Aetius of Amida on Diseases of the Brain: Translation and Commentary of ›Libri medicinales‹ 6.1–10 with Introduction 9783110795127, 9783110794366

Citation preview

Ricarda Gäbel Aetius of Amida on Diseases of the Brain

Science, Technology, and Medicine in Ancient Cultures

Edited by Markus Asper Philip van der Eijk Mark Geller Heinrich von Staden Liba Taub

Volume 13

Ricarda Gäbel

Aetius of Amida on Diseases of the Brain

Translation and Commentary of Libri medicinales 6.1–10 with Introduction

ISBN 978-3-11-079436-6 e-ISBN (PDF) 978-3-11-079512-7 ISSN 2194-976X Library of Congress Control Number: 2022941380 Bibliographic information published by the Deutsche Nationalbibliothek The Deutsche Nationalbibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data are available on the internet at http://dnb.dnb.de. © 2022 Walter de Gruyter GmbH, Berlin/Boston Druck und Bindung: CPI books GmbH, Leck www.degruyter.com

| Tradition ist die Bewahrung des Feuers, nicht Anbetung der Asche. (nach Jean Jaurès)

Table of contents Acknowledgements | IX How to use this book | XIII General introduction | 1 1

The aim and structure of this study | 1

2

Medicine in late antiquity | 2 2.1 Four important authors | 4 2.1.1 Oribasius of Pergamon | 4 2.1.2 Alexander of Tralleis | 5 2.1.3 Paul of Aegina | 6

3

Aetius of Amida | 7 3.1 Life | 7 3.2 Work – The Libri medicinales | 8 3.2.1 Sources for the text | 8 3.2.1.1 The manuscripts | 8 3.2.1.2 Latin translations | 9 3.2.1.3 Arabic translations | 9 3.2.1.4 Latin commentaries | 9 3.2.1.5 Critical editions | 9 3.2.2 Reception | 10 3.2.3 Modern translations | 11 3.2.4 Structure and contents | 12 3.2.5 Sources mentioned within the text | 14 3.3 The sixth book of the Libri medicinales | 15 3.3.1 Sources for the text | 15 3.3.2 Modern translations, commentaries, studies | 16 3.3.3 Structure and contents | 17 3.3.4 Sources mentioned within the text | 20 3.3.4.1 Leonides | 21 3.3.4.2 Galen of Pergamon | 22 3.3.4.3 Posidonius of Byzantium | 23 3.3.4.4 Archigenes of Apamea | 25 3.3.4.5 Rufus of Ephesus | 26 3.3.5 Compilation technique and literary technique | 27 3.3.5.1 Case study | 29 3.3.6 Relation to other compilations | 33 3.3.6.1 Case study | 35

VIII | Table of contents

4

Diseases of the brain and mental illness | 39 4.1 Problems connected to the term “mental” illness | 40 4.2 Mental illnesses in ancient medical texts | 43 4.2.1 Introductory remarks | 43 4.2.2 Medical texts from the fifth and fourth century BCE | 45 4.2.3 Aulus Cornelius Celsus | 46 4.2.4 Rufus of Ephesus | 48 4.2.5 Aretaeus of Cappadocia | 50 4.2.6 Anonymus Parisinus | 52 4.2.7 Galen of Pergamon | 53 4.2.8 Posidonius of Byzantium | 57 4.2.9 Caelius Aurelianus | 57 4.3 Mental illnesses in late antiquity | 59 4.3.1 Oribasius, Alexander, Paul | 60 4.3.2 Aetius | 64

Olivieri’s text and my translation | 71 List of changes to Olivieri’s edition | 71 Commentary | 132 On hydrokephaloi from Leonides | 132 On phrenitis from (the books of) Posidonius | 157 On lethargia from (the books of) Archigenes and Posidonius | 194 On katalepsis from (the books of) Archigenes and Posidonius | 241 On karos from Posidonius | 266 On koma from (the books of) Posidonius | 276 On those who suffer from skotoma (from the books of) Archigenes and Posidonius | 289 VI 8 On mania from (the books of) Archigenes and Posidonius | 335 VI 9 On melancholia from (the books of) Galen and Rufus and Posidonius | 403 VI 10 Therapy of those who suffer from melancholia | 458 VI 1 VI 2 VI 3 VI 4 VI 5 VI 6 VI 7

Bibliography | 492 Indices | 521 1 2 3 4

Index of Olivieri’s Greek text | 521 Index of the translation | 541 Index of passages cited | 565 Index of the commentary | 607

Acknowledgements This book is the revised and augmented version of my dissertation, which was submitted to and defended at the Institut für Klassische Philologie of the HumboldtUniversität zu Berlin in 2018. Two new chapters have been added to the text, in addition to extensive indices. As I approached the end of the long process of first writing this thesis and then turning it into a book and began to think about those who had helped and supported me along the way, I came to realize just how many people were owed a debt of gratitude for their direct or indirect involvement in my work. I want to take this opportunity to thank them all and I hope I can be forgiven for doing so at some length. First and foremost, I want to express my sincerest gratitude to Professor Philip van der Eijk, my Doktorvater, not only for being a perfect supervisor who read and commented at length on various parts of my work, but also for his constant encouragement and for always having an open door. As if that were not enough, I would like to thank Philip wholeheartedly for establishing an environment in his research group at the Institut für Klassische Philologie which is – and I mean this – quite unique! Throughout the years I have worked here, he has managed to create a friendly and familiar atmosphere that has provided a highly stimulating environment. To be part of this was a great pleasure for me. Next I would like to thank my second supervisor, PD Dr. Chiara Thumiger, for agreeing to take on this role and for reading and commenting on various parts of this thesis. I am deeply grateful to her for organizing the conference ‘Mental Diseases in Ancient Medicine’ in October 2014 in Berlin and for inviting me to participate in it before I had even finished my Master’s degree, let alone started on my doctoral project. Participating in this conference turned out to be invaluable for the present thesis. Another person I would like to thank for being directly involved in this project is Professor Stephen Menn. He read several of my chapters and gave me impressively learned comments, especially on parallel texts, which helped me expand my own perspective to a considerable degree. During my work on this thesis, I received support from several other members of Professor van der Eijk’s research group, to whom I am deeply grateful. I would like to highlight, in particular, Dr. Irene Calà, Dr. Christine Salazar, and Professor Matteo Martelli. Christine was my close colleague for more than two years, during which time we not only shared an office but also the joy and sorrow of working on Aetius. Christine died in 2021, so I am sadly unable to share with her this culminating moment of my research on Aetius. However, I am sure she would have been as “over the moon” as I am when holding this book in her hands. I would also like to thank all the other members of the research group for their comments on material which I

X | Acknowledgements

put up for discussion in several meetings of the Antike Medizin Kolloquium at the Institut für Klassische Philologie of the Humboldt-Universität zu Berlin, as well as the members of the Philosophical Colloquium convened by Professor Jonathan Beere and Professor Stephen Menn for their valuable feedback. I also owe a debt of gratitude to Dr. Peter Singer, former visiting scholar at the Institut für Klassische Philologie, who discussed with me several versions of a paper which was published in 2018. These discussions with Peter helped me immensely in clarifying my thoughts on the topic of my PhD project. I am most grateful to my friends Charlotte Schneider and Dr. Manuel Mühlbacher for helping me with the French literature and to my colleague Dr. Giulia Ecca for assisting me with the Italian literature. Invaluable support came from my proofreader and editor, Dr. Paul Scade, who read my complete thesis with an impressive accuracy and patience, helping me a great deal in improving the flow of my English and saving me from many mistakes. Everything which is still wrong is my own responsibility. Paul was willing to hold Skype meetings to discuss the text even on weekends or public holidays and it was not least due to him that I managed to let this thesis go out into the world. For all of this, I owe him a great debt of gratitude. The proofreading brings me to the institutions which financed my research. For, as important as all the previously mentioned people were for my research, none of it would have been possible without financial support. First, I am deeply grateful to the Graduate Program in Ancient Philosophy (formerly Graduate School of Ancient Philosophy, now part of the Research Training Group [RTG] Philosophy, Science and the Sciences) at the Humboldt-Universität zu Berlin, which provided me with a doctoral scholarship from October 2013–September 2017. As their representative, I would like to thank Professor Jonathan Beere, spokesperson of the RTG Philosophy, Science and the Sciences. The last year of funding, from October 2016–September 2017, covered an additional period necessitated by the birth of my first daughter and was financed by funds from Humboldt-Universität zu Berlin, to which I would like to express my gratitude. The costs for the English proofreading and editing were generously covered by the RTG Philosophy, Science and the Sciences, which is funded by the Deutsche Forschungsgemeinschaft (DFG), for which I am extremely grateful. From October 2017 to July 2020, I was part of the Sonderforschungsbereich 980 Episteme in Bewegung and held a position as Wissenschaftliche Mitarbeiterin at the Institut für Klassische Philologie at the Humboldt-Universität zu Berlin. Special thanks to both institutions for financing my research in its final stage. My work would not have been possible without the help of the administrative staff. First and foremost, I would like to warmly thank Irma Handwerker, the former coordinator of the RTG Philosophy, Science and the Sciences, for working tirelessly to secure the additional year of funding and for making it possible for the costs of the proofreading to be covered. I would also like to express my gratitude to the members of the Sekretariat of the Institut für Klassische Philologie, Dr. Friederike Herklotz,

Acknowledgements | XI

Birgit Dummin and Martin Helbig, for their help with all my organizational and administrative questions and for several helpful chats. I want to take this opportunity to thank my university teachers Dr. Roland Baumgarten, Dr. Thomas Poiss, and Professor Markus Asper for their courses and for their help in improving my knowledge of the Greek language and literature. Dr. Poiss also kindly wrote a letter of recommendation for my application at the Graduate School of Ancient Philosophy, without which it would not have been possible for me to move forward. Professor Asper gave me constant encouragement in the final stage of this project and I am grateful to him for his reassuring words. Turning the clock back a little further, there are two more people to whom I am deeply grateful. The first is Hartmut Loos, my teacher at the Gymnasium am Kaiserdom Speyer, without whom I would probably never have chosen to learn Greek. It was Hartmut who recommended the Humboldt-Universität zu Berlin and this suggestion set me on a road that would otherwise almost certainly have taken me to a very different destination. The second is the only Greek teacher I ever had at school, Jürgen Neutzling, who taught me everything I knew when I came to Berlin. It was not least due to his inspiring lessons that I started to become so enthusiastic about the Greek language and literature. I would also like to thank my friends and my colleagues, especially Maria Börno, Dr. Giouli Korobili and Dr. Sean Coughlin as well as Antje Tillmann, Dr. Katharina Christ-Pielensticker, and Mina Tuncay-Hoyt, for always listening to my complaints and for constantly encouraging me through every step of this work. Every discussion I had with them was helpful and supportive and they provided me with immeasurable benefits. I am grateful to the De Gruyter Verlag and the editors of the series Science, Technology and Medicine in Ancient Cultures for publishing this volume, and especially to Professor Markus Asper who oversaw my submission for the inclusion of this book in the series. Special thanks are due also to Dr. Carlo Vessella, Florian Ruppenstein and Dr. Torben Behm from De Gruyter for being reliable and competent contact persons. Although words are – so to speak – my “everyday business”, they can only fail to express the profound depth of the gratitude I feel towards my family: my mother, my sister and my brother, my grandparents and my husband and our two daughters. As long as I can remember, my mother, Christine Gäbel, has provided me with constant support and encouragement and has given me the strength that comes from knowing that someone will always believe in me. As well as this emotional support, which has been of inestimable value to me, I must also thank her wholeheartedly for her practical assistance with my two daughters; without this support I would not have been able to reach the endpoint of my work. My husband, Dr. Florian Gärtner, has supported my project with the greatest imaginable encouragement, patience and commitment. I would like to thank him wholeheartedly for discussing several research questions with me, for mastermind-

XII | Acknowledgements

ing and realizing the formatting of this book, for constructing the indices and especially for embarking on this journey with me ‒ a journey that has presented us with many a challenge, provided obstacles that we were able to overcome and made us focus on the rewards of family life when circumstances were sometimes hard to navigate. Without him, my rock against the tides, I would not have been able to do all this.

How to use this book In what follows I will provide some general basic information that will help the reader to make proper use of this study. In order to allow the reader to have a synoptic view of the Greek text and my English translation together, I reprint the Greek of Alessandro Olivieri’s CMG edition of 1950 alongside my translation. It is important to note that Olivieri’s edition was incorporated into the Classical Text Editor that was used to typeset this book. While there were, of course, no semantic changes, some smaller typographical details could not be reproduced in a manner that is completely identical to the formatting of the original.1 To give one example, this applies in several places to the printing of Greek numerals. As regards my translation, I tried to render the Greek text as closely to the original as possible; where it has not been possible to give a literal English translation I have erred on the side of readability. When it has been necessary, for the sake of readability or clarification, I have added words or phrases in brackets. Changes to the text of Olivieri’s edition are listed under List of Changes to Olivieri’s edition. Throughout the commentary I refer to the page and line numbers of Olivieri’s edition (in the form of, for example, p. 131.19–20), unless otherwise indicated. As far as the citation of primary literature is concerned, I always refer to the book and chapter numbering of the most recent edition I cite. This information is especially important in the case of Aretaeus, for whom the numbering in Hude’s edition differs from that of, for example, the TLG. In the case of Hippocrates and Galen, I always cite the editions of Littré (= L.) and Kühn (= K.), alongside modern editions when such exist.2 The abbreviations of the authors and their works are explained in the bibliography. For further information regarding the structure of the bibliography, see p. 492.

1 I am deeply grateful to Florian Gärtner for incorporating Olivieri’s edition into the Classical Text Editor. 2 The form 4.150.3 L. or 4.150.3 K. thereby refers to the volume (= Vol. 4), the page (= p. 150) and the line number (= line 3) of Littré or Kühn.

General introduction 1 The aim and structure of this study The overall aim of this study is to contribute to the research on late antique medicine, especially as it is presented in the work of Aetius of Amida. In particular, it focuses on late antique medical views about diseases of the brain as they are reflected in the sixth book of Aetius’ Libri medicinales, a text which has hitherto never been systematically studied (see p. 16 f.). In order to achieve this aim, my initial approach to Aetius comes from a philological perspective and seeks to provide close analysis of his text: therefore, in this study I present a translation and a detailed commentary on chapters 1–10 of the sixth book of Aetius’ compilation. The sixth book generally deals with diseases of the head and in doing so also takes into account diseases of the brain. In discussing diseases of the brain, Aetius considers affections that we might characterize as “mental” (for a detailed discussion and problematization of this term, see p. 39–70). In this study, I concentrate on the first ten chapters of the sixth book, which deal with such “mental” illnesses, as will be discussed shortly.1 Although Aetius’ sixth book contains more chapters which would be interesting to discuss in this regard (see p. 15–39 for a look at the sixth book as a whole), I restrict myself to the analysis of the first ten chapters. This selection is possible because each of the chapters in the sixth book deals with a different affection, stands on its own, and can be understood individually. As regards the more general questions concerning Aetius’ compilation in general and its sixth book in particular, the detailed analysis of ten chapters together with a general overview of the remaining chapters (see p. 17–20) will suffice to throw light on important issues relating to Aetius’ work, his modus operandi, and his way of dealing with diseases of the brain and, specifically, “mental” illnesses. My study is divided into three parts: an introduction, translation, and commentary: I begin with a detailed introduction to the topic, which includes a brief overview of the three most important authors of late antique medical literature standing alongside Aetius (p. 2–7), a general analysis of Aetius’ life and work (p. 7– 14), and a closer analysis of his sixth book as regards its sources, its structure and contents and its compilation technique and literary technique (p. 15–39). The introduction also includes an overview of the appearance of “mental” diseases in medical literature (p. 39–59) and an analysis of these kinds of disease in late antiquity, especially in Aetius’ writing (p. 59–70). The introduction is followed by the translation of chapters 1–10 of the sixth book of the Libri medicinales. The third part of the study consists of a detailed commentary on each of these ten chapters and 1 The first chapter of the book, on hydrokephalos, seems to be slightly different from the others with regard to its “mental” manifestations. For more detail, see p. 64 f.

2 | General introduction

constitutes the main part of this study. The commentary to each chapter is divided into four sections: an introduction to the disease concept, a discussion of the structure of the chapter, a discussion of the rationale of the chapter, and, finally, the actual line-by-line commentary. Each introduction to a disease concept offers an overview of the presentation of the affection in question in other medical texts besides Aetius. The section on the structure of the chapter offers short paraphrases of the different parts of the chapter, while the treatment of the rationale of the chapter attempts to trace Aetius’ line of thought when composing his work, highlighting peculiarities, identifying difficulties, and asking how the information contained in the chapter was selected and why the particular form of organization and structure was chosen. Finally, in the line-by-line commentary, I offer detailed comments on the text. Given that this book is a philological commentary to a Greek text, the reader will rarely wish to take it from the shelf to read from cover to cover. Rather, the normal approach will be to jump to the passages that he or she finds most relevant, problematic, or interesting. To meet the needs of the expected reader, this book contains repetitions in a number of places since some information is provided in a more succinct manner in introductory sections (such as “introduction to the disease concept” or “rationale of the chapter”) but is also discussed in more detail in the line-by-line commentary.

2 Medicine in late antiquity The study of medicine in late antiquity has taken a fortuitous and promising turn. The late antique period was once thought to be characterized by “stagnation, plagiarism of the great medical figures of classical antiquity, and a somber boredom that seemingly awaited the Italian Renaissance”.2 Now, by contrast, it is viewed as a period which is worth studying in its own right for its “intense intellectual and also practical activity”.3 This study will contribute to the “new” emerging picture of a vibrant and fascinating period and will strongly contradict the earlier view through the close analysis of the text of one prominent late antique author, Aetius of Amida. Medicine in late antiquity can be classified as part of the broader subject of Byzantine medicine, which can be divided very broadly into two phases.4 The first phase, referred to in the scholarship as the “Alexandrian period”,5 the early Byzan-

2 Scarborough 1984, ix. This statement, however, does not reflect Scarborough’s own view but is part of an overview of the past evaluation of medicine in this period. 3 Van der Eijk 2010, 519. See also van der Eijk & Geller & Lehmhaus & Martelli & Salazar 2015, 196–198. 4 See e.g. Temkin 1962, 97; Hunger 1978, 291–316; Garzya 2005b, 179 f. 5 Temkin 1962, 97.

2 Medicine in late antiquity | 3

tine era (“frühbyzantinische Jahrhunderte”),6 or the late antique Alexandrian phase (“spätantike ‘alexandrinische’ Phase”)7, to give just a few examples, is said to extend from the fourth to the seventh century.8 The second phase, referred to as the “period of Constantinople”9 or the middle and late Byzantine era (“mittel- und spätbyzantinische Epoche”),10 is generally treated as beginning in the eighth century and lasting until the fall of Constantinople in the fifteenth century.11 When I speak of late antique medicine, I refer to the first phase of Byzantine medicine, the intellectual center of which was the city of Alexandria.12 Alexandria was doubtless an important city for the study of medicine, and its “medical fame”13 was already established in the third century BCE with Herophilus’ work there. It has even been supposed that “Alexandria became synonymous with doctors and medical studies”.14 The most important authors of late antique medicine were Oribasius of Pergamon, Aetius of Amida, Alexander of Tralleis, and Paul of Aegina,15 all of whom probably spent some time in Alexandria.16 They all produced similar types of works, writing medical compilations in which they collected texts of earlier authors on nearly all important medical areas. For a long time, the works of these authors were viewed as “refrigerators of antiquity”17 and believed to add nothing new themselves to what Galen, in particular, had to say. To the extent that they were thought to be worth studying at all, it was only for the sake of the excerpts of earlier authors contained in their works and, in some cases, found nowhere else.18 This view, however, means losing sight of the authors’ own efforts and achievements. It cannot be denied that Galen played a crucial role for these authors and that he left them with an immense number of treatises to build from.19 Still, they did not copy him blindly but thought carefully about what texts (non-Galenic as well as Galenic) to 6 Hunger 1978, 291. 7 Garzya 2005b, 179. 8 See e.g. Temkin 1962, 97; Hunger 1978, 291; Garzya 2005b, 179. 9 Temkin 1962, 97. 10 Hunger 1978, 304. Garzya 2005b, 180 refers to it as “mittel- und spätbyz. ‘konstantinopolitanische[n]’ Phase”. 11 See e.g. Temkin 1962, 97; Garzya 2005b, 180. 12 See e.g. Temkin 1962, 97; Hunger 1978, 291; Garzya 2005b, 179. 13 von Staden 2004, 181. See also Pormann 2010, 419 who states that “Alexandria has always been at the forefront of medical science.” 14 Duffy 1984, 21. 15 See Garzya 2005b, 179 f.; Hunger 1978, 292–298, 302; Nutton 1984, 2; van der Eijk 2010, 520; Temkin 1962, 100. 16 See e.g. Hunger 1978, 292; Scarborough 2010, 236–242. 17 Nutton 1984, 2. Nutton himself, however, does not share this refrigerator-view, but coins the phrase. 18 See e.g. Nutton 1984, 2; van der Eijk 2010, 521. 19 Scarborough 2010, 237 suggests “a functioning medical library, possibly a flourishing book trade”, which probably promoted the use of Galen’s texts. For a closer look at the role Galen plays in the late antique medical compilations, see Bouras-Vallianatos 2019.

4 | General introduction

take into account for their works. The passages they selected were conflated and arranged according to their own plan and further information (sometimes entirely new) was also added where they deemed it necessary,20 as we will see throughout this study. For an example, see p. 29–33. For a closer look at Byzantine medicine, see e.g. Temkin 1962; Hunger 1978; Scarborough 1984; Duffy 1984; Nutton 1984; Strohmaier 1996; Nutton 2005, 292– 309; Garzya 2006; Garzya 2005b.

2.1 Four important authors In what follows, I will give a brief introduction to the three authors who stand alongside Aetius (on whom see in detail p. 7–39) as the most important writers of late antique medical texts: Oribasius of Pergamon, Alexander of Tralleis, and Paul of Aegina. As we will see, Oribasius, Aetius and Paul all produced what we may describe as “compilations”. Alexander of Tralleis stands apart from these three since his work is not a compilation in the same sense (see p. 5 f.). 2.1.1 Oribasius of Pergamon Oribasius of Pergamon lived in the fourth century CE.21 Eunapius records his biography in the Vitae sophistarum, crediting Oribasius as a pupil of Zeno of Cyprus as well as a confidant of Julian, who later became emperor.22 Unfortunately, not all of Oribasius’ works have come down to us. He wrote the extensive Collectiones medicae, which originally comprised seventy (or seventy-two) books covering all important medical topics, but only twenty-five of the books are fully extant.23 In the proem to this work, we learn that the emperor Julian instructed him to “seek through the most important writings of all the best authors and collect all that is of practical use to the very purpose of medicine”24 (πάντων τῶν ἀρίστων ἰατρῶν ἀναζητήσαντά με τὰ καιριώτατα συναγαγεῖν καὶ πάντα ὅσα χρησιμεύει πρὸς αὐτὸ τὸ τέλος τῆς ἰατρικῆς).25 We also learn that Oribasius aims to “collect only material from superior authors”26 and does not want to “leave out anything of what Galen said”.27 Oribasius 20 See e.g. Nutton 1984, 3; Garzya 2006, 10; van der Eijk 2010, 521 f. 21 See e.g. Nutton 2005, 295; van der Eijk 2010, 525; Scarborough 2008b, 595. 22 Eunapius, Vit. soph. 21.1.1–5 (87.16–88.12 Giangrande); see also Scarborough 2008b, 595; Langslow 2013, 4931. 23 See e.g. Langslow 2013, 4931; Scarborough 2008b, 595; Schröder 1940, 801 f. 24 The translation is quoted from van der Eijk 2010, 526. 25 See Oribasius, Coll. med. rel. proem (Vol. 1, 4.7–9 Raeder). 26 The translation is quoted from van der Eijk 2010, 526. For the Greek text, see Oribasius, Coll. med. rel. proem (Vol. 1, 4.14 Raeder). 27 The translation is quoted from van der Eijk 2010, 527. For the Greek text, see Oribasius, Coll. med. rel. proem (Vol. 1, 4.15 Raeder).

2 Medicine in late antiquity | 5

also wrote a Synopsis ad Eustathium, which he dedicated to his son, Eustathius, who, according to the proem of the work, wanted to have a summary of the larger Collectiones medicae.28 Oribasius explains that he himself recognized that such a summary might be useful for those who are already well versed in medicine and can thus easily bring to their minds all the details they need when reading this short summary.29 The Synopsis was thus thought to be useful for physicians who were traveling and unable to take the large and heavy Collectiones along with them.30 We also have a further work, the Libri ad Eunapium, dedicated to Eunapius of Sardis, which is intended to be helpful for people who, like Eunapius, are not experienced physicians but may want to know some basic and easily available remedies for when they are traveling and no physician is nearby.31 Another work, now lost, provided a synopsis of Galen’s works and was written by Oribasius on behalf of the emperor Julian. The proem of this work survives and is transmitted in Photius’ Bibliotheca.32 Oribasius’ works remained influential throughout late antiquity and acted as models for subsequent compilers such as Aetius or Paul (see p. 33). His works were also translated into Latin and Arabic.33 All the extant works of Oribasius have been edited in five volumes for the Corpus Medicorum Graecorum by Johannes Raeder (CMG volumes VI 1,1–VI 3). One of these volumes also contains the libri incerti of the Collectiones medicae, as well as the Eclogae medicamentorum, which may not have been written by Oribasius himself.34 For further information on Oribasius’ life and work, see Schröder 1940; Jones & Martindale et al. 1971; de Lucia 1999; de Lucia 2006; Scarborough 2008b; Fiorucci 2010; van der Eijk 2010; Langslow 2013. 2.1.2 Alexander of Tralleis Alexander of Tralleis lived in the sixth century CE.35 Scholars have supposed that he traveled through various countries, possibly as a military surgeon, and afterwards settled in Rome to be a practicing physician.36 He wrote a handbook, the Therapeutica, consisting of twelve books and dealing with various medical issues presented

28 See Oribasius, Synops. ad Eustath. proem (5.10 f. Raeder). 29 See Oribasius, Synops. ad Eustath. proem (5.13–17 Raeder). 30 See Oribasius, Synops. ad Eustath. proem (5.17 f. Raeder). 31 See Oribasius, Ad Eunap. proem (317.2–8 Raeder). 32 See Photius, Bibliotheca cod. 216 (131 f. Henry); for an English translation, see also van der Eijk 2010, 525 f. 33 See Langslow 2013, 4931; Ullmann 1970, 84; Schröder 1940, 811 f.; Fiorucci 2010, 750. 34 This is CMG volume VI 2,2. On the question of authenticity of the Eclogae medicamentorum, see Raeder in CMG VI 2,2: VIII. See also Buzzi’s forthcoming new critical edition of this work. I am grateful to Irene Calà for this reference. 35 See Nutton in DNP, s. v. Alexandros [29] von Tralleis; Wellmann 1894, 1460. 36 See e.g. Martindale 1992, 44; Garzya 2005a, 27; Puschmann 1878 in Alexander von Tralles Vol. 1, 83.

6 | General introduction

according to an a capite ad calcem approach.37 This handbook appears to differ from the works of Oribasius, Aetius and Paul insofar as it does not rely to the same extent on earlier sources.38 In his dedication to Cosmas, he explains that Cosmas, the son of his teacher, asked him to set forth the therapy for various affections, which he had gained knowledge about through his own experiences.39 Alexander goes on to state that now, as an old man, he wants to grant this wish and write this book (τοῦτο τὸ βιβλίον), putting together (συντάξας) what he has experienced as a practicing physician.40 He ends the dedication by saying that he has tried to use common and clear language in order to make it comprehensible for everyone.41 Alexander does not refer to his predecessors or his relation to them in the dedication and he even goes so far as to explicitly criticize Galen’s views.42 In addition to this work, Alexander wrote a treatise on fevers, a letter dealing with helminths, and a treatise on diseases of the eyes.43 Alexander’s works were translated into Latin and Arabic.44 His Therapeutica, together with the treatise on fevers and the letter dealing with helminths, has been edited by Theodor Puschmann in two volumes 1878 and 1879. For further information on Alexander’s life and work, see Puschmann 1878 in Alexander von Tralles Vol. 1, 75–286; Wellmann 1894; Martindale 1992; Garzya 2005a; Guardasole 2006. 2.1.3 Paul of Aegina Paul of Aegina lived in the seventh century CE.45 He wrote a compilation (Epitome medica) consisting of seven books that deals with nearly all major medical topics. In the proem to his work, Paul explains that he has written “this treatise not because the ancients have omitted anything substantial, but for the purpose of concise teaching”46 (συντόμου χάριν διδασκαλίας).47 He further states that it is strange that lawyers have portable handbooks to carry with them and have at hand for everyday 37 See e.g. Garzya 2005a, 28 for an overview of the topics Alexander deals with in these books. 38 Duffy 1984, 26 puts it as follows: “it [scil. the handbook] is based on earlier material to be sure, but made much more alive than other compilations by incorporating the results of extensive personal experience.” See also Wellmann 1894, 1461; Nutton in DNP, s.v. Alexandros [29] von Tralleis. 39 See Alexander, Therapeutica proem (Vol. 1, 289.1–3 Puschmann). 40 See Alexander, Therapeutica proem (Vol. 1, 289.8–10 Puschmann). 41 See Alexander, Therapeutica proem (Vol. 1, 289.12–14 Puschmann). 42 See e.g. Alexander, De febr. 1 (297.5 f. Puschmann), De febr. 1 (301.12 f. Puschmann), De febr. 3 (333.6 f. Puschmann). For a detailed discussion, see Bouras-Vallianatos 2019, 44–52. 43 See Alexander, De febr. (289.1–439.31 Puschmann), Alexander, Epist. (587.1–599.8 Puschmann). On the treatise dealing with diseases of the eyes, see Alexander, Therapeutica 2 (Vol. 2, 3.3 f. Puschmann) and Puschmann 1878 in Alexander von Tralles Vol. 1, 107. 44 See Puschmann 1878 in Alexander von Tralles Vol. 1, 91; Ullmann 1970, 85 f. 45 See e.g. Oberhelman 2013, 5101; Pormann 2005, 681. 46 The translation is quoted from van der Eijk 2010, 534. 47 See Paul proem (Vol. 1, 3.2–4 Heiberg).

2 Medicine in late antiquity | 7

use which contain the main points of the laws, while physicians lack something comparable, although, unlike lawyers, they often need to act straightaway.48 Since it is difficult to remember everything in every situation, Paul writes, he composed this compendious collection (τήνδε τὴν ἐπίτομον συναγωγήν) in which he draws on the works of the ancients. According to his own account, he did not add anything of his own besides a few elements drawn from the experience of his own practice.49 He then goes on to position his work in contrast to that of Oribasius (on this issue, see p. 33). Paul also wrote another work, dealing with pediatrics, but this is only transmitted in part through Arabic translations.50 In Arabic literature he is credited with having been an “obstetrician” due to his acquaintance with midwifery and he is also said to have been a gynecologist.51 Paul’s Epitome was translated into Latin, Arabic and even Syriac.52 All seven books of Paul’s Epitome medica have been edited for the Corpus Medicorum Graecorum by Johan Ludvig Heiberg in two volumes (CMG IX 1 in 1921, CMG IX 2 in 1924). For further information on Paul’s life and work, see Diller 1949; Pormann 2005; Lamagna 2006; van der Eijk 2010, 534–536; Oberhelman 2013.

3 Aetius of Amida 3.1 Life Little is known about the life of Aetius of Amida other than that he lived at the beginning of the sixth century CE.53 Some manuscripts, as well as Photius in his Bibliotheca, refer to him as Ἀετίου Ἀμιδήνου, indicating that he originated from Amida, a city in Mesopotamia, which is today on Turkish territory and called Diyarbakır.54 It has often been assumed that Aetius studied in Alexandria due to references to that city in his work but this claim should be treated with care, since the reference in question may already have been present in the texts Aetius uses as sources.55 Another claim that has been made about Aetius is that he held a position as courtphysician in Constantinople during the reign of the emperor Justinian (appr. 527– 48 See Paul proem (Vol. 1, 3.8–16 Heiberg). 49 See Paul proem (Vol. 1, 3.22–4.2 Heiberg). 50 See e.g. Pormann 2008, 629; Pormann 2005, 681. 51 See Pormann 2008, 629; Pormann 2005, 681; Ullmann 1970, 86. 52 See Oberhelman 2013, 5102; Pormann 2008, 629; Ullmann 1970, 86 f.; Diller 1949, 2388. 53 For a terminus post quem one may note Aetius’ mention of Oribasius and of Cyrillus, while the fact that Alexander of Tralleis mentions Aetius’ work gives us a terminus ante quem. On this issue, see Calà 2012a, 12 f.; Ieraci Bio 2010, 38; Romano 2006, 256; Martindale 1980, 20. 54 See e.g. Par. suppl. gr. 1240 (manuscript available online: http://gallica.bnf.fr/ark:/12148/ btv1b11005045h/f3.image; date of last access: 14/04/22), see Photius, Bibliotheca cod. 221 (140.14 Henry). On this issue, see also Calà 2012a, 11 f. 55 See Calà 2012a, 13–15; Touwaide 2013, 146; Scarborough 2010, 236–242.

8 | General introduction

565).56 This is based on the fact that some manuscripts refer to Aetius as κόμης τοῦ ὀψικίου. However, this attribution is rather problematic given that this term “did not exist before the seventh century”57 and probably found its way into the manuscripts “through confusion with a later person”.58 Similarly, it has even been suggested that Aetius may have been the personal physician of Theodora, Justinian’s wife.59 All these assumptions are persistent in the scholarship on Aetius and have often been taken for granted, despite the lack of any strong evidence. These claims should, therefore, be treated with due caution and should not be relied upon when confronting interpretative difficulties.

3.2 Work – The Libri medicinales 3.2.1 Sources for the text In what follows, I will give a very brief overview of the sources for the Libri medicinales that need to be taken into account when producing an edition of the text and which, of course, also offer an insight into the way the Libri medicinales were received, used or appreciated in later times (on this, see also p. 10 f.). This includes taking into account the existing manuscripts, the Latin and Arabic translations, the Latin commentaries and the critical editions that have been produced previously. 3.2.1.1 The manuscripts The Libri medicinales are preserved in a vast number of manuscripts which contain the whole or parts of the work.60 The database Pinakes – Textes et manuscrits grecs (http://pinakes.irht.cnrs.fr/) lists one hundred and seventy-seven manuscripts, of which the oldest probably date back to the tenth century (e.g. S. Salv. 084 from Messina)61 and the most recent come from the nineteenth century (e.g. gr. 65 from Leipzig).62 However, most of the manuscripts were produced between the fourteenth and sixteenth centuries.63 For a closer look at the manuscripts which are important for the sixth book, see p. 15 f.

56 Such was suggested by, for example, Hunger 1978, 294; Scarborough 2010, 236. 57 Martindale 1980, 20. 58 Martindale 1980, 20. On this problematic attribution, see also Metzger 2015, 322; Touwaide 2013, 146; Ieraci Bio 2010, 38. 59 See e.g. Scarborough 2008a, 38; Scarborough 2010, 236. For a critical view, see e.g. Touwaide 2013, 146. 60 See also Calà 2012a, 75. 61 See http://pinakes.irht.cnrs.fr/notices/cote/40745/ [date of last access: 14/04/22]. See also Calà 2012a, 75. This manuscript only contains books one to three of the Libri medicinales. 62 See http://pinakes.irht.cnrs.fr/notices/cote/38380/ [date of last access: 14/04/22]. See also Calà 2012a, 75. 63 See also Calà 2012a, 75.

3 Aetius of Amida | 9

3.2.1.2 Latin translations64 In 1533, Janus Cornarius published his Latin translation of books eight to thirteen of the Libri medicinales. In 1534, Johannes Montanus translated the Libri medicinales into Latin and published them in three volumes: the first volume contains a translation of books one to seven, the second volume contains Cornarius’ translation of books eight to thirteen from 1533, and the third volume contains a translation of books fourteen to sixteen. In 1542, Cornarius published a second translation of the Libri medicinales containing all sixteen books. These translations have all been reprinted frequently. 3.2.1.3 Arabic translations Some scholars have assumed that it took some time for Aetius’ Libri medicinales to find its way to the Arab world, since earlier Arabic literature does not mention him.65 Al-Bīrūnī, however, mentions Aetius and reports that his work was translated into Arabic.66 This translation is, unfortunately, lost but some fragments are preserved in other Arabic sources.67 3.2.1.4 Latin commentaries Christophorus Oroscius produced a particular interesting commentary to the Libri medicinales in 1540 which transmits versions of a manuscript now lost.68 In 1566, Nicolaus Rorarius published a work entitled Contradictiones, dubia, et paradoxa in libros Hippocratis, Celsi, Galeni, Aetii, Aeginetae, Avicennae in which he also dedicates fourteen pages to Aetius’ work.69 3.2.1.5 Critical editions The Aldine edition, containing the first eight books of the Libri medicinales, is the editio princeps of the work and was produced in 1534.70 Some attempts have been made to edit minor parts of Aetius’ work and Calà provides a detailed overview of those efforts.71 I will restrict myself to mentioning those which contain complete

64 For more detailed information on the following remarks, see Calà 2012a, 57–62; Calà 2012b, 188 f.; Touwaide 2013, 147. It is difficult to discover the exact dates of publication of the Latin translation since they have often been reprinted. I rely on the years suggested by Calà 2012a, which match those suggested by Touwaide 2013. 65 See Sezgin 1970, 164 f.; Ullmann 1970, 84 f. 66 See Sezgin 1970, 164 f.; Ullmann 1970, 84 f. 67 See Ullmann 1970, 84 f. 68 See Calà 2012b, in summary 205. 69 See Rorarius, 605–619; see Calà 2012a, 62 f. As for the difficulty of correctly dating the publication of Rorarius’ Contradictiones, see note 64. Again, I follow Calà 2012a. 70 For further information, see Calà 2012a, 56 f. 71 See Calà 2012a, 65–73.

10 | General introduction

books and are used in the present thesis. In 1879, Charles Daremberg and Charles-Émile Ruelle published an edition of the eleventh book of the Libri medicinales as part of their edition of Rufus’ treatises.72 In 1892, Georg Kostomiris published an edition of the twelfth book of the Libri medicinales.73 Skevos Zervos published editions of several books of Aetius’ Libri medicinales:74 in 1901, Zervos’ edition of the sixteenth book was published, followed by an edition of the thirteenth book in 1905 and an edition of the fifteenth book in 1909. Finally, in 1911, Zervos published an edition of the ninth book. Alessandro Olivieri edited books one to eight of the Libri medicinales for the Corpus Medicorum Graecorum: the first volume, containing books one to four, was published in 1935 and the second, containing books five to eight, was published in 1950. My own study, including a translation of, and commentary on, ten chapters of Aetius’ sixth book, is based on Olivieri’s edition, on which see also p. 15 f.; see also Diller 1953 and Calà 2012a, 71 f. on Olivieri’s edition. Some books of the Libri medicinales (i.e. books ten and fourteen) are not available in any critical edition yet, while other editions require some revision, given that they are based on a small number of manuscripts. A number of publications in the twentieth and twenty-first centuries have dealt with questions concerning the edition of parts of the Libri medicinales.75 Promising efforts to produce a new edition of the second book of Aetius’ immense treatise are currently ongoing within the Collaborative Research Center 980 Episteme in Motion (Sonderforschungsbereich 980 Episteme in Bewegung) in Berlin.76 3.2.2 Reception In Photius’ Bibliotheca we get an impression of how Aetius’ work might have been received in late antiquity.77 There, Photius writes that Aetius’ work “is in all respects superior to the summaries that Oribasius wrote both to Eustathius and to Eunapius, for it surpasses them in its causal explanations, in diagnosis and prognosis, in further specifications and in the wide range of its therapeutics.”78 Photius goes on to state that Aetius’ work is also superior to Oribasius’ summary of Galen’s works “in that it condenses (the subject) into lesser volume, and in making the teaching

72 See Aetius Amid., Libri med. 11 (85–126 Daremberg & Ruelle). For a closer look at the history of this edition, see Calà 2012a, 67–69. 73 For a closer look at this edition, see Calà 2012a, 69 f. 74 For a closer look at Zervos’ editions, see Calà 2012a, 71. 75 See e.g. Garzya 1984, Pignani 1999, Calà 2012a. 76 See http://www.sfb-episteme.de/en/teilprojekte/sagen/A03/index.html [date of last access: 14/04/22]. 77 For more on Photius’ Bibliotheca, see e.g. Wilson 1994 in Photius The Bibliotheca. 78 Photius, Bibliotheca cod. 221 (151.25–29 Henry). The translation is quoted from van der Eijk 2010, 533.

3 Aetius of Amida | 11

clearer, and in covering a larger number of affections.”79 However, it is said to be less theoretical and philosophical in nature compared to Oribasius’ works.80 Photius concludes that physicians should use Aetius’ work who do not aim to “go into great depth of theoretical medical study or to make discoveries in accordance with the study and the truth about the nature of things, but whose aim is solely the treatment of the body and not to neglect anything that is of practical benefit to this”.81 Of course, it needs to be borne in mind that this is Photius’ judgement, but it may very well be that Photius’ views were also shared by other readers of Aetius’ Libri medicinales. However, Photius’ particular accentuation of the “practical benefit” of Aetius’ compilation does indeed point to an important characteristic of his work, that is its focus on practical usability as it is reflected throughout the Libri medicinales (see in summary p. 19 f.). That the Libri medicinales remained a popular work for a long time is demonstrated by the large number of manuscripts (from the tenth to the nineteenth century) which contain this work (see p. 8). Further evidence is provided by the fact that the work was translated into Latin and commented on in the sixteenth century (see p. 9) and that it is contained in medical anthologies such as that produced by Henricus Stephanus in 1567.82 That Aetius’ work was popular or that he was regarded as a reputable physician is also illustrated by, for example, a drawing found on the front-page of a Renaissance-edition of the complete œuvre of Hippocrates dating back to 1588, in which Aetius is depicted in the company of Galen, Hippocrates and Avicenna as one of four figures who are clearly intended to represent the great physicians.83 3.2.3 Modern translations I will now turn to a brief overview of the translations of the Libri medicinales into modern languages.84 A German translation of parts of the seventh book was produced by Leopold Danelius in 1889, followed by a German translation of the first ninety chapters of the seventh book by Julius Hirschberg in 1899. In 1901, Max Wegscheider translated chapters one to one hundred and thirteen of the sixteenth book into the same language and in 1938 Heinrich Steinhagen translated the whole of the fourth book. James Ricci translated the sixteenth book into English and 79 Photius, Bibliotheca cod. 221 (151.30–152.4 Henry). The translation is quoted from van der Eijk 2010, 533. 80 See Photius, Bibliotheca cod. 221 (152.5–13 Henry). 81 Photius, Bibliotheca cod. 221 (152.17–22 Henry). The translation is quoted from van der Eijk 2010, 533. 82 For a closer look on Stephanus’ anthology, see Calà 2012a, 64. 83 The image is found on the front cover of the edition Hippocratis Coi opera quae extant graece et latine, ed. Hieron. Mercurialis Foroliviensis, Venice 1588. This edition can be viewed online: See https://archive.org/details/BIUSante_00033/page/n1/mode/2up [date of last access: 14/04/22]. 84 For such an overview, see also Calà 2012a, 69, 73.

12 | General introduction

annotated the text in 1950, basing his translation on the Latin version of Cornarius. In 2000, Richey Waugh translated Hirschberg’s German translation of the seventh book into English. Roberto Romano translated parts of the sixteenth book into Italian in 2006 and parts of the thirteenth book have been translated into French by JeanMarie Jacques in his 2007 work on Nicander. Eric Gowling produced an English translation with notes of the first book of the Libri medicinales in 2014. 3.2.4 Structure and contents The Libri medicinales (λόγοι ἰατρικοί, βιβλία ἰατρικά ἑκκαίδεκα) consist of sixteen books. They deal with a large number of medical issues: foodstuffs and remedies (book 1); stones, earth, salts, animal products, animals (book 2); therapeutics (book 3); dietetics, mixtures (book 4); prognostic and diagnostic questions, fever (book 5); diseases of the head (book 6); diseases of the eyes (book 7); diseases of the face, the teeth, the mouth, the respiratory system (book 8); diseases of the digestive tract (book 9); diseases of liver and spleen (book 10); diseases of the kidneys, bladder, urinary system and male genitals (book 11); ischias, podagra, arthritis, rheuma (book 12); venomous bites and antidotes, skin diseases (book 13); anal diseases, wounds, ulcers (book 14); swellings, tumors (book 15); and gynecology (book 16).85 As this list clearly shows, the Libri medicinales are a vast medical compilation comprising a collection of numerous texts dealing with a multitude of topics which are important for medical practice. Each book deals with one area of medicine or with a number of areas that are thematically linked.86 Each book is divided into chapters which deal with an affection, a remedy, a medical term or other medical topics. The headings of the chapters indicate the topic which is dealt with in the main text and sometimes mention the source which is allegedly cited, although the names of the sources are not transmitted consistently in the manuscripts (see also p. 14).87 In some chapters we also find references to sources in margine within the chapter but these are, again, not present in all manuscripts. The manuscripts also transmit pinakes at the beginning of each book, which usually list the headings (sometimes in an abridged version) found later in the book. We cannot be sure that these pinakes come from Aetius88 but, given that we have evidence that pinakes were used in the sixth century,89 it is quite possible that they might stem from Aetius’ original text.

85 The most detailed list of the topics addressed in each of the sixteen books is found in Bravos 1974, 6–8. 86 See also Bravos 1974, 4. 87 See also van der Eijk 2010, 532. 88 See also van der Eijk 2010, 532. 89 Sergius’ Syriac translation of Galen’s De simplicium medicamentorum contains a pinax. I am greatful to Irene Calà for pointing this out. See also Calà & Hawley 2017.

3 Aetius of Amida | 13

Unlike other late antique medical compilations (see p. 4–7), Aetius’ Libri medicinales do not contain a proem explaining the aim of the treatise, its structure or the way it is used best and nor does the compiler directly address his readers.90 Instead, the compilation starts with a synopsis of Galen’s treatise De simplicium medicamentorum temperamentis ac facultatibus (Σύνοψις τῶν ἁπλῶν Γαληνοῦ),91 which is an adaptation of the proem found in this Galenic treatise. However, this synopsis is thematically related to the first book of the Libri medicinales and not to the whole treatise. Throughout the Libri medicinales, it is difficult to find traces of Aetius himself, since he does not come to the fore, explicitly address his readers, or state why he cites the texts he does.92 And even where the first person is used in the work, we cannot read it as the voice of Aetius without further ado, since he often simply adopts it from his sources (although, sometimes, we can also observe the opposite phenomenon, when he deletes a personal pronoun which was contained in the text of his source).93 There are, however, a few phrases in the Libri medicinales which can almost certainly be traced back to the compiler himself. These phrases contain references to previous books or subsequent chapters, such as προείρηται ἐν τῷ περὶ καθαρτηρίων λόγῳ or τοῖς προγεγραμμένοις ἐν τῷ πρὸ τούτου λόγῳ πρὸς τοὺς ἀγρυπνοῦντας94 and by using such references, Aetius explicitly refers the reader to passages of his compilation where he addresses a topic in greater detail. Indeed, where such phrases occur one can usually find a passage in Aetius’ work that matches this reference. For the general issue of cross-references in scientific literature, see van der Eijk 1997, 111 f. To sum up, given that Aetius does not, for the most part, address his readers directly or give any meta-analysis of his work, our understanding of his compilation must rely almost entirely on the content and structure of the work. In other words, in order to learn more about what Aetius thought to be important in composing a medical compilation and what he actually accomplished during the process of compiling we must analyze the structure of the compilation, examine the texts he chooses to cite, and the ways in which he deals with those texts (this latter is only possible when one also has another version of the text at hand with which to compare Aetius’ version; as an example, see p. 29–32). The aim of the present work is to carry out exactly this kind of study of the sixth book of Aetius’ compilation and so to offer a possible framework for approaching the other books.

90 See also van der Eijk 2010, 532. 91 See Aetius Amid., Libri med. 1 proem (Vol. 1, 17.2–30.6 Olivieri). 92 See also van der Eijk 2010, 532. 93 A very good study on the topic of the use of personal pronouns in Aetius is provided by Debru 1992. 94 Aetius Amid., Libri med. 6.8 (Vol. 2, 141.4 f. Olivieri), Libri med. 6.2 (Vol. 2, 127.8 f. Olivieri). See e.g. also Libri med. 6.7 (Vol. 2, 135.21 f. Olivieri), Libri med. 6.2 (Vol. 2, 125.26 f. Olivieri). Since my study is concerned with the sixth book of the Libri medicinales, the passages are taken from this book. This does not mean that the other books do not contain such references.

14 | General introduction

3.2.5 Sources mentioned within the text Altogether, Aetius refers to a wide range of sources by name in his work. All the sources are listed by Bravos 1974, 13–47 (in the order of their appearance from book one to sixteen) and 48–161 (in alphabetic order), who counts references to approximately one hundred and eighty names in the complete Libri medicinales.95 Galen is Aetius’ main source, followed by Archigenes and Oribasius.96 For more on the sources, see p. 20–27. As mentioned above, the references to names in the headings of the chapters or in margine are not without problems, insofar as they are not consistently transmitted in each manuscript. We cannot be certain beyond the possibility of doubt that Aetius always cites who is claimed to be cited, that he actually mentions the names of his sources every time he cites them, or where he might have added something new to the material he uses.97 The only approach modern readers can take to throw light on Aetius’ use of his sources is to compare his versions of texts with other versions of the same text extant outside of the Libri medicinales. Unfortunately, we rarely have the opportunity to make such comparisons, other than in the case of Galenic texts, since Aetius’ compilation contains many texts that survive nowhere else. However, when Aetius does cite a Galenic text that is extant elsewhere, we can often discover something interesting about the way he works with his sources. For a detailed analysis of such a comparison, see p. 29– 32. Before moving on, it is important to emphasize two points. First, it is clear that Aetius does, indeed, change the texts he uses here and there and that he is not merely “copying and pasting”, as will be seen throughout the commentary. Secondly, it becomes evident that the references to Galen as they have come down to us are, indeed, in most cases followed by texts that are taken from Galenic treatises. This does not, however, exclude the possibility that Galen is also cited where either no source is mentioned or where a source other than Galen is mentioned, a phenomenon which can, indeed, be observed in places in the sixth book (see p. 22 f.).

95 See Bravos 1974, 163. 96 See Bravos 1974, 164 f. For a closer look at the role Galen plays in the late antique medical compilations, see Bouras-Vallianatos 2019. 97 I do not completely agree with Wellmann 1895, 126, who assumes that the “Autorenbeischriften” (the references to the sources) are “durchaus zuverlässig” (quite reliable); we can only check these references in very few cases and, apart from these few cases, there are also problems with the variants of the manuscripts; we, thus, cannot make such definite statements. Kudlien criticizes Wellmann for his assumption that Aetius’ references to the sources are reliable; see Kudlien 1964, 25 f.

3 Aetius of Amida | 15

3.3 The sixth book of the Libri medicinales 3.3.1 Sources for the text For a general overview of the sources for the Libri medicinales, including the existing manuscripts, the Latin and Arabic translations, the Latin commentaries and the critical editions, see p. 8–10. The Latin translations of Cornarius and Montanus, and the Latin commentary of Oroscius, all also take into account the sixth book. As for the existing manuscripts, according to the praefatio to the critical edition of Aetius’ sixth book, on which I have based my translation and commentary, Alessandro Olivieri has collated twenty-three manuscripts (out of the previously mentioned one hundred and seventy seven) for his edition of books five to eight, which he groups into four “families”, namely φ, χ, ψ and ω.98 In this praefatio, Olivieri refers to his first volume (containing a critical edition of books one to four) for more detailed information. There, he explains that he considers the manuscripts belonging to family φ as codices optimae notae, sc. qui archetypum directe vel propius repraesentant (as those which are best, that is to say, as directly or nearly representing the archetype).99 The manuscripts belonging to family χ and ψ are considered as codices bonae notae,100 while family ω is said to contain inferior manuscripts (codices deteriores continet).101 Olivieri states that of the manuscripts belonging to family φ, the Laurentianus graecus 75,20 (La), the Parisinus Suppl. gr. 1240 (Pa) and the Vaticanus Palatinus 199 (Px) are especially praiseworthy.102 These are the foundation for Olivieri’s edition (qui quasi fundamento editioni meae fuerunt).103 In the second volume, containing books five to eight, Olivieri additionally mentions the Laurentianus graecus 75,5 (La). This manuscript contains books six to eight, while the Laurentianus graecus 75,20 only contains books one to five,104 but both were copied by the same scribe. Since Olivieri does not say anything to the contrary about the families in his second volume, we can assume that what has been stated for the Laurentianus graecus 75,20 also applies to the Laurentianus graecus 75,5 for books six to eight. We can, thus, note that Olivieri relies heavily on the three manuscripts La, Pa and Px for his edition of the sixth book of Aetius’ Libri medicinales. The Laurentianus graecus 75,5 (La) stems from the hand of Ioannikios and probably goes back

98 See Olivieri 1950 in Aetii Amideni Libri medicinales V–VIII, I–IV. 99 Olivieri 1935 in Aetii Amideni Libri medicinales I–IV, X. 100 See Olivieri 1935 in Aetii Amideni Libri medicinales I–IV, XI. 101 See Olivieri 1935 in Aetii Amideni Libri medicinales I–IV, XIII. 102 See Olivieri 1935 in Aetii Amideni Libri medicinales I–IV, X. 103 See Olivieri 1935 in Aetii Amideni Libri medicinales I–IV, X. 104 See Olivieri 1950 in Aetii Amideni Libri medicinales V–VIII, I. See also the information given by http://pinakes.irht.cnrs.fr/notices/cote/16690/ [date of last access: 14/04/22], http://pinakes.irht. cnrs.fr/notices/cote/16705/ [date of last access: 14/04/22].

16 | General introduction

to the twelfth century;105 the part of the Parisinus Suppl. gr. 1240 (Pa) which contains the sixth book of the Libri medicinales probably also dates from the twelfth century,106 or even from the eleventh century, as Diels proposes;107 the Vaticanus Palatinus 199 (Px) probably goes back to the thirteenth or fourteenth century.108 La and Pa belong to the oldest manuscripts we have at hand for the text of Aetius’ sixth book. 3.3.2 Modern translations, commentaries, studies The sixth book of Aetius’ Libri medicinales has never been translated into any modern language and nor has a commentary upon it been written. Its standard edition is still that which was produced by Alessandro Olivieri for the Corpus Medicorum Graecorum in 1950.109 To my knowledge, there is no study that is exclusively dedicated to the sixth book although there are works in which the sixth book or, rather, chapters contained within it, are mentioned. Given that these studies are normally concerned with broader topics and the reference to a passage in Aetius only takes a small part of the work, it is difficult to identify all such mentions. In what follows, I will give an overview of the discussions I am aware of and which are important for the scope of my own study. Before I do so, I need to refer first to several of my own papers in which I try to shed light on Aetius and his compilation. In 2018, I published a paper entitled Mental Illnesses in the Medical Compilation of Late Antiquity: The Case of Aetius of Amida in which I deal with the set of illnesses that is discussed in Aetius’ sixth book and in which special attention is given to the chapters on phrenitis, on katalepsis, and on mania. My 2020 paper The Unknown Physician: Prolegomena to a collection of the fragments of Posidonius discusses Posidonius’ prominent position regarding the sources cited in the first half of the sixth book. Galen oder nicht Galen, das ist hier (nicht) die Frage! Ausschluss, Ablehnung und Annahme von Wissen in den medizinischen Enzyklopädien der Spätantike, published in 2021, discusses Aetius’ compilation technique, considering in more detail his chapter on melancholia. Bravos’ book Das Werk des Aetios v. Amida und seine medizinischen und nicht medizinischen Quellen 1974 includes a list of topics addressed in the sixth book, a list of sources mentioned, and a short summary of the chapters presented in this book.110 As for the first chapter of the sixth book, dealing with hydrokephalos, the 105 See http://pinakes.irht.cnrs.fr/notices/cote/16690/ [date of last access: 14/04/22]. Diels 1906, 5 misdates it to the fourteenth century. See also Olivieri 1904. For further information on Ioannikios, see e.g. Wilson 1983, especially 168 f. and 166. 106 See http://pinakes.irht.cnrs.fr/notices/cote/53904/ [date of last access: 14/04/22]. 107 See Diels 1906, 6. 108 See http://pinakes.irht.cnrs.fr/notices/cote/65931/ [date of last access: 14/04/22], Diels 1906, 6. 109 On this edition, see e.g. Diller 1953, Calà 2012a, 71 f. 110 See Bravos 1974, 7, 18–21, 62–64, 92 f., 115, 145–147, 149.

3 Aetius of Amida | 17

paper Concept and Treatment of Hydrocephalus in the Greco-Roman and Early Arabic Medicine by Grunert & Charalampaki & Ayyad 2007 presents a translation and short analysis of Aetius’ chapter.111 Grunert’s paper Der Hydrocephalus in der antiken Medizin 2012 is very similar. The excerpt of Posidonius which appears in the second chapter, dealing with phrenitis, is mentioned in several papers or monographs because it deals with the localization of the leading faculties in the ventricles of the brain. See, for example, Sudhoff 1913, Die Lehre von den Hirnventrikeln in textlicher und graphischer Tradition des Altertums und des Mittelalters, 157, 178 f.; Leyacker 1927, Zur Entstehung der Lehre von den Hirnventrikeln als Sitz psychischer Vermögen, 254 f.; Pagel 1958, Medieval and Renaissance Contribution to Knowledge of the Brain and its Functions, 97 f.; Manzoni 1998, The Cerebral Ventricles, the Animal Spirits and the Dawn of Brain Localization of Function, 141 f.; Rocca 2003, Galen On the Brain, 246; Grunert 2002, Die Bedeutung der Hirnkammern in der antiken Naturphilosophie und in der Medizin, 157–160; Green 2003, Where did the Ventricular Localization of Mental Faculties come from?, 137f. The fourth chapter, dealing with katalepsis, is referred to in the paper Die Katalepsie der Antiken by Baumann 1938, 21. Capone Ciollaro and Galli Calderini discuss Aetius’ eighth chapter, dealing with mania, and how it was used by Theophanes Nonnus, in their paper Aezio Amideno in Teofane Nonno-Crisobalante 1999, 32–36. In his monograph Melancholie und Melancholiker in den medizinischen Theorien der Antike 1966, 84–104, Flashar deals at length with Rufus’ account of melancholia and thereby also addresses the excerpts of Rufus which are found in Aetius’ chapters 9 and 10. On p. 118–126, he deals in great detail with Posidonius’ account of melancholia, also analyzing chapters 9–10 of Aetius’ sixth book, which contain excerpts of Posidonius. Pormann 2008 is also concerned with Aetius’ chapters 9–10 in his edition of Rufus’ fragments on melancholia. Metzger deals with chapters 11–12 of the sixth book of the Libri medicinales in her monograph Wolfsmenschen und nächtliche Heimsuchungen. Zur kulturhistorischen Verortung vormoderner Konzepte von Lykanthropie und Ephialtes 2011, 46 f., 155–164. These chapters are also discussed in, for example, Metzger’s papers Zwischen Mensch und Wolf. Zur Lykanthropie in der spätantiken Medizin 2012, Kynanthropy. Canine Madness in Byzantine Late Antiquity 2015 and Not a Daimon, but a Severe Illness: Oribasius, Posidonius and Later Ancient Perspectives on Superhuman Agents Causing Disease 2018. 3.3.3 Structure and contents112 The sixth book contains ninety-eight chapters, which all deal with affections that are located in, around, or on the head. To be more specific, they address affections of the brain, various forms of headaches, affections involving the hair of the head and the 111 See Grunert & Charalampaki & Ayyad 2007, 257 f. 112 The contents of this section have, in parts, already been addressed in my paper Gäbel 2018, 319–322, 325.

18 | General introduction

scalp, affections of the ears, and affections of the nose.113 One can, broadly speaking, distinguish two main parts of the sixth book, the first of which is concerned with “internal” affections (chapters 1–54) while the second deals with those that are “external” to the head (chapters 55–98). Given that the focus of my study is Aetius’ way of dealing with diseases of the brain, which also includes the discussion of “mental” illnesses (see p. 39–70), in the following I will concentrate on the first half of the sixth book, dealing with “internal” affections. At the outset, let me highlight that the affections discussed in the first half of the sixth book are arranged “from top to bottom” (as are those discussed in the second half), that is to say, the book proceeds from affections which are located around the skull to those located in the brain and even to those which originate in the brain but the symptoms of which pertain to lower bodily parts. The first half of the book deals with the following affections or groups of affections: hydrokephalos (chapter 1), phrenitis (chapter 2), lethargia (chapter 3), katoche/katalepsis (chapter 4), karos (chapter 5), koma (chapter 6), skotoma (chapter 7), mania (chapter 8), melancholia (chapters 9–10), lykanthropia (chapter 11), ephialtes (chapter 12), epilepsia (chapters 13–21), morosis and leros (chapter 22), loss of memory (chapter 23), being bitten by a mad dog/hydrophobia (chapter 24), inflammation of the brain (chapter 25), erysipelas of the brain (chapter 26), apoplexia (chapter 27), paralysis (chapters 28–37), spasmos/tetanos (chapters 38–39), kephalalgia, kephalaia, hemikrania (chapters 40–51), remedies capable of purging the inside of the head of detrimental substances (chapters 52–54). The brain plays a crucial role in many of the affections mentioned in these chapters, as is shown by the fact that the noun ἐγκέφαλος is used very often in this first half of the book; often the brain is either explicitly mentioned or should implicitly be understood as central due to the similarity between the affections. A number of chapters explicitly mention the brain (ἐγκέφαλος) and, in most cases, refer to it as the affected part in their discussion of the affections they deal with: chapters one to three,114 chapter five,115 chapters seven to ten,116 chapters twelve and thirteen,117 chapter twenty-two,118 and chapters twentyfive to twenty-seven.119 As far as the chapters without any explicit mention of the brain are concerned, in each case it is possible to see it should be implicitly understood as an affected part. The affliction dealt with in the fourth chapter, katalepsis, is 113 See the pinax to the sixth book: Aetius Amid., Libri med. 6 (Vol. 2, 120–122 Olivieri). 114 See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.20 Olivieri), Libri med. 6.2 (Vol. 2, 125.5 Olivieri), Libri med. 6.3 (Vol. 2, 128.8 f. Olivieri). 115 See Aetius Amid., Libri med. 6.5 (Vol. 2, 133.11 Olivieri). 116 See Aetius Amid., Libri med. 6.7 (Vol. 2, 134.13 Olivieri), Libri med. 6.8 (Vol. 2, 136.19 Olivieri), Libri med. 6.9 (Vol. 2, 141.16–20 Olivieri), Libri med. 6.10 (Vol. 2, 146.17 Olivieri). 117 See Aetius Amid., Libri med. 6.12 (Vol. 2, 152.16 Olivieri), Libri med. 6.13 (Vol. 2, 153.4 Olivieri). 118 See Aetius Amid., Libri med. 6.22 (Vol. 2, 160.3 Olivieri). 119 See Aetius Amid., Libri med. 6.25 (Vol. 2, 169.16 Olivieri), Libri med. 6.26 (Vol. 2, 169.26 f. Olivieri), Libri med. 6.27 (Vol. 2, 170.5 Olivieri).

3 Aetius of Amida | 19

referred to as being midway between phrenitis (chapter 2) and lethargia (chapter 3), both of which are related to the brain.120 The affection discussed in chapter six, koma, is similar to that which precedes it (karos), and it is likely that what is referred to as κεφαλή here stands in for ἐγκέφαλος.121 The affection discussed in chapter eleven, lykanthropia, is credited with being a form of melancholia (chapters 9–10), which, in turn, is understood as being located in the brain.122 Chapters fourteen to twenty-one need to be taken together with chapter thirteen (dealing with epilepsia), insofar as they present recipes for patients suffering from epilepsia and deal with its various forms.123 Given that epilepsia is said to be an affection of the brain, we need to understand the related chapters as also drawing on the notion that the brain is the affected part. In chapter twenty-three, dealing with the loss of memory, we can see that the brain is implicitly involved since memory was explicitly localized in the brain in the chapter on phrenitis.124 Chapter twenty-four is an exception since it deals with patients who have been bitten by a mad dog and whose complaints do not, therefore, originate primarily in the brain. The reason why the affection is still mentioned in the sixth book might be that it is similar to mania and the dogs which bite the humans are said to suffer from mania.125 Chapter twenty-eight deals with paralysis, an affection which is said to be deeply related to the previously discussed affection, apoplexia (chapter 27),126 which was said to originate in the brain. Chapters twenty-nine to thirty-seven present various forms of paralysis which are, qua forms of paralysis, also connected to the brain. From chapter thirty-eight onwards the brain is very rarely mentioned.127 This overview of the first twenty-four chapters of Aetius’ sixth book clearly reveals how central the brain is for the affections discussed here. It also becomes clear that Aetius deliberately groups these affections together in one book and even discusses all of them in the first half of this book, while the rest of the text is devoted to affections which do not involve the brain. The prominence of the brain in this part of the sixth book raises several interesting questions about possible implications of this frequency of treatment and about similarities that all these affections share. These themes are discussed in a separate section which is exclusively devoted to the topic of “mental” illness, for which see p. 39–70. I will now provide a short overview of the structure of the chapters. In most cases, the chapters address three main topics: the cause, the symptoms, and the

120 See Aetius Amid., Libri med. 6.4 (Vol. 2, 131.17 Olivieri). 121 See Aetius Amid., Libri med. 6.6 (Vol. 2, 133.22 f. Olivieri). 122 See Aetius Amid., Libri med. 6.11 (Vol. 2, 152.1 f. Olivieri). 123 See Aetius Amid., Libri med. 6.14–21 (Vol. 2, 155.3–159.28 Olivieri). 124 See Aetius Amid., Libri med. 6.2 (Vol. 2, 125.18–20 Olivieri). 125 See Aetius Amid., Libri med. 6.24 (Vol. 2, 164.5 f. Olivieri). 126 See Aetius Amid., Libri med. 6.28 (Vol. 2, 172.11–15 Olivieri). 127 The brain is mentioned in the following passage: Aetius Amid., Libri med. 6.47 (Vol. 2, 187.21 Olivieri), Libri med. 6.48 (Vol. 2, 188.16 f. Olivieri),

20 | General introduction

therapy of the affection. These topics are not equally arranged in every single chapter and nor do they receive the same attention in each chapter. Some chapters open with a discussion of the cause(s) of the affection, others with its symptoms. Some chapters deal in detail with the cause(s) of the affection, others focus on the range of symptoms. Common to all chapters is that they attach great importance to therapy, a fact that fits with Photius’ remark about the practical usability of Aetius’ compilation128 (see p. 10 f.) and makes it likely that the Libri medicinales were, indeed, written for practicing physicians looking for appropriate ways to treat their patients. 3.3.4 Sources mentioned within the text For a general discussion of the sources mentioned within the Libri medicinales and for an analysis of the problems related to it, see p. 14. For a complete list of sources mentioned in the sixth book, see Bravos 1974, 18–21. As for the sources mentioned in the first half of the sixth book, which is concerned with “internal” affections of the head including those pertaining to the brain, the main sources for chapters 1–54 are claimed to be Galen, Posidonius, Archigenes, and Rufus.129 Apart from these four, two other sources are also significant: Leonides, who is said to be cited in the first chapter (on hydrokephalos),130 and Marcellus, who is said to be cited in the eleventh chapter (on lykanthropia).131 References to other sources are, for the most part, restricted to the context of recipes or potions or to one-off mentions in a chapter and I will not discuss every such instance. For example, in the chapters dealing with the therapy of epilepsia, Didymus, Asclepiades, Dioscorides, Themison and Serenus are referred to (besides Archigenes and Posidonius) as sources for recipes.132 In the middle of a chapter dealing with kephalalgia, it is claimed that Erasistratus is cited

128 See also van der Eijk 2010, 534; Ieraci Bio 2010, 38. 129 Galen is claimed to be cited in the following chapters: 9 (together with Rufus, Posidonius), 10 (together with Rufus, Posidonius), 13 (together with Posidonius), 17, 23 (together with Rufus), 27 (together with Archigenes), 40, 48, 49, 50 (together with Archigenes); Posidonius is claimed to be cited in the following chapters: 2, 3 (together with Archigenes), 4 (together with Archigenes), 5, 6, 7 (together with Archigenes), 8 (together with Archigenes), 9 (together with Galen, Rufus), 10 (together with Galen, Rufus), 12, 13 (together with Galen), 19, 20, 21, 22, 24 (together with Rufus). Archigenes is claimed to be cited in the following chapters: 3 (together with Posidonius), 4 (together with Posidonius), 7 (together with Posidonius), 8 (together with Posidonius), 16 (as a source for recipes), 27 (together with Galen), 28, 36 (as author of a letter), 39, 47, 50 (together with Galen). Rufus is mentioned in the following chapters: 9 (together with Galen, Posidonius), 10 (together with Galen, Posidonius), 23 (together with Galen), 24 (together with Posidonius). 130 See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.2 Olivieri). 131 See Aetius Amid., Libri med. 6.11 (Vol. 2, 151.21 Olivieri). On Marcellus, see e.g. Metzger 2011, 150–164. 132 See Aetius Amid., Libri med. 6.14 (Vol. 2, 155.3 Olivieri), Libri med. 6.15 (Vol. 2, 155.7 Olivieri), Libri med. 6.15 (Vol. 2, 155.11 Olivieri), Libri med. 6.16 (Vol. 2, 155.22 Olivieri), Libri med. 6.16 (Vol. 2, 156.4 Olivieri), Libri med. 6.16 (Vol. 2, 156.24 f. Olivieri), Libri med. 6.16 (Vol. 2, 157.6 Olivieri).

3 Aetius of Amida | 21

verbatim.133 In a chapter dealing with poultices against kephalalgia, Asclepiades is, again, said to be cited.134 In a chapter dealing with soaps to be applied to the head, Constantinus, Andreas Comes and Theodosius are cited as sources for recipes.135 In this section, I concentrate on the five sources which are claimed to be cited in the chapters I analyze in this study. 3.3.4.1 Leonides Very little is known about Leonides, who can probably be dated to the first century CE.136 According to the pseudo-Galenic Introductio sive medicus Leonides is ranked among those who are eclectics (ἐπισυνθετικοὶ),137 and the same statement is found in Caelius Aurelianus (episyntheticus).138 In the edited books of Aetius’ Libri medicinales Leonides is cited eleven times139 and, according to Bravos’ valuable work, another eleven times in books ten and fourteen,140 which are, thus far, only approachable through the Latin translations.141 It is noteable that the chapters in which Leonides is claimed to be used as a source often deal with surgical matters142, just as does the chapter on hydrokephalos discussed in this study. Leonides is also cited in other authors, such as Paul of

133 See Aetius Amid., Libri med. 6.41 (Vol. 2, 184.14–16 (?) Olivieri). 134 See Aetius Amid., Libri med. 6.51 (Vol. 2, 194.24 Olivieri). 135 See Aetius Amid., Libri med. 6.54 (Vol. 2, 197.20 Olivieri), Libri med. 6.54 (Vol. 2, 197.28 Olivieri), Libri med. 6.54 (Vol. 2, 198.12 Olivieri). On Andreas in Aetius’ Libri medicinales, see Calà 2012c. 136 See e.g. Nutton in DNP s. v. Leonides [3], Witt forthcoming, 1. For a slightly different dating, see Gurlt 1898, 486; Scarborough 2010, 237 note 15. Witt forthcoming, 1 rightly points out that almost nothing is known about Leonides and that the dating is difficult; he suggests that as terminus ante quem we can assume the first third of the fourth century CE since Oribasius cites him in his treatise. 137 Pseudo-Galen, Introd. s. medic. 4.3 (10.7–9 Petit = 14.684.8 K.). 138 Caelius Aurel., Cel. pass. 2.7 (134.14 Bendz). 139 See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.1–125.3 Olivieri), Libri med. 7.71 (Vol. 2, 320.18– 322.11 Olivieri), Libri med. 7.93 (Vol. 2, 339.23–31 Olivieri), Libri med. pinax to book 8 (Vol. 2, 401.42 Olivieri), Libri med. 15.5 (17.10–19.13 Zervos), Libri med. 15.7 (24.15–26.25 Zervos), Libri med. 15.12 (34.12–37.18 Zervos), Libri med. 16.40 (354.5–29 Romano = 58.1–59.11 Zervos), Libri med. 16.42 (356.13–358.15 Romano = 60.1–61.5 Zervos), Libri med. 16.44 (358.23–360.8 Romano = 61.14–62.5 Zervos), Libri med. 16.49 (368.23–370.6 Romano = 68.10–22 Zervos). 140 See Bravos 1974, 115 f. 141 See Aetius Amid., Libri med. 10.30 (662 Cornarius’ translation), Libri med. 14.8 (842 Cornarius’ translation), Libri med. 14.9 (843 Cornarius’ translation), Libri med. 14.11 (843 Cornarius’ translation), Libri med. 14.13 (845 Cornarius’ translation), Libri med. 14.14 (845 Cornarius’ translation), Libri med. 14.21 (848 Cornarius’ translation), Libri med. 14.22 (849 Cornarius’ translation), Libri med. 14.23 (851 Cornarius’ translation), Libri med. 14.50 (877 Cornarius’ translation), Libri med. 14.85 (904 Cornarius’ translation). 142 See e.g. Aetius Amid., Libri med. 7.71 (Vol. 2, 320.18–322.11 Olivieri), Libri med. 7.93 (Vol. 2, 339.23–31 Olivieri), Libri med. 15.5 (17.10–22.23 Zervos).

22 | General introduction

Aegina, where his name is likewise found mainly in the context of surgery.143 This evidence confirms that Leonides was a surgeon or, at the very least, someone who taught or wrote about these matters.144 3.3.4.2 Galen of Pergamon Galen of Pergamon lived around 129–210 CE and was the most influential medical writer for centuries to come. For a closer look at his life and his immense œuvre, see e.g. Boudon-Millot 2012a. In chapters 1–10 of Aetius’ sixth book, Galen is not claimed to be cited as frequently as are Posidonius and Archigenes. Indeed, Galen is only said to be cited in chapters nine and ten,145 although his name also appears in the eighth chapter, where the administration of a potion, which is named after him, is mentioned.146 However, the references to Galen do not cover every passage in which he is cited. There is, in fact, at least one passage in chapters 1–10 where another author than Galen is cited but what we read matches a passage found in Galen.147 It is difficult to explain such findings. It might be that Aetius originally referred to Galen but that this reference was not adopted by later scribes. Alternatively, it might be the case that Aetius did not indicate that he cites Galen for some specific but unrecorded reason, such as that he deemed it to be essential for the purpose of the passage. It might also be the case that where another author is claimed to be cited in Aetius’ compilation and where this passage is also found in a Galenic work, Galen, actually, draws on this other author as a source and Aetius was aware of this or even used this other author himself, rather than the Galenic text. In this case, Galen would be the one who does not indicate his reference. This assumption is the most interesting possibility and, if it is correct, would have the most far-reaching consequences for the interpretation of Galenic texts. Unfortunately, none of these possibilities can be either ruled out or verified decisively, although there are some interesting indicators on both sides of the argument. To begin with, given that the manuscript tradition is inconsistent in transmitting references to Galen,148 it is likely that later scribes did not always transmit references to Galen which had appeared in Aetius’ original. It seems, however, rather unlikely that the scribes would change a reference to an 143 See e.g. Paul 6.7 (Vol. 2, 50.14 Heiberg), Paul 6.44 (Vol. 2, 85.13 Heiberg), Paul 6.64 (Vol. 2, 107.11 Heiberg). 144 See also Witt forthcoming, 1 f., Scarborough 2010, 236 f., Wellmann 1895, 16 f., Gurlt 1898, 486–492. 145 See Aetius Amid., Libri med. 6.9 (Vol. 2, 141.11 Olivieri), Libri med. 6.10 (Vol. 2, 146.17 Olivieri). 146 See Aetius Amid., Libri med. 6.8 (Vol. 2, 140.12 Olivieri). 147 See Aetius Amid., Libri med. 6.7 (Vol. 2, 134.19–27 Olivieri); see also p. 307, commentary on p. 134.19–27. 148 See e.g. Olivieri’s critical apparatus to p. 143.8 or to p. 145.5 in Aetii Amideni Libri medicinales V–VIII.

3 Aetius of Amida | 23

authority such as Galen into a reference to Archigenes. As far as the possibility that Galen actually draws on another author is concerned, a passage found in the seventh chapter of Aetius’ sixth book is particularly interesting (see note 147). According to the heading of the chapter, Aetius cites Archigenes and Posidonius.149 However, parts of the text appear nearly verbatim in Galen’s De locis affectis.150 Further down in Galen’s text, Archigenes is referred to by name and even explicitly cited.151 Given that Galen clearly credits Archigenes with having written about skotoma and given that he even cites him in proximity to the passage which appears in Aetius, one might conclude that Galen also draws on Archigenes in the passage in question without mentioning the fact. This could, then, mean that the passage in Aetius does, indeed, go back to Archigenes. For a closer look at Galen’s relation to Archigenes, see e.g. Wellmann 1895, 19–22, 91, 175 f.; Asper 2005, 32 f. It would have been very useful if Paul had indicated his source(s) for his chapter on skotoma, since he also uses phrases which are similar to those found in Galen and Aetius.152 But since he does not give any reference to source(s) here, he provides no help in determining the origin of the passage. Apart from these observations concerning the overlap between Galenic passages and passages found in Aetius’ compilation, it is, in general terms, notable that ideas, theories or concepts which are visible throughout the Galenic œuvre are also present in Aetius’ compilation. This does not necessarily mean that Aetius always explicitly draws on Galen but it shows that concepts which are dealt with in Galenic treatises (again, one often loses sight of the fact that some of these concepts are even older than Galen) frequently appear in one way or another also in Aetius’ compilation. For this reason, I often turn to Galenic treatises when trying to understand the theories and concepts which may lie behind a statement in Aetius’ compilation. In many cases, some background information is necessary if one is to understand the information provided by Aetius. For a closer look at the role Galen plays in the late antique medical compilations, see Bouras-Vallianatos 2019. 3.3.4.3 Posidonius of Byzantium For a detailed discussion of Posidonius, see Gäbel 2020. The present section presents the most important aspects of this paper in a condensed form. We do not know much about the Posidonius who is cited by Aetius and scholars have identified two likely candidates. Kudlien has argued that Aetius possibly refers to Posidonius of Apamea, the Stoic,153 and he bases his theory on an assumed

149 See Aetius Amid., Libri med. 6.7 (Vol. 2, 134.11 Olivieri). 150 See Galen, De loc. aff. 3.12 (8.202.2–14 K.), Aetius Amid., Libri med. 6.7 (Vol. 2, 134.19–27 Olivieri). 151 See Galen, De loc. aff. 3.12 (8.203.12–15 K.). 152 See Paul 3.12.1 (Vol. 1, 151.24–27 Heiberg). 153 See Kudlien 1962, especially 422–424.

24 | General introduction

relation between Posidonius of Apamea and the Pneumatist school.154 To begin with, he grounds this assumption on the fact that in Aetius’ compilation references to Posidonius are often linked with the name of Archigenes, who belonged to the Pneumatist school (see p. 25 f.).155 Secondly, Kudlien argues that Posidonius is only mentioned in the chapters dealing with diseases of the head and those which are connected to mental ailments, claiming that this pattern fits with the importance the Stoics attached to understanding the passions.156 However, more plausible than the claims of a Stoic source is the suggestion advanced by Flashar,157 with which I am in agreement, that Aetius refers to Posidonius of Byzantium, a physician in the fourth century CE.158 Flashar’s argument is based on a number of points. First, he argues that the name of Posidonius is connected to the names of Rufus, Archigenes and Galen, who were all physicians, and that the chapters where Posidonius is mentioned are full of difficult pharmacotherapy (“diffizile Pharmakotherapie”).159 He takes these as arguments against the assumption that the excerpts in Aetius come from Posidonius the philosopher. He also notes that in Aetius’ chapter on phrenitis, in which Posidonius is mentioned as a source, the theory of the ventricles of the brain goes beyond the theories which are found in Galenic treatises, arguing that the Posidonius who is cited must be later than Galen.160 Flashar also refers to a passage of the church historian Philostorgius who, in his Historia ecclesiastica, speaks about a physician named Posidonius who is reported to have said that not daimones (δαίμονες) are the reason why people become mad (ἐκβακχεύεσθαι) but that the affection, instead, is brought about by a bad mixture of humors (κακοχυμία).161 Interestingly, in the twelfth chapter of Aetius’ sixth book, dealing with ephialtes and said to be taken from Posidonius, it is stated that ephialtes is not a daimon (δαίμων), and further down the noun κακοχυμία is mentioned in the context of a discussion of the cause of the affection.162 The similarity between the phrases used by Philostorgius when citing Posidonius the physician and the passage in Aetius’ sixth book, which is said to be cited from Posidonius, are so striking that they speak

154 On the summary of Kudlien’s theory see also Gäbel 2020, 49. On the Pneumatists, see, besides Kudlien 1962, e.g. also Wellmann 1895, Tielemann 2005. 155 See Kudlien 1962, 423. 156 See Kudlien 1962, 423 f. 157 On the summary of Flashar’s theory see also Gäbel 2020, 49 f. 158 See Flashar 1966, 121–126. Flashar’s footnote 9 in this section discusses the views of earlier scholars who also assumed that the reference to Posidonius in Aetius is not to the Stoic. See e.g. also Metzger 2011, 46, and Bravos 1974, 167 f. See also Gäbel 2020, 50. 159 See Flashar 1966, 122. 160 See Flashar 1966, 123, especially footnote 8. See also Bravos 1974, 167. 161 See Philostorgius, Hist. eccl. 8.10 (111.11–15 Bidez). For a discussion of this passage, see Flashar 1966, 124 f., Meyer 2004, 108 f., Metzger 2018, 79 f. I am grateful to Nadine Metzger for informing me about the paper by Doris Meyer. 162 See Aetius Amid., Libri med. 6.12 (Vol. 2, 152.13 f. Olivieri), Libri med. 6.12 (Vol. 2, 152.27 Olivieri).

3 Aetius of Amida | 25

strongly in favor of the view that the Posidonius mentioned by Philostorgius and the one mentioned in Aetius are the same. Aetius would, then, draw on Posidonius of Byzantium.163 Posidonius is clearly the writer who is most frequently said to be cited within the first half of the sixth book and especially in chapters 1–24, where the brain is mostly referred to as the affected part and the symptoms mentioned pertain to the realm of cognitive faculties (see also p. 64–67).164 Apart from these references in the sixth book, there is only one other reference to Posidonius, which appears in the third book of the Libri medicinales in a chapter dealing with the administration of hellebore and which also mentions affections of the head (ἐπί τε τῶν περὶ κεφαλὴν παθῶν).165 The striking presence of Posidonius’ name in the first half of the sixth book of Aetius’ compilation, together with the mention in Philostorgius, has led to the assumption that Posidonius was regarded as an expert in the field of diseases of the brain and of “mental” diseases.166 This may very well be the case but it is impossible to prove. When it comes to Posidonius, one cannot fail to notice that his name is often mentioned together with that of Archigenes.167 It is not clear how to interpret this proximity or how to identify which parts of those chapters are taken from which of these two sources. Unlike in other chapters, the chapters with joint references to Posidonius and Archigenes do not contain references in margine to one of the two authors and, at least according to Olivieri’s critical apparatus, neither do other manuscripts and variants. While it is important to bear this in mind we currently have no proper explanation for it.168 3.3.4.4 Archigenes of Apamea Archigenes of Apamea lived sometime around the end of the first and the beginning of the second century CE and was a follower of the Pneumatists.169 According to Wellmann, he was even “der bedeutendste Anhänger der pneumatischen Schule”170 (the most important Pneumatist). Only fragments of his works are extant171 but he is

163 For more detail on this passage from Philostorgius see Gäbel 2020, 47 f. 164 On this topic see Gäbel 2020, 42–44. See note 129 for the exact references. 165 See Aetius Amid., Libri med. 3.122 (Vol. 1, 309.20–310.4 Olivieri). 166 On this conclusion, see Gäbel 2020, 42. See e.g. Flashar 1966, 120 f., 125; Metzger 2011, 46; Nutton 2005, 294 f.; Bravos 1974, 166. 167 For the references to the chapters where both are mentioned, see note 129. 168 For a more detailed discussion see Gäbel 2020, 44 f. For a detailed discussion of the problem of double quotations in the medical compilations of Oribasius and Aetius, see Witt 2019. 169 On Archigenes, see e.g. Wellmann 1895, 19–22; Mavroudis 2000 in ΑΡΧΙΓΕΝΗΣ; Lewis 2018. 170 Wellmann 1895, 19. 171 On Archigenes’ fragments, see the collection of Mavroudis 2000 in ΑΡΧΙΓΕΝΗΣ.

26 | General introduction

credited with having written various works on topics such as pharmacology, affected parts, or the pulse.172 In the first half of Aetius’ sixth book, he is not said to be cited as frequently as Posidonius but his name still appears remarkably often in the chapter headings.173 In contrast to Posidonius, Archigenes is cited frequently throughout the whole of the sixth book and not just in its first half. Indeed, he appears as a notable source throughout the complete Libri medicinales.174 This extensive presence makes it plain that Archigenes was, or was at least claimed to be, one of the major sources for Aetius’ compilation. As discussed above, the fact that some passages which are claimed to be derived from authors such as Archigenes are also found in Galenic treatises might possibly point to Galen’s dependence on Archigenes (see p. 22 f.). I also point out above that the first half of the sixth book contains a remarkable number of chapters that are claimed to be taken from Archigenes and Posidonius and I have suggested that these joint references are extremely difficult to explain since we do not have other versions of the texts of either of the two authors (see p. 25).175 3.3.4.5 Rufus of Ephesus Rufus of Ephesus was a physician who probably lived around the first century CE, although there are some difficulties in providing precise dates for his life.176 Rufus wrote on various topics belonging to the realm of medicine, such as diseases of the bladder and the kidneys, satyriasis, and medical questions and, in addition, we have a number of fragments of his works which are preserved in other writings (not only in Greek but also in Arabic and even Syriac).177 Aetius is one of the authors who cites Rufus and, thus, provides us with some fragments of Rufus’ works which would otherwise have been lost. Rufus is said to be cited throughout the Libri medicinales; for a list of passages which refer to Rufus by name, see Bravos 1974, 148–151. As far as the first half of the sixth book is concerned, Rufus is referred to as a source in chapters nine, ten, twenty-three and twenty-four.178 The references to Rufus in the headings of these chapters are all joint references in which he is mentioned alongside other authors. These circumstances, again, make it difficult or impossible to get a clear picture of which passages might stem from Rufus. Chapters nine and ten, which are both analyzed in this study, are especially interesting with 172 For a list of titles of treatises written by Archigenes, see Wellmann 1895, 20–22. 173 For the references, see note 129. 174 For a complete list of passage where Archigenes is mentioned and referred to, see Bravos 1974, 61–71. 175 See also Witt 2019. 176 See e.g. Nutton 2008, 140 f. 177 See Nutton 2008, 139 f. Daremberg-Ruelle 1879 produced an edition of Rufus’ writings. Further editions have been produced by Gärtner 1962, Sideras 1977 and Pormann 2008. 178 See also note 129.

3 Aetius of Amida | 27

regard to questions of authorship: both chapters deal with melancholia, chapter nine discussing its symptoms and its cause as well as offering a few, rather theoretical, remarks on therapy, while chapter ten focuses exclusively on therapy.179 Both chapters are claimed to be taken from Galen, Rufus and Posidonius. As for Rufus, a number of Arabic treatises, as well as Galen, attest to his writing of a work about melancholia,180 and Galen even praises it as the best work on this affection.181 Despite the high esteem this treatise was once held in, it is now lost, and Pormann assumes that this is due to the fact that “Galen adopted and adapted Rufus, so as to overshadow and eclipse him completely”.182 Nevertheless, these texts clearly testify that Rufus had, indeed, written on melancholia and Aetius’ reference to him in a chapter on melancholia is, therefore, very credible. It is still difficult to determine which parts of the chapters are derived directly from Rufus himself but, unlike in some other chapters which include references to more than one author, for chapters nine and ten some manuscripts transmit the names of the three authors in margine at certain points.183 The role of these mentions is to indicate that the passage which follows is derived from the named author. Of course, these marginal references are still highly problematic, not just because they are absent from most manuscripts but also because they do not indicate where an excerpt ends.184 3.3.5 Compilation technique and literary technique As mentioned above, scholarship has undergone a positive change in attitude towards the medical compilations of late antiquity (see p. 2).185 Part of this change has involved a move away from looking at these compilations only as sources for excerpts of earlier authors and, instead, towards analysis of the texts “for their own intrinsic interest”.186 This move has included a recognition of the compilers’ practice 179 See Aetius Amid., Libri med. 6.9 (Vol. 2, 141.11–146.16 Olivieri), Libri med. 6.10 (Vol. 2, 146.17–151.20 Olivieri). 180 See Rufus, De melanch. F1–F4 Pormann. 181 See Galen, De atra bile 1.3 (71.12–14 de Boer = 5.105.3 f. K.) = Rufus, De melanch. F3 Pormann. 182 Pormann 2008 in Rufus of Ephesus On Melancholy, 9. 183 See Aetius Amid., Libri med. 6.9 (Vol. 2, 143.8 Olivieri), see Olivieri’s critical apparatus to p. 143.17, see Aetius Amid., Libri med. 6.10 (Vol. 2, 146.17 Olivieri), Libri med. 6.10 (Vol. 2, 146.24 Olivieri), Libri med. 6.10 (Vol. 2, 147.1 Olivieri), Libri med. 6.10 (Vol. 2, 150.28 Olivieri), Libri med. 6.10 (Vol. 2, 151.9 Olivieri). 184 On these issues, see especially van der Eijk 2008, 176 f.; Flashar 1966, 85–88; Pormann 2008 in Rufus of Ephesus On Melancholy, 85. 185 Wellmann 1895, 125, for example, still makes the following statement, which cannot be sustained as will be evident shortly: “Aetius steht in seiner schriftstellerischen Thätigkeit noch eine Stufe tiefer als Paulus, insofern als er ganz stumpfsinnig mit Verzicht auf jede eigene Meinung nach Art des Oribasius einfach Excerpt an Excerpt reiht”. In contrast to such statements, see e.g. van der Eijk & Geller & Lehmhaus & Martelli & Salazar 2015, 196–198. 186 Van der Eijk 2010, 521. See also van der Eijk & Geller & Lehmhaus & Martelli & Salazar 2015, 196–198.

28 | General introduction

and the beginning of attempts to analyze it by looking at the way the compiler selects his material, the way he arranges it, the way he presents it and changes it, and the way he guides his readers, to give just some areas of current interest. The consideration of all the different tasks the compilers had to fulfill leads van der Eijk to argue for a similarity to ancient rhetoric: “digesting and re-presenting that material required, apart from subject-specific competence, literary skills very similar to those of ancient rhetoric: finding and selecting the material, arranging and presenting it, and remembering it well enough to keep control over it: heuresis, taxis, lexis, mneme”.187 This argument will be born out by the analysis of Aetius’ compilation that I provide below. I have emphasized above how difficult it is to find traces of Aetius, the compiler, within his work. However, given that his compilation discusses nearly all important medical issues, we can, for instance, understand that his aim was probably to produce a work that provided a thorough treatment of the areas practicing physicians needed to know about. Given that he rarely makes his own opinion explicit, nor even distinguishes it from those of the sources he cites, it is reasonable to assume that his aim was not to present himself as the one who completed what earlier physicians had begun. I have also explained above the structure of the books, which are divided into chapters introduced by headings indicating the topic and sometimes also the source(s) for the chapter.188 It is also worth noting that Aetius (and probably not his source) often announces his “program” for the following lines189 by using phrases such as σκοπεῖν μὲν οὖν χρὴ (…),190 θεραπεύοντες (…),191 θεραπεία (…).192 Such phrases guide the reader through the text. A similar role is served by the cross-references which can be found throughout the compilation and which I discuss on p. 13. Taken together with the fact that Aetius had to select the texts to be integrated into his compilation and make them fit within his overall arrangement by adapting them, all these different characteristics are part of Aetius’ craft as a compiler, part of his literary technique, and represent decisions Aetius made during the process of putting together his Libri medicinales. In the next section, I will present a case study, taken from the ninth chapter of the sixth book, which aims to illustrate Aetius’ compilation technique and literary technique by providing a significant textual example.

187 Van der Eijk 2010, 521. 188 For a general look at the structure and organization of ancient scientific texts, see van der Eijk 1997, 111–113. 189 For a discussion of this issue in ancient scientific texts, see van der Eijk 1997, 112. 190 See Aetius Amid., Libri med. 6.3 (Vol. 2, 128.22 Olivieri). 191 See e.g. Aetius Amid., Libri med. 6.3 (Vol. 2, 129.16 Olivieri). 192 See e.g. Aetius Amid., Libri med. 6.6 (Vol. 2, 134.3 Olivieri).

3 Aetius of Amida | 29

3.3.5.1 Case study193 The following table presents a comparison of a passage from Aetius’ ninth chapter, which deals with melancholia, and the parallel passage in Galen’s De locis affectis. Consistencies between both texts are printed in bold type, striking discrepancies are underlined. When I refer to lines in what follows, the line numbers refer to those which are printed in margine next to the table. They do not match the line numbers of the editions of Aetius and Galen.

193 I have also dealt with the comparison between Aetius’ ninth chapter and Galen’s De locis affectis in my paper Gäbel 2021, 340–348. For an earlier version of this paper, see also Gäbel 2019, 11–19.

30 | General introduction

Aetius (Libri med. 6.9, 141.12–24 Olivieri; 145.4–19 Olivieri)

 

ὥσπερ ἐν τοῖς φαινομένοις μέρεσι τοῦ σώματος ἐνίοτε μὲν ἅπασιν ἡ αὐτὴ φαίνεται κρᾶσις, ὡς ἐν καχέκταις τε καὶ κατὰ τὸν καλούμενον ἐλέφαντα καὶ τοὺς ὑδέρους,

5

10

15

20

25

30

ἐνίοτε δ' ἕν τι μόριον ἤτοι πικρόχολον ἢ μελαγχολικὸν ἢ φλεγματικὸν ὑποδεχόμενον χυμὸν αὐτὸ μόνον ἐξαλλάττεται τὴν κρᾶσιν, οὕτως ἐγχωρεῖ καὶ τὸν ἐγκέφαλον ἐνίοτε μὲν παντὸς τοῦ κατὰ τὰς φλέβας αἵματος μελαγχολικοῦ γεναμένου τῷ κοινῷ λόγῳ τῆς βλάβης καὶ τὸν ἐγκέφαλον βλαβῆναι, καθ' ἕτερον δὲ τρόπον καὶ καιρὸν ἀπαθοῦς διαμένοντος τοῦ καθ' ὅλον τὸν ἄνθρωπον αἵματος ἀλλοιωθῆναι τὸ κατὰ μόνον τὸν ἐγκέφαλον. καὶ συμβαίνει τοῦτο διττῶς, ἢ ῥυέντος εἰς αὐτὸν ἑτέρωθεν, ἢ γεννηθέντος ἐν τῷ τόπῳ τοῦ μελαγχολικοῦ χυμοῦ. γεννᾶται δὲ ὑπὸ θερμασίας πολλῆς ἐγχωρίου κατοπτώσης ἤτοι τὴν ξανθὴν χολὴν ἢ τὸ παχύτερόν τε καὶ μελάντερον αἷμα. […] διαφέρει δὲ εἰς τὴν θεραπείαν οὐ σμικρὰ τὸ εἰδέναι ὅθεν τὴν ἀρχὴν ἔσχε τὸ νόσημα. Γαληνοῦ. ὅταν μὲν γὰρ ὅλον τὸ σῶμα μελαγχολικὸν ἔχῃ τὸ αἷμα, τὴν ἀρχὴν τῆς θεραπείας ἀπὸ φλεβοτομίας ποιεῖσθαι προσῆκον· ὅταν δὲ τὰ κατὰ μόνον τὸν ἐγκέφαλον οὐ χρῄζει φλεβοτομίας ὁ κάμνων, εἰ μήτι γε πολύαιμος εἴη καὶ χάριν προφυλακῆς τὴν ἀφαίρεσιν ποιούμεθα. ἡ δ' οὖν διάγνωσις ἀπὸ τῶνδέ σοι γιγνέσθω, πότερον ὅλον τὸ σῶμα μελαγχολικὸν ἔχει τὸ αἷμα ἢ κατὰ τὸν ἐγκέφαλον μόνον ἤθροισταί τις τοιοῦτος.

35 οἱ 〈μὲν〉 μελάντεροι καὶ δασεῖς καὶ φλέβας εὐρείας ἔχοντες ἐπιτηδειότατοι πρὸς τὴν τοῦ μελαγχολικοῦ χυμοῦ γένεσιν, ἔσθ' ὅτε δὲ καὶ οἱ ἐξέρυθροι τὴν χρόαν ἄνθρωποι μεταπίπτουσιν 40 ἀθρόως εἰς τὴν μελαγχολικὴν κρᾶσιν· ἐφεξῆς δὲ αὐτῶν οἱ ξανθοὶ καὶ μάλισθ' ὅταν ἀγρυπνίαις καὶ πόνοις πλείοσι καὶ φροντίσι καὶ λεπτῇ διαίτῃ ἢ μελαγολικοῖς ἐδέσμασι διῃτημένοι τύχωσιν ὄντες· πρὸς τούτοις εἰ 45 ἐπέσχηταί τις αἱμορροῒς ἐν ἕδρᾳ ἢ ἄλλη τις συνήθης κένωσις αἵματος ἢ καταμήνια ταῖς γυναιξίν.

Galen (De loc. aff. 3.10, 8.181.9–183.8 K.)

ὥσπερ γὰρ ἐν τοῖς φαινομένοις μέρεσι τοῦ σώματος ἐνίοτε μὲν ἅπασιν ἡ αὐτὴ φαίνεται κρᾶσις, ὡς ἐν ἰκτέροις τε καὶ κατὰ τὸν καλούμενον ἐλέφαντα καὶ τοὺς ὑδέρους, ἔτι τε καχεξίας, καὶ πρὸς ταύταις ἐν ἡπατικαῖς τε καὶ σπληνικαῖς ἀχροίαις, ἐνίοτε δ' ἕν τι μόριον ἤτοι πικρόχολον ἢ φλεγματικὸν ἢ μελαγχολικὸν ὑποδεξάμενον χυμὸν αὐτὸ μόνον ἐξαλλάττεται τὴν κρᾶσιν, οὕτως ἐγχωρεῖ καὶ τὸν ἐγκέφαλον ἐνίοτε μὲν, ἅπαντος τοῦ κατὰ τὰς φλέβας αἵματος μελαγχολικοῦ γενομένου, τῷ κοινῷ λόγῳ τῆς βλάβης καὶ αὐτὸν βλαβῆναι· καθ' ἕτερον δὲ τρόπον ἀπαθοῦς διαμένοντος τοῦ καθ' ὅλον τὸν ἄνθρωπον αἵματος, ἀλλοιωθῆναι τὸ κατὰ μόνον τὸν ἐγκέφαλον, καὶ συμβῆναι τοῦτο διττῶς, ἢ ῥυέντος εἰς αὐτὸν ἑτέρωθεν, ἢ γεννηθέντος ἐν τῷ τόπῳ τοῦ μελαγχολικοῦ χυμοῦ· γεννᾶται δ' ὑπὸ θερμασίας πολλῆς ἐγχωρίου, κατοπτώσης ἤτοι τὴν ξανθὴν χολὴν, ἢ τὸ παχύτερόν τε καὶ μελάντερον αἷμα. διαφέρει δ' εἰς τὴν θεραπείαν οὐ σμικρὸν ὁ διορισμὸς οὗτος· ὅτ' ἂν μὲν γὰρ ὅλον τὸ σῶμα μελαγχολικὸν ἔχῃ τὸ αἷμα, τὴν ἀρχὴν τῆς θεραπείας ἀπὸ φλεβοτομίας προσῆκεν ποιεῖσθαι· ὅτ' ἂν δὲ τὸ κατὰ μόνον τὸν ἐγκέφαλον, οὐ χρῄζει φλεβοτομίας ὁ κάμνων, ὅσον γε ἐπὶ τῇ διαθέσει ταύτῃ, κατ' ἄλλο γάρ τι δυνατόν ἐστι χρῄζειν αὐτόν. ἡ δ' οὖν διάγνωσις ἀπὸ τῶνδέ σοι γιγνέσθω, πότερον ὅλον τὸ σῶμα μελαγχολικὸν ἔχει χυμὸν, ἢ κατὰ μόνον τὸν ἐγκέφαλον ἤθροισταί τις τοιοῦτος, καὶ ἀξιῶ σε πρῶτον μὲν ἐπισκέψασθαι τὴν τοῦ σώματος ἕξιν ὁποία τίς ἐστιν, μεμνημένον, ὡς οἱ μὲν ἁπαλοὶ καὶ λευκοὶ καὶ πίονες ἥκιστα μελαγχολικὸν ἴσχουσι χυμὸν, οἱ δ' ἰσχνοὶ καὶ μελάντεροι καὶ δασεῖς καὶ φλέβας εὐρείας ἔχοντες, ἐπιτηδειότατοι πρὸς ταὐτοῦ τοιούτου χυμοῦ γένεσιν ὑπάρχουσιν, ἔσθ' ὅτε δὲ καὶ οἱ ἐξέρυθροι τὴν χρόαν ἄνθρωποι μεταπίπτουσιν ἀθρόως ἐπὶ τὴν μελαγχολικὴν κρᾶσιν· ἐφεξῆς δ' αὐτῶν οἱ ξανθοὶ, καὶ μάλισθ' ὅταν ἐν ἀγρυπνίαις καὶ πόνοις πλείοσι καὶ φροντίσι καὶ λεπτῇ διαίτῃ προδεδιῃτημένοι τύχωσιν. ὁμογενῆ δὲ τούτοις ἐστὶ καὶ τὰ τοιαῦτα γνωρίσματα· πότερον ἐπέσχηταί τις αἱμοῤῥοῒς, ἢ καί τις ἄλλη συνήθης αἵματος κένωσις, ἢ καταμήνια ταῖς γυναιξί·

3 Aetius of Amida | 31

The discrepancies between Galen’s text and Aetius’ version of it in lines 1–21 (ὥσπερ – αἷμα) are only small and might even be explained by variants in the manuscript tradition. Of particular interest is the break between lines 21–22. Aetius stops quoting Galen’s De locis affectis here but goes on for three pages of Olivieri’s edition (p. 141.24–145.4 Olivieri) to draw on different material, the origin of which we can only guess at, except in those parts which explicitly refer to their sources.194 After this Aetius goes on to continue his quotation from the earlier Galenic passage from exactly the point at which he had stopped (line 22: διαφέρει δὲ). There is no indication in the text that Aetius stops quoting Galen and continues with the text of some other source or even with his own theories. If we did not have the Galenic text at hand and were, thus, unable to compare the original to Aetius’ adaptation, we would have no chance of spotting this particular “Aetian” way of dealing with Galen. The reason Aetius stops his quotation of Galen after line 21 may be that Galen goes on to discuss the therapy of melancholia (line 22: τὴν θεραπείαν…) while in the rationale of Aetius’ chapter the therapy is not to be discussed yet. He therefore continues with the discussion of the different forms of melancholia before returning to the Galenic passage. The fact that we do not receive any information about the source for the subsequent passage (from p. 141.24 Olivieri onwards) led Flashar to assume that it was taken from Posidonius, since his name appears in the heading but, in contrast to the others who also appear in the heading, not within the text.195 When it comes to the continuation of the Galenic lines (p. 145.4 Olivieri), another point stands out: the actual quote starts one sentence earlier than the reference (Γαληνοῦ) suggests, namely with διαφέρει δὲ (…). When comparing Aetius’ version of this sentence (line 22–23) with the Galenic original (line 22–23), we can see that Aetius writes τὸ εἰδέναι ὅθεν τὴν ἀρχὴν ἔσχε τὸ νόσημα where Galen has ὁ διορισμός οὗτος. This difference can clearly be traced back to the fact that Aetius needs to spell out what Galen simply refers to as “this distinction” (ὁ διορισμός οὗτος), since the reader of Aetius’ lines would not have the distinction in mind by this time. By using the phrase ὁ διορισμός οὗτος, Galen indicates the distinction between the melancholic blood residing in the brain alone or that found in the whole body, which he discussed in the preceding lines. Aetius, by contrast, explains that it makes a great difference for the therapy “to know where the affection had its origin” and he thus summarizes what Galen wrote by generalizing the statement and changing it according to the needs of his compilation. If we take into account that the sentence does not cite Galen verbatim but puts into Aetius’ own words what Galen intended to convey, functioning as an introduction to and explanation of the subsequent lines, we might even conclude that this is the reason why the reference to

194 See Aetius Amid., Libri med. 6.9 (Vol. 2, 143.8 Olivieri), and the critical apparatus to Libri med. 6.9 (Vol. 2, 143.17 Olivieri). 195 See Flashar 1966, 85 f.

32 | General introduction

Galen (Γαληνοῦ) appears only after this sentence.196 It is also worth noting that the arrangement of the text here is not consistently transmitted in all manuscripts; some manuscripts (Codex Marcianus 291 [Mo] and the manuscript group ω) suggest reading what is found in Olivieri’s edition on p. 145.2–5 (τὰ μὲν οὖν – νόσημα) in front of p. 144.26 (γινώσκειν τοίνυν).197 This arrangement, which is favored by Flashar and van der Eijk,198 would involve the sentence starting with διαφέρει δὲ becoming part of a passage which is probably cited from Rufus.199 Even if there are also good reasons for accepting this reading, it seems unlikely to have been Aetius’ “original” since, as we have seen, the sentence starting with διαφέρει δὲ goes back to Galen rather than to Rufus. As regards Galen’s lines 27–29 (ὅσον γε ἐπὶ τῇ διαθέσει ταύτῃ, κατ’ ἄλλο γάρ τι δυνατόν ἐστι χρῄζειν αὐτόν), they are put rather differently in Aetius’ version (lines 28–29: εἰ μήτι γε πολύαιμος εἴη καὶ χάριν προφυλακῆς τὴν ἀφαίρεσιν ποιούμεθα). Both phrases appear in the context of the claim that patients should not be phlebotomized if only the brain contains melancholic blood, presenting an exception to this “rule”. It is interesting that Aetius clearly wants to be more concrete here and provides an example of such an exception (“if the patient is full of blood and we need to undertake phlebotomy for the sake of prophylaxis”), whereas Galen only gives a general statement (“… at least not on account of this condition (for it is possible that he requires it on other grounds)”).200 It might be the case that being full of blood (πολύαιμος) is, according to Aetius’ view, the best and most frequently occurring example of a condition which would require phlebotomy, even if only the brain is full of melancholic blood. Another important difference is that lines 32–35 in Galen’s text (καὶ ἀξιῶ σε πρῶτον μὲν ἐπισκέψασθαι τὴν τοῦ σώματος ἕξιν ὁποία τίς ἐστιν, μεμνημένον, ὡς οἱ μὲν ἁπαλοὶ καὶ λευκοὶ καὶ πίονες ἥκιστα μελαγχολικὸν ἴσχουσι χυμὸν, οἱ δ’ ἰσχνοὶ καὶ) do not appear in Aetius’ compilation. Given that Galen deals in these lines with the bodily conditions which are least prone to produce a melancholic mixture, it may be that Aetius did not use them for his compilation since he wanted to lay special emphasis on those conditions which are prone to the melancholic mixture. Indeed, Aetius adopts only the part of the Galenic text which discusses those conditions. These examples give a valuable insight into the way Aetius proceeded when composing his compilation; they show the decisions he made when working with the texts of his sources and the steps he took in order to construct his compilation.

196 I owe Florian Gärtner a debt of gratitude for suggesting this interpretation. 197 See Olivieri’s apparatus of parallel texts to p. 145.2–5. 198 See Flashar 1966, 87 note 9; van der Eijk 2008, 176. 199 The excerpt of Rufus’ work probably starts on p. 143.17. 200 I cite van der Eijk’s translation of the Galenic passage here, which is found in Pormann 2008 in Rufus of Ephesus On Melancholy, 273.

3 Aetius of Amida | 33

3.3.6 Relation to other compilations All over Aetius’ Libri medicinales one can find passages which are extremely similar to passages found in the works of Oribasius, Alexander or Paul. It is clear that the compilers knew the works of their predecessors, since they mention them by name in their own works. Aetius, for instance, mentions Oribasius as a source in a number of chapters.201 Photius, in his Bibliotheca, presents a list of authors used by Aetius in his compilation, stating that, “Aetius has composed his work by drawing from what Oribasius has written to Julian, Eustathius and Eunapius, and further from the therapeutic books of Galen, and of Archigenes and of Rufus, further of Dioscorides and of Herodotus and of Soranus and of Philagrius and of Philumenus and of Posidonius and of others who have left their mark on the medical art”.202 This statement is remarkable insofar as it explicitly credits Aetius with having used Oribasius’ “encyclopedic” works for his own compilation, and Oribasius is mentioned as the first name in the list, even before Galen. It is, thus, clear that Aetius used Oribasius’ works and that authors posterior to Aetius still were aware of this.203 Aetius himself is mentioned by name as a source in the work of Alexander of Tralleis204 and the passage which follows this reference is, at least to some extent, indeed found in Aetius’ compilation.205 Paul does not refer to his sources by name as frequently as Aetius does206 but the name of Oribasius also appears in his compilation.207 In his proem, Paul even explicitly relates his own compilation to the works of Oribasius, setting out what his own compilation offers in contrast to Oribasius’ works.208 When coming across passages in Aetius’ compilation that show remarkable similarities, alongside notable differences, to passages found in other compilers, the question arises as to how to explain these similarities and differences. Answering this question is a difficult, sometimes even impossible, task. Various attempts to answer this question have been made and particular attention should be paid to treatments offered by Sideras 1974, Capone Ciollaro & Galli Calderini 1992 and van der Eijk 2010, 536–552.209 All of these deal, in part, with Aetius’ relation to

201 See e.g. Aetius Amid., Libri med. 2.197 (Vol. 1, 226.10 Olivieri), Libri med. 3.109 (Vol. 1, 300.4 Olivieri), Libri med. 6.55 (Vol. 2, 203.21 Olivieri). 202 See Photius, Bibliotheca cod. 221 (140.15–22 Henry). 203 See also van der Eijk 2010, 521, 533. 204 See Alexander, De febr. 7 (437.25 Puschmann). 205 See Aetius Amid., Libri med. 5.90 (Vol. 2, 69.14–71.19 Olivieri). 206 See also van der Eijk 2010, 535. 207 See e.g. Paul 3.22.25 (Vol. 1, 182.1 Heiberg), Paul 4.19.3 (Vol. 1, 339.28 Heiberg), Paul 7.17.86 (Vol. 2, 367.20 Heiberg). 208 See Paul proem (Vol. 1, 4.6–17 Heiberg). For an analysis of this passage, see also van der Eijk 2010, 535. 209 Further studies which are concerned with Aetius’ sources are Masullo 1992, Pignani 1992. They do, however, not focus on Aetius’ relation to Oribasius.

