates’ περὶ παθῶν (De Affectionibus). Editions available of this text are Littré 1849, 206– 272 and Potter 1988, 1–91. 2  See Nachmanson 1917 and 1918. 3  Both Ilberg 1894, 127 and Nachmanson 1917, 458 suggest that the list of treatises considered authentic included in Erotian’s preface may not be his own, but the work of some members of the dogmatic school, who considered themselves the heirs of Hippocrates. Be that as it may, the fact that Erotian himself was interested in authenticity is shown by the fact that he says that he will use only the treatises that were considered authentic (cf. Nachmanson 9.1 ὅθεν καὶ ἐπεὶ τῶν ἀληθῶς κομιζομένων συνταγμάτων) and mentions his intention of demonstrating that Prorrh. II was not the work of Hippocrates. (cf. Nachmanson 9.8, Προρρητικὸν αʹ καὶ βʹ, ὡς οὐκ ἔστιν Ἱπποκράτους, ἐν ἄλλοις δείξομεν). See Appendix for the list of treatises included and excluded by Erotian. No gloss was attributed to Aff. by Nachmanson, not even as dubious. Therefore not only was Aff. not mentioned explicitly in the preface, but unlike Vict. and Morb. 4, from which glosses were taken even though they were not mentioned by title (see Appendix), it appears that Aff. was not consulted at all by Erotian. 4  On Dioscorides and Artemidorus Capito see Manetti and Roselli 1994, 1617–33. Two of the five oldest manuscripts transmitting parts of the CH contain Aff.: the Marcianus gr. 269 (M) of the 10th c. and the Vindobonensis med. gr. 4 (θ) of the eleventh. The bibliography on both is very abundant and goes beyond the scope of this chapter. On Artemidorus’ edition as the origin of the version of the CH included in the medieval manuscripts see Pfaff 1933, esp. 76.

© koninklijke brill nv, leiden, ���6 | doi ��.��63/9789004307407_006

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stages in the formation of the CH, not even a single reference to the treatise has survived from this period.5 The first extant references to Affections are made by Galen. In contrast to Erotian, Galen takes into consideration all the treatises attributed to Hippocrates in his day—and not only the ones he considers authentic— when writing his Glossary.6 The Corpus that Galen glosses contains therefore about ten more treatises than the one Erotian used as a basis for his Glossary.7 However, Affections does not seem to have interested him much either, as he mentions it only twice.8 In both passages Galen refers to the authorship of the treatise, and it is worthwhile examining both of them in a wider context to try to uncover Galen’s intentions in mentioning Affections. The context in which this first reference to Affections appears is Galen’s commentary on Hippocrates’ Aphorism 6.1, which deals with lientery. In relation to this disease, Galen quotes Erasistratus’ description of what the ancients thought about lientery, only to immediately refute his view.9 According to Galen, no medical authority before Erasistratus had mentioned the existence of bloody mucous material mixed with undigested food in the excrement of people suffering from lientery, as Erasistratus claimed they had, because it was not there to be seen. Galen’s aim is to show his disagreement both with 5  The only extant source for Artemidorus and Dioscorides is Galen, who comments on readings appearing in the texts edited by both authors. The Hippocratic treatises involved are in general those that Galen commented on, there is therefore no citation of references to Aff. by these early editors. The testimonies were collected by Ilberg 1890, 111–137. 6  Galen, Glossary of Hippocratic Terms, 19.68.10 K, ἐπὶ τὴν ἐξήγησιν ἤδη τῶν γλωττῶν ἀφιξόμεθα, πάντων τῶν Ἱπποκράτει ἐπιγεγραμμένων βιβλίων ἐκλέγοντες αὐτά, οὐκ ἐκ τῶν γνησίων μόνον. 7  On this see Roselli 1998, 184–185. For a very detailed description of Galen’s lexicographical explanations and the identification of the passages they refer to see Anastassiou and Irmer 1997. 8  Anastassiou and Irmer 1997, 51–53 contains five glosses in which Galen explains uncommon terms that appear in Aff. as well as the two passages. 9  All translations included in this chapter are my own, unless otherwise stated. cf. Aph. 6.1 (4.562 L). Ἐν τῇσι χρονίῃσι λειεντερίῃσιν ὀξυρεγμίη ἐπιγινομένη, μὴ γενομένη πρότερον, σημεῖον ἀγαθόν. ‘In cases of lientery, acid eructations supervening which did not occur before are a good sign’. Commentary on Hippocrates’ Aphorisms 6.1. (18A. 6.11; 8.10 K), ἐν μὲν γὰρ τῷ περὶ παθῶν Ἱπποκράτους, εἴτ’ οὖν αὐτοῦ τοῦ Ἱπποκράτους ἐστὶ τὸ βιβλίον εἴτε Πολύβου τοῦ μαθητοῦ αὐτοῦ, ταυτὶ γέγραπται περὶ τῆς λειεντερίας. Λειεντερίη· τὰ σιτία διαχωρεῖ ἄσηπτα, ὑγρά· ὀδύνη δὲ οὐκ ἔνι· λεπτύνονται δὲ τὸ σῶμα. ‘In Hippocrates’ Affections—this book is either by Hippocrates himself or by Polybus, his pupil—is written the following on lientery: ‘Lientery: The foods are excreted undigested and moist; there is no pain, but they slim down the body’. The passage is edited in Garofalo 1988, no.261a. For Galen’s continuous attacks on Erasistratus and the Erasistrateans see Smith 2002, 78–84. For a discussion of this passage see ibid., 197–198.

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Erasistratus’ symptomatology and with his use of earlier authorities. To support his case, Galen cites as evidence first Diocles and Praxagoras and then he quotes the above reference to lientery appearing in Affections.10 This appeal to testimonies of previous medical authorities to back his arguments is by no means unusual in Galen’s rhetoric.11 The introduction of Affections as one of the medical authorities adduced to support his own view is illustrative: he must at least have considered the content of this medical writing valuable, as he used it with this purpose. More importantly, before quoting the text of the treatise, Galen mentions that the book is ‘either by Hippocrates himself or by Polybus’. The attribution to Polybus of writings that circulated under the name of Hippocrates is not infrequent in Galen’s works and the same hesitant attribution either to Hippocrates or to Polybus occurs in relation to other treatises.12 Did Galen think that Affections was an authentic work of Hippocrates? It is well known that he was not at all consistent in his opinions regarding authenticity and authorship. In this case it is possible that he just added the names to validate his arguments and to express a stronger refutation of Erasistratus’ doctrine. In this context, it would have been surprising if Galen had any negative assessment about the quality of this medical writing as he was using it as an argument by authority, by quoting it together with other ancient authors whose testimony disagrees with that of Erasistratus’. Completely different is the context in which the second and last reference to Affections made by Galen appears. τὰ δὲ προσκείμενα ἐν τούτῳ τῷ βιβλίῳ μετὰ τὸ λουτρόν, εἰ μὲν ὡς ἐν τύπῳ τις ὑπ’ αὐτοῦ γεγραμμένα ταῦτα, παρασκευάσαντος εἰς ἀνάμνησιν ἑαυτῷ, εὑρὼν ἐπὶ τῆς οἰκίας ἐξέδωκε μετὰ θάνατον τοῦ ἀνδρός, ἴσως ἄν τινα λόγον ἔχοι• ὡς σύγγραμμα δ’ οὔκ ἐστιν ἄξιον τῆς Ἱπποκράτους δυνάμεως, ὥσπερ οὐδὲ τὰ Περὶ νούσων τε καὶ παθῶν ἐπιγραφόμενα, καίτοι πολλὰ καλῶς ἐν αὐτοῖς εἴρηται• 10  The Diocles passage is also edited in van der Eijk 2000, fr. 132a, and 2001, 261. Van der Eijk notices that Diocles did not specify that stools were bloody and mucous, but apart from this, Erasitratus’ tripartition of diseases affecting the lower cavity seems to coincide with Diocles’s view. This is also the case in Aff. 23–25. 11  See Roselli 1999, especially 366, n.19 where this passage is discussed. 12  Apart from Aff., other treatises that Galen attributed to Polybus are Nat. Hom., Nat. Puer. and Oct. In the case of Nat. Hom. and Oct. both Hippocrates and Polybus are mentioned together as possible authors. For these attributions and their assessment see Grensemann 1968 and Jouanna 1969, 552–562. For Galen’s passages referring to this topic see Anastassiou and Irmer 1997 and 2002.

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διοριούμεθα δὲ τοῦτο αὐτὸ καὶ διακρινοῦμεν ἐν ταῖς εἰς αὐτὰ γενησομέναις ἐξηγήσεσι. It probably makes sense that what is added to this book, after the part on baths, he (sc. Hippocrates) wrote as a draft to aid his own memory, and someone found it in his house after his death and published it. As a composition it is not worthy of Hippocrates’ capacity, as neither are the works Diseases and Affections, though there is much in them that is correct. We will distinguish and separate that in the forthcoming commentaries on them.13 This passage strongly contrasts with the previous one, as Galen says that Affections is not a writing worthy of the name of Hippocrates.14 Galen is here assessing the value of Appendix to Regimen in Acute Diseases. Within this context, Galen is likely to be more sincere than in the previous passage, as he does not have the necessity of emphasizing the excellence and correctness of the sources he is using to contradict his rivals. Galen is not excluding the possibility that Hippocrates could be the author. He also says that the second part of On Regimen in Acute Diseases was written by Hippocrates as a sort of draft, and in this sense as a composition it is not comparable to better treatises existing among Hippocrates’ works. This same consideration applies to Affections and to the books called On Diseases. What Galen is criticizing here is the way the writings had been composed, not their content. Even if the quality of the writing did not compare with that of Hippocrates’ authentic works, Galen considered that it contained valuable material, and he even thought about writing a commentary on it.15 As we have seen, the scarcity of an indirect tradition for the treatise Affections is remarkable, especially if we compare it with other treatises included in the Hippocratic Collection. The treatise Nature of Woman is a similar example, but an even more extreme one, as it is not mentioned either by Erotian or by

13  Commentary on Hippocrates’ On Regimen in Acute Diseases 2.38 (Helmreich CMG 5.9.1 198, 3–5; 15.587.4 K). 14  When commenting on the contradiction between these passages, Anastassiou and Irmer 1997, 51, write ‘Der offensichtliche Widerspruch zwischen den beiden Aussagen läßt sich nicht erklären’. 15  This passage constitutes the only known notice about Galen’s intention to write a commentary on Aff. See Anastassiou and Irmer 2001, 411.

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Galen.16 The treatises are comparable not only in regard to the obscurity of their origins, but also in their composition, as they share some material with other extant treatises. Both writings seem to be the result of putting together material taken from previously existing sources.17 The fact that both treatises are the result of compilation work may be connected with their later inclusion in CH. Regarding the content of Affections, scholars have pointed out the similarities between the aetiological theories of the treatises Affections and Diseases 1 and those attributed to Dexippos of Cos and Hippocrates himself in the Anonymus Londinensis.18 But though the content of Affections presents clear affinities with other nosological writings,19 it differs strongly from them in that it is intended for laymen and not for practitioners.20 The treatise also contains a catalogue of foods and their properties, the second longest of the CH after 16  Some terms of the treatises Mul. 1 and 2 and Steril. that both Erotian and Galen glossed occur in the parallel passages of the treatise Nat. Mul. too. See Bourbon 2008, cxxiv–cxxi. 17  See Bourbon 2008, lx–lxi. 18  See Grensemann 1975, 205–217 and more recently Anastassiou and Irmer 2006, 318. 19  Aff. was traditionally related to the so-called Cnidian School, though the section devoted to dietetics does not appear in any of what were considered Cnidian treatises (principally Morb. 2, Int. and Morb. 3). However, Aff. was considered less representative of the socalled Cnidian school than other treatises. Ermerins 1862, vol. II, lxviii argued that the author of Aff. was a Cnidian physician because of the similarities of the treatise with the three books of Morb. Nevertheless he also admitted some influence of the Coan School because of the similarities with treatises such as Acut. Ilberg 1925 tried to prove that six Hippocratic treatises (the three books of Morb., Aff., Int. and Hebd.) derived from a lost treatise, Cnidian Sentences. He considered Aff. a simplified version of Cnidian doctrine because its nosological descriptions are not so detailed as the ones in other tracts. Ilberg’s view was influential in the first half of the 20th c. However, his list of treatises belonging to the so-called Cnidian School was not totally accepted and works like those of Temkin 1928, 9–43 and Edelstein, 1931 excluded Aff. from the list of supposed Cnidian works. Later on in the sixties and seventies, the studies of Lonie 1965 and Jouanna 1974 again included Aff. in the list of Cnidian treatises. Approximately half of the scholars who accepted a distinction between Coan and Cnidian schools considered Aff. as a work of Cnidian origin, whereas the rest did not find enough evidence to make such adscription. An extreme example of how far these claims of school influence may go is Wittenzellner 1969, the only modern commentary specifically devoted to Aff. This author uses a lexical study of fifteen medical terms to argue that Aff. is the work of a Coan practitioner who compiled earlier Cnidian writings, and thus confusion between the language and thought of both traditions is found throughout the book. 20  On Aff. as treatise intended for laymen see Pérez Cañizares 2010.

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On Regimen. The mixture of these two characteristics has no parallel in the rest of the Collection. The first part of the treatise, devoted to nosology, covers the first thirtyeight chapters.21 Here, after having attributed all diseases to phlegm and bile, the author provides a systematic discussion of diseases and their treatment.22 Chapters 2 to 32, with some exceptions, coincide in content with parts of Diseases 2 and Internal Affections.23 These chapters are based upon a bihumoral theory in which bile and phlegm are the ultimate causes of disease and health. Among the descriptions of diseases some more general and theoretical statements are included, such as: Τοὺς νοσέοντας χρὴ σκοπεῖν εὐθὺς ἀρχομένους ἐν τῇ καταστάσει τῶν νοσημάτων, ὅτου ἂν δέωνται, καὶ οἵους τε ὄντας φαρμακευθῆναι, καὶ ἄλλο ὅ τι ἄν τις θέλῃ προσενέγκαι. It is necessary to examine patients right at the beginning of the establishment of the diseases; what they need, whether they are able to be purged by means of drugs, or whatever else one would like to administer.24 This short exposition about when a physician should intervene appears immediately after an account of diseases of the head and interrupts the line of exposition that has just started. After it, the author continues with the order a capite ad calcem and refers to diseases of the ears and how they must be treated. Chapter 8 constitutes a similar example of a digression that appears between the accounts of pleurisy and pneumonia: Κρίνεσθαι δέ ἐστιν ἐν τῇσι νούσοισιν, ὅταν αὔξωνται αἱ νοῦσοι, ἢ μαραίνωνται, ἢ μεταπίπτωσιν ἐς ἕτερον νόσημα, ἢ τελευτῶσιν.

21  Approximately two thirds of the treatise is devoted to nosology (including skin diseases and wounds not found in other nosological treatises), with some digressions, and the last third to dietetics. 22  On the aetiology in Aff. see Jouanna 1974, 262–306. 23  For the comparison and edition of the parallel passages of Aff. and Morb. 2 see Jouanna 1974. 24  Aff. 3 (6.210 L = Potter 5.10). In the quotations of Aff. I refer to Littre’s and Potter’s text, but I print my own provisional edition and translation of the treatise.

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To have a crisis in diseases is when they increase, diminish, change into another disease, or end.25 The style of these parts is very different from the parts where the general treatment of diseases is exposed. In tone they resemble the Aphorisms. These abrupt changes are surprising and in some passages the implicit addressee seems to be a physician and not a layman: Ὅταν δὲ ἐπὶ νοσέοντα ἀφίκῃ, ἐπανερωτᾷν χρὴ ἃ πάσχει, καὶ ἐξ ὅτου, καὶ ποσταῖος, καὶ τὴν κοιλίην εἰ διαχωρεῖ, καὶ δίαιταν ἥντινα διαιτᾶται, καὶ ἐνθυμεῖσθαι πρῶτον μὲν τὸ νόσημα πότερον ἀπὸ χολῆς ἢ φλέγματος γεγένηται ἢ ἀμφότερα. When you arrive with the patient, you must ask what he suffers, what caused it and for how long; and whether the cavity passes anything through, what diet he is following and consider first of all whether the disease has arisen from bile or phlegm, or from both.26 Here, with the use of a verb in the second person, the author seems to address directly the person who will treat the patient. Because whenever the second person verb form is used it clearly signifies a physician some scholars have rejected the claim that the treatise is meant for laymen.27 Until now I have tried to argue that this author tried to assemble a handbook for laymen. In his aim to be exhaustive, this author collated different types of material, and it seems that in some cases he did not rework them properly to adapt them to the general purpose he states in the first chapter. Differences between these sections and the longer nosological expositions are apparent, not only regarding style, but also in vocabulary and syntax. For instance, in Affections 13 (6.20 L = Potter 5.22) it is significant that the word ὁ κάμνων is used to refer to the patient, whereas in the rest of the nosological part the term used is ὁ νοσέων. In the Hippocratic treatises there seems to be a clear tendency to use just one of these terms. In Diseases 1 and Internal Affections the term used is ὁ νοσέων, whereas there are no occurrences of ὁ κάμνων at all. Another example of this is the use of φαρμακεύω in Affections 3, 6.210 L. It is the 25  Aff. 8 (6.216 L = Potter 5.16). 26  Aff. 37 (6.248 L = Potter 5.58). 27  See for instance Potter 1988, 4 who thinks that the book cannot be regarded as a book on popular medicine. For a rejection of this view see van der Eijk 1997, 86–88.

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only occurrence of this verb in the treatise, as opposed to expressions such as φάρμακον διδόναι or φάρμακον προσφέρειν.28 The rest of the nosological treatises do not use φαρμακεύω at all.29 However, even more striking are the differences regarding doctrine. Probably one of the most controversial passages of the treatise is the following: Τούτοισι τοῖσι φαρμάκοισιν ἀποκαθαίροντα ὧδε χρῆσθαι· ὅσοι μὲν χολώδεις εἰσί, διδόναι ὑφ’ ὧν χολὴ καθαίρεται· ὅσοι δὲ φλεγματώδεις, ὑφ’ ὧν φλέγμα· ὅσοι δὲ μελαγχολῶσιν, ὑφ’ ὧν μέλαινα χολή· τοῖσι δὲ ὑδρωπιῶσιν ὑφ’ ὧν ὕδωρ. When purging, make use of these drugs in this way. To those who are bilious give something by which bile is purged; to those who are phlegmatic give something by which phlegm [is purged]; to those melancholic, give something by which black bile [is purged], and to those dropsical, give something by which water [is purged].30 Here four constitution types are mentioned in a way that seems to break with the bihumoral theory that constitutes the basis of the previous nosological theory. This clear incoherence has led some scholars to excise the references to dark bile and water as an insertion by a later commentator.31 It is true that there are no further references to four humours in Affections, but as we have seen, the apparent inconsistencies are not few, and they can be explained if we assume that the author compiled material from various sources that had different humoral theories. This theory is further supported by the fact that a parallel version of this same passage occurs in an excerpt of the treatise transmitted under the title Remedies, showing that both Affections and Remedies share a common source.32 Another uncommon feature of the treatise is the frequent reference to existing or yet-to-be-written discussions of specific issues.33 For example, instead 28  The occurrence of this type of infinitives (with an imperative nuance) shows that in many cases the author of Aff. just put together certain materials without reworking them to make them fit the intended laymen audience. 29  See Kühn and Fleischer 1986–1989, s. v. 30  Aff. 36 (6.246 L = Potter 5.58). 31  See Artelt 1937, 87. 32  See Schöne 1920–24, 441. 33  See Littré 1839, 54–59. His list is not exhaustive, and that is not my goal either, but many of the passages he quotes are discussed below. One of the problems when dealing with such references is deciding whether they should be interpreted as allusions to different treatises or if they just announce a short discussion on a particular topic that could be

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of detailing the preparation of remedies to be used in each disease, the author refers many times to a recipe collection called φαρμακῖτις or τὰ φάρμακα.34 He also mentions in two different passages his intention of writing separately on eye diseases, internal suppuration, and gynecological diseases.35 In another passage he justifies the absence of an extensive explanation of tertian and quartan fevers, saying that he has already dealt with this topic elsewhere.36 References to future medical works also appear in other Hippocratic treatises. The author of Articulations refers to a set of works he planned to write and the treatise contains the highest number of such allusions in the whole of CH. This author intended to write a wide range of works covering anatomy, physiology, pathology and therapy. Works specifically devoted to the rules of massage, the structure and function of glands, the danger of wounds in temporal located somewhere in the same writing. An example of this type is Nat. Hom. 8 (6.50 L = Jouanna CMG, 186 = Jones 4.22) Τὴν δὲ περίοδον αὖτις φράσω τὴν τῶν ἡμερέων. ‘About the period of days I shall speak afterwards’. Here, the author of Nature of Man promises to talk about the period of days in a very vague way. He does not deal at all with this topic in the treatise, but it is impossible to know if he did it in another work. An added difficulty is the frequent absence of titles as we know them today. Nachmanson 1941, 14–15 quotes the famous passage at the beginning of Acut., where the author refers to a book ‘called’ Cnidian Sentences. Nachmanson points out that the use of καλεόμενας shows that the title of this work was not fixed, but he considers it to be the oldest recorded title of a work in prose. In most of the references the Hippocratic authors just mention the main topic of the intended discussion governed by the preposition περί, it is therefore justified to think that these references could be meant as titles. 34  For the references to this collection of recipes in Aff. and the relationship to the excerpt περὶ φαρμάκων transmitted by the Vaticanus Urbinas 64 see Pérez Cañizares 2010 and the bibliography quoted there. 35  See Aff. 5 (6.214 L = Potter 5.14) Ταῦτα μὲν ὅσα ἀπὸ τῆς κεφαλῆς φύεται νοσήματα, πλὴν ὀφθαλμῶν· ταῦτα δὲ χωρὶς γεγράψεται. ‘These, then, are the diseases that arise from the head, except those of the eyes; these will be described separately’; Aff. 33 (6.244 L = Potter 5.56) Ταῦτα μὲν ὅσα κατὰ κοιλίην γίνεται νοσήματα πλὴν περὶ ἐμπύων καὶ φθινόντων καὶ τῶν γυναικείων, ταῦτα δὲ χωρὶς γεγράψεται. ‘These are the diseases that arise in the cavity, except for those involving internal suppurations, consumptions and diseases of women; these will be described separately’. About the possibility of identifying the first of these references with the extant Hippocratic treatise Vid. Ac. see Craik 2005 and 2006. Craik shows that Vid. Ac. has more similarities with other works such as Loc. Hom., Glan., Fract. and Artic. than it has with Aff. 36  Aff. 28 (6.226 L = Potter 5.32) Καὶ γίνεται μὲν ὁ τριταῖος καὶ ὁ τεταρταῖος ὑπὸ χολῆς καὶ φλέγματος· διότι δὲ ὁ τριταῖος καὶ ὁ τεταρταῖος ἑτέρωθί μοι γέγραπται. ‘Furthermore, the tertian and quartan fevers are produced by bile and phlegm; why one appears on the third day and the other on the fourth has already been written by me elsewhere’.

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muscles and the parts of the body filled with water or mucus are announced.37 Moreover, he mentions his intention to write on chronic diseases of the lung, on veins and arteries and movements and contractions of the uterus as well.38 Unlike Affections, whose author always uses the verb γράφω to express the act of composition, the author of Articulations uses a wider variety of expressions.39 Nevertheless there is no doubt that he too is referring to a range of works that were meant to be read and not delivered orally, and the treatise is presented as a part of the author’s much wider medical knowledge.40 The author of Articulations is very conscious of the advantages of writing, among which the ability to correct mistakes in treatment and the standardization of surgical procedures are especially important.41 Examples of this type of reference can be also be found in the treatise Prorrhetic 2. As in Affections, Prorrhetic 2 always uses the verb γράφω and in contrast to Articulations, all references in Prorrhetic 2 are in the past tense. This means that these statements are not promises, as it was the case in some of the passages of Affections or Articulations, but rather references to texts that definitely existed.42 The references are very concrete, as their titles appear in all three cases, as opposite to examples in other writings quoted above, where the authors indicated that a particular topic has been or will be handled somewhere else, but without indicating any title.43 37  Artic. 9 (4.100 L = Kühlewein 2.125), 11 (4.108 L = Kühlewein 2.129), 30 (4.142 L = Kühlewein 2.146) and 40 (4.174 L = Kühlewein 2.163) respectively. 38  Artic. 41 (4.182 L = Kühlewein 2.167), 45 (4.190 L = Kühlewein 2.171) and 57 (4.246 = Kühlewein 2.202). 39  For an account of the uses of γράφω in the CH see Usener 1990, 291–299. The author of Artic. uses expressions such as ἐν ἄλλῳ λόγῳ εἰρήσεται Artic. 30 (4.142 L = Kühlewein 2.146) or ἐν ἑτέρῳ λόγῳ δεδηλώσονται Artic. 45 (4.190 L = Kühlewein 2.171). For an exhaustive account of all the passages of Artic. referring to other treatises see Roselli 2006, 273. On the vocabulary of Artic. see Craik 2002, 288–89, who points out that the language used by the author ‘lends an air of authority, suggesting confidence in the importance and even permanence of these projected writings’. 40  See Roselli 2006. 41  See Lonie 1983, who mentions the relationship between the increase in literacy associated with the sophistic movement and the innovations introduced in a traditional manual craft such as the treatment of fractures. 42  Prorrh. 2.7 (9.24 L = Mondrain 15), 14 (9.38 L = Mondrain 27) and 21 (9.48 L = Mondrain 35). They are references to works dealing with internal suppuration, acute diseases and fevers. See Jouanna 1997, 55–73 who points out that these three examples show that titles had become a means of identifying a particular work, whereas earlier the function of titles was rather to define their subject and to relate them to a particular category of knowledge. 43  Cf. for instance Aff. 28 in n. 36.

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If they were ever written, the works promised by the author of Articulations were already lost in Galen’s time.44 Galen regrets their loss, above all because he considered Articulations to be a genuine work of Hippocrates. Although we do not know much about the CH in the Hellenistic period, we can assume that if these treatises were written they probably perished after a short time. The constitution of the CH was haphazard and probably based more on chance than on any sort of intended quality control. The collection of anonymous medical treatises that later on would circulate under the name of Hippocrates was assembled gradually. We know that Articulations and Fractures circulated under the name of Hippocrates as early as the 3rd c. BCE, as Bacchius of Tanagra glossed them in his lexicographical work.45 The surgeon who wrote Articulations and Fractures at the end of the 5th c. BCE was highly respected from the beginning: these treatises were considered genuine works of Hippocrates.46 On the other hand, authors such as those of Affections or Prorrhetic 2 were handled in a very different way. Affections is not mentioned by Erotian in his Glossary, while Prorrhetic 2 is mentioned in the preface only to say that it was not by Hippocrates. These two treatises never belonged to the core of CH. From the most ancient testimonies they are tainted with the suspicion of inauthenticity. In the case of Affections is it possible that it was introduced into the Corpus sometime after Erotian composed his Glossary because of its partial affinity to the nosological writings. The treatise was part of the Corpus by Galen’s time, but his opinion about Affections and Prorrhetic 2,47 namely, that they were not worthy of Hippocrates has had consequences until today: they are among the writings that scholars have most neglected.

44  Galen, Commentary on Hippocrates’ Articulations 3.18 (18A 512 K = Anastassiou and Irmer Testimonien 2.1.314) Πολλὰ καὶ ἄλλα κατὰ τὸ βιβλίον τοῦτο γράψαι ἐπηγγείλατο μὴ σωζόμενα νῦν, ἃ τάχα μὲν οὐδ’ ὅλως ἔγραψεν ἢ οὐκ ἐσώθη, καθάπερ καὶ ἄλλα πολλὰ τῶν παλαιῶν βιβλίων οὐκέτι σώζεται. ‘In this book he promised to write many others that are not extant now. Maybe he did not write them at all, or they were just not preserved, in the same way as a great number of other ancient books are not extant anymore’. 45  See von Staden 1992, 563 lists eighteen Hippocratic works, or part of them, that Bacchius glossed: Acut., Artic., Epid. 1–6, Fract., Liqu., Loc. Hom., Mochl., Morb. 1, Morb. Sacr., Off., Oss., Prog. Prorrh.1, and VC. 46  See Anastassiou and Irmer 2001, 106, who mention that even if Galen does not comment directly on the authorship of Artic., the fact that he uses the title together with the name of Hippocrates shows that he considered it authentic. Cf. Galen, Commentary on Hippocrates’ Articulations (18A 300–767 K). 47  Galen, On Prognosis 88, 20–90.1 (Nutton CMG 5.8.1; 14.620 K).

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But from a different point of view Affections and Prorrhetic 2 can be grouped with Articulations in the context of the CH. They are all works that allude to a whole constellation of written works on medicine; these authors wrote several treatises and their texts were composed to be read, not to be listened to. There is therefore an underlying presupposition of literacy, as the existence of treatises such as Affections, Articulations and Prorrhetic 2 shows that physicians were using written texts to disseminate their knowledge. To what extent they were complementing or substituting oral training is difficult to assess. The fact that we can situate these three works in a context of literacy has more far-reaching consequences in the case of Affections. Affections is a work intended for non-specialists, and as we have already mentioned, it is interesting to see how the author lets the reader know that it is on purpose that he is not dealing with particular subjects at a moment where he might be expected to, for instance, when following the order a capite ad calcem. In all these instances,48 the author recommends further reading on different topics to his lay audience. From the statements of the author we can infer that these writings formed a set of medical works composed in order to be read. We can assume that his audience had a certain level of literacy (they were at least able to read, which does not imply they could write), they had access to books, and they might be interested in knowing more about medical topics.49 This characterisation of his readership, together with other indications about language, medical content and similarities with other writings serve as basis for a date. Until now, the treatise has been dated either to 390 BCE on the basis of the rhetorical character of the introduction,50 or between 385 and 375 BCE, as it reflects that the duality phlegm/bile is already well established.51 These two proposed dates constitute a valid terminus post quem, but one more consideration suggests a slightly later date. A work like Affections, which is intended to be read by a lay intelligent audience—as the author himself puts it—and also presents the possibility of consulting other medical books presupposes the existence of an educated class of a meaningful size for whom books were undoubtedly accessible. This characterization of the readership strongly supports a date in the second 48  Cf. nn. 35 and 36. 49  On literacy in ancient Greece see Thomas 1992. On the role of written texts in medical training see Dean-Jones 2003. 50  See Wittenzellner 1969, 120. 51  See Jouanna 1974, 513 who proposes the decade 385–375 BCE as date of composition, quoting a passage of Plato’s Republic (564b–c) that in his opinion reflects a common acceptance and general knowledge of the bihumoral theory.

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quarter of the 4th c. BCE. At the end of the 5th c. BCE book collecting was still very uncommon; bookselling becomes a flourishing industry only in the 4th c.,52 and the existence of a literate upper class who owned private libraries and had an interest in intellectual matters is fully attested by the time Xenophon wrote works like his Memorabilia and Education of Cyrus.53 The dating of Xenophon’s works is by no means sure,54 but the range of dates proposed for them spans from 370 to 355 BCE. The treatise Affections may have originated in this period as the aim of the author is clearly to offer a wide medical knowledge to a lay public interested in medicine not professionally, but rather because they considered it an important part of general culture. Appendix The treatises Erotian lists in the preface are the following (cf. Nachmanson 9.7): Προγνωστικόν, Προρρητικὸν αʹ καὶ βʹ, Περὶ χυμῶν, Περὶ φυσῶν, Περὶ φύσεως ἀνθρώπου, Περὶ ἱερᾶς νόσου, Περὶ φύσεως παιδίου, Περὶ τόπων καὶ ὡρῶν, Περὶ ἀγμῶν, Περὶ ἄρθρων, Περὶ ἑλκῶν, Περὶ τραυμάτων καὶ βελῶν, Περὶ τῶν ἐν κεφαλῇ τραυμάτων, Κατὰ ἰητρεῖον, Μοχλικόν, Περὶ αἱμορροΐδων καὶ συρίγγων, Περὶ νούσων αʹ βʹ, Περὶ πτισάνης, Περὶ τόπων τῶν κατὰ ἄνθρωπον, Γυναικείων αʹ βʹ, Περὶ τροφῆς, Περὶ ἀφόρων, Περὶ ὑδάτων. Ἀφορισμοί, Ἐπιδημίαι ζʹ, Ὅρκος, Νόμος, Περὶ τέχνης, Περὶ ἀρχαίας ἰατρικῆς, Πρεσβευτικὸς, Ἐπιβώμιος. Prognostic, Prorrhetic 1 and 2, On Humours, On Winds, Nature of Man, On the Sacred Disease, On the Nature of the Child, On Airs, Waters and Places, Articulations, Fractures, On Ulcers, On Wounds and Arrows, On Head Wounds, In the Surgery, Leverage, On Haemorrhoids and Fistulas, On Diseases 1 and 2, On Regimen in Acute Diseases, On Places in Man, On Diseases of Women 1 and 2, On Nourishment, On Barren Women, On the Use of Liquids, Aphorisms, Epidemics 7, The Oath, The Law, On the Art, On Ancient Medicine, Embassy, Speech from the Altar.55

52  See Casson 2001. 53  On this see Jaeger 1945, vol. 3, 14–15. 54  Scholarship has suggested that some works were not published as a whole but rather in stages. See for instance Gray 1998, 4. 55  That this list does not include all the treatises Erotian glossed has been demonstrated by Nachmanson 1917, 281–83. He shows that three or even four of the glosses probably refer to the writing Vict., which is not mentioned in the list. Ilberg and Kühlewein 1884, xxxiv list writings that Erotian does not use. They are the following: Vict., Coac., Morb. 4, Aff., Gen., Superf., Oct., Virg., Gland., Dec., Medic., Cord., Vid. Ac., Praec. and Sarc., though as mentioned it is likely that he actually did use Vict. The same applies to Morb. 4, see Nachmanson 1917, 407–409.

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Ilberg, J. and Kühlewein, H., Prolegomena to H. Kühlewein, Hippocratis opera quae feruntur Omnia. Leipzig: Teubner, vol. I, 1884. Ilberg, J., ‘Die Hippokratesausgaben des Artemidoros Kapiton und Dioskurides’, Rheinisches Museum 45 (1890), 111–137. ———, ‘Das Hippokrates-Glossar des Erotianos und seine ursprüngliche Gestalt’, Abhandlungen der Philologisch-Historischen Klasse der Königl. Sächsischen Gesell­ schaft der Wissenschaften 14 (1894), 2. ———, Die Ärztschule von Knidos. Berichte über die Verhandlungen der Sächsischen Akademie der Wissenschaften zu Leipzig, Phil.-hist. Klasse, 76 (1924), 3. Heft, Leipzig. Jaeger, W., Paideia: the Ideals of Greek Culture. vol. III. Oxford, 1945. Jouanna, J., ‘Le médecin Polybe est-il l’auteur de plusieurs ouvrages de la Collection Hippocratique?’, Revue des études grecques, 82 (1969), 552–562. ———, Hippocrate. Pour une Archéologie de l’école de Cnide. Paris, 1974. ———, ‘Remarques sur les titres dans la Collection Hippocratique’, in: J.C. Fredouille et al. (eds.), Titres et articulations du texte dans les oeuvres antiques. Actes du Colloque International de Chantilly, 13–15 décembre 1994. Paris, 1997, 55–73. Kühn, J.H. and Fleischer, U., Index Hippocraticus. Göttingen, 1986–1989. Littré, E., Oeuvres completes d’Hippocrate. Paris, 1839–1861. Lonie, I.M., ‘The Cnidian treatises of the Corpus Hippocraticum’, Classical Quarterly 15 (1965), 1–30. ———, ‘Literacy and the Development of Hippocratic Medicine’, in: F. Lasserre and P. Mudry (eds.), Formes de pensée dans la Collection Hippocratique. (Actes du IVe Colloque Intenational Hippocratique, Lausanne, 21–26 Septembre 1981). Genève, 1983, 145–161. Manetti, D. and Roselli A., ‘Galeno commentatore di Ippocrate’, in Aufstieg und Niedergang der römischen Welt 2.37.2 (1994), 1530–1635. Nachmanson, E., Erotianstudien. Uppsala, 1917. ———, Erotiani vocum Hippocraticarum collectio cum fragmentis. Göteborg, 1918. ———, Der griechische Buchtitel. Göteborg, 1941. [repr. Darmstadt, 1969] Nutton, V., Galeni De praecognitione, edidit, in linguam Anglicam vertit, commentatus est, (CMG V 8,1). Berlin, 1979. Pérez Cañizares, P., ‘The importance of having medical knowledge as a layman: the Hippocratic treatise Affections in the context of the Hippocratic Collection’, in: H.F.J. Horstmannshoff (ed.), Hippocrates and Medical Education, Selected Papers Read at the XIIth International Hippocrates Colloquium, Universiteit Leiden, 24–26 August 2005. Leiden, 2010, 87–99. Pfaff, P., ‘Die Ueberlieferung des Corpus Hippocraticum in der nachalexandrinischen Zeit’, Wiener Studien 50 (1933), 67–82. Potter, P., Hippocrates vol. V: Aff., Morb.I, Morb.II. London-Cambridge (Mass.), 1988.

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Roselli, A., ‘The Doxai of Doctors in Galen’s Commentaries’, in: Ph. van der Eijk (ed.), Ancient Histories of Medicine: Essays in Medical Doxography and Historiography in Classical Antiquity. Leiden, 1999, 359–382. ———, ‘Un corpo che prende forma: L’ordine di successione dei trattati ippocratici dall’età ellenistica fino all’età bizantina’, in: G. Cerri (ed.), La letteratura pseudepigrafa nella cultura greca e romana, Atti di un Incontro di studi 15–17 gennaio 1998. Napoli, 2000, 167–195. ———, ‘Strategie spositive nei trattatti ippocratici: presenza autoriale e piano espositivo in Malattie IV e in Fratture e Articolazioni’, in: M.M. Sassi (ed.), La costruzione del discorso filosofico nell’età dei presocratici. Pisa, 2006, 259–283. Schöne, H., ‘Hippokrates Perì pharmákôn’, Rheinisches Museum 73 (1920–24), 434–448. Smith, W., The Hippocratic Tradition. Ithaca, 1979. [Second revised edition in: http:// www.bium.univ-paris5.fr/amn/Hippo2.pdf, 2002] Staden, H. von, ‘Lexicography in the Third Century BC: Bacchius of Tanagra, Erotian and Hippocrates’, in: J.A. López Férez (ed.), Tratados Hipocráticos. Estudios acerca de su contenido, forma e influencia. Actas del VIIe Colloque International Hippocratique (Madrid 24–29 de septiembre de 1990). Madrid, 1992, 549–569. Temkin, O., ‘Der systematische Zusammenhang im Corpus Hippocraticum’, Kyklos 1 (1928), 9–43. Thomas, R., Literacy and Orality in Ancient Greece. Cambridge, 1992. Usener, K., ‘“Schreiben” im Corpus Hippocraticum’, in: W. Kullmann and M. Reichel (eds.), Der Übergang von der Mündlichkeit zur Literatur bei den Griechen. Tübingen, 1990, 291–299. Wittenzellner, J., Untersuchungen zu der pseudohippokratischen Schrift peri pathon. Diss. Erlangen-Nürnberg, 1969.

CHAPTER 5

The Peripatetic Hippocrates and Other Monists in the Anonymus Londiniensis Susan Prince Near the beginning of his commentary on Hippocrates’ Nature of Man, Galen refers the reader who might wish to know more about the various opinions of ancient doctors to the Iatrike Sunagoge or Medical Collection composed in Aristotle’s school. By way of identifying the text fully, and perhaps emphasizing its merit and correspondence with the other Peripatetic scholarship he has cited in the context, he notes that it is attributed to Aristotle: but he then adds that everyone knows it was really written by Aristotle’s pupil Menon, an attribution which will lead to a certain qualification of its value. . . . ὥσπερ γε πάλιν, εἰ τὰς τῶν παλαιῶν ἰατρῶν δόξας ἐθέλοις ἱστορῆσαι, πάρεστί σοι τὰς τῆς Ἰατρικῆς συναγωγῆς ἀναγνῶναι βίβλους ἐπιγεγραμμένας μὲν Ἀριστοτέλους, ὁμολογουμένας δὲ ὑπὸ Μένωνος, ὃς ἦν μαθητὴς αὐτοῦ, γεγράφθαι, διὸ καὶ Μενώνεια προσαγορεύουσιν ἔνιοι ταυτὶ τὰ βιβλία. Just as also, if you should wish to investigate the opinions of the ancient doctors, you can read the books of the Medical Collection, attributed to Aristotle but agreed by everyone to have been written by Menon, who was his pupil: and for this reason some people call these the Menonian books.1 This passage is of course the basis for the original identification of the ‘Aristotle’ authority cited in the papyrus text of so-called Anonymus Londiniensis, preserved in P.Br.Libr. Inv. 137, as Menon.2 However we might care to name the papyrus writer’s Peripatetic authority,3 it is interesting that the text Galen 1  Galen, In Hipp. Nat. hom. Comment. 1.2 (CMG 5.9.1, 15.25–30). 2  Kenyon 1892, 238, endorsed by Diels 1893, 407. 3  Manetti (e.g., in 1999, 98–99) has cautioned against the careless assumption of earlier days, that a text by Menon was compiled thoughtlessly by Anonymous, or his intermediate source, into the text preserved on the papyrus. She also suggests that the title ‘Menonian books’ could refer to an editor rather than the author; Diels 1893, 407 n. 2 had suggested a d­ edicatee.

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has in mind seems to square up closely with Anonymus’ Aristotelian source. For, when Galen goes on to describe the work of this ‘Menon’ more fully, and indeed to mark out its deficiency as a history of pre-Hippocratic medicine, he dwells on its failure to represent any pre-Hippocratic version of a pluralist view of the constitution of the human body. δῆλον δὲ ὅτι καὶ ὁ Μένων ἐκεῖνος, ἀναζητήσας ἐπιμελῶς τὰ διασῳζόμενα κατ’ αὐτὸν ἔτι τῶν παλαιῶν ἰατρῶν βιβλία, τὰς δόξας αὐτῶν ἐκεῖθεν ἀνελέξατο• τῶν δ’ ἤδη διεφθαρμένων παντάπασιν ἢ σῳζομένων μέν, οὐ θεωρηθέντων δ’ αὐτῷ τὰς γνώμας οὐκ ἠδύνατο γράψαι. κατὰ ταῦτ’ οὖν τὰ βιβλία χολὴν ξανθὴν ἢ μέλαιναν ἢ φλέγμα στοιχεῖον ἀνθρώπου φύσεως οὐκ ἂν εὕροις οὐδ’ ὑφ’ ἑνὸς εἰρημένον, αἷμα δὲ καὶ τῶν μεθ’ Ἱπποκράτην φαίνονται πολλοὶ μόνον εἶναι νομίζοντες ἐν ἡμῖν, ὥστε καὶ τὴν πρώτην γένεσιν ἡμῶν ἐξ αὐτοῦ γίνεσθαι καὶ τὴν μετὰ ταῦτα κατὰ τὴν μήτραν αὔξησιν καὶ ἀποκυηθέντων τελείωσιν. ἀλλ’ ὅ γε Ἱπποκράτης ὀλίγον ὕστερον ἔγραψεν ὡς ὄντων τινων, οἳ καὶ φλέγμα καὶ χολὴν ἐνόμιζον εἶναι τὸν ἄνθρωπον, οὐκ ἂν οὕτω γράψας, εἰ μή τινες ἦσαν ἤτοι κατ’ αὐτὸν ἢ πρὸ αὐτοῦ δοξάζοντες οὕτως. And it is clear that this Menon carefully investigated the books of the ancient doctors still preserved in his time and excerpted their views from these. But from the books that had already completely perished, and from those that had been preserved but that he did not see, he was not able to record the opinions. According to these books (as represented by Menon), then, you cannot find bile, yellow or black, or phlegm said by even a single writer to be an element of human nature; yet as for blood, many of those after Hippocrates, too, seem to think that this is our only constituent, so that both our original genesis comes about from this, and our subsequent growth in the womb and our completion of growth after birth. But Hippocrates a bit later (in Nature of Man) wrote as though there were some thinkers who believed the human is phlegm and bile, and he would not have written in this way if there were not some either in his time or before him who believed this.4 This Menon, we learn, was a diligent in his research, and he consulted many books carefully. But some books escaped his account, and among these are For present purposes, nothing depends on naming Anonymus’ Peripatetic source author ‘Menon’, or anything else, but I do hope to show that the correspondences between the papyrus and Galen’s reference go further than we have previously seen. 4  Galen, In Hipp. Nat. hom. Comm. 1.2 (CMG 5.9.1, 15.30–16.11).

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the books that identified a plurality of humors, central of course to the doctrine in the Hippocratic text Nature of Man on which Galen is commenting, as part of the nature of the human, that is, we might surmise, as essential or congenital constituents of the healthy constitution, rather than pathogens, such as the unhealthy permutations of healthy bodily elements or of food residues. Indeed, Galen points us back to Nature of Man for evidence that Menon’s representation must be mistaken, for Hippocrates would not have referred to doctors who considered humans to be constituted by phlegm and bile if such people were not around in his time. The author of Nature of Man refers in the second chapter, whether truthfully or in the heat of his polemic, to monist physicians who thought the body was entirely bile or phlegm, as well as those who thought it was entirely blood.5 Surely Galen is advocating for nothing so extreme, merely for thinkers among the early doctors who included bile and phlegm among the essential constituents of human nature, since the balance of the several humors6 as basic to health and illness is the critical doctrine that his Hippocratic text is concerned to put across. I would like to propose that this interlude in Galen’s commentary reflects a conflict between two views of physiological doctrine in ancient medicine generally and especially in Hippocrates, ancient medicine’s most important emblem in the time of Galen and the somewhat earlier author of the papyrus:7 on the one hand, the pluralist view of the human’s material constitution, or, to be specific to what Galen wants to defend and attribute to Hippocrates, the four-humor view, and, on the other hand, a material monism, which, on the strength of present evidence and arguments, we should attribute to a specifically Peripatetic phase in the reception of ancient medicine, perhaps related to the unification and isolation of the hule or material as one cause among four in 5  Τῶν δὲ ἰητρῶν οἱ μέν τινες λέγουσιν, ὡς ὥνθρωπος αἷμά ἐστιν, οἱ δ’ αὐτῶν χολήν φασιν εἶναι τὸν ἄνθρωπον, ἔνιοι δέ τινες φλέγμα• ἐπίλογον δὲ ποιέονται καὶ οὗτοι πάντες τὸν αὐτόν• ἓν γάρ τι εἶναί φασιν, ὅ τι ἕκαστος αὐτῶν βούλεται ὀνομάσας, καὶ τοῦτο μεταλλάσσειν τὴν ἰδέην καὶ τὴν δύναμιν, ἀναγκαζόμενον ὑπό τε τοῦ θερμοῦ καὶ τοῦ ψυχροῦ, καὶ γίνεσθαι καὶ γλυκὺ καὶ πικρὸν καὶ λευκὸν καὶ μέλαν καὶ παντοῖον. (166.12–168.2 Jouanna 1975). In ch. 2 (168.9–13) the monism is stronger, and Galen may have read a text of ch. 1 which makes the monism of these opponents appear stronger also: ὡς ὁ ἄνθρωπος αἷμα μοῦνόν ἐστιν/καὶ τοῦτο ἓν ἐὸν μεταλλάσσειν τὴν ἰδέην. The manuscript tradition for both Nat. Hom. and Galen includes such variants (Jouanna 1975, 166). 6  The physiological and pathological doctrines in Nat. Hom. make use of only three humors, since black and yellow bile are not distinguished except in the polemical introduction (Jouanna 1975, 49). 7  Wellmann 1922 and Manetti 1994 date the papyrus text to the 1st c. CE. Diels 1893, 413 had said ‘under Domitian or Trajan’.

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Aristotle’s Physics and Metaphysics.8 Platonic concerns of course lurk further in the background to Aristotle’s four causes, and, if that, perhaps Pythagorean as well, and these previous or parallel receptions of older medical traditions might have contributed to the perception of a monist Hippocrates.9 Whatever the ultimate roots of this theoretical turn, the evidence of Anonymus Londiensis, especially as fortified by the passage in Galen, points to a conflict between allegedly genuine Hippocratic pluralism of materialist account and an ‘Aristotelian’ or Peripatetic presentation of monism. It may become no clearer through my investigation which Hippocrates, the pluralist or the monist, is closer to the historical one, and it could be that both figures of Hippocrates in this quarrel are constructions in the rival receptions. Indeed, modern opinion will reject Hippocrates the monist, who thought the human was constituted basically by air, or by blood, or by whatever the single substrate might be, and those who follow Geoffrey Lloyd will reject also Hippocrates the advocate of four humors.10 My account will imply that the view of Hippocrates favored by Galen is not as false as some claim in their firm distinction between the true Hippocrates and the Nature of Man authored by Polybus.11 It aims to show that a Peripatetic intervention sought to reduce the four-humor theory to some kind of materialist monism. Moreover, the Peripatetic reception might have tampered with, or at least did not lack interested motivations in favoring certain alternatives for, both the authorship and the content of the Hippocratic text that directly rejects monism and advocates the four humors, Nature of Man. First, let us note that Galen’s charge, that Menon represents no ancient doctor to say that phlegm or bile is an essential constituent of the healthy human nature, is not entirely accurate with respect to whatever version of Menon’s Iatrike Sunagoge survives for us in the London papyrus: there is one doctor, Menecrates surnamed Zeus of Syracuse, who appears to say that bodies are composed of four elements, blood, bile, breath and phlegm:12 8   Aristotle, Ph. 2.3, 194b23–26 (introduction of the first cause) and 195a3ff. (explication of the four causes using the term ὕλη) and Metaph. 8.4, 1044a15–20 (argument that each thing has its proper matter) and 1044a34–35 (identification of menstrual fluid as the material cause of the human being). 9   On the general philosophical background to 4th c. medicine see Longrigg 1993. 10  Lloyd 1991. 11  I follow Jouanna (1975, 45–52) in his view that Nat. Hom., a product of the early school of Cos, where Hippocrates’ son-in-law Polybus worked closely with Hippocrates, presents authentic doctrine of Hippocrates’ circle, despite the attribution of authorship to Polybus. Lloyd (1991) holds that Galen’s reception of Hippocrates is seriously skewed. 12  Texts of Anonymus are from Manetti 2011. Translations are mine; I have consulted and often borrowed phrases from Jones 1947.

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Μενεκράτ[η]ς δὲ ὁ Ζε̣[ὺ]ς ἐπικληθεὶς ἐν Ἰατρικῆι δ̣[ε]ῖξίν τ̣ι ̣[ν]α τ(ῶν) σωμάτ(ων) ἐκτιθέμενος ο(ὕτως) αἰτ̣ιολογεῖ τὰ πάθη, πρότερον περὶ τ(ῶν) π̣ ο̣[ιοτ]ή̣[τ]ω(ν) πολυπραγμον(ῶν) τ(ῶν) σωμάτ(ων). συνεστάναι γ[(ὰρ)] λέγει τὰ σώματα ἐκ τ(ῶν) τεσ̣ σ̣ά̣ρων στοιχείων β’ μ(ὲν) θερμῶ̣ν, β̣’ δὲ̣ [ψ]υχρῶν• θερμῶν μ(ὲν) αἵματος χολῆς, ψυχρῶν ̣ δὲ πνεύματος [κ]αὶ φλέγμα̣τος. τούτ(ων) μ(ὲν) δὴ μ̣ ὴ στασιαζόντ(ων), ἀλλ’ εὐκράτως διακειμέν(ων), ὑγιαίνει τὸ ζῶιον, δυσκράτως δὲ ἐχ̣όντων νο[σεῖ. But Menecrates surnamed Zeus, when setting forth in his Medical (Techne) a demonstration about bodies, explains the causes of ailments in the following way, first going on at length about the qualities of bodies. He says that bodies are constituted from the four elements, two hot and two cold: the hot ones are blood and bile, and the cold are breath and phlegm. And when these are not at odds, but firmly under control, the animal is healthy, but when they are out of control, it is ill.13 Of course, we are hampered both by the damaged text of the papyrus and by the fact that Anonymus is a mediator of Menon, and possibly not the only mediator. It could be that Galen in his own polemic overlooked this exception. It could be that the theory of Menecrates, which is peculiar in this catalog of ancient medical thinkers for calling heat and cold the ‘qualities’ (ποιότητες— this term is Diels’ supplement, but it is clear that something similar is required) of the four elements and putting these prior, in an apparently lengthy exposition, to blood, bile, breath and phlegm, at least according to the version we get here, was post-Platonic and so more complicated or abstract than what Galen is asking for.14 Alternatively, it could be that Menon’s records of other thinkers 13  Anon. Lond. 19.18–26. 14  I refer to the careful introduction of the term ποιότης in Tht. 182a8, which modern scholars generally take as the introduction of a new differentiation of ‘quality’ from substance. ‘Quality’ becomes a firm metaphysical term in Aristotle’s Cat., which supplies its system to much Peripatetic and post-Peripatetic doxography (Manetti 1999, 100–102). Menecrates seems to have been a contemporary of Plato’s (Craik 2009, 39–40). On the papyrus’ tendency to ‘doxographical deformation’, see Manetti’s 1990 consideration of the case of Philolaus.

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in addition to Menecrates belied Galen’s claim, but our text or Anonymus or both do not preserve everything that was in Menon. But it is also striking to what extent Galen’s account does agree with what we find in Anonymus. Phlegm and bile, when they are brought up in the doxography attributed to Aristotle (that is, Menon), are normally treated as pathogens, not as constituents of human nature. It is sooner Anonymus, that is, the master author of the papyrus (as Daniela Manetti shows),15 who believes in the multiple humors as natural constituents of the human body: in the third section of the document (col. 21.45–48), he lists blood, bile, phlegm, fluids and breath as the homogeneous or homoiomeral parts of the human body.16 Surely the most interesting case of the problem Galen describes must be Polybus, that is, on the assumption that he is reported qua author of Nature of Man. [. . . . ὁ δὲ] Πόλυβος ἐξ ἑνὸς μ̣ [(ὲν) στοιχείου οὐ λέγει] τὰ ἡμέτ̣ερ̣ α σώμ̣ [ατα γεννᾶσθαι ἀλ(λὰ) πολλ(ῶν) τὴν] αὐτὴν φύ̣σ̣ιν ἐ̣χ̣ό̣ν̣[τ(ων)—ἐξ ὑγροῦ τε καὶ ξηροῦ,] ψυχροῦ τε καὶ θερμ̣ [οῦ—, οὐ χωρὶς ὄντ(ων) τ]ούτ(ων) ἀλλὰ κεκραμέν(ων) α̣ὐ[τ(ῶν) μετρίως, ὑπερ-] βαλὸν δὲ θάτερον θ̣ατ̣[έρου, νόσους ἀπο-] τ̣ελ̣ ̣εῖ̣ ̣ν. δευτέ̣ρ[̣ ον δὲ λέγει τὴν] τῶ̣ν σωμάτ(ων) μίξ[̣ ιν (εἶναι) ἐξ αἵματός τε] καὶ φλέγματος καὶ χ[ολῆς ξανθῆς τε] καὶ μελαίνης· ἀπὸ δ̣[ +/-11 ] τούτ(ων) ἢ ἑνὸς αὐτ(ῶν) ν..[ +/-11 ] μεταβολὴν ἢ κ(ατὰ) τὸν αὐ̣[ +/-10 ] συμμίξεως κ(ατὰ) φύσιν [ +/-10 ] σώματι χωρισ̣ [θέ]ν̣α̣[ι] δ̣[ +/-10 ] νόσους γί(νεσ)θ(αι). νοσεῖν δὲ καὶ ἀ[φ’ ὧν ἐχω-] ρίσθη τόπων κ[α]ὶ εἰς ̣ [οὕσ μετε]χ̣[ώ-] ρησεν. 15  Manetti 1994. 16  κ[αὶ διεσπαρμ(έν)α] μ̣ (ὲν) οὖν (ἐστιν) αἷμα, χολή, φλέ-/γμ̣ [α καὶ ἁπλ]ῶς πάντα τὰ ἐν ἡμῖν ὑγρά,/ ο̣[7/8] πνεῦμα, τὰ τούτοις ἐοικότα./ [τὰ ἡνωμέ]ν̣α δὲ τὰ μὴ τοιαῦτα. ‘The equally distributed (parts) are blood, bile, phlegm and basically all the fluids in us, . . . breath, things like these, and the united (parts) are the ones not of this sort’. Diels’ text (with different supplements, i.e., reading ὁ[μοίως φῦσα], πνεῦμα, τὰ τούτοις ἐοιότα at 21.47), implies that these basic constituents come in two sets, the first fluid and the second air-like.

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Polybus says that our bodies are not brought to birth from one element, but from many having the same nature, from the wet and dry, the cold and hot, when these are not separated but blended proportionally. But when one overpowers the other, diseases occur. Secondly, he says that the mixture in bodies is from blood and phlegm and yellow bile and black bile. For from these or of one of them, change either according to of the mixture by nature ; in the body is separated, diseases occur. Both the places from which and those to which the separation occurs are diseased.17 Since Diels, this text has been recognized as a paraphrase from Nature of Man 3–4, attributed here to Polybus rather than Hippocrates, in conflict with the view of Galen. Diels indeed supplemented the missing line ends at 19.1–15 directly from Nature of Man 3 and 4. Even without these supplements (reduced in Manetti’s new edition), the preserved text, with its treatment of monism, mention of humors, and discussion of mixture, separation, and places which become ill, matches neatly with Nature of Man.18 Meanwhile, we know that Aristotle’s History of Animals (512b) cites a later part of Nature of Man verbatim and attributes it to Polybus. The suggestion I will defend in the remainder of this chapter is that separating Nature of Man from the writings and doctrine of Hippocrates enables the Peripatetic tradition to hold that Hippocrates was essentially a material monist, like them. Surely the attribution to Polybus was not outright fabrication; but in a situation where authorship was debatable, this insistence that Polybus was the author was convenient. In the papyrus, the passage about Polybus comes near the end of what scholars distinguish as the middle section of the text, the discussion of the aetiology of disease. In the second part of that section, Anonymus, after he has surveyed thirteen doctors who attribute disease to residues or περισσώματα from food intake, including Hippocrates in third position, goes on to survey six further thinkers who explain disease through the ‘elements’ (στοιχεῖα, the same term Galen uses) in human nature. But στοιχεῖα, as we know from Nature of Man itself, can be identified on various levels and in various realms, and two of the six, Plato and Philistion, who come first and last in Anonymus’ list, mean by στοιχεῖα the cosmic elements fire, air, water and earth; two others, Philolaus the Pythagorean and Petron of Aegina, mean heat and cold, although Philolaus says heat only and Petron adds dry and wet as so-called ἀντίστοιχα or 17  Anon. Lond. 19.1–18. 18  The parallels are laid out in Jouanna 1975, 56 n. 4, who does not distinguish between the transmitted letters and Diels’ supplements.

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partner elements; and the only two who might be talking about humoral elements such as phlegm and bile are the Menecrates we have mentioned and Polybus, who is treated immediately before him, third on the list. (The six are arranged in a chiastic pattern, beginning and ending with cosmic elements, with the advocates of humoral elements in the middle.) To leave aside the editorial supplements, reading only the beginnings of ll. 19.1–18, it could be that Menon said Polybus claimed we are in fact made from one element: the negation is supplied by Diels. Yet in l. 5 it is clear that we are talking about cold and hot, and so, in contrast to Philolaus whose doxai have just been reported, probably Anonymus did negate his ‘ἐξ ἑνός’. Menon represents here, perhaps, the first two chapters of Nature of Man, which polemically disputes seven possible ἐξ ἑνός positions, four from the cosmic physicists who claim man is made entirely from one of the four cosmic elements, and three from the medical theorists who claim he is entirely blood, bile or phlegm. But the positive tenet Menon seems to extract from chs. 1 and 2 of Nature of Man, that hot and cold, or possibly more such oppositions, are more causally basic than any one element, is not enunciated as such in Nature of Man. To be sure, hot, cold, wet and dry are mentioned often, and become structuring elements, so to speak, in the author’s eventual discussion in ch. 7 of correspondences between the four seasons and the humors, and so diseases, which predominate in each.19 But they are never called στοιχεῖα in the text, just as the humors and cosmic elements are not, and it takes a very confident or even biased reading of Nature of Man to pull cold and hot into first position in the causation of disease. Δευτέρον or second strategy in the explanation of disease, says Anonymus’ Menon, seems to involve changes in the balance of humors. As in the case of Menecrates, whose text in the papyrus is preserved rather better, so here the author has subordinated the humoral elements under their powers or qualities of hot and cold.20 Assuming Nature of Man is the source text, we can see how the theoretical advances (such as they are) of Menon’s time are imposed anachronistically onto an original. Galen’s allegation and explanation, the compromised sources for Menon’s scholarship, make the matter sound more innocent. Let us note, too, that among the nineteen ancient doctors in total whose aetiology is reported, only these two, Polybus and Menecrates, come even close 19  Also Jouanna 1975, 56 n. 6 notes that this reduction of hot, cold, dry and wet in the Nature of Man to hot and cold only in Anon. Lond. is a misrepresentation. 20  The term δύναμις was conjectured by Diels in 19.11, where Manetti leaves a lacuna. Compare the basic analysis of matter into combinations of hot versus cold and wet versus dry, etc., in Aristotle’s GC 2.1, 329a25ff.

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to holding a multi-humoral theory of the healthy constitution. In the case of Polybus we must in fact surmise this from Nature of Man; Anonymus states only the pathological role of the humors. And so Galen’s report of the omission of other humoral elements in the Peripatetic history of medicine seems to square up with the record in Anonymus. Let us turn now to Anonymus’ famous treatment of Hippocrates himself, and see how the difference between a monistic materialism and a pluralistic materialism plays out there, in the author’s well-known intervention in correction of his Peripatetic source. The whole conception of food residues or περισσώματα, which shapes the section where Hippocrates is treated, might itself be a strategy of materialist monism: Anonymus calls περισσώματα the first possibility for the ἀρχή and ὕλη of disease when he introduces the section (col. 4.29). When Anonymus mentions Hippocrates, he immediately says that gases are the cause of disease, according to the report of Aristotle: Ἱπποκράτης δέ φ(ησιν) αἰ(τίας) (εἶναι) τῆς νόσου τὰς φύσας, καθὼς διείληφεν περὶ αὐτοῦ Ἀριστοτέλης. ὁ γὰρ Ἱπποκράτης λέγει τὰς νόσους ἀποτελεῖσθαι κ(ατὰ) λ̣ (όγον) τοιοῦτον• ἢ παρὰ τὸ πλῆθος τῶν προσφερομέν(ων) ἢ παρὰ τὴν πο̣ικιλίαν ἢ παρὰ τὸ ἰσχυρὰ καὶ δυσκατέργαστα (εἶναι) τὰ προσφερόμε̣ν̣α σ̣ υ̣μ̣β̣αίνει περισσώματα ἀπογεννᾶ̣σ̣θ̣α̣ι ̣. [καὶ ὅ]ταν μὲν πλείονα ᾖ τ̣ὰ̣ π̣ [ροσενεχ]θ̣έντα κ̣ ατ̣ακρατ[ο]υ̣μέν[η ἡ ἐνεργο]ῦ̣[σ]α̣ τὴν πέψιν θερμότης π(ρὸς) πολλῶν [ὄ]ντ(ων) προ̣σ̣αρμάτ(ων) οὐκ ἐνεργεῖ τὴν πέ[ψ]ιν ἀπ[ὸ] δὲ τοῦ ταύτην παραποδίζεσθαι ⸏πε[ρ]ι ̣σ̣ σώματα γί(νεται). ὅταν δὲ ποικίλα ᾖ τ[ὰ] π(ροσ)ενεχθέντα, στασιάζει ̣ ἐν τῆι κοιλίᾳ πρὸς ἑαυτὰ καὶ κατὰ τ̣ὸν στασιασμὸν μεταβολὴ εἰς περισσώμα̣τα. ὅταν μέντοι γε ἐλάχιστα καὶ δυσκατέργαστα ἦ[ι, ο]ὕτως παραποδισμὸς γί(νεται) τῆς πέψεω(ς) δ̣ι ̣ὰ τὴν δυσκατεργασίαν καὶ οὕτως μεταβολὴ εἰς περισσώματα• ἐκ δὲ τῶν περισσωμάτ(ων) ἀναφέροντα̣ι ̣ φῦσαι• αἱ δὲ ἀν[ε]νεχθεῖσαι ἐπιφέρουσι τὰς νόσους.

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But Hippocrates says that gases are causes of disease, according to the account Aristotle has given of him. For Hippocrates says that diseases are brought about in the following fashion. Either because of the quantity of things taken, or because of their diversity, or because the things taken happen to be strong and difficult of digestion, residues are thereby produced. Αnd when the things that have been taken are too many, the heat that produces digestion is overpowered by the multitude of foods and does not effect digestion. Because digestion is hindered, residues are formed. And when the things that have been taken are of many kinds, they quarrel with one another in the belly, and because of the quarrel there is a change into residues. When, however, they are very few and hard to digest, there occurs hindrance of digestion because they are hard to assimilate, and so a change to residues takes place. From the residues rise gases, which once they have arisen bring on diseases.21 These gases are not constituent of man, as they are in the monism rejected by Nature of Man. Nor are they, in this first part of the passage, the first cause of disease, as they are later in the passage and in the Hippocratic treatise Breaths, which scholars since Diels have identified as Anonymus’ apparent source for this passage.22 Rather, as Steckerl and others point out, they are the byproducts of food, produced inside the body, and not far removed from the gases identified as responsible for ailments in the most aetiological section of On Ancient Medicine, around ch. 24. Much of the vocabulary resonates with terms in Breaths, such as ποικίλα and στασιάζει, which occur together in Breaths 7, but the doctrine is not incompatible with a view of health based on balance and regimen, and the one-versus-many polemic that can be seen in Nature of Man and Ancient Medicine, both arguing against single principles, and in Breaths, which argues for a single principle, is not apparent in the papyrus’ account. So far, so good. But Anonymus’ Aristotle, or Menon, then goes on to explain why Hippocrates believed this, and here the relics of a monist versus pluralist debate become evident. ταῦτα δὲ ἔφησεν ἁνὴρ κ̣ ι ̣[ν]ηθ̣εὶ̣ς ̣ δόγματι τοιούτῳ• τὸ γ(ὰρ) πνεῦμ(α) ἀνα̣γκα̣ιότατον καὶ κυριώτατον ἀπολείπει τ(ῶν) ἐν ἡμῖν, ἐπειδή γε παρὰ τὴν τού21  Anon. Lond. 5.35–6.13. 22  Jouanna 1988, 39–41 discusses the parallels.

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του εὔροιαν ὑγίεια γί(νεται), παρὰ δὲ τὴν δύσροιαν νόσοι. δίκην τε ἐπέχειν ἡμᾶς φυτῶν•

εἰ δὲ ταῦτα, φανερὸν ὡς κυριώτατόν (ἐστιν) τὸ πνεῦμα. τούτ(ων) ἐκκειμέν(ων), ὅταν γέν(ηται) περισσώμα, ἀπὸ τούτων γί(νονται) φῦσαι, αἳ δὴ ἀναθυμ(ιαθεῖσαι) τὰς νόσους ἀποτελοῦσι• παρά τε τὴν δια̣φορ[ὰν] τ(ῶν) [φ]υσῶν̣ ἀποτελοῦνται αἱ νόσοι. ἐὰν μ(ὲν) γ(ὰρ) πολλαὶ ὦσι, νοσάζουσιν, ἐὰν δ̣ὲ̣ ἐλάχισται, πάλι νόσους ἐπιφέρουσι• παρά τε τὴν μεταβολὴν τῶν φυσῶ(ν) γίνονται ̣ αἱ νόσοι• διχῶς δὲ μεταβάλλουσιν ἢ ἐπὶ τὸ ὑπέρμετρον θερμὸν ἢ ἐπὶ τὸ ὑπ[έ]ρμετρον ψυχρόν. καὶ ὁποίως ἂν γ[έ]νηται ̣ ἡ̣ μ̣ εταβολή, νόσους ἀποτελεῖ. κ̣ α̣[ὶ ὡ]ς μ(ὲν) ὁ Ἀριστοτέλης οἴεται περὶ Ἱππ̣ [οκρά]τ̣ο̣υς ταῦτα. Hippocrates said these things because he was moved by the following position. Breath, he holds, is the most necessary and the supreme component in us, since health is the result of its free passage, and disease of its impeded passage. We in fact present a likeness to plants. . . . If this be so, it is clear that breath is the supreme component. On this theory, when residues occur, they give rise to breaths, which rising as vapor cause diseases. Diseases arise in accordance with the variations in the breaths. If the breaths are many, they produce disease; and if they are very few, they again bring diseases. The changes of breaths also give rise to diseases. These changes take place in two directions, towards excessive heat or towards excessive cold. The nature of the change determines the character of the disease. This is how Aristotle thinks about Hippocrates.23 Here, as in the Breaths treatise from the CH, the πνεῦμα and φῦσαι, the breath of respiration and the gases of digestion within the body, are assimilated to the air outside of the body, a single material that we breathe or take in: this air is as fundamental, or κυριώτατον, a material substrate for us as the soil is for plants. When the Peripatetic writer turns then (6.33–42) to the explanation for variety in diseases, a debate between monism and pluralism becomes all the clearer: a monist theory of disease aetiology must have some special way to 23  Anon. Lond. 6.13–18 and 30–42.

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account for variety in the diseases we see. This is the argument on which the author of Nature of Man dwells for many sentences in refuting monism in ch. 2, and the argument that the author of Breaths undertakes in various ways, such as his distinction in chs. 6 and 7 between epidemics and diseases caused by bad regimen. In fact, the demand to explain the variety in diseases comes up repeatedly in Anonymus’ aetiology as well, and at least two medics are accused with failing to explain it. What is interesting here is that in Aristotle’s account of Hippocrates’ position, variety is explained quantitatively, as though different kinds of φῦσαι do not exist or do not matter, and the common Hippocratic explanations, reference to different places in the body or different seasons of the year or different types of person or different regimens, are not mentioned. We have only many gases (ἐὰν μὲν γὰρ πολλαὶ ὦσι) versus few (ἐὰν δὲ ἐλάχισται), and both produce disease (νοσάζουσιν. . ., πάλι νόσους ἐπιφέρουσι), different ones, as we must surmise. Then we have gases which change with respect to heat, ranging from excessive heat to excessive cold, and this is itself a standard monist explanation for variation, related to the rare and the condensed of the Presocratic monists, at least in Aristotle’s representation in Physics and elsewhere,24 and cited in the opening chapter of Nature of Man as an insufficient explanation for variety.25 Although Anonymus’ Peripatetic source has introduced his account of variation in disease with phrasing which normally implies qualitative variety (παρά τήν τε διαφορὰν τῶν φυσῶν, 6.33–34),26 the account itself has no component which is necessarily anything other than quantitative. 24  Ph. 1.4, 187a12–20. Cherniss 1935, 49ff. shows how Aristotle’s account of the Presocratic materialists is filtered through his own conceptions. 25  Jouanna 1988, 43 notes that Flat. 5, p. 108.10ff. refers only to quantitative variation to explain diversity of diseases, and states that a qualitative variation, heat and coldness, is added by Anonymus’ Aristotelian source. Flat. 5 actually offers, in full, four possibilities for the causation of disease by air: μετὰ τοῦτο τοίνυν εὐθέως ῥητέον, ὅτι οὐκ ἄλλοθέν ποθεν εἰκός ἐστι γίνεσθαι τὰς ἀῤῥωστίας ἢ ἐντεῦθεν, ὅταν τοῦτο (sc. ὁ ἠήρ) πλέον ἢ ἔλασσον ἢ ἀθροώτερον γένηται ἢ μεμιασμένον νοσηροῖσι μιάσμασιν ἐς τὸ σῶμα ἐσέλθῃ (‘whenever this (the air) becomes more or less or more concentrated (sc. than just right) or whenever it enters the body polluted by disease-bearing contaminants’). The final criterion opens the possible origin of the disease well beyond the quantity of air in itself by implying that air is not homogeneous, but it can be mixed with other elements that prove to be the pathogens. The Aristotelian source has possibly replaced this expansion beyond quantitative explanation with the variation hot and cold, which can be aligned with rarefaction and condensation, a nearly quantitative differentiation. 26  I thank Stephen White for pointing out that διαφορά should indicate qualitative variation, especially in Aristotle’s school.

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But Anonymus is well aware, in his report of Hippocrates as in no other case, that Aristotle is providing a biased view of the matter. ὡς δὲ αὐτὸς Ἱπποκράτης λέγει γί(νεσ)θ(αι) τὰς νόσο(υς) [+/-2 ]ν̣τ[̣ +/-5 ] . . . . () . . . . . [.]ε̣ρι̣ ̣ φύσεω() ἀνθ[ρωπ λέ-] γει δι[ ἢ ὑπ[ ].[.].ω̣ ν χολῆς καὶ φλέγμα[τ]ο̣ς, ν̣[ ταῦτα, ἐπειδὴ γ̣ι ̣ν̣ομένοις [ καὶ οὖσι σύν(εστιν) ὥ̣σθ[ ἑκάσ]τ̣ο̣υ̣ παρόντος ε̣ι ̣λ̣ [.]σ̣ τι̣ .τοσ[.].α̣.[ ].ω̣ ν̣ εἶναι ἐν ἡμῖν κ(ατὰ) φύσιν τὸ [αἷ]μα τ ̣ὸ[θερμότ(ατον)] ̣ τῶν [ὑ]γρῶν, παρ̣ὰ φύσ̣ ιν τε τὴν ε̣κ̣[ +/-3 ].ιν̣. ὅτι ὑπ̣ ὸ μ(ὲν) τ̣[(ῶν)] ἐ̣ν̣ ἡ̣μ̣ῖν̣ γί(νονται) αἱ ν̣ό̣σοι, χο[λῆς καὶ] φλέγματος, ὑ̣π̣ὸ̣ δὲ τ(ῶν) ἐκτός, [τραυμ]ά̣τ(̣ ων), πόνων, ὑπερμέτρου κ(ατα)[ψ]ύξεως [ἢ θερμ]ό̣[τ]η̣ τ̣(ος) παρά τε τ̣ὴν τ̣ῆ̣ς ̣ χ[ο]λῆς καὶ τοῦ φ[λέγ]μ̣ α̣το̣ ̣ς ̣ κατάψυξιν ἢ θερμ[ό]τ̣η̣[τ]α πά̣λ̣ι ̣ γί(νεσ)θ(αι) [τὰς νό-] σους. ἀλ(λὰ) γ(ὰρ) ἔτι φ(ησὶν) Ἱππο̣κράτης [γί(νεσ)θ(αι) τὰς] νόσους ἢ ἀπὸ τοῦ πν̣εύ̣ μα̣τος ἢ [ἀπὸ τῶν διαι-] τημά̣τ(ων), καὶ τα̣ῦ̣[τ]α̣ μ̣ (ὲν) ἐ̣π̣[ιχε]ι ̣ρ̣[ητέον] ἐκτίθεσθαι• ὅταν μ(ὲν) γ(άρ), φ(ησιν), ὑπὸ τ̣[ῆς] α̣ὐ̣τῆς νόσου πολλοὶ ἁ[λ]ίσκωνται [ἅμα, τὰς] αἰτίας ἀναθετ̣έ̣ο̣ν̣ τῶι ἀέρι• παρὰ [γ(ὰρ)] πᾶσιν ἐ]κ̣ τοῦτ̣[ο]υ ἧ̣π̣τα̣ι ̣ αὑτὴ [ν]όσ̣ ο̣ς.̣ ὅταν [δὲ π]ο̣λ̣λὰ ε̣ἴδη καὶ ποικίλα γί(νηται) ν̣ό̣σων, [αἴ(τια) λεκ-] τέον τὰ διαιτήματα, οὐχ ὑγιῶ[ς π]ο̣ι ̣ούμενος τὴν ἐπιχείρησιν . . . .  But what Hippocrates himself says is that diseases come about nature . . . man He says , either because of bile and phlegm these because when we are born and they persist with us when we live when each is present that we have in us by nature blood, the hottest of the fluids, and according to nature the that on the one hand diseases come about because of the elements in us, bile and phlegm, and on the other hand, because of external factors, (such as) injuries, toil, excessive cooling or heating; and in accordance with the cooling and heating of bile and phlegm, diseases also come about.

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But Hippocrates goes on to say that diseases have their origin in either the air or regimen, and one must try to set out the outline of these matters. Whenever, he says, many are attacked at the same time by the same disease, the cause must be attributed to the air. For from this (medium) the same disease takes hold of everyone. But whenever many varied forms of diseases occur, the cause must be said to be regimen. In saying this, he employs an unsound method of argument . . .27 Whereas Anonymus seems to lack an independent tradition in the cases of Polybus and the other ancient doctors (and he apparently does not recognize Nature of Man as the source for Polybus), for Hippocrates he is ready to recognize the distortion in his Peripatetic source. Here again the text is very bad (and Manetti’s readings and supplements differ from those of Diels, sometimes considerably), but there is a clear reference to ‘nature’ in the last line of col. 6 and probably to ‘human’ in the first line of col. 7. When we see bile and phlegm in l.4 of column 7, we can suspect we are in the company again of Nature of Man, this time attributed to Hippocrates rather than Polybus. That is, Anonymus, like Galen, sees Nature of Man and its multi-humoral theory as central to Hippocratic doctrine, more Hippocratic than Breaths with its quasi-monism and its liability to the materialist straitjacket of Aristotle. It is unclear from the text whether all the humors are part of health according to Anonymus’ correction of Menon, or whether bile and phlegm are only pathological, as they are in the Hippocratic Diseases 1 and in several others of the theories catalogued by Anonymus. Surely blood is natural or κατὰ φύσιν in l. 8, and a plurality of constituents seems to be born with us and persist with us in life, in ll. 5–6. But the doctrine of Diseases 1, where bile and phlegm are pathogens and not elements of healthy constitution, might be evoked by scholarship just to maintain the distinction from Nature of Man, whose first part is supposed to be attributed to Polybus in col. 19. Because we have two different traditions concerning the essence of Hippocrates’ teachings meeting in this papyrus, though, it could be that the same text is attributed to different authors by different layers in the reception.28 When Anonymus says in ll. 15–17 that Hippocrates ‘goes on to say’ (ἀλλὰ γὰρ ἔτι φησὶν Ἱπποκράτης) that both breath (πνεῦμα) and regimen (διαιτήματα) can be the cause of disease, it would seem that he means later in Nature of Man, although a similar idea comes up also in Breaths, and indeed l. 18 and following seem to quote Nature of Man 9 almost verbatim. Nature of Man with its pluralist basis seems to represent essential Hippocrates for Anonymus. 27  Anon. Lond. 6.43–7.23. 28  So also Jouanna 1975, 57.

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But the debate is not over yet, for Anonymus now turns to criticize the Hippocrates he has just claimed to represent more loyally, and in doing so Anonymus seems to extend his rejection of Aristotle’s Hippocrates by dismissing the monist strand in the Hippocratic position, even as Hippocrates himself framed it, and endorsing the pluralist. οὐχ ὑγιῶ[ς π]ο̣ι ̣ούμενος τὴν ἐπιχείρησιν· ἐν[ίοτε γ(ὰρ)] τὸ αὐτ̣ὸ̣ αἴ(τιον) πολλῶν καὶ ποικίλ[ων] νοση̣ μάτ(ων) γί(νεται). κ(ατα)σκευαστικὸν [γάρ-] τοι πλῆθος καὶ πυρετοῦ καὶ πλευ[ρίτι-] δος καὶ ἐπιληψίας (ἐστίν), ὅπε̣ρ κ(ατὰ) σ̣ ύ̣σ̣[τασιν] τῶν σωμάτ(ων) ἀναδεχομέν(ων) τ[ὸ πάθος τίκτει] καὶ τ̣ὰ̣ς ̣ νόσους. οὐ γὰρ δὴ πάντω̣[ν σωμάτ(ων)], ἐπεὶ ἕν (ἐστιν) αἴ(τιον), ἤ̣δ̣η̣ μία καὶ νόσο φέρ̣[εται] ἀλλ’ [ὥ]σπερ εἴπομ(εν), πολλὰ καὶ ποικίλ[α εἴδη]. καὶ τ̣[ἄμ]παλιν (ἔστιν) ὅτε ὑπὸ διαφερόν̣[τ(ων) αἰ(τίων)] ταὐτὰ γ̣ί(νεται)̣ πάθη. καὶ γ(ὰρ) διὰ πλῆθος π̣ [υρετ(ὸς) αἱ-] ρεῖ, ἔ̣τ[̣ ι] κ̣ αὶ διὰ δριμύτητα [κ]α̣ὶ̣ χο̣[λ]ήν̣· ἐξ ὧν φ̣α̣νερὸν ὡς ψεῦδό̣ς ̣ (ἐσ̣ τι̣ ̣ν̣) τ̣ο̣ῦ[το], ὡς προιόντος ἐπιδείξομ(ε̣ν̣) τ̣οῦ λό(γου). [ἐκεῖνο] μέντοι γε ῥητέον διότι ̣ [ἄλ]λ̣ ως [Ἀριστο-] τέλης περὶ τοῦ Ἱπποκράτους λέγε[ι καὶ] ἄλλως αὐτός φ(ησιν) γί(νεσ)θ(αι) τὰς ν̣[ό]σου̣[ς.] . . . he employs an unsound method of argument. For there are times when many different diseases have one and the same cause. For surely excess (of food) is productive of fever, pleurisy and epilepsy, and this (excess) produces also diseases corresponding to the constitution of the bodies that receive the affliction. Nor, in fact, because there is one cause, is there immediately one disease transmitted for all bodies, but rather, as we have said, (there are sometimes) many different forms. Conversely, sometimes different causes produce the same afflictions. For fever can seize (someone) because of excess (of food), but also because of pungency and bile. From these (considerations) it is manifest that this is a falsehood, as we shall show in the course of our discourse. Yet it must be said that what Aristotle tells us about Hippocrates is different from what he himself says about the origin of diseases.29 29  Anon. Lond. 7.23–40.

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More precisely, Anonymus destroys the major defensive refinement of monism, the distinction between epidemics from one cause which must affect everyone equally and ailments from a common single cause in regimen which occur differently in different people (a strategy that has occurred several times in his doxography of those blaming περισσώματα for causing disease) and allows us to entertain a single cause for varied diseases without this distinction. In doing so, Anonymus seems to imply that Hippocrates did not need his theory of πνεῦμα, since διαιτήματα covers the phenomena. His promise to return to the assessment of Hippocrates is, at any rate, famously unfulfilled, but there are many possible connections between Anonymus’ attention to the choice between a monist or a pluralist material basis to human diseases and the later, physiological part of the text (cols. 21–39), which remain underexplored. Anonymus, like Galen, sees Nature of Man and its multi-humoral theory as central to Hippocratic doctrine, more Hippocratic than Breaths with its quasimonism. The single Hippocratic material substrate in Anonymus’ discussion of pathology, to be confronted against the more Hippocratic Nature of Man, is not blood, as in Galen, but breath; yet both blood and breath, on their different levels, persist in post-Peripatetic medicine as leading principles of health and disease in ways that bile and phlegm do not. One might even see in the early Hellenistic Erasistratus, discussed in the physiological section of Anonymus’ treatise, a conflation of blood and breath, which to the distaste of rival schools is said to run in the arteries. At the end of the text, Anonymus himself and his most immediate interlocutors seem most interested in the material inputs to and effluences from the body, and how these maintain their identity of scent and so on despite their concoctions in the stomach and mutations through various states: furthermore, whatever is true of one kind of intake or effluence, or one kind of passage or pore, is true of all, and there is no meaningful distinction of types or classes of material constituents that act differently in and of themselves, by virtue of their different powers. By contrast with this basically material monism, which distinguishes itself instead against impulse and power (see 12.41–49), Hippocratic medicine for Anonymus, as for Galen, is concerned most emphatically with the rejection of a singular material substrate. Anonymus, unlike Galen, seems in the end to side more with the monists, but both agree against the Peripatetic tradition about what is historically Hippocratic.