34 | General introduction

Oribasius.210 In analyzing excerpts of Rufus’ treatise De renum et vesicae morbis that are found in both Oribasius and Aetius, Sideras argues, at first, that Aetius does not depend on Oribasius, and, secondly, that both compilers did not take the excerpts from the original text but from another, unknown, intermediary source.211 The first assumption is supported by reference to the fact that Aetius shares similarities to Rufus which he does not share with Oribasius and that he keeps passages which are not contained in Oribasius’ version. He must, therefore, be independent of Oribasius, Sideras concludes.212 The second claim is reinforced by the fact that Aetius and Oribasius share additions, changes and omissions when compared to Rufus’ text, which, Sideras argues, implies that both compilers used the same Vorlage which differed from Rufus’ original treatise.213 Capone Ciollaro and Galli Calderini compare passages of Aetius with the versions of Galen and Oribasius and find that Aetius’ text is often longer than Oribasius’ version. This observation leads them to conclude that Aetius did not use Oribasius as an intermediary source. Aetius may, they think, have made some modifications on his own, some parts may be derived from Galen, others from Oribasius, including some parts of Oribasius which are now lost.214 Van der Eijk, when comparing a set of texts which Oribasius, Aetius and Paul derive from Galenic material, suggests, in contrast to Sideras, that it is also possible that Aetius himself “decided to arrange his material in a different way”215 and that he did not necessarily always use another source whose version he adopts whenever he does not follow Oribasius’ text. As I have adumbrated previously, an answer to this question is highly difficult, or even impossible, to give because of the state of transmission. There are many possible ways to account for these observations but some things can be said for certain. First, it is beyond doubt that the compilers did not always, although they may on occasion, blindly copy every text they used, whether it be the text of the original author, of a source we do not have at hand, or of another compiler. Rather they were flexible in changing these texts according to their own opinions or preferences (see also p. 29–32). Unless we accept this we cannot, I think, reasonably explain why, in spite of all close parallels between the compilers, there are still remarkable differences of various kinds and in various parts of the passage. In my view, these differences cannot simply be explained away by reference to an unknown intermediary source. Secondly, it may very well be that the compilers used more than one text on the same topic, which is to say that Aetius may have used Galen’s original text (or another author’s text) on a certain topic but at the same time also made use of Oribasius’ version of it, taking from both what he deemed appropriate 210 See also Wellmann 1895, 72 f., 92–94, 110–114. 211 See in summary Sideras 1974, 126. 212 See in summary Sideras 1974, 127. 213 See in summary Sideras 1974, 127. 214 See in summary Capone Ciollaro & Galli Calderini 1992, 69–72. 215 Van der Eijk 2010, 545.

3 Aetius of Amida | 35

and, where necessary, adding elements included by neither. This is one possible explanation for the similarities and differences between the compilers. Of course, it could also be that the compilers did not use, or not only use, Galen (or another author) but also an intermediary source which contained a version of Galen’s text (or that of the other author). The fact that the compilers used such intermediary sources in different ways would then explain the differences and similarities between them. We cannot exclude such a possibility but it is important to emphasize that there are other ways of accounting for the similarities and differences between the compilers. In what follows, I will present a case-study that is based on a passage of Aetius’ tenth chapter (on the therapy of melancholia) taken from Galen’s De locis affectis and which shares similarities with the versions of the Galenic text appearing in Oribasius and Paul. The aim will be to illustrate the issues surrounding the relationship between the compilers and to identify similarities and differences between Aetius’ version and those of Oribasius and Paul, in the context of their relation to the Galenic original. 3.3.6.1 Case study The following table presents a comparison of a passage of Aetius’ tenth chapter with the parallel passage in Galen’s De locis affectis and the versions that appear in Oribasius and Paul. Similarities between Galen, Oribasius, Aetius and Paul are identified in bold type; similarities between all three compilers are double underlined; similarities between just two compilers are simply underlined; similarities only pertaining to Galen and one of the compilers are underlined with a dotted line, and passages which are only found in one compiler are underlined with a wavy line. When I refer to lines in what follows, the line numbers are those printed alongside the table rather than the line numbers in the editions of Galen, Oribasius, Aetius and Paul.

25

20

ἀναμιμνήσκω δὲ τοὺς ἰδόντας ἑταίρους διά τε λουτρῶν πολλῶν καὶ διαίτης εὐχύμου τε καὶ ὑγρᾶς τὴν τοιαύτην μελαγχολίαν 5 ἐκθεραπεύοντά με χωρὶς ἑτέρου βοηθήματος, ὅταν γε μήπω διά τε χρόνου μῆκος δυσεκκένωτος ᾖ ὁ λυπῶν χυμός· ὡς ὅταν γε ἤδη κεχρονικὸς ὑπάρχῃ τὸ νόσημα, 10 μειζόνων ἑτέρων ἐπὶ τοῖς εἰρημένοις δεῖται βοηθημάτων. ἐπιγίνεται δὲ ἡ τοιαύτη μελαγχολία προηγησαμέναις θερμαῖς διαθέσεσι τῆς κεφαλῆς, 15 […].

Galen (De loc. aff. 3.10, 8.192.13– 193.2 K.) δεῖ δὲ τὴν τοιαύτην μελαγχολίαν διά τε λουτρῶν  συνεχῶν καὶ διαίτης  εὐχύμου τε καὶ ὑγρᾶς ἐκθεραπεύειν χωρὶς ἑτέρου  βοηθήματος, ὅταν γε μήπω διὰ χρόνου μῆκος δυσεκκένωτος ὁ λυπῶν ᾖ χυμός, ἡνίκα ποικιλωτέρας τε  καὶ ἰσχυρὰς προσάγειν χρὴ τὰς ἰάσεις. ἀρχόμενον οὖν  θεραπεύειν τὸ πάθος προσήκει· χρονίσαν γὰρ καὶ αὐξηθὲν δυσμεταχείριστον γίνεται. καθαίρειν τοίνυν  πρώτοις χρὴ ἐπιθύμῳ ἢ ἀλόῃ· τούτων γὰρ εἰ καὶ ὀλίγον ἐφ' ἑκάστης ἡμέρας λαμβάνει, ὠφελεῖ τὰ μέτρια καὶ ἡσυχῇ ὑπάγει. καθήραντα γοῦν, ὡς  εἴρηται, διδόναι τοῦ ἀψινθίου, νῦν μὲν τῆς πόας βρέχων ἐν ὕδατι, καὶ ἑψῶν ὅσον κυάθους δύο, νῦν δὲ τοῦ χυλοῦ ὅσον ἡμίδραχμον διατήκων ὕδατι συνεχῶς·  τὴν μὲν οὖν ἐξ ἐγκεφάλου  πρωτοπαθοῦντος συνισταμένην μελαγχολίαν διά τε λουτρῶν συνεχῶν  καὶ διαίτης εὐχύμου τε καὶ ὑγρᾶς καὶ ἀφύσου ἐκθεραπεύειν χωρὶς  ἑτέρου δραστικοῦ βοηθήματος, ὅταν  γε μήπω διὰ χρόνου μῆκος δυσκένωτος ᾖ ὁ λυπῶν χυμός, ἡνίκα  ποικιλωτέρας καὶ ἰσχυροτέρας  προσάγειν χρὴ τὰς ἰάσεις. ἀρχόμενον  δὲ τὸ πάθος θεραπεύειν προσήκει. χρονίσαν γὰρ καὶ αὐξηθὲν δυσμεταχείριστον γίνεται. Ῥούφου. κοινὰ δέ ἐστι, κἂν ὁ ἐγκέφαλος πρωτοπαθῇ κἂν τὰ ὑποχόνδρια, τὰ ὑπακτικὰ τῆς γαστρὸς βοηθήματα. πρῶτον μὲν οὖν εὐπεψίας φροντίδα τίθεσθαι χρή, ἔπειτα δὲ  καθαίρειν πρῶτον μὲν ἐπιθύμῳ καὶ ἀλόῃ. τούτων γὰρ εἰ καὶ ὀλίγον ἐφ' ἑκάστης ἡμέρας λαμβάνοι, ὠφελεῖται τὰ μέτρια καὶ ἡσυχῇ ὑπάγειν. 

Oribasius (Synops. ad Eustath. 8.6, Aetius (Libri med. 6.10, 146.17–28 Olivieri) 248.25–249.4 Raeder)

τοὺς μὲν οὖν κατὰ πρωτοπάθειαν τοῦ  ἐγκεφάλου μελαγχολικοὺς διά τε  λουτρῶν συνεχῶν καὶ διαίτης  εὐχύμου τε καὶ ὑγρᾶς ἐκθεραπεύειν  ἅμα τῇ κατὰ τὴν ψυχὴν προσηκούσῃ θυμηδίᾳ χωρὶς ἑτέρου βοηθήματος,  ὅταν γε μήπω διὰ χρόνου μῆκος δυσεκκένωτος ὁ λυπῶν ᾖ χυμός, ὅτε   καὶ ποικιλωτέρας καὶ ἰσχυροτέρας  προσάγειν χρὴ τὰς ἰάσεις. καθαίρειν οὖν αὐτοὺς εὐθὺς ἐξ ἀρχῆς ἐπιθύμῳ ἢ ἀλόῃ· τούτων γὰρ εἰ καὶ ὀλίγον ἐφ' ἑκάστης ἡμέρας λαμβάνοιεν, ὠφελεῖ τὰ μέγιστα καὶ ἡσυχῆ ὑπάγει. καθήραντα οὖν, ὡς εἴρηται, διδόναι τοῦ ἀψινθίου, νῦν μὲν τῆς πόας βρέχων ἐν ὕδατι καὶ ἑψῶν ὅσον κυάθους δύο, νῦν δὲ τοῦ χυλοῦ ὅσον ἡμίδραχμον διατήκων ὕδατι συνεχῶς. 

Paul (3.14.2, Vol. 1, 157.6–15 Heiberg)

36 | General introduction

3 Aetius of Amida | 37

The first remarkable difference between Galen’s text and the versions of Oribasius, Aetius, and Paul is the fact that in Galen’s De locis affectis the passage is framed by a sentence in the first person which is used to highlight Galen’s achievements as a physician (lines 1–5: ἀναμιμνήσκω … τοὺς ἰδόντας ἑταίρους … ἐκθεραπεύοντά με, “I refer to friends who saw me treating…”).216 The personal elements completely disappear in the versions of the compilers. Instead, they use an impersonal construction (Oribasius: δεῖ … ἐκθεραπεύειν (lines 1–5); Aetius (line 5) and Paul (line 4): ἐκθεραπεύειν), since Galen’s way of presenting the therapeutic remarks does not fit with the aim of their compilations. In contrast to Galen and Oribasius, Aetius and Paul each spell out what the former two simply refer to as τὴν τοιαύτην μελαγχολίαν (Galen: line 4, Oribasius: lines 1–2): while Aetius uses the phrase τὴν μὲν οὖν ἐξ ἐγκεφάλου πρωτοπαθοῦντος συνισταμένην μελαγχολίαν (lines 1–3), Paul writes τοὺς μὲν οὖν κατὰ πρωτοπάθειαν τοῦ ἐγκεφάλου (lines 1–2). Although both interpret the pronoun τοιαύτην as referring to the form of melancholia which is brought about by a primary affection of the brain, the phrases they use are still different. This difference might suggest that the phrases come from Aetius and Paul themselves and are, thus, examples of changes they make where neither the original text nor the versions of earlier compilers meet their expectations. Indeed, it makes good sense within the framework of the texts to understand the pronoun τοιαύτην as referring to the form of melancholia brought about by a primary affection of the brain (for more on this, see p. 463, commentary on p. 146.17–18). As the text goes on, one realizes that all the compilers have changed Galen’s πολλῶν (line 2) to συνεχῶν (line 3), probably because they were in favor of a slightly more nuanced formulation. It may be the case that Aetius and Paul follow Oribasius’ model here. In adding the adjective ἀφύσου (line 5) to the list of characteristics of the appropriate regimen, Aetius departs from both Galen and Oribasius. In using this adjective, he picks up what has been said in the previous chapter on melancholia about the occurrence of flatulence.217 The usage of the adjective δραστικοῦ (line 6) in Aetius is another example of an addition which is found neither in Galen nor in Oribasius or Paul. This inclusion seems to stem, rather, from Aetius himself, who probably wanted to highlight what kind of “other remedy” (ἑτέρου … βοηθήματος) does not need to be applied as long as the troubling humor can easily be evacuated. Interestingly, Paul adds another phrase around these lines (lines 5–6: ἅμα τῇ κατὰ τὴν ψυχὴν προσηκούσῃ θυμηδίᾳ, “together with appropriate pleasantness for the soul”). This does not appear in Galen, Oribasius or Aetius and seems, as was the case with Aetius, to be Paul’s own addition. This phrase brings a different therapeutical sphere into play, namely that of psychology. The use of the adjective δυσκένωτος in 216 I quote van der Eijk’s translation of Galen here, which is found in Pormann 2008 in Rufus of Ephesus On Melancholy, 287. 217 See Aetius Amid., Libri med. 6.9 (Vol. 2, 142.8 f. Olivieri), where it is stated that the form of melancholia which is brought about by a primary affection of the hypochondria which leads the brain to co-affection, often starts from indigestion and flatulence.

38 | General introduction

Aetius (line 8) in contrast to the δυσεκκένωτος which is found in Galen (line 7), Oribasius (line 8) and Paul (line 8) might be explained by haplography which occurred during the process of copying the text. The subclause ἡνίκα ποικιλωτέρας καὶ ἰσχυροτέρας προσάγειν χρὴ τὰς ἰάσεις (“in which case it is necessary to administer more complex and stronger remedies”) is not contained in the Galenic original but only in Oribasius (lines 9–11), Aetius (lines 8–10) and Paul (lines 8–10). The latter, however, uses the subjunction ὅτε instead of ἡνίκα, which is the reading of Oribasius and Aetius. Aetius and Paul both have the comparative ἰσχυροτέρας whereas Oribasius reads ἰσχυρὰς. It is possible that this subclause is Oribasius’ addition which was later copied by Aetius, who changed the ἰσχυρὰς into ἰσχυροτέρας, and by Paul, who followed Aetius in changing the form of the adjective. It is, of course, also possible that this addition stems from another unknown source used by all three compilers but, given that there is the variance between ἰσχυρὰς and ἰσχυροτέρας and not all three transmit the same reading, it seems clear that at least one of the compilers changed the version he used. It is extremely interesting that the subclause seems to transmit an idea which is also expressed in Galen’s text: in Galen’s sentence starting with ὡς ὅταν γε ἤδη (line 8) it is stated that one needs to administer other, stronger remedies in comparison to those previously mentioned. As we see in this sentence, Galen also mentions stronger remedies (lines 10–11: μειζόνων … βοηθημάτων) and this phrase is similar in meaning to what we find in the versions of the compilers who mention “more complex and stronger remedies” (Oribasius lines 9–11: ποικιλωτέρας καὶ ἰσχυρὰς … τὰς ἰάσεις, Aetius lines 9–10: ποικιλωτέρας καὶ ἰσχυροτέρας … τὰς ἰάσεις, Paul lines 9–10: ποικιλωτέρας καὶ ἰσχυροτέρας … τὰς ἰάσεις). Galen also refers in this sentence to the illness having become chronic (line 9: κεχρονικὸς) and this topic is taken up in the versions of Oribasius and Aetius, who both state that the affection needs to be cured right at its beginning since it becomes difficult to gain control of it once it has become chronic (Oribasius lines 11–15: ἀρχόμενον οὖν θεραπεύειν τὸ πάθος προσήκει· χρονίσαν γὰρ καὶ αὐξηθὲν δυσμεταχείριστον γίνεται, Aetius lines 10–13: ἀρχόμενον δὲ τὸ πάθος θεραπεύειν προσήκει. χρονίσαν γὰρ καὶ αὐξηθὲν δυσμεταχείριστον γίνεται). The fact that ideas and topics found in Galen’s De locis affectis reappear in at least some of the compilers speaks strongly in favor of the assumption that the passage starting from ἡνίκα and ending with γίνεται is a reformulation and specification of Galenic ideas. One may assume that Aetius copies from Oribasius here but it is also possible that these parts of the chapter stem from a lost Galenic text or another unknown source. Wherever this passage derives from, Paul integrated only its first part into his compilation since the sentence starting with χρονίσαν does not appear in his work. If we look further at Aetius’ text, we see that the passage starting from line 14 is claimed to be taken from Rufus (Ῥούφου; for more on the problems connected to such references, see p. 12). If we assume that this reference to Rufus is reliable, it is noteworthy that the last part of the quote from Rufus (lines 18–22: χρὴ – ὑπάγειν) is

3 Aetius of Amida | 39

also contained in the compilations of Oribasius and Paul, where it is directly attached to the Galenic quote (Oribasius: lines 15–20, Paul: lines 10–14). It is worth asking whether all three compilers do indeed cite Rufus here or whether the reference to Rufus in Aetius’ chapter is not trustworthy. In the latter case, the lines might come instead from either a lost Galenic treatise, another unknown source, or from Oribasius, who would then have been copied by the other two compilers. Unfortunately, it is impossible to answer such questions. In spite of the many questions that remain open, it has become clear that, as discussed earlier (see p. 33–35), each compiler may have used several sources, and, in addition to what he found in those sources, also made changes himself. Notwithstanding the similarities between the compilers, each constructed his unique text by making his determinations about arrangement, abbreviation and additions to the source-texts.

4 Diseases of the brain and mental illness218 I now turn to the discussion of the term “mental” illness which I have so far used on a number of occasions as a phrase that could be applied to affections discussed in the first half of Aetius’ sixth book. In the present section, which is devoted exclusively to the notion of “mental” illness, this term shall be examined and explained in more detail.219 In what follows, I will begin by discussing the problems and caveats involved in speaking of an affection as mental and explain how this term is used in the present study. I will then go on to give an overview of the appearance in ancient medical texts of what I refer to here as mental illnesses. Since it would go beyond the scope of this study, it will not be possible to examine in detail the presence of mental illnesses in poetic texts, such as tragedy or epos, nor in philosophical texts, and I refer to the

218 Van der Eijk 2013, 308 makes an important point when he notes that “in talking about the ancient material, we tend to use expressions such as mental illness, condition, disturbance, dysfunctioning, disorder, failure, deficiency or impairment, as if they were interchangeable and as if it were clear what they included or excluded. However, as we are acutely aware from today’s medical discourse, such terms are not value-free, and one has to be extremely careful in their usage, as they have implications for the way people who are believed to be affected by such conditions are being perceived, labelled, categorised and indeed stigmatised by society, by policy makers and health insurance companies”. 219 I have used quotation marks around “mental” so far in order to highlight the difficulties in applying this term to ancient medical texts. From now on I will stop using quotation marks since this section is dedicated to the discussion of exactly these difficulties.

40 | General introduction

existing literature on these topics.220 Next, I will turn to mental illnesses in late antiquity, examining the appearance of such illnesses in Oribasius, Alexander and Paul on the one hand, and in Aetius on the other. Aetius and the presence of mental illnesses in his sixth book are the core of my study, and I will, therefore, also look at the set of symptoms which are discussed in the chapters upon which I focus. A recent and wide-ranging overview of the existing literature on mental illness in ancient medical thought, including literature on related fields of research, has been provided by Thumiger 2017a, 1–16.

4.1 Problems connected to the term “mental” illness and how it is used here221 Use of the term mental illness is problematic and by no means unambiguous, even in a modern medical context. This is not the right place to discuss the modern difficulties related to this term but, in order to give an idea of the issues raised when dealing with mental illnesses, I will briefly highlight some interesting aspects of the contemporary debate. There is, first of all, a problem of classification and definition, which also encompasses the question of which conditions should be regarded as pathological and which not.222 As Simon has concisely pointed out, “all observers agree that we have not achieved anything approaching an ideal, let alone perfect way of classifying”.223 The applicability of this statement is visible first and foremost in the fact that the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association, is subject to ongoing controversies and is regularly updated and revised. This process involves the global definition and redefinition of mental illnesses by an editorial board, including the “identification” or “creation” of new illnesses and the removal of old ones, often due to changing social norms.224 We are, then, far away from an objective classification and definition of mental illness which is clear and does not involve conceptual grey areas or problematic generalizations, and it may reasonably be supposed that “the quest for the perfect schema is unlikely to succeed in our lifetime”.225 In addition to these 220 For further analysis of mental illnesses in poetic and philosophical texts, see e.g. Mattes 1970, Simon 1978, Pigeaud 2006/11981, van der Eijk 1990, Padel 1992, Padel 1995, Gill 1996, Hershkowitz 1998, Gill 2000, Vogt 2013, Saïd 2013, Sassi 2013, Most 2013, Ahonen 2014, Ahonen 2018. 221 I have already demonstrated my methodology concerning mental illnesses in Gäbel 2018, 316 f. Parts of the methodological section of that paper reappear here. Where I quote my paper verbatim, I have indicated this by using quotation marks. 222 See e.g. also Ahonen 2014, 1 f. 223 Simon 2013, 27. 224 The latest update (DSM V) was published in 2013 (https://www.psychiatry.org/psychiatrists/ practice/dsm [date of last access: 14/04/22]). See e.g. Harris 2013, 2; Simon 2013, 27 f.; Hughes 2013, 41. See also Thumiger & Singer 2018. 225 Simon 2013, 29.

4 Diseases of the brain and mental illness | 41

problems, the questions of what an appropriate treatment for mental illnesses should look like and whether one needs to consider mental illnesses as a separate category from bodily illnesses, are also difficult to approach, let alone resolve.226 Keeping in mind these difficulties that emerge even when using the term mental illness in modern contexts, it should be clear that they certainly do not disappear when applying the term to ancient texts. We therefore now turn to the problems connected with the application of the notion of mental illness to ancient texts227 and to the methodological approach to this topic taken in the present study. I work on the assumption that it is “legitimate to talk of mental illness in ancient texts, provided that one (1) states clearly how the term is being used; (2) distinguishes carefully between the categories used by the texts themselves and any presuppositions we apply when reading them, and (3) justifies one’s focus on mental illnesses within certain ancient texts in terms of a categorisation that makes sense within the intellectual framework implied by those texts themselves”.228 (1) My usage of the term mental illness has a twofold motivation: on the one hand, I apply this term to affections which have, in modern scholarship, been discussed under the rubric of mental diseases, such as mental derangement (παραφροσύνη) (often taken as a symptom of the following affections), phrenitis, mania, melancholia, lethargia,229 and which are, therefore, important to consider in this context. There is a sense in which this approach is anachronistic but there are also indications within the ancient texts themselves which justify such a usage of the term. For example, there is a text from the first half of the first century CE that has come down to us as a “key testimony in the history of Western psychiatry because it is the first organic, extended account of mental suffering from a medical perspective”.230 I speak of Aulus Cornelius Celsus and the eighteenth chapter of the third book of his treatise De medicina,231 on which see for more detail p. 46–48. In this section of his work, Celsus deals with what he refers to as insania (derangement or “unsoundness of mind”232) of which he discusses three different kinds (genera) which obviously match what are referred to in Greek texts as phrenitis, melancholia

226 See e.g. Harris 2013, 1 f. 227 I should point out that my study only deals with ancient texts, and does not take into account socio-cultural aspects. 228 Gäbel 2018, 316. 229 See e.g. Heiberg 1927, 25; Pigeaud 2006/11981, 70; Harris 2013, 7 f. 230 Thumiger & Singer 2018, 14. 231 See Celsus, De med. 3.18 (122.11–127.15 Marx). 232 This translation has been suggested by Heinrich von Staden in a paper entitled “Aulus Cornelius Celsus on kinds of insania: classifications, causes, therapies and sources” delivered at the workshop Mental Diseases in Ancient Medicine on the 7th October 2014 in Berlin. In my view, this translation successfully conveys very precisely what the Latin noun expresses.

42 | General introduction

and mania.233 When using the term “mental illness” in the context of ancient medical texts, one cannot ignore Celsus’ important testimony, for in his presentation of such a clear categorization he reveals that already in antiquity there was an awareness of the kinds of affections that come along with mental derangement.234 The three affections that Celsus discusses under the category of insania are also discussed in the first half of Aetius’ sixth book and for this reason are also dealt with in this study. On the other hand, when speaking of mental illness, I do not mean to say anything at all about the cause of the illness. Rather, I intend to highlight that the affections discussed under this rubric show symptoms which belong to the realm of mental functioning, i.e. which consist in some form of damage to “cognitive faculties”, such as imagination, reasoning and memory (see on this issue, p. 43 f., p. 64–67).235 It is notable that, when dealing with affections which show such symptoms, these are often said to come along with what we might call “neurological” disturbances (again, this is an anachronistic term), such as a slackening or stiffness of the limbs, general motionless, etc. They are, furthermore, also said to present themselves alongside “emotional” or “behavioral” disturbances, such as being extremely angry or extremely willing to indulge in sexual pleasures (see further on this issue, p. 64–67). (2) It must be emphasized that, when talking about mental illnesses in ancient literature, I do not refer to a clear and distinct concept or category put forward in the texts themselves. Celsus’ text referred to in (1) above is certainly an important testimony to one possible categorization of mental derangement. Still, there is no single explicit, overarching classification or categorization of what one may call mental illnesses which stretches across different time periods and applies to all the ancient medical literature.236 One must therefore look at the individual texts and search for anything that suggests categorization there, although such hints are not to be found in every work. Aetius is one of those authors whose treatise lacks at least an explicit classification, although we might be able to detect an implicit categorization there (see (3) and in more detail p. 64 f.). When applying the term “mental illness” to texts such as to late antique medical compilations it must therefore be emphasized

233 See on this issue also Thumiger & Singer 2018, 9: “The three genera traced by Celsus map onto the three Greek diseases phrenitis, melancholia and mania, although a one-to-one correspondence is not explicitly established.” 234 See also Thumiger & Singer 2018, 14 f. for a summary of Celsus’ “innovative features” as they put it. 235 For a similar usage of the term mental illness, see e.g. Boudon-Millot 2013, 130. 236 See e.g. Ahonen 2014, 10. Wittern 1991, 1 highlights: “Und doch fehlt der griechischen Sprache ein Begriff, der alle derartigen Phänomene zusammenfaßt, ein Begriff, der diejenigen Erkrankungen, die wir heute als psychische zu bezeichnen gewöhnt sind, als eine eigenständige Gruppe aus der Gesamtheit der Krankheiten heraushebt.”

4 Diseases of the brain and mental illness | 43

that the term is being applied to treatises which do not use such terminology themselves. (3) Even if the affections which we would describe as mental, according to the criteria laid out in (1) above, are not explicitly termed or categorized as such in the texts of Aetius, Oribasius, Alexander or Paul, there are still good reasons to assume that the authors perceived them as belonging to a single class of affections. This typological classification is strongly suggested by the authors’ decision to collect and present together affections such as phrenitis, mania, melancholia, and lethargia. Indeed, Aetius presents them all in one book dealing with the head, and presents them as having a common source of origin in the brain. I think that it is, thus, legitimate to speak of an “implicit categorization” in Aetius’ discussion and this makes it entirely reasonable to use the language of mental illness in discussing his work.

4.2 Mental illnesses in ancient medical texts Before turning to the analysis of the most important ancient medical authors who dealt with mental illnesses, and whose texts are best preserved, I will provide some general introductory remarks on the analysis of mental illnesses in ancient medical literature. 4.2.1 Introductory remarks When we talk about mental illnesses in the ancient medical texts, we need to be aware of the questions and ideas which underlie the discussion and constitute the theoretical framework on which it is based. In what follows, I will give a very brief and selective overview of some of these ideas which seem to have influenced Aetius. The questions of where to locate the mental faculties and how to conceive of their functionality are important for the discussion of mental functioning. There were various attempts in ancient medical thought to localize the source of mental activities within the body and to explain the processes of mental activities, each of which attempts was ultimately related to the localization of the leading activity of the soul (τὸ ἡγεμονικόν).237 One way of approaching these activities was to locate them in the region around the heart (cardiocentrism),238 another to locate them in

237 As van der Eijk 2005, 122 points out “this term [scil. ἡγεμονικόν] is probably of Stoic origin (c. 300 BCE) and refers to the ‘leading’ principle in the soul”. For the connection between the leading principle and the soul, see also Rocca 2003, 17. 238 For an overview of the history of cardiocentrism, see e.g. van der Eijk 2005, 119–135; Thumiger 2017a, 32–42; Thumiger 2017b, 46 f.; Rocca 2003, 18 f. Van der Eijk 2005, 125 states that one may apply such categorization with caution.

44 | General introduction

the brain (encephalocentrism).239 It is the latter the view that had the greatest impact on Aetius. This becomes clear by the overarching importance that is attached to the brain in the discussion of the mental illnesses that are presented in the sixth book of his Libri medicinales. Besides this localization of mental activities, ancient medical authors also discussed several substances and bodily processes which they believed played a role in mental functioning. Substances such as pneuma, air or the mixture of humors, and the way these are disposed within, or are present, absent or about to enter the part of the body where the mental activities are localized (i.e. the brain in the case of encephalocentric theories) are mentioned in this regard.240 The assumption that the brain is the seat of mental activities and of the ruling part of the soul gained further momentum with Herophilus’ discovery of the nerves in the fourth/third century BCE,241 which were, then, also included in a description of the activities of the hegemonikon.242 In general, mental illnesses in ancient medical texts were traced back to physiological processes happening in the body. As Drabkin puts it, “throughout Greek medical history, from the Hippocratic period to the time of Galen and his successors, mental disorder is viewed in essentially physiologic terms”.243 As will become evident in the following discussion, the therapy for such illnesses, therefore, mainly aims at the restoration of a healthy bodily condition. However, the bodily basis of these illnesses does not exclude the possibility of therapeutical approaches which we might today refer to as psychological, as we will see shortly.

239 For an overview of the history of the encephalocentric view, see e.g. Manuli 1977, von Staden 2000, Rocca 2003, 17–47. Van der Eijk 2005, 125 states that one may apply such categorization with caution. 240 See e.g. Hippocrates, De morb. sacr. 16.1 (29.4–8 Jouanna = 6.390.10–13 L.), Diocles fr. 80.2–6 van der Eijk, Galen, De plac. Hipp. et Plat. 7.3.19–22 (442.36–444.11 de Lacy = 5.605.18–606.15 K.), Quod animi mor. 3 (16.5–7 Bazou = 4.774.18–775.3 K.). Van der Eijk 2005, 130 summarizes it as follows: “When speaking about exercising these faculties, they [scil. the authors which are discussed in this paper: “Hippocrates”, Diocles, Aristotle] virtually always do so in terms of certain substances (such as blood, air or water) or qualities (hot, cold, dry, wet) and of processes such as flowing and distributing or, in case the psychic faculties have been disturbed, of stagnation, constipation, blockage, and so on.” See also von Staden 2000, 106. 241 On Herophilus’ life and his theories on the brain and the nerves, see von Staden 2007/11989 in Herophilus The Art of Medicine, 35–50, 155–161; von Staden 2000, 87–91; Solmsen 1971, 258– 279. Alcmeon of Croton undertook important preliminary studies in this field; see e.g. von Staden 2007/11989 in Herophilus The Art of Medicine, 155; Drabkin 1955, 224; Rocca 2003, 22 f. 242 See e.g. von Staden 2000, 88. 243 Drabkin 1955, 225.

4 Diseases of the brain and mental illness | 45

4.2.2 Medical texts from the fifth and fourth century BCE (especially the “Corpus Hippocraticum”)244 When studying medical texts from this time period, there is no “clear conceptualisation of mental disease”.245 This does not mean that such affections are not discussed, only that they are not presented in a systematic way. Disease concepts such as phrenitis, mania, melancholia or lethargia are indeed mentioned in the “Corpus Hippocraticum”, sometimes through the use of the noun and sometimes by using its derivatives.246 These are explained as being accompanied by a derangement of the mind (which, in the case of phrenitis, is expressed by terms such as παράνοος, παραφρονεῖν, τοῦ νοῦ παρακόπτειν etc.).247 However, it is important to note that not all of these appear in the texts as distinct and actual diseases. Mania, for example, is used rather as “a more general term”,248 indicating “a state of mental disturbance” (see also p. 335).249 As Thumiger puts it, “although these [scil. phrenitis, mania, melancholia] will become the backbone of mental nosology for later authors returning to the Hippocratic authority in their discussions, their status as psychiatric objects in early medicine is problematic”.250 Given that the “Corpus Hippocraticum” contains a large number of texts written by different authors, one cannot make a statement about the localization of such disease concepts or about the processes involved which applies to all those texts, since they pose different answers. In De morbis I, for example, phrenitis and melancholia are said to emerge when bile (and in addition phlegm, in the case of melancholia) corrupts the blood, a process which causes the derangement.251 Another example is the famous treatise De morbo sacro, in which the brain is said to be the reason why people feel pleasure (ἡδοναὶ) and pain (λῦπαι), and to be the organ with which people think (φρονεῖν, νοεῖν), see (βλέπειν) and hear (ἀκούειν).252 Certain abnormal conditions of the brain (being hotter, colder, wetter, or dryer than usual) are, furthermore, said to be causative of people suffering from mania (μαίνεσθαι) and being deranged (παραφρονεῖν).253

244 Throughout this study I put the phrase “Corpus Hippocraticum” in quotation marks in order to emphasize that it is problematic to speak of a single corpus of treatises as if these are all undoubtedly connected. When I refer to “Hippocrates” or “Hippocratic”, I do not intend to make any statements about the actual authorship of the treatises but rather highlight that they have been transmitted under Hippocrates’ name. On these issues, see van der Eijk 2016. 245 Thumiger 2017a, 18. See also Heiberg 1927, 5. 246 See Thumiger 2013, 65–70. 247 See e.g. Hippocrates, De affect. 10 (18.19 Potter = 6.216.25 L.), De morb. 1.30 (88.10 Wittern = 6.200.21 L.), De morb. 1.34 (92.9 f. Wittern = 6.204.7 L.). Thumiger 2017a, 46 notes that “phrenitis is the only instance in our writings in which a straightforwardly mental nosos can be identified”. 248 Thumiger 2013, 64. 249 Thumiger 2017a, 49. See also van der Ejik 2001 in Diocles of Carystus Vol. 2, 153. 250 Thumiger 2017b, 48. 251 See Hippocrates, De morb. 1.30 (88.7–10 Wittern = 6.200.18–21 L.). 252 See Hippocrates, De morb. sacr. 14.1–2 (25.12–17 Jouanna = 6.386.15–20 L.). 253 See Hippocrates, De morb. sacr. 14.3–5 (26.4–13 Jouanna = 6. 386.22–388.7 L.).

46 | General introduction

Another feature of the “Hippocratic” texts are the case-studies, which also present cases of patients with symptoms affecting mental functioning. A good example in this regard is the case of the wife of Hermoptolemus, who is said to have been suffering from delirium (παραλήρησις), to chatter half-finished sentences during koma (ἐλάλει μετὰ κώματος ἡμιτελέα), to show “bursts of temper” (ἀκρηχολίαι), “childish weeping” (κλαυθμοὶ οἷον παιδαρίου), shouting (βοὴ), and fear (δείματα), to show signs of mania (μανίη), immoderate behavior (τὸ παρὰ καιρὸν) and the like together with bodily abnormalities, such as passing of yellow stool or having troubles with the intestines.254 As far as remarks concerning the therapy for mental illnesses in the “Hippocratic” texts are concerned, “a cure is rarely mentioned with specific reference to the mental”;255 this is a consequence of the lack of a systematic approach to mental illness in those texts. It will be worth briefly turning to another author from this period, Diocles of Carystus. Given that his complete work is not extant and only fragments in other authors have survived, it is difficult to get a clear picture of what he had to say on mental illnesses. According to the fragments, he is said to have dealt with phrenitis, mania, lethargia, and melancholia.256 Diocles’ proposed etiology of these affections takes into account the diaphragm and the heart (phrenitis), the blood in the heart (mania), the psychic pneuma around heart and brain (lethargia), and the black bile around the heart (melancholia).257 He is reported to have said that phrenitis comes along with derangement (παρακοπή),258 and that melancholia consists in a change of the psychic faculty (ψυχικὴ δύναμις).259 He is also credited with having addressed therapeutic questions, all of which aim at restoring bodily conditions, such as phlebotomy or the application of enemata.260 For further analysis, see Heiberg 1927, 5–9; Flashar 1966, 21–49, 50–59; Pigeaud 2006/11981; Pigeaud 1987, 29–63; Stok 1996, 2314–2318; van der Eijk 2005, 119–135; Thumiger 2017a; Thumiger 2017b. 4.2.3 Aulus Cornelius Celsus For a first discussion of the important role Celsus plays in the history of mental illness, see p. 41 f. Celsus lived some time around the first half of the first century CE 254 See Hippocrates, De morb. popul. 7.11 (58.21–61.4 Jouanna = 7.326.15–328.9 L.). I quote Smith’s translation here in parts. See Smith 1994 in Hippocrates Volume VII [listed under De morb. popul. 7], 299. On this passage, see also Thumiger 2017b, 49 f. 255 Thumiger 2017a, 64. 256 Diocles fr. 72 van der Eijk, fr. 73 van der Eijk, fr. 74 van der Eijk, fr. 75 van der Eijk, fr. 78 van der Eijk, fr. 79 van der Eijk, fr. 108 van der Eijk, fr. 109 van der Eijk. 257 See Diocles fr. 72.9–13 van der Ejik, fr. 74.5 f. van der Eijk, fr. 78.5–7 van der Ejik, fr. 108.2–4 van der Eijk. 258 See Diocles fr. 72.13 van der Ejik. 259 See Diocles fr. 108.3 van der Eijk. 260 See e.g. Diocles fr. 73.10–13 van der Eijk, fr. 73.19–22 van der Eijk.

4 Diseases of the brain and mental illness | 47

and wrote a treatise in Latin, De medicina, comprising eight books. These were part of a larger work (Artes), which also dealt with other topics, such as rhetoric or philosophy, but is now, unfortunately, lost.261 Of particular interest for our present purposes is the eighteenth chapter of the third book of Celsus’ De medicina, which deals with the genera insaniae, the three kinds of derangement.262 The discussion found there has been regarded as “an important watershed in the available ancient testimony about views of mental disorder”.263 Celsus distinguishes a form of insania, which is acute and occurs in fevers (quae et acuta et in febre est), which the Greeks call φρένησις, from the second form, which is longer than the first and begins without fever (quod spatium longius recipit, quia fere sine febre incipit), and from the third form, which is the longest one (longissimum).264 Patients suffering from the first form of insania (corresponding to what Greek texts refer to as phrenitis) are said to be deranged in their mind (desipere) in the beginning, to talk strangely (loqui aliena), and to suffer from continuous derangement (continua dementia) later on.265 In the end, the mind becomes addicted to vain images (vanas imagines; mens illis imaginibus addicta est).266 There are said to be several different forms of phrenesis, with it being accompanied by sadness (alii tristes sunt) or cheerfulness (alii hilares), being deranged only in speech (alii … intra verba desipiunt) or being violent (alii … violenter quaedam manu faciunt).267 The second form of insania (corresponding to what in Greek texts is referred to as melancholia) is said to consist in sadness (tristitia) and to be caused by black bile (bilis atra).268 The third form of insania (probably corresponding to what Greek texts refer to as mania) has two kinds, the first of which is said to mislead the patients not through their own mind but through images (imaginibus, non mente falluntur), while the second form is said to consist in a derangement of the mind (animo desipiunt).269 Celsus also gives recommendations regarding the appropriate therapy for patients who suffer from these kinds of insania and these are especially interesting for two main reasons: on the one hand, Celsus emphasizes that it is important to take account of each individual patient, since general rules do not apply equally to every human being.270 On the other hand, he 261 See Oser-Grote 2005, 189; Nutton 2005, 166, especially note 63 for the dating; Flashar 1966, 73 f. 262 See Celsus, De med. 3.18 (122.11–127.15 Marx). 263 Thumiger 2017b, 51. One may note that here that Celsus refers to Asclepiades a few times in his chapter, and this observation has led to the assumption that Celsus bases all of what he says on Asclepiades’ theories. See e.g. Flashar 1966, 75; Heiberg 1927, 18. 264 See Celsus, De med. 3.18.1 (122.14 f. Marx), 3.18.17 (125.27 f. Marx), 3.18.19 (126.12 Marx). 265 See Celsus, De med. 3.18.2 (122.16 f. Marx), 3.18.3 (122.21 f. Marx). 266 See Celsus, De med. 3.18.3 (122.22–24 Marx). 267 See Celsus, De med. 3.18.3 (122.24–26 Marx). 268 See Celsus, De med. 3.18.17 (125.28 f. Marx). 269 See Celsus, De med. 3.18.19 (126.14–16 Marx). 270 See Celsus, De med. 3.18.5 (123.8–12 Marx), 3.18.10 (124.10 f. Marx). See also Thumiger 2017b, 51.

48 | General introduction

recommends what we might call “psychological” approaches alongside treatments which merely aim to restore bodily conditions.271 He states that some patients need to be relieved of vain fear, giving the example of a rich man who feared that he would die of hunger and who was told that he had legacies waiting for him, in order to cure the fear.272 He also presents music as a possible way of detaching patients from their sad thoughts273 and states, in another context, that one should praise the works of the patient, if there are any, and show him his works, in order to cheer him up,274 so as to make him proud of himself. These are just a few examples of “psychological” approaches in Celsus’ chapter on the genera insaniae and they give a good insight into Celsus’ way of dealing with them. For further analysis of Celsus’ discussion of the genera insaniae, see Heiberg 1927, 16–18; Pigeaud 1987, 122 f.; Stok 1996, 2330–2341; Ahonen 2014, 17 f., 19 f.; Thumiger 2017b, 51; Thumiger & Singer 2018, 7–15. 4.2.4 Rufus of Ephesus Given that Rufus of Ephesus (who lived around the first century CE) wrote a complete treatise on melancholia – one of the most common examples of mental illness in ancient medical literature as we have seen (see p. 45) – it is important to mention him in this list of authors who dealt with mental illness.275 The case of Rufus, however, is rather difficult since his treatise De melancholia is unfortunately lost and only fragments have survived. Fortunately, the sixth book of Aetius of Amida is an important treasure trove for fragments of Rufus’ otherwise lost treatise. For an introduction to Rufus and a discussion of his work as a source for Aetius’ sixth book, see p. 26 f. Besides Aetius, there are several other treatises that preserve fragments of Rufus’ De melancholia in Greek, Latin or even Arabic, making it possible to gain a reasonable insight into Rufus’ lost treatise.276 To begin with, Rufus obviously distinguished three forms of melancholia, but he placed special emphasis on the so-called “hypochondriac” form.277 He also mentions a form of melancholia in which the brain is primarily affected and this statement is even preserved in Aetius’ tenth chapter on

271 Common approaches such as bloodletting, pouring rose-oil over the head, applying hellebore etc. are also recommended. See e.g. Celsus, De med. 3.18.7 (123.25 f. Marx), 3.18.8 (124.2 f. Marx), 3.18.20 (126.18 f. Marx). For further remarks on the psychological approaches, see Flashar 1966, 74 f.; Thumiger 2017b, 51. 272 See Celsus, De med. 3.18.10 (124.11–13 Marx). 273 See Celsus, De med. 3.18.10 (124.16 f. Marx). 274 See Celsus, De med. 3.18.18 (126.7 f. Marx). 275 Pormann produced an edition of the fragments of Rufus’ De melancholia. See Rufus of Ephesus On Melancholy, edited by P. Pormann 2008. 276 See Pormann 2008 in Rufus of Ephesus On Melancholy, 4. 277 See in summary Pormann 2008 in Rufus of Ephesus On Melancholy, 5.

4 Diseases of the brain and mental illness | 49

the therapy of melancholia.278 Given that Galen – who knew Rufus’ treatise and praises it highly (see also p. 27) – also discusses three different forms of melancholia, it has been argued that his “tripartite division of melancholy goes back to Rufus”.279 Another characteristic of Rufus’ discussion of melancholia is also preserved in Aetius’ compilation, that is his distinction between an innate mixture and an acquired mixture, both of which can lead to melancholia (see also p. 447 f., commentary on p. 144.26–29).280 While the innate mixture is the natural mixture of each individual patient, the acquired mixture is attributed to the patient’s “bad way of living” (ἐκ διαίτης φαύλης) which changes the mixture in a way that makes these patients prone to melancholia. Interestingly, Rufus also “recognised other, nonmaterial factors in the development of the disease” such as “excessive thinking” or “traumatic experiences such as drowning”.281 In light of the fact that ancient medical texts mainly deal with mental illness in bodily terms (see also p. 44), it is striking that Rufus introduces the possibility that melancholia may be brought about by what we today might call psychological factors. As far as the symptoms of melancholia are concerned, Rufus mentions several in which mental functioning is affected, such as delusions, fear of humans, suicidal tendencies, sadness, and anger, and he explains their occurrence in physiological terms.282 He also deals with gastrointestinal symptoms, which are especially important in the “hypochondriac” form of melancholia,283 and mentions various further symptoms.284 Several fragments of Rufus’ De melancholia also deal with the therapy for this affection, which includes common approaches such as purging or the application of remedies. It seems as if special emphasis is placed here on the “hypochondriac” form of melancholia.285 Although we only have fragments of Rufus’ De melancholia, it is clear that his treatise “enjoyed great popularity and authority not only in second-century Rome and Pergamum, but also in tenth-century Kairouan and thirteenth-century Damascus, two important regional medical hubs.”286 Rufus must therefore be understood as an expert on one of the most prominent mental illnesses.

278 See Aetius Amid., Libri med. 6.10 (Vol. 2, 146.24 f. Olivieri) = Rufus, De melanch. F 37.1 Pormann. 279 Pormann 2008 in Rufus of Ephesus On Melancholy, 5. See also Flashar 1966, 107. 280 See Aetius Amid., Libri med. 6.9 (Vol. 2, 144.26–29 Olivieri). 281 Pormann 2008 in Rufus of Ephesus On Melancholy, 6. The texts which preserve these fragments are Arabic sources. See Rufus, De melanch. F 34–36 Pormann. 282 See e.g. Aetius Amid., Libri med. 6.9 (Vol. 2, 143.17–144.3 Olivieri) = Rufus, De melanch. F 11.1–9 Pormann. 283 See e.g. Aetius Amid., Libri med. 6.9 (Vol. 2, 144.3–10 Olivieri) = Rufus, De melanch. F 11.10– 13 Pormann. 284 For an overview see e.g. Pormann 2008 in Rufus of Ephesus On Melancholy, 6 f. 285 See Rufus, De melanch. F 37–65 Pormann for the fragments dealing with the therapy. See also Aetius Amid., Libri med. 6.10 (Vol. 2, 146.24–28 Olivieri) = Rufus, De melanch. F 37 Pormann, Libri med. 6.10 (Vol. 2, 151.9–20 Olivieri) = Rufus, De melanch. F 39 Pormann. 286 Pormann 2008 in Rufus of Ephesus On Melancholy, 8.

50 | General introduction

For a detailed analysis of Rufus’ treatise, see especially Pormann 2008 in Rufus of Ephesus On Melancholy; Flashar 1966, 84–104; Letts 2018, 176–197. 4.2.5 Aretaeus of Cappadocia Aretaeus lived around the first or the second century CE and composed treatises entitled De causis et signis acutorum morborum (two books), De causis et signis diuturnorum morborum (two books), and another four books on the corresponding therapies. Unfortunately, not all parts of these eight books are extant in Greek.287 His work is a nosological treatise and deals with a number of affections which are discussed in separate chapters and in great detail, and this observation applies both to the books dealing with the causes and symptoms of the affections and to those dealing with their appropriate therapy.288 The affections are arranged according to their classification as acute or chronic diseases (on these terms, see p. 204, commentary on p. 128.9–10). In his books on acute diseases, Aretaeus, for example, devotes a chapter to phrenitis and another to lethargia, both of which are lost, but the chapters on their therapy have survived.289 In his books on chronic diseases, he deals with, to give just three examples, skotoma, melancholia, and mania; as regards the corresponding chapters on the therapies for these affections, only those on skotoma and melancholia are extant, whereas that on the therapy for mania is lost. I cannot dwell on each of these chapters here but I will briefly highlight some aspects which are noteworthy with regard to our topic. In the proem of his book on chronic affections, Aretaeus states that mania and melancholia are affections in which the soul is deranged through a bad mixture of the body (τὴν ψυχὴν ἐκμαίνει ἀκρασίῃ τοῦ σώματος).290 This statement is highly interesting insofar as it explicitly brings the soul into play while ascribing its affection to bodily processes. In the following chapters, Aretaeus mentions (in the chapter on melancholia) symptoms such as “disturbance of thought” (ξυντρέπει δὲ καὶ τὴν γνώμην),291 “despondency” (ἀθυμίη),292 “being irascible” (ὀργίλοι),293 “unusual fear” (τάρβος ἔκτοπον),294 or – as for patients suffering from mania – symptoms such as “derangement” (ἔκστασις),295 being joyful and therefore “laughing, playing, dancing night and day”

287 See Nutton 2005, 205, who also discusses the problem of dating Aretaeus’ life time. For Wellmann’s assumption that Aretaeus draws on Archigenes, see Wellmann 1895, 24; Heiberg 1927, 19; Ilberg 1923, 229. For a rejection of this view, see Flashar 1966, 76 note 6. 288 For more on his work, see Nutton 2005, 205 f. 289 For an overview of the extant and the lost chapters, see Hude 1958 in Aretaeus, XXVI–XXVII. 290 See Aretaeus 3.1.2 (36.16 f. Hude). 291 See Aretaeus 3.5.1 (39.16 Hude). 292 See Aretaeus 3.5.3 (39.27 Hude). 293 See Aretaeus 3.5.5 (40.16 Hude). 294 See Aretaeus 3.5.6 (40.17 Hude). 295 See Aretaeus 3.6.1 (41.13 Hude).

4 Diseases of the brain and mental illness | 51

(γελῶσι, παίζουσι, ὀρχῶνται νυκτὸς καὶ ἡμέρης),296 being angry and thus “rending the clothes, killing the attendants, attacking oneself”,297 or having “strange appearances” (ἀλλόκοτοι φαντασίαι).298 These symptoms all belong to the sphere of behavior or the sphere of mental functioning (some bodily symptoms are also mentioned)299 but they are explained by reference to the body and cured by bodily means. It is said that the causes of mania are the head and the hypochondria (κεφαλὴ καὶ ὑποχόνδρια) and it is furthermore stated that in mania and melancholia the main cause (τὸ κῦρος) is located in the internal organs (ἐν τοῖσι σπλάγχνοισί), while in phrenitis it is seated in the head and the senses (ἐν τῇ κεφαλῇ καὶ τῇσι αἰσθήσεσι).300 Black bile (in melancholia) as well as hotness and dryness (in mania) are said to be involved in the onset of these affections.301 As for the cure, bodily approaches such as bloodletting are, of course, recommended for the most part,302 but there are, in the chapter on the cure of phrenitis, also some “psychological” recommendations which aim to support such “bodily” procedures. It is, for example, allowed that the patient’s dearest friends should enter the sickroom, and stories and conversations should not “bite the thymos” (μὴ θυμοδακεῖς), but everything needs to be cheerful, especially when the derangement is prone to anger.303 In addition, there is one interesting story told by Aretaeus, of a man who was suffering from melancholia according to the physicians but who could not be cured by their means. He then fell in love and was cured by love (ὁ ἔρως μιν ἰήσατο). Aretaeus, however, thinks that this man was in love first and then became despondent because he thought he could not impress the girl; but when he did so, his symptoms ceased, and he became sound of mind again, “love being his physician” (ἔρωτι ἰητρῷ).304 Although this story stands out from the rest of the chapter, and although Aretaeus seems to incorporate it here in order to show that one may misinterpret love-sickness as melancholia,305 it is still noteworthy that love is referred to as “healing” the man and

296 See Aretaeus 3.6.4 (42.10 Hude). 297 See Aretaeus 3.6.5 (42.12–14 Hude). 298 See Aretaeus 3.6.5 (42.18 f. Hude). 299 See e.g. Aretaeus 3.5.1 (39.15 Hude), 3.6.9 (43.11 f. Hude). 300 See Aretaeus 3.6.7 (42.29–43.1 Hude). 301 See Aretaeus 3.5.1 (39.10 Hude), 3.6.2 (41.20 f. Hude). 302 See e.g. Aretaeus 7.5.1 (156.4 Hude). 303 See Aretaeus 5.1.2 (92.1 f. Hude). 304 See Aretaeus 3.5.8 (41.4–11 Hude). On this passage, see also Thumiger 2018, 270. 305 According to Flashar 1966, 79, in this passage “ist zum ersten Male in der Literatur der Liebeskummer als Form der Melancholie gedeutet.”

52 | General introduction

as being his “physician” twice in this section. For, this way of healing belongs to the realm of the “psychic”.306 For further analysis of Aretaeus’ discussion of mental affections, see Ilberg 1923; Heiberg 1927, 19–25; Flashar 1966, 75–79; Pigeaud 1987, 71–94; McDonald 2009, 86–119; Ahonen 2014, 16 f., 20 f. 4.2.6 Anonymus Parisinus In the case of the Anonymus Parisinus neither the author nor the original title are known.307 Garofalo, for his edition of the text, uses the title De morbis acutis et chroniis and I will follow this usage here. As for the dating, Garofalo mentions that the text was composed in the “imperial age”,308 while Nutton suggests that it stems from the first or the second century CE.309 The text presents several affections which are grouped together into the acute and the chronic (on these terms, see p. 204, commentary on p. 128.9–10) and are ordered a capite ad calcem.310 Each chapter deals with the cause (αἰτία), the signs (σημεῖα), and the therapy (θεραπεία) of the affection in question.311 The sections on the causes of the affections present the theories and doctrines of ancient physicians (οἱ ἀρχαῖοι / οἱ παλαιοί), such as Erasistratus, Praxagoras, Diocles or Hippocrates.312 Interestingly, the sections on the signs and the therapy of the affections do not present such historic doctrines,313 which may imply that these sections were the author’s own original work and did not derive from older sources. In the part of the work dealing with acute diseases, affections such as phrenitis and lethargia are discussed, and in the part on chronic diseases, affections such as skotoma, mania, and melancholia are dealt with.314 As for the signs of these affections, the Anonymus Parisinus mentions distinct bodily symptoms, such as “continuous fever” (συνεχὴς πυρετὸς)315 or a “small pulse” 306 See Flashar 1966, 78: “Nur ein einziges ‘Heilmittel’, das bezeichnenderweise nicht in dem Abschnitt über die Therapie der Melancholie steht, hält sich im Bereich des Psychischen.” He furthermore (79) poses the following assumption: “Vielleicht kann man in dem Nebeneinander einer als grundlos bezeichneten […] und einer auf ein bestimmtes Motiv zurückgeführten Melancholie (Liebeskummer) eine erste Vorform der klassischen Scheidung von endogener und reaktiver Melancholie erblicken”. 307 See Garofalo 1997 in Anonymi Medici, vii, xiv note 55; van der Eijk 1999a, 302. For a general overview of the characteristics of the text, see van der Eijk 1999a. 308 See Garofalo 1997 in Anonymi Medici, vii. 309 See Nutton 2005, 206. 310 See Garofalo 1997 in Anonymi Medici, ix. 311 See van der Eijk 1999a, 302 f. 312 See van der Eijk 1999a, 303. 313 See van der Eijk 1999a, 303. 314 See Anon. Par. 1 (2.1–10.13 Garofalo), Anon. Par. 2 (10.15–18.7 Garofalo), Anon. Par. 17 (110.1–112.14 Garofalo), Anon. Par. 18 (112.15–116.19 Garofalo), Anon. Par. 19 (116.20–120.9 Garofalo). 315 Anon. Par. 1.2.1 (2.23 Garofalo).

4 Diseases of the brain and mental illness | 53

(σφυγμὸς μικρός),316 together with symptoms belonging to the realm of the “mental”, such as “derangement of the mind” (παραφορὰ τῆς διανοίας),317 “pulling bits of wool out of items of clothing” (καρφολογοῦντος),318 “aversion to everything paired with despondency” (πάντων μετὰ δυσθυμίας ἀποστροφή),319 or “being misanthropic” (μισανθρωποῦσι).320 The recommended therapy mainly aims to restore the proper bodily conditions by means such as bloodletting or the application of enemata.321 There are, however, also some “psychological” recommendations such as using the “help of words” (ἡ διὰ τοῦ λόγου βοήθεια),322 inciting the patients to sexual pleasures (ἐρεθιστέον πρὸς συνουσίαν)323 or bringing in the patients’ children or wives or any other person who may comfort them.324 4.2.7 Galen of Pergamon For further remarks on Galen, see p. 22 f. Providing information on Galen’s approach to mental illness is a difficult task insofar as there are no extant treatises and no “systematic discussion”325 devoted specifically to this topic. In order to gain an insight into Galen’s views on mental illness, one needs to look at all of his treatises and collect the information found there, a task that it is clearly not possible to do justice to here. I will, therefore, restrict myself to some specific aspects of his views that are important for this study. I will also deal in more detail with some relevant Galenic passages in the commentary on Aetius’ chapters. We can start with two texts that are especially interesting in this regard, namely the third book of De locis affectis and parts of the fourth as well as the third chapter of De symptomatum differentiis.326 In these texts, Galen deals with affections such as phrenitis, lethargia, melancholia, and mania but also with karos, katalepsis and koma. Galen states that in these kinds of affection there are no signs, such as swellings, pains or secretions, which clearly indicate the affected bodily part.327 He continues to emphasize that all humans believe that the reasoning part of the soul (τὸ λογιζόμενον) is seated in the brain, while the courageous and spirited part (τὸ ἀνδρεῖόν τε καὶ θυμοειδὲς) is seated in the heart, and the appetitive part (τὸ ἐπιθυμη-

316 Anon. Par. 18.2.2 (114.12 Garofalo). 317 Anon. Par. 1.2.3 (4.3 Garofalo). 318 Anon. Par. 1.2.3 (4.6 Garofalo). 319 Anon. Par. 18.2.3 (114.15 f. Garofalo). 320 Anon. Par. 19.2.1 (118.4 Garofalo). 321 See e.g. Anon. Par. 19.3.1 (118.13 f. Garofalo), Anon. Par. 2.3.1 (12.20–22 Garofalo). 322 See Anon. Par. 19.3.7 (118.27 Garofalo), Anon. Par. 1.3.6 (6.16 Garofalo). 323 Anon. Par. 19.3.9 (120.5 f. Garofalo). 324 See Anon. Par. 1.3.6 (6.21–24 Garofalo). 325 Jackson 1969, 365. 326 See Galen, De loc. aff. 3.1–4.3 (8.136.1–234.12 K.), De sympt. diff. 3 (216.14–226.22 Gundert = 7.55.6–62.6 K.). 327 See Galen, De loc. aff. 3.5 (8.156.11–157.3 K.).

54 | General introduction

τικὸν) in the liver,328 clarifying that he refers to the activities of the reasoning part of the soul (αἱ τοῦ λογιστικοῦ τῆς ψυχῆς ἐνέργειαι) as leading activities (ἡγεμονικαὶ).329 These leading activities are said to be damaged in affections such as phrenitis, lethargia, mania and melancholia, karos, koma or katalepsis,330 and Galen therefore claims that all physicians need to be convinced that all affections of the leading activities involve the brain.331 He even explains further how these affections are brought about, stating that they all arise in the brain but differ from each other through differences in the bodily mixtures which caused them, as well as through the actual area where the dyscrasia is taking place (e.g. in the ventricles of the brain, the vessels of the brain, the body of the brain).332 In his treatise Quod animi mores corporis temperamenta sequantur, Galen is very explicit in this regard when stating “that the soul is slave to the mixtures of the body, since, indeed, these have the capacity to cause its separation, to force it into derangement, to take away memory and understanding, and to make it more distressed, more lacking in resolve and in spirit, as is apparent in cases of melancholy”.333 In order to give an insight into the way Galen conceived of the symptoms of these affections, I will provide one example of a patient suffering from phrenitis, which he discusses in several passages (this Galenic passage is also discussed on p. 172, commentary on p. 125.20–24). This patient is said to be impaired in his ability to think and judge correctly (οὐ κατὰ φύσιν ἔχουσι ταῖς διανοητικαῖς κρίσεσιν) but is not misled in his ability to discern what he sees by means of sensation (οὐδὲν ὅλως σφαλλόμενοι περὶ τὰς αἰσθητικὰς διαγνώσεις τῶν ὁρατῶν).334 This patient was thus once observed standing at his window, looking down to the street and watching the pedestrians walking by. He showed them each of the glass-vessels he had in his room and asked them whether he should throw these down. The people on the street said that he should do so and, accordingly, the patient threw down every vessel they asked him to, which they acknowledged with applause and laughter. When the patient asked the bystanders whether they also wanted him to throw down the wool-worker, who was working in his house at this time, they shouted encouragement, and the patient indeed threw down the wool-worker as well. The bystanders immediately stopped laughing, and

328 See Galen, De loc. aff. 3.5 (8.159.17–160.2 K.). 329 See Galen, De loc. aff. 3.6 (8.163.2–3 K.). 330 See Galen, De loc. aff. 3.7 (8.166.5–8 K.), De sympt. diff. 3.9 (224.9–13 Gundert = 7.60.3–8 K.). 331 See Galen, De loc. aff. 3.7 (8.166.18–167.3 K.). 332 See Galen, De loc. aff. 3.6 (8.164.6–14 K.). 333 See Galen, Quod animi mor. 3 (21.15–22.7 Bazou = 4.779.11–17 K.): ἀναγκαῖον οὖν ἔσται καὶ τοῖς ἰδίαν οὐσίαν ἔχειν ὑποθεμένοις τὴν ψυχὴν ὁμολογῆσαι δουλεύειν αὐτὴν ταῖς τοῦ σώματος κράσεσιν, εἴ γε καὶ χωρίζειν ἐξουσίαν ἔχουσι καὶ παραφρονεῖν ἀναγκάζουσι καὶ μνήμην καὶ σύνεσιν ἀφαιρεῖσθαι καὶ λυπηροτέραν καὶ ἀτολμοτέραν καὶ ἀθυμοτέραν ἐργάζονται, καθάπερ ἐν ταῖς μελαγχολίαις φαίνεται. The translation is quoted from Singer 2013, 384. 334 See Galen, De loc. aff. 4.2 (8.225.14–16 K.).

4 Diseases of the brain and mental illness | 55

caught the falling man.335 This story serves as an example of an intact sensation (i.e. the patient was able to recognize and to name the glass-vessels and the wool-worker) together with an impairment of judgement (i.e. the patient did not recognize that it is not reasonable to throw down vessels and even a human being). I cannot dwell sufficiently on Galen’s remarks concerning therapeutics here but it will be worth briefly noting some examples. Given that he understands affections such as phrenitis, lethargia, melancholia, mania and suchlike as being brought about by certain bodily processes in the brain, the therapy he recommends aims to restore this bodily imbalance. He states, for example, that he cured a patient suffering from melancholia by applying a regimen which is capable of producing good humors and which is moist (διαίτης εὐχύμου τε καὶ ὑγρᾶς),336 or that one should take into account whether the whole body contains the melancholic humor, in which case it is appropriate to start the treatment with phlebotomy, or whether only the brain contains the humor, in which case such an approach is not fitting.337 Besides these “pathological discussions”338 which were especially influential on Aetius, there are also other sets of Galenic texts which are rather more “ethical”339 in character. Under this rubric one may subsume the treatises De indolentia, De moribus, De propriorum animi cuiuslibet affectuum dignotione et curatione and De animi cuiuslibet peccatorum dignotione et curatione.340 To summarize the line of argument in these treatises, one may say with van der Eijk that “the discussion there is moral rather than medical, and it deals with the development and management of character, and the correction of emotional and cognitive malfunctioning”.341 To give one example, in De propriorum animi cuiuslibet affectuum dignotione et curatione, Galen states that affections of the soul (πάθη ψυχῆς) are spirit, anger, fear, grief, envy, vehement desire (θυμὸς καὶ ὀργὴ καὶ φόβος καὶ λύπη καὶ φθόνος καὶ ἐπιθυμία σφοδρά), and, according to his own opinion, also hastening to love or hate anything (τὸ φθάσαι πάνυ σφόδρα φιλεῖν ἢ μισεῖν ὁτιοῦν πρᾶγμα).342 Galen suggests several possible means of getting rid of such affections: one should ask oneself every morning whether it is best to be slave to these affections or to use reason (λογισμῷ χρῆσθαι) in every situation; one may appoint someone who points out everything one does wrong; one may constantly remind oneself of the ugliness of the souls of angry people and the beauty of the souls of those who are not angry.343 These are

335 See Galen, De loc. aff. 4.2 (8.226.2–13 K.). See also Galen, De sympt. diff. 3.12 (226.9–17 Gundert = 7.61.9–19 K.). 336 See Galen, De loc. aff. 3.10 (8.192.13–16 K.). 337 See Galen, De loc. aff. 3.10 (8.182.6–12 K.). 338 Singer 2013, 26. 339 Singer 2013, 25. 340 All these treatises are translated and discussed in Singer 2013. 341 Van der Eijk 2013, 328. 342 See Galen, De an. aff. dign. et cur. 3.1 (7.2–5 de Boer = 5.7.13–17 K.). 343 See Galen, De an. aff. dign. et cur. 5.6–7 (17.11–18.5 de Boer = 5.24.7–25.10 K.).

56 | General introduction

just a very few examples but they show that the approach taken in this set of treatises differs from the one discussed previously.344 It is worth emphasizing here that phrases such as πάθη ψυχῆς or παθήματα ψυχῆς are used in an ethical context and are not applied to affections such as phrenitis, lethargia, melancholia and the like. They are not related to the leading part of the soul which is affected in affections such as phrenitis, which we refer to as mental illnesses.345 A number of other passages are worth looking at when asking how Galen conceived of mental illnesses.346 In De praecognitione, he reports the case of a woman who could not sleep at night and was tossing and turning in bed, who had no fever,347 and who, as Galen realized when visiting her, did not suffer from a bodily affection but from a psychic unpleasantness (ἀπὸ ψυχικῆς τινος ἀηδίας ἐνοχλεῖσθαι).348 Through the observation of irregularities in her pulse and in her facial expressions and complexion, Galen found out that she was in love.349 Galen discusses the case of this woman as an example of how the body is affected by psychic affections (τὸ σῶμα διὰ τῆς ψυχῆς πάθη πάσχειν εἰώθει).350 A similar idea is also reflected in In Hippocratis Epidemiarum librum sextum commentaria I–VI, in which Galen reports several cases of patients in whom certain mental states caused the appearance of bodily problems: one of these cases deals with a man who was in such fear of death that fever befell him and deranged his mind so that he actually died.351 Unfortunately, this whole part is only extant in Arabic but according to Pfaff’s German translation Galen says: “Der Arzt muß also es als seine Aufgabe betrachten, außer den übrigen Neigungen des Kranken auch die Dinge ausfindig zu machen, die seinen Geist bedrücken. Denn die Heilung eines Menschen, dessen Krankheitsursache in seinem Geiste liegt, kann nur durch Beseitigung der fixen Idee, nicht aber durch Speisen und Getränke, durch Wohnung, Baden, Marschieren und dergleichen erreicht werden”.352 (The physician needs to look not only at the predispositions of the patient but to find out what oppresses his mind. For, the cure of a patient whose cause of the affection is his mind can only be achieved through elimination of the fixed idea, and not through food and drinks, through dwelling, baths, walking and suchlike). This statement, for which we would need the Greek 344 Several attempts have been made to explain these differences. See e.g. Singer 2013, 1–41; van der Eijk 2013, 328 f. 345 See e.g. Budon-Millot 2013, 139, who contrasts “psychic illnesses (which affect the rational mind located in the brain) and the ‘passions of the soul’ (ψυχῆς πάθη) (which depend on the heart and the liver)”. 346 I am grateful to Julien Devinant who in his talk at the conference Mental Diseases in Ancient Medicine in October 2014 in Berlin discussed the texts mentioned below. See also Devinant 2018. 347 See Galen, De praecogn. 6.2 (100.15–18 Nutton = 14.631.5–9 K.). 348 See Galen, De praecogn. 6.7 (102.10–12 Nutton = 14.632.10–12 K.). 349 See Galen, De praecogn. 6.8–10 (102.14–28 Nutton = 14.632.15–633.13 K.). 350 See Galen, De praecogn. 6.15 (104.12–13 Nutton = 14.634.14–16 K.). 351 See Galen, In Hipp. Epid. VI comm. 6 (485.32–486.12 Pfaff). 352 Galen, In Hipp. Epid. VI comm. 6 (487.18–23 Pfaff).

4 Diseases of the brain and mental illness | 57

original to discuss thoroughly, seems to suggest that there are cases in which dietary approaches cannot cure a condition, since it can only be cured by turning to the patient’s mind, to the cause of the suffering. This overview of Galen’s approach to mental illness is far from exhaustive. For further analysis, see Heiberg 1927, 31–37; Drabkin 1955, 229; Jackson 1969; Siegel 1973, 114–172, 231–278; Pigeaud 1988; Lloyd 1988; Garcia Ballester 1988; de Lacy 1988; Hankinson 1991; Stok 1996, 2371–2375; von Staden 2000, 105–116; Hankinson 2006; McDonald 2009, 120–153; van der Eijk 2013, 327–332; BoudonMillot 2013; Singer 2013; Nutton 2013; Holmes 2013; Ahonen 2014, 139–177; Hankinson 2014; Thumiger 2017b, 53–55; Singer 2018; Devinant 2018; Julião 2018. 4.2.8 Posidonius of Byzantium It seems appropriate to mention Posidonius of Byzantium in this list of authors who dealt with mental illness, although we actually do not have an extant work by him, nor even the title of a lost work. He is, however, the author who is most prominently mentioned as a source in the part of Aetius’ sixth book which deals with mental illness and he obviously had a lot to say regarding these affections. For a closer look at Posidonius, see p. 23–25. See also Gäbel 2020. 4.2.9 Caelius Aurelianus Caelius Aurelianus lived in the fifth century CE and wrote a work in Latin on Celeres passiones and Tardae passiones.353 Since Caelius claims on several occasions within his work that he translated Soranus’ treatise,354 which has the same title but is lost, scholars have mostly worked on the assumption that Caelius’ treatise represents Soranus’ lost remarks on acute and chronic diseases. This assumption needs to be treated with caution and for the sake of the present study it shall suffice to say that Caelius surely used Soranus but cannot straightforwardly be equated with Soranus’ treatise.355 Caelius’ treatise presents a detailed account of acute and chronic diseases and deals with a number of affections that are discussed by Aetius. Phrenitis and lethar-

353 See e.g. Nutton 2005, 195, 294; van der Eijk 1999b, 414 f. The standard critical edition of Caelius Aurelianus was published in 1990 and 1993 in the CML (CML VI 1) by Gerhard Bendz, with a German translation by Ingeborg Pape. 354 See Caelius Aurel., Cel. pass. 2.8 (134.23 Bendz), Cel. pass. 2.65 (170.19 f. Bendz), Cel. pass. 2.147 (232.6 f. Bendz), Cel. pass. 2.163 (242.10 Bendz), Tard. pass. praefatio 3 (428.5–7 Bendz). 355 On this issue, see van der Eijk 1999b with the following conclusion on 423: “It must at any rate be concluded that Caelius’ Acute and Chronic Diseases, though no doubt heavily dependent on Soranus, cannot be treated as a work by Soranus preserved in Latin”. See also Fögen 2009, 73–75.

58 | General introduction

gia are both discussed in the part on acute diseases,356 katalepsis is discussed in both parts of the text,357 while skotoma, mania and melancholia are all discussed in the part on chronic diseases.358 In general, Caelius provides information on the causes of the affections, on the symptoms and on the therapy, and deals with the doctrines of his (or Soranus’) predecessors. He states that in patients suffering from phrenitis, the body as a whole is affected (totum corpus pati) but a little later he concedes that the head is most affected (plus pati dicimus caput).359 A similar statement is found in the chapter on lethargia, in which Caelius emphasizes that the other physicians were wrong to say that the head is the affected part in lethargia and that it is correct to say instead that the body as a whole is affected (totum corpus patitur) while the head is especially affected (specialiter vero caput).360 As far as mania and melancholia are concerned, Caelius states that the former is an affection of the head and the latter an affection of the stomach (… principaliter stomachus patiatur, in furiosis vero caput).361 The kinds of symptoms which are mentioned are similar to those the previously discussed authors put forward; Caelius deals with distinct bodily symptoms, such as “acute fever” (febris acuta),362 “nosebleed” (sanguinis per nares destillatio),363 or “small, frequent and intense pulse” (pulsus parvus atque creber et vehemens),364 alongside symptoms which belong to the realm of the “mental”, such as “agitation of the mind and despondence without any reason” (mentis sollicitudo ac gravitas sine ratione),365 “talking nonsense” (non digna ratione referens),366 “disturbance of the mind” (alienatio mentis),367 or “fear of inane things” (timore … inanium rerum).368 Caelius explicitly addresses the idea of an “affection of the mind” when stating that those people who assumed that mania is an affection of the mind (animi passionem) rather than an affection of the body, are wrong, and this is said to be especially visible in the fact that none of the philosophers has a cure for those affections;369 the idea of an

356 See Caelius Aurel., Cel. pass. 1.4–183 (24.1–124.16 Bendz), Cel. pass. 2.1–55 (130.1–164.14 Bendz). 357 See Caelius Aurel., Cel. pass. 2.56–86 (164.15–184.27 Bendz), Tard. pass. 2.86–90 (596.6– 598.22 Bendz). 358 See Caelius Aurel., Tard. pass. 1.51–53 (458.4–460.3 Bendz), Tard. pass. 1.144–179 (514.27– 536.29 Bendz), Tard. pass. 1.180–184 (536.30–540.16 Bendz). 359 See Caelius Aurel., Cel. pass. 1.55 (52.29–54.2 Bendz). 360 See Caelius Aurel., Cel. pass. 2.26 (144.24–27 Bendz). 361 See Caelius Aurel., Tard. pass. 1.183 (538.28 f. Bendz). 362 Caelius Aurel., Cel. pass. 1.31 (38.16 f. Bendz). 363 See Caelius Aurel., Cel. pass. 1.31 (38.18 f. Bendz). 364 See Caelius Aurel., Tard. pass. 1.149 (518.16 Bendz). 365 See Caelius Aurel., Cel. pass. 1.31 (38.20 Bendz). 366 See Caelius Aurel., Cel. pass. 2.10 (136.10 f. Bendz). 367 See Caelius Aurel., Tard. pass. 1.150 (518.25 Bendz). 368 See Caelius Aurel., Tard. pass. 1.150 (518.29 Bendz). 369 See Caelius Aurel., Tard. pass. 1.154 (522.2–5 Bendz).

4 Diseases of the brain and mental illness | 59

affection of the mind is also reflected in the fact that Caelius poses the question of whether hydrophobia is an affection of the soul or of the body (utrumne animae an corporis passio sit hydrophobia).370 Caelius devotes a whole paragraph to the latter question and concludes that hydrophobia is in fact an affection of the body which also impairs the property of the soul (sed etiam animae occupet qualitatem), as in mania or melancholia.371 He also suggests, besides the common bodily approaches, some noteworthy “psychological” approaches for curing mania.372 He states, for example, that patients should meditate on various things or have debates, and that one should relax the patient’s mind (animum laxent) by providing an audience which expresses its support and appreciation;373 he also suggests that one might ask the patient questions in accordance with his educational background or, if he does not have any education at all, that one should ask general questions or let him play board games, because all of this sets the mind in motion (animum exerceat).374 Caelius furthermore acknowledges that the debates of philosophers might be helpful for these patients because they remove fear, sadness and anger through their words, which is very useful for the body.375 For further analysis of Caelius’ discussion of mental diseases, see Heiberg 1927, 25–31; Flashar 1966, 79–83; Pigeaud 2006/11981, 105–121, 193–195; Pigeaud 1987, 129–162; Ahonen 2014, 14–16, 21; Thumiger 2017b, 55 f.; Urso 2018.

4.3 Mental illnesses in late antiquity I will restrict my discussion of mental illnesses in late antiquity here to the analysis of the four most important authors of this period, introduced on p. 4–7 and on p. 7–39. It is worth noting that all four relate mental illnesses to the head and, more specifically, the brain, and were, therefore, clearly “sympathetic to encephalocentric theories”.376 This is important to state since this encephalocentric view had obviously become generally accepted by the time these authors wrote.377 To my knowledge, there has been no coherent analysis of mental illnesses in late antiquity that includes a discussion of the presentation of such affections in Oribasius, Aetius, Alexander and Paul. An exception to this is the paper written by Sharpe 1974 on

370 See Caelius Aurel., Cel. pass. 3.109 (356.22 Bendz). 371 See Caelius Aurel., Cel. pass. 3.111 (358.14–17 Bendz). 372 For a “bodily” therapy, see e.g. Caelius Aurel., Tard. pass. 1.160 (524.23–27 Bendz). 373 See Caelius Aurel., Tard. pass. 1.164 (526.27–34 Bendz). 374 See Caelius Aurel., Tard. pass. 1.165 (528.2–7 Bendz). 375 See Caelius Aurel., Tard. pass. 1.166–1.167 (528.22–25 Bendz). 376 Gäbel 2018, 339. 377 On this, see also Thumiger & Singer 2018, 30: “This point is of particular interest, not just for the historical victory that it suggests for Galen’s encephalocentric view […]”.

60 | General introduction

Mental Diseases in Paulus Aegineta’s Epitome, which tries to bring together those passages in Paul’s work which might fall under the rubric of mental disorder, although Sharpe does not compare Paul with Oribasius, Aetius and Alexander. 4.3.1 Oribasius, Alexander, Paul378 As pointed out on p. 4, parts of Oribasius’ works are lost, and this makes it difficult to get a clear and complete picture of his dealing with mental illness. In the extant parts of his Collectiones medicae, there is no section dealing with mental illnesses such as phrenitis, lethargia, melancholia, mania. However, this may be due to the textual losses rather than to Oribasius’ lack of interest in these affections.379 The eighth book of his Synopsis ad Eustathium, which, as discussed earlier (see p. 4 f.), is supposed to be a summary of the Collectiones, deals with diseases which are located in, around or on the head, and includes the discussion of mental illnesses. The eighth book starts with a chapter on “loss of memory and other affections related to wakefulness and deep sleep” (περὶ μνήμης ἀπωλείας καὶ τῶν ἄλλων ἀγρυπνητικῶν τε καὶ καταφορικῶν) and this is followed by chapters on ephialtes, epilepsia, skotoma, apoplexia, melancholia, mania, “people who are in love” (περὶ τῶν ἐρώντων),380 lykanthropia, inflammation of the brain, erysipelas of the brain, and on “people who were bitten by a mad dog” (περὶ λυσσοδήκτων).381 The subsequent chapters deal with affections such as paralysis, spasmos, tetanos, and various forms of headache,382 and in the further course of the book affections of the hair, the nose, the ears, and the eyes are also discussed.383 The affections dealt with in this book are similar to those of Aetius’ sixth book (on which, see p. 18–20) and also address the affections which one might refer to as mental. It is striking at first glance that there is no chapter dealing with phrenitis and lethargia. However, a closer look at the chapter on “loss of memory and other affections related to wakefulness and deep sleep” shows that phrenitis and lethargia are in fact mentioned there.384 Given that the Synopsis functions as a summary of the Collectiones, one might assume that the latter treatise contains more detailed counterparts to each chapter of the Synopsis.385 For, it is probably due to the abridged nature of the Synopsis that the chapters are rather short, mainly addressing therapeutical issues. The chapter on melancholia, for example, opens with the (Galenic) statement that one needs to start the therapy with phlebotomy in cases where the whole body contains melancholic blood but that one 378 The contents of this section have, in parts, already been addressed in my paper Gäbel 2018, 335–340. 379 I am grateful to Caroline Musgrove for emphasizing this. 380 On this chapter, see Thumiger 2018, 266 f. 381 See Oribasius, Synops. ad Eustath. 8.1–8.12 (244.1–252.5 Raeder). 382 See Oribasius, Synops. ad Eustath. 8.13–8.21 (252.6–256.27 Raeder). 383 See Oribasius, Synops. ad Eustath. 8.22–8.59 (257.1–270.7 Raeder). 384 See Oribasius, Synops. ad Eustath. 8.1.2 (244.8 f. Raeder). 385 See Metzger 2011, 152.

4 Diseases of the brain and mental illness | 61

should not proceed in this way if only the brain contains melancholic blood.386 In order to provide a basis for the therapeutic recommendations, this opening is followed by a few remarks concerning the form of melancholia which starts from the stomach, in contrast to that which involves a primary affection of the brain.387 The chapter goes on to provide information on the appropriate therapy, which includes approaches such as a regimen that is capable of producing good humors and is moist (διαίτης εὐχύμου τε καὶ ὑγρᾶς)388 or the application of wormwood (διδόναι τοῦ ἀψινθίου),389 to give just two examples. It is interesting that Oribasius devotes a chapter to those who are in love and thus treats being in love as an affection. He states that these people are despondent and sleepless through love (τοὺς δι’ ἔρωτας δυσθυμουμένους καὶ ἀγρυπνοῦντας) and that their thoughts should be distracted (τὴν διάνοιαν ἀπηγάγομεν), for example by means of things to look at or listen to, because spare time makes it difficult to free the patient from the affection.390 The treatise Eclogae medicamentorum, which is probably not by Oribasius himself (see p. 5), contains chapters on headache, epilepsia, spasmos, tetanos, and paralysis,391 and these also address questions of therapy. On Oribasius’ dealing with mental illness, see also Heiberg 1927, 39. Alexander of Tralleis dedicated the first book of his Therapeutica to diseases of the head, including chapters on diseases of the hair and the scalp, forms of headache,392 as well as phrenitis, lethargia, epilepsia, paresis, and melancholia.393 Again, the range of affections dealt with is similar to what we find in Aetius (see p. 18–20), although the latter deals with a much greater range. It is remarkable that Alexander’s treatise does not contain a chapter on mania and, as we learn from the chapter on melancholia, he was of the opinion that mania is “nothing else than melancholia which has increased in intensity towards becoming wilder” (οὐδὲν γάρ ἐστιν ἄλλο μανία ἢ ἐπίτασις τῆς μελαγχολίας ἐπὶ τὸ ἀγριώτερον).394 In general, it should be highlighted that Alexander’s chapters are very long and detailed, and contain remarks about the cause of the affections, their symptoms, and the appropriate therapy. The chapter on phrenitis provides a good example of Alexander’s way of dealing with mental illness. He states that phrenitis is brought about by yellow bile, which is distributed in the brain and causes inflammation there or in the meninges

386 See Oribasius, Synops. ad Eustath. 8.6.1 (248.12–14 Raeder). 387 See Oribasius, Synops. ad Eustath. 8.6.2–3 (248.14–25 Raeder). 388 See Oribasius, Synops. ad Eustath. 8.6.4 (248.26 Raeder). 389 See Oribasius, Synops. ad Eustath. 8.6.7 (249.2 Raeder). 390 See Oribasius, Synops. ad Eustath. 8.8.1 (249.32–250.4 Raeder). On this chapter, see Thumiger 2018, 266 f. 391 See Oribasius, Eclog. med. 1–2 (185.4–186.36 Raeder), Eclog. med. 36 (199.1–200.6 Raeder), Eclog. med. 71–73 (233.4–240.42 Raeder). 392 See Alexander, Therapeutica 1.1–1.12 (Vol. 1, 441.1–507.25 Puschmann). 393 See Alexander, Therapeutica 1.13–1.17 (Vol. 1, 509.1–617.7 Puschmann). 394 See Alexander, Therapeutica 1.17 (Vol. 1, 597.10 f. Puschmann).

62 | General introduction

of the brain.395 As symptoms he mentions, for example “twitching at the bedclothes” (κροκυδίζειν) and “pulling bits of wool out of items of clothing” (καρφολογεῖν),396 which are both very typical of ancient medical literature in the context of mental derangements (see p. 172 f., commentary on p. 125.20–24), or the fact that the patients are no longer able to give clear answers (οὐδ’ ἀπόκρισιν διδόναι σαφῆ δύνανται).397 It is also clearly stated that the brain brings about the strong derangements of the mind (ἰσχυρὰς … τὰς παραφροσύνας).398 The section dealing with the appropriate therapy begins with the recommendation to conduct a phlebotomy399 and mentions further approaches, such as the application of embrocations to the head (καταβρέχειν)400 or the administration of a remedy consisting of poppyheads (τὸ διὰ κωδειῶν).401 Alexander explicitly claims that sleep is the only and most important remedy for those who have a deranged mind, and for every affection (ὅπερ μόνον καὶ μέγιστόν ἐστι τῶν παραφρονούντων ἴαμα καὶ πάσης νόσου).402 He also gives some recommendations which might be thought of as “psychological”, such as the advice to allow intimate friends to stay in the sick room so that they may gently reprehend the patient about what he is doing but to forbid those people to enter the room who have caused the patient to feel grief or anger,403 since their presence would be irritating, agitating, and cause the patient to be very troubled (ἐρεθιστικὸν … κινητικὸν καὶ τοῦ πάνυ ταράττεσθαι φανερὸν αἴτιον γίνεται).404 Alexander also devotes separate paragraphs to the appropriate regimen, including the vegetables the patients should eat and the fruits and drinks they should consume, as well as to the bath they should take and the wine which they should drink.405 On Alexander’s discussion of mental illness, see also Heiberg 1927, 40–44. Paul of Aegina’s discussions concerning mental illness can be found in the third book of his Epitome medica, which deals with “affections in relation to their affected part” (περὶ τῶν κατὰ τόπους πεπονθότας παθῶν), starting from the head and ending with the feet.406 This book opens with chapters dealing with affections of the hair of the head and of the scalp, as well as with chapters on various forms of headache.407

395 See Alexander, Therapeutica 1.13 (616.2–4 Guardasole = Vol. 1, 509.11–13 Puschmann). See also Alexander, Therapeutica 1.13 (618.7 Guardasole = Vol. 1, 511.16 Puschmann). 396 See Alexander, Therapeutica 1.13 (618.1 Guardasole = Vol. 1, 511.10 f. Puschmann). 397 See Alexander, Therapeutica 1.13 (618.1 f. Guardasole = Vol. 1, 511.11 Puschmann). 398 See Alexander, Therapeutica 1.13 (618.11 Guardasole = Vol. 1, 511.20 Puschmann). 399 See Alexander, Therapeutica 1.13 (620.27 Guardasole = Vol. 1, 515.12 Puschmann). 400 See Alexander, Therapeutica 1.13 (622.24 f. Guardasole = Vol. 1, 517.14 Puschmann). 401 See Alexander, Therapeutica 1.13 (624.2 Guardasole = Vol. 1, 517.20 Puschmann). 402 See Alexander, Therapeutica 1.13 (622.28–30 Guardasole = Vol. 1, 517.17 f. Puschmann). 403 See Alexander, Therapeutica 1.13 (624.20–22 Guardasole = Vol. 1, 519.11–14 Puschmann). 404 See Alexander, Therapeutica 1.13 (624.23 f. Guardasole = Vol. 1, 519.14–16 Puschmann). 405 See Alexander, Therapeutica 1.13 (626.25–634.2 Guardasole = Vol. 1, 521.20–527.19 Puschmann). 406 See Paul 3 (Vol. 1, 127.2–5 Heiberg). 407 See Paul 3.1–3.5 (Vol. 1, 129.1–144.2 Heiberg).

4 Diseases of the brain and mental illness | 63

It then continues with chapters on phrenitis, on inflammation of the brain, on erysipelas of the brain, on lethargia, on katochos, on loss of memory and reasoning and karos and morosis, on skotoma, on epilepsia, on melancholia and mania and the “inspired”, on ephialtes, on lykanthropia, and on people who are in love.408 The following chapters deal with apoplexia and paralysis, spasmos, tetanos, and trembling.409 Afterwards, we find chapters dealing with diseases of the eyes, the ears, the nose, the mouth and affections pertaining to lower bodily parts.410 As is clear from this overview of the third book, there is no distinct book dealing exclusively with diseases of the head but their discussion is embedded in a book which presents affections from top to bottom. Again, the mental affections dealt with in Paul are similar to those discussed in Aetius but Paul subsumes some of them within one chapter (e.g. loss of memory, karos, morosis; melancholia, mania) instead of devoting a single chapter to each affection. Paul’s chapters usually include discussion of the causes of the affections, their symptoms and the recommended therapy. In comparison to what we find in the treatises of Aetius and Alexander, Paul’s chapters are much shorter. In order to provide an insight into Paul’s manner of presenting the mental affections, we can start with a number of chapters in which Paul explicitly addresses the fact that mental capacities are impaired within the definition of the affection. Lethargia, for example, is defined as damage to the reasoning capacity (βλάβη … τοῦ λογιστικοῦ),411 epilepsia is said to be a convulsion of the whole body together with damage to the leading capacities (σπασμὸς οὖσα τοῦ παντὸς σώματος μετὰ βλάβης τῶν ἡγεμονικῶν ἐνεργειῶν),412 melancholia is referred to as a derangement of the mind without fever (παραφροσύνη … ἄνευ πυρετοῦ),413 and the chapter on people who are in love (this topic also appears in Oribasius, see p. 60) is introduced with the remark that “it is not inappropriate to add love to the affections of the brain, because it consists in anxiety, and anxiety is an affection of the soul, when reasoning is set in wearing motion” (τοῖς κατὰ τὸν ἐγκέφαλον πάθεσι τοὺς ἔρωτας προσάπτειν οὐδὲν ἄτοπον φροντίδας τινὰς ὄντας· ἡ δὲ φροντὶς πάθος ἐστὶ τῆς ψυχῆς ἐν κινήσει κοπιώδει καθισταμένου τοῦ λογισμοῦ).414 The symptoms mentioned in these examples are similar to those found in the other authors. “Twitching at the bed-clothes” (κροκυδίζουσι) and “pulling bits of wool out of items of clothing” (καρφολογοῦσι), on which see p. 172 f., commentary on p. 125.20–24, are, again, listed as symptoms of phrenitis,415 while fear, despondency, and misan-

408 See Paul 3.6–3.17 (Vol. 1, 144.3–160.28 Heiberg). For a closer look at Paul’s chapter on people who are in love, see Thumiger 2018, 267. 409 See Paul 3.18–3.21 (Vol. 1, 161.1–170.24 Heiberg). 410 See Paul 3.22–3.81 (Vol. 1, 170.25–314.25 Heiberg). 411 See Paul 3.9.1 (Vol. 1, 147.6 Heiberg). 412 See Paul 3.13.1 (Vol. 1, 152.18 f. Heiberg). 413 See Paul 3.14.1 (Vol. 1, 156.9 Heiberg). 414 See Paul 3.17 (Vol. 1, 160.10–12 Heiberg). On this chapter, see Thumiger 2018, 267. 415 See Paul 3.6.1 (Vol. 1, 144.21 Heiberg).

64 | General introduction

thropy (φόβος … δυσθυμία … μισανθρωπία) are mentioned as symptoms of melancholia.416 Patients suffering from ephialtes are said to have the feeling that someone is attacking them and that they are unable to shout or can only produce unintelligible sounds. Sometimes they even imagine that they hear the voice of their attacker and that he desires sexual intercourse (ὡς ἐπιπεσόντος τινὸς μετὰ τοῦ ἀδυνατεῖν προσεκβοᾶν ἢ φωνεῖν ἀσημάντως· ἔνιοι δὲ φαντασιοῦνται καὶ ἀκούειν πολλάκις τοῦ ἐπιπεσόντος καὶ ἀφροδισίων αὐτὸν ὀρέγεσθαι).417 Alongside symptoms that affect mental functioning or behavior, we also find mention, of course, of a great number of purely bodily symptoms, such as having a small and weak pulse (τοὺς σφυγμοὺς μικροὺς καὶ ἀμυδροὺς ἴσχουσι),418 passing watery excretions (διαχωροῦσι δὲ διὰ γαστρὸς … ὑγρότερα),419 or suffering from indigestion (ἀπεψίαι).420 When it comes to the therapy, Paul mainly recommends the kind of bodily approaches which we have already seen in other authors, such as phlebotomy,421 the application of enemata,422 or bathing the patients.423 On Paul’s approach to mental illness, see also Heiberg 1927, 39 f.; Sharpe 1974. 4.3.2 Aetius I have already discussed the structure and the contents of the first half of the sixth book on p. 17–20, where I emphasized that the brain plays a crucial role in most of the affections discussed there. I also pointed out that the first half of the book includes the discussion of illnesses which are commonly ranked among mental illnesses, such as phrenitis, melancholia, and mania. Although Aetius himself does not give any explicit statement that these illnesses belong to a category which is comparable to what we refer to as mental illnesses, it is clear that he understands them as being somewhat similar and as sharing the brain as seat of the affection. This is what I have referred to as his “implicit categorization” earlier in this introduction (see p. 42 f.) and this categorization makes it legitimate, I believe, to discuss these affections as belonging to one set of illnesses.424 The fact that Posidonius is claimed as the source for many of these chapters adds weight to the suggestion that all the affections therein belong to a single category of brain affections on which Posidonius may have been an expert (see p. 23–25).425 It is worth noting here that the first chapter of the sixth book, the chapter on hydrokephalos, seems to be 416 See Paul 3.14.1 (Vol. 1, 156.16 f. Heiberg). 417 See Paul 3.15 (Vol. 1, 159.4–6 Heiberg). 418 See Paul 3.6.1 (Vol. 1, 144.23 Heiberg). 419 See Paul 3.9.1 (Vol. 1, 147.14 f. Heiberg). 420 See Paul 3.14.1 (Vol. 1, 156.27 Heiberg). 421 See e.g. Paul 3.6.2 (Vol. 1, 145.2 Heiberg). 422 See e.g. Paul 3.6.2 (Vol. 1, 145.7 Heiberg). 423 See e.g. Paul 3.14.2 (Vol. 1, 157.6 f. Heiberg). 424 See also Gäbel 2018, 317. 425 For a detailed look at Posidonius, see also Gäbel 2020.

4 Diseases of the brain and mental illness | 65

different from the other chapters discussed in the first half of Aetius’ sixth book in that it is heavily anatomical, on the one hand, and does not refer to mental symptoms in as much detail as the other chapters, on the other.426 This is also evident from the fact that the therapy for hydrokephalos is exclusively surgical in nature while the other chapters contain pharmacological and dietetic approaches that aim to restore a healthy state to the brain, which is responsible for the proper functioning of mental activities. In what follows, I will discuss the symptoms found in the chapters analyzed in this study and will try to classify them into different groups, although these cannot always be strictly separated as they are often interwoven and mutually dependent. The following list should, then, simply be understood as a means of making the great amount of symptoms visible, rather than as providing formal distinct and separable classifications. First, there are the symptoms which I refer to as affecting mental functioning. Among this group are symptoms such as παρακοπή, παράνοια, παραφορά, παραφροσύνη and their derivatives which describe a derangement of the mind (see p. 164 f., commentary on p. 125.4–6), damage to imagination (e.g. βέβλαπται δὲ τὸ φανταστικὸν),427 damage to reasoning (e.g. τὸ βεβλάφθαι τὸν λογισμόν),428 forgetfulness (e.g. ἐπιλήσμονές εἰσιν),429 and damage to the leading capacities (e.g. μετὰ βλάβης τῶν ἡγεμονικῶν ἐνεργειῶν)430 which latter subsume imagination, reasoning, and memory. It is also worth noting here the strange utterances (e.g. ἀλλόκοτα φθέγγονται),431 and speechlessness (e.g. ἄφωνοι)432 that can be ascribed to both the impairment of reasoning and also to a neurological disturbance of speech. Furthermore, symptoms such as touching nearby walls (προσάπτονται τῶν πλησίων τοίχων)433 or the fidgeting of one’s hands around the head (φέρουσι δὲ τὰς χεῖρας αὑτῶν ἐνίοτε περὶ κεφαλὴν καὶ ὀφθαλμοὺς καὶ ῥῖνας),434 which are commonly mentioned in ancient medical texts as symptoms of mental derangement, can be referred to an impairment of mental functioning (see p. 255 f., commentary on p. 132.3–5, see p. 258, commentary on p. 132.9–10). Symptoms such as the belief that one does not have a complete head (ὁ δέ τις οὐδὲ κεφαλὴν ἔχειν τὸ παράπαν ᾤετο),435 or is followed by daimones which have been sent by enemies through witchcraft (τινὲς δὲ 426 In the chapter on hydrokephalos we find a mention of the occurrence of continuous darkening of vision and of dimness of the senses. See Aetius Amid., Libri med. 6.1 (Vol. 2, 124.5 f. Olivieri). 427 See Aetius Amid., Libri med. 6.8 (Vol. 2, 137.3 Olivieri). 428 See Aetius Amid., Libri med. 6.3 (Vol. 2, 129.3 Olivieri). 429 See Aetius Amid., Libri med. 6.3 (Vol. 2, 128.25 Olivieri). 430 See Aetius Amid., Libri med. 6.5 (Vol. 2, 133.13 Olivieri). See also Libri med. 6.2 (Vol. 2, 125.10– 24 Olivieri). 431 See Aetius Amid., Libri med. 6.3 (Vol. 2, 128.25 Olivieri). 432 See Aetius Amid., Libri med. 6.4 (Vol. 2, 132.2 Olivieri). 433 See Aetius Amid., Libri med. 6.4 (Vol. 2, 132.9 f. Olivieri). 434 See Aetius Amid., Libri med. 6.4 (Vol. 2, 132.3 f. Olivieri). 435 See Aetius Amid., Libri med. 6.9 (Vol. 2, 142.16 f. Olivieri).

66 | General introduction

καὶ δαίμονας ἀπὸ γοητειῶν τῶν ἐχθρῶν ἐπῆχθαι αὐτοῖς ὑπολαμβάνουσιν),436 or that one has received a deadly poison (ἕτεροι δὲ δηλητήριον φάρμακον εἰληφέναι ὑποπτεύουσι),437 may also be traced back to a derangement of the mind. Secondly, one can find symptoms which affect the motor functions or, to use an anachronistic term, which can be described as neurological disturbances. Among this group one may rank motionlessness (ἀκινησία, ἀκίνητον),438 the appearance of spasms and convulsions (e.g. μετὰ σπασμοῦ καὶ συνολκῆς τῶν νεύρων),439 and probably also the various conditions of the eyes, such as having open eyelids, blinking or staring (e.g. ὁτὲ δὲ ἀνεῳγότα ἔχοντες τὰ βλέφαρα ἢ σκαρδαμύττουσιν ἢ ἀτενὲς ὁρῶσι καὶ ὡς πεπηγότας ἔχουσι τοὺς ὀφθαλμοὺς),440 which can also be included among the impairments of sensation. The impairment of speech or of correct utterance, which have already been mentioned among symptoms which affect mental functioning, should probably also be traced back to a neurological impairment. Thirdly, there are various symptoms affecting behavior or emotions and these may, to some extent, be consequences of the previously discussed mental impairment. Among this group of symptoms one may, for example, include unreasonable laughter (e.g. γέλως ἄσχετος),441 constant singing (e.g. ᾄδουσι συνεχῶς),442 being licentious regarding sexual intercourse (e.g. ἀκόλαστοι πρὸς ἀφροδίσια),443 suffering from fear and despondency (e.g. ὁ φόβος καὶ ἡ δυσθυμία),444 or being irascible (e.g. ὀργίλοι).445 Fourthly, one may distinguish a group of symptoms which affect sensation. Among this group we can include symptoms such as dimness of vision (e.g. ἀμβλυωγμοί),446 ringing in the ears (e.g. ὤτων ἦχοι),447 hardness of hearing (e.g. δυσηκοΐαι),448 and lack of sensation (e.g. ἀναισθησία). Also worth mentioning are the various conditions of the eyes, which have been discussed above under neurological disturbances but which, of course, also impair vision. The fifth group of symptoms is difficult to integrate with the previous four and might be best treated as entirely distinct. These are the symptoms which affect sleep 436 See Aetius Amid., Libri med. 6.9 (Vol. 2, 142.21 f. Olivieri). 437 See Aetius Amid., Libri med. 6.9 (Vol. 2, 142.23 Olivieri). 438 See e.g. Aetius Amid., Libri med. 6.5 (Vol. 2, 133.12 f. Olivieri), Libri med. 6.4 (Vol. 2, 132.1 Olivieri). 439 See Aetius Amid., Libri med. 6.3 (Vol. 2, 128.18 Olivieri). 440 See Aetius Amid., Libri med. 6.4 (Vol. 2, 131.21–132.1 Olivieri). 441 See Aetius Amid., Libri med. 6.8 (Vol. 2, 136.25 Olivieri). 442 See Aetius Amid., Libri med. 6.8 (Vol. 2, 136.27 Olivieri). 443 See Aetius Amid., Libri med. 6.9 (Vol. 2, 142.20 Olivieri). 444 See Aetius Amid., Libri med. 6.9 (Vol. 2, 143.4 Olivieri). 445 See Aetius Amid., Libri med. 6.8 (Vol. 2, 137.6 Olivieri). 446 See Aetius Amid., Libri med. 6.7 (Vol. 2, 134.13 Olivieri). 447 See Aetius Amid., Libri med. 6.7 (Vol. 2, 134.14 Olivieri). 448 See Aetius Amid., Libri med. 6.7 (Vol. 2, 134.14 Olivieri).

4 Diseases of the brain and mental illness | 67

and sleep habits. Among this group one may rank symptoms such as “being drowned in sleep” (e.g. βαπτίζεσθαι αὐτοὺς τῷ ὕπνῳ; ἕνα τὸν βαπτισμὸν ὑπομένουσιν),449 being sleepy (ὑπνώττειν),450 suffering from the deepest sleep (ὕπνῳ βαθυτάτῳ)451 or from sleeplessness (e.g. ἀγρυπνίαι).452 Under the sixth and last group of symptoms which are mentioned in the chapters in question, I subsume all further distinct bodily symptoms which do not belong to one of the previous groups. The most frequent examples of this kind of symptom are those affecting the patients’ pulse,453 their respiration,454 their digestive tract,455 and the occurrence of fever.456 Looking at these different groups of symptoms, it is interesting that, according to Galen, the leading capacities (ἠγεμονικαί), those belonging to sensation (αἰσθητικαί) and those belonging to movement (scil. through impulse) (κινητικαί), are all understood as psychic capacities (ψυχικαὶ ἐνέργειαι), as is discussed in greater detail on p. 167 f., commentary on p. 125.10–15.457 Along similar lines is the statement in the pseudo-Galenic Definitiones medicae that “sleep is a natural relaxation of the soul, from the extremities to the leading faculty” (ὕπνος ἐστὶν ἄνεσις ψυχῆς κατὰ φύσιν ἀπὸ τῶν περάτων ἐπὶ τὸ ἡγεμονικόν).458 It may seem odd to cite Galenic passages in a discussion of Aetius’ way of dealing with mental illnesses. For the question of what the symptoms mentioned in Aetius’ discussion of mental illnesses share in common, it is at least worth noting that Galen ranks most of them among activities of the soul, given that Galenic ideas and concepts appear to have influenced Aetius (see p. 23). The therapeutic recommendations given in Aetius’ chapters on mental illnesses are physiological in nature and aim to restore the healthy state of the body. The most common type of approaches are those which aim at evacuating the body of detrimental substances by means of phlebotomy, enemata, vomiting, and suchlike.459 We also often read that embrocations should be applied to the head460 or poultices to the abdomen,461 and we receive detailed information concerning the appropriate foodstuffs to be eaten.462 A detailed discussion of these and other approaches is

449 See Aetius Amid., Libri med. 6.3 (Vol. 2, 128.16 Olivieri), Libri med. 6.3 (Vol. 2, 128.20 Olivieri). 450 See Aetius Amid., Libri med. 6.4 (Vol. 2, 131.21 Olivieri). 451 See Aetius Amid., Libri med. 6.5 (Vol. 2, 133.16 Olivieri). 452 See Aetius Amid., Libri med. 6.8 (Vol. 2, 138.5 Olivieri). 453 See e.g. Aetius Amid., Libri med. 6.3 (Vol. 2, 128.23 f. Olivieri). 454 See e.g. Libri med. 6.3 (Vol. 2, 128.26–129.1 Olivieri). 455 See e.g. Libri med. 6.4 (Vol. 2, 132.7 f. Olivieri), Libri med. 6.7 (Vol. 2, 134.18 f. Olivieri). 456 See e.g. Libri med. 6.5 (Vol. 2, 133.11 f. Olivieri), Libri med. 6.6 (Vol. 2, 133.23 Olivieri). 457 See also von Staden 2000, 105–111. 458 See Pseudo-Galen, Def. med. 127 (19.381.14 f. K.). 459 See e.g. Aetius Amid., Libri med. 6.7 (Vol. 2, 135.6 Olivieri), Libri med. 6.8 (Vol. 2, 139.20 f. Olivieri), Libri med. 6.10 (Vol. 2, 151.9 Olivieri). 460 See e.g. Aetius Amid., Libri med. 6.8 (Vol. 2, 139.6 f. Olivieri). 461 See e.g. Aetius Amid., Libri med. 6.5 (Vol. 2, 133.20 f. Olivieri). 462 See e.g. Aetius Amid., Libri med. 6.3 (Vol. 2, 131.9–15 Olivieri).

68 | General introduction

provided in the commentary. As far as those chapters analyzed in this study are concerned, there is just one recommendation that we might call “psychological”: in his chapter on melancholia, Aetius reports that Philotimus used a leaden helmet which he put on the heads of those patients who had the delusion that their head was not complete. Being oppressed through the weight of this helmet, they felt their head again and were freed of the delusion (see p. 426 f., commentary on p. 142.16– 19).463 In summary, the sixth book of Aetius’ Libri medicinales offers a detailed account of mental illnesses, with the brain playing a crucial role in the causal explanation. The illnesses are traced back to certain bodily processes in the brain (or the abdominal region, which transfers detrimental substances to the brain). They are accompanied by a range of symptoms that affect mental functioning, motor functioning, behavior and emotions, sensation, sleep, and other distinct bodily processes, all of which are cured by physiological therapies. Given that the discussion of mental illnesses in the other important authors of late antiquity, Oribasius, Alexander, and Paul, either is not fully accessible due to textual losses (Oribasius), does not include as many affections (Alexander), or does not discuss the affections in the same detail as Aetius (Paul), Aetius’ sixth book appears to be a very valuable source for the discussion of mental illnesses in late antiquity.464 On Aetius’ discussion of mental illness, see also Heiberg 1927, 37–39. Before turning to the individual chapters of Aetius’ sixth book, it is worth very briefly addressing the questions of why Aetius composed his sixth book exactly as he did, why he cites precisely the authors he selects, and what may have been his agenda in following the approach he takes. Answers to these questions can only be hypothetical because Aetius himself does not provide any information about these topics throughout his compilation (on this, see also p. 13) and we must therefore infer answers to these questions from the compilation itself. As discussed above, Aetius’ agenda may have been to illustrate what he deemed to be worth knowing about a specific medical topic, and this may be connected to presenting what is of practical relevance for physicians (see also p. 19 f. and p. 28). It was obviously not his aim to cite all available authors and theories on a certain topic. It is, for example, notable that Aetius does not claim to cite, in the chapters of the sixth book discussed here, any author from the period before Christ. In other parts of the compilation, however, he also cites, for example, Hippocrates.465 With regard to the discussion of mental illnesses, authors such as Hippocrates seem to be neglected because they do not systematically discuss the affections dealt with in Aetius’ chapters (see also p. 45). Along similar lines, we also have to understand the fact that, in the chapters

463 See Aetius Amid., Libri med. 6.9 (Vol. 2, 142.16–19 Olivieri). 464 See also Gäbel 2018, 340. 465 For all passages in Aetius’ compilation where he claims to cite Hippocrates, see Bravos 1974, 108–110.

4 Diseases of the brain and mental illness | 69

discussed in this study, it is not Galen who is most frequently claimed to be cited (on possible discrepancies between the claim to cite an author and the actual citation, see p. 22 f.) but, rather, Posidonius (see note 129), although Galen is the author who is most frequently cited in the complete Libri medicinales.466 Galen did not deal with mental illness as systematically as he does with other medical topics (see p. 53). This might be the reason why Posidonius is prominently cited in the chapters discussed in this study, since he may have been an expert in this field, as has been suggested by several scholars (see p. 25).467 We must, presumably, suppose that Aetius thought that the name of Posidonius was one that had to be cited in the sixth century when talking about mental illnesses. Similarly, we also have to interpret the fact that Aetius claims to cite Rufus in his two chapters on melancholia. As I already discussed (see p. 27), even Galen praises Rufus’ work on melancholia as being the best and if we take this seriously, this fits very well into our reflections on Aetius’ choice of authors: Rufus’ name was presumably one that had to be cited when dealing with melancholia in Aetius’ life time, while earlier authors, such as Hippocrates, were not deemed worth being cited on this particular affection. When discussing Aetius’ selection of authors it might seem remarkable that one of the other authors who is frequently cited in the first half of the sixth book is Archigenes of Apamea (see p. 25 f.), who was known to be a follower of the Pneumatists and who obviously held a cardiocentric view.468 One might ask how the theories of a cardiocentrist, who was of the opinion that mental faculties should be located in the heart, could have convinced Aetius, who was clearly a supporter of encephalocentric theories (see p. 43 f.), to such a degree that he deemed him to be worth citing in his sixth book dealing with diseases of the head. It is important in this regard that the therapy for mental illness that is suggested by Archigenes (not only in the fragments preserved by Aetius but also elsewhere) actually aims at the head and not – as one might expect from a cardiocentrist – at the heart.469 This discrepancy was indeed an aspect of Archigenes’ theories that caused Galen to harshly criticize him for being “inconsistent with his psychophysiological theory”470 when speaking about the therapy of mental illness.471 How might we account for this apparent contradiction? Lewis has pointed out that it was not uncommon for cardiocentrists to focus on the head when trying to cure mental illness, and that this fact might be traced back to “empirical evidence and authoritative professional tradition”.472 Coming back to Aetius’ usage of Archigenes, one may conclude that Aetius uses Archigenes as a source for his sixth book because his therapeutical approaches are in line with the encephalocentric 466 See Bravos 1974, 164. 467 See also Gäbel 2020, 42. 468 See Lewis 2018, 143. 469 For an overview of Archigenes’ treatment of mental illness see Lewis 2018. 470 Lewis 2018, 145. 471 See e.g. Galen, De loc. aff. 3.5 (8.151.4–8 K.). 472 Lewis 2018, 147. For more detail see the complete paper by Lewis 2018.