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Bibliography Cherniss, H., Aristotle’s Criticism of Presocratic Philosophy. Baltimore, 1935. Craik, E., The Hippocratic Treatise ‘On Glands’. Leiden and Boston, 2009. Demont, P., ‘About Philosophy and Humoural Medicine’, in: P.J. van der Eijk (ed.), Hippocrates in Context. Leiden and Boston, 2005, 271–286. Diels, H., ‘Über die Excerpte von Menons Iatrika in dem Londoner Papyrus 137’, Hermes 29 (1893), 406–434. ———, Anonymi Londinensis ex Aristotelis Iatricis Menoniis et aliis medicis Eclogae, Supplementum Aristotelicum 3.1. Berlin, 1893. Eijk, P.J. van der, ‘Aristoteles über die Melancholie’, Mnemosyne 43 (1990), 33–72. Jones, W.H.S., The Medical Writings of Anonymus Londinensis. Cambridge, 1947. Jouanna, J. (ed.), Hippocrate. La Nature de l’Homme. Berlin, 1975. ——— (ed.), Hippocrate. Des vents. De l’art. Paris, 1988. Kenyon, F.G., ‘A Medical Papyrus in the British Museum’, Classical Review 6 (1892), 237–240. Lloyd, G.E.R., ‘Who is attacked in On Ancient Medicine?’, Phronesis 8 (1963), 108–26, repr. in G.E.R. Lloyd, Methods and Problems in Greek Science. Cambridge, 1991, 49–69. ———, ‘The Hippocratic Question’, Classical Quarterly 25 (1975), 171–192, repr. in G.E.R. Lloyd, Methods and Problems. Cambridge, 1991, 194–223. ———, ‘Galen on Hellenistics and Hippocrateans: contemporary battles and past authorities’, in: G.E.R. Lloyd, Methods and Problems. Cambridge, 1991, 398–416. Longrigg, J., Greek Rational Medicine. Philosophy and Medicine from Alcmaeon to the Alexandrians. London and New York, 1993. Manetti, D., ‘Note di Lettura dell’ Anonimo Londinese—Prolegomena ad una nuova Edizione̕, ZPE 63 (1986), 57–74. ———, ‘Autografi e incompiuti, il caso dell’ Anonimo londinese’, ZPE 100 (1994), 47–59. ———, ‘Doxographical Deformation of medical Tradition in the Report of Anonymus Londinensis on Philolaos’, ZPE 83 (1990), 219–233. ———, ‘Ὡς δὲ αὐτὸς Ἱπποκράτης λέγει. Teoria causale e ippocratismo nell’ Anonimo Londinese (VI 43 ss.)’, in: R. Wittern and P. Pellegrin (eds.), Hippokratische Medizin und antike Philosophie. Hildesheim, Zürich and New York, 1996, 295–310. ———, ‘ “Aristotle” and the Role of Doxography in the Anonymus Londiniensis (P.Br. Lib. Inv. 137)’, in: P.J. van der Eijk (ed.), Ancient Histories of Medicine. Essays in Medical Doxography and Historiography in Classical Antiquity. Leiden, Boston and Köln, 1999, 95–141. ——— (ed.), Anonymus Londiniensis De Medicina. Berlin and New York, 2011. Mewaldt, I. (ed.), Galeni In Hippocratis de natura Hominis Commentaria Tria. in: CMG vol. 9.1. Leipzig and Berlin, 1914.

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Schumacher, J., ‘Der Menon-Bericht zu Hippokrates im Anonymus Londinensis’, in: J. Schumacher (ed.), Melemata. Festchrift W. Leibbrand. Mannheim, 1967, 143–48. Smith, W., The Hippocratic Tradition. Ithaca and London, 1979. Staden, H. von, Herophilus: the Art of Medicine in Early Alexandria. Cambridge 1989. Steckerl, F., ‘Plato, Hippocrates and the Menon Papyrus’, Classical Philology 40 (1945), 166–180. Thivel, A., ‘La doctrine des περισσώματα et ses parallèles hippocratiques’, Revue de Philologie 39 (1965), 266–282. ———, ‘La doctrine d’Hippocrate dans l’Anonyme de Londres’, in: M. Woronoff, S. Follet and J. Jouanna (eds.), Dieux, héros et médecins grecs. Hommage à F. Robert. Paris, 2001. Wellmann, M., ‘Der Verfasser des Anonymus Londinensis’, Hermes 57 (1922), 396–429.

CHAPTER 6

Tracking the Hippocratic Woozle: Pseudepigrapha and the Formation of the Corpus Eric Nelson 1 Introduction What is ‘Hippocratic’ and how do we decide? One approach to this question might be to look at the early history of what others have meant by ‘Hippocratic’. But as an attribute, the term does not have as early of a history as one might think. It never appears, for instance, in the works of the CH, and so not even in those that might be by Hippocrates himself. This is not so surprising: Hippocrates, after all, might have been no more aware that he was Hippocratic than Jesus might have been aware that he was ‘Christian’. But shouldn’t we expect other writers of the Corpus to show some awareness, if only in the use of an adjective, that there was something distinctly Hippocratic about their enterprise? None—not even the writers of works attributed in antiquity to Hippocrates’ own family and students—seem to know that they are thinking Hippocratic things, or engaging in Hippocratic practices, or belong to some Hippocratic category. Nevertheless, when the term first appears in the 2nd c. CE, in Galen and Herodianus, it refers to works of the CH and to a tradition that the Corpus represents.1 What none of the works do individually (namely, help to explicate what is distinctly ‘Hippocratic’) the Corpus seems to be doing, like a compound lens in which multiple elements (texts, in this case) work collectively to bring something into focus. This lens, however, had already been retooled and refocused, as it were, by adding additional texts over several centuries. We do 1  Galen, In Hippocratis librum vi epidemiarum commentarii 6 (CMG 5.10.2.2, 23, Wenkebach 1925 = 17A, 831.12 K) refers to a ‘Hippocratic phrase’ (αὕτη μὲν οὖν ἡ Ἱπποκράτειός ἐστι ῥῆσις) and Aelius Herodianus (Partitiones 172.14), who, when talking about personal attributives, cites the examples an ‘Achillean breastplate’ (Ἀχίλλειος θώραξ) and a ‘Hippocratic book’ (Ἱπποκράτειος βίβλος). Neither reference seems to have meant ‘by Hippocrates’ (any more than ‘Achillean’ meant ‘made by Achilles’), but ‘of a Hippocratic type’, a categorization that depends upon judgments developed from the literary study of the Corpus (Smith 2002, 234–240).

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have a partial history of this process, which extends backwards from the editions of the Corpus by Dioscorides and Artemidorus, just prior to Galen and Herodianus, to its initial collection in Alexandria in the late 3rd c. BCE.2 And so, instead of investigating the history of a Hippocratic term, it may be more profitable, in terms of asking ‘What is “Hippocratic” about the Hippocratics?’ to investigate the history of a Hippocratic decision—namely, the decision about which texts to include in the Corpus—and to ask what these decisions tell us over time. I will explore, here, two converging lines of investigation that might begin to comprise such a study, and I employ a playful analogy taken from A. A. Milne’s Winnie the Pooh (2006, 36–38), where Pooh and Piglet track a ‘Woozle’ through the snow.3 The first is a consideration of a corpus: what it is, how the author whom the corpus is thought to represent differs from the author of one of its texts, and the discourses4 that bear upon the process of its formation. The second is a consideration of the textual decisions represented by the Lexeis of Bacchius of Tanagra (c. 275–200 BCE), where a discernible Hippocratic sensibility arguably first emerges. Because a comprehensive analysis of the Lexeis is beyond the scope of this chapter, I will focus on Bacchius’ inclusion of the pseudepigraphic speeches Epibomios (‘Speech from the Altar’) and Presbeutikos (‘Speech of the Envoy’). 2  The edition of Artemidorus was, according to Galen (In Hippocratis De natura hominis commentaria 3, CMG 5.9.1, 13 Westenberger 1914 = 15.21 K), highly esteemed by the Emperor Hadrian (76–138 CE) and others up through Galen’s own day. This massive edition ‘relaunched’, according to Flemming (2008, 335), the practice of Hippocratic commentary in the medical culture of the second century. See also below, n. 6 3  Milne, A. A. 2006, 30–38. The Woozle is a (fictional) creature that Pooh and Piglet think they are tracking through the snow when they are, in fact, following their own tracks around a small grove of trees. As the sets of tracks increase, they create narratives to account for them until Pooh finally realizes what is going on (with the help of the outside observer Christopher Robin). 4  I use ‘discourse’ to refer to a contextualized social language in which an area of human knowledge is collected, structured, and discussed, and the term ‘subjectivity’ to refer to a sense of identity created, shaped, and maintained through discourse (Murfin and Ray 1997, 89; Tyson 2006, 284–285). I locate discourses within ‘discourse communities’, by which I mean social groups that employ their own brands of discourse to self-identify, achieve cohesion, and seek common goals (Swales 1987, 1990; Porter 1991) and recognize Bourdieu’s concept of a ‘field’ as a kind of ‘social space’ in which discourse communities interact and compete (Thomson 2008, 67–75). Finally, I use the phrase ‘discursive concern’ to indicate a tension, created within a discourse community by this interaction and competition, to which members respond by adapting their discursive practices so as to maintain and promote their subjectivity and position within a given field.

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My decision to focus on pseudepigrapha may strike some as odd—even odder than comparing the notion of what is Hippocratic to a Woozle—since these texts have sometimes been regarded as the Corpus’ quixotic appendix, which can (and perhaps should) be excised from considerations of Hippocratic medicine.5 But pseudepigrapha have a marked presence at pivotal points in the Corpus’ formation, including Bacchius’ Lexeis, Erotian’s Glossary, and the editions of the CH by Dioscorides and Artemidorus.6 The fact that early 5  As the link between the pseudepigrapha and the historical Hippocrates has come under increasing suspicion, considerations of their bearing on the rest of the Corpus have shifted toward other questions (e.g., Philippson 1928; Diller 1933; De Lay 1969; Sakalis 1983; Smith 1990; Rubin-Pinault 1992; Rütten 1992; Jouanna 1999; Nelson 2005). For example, Roselli (2006, 179–183), keeps the pseudepigrapha separate in her consideration of the Corpus’ formation. 6  Which medical works Dioscorides and Artemidorus included in their related editions has been inferred primarily from Galen’s many critiques of them (Ilberg 1887 and 1890; Pfaff 1932). Which pseudepigraphic works these editions included depends on less secure inferences, an argument for which I can only outline here:  Galen’s numerous criticisms of Dioscorides and Artemidorus indicate that these editors produced a version of the corpus ‘in obvious imitation of the Alexandrian editors of classical Greek literary texts’ (Smith 2000, 235). Such editions frequently contained ancillary—and often pseudepigraphic—texts and letters that informed the author’s biography (βίος), which fronted an author’s corpus or circulated independently (Mansfield 1994, 6). This material was thought necessary (though, perhaps, not by Galen for himself), to fully appreciate the works of the author in question (Mansfield 1994, 108–111, 120–125; Rubin-Pinault 1992, 12–13 and n.34). Given the size and scope of Artemidorus’ edition, which had become the ‘standard edition’ by Galen’s day (Nutton 2013, 213), it seems very likely that it would include texts of this kind.  For example, Artemidorus’ edition probably included the Pres. (Speech of the Envoy) and Epib. (Speech at the Altar), since these works had been counted as ‘Hippocratic’ since Bacchius (3rd c. BCE) and were included in the list of works recognized by Erotian in his Hippocratic lexicon not that long before (during the time of Nero, 37–68 CE). It is also probable that it included some other texts that illustrated one or more episodes prominent in Hippocrates’ biographical tradition: namely, curing Perdiccas of lovesickness; rejecting Artaxerxes’ request to treat a plague; and accepting Abdera’s plea to come and cure the philosopher Democritus (Rubin-Pinault 1992). These episodes were treated as well-known by Galen and Plutarch (Rubin-Pinault 1992; Rütten 1992; Smith 2000, 83) and had been circulating in the form of epistolary romances (i.e., ‘Briefromans’), a form conducive to being included in a corpus, for some time.  How directly Dioscorides and Artemidorus’ editions are represented in our present Hippocratic manuscript tradition is a matter of debate (Nutton 2013, 213 and n.47; Jouanna 1999, 349 n.4), but it is reasonable to suppose that their choices of pseudepigrapha would remain influential on the branches of the tradition that preserved or emulated their ‘scholarly literary editions’ (Smith 2000, 236). The earliest and best representative of this branch is

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redactors incorporated pseudepigrapha at such moments ought to caution us against removing them from a consideration of what is Hippocratic about the Corpus, especially if we are considering that the Corpus functions as a whole. To do otherwise would be like investigating the development of Christianity through the Christian canon, but only after we removed texts such as the Song of Solomon, Revelation, Shepherd of Hermas, and several canonical and noncanonical epistles from consideration because they cluttered the view of ‘core’ Christian texts. I would argue that, just as each canon preserves a particular vision of what is Christian, and that these visions are distorted by removing texts from them, each permutation of the Corpus preserves a particular vision of what was ‘Hippocratic’ that cannot be fully appreciated or understood without considering all its texts. In this chapter, I argue that Bacchius, by including the Presbeutikos and Epibomios in his Lexeis, was attempting to exert authority within a nascent discourse community7 of elite scholar-physicians. I draw a parallel between this community and a long history of other Greek professions that asserted identity and status through associations with a founder and a textual tradition set in antiquity. I also place Bacchius’ project in the mainstream of Alexandrian scholarship, in which scholars established authority over texts and the past by means of philology. Within this context, the anonymity and apparent antiquity of the medical works gave them an opportune position to become privileged in elite medicine’s emerging textual tradition, and the association of Hippocrates as its oikistes (founder) was sealed by the popularization of Coan traditions during the 3rd c. BCE. Bacchius’ work, as I see it, represents the first attempt to bring two catalytic elements of a new ‘Hippocratic’ discourse community (a founder and foundational texts) to heel and to stake a claim over its core identity. I suggest that he may have chosen the pseudepigraphic texts ironically to undercut Coan claims to centrality in this identity by situating what was Hippocratic in the workings of a Hippocratic household abroad and in a version of Hippocrates that could be represented by Herophilus and the M, the 11th c. Marcianus Venetus 269 (see also below, n.13). It contains the Epib. (Ep. 26), Pres. (Ep. 27), Artaxerxes (Ep. 1–9) and Democritus (Ep.10–17) episodes, and the Dogma (Ep. 25), a fictitious Athenian decree bridging the narratives of the speeches and letters 1–9 (Smith 1990, 5; Rubin-Pinault 1992, 40–41). Since Ep. 18–21 and 23 grow out of the Democritus episode, and Ep. 22 and 24 (to Thessalus and King Demetrius, respectively) do not seem to inform subsequent Hippocratic biography, I think it likely that Artemidorus’ edition contained at least Ep. 1–17, the Dogma, Epib., and Pres 7  See above, n. 4

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Herophileans in Alexandria. But whatever his motivations were, the ensuing struggle for authority over Hippocratic texts and traditions indicates that an answer to ‘What is Hippocratic?’ has—from the beginning—been motivated as much by social as scientific concerns, and that the Corpus is as much a dynamic social artifact as it is the repository of a distinct kind of medical knowledge. 2

Qu’est-ce qu’un Corpus? ‘Now, look there’. He pointed to the ground in front of him. ‘What do you see there?’ ‘Tracks’, said Piglet. ‘Paw-marks’. He gave a little squeak, of excitement. ‘Oh, Pooh! Do you think it’s a—a—a Woozle?’ ‘It may, be’, said Pooh. ‘Sometimes it is, and sometime it isn’t. You never can tell with paw-marks’. —A.A. Milne, Pooh and Piglet Hunt.

As Diego Lanza notes in L’autore e l’opera (2006), the relationship between author and work is a tangled one, and particularly so when dealing with antiquity. As both Lanza and M.L. West (1999) point out, questions of authorship and interest in the personal lives of authors increased amongst the Greeks in the latter half of the 6th and 5th c. BCE as the authority of the named individual began to supplant the authority of anonymous tradition. But with little (if any) evidence other than literary creations themselves at hand, differences between authors’ personas and the authors themselves (such as between the ‘Sappho’ portrayed in poems and whoever the ‘real’ Sappho was) were often erased by the fact that the latter had to be inferred from the former. Nevertheless, the ensuing process of fleshing out authors from surviving works and tidbits of often questionable anecdote, and of creating literary and intellectual traditions based on those inferred authors, became a project of the Classical and Hellenistic ages and left an indelible imprint upon subsequent scholarship. However, in the aftermath of works such as Foucault’s Qu’est-ce qu’un auteur? (1969), and Mary Lefkowitz’ Lives of the Greek Poets (1981), we have come to discover that our search for an author often only comes full circle to . . . a previous search for an author. Like Pooh and Piglet hot on the trail of the Woozle, we find that we have been following the recursive tracks of curious imaginations, and that this process has obliterated any traces of the original culprit in question (if, in fact, there were any to begin with). In short, it often seems, as Susan

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Saïd (2001, 13) has observed, that the author is, at least in terms of antiquity, essentially the product, not the producer, of texts. But, if an ancient author is essentially the product of a text, the author represented by an ancient corpus is essentially a product of authors: a single, synthetic identity forged by redactors and editors from multiple textual productions. This is not to claim that the texts of a corpus are, in fact, written by different people (although this is often the case), but to recognize that redactors and editors assemble—and sometimes even shape8—the texts of a corpus to conform to an authorial identity that no single text of the collection represents.9 Moreover, this authorial identity is created only indirectly by the author him- or herself: even an ancient author as careful and self-conscious of documenting, defining, and promoting his legacy as Cicero was transformed as editions of his speeches and letters, shaped by the decisions of Tiro, Atticus, and others, became part of the Ciceronian Corpus. And it also bears emphasizing that redactors and editors do not operate in a vacuum, but as members of discourse communities with vested interests in the author—or what I might now provisionally call a ‘synthetic’ author—of the corpus that they create and then maintain. Of course, the availability of materials, various means of cultural production, and collateral traditions enable and contextualize the way that a corpus emerges, but this does not diminish the fact that a corpus reflects the conceptions of those who create it and that it is their needs and convictions that govern the way that it develops. Moreover, as Luciano Canfora 8  Such as in the Theocritean Corpus, where multiple attempts to correct and standardize dialects have left the original versions in dispute. 9  The gap between the ‘authors’ of individual texts and an ‘author’ of a corpus (whether in the form of an idealized agent or a concretized personality) varies from corpus to corpus, but, I would argue, is present in all of them. The Aristotle of the Metaph. and the Aristotle of the Aristotelian Corpus, for example, would seem to have a fairly direct connection. However, questions of what constitutes a work, of authorship, and of influence complicate what has been meant over time by both ‘Aristotle’, ‘pseudo-Aristotle’, and ‘Aristotelian’ (Lanza 2006, 15). The situation of the CH may not be that far removed, since ‘the’ Hippocrates was recognized early on as being the author of only some of the Corpus’ texts (usually the most important or correct in the eyes of the beholder). That the term ‘Hippocratic’ had come, by the time the Corpus had been assembled, to refer to something broader than to ‘the’ Hippocrates indicates that ‘Hippocrates’ may have come to serve as an idealized shorthand (as it does now) for a body of work passed on under his name (Jouanna 1999, 70–71). My earlier example of biblical canons provides an extreme example of how texts of a corpus may be recognized by editors and discourse communities as being penned by different authors individually but still be collectively attributed to a more or less abstracted and idealized agent as a kind of synthetic author.

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(2006) ably shows with the Demosthenic Corpus, these needs and convictions can bring about the addition of texts to a corpus that complement the maintenance of a synthetic author over time. Such texts, borrowed in whole from other sources or created from whole cloth, all contribute to making a corpus work harmoniously for the discourse communities that utilize it. The Letter of Philip, for example, seems to have been added to the Demosthenic Corpus to provide documentary support for claims in other texts and to accommodate the performance needs of students (Canfora 2006, 115–116). The Hippocratic Decree (Smith 1990, 106) operates somewhat similarly in terms of the CH. Purporting to be a 5th c. BCE decree of the Athenian assembly, the Decree adds no new information to the Corpus; rather, it provides evidentiary support for claims made in two separate and unrelated episodes in other Hippocratic pseudepigrapha. The first is the claim, made in the Presbeutikos (Pres. 7, Smith 1990, 116–120), that Hippocrates and his son Thessalus (working together with other family and students) were awarded a golden crown and given public honors for saving Greece from a plague. The second episode comes from the later-composed Letters (1–9; Smith 1990, 48–54), in which Hippocrates rejects an offer of wealth from the Persian king and refuses to save his army—barbarians that they are and enemies of the Greeks—from the ravages of a plague. Neither the Letters nor the Presbeutikos show any awareness of each other’s historical or biographical narratives: the Hippocrates of the Presbeutikos, who operates as part of a clan, and the Hippocrates of Letters 1–9, a more individual heroic figure, have, in fact, lived two very different lives. This would become problematic, however, when the Letters were added to the Corpus (which already contained the Presbeutikos) sometime after Erotian. The Hippocrates of the Corpus could have but one life. The Decree enables these two different traditions to be better synthesized into one Hippocratic narrative even as it emphasizes the more recent and individualistic version of Hippocrates by dropping Thessalus from mention and making Hippocrates more of an author.10 Whether it was originally created to insert into the Corpus along with the Letters, or already existed to bridge the older with the more recent tradition, makes little difference for my point: its inclusion in the Corpus 10  The Decree mentions that Hippocrates only ‘sent out his pupils’ (Smith 1990, 106.14–15, ἀποστείλας τοὺς αὑτοῦ μαθητὰς) around Greece with a therapy for the plague and also claims that he ‘generously published his compositions about the healing art’ (17–18: ἐξέδωκε δὲ καὶ ξυγγραφὰς ἀφθόνως τὰς περὶ τῆς ἰαγρικῆς τέχνης), whereas in the Pres. Thessalus and Hippocrates receive identical honors and Hippocrates only publishes the therapy that he has composed for avoiding the plague (Smith 1990, 118.14, ξυγγράφων θεραπείην ἐξετίθει περὶ τᾶς πόλιας).

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really only makes sense as a means to help create a Hippocrates who exists not in individual texts, nor even in history, but in the imagination of an editor. 3

A Corpus is a Product of Discourse ‘Pooh!’ cried Piglet. ‘Do you think it is another Woozle?’ ‘No’, said Pooh, ‘because it makes different marks’.

This kind of imagination, of course, does not function in isolation, but within the social and intellectual discourses that make creating or changing a particular corpus both possible and worthwhile, and whose imprimatur carries sufficient auctoritas to make things stick. As Kolbas (2001, 59) puts it, ‘[N]o single judgment creates a canon’. While Kolbas’ interests lie with literary canons, the same applies to the formation of literary corpora. Indeed, we might think of a corpus as one of the primary social artifacts that go into establishing a ‘field’, in Bourdieu’s terminology, since it sets some of the principal boundaries within which overlapping social stakeholders interact competitively.11 The history of the canons of the Christian Bible is but one illustration of how different communities attempt to assert dominance over a commonly held field by shaping its boundaries through inclusion and exclusion of texts, and why so much anxiety attends adding or subtracting elements of a corpus or the appearance of a text bearing upon its synthetic author. Authority over the boundaries of the field presumes authority over the field. The sudden appearance of new texts (like tracks, as in the case of Pooh and Piglet), such as the Suppliants of Aeschylus, the Dead Sea Scrolls, or the Anonymous Londoniensis (in terms of ancient Medicine), can threaten the stability of the communis opinio. Instability in discourse necessitates a renegotiation of boundaries and reformulation of the synthetic author. Depending upon the outcome, a corpus may be changed before the game continues. In any case, the discourses that create the texts of a corpus are not necessarily the same as those that create the corpus itself, and I would argue that the question of what is ‘Hippocratic’ belongs to the latter category. For example, we know that questions of what constituted technai12 were part of an emerging professional and social identity in 5th c. BC Greece, and that several important 11  See, for example, Thompson 2008, 70. 12  The concept of techne is complex, but entails teachable skills emanating from a body of knowledge that lead to some desired end. See the discussions of Nussbaum 1986, 94–121; Waring 2000; Laskaris 2002, 75–82; Nutton 2004, 62–66.

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medical texts of the CH (e.g., On the Sacred Disease, On Ancient Medicine, On the Art) result from practitioners seeking to position themselves within what we might call a ‘technelogical’ discourse. These texts became ‘Hippocratic’ two centuries later, when they were included in the CH, but, by then, the original questions of technicity had been largely settled, at least amongst the discourse communities responsible for assembling and maintaining the Corpus. To explain why these texts and texts as different from them as Aphorisms, Epidemics, Presbeutikos, and Epibomios were included as Hippocratic in the Corpus from the beginning requires a discourse larger than questions of technai. And as discourses evolve and take shape, so too may an associated corpus. New works may be added, or existing works altered, to buttress the original collection in order to carry its changing discursive load until a canonical form is achieved. In terms of the CH, we can observe this phenomenon taking place between Bacchius’ Lexeis and Erotian’s Glossary, and then again between the Glossary and the Hadrianic editions of the CH by Dioscorides and Artemidorus Capito.13 By the Hadrianic editions, the Corpus seems to have achieved a kind of stasis. The re-emergence of Hippocratic textual criticism in the 1st and 2nd c. CE, and the general agreement of which texts ranked as most Hippocratic among discourse communities with different ways of explaining what that meant, depended upon an established vision of Hippocrates as a literary author represented by a (more or less agreed-upon) set of works penned by his own hand. This established vision finds expression in biographical texts such as The Origins and Life of Hippocrates, According to Soranus (VHSS) and in the Suda, which flesh out the figure portrayed in Artemidorus’ likely version of the pseudepigrapha, and could explain why Artemidorus’ edition may form the basis of the manuscript tradition that emerges through the manuscripts MUV.14 These possibilities deserve a much more careful and extended consideration than I can offer here, but suffice to suggest that the collection that we know as the CH jells with Bacchius, remains malleable through Erotian, and begins to ossify with Artemidorus. But when a corpus becomes fixed, discourse communities that appeal to it must elicit, even if awkwardly or selectively, new responses from the existing structure of the canon. In terms of the CH, the Hadrianic editions appear to mark the point at which evolving discourse communities must retrofit their concerns to a fixed and increasingly remote body of works, a process that continues to this day. One recent example of this impulse might be the claim of rationality (often opposed to superstition or the uncritical acceptance of 13  Jouanna 1999; Smith 2002, 234; Nutton 2004, 208. 14  See above, n. 6

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t­ radition) as a distinguishing hallmark of what is Hippocratic about the texts of the CH (e.g., Longrigg 1993; Jouanna 1999, 56). Our contemporary preoccupation with rationality comes, surely in part, because rationality is so central to the subjectivity15 of the discourse communities that have laid claim to the Corpus since the Renaissance and, as Brandt (1991, 209) has argued, medical historiography seeks to address questions brought about by its own contemporary medicine. However, other scholarship, such as that by Julie Laskaris (2002) and Philip van der Eijk (in this volume), indicates that notions of rationality are not particularly useful either for defining or for differentiating what is Hippocratic in the Corpus. Such notions tend to be applied selectively and equivocally and, no matter how they are applied, fail to adequately distinguish Hippocratic texts from other Greek medical texts current during the Corpus’ formation. As Langholf’s (1990) study of the general coherence of medical methods in the early works of the Corpus indicates, this coherence may not come from a Hippocratic tradition per se, but from a larger Greek medical and intellectual tradition which precedes and contextualizes it. All this ought to suggest to us that rationality—even if it, in our view, permeates much of the Corpus—was not distinctly ‘Hippocratic’ to those who created the Corpus, and that the question of rationality—even if it, in their view, was a topic of concern—did not possess the kind of maius imperium for determining what was Hippocratic at the time of the Corpus’ formation as it does in our own. In any event, the discourses that create a corpus may not be the same as those that shape or eventually come to be identified with it. Put into the form of one of my earlier postulates, a corpus is essentially the product, not the producer, of discourse. It is an artifact of opportune moments when editors and redactors are able to adjust a collection of texts representing a synthetic author to the prevailing discourses of their time. This process is necessarily somewhat dialogic, in that once a corpus is established it becomes the prevailing sounding board against which new ideas and changing evidence is tried, and becomes, to adapt Kolbas (2001, 60) again, ‘a historically cumulative process’. However, I would claim that in cause and effect the corpus is secondary: the CH did not produce a Hippocratic discourse; a discourse (Hippocratic or not is another matter) produced the Corpus. Changes in the Corpus are manifestations of how this discourse changed and evolved over time. This (admittedly cursory) consideration of how a corpus is formed and maintained suggests that it may be fruitful to look for an answer to ‘What is Hippocratic about the Hippocratics?’ within the discourse communities that have been influential in creating and sustaining the CH, and to try and 15  See above, n. 4

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correlate the evolution of the Corpus with the evolution of these communities. An advantage of this approach is that it acknowledges the social, political, and ideological dynamics, brought to the fore in the so-called ‘new social history of medicine’, that have affected the role and position of the Corpus in discourse community narratives over time. Similar studies have been undertaken for the figure of Hippocrates and the Hippocratic tradition, and for episodes of the biographical tradition,16 but not so much for the Corpus itself. Such an examination would be fruitful for understanding the Corpus during many periods, including those after, as Brandt (1991, 200) puts it, ‘the days of reading Hippocrates and Sydenham for therapeutic ideas had come to an end’. However, if we are interested in learning what was originally Hippocratic about the Corpus, and whether the collection itself was the result of a haphazard process, it seems most productive to return to the period in which the Corpus went from collection to literary corpus, that is, from roughly Bacchius to Artemidorus. I do think that Smith’s suggestion (2002, 227–228) that Hippocrates represented something other than the sum or even the best of medicine to the redactors, commentators, and editors of this era has something to it, and that one way of getting at that ‘something other’ is through the discursive history of the Corpus and its synthetic author. 4

The Hippocratic Woozle Christopher Robin slowly came down out of his tree. ‘Silly old bear’, he said, ‘What were you doing?’

The Hippocratic pseudepigrapha offer two distinct advantages for peeling back the early discursive history of the Corpus. First, although contemporary scholars disagree widely as to their degree of veracity, virtually all agree that the pseudepigrapha are largely, if not wholly, projections of the subjectivities and discursive needs of their creators. And so, whether scholars assert that the pseudepigrapha are essentially ‘historical romances’ that contain ‘airy fancies’ or ‘a good many specific details’,17 whether they hold that the pseudepigrapha are ‘worthless as historical evidence for the life of Hippocrates’ or ‘based on more than mere rhetorical fancy’,18 nearly all maintain that these texts emerge from their creators’ need ‘to associate an ideal . . . with a flesh and blood figure’, 16  E.g., Cantor 2000; Smith 2002; Rubin-Pinault 1992; Rütten 1992. 17  Holzberg 1994, 1–4; Smith 1990, 2; Jouanna 1999, 9. 18  Rubin-Pinault 1992, 3; Nelson 2007, 235.

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‘to reconstruct the life of Hippocrates on the basis of information contained in the texts of the Hippocratic Corpus’, and ‘to fill the place of literary and social commentary and historical analysis’.19 Second, portions of the pseudepigrapha can be identified as entering the Corpus at the three rough stages of its initial formation, development, and maturation that I outlined above. The Presbeutikos and Epibomios appear to have been among the texts recognized by Bacchius in the Corpus’ initial formation. The pseudepigraphic Letters developed in the period between Bacchius and Erotian’s Glossary, during which the Corpus went from roughly twenty to forty texts (Jouanna 1999, 61–62) and entered the Corpus in its closing phase of development, perhaps in the edition of Dioscorides. To put this into the terms of my Pooh analogy, the pseudepigrapha are, in the first place, now generally recognized as being not really the tracks of the Woozle but the tracks of those interested in it; and, in the second, they allow us, like Christopher Robin from his oak tree, to observe those tracking the Woozle during the initial stages of their progress around the spinney. I must, however, qualify my intentionally playful analogy by differentiating roughly two separate kinds of actors at play in the formation of a corpus: the first who creates the trace (i.e. the author of an individual text), and the second who selects it from among other traces and preserves it as a signifier of the object of the search (the redactor). This demarcation is absent in the Pooh story, and Pooh’s ignorance of this fact creates the innocent humor of the episode (which might have had a darker cast if he had been consciously manipulating the pusillanimous Piglet). But in the case of the CH, authors of the texts and redactors of the Corpus do not appear to have been the same individuals. In deciding what is Hippocratic, it is not the discursive needs of individual authors that are at play, but of redactors and editors who, as members of discourse communities with vested interests in the figure authorized by the Corpus, embed their own subjectivities into the Corpus through their choices of selection and omission. There is, of course, a difference between individual medical authors who never thought of themselves as writing as or about Hippocrates, and pseudepigraphic authors who clearly did. There, the writers of the pseudepigrapha and the redactors of the Corpus share the fact that they both overtly have some kind of Hippocrates in mind. However, the authors of the pseudepigraphic episodes (even those writing well after the initial formation of the Corpus) never clearly connect their Hippocrates to the medical literature or, except for the Decree (see above), to other episodes of the pseudepigrapha. 19  Rubin-Pinault 1992, 2; Nutton 2004, 53; Smith 1990, 1. See also Costa 2001; Rosenmeyer 2001; Rütten 1992; Canfora 2006.

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This independence and compartmentalization is part of what links them with the authors of the medical texts and distinguishes them from the redactors and editors, who brought together the medical and pseudepigraphic texts into one collection with Hippocrates as its synthetic author. It is this latter set of actors in which I am interested here: for, if we can set their selections back into their context, the pseudepigrapha may indeed help us to ‘retrace the way in which the ancients themselves saw and experienced their past’ (Jouanna 1999, 9), and so contribute to an understanding of who, and what, was Hippocratic about the Corpus from the perspective of those who created it. 5

The Early Pseudepigrapha and the First Traces of the Corpus

As many others have noted,20 the Corpus came about as the early Alexandrians attempted to establish control over what John Vallance (2008, 98) calls ‘a deeply bookish’ strain of Greek medicine. But, as I have argued above, although the earliest evidence for this strain exists in the texts of the Corpus, it is not in the texts themselves but in the early acts of gathering them that we witness the attempt to represent a Hippocratic subjectivity by combining medical texts with texts about Hippocrates. Our earliest evidence for such as attempt comes through Erotion’s Glossary from Herophilus’ pupil, Bacchius, who composed the Lexeis, a study of words used in peculiar ways or contexts.21 Writing in the 1st c. CE, Erotian singles out the Presbeutikos and Epibomios from among the other Hippocratic works since ‘they show the man [Hippocrates] as more a patriot than a physician’ (36.18: φιλόπατριν μᾶλλον ἢ ἰατρὸν ἐμφαίνουσι τὸν ἄνδρα; Nachmanson 1918, 440). He nevertheless accepts them as an established part of the tradition, which appears to indicate that they were among the works known to him through Bacchius.22 If so, this would situate the incorporation of these texts into the Corpus coevally with the genesis of the Corpus itself. Such proximity has prompted Smith (1990, 6–8), Rubin-Pinault (1992, 5, 42) and myself (Nelson 2005, 209–210) to wonder if the 20  E.g., von Staden 1989; Jouanna 1999; Nutton 2004. 21  On the significance of the title Lexeis in comparison to Glottai (obsolete words fallen out of ordinary usage) and the literary focus of the Lexeis, which appears to model itself on the Lexeis of Aristophanes, see von Staden 1989, 492–493; Silk 1983, 303. 22  Smith 1990, 6–7; Smith 2002, 199–204; Jouanna 1999, 63–64. Erotian does not explicitly cite Bacchius in his glosses from the Pres. (Nachmanson 1918, 440–441), but this is not unusual (von Staden 1989, 490–495). His explanation of proxenoi, which appears to come from the Pres. (Nachmanson 1917, 441 and Smith 1990, 125), may be one such example.

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orations may have acted as a catalyst for branding a collection of anonymous medical writings as the CH and for its ensuing Hippocratic Question. Neither text, however, appears capable of being very catalytic. Neither identifies Hippocrates as an author, unless we count the therapy for the plague that he ‘writes down and posts around the cities’ in the Presbeutikos.23 Neither identifies him as the proponent of any distinct theory or approach. There is only a generic claim in the Presbeutikos about the environment playing a role in disease,24 and in the Epibomios about the art being ‘a cause of health and life for people’.25 And although both orations acknowledge the extent of Hippocrates’ fame, neither really treats him as if he were the defining character in the history of medicine, or as semi-divine, or with any of the reverence that we find later, for example, in some of the epistolary pseudepigrapha.26 The Presbeutikos, a speech about the long and pervasive service of the Coan Asclepiads to Greece, is placed into the mouth of Hippocrates’ son Thessalus, who lets it be known that both he and his father received similar honors while treating the plague independently, and the same honors when together in Athens (Pres. 7, Smith 1990, 118.32 and 120.2). Moreover, although Thessalus credits his father for volunteering him to serve as a doctor in the Sicilian Expedition, he makes it clear (Pres. 8, Smith 1990, 120.27–29) that it was he (Thessalus) who stayed on for an additional three years of hard service, received an additional golden crown and was ‘praised even more splendidly’ (καὶ ἔτι κάλλιον εὐφημεύμενος) before finally returning home to produce successors of his art and family line. And so, while Hippocrates plays a leading role in the narration of the Presbeutikos, it is the tradition, not Hippocrates, that is the subject of the speech and it is Thessalus, not Hippocrates, who is shown to be the heir through whom this tradition continues. Meanwhile, the Epibomios, with its twenty-two lines of Hippocrates appealing to the Thessalians, is neither particularly informative nor very flattering. While Hippocrates does mention 23  Smith 1990, 118,14: ξυγγράφων θεραπείην ἐξετίθει περὶ τὰς πόλιας. 24  Pres. 7, Smith 1990, 118.7–10: ὁ δὲ ἐρώτησιν ποιησάμενος ὁκοῖαί τινες ἐν μέρει κινήσιες γίνονται κατά τε καύματα καὶ ἀνέμους καὶ ἀχλύας καὶ τἄλλα ἃ πέφυκε ἓξιας κινεῖν παρὰ τὸ καθεστηκός, ‘And he made inquiry what kinds of disturbances there were, area by area, in heat and winds and mist and other things that produce unusual conditions’. Pres. 7, Smith 1990, 118.20–21: οὐ γὰρ πάντες τόποι τὰ αὐτὰ φέρουσι παθήματα, διὰ τὸ μὴ πάντη τὰ περιέχοντα ἐξ ἀέρος ὅμοια εἶναι, ‘For not all places produce the same diseases because the environment from the air is not completely the same’. 25  Smith 1990, 108.10–11: ὑγιείης τε καὶ ζωῆς αἴτιον ἀνθρώποισιν. 26  Such as the effusive claims of Ep. 2 (Smith 1990, 48–49): ‘He cleanses the earth and sea over wide areas, not of wild beasts but of beastly wild diseases, and as Triptolemus sowed everywhere the seeds of Demeter, he sows the cures of Asclepius’ (trans. Smith).

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the Athenians’ subjugation of the Coan metropolis, he is really there to complain about the confiscation of his hereditary Coan estates,27 and he comes off as less a patriot than an outraged expatriate. All in all, the Epibomios seems more like an embarrassing picture of one’s parent that, with all due respect, ought to be discarded from the family photo album. Nevertheless, if these texts had status as ancient texts, or as the only available picture of Hippocrates the Great, one can understand how Bacchius might have overlooked their deficiencies. However, odds are that these speeches were composed in the mid 3rd c. BCE,28 that is, roughly contemporary with Bacchius himself. By that time there was no shortage of Hippocratica: Hippocrates’ popular star was on the rise. We know that he was featured in the 3rd c. BCE genealogies of Eratosthenes and attacked by Andreas,29 and can reasonably presume that his story played a part in the Coans’ promotion of the Asclepieion and in Macareus’ History of Cos (Nelson 2005, 2007, 2013). If we take these manifestations of an emerging Hippocratic persona into account, together with the close ties between Cos and Alexandria, the Coan education of Bacchius’ teacher Herophilus, and the involvement of other Coans such as 27  Hippocrates’ outrage in the Epib. must be seen in the context of Thessalus’ request in the Pres. (Pres. 9, Smith 1990, 120.33–122.3 ) that, if the Athenians’ attack Cos, they at least spare the Asclepiads’ properties: ‘My father, O men of Athens, and I beseech you . . . not to undertake armed aggression from your land. But if [your attack] is necessary . . . we [the Coan Asclepiads] who are worthy of so much ask not . . . to be placed in the portion of a slave . . . and what is more that you not make our property your booty’ (ὁ πατὴρ, ὦ ἄνδρες Ἀθηναῖοι, καὶ ἐγὼ αἰτεόμενα ὑμέας . . . ἐκ πατρίδος τῆς ὑμετέρης ὅπλα πολέμια μὴ ἄρασθαι. Εἰ δὲ δεῖ . . . καὶ δεόμενα μὴ ἡμέας ἐόντας ἀξιωμάτων μεγάλων . . . ἐν δούλων μέρει τιθήσεσθαι. ἔτι δέ . . . μὴ ποιήσησθε . . . τὰ ἡμέτερα ὑμῖν αὐτοῖσι δουρίκτητα). When Hippocrates then complains in the Epib. to the Thessalians (Epib. Smith 1990, 108.15–16) that the Athenians ‘have put our metropolis of Cos in the portion of a slave, making that which was free through the possession of our ancestors into their own private property’, μητρόπολιν ἡμετέρην Κῶ ἐν δούλης μέρει διατίθενται, τὰ ἐλεύθερα διὰ προγόνων κρήσιος ἰδιόκτητα ποιεύμενοι, the ‘our’ does not indicate the Coans at large but, as he says a bit earlier, ‘myself and my children’, ἐμὲ ἐμεωυτὸν καὶ παῖδας ὑμῖν; Epib., Smith 1990, 108.7. 28  Some previous scholarship has allowed for their composition as early at 350 BCE (Herzog 1899) or at late as 190 BCE (Edelstein 1935). Smith (1990, 6–7) proposed, and I (Nelson 2005, 211–216) have argued for, a dating in the mid 3rd c. BCE. 29  The VHSS (Ilberg CMG 4.175) mentions Pherecydes (FGrHist 3F59; mid 5th c. BCE), Eratosthenes’ Chronographiai (mid 3rd c. BCE) and Andreas’ On Medical Genealogy (also mid 3rd c.) as sources. Rubin-Pinault (1992, 7–11 and n.12) is dubious about Pherecydes; Thomas (1989, 155–195) and von Staden (1999, 149–150) are more positive. For the ‘creative calculations’ used to establish dates and relative chronology by Eratosthenes and others, see Möller (2005).

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Philenus in Herophilus’ circle,30 it simply beggars belief that the Presbeutikos and Epibomios represent the only or best material about Hippocrates that Bacchius could acquire. What then was it that induced Bacchius to choose or retain these texts as indicative of Hippocrates as the author of a corpus? The historical and social context of this decision may provide some means to begin to answer. As I indicated above, the 3rd c. BCE was a time of broad popularization for the island of Cos and of its traditions. The birth of Ptolemy Philadelphus on the island in 309 and his education by Philetas, the poetry of Callimachus and Theocritus, local archaic epics like the Meropis31 and Hellenistic histories like Macareus’ History of Cos32 all contributed to familiarize and promote the island amongst the Hellenistic elite. Moreover, the intense promotion of the Coan Asclepieion and its festival by the Coans spread familiarity with these traditions among the Greek city-states and kingdoms from Sicily to the Black Sea. Their promotion, I have argued elsewhere (Nelson 2005, 2007, 2013), probably utilized the genealogical traditions of the Coan Asclepiadai along the lines found in the Presbeutikos and Epibomios. This confluence of popular exposure helps to explain why Hippocrates emerges as a popular hero over the next two centuries. However, this confluence encountered the assertion of a new kind of authority over medical traditions associated with Hippocrates by Herophilus and his immediate circle. Herophilus’ own writings, his overt criticism of Hippocrates, and his exegesis of medical texts utilized the methods by which the Alexandrians were beginning to establish authority within the field of academic culture. These tendencies continued amongst pupils such as Andreas, from whom we have the less-than-reverent report that Hippocrates moved to Thessaly after burning the medical texts at Cnidus,33 and Bacchius, who moved the study of medical texts further towards the center of an Alexandrian discourse, that promoted literary and textual criticism as marks of elite status. On this field of play, control over texts and tradition was a key factor in determining dominance. The Herophileans, faced with a popular resurgence of a Coan Hippocrates, may, as von Staden (1989, 155) suggests, have been acting to establish and maintain authority over the discourse that his representation 30  Von Staden (1989); Jouanna (1999); Nutton (2004). 31  For an overview of the fragment (P. Köln 3.126) preserved by Apollodorus of Athens see Parsons (1982). For the possible influence of this tradition upon other Classical and Hellenistic authors, see Heinrichs (1977) and Nesselrath (1998). 32  FGrHist 456. 33  Rubin-Pinault (1992) 6–18; von Staden (1999) 150–155; Nutton (2004) 61 and n.37).

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was coming to dominate. This is where Bacchius’ choice of pseudepigrapha begins to make sense. 6

The ‘Houses’ of Herophilus and Hippocrates

As M.L. West (1999, 365) points out, anonymity is either the rule or a commonplace at the early stages of many ancient literatures. Anonymity may actually confirm authority, since it carries the combined weight of tradition rather than the isolated authority of an individual. But when these traditions enter phases where individual authority and agency become esteemed, anonymity loses its status and foundational figures become associated with previously anonymous texts or practices. Once identified, these figures quickly become ‘object[s] of admiration, criticism, and biographical construction’ (West 1999, 364).34 Medicine appears to have been entering a similar phase when Bacchius branded a set of medical texts as Hippocratic with the Presbeutikos and Epibomios. His move incorporated ‘the broad, intense scholarly pre­occupation with precursor texts’ (von Staden 1989, 432) seen with Herophilus and (probably) Xenocritus,35 and medicine’s need for a foundational figure in a corpus. At the time, the apparent antiquity of some anonymous medical texts may have positioned them to become privileged if they could be associated with this figure. But what kind of Hippocrates did Bacchius envision? And where did he get the collection of (apparently) anonymous medical works?36 That too, remains something about which we have little clarity.37 The pseudepigrapha do not bear directly on those questions. And yet, if we hold to the premise that the choices of texts for a corpus represent a synthetic author according to the 34  This may be why Herophilus’ specific discussion of predecessors such as Praxagoras and Hippocrates seems to be a novelty and quickly becomes the rule (Smith 2002, 191). 35  Herophilus’ and Xenocritus’ works are a part of this process. But Herophilus seems to have engaged in glossography as a part of exegesis, and we have no information about the Xenocritus’ work other than that he was a grammarian who endeavored to explain φωναί (Heracleides of Tarentum apud Erotian 31, Nachmansson 1918, 4, 24–26). See also Smith 2002, 202; von Staden 1989, 76, 429–432 and 429 n. 10. 36  As van der Eijk (in this volume) shows, anonymity was by no means the norm for medical literature, and the anonymity of the individual works remains one of the puzzling features of the Corpus. For a counter-argument to Smith’s suggestion (2000, 201) that attestations of authorship may have been lost in Ptolemy’s collection of books through the port of Alexandria, see Nelson 2015. 37  For a representative sample of ideas as to how an initial Hippocratic collection was amassed, see Smith 1990, 7–8; Nutton 2004, 61; Jouanna 1999, 63.

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­ revailing discourses of their time, these texts must answer to those discourses; p if they seem not to assist us in answering our questions, it is probably because the Woozle that we are looking for is not the one that Bacchius had in mind. Given the position of the Herophileans within Hellenistic and Alexandrian culture, a clue to this missing element may be embedded in Bacchius’ use of oikia (οἰκία) or ‘house’ in conjunction with Herophilus and his immediate early circle. The unusual use of this term by Bacchius, who initiated Herophilean historiography with ‘The Memoirs of Herophilus and of Those of His House’ (Τὰ Ἀπομνημονεύματα Ἡροφίλου τε καὶ τῶν ἀπὸ τῆς οἰκίας αύτοῦ),38 and the identification of Callimachus and Callinax as being ‘from the House of Herophilus’ (ἀπὸ τῆς Ἡεροφίλου οἰκίας) by Erotian and Zeuxis39 may indicate more than, as Fraser (1972, 1.357) suggests, a close personal relationship between pupils and teacher.40 Von Staden (1989, 26–28) has already noted that Herophilus may have conducted much of his work independent of the Museum and at his own in-house iatreion, and Fraser (1972, 1.355–356) outlines the evidence for his commanding manner, personality, and presence that earned him the title medicina vates from Pliny (NH 11.219). Perhaps the early Herophileans adopted ‘The House’, just as followers of Epicurus adopted ‘The Garden’, and those of Zeno ‘The Stoa’, as a metonymy by which a place of community with their charismatic master signified a sense of distinct identity, at least before their ‘house’ split into the haireseis (sects). If so, Bacchius may have found an attractive analogue for the Herophilean community in the Presbeutikos. In one of the major episodes (Pres. 7, Smith 1990, 116–120), Hippocrates, his sons, and his students work together to combat a plague as members of an oikesis (οἴκησις), or ‘household’ that Hippocrates ‘maintained previously and even now’ (Pres. 7, Smith 1990, 118 4–5, καὶ πρότερον καὶ νῦν οἴκησιν εἶχε). Hippocrates’ Thessalian oikesis is not simply a residence: it serves as a kind of locus Hippocraticus, a place where medical knowledge is received, processed, and dispensed. This broader functionality may be implied by the use of the term oikesis, which can imply the conditions of residency in general (Hdt. 3.102, Th. 2.16, IG I2.110.31), a household compound where administrative functions take place (X. HG 3.2.1) or can even indicate the activities of administration itself (Pl. Min. 321b). Hippocrates’ household, perhaps like that of Herophilus, is a medical community: the itineraries that Hippocrates lays out for various members of the household in treating the plague indicate that 38  See van der Eijk 1999b, 14–15; von Staden 1989, 58. 39  Erotian 31 (Nachmanson 1917, 4); Zeuxis apud Galenum, in Hippocratis Epidemiarum 6.4.7 comment. 4.10 (CMG 5.10.2.2, 203, Wenkebach 1925 = 17B.145.11 K). 40  Von Staden 1989, 478–479 and n.4; Nutton 2004, 132.

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the whole Hippocratic clan and student body is in residence.41 If the works of the early Corpus did contain texts thought to be authored by Hippocrates’ sons and pupils, the Presbeutikos may have been attractive to Bacchius because the ‘House of Hippocrates’, like the ‘House of Herophilus’, was also one of multiple authors continuing the work of their headmaster.42 Finally, and perhaps more importantly, the Presbeutikos and Epibomios could show that, although the family of Hippocrates was historically tied to Cos, the Hippocratic tradition and legacy were not. Why Hippocrates lived and worked away from Cos, how there came to be so little non-Hippocratic material, and what his real contributions were, remained persistent questions in Hippocratic biography and were intermingled with questions about the nature of the Hippocratic tradition.43 Herophilus’ direct attacks on Hippocrates’ works and ideas, and Andreas’ report about Hippocrates burning the Cnidian library, show that the Herophileans were willing to answer these questions in ways that called the textual and historical Hippocrates into question. Coming at the same time as the emergence of Hippocrates as a popular heroic figure, the inclusion of the Presbeutikos and Epibomios in the CH could be understood as a means of resisting the looming shadow of the emerging Coan icon by exerting an alternate authority over an emerging Hippocratic discourse. For, while the Presbeutikos and Epibomios do not tell us why Hippocrates moved to Thessaly, what he really wrote, or what he really thought, they do suggest that what is ‘Hippocratic’ did not occur—and is not to be found—on the island of Cos but in the workings of a Hippocratic household. And if these speeches were, as I have suggested (Nelson 2005, 2007), excerpted from the work of the Coan historian Macareus and reflect the Coans’ promotion of the Asclepieion, Bacchius’ choice to use them for abstracting the Hippocratic tradition from Cos has a delicious academic irony—or perhaps, in von Staden’s (1989, 458) terms, a characteristically roguish ‘looking over one’s shoulder while looking ahead’—that is hard to resist. But before I myself am seduced completely by the lure of Hippocratic historical fiction, let me return to somewhat firmer ground and note that Bacchius’ work seems to have inaugurated—or perhaps continued—a kind 41  Besides Thessalus, Polybus, and Draco, the episode includes the involvement of ‘other students’ (ἄλλους τῶν μαθητέων), who might be thought to include Syennesis of Cyprus (Jouanna 1999, 48, 57). 42  Smith (2002, 236–239), however, advances the plausible alternative that it was Dioscorides who largely created the tradition of multiple family authors and assigned texts based on his sense of stylistics and the Empiric tradition. 43  See, for example, von Staden 1999, 150–155.

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of Coan and Alexandrian tit for tat. Herophilus’ unusually transparent discussion of his Coan teacher Praxagoras, and Bacchius’ supplanting of Xenocritus of Cos’ glossary were answered by another of Herophilus’ students, Philenus of Cos, who attacked Bacchius’ Lexeis and broke with Herophilus by establishing Empiricism. Philenus’ move to reinstate the authority of Hippocratic historia could be understood as an attempt to re-exert control over the elite subjectivity that created, and now depended upon, the Corpus. The ensuing embrace of agonistic philology and textual criticism by the Empirics and Herophileans (van der Eijk 1999, 14–18), as well as the emergence of the medical sects themselves, may be seen as a continuation of this struggle. It may be no accident that a rebellion against the emerging ‘Hippocratic’ subjectivity of the House of Herophilus came from Coans. The disassociation of ‘Hippocratic’ medicine and the heroic Hippocrates from the Coan homeland was surely not what Coans envisioned. On the contrary, the rise of other prominent figures and schools of medicine in other geographic locals would be a boon to the island’s prestige and economy only to the extent that Cos retained a localized claim to their common heritage and founding father. But with the rise of Alexandrian scholarship, this meant retaining control over—or at least influence upon— the positioning of texts now recognized as Hippocratic. Erotian’s mention of the attack of Lysimachus ‘the Coan’ upon the lexicography of the Herophilean Cydias may well, as von Staden (1989, 564–565) suggests, indicate that this lexicographical ‘rivalry between the ‘old’ medicine of Cos and the ‘new’ medicine of Alexandria’ continued into the 1st c. CE.44 7

What Is ‘Hippocratic’ about the Corpus? ‘Wait a moment’, said Winnie-the-Pooh, holding up his paw. He sat down and thought, in the most thoughtful way he could think. Then he fitted his paw into one of the Tracks . . . 

And so, in the search for ‘What is ‘Hippocratic’ about the Hippocratics?’ have we really only been following ancient tracks around a textual spinney? Has Hippocrates really been a Woozle all along? My aim here has been to suggest 44  We have little to go on for Lysimachus and Cydias. The dates for Lysimachus (Nachmanson 1917, 5)—perhaps the pharmacologist mentioned by Varro—are uncertain, with a terminus ante quem ranging from c. 60 BCE (Varro) to c. 60 CE (Erotian). All we can say for Cydias is that he preceded Lysimachus. Still, what little evidence remains of this period fits a pattern of Coan-centered scholarship that might be thought of as reactionary.

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that the overlapping tracks can be at least partially unwound and disentangled by recognizing that the choices of pseudepigrapha for the Corpus were an attempt to inculcate the redactor’s own sense of Hippocratic identity in response to a Hippocratic discourse. What may lie at the bottom of the tangle remains, I think, yet to be discovered. In any case, my consideration of corpus formation identifies how texts created by one set of discursive practices may become a part of a corpus through another, and suggests ways in which the early Hippocratic pseudepigraphica might help us to understand what is ‘Hippocratic’ about the Corpus. It may be that, as with recent discoveries about the appendix,45 the pseudepigrapha may indeed contribute to the function of the Corpus after all. And it may be that the CH, rather than being identified by cohesive and unchanging internal Hippocratic qualities, has been, all along, primarily a phenomenon of the changing discursive concerns of those whose social and professional status is (at least in some way) sustained and advanced by it. And so, if someone were to ask us, ‘What is ‘Hippocratic’ about the Hippocratics?’ we could perhaps do worse than to answer, ‘We are’. ‘Anyhow’, he said, ‘It is nearly Luncheon Time’. And so he went home for it. Bibliography Brandt, A., ‘Emerging Themes in the History of Medicine’, The Milbank Quarterly 69.2 (1991), 199–214. Canfora, L., ‘Falsi demostenici e storia del corpus’, in: F. Roscalla (ed.), L’autore e l’opera: attribuzioni, appropriazoni, apocrifi nella Grecia antica. Pisa 2006, 103–118. Cantor, D., Reinventing Hippocrates. Aldershot, 2002. Cerri, G. (ed.), La letteratura pseudepigrafica nella cultura greca e romana: atti di un incontro di studi, Napoli, 15–17 gennaio, 1998. Naples, 2000. Choi, C., ‘The Appendix: Useful and in Fact Promising’, LiveScience, 2009 posted August 24, 2009 07:05 ET [http://www.livescience.com/health/090824-appendix-evolution .html]. Retrieved August 24, 2009. De Angelis, F. (ed.), Regionalism and Globalism in Antiquity: Exploring their Limits (Colloquia Antiqua supplementary series). Leuven, 2000. Dubel, S. and Rabau, S. (eds.), Fiction d’auteur? Le discourse diographique sure l’auteur de l’Antiquité. Paris, 2001.

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Edelstein, L., ‘Hippocrates’, RE Suppl. 6 (1935), 1290–1346. ———, Ancient Medicine. Baltimore, 1967. Eijk, P. van der (ed.), Ancient Histories of Medicine. Essays in Medical Doxography and Historiography in Classical Antiquity. Leiden, 1999. ———, ‘Historical awareness, historiography and doxography in Greek and Roman medicine’, in: van der Eijk (ed.), 1999, 1–32. ———, (ed.), Hippocrates in Context. Papers Read at the XIth International Hippocrates Colloquium University of Newcastle Upon Tyne 27–31 August 2002. Leiden, 2005. Flemming, R., ‘Commentary’, in: Hankinson (ed.), 2008, 323–354. Fraser, P., Ptolemaic Alexandria, 3 vols. Oxford, 1972. Hankinson, R. (ed.), The Cambridge Companion to Galen. Cambridge, 2008. Heinrichs, A., ‘Zur Meropis: Herakles’ Löwenfell und Athenas zweite Haut’, Zeitschrift für Papyrologie und Epigraphik 27 (1977), 69–75. Holzberg, N., Der griechische Briefroman. Gattungstypologie und Textanalyse. Tübingen, 1994. Ilberg, J., ‘Zu Ueber lieferung des Hippocratischen Corpus’, Rheinisches Museum für Philologie 42 (1887), 436–461. ———, ‘Die Hippokratesausgaben des Artemidorus Kapiton und Dioskorides’, Rheinisches Museum für Philologie 45 (1890), 11–137. Irmer, D., Die hippokratischen Arbeiten am Hamburger Thesaurus. 2000. http://www1 .uni-hamburg.de/Thesaurus/HIPPO.PDF (accessed June 17th, 2015). Jouanna, J. (ed.), Médecine et Morale dans l’Antiquité, Entretiens sur l’Antiquité Classique. Geneva, 1997a. ———, 1997b. ‘La lecture de l’éthique hippocratique chez Galien’, in: Jouanna (ed.), 1997a, 211–253. ———, Hippocrates (trans. M. DeBevoise). Baltimore, 1999. ———, ‘Cause and Crisis in Historians and Medical Writers of the Classical Period’, in: van der Eijk (ed.), 2005, 3–27. Kolbas, E., Critical Theory and the Literary Canon. Oxford, 2001. Langholf, V., Medical Theories in Hippocrates: Early Texts and the ‘Epidemics’. Berlin, 1990. Lanza, D., ‘L’autore e l’opera’, in: Roscalla (ed.), 2006, 11–20. Laskaris, J., The Art is Long. On the Sacred Disease and the Scientific Tradition. Leiden, 2002. Lasserre, F. and Mudry, P. (eds.), Formes de pensee dans la collection hippocratique. Geneva, 1983. Lefkovitz, M., The Lives of the Greek Poets. London, 1981. Lloyd, G.E.R., ‘The Hippocratic Question’, Classical Quarterly n.s. 25.2 (1975), 171–192. Longrigg, J., Greek Rational Medicine: Philosophy from Alcmaeon to the Alexandrians. London, 1993.

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Milne, A.A., The World of Pooh. New York, 1957. Möller, A., ‘Epoch-Making Eratosthenes’, Greek, Roman, and Byzantine Studies 45 (2005), 245–260. Murfin, R. and Ray, S., The Bedford Glossary of Critical and Literary Terms. Boston, 1997. Nachmanson, E., Erotianstudien. Uppsala, 1917. ———, Erotiani vocum Hippocraticarum collectio cum fragmentis. Uppsala, 1918. Nelson, E., ‘Rereading Galen and Zeuxis on Ptolemy’s Port. Hippocratic Anonymity and Literary Malpractice’, Memnosyne. A Journal of Classical Studies, 68.3, 437–451. ———, ‘Coan Asylia: Small-state Diplomacy and the Hippocratic Legend ̕, in De Angelis (ed.), 2000, 253–266. ———, ‘Coan Promotions and the Author of the Presbeutikos’, in: van der Eijk (ed.), 2005, 209–236. ———, ‘Hippocrates, Heraclids, and ‘Kings of the Heracleidai’: Adaptations of Asclepiad History by the Author of the Presbeutikos’, Phoenix 61.3–4 (2007), 234–246. ———, ‘Coan Asylia: Small-state Diplomacy and the Hippocratic Legend’, in: F. De Angelis (ed.), Regionalism and Globalism in Antiquity: Exploring their Limits). Leuven, 1995, 247–266. Nesselrath, H-G., ‘Theopomps Meropis und Platon: Nachahmung und Parodie’, Göttinger Forum für Altertumswissenschaft 1 (1998), 1–8. Nussbaum, M., The Fragility of Goodness: Luck and Ethics in Greek Tragedy and Philosophy. Cambridge, 1986. Nutton, V., Ancient Medicine. London, 2004. Parsons, P., ‘Facts from Fragments’, Greece and Rome 2nd ser. 29.2 (1982), 184–195. Pfaff, F., ‘Die Ueberlieferung des Corpus Hippocraticum in der nachalexandrinischen Zeit’, Wiener Studien 50 (1932), 67–82. Porter, J., Audience and Rhetoric: An Archaeological Composition of the Discourse Community. Longman, 1992. Roscalla, F. (ed.), L’autore e l’opera. Attribuziioni, appropriazioni, apocrifi nella Grecia antica. Atti del Convegno internazionale (Pavia, 27–28 maggio 2005). Memorie e Atti di Convegni 34. Pisa, 2006. Roselli, A., ‘Un Corpo che Prende Forma: L’ordinedi successione dei trattati ippocratici dall’età ellenistica fino all’età Bizantina’, in: Cerri (ed.), 2000, 167–198. Rubin-Pinault, J., Hippocratic Lives and Legends. Leiden, 1992. Rütten, T., Demokrit: lachender Philosoph und sanguinischer Melancholikier. Eine pseudo­ hippokratische Geschichte. Leiden, 1992. ———, ‘Recent Scholarship on the Hippocratic Pseudepigrapha’, Society for Ancient Medicine Review 21 (1993), 148–160. Saïd, S., ‘De l’homme à l’oeuvre et retour: Lectures de l’auteur dans l’antiquité’, in: Dubel and Rabau (eds.), 2001, 9–15.

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Sakalis, D., ‘Beitrag zu den pseudo-hippokratischen Briefen’, in: Lasserre and Mudry (eds.), 1983, 499–514. Silk, M., ‘LSJ and the Problem of Poetic Archaism: From Meanings to Iconyms’, Classical Quarterly n.s. 33.2 (1983), 303–330. Smith, W.D., The Hippocratic Tradition. Ithaca, 1979. (Revised electronic edition, 2002) http://194.254.96.19/amn/Hippo2.pdf (accessed October 10th, 2006). ———, Hippocrates: Pseudepigraphic Writings. Letters—Embassy—Speech from the Altar—Decree. Leiden, 1990. Staden, H. von, Herophilus. The Art of Medicine in Early Alexandria. Cambridge, 1989. ———, ‘Rupture and continuity: Hellenistic reflections on the history of medicine’, in: van der Eijk (ed.), 1999a, 143–188. Swales, J., ‘Approaching the Concept of Discourse Community’, Paper presented at the 38th Annual Meeting of the Conference on College Composition and Communication, Atlanta, Georgia, March 19–21,1987. ———, Genre Analysis: English in Academic and Research Settings. Cambridge, 1990. Thomas, R., Oral Tradition and Written Record in Classical Athens. Cambridge, 1989. ———, ‘Field’, in: Grenfell (ed.), Pierre Bourdieu: Key Concepts. Stocksfield, 2008, 67–81. Tyson, L., Critical Theory Today. A User-friendly Guide, Second Edition. New York, 2006. Vallance, J., ‘Doctors in the Library: The Strange Tale of Apollonius the Bookworm and Other Stories’, in: MacLeod (ed.), 2004, 95–114. Waring, D., ‘Why the practice of medicine is not a phronetic activity’, Theoretical Medicine and Bioethics 21 (2000), 139–151. Wellmann, M., Hippokratesglossare (= Quellen und Studien zur Geschichte der Naturwissenschaften und der Medizin, 2). Berlin, 1931. Wenkebach, E., Untersuchungen über Galens Kommentar zu den Epidemien des Hippokrates (= Abhandlungen der preussischen Akademie der Wissenschaften, Berlin, phil.-hist. Kl., 1925.1). Berlin, 1925. West, M.L., ‘The Invention of Homer’, Classical Quarterly n.s. 49.2 (1999), 364–382.

part 2 Hippocratic Concepts

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CHAPTER 7

Is There a ‘Hippocratic’ Response to the Attack on Medicine? Joel E. Mann 1 Introduction Suppose that I were to claim to be a student of the science of alchemy. Should you care to rebut me, you might adopt any one of the following positions. You might argue that 1. 2. 3.

there is no such thing as alchemy; there is no such thing as science; or alchemy is not a science.

Most, I suspect, would adopt 1 and leave it at that, though, from a strictly logical point of view, nothing would prevent you from adopting 2 as well. Nor would logic itself keep you from adopting 3—indeed, quite the opposite! Both 1 and 2 entail 3. Note, however, that 3 does not return the favor: considered in isolation, it entails neither 1 nor 2. The logical asymmetry has pragmatic consequences. If you were to attack a particular pseudo-science such as alchemy, you would probably direct your dialectical attention to 1; 3 would follow trivially and would need no independent justification and perhaps would not even warrant independent articulation. But if you were to question an ambitious chef de cuisine’s pretensions to the mantle of science, you would probably limit yourself to arguing for 3. Cooking may not be a science, but it is real and really useful. Thus, there is a rough distinction to be made between those who, when questioning the status of a science, would adopt 1 or 2, both of which imply 3, and those who would adopt 3 while rejecting, or at least remaining agnostic about, 1 and 2. If in the above schema we replace ‘alchemy’ with ‘rhetorikē’, and ‘science’ with ‘technē’, the distinction would survive, and in fact we could ask which position Plato’s Socrates in the Gorgias adopts in rebutting Gorgias’ claim to practice a technē rhetorikē (e.g., 465a). It seems to me, for reasons that I will elaborate shortly, that Socrates adopts 3 but neither 1 nor 2. By contrast, other skeptics of the day might have opted for some combination of 1, 2, and 3 © koninklijke brill nv, leiden, ���6 | doi ��.��63/9789004307407_009

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when rebutting claims to technical proficiency. I have in mind principally the sophist Protagoras, who, Plato reports in the Sophist, published ‘the points one ought to raise in a debate against each craftsman himself (πρὸς ἕκαστον αὐτὸν τὸν δημιουργὸν), concerning all technai in general and each technē specifically (περὶ πασῶν τε καὶ κατὰ μίαν ἑκάστην τέχνην)’ (232d). Since the work in question is no longer extant, we shall have to satisfy ourselves with speculation, but Plato’s brief description surely suggests his approach combined at least 2 and 3, while Aristotle’s account of Protagoras’ attack on the geometers (Metaph. 997b–998a4) may constitute some evidence that he adopted 1 as well. Whether Protagoras attacked medicine is unknown, though, if he did not, the CH indicates that others did so. Within the first few lines of On the Art, the author denounces those who demean not just medicine but the arts generally, and his defense appears structured to deflect both a generic attack on technē and, in turn, an attack on medicine in particular. His second chapter opens with the ambitious assertion that ‘there is no technē that is not’ (τέχνη εἶναι οὐδεμία οὐκ ἐοῦσα; 2.1, 225.9–10 Jouanna = 6.2 L), and only once he has demonstrated this point to his (if not others’) satisfaction does he move on to the particular case of medicine (3.1, 226.9–12 Jouanna = 6.4 L), which, he later assures us, ‘has being’ (5.3, 228.13 Jouanna = 6.8 L). Remarks by other medical writers of the Corpus suggest a special sensitivity to the charge of non-being. In Ancient Medicine, the author opens by observing that ‘Some craftsmen are poor, but others are much different, which would not be the case if medicine wholly were not (εἰ μὴ ἦν ἰητρικὴ ὅλως) and there had been no investigation into it nor discoveries made’ (1.2, 118.10–13 Jouanna = 1.570 L).1 Later, he portrays his project as that of demonstrating ‘that medicine is’ (2.2, 120.2 Jouanna = 1.572 L). Consider also the complaint in Regimen in Acute Diseases that ‘In fact the whole art is the subject of considerable slander before the public, so that medicine does not seem to be at all (μὴ δοκεῖν ὄλως ἰητρικὴν εἶναι)’ (8.1, 39.10–12 Joly = 2.240 L).2 The author of Nature of Man echoes the concern in less emphatic language when he criticizes monistic medicine: ‘For one of them 1  Schiefsky’s (2005, 51) notion that the author of VM is taking sides in a dispute internal to the medical community cannot explain his concern with the peculiar charge that medicine ‘is not’ or doesn’t exist at all. Certainly no doctor would make such a claim. 2  The authors of the four treatises I will examine all begin by professing an interest in addressing the concerns of the lay public. See de Arte 1.2, 224.4–12 Jouanna = 6.2 L, Nat. Hom. 1.3–4, 166.2–11 Jouanna = 6.32–4 L, and VM 2.3, 120.3–5 Jouanna = 1.572 L. It is perhaps significant that Protagoras’ attack on the arts is said at Soph. 232d to have been published somewhere and set down in writing for anyone who wants to learn (δεδημοσιωμένα που καταβέβληται γεγραμμένα τῷ βουλομένῳ μαθεῖν).

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claims that this is air, and that it is ‘the one’ and ‘the all’, while another claims it is fire, another water, and yet another that it is earth, and each backs up his theory (λόγος) with proof and evidence that is not (ἅ ἐστιν οὐδέν)’ (1.2, 164.12–14 Jouanna = 6.32 L). It is of particular interest that this last charge of non-being is leveled not against medicine as a whole but against certain theoretical trends within the medical-theoretical community. Indeed, the four Hippocratic treatises just mentioned are often characterized as polemical,3 and with good reason: their authors stress disagreement with competing approaches or views of medicine. The treatises stand out also because of their occupation, to varying degrees, with methodological or other ‘meta-technical’ questions. My thesis is that the conjunction of such preoccupations and polemics is not arbitrary, but rather is the result of a Hippocratic effort to formulate an effective response to the charge that medicine is not. In the first section of this essay, I will explain what the critics of healing mean when they charge that the technē is not, and I will reconstruct (in very broad terms) some of their arguments in support of the charge. In the second, I will examine three polemic (or, as I would have it, ‘apologetic’) treatises in the Corpus in order to discover similarities and dissimilarities in their respective defense strategies. In the third, I will isolate the counterarguments deployed by the author of On the Art to underscore the treatise’s incongruity with the other apologetic treatises. Finally, I will conclude by sketching a few of the implications of this incongruity for Hippocratic interpretation. 2

Rhetoric, Medicine and the Problem of Being

How should one interpret what I will call the problem of being, namely, the charge that the art of medicine ‘wholly is not’ or ‘is nothing at all?’ Understandably, one might be tempted to read the expression through the lens of Plato’s discussions of technē in dialogues such as the Gorgias and Phaedrus, in which Socrates, adopting position 3 above, asks whether rhetoric is a technē.4 Perhaps the Hippocratic writers are laboring under the weight of similar

3  These treatises feature prominently, for example, in Lloyd’s discussion (1979, 86–98) of the influence of agonistic rhetoric on early Greek science and in Ducatillon’s study (1977) of polemics in the CH. 4  I shall not name names, but a casual review of the literature reveals a surprising failure to distinguish between the question of medicine’s being simpliciter versus its being a technē.

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questions about medicine, compelling them to reflect upon the technical status of their profession. I resist this temptation for a few reasons, the first of which is linguistic. At Gorgias 465a, Socrates suggests that rhetoric is not a technē (τέχνην δὲ αὐτὴν οὔ φημι εἶναι), and, famously, demotes it to the status of mere empeiria.5 The noun technē is predicative, the question being whether the predicate accurately applies to rhētorikē. This is an example of what has come to be known as the syntactically incomplete use of ἐστι, one of the obvious functions of which is to ascribe predicates to a subject.6 It is granted from the outset that rhetoric is; that much, it seems, must be true in order for it to be mere empeiria. Socrates disputes what it is, and the outcome of the discussion turns, understandably, on an analysis of both rhētorikē and technē and their interrelation. Indeed, such analysis consumes roughly the first half of the dialogue. In the Corpus, however, the apparent fungibility of the nouns technē and iētrikē may indicate a different way of framing the problem; one never finds the medical writers agonizing over the allegation that iētrikē is not a technē, but rather over whether iētrikē (or simply ‘the technē’) is.7 I would compare the Hippocratic locutions not to passages from the Gorgias but to language from Isocrates’ Against the Sophists. There, Isocrates rails against his philosophicalrhetorical competitors, who promise their students happiness and success: ‘I believe that such a technē is nothing at all (ὅλως μὲν γὰρ οὐδεμίαν ἡγοῦμαι τοιαύτην εἶναι τέχνην)’ (21). The syntax is strikingly similar to that found in the Corpus. We encounter here a syntactically complete occurrence of ἐστι functioning as what Kahn calls an ‘existential predicate’.8 To say that the gods are 5  That the charge facing the Hippocratics is that medicine ‘wholly is not’ or ‘is nothing at all’ militates against the hypothesis that they are at risk of being demoted to empeiriai, since even in that case medicine would have some being, namely, it would be empeiria. 6  Owen (1986, 280) used the terms ‘complete’ and ‘incomplete’ to mark a syntactic distinction between occurrences of ἐστι. As Kahn (1986, 2) rightly saw, the syntax or form of the verb should not be confused with questions surrounding its semantics or function, though such a confusion infects the history of scholarship on the subject. The incomplete form may have various ‘predicative’ functions or uses that include (but are not limited to) 1) the application of a predicate to a particular object, 2) the application of a predicate to a class, i.e., generic implication or inclusion, and 3) identity. In asking whether rhetoric is a technē, Socrates uses the ἐστι of generic implication. 7  See VM (12.2, 132.16 Jouanna = 1.596 L) and de Arte (8.1, 232.16–17 Jouanna = 6.12 L). 8  Kahn (1986, 10) notes that to speak of an ‘existential’ use is potentially misleading insofar as copulative uses may have existential import. But in such cases it is not the existence of the subject term that is in question. So it is in the Gorg., when Socrates calls rhetoric empeiria, but also in VM’s discussion of the evolution of medicine: ‘If this [cooking and basic nutrition]

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not, for example, would be to say that the gods cannot be the subject of a sentence with existential import. Zeus is not vengeful; nor is Athena wise. This is not because Zeus is forgiving or Athena is a dimwit. Rather, it’s because Zeus is neither vengeful nor forgiving, there being no such thing as Zeus in the first place.9 To understand the implications for the attack on medicine, let us return to our hypothetical dispute about alchemy, and specifically to rebuttal position 1. When you charge that there is no such thing as alchemy, what do you mean? Presumably, you do not mean that the practices and procedures in which selfdescribed alchemists engage, and to which they refer as ‘alchemy’ or ‘alchemical’, do not exist, i.e., never take place. Instead, you mean at least that these procedures do not bring about the result that alchemists claim, e.g., they do not turn lead into gold. You might also mean that self-proclaimed alchemists don’t know how to turn lead into gold, not because they are poor students of alchemy, but because it simply can’t be done. I propose, then, that when Isocrates claims that a particular technē wholly is not, he means roughly what you might mean by saying that there is no such thing as alchemy or, in the Hippocratic case, medicine. This is born out by Isocrates’ basic argument against the sophists. [When laymen observe that] those who make use of opinions are more apt to agree and are more often correct (πλείω κατορθοῦντας) than those who profess to have knowledge (τὴν ἐπιστήμην), I think [laymen] are likely to look down upon them and believe that such activities (τὰς τοιαύτας διατριβάς) are chatter and triviality, not care of the soul. (8) The sophists are engaged in some activity that they call philosophy (Isocrates is inconsistent in the names he uses to refer to it), but this activity does not achieve its professed aim, namely, to yield knowledge of how best to care for the soul. I limn the underlying logic of the argument as follows. is thought not to be a technē (μὴ τέχνη αὕτη νομίζεται εἶναι), it is not unreasonable. Where no one is a layperson but all are knowledgeable about something because they are compelled by necessity to use it, it is not appropriate for anyone to be called a technitēs’. (4.1, 123.9–12 Jouanna = 1.578 L). Cooking is (i.e., there is such a thing as cooking), though it is not a technē. 9  A problem of some interest arises when we ask whether Zeus is a god. If he’s not a god, then he is untouched by the general existential predication ‘the gods are not’. But if he is, then it appears, at least on initial inspection, that he is something, and it is not immediately clear how this is supposed to square with the claim that the gods are not. Incidentally, this is precisely the puzzle that the author of de Arte exploits to his own ends when he writes in defense of medicine that ‘There is no art that is not’ (2.1, 225.9–10 Jouanna = 6.2 L).

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1.

If there is a technē of this sort, then its practitioners possess knowledge of the domain in question. 2. If they possess such knowledge, then they will agree in their technical prescriptions, and their prescriptions will be generally correct. 3. But the sophists do not agree, nor are their prescriptions generally correct. 4. Therefore, there is no such technē. Isocrates does not appear to object to the notion or existence of a rhetorical technē aimed at improving one’s public standing and, thus, overall success in life.10 But the sophists, he writes, ‘try to persuade our young men that if they follow them they will know what is to be done and through this knowledge (διὰ ταύτης τῆς ἐπιστήμης) will flourish’ (3). Isocrates flatly disavows even the possibility of such knowledge (‘It is evident to all that it is not in our nature to know in advance what is going to happen’, (2) and thus the efficacy of any technē that aims to attain it: ‘I should have valued above many material possessions a philosophy that had as much power (δύνασθαι) as these men say. . . . But since it has no such power, I would wish that this nonsense might stop’ (11). I recommend that Isocrates’ remarks from Against the Sophists be used to elucidate the problem of being in the Corpus, starting from the premise that a technē has being when its practitioners have a specific power to effect some end. So philosophy, on the ‘sophistic’ conception, is the power to know precisely what one should do in life, i.e., how one ought to live. But, Isocrates argues, it is impossible to attain such precise knowledge, and so impossible to have the power to do so. Even if possible, no one actually has this power, as evidenced by the lack of agreement and success among self-proclaimed professionals.11 So there is no such thing as the technē of philosophy so conceived: the technē ‘wholly is not’. Accordingly, I will proceed on the hypothesis that the Hippocratic apologists are responding to a parallel series of challenges posed to medicine, namely, that there is no technē iētrikē that produces precise 10  Contra Roochnik (1996, 283–8), who argues that Isocrates is careful never to lay claim to a technē. I find it difficult to square this view with, for example, Against the Sophists 10–12, 14, and Antidosis 205–15. See also Hutchinson 1988, 29–32. 11  Isocrates feels no need to explain why disagreement and error pose such a threat to technical knowledge; it may be that certain criticisms were by Isocrates’ time entrenched topoi. Indeed, two of them may be traced back as far as the Presocratic philosopher Xenophanes, who questioned claims to know what the gods were like based in part on religious disagreement across cultures (DK B16) as well as the impossibility of empirical verification (DK B34). See further Barnes 1983, 136–43.

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knowledge of what a sick person should do to recover his health since 1) such knowledge is impossible (the ‘objection from impossibility’), and 2) even if it is possible, no one has the power to acquire such knowledge, as evidenced by the disagreement (the ‘objection from disagreement’) and widespread failure among physicians (the ‘objection from error’).12 The viability of this hypothesis rises and falls on its usefulness for identifying and explaining features common to the family of apologetic treatises in the CH. Before turning to these specific treatises, however, I shall sketch an argument in favor of taking the hypothesis seriously. First and foremost, medicine, as we know it from the Corpus, was conspicuous in its epistemic ambition to know the future. At times, prognosis comes close to competing with prescriptive treatment for the mantle of medicine’s raison d’etre, as exemplified by the familiar opening to Prognosis: It seems to me best for a physician to try to know things in advance. For if he prognosticates and predicts in the presence of his patients what is happening, what has happened, and what will happen (to the extent that any of these things were left out of the patient’s original account), the more he will be believed to know his patients’ real situations, so that people will dare to place themselves in the doctor’s hands. What’s more, he will give the best treatment if he knows in advance what will happen on the basis of present symptoms. (1, 2.110.2–9 L) It is interesting that prognosis is accorded a value independent of its usefulness in formulating effective therapy.13 More important for present purposes, however, is the author’s assertion of an additional value derived from the role

12  The critic or critics might have tailored these general objections specifically to medicine. As we shall see, some of the Hippocratics treat the objection from error as part of an argument that the apparent successes of medicine are attributable to chance (VM 1.2, 118.11–119.1 Jouanna = 1.570 L and 12.2, 132.18–133.6 Jouanna = 1.596–8 L; de Arte 4.1, 227.6–12 Jouanna = 6.6 L). Further, the sustained concern in VM (1.3, 119.4–11 Jouanna = 1.572 L), de Arte (10.1, 235.9–11 Jouanna = 6.16 L), and Nat. Hom (1.1, 164.5–7 Jouanna = 6. 32 L and 2.4, 168.9–13 Jouanna = 6.36 L) with claims to knowledge of unobservable states of affairs may indicate that the objection from impossibility gained traction from the difficulty of directly perceiving the body’s internal organs and processes. 13  Von Staden (1990, 109–11) shows that, on the whole, the Hippocratics value prognosis not only as a step in determining treatment but also as a means of enhancing a doctor’s reputation. Cf. Tht. 178a–e, where Socrates argues that all practical arts, insofar as they attempt to influence what will happen, are exercises in predicting the future.