70 | General introduction

theories with which Aetius is sympathetic. Thus, in spite of his cardiocentric background, Archigenes proves to be an appropriate source for the therapy of mental illness. In summary, I interpret Aetius’ compilation as his suggestion of what a physician at his time needed to know when he wanted to be “up-to-date” on certain affections and when he wanted to be capable of curing them. We should, thus, consider the way he arranged his compilation as reflecting exactly this agenda.

|

Olivieri’s text and my translation List of changes to Olivieri’s edition p. 123.21:

p. 126.13: p. 129.10: p. 131.8: p. 131.19: p. 134.14: p. 134.26: p. 135.6: p. 143.12: p. 143.17: p. 145.26: p. 150.2: p. 151.6:

κατὰ τὸ δέρμα ἔξωθεν τοῦ περικρανίου ὑμένος ἤ μεταξὺ τοῦ περικρανίου καὶ τοῦ ὀστέου instead of κατὰ τὸ δέρμα ἔξωθεν μεταξὺ τοῦ περικρανίου καὶ τοῦ ὀστέου γιγνομένην instead of γιγνομένης οὐροδόχου instead of οὐρητήρου τρύξ instead of τρύγη συμβαῖνον instead of συμβαίνοντι συνεχεῖς instead of συνηχεῖς τῶν τε χυμῶν instead of τόν τε χυμόν ἦ (standing for ᾖ) instead of εἴη τὸ instead of ὅ Ῥούφου ante πάντων addidi αὔταρκες instead of ἄνταρκες συνεδρεύουσι instead of ἐνεδρεύουσι α instead of ας

72 | Aetii Amideni Libri medicinales VI 1, p. 123.1–25 Olivieri

123 ᾱ

〈Ἀρχὴ τοῦ ἕκτου λόγου〉 Περὶ ὑδροκεφάλων Λεωνίδου. τὸ ὑδροκέφαλον πάθος προσαγορεύεται ἀπὸ τοῦ ἐν τῇ κεφαλῇ ὑδατώδους ὑγροῦ συλλεγομένου· κατὰ τὸ πλεῖστον μὲν οὖν τὸ ὑδατῶδες συλλέγεται, ἐνίοτε δὲ τρυγῶδες ἢ δίαιμον συνίσταται, ἀεὶ δὲ ἀργόν. γίγνεται δὲ τοῦτο ἢ ἐξ ἀδήλου ἢ ἐκ προδήλου αἰτίας· ἐξ ἀδήλου μὲν ἐκ τοῦ αὐτομάτου ἀραιουμένων τῶν τοπικῶν ἀγγείων καὶ τῆς ἐν αὐτοῖς ὑδατώδους οὐσίας τῆς συγκεκραμένης τῷ αἵματι παρωθουμένης καὶ εἰς ἕνα τόπον συνισταμένης· ἐκ δὲ τῆς τοιαύτης αἰτίας ὑδατῶδες συλλέγεται ὑγρόν. ἐκ προδήλου δὲ αἰτίας γίγνεται ἐκ πληγῆς ἢ θλάσματος ῥηγνυμένων τῶν τοπικῶν ἀγγείων καὶ τοῦ ἐν αὐτοῖς αἵματος παρεγχεομένου, ἔπειτα δὲ ἀργευομένου, εἰς λεπτὴν οὐσίαν τρυγώδη ἢ δίαιμον ἀναλυομένου· συνεχέστατα δὲ γίγνεται τὸ πάθος ἐκ τῆς τοιαύτης αἰτίας ἐπὶ νηπίων, ὅταν ἡ μαῖα ἀπείρως μαιουμένη σκληροτέρᾳ τῇ χειρὶ χρησαμένη κατὰ τὸ τοῦ ἐμβρύου κεφάλαιον θλάσῃ τινὰ σώματα. συνίσταται δὲ τὸ ὑγρὸν ἐπὶ τῶν ὑδροκεφάλων ἢ μεταξὺ τοῦ δέρματος καὶ τοῦ περικρανίου ὑμένος ἢ μυὸς τοῦ κροταφίτου ἢ ὑπὸ τὸν περικράνιον ὑμένα μεταξὺ αὐτοῦ καὶ τοῦ τῆς κεφαλῆς ὀστοῦ ἢ ὑπὸ τὸ κρανίον μεταξὺ τῆς μήνιγγος καὶ τοῦ ὀστέου. οἱ δὲ πρὸ ἡμῶν φασι καὶ μεταξὺ τῆς μήνιγγος καὶ αὐτοῦ τοῦ ἐγκεφάλου συνίστασθαι, ὅπερ ἐστὶν ὀλέθριον. ἀργοῦ μὲν οὖν ὑγροῦ συλλεγομένου κατὰ τὸ δέρμα ἔξωθεν μεταξὺ τοῦ περικρανίου καὶ τοῦ ὀστέου ὄγκος συνεδρεύει κατά τι μέρος τῆς κεφαλῆς, καθ’ ὃν ἡ γεγονυῖα συλλογὴ ὁμόχρους ἀναλγὴς εὐαφής, εἴκοντος καὶ μεθισταμένου κατὰ τὴν τῶν δακτύλων ἐπαφήν. καὶ εἰ μὲν αὐτόματος γένηται, ἐξ ἀρχῆς ἀνώδυνος καὶ ὁμόχρους ἔσται ὁ τόπος, εἰ δὲ ἐκ πληγῆς ἢ θλάσματος, κατ’ ἀρχὰς

5

10

15

20

25

123,2–5 ὑδροκέφαλον – συνίσταται cf. [Gal.] def. med. 390 (XIX, 442,15–17) 12–25 συνεχέστατα – τόπος cf. Or.c XLVI 28 (III 237,26–27,30–37) 15–20 συνίσταται – συνίστασθαι cf. Gal. ascrip. int. s. med. 19 (XIV, 782,14–17) 1 Ἀρχὴ ἕκτου βιβλίου P x Ἀετίου βιβλίον ἕκτον περὶ τῶν ἐν τῆ κεφαλῆ συνισταμένων πάντων παθῶν P Λόγος ἕκτος C p S om. La M o A At 2–125,3 totum cap. ᾱ om. M o P 2 Λεωνίδους La P x A S …δος At Αετίου ex Λεωνίδους ut vid. C p post Λεωνίδου: Ἔμπλαστροι λέγονται (…άστρου ..γοντος C p) διαφορεῖν τὰ ὑγρὰ ταῦτα ἡ διὰ καμπάρεως καὶ ἡ διὰ τοῦ ἀγαρικοῦ La C p 4 τὸ om. P a P x A At συστέλλεται P x 5  γίγνεται δὲ] συνίσταται (δὲ superscr. m. 2a S) ω 6 τοῦ] τῶν S αὐτομάτος (l. -τως) A …. των S 7  …μμένης φ S 8 παρηθουμένης χ A S 9 ante ὑγρόν: ὕδωρ add. At m. 1a S 10 post θλασμ.: ἢ ἐξ ἄλλων τινῶν ἢ καὶ πάλιν P x 11 ….χυνομένου P a C p ….κεχυμένου ω ἀραιουμένου At ante εἰς: καὶ C p m. 2a S 12 post ἀναλυομένου: εἰς λεπτὴν οὐσίαν τρυγώδη La 13 τῆς om. C p ω 14 μαιευομένη C p m. 2a S μετιομένη La ω χρησαμ.] μετερχομένη ω ante κατὰ: καὶ ω τὸ] τὴν P a τῆς A om. C p At m. 1a S 15  κεφαλὴν P a …ῆς A θλάσει La P x ω post τινὰ: ποιοῦσαν ἐν τῶ τοιούτω P x 17 τοῦ κροταφ.] που κροτάφου At m. 1a S τοῦII om. ω 18 μεταξὺ om. ω 20 ἀργοῦ –ὑγροῦ] ὑγροῦ μὲν οὖν At 21 post ἔξωθεν: τοῦ περικρανίου ὑμένος ἢ χ A ω 22 καθ’ ὃν sc. τόπον 24 αὐτομάτως χ A

VI 1 On hydrokephaloi from Leonides | 73

Beginning of book six

123

VI 1 On hydrokephaloi from Leonides

5

10

15

20

25

The affection hydrokephalos is so called because of the watery fluid that gathers in the head. In most cases, watery (fluid) is gathering, but sometimes what is brought together has a consistency like lees or is bloody, but it is always inert. It occurs either from an invisible or from a manifest cause: from an invisible (cause it occurs) without external agency when the local vessels become porous and when the watery substance that is contained in them and mixed with the blood is pushed aside and brought together in one place: it is from a cause such as this that the watery fluid gathers. From a manifest cause, on the other hand, it [scil. the gathering of the fluid] occurs in consequence of a blow or a bruise when the local vessels burst and when the blood that is contained in them pours out, afterwards becomes inert, and resolves into a thin substance with a consistency like lees or into a bloody one: most frequently this affection occurs from such a cause in newborns when the midwife delivers without experience and, with a very hard hand, bruises some parts at the head of the embryo. The fluid is brought together in the hydrokephaloi either between the skin and the pericranial membrane or the temporal muscle, or underneath the pericranial membrane, between it and the bone of the head, or underneath the skull between the dura mater and the bone. Those who came before us say that it can also be brought together between the dura mater and the brain itself, which is fatal. When inert fluid gathers at the skin outside of the pericranial membrane or between the pericranial membrane and the bone, a swelling comes along with it at the part of the head where the gathering (of fluid) that has taken place is uniform in color, not painful, and soft, insofar as it [scil. the swelling] gives way and changes its position according to the touch of the fingers. And if it occurs without external agency the place will cause no pain and be uniform in color from the beginning, but when it occurs as a consequence of a blow or a bruise the swelling becomes | red and painful 124

74 | Aetii Amideni Libri medicinales VI 1, p. 124.1–30 Olivieri

124

μὲν ἐνερευθὴς καὶ ἐπώδυνος γίνεται ὁ ὄγκος, ὕστερον δὲ ἀργευομένου τοῦ ὑγροῦ καὶ μεταβαλλομένου εἰς λεπτὴν οὐσίαν, τότε ὁ ὄγκος ὁμόχρους καὶ ἀνώδυνος γίνεται. τῆς δὲ συλλογῆς ὑπὸ κρανίον γεγενημένης μεταξὺ τοῦ ὀστέου καὶ τῆς μήνιγγος κατ’ ἀρχὰς ὀλίγου ὄντος τοῦ ὑγροῦ ἡ κεφαλὴ βαρύνεται καὶ σκοτισμοὶ γίγνονται συνεχεῖς καὶ αἱ αἰσθήσεις ἀμβλύνονται, λέγω δὲ ὅρασις ἀκοὴ καὶ αἱ λοιπαί. ὅταν δὲ πλεονάσῃ τὸ ὑγρὸν, αἱ ῥαφαὶ τῆς κεφαλῆς διὰ τὸ πλῆθος διίστανται ἀπ’ ἀλλήλων καὶ διὰ τοῦτο ἡ κεφαλὴ μεγάλη γίγνεται καὶ πρόδηλος ὁ τόπος τῆς συλλογῆς· τῷ γὰρ δακτύλῳ ἐπειγομένῳ εἴκει τὸ ὑγρόν. χειρουργία· κοινῶς μὲν οὖν ἐπὶ τῆς ὑπὸ τὸ δέρμα συλλογῆς καὶ τῆς μεταξὺ τοῦ περικρανίου ὑμένος καὶ τοῦ ὀστέου ταῖς αὐταῖς ἐπιβολαῖς χρώμεθα πρὸς τὴν τοῦ ὑγροῦ ἔκκρισιν καὶ μικροῦ μὲν τοῦ ὄγκου ὄντος διαίρεσις μία μικρὰ κατὰ τῆς τοῦ ὄγκου κορυφῆς διδόσθω, μείζονος δὲ τοῦ ὄγκου γεγονότος δύο ἢ τρεῖς ἢ πλείους διαιρέσεις διδόσθωσαν κατ’ ἀναλογίαν τοῦ μεγέθους ἐν τοῖς καθ’ ὑπόρρυσιν τόποις· οὐ δεῖ δέ, ὡς ἐπὶ ἀποστημάτων, μετὰ τὴν χειρουργίαν λημνίσκους διεκβάλλειν, ἀλλ’ αὐτὰς μόνας τὰς διαιρέσεις τοῖς μοτοῖς διαστέλλειν· μετὰ γὰρ τὴν τοῦ ὑγροῦ ἔκκρισιν ῥᾳδίως ἐπὶ τούτων παρακολλᾶται τὰ σώματα· διὸ ἀρκούμεθα ἐπ’ αὐτῶν τῇ διαμοτώσει, μετὰ δὲ τὴν διαμότωσιν, ἐὰν μὲν ᾖ νήπιον τὸ κεχειρισμένον, διὰ τὸ βάρος τὴν ἐπίδεσιν παραιτούμεθα. ὠοβραχὲς δὲ ἔριον ἐπιτιθέσθω καὶ πιλαρίῳ σκεπάσθω τὸ κεφάλαιον. ἐπὶ δὲ τῶν ἰσχυροτέρων μοτοφυλάκιον ἔξωθεν ἐπιτιθέσθω καὶ ἐπίδεσις ἐκκρινέσθω. δυνατὸν δὲ ἀπὸ τῆς τρίτης συνεργεῖν τῇ παρακολλήσει διά τινος τῶν κολλητικῶν ἐμπλάστρων. τῆς δὲ συλλογῆς ὑπὸ τὸν κροταφίτην μῦν γενομένης, ἵνα μὴ τμηθῇ ὁ μῦς, ἐκδέξασθαι χρὴ ἕως πλεονάσει τὸ ὑγρόν, ἔπειτα ἐκ πλαγίων τοῦ μυὸς δοῦναι τὴν διαίρεσιν. ἐὰν δὲ συνέχηται τὸ ὑγρὸν ἐν τῷ βάθει ὑπὸ τὸν μῦν, δύο διαιρέσεις διδόσθωσαν ἐκ τῶν δύο πλαγίων τοῦ μυός, ἑκατέρωθεν αὐτοῦ μία, ἔπειτα ὑποδιαιρεῖν τὸ σῶμα διὰ τοῦ λαβιδίου τοῦ σμιλαρίου ἀσφαλῶς. μετὰ δὲ τὴν τοῦ παντὸς ὑγροῦ ἔκκρισιν θεραπεύειν, καθὼς προδεδήλωται. καὶ

5

10

15

20

25

30

124,9–15 κοινῶς – τόποις cf. Gal. ascrip. int. s. med. ib. (ib. 783,4–5) 124,1 τόπος, supra scr. ὄγκος m. 1a P a 3 γίνεται om. At m. 1a S post ὑπὸ: τὸ χ ψ ω 5 αἱ om. ψ S 7  συνίστανται La P x 8 post πρόδηλος: γίγνεται P a χ ψ At canc. seps. S 9 ….κτυλίω La At ἐπερειδομένω P a χ ψ m. 2a S om. At m. 1a S χειρουργία om. C p ψ ω 10 ἐπὶ om. ω τὸ δέρμα] δένδρου P x τῆςII] τοῦ At τοῦ om. P x ψ 12 μικρὰ μία ω 13 δίδοται α, exc. La 14 δίδονται ω κατὰ χ ψ 15  καθυπορύσι La κατυπορύσεις P x 16 διεκβαλειν C p S ἐμβάλ(λ)ειν P x ψ ἀλλὰ ταύτας ψ ἀ. τοῦ τὰς P x 17 τῶ μότω P a 18 διαρκούμεθα La 19 δὲ om. La 20 ἐγχειρσμ. P a κεχρησμ. ψ κεχρισμ. P x κεγχρισμ. At 21 σκεπέσθω α, exc. La 22 μοτὸν ἔξωθεν φυλάκιον ω ἐπιθέσθω ψ καὶ – ἐκκρ. om. P a ἐγκρ. C p ψ 24 ἐπὶ P a ψ At post ὑπὸ: τὴν ἐνέργειαν τὸν ὑπὸ P x μῦν] μὴν La μυών ψ μὲν At m. 1a S 25  γιγνομ. α, exc. φ 26 ἐκπλαγείων P a ψ δὲ om. La P x At m. 1a S 26sq. συνέχη La 27 τῶν μυῶν P x ψ 28 αὐτοῦ om. La μία om. ω 28sq. ὑποδέρειν α, exc. φ 29 τὰ σώματα α, exc. φ διὰ] ὑπὸ α, exc. φ 30 ὑγροῦ om. P x ψ supra scr. m. 2a S

VI 1 On hydrokephaloi from Leonides | 75

5

10

15

20

25

30

in the beginning, but afterwards when the fluid becomes inert and turns into a thin substance, at that time the swelling becomes uniform in color and causes no pain. When the gathering occurs beneath the skull between the bone and the dura mater, if there is little fluid in the beginning, then the head is burdened and a continuous darkening occurs and the senses are dimmed, by which I mean sight, hearing, and the others. But when the fluid is in excess the sutures of the skull are separated from each other because of the amount (of fluid) and hence the head becomes big and the place of the gathering (of fluid) becomes apparent, for the fluid gives way to the finger which presses it. Surgery: In general, we use the same approaches for the excision of the fluid in the gathering (of fluid) beneath the skin and (in the gathering) between the pericranial membrane and the bone; and if the swelling is small then one small incision down from the top of the swelling shall be made, but, if the swelling is larger, then two or three or more incisions shall be made in relation to the size in the places concerning the draining of the water. It is not necessary, as it is in the case of abscesses, to thread ribbons after the surgery but only to put asunder the incisions themselves with tamponades: for after the excision of the fluid the bodies easily agglutinate in these instances. Therefore, it will be sufficient for us to use tamponades in these instances, but after having applied tamponades, if the patient is an infant, we reject the use of bandages because of their weight. One should place upon (the infant’s head) a piece of wool which was soaked in egg white, and one needs to cover the head with a cap. In those who are stronger, one should place a motophylakion externally and a bandage should be selected. From the third day onwards, it is possible to assist the gluing by means of one of those salves which are glutinous. If the gathering (of fluid) occurs underneath the temporal muscle then it is necessary, in order for the muscle not to be cut, to wait until the fluid is in excess, and thereafter to undertake the incision from the sides of the muscle. If the fluid is held together deep under the muscle, two incisions should be made from the two sides of the muscle, one on each side of it, and afterwards one has to get safely under the tissue with the handle of the knife. After the excision of the complete fluid, one should cure as has been made clear beforehand. And | in (the gatherings of fluid) 125

76 | Aetii Amideni Libri medicinales VI 1–2, p. 125.1–27 Olivieri

125

β

ἐπὶ δὲ τῶν ὑπὸ τὸ κρανίον ἀναμένειν δεῖ καὶ ὅταν πλεονάσῃ τὸ ὑγρὸν καὶ διαστῶσιν αἱ ῥαφαὶ καὶ φανερὸν γένηται τὸ ὑγρόν, διαιρεῖν τὸν κορυφούμενον τόπον καὶ τὰ ἀκόλουθα ποιεῖν. Περὶ φρενίτιδος ἐκ τῶν Ποσειδωνίου. ἡ φρενῖτις φλεγμονή ἐστι τῶν περὶ τὸν ἐγκέφαλον μηνίγγων μετὰ πυρετοῦ ὀξέος παρακοπὴν καὶ παραφορὰν τῆς διανοίας ἐπιφέρουσα. σπανίως δὲ ἡ φρενῖτις ἐξ ἀρχῆς συνεισβάλλει τῷ πυρετῷ· τοῖς δὲ πλείστοις ἀπὸ τῆς δʹ ἄρχεται καὶ εʹ καὶ ϛʹ καὶ ἔτι ὀψιαίτερον αὐτῷ σχεδὸν τῷ κινδύνῳ συνάπτουσα, ὥστε ἤδη οἱ μὲν ἑβδομαῖοι, οἱ δὲ ἐναταῖοι ἤρξαντο παραφρονεῖν. διαφοραὶ δὲ τῆς φρενίτιδος πλείους μέν, αἱ δὲ κυριώταται τρεῖς· ἢ γὰρ τὸ φανταστικὸν μόνον εἰσὶ βεβλαμμένοι, σῴζεται δὲ αὐτοῖς τὸ λογιστικὸν καὶ ἡ μνήμη, ἢ τὸ λογιστικὸν μόνον ἠδίκηται, σῴζεται δὲ τὸ φανταστικὸν καὶ ἡ μνήμη, ἢ καὶ τοῦ φανταστικοῦ καὶ τοῦ λογιστικοῦ ἐστιν ἡ βλάβη, σῴζεται δὲ ἡ μνήμη. μνήμης δὲ ἀπολλυμένης ἐπὶ τῶν πυρεκτικῶν νοσημάτων συναπόλλυται ὡς ἐπίπαν καὶ τὸ λογιστικὸν καὶ τὸ φανταστικόν. τοῦ μὲν οὖν ἐμπροσθίου μέρους τοῦ ἐγκεφάλου βλαβέντος τὸ φανταστικὸν μόνον ἠδίκηται, τῆς δὲ μέσης κοιλίας τοῦ ἐγκεφάλου βλαβείσης παρατροπὴ γίγνεται τοῦ λογιστικοῦ, τοῦ δὲ κατὰ τὸ ἰνίον ὀπισθίου ἐγκεφάλου βλαβέντος ἀπόλλυται τὸ μνημονευτικόν, σὺν αὐτῷ δὲ ὡς ἐπίπαν καὶ τὰ ἕτερα δύο. ὅσοις μὲν οὖν βέβλαπται τὸ φανταστικόν, κρίνουσι μὲν ὀρθῶς, φαντάζονται δὲ ἀλλόκοτα· ὅσοις δὲ ἠδίκηται τὸ λογιστικὸν μόνον, φαντάζονται μὲν ὀρθῶς, κρίνουσι δὲ οὐκ ὀρθῶς· ὅσοις δὲ τὸ μνημονευτικὸν ἠδίκηται, οὐδενὸς τῶν πρόσθεν γεγενημένων μνημονεύουσιν ὀρθῶς, ἀλλ’ οὐδὲ φαντάζονται οὐδὲ κρίνουσιν ὀρθῶς ὡς ἐπίπαν. προσήκει τοίνυν τῷ μᾶλλον ἠδικημένῳ μέρει, μᾶλλον τὰ βοηθήματα προσάγειν, μὴ μέντοι μηδὲ τῶν ἄλλων ἀμελεῖν. περὶ μὲν οὖν τῆς ἀπολλυμένης μνήμης κατ’ ἰδίαν μετὰ βραχὺ ἐροῦμεν, νυνὶ δὲ ὅπως χρὴ τῶν φρενιτικῶν

5

10

15

20

25

125,4sq. η φρενῖτις – ὀξέος cf. Gal. ascript. int. s. med. XIV 732,18–733,1 de symptom. caus. II 7 (VII, 5–6) 4–6 ἡ φρενῖτις – ἐπιφέρουσα [Gal.] def. med. 234 (XIX, 412,16sqq.) 4sq. ἡ φρενῖτις – μηνίγγων Paul. III 6 (I 144,3–5) 9sq. διαφοραὶ κτλ. cf. Gal. de loc. aff. IV 2 (VIII, 225,13sqq.) 125,1 ἐπὶ δὲ (δὲ om. C p) τῶν (τὸ La, τὸν S) ὑπὸ] ἔπειτα ὑπὸ At ὅτε A 2 καὶ διαστ. – τὸ ὑγρόν om. At 3 post ποιεῖν: ὡς ἐπὶ τῶν διισταμένων ῥαφῶν τῆς κεφαλῆς (συνισταμένων παθῶν πάντων add. A) add. C p P x A S 4 ante Περὶ: Περὶ τῶν περὶ τὴν κεφαλὴν συισταμένων παθῶν πάντων λόγος ϛ Cp P x sqr. multa: Ἑρμηνεία τίς ἡ κεφαλὴ καὶ κατὰ τί εἴρηται κεφαλὴ κτλ. – καὶ ταῦτα τοίνυν διερμηνεύσαμεν ἅπαντα περὶ τῆς κεφαλῆς· λοιπὸν διερευνήσομεν καὶ περὶ τῶν παθῶν αὐτῆς. Ἀρχὴ σὺν θεῶ ἁγίω περὶ τῶν ἐν τῆ κεφαλῆ παθῶν κεφάλαιον β P x ἐκ τῶν om. La φλεγμονὴν ἐμποιεῖ At 5 τ. ἐγκ.] τὴν κεφαλὴν P ω 8 ἀυτοσχεδὸν C p αὐτὸ M o συνέπουσα La 9 ἤδη om. La παραφέρειν M o ω 11sq.  καὶ ἡ μνήμη ἢ τὸ λογ. om. At 12sq. ἢ τὸ λογ. – καὶ ἡ μνήνη om. P 15 καὶI] οὐ La 16 οὖν om. M o P προσθίου P a P x At m. 1a S 20 ὅσους … βλάπτεται La 21 ante ὀρθῶς: οὖν At ὅσον La 23 οὐδὲ C p …ἐν P μνημονεύουσι P κρίνουσι At 24 κριν.] μνημονεύουσιν At 25 μᾶλλονII om. P x M o ψ m. 1a S 26sq. μνήμης om. ω

VI 1 On hydrokephaloi from Leonides | 77

underneath the skull one must wait and when the fluid is in excess and the sutures are separated and the fluid becomes visible, one should divide the protruding place and do what follows therefrom.

VI 2 On phrenitis from (the books of) Posidonius 5

10

15

20

25

Phrenitis is an inflammation of the meninges surrounding the brain with acute fever which brings about mental disturbance and derangement of thinking. Phrenitis rarely appears together with fever from the beginning: in most (patients) it starts from the fourth and the fifth and the sixth day, and even later, (the phrenitis) being connected with it [scil. the fever] in proximity to a dangerous situation, so that some (patients) began to be deranged already on the seventh day, others on the ninth day. Many different forms of phrenitis exist, but there are three that are most important: for either only the imaginative faculty is damaged but the reasoning faculty and the memory are preserved in them [scil. the patients], or only the reasoning faculty is harmed but the imaginative faculty and the memory are preserved, or the damage pertains to both the imaginative faculty and the reasoning faculty but the memory is preserved. When the memory is lost as a result of feverish diseases, the reasoning faculty and the imaginative faculty are also in most cases destroyed together with it. So, when the fore part of the brain is damaged, only the imaginative faculty is harmed; when the middle ventricle of the brain is damaged, an aberration of the reasoning faculty occurs; when the hind part of the brain in the occiput is damaged, the recollective faculty is lost, and together with it, in most cases, also the other two. So, those whose imaginative faculty is damaged judge correctly but see obscure things in front of their eyes. Those in whom only the reasoning faculty is harmed form images correctly but do not judge correctly. Those whose recollective faculty is harmed do not correctly remember anything of previous events, nor do they form images correctly or judge correctly in most cases. So, it is appropriate to apply more remedies to the part (of the body) which is harmed more but it is not appropriate to lose sight of the other parts. We will shortly speak separately about the lost memory but now it is necessary to speak about how one should | care for those suffering from 126

78 | Aetii Amideni Libri medicinales VI 2, p. 126.1–23 Olivieri

126

ἐπιμελεῖσθαι ῥητέον. κατακεκλίσθαι τοίνυν προσήκει τὸν νοσοῦντα ἐν οἴκῳ χειμῶνος μὲν ἀλεεινῷ, θέρους δὲ ψυχεινοτέρῳ, ἡσυχίαν δὲ ἄγειν κελεύειν καὶ τὸν νοσοῦντα μὲν αὐτὸν καὶ τοὺς ἐπὶ τῆς οἰκίας ἅπαντας καὶ τοὺς πλησίον· καὶ τοὺς μὲν πρὸς τὸ φῶς ἀγριαινομένους ἐν σκοτεινοτέρῳ οἴκῳ κατακλίνειν, τοὺς δὲ πρὸς τὴν αὐγὴν μᾶλλον σωφρονοῦντας ἐν φωτεινῷ οἴκῳ διαιτᾶν. εἰ μὲν οὖν ἡ φρενῖτις σὺν τῷ πυρετῷ ἐξ ἀρχῆς ἐν τῇ πρώτῃ τῶν ἡμερῶν ἢ τῇ δευτέρᾳ ἢ μέχρι τῆς τετάρτης εἰσέβαλε καὶ μὴ ἐκ μεταπτώσεως ἑτέρου νοσήματος ἐπεγένετο οὔρων τε ὑφαίμων ὄντων καὶ τοῦ προσώπου ἐρυθροῦ καὶ ἡλικίας ἀκμαζούσης καὶ εὐεξίας τοῦ σώματος παρούσης καὶ πάντων ἅμα τῶν σημείων ὑπαγορευόντων αἵματος πλῆθος, φλεβοτομητέον ἀπ’ ἀγκῶνος. τέμνειν δὲ τὴν μέσην φλέβα καὶ κενοῦν πρὸς δύναμιν καὶ μὴ μέχρι λειποθυμίας, ἔλαττον μᾶλλον τοῦ δέοντος ἀφαιροῦντας διὰ τὴν ἐκ τῆς σφοδρᾶς κινήσεως γιγνομένης ἐπ’ αὐτῶν πλείστην διαφόρησιν καὶ τὸν κόπον. καὶ ἡ διαίρεσις δὲ σύμμετρος ἔστω, μή πως λάθρα ὁ κάμνων λύσῃ τὸν δεσμὸν τοῦ βραχίονος· κίνδυνος γὰρ ἐκ τῆς αἱμορραγίας παρέπεται. παραλειφθέντος δὲ διά τινα αἰτίαν τοῦ τῆς φλεβοτομίας βοηθήματος, κλυστῆρσι χρὴ κενοῦν τὴν γαστέρα διὰ χυλοῦ πιτύρων ἢ πτισσανῶν ἀφρονίτρου τε βραχέος καὶ μέλιτος ὀλίγου, τὴν δὲ κεφαλὴν ἐμβρέχειν ῥοδίνῳ μᾶλλον χλιαρῷ. φλεγμαινούσης γὰρ τῆς μήνιγγος, οὐκ ἀβλαβὲς τὸ ψυχρὸν οὐδὲ μὴν τὸ πάνυ θερμόν. τὸ μὲν γὰρ ψυχρὸν πυκνοῖ τοὺς πόρους καὶ οὐ συγχωρεῖ διαφορεῖσθαι τὰ ἐν τῇ κεφαλῇ περιττώματα· τὸ δὲ πάνυ θερμὸν διπλασιάζει τὴν πύρωσιν, ὥστε θέρους μὲν ἄκρως χλιαρὸν τὸ ῥόδινον

5

10

15

20

126,1–6 κατακεκλίσθαι – διαιτᾶν Aret. V 1 (91,12–15 cf. 92,2–8) Paul. ib. (ib. 145,12–13) 11–19  φλεβοτομητέον – χλιαρῷ cf. Paul. ib. (ib. 145,1–9) 11sq. τέμνειν – φλέβα cf. Aret. ib. (92,16–17, 21) 19 τὴν δὲ – ῥοδίνῳ] cf. Gal. meth. med. XIII 21 (X 928,14–16) cf. Aret. ib. (93,31sqq.) 23– 127,1 τὸ ῥόδινον –ὄξους] cf. Gal. meth. med. XIII, 21 (X 928,15–16, 930,11–12) de simpl. med. temp. ac fac. III 9 (XI, 559,16–17) 126,1 post ῥητέον: Ἄλλη ἑρμηνεία περὶ φρενίτιδος Παύλου· ἡ κυρίως φρενῖτις φλεγμονή ἐστι τῶν μηνίγγων – οἱ δὲ παλαιότεροι τοῦ Γαληνοῦ κάτοχον τοῦτο προσαγορεύουσιν Θεραπεία φρενιτίδος Ποσειδωνίου P x ….κλεῖσθαι χ A ω χρὴ P a om. P x 2 ψυχικωτέρω P x ψυχοειτέρω supra scr. m. 2a S ..χροτέρω At 3 τῆς om. At 5 κατακλείειν P S …κλίειν (κλύειν At) La 6 ante φωτ.: τῶ ω διαιτεῖν La διάγειν αιτᾶν supra scr. m. 2a S διάγειν At 7 τῇII om. P ω …βαλλε P x P m. 2a S ..σβάλλει At m. 1a S 11  post ἀγκῶνος: ἢ καὶ ἀπὸ τῆς ἀνωτέρας φλεβὸς τῆς κεφαλῆς· εἰ δὲ μὴ ηὑρίσκομεν τὴν μέσην – ἥδε τῆς χειρὸς φλεβοτομία P x 11sq. τέμνειν – φλέβα καὶ om. P x 12 κένωσον αἷμα πρὸς τὴν τοῦ κάμνοντος δύναμιν P x ante ἔλαττον: ἀλλ’ P x post ἔλαττ.: δὲ ω 13 ….ροῦντες P a M o A S -τος La P x …ται At …μένην α, exc. La 14 τὸν om. P x A ἡ om. La P At m. 1a S 15 λύσας (…αντος A) P x M o P At 16 γὰρ om. P x M o A P ante ἐκ: ὁ χ ψ ω παρέπηται A S …έψοιτο P 18sq. διὰ χυλοῦ – χλιαρῷ] οἷον σεύτλου ἴων δαμασκίνων πτισάνης κριθῆς μελοχ καὶ μαρουλίων – ταῦτα γὰρ πάντα πρόσφερε χλιαρ〈ά〉 P x 18  χυλῶν C p P x ω πτισανων C p M o …σσάνης (…σάνης) P a P x ψ ω τε om. La P x ω supra scr. m. 2a S 23  ἀκροχλιαρὸν C p M o P m. 2a S ἄκρω P x A 23–127,1 χλιαρὸν –ὄξους] χλιαρ〈ὰ〉 τὰ ἐπιθέματα πάντα τῆς κεφαλῆς καὶ τοῦ παντὸς σώματος P x

VI 2 On phrenitis from (the books of) Posidonius | 79

phrenitis. It is appropriate that the patient is put to bed in a warm house in winter and in a colder house in summer, and one must command both the patient himself and all the people in his house and the neighbors to keep quiet. One has to put to bed in a darker place those who become wild in the light, while those who are quite 5 sound of mind in the light should live in a bright place. So, if phrenitis began together with fever from the beginning on the first or the second day or even up to the fourth day, and if it did not supervene upon a change of another disease, and if the urine is bloody and the face is red and the age of life is in its prime, and if good health of the body is present, and if at the same time all signs suggest a great amount 10 of blood, then one should phlebotomize from the elbow. One shall cut the middle vein and empty according to the strength (of the patient) and not up to the point of fainting, but rather one should take away less than what is necessary because of the very great exhaustion and the fatigue which occurs in them as a result of the violent motion. The incision has to be moderate so that the patient does not in any way 15 secretly unfasten the bandage of the arm; for danger results from a violent bleeding. If the remedy “phlebotomy” has been omitted for any reason, one has to empty the stomach with enemata made from the juice of bran or of barley-gruel and from a bit native soda and a little honey, but one should treat the head with embrocations (made from) quite lukewarm rose oil. For if the dura mater is inflamed, the cold is not 20 harmless and neither is that which is rather hot. For the cold blocks the pores and does not allow for the superfluities in the head to be segregated: what is quite hot, by contrast, doubles the inflammation so that one should administer perfectly lukewarm rose oil in summer, on the one hand, | together with a little vinegar and in 127

80 | Aetii Amideni Libri medicinales VI 2, p. 127.1–26 Olivieri

127

προσφέρειν μετὰ βραχέος ὄξους· χειμῶνος δέ, μετρίως θερμόν. εὔθετον δὲ καὶ τὸ χαμαιμήλινον αὐτῷ μιγνύμενον ἐξ ἴσου ψυχροτέρου ὄντος τοῦ περιέχοντος· εἰ δὲ σφοδροτέρα εἴη ἡ παραφορά, προκενώσας, ὡς εἴρηται, τῇ φλεβοτομίᾳ ἢ κλυστῆρσι καὶ ἀφεψήσας ἐλαίῳ κωδίας καταιόνα τὴν κεφαλὴν καὶ τὸ πρόσωπον καὶ συνεχῶς δίδου προσκλύζεσθαι ὕδατι, ἀνεφεψημένων αὐτῷ κωδιῶν καὶ τὸ μέτωπον χρῖε ὑπνωτικῷ τινι τροχίσκῳ οἷον τῷ παγχρήστῳ ἢ τῷ διὰ σπερμάτων, καὶ ὀσφραίνειν δὲ συνεχῶς ὑπνοποιοῖς τοῖς προγεγραμμένοις ἐν τῷ πρὸ τούτου λόγῳ πρὸς τοὺς ἀγρυπνοῦντας· καὶ ὑπὸ τὸ προσκεφάλαιον κωδίας ὑποτιθέναι ἢ μανδραγόρου μῆλα. ἐπιταθέντων δὲ τῶν κακῶν, διδόναι καὶ τοῦ διὰ τῶν κωδιῶν ὑπνωτικοῦ φαρμάκου ὅσον κοχλιάριον, ἢ πλέον ἢ ἔλαττον πρὸς δύναμιν. δοτέον δὲ τοῦ διὰ μέλιτος ἐσκευασμένου, οὐ τοῦ διὰ τοῦ γλυκέος διὰ τὸ οἰνῶδες· ἐν παρακμῇ δὲ τοῦ παροξυσμοῦ δίδου τὸ φάρμακον. ἐν γὰρ τῇ ἀκμῇ εἰ δοθείη τὸ μὲν φάρμακον ἕλκει πρὸς ὕπνον, ὁ δὲ πυρετὸς διανίστησι καὶ μεριζόμενος ὁ κάμνων εἰς ἄμφω χαλεπώτερον φέρει τὸ γιγνόμενον· δοὺς δὲ τὸ φάρμακον ἡσυχίαν εἶναι κέλευε. βέλτιον δὲ τοῦ ῥοδομέλιτος προσπλέκειν τῷ διὰ κωδιῶν· κατακεραστικὸν γὰρ τῆς δριμύτητος ὑπάρχει καὶ τῆς κοιλίας ὑπαγωγόν· διὸ καὶ τῷ πινομένῳ ὕδατι ἐν τῇ τοῦ παροξυσμοῦ ἀκμῇ καλὸν ἐπιφέρειν τὸ ῥοδόμελι. φυλάττεσθαι δὲ χρὴ τὴν συνεχῆ χρῆσιν τῶν ναρκωτικῶν πάντων φαρμάκων, πομάτων τε καὶ καταντλημάτων καὶ ἐπιχρίστων. ῥᾳδίως γὰρ ἐπὶ τῶν ἀμέτρως ψυχομένων μετάπτωσις γίγνεται ἀπὸ φρενίτιδος εἰς λήθαργον, ὅτε καὶ ὀλέθριον γίγνεται τὸ νόσημα· ὅθεν ὅταν ἡ παραφορὰ ἐμβραδύνῃ, ἕρπυλλον ἢ σπονδύλιον ἐναφεψεῖν δεῖ τῷ καταιονουμένῳ τῇ κεφαλῇ ἐλαίῳ. διαπνευστικὰ γὰρ τῶν παχέων ἀτμῶν τυγχάνει. μένοντος δὲ τοῦ προσώπου καὶ μετὰ τὴν φλεβοτομίαν

5

10

15

20

25

127,4sq. ἀφεψήσας–κεφαλήν | 5sq. ὕδατι – κωδιῶν cf. Paul. ib. (ib. 145,10) Gal. meth. med. ib. (ib 17) 8 ὑπνοποιοῖς cf. supra, p. 97,23sqq. et Gal. ascrip. int. s. med. 13 (XIV, 733,7) 24–26 ὅταν – τυγχάνει cf. Aret. ib. (94,1–6) 127,1 post θερμόν: εἰ δὲ καὶ ὀλίγον ὄξος ἐπιβάλλ〈ης〉 οὐκ ἀβλαβές P x 1–3 εὔθετον – περιέχ.] εἰ δὲ χειμὼν σφοδρ〈ὸς〉 εἴη σὺν† τῶν καταπλασμάτων μίγνυε ὀλίγον χαμαιμήλινον ἔλαιον P x 3 παραφροσύνη ω 4 τῇ om. A 5 καὶII om. χ ψ ω δίδου om. P a P 7 οἷον – σπερμάτων om. C p P ω post σπερμ.: ἔστι δὲ ἡ σκευασία τοῦ παγχρήστου αὕτη· χυλὸν γλυκυρίζης – ὑοσκυάμου σπέρμα δρμ σ, ὕδατι δεῦσον P x 10 μήλων At -ου S post μῆλα: δίδου ὀσφραίνεσθαι P x τοῦ] τὴν ἀντίδοτον τὴν P x 11 τῶν κοχλ.] ουΓΓ´ C p post κοχλ.: ἔστι δὲ ἡ σκευασία αὐτῆς (τ)αὕτη· γλυκύριζον om. P x A At m. 1a S τετράγκανθον – καὶ δροσάτον τῶν ἴων τὸ ἀρκοῦν P x 11–13 ἢ πλέον – οἰνῶδες om. P x 12 πρὸς] εἰς At ante μελιτ.: τοῦ C p M o P τοῦII] τὸ ψ At m. 1a S τοῦIII om. A At 15 εἰς ἄμφω (ἄφνω At) ὁ κάμνων P At ὁ κάμνων om. P a 17 post διὰ: τῶν P ω 19 ἐπιφ.] ἐπιρραίνειν χ A ω 20 post ῥοδόμελι: κατακείσθω δὲ ὁ κάμνων ἐν τόπω φωτιστ〈ικῶ〉 καὶ κράσεως συμμέτρου ἔχοντι – ἐπίθες βδέλ〈λ〉ας καὶ τῆς ῥινὸς καὶ τοῦ ** πω´ P x χρὴ om. P ω 21 πάντων om. ω post φαρμάκων: τῶν πλέον τοῦ δέοντος χρησαμένων οἷον P x 24sq. δεῖ –κεφαλῇ om. P At m. 1a S 25 ….νωμ.? διαφορητικὰ P a 26 post φλεβ.: καὶ τῶν βδέλλων P x

VI 2 On phrenitis from (the books of) Posidonius | 81

5

10

15

20

25

winter, on the other, (one shall administer) moderately warm (rose oil). Camomile oil is also suitable when it is equally mixed with it [scil. rose oil], when the surrounding is colder. If the derangement is more vehement, then, after having emptied beforehand, as was said, by means of phlebotomy or enemata, one should, after having boiled down poppyheads in oil, pour it [scil. the liquid] over the head and the face; and one should make it such that it [scil. the head and the face] is constantly washed with water after the poppyheads have been boiled down in it again; and one has to anoint the forehead with a hypnotic troche such as the panchreston or that made from seeds; and one needs to make (the patient) constantly smell the substances which are bringing about sleep and which have been mentioned in the previous book on those who are sleepless. One should also place poppyheads or the fruits of mandrake under the pillow. If the evils have intensified, one needs to apply the hypnotic remedy made from poppyhead as well, as much as fits on a spoon, or more or less according to the strength (of the patient). One has to apply some of the remedy prepared from honey, not from that which is made from sweet (wine), since it is vinous. During the abatement of the paroxysm, you have to apply the remedy. For, if the remedy is applied at the peak it leads to sleep, but the fever wakes (him) up and the patient being divided between both endures the situation with more difficulties. After having applied the remedy, you have to command (the patient) to keep quiet. It is better to mix a little rose honey with the remedy made from poppyhead: for it is demulcent for the sharpness and evacuating for the bowels. Therefore, it is also good to add rose honey to the water that has to be drunk in the prime of the paroxysm. It is necessary to avoid the constant use of all narcotic remedies, both of drinks and of rinsings and of those which are smeared on. For in those who have been immoderately cooled a change from phrenitis to lethargia easily occurs at which point the affection also becomes fatal. Therefore, it is necessary that when the derangement remains for a long time one should boil down tufted thyme or cow parsnip in the oil which is poured over the head. For these promote the dissipation of thick vapors. If the face continues not to be sunken and to be red even after

82 | Aetii Amideni Libri medicinales VI 2–3, p. 127.27–128.23 Olivieri

128

γ

ἀσυμπτώτου καὶ ἐρυθροῦ σικύας κολλήσας τῷ ἰνίῳ χάρασσε ἀμυχαῖς μετρίως τὸ δέρμα καὶ κένωσον ὅσον λίτραν τοῦ αἵματος. τροφὴν δὲ δοτέον πτισσάνης χυλὸν ἢ ἄλικος ἢ ψίχας πλειστάκις πλυθείσας μετὰ ῥοδομέλιτος· πραϋνθέντος δὲ τοῦ πυρετοῦ διδόναι ὠὰ ῥοφητὰ καὶ θριδακίνας ἀπεζεσμένας καὶ ὅσα ὑγραίνει καὶ ψύχει μετρίως μετὰ τοῦ τρέφειν διὰ τὴν ἀσθενήσασαν δύναμιν. Περὶ ληθάργου κατὰ τῶν Ἀρχιγένους καὶ Ποσειδωνίου. ληθάργου ἀρχαὶ δύο· οἷς μὲν γὰρ τὰ περὶ τὰς φρένας καὶ τὰ σπλάγχνα πρωτοπαθήσαντα εἰς συμπάθειαν ἄγει τὸν ἐγκέφαλον, οἷς δὲ τὰ περὶ τὸν ἐγκέφαλον κατάρχει καὶ οἷς μὲν εὐθέως ἐξ ἀρχῆς τὸ πάθος ἐπιπίπτει, οἷς δὲ ἐκ μεταπτώσεως τινὸς τῶν ὀξέων νοσημάτων. μάλιστα μὲν γὰρ ἀπὸ φρενίτιδος τοῖς σφοδρότερον διὰ τῶν ναρκωτικῶν φαρμάκων ψυχθεῖσιν ἡ μετάπτωσις εἰς τὸν λήθαργον γίγνεται, ἤδη δὲ πλειστάκις καὶ ἀπὸ τοῦ συνόχου πυρετοῦ ἡ μετάπτωσις εἰς τὸν λήθαργον γέγονε καὶ ἐξ ἑτέρων δὲ πλείστων νοσημάτων, ἐφ’ ὧν μάλιστα κενώσεις πλείους παρηκολούθησαν. ἐνίοτε δὲ καὶ ἐπὶ τῶν χρονίων πυρετῶν συμβαίνει κατὰ περίοδον βαπτίζεσθαι αὐτοὺς τῷ ὕπνῳ, οἷον πολλάκις γίνεται ἐπὶ ἀμφημερινῶν πυρετῶν καὶ ἡμιτριταίων, ἔστι δ’ ὅτε καὶ ἐπὶ τεταρταίων καὶ οἱ μὲν μετὰ σπασμοῦ καὶ συνολκῆς τῶν νεύρων καταφέρονται, οἱ δὲ δίχα σπασμοῦ καὶ οἱ μὲν ἀθρόως καταφέρονται, οἱ δὲ ἐκ προσαγωγῆς καὶ οἱ μὲν ἕνα τὸν βαπτισμὸν ὑπομένουσιν, ἐφ’ ᾧ τὰ ἔσχατα κινδυνεύουσιν, οἱ δὲ ἐν ταῖς περιόδοις καταφέρονται καὶ πάλιν ἀνακαλοῦνται. σκοπεῖν μὲν οὖν χρὴ τὸ εἶδος τῆς καταφορᾶς· οἱ μὲν γὰρ κατὰ περίοδον τῷ ὕπνῳ βαπτιζόμενοι σομφότερον τὸν σφυγμὸν ἔχουσιν,

5

10

15

20

128,1–5 τροφὴν – δύναμιν cf. Aret. ib. (93,6sqq.) Paul. ib. (ib. 145,17–19, 23–25) 22–129,1 οἱ μὲν γὰρ – καταφέρονται cf. Paul III 9 (I 147,10–13) 27 καὶ συκίας κούφας P x κωλύσας (κολλήσας) τῆ ῥάχει ἀπὸ τοῦ ᾱ σπονδύλου καὶ ἕως τοῦ κτ ἔνθεν ante χάρασσε: συκίαν P x 128,1 μετρίαις A om. P a P κἀκεῖθεν, εἶτα κώλυσον (κόλλησον) καὶ P x post ὅσον: ἡ δύναμις ἐπιτρέπει, εἶτα, εἰ μὲν βούλη, ἐπίθες ὄρνιθ〈ας〉· εἰ δέ γε ὁ καῦσος καὶ ἡ ἀγρυπνία ἐπιμένη, ἐπίθες βατράχους κατὰ τῆς κεφαλῆς (subscr. in marg.) P x λίτραν τοῦ αἵματος om. P x post λίτραν: μίαν ω τροφῆς La P ω 2 ψιχίας La post πλυθείσας: ἐν ὕδατι ψυχρῶ ἢ ὁμ ´ καὶ P x 3 post ῥοδομ.: μετὰ δὲ τὴν παρακμὴν τοῦ νοσήματος καὶ P x δὲ om. P x post ῥοφητὰ: ἢ ὄρνιθας τοὺς λίαν τρυφεροὺς ἔχον〈τας〉 ἐν τῆ ἑψήσει κριθ〈ά〉ρ〈ιον〉 P x 5 post δύναμιν: προκοπτούσης δὲ τῆς παρακμῆς καὶ ὥρα χρηστέον καὶ τῆ προσηκούση – μέθας ὀργὰς σιτίων διαφορὰς καὶ πρὸ πάντων ἡλιοκαΐας P x 6 ἐκ τῶν P a M o ἐκ τοῦ P x om. C p ψ ω 12sq. γίγνεται – εἰς τὸν λήθαργον om. φ add. in marg. m. 2a S 12 post γίγνεται: ὡς ἐν τῶ πρὸ τούτου κεφαλαίω εἰρήκαμεν ἐπὶ τῶν φρενιτικῶν, ὅτε καὶ ὀλέθριόν ἐστι add. P x 12sq. ἤδη – εἰς τὸν λήθαργον om. P x 13 γέγονε] γίγνεται (δὲ add. P x) P x C p A ω 14 δὲ om. P x νοσ. πλ. transp. P a 16 αὐτ. βαπτ. transp. P a 17 ante ἀμφημ.: τῶν add. P x M o A 17sq. post τερταίων: ἱστορεῖ δὲ ὁ Ἀρχιγένης ὅτι καὶ ἐν τριταίω τις ὤφθη καταφερόμενος C p 19 δίχα σπασμοῦ (…ῶν C p S) – καταφ. οἱ δὲ om. M o P S 19sq. προαγωγῆς P x A 20 ὧν P At ὅσον La τὸ ἔσχατον P a τὸν …τον P x A τοὔσχατον M o καὶ εἰς ἔσχατον P 21 ὑποκινδ. S 23 τῷ om. A m. 1a S σοφότ. P a σφοδρότ. P σαμφότ. At

VI 2 On phrenitis from (the books of) Posidonius | 83

5

phlebotomy, you should fasten cupping instruments at the rear of the head and moderately incise | the skin with scratches and you have to empty as much as one 128 litra of blood. As nourishment, one has to apply the juice of barley-gruel or of ricewheat or crumbs (of bread) which have been frequently washed with rose honey. When the fever has abated, one needs to give eggs that can be supped up and boiled lettuce, and what moistens and cools moderately together with the nourishment because of the (patients’) weak strength.

VI 3 On lethargia from (the books of) Archigenes and Posidonius There are two origins of lethargia: that is to say in one group (of patients) the area around the diaphragm and the internal organs, after being primarily affected, leads the brain to co-affection, while in the other group the area around the brain begins (to be affected), and the affection befalls one group immediately from the beginning, the other due to a change of acute diseases. The change from phrenitis to 15 lethargia happens especially to those who have been very heavily cooled by narcotic remedies but, indeed, the change into lethargia often also happened from an unintermittent fever and from most of the other diseases which are especially accompanied by more evacuations. Sometimes, however, it also occurs in long-term fevers that they [scil. the patients] are periodically drowned in sleep, as often happens in 20 quotidian and semi-tertian fevers, and sometimes also in quartan (fevers). And so some fall asleep together with spasm and convulsion of the nerves, others without spasm, and some fall asleep suddenly, others gradually, and some endure one attack of being drowned in sleep in which they are in extreme danger, others fall asleep periodically and are woken up again. It is therefore necessary to examine the 25 manifestation of the falling asleep: for, some who are periodically drowned in sleep have a very soft pulse, others who are always suffering (have) an extremely small and 10

84 | Aetii Amideni Libri medicinales VI 3, p. 128.24–129.23 Olivieri

οἱ δὲ ἀεὶ τὸ πάθος ἔχοντες σμικρότατον καὶ δυσκίνητον. οὗτοι δὲ καὶ διεγειρόμενοι ἀλλόκοτα φθέγγονται καὶ ἐπιλήσμονές εἰσιν· οἱ δὲ κατὰ περίοδον οὐδὲν τοιοῦτον ὑπομένουσι καὶ οἱ μὲν μετὰ βαρείας καὶ ἐπηρ129 μένης ἀναπνοῆς καταφέρονται, ὥστε καὶ ῥέγχειν καὶ νυγμοὺς καὶ στεναγμοὺς ἀναφέρειν ἐκφαντιστικοὺς τῆς ὀδύνης, ἣν οὐδὲ ἐξειπεῖν δύνανται ἀνακληθέντες διὰ τὸ βεβλάφθαι τὸν λογισμόν· οἱ δὲ ἡσυχέστατα δοκοῦσιν ὑπνοῦν καὶ οἷς μὲν περιέψυκται τὰ κῶλα καὶ ῥυσὰ καὶ ὠχρά ἐστι καὶ πέπηγε σχεδὸν ἡ σύγκρισις, οἷς δὲ διακέχυται καὶ οἷον δροσίζει περὶ τὰς παρακμὰς τῶν παροξυσμῶν. τοῖς μὲν οὖν κατεχομένοις τῷ πάθει ταῦτα συνεδρεύει· ἀνέσπαται τὸ ὑποχόνδριον καὶ συνῆκται ἡ κοιλία καὶ διεγειρόμενοι βίᾳ ὑπὸ τῶν προσεδρευόντων πάλιν εἰς ὕπνον ἕλκονται καὶ λήθη αὐτοῖς συνεδρεύει· καὶ γὰρ πρὸς οὔρησιν πολλάκις ἐπειγόμενοι, ἐπιδοθέντος αὐτοῖς οὐρητήρου σκεύους κατέχοντες αὐτὸ τῇ χειρὶ ἐπιλανθάνονται. ἐπιτεινομένου δὲ τοῦ κακοῦ σύμπαν τὸ σῶμα νωθρὸν καὶ οἷον νεκρῶδες γίγνεται, ὕπτιοι κατακείμενοι ἐπὶ πόδας καταρρέουσι, διερριμμένοι τὰς χεῖρας καὶ τὰ σκέλη, μυκτὴρ ἐνίοις ἀποστάζει, κέχηνεν αὐτοῖς τὸ στόμα καὶ ῥωγμὸς ἰσχυρότερος ἐπιγίγνεται, ἡ κάτω γένυς οἷον παρειμένη καὶ κεχαλασμένη ὁρᾶται. τὰ μὲν συνεδρεύοντα τῷ ληθαργικῷ πάθει ταῦτα. θεραπεύοντες δὲ κατακλινοῦμεν αὐτοὺς ἐν οἴκῳ φωτεινῷ πρὸς αὐγήν· ἔστω δὲ ὁ οἶκος ἀλεεινός· ψηλαφητέον δὲ πόδας καὶ χεῖρας καὶ ὀσφραντὰ διεγερτικὰ προσάγειν, οἷόν ἐστι τὸ καστόριον ἐλλύχνιον ἐσβεσμένον πίσσα· ὑγρὰ ἄσφαλτος χαλβάνη· καὶ ὑποθυμιώμενα δὲ διεγείρει τοὺς ληθαργικούς· λίθος γαγάτης ἄσφαλτος καστόριον πευκέδανον θεῖον χαλβάνη σαγαπηνὸν κέρας ἐλάφειον τράγου ῥύπος ἀβρότονον σίλφιον· προσάγειν δὲ ταῖς ῥισὶ καὶ τὰ πταρμικά πλήθους δὲ ὑποκειμένου, εἰ μὲν αἷμα εἴη τὸ πλεονάζον, τέμνειν φλέβα

25

5

10

15

20

24sq. οὗτοι – εἰσιν cf. Gal. ascr. int. s. med. 13 (XIV 741,10–11) 129,6sq. τοῖς μὲν – συνεδερεύει cf. Gal. ib. (ib. 11) 9sq. πρὸς οὐρησιν – σκεύους cf. Paul. ib. (ib. 16) 13sq. κέχηνεν – στόμα cf. Paul. ib. (ib 13–14) 16–19 κατακλινοῦμεν – καστόριον Aret. ib. 98,8–9, 11, 13–14, 20 Paul. ib. (147,27–29) 19 καστόριον ἐλλύχνιον cf. Gal. de simpl. med. XI, 15 (XII, 341,3–6) 22sq.  πρόσάγειν – φλέβα Gal. meth. med. XIII 21 (X 931,9–15) cf. Paul. ib. (148,16sqq.) 24 μικρότατον C p σμικρότερον At 26 τοιοῦτο C p M o 129,1 ῥόγχην C p P 2 ἐμφαντικοὺς (…φατ. ω) P a χ ω 3 ἀνακληθέντας C p M o ψ S …κλυθ. At 5 σύγκρασις P …κρησις S δροσίζου〈σι〉ν τὰ ἄκρα P x …σίζειν At 6 post παροξ.: παρέπεται δὲ τοῖς ληθαργικοῖς σημεῖα ταῦτα P x in marg. σημεῖα ληθάργου P a 8 συνεδρευόντων P …όντων μᾶλλον δὲ προεδρευόντων P x 9 συνεδ.] ἐπιγίγνεται ω 10 οὐροδόχου P a (τοῦ C p P) οὐρητικοῦ χ ψ οὐρηροῦ ω 13 ante κέχηνεν: καὶ P x 14 ῥωχμὸς P a C p S ῥυγμὸς P x A ῥογχμὸς P ῥοχμός At ἰσχυρότατος P a χ ψ S 15 post ὁρᾶται: ὑπάρχει δὲ βλάβη τις τοῦ λογιστικοῦ· ὁ λήθαργος – τινὲς δὲ καὶ τρέμουσιν καὶ περιιδροῦσιν add. P x post μὲν: οὖν P a χ P ω 16 post ταῦτα: θεραπεία ληθάργου Ἀρχιγένους καὶ Ποσειδωνίου P x κατακλίνομεν P x A ω …νωμεν C p 17 ante ὁ: καὶ P x A ante ἀλεειν.: καὶ P a C p M o 18 χεῖρας καὶ πόδας P a P x ψ At χεγῖρ. κβ. παόδ. C p post ὀσφρ.: δὲ S post γαγ.: καὶ τὰ ὅμοια οἷον P x 22 post πταρμ.: οἷον ἑλλέβορον μέλαν πέπερι 20 γάγατος P a ω καστόριον εὐφόρβ〈ιον〉 καὶ ὅσα τοιαῦτα P x

VI 3 On lethargia from (the books of) Archigenes and Posidonius | 85

5

10

15

20

25

hardly moveable (pulse). Those (who are always suffering), when waking up, make strange utterances and are forgetful: those who are periodically (drowned in sleep) do not endure anything such as this and some fall asleep together with heavy and | excited breathing so that they snore and bring up pricking sensations and groaning, 129 revealing the pain they are not able to express with words after having been woken up, since their reasoning power is damaged. Others seem to sleep extremely quietly and the limbs of one group (of patients) are cold all over and wrinkled and pale and the constitution (of the limbs) seems to be nearly stiffened, while (the constitution) of the other group (of patients) is relaxed and as if it were flaccid around the time of the abatement of the paroxysm. Those who are seized by this affection are accompanied by the following: the hypochondrion is pulled up and the stomach is contracted and, being woken up forcibly by the accompaniments, they [scil. the patients] are put to sleep again and forgetfulness accompanies them. And often when they feel an urgent need to urinate, they forget, after having been given the chamber pot, that they have taken hold of it with their hand. When the evil intensifies, the whole body becomes sluggish and corpse-like, they lie on their backs and sink down to the feet while flailing their arms and legs, in some patients the nose is running, their mouth gapes open and very strong wheezing supervenes, the lower jaw looks like it is hanging down and is slack. These are the accompaniments to the lethargic affection. In order to treat them, we put them to bed in a bright room facing towards the light: the room should be warm: one must massage the feet and hands and apply awakening substances which can be smelled, such as castoreum, the extinguished wick of a lamp, moist pitch, bitumen, and galbanum. Fumigated substances also wake up those suffering from lethargia: lignite stone, bitumen, castoreum, sulphurwort, sulphur, galbanum, sagapenon, hartshorn, the filth of a male goat, wormwood, and laserwort. One should apply sternutatories to the nostrils as well if there is a great amount (of detrimental substances) underlying. If, on the one hand, blood is prevail-

86 | Aetii Amideni Libri medicinales VI 3, p. 129.24–130.24 Olivieri

τῇ δευτέρᾳ τῶν ἡμερῶν καὶ κενοῦν πρὸς δύναμιν. εἰ δὲ φλεγματώδης καὶ ὑγροτέρα ἡ ὕλη εἴη, ὥσπερ καὶ εἴωθεν ἐπὶ τῶν ληθαργικῶν πλεονεκτεῖν, προσφέρειν δεῖ τὰ λεπτύνειν δυνάμενα καὶ τέμνειν τὸ πάχος, 130 καὶ ἐπὶ μὲν τῶν μὴ κεκακωμένων τὸ νευρῶδες ὀξύμελι διδόντας, ἐπὶ δὲ τῶν κεκακωμένων ἀφέψημα σελίνου μαράθρου ἀδιάντου καὶ τῶν ὁμοίων καὶ κλύζειν δὲ τὴν κοιλίαν δραστικωτέρῳ κλύσματι καὶ βαλάνοις χρηστέον τοῖς διὰ πηγάνου καὶ νίτρου καὶ κυμίνου καὶ μέλιτος ἑφθοῦ· ἐμβρέχειν δὲ τὴν κεφαλὴν κατ’ ἀρχὰς μὲν ἕρπυλλον ἐναφέψοντες σὺν ὄξει καὶ ἐλαίῳ· ἐν δὲ ταῖς ἐπιτεταμέναις κατοχαῖς πευκεδάνου ῥίζα ἀντὶ τοῦ ἑρπύλλου ἐναφέψεται τῷ ὄξει καὶ σὺν τῷ ἐλαίῳ προσάγεται τῇ κεφαλῇ· ἀγαθὸν δὲ ἐπ’ αὐτῶν καὶ τὸ ἴρινον ἔλαιον. τρόμων δὲ καὶ συνολκῶν ἐπιγιγνομένων καστόριον σὺν ὀλίγῳ ὄξει λεαίνοντες σὺν τῷ ἐλαίῳ τὴν κεφαλὴν ἐμβρέχομεν. εἰ δὲ φλεγμαίνοι τὰ ὑποχόνδρια, καταπλάσσειν ἐν ἀρχαῖς διὰ γύρεως ἢ ἄρτου ἢ κυδωνίου μήλου ἑφθοῦ ἢ ἑλίκων ἀμπέλου. προελθόντων δὲ λινόσπερμον τῇ γύρει ἢ τῷ ἄρτῳ προσπλεκτέον καὶ ἀψινθίου καὶ τῆς ἀλθαίας τὰ φύλλα κάτεφθα, ὕστερον δὲ διὰ κριθίνου ἀλεύρου καὶ τήλεως καὶ ἀλθαίας ῥίζης, πᾶσι δὲ ἀψίνθιον προσπλέκειν. ἔστω δὲ πλατὺ τὸ ῥάκος, ὥστε περιλαμβάνειν ἑκατέρωθεν τὰς πλευρὰς καὶ τοῦ θώρακος τὰ ὑπὸ τοὺς μασθούς· μετὰ δὲ τὸ κατάπλασμα οὐ χρὴ γυμνὰ τὰ μέρη καταλιμπάνεσθαι, ἀλλὰ κηρωτῇ ναρδίνῃ ἢ κυπρίνῃ σκέπειν αὐτά, ὄπισθεν δὲ κατὰ τοῦ μεταφρένου κηρωτὴν διὰ Σικυωνίου γεγενημένην ἐπιθεῖναι, ἔχουσαν δὲ τερεβινθίνην καὶ δαφνίδων λείων ἐμπεπασμένων. καὶ εἰ μὲν ἐμπνευμάτωσις συνεδρεύοι, προσπλέκειν τοῖς καταπλάσμασι τὰ ἄφυσα, οἷον κύμινον δαφνίδας πήγανον καὶ τὰ ὅμοια. εἰ δὲ σκληρῶδές τι ὑποπίπτει καὶ λιβανωτίδος προσπλέκειν καὶ κυάμινον ἄλευρον. ἐπὶ δὲ τῶν ἤδη χρονιζόντων ληθαργικῶν, δυνάμεως ὑποκειμένης, διδόναι τὴν διὰ κολοκυνθίδος ἱερὰν

25

5

10

15

20

130,5sq. ἐμβρέχειν δὲ τὴν κεφαλὴν κτλ. cf. Gal. ascr. int. s. med. 13 (XIV, 732,6sqq.) id. meth. med. ib. (ib. 14sqq.) 23sq. ἐπὶ δὲ τῶν sqq. cf. Gal. meth. med. ib. (ib. 8sqq.) 25 ὑγροτ.] ψυχρότερα P a ἀργοτ. (recte?) χ ψ ω ληθάργων χ ψ S 26 λεπτύνοντα καὶ τέμνειν δυνάμενα ω 130,1 καὶ om. α, exc. La post διδόντας: ἔχον σελίνου μακιδωνισσίου ἀσπαράγγου ὑσσώπου ἀδιάντου κτλ. P x 2 μαράθ. ἀδ. om. P x 3 post ὁμοίων: οὐχὶ δὲ μέλι ἀλλὰ σάχαρ P x post κλύσμ.: οἷον κενταυρίου πολυποδίου ἐντεριώνης ἀψινθίου – ἐπίθες ἀλεκτρυόνα ἢ κύωνα μικρὸν καὶ τοῦτο ποίει πλειστάκις συχνῶς διαλλάσσων P x 3–5 καὶ βαλάνοις – κατ’ ἀρχὰς om. P x 3 βαλανείοις P a ω 4 χρῆσθαι ω 5 …ψήσαντες P At …ψῶντες (εἶτα ἕψε ἕρπ. P x) La S σὺν om. A P 6 ῥίζαν P a M o ω 7 ἐπαφέψ. La ἐν ….ψεῖται P ..έψει (..εψεῖν P a) At προσάγειν P a …αγάγηται M o πρόσαγε At 8 τὴν κεφαλὴν At αὐτῶ At post ἔλαιον: καὶ προεγράφη ἐν τῶ πρὸ τούτου ῥηθησομένω (l. εἰρημένω) βιβλίω ἐπὶ τῶν τεταρταίων P x 9 ἐπιγενομ. P a A 10 post ἐμβρέχ.: ἢ κατόριον καὶ ἔλαιον χλιάνας ἐπάλειφε τὸ ἰνίον καὶ τὴν ῥάχιν ὅλην P x φλεγμαίνει M o P S 12 ἀμπέλων A ω 14 δὲI om. La κριθῆς A ω 16 μαστούς C p M o A …τθούς P 17 μέλη C p ω 18 ὄπιθεν C p P x ω 19 δὲ] καὶ P a χ S om. P At 20 ἐμπεπλασμένων La (P) ω 20sq. συνεδρεύει C p P x ψ ω 22 πήγανον om. A σκηρῶδες A …η̈ρῶδες C p …ηρῶδες corr. σκιρῶδες S σκιρρ. P x P a At ὑποπ.] ὑπάρχει ω 24 ante κολοκ.:τῆς A

VI 3 On lethargia from (the books of) Archigenes and Posidonius | 87

5

10

15

20

25

30

ing, one should cut a vein on the second day and empty according to the strength (of the patient). If, on the other hand, the substance is phlegmatic and rather moist, such as usually has a larger share in those suffering from lethargia, one should administer remedies which are capable of thinning and one should cut the thickness. | And one thus needs to apply oxymel to those whose nerve-like system is 130 not afflicted, on the one hand, and, on the other, to those whose (nerve-like system) is afflicted, one needs to apply the decoction of celery, fennel, maidenhair and suchlike, and one should purge the stomach with a very drastic enema and one should use suppositories made out of rue and sodium carbonate and cumin and boiled honey. The head, though, one should treat with embrocations at the beginning, by boiling down tufted thyme together with vinegar and oil, but when the katochai increase in intensity, the root of sulphurwort instead of tufted thyme is boiled down in vinegar and, together with oil, applied to the head: the iris oil is also good for these. But if trembling and convulsions supervene, we treat the head with embrocations while triturating castoreum together with a bit of vinegar and oil. If the hypochondria are inflamed, one should apply poultices at the beginning made out of fine meal or bread or boiled quinces or tendrils of vine. After some time has passed, one must add linseed to the fine meal or the bread and boiled leaves of wormwood and marsh mallow; later on, (one should apply poultices) made out of meal made from barley and fenugreek and the root of marsh mallow, but to all of them one must add wormwood. The lint should be broad, so as to surround the ribs on both sides and the part of the thorax which lies under the breasts: after the use of a poultice one should not leave the parts naked but one needs to cover them with a salve made of nard or henna. Hereafter one should apply to the back a salve made out of Sicyonian (oil) which has terebinth in it and after smooth bayberries have been sprinkled (on it). And if flatulence accompanies (the patients), one should add to the poultices substances which do not cause flatulence, such as cumin, bayberry, rue and suchlike. But if hardening befalls the patient, one needs to add some rosemary and bean meal. To those who have been suffering from lethargia for a long time, one should administer, if the strength (of the patient) allows it, the holy remedy made from colocynth, and one should apply to the nostrils sternutatories made from white

88 | Aetii Amideni Libri medicinales VI 3–4, p. 130.25–131.19 Olivieri

καὶ πταρμικὰ προσάγειν ταῖς ῥισὶ δι’ ἐλλεβόρου λευκοῦ καὶ στρουθίου καὶ πεπέρεως καὶ καστορίου καὶ ταῖς ῥισὶν ἐγχέειν ἐλατήριον μετὰ γάλακτος ἢ κυκλαμίνου χυλὸν ἢ αὐτὴν τὴν ῥίζαν ξηρὰν λείαν ἐμφυσᾶν 131 καὶ διαχρίειν τὸ στόμα καὶ τὸν οὐρανίσκον σινήπει μετὰ μέλιτος, ἔπειτα σικυαστέον τὰ ὀπίσθια τῆς κεφαλῆς μετὰ φλογὸς πλείονος καὶ τὰ περὶ τὸν πρῶτον καὶ δεύτερον σπόνδυλον καὶ ἀφαιρεῖν αἷμα ἐκ τοῦ ὀπισθίου τῆς κεφαλῆς, εἶτα ξυρίσαντας τὰς τρίχας τῆς κεφαλῆς σιναπίζειν ἰσχάσι μετὰ τοῦ νάπυος ὄξει βεβρεγμένου. ἐπὶ δὲ τῶν τρομωδῶν καὶ καστόριον συνεχῶς ποτίζειν ὅσον < α̅ μετὰ μελικράτου κυάθων Γʹϲ. παρακμάσαντος δὲ τοῦ πάθους ἐπὶ λουτρὸν ἄγειν σμήγματι δηκτικωτέρῳ χρωμένους, οἷόν ἐστι τρύγη κεκαυμένη νᾶπυ πύρεθρον πέπερι δαφνίδες ἄσβεστος· νίτρου δὲ τὸ διπλοῦν ἐμβαλλέσθω. τροφαὶ δὲ ἔστωσαν λεπτομερεῖς καὶ τμητικαὶ καὶ ξηραντικαὶ καὶ δι’ ἀρτυμάτων σελίνου καὶ κυμίνου καὶ ἀνήθου πεπέρεώς τε καὶ δαφνίδων, καὶ πτηνῶν μὲν ὄρνις κατοικίδιος περιστερὰ καὶ τῶν στρουθίων οἱ ὄρειοι καὶ πέρδιξ, ἰχθύων δὲ οἱ πετραῖοι, λαχάνων πράσα ἀσπάραγος πετροσέλινα χαμαιδάφναι, οἶνος ὁ ὑδατώδης λεγόμενος λεπτὸς καὶ λευκὸς ὑποστύφων καὶ ἡ λοιπὴ ἐπιμέλεια ὁμοία γιγνέσθω. δ Περὶ κατοχῆς καὶ καταλήψεως ἐκ τῶν Ἀρχιγένους καὶ Ποσειδωνίου. μέσον τι φρενίτιδος καὶ ληθάργου πάθος εὑρήσεις, ὅ ἐστιν εἶδος παρανοίας ἢ παρακοπῆς. καλεῖν δὲ τοῦτο εἰθίσθησαν οἱ ἰατροὶ κατοχὴν καὶ κατάληψιν ἐπὶ χυμῷ συμβαίνοντι μᾶλλον μελαγχολικῷ. ἐπισφαλέ-

25

5

10

15

131,9 τροφαὶ κτλ. cf. Aret. de morb. ac 2,4 (99,3sqq.) 18sq. καλεῖν – κατάληψιν cf. Gal. de caus. pulsuum IV, 16 (IX 189,5–7) de puls. 12 (VIII 485,9–11) Paul. III, 10 (I 149,27–29) 26 κ. καστορίου om. At post καστ.:καὶ εὐφορβίου P x 27 ἐμφύσα La 131,1 post μέλιτος: εἶτα ἐπιμένοντος τοῦ πάθους πυρίαν πρόσφερε διὰ κέγχρου τοῖς ὄπιθεν εἰρημένοις ἐν τῶ πρὸ τούτου βιβλίω ἐν τοῖς καταφερομένοις ἐν πυρετοῖς P x 2 post σικ.: συκίας κούφας P x 2–4 τὰ ὀπίσθια – τὰς τρίχας τῆς κεφαλῆς] μετὰ πολλῆς φλογώσεως, ἔπειτα δὲ καὶ μετ’ ἐγχαράξεως κατὰ τὰ ὀπίσθια τῆς κεφαλῆς καὶ αὐτὴν μετὰ φλογὸς, ἀπὸ τοῦ ᾱ ἕως τοῦ δευτέρου· εἶτα πάλιν P x 4 ξυρήσαντας C p …τες M o A At ξηρίσαντες La P x P S (in marg. add. m. 2a) 6 ὅσον – μετὰ μελικράτου (μέλιτος P a μέλιτος ἀκράτου S) κυάθων (…θους P x) Γʹϲ om. C p P At m. 1a. S post ϲ: τάς τε φυσικὰς ἐκκρίσεις φυσικῶς ὑπομιμνήσκειν – μερῶν τε καὶ σκελῶν πολλ~ εὐχριστοῦσιν P x 7 …νοις P x ω 8 τρὺξ P a P x τρυγία A 9 ..βαλέσθω C p M o A S 10 καὶII om. P a C p S 10sq. καὶ (om. P a At) ἀνίσου (…ήσου M o …ήθου P a) καὶ (κ. om. P a At) κυμίνου α, exc. La 11sq. ὄρνεις κατοικειδίων περιστερίων νεοσ〈σ〉οὺς ἡμέρους P x 12 στρουθῶν P a C p P x ψ ω δὲ om. La M o ω 12sq. post πετραῖοι: οἷον βούγλωσσ〈οι〉 σίκκια γυμβρίδ〈ες〉 καὶ ὅσα ὅμοια P x 13  πράσσα (= A) δίσεφθα P x post πετροσ.: μάραθ〈ον〉 P x ante χαμαιδ.: καὶ P a ω ante οἶνος: πόμα δὲ P x ὁ om. La P 14 λεγόμ. om. P ω οἱ λοιποὶ Ald. 15 ὁμοίως M o P At γενέσθω P x A sq. ὡς ἐν τοῖς καταφερομένοις ἐν πυρετοῖς, καθὼς ἐν τῶ πρὸ τούτου βιβλίω ἀνιστορήσαμεν ἅπαντα P x 16 κατόχου C p P x A 16sq. ἐκ Ποσειδ. om. C p M o P ω 17 ante μέσον: ἤδη μὲν ἐν τῶ περὶ φρενίτιδος λόγω τὴν σύστασιν τούτου τοῦ νοσήματος εἰρήκαμεν· τὰ δὲ σημ〈εῖα〉 καθόλου μὲν εἰπεῖν κʹιʹὰ P x τι] τῆς La ω post εὑρήσ.: πρὸς τὴν ἐπικρατοῦσαν ὕλην ἐξαλλασ〈σ〉όμ〈ε〉ν〈ον〉 P x 18 post παρακοπῆς: κατὰ μέρος δέ, καταλαμβάνεται δὲ ὁ κάμνων ὕπτιος ὑποτεταμένος κτλ. P x 19 συμβαῖνον P a ψ

VI 3 On lethargia from (the books of) Archigenes and Posidonius | 89

hellebore and soapwort and pepper and castoreum, and one must pour elaterion into the nose together with milk or the juice of cyclamen, or one should apply the dry and smooth root (of cyclamen) itself into the nose, | and one needs to smear the mouth 131 and the palate all over with mustard together with honey, afterwards one must cup 5 the rear of the head with rather great heat as well as the area around the first and the second vertebra, and one has to remove blood from the rear of the head, then after having shaved the hair of the head, one should apply a mustard plaster with dried figs together with mustard drenched in vinegar. To those who are trembling, one should also continuously give castoreum as a drink, as much as one drachma 10 together with three and a half kyathoi of honey-water. When the affection abates, one needs to carry (the patients) to the bath and use soap that is very stinging, such as burned wine lees, mustard, pellitory, pepper, bayberries, unslaked lime: a double amount of sodium carbonate has to be put in. The foodstuffs should be fine in their substances and be cutting and drying and they should be made out of the condi15 ments of celery and cumin and dill and pepper and bayberries; of poultry, on the one hand, the domestic bird, the pigeon and the birds of the mountains and the partridge (are recommendable), while of fish, on the other, those living among the rocks (are recommendable); of vegetables, leeks, asparagus, parsley, periwinkle (are recommendable), wine (should be) the so called watery wine, thin and white, it should be 20 astringent and the remaining treatment should be alike.

VI 4 On katalepsis from (the books of) Archigenes and Posidonius Midway between phrenitis and lethargia you will find an affection which is a form of derangement or mental disturbance. The physicians are accustomed to call it 25 katoche and katalepsis while it happens in dependence of a rather melancholic

90 | Aetii Amideni Libri medicinales VI 4, p. 131.20–132.22 Olivieri

στερον δὲ τοῦτο τὸ πάθος ἐστὶ ληθάργου. ἐπὶ πυρετοῖς δὲ συνίστανται παρομοίοις ληθάργῳ καὶ ὁτὲ μὲν δοκοῦσιν ὑπνώττειν, ὁτὲ δὲ ἀνεῳγότα ἔχοντες τὰ βλέφαρα ἢ σκαρδαμύττουσιν ἢ ἀτενὲς ὁρῶσι καὶ ὡς πεπη132 γότας ἔχουσι τοὺς ὀφθαλμοὺς καὶ ἀκινήτους, ὡς ἐνίοτε οὐδ’ εἰ τὴν χεῖρά τις φέροι κατὰ τοὺς αὐτῶν ὀφθαλμοὺς μύουσιν· ἄφωνοί τέ εἰσι καὶ ἀναίσθητοι μηδ’ ἀκούοντες μηδ’ ἀποκρινόμενοι. φέρουσι δὲ τὰς χεῖρας αὑτῶν ἐνίοτε περὶ κεφαλὴν καὶ ὀφθαλμοὺς καὶ ῥῖνας, ὡς κνώμενοι, οὐ μετ’ αἰσθήσεως· σφυγμοὶ μικροὶ νωθροὶ ὀλίγου δεῖν ἐκλείποντες· πνεῦμα ποτὲ μὲν πυκνὸν ποτὲ δὲ ἀραιὸν καὶ ἐκ διαστημάτων τινῶν ἀναπνέουσι μεγάλως, κοιλίας καὶ οὔρων ἐποχὴ οὐχ ὑπὸ ξηρότητος· ἔχει γὰρ ὑγρὸν καὶ πολύ, ἀλλὰ διὰ τὴν ἀναισθησίαν· λῆμαι τούτοις ὑπόξηροι τοῖς κανθοῖς προσπεπήγασιν· ἐνίοτε δὲ καὶ προσάπτονται τῶν πλησίων τοίχων καὶ ἁπλῶς εἰπεῖν οὔτε φρενιτικοῖς τὸ πᾶν ἐοίκασιν οὔτε ληθάργοις. γίγνεται δ’ ἐνίοτε τὸ πάθος καὶ διὰ πλῆθος αἵματος ἀθρόαν τὴν ὁρμὴν ἐπὶ τὴν κεφαλὴν λαμβάνοντος καὶ ὑπερπληροῦντος ταύτην, ὥσπερ ἐθεασάμεθα ἐπί τινος νεανίσκου πολυαίμου. διατελέσας γὰρ οὗτος τρεῖς ἡμέρας μήτε μύων τὰ βλέφαρα μήτε πρὸς τὰς σφοδρὰς ἐκβοήσεις μετακινῶν τοὺς ὀφθαλμοὺς μήτε μὴν ὑποκρινόμενος, τῇ δὲ τετάρτῃ αἰφνίδιον αἱμορραγία λάβρος διὰ ῥινῶν γέγονε πλείστη καὶ παραχρῆμα πάντων τῶν ὀχληρῶν ἀπηλλάγη. ὅθεν εἰ μὲν πολύαιμός σοι φαίνοιτο ὁ κάμνων, ἀνυπερθέτως τέμνειν ἐν ἀγκῶνι φλέβα τὴν ἀνωτέραν καὶ ἄφελε πρὸς δύναμιν. ἐπὶ δὲ τῶν ἄλλων, πρῶτον μὲν κλύζειν χρὴ τὴν κοιλίαν τοῖς ἁπλουστέροις κλύσμασιν, οἷον πιτύρων χυλῷ καὶ ἀφρονίτρῳ καὶ μέλιτι, ἔπειτα καὶ πολυποδίου ῥίζαν συνεψεῖν τοῖς πιτύροις. τὴν δὲ κεφαλὴν πρῶτον μὲν ἐμβρέχειν ἐλαίῳ

20

5

10

15

20

132,7 21sq. ὅτε δὲ – σκαρδαμύττουσιν | 2sq. ἄφωνοι – ἀποκρινόμενοι | σφυγμοὶ μικροὶ | κοιλίας καὶ οὔρων ἐποχὴ cf. Paul. ib. (ib. 149,8–11) 17–20 εἰ μεν πολύαιμος – κλύσμασιν cf. Paul. ib. (ib. 150,2–4) 20 ante συνίστ.: τὸ πλεῖστον P x 22 ἔχουσι P ω 132,1 post ἔχ.: βλέφαρα ἢ Ald. 2 φέρει P a ψ At .. ειοι P x 4 περὶ κεφ. ἐνίοτε transp. A 5 post μικροὶ: καὶ ἀμυδροὶ P x 5–7 νωθροὶ –ἐποχὴ] καὶ σφόδρα πυκνοί, τὰ δὲ οὖρα καὶ ἡ κοιλία ἐπέχεται P x 6sq. τὸ δὲ πνεῦμα ποτὲ – μέγα (vide ad lin. 8) P x 7 μέγα α, exc. La 8 post ἀναισθησίαν: ἢ ἐπ’ ὀλίγον ἐκφέρεται, sqr. τὸ δὲ πνεῦμα – μέγα (ll. 6–7) καὶ οἱ μὲν μετρίως ἔχοντ〈ες〉 ἐγχυθέντ〈ος〉 αὐτοῖς τινος ὑγροῦ καταπίνουσιν ἢ καὶ κρατηθέντ〈ες〉 ἀνακόπτουσιν ἐπὶ τὰς ῥῖνας P x 11 ληθαργικοῖς P a P ante γίγνεται: τὸ οὖν φλεγμτ ´ ἐπικρατοῦντ τῆς χολῆς συνισταμένης διακρίνομ〈εν〉 ἐπὶ τῶν ληθαργικῶν κτλ. P x ἐνίοτε δὲ γίγνεται ω γίγνεται τὸ πλεῖστον P x 12  ἀθρόως A ἀθρόον ω τὴν ὁρμὴν om. ω post κεφαλὴν: τῶ πλήθει ω 13 αὐτὴν ω 14 διετέλεσε ψ οὕτω ω 15 τὰς om. La ἐμβοήσεις χ A ἐμβολὰς P μήτε κινῶν P x 16 λάβρως C p At λαῦρος φ P x P At λάθρως S 18 …νηται At τέμνε C p M o P ω ante ἐν: τὴν χ ψ ω ἐπ’ La ἀπ’P a ..ῶνος P a 19 ἀνωτέρω P a P post δύναμιν: εἰ δὲ γυνὴ εἴη τὴν ἐν τῶ σφοιρῶ (l. σφυρῶ) τέμνειν δεῖ τὴν ἀνωτέραν τοῦ ἑνὸς ποδός, ἐπὶ τῆ ἐξῆς ἐὰν ἐπιφέρη ὁ κάμνων κατὰ τοῦ ἑτέρου σφοιροῦ (l. σφυροῦ) P x 20 χρὴ κλύζειν P a A 20–22 τοῖς ἁπλουστέροις –τοῖς πιτύροις] καὶ ἐπιθετ〈έον〉 ὅσα ἐπὶ τῶν ληθαργικῶν εἰρήκαμεν. ἐπιθετε〈έον〉 δὲ ἐπὶ τοῖς ἐνέμασι ἀφόνιτρον καὶ πολυπόδιον P x 21 χυλῶ (…ὸν φ P x ω) πιτύρων (….ρου At) P a χ ψ ω ἀφο(ἀφρο…)νίτρου P x ω μέλιτος P x ω

VI 4 On katalepsis from (the books of) Archigenes and Posidonius | 91

humor. This affection is more delusive than lethargia. They [scil. the affections] occur in fevers which are similar to lethargia and sometimes they [scil. the patients] seem to be sleepy, sometimes they have open eyelids and either blink or stare and have eyes which are as if | they are fixed and which are motionless, so that they sometimes 132 5 do not even close them if someone reaches out for their eyes. They are both speechless and without sensation insofar as they do not hear nor answer. Sometimes they fidget with their hands around head and eyes and nostrils as if they felt an itch, without knowing that they do so. The pulse is small, sluggish and almost remittent: the breath is sometimes frequent, sometimes intermittent and they breathe deeply at 10 intervals, (there is) a retention of excrement and urine, not because of dryness, for it has much moisture, but because of the lack of sensation. In them [scil. the patients] dry substances adhere to the corners of the eye. Sometimes they even touch nearby walls and, simply speaking, they are not completely similar to patients suffering from phrenitis nor to those who suffer from lethargia. Sometimes the affection also 15 occurs because of a great amount of blood which moves to the head all at once and fills it, as we observed in the case of a young man who was full of blood. For, he continuously, for three days, neither closed his eyelids nor moved his eyes in reaction to loud shouting nor answered. But at the fourth day, suddenly a most fierce hemorrhage through the nose occurred and he was immediately released from all his 20 troubles. Hence, if the patient appears to you to be full of blood, you immediately have to cut the upper vein at the elbow and remove (blood) according to the strength (of the patient). In all other (patients) it is necessary to first purge the stomach with a very simple enema, such as the juice of bran and native soda and honey, afterwards to cook the root of polypody together with the bran. The head you first have to treat

92 | Aetii Amideni Libri medicinales VI 4–6, p. 132.23–133.23 Olivieri

γλυκεῖ χλιαρῷ, ἔπειτα δὲ εἰ μὲν θερμοτέρα φαίνοιτο ἡ κεφαλὴ κωδίαν ἐναφεψεῖν τῷ ἐλαίῳ, εἰ δὲ ψυχροτέρα, ἕρπυλλον· καὶ εἰ μὲν εὔλυτος γένοιτο ἡ κοιλία ἐπὶ τοῖς εἰρημένοις κλύσμασιν, ἐπιμένειν αὐτοῖς· εἰ 133 δὲ ἐπέχοιτο, ἐλλεβόρου μέλανος ῥίζαν συναφεψεῖν τοῖς πιτύροις. πόμα δ’ αὐτοῖς ἁρμόδιον τὸ ἀπόμελι ἢ μελίκρατον ἐπὶ πολὺ ἑψημένον πρὸς τὴν ὥραν. εἰ δὲ πάχος ἐν τοῖς οὔροις εἴη καὶ ἀνήθου ἀφέψημα καὶ σελίνου διδόναι. τροφαὶ δ’ ἔστωσαν πτισσάνης χυλὸς καὶ τὰ παραπλήσια. ὕδωρ δὲ τούτοις πολέμιον πινόμενον· ἐπιτείνει γὰρ τὴν ἐμπνευμάτωσιν καὶ κλύδωνας ἐργάζεται καὶ σπλῆνας ἐγείρει καὶ τὴν δίψαν οὐ παύει. ἀλειφέσθωσαν δὲ τὸ πᾶν σῶμα ἀνηθίνῳ καὶ μάλιστα χειμῶνος· ἐφ’ ὧν δὲ καὶ τρόμος ἐπιγίγνεται καὶ καστόριον λεαίνων ὅσον < α̅ σὺν τῷ μελικράτῳ ἐγχεῖν τῷ στόματι. ε Περὶ κάρου Ποσειδωνίου. ψυχρῶν καὶ ὑγρῶν καὶ φλεγματικῶν χυμῶν καταλαμβανόντων τὸν ἐγκέφαλον ὁ κάρος ἐπιγίγνεται μετὰ πυρετοῦ βληχροῦ· παρέπεται δὲ αὐτοῖς ἀναισθησία καὶ ἀκινησία τοῦ παντὸς σώματος μετὰ βλάβης τῶν ἡγεμονικῶν ἐνεργειῶν. μεμύκασι δ’ αὐτῶν διὰ παντὸς οἱ ὀφθαλμοί. διαφέρει δὲ κάρος ληθάργου τῷ τοὺς μὲν ληθαργικοὺς ἐρωτωμένους ἀποκρίνεσθαι καὶ μὴ παντελῶς ἀφώνους κατακεῖσθαι, τοὺς δὲ κάρῳ περιπεπτωκότας ὕπνῳ βαθυτάτῳ κατέχεσθαι, ὡς νυττομένων αὐτῶν αἰσθάνεσθαι μέν, μὴ μέντοι φθέγξασθαι μηδ’ ἀνοίγειν τοὺς ὀφθαλμούς. θεραπεύειν δὲ τούτους παραπλησίως τοῖς ληθαργικοῖς, λεπτυντικωτέραν καὶ τμητικωτέραν τὴν ἀγωγὴν ποιουμένους. μετεχέτω δὲ καὶ καταπλάσματα καὶ τὰ ἐπιθέματα τοῦ στομάχου σὺν τῷ θερμαίνειν καὶ τῆς τονωτικῆς δυνάμεως. Περὶ κώματος ἐκ τῶν Ποσειδωνίου. ἀτμοὶ ὑγροὶ καὶ θερμοὶ ἐκ Ϛ τῶν ὑποκειμένων ἐπὶ τὴν κεφαλὴν ἀναφερόμενοι ἐν πυρετοῖς καὶ πλη-

25

5

10

15

20

133,8sq. καστόριον – τῷ στόματι cf. Aret. V 3 (102,16sq.) 10sq. ψυχρῶν – ἐπιγίγνεται cf. Gal. de loc. aff. III 6 (VIII 162,14–15) 12sq. παρέπεται – σώματος cf. Gal. de loc. aff. IV 3 (VIII, 231,7–8) 23 φαίν.] γένοιτο At 24 post ἕρπυλλον: ἐπιθέτην (l. …ετέον) δὲ καὶ ὄρνιθ〈ας〉 καὶ κυ〈δ〉ώνια μικρὰ καὶ συκίας καὶ καταπλάσματα κτλ. P x 25 αὐτοὺς La M o 133,1 ἐπέχοιντο ω τοῖς πιτ.] εἰ τὸ ὕδωρ τοῦ κλυστῆρος P x 2 ante ἁρμόδ.: ἁρμόζει πάντα τὰ διουρητικὰ P x post ἁρμόδ.: δὲ P x ἡψημ. P a C p P …νω M o 3 post εἴη: σκεύασον τὸ τοιοῦτον δρόσατον καὶ δίδου ἔχων (..ον?) ῥίζας πάσας οἷον P x 3sq.  καὶ ἀνήθου – διδόναι] μαράθ〈ου〉 ἀνήθ〈ου〉 σελίνου μακιδωνισσίου ἀσπαράγγου βουγλώσσου κτλ. P x 5 δὲ om. α, exc. P a A 6 σπλῆνα P πλείωνας P x 7 ἀλειφέσθω P x P καὶ om. ω post μαλ.: δὲ S 8 καὶI om. P a A λεαίνοντα P …ες χ A ω 9 ἐγχέομεν A post στόματι: καὶ ἡ λοιπὴ ἐπιμέλεια ὡς τῶν ληθαργικῶν τε καὶ τῶν φρενιτικῶν ὁμ〈οία〉 P x 10 ante Ποσειδ.: ἐκ τῶν P a καὶ φλεγμ. om. M o ω 13 post βλάβης: καὶ P a χ ω 14 διὰ παντὸς om. La post ὀφθ.: ὡς τῶν ληθαργικῶν παρόμοια πάντα P x δὲ] γὰρ ω post ληθ.: ὅτι τὸ τῶν μὲν πυρετῶν ἡγεῖσθαι μὲν τοῦ κάρου – τὸν δὲ λήθαργον ἰδίαν τινὰ σύστασιν ἔχειν οἷον P x τῷ] τὸ P x A om. C p 17 post μέντοι: γε χ P ω 18 post δὲ: καὶ χ ψ S 19 post ληθ.: μόνον μὲν P x τμητικ. καὶ λεπτ. (κ. λεπτ. om. P a) transp. χ ψ ω 19sq. ποιούμενος P x M o A ….οι P ω 20 μετέχειν δὲ δεῖ ω ante καταπλ. τὰ P a P x M o A ω καὶ τὰ ἐπιθ. om. P ω 21 τῷ] τὸ P x A om. C p 22 ἐκ τῶν om. χ ψ ω ante ἀτμοὶ: μόνοι χ ψ ω

VI 4 On katalepsis from (the books of) Archigenes and Posidonius | 93

with embrocations made of lukewarm sweet oil but, afterwards, if the head seems warmer, you have to boil down poppyhead in the oil, if colder, tufted thyme: and if the stomach is relaxed by the mentioned enemata, you should continue with these: if | it [scil. the excretion] is held back, you should cook the root of black hellebore 133 5 together with the bran. A suitable drink for them is apomeli or honey-water when cooked for a long time according to the season of the year. If there is thickness in the urine you must also apply the decoction of dill and celery. Food should be the juice of barley-gruel and suchlike, but water is hostile to them [scil. the patients] when drunk: for it intensifies the flatulence and causes splashing and stirs up the spleen 10 and does not stop the thirst. They should be anointed on their whole body with oil made of dill, and especially so in winter: for patients in whom trembling also supervenes, you should triturate castoreum and pour as much as one drachma together with honey-water into the mouth.

VI 5 On karos from Posidonius When cold and moist and phlegmatic humors befall the brain, karos supervenes together with a slight fever: lack of sensation and motionlessness of the whole body accompany them [scil. the patients] together with damage to the leading capacities. Their eyes are closed the whole time. Karos differs from lethargia, on the one hand, in the fact that the patients suffering from lethargia answer when asked and do not 20 lie in bed completely speechless and, on the other hand, in the fact that those who fall ill with karos are seized by a very deep sleep, so that they, when being pricked, have sensation but do not utter any sound nor open their eyes. One should treat them in a way similar to patients suffering from lethargia, applying an approach which is even more thinning and more cutting. Both the poultices and the coverings 25 of the stomach shall, together with being warming, also partake in a strengthening capacity.

15

VI 6 On koma from (the books of) Posidonius Moist and warm vapors being carried up from lower parts to the head in fevers and filling it, cause the affection which the physicians call koma. The diagnosis will be

94 | Aetii Amideni Libri medicinales VI 6–7, p. 133.24–134.26 Olivieri

ροῦντες ταύτην πάθος ἐργάζονται, ὅπερ ὀνομάζουσιν οἱ ἰατροὶ κῶμα. διάγνωσις δέ σοι σαφὴς ἔσται ὕπνου γιγνομένου πλείονος τοῦ κατὰ φύσιν καὶ φθέγγονται ἐν τοῖς ὕπνοις ἀλλόκοτα καὶ τὸ σῶμα ἀνωμάλως 134 ἔχουσι καὶ τὴν κάτω γένυν ἐν τῷ καθεύδειν χαλωμένην καὶ διεγερθέντες πολλάκις ἀθρόως πάλιν ἐπικαταφέρονται τῷ ὕπνῳ καὶ τὴν κεφαλὴν ὑγροτέραν ἔχουσι. θεραπεία δὲ ἐμβροχὴ διὰ ῥοδίνου τὸ εἰκοστὸν μέρος προσλαβόντος ὄξους· μὴ παρόντος δὲ τοῦ ῥοδίνου χαμαιμηλίνῳ χρηστέον σὺν τῷ ὄξει· ἔστω δὲ δριμύτατον τὸ ὄξος. εἰ δὲ ψυχροτέρα ἡ κεφαλὴ φαίνοιτο, ἀνήθινον σὺν γλυκεῖ ἐλαίῳ προσπλέξας ἐξ ἴσου καὶ θερμάνας ἔμβρεχε καὶ συντόμως εἰπεῖν ἐφ’ ὅσον ἐπιτέταται ἡ ψῦξις, ἐπὶ τοσοῦτον καὶ τὰ θερμάσματα ἐπιτείνειν, ὥστε καὶ γλήχωνά ποτε καὶ πήγανον ἐναφεψεῖν τῷ ἐλαίῳ· βαλανιστέον δὲ καὶ τὴν ἕδραν τοῖς ἱκανῶς ἐρεθίζειν δυναμένοις, τρέφειν δὲ χυλῷ πτισσάνης σὺν ἀπομέλιτι. ζ Περὶ σκοτωματικῶν Ἀρχιγένους καὶ Ποσειδωνίου. ἀτμῶν θερμῶν καὶ δριμέων ἐπὶ τὴν κεφαλὴν ἀναφερομένων καὶ τρεπόντων τὸ ψυχικὸν ἐν τῷ ἐγκεφάλῳ πνεῦμα, πρῶτον μὲν ἀμβλυωγμοί τινες τοῖς ὀφθαλμοῖς ἐγγίγνονται, ἔπειτα καὶ ὤτων ἦχοι συνηχεῖς καὶ δυσηκοΐαι. μάλιστα δὲ τοῦτο συμβαίνει περὶ τὰς τῶν σιτίων πέψεις καὶ ἀνισταμένοις ἐξ ὕπνου. ἐπιτεινομένου δὲ τοῦ πάθους ἐπιγίγνονται ἴλιγγοι καὶ σκοτώματα, ὡς δοκεῖν πάντα ὁρᾶν περιστρεφόμενα. καὶ τοῦτο δὲ συμβαίνει ἐπειδὰν ἀθρόως ἐξαναστῶσιν ἐκ τῶν καθεδρῶν, ἀπεψίας προηγησαμένης τινός. χρονίζοντος δὲ τοῦ πάθους καὶ ἐπὶ μικραῖς προφάσεσι σκοτοῦνται, ὥστε καὶ καταπίπτειν ἐνίοτε, μάλιστα μὲν ὅταν αὐτοί ποτε ἐν κύκλῳ περιστραφῶσιν· ὅπερ γὰρ ἄλλοις ἐπὶ πολλαῖς περιστροφαῖς γίγνεται, τοῦτ’ ἐκείνοις ἐπὶ μιᾶς, κἂν ἕτερον δέ τινα περιστρεφόμενον ἴδωσι σκοτοῦνται, κἂν τροχὸν ἤ τι τοιοῦτον περιδινούμενον θεάσωνται, ταὐτὸ ὑπομένουσι· τὸ γὰρ ὀπτικὸν πνεῦμα προσπῖπτον τῷ περιδινουμένῳ τροχῷ κινεῖται καὶ αὐτὸ συμπεριφερόμενον ἐκείνῳ καὶ οὕτως ἀνώμαλον καὶ ταραχώδη καὶ ἄτακτον τόν τε χυμὸν καὶ τοῦ πνεύματος

25

5

10

15

20

25

134,11–13 ἀτμῶν – πνεῦμα cf. Gal. de loc. aff. III 12 (VIII, 203,5–6) 14 ὤτων – δυσηκοΐαι Gal. ib. (ib. 203,18) cf. Aret. III 2 (37,25sqq.) Paul. III 12 (I 152,1) 19–27 χρονίζοντος – ἐργάζεται Gal. ib. (ib. 202,2–14) 22–27 κἂν ἕτερον – ἐργάζεται cf. Paul. III 12 (I 151,25–27) 24 αὐτὴν χ ψ ω post κῶμα: κῶμα δὲ ἐπονομάζεται βάθος καὶ παρὰ φύσιν ὕπνος κτλ. P x 25 ἔστιν σαφὴς ω ἔφη~ ´ς ἔσται P a ἐπὶ τουτ ´ σαφ~ ´ παραθῶμεν P x γενομένου P x A At 134,2 τῷ ὕπνῳ om. ω 3sq. τὸ εἰκοστὸν (εἰκ.] κατὰ La) μέρος (ante μ.: δὲ P x) προσλαβόντος (…λαβὼν τὸ La …λαβὼν P x M o S …λαβοῦσα A At) ὄξους (…ος P x) – ῥοδίνου om. Ald. 5 post ὄξει: χλιαρῶ P x 6 ante ἀνήθ.: τὸ M o At 7  …μήνας P a ….μανθὲν M o 8 ..τείνει La 9 post ἐλαίῳ: ἢ πήγανον ἔλ〈αιον〉 μετὰ καστορίου καὶ ὄξους ξηρίσας ὅλην τὴν κεφαλὴν ἐπιτίθει κτλ. P x 10 post δυναμ.: εἰ δὲ μὴ κλυστῆρι χρᾶσθαι δριμυτέρω P x post ἀπομ.: ἡ δὲ λοιπὴ τούτ〈ου〉 θεραπεία ὅσα καὶ ἤτοινα (l. ἅτινα?) διωρίσαμεν παντοῖα ἐπὶ τῶν ληθαργικῶν P x 11 ante Ἀρχιγ.: ἐκ τῶν P a C p M o ψ ω 13 πρῶτοι C p M o P S ἀμβλυωσμοὶ C p M o …οσμοὶ La P x ….υσμοὶ A …υωπισμοὶ ω 15 ταῦτα At 15sq. ἐξανισταμένοις M o ψ S …σταμένων P x At 20 ὅτι P a P ω 21 ἐπιστροφαῖς P x A 24 τὸ αὐτὸ P ταὐτὸν P a ψ 26 τῶν τε χυμῶν P a χ

VI 6 On koma from (the books of) Posidonius | 95

clear to you if sleep occurs to a higher degree than is in accordance with nature and they [scil. the patients] make strange utterances during sleep and their body behaves unevenly | and they have a slackened lower jaw during sleep and after having been 134 woken up they often, all at once, fall asleep again and have a very moist head. As 5 treatment, an embrocation made of rose oil (is suitable), which in addition takes one twentieth of vinegar. If no rose oil is at hand, one should use camomile oil together with vinegar. The vinegar should be the sharpest. If the head appears to be colder, you should mix equal parts of dill oil with sweet oil and, after having warmed it, you should apply it as embrocation and, concisely speaking, as much as the coldness 10 intensifies, so much one also should intensify the warm fomentations, so that one sometimes also needs to boil down pennyroyal and rue in the oil: one must also administer a suppository to the anus with substances which are capable of sufficiently provoking; as nourishment one has to give barley-gruel together with apomeli.

15

VI 7 On those who suffer from skotoma (from the books of) Archigenes and Posidonius

When warm and sharp vapors are carried up to the head and change the psychic pneuma in the brain some dimness of vision at first supervenes upon the eyes, afterwards also continuous ringing in the ears and hardness of hearing. This 20 happens especially during the digestion of food and to those who rise from sleep. When the affection intensifies, iliggoi and skotomata supervene, so that they [scil. the patients] seem to see everything whirling around. This, too, happens when they suddenly rise from their seats or when some indigestion precedes. When the affection already lasts for some time, they suffer from a darkening of the vision even 25 from slight causes, so that they sometimes even fall, especially when they themselves turn around in a circle on occasions: for, what happens to others after many turnings around, this (happens) to them after one (turning around), and even if they see someone else turning around, they suffer from darkening of vision, and also if they see a wheel or something else whirling around, they suffer the same: for, 30 the optical pneuma, when falling upon the wheel which is whirling around, is moved and when it is itself carried around together with it [scil. the wheel] it also causes in this way an irregular and troubled and disordered movement of the humors and of

96 | Aetii Amideni Libri medicinales VI 7, p. 134.27–135.22 Olivieri

τὴν κίνησιν ἐργάζεται. εὐάλωτοι δὲ τῷ πάθει οἱ ἐπεσχημένοι τὰς συνήθεις ἐκκρίσεις καὶ ἀπεψίαι δὲ καὶ ἐγκαύσεις συνεχεῖς καὶ μέθαι ἀποτελεστικαὶ τοῦ πάθους εἰσί. παρακολουθεῖ δ’ αὐτοῖς καὶ ἐποχὴ τῆς κοιλίας καὶ διὰ τοῦτο ἐμπνευμάτωσις ἱκανὴ καὶ οὔρων λεπτῶν καὶ ὀλίγων 135 ἔκκρισις τῆς ὕλης ἐπὶ τὴν κεφαλὴν τὴν ὁρμὴν ἐχούσης. ἰσχνοὶ δὲ ὡς ἐπίπαν γίγνονται καὶ νωθροὶ πρὸς πᾶσαν ἐπιβολήν. οἱ μὲν οὖν ἐναιμότερα τὰ προφαινόμενα τῶν ὀφθαλμῶν δοκοῦντες ὁρᾶν πρὸς μανίαν μᾶλλον ἐπιτηδείως ἔχουσιν, οἱ δὲ πορφυρίζοντα ὁρῶντες πρὸς ἐπιληψίαν. τῆς μὲν οὖν δυνάμεως ἰσχυρᾶς ὑπαρχούσης καὶ μηδενὸς ἑτέρου ἐναντιουμένου φλεβοτομητέον, ἄν τε ἀρχὴ τοῦ πάθους εἴη ἄν τε καὶ προκόψαντος ἤδη τοῦ χρόνου. ἐν δὲ τῇ φλεβοτομίᾳ φυλακτέον [χρὴ] μὴ ἀθρόον κενοῦν διὰ τὸ ἐκ τῆς τυχούσης προφάσεως αὐτοὺς καταπίπτειν, ὅθεν πλείοσιν ἀφαιρέσεσι χρώμενοι ἐκ διαστημάτων τινῶν ἀναπληρώσομεν τὴν συμμετρίαν. ἐμβρεχέσθω δὲ ἡ κεφαλὴ κατὰ τὸν καιρὸν τῆς φλεβοτομίας ὀξυροδίνῳ, προσπλέκοντες πολυγόνου χυλὸν ἢ κισσοῦ καὶ πιλήματα δὲ ἐξ ἐρίου διάβροχα ῥοδίνῳ ἢ οἰνανθίνῳ τῇ κοιλίᾳ ἐπιτιθέσθω κατὰ τοῦτον τὸν καιρόν. εἰ δὲ τὴν ἀφαίρεσιν τοῦ αἵματος εἴη τι κωλῦον, ὥσπερ ἰσχνότης ἢ ἕτερόν τι τῶν πλειστάκις εἰρημένων, ὑποσυρέσθω ἡ κοιλία, πρῶτον μὲν τῷ διὰ πιτύρων καὶ μέλιτος καὶ ἀφρονίτρου κλυστῆρι, ἔπειτα δὲ τὴν δι’ ἀλόης πικρὰν διδόναι συνεχῶς. εἰ δ’ ἐπιμένοι τὰ συμπτώματα, δεήσει καὶ σφοδροτέροις καθαρτηρίοις χρῆσθαι. ὁρῶν δὲ τὸν πλεονάζοντα χυμὸν πρὸς τοῦτον ἅρμοζε τὸ φάρμακον. τῶν δὲ δραστικωτέρων καθαρτηρίων εὐδοκιμεῖ ἅτινα μάραθρα συναφεψόμενα τῷ ὀξυμέλιτι ἔχει καὶ τὸ διὰ φοινίκων καὶ πηγάνου καὶ σκαμμωνίας, ὧν αἱ συνθέσεις προείρηνται ἐν τῷ περὶ καθαρτηρίων λόγῳ. καὶ ἀποφλεγματισμοῖς δὲ χρηστέον καὶ ἀναγαργαρίσμασι τοῖς δι’

30

5

10

15

20

135,6 φλεβοτομητέον κτλ. cf. Or.a VIII 4 (247,24sqq.) Paul. ib. (ib. 152,6sqq.) 17sq. καθαρτηρίοις χρῆσθαι cf. Gal. de purg. med. fac. 5 (XI, 341,4–5) 21sq. ἐν τῷ π. καθ. λόγῳ cf. III 25 etc (I 296,6 sqq.) 27 ἐπισχημ. χ ω …..σχεθέντες P a 30 πνευμάτ. χ ψ ω 135,1 ἐκκρίσεις C p M o ante τῆς: καὶ ἀπεψίαι M o τὴν ὁρμὴν om. ω 2 post ἐπιβολήν: Ἕτεροι δὲ τῶν παλαιῶν φασιν ὅτι τὸ σκοτωματικὸν πάθος πονηρότατόν ἐστι – νωθροὶ πρὸς πᾶσαν ἐπιβολήν P x οἱ] εἰ ω 3 δοκοῦνται ω 4sq. post ἐπιληψίαν: Σκοτωματικῶν θεραπεία Ἀρχιγένους καὶ Ποσειδωνίου. τοὺς σκοτωματικοὺς ἐν ἐπιθέσει μὲν γενομένους διεγερτέον τοῖς τε ἐπιτηδείοις ὀσφραντοῖς χρωμένους καὶ τρίψεσιν καὶ τοῖς τοιούτοις· ἐν ἀνέσει δὲ τυγχάνοντας πρὸς ἀνασκευὴν τοῦ πάθους P x 6 ἦ P x M o ψ 7 προκόψαν ἦ (ἤδη om.) P …κόψοντος M o τῶ χρόνω P a P χρὴ delevi 8 μὴ om. P a C p P At m. 1a S ἀθρόως P a P 9 …μένοις P x A διαιτημ. At 10 …ρώσωμεν P x M o A ω 11 ..κοντας A …κόντων P χυλω La ω 12 δὲ om. At 14 post τιI: τὸ C p P x ψ τιII om. χ P ω 15 πρῶτον μὲν τῷ] διὰ κλυτῆρ〈ος〉 οἷον P x 15sq. διὰ –κλυστῆρι] πιτύρων ἀφρονίτρου πολυποδίου ἐντεριώνης κενταυρίου – ὡς ἐν τοῖς χειρουργουμένοις τὰ τοιαῦτα εἰρήσεται P x 15sq. ἀφρονίτρων C p M o A 16 δι’] διὰ τῆς C p M o P 17 καθαρτ. om. P a P 18 χρήσασθαι P x M o A τούτοις La ω 20 τῷ ὀξυμ.] σύν μέλιτι P x ἔχουσιν P …ειν P x At post διὰ: τῶν ἑτέρων πάντων ῥιζῶν καὶ σκολοπενδρίου – ἁρμόζει δὲ καὶ τὸ διὰ P x 21 post περὶ: τῶν C p P x A 22 δὲ] τε M o om. At

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius | 97

5

10

15

20

25

pneuma. Those who hold back the accustomed excretions are liable to the affection, and indigestion and continuous influence of heat and drunkenness are causative of the affection. Retention of excrement accompanies them [scil. the patients] and, hence, considerable flatulence and the excretion of small quantities of thin urine, | if 135 the material moves towards the head. They [scil. the patients] become weak and sluggish in most cases in consequence of any impulse. Some, on the one hand, who seem to see what appears in front of their eyes as rather blood-colored, have a tendency to suffer from mania, some, on the other hand, who see (what appears in front of their eyes) to be purplish, (have a tendency to suffer from) epilepsia. If the strength (of the patient) is strong, and if nothing else speaks against it, one should conduct phlebotomy, both if it is the beginning of the affection and also if time has already passed. During phlebotomy one must beware of emptying all at once because of the fact that they [scil. the patients] fall due to trifling causes, for which reason we fill up the due proportion (of blood in the body) by undertaking more removals (of blood) at intervals. The head needs to be treated with embrocations made out of rose oil mixed with vinegar at the time of phlebotomy, and one should add (to it) the juice of knotgrass or of ivy and one should lay upon the stomach compressions made of wool and soaked in rose oil or wild-vine flower during this very time. If something prohibits the removal of blood, such as weakness (of the patient) or any other of the often mentioned things, the stomach must be purged, at first with an enema made out of bran and honey and native soda, and afterwards one should continuously administer the bitter remedy made from aloe. If the symptoms persist, it will be necessary to use stronger purgatives as well. Look at the prevailing humor and adjust the remedy to it. Of the more drastic purgatives, highly approved is whatever has fennel cooked with oxymel (in it) and what is made out of date palms and rue and scammony, the compositions of which have been described previously in the discussion of purgatives. And one has to use phlegm purging remedies and

98 | Aetii Amideni Libri medicinales VI 7–8, p. 135.23–136.21 Olivieri

ὀριγάνου καὶ γλήχωνος καὶ ὀξυμέλιτος, ἔπειτα καὶ ταῖς ῥισὶν ἀναγαλλίδος χυλὸν ἐγχεῖν ἢ κυκλαμίνου ἢ σεύτλου ῥίζης ἢ ἐλατήριον μετὰ γάλακτος καὶ νίτρον δὲ σὺν μελανθίῳ λειωθὲν καὶ ἐλαίῳ παλαιῷ ἀναμιχθὲν γενναίως διὰ τῶν ῥινῶν ποιεῖται τὴν κάθαρσιν. μετὰ δὲ ταῦτα ἐπὶ βαλανεῖον διάγειν. τριμμάτιον δ’ αὐτοῖς ἁρμόζει τονωτικὸν τῆς 136 κεφαλῆς τοῦτο· λίθου Ἀσίου Γʹ α̅ ἀφρονίτρου λευκοῦ Γʹ α̅ ἴρεως Γʹ α̅ σχοίνου ἄνθους Γʹ βʹ ῥόδων ξηρῶν Γʹ βʹ· ἐκ τούτου λαβὼν τὸ ἀρκοῦν ἐπίπασσε τῷ βρέγματι τῆς κεφαλῆς, ἐπιρραίνων ὕδατος θερμοῦ βραχύ· εἶτα λουσάμενος καὶ μὴ βρέχων τὴν κεφαλὴν τῷ θερμῷ, ἀλλὰ μόνον ἀποπλύνων, ἐξελθὼν βρεχέτω τῷ ψυχρῷ τρίτον ἢ πλεονάκις. τοῖς δὲ ἄγαν θερμὴν ἔχουσι τὴν κεφαλὴν καὶ ῥόδινον σὺν ὄξει πολλάκις ἐπιβάλλειν καὶ ψύχειν αὐτὴν τῷ ἐκ τῶν κρουνῶν ὕδατι ἐν τοῖς βαλανείοις. εἰ μὲν οὖν ἐπὶ τούτοις εἴκοι τὸ πάθος, παύειν τὴν ὀχληρὰν προσαγωγήν· εἰ δ’ ἐπιμένοι, τέμνειν τὰς ἐν τῇ κεφαλῇ κατὰ τοὺς κροτάφους ἀνωτέρω τῶν ὤτων ἀρτηρίας προκενώσας τὴν κοιλίαν ἢ τῇ ἱερᾷ ἢ κλυστῆρι. μετὰ δὲ ταῦτα τριμματίοις ἰσχυροτέροις κεχρῆσθαι τοῖς ἐπὶ τῶν μαινομένων ῥηθησομένοις. τροφαὶ δ’ ἔστωσαν εὔχυμοι εὐδιοίκητοι ἄφυσοι παντάπασιν εὐστόμαχοι εὐκοίλιοι· οἶνος δ’ ὀλίγος μὲν λευκὸς δὲ καὶ λεπτότατος καὶ μὴ πάνυ παλαιός· ἁρμόδια δὲ τούτοις τὰ στυπτηριώδη αὐτοφυῆ λουτρά. μεγίστη δὲ καὶ πρώτη καὶ ὑστάτη τούτων προφυλακὴ καὶ θεραπεία ἐστὶν ἡ ὑπόμνησις τῶν ἐπεσχημένων ἐκκρίσεων, μάλιστα ἐπὶ γυναικῶν. η Περὶ μανίας ἐκ τῶν Ἀρχιγένους καὶ Ποσειδωνίου. γίγνεται μανία χωρὶς πυρετοῦ αἵματος πολλοῦ ἀσαποῦς ἐπιρρεύσαντος τῷ ἐγκεφάλῳ, ποτὲ μὲν εὐκράτου, τῷ πλήθει μόνον λυποῦντος, ὡς ἐπὶ τῶν μεθυόντων, ποτὲ δὲ ξανθοχόλου. προηγεῖται δὲ τῆς μανίας ἀσθένεια τῆς κε-

25

5

10

15

20

23sq. ταῖς ῥισὶν – κυκλαμίνου cf. Aret. VII, 3 (149,27–28) 136,9–11 τέμνειν – κλυστῆρι cf. Paul III 12 (I 152,8–9) 9sq. τέμνειν – ἀρτηρίας cf. Gal. de loc. aff. ib. (ib. 202,16sqq.) Aret. VII, 3 (149,23–29) 12 τοῖς ἐπὶ τῶν μαινομένων ῥηθησομένοις cf. p. 150,15 18–21 γίγνεται – ξανθοχόλου cf. Gal. de symptom. caus. II 7 (VII 202,6–10) Paul. III 14 (I 157,1sqq.) 19 χωρὶς πυρετοῦ (Gal.) def. med. 246 (XIX, 416,8) Aret. III 6 (41,12–13) 21 ποτὲ δὲ ξανθοχόλου cf. Gal. ascrip. introd. s. med. XIV 740,16–17 24 ἐγχεῖν ante ἀναγαλλ. transp. P x om. P a 25 λεανθὲν χ ψ ω 26 γενναίαν χ ψ ω 136,1 τοῦτο] τὸ (om. P) τοιοῦτον (…το C p M o) χ ψ ω ἀφο(ἀφρο…) νίτρων λευκῶν C p M o ἴρεως Γʹ α̅ om. A 1sq. σχίνου P At 2 ἄνθος C p At βʹI] α̅ M o ῥόδων ξηρῶν Γʹ βʹ (α̅ M o) om. ψ At m. 1a S τούτων P a P At 2sq.  ἐπίπασαι ex …σσαι C p …ασε Mo ω ….παττε P 4 κεφ.] κοιλίαν La τῷ θερμῷ om. La τῷ om. P x At μόνον] μᾶλλον A μᾶλλον μόνον P x 5 βρέχε P ω τὸ ψυχρὸν La At τῶ ψυχρῶ ex τὸ ψυχρὸν P a ante τρίτον: δεύτερον καὶ P a ante πλεον.: καὶ P a 8 οὖν om. Ald. 9 ἐπιμένει P x P …ειενAt κατὰ τοὺς] καὶ P a 9sq. κροτάφοις P a 10 ἀνωτ. τ. ὤτων om. P a ὄντων La At 13 post εὐκ.: διουρητικαὶ χ ψ ω δ’ om. P x A 14 δὲI om. La P x ψ ω δὲII om. C p M o P ω 16 ἡ om. La ἐπισχ. C p M o A ω ἐπησχ. P ἐπισχομ. P x 21 ξανθηχ. A …οχώλου P x ξανθὴ χολή ω ante προηγ.: ὡς ἐπὶ τῶν φρενοβλαβούντων φρενιτικῶν P x

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius | 99

5

10

15

20

25

gargles made from oregano and pennyroyal and oxymel; afterwards one has to pour into the nose the juice of pimpernel or of cyclamen or of the root of beet or elaterion with milk, and sodium carbonate, which has been triturated with black cumin and has been mixed with old oil, brings about the purging through the nose excellently. Thereafter one has to bring them [scil. the patients] to the bath. As trimmation which is strengthening for | the head, the following is suitable for them: one uncia of Asian 136 stone, one uncia of white native soda, one uncia of iris, two unciae of the flower of rush, two unciae of dry roses: thereof one needs to take the appropriate amount and smear it on the front part of the head, sprinkling (on the head) a bit of warm water: afterwards, when (the patient) is in the bath, one should not drench the head with warm (water), but only wash (it), then when (the patient) leaves (the bath), one should drench (the head) with cold (water) three times or more. To those who have a very warm head one often has to apply rose oil as well, together with vinegar, and one should cool it [scil. the head] in the bath with water from watercourses. If the affection ceases due to these (therapies), one should end the aggressive approach: but in case it persists, one needs to cut the arteries in the head at the temples above the ears after having emptied the stomach first, either with the holy remedy or with an enema. Afterwards one has to use stronger trimmatia, which will be dealt with in the (chapter on those) who suffer from mania. The foodstuffs should be productive of healthy humors, be easy to digest, cause absolutely no flatulence, be good for the stomach, and ease the gastro-intestinal tract. There should be only a little wine, it should be white and the thinnest and not very old. The astringent and natural baths are suitable for them. The greatest and first and last prophylaxis and therapy for these (patients) is the provocation of the excretions which have been held back, especially in women.

VI 8 On mania from (the books of) Archigenes and Posidonius Mania occurs without fever when plenty of non-putrefied blood flows to the brain, which [scil. the blood], in some cases, is well-tempered, causing distress just because of its great quantity, as in drunk people and, in other cases, is full of yellow bile. A

100 | Aetii Amideni Libri medicinales VI 8, p. 136.22–137.23 Olivieri

φαλῆς, ὡς ἐπὶ τῶν ποδαγρῶν ἡ ἀσθένεια τῶν ποδῶν ἀεὶ μὲν πάρεστι. τότε δ’ ὀδυνῶνται, ὁπόταν ἡ ὕλη ἐπιρρεύσῃ τοῖς τόποις. ἐπὶ μόνῳ τοίνυν τῷ αἵματι γιγνομένης τῆς μανίας ταῦτα παρέπεται τοῖς πάσχουσι· γέλως ἄσχετος αὐτοῖς κινεῖται θεωμένοις πολλάκις πρὸ τῶν ὀφθαλμῶν εἴδωλά τινα γέλωτος ἄξια φαιδρόν τε αὐτοῖς ἐστι τὸ πρόςωπον καὶ ᾄδουσι συνεχῶς· ἐνίοτε γὰρ ἐκ τῶν γιγνομένων ἀναθυμιά137 σεων ἦχοι περὶ τὰ ὦτα συνεδρεύουσιν, ὡς δοκεῖν αὐτοὺς αὐλητῶν τινων ἀκροᾶσθαι. σῴζεται δ’ αὐτοῖς ἡ μνήμη, ὡς ἐξ ὧν ᾄδουσι συνήθη αὐτοῖς ὄντα ἔνεστι τεκμαίρεσθαι· βέβλαπται δὲ τὸ φανταστικὸν καὶ τὸ λογιστικόν. μιχθείσης δὲ τῷ αἵματι τῆς ξανθῆς χολῆς καὶ δακνῶδες αὐτὸ ἀποτελεσάσης, οἷον κεντουμένου καὶ νυττομένου ἐξ αὐτῆς ἔνδοθεν τοῦ ἐγκεφάλου καὶ τῶν μηνίγγων, ὀργίλοι καὶ θρασεῖς γίνονται καὶ πλῆκται καὶ ὑβρισταί. ἐφ’ ὅσον γὰρ ἡ χολὴ ἀναμέμικται τῷ αἵματι, ἐπὶ τοσοῦτον παραλλάξει τὰ τερπνὰ καὶ ἐπιτείνει τὰ ἀηδῆ καὶ θυμικά· ὑπεροπτωμένης δὲ ἐπὶ πλέον τῆς ξανθῆς χολῆς καὶ παχυνομένης καὶ οἷον προσπλαττομένης αὐτῷ τῷ σώματι τοῦ ἐγκεφάλου καὶ τῶν μηνίγγων ἰξωδῶς καὶ νυττούσης καὶ διασπώσης, τὰς θηριώδεις παραφροσύνας ἐργάζεται. ἤδη γάρ τινες καὶ τῆς ἰδίας σαρκὸς ἐγεύσαντο καὶ τοὺς οἰκείους ὡς ἐπιβούλους ἐτύπτησαν ἢ ἐτραυμάτισαν ἢ διεχειρίσαντο· ἐγχωρεῖ δὲ καὶ τὸν αὐτὸν ἄνθρωπον ποτὲ μὲν γέλωτι παραλόγῳ κατέχεσθαι, ποτὲ δὲ θυμοῖς καὶ ὀργαῖς. ἐν γὰρ ταῖς ἀσιτίαις καὶ ταῖς δριμυτέραις καὶ ἁλυκωτέραις τροφαῖς καὶ ἐν ταῖς πλείοσι κινήσεσι καὶ ταραχαῖς δριμύτερον ἑαυτοῦ ἀποτελεῖται τὸ αἷμα, ἐν δὲ τῇ ἐναντίᾳ καταστάσει ἠπιώτερον. πολλάκις δὲ καὶ μηδενὸς βοηθήματος προσαχθέντος ταῖς ὀλιγοσιτίαις καὶ ἐπιτηδείαις τροφαῖς ἀναλωθέντος τῷ χρόνῳ τοῦ παρενοχλοῦντος καὶ μένοντος τοῦ ἐγκεφάλου ἀπερίττου διάλειμμα καθαρὸν τῆς ἐκστάσεως γίγνεται. τισὶ δὲ καὶ κατὰ περίοδόν τινα ἐπιπίπτει τὸ πάθος, τισὶ δὲ ἅπαξ τοῦ ἔτους, τισὶ δὲ δεύτερον ἢ πλεονάκις, ἀθροιζομένου κατὰ βραχὺ δηλονότι τοῦ ἐνοχλοῦντος. ἁλίσκονται δὲ

25

5

10

15

20

137,12–15 ἤδη γ. – ὀργαῖς cf. Aret. ib. (ib. 42,12–14) 22 ποδαγρικῶν P a A ante ἀεὶ: ἥτις A 23 τότε] ποτὲ A ω ὅταν P a ω 24 post μανίας: Τίνα δὲ σημεῖα P x ταῦτα post πασχ. P x 25 post αὐτοῖς: καὶ ἄδουσιν καθάπερ οἱ μεθύοντες P x 26 εἰδώλια P S …λεῖα C p M o At τε] δὲ P x P 137,1 αὐτοῖς P x P 2 post ἀκροᾶσθαι: ποτὲ δὲ ξανθοχολικοῦ καὶ δριμαίου τοῦ αἵματος καὶ γίνονται οὗτοι θρασεῖς καὶ ὀργίλοι καὶ τῶν ἰδίων σαρκῶν ἐμφορούμ(ε)ν〈οι〉 P x 2sq. σῴζεται –ὄντα om. P x 2 ὧν om. La 2sq. συνήθων …ὄντων P x P 2 συνήθως P a At 3 τεκμήρασθαι P a 3sq. καὶ τὸ λογ. om. La 6 τῶν om. ω post μηνιγγ.: γίγνεται δὲ ἐπὶ τούτοις τὸ πάθος καὶ κατὰ περιόδους τισί· οἱ τοιοῦτοι δὲ P a 7 ἀναμ. ἡ χολὴ A 8 παραλλάξης P ….σσει M o At …τείνης P 10 αὐτὸν La …ὸ A …τῶν P a At στόματι P x A 12 post τινες: τῶν τοιούτων καμνόντων P x τῶν ἰδίων σαρκῶν, ὡς εἰρήκαμεν, πλειστάκις P x 13 ἐτύπτ. ἢ ἐτραυμ. om. P a A διεχειρίσαντο (…ώσαντο ἢ C p) ἐτύπτησαν (ἢ C p) ἐτραυματ. C p P ω …ρώσαντο M o A 14 γέλωτα ω παραλόγως ω 19 …δείοις χ S ἀναλωθὲν χ P ω τῷ om. ω 20 τὸ παρενοχλοῦν χ ψ ω μένων (…ον A S) χ P At ὁ ἐγκέφαλος ἀπέριττος χ ψ ω 21 δὲ μὲν χ ψ ω 23 δὲ] μὲν La

VI 8 On mania from (the books of) Archigenes and Posidonius | 101

5

10

15

20

25

diseased condition of the head precedes mania, as a diseased condition of the feet is always present in podagra, but then they feel pain, when the material flows towards the parts [scil. the feet]. So, if mania occurs due to blood alone, the following accompanies those who suffer from it: ungovernable laughter attacks them because they often see images in front of their eyes which are worth laughing at and their face is cheerful and they constantly sing: for, sometimes | ringing around the ears accompa- 137 nies (them) because of the rise of vapors which occurs, so that they [scil. the patients] seem to hear flute-players. Their memory is preserved, as is possible to infer from the fact that they sing what they are accustomed to, but their imaginative faculty and their reasoning faculty are damaged. If yellow bile is mixed with the blood and makes it biting, as if the brain and the meninges were being pricked and stabbed from inside because of it [scil. the yellow bile], they [scil. the patients] become inclined to anger and bold and turn into brawlers and insolent men. For, the more bile is mixed with the blood, the more do the pleasures alter and the unpleasant and high-spirited things increase. If the yellow bile is further overheated and becomes thick, and as if it stickily adheres to the body of the brain and the meninges itself and as if it stabs them and tears them apart, it brings about beast-like derangements. Indeed, some even tasted their own flesh and beat or wounded or laid hands on the people in the house as if these were plotting against them: it is possible that one and the same human being is, at one time, seized by unreasonable laughter and, at another time, by passions and anger. For during abstinence from food and through sharper and saltier foods and during greater movements and disturbances, the blood becomes sharper than usual, in the opposite condition (it becomes) milder. And often when no remedy is applied to the eating of only a little food, and when through appropriate food that which causes trouble is eaten up by and by, and when the brain remains without superfluity a period of time occurs which is free from derangement. The affection befalls some (patients) periodically, some once a year, others twice a year or more, when that which causes trouble gathers and manifests itself within a short time. Seized by the affection are: few patients, on the one hand, before

102 | Aetii Amideni Libri medicinales VI 8, p. 137.24–138.21 Olivieri

τῷ πάθει, ὀλίγοι μὲν πρὸ τῆς ἀκμῆς, οἱ πλεῖστοι δὲ ἐν τῇ ἀκμῇ καὶ μετὰ ταύτην, ἄνδρες δὲ μᾶλλον γυναικῶν καὶ τούτων οἱ παθήμασί τισι ψυχικοῖς ἐνοχλούμενοι, οἷον οἱ σκῶπται οἱ φιλογέλωτες ἢ ἀκαιρογέλωτες οἱ δυσπειθεῖς οἱ ὀργίλοι οἱ φροντιστικοὶ οἱ φιλάργυροι, ἤδη δὲ καὶ οἱ πολυπόται καὶ οἱ συνεχῶς ἀπεπτοῦντες καὶ οἱ τὰς συνήθεις ἐκκρίσεις ἐπεσχημένοι· διὰ τοῦτο καὶ γυναῖκες ἐνίοτε μαίνονται, αἷς 138 ἐπίσχηται τὰ καταμήνια. μυρίαι δὲ ἰδέαι μανίας εἰσίν, ἃς ἐκθεῖναι περιττόν. τοῖς μὲν οὖν μέλλουσι περιπίπτειν τῷ πάθει προηγεῖταί τινα προοίμια τῶν προρρηθέντων οἷον γέλως παράλογος οὐχ οὕτως εἰθισμένοις καὶ ὀργίζονται ἐπὶ τῇ τυχούσῃ προφάσει καὶ ἦχοι ὤτων καὶ μαρμαρυγαὶ πρὸ τῶν ὀφθαλμῶν προφαίνονται, ἀγρυπνίαι τε σύντονοι καὶ φροντίδες ἐπάλληλοι καὶ ἀλλόκοτοι, βάρος καὶ παλμὸς τῆς κεφαλῆς. προκόπτοντος δὲ τοῦ χρόνου πάντα ταῦτα ἐπιτείνεται καὶ λυσσωδέστεραι αὐτοῖς αἱ ὀρέξεις γίγνονται καὶ πρὸς τὰ ἀφροδίσια προθυμίαι· διὰ τοῦτο καὶ ὀνειρωγμοὶ συνεχεῖς, ὀφθαλμοί τε κοιλαίνονται μετὰ τοῦ ἀτενῶς ἵστασθαι καὶ ταῦτα παρακολουθεῖ μέχρι τελείας ἐκστάσεως. δεῖ οὖν τὸν ἐπιστήμονα ἰατρὸν ἐπιμελούμενον τοῦ κάμνοντος τούτων προφανέντων ἤ τινων αὐτῶν τὰ δέοντα πρᾶξαι· προσημαίνοντος τοίνυν τοῦ πάθους ἢ καὶ ἤδη ἐνεστηκότος τὴν μὲν δίαιταν λεπτὴν ἁρμόζειν ῥοφηματώδη ὑγρὰν ἄπληκτον εὐκοίλιον, οἷον σεμίδαλιν [θασίφορον θασύγαλα] τρέφουσαν σεμιδαλιθάσιον χυλὸν πτισσάνης ἢ τρόγαλα καὶ ψίχας μετὰ ἀκρατομέλιτος. τοιαύτην οὖν τὴν δίαιταν ἁρμόζειν ἢ οὐδαμῶς ἢ ἥκιστα γεννᾶν αἷμα δυναμένην καὶ οἴνου παντάπασιν ἀπέχειν. τριῶν δὲ οὕτως ἡμερῶν διαιτήσας τὸν ἄνθρωπον τέμνε τῶν ἐν ἀγκῶνι φλεβῶν, προηγουμένως μὲν τὴν ἄνω, εἰ δὲ μὴ φαίνοιτο, τὴν μέσην, εἰ δὲ μηδ’ αὐτὴ τὴν κάτω. μὴ φαινομένων δὲ τούτων τὰς ἐπὶ τῶν σφυρῶν ἐπιζητεῖν, καὶ μάλιστα ἐπὶ γυναικῶν. προτρέπεται γὰρ τῇ ῥοπῇ καὶ τὰ καταμήνια,

25

5

10

15

20

138,8 29–138,2 διὰ τοῦτο – περιττόν | ἀγρυπνίαι τε σύντονοι | βάρος – κεφαλῆς | πρὸς τὰ ἀφροδ. προθυμίαι cf. Aret. ib. (ib. 42,5–7, 43,8, 42,5) 25 μετ’ αὐτὴν P a P x M o ω πάθεσι ω 26 οἱI] ἢ P x om. ψ οἱII] ἢ P x P 26sq. ἢ ἀκαιρογ. om. P a 27  οἱI –οἱIV] ἢ … ἢ … ἢ … ἢ P x P 28 ante πολυπ.: φιλοπόται καὶ οἱ P οἱII om. P a ἀπαιτοῦντες C p ἀποπτύοντες P 29 ἐπισχημ. La C p A P S …σχόμενοι M o At 138,1 ἐπίσχεται ψ …ονται P a …σχεῖται P x …έσχηται ω 3 προρηθ. χ ω 4 ….ζεται ω 5 φαίνονται P x A m. 1a S 6 ἀλλόκοτον P a M o 7 ταῦτα πάντα P a ante ἐπιτ.: ἐπιγίγνεται καὶ P x λυσωδέστεροι P x M o λυσσηδ. …οι A δυσωδέστεραι La ω αὐτοῖς om. La 8 πρόθυμοι ω 10 post ἐκστ.: Θεραπεία ἐκ τοῦ Ἀρχιγένους καὶ Ποσειδωνίου μανίας. χρὴ τοίνυν τοιγαροῦν ἐπὶ τῶν τοιούτων νοσημάτων σκληροτάτων καὶ 〈ὀ〉δυνηροτάων καὶ πονηρευόντων ὄντων καὶ P x δεῖ οὖν om. P x 10sq. τὸν –κάμνοντος] τὸν ἰατρὸν ἐπιστήμονα ὄντα ἀσχολούμενον καὶ ἐπιμελούμενον P x 12 τινα La χ ω 13 ἁρμόζει La P x At m. 1a S 13sq. (ἐκ A) ῥοφημάτων διύγρων P x A 14–16 οἷον –ἁρμόζειν om. χ ψ ω 14 θασόφορον θασόγαλα P a canc. sepsi 15 τρωγάλια ἢII om. C p A ω 17 ante ἀπέχειν: ἁρμόζει P x legendum? 16 εὐκρατομέλιτος P a ἢI] καὶ α, exc. φ ἀπέχεσθαι δεῖ P a 17sq. τρεῖς …ἡμέρας P a 18 τὴν …. φλέβα P x A 19sq. εἰ δὲ μηδ’ (μὴ P x …δὲ C p) αὐτὴ (…ήν P a P x M o) τὴν κάτω om. P ω

VI 8 On mania from (the books of) Archigenes and Posidonius | 103

5

10

15

20

25

the prime of life, most patients, on the other, in the prime of life and afterwards; men rather than women; and of those those who are troubled by psychic affections, such as scoffers, people who love to laugh, those who laugh at the wrong moments, the disobedient, those inclined to anger, those who overthink things, those who are fond of money, but also the hard drinking people and those who constantly suffer from indigestion and those who hold back the accustomed excretions: therefore, also women | whose menses are held back sometimes suffer from mania. There are 138 numberless forms of mania, which it is superfluous to set out. Some preludes of what was mentioned previously precede those who are about to fall into the affection, such as unreasonable laughter that they are not used to in this way, and they become angry because of a trifling cause, and there is ringing in their ears and sparks appear in front of their eyes, and there is intense sleeplessness, and continuous and strange anxiety, heaviness and palpitation of the head. When time passes, all this intensifies and their desires become more raging as does their willingness to engage in sexual intercourse: therefore constant effusions (of semen) during sleep (occur), and the eyes become hollow together with being set in a stare and this accompanies (them) up to complete derangement. It is, therefore, necessary that the wise physician takes care of the patient as soon as these (symptoms), or some of these (symptoms), appear and that he undertakes what needs to be done. So, if the affection is indicated or already present, it is necessary to conduct a thinning regimen which is gruel-like, moist, not irritating, and which eases the gastro-intestinal tract, such as wheaten flour that is nourishing, semidalithasios, the juice of barley-gruel or trogala and crumbs with unmixed honey. One should set in order such a regimen as is capable of producing no blood at all or the least blood possible, and one should completely stay away from wine. After having administered this regimen to the human being for three days you need to cut from amongst the veins in the elbow, preferably the upper vein but, in case it is not visible, the middle but, in case this is not visible either, the lower. If they are (all) not visible, one should search for those [scil. veins] near the ankles, and especially so in women. For also the menses are brought about by the

104 | Aetii Amideni Libri medicinales VI 8, p. 138.22–139.22 Olivieri

εἰ δὲ μηδ’ αὗται φαίνοιντο, τὰς ἀπ’ ἄκρων χειρῶν ἢ ποδῶν. σπουδαστέον γάρ ἐστι πρότερον ἀπὸ φλεβὸς γενναίαν κένωσιν γενέσθαι καὶ οὕτως τῶν πεπονθότων μερῶν τὴν ἐπιμέλειαν ποιεῖσθαι. τέμνοντα δὲ τὴν φλέβα πρὸς δύναμιν τὴν κένωσιν ποιεῖσθαι χρή· ἀποσβεννυμένου γὰρ τοῦ φλογώδους, παραχρῆμα μὲν ἐπιστατικοὶ γίγνονται, ἅμα δὲ καὶ χώρα γίγνεται τοῖς ἄλλοις βοηθήμασιν. ἐπειδὴ δέ τινες ἐν μὲν τῇ πρώτῃ ἀφαιρέσει γενναίως φέρουσι τὴν κένωσιν, ἐν δὲ ταῖς μετὰ ταῦτα ἐπαφαιρέσεσιν εἰώθασι λειποθυμίαις ἁλίσκεσθαι, προσήκει τούτους ἐν 139 τῇ πρώτῃ ἀφαιρέσει κενοῦν ὅσον ἡ χρεία ἀπαιτεῖ· συγκενοῦνται γὰρ οὕτως πολὺ τοῦ φυσώδους καὶ ἀτμώδους πνεύματος. δεῖ τοίνυν συνεχῶς ἅπτεσθαι τῶν σφυγμῶν ἐν τῷ ῥεῖν τὸ αἷμα καὶ εἰ καταπίπτοιεν, τότε ταμιεύεσθαι εἰς ἐπαφαιρέσεις. πολλάκις γὰρ ἀνακτησάμενοι τὴν δύναμιν τῇ δευτέρᾳ τῶν ἡμερῶν τὴν ἐπαφαίρεσιν ἐποιησάμεθα, ἔσθ’ ὅτε δὲ καὶ τῇ τρίτῃ φυλάξαντες τὴν διαίρεσιν ἁλῶν ἐπιθέσει. ἐμβρέχειν δὲ τὴν κεφαλὴν χρὴ ῥοδίνῳ σὺν ὄξει ἢ χυλῷ πολυγόνου ἢ κισσοῦ ἢ οἰνανθίνῳ ἐλαίῳ ἢ μηλίνῳ. ῥυπαρὸν δ’ ἔριον δευθὲν τῷ ἐλαίῳ ἐπιτιθέσθω καὶ συνεχέστερον νεαροποιεῖσθαι τῷ βρέγματι. παντὶ δὲ τρόπῳ μετὰ τὴν κένωσιν εἰς ἑσπέραν ὕπνον μηχανητέον· κενωθέντος γὰρ τοῦ αἵματος εἰ ἐπιγένοιτο ἀγρυπνία, δριμυτέρους καὶ ἀγριωτέρους αὐτοὺς ἀποτελεῖ. διὸ θαρροῦντες προσενέγκωμεν τὸ διὰ τῶν κωδιῶν ὑπνωτικὸν φάρμακον σὺν χυλῷ πτισσάνης ἢ ἄλικος ἢ σὺν τῷ πινομένῳ ὕδατι. ἀσμενὲς γὰρ εἰ καὶ μετὰ ταῦτα γενήσεται ὕπνος· οἱ γὰρ πλεῖστοι αὐτῶν περιφρονοῦσι παντὸς ὑπνωτικοῦ. διὸ κἂν τὴν πρώτην λαβόντες ὑπνώσωσι, διαλείποντες ἡμέραν μίαν πάλιν διδόναι τὸ διὰ κωδιῶν ὅσον κοχλιάριον. εἴωθε γὰρ καὶ μόνη μετὰ τὴν φλεβοτομίαν τελείαν ἀποκατάστασιν τῷ πάθει διδόναι μετὰ τῆς προσηκούσης διαίτης· παραφυλάττεσθαι μέντοι ἐφεξῆς αὐτὴν προσφέρειν· ναρκοῖ γὰρ τὴν αἴσθησιν. σπουδαστέον δὲ καὶ τὴν κοιλίαν εὔλυτον ποιεῖν διά τε τροφῶν καὶ κλυστήρων· τούτων προγεγενημένων ἄρχεσθαι χρὴ τῶν τοπικῶν βοηθημάτων ἐνθένδε· αἷμα προσήκει ἀφαιρεῖν ἐκ τῶν ἐν με-

25

5

10

15

20

139,6sq. ἐμβρέχειν – ὄξει cf. Paul. III 14 (I 158,15–16) 22 δὲ om. C p A At αὐτὸ φαίνοιτο La ἐπ’ C p ψ ω 23 φλεβοτομίας ω ποιεῖσθαι P x A 24 οὕτω (ταύτη A) χ P ω τέμνοντες (….τας P) P x ω 24–141,4 τέμνοντα –χρήσεως om. M o 26 ante μὲν: δὲ La μὲν om. P a 28–139,1 γενναίως –ἀφαιρέσει om. At 139,1 συγκενοῦται P a P x A ω 2 πνεύμ.] περιττώματος ω 3 …πίπτειεν P x A 4 ἐπαφαίρεσιν P ω 5 ἀφαίρεσιν P x A ποιησόμεθα (…ώμεθα S) At 6  τὴν τρίτην La P x ω 7 χυλὸν P x ω 7sq. ἢ κίσσου om. χ ψ ω 8 post ἔριον: ἔλαιον (…ίω At) χ P ω S τῷ ἐλαίῳ om. ω 9 τῷ βρέγματι (τὸ βρέγμα S) post ἐπιτιθέσθω χ ψ ω 12 …νέγκομεν A S τὸ] τῶ P x A 13 ὑπνωτικὸν om. La ὑπ. …κῶ …κω P x A φάρ…ον ὑπν. …ὸν ω ante σὺνI: καὶ προεγράφη ἐν τῶ περὶ φρενίτιδος λόγω P x 14 εἰ] ἂν εἰ P a P εἲ εἰ P x ἂν (om. At) εἴη ω γίνεται P x A γένοιτο At γένηται C p P S 16 …νώσουσι S …λιπόντες Cp ….ας A τὸ] τῆς C p A S τ~ P a τοῖς At 16sq. τὸ –κωδιῶν] ἐκ τῆς αὐτῆς ἀντιδότου P x 17 post κοχλ.: ἕν P x A 20 δὲ om. A ω κοίλην P x ω 21 …στηρίων χ ψ ω post ἄρχ.: δὲ P x At 22 ἔνθεν La καντεῦθεν δὲ P x ante αἷμα: γὰρ La tantum

VI 8 On mania from (the books of) Archigenes and Posidonius | 105

5

10

15

20

25

30

flow of blood, but if they are not visible either, one should cut (the veins) in the hands or the feet. For, one must seek to ensure that, at first, the excellent evacuation comes from the veins and that in this way the care for the affected parts is achieved. It is necessary to undertake the evacuation according to the strength (of the patient) when cutting the vein. For when that which is hot like a flame is quenched, the patients immediately regain control of themselves, on the one hand, and, on the other, at the same time room for other remedies develops. Since some excellently endure the evacuation in the first removal (of blood), but are usually caught by fainting in further removals thereafter, it is appropriate | to empty in the first removal 139 as much as is necessary: for in this way they are also emptied of flatulent and vaporous pneuma to a great extent. It is necessary to continuously feel the pulse during the flowing of blood and if it falls, one should distribute (the evacuations) over further removals. For we often undertook a further removal after having restored the strength (of the patient) on the second day, sometimes also on the third day while guarding the incision through the application of salts. It is necessary to treat the head with embrocations made out of rose oil mixed with vinegar or made out of the juice of knotgrass or of ivy or made out of oil from wild-vine flower or made out of quince. Greasy wool drenched with oil should be applied and one should continuously renew it for the front part of the head. One needs to provide for sleep by all means towards the evening after the evacuation: for, if sleeplessness supervenes after the blood has been emptied, it makes them [scil. the patients] sharper and wilder. Therefore, let us be confident and administer the hypnotic remedy made of poppyhead together with the juice of barley-gruel or of rice-wheat or together with water that needs to be drunk. For it is also good when afterwards sleep occurs: for, most of the patients defy all hypnotics. Therefore, even if they fall asleep after having taken the first dose, one should apply the remedy made of poppyhead again, as much as fits on a spoon, leaving an interval of one day. For usually even this alone gives complete recovery to the affection after phlebotomy, together with an appropriate regimen. One should be careful about administering it continuously, for it numbs sense-perception. One must seek also to make the stomach relaxed, both through food and through enemata: when these are fulfilled, it is necessary to begin with (the application of) local remedies from that time. It is appropriate to remove blood from

106 | Aetii Amideni Libri medicinales VI 8, p. 139.23–140.19 Olivieri

τώπῳ κυρτουμένων φλεβῶν τῆς μεσαιτάτης, φλεβοτόμῳ αὐτὴν διαιροῦντες οὐκ ἐπικρουστικῷ, ὥς τινες ποιοῦσι, διὰ τὰς ἐπιγιγνομένας πολλάκις μεγίστας φλεγμονὰς τοῦ περικρανίου ὑμένος τρωθέντος. ἀφαιρεῖν δὲ ὡς μίαν λίτραν αἵματος· μετὰ δὲ τὴν κένωσιν ταύτην ἐπὶ τῶν χολερικώτερον ἐχόντων τὸ αἷμα, διαστήσαντα ἡμέρας πέντε, διδόναι τὴν διὰ ἀλόης πικρὰν κοχλιαρίου μεγάλου πλῆθος σὺν μελικράτῳ, εἶτα καὶ διὰ ῥινῶν καθαίρειν τὴν κεφαλήν, σεύτλου ῥιζῶν χυλὸν ἐγχέοντα 140 ἢ ἐλατήριον ἢ χάλκανθον σὺν γάλακτι καὶ πταρμικὸν προσφέρειν δι’ ἐλλεβόρου λευκοῦ καὶ στρουθίου καὶ ἀποφλεγματίζειν διά τε μαστίχης καὶ σταφίδος ἀγρίας διά τε ἀναγαργαρισμάτων δι’ ὀξυμέλιτος γιγνομένων, ἐν ᾧ ἕψηται γλήχων ὕσσωπον. ὑποσυρέσθω δ’ ἡ κοιλία κλύσμασι δριμέσι τοῖς διὰ κενταυρίου καθαρτηρίοις καὶ τοῖς διὰ γεντιανῆς· καὶ αὐτὴ δὲ καθ’ ἑαυτὴν ἡ γεντιανὴ ῥίζα χρησίμη προποτιζομένη δραχμῆς μιᾶς ὁλκῆς σὺν μελικράτῳ· δίδοται δὲ καὶ ἀριστολοχία ὡσαύτως. μάλιστα δ’ αὐτοὺς ὠφελεῖ ἱππομαράθου ῥίζα καὶ τὸ σπέρμα πινόμενον σὺν ὕδατι καθ’ ἡμέραν καὶ βρυωνίας ῥίζης < α̅ καὶ βδέλλας δὲ μετὰ ταῦτα κολλητέον τῇ κεφαλῇ πάσῃ κατὰ κύκλον καὶ μάλιστα τῷ βρέγματι. ἐπὶ δὲ τῶν γυναικῶν σπουδαστέον τὰ καταμήνια κινεῖν, εἶτα ἀναλαβόντα τὴν δύναμιν ἐπὶ ἡμέρας ζʹ πρόσαγε τὴν Γαληνοῦ ἱεράν, ἥτις μάλιστα κεφαλὴν κενοῖ τῷ πλήθει τῆς στοιχάδος· δίδου δὲ < δʹ μετὰ μελικράτου· ἔπειτα τὰ ἔρρινα πάλιν προσάγειν. παρακμάζοντος δὲ τοῦ πάθους ἐπὶ λουτρὸν ἄγειν· τριμμάτιον δ’ αὐτοῖς ἐν τῷ λουτρῷ ἁρμόδιον τοῦτο· ἴρεως Ἰλλυρικῆς λίθου Ἀσίου μάννης ἀφρονίτρων λευκῶν κισσήρεως κηρύκων κεκαυμένων σχοίνου ἄνθους σελίνου ἑλενίου κασσίας ῥόδων ξηρῶν ἀνὰ Γ α̅, κόψας σήσας χρῶ ἐν τῷ πρώτῳ οἴκῳ τοῦ βαλανείου ἐπιπάττων τῷ βρέγματι ὅσον ἐξαρκεῖ, καὶ ἐπιρραίνων ὕδατος 26–28 μετὰ δὲ τὴν κένωσιν – πικράν cf. Paul. ib. (ib. 16) 17–19) 8sq. μάλιστα – ῥίζης < α̅ Or.a VIII 7 (249,28–30)

25

5

10

15

140,8–10 μάλιστα – πάσῃ Paul. ib. (ib.

23 μεσωτάτης C p …οτάτης P x A 24 …κρουστίω α exc. La 26 δὲII om. At m. 1a S 27 χολερικωτέρων La P x S χορητικωτέρων At χολωδέστερον P a …στήσαντας P …ες P x ω 29 χυλὸς La (τοῦ P x) χυλοῦ C p A om. S ἐγχυόμενος La ..χέοντες ω …ας P …ος P a 140,1 ἢI] καὶ P x om. ω post ἐλατ.: σὺν γάλακτι P x ψ σ. γαλ.] ὁμοίως P x …μικῶν P x …μοὺς P 3 ἀσταφ. P x P ….ρίσματος ω 3sq. γεγενημένων P x om. A 4 ἥψηται C p P x P m. 2a S ἑψῆται P a …ήτε A post κοιλία: καὶ La 4sq. κλ. δριμ. om. C p P ω 5 καὶ] ἢ P om. P a ω 6 ἑαυτῇ P x αὑτὴν A χρήσιμος P x A ω τοῖς ποτιζομένοις P a 6sq. < μίαν P a Γο C p 7 ὁλκὴ χ ψ ω 8 μᾶλλον P x A ….ράθρου P a P At τῶ σπέρματι P x σπέρματι A 9 post καθ’: ἑκάστην At ῥίζα La δὲ om. P ω 10 κατὰ κύκλ.] κύκλω P x ω 11sq. …βόντες C p …βὼν A P …βόντος P x S …λαμβάνοντος At 13 κεφ. om. ω στυχάδος ψ S δὲ om. ψ post δʹ: ἢ τὸ πολὺ τὸ κατὰ τὴν δύναμιν καὶ ἔλαττον τούτων ὅσον < δʹ P x 14 τὰ om. P a ψ 15 post ἄγειν: σπασμοὶ ω ἐπὶ λουτρὸν P x A 16  ἀφο(ἀφρο)νίτρου P a P x P λευκοῦ P a P x P 17 σχίνου P a At ἄνθος P x ω σελίνου om. P a χ A ἐλεν. om. P ω 18 Γ] δρμ ´ P x α̅] βʹ P ante σησ.: καὶ P x P 19 ἐπὶ πάντων P a ἐπιπλάττων ω ἐπ(ε)ιραίνειν P x A 19sq. ὕδατι χλιαρῶ P x

VI 8 On mania from (the books of) Archigenes and Posidonius | 107

5

10

15

20

25

the bulged veins in the forehead, namely from that in the very middle, dividing it with a phlebotomon, not with an epikroustikon, as some do, because greatest inflammations of the injured pericranial membrane often supervene. One should remove as much as one litra of blood. After this evacuation one should, in those who have rather bilious blood, while leaving an interval of five days, apply the bitter remedy made of aloe in the amount of a full spoon together with honey-water; afterwards one also needs to purge the head through the nose by pouring into it the juice of the roots of beet | or elaterion or copper sulphate together with milk and one needs to 140 administer sternutatories made of white hellebore and soapwort and one should purge away phlegm both through mastic and stavesacre and through gargles made of oxymel in which pennyroyal and hyssop are cooked. The stomach has to be purged with sharp enemata and with purging remedies made of centaury and those made of gentian; and the root of gentian alone by itself is useful taken as a drink of one drachma together with honey-water; birthwort is applied in the same way. The root of horse-fennel is especially useful for them [scil. the patients] as is its seed when drunk with water every day and as is one drachma of the root of bryony, and one needs to apply leeches to the whole head afterwards in a circle, and especially to the front part of the head. In women one has to seek to set the menses in motion; afterwards, after having reestablished the strength (of the patient) for up to seven days, you should administer the holy remedy of Galen which especially empties the head through a great quantity of Spanish lavender; you should administer four drachmae with honey-water; then, one should again administer sternutatories. When the affection abates, one needs to bring (the patient) to the bath: as trimmation, the following is suitable for them in the bath: of Illyrian iris, of Asian stone, of manna, of white native soda, of pumice stone, of burned trumpet-shells, of the flower of rush, of celery, of calamint, of cassia, of dry roses use up to one uncia, after having pounded and sifted them, in the first room of the bath, while smearing on the front part of the head as much as suffices and sprinkling on it a bit of lukewarm water, and while staying in this room for a sufficient amount of time, so that the property of the

108 | Aetii Amideni Libri medicinales VI 8–9, p. 140.20–141.19 Olivieri

χλιαροῦ καὶ ἐφ’ ἱκανὸν χρόνον διατρίβων ἐν τῷ οἴκῳ, ὥστε διαδοθῆναι τὴν δύναμιν τοῦ φαρμάκου μέχρι τῶν ἐν βάθει. εἶτα σμηξάμενος ἠρέμα τὴν κεφαλὴν καὶ ἀποπλύνων καὶ λουσάμενος μὴ βρέχων τὴν κεφαλὴν ἐν τῷ θερμῷ ἐν τῇ ἐμβάσει, ἐξίτω καὶ βρεχέτω τῷ ψυχρῷ δεύτερον καὶ τρίτον. εἰ δὲ κατὰ θερμὸν ἔχοιεν τὴν κεφαλὴν πάνυ, καὶ πλεονάκις βάπτειν τῷ ψυχρῷ· μετὰ δὲ ταῦτα τῷ διὰ σινάπεως καὶ ἰσχάδων φοινιγμῷ τόνον διδόναι τῇ κεφαλῇ καὶ ἐκ διαστημάτων 141 τινῶν ἀποφλεγματίζειν, καὶ τοῖς ἐρρίνοις κεχρῆσθαι. δίαιταν δὲ θετέον λεπτοτέραν εὐδιοίκητον εὐκοίλιον ἄφυσον κατακεραστικήν, οἴνου δὲ σπάνιος ἡ χρῆσις ἐπὶ τούτων· εἰ δ’ ἐγκατάλειμμα εἴη τῆς διαθέσεως ἐπὶ τὸν λευκὸν ἐλλέβορον ἐλθέ· ὁ δὲ τρόπος τῆς χρήσεως προείρηται ἐν τῷ περὶ καθαρτηρίων λόγῳ. ἀπέχεσθαι δὲ τοῦ λοιποῦ παραινεῖν πάντων τῶν χολὴν γεννώντων ἐδεσμάτων τε καὶ πομάτων καὶ ἐπιτηδευμάτων. φλεβοτομείσθωσαν δὲ καθ’ ἕκαστον ἔαρ προφυλακῆς χάριν, ἔπειτα καὶ καθαιρέσθωσαν καὶ μάλιστα εἰ πλεονάζοι μᾶλλον ἡ χολή· ταῖς δὲ γυναιξὶ καὶ καταμήνια παρασκευάζειν κατὰ τὸν εἰωθότα καιρὸν ἀπαραποδίστως κενοῦσθαι καὶ τοῖς ἄλλοις τὰς συνήθεις ἐκκρίσεις. θ Περὶ μελαγχολίας ἐκ τῶν Γαληνοῦ καὶ Ῥούφου καὶ Ποσειδωνίου. ὥσπερ ἐν τοῖς φαινομένοις μέρεσι τοῦ σώματος ἐνίοτε μὲν ἅπασιν ἡ αὐτὴ φαίνεται κρᾶσις, ὡς ἐν καχέκταις τε καὶ κατὰ τὸν καλούμενον ἐλέφαντα καὶ τοὺς ὑδέρους, ἐνίοτε δ’ ἕν τι μόριον ἤτοι πικρόχολον ἢ μελαγχολικὸν ἢ φλεγματικὸν ὑποδεχόμενον χυμὸν αὐτὸ μόνον ἐξαλλάττεται τὴν κρᾶσιν, οὕτως ἐγχωρεῖ καὶ τὸν ἐγκέφαλον ἐνίοτε μὲν παντὸς τοῦ κατὰ τὰς φλέβας αἵματος μελαγχολικοῦ γεναμένου τῷ κοινῷ λόγῳ τῆς βλάβης καὶ τὸν ἐγκέφαλον βλαβῆναι, καθ’ ἕτερον δὲ τρόπον καὶ καιρὸν ἀπαθοῦς διαμένοντος τοῦ καθ’ ὅλον τὸν ἄνθρωπον

20

25

5

10

15

141,5 ἐν τῷ περὶ καθαρτηρίων λόγῳ cf. III 121 etc. (I 309,10sqq.) 11 – p. 152,12 Περὶ μελαγχολίας–ὑπνωτικῶν (Gal.) de melancholia ex Gal. Ruf. Posidonio etc. XIX, 699–720 14 ἐνίοτε δ’ ἕν τι μόριον κτλ. cf. Paul. III 14 (ib. 156,9sqq.) 20 κοχλιαροῦ P a P x P ἐνδιατρίβων P a ἐνδιατρίβων C p διατρίβειν A ἐν om. P a C p 22 ἀποπλύνας P a 23 ἐνI om. P a C p ψ ἐν τῆ ἐμβ. om. P a ἐκβ. At ἐξείτω A S ἐξείτω C p τῶ ψυχ.] τὸ ψυχρωδέστερον La 24 post δεύτ.: ἢ P a 25 τῷII] τὸ P a A ω …πεος La …ήπεος P ω 26 post φοινιγ.: χρηστέον ὥστε P a ἐκ supra scr. m. 1a C p om. La 141,1 post κεχρ.: καὶ ἀποφλεγματίζειν διὰ τῆς μαστίχης καὶ στάφιδος ἀγρίας· δίδου δὲ καὶ τὸ ἀφέψημα τῆς στοιχάδος πίνειν καὶ τὴν γεντιανήν P x 3 σπανία A …ίως La P x P ω 4 ἐλθετέον (ἰτέον P) C p P x A ω 6sq. καὶ (om. P a) ἐπιτηδ. om. P At m. 1a S 7 …τομήτωσαν A …τομείσθω P 8 …ρέτωσαν A …έσθω P …ζει P x M o ψ S post χολή: τὸ εἰρημένον βοήθημα ἐν τοῖς συνεχέσι πυρετοῖς τε καὶ καυσώδεσιν ἐν τῶ πρὸ τούτου βιβλίω κτλ. P x 9 ante καταμ.: τὰ χ ψ S 10 post ἐκκρισ.: Ἀπόζεμα εἰς μελαγχολίαν ὅταν οὐ φύσει ὑπάρχ〈η〉 μέλαινα χολὴ – οἶνον δὲ λεπτὸν καὶ λευκὸν καὶ ὀλίγον P x 11 tit. om. M o καὶ Ποσειδωνίου post Γαληνοῦ P x A om. S post tit.: τὸ πάθος τὸ καλούμενον μελαγχολία παραφροσύνη τίς ἐστιν – οὓς καὶ ἐνθεαστικοὺς ἰδίως ὀνομάζουσιν P x 12 μέλεσι χ ψ S 13sq. κατὰ (om. La χ A) τὸν – ἐλεφ.] τῶ καλουμένω ἐλέφαντι ω (Gal.) 14 τοῖς ὑδέροις P x ω (Gal.) 17 γινομ. P a γενομ. P x M o ψ ω 19 τρόπον καὶ om. α (Gal.), add. tant. La

VI 8 On mania from (the books of) Archigenes and Posidonius | 109

remedy is passed on to those in the depths. And afterwards, after having gently rinsed off the head, also wash it and, while the patient is in the bath, do not drench the head in the warm house in the bathing tub; the patient should leave the bath and the physician should drench (his head) with cold (water) two or three times. If they 5 have a very warm head, one often has to dip it in cold (water); afterwards one has to provide the head with tension by means of an irritation of the skin through mustard and dried figs, and at intervals | one needs to purge away phlegm and use sternutato- 141 ries. One should establish a regimen which is very thinning, easy to digest, which eases the gastro-intestinal tract, causes no flatulence, and restores a good mixture, 10 but the use of wine should be rare in those (patients). If there is a remnant of the condition, you must turn to white hellebore: the way of usage has been described previously in the discussion of purgatives. One should give the advice to keep away from all foods and drinks and habits which produce bile, also in the future. They should be phlebotomized each spring for the sake of prophylaxis; afterwards they 15 also should be purged, and especially so if bile is rather prevailing. In women one needs to make sure that the menses are emptied at the usual point in time without any interference, and in the other patients (one has to take care) that the accustomed excretions (are emptied).

20

VI 9 On melancholia from (the books of) Galen and Rufus and Posidonius

Just as, sometimes, the same mixture appears in all visible parts of the body ‒ as in those suffering from kachexia and in the so-called elephantiasis and in hyderos ‒ and just as, sometimes, only one part (of the body), by collecting either a picrocholic or a melancholic or a phlegmatic humor, is altered in its mixture, so it is possible that 25 also the brain sometimes, when all of the blood in the veins becomes melancholic, is damaged for the same reason as the other parts of the body are damaged, while, in

110 | Aetii Amideni Libri medicinales VI 9, p. 141.20–142.20 Olivieri

αἵματος ἀλλοιωθῆναι τὸ κατὰ μόνον τὸν ἐγκέφαλον. καὶ συμβαίνει τοῦτο διττῶς, ἢ ῥυέντος εἰς αὐτὸν ἑτέρωθεν, ἢ γεννηθέντος ἐν τῷ τόπῳ τοῦ μελαγχολικοῦ χυμοῦ. γεννᾶται δὲ ὑπὸ θερμασίας πολλῆς ἐγχωρίου κατοπτώσης ἤτοι τὴν ξανθὴν χολὴν ἢ τὸ παχύτερόν τε καὶ μελάντερον αἷμα. ὡς ἐπίπαν δὲ τὰ κατὰ τὰ ὑποχόνδρια μέρη πρωτοπαθοῦντα εἰς συμπάθειαν ἄγει τὴν κεφαλὴν καὶ τὴν παραφροσύνην ἐργάζεται, ἤτοι αὐτῆς τῆς χολῆς καταλαβούσης τὸν ἐγκέφαλον, ἤ τινος ἀναθυμιάσεως ἀτμοῦ μελαγχολικοῦ καθάπερ ἐν τῷ νοσήματι τῷ φυσώδει καὶ ἐν τῷ ὑποχονδριακῷ προσαγορευομένῳ. οὐδὲν γὰρ παρεμ142 ποδὼν γίγνεται τῷ λόγῳ ἑτέρωθεν ἐξ ἄλλου τε μορίου εἶναι τὴν ἀρχὴν καὶ γένεσιν τοῦ πάθους. ῥᾳδίως γὰρ τὸ στόμα τῆς γαστρὸς ὁτιοῦν πάσχον εἰς συμπάθειαν ἄγει τὸν ἐγκέφαλον τῇ συγγενείᾳ διὰ τῶν καθηκόντων εἰς αὐτὸν ἄνωθεν μεγίστων δύο νεύρων· εἰς συμπάθειαν δὲ ἄγει καὶ τὴν καρδίαν τῇ γειτνιάσει, ὁμοίως δὲ καὶ τὸ διάφραγμα, ᾧ καὶ συμπέφυκε. κοινωνία δ’ ἐστὶ τῷ στομάχῳ καὶ πρὸς τὸν νωτιαῖον, καθ’ ὃ μέρος καὶ σύγκειται καὶ συνδέδεται τοῖς τοῦ τραχήλου σπονδύλοις. ἀρχὴ τοίνυν τῆς τοιαύτης μελαγχολίας ὡς ἐπίπαν ἐξ ἀπεψιῶν γίγνεται· φῦσαι γὰρ αὐτοῖς ἐπιγίγνονται πολλαὶ καὶ ἐπὶ τῷ τυχόντι σιτίῳ μετέωροι καὶ περὶ τὰ ὑποχόνδρια ἐπὶ πολὺ διατρίβουσιν, ἐρυγαί τε ὀξώδεις καὶ βρομώδεις καὶ οἷον ἰχθυώδεις αὐτοῖς ἐπιγίγνονται, μηδενὸς τοιούτου ἐδηδεσμένου· ξηραὶ ὡς ἐπίπαν αὐτοῖς αἱ κοιλίαι, ὕπνοι μικροὶ διεσπασμένοι, ἐνύπνια ταραχώδη καὶ ἀλλόκοτα, παλμοὶ ἄλλοτε ἀλλαχοῦ ἄλλοι τοῦ σώματος, ἴλιγγοι τῆς κεφαλῆς καὶ πνευμάτων ἦχοι κατὰ τὰ ὦτα. δοκεῖ δὲ τοῖς μὲν αὐτῶν μεστὴ καὶ βαρεῖα εἶναι ἡ κεφαλή, τοῖς δὲ κενὴ ἢ κούφη, τοῖς δὲ ξηρά. ὁ δέ τις οὐδὲ κεφαλὴν ἔχειν τὸ παράπαν ᾤετο, πρὸς ὃν ἐξευρεῖν ὁ Φιλότιμος λέγεται πρὸς τῇ ἄλλῃ θεραπείᾳ τὸν πῖλον τὸν μολύβδινον, ὑφ’ οὗ βαρυνόμενος συνίει τῆς κεφαλῆς. γίγνονται δὲ οἱ πολλοὶ τῶν μελαγχολικῶν καὶ ἀκόλαστοι πρὸς ἀφροδίσια, γίγνονται καὶ τὴν γνώμην ἐπίλυποι καὶ

20

25

5

10

15

20

142,8–11 ἀρχὴ – βρομώδεις cf. Paul. ib. (ib. 27–32) Aret. III 5 (41,1–2) 13 φῦσαι – ἐπιγίγνονται | ἐρυγαί | ξηραὶ – κοιλίαι | ἐνύπνια – ἀλλόκοτα Aret. ib. (39,15; 40,29, 30,16–17, 18) 20 τὸ] τοῦ P x αὐτὸ At συμβῆναι P a 21 ἑτέρωθ P a S ..θι P x At 23 …πτούσης P x A …σπώσης At τε om. P x A 24 τὰI om. P x A At 26 ….λαμβανούσης ω (Gal.) 27 ἀτμοῦ –τῷII om. La 27sq. φυσώδους La 28 ἐν τῷ om. α (Gal.), exc. La 28–142,1 …εμποδὸν C p P x A προσεμποδὼν P 142,1 ante ἐξ: καὶ P a χ A ω (Gal.) ἢ P τε om. α (Gal.), exc. La 1sq. μορίου –γὰρ om. La 2 ῥᾳδίως –γαστρὸς om. A 5 δὲI om. P x A 6 ᾧ] ὃ La ω 7 ἐγκεῖται α (Gal.), exc. La οὐ δέδεται La 10 σιτίῳ om. ω …τρίβουσαι P a C p M o ω (Gal.) 11 ante ὀξ.: αὐτοῖς P ω καὶ βρομ. (om. La) – αὐτοῖς (…ὶ La) om. P ω 13 ἀλλοκώτατα Gal. 14 …χοῦ om. P a C p M o ω (Gal.) ἄλλη C p M o …η corr. …οι P a ἀλλ’ ἢ P x ὅλου A om. P 14sq. πνεύματος La 16 κενὴ καὶ κούφη P x ψ κούφη ἢ (ἡ) κενὴ ω (Gal.) ὁ] ἤδη Gal. 17 φυλότ. χ 18 ante τὸνI: καὶ P x A 19 συνείη P x …νήει A …νίησι P 19sq. οἱ (om. La) πολλοὶ ….ικῶν (….χόλων P x A) καὶ (κ. om. La) – γίγνονται (sq. δὲ P a) om. C p ω 20 γίγνονται καὶ om. Gal. ..ληπτοι P ω

VI 9 On melancholia from (the books of) Galen and Rufus and Posidonius | 111

5

10

15

20

25

another way and time, (it is possible that), when the blood in the whole human remains unaffected, only the blood in the brain is altered. And this happens in two ways, either when the melancholic humor flows to it [scil. the brain] from elsewhere or when it is produced in this area [scil. the brain]. It is produced through a great deal of local heat which overheats either the yellow bile or both the thicker and darker blood. In most cases, the parts around the hypochondria being primarily affected coaffect the head and cause derangement, either when the bile itself befalls the brain or when melancholic vapor rises to it, as in the flatulent and the so-called hypochondriac disease. For nothing | conflicts with the theory that the beginning and origin of 142 an affection come from elsewhere, that is from another part (of the body). For the orifice of the stomach, when suffering something, easily co-affects the brain because of their kinship through the two greatest nerves coming down to it [scil. the stomach] from above. It [scil. the orifice of the stomach] also co-affects the heart because of proximity, in like manner also the diaphragm, which it is united with. There is an association of the stomach also with the spinal cord at the part where it lies together and is bound together with the vertebrae of the neck. The beginning of such melancholia in most cases happens from indigestion. For much flatulence supervenes upon them [scil. the patients] and because of any food (which they ingest) they are inflated and they rub the region around their hypochondria very hard and acid and foulsmelling and fish-smelling belching supervenes upon them, even if nothing suchlike has been eaten. Their bowels are in most cases dry, sleep is little and disturbed, dreams are troubled and strange, there is palpitation at different times, at different places, in different ways in the body, there are iliggoi in the head and ringing in the ears because of pneuma. The head of some (patients) seems to be full of it [scil. pneuma] and heavy, of others empty and light, of others dry. A certain patient even believed that he did not have a complete head. Philotimus is said to have found for him, in addition to another therapy, the leaden helmet, by which he was oppressed and thus was aware of his head. Most of the melancholics also become licentious towards sexual intercourse, they also become sad in their thought and cowardly and

112 | Aetii Amideni Libri medicinales VI 9, p. 142.21–143.19 Olivieri

δειλοὶ καὶ ἐλεήμονες καὶ δακρυτικοὶ καὶ διώκουσι τὰ ἔρημα. τινὲς δὲ καὶ δαίμονας ἀπὸ γοητειῶν τῶν ἐχθρῶν ἐπῆχθαι αὐτοῖς ὑπολαμβάνουσιν, ἕτεροι δὲ δηλητήριον φάρμακον εἰληφέναι ὑποπτεύουσι καὶ βεβαίαν αὐτῶν τὴν ὑποψίαν ἐργάζονται αἱ συνεδρεύουσαι αὐτοῖς βρομώδεις καὶ ἀλλόκοτοι ἐρυγαί. δοκεῖ δὲ ἄλλα ἄλλοις καί ἐστιν ἡ νόσος παντοδαπὴς καὶ οὐκ εὐαρίθμητος, οἷον αὐτίκα περὶ τοὺς φόβους καὶ ὁ μὲν δέδοικε τοὺς φιλτάτους, ὁ δὲ ὅλους τοὺς ἀνθρώπους, καὶ ὁ μὲν δέδοικεν εἰς φῶς ἰέναι, τὰ δὲ σκοτεινὰ διώκει, ὁ δὲ φεύγει τὰ ζοφώδη, οἱ πλείους μέντοι ἐν σκοτεινοῖς τόποις χαίρουσι διατρίβειν καὶ ἐν μνήμασι καὶ ἐν ἐρήμοις. ἔνιοι δὲ καὶ τὸ ὕδωρ δεδοίκασι καὶ οἶνον καὶ ἔλαιον 143 καὶ πᾶν ὑγρὸν ὁτιοῦν, ὥσπερ οἱ δηχθέντες ὑπὸ λυττῶντος κυνὸς καὶ συντόμως εἰπεῖν αἱ μελαγχολικαὶ παράνοιαι πολυειδεῖς μέν εἰσι ταῖς κατὰ μέρους ὑπούλοις φαντασίαις· ἐν δ’ αὐταῖς ἁπάσαις ὑπάρχει κοινὸν ὁ φόβος καὶ ἡ δυσθυμία. δυσθυμοῦσι μὲν γὰρ ἅπαντες ἀλόγως, οὐδ’ ἂν ἐρωτήσῃς ἔχοντες εἰπεῖν ἐφ’ ὅτῳ λυποῦνται· δεδίασι δὲ ἐξ αὐτῶν οὐκ ὀλίγοι θάνατόν τε καὶ ἕτερά τινα μηδενὸς ἄξια δείματος· εἰσὶ δ’ οἳ καὶ σφοδρῶς ἐπιθυμοῦσι τὸν θάνατον. Γαληνοῦ. τὸ μὲν οὖν ἐπὶ μελαίνῃ χολῇ καταλαβούσῃ τὰς ἀρχὰς τῆς λογικῆς ψυχῆς φόβους τε γίγνεσθαι καὶ δυσθυμίας καὶ θανάτου προςδοκίας οὐδὲν θαυμαστόν· ὁρῶμεν γὰρ καὶ τῶν ἔξωθεν τοῦ σώματος οὐδὲν οὕτως ἡμῖν φοβερὸν ὡς τὸ σκότος. ὅταν οὖν οἷον ζόφος τις περισχεθῇ τὸ λογικὸν μόριον ὃ τῆς ψυχῆς, ἀναγκαῖον ἀεὶ φοβεῖσθαι τὸν ἄνθρωπον, ὡς ἂν τὴν αἰτίαν τοῦ φόβου συμπεριφέροντα τῷ σώματι· ὡς γὰρ ἐν σκότῳ βαθεῖ τὰ παιδία φοβεῖται καὶ τῶν τελείων οἱ ἀπαίδευτοι, οὕτως καὶ τῆς μελαίνης χολῆς τὸ χρῶμα παραπλησίως σκότῳ τὸν φρονοῦντα τόπον ἐπισκιάζον ἐργάζεται τοὺς φόβους. Πάντων μὲν οὖν τῶν παρεπομένων ἑκάστῳ συμπτωμάτων τὰς αἰτίας εἰπεῖν ἀδύνατον· ἀπορίαν γὰρ πολλὴν ἔχει τὰ πλεῖστα, οἷον διὰ τί τὰ μὲν φεύγουσιν ὡς δεινὰ μὴ ὄντα δεινά, τὰ δὲ διώκουσιν

25

30

5

10

15

26–30 οἷον – ἐρήμοις cf. Aret. ib. 2–3,23 143,2–14 αἱ μελαγχολικαὶ – σώματι Gal. de symptom. caus. II 7 (VII 202,18, 203,2, 3, 4–15) 3sq. ἐν – δυσθυμία | 5–7 δεδίασι – θάνατον Paul. ib. (ib. 16,19–20 [Aret. ib. 23–24]) 14–16 ὡς – φόβους Gal. de loc. aff. III 10 (VIII, 190,2–3, 5–8) 17– 145,12 Πάντων – τοιοῦτος Ruf. ib. 354–358 21 καὶI om. P x A διακριτικοὶ ψ 22 γοητίας P x A 25 (καὶ A) ἄλλοις ἄλλα α, exc. La τοῖς ἄλλοις ἄλλα (Gal.) Ald. 26 καὶII om. La P x A (Gal.) 27 ante ὅλους: καὶ add. ω τοὺςII om. P a χ ψ 29 μνημείοις (μνήμη At) M o S (Gal.) 143,1 ante πᾶν: τὸ La 2 ταῖς om. La 4 ὁ et ἡ om. La μὲν om. φ 5 …σεις ω ἔχονται At …τας P x S post λυπ.: Γαληνοῦ P x id. in mg. A δεδοίκασι P x A …δοίασι P At δὲ] τε P a C p τ’ M o γὰρ P 7 τὸν φ tantum …νάτου C p M o ω (Gal.) 8 Γαλ. om. P a χ ψ S post ἐπὶ: τῇ Gal. …νης …ῆς ….βούσης La 11 ἡμῖν οὕτως ω οἷον om. Gal. ζόφω La 12 τῶ …γικῶ (…γιστικῶ A) ..ρίω χ ψ ω (Gal.) ὃ La tant. 13 ….φέροντες P …φέρον S ….φέροντος P a P x περιφέροντ At 14 σκότει P At …βοῦνται ω 15 οὕτω χ ψ ω (Gal.) καὶ] δὲ La 16 φοβ.] τόπους La 17 ante Πάντων: Ῥούφου P x A At (Gal.) 19 τὰI om. At

VI 9 On melancholia from (the books of) Galen and Rufus and Posidonius | 113

5

10

15

20

25

pitiful and tearful and they pursue loneliness. Some even believe that daimones are brought upon them by the witchcraft of their enemies, others suspect that they have received a poison and the accompanying foul-smelling and strange belching confirms their suspicion. Every patient has different beliefs and the disease is manifold and (its forms are) not few in number; to begin with, for example, concerning the fear, one even fears his dearest people, another (fears) the whole of mankind, and one fears to go into the light but pursues darkness, another avoids dark-colored things. The greater number (of patients), however, likes to spend time in dark places and in memorials and in lonely areas. Some also fear water and wine and oil | and 143 any liquid, like those who were bitten by a dog suffering from rabies, and, concisely speaking, the melancholic derangements are manifold, in part through false appearances, but common to all of these are fear and despondency. For they are all irrationally despondent and if you asked them they could not tell why they are distressed. Not a few of them fear death and other things which are not worthy of fear. Some also strongly desire death. From Galen: It is not surprising that through black bile which befalls the foundations of the rational soul both fear and despondency arise and the expectation of death. For we see that also from outside of the body nothing causes as much fear in us as darkness. Whensoever, then, some kind of darkness encompasses the rational part of the soul, the human being is necessarily always in fear since he carries around the cause of the fear in his body. For just as children and uneducated adults are in fear when in deep darkness, likewise also the color of black bile darkens the thinking part (of the soul) similarly to darkness and thus causes the fear. (From Rufus:) It is impossible to tell the causes of all symptoms accompanying each (patient): for most of them include many puzzles, such as why do patients, on the one hand, flee things as if they are fearful although they are not fearful but, on the other, pursue things as if they are useful although they are not useful, and why

114 | Aetii Amideni Libri medicinales VI 9, p. 143.20–144.20 Olivieri

ὡς χρηστὰ μὴ ὄντα χρηστά, καὶ διὰ τί ὁ μὲν τοὺς οἰκείους φοβεῖται, ὁ δὲ ὅλους ἀνθρώπους καὶ τὰ τοιαῦτα. τῶν πλείστων δὲ συμπτωμάτων εἰπεῖν τὰς αἰτίας τὸν ἰατρὸν οὐ χαλεπόν, οἷον ὁ δοκῶν ἑαυτὸν κέραμον εἶναι, διὰ τὴν ξηρότητα τοῦτο πάσχει· ψυχρὸς γὰρ καὶ ξηρὸς ὁ μελαγχολικὸς χυμός. ὁμοίως δὲ καὶ ὁ τὸ ἑαυτοῦ δέρμα δοκῶν εἶναι ταῖς ξηραῖς διφθέραις ὅμοιον. ὁ δὲ οἰόμενος μὴ ἔχειν κεφαλὴν ἴσως διὰ κουφότητα τῆς κεφαλῆς τοῦτο ᾤετο, τὴν δὲ κουφότητα τὸ ἀναφερόμενον πνεῦμα παρεῖχεν αὐτῇ. διὰ τί δὲ ὀρέγονται οἱ μελαγχολικοὶ πλειόνων σιτίων, ἢ ὅτι ψύχεται αὐτοῖς τὸ στόμα τῆς γαστρός; διὰ τί δὲ ἔνιοι αὐτῶν οἰνοπόται, ἢ ὅτι ψυχρὸν ὂν θερμανθῆναι χρῄζει; διὰ 144 τί δὲ ἀποκτενοῦσι σφᾶς αὐτῶν, ἢ ὅτι μειζόνων κακῶν ὑπολαμβάνουσιν ἀπαλλάττεσθαι; εἰ μὴ ἄρα δόξα τοιαύτη ὑπογίγνεται αὐτοῖς, ἢ ὅτι τὸ ἀποθνήσκειν ἐστὶ καλόν, ὥσπερ τῶν βαρβάρων ἐνίοις; διὰ τί δὲ ἀπεψίαι συνεχεῖς αὐτοῖς γίγνονται, ἢ ὅτι θολερὸν καὶ περιττωμάτων μεστόν ἐστιν αὐτῶν τὸ σῶμα καὶ διὰ τοῦτο καὶ δύσκρατος ἡ γαστὴρ ψυχομένη διὰ παντὸς ἐκ τοῦ μελαγχολικοῦ χυμοῦ; διὰ τί δὲ αἱ κοιλίαι ὡς ἐπίπαν αὐτοῖς ξηραίνονται, ἢ ὅτι τὸ πνεῦμα τοῖς ἄνω περὶ τὰ ὑποχόνδρια προίσταται καὶ οὐ πάνυ κάτω διαχωρεῖ; ἀνάγκη τοίνυν δι’ αὐτὸ τοῦτο καὶ τὰς γαστέρας εἶναι ξηράς· ἐκ δὲ πολλῆς τῆς ἐπισχέσεως ἀθρόα ποτὲ καὶ περιτετηκότα διαχωροῦσι. σκαρδαμυκταὶ δὲ καὶ ἐξόφθαλμοι καὶ παχύχειλοι ὡς ἐπίπαν γίγνονται διὰ τὸ παχὺ πνεῦμα, μελανόχροες δὲ διὰ τὴν φύσιν τοῦ χυμοῦ. δασεῖς δὲ οἱ πλείους αὐτῶν διὰ τὸ πλῆθος τῶν παχέων περιττωμάτων, ταχύγλωσσοι δ’ ὡς ἐπίπαν εἰσὶ καὶ τραυλοὶ καὶ ἰσχνόφωνοι τῷ ἀκρατεῖ τῆς γλώττης. αἱ γὰρ συντονίαι τῆς κινήσεως κατὰ τὸ πνεῦμα γίγνονται· πᾶν δὲ τὸ συντόνως κινηθὲν ἀπορρεῖ ταχέως. εὐπετὲς μὲν τῷ βουλομένῳ καὶ τῶν λοιπῶν συμπτωμάτων ἀποδοῦναι τὰς αἰτίας ἐκ τούτων ὁρμωμένῳ. μελαίνεται δὲ ὁ χυμὸς οὗτος ποτὲ μὲν ὑπερθερμαινόμενος, ποτὲ δὲ ὑπερψυχόμενος· οἷον γάρ τι πάσχουσι οἱ καιόμενοι ἄνθρακες, διαυγέστατοι μὲν ὄντες τῇ φλογί, σβεννυμένης δὲ τῆς φλογὸς ἀπομελαίνονται, τοιοῦτόν τι καὶ

20

25

5

10

15

20

21 post ὅλους: τοὺς At 22 τὰς αἰτίας ante συμπτωμ. ω post P a 24 δὲ om. P x M o ψ ω (Gal.) ἐπ’ αὐτοῦ La αὑτοῦ P 25 μὴ ἔχειν] σμήχειν ω 26 τῆς –κουφότηταII] ἣν P om. P a ω 26sq. τὸ ἀναφ. – αὐτῇ] τοῦ ἀναφερομένου ἐκ τοῦ χυμοῦ πνεύματος P a 28 ἢ om. P x A 29 ἢ om. A ante ψυχρὸν: τὸ χ ψ ω (Gal.) ὂν om. χ ψ ω (Gal.) 144,1 ἀποκτείνουσι P a (Gal.) …κτινύουσι C p P …κτενύουσι P x A …κτεννυ οὔσης M o …κταινίουσι At 4 γίγν. αὐτοῖς P At θολερῶν La P x A καὶ om. P x A 4sq. μεστῶν C p om. ω 5 αὐτῶν ἐστι P a M o σῶμα] στόμα τῆς γαστρὸς P x 6 χυμοῦ om. La 7 τὰ πνεύματα α, exc. La 8 συνίσταται P x A ω ἕπεται La κάτω om. P x M o A χωρεῖ P x A δι’ om. La 9 αὐτῶ La om. P x A 10 σκάρδαμοι La At σκαρδαμύται Cp ….δομύτται M o …δαμίται A ….μμύται S …δάμυτται P …μύττουσι P a P x …μυκταὶ correxi δὲ] τε La 12 μελάγχροες (…χολες At) α, exc. La μελάγχρους Gal. 13 δ’ (δὲ) om. P x M o ω 14 γλώσσης C p P ω 16 καὶ τάχεως ἀπορρεῖ A μὴν ω λοιπ.] ἄλλων P a ὅλων P 17 τὰς αἰτ. ἀποδ. P a ….μένας La ….νων C p P x At 17sq. Διττῶς μελαίν. ὁ χ. οὕτως P x 19 πάσχουσι γάρ τι ω 20 δὲ] μὲν ω μελαιν. P a ὑπομ. At ἀπομελαινομένοι P τοιοῦτο C p A

VI 9 On melancholia from (the books of) Galen and Rufus and Posidonius | 115

5

10

15

20

25

30

does one patient fear his intimates and another all mankind and suchlike. It is not difficult for the physician to tell the causes of most of the symptoms, for example the one who believes that he is an earthen vessel suffers this because of dryness, for the melancholic humor is cold and dry. It is similar with the one who believes that his skin resembles dry parchment. The one who believed himself not to have a head presumably did so because of the lightness of his head, and the pneuma which had been carried up caused it (to have) this lightness. Why do the patients suffering from melancholia yearn for more food? Is it because the orifice of their stomach is cooled? Why do some of them drink a great deal of wine? Is it because that which is cold needs to be warmed? Why | are they going to kill themselves? Is it because they 144 believe that they are released from greater harm? But if there is not such a notion underlying, do they (try to kill themselves) because dying is a good like some of the barbarians believe? Why do they suffer from continuous indigestion? Is it so because their body is turbid and full of superfluities and therefore also the stomach has a bad mixture because it is completely cooled by the melancholic humor? Why are their bowels in most cases dried up? Is it because the pneuma is put in front of the upper hypochondria and does not completely move downwards? So, necessarily, through this also the stomach is dry. But after much retention, sometimes they also excrete liquid feces all at once. In most cases, they become people who blink and have prominent eyes and thick lips because of the thick pneuma, and they become darkskinned because of the nature of the humor. Most of them are hairy because of the amount of thick superfluities; they talk fast, in most cases, and lisp and have a weak voice through the lack of control over the tongue. For the intensity of movement occurs with regard to the pneuma. Everything which is intensely moved decays quickly. It is easy for anyone who wants to do so to explain also the causes of the remaining symptoms when he starts from those (which have already been explained). This humor is made black sometimes when excessively heated, sometimes when being excessively cooled. For such as happens to burned coal, which is, on the one hand, very radiant through the flame and, on the other, turns black after the flame has been extinguished, such as this also causes the coldness

116 | Aetii Amideni Libri medicinales VI 9, p. 144.21–145.14 Olivieri

ἡ ψῦξις περὶ τὸ φαιδρὸν χρῶμα τοῦ αἵματος ἐργάζεται. ὁρῶμεν γὰρ κἀπὶ τῶν ἐκτὸς πελιδνὰ γιγνόμενά τινα τῶν σωμάτων καὶ μελαινόμενα ὑπὸ ψύξεως. ἡ δὲ ὑπερβολὴ τοῦ θερμοῦ πάλιν ξηράνασα καὶ δαπανήσασα τὰς ὑγρότητας, ὑφ’ ὧν τρέφεται τὸ θερμόν, μελαίνει τοὺς χυμούς, ὥσπερ καὶ ὁ ἥλιος τοὺς καρποὺς καὶ τὰ τῶν ἀνθρώπων σώματα. γινώσκειν τοίνυν χρὴ ὡς διττὸν τὸ εἶδος τῆς μελαγχολίας. τινὲς μὲν γὰρ αὐτῶν ἐκ φύσεως καὶ τῆς ἐξ ἀρχῆς κράσεως ἔχουσι τὸ μελαγχολικόν, τινὲς δὲ ἐκ διαίτης φαύλης εἰς ὕστερον τὴν κρᾶσιν ταύτην ἐπεκτήσαντο. καί ἐστι τὸ εἶδος τοῦτο νωθρὸν καὶ κατηφὲς ἀεί. ὅτι δὲ ἐξ ὑπεροπτήσεως τῆς ξανθῆς χολῆς τῇ παραφροσύνῃ περιπίπτουσι, θρασύτεροι καὶ ὀργιλώτεροι τῶν ἄλλων εἰσὶ καὶ πλῆκται καὶ τὰ πάνδεινα πράττοντες κατὰ τὸν καιρὸν ἐκεῖνον μάλιστα, ἐν ᾧ ὑπεροπτᾶται 145 ἡ χολή· τῷ χρόνῳ δὲ ὅταν καὶ αὐτὴ ἀποσβεσθῇ, κατηφεῖς καὶ ἐπίλυποι καὶ ἐπίφοβοι γίγνονται. τὰ μὲν οὖν πρὸ τῆς θεραπείας εἰς τοσοῦτον διεγνωκέναι χρὴ τὸν ἰατρόν· ἃ δ’ ἄν τις μαθὼν ἔχοι βοηθεῖν τοῖς οὕτω νοσοῦσιν, ἤδη καιρὸς ἐκτίθεσθαι. διαφέρει δὲ εἰς τὴν θεραπείαν οὐ σμικρὰ τὸ εἰδέναι ὅθεν τὴν ἀρχὴν ἔσχε τὸ νόσημα. Γαληνοῦ. ὅταν μὲν γὰρ ὅλον τὸ σῶμα μελαγχολικὸν ἔχῃ τὸ αἷμα, τὴν ἀρχὴν τῆς θεραπείας ἀπὸ φλεβοτομίας ποιεῖσθαι προσῆκον· ὅταν δὲ τὰ κατὰ μόνον τὸν ἐγκέφαλον οὐ χρῄζει φλεβοτομίας ὁ κάμνων, εἰ μήτι γε πολύαιμος εἴη καὶ χάριν προφυλακῆς τὴν ἀφαίρεσιν ποιούμεθα. ἡ δ’ οὖν διάγνωσις ἀπὸ τῶνδέ σοι γιγνέσθω, πότερον ὅλον τὸ σῶμα μελαγχολικὸν ἔχει τὸ αἷμα ἢ κατὰ τὸν ἐγκέφαλον μόνον ἤθροισταί τις τοιοῦτος. οἱ μελάντεροι καὶ δασεῖς καὶ φλέβας εὐρείας ἔχοντες ἐπιτηδειότατοι πρὸς τὴν τοῦ μελαγχολικοῦ χυμοῦ γένεσιν, ἔσθ’ ὅτε δὲ καὶ οἱ ἐξέρυθροι τὴν χρόαν ἄνθρωποι μεταπίπτουσιν ἀθρόως εἰς τὴν

25

30

5

10

145,2–5 τὰ – νόσημα ante γινώσκειν (p. 144,26) transp. Gal. de melanchol. etc. 6–19 ὅταν – γυναιξίν Gal. de loc. aff. III 10 (VIII, 182,7–10, 12–14, 17–183,8) 6–8 ὅταν – κάμνων Or.a VIII 6 (248,12–14) 22 τ. σωμ] σώματα P ω post σωμ.: Ποσαχῶς τὸ εἶδος τῆς μελαγχολίας; P x 26–145,2 γινώσκειν – γίγνονται om. C p P 26 χρὴ τοίνυν ω (Gal.) χρὴ ante γιγνώσκ. P x 27sq. τὸν μελαγχ. χυμὸν P x A 28  ἐσύτερον P a ω (Gal.) ταύτην om. ω (Gal.) 29 ὅτι] ὅσοι P a P x A 31sq. πάντα δεινὰ P a M o m. 2a S 32 ἐν ᾧ] καθ’ ὃν P a 145,1 καὶI om. P x A καὶII om. S (Gal.) 1sq. ἐπίληπτοι At m. 2a S 2 γενόμενοι ω (Gal.) 2–5 τὰ –νόσημα ante γινώσκειν τοίνυν (p. 144,26) transp. M o ω 3 ἐκγινώσκειν M o χρὴ] δεῖ P a om. La ἔχει P x A At 4 τίθεσθαι P a C p P ὑποτίθ. ω (Gal.) 5 μικρά La τὸ (om. Gal.) εἰδ. om. ω Γαλ. La tantum 6 ἔχει P x M o ω (Gal.) ..εΗ C p 7 ποιεῖσθαι om. La M o ω …ήκει P …ῆκεν C p M o A ω (Gal.) τὰ] τὸ P om. P x 8 χρήζη ω εἰ om. La χ μὴ P a μήποτε S μήτοι ψ At (Gal.) γε om. P a S 9 ποιούμ. τ. ἀφ. transp. P a 9sq. δ’ οὖν] γοῦν P a P At 10 τῶνδέ] τῶν τότε Gal. post γιγν.: τῶν σημείων P x 11 τις] ὁ A om. At 12 post τοιοῦτ.: διάγνωσις Γαληνοῦ A χυμὸς P καὶ ἀξιῶ σε πρῶτον μὲν ἐπισκέπτεσθαι τὴν τοῦ σώματος ἕξιν, ὁποία τίς ἐστιν, μεμνημένον ὡς οἱ μὲν ἁπαλοὶ καὶ λευκοὶ καὶ πίονες ἥκιστα μελαγχολικόν, οἱ δ’ ἰσχνοὶ καὶ P x οἱ om. P a add. ex Gal. post μελάντ.: δὲ C p ω 13 χυμοῦ om. P x A 14 χροιὰν P a A

VI 9 On melancholia from (the books of) Galen and Rufus and Posidonius | 117

with regard to the bright color of the blood. For we see that also in external parts of the body some become livid and black because of coldness. Excessive heat, in turn, dries up and consumes the moisture by which the heat is nourished, and thus makes the humor black as also does the sun with fruits and the bodies of humans. It is 5 necessary to recognize that the nature of melancholia is twofold. For some of them [scil. the patients] have the melancholic mixture by nature and from their initial mixture, others acquired this mixture from a bad way of living later. And this form is sluggish and always downcast. Since they fall into derangement because of an overheating of yellow bile, they are bolder and angrier than others and they are 10 brawlers and they do terrible things, especially at the time when | the bile is 145 overheated. At the time when it itself is extinguished, they become downcast and sad and timid. It is necessary that the physician so far discerns these circumstances before the therapy and, how one can help those who are ill in this way, after having learned it, it is now the right moment to set out. It makes no small difference for the 15 therapy to know from where the disease had its origin. From Galen: For if the whole body has melancholic blood, it is appropriate to start the therapy from phlebotomy but if only the parts around the brain (have melancholic blood), the patient is not in need of phlebotomy, as long as he is not full of blood and we undertake the removal for the sake of prophylaxis. Therefore, your diagnosis shall arise from these 20 questions, whether the whole body has melancholic blood or such had only gathered around the brain. Those who are darker and hairy and have broad veins have a tendency to the production of the melancholic humor, but sometimes also humans

118 | Aetii Amideni Libri medicinales VI 9, p. 145.15–146.16 Olivieri

μελαγχολικὴν κρᾶσιν· ἐφεξῆς δὲ αὐτῶν οἱ ξανθοὶ καὶ μάλισθ’ ὅταν ἀγρυπνίαις καὶ πόνοις πλείοσι καὶ φροντίσι καὶ λεπτῇ διαίτῃ ἢ μελαγχολικοῖς ἐδέσμασι διῃτημένοι τύχωσιν ὄντες· πρὸς τούτοις εἰ ἐπέσχηταί τις αἱμορροῒς ἐν ἕδρᾳ ἢ ἄλλη τις συνήθης κένωσις αἵματος ἢ καταμήνια ταῖς γυναιξίν. οὐ μικρὰ δὲ συντελεῖ καὶ ἡ ὥρα τοῦ ἔτους καὶ ἡ κατάστασις τοῦ ἀέρος καὶ τὸ χωρίον ἥ τε τοῦ κάμνοντος ἡλικία καὶ τὸ ἐπιτήδευμα. ταῦτα δὲ πάντα προσδιασκεψάμενος, ὅταν ἐλπίσῃς ἐν ταῖς καθ’ ὅλον τὸ σῶμα φλεψὶ μελαγχολικὸν αἷμα περιέχεσθαι, τὴν βεβαιοτάτην ἐπάγειν διάγνωσιν ἐκ τοῦ τεμεῖν τὴν κατ’ ἀγκῶνα φλέβα· βέλτιον δὲ τὴν μέσην τέμνειν· εἶτα εἰ μὴ φαίνοιτο μελαγχολικὸν εἶναι τὸ ῥέον αἷμα, ἐπίσχειν εὐθέως· εἰ δὲ τοιοῦτον φαίνοιτο, κένωσον ὅσον ἂν ὑπολάβοις ἄνταρκες ἔσεσθαι τῇ τοῦ κάμνοντος σώματος ἕξει. 146 ἡ δὲ τρίτη διαφορὰ τῆς μελαγχολίας, ἧς τὴν ἀρχὴν ἀπὸ τῆς κοιλίας ἴσχειν ἐλέγομεν, ὑποχονδριακὸν πάθος ὀνομαζομένη, διαγιγνώσκεται ἐκ τῶν προειρημένων πολλάκις. πρῶτον γὰρ ἄρχεται τὰ κατὰ τὴν γαστέρα συμπτώματα, οἷον ἐμπνευματώσεις βορβορυγμοὶ ἐρυγαὶ[ ὀρέξεις] ὀξώδεις καὶ βρομώδεις καὶ τὸ ἐπιξηραίνεσθαι τὴν γαστέρα καὶ τὸ ἐπὶ ταῖς διαχωρήσεσι καὶ τοῖς ἐμέτοις καὶ ταῖς ἐρυγαῖς ἐπικουφίζεσθαι καὶ τὸ τοὺς κάμνοντας αὐτοὺς συναισθάνεσθαι τῶν ὀχληρῶν πάντων περὶ τὰ ὑποχόνδρια συνεδρευόντων. ὥσπερ οὖν τισι πολλάκις ἀναφερομένης ἐκ τῆς γαστρὸς αἰθαλώδους τινὸς ἢ καπνώδους ἀναθυμιάσεως ἢ ὅλως ἀτμῶν τινων παχέων, ὅμοια τοῖς τῶν ὑποχεομένων δοκεῖ φαίνεσθαι πρὸ τῶν ὀφθαλμῶν, κατὰ τὸν αὐτὸν λόγον καὶ νῦν, ἐπὶ τὸν ἐγκέφαλον ἀναφερομένης τῆς μελαγχολικῆς ἀναθυμιάσεως, οἷον αἰθάλη ἢ καπνὸς τὰ μελαγχολικὰ γενήσεται περὶ τὴν διάνοιαν συμπτώματα. ὅταν μὲν οὖν τὰ τῆς μελαγχολικῆς παρανοίας ἴδια σημεῖα φαίνηται μεγάλα, κατὰ δὲ τὴν κοιλίαν ἤτοι μηδὲν ὀχλεῖν ἢ σμικρότατον τοῦτο εἴη, τὸν ἐγκέφαλον ἡγητέον ἐπὶ τούτων πρωτοπαθεῖν, καθὼς προείρηται.

15

20

25

5

10

15

146,1–4 ἡ – συμπτώματα | 5sq. καὶIII – ἐπικουφίζεσθαι Or.a ib. (ib. 14–20) 13–16 ὅταν – πρωτοπαθεῖν Gal. ib. (ib. 192,8–10) Or.a ib. (ib 22–24) 15 post ὅταν: ἐν P a 17 προδεδιητ. P a εἰ] ἵν’ P a ἐπίσχηται P a C p M o (Gal.) …έται P At …σχεῖται P x A 18 συνήθης om. La ἔκκρισις αἵματος S ἔκκρισις At 19 σμικρὰ P a P 22 περιχεῖσθαι At 23 ἔπαγε P a M o ψ ..άγαγε C p ἀπαγάγη Gal. τέμνειν α (Gal.), exc. La 25 τὸ αἷμα τὸ ἐκ τῆς φλεβὸς ῥέον P x εἰ] ἐπεὶ ω τοιοῦτο C p M o 26 …λαμβάνης P a …λάβης χ ψ ω (Gal.) post ἕξει: Τρίτη διάγνωσις Γαληνοῦ P x 146,1 ἡ –μελαγχολίας] ἡ δὲ τρίτη διάγνωσις τῆς θεραπείας τῆς μελαγχολικῆς διαφορᾶς P x τὴν δὲ τρίτην διαφορὰν A τῆ δὲ τρίτη διαφορᾶ ω ἣν P a P S om. A 2 ἔχειν P At …ζομένην α corr. ex Gal. ante διαγιγν.: ἣ ω 3 post πρῶτον: μὲν P x A ω ἄρχ. om. P x A 4 ὀρεξ. om. P a χ ψ S (Gal. Ruf.) 5  ὀξώδ. om. S 6 post ἐπικ.: ἢ P x A 7 τὸ om. ω (Gal.) αἰσθάν. P a A 9 ἢ καπν. om. P a 14 τῆς μελαγχ.] μελαγχολικὰ At σημ.] συμπτώματα ω …νεται P a …νονται P 15 ἐνοχλεῖν P x …χλοῦν A ὀχλῆ P a ὀχληρὸν C p P ω (Gal.) τὸν] τῶν P x A 16 ἐπὶ ante τὸν transp. La

VI 9 On melancholia from (the books of) Galen and Rufus and Posidonius | 119

5

10

15

20

25

with a very red complexion change all of a sudden to the melancholic mixture. Next to them are the people with a yellow complexion and especially if they happen to be living with sleeplessness and more troubles and anxiety and a thinning regimen or melancholic food. In addition, (they have a tendency to the production of the melancholic humor) if some hemorrhoids around the anus do not discharge blood or if some other accustomed evacuation of blood is held back or if, in women, the menses are held back. Not a little also does the season of the year contribute and the condition of the air and the place and the age of the patient and the everyday habits. After having considered all this, if you suppose that melancholic blood is contained in the veins of the whole body, you should bring forward the most certain diagnosis from cutting a vein in the elbow: it is better to cut the middle vein. Then, if the blood which flows does not seem to be melancholic, you immediately have to stop; but if it seems to be suchlike [scil. melancholic], you have to empty as much as you believe will be sufficient for the condition of the affected body. | The third form of melancho- 146 lia, whose origin is from the stomach, as we said, and which is called hypochondriac affection, is often distinguished from what has been discussed previously. For, first, the symptoms related to the stomach begin (to appear), such as flatulence, intestinal rumbling, acid and foul-smelling belching, drying up of the stomach, and being relieved through excretions and vomiting and belching and the fact that the patients themselves are aware of all the troublesome accompaniments around the hypochondria. So, just as it often seems to some (patients), when some sooty or smoky vapors are carried up from the stomach or actually some thick vapors, that things similar to those that occur to people suffering from cataracts appear in front of their eyes, in the same way also in the present case the melancholic symptoms with regard to thinking will occur, when melancholic vapors are carried up to the brain like thick soot or smoke. So, if, on the one hand, the characteristic signs of melancholic derangement appear to be great, while, on the other hand, no or only very few symptoms of the gastric tract can be observed, one needs to consider the brain to be primarily affected in these (patients), as has been discussed previously.

120 | Aetii Amideni Libri medicinales VI 10, p. 146.17–147.14 Olivieri

Θεραπεία μελαγχολικῶν Γαληνοῦ. τὴν μὲν οὖν ἐξ ἐγκεφάλου πρωτοπαθοῦντος συνισταμένην μελαγχολίαν διά τε λουτρῶν συνεχῶν καὶ διαίτης εὐχύμου τε καὶ ὑγρᾶς καὶ ἀφύσου ἐκθεραπεύειν χωρὶς ἑτέρου δραστικοῦ βοηθήματος, ὅταν γε μήπω διὰ χρόνου μῆκος δυσκένωτος ᾖ ὁ λυπῶν χυμός, ἡνίκα ποικιλωτέρας καὶ ἰσχυροτέρας προσάγειν χρὴ τὰς ἰάσεις. ἀρχόμενον δὲ τὸ πάθος θεραπεύειν προσήκει. χρονίσαν γὰρ καὶ αὐξηθὲν δυσμεταχείριστον γίνεται. Ῥούφου. κοινὰ δέ ἐστι, κἂν ὁ ἐγκέφαλος πρωτοπαθῇ κἂν τὰ ὑποχόνδρια, τὰ ὑπακτικὰ τῆς γαστρὸς βοηθήματα. πρῶτον μὲν οὖν εὐπεψίας φροντίδα τίθεσθαι χρή, ἔπειτα δὲ καθαίρειν πρῶτον μὲν ἐπιθύμῳ καὶ ἀλόῃ. τούτων γὰρ εἰ καὶ ὀλίγον ἐφ’ ἑκάστης ἡμέρας λαμβάνοι, ὠφελεῖται τὰ μέτρια καὶ ἡσυχῇ ὑπάγειν. 147 Ποσειδωνίου. ἐφ’ ὧν δὲ αἷμα πλεονάζειν φαίνοιτο, εὐθὺς ἐξ ἀρχῆς φλέβα τέμνειν προσήκει τὴν ἐν ἀγκῶνι καὶ μάλιστα ἐφ’ ὧν συνήθεις ἐκκρίσεις εἰσὶ τοῦ αἵματος ἐπεσχημέναι. ἐπὶ δὲ γυναικῶν, αἷς ἐκλείπει τὰ καταμήνια, τὴν ἐν τῷ σφυρῷ φλέβα τέμνειν χρή, κενοῦν δ’ ἕκαστον πρὸς δύναμιν· ἐφ’ ὧν δὲ ἡ κακοχυμία μᾶλλον πλεονεκτεῖ, προδιαιτήσας τὸν πάσχοντα κάθαιρε τῇ ἱερᾷ Ῥούφου ἢ Ἀρχιγένους ἢ Ἰούστου. εἰ δ’ ἄμφω πλεονάζοι, προφλεβοτομήσας κάθαιρε. μετὰ δὲ ταῦτα διαλιπὼν ἡμέρας τινὰς κλυστῆρσι τὴν κοιλίαν κενοῦν, πρῶτον μὲν διὰ χυλῶν πιτύρων καὶ κενταυρίου τοῦ μικροῦ καὶ ἀφρονίτρου καὶ μέλιτος, μετέπειτα δὲ καὶ πολυποδίου ῥίζας τεθλασμένας συνέψειν τοῖς πιτύροις καὶ ἐπίθυμον. μετὰ δὲ τρεῖς ἡμέρας τοῦ κλυστῆρος δοτέον αὐτοῖς τὴν δι’ ἀλόης πικρὰν προσειληφυῖαν πρὸς τοῖς ἄλλοις πᾶσι καὶ ἐπιθύμου. σκευάζειν δὲ αὐτὴν ὡς Θεμίσων βούλεται· ἀλόης μὲν βαλὼν < ρ̅ μαστίχης δὲ καὶ κρόκου καὶ ναρδοστάχυος κινναμώμου τε ἢ κασσίας τὸ διι

20

25

5

10

17–23 τὴν – γίνεται Or.a ib. (ib. 25–30) 17–22 τὴν – ἰάσεις Paul. III 14 (I 157,5–10) 24–28  Ῥούφου – ὑπάγειν Ruf. id. 359 26–28 καθαίρειν – ὑπάγειν Or.a ib. (ib. 30–249,1) Paul. ib. (ib. 2–5 φλέβα – δύναμιν cf. Aret. VIII 5 10–12) 147,1sq. ἐφ’ – ἀγκῶνι cf. Or.a ib. (ib. 249,7–8) (156,4. 7–8) 6 τῇ ἱερᾷ Ῥούφου ἢ Ἀρχιγένους ἢ Ἰούστου cf. III 115–117 (I p. 304sqq.) 11sq. δοτέον – ἐπιθύμου Aret. ib. (157,7sqq.) 11sq. δοτέον – προσειληφυῖαν Or.a ib. (ib. 10–11) 17 …χολίας ω (Gal.) Γαληνοῦ om. At 18 ante συνεχ.: καὶ At (Gal.) 20 μήπου C p M o A S μῆκος χρόνου At 21 εἴη P a P x m. 2a S εἶ C p λοιπὸς A λοιπ´~ P x 22 προσήκ. θεραπ. transp. P a 24 Ῥούφου om. P a C p M o ψ 25 ante ὑποχ. add. καθ’ M o A 27 ἐφ’] καθ’ P x A 27sq. λαμβάνει P a A 28 τὸ M o ψ At τῶ P a C p P x S μετρίως P x ω 147,1 Ποσειδ.] in marg. m. 2a ut vid. P a om. χ ψ 2 ἀγκῶσι ω 3 ἐπισχ. φ P x M o ψ ω ἐκλείποι P a 4 τὸ …μήνιον χ A 6 πάσχ.] κάμνοντα ω καθαίρειν ω 7 …νάζει P a M o ω (Gal.) ante μετὰ: Ποσειδωνίου A διαλοιπὸν A …πὼν P At διὰ λειπὼν P x 8sq. χυλοῦ …ρων P a χ ψ (Gal.) πιτύρων χυλῶν ω 9 κ. κενταύριον μικρὸν in marg. M o κ. κενταυρίου τοῦ μικροῦ post ἀφρονίτρου A om. C p P x P ω (Gal.) ἀφονίτρου P a …νίτρων C p …φρονίτρων M o P ω post μέλιτος: κἄπειτα δὲ καὶ κενταύριον μικρὸν P 9sq. μετέπ. om. P 10 δὲ om. P x P ω 11 καὶ] ἢ χ ψ ω (Gal.) 12 πρὸς –ἐπιθύμου] μετὰ τὴν κάθαρσιν καὶ τὸν κλυστῆρα P 13 post βούλεται: Σκευασία τῆς πικρᾶσ. Θεμίσων P x ἡ πικρὰ ὡς Θεμίσων M o βάλλων A ω 14sq. τε – διπλοῦν om. P x 14 ἢ] καὶ A ω

VI 10 Therapy of those who suffer from melancholia | 121

VI 10 Therapy of those who suffer from melancholia

5

10

15

20

25

From Galen: So, one has to perfectly cure the melancholia, which is brought about by a primary affection of the brain, both through frequent bathing and a regimen which is productive of healthy humors and is moist and causes no flatulence, without any other drastic remedy if the humor that is causing distress has not yet become hard to evacuate through length of time; in which case it is necessary to administer a more diversified and stronger mode of healing. It is appropriate to cure the affection at the moment when it starts. For once it has become chronic and intensified, it becomes hard to handle. From Rufus: Whether the brain or the hypochondria are primarily affected, the remedies which are capable of evacuating the stomach are shared in common. So, at first it is necessary to pay attention to good digestion, then it is necessary to purge, at first with epithymum and aloe. For if he [scil. the patient] takes even a little of these every day, it is beneficial for opening the bowels moderately and smoothly. | From 147 Posidonius: As regards those (patients) in whom blood seems to be prevailing, it is appropriate to cut the vein in the elbow immediately from the beginning, and especially in those in whom the accustomed excretions of blood are held back. But in women whose menses fail to appear, it is necessary to cut the vein in the ankle and to empty each (patient) according to their strength. As regards those (patients) in whom the bad mixture of humors has a larger share, one should prepare the patient through a suitable regimen first and then purge with the holy remedy of Rufus or Archigenes or Justus. If both prevail, one should purge after having first phlebotomized. Afterwards one needs to leave an interval of a few days and then empty the bowels with an enema, at first with one made of the juice of bran and the lesser centaury and native soda and honey, afterwards one also has to cook the bruised roots of polypody with the bran and epithymum. After three days of (the application of) the enema, one has to give them the bitter remedy made of aloe which contains in addition to all the others also (a bit) of epithymum. One should prepare it as Themison prefers: of aloe one has to throw in one hundred drachmae,

122 | Aetii Amideni Libri medicinales VI 10, p. 147.15–148.16 Olivieri

πλοῦν ἀσάρου καὶ καρποβαλσάμου ἑκάστου ἀνὰ Γʹ α̅. προστιθέναι δὲ τούτοις καὶ ἐπιθύμου Γʹ βʹ καὶ σχοίνου ἄνθους Γʹ α̅ καὶ διδόναι κοχλιαρίου μεγάλου τὸ πλῆθος μετὰ μελικράτου. δοτέον δὲ αὐτοῖς ἐκ διαστημάτων ὀλίγων δεύτερον ἢ τρίτον, εἶτα πάλιν διαιτήσας καὶ ἀναλαβὼν τὰς δυνάμεις δίδου πάλιν τὴν ἱερὰν Ῥούφου ἢ Ἀρχιγένους ἢ Ἰούστου. πλῆθος δὲ ἔστω τὸ ξηρίον διδόμενον ὡς < δʹ μετὰ μελικράτου καὶ ἁλῶν ὅσον κοχλιάριον· βέλτιον δὲ καὶ τοῖς ἐφ’ ἡμέραν κενοῦσι πρᾴως ὑπάγειν τὴν γαστέρα· μελάνων δὲ ἀγωγά ἐστιν ἀμάρακον καὶ ἡ κονίλη λεγομένη διδόμενα ὅσον < βʹ ἐπιπασσόμεναι μελικράτῳ καὶ πινόμεναι· συμφέρει δὲ καὶ τῷ ὀρρῷ τοῦ γάλακτος ὑπάγειν τὴν κοι148 λίαν, ἀλλὰ μὴ ἀπὸ τῶν τυρῶν δοτέον τὸν ὀρρόν· ἄμεινον γὰρ τὸ ἐκ τοῦ ἑψημένου γάλακτος ἀποχωριζόμενον· μᾶλλον δὲ ἵππειον ἔστω τὸ γάλα, εἰ δὲ μή, βόειον. ἐμβλητέον δὲ τὸ γάλα ἐν καινῇ χύτρᾳ κινοῦντα κλάδῳ συκῆς. ὅταν δὲ ἀναζέσῃ τρὶς ἢ τετράκις καταρραίνειν ὀξυμέλιτι, εἶτα διηθήσας δίδου πίνειν τὰ μὲν πρῶτα μέλι προσμίσγων· ὅταν δὲ ἄρξηται ὑπέρχεσθαι ἡ γαστὴρ μηκέτι βάλλειν τὸ μέλι. λαμβάνεται δὲ κατὰ κοτύλην μὴ ἔλαττον τῶν πέντε κοτυλῶν. χρῆσθαι δὲ ἐπὶ πάσῃ κενώσει μαλάχης σπέρματι ἢ τῆς ἡμέρας ἢ τῆς ἀγρίας λειοτάτης διδόντα ὅσον < βʹ μεθ’ ὕδατος κυάθων τριῶν· ἄκρως γὰρ ποιεῖ, ὅθεν πολλάκις αὐτῷ χρηστέον. κράτιστον δὲ καὶ γλήχωνος ἀφεψήματος πίνειν συνεχῶς καὶ πρὸ τῶν καθαρτικῶν καὶ μετὰ καθαρτικὰ καὶ τοῦ μικροῦ κενταυρίου ὁμοίως. τοῦ δὲ ἀψινθίου τὸ ἀφέψημα καὶ συνεχῶς καὶ ἐφεξῆς δίδου· στομάχῳ γὰρ καὶ γαστρὶ κατάλληλον ἐπὶ τούτων καὶ οὔτε φῦσαν συγχωρεῖ ἐγγίγνεσθαι τῇ γαστρὶ πολλὴν οὔτε εἰς τέλος ἀποξηραίνεσθαι τὴν διαχώρησιν καὶ οὔρησιν κινεῖ καὶ πέττειν ἀκριβέστερον παρασκευάζει, ὥστε ἐγὼ καὶ μόνῳ τούτῳ τινὰς οἶδα ἀπηλλαγ-

15

20

5

10

15

148,7–9 χρῆσθαι – τριῶν cf. Aret. ib. (158,12–13) 12 τοῦ δὲ ἀψινθίου τὸ ἀφέψημα cf. Or.a ib. (ib. 249,1sqq.) Paul. ib. (ib. 157,13sqq.) τοῦ δὲ ἀψινθίου κτλ. Aret. ib. 157,5sqq. 15 ἑκ. om. P a P x ἀνὰ om. C p M o ψ ω Γʹ] δρμ P x α̅ om. P x 15sq. προστιθ. δὲ τούτ. κ.] κασίας δρμ βʹ P x 16 καὶII –α̅ add. ex Gal. 17 μεγ. τὸ] μεγαλου P S μέγα La At αὐτὸν La …τὴν P a …τοῖς corr. …ῆς (αὐτ~ C p) M o 18 ὀλίγον At 19sq. ἢ Ἰούστου ἢ Ἄρχιγ. P a 20 post Ἰούστου: ὧν τὰς σκευασίας ἐροῦξηρίον om. χ ψ ω (Gal.) μεν ἐνταῦθα. Σκευασία τῆς ἱερᾶς Ρούφου δέχεται· κολοκυνθίδος κτλ. P x ὡς] ὅσον P x om. C p M o ψ ω (Gal.) 21 post κοχ.: μικρόν χ ψ ω (Gal.) δὲ om. La ἐφ’ ἡμέρα (..ας) κεν. P a P ἐφήμερον κεν. P x A (Gal.) κεν…ιν ἐφ’ ἡμέραν κεν…σι ω 22 μέλανος P …αντέρων P a …αγχολικοῦ A ..λαίνης ω ἀγωγὸν ω ἀμαράκινον La 23 κονία La κονίλα At …νήλη C p S ante λεγ.: ἡ P x M o A διδόμ. om. χ ψ ω (Gal.) …σσόμενα P x A πασσόμενα P πασ…αι P a M o ω καὶ om. P a 24 …νόμενα P x A om. P a 148,1 γὰρ] δὲ P a P ἐκ] ἀπὸ ω 2 ἑψομ. χ A S ἑψουμ. P 3 κενῆ P a C p M o S κινῶν ω 4 μεταρραίνειν La 5 …μιγνύων P a …μίγου A ..μίγων M o P ω (Gal.) 6 βαλεῖν A S (Gal.) ….ανέτω Gal. 8 ἢI – ἀγρίας post διδ. P x om. C p M o ψ ω (Gal.) …τάτοις M o A …τω C p P ω (Gal.) 8sq. διδοῦντα La C p P S ..δοῦντας A M o ..δόναι At 9 post βʹ: ἔστω δὲ ξηρὸν τὸ σπέρμα, πλεῖόν ἐστιν καὶ ὑπακτικώτερον τοῦ χλωροῦ κτλ. P x 10 ἀφέψημα P ω 11 πρὸς ω post μετὰ: τὰ χ P ω (Gal.) 12 post κεντ.: ὁ χυλὸς add. P x 14 γιγν. P a P ω 15sq. ἀκριβῶς ω 16 ….άζειν ω τούτω μόνω La

VI 10 Therapy of those who suffer from melancholia | 123

5

10

15

20

25

but of mastic and saffron and spikenard and cinnamon or cassia the double amount, of hazelwort and balsam fruit up to one uncia each. One should add to these (substances) also two unciae of epithymum and one uncia of the flower of rush and one should apply it as a great spoonful together with honey-water. One should give it to them at small intervals for the second or the third time, then, one again needs to apply a suitable regimen and restore the strength (of the patient) and apply again the holy remedy of Rufus or Archigenes or Justus. The desiccative remedy should be given in a great amount, as much as four drachmae, together with a spoonful of honey-water and salt: it is better to open the stomach gently also with everyday evacuants. Marjoram and the so-called oregano are remedies which draw away black bile and they are applied in an amount of two drachmae and smeared on with honeywater and drunk. It is useful to open the bowels also with the whey of milk, | but one 148 should not give the whey from cheese, for that which is separated from cooked milk is better. The milk should rather be from a horse but, if not, from a cow. One should put the milk in a new earthen vessel, stirring it with the branch of a fig-tree. When it is boiling up, one should sprinkle it with oxymel three or four times, afterwards one has to filter it and apply it as a drink, while, at first, mixing in honey as well. But when the bowels start to pass stool, one should no longer put in honey. As regards the kotylae, not less than five kotylae should be taken. During every evacuation one needs to use the seed of the smoothest mallow, either of the cultivated or the wild form, and one should give as much as two drachmae together with three kyathoi of water: for, this perfectly brings about (the evacuation), for which reason one should often use it. Best is also to drink frequently from the decoction of pennyroyal both before the purgatives and after the purgatives and likewise also from the lesser centaury. You should apply the decoction of wormwood both frequently and continuously: for it is appropriate for the abdominal region in those (patients) and it neither allows that a great quantity of flatulence appears in the stomach nor that, in the end, the excretion is dried up, but it promotes urine and it helps to digest more accurately,

124 | Aetii Amideni Libri medicinales VI 10, p. 148.17–149.15 Olivieri

μένους τῆς νόσου. διδόναι δὲ καὶ τῶν διουρητικῶν ἀνίσου δαύκου πετροσελίνου ἀσάρου καὶ νάρδου καὶ μᾶλλον τούτων τὸ τοῦ ἱππομαράθου σπέρμα καὶ τὴν ῥίζαν. τὴν δὲ χαμαιπίτυν καὶ τὴν χαμαίδρυν προθυμότερον λαμβάνειν, ἕκαστον τούτων ἕψοντα σὺν ὕδατι ἢ ξηρὸν λεῖον ἐπιπάσσοντα τῷ ποτῷ. ἀγαθαὶ δὲ καὶ αἱ διὰ τῶν ἱδρώτων καθάρσεις διά τε πόνων καὶ λουτρῶν γιγνόμεναι καὶ χρίσμασιν ἐν ἡλίῳ, οἷον τό τε διὰ τοῦ χαμαιμήλου ἔλαιον καὶ νίτρον σὺν ἐλαίῳ. καὶ ὅταν ἐπιδιδῷ ἡ ἕξις, πάλιν καθαίρειν τῇ ἱερᾷ· προσήκει δὲ μηδὲ τῶν ὑποχονδρίων ἀμελεῖν ἀρχόμενον τῆς θεραπείας καὶ μάλιστα προεληλυθότα. 149 πυρίαι μὲν οὖν ἁρμόδιοι δι’ ἐλαίου ἐναφεψημένων αὐτῷ πηγάνου κυμίνου ἀνήθου ἑρπύλλου ἀψινθίου ἀρτεμισίας γλήχωνος ἄγνου σπέρματος δάφνης τοῦ καρποῦ ἢ τῶν φύλλων ἁπαλῶν· ταῦτα γὰρ καὶ τοὺς πόνους παρηγορεῖ καὶ τὰς φύσας μειοῖ. ἐπὶ δὲ τῶν μετὰ δήξεως τοῦ στομάχου ἐκπνευματώσεων ὄξει ἀφεψήσαντες κύμινον καὶ γλήχωνα σπόγγοις πυριᾶν τὸν στόμαχον, ἐνίοτε δὲ καὶ στυπτηρίαν ἐπιπάσσομεν τῷ ὄξει καὶ θερμαίνοντες πυριᾶν τὸν στόμαχον. τὰ δὲ καταπλάσματα ἐχέτω προαπεζεσμένον ἐν τῷ ἐλαίῳ ἢ ἄνισον ἢ σελινόκοκκον ἢ κύμινον καὶ κύπερον λειοτάτην καὶ ἶριν καὶ λιβανωτίδα ἐμβάλλων τῷ καταπλάσματι. συγχωρεῖν δὲ ἐπιπολὺ προσκεῖσθαι καὶ ἀσίτῳ καὶ τραφέντι. ἀφαιρεθέντος δὲ τοῦ καταπλάσματος σκέπειν τὰ ὑποχόνδρια ἢ ἐρίῳ πλατυτάτῳ ἢ κουφοτάτῃ καὶ καθαρᾷ ἀρνακίδι προυποχρίων τοὺς τόπους ναρδίνῳ· χρήσαιο δ’ ἂν καὶ σικυῶν προσθέσει, πρὸς μὲν τὰ ἀφλέγμαντα κούφαις, πρὸς δὲ τὰς φλεγμονὰς καὶ σκληρίας μετὰ κατασχασμοῦ μετὰ δὲ ταῦτα ταῖς διὰ κυπρίνου κηρωταῖς χρῆσθαι καὶ τῷ πολυαρχίῳ

20

25

5

10

15

17 διδόναι – διουρητικῶν cf. Or.a ib. (ib. 249,12) Paul. ib. (24) 21sq. ἀγαθαὶ – καθάρσεις] Or.a ib. (ib. 12–13) Paul ib. (24–25) 24–149,18 προσήκει – χρῆσθαι cf. Or.a ib. (ib. 13–24 [nonn. om. vel mut.]) Paul. ib. (25–158,6) 17 post διουρ.: πάντων οἷον P x 18 supra πετροσ.: σύνες, supra ἀσάρου : πουραγγίου scripsit P x νάρδων M o P ω 19 μαράθρου P a P x P (Gal.) τὴνI om. α (Gal.), exc. La δὲ (τε P) om. φ 20 ἕψοντας P a ….ῶντας P x A …ῶντα C p P ω συνέψοντες M o 21 …σσοντας P a 21sq. καθ.] κενώσεις ω 22 ἡλίῳ] ἐλαίω La P 23 ἔλαιον] ἐλαίου La ω νίτρων C p …ου La P x A ω 24 τῆ ἑξῆς P x A post ἱερᾷ: ὡς (ἣ S) εἴρηται Ῥούφου ἢ Ἀρχιγένους ἢ Ἰούστου M o supra scr. m. 2a S sq. εἴρηται δὲ ἡ σ〈κευασία〉 αὐτῶν ἐν τῶ τρίτω λόγω κεφαλαίω ρ̅ι̅ε̅ (ρ̅ι̅ϛ̅ supra scr. m. 2) S Ἔμπλαστρος εἰς τὸ προσκαλεῖν ἱδρῶτας δέχεται σάνδαλα λευκὰ κτλ. P x μηδὲν τὴν P x μὴ tant. M o 25 …μένης P x χ στοχαζόμενον ω (Gal.) προσεληλυθυίας P προσ…θότα La C p P ω om. sed. spat. vac. M o 149,1 ….ψημένου C p …ηψημ. P …εψημένω M o ἀφεψ…νων At ante αὐτῷ: ἐν C p ω (Gal.) αὐτῆ At om. P spat. vac. M o 1sq. ante κυμίνου: καὶ La 1sq. κυμ. om. C p P x At (Gal.) supra scr. m. 2a S 2sq. σπέρμα M o A …ατα ω 3 τοὺς κάρπους M o ω 5  ἀφεψ. ὄξει transp. P a 6 …σσωμεν P a P x M o 7 καὶ θερμ. πυριᾶν (…ιῶμεν P x M o A) τ. στ. om. C p P ω (Gal.) deleverim 8 …μένων A ….νω P x ἢI om. C p P x P σέλινον α Gal., exc. La 9 ἐμβάλλειν P a C p M o P ..βαλεῖν P x ….ὼν A ω (Gal.) 10 προκ. P a om. At m. 1a S (Gal.) 12 καθ. ἀρνακ. καὶ κουφ. transp. P a καὶ] ἢ P om. S καθαρῶ P ω 13 ῥοδίνω La χρήσαις M o προχρίσαιο P χρίσαις (ex χρήσ. ut vid.) S χρήσεων At -στέον Gal. συκυιῶν A συκιῶν P 13sq. ἀφλέγμ.] πνεύματα α (Gal.), exc. La 14 κούφεις La …εων P At …φων Gal.