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prognosis plays in determining treatment, a role made possible by the physician’s cognizance of current conditions. For the author of Prognosis, the relevant conditions are observable symptoms—he is notoriously circumspect about the underlying causes of the diseases he discusses, despite his insistence that the best doctors are those who ‘know the natures of the diseases’. Knowing their natures will allow the physician to predict with greater certainty which therapeutic measures will be effective (1, 2.112.3–11 L). Other Hippocratic writers echo and amplify the sentiment. The author of Regimen, who can ‘in advance of a patient’s falling ill from excess, discern the course that the condition will take’ (1.2.4, 124.28–9 Joly = 6.472 L), recommends that the doctor know and discern human nature. He must know from what a human being is composed in terms of a first principle, and he must perceive by what constituents it has been mastered. For if he doesn’t know the composition in terms of a first principle he will be unable to know what comes to be through these components. If he doesn’t know what is dominant in the body, he will be incapable of applying beneficial treatment to the body. (1.2.1, 122.22–7 Joly = 6.466 L) Clearly, a vocal contingent of Hippocratic writers regarded prognosis, first, as inextricably bound up with successful treatment and, second, as requiring proper diagnosis formed from a comprehensive causal theory. The end of medicine, as opposed to magical healing, or midwifery, or root-cutting, includes essentially its epistemic means. Indeed, medicine’s commitment to securing precise knowledge through the investigation of causes, natures and powers led Plato to hold it up as something of a paradigm in the Gorgias (464b–465a; 501a) and to praise Hippocrates in particular in the Phaedrus (270c–d). 3

The Apologies of ‘Hippocrates’

The apologetic treatises, too, follow this pattern. Foreknowledge of what will happen to the patient, with and without being treated, is recognized as a central aim of the technē, an aim that will be attained through causal understanding. The author of Nature of Man is unambiguous. Those diseases that develop in a short time and whose antecedent causes are well known are those that are predicted with most certainty. Further, in order to heal, it is necessary to apply the very thing opposed to the

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disease’s cause. For thus will you remove that which produced the disease in the body. (13.1, 200.13–16 Jouanna = 6.64 L) Causal understanding of the disease is key both to prognosis and treatment, the two sides of the coin of medicine. So, too, in Ancient Medicine: ‘whoever does not learn how these [causes] stand in relation to a human being will be able neither to know their results nor to use them correctly (21.3, 148.17–19 Jouanna = 1.626 L). The connection between foreknowledge, treatment and causation is made less explicitly in Regimen in Acute Diseases, though it is clearly made, e.g., in ch. 43. But if there is general agreement that knowledge of causes is a necessary condition of successful medical practice, there is little agreement on what those causes are. Accordingly, there will be little agreement on how to treat them, and not everyone can be correct. Theoretical disagreement guarantees therapeutic disagreement, and this in turn insures that some doctors will fail. The apologists are sensitive to the criticism that the success rates of doctors aren’t as high as they ought to be. In an attempt to turn the tables on his critics, the author of Ancient Medicine concedes (in the passage quoted in the introduction to this essay) that some doctors are failures, though others get much different results (οἱ δὲ πολλὸν διαφέροντες), which proves that there is an art of medicine after all (1.2, 118.10–11 Jouanna = 1.570 L). The argument is a good start but still ultimately unsatisfying; it is as though the author relaxes the requirement of extraordinary success only to reinforce the expectation of something very close to it. Elsewhere, he concedes that there are inherent limits on the precision of medical practice, though perfect accuracy nonetheless is possible, if rare (9.4, 128.15–17 Jouanna = 1.590 L). Furthermore, (i) we ought not reject the ancient art as not being (ὡς οὐκ ἐοῦσαν) and as having been poorly investigated (οὐδὲ καλῶς ζητεομένην) just because it is not precise in all respects. Rather, since (ii) it was able through reasoning to achieve near perfect accuracy from a state of considerable ignorance, much more do I think we ought to admire its discoveries insofar as (iii) they were made in an excellent and correct manner and not by chance (ὡς καλῶς καὶ ὀρθῶς ἐξεύρηται καὶ οὐκ ἀπὸ τύχης). (12.2, 132.18–133.6 Jouanna = 1.596–8 L; numerals in parentheses are my addition). The remarks in (i) confirm my hypothesis regarding the attacks on medicine. The imprecision of medical treatment appears to have been cited in arguing that 1) the technē was improperly investigated, i.e., its practitioners have not acquired genuine knowledge of the domain in question, and, thus, that 2) the

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technē is not. The author nonetheless makes a claim to near-perfect accuracy in (ii), though the more important point may be that there has been gradual improvement in therapeutic success. Ultimately, however, his defense of medicine’s existence rests not on the correctness of its prescriptions at any given moment, but on the continuity and correctness of its method, its having made discoveries ‘in an excellent and correct manner’. It is significant that this method is said to belong to the ancient art (τὴν τὲχνην τὴν ἀρχαίην), which should not be thrown out on the grounds that it is not. There are non-ancient approaches to medicine that make use of ‘a newfangled hypothesis’ (1.3, 119.4–5 Jouanna = 1.572 L), and the author is keen to facilitate their ejection from the canon of technai based on their use of such hypotheses.14 A convincing account of medical method not only secures the epistemological foundations of the theory and practice of the ancient art, but it delegitimizes the theory and practice of competitors who do not conform to the methodological strictures imposed by the author of Ancient Medicine. To frame it in the context of the hypothesized attack on medicine, Ancient Medicine’s identification of genuine medicine with sound method efficiently 1) demonstrates the possibility of acquiring knowledge of the causes of disease, and therefore the possibility of knowing how to treat them correctly; 2) excludes from the technē those who disagree with Ancient Medicine, thereby circumventing the objection from disagreement; and 3) excludes from the technē those who, because they have not met a necessary condition for successful practice (namely, a correct causal theory), do not possess the capacity to issue correct prescriptions with any regularity. Thus, there is no determinate answer to the question of who is attacked in Ancient Medicine, since the intra-technical targets of the author’s polemic are defined negatively: anybody who claims to practice medicine but does not adhere to the author’s methodological guidelines. Moreover, the question of who is attacked is subsidiary to the question of who is counterattacked. As I have argued elsewhere, Protagoras seems a good candidate,15 though it is difficult to say more than this, and, in any case, speculation about the extra-medical antagonist’s identity is less pressing than is the need to come to terms with the fact that a critic or critics from outside the technē attacked medicine on the above grounds, and further that the attack was prominent enough to prompt responses in Ancient Medicine and other Hippocratic treatises. Let us turn, 14  Especially 2.1–3, 119.12–120 15 Jouanna = 1.572–4 L. For a thorough reconstruction of the author’s criticism, see Hankinson 1992. Also helpful are Cooper 2004, 3–42; Schiefsky 2005, 143–52. 15  See Mann 2008, 98–108.

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then, to examine two such treatises, Regimen in Acute Diseases and Nature of Man, both of which share Ancient Medicine’s commitment to refuting the charge that medicine is not. The author of Regimen in Acute Diseases confronts openly the objection from disagreement and the threat it poses to the existence of medicine. In fact the whole art is the subject of considerable slander before the public, so that medicine does not seem to be at all (μὴ δοκεῖν ὄλως ἰητρικὴν εἶναι). So if in acute diseases practitioners differ from each other to such an extent that whatever one doctor thinks best to apply are considered bad by another, it is likely to be said in such cases that the technē is similar to divination (8.1–2, 39.10–17 Joly = 2.240–2 L) The treatise begins with a polemic against the authors of Cnidian Sentences in particular (1.1, 36.1–5 Joly = 2.224 L). The main complaint is that the remedies they recommend are often incorrect (3.1, 36.18–21 Joly = 2.224 L), and he appears to attribute this to a methodological failure, specifically in the area of nosology. Some, however, were not ignorant of the many subdivisions and various characters within each kind of disease, though, despite their desire to give a clear account of the number of each kind of disease, their writings on the topic are not correct. For the number will be almost incalculable if one makes inferences about the diseases of sick people based on just any difference of one from the other, and doesn’t think a disease is the same one unless it has the same name. (3.2, 37.4–10 Joly = 2.226–228 L) The mistake is one of classification, and while the precise meaning of this passage is much disputed,16 the idea must be that too many doctors misclassify diseases because they do not understand which similarities are causally relevant and which are not. Elsewhere, he accuses the majority of doctors of laboring under a comparable ignorance. For nor do I see physicians familiar with how one ought to distinguish the kinds of weakness present in the diseases, whether they come about through (διά) starvation or through some other irritation, or through pain and the acuteness of the disease—whatever affections, with their various forms, our individual natures and constitutions engender. Knowledge of 16  See Joly’s discussion of the passage ad loc, which includes a brief survey of the relevant literature.

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such things brings safety, while lack of knowledge brings death. (43.1, 54.18–25 Joly = 2.314–16 L) It is in cases of acute disease that, to non-professionals, those who are not doctors (μὴ ἰητροί) most appear to be doctors, because it is easy for them to learn the names of the various remedies commonly applied (6.2, 38.12–18 Joly = 2.238 L; for a specific illustration of his complaint, see 40.1–2, 53.8–16 Joly = 2.308 L), even if they have never done the hard work of learning when and why (διὰ τί) they should be applied (7.1, 38.22 Joly = 2.238 L). As was the case in Ancient Medicine, the author’s strategy is to vindicate medicine’s existence by undermining the approaches of all who disagree with him. Among other things, methodological critique represents a way of marginalizing disagreeable doctors en bloc without having to address the specifics of every therapeutic disagreement. Likewise, the author of Nature of Man finds it unnecessary to combat the individual physical-monistic theories of human composition. The arguments in support of their theories ‘are not’ (ἐστιν οὐδέν, in apparent contrast to his own), and this is demonstrated by their disagreement: ‘When they use the same idea but do not make the same arguments, it is clear that they don’t have knowledge of these things’ (1.2, 166.1–2 Jouanna = 6.32 L). In public debate, none of the monists is able to hold his own consistently, though ‘It is right that he who claims to have correct knowledge (ὀρθῶς γινώσκειν) of matters should produce an argument for his position that is always successful, if indeed he knows things that are and lays them out correctly (ὀρθῶς)’ (1.3, 166.7–9 Jouanna = 6.34 L). Not only will the doctor with accurate knowledge of medicine apply successful therapies, but, when called upon to defend his knowledge in public, he will meet with rhetorical success as well. The chief failure of all monistic accounts of human nature, however, is methodological. He dismisses philosophical monists as a group on the grounds that the explananda they employ (whether fire, water, air, or earth) are ‘not evidently in a human being’ (μὴ φανερόν ἐστιν ἐνεὸν; 1.1, 164.7 Jouanna = 6.32 L).17 Medical monists, too, are subjected to a similar criticism: But I require anyone who claims that a human being is only blood and nothing else to point out a human being whose form does not change and who does not take on all sorts of qualities, and to point out a time of the

17  Accepting the reading of A and V instead of M’s μὴ φανερόν ἐστιν ἓν ἐὸν, but see Hankinson in this volume.

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year or a time in the life of a human being when blood alone is evident in him (ἐνεὸν φαίνεται μοῦνον ἐν τῷ ἀνθρώπῳ). (2.4, 168.9–13 Jouanna = 6.36 L) Like Ancient Medicine, the author of Nature of Man rejects any medical theory based on axioms about the material constitution of a human being that are not verifiable by direct observation. He believes his own axiom, that a human being is composed of blood, phlegm, and yellow and black bile, passes this test, and the remainder of the treatise is dedicated to laying out the details of his theory. In this, Nature of Man again resembles Ancient Medicine and Regimen in Acute Diseases, both of which transition from a methodological critique of competing approaches to exhaustive expositions of their own. In fact, we can discern in these three treatises a common strategy for dealing with the attack on medicine. With respect to the objection from error, there is little attempt to discredit the basic premise. None of the authors questions the fact that failure is rampant in the medical profession, and some aggressively affirm it: ‘Thus it is with poor doctors, who make up the majority’ (Ancient Medicine 9.5 129.4 Jouanna = 1.590 L); ‘All these things, then, are strong evidence that doctors do not correctly guide the sick in matters of regimen’ (Regimen in Acute Diseases 41.1, 53.17–19 Joly = 2.308–10 L). Instead, they deny, quite rightly, that widespread error in itself is conclusive proof that there is no such thing as medicine. Poor practice is to be explained at least in part by poor theory, and there is no doubt that the medical profession is populated by a wide variety of theories and practices, most of which must be wrong. However, it does not follow that all are wrong. Medicine, properly conceived, does exist, but few actually practice it. So both Ancient Medicine and Nature of Man imply that many doctors are more like physikoi than physicians; Regimen in Acute Diseases implies a comparison between the quacks who simply learn the names of various remedies and the doctors who do not investigate why certain remedies are appropriate under certain circumstances but not under others. All seem to regard their own approaches as the ‘true’ medicine, and all would no doubt agree about the incorrect approaches that, in the words of Nature of Man, ‘the majority hold such views, or views very near to these’ (2.3, 168.3–4 Jouanna = 6.34 L). Thus, these three treatises, while apologetic, are not defensive. The best defense, on their model, is a good offense: the strategy is to absorb the objections of critics and redirect them at medical competitors. ‘If only the medical community agreed with me’, each of these authors must be thinking, ‘then there would not be such widespread error!’ Their protreptics represent not only efforts to allay the misgivings of potential patients but also attempts to resolve the crisis in medicine by imposing professional uniformity in theory

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and practice. As I have already suggested, this is accomplished by introducing methodological principles to filter the bad medicine from the good. If we may ascribe to medicine the telos of knowing what will happen to a patient with and without therapy, there remains the further question of how one should go about acquiring such knowledge. All the apologists subscribe to an aetiological method: in order to know what will happen to the patient, one must know the causes of his disease. The author of Regimen in Acute Diseases offers advice on how to relate diseases to underlying causes, while the authors of Ancient Medicine and Nature of Man limit the range of things that may be put forward as legitimate causes. So it is that the apologists can explain away medical error as failures in medical theory, in turn explaining away the diverse mistakes in theory as the result of unsound method, a problem that does not plague their own approaches. In one fell stroke, then, methodology cuts down the objections from error, disagreement, and knowledge, clearing the way for a medicine that is. 4

An Apology Excepted

On the Art is different. It has become commonplace to refer to the treatise as ‘sophistic’ in style, in part because of its highly wrought prose and engagement with conceptual frameworks (e.g., the nomos-physis antithesis) that occupied many of the sophists. Some have argued that the work was written not by a practicing physician but by a sophist of some stripe. An observation sometimes adduced in favor of sophistic authorship is the relative paucity of medical-theoretical content in On the Art. As G.E.R. Lloyd puts it, ‘The actual medical knowledge [the author] displays is none too impressive’ (1991, 254). It may after all be true that the treatise itself contains very little of direct theoretical interest, though I would suggest a reason for resisting the inference that the author himself had little knowledge of or interest in medical theory. The author may have developed views on the causes of health and disease, but his rhetorical strategy does not require their articulation. I will argue, in fact, that it requires their suppression. Like the other apologetics, the author of On the Art links foreknowledge and causation directly to the question of medicine’s being at the close of his sixth chapter, concluding that ‘Medicine clearly has and always will have being, both in virtue of things that happen ‘because of something’ (ἐν τοῖσι διά τι) and in virtue of the things known in advance’ (6.4, 230.18–20 = 6.10 L). Further, ‘Knowing the causes of diseases and knowing how to treat them by all the means that hinder their progress belong to the same intellect’ (11.4, 238.2–5 Jouanna = 6.20 L).

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This last statement is especially significant, since it is made in the middle of the author’s discussion of non-evident diseases. The causes of most diseases are not evident to human perception; the challenge for medicine is to acquire knowledge of them despite their obscurity. This is not impossible: ‘For what eludes the sight of the eyes is captured by the sight of the mind’ (11.2, 237.11–13 Jouanna = 6.20 L). The author’s account of how this is to be done deserves attention: Taking as its criteria the clarity or scratchiness of the voice, the quickness or slowness of breath, and, for the fluids regularly discharged through their respective orifices, sometimes their smell, sometimes their color and at other times their thinness and thickness, medicine makes an inference to the conditions of which these things are signs, including both the conditions already suffered and the conditions that may yet be suffered. And whenever nature herself does not willingly relinquish these informants, medicine has discovered devices of compulsion by which nature is forced—without injury—to surrender them. Once they have been set free, they reveal to those knowledgeable in the art what is to be done. (12.2–3, 240.5–13 Jouanna = 6.24 L) Sound medical method, then, will include inferences about unseen, underlying conditions—past, present and future—based on observable criteria, or signs. There is nothing mysterious about this ability to ‘see’ the unseen. The conditions at issue are not categorically invisible; they are buried under layers of tissue. The semiotic fluids did not just appear out of nowhere; they originated from within the patient’s body. Thus, they carry information about the conditions in that body, information that can be used by those with knowledge of the technē to make inferences. The security of these inferences is guaranteed by the causal necessity that governs the fluids and physical structures involved. Since doctors understand the physical mechanisms by which fluids change density, color, and odor, they are able to draw conclusions about the processes taking place in the patient’s body.18 The author is notoriously reticent regarding the nature of those physical mechanisms and the kinds of conditions they indicate. In purporting to provide examples to illustrate the above passage, he writes the following:

18  This may be an example of ‘Hippocratic’ physics in action. Again, see Hankinson in this volume.

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Using acrid food and drink the art forces fever to melt the congealed phlegm in order to draw an inference about what it was unable to see based on what has been seen. In turn, by means of steep roads and running the art forces breath to bring a charge against those things of which it is the accuser. And inducing sweats by the aforementioned means or by the vapors of hot water, the art makes an inference. There are things that, in passing through the bladder, are better at revealing the disease than when they pass out through the skin. (12.4–5, 240.14–241.4 Jouanna = 6.24 L) Conspicuously, the author does not offer his view on which signs correlate to which conditions; nor does he recommend any particular course of treatment. Where other apologists would have seized the opportunity to explicate and advocate their own views, he demurs. His demurral is all the more striking because it weakens the immediate methodological point, which surely would have benefited from a concrete and convincing example of sign-inference at work. The unwillingness to make specific aetiological and therapeutic commitments is consistent, I would claim, with an overall strategy that stresses the uniformity of method among physicians while minimizing their substantive disagreements. Indeed, of all four apologetic treatises, On the Art stands alone in its silence on the subject of intra-technical disagreement. Never does the author draw attention to the variety of medical theories and therapies in circulation. Even when his argument leads into what one would expect to be disputed territory, the author refuses to take sides in, or even to acknowledge, controversy. Consider the following excerpt from his rushed excursus on anatomy and physiology, which is perhaps the most theory-laden section of the treatise: With respect to these evident diseases, then, the art ought to be thus well equipped. But neither ought it be unequipped to deal with the less evident diseases, namely, those affecting the bones and the bodily cavity. Actually, the body does not have just one cavity, but many. There are two that take in and expel food, for example, and there are many others that are known to those who take an interest in these matters. (10.1–2, 235.9–15 Jouanna = 6.16 L) Consistent with Lloyd’s evaluation, the description is remarkable for its superficiality and vagueness. From it, we glean that 1) the body contains bones; 2) there is a large bodily cavity; 3) there are many cavities, including 4) two for

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the ingestion and excretion of food matter. Probably he has in mind the stomach and intestines, though we cannot rule out the possibility that he is referring to the oral and anal cavities, or some combination or fusion (respectively) thereof. In any case, he says little that would not be plain to any layman. But this is precisely the point. By appealing to popular knowledge of anatomy, he secures assent to the basic proposition that some of the body’s internal structures can be known. The anatomy of more obscure or complicated structures (the ‘many other’ cavities) is continuous with this popular knowledge, which differs from the knowledge of ‘those who take an interest in these matters’ not in kind but rather in degree. At the same time, the author stops short of enumerating these more complicated structures, leaving ample room for theoretical disagreement on the anatomic details. To take a firm theoretical stand would amount to the de facto exclusion of alternative theories and therapeutics from a generic defense of medicine that any doctor could find useful. Unlike the other apologetic treatises, exclusion is not the dominant modus operandi in On the Art. Only once does the author attempt to disqualify doctors from the profession proper, and even then his difference from the other apologists is instructive. So, then, those who criticize doctors for not handling sick people overcome by disease are demanding that they touch what is improper no less than what is. And while in making these demands they gain the admiration of those who are physicians in name, they are ridiculed by those who are physicians also in virtue of their technē. Those experienced in this craft have no need for such mindless criticism or praise. Instead, they require people who have thought through what the fully finished products of the craft are; in what respect imperfect products are deficient; and further, concerning these deficiencies, which are to be attributed to the craftsman and which to the things he works on. (8.6–7, 233.17–234.9 Jouanna = 6.14 L) Significantly, these ‘physicians in name’ are disqualified not on methodological grounds, that is, because they adopt a fundamentally flawed approach to achieving medicine’s ends. Rather, they are disqualified on what I would call ‘meta-technical’ grounds. They operate under a flawed conception of the technical ends themselves, which the author identifies elsewhere as ‘totally removing the sufferings of the sick or alleviating the violent effects of their diseases, as well as not taking in hand the sick who have been overwhelmed by their diseases’ (3.2, 226.13–16 Jouanna = 6.4–6 L).

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Accordingly, On the Art does not, like the other treatises, absorb and redirect the objection from error. Instead, it challenges the assumptions of the objection, at least in its naïve form. The tripartite definition of medicine implies that full recovery of a patient is not the standard against which therapeutic correctness should be judged. Moreover, it is not the success of doctors that is salient to the problem of medicine’s being so much as the success of particular types of therapies when applied to certain conditions. Thus, in answering those who, in light of the fact that not all who are treated recover fully, claim that ‘Those who escape [their diseases] do so by chance (τύχη) and not because of technē’. (4.1, 227.11–12 Jouanna = 6.6 L), the author’s response is pithy and powerful. I myself do not deny chance its accomplishment; however, I do believe that for the most part (τὰ πολλά) misfortune (ἀτυχίη) follows upon the poor treatment of a disease, while good fortune (εὐτυχίη) follows upon good treatment. (4.2, 227.12–15 Jouanna = 6.6 L) This is more than just a bad pun. Even if there is such a thing as medicine, it does not follow that every doctor will be able to cure every patient who seeks treatment. It is enough that the doctor’s therapeutic repertoire includes treatments whose efficacy is validated by the fact that, when applied to patients in a certain condition, results are positive, at least for the most part (τὰ πολλά). The choice of words is deliberate, I think, intended at once to concede that it is reasonable to expect a high degree of regularity and to assert that it is unreasonable to expect perfect regularity. As with any technē, the success of medicine’s procedures will be vulnerable to physical limitations (e.g., when a caustic hotter than fire is required; 8.4, 233.11–14 Jouanna = 6.14 L) and the interference of external contingencies (e.g., when the patient fails to follow the prescription; 7.1–2, 231.2–11 Jouanna = 6.10 L). The doctor may be faulted only when the limitations are his own or the errors are internal to his technical procedures.19 As for the second possibility, the author argues that patient error is much more likely than physician error, since the former is ill and lacks self-control, while the latter is sound in body and mind (7.2–3, 231.4–12 Jouanna = 6.10 L). Thus, blaming the doctor for the failed recovery is tantamount to letting the guilty go free (7.5, 232.7–11 Jouanna = 6.12 L). 19  This point is put persuasively by Allen (1994, 85), who argues that the Hippocratics adhere to the requirement that a true craftsman will not fail except where extrinsic circumstances interfere. He cites VM 9 as an important exception, though I fail to see how the account of error and precision differs materially from that in de Arte. See also Mann 2008, 112.

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5 Conclusion I cannot imagine finding this last argument in Ancient Medicine, Nature of Man, or Regimen in Acute Diseases, and not just because it trades on a sophism.20 None of these authors would concoct an excuse that might be used in defense even of genuinely bad doctors, for their claim is that 1) there are bad doctors and 2) these can be identified and justly excluded from the technē on methodological grounds. I do not mean to argue that their remarks on methodology are mere rhetorical devices. But their methodological reflections are manipulated as means to the rhetorical end of refuting the charge that medicine is not, a goal the three appear to share. Indeed, it is nearly their only shared commitment, and it may be that, more than any particular item of method, theory or practice, what makes these apologetic treatises ‘Hippocratic’ is their faith in a medicine whose practice reflects a considered causal theory, whose theory is grounded in sound method, and whose method is in turn susceptible of clear articulation and rational justification. Despite its difference in approach, On the Art would seem to share this same faith. By avoiding theoretical controversies, the author is free to focus on what legitimate practitioners of medicine have in common. Doctors are united around a common conception of their technical ends, and they employ a common method to achieve those ends. They treat a patient by discovering the causes of his disease, using past cases to determine what should be done in the present, and making sign inferences to discover non-evident causes. With this rational framework in place, the author may think that the technē has the means to resolve internal disagreements over theoretical specifics. (After all, he chastises the critics of the technai not for pointing out the shortcomings of the arts, but for doing so ‘while suggesting no improvements’ (1.2, 224.9 Jouanna = 6.2 L), as though setting the agenda for the authors of Ancient Medicine, Regimen in Acute Diseases and Nature of Man.) So it is that the author of On the Art, so often dismissed as one of the least ‘medical’ contributors to the Corpus, may have given us the most generically ‘Hippocratic’ picture of medicine.

20  The underlying point, however, is valid. Just because a patient fails to recover after being treated by a doctor, it does not follow that the failure to recover is attributable to medical error.

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Bibliography Allen, J., ‘Failure and Expertise in the Ancient Conception of an Art’, in: T. Horowitz and A. Janis (eds.), Scientific Failure. Lanham, MD, 1994, 83–110. Barnes, J., The Presocratic Philosophers. New York, 1983. Cooper, J., ‘Method and Science in On Ancient Medicine’, in: J. Cooper (ed.), Knowledge, Nature, and the Good: Essays on Ancient Philosophy. Princeton, 2004, 3–42. Ducatillon, J., Polemique dans la collection hippocratique. Paris, 1977. Hankinson, R.J., ‘Doing Without Hypotheses: the Nature of Ancient Medicine’, in J.A. Lopez Ferez (ed.), Tratados hipocraticos (Estudios acerca de su contendo, forma y influencia) Actas del VII colloque International Hippocratique. Madrid, 1992, 55–67. Hutchinson, D.S., ‘Doctrines of the mean and the epistemology of skill in ancient medicine and ethics’, Apeiron 21 (1988), 17–52. Kahn, C., ‘The verb “to be” and the concept of being’, in: S. Knuutila and J. Hintikka (eds.), The Logic of Being. Dordrecht, 1986, 1–28. Lloyd, G.E.R., Magic, Reason, and Experience. Cambridge, 1979. Mann, J.E., ‘Prediction, Precision, and Practical Experience: the Hippocratics on technē’, Apeiron 41 (2008), 89–122. Owen, G.E.L., ‘Aristotle on the snares of ontology’, in: G.E.L. Owen and M. Nussbaum (eds.), Logic, Science, and Dialectic. Ithaca, NY, 1986, 259–78. Roochnik, D., Of Art and Wisdom: Plato’s Understanding of techne. University Park, PA, 1996. Schiefsky, M.J., Hippocrates’ On Ancient Medicine. Leiden, 2005. Staden, H. von, ‘Incurability and Hopelessness: the Hippocractic Corpus’, in: P. Potter, G. Maloney and J. Desautels (eds.), La Maladie et les maladies dans la Collection hippocratique: actes due Vie Colloque International Hippocratique (Québec, du 28 septembre au 3 octobre 1987). Québec, 1990, 75–112.

CHAPTER 8

Perceiving the Coherence of the Perceiving Body: Is There Such a Thing as a ‘Hippocratic’ View on Sense Perception and Cognition? Roberto Lo Presti 1

Introduction. ‘Hippocratic’ and ‘Presocratic’: Two Hazardous Classifications

Is there such a thing as a ‘Hippocratic’ view on sense perception and cognition? Is it legitimate to discern a specifically ‘Hippocratic’ approach to the senses and cognition in the Greek medical and philosophical theories, as well as in the literary texts, of the 5th and early 4th c. BCE?1 In this chapter I seek to address the many difficulties one must confront in any attempt to answer such a question, by examining as exhaustively as possible the manner in which (the so-called) ‘Presocratic’ and (the so-called) ‘Hippocratic’ authors dealt with issues of perception and cognition in the light of man’s constitution as ‘living matter’. The questions I address are when, in which theoretical contexts, and eventually through which intellectual processes could humans, endowed with psychic functions, first be conceived of, and represented, as a ‘perceiving

*  I would like to thank Amneris Roselli, Manfred Horstmanshoff, Hans Haak, and Hélène Cazes for reading and commenting on an earlier version of this chapter. I am, of course, solely responsible for any remaining faults or mistakes. 1  A history of the scholarship on the existence of an authentically ‘Hippocratic’ group of treatises within the Hippocratic collection would far exceed the limits of a footnote. I limit myself to a few contributions that remain cornerstones of scholarship for the last forty years, beginning with Jouanna’s and Grensemann’s pioneering investigations on the existence of two different medical schools (in Cos and Cnidos) and the specificity of the Cnidian school: see Jouanna 1974 and Grensemann 1975. On the (presumed) opposition between Coan and Cnidians see also Thivel 1981. On the features shared by the gynecological treatises see Grensemann 1982 and 1987. On the cluster of clinical works collected under the name Epid. see Langholf 1990 and 2004, for an attempt to classify the treatises included in the CH according to both linguistic and rhetorical/pragmatic criteria.

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body’—i.e., a complex and nonetheless coherent perceptual, cognitive, as well as biological, unity.2 Anyone who intends to shed light on the cluster of theories and assumptions about cognition put forward in the CH is faced with a remarkable and in some respects discouraging variety of positions. We find some more or less explicit claims of the centrality of the brain3 (paradigmatic in this connection is On the Sacred Disease’s doctrine, where, interestingly enough, the word psyche does not appear at all) as well as, and sometimes in opposition to, explicitly psycho- and haematocentric views (such views are exemplified, respectively, by the first and fourth book of On Regimen and by On Breaths, where blood is assumed to be the seat of cognition as its alterations seem to cause psyche and thoughts in it to change),4 and we are certainly in no position to say that one theory is in principle more ‘Hippocratic’ than the others. Furthermore, it is characteristic of the treatises where these contrasting positions are expounded to substantiate their respective arguments by employing very different rhetorical strategies, and to achieve widely varying levels of conceptualization and expositive coherence.5 On the other hand, many of those theories of cognition that we usually and without distinction label as ‘Hippocratic’ as a consequence of their being 2  On the emergence of the ‘subject’ in the medical thought of the classical age see Holmes 2010, 121–191. 3  A group of treatises among those included in the CH seem to share a common representation of the physiology of the brain. These treatises (which include Gland., Loc. Hom. and Sarc.) conceive the brain as a bodily structure endowed with cavities and the function of purifying the body from any excess of humors (especially of phlegm): see Gland. 10 and 11 (respectively, 118.14 and 118.23 Joly = 8.564 L); Carn. 10 (198.6 Joly = 8.604 L); Loc.Hom. 1 (38.16 Joly = 6.276 L), 2 (40.8 Joly = 6.280 L), 3 (41.11 Joly = 6.280 L). On the account of the physiology of the brain that we find in Loc. Hom. see Craik 1998, 106–114. 4  Vict.’s theory of intelligence is discussed in section 2 of this chapter. For the views expressed by the author of Flat. see especially ch. 14 (121.9 Jouanna = 6.110 L): ἡγέομαι οὐδὲν ἔμπροσθεν οὐδενὶ εἶναι μᾶλλον τῶν ἐν τῷ σώματι συμβαλλομένων ἐϛ φρόνησιν ἢ τὸ αἷμα. Τοῦτο δ ̓ ὅταν μὲν ἐν τῷ καθεστεῶτι μένῃ, μένει καὶ ἡ φρόνησιϛ· ἑτεροιουμένου δὲ τοῦ αἵματοϛ, μεταπίπτει καὶ ἡ φρόνησιϛ. Cf. Morb. 1.34 (92.7 Wittern = 6.204 L)· παραφρονέουσιν ἐν τῇ νούσῳ διὰ παντὸϛ ἅτε τοῦ αἵματοϛ ἐφθαρμένου τε καὶ κεκινημένου οὐ τὴν ἐωθυῖαν κίνησιν. See Jouanna 1988, 37–38; van der Eijk 2005, 132–133; Lo Presti 2008, 92–99. 5  Geoffrey Lloyd has widely studied the rhetorical aspects of the medical literature in the age of Hippocrates: see Lloyd 1979, 1983, 1990. See also Thomas 1993, 225–244; van der Eijk 1997, 77–130; Langholf 2004. For remarks on the rhetorical structure of single treatises see among the others: Laskaris 2002, 73–124 (Sac. Morb.); Jouanna 1988, 10–24 (Flat.); Jouanna 1988, 167–174, and Jori 1996, 289–306 and 359–416 (de Arte); Stover 2005, 345–362 (Prorrh. 2); Pérez Cañizares 2005, 363–370 (Int.).

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included in the same corpus of texts seem, in spite of their differences with each other, to share standpoints, theoretical assumptions and epistemological approaches with some of the early philosophical investigations into nature, the nature of man and the rise of thought and understanding carried out by the so-called ‘Presocratic’ thinkers. Sometimes one has the impression that these commonalities result from this or that medical author simply drawing concepts and theoretical patterns from earlier or contemporary physiologoi in order to better arrange an apology for the medical art (this is perhaps the case of the author of On Breaths), or that they result from some ‘Hippocratic’ treatise being the expression of a cosmological-anthropological project with no necessary link with medical practice (as seems the case of the treatise On Fleshes). Other times, as I shall demonstrate, these commonalities seem to originate from a deeper and perhaps programmatic effort, on the side of the medical authors, to make issues and doctrines taken from the field of natural philosophy consistent with a medically oriented argumentative context. This effort, which often results in combining and rethinking the questions to be addressed and the answers to be put forward, must lead us to wonder whether a distinction between ‘medical’ and ‘philosophical’ theories of cognition was effectively claimed by the protagonists of the intellectual debate that flourished in Greece between the 5th and the early 4th c. BCE, and if so, in what terms and with what aims. In fact, several ‘Hippocratic’ doctors display clearly theoretical attitudes, e.g., the authors of On Regimen, On Fleshes, On the Nature of Man, On the Art and, in several respects, of On The Sacred Disease.6 On the other hand, we should not overlook the fact that medical issues were probably an integral part of many physiologiai and that some protagonists of the early investigation into nature used to practise medicine and were in fact celebrated as physicians (most notably perhaps Alcmaeon, Empedocles and Diogenes of Apollonia, but also Democritus seems to have had more than a superficial interest in medical matters);7 nor should we forget that the very term ‘Presocratic’ as a generalising category of philosophical historiography is quite controversial, so much so that its legitimacy has been long debated and its use even in recent times has given ample room for doubts and objections from scholars, objections that are 6  See van der Eijk 2005, 18–21 and 29–41. 7  For Alcmaeon’s medical interests see DK 24A 1, A 2; as regards Empedocles, see DK 31A 2. The scholarship on this topic is extremely vast and reflects a variety of positions. I limit myself to quote Mansfeld 1975, 26–38, and Zhmud 1997, 240 (on Alcmaeon); Sassi 1978, 181–184 (on Democritus); Lloyd 2006, 237–258 (on Diogenes). For further bibliography see Lo Presti 2008, 15–16.

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definitely not less strong than those raised about the use of the term ‘Hippocratic’.8 Finally, as Philip van der Eijk suggests in his chapter included in this volume,9 we should always keep well in mind that the CH is far from being comprehensive of all the medical knowledge and all the medical texts of the Classical Age. Much of that knowledge is in fact to be looked for in the writings of doctors and other intellectual figures whose interest in medical subjects is evident, even if their works were not included in the Hippocratic canon. Furthermore, their not being part of this canon does not imply at all that these texts could not share theories, doctrines and views with those treatises that happened to be included in the Corpus and thus canonized as ‘Hippocratic’. 2

Suspensions and Dispersions of the ‘Subject’: ‘Presocratics’ on Identity and Multiplicity

Gábor Betegh has recently pointed out that Presocratic accounts of psychic functions seem to conform to one of two different, and in many respects contrasting, models. Betegh defines them, respectively, as the ‘journey’ and the ‘portion’ model.10 Theories that follow the ‘journey model’ (e.g., Pythagoreanism 8   It is worth bearing in mind that the expression ‘Presocratic philosophy’ used to define a fixed period or a stage of the history of philosophy is a modern creation and was first used by J. A. Eberhard in 1788, as a title of a section of his handbook on the history of philosophy. Of course, in this it is substantially different from the category of ‘Hippocratic’, which is far more ancient and can be traced back to the Hellenistic age. The most significant positions that characterize the debate on the existence of a ‘Presocratic philosophy’ (or of ‘Presocratic philosophers’) are significantly reflected in the papers collected in Laks-Louguet 2002. See especially Laks’ contribution (17–38), Sassi’s (55–82), Lloyd’s (39–54), and Gemelli Marciano’s (83–114). While Lloyd argues for the fallacy of the label ‘Presocratics’ as an effective category of the philosophical historiography and emphasizes the plurality of intellectual enterprises in late-archaic and classical Greece, both Laks and Sassi aim at identifying commonalities and elements of coherence in early Greek philosophical discourse, and argue for coherence being the condition rather than the negation of the plurality and diversity of the philosophical discourse(s). 9  See also van der Eijk 2005, 21–29. 10  See Betegh 2006, 29–32. The question, however central, of the materiality or immateriality of the specific stuff endowed with psychic function is not strictly relevant to the definition of these two models. While, in general terms, it has been maintained that the Presocratic psychological theories are predominantly physicalist (see Barnes 1982, 472– 477, Wright 1990, Gill 2001, 169–172), even the admission of some form of substance dualism as characteristic of some ‘Presocratic’ theories would not compromise the coherence and the explicatory efficaciousness of Betegh’s interpretative pattern. As he points out in

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and in many respects Orphism, but also the traditional Homeric representations of psyche) treat soul, seen as the cognitive agent par excellence, as an entity that departs from the body after the death of the human being and retains its identity throughout its cosmic migrations. By contrast, theories informed by the ‘portion model’ (e.g., Heraclitus’, Diogenes’, and Empedocles’) postulate that the soul, or whatever other thing is said to carry out the psychic functions of a human being, is just a portion of one or more specific materials that also have cosmic functions. A perfect example of this attitude of mind is provided by Heraclitus, B36: ‘For souls it is death to become water, for water it is death to become earth, from earth water becomes, from water soul’ (ψυχῇσιν θάνατοϛ ὕδωρ γενέσθαι, ὕδατι δὲ θάνατοϛ γῆν γενέσθαι, ἐκ γῆϛ δὲ ὕδωρ γίνεται, ἐξ ὕδατοϛ δὲ ψυχή),11 and A16 (Sext. Adv. Math. 7.129): ‘According to Heraclitus, we become intelligent (νοεροί) by drawing in these divine logos through breathing, and forgetful when asleep, but we regain our senses when we wake up again’.12 But Sextus’ testimony is important also as it reconstructs the rationale behind the link that Heraclitus establishes between being asleep and being unconscious, on the one hand, and between being awake and being conscious, on the other: For in sleep, when the channels of perception are shut, our mind is sundered from its kinship with the surrounding (τῆϛ πρὸϛ τὸ περιέχον συμφυΐαϛ ὁ ἐν ἡμῖν νοῦϛ), and breathing is the only point of attachment to be preserved, like a kind of root; being sundered, our mind casts off its former power of memory (μνημονικὴν δύναμιν). But in the waking state it again peeps out through the channels of perception as though through a kind of window, and meeting with the surrounding (τῷ περιέχοντι συμβαλὼν) it puts on its power of reason (λογικὴν ἐνδύεται δύναμιν).13

relation to the portion model, ‘the criterion is not the metaphysical status of the bearer of psychic functions, but the fact that the stuff responsible for psychic functions in human beings has cosmological roles as well’. 11  This passage and, in the light of it, Heraclitus’s whole theory of the soul have been widely analyzed by Schofield 1991. 12  DK 22A 16 (Sext. Adv. Math. 7.129): τοῦτον οὖν τὸν θεῖον λόγον καθ ̓ Η ̔ ράκλειτον δι ̓ ἀναπνοῆϛ σπάσαντεϛ νοεροὶ γινόμεθα, καὶ ἐν μὲν ὕπνοιϛ ληθαῖοι, κατὰ δὲ ἔγερσιν πάλιν ἔμφρονεϛ. 13  ἐν γὰρ τοῖϛ ὕπνοιϛ μυσάντων τῶν αἰσθητικῶν πόρων χωρίζεται τῆϛ πρὸϛ τὸ περιέχον συμφυΐαϛ ὁ ἐν ἡμῖν νοῦϛ, μόνηϛ τῆϛ κατὰ ἀναπνοὴν προσφύσεωϛ σῳζομένηϛ οἱονεί τινοϛ ῥίζηϛ, χωρισθείϛ τε ἀποβάλλει ἣν πρότερον εἶχε μνημονικὴν δύναμιν. ἐν δὲ ἐγρηγόρσει πάλιν διὰ τῶν αἰσθητικῶν πόρων ὥσπερ διά τινων θυρίδων προκύψαϛ καὶ τῷ περιέχοντι συμβαλὼν λογικὴν ἐνδύεται δύναμιν.

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Aristotle had already remarked in his criticism of earlier psychological theories in De Anima 1.5 that as a consequence of its being so strictly related to and of its interacting with the other constituents of the world, ‘psychic matter’ would be in this case deprived of any individual identity, and it could not provide a persistent unity, a fixed core, which is able to carry responsibility and memory.14 This is exactly the case of (what we can reconstruct of) Heraclitus’s theory of consciousness/unconsciousness and memory as reported by Sextus. To quote Betegh, while the journey model ‘takes the self-identity of the soul for granted but then is unable to analyse the soul in relation to the world’ and, perhaps more importantly, is totally uninterested in identifying any kind of link between the soul and the body, the portion model ‘can give an account of how ‘psychic matter’ interacts with the other constituents of the cosmos, but is unable to explain the unity and self-identity of the individual soul’.15 Indicative of this inability are also, to my eyes, Empedocles’ views on sense perception and cognition, which belong entirely within the ‘portion model’. As we know, Empedocles conceives reality as a sort of pan-aesthetic whole, where he puts aisthesis and phronesis—that is, ‘perceiving’ and ‘thinking’— and each entity endowed with aisthesis into a hierarchical scale ordered only by the criterion of the more or less tempered krasis of the four elementary roots,16 which, according to Empedocles, all things consist of.17 Furthermore, Empedocles looks at perception as a holo-somatic activity resulting from inter similia contacts and, therefore, coherently localizes the seat of thinking in the blood, as he does not think it possible to find so homogeneous and balanced a mixture of the four elements in any other part of the body.18 At the very 14  See Aristot. An. 1.5, 409b1–411b31. 15  Betegh 2006, 35. 16  See DK 31B 103, τῇδε μὲν οὖν ἰότητι Τύχηϛ πεφρόνηκεν ἅπαντα; Β107, ἐκ τούτων γὰρ πάντα πεπήγασιν ἁρμοσθέντα καὶ τούτοιϛ φρονέουσι καὶ ἥδοντ ̓ ἠδ ̓ ἀνιῶνται; B110, πάντα γὰρ ἴσθι φρόνησιν ἔχειν καὶ νώματοϛ αἶσαν. A detailed (and critical) account of these aspects of Empedocles’ doctrine is to be found in Theophrastus’ Sens., chs. 11–12 (74–76 Stratton). Especially in ch. 12, Theophrastus remarks that, according to Empedocles’ theory, πάντα τε αἰσθήσεται καὶ ταὐτὸν ἔσται μῖξιϛ καὶ αἴσθησιϛ καὶ αὔξησιϛ· πάντα γὰρ ποιεῖ τῇ συμμετρίᾳ τῶν πόρων, ἐὰν μὴ προσθῇ τινα διαφοράν. For a critical survey of the matter see Sassi 1978, 24–26; Laks 1999, 258; Lo Presti 2008, 30–39. 17  See DK 31A 21, 24, 28, 28a, 30, 33, 46; see also DK 31B 6. Of special relevance is A28 (Aristot. Metaph. 1.3, 984 a 8): τά τέτταρα πρὸϛ τοῖϛ εἰρημένοιϛ γῆν προσθεῖϛ τέταρτον· ταῦτα γὰρ ἀεὶ διαμένειν καὶ οὐ γίγνεσθαι ἀλλ ̓ ἢ πλήθει καὶ ὀλιγότητι συγκρινόμενα καὶ διακρινόμενα εἰϛ ἕν τε καὶ ἐξ ἑνόϛ. See Giannantoni 1997, 235–255. 18  DK 31B 105: Αἵματοϛ ἐν πελάγεσσι τετραμμένα ἀντιθορόντοϛ. Τῇ τε νόημα μάλιστα κικλή�́ σκεται ἀνθρώποισιν· αἷμα γὰρ ἀνθρώποιϛ περικάρδιόν ἐστι νόημα.

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same time, Empedocles admits that each region of the body can participate in phronesis in different ways, in proportion to the balance or lack of balance of the elements occurring in that specific part of the body. This would explain, for example, why some can attain excellence in oratory eloquence while others are endowed with manual and technical skills: as reported by Theophrastus in De sensibus 11, ‘In one case the happy mixture is presumed to be in the tongue, in the other it is in the hands. And the like holds true for all the other forms of ability’.19 Now, Empedocles’ efforts to account both for the human body as a living unity within a broader cosmic life and for the ‘subject’ as an intricate aggregate of different abilities, perceptual and cognitive functions eventually result in an idea of the body that I would formulate as follows: a physical space within which a complex of biological, perceptual and cognitive events occur while remaining somewhat extrinsic to the very morpho- and onto-genetic processes through which matter gradually forms into an individual body. This is proved by the fact that different abilities are located in various parts of the body in consequence of the happy mixture of the four elements attained by that specific part and not by the body as a whole. When focusing on another ‘Presocratic’ thinker with clear medical interests such as Diogenes of Apollonia, we deal with problems of a similar kind. Diogenes identifies psyche with the air and it is in fact in the air that he locates the seat and the cause of intelligence (noesis) in man. Furthermore, he states that each living being (men, animals, plants) is endowed with noesis in even greatly different degrees according both to the quality of the air inspired and to its own physical conformation (DK 64B 5).20 This, on the one hand, makes Diogenes’s thought noteworthy, as it implies the existence of a link between life and thinking and allows a differentiation between aisthesis and noesis as well as a description and an explanation of the differences between living beings and of the inhomogeneous degrees of participation of men to the universal noesis. On the other hand, in Diogenes’s theoretical framework, the 19  Thphr. Sens. 11 (74 Stratton): οἷϛ δὲ καθ ̓ ἕν καθ ̓ ἕν τι μόριον ἡ μέση κρᾶσίϛ ἐστι, ταύτῃ σοφοὺϛ ἑκάστουϛ εἶναι· διὸ τοὺϛ μὲν ῥήτοραϛ ἀγαθοὺϛ, τοὺϛ δὲ τεχνίταϛ, ὡϛ τοῖϛ μὲν ἐν ταῖϛ χερσὶ, τοῖϛ δὲ ἐν τῇ γλώττῃ τὴν κρᾶσιν οὖσαν· ὁμοίωϛ δὲ ἔχειν καὶ κατὰ τὰϛ ἄλλαϛ δυνάμειϛ. 20  ὅμοιον δὲ τοῦτο τὸ θερμὸν οὐδενὸϛ τῶν ζῴων ἐστίν (ἐπεὶ οὐδὲ τῶν ἀνθρώπων ἀλλήλοιϛ), ἀλλὰ διαφέρει μέγα μὲν οὔ, ἀλλ ̓ ὥστε παραπλήσια εἶναι. Οὐ μέντοι ἀτρεκέωϛ γε ὅμοιον οὐδὲν οἷόν τε γενέσθαι τῶν ἑτεροιουμένων ἕτερον τῷ ἑτέρῳ, πρὶν τὸ αὐτὸ γένηται. ἅτε οὖν πολυτρόπου ἐούσηϛ τῆϛ ἑτεροιώσιοϛ πολύτροπα καὶ τὰ ζῷα καὶ πολλὰ καὶ οὔτε ἰδέαν ἀλλήλοιϛ ἐοικότα οὔτε δίαιταν οὔτε νόησιν ὑπὸ τοῦ πλήθεοϛ τῶν ἑτεροιώσεων. ὅμωϛ δὲ πάντα τῷ αὐτῷ καὶ ζῇ καὶ ὁρᾷ καὶ ἀκούει, καὶ τὴν ἄλλην νόησιν ἔχει ἀπὸ τοῦ αὐτοῦ πάντα.

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structure of the bodies serves as necessary material precondition in order to the air make effective its noetic potential. But the very process of actualization of this potential remains somewhat extrinsic to the bodily processes, in that the body (or parts of it) is represented not as the subject or the seat of thinking (which is in any case the air) but as a sort of theatre in which the air can fully display its own cognitive power.21 Moreover, even in ‘portion’ theories, the way in which ‘psychic matter’ interacts with the other constituents of the cosmos is not self-evident. Ancient theories of cognition that result from a ‘physical’, that is integrally material, explanatory pattern imply a relationship of the perceiving matter both with the inside of one’s body and with the outside world, which is expected to produce definite images and/or awareness of the internal states of the body as well as of its environmental context. This interplay between ‘inside’ and ‘outside’ seen both as spatial and as ontological and phenomenological in nature leaves, however, somewhat unresolved the problem of what position the ‘thinking’ and ‘perceiving’ matter—i.e., any physical element or elements that Presocratic thinkers may have represented as endowed with cognitive faculties—holds in physiology and cosmology. 3

Shifting from Multiplicity to Differentiation: On Regimen’s Theory of Intelligence

As Jacques Jouanna has lucidly argued,22 Empedocles’ views on phronesis show remarkable similarities and points of contact with the theory of intelligence (phronesis) outlined in a dedicated section (chs. 35–36) of the first book of the Hippocratic On Regimen,23 similarities that seem to testify to Empedocles’ direct influence on this medical author.24 As is well known, On Regimen is the Hippocratic medical text for which the most diverse influences from, or analogies with, early philosophical inquiries have been traced by a large number of scholars, and whose main medical interest has been questioned many times.25 One of the main subjects on which 21  For a wider analysis of Diogenes’ theory of psychic functions see Lo Presti 2008, 48–54. 22  See Jouanna 1966, 15–18, and 2007, 9–38. 23  Vict. 1.35–36 (150.29–156.32 Joly CMG = 6.512–524 L). 24  On the presence of Empedocles in the ‘Hippocratic’ Corpus see Jouanna 1961, 452–463. 25  See Jouanna 2007, 9–38. See also Joly 2003, 25–34; Vegetti 1976, 496 n.10. On the NearEastern background of the theory of sleep and dreams expounded in Vict. 4, see van der Eijk 2004, 187–218.

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the first book of On Regimen focuses concerns the status of psyche, which is described in exclusively physical terms as a material substance consisting in a more or less balanced mixture of a hot and dry element and a cold and wet one.26 Moreover, psyche is referred to both as air, which all animals breathe, and as seed (sperma), thus resulting in an overall generating principle related both to the ontological definition of man—as he breathes, man is a living being—and to his embryonic formation, since this psychic substance plays a pivotal role in the development of the body from the embryo to the child.27 Furthermore, the author of On Regimen makes psyche the centre of phronesis, in other words the actual agent of sense perception and cognition in man. It is thanks to a complex system of ‘revolutions’, that is of circular motions occurring inside the body, that psyche accomplishes its physiological as well as its cognitive duties, as in their unceasing circulation psychic particles precipitate themselves toward—and thus mingle with—perceptible particles (αἰσθήσιεϛ) which are said to penetrate into the body through specific configurations defined as σχήματα αἰσθήσεων in ch. 23.28 According to the different proportions in which the two elements are mingled, seven different typologies of psyche can be identified, each of them showing distinctive intellectual and temperamental features (On Regimen 1.35). The one composed of the moister fire and the dryer water is the perfect, that is the most balanced, form of intelligence. Different degrees of predominance of water give rise to lesser and slower forms of intelligence down to the condition that Jouanna (1966, xvi) has defined as ‘folie dépressive’ (On Regimen 1.35.7: τούτουϛ ἤδη οἱ μὲν ἄφροναϛ ὀνομάζουσιν, οἱ δὲ ἐμβροντήτουı); on the other hand, different degrees of predominance of fire give rise to quicker kinds of psychai, which however are characterized by increasing instability. This instability, in its extreme manifestations, results in a sort of hallucinatory madness (subjects endowed with this form of intelligence are defined as ὑπομαινόμενοι by the author of On Regimen). The most 26  Vict. 1.6 (128.24 Joly CMG = 6.478 L): Τὰ δὲ ἄλλα πάντα, καὶ ψυχὴ ἀνθρώπου, καὶ σῶμα ὁποῖον ἡ ψυχὴ, διακοσμεῖται. ἐσέρπει δὲ ἐϛ ἄνθρωπον μέρεα μερέων, ὅλα ὅλων, ἔχοντα σύγκρησιν πυρὸϛ καὶ ὕδατοϛ, τὰ μὲν ληψόμενα, τὰ δὲ δώσοντα· καὶ τὰ μὲν λαμβάνοντα μεῖον ποιεῖ, τὰ δὲ διδόντα πλέον. 27  Vict. 1.7 (130.18 Joly CMG = 6.480 L): ἐσέρπει γὰρ ἐϛ ἄνθρωπον ψυχὴ πυρὸϛ καὶ ὕδατοϛ σύγκρησιν ἔχουσα, μοῖραν σώματοϛ ἀνθρώπου. Ταῦτα δὲ καὶ θήλεα καὶ ἄρσενα πολλὰ καὶ παντοῖα τρέφεταί τε καὶ αὔξεται διαίτῃ, τῇπερ ἄνθρωποϛ. ἀνάγκη δὲ τὰ μέρεα ἔχειν πάντα τὰ ἐσιόντα· οὗτινοϛ γὰρ μὴ ἐνείη μοῖρα ἐξ ἀρχῆϛ οὐκ ἂν αὐξηθείη οὔτε πολλῆϛ ἐπιούσηϛ τροφῆϛ οὔτε ὀλίγηϛ, οὐ γὰρ ἔχει τὸ προσαυξόμενον. ἔχον δὲ πάντα αὔξεται ἐν χώρῃ τῇ ἑωυτοῦ ἕκαστον τροφῆϛ ἐπιούσηϛ ἀπὸ ὕδατοϛ ξηροῦ καὶ πυρὸϛ ὑγροῦ, τὰ μὲν ἔσω βιαζομένηϛ, τὰ δὲ ἔξω. 28  Vict. 1.23 (140.17 Joly CMG = 6.494 L). On the notion of ‘perceptible particles’ as expressed by the plural αἰσθήσιεϛ in Vict. see Jouanna 2007, 19–25.

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striking point of contact between Empedocles’ and On Regimen’s theories of intelligence is to be traced to the fact that they share some lexical choices and explicative principles, especially as regards two intermediate forms of intelligence as described both in the ‘Hippocratic’ and in Empedocles’ account (the latter, reported in Theophrastus’ De sensibus 11,29 admits the existence of two intermediate forms of intelligence, while the author of On Regimen, as I have just shown, speaks of four intermediate grades of phronesis, along with two extreme grades and a central and perfectly balanced one). In both theories, these intermediate psychai obey a sort of law of compensation: a fault of intelligence, la lenteur d’esprit, is counterbalanced by a temperamental feature such as firmness; by contrast, distinctive qualities such as rapidity and vividness (cf. On Regimen 35: διὰ ταχύτητα of the revolution of the soul; Theophrastus De Sensu 11: διὰ τὴν ὀξύτητα τῆϛ τοῦ αἵματοϛ φορᾶϛ), which connote the cognitive activity in a positive way, can result in a fault of character like inconstancy. This has enabled Jouanna to conclude that: Empédocle déjà—et probablement plus que nous le dit Théophraste— faisait intervenir la vitesse d’une révolution à l’intérieur du corps pour expliquer les diverses catégories d’intelligence. Toutefois, par rapport à Empédocle, la théorie du Régime comporte une transposition historiquement importante. Il ne s’agit plus de la circulation du sang, mais de la révolution de l’âme.30 It is not only the shift from blood to soul, however, that marks originality and specificity in the medical theory of intelligence expounded in On Regimen, 29  Thphr. Sens. 11 (74 Stratton): ὅσοιϛ μὲν οὖν ἴσα καὶ παραπλήσια μέμεικται καὶ μὴ διὰ πολλοῦ μηδ᾿ αὖ μικρὰ μηδ᾿ ὑπερβάλλοντα τῷ μεγέθει, τούτουϛ φρονιμωτάτουϛ εἶναι καὶ κατὰ τὰϛ αἰσθήσειϛ ἀκριβεστάτουϛ, κατὰ λόγον δὲ καὶ τοὺϛ ἐγγυτάτω τούτων, ὅσοιϛ δ ̓ ἐναντίωϛ, ἀφρονεστάτουϛ, καὶ ὧν μὲν μανὰ καὶ ἀραιὰ κεῖται τὰ στοιχεῖα, νωθροὺϛ καὶ ἐπιπόνουϛ· ὧν δὲ πυκνὰ καὶ κατὰ μικρὰ τεθραυσμένα, τοὺϛ δὲ τοιούτουϛ ὀξεῖϛ φερομένουϛ καὶ πολλοῖϛ ἐπιβαλλομένουϛ ὀλίγα ἐπιτελεῖν διὰ τὴν ὀξύτητα τῆϛ τοῦ αἵματοϛ φορᾶϛ· οἷϛ δὲ καθ ̓ ἕν καθ ̓ ἕν τι μόριον ἡ μέση κρᾶσίϛ ἐστι, ταύτῃ σοφοὺϛ ἑκάστουϛ εἶναι· διὸ τοὺϛ μὲν ῥήτοραϛ ἀγαθοὺϛ, τοὺϛ δὲ τεχνίταϛ, ὡϛ τοῖϛ μὲν ἐν ταῖϛ χερσὶ, τοῖϛ δὲ ἐν τῇ γλώττῃ τὴν κρᾶσιν οὖσαν· ὁμοίωϛ δὲ ἔχειν καὶ κατὰ τὰϛ ἄλλαϛ δυνάμειϛ. For a detailed comparison between Theophrastus’ account of Empedocles’ theory of intelligence and the theory expounded in Vict. see Jouanna 2007, 27–31. 30  Jouanna 1966, 17. In his more recent contribution Jouanna (2007, 31) has slightly modified his view, setting forth that ‘il ne s’agit pas seulement de la circulation du sang, mais aussi de la révolution de l’âme’. Jouanna does not rule out that in Vict.’s theoretical framework the revolution of the soul may coincide with the ‘circulation’ of blood; what he aims to emphasize is in fact the link between Empedocles and Plato’s Ti. made by Vict.’s theory of intelligence. See also Joly 1960, 88; Hüffmeier 1961, 51–84; Byl 2002, 218–219.

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since many other ‘Presocratic’ accounts (Heraclitus’ for instance) maintain the notion of psyche as a key notion. Rather, this theory goes farther and deeper in an attempt to define the body as a biological and cognitive agent. What to my eyes marks a visible rupture between this account of cognition and Empedocles’ is the attempt by the author of On Regimen to trace a principium individuationis that makes it possible to account for the rise of perception and that of intelligence consistently and conjointly. Now, this principle of individuation rests in the soma rather than in the psyche, surprising though it may seem: notwithstanding that phronesis is said to be exclusively a faculty or an activity of the soul, the soul is in fact looked at, and explicitly defined as, an actual part of the body, μοῖρα τοῦ σώματος (ch. 7). The intrinsic nature of each of the types of phronesis differentiates according to a combination and proportion of elements by which the entire body, no part of it being excepted, is affected and to which each of these parts somehow responds. This being the scheme of things, we can say that On Regimen’s theory of intelligence does not admit, or simply disregards, the possibility that various qualities of thinking, as well as a diverse range of temperamental features, thrive in different parts of the same body. It is true that a substantial variety of characters exists, and that the intelligence of the soul changes as the mixture of elementary constituents changes. However, what does not change at any stage of differentiation is the soul’s power to ‘express’ or, rather, to ‘correspond’ to the system of physiological processes which soul is embodied in. This centrality of the body, so strongly affirmed, enables individualization of the person and differentiation of abilities in body parts to be accounted for conjointly as the two opposite and complementary poles of the physiological and cognitive life of the human body, and also to account for the differentiation of faculties as immanent in, rather than a negation or a reduction of, the coherence of the body. 4

Localization as a Key to Complexity: On the Sacred Disease’s Encephalocentrism

Moving on to On the Sacred Disease’s theory of cognition, the core of which we find in chs. 16–17 of the treatise, we find a new epistemological shift, this time from psyche to the brain, which is even richer in implications than that from blood to psyche. First of all, let us consider ch. 16: For these reasons I believe that the brain is the most powerful part in a human being. So long as it is healthy (ἢν ὑγιαίνων τυγχάνη), it is the hermeneus of what comes to the body from the air (οὗτοϛ γὰρ ἡμῖν ἐστι τῶν ἀπὸ τοῦ ἠέροϛ γινομένων ἑρμηνεύϛ). Consciousness is provided by the air

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(τὴν δὲ φρόνησιν αὐτῷ ὁ ἀὴρ παρέχεται). The eyes, tongue, hands and feet carry out what the brain knows (οἱ δ ὀ̓ φθαλμοὶ καὶ τὰ ὦτα καὶ ἡ γλῶσσα καὶ αἱ χεῖρεϛ καὶ οἱ πόδεϛ οἷα ἂν ὁ ἐγκέφαλοϛ γινώσκῃ, τοιαῦτα πρήσσουσι), for throughout the body there is a degree of consciousness proportionate to the amount of air which it receives (γίνεται γὰρ ἐν ἅπαντι τῷ σώματι τῆϛ φρονήσιοϛ, τέωϛ ἂν μετέχῃ τοῦ ἠέροϛ). As far as understanding is concerned, the brain is also the part that transmits this (ἐϛ δὲ τὴν σύνεσιν ὁ ἐγκέφαλόϛ ἐστιν ὁ διαγγέλλων), for when a man draws in a breath it first arrives at the brain, and from there it is distributed over the rest of the body, having left behind in the brain its best portion (ἀκμὴν) and whatever contains consciousness and thought (φρόνιμόν τε καὶ γνώμην ἔχον). For if the air went first to the body and subsequently to the brain, the power of discerning thinking would be left to the flesh and to the blood vessels; it would reach the brain in a hot and no longer pure state but mixed with moisture from the flesh and from the blood so that it would no longer be accurate. I therefore state that the brain is the hermeneus of consciousness.31 The apology for the brain, and the consequent total or partial rejection of heart, phrenes or any other part of the body as ruling centres of perceiving and thinking is not at all unheard of in early Greek thought—a passage of Plato’s Phaedo (96a–b) provides us with clear evidence of this. In fact, such an encephalocentric standpoint represents a substantial point of contact between this medical author and thinkers contemporary to him or slightly earlier, such as Alcmaeon, Anaxagoras and Democritus.32 Nevertheless, the radical absence of the concept of ‘soul’ in its sense of elementary and physical principle of life from the conceptual framework of On the Sacred Disease marks the originality of this encephalocentric view with respect to other accounts with which it otherwise shows affinities, and also draws not the only but perhaps one of the most remarkable distinctions between the argument of this treatise and that of On Regimen. It is not my intention, however, to put forward in this chapter an exhaustive and systematic account of On the Sacred Disease and its rationale.33 My scope is rather to excerpt some crucial points from it and to illuminate what seems to me a major though not yet clearly defined concept—i.e., localization as a key

31  Morb. Sacr. 16 (29.4 Jouanna = 6.390 L), tr. Jones, modified by van der Eijk. 32  See Lo Presti 2009, 9–30. 33  I gave such an account in Lo Presti 2008 (see especially ch. 5, 159–194).

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to complexity—as it stems from the theoretical and epistemological framework of this medical treatise. First of all, let me clarify why one should adopt two so strongly connoted notions as ‘localization’ and ‘complexity’ in order to account for On the Sacred Disease’s encephalocentric paradigm. As regards ‘localization’, it is the author who repeatedly describes the brain now as the seat or the reservoir (16: ἀὴρ καταλελοιπὼϛ ἐν τῷ ἐγκεφάλῳ. . .ὅ τι ἂν ᾖ φρόνιμόν τε καὶ γνώμην ἔχον), now as the main agent (16: τὸν ἐγκέφαλον δύναμιν ἔχειν πλείστην ἐν τῷ ἀνθρώπῳ), the hermeneus or the messenger (16: ἐϛ δὲ τὴν σύνεσιν ὁ ἐγκέφαλόϛ ἐστιν ὁ διαγγέλλων), and even as the ‘cause’ (17: ἁπάντων τούτων αἴτιοϛ ὁ ἐγκέφαλόϛ ἐστιν, said in relation to αἰσθάνεσθαι and φρόνησιϛ) of a number of cognitive activities ranging from sensation to comprehension, from perceiving to discerning thinking. These activities as well as the various roles played by the brain are not always perfectly distinguishable from each other, in part by reason of a certain interdependence admitted between them, in part because the author is unable or simply uninterested in defining them in a rigorous way, his scope being basically aetiological and polemical rather than theoretical.34 As for the notion of ‘complexity’, by this I intend to refer to a view of the body and its own biological status that includes and accounts both for the ‘outside/inside’ relationship between man’s individual body and the environment and for the two distinct but, as we will see, interconnected and cooperating morphogenetic processes of individualization of the person and differentiation of the faculties.35 Let us start off by asking what are these ‘things coming from air’ (τῶν ἀπὸ τοῦ ἠέροϛ γινομένων) that air leaves or is said to leave while passing through the brain. It is striking how rich is the repertory of terms and definitions by which the author qualifies human cognitive activity and refers to the substance(s) or entity(ies) having some active part in such activity. In the few lines of one chapter (16) he defines them as follows: ‘the best and most active part (of air), and whatever contains consciousness and thought’ (τὴν ἀκμὴν καὶ ὅ τι ἂν ᾖ φρόνιμόν τε καὶ γνώμην ἔχον); ‘consciousness’ (τὴν δὲ φρόνησιν αὐτῷ ὁ ἀὴρ παρέχεται); ‘comprehension’ (σύνεσιν); and, finally, ‘discernment’ (the author states that if air reached the brain after passing through the rest of body, but this is not the case, it would disperse the power of discerning, διάγνωσιν, in the flesh and the vessels). As a consequence of such a variety of terminological 34  On the polemical attitudes of the author of Morb. Sacr. see Laskaris 2002, whose emphasis on the ‘agonal’ features present in the treatise seems, however, excessive. 35  On the accounts (as found in the ‘Hippocratic’ Corpus) of the relationship inside/outside as a key to physiology see Lo Presti 2007, 139–144.

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choices (behind which there could be a variety of ‘things’ or of different aspects of the same ‘cognitively active substance’) one can have the impression—as many have had, in fact—that the brain is depicted here as a sort of reservoir where actual ‘contents’ and linguistically-shaped ‘information’ is collected and interpreted before being transmitted to the rest of the body.36 The idea that air is the source of perception and thinking and conveys somewhat knowable contents into the body (first passing through the brain) does not sound new to those who are familiar with Diogenes’ ‘theory’ of cognition. But, in spite of his clear adoption of terms and images that hint at thought and discernment as transmittable ‘contents’ with which air provides the body—which could well be consistent, for example, with Diogenes’ point—it seems to me that the medical author of On the Sacred Disease explains the rise of perception and cognition by describing the interaction between the air and the brain and between the latter and the rest of the body in new and unheard of terms: first, he attributes a physical function to the inhaled air; second, he endows the brain with a complex morphogenetic activity, which concerns both the formation of physical shapes and the rise of ‘sense’. The point I shall try to briefly illustrate in this paragraph is that, while adopting a theoretical pattern (air is the source of thought as well as of life) very popular in early Greek culture and especially among physiologoi, the author of On the Sacred Diseases addresses—or tries to address—in a different way the role played by the physiological processes in the actualization of ‘thought’ in a cognitive subject. In other terms, while he seems to take for granted the existence of ‘thought’, ‘discernment’, ‘consciousness’ as ‘things’ and ‘contents’ provided by the air (and in this respect he does not break with other thinkers contemporary or slightly antecedent to him), he is perhaps the first to pose and think about the question of the emergence of such ‘things’ in form of embodied features of a cognitive subject, that is in form of ‘sense’. In this regard, it is of the greatest importance to establish what the hermeneutic function with which the brain is endowed actually represents in On the Sacred Disease’s theoretical framework, as I am not sure we can limit to describe it as an interpretation of ‘linguistically-shaped’ contents (I am not skeptical about ‘contents’, but about their being ‘linguistically-shaped’). I am arguing that the enkephalos-hermeneus does not merely play the role of reception and transmission of preformed knowledge, but performs a morphogenesis of sense, which implies, primarily on a physiological level and thus on a semantic one, ruptures of continuity and the formation of a system of differentiated 36  I have widely discussed all the implications of this sort of ‘cognitivist’ reading of Morb. Sacr.’s theory of cognition in Lo Presti 2008, 101–129 (with bibliography).

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and reciprocally alternating shapes, whose changes are strictly oriented by and bound to the environmental events, such changes being directly caused by the transformative influence that only the best portion of the air is able to exert over man’s body, once it has been breathed in and ‘filtered’ in the brain. But let us look more in detail at the brain’s activity. In Sacred Disease 17, we find a passage in which it is plainly set forth that cognitive and physiological processes are strictly correlated with each other, and that the brain is the first to perceive phronesis from the air (τῆϛ φρονήσιοϛ τοῦ ἠέροϛ πρῶτοϛ αἰσθάνεται τῶν ἐν τῷ σώματι ἐόντων), but also the first to perceive any kind of violent alteration occurring in the air as a consequence of seasonal changes of wind.37 Now, what I would like to define as the ‘physical function’ of the air depends on these alterations and changes of wind, as the argument put forward in Sacred Disease 13 (23.6—25.11 Jouanna = 6.384.4–386.14 L), makes clear. Here, we find a detailed account of both the properties of winds and the influence that each wind exerts on the brain and the other natural shapes. Winds blowing from the north are said to be cold and dry, and to compact and purify everything from wetness and turbidity (ὁ μὲν γὰρ βορέηϛ ξυνίστησι τὸν ἠέρα καὶ τὸ θολερόν τε καὶ τὸ νοτῶδεϛ ἐκκρίνει καὶ λαμπρόν τε καὶ διαφανέα ποιεῖ), while winds from the south do the opposite (ὁ δὲ νότοϛ τἀντία τούτῳ ἐργάζεται), and cause shapes to loosen and liquefy and to fill with wet, warm and impure matter.38 Such a phenomenon is said to happen both inside and outside the human body, both in living beings and in inert shapes.39 This natural and cyclical process of compaction/secretion and loosening/liquefaction has its counterpart in the brain. This is, in fact, the first part of the body to conform its own shape to the transformative process occurring in nature by activating an internal morphogenesis. If the brain is in good health, the passage from thickening to loosening and vice versa keeps within defined bounds, so providing the best conditions for perceiving and thinking.40 Otherwise, the alteration of a regular

37  31.10 Jouanna = 6.394 L: οὕτω καὶ ἤν τιϛ μεταβολὴ ἰσχυρὴ γένηται ἐν τῷ ἠέρι ὑπὸ τῶν ὡρέων καὶ αὐτὸϛ ἑωυτοῦ διάφοροϛ γένηται ὁ ἐγκέφαλοϛ πρῶτοϛ αἰσθάνεται. 38  23.18 Jouanna = 6.384 L: πρῶτον μὲν γὰρ ἄρχεται τὸν ἠέρα συνεστηκότα κατατήκειν καὶ διαχεῖν. . .ἅπαντα δὲ ταῦτα αἰσθάνεται τοῦ πνεύματοϛ τούτου, καὶ ἔκ τε λαμπρῶν δνοφώδεα γίνεται καὶ ἐκ ψυχρῶν θερμά, καὶ ἐκ ξηρῶν νοτώδεα. 39  24.5 Jouanna = 6.384 L: τὸ δ ̓ αὐτὸ τοῦτο καὶ τὴν γῆν ἐργάζεται καὶ τὴν θάλασσαν καὶ ποταμοὺϛ καὶ κρήναϛ καὶ φρέατα καὶ ὅσα φύεται. . .ὅσα τε ἐν οἰκήμασι κεράμεα. . .τόν τε ἥλιον καὶ τὴν σελήνην καὶ τἆλλα ἄστρα πολὺ ἀμβλυωπότερα καθίστησι τῆϛ φύσιοϛ. 40  25.1 Jouanna = 6.386 L: ἐν τῶν ἀνέμων τούτων τῇσι μεταλλαγῇσιν ἀνάγκη τοῖσι μὲν νοτίοισι λύεσθαί τε καὶ φλυδᾶν τὸν ἐγκέφαλον καὶ τὰϛ φλέβαϛ χαλαρωτέραϛ γίνεσθαι, τοῖσι δὲ βορείοισι συνίστασθαι τὸ ὑγιηρότατον τοῦ ἐγκεφάλου.

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process of morphogenesis results in a pathological flow of humours towards vessels, organs and limbs.41 This account has its most interesting feature in that it develops the traditional idea according to which the outside world exerts its influence on, or even rules over, the internal states of the body. The author of On the Sacred Disease substantially modifies this paradigm by presenting a dynamical representation of the inside/outside interaction as the result of a chain of common and homogeneous transformations involving the human body (and especially the brain) and its physical surroundings simultaneously. This is clearly expressed as regards the most violent climatic changes but must be true in proportion also in the case of minor metabolai, as the environment—as well as man, who is part of it—is represented as being involved in a continuous transformative process. In this sense, by making it effective inside the body, the physiology of the brain plays the role of the hermeneus of a wider system in which matter can experience transformation without each natural shape losing its own nature as an individualized and differentiated physical body. On the other hand, when considered in terms of semantics, the outcome of this morphogenetic/hermeneutic process consists of what the author defines as the arising of διάγνωσις and διάκρισις (in ch. 14, the author refers to man’s cognitive activities by using the verb διακρίνειν along with διαγινώσκειν, see 25.15 Jouanna: καὶ τούτῳ μάλιστα. . . διαγινώσκομεν. . .τὰ μὲν νόμῳ διακρίνοντεϛ),42 which are higher cognitive activities/faculties implying intelligence and discernment. In this connection, it is interesting to note the common derivation from κρίνω (‘to separate’, ‘to discern’) of words designating, respectively, the physiological phenomenon of secretion (ἔκ-κρισιϛ, ἀπό-κρισιϛ) and the cognitive one of discerning (διακρίνειν, which in many respects is synonymic of διαγινώσκειν). These are the reasons why, I think, we are allowed to refer to the

41  25.6 Jouanna; = 6.386 L: τὸ δὲ νοσερώτατον καὶ ὑγρότατον ἐκκρίνεσθαι καὶ περικλύζειν ἔξωθεν, καὶ οὕτω τοὺϛ καταρρόουϛ ἐπιγίνεσθαι ἐν τῇσι μεταβολῇσι τούτων τῶν πνευμάτων. Cf. Morb. Sacr. 10.2 (19.7 Jouanna = 6.378 L). 42  If διάγνωσιϛ occurs exclusively in ch. 16 to designate the cognitively active part of matter deposited in the brain, we have 4 passages where the verb διαγινώσκειν means ‘discerning’, ‘recognizing by operating a distinction’ (see Morb. Sacr. 14 twice, 18 twice). On the other hand, there are a number of occurrences of ἀποκρίνω and ἐκκρίνειν where they both designate the separation and secretion of humoral matter. For ἀποκρίνω see 10.2 (19.10 Jouanna), 10.4 (20.8 Jouanna), 18.1 (32.2 Jouanna); for ἐκκρίνειν see 11.2 (21.13 Jouanna), 13.2 (23.13, 15 Jouanna), 13.4 (25.6 Jouanna). On the semantic field of κρίνειν/κρίσις and its linguistic, cultural and ideological implications in ancient Greek culture see Nicosia 2000, 55–68.

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brain’s hermeneutic performance as a morphogenesis of sense, and to think of it in physical and thus naturalistic terms. Moreover, although ‘discerning thinking’ as well as ‘understanding’ (σύνεσιϛ) are located in the brain (but the brain functions both as the location of synesis and as the ‘origin’ from which understanding is transmitted to the rest of the body), the Hippocratic author also links these two aspects of cognitive life to another manifestation of it, like phronesis, that we might plausibly define as consciousness-like. As van der Eijk has pointed out, in fact, ‘in this context phronesis means ‘having one’s senses together’ and refers to a universal force by which a living being can focus on its surroundings and can undertake activities [. . .] Phronesis can be found throughout the body, whereas ‘understanding’ is restricted to the brain’.43 On the other hand, as concerns individualization and differentiation, there are deep traces in the text that these two concepts are interconnected. Both prove to be results of the morphogenetic process occurring in the brain, since both the stability of the cognitive subject and the structuring of the body as a coherent physiological whole (distinct from, but interrelated with, its physical context) depend on how effectively and appropriately phenomena of compaction and humoral secretion alternate with phenomena of loosening and liquefaction. There are different levels of analysis from which these concepts can be approached, since they recur in the text with respect to at least three different stages of the morphogenetic process. The first stage, which we might define as intra-somatic, concerns the shaping of the brain’s matter as an aspect of the overall process through which the body purifies itself and forms into a system of limbs while still an embryo.44 Failure of the brain to correctly constitute itself can produce, after birth, a diversity of bodily features and of proneness to epilepsy. This represents a second stage of individualization and differentiation, one which is very accurately accounted for in various sections of the treatise. Especially chs. 8–11 are rich in details concerning the different consequences of the diseases for adults and old people—which, according to the author, can prove fatal for the latter but not for the former—and concerning the modes of manifestation of the ‘attacks’ in children, since fluxes from the brain are said to become manifest through symptoms of different intensity and importance according as they are more or less copious, are provoked by winds

43  Van der Eijk 2005, 127. 44  See Morb. Sacr. 5 (12.21–14.2 Jouanna = 6.368–370 L).

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blowing from the north rather than from the south, occur in both sides of the body or just in one.45 But what is more striking is that, at some point in the author’s argument, both the category of ‘individualization’ of the perceiving subject and that of ‘differentiation’ of bodily functions come to be assumed as a key to the inside/ outside interaction between the body and its physical surroundings. This happens especially when the author points out (ch. 16) that the brain would not receive any kind of phronesis from the air and therefore would not be able to carry out its cognitive duties if air passed through the body before reaching the brain and left the power of discernment (diagnosis) in the fleshes and the vessels. The impossibility of carrying out its cognitive function would be caused by air mingling with the wet and warm matter of the body and loosing its pureness (οὐκ ἀκραιφνήϛ) and exactness (ὥστε μηκέτι εἶναι ἀκριβήϛ) before it reached the brain. As being the sole part deputed to interpret (hermeneuein)— which means to make visible and effective in the body46—the transformative morphogenesis occurring in the whole physical world, the brain is said to require air of the best quality, that is air whose properties are the purest and least contaminated by the matter and the physiology of the body. The continual reshaping of the brain—this is the author’s argument—binds the body to its physical context by means of a system of morphogenetic correspondences only insofar as the enkephalos is affected by the ‘otherness’ of the air breathed in from the outside world (this otherness of air being relative to the constitution and physiology of the body). Therefore, paradoxical though it may appear, a new epistemological scenario is drawn. The perception of difference starts to be seen from a double perspective: on the one hand, it is now conceived as the condition that must be satisfied in order for the body to form into a physiological and cognitive complex whole; on the other hand, the constitution of the body as a result of a combined process of individualization of the person and differentiation of parts and faculties somehow corresponds to the relationship between the inside and the outside world and, consequently, becomes a key to the dynamic pairing of bodies and surroundings within the overall coherence of matter.

45  See Morb. Sacr. 8 (16.24–17.4 Jouanna), 9 (18.5–19.3 Jouanna), 10 (19.7–14; 20.5–9; 20.18–21.5 Jouanna), 11 (21.6–15 Jouanna). 46  For a careful semantic analysis of the meanings of ἑρμηνεύειν in the classical age see Most 1986, 304–316.

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‘Hippocratics’ on the Suspension of the Senses. A ‘Negative Way’ to the Rise and Description of the Cognitive Subject

In the third and last part of this chapter I would like to pass a few remarks upon the notion of ‘having one’s senses together’, which could translate the Greek φρόνησις as we find it conceptualized in On the Sacred Disease’s theoretical framework.47 Actually, I do not intend to discuss it in its ‘positive’ formulation; instead, I would like to focus on its ‘negative’ counterpart, that is: what does it happen when one does not have his senses together or does not have them together yet or any more? And, how do the treatises included in the ‘Hippocratic’ canon describe and explain derangements and suspensions of one’s perceptual activity as well as the temporary or permanent loss of one’s sense of self and one’s awareness of the external world? In the fragments and testimonies at our disposal we find no evidence that any ‘Presocratic’ thinker has ever systematically dealt with, or could have been interested in dealing with, the phenomenology of anaisthesia in itself—that is, as a definite object of investigation48—while, on the other hand, many authors that we label as ‘Hippocratic’ effectively did. Indeed, in the latter texts we find many detailed descriptions of cases of ‘perception suspended’, because these cases were thought to have a significant clinical impact and to provide the physician with valuable diagnostic and prognostic information. I will therefore discuss some examples of such descriptions, where we find clear traces of an original insight into 1) the absence and the derangement of perception as forms of a cognitive and biological ‘regression’; 2) the connection between the physiopathology of perception, breathing, and the power of speech.

47  I thus agree with van der Eijk 2005, 127. 48  We find 4 occurrences of ἀναίσθητοϛ in Die Fragmente der Vorsokratiker: DK 85B 1 (ἢ γὰρ ἀναίσθητοϛ ἢ καρτερώτατόϛ ἐστιν, ὅστιϛ ἐξαμαρτάνειν ἑαυτὸν ἔτι παρέξει τοῖϛ βουλομένοιϛ καὶ τῆϛ ἑτέρων ἐπιβουλῆϛ τε καὶ κακίαϛ αὐτὸϛ ὑποσχήσει τὰϛ αἰτίαϛ), DK 68A 135, DK 31A 94 (in both these passages ἀναίσθητον occurs with the meaning of ‘not perceptible’ and is referred to the elementary constituents of things). Particularly interesting is a passage in the Anonymus Londinensis (DK 38A 10) on Hippon’s physiological doctrine: Ἱππων δὲ ὁ Κροτωνιάτηϛ οἴεται ἐν ἡμῖν οἰκείαν εἶναι ὑγρότητα, καθ ̓ ἣν καὶ αἰσθανόμεθα καὶ ᾗ ζῶμεν· ὅταν μὲν οὖν οἰκείωϛ ἔχῃ ἡ τοιαύτη ὑγρότηϛ, ὑγιαίνει τὸ ζῷον, ὅταν δὲ ἀναξηρανθῇ, ἀναισθητεῖ δὲ τὸ ζῷον καὶ ἀποθνῄσκει. Διὰ δὴ τοῦτο οἱ γέροντεϛ ξηροὶ καὶ ἀναίσθητοι, ὅτι χωρὶϛ ὑγρότητοϛ. In this case, the adjective ἀναίσθητοι and the verb ἀναισθητεῖ occur, respectively, with the meaning of ‘lacking of understanding’ and ‘to be incapable to comprehend’, providing evidence of a use which is not incomparable with that that we find in ‘Hippocratic’ context.

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Here is a first set of texts: Οἷσι δ ̓ ἅπαϛ ὁ πλεύμων φλεγμήνῃ μετὰ τῆϛ καρδίηϛ ὥστε καὶ προσπεσεῖν πρὸϛ τὴν πλευρήν, παραλύεται πᾶϛ ὁ νοσέων, καὶ κεῖται ψυχρὸϛ ὁ νοσέων ἀναίσθητοϛ· θνήσκει δὲ δευτεραῖοϛ ἢ τριταῖοϛ·

In cases where the whole lung is inflamed, together with the heart, so that they fall against the side, the patient is completely paralysed, and lies in his bed cold and insensible; he dies on the second or third day.50

Τῇ δ ̓ οὖν ἑπτακαιδεκάτῃ ἑσπέρηϛ ἀνακατεζόμενοϛ ἐϛ δίφρον ἠψύχησε· καὶ ἄφωνοϛ πολὺν χρόνον καὶ ἀναίσθητοϛ ἔκειτο.

Then on the seventeenth, in the evening, as he was getting up to sit on a chair, he fainted. He lay speechless for a long time, perceiving nothing.51

ἐν Ἡλιδι Τιμοκράτηϛ ἔπιε πλέον· μαινόμενοϛ δὲ ὑπὸ χολῆϛ μελαίνηϛ ἔπιε τὸ φάρμακον· οὗτοϛ ἐκαθήρθη τὸ κάθαρμα πολύ, φλέγμα τε καὶ χολὴν μέλαιναν· διίει διὰ ἡμέρηϛ· πρὸϛ δείλην ἐπαύσατο τῆϛ καθάρσιοϛ· καὶ πόνον ἐπόνησεν ἐν τῇ καθάρσει πολύν. Καὶ πιὼν ἄλφιτον ὕπνοϛ ἔλαβεν αὐτὸν καὶ εἶχε τὴν νύκτα μέχρι ἥλιοϛ ἀνεκὰϛ ἐγένετο· ἐν δὲ τῷ ὕπνῳ οὐκ ἐδόκει τοῖσι παρεοῦσιν ἀναπνεῖν οὐδὲν ἀλλὰ τεθνάναι, οὐδ ̓ ᾐσθάνετο οὐδενὸϛ οὔτε λόγου οὔτ ̓ ἔργου· ἐτάθη δὲ τὸ σῶμα καὶ ἐπάγη. ̓Εβίω δὲ καὶ ἐξήγρετο

In Elis, Timocrates drank too much and went insane from black bile. He took the drug and was purged. Much was purged from him: he produced phlegm and black bile throughout the day. Towards afternoon he stopped the purging. He had much pain in the purging. He drank barley broth; sleep took him and held him all night until the sun was high. In sleep he did not seem to those who were present to be breathing, but to have died. He perceived nothing, speech or action, and his body was stretched out and rigid. But he survived and waked up.52



A common element of these texts is that they describe derangements and interruptions of those faculties that allow a subject to interact with his immediate surroundings. In the first text (Coan Prenotions 2.395) the author reports an absence of sensitivity, a cooling of the limbs and immobility, that is, suspension of the motor functions; in the case of Polycrates (Epidemics 7.1), his being aphonos is given particular emphasis, so that the suspension or absence of phonation becomes part of what one might regard as a definition of the ‘lack 49  Coac. 2.395 (5.672 L), tr. Potter 2010, 201. 50  Epid. 7.1 (48.15 Jouanna = 5.366 L), tr. Smith 1994, 279. 51  Hp. Epid. 5.2 (p.2, 8 Jouanna; 5.204 Littré) (Tr. Smith 1994, 143).