VI 10 Therapy of those who suffer from melancholia | 125

5

10

15

20

25

so that I even know that some have been released from the disease just through this (remedy). One should also give of diuretics, from dill, wild carrot, parsley, hazelwort and from spikenard and more than these (one should apply) the seed and the root of horse-fennel. One has to take ground-pine and germander more readily, cooking each of these with water or sprinkling it upon the potion when dry and smooth. Also good are the purgations through sweat which are brought about through hard work and bathing and through anointing in the sun, such as the oil made of camomile and sodium carbonate with oil. And if the condition (of the patient) allows it, one again needs to purge with the holy remedy. It is appropriate not to lose sight of the hypochondria when starting with the therapy and especially as one proceeds. | So, 149 applications of heat made of oil are suitable, when rue, cumin, dill, tufted thyme, wormwood [apsynthion], wormwood [artemisia], pennyroyal, the seed of the chastetree, the fruit or the soft leaves of sweet bay have been boiled down in it [scil. the oil]. For these sooth pains and diminish flatulence. In flatulence together with biting of the stomach, one should boil down cumin and pennyroyal in vinegar and, afterwards use it for the application of heat to the stomach through sponges; sometimes we also sprinkle an astringent substance on the vinegar and, warming it, use it for the application of heat to the stomach. One should have poultices and, after having boiled them [scil. the following substances] down in oil beforehand, one should throw into the poultices either dill or the seed of celery or cumin and nutgrass and the smoothest iris and rosemary. In general, it is allowed that these (poultices) are placed both on a patient who fasts and on one who eats. After the poultices have been removed, one has to cover the hypochondria either with a very broad piece of wool or with a very light and clean sheepskin coat, after having anointed the parts with spikenard beforehand. One may also use the application of cupping instruments: for those parts, on the one hand, that are free from inflammation, (one has to

126 | Aetii Amideni Libri medicinales VI 10, p. 149.16–150.16 Olivieri

καὶ τῷ διὰ στύρακος καὶ τῷ διὰ σπερμάτων μάλιστα καὶ τοῖς ὁμοίοις· προιούσης δὲ τῆς θεραπείας καὶ τῷ διὰ τῶν ἰσχάδων καὶ νάπυος φοινιγμῷ χρῆσθαι· πάνυ γὰρ ὀνίνησι· καὶ γὰρ καὶ τὰς πέψεις ἀνακαλεῖται ῥώμην τῇ γαστρὶ ἐντιθεὶς καὶ εἴ τις πόνος ἐγκαταλείπεται τῷ ὑποχονδρίῳ, τοῦτον ἐξαίρει. χρῆσθαι δὲ καὶ τοῖς δριμέσι σμήγμασι κατὰ τῶν ὑποχονδρίων καὶ τῷ τῶν πιττωτῶν φαρμάκῳ, τουτέστι πίσση ξηρὰ τετηκυῖα καθ’ ἑαυτὴν ἢ μετὰ βραχυτάτου ἐλαίου. θερμὴ δὲ ἐμπλάττεται δέρματι καὶ ἐπιτίθεται τῇ γαστρὶ καὶ τῷ μεταφρένῳ καὶ ἐᾶν μέχρις αὐτόματον ἀποπέσῃ, ὥστε καὶ συλλούεσθαι αὐτῷ ἐγχωρεῖ καὶ τὸ κατὰ βραχὺ ἀφιστάμενον ψαλίδι ἀφαιρεῖν. πάνυ δὲ ὠφελοῦνται καταπλασσόμενοι βολβίτοις ἀγελαίας βοὸς ξηροῖς ἐμπασσομένοις ὀξυμέλιτι καὶ βολβοὶ δὲ μετὰ νίτρου ἢ στυπτηρίας λεῖοι καταπλασσόμενοι μεγάλως ὠφελοῦσι. καὶ μιγνύμενον δὲ τοῦτο τοῖς βολβίτοις ὠφέλιμον γίγνεται καὶ μάλιστα 150 ἐπὰν δήξεως αἴσθησις αὐτοῖς περὶ τὸν στόμαχον εἴη. ἐφ’ ὧν δὲ συνεχῶς παλμοὶ τοῦ σώματος ἐνεδρεύουσι, συμφέρει καὶ τοῦ καστορίου πίνειν καὶ χρίειν τὸ στόμα καστορίῳ σὺν ἐλαίῳ καὶ τῷ Σικυωνίῳ. προσήκει δὲ καὶ κινεῖσθαι καὶ γυμνάζεσθαι αὐτοὺς πρὸς δύναμιν πρὸ τῶν σιτίων. λουτρὰ δὲ τῷ μὲν καλῶς πέττοντι οὐ πάνυ ἀναγκαῖα, εἰ μὴ κόπον τινὰ θεραπεῦσαι βουληθείης. ὅστις δὲ οὐκ ἀγαθὴν ἔχει τὴν κοιλίαν εἰς πέψιν, τούτῳ συμφέρει λούεσθαι συνεχέστερον ἢ νήστει ἢ μετὰ τὴν τελείαν πέψιν· μετὰ δὲ τὰ λουτρὰ σιτία διδόναι εὔπεπτα ἄφυσα διαχωρητικὰ ἀκριβῶς κατανοῶν ὅπως ἐφ’ ἑκάστου διατίθεται ὁ πάσχων· οὐ γὰρ πάντες πρὸς ἅπαντα τὰ σιτία ὁμοίως διάκεινται. τὸ δ’ ἐπίπαν ἁρμόδια τούτοις ἄρτων μὲν οἱ κλιβανῖται καλῶς ἐσκευασμένοι, πτηνῶν δὲ τὰ ἀπίμελα καὶ ἄβρομα καὶ ὄρεια, ὠὰ ἀλεκτορίδων ἁπαλά, ἰχθύων οἱ πετραῖοι καὶ οἱ ἁπαλόσαρκοι, ἐχῖνοι δὲ θαλάττιοι πλεῖστον προὔχουσιν εἰς ἡδονὴν καὶ εἰς ὠφέλειαν· παραιτεῖσθαι δὲ τὰ ἐν ταῖς λίμναις διαιτώμενα πάντα καὶ τὰ ἐν τοῖς ἕλεσι. κρέα δὲ ἁρμόδια ἐρίφεια καὶ γαλαθηνὰ καὶ τούτων αὐτῶν μᾶλλον τὰ ἄκρεα μόρια καὶ κάτεφθα. 149,20–23 χρῆσθαι – μεταφρένῳ cf. Or.a ib. (ib. 25–26) ib. (158,28)

20

25

5

10

15

150,11sq. πτηνῶν δὲ τὰ ἀπίμελα cf. Aret.

16 post ὁμ.: ὧν τὰς τοιαύτας σκευασίας νυνὶ ἐροῦμεν. τῶν νῦν ῥηθέντων κηρωτῶν καὶ ἐμπλάστρων σκευασία· ἡ διὰ κυπρίνου κτλ. P x 18 γὰρI om., ὀνήσει ω (Gal.) γὰρ καὶ om. ω (Gal.) 19 ἀντίθησι P x A ….λείπηται P x ἐγκαλύπτεται P 21 πιπτόντων P x πιττώντων A 24 …πέσει P x A ω …σοι (Gal.) Ald. 26 ἀγελαίου P om. C p ω (Gal.) ἐμπλασσ. P x A ω (Gal.) 27 ante μετὰ: πυροὶ M o πυρροὶ A πυρὶ P x 28  μιγνυμένων ω (Gal.) τούτων ω (Gal.) ὠφέλιμοι γίγνονται Gal. 150,1 εἴη ante περὶ transp. P a 2  σπασμοὶ ω (Gal.) συνεδρ. χ ψ ω (Gal.) 3 καὶ (om. P a) τῷ om. ω (Gal.) fort. recte 6 …θείη C p At …θῆ P 7 τοῦτο χ At νήστης P x A νῆστις La C p M o ω (Gal.) 8 δίδομεν At (Gal.) 8sq. ante διαχ.: καὶ P x A 9 πῶς M o om. La ἀφ’ C p M o ω (Gal.) …στω P a …η At 11 αὐτοῖς ω (Gal.) 12 ἄβρωμα P a χ P S ὠὰ] ὡς La At 13 καὶ οἱ ἁπ. om. P οἱII om. A post πλεῖστον: ἃ La 14 εἰςII om. P a A At δὲ om. At (Gal.) 15 δὲ om. ω (Gal.) 16 γαλαθήνεια La χ ω τούτων om. La αὐτ. om. P a P ω (Gal.) ἀκροκωλ ´ P a ἀκραῖα P

VI 10 Therapy of those who suffer from melancholia | 127

5

10

15

20

25

30

use) dry (cupping), for inflammations and hardness, on the other, (one has to use cupping) with scarification and afterwards one has to use salves made of henna and the remedy invented by Polyarchus and that made of storax and that made of seeds especially, and suchlike. As the therapy proceeds, one should also use the irritation of the skin through dried fig and mustard. For it is very useful: that is to say, it also restores digestion to health by giving strength to the stomach and if some pain remains in the hypochondrion it removes it. One should also use sharp soaps around the hypochondria and the remedy of those who apply pitch-plasters, that is to say dry pitch which is dissolved in itself or with very little oil. When warm, it is plastered over the skin and it is laid on the stomach and the back and one may leave it there until it falls off by itself, so that it is possible to bathe with it and to remove with scissors the part of it which stands a little aloof. Very useful when applied as a poultice together with the dry dung of a cow belonging to a herd, which is smeared on with oxymel, are also purse-tassels with sodium carbonate or astringent substances when they are smooth. And when this is mixed with the dung it becomes useful and especially so | if they have a sensation of biting around the stomach. For 150 those whom palpitation of the body constantly accompanies, it is useful also to drink of castoreum and to smear the mouth with castoreum together with oil, that is to say with Sicyonian oil. It is appropriate that they move and do gymnastics according to their strength before the meal. Baths are not quite necessary for those whose digestion works properly, if you do not want to cure some weariness. As regards a patient who has a digestive tract that is not serviceable for digestion, it is useful to bathe him very frequently, either when he is fasting or after the complete digestion. After the baths you have to give food that is easy to digest, that causes no flatulence, that is laxative, and you have to observe exactly what disposition the patient is in in each case. For not all are in the same disposition towards all foodstuffs. In most cases, of breads, on the one hand, those which are baked in a pan and are well prepared are suitable for them; of poultry, on the other, that which has no fat and is free from smell and comes from the mountains; (further) soft-boiled eggs of hens, of fish those living around the rocks and having soft flesh, but the sea urchins offer the most for pleasure and benefit. One needs to decline anything that lives in meres and marsh meadows. Flesh of kids and of young sheep is suitable, and of these rather the outermost parts and having been boiled. Not useless are also the wombs and the

128 | Aetii Amideni Libri medicinales VI 10, p. 150.17–151.17 Olivieri

οὐκ ἀχρεῖον δὲ καὶ μῆτραι καὶ γαστέρες καὶ πόδες ὑῶν. λαχάνων δὲ πρὸς μὲν τὴν κοινὴν δίαιταν τὰ γλυκέα, τὰ δὲ δριμύτερα ὡς φάρμακόν ποτε δοτέον, οἷον ἕλειος ἀσπάραγος πετροσέλινα καὶ τὰ ὅμοια. μέτρια δὲ ἔστω τῷ πλήθει τὰ λαμβανόμενα πάντα. οἶνος δὲ λεπτὸς καὶ λευκὸς καὶ μὴ πάνυ παλαιός. μὴ ἀθρόον δὲ διδόναι ἐπὶ τῇ τροφῇ τὸ ποτόν, μηδὲ πλῆθος ἔστω τὸ πινόμενον, ἵνα μὴ ἐπιπολάζῃ τὰ σιτία· οὐ χεῖρον δὲ πρὸς τὰ παρόντα καὶ ὄξους ἐπιρροφεῖν δριμυτάτου ὅσον κοχλιάριον καθεύδειν μέλλοντα μετὰ πᾶσαν τροφὴν καὶ τὰ πολλὰ τῶν ὄψων εἰς αὐτὸ ἀποβάπτοντα ἐσθίειν. ἄμεινον δὲ μεμῖχθαι τῷ ὄξει σκίλλης βραχὺ καὶ πηγάνου καὶ τῆς λεπτῆς ἀριστολοχίας ἢ τῆς στρογγύλης < α̅· σὺν οἴνῳ δοτέον. Ποσειδωνίου. ἁρμόδιον δὲ πρὸς τὰς γιγνομένας ἐμπνευματώσεις ὀξυπόριον τοιοῦτον σκευάζειν· Λιβυστικοῦ σελίνου σπέρματος ζιγγιβέρεως 151 θύμου ἀνὰ Γʹ α̅ μέλιτος ἀπηφρισμένου τὸ ἀρκοῦν· δίδου κοχλιαρίου τὸ ἥμισυ ἕωθεν καὶ ἑσπέρας ὁμοίως· εἰ δὲ ἀποστρέφοιντο τὴν τοῦ μέλιτος γλυκύτητα, ἅλας πεπτικὸν αὐτοῖς σκευάζειν τοιοῦτον· σκίλλης ὀπτῆς Γʹ α̅ ἁλῶν ἀμμωνιακῶν Γʹ ε̅ σελίνου σπέρματος μαράρθου θύμου πετροσελίνου ἀνίσου σίνωνος ζιγγιβέρεως ἀνὰ < δʹ ἄρτου καθαροῦ ξηροῦ Γʹ ε̅ πεπέρεως Γʹ α̅ϲ̅· ἐκ τούτου δίδου ὅσον κοχλιάριον ἐσθίειν σὺν τῇ τροφῇ ἢ ὡς βούλεται. διδόναι δὲ αὐτοῖς χρὴ ἐκ διαστημάτων τινῶν καὶ τῆς θηριακῆς ἀντιδότου καὶ μάλιστα χειμῶνος καὶ ἔαρος ἀρχομένου. Ῥούφου. ἐμείτωσαν δὲ ἐκ μειζόνων διαστημάτων μὴ ἀπὸ σιτίων, ἀλλ’ ἀπὸ ῥαφανίδων νήστεις ἢ ὀριγάνου ἢ θύμου, μὴ μέντοι τοῖς δραστηρίοις ἐμετικοῖς κεχρῆσθαι· βλαβερὰ γὰρ τὰ τοιαῦτα ἐπὶ τούτων ταλαιπωρίαν προστιθέντα τῇ γαστρὶ καὶ τῷ στομάχῳ ἤδη προπεπονηκόσι τῇ νόσῳ. ὁρῶνται γάρ τινες ἐκ τῶν δραστικωτέρων ἐμετικῶν ἁλισκόμενοι τῇ μελαγχολίᾳ. εὖ γε μὴν εἰδέναι χρὴ ὅτι πολλοὶ τῶν οὕτω νοσούντων ἐν μὲν τῷ καιρῷ τῆς θεραπείας οὐδέν τι ὠφελήθησαν, ἀφεθέντες δὲ κατέστησαν τῷ προθεραπεύεσθαι καλῶς ἰσχυσάσης τῆς φύσεως κατὰ τῶν νοσημάτων ἀσθενῶν τῇ βοηθείᾳ γεγενημένων. διόπερ χρὴ ἄνεσιν 23–26 καὶ – ἀριστολοχίας Or.a ib. (ib. 4–6) Paul ib. (157,15–18) προλεπτυνθέντων] Ruf. id. 359–360

20

25

5

10

15

151,9–20 ῥούφου –

17 ἀχρεῖαι ω (Gal.) 19 …αγγος P x A ….σέλινον P x A …λιν ´ P 20 ἐστι ω (Gal.) 20sq. λευκὸς καὶ λεπτὸς M o A At 21 δὲ om. P x A 22 ἔστωαι m. 1a P 23 παρ.] πάντα M o S 24 post καθεύδ.: δὲ P x A 25 μιχθὲν ω (Gal.) 26 ….στολοχ ´ P a P ..χης Cp P x A ω (Gal.) 26sq. ἢ –δοτέον om. C p ω (Gal.) 28  Ποσειδ. om. P a C p P x A in marg. Ποσειδ. ὀξυπόριον ἄφυσον M o in marg. Π. ἄφυσσον P 29 λιγ. P x M o σελ. σπέρμα P a M o σπέρματος (…μα At) σελίνου P ω 29–151,1 ζιγγ. – Γʹ α̅] μαράθρου θύμου ἀνίσου πετροσελίνου σίνωνος ζιγγιβέρεως ἀνὰ < δʹ ἄρτου καθαροῦ (p. 151, ll. 4–5) P a 151,3 τοιοῦτο C p M o 4 σπέρμα La M o 5 ζιγγιβ.] σμυρνείου P om. At 6 ϲ om. C p M o ψ 7 ἢ om. χ ψ ω ante χρὴ: ὡς ω (Gal.) post χρὴ: κοχλιάριον ἐσθίειν σὺν τῇ τροφῇ Gal. 9 Ῥούφου in marg. M o om. P a C p μὴ] καὶ Gal. 10  νήστης A S …ις C p M o At (Gal.) 12 προτιθ P x A 14 ante χρὴ: δὲ P x A 15 τοι P om. P a At 16 τῷ] τὸ P a P x A ω (Gal.) προτεθεραπεῦσθαι P a P x P ..ύεσθαι M o …πευσθῆναι C p

VI 10 Therapy of those who suffer from melancholia | 129

5

10

15

20

25

30

stomachs and the feet of pigs. Of vegetables, one needs to give in view of the general regimen, on the one hand, the sweet ones; the sharper ones, on the other, one needs to give as a remedy, for example marsh-asparagus, parsley and suchlike. Everything that is taken needs to be moderate in amount. Wine needs to be thin and white and not very old. One should not apply the drink all at once during the meal and neither should that which is about to be drunk be a great amount, so that the food (that was ingested) does not come up again. It is not worse that one who is about to sleep after the meal swallows in addition to what is already at hand also of the sharpest vinegar as much as fits on a spoon and eats all of the dishes after they have been dipped into it. It is better to mix a bit of squill with the vinegar and of rue and of fine or round birthwort one drachma. One needs to give it with wine. From Posidonius: It is suitable to prepare the following quick-passing remedy for flatulence that occurs: of bastard lovage, seed, ginger, | thyme up to one drachma, 151 the appropriate amount of skimmed honey: give half of a spoonful early in the morning and the same in the evening. If they turn away from the sweetness of the honey, you should prepare for them salts, (that is to say) the following remedy promoting digestion: of broiled squill one uncia, of rock salts five unciae, of celery, seed, fennel, thyme, parsley, dill, stone parsley, ginger up to four drachmae, of pure and dry bread five unciae, of pepper one uncia: thereof you should give as much as fits on a spoon to eat together with the food or as he likes. It is necessary to give them at intervals also of the theriac and especially in winter and in the beginning of spring. From Rufus: They should vomit at greater intervals not after food but, when fasting, after radish or oregano or thyme but one should not use drastic emetics. For such are harmful for them, insofar as they put additional stress on the belly and the stomach which are already suffering before through the disease. For some can be observed to be caught by melancholia from (taking) rather drastic emetics. It is necessary to know exactly that many of those who suffer in this way did not, on the one hand, derive advantage in the actual moment of the treatment, but, on the other, after they had been let go they came into a healthy state again through having been treated in a good way before, because their nature regained its strength, while the affections have been made weak through the therapy. Therefore one needs to give

130 | Aetii Amideni Libri medicinales VI 10, p. 151.18–20 Olivieri

διδόναι τῇ φύσει. ἔοικε γὰρ συνταλαιπωρεῖσθαι ταῖς θεραπείαις, ἰσχύειν δὲ ἐν τῇ ἀναπαύσει καὶ κρατεῖν τῶν νοσημάτων ἤδη προλεπτυνθέντων. 19sq. προλελεπτυνθέντων La ω Ω“ τούρπετον ἐξΓ ς κτλ. P x

20

19sq. post προλεπτ.: Bοήθημα εἰς μελαγχολικούς· ἀγαρικὸν ἐξΓ σ

VI 10 Therapy of those who suffer from melancholia | 131

nature time to relax. For, it seems to suffer additional stress together with the treatments, but to be strong during rest and to rule over the affections when they have already been mitigated.

Commentary VI 1 On hydrokephaloi from Leonides Introduction to the disease concept hydrokephalos As is clear from its name, the disease concept denoted by the noun ὑδροκέφαλον involves the presence of water (ὕδωρ) in the head (κεφαλή). It is perhaps no surprise that this defining characteristic appears in all of the ancient texts that deal with the disease. Our main sources1 for discussions of hydrokephalos in the medical literature are Celsus’ De medicina, Soranus’ Gynaeciorum libri, pseudo-Soranus’ Quaestiones medicinales, the pseudo-Galenic treatises Definitiones medicae and Introductio sive medicus, and, most extensively, the chapters on this topic found in the compilations of Oribasius, Aetius, and Paul. In addition to Aetius’ chapter in the sixth book of his work there is also a chapter on hydrokephalos in the fifteenth book of his Libri medicinales which needs to be taken into account (on the relationship between these two, see in more detail p. 137 – 139). For a closer look at a number of papyri which deal with hydrokephalos in a question-and-answer form (erotapokriseis) – which also share important similarities with the other medical texts on the topic – see Hanson 2003, 210–217, Hanson & Mattern 2001. Celsus mentions hydrokephalos in the context of headache, stating that one type of this illness may become chronic; this variant involves a fluid which causes the scalp to swell and which the Greeks call ὑδροκέφαλον.2 In Soranus’ Gynaeciorum libri, hydrokephalos (referred to here as ὑγροκέφαλον) appears in the context of childbirth, with it being said that one needs to make an incision in the hydrokephalos if the fetus is suffering from this illness in order to reduce the circumference of its head.3 In the pseudo-Soranian Quaestiones medicinales,4 hydrokephalos is defined as a watery or bloody gathering of fluid in any part of the head or in the whole head.5 As a surgical therapy, the treatise recommends making incisions to the head in order to allow the fluid to flow off. It also discusses the procedure that should be conducted if the fluid gathers underneath the muscle, as well as providing postsurgical advice; in this latter context, a bandage is mentioned that is referred to as

1 There are also other texts which refer to the gathering of water in the head. See e.g. Hippocrates, De morb. 2.15 (149.1–150.7 Jouanna = 7.26.24–28.21 L.). A passing mention of hydrokephalos is also found in Aretaeus 4.1.13 (64.33 Hude). 2 See Celsus, De med. 4.2.4 (152.16–19 Marx). 3 See Soranus, Gyn. 4.11.3 (142.12–14 Ilberg). 4 On Pseudo-Soranus’ Quaestiones see Fischer 2017 in Sorani quae feruntur Quaestiones, 11–18. Fischer suggests that the treatise was written between the first century BCE and the third/fourth century CE. The treatise is written in the format of ἐρωταπόκρισις (question and answer). 5 See Pseudo-Soranus, Quaestiones 336 (325.14–16 Fischer).

VI 1 On hydrokephaloi from Leonides

|

133

“bunny without ears” (lepus sine auribus).6 The pseudo-Galenic Definitiones medicae explain hydrokephalos as a gathering of watery fluid,7 while the likewise pseudoGalenic Introductio distinguishes four forms of hydrokephaloi which are also dealt with later in the chapters on hydrokephalos by the three compilers. The author has it that hydrokephalos may be located between the brain and the dura mater, between the dura mater and the bone, between the bone and the pericranium or between the bone and the skin.8 The recommended therapy is the emptying of the hydrokephaloi by making surgical incisions, although the type in which the fluid is found between the dura mater and the brain is said to be incurable.9 As we will see both later in this introduction and in the detailed commentary below, the information on hydrokephalos provided by the texts summarized above shares many general similarities to the accounts given by the compilers. While none of these references to hydrokephalos amount to much more than passing mentions, the most detailed accounts of the affections are preserved in the treatises of Oribasius, Aetius, and Paul. Oribasius claims to be citing from Antyllus in his chapter on hydrokephalos (Ἐκ τῶν Ἀντύλλου. Περὶ ὑδροκεφάλων),10 while Aetius claims that he cites from Leonides both in the chapter found in his sixth book (Περὶ ὑδροκεφάλων Λεωνίδου)11 and in the chapter found in the fifteenth book (Περὶ ὑδροκεφάλου, Λεωνίδου).12 Paul, by contrast, does not mention his source by name. As Witt has convincingly pointed out, a joint reference to Paul and Antyllus in Rhazes’ Liber continens and verbatim parallels between the chapters in Oribasius and Paul strongly suggest that Paul also used Antyllus as a source.13 However, we can likewise assume that Paul was using Oribasius directly, or he was using Antyllus and Oribasius, or he was using Antyllus, Oribasius, and Aetius (on this issue, see also p. 138 f.). If we assume that the references to sources in Oribasius and Aetius are reliable (for more on this problematic question, see p. 14) then these chapters may give a sense of the otherwise lost theories of Antyllus and Leonides concerning hydrokephalos, albeit a sense that is filtered through the lenses of the compilers. These four chapters each offer a different account of hydrokephalos (especially with regard to the level of detail), although there are certain similarities to be found across them: all four chapters connect hydrokephalos to the action of midwives,14 all four

6 See Pseudo-Soranus, Quaestiones 337.1–2 (326.1–327.2 Fischer). 7 See Pseudo-Galen, Def. med. 390 (19.442.15–17 K.). 8 See Pseudo-Galen, Introd. s. medic. 19.3 (91.21–92.4 Petit = 14.782.14–17 K.). 9 See Pseudo-Galen, Introd. s. medic. 19.4 (92.9–13 Petit = 14.783.4–7 K.). 10 See Oribasius, Coll. med. rel. 46.28 (Vol. 3, 237.25 Raeder). 11 See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.2 Olivieri). 12 See Aetius Amid., Libri med. 15.12 (34.12 Zervos). 13 See Witt forthcoming, 14, 16. 14 See Oribasius, Coll. med. rel. 46.28.1 (Vol. 3, 237.26 f. Raeder), Aetius Amid., Libri med. 6.1 (Vol. 2, 123.13 f. Olivieri), Libri med. 15.12 (34.22–35.1 Zervos), Paul 6.3.1 (Vol. 2, 46.11–13 Heiberg).

134 | Commentary

speak of the development of a swelling (ὄγκος),15 they all mention the same or nearly the same range of localizations of the fluid in the head,16 and they all recommend the same surgical therapy for the affection.17 In a few passages, we find verbatim parallels between the different chapters.18 Nevertheless, Witt suggests that none of the passages in these chapters strongly suggest a dependence between Antyllus and Leonides and that the similarities just noted can be explained instead by the fact that the authors may all have used similar medical books and were relying on the consensus of general medical knowledge.19 The chapters on hydrokephalos in Aetius’ Libri medicinales (books VI and XV) are both more detailed than the chapters in Oribasius and Paul with regard to the etiological considerations relating to the disease. Aetius’ chapters both explicitly distinguish between hydrokephaloi that occur due to an invisible cause and those

15 See Oribasius, Coll. med. rel. 46.28.3 (Vol. 3, 237.35–37 Raeder), Aetius Amid., Libri med. 6.1 (Vol. 2, 123.22 Olivieri), Libri med. 15.12 (35.6 Zervos), Paul 6.3.1 (Vol. 2, 46.18 Heiberg). 16 See Oribasius, Coll. med. rel. 46.28.2 (Vol. 3, 237.29–33 Raeder), Aetius Amid., Libri med. 6.1 (Vol. 2, 123.15–19 Olivieri), Libri med. 15.12 (35.1–5 Zervos), Paul 6.3.1 (Vol. 2, 46.15–18 Heiberg). 17 See Oribasius, Coll. med. rel. 46.28.8–16 (Vol. 3, 238.22–239.7 Raeder), Aetius Amid., Libri med. 6.1 (Vol. 2, 124.9–125.3 Olivieri), Libri med. 15.12 (35.17–37.18 Zervos), Paul 6.3.2 (Vol. 2, 47.3–14 Heiberg). For a discussion of surgery of the skull in antiquity, see Jackson 2005, especially 116 dealing with hydrokephalos. 18 For the following list, compare also Witt forthcoming, 15 f. The mention of watery fluid (ὑδατώδες ὑγρόν), for example, occurs in both chapters of Aetius’ Libri medicinales, as well as in Paul’s chapter [see Aetius Amid., Libri med. 6.1 (Vol. 2, 123.3 Olivieri), Libri med. 15.12 (34.15 Zervos), Paul 6.3.1 (Vol. 2, 46.11 Heiberg)]; the discussion about hydrokephaloi occurring through an invisible cause (ἐξ ἀδήλου αἰτίας) is likewise found in these three texts [see Aetius Amid., Libri med. 6.1 (Vol. 2, 123.5 f. Olivieri), Libri med. 15.12 (34.17 Zervos), Paul 6.3.1 (Vol. 2, 46.13 Heiberg)], as is the reference to the fluid being inert (ἀργόν) [see Aetius Amid., Libri med. 6.1 (Vol. 2, 123.5 Olivieri), Libri med. 15.12 (34.16 Zervos), Paul 6.3.1 (Vol. 2, 46.14 Heiberg)], and the mention of the porosity of the vessels (ἀραιοῦσθαι / ἀραίωσις) [see Aetius Amid., Libri med. 6.1 (Vol. 2, 123.6 Olivieri), Libri med. 15.12 (34.18 Zervos), Paul 6.3.1 (Vol. 2, 46.14 f. Heiberg)] and their bursting (ῥηγνύναι / ῥῆξις) [The bursting is not explicitly mentioned in Aetius’ fifteenth book. See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.10 Olivieri), Paul 6.3.1 (Vol. 2, 46.13 Heiberg)]. All four chapters mention that the swelling that occurs if the fluid gathers between the skin and the pericranium is uniform in color (ὁμόχρους), not painful (ἀναλγής / ἀνώδυνος) and soft (εὐαφής) [see Aetius Amid., Libri med. 6.1 (Vol. 2, 123.23 Olivieri), Libri med. 15.12 (35.6 f. Zervos), Oribasius, Coll. med. rel. 46.28.3 (Vol. 3, 237.35 Raeder), Paul 6.3.1 (Vol. 2, 46.18 f. Heiberg)]. Oribasius and both chapters in Aetius discuss the separation of the sutures of the skull (αἱ ῥαφαὶ … διίστανται) [see Aetius Amid., Libri med. 6.1 (Vol. 2, 124.7 Olivieri), Libri med. 15.12 (35.13 f. Zervos), Oribasius, Coll. med. rel. 46.28.6 (Vol. 3, 238.13 f. Raeder). Paul mentions the porosity of the sutures: see Paul 6.3.1 (Vol. 2, 46.27 Heiberg)]. Paul and both chapters in Aetius mention the use of tamponades (διαμότωσις / διαμοτοῦν) in the post-operative treatment [see Aetius Amid., Libri med. 6.1 (Vol. 2, 124.19 Olivieri), Libri med. 15.12 (35.23 Zervos), Paul 6.3.2 (Vol. 2, 47.11 Heiberg)]. 19 See Witt forthcoming, 15 f., 47. See also Hanson 2003, 201; Hanson & Mattern 2001, 80. Witt argues here against Wellmann, who suggested that Leonides was the main source for Antyllus (and Heliodorus and Archigenes). See Wellmann 1895, 16–18.

VI 1 On hydrokephaloi from Leonides

|

135

that occur due to a manifest cause, providing examples for each.20 This distinction is taken up again within the present chapter with a remark that is found in none of the other chapters.21 Both chapters in Aetius take account of the temporal muscle in their discussion of hydrokephalos, while this muscle is only cursorily mentioned in Oribasius22 and not at all in Paul. In comparison to the discussions in Oribasius and Paul of the symptoms that are connected to the different possible localizations of the fluid in the head, Aetius’ discussion is less detailed in parts. This is the case especially for the remarks given about the gathering of the fluid between the bone and the dura mater. While the remarks about the surgical therapy for the hydrokephalos are, on the whole, comparable in all four chapters (see above), the recommendations given regarding post-operative treatment are rather different: we even find a contradictory recommendation in Oribasius and in Aetius’ sixth book (about the similarity of the therapy to that applied to abscesses).23 The most detailed account of the post-operative treatment of hydrokephaloi is given in the chapter on hydrokephalos in Aetius’ fifteenth book, in which a great deal of information is provided that is not found in any of the other versions.24 It is worth noting that the two chapters on hydrokephalos in Aetius’ Libri medicinales are not as similar as one might expect them to be. Although they share some general similarities, they also reflect the different manners in which Aetius handled his alleged source, Leonides.25 For further discussion of these issues, see p. 137 – 139. Given that the term hydrokephalos is still used in modern medical terminology, it will be necessary to ask to what extent the ancient and modern usages correspond to each other and in what sense they diverge. Comparative research of this sort has been conducted in particular depth by Pandel 1976, Grunert & Charalampaki & Ayyad 2007 and Grunert 2012, and Witt forthcoming, and it will be useful to summarize their findings briefly. The modern medical term hydrokephalos refers to a pathological extension of the ventricles of the brain which is connected to a disturbed circulation of the cerebrospinal fluid.26 The first two forms of hydrokephalos which are distinguished in ancient texts (i.e. the gathering of fluid between the skin and the pericranial membrane and the gathering of fluid between the pericranial membrane and the bone) do not correspond to the modern terminology but rather describe what physicians today would call a hematoma or a cephalohematoma.27 Apart from the terminological difference, the ancient accounts of these two intracra-

20 See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.5–15 Olivieri), Libri med. 15.12 (34.17–35.1 Zervos). 21 See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.24–124.3 Olivieri). 22 See Oribasius, Coll. med. rel. 46.28.12 (Vol. 3, 238.33 f. Raeder). 23 See Aetius Amid., Libri med. 6.1 (Vol. 2, 124.15–17 Olivieri), Oribasius, Coll. med. rel. 46.28.10 (Vol. 3, 238.27–29 Raeder). 24 See Aetius Amid., Libri med. 15.12 (35.25–37.18 Zervos). 25 See also Witt forthcoming, 5 f. 26 See Grunert 2012, 134. 27 See Witt forthcoming, 6 f., Grunert 2012, 142.

136 | Commentary

nial forms seem to meet the modern understanding of these hematomata with regard to localization, origin, and symptomatological descriptions.28 The description of the third form of hydrokephalos discussed in ancient texts (i.e. that in which the fluid gathers between the bone of the head and the dura mater) seems to correspond with the modern terminology of hydrokephalos,29 especially with regard to the increase of the circumference of the head. When occurring in infancy, this is, according to Grunert, nearly exclusively caused by hydrokephalos in the modern sense of the term.30

Structure of the chapter p. 123.2–15: Περὶ – σώματα: The origins of hydrokephaloi The chapter opens with a discussion of the etymology of the affection (it is called hydro-kephalos because of watery fluid that gathers in the head) as well as its origins. The text distinguishes between hydrokephaloi that occur due to an invisible cause and those that occur as a result of a manifest cause. Those hydrokephaloi which are linked to an invisible cause are said to occur “without external agency”, resulting from an increasing porosity of the vessels in the head. If the hydrokephalos is the result of a manifest cause, it happens as a consequence of a stroke or a bruise which causes the vessels in the head to burst. The midwife bruising the head of the child during birth is identified as the most common example of a hydrokephalos that occurs as a result of a manifest cause. p. 123.15–124.9: συνίσταται – ὑγρόν: Localization of fluid in hydrokephaloi These lines discuss several different possible localizations of the fluid in the head that can be observed in hydrokephaloi. 1. The fluid can gather between the skin and the pericranial membrane or the temporal muscle. 2. The fluid can gather underneath the pericranial membrane, between the membrane and the bone of the head. 3. The fluid can gather underneath the skull, between the dura mater and the bone. The different possible locations of the fluid in the head are then explained in more detail. p. 124.9–125.3: χειρουργία – ποιεῖν: Surgery of the hydrokephalos This section of the chapter deals with the surgical procedure which should be applied to patients suffering from hydrokephalos. The same surgical approach is recommended in cases in which the fluid is localized under the skin and those in which 28 See Grunert 2012, 142 f. who praises Oribasius’ text in particular for its excellent description. 29 See Grunert 2012, 143. See also Witt forthcoming, 7. 30 See Grunert 2012, 143 who states: “Das übereinstimmende Merkmal des Typ III „Hydrocephalus“ bei Oreibasios und Aetios scheint der wachsende Kopfumfang mit Sprengung der Knochennähte zu sein. Wenn man sich von diesem Symptom leiten lässt, dann ist die wahrscheinlichste Interpretation, dass sich hinter dem Typ III „Hydrocephalus“ der Hydrocephalus in unserem pathologischen Verständnis mit Erweiterung der Hirnkammern verbirgt.”

VI 1 On hydrokephaloi from Leonides |

137

it is localized between the pericranial membrane and the bone. If the fluid gathers underneath the skull, a different surgical approach is needed. In addition to describing the concrete modes of incision, these lines also provide information on postoperative treatment.

Rationale of the chapter The chapter on hydrokephalos found in the sixth book of Aetius’ Libri medicinales deals with the etiology of the affection (p. 123.5–15), with different possible localizations of the characteristic fluid in the head – and the symptomatology of each (p. 123.15–124.9) – as well as with the appropriate surgical therapy (p. 124.9–125.3). As such, it presents a coherent and comprehensive account of the affection that offers helpful advice to the reader. The section on the appropriate surgery for hydrokephalos makes reference to the part of the chapter in which the different localizations of the fluid are introduced and offers different surgical interventions for each (see p. 124.9–11, p. 124.24, p. 125.1). We also often find passages in which information given at the beginning of the chapter is taken up again later on, with the use of the same terms or derivatives of them (see e.g. p. 123.5: ἀργόν, p. 123.11: ἀργευομένου; p. 123.4: τρυγῶδες ἢ δίαιμον, p. 123.12: τρυγώδη ἢ δίαιμον; p. 123.10: θλάσματος, p. 123.15: θλάσῃ). Such parallels (or implicit cross references, as one might even call them) contribute to the coherence and the readability of the chapter and ensure that the recipients of the information can easily find their way through the material. It is very surprising to find a chapter on hydrokephalos not only in the sixth book of Aetius’ Libri medicinales (dealing with diseases of the head) but also in the fifteenth book dealing with swellings and tumors.31 It is notable that both chapters are said to have been taken from Leonides. This raises the question as to why Aetius as compiler felt it necessary to include the chapter on hydrokephalos twice in different books (although with considerable differences in each case) and why the chapter in the fifteenth book does not appear in the Latin translations of Cornarius and Montanus.32 At the same time, this doubling up of material allows us to compare the two versions with regard to their different foci (which also enables us to make further suggestions about their rationale) and to examine the different use Aetius seems to have made of his source in each case. For a synoptic view of both versions and a short discussion, see also Witt forthcoming, 4–13. To begin with, the chapter on hydrokephalos fits well with the context 31 See Aetius Amid., Libri med. 15.12 (34.12–37.18 Zervos). 32 The manuscripts the two translators draw upon transmit the chapter on hydrokephalos in the fifteenth book, supporting the claim that it is authentic. I am grateful to Irene Calà for discussing this issue with me. It may be that the translators left this chapter out of their own work because they considered a second chapter on the same topic to be redundant, as has been suggested to me by Florian Gärtner.

138 | Commentary

of both books of the Libri medicinales insofar as it deals with an affection that is localized in the head and near the brain, and that, as such, has an impact on the proper functioning of the brain (book six) and consists in a swelling (book fifteen). In spite of this contextual fit, it is noteworthy that the present chapter is slightly different to the others found in the first half of the sixth book (on which see also p. 64 f.) insofar as it is the only one for which extensive brain surgery is recommended as a therapy. However, with the exception of this therapeutical difference, hydrokephalos is far from being an affection that consists only in a swelling that needs to be operated upon and that has no further perceptible effect on the patient. On the contrary, as the present chapter makes clear, patients suffer from a continuous darkening (p. 124.5: σκοτισμοὶ γίγνονται συνεχεῖς), their senses are dimmed (p. 124.5–6: αἱ αἰσθήσεις ἀμβλύνονται) and their head is burdened (p. 124.5: ἡ κεφαλὴ βαρύνεται). These symptoms are perfectly in line with the other chapters found in the sixth book, in which similar symptoms are discussed (see also p. 65 – 67). In the present chapter, the mention of the dimness of the senses is followed by the explanation λέγω δὲ ὅρασις ἀκοὴ καὶ αἱ λοιπαί (p. 124.6), which is not found in the fifteenth book. On the other hand, the chapter on hydrokephalos in the fifteenth book is much more detailed with regard to the appropriate postoperative treatment. This detail might be attributed to the book’s focus on swellings and tumors, many of which need to be treated with surgery and require proper postoperative care.33 For the purposes of the sixth book, it sufficed to mention only the most important features of postsurgical care, while a much more exhaustive discussion is required to meet the purpose of the fifteenth book. Considering these points makes it clear that Aetius adapted the chapter on hydrokephalos he found in his source to the particular aims of the book in which it is discussed. The fact that Leonides’ name is mentioned as the source of both chapters strongly suggests that Aetius did indeed make use of his work and that the reference to him is reliable. Aetius cites Leonides’ discussion of hydrokephalos because he was obviously an expert on surgical matters and he is also cited in such contexts in other chapters of the Libri medicinales (see p. 21 f. for further information on Leonides). While Oribasius (and probably also Paul, see p. 133 f.) used Antyllus in his chapter on hydrokephalos, Aetius seems to have had a clear preference for Leonides’ discussion of the topic, given that he does not mention Antyllus, although in other cases he cites more than one author (see p. 25). Generally, Aetius seems to have preferred Leonides over Antyllus in his Libri medicinales: while the former is cited on twentytwo occasions throughout the work (see p. 21 f.), Antyllus is only cited twelve

33 See e.g. Aetius Amid., Libri med. 15.5 (19.14–20.23 Zervos), Libri med. 15.7 (25.23–26.25 Zervos), Libri med. 15.10 (32.7–26 Zervos).

VI 1 On hydrokephaloi from Leonides

|

139

times.34 Compared to the references to Leonides, the chapters in which Antyllus’ name is mentioned are concerned with general medical interventions such as phlebotomy, cupping, or the application of leeches,35 while the chapters citing Leonides deal with more surgical matters, such as the sugery appropriate for hydrokephalos discussed in the present chapter or the surgery for atheromata and the like in other places.36 To summarize, the chapter on hydrokephalos in Aetius’ sixth book offers an account of the affection that addresses all relevant aspects of its origin, symptomatology, and therapy and that fits well with the broader context of the sixth book.

Commentary p. 123.2: Περὶ – Λεωνίδου: For further information on Leonides, see p. 21 f. For a more detailed discussion of the fact that the fifteenth book of Aetius’ Libri medicinales also contains a chapter on hydrokephalos which the author claims is cited from Leonides, see p. 134 f. and p. 137 f. p. 123.2–3: τὸ – συλλεγομένου: The adjective ὑδατώδες is used here in order to explain the etymology of the affection, since ὑδατώδες and the prefix ὑδρο in ὑδροκέφαλος are derivatives. The emphasis on the etymological considerations in these opening lines also accounts for the presence in the following lines of other characteristic features of the fluid gathering in the head, beyond it being watery. The fact that the fluid gathering in the head and bringing about the affection can be watery explains the name of the affection, but this does not mean that the fluid cannot have other characteristics as well. See also p. 140 f., commentary on p. 123.3–5. We find very similar etymological considerations in the opening of Paul’s chapter on hydrokephalos. Here we read that the hydrokephalos affection takes its name from the peculiarity (ἰδιότης) of the wateriness of the fluid.37 In the pseudo-Galenic Definitiones medicae, the hydrokephalos is similarly described as the gathering of watery fluid (ὑδατώδους ὑγροῦ … συλλογὴ).38 For further considerations about the similarities between the texts, see p. 133 – 135. That the gathering of fluid in the head

34 See Aetius Amid., Libri med. 3.9 (Vol. 1, 268.13 Olivieri), Libri med. 3.13 (Vol. 1, 273.15 Olivieri), Libri med. 3.14 (Vol. 1, 273.26 Olivieri), Libri med. 3.15 (Vol. 1, 274.12 Olivieri), Libri med. 3.20 (Vol. 1, 276.9 Olivieri), Libri med. 3.22 (Vol. 1, 277.19 Olivieri), Libri med. 3.23 (Vol. 1, 277.30 Olivieri), Libri med. 3.122 (Vol. 1, 309.20 Olivieri), Libri med. 7.74 (Vol. 2, 323.5 Olivieri), Libri med. 9.40 (374.24 Zervos), Libri med. 9.42 (387.11 f. Zervos), Libri med. 12.1 (17.15 Kostomiris). See also Bravos 1974, 57 f. 35 See Aetius Amid., Libri med. 3.13 (Vol. 1, 273.15 Olivieri), Libri med. 3.20 (Vol. 1, 276.9 Olivieri), Libri med. 3.22 (Vol. 1, 277.19 Olivieri). 36 See Aetius Amid., Libri med. 15.7 (24.15–26.25 Zervos). 37 See Paul 6.3.1 (Vol. 2, 46.10 f. Heiberg). 38 See Pseudo-Galen, Def. med. 390 (19.442.15 f. K.).

140 | Commentary

is the defining feature of hydrokephalos is also reflected in the frequent usage of the verbs συλλέγεσθαι and συνίστασθαι throughout the chapter.39 p. 123.3–5: κατὰ – ἀργόν: The preceding statement about the name of the affection deriving from the watery fluid that gathers in the head is now supplemented by the three adjectives τρυγῶδες, δίαιμον and ἀργόν, each of which describes further possible characteristic of the fluid. See also p. 139 f., commentary on p. 123.2–3. The adjective τρυγῶδες describes the fluid as being comparable to lees (τρύξ). This comparison may be based on the consistency and/or the color of the liquid, as is suggested by the use of the adjective in both senses in other medical texts.40 It is possible that both meanings are intended simultaneously here. In the pseudoGalenic Definitiones medicae, the same adjective is used to describe the hydrokephalos which results from the gathering of watery fluid or of blood that has a consistency like that of lees (αἵματος τοῦ τρυγώδους συλλογὴ).41 The notion that blood can also gather in the head of those suffering from hydrokephalos is expressed in the present passage by the adjective δίαιμον. Later in the chapter, the mixture of the watery substance with the blood is mentioned again (see p. 123.7–8). While the previously mentioned characteristics are said to apply to the fluid “in most cases” (κατὰ τὸ πλεῖστον) or “sometimes” (ἐνίοτε), the fluid is also said to be “always inert” (ἀεὶ δὲ ἀργόν). We also find the characterization of the fluid as “inert” (εἰς ἀργὴν οὐσίαν) in Paul’s chapter on hydrokephalos,42 as well as in the chapter on hydrokephalos in Aetius’ fifteenth book, where an additional element appears: “in all cases, the fluid is inert, therefore it is not putrefied” (ἐπὶ δὲ πάντων ἀργόν ἐστι τὸ ὑγρόν, διὸ οὐ σήπεται).43 According to Witt, the addition of διὸ οὐ σήπεται in the fifteenth book makes clear that the adjective “inert” means that the fluid is “completely inactive” (“gänzlich inaktiv”) and “is not exposed to any process of transformation” (“keinem Umwandlungsprozeß ausgesetzt”), and that it therefore “does not putrefy” (“kann somit nicht faulen”).44 This explanation does not seem to correspond to the interpretation of the adjective ἀργόν as put forward by the sixteenthcentury commentator Oroscius (see p. 9), who states that the Greek phrase ἀεὶ δὲ ἀργὸν συνίσταται τοῦτο (probably a re-translation into Greek of Montanus’ Latin translation) means that this substance is always “raw” (id est, semper autem materia 39 See Aetius Amid., Libri med. 6.1 (Vol. 2, 123.3 Olivieri), Libri med. 6.1 (Vol. 2, 123.4 Olivieri), Libri med. 6.1 (Vol. 2, 123.5 Olivieri), Libri med. 6.1 (Vol. 2, 123.8 Olivieri), Libri med. 6.1 (Vol. 2, 123.9 Olivieri), Libri med. 6.1 (Vol. 2, 123.15 Olivieri), Libri med. 6.1 (Vol. 2, 123.20 Olivieri), Libri med. 6.1 (Vol. 2, 123.20 f. Olivieri). 40 See e.g. Galen, De loc. aff. 5.8 (8.370.1 f. K.), where the adjective is used in comparison to the adjective παχύς (thick), which suggests a comparison with the consistency of lees. See e.g. Paul 3.67.1 (Vol. 1, 284.11 Heiberg) where the comparison is explicitly with the color of lees (χρόᾳ τρυγώδης). See also Overwien 2014 in Hippocratis De humoribus, 193. 41 See Pseudo-Galen, Def. med. 390 (19.442.15 f. K.). 42 See Paul 6.3.1 (Vol. 2, 46.14 Heiberg). 43 Aetius Amid., Libri med. 15.12 (34.16 f. Zervos). 44 See Witt forthcoming, 6 note 31.

VI 1 On hydrokephaloi from Leonides

|

141

haec cruda est).45 Oroscius probably misunderstands the meaning of ἀργόν in the present passage, which can indeed be used in a general sense to mean “unwrought”, “unprepared for eating”.46 The Latin translations of Cornarius and Montanus, by contrast, translate the passage with semper vero lentus constitit (Cornarius) and semper autem segnis pigerque morbus est (Montanus),47 expressing rather the clumsiness and inactivity of the fluid than any state of being raw. It is noticeable that the phrase ὑγρὸν ἀργὸν is often used to describe the accumulation (e.g. σύστασις, συλλογή) of fluids that takes place in affections such as “hydrocele” (ὑδροκήλη), “umbilical hernia” (ὑδρόμφαλον) or “atheroma” (ἀθέρωμα).48 From this it is clear that a certain degree of inactivity in these fluids is central to the understanding of affections with which they are connected, including the hydrokephalos discussed here. For more on this inactivity, which is later also expressed by the verb ἀργεύεσθαι, see p. 143, commentary on p. 123.11–12. p. 123.5–6: γίγνεται – αἰτίας: The phrase ἐξ ἀδήλου αἰτίας also appears in Paul’s chapter on hydrokephalos but it is not dealt with as systematically there as it is in Aetius’ chapter.49 In the the lines that follow, Aetius provides examples of both types of causes, clarifying what is meant by the distinction between “invisible” (ἄδηλον) and “apparent” (πρόδηλον) causes. See p. 141 f., commentary on p. 123.6– 8, and p. 142 f., commentary on p. 123.9–11. p. 123.6–8: ἐξ – συνισταμένης: These lines spell out what is meant by ἐξ ἀδήλου αἰτίας, used above. This phrase is closely connected to ἐκ τοῦ αὐτομάτου (“without external agency”), which denotes that something happens without a perceptible cause to which the thing happening (such as an affection, a symptom or the like) can be traced back. This sort of meaning is made explicit in, for example, a passage of Galen’s De sectis in which he distinguishes between affections that happen “without external agency” (ἀπὸ ταὐτομάτου) and those whose cause is apparent (ἕτερα δ’ ὧν τὸ μὲν αἴτιον ἐφαίνετ’).50 The former group of affections is characterized by the sentence, “whereas the agent does not have a perceptible cause” (οὐ μὴν τό γε ποιῆσαν αἴτιον αἰσθητὸν ἔχον).51 Similarly, in his In Hippocratis Epidemiarum librum primum commentaria III, Galen explains that αὐτόματα is called that which happens without external cause (τὰ χωρὶς τῆς ἔξωθεν αἰτίας).52 In the present passage, the fact that the vessels in the head may become porous (ἀραιοῦσθαι) is introduced as an example of what happens “without external agency”. That is to say, the porosity

45 See Oroscius, 166. 46 See LSJ s.v. ἀργός (B). 47 See Cornarius, 291; Montanus, 234. 48 See e.g. Pseudo-Galen, Def. med. 407 (19.444.17 K.), Pseudo-Galen, Def. med. 424 (19.447.11 K.), Paul 6.62.1 (Vol. 2, 102.5 f. Heiberg), Aetius Amid., Libri med. 15.7 (24.18 Zervos). 49 See Paul 6.3.1 (Vol. 2, 46.13 Heiberg). 50 See Galen, De sectis 2 (2.13–18 Helmreich = 1.66.2–7 K.). 51 See Galen, De sectis 2 (2.17 f. Helmreich = 1.66.6 K.). 52 See Galen, In Hipp. Epid. I comm. 3.22 (138.21 Wenkebach = 17a.276.7 f. K.).

142 | Commentary

of the vessels cannot be explained adequately by reference to an external cause either because there is none or because there is none that is perceptible to the physician. The complete process (the vessels first become porous and then, as a consequence, the watery substance is pushed out of the vessels and gathers in one place in the head, bringing about the hydrokephalos) is thus referred to as an example of hydrokephalos which starts from an invisible cause (ἐξ ἀδήλου μὲν). The text speaks about a watery substance that is contained in the vessels (ἐν αὐτοῖς) and mixed with the blood. In doing so, it reflects the common notion that blood is made of different components and also contains a watery part.53 In Aetius’ other chapter on hydrokephalos, found in the fifteenth book of his Libri medicinales, the adjective ὀρρώδες is used instead of ὑδατώδες.54 This sheds light on the meaning of ὑδατώδες in the present chapter as the noun ὀρός is used in medical texts as a term for the serous part of the blood.55 The formulation in the fifteenth book thus further confirms that the text here is indeed concerned with the different components of the blood. p. 123.8–9: ἐκ – ὑγρόν: This sentence, which does not appear in the version of the chapter found in the fifteenth book, summarizes the information previously provided about the hydrokephalos that occurs as a result of an invisible cause. p. 123.9–11: ἐκ – παρεγχεομένου: The distinction introduced at p. 123.5–6 between hydrokephaloi that occur due to invisible causes and those that occur due to apparent causes56 is also highlighted by parallel sentence structures. Not only is the phrase ἐκ προδήλου δὲ here contrasted with the previous ἐξ ἀδήλου μὲν (p. 123.6) but ἐκ πληγῆς ἢ θλάσματος is also opposed to ἐκ τοῦ αὐτομάτου (p. 123.6), while the verbs ἀραιουμένων (p. 123.6) and ῥηγνυμένων similarly stand in clear contrast. See also p. 141 f., commentary on p. 123.6–8. A blow or a bruise are clear apparent causes which can be named and to which the subsequent processes which cause hydrokephalos can be traced back. As such, they stand in clear contrast to the previously discussed origin of hydrokephalos as happening “without external agency”. In Paul’s chapter on hydrokephalos, the nouns ῥῆξις and ἀραίωσις, corresponding to the verbs found in Aetius’ chapter, are used to describe the processes by which the vessels in the head either burst or become porous.57 While the previous passage, which dealt with the hydrokephaloi that occur due to invisible causes, used the verb παρωθεῖσθαι to describe the process of the blood leaving the vessels, the present

53 See e.g. Galen, De elem. sec. Hipp. 11.8–13 (142.17–144.7 de Lacy = 1.495.16–497.3 K.), De loc. aff. 5.7 (8.352.17 K.), Aetius Amid., Libri med. 3.175 (Vol. 1, 346.21 Olivieri). 54 See Aetius Amid., Libri med. 15.12 (34.19 Zervos). 55 See e.g. Galen, De loc. aff. 6.3 (8.398.6 f. K.), Aetius Amid., Libri med. 4.30 (Vol. 1, 373.4 Olivieri), Galen, De elem. sec. Hipp. 11.11 (142.23–25 de Lacy = 1.496.6–9 K.). See also p. 472 f., commentary on p. 147.24–148.2. 56 See also Grunert 2012, 136. 57 See Paul 6.3.1 (Vol. 2, 46.13–15 Heiberg).

VI 1 On hydrokephaloi from Leonides

| 143

passage uses παρεγχεῖσθαι instead.58 This is noteworthy insofar as the parallel passage in Aetius’ fifteenth book applies the same verb (διηθεῖσθαι) to both processes.59 p. 123.11–12: ἔπειτα – ἀναλυομένου: According to the TLG, the verb ἀργεύεσθαι is only found three times in the extant ancient medical literature (the verb ἀργεῖν is more common), with two of those instances appearing in the present chapter.60 This usage clearly refers back to the previous use of the adjective ἀργόν, which has a prominent role in the present chapter’s description of hydrokephalos (see p. 140 f., commentary on p. 123.3–5). The verb thus describes the process by which the blood becomes inert; the verb ἀργεῖν can generally be used to describe bodily parts or substances that are inactive or immobile.61 In the parallel passage in Aetius’ fifteenth book, the verb is not used. In Paul’s chapter on hydrokephalos, we find the formulation εἰς ἀργὴν οὐσίαν τοῦ ἐκχυθέντος αἵματος μεταβεβλημένου, which clearly describes the same process.62 For a discussion of the adjectives τρυγώδες and δίαιμον, which also refer back to the beginning of the chapter and take up the characterization of the fluid that was given there, see p. 140, commentary on p. 123.3–5. The fact that these adjectives were not mentioned in the previous discussion of hydrokephaloi that occur due to invisible causes and that no information was provided about the possible changes which the substance leaving the vessels might undergo, suggests that the substance becoming bloody and taking on a consistency like that of lees is intrinsically tied to the cause of the hydrokephalos, i.e. to the blow or bruise. See also p. 148, commentary on p. 123.24–124.3. Interestingly, Grunert highlights that the observation that the color of the fluid changes over time is correct and can be traced back to the decomposing of the hemoglobin. While it has a red hue to begin with, the fluid becomes brownish-yellow after a few days, and this change is, according to Grunert, described by the adjective τρυγώδες in the present passage.63 p. 123.12–15: συνεχέστατα – σώματα: The phrase ἐκ τῆς τοιαύτης αἰτίας refers back to the previous discussion of hydrokephaloi that occur due to apparent causes (see p. 142 f., commentary on p. 123.9–11), providing an additional – and the most frequently occurring – example. The verb θλᾶν (p. 123.15), which is used here to describe the action of the midwife, is related to the noun θλάσμα, which was used previously in the context of apparent causes to denote the direct cause of the bursting of the vessels (see p. 123.10). There is, thus, a linguistic parallel between the

58 For other passages which use παρεγχεῖσθαι in connection to blood, see e.g. Galen, De venae sect. adv. Erasistratum 8 (11.176.15 K.). 59 See See Aetius Amid., Libri med. 15.12 (34.19 Zervos), Libri med. 15.12 (34.21 f. Zervos). 60 The third instance is found in Galen, In Hipp. Epid. III comm. 1.4 (11.10 Wenkebach = 17a.498.4 f. K.). 61 See e.g. Galen, De fac. nat. 2.3 (161.24 f. Helmreich = 2.84.4 K.), De usu part. 2.17 (Vol. 1, 118.10 Helmreich = 3.161.4 K.), Oribasius, Coll. med. rel. libri incerti 10.14 (Vol. 4, 97.9 Raeder). 62 See Paul 6.3.1 (Vol. 2, 46.14 Heiberg). 63 See Grunert 2012, 142 f.

144 | Commentary

example of apparent causes found here and the previous example. The phenomenon described here – the occurrence of hydrokephaloi during childbirth – was well known in antiquity. It is mentioned in Oribasius (who claims to be citing Antyllus) as the only cause for hydrokephalos64 while Paul (who probably also cites Antyllus)65 refers to it as one possible cause.66 In Soranus’ Gynaeciorum libri, hydrokephalos (referred to as ὑγροκέφαλον) is dealt with in the context of childbirth, with Soranus explaining how the incision needs to be made in order to reduce the circumference of a child’s head.67 See also Witt forthcoming, 6 note 32, 15; Grunert 2012, 135, 142; Hummel 1999, 176–178; Pandel 1976, 31 f. p. 123.15–19: συνίσταται – ὀστέου: The fact that the fluid which characterizes hydrokephaloi can gather at various different places in the head is reflected in several other texts that deal with this affection. In the pseudo-Galenic Introductio sive medicus, the author distinguishes four types of hydrokephaloi, of which three are essentially the same as those depicted here.68 Oribasius and Paul also distinguish three types of hydrokephaloi in their chapters on the affection.69 For a discussion of the fourth type, which is also mentioned in Aetius’ subsequent sentence, see p. 145 f., commentary on p 123.19–20. To clarify the details of the different layers of the head and the brain that are mentioned here, it will be useful to paraphrase a passage of Galen’s De usu partium. In the eighth book of De usu partium, Galen discusses the head and the brain, in the context of which he explains how the skull, the pericranial membrane, the thick and thin membrane, and the brain itself are related to, and bound to one another.70 Galen holds that, since the skull and the brain differ in their substance, the soft brain must be protected from the hardness of the skull. The two meninges, that is the thick membrane (ἡ παχεῖα μῆνιγξ), also known as the dura mater, and the thin membrane (λεπτὴ μῆνιγξ), also referred to as the pia mater, provide this protection.71 Since the proximity of the thick membrane would still have been too painful to the brain, nature created the pia mater as a direct covering (σκέπασμα) of the brain while the thick membrane was placed near the skull. Galen thus sketches the following arrangement of skull, meninges, and brain: the skull is very hard in its substance and the thick membrane (dura mater), being softer than the skull but harder than the brain, is in close proximity to it. The thin membrane (pia mater) is 64 See Oribasius, Coll. med. rel. 46.28.1 (Vol. 3, 237.26 f. Raeder). 65 See Witt forthcoming, 14. 66 See Paul 6.3.1 (Vol. 2, 46.12 f. Heiberg). 67 See Soranus, Gyn. 4.11.3 (142.12–14 Ilberg). 68 See Pseudo-Galen, Introd. s. medic. 19.3 (91.21–92.4 Petit = 14.782.14–17 K.). 69 See Oribasius, Coll. med. rel. 46.28.2 (Vol. 3, 237.29–31 Raeder), Paul 6.3.1 (Vol. 2, 46.16 f. Heiberg). 70 For the following paraphrase, see Galen, De usu part. 8.9 (Vol. 1, 478.3–479.11 Helmreich = 3.659.1–660.14 K.). See also Grunert 2012, 134 f. 71 For an overview of the history of the terms “dura mater” and “pia mater”, see in detail Strohmaier 1970.

VI 1 On hydrokephaloi from Leonides

| 145

softer than the thick membrane but a little harder than the brain to which it stands in close proximity. Galen explains that through this arrangement it was possible to place bone and brain near to one another. A little later in this passage of De usu partium, the term “pericranial membrane” is introduced with the explanation that the pericranial membrane connects the hard membrane (i.e. the dura mater) with the skull.72 In the light of these Galenic explanations, it becomes clear that the author of our present passage shares a similar understanding of the different layers of the brain. He lists the different localizations of fluid in hydrokephaloi from the outside (skin) to the inside (“underneath the skull”). The term μῆνιγξ (p. 123.18) should therefore be understood as what Galen calls παχεῖα μῆνιγξ. In contrast to the other texts that deal with hydrokephalos, the present passage adds an additional variant of the gathering of the fluid between skin and pericranial membrane. Here were read that the fluid may also gather between the skin and the temporal muscle (κροταφίτης μῦς). According to Galen’s De usu partium, the temporal muscle is located in the bones of the head73 and can do more damage to the brain than can the muscles of the eyes because several sources of nerves are “inserted into” the temporal muscle.74 It seems to be the temporal muscle’s localization and its potential to damage the brain that makes a gathering of fluid between it and the skin dangerous. p. 123.19–20: οἱ – ὀλέθριον: Unfortunately, it is not clear whether the phrase οἱ δὲ πρὸ ἡμῶν is Aetius’ own or is taken from his alleged source, Leonides.75 If it was inserted by Aetius himself, it might refer to the pseudo-Galenic Introductio where this localization of fluid is mentioned as one of four forms of hydrokephalos (see also p. 144, commentary on p. 123.15–19).76 If, on the other hand, it has its origin in Leonides, it remains unclear to whom he was referring with this phrase. In the chapter on hydrokephalos in Aetius’ fifteenth book, the phrase τινὲς δέ φασι is used instead of the personal construction that we find here,77 which implies that Aetius must have varied the formulation he originally found in Leonides in at least one of the two chapters. Oribasius also deals with the gathering of fluid between the dura mater and the brain in the context of hydrokephalos, but he claims that it is impossible for this to take place since the patient would die before the hydrokephalos could develop.78 Oribasius’ use of the adjective ἀδύνατον in this context distances him from this statement claiming that such is impossible. Whether Aetius also criticizes this statement or simply wished to add a further variant to the list of localizations is

72 See Galen, De usu part. 8.9 (Vol. 1, 480.13–16 Helmreich = 3.662.6–8 K.): (…) ἐξ ἁπάντων ἑαυτῶν ἕνα γεννῶσιν ὑμένα, τὸν περικράνιον ὀνομαζόμενον, ὃς ὅτι μὲν συνδεῖ τὴν σκληρὰν μήνιγγα τῷ κρανίῳ (…). 73 See Galen, De usu part. 11.3 (Vol. 2, 117.26 f. Helmreich = 3.849.3 f. K.). 74 See Galen, De usu part. 11.3 (Vol. 2, 118.12–16 Helmreich = 3.849.15–850.1 K.). 75 For the use of personal pronouns in the scientific literature, see Asper 2007, 43. 76 See Pseudo-Galen, Introd. s. medic. 19.3 (92.1 f. Petit = 14.782.14 f. K.). 77 See Aetius Amid., Libri med. 15.12 (35.3 Zervos). 78 See Oribasius, Coll. med. rel. 46.28.2 (Vol. 3, 237.31–33 Raeder).

146 | Commentary

unclear. Interestingly, in the pseudo-Galenic Introductio, shortly after this form of hydrokephalos is mentioned as one of four types, it is said to be incurable (ἀθεράπευτα).79 The lethality of a case of hydrokephalos in which the fluid gathers between the dura mater and the brain is, then, clearly acknowledged by both Oribasius and the author of the pseudo-Galenic Introductio. Grunert 2012 tries to interpret this ancient concept of fluid gathering between the dura mater and the brain through modern medical eyes, concluding that it might correspond with all those instances of intracranial affections in nursing infants which lead to an acute lethal increase in intracranial pressure.80 See also Pandel 1976: p. 32–33. p. 123.20–24: ἀργοῦ – ἐπαφήν: The adjective ἀργόν is taken up here. This language first appears at the beginning of the chapter, on which see p. 140 f., commentary on p. 123.3–5. As far as the phrase κατὰ τὸ δέρμα ἔξωθεν μεταξὺ τοῦ περικρανίου καὶ τοῦ ὀστέου is concerned, I follow the reading preserved by two groups of manuscripts (groups χ and ω) as well as the manuscript Codex Athous Λαύρας 718 Ω 63 (A), which is part of manuscript group ψ. They read κατὰ τὸ δέρμα ἔξωθεν τοῦ περικρανίου ὑμένος ἤ μεταξὺ τοῦ περικρανίου καὶ τοῦ ὀστέου (“at the skin outside of the pericranial membrane or between the pericranial membrane and the bone”).81 This reading makes better sense insofar as it ensures that all three of the previously discussed possible localizations of fluid (see p. 144 f., commentary on p. 123.15–19) are taken up again in this part of the chapter, which elaborates on the consequences of the gathering of the fluid. This reading mentions both the localization of fluid between the skin and the pericranial membrane and the localization of fluid between the pericranial membrane and the bone,82 while the third possible localization – between the bone and the dura mater – is dealt with on p. 124.4. Not only does this reading make better sense than the alternative but it also runs much more smoothly from a syntactical perspective than that printed in Olivieri’s edition, where the ἔξωθεν is directly followed by the μεταξὺ. Since the reading transmitted by χ, ω, and Α contains the noun τοῦ περικρανίου twice, one might reasonably explain the omission of the phrase τοῦ περικρανίου ὑμένος ἤ supposing that the copyist failed to recognize that the doubling here was intentional, and he consequently left out the first mention. Alternatively, it may have caused him to slip out of the line while copying the text.83 The formulation τοῦ μὲν οὖν ὑγροῦ ἔξωθεν τοῦ περικρανίου συνειλεγμένου is used in the parallel chapter on hydrokephalos in Aetius’ fifteenth book,84 which further speaks in favor of the alternative reading insofar as ἔξωθεν is 79 See Pseudo-Galen, Introd. s. medic. 19.4 (92.13 Petit = 14.783.7 K.). 80 See Grunert 2012, 144. 81 See Olivieri’s critical apparatus to p. 123.21. 82 See also Pandel 1976, 33: “(…) in jedem Fall scheinen die Symptome der Ergüsse zwischen Haut und Perikranium und Perikranium und Knochen die gleichen zu sein.” 83 I am grateful to Florian Gärtner for discussing this passage with me and for providing some valuable suggestions. 84 See Aetius Amid., Libri med. 15.12 (35.5 f. Zervos).

VI 1 On hydrokephaloi from Leonides

| 147

also followed there by τοῦ περικρανίου. The adjective ὁμόχρους, which is used here to describe the gathering (συλλογὴ) of the fluid and later to describe the swelling (ὄγκος), needs to be understood as standing in contrast to the redness (ἐνερευθὴς) that is mentioned later (see p. 124.1). It seems to point to a uniformity of the fluid and probably even to a certain transparency, as is suggested by a parallel passage in Paul. Here it is said that if the fluid which causes the affection hydrokele is watery (εἰ μὲν ὑδατῶδες εἴη τὸ ὑγρόν), then the swelling that forms will be uniform in color and transparent (ὁμόχρους ὁ ὄγκος διαυγάζεται), while if the fluid has a consistency like lees or is bloody (εἰ δὲ τρυγῶδες ἢ αἱματῶδες), it is either red or livid (ἢ ἐνερευθὴς ἢ πελιδνὸς).85 To the genitive absolute εἴκοντος καὶ μεθισταμένου κατὰ τὴν τῶν δακτύλων ἐπαφήν one needs to supply ὄγκου in addition. The development of a swelling (ὄγκος)86 as a consequence of the gathering of fluid is also discussed in the chapters on hydrokephalos in Oribasius and Paul: in Oribasius’ chapter it is stated that the characteristic sign of patients who have the fluid between the skin and the pericranial membrane (μεταξὺ τοῦ δέρματος καὶ περικρανίου) is a soft swelling that is uniform in color and not painful (ὄγκος εὐαφής, ὁμόχρους, ἀναλγής). Oribasius also mentions that the swelling moves easily from one side to the other when touched.87 With the exception of some differences in formulation, this is exactly what we read in Aetius. However, Oribasius makes a distinction between this localization of fluid and the localization between the pericranial membrane and the bone (μεταξὺ περικρανίου καὶ ὀστοῦ), both of which seem to be discussed under a single rubric in Aetius. Oribasius writes that the latter is similar to the former in all other respects, except for the fact that it causes more pain in the patient, that the swelling is not so clearly visible, that the swelling is slower in moving from one side to the other and that highly stretched tissue will be found by those who touch the swelling.88 According to Grunert, from a modern medical point of view Oribasius was not only right to distinguish the gathering of fluid between the skin and the pericranial membrane from that between the pericranial membrane and the bone, but he also correctly identified the differences.89 The reason the swelling is not so easily moveable in cases in which the fluid gathers between the pericranial membrane and the bone is, according to Grunert, that the pericranial membrane envelops not the skull as a whole but rather each bone of the skull. The consequence is that the fluid cannot pass the borders of the particular bone with which that part of the membrane is associated.90 Patients in whom the fluid gathers between the pericranial membrane and the bone feel more pain because the pericranial membrane contains many pain 85 See Paul 6.62.1 (Vol. 2, 102.25 f. Heiberg). 86 For a definition of the noun ὄγκος see e.g. the opening of Galen’s treatise De tumoribus praeter naturam: Galen, De tum. praeter nat. 1 (1.4–8 Reedy = 7.705.4–8 K.). 87 See Oribasius, Coll. med. rel. 46.28.3 (Vol. 3, 237.35–37 Raeder). 88 See Oribasius, Coll. med. rel. 46.28.4 (Vol. 3, 237.37–238.4 Raeder). 89 See Grunert 2012, 142. 90 See Grunert 2012, 142.

148 | Commentary

receptors.91 In Paul’s chapter on hydrokephalos, we find almost the same information as in Oribasius, albeit with slight differences in formulation.92 p. 123.24–124.3: καὶ – γίνεται: These lines take up the etiological considerations from the beginning of the chapter using the same terminology (see p. 141 f., commentary on p. 123.6–8, p. 142 f., commentary on p. 123.9–11). The etiological considerations are applied here to the previously discussed gathering of fluid “at the skin outside of the pericranial membrane or between the pericranial membrane and the bone” (see p. 146, commentary on p. 123.20–24) and used to provide information about the different developments that arise from this gathering of fluid depending on its particular etiology. We do not find such etiologically based differentiation in Oribasius or Paul and neither does it appear in the twelfth chapter of Aetius’ fifteenth book.93 In those patients in whom the gathering of fluid has happened “without external agency” (αὐτόματος), the place where the fluid gathers is not painful but uniform in color from the beginning (ἐξ ἀρχῆς). Those whose hydrokephalos has developed as a consequence of a blow or a bruise, by contrast, will have a red and painful swelling to begin with. As Pandel has noted, the link betweenn occurrence of hydrokephalos due to a blow or a bruise and the redness and painfulness of the swelling is easily understandable.94 It also further highlights the difference between a porosity of the vessels that is not dependent on an external agent (p. 123.6–7) and the bursting of the vessels that results from external violence (p. 123.10–11). The formulation ὕστερον δὲ ἀργευομένου τοῦ ὑγροῦ καὶ μεταβαλλομένου εἰς λεπτὴν οὐσίαν also takes up the discussion from the start of the chapter with verbatim parallels (see p. 123.11–12: ἔπειτα δὲ ἀργευομένου, εἰς λεπτὴν οὐσίαν τρυγώδη ἢ δίαιμον ἀναλυομένου), thus reflecting the two-step process illustrated previously (the formulation ἔπειτα δὲ [p. 123.11] corresponds to ὕστερον δὲ in the present passage). See also the discussion on p. 143, commentary on p. 123.11–12. p. 124.3–9: τῆς – ὑγρόν: When fluid gathers beneath the skull between the bone and the dura mater, this is when it comes closest to the brain. This proximity between fluid and brain also accounts for the symptoms of “darkening” (σκοτισμοὶ) and the impairment of sensation (αἱ αἰσθήσεις ἀμβλύνονται). The noun αἴσθησις (sensation) is exemplified using the nouns ὅρασις (sight) and ἀκοὴ (hearing). The phrase αἱ λοιπαί thus refers to the other three senses – touch (ἁφή), taste (γεῦσις), and smell (ὄσφρησις) – collectively.95 For a closer look at the term σκοτισμός and its derivatives, see p. 289 – 291. For a discussion of the role of the brain in sensation, see p. 167 f., commentary on p. 125.10–15. Phrases such as ἡ κεφαλὴ βαρύνεται are 91 See Grunert 2012, 142. 92 See Paul 6.3.1 (Vol. 2, 46.18–23 Heiberg). 93 Pandel 1976, 33 states the following in respect to the differentiation found in Aetius: “Wir wollen hervorheben, daß hier eine ätiologische Differenzierung im Vordergrund steht”. 94 See Pandel 1976, 33. 95 See e.g. Aetius Amid., Libri med. 6.50 (Vol. 2, 192.13 f. Olivieri), Galen, De sympt. caus. 1.6 (7.115.4–8 K.), De loc. aff. 4.3 (8.229.14–17 K.).

VI 1 On hydrokephaloi from Leonides

|

149

widely used in the ancient medical literature.96 Interestingly, Celsus discusses hydrokephalos in a section dealing with headache (κεφαλαία),97 an affection which consists in a feeling of pain in the head. The twelfth chapter of Aetius’ fifteenth book also mentions the heaviness of the head, the occurrence of darkening and the dimness of sensation.98 In Oribasius’ section on the gathering of fluid between the dura mater and the bone, he writes that sparkling and blinking of the eyes can be observed in patients with the affection.99 The use of the first person singular (λέγω) here raises the question of how to interpret such personalized formulations: this might be a statement by Aetius himself explicitly adding information to his source (probably for the sake of clarification) or the phrasing could be taken directly from Leonides, which Aetius has simply copied across. Unfortunately, in the present case we cannot decide which of the two possibilities is more likely because we do not have access to Leonides’ own text. We do have a second version of Leonides’ text in Aetius’ fifteenth book, in which this phrase does not appear, but we cannot use this parallel to make reliable statements about the origin of the λέγω since Aetius uses Leonides’ text quite differently in each of these two chapters. For a closer look at the use of “I” in Aetius’ treatise, see Debru 1992. There is no mention of the development of a swelling (ὄγκος) in this form of hydrokephalos as was the case with the other, extracranial, forms. In the chapters written by Oribasius and Paul, on the other hand, it is said that a swelling also develops in this form of hydrokephalos.100 However, in Oribasius’ chapter the development of a swelling seems to be explained by the fact that the bone of the head in nursing infants has not yet become fixed and can thus easily expand.101 A further possibility is raised a little later in Oribasius’ chapter: sometimes the fluid does not push forward or cause the bone to bulge but separates the sutures of the skull (διαστήσειε τὰς ῥαφάς).102 The separation of the sutures of the skull is also mentioned in Aetius’ chapter. It is thus reasonable to assume that the author of our text does not use the term swelling (ὄγκος) here because he is thinking of the divergence of the sutures instead. The formulation κατ’ ἀρχὰς ὀλίγου ὄντος τοῦ ὑγροῦ thus corresponds to the ὅταν δὲ πλεονάσῃ τὸ ὑγρὸν: while the presence of a small amount of fluid between the dura mater and the bone initially leads to sensory impairment, the excess of fluid that is present a little later leads to the sutures coming apart. This differentiation between a small quantity of fluid in the beginning and more fluid later on may also correspond to the earlier differentiation set out in the context of the different etiologies of the affection (see p. 96 See e.g. Galen, De loc. aff. 6.5 (8.417.18 K.), Paul 1.63 (Vol. 1, 42.17 f. Heiberg), Aetius Amid., Libri med. 3.8 (Vol. 1, 266.19 f. Olivieri). 97 See Celsus, De med. 4.2.2–4 (152.6–19 Marx). 98 See Aetius Amid., Libri med. 15.12 (35.10 Zervos), Libri med. 15.12 (35.16 f. Zervos). 99 See Oribasius, Coll. med. rel. 46.28.5 (Vol. 3, 238.11 f. Raeder). 100 See Oribasius, Coll. med. rel. 46.28.5 (Vol. 3, 238.4 f. Raeder), Paul 6.3.1 (Vol. 2, 46.23 f. Heiberg). 101 See Oribasius, Coll. med. rel. 46.28.5 (Vol. 3, 238.5–7 Raeder). 102 See Oribasius, Coll. med. rel. 46.28.6 (Vol. 3, 238.13 f. Raeder).

150 | Commentary

148, commentary on p. 123.24–124.3). According to Galen, the sutures of the skull were put in place for several reasons: to provide an outlet for superfluities, to allow for the attachment of the dura mater to the bone of the head, and to permit the passing through of vessels and the generation of the pericranium.103 The statement that the head becomes big (μεγάλη) means that it increases in circumference, as is expressed by the verb μεγεθύνεσθαι in Aetius’ fifteenth book.104 Some explanation is required for the statement that the location in which the fluid gathers becomes apparent (πρόδηλος) and that the fluid will give way to a finger that presses upon it. On the one hand, one might interpret the fact that the location of the fluid is “apparent” as being a result of the divergence of the sutures, insofar as the location at which the sutures are separated indicates that the fluid must have been somewhere nearby. The claim that the fluid gives way to the finger which presses it appears earlier in a similar form (see p. 123.23–24). On the other hand, Oribasius’ chapter and the parallel chapter in Aetius’ fifteenth book show that our text can also be read as suggesting a closer relationship between the “apparentness” of the fluid and the fact that the fluid gives way to the pressing finger. According to Oribasius, the divergence of the sutures causes the fluid to rise upwards and to be found between the pericranial membrane and the bone (ἀνελεύσεται μὲν τὸ ὑγρὸν καὶ εὑρεθήσεται μεταξὺ περικρανίου καὶ ὀστοῦ). When the swelling is squeezed from every side, the amount of fluid seems to lessen as if – through the space that opens up when the suture comes apart – it sinks down to the place from which it initially rose up (scil. from between the dura mater and the bone).105 Aetius’ fifteenth book similarly has it that the fluid sinks down because it gives way to touch (ὑποπίπτει τὸ ὑγρὸν εἶκον τῇ ἀφῇ).106 Bearing these parallel passages in mind, one might reasonably understand the present statements as indicating that the place at which the fluid gathers becomes apparent because the fluid sinks down to its initial location (between the dura mater and the bone) when pressed with a finger. p. 124.9: χειρουργία: According to Olivieri’s critical apparatus, the manuscript groups ψ and ω omit χειρουργία, as does the Codex Parisinus Graecus 2228 (Cp).107 This word might have been added by scribes who wanted to make clear that the chapter now begins to discuss the surgical therapy for hydrokephalos. Alternatively, it could go back to Aetius or even to his source, Leonides. In the twelfth chapter of Aetius’ fifteenth book, the noun χειρουργία is used in the text (τῷ αὐτῷ τρόπῳ τῆς

103 See Galen, De usu part. 9.17 (Vol. 2, 49.12–17 Helmreich = 3.750.13–18 K.). See also Rocca 2003, 89–91 and May’s translation in Galen On the Usefulness of the Parts of the Body Vol. I 1968, 458. 104 See also Grunert 2012, 138; Pandel 1976, 35. See Aetius Amid., Libri med. 15.12 (35.14 Zervos). 105 See Oribasius, Coll. med. rel. 46.28.6 (Vol. 3, 238.13–15 Raeder), Coll. med. rel. 46.28.7 (Vol. 3, 238.18–20 Raeder). 106 See Aetius Amid., Libri med. 15.12 (35.15 f. Zervos). For a similar formulation, see also Paul 6.3.1 (Vol. 2, 46.28–47.1 Heiberg): γινώσκεται δὲ τοῦτο ῥᾳδίως τῷ δραπετεύειν ἀντιπαραγόμενον εἰς τὸ βάθος ἐν τῇ πιλήσει τοῦ ὑγροῦ. 107 See Olivieri’s critical apparatus to p. 124.9.

VI 1 On hydrokephaloi from Leonides

|

151

χειρουργίας χρώμεθα),108 and in Zervos’ edition we also read the phrase χειρουργία ὑδροκεφάλου in the margin, although this seems to be the editor’s placement.109 If the mention of χειρουργία in the present passage goes back to Aetius or his source, then this would be an example of how the author explicitly announces what he will discuss in the lines that follow. For further discussion of such structural formulations in medical texts, see van der Eijk 1997, 111–113. p. 124.9–12: κοινῶς – ἔκκρισιν: The phrase ἐπὶ τῆς ὑπὸ τὸ δέρμα συλλογῆς refers to the gathering of fluid between the skin and the pericranial membrane (p. 123.16). The two localizations of fluid mentioned here are the extracranial forms of hydrokephalos, for both of which the same approach is recommended. The surgical therapy for the intracranial form is only dealt with later in the chapter and is said to require a different method (see p. 125.1–3). In the twelfth chapter of Aetius’ fifteenth book, the following advice is explicitly introduced with reference to the extracranial gathering of the fluid (ἐπὶ μὲν οὖν τῆς ἔξωθεν τοῦ κρανίου συλλογῆς).110 The aim of the surgical intervention is said to be the excision of the fluid (πρὸς τὴν τοῦ ὑγροῦ ἔκκρισιν),111 which was earlier said to be the cause of the affection (see p. 123.2–3). In Oribasius’ chapter on hydrokephalos, the phrase ἔκκρισις τοῦ ὑγροῦ is also used in the same context,112 while in Paul’s chapter we read the phrase ἐκκρίναντες τὸ ὑγρὸν.113 This language thus seems to have been a common way to denote the surgical intervention for hydrokephaloi (on the similarities between the chapters, see also p. 133 f.). It is conspicuous that here, at the beginning of the section dealing with the therapeutics of hydrokephalos, the text includes a personal formulation in the form of the first person plural (χρώμεθα). The first person plural is used on two other occasions later on in the chapter (p. 124.18, p. 124.20) and the frequency of the usage of personal constructions seems to be linked to the therapeutic character of this section: during the surgical interventions, the physician himself is “active” and the personal formulations suggest a direct linkage between the writer who recommends the interventions and the reader who actually performs them. For a discussion of personal and impersonal formulations (“Persönlichkeit” versus “Unpersönlichkeit”) in ancient scientific texts, see Asper 2007, 43–45; von Staden 1994; Hine 2009.

108 See Aetius Amid., Libri med. 15.12 (35.19 Zervos). 109 See the margin to Aetius Amid., Libri med. 15.12 (35.17 Zervos). 110 See Aetius Amid., Libri med. 15.12 (35.17 Zervos). 111 The noun ἔκκρισις is also used in medical texts to describe the excretion of bodily substances (such as urine) being caused by the body itself. See e.g. Galen, Ars med. 19.3 (332.2 f. Boudon = 1.353.9 K.), Galen, De loc. aff. 6.4 (8.402.5 K.), Alexander, Therapeutica 11.6 (Vol. 2, 493.27 Puschmann). 112 See Oribasius, Coll. med. rel. 46.28.10 (Vol. 3, 238.28 Raeder). 113 See Paul 6.3.2 (Vol. 2, 47.11 Heiberg).

152 | Commentary

p. 124.12–15: καὶ – τόποις: The noun διαίρεσις describes a surgical “division”, i.e. the incision the physician has to make.114 The statement that a small swelling requires one incision, while a larger swelling requires two or three or even more incisions implicitly suggests a connection between the size of the swelling and the number of incisions that are needed to let out the fluid that has gathered in the head. The phrase κατ’ ἀναλογίαν τοῦ μεγέθους, meanwhile, spells out this relationship explicitly. The phrase κατὰ τῆς τοῦ ὄγκου κορυφῆς describes the place where the physician has to place the tip of the scalpel and the noun κορυφή thus identifies the summit of the hydrokephalos, that is, the highest point of the swelling. The formulation ἐν τοῖς καθ’ ὑπόρρυσιν τόποις also refers to the places on the head which are in need of being drained, that is, the swellings which were caused by the fluid. In the chapters on hydrokephalos by Oribasius and Paul, nearly identical surgical instructions are given, with both texts recommending that the surgeon make one incision if the swelling is small and two (or more) incisions if the swelling is larger.115 In the pseudo-Galenic Introductio, it is said that one should empty those hydrokephaloi which are located underneath the skin and the pericranial membrane by means of two or three straight incisions.116 The use of the imperative (διδόσθω, διδόσθωσαν) reflects the character of the therapeutic section of the text, which aims at providing practical and concrete advice for physicians and creates a certain directness.117 In the further course of this section, the imperative is used several more times (p. 124.21, p. 124.22, p. 124.27), a phenomenon that can be observed in other chapters as well. p. 124.15–17: οὐ – διαστέλλειν: By using the abscess (ἀπόστημα) as the point of comparison, the author of the text avails himself of a well-known nosological concept. In the pseudo-Galenic Definitiones medicae, an abscess is defined as “a change of bodies from inflammation to pus” (ἀπόστημά ἐστι μεταβολὴ σωμάτων ἐκ φλεγμονῆς εἰς πύον).118 In his Methodus medendi, Galen classifies the abscess as a form of swelling (ὄγκος) and states that two kinds exist: in the first kind of abscess, after an inflammation has suppurated, pus gathers as in a hollow, while in the second kind, some type of fluid (which he describes as “sharp”) gathers somewhere without any preceding inflammation.119 The similarity between abscesses and hydrokephaloi is especially visible in the classification of an abscess as a form of swelling (for hy114 See in the same sense e.g. Galen, De anat. admin. 9.3 (Vol. 2, 571.1 Garofalo = 2.723.11 K.), De anat. admin. 1.3 (Vol. 1, 17.7 Garofalo = 2.229.13 K.), De anat. admin. 3.2 (Vol. 1, 145.8 Garofalo = 2.353.12 K.). For further passages which use the formulation διαίρεσιν διδόναι, see e.g. Paul 6.6 (Vol. 2, 49.8 Heiberg), Paul 6.8.1 (Vol. 2, 51.24 f. Heiberg), Oribasius, Coll. med. rel. 44.7.3 (Vol. 3, 121.9 f. Raeder). 115 See Oribasius, Coll. med. rel. 46.28.8 (Vol. 3, 238.24 f. Raeder), Coll. med. rel. 46.28.11 (Vol. 3, 238.29 f. Raeder), Paul 6.3.2 (Vol. 2, 47.6–10 Heiberg). 116 See Pseudo-Galen, Introd. s. medic. 19.4 (92.9–11 Petit = 14.783.5 K.). 117 In a different context, see Asper 2007, 197 f., van der Eijk 1997, 117 f. 118 See Pseudo-Galen, Def. med. 387 (19.442.10 f. K.). 119 See Galen, Meth. med. 14.12 (482.5–11 Johnston & Horsley = 10.984.4–10 K.).

VI 1 On hydrokephaloi from Leonides

|

153

drokephalos, see p. 147 f., commentary on p. 123.20–24 ) and in the statement that an abscess may involve a gathering of fluid. As is the case for hydrokephalos in the present chapter, abscesses were also treated with a surgical procedure.120 This is why the author of the present text can use the postoperative approach deployed in the treatment of abscesses as a point of reference for the approach in the treatment of hydrokephaloi. Interestingly, as in Aetius’ text, Oribasius’ chapter on hydrokephalos emphasizes that the treatment of hydrokephaloi should be the same as that of abscesses.121 With the exception of two instances in Galen and Paul of Nicea, the noun λημνίσκος is only used in Oribasius, Aetius, and Paul.122 In some of these texts, it is used in connection with the therapy of abscesses and several passages suggest that ribbons of this sort were used after the removal of pus. Once the abscess was opened, the ribbons would be applied to the evacuated hollow in order to ensure that the wound stayed open until it was completely clean.123 In some instances, the postoperative application of ribbons is recommended in cases in which more than one incision has been made to open the abscess, while the application of a tamponade (διαμότωσις) is recommended when the abscess is small and only one incision is needed.124 In the present passage, the application of tamponades (μοτοί) is also contrasted with the application of ribbons. According to Grunert, the method that is rejected in our text – which consists in threading ribbons through a wound cavity after having made two insicions through which to pull them – is still used in modern medicine, although it is needed less often now because of the existence of antibiotics. The reason the physician would use such ribbons is, according to Grunert, to prevent inflammatory pockets (“entzündliche Taschen”) from being formed.125 p. 124.17–18: μετὰ – σώματα: This sentence provides an explanation for the recommended application of tamponades (μοτοί): since the cut would easily agglutinate (ῥᾳδίως … παρακολλᾶται) but needs to heal first,126 tamponades are needed to keep the wound open until the healing process is completed and the agglutination can start. Although the application of ribbons (λημνίσκοι) has already been rejected, both the ribbons and the tamponades serve the same purpose, that is, to prevent a 120 See e.g. Galen, Meth. med. 14.12 (482.15–17 Johnston & Horsley = 10.984.14–16 K.), De anat. admin. 3.1 (Vol. 1, 133.19 Garofalo = 2.343.3 f. K.), Paul 6.34.2 (Vol. 2, 72.7–10 Heiberg). 121 See Oribasius, Coll. med. rel. 46.28.10–11 (Vol. 3, 238.27–31 Raeder). 122 See Galen, Ling. s. dict. exolet. expl. ε 42 (196.16 Perilli = 19.97.14 K.), Paul of Nicea 70 (151.13–14 Ieraci Bio). 123 See e.g. Oribasius, Coll. med. rel. 44.11.5 (Vol. 3, 124.33–35 Raeder), Eclog. med. 97.41 (276.13–15 Raeder), Paul 6.73.2 (Vol. 2, 114.21–23 Heiberg). The phrase λημνίσκους διεκβάλλειν is also used in Paul 6.62.3 (Vol. 2, 104.6 f. Heiberg) and a similar phrase λημνίσκον διεισβάλειν is used in Paul 6.65.3 (Vol. 2, 109.21 Heiberg). 124 See Oribasius, Eclog. med. 97.39–41 (276.9–15 Raeder), Paul 6.34.3 (Vol. 2, 72.19–23 Heiberg). 125 See Grunert 2012, 139 note 17. 126 See Oribasius, Eclog. med. 97.41 (276.15 f. Raeder): χρώμεθα δ’ αὐτοῖς ὑπὲρ τοῦ συνέχειν τὰ σώματα ἐν διαστάσει, μέχρις ἂν καθαρὰ γένηται τὰ ἕλκη. This statement refers to the application of ribbons (λημνίσκοι) but tamponades are applied for the same reason.

154 | Commentary

wound from agglutinating too fast. See p. 153, commentary on p. 124.15–17 for further information on ribbons and tamponades. p. 124.18–20: διὸ – παραιτούμεθα: For a discussion of the use of the first person plural in the section on therapeutics, see p. 151, commentary on p. 124.9–12. The noun διαμότωσις is used in the works of Oribasius, Aetius, and Paul to describe the application of a tamponade (μοτός).127 The use of νήπιον refers back to the beginning of the chapter (p. 123.13), where it was said that a hydrokephalos is particularly likely to develop in infants during birth. The noun νήπιον seems to be contrasted with the phrase ἐπὶ δὲ τῶν ἰσχυροτέρων (p. 124.21–22), which appears to refer to patients older than small infants. The reason that bandages are not used for infants is their weight (διὰ τὸ βάρος): in Oribasius’ and Paul’s chapters on hydrokephalos, it is noted that the bone of the head of a newborn is not yet firm and can thus easily be moved or bruised.128 Although these characteristics are not explicitly mentioned in Aetius’ chapter, it seems very likely that they also inform the present suggestions. p. 124.20–21: ὠοβραχὲς – κεφάλαιον: This is the procedure one should undertake in the case of newborns instead of using a bandage. The application of a piece of wool soaked in egg white (ὠοβραχὲς ἔριον) is recommended elsewhere in Oribasius, Aetius, and Paul, often after a surgical intervention.129 The application of a cap (πιλάριον) should be understood as a lighter alternative to the bandage mentioned earlier. p. 124.21–22: ἐπὶ – ἐκκρινέσθω: The phrase ἐπὶ δὲ τῶν ἰσχυροτέρων is contrasted with the previous subclause ἐὰν μὲν ᾖ νήπιον τὸ κεχειρισμένον (p. 124.19– 20). In this sense, the adjective ἰσχυρόν refers to “stronger patients”, that is, to those who are no longer newborns and who are strong enough to endure the recommended treatment. In the parallel chapter of Aetius’ fifteenth book, the phrase εἰ δὲ τελειότερος εἴη ὁ πάσχων is used to express the contrast with the noun νήπιον.130 Rather than applying (ἐπιτιθέσθω is the verb form used in both sentences) a piece of wool soaked in egg white, one should instead apply a “bandage that keeps the tamponade in place” (μοτοφυλάκιον). For the previously mentioned application of tamponades, see p. 153 f., commentary on p. 124.17–18. The noun μοτοφυλάκιον is rarely used in medical context, as is also the case for the related noun μοτοφύλαξ. Indeed, they are almost completely absent from the literature outside their use in

127 See e.g. Paul 6.34.3 (Vol. 2, 72.21 Heiberg), Oribasius, Coll. med. rel. 46.8.5 (Vol. 3, 218.1 f. Raeder). 128 See Oribasius, Coll. med. rel. 46.28.5 (Vol. 3, 238.5–7 Raeder), Paul 6.3.1 (Vol. 2, 46.25 f. Heiberg). For further discussion of the nature of the bone of the head in newborns, see Galen, De foet. form. 3.28 (76.21–24 Nickel = 4.673.2–7 K.). 129 See e.g. Paul 6.15 (Vol. 2, 57.29–33 Heiberg), Paul 6.18 (Vol. 2, 59.2 f. Heiberg), Aetius Amid., Libri med. 7.62 (Vol. 2, 316.3–5 Olivieri). 130 See Aetius Amid., Libri med. 15.12 (36.1 f. Zervos).

VI 1 On hydrokephaloi from Leonides

| 155

the three compilers.131 The role of a μοτοφυλάκιον/μοτοφύλαξ is made explicit in a passage of Oribasius’ Collectiones medicae. Here we read that one must keep the sides of the incision apart with tamponades, and that afterwards one should place a μοτοφύλαξ on top of it.132 p. 124.23–24: δυνατὸν – ἐμπλάστρων: For further discussion of the agglutination of wounds, see p. 153 f., commentary on p. 124.17–18. The author of our text clearly thinks that it takes approximately two days for the cut to heal, since it is only from the third day onwards (ἀπὸ τῆς τρίτης) that the physician may permit and contribute to its agglutination. In Paul’s chapter on hydrokephalos, the number three (ἄχρι τῆς τρίτης) also occurs in the context of bandaging the wound and unfastening the bandages.133 Examples of agglutinating salves (κολλητικὰ ἔμπλαστρα) are given in several chapters of the compilers and in Galen’s De compositione medicamentorum per genera, in a chapter entitled περὶ τῶν κολλητικῶν ἐμπλάστρων.134 p. 124.24–26: τῆς – διαίρεσιν: These lines refer to the gathering of fluid between skin and temporal muscle which was mentioned at the beginning of the chapter (p. 123.16–17; see p. 144 f., commentary on p. 123.15–19). As becomes clear from the instructions given here, this localization of fluid requires a specific treatment which differs from that discussed previously. If the fluid gathers underneath the temporal muscle, the danger of cutting the muscle during surgery seems to be high and measures thus need to be taken to limit the risk. The difference between the previously mentioned surgical procedure and the present one is that one should not make the incision downwards from the top of the swelling (p. 124.13: κατὰ τῆς τοῦ ὄγκου κορυφῆς) but should rather cut “from the sides of the muscle” (ἐκ πλαγίων τοῦ μυὸς). The same recommendation is provided in Oribasius’ chapter on hydrokephalos, in which the phrase παρ’ αὐτοὺς is used in this regard.135 Our text also recommends waiting to make the incision until the fluid is in excess (ἕως πλεονάσει τὸ ὑγρόν) (a similar phrase was used earlier in the chapter (p. 124.6–7), see p. 149 f., commentary on p. 124.3–9). No further explanation is given as to why it is necessary to wait until the fluid is in excess (and this recommendation is not found in the parallel chapter in Aetius’ fifteenth book). One might assume that the reason is that it is at this stage that the fluid comes forward from beneath the muscle and can therefore be evacuated easily through the incisions. Together with the following remarks about the fluid staying “in the depth” (ἐν τῷ βάθει; see p. 156, commentary

131 See e.g. Oribasius, Coll. med. rel. 44.20.74 (Vol. 3, 141.33 f. Raeder), Paul 6.107.3 (Vol. 2, 162.13 Heiberg), Aetius Amid., Libri med. 7.92 (Vol. 2, 338.17 Olivieri). 132 See Oribasius, Coll. med. rel. 46.8.10 (Vol. 3, 218.16–19 Raeder). 133 See Paul 6.3.2 (Vol. 2, 47.12 f. Heiberg). 134 See Galen, De comp. med. per gen. 2.21 (13.551.13 K.), Aetius Amid., Libri med. 15.13 (37.19 Zervos), Oribasius, Eclog. med. 95.2 (272.9 f. Raeder). 135 See Oribasius, Coll. med. rel. 46.28.12 (Vol. 3, 238.33–35 Raeder): φυλαξόμεθα δὲ τοὺς ἐμπίπτοντας μῦς, οἷον τοὺς τῶν κροτάφων, καὶ οὐ κατ’ αὐτούς, ἀλλὰ παρ’ αὐτοὺς τὰς διαιρέσεις δώσομεν.

156 | Commentary

on p. 124.26–29) and not coming up, the text presents two cases to which the physician will need to react in a special way. p. 124.26–29: ἐὰν – ἀσφαλῶς: This sentence is distinguished from that which precedes it by the phrase ἐν τῷ βάθει ὑπὸ τὸν μῦν. Advice is provided here concerning the surgical interventions that need to be undertaken if the fluid remains “in the depth” beneath the muscle and does not come up. See also p. 155 f., commentary on p. 124.24–26. In the present case, it is explicitly said that two incisions (δύο διαιρέσεις) should be made, while in the previous instance only one was required (p. 124.26: τὴν διαίρεσιν). The formulation ὑποδιαιρεῖν τὸ σῶμα, which marks the core difference between the previous procedure and the present one, is difficult to understand. The verb ὑποδιαιρεῖν, which is related to the noun διαίρεσις, usually means “subdivide” and is rarely used in medical texts, although when it is, it tends to appear in surgical contexts.136 However, in the present context it seems to be used in the slightly different sense of “to undermine”.137 Together with the noun σῶμα, understood as (muscular) tissue, this verb explains the process of lifting the muscle slightly in order to drain the fluid that is enclosed underneath. Thus, the knife (σμιλάριον is the diminutive to σμίλη)138 is not used here to literally cut something but rather to undermine it, and it is the handle (λαβίδιον)139 of the knife, to be precise, that shall be used to this end. The information provided in this sentence is not found in the parallel passage of Aetius’ fifteenth book. p. 124.29–30: μετὰ – προδεδήλωται: See the postoperative recommendations given on p. 124.15–24 and the corresponding commentary entries. p. 124.30–125.1: καὶ – κρανίον: This formulation refers back to p. 123.18–19 where the gathering of fluid underneath the skull, between dura mater and the bone of the head, was presented as one possible localization of fluid in the head. Taking this localization up here completes the discussion of all four localizations in the therapeutical section. p. 125.1–3: ἀναμένειν – ποιεῖν: These recommendations clearly refer back to p. 124.6–9, where the process of the separation of the sutures was explained in a similar way. See p. 149 f., commentary on p. 124.3–9. The phrase τὸν κορυφούμενον τόπον takes up the earlier surgical advice that one should make the incision downwards from the top of the swelling (p. 124.12–13: διαίρεσις μία μικρὰ κατὰ τῆς τοῦ ὄγκου κορυφῆς διδόσθω). See also p. 152, commentary on p. 124.12–15. With the statement that one should do “what follows therefrom” (τὰ ἀκόλουθα), the text refers to the previously discussed postoperative instructions, on which see p. 152 f., commentary on p. 124.15–17; p. 153 f., commentary on p. 124.17–18; p. 154, commentary on p. 124.18–20; p. 154, commentary on p. 124.20–21; p. 154 f., commentary on p. 124.21–22; and p. 155, commentary on p. 124.23–24. Interestingly, Oribasius ad136 137 138 139

See e.g. Oribasius, Coll. med. rel. 45.17.9 (Vol. 3, 171.23 f. Raeder). See also Grunert 2012, 141 who translates “unterminieren”. See LSJ s.v. σμιλάριον. See also the Latin translations of Cornarius, 293 (manubrium) and Montanus, 235 (capulo).

VI 1 On hydrokephaloi from Leonides

| 157

vises against performing surgery in patients whose hydrokephalos is located underneath the bone, regardless of whether or not the sutures are separated.140 He states that this condition of the dura mater cannot be cured and that the separation of the sutures is irreversible. Even if there is no separation of the sutures, there is no possibility of undoing the deformation.141

VI 2 On phrenitis from (the books of) Posidonius Introduction to the disease concept phrenitis Phrenitis was a widely discussed affection in the ancient medical literature, and even in texts as early as those of the “Corpus Hippocraticum” it is already discussed as “a well-defined concept”142. The name of the affection can be traced back to the noun φρήν (plural φρένες), which denotes the diaphragm, a part of the body which was also associated “in an abstract/metaphorical sense”143 with the mind, thinking, rationality and the “self”.144 These connotations of the noun φρήν date back to the Homeric epics.145 Keeping them in mind in the present discussion of phrenitis will, as Thumiger puts it, likely lead the reader to “immediately interpret the disease label phren-itis as localized disease; as a disease with a mental quality; and with a connection with the chest area – to a modern ear, sounding like something between ‘mind-itis’ and ‘chest-itis’”.146 In general, phrenitis is associated with fever and with a form of derangement.147 The idea that phrenitis is an inflammation of the meninges of the brain (appearing in parallel with fever) is expressed at the beginning of the present chapter (see p. 125.4–6) and is also reflected by other authors such as Erasistratus (according to the Anonymus Parisinus), Galen, Paul, and Alexander, as well as Stephanus in his commentary on the “Hippocratic” Aphorismi.148 However, there is no consensus on this issue and other texts describe phrenitis as consisting in an inflammation of the heart or the diaphragm rather than the brain. The view that phrenitis is an inflammation of the heart is ascribed to Praxagoras, who is reported to have held that

140 See Oribasius, Coll. med. rel. 46.28.14 (Vol. 3, 238.37–39 Raeder). 141 See Oribasius, Coll. med. rel. 46.28.14–16 (Vol. 3, 238.39–239.7 Raeder). 142 Thumiger 2013, 69. See also McDonald 2009, 1. 143 Thumiger 2021, 60. 144 Thumiger 2021, 60. See also McDonald 2009, 1; Thumiger 2021, 60 f. 145 See McDonald 2009, 1. 146 Thumiger 2021, 61. 147 See also McDonald 2009, 1. 148 See Erasistratus fr. 176 Garofalo, Galen, De sympt. caus. 2.7 (7.202.11–13 K.), Paul 3.6.1 (Vol. 1, 144.4 f. Heiberg), Alexander, Therapeutica 1.13 (616.2–4 Guardasole = Vol. 1, 509.11–13 Puschmann), Stephanus, In Hipp. Aph. comm. 3.33 (194.37 f. Westerink).

158 | Commentary

thinking (φρόνησις) is the natural activity (τὸ κατὰ φύσιν ἔργον) of the heart.149 Diocles is said to have asserted that phrenitis is an affection of the diaphragm and “the heart being affected simultaneously”.150 The Anonymus Parisinus who reports the views of both Praxagoras and Diocles comments on Diocles’ theory by saying that he used the term phrenitis with regard to the affected place and not the affected function, adding that Diocles clearly located rational thought in the region of the heart.151 The differences in the location of phrenitis, placing it either in the brain or in the region of the heart and the diaphragm, reflect the fact that it is discussed “at the crossroad between encephalocentrism and cardiocentrism”152 (see also p. 43 f.). Consequently, these differences depend on the view of each author on the location of the seat of rational thought and mental activities. Thumiger suggests that these different theories about phrenitis, shaped either by encephalocentric or cardiocentric views, gave phrenitis “a unique advantage that made it of enduring appeal in history of science.”153 It is important to note that the chapter on phrenitis in Aetius’ Libri medicinales does not just locate phrenitis in the brain but goes further in locating in specific parts of the brain the mental activities that are said to be damaged by phrenitis (for a more detailed discussion, see p. 162 f. and p. 168 – 171, commentary on p. 125.16–20). In this respect, Aetius’ work clearly differs from other texts. The question of where the mental activities are located is important because phrenitis is understood as consisting fundamentally in mental derangement. This is the case in every text that deals with the subject, from the “Hippocratic” texts to Diocles’ account of the affection and from the views of Celsus to those of Galen, to mention just a few of the authors who discuss this affection. For instance, in the “Hippocratic” De affectionibus we read that when the patients’ fever intensifies, it is possible to observe a derangement of their minds (καὶ τοῦ νοῦ παρακόπτει).154 Other texts of the “Corpus Hippocraticum” also make use of terms such as παρανοεῖν, παράνοια, παραφρονεῖν, and ἔκφρονες to describe the mental state of the patient suffering from phrenitis.155 In Diocles’ account of phrenitis, as reported by the Anonymus Parisinus, it is likewise stated that παρακοπαί are accompaniments of the affection,156 while Celsus uses the verbs desipere (being deranged) and loqui aliena (talking strangely) to describe the important symptoms of the affection.157 In his De symptomatum causis, Galen classifies phrenitis under what he calls παραφροσύναι,158 while in De locis 149 See Praxagoras fr. 62 Steckerl. 150 See Diocles fr. 72.9–13 van der Eijk. I quote van der Eijk’s translation here. 151 See Diocles fr. 72.10–12 van der Eijk. 152 Thumiger 2021, 64. 153 Thumiger 2021, 64. For more on this topic, see Thumiger 2021, 64–67. 154 See Hippocrates, De affect. 10 (18.10 Potter = 6.216.24 f. L.). 155 See e.g. Hippocrates, De morb. 1.30 (88.7–13 Wittern = 6.200.18–23 L.), De morb. 1.34 (92.7–10 Wittern = 6.204.5–7 L.), De morb. 3.9 (76.21 f. Potter = 7.128.7 L.). 156 See Diocles fr. 72.13 van der Eijk. 157 See Celsus, De med. 3.18.2 (122.16 f. Marx). 158 See Galen, De sympt. caus. 2.7 (7.202.2–6 K.).

VI 2 On phrenitis from (the books of) Posidonius

|

159

affectis he deals with nearly the same mental disturbances as in our present text, that is with the impairment of sense-perception and of intellectual judgement.159 It is worth noting that several texts discuss the existence of different forms of phrenitis, as does the present chapter. While Galen’s discussion of the varieties of phrenitis is similar to that found in Aetius’ chapter,160 other authors make reference to the mood of the patient (cheerful versus sad) or to the detrimental substances which cause phrenitis (blood, yellow bile).161 See also p. 166 f., commentary on p. 125.9–10. In Celsus’ account of the three genera insaniae (on which see p. 46 – 48 for more detail) phrenitis is discussed alongside mania and melancholia.162 This trinity reflects the fact that these three affections were clearly “thought to cause madness in the ancient world”163 and are often held up as the most prominent examples of mental illness in ancient medicine.164 While phrenitis is generally classified as an acute affection that occurs alongside fever, mania and melancholia are considered to be chronic ailments.165 In Galen’s De symptomatum causis, fever is said to be a distinguishing feature that marks out phrenitis, which occurs with fever, from mania, which does not.166 However, this kind of comparative and classificatory information is absent from the chapter on phrenitis in Aetius’ compilation. The disease concept phrenitis is discussed not only in ancient medical literature but also in later treatises.167 Retrospective diagnosis is, of course, extremely difficult, indeed, often impossible, and one should thus refrain from any sort of direct identification with modern medical terms. However, in the light of this disease concept’s longevity, it is interesting to ask which modern affection might come closest to it. With regard to the symptoms associated with phrenitis in ancient medical texts, there are similarities that can be identified with viral meningitis or viral encephalitis and with a range of mental illnesses which are accompanied by fever.168 For a de159 See Galen, De loc. aff. 4.2 (8.225.11–226.1 K.). 160 See Galen, De loc. aff. 4.2 (8.225.11–14 K.). 161 See e.g. Celsus, De med. 3.18.3 (122.24 f. Marx), Alexander, Therapeutica 1.13 (616.9–14 Guardasole = Vol. 1, 509.18–23 Puschmann), Paul 3.6.1 (Vol. 1, 144.15–17 Heiberg). 162 See Celsus, De med. 3.18 (122.11–127.15 Marx). For more detail see Thumiger & Singer 2018, 7–15. 163 McDonald 2009, 1. 164 One should bear in mind that in the early medical texts from the “Corpus Hippocraticum”, phrenitis, melancholia, and mania are “in no way three diseases that it is appropriate to take as categorically homogenous, even if they will be more than once classified as competing types of insanity by the later medical tradition” (Thumiger 2013, 65). In addition to Celsus, Thumiger also cites Aretaeus and Caelius Aurelianus as examples of authors who provide such a classification (see Thumiger 2013, 65 note 21). 165 See e.g. Celsus, De med. 3.18.1 (122.14 f. Marx), 3.18.17 (125.27 f. Marx), 3.18.19 (126.12 Marx), Aretaeus 3.1 (36.4–18 Hude), Caelius Aurel., Tard. pass. liber primus cui haec insunt (430.1–9 Bendz). 166 See Galen, De sympt. caus. 2.7 (7.202.5 f. K.). 167 See e.g. Thumiger 2021, McDonald 2009, 1. 168 See e.g. McDonald 2009, 5; Drabkin 1955, 266; Moog 1994 in Die Fragmente des Themison von Laodikeia, 222.

160 | Commentary

tailed and thorough account of phrenitis in ancient medical texts, see McDonald 2009.

Structure of the chapter p. 125.4–9: Περὶ – παραφρονεῖν: Definition of phrenitis Paraphrase: The chapter opens by defining phrenitis as an inflammation of the meninges of the brain, that occurs alongside acute fever and brings about mental derangement. It is further stated that phrenitis becomes more severe after the patient has already suffered from fever for four, five, or six days. p. 125.9–24: διαφοραὶ – ἐπίπαν: Different forms of phrenitis Paraphrase: These lines highlight the existence of different forms of phrenitis and introduce the three most important forms, all of which consist in damage to different mental capacities: 1. the imaginative faculty of the patients is damaged; 2. their reasoning faculty is damaged; 3. both the imaginative faculty and the reasoning faculty are damaged at the same time. Damage to the memory of the patient is said to occur alongside damage to the imaginative faculty and the reasoning faculty in most cases. In the further course of this section, the impairment of these mental capacities that occurs in the different forms of phrenitis is linked to an impairment of different parts of the brain: 1. damage to the front part of the brain brings about damage to the imaginative faculty. 2. damage to the middle ventricle of the brain leads to damage to the reasoning faculty. 3. damage to the rear part of the brain causes an impairment of the recollective faculty, which normally occurs in parallel with an impairment of the imaginative faculty and the reasoning faculty. If the patients’ imaginative faculty is impaired they are said to see obscure things in front of their eyes, while if their reasoning faculty is damaged they do not judge correctly and if their recollective faculty is damaged they neither remember anything nor form images correctly nor judge correctly. p. 125.24–126.6: προσήκει – διαιτᾶν: General instructions for the treatment of phrenitis Paraphrase: These lines provide general information about what must be considered when treating patients who suffer from phrenitis, as well as dealing with the general care of these patients. This latter includes recommendations regarding how to put the patient to bed and considerations about the lighting in the sick room. p. 126.6–16: εἰ – παρέπεται: Therapy for phrenitis I (phlebotomy) Paraphrase: This section of the chapter discusses the conditions that need to be fulfilled in order to carry out the phlebotomy in a patient suffering from phrenitis. It also gives concrete advice regarding which veins need to be cut and the amount of blood that should be removed.

VI 2 On phrenitis from (the books of) Posidonius

| 161

p. 126.16–127.3: παραλειφθέντος – περιέχοντος: Therapy for phrenitis II (alternatives to phlebotomy) Paraphrase: These lines deal with cases in which the physician cannot phlebotomize the patient because the necessary conditions have not been fulfilled, providing alternative methods of therapy that can be applied instead: the application of enemata and the application of embrocations to the head. p. 127.3–10: εἰ – μῆλα: Therapy for phrenitis III (more vehement derangement: poppyheads, sternutatories) Paraphrase: This section of the chapter discusses the treatment that is necessary if the derangement is more vehement. In such cases, it is recommended that, after emptying the patient by means of phlebotomy or enemata, one should apply fomentations made of poppyheads to the head, in addition to washing the head constantly and applying a narcotic troche. The application of sternutatories is also recommended. p. 127.10–20: ἐπιταθέντων – ῥοδόμελι: Therapy for phrenitis IV (intensification of the affection) Paraphrase: In this section, advice is given as to what to do if the affection intensifies further. In such cases, one should orally apply a narcotic remedy made from poppyheads. This remedy must be applied during the abatement of the paroxysm and not during the peak of the affection. p. 127.20–128.1: φυλάττεσθαι – αἵματος: Therapy for phrenitis V (preventing a change from phrenitis to lethargia) Paraphrase: This section touches on the possibility that phrenitis may change into lethargia if the patients have been cooled significantly by the application of narcotic remedies. To avoid such outcomes, the physician is advised against the overuse of narcotic remedies and the application of tufted thyme and cow parsnip is recommended as an alternative. If phlebotomy is not succesful, the physician should use cupping instruments. p. 128.1–5: τροφὴν – δύναμιν: Therapy for phrenitis VI (food) Paraphrase: The last lines of the chapter are concerned with the appropriate foodstuffs for those afflicted by phrenitis. The application of barley-gruel and, in general, food that moderately cools and moistens is recommended here.

Rationale of the chapter The chapter on phrenitis in Aetius’ Libri medicinales opens with a clear definition of the affection (see p. 125.4–5: phrenitis is an inflammation of the meninges of the brain), immediately followed by a concise mention of its main symptoms (see p. 125.5–6: it is accompanied by acute fever and brings about mental derangement). The text also provides information about the three most important forms of phrenitis and how these forms manifest themselves (see p. 125.9–24), as well as dealing at

162 | Commentary

length with the appropriate therapy of the affection (see p. 125.24–128.5), which takes up most of the chapter. As such, the chapter discusses all the relevant aspects of phrenitis that – according to Aetius as compiler of this chapter – a physician needs to know if they are to cure the affection (for a more detailed discussion of the aim of Aetius’ compilation, see p. 68 – 70). The chapter on phrenitis is of special interest because it contains one of the earliest extant localizations of different mental capacities in different parts of the brain, including the ventricles. It thus obviously draws on Posidonius, as Aetius’ chapter heading suggests (a thorough discussion of these lines with regard to their contents is offered on p. 168 – 171, commentary on p. 125.16–20).169 When looking at the rationale of the chapter it is therefore worth considering how this particularly interesting section is structurally embedded into the broader chapter on phrenitis, and to what extent it influences the remarks on therapeutics. The lines that implicitly suggest the location of the imaginative faculty, the reasoning faculty and the recollective faculty (see p. 125.16–20) appear in the first half of the chapter and are directly linked to the discussion about the different forms of phrenitis (see p. 125.9– 10; see also p. 166 f., commentary on p. 125.9–10). Impairments of the imaginative faculty, the reasoning faculty, and the recollective faculty are accordingly said to be the most important forms of phrenitis (see p. 125.9–15), and these different impairments of mental faculties are then linked in a second step to impairments of different parts of the brain (see p. 125.16–20). This implicit localization of the faculties is embedded neatly into the section dealing with different forms of phrenitis and is, thus, ultimately linked to the pathology of the affection rather than being given for its own sake.170 Bearing in mind the strong pathological and practical context of the section, it is noteworthy that there is no explicit connection between the definition of phrenitis as an inflammation of the meninges of the brain (which surround it) and the statement that different forms of phrenitis consist in the damage done to different parts or ventricles of the brain (which lie inside it). The question then arises as to what extent an impairment of different parts of the brain fits with the concise definition of phrenitis as an inflammation of the meninges. Must we assume that there is a physiological connection between meninges and ventricles? If this is in fact the case, it is not explicitly announced anywhere in the chapter. Yet, as it stands, it seems as if there is a slight discrepancy regarding the exact locus affectus in the brain between the definition of phrenitis at the beginning and the discussion about its different forms a few lines later. However, a very clear connection does exist between the mention of παρακοπή and παραφορά as main symptoms of phrenitis in the opening lines and the mention of impairments of the imaginative faculty, the reasoning faculty and the recollective faculty. It is these latter that constitutes the mental derangement. The discussion of the impairments of these three mental facul-

169 For a closer look on Posidonius, see Gäbel 2020. 170 See also Wright 2016, 189.

VI 2 On phrenitis from (the books of) Posidonius

|

163

ties thus matches perfectly with the opening lines of the chapter, refers back to it, and provides further important information about mental derangement. As noted above, the section dealing with the localization of mental faculties and with the manifestation of the mental derangement is embedded in the discussion of different forms of phrenitis. As such it opens with the statement that different forms of phrenitis do exist (p. 125.9–10) and it closes with the statement that it is necessary to apply more remedies to the bodily part that has been more harmed yet not to neglect the other parts (p. 125.14–26). This latter statement clearly forms a bridge to the section dealing with therapeutics and, as such, it contributes to the smoothness of the transition of the sections and to the readability of the whole chapter. One might, however, think that this remark does not refer to the different parts of the brain which may be affected in phrenitis, although the previous remarks about different forms of phrenitis and their connection to these different affected parts of the brain could suggest such reading. Rather, it seems to refer generally to the brain in contrast to the rest of the body, as being the affected part. This becomes clear when considering the therapeutic remarks that follow, since these do not refer in any way back to the previous distinctions between different parts of the brain. This lack of any reference to the different forms and manifestations of phrenitis is especially noteworthy in view of the detailed description of these topics at the beginning of the chapter. It seems as if these varying forms of phrenitis do not require a range of significantly different therapies and as if the brain as the locus affectus is important when discussing the appropriate therapy while the different parts of the brain are not. The therapy that is recommended is a therapy for the head, and more specifically for the brain, rather than for any sub-part. This becomes clear through, for example, an explicit cross reference to the meninges (p. 126.20), which have been mentioned at the very beginning of the chapter as being inflamed in cases of phrenitis (p. 125.4–5). The chapter on phrenitis is full of such cross references, which both provide it with an internal structure (see e.g. p. 183, commentary on p. 127.3–4; see p. 189, commentary on p. 127.20–23) and embed it within the broader Libri medicinales. The latter connections take the form of references to other chapters of the sixth book, as well as to other books of the treatise. For example, we are told that the loss of memory, which was presented as attendant on one form of phrenitis, will be discussed in more detail shortly (see p. 125.26–27). Chapter 23 of the sixth book does then indeed deal with exactly this topic (see also p. 174, commentary on p. 125.26–27). The present chapter also contains information on a possible way in which phrenitis can change into lethargia, which is particularly noteworthy because the same information is also given in the subsequent chapter on lethargia (on this issue see p. 189, commentary on p. 127.20–23 and p. 204 f., commentary on p. 128.10–12). This similarity between the two chapters provides further evidence for the supposition that the present chapter is embedded within the overall structure of Aetius’ treatise (for another reference in the present chapter to one of the previous books, see p. 185, commentary on p. 127.7–9).

164 | Commentary

To sum up, the chapter on phrenitis that is found in Aetius’ Libri medicinales clearly focuses on therapeutics as do the other chapters of the sixth book (see also p. 19 f.). However, this chapter sets itself apart from the others insofar as it deals in a relatively detailed manner with the impairments of mental faculties and their location within the brain. Although the chapter contains this information about the mental faculties, it does not play any role in the section on therapeutics. This might seem surprising, but it also reveals that it is not the location of the mental faculties in different parts of the brain that matters in therapeutics. Rather, it is the brain as such as the locus affectus that is of central importance when it comes to therapy. Once this is acknowledged, the chapter on phrenitis can be understood as presenting both an impressive account of the localization of the mental faculties in the brain and a detailed account of the appropriate therapy.

Commentary p. 125.4: Περὶ – Ποσειδωνίου: For an introduction to Posidonius, who is said to be the source of the present chapter, see p. 23 – 25. See also Gäbel 2020. p. 125.4–6: ἡ – ἐπιφέρουσα: For a discussion of inflammation and fever as two of the main constituents and characteristics connected to phrenitis in ancient medical texts, see p. 157 f., where I also deal with the texts which suggest that it is not the brain but the heart or the diaphragm that are affected in cases of phrenitis. In the opening lines of the present chapter, mental derangement, which is the most prominent symptom of phrenitis (for more details, see also p. 157 – 159),171 is referred to by the nouns παρακοπή and παραφορὰ τῆς διανοίας, and later in the chapter the verb παραφρονεῖν is also used in this regard.172 Throughout Aetius’ sixth book, these terms and other similar ones (such as παραφροσύνη173 or παράνοια174) are used interchangeably and synonymously to denote a deranged state of the mind.175 Although these terms are used in Aetius’ compilation without being further explained, it is clear both from the places in which they appear (i.e. in the book dealing with diseases of the head) and from the fact that phrenitis is explicitly said to be an affection of the brain that Posidonius – as the author of the text cited here – locates mental activities in the brain and is influenced by encephalocentric doc-

171 See e.g. Hippocrates, De affect. 10 (18.10 Potter = 6.216.24 f. L.), Diocles fr. 72.12 f. van der Eijk, Pseudo-Galen, Def. med. 234 (19.412.16 K.), Introd. s. medic. 13.9 (51.4 f. Petit = 14.732.18 f. K.), Galen, Meth. med. 2.7 (230.22 Johnston & Horsley = 10.149.7 f. K.), De loc. aff. 3.9 (8.178.12–14 K.), Celsus, De med. 3.18.2 (122.16 f. Marx). 172 See Aetius Amid., Libri med. 6.2 (Vol. 2, 125.9 Olivieri). 173 See e.g. Aetius Amid., Libri med. 6.8 (Vol. 2, 137.11 f. Olivieri), Libri med. 6.9 (Vol. 2, 141.25 Olivieri). 174 See e.g. Aetius Amid., Libri med. 6.9 (Vol. 2, 146.14 Olivieri). 175 See also Gäbel 2018, 327.

VI 2 On phrenitis from (the books of) Posidonius |

165

trines. Later in the present chapter, we are given a glimpse of how this mental derangement should be understood (see p. 171 – 174, commentary on p. 125.20–24). Galen, who is more theoretical in this regard in his treatises, defines all παραφροσύναι as false movements of the leading capacity (πλημμελεῖς κινήσεις τῆς ἡγεμονικῆς δυνάμεως) and explains that they are brought about by humors which are in a bad condition or by a dyskrasia of those in the brain.176 The further course of the chapter reveals that the author of our text seems to hold a similar view about mental derangement consisting in damage to the leading capacities (see p. 167 f., commentary on p. 125.10–15). That acute fever (μετὰ πυρετοῦ ὀξέος) is an accompaniment to phrenitis points to the common labeling of this affection as an acute one.177 Fever is commonly presented as an accompaniment to inflammations.178 According to Galen, the development of phrenitis not only involves inflammation of the brain and meninges but also hot humors (in the brain), such as yellow bile.179 The involvement of yellow bile or blood in the development of phrenitis is also reflected in the texts of Paul and Alexander, in which it is said that the cause of phrenitis is either an abundance of blood or of yellow bile (Paul) and that phrenitis occurs if yellow bile gathers in the brain or around the meninges and causes inflammation (Alexander).180 p. 125.6–7: σπανίως – πυρετῷ: The noun φρενῖτις here seems to be used in such a way as to refer to the severity of the affection,181 which probably goes along with the mental derangement that is brought about by the inflammation of the meninges of the brain (see p. 164 f., commentary on p. 125.4–6). The assumption that fever might lead to mental derangement is expressed in other texts as well.182 See also p. 166, commentary on p. 125.7–9.

176 Galen, De sympt. caus. 2.7 (7.202.2–5 K.). 177 See e.g. Aretaeus 5 proem (91.3–11 Hude), Caelius Aurel., Cel. pass. 1.3 (22.15–19 Bendz). The term πυρετὸς ὀξύς is also used in Pseudo-Galen, Def. med. 234 (19.412.16 f. K.), Introd. s. medic. 13.9 (51.4–7 Petit = 14.732.18–733.1 K.), Celsus, De med. 3.18.1 (122.14 f. Marx). 178 See e.g. Galen, Ad Glauc. 2.1 (446.2–5 Johnston = 11.71.3–6 K.), De loc. aff. 2.9.16 (362.18 Gärtner = 8.119.10 f. K.). On fever and inflammation, see also Sticker 1928–1930. 179 See Galen, De sympt. caus. 2.7 (7.202.6–13 K.). See also McDonald 2009, 143 for further discussion. 180 See Paul 3.6.1 (Vol. 1, 144.6–8 Heiberg), Alexander, Therapeutica 1.13 (616.2–4 Guardasole = Vol. 1, 509.11–13 Puschmann). 181 See also Diocles fr. 71.23–25 van der Eijk. In his commentary on this passage, van der Eijk states: “Diocles is reported to have posited the twenty-first day as the limit for a crisis in acute diseases. Galen comments that this is correct in some sense (although wrong in others), as some acute diseases may have a rather slow start and need a few days to become really severe. Galen then says that Diocles must have known this fact about acute diseases too, and as evidence for this assumption Galen mentions Diocles’ statement that with people suffering from phrenitis it may take a few days for the disease to become really acute” (see van der Eijk 2001 in Diocles of Carystus, 142). 182 See e.g. Galen, De sympt. caus. 2.7 (7.202.13–18 K.), Galen, De loc. aff. 2.10.24 (380.16–17 Gärtner = 8.133.15 f. K.).

166 | Commentary

p. 125.7–9: τοῖς – παραφρονεῖν: In contrast to the previous lines, the text now presents the more commonly observable course of phrenitis (the contrast is found in the use of σπανίως in line 6 compared to τοῖς δὲ πλείστοις in the present passage). The timeframes given here are clearly counted from the beginning of the fever. The view that it takes several days before phrenitis becomes severe or is accompanied by mental disturbances is also reflected in other texts, such as the “Hippocratic” De affectionibus, Celsus’ work, and Galen’s De diebus decretoriis, which latter attributes a similar view to Diocles (see also note 181): the “Hippocratic” text states that in cases of phrenitis the fever is mild in the beginning and becomes more intense on the fourth and fifth days (ὅταν δὲ τεταρταῖος γένηται καὶ πεμπταῖος), when the mind becomes deranged.183 In his discussion of the mental derangement (desipere et loqui aliena) of patients suffering from phrenitis, Celsus states that this condition can only occur when there is a heavy fever (incidere potest nisi in febre vehementi).184 According to Galen, Diocles said “that people do not become severely affected by phrenitis immediately from the first day (φρενιτικοὺς γοῦν εὐθὺς ἀπὸ τῆς πρώτης ἡμέρας οὐ πάνυ τι γίνεσθαί)”.185 The phrase καὶ ἔτι ὀψιαίτερον αὐτῷ σχεδὸν τῷ κινδύνῳ συνάπτουσα is slightly odd but seems to denote that phrenitis is more dangerous if it occurs later than the sixth day of the fever. This view might be connected to the decreasing strength of the patients after suffering from a fever for more than six days, which could make the derangement even more severe than it would otherwise have been. See also p. 176 f., commentary on p. 126.6–7. p. 125.9–10: διαφοραὶ – τρεῖς: In his De locis affectis, Galen also speaks of different forms (διαφοραῖς) of phrenitis, stating that there are two simple forms and a third form that is a combination of both.186 The explanation of these forms is very similar to what the present text offers in this regard, on which see in detail p. 171 – 174, commentary on p. 125.20–24. Other texts also speak of different forms of phrenitis but do so in a different manner, often connecting these forms to distinct processes in the brain which are said to have caused the affection. Alexander, for example, explicitly acknowledges the existence of different forms (ἔστι δὲ καὶ αὐτῆς τῆς φρενίτιδος οὐχ ἓν εἶδος μόνον, ἀλλὰ καὶ διάφορα) but connects these to the presence of pale-yellow bile, yellow bile, or yellow bile that has been overheated, stating that the first form is rather mild, the second is more violent, and the third can even be called beast-like.187 Similarly, Paul states that the form of phrenitis that is brought about by blood is accompanied by laughter, the one brought about by yellow bile is accompanied by boldness, while the one in whose origin black bile plays a role causes the patient to 183 184 185 186 187

See Hippocrates, De affect. 10 (18.8–10 Potter = 6.216.23–25 L.). See Celsus, De med. 3.18.2 (122.16–18 Marx). See Diocles fr. 71.24–25 van der Eijk. I quote van der Eijk’s translation here. See Galen, De loc. aff. 4.2 (8.225.11–14 K.). See Alexander, Therapeutica 1.13 (616.9–14 Guardasole = Vol. 1, 509.18–23 Puschmann).

VI 2 On phrenitis from (the books of) Posidonius

|

167

become mad and uncontrollable.188 A similar notion is also reflected in Celsus, who states that there are many forms (plura genera) and some patients are sad, while others are cheerful.189 These remarks are reminiscent of the affection known as mania, which is also discussed later on in Aetius’ sixth book (see p. 358, commentary on p. 137.14–15). However, we find no such information in the present passage. p. 125.10–15: ἢ – φανταστικόν: These lines introduce the different forms of phrenitis, which are said to consist in damage to the mental capacities – i.e. to the imaginative faculty (φανταστικόν), the reasoning faculty (λογιστικόν), and the recollective faculty (μνημονευτικόν) or memory (μνήμη) – in a variety of combinations. Damage to the imaginative faculty, the reasoning faculty, and the recollective faculty is what constitutes the mental derangement that was referred to earlier in the chapter (see p. 164 f., commentary on p. 125.4–6). These three terms and their derivatives are crucial for many of the affections discussed in Aetius’s sixth book insofar as the capacities are located in the brain and are thus potentially impaired in diseases of the brain. As discussed above (see p. 23), Aetius often uses technical terms in his compilation without providing explanations, and the same applies here. It will thus be useful to summarize the Galenic views about these mental capacities190 to cast some light on the tradition in which Aetius and Posidonius, the claimed source for the present chapter, stand. Throughout his works, Galen distinguishes between natural organs (φυσικὰ ὄργανα) and psychic organs (ψυχικὰ ὄργανα). He refers to the former group (such as veins and arteries) as being moved without impulse and to the latter (such as muscles) as being moved through impulse.191 Galen makes a similar distinction between natural capacities (φυσικαὶ ἐνέργειαι) and psychic capacities (ψυχικαὶ ἐνέργειαι), and in doing so subdivides the psychic capacities into the leading capacities (ἡγεμονικαί), those belonging to sensation (αἰσθητικαί), and those belonging to movement (κινητικαί).192 The psychic capacities belonging to movement should be understood as the capacities involved in the movement of the muscles through impulse (ὄργανα κινήσεως τῆς καθʹ ὁρμὴν οἱ μύες εἰσίν).193 The capacity of the soul that belongs to sensation is subdivided into sight, smell, taste, hearing, and touch, while the leading capacity of the soul, the hegemonikon, is divided into the imaginative faculty,

188 See Paul 3.6.1 (Vol. 1, 144.15–17 Heiberg). 189 See Celsus, De med. 3.18.3 (122.24 f. Marx). 190 See for more detail e.g. Hankinson 1991, Hankinson 2014, Juliao 2018. 191 See e.g. Galen, De motu musc. 1.1 (3.17–19 Rosa = 4.372.13–15 K.), De loc. aff. 6.4 (8.405.8–11 K.). On this issue, see also Gärtner 2015 in Galeni De locis affectis, 653 f.; Gundert 2009 in Galeni De symptomatum differentiis, 283. 192 See Galen, De sympt. diff. 3.1 (216.18–20 Gundert = 7.55.11–14 K.). On this issue, see also Gärtner 2015 in Galeni De locis affectis, 654; Gundert 2009 in Galeni De symptomatum differentiis, 283; von Staden 2000, 108 f. 193 See Galen, De motu musc. 1.1 (1.3 Rosa = 4.367.4 f. K.). See on this issue also Gundert 2009 in Galeni De symptomatum differentiis, 284.

168 | Commentary

the reasoning faculty and the recollective faculty.194 Galen explicitly localizes these latter three in the head, and in the brain more specifically.195 A few lines further down in the present chapter (p. 125.20–24), we are told more about the specific functions of the imaginative faculty, the reasoning faculty, and the recollective faculty, and the mental impairment that might follow from damage to each of these. See p. 171 – 174, commentary on p. 125.20–24.. The author adds that an impairment of memory will, in most cases, also lead to an impairment of the reasoning faculty and the imaginative faculty. The first three forms (impairment of the imaginative faculty, impairment of the reasoning faculty, impairment of both) are also dealt with in the section on phrenitis in Galen’s De locis affectis, while the additional information is not given there.196 The phrase ἐπὶ τῶν πυρεκτικῶν νοσημάτων raises the further question of whether the statement about the impairment of memory should be understood as a more general side remark about memory rather than referring to phrenitis alone. This seems to be a reasonable assumption, especially since the sixth book of Aetius’ Libri medicinales also includes a separate chapter on the loss of memory which states that damage to memory often occurs “in affections” (ἐν νοσήμασί τισι) and leads to a similar impairment of the reasoning faculty.197 p. 125.16–20: τοῦ μὲν – δύο: These lines are a very important source for the location of mental faculties in the ventricles of the brain. This location was to continue to exert an influence on medical thought from antiquity to the middle ages, not only on texts but also on graphic representations (see also p. 162 f.).198 The present section, transmitted via Aetius’ compilation but probably stemming from Posidonius, is one of the earliest literary testimonies that specifically locates the mental faculties in the ventricles.199 The precise location here is only implied, but can be deduced from the attribution of impaired parts of the brain to an impairment of specific mental faculties. In a way, it is also an incomplete location given that the technical term κοιλία (ventricle) is only used once in this section and only in relation to the middle ventricle, while for the front and hind part of the brain general terms such as μέρος and ὀπίσθιον are used. It is not clear from the text whether the author intends these general terms to refer to the ventricles that are located in the front and hind part of the brain or whether they are instead meant to locate the faculties rather loosely somewhere in the brain.200

194 See Galen, De sympt. diff. 3.1 (218.2–9 Gundert= 7.55.16–56.7 K.). 195 See e.g. Galen, De plac. Hipp. et Plat. 7.3.2 (438.28–33 de Lacy = 5.600.12–18 K.), De plac. Hipp. et Plat. 2.3.24 (114.25 f. de Lacy = 5.225.14 f. K.), De loc. aff. 3.7 (8.166.18–167.3 K.). 196 See Galen, De loc. aff. 4.2 (8.225.11–226.1 K.). 197 See Aetius Amid., Libri med. 6.23 (Vol. 2, 160.15–17 Olivieri). 198 See e.g. Rocca 2003, 245: “One of the longest themes in the history of knowledge of the brain is that of ventricular localisation”. Literature on this topic is vast. See e.g. Sudhoff 1913; Manzoni 1998; Wright 2016, 182–195. 199 See e.g. Wright 2016, 187–190. 200 See e.g. also Green 2003, 138.

VI 2 On phrenitis from (the books of) Posidonius

|

169

One of the earliest authors to attach great importance to the ventricles of the brain, and who might thus be seen as an ancestors of the ventricular location, was Herophilus, who lived in the fourth/third century BCE.201 According to Galen’s De historia philosopha, Herophilus located the soul’s leading part (ἡγεμονικόν) in a ventricle.202 With the exception of the location of each of the capacities of this leading part in specific ventricles or areas of the brain, Galen’s representation of Herophilus’ theory is quite similar to what we read here. Given that the present text is one of the earliest testimonies to identify the location of mental faculties in the ventricles of the brain, one needs to explain how Galen’s theories – which were in many respects so influential and sophisticated, and which preceded both Posidonius and Aetius – fit into the history of ventricular localization. As we saw earlier, Galen locates the mental faculties (the imaginative faculty, the reasoning faculty and the recollective faculty) in the brain (see p. 167 f., commentary on p. 125.10–15). He also knew the ventricles of the brain and ascribed great importance to them for an animal’s sensation and motion.203 However, in his extant works at least, Galen locates the soul in the “body of the brain” (σῶμα τοῦ ἐγκεφάλου) where thinking (τὸ λογίζεσθαι) takes place and where the memory of visual appearances (ἡ τῶν αἰσθητικῶν φαντασιῶν … μνήμη) is stored,204 stating that the soul’s “first instrument” (πρῶτον ὄργανον) is the psychic pneuma that resides in the ventricles of the brain.205 This theoretical framework does not map onto the assumptions relied on in the present section (and also by Herophilus).206 The present lines find a very close parallel in the late antique (late fourth century) Christian author Nemesius of Emesa, who was also highly influenced by medical works.207 In view of the close similarity between Nemesius’ ideas and those found in the present section, it will be useful to quote Nemesius’ wording verbatim: ἐπειδὴ δὲ τῶν μὲν αἰσθήσεων ἀρχὰς καὶ ῥίζας τὰς ἔμπροσθεν εἶναι κοιλίας φαμὲν τοῦ ἐγκεφάλου, τοῦ δὲ διανοητικοῦ τὴν μέσην, τοῦ δὲ μνημονευτικοῦ τὴν ὄπισθεν, ἀναγκαῖόν ἐστιν ἐπιδεῖξαι εἰ ταῦτα τοῦτον ἔχει τὸν τρόπον, ἵνα μὴ δόξωμεν ἀλόγως πιστεύειν τοῖς λεγομένοις. ἱκανωτάτη δὲ ἀπόδειξις ἡ ἐξ αὐτῆς τῆς τῶν μορίων ἐνερ201 See Sudhoff 1913, 154: “und so geht auf ihn [scil. Herophilus] die ganze Lehre von dem Sitz der seelischen Kräfte in den drei respektive vier Hirnhöhlen schließlich zurück.”. 202 See Herophilus T 137d von Staden. The Galenic testimony says the following: Ἡρόφιλος ἐν τῇ τοῦ ἐγκεφάλου κοιλίᾳ, ἥτις ἐστὶ καὶ βάσις (von Staden’s translation: “Herophilus [scil. locates it [i.e. the command centre (τὸ τῆς ψυχῆς ἡγεμονικόν)]] in the ventricle of the brain which is also its ‘base’”). 203 See Galen, De plac. Hipp. et Plat. 7.3.16 (442.27–30 de Lacy = 5.605.7–10 K.). 204 See Galen, De loc. aff. 3.9 (8.174.15–175.1 K.). 205 See Galen, De plac. Hipp. et Plat. 7.3.21–22 (444.4–11 de Lacy = 5.606.7–15 K.), Galen, De loc. aff. 3.9 (8.174.15–175.4 K.). 206 See also Sudhoff 1913, 156. 207 See Sharples & van der Eijk 2008 in Nemesius On the Nature of Man, 1: “The medical works of Galen and the philosophical writings of Plato, Aristotle and the Neoplatonist Porphyry are all major influences on Nemesius, directly or indirectly.”

170 | Commentary

γείας λαμβανομένη. τῶν μὲν γὰρ προσθίων κοιλιῶν καθ’ ὅντινα δήποτε τρόπον βλαβεισῶν, αἱ μὲν αἰσθήσεις παραποδίζονται, τὸ δὲ διανοητικὸν ἔτι μένει σῳζόμενον· τῆς δὲ μέσης κοιλίας μόνης παθούσης, ἡ μὲν διάνοια σφάλλεται, τὰ δὲ αἰσθητήρια μένει φυλάττοντα τὴν κατὰ φύσιν αἴσθησιν· ἐὰν δὲ καὶ αἱ πρόσθιοι καὶ ἡ μέση κοιλία πάθωσιν, ὁ λογισμὸς ἅμα ταῖς αἰσθήσεσι παρακόπτει· τῆς δὲ παρεγκεφαλίδος παθούσης, ἡ μνήμη μόνη παραπόλλυται, τῆς αἰσθήσεως καὶ τῆς διανοίας εἰς οὐδὲν βλαπτομένων [δῆλον δὲ ὡς οὐκ ἔστιν ἡμῖν ὁ λόγος νῦν περὶ τῆς καθ’ ὁρμὴν κινήσεως]· ἐὰν δὲ σὺν ταῖς προσθίοις καὶ ἡ μέση καὶ ἡ ὄπισθεν πάθῃ τι, καὶ τὴν αἴσθησιν καὶ τὸν λογισμὸν καὶ τὴν μνήμην ὁμοῦ παραφθείρονται, πρὸς τῷ καὶ τὸ πᾶν κινδυνεύειν ἀπολέσθαι ζῷον. γίνεται δὲ τοῦτο δῆλον καὶ δι’ ἄλλων μὲν πολλῶν παθῶν τε καὶ συμπτωμάτων, μάλιστα δὲ ἐκ τῆς φρενίτιδος.208 “Since we say that the frontal cavities of the brain are the origin and roots of sensation, that of thought the central cavitiy and the posterior of memory, it is necessary to demonstrate whether this is the state of affairs, lest we should seem to believe what is being said without having a good reason for it. The most adequate demonstration is gained from the activity of the parts. If the frontal cavities are damaged in any way the senses are impaired but thought remains unharmed. If the central cavity alone suffers thought is overthrown but the sense-organs continue to preserve their natural [power of] sensation. If both the frontal and the central cavities suffer, reason is damaged together with the senses. But if the cerebellum suffers, memory alone is lost together with it without sensation and thought being harmed in any way. But if the posterior suffers together with the frontal and the central ones, sense, reason and memory also are destroyed, in addition to the whole creature being in danger of perishing. This becomes clear from many affections and symptoms, particularly from phrenitis.”209 It is evident that Nemesius advances the same ideas that are also reflected in the present section of Aetius’ compilation. He states that the imaginative faculty (at a different place in his work, Nemesius uses the term φανταστικόν rather than the αἱ αἰσθήσεις he deploys in the passage cited above)210 is located in the front ventricle of the brain, the reasoning faculty in the middle, and the recollective faculty in the posterior. The difference between the two texts is that Nemesius refers to the ventricles in all three instances using the technical term κοιλία, which the author of our present text does not. It is also noteworthy that the order of the argument is different in Nemesius. While Nemesius begins with the location of the mental faculties in the ventricles of the brain and then goes on to the “demonstration” of the correctness of what has been said, Posidonius, the presumed author of the present text, provides only an implicit location as part of his discussion of the clinical picture of phrenitis. Although they both advance strikingly similar ideas, the focus of each text is quite 208 Nemesius, De nat. hom. 13 (69.20–70.12 Morani). 209 I quote van der Eijk’s translation of Nemesius here. See Sharples & van der Eijk 2008 in Nemesius On the Nature of Man, 121 f. 210 See Nemesius, De nat. hom. 6 (55.8–56.4 Morani).

VI 2 On phrenitis from (the books of) Posidonius |

171

different. Nemesius obviously deals with the proper functioning of the imaginative faculty, the reasoning faculty, and the recollective faculty, reflecting on their location as part of this undertaking. Posidonius, by contrast, discusses the disease phrenitis from a medical perspective, and in doing so provides information about damaged bodily parts and their consequences.211 Given that Nemesius made use of the medical literature available to him (explicitly mentioning Galen, for example) it is possible that he also used Posidonius’ text for the passage cited above.212 Another text worth mentioning in this context explicitly connects mental faculties to the ventricles of the brain. This passage is found in the treatise In Aristotelis De anima libros commentaria, written by John Philoponus in the early sixth century CE. After stating that it is clear “that something proceeds from the affections of the body to the soul” (ὅτι δὲ καὶ ἐκ τῶν παθῶν τοῦ σώματος διαβαίνει τι καὶ πρὸς τὴν ψυχήν, πρόδηλον)213 and that if one of the two suffers, the other one suffers with it (ἀλγοῦντι γὰρ συναλγεῖ) or if one of the two is cheerful, the other one is also pleased (καὶ εὐθυμοῦντι συνήδεται),214 Philoponus provides a concrete example for these statements. He writes: “(…) just as memory is affected when a particular cavity at the back of the brain is affected, as is the reasoning faculty of the soul when some other cavity is affected, and when the brain is in a certain state it is easy for the soul to exercise imagination, but when it is in a different state, it is very difficult for it to imagine” (ὡς τοῦ ἐγκεφάλου τινὸς μὲν κοιλίας παθούσης τῆς ὄπισθεν τὸ μνημονευτικὸν πάσχειν, ἄλλης δὲ αὐτὸ τὸ λογιστικόν, καὶ τοιῶσδε μὲν διακειμένου εὐφάνταστον εἶναι τὴν ψυχήν, τοιῶσδε δυσφάνταστον).215 Philoponus indirectly locates the mental faculties in the ventricles here, providing an example of the claimed dependence between soul and body. Only one ventricle is specifically mentioned – the posterior ventricle in which the recollective faculty is located – while the ventricle in which the reasoning faculty resides is referred to only as “another” (ἄλλης). No location at all is mentioned for the imaginative faculty here. This rather loose treatment of the location of the faculties seems to be a by-product of Philoponus’ focus, which is on the soul and the dependence between soul and body. It seems reasonable to assume that Philoponus used the texts of Posidonius or Nemesius, or possibly another similar text which is not extant, as sources for the medical information regarding the soul’s dependence on the body. p. 125.20–24: ὅσοις – ἐπίπαν: These lines provide information concerning the consequences of damage to the imaginative faculty, the reasoning faculty, and the 211 See also Wright 2016, 189. 212 See also Sharples & van der Eijk 2008 in Nemesius On the Nature of Man, 25 and 121 note 607. For a different explanation see e.g. Leyacker 1927, 277 f. 213 See Ioannes Philoponus, In Arist. De anima comm. 1.4 (155.23 f. Hayduck). I quote van der Eijk’s translation here: see van der Eijk 2006 in Philoponus On Aristotle on the Soul, 77. 214 See Ioannes Philoponus, In Arist. De anima comm. 1.4 (155.24 f. Hayduck). 215 See Ioannes Philoponus, In Arist. De anima comm. 1.4 (155.28–31 Hayduck). I quote van der Eijk’s translation here: see van der Eijk 2006 in Philoponus On Aristotle on the Soul, 77 f.

172 | Commentary

recollective faculty, and thereby implicitly also about the proper functioning of these three faculties.216 The function of the imaginative faculty is, thus, “to form images” (φαντάζεσθαι) while the function of the reasoning faculty is “to judge” (κρίνειν), and the function of the recollective faculty is “to remember” (μνημονεύειν). In turn, damage to the imaginative faculty leads the patients to “see obscure things in front of their eyes” (φαντάζονται ἀλλόκοτα), damage to the reasoning faculty leads them to “not judge correctly” (κρίνουσι οὐκ ὀρθῶς), and damage to the recollective faculty leads them to “not remember anything of previous events correctly nor to form images correctly nor to judge correctly in most cases” (οὐδενὸς τῶν πρόσθεν γεγενημένων μνημονεύουσιν ὀρθῶς, ἀλλ’ οὐδὲ φαντάζονται οὐδὲ κρίνουσιν ὀρθῶς ὡς ἐπίπαν). In a passage of De locis affectis in which Galen illustrates the different forms of phrenitis, he provides statements and examples that shed light on the meaning of the verbs φαντάζεσθαι and κρίνειν in the present passage:217 Galen states there that some patients suffering from phrenitis “are not misled in their discernment of the things seen as this discernment belongs to sense-perception” (οὐδὲν ὅλως σφαλλόμενοι περὶ τὰς αἰσθητικὰς διαγνώσεις τῶν ὁρατῶν), but they “do not behave naturally as regards their intellectual judgement” (οὐ κατὰ φύσιν ἔχουσι ταῖς διανοητικαῖς κρίσεσιν).218 In other patients, it is said to be the other way round while still others suffer from both impairments.219 These two explanations presumably correspond to what in other texts is referred to as damage to the imaginative faculty and the reasoning faculty. Galen further illustrates the two types of damage with the following examples. As an example of a patient who is not misled in his discernment of the things seen but does not behave naturally as regards his intellectual judgement, Galen tells us the story of a man in Rome (the following Galenic passage is also discussed on p. 54 f.). Standing at the window of his house, he held up glass vessels to the passing pedestrians and asked them to tell him to throw the vessels out of the window. The pedestrians did so, and the man then threw them down in response. Later, the man asked whether the pedestrians also wanted him to throw down the wool worker who was working in his house at that time, and when they showed approval, he also threw the man down into the street. The pedestrians immediately stopped laughing and caught the falling man.220 The man in the house was perfectly able to recognize the glass vessels and the wool worker as such, and he was, therefore, not impaired in his “discernment of the things seen, as this discernment belongs to sense-perception”. However, the fact that he threw the glass vessels out of the window, and later even did the same with a human being, clearly shows that he did not “behave naturally as regards his intellectual judgement”. As an example of the contrary condition, Galen tells a story 216 217 218 219 220

On this issue, see also Gäbel 2018, 328 f., where I discuss this topic very briefly. For further analysis of this Galenic passage, see in detail McDonald 2009, 131–137. See Galen, De loc. aff. 4.2 (8.225.14–16 K.). See Galen, De loc. aff. 4.2 (8.225.16–226.2 K.). See Galen, De loc. aff. 4.2 (8.226.2–13 K.).

VI 2 On phrenitis from (the books of) Posidonius

|

173

about himself. Once, when he was suffering from a high fever, he fidgeted with the bed clothes and pulled at his own clothing, because he thought that dry twigs (τινα κάρφη) and bits of wool (κροκύδας) were stuck in his bed and garments. When he was unable to get hold of any of the twigs or wool, and after overhearing his friends talking about his deranged condition, he realized that he was suffering from this sort of condition and that no twigs or wool were actually present. He then asked his friends to help him, and they cooled his head and took further steps to cure his condition.221 In this example, it is clear that Galen himself was impaired in his “discernment of the things seen, as this discernment belongs to sense-perception”, insofar as he thought he saw things that were not actually there. However, at the same time he was able to “behave naturally with regard to his intellectual judgement”, insofar as he was capable of reflecting upon his situation and of grasping the condition that affected him. Galen also reports such cases in several of his other writings.222 “Twitching at the bed-clothes” (κροκυδίζειν) and “pulling bits of wool out of items of clothing” (καρφολογεῖν) are very common symptoms of phrenitis and are manifestations of the mental derangement.223 The statement that patients whose recollective faculty is impaired not only fail to remember anything of previous events correctly but also neither form images correctly (οὐδὲ φαντάζονται) nor judge correctly in most cases (οὐδὲ κρίνουσιν ὀρθῶς ὡς ἐπίπαν) is reflected in a similar way in the chapter of Aetius’ sixth book which deals with the loss of memory (Περὶ μνήμης ἀπολωλυίας ἐκ τοῦ Ῥούφου καὶ Γαληνοῦ). There it is stated that damage to memory often involves the reasoning faculty being harmed together with it (συμβεβλαμμένου καὶ τοῦ λογισμοῦ).224 This passage is obviously cited from Galen’s De locis affectis.225 The fact that damage to the mental capacities is closely linked in the present chapter to the impairment of specific parts of the brain raises the question of how the close connection between damage to the recollective faculty, on the one hand, and to the imaginative faculty and the reasoning faculty, on the other, can be explained from an anatomical perspective. The present chapter does not offer any explanation and it therefore remains open as to whether this assumed close connection can indeed be traced back to some anatomical peculiarity of the hindbrain or whether there are, in fact, no anatomical grounds for this common assumption. However, it interesting that Herophilus, on whom see also p. 169, commentary on p. 125.16–20, regarded the hindbrain as being especially important and “assign[ed] a major controlling function to the hindbrain, and, more specifically, either to what today is known as the fourth ventricle (in the hindbrain), or to the roof portion of the hindbrain which we 221 See Galen, De loc. aff. 4.2 (8.226.13–227.11 K.). 222 See Galen, De sympt. diff. 3.11–13 (224.18–226.22 Gundert = 7.60.14–62.6 K.), In Hipp. Progn. comm. 1.23 (237.17–238.2 Heeg = 18b.74.10–75.9 K.). 223 See e.g. also McDonald 2009, 43–45, 134 f., 136, 159, 204–206. See also Thumiger 2021, 63. 224 See Aetius Amid., Libri med. 6.23 (Vol. 2, 160.16 f. Olivieri). 225 See Galen, De loc. aff. 3.6 (8.160.13–18 K.).

174 | Commentary

call cerebellum.”226 Given that the recollective faculty is located in the hindpart of the brain in the present chapter, one might reasonably assume that theories similar to those that it is assumed were advanced by Herophilus may have informed the present remarks. p. 125.24–26: προσήκει – ἀμελεῖν: This remark opens the section on the therapy for phrenitis, which takes up the rest of the chapter. For further discussion of the phrase τῷ μᾶλλον ἠδικημένῳ μέρει, see p. 163. p. 125.26–27: περὶ – ἐροῦμεν: This reference is to chapter twenty-three of Aetius’ sixth book, which deals with the loss of memory (Περὶ μνήμης ἀπολωλυίας).227 Given that this is an explicit reference to a later part of the book, it is clear that it must stem from Aetius, the compiler himself, and not from his source, Posidonius. For further discussion of this kind of cross-reference in Aetius’ Libri medicinales, see p. 163. p. 125.27–126.1: νυνὶ – ῥητέον: This is an explicit announcement of the therapeutical remarks that are to follow. It is interesting that the verb ἐπιμελεῖσθαι is used here and not the more common verb θεραπεύειν. Given that the immediately following instructions (p. 126.1–6) pertain to the questions of getting the patients into bed while only the lines from p. 126.6 onwards deal with therapeutic issues such as phlebotomy, etc., it seems reasonable to assume that the verb ἐπιμελεῖσθαι refers to this general care of the patient, which does not include strictly medical interventions.228 p. 126.1–2: κατακεκλίσθαι – ψυχεινοτέρῳ: Instructions on how and where to get the patients suffering from phrenitis into bed are commonly provided in other texts as well. Aretaeus gives the same recommendation to put the patients to bed in a warm room in winter and in a cold and moist one in summer, introducing these remarks by saying that the patients need to be put to bed (κατακεκλίσθαι) in a room that is well-measured and well-tempered (ἐν οἴκῳ εὐμέτρῳ, εὐκρήτῳ).229 Providing a good mixture and avoiding extremes seems to be the core of these recommendations.230 Alexander of Tralleis dedicates an entire section of his work to the rooms in which patients suffering from phrenitis should be put to bed and states that the air 226 von Staden 2007 in Herophilus The Art of Medicine, 247. See also Herophilus T 137d von Staden and Rocca 2003, 37. 227 See Aetius Amid., Libri med. 6.23 (Vol. 2, 160.15–163.30 Olivieri). 228 In Aetius Amid., Libri med. 7.33 (Vol. 2, 283.13 Olivieri) we read θεραπευτέον δὲ ἐπιμελουμένους τοῦ παντὸς σώματος (…), which implies a difference between θεραπεύειν and ἐπιμελεῖσθαι in the sense that the latter refers to a more general care which pertains to the whole body. For similar passages, see e.g. Galen, Meth. med. 4.4 (394.24 f. Johnston & Horsley = 10.260.18 K.), Meth. med. 13.6 (342.23 Johnston & Horsley = 10.891.8 K.). Nevertheless, ἐπιμελεῖσθαι is also used in a way that is similar to θεραπεύειν: see e.g. Galen, De praecogn. 8.14 (114.26 Nutton = 14.645.17 f. K.), Soranus, Gyn. 3.9.4 (99.13 Ilberg). 229 See Aretaeus 5.1.1 (91.12 f. Hude). 230 In Aretaeus 5.1.1 (91.21 Hude) we also read that the length and width of the patients’ bed shall be moderate (ξύμμετρον). See also McDonald 2009, 108 f.

VI 2 On phrenitis from (the books of) Posidonius

| 175

should not be very thick nor moist nor cold nor warm in order to ensure that there will be no condensation nor a filling of the head, instead the air should be welltempered (εὔκρατον).231 In Paul’s section on the therapy of phrenitis, we read that the patients should be put to bed in a place that is moderate with regard to light and “mixture” (ἐν τόπῳ φωτός τε καὶ κράσεως συμμέτρως ἔχοντι).232 Caelius Aurelianus does not connect his recommendations concerning the temperature of the room to the seasons but, rather, to the form phrenitis takes in each patient: if the patients are suffering as a consequence of strictura then they should be put to bed in a warm room,233 while if they suffer as a consequence of solutio, their bed should be in a cool room.234 Caelius argues that a very hot room induces fever while a cold room has a contracting effect and increases the density of the body.235 p. 126.2–4: ἡσυχίαν – πλησίον: The same recommendation is given nearly verbatim in Aretaeus as well (ἔπειτα ἡσυχίην ἄγειν κελεύειν καὶ αὐτὸν τὸν νοσέοντα καὶ τοὺς ἐπὶ τῆς οἰκίης ἅπαντας), where it is argued that patients suffering from phrenitis are quick of hearing (ὀξυήκοοι) and sensitive to noise (ψόφου καθαπτόμενοι) and thus become mad (μαίνονται).236 The statement that patients suffering from phrenitis easily become mad or irritated as a result of noises reads as an explanation of the recommendation to keep noises to a minimum, an explanation which is not given in Aetius’ text. Caelius recommends putting the patients to bed in an isolated room where no noises from people passing by can reach them,237 while Alexander states that no member of the household nor any relative who has at any time caused the patient to be aggrieved or angry should be allowed to enter the room, since the patients would become irritated, excited, and disturbed as a result of such a visit.238 Both Aretaeus and Alexander argue on the basis of the mental condition of the patients, which is rather unstable and can easily change for the worse. p. 126.4–6: καὶ τοὺς μὲν – διαιτᾶν: In these lines, the mental condition of the patients is addressed in relation to the presence of light. Patients suffering from phrenitis respond in a variety of different ways to illumination: while some become wild (ἀγριαινομένους) as a result of light, others become sound of mind (σωφρονοῦντας). See also p. 175, commentary on p. 126.2–4 for the connection between noises and mental conditions. Striking parallels can be observed in Aretaeus’ description of the illumination of the sick room: he also makes use of the verb ἀγριαί-

231 See Alexander, Therapeutica 1.13 (624.13–18 Guardasole = Vol. 1, 519.5–10 Puschmann). 232 See Paul 3.6.2 (Vol. 1, 145.12 f. Heiberg). 233 See Caelius Aurel., Cel. pass. 1.58 (54.30–56.1 Bendz). For a discussion of the terms strictura and solutio, which are central to the Methodists, see Frede 1987, 272. 234 Caelius Aurel., Cel. pass. 1.60 (56.13 f. Bendz). 235 See Caelius Aurel., Cel. pass. 1.58 (56.1–3 Bendz). 236 See Aretaeus 5.1.1 (91.14–17 Hude). 237 See Caelius Aurel., Cel. pass. 1.58 (54.26–28 Bendz). 238 See Alexander, Therapeutica 1.13 (624.21–24 Guardasole = Vol. 1, 519.13–16 Puschmann).

176 | Commentary

νειν to describe the ways in which patients might react to light.239 However, he goes further in his description of the patients’ mental conditions, saying that some patients might even see things that are not actually there, consider one thing to be another, or even become frightened by the light.240 These remarks are evocative of the description of damage to the imaginative faculty given earlier in the present chapter (see p. 171 – 174, commentary on p. 125.20–24).241 It can also be observed in other texts dealing with phrenitis that different recommendations regarding the illumination of the sick room are connected to different assumptions about the patients’ mental conditions and their intensification or relief in relation to light and darkness.242 The different authors, thereby, put forward different explanations of their statements and are sometimes (as in the case of Caelius) quite detailed in their discussion of light and darkness and the effects these have on the human mind.243 p. 126.6–7: εἰ – εἰσέβαλε: The remarks here deal with the conditions that have to be fulfilled in order to be able to conduct a phlebotomy. They refer back to the statements made at the beginning of the chapter about the chronological appearance of fever and phrenitis (see p. 165, commentary on p. 125.6–7). The constraint that phlebotomy may only be conducted if phrenitis (i.e. the mental derangement) occurs together with fever either right from the beginning or up to the fourth day may be explained by reference to the danger mentioned at the beginning of the chapter, which could imply a loss of strength in the patients (p. 125.7–9). In a very similar manner, Aretaeus discusses the constraints on the use of phlebotomy in patients suffering from phrenitis: He states that a phlebotomy can be conducted if the mental derangement (ἡ παραφορὴ)244 occurs together with fever from the very beginning, or on the first, second, third, or fourth day, and “up to first period of critical days” (μέσφι τῆς πρώτης τῶν κρισίμων περιόδου).245 If the mental derangement occurs later, then one should evacuate by other means.246 The concept of certain critical days is crucial for Aretaeus’ passage and it was a familiar and frequently applied principle in ancient medicine: The core of this concept is the view that there

239 See Aretaeus 5.1.3 (92.3 f. Hude). This verb is also used in the Anonymus Parisinus’ chapter on phrenitis, albeit in a different context: See Anon. Par. 1.2.3 (4.4 Garofalo). 240 See Aretaeus 5.1.3 (92.4–6 Hude). 241 For a discussion of Aretaeus 5.1.3 (92.4–6 Hude), see McDonald 2009, 102 f. 242 See Celsus, De med. 3.18.5 (123.4–13 Marx), Caelius Aurel., Cel. pass. 1.58 (54.30–56.4 Bendz), Cel. pass. 1.60 (56.13–15 Bendz), Cel. pass. 1.61–63 (56.22–58.10 Bendz), Cel. pass. 1.118–119 (88.6–16 Bendz), Anon. Par. 1.3.1 (4.18–21 Garofalo), Paul 3.6.2 (Vol. 1, 145.12–14 Heiberg), Alexander, Therapeutica 1.13 (624.18–20 Guardasole = Vol. 1, 519.10 f. Puschmann). 243 See also McDonald 2009, 177–179. 244 It is notable that Aretaeus uses the noun παραφορή here rather than φρενῖτις, as is used in the present chapter, since, as has been argued above, in the present context (and at the beginning of the chapter) φρενῖτις is actually used to mark out the severity of the affection which might manifest itself in the occurrence of mental derangement. Aretaeus’ usage thus confirms this assumption. 245 See Aretaeus 5.1.4 (92.15–18 Hude). 246 See Aretaeus 5.1.4 (92.18–21 Hude).

VI 2 On phrenitis from (the books of) Posidonius

|

177

are days in the development of an affection on which signs can be detected regarding whether the patient is going to recover or whether their condition is going to change for the worse. These days are also important when making therapeutic decisions.247 Windows of time for conducting phlebotomies in patients suffering from phrenitis are also identified in other texts. For instance, it is reported that Diocles said that patients suffering from phrenitis should be phlebotomized, “some of them within six days, others on the other hand even after the seventh and the eighth day.”248 Caelius Aurelianus explains his recommendation that patients may be phlebotomized up to the third day of the affection by saying that the strength of the patient decreases after this.249 In the Anonymus Parisinus, it is stated that those who are mentally deranged from the first or the second day should be phlebotomized around the second or third day if the conditions for phlebotomy are fulfilled, but rarely on the fourth day.250 p. 126.8: καὶ μὴ – ἐπεγένετο: The change of one affection into another is commonly discussed in medical texts. See p. 203 f., commentary on p. 128.9–10. In a chapter of Paul’s compilation dealing with peripneumonia, it is also stated that one should avoid phlebotomy if the affection occurs as a result of a change from another disease.251 The yardstick against which such recommendations are made seems to be the strength of the patient, which is probably supposed to have already decreased during the first affection and which is therefore too weak to be able to endure phlebotomy.252 p. 126.8–9: οὔρων – ὄντων: In addition to the present passage, thin and white urine is also said to be a sign of an impending case of phrenitis in Aetius’ fifth book,253 as well as in certain “Hippocratic” treatises in which the urine is said to be white, colorless, or translucent.254 While other texts do not mention bloody urine in patients suffering from phrenitis, they do mention a flow of blood from the nos247 See e.g. Cooper 2011 in Galen De diebus decretoriis. 248 See Diocles fr. 73.7–10 van der Eijk. I quote van der Eijk’s translation here. According to van der Eijk 2001 in Diocles of Carystus, 150 Diocles probably regarded the sixth day as a critical day. 249 See Caelius Aurel., Cel. pass. 1.70 (62.3–7 Bendz). 250 See Anon. Par. 1.3.2 (4.22–24 Garofalo). 251 See Paul 3.30 (Vol. 1, 211.16–18 Heiberg). 252 It is noteworthy in this regard that Anon. Par. 1.3.10 (8.19 f. Garofalo) provides another recommendation stating that those who are suffering from phrenitis because of a change of other affections should be treated like those who are just beginning to suffer from phrenitis. With regard to this latter group, however, it was said that they should be treated with phlebotomy (see Anon. Par. 1.3.2 (4.22–24 Garofalo)), which is in direct opposition to the recommendation in the present passage. However, it is important to note that the remarks about the patients suffering from a change are accompanied by the statement that one should always consider the patients’ strength (see Anon. Par. 1.3.10 (8.20 f. Garofalo)). 253 See Aetius Amid., Libri med. 5.37 (Vol. 2, 22.26–28 Olivieri). 254 See e.g. Hippocrates, Coac. 568 (248.8–16 Potter = 5.714.7–15 L.), Prorrh. 1.4 (75.8–10 Polack = 5.510.7–512.1 L.). See also Thumiger 2021, 63.

178 | Commentary

trils.255 The loss of blood in such cases might be traced back to the role of blood in the onset of phrenitis, which is not mentioned in the present chapter but does appear in other texts.256 In the present context, the remark about bloody urine is embedded in the list of conditions that have to be fulfilled in order for a phlebotomy to be permissible, and as such it can be interpreted as one of the signs “that suggest a great amount of blood (in the body)” (see p. 126.10–11). p. 126.9: καὶ τοῦ – ἐρυθροῦ: Similarly, Paul states that the area around the face of patients suffering from phrenitis is warm and bloodshot,257 while Alexander mentions that the patients’ heads are very hot.258 Redness is commonly linked to inflammations,259 of which phrenitis is said to be a type. According to Galen’s De locis affectis, “the heat is greater in the head and face of those patients in whom the delirium starts in the head”.260 p. 126.9–10: καὶ ἡλικίας – παρούσης: The recommendation to phlebotomize patients only if they are in their prime of life (on which see in more detail p. 363, commentary on p. 137.23–25) and if their body is in a good condition rests on the assumption that the patient is sufficiently strong. In Galen’s De curandi ratione per venae sectionem, it is explicitly stated that one should phlebotomize patients if they are in their prime of life and are strong in body.261 For similar remarks in the context of phrenitis see also Diocles, the Anonymus Parisinus, Caelius Aurelianus or Paul.262 p. 126.10–11: πάντων – πλῆθος: The previous remarks about the bloody urine and the redness of the face are to be understood as signifying an excess of blood in the body. See also p. 177 f., commentary on p. 126.8–9. This surplus blood can be evacuated through phlebotomy. On the aims of phlebotomy, see also p. 178 f., commentary on p. 126.11–12. p. 126.11–12: φλεβοτομητέον – φλέβα: Phlebotomy is one of the most common therapies in ancient medicine, if not the most common, and was considered to be suitable for treating many affections.263 In his Methodus medendi, Galen considers the indicators of phlebotomy, in the course of which discussion he states that, since

255 See e.g. Galen, De loc. aff. 5.4 (8.330.13 f. K.), Paul 3.6.1 (Vol. 1, 144.20 Heiberg), Alexander, Therapeutica 1.13 (618.15 Guardasole = Vol. 1, 511.24 Puschmann). 256 See e.g. Paul 3.6.1 (Vol. 1, 144.6 Heiberg), Hippocrates, De morb. 1.30 (86.19–88.6 Wittern = 6.200.11–18 L.), De morb. 1.34 (92.7–9 Wittern = 6.204.5–7 L.). 257 See Paul 3.6.1 (Vol. 1, 144.27 f. Heiberg). 258 See Alexander, Therapeutica 1.13 (618.15 f. Guardasole = Vol. 1, 511.24 f. Puschmann). 259 See e.g. Galen, De loc. aff. 2.8.8 (336.7–9 Gärtner = 8.96.11–14 K.). 260 See Galen, De loc. aff. 5.4 (8.332.10–12 K.). I cite Siegel’s translation: see Siegel 1976 in Galen. On the affected parts, 149. 261 See Galen, De cur. rat. per venae sect. 9 (11.277.1–3 K.), see e.g. also Alexander, Therapeutica 4 (Vol. 2, 143.7 f. Puschmann). 262 See Diocles fr. 73.6–13 van der Eijk, Anon. Par. 1.3.2 (4.23 f. Garofalo), Caelius Aurel., Cel. pass. 1.70 (62.4 f. Bendz), Paul 3.6.2 (Vol. 1, 145.2 Heiberg). 263 See e.g. Leven 2005a, Brain 2009 in Galen On Bloodletting [listed under De curandi ratione per venae sectionem].

VI 2 On phrenitis from (the books of) Posidonius

| 179

blood is naturally useful (χρηστὸν τῇ φύσει τὸ αἷμα) and phlebotomy is the evacuation of blood (αἵματος κένωσις), it is necessary that one evacuates only that which is useless (τὸ ἄχρηστον).264 He then distinguishes two ways (διττῶς) in which blood may be useless: either when it no longer maintains its quality (τὸ μὴ φυλάττον ἀκριβῶς τὴν ἑαυτοῦ ποιότητα) or when there is so much blood “that the capacity of the blood is disabled” (τὸ πλῆθος τοσοῦτον γενόμενον, ὡς ἤτοι βαρύνειν τὴν δύναμιν).265 In a nutshell, phlebotomy may be applied in cases in which the quality of the blood is contrary to nature or there is a quantitative excess of blood. The previous statement about the signs signifying a great amount of blood in the body and therefore indicating phlebotomy (on which, see also p. 178, commentary on p. 126.10–11) suggests that a quantitative excess of blood is the indicator for phlebotomy in the present context. It is not unusual for ancient medical writers to specify the exact place where the veins are to be cut,266 with the present passage identifying the elbow (ἀπ’ ἀγκῶνος), and even more specifically, its middle vein (τὴν μέσην φλέβα).267 Exactly the same recommendation to phlebotomize patients suffering from phrenitis is found in Aretaeus, who likewise suggests that the incision should be made in the middle vein of the elbow.268 Paul and Alexander also discuss the cutting of veins in the elbow.269 p. 126.12: καὶ κενοῦν – λειποθυμίας: On evacuation (κενοῦν) as the aim of phlebotomy, see p. 178 f., commentary on p. 126.11–12. The formulation πρὸς δύναμιν (according to the strength of the patients) is commonly used in the context of phlebotomy and aims to highlight the need to take into account the bodily constitution of each patient before starting to cut a vein.270 The noun λειποθυμία is likewise commonly used with regard to phlebotomy and the authors also frequently discuss whether one should phlebotomize until the patient faints or whether one should use all means possible to attempt to avoid causing the patients to fall unconscious.271 In Aretaeus’ chapter on phrenitis, it is similarly recommended that one should not remove a great deal of blood after having cut a vein since phrenitis easily changes

264 See Galen, Meth. med. 9.11 (510.15–17 Johnston & Horsley = 10.640.11–15 K.). 265 See Galen, Meth. med. 9.11 (510.18–21 Johnston & Horsley = 10.640.15–18 K.). 266 See e.g. Galen, De cur. rat. per venae sect. 16 (11.296.16–297.2 K.). For a more detailed discussion, see also Brain 2009 in Galen On Bloodletting [listed under De curandi ratione per venae sectionem], 122–134. 267 See also Galen’s discussion of cutting veins in the elbow: Galen, De cur. rat. per venae sect. 16 (11.298.10–299.9 K.). 268 See Aretaeus 5.1.4 (92.16 f. Hude). 269 See Paul 3.6.2 (Vol. 1, 145.2 Heiberg), Alexander, Therapeutica 1.13 (622.17 f. Guardasole = Vol. 1, 517.7 Puschmann). 270 See e.g. Galen, De cur. rat. per venae sect. 9 (11.277.1–3 K.): καλῶς οὖν ἐν τοῖς προκειμένοις τῶν περὶ διαίτης ὀξέων παρῄνηται φλεβοτομεῖν ἡμᾶς, ὅταν ᾖ μέγα τὸ νόσημα καὶ ἀκμάζῃ [ἡ νόσος, ἢ] ὁ νοσῶν καὶ ῥώμη παρῇ. 271 See e.g. Galen, De cur. rat. per venae sect. 1 (11.252.1 f. K.).

180 | Commentary

into syncope, which is bad.272 Caelius Aurelianus also advises against phlebotomizing until the patient faints (he even uses the Latin lipothymia in this regard, which is borrowed from the Greek λειποθυμία), stating that this would weaken the patient further.273 p. 126.12–14: ἔλαττον – κόπον: Instead of γιγνομένης, which is the reading of the Laurentianus graecus 75,20 (La) and is followed by Olivieri in his edition of the text, one should rather read γιγνομένην, which is, according to Olivieri’s critical apparatus, the consensus codicum,274 and which makes much better sense, since it is congruent with διαφόρησιν. The recommendation to take away rather less blood than is actually necessary (ἔλαττον μᾶλλον τοῦ δέοντος ἀφαιροῦντας) is linked to the exhaustion (διαφρόρησις)275 and fatigue (κόπος) the patients will suffer as a result of the violent motion (ἐκ τῆς σφοδρᾶς κινήσεως).276 This “violent motion”277 seems to refer to the fact that patients suffering from phrenitis are often said to become furious,278 although this outcome is not explicitly mentioned in the present chapter. If the patients move about too much in their agitation and thus become exhausted, the loss of a great deal of blood would be a further factor that contributes to their weakening. Blood loss should, thus, be kept to a minimum. See also p. 179 f., commentary on p. 126.12. p. 126.14–16: καὶ ἡ – παρέπεται: This section is slightly problematic given that it remains unclear how a moderate incision can help to prevent the patient secretly unfastening their bandage. It is clear that the gist of the section is that the physician should avoid too great a loss of blood, since this loss will be dangerous for patients suffering from phrenitis (see also p. 180, commentary on p. 126.12–14). “The bandage of the arm” (τὸν δεσμὸν τοῦ βραχίονος) probably refers to a kind of plaster which is placed on the part of the arm where the veins have been cut after the phlebotomy. If the physician makes a moderate incision, the loss of blood should not be as great as it would be if the incision is enormous. If the patient then unfastens the plaster,

272 See Aretaeus 5.1.5 (92.21 f. Hude). 273 See Caelius Aurel., Cel. pass. 1.70–71 (62.9–14 Bendz). 274 See Olivieri’s critical apparatus to p. 126.13. The siglum α stands, according to the signorum explicatio of Olivieri’s first volume of Aetius’ Libri medicinales (books I–IV) for consensus codicum: See CMG VIII 1, XVII. 275 This meaning of διαφρόρησις is suggested by LSJ and could be etymologically explained by the “dispersion” of the patients’ energy. I am grateful to Christine Salazar for suggesting this meaning in the present context. 276 The notion that fatigue results from violent motion is commonly expressed in Galen. See e.g. Galen, De san. tuenda 3.7.1 (88.20 f. Koch = 6.199.13 f. K.). 277 The reference to patients who “become wild” (p. 126.4: ἀγριαινομένους) can be interpreted as one form of the patients’ violent motion. 278 See e.g. Paul 3.6.2 (Vol. 1, 145.5 Heiberg): ἐκ τοῦ παρακοπτικῶς ταράττεσθαι, Paul 3.6.2 (Vol. 1, 146.1 Heiberg): συγκοπτικὴ γάρ ἐστι τῆς δυνάμεως ἡ ἄτακτος κίνησις. I am grateful to Christine Salazar for discussing this passage with me and for providing helpful advice on how best to interpret it.

VI 2 On phrenitis from (the books of) Posidonius

|

181

which is supposed to stem the flow of blood, the blood loss will also not be as great as it would be if the incision was larger.279 p. 126.16–17: παραλειφθέντος – βοηθήματος: This genitive absolute refers back to the previously discussed conditions that have to be fulfilled in order for a phlebotomy to be warranted (p. 126.6–11) and introduces the following list of alternative curing methods that should be selected if one or more of these conditions are not fulfilled. See also p. 181, commentary on p. 126.17–19. p. 126.17–19: κλυστῆρσι – ὀλίγου: The application of enemata is the first alternative approach to phlebotomy recommended here. The application of enemata is a common therapy in ancient medicine. It is regarded as an evacuative therapeutical approach – like phlebotomy (in both cases the verb κενοῦν is used in the present chapter) – and its application is, therefore, recommended as a treatment for several different affections.280 Phlebotomy and the application of enemata are often referred to as comparable methods.281 The application of enemata in patients suffering from phrenitis is also recommended by Aretaeus, Caelius Aurelianus, Paul and the Anonymus Parisinus.282 The ingredients of the enema that are mentioned here – that is the juice of bran or of barley gruel (χυλὸς πιτύρων ἢ πτισσανῶν), native soda (ἀφρόνιτρον), and honey (μέλι) – are commonly recommended in a variety of texts as ingredients of enemata.283 Bran has a cleansing capacity, according to Galen’s De alimentorum facultatibus, and supports excretion by stimulating the internal organs.284 Galen wrote a treatise dealing with barley gruel in which he states that it has a cleansing capacity and that it does not disturb the stomach.285 Native soda is also regarded as having a cleansing capacity according to Aetius’ second book,286 as is honey in the first book.287 p. 126.19: τὴν – χλιαρῷ: Treating the head with embrocations is a very common therapeutic approach and phrases such as ἐμβρέχειν τὴν κεφαλήν appear frequently

279 I am grateful to Christine Salazar for her assistance in interpreting this passage. 280 See e.g. Hippocrates, De affect. int. 28 (150.19–21 Potter = 7.242.1–4 L.), Galen, De diff. febr. 2.16 (7.392.11–16 K.), Aetius Amid., Libri med. 7.24 (Vol. 2, 271.21 f. Olivieri). See also Stamatu 2005. 281 See e.g. Galen, De venae sect. adv. Erasistrateos 3 (11.210.19–211.7 K.), Aetius Amid., Libri med. 7.24 (Vol. 2, 271.21 f. Olivieri), Oribasius, Eclog. med. 103.2 (282.34 f. Raeder). 282 See Aretaeus 5.1.20 (96.5–7 Hude), Caelius Aurel., Cel. pass. 1.74 (64.5–7 Bendz), Paul 3.6.2 (Vol. 1, 145.7 f. Heiberg), Anon. Par. 1.3.2 (4.25 Garofalo). 283 See e.g. Aetius Amid., Libri med. 6.4 (Vol. 2, 132.19–22 Olivieri). 284 See Galen, De alim. fac. 1.2 (25.16–18 Wilkins = 6.482.1–4 K.). 285 See Galen, De ptis. 5.2 (459.2–4 Hartlich = 6.822.14–16 K.), De ptis. 5.11 (460.16 f. Hartlich = 6.825.14–16 K.). 286 See Aetius Amid., Libri med. 2.50 (Vol. 1, 171.21 f. Olivieri). See e.g. also Galen, Meth. med. 8.2 (372.7–9 Johnston & Horsley = 10.547.14–16 K.). 287 See Aetius Amid., Libri med. 1.273 (Vol. 1, 108.17 f. Olivieri).

182 | Commentary

in medical texts.288 It is often recommended that substances be applied to the head if the head is the affected part,289 as is the case with phrenitis. According to Aetius’ first book, rose oil (ῥόδινον [scil. ἔλαιον]) is suitable for patients whose heads are warm and dry, since it moistens, soothes, and brings about sleep.290 Other texts also recommend the application of rose oil as a remedy against sleeplessness.291 Since sleeplessness was commonly connected to warmth (see p. 189, commentary on p. 127.20–23), it seems plain that the efficacy of rose oil in this area was attributed to a supposed cooling capacity. Given that phrenitis was understood to be an inflammation, it is unsurprising that the application of embrocations made of rose oil was a common therapeutic approach.292 p. 126.20–127.1: φλεγμαινούσης – θερμόν: These lines provide an explanation for the recommendation that the rose oil should be lukewarm (p. 126.19: ῥοδίνῳ μᾶλλον χλιαρῷ). The explanation is based on the assumption that both the cold and the very hot can be harmful for inflamed meninges: while the cold can block the pores, the hot doubles the inflammation. “Pores” (πόροι) is generally used to denote channels through which substances can pass,293 with it being possible to remove superfluities (περιττώματα) through these channels, as the present passage makes clear. The blockage of these pores thus needs to be prevented. Since phrenitis itself is an inflammation, it is clear that hot rose oil cannot be applied to the patients, since it would double the inflammation (πύρωσις). The connection between the season of the year and the recommended temperature of the rose oil that needs to be applied is very similar to that identified earlier in the chapter, when the author discusses the relationship between the recommended temperature of the sick room and the season of the year (see p. 174 f., commentary on p. 126.1–2). The assumption that underlies the present recommendation is that the adaptation of the temperature

288 See e.g. Galen, Meth. med. 13.21 (400.6 f. Johnston & Horsley = 10.928.14 f. K.); Alexander, Therapeutica 1.13 (622.18 f. Guardasole = Vol. 1, 517.7–9 Puschmann). 289 See e.g. Galen, Meth. med. 13.21 (400.2–402.2 Johnston & Horsley = 10.928.11–929.16 K.) where Galen criticizes physicians who apply substances to the head in affections which damage the hegemonikon despite their localization of the hegemonikon in the heart, which should require them to apply those substances to the heart instead. Galen localizes the hegemonikon in the brain and would, thus, of course apply substances to the head in seeking to treat this faculty. On this topic, see also Lewis 2018. 290 See Aetius Amid., Libri med. 1.113 (Vol. 1, 58.10–12 Olivieri). 291 See e.g. Aretaeus 5.1.10 (93.31 f. Hude), Paul 3.6.2 (Vol. 1, 145.8 f. Heiberg), Alexander, Therapeutica 1.10 (594.4 f. Guardasole = Vol. 1, 485.1 f. Puschmann). 292 See e.g. Galen, Meth. med. 13.21 (400.6–8 Johnston & Horsley = 10.928.14–16 K.), Alexander, Therapeutica 1.13 (622.18 f. Guardasole = Vol. 1, 517.7–9 Puschmann), Paul 3.6.2 (Vol. 1, 145.8–10 Heiberg), Aretaeus 5.1.10 (93.31–94.1 Hude). 293 See e.g. Galen, De instr. odor. 6.3 (60.24–27 Kollesch = 2.883.15–884.1 K.), Meth. med. 12.5 (274.11–14 Johnston & Horsley = 10.844.10–14 K.), De usu part. 10.14 (Vol. 2, 106.8–10 Helmreich = 3.831.16–18 K.). See also Rocca 2003, 23f . for a more detailed discussion of the role of pores in ancient medicine.

VI 2 On phrenitis from (the books of) Posidonius

|

183

of the rose oil to the season of the year (and thus to the typical ambient temperature) helps to create a balance of the temperature. p. 127.1–3: εὔθετον – περιέχοντος: According to Aetius’ first book, camomile oil can be applied to the head in cases of fever, as it opens the pores and disperses vapors (διαφορεῖ τοὺς ἀτμοὺς).294 The danger of a blockage of the pores has been discussed previously (see p. 182 f., commentary on p. 126.20–127.1). The remark that camomile oil should be applied if the surrounding is cold (ψυχροτέρου ὄντος τοῦ περιέχοντος) matches a passage in Aetius’ fifth book which also states that one should apply camomile oil, and especially if the surrounding is cold (καὶ μάλιστα ὅταν τὸ περιέχον ψυχρὸν ᾖ).295 Similar statements are found in other texts,296 from which it is possible to conclude that camomile oil is regarded as especially useful in the winter. p. 127.3: εἰ δὲ – παραφορά: This subclause introduces the subsequent therapeutic remarks by making it clear that they refer to patients whose mental derangement is more vehement and who require therapies other than those previously mentioned. p. 127.3–4: προκενώσας – κλυστῆρσι: Evacuation by means of phlebotomy and enemata has been discussed in detail previously (see p. 178 f., commentary on p. 126.11–12 and p. 181, commentary on p. 126.17–19), which explains the use of the phrase ὡς εἴρηται (“as was said”) here. p. 127.4–5: ἀφεψήσας – πρόσωπον: The application of a remedy made of poppyhead (κωδία) is, according to Aetius’ fifth book, useful for treating warm affections, fevers, and cases of sleeplessness, among other things.297 The application of poppyheads to patients suffering from phrenitis is frequently recommended in the ancient literature.298 For more on the connection between warmth and sleeplessness, on the one hand, and coldness and sleep, on the other, see also p. 189, commentary on p. 127.20–23. A chapter of Aetius’ third book dedicated to “fomentations” (περὶ καταιονήσεων – the noun καταιόνησις is a derivative of the verb καταιονᾶν, which is used in the present context) explains the cases in which this therapeutical procedure should be applied: in patients suffering from sleeplessness, in cases of fever, and in patients who are mentally deranged.299 As regards the procedure itself, the same ad-

294 See Aetius Amid., Libri med. 1.114 (Vol. 1, 59.18 Olivieri). 295 See Aetius Amid., Libri med. 5.78 (Vol. 2, 55.17 f. Olivieri). 296 See e.g. Galen, De comp. med. sec. loc. 2.1 (12.561.1 K.), Meth. med. 12.3 (242.5–7 Johnston & Horsley = 10.822.9–12 K.), Paul 2.36 (Vol. 1, 110.11–13 Heiberg). 297 See Aetius Amid., Libri med. 5.137 (Vol. 2, 113.3–8 Olivieri). 298 See e.g. Anon. Par. 1.3.7 (6.25 f. Garofalo), Aretaeus 5.1.13–14 (94.19 f. Hude and 94.25 Hude), Paul 3.6.2 (Vol. 1, 145.8–10 Heiberg), Alexander, Therapeutica 1.13 (622.23–29 Guardasole = Vol. 1, 517.12–17 Puschmann). 299 See Aetius Amid., Libri med. 3.172 (Vol. 1, 345.4–6 Olivieri).

184 | Commentary

vice is given as in the present passage: one needs to boil down poppyheads in oil and pour it over the head, which is said to bring about sleep immediately.300 p. 127.5–6: συνεχῶς – κωδιῶν: Washing (προσκλύζεσθαι) the face and the head is a common approach in ancient medicine.301 It is also recommended in other texts for patients suffering from phrenitis.302 According to the “Hippocratic” De affectionibus, washing the head of patients suffering from phrenitis is useful because it softens the body, leads to an increased production of sweat and to the excretion of stool and urine, as well as causing the patient to regain a greater degree of self-control.303 Taking the patient to the bath is recommended in Diocles’ account of phrenitis if the patient is “strong and impetuous”,304 while Alexander goes so far as to dedicate a whole paragraph of his chapter on phrenitis to baths (περὶ λουτροῦ)305 writing that bathing the patient is necessary for defeating the affection.306 I take the genitive absolute ἀνεφεψημένων αὐτῷ κωδιῶν to refer to the washing of the head and face, and, more specifically, the αὐτῷ to refer to the water that will be used in the washing. For the usage of poppyheads in the therapy for phrenitis, see also p. 183, commentary on p. 127.4–5. p. 127.6–7: καὶ τὸ – σπερμάτων: The noun τρόχισκος, a diminutive of τροχός,307 describes a troche. According to Paul, this name derives from the remedy’s form (τροχίσκοι ὀνομάζονται μὲν ἀπὸ τοῦ σχήματος),308 which is round like a circle and can either be used as a drink (πότιμοι), for injections (ἐνετικοί), or for ointments (κατάχριστοι).309 In the present context, the troche is used for anointing the forehead. See also p. 183, commentary on p. 127.4–5 for the hypnotic purposes of this application. The panchreston that is used here as an example of the recommended troche denotes, according to its literal meaning, a substance that is “useful for everything”. In medical literature, the term is generally used to refer to a remedy and is occasionally connected to the name of Erasistratus in this context.310 The reference to the 300 See Aetius Amid., Libri med. 3.172 (Vol. 1, 345.7 f. Olivieri): καὶ ἐλαίῳ δὲ κωδύας ἀφεψήσαντες καταιονοῦμεν τὴν κεφαλὴν καὶ παραχρῆμα ὕπνον ἡδὺν ἐπιφέρει. 301 See e.g. Galen, De comp. med. sec. loc. 4.9 (12.790.16 K.), De comp. med. sec. loc. 5.3 (12.826.3 f. K.), Paul 1.40 (Vol. 1, 26.28 f. Heiberg), Aetius Amid., Libri med. 5.120 (Vol. 2, 97.19 Olivieri). 302 See e.g. Paul 3.6.2 (Vol. 1, 145.9 f. Heiberg), (here the verb προκαταντλεῖν is used), Galen, Meth. med. 13.21 (400.6 f. Johnston & Horsley = 10.928.14 f. K.) (here the verb ἐπιβρέχειν is used), Aretaeus 5.1.29 (98.2 f. Hude) (here the verb λούειν is used). 303 See Hippocrates, De affect. 10 (18.16–20 Potter = 6.218.5–8 L.). 304 See Diocles fr. 73.6–7 van der Eijk. I quote van der Eijk’s translation here. See also van der Eijk 2001 in Diocles of Carystus, 150. 305 See Alexander, Therapeutica 1.13 (630.27–632.8 Guardasole = Vol. 1, 525.16–26 Puschmann). 306 See Alexander, Therapeutica 1.13 (632.6–8 Guardasole = Vol. 1, 525.23–26 Puschmann). 307 See LSJ s.v. τρόχισκος. 308 See Paul 7.12.1 (Vol. 2, 313.20 Heiberg). 309 See Paul 7.12.1 (Vol. 2, 313.20 f. Heiberg). 310 See e.g. Galen, De comp. med. sec. loc. 4.8 (12.735.17 K.), Aetius Amid., Libri med. 6.83 (Vol. 2, 229.7 Olivieri), Paul 7.16.57 (Vol. 2, 346.11 Heiberg).

VI 2 On phrenitis from (the books of) Posidonius

|

185

remedy τῷ διὰ σπερμάτων is similarly unspecific but is also common in the medical literature: The “remedy made from seeds” is recommended in many other medical passages as well,311 and was obviously a technical term in ancient medicine. This is why Galen, for instance, can speak about those remedies that are called “remedies made from seeds” (τά διὰ σπερμάτων λεγόμενα).312 Several recipes for remedies made from seeds (διὰ σπερμάτων) are transmitted in the ancient medical literature.313 Given that in the present context the remedy made from seed is referred to as an example of a hypnotic troche, it is likely that the reference is to the seed of poppyheads (σπέρμα μήκωνος or κωδυῶν), which has a hypnotic capacity (see p. 183, commentary on p. 127.4–5).314 p. 127.7–9: καὶ ὀσφραίνειν – ἀγρυπνοῦντας: The reference to the “previous book on those who are sleepless” is to a passage in the fifth book in which sleeplessness was discussed in the context of fevers (the corresponding chapter is entitled Ἐκ τῶν Ἡροδότου καὶ Φιλουμένου περὶ ἀγρυπνίας ἐν πυρετοῖς).315 This chapter includes the statement that one needs to use smelling remedies (καὶ ὀσφραντοῖς δὲ χρηστέον) against sleeplessness, listing poppy, the so-called poppy-like lettuce, coriander, and rose oil as examples.316 The benefit of smelling drugs in the context of sleeplessness is also attested in other texts.317 This reference to the previous book is highly interesting with regard to the whole compilation insofar as it offers an insight into Aetius’ method of assembling his huge work. The reference demonstrates that Aetius used cross-references, such as as the one found here, to guide his readers through his compilation, which is a further indication that Aetius composed his work as a unified whole rather than simply putting together different parts of other treatises without pursuing an overall agenda (see also p. 13 and p. 27 – 32). p. 127.9–10: καὶ ὑπὸ – μῆλα: The same instructions were also given in the previously mentioned chapter of the fifth book of the Libri medicinales, dealing with

311 See e.g. Galen, De comp. med. per gen. 7.7 (13.978.3 K.), Paul 3.43.2 (Vol. 1, 237.16 Heiberg), Alexander, Therapeutica 8.2 (Vol. 2, 347.12 Puschmann), Oribasius, Eclog. med. 53.4 (214.34 Raeder). 312 See Galen, Meth. med. 5.9 (60.18–19 Johnston & Horsley = 10.345.16 K.). 313 See e.g. Galen, De comp. med. per gen. 7.7 (13.978.3 K.), Paul 7.18.17 (Vol. 2, 372.15–19 Heiberg), Oribasius, Eclog. med. 81.3 (256.21–34 Raeder). 314 See e.g. also Aetius Amid., Libri med. 8.29 (Vol. 2, 439.7 f. Olivieri), Libri med. 12.36 (63.11 f. Kostomiris), Galen, Meth. med. 5.13 (100.16–18 Jonston/Horsley = 10.372.10–13 K.) where the term τὸ διὰ σπερμάτων is connected to a hypnotic capacity. See also Galen, De alim. fac. 1.31 (80.17–22 Wilkins = 6.548.9–13 K.), Oribasius, Coll. med. rel. 1.29.1 (Vol. 1, 17.17–20 Raeder), where it is precisely the seed of poppyheads that is said to have a sleep-inducing capacity. 315 See Aetius Amid., Libri med. 5.120 (Vol. 2, 97.14–98.18 Olivieri). 316 See Aetius Amid., Libri med. 5.120 (Vol. 2, 97.16–18 Olivieri). 317 See Alexander, Therapeutica 1.13 (622.27 Guardasole = Vol. 1, 517.16 Puschmann), where the application of smelling remedies is also recommended in the context of phrenitis. See also e.g. Galen, De comp. med. sec. loc. 4.9 (12.795.11–13 K.), Paul 2.41 (Vol. 1, 113.18–21 Heiberg).

186 | Commentary

sleeplessness in the context of fevers (see also p. 185, commentary on p. 127.7–9).318 For a closer look at the sleep-inducing capacities of poppyheads, see p. 183, commentary on p. 127.4–5. Mandrake (μανδραγόρας) is likewise known for its power to induce sleep.319 A similar recommendation to place sleep-inducing substances under the patients’ pillows is also given by Aretaeus.320 p. 127.10: ἐπιταθέντων δὲ τῶν κακῶν: This genitive absolute introduces a new section of therapeutic instructions, with the text now turning to patients who, it seems, must not have responded well to the treatment and who may even be suffering from an intensification of the affection. It seems to take up the subclause εἰ δὲ σφοδροτέρα εἴη ἡ παραφορά (p. 127.3), on which see p. 183, commentary on p. 127.3, and to further develop the idea that patients may require special treatment because the course of their affection differs from that of others in terms of intensity of symptoms. p. 127.10–12: διδόναι – δύναμιν: The application of remedies made from poppyheads has already been recommended prominently in earlier parts of this chapter (see especially p. 183, commentary on p. 127.4–5 and p. 184 f., commentary on p. 127.6–7), grounded on the sleep-inducing capacities of the plant. The present passage now turns to the oral application of poppyheads in accordance with the intensification of the evils. Phrases such as ὅσον κοχλιάριον (“as much as fits on a spoon”) are commonly used in medical texts to denote the appropriate dosage of a remedy.321 The further recommendation to adapt the dosage to the strength of the patient (πρὸς δύναμιν) is a common instruction in ancient medical texts and indirectly implies that the physician should carefully examine his patient before administering the recommended remedies. On the phrase πρὸς δύναμιν, see also p. 179, commentary on p. 126.12. p. 127.12–13: δοτέον – οἰνῶδες: I take it that these remarks refer to the remedy made from poppyheads mentioned previously (see p. 186, commentary on p. 127.10– 12) and to further specify the composition of this remedy. Poppyheads clearly serve as the basic ingredient, while the mention of honey clarifies which of the poppybased remedies should be used in this specific context. The sleep-inducing remedy composed of a decoction of poppyheads and honey is also mentioned in the fifth book of the Libri medicinales – to which Aetius has recently referred in this chapter (see p. 185,11 – 25, commentary on p. 127.7–9) – where it is said to be sweeter in taste

318 See Aetius Amid., Libri med. 5.120 (Vol. 2, 97.15 f. Olivieri): τοῖς δὲ προσκεφαλαίοις τῶν ἀγρυπνούντων ὑποθετέον κωδίας ἢ καὶ ῥίζας μήκωνος μελαίνης ἢ μῆλα μανδραγόρου ἢ ὑοσκυάμου. 319 See Aetius Amid., Libri med. 1.268 (Vol. 1, 107.17 f. Olivieri): (…) κωματώδη τὴν δύναμίν ἐστι (…). See also e.g. Galen, De temp. 2.2 (48.20–22 Helmreich = 1.585.14 f. K.), De comp. med. sec. loc. 4.9 (12.795.11–13 K.). 320 See Aretaeus 5.1.14 (94.21 f. Hude). 321 See e.g. Dioscorides, De mat. med. 2.163 (Vol. 1, 227.15 f. Wellmann), Galen, Meth. med. 7.11 (324.13 f. Johnston & Horsley = 10.516.8 f. K.), Aetius Amid., Libri med. 6.24 (Vol. 2, 166.20 Olivieri).

VI 2 On phrenitis from (the books of) Posidonius

|

187

than the other sleep-inducing remedies.322 I take the phrase διὰ τοῦ γλυκέος to refer to sweet wine (γλυκὺς οἶνος).323 The instruction to refrain from using the remedy made from sweet wine is explained by its “being vinous” (διὰ τὸ οἰνῶδες). Although wine is used as a remedy in several other contexts, the author of the present passage obviously takes it to be contraindicated here and recommends honey (which is also sweet) as an alternative. As far is phrenitis is concerned, opinions differ as to whether wine is useful or harmful for the patient: in the “Hippocratic” De affectionibus it is stated that wine should not be applied to patients suffering from phrenitis since it does not provide any advantage for patients whose minds are already deranged.324 According to Aretaeus, one should also avoid fruits that “contain wine” because they affect the patient’s head.325 In Caelius’ remarks on phrenitis, we read that under certain circumstances one may also apply wine to the patients, but only in small amounts since the incorrect application of wine may cause irreparable derangement.326 Alexander of Tralleis dedicates a whole section of his work to the application of wine to patients suffering from phrenitis, concluding that giving wine in moderation (συμμέτρως) may have a positive effect on the patients.327 p. 127.13–16: ἐν παρακμῇ – γιγνόμενον: The terms παροξυσμός, παρακμή and ἀκμή are technical medical terms used to describe certain phases of diseases, and of fevers in particular. The term παροξυσμός denotes the fit of a disease. In Aetius’ fifth book, it is defined as κίνημα νοσήματος μερικὸν ἐπὶ τὸ χεῖρον ἀπὸ ἀνέσεως,328 a partial movement of a disease from a point of relaxation to a worsening of the condition (ἄνεσις being defined in the subsequent chapter as a pause of the disease and the symptoms).329 In this context, the Greek παρακμή describes the abatement of such a fit,330 while ἀκμή describes the peak of a disease.331 The phrase εἰς ὕπνον ἕλκεσθαι is rather unusual in medical literature but is also found in the third chapter (on lethargia) of Aetius’ sixth book and in Alexander’s De

322 See Aetius Amid., Libri med. 5.120 (Vol. 2, 98.13–15 Olivieri). 323 Wine, and more specifically sweet wine, is indeed discussed as a remedy in ancient medical writings. See e.g. Galen, De plac. Hipp. et Plat. 9.6.42–51 (580.26–582.25 de Lacy = 5.771.5–773.11 K.). For a detailed discussion of wine in ancient medical thought, see Jouanna 2012b. 324 See Hippocrates, De affect. 10 (18.13–15 Potter = 6.218.3–5 L.). See also Hippocrates, De morb. 3.9 (76.24 Potter = 7.128.9 f. L.). 325 See Aretaeus 5.1.9 (93.24 Hude). 326 See Caelius Aurel., Cel. pass. 1.86 (70.14–20 Bendz). 327 See Alexander, Therapeutica 1.13 (632.15 f. Guardasole = Vol. 1, 527.4 f. Puschmann). 328 See Aetius Amid., Libri med. 5.8 (Vol. 2, 10.21 f. Olivieri). 329 See Aetius Amid., Libri med. 5.9 (Vol. 2, 10.24 f. Olivieri). 330 See Aetius Amid., Libri med. 5.14 (Vol. 2, 12.5–7 Olivieri): παρακμὴ δέ ἐστιν ἀρχομένων μειοῦσθαί τινων ἢ πάντων τῶν εἰρημένων συμπτωμάτων καὶ τῶν σφυγμῶν ποσῶς εἰς εὐταξίαν ἐρχομένων. 331 See Aetius Amid., Libri med. 5.17 (Vol. 2, 12.24 f. Olivieri: ἡ γὰρ ἀκμή ἐστι τὸ σφοδρότατον μέρος ὅλης τῆς νόσου).

188 | Commentary

febribus.332 Given that the text deals with the application of a hypnotic remedy (p. 127.11: ὑπνωτικοῦ φαρμάκου), it seems odd to advise the physician against applying the remedy during the peak of the affection with the explanation that this would put the patient to sleep (ἕλκει πρὸς ὕπνον), since putting the patient to sleep is exactly what a hypnotic remedy is supposed to do. The reason why this effect is still problematic when brought about during the peak of the affection is that the fever (which is especially strong during the peak of the affection) would immediately wake up the patient again.333 The sleep-inducing effect of the remedy would thus conflict with the (high) fever that leads to sleeplessness. According to the present passage, this situation places the patient in a difficult position in which he is “divided up” (μερίζεσθαι εἰς ἄμφω)334 between sleep brought about by the remedy and sleeplessness brought about by the fever. This conflict has the effect that the patient endures the situation with more difficulties (χαλεπώτερον). But when it is applied during the abatement of the paroxysm, the remedy is capable of having its effect without being disturbed by the fever and its accompanying awakening effect. p. 127.16–17: δοὺς – κέλευε: The same recommendation was given earlier on p. 126.2–3. See also p. 175, commentary on p. 126.2–4. p. 127.17–18: βέλτιον – ὑπαγωγόν: The application of the hypnotic remedy made from poppyheads mixed with honey was mentioned earlier in the chapter (p. 127.12; see also p. 186 f., commentary on p. 127.12–13). Here, the previous recommendation seems to be recapitulated and specified in the statement that one should mix the remedy made from poppyheads with rose-honey (τὸ ῥοδόμελι). The preparation of rose-honey is explained in detail in Aetius’ fifth book,335 where it is also said to be useful in treating feverish affections.336 In the present context, the usefulness of rose-honey for patients suffering from phrenitis is explained by it providing relief for the sharpness (κατακεραστικὸν τῆς δριμύτητος) and evacuation for the bowels (τῆς κοιλίας ὑπαγωγόν). The reference to sharpness here might refer either to the sharpness of the remedy (which has not been mentioned previously in the chapter) or to the accompanying fever being sharp. Several texts characterize fever as sharp (δριμύς).337 For further discussion of the application of evacuating remedies to patients suffering from phrenitis, see p. 181, commentary on p. 126.17–19. The assumption

332 See Aetius Amid., Libri med. 6.3 (Vol. 2, 129.8 Olivieri), Alexander, De febr. 4 (353.7 Puschmann). 333 For a more detailed discussion about the connection between heat and sleeplessness, see p. 189, commentary on p. 127.20–23. 334 For further passages which make use of the phrase μερίζεσθαι εἴς τι, see e.g. Galen, De temp. 3.3 (96.6 Helmreich = 1.662.3 K.), Galen, De sympt. caus. 1.2 (7.89.5 f. K.), Oribasius, Coll. med. rel. 7.5.2 (Vol. 1, 203.31 Raeder). 335 See Aetius Amid., Libri med. 5.139 (Vol. 2, 115.21–116.12 Olivieri). 336 See Aetius Amid., Libri med. 5.139 (Vol. 2, 116.7–10 Olivieri). 337 See e.g. Galen, Meth. med. 8.2 (364.10 Johnston & Horsley = 10.542.10 f. K.), Meth. med. 11.15 (192.1 f. Johnston & Horsley = 10.788.13 f. K.), Paul 2.47 (Vol. 1, 118.16 f. Heiberg).

VI 2 On phrenitis from (the books of) Posidonius |

189

that rose-honey has an evacuating and cleansing effect is also found in other medical writings.338 p. 127.18–20: διὸ – ῥοδόμελι: The reference to the peak of the paroxysm (ἐν τῇ τοῦ παροξυσμοῦ ἀκμῇ) recalls the previous recommendation to avoid applying the narcotic remedy during the peak and to apply it during the abatement of the paroxysm instead (see p. 187 f., commentary on p. 127.13–16). The present recommendation seems to take up these previous remarks concerning the right moment for the application of the remedy and to deal with the moment in which the narcotic remedy cannot be applied but the patient can drink water. The addition of rose-honey to this water seems to have positive effects on the patient, effects that were listed in the previous sentence: it provides relief for the sharpness and evacuation for the bowels (see p. 188 f., commentary on p. 127.17–18). The recommendation that patients suffering from phrenitis should ingest water and honey is also reflected in other writings, such as in the “Hippocratic” De affectionibus339 and the Anonymus Parisinus, in which latter the constant application of honey-water is recommended.340 p. 127.20–23: φυλάττεσθαι – νόσημα: The statement that phrenitis can easily change into lethargia if patients have been heavily cooled by narcotic remedies is also found in Aetius’ subsequent chapter on lethargia, which he claims to have taken from Archigenes and Posidonius (for more on the fact that Posidonius is claimed as a direct source in both chapters see p. 204 f., commentary on p. 128.10– 12). The view that coldness is connected to deep sleep (as found in lethargia) and that heat is connected to sleeplessness (as found in phrenitis) is attested in many ancient medical texts.341 This view explains why the application of too many narcotic remedies cools the patient and thus leads to lethargia. A similar notion is also expressed in Galen’s De alimentorum facultatibus, which discusses the characteristics of poppy seed and states that it has a cooling property and therefore a narcotic effect which can also lead to a deep sleep (καταφορικόν) if it is taken in too great an amount.342 The crucial point in the present passage is, thus, the constant use (τὴν συνεχῆ χρῆσιν) of narcotic remedies which the physicians are advised against, since its ongoing application may lead to a cooling of the patient that is too intense. One thus needs to be moderate in the application of narcotic remedies. The fact that phrenitis can change into lethargia is also reflected in other medical texts, such as Celsus and Caelius Aurelianus. In his section on phrenitis, Celsus reports that Asclepiades said that fomenting the head of the patient with poppy338 See e.g. Aetius Amid., Libri med. 5.139 (Vol. 2, 116.1 f. Olivieri). 339 See Hippocrates, De affect. 10 (18.13 f. Potter = 6.218.3 L.). 340 See Anon. Par. 1.3.13 (10.8 Garofalo). 341 See e.g. Galen, De sympt. caus. 1.8 (7.144.5–11 K.), Galen, De loc. aff. 2.10.20 (378.5–8 Gärtner = 8.131.7–11 K.), De loc. aff. 3.6 (8.161.15 f. K.). Likewise remedies which shall bring about sleep are said to have cooling properties: see e.g. Paul 1.74 (Vol. 1, 53.13 f. Heiberg), Aetius Amid., Libri med. 1.395 (Vol. 1, 141.22 f. Olivieri). 342 See Galen, De alim. fac. 1.31 (80.22 Wilkins = 6.548.13 f. K.).

190 | Commentary

heads is not productive because this often leads to a change into lethargia,343 while Caelius reports that in some patients their phrenitis turns into lethargia during the increase of the affection.344 In the present passage, the mention of πόματα, καταντλήματα, and ἐπίχριστα refers back to the multitude of previous approaches for applying poppyheads to the patient: the drinks (πόματα) refer to the last-mentioned remedy, which is supposed to be applied orally (see p. 127.10–12), the rinsings (καταντλήματα) refer to the washing of the face and the recommendation to pour oil with boiled poppyheads over the face (see p. 127.4–5), while the remedies that are smeared on (ἐπίχριστα) refer to the recommendation to smear a narcotic troche upon the forehead (see p. 127.6–7). The subclause ὅτε καὶ ὀλέθριον γίγνεται τὸ νόσημα marks both phrenitis and lethargia as being potentially fatal. The fact that both affections are severe illnesses is reflected in other writings in which a potentially deadly outcome for phrenitis and lethargia is explicitly mentioned.345 p. 127.23–25: ὅθεν – ἐλαίῳ: The verb ἐμβραδύνειν is used here in the absolute sense to denote the fact that the mental derangement (παραφορὰ) persists despite the provision of treatment.346 The subclause ὅταν ἡ παραφορὰ ἐμβραδύνῃ takes up the recommendations given earlier about what to do when the mental derangement is more vehement (see p. 127.3: εἰ δὲ σφοδροτέρα εἴη ἡ παραφορά) and supplements it in view of the previous warning to be careful with the constant use of narcotics. The present recommendation thus responds to the potential case in which the mental derangement still persists despite the provision of the previously discussed treatment (see p. 127.3–20), and suggests alternative remedies other than the narcotics, which have probably been provided already in too great a quantity. Instead of applying poppyheads and cooking them in oil, as was recommended earlier (see p. 127.4), one should apply tufted thyme (ἕρπυλλος) or cow parsnip (σπονδύλιον), also cooked in oil. The application of tufted thyme and cow parsnip to patients suffering from phrenitis is recommended in other texts as well.347 In Aretaeus’ chapter on the therapy of phrenitis, both substances are not only recommended but the application of cow parsnip is interestingly also connected to the persistence of the mental derangement.348 A similar connection between the application of tufted thyme and the 343 See Celsus, De med. 3.18.14 (125.6 f. Marx). 344 Caelius Aurel., Cel. pass. 1.49 (50.4 f. Bendz). 345 See e.g. Hippocrates, Coac. 96 (126.1 Potter = 5.604.1 f. L.), Galen, De cris. 3.11 (200.4 f. Alexanderson = 9.752.17 f. K.), Hippocrates, De morb. 3.5 (74.1 Potter = 7.122.19 L.). See also Hedtkamp 1993, 50 and 69. 346 For different usages of the verb ἐμβραδύνειν see e.g. also Aetius Amid., Libri med. 6.13 (Vol. 2, 153.32–154.1 Olivieri), Libri med. 5.92 (Vol. 2, 76.7 f. Olivieri). 347 See e.g. Galen, Meth. med. 13.21 (400.11–19 Johnston & Horsley = 10.929.2–10 K.) where Athenaeus is reported to have applied tufted thyme and cow parsnip to patients suffering from phrenitis. 348 See Aretaeus 5.1.10–11 (94.2–5 Hude), who uses the following subclause to denote the persistence of the mental derangement: ἢν δ’ ἐπὶ μᾶλλον ἡ παραφορὴ ἐξάπτηται.

VI 2 On phrenitis from (the books of) Posidonius

| 191

persistence of the mental derangement is also made by the Anonymus Parisinus in his chapter on phrenitis.349 The recommendation to apply tufted thyme and cow parsnip in cases in which narcotic remedies have already been applied in too great a quantity might be motivated by their warming capacities, which are mentioned in several medical treatises.350 These warming capacities could thus help to counteract the excessively intense cooling that can be brought about by the application of a great quantity of narcotic remedies and they can, consequently, help to prevent the change from phrenitis into lethargia. p. 127.25–26: διαπνευστικὰ – τυγχάνει: The adjective διαπνευστικόν is rarely attested in ancient medical texts, but the related verb διαπνεῖν and the noun διαπνοή are commonly used to describe the dissipation of substances that are inside the body.351 The dissipation of substances has already been dealt with earlier in this chapter, where it was highlighted that the pores should be prevented from becoming blocked because such a blockage would not allow the superfluities (περιττώματα) in the head to dissipate (for more detail see p. 182 f., commentary on p. 126.20–127.1). In the present passage, it is not superfluities but thick vapors (τῶν παχέων ἀτμῶν) that are in need of dissipation and we are told that tufted thyme and cow parsnip are remedies that can promote this goal. Interestingly, the same information is also given in Aretaeus’ chapter on the therapy for phrenitis, in which we read that cow parsnip (in addition to certain other substances) promotes the dissipation of vapors and heat and dissolves thick humors which are causative of the mental derangment.352 Aretaeus’ text even uses the same words (ἀτμῶν, διαπνευστικὰ) as Aetius’ text. Although the author of the present passage does not make explicit the connection between vapors and heat, on the one hand, and mental derangement, on the other, in view of the similarities with Aretaeus’ statements, it seems very likely that the same connections are also implicit here. p. 127.26–27: μένοντος – ἐρυθροῦ: This genitive absolute refers to p. 126.9–11, where having a red face (p. 126.9: τοῦ προσώπου ἐρυθροῦ) was listed as one possible indication of the need to conduct a phlebotomy (see p. 178, commentary on p. 126.9 and p. 178 f., commentary on p. 126.11–12). It introduces an alternative therapy to be conducted in cases in which the previously recommended phlebotomy was not successful. p. 127.27–128.1: σικύας – αἵματος: The alternative therapy that is recommended here is cupping through the use of cupping instruments (σικύαι). Cupping is a com349 See Anon. Par. 1.3.5 (6.7–9 Garofalo). 350 See e.g. Aetius Amid., Libri med. 1.146 (Vol. 1, 72.6 Olivieri), Galen, Meth. med. 11.18 (206.18–20 Johnston & Horsley = 10.799.7 f. K.), Galen, De simpl. med. temp. et fac. 6.5 (11.877.12 K.). 351 See e.g. Galen, De alim. fac. 1.10 (45.16 Wilkins = 6.505.5 f. K.), Galen, De sympt. caus. 2.5 (7.178.3 f. K.), Aetius Amid., Libri med. 5.74 (Vol. 2, 48.1 f. Olivieri). 352 See Aretaeus 5.1.11 (94.4–6 Hude): (…) σπονδύλιον τοῖσι ἐλαίοισι ἐνεψεῖν (…)· ἀτμῶν γὰρ τάδε καὶ θέρμης διαπνευστικὰ καὶ παχέων χυμῶν διαλυτικά, τὰ τῆς παραφορῆς ξυναίτια.

192 | Commentary

mon therapy in the ancient medical literature: according to the “Hippocratic” treatise De vetere medicina, cupping instruments are capable of drawing substances from the flesh (πρὸς τὸ ἕλκειν ἐκ τῆς σαρκὸς)353 and Galen, in his Methodus medendi, describes them as an excellent remedy for drawing substances “out of the depth” (ἡ σικύα βοήθημα γενναῖον εὕρηται τῆς τʹ ἔξω φορᾶς τῶν ἐν τῷ βάθει).354 In general, cupping is comparable to phlebotomy insofar as both aim to remove detrimental substances from the body (see also p. 178 f., commentary on p. 126.11–12), and this similarity explains why cupping is mentioned as an alternative approach here. For the application of cupping instruments to the rear of the head, see also p. 237 f., commentary on p. 131.1–4. In the third book of Aetius’ Libri medicinales, a complete chapter is dedicated to cupping.355 The phrase χάρασσε ἀμυχαῖς μετρίως τὸ δέρμα refers to cupping along with scarification, that is to say to cupping which is conducted after the area of the skin to which the cupping instruments are applied (in the present case, the rear of the head) has been scarified. Cupping with scarification is commonly discussed in ancient medical texts and a variety of terms for the process of scarifying the skin are used.356 For more on cupping without scarification, see also p. 480, commentary on p. 149.13–14. Information about the quantity of blood to be removed, such as the remark in the present context that one should empty as much as one litra of blood appears frequently in other texts as well.357 Other texts also recommend the application of cupping instruments to patients suffering from phrenitis: Aretaeus mentions cupping with scarification in cases in which the inflammation does not subside,358 as does the Anonymus Parisinus in cases in which there is an inflammation in the middle parts of the body.359 In Paul’s chapter on phrenitis, “dry” cupping and cupping with scarification are mentioned and said to be conducted at the rear of the head (among other locations), just as in the present passage.360 Alexander also mentions the application of cupping instruments to patients suffering from phrenitis.361 Celsus recommends cupping with scarification at the rear of the head and

353 See Hippocrates, De vet. med. 22.3 (150.4 Jouanna = 1.628.1 f. L.). 354 See Galen, Meth. med. 13.19 (394.14 f. Johnston & Horsley = 10.925.6–8 K.). 355 See Aetius Amid., Libri med. 3.20 (Vol. 1, 276.9–277.7 Olivieri). 356 See e.g. Galen, De loc. aff. 3.5 (8.151.18 f. K.), De cur. rat. per venae sect. 19 (11.306.3–5 K.), Aetius Amid., Libri med. 6.13 (Vol. 2, 154.17 Olivieri). 357 See e.g. Galen, De cur. rat. per venae sect. 14 (11.294.14 K.), De cur. rat. per venae sect. 17 (11.300.12 f. K.). 358 See Aretaeus 5.1.21 (96.7–11 Hude). 359 See Anon. Par. 1.3.5 (6.9 f. Garofalo). 360 See Paul 3.6.2 (Vol. 1, 146.9 f. Heiberg). For the term “dry cupping”, see also Adams’ translation: Adams 1844, Vol. 1 in The seven books of Paulus Aegineta, 362. 361 See Alexander, Therapeutica 1.13 (626.8 f. Guardasole = Vol. 1, 521.5 Puschmann).