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of consciousness’: ‘He lay for a long time, without voice and out of his senses (ἄφωνοϛ πολὺν χρόνον καὶ ἀναίσθητοϛ ἔκειτο)’. Another case in which anaisthesie and aphonie are associated is referred to in Epidemics 5.14 (9.7 Jouanna = 5.214 L): here the author describes the process of the cognitive decay of a patient who was near death: at first he showed signs of delirium (παρακόπτειν ἤρχετο), in the evening of the sixth day he lost the power of speech (πρὸϛ τὴν ἑσπέρην οὔτε ἐφθέγγετο), and became unable to perceive either erga or logoi around him (οὔτε ᾐσθάνετο οὔτε ἔργου οὔτε λόγου). There are other cases of sensation loss and cognitive decay described in the books of Epidemics and in other treatises. In Epidemics 7.5 we are told about a young boy whose feet became numb when he was very near death.52 Internal Affections 4853 informs us of patients suffering from a ‘thick’ disease, whose blindness can be diagnosed by verifying that they do not blink their eyes involuntarily as they normally should (the Greek verb that expresses this action is σκαρδαμύσσειν) in response to the physician bringing his finger nearer to them. By contrast, in two of the passages cited above (Epidemics 5.2 and 14), the loss of hearing is considered in relation to that peculiar percipiendum that is logos, i.e., language demanding attention as well as intentional and conscious participation from the hearer in making sense out of words.54 When suffering from loss or derangement of this faculty, a subject clearly loses one of the higher and most complex forms of interaction with his environment. The significance of the references to aphonie becomes clearer if seen in light of the control exerted by a subject on his surroundings, especially considering that these references may follow or be paired with descriptions of suspended or deranged hearing.55 Let us consider Epidemics 5.91 (41.4 Jouanna = 5.254 L; tr. Smith 1994, 199; parallel text Epidemics 7.100):

52  Epid. 7.5 (55.5 Jouanna = 5.376 L): Κατὰ τὸν τελευταῖον χρόνον, ποδῶν ἅψιοϛ οὐ πάνυ καταισθανόμενοϛ. 53  Int. 48 (6.230 Potter = 7.284 L): ἄλλο παχύ· γίνεται μὲν ἀπὸ χολῆϛ, ὅταν χολὴ ἐπὶ τὸ ἧπαρ ἐπιρρυῇ καὶ ἐϛ τὴν κεφαλὴν καταστῇ [. . .] καὶ αἱ κόραι σκίδνανται τῶν ὀφθαλμῶν, καὶ σκιαυγέει, καὶ ἢν προσφέρῃϛ τὸν δάκτυλον πρὸϛ τοὺϛ ὀφθαλμούϛ, οὐκ αἰσθήσεται διὰ τὸ μὴ ὁρᾶν· τούτῳ δ ̓ ἂν γνοίηϛ ὅτι οὐχ ὁρᾷ, οὐ γὰρ σκαρδαμύσσει προσφερομένου τοῦ δακτύλου. 54  See Ferrari 1997, 1104. 55  Cf. Epid. 5.60 (27.1 Jouanna = 5.240 L): ὁ τὴν κεφαλὴν ὑπὸ Μακεδόνοϛ λίθῳ πληγεὶϛ ὑπὲρ κροτάφου ἀριστεροῦ ὅσην ἀμυχὴν διεκόπη· ἐσκοτώθη πληγεὶϛ καὶ ἔπεσε. Τρίτῃ ἄφωνοϛ ἦν· ἀλυσμόϛ· πυρετὸϛ οὐ πάνυ λεπτόϛ· σφυγμὸϛ ἐν κροτάφοισιν· ἤκουεν οὐδὲν οὐδὲ ἐφρόνει. The same case is repeated at Epid. 7.32. Cf. also Coac. 2.194 (5.626 L), where we find a link between deafness (κώφωσιϛ) and aphonia in patients suffering from an icteric affection.

184 Τῇ Πολεμάρχου ἐν ἀρθριτικοῖσιν ἰσχίου ἄλγημά τι δεινόν ἐξαίφνηϛ, γυναικείων οὐ γινομένων· ἡ φωνὴ ἔσχετο νύκτα ἄχρι μέσον ἡμέρηϛ· ἤκουε δὲ καὶ ἐφρόνει· καὶ ἐσήμαινε τῇ χειρὶ περὶ τὸ ἰσχίον εἶναι τὸ ἄλγημα.

Lo Presti Polemarchus’ wife, in an arthritic condition, with a terrible pain in the hip joint, caused by the failure of her menses, lost her voice during the night and until midday. But she could hear, her mind was sound; she indicated with her hand that the pain was around the hip joint.

The very sense of this text is given by the adversative particle δὲ—one which suggests opposition between concepts that are otherwise connected as they do not exclude but balance with each other56—so that aphonie, absence of hearing and lack of consciousness are to be looked at as linked from a logical point of view. In fact, it is only on the basis of such a link that the absence of voice and the contextual presence of hearing attain observational relevance for the medical author. Differentiating between ἀκούειν and φρονεῖν on the one hand and φωνεῖν on the other hand must in fact have appeared to this author to be a formidable way to evaluate precisely if and to what extent the patient was in possession of his own mental faculties, as in the cooperative process of the constitution of sense the power of speaking testifies to a considerably higher and more complex capacity of cognitive interaction than that of listening (of course, it does not imply that each act of speaking must be always and necessarily more cognitive than an act of listening).57 Aphonie is referred to in order to express the specific inability of patients to talk (διαλέγεσθαι) with others (this inability often being the result of, or even the most revealing expression of, a mental derangement)58 rather than a generic 56  Cf. Denniston 1954, 165: ‘Normally, while ἀλλά is a strong adversative eliminating, or almost eliminating, the opposed idea, δέ balances two opposed ideas’ (italics are mine). 57  In this connection, it has been remarked by Watzlawick-Beavin-Jackson 1967, 58–60, that speaking and listening are to be seen as complementary rather than symmetrical cognitive functions. 58  Epid. 7.108 (111.10 Jouanna = 5.458 L): τῷ τοῦ Θυνοῦ—σφόδρα ἐν πυρετῷ καυσώδει ἐλιμοκτονήθη—ὑποχώρησιϛ συχνὴ χολῆϛ ἐγένετο μετὰ ἀψυχίηϛ καὶ ἱδρῶτοϛ πολλοῦ· κατεψύχθη σφόδρα· καὶ ἄφωνοϛ ἦν ἡμέρην ὅλην καὶ νύκτα. ̓ Εγχεόμενοϛ χυλὸν πτισάνηϛ κατείχετο, ἐφρόνει, εὔπνοοϛ ἦν. Cf. Morb. 3.8 (7.126 L): ὅταν δ ̓ ἀπὸ τῆϛ κεφαλῆϛ ἀρξαμένη ὀδύνη ὀξέη ἄφωνον ποιήσῃ παραχρῆμα. . .καὶ ἢν ἐπαίσθηται. Cf. Ciani 1983, 19, and Montiglio 2000, 228–233: ‘Galen criticizes the privileged role played by aphonie in the diagnosis of the Hippocratic school. Although he too stresses the link between voice and life, he blames the Hippocratics for their questionable habit of calling aphonie not only disturbances related to the voice, but also all absence of perception and movement that characterizes coma. This remark suggests that the Hippocratics regarded aphonie as such a

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disorder of phonation, as is suggested from the syntagm ἄφωνοϛ καὶ πάλιν διελέγετο that we find in a passage at Epidemics 3.17.2, from the case of a patient described as delirious (παράληρος) and aphonos at the same time,59 from a passage of On the Sacred Disease 7 (15.20 Jouanna = 6.374 L: ἄφωνον καθιστᾶσι καὶ ἄφρονα τὸν ἄνθρωπον),60 and, e contrario, also from the case of Hermocrates (Epidemics 3.1.2), who is described as capable of understanding but not of talking (κατενόει πάντα, διαλέγεσθαι οὐκ ἠδύνατο). On the other hand, the author of Diseases 4 can refer to a kind of dropsy in which patients die keeping the faculties of ‘paying attention’ and ‘talking’ (ἐπαΐων τε καὶ διαλεγόμενοϛ) until the end.61 This syntagm has been correctly translated into French ‘avec tout son sens et la parole’ by R. Joly in his edition of On Diseases 4 for the Collection des Universités de France: in fact, the use of the verb ἐπαῖειν—whose accepted meanings range from ‘to listen’ through ‘to understand’ or ‘to pay attention to’ something62—enables the author to somehow connect a superficial level of serious and comprehensive symptom that it could aptly signify the more complex condition of coma. Furthermore, they never fail to notice the loss of speech alongside mental disorders, whether it be because of a cerebral illness, a hysterical choking, or a burning fever’. See also Gourevitch 1983. 59  Epid. 3.17.13 (1.280 Jones = 3.140 L): περὶ δὲ τριηκοστὴν πυρετὸϛ ὀξύϛ, διαχωρήματα πολλὰ λεπτά, παράληροϛ, ἄκρεα ψυχρά, ἄφωνοϛ. See Laspia 1997, 51–58, and 1996, especially p.7: ‘Quel che è singolare nei testi di Ippocrate, Aristotele, Galeno, è che la fonazione non è mai descritta in modo puramente meccanico, ma sempre in rapporto alla cognizione: l’organo della voce è o immediatamente identificato, o posto in diretta relazione, con l’organo del pensiero’. 60  Cf. Morb. 2.21 (155.10 Jouanna = 7.36 L): ἐξαπίνηϛ ὑγιαίνοντα ὀδύνη ἔλαβε τὴν κεφαλὴν καὶ παραχρῆμα ἄφωνοϛ γίνεται καὶ ῥέγκει καὶ τὸ στόμα κέχηνε καὶ ἤν τιϛ αὐτὸν καλῇ ἢ κινήσῃ, στενάζει, ξυνιεῖ δὲ οὐδέν̀ Mul. 2.203 (8.226 L): Ἠν δὲ ἄχριϛ ἤπατοϛ ἀνίωσι, καὶ πνίγεται, ἄφωνοϛ γίνεται, καὶ οὐδὲν ὁρᾷ, καὶ τοὺϛ ὀδόνταϛ συνερείδει, καὶ σκληρὴ γίνεται, καὶ οὐδὲν φρονέει, καὶ ἀναπνεῖ πυκνά, καὶ οὐδὲν ἀκούει, Morb. Sacr. 7 (14.21 Jouanna = 6.372 L): Ἠν δὲ τούτων μὲν τῶν ὁδῶν ἀποκλεισθῇ, ἐϛ δὲ τὰϛ φλέβαϛ ἃϛ προείρηκα τὸν κατάρροον ποιήσεται, ἄφωνόϛ τε γίνεται καὶ πνίγεται καὶ ἀφρὸϛ ἐκ τοῦ στόματοϛ ῥεῖ, καὶ οἱ ὀδόντεϛ συνηρείκασι, καὶ αἱ χεῖρεϛ συσπῶνται καὶ τὰ ὄμματα διαστρέφονται, καὶ οὐδὲν φρονέουσι. 61  Morb. 4.57 (124.6 Joly = 7.614 L): ἢν μὲν οὖν ἐν τάχει προκαταλάβηται τὸ νόσημα τὸν ἄνθρωπον, θνῄσκει, ἅτε τῆϛ νούσου χρονιωτάτηϛ γενομένηϛ· ἐπὴν δὲ καὶ ἡ κοιλίη μὴ εὔροοϛ γένηται, κάρτα θνῄσκει τάχιστα, ἐπαΐων τε καὶ διαλεγόμενοϛ. 62  In this connection, it seems to me that the preverbal ἐπι- modifies the meaning of ἀίω providing it with a stronger idea of intentionality. On the meaning of ἀίω (whose first occurrences are to be traced back to Homer) see Arnetta 1996–1997, especially 14–16: ‘La percezione sensoriale espressa dal verbo ἀίω produce un’alterazione di stato nel soggetto che, repentinamente, passa da uno stato di incoscienza riguardo una parte dei fenomeni del mondo circostante, ad uno stato di presa di coscienza sia pure indotta ­involontariamente e senza la sua iniziale partecipazione. Nel momento in cui percepisce

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observation—the patient talks and lends his ears to other people’s words— with a deeper one, which implies the existence of a multi-sensorial matrix of ‘understanding’ and ascribes to ‘listening’ the status of a paradigmatic manifestation of man’s power of having cognition of things. I think it is sufficiently clear from these examples how the decay/derangement of the senses could be accounted for as the expression of an alteration or destruction of the system of relationships between the body and its environment. As it belongs within the sphere of physiopathological phenomena, this decay is endowed with features such as variability and reversibility (stories of patients are recorded who have recovered from a state of anaisthesie thanks to an effective therapy)63 as well as with a certain degree of unpredictability in its clinical evolution (some case is reported in which patients lie ­anaisthetoi intermittently).64 On the other hand, if both the reversibility and unpredictability of anaisthesie-related phenomena could make us think of a net of complex relations by which they are bound to the other (physio)pathological phenomena, their variability could testify to an idea of aisthesis based on a principle of biological signification. Yet, although perception in all its physiological and pathological manifestations is looked at as an integral part of the life of the human body, its suspension represents just a sign, not positive evidence, of death—evidence that is instead to be found in the absence of breathing. Let us look again at Epidemics 5.2. At some point the author of this clinical report notes down,

la sua volontà è fuori gioco, ma è proprio questo stimolo esterno che attiva la volontà, che la spinge ad agire in modo consequenziale alle circostanze [. . .] la percezione è quindi la principale forma di assimilazione del mondo circostante da parte del soggetto senziente; con il verbo ἀίω si indica quella particolare relazione che il mondo instaura con il soggetto, coinvolgendo tutta quanta la sua sensibilità nell’interpretazione dei suoi messaggi’. See also Boehm 1996. On the modifications of meaning produced by ἐπι- with preverbal function see Humbert 1986, 308–310. 63  Cf. Epid. 7.1 (see supra, n.44). 64  See, for example, Epid. 5.14 (9.3 Jouanna = 5.212 L); Epid. 3.1.2 (1.218 Jones = 3.32 L): Ἑρμοκράτην, ὃϛ κατέκειτο παρὰ τὸ καινὸν τεῖχοϛ, πῦρ ἔλαβεν. . . . Ἐκτῃ ἰκτεριώδηϛ, πάντα παρωξύνθη, οὐ κατενόει. ἑβδόμῃ δυσφόρωϛ, οὖρα λεπτά, ὅμοια. Τὰϛ ἑπομέναϛ παραπλησίωϛ. Περὶ δὲ ἑνδεκάτην ἐόντι πάντα ἔδοξε κουφισθῆναι· κῶμα ἤρξατο, οὔρει παχύτερα, ὑπέρυθρα, κάτω λεπτά· οὐ καθίστατο· ἡσυχῇ κατενόει. Τεσσαρεσκαιδεκάτῃ ἄπυροϛ, οὐχ ἵδρωσεν, ἐκοιμήθη, κατενόει πάντα, οὖρα παραπλήσια. Περὶ δὲ ἑπτακαιδεκάτην ἐόντι ὑπέστρεφεν, ἐθερμάνθη. Τὰϛ ἑπομέναϛ πυρετὸϛ ὀξύϛ, οὖρα λεπτά, παρέκρουσεν. Πάλιν δὲ εἰκοστῇ ἐκρίθη, ἄπυροϛ, οὐχ ἵδρωσεν. Α ̓ πόσιτοϛ παρὰ πάντα τὸν χρόνον, κατενόει πάντα, διαλέγεσθαι οὐκ ἠδύνατο, γλῶσσα ἐπίξηροϛ, οὐκ ἐδίψη· κατεκοιμᾶτο σμικρά, κωματῶδηϛ.

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‘While ­sleeping, it seemed to all those present that Timocrates did not breathe, and that he had died (ἐν δὲ τῷ ὕπνῳ οὐκ ἐδόκει τοῖσι παρεοῦσιν ἀναπνεῖν οὐδὲν ἀλλὰ τεθνάναι)’. As the author of this clinical report informs us, Timocrates was alive, but decisive in deceiving those who had examined him was the apparent absence of breathing rather than his lying immobile and not responding to the stimuli from the outside.65 The Hippocratics expected disturbances of breath often to be connected with loss of consciousness and alterations in sense faculties: in Epidemics 5.39 (20.1 Jouanna = 5.230 L) a child was suffering from rapid breathing while having his mental faculties deranged (τὸ δὲ πνεῦμα πυκινὸν εἶχε καὶ οὐ κατενόει); in Epidemics 5.14 (9.3 Jouanna = 5.212 L), the acceleration of breathing is followed by and paired with delirium (καὶ παρακόπτειν ἤρχετο), a pairing which elsewhere in the same book is accounted for as characteristically observable in point of death (Epidemics 5.55: πνεῦμα πυκνόν, ὡϛ τῶν θνῃσκόντων); by contrast, in Epidemics 7.108 (111.10 Jouanna = 5.458 L), we are told of a patient who regained consciousness and good and regular breathing at the same time by effect of a decoction that the physician made him take (ἐγχεόμενοϛ χυλὸν πτισάνηϛ κατείχετο, ἐφρόνει, εὔπνοοϛ ἦν); in 7.1 (48.10 Jouanna = 5.364 L) we are informed of a man in his sixteenth day of illness whose thinking suddenly became more stable and whose breathing became measured (ἡ διάνοια θρασυτέρη· πνεῦμα μέτριον).66 In other respects, we find a number of passages telling us about cases of patients who suffer from dyspnoea in combination with various cognitive deficits and/or with aphonie: examples of this pathological condition are provided by Internal Affections 48, where we find aphonie in association with the acceleration of breathing in patients affected by delirium and nightmares,67 by Epidemics 3.17.3, where we find that the absence of phonation is paired with

65   See Jouanna-Grmek 2000, 3 n.2: ‘L’absence de respiration, l’insensibilité générale, l’immobilité et la raideur du corps sont énumérées ici comme signes de la mort. Le médecin hippocratique ne semble attribuer une signification décisive qu’au premier de ces symptômes. C’est pourquoi il doute de l’absence réelle de la respiration et donne à entendre que ce n’est qu’une erreur d’observation faite par les profanes’. The physiological primacy of breathing is affirmed by Flat. 4 (107.12 Jouanna = 6.96 L). 66  Cf. Aph. 4.50 (4.149 Jones): ὅκου ἐν πυρετῷ μὴ διαλείποντι δύσπνοια γίνεται καὶ παραφροσύνη, θανάσιμον; Prog. 5 (199.6 Alexanderson): μέγα δὲ ἀναπνεόμενον καὶ διὰ πολλοῦ χρόνου παραφροσύνην σημαίνει; Prog. 20 (222.5 Alexanderson): οἱ δὲ ἀπολούμενοι δύσπνοοι γίνονται, ἀλλοφάσσοντεϛ, ἀγρυπνέοντεϛ; Coac. 2.255 (5.638 L). 67  Int. 48 (7.286 L): ἔστι δὲ ὅτε καὶ κεῖται ἄφωνοϛ ὅλην τὴν ἡμέρην καὶ τὴν νύκτα ἀναπνέων ἀθρόον πολὺ τὸ πνεῦμα.

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thin and weak breathing (a̓φωνίη, λεπτὸν πνεῦμα καὶ μινυθῶδεϛ),68 and also by Diseases of Women 2.203,69 where ἀφωνίη, πυκνὰ ἀναπνεῖν, οὐδὲν φρονεῖν are noted down in rapid sequence as symptoms co-occurring in consequence of the displacement of the womb.70 What is more, such co-occurrence testifies to a very interesting epistemological scenario, one in which language as a specifically human faculty rises to become a key to the coherence of man’s body as a perceiving entity, insofar as the power of speech is said to be affected and eventually disturbed by the alteration of both the ‘higher’ (that is the most complex) and the ‘lower’ (that is the most elementary) forms of man’s cognitive life—namely, φρονεῖν and ἀναπνεῖν—and its physiology comes to be assimilated into—or, at least, to be put in correspondence with—the rest of the bodily processes.71 6 Conclusions The parabola I have tried to draw from ‘multiplicity’ to ‘differentiation’ as a key to cognition speaks of a historical and epistemological shift from theories which tend to subordinate the ‘unity’ of the subject to the variety of cognitive functions, and to look at the very concept of ‘unity’ as logically and ontologically secondary to that of ‘multiplicity’, to theories which tend, if not explicitly aim, to account for the various manifestations of cognitive life (emotions, perceptions, thinking) as the result of the very unity and coherence of what I have 68  Cf. Epid 7.17 (5.390 L): φωνὴ πονηρή, ἀσαφήϛ· γλῶσσα περιπλευμονική· οὐκ ἔμφρων· πνεῦμα πρὸϛ χεῖρα πονηρόν, οὐ πυκνὸν οὐδὲ μέγα; Epid. 7.41 (77.6 Jouanna = 7.408 L): ἡ φωνὴ οὐκ ἐλύετο . . . πνεῦμα μετέωρον, κατὰ ῥῖνα σπώμενον. Jouanna-Grmek 2000, 215 n.5, remark that ‘Galien explique dans le De difficultate respirationis 3, c. 11, ce qu’il convient d’entendre par πνεῦμα μετέωρον, c’est-à-dire une petite respiration comme si l’on croyait que l’air pénétrait dans la gorge et n’allait pas au fond du thorax’. 69  Mul. 2.203 (8.388 L): ἢν δὲ ἄχριϛ ἥπατοϛ ἀνίωσι, καὶ πνίγηται, ἄφωνοϛ γίνεται, καὶ οὐδὲν ὁρᾷ, καὶ τοὺϛ ὀδόνταϛ συνερείδει, καὶ σκληρὴ γίνεται, καὶ οὐδὲν φρονέει, καὶ ἀναπνεῖ πυκνά, καὶ οὐδὲν ἀκούει. 70  Cf. Mul. 2.203 (8.386 L); see also ch. 201 (8.384 Littré): ὅταν ὑστέρη πνίγῃ, πνεῦμα δὲ σεύηται ἄλεϛ ἄνω, καὶ βάροϛ ἔχῃ, καὶ γνώμη καταπλήξ, ἀναυδίη, περίψυξιϛ, πνεῦμα προσπταῖον. See Manuli 1980, Dean-Jones 1994 and 1995, King 1993 and 1995. Aphonia and suffocation are referred to as linked with each other also in Morb. Sacr. 7 (14.21 Jouanna = 6.372 L). 71  See Rodríguez Alfageme 2002, 149–171, and, above all, Levine Gera 2003, 200: ‘Yet for Greek medical writers, at least, loss of voice is linked to loss of intelligence and loss of life. Often the loss of voice or speech indicates a terminal illness in Hippocratic writings. Voice is the breath of human life, and for the Hippocratics loss of voice is perceived as loss of life’.

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defined as the ‘perceiving body’. However, if it is true that such a shift somehow testifies to medicine’s claim for autonomy from philosophy and, to some extent and with regard to some treatises and some specific argumentative contexts, seems even to reflect the distinction drawn between ‘Presocratics’ and ‘Hippocratics’ and in fact to reinforce its legitimacy, we would nonetheless be mistaken if we thought that there existed a ‘Hippocratic’ theory of cognition as such. Too many and too pronounced are the differences among the Hippocratic authors in approaching this idea of the ‘coherence of the body’, which seems to have been—at least to begin with—a clinical and pragmatic intuition rather than a theoretical assumption programmatically pursued. The fact remains that this intuition as trait d’union between treatises and argumentative contexts that otherwise do not have necessarily so much or even have very little in common apart from being redacted in Ionian dialect may suggest neither the only nor the most important, but perhaps one of the possible discriminating reasons why in the very process of the constitution of the Hippocratic canon some texts could be seen as expression of the same rational approach to medicine, and thus collected in a unitary canon as genuine membra of the same corpus.72 In other words, the ‘coherence of the body’ as a concept invented or, rather, a perspective shared by a number of medical authors may be plausibly seen as a key to the ‘consistency’ of the fifth to 4th c. medical enterprise as it must have appeared to those who first attempted to systematize such an enterprise both from a theoretical/methodological and from a textual point of view.73 Such reasoning implies that this canonization was not, or at least not entirely, the result of a merely aleatory process, but resulted from a number of circumstances among which it seems plausible to count, along with hazard and chance, more or less deliberate processes of selection of materials and of construction of medicine as a literary genre.74 On the other hand, only by 72  See Roselli 2000, 176. See also von Staden 1992, 549–569. 73  I think it can be of some use here to adopt the notion of ‘consistency’ as one finds it in Laks 2002, where it is used to account for the dynamics of differentiation between ‘Presocratic’ theories, methods of investigations, and structures of the philosophical discourse. See especially p. 34: ‘On peut s’interroger ensuite sur la dynamique interne de cette diversité. Le point essentiel est qu’il s’agit d’une diversité non pas sauvage, mais réflexive, qui suppose aussi bien des lignes de continuité, que l’exploration systématique de modèles incompatibles [. . .] Si l’on cherche à saisir la forme la plus générale du critère qui préside à la série, je ne voie pas de meilleur terme que celui de “consistence” ’. 74  See in this volume the contribution of Ann E. Hanson. A similar process of historiographical construction can be traced also in Plato’s and Aristotle’s accounts of the early philosophical investigations into nature, although the strategies they followed were obviously

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seeking what has historically caused a collection of texts that have been seen as ‘Hippocratic’ to become such, will we move forward to a better comprehension of the epistemological status held by 5th c. medicine as a form of knowledge about the nature (and the natures) of man as well as of the intellectual context within which doctors and medical authors made efforts to impose their views and to claim legitimacy for their therapeutic practices and their methods of investigation of reality. Bibliography Adomenas, M., ‘Plato, Presocratics, and the Question of Intellectual Genre’, in: Sassi (ed.), 2006, 329–353. Arnetta, S., Α ̓ ίω e αἴσθησιϛ. La percezione da Omero ai Presocratici, Dissertazione di dottorato, Anno Accademico 1996–1997, Università degli Studi di Palermo, Facoltà di Lettere e Filosofia. Barnes, J., The Presocratic Philosophers. London-New York, 1982. Betegh, G., ‘Eschatology and Cosmology: Models and Problems’, in: Sassi (ed.), 2006, 27–50. Boehm, I., De l’audition à l’intellection. Naissance et développement de αἰσθάνομαι et de sa famille e l’époque archaïque à la fin du Ve siècle, Thèse de doctorat ParisSorbonne (Paris IV), 1996. Byl, S., ‘Le vocabulaire de l’intelligence dans le chapitre 35 du livre I du traité du Régime’, Revue de philologie, de literature et d’histoire anciennes 76 (2002), 217–224. Ciani, M. G., Le regioni del silenzio. Studi sui disagi della comunicazione. Padova, 1983. Craik, E., Hippocrates. On Places in Man. Oxford, 1998. very different as responding to different theoretical aims. As Adomenas has suggested, Plato first shaped the category of the ‘philosophers before Socrates’ as a somewhat unitary category in order to answer the question of intellectual genre (Adomenas 2006, 329– 353). Adomenas (352) argues that Plato singles out some features that he sees as typical of the philosophical discourse before Socrates: ‘a) mythical type of narrative that relies on authority for its acceptance; b) obscurity, or hermeneutic deficiency, that generates the need for additional interpretation; c) exegesis of past cultural authorities and other Presocratic figures which consists in re-interpreting appropriation of their theses as identical to one’s own; d) construction of retrospective pedigrees for one’s own discipline or doctrinal position; e) privileging one’s discipline and its categories over those of others, both historically and synchronically’. On Aristotle’s views on the unity of Presocratic philosophy see also Leszl 2006, 355–380 (as Leszl has put forward, 374, Aristotle drew the development of three different lines of thought, namely that of physiologoi, the inquirers of nature, that of Eleatics and that of Pythagoreans).

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Dean-Jones, L., Women’s Bodies in Classical Greek Science. Oxford, 1994. ———, ‘Autopsia, historia and what women know: the authority of women in Hippocratic gynaecology’, in: D. Bates (ed.), Knowledge and the scholarly medical traditions. Cambridge, 1995, 41–58. Denniston, J. D., The Greek Particles. Oxford, 1954. Eberhard, J.-A., Allgemeine Geschichte der Philosophie, 2nd ed. Halle, 1796 (1st ed. 1788). Ferrari, F., ‘Logos’, in: I Greci. Storia cultura arte società, vol. 2.2. Definizione, a cura di S. Settis. Torino, 1997, 1103–1115. Gemelli, M. and Laura, M., ‘Le contexte culturel des Présocratiques: adversaries et destinataires’, in: Laks and Louguet (eds.), 2002, 83–114. Gera, D. L., Ancient Greek Ideas on Speech, Language and Civilization. Oxford, 2003. Giannantoni, G., ‘L’originalità del pluralismo empedocleo’, Elenchos 18 (1997), 235–255. Gill, C., ‘La ‘psychologie présocratique: quelques questions interprétatives’, in: P.-M. Morel and J.F. Pradeau (eds.), Les anciens savants. Strasbourg, 2001, 169–190 Gourevitch, D., ‘L’aphonie hippocratique’, in: F. Lasserre and Ph. Mudry (eds.), Formes de pensée dans la Collection hippocratique. Actes du IV ème Colloque international hippocratique (Lausanne, 21–26 septembre 1981). Genève, 1983, 297–305. Grensemann, H., Knidische Medizin I: die Testimonien zur ältesten knidischen Lehre und Analysen knidischer Schriften im Corpus hippocraticum. Berlin, 1975. ———, Hippokratische Gynäkologie. Die Gynäkologischen Texte des Autors C, nach den pseudohippokratischen Schriften De muliebribus I, II und De sterilibus. Wiesbaden, 1982. ———, Knidische Medizin II: Versuch einer weiteren Analyse der Schrift A in den pseudo­ hippokratischen Schriften De natura muliebri und De muliebribus I und II, Hermes Einzelsch. 51. Stuttgart, 1987. Hüffmeier, F., ‘Phronesis in den Schriften des Corpus Hippocraticum’, Hermes 89 (1961), 51–84. Humbert, J., Syntaxe grecque. Paris, 1986. Joly, R., Recherches sur le traité pseudo-hippocratique du Régime. Paris, 1960. ———, Hippocrate. Du Régime. Berlin, 2003. Jori, A., Medicina e medici nell’antica Grecia. Saggio sul Perì technes ippocratico. Napoli, 1996. Jouanna, J., ‘Présence d’Empédocle dans la Collection hippocratique’, Bulletin de l’Association Guillaume Budé 20 (1961), 452–463. ———, ‘La théorie de l’intelligence et de l’âme dans le traité hippocratique Du Régime: ses rapports avec Empédocle et le Timée de Platon’, Revue des études grecques 79 (1966), 15–18. ———, Pour une archéologie de l’école de Cnide. Paris, 1974. ———, Hippocrate. Des vents—De l’art. Paris, 1988. ———, Hippocrate. La maladie sacrée. Paris, 2003.

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———, ‘La théorie de la sensation, de la pensée et de l’âme dans le traité hippocratique du Régime: ses rapports avec Empédocle et le Timée de Platon’, A.I.O.N. 29 (2007), 9–38. Jouanna, J. and Grmek, M.D., Hippocrate, Epidémies V et VII. Paris, 2000. King, H., Hippocrates’ Woman. Reading the female body in ancient Greece, London-New York, 1993. ———, ‘Self-help, self-knowledge: in search of the patient in Hippocratic gynaecology’, in: R. Hawley and B. Levick (eds.), Women in Antiquity. London-New York, 1995, 135–148. Laks, A., ‘Soul, Sensation, and Thought’, in: A.A. Long (ed.), The Cambridge Companion to Early Greek Philosophy. Cambridge, 1999, 250–270. ———, ‘Philosophes présocratiques: Remarques sur la construction d’une catégorie de l’historiographie philosophique’, in: Laks and Louguet (eds.), 2002, 17–38. Laks, A. and Louguet, C., (eds.), Qu’est-ce que la philosophie présocratique?/What is Presocratic Philosophy? Lille, 2002. Langholf, V., Medical Theories in Hippocrates. Early texts and the Epidemics. Berlin-New York, 1990. ———, ‘Structure and Genesis of some Hippocratic Treatises’, in: H.F.J. Horstmannshoff and M. Stol (eds.), Magic and Rationality in Ancient Near-Eastern and Graeco-Roman Medicine. Leiden-Boston, 2004, 219–275. Laskaris, J., The Art is Long. On the Sacred Disease and the Scientific Tradition. LeidenBoston-Köln, 2002. Laspia, P., Omero linguista. Voce e voce articolata nell’enciclopedia omerica. Palermo, 1996. ———, L’articolazione linguistica. Origini biologiche di una metafora. Roma, 1997. Leszl, W., ‘Aristoteles on the Unity of Presocratic Philosophy. A Contribution to the Reconstruction of the Early Retrospective View of Presocratic Philosophy’, in: Sassi (ed.), 2006, 355–380. Lloyd, G.E.R., Magic, Reason and Experience. Studies in the Origins and Development of Greek Science. Cambridge, 1979. ———, Science, Folklore and Ideology. Studies in the Life Sciences in Ancient Greece. Cambridge, 1983. ———, Demystifying Mentalities. Cambridge, 1990. ———, ‘Le pluralisme de la vie intellectuelle avant Platon’, in: Laks and Louguet (eds.), 2002, 39–54. ———, ‘Diogenes of Apollonia: Master of Ducts’, in: Sassi (ed.), 2006, 237–258. Lo Presti, R., ‘The Ambiguous Role of Perception. Empiricist Views and Biological Perspectives on Sense Perception among the Hippocratics’, Acta Classica 50 (2007), 129–146.

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———, In forma di senso. L’encefalocentrismo del trattato ippocratico Sulla malattia sacra nel suo contesto epistemologico. Roma, 2008. ———, ‘Between Distinction and Separation: Rethinking the Centrality of the Brain in Alcmaeon’s Theory of Sense Perception and Cognition’, Antike Naturwissenschaften und ihre Rezeption 19 (2009), 9–30. Mansfeld, J., ‘Alcmaeon, ‘Physikos’ or Physician?’, in: J. Mansfeld and L.M. de Rijk (eds.), Kephalaion. Studies in Greek Philosophy and its Continuation Offered to Professor C.J. de Vogel. Assen, 1975, 26–38. Manuli, P., ‘Fisiologia e patologia del femminile negli scritti ippocratici dell’antica ginecologia greca’, in: M.D. Grmek (ed.), Hippocratica. Actes du Colloque hippocratique de Paris (4–9 septembre 1978). Paris, 1980, 393–408. Montiglio, S., Silence in the land of logos. Princeton, 2000. Most, G., ‘Pindar, O. 2.83–90’, Classical Quarterly 36 (1986), 304–316. Nicosia, S., ‘Sul concetto di ‘giudizio’ (κρίσιϛ) in Grecia. Un approccio linguistico’, in: S. Nicosia (ed.), Il giudizio. Filosofia, teologia, diritto, estetica. Roma, 2000, 55–68. Pérez Cañizares, P., ‘Special features in Internal Affections. Comparison to other nosological treatises’, in: van der Eijk (ed.), 2005, 363–370. Potter, P., Hippocrates: Anatomy, Bones, Heart, Eight Months Child, Coan Prenotions, Crises, Critical Days, Superfetation, Girls, Excision of Fetus, Sight (Loeb vol. 9), Cambridge, MA, 2010. Rodríguez Alfageme, I., ‘Patología del habla en el Corpus Hippocraticum’, in: A. Thivel and A. Zucker (eds.), Le normal et le pathologique. Actes du X ème Colloque inter­ national hippocratique (Nice, 6–8 octobre 1999). Nice, 2002, 149–171. Roselli, A., ‘Un corpo che prende forma: l’ordine di successione dei trattati ippocratici dall’età ellenistica fino all’età bizantina’, A.I.O.N. 22 (2000), 167–195. Sassi, M.M., Le teorie della percezione in Democrito. Firenze, 1978. ———, ‘La naissance de la philosophie de l’esprit de la tradition’, in: Laks and Louguet (eds.), 2002, 55–82. ——— (ed.), La costruzione del discorso filosofico nell’età dei Presocratici/The construction of Philosophical Discourse in the Age of the Presocratics. Pisa, 2006. Schofield, M., ‘Heraclitus’ Theory of the Soul and its Antecedents’, in: S. Everson (ed.), Companions to Ancient Thought, 2: Psychology. Cambridge, 1991, 13–34. Smith, W., Hippocrates: Epidemics 2, 4–7 (Loeb vol. 7). Cambridge, MA, 1994. Stover, T., ‘Form and function in Prorrhetic 2’, in: van der Eijk (ed.), 2005, 345–362. Stratton, G.M., Theophrastus and the Greek Physiological Psychology before Aristotle. Amsterdam, 1964. Thivel, A., Cnide et Cos. Essai sur les doctrines médicales dans la Collection hippocratique. Paris, 1981.

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Thomas, R., ‘Performance and Written Publication in Herodotus and the Sophistic Generation’, in: W. Kullman and J. Althoff (eds.), Vermittlung und Tradierung von Wissen in der griechischen Kultur. ScriptOralia 61. Tübingen, 1993, 225–244. van der Eijk, Ph. J., ‘Towards a Rhetoric of Ancient Scientific Discourse: Some Formal Characteristics of Greek Medical and Philosophical Texts (Hippocratic Corpus, Aristotle)’, in: E.J. Bakker (ed.), Grammar as Interpretation. Leiden, 1997, 77–130. ———, ‘Divination, Prognosis and Prophylaxis: The Hippocratic Work On Dreams (De Victu 4) and Its Near-Eastern Background’, in: H.F.J. Horstmanshoff and M. Stol (eds.), Magic and Rationality in Ancient Near-Eastern and Graeco-Roman Medicine. Leiden-Boston, 2004, 187–218. ———, Medicine and Philosophy in Classical Antiquity. Cambridge, 2005. ———, Hippocrates in Context. Papers read at the XIth International Hippocrates Colloquium (University of Newcastle upon Tyne, 27–31 August 2002). Leiden-Boston, 2005. Vegetti, M., Opere di Ippocrate. Torino, 1976. von Staden, H., ‘Lexicography in the Third Century BC: Bacchius of Tanagra, Erotian and Hippocrates’, in: J.A. López Férez (ed.), Tratados hipocraticos (Estudios acerca de su contenido forma e influencia). Actas del VIIe Colloque international hippocratique (Madrid, 24–29 de septiembre de 1990). Madrid, 1992, 549–569. Watzlawick, P., J.H. Beavin and D.D. Jackson, Pragmatics of Human Communication: A Study of Interactional Patterns Pathologies, and Paradoxes. New York, 1967. Wright, M.R., ‘Presocratic Minds’, in: C. Gill (ed.), The Person and the Human Mind. Oxford, 1990, 207–225. Zhmud, L., Wissenschaft, Philosophie und Religion im frühen Pythagoreismus. Berlin, 1997.

CHAPTER 9

[Hippocrates] On Glands Elizabeth Craik The square brackets that enclose the name of Hippocrates indicate, by the convenient shorthand conventionally employed in classical scholarship, spurious attribution. No treatise would now be regarded as ‘genuine’ in the narrow absolute sense envisaged by Adams, or even as more or less authentic in the broad relative sense of the judgments made by Littré on different ‘classes’ of Hippocratic works.1 However, the authorship of On Glands has been particularly questioned and the work much slighted. In this, Galen’s unfavorable judgment has been influential.2 While the notion of Hippocratic authorship is to be discarded, it may still be possible to suggest common (anonymous) authorship with other works which evince pervasive common traits with On Glands, especially unusual traits, in linguistic expression and scientific thought. In this chapter, affinities in form and content with contemporary medical writing are isolated and questions of authorship are addressed. On Glands is rehabilitated as a significant work of the early 4th c. A summary of this short and little known treatise on the subject of glands, or rather the lymphatic system, follows. The general character of glands in nature and appearance is outlined; the nature and cause of maladies affecting them is described; their distribution and function is indicated; an association of glands, moisture and hair is postulated; it is, however, allowed that hair is absent from some places where glands are present. Particular glandular areas are discussed: the kidneys; the neck; the armpits and groin; the intestines; the head, specifically the brain. It is stated that the head may send an excess of moisture in flux to the ears, the eyes, the nose, the throat, the esophagus, the spine or the hip joint; and that the brain itself may be affected if this flux goes wrong. The relatively minor hazards of fluxes to the eyes, nose and ears are outlined; flux via the esophagus (to the belly) and via the trachea (to the lungs) *  The argument of this chapter is based on parts of the introduction to my edition of Gland. (Craik 2009). Previous editions are: Littré 1839–61, vol. 8, 1853, 550–575; Ermerins 1859–64, vol. 3, 1864, 185–195; Joly CUF Hippocrate t. 13, 1978, 113–129; Potter (Loeb Hippocrates vol. 8), 1995, 105–125. 1  Adams 1849; Littré 1839–61. 2  Hippocratis de articulis liber et Galeni commentarii, 18A.379 K.

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and the extreme dangers of flux to the hips are described. The final sections have a tangential air: it is noted that the brain may suffer other dangerous maladies, and that these affect the rest of the body also; a glandular difference— breasts—between men and women is discussed and the general physiology and pathology of the breasts is adumbrated. In short, the work is a serious and wide-ranging attempt to observe the broad anatomy, to understand the underlying physiology, and to account for the general pathology of glands. It is appreciated in a recent medical journal: The modern scientist stands amazed before the innovative concepts expounded in this ancient medical document. Indeed, the functional anatomy of the lymphatic system and lymph nodes emerges with impressive precision . . . the author provides an absolutely modern interpretation of their physiopathological significance.3 At first sight, the treatise appears unique, not only in the CH but in all of ancient medicine.4 However, closer examination contradicts this impression. First, it can readily be seen that aspects of the style, in general terms, are common to many other works which, like On Glands, can be described as didactic, logical, rhetorical, poetic or paratactic. Second, it is evident that aspects of the content, in general terms, are common to many other works which, like On Glands, express theories of flux related to changes in pressure and space in the body, or express theories of bodily and mental balance, or embrace topics in physiology (especially embryology) and nosology (notably phthisis). To some extent, broad similarities in expression and content result from a common expository purpose and a common physiological theme. We are concerned here with closer, more precise and more particular resemblances. But before embarking on these, it may be observed that some works making no explicit mention of glands nevertheless seem to allude obliquely to theories of glandular function: among these, On the Art is a striking instance. And on a more practical plane, there is evident awareness of glandular troubles in the case studies of Epidemics as well as clear references to glandular symptoms in aphoristic texts. Some years ago, I argued that On Glands has strong affinities with Places in Man.5 These two works are similar in structure, both beginning with general remarks on bodily nature and both ending with an excursus on gynecology. There are many unusual common elements in vocabulary, dialect and syntax. 3  Crivellato, Travan and Ribatti 2007. 4  But see Dean-Jones 1994, 56–58 on the gynaecological content. 5  Craik 2002, 285–287.

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They share an idiosyncratic conceptual view of phlegm and phlegmone, related closely to moisture. The ordering of the seven fluxes regarded as precipitating illness is identical—to ears, eyes, nose, throat, belly, back (sacrum), hips (hipjoints)—and in addition the anatomy and physiology of ear and omentum are similarly described. The author of On Glands seems to have adopted and adhered to the salient doctrines of Places in Man, failing to adapt these to his more sophisticated system. In particular, the destinations of disease-inducing flux conflict somewhat with the locations of glands managing moisture. Affinities between On Glands and Joints have been much noted. The author of Joints states that: In another work there will be an account of glands over-all, what they are and what sort of things they signify and can effect in what parts of the body. ( Joints 11, 4.108 L) The phrase ‘of glands over-all’ recurs in On Glands and the two works share other expressions, some relatively unusual. That there are some resemblances also between Fractures and On Glands reinforces the likelihood of authorial influence or interaction. The possibility of common authorship, fiercely rebutted by Galen, has been much discussed and need not be rehearsed here.6 On Glands, like Fractures and Joints, employs many conspicuously rhetorical stylistic features. However, the elegant style of Joints and Fractures is far removed from the clumsy and labored, though at times ostentatiously poetic, expression of On Glands. We come now to a different and much more significant range of connections evident in a large group of related texts devoted in a theoretical fashion to issues of obstetrics and gynecology, and especially to topics in embryology and pregnancy. There are peculiarly pervasive affinities in language and style, as well as striking common elements in tenor and thought, with the treatises Generation, Nature of the Child and Diseases 4 on the one hand and also with Diseases of Girls, certain parts of Diseases of Women and certain parts of other gynecological texts, especially Infertile Women, on the other. On Glands can be so closely aligned in so many ways with these writings that there is a strong case for common authorship. This body of material, comprising some works which have survived complete along with miscellaneous blocks of material which have survived embedded in a setting where they do not totally cohere, is hereafter referred to as ‘the group’ and its supposed common author as ‘the 6  In addition to the editorial comments of Littré, Ermerins, Joly and Potter, see Diels 1910, Heidel 1914, Mørland 1941, Rodriguez Alfageme 1992.

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author’. Littré already saw the affinity of all these works, which he regarded as an entity, and as all by the same author, characterized only as non-Hippocratic and pre-Aristotelian. He believed that the gynecological works had originally comprised a continuum, beginning with Diseases of Girls, followed by Diseases of Women 1 and 2, then by Infertile Women. The three works conventionally entitled Generation, Nature of the Child and Diseases 4 were similarly regarded as continuous by Littré. Since then it has been argued that, while Generation and Nature of the Child cohere, Diseases 4 though by the same author is not part of the same work.7 In a detailed analytical study of Generation, Nature of the Child and Diseases 4, Regenbogen demonstrated the pervasive character of their affinities in writing style, scientific methodology and medical doctrine.8 The interconnections between Diseases of Women 1 and 2 and Infertile Women first noted by Littré were explored by Grensemann, who isolated three separate strata in the gynecological treatises, using the term ‘Autor C’ for the latest. The parts of these works in the ‘group’ showing strong affinities with On Glands belong to this stratum.9 This work, pioneering in its day, has been deservedly influential; but a full reexamination would now be timely. In the past some reservations have been expressed: Joly argued convincingly that Grensemann’s criteria are not all equally significant.10 Whereas the narrative flow in the gynecological texts generally is much interrupted by repetitions and digressions such as lists of recipes (suggestive of different hands and a process of accretion) Generation-Nature of the Child and, to a lesser extent, the more diffusely argued work Diseases 4 resemble On Glands in having a clear and reasoned presentation (suggestive of a single author). One of the most immediately striking stylistic features of On Glands is the author’s tendency to indicate, in a somewhat long-winded way, transitional points in his exposition; this is otiose in a work of such short compass and restricted subject matter (On Glands 4.1, 7.1, 8, 14.2). The works GenerationNature of the Child and Diseases 4 share this ostentatiously didactic arrangement of topics. So in these related works, the writer constantly tells us in the perfect tense that he has dealt with a particular topic, and in the future tense that he is about to return to his main theme (for instance, Generation 11, 7.484 L, and Nature of the Child 20, 7.510 L). This persistent schematic emphasis

7   See Kahlenberg 1955; Joly 1970/2003, 24–27; Lonie 1981, 44–45; Müller 1998; Giorgianni 2006, 6–30. 8   Regenbogen 1950, repr. 1961. 9   Grensemann 1975, 1982. 10  Joly 1977.

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can seem tiresomely pedantic.11 In the parts of Diseases of Women plausibly attributed to our author on other grounds, the same stylistic trait is evident (as Diseases of Women 2.133, 8.294, 296, 302 L; Infertile Women 213, 8.408 L). A related feature is the repeated use of such corroborative expressions as σημεῖον ‘sign’ or μαρτύριον ‘evidence’ to guarantee authenticity, and the regular use of ἀνάγκη ‘necessity’ or the cognate verb ‘necessitate’ to hammer home a point, reinforce an argument or bolster up a conclusion (On Glands 4.1, 16.2, 17; cf. Diseases 4.54, 7.596, 598 L). But, despite such loftiness, the author’s scientific method is at times questionable, displaying a tendency to validate a hypothesis or theory by conveniently observed ‘facts’ (as at 4, 17).12 There are in addition many instances of shared idiosyncratic preferences in vocabulary, such as the strange verb ἐκβρασσόμενον (4), the emphatic ἐπαυρισκόμεναι (9), the colorful ἀίσσει (14), the use of πῦρ in the sense ‘fever’ (2) and ὀδάξονται of pain (12). The use throughout the group of κάρτα rather than the more common synonymous σφόδρα as an intensifying adverb is notable. Similarly, the conjunction ἐπήν is preferred to ὅταν ‘when’.13 Unusual alpha privative forms are strongly favoured both in On Glands and throughout the group; so too are use of the dual number and use of diminutives. But by far the most striking shared stylistic features are two grammatical and syntactical tics. First, where a sequence of conditional clauses is found, there is a predilection for an inconstant and unusual syntactic construction: after a first protasis expressed by εἰ and the optative, a second parallel protasis is expressed by ἤν with the subjunctive (as On Glands 12.2). Second, the regular voice of the verb πονέειν shifts in a peculiar idiom: the verb is used transitively, in the sense ‘give trouble’, as well as intransitively, in the sense ‘have trouble’; further, it is used in both passive and active forms so that the middle form πονέεσθαι rather than the active form πονέειν can have the sense ‘suffer’ (as On Glands 1 and 2). In content, the fundamental concepts pervasive in On Glands appear throughout these other works also, expressed in similar terms; most notably the notion that parts of the body ‘draw’ moisture from one another (as Diseases 4.35, 7.348 L, similar to On Glands 4; cf. Nature of the Child 15, 7.494 L). It is significant that physiological ideas merely adumbrated in On Glands are given more extended treatment elsewhere: the theory that the male and the female body differ in texture (On Glands 1 and 16); the theory that 11  See Lonie 1981, 119 on the ‘style of the lecturer’ and Joly 1970/2003, 98, n.3 taking a more critical view. 12  See Joly 1970/2003, 53, n.2 and 72, n.3; also Lonie 1977. 13  On these features, see Grensemann 1975 and Joly 1977.

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lactation has a digestive origin (On Glands 16.1); the theory that hair is connected with moisture (On Glands 4, 5, 10); the theory that plant and human growth are analogous (On Glands 5); theories that fluid motion in the body is governed by pressure and by attraction between its parts, and especially that moisture is ‘drawn’ to empty space (On Glands 10); theories of bodily balance, reciprocity and equilibrium (On Glands 3, 9, 14). These similarities are not all equally weighty as determinants of common authorship or even common affiliation. Several instances, however, are peculiarly colorful and those where allusive reference is made and a fuller account is extant elsewhere can be regarded as particularly significant. As the belief that women are more ‘moist’ than men is generally prevalent in the Corpus and underlies much theorizing about menstruation, pregnancy and birth, its occurrence in different works is unsurprising. However, it is notable that the brief assertion in On Glands 16 that the male body, not retaining moisture, is dense like cloth and the female, retaining moisture, is loose like wool is clarified by an experiment described at the beginning of Diseases of Women 1.1 (8.12–14 or 8.12,14 L): when cloth and wool of similar weight are soaked in water for two days and two nights, their relative denseness or looseness is seen to be significant in determining the amount of water each can absorb. The emphasis accorded the statement in Diseases of Women 1 suggests that the author attached much importance to this experimental corroboration of the existence of differences between the sexes in body texture and may have reiterated it frequently. A refinement of the theory appears in Nature of the Child 21: different women may be relatively dense or relatively loose in flesh (7.512 L). Lactation is explained briefly but quite clearly in the same context (On Glands 16): food is changed into milk and goes from womb to breasts through pressure of the womb on the stomach. More extended accounts of this process can be seen in both Nature of the Child 21 (7.512 L) and Diseases of Women 1.73 (8.152–154 L or 8.152, 154 L). Botanical similes and metaphors linking people and plants (as at On Glands 5) are important throughout these works; it is explicitly asserted that plant and human growth are the same (Nature of the Child 27, 7.528 L; see also 17 and 22–24, 7.498 and 514–522 L, and Diseases 4. 34, 7.544, 546 L) and in a lengthy excursus the analogy is developed.14 The observation in On Glands 5.1 that too much moisture in the earth will stifle seed growth is expressed in identical language to an account in Diseases of Women 1.60 and 78 of fetal distress resulting in miscarriage (8.120, 186 L). There is a network of parallel passages, where corresponding ideas are developed in corresponding language. The theory of reciprocal nutrition 14  See Lonie 1969.

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between different parts of the body and the theory of bodily drainage based on reciprocity between the belly and the rest of the body is expressed in terms of distribution and mutual benefit in both Diseases 4.39 and 41 (7.558 and 562 L) and Diseases of Women 1.61 (8.122 L). In the former, the activity imputed to the four πηγαί ‘sources’ is very similar to that of glands in On Glands; in the latter, the activity of the spleen, which is described as fine, spongy and, to the touch, soft like down is similarly envisaged. It is even more significant that On Glands contains several passages, obscure in isolated context, but clarified by other works in the group, and especially by the lengthy exposition in Diseases 4 of theories of physiological function and pathological change. Thus the brief and cryptic statement that the body ‘sends all kinds of vapors up to the head’ (On Glands 7.2) is made clear by the extended description of the presumed pathology, based on the vaporizing effect of heat, which forces fluids in the body to ascend to the head (Diseases 4.51, 7.584 L). The passing reference to moisture in the intestines (On Glands 9) is clarified by the account in Diseases 4.44 and 49 of the place of moisture in the digestive process (7.566–568 and 578–580 L). The physiology of ‘secretion’ noted briefly (On Glands 11) is the same as the physiology of secretion and purgation described at length in Diseases 4.46 and 51 (7.572 and 584 L). Also, the etiology and pathology of eileoi ‘twisters’ in On Glands 14.1 is identical to the disease described in related terms in Diseases 4.51 (7.584 L). Two passages (On Glands 12 and 15) have close resemblances to passages in the extant Diseases of Girls, one on hallucinatory experiences and one on delirium and madness; here too the passages in our treatise are clarified by comparison (Diseases of Girls 1, 8.466 and 468 L); and in the two works vital body parts are similarly defined. Whereas the other known works attributable to our author are concerned primarily with the working of the female body, On Glands gives an account of an important aspect of general anatomy and physiology. In this it resembles Diseases 4. There is no doubt that this author sees himself as a pioneer. Some of the key terminology in his work is his own invention; he explicitly tells us twice that he has ‘named’ the humoral sources (Diseases 4.34 and 39, 7.548 and 556 L). Where should we place On Glands in the chronology of the author’s scientific oeuvre? In content, the extraordinary brevity and allusiveness might be taken as backward reference to an earlier work, or as forward reference to ideas not yet fully developed or recorded in written form. In expression, the idiom and argumentation is unmistakably that of the group, yet the extraordinary terseness suggests a different purpose or a different audience. In relation to Diseases 4, On Glands may be viewed as preliminary jottings of ideas later amplified, or alternatively as backward reference to thoughts already more

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fully expressed; nothing can settle the question definitively. To some extent, the question may be inappropriate, even anachronistic. Both of these works seem to grow from a vast ambient tradition from which the author can adopt and adapt material. The final chapters (On Glands 16–17) slightly spoil the coherent story already presented of glandular function: there are inconsistencies in the glandular view of the breasts. These chapters are detachable. But whether they are an add-on or a starting-point is impossible to say. There is a fundamental methodological problem in attempting to gauge the degree to which an author’s own ideas may develop and change, or the degree to which he may present apparently different ideas through choosing a different emphasis for a different topic or different intended audience. The difficulty is compounded by the apparent readiness of authors to adopt, with or without adaptation, material from their predecessors. This is evident in Nature of Woman, almost entirely derivative. Although our author has an idiosyncratic style and distinctive cast of thought, these have many resonances in the wider Hippocratic milieu. One example is that Regimen, an impressively wide-ranging work in four books, contains similar theories about human reproduction and heredity and about abnormal mental states. However, there they have somewhat more sophisticated expression and more developed form, and the language of Regimen is completely different, as is its general, more philosophical, tenor. ‘Behind the intellectual constructs [of Generation and Nature of the Child] there is a considerable history of the thought of the best minds in Greece’.15 It is evident that the same statement is applicable to On Glands. The author might be viewed as a doctor with a scientific bent (interested in botany and zoology) or as a biologist with medical interests (concerned with human as well as animal function); but any such categorization is anachronistic. In 5th and 4th c. terms he belongs among ἰατροτέχναι the intellectual ‘doctorscientists’ parodied by Aristophanes in Clouds (331–334) of which the first version was produced in 423. Thus, there are traces of the ideas of Diogenes of Apollonia, an influential but now shadowy figure. Observation of the effects of heat on fluids, expressed by Diogenes in relation to humidity attracted by the sun, seems to underlie the author’s physiological theory (On Glands 7.2; cf. Clouds 231–234). Diogenes had parallel interests to our author in generation and embryology, and in addition may have written specifically on glands: truncated fragments describe the brain as loose in texture and the tongue as fine, soft and spongy.16 Ideas relating to bodily balance and equipoise are pervasive 15  Lonie 1981, 48. 16  DK 64A 19 = Thphr. Sens. 39; DK 64A 21 = Aet. 4.6.13.

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in early Greek medicine, but it is notable that Alkmaion gives them a political slant in terms of ἰσονομία similar to that put forward by our author in terms of ἰσότης.17 The poetic diction and penchant for simile evident in On Glands are features endemic in early prose writing; however, these are particularly characteristic of Empedokles, who, like our author, took an interest in dream experience and who, like our author, saw analogies between plant in the earth and fetus in the womb (On Glands 5, 7, 12). The most pervasive underlying presence is that of Demokritos. Although Demokritos is not generally viewed as a ‘doctor’, it is remarkable that many of his works have titles the same as, or similar to, several which are transmitted in the CH: it seems he wrote on the nature of man or on flesh; on humors; and on dietetics. In addition, tradition records a treatise on fever and chronic cough, suggesting an interest in consumptive illnesses, shared with the author of On Glands.18 Speculation on the formation of the body and its different components was a topic of general interest; but it is notable that Demokritos gives an account of the formation of horn similar to that essayed in On Glands 5 on the formation of hair. In addition, Demokritos wrote on topics in embryology, explaining multiple births in such animals as dogs and pigs, a topic covered in similar terms in Nature of the Child.19 And if the account in the Hippocratic letters that Demokritos cut up many animals, scrutinizing their σπλάγχνα ‘innards’ in order to assess the significance of χολή ‘bile’ is correct, this may have a peculiar relevance to research on glands (Letters 17, 9.350 L): observation of the lymph nodes (lacteals) in the gut, through extensive animal dissection, was the first step to discovery of other parts of the lymphatic system in the 17th c. More theoretical aspects of Demokritean thought can be glimpsed also. Demokritos gives the earliest known expression of a comparison, appearing in On Glands and with a long future in philosophical circles, between elements or flavors such as δριμύ (cf. On Glands 7). And the most celebrated theory of all associated with his name, the ‘atomic theory’ of Demokritos and Leukippos, was based on the concept that matter moves into στενοχωρία ‘empty space’ (cf. On Glands 17). Demokritos had a fundamental place in the interpenetration between medical and philosophical ideas, probably a two-way process.20 There are many echoes of Demokritean language and thought in the group, and a clear collocation at the beginning of Diseases of Girls 1 (8.466 L).21 17  Gland. 9; cf. DK 24B 4 = Aet. 5.30.1. 18  DK 68A 33 = D.L. 9.46. 19  DK 68A 151= Ael. NA 12.16; cf. Nat. Puer. 31, 7.540 L. 20  See Perilli 2007. 21  Cf. DK 67A 13 = Simpl. Phys. 925 and DK 68A 135 = Thphr. Sens. 59.

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At the same time, it is easy to find similarities between the theories propounded by our author and the doctrines of the early medical writers surveyed in Anonymus Londinensis.22 A striking instance is Dexippos of Kos.23 The view of Dexippos that bile and phlegm, on becoming more wet, turned into ichors and sweats, causing trouble as they became thick and purulent, is close to the theory of pathological change in On Glands (especially at 7, 8, 12): in both, the stress is on the proper degree of moisture and terms such as purulence and ichor are used; also in both the action of heat is regarded as significant in precipitating disease. Galen’s references to Dexippos consistently name him with Apollonios as ‘pupils’ of Hippocrates, or Hippocrates as their ‘teacher’; these references are silent on abstract doctrine and relate uniformly to their stringent dietary prescriptions in cases of fever.24 Menekrates too is similar in certain key respects:25 health depends on harmony and, in a political metaphor, ill health results from stasis (cf. On Glands 9, similar also to Alkmaion); excess of phlegm leads to the eruption of pustules; and also to various fluxes—flux to hips, lungs, ribs, intestines is specified; peccant matter remaining (as On Glands 7) in the body gives rise to black bile (as On Glands 12). There is good ancient evidence (later and anecdotal, but congruous) that Menekrates, originally from Syracuse in Sicily, went to Macedon to be court doctor to Philip, father of Alexander the Great. Menekrates, who was nicknamed ‘Zeus’, was a colorful international figure, evidently well known to the Athenians: his vanity and bombast are mocked by the comic dramatists Alexis and Ephippos in the era of ‘Middle’ Comedy, mid 4th c.26 If we place credence in these traditions, Menekrates must have been known to Aristotle, and may have been known to Plato. Aristotle’s father had been court physician to an earlier Macedonian monarch (Amyntas II); Aristotle himself became tutor to the young Alexander late in the decade 350–340; Philip reigned from 359 to 336. In Plato’s Symposium (which has a dramatic date of 416 BCE, a date of narration of c. 400 BCE and a date of composition of perhaps c. 380 BCE), the doctor Eryximachos, who is treated with scant respect by Plato, shows familiarity with many Hippocratic ideas, notably those of Regimen 1, which has some affinities with On Glands. Our author, whose style is nothing if not magisterial and pompous, fits the stereotype of the comic doctor, and belongs with such 22  Diels 1893; Jones 1947. 23  Anon. Lond. 11, especially at 8–36. 24  De optima secta, 1.144 K; de venae sectione, 11.182 K; Hippocratis de acutorum morborum victu liber et Galeni commentarius, 15.478, 703, 744 K. 25  Anon. Lond. 19, especially at 20–33. 26  Athen. 7.289a–290a.

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figures as Menekrates and Eryximachos. Equally, as noted above, he fits the stereotype of the comic scientist vividly presented in Aristophanes Clouds and can be aligned with such figures as Diogenes. There are many elements reminiscent of the subject matter and thought of On Glands in Aristotle’s biological writings and there are some close parallels also in the Aristotelian Problemata. For example, these topics are covered in similar terms: bodily ducts and vessels; the nature of joints; the growth of hair; the anatomy of the gut; an analogy between the body and the earth; bodily ‘parity’; a possible connection between ‘madness’ and bile; differences in texture between the male and the female body. Aristotle refers on many occasions to his Anatomai books on anatomy.27 His debt to his predecessors, especially Demokritos, in this area has long been recognized.28 As to the Problemata, the collection is probably based on a long oral tradition with a poetic tenor; for the most part, the content displays pure intellectual curiosity where exploration of therapeutic issues has no place. There are many later examples of the genre, in which the same or similar questions tend to be repeated. Aristotle was evidently familiar with glands in such animals as cat, dog, pig, sheep and ox: his account of comparative anatomy—including descriptions of tonsils, breasts (udders), genitals, axilla, throat, groin and mesenterion—is couched in terms rather similar to those used in the Hippocratic treatise.29 Although a degree of specialization is apparent in Hippocratic works, it seems too that many medical writers produced, or projected, a large output on multifarious subjects. Thus, our author claims to have written also on chest complaints, such as phthisis and pneumonia (Diseases of Women 1.2, 8.18 L; cf. Diseases 4.56, 7.606 L). The author of Joints (an orthopedic surgeon) was similarly prolific. Among the topics he declared he had treated, or would treat, are—in addition to glands, already discussed—principles of massage; lung diseases; intercommunication of the vessels (phlebes and arteriai) and of the spinal fluid; the various ways in which all parts of the body interact; the potential dangers of surgical intervention ( Joints 9, 40, 41, 45, 57, 4.102, 174, 182, 190, 246 L). The author of Affections states his intention to write on various other subjects: diseases of the eye; diseases involving suppuration; phthisis and gynecology (Affections 5, 33, 6.214, 244 L). It is always tempting to speculate on common authorship of extant works; but in view of the large number of unknown doctors, the huge number of lost works, and the evident overlap of interests, this is rarely fruitful. On Glands is a rare case, in that it can be assigned to a 27  Cf. PA 3.5, 668a. 28  See Regenbogen 1931, repr. 1961; Byl 1977, 325. 29  HA 493a–496b.

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grouping; though paradoxically to an unexpected, and unexpectedly early, one. It may plausibly be dated to the early decades of the 4th c. An important implication is that there was considerable awareness of glandular anatomy, physiology and pathology among Hippocratic doctors, especially among those who specialized in the theory and practice of obstetrics and gynecology. In conclusion, the career path of our anonymous author may be conjecturally reconstructed. It would be perverse to deny him the designation ‘Hippocratic’: after all, his work comprises a substantial fraction of the material preserved in the CH. But, as we have seen, these blocks of material transmitted as ‘Hippocratic’ may be viewed not only in relation to one another but also in relation to material from ‘non-Hippocratic’ sources. In view of the doctrinal similarities to Places in Man, discussed above, it may be suggested (and the occasional Doric feature reinforces this possibility) that the writer’s earliest scientific influence was west Greek in character, and that this was overlaid by wider experience of medical and scientific thought originating in other regions. There was evidently a considerable degree of mobility among scientists and intellectuals. The reputations of Hippocrates and of Demokritos surely attracted followers: we may postulate a move to areas where Hippocrates was practising and Demokritos researching. A further (short) step north might have led to an association with the young Aristotle. This reconstruction is, of course, highly speculative. But there is no doubt that the writer is an important figure, occupying an intermediate place between the thought of the Presocratics and study in the Academy and Lyceum.30 Bibliography Adams, F., The Genuine Works of Hippocrates. London, 1849. Byl, S., ‘Les grands traités biologiques d’Aristote et la Collection hippocratique’, in: R. Joly (ed.), Corpus Hippocraticum, CIH 2. Mons, 1977, 313–344. Craik, E.M., Hippocrates Places in Man. Oxford, 1998. ———, ‘Phlegmone normal and abnormal’, in: A. Thivel and A. Zucker (eds), Le normal et le pathologique dans la Collection hippocratique, CIH 10. Nice, 2002, 285–301. ———, Two Hippocratic Treatises: On Sight and On Anatomy. Leiden, 2006. ———, The Hippocratic Treatise On Glands. Leiden, 2009. Crivellato, E., Travan, L. and Ribatti, D., ‘The Hippocratic treatise ‘On Glands’: the first document on lymphoid tissue and lymph nodes’, Leukemia 21 (2007), 591–592. 30  I am grateful to Philip van der Eijk for constructive criticism, and to Lesley Dean-Jones and Ralph Rosen for helpful editorial suggestions.

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Dean-Jones, L.A., Women’s Bodies in Classical Greek Science. Oxford, 1994. Diels, H., Anonymi Londinensis ex Aristotelis Iatricis Menoniis et aliis Medicis Eclogae. Berlin, 1893. ———, ‘Über einen neuen Versuch, die Echtheit einiger Hippokratischen Schriften nachzuweisen’, Sitzungsb. Preuss. Akad. Wiss. 53 (1910), 1140–1155. Diels, H. and Kranz, W. (eds.), Die Fragmente der Vorsokratiker, 6th edn. Berlin and Zurich, 1952. Ermerins, F.Z., Hippocratis et aliorum medicorum veterum reliquiae. Utrecht, 1859–64. Flashar, H., Aristoteles. Problemata Physica: Aristoteles Werke in Deutscher Ubersetzung 19. Berlin, 1962. Giorgianni, F., Hippokrates, Über die Natur des Kindes (De genitura und De natura pueri), herausgegeben, ins Deutsche und Italienische übersetzt und textkritisch kommentiert. Wiesbaden, 2006. Grensemann, H., Knidische Medizin, Teil I: Die Testimonien zur ältesten Knidischen Lehre und Analysen Knidischer Schriften im Corpus Hippocraticum, Ars Medica Abt. 2, Gr.-Lat. Med. Bd. 4. Berlin and New York, 1975. ———, Hippokratische Gynäkologie: Die gynäkologischen Texte des Autors C nach den pseudohippokratischen Schriften de muliebribus I, II und de sterilibus. Wiesbaden, 1982. ———, ‘Kennzeichnet der erste Teil von De natura muliebri, eine selbstständige Stufe der griechischen Medizin’, Medizinhistorisches Journal 24 (1989), 3–24. Heidel, W.A., ‘Hippocratea I’, Harvard Studies in Classical Philology 15 (1914), 139–203. Joly, R., Hippocrate: CUF t. 11, Genit., Nat. Pue., Morb. 4, Octam. Paris, 1970 (2me tirage avec A. Thivel, 2003). ———, ‘Indices lexicaux pour la datation de Géneration, Nature de l’enfant et Maladies IV’, in: R. Joly (ed.), Corpus Hippocraticum, CIH 2. Mons, 1977, 136–147. Jones, W.H.S., The Medical Writings of Anonymus Londinensis. Cambridge, 1947. Kahlenberg, W., ‘Die zeitliche Reihenfolge der Schriften περὶ γονῆς, περὶ φύσιος παιδίου und περὶ νούσων 4 und ihre Zusammengehörigkeit’, Hermes 83 (1955), 252–256. Littré, E., Oeuvres complètes d’Hippocrate. Paris, 1839–61. Lonie, I.M., ‘On the botanical excursus in De natura pueri 22–27’, Hermes 97 (1969), 391–411. ———, ‘De natura pueri, ch. 13’, in: R. Joly (ed.), Corpus Hippocraticum, CIH 2. Mons, 1977, 123–135. ———, The Hippocratic Treatises ‘On Generation’, ‘On the Nature of the Child’, ‘Diseases IV’. Berlin and New York, 1981. Mørland, H., ‘Zur pseudohippokratischen Schrift περὶ ἀδένων’, Symbolae Osloenses 21 (1941), 84–97. Müller, C.W., ‘Zur Textgeschichte und Verfasserschaft der Hippokratischen Schrift de Natura Pueri’, in K.-D. Fischer, D. Nickel and P. Potter (eds), Text and Tradition,

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Studies in Ancient Medicine and its Transmission presented to Jutta Kollesch. Leiden, 1998, 203–221. Perilli, L., ‘Democritus, Zoology and the Physicians’, in A. Brancaci and P.-M. Morel (eds), Democritus: Science, the Arts, and the Care of the Soul. Leiden, 2007. Regenbogen, O., ‘Die Naturwissenschaft der Peripatetiker’, Scientia 50 (1931), 345–354; repr. in Kleine Schriften, ed. F. Dirlmeier. Munich, 1961, 286–295. ———, ‘Eine Forschungsmethode antiker Naturwissenschaft’, Quellen und Studien zur Geschichte der Mathematik 1.2 (1950), 151–82; repr. in Kleine Schriften, ed. F. Dirlmeier. Munich, 1961, 141–194. Rodriguez Alfageme, I., ‘Las fuentes del tratado de glandulis’, in: J.A. López-Ferez (ed.), Tratados Hipocraticos, CIH 7. Madrid, 1992, 421–435. ———, ‘Sobre la fecha de Hipp. De glandulis’, Epos 8 (1992), 549–565.

CHAPTER 10

Regimen in the Hippocratic Corpus: Diaita and Its Problems Jacques Jouanna In Greek literature of the Classical period prior to the philosophers Plato and Aristotle, comedy, reflecting as it does ordinary life, offers a particularly rich source of evidence concerning dietary practices. The historians Herodotus and Thucydides, and later Xenophon, also provide evidence, in passing, about the regimen of both individuals and societies. But medical literature is the most important source we possess in regard to Greek regimen of the Classical period, both for people in good health and for those who are ill. Indeed, it is in the corpus of sixty or so medical treatises attributed to Hippocrates, an important part of which dates from the second half of the 5th and the first half of the 4th centuries, that the Greek word for regimen, δίαιτα, occurs most frequently. It is first attested in the 6th century in the lyric poetry of Alcaeus (once), then at the beginning of the 5th century in the lyric poetry of Pindar (on two occasions), and in the tragedies of Aeschylus (once).1 It continues to be attested in the second half of the 5th century in both tragedy and comedy, although without much of an increase in frequency: Sophocles (three instances), Euripides (five), and a mere seven times in Aristophanes, even though comedy provides detailed evidence concerning dietary regimen.2 It is with the historians that the term first begins to take on serious importance, particularly in the Ionic prose of Herodotus (where it occurs 19 times),3 rather more so than in the case of Thucydides (10 times).4 Yet even if one adds the twenty or so o­ ccurrences 1  Alcaeus 61.12; Pindar, Ol. 2.65, and P. 1.93; Aeschylus, Pr. 490 (cf. Pers. 41). 2  Sophocles, El. 1073; OC 352, 751; Euripides Fr. 21.4, 812.6 (sing); 525.5, 759.2, 917.2 (pl.); Aristophanes, Vesp. 624; Eccl. 673, 1103, 1112; Pax 572; Av. 413; Ran. 114 (pl.). 3  For Herodotus, see Powell 1938/1960, s.v. δίαιτα. He distinguishes 3 senses: – 1. (6) dwell (δίαιταν ἔχειν): 1.36.1; 136.2; also δ. ποιέεσθαι 2.68.4; 3.51.2; 5.49.7; but set to dwell 2.2.5 – 2. (11) way of life: 1.157.2; 202.2; 215.1; 2.36.2 bis; 3.102.1; 4.78.3; 78.4; 95.2; 109.1; 116.2 – 3. (2) diet: 3.23.1 and perh. 9, 82.3. 4  For Thucydides, see Betant 1843/1961, s.v. δίαιτα where the ten occurrences are collected under four headings:

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in Xenophon,5 there is simply no comparison with the CH, where the occurrences of the term are numbered in the hundreds, (slightly more than two hundred in fact).6 Moreover, the substantive δίαιτα, which appears only relatively late in Greek (it is not attested before the 6th century BC), underwent an unprecedented increase in occurrences as a result of this earliest surviving medical literature. These simple statistical facts demonstrate that what we call dietetics is at the heart of the thought of the medical writers, or at any rate of some them. In fact the historian of nutrition can mine a rich seam of information from these earliest doctors. Theirs is the first body of work in Greece to provide detailed lists of foodstuffs and their different natural and artificial properties. The catalogue contained in the treatise aptly named Regimen offers the fullest and most complete example.7 It goes through, in a logical order, the properties of cereals, of meat and poultry, of fish, of vegetables, and of fruits. From among a mass of information concerning foodstuffs, their preparation and manner of preservation, we discover that Greeks ate dogs, foxes and hedgehogs.8 But the principal originality of these doctors is not simply a matter of their having systematized these inventories of foods prior to Aristotle’s classifications. It consists rather in their having investigated, for the first time in the history of Greek thought, the concept of regimen (δίαιτα).9 For this reason I have – vitae genus: 1.6.1; 1.6.3; 2.16.2; 6.15.4; 7.69.2. – victus, cultus: 7.74.1; 82.2. – curatio medica: 2.51.3. – habitatio, mansio: 1.135.3; 2.102.6. 5  For Xenophon, I have not thought it worthwhile to list the vague differences in meaning identified by the Lexicon Xenophonteum of F.G. Sturz. Here are the attestations: Mem. 1.2.5; 1.3.3; 1.3.5; 1.6.5; 1.6.9; 2.1.16; Econ. 2.8.4; 7.19.5; Cyr. 1.2.16 (ter); 1.3.2 (pl.); 7.5.6; 8.1.9; 8.2.6; 8.2.24; 8.4.2; 8.6.22; Lac. 5.1.2. 6  See J.H. Kühn/Ulrich Fleischer, Index hippocraticus, fasc. I (1986), s.v. δίαιτα. 7  Vict. 39ff., Joly 162ff. (= Jones 4.306ff. = 6.534ff. L). See also the list of foodstuffs at the end of the treatise Aff.: 47–60, Potter 5.70–86 (= 6.254–269 L). On these lists, and more generally on the development of dietetics, see Joly 1960, 99–181; Lonie 1977, 235–260; Smith 1980, 439–448; see also, on the place of Vict. in the history of dietetics, Smith 1992, 263–271. 8  Vict. 46, Joly 168.22–27 (= Jones 4.318.21–29 = 6.546.14–20 L). 9  In spite of the importance of the concept of δίαιτα, studies devoted to its vocabulary are rare. See Laín Entralgo 1987, 485–497: one may take issue with the first section, on the original sense of the word δίαιτα, insofar as it seeks to reconstruct, without textual support, an archaic δίαιτα which relates to the concepts of the microcosm and of catharsis (purgation/purification), and then a transition from the archaic concept of δίαιτα to a rationalized one by way of the Presocratic philosophers. Cf. Wöhrle 1990, 31–35 (Zum Begriff δίαιτα), in addition to the study of Laín Entralgo. See also Thivel 2000, 25–37: Thivel’s study is more philological than

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orientated this account of Hippocratic regimen, and a selection of the serious problems which relate to it, around this concept.10 It makes sense at the outset to investigate the meaning and content of what the Hippocratic doctors understood by the Greek substantive δίαιτα, from which derives both the French ‘diète’ and the English ‘diet’. The inquiry cannot be restricted in the usual manner to the substantive form only, but must be broadened to include other words in the family, of which the main ones are, on the one hand, the verb, in both its active (διαιτάω) and in its mediopassive (διαιτάομαι) forms, and, on the other, the verbal noun διαίτημα which occurs rather later in our surviving Greek texts than the substantive δίαιτα.11 Let us first consider the general semantic field of the concept. In contrast with the French word ‘diète’, whose usage is restricted to the diet of the sick, but analogously with the English ‘diet’, which has retained a more general sense, the Greek substantive δίαιτα may just as well be used to refer to the regimen of people in good health as to that of people who are ill. For example, in the treatise Ancient Medicine the case of the regimen of the healthy and that of the sick is referred to by two entirely comparable expressions (VM 3: τῶν ὑγιαινόντων δίαιτάν τε καὶ τρόφην, ‘the regimen and nutrition of healthy people’;12 VM 7: τὴν ἀμφὶ τοὺς κάμνοντας δίαιτάν τε καὶ τρόφην, ‘regimen and nutrition in that of Laín Entralgo, but it still derives the fundamental sense of the term δίαιτα on the basis of a hypothetical etymology of an imprecise nature. I have recently re-examined the question of the meaning of δίαιτα, beginning not from a dubious etymology, but rather by examining the sense of the family of words, insofar as one may seek to establish it on the basis of their earliest attested occurrences examined in the chronological order of their appearance; see Jouanna 2008b, 17–42, esp. 28–42. 10  On Hippocratic regimen from the standpoint of foods in antiquity, see Craik 1995, 343– 350; see also Craik 1995, 387–402. 11  While the substantive δίαιτα is attested from the 6th century BC, διαίτημα only appears at the turn of the 5th and 4th centuries, in Thucydides (1 occurrence), Xenophon (1 occurrence: Mem. 1.6.5), and in particular in several treatises of the CH (some forty ­occurrences). Other words which are rarer in the Corpus: διαίτησις, διαιτητικός. The adjective appears only once in Acut. (App.) 22.54, Joly 92.17 (= Potter 6.316.3 = 2.502.8 L), in its substantival form ἡ διαιτητική (sc. τέχνη), ‘the art of regimen’. As for the substantive διαίτησις, this variant appears in two passages of Vict.: – 27 Joly 144.3 (= Jones 4.264.19 = 6.500.6 L) διαιτήσει M Littré: διαίτῃ θ Jones Joly. – 76 Joly 208.18 (= Jones 4.400.4 = 6.620.2 L) διαιτήσιος θ Littré Jones: διαίτης M Joly. In both of these passages the substantive διαίτησις is the lectio difficilior. Littré’s choice of reading is thus to be preferred. 12  VM 3, Jouanna 121.6–7 (= Jones 1.16.21–2 = 1.576.2 L).

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relation to the sick’).13 The noun διαίτημα is used in exactly the same way: in the same treatise, it is used just as much in the case of the healthy as it is in that of the sick (VM 5, εἰ ταὐτὰ διαιτήματα τοῖσί τε κάμνουσι καὶ τοῖσιν ὑγιαίνουσιν ἥρμοζεν, ‘if the same types of regimen are suitable both for the healthy and the sick’).14 We may then investigate the difference in sense or usage which one might discern between the two substantives δίαιτα and διαίτημα. This is a linguistic question analogous to that which arises in connection with the sequence νόσος, νοσέω, νόσημα. Indeed, the sequence δίαιτα, διαιτάω, διαίτημα is comparable, albeit with the following difference—which would not be apparent to a speaker—that διαιτάω is not a derivative of δίαιτα.15 In these two sequences, the verbal nouns which end in -μα, which are known to have arisen in technical languages, have come to challenge the older substantives. In the same way as νόσος was challenged by νόσημα, δίαιτα was too by διαίτημα. But the development of the more recent substantive διαίτημα (which only made an appearance in Hippocrates, Thucydides and Xenophon) did not completely supplant the older term δίαιτα in the CH. In fact there are only forty or so instances of διαίτημα, as against the two hundred occurrences of δίαιτα which we have already noted.16 There is no discernible difference in usage between the two terms, apart from the fact that διαίτημα always has a plural form, while δίαιτα rarely does. In Ancient Medicine we find in every case in comparable passages that the two substantives are used indifferently. Although we have just seen the use of διαιτήματα in the context of the comparison between the regimens for the healthy and the sick, the very same comparison is expressed in ch. 8 with the substantive δίαιτα (Εἰ δέ τις σκέπτοιτο τὴν τῶν καμνόντων δίαιταν πρὸς τὴν τῶν ὑγιαινόντων, ‘If one were to examine the regimen of the sick in comparison with

13  VM 7, Jouanna 126.5–6 (= Jones 1.24.3–4 = 1.584.8–9 L). 14  VM 5, Jouanna 124.3–4 (= Jones 1.20.21–2 = 1.580.9–10 L). 15  See P. Chantraine, DELG, s.v. δίαιτα: ‘Le substantif δίαιτα est un dérivé postverbal comme le confirme la phonétique: un thème διαιτ- + le suffixe -ya n’aurait pu donner δίαιτα’. 16  In any event, it would be interesting to pursue this inquiry further by showing how the comparative frequency of the usages varies considerably from one treatise to another. In the nosological and gynaecological treatises (which are Cnidian in origin) the later form διαίτημα does not appear at all. In the treatises where it does, its frequency varies. In VM there are nine occurrence of δίαιτα as against three of διαίτημα. By contrast, it is characteristic of the treatise Nat. Hom. that the relative frequency is exactly the opposite of what one would expect on the basis of the overall statistics. There are only three occurrences of δίαιτα as opposed to 12 of διαίτημα.

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that of those in good health’).17 The synonymy between the terms is such that one finds them in the same passage as variants in the manuscript tradition.18 But while the substantives (δίαιτα and διαίτημα) can equally well refer to the regimen of the healthy and that of the sick, one may observe in the case of the corresponding verb a clear distinction of usage between the active and mediopassive voices. In the mediopassive, the verb διαιτάομαι may refer equally well to the regimen of those in good condition as well as that of the sick, just as in the case of the substantives, since it signifies ‘employ a regimen’, and has for its subject both the sick (VM 3, τοῖσιν κάμνουσι . . . διαιτωμένοισί)19 as well those in good health (VM 5, ὅνπερ οἱ ὑγιαίνοντες διαιτέονται, ‘the regimen followed by those in good health’).20 By contrast, however, the active verb, which means ‘prescribe a regimen’, is used only for the doctor’s orders. There is no exception to this distinction, even if, in all the cases where the verb is used in the active (and these are almost as numerous—forty or so—as the fifty or so mediopassive usages), one must always understand, even when the subject is not named or made clear, that it is the doctor who is intervening to control the patient’s regimen.21 These generally involve the imperative infinitive (διαιτᾶν). They are to be found particularly in the nosological treatises, in the course of the development of the therapy appropriate to each disease, whether it be of diseases common to both sexes (Diseases 2, Diseases 3, Internal Affections, Affections), or of those restricted to women (Nature of Woman, Diseases of Women 1, Diseases of Women 2). This formulation is also to be found in the surgical treatises, in prescribing the regimen to follow after operations (Fractures). Here then are the facts concerning the usage of the principal words of the δίαιτα family. In summary, the substantives, whether in the older form δίαιτα or the later διαίτημα, are used indifferently for the regimen of people and good health and the sick. As for the verbal form, its sense clearly differs according to 17  VM 8, Jouanna 1.586.3–4 (= Jones 1.24.17–18 = 1.286.3–4 L). Compare Acut. 9.28, Joly 47.22–3 (= Jones 2.84.14–15 = 2.280.8–9 L), τὰ μαθήματα ποιεῖσθαι ἐν τῇ διαίτῃ τῶν ἀνθρώπων ἔτι ὑγιαινόντων. 18  The same is true in Nat. Hom 9. διαίτῃ A Jones, Jouanna: διαιτήμασιν MV Gal (V) Littré: διαίτῃσιν Gal (L). See Jouanna 190.12 (= Jones 4.26.22 = 6.54.17 L). 19  VM 3, Jouanna 120.17–18 (= Jones 1.16.13–14 = 1.574.9–10 L). 20  VM 5, Jouanna 124.7 (= Jones 1.20.24ff. = 1.580.12 L). 21  Translators do not always observe the distinction between the active and mediopassive. Thus, in Acut. 4, Joly 41.20 (= Jones 2.72.24–25 = 2.254.4–5 L), καὶ ἔμπυοι ἧσσον γίνονται ἢ εἰ ἀλλοίως τις διαιτῴη is translated by Littré as ‘les empyèmes se forment moins que sous un autre régime’; this translation is ambiguous, since the Greek clearly reads ‘and they become less empyematic than if one prescribed an alternative regimen’.