VI 2 On phrenitis from (the books of) Posidonius

| 193

states that such cupping may lead to sleep,362 while Caelius dedicates a whole section of his chapter on phrenitis to the application of cupping instruments.363 p. 128.1–3: τροφὴν – ῥοδομέλιτος: The juice of barley gruel (πτισσάνης χυλός) is mentioned earlier in the chapter as an ingredient of the enema (for more detail, see p. 181, commentary on p. 126.17–19). Giving the patient who is suffering from phrenitis the juice of barley gruel to eat is also recommended in Aretaeus, Paul, and Alexander.364 The juice of rice-wheat (ἄλικος χυλός) is often mentioned in connection with barley gruel,365 which suggests that it has similar properties. The noun ψίξ, which is also used here, typically denotes crumbs of bread.366 Paul also recommends the application of bread washed in water to patients who are suffering from phrenitis.367 Rose-honey, which is supposed to be mixed with the crumbs of bread, has been recommended earlier for patients who suffer from phrenitis: for more detail, see p. 188 f., commentary on p. 127.17–18. p. 128.3–5: πραϋνθέντος – δύναμιν: The term ὠὰ ῥοφητὰ is a technical term for eggs that have been prepared in a special way. According to Galen’s De alimentorum facultatibus, these eggs, which can be supped up, have only been warmed and not boiled (τὰ δὲ μόνον τεθέρμανται).368 Although they are said to be less nourishing than others, they are also said to pass easily.369 The application of lettuce (θριδακίνη) to patients suffering from phrenitis is also recommended in Paul’s chapter, where it is said that it should be boiled before being applied.370 Lettuce is said to have cooling properties and to cure sleeplessness,371 both of which capacities are suitable for curing phrenitis, since the affection occurs alongside sleeplessness and is thus understood to be a warm disease (see p. 181 f., commentary on p. 126.19). Indeed, the application of cooling substances is explicitly recommended in the present passage (ὅσα ὑγραίνει καὶ ψύχει μετρίως). The phrase μετὰ τοῦ τρέφειν accordingly refers to the application of such substances through nourishment.

362 See Celsus, De med. 3.18.16 (125.20 f. Marx). 363 See Caelius Aurel., Cel. pass. 1.76–80 (64.17–66.28 Bendz). 364 See Aretaeus 5.1.8 (93.15 Hude), Paul 3.6.2 (Vol. 1, 145.17 Heiberg), Alexander, Therapeutica 1.13 (628.9–12 Guardasole = Vol. 1, 523.7–9 Puschmann). 365 See e.g. Aetius Amid., Libri med. 6.8 (Vol. 2, 139.13 Olivieri), Libri med. 6.43 (Vol. 2, 185.22 Olivieri), Libri med. 4.44 (Vol. 1, 387.18 Olivieri). 366 See e.g. Paul 3.42.6 (Vol. 1, 235.21 Heiberg), Aetius Amid., Libri med. 5.78 (Vol. 2, 53.16 Olivieri). 367 See Paul 3.6.2 (Vol. 1, 145.23 Heiberg). 368 See Galen, De alim. fac. 3.21 (219.17 Wilkins = 6.706.6 K.). 369 See Galen, De alim. fac. 3.21 (219.21 f. Wilkins = 6.706.8 f. K.). 370 See Paul 3.6.2 (Vol. 1, 145.23 Heiberg). 371 See Galen, De alim. fac. 2.40 (147.18–24 Wilkins = 6.626.10–16 K.), Galen, De loc. aff. 2.10.21 (378.11–13 Gärtner = 8.131.16–132.2 K.).

194 | Commentary

VI 3 On lethargia from (the books of) Archigenes and Posidonius Introduction to the disease concept lethargia The Greek term λήθαργος is, according to Caelius Aurelianus, derived from the oblivion and idleness that accompany the affection and which the Greeks call λήθη and ἀργία.372 As we will also see in this introduction, these symptoms – forgetfulness and sleep – are two of the most commonly mentioned in the context of lethargia and are also prominently discussed in Aetius’ chapter. References to lethargia are already found in the “Corpus Hippocraticum”373 and are also attested for other earlier authors such as Diocles or Erasistratus.374 According to the Anonymus Parisinus, who reports on the accounts of all three of these sources, they all connect lethargia to the brain (as does the present chapter), albeit in varying degrees. Hippocrates is said to have held the opinion that lethargia occurs when phlegm burdens the brain, which is, in turn, no longer able to send the psychic capacity (ψυχικὴ δύναμις) to each bodily part.375 Erasistratus is reported to have said that lethargia is an affection of the psychic capacity (ψυχικὴ δύναμις) in the meninx, while Diocles is said to have held that it is a cooling of the psychic pneuma around the heart and the brain and a coagulation of the blood near the heart.376 In general, most of the texts dealing with lethargia assume that the brain is somehow involved in its onset but, as is also visible in the present chapter and in Diocles’ account, it is not always the brain exclusively. While the chapters on lethargia by Alexander and Paul, for example, present only the brain as the affected bodily part,377 Galen in his De locis affectis treats lethargia as a form of damage to the leading activities (ἡγεμονικαὶ ἐνέργειαι) which may occur due to primary or coaffection of the brain,378 as is also assumed in the present chapter (see p. 128.7–8). Furthermore, Caelius does not agree that it is just the head that is the affected part in lethargia. Rather, he claims that it is essential to see that the body as a whole is affected and that it is as part of the body that the head is especially affected because of the multitude of troubles with which it is afflicted.379

372 See Caelius Aurel., Cel. pass. 2.1 (130.5–8 Bendz). 373 See e.g. Hippocrates, Coac. 136 (134.3 Potter = 5.610.13 f. L.), De morb. 3.5 (72.29 Potter = 7.122.15 L.), De morb. 2.65.1 (204.3 Jouanna = 7.100.1 L.). 374 See Erasistratus fr. 177 Garofalo, Diocles fr. 78 van der Eijk. 375 See Anon. Par. 2.1.3 (10.23–27 Garofalo). See also Fuchs’ translation on p. 11 in Garofalo’s edition of the Anonymus Parisinus. 376 See Erasistratus fr. 177 Garofalo, Diocles fr. 78.5–7 van der Eijk and Anon. Par. 2.1.1–2 (10.17–22 Garofalo). 377 See Alexander, Therapeutica 1.14 (634.4 f. Guardasole = Vol. 1, 527.22–24 Puschmann), Paul 3.9.1 (Vol. 1, 147.6–9 Heiberg). 378 See Galen, De loc. aff. 3.7 (8.166.8 f. K.). 379 See Caelius Aurel., Cel. pass. 2.26 (144.24–27 Bendz).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

195

Several texts also discuss lethargia in comparison to phrenitis. Alexander and Paul open their chapters on lethargia with the distinction between the two affections, which are both said to have the same seat (i.e. the brain) but to be brought about by different bodily substances (i.e. phlegm in the case of lethargia).380 In Galen’s De locis affectis, lethargia and phrenitis are mentioned in close connection as two examples of affections which are accompanied by fever and cause damage to the leading capacities.381 Caelius, meanwhile, explains that phrenitis often changes into lethargia and that lethargia also often changes into phrenitis.382 This account is very similar to that found in the present chapter, where the change from phrenitis into lethargia is also discussed (see p. 128.9–12). To some extent, the comparability of the two affections is also based on their being acute diseases, a group of affections among which phrenitis and lethargia are ranked by authors such as the Anonymus Parisinus, Aretaeus, Celsus, and Caelius Aurelianus.383 Most of the texts dealing with lethargia mention sleep as one of its main symptoms: in several “Hippocratic” treatises, lethargia is said to manifest itself especially in sleeping,384 while Celsus in his De medicina mentions a nearly unavoidable impulse to sleep (inexpugnabilis paene dormiendi necessitas) as its central characteristic.385 According to the pseudo-Galenic Definitiones medicae, lethargia is a form of sleep from which it is difficult to be roused.386 In Galen’s De symptomatum causis, lethargia is linked with sleep that is contrary to nature,387 while both Alexander and Paul state that patients in lethargia suffer from deep sleep.388 In addition, a number of texts which do not explicitly refer to sleep as a symptom of lethargia mention behavioral patterns of the patients which indicate that they are at least in a sleepy condition.389 Another symptom with which lethargia is commonly connected is forgetfulness.390 Some texts which do not explicitly state that patients are forgetful 380 See Alexander, Therapeutica 1.14 (634.4 f. Guardasole = Vol. 1, 527.22–24 Puschmann), Paul 3.9.1 (Vol. 1, 147.6–8 Heiberg). 381 See Galen, De loc. aff. 3.7 (8.166.5–9 K.). 382 See Caelius Aurel., Cel. pass. 2.2 (130.12–14 Bendz). 383 See Garofalo 1997 in Anonymi Medici De morbis acutis et chroniis, ix; Aretaeus 5.proem (91.1–3 Hude), Celsus, De med. 3.20.1 (129.3 f. Marx), Caelius Aurel., Cel. pass. 2.1 (130.4 f. Bendz). 384 See e.g. Hippocrates, Coac. 136 (134.3 f. Potter = 5.610.14 L.), De morb. 2.65.1 (204.5 Jouanna = 7.100.3 L.), Hippocrates, De morb. 3.5 (72.31 Potter = 7.122.18 L.). 385 See Celsus, De med. 3.20.1 (129.1 f. Marx). 386 See Pseudo-Galen, Def. med. 235 (19.413.5 K.). 387 See Galen, De sympt. caus. 1.8 (7.142.14 f. K.). 388 See Alexander, Therapeutica 1.14 (634.7–9 Guardasole = Vol. 1, 527.24–529.1 Puschmann), Paul 3.9.1 (Vol. 1, 147.10 Heiberg). 389 See e.g. the Anonymus Parisinus, who states that the patients are lying on their backs: see Anon. Par. 2.2.4 (12.10 Garofalo). 390 See e.g. Anon. Par. 2.2.6 (12.15 f. Garofalo), Galen, De loc. aff. 3.6 (8.161.1 K.), Pseudo-Galen, Introd. s. medic. 13.25 (57.23–25 Petit = 14.741.10–12 K.), Caelius Aurel., Cel. pass. 2.1 (130.5–7 Bendz), Alexander, Therapeutica 1.14 (634.6 f. Guardasole = Vol. 1, 527.24 f. Puschmann), Paul 3.9.1 (Vol. 1, 147.13 Heiberg).

196 | Commentary

deal instead with cases in which forms of derangement can be observed in the patients.391 Fever is a symptom of lethargia that is dealt with prominently in Aetius’ chapter and is also mentioned in many other texts dealing with this affection, although not in a detailed manner.392 To summarize, most of the sources mention sleep as the main symptom of lethargia and suppose that the head, or more precisely the brain, is the seat of the affection. Hedtkamp and Moog attempt to identify the concept of lethargia with a modern affection and mention, amongst other possibilities, encephalitis and meningitis as potential candidates, although they rightly urge caution in attempts to compare the ancient descriptions with modern disease concepts.393

Structure of the chapter p. 128.6–15: Περὶ – παρηκολούθησαν: Two origins of lethargia Paraphrase: The beginning of this chapter is concerned with the origins of lethargia, which are said to be twofold: either the brain is co-affected with the diaphragm and the inward parts or it is primarily affected. While the affection befalls one group of patients immediately (probably those whose brain is primarily affected), the other group is affected through a change of acute diseases. Different possible changes from another affection into lethargia are discussed and the change from phrenitis into lethargia is said to be the most important, followed by the change from unintermittent fevers or the change from affections which are connected to evacuation. p. 128.15–22: ἐνίοτε – καλοῦνται: Lethargia during fevers Paraphrase: These lines are concerned with the possibility of lethargia occurring during long-term fevers. Phrases such as βαπτίζεσθαι τῷ ὕπνῳ, βαπτισμός or καταφερέσθαι and καταφορά are used to denote the process of “being drowned in sleep” or of falling asleep, which should be understood as referring to the main symptom of lethargia. Different ways in which the patients might fall asleep are also discussed. p. 128.22–129.6: σκοπεῖν – παροξυσμῶν: Manifestation of the process of falling asleep Paraphrase: These lines are concerned with the manifestation of falling asleep and, in this context, they discuss the patients’ pulse, their respiration, the constitution of their limbs, and the way they behave when they wake up, which is determined by the fact that their reasoning power is damaged. 391 See e.g. Hippocrates, De morb. 2.65.1 (204.4 Jouanna = 7.100.2 L.), Coac. 136 (134.9 Potter = 5.610.18 f. L.), Anon. Par. 2.2.2 (12.7 f. Garofalo). 392 See e.g. Galen, De loc. aff. 3.7 (8.166.5–7 K.), Pseudo-Galen, Introd. s. medic. 13.25 (57.24 f. Petit = 14.741.11 K.), Paul 3.9.1 (Vol. 1, 147.9 Heiberg). 393 See Hedtkamp 1993, 166–169, Moog 1994 in Die Fragmente des Themison von Laodikeia, 232. See also Mettler 1947, 508 f.

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

197

p. 129.6–16: τοῖς μὲν – ταῦτα: Accompaniments of lethargia Paraphrase: In these lines the characteristics that accompany lethargia are discussed: they deal with the constitution of the patients’ hypochondria, their forgetfulness, and their general bodily constitutions, which are especially characterized by an uncontrolled movement of the arms and legs, by the fact that the patients do not shut their mouths, by a slackening of the lower jaw, and by intense wheezing. p. 129.16–23: θεραπεύοντες – ὑποκειμένου: Therapy for lethargia I (awakening substances, sternutatories etc.) Paraphrase: These lines open the section dealing with the appropriate therapy. We are first told how to put the patients to bed. Afterwards it is recommended that the hands and feet be massaged and that “awakening substances that can be smelled” be applied. It is also recommended that fumigated substances and sternutatories be applied. p. 129.23–130.4: εἰ μὲν – ἑφθοῦ: Therapy for lethargia II (phlebotomy, thinning substances etc.) Paraphrase: These lines recommend phlebotomizing those patients who have an abundance of blood and the application of thinning and cutting substances when phlegm and moisture are abundant, as is usually the case in lethargia. They also recommend the application of enemata and suppositories. p. 130.5–10: ἐμβρέχειν – ἐμβρέχομεν: Therapy for lethargia III (embrocations) Paraphrase: These lines deal with embrocations of the head as one appropriate therapy for patients suffering from lethargia. p. 130.10–23: εἰ δὲ – ἄλευρον: Therapy for lethargia IV (poultices) Paraphrase: These lines are concerned with poultices which should be applied when the hypochondrion is inflamed, with those to be applied in case of flatulence, and with those to be applied when hardening befalls the patient. p. 130.23–131.9: ἐπὶ δὲ – ἐμβαλλέσθω: Therapy for lethargia V (long-lasting lethargia) Paraphrase: These lines deal with patients who have already been suffering from lethargia for a long time and discuss the therapy which should be applied in this case. To begin with, the application of sternutatories is recommended again (as in the previous advice) but with different ingredients. We are then told that elaterion should be applied, smeared on the mouth and the palate, the rear part of the head should be cupped, a mustard plaster should be applied, and that the patients should be bathed when the affection abates. p. 131.9–15: τροφαὶ – γιγνέσθω: Therapy for lethargia VI (food) Paraphrase: The last lines of the chapter are concerned with the appropriate food, which should be fine in its substance and have a cutting and drying property.

198 | Commentary

Rationale of the chapter The chapter on lethargia presents an account of the disease concept which includes discussion of its origin (i.e. the brain, which is either primary or co-affected: see p. 128.6–10), its cause (phlegm and moisture: see p. 129.24–26), its symptoms or characteristics and accompaniments (deep sleep, the pulse, respiration, bodily constitution, damage to the reasoning power, constitution of the patients’ hypochondrion, uncontrolled movement of the arms and legs, etc.: see p. 128.16–129.16), and its therapy (see p. 129.16–131.15). While the opening sentence of the chapter is rather clear, straightforward, and catchy insofar as it states that there are two origins of the affection and presents the brain as having a prominent role in its onset, the following lines are not as easily understood. First of all, further information on the actual cause of lethargia is lacking, since the reader is not told anything about how it is brought about. It is only much later on, in the section dealing with the appropriate therapy (see p. 129.24– 26), that we find out that phlegm and moisture are abundant in the patients suffering from lethargia and one is inclined to read this as the cause of lethargia, especially since this is given as the cause in other texts (see p. 225 f., commentary on p. 129.24–26). Instead, what we are presented with after the opening lines is a discussion of the different ways a change (μετάπτωσις) from another affection into lethargia might be brought about (see p. 128.10–15) and this leads immediately into the discussion of long-term fevers during which patients are drowned in sleep (see p. 128.16: βαπτίζεσθαι τῷ ὕπνῳ). Although λήθαργος is not explicitly mentioned here, and one might wonder on a first reading how this statement is even related to lethargia and how it fits into the chapter, I am of the opinion that the mention of being drowned in sleep here represents the main symptom of the affection (see also p. 207 f., commentary on p. 128.15–16). This assumption finds confirmation in the fact that the information which follows is all concerned with being drowned in sleep and its various peculiarities as they differ from patient to patient. We can, thus, assume that this is crucial for the discussion of lethargia. However, the transition from dealing with lethargia and its origins to dealing with deep sleep as the main symptom of lethargia is not smooth. It is impossible to tell whether these issues might be due to problems in putting together a text that draws on different authors (i.e. Archigenes and Posidonius, as mentioned in the heading) or whether they only appear peculiar and complex to our modern eyes. Nevertheless, as the discussion of deep sleep proceeds, one also reads the concrete announcement that the following lines deal with the manifestation of falling asleep (see p. 128.22: σκοπεῖν μὲν οὖν χρὴ τὸ εἶδος τῆς καταφορᾶς, see also p. 212, commentary on p. 128.22). Such explicit announcements, and even short summarizing remarks, are also found later in the chapter (see p. 129.6–7, p. 129.15–16) and they contribute to its readability and assist in the use to

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

199

which the compilation was obviously meant to be put, namely as a practical handbook which could be drawn on in case something needed to be looked up.394 The discussion of the therapy of lethargia receives much attention within the chapter and this is also due to the fact that the compilation is meant to be of practical use. The recommendations found in the various sections on therapy can often be explained by correlating previous statements about the affection with the properties of remedies or with approaches which match those statements (i.e. the application of thinning remedies is supposed to thin the phlegm which is abundant in lethargia: see p. 226, commentary on p. 129.26). Of course, the chapter also mentions therapeutical approaches, such as phlebotomy (see p. 225, commentary on p. 129.23–24), which were generally deemed to be useful in ancient medical therapeutics but even this recommendation is explained by an abundance of blood in the present chapter. In general, one may say that the therapeutical advice is convincing within the framework of the chapter. Considering the chapter as a whole, it is worth asking how the information within it was selected and why the particular form of organization and structure was chosen. To begin with, we can ask whether the information contained in the chapter does indeed stem from Archigenes and Posidonius and which parts derive from each of the supposed sources. This question is, of course, difficult to answer, but it is illuminating to note that the beginning of the chapter contains a passage which is similar to one in the preceding chapter on phrenitis. This earlier passage was, the text claims, drawn from Posidonius (on this issue, see in detail p. 204 f., commentary on p. 128.10–12). Such a similarity could support the assumption that the corresponding passage in the chapter on lethargia was taken from the same source. Secondly, we can ask why Aetius decided to include in this chapter this information about lethargia and this information only. This is another difficult question but a comparison with other authors who deal with lethargia can at least reveal whether the information passed on in Aetius’ work is also reflected in other writings or whether it appears to be unique. Detailed discussion on this topic can be found throughout the commentary, but, in short, many of the topics which are discussed in Aetius’ chapter on lethargia also appear in other writings. Some of these topics are presented in a similar manner in other works (e.g. the statement that the hypochondrion is pulled up in patients suffering from lethargia is also reflected in the Anonymus Parisinus and in Caelius Aurelianus: see p. 217, commentary on p. 129.7; the assumption that the patient’s mouth gapes open is similarly also reflected in the accounts of lethargia in Paul, the Anonymus Parisinus, and Caelius Aurelianus: see p. 220 f., commentary on p. 129.13–15). In other cases we find that the topics appear in other writings as well but that they are presented in Aetius either in a very special and unique way or in greater detail. These findings may in turn shed light on the

394 See on the use of such patterns in ancient scientific literature in general van der Eijk 1997, 111– 113.

200 | Commentary

question of what Aetius deemed to be especially important for discussion in a chapter on lethargia. In this regard, three aspects are especially notable. First, the discussion of the fevers out of which lethargia may develop or during which it may occur takes up greater space than it does elsewhere and technical terms for the fevers are provided as well (see p. 205 f., commentary on p. 128.12–13, p. 207 f., commentary on p. 128.15–16, p. 209, commentary on p. 128.16–18). It is, furthermore, remarkable that deep sleep and its manifestations as a symptom of lethargia are discussed in great detail (p. 128.18–129.4; see p. 209–216). Finally, as I have mentioned above, therapeutic recommendations take up most of the space in the chapter and their applications are explained in great detail. Aetius obviously wanted to make sure that the user of his handbook received all the information he might need in order to cure patients suffering from lethargia.

Commentary p. 128.6: Περὶ – Ποσειδωνίου: The expression κατὰ τῶν Ἀρχιγένους καὶ Ποσειδωνίου is rather surprising, since one would expect the preposition ἐκ instead of κατά, which is usually used in the headings of Aetius’ sixth book.395 Olivieri’s critical apparatus reveals that the manuscripts Parisinus Suppl. gr. 1240 (Pa) and Venetus Marcianus gr. 291 (Mo) transmit the reading ἐκ τῶν and the Vaticanus Palatinus 199 (Px) transmits ἐκ τοῦ.396 For a detailed discussion of Archigenes and Posidonius as sources of the sixth book, see p. 23 – 26. p. 128.6–10: ληθάργου – νοσημάτων: There seem to be two ways of understanding the noun ἀρχαὶ in the present context: it could either refer to the two possible bodily origins (diaphragm/inward parts or brain), and hence to the first pair of the correlatives, οἷς μὲν and οἷς δὲ (p. 128.7–9), or it could refer to the two pairs of οἷς μὲν and οἷς δὲ (first pair: p. 128.7–9, second pair: p. 128.9–10), thus distinguishing between two principles that should be borne in mind, that is to say between the bodily origin (diaphragm/inward parts or brain) and the chronology of the affection (either it befalls the patients directly from the beginning (εὐθέως ἐξ ἀρχῆς) or due to a change (ἐκ μεταπτώσεως) of acute diseases). Since in other places throughout Aetius’ sixth book an explicit distinction is made between a primary and a co-affection of the brain,397 I assume that the noun ἀρχαὶ refers to the two possible bodily origins and thus only to the first pair of οἷς μὲν and οἷς δὲ. This assumption leaves the question open as to how the two pairs of correlatives are related to each other, which is to say how the remarks concerning bodily origin and the remarks concern395 See e.g. Aetius Amid., Libri med. 6.2 (Vol. 2, 125.4 Olivieri), Libri med. 6.4 (Vol. 2, 131.16 Olivieri), Libri med. 6.6 (Vol. 2, 133.22 Olivieri). 396 See Olivieri’s critical apparatus to p. 128.6. 397 See e.g. Aetius Amid., Libri med. 6.9 (Vol. 2, 141.24–26 Olivieri), Libri med. 6.9 (Vol. 2, 142.2–4 Olivieri).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

201

ing chronology fit together. The arrangement is probably chiastic, such that the first occurrence of οἷς μὲν (p. 128.7) corresponds to the second occurrence of οἷς δὲ (p. 128.10), while the first occurrence of οἷς δὲ (p. 128.8) corresponds to the second occurrence of οἷς μὲν (p. 128.9): patients whose diaphragm and inward parts are primarily affected are befallen by the affection (πάθος) through a change (ἐκ μεταπτώσεως) of acute diseases, while patients whose brain is primarily affected are befallen directly from the beginning (εὐθέως ἐξ ἀρχῆς). The noun πάθος in this regard refers to lethargia, which seems to be connected to the brain being affected. The brain is said to be affected in both possible origins and the difference between the two is that, on the one hand, it is affected only in a second step, through a coaffection with other bodily parts, while, on the other hand, it is primarily affected (on the concept of primary and co-affection, see p. 201, commentary on p. 128.6–9). The brain is, therefore, obviously of great importance in the origin of lethargia. For further discussion of the role of the brain in lethargia, see p. 203, commentary on p. 128.6–9. The statement that the πάθος befalls some patients directly from the beginning clearly takes account of the fact that those whose brain is primarily affected suffer from lethargia more suddenly, while those whose brain is co-affected suffer from other affections first. p. 128.6–9: ληθάργου – κατάρχει: The concepts of primary affection (πρωτοπάθεια) and co-affection (συμπάθεια) are commonly used in medical literature: the noun συμπάθεια already occurs in the “Hippocratic” writings,398 in Soranus,399 and Aretaeus,400 while the noun πρωτοπάθεια and its derivative πρωτοπαθεῖν are documented from the Anonymus Parisinus401 and Soranus402 onwards.403 Galen deals with this concept in detail and expands upon it, introducing further terms such as ἰδιοπάθεια, δευτεροπάθεια or ὑστεροπάθεια.404 One of Galen’s vivid examples of primary and co-affection is found in De locis affectis where he deals with the case of detrimental vapors or humors rising from the stomach to the brain and damaging the ability to think.405 He states that in this case one ought not to say that the brain is primarily affected, nor may one say that it is not affected at all, but the best way to explain what happens is to use the verb συμπάσχειν. For a detailed discussion of the concept in Galen with reference to earlier sources, see Gärtner 2015 in Galeni De locis affectis, 542–544 and Holmes 2013, 163–176. In the passage at hand the coaffection is said to be between the diaphragm or the inward parts and the brain. The

398 See e.g. Hippocrates, Praec. 10.3 (128.12–14 Ecca = 9.272.1 f. L.) where not only ξυμπάθεια, but also ξυμπάθησις is used. 399 See e.g. Soranus, Gyn. 1.15.2 (10.27 Ilberg), Gyn. 1.63.3 (47.16 Ilberg), Gyn. 3.17.3 (105.17 Ilberg). 400 See e.g. Aretaeus 1.8.3 (10.20 Hude), 4.6.1 (72.8 Hude), 4.8.2 (75.13 Hude). 401 See Anon. Par. 37.1 (192.20 Garofalo). 402 See e.g. Soranus, Gyn. 3.38.3 (117.13 Ilberg). 403 On this issue, see Gärtner 2015 in Galeni De locis affectis, 543 f. 404 See Galen, De loc. aff. 1.3.2 (260.17–20 Gärtner = 8.30.16–31.3 K.). 405 See Galen, De loc. aff. 1.6.2 (282.9–13 Gärtner = 8.48.16–49.4 K.).

202 | Commentary

Greek term φρήν is used with several different connotations in ancient literature. In Homer, for example, it is used to denote the part of the body where the affections are localized.406 The author of the “Hippocratic” treatise De morbo sacro states that the diaphragm has its name only due to chance and custom, not because of its nature, and does not contribute to thinking and understanding, which is the brain’s realm. He adds that when a person is in a state of extreme joy or grief the diaphragm jumps but this fact is only due to its anatomy.407 In his Timaeus, Plato calls the diaphragm διάφραγμα in the context of his explanation of the localization of the soul in the body:408 according to Plato, the φρήν functions as a barrier (διάφραγμα) between the two different parts of the mortal soul.409 Galen, in his De locis affectis, summarizes these terminological issues by stating that all the ancients called the lower boundary of the thorax (τὸν δὲ κάτω τοῦ θώρακος ὅρον) φρένες either for no particular reason (“because it simply came to their mind”) or, as some believe, because the patients are damaged in their ability to think when the diaphragm is inflamed (διότι φλεγμαίνοντος αὐτοῦ βλάπτονται τὴν φρόνησιν οἱ κάμνοντες).410 Galen further acknowledges that from Plato onwards it became standard to call it διάφραγμα.411 A similar statement appears as early as Aristotle, who argues that people call the diaphragm φρένες as if it was partaking in thinking (ὡς μετέχουσαί τι τοῦ φρονεῖν).412 This assumption, however, is wrong, Aristotle claims, but because the diaphragm is near to those parts which partake in thinking it clearly causes a change of thought (τὴν μεταβολὴν τῆς διανοίας).413 Interestingly, the term phrenitis was explained by reference to the diaphragm (φρένες) which some scholars supposed to be the affected part in phrenitis, or to the damage of thinking (φρονεῖν) coming along with it.414 On this issue, see also p. 157. For further discussion of the diaphragm, see also Leven 2005c and Kudlien 1967, 83–85. The term σπλάγχνον is also used with different connotations: on the one hand, it is used just like φρήν in non-medical literature to describe the part of the body where affections are localized.415 Medical texts, by contrast, generally refer to it as the “internal organs”: in his De usu partium Galen, for example, states that the diaphragm is the boundary

406 See e.g. Homer, Ilias 10.10, Ilias 15.61. 407 See Hippocrates, De morb. sacr. 17.1–2 (30.4–10 Jouanna = 6.392.5–9 L.) 408 See Plato, Tim. 69e5–70a7. 409 See Plato, Tim. 69e5–70a7. 410 See Galen, De loc. aff. 5.4 (8.327.15 f. K.). 411 See Galen, De loc. aff. 5.4 (8.327.16 f. K.). 412 See Aristotle, De part. anim. 3.10 (672b30 f.). 413 See Aristotle, De part. anim. 3.10 (672b31–33). For a discussion of this Aristotelian passage see van der Eijk 2005, 224. 414 See e.g. Diocles fr. 72.9 f. van der Eijk, Pseudo-Galen, Introd. s. medic. 13.9 (51.8 f. Petit = 14.733.2–4 K.). For a discussion of this issue see van der Eijk 2001 in Diocles of Carystus Vol. 2, 146. 415 See e.g. Aristophanes, Ranae 844, Euripides, Alcestis 1009–1010.

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

203

between the upper and the lower σπλάγχνα.416 Furthermore, Galen supports the notion that nerves coming from the brain also extend to the σπλάγχνα,417 which is interesting in the context of understanding how the co-affection between internal organs and brain might be conceived. As regards the connection between diaphragm and brain, we find a very similar notion of co-affection in Paul’s chapter on phrenitis, where he states that phrenitis sometimes occurs when the brain is co-affected with the diaphragm through the nerves, which are spread in it (διὰ τῶν κατασπειρομένων ἐν αὐτῷ νεύρων).418 In De locis affectis Galen distinguishes a form of derangement, which comes into being through the diaphragm, from phrenitis in which the brain is not co-affected but primarily affected.419 Our text clearly presents the brain as the affected part in lethargia (see also p. 201, commentary on p. 128.6–10). The two different origins which are dealt with in the text do not question the brain’s prominent role in lethargia, but discuss the two possible causes of the affection of the brain. Other texts likewise present the brain as the affected part in lethargia: Diocles is reported as holding the opinion that lethargia is a cooling of the psychic pneuma around the heart and the brain;420 Erasistratus is reported to have said that lethargia is an affection of the psychic faculty in the membrane surrounding the brain;421 Galen states that affections such as mental derangement (παραφροσύνη), phrenitis, lethargia, mania and melancholia come into being when the brain is affected either in the first place or according to co-affection;422 Alexander and Paul of Aegina both state that lethargia has the same place as phrenitis, namely the brain;423 and Paul of Nicea puts forward the notion that in lethargia the brain is filled with cold humors.424 p. 128.9–10: καὶ οἷς μὲν – νοσημάτων: For a general discussion of these lines, see also p. 200 f., commentary on p. 128.6–10. The phrase ἐξ ἀρχῆς is contrasted with ἐκ μεταπτώσεως in these lines. The term μετάπτωσις thereby describes the process of one disease changing into another. It is commonly used in this way in medical texts: the Anonymus Parisinus deals with cases in which phrenitis develops through a change of another disease (τοὺς δὲ ἀπὸ μεταπτώσεως γινομένους φρενιτι416 See Galen, De usu part. 4.14 (Vol. 1, 230.25–231.2 Helmreich = 3.314.13–15 K.). Aristotle states in De part. anim. 3.7 (670b30–32) that the diaphragm is one of the parts which is near the σπλάγχνα. 417 See Galen, De usu part. 16.5 (Vol. 2, 394.16–19 Helmreich = 4.289.4–7 K.), De nerv. dissect. 11 (38.12–16 Garofalo = 2.843.13–844.1 K.). In Garofalo’s edition, the term τὰ ἔντερα is used instead of τὰ σπλάγχνα. 418 See Paul 3.6.1 (Vol. 1, 144.8–10 Heiberg). 419 See Galen, De loc. aff. 5.4 (8.329.5–13 K.). 420 See Diocles fr. 78.5–7 van der Eijk. 421 See Anon. Par. 2.1.1 (10.17–19 Garofalo). 422 See Galen, De usu part. 17.2 (Vol. 2, 450.2–6 Helmreich = 4.363.9–12 K.). Another similar statement can be found in Galen, De loc. aff. 3.7 (8.166.5–9 K.). 423 See Alexander, Therapeutica 1.14 (634.4 f. Guardasole = Vol. 1, 527.22 Puschmann), Paul 3.9.1 (Vol. 1, 147.6 f. Heiberg). 424 See Paul of Nicea 11 (67.4 f. Ieraci Bio).

204 | Commentary

κοὺς)425 while Alexander discusses forms of fever which come into being through a change of acute diseases (ἐκ μεταπτώσεως τῶν ὀξέων νοσημάτων)426 and Galen distinguishes between acute diseases which occur independently or which occur “simply” (τῶν ἁπλῶς ὀξέων), and those which occur through a change (τῶν ἐκ μεταπτώσεως),427 to mention just three examples. The term νοσήματα ὀξέα (acute diseases) is a commonly used technical medical term for a special group of affections which is contrasted with νοσήματα χρόνια (chronic diseases).428 In the third book of his De medicina Celsus deals at length with the differences between these two groups of diseases.429 He starts by stating that the Greeks distinguished between two species (in duas species … diviserunt) of diseases, namely the acute and the chronic (aliosque ex his acutos, alios longos esse dixerunt), before noting that some rank among acute diseases conditions that others place amongst the chronic.430 Celsus infers from these terminological issues that there must be more than two species of diseases (ex quo plura eorum genera esse manifestum est),431 which he then goes on to discuss. In the further course of his remarks he states that an acute disease is of short duration (breve spatium est) and the patient might die if the remedy is not useful, while chronic diseases give time for consideration and a modification of remedies.432 But when a chronic disease is completely incorporated (cum penitus insedit) it is as difficult to cure as an acute one.433 Caelius Aurelianus, who uses the distinction between acute and chronic diseases as a principle of arrangement in his work, just as Aretaeus does,434 states that some acute diseases, such as phrenitis and lethargia, are accompanied by fever and others are not.435 For a detailed discussion of acute and chronic diseases see Gundert 2005a and Gundert 2005b. See also Kudlien 1967, 63–65. p. 128.10–12: μάλιστα μὲν – γίγνεται: These lines are evocative of a passage in the previous chapter on phrenitis in which we read that, when treating phrenitis, one should avoid the continuous use of all narcotic remedies (φυλάττεσθαι δὲ χρὴ τὴν συνεχῆ χρῆσιν τῶν ναρκωτικῶν πάντων φαρμάκων) because in those patients who have been immoderately cooled a change from phrenitis to lethargia easily occurs (ῥᾳδίως γὰρ ἐπὶ τῶν ἀμέτρως ψυχομένων μετάπτωσις γίγνεται ἀπὸ φρενίτιδος εἰς

425 See Anon. Par. 1.3.10 (8.19 f. Garofalo). 426 See Alexander, De febr. 4 (357.8 Puschmann). 427 See Galen, De diebus decr. 2.12 (9.891.13–15 K.). 428 See e.g. Galen, In Hipp. De diaeta acut. comm. 1.3 (119.28–120.1 Helmreich = 15.423.14–424.1 K.), Paul 2.4 (Vol. 1, 76.15–77.7 Heiberg). 429 See Celsus, De med. 3.1.1–3.2.4 (101.1–102.32 Marx). 430 See Celsus, De med. 3.1.1 (101.2–5 Marx). 431 See Celsus, De med. 3.1.1 (101.5 f. Marx). 432 See Celsus, De med. 3.1.4 (101.20–22 Marx). 433 See Celsus, De med. 3.1.5 (101.23 f. Marx). 434 See Aretaeus 3.proem (36.1–18 Hude). 435 See Caelius Aurel., Cel. pass. 1.3 (22.15–19 Bendz).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

205

λήθαργον).436 See p. 189 f., commentary on p. 127.20–23. In the passage at hand almost the same expressions are used, namely ναρκωτικὰ φαρμακά, a form of the verb ψυχεῖν (ψυχομένων and ψυχθεῖσιν), and the phrase μετάπτωσις γίγνεσθαι ἀπὸ φρενίτιδος εἰς λήθαργον. This is particularly interesting since the previous chapter on phrenitis was, our text claims, derived from Posidonius, while the present chapter is said to be taken from Archigenes and Posidonius. The fact that both chapters convey the same idea by using the same, or at least very similar, expressions might lead to a number of conclusions. To begin with, due to the similarity we might assume that the present passage is taken from Posidonius alone and not from Archigenes. It is also possible that Aetius himself added the passage deliberately, in order to make the two chapters fit together and in order to remind his readers of the previous passage when reading the present one. These assumptions can neither be verified nor falsified but must remain mere assumptions. The notion that lethargia is connected with coldness is found elsewhere: Diocles, for example, is said to have stated that lethargia is a cooling of the psychic pneuma;437 Paul states that lethargia has the same place as phrenitis, namely the brain, but is caused by a different material, namely a very moist and very cold phlegm which befalls the brain;438 and Alexander also puts forward the notion that lethargia might occur through moisture and coldness, which numbs the psychic pneuma.439 Phrenitis is commonly ranked among acute diseases,440 which fits with the previous statement that lethargia might occur through a change of acute diseases (see p. 203 f., commentary on p. 128.9–10). p. 128.12–13: ἤδη δὲ – γέγονε: The term πύρετος σύνοχος is a medical technical term for a special kind of fever. In his fifth book Aetius dedicates a chapter to the “unintermittent” fever which he describes as involving a single paroxysm from beginning to end which does not indicate the beginning of any other paroxysm.441 In his De differentiis febrium Galen makes the same statement and ranks the πύρετος σύνοχος among the so-called continuous fevers (πύρετος συνεχής), which he distinguishes from intermittent fevers (διαλείπων πύρετος).442 The pseudo-Galenic Definitiones medicae define the πύρετος σύνοχος as being always continuous and not intermittent at any point during the night or day, and as bringing neither remission nor paroxysms.443 The phrase πύρετος συνεχής is already documented in “Hippo436 Aetius Amid., Libri med. 6.2 (Vol. 2, 127.20–23 Olivieri). 437 See Diocles fr. 78.5–6 van der Eijk. 438 See Paul 3.9.1 (Vol. 1, 147.6–9 Heiberg): τόπον μὲν ἔχει τὸν αὐτὸν τῇ φρενίτιδι, φημὶ τὸν ἐγκέφαλον, ὕλην δὲ τὴν ἐναντίαν· ἐπὶ φλέγματι γὰρ ὑγροτέρῳ καὶ ψυχροτέρῳ διαβρέχοντι τὸν ἐγκέφαλον γίνεται. 439 See Alexander, Therapeutica 1.14 (634-8 f. Guardasole = Vol. 1, 527.25–529.1 Puschmann): δι’ ὅλου καρουμένους ὑπὸ τῆς καταπνιγούσης καὶ ναρκούσης τὸ ψυχικὸν πνεῦμα ὑγρότητος ἅμα καὶ ψύξεως. 440 See e.g. Aretaeus 5.proem (91.7 f. Hude), Caelius Aurel., Cel. pass. 1.3 (22.15–17 Bendz). 441 See Aetius Amid., Libri med. 5.70 (Vol. 2, 43.13–15 Olivieri). 442 See Galen, De diff. febr. 2.2 (7.336.12–14 K.). 443 See Pseudo-Galen, Def. med. 187 (19.399.4–6 K.).

206 | Commentary

cratic” writings444 while πύρετος σύνοχος is not. For a discussion of the terms for various fevers see Sticker (1928–1930), p. 330–334. Lethargia is often said to be accompanied by fever.445 The present passage, however, puts forward a slightly different notion, namely that the affection develops out of fever. Fever is often referred to as a symptom of acute diseases,446 which fits with the statement made on p. 128.10 that lethargia develops out of acute diseases (see p. 203 f., commentary on p. 128.9– 10). Phrenitis is also said to be accompanied by acute fever (μετὰ πυρετοῦ ὀξέος)447 and, with this in mind, it seems reasonable to assume that the change from unintermittent fever to lethargia might also be brought about by cooling. Phrenitis is cured through cooling remedies (see p. 189 f., commentary on p. 127.20–23 and p. 204 f., commentary on p. 128.10–12) and fever might, along similar lines, also be cured by cooling remedies,448 which can potentially bring about lethargia. In De locis affectis Galen states that patients suffering from the beginning of a paroxysm of fever become καρώδεις or κωματώδεις because the brain has been cooled.449 Such a cooling may be provoked by the body itself in order to cool the heat which comes along with the fever.450 The phrase ἤδη δὲ πλειστάκις, in contrast to the previously used μάλιστα μέν (p. 128.10), probably indicates that the latter happens more often than the former. There seems to be a gradation between μάλιστα μέν, ἤδη δὲ πλειστάκις and ἐνίοτε δέ (p. 128.15) as regards the frequency of the different possible forms of μετάπτωσις. p. 128.13–15: καὶ ἐξ – παρηκολούθησαν: The term κένωσις is usually used in one of two ways, denoting either the evacuation of abundant substances from within the body, provoked by the body itself (e.g. in cases where the patients vomit), or an evacuation indicated and afterwards conducted by the physician (e.g. through phlebotomy or the like).451 In both cases a superfluity (either qualitative or quantitative) of certain substances precedes evacuation. By stating that lethargia can also arise from most of the other diseases which lead to evacuation,452 the text seems to suppose that the previously mentioned affections – phrenitis and unintermittent fever – are also followed by evacuation: in fact, phrenitis and fever are cured by evacuation, 444 See e.g. Hippocrates, Progn. 19.5 (56.8 f. Jouanna = 2.168.1 f. L.), De morb. popul. 1.24 (200.3 Kühlewein = 2.670.16 L.). 445 See e.g. Anon. Par. 2.2.1 (12.2 Garofalo), Caelius Aurel., Cel. pass. 2.1 (130.4 f. Bendz), Paul 3.9.1 (Vol. 1, 147.9 Heiberg), Pseudo-Galen, Def. med. 235 (19.413.8 K.), Galen, De loc. aff. 3.7 (8.166.5–7 K.). See also Caelius Aurel., Cel. pass. 1.3 (22.15–17 Bendz). 446 See e.g. Caelius Aurel., Cel. pass. 1.3 (22.21 Bendz), Galen, De diebus decr. 2.12 (9.889.5 f. K.), Aetius Amid., Libri med. 5.4 (Vol. 2, 8.17 f. Olivieri). 447 See Aetius Amid., Libri med. 6.2 (Vol. 2, 125.5 Olivieri). 448 See e.g.Galen, Meth. med. 9.14 (520.18 f. Johnston & Horsley = 10.647.7 f. K.). 449 See Galen, De loc. aff. 2.10.27 (382.5–7 Gärtner = 8.134.13–15 K.). 450 See also Gärtner 2015 in Galeni De locis affectis, 836. 451 See e.g. Galen, De fac. nat. 3.13 (240.12–15 Helmreich = 2.192.4–7 K.), De sympt. caus. 3.2 (7.217.13–15 K.), De diebus decr. 2.5 (9.864.15–17 K.). 452 For a closer look at the verb παρακολουθεῖν see p. 317 f., commentary on p. 134.29–135.1.

VI 3 On lethargia from (the books of) Archigenes and Posidonius |

207

amongst other possible therapies.453 Interestingly, in his commentary on the “Hippocratic” De victu acutorum, Galen mentions evacuation (κένωσις) through the stomach and through phlebotomy as therapies for those who suffer from acute diseases.454 This Galenic view fits with the claim that lethargia can occur through a change of acute diseases (see p. 203 f., commentary on p. 128.9–10), for which the present lines might serve as examples. No further explanation is given as to why κένωσις is mentioned here as a characteristic feature of those diseases which might potentially change into lethargia. It is, however, worth noting that a passage of Galen’s De temperamentis connects evacuation (κένωσις) with coldness (ψῦξις), stating that the peculiar remedy for inflammations brought about by a flow of heat is evacuation and that what follows the evacuation is the cooling of the part which has been heated through the inflammation (τὸ δὲ τῇ κενώσει πάντως ἑπόμενον ἡ ψῦξις τοῦ διὰ τὴν φλεγμονὴν τεθερμασμένου μορίου).455 One should probably understand the present remark about evacuation along similar lines. p. 128.15–16: ἐνίοτε δὲ – ὕπνῳ: With the phrase ἐπὶ τῶν χρονίων πυρετῶν the author turns away from his remarks concerning acute diseases, since the adjective χρόνιος is opposed to ὀξύς.456 For a detailed look at these two technical medical terms, see p. 204, commentary on p. 128.9–10, and for a discussion of technical terms for fever, see p. 205 f., commentary on p. 128.12–13. The term χρόνιος πύρετος is used elsewhere in medical literature457 and in the present passage probably indicates nothing more than a long-term fever which does not subside shortly after its beginning, but either remains or recurs. Such an understanding of the phrase would fit with the following examples of fevers (see p. 209, commentary on p. 128.16–18). The use of the preposition ἐπί furthermore differs from the previously used ἀπό and ἐξ insofar as these denoted a change into lethargia from another disease (p. 128.11: ἀπὸ φρενίτιδος, p. 128.12–13: ἀπὸ τοῦ συνόχου πυρετοῦ, p. 128.13–14: ἐξ ἑτέρων δὲ πλείστων νοσημάτων), while the preposition ἐπί expresses “familiar relations and natural position”.458 The present statements are, thus, on a different level than those

453 In terms of phrenitis, see e.g. Aetius Amid., Libri med. 6.2 (Vol. 2, 126.11 Olivieri), in regard to fever see e.g. Galen, Meth. med. 10.10 (78.4 f. Johnston & Horsley = 10.712.10 f. K.): ἡ μὲν οὖν κένωσις τῶν περιττωμάτων χρησιμωτάτη πᾶσι πυρετοῖς ἐστιν. 454 See Galen, In Hipp. De diaeta acut. comm. 2.1 (164.20 f. Helmreich = 15.517.6 f. K.): ἀξιόλογος δὲ κένωσις ἐπὶ τῶν ὀξέως νοσούντων ἥ τε διὰ τῆς γαστρὸς καὶ ἡ διὰ τῆς φλεβοτομίας (…). This passage is interesting for our present issues insofar as it connects acute diseases with evacuation and deals with different forms of it which are worth mentioning. 455 See Galen, De temp. 3.5 (113.12–14 Helmreich = 1.690.11 f. K.). 456 As Galen puts it in Meth. med. 2.3 (142.9–11 Johnston & Horsley = 10.91.5 f. K.): εἰ μὲν [scil. νοσήματα] ὀλιγοχρόνια, δῆλον ὡς ὀξέα, εἰ δὲ δύσλυτα, χρόνια […]. He distinguishes between diseases of short duration (called acute) and those being hard to resolve and thus called chronic. 457 See e.g. Hippocrates, Coac. 415 (206.21 Potter = 5.676.21 L.) Dioscorides, De mat. med. 5.3.2 (Vol. 3, 3.1 f. Wellmann), Galen, De comp. med. sec. loc. 7.5 (13.104.9 K.). On the different kinds of fevers see Sticker 1928–1930, 330–334. 458 Smyth § 1689a.

208 | Commentary

that have gone before insofar as they do not refer to the possible forms of changes (μετάπτωσις) into lethargia but, rather, deal with what happens during long-term fevers. Consequently, it may be assumed that the present sentence takes up the twofold distinction made on p. 128.9–10 (οἷς μὲν εὐθέως ἐξ ἀρχῆς τὸ πάθος ἐπιπίπτει, οἷς δὲ ἐκ μεταπτώσεως τινὸς τῶν ὀξέων νοσημάτων) and adds a third possibility, introduced by the term ἐνίοτε δὲ. This reading is supported not only by the use of the preposition ἐπί but also by the fact that the information given in these lines concerns lethargia in general. For the connection between lethargia and fever, see note 445. The expression βαπτίζεσθαι τῷ ὕπνῳ is not frequently found in medical texts, but it does appear in the active voice in Dioscorides’ work De materia medica in the context of the properties of poppy:459 Dioscorides states that poppy, if drunk in sufficient quantity, drowns the patients in a lethargic sleep. He thereby uses the adverb ληθαργωδῶς in order to characterize the process of the drowning in sleep more clearly. The phrase βαπτίζεσθαι τῷ ὕπνῳ is more commonly used in a number of theological texts.460 All these passages make use of the verb βαπτίζειν in a metaphorical sense: its basic meaning “dip, plunge”461 is applied to the falling asleep of the patients, which is obviously conceived as closer to “being drowned in sleep”. The phrase thus describes the falling asleep as being very intense. It points out the main symptom of lethargia, the deep sleep, for the first time in the present chapter. The assumption that sleep is the main symptom or one of the main symptoms can also be seen in the following information, most of which is connected or related to sleep.462 The term κατὰ περίοδον is commonly used in medical literature, both in connection with fever and with diseases in general.463 It indicates the paroxysm of an affection occurring periodically, that is to say with intervals between one fit and the next.464 In the present passage it refers to the verb βαπτίζεσθαι and characterizes the being drowned in sleep as something which happens periodically.

459 See Dioscorides, De mat. med. 4.64.3 (Vol. 2, 219.20 f. Wellmann): πλείων δὲ ποθεὶς βαπτίζει 〈ὕπνῳ〉 ληθαργωδῶς. 460 See e.g. Ioannes Chrysostomus, In Epistulam I ad Corinthios 6 (105.3 f. Migne): καὶ βαπτιζόμενοι ὕπνῳ βαθεῖ, Clement, Paedagogus 2.2 (84.4 f. Marcovich): ἀλλὰ ὑπὸ μέθης βαπτιζόμενος εἰς ὕπνον. In Christian context the verb βαπτίζειν also means to baptize. 461 See LSJ, s.v. βαπτίζω. 462 See e.g. Aetius Amid., Libri med. 6.3 (Vol. 2, 128.18–23 Olivieri): καταφέρονται (twice), τὸν βαπτισμὸν, καταφέρονται, τὸ εἶδος τῆς καταφορᾶς, τῷ ὕπνῳ βαπτιζόμενοι. For closer look on the verb καταφέρεσθαι and the noun καταφορά, see p. 210, commentary on p. 128.18–19. 463 See e.g. Hippocrates, Aphor. 1.11 (380.7 Magdelaine = 4.464.12 L.), De hum. 18 (174.21 Overwien = 5.98.14 f. L.), Galen, De diff. febr. 2.13 (7.379.13–380.7 K.): In this passage, Galen states that it is difficult to identify the cause of fevers which occur κατὰ περίοδον and thus begins to analyze other diseases which occur κατὰ περίοδον. See e.g. Oribasius, Ad Eunap. 3.5.5 (401.17 Raeder). 464 See e.g. Alexander, Therapeutica 1.17 (Vol. 1, 599.2f . Puschmann): […] καὶ διαλείμματα καὶ παροξυσμοὺς ἔχουσιν, ὥσπερ ἐπὶ τῶν κατὰ περίοδον κινουμένων συμβαίνει πυρετῶν.

VI 3 On lethargia from (the books of) Archigenes and Posidonius

| 209

p. 128.16–18: οἷον – τεταρταίων: The phrases ἀμφημερινός (quotidian), ἡμιτριταῖος (semi-tertian) and τεταρταῖος (quartan) are technical terms for special kinds of fever. They were in use as early as the “Hippocratic” writings465 but are also found in Galen466 and later authors, such as Oribasius,467 Aetius,468 Alexander469 and Paul.470 According to the “Hippocratic” treatise De natura hominis, the quotidian, tertian and quartan fevers arise from bile.471 Galen ranks them among the intermittent fevers (see on this issue also p. 205 f., commentary on p. 128.12–13), stating that the quotidian arises from phlegm, the tertian from yellow bile and the quartan from black bile.472 The semi-tertian fever is said to be a mixture of the tertian and the quotidian, with yellow bile being abundant.473 According to Aetius’ fifth book, the semi-tertian fever occurs when the putrid phlegm is mixed with the putrid bilious humor,474 the quartan fever occurs in melancholic bodies and is connected to coldness and dryness,475 and the quotidian fever occurs in phlegmatic constitutions and is connected to moisture and coldness.476 For a discussion of these technical terms, see also Sticker (1928–1930), p. 332–333. As expressed by the use of οἷον, these different kinds of fever are supposed to serve as examples for the previously made claim that lethargia happens during long-term fevers. When reading the phrase πύρετος χρόνιος as denoting a fever which lasts for a long time (in which “long” is a relative term), as suggested above (see p. 207, commentary on p. 128.15–16), the term would be applicable to the quotidian, semi-tertian and quartan fevers. The fact that lethargia is commonly connected with fever has been pointed out elsewhere (see note 445). There are very few passages in other texts in which lethargia is mentioned in the same context as special kinds of fever477 and those that do exist do not suggest any explicit or deeper connection or relation between lethargia and the kinds of fever in question. p. 128.18–19: καὶ οἱ μὲν – σπασμοῦ: These statements concerning the process of falling asleep (καταφέρονται) seem to refer to the phrase βαπτίζεσθαι τῷ ὕπνῳ (p. 465 See e.g. Hippocrates, De nat. hom. 15.1 (202.12 f. Jouanna = 6.66.12 f. L.). 466 See e.g. Galen, De diff. febr. 2.2 (7.336.8 f. K.), De diff. febr. 2.8 (7.363.6 f. K.). 467 See e.g. Oribasius, Synops. ad Eustath. 6.23 (197.11–198.3 Raeder). 468 See e.g. Aetius Amid., Libri med. 5.82–86 (Vol. 2, 59.13–67.10 Olivieri). 469 See e.g. Alexander, De febr. 6–7 (385.12–439.31 Puschmann). 470 See e.g. Paul 2.18–24 (Vol. 1, 98.17–102.7 Heiberg). 471 See Hippocrates, De nat. hom. 15.1 (202.10–13 Jouanna = 6.66.10–13 L.). 472 See Galen, De diff. febr. 2.2 (7.336.8–12 K.). 473 See Galen, De diff. febr. 2.8 (7.363.6–8 K.). 474 See Aetius Amid., Libri med. 5.82 (Vol. 2, 59.13–15 Olivieri). 475 See Aetius Amid., Libri med. 5.83 (Vol. 2, 60.23–25 Olivieri). 476 See Aetius Amid., Libri med. 5.85 (Vol. 2, 66.9–11 Olivieri). 477 See e.g. Aetius Amid., Libri med. 3.6 (Vol. 1, 264.8 Olivieri): ἐν φορείῳ δὲ κατακειμένους αἰωροῦμεν ληθαργικῷ πυρετῷ συνεχομένους καὶ ἡμιτριταικῷ καὶ ἀμφημερινῷ, Galen, De praseag. ex puls. 2.9 (9.310.14 f. K.): συμβαίνει δὲ μάλιστα τοῦτο κατὰ τὰ ληθαργικὰ πάθη καὶ τοὺς ἀμφημερινοὺς πυρετοὺς, Oribasius, Coll. med. rel. 7.26.129 (Vol. 1, 238.10 f. Raeder): ἀλλὰ μᾶλλον ἰκτεριῶντί τε καὶ κεφαλαλγεῖ καὶ ληθαργικῷ καὶ πυρετῷ τεταρταίῳ καὶ ἀμφημερινῷ.

210 | Commentary

128.16) which I understand as describing the main symptom of lethargia (see p. 208, commentary on p. 128.15–16). We can, thus, conclude that these remarks deal with lethargia in general rather than with the special kinds of fever. The quotidian, the semi-tertian and the quartan fevers serve as examples (see p. 128.16: οἷον) for fevers in which the main symptom of lethargia can be observed, and from the present line onwards, this symptom is explained in greater detail. The καί before οἱ μὲν is used to indicate that the term βαπτίζεσθαι τῷ ὕπνῳ will be explained further in the subsequent lines.478 I suggest putting a full stop after ἐπὶ τεταρταίων (p. 128.17–18) in order to make it clear that the information beginning with καὶ οἱ μὲν μετὰ σπασμοῦ regards lethargia in general. The verb καταφέρεσθαι is used several times in the following paragraph, as is the related noun καταφορά (see p. 128.19, 21, 22 and p. 129.1). In the present context it has the meaning “to fall asleep”, as is particularly clear on p. 128.21–22, where καταφέρεσθαι is contrasted with ἀνακαλεῖσθαι. In general, this meaning is commonly found in medical contexts.479 The occurrence of spasms (σπασμός) is mentioned in numerous medical treatises. According to the pseudo-Galenic Definitiones medicae, the term σπασμός is defined as an affection which arises on account of the nerves and the muscles and causes either the whole body or parts of it to be wrenched at without a purpose.480 In the further course of his sixth book Aetius dedicates two chapters to spasm and tetanus.481 He explains that spasm occurs either due to fullness (ὑπὸ πληρώσεως) or due to dryness (ἐπὶ ξηρότητι)482 and distinguishes between the case in which the members of the body are stretched (τείνηται) forwards and the case in which they are stretched backwards.483 If they are evenly stretched both ways, it is called tetanus.484 The term συνολκή is often used together with σπασμός both being connected with a καί485 and in some texts the phrase συνολκὴ σπασμώδης is even used.486 An explicit comparison between the two nouns is 478 See Smyth § 2869a: “Here καί often = namely, for example, and so where an antecedent statement is explained either by another word or by an example.” 479 See e.g. Soranus, Gyn. 3.27.4 (110.15–17 Ilberg), Dioscorides, De mat. med. 3.76.2 (Vol. 2, 89.3 f. Wellmann), Oribasius, Coll. med. rel. 6.7.2 (Vol. 1, 159.2 Raeder), Alexander, Therapeutica 1.13 (618.28 f. Guardasole = Vol. 1, 513.12 f. Puschmann). See also Aristotle, De insomn. 3 (462a10 f.), De gener. anim. 5.1 (779a9 f.). 480 See Pseudo-Galen, Def. med. 236 (19.413.10–12 K.): Σπασμός ἐστι περὶ νεύροις καὶ μυσὶ γινόμενον πάθος μετὰ τοῦ ἄνευ προαιρέσεως ἕλκεσθαι ποτὲ μὲν ὅλον τὸ σῶμα, ποτὲ δὲ μέρος. See also Caelius Aurel., Cel. pass. 2.18 (140.26 f. Bendz), who simply says (…) spasmus, hoc est membrorum conductio. 481 Aetius Amid., Libri med. 6.38–39 (Vol. 2, 180.12–183.8 Olivieri). 482 See Aetius Amid., Libri med. 6.38 (Vol. 2, 180.13 f. Olivieri) and 6.38 (Vol. 2, 180.16 f. Olivieri). 483 See Aetius Amid., Libri med. 6.38 (Vol. 2, 180.22 f. Olivieri). 484 See Aetius Amid., Libri med. 6.38 (Vol. 2, 180.24–181.1 Olivieri). 485 See e.g. Diocles fr. 107.5 f. van der Eijk, Soranus, Gyn. 4.15.1 (145.18 Ilberg), Anon. Par. 3.1.3 (20.1 Garofalo), Pseudo-Galen, Introd. s. medic. 13.16 (53.17 f. Petit = 14.736.6 K.), Aetius Amid., Libri med. 3.131 (Vol. 1, 312.11 Olivieri). 486 See e.g. Galen, In Hipp. Prorrh. comm. 3.26 (139.30 Diels = 16.773.13 K.), Soranus, Gyn. 3.26.3 (109.18 Ilberg), Paul 3.39.2 (Vol. 1, 229.17 Heiberg).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

211

found in Galen’s In Hippocratis Epidemiarum librum sextum commentaria I–VI where he states that some of the so-called hysterical women are affected by συνολκαί and τάσεις which are nearly equal (παραπλήσιαι) to σπασμός.487 In the present passage both nouns seem to be used almost synonymously. The phrase συνολκὴ τῶν νεύρων is also documented in other passages488 and points to the convulsion of the nerves. Other texts mention the occurrence of trembling in lethargia (see note 636). p. 128.19–20: καὶ οἱ μὲν – προσαγωγῆς: The term ἀθρόως (suddenly) is clearly contrasted with the phrase ἐκ προσαγωγῆς (gradually) by the use of οἱ μέν and οἱ δέ. In the further course of Aetius’ sixth book the term ἀθρόως is again used in the context of sleep: in the sixth chapter the expression διεγερθέντες πολλάκις is contrasted with ἀθρόως πάλιν ἐπικαταφέρονται τῷ ὕπνῳ489 and it is thus emphasized that, although the patients are often woken up, they fall asleep again suddenly. See also p. 286, commentary on p. 134.1–2. In both passages “suddenly” presumably means without previous indication of the event happening and, especially, not slowly. In contrast to this first mentioned group of patients, the other group falls asleep gradually, which could mean that they get tired first, then become drowsy, and finally fall asleep and that the physician may notice all those indications of falling asleep. p. 128.20–22: καὶ οἱ μὲν – ἀνακαλοῦνται: The noun βαπτισμός takes up the expression βαπτίζεσθαι αὐτοὺς τῷ ὕπνῳ (p. 128.16, see p. 208, commentary on p. 128.15–16) and has here the exact same connotation as the verbal phrase. It is used only once more in a medical context, in Oribasius who uses it in its simple sense of “immersion”.490 Apart from this occurrence the term appears mainly in theological writings491 where it often has the metaphorical meaning of “baptism”. In order to emphasize the terminological relation between the noun βαπτισμός and the previously used verbal expression βαπτίζεσθαι αὐτοὺς τῷ ὕπνῳ I stick to the translation “to be drowned in sleep” and nominalize it. The use of the numeral ἕνα in connection to βαπτισμός seems to suggest that it is countable; what lies behind this usage is probably the notion that the patients may suffer from several attacks of being drowned in sleep. The phrase ἕνα τὸν βαπτισμὸν ὑπομένουσιν might then stand in contrast to the subsequent statement that some patients fall asleep and are woken up again: both statements are contrasted by the use of οἱ μὲν and οἱ δὲ. While the first group of patients is said to suffer from one single attack of being drowned in sleep, the second group of patients also falls asleep but is woken up again and then repeats the cycle again, as the phrase ἐν ταῖς περιόδοις suggests. See also p. 208, commentary on p. 128.15–16. The notion that patients do not suffer continuously 487 See Galen, In Hipp. Epid. VI comm. 1.2 (10.3–5 Wenkebach = 17a.805.13–15 K.). 488 See e.g. Galen, De comp. med. per gen. 6.2 (13.877.18 K.), Aetius Amid., Libri med. 12.49 (81.1 f. Kostomiris), Libri med. 15.15 (92.17 Zervos). 489 See Aetius Amid., Libri med. 6.6 (Vol. 2, 134.1 f. Olivieri). 490 See Oribasius, Coll. med. rel. 10.3.10 (Vol. 2, 46.18 Raeder). 491 See e.g. Novum Testamentum, Epistula Pauli ad Hebraeos 6.2.

212 | Commentary

from a deep sleep but, rather, periodically is also found in Caelius Aurelianus, for example, who uses the noun dismissio to express the notion of intermittent sleep (pressura).492 The relative clause provides us with the information that the attack of “being drowned in sleep” is most dangerous for the patients. By using the adverbial accusative τὰ ἔσχατα493 the author clearly marks the danger as being extremely high. Unfortunately, we do not receive any further information about the sense in which patients are in great danger when they suffer from the βαπτισμός. Since we find various reports of lethargia being a potentially lethal disease,494 the intention might actually be to stress that patients suffering from this form of sleep are in danger of death. p. 128.22: σκοπεῖν – καταφορᾶς: With this sentence the author announces his “program” for the following lines, that is to say he marks out clearly what he will deal with. Such explicit announcements are found all over Aetius’ compilation,495 as well as in other medical texts.496 They probably help the reader to find exactly those passages which are important for his needs and interests and, thus, they help to ensure the practical usability of the compilation. The noun καταφορά is a derivative of the frequently used verb καταφέρεσθαι and thus accordingly denotes the process of falling asleep (see p. 210, commentary on p. 128.18–19). As in the case of the translation of βαπτισμός (see the p. 211 f., commentary on p. 128.20–22), I stick to the translation of the verb καταφέρεσθαι and nominalize it in order to emphasize the relation between verb and noun. The noun καταφορά is also used in the pseudo-Galenic Definitiones medicae in order to explain lethargia.497 p. 128.22–24: οἱ μὲν γὰρ – δυσκίνητον: The phrase οἱ μὲν γὰρ κατὰ περίοδον τῷ ὕπνῳ βαπτιζόμενοι refers back to lines 21–22 (οἱ δὲ ἐν ταῖς περιόδοις καταφέρονται καὶ πάλιν ἀνακαλοῦνται) while οἱ δὲ ἀεὶ τὸ πάθος ἔχοντες refers back to lines 20–21 (καὶ οἱ μὲν ἕνα τὸν βαπτισμὸν ὑπομένουσιν, ἐφ’ ᾧ τὰ ἔσχατα κινδυνεύουσιν). See also p. 211 f., commentary on p. 128.20–22. In the Anonymus Parisinus we also find the notion that the pulse of patients with lethargia is σομφός498 and the same view is expressed in Marcellinus’ work De pulsibus, where the adjective ὑπόσομφος is used

492 See Caelius Aurel., Cel. pass. 2.7 (134.8–11 Bendz) and see also Cel. pass. 2.5 (132.24 f. Bendz). 493 A connection between κινδυνεύειν respectively κίνδυνος and a form of ἔσχατος can often be found in medical literature. See e.g. Galen, De plac. Hipp. et Plat. 8.4.32 (504.30 de Lacy = 5.679.5 K.), De sympt. caus. 1.2 (7.99.16 f. K.), Meth. med. 12.3 (244.15 Johnston & Horsley = 10.824.7 K.) In Paul 6.121 (Vol. 2, 182.8 Heiberg) we find a distinction between great and lethal danger. 494 See e.g. Hippocrates, De morb. 3.5 (74.1 Potter = 7.122.19 L.), Caelius Aurel., Cel. pass. 2.4 (132.11 Bendz). See also Hedtkamp 1993, 50 and 69. 495 See e.g. Aetius Amid., Libri med. 6.1 (Vol. 2, 124.9 Olivieri), Libri med. 6.2 (Vol. 2, 125.27–126.1 Olivieri). 496 See on this issue van der Eijk 1997, 111–113. 497 See Pseudo-Galen, Def. med. 235 (19.413.5 K.). 498 See Anon. Par. 2.2.1 (12.3 f. Garofalo).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

213

in this context:499 Marcellinus states that the pulse of patients suffering from lethargia is amongst other things somewhat soft, not having vehemence in its beat (οἷον ὑπόσομφος, τὴν ἐν τῇ πληγῇ σφοδρότητα οὐκ ἔχων). I read the τὴν ἐν τῇ πληγῇ σφοδρότητα οὐκ ἔχων as explaining the adjective ὑπόσομφος: the beat of the pulse is not vehement, but soft. The adjectives σομφός and ὑπόσομφος are derived from the noun ἡ σπογγία (sponge) and their meaning is obviously derived from the softness of a sponge. While the phrase σφυγμὸς σομφός is not commonly used in medical texts, the pulse is frequently characterized as being μαλακός,500 which also means soft. According to the pseudo-Galenic Definitiones medicae a soft pulse (μαλακὸς σφυγμός) is the opposite of a hard pulse (ὑπεναντίος τῷ σκληρῷ) and has a soft artery; the inherent pneuma has been set free and the beat is soft.501 The pulse is very commonly described as μικρός,502 as, for example, also in Alexander’s chapter on lethargia.503 In De causis pulsuum Galen defines the pulse of a patient as being μικρός when it is smaller than it should be according to nature (κατὰ φύσιν), while the pulse is defined as being κατὰ φύσιν and σύμμετρος if it is neither too large (μέγας) nor too small.504 Related to the idea that the pulse is small in patients who constantly sleep, is the notion that the pulse is also δυσκίνητος. Again, there are only a few passages in the medical literature in which the pulse is characterized in this way.505 In one of these passages a pulse is characterized as being δυσκίνητος and ἀργός.506 The meaning of both adjectives is obviously similar, since both refer to something as being hardly moveable, lazy or idle. In Caelius Aurelianus the pulse of patients suffering from lethargia is described as, amongst other things, being piger ac inanis.507 p. 128.24–26: οὗτοι δὲ – ὑπομένουσι: The pronoun οὗτοι refers to those patients who were said to always have the affection (p. 128.24: οἱ δὲ ἀεὶ τὸ πάθος ἔχοντες), 499 See Marcellinus, De puls. 16.296–297 (464 Schöne). On Marcellinus, see also von Staden 1996. 500 See e.g. Galen, Ars med. 10.9 (305.4 f. Boudon = 1.334.8 K.), Oribasius, Synops. ad Eustath. 5.49.6 (177.9 Raeder), Aetius Amid., Libri med. 4.83 (Vol. 1, 403.14 Olivieri), Paul 1.66 (Vol. 1, 45.17 Heiberg). 501 See Pseudo-Galen, Def. med. 210 (19.405.4–6 K.). 502 See e.g. Galen, Ars med. 10.7 (303.17–304.1 Boudon = 1.333.13 K.), De plac. Hipp. et Plat. 6.1.15 (364.4 de Lacy = 5.509.15 K.), Aetius Amid., Libri med. 5.60 (Vol. 2, 36.24 Olivieri). 503 See Alexander, Therapeutica 1.14 (634.20 Guardasole = Vol. 1, 529.10 f. Puschmann). 504 See Galen, De caus. puls. 1.7 (9.13.8–12 K.): τοῦ μὲν γὰρ μεγάλου τε καὶ μικροῦ σφυγμοῦ μέσος τίς ἐστιν ὁ κατὰ φύσιν τε καὶ σύμμετρος, ᾧ παραβάλλοντές τε καὶ παραμετροῦντες τοὺς ἄλλους ἅπαντας, ὅσοι μὲν ἂν μείζους ὦσιν αὐτοῦ, τούτους μὲν μεγάλους ὀνομάζομεν, τοὺς δ’ ἐλάττους μικρούς. 505 See Aetius Amid., Libri med. 8.77 (Vol. 2, 552.13 Olivieri), Oribasius, Coll. med. rel. 8.24.61 (Vol. 1, 276.29 Raeder). 506 See Oribasius, Coll. med. rel. 8.24.61 (Vol. 1, 276.29 Raeder). 507 Caelius Aurel., Cel. pass. 2.3 (132.2 f. Bendz). In the first chapter of Aetius’ sixth book, the Greek ἀργός is translated with segnis pigerque in Montanus’ Latin translation (see Montanus, 234). The adjective piger might thus also correspond to the Greek adjective ἀργός in the passage of Caelius Aurelianus.

214 | Commentary

that is to say to those who are constantly sleeping, while the phrase οἱ δὲ κατὰ περίοδον refers to those patients who are periodically drowned in sleep (p. 128.22–23: οἱ μὲν γὰρ κατὰ περίοδον τῷ ὕπνῳ βαπτιζόμενοι). The participle διεγειρόμενοι indicates that the information that follows concerns the point in time when the patients wake up. Given that the pronoun οὗτοι refers to those patients who are said to endure one attack of being drowned in sleep, the διεγειρόμενοι obviously deals with the point at which the patients wake up from this deep sleep. The supposition that patients suffering from lethargia make strange utterances (ἀλλόκοτα φθέγγονται) and are forgetful (ἐπιλήσμονές εἰσιν) is commonly found in other texts as well.508 These symptoms might be traced back to the fact that the brain is thought to be damaged in lethargia (see p. 203, commentary on p. 128.6–9) and that the faculties of reasoning and memory are localized in the brain, as discussed in the second chapter of Aetius’ sixth book on phrenitis (for a closer look on the terms imaginative faculty, reasoning faculty and recollective faculty see p. 171 – 174, commentary on p. 125.20–24). This assumption is supported by the fact that it is explicitly stated later on in the chapter that the λογισμός is damaged in lethargia (p. 129.3: διὰ τὸ βεβλάφθαι τὸν λογισμόν). The phrase οὐδὲν τοιοῦτον ὑπομένουσι refers to the phrase ἀλλόκοτα φθέγγονται καὶ ἐπιλήσμονές εἰσιν. p. 128.26–129.3: καὶ οἱ μὲν – λογισμόν: It is not clear what the distinction between οἱ μέν (p. 128.26) and οἱ δέ (p. 129.3) refers to here. Either it is supposed to take up the previously distinguished groups of patients, that is to say those who suffer periodically and those who are always suffering (see p. 212, commentary on p. 128.22–24), or it is supposed to present subgroups of patients who fall asleep periodically, or it refers to patients suffering from lethargia in general. Since no further indication is given as to how to understand the relation between the corresponding particles and the preceding distinction between the several groups of patients, I understand οἱ μέν and οἱ δέ as referring generally to patients suffering from lethargia. Other texts also deal with the breathing of patients suffering from lethargia and we find various notions of ἀναπνοή in this context: in Paul’s compilation it is said that the breathing is intermittent (ἀραιός) and weak (ἀσθενής);509 the Anonymus Parisinus suggests that the breathing has a great interval (ἀναπνοὴ διάστημα πολὺ ἔχουσα);510 and Caelius Aurelianus states that the breathing slows down and becomes deeper, together with a kind of sighing (respiratio tardior ac maior cum quo508 See e.g. Paul 3.9.1 (Vol. 1, 147.13 Heiberg): ἐπιλήσμονες, Anon. Par. 2.2.2 (12.6 f. Garofalo): ἀμαυρὰ φθέγγονται καὶ μόλις ἐξάκουστα, Pseudo-Galen, Introd. s. medic. 13.25 (57.23 f. Petit = 14.741.10 f. K.): οἱ κάμνοντες ἐπιλανθανόμενοι πάντων ὅσα λέγουσι, Caelius Aurel., Cel. pass. 2.1 (130.5–7 Bendz), who states that the noun lethargus is derived from the Greek λήθη and ἀργία. See also p. 193. See also Alexander, Therapeutica 1.14 (634.6 f. Guardasole = Vol. 1, 527.24 f. Puschmann). 509 See Paul 3.9.1 (Vol. 1, 147.11 Heiberg). 510 See Anon. Par. 2.2.1 (12.4 f. Garofalo).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

215

dam gemitu).511 A few lines later he adds that it intensifies and thus seems rough (respiratio crassescit ita ut hirta videatur) when the affliction changes for the worse.512 All these notions concerning breathing are rather different from what we read in Aetius. The characterization of breathing as βαρύς is not common in the ancient medical context; besides the example in Aetius it is only documented in the Hippiatrica Berolinensia,513 in addition to a few examples in non-medical texts.514 The expression ἀναπνοὴ ἐπηρμένη appears to be unique to Aetius’ text and I have been unable to find any other text in which the verb ἐπαίρειν is used in order to characterize breathing. These characteristics of the patient’s breathing are closely linked to the snoring (ῥέγχειν), the pricking sensations (νυγμοί), and the groaning (στεναγμοί). Snoring and groaning are often connected with respiration.515 The noun νυγμός describes a displeasing and pricking feeling, which is closely related to pain.516 The adjective ἐκφαντιστικόν is only documented in the present passage. It refers to and characterizes the noun στεναγμοὺς: the groaning reveals the patient’s pain, which they cannot express with words since their reasoning faculty (λογισμός) is damaged. On this issue, see also p. 214, commentary on p. 128.24–26. Since the pricking sensations and the groaning lack symmetry, insofar as the former describes a feeling while the latter denotes a vocal utterance, it may be assumed that the groaning is already an expression of the painful feeling the patients have and that the phrase ἐκφαντιστικοὺς τῆς ὀδύνης thus refers to the pricking sensations. Interestingly, Nemesius of Emesa states in his De natura hominis that respiration is an activity belonging to the soul, which is shown by the στεναγματώδης ἀναπνοή which occurs in great grief.517 According to Nemesius, such a groaning breath embodies a certain state of the soul. p. 129.3–4: οἱ δὲ – ὑπνοῦν: In stating that the other group of patients has a very quiet sleep, the author implies that the sleep of the previously discussed patients, with their heavy and excited breathing, their snoring and their groaning, is rather disturbed. See the preceding commentary on p. 128.26–129.3.

511 See Caelius Aurel., Cel. pass. 2.16 (140.5 f. Bendz). 512 See Caelius Aurel., Cel. pass. 2.17 (140.15 f. Bendz). 513 See Hippiatrica Berolinensia 1.3 (1.21–2.1 Oder/Hoppe), Hippiatrica Berolinensia 1.15 (7.3 Oder/Hoppe). 514 See e.g. Empedocles fr. A 94.19 Diels/Kranz, Aetius Dox., De plac. rel. 4.17.2 (407.7 f. Diels). 515 See e.g. Galen, De diff. resp. 3.7 (7.924.3 f. K.), De loc. aff. 4.3 (8.231.9–12 K.), Hippocrates, De morb. 1.32 (90.16 f. Wittern = 6.202.17 f. L.), Paul 3.20.1 (Vol. 1, 168.7 Heiberg), Nemesius, De nat. hom. 28 (89.19–22 Morani). 516 See e.g. Paul 6.97 (Vol. 2, 150.25 f. Heiberg): παρέπεται δὲ αὐτοῖς ἄλγημα τοπικὸν νυγμός τε καὶ σφυγματώδης συναίσθησις (…). 517 Nemesius, De nat. hom. 28 (89.19–22 Morani): Καὶ ἡ ἀναπνοὴ δὲ τῶν ψυχικῶν ἐστιν ἔργων. καὶ γὰρ μύες εἰσὶν οἱ διαστέλλοντες τὸν θώρακα, τὸ κυριώτατον τῆς ἀναπνοῆς ὄργανον, καὶ ἡ ἀθρόα καὶ στεναγματώδης ἀναπνοή, ἐπὶ ταῖς μεγάλαις λύπαις γινομένη, ψυχικὴν δείκνυσι τὴν ἐνέργειαν.

216 | Commentary

p. 129.4: καὶ οἷς μὲν – ἐστι: The statement that the limbs of patients suffering from lethargia are cold might be derived from the fact that lethargia is connected with coldness (see p. 204 f., commentary on p. 128.10–12). The verb περιψύχεσθαι also appears in the Anonymus Parisinus in the context of lethargia,518 where the patients are said to become cold. Being pale (ὠχρόν) is often connected to coldness: things which become cold frequently turn pale.519 p. 129.4–5: καὶ – σύγκρισις: The noun σύγκρισις presumably refers back to τὰ κῶλα and means σύγκρισις τῶν κώλων, the constitution of the limbs. This reading of σύγκρισις would imply a connection between the limbs being cold (περιέψυκται τὰ κῶλα) and the constitution of the limbs being nearly stiffened (πηγνύναι). The notion that coldness causes stiffness is common in ancient medical literature.520 p. 129.5–6: οἷς δὲ – παροξυσμῶν: The information given in the words introduced by οἷς δὲ refers to another group of patients: it illustrates that patients can also suffer from the opposite of what has been discussed in the οἷς μὲν-part of the sentence (see the two preceding entries of the commentary on p. 129.4 and 129.4–5): their constitution (one probably has to understand σύγκρισις also with the διακέχυται and δροσίζει) is relaxed (διακέχυται). The verb διαχεῖν is sometimes understood as the opposite of πηγνύναι521 and thus presents the limbs as being rather flaccid. The verb δροσίζειν usually denotes that something drops or is fluid and moistens something.522 In the present context it is used in a metaphorical sense (οἷον δροσίζει) and as parallel to διαχεῖν, thus emphasizing that the constitution is flaccid. The phrase περὶ τὰς παρακμὰς τῶν παροξυσμῶν indicates the point in time at which the flaccid condition of the patients can be observed, namely during the abatement of the paroxysm. For more on the terms παροξυσμός and παρακμή see p. 187 f., commentary on p. 127.13–16. The author’s decision to connect the abatement of the paroxysm and the flaccid constitution might also be motivated by the fact that lethargia is connected to coldness (see p. 204 f., commentary on p. 128.10–12) and that an abatement of lethargia is, thus, possibly associated with heat or at least a decrease in coldness, which might cause the patient’s constitution to be flaccid rather than stiffened. p. 129.6–7: τοῖς μὲν – συνεδρεύει: It is unclear whether the phrase τοῖς μὲν οὖν κατεχομένοις τῷ πάθει ταῦτα συνεδρεύει refers forward, as one might be inclined to think, announcing the author’s “program” for the following lines (see p. 212, com-

518 See Anon. Par. 2.2.6 (12.14 f. Garofalo). 519 See e.g. Galen, De plac. Hipp. et Plat. 2.7.16 (154.24 f. de Lacy = 5.270.11 f. K.), Meth. med. 10.3 (34.14 f. Johnston & Horsley = 10.676.12 f. K.), Alexander, Therapeutica 5.1 (Vol. 2, 149.2 f. Puschmann). 520 See e.g. Hippocrates, De morb. 2.6a.3 (138.2–5 Jouanna = 7.14.18–20 L.),Galen, De usu part. 6.13 (Vol. 1, 343.22 Helmreich = 3.471.8 K.), Aetius Amid., Libri med. 12.9 (35.12 f. Kostomiris). 521 See e.g. Galen, De simpl. med. temp. et fac. 4.2 (11.625.6–8 K.), Aetius Amid., Libri med. 1 proem (Vol. 1, 25.15 f. Olivieri), Alexander, Therapeutica 12 (Vol. 2, 535.30 Puschmann). 522 See e.g. Anon. Par. 10.2.1 (72.18 f. Garofalo), Paul 3.71.1 (Vol. 1, 288.22 f. Heiberg).

VI 3 On lethargia from (the books of) Archigenes and Posidonius | 217

mentary on p. 128.22), since the pronoun ταῦτα is usually used to refer backwards.523 A few lines later the phrase is repeated in a similar form where ταῦτα does refer backwards, summarizing the preceding lines and turning to a new topic, namely the therapy (p. 129.15–16; see p. 221, commentary on p. 129.15–16). Given this repetition it might be best to interpret these phrases as forming a circular structure with the discussion of the accompanying symptoms (τὰ συνεδρεύοντα) in the middle. However, for this interpretation to work ταῦτα would need to refer forward, to a word that appears later in the text, as it usually does not. Either it does refer forward despite the rarity of this usage, or it actually refers backwards as it usually does, thus referring to the accompaniments of the patient’s sleep discussed earlier in the passage (announced by the phrase σκοπεῖν μὲν οὖν χρὴ τὸ εἶδος τῆς καταφορᾶς on p. 128.22; see p. 212, commentary on p. 128.22). Or it may, and I think this is most likely, even serve both purposes, referring backwards and forwards. The verb συνεδρεύειν commonly refers to accompanying symptoms of an affection.524 p. 129.7: ἀνέσπαται – κοιλία: The phrase ὑποχόνδριον ἀνασπᾶσθαι is also found in other medical texts and describes a special pathological condition of the hypochondrion.525 In a passage of Aetius’ fifth book, for example which is partly taken from Galen’s De differentiis febrium, we find a passage which deals with this condition in the context of fever. It is stated there that if the physician bares the parts around the belly and takes a look at them, he will get the impression that neither the intestines nor the internal organs have been preserved, but he will see that the hypochondrion is pulled up to the thorax and the skin is dry and parched, and when touching it with his fingers and lifting it up, it stands like hide.526 The notion that the hypochondrion is pulled up in patients suffering from lethargia is also to be found in the Anonymus Parisinus, who uses exactly the same words (ὑποχόνδριον ἀνασπᾶται) in this context.527 Caelius Aurelianus provides similar information by using the phrase conductio praecordiorum ad superiora.528 The noun ὑποχόνδριον literally describes the area under the χόνδρος, which refers to the cartilage of the breast.529 According to Galen’s In Hippocratis Aphorismos commentarii the whole epigastrion can be divided into three parts, namely the hypochondrion, the area around the 523 See Smyth § 1245: “οὗτος […] generally refers to what precedes, ὅδε […] to what follows.” 524 See e.g. Galen, De trem., palp., convuls. et rig. 7 (7.627.16 K.), Aetius Amid., Libri med. 5.4 (Vol. 2, 8.18 f. Olivieri), Libri med. 5.11 (Vol. 2, 11.18 f. Olivieri). 525 See e.g. Anon. Par. 30.2.3 (164.12 Garofalo),Galen, De loc. aff. 5.4 (8.332.6 f. K.), Paul 2.9.1 (Vol. 1, 79.28 Heiberg), Aetius Amid., Libri med. 5.93 (Vol. 2, 77.27 Olivieri). 526 See Aetius Amid., Libri med. 5.93 (Vol. 2, 77.25–78.1 Olivieri): ὡς εἰ καὶ γυμνώσας ἐπισκέψαιο τὰ κατὰ τὴν γαστέρα, δόξειέ σοι μήτε τῶν ἐντέρων τι μήτε τῶν σπλάγχνων μηδὲν ἀποσώζεσθαι καὶ τὸ ὑποχόνδριον ἀνεσπᾶσθαι σφοδρῶς εἰς τὸν θώρακα καὶ τὸ δέρμα ὅλον ξηρὸν καὶ καρφαλέον, καὶ εἰ ἀνατείνεις ἐπιλαβόμενος τοῖς δακτύλοις ὡς βύρσα τις ἵσταται. Compare Galen, De diff. febr. 1.11 (7.317.3–6 K.). 527 See Anon. Par. 2.2.6 (12.13 f. Garofalo). 528 Caelius Aurel., Cel. pass. 2.16 (140.6 f. Bendz). 529 See Pseudo-Galen, Introd. s. medic. 10.8 (27.11–13 Petit = 14.705.8–10 K.).

218 | Commentary

navel, and the ἦτρον, which he defines as the lower part of the belly, located between the pudenda and the navel.530 Given this distinction, the hypochondrion might be localized under the cartilage and above the navel.531 The phrase κοιλία συνάγεσθαι is not commonly used in medical texts but in the present context it should clearly be understood with the phrase ὑποχόνδριον ἀνασπᾶσθαι, describing a certain alteration of the stomach’s regular condition: when the hypochondrion is pulled up, the other internal organs accordingly also change their position to some extent. The noun κοιλία is used with several different meanings throughout medical literature but, in general, it describes any cavity of the body (cf. the adjective κοῖλος).532 In his treatise In Hippocratis De diaeta acutorum commentaria IV, Galen reports that the ancients called the thorax (θώραξ) upper cavity (τὴν ἄνω κοιλίαν) while referring to the whole reservoir of food under the diaphragm as lower cavity (κοιλίαν κάτω), sometimes only referring to the thick parts of the intestines as lower cavity.533 According to the pseudo-Galenic Definitiones medicae, the noun κοιλία is defined as a sinewy reservoir of moist and dry food which prepares the food for digestion.534 In this work it is also ranked among the nine functions (τάξεις) of the intestines.535 Given that different texts use κοιλία in a variety of senses, some using it to describe a broader area of the body while others use it to denote a specific bodily part, it is difficult to decide precisely what the author of our text had in mind when using it here. I translate κοιλία with stomach in the present context, since κοιλία is most commonly referred to as part of the body which plays a role in digestion. p. 129.7–9: καὶ διεγειρόμενοι – συνεδρεύει: The expression διεγειρόμενοι βίᾳ emphasizes the depth of the patients’ sleep, from which it is difficult to wake them. The notion that the sleep of patients suffering from lethargia is deep is very common and is, for example, explicitly referred to in Alexander’s work when he states that the patients are δυσδιέγερτοι and suffering from a ὑπνὸς βαθύς.536 Paul also uses the adjectives ὑπνώδεις and δυσέγερτοι to describe people who suffer from lethargia.537 See also p. 208, commentary on p. 128.15–16 for the characterization of the patients’ sleep. On the other hand the phrase διεγειρόμενοι βίᾳ also refers to ὑπὸ τῶν προσεδρευόντων and highlights the fact that the accompanying symptoms are of such a strong nature that they forcibly wake up the patients. The verb προσεδρεύειν is used

530 See Galen, In Hipp. Aph. comm. 2.35 (17b.534.11–15 K.). 531 On this issue, see also Gärtner 2015 in Galeni De locis affectis, 591. 532 This is why also the ventricles of the brain are referred to as κοιλίαι. See e.g. Aetius Amid., Libri med. 6.2 (Vol. 2, 125.17 Olivieri). 533 See Galen, In Hipp. De diaeta acut. comm. 4.107 (354.27–355.3 Helmreich = 15.896.8–13 K.). 534 See Pseudo-Galen, Def. med. 54 (19.361.7 f. K.): κοιλία ἐστὶ νευρώδης ὑποδοχεῖον τροφῆς ὑγρᾶς καὶ ξηρᾶς πρὸς τὸ πέττεσθαι τὴν τροφὴν κατεσκευασμένη. 535 See Pseudo-Galen, Def. med. 55 (19.361.13–15 K.). 536 Alexander, Therapeutica 1.14 (636.12 Guardasole = Vol. 1, 531.3 Puschmann), Therapeutica 1.14 (636.19 Guardasole = Vol. 1, 531.10 f. Puschmann). 537 See Paul 3.9.1 (Vol. 1, 147.12 Heiberg).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

| 219

as a synonym here for the previously used συνεδρεύειν.538 For a closer look at συνεδρεύειν see p. 217, commentary on p. 129.6–7. The participle τὰ προσεδρεύοντα probably refers back to all the previously discussed accompaniments of the deep sleep, found between p. 128.22 and p. 129.6. It might refer, in particular, to the pain (ὀδύνη) from which the patients are said to suffer (p. 129.2; see p. 215, commentary on p. 128.26–129.3), which is neither dealt with further nor explained. The phrase εἰς ὕπνον ἕλκεσθαι is rather unusual. See also p. 187 f., commentary on p. 127.13–16. Forgetfulness as an accompaniment of lethargia is dealt with earlier in the chapter (p. 128.25; see p. 214, commentary on p. 128.24–26). p. 129.9–11: καὶ γὰρ – ἐπιλανθάνονται: These lines find a close parallel in Caelius Aurelianus who, in his chapter on lethargia, reports a comparable incident: a patient who has been told to urinate, does not call for a chamber pot, or if he has called for one, he does not remember that he was given one.539 In De locis affectis Galen deals with what he calls irrational forgetfulness (ἄλογος ἐπιλησμοσύνη) and as an example of this forgetfulness he reports that patients ask for the chamber pot but do not urinate or that they forget to return the chamber pot after having urinated.540 In the present context, these lines also serve as an example of the degree of forgetfulness which can be observed in lethargia (see also p. 218 f., commentary on p. 129.7–9). The term σκεῦος denotes the chamber pot here, as it also does in the passage of De locis affectis. The genitive οὐρητήρου does not fit in this context since it usually refers to the urethra. I follow instead the reading of the manuscript Parisinus Suppl. gr. 1240 (Pa) which gives οὐροδόχου:541 the phrase οὐροδόχον σκεῦος thus denotes an object which holds the urine, i.e. a chamber pot. p. 129.11–12: ἐπιτεινομένου – γίγνεται: The adjective νωθρόν is commonly used together with words like βαρύς, βραδύς or δυσκίνητος542 and also with words that are connected to sleep.543 Together with the phrase οἷον νεκρῶδες this passage illustrates that the patients are in a deep sleep and hardly able to move. See also p. 216, commentary on p. 129.4, p. 216, commentary on p. 129.4–5 and p. 216, commentary on p. 129.5–6 for a closer look at the constitution of the patients’ limbs. p. 129.12: ὕπτιοι – καταρρέουσι: The fact that patients suffering from lethargia lie on their back (ὕπτιοι κατακείμενοι) is also expressed in the Anonymus Parisinus

538 See e.g. Galen, De diebus decr. 1.7 (9.802.1 K.), Aetius Amid., Libri med. 8.65 (Vol. 2, 520.6 Olivieri) for this meaning of προσεδρεύειν. 539 Caelius Aurel., Cel. pass. 2.15 (138.26 f. Bendz): Si urinam mittere fuerit admonitus, matellam non postulet vel, si petiverit, nesciat datam atque urinam non dimittat, nisi fuerit admonitus. 540 See Galen, De loc. aff. 5.4 (8.330.4 f. K.). 541 See Olivieri’s critical apparatus to p. 129.10. 542 See e.g. Hippocrates, De vet. med. 10.3 (130.10 f. Jouanna = 1.592.8 f. L.), Galen, De diebus decr. 1.6 (9.795.11 K.), In Hipp. Prorrh. comm. 2.35 (81.6 f. Diels = 16.653.12 K.). 543 See e.g. Aetius Amid., Libri med. 6.24 (Vol. 2, 164.13 f. Olivieri), Galen, De diebus decr. 1.12 (9.831.15 f. K.), Aretaeus 2.1.4 (16.9 Hude).

220 | Commentary

and in Caelius Aurelianus.544 According to the “Hippocratic” Coacae praenotiones, lying on one’s back is a bad sign and the best position in bed is the one people usually take when they are healthy.545 The same idea is also reflected in the Prognosticon, in which we find almost the same expression.546 According to Oribasius, a similar notion was advanced by Diocles. It is not better for anyone to sleep on their back, he claimed, since those who sleep in this way are especially prone to breathing problems, suffocation, epileptic complaints, and emission of semen during sleep.547 For further discussion on the issue of lying on one’s back, see also Wittern 1989, 18. The phrase ἐπὶ πόδας καταρρέουσι, which in our passage is connected to lying on the back, finds echoes in the Coacae praenotiones and in the Prognosticon, in both of which lying on one’s back is connected with the claim that it is a bad sign if the patient falls forwards (προπετὴς) and sinks down to the feet (καταρρέοι … ἐπὶ τούς πόδας).548 Caelius Aurelianus states that patients suffering from lethargia slip down from the upper part of the bed to the lower part549 and the Anonymus Parisinus has it that they slip down from the pillow.550 There has been some discussion in the scholarship as to whether the phrase καταρρεῖν ἐπὶ πόδας indicates that the patients fall to the floor or that they remain in bed but fall towards their feet.551 Given that Caelius explicitly states that the patients slip from the upper part of the bed to the lower part, I think the latter must be the correct interpretation. p. 129.12–13: διερριμμένοι – σκέλη: The very same phrase is used in the “Hippocratic” Coacae praenotiones and Prognosticon where the flailing of arms and legs is referred to as being a bad sign which indicates distress (ἀλυσμός).552 p. 129.13: μυκτὴρ – ἀποστάζει: The phrase μυκτὴρ ἀποστάζει is used elsewhere in medical literature and according to “Hippocrates” is a bad sign.553 p. 129.13–15: κέχηνεν – ὁρᾶται: The observation that the mouth of the patient suffering from lethargia gapes open and very strong wheezing follows is comparable with the earlier observation about the groaning of the patients (p. 129.1–2; see p. 544 See Anon. Par. 2.2.4 (12.10 f. Garofalo), Caelius Aurel., Cel. pass. 2.10 (136.12 f. Bendz), Cel. pass. 2.16 (138.31 Bendz). 545 See Hippocrates, Coac. 487 (226.3–6 Potter = 5.694.8–10 L.). 546 See Hippocrates, Progn. 3.2 (10.2–6 Jouanna = 2.118.12–15 L.). 547 See Diocles fr. 182.152–154 van der Eijk. 548 See Hippocrates, Coac. 487 (226.5 f. Potter = 5.694.10 L.), Progn. 3.2 (10.4–6 Jouanna = 2.118.14 f. L.). 549 See Caelius Aurel., Cel. pass. 2.16 (140.3–4 Bendz): lapsus etiam a superioribus lecti partibus ad inferiora. 550 See Anon. Par. 2.2.4 (12.11 Garofalo). 551 See e.g. Sider & McVaugh 1979 in Galen On Tremor, Palpitation, Spasm, and Rigor, 188 note 15; Jones 2006 in Hippocrates Volume II [listed under Prognosticon], 13 note 1. See also Wittern 1989, 18. 552 See Hippocrates, Coac. 487 (226.11 f. Potter = 5.694.15 f. L.): καὶ τὰ σκέλεα διερρῖφθαι, κακὸν, ἀλυσμὸν γὰρ σημαίνει, Progn. 3.3 (10.8 f. Jouanna = 2.120.1 f. L.): καὶ τὰ σκέλεα ἀνωμάλως διερριμμένα καὶ γυμνά, κακόν· ἀλυσμὸν γὰρ σημαίνει. 553 See Hippocrates, Coac. 175 (144.18 f. Potter = 5.622.2 L.), Prorrh. 1.79 (84.9 f. Polack = 5.530.6 f. L.). See also Oribasius, Coll. med. rel. 45.30.22 (Vol. 3, 192.40 Raeder).

VI 3 On lethargia from (the books of) Archigenes and Posidonius |

221

214 f., commentary on p. 128.26–129.3). In Paul’s chapter on lethargia, it is similarly claimed that patients constantly yawn (χασμῶνταί τε συχνῶς) and that their mouths sometimes remain open as if they have forgotten to close them (μένουσιν ἔσθ’ ὅτε κεχηνότες ὡς ἐπιλανθανόμενοι μῦσαι τὸ στόμα).554 The Anonymus Parisinus describes a constant yawning (χάσμα συνεχές) in patients suffering from lethargia, as does Caelius Aurelianus (oscitatio iugis).555 The opening of the mouth appears as a symptom alongside the hanging down of the lower jaw, which is also discussed in Caelius Aurelianus.556 p. 129.15–16: τὰ μὲν – θεραπεύοντες δὲ: For a discussion of the phrase τὰ μὲν συνεδρεύοντα τῷ ληθαργικῷ πάθει ταῦτα, see p. 216 f., commentary on p. 129.6–7. The author briefly mentions the topic he dealt with in the previous lines and, by using the participle θεραπεύοντες, announces his “program” for the rest of the chapter (see p. 212, commentary on p. 128.22). p. 129.16–17: κατακλινοῦμεν – ἀλεεινός: This first sentence in the section dealing with therapy finds a close parallel in the previous chapter of Aetius’ sixth book dealing with phrenitis, on which see also p. 174–176, commentary on p. 126.1–2, p. 126.2–4, and p. 126.4–6:557 both in the previous and in the present chapter the author starts his therapeutic remarks with advice on where to put the patients to bed using the same terms in both contexts (i.e. κατακλίνειν, οἶκος, ἀλεεινόν, φωτεινόν, πρὸς αὐγήν). Similarly precise recommendations concerning the question of where to put patients suffering from lethargia to bed are also found in other authors: Aretaeus recommends bedding the patients where they will be in the light and facing towards the sun (ἐν φωτὶ καὶ πρὸς αὐγήν);558 the Anonymus Parisinus states that the bed should be in a large place which is neither bright nor dark (ἐν τόπῳ εὐμεγέθει μήτε λαμπρῷ μήτε ζοφώδει);559 Paul identifies the ideal location as in a large room with moderate light (ἐν οἴκῳ μείζονι σύμμετρον ἔχοντι φῶς);560 and Caelius Aurelianus recommends a bright and moderately warm place (in loco lucido atque calido mediocriter).561 As regards the temperature of the room our author probably recommends a warm room since coldness has been identified earlier as a cause of lethargia (p. 128.11–12; see p. 204 f., commentary on p. 128.10–12). Aretaeus explicitly justifies this recommendation by referring to coldness as a cause of lethargia.562

554 See Paul 3.9.1 (Vol. 1, 147.13 f. Heiberg). 555 See Anon. Par. 2.2.4 (12.12 Garofalo), Caelius Aurel., Cel. pass. 2.10 (136.13 Bendz). 556 See Caelius Aurel., Cel. pass. 2.18 (140.19 f. Bendz): vel certe semiclauso ore ac dimisso, ita ut mentum propendens videatur et neque manu conduci separata possint. 557 See Aetius Amid., Libri med. 6.2 (Vol. 2, 126.1–6 Olivieri). 558 See Aretaeus 5.2.1 (98.8 f. Hude). 559 See Anon. Par. 2.3.1 (12.18 f. Garofalo). 560 See Paul 3.9.3 (Vol. 1, 147.27 f. Heiberg). 561 See Caelius Aurel., Cel. pass. 2.26 (144.29 Bendz). 562 See Aretaeus 5.2.1 (98.9 f. Hude): ἠδὲ ἐν ἀλέῃ μᾶλλον· ψῦξις γὰρ ἔμφυτος ἡ αἰτίη.

222 | Commentary

p. 129.17–18: ψηλαφητέον – χεῖρας: Expressions such as ψηλαφᾶν πόδας or ψηλαφᾶν χεῖρας are used elsewhere in medical literature.563 In Caelius Aurelianus we also find the notion that patients suffering from lethargia should be treated with a massage (fricatio) of the limbs.564 Caelius states that one has to heat those limbs that are cold by gently touching and rubbing them565 and also reports that Diocles rubs the bodies of patients suffering from lethargia (iugiter corpus defricat).566 Aretaeus also mentions the need to massage the feet (ψηλαφίη) as part of the therapy for lethargia.567 According to Alexander’ chapter on lethargia, a massage of the limbs wakes people up even if they are in a deep sleep.568 In Paul’s chapter on phrenitis it is recommended that the patients’ feet be massaged for the sake of removing detrimental substances from a part of the body (ἀντισπάσεως ἕνεκα).569 In our present context ψηλαφητέον might also indicate the ability of massage to provide a therapy for the previously mentioned constitution of the limbs (p. 129.4–6; see also p. 216, commentary on p. 129.4, see p. 216, commentary on p. 129.4–5, see p. 216, commentary on p. 129.5–6) and aim to restore their healthy condition. p. 129.18: καὶ ὀσφραντὰ – προσάγειν: The phrase ὀσφραντὰ διεγερτικά is used in other passages of Aetius’ sixth book570 and one of these passages provides a recipe for an awakening substance which can be smelled (ὀσφραντὸν διεγερτικὸν) that can be applied to people with epilepsia.571 The adjective ὀσφραντός describes substances which can be sensed by smell: according to Galen’s De instrumento odorato, smell (ὄσφρησις) is the perception of substances which can be smelled (τὰ ὀσφραντά) and the ability which enables us to do so.572 The adjective διεγερτικόν here refers to substances which are able to awake or stimulate patients and it is used in the same way in other passages as well.573 The Anonymus Parisinus even recommends the use of such substances in the context of lethargia.574 The notion that substances which can be smelled are able to have an awakening or stimulant effect on patients is reflected in other passages as well.575 Aretaeus states that when treat563 See e.g. Anon. Par. 8.3.12 (62.23 Garofalo), Oribasius, Coll. med. rel. 8.1.34 (Vol. 1, 250.8 Raeder), Oribasius, Ad Eunap. 4.14.2 (445.4 Raeder). 564 See Caelius Aurel., Cel. pass. 2.27 (146.4 Bendz), Cel. pass. 2.29 (146.24 f. Bendz), Cel. pass. 2.30 (146.35 f. Bendz). 565 See Caelius Aurel., Cel. pass. 2.30 (146.35–148.1 Bendz). 566 See Diocles fr. 79.7 van der Eijk. 567 See Aretaeus 5.2.1 (98.11 Hude). 568 See Alexander, Therapeutica 1.14 (636.16–18 Guardasole = Vol. 1, 531.8–11 Puschmann). 569 See Paul 3.6.2 (Vol. 1, 146.2 f. Heiberg). 570 See Aetius Amid., Libri med. 6.15 (Vol. 2, 155.11 Olivieri), Libri med. 6.27 (Vol. 2, 171.10 Olivieri). 571 See Aetius Amid., Libri med. 6.15 (Vol. 2, 155.11 Olivieri). 572 See Galen, De instr. odor. proem (30.6–8 Kollesch = 2.857.3–5 K.). 573 See e.g. Aetius Amid., Libri med. 5.121 (Vol. 2, 98.25 Olivieri), Libri med. 6.15 (Vol. 2, 155.7 Olivieri), Oribasius, Synops. ad Eustath. 8.5.4 (284.10 Raeder). 574 See Anon. Par. 2.3.7 (16.18 f. Garofalo): πάντα τὰ τμητικὰ καὶ διεγερτικὴν δύναμιν ἔχοντα. 575 See e.g. Aetius Amid., Libri med. 6.15 (Vol. 2, 155.14 f. Olivieri), Paul 3.12.2 (Vol. 1, 152.6 f. Heiberg), Oribasius, Synops. ad Eustath. 8.4.1 (247.22 f. Raeder).

VI 3 On lethargia from (the books of) Archigenes and Posidonius |

223

ing lethargia one has to do everything to awaken the patient.576 On the issue of awakening substances which can be smelled, see also p. 223, commentary on p. 129.18–19, p. 224, commentary on p. 129.19–22, and p. 224 f., commentary on p. 129.22–23. p. 129.18–19: οἷόν – χαλβάνη: These substances serve as examples for the previously mentioned ὀσφραντὰ διεγερτικά. The physician is clearly meant to choose from this list those substances which he has at hand or can easily get. That castoreum (καστόριον) has a stimulating and awakening effect when smelled is reflected in many other passages and it is often referred to as an effective aid against lethargia or deep sleep in general.577 In his work De materia medica, Dioscorides describes in detail how the castoreum is extracted from the testicles of a beaver and in which cases it serves as an effective remedy.578 Some texts make the claim that it has a heating (and drying) capacity579 and this assumption might be one of the reasons why it is often recommended for patients who are suffering from a deep sleep: coldness is regarded as bringing about sleep (see p. 189 f., commentary on p. 127.20–23) and the contrary (i.e. heat) helps to awake patients from sleep. According to Aetius’ first book, pitch (πίσσα) and galbanum (χαλβάνη) also have a warming capacity.580 All the substances which are mentioned here (i.e. καστόριον, ἐλλύχνιον, πίσσα, ἄσφαλτος, χαλβάνη) are also listed together in other passages and they are said to be smelled (ὀσφραινόμενα) and to wake patients (διεγείρει).581 Some passages even explicitly refer to one or more of these substances as being ill-smelling (κακώδες or δυσώδες)582 and the penetrant smell seems to be what they all have in common and what helps to stimulate or wake patients.583 This capacity is made explicit in Celsus’ De medicina, where it is said that one should apply substances which are ill-smelling to patients suffering from lethargia in order to excite them and to wake them up. In this context he mentions the use of castoreum, pitch, and galbanum.584

576 See Aretaeus 5.2.2 (98.13 f. Hude). 577 See e.g. Aetius Amid., Libri med. 5.121 (Vol. 2, 98.25–99.1 Olivieri), Alexander, Therapeutica 1.14 (636.8 f. Guardasole = Vol. 1, 531.3 f. Puschmann), Paul 7.3 (Vol. 2, 222.11 f. Heiberg). 578 See Dioscorides, De mat. med. 2.24.1 (Vol. 1, 129.5 Wellmann), De mat. med. 2.24.1 (Vol. 1, 129.11 f. Wellmann). 579 See e.g. Galen, De trem., palp., convuls. et rig. 5 (58.4–6 Konstantinides = 7.601.4–6 K.), Paul 3.9.3 (Vol. 1, 148.1 f. Heiberg), Anon. Par. 2.3.1 (14.2 f. Garofalo). 580 See Aetius Amid., Libri med. 1.322 (Vol. 1, 122.25 Olivieri), Libri med. 1.409 (Vol. 1, 145.2 Olivieri). 581 See e.g. Dioscorides, Simpl. 2.91 (288.10–15 Wellmann), Oribasius, Synops. ad Eustath. 9.41.2 (301.11–14 Raeder), Oribasius, Ad Eunap. 4.109.2 (485.19–22 Raeder). 582 See e.g. Hippocrates, De nat. mul. 26 (26.3–6 Bourbon = 7.342.18–20 L.), Paul 3.71.2 (Vol. 1, 288.29 f. Heiberg). 583 See also Paul 3.71.2 (Vol. 1, 288.31 Heiberg) who reports that some are even brought close to a chamber pot containing urine and feces. 584 See Celsus, De med. 3.20.1 (129.4–8 Marx).