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voice: in the active, it takes as its subject the doctor who prescribes a regimen for the patient; in the mediopassive, its subject is either the patient for whom the doctor has prescribed the regimen or people in good health who are following some regimen or other.22 After considering the matter of usage, let us now turn to the content of the concept. What are the elements which constitute regimen for the Hippocratic doctors? The answer is not as straightforward as it might seem, since even in its technical sense its content varies much more than one would have thought, both from doctor to doctor and according to context. In certain treatises of the corpus, δίαιτα has a restricted sense, comparable to what we mean by ‘nourishment’. Regimen covers everything that is ingested, both food and drink. This is the case, for instance, in Ancient Medicine and Regimen in Acute Diseases. When the author of the latter work states that one must observe the patient’s individual regimen in order to take it into account when prescribing the regimen for the illness, he makes it clear what should be understood by ‘normal regimen’ when he says ὁ τρόπος . . . τοῦ ἔθεος τῆς διαίτης τοῦ κάμνοντος, οὐ μόνον σιτίων, ἀλλὰ καὶ ποτῶν, ‘the patient’s normal practice, not only foods but also drinks’.23 Regimen, then, is two-fold; it involves not only food but drink as well. The same is true in Ancient Medicine, where the author says that the regimen (δίαιτα) for people in good health would never have been discovered, if it had been enough for man to eat and drink (ἐσθίοντι καὶ πίνοντι) the same things as cattle.24 Thus regimen in health is understood by both doctors as consisting of the traditional pairing of foods and drinks. But they also know that regimen for the sick is more complicated, and that doctors’ discoveries have introduced a category intermediate between that of the solid (τὰ σιτία) and the liquid (τὰ ποτά or τὰ πόματα or more rarely τὰ ποτήματα), one which doctors call τὰ ῥυφήματα. The best example of this occurs in the passage of Ancient Medicine 5, where the author enumerates the three discoveries regarding the regimen of the sick which have taken the form of modifying the regimen of those in health in order to accommodate it to the different conditions of the patient: first of all, a solid regimen, then a regimen intermediate between solid and liquid, then finally a wholly liquid regimen for 22  One may add in conclusion of this first point that the class of individuals concerned varies according to context. To take as an example the category of the sick, which is obviously mentioned more frequently than that of those in good condition: the regimen in question might be that of the class of the sick as a whole, or of a type of sick person, or of one individual in particular. 23  Acut. 38, Joly 52.4–7 (= Jones 2.92.29–94.1 = 2.302.10–304.2 L). 24  VM 3, Jouanna 1.24.18–20 (= Jones 1.16.21–27 = 1.576.1–5 L).

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the weakest patients. This is what he says about the discovery of the intermediate regimen: They discovered gruels (ῥυφήματα) by mixing small quantities of strong substances with a lot of water, thus eradicating the strength of these substances by dilution and cooking.25 The regimen of the sick thus consists of a triad, in which gruels (ῥυφήματα) have been inserted between foods and drinks. Moreover, we know that the doctors made much finer distinctions than this lucid but schematic classification of Ancient Medicine between the elements of regimen, since the author of Regimen in Acute Diseases 4.10ff. discusses at length and in detail the recipe for one of these gruels for acute diseases, πτισάνη, which is made from grains of boiled barley, and comes in two forms, either a gruel with the grains still in it, or the strained juice of the πτισάνη without the grains.26 Do these authors consider any other elements to be constitutive of regimen, apart from the pair of food and drink for the healthy, with addition of gruel for the sick? The question arises when the author of Ancient Medicine uses the expression ἅπερ οἱ ὑγιαίνοντες ἐσθίουσί τε καὶ πίνουσι καὶ τἄλλα διαιτέονται’, ‘things which people in good health eat, drink, and conform to in the ret of their regimen’, to characterize the regimen of those in good condition.27 Food and drink do not seem to exhaust what the author understands by ‘regimen’. But nothing in the remainder of the treatise allows us to give any concrete content to any actual additions. In the treatise Regimen in Acute Diseases, one would be tempted to add bathing, to which the author devotes a discussion at the end of the treatise to the regimen of the sick. However, if one looks closely at the vocabulary he employs, he reserves the term δίαιτα (regimen) for foods, gruels and drinks, even when he talks about bathing. Here then is what he says about prescribing bathing: Τεκμαίρεσθαι δὲ χρὴ τοῖσι προγεγραμμένοισιν, οὕς τε μέλλει λουτρὸν ὠφελεῖν ἐν ἑκάστοισι τῶν τρόπων τῆς διαίτης οὕς τε μή.

25  VM 5, Jouanna 1.24.18–20 (= Jones 1.22.5–7 = 1.582–3 L). 26  Acut. 4.10ff., Joly 40.2ff. (= Jones 2.70.7ff. = 2.244.7ff. L). 27  VM 3, Jouanna 120.19–121.1 (= Jones 1.16.14–15 = 1.574.10–11 L).

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We need to distinguish, on the basis of what was said before, those patients for whom bathing will be useful in the case of each type of regimen, and those for whom it will not.28 The types of regimen in the context are that of unstrained πτισάνη, of strained πτισάνη, and of drink alone, i.e. three types which answer to two of the three categories of the general classification established by the author of Ancient Medicine: regimen of drink alone, and regimen of gruels, with the subsidiary distinction between unstrained and strained πτισάνη. Thus bathing does not form part of the definition of δίαιτα, but is rather prescribed in connection with the type of δίαιτα defined by what the patient ingests. That, then, is what is involved in the most restricted definition of δίαιτα in the CH. It is what we ingest. But there are texts in which the concept of δίαιτα has a broader extension, since it includes exercise as well. Here, for example, is how the author of Airs, Waters, Places defines the regimen of the inhabitants which the itinerant doctor needs to take note of when he arrives in a new city where he wants to practise his profession: He needs to take account of the regimen (δίαιτα) of the inhabitants, what is agreeable to them, if they like drinks, take a meal at midday and are inactive, or whether they like exercise and exertion, eat a lot and drink little.29 So the regimen of those in good health involves more than just food and drink.30 Exercise also appears in the definition, since the doctor must see whether the inhabitants are inactive or whether they enjoy exercise and exertion. Thus regimen presents itself in the form of a triad which comprises three components on the same level: drink, food and exercise. This triad gives rise to formulations which involve stylistic effects. Thus, here is what is recommended concerning regimen in the course of the therapeutics of leucophlegmasia in the treatise Affections:

28  Acut. 18.68, Joly 67.12–14 (= Jones 2.124.10–13 = 2.372.6–8 L). 29  Aer. 1, Jouanna 188.2–5 (= Diller 26.2–4 = Jones 1.70–72 = 2.12.18–21 L); see the detailed commentary on the passage in Jouanna, 188, n. 2 (= p. 254ff.) 30  The distinction between the two is so clear-cut in this text that the author thinks it impossible to be both ‘big eaters and big drinkers’; see Aer. 4, Jouanna 191.1–3 (= Diller 30.13–15 = Jones 1.78.1–3 = 2.20.10–11 L).

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διαιτᾶν δὲ σιτίοισι καὶ ποτοῖσι καὶ πόνοισιν, ὑφ᾿ ὧν ξηρότατος ἔσται καὶ ἰσχνότατος. Prescribe a regimen involving food, drink and exercise as a result of which he [sc. the patient] will be as dry and thin as possible.31 The three datives of means dependent upon the imperative infinitive διαιτᾶν form a triad which show the effects of parisosis and parahomoioisis. The three terms σιτίοισι, ποτοῖσι, πόνοισιν, are of roughly the same length (4/3/3 syllables) and end with the same phonemes (οισι -οισιν); furthermore, the latter two begin with the same phoneme (πο-), thus differing only by the change of a single letter in their root (τ/ν). The doctors are not averse to employing artful prose.32 Such triads, so seductive from a stylistic point of view, are not the sole province of a single doctor. We find another in the treatise Regimen: διαιτᾶσθαι δὲ συμφέρει ὅσα ξηραίνοντα ψύχει καὶ σίτων καὶ ποτῶν καὶ πόνων. As far as regimen is concerned it is useful for him (sc. someone who has a moist and warm nature) to make use of everything which chills while drying: foods, drinks and exercises.33 Thanks to the possibility of using not only τὰ σιτία but also τὰ σῖτα to designate foodstuffs, the author here achieves a rhetorically-perfect triad, comprising three phonetically linked trisyllabic homoioteleuta such that the central term ποτῶν forms a pivot which relates in specific ways both with the preceding term (same final -τῶν) and with the one which follows (same initial πο-).34 This reminds us incidentally of the fact that the Hippocratic doctors are not only professional men, but writers as well. Thus we may speak of ‘literature’ in the broad sense of the term. We may also expect from the doctors, just as from the other writers of the period, coherence as well as flexibility. In fact, when one gets down to the details, we discover such a flexibility of expression that we may find variations in the ways in which the elements of δίαιτα are 31  Aff. 10, Potter 5.32.20–22 (= 6.228.10–11 L). 32  These stylistic effects are even more in evidence in the sentence they follow, which involves of two other co-ordinate adjectives of the same length and sonic value (ξηρότατος / ἰσχνότατος). 33  Vict. 32, Joly (= Jones 4.276.19–21 = 6.510.6–7 L). 34  Cf. also Vict. 35, Joly 154.18 (= Jones 4.288.9 = 6.518.16–17 L): καὶ σίτων καὶ ποτῶν καὶ πόνων.

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organized even in the same author and in the same context. This is the case with the author of Regimen, in the very exposition in which he deploys the formally-perfect triad involving foodstuffs, drinks and exercises. The author defines the different human constitutions which result from the different mixtures of its two primary constitutive elements, namely fire and water. And for each of these six constitutions, apart from the first which is perfect, the author describes the regimen which will allow him to counteract the deficiencies of each of them. The triad we have just remarked upon occurs in the fourth constitution (moist and warm). In the subsequent fifth constitution (dry and warm), we find the following regimen: δίαιται, ὅσαι ψύχουσι καὶ ὑγραίνουσι, καὶ τῶν πόνων ὅσοι ἥκιστα ἐκθερμαίνοντες καὶ συντήκοντες πλείστην ψῦξιν παρασχήσουσιν. Regimens which cool and moisten, and of exercises those which warm and which, while provoking melting to the least extent, provide warming to the greatest.35 The conceptual organisation is no longer the same. We have returned to a restricted conception of δίαιτα, composed of two elements only (food and drink); as far as exercises are concerned, they are paired with δίαιτα, which is used in the remainder in the plural, something which is fairly rare when δίαιτα means ‘regimen’. For all that, this organisation is not exceptional, since in the sixth and final constitution (cold and moist), regimen is also coupled with exercise: δίαιται . . . καὶ πόνοι.36 Is this merely a function of the fact that the definition of regimen involving two elements (food and drink) occurs more frequently among the doctors than the tripartite definition (food, drink, exercise)? Or does it also allow the author to formulate, by way of the pair regimen/exercise, a redistribution which better corresponds to his fundamental views on the matter? To be sure, the basic idea which the author of Regimen presents as being his own discovery is that health is the result of a balance between two factors, both what we call nourishment (including both eating and drinking) and physical activity, while illness occurs as a result of an imbalance between them.37 35  Vict. 32, Joly 148.32–3 (= Jones 4.276.19–21 = 6.510.6–7 L). 36  Vict. 32, Joly 150.8 (= Jones 4.278.10–11 = 6.510.20–1 L). See also Vict. 75, Joly 206.34 (= Jones 4.396.25–6 = 6.616.22.3 L): ἀπό τε τῆς διαίτης καὶ τῶν πόνων. 37  This definition of health is set out at the beginning of the treatise: Vict. 2, Joly 124.5–8 (= Jones 4.226.19–228.25 = 6.468.19–470.3 L): ‘Man cannot be in good health if he eats without also taking exercise. The fact is that foodstuffs and exercises, even though they

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This flexibility in the content of the concept of regimen is also seen going the other way (also in Regimen), in the form of a broader content, when the author turns, in one of the more medical sections, to the exposition of the regimen which should be adopted to preserve the health of the population as a whole, whether they be poor or rich (chs. 68–9). The range of factors of concern to the physician of regimen is thus supplemented by secondary elements which serve to complement the principal ones (i.e. food, drink and exercise), notably bathing, exposure to the sun, sexual relations, and finally vomiting and sleep.38 This, then, is the content of the Hippocratic concept of δίαιτα. Even if it varies from author to author, or even according to context, it comprises the following principal elements: Either (a) What is ingested, without including exercise. In this case, it consists either in the pair foodstuffs/drink or in the triad foodstuffs/gruels/drink. Or (b) The combination of both what is ingested and exercise. In this case, we have the triad foodstuffs/drink/exercises. To these principal elements may be added secondary ones, including bathing, exposure to the sun, not to mention sleep and sexual relations (although this list is not exhaustive) Finally, the concept of δίαιτα may be descriptive, when it involves the doctor’s taking into account the regimen of an individual or group of individuals; but in general it is prescriptive, since for the most part it involves rules prescribed by the doctor for curing the sick or for the preservation of health. When the concept is prescriptive, it becomes part of therapeutics. Within the context of therapeutics, one may demarcate the concept of δίαιτα negatively, by what it does not include. We may now complete the definition of δίαιτα. Regimen is in general distinguished from remedies. In fact, while the parts of medicine are not at this time cleanly divided, doctors still distinguish, in the treatment have properties opposed to one another, are mutually conducive to health; for exercise is by nature such as to consume what exists, while foodstuffs and drink replenish what has been used up’. The author reaffirms this view at Vict. 69, Joly 200.32–202.2 (= Jones 4.382.14–16 = 6.606.8–9 L): ‘Since it is from the predominance of one of these two elements that illnesses arise, while health depends upon the balance between them’. 38  Already in his catalogue of foodstuffs and exercises, the author makes several additions which he would certainly want to include in regimen: ch. 57, bathing; ch. 58, several things, including exposure to the sun and sexual relations; ch. 59, sleep.

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of diseases, purgative drugs (φάρμακα) from foodstuffs (σιτία)39 and more generally purgation by drugs (φάρμακα, φαρμακεία) from regimen (δίαιτα).40 For example, Nature of Man clearly states that therapeutics (θεραπεία) breaks down into two branches: drug-therapy (φαρμακεία) and regimen (δίαιτα or διαιτήματα).41 And as is well known, one of the characteristics of Hippocratic medicine is to have developed a dietetics alongside the more traditional drugtherapies, and even to have suggested a purely dietetic therapeutics as an alternative to pharmacological therapeutics.42 So here, then, are the usages and senses of the substantives δίαιτα and διαίτημα, along with the corresponding verb διαιτᾶν, in both the active and the mediopassive, in the earliest surviving medical writings. There is certainly a technical sense, even if the concept is more complex and flexible than one might have supposed. We now need to relocate this technical sense within its linguistic context, i.e. within the ensemble of usages of the δίαιτα family, as understood both from a synchronic and from a diachronic perspective. I cannot consider this question in detail here; but I have dealt with it elsewhere in a recent article,43 whose principal conclusions I will now briefly present. 39  See for example, in Morb II.72, Jouanna 212.2–7 (= Potter 5.326.14–20 = 7.110.5–10 L) the beginning of the treatment for the disease called ‘anxiety’ (φροντίς): ‘In this case, give hellebore to drink; purge the head; and after the purging of the head, give them a drug (φάρμακον) to drink which evacuates through the lower regions, and then have the patient drink the milk of a female donkey. As for foodstuffs (σιτίοισι), he should take them in the smallest possible quantities, if he is not weak; they should be cold and laxative, and should be neither acrid, warm, greasy, or sweet. . . .’ 40  For the distinction between drugs (φάρμακα) and regimen in general (δίαιτα), see the critique in Acut 1.1–3, of Cnidian Sentences, a medical work now lost apart from fragments: after criticizing the use of drugs in this older treatise, which amounts simply to the use of purgative drugs (Joly 36.16 = Jones 2.62.16–17 = 2.226.4 L, φάρμακα ἐλατήρια), the author goes on to say (Joly 37.2–3 = Jones 2.64.4–6 = 2.226.9–11 L): ‘But not even in the case of regimen (δίαιτα) have the ancients written anything of value: and this is a huge gap’. 41  Nat. Hom. 9, Jouanna 190.9–12 (= Jones 4.26.17–22 = 6.54.14–17 L). Other Hippocratic texts confirm this distinction; see Prog. 15, Alexanderson 212.3–4 (= Jones 2.30.17–18 = 2.148.2–3 L), where we find mentioned on an equal footing purgative drugs (φαρμακείας) and regimen (διαίτας); see also Aff. 20, Potter 5.34.20 (=6.230.3–4 L): ‘If those who are sick (in the spleen) do not need purging (φαρμακείης), prescribe a regimen (διαιτᾶν)’; and see Mul. I.66, 8.136.12 L: ‘After purging (μετὰ τὴν φαρμακείην), prescribe a regimen such that (διαιτᾶν διαίτῃ τοιαύτῃ) the woman be as dry as possible’. 42  See for example Vict. 73, Joly 206.5 (= Jones 4.392.28 = 6.614.9 L) where, after a rapid pharmacological treatment, an alternative dietetic treatment is proposed for those who refuse to take drugs (εἰ δὲ μὴ βούλοιτο φαρμακοποτεῖν). 43  Op.cit. n. 9 above, pp. 17–42; precise references to the texts here mentioned in passing can be found in this article.

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From its earliest appearances in the lyric poets Alcaeus and Pindar, as well as in Aeschylus, the term δίαιτα has a broad sense: it designates the ‘way of life’ or ‘kind of life’, be it of individuals, humanity as a whole or peoples, a broad sense which can also be found in the historians Herodotus and Thucydides, and indeed in the ethnographical section of Airs, Water, Places.44 This broad sense leads one to conclude that the medical sense of ‘regimen’ is not the primary one, but is rather a particularisation of the original sense of δίαιτα, a word which had from the outset a more extended range of meaning. This accounts for the fact that the concept of δίαιτα could also be given another particular technical sense, one quite different from the medical, namely the legal sense of ‘judgment’ for the substantive δίαιτα and ‘judge’ for the verb διαιτᾶν. In order to understand the link which connects these two apparently so widely separated technical senses, the medical and the legal, we need to go back to two of the earliest uses of the verb διαιτᾶν, attested in the active voice in Pindar, where it has the sense of ‘rule’ or ‘direct’ a city and its people. From this standpoint, one sees how the verb διαιτᾶν could have been used in regard to the judge who rules over a matter in a difficult case and of the doctor who regulates the regimen in the case of a disease. Going back in this way, if not to its origins (since the etymology remains hypothetical), then at least to its earliest attested uses, makes us aware of a fundamental idea underlying the concept of δίαιτα, no matter what its particular domain may be, namely that of rule, of the organisation which one enforces (verb in the active voice), or imposes on oneself, or has imposed on one (verb in the mediopassive). Whatever the domain of use, whatever the particular content of the concept of δίαιτα, the idea of ‘rule’ or ‘regularity’ is always present.45 In the medical context, the concept 44  In the second part of the treatise Aër., which is more ethnographic than medical, the word δίαιτα is used in the broader sense of ‘kind of life’ in regard to the Scythians, Aër. 18/19, Jouanna 232.12 (= Diller 66.17 = Jones 1.120.3 = 2.70.1 L); it is treated on the same level as νόμοι, ‘customs’. This kind of life comprises not only nutrition, drink and exercise but also, among other things, the place where one lives one’s life (cf. the two uses of the corresponding verb διαιτέομαι in the same ch. 18; and cf. the usage of δίαιτα in regard to the inhabitants of Phasis in ch. 15, Jouanna 225.10 (= Diller 60.3 = Jones 1.112.5 = 2.60.11 L). 45  Thus the family of the Greek word διαιτᾶν has ancient usages which are not very different from those of the family of the Latin regere, and the fact that the French word ‘régime’, which is usually used in medical contexts to translate the Greek δίαιτα, even though it derives from the Latin regimen, is not entirely arbitrary. Families of words with different morphologies but similar sense, may undergo, within their respective languages, analogous semantic evolutions in comparable domains, even if their chronology is not necessarily the same. The medical sense of the Latin regimen appears only in late Latin, which is evidently not the case for the Greek διαίτα. On the other hand, the transliteration of δίαιτα into the Latin diaeta, did not meet with much success in Latin medicine. A passage

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of δίαιτα as comprising an organised ensemble of elements is evidently more apparent when it involves the regimen prescribed by the doctor to the patient than when it involves the regimen followed by the patient before his illness. But what defines regimen, even when it is not prescribed, are the normal and regular behaviours in regard to nutrition, drink, as well as exercise. Equally, outside the domain of medicine, in the usual sense of δίαιτα which signifies in a broad sense the kind of life of an individual or of a people, including where they live, even though nutrition need not be one of its primary elements, it is still the regularity of conduct which remains at the basis of the concept. Let us now turn to the major problems which the ancient doctors raised concerning regimen, or which we may raise concerning it. I should like first of all to clarify the spirit in which I approach these problems. I have no intention, even if it were possible, of expounding in detail the positions of this or that doctor in their thinking about regimen. I have no intention of taking as my starting-point the distinction described and prescribed regimen. Rather, following the theme of the Colloque, I would like to consider regimen from a broad perspective as much from the standpoint of the concept itself as from that of the Hippocratic doctors, without ruling out a comparison, where possible, with other doctors of the classical period and even with the contemporary historians. I have chosen three areas for examination: regimen in cities and peoples; regimen and human nature; regimen and the environment. As regards regimen of cities and peoples, people nowadays will think immediately of the Cretan or Mediterranean diets, so much promoted by nutritionists and dieticians. The problem which I raise is that of whether the ancients of the Classical era were aware of the existence of a nutritional regimen specific to different cities and peoples, and particularly a Greek regimen distinct from that for other peoples. First, as regards the cities, the Hippocratic ­doctors were aware that the Greek regimen could vary from one city to another.46 of Caelius Aurelianus (Acut. 3.135, ed. G. Bendz CML VI 1, p. 373.34–374.1) says that it is the Greek word corresponding to the Latin regulae ciborum; even so, the books on regimen which are called in Latin libri regulares are so called by transliteration from the Greek diaetetici (Caelius Aurelianus, Tard. 2.145, ed. G. Bendz CML VI 1, p. 632.10). So there was another term from the regere family, regula, with the derivative adjective regularis which corresponded in Latin to the Greek δίαιτα prior to the use of regimen in late antiquity. 46  This is idea is also found in the historians. Among the regimens of the cities, that of the Spartans was famous for its austerity (Xenophon, Spartan Republic 2.5 and 5.3). This is confirmed by the testimony of Herodotus, when he speaks of the simplicity and frugality of dinner in the Spartan fashion of Pausanias by contrast with the luxury and sumptuousness

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In fact, since the author of Airs, Waters, Places, in the passage I cited in order to define the regimen with three elements, advises the doctor, on arriving in a city unfamiliar to him, to take note of the regimen of its inhabitants (Aër. 1, Καὶ τὴν δίαιταν τῶν ἀνθρώπων ὁκοίῃ ἥδονται),47 this implies that a city can be characterised as much in terms of the general orientation of its inhabitants’ regimen as by its geographical orientation. The same advice for all doctors wishing to treat correctly to take note of the regimen of the city’s inhabitants is also attested in a fragment of Euripides quoted by Clement of Alexandria.48 Euripides’ formulation is so close to that of the Hippocratic doctor (frag. 917 Kannicht v. 2, πρὸς τὰς διαίτας τῶν ἐνοικούντων πόλιν) that one wonders whether Euripides did not know the treatise Airs, Waters, Places. The only difference is that the substantive δίαιτα is used in the singular by the doctor and in the plural by the poet. But this difference is not significant.49 It is a matter of regret that the author of Airs, Waters, Places did not devote a separate discussion to this particular factor, as he did to the others which he mentioned in the same schema. But a few remarks made in passing about regimen in two of the discussions of the orientations of cities, one on the south-facing city (ch. 3) and the other on the north-facing city (ch. 4),50 allow us to infer that the regimen of the inhabitants, like their constitution, is determined at least in part by the geographical orientation of the city in relation to the sun and winds. Moreover, it is implicit that the regimen of the inhabitants of a city, according to this doctor, is located within a huge network of links between man and his natural environment.51 of dinner in the Persian fashion prepared Mardonius’s chefs (Histories 9.82). The contrast between Greek and Persian here is all the greater, since the regimen of the Spartans was especially frugal. 47  Aer. 1, Jouanna 188.2–3 (= Diller 26.2 = 2.12.18–19 L). 48  On the relationship between medicine and tragedy, see Nestle 1938, 24 and n. 2; Jouanna 1987, 109–131 (esp. 119–120); Guardasole 2000, 77–79, 84, 269. 49  The plural is also found in the Hippocratics, although much more rarely than the singular (24 times out of more than two hundred). See Index hippocraticus s. v. δίαιτα, where the plural uses are reported at the beginning of the article. 50  Aer. 3, Jouanna 190.11–13: ‘The inhabitants are incapable of either eating or drinking well; for those with weak heads are unable to drink well; drunkenness overwhelms them more than it does other people’; Aer. 4, Jouanna, 193.12–194.2: ‘It is necessary for those with this sort of constitution to be great eaters and not great drinkers: for it is impossible to be both a great drinker and a great eater’. 51  According to Vict. 67, Joly 194.7 (= Jones 4.366.10–11 = 6. 592.7–8 L), the location of sites, as well as the direction of winds, is also one of the variables which must be taken into account in the study of regimen.

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Furthermore, doctors were able to observe that within a single city groups of inhabitants could be differentiated according to their regimen. Thus the author of Nature of Man, in adopting the tripartite division of the components of regimen (drinks, foodstuffs, exercise), distinguishes within the same city between wine-drinkers and water-drinkers, consumers of wheat bread and of barleycakes, those who exercise a great deal and those who exercise ­sparingly.52 He contrasts this diversity of regimen with the uniformity of the air which all of the inhabitants breathe. This contrast allows him to account for the difference between epidemic and particular diseases.53 One of the differences in regimen which particularly caught the doctors’ attention was the number of meals per day. This is precisely what the author of Airs, Waters, Places, tells the doctor to take note of in regard to nutritional regimen when he arrives in a city he does not know. He should find out whether the inhabitants are ἀριστηταί, whether that is they take lunch at midday, which amounts to saying that they eat twice a day. For some people take only one meal a day, the evening meal, dinner (δεῖπνον), while others take two meals, one at midday, lunch (ἄριστον), in addition to the evening meal. The technical medical vocabulary itself attests to the doctors’ concern with this difference in regimen: here we meet, in fact for the first time in the CH, a compound Greek verb coined to designate the fact of taking only one meal a day: μονοσιτεῖν.54 This verb, which is rarely attested outside medical literature, is a 52  Nat. Hom. 9, Jouanna 188.18–20 (= Jones 4.24–26 = 6.54.1–4 L). It is worth quoting in this context the passage on different regimens: ‘It is perfectly clear that the regimen (τὰ διαιτήματα) of each of us cannot be the cause of the disease if it attacks everybody indifferently, young and old, women and men, and, without distinction, wine-drinkers and water-drinkers, those who eat barley bread and those who consume wheat bread, those who exercise a great deal and those who do so sparingly’. 53  Nat. Hom. 9, Jouanna 188.20–190.3 (= Jones 4.26.3–8 = 6.54.4–7 L): ‘(For epidemic diseases) regimen (τὰ διαίτηματα) cannot be the cause when, notwithstanding the great diversity in regimen (διαιτώμενοι πάντας τρόπους), individuals are stricken with the same disease. But when diseases of all different kinds arise at the same time, it is clear that the cause of them in each case is the regimen (τὰ διαιτήματα) of each of them’. 54  The verb μονοσιτεῖν occurs three times in VM (ch. 10 bis; ch. 11); three times also in Acut. (ch. 4, ch. 9 bis); and once in Acut. (App.) 18; cf. also Nat. Hom. 19 (= Salubr. 4), 22 (= Salubr. 7); Vict. 81. It is not insignificant that this word appears particularly in texts in which dietetics play an important role; see also Epid. 7.3, Int. Aff. 20, Mul. I.1, cf. also an attestation in a dietetic context in Diocles of Carystus fr. (verbatim) 182.1, 174 van der Eijk; see below, p. 226. We also find the substantive μονοσιτίη, both in texts which also employ the verb (Acut. 9, Vict. 60 bis and 68), as well as in other treatises (Epid. II.2.1, Aff. 43, Mul. 2.110). There is no corresponding compound word to designate the taking of two meals a day. The opposite of μονοσιτεῖν is δὶς σιτεῖσθαι (Acut. 4 and 9); or the verb

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sign, among others, of the importance the doctors accorded to the rhythm of meals in nutritional practice. In the classical period, outside medical literature, where it occurs 14 times, the verb μονοσιτεῖν is found only twice, in the same passage at the end of Xenophon’s Cyropaedia (8.8.9), in which he describes the regimen of the Persians: On the other hand, there was a practice among them (sc. the Persians) of taking only one meal a day (μονοσιτεῖν) in order to devote the day to activity and exercise. To be sure, they eat only one meal a day (μονοσιτεῖν), but they start eating at the time when those who lunch earliest begin, and continue to eat and drink until the time when those who sleep latest begin their dinners. This text then tells us about a nutritional practice characteristic of the Persians, that of taking a single meal. In the time of Cyrus, the single evening meal allowed them to lose no time in eating, and to devote the whole day to a life of activity and exercise prior to eating.55 But this ancient practice had changed in character by the time of the decadence of Persian customs in his time which Xenophon sought to expose. Even though they continued to take only one meal a day, the Persians spent most of the day eating. There is a tendency to contrast this single-meal Persian regimen with that of the Greeks, with its two daily meals;56 but this is an over-simplification. As we have just seen, according to the testimony of the doctors, Greek nutritional practice varied from one city to the next, and among the inhabitants of a single city. That being said, when another doctor of the Classical period, Diocles of Carystus, lays out the regimen to be followed throughout the day in order to preserve a man’s health (fr. 182 van der Eijk), he thinks of a midday meal and an evening meal as being the norm. Yet in certain cases and for ἀριστᾶν or ἀριστίζεσθαι to designate the fact of taking a meal at midday, which is equivalent to taking two meals; cf. ἀριστητής in Aer. 1. On μονοσιτεῖν see the brief comments in Moussy 1969, 107. 55  In fact, when Xenophon speaks of Cyrus himself, he says that he never took his dinner without having previously worked up a sweat in his exercises (Cyropaedia 8.1.38). The Persian habit of taking only a single meal is confirmed by Herodotus (7.120), where he alludes to the regimen of Xerxes, who ate only lunch at midday. 56  See the note of E. Delebecque in his edition, on this passage (151, n. 1): ‘Xénophon est d’accord avec Hérodote 7.120, sur ce point, mais dans la Cyropédie il fait suivre aux Perses l’usage grec de l’ἄριστον et du δεῖπνον’.

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certain p ­ eriods of the year he advocates taking a single meal (fr. 182.1, 174 van der Eijk: μονοσιτεῖν).57 The case of the regimen of the Persians may serve by way of transition from the regimen of different cities to that of different peoples. Were the Hippocratic doctors aware of this issue? To be sure, such matters are not of direct concern to them in the course of their medical practice, since the doctors whose writings are collected in the CH seem to have all practised in Greek locales; even so, two of them touch incidentally upon two aspects of the question. One of them, the author of Airs, Waters, Places, in generalizing the ­theories derived from his medical practice in the Greek cities, touches incidentally, in his comparison between Europe and Asia, on the δίαιτα of the inhabitants of the marshes of Phasis (ch. 15) and the cold Scythian plains (ch. 18), which indicates this Greek doctor’s awareness of the diversity or singularity of regimen or way of life of non-Greek peoples, an awareness comparable to that of Herodotus. However, the author of Ancient Medicine adopts, in his reflections on the birth of the medical art, a decidedly Hellenocentric stance, which bears comparison with the other great historian of the Classical period, Thucydides. Here is the passage of Ancient Medicine (ch. 5) where the author contrasts the majority of Greeks with the barbarians in regard to the regimen practised in the case of diseases: In my opinion, research in medicine would never have started if the same regimen (διαιτήματα) had been equally suitable both to the sick and do those in good condition. What is certain is that, even nowadays (ἔτι καὶ νῦν), all those who make no use of medicine—barbarians and a small number of Greeks (οἵ τε βάρβαροι καὶ τῶν Ἑ λλήνων ἔνιοι)—employ the same regimen when they are sick as do people in good condition (ὅνπερ οἱ ὑγιαίνοντες διαιτέονται), thinking of nothing but their pleasure, and they do not know how to give up any of the dishes which they desire, nor even how to reduce them in quantity. But those who have sought and discovered medicine . . ., first of all (πρῶτον), in my opinion, cut back on the amount of these foodstuffs themselves and reduce their quantity from a great deal to very little.58 In order to reconstruct the birth of medicine in the differentiation of the regimen of the sick from that of those in good condition, the author focuses on the 57  People who are well-fleshed and moist should take only one meal after the setting of the Pleiades and before their rising. 58  VM 5, Jouanna 124.2–13 (= Jones 1.20.19–31 = 1.580.8–17 L).

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current state of peoples who do not practice medicine and make no change in their regimen when they are sick. Who are the peoples in question? All of the barbarians and a minority of the Greeks. Thus the doctor asserts the superiority of the majority of the Greeks over the barbarians and a small number of Greeks who live like barbarians. According to this doctor, this superiority of Greek over barbarian is both scientific and ethical: scientific, since they have discovered the art of medicine in order to modify regimen, ethical, since they know how to give up pleasure in order to recover their health. This reconstruction of past advances in δίαιτα by way of reference to the present state of the barbarians and a small and backward part of the Greek world finds a remarkable parallel in Thucydides (1.6), even if the word δίαιτα is used not in its technical medical sense, but in the broader sense of ‘kind of life’. Here is the passage in question: 1 Πᾶσα γὰρ ἡ Ἑ λλὰς ἐσιδηροφόρει διὰ τὰς ἀφάρκτους τε οἰκήσεις καὶ οὐκ ἀσφαλεῖς παρ᾿ἀλλήλους ἐφόδους, καὶ ξυνήθη τὴν δίαιταν μεθ᾿ ὅπλων ἐποιήσαντο ὥσπερ οἱ βάρβαροι. 2 Σημεῖον δ᾿ ἐστὶ ταῦτα τῆς Ἑ λλάδος ἔτι οὕτω νεμόμενα τῶν ποτε καὶ ἐς πάντας ὁμοίων διαιτημάτων. 3 Ἐ ν τοῖς πρῶτοι δὲ Ἀθηναῖοι τόν τε σίδηρον κατέθεντο καὶ ἀνειμένῃ τῇ διαίτῃ ἐς τὸ τρυφερώτερον μετέστησαν. 1 The whole of Greece bore arms, since their dwellings were not fortified, and because encounters between people were not safe and it was for the Greeks part of their individual way of life (δίαιτα) to carry arms, just like the barbarians. 2 Those parts of Greece where the habit persists are an indication of former ways of life (διαιτήματα) which were the same for everyone. The first of all to lay down their arms were the Athenians, who adopted a more relaxed way of life (δίαιτα) and became softer. The agreement between the method of the Hippocratic doctor and that of the historian Thucydides is remarkable.59 In order to reconstruct the Greek past prior to the advances of civilisation, both doctor and historian concentrate on the analogy with the current state of the barbarian world in general and of that small part of the Greek world which has not experienced these civilized advances.60 This accord holds even for the details of the wording. The ­reference 59  On this comparison between the method of the doctor and that of the historian, see Jouanna 1990, 44–45, with n. 1 of p. 45 for the bibliography. 60  The difference is that the historian singled out, immediately before the passage quoted, those parts of the Greek world where the old habits have survived (the Ozolian Locrians,

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to the survivals into the present of a state prior to the advances is introduced by the same adverb ἔτι. And the past advances are situated in the time following the first changes (VM.: prôton; Thucydides: prôtoi). These are those changes which involve δίαιτα. The vocabulary of the δίαιτα family is very much present in the passage of Thucydides, just as in that of the Hippocratic doctor, even if it is used in a broader sense. Here we find the same use of the substantive in -μα in the plural (VM: διαιτήματα; Thucydides: διαιτημάτων); and the substantive δίαιτα is used twice by the historian. Thus the two texts agree in both mentality and method, in which the advances of civilisation (the discovery of the arts, or of peaceful relations) are thought of by the Greeks as advances in δίαιτα (regimen, or kind of life), in which the barbarians, and even a small number of Greeks, are unable to share. What do these advances in regimen which amount to the discovery of medicine consist in? In the fact, according to the author of Ancient Medicine, that these first discoverers of medicine both needed and were able to modify regimen to adapt to the different states of human nature. So we may embark on the second of the problems I selected, namely that of the relations between regimen and the nature of man. The author of Ancient Medicine sketches in his treatise the first history of dietetics which we possess in western thought.61 This history is particularly well known as an illustration of the idea of progress, both in the arts and in civilisation more generally, in the 5th century.62 The comparison which I have just made between δίαιτα in Ancient Medicine and in Thucydides tends in this direction. But I want now to approach the history of dietetics from another angle, that of the relations between human nature and regimen: for the fundamental idea which runs through the entire text is that of the necessary adjustment of regimen to the nature of a man in good health or to the state of the sick man. In the beginning, the first men employed a diet similar to that of the animals. This powerful and bestial regimen caused suffering and death. The author continues: 4 . . . Διὰ δὴ ταύτην τὴν χρείην καὶ οὗτοί μοι δοκέουσι ζητῆσαι τροφὴν ἁρμόζουσαν τῇ φύσει καὶ εὑρεῖν ταύτην ᾗ νῦν χρεώμεθα. Aetolia, Acarnania), while the doctor is happy to speak of a small number of Greeks without further specification. 61  For the history of medicine as it was seen by the first Greek doctors and philosophers, see Jouanna 2003, 319–329. 62  See Jouanna 1990, 34–49.

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As a result of this necessity, these people, in my opinion, sought out a diet adapted to their nature, and discovered the one which we use today.63 From this very first sentence, the author presents the essential idea: in order to be beneficial, diet must be adjusted to human nature (ἁρμόζουσαν τῇ φύσει). The rest of the text clarifies what he means by adjustment. Adjustment in this case consists in a relationship between forces. Foodstuffs are defined by properties of varying strengths, and human nature needs to have the strength to prevail in order for the food ingested to be useful. We know that what we call digestion and assimilation is seen by our doctor as a struggle in which human nature must prevail over the food in order to appropriate it. So, to avoid the harmful effects of too strong a regimen, it was necessary to discover the manifold methods of preparing food, in particular cooking and mixing, in order to eliminate whatever might be too strong and allow human nature to prevail over it: ἥψησάν τε καὶ ὤπτησαν καὶ ἔμιξαν καὶ ἐκέρασαν τὰ ἰσχυρά τε καὶ ἄκρητα τοῖσιν ἀσθενεστέροισι, πλασσόντες πάντα πρὸς τὴν τοῦ ἀνθρώπου φύσιν τε καὶ δύναμιν, ἡγεύμενοι ὡς, ἃ μὲν ἂν ἰσχυρότερα ᾖ, οὐ δυνήσεται κρατεῖν ἡ φύσις ἢν ἐσφέρηται, ἀπὸ τούτων τε αὐτῶν πόνους τε καὶ νούσους καὶ θανάτους ἔσεσθαι, ὁπόσων δ᾿ἂν δύνηται ἐπικρατεῖν, ἀπὸ τούτων τροφήν τε καὶ αὔξησιν καὶ ὑγίειαν. They boiled and roasted, mixed and tempered strong and untempered substances with the aid of weaker substances, confecting everything in conformity with the natural capacity of humans, since they thought that, in the case of foods which were too strong, the nature of man would not be capable of dominating them if they were ingested, and that from these foods sufferings, illnesses and death would result, while from all those foods which it was capable of dominating there would result nourishment, growth and health.64 The author next deals with the discovery of medicine proper, which he describes in ch. 5. We have already seen, in the context of studying the concept of δίαιτα, that it comes in three successive stages, corresponding to the three categories of regimen of the sick: solid regimen, regimen of gruels, and liquid regimen. I will not go back over this in detail. But I would like to draw 63  VM 3, Jouanna 122.6–8 (= Jones 1.18.13–16 = 1.576.18–20 L). 64  VM 3, Jouanna 122.12–123.3 (= Jones 1.18.20–20.3 = 1.578.1–10 L).

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attention to the fact that the author is acutely aware of the continuity between the successive discoveries concerning regimen for the healthy, and the various regimens for the sick: this continuity is manifested in the same principle, according to which one should diminish the strength of the regimen so that the nature, φύσις, of the healthy individual or the condition, διάθεσις, of the sick might win out (ἐπικρατεῖν). This parallelism is perfectly exhibited in ch. 7: Ἐμοὶ μὲν γὰρ φαίνεται ωὑτὸς τρόπος καὶ ἓν καὶ ὅμοιον τὸ εὕρημα· ὁ μέν, ὅσων μὴ ἐδύνατο ἡ φύσις ἡ ἀνθρωπίνη ὑγιαίνουσα ἐπικρατεῖν ἐμπιπτόντων διὰ τὴν θηριότητά τε καὶ τὴν ἀκρησίην, ὁ δέ, ὅσων ἡ διάθεσις ἐν οἵῃ ἂν ἑκάστοτε ἕκαστος τύχῃ διακείμενος μὴ δύνηται ἐπικρατεῖν, ταῦτα ἐζήτησεν ἀφελεῖν. What is obvious to me is the identity of the method, the unity and similarity of the discovery. One has sought to eliminate all of those foods which human nature is incapable of overcoming because of their bestial and untempered properties, while the other sought to eliminate all those foods over which the patient, in the condition in which he found himself on each occasion, was unable to overcome.65 The idea that regimen is a source of health if it is not more powerful than human nature is shared by Diocles of Carystus. He says as much in a verbatim fragment (fr. 182.210 van der Eijk): The most important thing in regard to health is that nothing becomes more powerful than nature of the body (μέγιστον δὲ πρὸς ὑγίειάν ἐστι τὸ μηδὲν κρεῖττον γίνεσθαι τῆς τοῦ σώματος φύσεως) This is an echo of what the author of Ancient Medicine said at the end of the last passage but one: From all those foods which it (sc. the human nature) was capable of dominating there would result nourishment, growth and health (ὁπόσων δ᾿ἂν δύνηται [sc. ἡ φύσις] ἐπικρατεῖν, ἀπὸ τούτων τροφήν τε καὶ αὔξησιν καὶ ὑγίειαν). However, the Hippocratic author goes further. He guards against too simplistic a vision which would consist in thinking that one ought systematically to diminish, as a precautionary measure, the strength of the patient’s regimen so 65  VM 7, Jouanna 126.8–14 (= Jones 1.24.7–13 = 1.584.11–16 L).

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that he might prevail over it more easily: for too little or too weak nourishment is just as dangerous that which is overabundant and too strong. This results in a fundamental difficulty for medicine in its search for the regimen best adapted to the state of the patient, as expressed by the author in a famous passage: This is why the doctor’s tasks are so very diversified and require much greater precision. (διὰ πλείονος ἀκριβείης ἐστί). One must, in effect, look to a measure (μέτρον); but there is no measure—neither of number ­(ἀριθμόν) nor of weight—to which one can refer in order to determine what is precise (ἀκριβές), apart from bodily sensation (τοῦ σώματος τὴν αἴσθησιν). Thus it is hard work to acquire knowledge precise enough to make only small mistakes on either side.66 It is the ‘bodily sensation’ of the patient, i.e. what the patient feels, which is the measure (μέτρον) that guides the doctor in managing the regimen. The ideal is to find by way of this measure the exact point of equilibrium in the supply of nutrition adapted to the patient’s state which is neither deficient (which would weaken the patient) nor excessive (which would reinforce the disease).67 But what matters is to deviate as little as possible from it. From this necessary relationship between foodstuffs and the nature of the man who ingests them, the Hippocratic doctor even draws the conclusion that medical research is the starting-point for the understanding of human nature: I think that, in order to have a precise understanding of (human) nature, there exists no other source than medicine.68 This understanding is gained by the study of the different effects produced by different nutritional regimes on different individuals, which allows him to determine the kinds of natures (φύσιες in the plural!), for example those for which cheese is a harmful food. In this way the author of Ancient Medicine takes sides openly against a more philosophical type of medicine, expressly 66  VM 9, Jouanna 128.9–15 (= Jones 1.26 = 1.588.13–590.1 L). 67  Craik 1995, 346–347 has rightly insisted on the Hippocratic notion of equilibrium (‘Hippocratic balance’). But she fails to cite this passage, which shows how much the Hippocratics were aware of the difficulty involved in achieving this equilibrium. The expression ‘bodily sensation’ has been much discussed, in particular as to whether it concerns the body of the patient or that of the doctor; see Jouanna 1990, 128, n. 8 (= 174); Schiefsky 2005, 196–199. 68  VM 20, Jouanna 146.9–11 (= Jones 1.52 = 1.620.14–622.1 L).

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naming Empedocles, who thought on the contrary that dietetics presupposes a necessary understanding of human nature. And we know that this philosophical propensity has its representatives in the CH itself, notably in Regimen with its opening declaration: Φημὶ δὲ δεῖν τὸν μέλλοντα ὀρθῶς συγγράφειν περὶ διαίτης ἀνθρωπίνης πρῶτον μὲν παντὸς φύσιν ἀνθρώπου γνῶναι καὶ διαγνῶναι. I hold that whoever wants to write correctly about human regimen must first understand and discriminate the nature of man.69 However, notwithstanding these methodological differences concerning the relation between regimen and human nature, there are none the less some points of contact between these two treatises in the CH. The goal of this volume is to emphasize these points of contact rather than the divergences. And indeed there is, after all, a very close affinity between the two authors in the matter of the problem of the relations between regimen and the nature of man, namely their joint concern with adjusting regimen to human nature with the greatest possible precision, and in their both raising a similar question concerning measure. In fact, for the author of Regimen, the ideal would be to discover ‘for each individual nature the measure of food and the number of exercises corresponding to that measure’ (πρὸς ἑκάστου φύσιν σίτου μέτρον καὶ πόνων ἀριθμός σύμμετρος),70 in order for an exact balance between the two elements of regimen to ensure health, without deviating in the direction of either the greater or the smaller. This passage recalls the one from Ancient Medicine 9 already cited (v.66), where the doctor raises the question of what measure one ought to refer to. Thus the two doctors are very closely linked in their search for a measure (μέτρον) or a number (ἀριθμός) with which to prescribe the regimen best adapted to each nature. And they are also close as regards their awareness of the difficulty (according to one of them), or the impossibility (according to the other), of actually achieving this.71 But they are in agreement as to the essential point, which consists for the one in deviating as little as possible in either direction from this limit (VM 9), and for the other in approaching it as 69  Vict. 2, Joly 122.22–3 (= Jones 4.226.12–14 = 6.468.6–8 L). 70  Vict. 2, Joly 124.18 (= Jones 4.228.23–4 = 6.470.15–16 L). 71  For VM 9 see Jouanna 128.16–17: ‘precision is rarely seen’ (τὸ δὲ ἀτρεκὲς ὀλιγάκις ἔστι κατιδεῖν). For Vict. 67 see Joly 194.16: ‘precision has never been achieved by anyone’ (τὸ δ᾿ἀκριβὲς οὐδενί).

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closely as possible (ἔγγιστα τοῦ ὅρου: Vict. 67, Joly 194.15–16 = Jones 4.368.3 = 6.594.1 L).72 Human nature, however, does not exist in isolation. It is moulded by environmental factors which the doctor must take into account in managing regimen, whether in order to re-establish health or to preserve it. Here I turn to the third category of issues relating to regimen: its relations with the environment. I will consider two quite distinct issues: that of customary practice, which is part of the human domain, and that of the seasonal cycle, which is part of the natural. Hippocratic doctors, however, could treat them as both being on a par. Thus, at Aphorisms I.17 it is said that in administering regimen one must pay attention to the season and to customary practices among other factors.73 And as we shall see, the two domains are connected by issues of change and gradualness. Let us first look at customary practices. Each individual nature is moulded by practices regarding foods which doctors must take into account. This is the natural consequence of the doctors’ reflections on the relationship between regimen and human nature. They guard against the mistakes which would result from imposing on the patient a regimen too far removed from his own customary practices. The most sophisticated treatment of the question of customary practice and of change occurs in the treatise Regimen in Acute Diseases (ch. 9–10 Littré).74 Disease demands a change in regimen. But one must avoid 72  For a more detailed comparison between the position of VM and that of Vict. on measure, see Jouanna 2008a, 37–52 73  Aph. I.17, Jones 4.106.9–10 (= 4.468.1–2 L), ‘One should pay attention also to the season, to the region, to customary practices, and to age’ (δοτέον δέ τι καὶ τῇ ὥρῃ καὶ τῇ χώρῃ καὶ τῷ ἔθει καὶ τῇ ἡλικίῃ). 74  Acut. 9.28–10.37, Joly 47–51 (= Jones 2.84–92 = 2.298–328 L). On the question of change in this treatise, see Jouanna 1980, 299–319. More recently, Camassa 2006, 16–25 (esp. n. 30 and n. 38), while recognizing the importance of my study, does not share my conclusion that the author of Acut. is criticizing traditional therapeutics; indeed he takes a position diametrically opposed to mine (n. 38 ‘Rovescio pertanto la prospettiva di Jouanna’), seeing in it rather a critique of ‘a new orientation, which derives its nourishment from relativism (nuovo orientamento, che traeva linfa dal relativismo)’ (p. 25), and citing the defence of change represented by Loc. Hom. But this hypothesis is in no way supported by the polemic of Acut. which criticizes all doctors, not just some ‘new orientation’. I quote the passage from Acut. 8.26, Joly 47.7–13 (= Jones 2.82.4–84.11 = 2.278.8–280.1 L): ‘I know that doctors do the opposite of what they ought to do. All of them, at the onset of diseases, first of all dry their patients out for two or three days, or even more, before giving them gruels and drinks. Perhaps it seems reasonable to them, at the moment when a great change is talking place in the body, to counteract that great and powerful change’. Texts are more to be believed than hypotheses. One cannot simply overturn them. The author

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too great a change, since even in an individual in good health, any change of regimen is harmful. To illustrate this, the Hippocratic author cites the example of the regularity of daily meals. We have already mentioned the fact that certain people were in the habit of taking only one meal a day, while others took two. According to this doctor, simply changing individual regimen for half a day—adding a meal for the former, subtracting one for the latter—entails disturbances which the author is happy to enumerate. The conclusion is that, in managing the regimen of the sick, one should neither add to nor detract from it in any way that clashes with customary practices, and that even in the case of someone healthy it is better to stick to a bad regimen than to effect a rapid change towards a better one.75 The connecting idea is that of gradualness, expressed in particular by the expression ἐκ προσαγωγῆς; this is one of the fundamental concepts in the management of regimen.76 It goes without saying that this concept is not peculiar to this treatise; it is a commonplace of what one might describe as ‘Hippocratic’ in the broad sense of the term.77 But this of Acut. wishes to affirm his originality in the face of all other doctors. That he may be guilty of oversimplifying matters in the course of an exaggerated polemic is another matter. Moreover, it is not impossible that the author of Loc.Hom., who is an advocate of change (cf. especially ch. 45, Joly 75.4–6 (= Potter 8.90.10–12 = 6.340.5–7 L): ‘Every change from the current condition is beneficial to the patient, since if no change is made, the harm gets worse’), is one of the advocates of the position attacked by the author of Acut.; cf. the edition of Joly (CUF VI, 2, 1972, 47 n. 2): ‘It is not impossible that our author has this treatise [sc. Loc. Hom], which might be earlier, directly in mind’). However, the generality of the polemic in Acut. rules out establishing any particular connection between the two treatises or of deducing their relative chronology, namely the precedence of Loc. Hom. to Acut. 75  The dangers of changing regimen away from customary practice are similarly emphasized in VM 10–11 using the same example of the frequency of daily meals, Jouanna 129–132 (= Jones 1.28–32 = 1.590–594 L), but with the difference that for the author of Acut., such changes of one meal to two or conversely of two to one are not harmful for everybody, but only for those who are weaker than others. On the vocabulary of change in the CH, see Demont 1992, 305–317. 76  The expression occurs three times in Acut. and once in Acut. (App.) 77  The expression is used in the context of dietetic recommendations. We may note two significant uses of the term in the regimen (δίαιτα) recommended by the author of Fract. after two operations: in ch. 7 (3.440.16 L), during the reduction of a fracture of the forearm, after a mild regimen (δίαιτα ὑποφαύλη) one returns gradually to full nourishment (ἐκ προσαγωγῆς ἀνακομίζεσθαι); and in ch. 36 (3.540.3 L) during the reduction of a dislocated femur or humerus, after a complete withdrawal of nourishment (σιτίου δέ στερῆσαι τελέως), one returns gradually to a stronger regimen (ἐκ προσαγωγῆς . . . ἐς φαύλην δίαιταν). But the expression is also found in injunctions of a more general nature: Epid. 2.3.1, ἐκ

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particular account of the importance of customary practice, and the danger of abrupt changes to it, in Regimen in Acute Diseases remained well known. It is quoted at length by Galen in his treatise Customary Practices.78 However, the fame of the Hippocratic texts has tended to overshadow other medical treatises of roughly the same period which developed the same theme. Thus Diocles of Carystus, in a fragment quoted verbatim by Oribasius, recommends in the case of emetics sticking to that which is closest to the patient’s habitual regimen (fr. 153.3–4 van der Eijk: χρῆσθαι δὲ τοῖς οἰκείοις μάλιστα τῆς συνήθους διαίτης).79 In another long fragment from which I have already quoted and to which I shall return (fr. 182.202 van der Eijk), it is said in connection with alimentary regimen that ‘One should always guard against unfamiliar foods’ (φυλάττεσθαι δ᾿ ἀεὶ δεῖ τά τε ἀήθη . . . τῶν βρωμάτων). In the same vein, major seasonal changes are as harmful for human beings as major changes of regimen, while gradual seasonal changes are safer, just as in the case of change of regimen. The treatise Humours establishes this parallelism between seasons and regimen. After saying that changes (μεταβολαί) are responsible for diseases, in the seasons just as in everything else, he goes on: Seasons (ὧραι) which arrive gradually (ἐκ προσαγωγῆς) are the safest, just as are regimens (ὥσπερ καὶ αἱ δίαιται) . . . which are directed gradually (ἐκ προσαγωγῆς).80 In order to protect oneself against the changes due to the seasons, one needs to change one’s regimen to counteract the different effects that they produce in the body, all the while ensuring that the changes are managed gradually. προσαγωγῆς ἐστι μᾶλλον καὶ τὸ μηδὲν τῇ φύσει πάθος γίνεσθαι, ‘It its by progressing gradually that nothing bad happens to nature’, Smith 7.48.8–10 (= 5.102.15 L, with different punctuation); Epid. 6.2.12, ἐκ προσαγωγῆς τἀναντία προσάγειν καὶ διαναπαύειν, ‘One should introduce opposites gradually, and during the remissions’, Manetti-Roselli 37.6–7, with the note ad loc. (= 5.284.1–2 L). 78  In this text, Galen quotes (ch. 1, Mueller 12.15–16.2) Acut. 9, 2.282.4–284.6 L, then 286.6– 294.1, then ch. 10, 2.298.1–302.5. He also quotes from Aph. 2.49 (ch. 1 Mueller 9.15–18). On the other hand, he does not quote from the account in VM, since he did not think it to be authentically Hippocratic. 79  This expression (συνήθης [vel ξυνήθης] δίαιτα) also occurs in Thucydides 1.6.1 (quoted above, 227), with the difference that δίαιτα is employed in its general sense of ‘kind of life’ in the historian and in the narrow technical sense of regimen by the doctor. Diocles talks of the individual alimentary regimen (food and drink) as being opposed to pharmacological emetics. The opposition is the same as that found in the Hippocratics; see above, 220. 80  Hum. 15, Jones 4.88.21–23 (= 5.496.15–16 L).

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It is in the text Nature of Man that we find the clearest theory regarding the influence of the seasons on the nature of man and of the seasonal regimen required to counterbalance it. Each of the four seasons is defined in terms of two elementary qualities which it induces in the body.81 Consequently one should follow a regimen whose qualities are opposed to those of the season. In winter, the cold and wet season, one’s regimen ought to keep the body warm and dry.82 Conversely, in the summer one needs to follow a cold and moist regimen to counterbalance the warmth and dryness of the season.83 The regimens of spring and autumn are transitional between these two contraries; they need to accomplish the transition from one contrary regimen to the other while avoiding changes which are too great and too abrupt. This preoccupation with avoiding excessive change by way of these transitional regimens is explicitly expressed in regard to that of the spring (‘in order to avoid a large and abrupt change’ (ὅπως) καὶ μὴ μεγάλη ἡ μεταβολὴ ἔσται ἐξαπίνης χρεωμένῳ).84 The question of the change of regimen in health thus remains the same as that of regimen in the case of disease. Here too, just as in the case of customary practices, we need to emphasize that analogous positions are to be found in contemporary medical literature not collected under the name of Hippocrates. Diocles of Carystus, in the long verbatim fragment on regimen in health already mentioned (fr. 182.78–82 van der Eijk), recommends altering not only the midday meal, but also regimen as a whole according to the season:

81  Nat. Hom. 7, Jouanna 182–186 (= Jones 4.18–22 = 6.46–50 L). 82  Nat. Hom. 16 (= Salubr. 1), Jouanna 204.22–206.3 (= Jones 4.44.1–7 = 6.72.1–5 L). He returns, by way of ring-composition, to winter at the end of the chapter, after dealing with regimen in the three other seasons: ‘Small quantities of extremely pure drinks, and food as plentiful and as dry as possible. Thanks to this regimen, indeed, you will get on best and suffer the least from the cold; for the season is cold and wet’ (ibid., Jouanna 208.5–8 = Jones 4.46.13–17 = 6.74.9–13 L). The two passages correspond to and complement one another. The recommended regimen is dry and warm to counteract the coldness and dampness of the season. 83  Nat. Hom. 16 (= Salubr. 1), Jouanna 206.8–16 (= Jones 4.44.14–46.26 = 6.72.10–74.4. L). 84  For the spring regimen, see Nat. Hom. 16 (= Salubr. 1), Jouanna 206.3 ff. (= Jones 4.44.7 ff. = 6.72.5 ff. L); for that of autumn, ibid., Jouanna 206.16–208.5 (= Jones 4.46.30–34 = 6.74.4–8 L). The spring regimen is a transitional one which allows one to pass from the hot and dry regimen of winter to the cold and moist one of summer, while that of autumn is a transition which conversely eases the passage from the cold and dry regimen to the warm and dry of winter.

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It is perfectly clear that, for the midday meal (ἄριστον) as well as for regimen (δίαιτα) as a whole, it will be appropriate that it not be heating and drying in summer and that it be neither cooling nor moistening in winter, while in spring and autumn it should adopt an intermediate position (μέσον).85 This position is fundamentally the same as that of the author of Nature of Man. Regimen needs to be adjusted for each season by countering the elementary qualities of the two extreme seasons (summer: hot and dry; winter: cold and wet), and by adopting an intermediate regimen for the two transitional seasons, spring and autumn. We also find at the end of Diocles’ account of regimen in health the same issue concerning change that we encountered in Nature of Man: What matters most for health is that nothing [ingested] be more powerful than the nature of the body and that the other components of regimen change at the same time as the seasons, altering by small steps towards their opposites without making any sudden change, μέγιστον δὲ 85  Diocles returns to the same idea in the conclusion of his account (fr. 182.201 μέση δίαιτα). These two mentions of δίαιτα in fr. 182.79 et 201 (verbatim) in Diocles should be added to the one already quoted above (235) in fr. 153.3–4 (verbatim) on individual regimen, cf. n. 79. These are the only three verbatim attestations securely attested for Diocles. A fourth case occurs in the dubious letter from Diocles to Antigonus (fr. 183.62 μετὰ διαίτας ἄνευ φαρμακείας). What exactly is the extension of the concept of δίαιτα in this doctor? We have already seen in the case of ‘individual regimen’ (above, 235) that the term did not have the broad sense of ‘way of life’ that it had in Thucydides, but the restricted technical sense of regimen (foods and drinks) as opposed to remedies. This is also its sense in the letter to Antigonus. What does Diocles mean in this passage (fr. 182.79) by ‘regimen as a whole’? From the context, it appears to be an expansion of the ‘midday meal’ (ἄριστον), and that it simply refers to ‘nutritional regimen’ (food and drink) in general, including evening as well as midday meals. This is the same expansion which occurs in frs. 153.3 and 183.62, and corresponds to the most restricted definition of diaita to be found in the CH, namely that involving only food and drink. All the same, as is the case in his account of the healthy man’s day (fr. 182), exercises are also involved, and one may wonder whether diaita might not also have a broader extension, as it does in the Hippocratic Vict. The question turns on knowing whether or not the title ὑγιεινὴ δίαιτα given by Oribasius at the beginning of the Diocles extract should be attributed to Diocles, which seems implausible (van der Eijk does not list this occurrence in his index of the verbatim fragments: 2.417 s.v. δίαιτα). Thus the restricted sense ‘nutritional regimen’ is the more likely. In any event, what matters is to establish that the content of the technical concept of δίαιτα in Diocles is circumscribed by the same boundaries as it is in the CH.

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πρὸς ὑγίειάν ἐστι τὸ μηδὲν κρεῖττον γίνεσθαι τῆς τοῦ σώματος φύσεως, ἅμα δὲ ταῖς ὥραις μεταβαλλούσαις καὶ τὴν ἄλλην διαγωγὴν μεταβάλλειν, κατὰ μικρὸν εἰς τοὐναντίον ἀπονεύοντα, καὶ μὴ μεγάλην ἐξαπίνης ποιοῦντα μεταβολήν.86 This passage resembles very closely the account given in Nature of Man concerning the question of change. Change of regimen is required to counter the changing of the seasons, but it must be gradual. The genuineness of this resemblance is emphasized by the very wording of the warning against sudden major change, which is remarkably similar (Nat. Hom. 16 [= Salubr. 1], 206.10–11 Jouanna: (ὅπως) καὶ μὴ μεγάλη ἡ μεταβολὴ ἔσται ἐξαπίνης χρεωμένῳ; Diocles fr. 182.213–14. van der Eijk: καὶ μὴ μεγάλην ἐξαπίνης ποιοῦντα μεταβολήν). One finds nowhere else such a close affinity of expression, so much so that one wonders whether Diocles is not here directly recalling Nature of Man.87 Returning to the CH, we find (in Regimen 68) another comparable discussion of change of regimen according to the seasons.88 But while Nature of Man restricts itself to nutritional regimen, Regimen adds some advice about exercise as well, which is hardly surprising in view of the fact that the author, as we have seen, defines health in terms of the balance between nutrition and exercise.89 But what is surprising is the context in which the author of Regimen lays out his seasonal regimen, namely one of two-tier medicine. At chs. 68–9, the author distinguishes two different audiences, for whom he recommends two different types of regimen. On the one hand there are the masses, who as a result of the exigencies of their social positions choose neither their food nor their drink, who undertake whatever physical exercise that is imposed upon them, expose themselves to the sun and to the cold more than they should, 86  Fr. 182.210–14 van der Eijk. 87  In his commentary on this passage of Diocles, van der Eijk 2001, 351, compares it with the Hippocratic Hum. 15 (5.496 L), quoted above, 235. The resemblance to Nat. Hom. should be added to his commentary on Diocles, as should the resemblance to Diocles to my edition with commentary of Nat. Hom., Jouanna 2002/1975, ad 206.11. It is to be regretted that van der Eijk, whose edition with commentary of Diocles is a superb philological achievement, still, at the beginning of the 21st century, perpetuates the idea (promoted by Littré in the 19th century, and unfortunately followed by Jones) that there exists a Hippocratic text entitled περὶ διαίτης ὑγιεινῆς (vdE 2001, 348). It has been established since the beginning of the 20th century (O. Villaret Nat. Hom. Diss. Berlin 1911) that this is an integral part of Nat. Hom. in the ancient manuscript tradition (both Greek and Latin). 88  Vict. 68, Joly 194–200 (= Jones 4.368–380 = 6.594–604 L). The resemblances between the two accounts are close, but the explanation for this is disputed. See Jouanna 2002, 52–54 with the appended p. 335. 89  See above, 232

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and who as far as everything else is concerned lead a disorderly kind of life (ch. 68). On the other is the elite, able to avoid other types of activity so as not to neglect their health, and who are convinced that wealth without health is not worth having (ch. 69).90 It is for the masses that the doctor lays out his seasonal regimen, while reserving for the elite the discovery he claims to have made of maintaining or re-establishing health by way of an exact balance between nourishment and exercise.91 In this duality, the treatise entitled Regimen is at once both the most and the least modern of the all the Hippocratic texts; the least modern in that it advocates a two-tier medicine; the most modern in its pursuit of the proper balance between nutrition and physical exercise which is central to modern dietetics. Allow me to conclude with a personal reminiscence. During my stay at Princeton in 2001, I did a great deal of Greek (Hippocrates and Sophocles), but not much American, which I regret. However, a lady who was giving me lessons recommended to me the Longman Dictionary of American English. Your Complete Guide to American English. I treasure it still. This is what I find in the entry on ‘diet’: ‘1. The type of food you eat each day’, with the following example in italics: ‘A healthy diet and exercise are important for good health’. So Hippocrates is not yet dead; or to put it in more poetic language, as well as more properly employing the plural, along with the chorus of Sophocles’ Electra, ζῶσιν οἱ γᾶς ὑπαὶ κείμενοι, ‘They are still alive, those who lie beneath the earth’. Translated from the French by R.J. Hankinson Bibliography Betant, E.-A., Lexicon Thucydideum I. Geneva, 1843 (repr. Hildesheim, 1961). Camassa, G., ‘L’idea del mutamento nel Corpus Hippocraticum’, in: A. Marcone (ed.), Medicina e società nel mondo antico (Atti del convegno di Udine (4–5 ottobre 2005). Firenze, 2006, 16–25. 90  On these two regimens and two audiences, see Joly 1960, 125 ff., Ducatillon 1969, 33–42. It should be noted that an analogous distinction exists in Diocles of Carystus too between ‘those who are forced to do something else’ (τοὺς μὲν ἕτερόν τι πράττειν ἀναγκαζομένους) and ‘those who enjoy leisure’ (τοὺς δὲ σχολάζοντας), fr. 182.40–1 van der Eijk; but this does not entail differences of detail in regimen, and certainly not two entirely different kinds of regimen, as it does in Vict. 91  See above 232 and n. 70.

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Craik, E., ‘Hippocratic Diaita’, in: J. Wilkins, D. Harvey and M. Dobson (eds.), Food in Antiquity. Exeter, 1995, 343–350. ———, ‘Diet, Diaita and Dietetics’, in: A. Powell (ed.), The Greek World. New York and London, 1995, 387–402. Demont, P., ‘Observations sur le champ sémantique du changement dans la Collection hippocratique’, in: J.A. Lopez Férez (ed.), Tratados hipocráticos (VIIe Colloque international hippocratique). Madrid, 1992, 305–317. Ducatillon, J., ‘Collection hippocratique. Du régime, Livre III. Les deux publics’, REG 82 (1969), 33–42. Laín Entralgo, P., ‘El sentido de la ‘diaita’ en la Grecia clásica’, Athlon. Satura grammatica in honorem F.R. Adrados, II. Madrid, Gredos, 1987, 485–497. Guardasole, A., Tragedia e Medicina nell’Atene del V secolo A.C. Napoli, 2000. Joly, R., Recherches sur le traité pseudo-hippocratique Du Régime. Paris, 1960. Jones, W.H.S., Hippocrates vol. 4, Loeb series, London and Cambridge, MA. Jouanna, J., ‘Politique et médecine. La problématique du changement dans le Régime des maladies aiguës et chez Thucydide, livre VI’, in: M. Grmek (ed.), Hippocratica, Actes du Colloque hippocratique de Paris, 4–9 septembre 1978. Paris, 1980, 299–319. (= ‘Politics and Medicine. The Problem of Change in Regimen in Acute Diseases and Thucydides (Book 6)’, in: J. Jouanna (trans. N. Allies), Greek Medicine From Hippocrates to Galen: Selected Papers. Leiden 2012, 21–38.) ———, ‘Médecine hippocratique et tragédie grecque’, in: Anthropologie et Théâtre antique (Actes du colloque international Montpellier 6–8 mars 1986), textes réunis par P. Ghiron-Bistagne avec la collaboration de B. Schouler, Cahiers du Gita 3. Montpellier, 1987, 109–131. (= ‘Hippocratic Medicine and Greek Tragedy’, in: J. Jouanna (trans. N. Allies), Greek Medicine From Hippocrates to Galen: Selected Papers, Leiden 2012, 55–79.) ———, Ancienne médecine. Paris, 1990. ———, Hippocrate. La Nature de l’homme, CMG I 1.3. Berlin, 2002 (1st ed. 1975). ———, ‘La naissance de l’histoire de la médecine en Grèce à l’époque classique’, in: Histoire des Sciences médicales (Centenaire de la Société française d’histoire de la médecine, 1902–2002, Paris 29 et 30 novembre 2002), t. 37, n° 3 (2003), 319–329. ———, ‘La nozione di misura e la sua problematica nella medicina ippocratica’, Aion (2008), 37–52. [2008a] ———, ‘Réflexions sur le régime des peuples dans la Grèce classique (Hérodote 1.133; Hippocrate, Ancienne médecine, c 5; Thucydide 1.6) et sur le sens des mots de la famille de δίαιτα’, REG 121 (2008), 17–42. [2008b] Lonie, I.M., ‘A structural pattern in Greek dietetics and the early history of Greek Medicine’, Medical History 11 (1977), 235–260. Moussy, C., Recherches sur τρέφω et les verbes signifiant ‘nourrir’, Paris, Klincksieck, 1969 (Études et commentaires 70), 107.

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Nestle, W., ‘Hippocratica’, Hermes 73 (1938), 1–38. Powell, J.E., A Lexicon to Herodotus. Cambridge, 1938 (repr. 1960). Schiefsky, M.J., Hippocrates, On Ancient Medicine, transl. with Introduction and Commentary. Leiden, 2005. Smith, W.D., ‘The development of classical dietetic theory’, in: M.D. Grmek (ed.), Hippocratica, Actes du Colloque hippocratique de Paris, 4–9 septembre 1978. Paris, 1980, 439–448. ———, ‘Regimen, κρῆσις, and the History of Dietetics’, in: J.A. Lopez Férez (ed.), Tratados hipocráticos (VIIe Colloque international hippocratique). Madrid, 1992, 263–271. Thivel, A., ‘L’évolution du sens de DIAITA’, in: Juan Antonio López Férez (ed.), La lengua científica griega I. Madrid, 2000, 25–37. Van der Eijk, Ph. J., Diocles of Carystus. A Collection of the Fragments with Translation and Commentary II. Leiden, 2001. Wöhrle, G., Studien zur Theorie der antiken Gesundheitslehre, (Hermes Einzelschriften, 56). Stuttgart, 1990.

CHAPTER 11

Towards a Hippocratic Anthropology: On Ancient Medicine and the Origins of Humans Ralph M. Rosen The Hippocratic On Ancient Medicine (VM) is one of the earliest treatises in the corpus and, as such, offers a valuable glimpse at an otherwise poorly documented period of intellectual history. What makes this text so intriguing is that, on the one hand, it sits comfortably within the familiar philosophical and scientific debates of late fifth-century Greece, but, on the other, offers what seem to be idiosyncratic approaches to them. At its most fundamental level, On Ancient Medicine offers a polemic against speculative philosophy that relies on ‘newfangled hypothesis’1 (καινὴ ὑπόθεσις at 1.3) to account for disease and formulate treatment, and argues for a method that instead combines empirical research and analogical reasoning. What is distinct about the work, however, is the author’s focus on food and dietary regimen as the foundation of medical τέχνη and the steps in his thinking that lead him to this position. To reach this conclusion, the author deploys in a famous section of the work (ch. 3) his own form of hypothesizing about the condition of the human species in an imagined prehistorical state of primitivity. That chapter is, in part, a self-promotional argument for the antiquity and validity of medicine as a τέχνη, but it also deserves a place, as many have observed, alongside other works of the period that took an interest in what we would call cultural anthropology. It would serve the theme of this volume well if I could argue that On Ancient Medicine’s particular foray into cultural anthropology was distinctly ‘Hippocratic’, and that any ancient doctor aligning himself with Hippocratic medicine would have been familiar with, and sympathetic to, On Ancient Medicine’s anthropological explanation of the origins of medicine. In fact, however, the available evidence does not allow us to say much 1  Schiefsky’s translation; see Schiefsky 2005, 111–15. For the meaning of ‘hypothesis’ Schiefsky argues for ‘basis’ or ‘foundation’ as preferable to the traditional ‘postulate’. On the reading of καινή, see Jouanna 1990 [2003], 157–58, and Schiefsky 2005, 135–36. See also Lloyd 1991, 49–69. Throughout this chapter Jouanna’s and Schiefsky’s editions of VM will be cited by last name only. Greek text is quoted from Jouanna’s edition, English translations throughout are based on Schiefsky, with occasional modification.

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about that idea one way or another. If anything, it might make more sense to claim that an interest in cultural anthropology was decidedly un-Hippocratic, and that when it came to On Ancient Medicine’s particular anthropological take on the evolution of medicine, its author was something of a Hippocratic outlier. If the authors we now regard as ‘Hippocratic’ were not actively opposed to anthropological theorizing, they were for the most part indifferent to it, at least to theorizing that was not directly relevant to medical praxis.2 I am less concerned, however, with what is (or is not) Hippocratic about an interest in anthropology in general, but rather what this particular example of anthropological thinking in On Ancient Medicine might have to tell us about Hippocratic medicine, especially its philosophical and methodological underpinnings, and whether the premises that inform the author’s very distinctive narrative of human origins might indicate something we might conceptualize as specifically ‘Hippocratic’. In what follows I will suggest that what marks this work as particularly Hippocratic is the way in which it combines a pervasively negative conception of human nature—humans as essentially abject, weak creatures, inferior in many ways to animals, and in a state that has changed little since even the most primitive times—with a positive belief in the efficacy of medical τέχνη. Indeed, as I will argue, On Ancient Medicine’s persistent plea for medicine to be taken seriously as a τέχνη, and as a τέχνη with a history as old as the human species itself, stems from its assumption that human φύσις is essentially a steady state of misery, with little hope of biological or physical progress without the intervention of human reason. Medicine, on this conception, becomes an almost heroic struggle against an inherently flawed physical machine. In the end, it may be impossible to say whether this notion was in itself distinctively Hippocratic—a pessimistic view of human nature, after all, is a familiar enough thread in archaic and classical Greek literature—but what does seem to be Hippocratic about On Ancient Medicine, as I hope to show, is the way in which it situates the etiology of disease within a progessivist narrative of investigation and discovery (εὕρημα), itself in continual tension with an anti-progressivist view of human biological φύσις. At the end of the chapter, I offer some observations on how Galen seems to have absorbed such an

2  See Jouanna, 1999 278, in reference to Carn., another work that professes an interest in human origins: ‘the author . . . has no interest in discussing cosmology for its own sake, but wishes only to briefly establish those elements involved in the formation of the universe that are necessary for the purposes of anthropology’. Carn., however has a far more extensive interest in the material origins of humans than the author of VM has any patience for; see next note.

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attitude from the Hippocratic tradition—and quite possibly from On Ancient Medicine directly—with at least some degree of self-consciousness. The passage I will focus on in the greatest detail occurs in chapter 3 of On Ancient Medicine, but a few prefatory remarks are in order about its author’s own statement of his purpose and method. On Ancient Medicine most famously stakes out its intellectual position in the polemical chapter 20. There, the author sets himself against opponents to whom he refers as ‘sophists’ and ‘doctors’. It would be best for us to resist the assumption for now that these ‘doctors’ must mean ‘non-Hippocratic doctors’, and that On Ancient Medicine must, therefore, present distinctly Hippocratic views. As scholars have shown, after all, several other treatises in the CH at least flirt with some of the approaches On Ancient Medicine’s author is trying to repudiate.3 We need only observe, however, that On Ancient Medicine is arguing against what seems to be a common, probably orthodox, approach of the late fifth century that spoke of disease, the human body and medicine in terms of cosmology and theories of nature (φύσις).4 The author complains at the opening of chapter 20 that these theories ‘tend towards philosophy’ and are more like ‘Empedocles or others who have written about nature from the beginning, as to what a human being is’, (τείνει . . .  ὁ λόγος ἐς φιλοσοφίην καθάπερ Ἐμπεδοκλῆς ἢ ἄλλοι οἳ περὶ φύσιος γεγράφασιν ἐξ ἀρχῆς ὅ τί ἐστιν ἄνθρωπος . . .). He then proceeds to make several quite striking claims, first that one can only have a precise understanding of nature from medicine (νομίζω δὲ περὶ φύσιος γνῶναί τι σαφὲς οὐδαμόθεν ἄλλοθεν εἶναι ἢ ἐξ ἰητρικῆς, 20.2), and second that the aspect of human nature doctors need especially to understand is ‘what a human being is in relation to things eaten and drunk, and what it is in relation to other practices, and what is the result of each thing on each person’ (ὅ τί ἐστιν ἄνθρωπος πρὸς τὰ ἐσθιόμενα καὶ πινόμενα, καὶ ὅ τι πρὸς τὰ ἄλλα ἐπιτηδεύματα, καὶ ὅ τι ἀφ’ ἑκάστου ἑκάστῳ ξυμβήσεται, 20.3). This passage shows that On Ancient Medicine was concerned to address a fundamental controversy over how a doctor should conceptualize the etiology of disease, and what the relationship is between this etiology and effective treatment.5 To understand the causes of diseases implies an understanding of the nature of human beings, and this is the main point of contention. Whereas the author’s opponents believe they can analyze human φύσις in terms of the interaction of a few ingredients (‘laying down the same one or two things as the cause in all cases . . .’ 1.1.5–6), whether it be Empedoclean elements (air, fire, 3  See Schiefsky 2005, 20–23, who argues that VM positions itself explicitly against the kind of materialist anthropology found in Carn. (cf., e.g., Carn. 1.188.1–11; also Vict. 2.122–27). 4  See Schiefsky 2005, 295–98, with further bibliography. 5  See Schiefsky 2005, 313–15.

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water, earth) or the related principles of hot, cold, wet and dry, the author of On Ancient Medicine finds this approach both philosophically speculative and therapeutically misguided, as he almost petulantly demonstrates in chapter 13 with a hypothetical experiment.6 As is often pointed out, this debate is well entrenched in Presocratic theorizing about the cosmos and its material constituents. At root, such theorizing reflects an interest in origins—origins of matter, origins of natural phenomena, and for others, origins of human behavior and institutions. In this regard, On Ancient Medicine is simply another installment in a familiar enough intellectual narrative. The author is certainly impatient with his opponents’ ‘newfangled hypotheses’, but as I noted earlier, he still thinks a knowledge of human nature, even one that must remain at least partially speculative, is crucial for the successful doctor. Indeed, one of the main didactic impulses of On Ancient Medicine is to make the case, clearly stated at the opening of chapter 2, that medicine is an age-old τέχνη, and that its roots go back in to the proverbial dawn of time. In one sense, then, the author is simply trying to replace one origins-narrative (the new ὑποθέσεις of his opponents) with another, the ‘correct’ one that can furnish the principles according to which medicine should be practiced.7 The matter, however, is somewhat more involved. The opening of chapter 20 does indeed contrast a speculative interest in cosmology (à la Empedocles) with a more delimited focus on medical knowledge attained through empirical investigation, inference and application. Schiefsky has summed up this chapter by saying that the author here ‘takes a clear stand against the attempt to base medicine on theories of the origin and development of the human being’ (2005, 23). But this seems to me to be overstated, for, as we will find, while the author may himself be uncomfortable with highly speculative theories of human origins promoted by his opponents, his own attempts to rationalize medicine as τέχνη rely on any number of inferences about human beings, and human φύσις, in an original state. It is this author’s particular take on origins that I think points to certain attitudes that we may well be able to characterize as Hippocratic. The preoccupation with food and diet in this treatise as a defining element of medicine characterizes one of these attitudes, especially when we consider that it is presented as its own story of origins. The author, in other words, evidently feels compelled to explain not only that the treatment of disease is usually a matter of calibrating the quality and quantity of foods appropriate to an individual’s particular physiology, but why this would be so—and this 6  On ch. 13, see further below, 246. 7  See Jouanna 1990 [2003], 36–37.

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leads him to his own form of etiological thinking. It may be true that he does not spell this out in an especially orderly way in the treatise, but by the end of the work his thinking on these matters seems reasonably clear. Furthermore, we should not forget that one of the stated claims of the treatise (as the title itself implies) is to defend the antiquity of the medical art. It should come as no surprise, therefore, that the author shows at least an occasional interest in arguments from origins. Chapters 13–14, for example, offer an excellent glimpse of how the author’s method eventually leads him to the topic of origins. At the opening of 13, he recapitulates his suspicion of the ‘new method . . . based on hypothesis’ (καινὸν τρόπον . . . ἐξ ὑποθέσιος, 13.1) and challenges a hypothetical opponent to imagine the following scenario: take a weak person, give him only a diet of raw foods, watch him get sick, and consider how to restore him to health. His test case is contemporary and grounded in the experiences of real bodies, but it is calculated to lead him back to a time early in the history of what he would call medicine. The consequence of eating a raw diet is easy enough for the author to predict—εὖ οἶδ’ ὅτι πείσεται πολλὰ καὶ δεινά• ‘I know well that he will suffer many terrible things’—but making him healthy again is the real challenge. The answer is obvious enough for the author, who says, perhaps with a slight touch of humor, that one should put him back on a normal diet of cooked and processed foods. He questions, however, whether in that case ideas about the hot, cold, wet and dry have any explanatory power at all, since even making something as elemental as bread involves a complex blending and mixing (κρῆσις) of the various properties inherent in its ingredients. This section is a brief for understanding the ‘power’ (δύναμις) and ‘nature’ (φύσις) of foods on health, and the complex changes brought about in them by cooking and other forms of processing. For, as the author says in chapter 14, the processing of foods ‘changes’ and ‘alters’ all aspects of human life (. . . πᾶς ὁ βίος καὶ ὑγιαίνοντι, καὶ ἐκ νούσου ἀνατρεφομένῳ, καὶ κάμνοντι). As if imagining that his opponent might ask him where he actually gets such knowledge, and on what physiological principles he bases his argument about the properties of foods, the author evokes in 14.3 an originary moment in the history of medicine when ‘the first discoverers’ (οἱ πρῶτοι εὑρόντες), through rational thinking (λογισμῷ) and an interest in the φύσις of humans (πρὸς τὴν τοῦ ἀνθρώπου φύσιν), made the kinds of discoveries that he has been talking about: οὐ γὰρ τὸ ξηρὸν, οὐδὲ τὸ ὑγρὸν οὐδὲ τὸ θερμὸν οὐδὲ τὸ ψυχρὸν οὐδ’ ἄλλο τούτων οὐδὲν ἡγησάμενοι οὔτε λυμαίνεσθαι οὔτε προσδεῖσθαι οὐδενὸς τούτων τὸν ἄνθρωπον, ἀλλὰ τὸ ἰσχυρὸν ἑκάστου καὶ τὸ κρέσσον τῆς φύσιος τῆς ἀνθρωπίνης•

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οὗ μὴ ἠδύνατο κρατεῖν, τοῦτο βλάπτειν ἡγήσαντο, καὶ τοῦτο ἐζήτησαν ἀφελεῖν. (14.3) For since they thought that it is not the dry or the wet or the hot or the cold or any other of these things that harms the human being—or that the human being has any need of them—but rather the strength of each thing and that which is more powerful than the human constitution, they regarded as harmful that which the human constitution was unable to overcome, and this they sought to remove. The author here ascribes to the earliest medical thinkers a quite sophisticated theory of the effects of foods on the body, based on observation and inference. He would, of course, like us to believe that his method is radically different from that of his opponents, but it is worth pointing out that what he presents as rational and empirical argumentation itself relies on a fair amount of speculation, even if it is a kind of ‘common-sense’ speculation that would not be terribly difficult for most people to accept. The author relies, in short, on a myth of origins not functionally dissimilar to that of his opponents—both believe in something they would call human φύσις, more or less stable through time, but they differ specifically on how they reach their particular conception of it. 14.3, just quoted, spells out this difference clearly: the opponents imagine a primordial time when humans were being formed out of the four Empedoclean elements; from that point on, medicine would consist in the regulation of the properties that accrue to each of the elements (the hot, cold, etc.). The author of On Ancient Medicine, by contrast, has no patience with speculation about any period when humans were not already physiologically humans, and prefers to begin his story at a point when humans were barely distinguishable from other animals, childlike, vulnerable, without developed skills, and powerless in the face of a cruel natural world.8 8  For a Greek mythological parallel, we perhaps come close with Hesiod’s description of the ‘iron age’ WD 174–201. In his tale of the various ages of humankind corresponding to various metals, the iron age is the last and most debilitated. It is also ‘our age’, as Hesiod states in 176, a world full of disease, suffering and injustice. For discussion and other mythological parallels, see West 1978, 196–204. This would be the age that interested the author of VM, and in which he would situate his thumbnail sketch of the origins of medicine. Note also that Hesiod’s iron age resembles his earlier description of the wretched world (again, ‘our’ world) that Pandora ushered in (WD 100–105) when she opened the great jar and let loose all the evils it contained. Chief among these, Hesiod famously notes, are the many sicknesses that now wander silently through the earth (102–103).

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The author of On Ancient Medicine dilates at some length on this imagined period in human history early in the treatise, chapter 3, and it has justifiably become a much celebrated passage, if only because it is one of only a handful of extended accounts of Kulturgeschichte from the classical period, and quite possibly the only example from the fifth century. The passage is often compared to Protagoras’ myth in Plato’s dialogue of that name, and later accounts of Democritus’ own variations on the theme are often brought to bear on certain aspects of On Ancient Medicine’s account.9 It is reasonably clear that the motif of ‘humans in an original state, and the development of arts and culture’ appealed to a number of so-called sophists of fifth-century Greece, so it is easy enough to set On Ancient Medicine squarely within that intellectual milieu.10 Excellent work on the background to this passage has been done by such scholars as Vlastos, Miller, Herter, Jouanna, Demont, Dunn, and Schiefsky,11 so there is no need to rehearse these connections here. My focus will be instead on the specific premises that underlie the argument of chapter 3, especially as a key step in the author’s subsequent discussion of medicine as a τέχνη ultimately about food and cooking. Whereas the other well known Classical accounts of the history of culture see early humans as moving from savagery to civilization through the development of various τέχναι, whether this be language, political art, or skill in building and manufacture, On Ancient Medicine distinguishes itself from these accounts in chapter 3, as Schiefsky and others have pointed out, with its very specific focus on the transition from raw to cooked foods, a transition facilitated by a gradual, continually improved understanding of blending and mixing. The assumption, too, that humans were originally beast-like and uncivilized is in line with other contemporary anthropological analogues (see n. 11), but on this point, again, the author of On Ancient Medicine has a distinct angle, in keeping with his particular concern with food. This angle, in fact, is perhaps even more original than is often thought, for it not only reduces all of medicine to one form or another of regimen, but its particular conceptualization of ‘man in a natural state’ is highly idiosyncratic. The narrative of origins in chapter 3 does indeed resemble other near-contemporary variations, such as the famous myth told by Protagoras in the Platonic dialogue of the same name (320c ff.). The author of On Ancient Medicine, of course, has 9  Further detail, with an overview of the scholarship at Schiefsky 2005, 152–60. 10  See, e.g., Schiefsky 2005, 53–55, 158–60. 11  In addition to Schiefsky 2005 (cf. above, n. 9), see also Vlastos 1945; Vlastos 1946; Miller, 1949; Miller 1955; Herter, 1963; Jouanna 1990 [2003], 43–49, 161–65; Jouanna 1992; Demont 1994, Dunn 2005, and Holmes 2010, 162–77.

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no ­interest in mythological explanations of human deficiency, but he wrestles with the same question as Plato’s Protagoras, namely, why do human beings, when compared to animals, seem so lacking in self-sufficiency? Why do they need τέχναι to compensate for inherent weakness? Plato’s Protagoras answers these questions by blaming Epimetheus (321c), originally charged at the creation of the natural world with provisioning its living inhabitants. As the story goes, he used up on the animals all the gifts he had to bestow, so humans were left high and dry, unprotected in a hostile world. The result was that Prometheus first had to steal fire and political skill from the gods, and then invent such things as language, shelter and agriculture. What is striking about On Ancient Medicine’s non-mythological version, by contrast, is how monolithic his attempt to visualize the life of early humans is—no mention of social skills, no praise of grand cultural achievements (with the exception of medicine), or of the ultimate superiority of humans over animals. All the ills of humankind, it seems, are reducible to matters of diet. As the author states at the opening of chapter 3, insofar as medicine ultimately concerns the regulation of food-intake, and its effects on the body, if humans originally ate a diet that was appropriate for their φύσις, there would have been no need from the start for anyone to discover a τέχνη intended to correct what was inappropriate to it. τὴν γὰρ ἀρχὴν οὔτ’ ἂν εὑρέθη ἡ τέχνη ἡ ἰητρικὴ, οὔτ’ ἂν ἐζητήθη (οὐδὲν γὰρ αὐτέης ἔδει), εἰ τοῖσι κάμνουσι τῶν ἀνθρώπων, τὰ αὐτὰ διαιτωμένοισί τε καὶ προσφερομένοισιν, ἅπερ οἱ ὑγιαίνοντες ἐσθίουσί τε καὶ πίνουσι καὶ τἄλλα διαιτέονται, ξυνέφερε, καὶ εἰ μὴ ἦν ἕτερα τουτέων βελτίω. (3.1) For the art of medicine would never have been discovered to begin with, nor would anyone have sought for it—for there would have been no need for it—if it were beneficial for the sick to follow the same regimen and diet as the healthy, taking the same foods and drinks and following the same regimen in other respects, and if there were not other things better than these. In 3.3 the author tells us how he has come to see it this way: human beings originally ate the same foods as animals; animals have no cooking or processing, so humans, like animals, ate only raw and uncooked foods.12 They were constitutionally unsuited for such a diet, and so they suffered then just as they would in his own day if they were to eat the same diet. As Schiefsky notes 12  On the topos of the θηριώδης δίαιτα, evidently popular in the fifth century, see Schiefsky 2005, 162–63.

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(2005, 154), the first step towards discovering a systematic medical τέχνη was the observation that different subjects reacted differently to different foods— thus indicating that people had different φύσεις. From here, people were then able to observe how different foods affected the same φύσις. Slowly over time, humans figured out a diet more appropriate to their natures. So when someone is sick he reverts to a condition analogous to early humans—the bodily fluids are out of balance, and can only be brought back into order by the intake of the appropriate foods.13 Such is the basic argument of this chapter, but several questions arise: it is clear, as scholars have often pointed out,14 that the author is arguing backward from his empirical observations about how sick people respond to different foods differently from healthy people. He imagines, therefore, that people discovered the therapeutic effects of a proper regimen when they realized that humans cannot eat like animals. But why should he imagine that the human diet was originally bad for them? The author really does seem to believe that if humans had been able to eat the same diet as animals, they would have been just fine. He does not say as much, but he does seem to imply that if it were not for the human inability to eat raw foods, there would have been no disease and no suffering. Consider what he says about the life of animals in 3.3: ἔτι δ’ ἄνωθεν ἔγωγε ἀξιῶ οὐδ’ ἂν τῶν ὑγιαινόντων δίαιτάν τε καὶ τροφὴν, ᾗ νῦν χρέονται, εὑρεθῆναι, εἰ ἐξήρκεε τῷ ἀνθρώπῳ ταὐτὰ ἐσθίοντι καὶ πίνοντι βοΐ τε 13  It is not entirely clear how the author of VM differentiates in his mind between early humans who were sick only because they ate the wrong diet out of ignorance, and sick humans of his own day. That is, if his contemporaries had the benefit of knowing what a diet appropriate to humans was (that is a processed, ‘blended’ diet, rather than a raw, ‘bestial’ one), why would they get ever get sick in the first place if the root of all sickness seemed to be the improper diet which they had gradually corrected for? The nuances of his thinking are not in the text, but the implication seems to be that there is not a single food or type of food appropriate to all physeis, and that even among the earliest humans the process of discovering the proper foods for health was dependent on calibrating to individual physeis and understanding fully the properties of all foods. Sick humans of his own day, therefore, must not be eating fully correct foods for their particular physeis, and so they become sick—which is why they then need to be treated with a change in dietary regimen. 14  See, e.g., Miller 1949, 192, ‘. . . by an analysis of medicine as an established τέχνη, as currently known and practiced, [the author] tries to demonstrate that medicine and the discovery of human regimen involved basically the same factors. Finding the same factors and processes at work underlying both activities, he draws the conclusion that the discovery of medicine and of human regimen was essentially the same process’.

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καὶ ἵππῳ καὶ πᾶσιν ἐκτὸς ἀνθρώπου, οἷον τὰ ἐκ τῆς γῆς φυόμενα, καρπούς τε καὶ ὕλην καὶ χόρτον• ἀπὸ τουτέων γὰρ καὶ αὔξονται καὶ ἄπονοι διάγουσιν, οὐδὲν προσδεόμενοι ἄλλης διαίτης. And, to go still further back, I hold that not even the regimen and nourishment that the sick make use of today would have been discovered if it were sufficient for the human being to eat and drink the same things as an ox and a horse and all the animals other than man—for example, the things that grow from the earth: fruits, brush, and grass. For from these things they are nourished, grow, and lead their lives free of trouble, having no need of any other regimen. Peculiar as it may sound to us, the implication here is that animals simply do not get sick. They eat a diet that is just there in the world, raw and unprocessed as it is, and, because this is appropriate to them, they do not suffer. Given the logic of the whole chapter, this is tantamount to saying, simply, that human beings are by nature ‘sick’ in that they, unlike animals, are ignorant of what they should eat to remain healthy. For he says at the opening of chapter 3 that medicine would never have been discovered if it were the case (which it is not, he means) that the sick person should eat the same food as the healthy person. This statement guides the author’s train of thought to the hypothetical condition of humankind: the only reason why, in the author’s time, the sick get better when one attends to their diet is because people figured out that their original diet was actually making them sick. If they had not once lived on that diet, they would not have become sick to begin with. This passage is suffused, therefore, with an odd, almost melancholic, pessimism about the human condition.15 Scholars are certainly not wrong to emphasize, as they traditionally have done, the treatise’s optimistic promotion of medical τέχνη, but this is a τέχνη that arose in response to a pervasively negative assessment of humans as creatures of the natural world. There is in fact something almost counterintuitive about the reasoning here, which has animals—living, as they are here imagined to do, ἄπονοι and without need of dietary instruction (3.3, 11 J)—emerging as superior to humans. Whatever animals happen to eat is apparently appropriate to their constitution; humans, 15  See Dunn 2005, 59–60, who sees the development of human culture in the treatise as ‘a process that is pervasive, uncertain, and unpredictable’, and downplays (persuasively, as I see it) its ‘supposed optimism’. See also Holmes’ discussion (2010, 165–67), who likens the thrust of this passage to the Greek tragic axiom ‘knowledge through suffering’, pathei mathos.

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by contrast, if left uninstructed eat whatever happens to be available, like the animals, but suffer for it and die as a result. What led the author to assume such a situation in which humans were worse off than animals in some hypothetical primitive time? Or put another way, why exactly should a brutish diet be appropriate to animals, but not humans? Indeed, what does it even mean for the author to conceptualize humans as existing in a ‘state of nature’? Protagoras’ myth in Plato’s Protagoras also tried to account for why humans are inherently flawed in comparison to animals, and his solution is to say that humans in their natural state in fact should have been better off, but a problem at the time of manufacture left them vulnerable and weak. The author of On Ancient Medicine can have no recourse to mythological explanation, however, so he must leave unanswered the question of why humans should end up inadequately designed for their environment. But it is precisely this inherent inadequacy, according to the author, that medicine evolved to address. On Ancient Medicine’s interest in Kulturgeschichte is, therefore, crucial for appreciating the full implications of the author’s argument, and quite possibly one of the distinctly ‘Hippocratic’ features of the treatise. I would locate this Hippocratism not only in On Ancient Medicine’s intense focus on food as a key element in the etiology of disease, but also in the ways in which On Ancient Medicine accounts for such a focus to begin with. Any doctor might treat a disease by altering the patient’s diet, if only when he observes that the patient cannot tolerate the diet he or she normally follows. But the Hippocratic doctor is after more than this—the principles at work when the body processes food, for example, and whether these principles can be organized in such a way as to constitute the object of a τέχνη.16 On Ancient Medicine suggests that Hippocratic medicine saw its approach to illness specifically as a response to the inherent, paradoxically natural, imperfection of the human body. The assumption that humans are by nature deficient explained the Hippocratic insistence on the necessity of applying rationality to such deficiency, since the proper regimen for humans, it turns out, is not something that exists, to use Miller’s phrase, κατὰ φύσιν,17 i.e., not something they can come upon without 16  Such a concern guides any number of Hippocratic treatises, e.g., Vict., with its systematic approach to the mixing of barley-gruel for specific disease, or Morb. 4, with its fixation on the processes of digestion. 17  Pace Miller (1949, 198: ‘As visualized by the author, human regimen was generated and prescribed solely by the natural needs and demands of the physical organism. The whole process is conceived as having occurred in the fullest sense κατὰ φύσιν and, so far as the active, causative factors are concerned, mechanically and impersonally. For the function of the human mind and reasoning in the scheme, while of course necessary, is really subsidiary—it is a “co-worker”. Human regimen is thus not primarily a product of the mind of man in this conception, but actually the product of Nature itself’. This does not seem

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the purely intellectual intervention of abstract, syllogistic thinking. Nature itself cannot, in the end, take care of humans, at least not in a predictable, explicable way; sick people may well recover by chance (τύχῃ), as the author On Ancient Medicine is well aware,18 but this occurs in spite of human φύσις, which, if left unassisted by τέχνη, is programmed, according to the narrative of On Ancient Medicine 3.3, to lead humans towards a brutish life for which they are physiologically unsuited. This notion of medicine as a τέχνη that attempted to improve upon an essentially defective product explains why the author of On Ancient Medicine bothers at all in 3.3 to bring up a hypothetical primitive diet, and why this section, insofar as it provides the rationale for positing a strong link between food and disease, is an important piece of his polemic. It remains possible, moreover, that On Ancient Medicine’s premise that medicine as a kind of response to human imperfection was recognizably ‘Hippocratic’ in antiquity. Underlying the Hippocratic concern for food and dietetics, I suggest, was the more fundamental principle that dietary regimen is not a ‘natural’ phenomenon. Nature may go to great lengths to heal the diseased body, as Hippocratic treatises are fond of saying,19 but it does not in fact do such a good job of directing humans towards foods and dietary habits that will keep them healthy or heal them when sick. That requires the intervention of intelligence and agency: the τέχνη of regimen, in other words, addresses a deficiency that needs to be rectified, and this is the polemic on which much Hippocratic medicine seems to have been based; it forms, in fact, the rationale for the very notion of medical intervention. It is not insignificant that Hippocrates was credited in antiquity with saying that medicine was a ‘servant of Nature’,20 for servants are brought in to do what masters cannot or will not do themselves. Galen, in fact, was fond of citing this Hippocratean adage,21 and in doing so he seems to have internalized this ‘deficiency model’ as a Hippocratic principle. Indeed, Galen, like the author of On Ancient Medicine, was very interested right: VM rather seems to take some pride in differentiating the i­ ntellectual agency he sees behind the early evolution of a medical τέχνη from the ‘mechanical’, ‘impersonal’ force of an unintending ‘Nature’. 18  See VM 1.2 and 12.2, where the author contrasts medicine as a τέχνη discovered by humans to τύχη, luck. This contrast was a concern of other Hippocratic writers as well, e.g., Loc. hom. 46.1 Craik (though instead of τέχνη here, the author speaks of the ἐπιστήμη of medicine), on which see Craik 1998, 216–17 and Schiefsky 2005, 7, 131–32; De arte 4.227.12–15; Jouanna 1990 [2003], with discussion at Schiefsky 2005, 7–11. 19  Captured laconically, e.g., by Alim. 15 Joly: ‘Nature is sufficient in all cases for all things’ (φύσις ἐξαρκεῖ πάντα πᾶσιν). 20  Cf., e.g., Epid. I.11. 21  E.g. Thrasybulus 853 Kühn.

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in imagining what human existence in the proverbial ‘state of nature’ must have been like, and this frequent thought-experiment led him, too, to conclude that medicine evolved as a response to the inadequacies of human φύσις. One of the most explicit and interesting passages—the opening of On the Use of Parts—will give us a good sense of some affinities he had with the author of On Ancient Medicine. On the Use of Parts is a sprawling work in seventeen books in the tradition of Aristotle’s biological writings, but it displays a passion and intellectual tenacity that is characteristically Galen. He focuses on the parts of the human body, combining detailed anatomical description with teleological analysis: why is the body designed as it is? What purpose does the design serve?22 Galen, like others working on such question before him, often looked to the non-human animal world for comparisons and contrasts to humans. As he lays out his notion of Nature, φύσις, in the opening paragraphs, Galen does not explicitly mention On Ancient Medicine,23 but it is clear that, like the author of that work, he is conjuring up similar primordial scenarios in which animals and humans are left to their own devices, and compelled to rely only on their physiological capacities for survival. For Galen, too, there is quite a difference between the way Nature designed animals and the way it designed humans: the animal world may be extremely diverse, he notes, but their bodies are all ‘adapted to the character and faculties of the soul’ (πᾶσι δ’ οὖν ἐπιτήδειον τὸ σῶμα τοῖς τῆς ψυχῆς ἤθεσί τε καὶ δυνάμεσιν, 1.2 Helm.). Nature sees to it that whatever physical deficiency an animal has for its survival is compensated for by something else—each has what he calls its ‘innate weapons’ (ὅπλα ξύμφυτα): the bull its horns, the pig its protuberant teeth, the deer 22  For detailed discussion of Galen’s teleology, in De usu and elsewhere, see Hankinson 1989; Hankinson 1998, 385–92, and in the context of ancient versions of what we have come to call ‘creationism’, see now Sedley 2007, 239–44. 23  It is striking, in fact, that Galen never mentions VM directly in any of his surviving works. It is clear, however, that he knew the work, since an Arabic version of his commentary on Epid. II mentions it explicitly, and several glosses in his Hippocratic lexicon Linguarum seu dictionum exoletarum Hippocratis explicatio suggest he knew the treatise. For details, see Schiefsky 2005, 66–67 and Jouanna 1990 [2003], 97–99. The wording of the passage from the Arabic commentary is usually taken to imply that Galen thought VM was not genuine, but this seems an open question to me. It could well be, moreover, as Schiefsky intimates, that Galen was embarrassed by VM’s repudiation of the role of the hot, cold, wet and dry (which was central to Galen’s own Hippocratism), and so ignored it in his other writings as much as he could. For our purposes, however, it is sufficient to have determined that he was familiar with the work; he may well have admired the vignette of Kultugeschichte in VM 3.3, without worrying about other aspects of the treatise’s theorizing which he may have found unappealing, if not spurious.

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or rabbit their swift legs, and so on (1.2). Humans, however, are different. As we might expect, Galen elevates human beings above animals, describing them in the same section, with a nod to Aristotle (De part. anim. 656a7–8), as both intelligent (σοφός) and god-like (θεῖος). But there is slight defensiveness in his tone when he compares their self-sufficiency to that of an animal. For humans are not in fact endowed with any especially impressive natural weapons. Rather, they are given hands, as Galen continues, ‘in place of all defenses, and as instruments necessary for all the arts, in peace no less than war’. (ἀντὶ πάντων ὁμοῦ τῶν ἀμυντηρίων ὅπλων χεῖρας ἔδωκεν, ὄργανον εἰς ἁπάσας μὲν τὰς τέχνας ἀναγκαῖον, εἰρηνικὸν δ’ οὐδὲν ἧττον ἢ πολεμικόν, 1.2 Helm.). With hands, after all, a human can pick things up, hurl them, make things, etc. Not everyone would agree that hands make humans superior to all animals, apparently, for he imagines someone objecting that a lion can always run faster than a man (ἀλλ’ ὠκύτερος ἀνθρώπου λέων. τί δὲ τοῦτο;). His retort to this challenge is key: humans can use their intelligence and hands (σοφίᾳ καὶ χερσίν) to tame horses, and since horses are faster than lions, humans can ride horses and so overcome the lion, even though he is an inherently slower creature. (ἄνθρωπος γὰρ ἵππον ἐδαμάσατο σοφίᾳ καὶ χερσίν, ὠκύτερον λέοντος ζῷον, ᾧ χρώμενος καὶ ὑποφεύγει καὶ διώκει λέοντα καὶ καθεζόμενος ἀφ’ ὑψηλοῦ βάλλει τὸν ταπεινόν, 1.2–3 Helm.). His conclusion suggests just how well Nature provided for human self-sufficiency: οὔκουν γυμνὸς οὐδ’ εὔτρωτος οὐδ’ ἄοπλος οὐδ’ ἀνυπόδετος ἄνθρωπος, ἀλλ’ ἔστι μὲν αὐτῷ θώραξ σιδηροῦς, ὁπότε βούλοιτο, πάντων δερμάτων δυστρωτότερον ὄργανον, ἔστι δ’ ὑποδημάτων παντοῖον εἶδος, ἔστι δ’ ὅπλων, ἔστι δὲ καὶ σκεπασμάτων. (1.3 Helm.) And so a human is not naked, easily wounded, defenseless, or shoeless, but he has a breastplate of iron whenever he wants—an instrument harder to pierce than any kind of skin—and he has all kinds of shoes, weapons and coverings. Galen ends up prevaricating on this point, however, since a few paragraphs later (1.5–6 Helm.), he has to concede what sounds like the opposite. There, he describes the human body as ‘bare of weapons’ and the soul as ‘bereft of skills’ (ἄνθρωπος . . . τὸ σῶμα γυμνὸς ὅπλων . . . τεχνῶν τὴν ψυχὴν ἔρημος). And, he continues, to compensate for this ‘nakedness of the body’ (ἀντὶ μὲν τῆς τοῦ σώματος γυμνότητος), Nature gives him hands, and to compensate for his ἀτεχνία of soul (ἀντὶ δὲ τῆς κατὰ τὴν ψυχὴν ἀτεχνίας, by which I assume he means humans have no innate, perhaps instinctual, intellectual capacity to compensate for their physical inferiority to stronger animals), he gets λόγος. The result is the

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peculiar paradox that humans are, on the one hand, the most exalted of all creatures on the earth, but, on the other, strikingly ill-equipped, physically, to survive in the world unassisted. He sums up the irony at 1.6 Helm.: ‘Since it was better [for humans] to have recourse to all weapons and all the arts, for this reason none of them was granted to him at birth’, (ἐπεὶ δ’ ἄμεινον ἦν ἅπασι μὲν ὅπλοις, ἁπάσαις δὲ χρῆσθαι τέχναις, διὰ τοῦτ’ αὐτῷ ξύμφυτον οὐδὲν ἐδόθη). In other words, man’s great achievements, his superiority to animals and mastery of the world, arise because he is able to direct his considerable mental endowments towards compensating for the relatively mediocre physical machine he has to work with.24 It is impossible to say whether Galen had On Ancient Medicine anywhere in his mind when he was writing this section of On the Use of Parts (cf. n. 23), but it seems clear that both authors, despite a predictably self-congratulatory view of humanity in general, share a more ‘pessimistic’ qualification of this view, namely, that humans cannot thrive in the world if they rely only on their bodies and instincts. As the author of On Ancient Medicine suggests, this is the very reason why medicine is necessary in the first place, and why he is at pains to make the argument for medicine as a τέχνη. Galen too saw that τέχναι were essential externals to human nature, not innate or something one could take for granted; and since medicine was one of the τέχναι, it too was something that needed to be continually cultivated and improved by λόγος, and likewise never taken for granted. How widespread such a view was among ancient medical thinkers is difficult to say, but it seems likely enough that Galen would regard it as fundamentally Hippocratic. Bibliography Craik, E., Hippocrates: Places in Man. Oxford 1998. Demont, P., ‘Le Protagoras de Platon, Hérodote et la Providence’, Actas del VIII Congreso Espanol de Estudios Clasicos, vol. 2, Madrid 1994, 145–158. Dunn, F., ‘On Ancient Medicine and its Intellectual Context’, in van der Eijk 2005, 49–67.

24  We might imagine that the explicit teleology behind Galen’s depiction of human helplessness—it was all part of Nature’s plan—was implicit in VM’s notion of humankind’s primeval helplessness (e.g., that it was somehow teleologically necessary so that humans could eventually use their intellect to transcend their animal affiliations), but this is not a perspective that seems to interest the author of VM.

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Hankinson, R.J., ‘Galen and the Best of all Possible Worlds’, Classical Quarterly 39 (1989) 206–27. ———, Cause and Explanation in Ancient Greek Thought. Oxford 1988. Herter, H., ‘Die kulturhistorische Theorie der hippokratischen Schrift von der Medizin’, Maia 12 (1963), 464–83. Holmes, B., The Symptom and the Subject: The Emergence of the Physical Body in Ancient Greece. Princeton 2010. Jouanna, J., ‘La naissance de la science de l’homme chez les médecins et les savants à l’époque d’Hippocrate: problème et méthode’, in: J.A. López-Ferez (ed.), Tratados hipocráticos: estudios de su contenido, forma, e influencia. Madrid 1992, 91–111. ———, Hippocrate, Oeuvres Complètes vol. 2.1, De l’ancienne médecine. Paris 1990 [2003]. ———, Hippocrates, tr. M. DeBevoise. Baltimore 1999. Lloyd, G.E.R., Methods and Problems in Greek Science. Cambridge 1991. Miller, H.W., ‘On Ancient Medicine and the Origin of Medicine’, Transactions and Proceedings of the American Philological Association 80 (1949), 187–202. ———, ‘Technê and Discovery in On Ancient Medicine’, Transactions and Proceedings of the American Philological Association 86 (1955), 51–62. Schiefsky, M., Hippocrates: On Ancient Medicine. Leiden 2005. Sedley, D., Creationism and its Critics in Antiquity. Berkeley 2007. van der Eijk, P., Hippocrates in Context: Papers Read at the XIth International Hippocrates Colloquium. Leiden 2005. Vlastos, G., ‘Ethics and Physics in Democritus’, The Philosophical Review 54 (1945), 6, 578–92. ———, ‘On the Pre-History in Diodorus’, The American Journal of Philology 67 (1946), 51–59. West, M.L., Hesiod: Works and Days. Oxford 1978.

CHAPTER 12

On Regimen and the Question of Medical Dreams in the Hippocratic Corpus Maithe Hulskamp ἐμοὶ δὲ ταῦτα ἐξεύρηται, καὶ πρὸ τοῦ κάμνειν τὸν ἄνθρωπον ἀπὸ τῆς ὑπερβολῆς, ἐφ’ ὁπότερον ἂν γένηται, προδιάγνωσις. Οὐ γὰρ εὐθέως αἱ νοῦσοι τοῖσιν ἀνθρώποισιν ἐπιγίνονται, ἀλλὰ κατὰ μικρὸν συλλεγόμεναι ἀθρόως ἐκφαίνονται. Πρὶν οὖν κρατεῖσθαι ἐν τῷ ἀνθρώπῳ τὸ ὑγιὲς ὑπὸ τοῦ νοσεροῦ, ἃ πάσχουσιν ἐξεύρηταί μοι, καὶ ὅπως χρὴ ταῦτα καθιστάναι ἐς τὴν ὑγείην.1 And I have discovered these things, and also prodiagnôsis, implemented before a man falls ill due to excess, concerning the way in which the disease may develop. For diseases do not come upon men suddenly, rather they gather themselves together bit by bit and then appear in full. Thus I have discovered what people suffer before health is mastered by disease, and how one should change these things into a state of health. This bold claim is made by the author of the Hippocratic treatise On Regimen at the beginning of the first of four books. He prides himself on the discovery of a means to discern the presence of trouble in the body before it has had a chance to gather enough momentum to manifest itself as a fully-fledged disease. According to the author, this prodiagnôsis makes non-invasive eradication of the beginnings of illness possible, by means of minor or major adjustments to a person’s regimen—depending on the severity of the impending affliction. Instrumental to the author’s method is the interpretation of a patient’s dreams: these are useful indicators of the dreamer’s mental and physical wellbeing because, ὁποῖα γάρ τινα πάσχει τὸ σῶμα, τοιαῦτα ὁρῇ ἡ ψυχὴ, κρυπτομένης τῆς ὄψιος,2 ‘as the experiences of the body are, so are the visions of the soul when sight does not function’. * I am grateful to the Wellcome Trust for their financial support of my research. I thank Professor Jacques Jouanna for his comments on the oral version of this chapter. This chapter elaborates on points I have made in Hulskamp 2013, 42–47. 1  Vict. 1.2.124.28–126.3 Joly/Byl, 6.472 L. Translations are mine, unless indicated otherwise. 2  Vict. 3.71, 204.5–6 Joly/Byl, 6.610 L.

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The author elaborates on this remark in book four, explaining that ὅσα δὲ ἡ ψυχὴ τοῦ σώματος παθήματα προσημαίνει, πλησμονῆς ἢ κενώσιος ὑπερβολὴν τῶν συμφύτων, ἢ μεταβολὴν τῶν ἀηθέων. . . . 3 the soul foretells affections of the body, surfeit or depletion of things that are natural, or change into unaccustomed things. . . .  In this fourth book, also known as On Dreams, the author clarifies that dreams are made up of the acts of the soul, which is active and autonomous when the body is resting. ὅταν δὲ τὸ σῶμα ἡσυχάσῃ, ἡ ψυχὴ κινεομένη καὶ ἐγρηγορέουσα διοικεῖ τον ἑωυτῆς οἶκον καὶ τὰς τοῦ σώματος πρήξιας ἁπάσας αὐτὴ διαπρήσσεται. τὸ μὲν γὰρ σῶμα καθεῦδον οὐκ αἰσθάνεται, ἡ δ’ ἐγρηγορέουσα γινώσκει πάντα, καὶ ὁρῇ τε τὰ ὁρητὰ καὶ ἀκούει τὰ ἀκουστὰ, βαδίζει, ψαύει, λυπεῖται, ἐνθυμεῖται, ἐν ὀλίγῳ ἐοῦσα, ὅσαι τοῦ σώματος ὑπηρεσίαι ἢ τῆς ψυχῆς, πάντα ταῦτα ἡ ψυχὴ ἐν τῷ ὕπνῳ διαπρήσσεται.4 But when the body is at rest, the soul, being set in motion and awake, manages her own household, and takes care of all the activities of the body herself. For the sleeping body does not perceive, but she [sc. the soul] when awake knows all, and sees what is visible, hears what is audible, walks, touches, feels pain, ponders, in her limited dwelling space. Functions of the body or of the soul: in sleep, the soul performs all those. By carefully interpreting these acts, the author contends, one can learn a great deal about the dreamer’s health. On Regimen is given a unique position, not only by its author, who makes self-assured claims as to his own originality, but also by modern scholarship, mainly because of its exceptional anthropology (a mixture of fire and water), the fact that it links the microcosmos of the body and the macrocosmos of the universe as analogues of one another, and its overt inclusion of the gods.5 But there is one other aspect of On Regimen that sets the treatise apart, namely, the fact that its author uses dream interpretation as a medical diagnostic tool. Previous scholars have noted that other Hippocratic authors 3  Vict. 4.87, 218.16–7 Joly, 6.642 L. 4  Vict. 4.86, 218.7–12 Joly/Byl, 6.640 L. 5  E.g. Diller 1959; Jouanna 1998; van der Eijk 2004.

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also made use of dreams as indicators of their patients’ well-being, but none of these Hippocratics ever seems to have taken it to the lengths the author of On Regimen has.6 In addition, closer inspection shows that most of the references to dreams in the CH are to their occurrence or effect as symptoms, and not so much to the potential meaning of their content in the way On Regimen utilised them. No clear parallels to On Regimen’s elaborate dream theory have been identified as yet, and thus it retains a distinctive position.7 This chapter will show, however, that in some Hippocratic treatises the similarity to On Regimen’s dream theory runs deeper than has hitherto been realized, and that its detailed consideration of the actual content of dreams was perhaps less of a unique heurêma than the author would have us believe. The passage on dreams that seems to display ideas closest to those formulated in On Regimen consists of chapters 9 and 10 of Epidemics 6.8.8 I quote them here in full, from Manetti and Roselli’s 1982 edition, accompanied by translations from Smith 1994: 9. Ἡλίου θάλπος, ψῦχος, τέγξις, ξηρότης· μεταβολὴ διὰ οἷα, ἐξ οἵων, ἐς οἷα [ἔχει]. πόνοι, ἀργίαι, ὕπνοι, ἀγρυπνίαι. τὰ ἐν ὕπνῳ· ἐνύπνια, κοῖται, καὶ ἐν οἷσι, καὶ ὑφ’ οἵων. 10. καὶ τῆς γνώμης· ξύννοια, αὐτὴ καθ’ ἑωυτὴν, χωρὶς τῶν ὀργάνων καὶ τῶν πρηγμάτων, ἄχθεται, καὶ ἥδεται, καὶ φοβεῖται, καὶ θαρσεῖ, καὶ ἐλπίζει, καὶ †ἀδοξέει†, οἷον ἡ Ἱπποθόου οἰκουρὸς, †τῆς γνώμης αὐτῆς καθ’ ἑωυτὴν ἐπίστημος ἐοῦσα† τῶν ἐν τῇ νούσῳ ἐπιγενομένων . . .9 9. Sun’s heat, cold, dampness, dryness, the nature of alteration, on account of what it occurs, from what to what. Pains, lassitude, sleep, restlessness. Phenomena of sleep: dreams, going to bed, both in what circumstances and from what cause. 10. Even the mind’s consciousness, itself by itself, distinct from the organs and events, feels misery and joy, is fearful and optimistic, feels hope and 6  E.g. Joly 1967, xxii; Joly/Byl 1984, 21; Lloyd 1979, 43; Oberhelman 1993, 127. The passages usually mentioned as evidence are Epid. I.10, Hum. 4, Prorrh. I.5, VM 10–11 (and Hebd. 45, though this treatise is of course not part of the ancient core of the CH). 7  For an elaborate study of the use of dreams in Hippocratic diagnosis and prognosis, see Hulskamp 2008 and 2013. 8  Deichgräber 1971, 52–64 has pointed out Herodicos of Selymbria as a possible common source of influence on the dietetics of Epid. 6 and Vict. Joly 1960, 202–205 acknowledges this, but is not satisfied that it fully accounts for the resemblances between the treatises. 9  Epid. 6.8.9–10, 174.1–8 Manetti/Roselli, 5.346–8 L.

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despair. Like the servant of Hippothoos, although by herself in her mind she was conscious of the things that followed on her disease. These two brief chapters have long been subject to ancient and modern scholarly debate. Two main problems make their interpretation difficult: first, the shorthand style of the text, already an issue for Galen, severely compromises our understanding of it; and second, the fact that in several places the text is corrupt automatically hinders interpretation10 so the meaning and purpose of the two chapters remain vague at best. Nonetheless, the topics referred to make them potentially interesting to the subject of medical dream interpretation, and a discussion from that perspective seems in order. To make the two chapters more comprehensible than they are now, I would like to propose that they be viewed as one. They belong to the text from a writing tablet containing σκεπτέα, things to which a physician should pay attention when treating his patients.11 Let us consider the current division of the chapters into two. Chapter 9 deals with several different phenomena. First mentioned is the natural external influence of the four qualities—or so we may assume: the author speaks of the sun’s heat, which leads us to infer that the other three qualities mentioned are also influences on the human body from the outside.12 More specifically, the external qualities are mentioned because they may have an influence on the corresponding internal qualities of the body, thus potentially jeopardizing a person’s health. Next, a process of change is mentioned, followed by another two pairs of opposites: exertion and rest, and sleep and insomnia. As noted earlier, the shorthand style of the text 10  Cf. Manetti/Roselli 1982, 175. 11  The subdivision of this list into chapters is modern; any sense to be made of the text by this means, though (potentially) helpful, is therefore entirely artificial. Also, this explains why the text is very succinct and somewhat difficult to understand for someone who does not already know what is intimated by the short remarks. 12  Galen sees it differently: he reads ἥλιος, not ἡλίου, and takes sun and θάλπος to be separate from each other, which leaves him free to interpret the subsequent four qualities as properties of the body only, and not as external influences. This approach is of course defensible, especially if one considers the fact that the list, as part of which these qualities are mentioned, is one of symptoms evinced by the body itself. However, Galen seems to be the only one to read ἥλιος instead of ἡλίου (cf. In Hip. Epid. 6.8, 455 Pfaff; Manetti/ Roselli 1982, 174). Be it ἥλιος or ἡλίου—or even if ἡλίου were a mistaken gloss—the more general theory of health and illness being dependent on the mixtures of the body posits that health is subject to influences from outside, which are responsible for alterations in the body’s mixture—and I believe it is this to which the author refers in the rest of the sentence, thus making the consequent μεταβολὴ one pertaining to the body’s mixture.

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makes it difficult to see what this passage is really about, but I think the process of change mentioned—the μεταβολὴ διὰ οἷα, ἐξ οἵων, ἐς οἷα—is the reciprocal relation between the two pairs of opposite events and the two pairs of internal qualities: they influence and are influenced by each other.13 The notion of this process of change as a connecting link even appears to be supported visually by its position between the two groups of words. That such changes should be of consequence to a physician is understandable: the concept of illness as a result of an imbalance between the components of the body is not uncommon in the CH.14 Now that the author has touched on the subject of sleeping and waking, he smoothly turns to the things that happen in sleep; and so I would propose removing the division between chapters 9 and 10. Firstly, chapter 10 begins with καὶ, something Manetti and Roselli clearly thought out of the ordinary since they saw the need to justify its position as the first word of a chapter. Secondly, the text arrangement as it is now makes the second half of the chapter quite incomprehensible,15 especially if one also considers the corrupt nature of the passage. If one looks at the resulting single chapter with the idea of medical dream interpretation in mind, things become clearer immediately: Ἡλίου θάλπος, ψῦχος, τέγξις, ξηρότης· μεταβολὴ διὰ οἷα, ἐξ οἵων, ἐς οἷα [ἔχει]. πόνοι, ἀργίαι, ὕπνοι, ἀγρυπνίαι. τὰ ἐν ὕπνῳ· ἐνύπνια, κοῖται, καὶ ἐν οἷσι, καὶ ὑφ’ οἵων. καὶ τῆς γνώμης ξύννοια, αὐτὴ καθ’ ἑωυτὴν, χωρὶς τῶν ὀργάνων καὶ τῶν πρηγμάτων, ἄχθεται, καὶ ἥδεται, καὶ φοβεῖται, καὶ θαρσεῖ, καὶ ἐλπίζει, καὶ †ἀδοξέει†, οἷον ἡ Ἱπποθόου οἰκουρὸς, †τῆς γνώμης αὐτῆς καθ’ ἑωυτὴν ἐπίστημος ἐοῦσα† τῶν ἐν τῇ νούσῳ ἐπιγενομένων . . .

13  Galen sees the two pairs of opposites merely as influencing factors (causes), not as somatic components or phenomena that may be influenced by their opposites. He says: ‘Ich sagte schon, daß die Erwähnung dieser Dinge im Zusammenhang steht mit der Aufzählung der vorangegangenem Ursachen, so daß die gesamte Angabe folgende ist: “die Sonne, die Hitze, die Kälte, die Feuchtigkeit, die Trockenheit, die Anstrengung, die Trägheit, der Schlaf, die Schlaflosigkeit”. Alle diese Dinge sind nur eine Aufzählung von Ursachen, die den Menschen in Krankheit stürzen’. (See In Hip. Epid. 6.8, 458 Pfaff.) This is of course a possibility; perhaps one interpretation does not have to exclude the other, in which case the connection of μεταβολὴ could work both ways: the four somatic processes mentioned can certainly fulfil the role both of result of and influence on the qualities in the body. Similarly, the qualities of the body are immediately related to any somatic processes taking place. 14  Cf. Jouanna 1999, 326, 328; Nutton 2004, 79–81. 15  Even Galen speaks of ‘dunkle und rätselhafte Worte’ (In Hipp. Epid. 6.8, 460 Pfaff).

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Heat of the sun, cold, moistness, dryness. Change, due to what, from what to what. Exertion, rest, sleep, insomnia. Things in sleep: dreams, circumstances in which, and because of which, one goes to bed, and the meditation of the intellect on its own: separate from the sense organs and the things that are done it worries, is happy, does and does not fear, hopes and despairs, like Hippothoos’ servant, who, while her intellect was on its own, was aware of the things that happened during her illness . . . If read in this manner, the text now explains how the things the γνώμη experiences in sleep—which constitute dreams—can be of importance to diagnosis. Thus, the passage is strongly reminiscent of the beginning chapter of On Regimen 4, where the role of the soul in sleep is explained: ὅταν δὲ τὸ σῶμα ἡσυχάσῃ, ἡ ψυχὴ κινεομένη καὶ ἐγρηγορέουσα διοικεῖ τον ἑωυτῆς οἶκον καὶ τὰς τοῦ σώματος πρήξιας ἁπάσας αὐτὴ διαπρήσσεται. τὸ μὲν γὰρ σῶμα καθεῦδον οὐκ αἰσθάνεται, ἡ δ’ ἐγρηγορέουσα γινώσκει πάντα, καὶ ὁρῇ τε τὰ ὁρητὰ καὶ ἀκούει τὰ ἀκουστὰ, βαδίζει, ψαύει, λυπεῖται, ἐνθυμεῖται, ἐν ὀλίγῳ ἐοῦσα.16 But when the body is at rest, the soul, being set in motion and awake, manages her own household, and takes care of all the activities of the body herself. For the sleeping body does not perceive, but she [sc. the soul] when awake knows all, and sees what is visible, hears what is audible, walks, touches, feels pain, ponders, in her limited dwelling space. Although there is a difference in terminology—On Regimen speaks of the soul, ψυχή, while the Epidemics text speaks of the intellect, γνώμη—17 it is beyond doubt that in both cases we are dealing with the concept of observation of the body and its condition in sleep by some other part of the same individual, which has the ability to act independently of the body; in the case of Epidemics 16  Vict. 4.86, 218.7–11 Joly/Byl, 6.640 L. 17  Galen seems to identify the γνώμη with the soul—Pfaff’s translation of Galen’s commentary reads ‘Seele’—which brings Epid. 6.9 and 10 even closer to Vict. 4.86. Additionally, Galen mentions that some interpreters have taken the dreams mentioned in the Hippocratic text to be, in Pfaff’s translation, ‘die Traumbilder, die der Kranke während des Schlafes sich vorstellt’. Galen further paraphrases these interpreters’ views on what was to be done with such dreams as follows: ‘Man müsse untersuchen, ob sie beunruhigend und beängstigend, ob sie häßlich, widernatürlich oder ob sie gewöhnliche und übliche Visionen sind’. See Gal. In Hip. Epid. 6.8, 458–60 Pfaff. All of these properties we see described in Vict. 4, with recommended treatment to boot.

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6 this is the γνώμη, in the case of On Regimen the ψυχή. In support of this interpretation, we might consider an earlier indication in the treatise of the fact that the author was thinking of mental processes in sleep. Epidemics 6.8.5 is closely related to the issues addressed in Epidemics 6.8.9–10: τὰ ἐν τοῖσιν ὕπνοισι παροξυνόμενα, καὶ ὅσοισιν ἄκρεα περιψύχεται καὶ ἡ γνώμη ταράσσεται, καὶ τἄλλα ὅσα περὶ ὕπνον τοιαῦτα, καὶ οἷσι τἀναντία.18 Affections with paroxysms in sleep, and cases in which extremities become cold and the mind disordered, and all other things concerning sleep, and cases in which the opposite happens. The author mentions a number of symptoms that occur in sleep, among which are the cooling off of the extremities and the confusion of the γνώμη. From here the step to the actions of the γνώμη in sections 9 and 10 is relatively small. In Diseases 2 and Internal Affections, there are two passages that contain imagery which bears a striking resemblance to some of the imagery described in On Regimen 92 and 93, which deal with the interpretation of dream symbols that include the dead, strangely formed bodies, fear, fighting, struggle and pain.19 Diseases 2.72 describes a case of anxiety (φροντίς). Its symptoms seem to manifest themselves both physically and psychologically: δοκεῖ ἐν τοῖσι σπλάγχνοισιν εἶναι οἷον ἄκανθα καὶ κεντεῖν, καὶ ἄση αὐτὸν λάζυται, καὶ τὸ φῶς φεύγει καὶ τοὺς ἀνθρώπους, καὶ τὸ σκότος φιλέει, καὶ φόβος λάζεται, καὶ αἱ φρένες οἰδέουσιν ἐκτὸς, καὶ ἀλγεῖ ψαυόμενος, καὶ φοβεῖται, καὶ δείματα ὁρᾷ καὶ ὀνείρατα φοβερὰ καὶ τοὺς τεθνηκότας ἐνίοτε•20

18  Epid. 6.8.5, 164.5–7 Manetti/Roselli, 5.344 L. Manetti and Rosellli notice the connection as well, cf. Manetti/Roselli 1982, 165. In addition, there is a potential link to Epid. 4.43: observation by both physician and patient was important. It is very possible that ‘knowing other things in as many ways’, τἆλλα οἷσι γινώσκομεν, includes information gained through (medical) dreams. Considering the fact that Epid. 4 was probably a product of the same author who wrote Epid. VI, cf. Jouanna 1999, 389, this is not at all unthinkable. 19  Joly has already pointed out that Morb. 2, Int. Aff., and Vict. (mainly book 3) display remarkable similarities, cf. Joly 1960, 193–201. Also, Jouanna points out that Int. Aff. ‘contains wording similar to that of Diseases II’, cf. Jouanna 1999, 395. The likeness of Morb. 2.72 and Int. 48 to Vict. 4.92 and 93 has also been noted before, e.g., in the text editions by Littré, Joly/Byl, and Jouanna, and by Palm 1933, 73, but, as far as I know, the three passages have never been subjected to elaborate comparison. 20  Morb. 2.72, 211.15–20 Jouanna, 7.108–110 L.

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In the viscera there seems to be a thorn pricking, and nausea attacks him, and he flees the light and people, and he loves the dark, and he is gripped by fear, and the diaphragm is distended, and he suffers when touched, and he is scared, and he sees frightening things and scary dreams and sometimes the dead. The patient is plagued by pricking pains in his intestines, nausea, a distended diaphragm, and over-sensitivity to touch. He is afraid of light and people, prone to anxiousness, sees frightening things (δείματα), has fearful dreams (ὀνείρατα φοβερά), and sometimes even sees the deceased. Although most of the symptoms described do not occur in a state of sleep, the correspondence to some of the imagery described in On Regimen IV is striking. However, before proceeding with our analysis of this passage, let us first consider the second passage in question. Internal Affections 48 contains a description of a ‘thick (παχύ) disease’.21 The cause of this disease is an accumulation of bile in the liver and in the head. As a result of this, the liver swells up and starts to exert pressure on the diaphragm (ἀναπτύσσεται πρὸς τὰς φρένας). The patient also experiences severe pain in the head, especially in the area of the temples. His perception is impaired, there is fever and shivering, and carphology.22 The point in the disease when things start to become interesting for us is when the build-up of bile continues and the liver expands even further against the diaphragm. Now the patient begins to display symptoms of a more psychological nature: Καὶ ὅταν τὸ ἧπαρ μᾶλλον ἀναπτυγῇ πρὸς τὰς φρένας, παραφρονέει• καὶ προφαίνεσθαί οἱ δοκέει πρὸ τῶν ὀφθαλμῶν ἑρπετὰ καὶ ἄλλα παντοδαπὰ θηρία καὶ ὁπλῖται μαχόμενοι, καὶ αὐτὸς ἐν αὐτοῖσι δοκέει μάχεσθαι· τοιαῦτα λέγει ὡς ὁρῶν καὶ ἐπέρχεται, καὶ ἀπειλεῖ, ἢν μή τις αὐτὸν ἐᾷ ἔξω ἐξιέναι• (. . .) καὶ ὅταν καθεύδῃ, ἀναΐσσει ἐκ τοῦ ὕπνου ὅταν ἐνύπνια ἴδῃ φοβερά. τῷδε δὲ γινώσκομεν, ὅτι ἀπὸ ἐνυπνίων ἀΐσσει καὶ φοβεῖται• ὅταν ἔννοος γένηται, ἀφηγεῖται τὰ ἐνύπνια τοιαῦτα ὁρᾶν ὁποῖα καὶ τῷ σώματι ἐποίει καὶ τῇ γλώσσῃ ἔλεγε.23 And when the liver expands more against the diaphragm, he becomes deranged; and in front of his eyes reptiles seem to appear and beasts of 21  In Dieb. Jud, this disease description appears practically verbatim, but there it typifies acute diseases, τὰ δὲ ὀξέα τῶν νοσημάτων, cf. Dieb. Jud.3, 9.300–302 L. As Dieb. Jud is a compilation, I focus on the Int. Aff. passage here. 22  Int. 48, 230.18–232.14 Potter, 7.284 L. 23  Int. 48, 232.14–234.3 Potter, 7.284–286 L.

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every other kind and fighting hoplites, and he seems to be fighting among them himself; he talks as if he is seeing such things and he attacks and withdraws, if someone does not allow him to go outside; (. . .) and when he sleeps, he starts up out of his sleep when he sees scary dreams. We know that he starts up and is afraid due to his dreams owing to the following: when he is in his right mind again, he relates that he has seen such dreams as correspond to what he did with his body and said with his tongue. The author speaks of derangement (παραφρονεῖν), which is apparently directly linked to the repressed position of the diaphragm, which in turn is caused by the expansion of the liver due to the collection of bile there. Curiously, this type of derangement—seeing reptilian creatures, soldiers and fighting, the impression of participating in the fight, and seeing frightening dreams at night—only seems to come on when a certain threshold in the severity of the affliction is crossed. Additionally, the verification included in the description is intriguing; it is proof of a direct link between the patient’s actions, which are visible to observers, and the things he sees in his dreams, which are of course unobservable to anyone but the patient.24 If we compare the two passages, we see that they both report problems regarding the diaphragm (αἱ φρένες), and in both cases the patient experiences psychological problems, most notably fears and anxieties, and their dreams are frightening. Although the content of the dreams is not specifically mentioned, there does seem to be a suggestion of a link between the images seen in waking and those seen in sleep. However, even if this is not the case, there is still an interesting resemblance to chapters 92 and 93 of On Regimen. The table below illustrates just how many similarities there are between the three passages: 24  The only other concrete example of a direct response of the dreamer’s body to what he sees in his dreams is Semin.1, 7.470–472 L. A potential reference to the concept we find in Hum. 4, where the author recommends paying attention to a patient’s dreams and what he does in sleep, ἐνύπνια οἷα ἃ ὁρῇ, καὶ ἐν τοῖσιν ὕπνοισιν οἷα ἂν ποιῇ, Hum. 4, 68.19–20 Jones, 5.480–2 L. Incidentally, it is interesting to note that Potter, in his Loeb edition, has Morb. 2.72 describing the symptoms of phrenitis, which is understandable, considering the evidence elsewhere in the CH, cf. Aff. 10, 6.218 L; Morb. 1.30 and 34, 6.200 L; Morb. 3.9, 7.128 L. In turn, the similarity of Int. 48 is doubly interesting for the following reason: on the one hand it is very similar to Morb. 2.72, which Potter thought to be dealing with phrenitis, on the other it has a fascinating potential to be linked to Prorrh. 1.5, because it tells us that dreams of those who suffer from phrenitis are vivid (ἐναργής). Phrenitis has the potential to function as the ‘missing link’ here.

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Morb. II.72

Int. 48

Vict. 92–93

αἱ φρένες (distended diaphragm)

ἀναπτύσσεται πρὸς τὰς φρένας (pressure on diaphragm) ἐνύπνια φοβερά (scary dreams)  

 

ὀνείρατα φοβερὰ (scary dreams) seeing the dead (τοὺς τεθνηκότας) δείματα (seeing of frightening things)

φοβεῖται (fear)  

if untreated, deadly

καθαίρειν (purgative treatment)  

 

  κεντεῖν (pricking sensation in intestines)

ἑρπετὰ καὶ ἄλλα παντοδαπὰ θηρία (seeing reptiles and other beasts)

ἀΐσσει και φοβεῖται (fright and fear) χολὴ (collection of bile in liver and head) thick disease (that may end in death)/ acute diseases (= Dieb. Jud.3) hellebore, κλύζειν (purgative treatment) αὐτὸς δοκέει μάχεσθαι (imagining to be fighting) ὁπλῖται μαχόμενοι (seeing fighting hoplites) παραφρονέει (derangement)  

ἐν τοῖσιν ὕπνοισι φοβεῖ (scary dreams) seeing the dead (τοὺς ἀποθανόντας) ἀλλόμορφα σώματα (seeing strangely shaped, frightening bodies) & τέρατα ἀλλόμορφα (strangely shaped monsters) φοβεῖ τὸν ἄνθρωπον (fear) χολέραν (bilious flux) νοῦσον κινδυνώδεα (dangerous disease)

ἀποκαθαίρεσθαι [92] ἔμετον ποιήσασθαι [93] (purgative treatment) μάχεται (fighting) ὁπλῖται πολέμιοι (enemy hoplites) μανίην (madness) κεντεῖται (being pricked by someone)

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Chapter 92 of On Regimen clarifies what it means to see the dead in dreams, imagery that is mentioned in Diseases 2.72 as well. There is no specification of the images seen in Diseases II, but On Regimen does show some differentiation. There is a distinct difference between the imagery related to health and that related to illness: the colour white and purity in combination with the deceased are qualities that indicate good things and health, whereas the colour black and impurity signify disease. The recommended treatment involves purgation, a method of treatment that also has a prominent place in Diseases II and Internal Affections.25 The similarities to chapter 93 are more numerous; it mentions strangely shaped, frightening bodies that scare the patient, which indicate a bilious flux and a dangerous disease; purgation is again recommended. In Internal Diseases, bile is also the origin of trouble, and the disease it causes is one that may well end in death, so it could be classified as dangerous. To believe oneself to be fighting in, or to be witness to a fray is imagery we encounter in both Internal Affections and On Regimen. Derangement or madness seems to be directly linked with it. And lastly, to imagine oneself being pricked is something Diseases II and On Regimen have in common, just like the recommended treatment of purgation. Of course, the fact that there are a number of similarities between the three passages is not in and of itself grounds for assuming that the authors’ views and underlying theories were of a kind, but they do seem to indicate that certain ideas were more widely accepted in the CH. If we assume that the three passages complement each other, some interesting information is revealed. For example: bile seems to be the factor that inspires fear.26 Though in Diseases II.72 there is no mention of this humour, if we complement the information with that provided in Internal Affections 48 and On Regimen IV.93, we can deduce that in Diseases II bile may have played a role as well, since in all three treatises fear is a factor. Similarly, distension of the diaphragm is associated with fear in Diseases II and On Regimen, and so we can assume it was also thought to play a role in Internal Affections. The above comparison embeds On Regimen more deeply into the Hippocratic tradition, and contributes to the moderation of its position as an isolated treatise. On Regimen remains an extraordinary treatise, containing unique ideas and theories. However, by means of these two brief analyses, I hope to have shown that the dream theory presented in On Regimen IV does contain elements 25  Cf. Joly 1960, 196, 200; Hoessly 2001, 307–309. 26  Cf. also Morb. Sacr.18, in which bile is responsible for sudden heating of the brain and consequent fearful dreams.

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which also occur elsewhere in the CH, and that, in some respects at least, the author’s claims of innovation should perhaps be somewhat softened. With these new insights, a comparison with sources outside the CH becomes more interesting, and could even go some way towards determining whether or not the approach to dreams voiced in On Regimen, and to a certain extent reflected in several other treatises, was part of what made the Hippocratics Hippocratic. Bibliography Deichgräber, K., Die Epidemien und das Corpus Hippocraticum: Voruntersuchungen zu einer Geschichte der Koischen Ärzteschule. Berlin/New York, 1933. Diller, H., ‘Der innere Zusammenhang der hippocratischen Schriften De Victu’, Hermes 87 (1959), 39–56. Eijk, P.J. van der, ‘Divination, prognosis and prophylaxis: The Hippocratic work ‘On Dreams’ (De Victu 4) and its Near Eastern background’, in: H.F.J. Horstmanshoff and M. Stol (eds.), Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine, Leiden, 2004, 187–218. Hoessly F., Katharsis: Reinigung als Heilverfahren: Studien zum Ritual der archaischen und klassischen Zeit sowie zum Corpus Hippocraticum. Göttingen, 2001. Hulskamp, M.A.A., ‘The Value of Dream Diagnosis to the Hippocratics and Galen’, in: S. Oberhelman (ed.), Dreams Healing, and Medicine in Greece: From Hippocrates to Modern Naxos, Farnham & London 2013, 33–68. ———, Sleep and Dreams in Ancient Medical Diagnosis and Prognosis, diss. Newcastle upon Tyne, 2008. Joly, R., Recherches sur le Traité pseudo-Hippocratique Du Régime. Paris, 1960. ———, Hippocrate: Du Régime. Paris, 1967. Joly, R. and S. Byl, Hippocrate: Du Régime (Hippocratis De Diaeta, CMG I.2.4). Berlin 1984. Jouanna, J., Hippocrate: Maladies II. Paris, 1983. ———, ‘L’interpretation des rêves et la théorie micro-macrocosmique dans le traité Hippocratique Du Regime: semiotique et mimesis’ in: K.-D. Fischer, D. Nickel and P. Potter (eds.), Text and Translation, Leiden 1998, 161–174. ———, Hippocrates, Baltimore, 1999 (Eng. trnsl. of (1992), Hippocrate, Paris) 1999. Lloyd, G.E.R., Magic, Reason and Experience: Studies in the Origin and Development of Greek Science. Cambridge/New York, 1979. Manetti, D. and A. Roselli, Ippocrate: Epidemie Libro Sesto. Florence 1982. Nutton, V., Ancient Medicine. London/New York, 2004. Oberhelman, S., ‘Dreams in Graeco-Roman medicine’, ANRW II 37.1 (1993), 121–156.

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Palm, A., Studien zur Hippocratischen Schrift ‘Peri Diaitês’. diss. Tübingen 1933. Potter, P., Hippocrates vol. V: Affections. Diseases 1. Diseases 2. Cambridge Mass./London 1988a. ———, Hippocrates vol. VI: Diseases 3. Internal Affections. Regimen in Acute Diseases. Cambridge Mass./London, 1988b. Smith, W.D., Hippocrates vol. VII: Epidemics 2, 4–7. London and Cambridge MA, 1994. Wenkebach, E. and F. Pfaff (eds.), Galeni In Hippocratis Epidemiarum librum VI commentaria I–VIII, CMG 5.10.2.2. Berlin, 1956.

Part 3 Hippocratic Topics in Cultural Contexts

∵

CHAPTER 13

Teeth in the Hippocratic Corpus Patrick Macfarlane 1 Introduction There are fascinating connections between comments on the teeth offered by medical writers in the Corpus Hippocraticum (hereafter, CH), and the more philosophical reflection on the teeth offered mainly by Aristotle, but also by Plato, and even non-Hippocratic medical writers in antiquity, such as Herophilus and Erasistratus.1 The teeth were important to the various Hippo­ cratic writers for many reasons: as involved in symptoms of disease, as marking important stages in the development of a child (teething and the shedding of primary teeth), and as a tissue of the body that is necessary in vital functions such as eating and speaking. This chapter contributes to the theme of this volume in two ways: first, by exploring an area of Hippocratic medicine that has received little attention from scholars heretofore, and second, by seeking to draw connections between various Hippocratic treatises that concern the teeth to see if any unified thought on the teeth emerges. Given the wide range of contexts that concern the teeth in the CH, I propose in this chapter to cover three areas: the nature of the teeth (Fleshes 12 and 13), teething or dentition (Dentition 6–12), and pathological sections where the main focus is on the teeth.2 Along with these three main sections of the chapter, I also draw connections from the CH with other philosophical and medical writers. In this regard I make frequent reference to Aristotle because we find

1  A good general survey of the teeth in antiquity is Hoffmann-Axthelm 1981, though he eschews any close engagement with the Greek texts. The most recent survey of oral pathology in the CH, Mylonas and Tzerbos 2006, is helpful but deficient insofar as they present Hippocrates as merely anticipating dental therapeutics of the present day. 2  Part of the difficulty in discussing teeth in connection with ancient Greek medicine is the lack of specialization, so that there is no treatise specifically concerning ancient Greek ‘dentistry’. Herodotus observes (2.84), however, that Egyptian physicians did specialize: ‘The art of medicine is divided so that each physician treats just one illness and no more. Doctors are everywhere, as there are specific physicians for the eyes, the head, the abdomen, and still others for illnesses that are invisible’, tr. Strassler 2007, 152.

© koninklijke brill nv, leiden, ���6 | doi ��.��63/9789004307407_015

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in his corpus comprehensive reflection on the nature of the teeth.3 Aristotle’s reflections serve in part to buttress his argumentation for final causality, but they are also important for their anatomical and physiological insight. It is instructive to understand the medical background that Aristotle incorporates into his account of teeth in terms of final causality (cf. esp. Physics 2.8). 2

The Nature of Teeth

We find the fullest treatment of the nature of the teeth in Fleshes 12 and 13.4 The author speaks not only about the nature of the teeth, but also provides details about teething and shedding the first teeth. He states that the teeth grow out of the bones of the skull and jaws (ἀπὸ τῶν ὀστέων τῶν ἐν τῇ κεφαλῇ καὶ ταῖν γνάθοιν).5 The teeth are harder than the other bones because they contain no cold (καὶ γίνονται ὀδόντες σκληρότεροι τῶν ἄλλων ὀστέων, ὅτι οὐκ

3  It is my pleasure to thank here Mariska Leunissen for her instructive comments on Aristotle’s complex account of the teeth, which she presented at the Fourth Pittsburgh-London, Ontario Generation of Animals Workshop held at the University of Pittsburgh, April 26–27, 2008. Cootjans 1991 surveys Aristotle’s various discussions of the teeth throughout his corpus. 4  Interestingly, Aristotle reserves his most detailed remarks about the nature of the teeth for a similar context, in the Generation of Animals (GA 2.6.745a19–745b16 and 5.8.788b3–789b3). 5  Carn. 12. In the CH, along with the typical word for ‘tooth’ (ὀδούς), there is in some cases a numbering of the teeth, e.g. in Epid. 4.19 (Epid. 5.44 seems to be a shorter version of Epid. 4.19), 4.25, and 4.52. Sometimes the Hippocratic writers speak of the front teeth, back teeth, right and left, upper and lower (cf. Epid. 4.19 for various combinations of these terms; for upper and lower, cf. Artic. 31). They also use particular names, such as ‘molars’ (Epid. 5.100 and cf. Epid. 7.113) or ‘wisdom teeth’ (Carn. 13; the Greek text reads σωφρονιστῆρες, which Hanson 2003, 202 translates more literally as ‘more prudent’ teeth). The canines are mentioned once in the CH, in Aph. 3.25, in the context of dentition; the writer of Prorrh. 2.11 may be thinking of the canines when he admonishes physicians to check for sharp teeth (τῶν ὀδόντων τις ὀξύς) in the cases of those who develop ulcers on their tongues. Aristotle (PA 3.1.661a6–661b16) observes that humans have three kinds of teeth: sharp front teeth for cutting food, flat molars for grinding food, and intermediate canine teeth that are sharp and flat, sharing the nature of both the front teeth and the molars. Cf. HA 2.4.501b25 and GA 5.8.789a19, where the wisdom teeth are referred to as οἱ ἔσχατοι [sc. ὀδόντες]); Aristotle also speaks of the molars that come in last in human beings, though his term for them is literally translated as ‘completers’ (κραντῆρας) cf. Peck 1961, 101n.a. Anonymous of London adds more terminology (24, in Jones 1968, 92–93). He writes that the food is ‘cut up by the front teeth, called incisors, and ground by the molars’ (τεμνομένη μὲν πρὸς τῶν προσθίων ὀδόντων— τομεῖς καλοῦνται—, καταλεαινομένη δὲ πρὸς τῶν μυλῶν).

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ἔνεστι τοῦ ψυχροῦ).6 Aristotle similarly holds that the teeth are bones.7 Both the Hippocratic writer of Fleshes and Aristotle have the difficulty, however, of explaining why the teeth are shed and grow again, unlike the other bones; and furthermore, why the teeth, unlike the bones, only develop after the rest of the bones have formed while the child is in utero. Interestingly, both have similar explanations as well. The writer of Fleshes 13 argues that the ‘jaws alone of the bones have vessels inside themselves’ (μοῦναι τῶν ὀστέων αἱ γνάθοι φλέβας ἔχουσιν αὐταὶ ἐν ἑωυταῖσι) that furnish them with continuous nourishment as the child grows: ‘This is why more nourishment is drawn to them than to other bones’ (καὶ διὰ τοῦτο τροφὴ ἕλκεται πλέον ἢ ἐς τὰ ἄλλα ὀστέα). The nourishment comes to the vessels in the jaw in a ‘more massive afflux’ (ἀθροωτέρην τὴν ἐπιρροήν8) from ‘the lower cavity’ (ἐκ τῆς κάτω κοιλίης); i.e., drawn through vessels from ‘the stomach and the upper intestines above the jejunum’ (ἐκ τῆς νηδύος καὶ τῶν ἐντέρων τῶν ἄνωθεν τῆς νήστιος). Teeth come to be in an Anaxagorean manner of like tissue being added to like. Aristotle makes a finer distinction.9 While holding that the teeth are bones, he claims that ‘The teeth do not possess the same nature as the rest of the bones’ (συμβαίνει δὲ μηδὲ τὴν αὐτὴν ἔχειν φύσιν τοῖς ἄλλοις ὀστοῖς τοὺς ὀδόντας). The teeth 6  This detail may be important; Cootjans 1955, 680 notes that cold is said to be the enemy of the teeth (πολέμιον ὀδοῦσι) in Aph. 5.18. He believes that the explanation for this is given in Liq. 2: the teeth (and other tissues such as bones and cords) are like the brain, insofar as they are ‘by nature colder and solider’ (ψυχρότερον καὶ στερεώτερον φύσει) than the other parts of the body. Therefore cold is hostile to them (τὸ ψυχρὸν πολέμιον). In fact, the author of Liq. 2 explains, this is why ‘convulsions, spasms, and febrile chills arise from them [sc. bones, teeth, and cords] (σπασμοί, τέτανοι, ῥίγεα πυρετώδεα), and why heat can stop these (θερμὸν παύει); cf. Aph. 5.17, which repeats this statement almost verbatim. Similar reasoning may support other passages where hot and cold affect the teeth. For example, heated vinegar (Liq. 2) and drying the teeth by cauterization (Aff. 4) are suggested as remedies for tooth pain. The writer of the pseudo-Aristotelian Prob. 34.2, 3 wonders why teeth are so sensitive to cold and why cold is a source of tooth pain, despite the fact that the teeth themselves are cold (963b28); perhaps this is because teeth = bones = earthy = cold? Cf., however, Coac. 230 and Prob. 22.14.931a28–32, where heat is portrayed as harmful to the teeth, and Dent. 9, where the writer claims that children who teethe in winter ‘come off better’ (βέλτιον ἀπαλλάσσει), i.e., cold is beneficial. 7  ὀδόντες ὀστέινοι, HA 1.11.493a3; cf. GA 2.6.745a20–21 and PA 2.9.655b11–12 where bones, like hoofs, horns, and beaks have ‘an earthen and hard nature’ (ταῦτα γεώδη καὶ στερεὰν ἔχει τὴν φύσιν). 8  Interesting is Aristotle’s use of ἐπιρρεῖν in a similar explanation at GA 5.8.789a4: since the jaw bone is wider under the molars, it can accept a larger amount of nourishment to flow out, making the molars larger than the front teeth, which are on a narrower part of the jaw bone. 9  G A 2.6.745b3–10.

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are ‘in touch with the bones’ but not ‘all of a piece with them’ (ἅπτονται γάρ, ἀλλ᾿ οὐ συμπεφύκασι τοῖς ὀστοῖς). Aristotle makes this distinction so that he can explain why the teeth are able to grow again after they have fallen out; it turns out that the teeth, ἐκ μέντοι τῆς τροφῆς τῆς εἰς τὰ ὀστᾶ διαδιδομένης γίνονται, διὸ τὴν αὐτὴν ἔχουσι φύσιν, καὶ τότε ὅταν ἐκεῖνα ἔχῃ ἤδη τὸν ἀριθμὸν τὸν αὑτῶν. are formed out of the nourishment which is distributed to the bones (which is why they possess the same nature), and at a time when the bones have already attained their full complement.10 Aristotle, in his vascular system, also has extremely thin blood vessels extend into the teeth (ἀποτελευτῶσι καὶ τοὺς ὀδόντας λεπτοῖς πάμπαν φλεβίοις) from the great vein.11 He further explains that the molars are larger and come in later than the front teeth because the jawbone (τὸ ὀστοῦν τῆς σιαγόνος) out of which they grow is wider and hence can accept more nourishment than the front teeth.12 The notion that the teeth were bones or shared the nature of the bones seems to be a consensus view in antiquity; Galen also treats the teeth in his works on the bones.13 Hippocratic medical writers also include physiognomic reflections about the teeth, and what they were thought to disclose about the nature or char­ acteristics of persons. Epidemics 2.6.1 begins an interesting series of physiognomic reflections: ‘People who are long-lived have more teeth’ (οἱ μακρόβιοι πλείους ὀδόντας ἔχουσιν). This sentiment is repeated in Aristotle, HA 2.3.501b22– 24, following his assertion that male humans, sheep, goats, and swine all have more teeth than females of the same species: ὅσοι δὲ πλείους ἔχουσι, μακροβιώτεροι ὡς ἐπὶ τὸ πολύ εἰσιν, οἱ δ᾿ ἐλάττους καὶ ἀραιόδοντες ὡς ἐπὶ τὸ πολὺ βραχυβιώτεροι.14 Those that have more teeth are longer-lived as a rule; those with fewer teeth more widely-spaced are shorter-lived as a rule.15 10  Peck 1942. 11  HA 3.3.514a20–22. 12  GA 5.8.788b30–789a4. 13  Cf. Hoffmann-Axthelm 1981, 76. 14  Balme 2002. 15  Barnes 1995, modified.

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Aristotle does not make it immediately clear why it should be true that the number of teeth correlates with length of life; he merely notes the correlation like the author of Epidemics 2.6.1.16 3

Dentition and Shedding of Teeth

The process of teething forms a large part of the Hippocratic interest in teeth in the treatise Dentition.17 But Dentition is only concerned with the process of teething up to a certain extent; its other aphorisms take up suckling and other infant afflictions such as tonsillitis. According the author of Fleshes 12, the first teeth begin to grow from the nourishment provided in the uterus (ἀπὸ τῆς διαίτης τῆς ἐν τῇ μήτρῃ), then after birth from milk while suckling (ἀπὸ τοῦ γάλακτος θηλάζοντι), and finally, after the primary teeth have been shed, from food and drink (ἀπὸ τῶν σιτίων καὶ τῶν ποτῶν). Aristotle presents Democritus as wrongly arguing that the teeth are formed prematurely from suckling alone (τοῦ δὲ πρὸ ὥρας γίνεσθαι τὸ θηλάζειν αἰτιᾶται).18 According to Aristotle, ‘The warmth of the milk makes them [sc. the teeth] come through more quickly’ (ἡ δὲ τοῦ γάλακτος θερμότης ποιεῖ θᾶττον βλαστάνειν τοὺς ὀδόντας).19 16  Similar physiognomic considerations involving the teeth are found in Prob. at 10.48.896a30 and 34.1.963b21. At 10.48.869a30 the writer asks ‘Why it is that men who have widelyspaced teeth (οἱ ἀραιοὺς ἔχοντες τοὺς ὀδόντας) are generally short lived?’ Barnes 1995. No answer is immediately given, but in the second passage, at 34.1.963b21, perhaps we get something of an answer: ‘Those men who have widely-spaced teeth apparently resemble those who have fewer teeth’ (οἱ οὖν ἀραιόδοντες ὥσπερ ἂν ἑλάττονας ἔχουσιν ὀδόντας ἐοίκασιν). Dean-Jones 1994, 82 n.136 offers some persuasive explanation for what might have led Aristotle to hold that men had more teeth than women. We find the same notion (the men have more teeth than women, and the number of teeth correlates with length of life) in Pliny NH 7.16.71. Hoffmann-Axthelm 1981, 62 comments that the correlation between the number of teeth and length of life is the product of folklore. 17  Good discussions of teething may be found in Garland 1990, 118–121 and Hanson 2003, 200–203. According to Garland 1990, Demand 1994 and Hanson 2003, Dentition is the only treatise that concerns itself with infant illnesses. 18  GA 5.8.788b14. 19  GA 5.8.789a5–6; cf. HA 7.10.587b16–18: ‘And the warmer the nurses’ milk so much the quicker are the children’s teeth to come’ (πάντα δὲ θᾶττον φύουσιν ὅσων αἱ τίτθαι θερμότερον ἔχουσι τὸ γάλα). Aristotle concludes his argument against Democritus with the general principle that ‘That which is hot tends to promote growth’ (αὐξητικὸν γὰρ τὸ θερμόν), GA 5.8.789a8–9; cf. PA 3.6.669b3.

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The process of teething or dentition was often a stormy time20 in the life of an infant, accompanied by many difficulties that are recorded in Den­ tition 6–12, but also in Aphorisms 3.25.21 The most prominent difficulty mentioned by the author of Dentition 6–12 is spasms or convulsions, which figure in four out of the six aphorisms that speak of teething: Dentition 6, 7, 8, 10. Aphorisms 3.25 records, along with convulsions, irritation of the gums, fevers (cf. Dentition 7), and diarrhoea.22 The afflictions associated with teething, particularly spasms and convulsions, were also noticed by Aristotle.23 Plato famously likens the experience of teething to the soul’s sprouting of wings in the Phaedrus, a crucial step in its eventual contemplation of the forms.24 Plato’s metaphor, however, is not entirely whimsical, since he also mentions symptoms such as ‘itching and irritation around the gums’ (κνῆσίς τε καὶ ἀγανάκτησις 20  χειμῶνας ἔχει, Dent. 12. 21  Bertier 1990 interestingly presents teething as a malady of infancy. 22  ‘At the approach of dentition, irritation of the gums, fevers, convulsions, diarrhoea, especially when cutting the canine teeth, and in the case of very fat children, and if the bowels are hard’. Πρὸς δὲ τὸ ὀδοντοφυεῖν προσάγουσιν, οὔλων ὀδαξησμοί, πυρετοί, σπασμοί, διάρροιαι, μάλιστα ὅταν ἀνάγωσι τοὺς κυνόδοντας, καὶ τοῖσι παχυτάτοισι τῶν παίδων, καὶ τοῖσι τὰς κοιλίας σκληρὰς ἔχουσιν, Jones 1931. 23  Cf. HA 7.12.588a3–12, which bears striking similarities with Dent. 6 and 8: ‘Children are very commonly subject to convulsions, more especially such of them as are more than ordinarily well-nourished (εὐτραφέστερα) [cf. Dent. 8: ‘Those who while teething are lethargic while remaining well-nourished (εὔτροφα) run a risk of being seized with convulsions’] on rich or unusually plentiful milk from a stout nurse. Wine tends to excite this malady, and red wine is worse than white, especially when taken undiluted; and most things that tend to induce flatulency are also bad, and constipation too is prejudicial [cf. Dent. 6: ‘Those who while teething have their bowels moved often are less subject to convulsions than those who have them moved seldom]. The majority of deaths in infancy occur before the child is a week old, hence it is customary to name the child at that age, from a belief that it has now a better chance of survival. This malady is worst at the full moon; and it is a dangerous symptom when the spasms begin in the child’s back’, Barnes 1995. In Ph. 7.3.248a1–2, Aristotle also speaks about how childhood is marked by a ‘great amount of restlessness and motion’ in the souls of children. Nature itself gradually causes the soul to settle down and come to a state of rest with age; he perhaps picks up on this theme from Plato’s Timaeus 43a–d. In certain treatises of the CH, affections involving the teeth (e.g. the clenching of the jaw) are connected with spasms, perhaps tetanus (cf. Epid. 5.75 and 7.37) or epilepsy, a condition that other Hippocratics, as well as Aristotle, observed to begin often in childhood (cf. van der Eijk 2005, 133–134). Aristotle repeats similar warnings about wet nurses consuming wine in Somn.Vig. 3.457a14–20 and Pol. 7.17.1336a5–8; cf. Hanson 2003, 200–201 for the views of Galen and Soranus on the proper nourishment for infants. 24  Plato, Phdr. 251c.

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περὶ τὰ οὖλα) that come along with teething, similar to the ‘irritation of the gums’ (οὔλων ὀδαξησμοί) of Aphorisms 3.25. The passage from the Phaedrus indicates that Plato metaphorically regarded the sprouting of the soul’s wings as an important phase in the development of a young philosopher, similar to teething in infancy. Other scholars25 have noticed that Hippocratic concern with teething and the shedding of the primary teeth stems in part from their desire to mark important stages in the development of the child.26 I believe that there is some grammatical evidence in Dentition itself that signifies a concern with differentiating stages in the very process of teething.27 25  E.g. Hanson 2003, 202. 26  Garland 1990, 120 includes Pliny’s observation that it is ‘a universal custom not to cremate a person before the teething stage’ as evidence that ‘An infant who had survived the difficult teething stage was credited with a new and enlarged physiological and social identity’ NH 7.16.72. 27  Dent. 7 states that: ‘Those who while teething are attacked by acute fever seldom suffer from convulsions’ (Ὁπόσοισιν ἐπὶ ὀδοντοφυΐῃ πυρετὸς ὀξὺς ἐπιγίγνεται ὀλιγάκις σπῶνται). Different here is the use of the preposition ἐπί with the dative ὀδοντοφυΐῃ, where previously in Dent. 6 the preposition ἐν with the dative ὀδοντοφυΐῃ was used, suggesting perhaps an infant at the beginning of teething rather than one already in the process of teething. There is a progressive change in the grammar the Hippocratic writer uses to express the process of teething; Dent. 8 reads: ‘Those who while teething are lethargic while remaining well-nourished run a risk of being seized with convulsions’ (ὁπόσα ὀδοντοφυεῦντα εὔτροφα μένει καταφορικὰ ἐόντα κίνδυνος σπασμὸν ἐπιλαβεῖν). Dent. 9 similarly uses the participial form of ὀδοντοφυεῖν, perhaps suggesting infants who are actually going through the process of cutting teeth: ‘Those who teethe in winter, other things being equal, come off better’ (τὰ ἐν χειμῶνι ὀδοντοφυεῦντα, τῶν ἄλλων ὁμοίων ἐόντων, βέλτιον ἀπαλλάσσει). In Dent. 10, though Jones 1923b translates as if the Hippocratic continues to speak of teething, the actual aphorism speaks of teeth only: ‘Not all children die that are seized with convulsions while teething; many recover’ (Οὐ πάντα τὰ ἐπὶ ὀδοῦσι σπασθέντα τελευτᾷ• πολλὰ δὲ καὶ διασῴζεται); this phrasing might refer to an infant who is at the threshold of having most of the teeth come through. Dent. 11 reads: ‘Teething is protracted when complicated with a cough, and emaciation in such cases is excessive while the teeth are coming through’ (τὰ μετὰ βηχὸς ὀδοντοφυεῦντα χρονίζει• ἐν δὲ τῇ διακεντήσει ἰσχναίνεται μᾶλλον). Here we see a reversion to the terminology of Dent. 8 and 9 (present participle); note also that Dent. 9 and 11 are similar, both dropping the indefinite correlative pronoun in favor of the neuter plural τά plus the present participle of odontophuein. In Dent. 12 the Hippocratic returns to the indefinite correlative pronoun, but employs the articular infinitive construction, perhaps to refer to the process of teething in a rather general manner: ‘Children who have a troublesome time while teething, if they are suitably attended to, bear up more easily against teething’ (Ὁπόσα ἐν τῷ ὀδοντοφυεῖν χειμῶνας ἔχει, ταῦτα καὶ προσεχόντως ἠγμένα ῥᾷον φέρει ὀδοντοφυΐαν).

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The concern with stages recurs in the process corollary to teething in human beings: the shedding of the primary teeth. Aristotle speaks of a number of animals, besides humans, that shed their teeth (or do not shed their teeth, e.g., the pig, HA 2.1.501b5), and even records animals that shed particular teeth only, such as the lion that sheds (ἐκβάλλει) its canines only.28 When it comes to the human being, Aristotle is in broad agreement with certain Hippocratic writers that the shedding of human teeth occurs at seven years of age.29 In Fleshes 12 we read that the teeth fall out in humans after seven years of first nutriment; this is repeated in the hebdomadic schematization of human life given in the final chapter, Fleshes 19.30 In Sevens 5, the author portrays human life as unfolding in seven stages: παιδίον, παῖς, μειράκιον, νεανίκος, ἀνὴρ, πρεσβύτης, γέρων.31 The first stage, παιδίον, is over at seven years, when the teeth fall out (ὀδόντων ἐκβολῆς). Aristotle similarly has the teeth falling out at seven years (ἐν ἑπτὰ δὲ ὀδόντας βάλλει),32 but only the front teeth, not the molars.33 4

Oral Pathologies Involving the Teeth and Therapeutics

Teeth are involved in a variety of pathological contexts in the CH, though, as Walter Hoffmann-Axthelm has noticed, in the CH the teeth usually ‘were discussed as ancillaries of other disease pictures’.34 Given the constraints of this chapter, I will discuss just a few pathological contexts where teeth come into focus as the center of attention: grinding or gnashing the teeth, the phenomenon of teeth being set on edge, and tooth pain. I will also briefly touch upon some therapeutic measures (remedies and extraction) regarding the teeth. 28  HA 6.31.579b13 and GA 5.8.788b17. The dog also sheds its canines only: HA 6.20.575a6. 29  Notably, Aristotle holds that teething begins in the seventh month after birth, HA 7.10.587b14–15, in agreement with the author of De octimestri partu (Oct.) 1.7, 78.20–80.2, Grensemann 1968 (=7.448 L) and Soranus; cf. Hanson 2003, 200n55. In contrast, Pliny holds that dentition begins in the sixth month after birth, and that the primary teeth are shed after six years (NH 7.16.68). Mansfeld 1971.174–178 gives a detailed synopsis of the hebdomad doctrine concerning the teeth shared by Solon, the Hippocratic writers of Carn., Oct., Hebd., Diocles, Aristotle, and Strato. 30  Cf. Oct. 1.15–18, 82.2–15 Grensemann 1968 (= 7.450–452 L). 31  8.636 L. Cf. Epid. 6.8.11, which Hanson 2003, 201 nicely observes reproduces Solon’s elegy on the ages of man in its ‘concern for the growing of deciduous teeth and exhibiting signs of puberty in the requisite periods’. 32  Meta. 14.6.1093a14–15. 33  HA 2.1.501b2–3 and GA 5.8.788b6–10. 34  Hoffmann-Axthelm 1981, 61.

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Grinding or gnashing the teeth (bruxism) seems to occur mostly as a symptom of a more grave pathological condition. For example, the author of Sacred Disease 10 mentions it as one of the symptoms of epileptic seizure (καὶ οἱ ὀδόντες συνηρείκασι), and in Diseases of Women I.2, grinding the teeth appears as a symptom of menses that have been suppressed for four months.35 However, in three places, we read that bruxism, whether it is accompanied by another condition such as fever (e.g. in Prognostic 3) or simply by itself, is a deadly sign: Prognostic 3, Prorrhetic I.48, and Coan Prognoses 230. Prog. 3: ὀδόντας δὲ πρίειν ἐν πυρετῷ, ὁκόσοισι μὴ σύνηθές ἐστιν ἀπὸ παίδων, μανικὸν καὶ θανατῶδες• ἣν δὲ καὶ παραφρονέων τοῦτο ποιῇ, ὀλέθριον κάρτα ἤδη γίνεται. To grind the teeth in fevers, when this has not been a habit from childhood, signifies madness and death; and if the grinding be also accompanied by delirium it is a very deadly sign indeed.36 Prorr. 2.48: Ὀδόντων πρίσιες ὀλέθριον οἷς μὴ σύνηθες καὶ ὑγιαίνουσι, πνιγμοὶ ἐν τούτοισι κακὸν πάνυ. To grind the teeth is a fatal sign in persons who do not habitually grind them when they are healthy, and difficulty in breathing in these is exceedingly bad.37 Coac. 230: Ὀδόντας συνερίζειν ἢ πρίειν, ᾧ μὴ σύνηθες ἐκ παιδίου, μανικὸν καὶ θανάσιμον• ἤδη δὲ παραφρονέων ἢν ποιέῃ τοῦτο, παντελῶς ὀλέθριον• ὀλέθριον δὲ καὶ ξηραίνεσθαι τοὺς ὀδόντας. To clench the teeth together or to grind them, in one not accustomed to from youth, is a sign of madness and nearness to death; and if someone 35  Cf. Dean-Jones 1994, 133. It is noteworthy that many of the cases in the Epid. that involve the teeth involve women (and some of these involve clenching the teeth as a symptom): 5.67 and 7.64 (Aspasius’ wife), 5.104 and 7.18 (the woman with quinsy: one of the symptoms was ‘clenching the teeth’, ὀδόντων ξυνέρεισις, Smith 1994, 6.7.2, and 7.8 (the woman who lived over the gate: ‘Her jaws were clenched and the teeth could not relax themselves more than the width of a probe’, γένυες δὲ ξυνηγμέναι καὶ ἑωυτοὺς ὀδόντας πλέον ἢ μήλην παρεῖναι οὐκ ἦν, Smith 1994. 36  Jones 1923b. 37  Potter 1995.

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delirious does this already, it is altogether fatal. And it is fatal for the teeth to be dried. All three passages focus on bruxism as an indicator of some serious pathological condition that eventually becomes fatal. Both Prognostic 3 and Coan Prognoses 230 speak of those who do not habitually grind their teeth from youth, while Prorrhetic 2.48 only speaks of those who do not grind them when healthy. In all three cases, however, the onset of bruxism is a symptom of a more grave condition, including even madness or insanity. Prognostic 3 and Coan Prognoses 230 further observe that for those who are already delirious or insane (παραφρονέων), grinding the teeth is an especially fatal sign. The connection made in these passages between a mental affliction such as madness and a bodily expression of that affliction, bruxism, is similar to the notion explored by the author of Humors 9 who describes how teeth are ‘set on edge’ by perception. In a number of different contexts, Hippocratic writers speak of the teeth being ‘set on edge’, using some form of the verb αἱμωδέω or αἱμωδιάω, and its nominative equivalent.38 Usually the teeth are put into this condition as a result of vomiting in conjunction with some other pathological condition, such as the ‘dark disease’ or erysipelas.39 This condition of the teeth was noticed by a number of other philosophers and medical writers, including [Aristotle], Diocles of Carystus, and Erasistratus. If there is one pathological condition associated with the teeth that links the CH with other philosophical and nonHippocratic writings, it is this condition of the teeth being ‘set on edge’. The author of Humors 9 describes certain ‘psychical symptoms’ (ψυχῆς), i.e., affections of the soul that excite reactions in the body. This happens when an individual perceives something, either through seeing or hearing (διὰ τῶν ὀμμάτων ἢ ἀκοῆς), that then affects the body of the person seeing or hearing. The author writes: ‘when a mill grinds the teeth are set on edge’ (μύλης μὲν τριφθείσης πρὸς ἑωυτήν, ὀδόντες ᾑμώδησαν). The phenomenon described in this case seems to be similar to the reactions certain people have when nails are run down a chalkboard: painful tingling or cringing due to vibrations through the ears and in the teeth; perhaps the teeth chatter, and this is the sense that ᾑμώδησαν has here.40 In the Peripatetic Problems we find a case of 38  LSJ9, 39. LSJ note s.v. αἱμωδέω that this form of the word is more correct than αἱμωδιάω according to Phrynichus in his second-century CE work Praeparatio Sophistica. 39  ‘Dark disease’, Morb. 2.73; erysipelas, Morb. 2.55 and Int. 6. 40  These examples could be cited as showing the close connection between soul and body in the CH; cf. Gundert 2000. For specific commentary on Hum. 9, see Pigeaud 1981, 41–47.

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the teeth being set on edge similar to the account in Humors 9. In Problems 7, the book concerning problems arising from sympathy (ὅσα ἐκ συμπαθείας), the writer asks: Διὰ τί τῶν μὲν διὰ τῆς ἀκοῆς λυπηρῶν ἔνια φρίττειν ἡμᾶς ποιεῖ, οἷον πρίων ἀκονώμενος καὶ κίσηρις τεμνομένη καὶ λίθος ἀλούμενος, τὰ δὲ διὰ τῆς ὄψεως σημεῖα τῶν παθῶν αὐτὰ ἡμῖν τὰ πάθη ἐμποιεῖ; αἱμωδιῶμέν τε γὰρ τοὺς ὀξὺ ὁρῶντες ἐσθίοντας, καὶ τοὺς ἀπαγχομένους ἔνιοι ὁρῶντες ἐκψύχουσιν. Why do some things unpleasant to hear make us shudder, such as the sharpening of a saw, the cutting of pumice-stone, and the grinding of stone, and the signs we see of their effects on others themselves produce the same feelings in us? For our teeth are set on edge when we see others eating something bitter, and some faint when they see others choking.41 There are clear parallels between this passage and Humors 9: the writer of the Problems similarly notes that the grinding of stone sets the teeth on edge; the bodily reaction of the teeth being set on edge is caused only by sight and hearing in both the Problems and Humors 9; and finally, just like the case described in Humors 9, we find the phenomenon described in the Problems to be something other than the gums or teeth being irritated to the point of bleeding (which is what the etymology of the word itself suggests). Rather, it appears to be sharp vibrations that cause shuddering (φρίττειν) in the ­perceiver.42 In fact, the writer of Problems goes on to say this phenomenon occurs ‘because every sound or noise is a breath, and this penetrating into us naturally causes disturbance’ (διότι φωνὴ μὲν πᾶσα καὶ ψόφος πνεῦμά ἐστιν; τοῦτο δὲ εἰσδυόμενον ἡμῖν πέφυκεν κινεῖν). The phenomenon of teeth being set on edge is more commonly associated with vomiting in the CH, which is more in accordance with the definition given in LSJ9. Usually the vomiting itself is brought on by some greater, primary ailment, however. For instance, in Diseases 2.55 and Internal Affections 6, the primary ailment that leads to vomiting is erysipelas that arises in the lung:43 41  886b9–14, Hett 1953. 42  According to LSJ, φρίττειν can mean to bristle, shudder, shiver, and tremble; they note at least one instance where the verb is used to denote chattering teeth. 43  Grmek 1989, 129 writing on erysipelas, explains that it ‘designates various diseases that ‘redden the skin’ and also diffuse, purulent inflammations of internal organs, but in its commonest sense . . . designates a group of skin diseases with hot, painful, reddish swelling, now thought to be streptococcic dermatitis’. Grmek goes on to observe that it also

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Morb. 2.55: καὶ ἐμέει λάππην καὶ οἷον ὄξος, καὶ τοὺς ὀδόντας αἱμωδιᾷ• καὶ πυρετὸς καὶ ῥῖγος καὶ δίψα λαμβάνει. He vomits up scum and material like vinegar, and his teeth are set on edge; fever, chills and thirst are present.44 Int. 6: καὶ ἐμέει λάμπην ὀξέην, καὶ τὸ ἔμεσμα ἢν ἐκχέῃς χαμάζε, ξύει τὴν γῆν ὥσπερ ὄξος ἐπιχέαντι. καὶ τοὺς ὀδόντας αἱμωδιᾷ, καὶ ῥῖγος καὶ πυρετὸς καὶ δίψα ἔχει ἰσχυρή. He vomits up a sharp scum, and if you pour out the vomitus onto the earth, it corrodes the earth as vinegar does when it is poured on the earth. His teeth are set on edge, and chills, fever and violent thirst are present.45 Both passages are quite similar, even down to the accompanying affections that follow the teeth being set on edge: fever, chills, and thirst. One curious detail of the passage from Internal Affections 6 is that when the vomitus is poured onto the earth, it corrodes it like vinegar. This detail occurs again in Diseases 2.73: Μέλαινα• μέλαν ἐμέει οἷον τρύγα, τοτὲ δὲ αἱματῶδες, τοτὲ δὲ οἷον οἶνον τὸν δεύτερον, τοτὲ δὲ οἷον πωλύπου θολόν, τοτὲ δὲ δριμὺ οἷον ὄξος, τοτὲ δὲ σίαλον καὶ λάππην, τοτὲ δὲ χολὴν χλωρήν. καὶ ὅταν μὲν μέλαν καὶ τὸ αἱματῶδες ἐμέῃ, δοκέει οἷον φόνου ὄζειν, καὶ ἡ φάρυγξ καὶ τὸ στόμα καίεται ὑπὸ τοῦ ἐμέσματος, καὶ τοὺς ὀδόντας αἱμωδιᾷ, καὶ τὸ ἔμεσμα τὴν γῆν αἴρει. Dark disease: the patient vomits up dark material that is like the lees of wine, sometimes like blood, sometimes sharp like vinegar, sometimes saliva and scum, sometimes yellow-green bile. When he vomits dark bloody material, it smells of gore, his throat and mouth are burned by the vomitus, his teeth are set on edge, and the vomitus raises the earth.46

applies certainly to cases of gas gangrene, and perhaps even tetanus and anthrax. Cf. Epid. 3.3.5 where abscesses around the teeth (τὰ παρ᾿ ὀδόντας ἀποστήματα) are included in the symptoms of an outbreak of erysipelas. 44  Potter 1988a. 45  Potter 1988b. 46  Potter 1988a.

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In this passage, in addition to the description that the vomitus affects the earth in a certain way, we find more similar details such as the sharpness of the vomitus being similar to vinegar. What exactly the ‘dark’ disease is remains unclear, though Diocles of Carystus notes that one of the symptoms of flatulent or hypochondriac melancholy is the teeth being set on edge.47 After eating foods difficult to digest, the patient may vomit, and when vomiting foods and phlegms that are ‘bitter, hot, and sharp’ (ὑπόπικρα καὶ θερμὰ καὶ ὀξέα), the teeth are ‘set on edge’ (ὥστε καὶ τοὺς ὀδόντας αἱμωδιᾶν).48 The last passage that associates the teeth being set on edge with vomiting is Diseases 2.16. The primary affliction that leads to vomiting is left vague by the writer; he simply writes ‘another disease’ (ἑτέρη νοῦσος), and then begins listing various symptoms including ‘chills, pain and fever throughout the head, especially in the ear, temples and bregma’.49 The writer then observes: ‘If anyone moves him, he vomits copiously and easily; his teeth are set on edge, and he is numb’ (καὶ ἤν τίς μὲν κινήσῃ, ἐμέσει, καὶ ἐμέει πολὺ καὶ ῥηιδίως, καὶ τοὺς ὀδόντας αἱμωδίη καὶ νάρκα ἔχει). As opposed to the other passages that speak of the teeth being set on edge, this is one of the two that use the noun instead of the verb.50 The final passage is Prorrhetic 2.27, in the context of a discussion about chronic fluxes (τῶν ῥόων τῶν πολυχρονίων) that affect women. The author writes that one must ask women who have these chronic fluxes, among other things, ‘whether they feel their teeth set on edge’ (περὶ αἱμωδίας). How we should understand the phenomenon of ‘teeth being set on edge’ in this context as opposed to the instances described in Humors 9 and Problems 7.5 is difficult to say. In most of the instances where we find the phrase in the CH, it denotes a painful cutting or burning sensation on the teeth that comes from the sharpness of the vomitus. But in at least one case, the psychosomatic case reported in Humors 9, it seems to mean something like painful tingling in the teeth, perhaps similar to the sensation that accompanies vomiting; the same is true of the passage from the Problems. The phenomenon generally seems to denote an irritation of the gums, but as the etymology of αἱμωδέω suggests, it could also refer to bleeding of the gums. Sharp or burning vomitus might cause bleeding of the gums, but this seems unlikely in the cases where irritation is caused from hearing or seeing things such as stones being ground together.

47  Fr. 109 van der Eijk 2000, vol. 1. 48  van der Eijk 2000, vol. 2, 218 connects fr. 109 with Morb. 2.73. 49  Potter 1988a. 50  Prorr. 2.27.

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Some medical writers discuss remedies to the affliction of the teeth being set on edge. For example, in the Problems the writer wonders why purslane (Portulaca oleracea) and salt stop the teeth being set on edge: Διὰ τί τὴν αἱμωδίαν παύει ἡ ἀνδράχνη καὶ ἅλες.51 Galen, criticizing the Erasistrateans for their simple cures from experience, gives as an example purslane being a cure for teeth being set on edge.52 The final pathological condition left to discuss is tooth pain. There is a passage concerning tooth pain in Affections 4, found among a catalogue of other affections in the region of the head, including the ears, throat and nose. The Hippocratic writer argues that the cause of these affections is the obtrusive (corrosive, irritating) presence of phlegm. The Hippocratic writer believes that phlegm is the cause of tooth pain: Αἱ δὲ ὀδύναι γίνονται, ὅταν φλέγμα ὑπέλθῃ ὑπὸ τὰς ῥίζας τῶν ὀδόντων• ἐσθίονται δὲ οἱ μὲν ὑπὸ φλέγματος, οἱ δὲ ὑπὸ σίτων, ἢν φύσει ἀσθενεῖς ἔωσι, καὶ κοιλίην ἔχοντες, καὶ πεπηγότες ἐν τοῖσιν οὔλοισι κακῶς. These pains occur when phlegm invades beneath the roots of the teeth; some teeth are decayed by phlegm, others by foods, when they are weak by nature, have caries, and are poorly fixed in the gums.53 Tooth pain is specifically caused by phlegm invading the roots; tooth decay is said to be due either to phlegm or to foods that attack teeth that are weak, have cavities (dental caries) and are loosely fixed in the gums.54 Affections 4 also mentions remedies for alleviating tooth pain. The author says that if the tooth is decayed and loose, to remove it (ἢν μὲν βεβρωμένος ᾖ καὶ κινέηται, ἐξαιρέειν); if the tooth is not decayed or loose, the author recommends drying the tooth by cautery (ἢν δὲ μὴ βέβρωται ἢ μὴ κινέηται, ὀδύνην δὲ παρέχῃ, καύσαντα ἀποξηρῆναι). 51  863b11 and 887b1, Hett 1953. Hett’s inconsistency in translating the phrase τὴν αἱμωδίαν shows how difficult it is to construe the meaning of the term. At 863b11 he translates with ‘bleeding of the gums’; though at 887b1 he translates with ‘inflammation of the gums’. 52  ἡ ἀνδράχνη τῆς αἱμωδίας ἴαμά ἐστιν, fr. 34, Garofalo 1988. 53  Potter 1988a. 54  Cf. Epid. 4.7 for flows of phlegm going to the teeth in a case of jaundice. Cases of tooth decay or corrosion occur in the Epid., especially Epid. 4.19 (cf. 5.44): phagedaenic ulcer, tooth ‘knuckles’—bony growths—and corrosion, e.g., of ‘the small front tooth by the two adjoining’, ὁ σμικρὸς πρῶτος ἔνδοθεν κατὰ τοὺς δύο ἐβέβρωτο, Smith 1994, 4.25: the case of Hegesistratius included suppuration and ‘His two back teeth were eaten away where they met. The back one had two ‘knuckles’ above the gum, one next to where it was eaten away, the other opposite’, Smith 1994, and 4.52.

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He also mentions that medications that are chewed are helpful (ὠφελέει δὲ καὶ τὰ διαμασήματα). The author of Epidemics 5.100 (cf. 7.113) also mentions tooth pain, but his case, the one involving Metrodorus’ son, seems especially grave: ‘In Cardia, Metrodorus’ son had pain from the teeth, mortification of the jaw. Flesh grew over the gums. He was moderately purulent. The molars and the jawbone collapsed’ (ἐν Καρδίῃ, τῷ Μητροδώρου παιδὶ ἐξ ὀδόντος ὀδύνη, σφακελισμὸς τῆς γνάθου, καὶ οὔλων ὑπερσάρκωσις• μετρίως ἐξεπύησεν• ἐξέπεσον οἱ γόμφιοι καὶ ἡ σιηγών).55 Remedies for tooth pain are found in various places in the CH.56 In Use of Liquids 4, the writer recommends vinegar (ὄξος), used warm (θερμῷ), as a remedy for tooth pain. In Epidemics 5.67 we read: ‘Aspasius’ wife had a severe pain in the tooth, and her jaws were swollen. She was helped when she rinsed it with castorium and pepper’ (τῇ Ἀσπασίου ὀδόντος δεινὸν ἄλγημα• καὶ γνάθοι ἐπήρθησαν• καστόριον καὶ πέπερι διακλυζομένη ὠφελεῖτο)’.57 The author of Epidemics 7.64, which closely resembles Epidemics 5.67, adds the detail that Aspasius’ wife held in her mouth (κατέχουσα ἐν τῷ στόματι) the castorium and pepper solution.58 The writer of Epidemics 7.47 records the case of Cleochus who had, among other symptoms, ‘on the gums by the teeth developed large grapelike swellings, livid, blackish, painless except when eating, as were the legs if he did not stand up’ (καὶ ἐς τὰ οὖλα παρ᾿ ὀδόντας μεγάλα, ὡς ῥᾶγες, πελιδνά, μελαινόμενα, ἀνώδυνα ὁπότε μὴ ἐσθίοι, καὶ τὰ σκέλεα, εἰ μὴ ἐξανίσταιτο). Later we read that remedies beneficial for the mouth specifically in this case included manna in a mixture (μαννῶδες ξὺν τοῖσιν μισγομένοισι ξυνήνεγκεν) and lentil soup as a porridge (ῥύφημα φακῆ).59 In some instances the remedy seems strange or rather excessive, such as ‘opening the vein of the arm’ (ἀπόσχασις

55  Smith 1994. 56  And we are told what should not be used on the teeth, Epid. 5.54 (cf. Epid. 7.76d): ‘Oregano is a bad thing for eyes when drunk, and for teeth’, Ὀρίγανον ὀφθαλμοῖσι κακὸν πινόμενον, καὶ ὀδοῦσιν, Smith 1994. 57  Smith 1994, 187 n.27 notes that ‘Castorium is a potion derived from the beaver’s musk gland’. Castorium figures as a remedy for other affections, notably affections in women: Epid. 7.64 mentions castorium stopping headaches from the womb; cf. Soranus 4.36, who wishes to censor Straton for using a suppository of castorium as a remedy for a prolapsed uterus. Castorium is also mentioned as a remedy by Anonymous of Brussels for ileus, asthma, and trembling. 58  Epid. 6.6.13 also recommends pepper for pain in the teeth accompanied by thin discharges from the nose. Pepper figures in Diocles’ remedies for tooth pain as well; cf. frs. 148a and 148b van der Eijk 2000. 59  Smith 1994.

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βραχίονος) for the case of Melisander, who had painful and swollen gums, Epidemics 7.66 (cf. 5.69). The removal of teeth as a remedy was accomplished with forceps used for drawing them out. These forceps (ὀδοντάγρα) are mentioned by the writer of Physician 9 as an instrument that anyone (τὸν τυχόντα) can use.60 [Aristotle], in Mechanics 21.854a16, wonders why iron forceps are used to extract teeth when the flesh of the fingers adheres to teeth better than iron, which slips more often. He concludes that dental forceps are useful for wrenching the teeth loose, but the fingers are best for finishing the job of extraction. There is some evidence to suggest that pulling teeth was not in all cases a safe or common procedure, however. Caelius Aurelianus records that Herophilus and Heracleides of Tarentum warned that ‘some people die on account of the pulling of a tooth’ (mori quosdam detractione dentis).61 In the same passage Caelius mentions that Erasistratus used dental forceps, but he says this to reinforce the notion that Erasistratus used the forceps only in extreme situations,62 which suggests that pulling teeth could be very dangerous.63

60  Mylonas and Tzerbos 2006 observe that the writer of Physician mentions the use of the dental forceps almost casually, but Dean-Jones 2010 argues that Physician is a metapedagogical text ‘written for a colleague of the author, an instructor seeking advice on the selection and early training of mature students’, and not, as is commonly thought, a medical treatise written for those beginning their medical practice. Those reading the treatise would therefore already be familiar with the dental forceps and the circumstances in which they should be used. 61  Tard. 2.4.84; cf. von Staden 1989, fr. 218. 62  Garofalo 1988, 69. 63  Cf. fr. 193 Garofalo: Nam Erasistratus plumbem inquit odontagogem quod nos dentiducum dicere poterimus, apud Delphum in Apollinis templo ostentationis causa propositum, quo demonstratur oportere eos dentes auferri qui sint faciles, vel mobilitate laxati, vel quibus sufficiat plumbei ferramenti conamen ad summum. Drabkin 1950, 621 translates: ‘And Erasistratus says that a lead dental forceps (Greek odontagogon, which we may call den­ tiducum in Latin) is prominently displayed in the temple of Apollo at Delphi for the purpose of showing that those teeth should be pulled which are ready to come out or are loose and shaky, in short, those requiring for extraction no more than the pull of a lead instrument’ (my emphasis). Pliny records a remedy for toothache from Erasistratus (fr. 275 Garofalo): ‘Erasistratus prescribed five berries of the same [sc. golden-berried] ivy, pounded in rose oil and warmed in the rind of a pomegranate, for tooth-ache, the injection to be made drop by drop into the ear opposite to the pain’, NH 24.47.77 (Jones 1938a).

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5 Conclusion As is evident, the teeth form an important topic for inquiry in the CH and in other philosophical and medical inquiries in antiquity. Unfortunately it lies beyond the scope of this chapter to consider other interesting topics involving the teeth, such as tooth lore, that were prevalent in antiquity as well.64 It is surprising also, given the enormous modern concern with dental hygiene, that this is nowhere treated in the CH.65 64  ‘This part of the body [sc. the teeth] is believed to possess prophetic powers (augurium)’, NH 7.16.71 (Rackham 1947). Pliny also reports some intriguing anecdotes, such as cases where children were born with teeth. He claims that females being born with teeth was considered a sign of bad luck (inauspicati) in the royal period (regnum temporibus): ‘Valeria was born with teeth, and the soothsayers in reply to inquiry prophesied that she would bring disaster to any community to which she was taken; she was deported to Suessa Pometia, at that period a very flourishing place, the eventual result verifying the oracle’, NH 7.16.69 (Rackham 1947). Two canines on the right side of the upper jaw in women are ‘a promise of fortune’s favors, as in the case of Domitius Nero’s mother Agrippina; on the left side the opposite’, NH 7.16.71 (Rackham 1947). Later in the NH (28.9.41–42) Pliny writes ‘The first tooth of a child to fall out, provided that it does not touch the ground, if set in a bracelet and worn constantly on a woman’s arm, keeps pain away from her private parts (muliebrium locorum dolores prohibet)’ (Jones 1938b). Herodotus also seems to grant the teeth some prophetic power in his report of Hippias coughing out his teeth prior to the battle of Marathon (Hdt. 6.107): ‘When the barbarians had come ashore, he [sc. Hippias] set about assigning them to their various positions. In the midst of this work, however, he was seized by an unusually severe fit of sneezing and coughing, and since he was getting on in age, most of his teeth were loose, and one of them fell out with the force of his coughing and landed on the sand. Hippias tried very hard to find it, but the tooth was nowhere to be seen. He then groaned to those standing nearby, ‘This land is not ours, and we shall not make it subject to us, either, for my tooth now holds all that was to be my share’. In this way, then, Hippias concluded that his vision had been fulfilled’, Strassler 2007, 470. Lastly, I should mention the ancient belief in a tooth-borer or tooth-worm, which was thought to cause the pain of teething; a reference to this worm may appear in the Homeric Hymn to Demeter (cf. Garland 1990, 317–318). 65  Recipes for mouthwashes and gargles are listed in Morb. 2.26–32, but these are not explicitly for the teeth, but rather for conditions that affect areas connected with the mouth and throat (palate, tonsils, tongue, gums). Diocles of Carystus recommends cleaning the teeth each day: ‘[One should] wet the face and the eyes with cold and clean water and wash them every day with clean hands, and brush the gums towards the teeth and the teeth [themselves] either simply with the fingers themselves or with rubbed pennyroyal of even smoothness, both on the inside and on the outside, and wipe off the remains of food that are attached to them’ (fr. 182, van der Eijk 2000).

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To answer the question about what is genuinely Hippocratic about Hippocratic reflection on the teeth is, not surprisingly, difficult. Instead of there being any one particular Hippocratic doctrine concerning the teeth, we find that there are many shared notions between Hippocratic medical writers and other philosophical and scientific writers in antiquity, such as Plato and Aristotle. We have seen that both the Hippocratics and Aristotle argue that the teeth are bones, that they mark important stages in the development of humans (perhaps even Plato might be included in this category), and even that they figure in similar pathological conditions, e.g., when the teeth are ‘set on edge’. This suggests that Hippocratic medical reflection was much less peculiar and monolithic in antiquity than has generally been assumed. While it is true that we have uncovered certain pathological conditions that seem to have been distinctly noticed by Hippocratic writers, such as bruxism and tooth pain, these, while important in their own right, also belong to disease pictures that physicians could not help but have noticed in their patients. This chapter has accomplished its goal if it has made clear that teeth were an important source of fruitful philosophical, scientific, and medical ideas in antiquity. Bibliography Balme, D., Aristotle: Historia Animalium. Cambridge, 2002. Barnes, J., The Complete Works of Aristotle, 2 vols. Princeton, 1995. Bertier, J., ‘Enfants malades et maladies des enfants dans le Corpus Hippocratique’, in: Potter et al. 1990, 209–220. Braund, S. and G. Most (eds.), Ancient Anger: Perspectives from Homer to Galen. Yale Classical Studies, 32. Cambridge, 2003. Cootjans, G., ‘Le problème étiologique de la carie dentaire dans l’Antiquité’, Revue Belge de Stomatologie 52 (1955), 677–688. Cootjans, G., La stomatologie dans le corpus aristotélicien. Brussels, 1991. Dean-Jones, L., Women’s Bodies in Classical Greek Science. Oxford, 1994. ———, ‘Physician. A Metapaedogogical Text’, in: M. Horstmanshoff (ed.), Hippocrates and Medical Education. Leiden, 2010, 53–72. Demand, N., Birth, Death, and Motherhood in Classical Greece. Baltimore, MD, 1994. Drabkin, I.E., Caelius Aurelianus on Acute and Chronic Diseases. Chicago, 1950. van der Eijk, P.J., Diocles of Carystus, 2 vols. Leiden, 2000. ———, Medicine and Philosophy in Classical Antiquity. Cambridge, 2005. Garland, R., The Greek Way of Life: From Conception to Old Age. Ithaca, NY, 1990. Garofalo, I., Erasistrati Fragmenta. Pisa, 1988. Grensemann, H., Über Achtmonatskinder (De octimestri partu). Berlin, 1968.

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Grmek, M.D., Diseases of the Ancient World (trans. M. Muellner and L. Muellner). Baltimore, MD, 1989. Hanson, A.E., ‘ “Your Mother Nursed You with Bile”: Anger in Babies and Small Children’, in: Braund and Most 2003, 185–207. Hett, W.S., Aristotle: Minor Works. Cambridge, MA, 1936. Hett, W.S., Aristotle: Problems, Books 1–21. Cambridge, MA, 1953. Hoffmann-Axthelm, W., History of Dentistry (H.M. Koehler, trans.). Chicago, 1981. Jones, W.H.S., Hippocrates, vol. 1. Cambridge, MA, 1923. [1923a] ———, Hippocrates, vol. 2. Cambridge, MA, 1923. [1923b] ———, Hippocrates, vol. 4. Cambridge, MA, 1931. ———, Pliny: Natural History, vol. 7. Cambridge, MA, 1938. [1938a] ———, Pliny: Natural History, vol. 8. Cambridge, MA, 1938. [1938b] ———, The Medical Writings of Anonymus Londinensis. Amsterdam, 1968. Mansfeld, J., The Pseudo-Hippocratic Tract ΠΕΡΙ ΕΒΔΟΜΑΔΩΝ. Assen, 1971. Mylonas, A.I. and F.H. Tzerbos, ‘Cranio-maxillofacial Surgery in Corpus Hippocraticum’, Journal of Cranio-maxillofacial Surgery 34 (2006), 129–134. Peck, A.L., Aristotle: Generation of Animals. Cambridge, MA, 1942. ———, Aristotle: History of Animals, Books I–III. Cambridge, MA, 1965. Pigeaud, J., La Maladie de l’âme. Paris, 1981. Potter, P., Hippocrates, vol. 5. Cambridge, MA, 1988. [1988a] ———, Hippocrates, vol. 6. Cambridge, MA, 1988. [1988b] ———, Hippocrates, vol. 8. Cambridge, MA, 1995. Potter, P., G. Maloney and J. Desautels (eds.), La maladie et les maladies dans la Collection Hippocratique. Quebec, 1990. Rackham, H., Pliny: Natural History, vol. 2. Cambridge, MA, 1947. Smith, W., Hippocrates, vol. 7. Cambridge, MA, 1994. von Staden, H., Herophilus: The Art of Medicine in Early Alexandria. Cambridge, 1989. Strassler, R., The Landmark Herodotus: The Histories. New York, 2007.

CHAPTER 14

Hippocratic and Aristophanic Recipes: A Comparative Study Laurence Totelin The CH contains over 1500 recipes; it is the largest body of recipes that has come down to us from the classical period.1 In fact, very few recipes—medical, magical or culinary—are preserved outside the CH for that period. Among those non-Hippocratic recipes, one can count some fragments of Archestratus of Gela (mid-fourth century BCE) and some recipes preserved in the works of the Attic comedians.2 This chapter compares the recipes preserved in the CH with three recipes from the comedies of Aristophanes. This comparison between two sets of roughly contemporary recipes (end of the fifth century BCE— beginning of the fourth century BCE) can help us to understand better the context in which these prescriptions were composed and transmitted.3 In particular, I will stress the accidental nature of much recipe preservation in the classical period. 1

The Hippocratic Recipes

Most Hippocratic recipes (at least 80%) are found in the gynecological treatises of the CH: in Diseases of Women I and II, Barren Women, Nature of Women, and Superfetation. Other recipes are located in the nosological treatises: Diseases II and III, and Internal Affections, and in the short surgical treatises Ulcers, Haemorrhoids and Fistulas. In addition, references to recipe books entitled The Pharmacological Book (Pharmakitis) and The Remedies (Ta pharmaka) are found in the treatise Affections. Following Elizabeth Craik, I interpret these references as meaning ‘your recipe book’ (the possessive pronoun need not be used in Greek) rather than ‘The Recipe Book’, thus postulating the existence of The Pharmacological Book in your possession rather than that of a single, fixed 1  I have counted 1551 recipes in the CH: see Totelin 2009, 66. 2  For the fragments of Archestratus, see Olson and Sens 2000. 3  The literature on medicine in Aristophanes is abundant, see bibliography in Jouanna 2000, 171 n. 2.

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treatise.4 If this suggestion is to be retained, it means that in addition to the recipes we read today in the CH, several—maybe even many—pharmacological recipe books were in circulation in the classical period. One of the most conspicuous characteristics of the Hippocratic recipes is the use of expensive and/or exotic ingredients. Three of the four enema recipes listed below contain such ingredients (they are indicated in bold): 1. ἄλλος κλυσμός• βούτυρον, λιβανωτόν, ῥητίνην, μέλιτι τήξας ἐν τῷ αὐτῷ, οἶνόν τε ἐπιχέας, κλύζε χλιαρῷ. 2. ἢ ἀκτῆς καρπὸν ἑψήσας ἐν ὕδατι, ἀποχέας τὸ ὕδωρ, τρίψας ἐν τῷ αὐτῷ σέλινον, σμύρναν, ἄννησον, λιβανωτόν, ἐπιχέας οἶνον ὡς εὐωδέστατον ἴσον τῷ ὕδατι, διηθήσας δι’ ὀθονίου, χλιήνας, κλύσαι. 3. ἄλλο• κράμβην, καὶ λινόζωστιν, καὶ λίνου σπέρμα, καὶ χλωρὸν τὸ λίνον ἑψήσας ἐν ὕδατι, ἀπηθήσας, κλύσαι τῷ ὕδατι. 4. ἢ μυρσίνης τῶν φύλλων ὀξύβαφον, σμύρνης, ἀννήσον, μέλι, ῥητίνην, μύρον Αἰγύπτιον, τρίψας πάντα καὶ ἑνώσας, ἐπιχέας οἴνου λευκοῦ ὡς εὐωδεστάτου κοτύλας δύο, διηθήσας, χλιήνας, κλύσον τούτῳ.5 1. Another enema: butter, frankincense, resin; melt together with honey, add wine and inject lukewarm. 2. Or boil elderberries in water; pour off the water, crush together with celery, myrrh, anise, and frankincense; add wine as fragrant as possible, in the same amount as the water; filter through a cloth, warm up and inject. 3. Another: cabbage, the plant mercury, linseed, fresh flax; boil in water, filter and inject the water. 4. Or myrtle leaves, one oxybaphon, myrrh, anise, honey, resin, Egyptian perfume; crush all and combine; add two kotylai of the most fragrant white wine, filter, warm up, and inject. Myrrh and frankincense (recipes 1, 2 and 4) were the two quintessential Arabic products.6 The Egyptian perfume (recipe 4) may have been manufactured in Athens, but it contained several exotic ingredients.7 4  See Craik 2006, 17. See also Totelin 2009, 98–102. 5  Mul. 1.78 (8.190.8–17 L). 6  Myrrh (Commiphora myrrha Engl.): see Hünemörder 2000; Dalby 2003, 226–227. Frankincense (Boswellia spp.): see Hünemörder 2002; Dalby 2003, 150–151. 7  Theophrastus reports that the Egyptian perfume was made of several ingredients, including cinnamon and myrrh (Odor. 6.28). Egyptian perfumers were established at Athens and

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Ingredients qualified by a geographical epithet, like the Egyptian perfume, appear in a number of Hippocratic recipes. Products qualified in this way include the Egyptian alum, Indian pepper, Ethiopian cumin, Pontic nut, Attic honey, Chian wine, Milesian wool, and the Thasian nut.8 The geographical epithets attached to these ingredients refer to places both within the Greek world and beyond its boundaries. In some cases, these epithets are used to distinguish between two plant species: for instance ‘Thasian nut’ was one Greek name for our sweet almond (Amygdalus communis L.), whereas ‘Pontic nut’ was one Greek name for our hazelnut (Corylus avellana L.).9 However, in most cases, geographical epithets were used as a means to mark out the quality of a product, or in other words to distinguish an ordinary commodity from a more luxurious or prized version. Thus, for instance, Chian wine or Milesian wool were of a better standard than most other wines and wools.10 This way of qualifying products with geographical epithets is also documented in non-medical Greek texts, including the comedies of Aristophanes (as we will see later). Catalogues of goods identified by their place of origin can be found in Pindar’s ode to the Sicilian tyrant Hieron, and fragment 63 of the comedian Hermippus, to mention only two examples.11 Not all Hippocratic recipes include exotic ingredients, however. The third of our recipes only contains easily available, cheap ingredients. And the three other recipes also contain widely available ingredients such as resin, celery, anise, and honey. With these preliminaries about Hippocratic recipes in mind, let us turn to the recipes of Aristophanes.

may have prepared ‘Egyptian’ perfumes there; the comedian Strattis mentions Deinas the Egyptian perfumer (fr. 34 Kassel and Austin). See Froidefond 1971, 60. 8  Egyptian alum: see for instance Ulc. 14 (63.9 Duminil, 6.416.17 L); Indian pepper: see for instance Mul. 1.81 (8.202.15–16 L); Ethiopian cumin: see for instance Int. Aff. 35 (192.15 Potter, 6.256.10 L); Pontic nut: Mul. 2.208 (8.402.20 L); Attic honey: see for instance Int. Aff. 51 (246.5–7 Potter, 7.294.24–296.1 L); Chian wine: Exc. 4 (8.516.9 L); Milesian wool: see for instance Mul. 2.221 (8.426.8 L); Thasian nut: Morb. 3.11 (78.29 Potter, 7.132.1 L). 9  See Dalby 2003, 6 (s.v. almond) and 173 (s.v. hazelnut). 10  See Totelin 2009, 145–177 for more detail. 11  Pindar fr. 106 (Maehler) = Pindar ap. Athenaeus, Deipn. 1.28a; Hermippus fr. 63 (Kassel and Austin) = Hermippus ap. Athenaeus, Deipn. 1.27e–f. On Hermippus’ catalogue of food, see Gilula 2000.

Hippocratic and Aristophanic Recipes

2

295

The Aristophanic Recipes

I count three recipes in the Aristophanic corpus. One is for a bellyache; the two others are eye remedies.12 The first recipe is found in the Women at the Thesmophoria (which dates to 411 BCE).13 The women of Athens are plotting against the tragic poet Euripides, outraged as they are by his mis­ ogynistic representation of female behavior in his plays. Euripides attempts to forestall this plot by sending one of his relatives dressed up as a woman to the Thesmophoria, the women’s festival in honor of Demeter and Persephone. The impostor tries to defend Euripides by listing the faults of women. For instance, a woman lies to her husband, pretending to go to the loo with a bellyache, when in reality she is escaping to meet with her lover. All this, while the doting husband is concocting a soothing remedy: ὁ δ’ ἀνὴρ ἐρωτᾷ• ‘Ποῖ σὺ καταβαίνεις’; ‘ὅποι; στρόφος μ’ ἔχει τὴν γαστέρ’, ὦνερ, κὠδύνη• εἰς τὸν κοπρῶν’ οὖν ἔρχομαι’. ‘βάδιζέ νυν’. κᾆθ’ ὁ μὲν ἔτριβε κεδρίδας, ἄννηθον, σφάκον.14 But my husband asked me ‘Where are you going?’—‘Where to? I have a colic and pain in my belly, husband, and I am going to the loo’. ‘Go on then’. And he pounded juniper berries, anise, and sage. One does not need much medical knowledge to realize that this recipe would be quite effective against cramps. Modern herbal medicine recognises the efficacy of juniper berries (the berries of Juniperus oxycedrus L.),15 anise (Pimpinella anisum L.),16 and sage (Salvia spp.) in the treatment of poor

12  In addition to these recipes, there are also numerous descriptions of therapies in the plays of Aristophanes: see Rodríguez Alfageme 1999. 13  For discussion of the date of this play, see Austin and Olson 2004, xxxiii–xxxvi. 14  Thesm. 483–486. The full passage discussed here is Thesm. 466–519. 15  Κέδρις: identification: Amigues 2006, 296. Κέδρις could also designate the berry of our Cedar (Cedrus spp. L). On the difficulty of distinguishing our juniper and our cedar in Greek and Roman texts, see Meiggs 1982, 410–416. 16  For the identification of ἄννηθον, see scholia in Nicandrum, Theriaca 650a (243 Crugnola): ἀννήσοιο διπλοῦν τὸ ν, ἀντὶ τοῦ ἀνήσου˙ οὕτως Ἀττικῶς. See Prato and Del Corno 2001, 249. Other scholars translate ἄννηθον as ‘dill’: see Sommerstein 1994, 65 and 187; Austin and Olson 2004, 200. The form ἄννηθον also appears at Nu. 982. See the comments to that line by Dover 1968, 217.

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d­ igestion, f­latulence, and colic.17 The use of these three plants against belly ailments was also noted by the ancient authors Pliny the Elder, Dioscorides, and Galen.18 When one turns to the CH, On Regimen in Acute Diseases recommends anise as part of a remedy to soften the bowel, and the author of Regimen notes that sage is ‘dry and astringent’, a vague comment that may, among other things, refer to the digestive properties of that herb.19 Most references to these three plants in the Corpus, however, are to be found in the gynecological treatises where a combination of juniper and sage appears in a remedy to enhance lactation; anise and juniper berries are listed in two expulsive remedies (one of which is designated as a remedy to ‘speed up the birth’); and a combination of anise and sage is used in a remedy for a displaced womb.20 It is interesting to note that the Hippocratics also prescribed sexual intercourse in cases of displacement of the womb.21 Aristophanes and his audience might have been aware that anise and sage were herbal substitutes for a sexual treatment. The joke in the Women at the Thesmophoria would therefore come from the fact that the husband, whilst preparing a remedy for his perfectly healthy wife, was in fact offering her a very poor substitute for the sex she would get from her lover.22 Thus the Aristophanic recipe, whilst being a perfectly good one to treat a bellyache, might also be a parody of those gynecological treatments that recommended herbal remedies alongside sexual intercourse. The use of the technical verb τρίβω (to pound) may have added to the sexual undertones of the passage: it could also mean ‘to rub’.23 The second and third Aristophanic recipes are both destined for the eyes of the politician Neocleides.24 The second, preserved in the Assembly Women 17  See Bown 2002, 248 (juniper), 317 (anise), and 354 (sage). 18  Juniper: Dioscorides, Mat. Med. 1.75 and 1.77 (warming, astringent, good for the stomach, flatulence, colic); Pliny, NH 24.36.54–55 (seed beneficial for stomach pains; dispels flatulence; berry used in digestive remedies). Dioscorides and Galen (De alimentorum facultatibus 2.16; 6.591.12 K) noted that κεδρίδες were an irritant if taken in excess. Anise: Dioscorides, Mat. Med. 3.56 (against diarrhea); Pliny, NH 20.73.189–190 (against flatulence, beneficial to the belly). Sage: Pliny, NH 22.71.146–147 (against dysentery). 19  Acut. 23 (80.25–27 Jones, 2.274.2–5 L); Vict. 2.54 (52.22–23 Joly, 6.558.18 L). 20  Juniper and sage: Mul. 1.44 (8.102.13–14 L) = Nat. Mul. 93 (80.7–9 Bourbon, 7.410.18–19 L). Anise and juniper berries: Mul. 1.77 (8.170.12 L) and 1.78 (8.184.12–13 L); Anise and sage: Nat. Mul. 58 (69.4–5 Bourbon, 7.398.3–4 L). 21  See for instance Mul. 2.128 (8.274.10 and 276.8 L). On the use of sexual therapy by the Hippocratics, see Dean-Jones 1992, 60–61; King 1994, 34–35; Totelin 2007. 22  I am thankful to Lesley Dean-Jones for suggesting this reading to me. 23  See Prato and Del Corno 2001, 249; Austin and Olson 2004, 200. 24  I have made some comments on these two recipes in Totelin 2009, 122–123 and 176–177.

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(393 BC), is a recipe for an ointment to be applied onto the eyelids (παραλείφειν τὰ βλέφαρα). It is detailed by Blepyrus, the husband of Praxagora, the woman who has led a group of friends to infiltrate the Athenian assembly.25 Blepyrus’ neighbour, Chremes, comes back from the assembly and recounts the events of the day to his friend: the safety of the state has been the topic of discussion. The bleary-eyed Neocleides was the first to try to speak, but when he got up all those assembled roared:26 ‘οὐ δεινὰ τολμᾶν τουτονὶ δημηγορεῖν, καὶ ταῦτα περὶ σωτηρίας προκειμένου, ὃς αὐτὸς αὑτῷ βλεφαρίδ’ οὐκ ἐσώσατο;’ ὁ δ’ ἀναβοήσας καὶ περιβλέψας ἔφη ‘τί δαί με χρὴ δρᾶν;’{Βλ.} ‘σκόροδ’ ὁμοῦ τρίψαντ’ ὀπῷ τιθύμαλλον ἐμβαλόντα τοῦ Λακωνικοῦ σαυτοῦ παραλείφειν τὰ βλέφαρα τῆς ἑσπέρας’, ἔγωγ’ ἂν εἶπον, εἰ παρὼν ἐτύγχανον.27 ‘What! he dares to speak, especially when the safety of the state is concerned, he a man who has not been able to save even his own eyelashes!’ He, however, shouted louder, and looking at them asked ‘Why, what was I supposed to have done?’ Blepyrus: ‘Crush garlic with verjuice, add Laconian spurge; cover your eyelids with this ointment in the evening’. This is what I would have said if I had been there . The final recipe is preserved in the Wealth (388 BC, the last of Aristophanes’ extant plays).28 Chremylus and his slave Cario meet an old blind man who turns out to be Plutus, the god of wealth, blinded by Zeus in his youth and therefore unable to tell the difference between virtuous and non-virtuous people. Chremylus believes that, if Plutus recovers his eyesight, the world will become a better place, as wealth will be distributed in a just manner.29 Since all the physicians have left Athens because of its lack of money, they decide

25  For the date of the play, see Ussher 1973, xxv. 26  Neocleides is qualified as bleary-eyed at lines 254 and 398: Νεοκλείδης ὁ γλάμων. 27  Eccl. 400–407. 28  For the date of the play, see Sommerstein 2001, 1. 29  For a summary of the play, see Jouanna 2000, 186.

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to visit the temple of Asclepius, the healing god.30 There they meet, among other sick people, Neocleides, by now completely blind.31 For that politician, Asclepius concocts a plaster (καταπλαστόν, κατέπλασεν), to be applied inside the eyelids (τὰ βλέφαρ’ ἐκστρέψας), composed of similar ingredients to those used by Blepyrus: πρῶτον δὲ πάντων τῷ Νεοκλείδῃ φάρμακον καταπλαστόν ἐνεχείρησε τρίβειν, ἐμβαλὼν σκορόδων κεφαλὰς τρεῖς Τηνίων. ἔπειτ’ ἔφλα ἐν τῇ θυείᾳ συμπαραμειγνύων ὀπὸν καὶ σχῖνον• εἶτ’ ὄξει διέμενος Σφηττίῳ κατέπλασεν αὐτοῦ τὰ βλέφαρ’ ἐκστρέψας, ἵνα ὀδυνῷτο μᾶλλον.32 First of all, for Neocleides, he set himself to knead a ­plaster, throwing in three cloves of Tenian garlic. Then, he crushed them in the mortar, mixing them together with verjuice and mastic. Then, he soaked with Sphettian vinegar. And turning out the eyelids of the man, he plastered them to make him suffer more. Neocleides ends up even more blind than he was, whereas Plutus is healed by two snakes.33 It is worth noting that the first of these two recipes is detailed by a layman (Blepyrus), whereas the second is prepared by the god Asclepius. Aristophanes thus conceived the remedies prepared in a secular context and those concocted in the context of temple medicine as very similar. Recent scholarship has stressed the areas of overlap between Greek secular and temple medicine—the recipes of Aristophanes, even though they are jocular, may be added to the evidence indicating that secular and religious healing used the 30  Pl. 407–408: Τίς δῆτ’ ἰατρός ἐστι νῦν ἐν τῇ πόλει; Οὔτε γὰρ ὁ μισθὸς οὐδέν ἐστ’ οὔθ’ ἡ τέχνη. ‘What physician is there now in the city? For there is no wage, and therefore no practice’. On this line, see Jouanna 2000, 188–189. 31  Pl. 665: Νεοκλείδης, ὅς ἐστι μὲν τυφλός: ‘Neocleides, who is blind’. 32  Pl. 716–722. This recipe is mentioned in passing by Rodríguez Alfageme 1999, 383. 33  Pl. 745–747: ἐγὼ δ’ ἐπῄνουν τὸν θεὸν πάνυ σφόδρα, ὅτι βλέπειν ἐποίησε τὸν Πλοῦτον ταχύ, τὸν δὲ Νεοκλείδην μᾶλλον ἐποίησεν τυφλόν. ‘I praised the god very much because he had quickly given back his sight to Plutus, but made Neocleides even more blind’.

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same therapeutic methods. I will not dwell on this point any further, but will instead turn to an analysis of the ingredients used in these two recipes.34 Three ingredients of Aristophanes’ eye remedies are accompanied by a reference to their geographical origin: the Laconian spurge, or the spurge ‘of the Laconian variety’ (τιθύμαλλον τοῦ Λακωνικοῦ; τοῦ Λακωνικοῦ is not an epithet but a genitive of origin),35 Tenian garlic (σκορόδων Τηνίων) and Sphettian vinegar (ὄξει Σφηττίῳ). Aristophanes appears to be parodying the Greek habit of identifying a product with its place of origin. He mocks those who, like the Hippocratic compilers of recipes, thought that, when mundane goods came from a particular locality, they became special, they became more powerful. None of these three ingredients appears in the ancient medical or botanical texts, and not a single ingredient from Tenos (one of the Cyclad islands) or Sphettos (a village about eight miles from Athens) is listed in ancient scientific literature.36 On the other hand, Theophrastus informs us that Laconia was a region rich in medicinal resources and that it grew particular varieties of figs, lettuce, cucumber, and wheat; but he does not mention spurge as a Laconian herb.37 That plant he associated with neighboring Arcadia, and more particularly with Tegea.38 It should be noted, however, that Theophrastus stressed the similarity between the medicinal plants growing in Arcadia and those of Laconia. In addition, Suzanne Amigues, in her study of Enquiry into Plants, found spurge growing abundantly in Laconia.39 It seems that Aristophanes was not wrong in associating spurge with that region. Some ancient scholiasts and lexicographers, and modern commentators, have suggested that in Aristophanes’ time Tenos had been reputed for its sharp garlic and Sphettos for its vinegar.40 Other ancient commentators believed that political allusions were hiding behind these products. Thus Didymus, one 34  For discussions of the links between secular and religious healing in the Greek world, see for instance, Lloyd 1983, 131–132; von Staden 1992; Laskaris 1999; Lloyd 2003, ch. 3; Gorrini 2005. 35  This use of the genitive is unique; see Ussher 1973, 132. 36  On the localization of Sphettos, see the map in Eliot 1962, 139. 37  Theophrastus, Hist. Plant. 9.15.4 and 8 (rich in medicinal resources); 2.7.1 (fig.); 7.4.5 (lettuce); cucumber (7.4.6); wheat (8.4.5). 38  Theophrastus, Hist. Plant. 9.15.6. 39  Theophrastus, Hist. Plant. 9.15.8. Amigues 2006, 193. See also Scholia in Aristoph., Eccl. 405a and b (97 Regtuit); Suda, s.v. τιθύμαλλος 582 (4.548.22–23 Adler); s.v. γλάμων 277 (1.525 Adler); s.v. ἰατρός 63 (2.606 Adler). 40  Garlic from Tenos: see Scholia recentiora in Aristoph., Pl. 718b (195 Chantry). Herodian also mentions this garlic in his Partitiones (133 Boissonade). See Sommerstein (2001): 183: ‘Tenos in the Cyclades was evidently noted for the quality and/or pungency of its garlic’.

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of the guests at Athenaeus’ dinner of Sophists, argued that Aristophanes’ mention of Sphettian vinegar was an allusion to the sharpness of the Sphettians; and a scholiast suggested that the mention of Tenian garlic was an allusion to the sycophancy of the Tenians (who were like scorpions).41 Obviously, the two explanations are not mutually exclusive: Aristophanes may have mentioned real products for the purpose of political diatribe. This may have been the case for the Laconian spurge: it served Aristophanes’ purpose that Laconia, the land of the troublesome Spartans, produced spurge in abundance. However, one suspects that Aristophanes has invented Tenian garlic and Sphettian vinegar to ridicule the Tenians and the Sphettians. Aristophanes is quite clear that the two eye remedies do not work: both recipes are destined to hurt Neocleides and make him even blinder than he was before. However, even though Aristophanes’ eye recipes are meant to make the audience laugh, they may be based on some medical knowledge. In the Hippocratic treatise Regimen, one learns that eating garlic is bad for the eyes, whilst onion is good for sight: σκόροδον. . .ἀγαθὸν τῷ σώματι, τοῖσι δ’ ὀφθαλμοῖσι φλαῦρον• κάθαρσιν γὰρ τοῦ σώματος πολλὴν ποιεύμενον, τὴν ὄψιν ἀπαμβλύνει. . .κρόμμυον τῇ μὲν ὄψει ἀγαθόν, τῷ δὲ σώματι κακόν, διότι θερμὸν καὶ καυσῶδές ἐστι καὶ οὐ διαχωρεῖ.42 Garlic . . . is good for the body though bad for the eyes. For by making a considerable purgation of the body it dulls the sight . . . The onion is good for sight, but bad for the body, because it is hot and burning, and does not lead to stool. On the other hand, at Organ of Sight 7, if one follows Elizabeth Craik’s emendation, eating raw garlic is recommended in the treatment of night blindness.43 Finally, in the Epidemics eating garlic and barley cake is recommended after Vinegar from Sphettos: see Scholia recentiora in Aristoph. Pl., line 720d–e (196 Chantry). Herodian also mentions this vinegar in his Partitiones (129 Boissonade). 41  Sharp Sphettians: Scholia vetera in Aristoph., Pl. 720; Athenaeus, Deipn. 2.67d; Pausanias Grammaticus, s.v. Σφήττοι (210 Erbse); Hesychius, s.v. ὄξος Σφήττειον (3.210 Schmidt). Sycophantic Tenians: Scholia vetera in Aristoph., Pl. 718 (364 Dübner). 42  Vict. 2.54.1 (51.16–52.3 Joly, 6.556.16–22 L). 43  Vid. Ac. 7 (44.1–4 Craik, 9.158.12–15 L): Νυκτάλωπος• φάρμακον πινέτω ἐλατήριον, καὶ τὴν κεφαλὴν καθαιρέσθω, καὶ κατάξας τὸν αὐχένα ὡς μάλιστα, πιέσας πλεῖστον χρόνον, ἐπανιεὶς δὲ διδόναι ἐν μέλιτι βάπτων ὠμὰ καταπιεῖν μέγιστα ὡς ἂν δύνηται ἓν ἢ δύο ἧπαρ βοὸς. Translation (Craik, slightly modified): ‘ night blindness: let him drink as purge squirting cucumber and let his head be purged; cut into the neck; exert as

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the application of an eye remedy.44 In the CH, then, onion and/or garlic have to be ingested in order to treat eye ailments. In later medical works, on the other hand, one finds remedies to be applied directly to the eyes that contain garlic (but not onion), for instance in the Easy Remedies attributed to Galen and in the Hippiatrica of Berlin.45 Verjuice, the juice of unripe figs which appears in both recipes for Neocleides (the word ὀπός can be used of all plant saps, but in literary works such as comedies, it is especially used of the juice of fig tree),46 does not figure in eye remedies recorded in medical literature, but figs, presumably ripe, are recommended by Dioscorides to treat eye afflictions.47 Similarly, mastic (σχῖνος, gum of Pistacia lentiscus L.)48 and vinegar, which both appear in Asclepius’ recipe, enter in the composition of eye remedies preserved in the works of authors such as Galen and Aetius.49 Spurge (τιθύμαλλος, Euphorbia spp.), on the other much pressure as possible for a ling time; release; dip in honey and give to swallow one or two raw as big as possible ox liver’. 44  Epid. 2.5.22 (78.21–24 Smith, 5.132.5–8 L): Ὀφθαλμῶν, σποδίου δωδέκατον, κρόκου πέμπτον, πυρῆνος ἕν, ψιμυθίου ἕν, σμύρνης ἕν• τὸ ὕδωρ κατὰ τῆς κεφαλῆς ψυχρὸν καταχεῖν, καὶ διδόναι σκόροδα σὺν μάζῃ. ‘For the eyes: one twelfth part of ashes, one fifth part of saffron, one part of fruit stone, one of white lead, one of myrrh. Pour cold water over the head and give garlic with barley cake’. 45  [Galen], De remediis parabilibus 1.14 (14.343.4–5 K) [Πρὸς τὰς ἐκ χρόνων ὀφθαλμίας.] Πυρῆνα μήλης καθέντες εἰς σκόροδον, ὡς χρωσθῆναι τῷ χυλῷ ἐγχρίομεν. ‘Against chronic diseases of the eye: having dropped apple pips into garlic juice so that they become coloured, we anoint ’. Hippiatrica Berolinensia 11.37 (1.69.9–13 Hoppe and Oder): Πρὸς τὰ ἐν ὀφθαλμοῖς τραύματα. Τὰ ἐν ὀφθαλμοῖς τραύματα θεραπεύσεις οὕτως• λαβὼν κρόκου, πεπέρεως λευκοῦ, ἅλατος ἀμμωνιακοῦ, ὀπίου, σκορόδου ἀνὰ γο μίαν, καὶ λειώσας ἕκαστα, μέλιτι ἀναλάμβανε καὶ ἀπ’ αὐτοῦ ἔγχριε. ‘Against wounds in the eyes. You will treat wounds in the eyes in the following way: take saffron, white pepper, ammoniac salt, opium, garlic, of each one ounce; crush each , take up with honey and anoint with this ’. 46  See Rogers 1917, 64. 47  Dioscorides, Mat. Med. 1.128.2: σῦκα . . . σὺν σιδίῳ δὲ ῥόας πτερύγια ἀνακαθαίρει. ‘Figs . . . with pomegranate peel; they completely clear pterygion (disease of the eye where a membrane grows over it)’. 48  On mastic, see Dalby 2003, 209–210; Hurschmann 1999. 49  Mastic: see for instance Aetius 3.138 (1.318.14 and 16–18 Olivieri): ὅσα ὀφθαλμῶν καθαρτικὰ καὶ ἀποδακρυτικά . . . ἐστὶ δὲ ἀποδακρυτικὰ καὶ σμηκτικὰ ταῦτα• μέλι ἔλαιον νέον καὶ τὸ παλαιὸν κίκινον ἀμυγδάλινον καρύινον σχίνινον . . . ‘Such are the that purge and make the eyes cry . . . These make the eyes cry and are detersive: honey, new and old oil, castor oil, almond oil, nut oil, mastic oil . . .’ Vinegar: see for instance Galen, Comp. Med. Sec. Loc. 4.8 (12.797.17–798.1): πρὸς δὲ τὰ γινόμενα περὶ τοὺς ὀφθαλμοὺς οἰδήματα διὰ τὰς πληγὰς λίαν ἁρμόττει πυρία μαλακῷ σπόγγῳ συνεχῶς γινομένη, εἶτα ὄξει βρεχόμενος κεκραμένῳ καλῶς ὁ

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hand, does not appear in any eye remedy preserved in the works of the ancient medical writers. Spurge can cause dreadful eye inflammation—a fact known to modern gardeners.50 Thus of the five ingredients mentioned in the recipes of Aristophanes, four enter in the composition of remedies for the eyes. These remedies would have hurt terribly, but this seems to have been common to most ancient eye treatments. One type of ancient eye remedy was so unpleasant that it was called the acharistum, the thankless.51 There are a handful of eye remedies preserved in the CH: one at Organ of Sight 6, one at Diseases of Women 1.102 and five at Diseases of Women 1.105. Most sound rather unpleasant, like this recipe preserved in Diseases of Women 1: ἐὰν δὲ δακρύῃ καὶ γλαμυρὸς ᾖ ὁ ὀφθαλμός, ὅταν ἡ σταφυλὴ ἡ λευκὴ πέπειρος ἰσχυρῶς καὶ ἰσχνὴ ἐπὶ τῇ ἀμπέλῳ ᾖ, ἐπιδρέψας ἐξηθῆσαι, εἶτα ξηραίνειν ἐν τῷ ἡλίῳ• ὅταν δὲ ξηρὸν ᾖ, ἀποξέσαι, μῖξαι δὲ ἴου ἡμιωβόλιον ἀττικῷ σταθμῷ• εἶτα τούτῳ ὑπαλείφειν.52 If the eye is weepy and bleary-eyed: when white grapes are very ripe and withering on the vine, pluck them and squeeze the juice out, then dry in the sun. When it is dry, scrape it, mix with verdigris, to the amount of half an Attic obolos; then anoint. It seems that Aristophanes, with his recipes for Neocleides, was parodying the horrible eye medications that pompous physicians had created. Up to a point, the Aristophanic recipes are not unrealistic: ancient eye remedies would have hurt and contained sharp ingredients that caused a purgative flow of tears. However, no ancient eye medicament would have contained spurge (as in Blepyrus’ recipe) or would have been applied inside the eyelid (as in Asclepius’ σπόγγος καὶ ἐπιτιθέμενος. ‘Against tumors around the eyes caused by blows, as soon as it happens, a fomentation with a soft sponge helps very much. Then the sponge is steeped well in mixed vinegar and applied’. 50  See Bown, 2002, 210. On cases of ocular inflammation caused by euphorbia sap, see Eke et al. 2000. 51  See for instance Galen, Comp. Med. sec. Loc. 4.7 (12.731.1–4 K): ἐκ τῶν Φιλοξένου ξηρὸν ἀχάριστον. ♃ καδμείας βʹ. χαλκίτεως ηʹ. ἀλόης ὀβολοὺς βʹ. ἰοῦ ὀβολοὺς βʹ. πεπέρεως κόκκους δέκα, ῥόδων ἄνθους αʹ. λείοις χρῶ. ‘Dried acharistum from the of Philoxenus: cadmia, 2 drachmai, copper ore, 8 drachmai, aloes, 2 oboloi, verdigris, 2 oboloi, 10 grains of pepper, rose flowers, 1 drachma; use these crushed’. On the acharistum, see Gourevitch 2003, 64. 52  Mul. 1.105 (8.228.16–20 L). On the properties of verdigris, see Majno 1975, 113.

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recipe). Interestingly, spurge is the final ingredient to be listed in Blepyrus’ recipe; and the fact that Asclepius turned out the eyelids of Neocleides to apply his plaster is mentioned at the very end of the Wealth passage. Aristophanes’ audience might have thought that Blepyrus and Ascelpius were genuinely concerned about Neocleides’ sight and truly seeking to heal him with proper remedies, until they found out at the very end of the recipes that this was anything but the case. Scholars have suggested that Aristophanes had read medical l­iterature, including texts that are now lost. Similarly, I would like to argue that Aristo­ phanes had access to recipes for eye remedies that have not been preserved.53 Although, there are few recipes for the eyes in the CH, it is not far-fetched to postulate the existence of a larger body of such recipes circulating in the classical period. Eye diseases were common in the ancient world: they get mentioned regularly in ancient comedies and in stories of healing recorded on inscriptions at the temples of Asclepius.54 Ophthalmologic preparations constitute a non-negligible proportion of later recipes, preserved either in the writings of famous medical authors such as Galen, or on papyri—in 1994 Marie-Hélène Marganne counted 15 such papyri, containing some 50 ophthalmological recipes (ranging from the third century BCE to the seventh century CE).55 3

Conclusion: What is Hippocratic about the Hippocratic Recipes?

I would suggest, then, that Aristophanes parodied, on the one hand, gynecological recipes with his concoction for a bellyache, and on the other hand, prescriptions for eye ailments with his recipes for Neocleides. We know that written gynecological recipes circulated in the classical period, as they are preserved in the gynecological treatises of the CH, but eye remedies are almost absent from the CH. How can one explain this absence? In fact, why are ‘nongynecological’ recipes so rare in the CH? Many scholars have suggested that 53  On Aristophanes as a reader of medical literature, see Jouanna 2000, 183. 54  Eye diseases in comedy: see Rodríguez Alfageme 1999, 382; Jouanna 2000, 175–177. Temple healing: of the 43 iamata recorded on the stelae at the temple of Asclepius at Epidaurus (T423 Edelstein, second half of the 4th century BC), 7 pertain to eye problems. See Herzog 1931, 95–97. On the prominence of eye cures in Greek propitiatory inscriptions of Lydia and Phrygia (2nd–3rd century CE), see Chaniotis 1995, 327–328. 55  Galen devotes book 4 of his Comp. med. sec. loc. to eye remedies. On Roman eye medicines, see Jackson 1996, 2238–2243. On ophthalmological recipes preserved on papyri, see Marganne 1994, 173–176.

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there are more recipes in the gynecological treatises of the Corpus than in any other Hippocratic text because women were treated in a different manner, and by a different personnel from men. The recipes preserved in the Hippocratic text are the reflection of the lore of ancient midwives and housewives.56 I wish to depart from this type of explanation and suggest that the high number of gynecological recipes preserved in the Corpus is actually an accident of textual transmission. There were many other ‘general’ recipe books and recipe collections, many Pharmacological Books, circulated at the time of Hippocrates and Aristophanes, but they have gone missing. These Pharmacological Books may have contained, inter alia, recipes for eye remedies, as eye ailments were a common occurrence in the ancient world. Like the few prescriptions recorded in the CH and the parodies offered by Aristophanes, these eye recipes must have been short, included some ingredients identified by their place of origin, and hurt like hell. Bibliography Adler, A. (ed.), Suidae lexicon. 5 vols. Leipzig, 1928–1938. Amigues, S. (ed.), Théophraste: Recherches sur les plantes. Tome V. Livre IX. Paris, 2006. Andò, V., ‘Terapie ginecologiche, saperi femminili e specificità di genere’, in: I. Garofalo et al. (eds.). Aspetti della terapia nel Corpus Hippocraticum. Florence, 1999, 255–270. Austin, C. and S.D. Olson, Aristophanes: Thesmophorizusae. Edited with Introduction and Commentary. Oxford, 2004. Boissonade, J.-F. (ed.), Herodiani partitiones. London, 1819. Bourbon, F. (ed.), Hippocrate. Tome XX. 1ère partie. Nature de la femme. Paris, 2008. Bown, D., The Royal Horticultural Society New Encylcopedia of Herbs and their Uses. London, 2002. Chaniotis, A., ‘Illness and Cures in the Greek Propitiatory Inscriptions and Dedications of Lydia and Phrygia’, in: P.J. van der Eijk et al. (eds.), Ancient Medicine in its SocioCultural Context: Papers read at the Congress held at Leiden University (13–15 April 1992). Amsterdam and Atlanta, 1995, 323–344. Chantry, M., Scholia in Aristophanem. Pars 3. Scholia in Thesmophoriazusas; Ranas; Ecclesiazusas et Plutum. Fasc. IVb continens scholia recentiora in Aristophanis Plutum, Groningen, 1996. Crugnola, A., Scholia in Nicandri Theriaka cum glossis. Milan, 1971. 56  The literature on the topic is abundant: see for instance: Rousselle 1980, especially p. 1096; Hanson 1991; 1992; Demand 1994, 63–65; Dean-Jones 1995, 47; Andò 1999. Some scholars are warier of the notion of women’s home remedies: see King 1995; Hanson 1998.

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Craik, E.M., Two Hippocratic Treatises On Sight and On Anatomy: Edited and Translated with Introduction and Commentary. Leiden, 2006. Dalby, A., Food in the Ancient World: From A to Z. London and New York, 2003. Dean-Jones, L.A., ‘The Politics of Pleasure: Female Sexual Appetite in the Hippocratic Corpus’, in: D.C. Stanton (ed.), Discourses of Sexuality: From Aristotle to AIDS. Ann Arbor, 1992, 48–77. ———, ‘Autopsia, Historia and What Women Know: The Authority of Women in Hippocratic Gynaecology’, in: D. Bates (ed.), Knowledge and the Scholarly Medical Traditions. Cambridge, 1995, 41–59. Demand, N., Birth, Death and Motherhood in Classical Greece. Baltimore and London, 1994. Dover, K.J., Aristophanes: Clouds. Edited with Introduction and Commentary. Oxford, 1968. Dübner, F., Scholia Graeca in Aristophanem. Paris, 1842. Duminil, M.-P. (ed.), Hippocrate. Tome VIII. Plaies. Nature des os. Coeur. Anatomie. Paris, 1998. Edelstein, E.J. and L. Edelstein, Asclepius: A Collection and Interpretation of the Testimonies. 2 vols, Baltimore, 1945. Eke, T. et al. ‘The Spectrum of Ocular Inflammation caused by Euphorbia Plant Sap’, Archives of Ophthalmology 118 (2000), 13–16. Eliot, C.W.J., Coastal Demes of Attika: A Study of the Policy of Kleisthenes. Toronto, 1962. Erbse, H., Untersuchungen zu den attizischen Lexika. Berlin, 1950. Froidefond, C., Le mirage égyptien dans la littérature grecque d’Homère à Aristote. Aix-en-Provence, 1971. Gilula, D., ‘Hermippus and his Catalogue of Goods (fr. 63)’, in: D. Harvey and J. Wilkins (eds.), The Rivals of Aristophanes: Studies in Athenian Old Comedy. London, 2000, 75–90. Gorrini, M.E., ‘The Hippocratic Impact on Healing Cults: The Archaeological Evidence in Attica’, in: P.J.van der Eijk (ed.), Hippocrates in Context: Papers Read at the XIth International Hippocrates Colloquium, University of Newcastle-upon-Tyne, 27–31 August 2002. Leiden, 2005, 135–156. Gourevitch, D., ‘Fabriquer un médicament composé, solide et compact, dur et sec: formulaire et réalités’, in: F. Gaide and F. Biville (eds.), Manus medica: actions et gestes de l’officiant dans les textes médicaux latins: questions de thérapeutique et de lexique. Actes du colloque tenu à l’Université Lumière-Lyon II, les 18 et 19 septembre 2001. Aix-en-Provence, 2003, 49–67. Hanson, A.E., ‘Continuity and Change: Three Case Studies in Hippocratic Gynecological Therapy and Theory’, in: S.B. Pomeroy (ed.), Women’s History and Ancient History. Chapel Hill, 1991, 73–110.

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———, ‘The Logic of the Gynecological Prescriptions’, in: J.A. López Férez (ed.), Tratados Hipocráticos: estudios acerca de su contenido, forma e influencia. Actas del VIIe Colloque international hippocratique (Madrid, 24–29 de septiembre de 1990). Madrid, 1992, 235–250. ———, ‘Talking Recipes in the Gynaecological Texts of the Hippocratic Corpus’, in: M. Wyke (ed.), Parchments of Gender: Deciphering the Bodies of Antiquity. Oxford, 1998, 71–94. Herzog, R., Die Wunderheilungen von Epidauros: Ein Beitrag zur Geschichte der Medizin und der Religion. Leipzig: Philologus, Supplementband 22.3, 1931. Hoppe, C. and E. Oder, Corpus hippiatricorum Graecorum. 2 vols. Leipzig, 1924–1927. Hort, A., Theophrastus: Enquiry into Plants and Minor Works on Odours and Weather Signs. With an English Translation. Cambridge, Mass. and London, 1926. Hünemörder, C., ‘Myrrhe’, in: H. Cancik and H. Schneider (eds.), Der neue Pauly Enzylopädie der Antike: Altertum. Band 8 (Mer–Op). Stuttgart and Weimar, 2000, 996–997. ———, ‘Weihrauch’, in: H. Cancik and H. Schneider (eds.), Der neue Pauly Enzylopädie der Antike: Altertum. Band 8 (Mer–Op). Stuttgart and Weimar, 2002, 418. Hurschmann, R., ‘Mastix’, in: H. Cancik and H. Schneider (eds.), Der neue Pauly Enzylopädie der Antike: Altertum. Band 7 (Lef–Men). Stuttgart and Weimar, 1999, 996–997. Jackson, R.P.J., ‘Eye Medicine in the Roman Empire’, ANRW 37.3, ed. W. Haase. Berlin & New York, 1996, 2228–2251. Joly, R. (ed.), Hippocrate: Du régime. Paris, 1967. Jones, W.H.S. (ed.), Hippocrates. Vol. II. With an English Translation. London and New York, 1923. Jouanna, J., ‘Maladies et médecine chez Aristophane’, in: J. Leclant and J. Jouanna (eds.) Le théâtre grec antique: la comédie. Actes du 10ème colloque de la Villa Kérylos à Beaulieu-sur-Mer les 1er et 2 octobre 1999. Paris, 2000, 171–195. Kassel, R. and C. Austin, Poetae Comici Graeci, Berlin, 1983–. King, H., ‘Sowing the Field: Greek and Roman Sexology’, in: R. Porter and M. Teich (eds.), Sexual Knowledge, Sexual Science: The History of Attitudes to Sexuality. Cambridge, 1994, 29–46. ———, ‘Self-Help, Self-Knowledge: In Search of the Patient in Hippocratic Gynaeco­ logy’, in: R. Hawley and B. Levick (eds.), Women in Antiquity: New Assessments, London and New York, 1995, 135–148. Laskaris, J., ‘Archaic Healing Cults as a Source for Hippocratic Pharmacology’, in: I. Garofalo et al. (eds.), Aspetti della terapia nel Corpus Hippocraticum. Florence, 1999, 1–12. Lloyd, G.E.R., Science, Folklore and Ideology: Studies in the Life Sciences in Ancient Greece. Cambridge, 1983.

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———, In the Grip of Disease: Studies in the Greek Imagination. Oxford, 2003. Maehler, H., Pindarii carmina cum fragmentis. Pars II. Fragmenta. Indices. Leipzig, 1989. Majno, G., The Healing Hand: Man and Wound in the Ancient World, Cambridge, Mass. and London, 1975. Marganne, M.-H., L’ophtlamologie dans l’Égypte gréco-romaine d’après les papyrus littéraires grecs. Leiden, 1994. Meiggs, R., Trees and Timber in the Ancient Mediterranean World. Oxford, 1982. Olivieri, A. (ed.), Aetii Amideni Libri medicinales. 2 vols. Leipzig and Berlin, 1935–1950. Olson, S.D. and A. Sens, Archestratos of Gela: Greek Culture and Cuisine in the Fourth Century BCE. Oxford, 2000. Potter, P. (ed.), Hippokrates: Über die Krankheiten III. Berlin, 1980. ——— (ed.), Hippocrates. Vol. VI. With an English Translation. Cambridge, Mass. And London, 1988. Prato, C. and D. Del Corno. Le donne alle Tesmoforie. Florence, 2001. Regtuit, R.F., Scholia in Aristophanem. Pars 3. Scholia in Thesmophoriazusas; Ranas; Ecclesiazusas et Plutum. Fasc. 2/3. Scholia in Aristophanis Thesmophoriazusas et Ecclesiazusas. Groningen, 2007. Rodríguez Alfageme, I., ‘Terapéutica hipocrática en la comedia’, in: I. Garofalo et al. (eds.) Aspetti della terapia nel Corpus Hippocraticum. Florence, 1999, 371–388. Rogers, B.B., The Ecclesiazusae of Aristophanes. London, 1917. Rousselle, A., ‘Images médicales du corps. Observation féminine et idéologie masculine: le corps de la femme d’après les médecins grecs’, Annales ESC 35 (1980), 1089–1115. Schmidt, M., Hesychii Alexandrini lexicon. 4 vols. Jena, 1958–1962. Smith, W.D. (ed.), Hippocrates. Vol. VII. With an English Translation. Cambridge, Mass. and London, 1994. Sommerstein, A.H., Thesmophoriazusae: Edited with Translation and Notes. Warminster, 1994. ———. Wealth. Edited with Translation and Commentary. Warminster, 2001. Staden, H. von, ‘Women and Dirt’, Helios 19 (1992), 7–30. Totelin, L.M.V., ‘Sex and Vegetables in the Hippocratic Gynaecological Treatises’, Studies in History and Philosophy of Biological and Biomedical Sciences 38 (2007), 531–540. ———, Hippocratic Recipes: Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece. Leiden, 2009. Ussher, R.G., Aristophanes: Ecclesiazusae. Edited with Introduction and Commentary. Oxford, 1973. Wellmann, M., Pedanii Dioscuridis Anazarbei De materia medica libri quinque. 3 vols, Berlin, 1907–1914.

CHAPTER 15

Hippocratic and Non-Hippocratic Approaches to Lovesickness Leanne McNamara This chapter examines the curious lack of any explicit discussion of lovesickness, eros, in the CH. While the accidents of preservation inevitably confound our ability to account for any absence in the CH,1 the absence of eros seems especially striking given how broadly across Greek culture lovesickness was regarded as a true nosos. It was a feared condition, appearing frequently in the surviving non-medical literature. Literary genres in fields as diverse as history, drama and philosophy treat eros in the same category as other diseases, with causes, symptoms and treatments similar in type to those of other somatic nosoi.2 One might well expect a condition that so exercised the popular imagination to recur throughout the CH as frequently as, for example, the ‘sacred disease’.3 The first part of this chapter examines very briefly the depiction of eros in non-Hippocratic genres, simply to synthesize a clinical picture of its various manifestations. I will argue that the treatment of eros was considered particularly difficult and associated not with iatroi, but with folk healers, especially female healers. The second part examines parallels between this clinical picture and a number of the illnesses in the Hippocratic medical literature. I suggest that the Hippocratic material redefines eros and legitimizes certain aspects of it as other nosoi, particularly the disease of young girls. This can be read in the context of the medical marketplace in which Hippocratic medicine * I wish to express my thanks to Paul Demont, Rebecca Flemming and Jim Hankinson for helpful comments on an oral version of chapter. 1  Nutton 2004, 1–9 reminds us of the fragility of the historical record. 2  For example, Xen. Cyr. 5.1.12; Ar. Thesm. 1116–1118; Eur. Andr. 220, 956; Hipp. 131–140; 170–249; Pl. Symp. 207a; Ti. 86d. 3  For the Greeks of the classical period eros designated a sexual desire for a particular individual that becomes pathological when it is unrequited. It is frequently characterized by insomnia, loss of appetite, pallor or at least a change in the color of the complexion, mental confusion and, above all, burning fever. It is typically an unpleasant condition which the sufferer wants resolved. See further Halperin 1985, 163; Calame 1999, 19–21; Nussbaum 2002; Sanders, Thumiger, Carey and Lowe 2013, 1–5.

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arose, which, as Lloyd, Nutton and others have emphasised, was a competitive and pluralistic environment.4 Thus, while the corpus does not deal with eros in its classical, non-Hippocratic form, it does bring the treatment of a circumscribed version of this important nosos into the Hippocratic domain without either associating Hippocratic practitioners with, or legitimizing the theories or practices of, rival healers. I will conclude with some brief, if speculative, remarks concerning the appearance of eros as an acceptable subject in later Greco-Roman medical literature. 1

Eros in Non-Hippocratic Literature

Lovesickness has a long history in Greek thought. The disease metaphor was already established in archaic literature as one, if not the, standard way in which sexual passion was described. In documenting the gradual appearance of elements of eros in archaic Greek poetic literature, Cyrino has demonstrated that the metaphor of eros as a disease and a madness was a crucial aspect of archaic depictions of love.5 Successive poets built on the nosological images used by their predecessors, culminating in Sappho’s poetry. The physical effects of eros on the sufferer are emphasized, and its characteristic features, that is, its symptoms and signs, are established. These features include palpitations, fever, sweating, changed complexion, either pallor, or, more probably as King has argued, a green complexion, and madness.6 The essential nosological features of eros, then, had crystallized in archaic Greek poetry. Throughout the classical period, eros continues to be described in non-Hippocratic literature predominantly using medical language and disease imagery. It is explicitly labeled a nosos by authors from diverse genres, including Plato, Xenophon, Aristophanes and Euripides.7 It is to some of these texts that I now wish to turn. One of the most complete and well known descriptions of eros in classical literature is Phaedra’s lovesickness for her stepson in Euripides’ Hippolytus.8 Phaedra’s symptoms are explicated in detail throughout the play. She has taken to her bed and does not eat for three days. She wishes to die, as the chorus explains: 4  Nutton 1992, 25–26; Nutton 1995, 3–4; Lloyd 1979, 38–39, 69. 5  Cyrino 1995. See also Thornton 1997, 33–35. 6  King 2004, 38–40. Cf., e.g., Sappho fr. 31, with Calame 1999, 19–21. 7  See for example Pl. Symp. 207a–b; Xen. Cyr. 5.1.12; Ar. Thesm. 1116–1118; Eur. Andr. 220–221. 8  For a detailed, medically oriented, discussion of Phaedra’s pathology, see Kosak 2004, 49–64.

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Suffering with a sickness in bed, she keeps her body inside the house, and fine clothes shadow her golden head; and I hear this is the third day that by starving her mouth she has kept her body pure from Demeter’s grain, because of a secret suffering wishing to drive herself to the wretched end of death.9 They note that Phaedra is weak and thin and her complexion is changed: A loathesome cloud is growing on her brow. My soul longs to learn whatever it is, why the queen’s body, so changed in colour, is ravaged.10 Phaedra herself complains that her limbs are weak: ‘Lift up my body, hold my head straight. The ligaments of my dear limbs are slack’.11 Finally, she makes her prominent mental symptoms clear. She is mad, unhappy, confused and unsettled, raving, ashamed, crying and suicidal: I was mad, I fell from the destruction of a god. Alas, alas I am a wretch! Nurse, cover my head again, for I am ashamed of what was said by me. Cover it! A tear is coming from my eyes and my face is turned in shame. For to be right in my mind is painful, but being mad is an ill thing. But it is best to die not conscious.12 9  Eur. Hipp. 131–140. τειρομέναν νοσερᾷ κοίτᾳ δέμας ἐντὸς ἔχειν οἴκων, λεπτὰ δὲ φά ρη ξανθὰν κεφαλὰν σκιάζειν• τριτάταν δέ νιν κλύω τάνδ’ ἀβρωσίᾳ  στόματος ἁμέραν Δάματος ἀκτᾶς δέμας ἁγνὸν ἴσχειν, κρυπτῷ πένθει θανάτου θέλουσαν κέλσαι ποτὶ τέρμα δύστανον. 10  Eur. Hipp. 172–175. στυγνὸν δ’ ὀφρύων νέφος αὐξάνεται τί ποτ’ ἔστι μαθεῖν ἔραται ψυχή,  τί δεδήληται δέμας ἀλλόχροον βασιλείας. 11  Eur. Hipp. 198–199. αἴρετέ μου δέμας, ὀρθοῦτε κάρα• λέλυμαι μελέων σύνδεσμα φίλων. 12  Eur. Hipp. 241–249. ἐμάνην, ἔπεσον δαίμονος ἄτῃ. φεῦ φεῦ, τλήμων.

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The play also hints at who is best qualified to treat Phaedra’s ills. The nurse famously asks Phaedra: And if you are sick with one of the unmentionable troubles, here are the women to treat the disease. But if the problem may be divulged to men, speak so that the matter may be revealed to the iatroi.13 In fact, once the nurse finally establishes that Phaedra is lovesick, she decides to treat her with love charms, philtra thelkteria, which require some of her beloved’s hair or clothing as ingredients.14 This charm is a folk remedy, of the type particularly associated with the pharmakeis and pharmakides, or sorcerers. These healers, and not iatroi, are the usual resort for those suffering eros. The nurse proves an incompetent healer, of course, and Phaedra hangs herself.15 Sophocles’ Trachiniae also describes the effects of eros in a somewhat more complex three-way scenario. Heracles’ lovesick wife Deianeira is attempting to transfer Heracles’ desire, which has strayed to Iole, back to herself. Significantly, Heracles’ eros is also termed a nosos throughout the play.16 This play in particular takes up the burning or fire imagery of eros that we saw in the earlier fragment from Sappho. Deianeira sends Heracles a poisoned cloak which burns his flesh so painfully that he commits suicide by flinging himself onto a funeral pyre.17 Eros, then, leads to Heracles literally burning to death.18 μαῖα, πάλιν μου κρύψον κεφαλήν, αἰδούμεθα γὰρ τὰ λελεγμένα μοι. κρύπτε• κατ’ ὄσσων δάκρυ μοι βαίνει, καὶ ἐπ’ αἰσχύνην ὄμμα τέτραπται. τὸ γὰρ ὀρθοῦσθαι γνώμην ὀδυνᾷ, τὸ δὲ μαινόμενον κακόν• ἀλλὰ κρατεῖ μὴ γιγνώσκοντ’ ἀπολέσθαι. 13  Eur. Hipp. 293–296. κεἰ μὲν νοσεῖς τι τῶν ἀπορρήτων κακῶν, γυναῖκες αἵδε συγκαθιστάναι νόσον• εἰ δ’ ἔκφορός σοι συμφορὰ πρὸς ἄρσενας, λέγ’, ὡς ἰατροῖς πρᾶγμα μηνυθῇ τόδε. 14  On the nurse’s gradual realisation that Phaedra is lovesick see Eur. Hipp. 267–352. On her use of philtra thelkteria see Eur. Hipp. 509–515. 15  On the nurse as a ‘charlatan’ healer, see Kosak 2004, 49–65, esp. 60–61 on her use of incantations and love potions. 16  For example, at Soph. Trach. 445, 853. 17  Soph. Trach. 1080–1089, 1195–1199. 18  Soph. Trach. 354–355 on Eros as the instigator of events.

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Deianeira has been deceived by the centaur Nessos, into believing that this poisoned cloak is a love potion, a pharmakon. The term pharmakon has a wide semantic range, encompassing both remedies and poisons in what we might today call the medical and magical spheres, spheres that were much less often and much less clearly separated in classical Greek thought.19 Sophocles also describes Nessos as a pharmakeus, a sorcerer-healer who employs pharmaka to treat his clients.20 So like other nosoi, eros may be induced or treated by pharmaka.21 The theme of eros as being treatable by pharmaka is also found in nonpoetic authors. Antiphon’s first law court speech is entitled φαρμακείας κατὰ τῆς μητρυιᾶς (usually rendered as ‘Against the Poisoning Stepmother’, but which could also be interpreted as ‘Against the Stepmother, the Pharmakis’). In this account the prosecutor accuses the titular stepmother of giving a pharmakon to Philoneos’ spurned mistress. The stepmother pretends that the pharmakon is a love philtre but it is in reality a deadly poison. The mistress then inadvertently poisons Philoneos and his guest-friend, the prosecutor’s father, while trying to regain his affection. Philoneos dies immediately, while the prosecutor’s father dies after twenty days of terrible illness. This story is paralleled in ps.-Aristotle’s Magna Moralia so closely that it may be a re-telling of the same basic tale.22 The account is given as an exemplar in a discussion of the notion of intent. In the past, the author relates, a woman was tried before the Areopagus after giving a love potion to a man, who subsequently died. This woman was acquitted because she did not intend to kill the man. Central to this illustration is the accused woman’s belief that a pharmakon could relieve her own lovesickness by causing its receiver to fall in love with her. Plato’s most explicitly medical work, Timaeus, recommends a treatment other than pharmaka for desire: regimen. This work also provides an aetiology for the condition, which he considers a nosos of the psyche.23 He writes:

19  On the semantic range of the term pharmakon see Graf 1995, 36–37, following Pharr 1932, 272–274. 20  Soph. Trach. 1140. 21  See Goldhill 1995, 21 on the search for a pharmakon to cure eros as a Hellenistic literary topos. 22  Arist. [Mag. mor.] 1.16.2, 1188b32–39. 23  On the Platonic depiction of eros as a madness see Ciavolella 1976, 16; Halperin 1985, 167; Carson 1986, 148–149, 153–155; Gaca 2003, 34, 40.

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In truth, this excessive desire (aphrodisia), for the most part because of the fluidity and moistness of one substance due to the porosity of the bones in the body, becomes a disease of the soul (psyche).24 The aetiology is consistent with his aetiologies of somatic nosoi which precede his discussion of diseases of the psyche. For Plato, these diseases have the same (essentially humoral) underlying causes as diseases of the body.25 Their treatment is also equated to the treatment of somatic nosoi.26 The basis of all treatment is the restoration of symmetry in the bodily fluids by regimen. In addition to internal symmetry, the soul and body should also be in balance with each other otherwise, he argues, a strong soul in a weak body will lead to somatic nosoi, while a weak soul in a strong body will result in psychic nosoi. He concludes that both must be evenly matched and healthy.27 Both body and intellect should always be supplied with suitable nourishment and exercise.28 Disease of the soul is treated according to the same underlying principles and methods as the somatic nosoi we would more easily recognise as diseases today, and the health of the body and soul is maintained by the same principles of regimen. For Plato real and fundamental similarities exist between somatic nosoi and psychic nosoi, including erotic mania. Finally, there are references to eros and its treatment in what we might term the non-Hippocratic ‘scientific’, ‘biological’ or even ‘medical’ literature. These references are less descriptive, less extensive and more often incidental as part of some other discussion rather than the focus of the passage. This suggests that eros was well enough accepted that it did not require any further explanation or justification by these authors. Aristotle’s Enquiry into Animals, for example, remarks that hippomanes, a foal’s amniotic sac, is prized by pharmakides.29 This is almost certainly a reference to the virtually exclusive use of hippomanes in love potions.30 Book 30 of the peripatetic text Problemata links melancholia, the excess of black bile, with a number of conditions, including both the sacred disease, to which I 24  Pl. Ti. 86d. τὸ δὲ ἀληθὲς ἡ περὶ τὰ ἀφροδίσια ἀκολασία κατὰ τὸ πολὺ μέρος διὰ τὴν ἑνὸς γένους ἕξιν ὑπὸ μανότητος ὀστῶν ἐν σώματι ῥυώδη καὶ ὑγραίνουσαν νόσος ψυχῆς γέγονεν.  Cf. Pl. Leg. 783a. 25  Pl. Ti. 86b, 86e–87e. Cf. Pl. Resp. 571d; Soph. 228a; Leg. 689a–b. 26  Pl. Ti. 87c–88c. 27  Pl. Ti. 88b–c. 28  Pl. Ti. 88b–90d. 29  Arist. HA 6.22, 577a13. 30  Watson 1993, n. 14, 845.

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will return, and eros.31 The chronic effects of atrabilia are likened to the acute sexual intemperance observed in those who drink excessively. So eros is again given a somatic basis, founded on the humoral model of the body. Theophrastus’ Enquiry into Plants describes some of the pharmaka that might be used to make love philtres, including mandrake root and cyclamen.32 The passage, famously excluded from the 1916 Loeb version of the text, also describes the effects of various pharmaka on potency and fertility.33 Theophrastus emphasizes that his informants include the herbalists, rhizotomoi and pharmakopolai, rather than iatroi.34 He rejects some of their harvesting techniques and uses of pharmaka as ‘far-fetched and unconvincing’.35 However, he does not regard aphrodisiacs as suspect or irrational. Finally, Diocles makes mention of three remedies which may be used as aphrodisiacs: turnip seed, wild skirwort (parsnip) and molluscs.36 While the testimonials and extant fragments of Diocles’ work give no indication that he discussed the condition eros, it is significant that at least one medical author from the classical period whose work is excluded from the CH can refer to remedies explicitly intended to increase sexual desire. So lovesickness is not just a poetic metaphor that features only in imaginative genres, but was regarded as a true disease, and appears in more factual or scientific genres, even non-Hippocratic medical works. It has particular symptoms, both physical and mental, it is caused by the same sorts of processes that cause other nosoi and, like other nosoi, it can be treated with pharmaka. This is all literary evidence and as such privileges the views of elite male Athenian authors. Much of this literature, however, is written for a broad audience, drama and law court speeches in particular, and there is nothing to suggest that these same views are not found in the non-literate sectors of the community. There may be some non-literary evidence for lovesickness in the katadesmoi or curse tablets, as well as the amatory agogai spells of the 31  Arist. [Pr.] 30.1, 953a10–954a10. 32  Theophr. Hist. pl. 9.9.1, 9.9.3. 33  Theophr. Hist. pl. 9.18.3–11. See also Gemmil 1973. I wonder whether this excision, apparently based purely on the prudishness of the modern editor, may provide some hint for the reasons eros does not feature more prominently in this text as well as medical texts: eros was simply considered an illegitimate or inappropriate subject and therefore references to it were judged by later editors, ancient or modern, to be spurious. 34  Theophr. Hist. pl. 9.8.6. On Theophrastus’ use of the rhizotomoi and pharmakopolai as sources, see Scarborough 1978, 355. 35  Theophr. Hist. pl. 9.8.5. ἐπίθετα καὶ πόρρωθεν. Cf. Theophr. Hist. pl. 9.19.2–3. 36  Diocles 211a and b, 212, 222. See testimonials in van der Eijk 2000, vol. 1, 362, 364, 372, and commentary; vol. 2, 393–395, 400–401.

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Greek and Demotic magical papyri. These sources differ from literary accounts in that they are genuine remedies, employed in the real world. Faraone has argued convincingly that there are clear links between these agogai spells and Greek archaic and classical period understandings of eros and its treatment.37 Eros is labelled a nosos in these sources, and in addition, its symptoms are consistent with the classical period literary accounts of eros. They are problematic sources, however, not least because they are from different geographic and chronologic origins than the texts of the CH. Beyond this brief acknowledgment of their existence, then, I will not consider them further in this chapter. In any case, there seems little doubt from the literary record that eros was accepted as a genuine nosos throughout a wide cross section of the Greek population. 2

The Clinical Features of Eros

Using all these strands of evidence we can put together a typical profile of a person suffering from eros. Eros predominantly afflicts women, at least in poetic and forensic literature. The philosophical texts are silent on the issue of gender, and Theophrastus’ writings make it clear that there are pharmaka to increase (or decrease) potency or fertility in both men and women, but do not discuss whether one gender is more often afflicted with eros than the other.38 The precise aetiology of eros is not explicitly discussed in the nonHippocratic sources, but it is clear that it is thought to be caused by the same sorts of processes that cause other nosoi. In sources such as drama where diseases are routinely attributed to the intervention of the gods, eros is seen as a divinely afflicted condition, while it is seen as a naturalistic condition in those philosophical sources where disease is seen as a natural process, and often given a humoral pathogenesis. It is clearly linked to disorders of the mind, and is sometimes explicitly said to arise in the seat of psychological symptoms, although there was no agreement about where that might be, whether the heart, liver or brain. Thus Plato sees eros as a disease of the soul, caused by a lack of symmetry in the humors. Aristotle and the peripatetics go further in linking eros to an excess of a specific humour: black bile. 37  Faraone 1999, 49–55. 38  The gendering of eros (and in particular the disjunction between the literary depiction of this socially shameful condition and its representation in the later agogai spells, in which the sufferer of eros is typically male) is beyond the scope of this paper, but would be an interesting subject to pursue further in another forum.

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The predominant symptoms of eros are fever, sweating, pallor or a changed colour of the sufferer’s complexion, cardiac symptoms, especially palpitations, insomnia accompanied by tiredness, limb or muscle weakness and wasting, trembling, an inability to eat or drink, and psychological symptoms including confusion, depression and madness. Despite the array of symptoms, however, the shame felt by sufferers and their subsequent deception or reticence to reveal the truth mean that it is not always easily diagnosed, as Phaedra’s case illustrates. Untreated, its course is unremitting and it has a very poor prognosis, often leading to suicide in literary depictions, as in the cases of Heracles and Phaedra. Its management is difficult. It is treated with pharmaka like other nosoi, but unlike most nosoi, these are typically administered not to the sufferer but to the object of the unrequited desire, with the aim of gaining his or her affections. I have argued elsewhere that this sort of remedy relies on the concept of the transference of the symptoms and thus the illness itself from the sufferer to the beloved.39 Finally, eros is characteristically treated by folk healers, and at least in the literary world, these healers are more often (but not exclusively) female. Literary pharmakeis/ides (the healing role that Phaedra’s nurse adopts, as I suggested above) in particular are depicted as ministering to those with unrequited desire. In the real world, midwives played a role as matchmakers, if we can believe Plato’s testimony, and may also have contributed to the treatment of lovesickness.40 Nevertheless, these folk practitioners and their pharmaka are clearly regarded with a great degree of suspicion, given the number of stories of substitution of love philtres for poisons. The central elements of this clinical picture become well-worn literary topoi by the Hellenistic period. Theocritus’ 2nd Idyll provides a convenient exemplar. It revolves around the dubious Simaetha, the titular Pharmakeutria. She uses incantations and pharmaka against the lover who has spurned her, leaving her with an inflamed heart, insomnia, fever, confusion, alopecia, pallor and wasting, all of which wise women fail to remedy.41

39  McNamara 2008, 141–144. 40  Pl. Tht. 149d. 41  Theoc. Id. 2.1–16, 82–91.

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The Hippocratic Literature

In contrast to the wealth of non-Hippocratic material that this short chapter can merely gloss over, there is no reference to eros as a nosos in the classical CH. This is not, however, to suggest that sexual desire was unrecognised in the corpus. Intercourse and orgasm, including wet dreams, are frequently discussed.42 The regulation of the frequency of sex according to the season, age and constitution of the patient was an important aspect of a healthy regimen.43 Intercourse, in moderation, is generally considered necessary to maintain health and prevent illness in both men and women.44 In addition, the gynaecological treatises contain extensive advice concerning the timing of intercourse, along with various other therapeutic measures, in order for a woman to become pregnant.45 Venery, λαγνεία or ἀφροδίσια, is temporally related to certain specific illnesses, and abstinence advised as a therapeutic measure for others in several treatises.46 The authors of Epidemics 6 and 7 and the gynaecological treatises, on the other hand, consider intercourse helpful in the treatment or prevention of other specific illnesses.47 However, neither lagneia nor aphrodisia in the CH equate directly with eros, lust or passion. Both terms refer 42  For some examples, see the references to orgasm (ὀργή/ὀργασμός) in Aph. 1.22, 4.1, 4.10, 5.29; Hum. 3, 6. The mechanics of male and female orgasm are discussed in Genit. 1.1–3 and 4.1–2 respectively. Wet dreams (ἐξονειρώττω) are specifically discussed as a symptom/ sign in Morb. 2.51, Epid. 4.57 (where a wet dream is a positive sign) and Epid. 6.8.29 (where it is regarded as harmful). Wet dreams are even regarded as a precursor to insanity in Genit. 1.3. (Cf. Vict. 1.35). See Lonie 1981, 108–110 for further discussion. 43  Vict. 1.35, 2.58, 3.68, Aff. 1, Epid. 6.8.23. 44  Intercourse, in Prorrh. 2.4; Epid. 6.6.2; Vict. 3.80, 3.85. The greater likelihood of specific diseases in unmarried (and presumed sexually inactive) women is recorded in Mul. 1.2, 1.4, 1.7 and Virg. 1. Dean-Jones (1992, 57–58, 62–63) notes that in general men’s health was more likely to be at risk from too much intercourse and thus for them abstention was more often recommended, while women’s bodies were more likely to suffer from too infrequent sex and thus for them intercourse more often recommended. 45  See, for example, Mul. 1.11–12. 46  For illness linked to venery see Epid. 3 cases 10 and case 16; Aph. 6.30; Morb. 1.15; Int. 28. On abstinence as a therapeutic measure see Vict. 3.73; Morb. 2.49; 2.50; 2.73; 3.16, Int. 32; Mul. 2.143, 2.149. Hanson (1991, 84 n.62, 104) further discusses the recommendation for abstinence in uterine prolapse. 47  Epid. 6.5.15, 7.69, 7.122; Mul. 1.59, 1.60, 2.141; Nat. Mul. 40, 43. Lonie (1981, 122) discusses therapeutic intercourse for women with retained menses further. Hanson (1991, 84 and 104 nn.62–3) discusses the passages recommending intercourse as a preventative measure against uterine displacement in Mul. 2.127, 2.128, 2.131, 2.134, 2.135, 2.139, 2.141, 2.146. See also the bibliography cited in Totelin 2007, 532 n.5. Totelin argues further that in a number

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rather to the physical act of intercourse than the emotional desire for sex (let alone any other sort of relationship) with a particular beloved. The corpus has less to say about sexual desire than sex itself, at least at the explicit level, although it is by no means silent. It will suffice to note here the well known passage in Airs, Waters, Places, in which the Scythian men are said to have ‘no great desire for intercourse’.48 Their impotence is linked in part to them ‘forgetting about desire and sex’.49 Diseases of Women also comments on the lack of desire for sex with their husbands in women suffering from various illnesses, and conversely on the increase of desire upon treatment.50 Molluscs, which, as I commented upon above, Diocles considered aphrodisiac, feature in a remedy for hydropsy of the womb in On the Nature of Women.51 However, the remedy does not appear to be intended to increase desire, that is, to be aphrodisiac, here.52 There is, to my knowledge, no reference to aphrodisiacs in the CH. The corpus then, apparently considers sexual desire normal and healthy, and a lack of desire as suspect. There is, however, neither reference to desire for a particular person, nor to the treatment, or even recognition of the phenomenon, of unrequited desire in the corpus.53 Nevertheless, some of the traditional symptoms of eros were recognized, but were attributed to other causes. I have already commented on the association between melancholy and eros in the Problemata. In later Byzantine and Arabic medical literature, as well as Western medieval medicine, lovesickness became firmly associated with melancholy.54 Certainly from the first century onwards, there is a firm relationship between melancholy and lovesickness: Aretaeus explicitly notes the similarities between the symptoms of melancholy and love.55 Oribasius, following Rufus of Ephesus, recommends sex as a remedy of instances in which intercourse itself is not explicitly recommended, the gynaecological recipes contain ingredients with sexual signification such as phallic vegetables. 48  Aër. 21 (2.74.18–19 L) οὔτε γὰρ τῷ ἀνδρὶ ἡ ἐπιθυμίη τῆς μείξιος γίνεται πολλὴ. 49  Aër. 22 (2.82.3 L) ἐπιλήθεσθαι τοῦ ἱμέρου καὶ τῆς μείξιος. 50  On the lack of desire see Mul. 1.24, 1.57 and on increase in desire upon treatment see Mul. 1.17. Dean Jones 1994, 55 argues convincingly that in contrast to the depiction of male sexual desire in the CH, female sexual appetite is regarded as an entirely physiological (and not psychological or affective) compulsion. 51  Nat. Mul. 2. 52  I differ with the suggestion of van der Eijk 2000 vol. 2, 401 that the aphrodisiac function of molluscs is implied in this passage. 53  I will discuss the later Lives, attributed to Soranus, in which Hippocrates said to treat the lovesickness of Perdiccas, below 323. 54  Ciavolella 1976, 7–39; Ferrand 1990, 39–54; Wack 1990, 6–14 note the ancient predecessors of this link. 55  Aretaeus On CD III.5.4–11.

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for melancholy.56 In addition, several Hippocratic texts reference melancholy, linking an excess of black bile with both mania and fever.57 However, melancholy is far from an exact replica of eros, and there is no explicit or implicit link between the conditions in the CH. The association appears in later literature. Instead, I would like to focus on another Hippocratic illness, which more closely parallels eros: the disease of young girls. Indeed Helen King has already noted that while they should not be considered the same clinical entities, there are ‘fragile boundaries’ between the disease of young girls, lovesickness and the condition ‘green sickness’.58 The author of the treatise On the Diseases of Young Girls describes the typical sufferer: Young girls who when ripe for marriage, remain unmarried, suffer this especially at the same time as the descent of their menses.59 So like eros, this disease is a strongly gendered condition, here explicitly defined in biological terms through its linkage to menarche. There are also similarities in the symptoms. The relevant passage of On the Diseases of Young Girls states: The heart is numbed; then after the numbness, lethargy; then after the lethargy, paranoia seizes them60 There follows an analogy with the numbness experienced in the feet and legs when one has been sitting on them and then the blood flow returns upon standing and walking. The author continues: The place [the heart] is important for mental derangement and actual mania. Whenever these parts themselves are filled [with blood] a shivering with fever rises up . . . She is mad from the violent inflammation . . . they long for nooses.61

56  Lonie 1981, 110; Wack 1990, 10. 57  Morb. Sacr. 18; Aph. 6.23; Nat. Hom. 15. See further discussion in Pigeaud 1981, 122–138. 58  King 2004, 140. 59  Virg. 1, αἱ δὲ παρθένοι, ὁκόσῃσιν ὥρη γάμου, παρανδρούμεναι, τοῦτο μᾶλλον πάσχουσιν ἅμα τῇ καθόδῳ τῶν ἐπιμηνίων 60  Virg. 1, ἐμωρώθη ἡ καρδίη• εἶτα ἐκ τῆς μωρώσιος νάρκη• εἶτα ἐκ τῆς ναρκῆς παράνοια ἔλαβεν 61  Virg. 1, ὁ τόπος ἐπίκαιρος ἔς τε παραφοσύνην καὶ μαινίην ἕτοιμος. ὁκόταν δὲ πληρωθέωσι ταῦτα τὰ μέρεα, καὶ φρίκη ξὺν πυρετῷ ἀναίσσει . . . ὑπὸ μὲν τῆς ὀξυφλεγμασίης μαίνεται . . . ἀγχόνας κραίνουσιν.

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In both eros and this disease there are cardiac symptoms, a ‘numb’ heart here versus the palpitations of eros; both have sleep disturbance, lethargy versus the insomnia of eros; the lethargy can also be compared to the weakness of eros; and last but by no means least, both are characterised by fever, and mental symptoms or mania, including suicidal thoughts. There are also similarities between the origins of the conditions. Both arise in the seat of psychological symptoms. As I have already noted, there was no agreement about where precisely this might be in the classical period. Plato, for example, who believes that eros arises in the soul, sees the soul itself as the seat of psychological symptoms. Later medical authors, including Galen, continue to perceive eros as a predominantly psychological disorder.62 Similarly, this Hippocratic author believes the disease of young girls arises in what is for him the seat of mental or psychological symptoms: the heart.63 In short, eros and the disease of young girls are both seen as psychological conditions. In terms of treatment, the author of On Diseases of Young Girls derides those women who offer robes at the temple of Artemis on the orders of manteis or healer-priests, maintaining that: When she regains her senses, the women dedicate to Artemis many other things and very expensive robes at the order of the goddess’ priests. But they are being utterly deceived.64 It would seem that resort to non-Hippocratic religious healing was a common, if not the usual course of action for a sufferer of the disease of young girls. The author, on the other hand, argues that the disease can be explained and treated only with reference to Hippocratic theories of blood flow and stagnation. Intercourse cures by allowing pooled menstrual blood free downward passage out of the body. He concludes: I beseech young girls, whenever they suffer this, to live with a husband as quickly as possible.65 62  Wack 1990, 7–9. 63  Cf. Aris. de An. 403a30, who suggests that the physiological cause of an affection of the soul (such as eros) is the boiling of the blood around the heart. 64  Virg. 1, φρονησάσης δὲ τῆς ἀνθρώπου, τῇ Ἀρτέμιδι αἱ γυναῖκες ἄλλα τε πολλὰ, ἀλλὰ δὴ καὶ τὰ πουλυτελέστατα τῶν ἱματίων καθιεροῦσι τῶν γυναικείων, κελευόντων τῶν μάντεων, ἐξαπατεώμεναι. 65  Virg. 1, κελεύω δ’ ἔγωγε τὰς παρθένους, ὁκόταν τὸ τοιοῦτον πάσχωσιν, ὡς τάχιστα ξυνοικῆσαι ἀνδράσιν.

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Some of the cases recorded in the Epidemics may represent specific instances of the disease of young girls. In Case 6 of the 12 cases in Epidemics 3, the maiden daughter of Euryanax becomes febrile, delirious and despairing, while in case 8 of the 16 cases the maiden by the sacred way in Abdera becomes febrile and delirious during menarche. But just as in On the Diseases of Young Girls, there is no comment, speculation or other evidence of any interest in the role (or lack of role) sexual desire or unrequited love may have played. These Hippocratic authors then are not describing eros. The disease of young girls is a more specific condition, confined totally to patients of a particular gender and also biological age. It also has an explicit, naturalistic humoural pathogenesis. The patient is treated directly. The broad condition of eros as it was diagnosed, legitimised and treated by folk healers is unrecognised by Hippocratic iatroi. Yet this Hippocratic disease gives a limited legitimacy to the some of the fundamental features of eros, renaming and redefining it in the process. The author of On Diseases of Young Girls is also claiming superior authority when dealing with the condition. A particular group of sufferers are brought from the domain of folk healers into the Hippocratic domain. The author of On Diseases of Young Girls also explicitly links this condition with the sacred disease, noting in his introductory remarks that his treatise is ‘firstly, concerned with the so-called sacred disease’.66 At first glance, the association between the sacred disease and either the disease of young girls or eros is not self-evident. There is little resemblance in their symptoms and the conditions would certainly not have been confused. However, all three conditions had prominent mental symptoms and were thought to arise in the seat of psychological symptoms (with the author of On the Sacred Disease arguing that this is the brain). Both the sacred disease and eros are well recognised by the lay population and are commonly depicted in non-medical literature, including tragedy. Both conditions were marked out by the difficulty in treating them, and their attendant poor prognosis. Moreover both eros and the sacred disease were considered particularly shameful.67 It is especially significant, however, that, like eros, the sacred disease was typically treated by non-Hippocratic healers.68 The author of On the Sacred Disease derides these so-called ‘conjurors, purifiers, vagabonds and quacks’, and their non-Hippocratic therapeutic measures, which included purifications, incantations, prohibitions against wearing black clothing, goats, and

66  Virg. 1, πρῶτον περί τῆς ἱερῆς νούσου καλεομένης. 67  Morb. Sacr. 15. 68  Temkin 1971, esp. 14–15.

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certain binding gestures as well as more Hippocratic dietary measures.69 The first part of the treatise is devoted to painting these healers, their beliefs and their practices as irrational or illogical and also impious.70 The author returns to this theme in his final sentence, where he concludes: But whoever knows how to cause in men dry and wet, and cold and warm by regimen, he may treat this disease too, if he recognises the right season for treatment without purifications and magic.71 The author thus contrasts himself and like-minded iatroi with other practitioners. He and his colleagues are the true authorities in the disease, the healers who can provide the sufferer with a full physiological explanation for their condition, as well as successfully treating it. The text can be read as an attempt to draw patients away from competing healers towards Hippocratic treatment while simultaneously maintaining the naturalism of their theories and treatments as a point of difference. On the Diseases of Young Girls and On the Sacred Disease suggest at least one of the reasons that eros may not be included in the corpus. It is too closely associated with folk practices from which the Hippocratics are keen to distance themselves in the classical period, when Hippocratic medicine was first arising. Nevertheless it seems that the Hippocratics were not prepared to completely overlook a nosos so firmly entrenched in the popular imagination. Rather significant elements of the disease were recast into forms that fitted more neatly into Hippocratic theories of the body and disease and its treatment. 4

Later Graeco-Roman Medical Literature

It would be remiss to ignore the fact that the absence of eros in the CH is not only in stark contrast to other literature of the Greek classical period, but is also out of keeping with the portrayal of lovesickness in later medical texts 69  μάγοι τε καὶ καθάρται καὶ ἀγύρται καὶ ἀλζόνες. Morb. Sacr. 1.10–19. 70  Lloyd 1979, 15–29 further discusses these criticisms. For further discussion of the rhetorical strategies levelled against other healers, see also Laskaris, 2002. 71  Morb. Sacr. 18.6. ὅστις δὲ ἐπίσταται ἐν ἀνθρώποισι τὴν τοιαύτην μεταβολὴν καὶ δύναται ὑγρὸν καὶ ξηρὸν ποιέειν καὶ θερμὸν καὶ ψυχρὸν ὑπὸ διαίτης τὸν ἄνθρωπον, οὗτος καὶ ταύτην τὴν νοῦσον ἰῷτο ἂν, εἰ τοὺς καιροὺς διαγινώσκοι τῶν ξυμφερόντων, ἄνευ καθαρμῶν καὶ μαγευμάτων καὶ πάσης ἄλλης βαναυσίης τοιαύτης. My italics.

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where eros, or at least sufferers of eros are recorded in relative abundance. I have already noted the interest of Aretaeus, Rufus and Oribasius in the subject.72 Galen too famously claims that he diagnosed the insomnia and restlessness of the wife of Justus as lovesickness. He reached his diagnosis by observing her changed expression and color as well as the quickening of her pulse while talking about the dancer Pylades, the object of her desire.73 Galen bases this celebration of his own diagnostic acumen on the oft-told tale, in which the great Hellenistic doctor Erasistratus (or in some versions, his father or his astrologer Leptines) is said to have diagnosed Antiochus’ love for his stepmother Stratonike from his observations of his symptoms and pulse in her presence.74 This later ancient interest in the diagnosis of eros is even projected back into earlier Hippocratic medicine. In Soranus’ Vita Hippocratis, included in later catalogues of the CH, Hippocrates himself is said to have diagnosed and cured the condition in Perdiccas, the king of Macedonia after noting the change in the colour of his complexion.75 Pinault’s study of the relationship between the various accounts of these three basic tales concludes that this topos was first ascribed to Hippocrates in the 1st or 2nd centuries CE at a time when the ability to diagnose lovesickness had become the quintessential sign of a brilliant physician.76 I can only speculate on why eros began to enter later medical texts. There are of course a great many differences between the anonymous works of the CH and these later medical treatises, many of which could contribute towards the differences in the interest in eros. Galen’s interest in self-promotion, for example, is well recognised.77 He is certainly concerned with establishing his own reputation as an exceptional diagnostician routinely consulted by the rich and powerful for intractable diagnostic dilemmas. This may account at least in part for his choice of reports of his success in managing the lovesickness, in 72  See above, 318. 73  Gal. Hippocratis Prognosticum commentarii 1.4, 18.2 K, Gal. De praenotione ad Posthumum 6, 14.631 K. See Pinault 1992, 68 n.37 for a useful list of other references to lovesickness in Galen’s writings. See also Rosen 2013, 111–27, which discusses Galen’s limited interest in erotic matters, medical or otherwise. 74  Val. Max. Fact. et Dict. Mem. 5.7.3, ext. 1; Plut Vit. Demetr. 38; App. Hist. Rom. 11.10; Luc. Syr. D. 17–18, Hist. conscr. 35; Julian Mis. 347; Suda s.v. Erasistratus. Amundsen 1974, 328– 337 discusses the contribution this and other tales of the diagnosis of lovesickness make towards romanticizing the diagnostic proficiency of the ancient physician. 75  Vita Hippocratis secundum Soranum 2.4–10. 76  Pinault 1992, 61–77, 125. 77  See for example, Nutton 2004, 227.

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particular, of high profile patients. Lovesickness, after all, was notoriously difficult to diagnose and treat. Galen’s self-aggrandizement or the encomia to other physicians cannot, however, fully account for the move from the absence of eros in the Hippocratic texts (when the condition was clearly recognised by the broader society) to its acceptance within medical literature as a difficult diagnostic and therapeutic problem. There are numerous potential opportunities to discuss eros within the CH. An individual case study of a sufferer of eros would not be out of place in texts such as the Epidemics (which do contain descriptions of girls suffering symptoms consistent with the diagnosis of the disease of young girls).78 A discussion of the general features of eros could easily be contained in nosological treatises such as Diseases, Internal Affections or Affections. The physiological mechanisms behind unrequited sexual desire could have been considered in a text such as Humors, where the somatic effects of other psychological or emotional affects, including ‘some desires such as love of gambling’ are discussed.79 An entire treatise, along the lines of On the Disease of Young Girls or On the Sacred Disease could even have been devoted to such a sociologically important condition. Despite these possibilities, the extant Hippocratic works do not deal with the broad condition of eros so strongly associated with magicoreligious practitioners such as the pharmakides. Its characteristic features, however, are reframed within other diagnostic categories, including, most prominently, the disease of young girls. Non-Hippocratic healers treat eros, the Hippocratics diagnose and treat patients suffering the disease of young girls, mania or fever. It may be that as Hippocratic or rationalistic medicine became more firmly entrenched and recognizably different from folk or religious medicine there was less incentive to deny what was, after all, a condition widely recognised by the lay public and considered very dangerous. Just as in the classical period, the Hippocratics attempted to appropriate the sacred disease from the domain of other healers, as well as obstetric and gynaecological conditions away from midwives, perhaps in later eras, healers in the rationalistic tradition began to appropriate eros.80 I am not suggesting that the Hippocratics deny eros because of its magicoreligious overtones per se, nor that what makes Hippocratic medicine ‘Hippocratic’ is its rationality. The corpus contains many elements that we

78  See above, 321. 79  ἔρωτάς τινας, οἷον κύβων Hum. 9. 80  Hanson 1991, 87. Cf. Hanson 1998, 71–94; Demand 1994, 63–65; Dean-Jones 1994, 29–30; Laskaris 2002, 13.

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would today consider irrational, from dream analysis to prayers to the gods.81 Conversely, as van der Eijk has shown in this volume, the corpus certainly does not contain all the treatises that deal with medical topics within a largely rationalistic framework.82 Nevertheless, I am suggesting that there is a subtle desire running through the corpus to differentiate Hippocratic from other medical practice. Where it suits the Hippocratic authors, they use the claim of rationality as one (but not the sole) way to set themselves apart from other traditions. This is most explicit in the treatise On the Sacred Disease. But the claim that they are different from (and better than) other healers is evident more implicitly elsewhere. The apparent lack of recognition of eros may be one such understated example. Perhaps, ultimately, if unedifyingly, what makes a text Hippocratic is simply that its author(s), or more properly, the compilers of the corpus claim that it is so. Bibliography Amundsen, D.W., ‘Romanticizing the Ancient Medical Profession: The Characterization of the Physician in the Graeco-Roman Novel’, Bulletin of the History of Medicine 48 (1974), 320–33. Calame, C., The Poetics of Eros in Ancient Greece (trans. Janet Lloyd). Princeton, 1999. Carson, A., Eros the Bittersweet. Princeton, 1986. Ciavolella, M., La Malattia d’Amore dall’Antichita al Medioevo. Roma, 1976. Cyrino, M.S., In Pandora’s Jar: Lovesickness in Early Greek Poetry. Lanham, 1995. Dean-Jones, L., ‘Politics of Pleasure: Female Sexual Appetite in the Hippocratic Corpus’, in: D.C. Stanton (ed.), Discourses of Sexuality: From Aristotle to AIDS. Ann Arbor, 1992. ———, Women’s Bodies in Classical Greek Science. Oxford, 1994. Demand, N., Birth, Death, and Motherhood in Classical Greece. Baltimore, 1994. Faraone, C.A., Ancient Greek Love Magic. Cambridge, MA, 1999. Ferrand, J., A Treatise on Lovesickness, Translated and Edited and with a Critical Introduction and Notes by Donald A. Beecher and Massimo Ciavolella. Syracuse, 1990. Gaca, K.L., The Making of Fornication: Eros, Ethics, and Political Reform in Greek Philosophy and Early Christianity. Berkeley, CA, 2003. Goldhill, S., Foucault’s Virginity: Ancient Erotic Fiction and the History of Sexuality. Cambridge, 1995.

81  Horstmanshoff and Stol 2004. 82  See Chapter 1.

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Graf, F., ‘Excluding the Charming: The Development of the Greek Concept of Magic’, in: M. Meyer and P. Mirecki (eds.), Ancient Magic and Ritual Power. Leiden, 1995, 29–42. Halperin, D.M., ‘Platonic Eros and What Men Call Love’, Ancient Philosophy 5 (1985), 161–204. Hanson, A.E., ‘Continuity and Change: Three Case Studies in Hippocratic Gynae­ cological Therapy and Theory’, in: S.B. Pomeroy (ed.), Women’s History and Ancient History. Chapel Hill, NC, 1991, 73–110. ———, ‘Talking Recipes in the Gynaecological Texts of the Hippocratic Corpus’, in: M. Wyke (ed.), Parchments of Gender: Deciphering the Bodies of Antiquity. Oxford, 1998, 71–94. Horstmanshoff, H.F.J., and M. Stol, Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine. Leiden, 2004. King, H., The Disease of Virgins: Green Sickness, Chlorosis and the Problems of Puberty. London, 2004. Kosak, J.C., Heroic Measures, Hippocratic Medicine in the Making of Euripidean Tragedy. Leiden, 2004. Laskaris, J., The Art is Long: On the Sacred Disease and the Scientific Tradition. Leiden, 2002. Lefkowitz, M.R. and M.B. Fant, Women’s Life in Greece and Rome: A Source Book in Translation. Baltimore, 1985. Lloyd, G.E.R., Magic, Reason and Experience: Studies in the Origin and Development of Greek Science. Cambridge, 1979. Lonie, I.M., The Hippocratic treatises On generation, On the nature of the child, Diseases IV: A Commentary. Berlin, 1981. McNamara, L., ‘’Conjurors, Purifiers, Vagabonds and Quacks’ The Role of Folk Medicine in the Greek Medical System during the Classical Period’, Diss. University of Melbourne, 2008. Nussbaum, M.C., ‘Eros and ethical norms: Philosophers respond to a cultural dilemma’, in: M.C. Nussbaum and J. Sihvola (eds.), The sleep of reason: erotic experience and sexual ethics in ancient Greece. Chicago, 2002, 53–94. Nutton, V., Ancient Medicine. London, 2004. ———, ‘Healers in the Medical Marketplace: Towards a Social History of GraecoRoman Medicine’, in: A. Wear (ed.), Medicine in Society: Historical Essays. Cambridge, 1992, 15–58. ———, ‘The Medical Meeting Place’, in: Ph J. van der Eijk, H.F.J. Horstmanshoff and P.H. Schrijvers (eds.), Ancient Medicine in its Socio-Cultural Context: Papers Read at the Congress held at Leiden University 13–15 April 1992. Amsterdam, 1995, 3–25. Pharr, C., ‘The Interdiction of Magic in Roman Law’, Transactions of the American Philological Association 63 (1932), 269–95.

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Pigeaud, J., La Maladie de l’âme: étude sur la relation de l’âme et du corps dans la tradition médico-philosophique antique. Paris, 1981. Pinault, J.R., Hippocratic Lives and Legends. Leiden, 1992. Rosen, R.M., ‘Galen, Plato and the Physiology of Eros’, in Sanders et al. 2013, 111–27. Sanders, E., C. Thumiger, C. Carey and N. Lowe (eds.), Erôs in Ancient Greece, Oxford, 2013. Scarborough, J., ‘Theophrastus on Herbals and Herbal Remedies’, Journal of the History of Biology 11 (1978), 353–85. Temkin, O., The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology. 2nd Revised ed. Baltimore, 1971. Thornton, B.S., Eros: The Myth of Ancient Greek Sexuality. Boulder, 1997. Totelin, L., ‘Sex and Vegetables in the Hippocratic Gynaecological Treatises’, Studies in the History and Philosophy of the Biological and Biomedical Sciences 38 (2007), 531–40. van der Eijk, Ph. J., Diocles of Carystus: A Collection of the Fragments with Translation and Commentary. Boston, 2000. Wack, M., Lovesickness in the Middle Ages: The Viaticum and its Commentaries. Philadelphia, 1990. Watson, P.A., ‘Stepmothers and Hippomanes: Georgics 3.282f.’, Latomus 52 (1993), 842–47.

Part 4 Galen’s Hippocratism

∵

CHAPTER 16

‘According to both Hippocrates and the Truth’: Hippocrates as Witness to the Truth, from Apollonius of Citium to Galen Amneris Roselli σωφροσύνης γοῦν φίλος ὥσπερ γε καὶ ἀληθείας ἑταῖρος, ὅ γ᾿ ἀληθὴς ἰατρὸς ἐξεύρηται. 1 1

Physicians in Bad Faith

At the beginning of his treatise De bonis malisque sucis, Galen speaks of certain contemporary physicians who denied the doctrine of the humors and the importance of the properties of food in maintaining good health. Some of these doctors had confided to him in secret that they knew they were wrong but dared not admit as much for fear of losing students and patients. Somewhat surprisingly Galen treats them with understanding (συγγνώμη) and turns his invective on their teachers and the founders of the school to which they belonged, who had evolved their doctrines simply out of rivalry (φιλονεικία) with Hippocrates. In spite of the fact that they criticize their sect only in secret (λαθραίως), these physicians become in Galen’s eyes involuntary testimony to the merit of the Hippocratic doctrine, while he accuses the founders of their school of deliberate deception (ἑκόντες ἐξαπατᾶν).2 He affirms that he has no reason to distort the truth, and is merely motivated by his discomfort at seeing many famous men being duped by the books written by the founders of their school. Calling on the gods as his witness, Galen sets out to illustrate his own doctrine concerning the properties of food, which is derived from Hippocrates and based on the experience of a lifetime. For Galen, this outburst against doctrines at odds with his own is not an isolated case. It is a theme that recurs frequently in his works because he is convinced that rivalry (usually rivalry with Hippocrates) and the disputes 1  Opt. Med. 4.290.5 Boudon-Millot, ‘The true doctor has been found to be a friend of moderation, just as he is also a follower of truth’. 2  Gal. De bon. mal. sucis 6.753.6 K = 391.4ff. Helmreich.

© koninklijke brill nv, leiden, ���6 | doi ��.��63/9789004307407_018

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between the schools have a lot to answer for in the adoption of theories that are patently false. Here we may offer a few examples: ‘On the fact that all the affections of the hegemonic activities occur in the brain all physicians agree, apart from those who, out of rivalry in defence of their sect, think some things and say others’,3 and further on, ‘One might perhaps pardon this error in philosophers who sit around in a corner,4 but in those who have grown old in practicing medicine the love for dispute, and perhaps it would be more accurate to say for effrontery, is unforgivable’.5 In this passage one detects a certain indulgence towards falsehood in philosophy, seen as the appropriate domain for discussion, but no tolerance for falsehood in medicine. In another passage Galen states, ‘But those whose desire it is that any discourse should be true except that of Hippocrates destroy also commonly accepted notions out of rivalry’.6 Galen holds that this attitude was typical of Erasistratus, even though the latter was not inclined to polemicize.7 As he states in De atra bile ‘but the rivalry towards Hippocrates forced also him (sc. Erasistratus) to write things in contradiction with his own doctrine’,8 and in De venae sectione adversus Erasistratum, ‘but it seems to me that as a result of the rivalry with Hippocrates you (sc. Erasistratus) are even more unreasonable than the others’,9 and shortly afterwards, ‘but Erasistratus on account of the rivalry with Hippocrates seems not to have safeguarded even the opinions common to all men’.10 3  Gal. Loc. aff. 8.167.1ff. K, ὅσοι γε μὴ διὰ φιλονεικίαν αἱρέσεως ἄλλα μὲν ἐν τῇ ψυχῇ φρονοῦσιν, ἄλλα δὲ λέγουσιν. 4  Galen adopts the expression ‘in a corner’ (ἐν γωνίᾳ) alluding to Plato Gorg. 485 d–e, where Callicles quarrels with the philosophers who whisper in a corner with three or four boys, far from political life: τὸν λοιπὸν βίον βιῶναι μετὰ μειρακίων ἐν γωνίᾳ τριῶν ἢ τεττάρων ψιθυρίζοντα, ἐλεύθερον δὲ καὶ μέγα καὶ ἱκανὸν μηδέποτε φθέγξασθαι. This passage from the Gorgias was subsequently taken up by Themistius, περὶ φιλίας 265 b–c, where what is permissible for philosophers is clearly not for those who practice the art of medicine. 5  Gal. Loc. aff. 8.167.8ff. K, φιλοσόφοις μὲν οὖν ἐν γωνίᾳ καθημένοις ἁμαρτάνειν ἐν τῷδε τάχ’ ἄν τις συγγνοίη· γεγηρακόσι δ’ ἐν τοῖς ἰατρικοῖς ἔργοις ἀσύγγνωστος ἡ φιλονεικία, τάχα δ’ ἀληθέστερόν ἐστιν εἰρεῖν, ἀναισχυντία. 6  Gal. De purg. medicam. facul. 11.340.8ff. K, ἀλλ’ οἱ πάντα μᾶλλον ἢ τὸν Ἱπποκράτειον λόγον ἀληθεύειν βουλόμενοι καὶ τὰς κοινὰς ἐννοίας προσαπολλύουσι τῇ φιλονεικίᾳ. 7  Gal. De atr. bil. 5.131.7ff. K, ‘Yet some of them have a nature which is decidedly mild, and one might well think that Erasistratus too is one of their number’. 8  Gal. De atr. bil. 5.131.10f. K, ἀλλὰ καὶ τοῦτον ἡ πρὸς Ἱπποκράτην φιλονεικία μαχόμενα γράφειν ἑαυτῷ κατηνάγκασε. 9  Gal. De venae sect. adv. Erasistr. 11.167.8ff. K, ἀλλά μοι δοκεῖς ὑπὸ τῆς πρὸς Ἱπποκράτη φιλονεικίας καὶ τῶν ἄλλων ἀνοητότερος εἶναι. 10  Gal. De venae sect. adv. Erasistr. 11.168.9f. K, ἀλλὰ Ἐρασίστρατος ὑπὸ τῆς πρὸς Ἱπποκράτη φιλονεικίας οὐδὲ τὰς κοινὰς ἁπάντων ἀνθρώπων ἐννοίας φαίνεται διασώζων.

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This then is something of a hobby-horse for Galen, but a passage in Plutarch shows that the opposition ‘lover of dispute/lover of truth’ (φιλόνεικος, φιλαλήθης), referring here to a young disciple, is not his own coinage: ‘the man who has the habit of listening with restraint and respect takes in and masters a useful discourse, and more readily sees through and detects a useless or false one, showing himself thus to be a lover of truth and not a lover of disputation, nor forward and contentious’ (tr. Babbitt).11 The lover of dispute and the lover of truth constitute two types of personality, each with his own ethos, style and mode of behavior. Clearly the aspiration of the former to recognition as a good student is illegitimate. 2

Galen’s Hippocrates

Galen’s presentation of physicians of bad faith, devoid of probity and a sense of shame, who deny or conceal the truth out of antagonism and rivalry, or even mere calculation, has a counterpart, ‘the lover of truth’. The definition of Hippocrates as ‘a lover of the truth’ was a topos, as Celsus, Quintilian and Plutarch testify, praising him because he was not too proud to admit his failures and errors, and who indeed used his mistakes as a lesson to alert others to mistaken diagnoses or useless and inappropriate therapeutic experiments.12 Surprisingly, however, although Galen accepts Hippocrates as a paradigm ‘lover of truth’, nowhere in his writing does he cite Epidemics 5.27, which is the source of the topos, where the author (who Galen believes is Hippocrates himself) states that he was deceived by sutures in making a diagnosis of a cranial lesion which proved fatal.13 It is true that we no longer have Galen’s commentary 11  Plut. De audiendo 39 c–d, τὸν μὲν ὠφέλιμον λόγον ἐδέξατο καὶ κατέσχε, τὸν δὲ ἄχρηστον ἢ ψευδῆ μᾶλλον διεῖδε καὶ κατεφώρασε, φιλαλήθης φανείς, οὐ φιλόνεικος οὐδὲ προπετὴς καὶ δύσερις. 12  Cels. 8.4.3–4, a suturis se deceptum esse Hippocrates memoriae prodidit, more scilicet magnorum virorum et fiduciam magnarum rerum habentium; Quint. Inst. 3.6.64, nam et Hippocrates clarus arte medicinae uidetur honestissime fecisse quod quosdam errores suos, ne posteri errarent, confessus est; Plut. quomodo quis sent. prof. virt. 11.82 d, ὁ δὲ προκόπτων ἀληθῶς τὸν Ἱπποκράτην παράδειγμα ποιεῖται, τὸ περὶ τὰς ῥαφὰς ἀγνοηθὲν αὐτῷ τῆς καφαλῆς ἐξαγορεύσαντα καὶ γράψαντα, λογιζόμενος ὅτι δεινόν ἐστι ἐκεῖνον μέν, ὅπως ἂν ἕτεροι μὴ τὸ αὐτὸ πάθωσιν, αὐτοῦ τὴν ἁμαρτίαν κατειπεῖν, αὐτὸν δέ τινα μέλλοντα σῴζεσθαι μὴ τολμᾶν ἐλέγχεσθαι μηδ’ ὁμολογεῖν τὴν ἀβελτερίαν καὶ ἀμαθίαν; clearly Hippocrates was a model of ethical behaviour. See also Anastassiou-Irmer I, 229–230. 13  Epid. 5.27 (5.226.8ff. L = 16.20ff. Jouanna) ‘Autonomus, in Omilos, died on the sixteenth day from a head wound in midsummer. The stone, thrown by hand, hit him on the sutures in

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on Wounds in the Head which would be a likely source for observations of this kind,14 but in fact, Galen shows no particular interest in the role of admitting diagnostic and therapeutic errors in the concept of telling the truth. For these same reasons, in his commentary on Hippocrates’ On Joints 47, Galen has nothing to say about the passage in which the author (again, Hippocrates himself in Galen’s estimation) states he has deliberately described a misconceived operation so that others should not make the same mistake.15 Galen could here draw attention to the facet of Hippocrates’ writing that Celsus, Quintilian and Plutarch found of paramount importance in characterizing him as a ‘lover of truth’ but he lets it pass unremarked. He is more interested in the problem of reticence and falsehood in the dispute between sects than in the problem of reticence in admitting mistakes and failures; to his mind the sects are the root of the most serious evil affecting medical tekhnê. A passage from De atra bile in which Galen gives a thumbnail sketch of Hippocrates, contrasting him with the physicians who talk nonsense merely for the sake of being contentious (σοφιστικῶς ληροῦντες), gives a splendid synthesis of his opinion: ‘Hippocrates was a noble man, a lover not of honors and vain show, but of truth’.16 Even if he was ambitious, Galen continues, he had every reason for being so; prior to him there were in fact no sects of any note with whom to compete; the sects came after him, thanks to physicians in search of unmerited fame who founded sects merely to compete with their predecessors.17 As one might expect, Galen depicted Hippocrates as the middle of the bregma. I was unaware that I should trephine, because I did not notice (ἔκλεψαν δέ μευ τὴν γνώμην) that the sutures had the injury of the weapon right on them, since it became obvious only later . . .’ (tr. Smith). The author seems to be adopting the terminology of VC 12 (see next note). 14  Cf. VC 12 (3.222.6ff. L = II.16.1ff. Kw.), Ξυγκλέπτουσι γὰρ τὴν γνώμην καὶ τὴν ὄψιν τοῦ ἰητροῦ αὗται αἱ ῥαφαὶ ῥωγμοειδέες φαινόμεναι, καὶ τρηχύτεραι ἐοῦσαι τοῦ ἄλλου ὀστέου, ‘For the sutures themselves, appearing like fractures and being rougher than the rest of the bone, deceive the judgment and the eyesight of the doctor’ (tr. Hanson). 15  Art. 47 (4.212.4f. L = 2.182.3 Kw.), ἔγραψα ἐπίτηδες τοῦτο. καλὰ γὰρ ταῦτα τὰ μαθήματά ἐστιν, ἃ πειρηθέντα ἀπορηθέντα ἐφάνη καὶ δι’ ἅσσα ἠπορήθη, ‘I relate this on purpose; for those things also give good instruction which after trial show themselves failures, and show why they failed’ (tr. Withington). Instead Galen cites this passage at 18A 312.10ff. K where— speaking of a particular dislocation of the shoulder, feasible in theory but never observed—he refers to direct experience as the requisite for describing a pathology or recommending a therapy; cf. Anastassiou-Irmer, II 1, 160. 16  Gal. De atra bile 5.130.14f. K, Ἱπποκράτης μὲν οὖν φαίνεται καλός τε καὶ ἀγαθός τις ἀνὴρ γεγονέναι, μὴ φιλοτιμίας ἢ φιλοδοξίας, ἀλλὰ ἀληθείας ἐραστής. 17  Gal. De atra bile 5.131.2ff. K, εἰ δὲ καὶ δόξης ἢ τιμῆς αὐτὸν ἐριθυμῆσαι φαίη τις, ἀλλὰ καὶ κτήσασθαί γε αὐτὴν ῥᾷστον ἦν ἐκείνῳ τἀνδρὶ βουληθέντι τοῦτο, φιλονεικεῖν ἐν λόγοις αἱρέσεσιν

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the supreme representative of an ideal past in which the best were recognized as such and competition (eris), as Hesiod would have put it, was good competition. 3

Truth and Lies in the Hippocratic Writings

Although Galen did not make much of it, there is no lack of reference in Hippocratic writings to competition and antagonism among physicians (and the accompanying reticence and lies). The topic occurs in Sacred Disease,18 and features conspicuously in the surgical treatises. Here the author (Hippocrates in Galen’s estimation) writes at length on the need to be rigorous in choosing the best therapies so as to rank among the true experts of orthopedics and undermine those who deliberately advocate spectacular interventions which cannot benefit the patient. Thus, for instance, in On Joints 35 the author criticizes those physicians who apply complicated bandaging to the nose in order to gratify the patient, and adopt spectacular therapies that pull in the crowds and ensure a momentary success, merely by virtue of an extraordinary inventiveness and ability. The implication here is that such practitioners are deliberately deceptive. If we turn to what the Hippocratic authors say concerning the content of their own doctrines and observations, we find that the question of their accuracy recurs with a certain persistence, but they do not imply any deliberate deception. In what follows I shall focus on verbs which could imply deception (ἀπατᾶν, ἐξαπατᾶν, συγκλέπτειν), but it will be seen that the verbs are used to signify mistakes on the part of physicians, not deliberate attempts to mislead. Physicians may make mistakes on account of the difficulties of deciphering certain anatomic structures, or when it comes to formulating a diagnosis or establishing a therapy.19 Once again it is the surgical treatises that have most ἐνδόξοις ἑαυτοῦ πρεσβυτέραις· οὐδεμία γὰρ ἦν ἱκανῶς ἔνδοξος. οἱ δὲ μετ’ αὐτὸν ἀπλήστως ὀρεχθέντες ἀδίκου δόξης αἱρέσεις ἰδίας συνεστήσαντο μοχθηρὰς ἀντιλογίας πρὸς τοὺς ἑαυτῶν πρεσβυτέρους ποιησάμενοι. 18  E.g., Morb. Sacr. 1.8 (6.358ff. L = 6.15ff. Jouanna), τοιαῦτα λέγοντες καὶ μηχανώμενοι προσποιέονται πλέον τι εἰδέναι, καὶ ἀνθρώπους ἐξαπατῶσι προστιθέμενοι τούτοισιν ἁγνείας τε καὶ καθαρότητας, ὅ τε πολὺς αὐτοῖσι τοῦ λόγου ἐς τὸ θεῖον ἀφήκει καὶ τὸ δαιμόνιον. However, Morb. Sacr. did not figure among the texts Galen considered authentic. 19  To use the formula given in Mochl. 40 (4.388.13ff. L = II.271.6f. Kw.), ἃ ἀπατῶνται, καὶ διὰ ἃ, ἐν οἷσιν ὁρῶσιν, ἐν οἷσι διανοεῦνται ἀμφὶ τὰ παθήματα, ἀμφὶ τὰ θεραπεύματα, ‘In what they are deceived and why, in what they see and conjecture concerning maladies and concerning treatments’.

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to say on the matter. Thus the author of On Fractures and On Joints often warns against the risk of error. See, for example: If, perchance, you are deceived in fresh cases, and think there will be no elimination of bones . . .20 Practitioners, indeed, think forward dislocation often happens, and they are especially deceived in cases where there is wasting of the flesh about the joint and the arm.21 Thus practitioners are especially deceived by this injury—since the detached bone being raised up, the point of the shoulder looks depressed and hollow.22 Many open them thinking to find a flux of humours to such parts. The practitioner is deceived in his opinion . . .23 Now this is how they are deceived. They think that the projecting ridge along the spine represents the vertebrae themselves, because each of the processes feels rounded on palpation; [. . .] and therefore they are deceived, and think the vertebrae have gone inwards. And the attitudes of the patients helps to deceive them still more.24 For all pulpy tissues and those full of moisture are deceptive.25 20  Fract. 28 (3.510.20ff. L = II.88.7ff. Kw.), ἢν δὲ ἄρα ἐξαπατηθῆς ἐν τοῖσι νεοτρώτοισι, μὴ οἰόμενος ὀστέων ἀπόστασιν ἔσεσθαι, κτλ. (tr. Withington 1959, 161). 21  Art. 1 (4.78.6ff. L = II.111.7ff. Kw.), τοῖσι μέντοι ἰητροῖσι δοκέει κάρτα ἐς τοὔμπροσθεν ὀλισθάνειν, καὶ μάλιστα ἐξαπατῶνται ἐν τουτέοισιν, ὧν ἂν φθίσις καταλάβῃ τὰς σάρκας τὰς περὶ τὸ ἄρθρον τε καὶ τὸν βραχίονα. (tr. Withington 1959, 201). 22  Art. 13 (4.116.7ff. L = II.133.7ff. Kw.), οἱ οὖν ἰητροὶ ἐξαπατῶνται μάλιστα ἐν τούτῳ τῷ τρώματι· ἅτε γὰρ ἀνασχόντος τοῦ ὀστέου τοῦ ἀποσπασθέντος ἡ ἐπωμὶς φαίνεται χαμαιζήλη καὶ κοίλη. (tr. Withington 1959, 233). 23  Art. 40 (4.174.13ff. L = II.163.6ff. Kw.), πολλοὶ στομοῦσιν, οἰόμενοι ῥεῦμα ἀνευρήσειν ἐς τὰ τοιαῦτα· ἡ μὲν οὖν γνώμη τοῦ ἰητροῦ ἐξαπατᾶται . . . (tr. Withington 1959, 277). 24  Art. 46 (4.198.10ff. L = II.175.10ff. Kw.), ἐξαπατῶνται δὲ διὰ τόδε· οἴονται γὰρ τὴν ἄκανθαν τὴν ἐξέχουσαν κατὰ τὴν ῥάχιν ταύτην τοὺς σπονδύλους αὐτοὺς εἶναι [. . .] [175.21] καὶ διὰ τοῦτο ἐξαπατῶνται, οἰόμενοι τοὺς σπονδύλους ἔσω οἴχεσθαι· προσεξαπατᾷ δὲ ἔτι αὐτούς καὶ τὰ σχήματα τῶν τετρωμένων. In this case the author observes that the diagnostic error, mistaking a minor lesion for a major one, favors the physicians, who gain all the more kudos from the success of their therapy, ἀγνοέουσι δὲ πολλοὶ, καὶ κερδαίνουσιν, ὅτι ἀγνοέουσιν· πείθουσι γὰρ τοὺς πέλας (175.9), (tr. Withington 1959, 293). 25  Mochl. 3 (4.346.10f. L = II.248.8 Kw.), πάντα δὲ τὰ ὑπόμυξα καὶ τῇ ὑγρῇ σαρκὶ πλήρεα ἐξαπατᾷ. (tr. Withington 1959, 405).

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And the deception, because they think, when vertebrae are fractured . . .26 In other treatises we read that there may be a risk of error in the diagnosis of diseases of the urinary tract27 and in the diagnosis of intestinal functions28 and lung pathologies.29 And the author of Ancient Medicine (a treatise to which Galen paid scant attention) shows a clear awareness of the problem of error in choosing the method of inquiry (cf. ch. 2, ‘But anyone who, casting aside and rejecting all these means, attempts to conduct research in any other way or after another fashion, and asserts that he has found out anything, is and has been the victim of deception’. [tr. Jones]).30 In general, for the physician it is necessary to respect the limits of knowledge determined by the possibility and the quality of observation of data. In the Hippocratic treatises we frequently come across the expression ‘I don’t know’ (οὐκ οἶδα), and also expressions of doubt introduced by ‘perhaps’ (ἴσως) ‘perhaps because’ (ἴσως ὅτι) and suchlike. In his commentaries Galen usually pays great attention to these hedging formulae, declaring his esteem for the prudence of, as he believes, Hippocrates. A major lacuna in our documentation prevents us from saying any more about the position of post-Hippocratic physicians vis-à-vis the problem of error. The scant records of works dating from the 4th–2nd centuries are provided by doxographies that were not particularly interested in the question. To know more about how physicians considered error and truth we are obliged to move on to the 1st century BCE and the evidence of Apollonius of Citium.

26  Mochl. 38 (4.384.2f. L = II.268.12 Kw.), ἡ δὲ ἀπάτη, ὅτι οἴονταί ποτε καταγέντων τῶν σπονδύλων κτλ. As we have already seen in the case of Epid. 5.27, above 333, the Hippocratic authors frequently attribute their own mistakes to the difficulty of deciphering the anatomy. 27  Progn. 12 (2.142.12f. L = 36.6f. Jouanna), μὴ ἐξαπατάτω δέ σε, ἤν γε ἡ κύστις τι νούσημα ἔχουσα τῶν οὔρων τὰ τοιαῦτα ἀποδιδῷ. 28  Prorrh. 2.3 (9.12.14f. L), ἔπειτα τῇσι χερσὶ ψαύσαντα τῆς γαστρός τε καὶ τῶν φλεβῶν ἧσσόν ἐστιν ἐξαπατᾶσθαι ἢ μὴ ψαύσαντα. 29  Morb. 3.15 (7.140.1f. L), ἢν δὲ ὀλίγα ἔχῃ τούτων τῶν σημηϊ΄ων, μὴ ἐξαπατάτω ὡς οὐ περιπλευμονίη ἐστίν· ἔστι γὰρ μαλθακή. 30  VM 2 (1.572.12ff. L = 119.16ff. Jouanna, ὅστις δὲ ταῦτα ἀποβαλὼν καὶ ἀποδοκιμάσας πάντα ἑτέρῃ ὁδῷ καὶ ἑτέρῳ σχήματι ἐπιχειρεῖ ζητεῖν, καὶ φησί τι ἐξευρηκέναι, ἐξηπάτηται καὶ ἐξαπατᾶται· ἀδύνατον γάρ.

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Apollonius of Citium

Apollonius of Citium, the author of the treatise On Joints, was a pupil of the Hippocratean physician Zopirus and, in my opinion, himself a Hippocratean (rather than an Empiric, as he is usually considered).31 He is the first commentator known to us to link the name and teaching of Hippocrates to the enunciation of a doctrine characterised by its truth content. In order to confute the opinion of the Herophilean Hegetor,32 dismissing the possibility of permanent reduction of a particular dislocation of the head of the femur,33 Apollonius relies exclusively on the evidence of the treatise On Joints, which he took to be written by Hippocrates. Apollonius says that he is in agreement with Hippocrates in his belief that it is possible to permanently reduce the dislocation in question. But the surprising thing is that On Joints says nothing on this point. How then can Apollonius claim to base his position on the evidence of Hippocrates? Simply by starting from the premise that Hippocrates always told the truth, and did not omit to give an account of his failures. Hence Hippocrates’ silence concerning the failure to reduce the dislocation was the guarantee that he had performed it with success. A particular kind of argumentum ex silentio. In an almost obsessive way, Apollonius returns at least six times in just a few pages to the value of Hippocrates’ testimony since it came from a witness who was absolutely truthful. First of all we have two observations on Hippocrates’ ‘silence’ on the matter of the difficulty in permanently reducing the dislocation of the femur: . . . he (sc. Hippocrates), who is a lover of truth and explains the peculiar features pertaining to the other cases, has given no clarification concerning the femur, which could not be reduced and maintained in place completely, but on the contrary has encouraged reductions of the femur, and indeed has even invented a machine (sc. the so-called bench) to serve this end.34 31  Roselli forthcoming. 32  Cf. Apoll. Cit. 80.15f. Kollesch-Kudlien, ἐν τούτοις ὁ Ἡγήτωρ οὐ μόνον πεπλάνηται, ἀλλὰ καὶ τοὺς φιλιατροῦντας ὅσον ἐφ’ ἑαυτῷ διέστρεφεν. 33  Galen’s Commentary on De articulis and Celsus show that in the Hellenistic era this was a problem that was debated by several authors. For details, cf. Potter 1993. 34  Apoll. Cit. 82.2ff. Kollesch-Kudlien, οὗτος (scripsi: οὕτως L edd.) δὲ φιλαλήθης ὑπάρχων καὶ τὰ[ς] ἐπὶ τῶν λοιπῶν ἰδιώματα διασαφῶν οὐδὲν περὶ μηροῦ δεδήλωκεν, ὅτι οὐκ ἂν δύναιτο καθόλου κρατεῖσθαι, ἀλλ’ ἐκ τῶν ἐναντίων ἐμπεπνευμάτωκέν (Schöne: ἐκπ- L KolleschKudlien) πως ἐπὶ τῶν τοῦ μηροῦ ἐμβολῶν, ὥστε καὶ ὀργανικὴν ἐπίνοιαν ποιήσασθαι.

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. . . . . . . . . . . . . . . . .  . . . thus if the dislocated femur put back in place had not stayed in that position, then he (Hippocrates) would not have illustrated many varying types of reduction, showing a passion for a technique not aiming at results, and would not have abstained from indicating the truth.35 Apollonius goes on to cite passages in On Joints referring to other lesions and comments: The fact that especially in these cases he (sc. Hippocrates) sets himself up as a lover of truth, and his invectives against the physicians who in reducing dislocations act as charlatans, can be seen from what he says in the same work on the subject of the kyphosis of the spine.36 . . . . . . . . . . . . . . . . . . . However, subsequently, having described the way in which, if necessary, the patient must be shaken with the ladder, without ever departing from the truth he (sc. Hippocrates) says . . .37 And finally, some pages later, Apollonius emphatically concludes: He who in all these cases has treated the doctrine of the dislocation of the femur in an exemplary fashion and with love for the truth—how is it possible that, if the reduced femur had not stayed in place but was dislocated again, he could have kept quiet about it?38 The truth to which Apollonius’s Hippocrates adheres is that of the physician who does not avoid treating problematic pathologies, does not conceal his ignorance, and does not cover up his mistakes.

35  Apoll. Cit. 82.24ff. Kollesch-Kudlien, εἰ τοίνυν μηρὸς ἐξαρθρήσας καὶ ἐντεθεὶς οὐκ ἔμενεν κατὰ χώραν, οὔτε ἂν πλείονας καὶ ποικίλας ἐμβολὰς ἐκτέθειτο πρὸς τὸ μηδὲν φιλοτεχνῶν οὔτ’ ἂν ἀπέστη τοῦ τὴν ἀλήθειαν σημᾶναι. 36  Apoll. Cit. 82.26ff. Kollesch-Kudlien, ὅτι γὰρ ἐν τοῖς τοιούτοις μάλιστά πως φιλαλήθως ἵσταται, ὃ καὶ κατατρέχει τῶν ἀλαζονικώτερον ἱσταμένων ἐν τοῖς καταρτισμοῖς ἰατρῶν, δι’ ὧν φησιν οὗτος (scripsi: οὕτως L edd.) ἐν τοῖς αὐτοῖς ἐπὶ ῥάχεως κυφώσεως πάρεστι σκοπεῖν. 37  Apoll. Cit. 84.10ff. Kollesch-Kudlien, ὅμως δὲ μετὰ ταῦτα τὸν τρόπον ὑπογράψας, εἰ δέοι διὰ τῆς κλίμακος κατασείειν, οὐδαμῶς τῆς ἀληθείας ἀφιστάμενος, οὕτως ἐκτίθεται κτλ. 38  Apoll. Cit. 92.26ff. Kollesch-Kudlien, ὁ δὴ διὰ πάντων τούτων δεόντως καὶ φιλαλήθως περὶ μηροῦ ἐξαρθρήσεως διεσταλμένος—πῶς συμβαίνει, εἴπερ μὴ καταρτισθεὶς ἐπέμενεν, ἀλλὰ πάλιν ἐξήρθρει, κατασιωπῆσαι;

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In the above list I omitted the words that Apollonius says at the end of the first section of his confutation: But if this type of reduction, or indeed others which he [sc. Hippocrates] enumerates had been invented gratuitously, he would absolutely have said it, just as he did also [in On Joints] speaking of the dislocation of vertebrae, where he says: ‘I relate this on purpose; for those things also give good instruction which after trial show themselves failures, and show why they failed’.39 In this quotation of On Joints 47 Apollonius provides the first testimony of the topos of Hippocrates admitting his own errors to which we referred at the outset (333ff.). 5

The Reticent and the φιλαλήθεις

The link between the two notions of ‘love of truth’ (φιλαλήθεια) and ‘refusal to keep quiet’ (μὴ σιωπῆσαι) is not peculiar to Apollonius. In fact, the same link occurs also in Ptolemaeus’ Syntaxis with reference to the astronomer Hipparchus: ‘But only out of love for truth he (sc. Hipparchus) wanted not to keep quiet about anything that could in any way lead someone to nurture ­suspicions’.40 However, to better understand the significance of the attribution of the term ‘lover of truth’ to Hippocrates, we should summarize briefly the use of the adjective in texts referring to other individuals who have also been credited with a love for truth. The first attestation of φιλαλήθης, which also provides a definition of the term, comes in Aristotle’s Nicomachean Ethics, and it is clear that the term already includes the notion of speaking out in every situation: ‘. . . in fact the φιλαλήθης, who tells the truth even in matters where telling it makes no difference, will tell it even more in cases in which it is not indifferent’.41 39  Apoll. Cit. 84.23–28ff. Kollesch-Kudlien, ἀλλ’ εἴπερ οὗτος ὁ τῆς ἐμβολῆς τρόπος ἢ καί τινες τῶν διηριθμημένων ὑπ’ αὐτοῦ πρὸς τὸ μηδὲν ἦσαν ἐπινενοημένοι, πάντως ἂν ἐδήλωσεν, ὃν τρόπον καὶ ἐπὶ τῆς τῶν σφονδύλων διορθώσεως λέγων οὕτως· ἔγραψα ἐπίτηδες τοῦτο. καλὰ γὰρ ταῦτα τὰ μαθήματά ἐστιν, ἃ πειρηθέντα ἀπορηθέντα ἐφάνη καὶ διὰ τί ἠπορήθη. 40  Ptol. Syntax. I, 200.20 Heiberg, βεβουλῆσθαι δὲ μόνον ὑπὸ φιλαληθείας μὴ σιωπῆσαί τι τῶν ἐνίους εἰς ὑποψίαν ὁπωσδήποτε, δυναμένων ἐνεγκεῖν. 41  Arist. EN 1127 b 4ff., ὁ γὰρ φιλαλήθης, καὶ ἐν οἷς μὴ διαφέρει ἀληθεύων, ἀληθεύσει καὶ ἐν οἷς διαφέρει ἔτι μᾶλλον.

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Numerous individuals are designated with this adjective. Two physicians of the Herophilean school are referred to in the sources as Alexander Philalethes and Demosthenes Philalethes, but we know too little about them to be able to explain their name.42 The attribute philalêthês has also been applied to other figures: historians (Theopompus)43 and philosophers (Plato44, Epicurus45, Eudemos46), as well as to the astronomer Hipparchus, who is repeatedly described as ‘lover of truth’ by Ptolemaeus.47 And Ptolemaeus may have come across the notion of ‘love of truth’ in Hipparchus himself, as we can see from a passage of Hipparchus’ Commentary on the Phainomena by Aratus 1.3.11 where the φιλαλήθης is opposed to the κενόσπουδος: ‘and indeed it is not appropriate for a lover of truth, but it is for one who pursues futile things, holding to what is totally opposed to their false hypothesis’.48 In all these cases ‘love of truth’ stands as a principle of professional good conduct. It is reiterated as such by both Galen, ‘The lover of truth does not depart either from certain knowledge because he ignores the obscure, nor does he give his assent to things not known’,49 and Ptolemaeus, ‘It behooves those who approach this enquiry in true love for truth and with a disposition of research not to devote themselves merely to correcting the hypotheses of the ancients’.50 Similarly, ‘To whoever wishes to approach research and investigate in love for truth . . .’,51 and ‘Man by nature tends to the truth, just as by nature he tends to society, since in his actions he is a being who is extremely friendly 42   Cf. von Staden 1989, 532–539 (Alexander Philalethes) and 570–78 (Demosthenes Philalethes). 43  Athen. 3.85 a; Suid. s.v. Ἔφορος. 44  Clem. Al. Strom. 1.8.42.1.1; 5.10.66.3.4; 5.12.78.2.1. 45  Athen. 8.354b; 13.588a. 46  Simpl. In Arist. phys. 10.1024.7 Diels 47  Ptol. Syntax. 2.210.8 Heiberg, ὅθεν καὶ τὸν Ἵππαρχον ἡγοῦμαι φιλαληθέστατον γενόμενον διά τε ταῦτα πάντα καὶ μάλιστα διὰ τὸ μήπω τοσαύτας ἄνωθεν ἀφορμὰς ἀκριβῶν τηρήσεων εἰληφέναι κτλ. and Syntax. I, 191.19 Heiberg, καὶ μάλιστα τῷ Ἱππάρχῳ ἀνδρὶ φιλοπόνῳ τε ὁμοῦ καὶ φιλαλήθει. 48  Hipparch. In Arati Phaenom. 1.3.11 (28.21ff. Manitius), οὐδὲ γὰρ φιλαλήθους, ἀλλὰ κενοσπούδου, τὸ . . . ἐπιλαμβάνεσθαι. 49  Gal. An. in arteriis 4.720.15 K, ὁ μὲν δὴ φιλαλήθης ἀνὴρ οὔτε τῶν ἐναργῶς γιγνωσκομένων ἀφίσταται διὰ τὴν τῶν ἀδήλων ἀγνωσίαν οὔτε τοῖς ἀγνώστοις συγκατατίθεται. However Galen rarely uses the adjective φιλαλήθης, and seems to prefer ἀληθείας ἑταῖρος (Quod opt. med. 1.59.10 K; Dieb. decr. 9.831.3 K) and the Platonic expression (Resp. 501 d 2) ἀληθείας ἐραστής (see De atra bil. 5.131.1 K; De sympt. diff. 7.45.14 K; De caus. puls. 9.97.9 K, etc.). 50  Ptol. Syntax. I, 328.3 Heiberg, προσήκει γὰρ τοῖς τῷ ὄντι φιλαλήθως καὶ ζητητικῶς τῇ τοιαύτῃ θεωρίᾳ προσερχομένοις μὴ πρὸς μόνην τὴν τῶν παλαιῶν ὑποθέσεων διόρθωσιν συγχρῆσθαι. 51  Ibid. 2.3.23f. Heiberg, παντὶ τῷ βουλομένῳ προσάγειν τὴν ἐξέτασιν καὶ φιλαλήθως ἀναθεωρεῖν . . .

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towards his kin and in his research supremely a lover of the truth’.52 And finally, ‘If we wish to investigate with love for truth . . .’53 In both authors, Galen and Ptolemaeus, this impulse to defend their research method and the results obtained was evolved in the context of disputes with adversaries, whom they denounced for not being guided by such devotion to truth. 6

Conclusion: Hippocratic and Truthful

Thus it comes as no surprise that, in Galen’s strategy for advancing his arguments, Hippocrates comes to represent the paradigm of probity in research methodology and the most authoritative witness to truth. It is enough to draw on his authority to give one’s own doctrines weight. Galen says as much in Dieb. decr., where he refers to Hippocrates in parrying a possible accusation of falsehood: If I relate the clinical cases I myself have collected someone could think that I am lying, whereas if I relate those collected by Hippocrates, who all men hold to be the most truthful of all and the most able to judge. . . .54 and he reiterates it at the end of the book: I have shown according to truth and according to the opinion of Hippocrates that none of these [abscesses] can be indicated in an exact number of days. . . .55 We find the same dual reference to truth and Hippocrates in the Commentary on Aphorisms. In arguing against some interpreters Galen says: 52  Ptol. De judicandi fac. et animi principatu 2, 4.21ff. Boer, ὁ δ’ ἄνθρωπος ὀρέγεται φύσει τῆς ἀληθείας καθάπερ τῆς κοινωνίας, ἐν μὲν ταῖς πράξεσι φιλοικειότατός τις ὤν, ἐν δὲ τοῖς θεωρήμασι φιλαληθέστατος. 53  Ibid. 14, 21.13 Boer, εἰ φιλαληθῶς ἐθέλοιμεν σκοπεῖν κτλ. 54  Gal. Dieb. decr. 9.842.5 K, τοὺς μὲν ὑπ’ ἐμοῦ παρατηρηθέντας ἀρρώστους εἰ γράψαιμι, τάχ’ ἄν τῳ ψεύδεσθαι δόξαιμι, τοὺς δ’ ὑφ’ Ἱπποκράτους, ὃν ἀληθέστατόν γε πάντων καὶ κρίνειν ἱκανώτατον ἅπαντες εἶναι πεπιστεύκαμεν κτλ. 55  Ibid. 9.933.12f. K, ἐμοὶ μὲν δέδεικται κατά τε τὸ ἀληθὲς αὐτὸ καὶ κατὰ τὴν Ἱπποκράτους γνώμην ὅτι μηδὲν τούτων ὅλῃσιν ἡμέρῃσιν ἀτρεκέως ἀριθμεῖσθαι δύναται.

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They fail to render both the truth of the facts and the opinion of Hippocrates.56 And finally, to return to the subject of the good and bad teachers with which we commenced, we may simply cite a short, pithy comment found in Galen’s polemical treatise Adv. ea quae a Juliano in Hipp. aph. enuntiata sunt: ‘If Iulianus had learnt the art from Hippocratean physicians, he would not have dared to speak against things which are true’.57 The notions of ‘Hippocratic’ and ‘truthful’ become so identified in Galen that he coins a standard pair of terms (Ἱπποκράτειος and ἀληθής). Thus in De usu part., referring to the theory of the function of respiration, Galen praises Aristotle for illustrating it ‘according to Hippocrates and according to truth’ (Ἱπποκρατείως τε ἅμα καὶ ἀληθῶς)58 and in De methodo medendi he sets out the therapy for circular sores, describing it as the ‘Hippocratic and true’ (Ἱπποκράτειόν τε ἅμα καὶ ἀληθῆ) method.59 In this case ‘Hippocratic’ means not so much ‘according to the writings of Hippocrates himself’ but rather ‘according to the doctrine of the physicians who can rightly be called Hippocratic’. Professional probity in research and affiliation with the Hippocratic tradition are one and the same thing for Galen. He proceeds in the direction taken by Apollonius, but tends to play down that admission of therapeutic errors which was central in the Hippocratic literature. Through the notion of ‘love of truth’, Galen seeks instead to promote a new myth of Hippocrates, the companion of truth (ἀληθείας ἑταῖρος), who was fortunate enough to live long before the sects came into being. He dedicated all his work to the disinterested pursuit of truth remaining supremely unaffected by the ill will and bad faith that marked the members of the sects in Galen’s time.

56  Gal. In Hipp. Aph. 17B.532.15 K, καὶ τῆς τῶν πραγμάτων ἀληθείας καὶ τῆς Ἱπποκράτους γνώμης ἁμαρτάνοντες. 57  Gal. Adv. Iulianum 18A.249 K = 35.6f. Wenkenbach, εἰ μὲν οὖν ἐμεμαθήκει τὴν τέχνην Ἰουλιανὸς ὑπὸ διδασκάλων Ἱπποκρατείων, οὐκ ἂν ἐτόλμησε τοῖς ἀληθέσιν ἀντιλέγειν. 58  Gal. UP 3.620 = 1.449.26 Helmreich, ἀλλὰ τούτου μὲν ἕνεκα δίκαιον ἐπαινεῖν αὐτόν, Ἱπποκρατείως τε ἅμα καὶ ἀληθῶς ἀποφαινόμενον περὶ χρείας ἀναπνοῆς. 59  Gal. Meth. med. 10.173.18 K, εἴπωμεν οὖν ἡμεῖς ἤδη τὴν Ἱπποκράτειόν τε ἅμα καὶ ἀληθῆ μέθοδον ἑλκῶν κοίλων ἰάσεως.

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Bibliography

Editions of Hippocrates



Editions of Galen



Other Editions

In addition to the editions of Hippocrates in Littré (here ‘L’; see also ‘Abbreviations’): Hippocratis Opera omnia vol. II, ed. H. Kühlewein, Leipzig, Teubner, 1902. Hippocrates, vol. 3, Loeb edition, ed. E.T. Withington, Cambridge, MA, 1959. Hippocrate, La maladie sacrée, texte établi et édité par J. Jouanna, CUF, Paris, 2003. Hippocrate, L’ancienne médecine, texte établi et édité par J. Jouanna, CUF, Paris, 1990. Hippocrate, Épidémies V et VII, texte établi et édité par J. Jouanna, annoté par J. Jouanna et M.D. Grmek, CUF, Paris, 2000. Hippocrate, Pronostic, texte établi et édité par J. Jouanna avec la collaboration de A. Anastassiou et C. Magdelaine, Paris, 2013.

In addition to Kühn’s edition of Galen (here ‘K’; see also ‘Abbreviations’): Galen: De bonis malisque sucis, ed. G. Helmreich, CMG V 4.2 Leipzig und Berlin 1923. Galen: Adversus Iulianum ed. E. Wenkebach CMG V 10 3 Berlin 1951. Galen: De usu partium ed. I. Helmreich, Leipzig, Teubner 1907–1909.

Apollonii Citiensis in Hippocratis de articulis commentarius, edd. J. Kollesch-F. Kudlien, CMG 11.1.1, Berlin 1965. Hipparchi in Arati et Eudoxi Phaenomena commentariorum libri tres, ed. K. Manitius, Leipzig, Teubner 1894. Hipparchi Opera quae extant omnia, ed. J. L. Heiberg, 2 vols. Lipsiae, Teubner, 1989–1903. De judicandi facultate et animi principatu. Fructus sive centiloquium, ed. Fr. Lammert-Ae. Boer, Leipzig, 1952.

Studies

Anastassiou, A. & D. Irmer, Testimonien zum Corpus Hippocraticum, vols. I, II 1, Göttingen, 1997–2009. Potter, P., ‘Apollonius and Galen on Joints’, Archiv für Geschichte der Medizin 32 (1993), 117–123. Roselli, A., ‘Ippocrate φιλαλήθης contro Egetore: l’esegesi ippocratica come strumento polemico in Apollonio di Czio’, in: Roselli A., ‘L’Ippocrate di Apollonio di Cizio’, Studi Magrebini. Festschrift Carmela Baffioni, Forthcoming. von Staden H., Herophilus. The Art of Medicine in Early Alexandria. Cambridge, 1989.

Chapter 17

Bodily Features in the Corpus Hippocraticum: On the Classification of Individuals into Groups Robert Alessi 1

Introduction

My purpose is to comment on the method of classification exhibited by the Hippocratic physicians when they attempted to form ‘groups’ of patients, and to situate their remarks in the larger frame of physiognomical and other individual descriptions. Although we can find several passages of so-called physiognomical interest in the CH,1 it seems to me more helpful to start from one particular treatise, Epidemics 2, since it is the only one in the Corpus where the words φυσιογνωμονίη (2.5.1) and φυσιογνωμονικός (2.6.1) occur. After I have briefly discussed the authenticity of these words, I will comment on some of the so-called physiognomical statements of Epidemics 2.5.1 and 6.1, mostly with the help of Galen’s commentary. Two ‘types’ are found in these passages: those of the body and those of the disease. Finally, I will comment on some other passages of the CH where ‘groups’ are constituted, mostly according to bodily features, and try to identify the purpose of the authors. Of particular interest will be the disagreements between ancient commentators about the categories which are constituted by such physiognomical remarks, and the method of classification followed by the physician.

*  I am deeply grateful to Lesley Dean-Jones for her invitation to the original conference and for her patience during the revision of this chapter for publication. Her comments and questions on many passages improved this article immensely. I also thank Ralph Rosen for his help and generosity during the final revision. I would like to thank as well Ryad Atlagh who read a first draft of this essay and suggested some important corrections. 1  Epid. 2.5 and 6 (5.128 and 132 L = Smith 74 and 80); 3.3.14.1 (3.96.4–98.5 L); 4.45 (5.186.3 L = Langholf 1977, Per. 259); 6.1.2 (5.266.7 L = Manetti/Roselli 2.7), 7.1 (334.8–11 L = Manetti/ Roselli 146.30–34), 8.26 (5.352.16–354.2 L = Manetti/Roselli 186–188): see below 374–75; see also VM 23.1 below 373.

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φυσιογνωμονίη/φυσιογνωμονικός in Epidemics 2

As mentioned above, the words φυσιογνωμονίη and φυσιογνωμονικός occur only in Epidemics 2 among the extant treatises of the CH. Furthermore, it is worth remarking that these two occurrences of this word family are the earliest in Greek literature.2 They are usually presented as the titles of the last two sections (5 and 6) of Epidemics 2. This is the case in Littré’s edition, where we read ‘Τμῆμα πέμπτον. Φυσιογνωμονίη’ (128) and ‘Τμῆμα ἕκτον. Φυσιογνωμονικόν’ (132) and was already the case in the Aldine edition of 1526 (see 136v). Smith is the first modern editor who deleted these words from his edition, although he kept the Greek numbering of the sections.3 So it is worth commenting on the place of these words in connection with the division of the text of Epidemics 2 into 6 sections based both on the earliest Hippocratic manuscripts and on Galen’s commentary.4 As I have presented the manuscripts and discussed how the placement of φυσιογνωμονίη and φυσιογνωμονικός connects with the sectional division of the text of Epidemics 2 elsewhere,5 I will here briefly summarize my conclusions. I am here focusing on the Hippocratic manuscripts of the upper part of the stemma that are worthy of interest: Vaticanus Gr. 276 (V), s. XII, Parisinus Gr. 2140 (I), s. XIII, Vaticanus Gr. 277 (R), s. XIV, Parisinus Gr. 2142, (H) part. rec., s. XIV. These four manuscripts are to be divided into two branches: V and its descendants, and IRH. On the particular question of the division of Galen’s commentary on Hippocrates’ Epidemics 2 into six sections, see Pormann 2008 for his examination of the Arabic manuscripts; see also Garofalo, forthcoming. Roughly speaking, both Hippocrates’ Epidemics 2 and Galen’s Commentary are divided into six sections, but the section breaks in these respective treatises do not match. The section breaks that occur in the mss. of the Ηippocratic text 2   Only these two forms out of the six which are based on φυσιογνωμ- (φυσιογνωμία, φυσιογνωμονέω, φυσιογνωμονία, φυσιονωμονικός, φυσιογνωμοσύνη, φυσιογνώμων) are found in Epid. 2. One cannot count the variant φυσιογνωμοσύνη presented by cod. Laurentianus plut. 74, 1 (s. XV = L in Littré’s edition) as Vogt 1999, 210 seems to do (following 5.128 L, see apparatus ‘φυσιογνωμία aut φυσιογνωμοσύνη L’), for this variant has no chance of being ancient. 3  Smith 1994, 74 and 80. Unfortunately, he does not give any justification for this deletion, although two reasons might have induced him to remove them: 1) Sections 5 and 6 of Epid. 2 consist of roughly 24 and 32 ‘subsections’ or ‘paragraphs’ respectively, but it is hard to find actual physiognomical statements beyond the first paragraph in either section; 2) One cannot find any trace of the words φυσιογνωμονίη/φυσιογνωμονικός in Galen’s commentary. 4  See Pfaff (1934, 345 l. 20 and 355). The Greek version of this commentary is lost, but we still can read it in the translation of Ḥunayn ibn Isḥāq (9th CE). The first critical edition of Ḥunayn’s Arabic text, to be published in the CMG, is in preparation; see Hallum/Vagelpohl. 5  Alessi 2012, 75–77.

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and Galen’s commentary seem to be independent from each other. For the first three sections, the Hippocratic manuscripts do not include any title, nor any section numbering, and the section breaks disagree with each other:6 in the first three sections of the Epidemics 2, the manuscripts do not include any title or section numbering. Furthermore, the Hippocratic manuscripts do not agree with each other: for example, while manuscripts RH have break marks that match the section breaks that we find in Littré’s edition,7 manuscript V which is the oldest one, does not have any break mark until section 3 of the treatise.8 Starting from section 4, the situation appears to be different. For section 4, all the Hippocratic manuscripts present first a title (περὶ φλεβῶν), and then, for the first time, a section number (τμῆμα δ’). Section 4 of Galen’s commentary starts at the same place.9 This is the first significant coincidence in section division. But much more interesting is the case of section 5: all the Hippocratic manuscripts present φυσιογνωμονίη (IRH: -ία V) as the first word after a break mark,10 but only manuscripts IRH have τμῆμα ε’ immediately following, while manuscript V presents this section numbering five lines below in Littré’s edition, after the words οὐκ οἷόν τε λύεσθαι,11 where we also find a break mark, exactly at the place where section 5 of Galen’s commentary starts.12 At this 6  See Alessi 2012, 75–76 for details. In the Hippocratic manuscripts, section breaks mostly appear in the form of a colon, followed by a hyphen and a thin blank space. 7  The same section breaks which are found already in the 1526 Aldine edition. To be more precise, the section break which goes with section 3 is missing in manuscript H, although it is a rather important break, since it also indicates the beginning of the so-called katástasis of Perinthus. More details in Alessi 2012, 76, note 9. 8  In mss. IRH the break mark here takes the form of a colon followed by an hyphen. See above n. 7. َ ُ َ ‫َ قَ َةُ ٱ َّ َ ةُ تَ ف‬ 9  The title at this place in Galen reads as follows: ‫ا لم�����ا �ل�� � �لرا ��ع�� �مِ � ن� �������سي��ر ج��ا �لي�� ن��و��س‬

َ‫�ٰ ق‬ ‫� ��س‬ �‫ح‬ ِ‫إ‬

ِ ِ ‫ٱ ثَّ ن َ ِ تَ �أَ ُق َ َ ٱ‬ ُ ُ‫تَ َ َ ة‬