224 | Commentary

p. 129.19–22: καὶ ὑποθυμιώμενα – σίλφιον: The notion that fumigated substances (ὑποθυμιώμενα) have the ability to wake people up is also reflected in other passages.585 These substances closely correspond to the previously mentioned awakening substances which can be smelled (ὀσφραντὰ διεγερτικά) and some of these latter (namely bitumen, castoreum and galbanum) are also now mentioned in the list of fumigated substances. See also p. 222 f., commentary on p. 129.18, and p. 223, commentary on p. 129.18–19. A strong smell is probably what they all share in common. Celsus mentions that one may burn certain substances in order to produce a certain smell, which in turn can wake up patients suffering from lethargia.586 Sulphurwort, galbanum, wormwood and laserwort are all said to have a warming capacity, according to Aetius’ first book,587 which might further contribute to waking the patients up. On this issue see p. 223, commentary on p. 129.18–19. All substances which are mentioned in our text are also contained in a long list of “fumigated substances which wake people up” (ὑποθυμιώμενα δὲ ἐγείρει) in Dioscorides’ De simplicibus medicinis.588 Hartshorn (κέρας ἐλάφειον) is commonly mentioned as part of a remedy in medical texts and is also mentioned in Celsus’ section on lethargia.589 p. 129.22–23: προσάγειν – ὑποκειμένου: The application of sternutatories is also recommended in Alexander’s chapter on lethargia, where it is stated that this application may help to wake the patients up.590 Aretaeus, the Anonymus Parisinus, Celsus, and Paul also mention the application of sternutatories in their chapters on lethargia.591 Caelius Aurelianus reports that Diocles applied sternutamenta, which the Greeks call ptarmica.592 The application of sternutatories is obviously related to the previously mentioned application of awakening substances which can be smelled (ὀσφραντὰ διεγερτικά) and of fumigated substances (τὰ ὑποθυμιώμενα), insofar as all of these are connected to the sense of smell. See also p. 222–224, commentaries on p. 129.18, 129.18–19, 129.19–22. Later in Aetius’ sixth book a chapter is devoted to sternutatories (περὶ πταρμικῶν) and in this context it is stated that sneezing cures the heaviness of the head (τὰ τῆς κεφαλῆς βάρη).593 Accordingly, the fact

585 See e.g. Dioscorides, De mat. med. 2.7 (Vol. 1, 124.1 Wellmann), De mat. med. 2.8 (Vol. 1, 124.10 Wellmann), Paul 7.3 (Vol. 2, 254.3 f. Heiberg). For an interesting statement, see also Galen, De simpl. med. temp. et fac. 11.1 (12.340.18–341.3 K.): ὠφελεῖ δὲ καὶ εἴ τις ἐπ’ ἄνθραξιν αὐτὸ θυμιῶν ἀρύῃ διὰ τῆς εἰσπνοῆς, καὶ μάλιστα τὰ κατὰ τὸν πνεύμονα καὶ ἐγκέφαλον ὑγρὰ καὶ ψυχρὰ πάθη. 586 See Celsus, De med. 3.20.1 (129.4–8 Marx). 587 See Aetius Amid., Libri med. 1.320 (Vol. 1, 121.7 Olivieri), Libri med. 1.409 (Vol. 1, 145.2 Olivieri), Libri med. 1.1 (Vol. 1, 30.7 Olivieri), Libri med. 1.361 (Vol. 1, 132.1 Olivieri). 588 See Dioscorides, Simpl. 1.15 (157.8–12 Wellmann). 589 See e.g. Paul 5.1.2 (Vol. 2, 6.3 Heiberg), Aetius Amid., Libri med. 3.138 (Vol. 1, 319.2 Olivieri), Libri med. 3.147 (Vol. 1, 323.3 f. Olivieri). For the reference to Celsus, see note 586. 590 Alexander, Therapeutica 1.14 (636.12–16 Guardasole = Vol. 1, 531.3–7 Puschmann). 591 See Aretaeus 5.2.11 (100.26 Hude), Anon. Par. 2.3.8 (16.20 f. Garofalo), Celsus, De med. 3.20.1 (129.4–8 Marx), Paul 3.9.3 (Vol. 1, 148.16 f. Heiberg). 592 See Diocles fr. 79.8 van der Eijk. 593 See Aetius Amid., Libri med. 6.97 (Vol. 2, 248.22 f. Olivieri).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

225

that sneezing cures affections which are localized in the brain is discussed and lethargia is mentioned as an example.594 Both statements are also found in Galen’s De instrumento odoratus,595 which Aetius used in part as a source for this chapter on sternutatories. The genitive absolute πλήθους δὲ ὑποκειμένου probably refers to a great amount of (detrimental) substances which fill the head and which need to be evacuated through the application of sternutatories. p. 129.23–24: εἰ μὲν – δύναμιν: For a more detailed discussion of phlebotomy see p. 178 f., commentary on p. 126.11–12. In the context of the present passage there is obviously an excess of blood and it is this that phlebotomy aims to reduce.596 The phrase τῇ δευτέρᾳ τῶν ἡμερῶν gives an exact instruction as to when to conduct a phlebotomy. Such instructions are common in the medical literature,597 and so, too, is the instruction to empty according to the strength of the patients (πρὸς δύναμιν).598 See also p. 179, commentary on p. 126.12. The advice to treat patients suffering from lethargia with phlebotomy is also found in Paul, Alexander, Aretaeus, Oribasius, the Anonymus Parisinus, and Caelius Aurelianus.599 p. 129.24–26: εἰ δὲ – πλεονεκτεῖν: The notion that a phlegmatic and moist substance is present in those who are suffering from lethargia is common. Paul opens his chapter on lethargia with the statement that the place of the affection is the same as in phrenitis, namely the brain, but the ὕλη is different, for lethargia occurs due to very moist and cold phlegm.600 Here we find the noun ὕλη, which is used in our text in the very same context as well. Alexander is close to Paul when he states that, as a consequence of the gathering of phlegm in the brain the patients are not able to remember what has been said and are constantly willing to close their eyes and

594 See Aetius Amid., Libri med. 6.97 (Vol. 2, 248.21–25 Olivieri): ὅθεν ἰῶνται οἱ πταρμοί, ὡς προείρηται, τὰ τῆς κεφαλῆς βάρη καὶ μὲν δὴ καὶ πάθη τινὰ τῶν κατὰ τὸν ἐγκέφαλον συνισταμένων, οἷα μάλιστά ἐστι τὰ ληθαργικὰ καὶ καρώδη καὶ τὰ παραπλήσια· διὰ τῶν πταρμικῶν γὰρ τὰ τοιαῦτα μάλιστα θεραπεύεται φαρμάκων. 595 See Galen, De instr. odor. 6.1–2 (60.10–19 Kollesch = 2.882.13–883.10 K.). 596 See e.g. also Galen, De trem., palp., convuls. et rig. 5 (61.7 f. Konstantinides = 7.604.7 f. K.): ὅτι μὲν οὖν αἵματος πλεονάζοντος φλεβοτομεῖν χρὴ, δῆλον οἶμαι παντὶ, τὸ γὰρ αἷμα ἐν φλεψὶ περιέχεται. 597 See e.g. Galen, De cur. rat. per venae sect. 20 (11.309.2 K.), Galen, Meth. med. 5.13 (96.12 Johnston & Horsley = 10.369.11 K.), Aetius Amid., Libri med. 6.8 (Vol. 2, 138.17 f. Olivieri). 598 See e.g. Galen, De cur. rat. per venae sect. 9 (11.277.1–3 K.): καλῶς οὖν ἐν τοῖς προκειμένοις τῶν περὶ διαίτης ὀξέων παρῄνηται φλεβοτομεῖν ἡμᾶς, ὅταν ᾖ μέγα τὸ νόσημα καὶ ἀκμάζῃ [ἡ νόσος, ἢ] ὁ νοσῶν καὶ ῥώμη παρῇ. 599 See Paul 3.9.3 (Vol. 1, 147.26 Heiberg), Alexander, Therapeutica 1.14 (634.26 f. Guardasole = Vol. 1, 529.16 f. Puschmann), Aretaeus 5.2.3 (98.22 f. Hude), Oribasius, Synops. ad Eustath. 8.1.2 (244.8 f. Raeder), Anon. Par. 2.3.1 (12.20 f. Garofalo), Caelius Aurel., Cel. pass. 2.28 (146.13–15 Bendz). 600 Paul 3.9.1 (Vol. 1, 147.6–9 Heiberg): Καὶ ὁ λήθαργος βλάβη τις ὑπάρχων τοῦ λογιστικοῦ τόπον μὲν ἔχει τὸν αὐτὸν τῇ φρενίτιδι, φημὶ τὸν ἐγκέφαλον, ὕλην δὲ τὴν ἐναντίαν· ἐπὶ φλέγματι γὰρ ὑγροτέρῳ καὶ ψυχροτέρῳ διαβρέχοντι τὸν ἐγκέφαλον γίνεται.

226 | Commentary

rest.601 According to the Anonymus Parisinus, Hippocrates was also of the opinion that lethargia occurs due to a cold and moist humor called phlegm, which oppresses the brain so that it is no longer able to send the psychic capacity (ψυχικὴ δύναμις) to each part of the body.602 There are further passages which suggest a connection between phlegm and the occurrence of lethargia.603 The fact that phlegm is often regarded as being cold (and moist)604 could explain why it is connected with the occurrence of lethargia. For further discussion of the connection between coldness and deep sleep, see p. 189 f., commentary on p. 127.20–23. p. 129.26: προσφέρειν – πάχος: The phrases τὰ λεπτύνειν δυνάμενα and τέμνειν τὸ πάχος are related to each other and refer to the thinning of humors and to the cutting of the thickness of humors. Galen devoted a whole treatise to the thinning diet (ἡ λεπτύνουσα δίαιτα) and explains that the term refers to the effect which the diet has on the humors in the body.605 He claims that all bodies which are full of thick, sticky and cold humors benefit from food which has a thinning effect.606 Both phrases (λεπτύνειν and τέμνειν) are commonly used together in the same context in medical literature, since they both refer to the same procedure.607 In our context both verbs obviously refer to the thinning and the cutting the thickness of the phlegm, which is understood as the humor which causes lethargia (see p. 225 f., commentary on p. 129.24–26). In his Methodus medendi, Galen states that one should “cut the thickness of the harmful humor” (τέμνειν τὸ πάχος τοῦ λυποῦντος χυμοῦ) in those affections which involve the occurrence of deep sleep.608 p. 130.1–3: καὶ ἐπὶ – ὁμοίων: The adjective νευρῶδες is commonly used in ancient medical literature already from “Hippocrates” onwards.609 However, its concrete meaning is often difficult to grasp. According to Galen’s De usu partium there 601 See Alexander, Therapeutica 1.14 (634.4–7 Guardasole = Vol. 1, 527.22–25 Puschmann): ὁ γνήσιος λήθαργος, ὥσπερ ἡ φρενῖτις, ἔχει μὲν τόπον ἐγκεφάλου, ὕλην δ’ ἐναντίαν τῇ φρενίτιδι. ἐπὶ φλέγματι γὰρ πλεονάζοντι γίνεται ὑγραίνοντι αὐτὸν καὶ διαβρέχοντι ἰσχυρῶς, ὡς μὴ δύνασθαι μεμνῆσθαι τῶν λεγομένων, ἀλλὰ μύειν ἀεὶ ἐθέλειν τὰ βλέφαρα καὶ ἡσυχάζειν. 602 See Anon. Par. 2.1.3 (10.23–27 Garofalo): Ἱπποκράτης δὲ ὑπὸ τοῦ ψυχροῦ καὶ ὑγροῦ γίνεσθαι χυμοῦ τὸν λήθαργόν φησιν· ἔστι δὲ οὗτος τὸ φλέγμα, ὑφ’ οὗ δὴ βαρούμενον τὸν ἐγκέφαλον μηκέτι δύνασθαι τὴν ψυχικὴν δύναμιν εἰς ἕκαστον μέρος τοῦ σώματος ἐπιπέμπειν καὶ οὕτω τὰς καταφορὰς γίνεσθαι. 603 See e.g. Galen, Quod animi mor. 3 (18.12 f. Bazou = 4.777.2 f. K.), De caus. puls. 4.13 (9.183.12 K.), In Hipp. Prorrh. comm. 3.30 (143.17 f. Diels = 16.780.14–16 K.). 604 See e.g. Galen, De temp. 1.9 (38.1 Helmreich = 1.568.16 f. K.), De loc. aff. 3.9 (8.175.14–17 K.). 605 See Galen, De vict. att. 1.3 (433.16–18 Kalbfleisch). 606 See Galen, De vict. att. 1.5 (434.8–10 Kalbfleisch). 607 See e.g. Galen, De vict. att. 11.85 (446.7 Kalbfleisch), Paul 7.1 (Vol. 2, 185.21 Heiberg), Aetius Amid., Libri med. 1.175 (Vol. 1, 79.28 f. Olivieri). 608 See Galen, Meth. med. 13.21 (404.1–3 Johnston & Horsley = 10.931.4 f. K.). 609 See e.g. Hippocrates, De vet. med. 22.9 (152.15 Jouanna = 1.634.2 f. L.), Dioscorides, De mat. med. 2.70.6 (Vol. 1, 145.17 Wellmann), Soranus, Gyn. 2.38.4 (81.14 Ilberg), Galen, Meth. med. 9.5 (482.28 Johnston & Horsley = 10.622.2 K.), Oribasius, Coll. med. rel. 6.27.3 (Vol. 1, 183.29 Raeder), Alexander, Therapeutica 1.16 (Vol. 1, 575.17 Puschmann).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

227

exist three kinds of nerve-like bodies (νευρώδη σώματα): the nerves themselves (νεῦρα), which originate from the brain and the spinal cord; the tendons (τένοντες), which grow from the muscles; and the ligaments (σύνδεσμοι) which grow from the bones.610 The assumption that there may be an affliction (κακοῦσθαι) of that which is referred to in our text as τὸ νευρῶδες is also reflected in other passages.611 Indeed, in Aetius’ fifth book it is even stated that some patients are seized by lethargia or phrenitis or spasms and the like, and to put it briefly (συλλήβδην εἰπεῖν), “their whole nerve-like system is afflicted, as well as the head” (κακοῦται πᾶν τὸ νευρῶδες αὐτοῖς καὶ ἡ κεφαλή).612 I translate “nerve-like system” here in order to avoid any anachronistic assumptions that might be attendant on translating the phrase as “nervous system”. In addition, translating νευρῶδες as “nerve-like” also leaves room for the possibility that it refers to the other bodily parts which Galen characterizes as nerve-like, such as tendons or ligaments. There are other passages which also suggest a connection between the affliction of the nerve-like system and the occurrence of spasms or epilepsia or similar affections,613 and these lead me to conclude that our present passage refers to the distinction made earlier between patients who fall asleep with spasms and those who fall asleep without (p. 128.18–19; see p. 210 f., commentary on p. 128.18–19). Those whose nerve-like system is not afflicted (ἐπὶ μὲν τῶν μὴ κεκακωμένων τὸ νευρῶδες) would, then, correspond to those who do not suffer from spasms when falling asleep, while those whose nervelike system is afflicted (ἐπὶ δὲ τῶν κεκακωμένων) would correspond to those who do suffer from spasms. On the discovery of the nerves, see also Solmsen 1971. The application of oxymel (ὀξύμελι) in the context of the therapy of lethargia is also recommended by both the Anonymus Parisinus and Paul, who refer to it as being ἀποφλεγματισμός or purgative of phlegm.614 There are other passages which put forward the notion that as a remedy it has a thinning power (λεπτύνειν).615 Given that our text has already stated that one has to apply thinning substances (p. 129.26, see the preceding commentary on p. 129.26), oxymel is clearly given as one example of how this thinning can be accomplished in cases where the nerve-like system is not afflicted. Interestingly, in his In Hippocratis librum de fracturis commentarii III, Galen states that it is not useful to apply oxymel when the nerve-like system is affected,616 which fits with the views of the present passage. Celery (σέλινον), fennel (μάρα610 See Galen, De usu part. 15.1 (Vol. 2, 339.26–340.20 Helmreich = 4.215.6–216.8 K.). See on this issue in detail also Gärtner 2015 in Galeni De locis affectis, 762. 611 See e.g. Galen, Meth. med. 9.5 (482.27 f. Johnston & Horsley = 10.622.2 K.), Soranus, Gyn. 2.38.3 (81.13 f. Ilberg), Aetius Amid., Libri med. 3.172 (Vol. 1, 345.14 Olivieri). 612 See Aetius Amid., Libri med. 5.72 (Vol. 2, 46.30–47.1 Olivieri). 613 See e.g. Soranus, Gyn. 2.38.3 (81.13 f. Ilberg), Galen, Meth. med. 9.5 (482.26–28 Johnston & Horsley = 10.622.1 f. K.). 614 See Anon. Par. 2.3.2 (14.6 f. Garofalo), Paul 3.9.3 (Vol. 1, 148.8 f. Heiberg). 615 See e.g. Galen, De vict. att. 11.86 (446.15 f. Kalbfleisch), De vict. att. 12.111 (450.7–9 Kalbfleisch) 616 See Galen, In Hipp. Fract. comm. 2.29 (18b.466.18–467.1 K.): οὐ μὴν ὀξυμέλιτί γε συμφέρει χρῆσθαι πεπονθότων νευρωδῶν μορίων.

228 | Commentary

θρον), and maidenhair (ἀδίαντος), the application of all three of which is recommended when the nerve-like system is afflicted, are all discussed in Aetius’ first book. While celery and fennel are said to have a warm capacity, maidenhair is said to rank between warmth and coldness in its mixture, but is still referred to as thinning.617 Given that these substances are recommended in case the nerve-like system is afflicted, it is interesting that there are few passages which connect an affliction of the nerve-like system to coldness.618 Celery and fennel probably counteract the affliction of the nerve-like system brought about by coldness through their warming power, while the effect that maidenhair has is most likely restricted to its thinning property, since it is neutral as regards warmth and coldness. p. 130.3: καὶ κλύζειν – κλύσματι: For further discussion of the application of enemata see p. 181, commentary on p. 126.17–19. In the case of lethargia, the application of an enema is also recommended in other writings, such as the treatises of the Anonymus Parisinus, Aretaeus, Caelius Aurelianus, Paul, and Alexander.619 p. 130.3–4: καὶ βαλάνοις – ἑφθοῦ: The Greek ἡ βάλανος is feminine, which means that the article τοῖς being used here is actually not congruent with it. The critical apparatus shows that the Codex Parisinus Suppl. gr. 1240 (Pa) and the manuscript group ω transmit βαλανείοις instead of βαλάνοις, which would make a difference in meaning (βαλανεῖον means “bath”, while βάλανος means “suppository” here) but would be congruent with the male article. There are also other texts which deal with suppositories made out of rue, sodium carbonate, cumin, or honey.620 Taking these together with the facts that the bathing of patients is discussed at the end of this chapter (see p. 131.6–9; see p. 238 f., commentary on p. 131.6–9) and that the application of an enema is more akin to the application of a suppository,621 it seems very likely that βαλάνοις is the noun which fits best into the context (as Olivieri concluded), despite the incongruity of the noun with the article. In Aetius’ third book, a chapter is devoted to suppositories and here it is said that their application is also useful for all cold affections which are localized around the head (τοῖς περὶ τὴν κεφαλὴν ψυχροῖς πᾶσι πάθεσι). Patients suffering from deep sleep are also explicitly mentioned.622 As regards the composition of the suppository, the same 617 See Aetius Amid., Libri med. 1.354 (Vol. 1, 130.6 Olivieri), Libri med. 1.269 (Vol. 1, 107.21 Olivieri), Libri med. 1.7 (Vol. 1, 32.25–33.4 Olivieri). 618 See Aetius Amid., Libri med. 4.45 (Vol. 1, 388.27–29 Olivieri), Oribasius, Coll. med. rel. 6.27.3 (Vol. 1, 183.29 Raeder). 619 See Anon. Par. 2.3.1 (12.21 f. Garofalo), Aretaeus 5.2.2 (98.17 f. Hude), Caelius Aurel., Cel. pass. 2.29 (146.28 f. Bendz), Paul 3.9.3 (Vol. 1, 147.27 Heiberg), Alexander, Therapeutica 1.14 (638.14 f. Guardasole = Vol. 1, 533.3 f. Puschmann). 620 See e.g. Oribasius, Eclog. med. 59.2 (224.1 Raeder), Oribasius, Eclog. med. 59.3 (224.20 f. Raeder), Aetius Amid., Libri med. 3.160 (Vol. 1, 330.14–16 Olivieri). 621 For passages in which the application of enemata and suppositories is mentioned in one line, see e.g. Aetius Amid., Libri med. 3.23 (Vol. 1, 279.11 f. Olivieri), Anon. Par. 15.3.8 (104.21 f. Garofalo), Galen, In Hipp. De diaeta acut. comm. 2.17 (178.3 Helmreich = 15.546.8 K.). 622 See Aetius Amid., Libri med. 3.160 (Vol. 1, 330.11–13 Olivieri).

VI 3 On lethargia from (the books of) Archigenes and Posidonius |

229

ingredients are mentioned in the third book as in the present context.623 According to Aetius’ first book, rue (πήγανον) is warming and drying, sharp and bitter, capable of cutting thick humors and useful for patients suffering from lethargia, both as a drink or applied as an enema.624 Cumin (κύμινον) is also said to have a warming capacity and to be suitable as a cure for flatulence.625 Honey (μέλι) is likewise referred to as warming and drying and is also described as having a cleansing capacity.626 The foam of sodium carbonate (νίτρου ἀφρός) is a drying remedy according to Aetius’ second book and it, too, has a cleansing capacity.627 p. 130.5–6: ἐμβρέχειν – ἐλαίῳ: For more on embrocations see also p. 181 f., commentary on p. 126.19. According to Aetius’ first book, tufted thyme (ἕρπυλλος) has a warming capacity and relieves headaches when cooked with vinegar; it is especially useful for patients suffering from lethargia or chronic phrenitis.628 Vinegar (ὄξος) and oil (ἔλαιον) are commonly mentioned as ingredients of remedies or as substances in which or together with which other substances are boiled down.629 For a closer look at the way the application of embrocations is dealt with here see also p. 230 f., commentary on p. 130.8–10. p. 130.6–8: ἐν δὲ – κεφαλῇ: The use of the noun κατοχή is remarkable in this context, since the following chapter of Aetius’ sixth book deals with it as an affection of its own (see p. 131.16–133.9: περὶ κατοχῆς καὶ καταλήψεως ἐκ τῶν Ἀρχιγένους καὶ Ποσειδωνίου; see p. 241 – 243). There, katoche (or katalepsis as it is also called) is said to be an affection which is midway between phrenitis and lethargia (μέσον τι φρενίτιδος καὶ ληθάργου πάθος εὑρήσεις …).630 This description shows that there is indeed a relation between katoche and lethargia, which might explain why the noun κατοχή appears in the chapter on lethargia. In the following chapter, which focuses on katoche, several different symptoms are mentioned: patients are said to be sleepy, to have open eyelids, to stare, to have motionless eyes, to be voiceless and without sensation, to give just the most vivid examples.631 For a closer look at the

623 See Aetius Amid., Libri med. 3.160 (Vol. 1, 330.15–17 Olivieri): καὶ γὰρ διὰ μέλιτος ἑφθοῦ καὶ ἁλὸς ὀπτοῦ καὶ νίτρου συντίθεται καὶ διὰ κυμίνου καὶ πηγάνου καὶ νίτρου καὶ μέλιτος ἑφθοῦ, ἐφ’ ὧν μᾶλλον πνευμάτωσις ἐνοχλεῖ. 624 See Aetius Amid., Libri med. 1.321 (Vol. 1, 121.16–19 Olivieri), Libri med. 1.321 (Vol. 1, 122.18 f. Olivieri). 625 See Aetius Amid., Libri med. 1.235 (Vol. 1, 99.12–14 Olivieri). 626 See Aetius Amid., Libri med. 1.273 (Vol. 1, 108.16–18 Olivieri). 627 See Aetius Amid., Libri med. 2.50 (Vol. 1, 171.15 f. Olivieri), Libri med. 2.50 (Vol. 1, 171.21 f. Olivieri). 628 See Aetius Amid., Libri med. 1.146 (Vol. 1, 72.6 Olivieri), Libri med. 1.146 (Vol. 1, 72.15–18 Olivieri). Parts of this chapter seem to be taken from Dioscorides, De mat. med. 3.38.2 (Vol. 2, 51.5–11 Wellmann). 629 See e.g. Aetius Amid., Libri med. 6.8 (Vol. 2, 139.7 Olivieri), Galen, De comp. med. sec. loc. 1.2 (12.419.3 f. K.), Meth. med. 14.7 (454.7–9 Johnston & Horsley = 10.965.5 f. K.). 630 See Aetius Amid., Libri med. 6.4 (Vol. 2, 131.17 Olivieri). 631 See Aetius Amid., Libri med. 6.4 (Vol. 2, 131.21–132.3 Olivieri).

230 | Commentary

different symptoms, see p. 230 f., commentary on p. 130.8–10. When referring to katoche in the present context, the author presumably has exactly these or comparable symptoms in mind. He subsumes them under the noun κατοχή, without suggesting that it should be taken as an affection of its own. Rather, he uses it to refer to a symptom of lethargia, a usage which is also suggested by the participle ἐπιτεταμέναις (to increase in intensity) and the plural (κατοχαῖς). The genitive absolute that follows a few lines later (p. 130.8–9: τρόμων δὲ καὶ συνολκῶν ἐπιγιγνομένων) also seems to be parallel to the present phrase ἐν δὲ ταῖς ἐπιτεταμέναις κατοχαῖς and deals with symptoms of lethargia (τρόμοι and συνολκαί; see also p. 230 f., commentary on p. 130.8–10). The fact that certain nouns are used in some texts to indicate an affection in its own right and in other texts to indicate symptoms can also be seen in, for example, the case of mania (see p. 335 – 337). However, in the present context the case is slightly different since one author, Aetius, uses the same noun to indicate a symptom in one chapter and to refer to an affection of its own in another. Both chapters are even claimed to be cited from Archigenes and Posidonius. Nevertheless, one should not start to assume that we face irreconcilable difficulties in interpreting the differences between the chapters, but rather interpret the use of κατοχή in the present context as being due to everyday language use (κατέχεσθαι - to be seized). The text now proposes an alternative substance, namely the root of sulphurwort (πευκέδανον), which is to be applied to the head if the katochai increase in intensity. The only substance which has to be replaced if this substitution is followed is tufted thyme, while both the oil and vinegar remain the same. Sulphurwort is warming according to Aetius’ first book632 and, according to Dioscorides, it is beneficial for those who suffer from lethargia when applied with vinegar and, in general, is suitable for diseases in which the nerves are involved.633 The same notion is found in Galen.634 For a closer look at the way the application of embrocations is dealt with here, see also p. 230 f., commentary on p. 130.8–10. p. 130.8: ἀγαθὸν – ἔλαιον: The phrase ἐπ’ αὐτῶν refers to those in whom the katochai have increased in intensity. According to Aetius’ first book iris oil (ἴρινον ἔλαιον) has a warming capacity and is useful for parts which have been cooled.635 p. 130.8–10: τρόμων δὲ – ἐμβρέχομεν: The author arranges the information concerning the embrocations of the head (p. 130.5–10) in sequence of ascending seriousness, beginning with the general advice to apply them, continuing with the embrocations which have to be used in increasing katochai and ending with those which should be administered to patients who are, in addition, afflicted with trembling and convulsions. The occurrence of convulsions has been mentioned earlier in the chapter, see p. 210 f., commentary on p. 128.18–19. The occurrence of trembling 632 633 634 635

See Aetius Amid., Libri med. 1.320 (Vol. 1, 121.7 Olivieri). See Dioscorides, De mat. med. 3.78.2 (Vol. 2, 91.10–13 Wellmann). See Galen, De simpl. med. temp. et fac. 8.16 (12.99.17 f. K.). See Aetius Amid., Libri med. 1.130 (Vol. 1, 65.2 Olivieri).

VI 3 On lethargia from (the books of) Archigenes and Posidonius |

231

in lethargia is also discussed in, for example, the Anonymus Parisinus, Aretaeus, Caelius Aurelianus, and Paul.636 In Aretaeus and Paul we also find the recommendation that castoreum should be applied in such cases.637 For further discussion of the properties of castoreum see p. 223, commentary on p. 129.18–19. The advice to apply embrocations of castoreum to the head is also given in Paul and the Anonymus Parisinus.638 p. 130.10–12: εἰ δὲ – ἀμπέλου: The hypochondrion has been mentioned previously in the chapter, where it was said to be pulled up in patients suffering from lethargia (p. 129.7; see p. 217 f., commentary on p. 129.7), and the present mention of the hypochondrion being inflamed is probably meant to add to this. The inflammation of the hypochondrion may also be an example of the affection of the internal organs (σπλάγχνα), referred to at the very beginning of the chapter as being a possible cause of lethargia occurring due to co-affection (p. 128.7–8; see p. 202 f., commentary on p. 128.6–9). Aretaeus also discusses the inflammation of the hypochondria in patients suffering from lethargia and likewise recommends the application of poultices in this case.639 Paul states that one should apply embrocations and poultices (καταπλάσματα) if there is an inflammation around the middle parts.640 The same recommendation is made in Caelius Aurelianus’ account of lethargia.641 The application of poultices (καταπλάσσειν; the cognate noun is καταπλάσματα) is frequently recommended in ancient medical literature and was a common therapy for various affections (including inflammations).642 Aetius devotes various chapters in his compilation to poultices.643 In one passage he states that they are appropriate for curing inflammations644 and in another puts forward the notion that they are capable of warming the hypochondria.645 The poultices are obviously wrapped around the bodily parts to be treated, as becomes clear from the subsequent statement that a lint (ῥάκος) has to surround (περιλαμβάνειν) the relevant parts (p. 130.15–16; see p. 233, commentary on p. 130.15–16). The author distinguishes between the poultices which should be applied in the beginning (ἐν ἀρχαῖς), those to be applied when

636 See Anon. Par. 2.2.6 (12.14 Garofalo), Aretaeus 5.2.6 (99.20 f. Hude), Aretaeus 5.2.10 (100.15 Hude), Caelius Aurel., Cel. pass. 2.15 (138.24 Bendz), Paul 3.9.3 (Vol. 1, 148.11 f. Heiberg). 637 See Aretaeus 5.2.10 (100.15 Hude), Paul 3.9.3 (Vol. 1, 148.11 f. Heiberg). 638 See Anon. Par. 2.3.1 (12.22–14.3 Garofalo), Paul 3.9.3 (Vol. 1, 147.28 f. Heiberg). 639 See Aretaeus 5.2.6 (99.22–25 Hude). 640 See Paul 3.9.3 (Vol. 1, 148.23–25 Heiberg). 641 See Caelius Aurel., Cel. pass. 2.30 (146.32 f. Bendz): at si media tumeant, simili curatione cucurbitae atque cataplasmatum utemur, tamquam in phreniticis ordinavimus. 642 See e.g. Hippocrates, De cap. vuln. 14.8 (80.20 f. Hanson = 3.236.3 L.), Dioscorides, De mat. med. 1.43.4 (Vol. 1, 43.11 f. Wellmann), Galen, De loc. aff. 3.3 (8.142.3 f. K.). 643 See e.g. Aetius Amid., Libri med. 3.175–179 (Vol. 1, 346.13–351.2 Olivieri), Libri med. 7.98 (Vol. 2, 342.12–343.12 Olivieri), Libri med. 8.7 (Vol. 2, 410.23–412.16 Olivieri). 644 See Aetius Amid., Libri med. 9.15 (304.30 Zervos). 645 See Aetius Amid., Libri med. 3.175 (Vol. 1, 346.23 Olivieri).

232 | Commentary

some time has passed (p. 130.12: προελθόντων), and those to be applied even later (p. 130.13: ὕστερον). See also p. 232 f., commentary on p. 130.12–15. As regards the composition of the poultice, fine meal (γῦρις) and bread (ἄρτος) are identified as suitable ingredients in other passages of Aetius’ compilation.646 According to Dioscorides’ De materia medica, fine meal of wheat is said to cure all inflammations when cooked with honey-water.647 Bread is also said to relieve all inflammations when cooked with honey-water or even when raw, since it is very softening and cools gently.648 Quinces (μηλᾶ κυδώνια) are said to promote digestion (πεπτικόν) in several passages of Aetius649 and regarded as good for the stomach (εὐστόμαχον, χρήσιμον κοιλιακοῖς) by Dioscorides.650 The tendrils of vine (ἕλικες ἀμπέλου) are said by Dioscorides to soothe inflammations of the stomach, amongst other things, when applied as a poultice.651 p. 130.12–15: προελθόντων – προσπλέκειν: The phrase προελθόντων obviously refers to the time which has passed. In other texts the phrase προελθόντος δὲ τοῦ χρόνου is used to express the same idea.652 The assumption that προελθόντων refers to time in the present context is based on the fact that it appears together with the phrases ἐν ἀρχαῖς (p. 130.11) and ὕστερον, which both denote time. See on this issue also p. 231 f., commentary on p. 130.10–12. According to Aetius’ first book, linseed (λινόσπερμον) which is recommended to be added to the fine meal and bread, causes flatulence when eaten and is bad for the stomach and difficult to digest.653 These properties are all associated with the swallowing of linseed. According to Dioscorides, linseed removes and softens every inflammation, both internal and external.654 Wormwood (ἀψίνθιον) is applied as a poultice to chronically suffering hypochondria, according to Dioscorides.655 The Greek noun ἀλθαία (marsh mallow) is synonymous to ἐβίσκος, according to Aetius’ first book, and is characterized as relieving inflammations (ἀφλέγμαντος).656 Meal made from barley (κρίθινον ἄλευρον) relieves inflammations, according to Dioscori-

646 Aetius Amid., Libri med. 7.98 (Vol. 2, 343.5 f. Olivieri), Libri med. 12.33 (59.24 Kostomiris). 647 See Dioscorides, De mat. med. 2.85.2 (Vol. 1, 169.20 f. Wellmann). 648 See Dioscorides, De mat. med. 2.85.3 (Vol. 1, 169.21–23 Wellmann). 649 See e.g. Aetius Amid., Libri med. 9.24 (321.13–16 Zervos), Libri med. 3.91 (Vol. 1, 294.19 f. Olivieri). 650 See Dioscorides, De mat. med. 1.115.1 (Vol. 1, 107.10 f. Wellmann). 651 See Dioscorides, De mat. med. 5.1 (Vol. 3, 1.12–15 Wellmann). 652 See e.g. Galen, De temp. 2.6 (83.12–13 Helmreich = 1.641.16 K.), Paul 4.5.2 (Vol. 1, 326.25 Heiberg). 653 See Aetius Amid., Libri med. 1.257 (Vol. 1, 105.6–10 Olivieri). 654 See Dioscorides, De mat. med. 2.103 (Vol. 1, 177.5–7 Wellmann). 655 See Dioscorides, De mat. med. 3.23.3 (Vol. 2, 31.13 f. Wellmann). 656 See Aetius Amid., Libri med. 1.96 (Vol. 1, 53.4 f. Olivieri).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

233

des,657 and fenugreek (τῆλις) is said to relieve less warm and hard inflammations, according to Aetius’ first book.658 p. 130.15–16: ἔστω – μασθούς: For a discussion of these recommendations see p. 231 f., commentary on p. 130.10–12. The noun ῤάκος clearly describes the actual material which is applied as a poultice and wrapped around the body.659 The description of the way the rag should be wrapped around the body corresponds to the area where the hypochondrion is thought to be located (see on this issue p. 217 f., commentary on p. 129.7), which needs to be cured of the inflammation. p. 130.16–18: μετὰ δὲ – αὐτά: The recommendation that salves be applied after the use of a poultice is also found in other passages.660 Indeed, it is even reflected in the tenth chapter of Aetius’ sixth book (see p. 479 f., commentary on p. 149.11–13). There are a few more passages in which the application of a salve made of nard or henna is recommended.661 According to Aetius’ first book, henna is capable of curing inflammations.662 Both adjectives (νάρδινον and κύπρινον) are mentioned in the same context and in close connection in some other passages as well, which supports the assumption that both have similar properties or a similar effect.663 In a passage of De materia medica, Dioscorides advises the use of a poultice made of wormwood pounded together with a salve made of henna in cases where the patient has an unhealthy hypochondrion.664 p. 130.18–20: ὄπισθεν δὲ – ἐμπεπασμένων: The noun μετάφρενον describes a person’s back.665 One has to understand ἐλαίου with the adjective Σικυωνίου: the term Σικυώνιον ἔλαιον is very often used in ancient medical literature and mentioned as an ingredient in various remedies.666 In Aetius’ first book we find a description of its production.667 According to Dioscorides, it has heating properties (δύναμις θερμαντική) and is suitable for curing fevers and diseases that affect the

657 See Dioscorides, De mat. med. 2.86.2 (Vol. 1, 170.13–15 Wellmann). 658 See Aetius Amid., Libri med. 1.390 (Vol. 1, 140.5–8 Olivieri). 659 See also Oribasius, Coll. med. rel. 9.28.7 (Vol. 2, 30.32–31.1 Raeder) for this understanding of ῤάκος. 660 See e.g. Galen, Meth. med. 13.15 (374.13–15 Johnston & Horsley = 10.912.1–3 K.), Aetius Amid., Libri med. 11.26 (110.8–10 Daremberg & Ruelle), Aetius Amid., Libri med. 8.49 (Vol. 2, 474.15–17 Olivieri). 661 See e.g. Paul 3.64.2 (Vol. 1, 280.27 f. Heiberg), Aetius Amid., Libri med. 8.49 (Vol. 2, 474.15–17 Olivieri). 662 See Aetius Amid., Libri med. 1.238 (Vol. 1, 100.20 Olivieri). 663 See e.g. Paul 3.78.15 (Vol. 1, 304.8 f. Heiberg), Paul 3.64.2 (Vol. 1, 280.27 f. Heiberg), Paul 3.49.2 (Vol. 1, 259.31 Heiberg), Alexander, Therapeutica 12 (Vol. 2, 531.19 Puschmann). 664 See Dioscorides, De mat. med. 3.23.3 (Vol. 2, 31.13–15 Wellmann). 665 See e.g. Aetius Amid., Libri med. 11.16 (99.3 Daremberg & Ruelle), Libri med. 15.15 (96.11 f. Zervos). 666 See e.g. Dioscorides, De mat. med. 1.30.5 (Vol. 1, 35.17–26 Wellmann), Galen, Meth. med. 12.3 (242.7 Johnston & Horsley = 10.822.11 K.), Oribasius, Eclog. med. 72.1 (233.19 Raeder). 667 See Aetius Amid., Libri med. 1.124 (Vol. 1, 62.24–63.2 Olivieri).

234 | Commentary

νεῦρα.668 The application of Sicyonian oil for lethargia is also recommended in the Anonymus Parisinus, Aretaeus, Alexander, and Paul: the Anonymus Parisinus and Paul recommend its application as an embrocation to the lower belly;669 Aretaeus mentions it three times in his chapter on the therapy of lethargia and in one of these occurrences it is recommended that it be applied to the spine;670 and Alexander recommends anointing the limbs with it.671 The adjective τερεβίνθινος is related to the noun τερέβινθος (terebinth) and obviously refers to the resin which is extracted from this tree.672 According to Aetius’ first book, the terebinth is slightly warming and drying.673 The bayberries (δαφνίδες) are the fruits of the bay tree (δάφνη),674 which, according to Aetius’ first book, are strongly warming and drying.675 p. 130.20–22: καὶ εἰ – ὅμοια: For further information on the verb συνεδρεύειν, see p. 217, commentary on p. 129.6–7. The concept underlying the noun ἐμπνευμάτωσις is explained as starting from nourishment which is poorly digested and as occurring when superfluities residing in the body are neither expelled through the mouth (i.e. through belching) nor through the anus (i.e. through noisy or noiseless flatus).676 The occurrence of flatulence (as well as the previously mentioned inflammation of the hypochondrion) may also be an example of the affection of the internal organs (σπλάγχνα), referred to at the very beginning of the chapter as being a possible origin of lethargia that occurs due to co-affection (p. 128.7–8; see p. 202 f., commentary on p. 128.6–9). The occurrence of flatus in lethargia is also mentioned by Aretaeus.677 He recommends, amongst other treatments, the application of cumin in this case.678 The phrase προσπλέκειν τοῖς καταπλάσμασι refers back to the previous lines (p. 130.10–20) where the author deals with the poultices which should be used when the hypochondrion is inflamed. If flatulence occurs one should add further substances to the poultices, namely those which do not cause flatulences (τὰ

668 See Dioscorides, De mat. med. 1.30.5 (Vol. 1, 35.24 f. Wellmann). 669 See Anon. Par. 2.3.5 (14.19–16.2 Garofalo), Paul 3.9.3 (Vol. 1, 148.20 Heiberg). 670 See Aretaeus 5.2.5 (99.16 Hude). See also Aretaeus 5.2.6 (99.21 Hude), 5.2.14 (101.16 Hude). 671 See Alexander, Therapeutica 1.14 (636.16 f. Guardasole = Vol. 1, 531.7–9 Puschmann). 672 See e.g. Diocles fr. 154.20 van der Eijk, Dioscorides, De mat. med. 1.71.2 (Vol. 1, 68.5 f. Wellmann), Soranus, Gyn. 3.14.3 (103.8 f. Ilberg), Aetius Amid., Libri med. 2.223 (Vol. 1, 232.21 Olivieri). 673 See Aetius Amid., Libri med. 1.386 (Vol. 1, 138.24–27 Olivieri). These properties of terebinth are reflected elsewhere. See e.g. Dioscorides, De mat. med. 1.71.2 (Vol. 1, 68.8 Wellmann), Paul 7.3 (Vol. 2, 265.16 Heiberg), Galen, De comp. med. per gen. 2.2 (13.474.18–475.3 K.). 674 See e.g. explicitly Dioscorides, De mat. med. 1.78.2 (Vol. 1, 78.12 Wellmann). 675 See Aetius Amid., Libri med. 1.89 (Vol. 1, 51.16 f. Olivieri). See e.g. also Dioscorides, De mat. med. 1.78.2 (Vol. 1, 78.12 Wellmann). 676 See Aetius Amid., Libri med. 9.27 (329.5–25 Zervos). See also Galen, De sympt. caus. 3.6 (7.240.14–241.1. K.) where Aetius cites from. 677 See Aretaeus 5.2.4 (99.9 Hude), 5.2.6 (99.23 Hude), 5.2.8 (100.4 Hude), 5.2.8 (100.9 Hude), 5.2.9 (100.11 Hude), 5.2.9 (100.14 Hude), 5.2.15 (101.29 Hude). 678 See Aretaeus 5.2.4 (99.9 Hude).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

235

ἄφυσα). The examples given, namely cumin (κύμινον),679 bayberries (δαφνίδες),680 and rue (πήγανον),681 are also said to suppress flatulence in other texts. p. 130.22–23: εἰ δὲ – ἄλευρον: Given that the phrase εἰ δὲ σκληρῶδές τι ὑποπίπτει appears in the context of, and as contrast to, the previously mentioned occurrence of flatulence (εἰ μὲν ἐμπνευμάτωσις συνεδρεύοι), the adjective σκληρῶδες presumably describes the hardening of the stomach, the digestive tract, or the stool. Derivatives of σκληρῶδες (e.g. the adjective σκληρός or the noun σκληρότης) are often used in medical literature to describe hard stool situated in the intestine, which causes a hardening of the intestine and often cannot be excreted.682 According to Aetius’ first book, rosemary (λιβανωτίς) has a cleansing capacity683 and beans (κύαμοι) are applied to, for example, those who suffer around the stomach (κοιλιακοί).684 The phrase κυάμινον ἄλευρον is commonly used in medical texts.685 p. 130.23–24: ἐπὶ δὲ – ὑποκειμένης: The verb χρονίζειν is not used here in the technical sense of “being chronic” (see on this issue p. 203 f., commentary on p. 128.9–10), but, rather, simply to indicate that the patients have been suffering for a long time. The phrase ἐπὶ δὲ τῶν ἤδη χρονιζόντων ληθαργικῶν emphasizes the fact that the patients who are dealt with in the following lines are still suffering despite the application of all previously recommended approaches. This interpretation is supported by the therapeutical information that follows, which is, to some extent, quite similar to that which is found earlier in the chapter. While the present passage uses the phrase πταρμικὰ προσάγειν ταῖς ῥισὶ, the phrase προσάγειν δὲ ταῖς ῥισὶ καὶ τὰ πταρμικά (p. 129.22) has been used in an earlier paragraph. The recommended substances are modified in the present passage. Paul uses a similar phrase (i.e. ἐπιμένοντος δὲ τοῦ πάθους) in his chapter on lethargia to introduce therapeutical recommendations for those who have already been suffering for a long time.686 In Methodus medendi Galen is concerned with a similar issue: in the context of curing deep sleep, after stating that one has to use sternutatories he adds that one should increase the intensity of the remedies in case the affection lasts (χρονίζειν).687

679 See e.g. Aetius Amid., Libri med. 1.235 (Vol. 1, 99.13 Olivieri), Galen, Meth. med. 8.5 (418.1–3 Johnston & Horsley = 10.578.1 f. K.), Paul 7.3. (Vol. 2, 232.26 f. Heiberg), Oribasius, Ad Eunap. 2.1. K 97 (369.2 f. Raeder). 680 See e.g. Pseudo-Galen, De remed. parab. 3 (14.521.13 K.), Aetius Amid., Libri med. 9.32 (351.29– 32 Zervos). 681 See e.g. Aetius Amid., Libri med. 1.321 (Vol. 1, 121.20 Olivieri), Galen, De simpl. med. temp. et fac. 8.16 (12.101.3 f. K.). 682 See e.g. Galen, De sympt. caus. 3.2 (7.220.14–16 K.), Alexander, Therapeutica 8.2 (Vol. 2, 361.28– 30 Puschmann), Oribasius, Coll. med. rel. 7.24.1 (Vol. 1, 226.21–23 Raeder). 683 See Aetius Amid., Libri med. 1.254 (Vol. 1, 104.17 Olivieri). 684 See Aetius Amid., Libri med. 1.233 (Vol. 1, 97.21–26 Olivieri). 685 See e.g. Dioscorides, De mat. med. 5.3.3 (Vol. 3, 3.16 Wellmann), Galen, Meth. med. 3.3 (272.21 f. Johnston & Horsley = 10.178.1 K.), Aetius Amid., Libri med. 7.36 (Vol. 2, 287.22 Olivieri). 686 See Paul 3.9.3 (Vol. 1, 148.14 Heiberg). 687 See Galen, Meth. med. 13.21 (404.13–17 Johnston & Horsley = 10.931.14–18 K.).

236 | Commentary

The genitive absolute δυνάμεως ὑποκειμένης highlights the fact that the subsequent therapeutical advice is only to be followed if the strength of the patient is sufficient. On the common notion that the physician has to consider the patient’s strength and bodily condition, see further p. 225, commentary on 129.23–24. p. 130.24–26: διδόναι – καστορίου: The holy remedy made from colocynth (ἡ διὰ κολοκυνθίδος ἱερά) is frequently referred to in ancient medical literature.688 For more on the holy remedy, see p. 324 f., commentary on p. 135.16. For a closer discussion of the phrase πταρμικὰ προσάγειν ταῖς ῥισὶ, which is used earlier in the chapter, see p. 224 f., commentary on p. 129.22–23 and p. 235, commentary on p. 130.23–24. The white hellebore (ἑλλέβορος λευκός) cleanses and warms, according to Aetius’ first book;689 soapwort (στρούθιον) is also said to be cleansing and to cause sneezing;690 pepper (πέπερι) is referred to as warming and drying.691 For the properties of castoreum, see p. 223, commentary on p. 129.18–19. Soapwort, pepper and castoreum are all recommended in Alexander’s chapter on lethargia and listed as appropriate sternutatories.692 Pepper, hellebore and soapwort are listed as suitable sternutatories in Aretaeus’ chapter on lethargia.693 p. 130.26–27: καὶ ταῖς – ἐμφυσᾶν: The verbs ἐγχεῖν and ἐμφυσᾶν are frequently used in medical literature in connection with the nose: while the former seems to refer to pouring liquid substances into the nose, the latter clearly refers to the application of dry substances into the nose.694 Pouring elaterion (ἐλατήριον) with milk into the nose is commonly recommended and often said to cure headaches.695 According to Aetius’ first book, elaterion is the juice of squirting cucumber (σικὺς ἄγριος).696 Cyclamen (κυκλάμινος) is likewise said to be applied through the nose and to purge the head of thick humors and to cure headaches in this way.697 The phrase αὐτὴν τὴν ῥίζαν still refers to cyclamen and deals with the possibility of 688 See e.g. Galen, De comp. med. sec. loc. 1.2 (12.382.18 K.), Paul 3.13.2 (Vol. 1, 154.15 Heiberg), Aetius Amid., Libri med. 8.73 (Vol. 2, 538.20 f. Olivieri). 689 See Aetius Amid., Libri med. 1.140 (Vol. 1, 70.14 f. Olivieri). In, for example, Alexander, The rapeutica 3.6 (Vol. 2, 103.1–3 Puschmann) it is listed as a remedy wich causes sneezing. For further discussion on hellebore as a remedy commonly used in the context of mental affections, see Thumiger 2017a, 221 note 106. 690 See Aetius Amid., Libri med. 1.377 (Vol. 1, 134.25–27 Olivieri). The same notion is e.g. also reflected in Dioscorides, De mat. med. 2.163 (Vol. 1, 228.6 f. Wellmann). 691 See Aetius Amid., Libri med. 1.316 (Vol. 1, 120.2 f. Olivieri). 692 See Alexander, Therapeutica 1.14 (636.11–14 Guardasole = Vol. 1, 531.3–5 Puschmann). According to Dioscorides the soapwort is an appropriate remedy to cause sneezing (see Dioscorides, De mat. med. 2.163 (Vol. 1, 228.6 f. Wellmann)). 693 See Aretaeus 5.2.11 (100.26 f. Hude). 694 See e.g. Paul 3.5.1 (Vol. 1, 141.21 f. Heiberg), Aetius Amid., Libri med. 6.52 (Vol. 2, 195.12 f. Olivieri), Libri med. 6.85 (Vol. 2, 230.22 Olivieri). 695 See e.g. Aetius Amid., Libri med. 1.360 (Vol. 1, 131.20–22 Olivieri), Dioscorides, De mat. med. 4.150.7 (Vol. 2, 296.8–12 Wellmann), Paul 3.5.1 (Vol. 1, 141.20–22 Heiberg). 696 See Aetius Amid., Libri med. 1.360 (Vol. 1, 131.14 f. Olivieri). 697 See Aetius Amid., Libri med. 1.234 (Vol. 1, 99.9–11 Olivieri).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

237

applying the root of cyclamen into the nose instead of pouring in its juice. The fact that the substances are often said to cure conditions of the head (headaches or thick humors residing in the head) fits the present context insofar as lethargia is said to be localized in the brain (see on this issue in general p. 203, commentary on p. 128.6–9, but also p. 224 f., commentary on p. 129.22–23). The verb ἐμφυσᾶν is also used in the accounts of lethargia given by Alexander and Aretaeus.698 p. 131.1: καὶ διαχρίειν – μέλιτος: The recommendation that the mouth be smeared is also found in the accounts of lethargia given by the Anonymus Parisinus, Aretaeus and Paul. Indeed, Paul even makes use of the same words, στόμα and οὐρανίσκος, and identifies the same substances to be smeared on, namely mustard and honey.699 The Anonymus Parisinus closely links the instruction to smear the mouth with the direction to remove phlegm which is already there (παρακεῖσθαι) or which is about to enter (ἐπιφέρειν): the smearing of the mouth seems to be one way of removing this phlegm.700 A similar notion is reflected in Aretaeus’ chapter on lethargia: he states that one has to purge phlegm through the mouth in cases where the patient feels a heaviness of the head or hears ringing in the ears. In this case one should give mustard, in particular, since it is more capable of purging phlegm than are other remedies.701 Mustard is commonly characterized as having the capacity to purge phlegm in other passages as well.702 Since it is noted earlier in the text that patients suffering from lethargia often have a great amount of phlegm (see p. 225 f., commentary on p. 129.24–26), it is possible that the present instructions are intended to combat this issue. Celsus mentions that one should hold mustard under the patient’s mouth or apply mustard to the head or the forehead.703 According to the pseudo-Galenic Definitiones medicae, the noun οὐρανίσκος denotes the upper part of the mouth, which has its name from the similarity to the sky.704 p. 131.1–4: ἔπειτα – κεφαλῆς: For more on cupping, see p. 191 – 193, commentary on p. 127.27–128.1. The phrase μετὰ φλογὸς πλείονος clearly refers to the fact that cupping works by the creation of a vacuum which can be produced through heating the air.705 The application of cupping instruments to the rear of the head in patients suffering from lethargia is also recommended in Aretaeus,706 the Anonymus

698 See Alexander, Therapeutica 1.14 (636.14 Guardasole = Vol. 1, 531.5 Puschmann), Aretaeus 5.2.11 (100.23 Hude). 699 See Paul 3.9.3 (Vol. 1, 148.6–8 Heiberg). 700 See Anon. Par. 2.3.2 (14.8–10 Garofalo). 701 See Aretaeus 5.2.15 (101.23–27 Hude). 702 See e.g. Dioscorides, De mat. med. 2.154.1 (Vol. 1, 220.7 f. Wellmann), Galen, De comp. med. sec. loc. 2.2 (12.565.16 f. K.). 703 See Celsus, De med. 3.20.4 (129.26–130.1 Marx). 704 See Pseudo-Galen, Def. med. 88 (19.368.15 f. K.): Οὐρανίσκος ἐστὶ τὸ ἀνώτερον μέρος τοῦ στόματος ἐκ τῆς πρὸς οὐρανὸν ὁμοιότητος τὸ ὄνομα λαμβάνων. 705 See Leven 2005b. 706 See Aretaeus 5.2.7 (100.1–3 Hude).

238 | Commentary

Parisinus,707 and Paul,708 the latter of whom even uses the phrase μετὰ πολλῆς φλογός. The instruction to cup the first and the second vertebra in addition to the back of the head may be explained by the fact that they are close to the head.709 p. 131.4–5: εἶτα – βεβρεγμένου: According to Aetius’ third book, the application of a poultice of mustard is commonly called σιναπισμός and was considered to be a very drastic remedy.710 It is also stated that a mustard plaster is an especially good treatment for the head in cases of headaches, skotoma, epilepsia, and mania.711 As discussed above, mustard is characterized as having the capacity to purge phlegm (see p. 237, commentary on p. 131.1) and it is also regarded as being warming,712 which may assist in minimizing the coldness which contributes to deep sleep (see p. 189 f., commentary on p. 127.20–23). Paul also recommends the application of sinapismoi in his chapter on lethargia.713 The advice to shave the head before applying the mustard plaster makes it clear that, in his view as well, it should be applied to the head. Dioscorides likewise recommends applying a poultice made of mustard to the shaved head of patients suffering from lethargia.714 The possibility of adding dried figs (ἰσχάδες) to the mustard plaster is also mentioned in Aetius’ chapter on the topic, where it is stated that one should combine two portions of mustard with one portion of dried figs in order to intensify the application.715 p. 131.5–6: ἐπὶ δὲ – Γʹϲ: Trembling patients have already been dealt with on p. 130.8–9 (see p. 230 f., commentary on p. 130.8–10). The use of castoreum was recommended there, although rather than an oral application the suggestion was that it be smeared on the head. The text offers precise measurements here. For an explanation of the symbols used in those recipes see Hultsch 1864.716 p. 131.6–9: παρακμάσαντος – ἐμβαλλέσθω: The verb παρακμάζειν is related to the noun παρακμή which describes “the beginning of the abatement of some or all of the symptoms” of an affection according to Aetius’ fifth book.717 The notion that those who suffer from lethargia should be bathed after the abatement is very common and found in other texts as well. Paul uses the same genitive absolute (παρακμάσαντος δὲ τοῦ πάθους) in this context and recommends taking the patient to the bath and applying an appropriate restorative treatment.718 The Anonymus Parisinus 707 See Anon. Par. 2.3.6 (16.8 f. Garofalo). 708 See Paul 3.9.3 (Vol. 1, 148.17 f. Heiberg). 709 See e.g. Galen, De anat. admin. 4.7 (Vol. 1, 247.24–27 Garofalo = 2.455.6–10 K.). 710 See Aetius Amid., Libri med. 3.181 (Vol. 1, 352.9 f. Olivieri). 711 See Aetius Amid., Libri med. 3.181 (Vol. 1, 352.23 f. Olivieri). 712 See e.g. Aetius Amid., Libri med. 1.292 (Vol. 1, 114.1 Olivieri), Galen, De loc. aff. 3.5 (8.153.1–3 K.). 713 See Paul 3.9.3 (Vol. 1, 148.16 Heiberg). 714 See Dioscorides, De mat. med. 2.154.2 (Vol. 1, 220.12 f. Wellmann). 715 See Aetius Amid., Libri med. 3.181 (Vol. 1, 353.7 f. Olivieri). 716 I am grateful to Matteo Martelli for helping me with measurements in ancient medical texts. 717 See Aetius Amid., Libri med. 5.14 (Vol. 2, 12.5 f. Olivieri): παρακμὴ δέ ἐστιν ἀρχομένων μειοῦσθαί τινων ἢ πάντων τῶν εἰρημένων συμπτωμάτων. 718 See Paul 3.9.3 (Vol. 1, 148.32 f. Heiberg).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

|

239

states that one should take the patient to the bath and apply the restorative treatment after the end of the καταφορά and after the fever has abated.719 Caelius says that the patient should be taken to the bath when the disease is very certainly declining (in declinatione vero certissima).720 Alexander deals in detail with bathing patients suffering from lethargia: he claims that patients should only use the public bath if their strength (δύναμις) allows it, otherwise they have to bath at home. He furthermore states that the superfluities which are located on the skin are dispersed by the moderate heat of the bath.721 Aretaeus also recommends taking the patient to the bath at the end of his chapter.722 The use of soaps (σμήγματα) in the bath is also recommended in other passages of Aetius’ compilation and they are often said to be applied to the head.723 As far as the examples of biting soap given in the following lines are concerned (οἷόν ἐστι …), I suggest changing τρυγή into τρύξ, which is transmitted by the Codex Parisinus Suppl. gr. 1240 (Pa) and the Codex Vaticanus Palatinus 199 (Px).724 There is much evidence that wine lees (τρύγες) were burned725 and used as a remedy. The burned lees are said to have burning and purging properties726 and pellitory (πύρεθρον) is likewise said to have burning properties,727 as is unslaked lime (ἄσβεστος [scil. τίτανος]).728 For the properties of mustard (νᾶπυ), bayberries (δαφνίδες) and sodium carbonate (νίτρον), see p. 237, commentary on p. 131.1; p. 234, commentary on p. 130.18–20; and p. 229, commentary on p. 130.3–4. p. 131.9–11: τροφαὶ – δαφνίδων: The phrase τροφαὶ δὲ ἔστωσαν marks out clearly that the following lines will deal with the appropriate foodstuff. For further discussion of the use of such announcing phrases throughout Aetius’ sixth book, see p. 212, commentary on p. 128.22. The three adjectives λεπτομερές, τμητικόν and ξηραντικόν characterize the appropriate food before any examples are provided. The adjective λεπτομερές thereby describes the consistency of the food, but this consistency obviously correlates to its properties: according to Galen’s De alimentorum facultatibus food which is fine in its substance (λεπτομερῆ) thins thick and viscous humors (λεπτύνει δ’ ἐσθιόμενα τοὺς παχεῖς καὶ κολλώδεις χυμούς).729 This assump719 See Anon. Par. 2.3.10 (18.5–7 Garofalo). 720 See Caelius Aurel., Cel. pass. 2.32 (148.16 f. Bendz). 721 See Alexander, Therapeutica 1.14 (638.15 f. Guardasole = Vol. 1, 533.5–15 Puschmann). 722 See Aretaeus 5.2.16 (102.8–11 Hude). 723 See e.g. Aetius Amid., Libri med. 6.54 (Vol. 2, 197.16 Olivieri), Libri med. 7.6 (Vol. 2, 258.26 Olivieri), Libri med. 7.6 (Vol. 2, 259.2 Olivieri). 724 See Olivieri’s critical apparatus to p. 131.8. 725 See e.g. Dioscorides, De mat. med. 5.114.1 (Vol. 3, 84.20 Wellmann), Galen, De comp. med. sec. loc. 1.9 (12.479.3 K.), Paul 3.29.1 (Vol. 1, 210.16 Heiberg). 726 See Dioscorides, De mat. med. 5.114.2 (Vol. 3, 85.7 Wellmann): δύναμιν δὲ ἔχει καυστικὴν σφόδρα καὶ σμηκτικήν. 727 See Aetius Amid., Libri med. 1.337 (Vol. 1, 126.9 f. Olivieri). 728 See e.g. Aetius Amid., Libri med. 2.75 (Vol. 1, 176.14 Olivieri). 729 See Galen, De alim. fac. 3.40a (251.23 f. Wilkins = 6.747.5 f. K.).

240 | Commentary

tion might explain why the fine substance of the food is mentioned together with its cutting and drying properties: all three characteristics would then refer back to p. 129.24–26 where it was stated that phlegm and moisture are abundant in those suffering from lethargia and that one should apply substances which are able to thin and to cut the thickness of the phlegm. For a closer look at this passage, see p. 226, commentary on p. 129.26. The food being characterized as fine (and thus probably also thinning, if we follow the assumption put forward in Galen) and as having cutting and drying properties is thus thought to counteract the abundance of phlegm and moisture and to support the thinning and cutting of thick humors, as mentioned previously. In Alexander’s chapter on lethargia it is likewise stated that the foodstuff should also contribute to the thinning.730 The notion that the food should be thinning is also expressed in Aretaeus.731 For a discussion of the properties of celery, cumin, pepper, and bayberries see p. 227 f., commentary on p. 130.1–3; p. 229, commentary on p. 130.3–4; p. 236, commentary on p. 130.24–26; and p. 234, commentary on p. 130.18–20. Dill (ἄνηθον) has warming properties, according to Aetius’ first book.732 The application of celery is also recommended in the chapters on lethargia by Alexander and Aretaeus as a suitable treatment for patients suffering from lethargia.733 p. 131.11–14: καὶ πτηνῶν – ὑποστύφων: This passage is divided into different sections dealing with the poultry (πτηνῶν μὲν), fish (ἰχθύων δὲ), vegetables (λαχάνων), and wine (οἶνος) that is suitable for patients suffering from lethargia. The text here is rather precise and detailed. The domestic bird (ὄρνις κατοικίδιος) and the pigeon (περιστερά) are also mentioned as food in other texts in the context of appropriate foodstuffs for a number of affections734 and the partridge (πέρδιξ) is even referred to in Galen’s De victu attenuante as suitable for the thinning diet.735 As far as the birds of the mountains (τῶν στρουθίων οἱ ὄρειοι) and the fish living among the rocks (ἰχθύων οἱ πετραῖοι) are concerned, these are also mentioned in De victu attenuante where they are said to be most useful for the thinning diet.736 Leeks (πράσα) are likewise referred to as having an especially thinning effect,737 and asparagus (ἀσπάραγος) and periwinkle (χαμαιδάφνη) are ranked among thinning vegetables as

730 See Alexander, Therapeutica 1.14 (638.3 f. Guardasole = Vol. 1, 531.21 f. Puschmann). 731 See Aretaeus 5.2.4 (99.3 f. Hude). 732 See Aetius Amid., Libri med. 1.37 (Vol. 1, 39.19 Olivieri). 733 See Alexander, Therapeutica 1.14 (638.7–9 Guardasole = Vol. 1, 531.24–26 Puschmann), Aretaeus 5.2.4 (99.7 Hude). 734 See e.g. Soranus, Gyn. 2.25.2 (72.15 Ilberg), Alexander, Therapeutica 8.2 (Vol. 2, 339.21 Puschmann), Paul 7.3 (Vol. 2, 229.2–5 Heiberg). 735 See Galen, De vict. att. 8.57 (441.29–32 Kalbfleisch). 736 See Galen, De vict. att. 8.55 (441.20–22 Kalbfleisch). 737 See Galen, De vict. att. 2.7 (434.15 f. Kalbfleisch). See also Aetius Amid., Libri med. 1.333 (Vol. 1, 125.13–15 Olivieri).

VI 3 On lethargia from (the books of) Archigenes and Posidonius

| 241

well.738 So is parsley (πετροσέλινον).739 As for the wine, in his De victu attenuante Galen states that thin and white wines (λεπτὸς καὶ λευκὸς) are capable of cutting thick humors.740 Those thin and white wines are commonly referred to as being watery (ὑδατώδης),741 just as in the present passage, which might also be the reason why the phrase οἶνος ὁ ὑδατώδης λεγόμενος is used in the present passage. The astringency (ὑποστύφων) of the wine is often mentioned in the context of its therapeutical use.742 For a detailed discussion of wine in ancient medical thought, see Jouanna 2012b. p. 131.14–15: καὶ ἡ – γιγνέσθω: When stating that the remaining treatment should be alike (ὁμοία) the author presumably refers back to p. 131.9–10 where the suitable food was characterized as being fine in its substance, cutting, and thinning. See also p. 239 f., commentary on p. 131.9–11. Everything else that the physician might undertake should serve the purpose of cutting and thinning the phlegm.

VI 4 On katalepsis from (the books of) Archigenes and Posidonius Introduction to the disease concept katoche/katalepsis The Greek nouns κατοχή and κατάληψις are used to convey the fact that the patients afflicted by the disease are thought to remain in the position they were in when they were seized by the affection, and that they are, thus, literally “held” (κατεχόμενοι).743 Various texts report that the ancients referred to the affection as κάτοχος or called the patients suffering from it κάτοχοι or κατεχόμενοι. Later physicians are said to have referred to it as κατοχή and κατάληψις.744 According to Caelius Aurelianus, Hippocrates and Diocles even referred to this affection as aphonia in reference to its principal symptom.745 Caelius’ report of the naming of the affection suggests that Asclepiades and his followers were the first to refer to it as catalepsis.746 A 738 See Galen, De vict. att. 4.23 (436.32–35 Kalbfleisch). 739 See Galen, De vict. att. 2.9 (434.27 Kalbfleisch). See also Aetius Amid., Libri med. 1.319 (Vol. 1, 121.3 Olivieri). 740 See Galen, De vict. att. 12.93 (447.30 f. Kalbfleisch). 741 See e.g. Galen, De san. tuenda 5.12.25 (167.6 f. Koch = 6.378.11–13 K.): οἶνον δώσομεν ὀλίγον καὶ ὑδατώδη· τοιοῦτος δ’ ἐστὶν ὁ λευκὸς μὲν τὴν χροιάν, λεπτὸς δὲ τὴν σύστασιν, Meth. med. 7.6 (276.18 f. Johnston & Horsley = 10.484.1 f. K.), Aetius Amid., Libri med. 5.97 (Vol. 2, 84.8 f. Olivieri). 742 See e.g. Dioscorides, De mat. med. 5.36.2 (Vol. 3, 26.1 f. Wellmann), Aetius Amid., Libri med. 7.33 (Vol. 2, 284.6 f. Olivieri), Anon. Par. 26.3.12 (146.14 Garofalo). 743 See e.g. Paul 3.10.1 (Vol. 1, 149.25–29 Heiberg). 744 See e.g. Galen, De loc. aff. 3.5 (8.156.15 f. K.), De caus. puls. 4.16 (9.189.5–7 K.), De puls. ad tir. 12 (8.485.9–11 K.), Paul 3.10.1 (Vol. 1, 149.25–29 Heiberg). 745 See Caelius Aurel., Cel. pass. 2.56 (164.20–22 Bendz), Diocles fr. 97.4 van der Eijk. 746 See Caelius Aurel., Cel. pass. 2.56 (164.25 f. Bendz), Cel. pass. 2.57 (166.5–8 Bendz). Asclepiades of Bithynia obviously lived around the end of the second and the beginning of the first century BCE: see e.g. Rawson 1982.

242 | Commentary

number of texts, including Aetius’ present chapter, also claim that katalepsis was thought to be similar to lethargia.747 Caelius emphasizes this connection in his report by stating that the ancients did discuss katalepsis but often treated it as identical to lethargia and thus also referred to it as lethargia.748 Although the terms κάτοχος, κατοχή, and κατάληψις are mentioned in various medical texts, there are only a few extant coherent accounts of the affection, one of which is found in the present chapter of Aetius’ compilation.749 Speechlessness or the inability to utter any sound are the symptoms which are most commonly connected to katalepsis,750 which is also the reason why Hippocrates and Diocles went so far as to refer to the affection as aphonia (see above note 745). The fact that katalepsis is often said to manifest itself in speechlessness seems to be connected to the general torpidity that affects the patients and that also gave the affection its name: the part of the body which is most frequently said to be affected by a torpidity is the area around the eyes: according to Caelius, Hippocrates said that the patients’ eyes do not move at all (oculorum statio sine ulla palpebratione),751 while his own account of the affection (in which Caelius probably cites and refers to Soranus)752 mentions a stiff and motionless gaze (oculorum stans atque fixus obtutus) as amongst the characteristic signs of katalepsis.753 In his De locis affectis Galen mentions open eyelids as symptoms of the affection,754 while in his In Hippocratis Prorrheticum I commentaria III he states that patients suffering from katalepsis have open eyes and do not blink.755 Paul, who also dedicates a chapter of his compilation to katochos, mentions in a similar manner that the patients’ upper eyelids are pulled up, protruding, and unable to blink.756 These are a few examples of the prominence given to the condition of the patients’ eyes in discussions of katalepsis, a prominence that is also reflected in the present chapter of Aetius’ compilation, which provides similar information about the eyes (see p. 131.21–132.2; p. 132.14–16). Many sources also highlight that the patients suffer from a lack of sensation, ἀναισθησία, 747 See e.g. Pseudo-Galen, Def. med. 241 (19.414.15 f. K.), Galen, De caus. puls. 4.16 (9.189.7 f. K.), De puls. ad tir. 12 (8.485.11 f. K.), Paul 3.10.1 (Vol. 1, 149.3–5 Heiberg). 748 See Caelius Aurel., Cel. pass. 2.57 (166.4–6 Bendz). 749 Caelius’ account is of course another example of a coherent and extremely detailed discussion of the affection (see Caelius Aurel., Cel. pass. 2.56–86 (164.15–184.27 Bendz)) as is Paul’s chapter (see Paul 3.10 (Vol. 1, 149.1–150.15 Heiberg)). 750 See e.g. Caelius Aurel., Cel. pass. 2.74 (176.7 f. Bendz), Hippocrates, Prorrh. 1.96 (87.7 f. Polack = 5.536.3 f. L.), Coac. 245 (162.6 Potter = 5.636.17 f. L.), Galen, In Hipp. Prorrh. comm. 2.55 (96.7 Diels = 16.684.13 f. K.). 751 See Caelius Aurel., Cel. pass. 2.59 (166.24 Bendz). 752 Soranus’ work on acute and chronic diseases is lost in the Greek original but extant in Caelius Aurelianus’ detailed Latin version: see Hedtkamp 1993, 1 and 11. See Caelius Aurel., Cel. pass. 2.65 (170.19 f. Bendz). 753 See Caelius Aurel., Cel. pass. 2.74 (176.9 Bendz). 754 See Galen, De loc. aff. 4.3 (8.232.14 f. K.). 755 See Galen, In Hipp. Prorrh. comm. 2.55 (96.6 f. Diels = 16.684.12f . K.). 756 See Paul 3.10.1 (Vol. 1, 149.5–9 Heiberg).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

|

243

as the author(s) of the present chapter put it (see p. 132.3), and several texts explicitly connect this lack of sensation either to the body, on the one hand, or to the soul and the mind, on the other, or to both. In Caelius’ account of katalepsis, for example, Asclepiades is credited with having talked about an affection which is similar to lethargia and comes along with torpidity of body and mind (cum corporis atque mentis oppresione),757 while in the pseudo-Galenic Definitiones medicae, katochos is defined as a lack of sensation of the soul (ἀναισθησία τῆς ψυχῆς).758 In his De symptomatum differentiis, Galen explicitly ranks katalepsis among the forms of damage to the leading capacity (τὰς τῶν ἡγεμονικῶν ἐνεργειῶν βλάβας), and more precisely among the forms of damage to the imaginative capacity (τῆς φανταστικῆς), thereby explaining that it consists in a paralysis of this capacity.759 Similar information is also found in De symptomatum causis.760 In these statements, Galen clearly acknowledges that katalepsis affects the leading capacities and thus the brain. The fact that the brain is affected in katalepsis is an important similarity it shares with phrenitis and lethargia, two affections to which it is often compared. The present chapter opens by introducing katalepsis as an affection which is “midway between phrenitis and lethargia” and “a form of derangement and mental disturbance” (see p. 131.17–18; see also p. 249, commentary on p. 131.17–18). The mental derangement which can be observed in all three affections seems to be a common ground that phrenitis, lethargia, and katalepsis share. Other texts also point to the comparability of these three affections, with several stating, for example, that one form of katalepsis is called sleepy (ὑπνώδης) due to its similarity to lethargia while another is called “phrenetic” (φρενιτικόν) due to its similarity to phrenitis.761 For a detailed overview of ancient views on katalepsis, see Baumann 1938; for a short summary of the Galenic account, see Siegel 1973, 258–262. In trying to understand what modern physicians refer to as katalepsis, Baumann notes that aspects of katalepsis occur mainly in dementia praecox, hysteria, hypnosis, and ecstasy, but may also occur in other diseases of the brain, such as tumors or meningitis.762 Siegel mentions a similarity between Parkinson’s disease and the symptoms of katalepsis referred to by Galen.763 Moog also draws a comparison between the symptoms of narcolepsy and traumatic psychic states, on the one hand, and those which accompany katalepsis as it is presented by the ancients, on the other.764 However, great

757 See Caelius Aurel., Cel. pass. 2.63 (168.27 f. Bendz). 758 See Pseudo-Galen, Def. med. 241 (19.414.14 f. K.). 759 See Galen, De sympt. diff. 3.9 (224.9–11 Gundert = 7.60.3–6 K.). 760 See Galen, De sympt. caus. 1.7 (7.137.5–9 K.). 761 See Pseudo-Galen, Def. med. 241 (19.414.18–415.1 K.). On the similarity between phrenitis, lethargia and katalepsis, see e.g. also Paul 3.10.1 (Vol. 1, 149.3 f. Heiberg), Caelius Aurel., Cel. pass. 2.73 (174.24–26 Bendz), Cel. pass. 2.56 (164.18 f. Bendz). 762 See Baumann 1938, 7. 763 See Siegel 1973, 260 f. 764 See Moog 1994 in Die Fragmente des Themison von Laodikeia, 239.

244 | Commentary

care should be taken in making use of such comparisons due to the radically different paradigms that underlie ancient and modern medicine.

Structure of the chapter p. 131.16–21: Περὶ – ληθάργῳ: Relation between katalepsis, phrenitis and lethargia Paraphrase: The beginning of this chapter is concerned with the relation between katalepsis and both phrenitis and lethargia, which are discussed in the previous chapters of Aetius’ compilation. Katalepsis is said to be midway between phrenitis and lethargia and to be a form of derangement of the mind. It is furthermore connected to the melancholic humor and referred to as coming into being in fevers. p. 131.21–132.11: καὶ ὁτὲ – ληθάργοις: Symptoms and accompaniments of katalepsis Paraphrase: These lines are concerned with the symptoms and accompaniments of katalepsis. In this context the text discusses the condition of the patients’ eyes, the fact that they are voiceless and without sensation, and deals with behavior which obviously points to the patients’ deranged minds. The lines also deal with the pulse and breath, with the retention of excretion, and with substances adhering to the corner of the eyes. They conclude with the statement that patients suffering from katalepsis are not entirely similar to those suffering from phrenitis nor to those suffering from lethargia. p. 132.11–17: γίγνεται – ἀπηλλάγη: Blood as a possible cause of katalepsis Paraphrase: These lines deal with the possibility that a great amount of blood is a cause of katalepsis. They present the example of a young man who was full of blood and was suffering from symptoms which are similar to those of katalepsis, whose symptoms eased after a hemorrhage through the nose. p. 132.17–22: ὅθεν – πιτύροις: Therapy for katalepsis I (phlebotomy, enemata) Paraphrase: These lines deal with phlebotomy and the application of enemata as suitable treatments for patients suffering from katalepsis. p. 132.22–24: τὴν – ἕρπυλλον: Therapy for katalepsis II (embrocations of the head) Paraphrase: These lines deal with embrocations of the head as a suitable treatment for patients suffering from katalepsis. Two different procedures are mentioned, their suitability depending on the temperature of the patient’s head. p. 132.24–133.4: καὶ εἰ – διδόναι: Therapy for katalepsis III (enemata, drinks) Paraphrase: In these lines it is emphasized that the application of the enemata should continue when they bring about the intended effect and alternatives are given in case they do not. These lines go on to deal with the appropriate drinks for patients suffering from katalepsis and recommend treatments that are appropriate when there is thickness in the patients’ urine.

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

|

245

p. 133.4–6: τροφαὶ – παύει: Therapy for katalepsis IV (food) Paraphrase: These lines deal with the appropriate food, presenting the juice of bran as suitable and water as being hostile to an individual suffering from katalepsis. p. 133.7–9: ἀλειφέσθωσαν – στόματι: Therapy for katalepsis V (anointments, treatment of trembling) Paraphrase: The last lines of the chapter recommend the anointing of the whole body of patients who suffer from katalepsis and discuss what should be done if trembling befalls them.

Rationale of the chapter The chapter on katalepsis presents an account of the disease concept, starting with general information on the affection (i.e. its relation to phrenitis and lethargia, its labeling as a form of derangement of the mind, the naming of the affection, information on the humor which is present in katalepsis, katalepsis as being delusive and connected to fever: see p. 131.17–21). It then goes on to provide a discussion of its symptoms and accompaniments (patients being sleepy, condition of the eyes, speechlessness, lack of perception, moving the hands around the head, pulse, respiration, retention of excretion, substances adhering to the corner of the eyes, touching the walls, lack of complete similarity to phrenitis and lethargia: see p. 131.21– 132.11), as well as the possible cause of the affection (i.e. a great amount of blood: see p. 132.11–17) and its appropriate therapy (see p. 132.17–133.9). The opening sentence of the chapter refers to the two previous chapters of Aetius’ compilation on phrenitis and lethargia and relates these affections to katalepsis by stating that the latter is midway between the two. However, it is not further explained how exactly this relation manifests itself, that is to say what it is that katalepsis shares in common with phrenitis and what it shares with lethargia. The reader of these lines is forced to draw this information from the text in comparison to the previous two chapters: one might, for example, relate the fact that patients suffering from katalepsis seem to be sleepy to the fact that patients suffering from lethargia are said to fall into a deep sleep (see p. 252 f., commentary on p. 131.21). One might also relate the statement that katalepsis is a form of derangement of the mind to its similarity with phrenitis, which was characterized in the same way (see p. 249, commentary on p. 131.17–18). Just as the similarity between katalepsis on the hand, and phrenitis and lethargia on the other, is merely stated and not elaborated upon, the same also applies to the statement that katalepsis is a form of derangement of the mind. This is not explained any further (see p. 249 f., commentary on p. 131.17–18), although a reader might well wish to hear how this derangement manifests itself. Again, one needs to look at the chapter on phrenitis and the symptoms which are discussed in the further course of the chapter on katalepsis in order to gain a glimpse of what probably lies behind this statement. In doing so one might,

246 | Commentary

for example, come to the conclusion that katalepsis consists in a derangement of the reasoning faculty which manifests itself in moving the hands around the head or in touching the walls (see p. 249 f., commentary on p. 131.17–18). While the reader of this chapter is forced to draw information on the similarity between katalepsis on the one hand and phrenitis and lethargia on the other, and on the manifestation of the derangement of the mind, from the previous chapters, the bare statement that the affection happens “in dependence of a rather melancholic humor” is even more difficult to grasp (see p. 250 f., commentary on p. 131.19). First of all, the statement is not elaborated on any further and, secondly, the melancholic humor is only mentioned once in the whole chapter. Given that bile is said to play a role in katalepsis in Paul’s account of the affection and that in the further course of our chapter the section on the cause of the affection suggests that there is more than one possible cause (see p. 259, commentary on p. 132.11–13), it seems reasonable to assume that the reference to the melancholic humor should be understood as a reference to a possible cause of the affection. The relation between katalepsis and phrenitis and lethargia seems to be an important part of the understanding of the affection. The first half of the chapter (dealing with general aspects, symptoms and the cause of katalepsis) is framed by the statement that katalepsis is midway between phrenitis and lethargia, at the start of the chapter (p. 131.17), and the statement that it is not completely similar to phrenitis or lethargia at p. 132.10–11. On this issue, see also p. 259, commentary on p. 132.10–11. Despite the lack of detail in the first lines of the chapter, which only contain general information on the affection, the sections on the symptoms, cause and therapy of katalepsis are more or less straightforward. The section on the therapy of katalepsis does not take up as much room as it did in the chapter on lethargia (see p. 199). This may be due to the fact that the sections on the treatment of phrenitis and lethargia were quite detailed and that katalepsis is said to be midway between the two. The fact that katalepsis is somehow related to phrenitis and lethargia is also reflected in the therapeutical recommendations that are offered (e.g. the distinction between patients who have a warmer and those who have a colder head corresponds to those who are more similar to patients suffering from phrenitis and those who are more similar to patients suffering from lethargia: see p. 262 f., commentary on p. 132.22–24). Some therapeutical recommendations can be explained by reference to statements about the affection found earlier in the text (e.g. the advice to carry out phlebotomy corresponds to the great amount of blood which might cause the affection: see p. 261, commentary on p. 132.17–19), while others remain difficult to grasp within the context of the chapter (such as the advice against drinking water: see p. 264 f., commentary on p. 133.5–6). In general, the therapeutical recommendations are similar to those found in the previous two chapters on phrenitis and lethargia. Looking at the chapter as a whole, interesting questions arise about the way the organization and structure of the chapter were developed and the way the information presented was selected. To begin with, we might ask whether the information

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

|

247

contained in the chapter indeed stems from Archigenes and Posidonius and which parts stem from which of the two claimed sources. It is remarkable in this regard that, especially in the section on therapy, information is provided which is also given in a very similar manner in the chapters on phrenitis and lethargia (see e.g. p. 262 f., commentary on p. 132.22–24). The last sentence of the chapter is even to be found nearly verbatim in the previous chapter on lethargia (see p. 266, commentary on p. 133.7–9). Given that the chapter on phrenitis was claimed to be drawn from Posidonius and that on lethargia from Archigenes and Posidonius (see p. 164, commentary on p. 125.4, and p. 205, commentary on p. 128.10–12), one might assume that these similarities can be explained by the fact that all three chapters were written by the same author(s). However, in my view it is important to pay attention to the fact that Aetius was the compiler of all three chapters. He was surely a close reader of the texts he used as sources and was thus able to take information from the chapters on phrenitis and lethargia and add them to the chapter on katalepsis where reasonable, even if these points might not have been contained in the original text of his source. In addition, we might also ask why Aetius decided to include in this chapter this information about katalepsis and this information only. Comparing Aetius’ account of the affection with other accounts, as I do throughout the commentary, casts light on this question. In summary, many issues which are discussed in Aetius’ chapter are also reflected in other writings and this pertains especially to the general information on katalepsis (e.g. the statement that katalepsis is midway between phrenitis and lethargia is reflected in Pseudo-Galen, Galen, Caelius, Paul: see p. 248 f., commentary on p. 131.17) and to its symptoms (e.g. the condition of the patients’ eyes is also discussed in Soranus, Caelius, Galen and Paul: see p. 253 f., commentary on p. 131.21–132.1). In comparison to other writings, Aetius’ account of the affection is rather detailed, taking into account many different symptoms, including those which might be traced back to a derangement of the mind (see p. 249 f., commentary on p. 131.17–18). The detailed description of blood as a possible cause of katalepsis and the example of the young man who was full of blood is, to my knowledge, not found in any other account of the affection. Grasping the relation between katalepsis and phrenitis and lethargia is obviously an important element in understanding and treating the affection. This nicely illustrates that the place of the chapter within the sixth book has been chosen deliberately. Since it is preceded by the chapters on phrenitis and lethargia, the fundamentals for understanding the chapter on katalepsis have already been laid down and the reader is easily able to find the relevant information on the other two affections and, thus, gain a deeper understanding of katalepsis through these comparisons.

248 | Commentary

Commentary p. 131.16–17: Περὶ – Ποσειδωνίου: For a detailed discussion of Archigenes and Posidonius as sources for the sixth book see p. 23 – 26. p. 131.17: μέσον – εὑρήσεις: There are other passages in the ancient medical literature which mention katoche or katalepsis in the same context as lethargia (and sometimes also phrenitis), as if they all belong to one class of affections.765 Some passages are similar to Aetius’ account, insofar as they are also explicit in comparing the affections. In the chapter entitled Περὶ κατόχου ἤγουν ἀγρύπνου κώματος Paul states that the signs of katochos (κάτοχος) are similar to those of phrenitis and lethargia, “being modified according to the prevailing material”.766 In the further course of the chapter he distinguishes patients with this affection from those suffering from lethargia by the fact that there are no swellings, nor the livid color found in those suffering from lethargia, and that the patients perspire moderately.767 In the pseudo-Galenic Definitiones medicae three forms of katochos are distinguished: the first form is called sleepy (ὑπνώδης) and is said to be nearest to lethargia, while the third form may be called phrenetic (φρενιτικόν), insofar as it occurs due to a mixture of phrenitis and katochos.768 In De causis pulsuum and De pulsibus libellus ad tirones, Galen points out that the pulse in katochos is similar to that in lethargia and that both affections are, on the whole, not very different.769 Caelius opens his chapter on katalepsis with the remark that it is an affection that is close and similar to lethargia.770 Owing to this similarity, physicians easily take patients suffering from katalepsis to be suffering from lethargia, according to Caelius.771 He furthermore mentions that patients suffering from katalepsis may fall back into phrenitis or lethargia.772 Caelius also explicitly discusses the similarities and differences between lethargia and katalepsis, stating that patients who are about to suffer from katalepsis share drowsiness and slow movement of the body in common with those suffering from lethargia, as well as the silent enduring of their complaints, a very deep sleep, and the lengthy time it takes for them to answer a question.773 Specific signs of an impending katalepsis are redness of the cheeks without abatement of the fever, salivation, elevation and amplitude of the pulse, as well as retention of excrement 765 See e.g. Galen, De sympt. diff. 3.9 (224.9–13 Gundert = 7.60.3–8 K.), where κατάληψις and ληθάργος are mentioned in context of damages of the ἡγεμονικαὶ ἐνέργειαι. See Galen, De loc. aff. 3.5 (8.156.14–16 K.), De loc. aff. 5.1 (8.300.8–10 K.), Oribasius, Coll. med. rel. 10.13.10 (Vol. 2, 56.28 f. Raeder). 766 See Paul 3.10.1 (Vol. 1, 149.3–5 Heiberg). 767 See Paul 3.10.1 (Vol. 1, 149.13–16 Heiberg). 768 See Pseudo-Galen, Def. med. 241 (19.414.18–415.3 K.). 769 See Galen, De caus. puls. 4.16 (9.189.7–13 K.), De puls. ad tir. 12 (8.485.11–17 K.). 770 See Caelius Aurel., Cel. pass. 2.56 (164.18 f. Bendz). 771 See Caelius Aurel., Cel. pass. 2.57 (166.4 f. Bendz). 772 See Caelius Aurel., Cel. pass. 2.73 (174.24–26 Bendz). 773 See Caelius Aurel., Cel. pass. 2.68 (172.6–10 Bendz).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius |

249

or diarrhea.774 He also mentions that the eyelids of patients suffering from lethargia are closed while in the case of those suffering from katalepsis they are open.775 Interestingly, in De pulsibus libellus ad tirones Galen, too, speaks about a disease which, despite it lacking a name, he describes as being a mixture of phrenitis and lethargia (μικτὸν ἔκ τε τῶν φρενίτιδος εἰδῶν ἔκ τε τῶν ληθάργου) and which he also compares to katochos a little later.776 p. 131.17–18: ὅ – παρακοπῆς: For a more detailed discussion of the usage of nouns such as παράνοια or παρακοπή in Aetius’ sixth book, see p. 164 f., commentary on p. 125.4–6. Given that katalepsis is said to be midway between phrenitis and lethargia, and given that the occurrence of παράνοια and παρακοπή is also explicitly mentioned here, as it was in the chapter on phrenitis, it is reasonable to assume that such forms of damage to the imaginative faculty, the reasoning faculty or the recollective faculty which are dealt with in detail in the chapter on phrenitis (see p. 171 – 174, commentary on p. 125.20–24), are likewise thought to happen in katalepsis. Symptoms of katalepsis, such as the fidgeting of hands around the head (p. 132.3–5; see p. 255 f., commentary on p. 132.3–5) or the touching of walls (p. 132.9–10; see p. 258, commentary on p. 132.9–10) seem to point to a derangement of the mind, which consists of damage to the reasoning faculty. For a more detailed discussion of this sort of symptoms, see also p. 172 f., commentary on p. 125.20–24. In the chapter on lethargia it is also stated that the reasoning capacity of the patients is damaged (see p. 214, commentary on p. 128.24–26). Interestingly, in the Galenic treatise In Hippocratis Prorrheticum I commentaria III it is stated that, in patients who suffer from katalepsis and do not move at all, it is not possible to identify mental derangement (παραφροσύνη).777 Galen continues to say that katoche might follow after the preceding mental derangement and that it might be possible that derangement manifests itself at the time when the patients are still able to utter sounds.778 Interestingly, Galen thereby links the detectability of mental derangement to movement and uttering. In his De symptomatum differentiis Galen ranks mental derangement (παραφροσύνη) among the types of damage to the imaginative capacity (ἐνέργεια φανταστική; this is a synonym for the term φανταστικόν) and the reasoning capacity (ἐνέργεια διανοητική; this is a synonym for the terms διανοητικόν or λογιστικόν) and explains that it is a false movement (of the imaginative capacity or of the rea-

774 See Caelius Aurel., Cel. pass. 2.68 (172.10–13 Bendz). 775 See Caelius Aurel., Cel. pass. 2.75 (176.18–21 Bendz). 776 See Galen, De puls. ad tir. 12 (8.484.6–9 K.), De puls. ad tir. 12 (8.484.14 K.). 777 See Galen, In Hipp. Prorrh. comm. 2.55 (96.17 f. Diels = 16.685.6 f. K.): ἐπὶ δὲ τῶν κατόχων οὐδεμίαν κίνησιν κινουμένων οὐδὲ τὴν παραφροσύνην ἔστιν γνωρίσαι. 778 See Galen, In Hipp. Prorrh. comm. 2.55 (96.21–24 Diels = 16.685.10–15 K.): ἢ προηγησαμένης τῆς παραφροσύνης παρηκολούθησεν ἡ κατοχή […]. ἐγχωρεῖ δὲ καὶ κατὰ τὴν πρώτην αὐτοῦ σύστασιν ἐπιφθεγγομένων αὐτῶν δηλοῦσθαι τὴν παραφροσύνην.

250 | Commentary

soning capacity or of both).779 Interestingly, in this very passage katalepsis is also ranked among the kinds of damage to the imaginative capacity and described as consisting in a paralysis of this capacity.780 Unfortunately, Galen does not explain any further in exactly what sense katalepsis is a paralysis of the imaginative capacity and the peculiar function of this capacity is, in any case, already difficult to grasp (see p. 171 – 174, commentary on p. 125.20–24). However, as I discuss on p. 167 f., commentary on p. 125.10–15, Galen also ranked sensation and the imaginative capacity among the capacities of the soul and one might therefore assume, albeit with some caution, that Galen might have been thinking of what is referred to in our text as a lack of sensation (p. 132.3: ἀναίσθητοι, p. 132.5: οὐ μετ’ αἰσθήσεως) or even as speechlessness (p. 132.2: ἄφωνοί) when speaking of katalepsis as a paralysis of the imaginative capacity. p. 131.18–19: καλεῖν – κατάληψιν: The term οἱ ἰατροί refers to physicians in general, who differ in the terms they use to describe the affection. These differences are reflected in other texts as well: according to Caelius Aurelianus, Hippocrates and Diocles called this affection ἀφωνία, on account of one of its symptoms, while Praxagoras referred to it as κατοχή.781 The followers of Asclepiades are said to have distinguished this affection from lethargia and to have given it a name of its own by calling it κατάληψις.782 In his De locis affectis, Galen states that the younger physicians refer to it as κατοχή and κατάληψις.783 In his De pulsibus libellus ad tirones and De causis pulsuum he is slightly more detailed in this regard, stating that the ancients called the affection κάτοχος or “those who are held” (κατεχόμενοι), while the younger physicians call it κατοχή and κατάληψις.784 The same is stated in Paul’s chapter on katalepsis.785 The name is obviously derived from the fact that the patients are thought to remain in the position they were in when seized by the affection and are thus “held” by the affection.786 p. 131.19: ἐπὶ – μελαγχολικῷ: The connection between this prepositional clause and the statement concerning the naming of the affection is puzzling. In what way are the terms κατοχή and κατάληψις related to the melancholic humor? Given that the Latin translations of this passage also put forward the notion that the affection originates from black bile, but do not suggest any causal relation between the nam-

779 See Galen, De sympt. diff. 3.9 (224.9–12 Gundert = 7.60.3–7 K.), De sympt. diff. 3.10 (224.13–18 Gundert = 7.60.8–14 K.). 780 See Galen, De sympt. diff. 3.9 (224.10 f. Gundert = 7.60.4–6 K.). 781 See Caelius Aurel., Cel. pass. 2.56 (164.20–23 Bendz), Diocles fr. 97.4 van der Eijk, Praxagoras fr. 63 Steckerl. 782 See Caelius Aurel., Cel. pass. 2.57 (166.5–7 Bendz). 783 See Galen, De loc. aff. 3.5 (8.156.15 f. K.). 784 See Galen, De caus. puls. 4.16 (9.189.5–7 K.), De puls. ad tir. 12 (8.485.9–11 K.). 785 See Paul 3.10.1 (Vol. 1, 149.27–29 Heiberg). 786 See e.g. Paul 3.10.1 (Vol. 1, 149.25–29 Heiberg).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

|

251

ing of the affection and the melancholic humor,787 I have opted to follow the reading suggested by the manuscript group ψ and the Parisinus suppl. gr. 1240 (Pa), both of which give συμβαῖνον.788 The participle συμβαῖνον is then used as an accusative absolute which provides information on the onset of katalepsis but is not syntactically connected with the beginning of the sentence.789 The reference to the melancholic humor is still puzzling insofar as it is not mentioned in the further course of the chapter and no explanation for this statement is provided. The only hint that bile was thought to play a role in katalepsis is to be found in Paul, who puts forward the notion that bile (though he does not mention black bile) or phlegm are present in patients suffering from katalepsis.790 In Alexander’s account of lethargia, the possibility is considered that lethargia might arise not only from phlegm, but also from bile, and one of the symptoms of this mixed form, i.e. the moving of the hands around the head, is also mentioned in our chapter on katalepsis.791 p. 131.19–20: ἐπισφαλέστερον – ληθάργου: Cornarius and Montanus translate the Greek adjective ἐπισφαλές with different Latin equivalents: while Cornarius translates periculosior, Montanus translates fallacior.792 Both translations stress different aspects of the Greek term, the basic meaning of which is derived from the verb σφάλλεσθαι (being misled) and can also denote “dangerous” qua being potentially misleading. The notion that katalepsis is a delusive affection is also reflected in Caelius’ description of the accounts of katalepsis given by Praxagoras, Asclepiades and Diocles. Some patients have been released from the affection, and believed themselves to be completely healthy, but then died after a bout of hard work, according to Praxagoras.793 Asclepiades is reported to have stated that the decline of the affection can potentially be an illusion and the patients might be led to death anyway.794 Diocles is said to have claimed that the patients may be in danger in cases where they become speechless during the attack of the affection or when they are afflicted with alternating cramps.795 Paul states that it is hard to deal with cases (χαλεποὶ) in which there is much sleeplessness, retention of urine, difficulty of breathing, perspiration, and where what has been drunk is thrown up through the nose.796 Our text does not provide further information on the question why katalepsis is more delusive than lethargia. 787 See Cornarius, 297: Medici autem catocham et catalepsim, hoc est mentis occupationem et appraehensionem vocare solent, ex humore atrae bilis magis contingens. See Montanus, 237: medici hanc catochen seu catalepsim appellare consueverunt, quae ab humore contingit melancholico. 788 See Olivieri’s critical apparatus to p. 131.19. 789 See Smyth § 2076. 790 Paul 3.10.1 (Vol. 1, 149.14 Heiberg), Paul 3.10.2 (Vol. 1, 150.4 f. Heiberg). 791 See Alexander, Therapeutica 1.14 (634.11–16 Guardasole = Vol. 1, 529.3–7 Puschmann). 792 See Cornarius, 297; Montanus, 237. 793 See Caelius Aurel., Cel. pass. 2.61 (168.6–9 Bendz), Praxagoras fr. 63 Steckerl. 794 See Caelius Aurel., Cel. pass. 2.63 (168.31–33 Bendz). 795 See Diocles fr. 97.21–24 van der Eijk, Caelius Aurel., Cel. pass. 2.60 (166.29–32 Bendz). 796 See Paul 3.10.1 (Vol. 1, 149.17–19 Heiberg).

252 | Commentary

p. 131.20–21: ἐπὶ – ληθάργῳ: The assumption that katalepsis occurs in fevers is also reflected in other writings. Caelius Aurelianus cites various scholars, namely Diocles, Praxagoras, Archigenes and Asclepiades, who note a connection between fever and the occurrence of katalepsis.797 He also reports that Soranus mentioned that it is possible for katalepsis to accompany all feverish affections (febriculae) and that it is understood that its severity depends on the intensity of the fever.798 In his Gynaeciorum libri, Soranus distinguishes katalepsis from hysteric suffocation (ὑστερικὴ πνίξ) on the grounds that, amongst other things, the former occurs with fever and the latter without.799 According to Galen’s Methodus medendi, katoche occurs without fever.800 The comparison between lethargia and fevers in which katalepsis comes into being fits with the previous statement that katalepsis is midway between phrenitis and lethargia (see p. 248 f., commentary on p. 131.17) and with the fact that the discussion of fever played a prominent role in the chapter on lethargia (see p. 209, commentary on p. 128.16–18). p. 131.21: ὁτὲ μὲν – ὑπνώττειν: Being sleepy is a symptom which patients suffering from katalepsis share with those who suffer from lethargia (see p. 208, commentary on p. 128.15–16). It thus also fits with the opening of the chapter, where it was stated that katalepsis is midway between phrenitis and lethargia (see p. 248 f., commentary on p. 131.17). The notion that patients suffering from katalepsis are sleepy is likewise reflected in other texts: Caelius states that those who are about to be caught by katalepsis suffer from a kind of deep sleep801 and in the pseudo-Galenic Definitiones medicae one form of katalepsis is referred to as ὑπνώδης (sleepy) and said to be similar to lethargia.802 However, the fact that our text uses the phrase δοκοῦσιν ὑπνώττειν is not insignificant, for it highlights the fact that those suffering from katalepsis probably do not always actually sleep or feel sleepy. Rather, they suffer from a condition which one may believe is sleep but which is actually most likely a numbed condition, as is suggested by symptoms discussed later, such as open eyelids (p. 131.21–22: ἀνεῳγότα ἔχοντες τὰ βλέφαρα), staring as if the eyes are fixed (p. 131.22–132.1: ἀτενὲς ὁρῶσι καὶ ὡς πεπηγότας ἔχουσι τοὺς ὀφθαλμοὺς), motionless eyes (p. 132.1: ὀφθαλμοὺς … ἀκινήτους), or a lack of perception (p. 132.3: ἀναίσθητοι). In the pseudo-Galenic Definitiones medicae it is explicitly stated that katochos comes along with a freezing in place of the whole body (μετὰ πήξεως τοῦ παντὸς σώματος),803 which is also reflected in Galen’s In Hippocratis Prorrheticum I com-

797 See Caelius Aurel., Cel. pass. 2.60 (166.28 f. Bendz), Cel. pass. 2.60 (168.1 Bendz), Cel. pass. 2.61 (168.11–22 Bendz), Cel. pass. 2.63 (168.23 f. Bendz). 798 See Caelius Aurel., Cel. pass. 2.66 (170.28 f. Bendz), Cel. pass. 2.67 (170.32–34 Bendz). 799 See Soranus, Gyn. 3.27.3 (110.11–15 Ilberg). 800 See Galen, Meth. med. 13.21 (404.4 f. Johnston & Horsley = 10.931.6–8 K.). 801 See Caelius Aurel., Cel. pass. 2.68 (172.9 Bendz). 802 See Pseudo-Galen, Def. med. 241 (19.415.15 f. K.). 803 See Pseudo-Galen, Def. med. 241 (19.415.14 f. K.).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

|

253

mentaria III.804 Paul explains that the naming of the affection as katochos is derived from the fact that the patients remain in the position (they are “held”) they had when seized by the affection.805 This numbness might partly be the reason why our text states that the patients seem to be sleepy, although this formulation does not necessarily exclude the possibility that sometimes they did indeed sleep. p. 131.21–132.1: ὁτὲ δὲ – ἀκινήτους: The condition of the eyes and eyelids of patients who suffer from katalepsis is commonly discussed in texts which deal with the affection. Caelius Aurelianus, for instance, reports that Hippocrates said that the eyes stand still without any blinking (oculorum statio sine ulla palpebratione).806 When dealing with the peculiar symptoms of katalepsis, Caelius states that the patients’ eyelids remain apart (palpebrarum distantia) and that the gaze of the eyes is stiff and motionless (et infixa atque immobilis intentio luminum).807 Soranus, in his Gynaeciorum libri, says that the eyelids of patients suffering from katalepsis are stretched (διατετάσθαι τὰ βλέφαρα).808 In De locis affectis, Galen states that the eyelids remain open in katalepsis ([…] τῶν βλεφάρων, ἡ κατάληψις δὲ ἀνεῳγότων) whereas they are closed in karos,809 and in his In Hippocratis Prorrheticum I commentaria III he reports that one of his schoolfellows who was suffering from katalepsis once looked at him with open eyes (ἀνεῳγότων τῶν ὀφθαλμῶν) and did not blink (μηδὲ σκαρδαμύττειν).810 Paul claims that the upper eyelids seem to be pulled up (ἀνασπᾶσθαι) and to protrude (ἐξέχειν), so that they are not capable of blinking (σκαρδαμύττειν).811 Interestingly, the blinking of the eyes is denied in the other accounts of katalepsis, but mentioned in Aetius. In Caelius’ account of the possible changes from katalepsis into phrenitis or lethargia it is claimed that the stiff gaze of those patients who are about to fall into phrenitis becomes mobile (oculorum fixus obtutus mutatur atque mobilis efficitur).812 Against the background of this statement, one may cautiously suggest that a similar connection between the blinking and the relation between katalepsis and phrenitis might also inform the present passage, especially since katalepsis has been referred to as being midway between phrenitis and lethargia (see p. 248 f., commentary on p. 131.17). The phrase ὡς πεπηγότας ἔχουσι τοὺς ὀφθαλμοὺς reminds us of the two Galenic passages which were discussed in the preceding entry of the commentary (see especially notes 803 and 804) 804 See Galen, In Hipp. Prorrh. comm. 2.55 (96.19 Diels = 16.685.9 K.): πεπηγὸς ὅλον τὸ σῶμα. 805 See Paul 3.10.1 (Vol. 1, 149.25–29 Heiberg). See on this issue also p. 250, commentary on p. 131.18–19. 806 See Caelius Aurel., Cel. pass. 2.59 (166.24 Bendz). 807 See Caelius Aurel., Cel. pass. 2.69 (172.16–18 Bendz). This statement is repeated a bit further down. See Cel. pass. 2.74 (176.9 Bendz): oculorum stans atque fixus obtutus. 808 See Soranus, Gyn. 3.27.3 (110.12 f. Ilberg). 809 See Galen, De loc. aff. 4.3 (8.232.13–15 K.). 810 See Galen, In Hipp. Prorrh. comm. 2.55 (96.6 f. Diels = 16.684.12 f. K.). See also Galen, In Hipp. Prorrh. comm. 2.55 (95.31–96.2 Diels = 16.684.5–7 K.). 811 See Paul 3.10.1 (Vol. 1, 149.8 f. Heiberg). 812 See Caelius Aurel., Cel. pass. 2.73 (174.27 f. Bendz).

254 | Commentary

and which also used the verb πηγνύναι or the related noun πῆξις to explain the bodily condition of patients suffering from katalepsis. For further discussion of the adjective ἀκίνητον see p. 255, commentary on p. 132.2–3. p. 132.1–2: ὡς – μύουσιν: I take the ὡς to have consecutive force here813 and to illustrate the previously mentioned stiffness and motionlessness of the eyes. For, according to Galen’s De usu partium, both eyelashes and eyelids serve the purpose of preventing things from falling into the eyes: the eyelashes are able to catch small potentially threatening things while the eyelids fold together in case something bigger threatens it.814 The fact that the patients do not even close their eyes when someone reaches out for them emphasizes the stiffness and motionlessness of the eyes, insofar as the closing would normally be the natural reaction in this case. p. 132.2–3: ἄφωνοί – ἀποκρινόμενοι: The mention of speechlessness (ἄφωνοι) as a symptom of katalepsis is dealt with prominently in the account of the affection given by Caelius Aurelianus, who states that Hippocrates and Diocles even called the affection aphonia.815 According to Caelius, Hippocrates said that the patients suddenly lose their voice and Diocles claimed that patients who become speechless during fever when being seized by the affection are in danger.816 In the “Hippocratic” Prorrheticon it is stated that those forms of speechlessness which are accompanied by feebleness and katochos (κατόχως) are fatal.817 According to Galen’s In Hippocratis Prorrheticum I commentaria III, a schoolfellow of his who was once suffering from katalepsis was not able to utter any sound.818 The explicit statement that the patients are without sensation (ἀναίσθητοι) is also reflected in Caelius Aurelianus’ account of the affection, which refers to stupor and numbness of the senses (sensuum torpor atque hebetudo) as a peculiar sign of katalepsis.819 On the Galenic notion that katalepsis is a paralysis of the imaginative faculty see p. 249 f., commentary on p. 131.17–18. According to Galen, sensation (αἴσθησις) is an activity belonging to the soul,820 on which account see p. 167 f., commentary on p. 125.10–15 for more detail. Galen defines sensation (αἴσθησις) as discernment of change (διάγνωσις ἀλλοιώσεως), which means, he explains, that the sense organ is changed and the discernment of this change develops through one single power which is common to all sense organs and which flows from the arche (scil. the leading organ, i.e. the

813 See Smyth § 2273–2274. 814 See Galen, De usu part. 10.6 (Vol. 2, 77.9–14 Helmreich = 3.790.3–8 K.). 815 See Caelius Aurel., Cel. pass. 2.56 (164.21 f. Bendz), Diocles fr. 97.4 van der Eijk. 816 See Caelius Aurel., Cel. pass. 2.59 (166.21 f. Bendz), Cel. pass. 2.60 (166.28–30 Bendz), Diocles fr. 97.20–22 van der Eijk. 817 See Hippocrates, Prorrh. 1.96 (87.7 f. Polack = 5.536.3 f. L.). 818 See Galen, In Hipp. Prorrh. comm. 2.55 (96.7 Diels = 16.684.13 f. K.), In Hipp. Prorrh. comm. 2.55 (96.11 Diels = 16.684.18 K.). 819 See Caelius Aurel., Cel. pass. 2.69 (172.16 Bendz), Cel. pass. 2.74 (176.8 Bendz). 820 See Galen, De sympt. diff. 3.1 (216.18–20 Gundert = 7.55.11–14 K.).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

| 255

brain).821 Damage to the sensory capacities includes all kinds of lack of sensation (ἀναισθησίαι) and of sensory misfunction (δυσαισθησίαι).822 According to Galen’s De placitis Hippocratis et Platonis, an animal becomes motionless (ἀκίνητόν), is deprived of sensation (ἀναίσθητον), becomes breathless (ἄπνουν) and speechless (ἄφωνον) when one of its ventricles of the brain (κοιλίας ἐγκεφάλου) is wounded or oppressed.823 In De locis affectis, Galen states that in katalepsis the rear parts of the brain (τοῦ ἐγκεφάλου … τὰ ὀπίσω) are more impaired824 and this statement could also refer to the posterior ventricles of the brain. It is remarkable that Galen connects speechlessness and a lack of sensation to varieties of damage to the ventricles of the brain since they also play an important role in Aetius’ chapter on phrenitis. For a detailed discussion of this passage, see p. 168 – 171, commentary on p. 125.16– 20. Given that it was said in the opening of this chapter that katalepsis is midway between phrenitis and lethargia, and setting this against the background of the Galenic passage, it might be the case that damage to the ventricles of the brain is thought to be part of what these affections share in common. The fact that the participles ἀκούοντες and ἀποκρινόμενοι are negativized with μηδέ argues for the interpretation that they should be understood as conditions of the previously mentioned speechlessness and lack of sensation, since otherwise they would need to be negativized with οὐδέ.825 This conditional force might explain the use of μηδέ, but I translate the whole phrase as “insofar as …” because I assume that the aim of the sentence as a whole is to express that not hearing and not answering are signs of the speechlessness and the lack of sensation. According to this reading, the adjective ἄφωνοι would correspond to μηδ’ ἀποκρινόμενοι, while ἀναίσθητοι would correspond to μηδ’ ἀκούοντες. Caelius Aurelianus mentions that a patient’s answer to a question often takes a long time.826 p. 132.3–5: φέρουσι – αἰσθήσεως: For a discussion of this passage see also p. 249, commentary on p. 131.17–18, where I have already pointed out that the fidgeting of hands around the head is often understood as a symptom of a deranged mind. See also p. 172 f., commentary on p. 125.20–24. In Alexander’s account of lethargia, it is, for example, presented as a symptom which occurs if the affection is brought

821 See Galen, De plac. Hipp. et Plat. 7.6.31 (468.15 f. de Lacy = 5.636.3 f. K.), De plac. Hipp. et Plat. 7.8.1–2 (474.31–476.1 de Lacy = 5.644.5–10 K.). 822 See Galen, De sympt. diff. 3.2 (218.10 f. Gundert = 7.56.7–10 K.). 823 See Galen, De plac. Hipp. et Plat. 1.6.5 (78.30–33 de Lacy = 5.185.12–16 K.), De plac. Hipp. et Plat. 2.4.42 (126.14–17 de Lacy = 5.238.3–7 K.), De plac. Hipp. et Plat. 7.3.16 (442.27–30 de Lacy = 5.605.7– 10 K.). In De usu part. 12.4 (Vol. 2, 189.9–17 Helmreich = 4.11.7–14 K.) he states the same about the joint (ἄρθρον) of the head since a damage or displacement of this joint affects the roots of the nerves. 824 See Galen, De loc. aff. 4.3 (8.232.7–9 K.). 825 See Smyth § 2688: “μή (…) rejects or deprecates. The difference between the simple negatives holds true also of their compounds (…)”. 826 See Caelius Aurel., Cel. pass. 2.68 (172.10 Bendz).

256 | Commentary

about by a mixture of phlegm and bile.827 On this issue, see also p. 250 f., commentary on p. 131.19. The phrase ὡς κνώμενοι in connection with fidgeting of hands around the head, eyes and nose is also found in Galen’s Ad Glauconem De methodo medendi and in a chapter of Paul, who cites the Galenic passages verbatim in his compilation.828 These two passages deal with patients who fidget their nose as if they feel an itch (καὶ τὰς χεῖρας ἐπὶ τὰς ῥῖνας φέροιεν ὡς κνώμενοι) in the context of recognizing the krisis of an affection. In the present passage, the connection of the phrase οὐ μετ’ αἰσθήσεως with the statement that the patients fidget with their hands around the head highlights that they do this without knowing. They do not perceive that they are moving their hands and this lack of awareness of their actions is obviously indicative of their deranged mind. p. 132.5–6: σφυγμοὶ – ἐκλείποντες: For the meaning of the adjective μικρόν in the context of a patient’s pulse, see p. 213, commentary on p. 128.22–24. The pulse of patients suffering from lethargia is also characterized as being small in the previous chapter. In Galen’s De pulsibus libellus ad tirones and De causis pulsuum, it is explicitly stated that the pulse in the case of katalepsis is similar to that in lethargia as far as magnitude (μέγεθος), slowness (βραδύτης), and intermittency (ἀραιότης) are concerned.829 Paul also states that the pulse of patients suffering from katalepsis is small,830 whereas Caelius Aurelianus, by contrast, states that it is big (pulsus magnus).831 The adjectives μικρόν and νωθρόν are also used side by side in a few passages of Aretaeus in order to characterize the pulse.832 In one of these passages, this characterization is explained by the subclause ὅκως διὰ ἰλύος μόλις κινεύμενοι (as if it [scil. the pulse] was moving through mud).833 This subclause clearly highlights that a pulse characterized as μικρόν and νωθρόν is perceived as being weighed down by some external hindrance. Both adjectives seem to be closely connected to the participle ἐκλείποντες: according to the pseudo-Galenic treatise Definitiones medicae, a pulse which is remittent (ἐκλείπων σφυγμὸς) is one in which the artery remains without movement (ἀκίνητος), not only for two but for three or more beats.834 In the Coacae praenotiones, it is said that patients who suffer from lethargia have a σφυγμός νωθρός.835 p. 132.6–7: πνεῦμα – μεγάλως: The adjectives πυκνόν and ἀραιόν are commonly used to characterize breathing: in several Galenic passages frequent (πυκνόν) breathing is connected to shallow (μικρόν) breathing, while intermittent (ἀραιόν)

827 See Alexander, Therapeutica 1.14 (634.11–16 Guardasole = Vol. 1, 529.3–7 Puschmann). 828 Galen, Ad Glauc. 1.16 (440.8 f. Johnston = 11.67.8 f. K.), Paul 2.9.2 (Vol. 1, 80.19 f. Heiberg). 829 Galen, De puls. ad tir. 12 (8.485.11–14 K.), De caus. puls. 4.16 (9.189.7–9 K.). 830 See Paul 3.10.1 (Vol. 1, 149.10 Heiberg). 831 See Caelius Aurel., Cel. pass. 2.74 (176.8 f. Bendz), Cel. pass. 2.75 (176.20 Bendz). 832 See e.g. Aretaeus 3.5.7 (41.3 f. Hude), 3.9.4 (50.11 Hude), 4.13.14 (88.21 f. Hude). 833 See Aretaeus 4.13.14 (88.22 Hude). 834 Pseudo-Galen, Def. med. 230 (19.411.16–18 K.). 835 Hippocrates, Coac. 136 (134.4 f. Potter = 5.610.15 L.).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius |

257

breathing is connected to deep (μέγα) breathing.836 The connection between intermittent and deep breathing is also reflected in our passage by the use of the adverb μεγάλως. Interestingly, some of these Galenic passages connect a deep and intermittent breathing to a derangement of the mind which is brought about by the brain, while shallow and frequent breathing is connected to a derangement of the mind which is brought about by the diaphragm.837 p. 132.7–8: κοιλίας – ἀναισθησίαν: The noun κοιλία refers particularly to human excrement here838 and, as such, describes the waste product of the stomach’s activity. The noun ἐποχή, as well as its derivative ἐπέχεσθαι, are often used in medical texts to refer to the retention of excrement.839 The notion that patients who are affected by katalepsis suffer from a retention of excrement is also reflected in the accounts of the affection given by Paul and Caelius.840 The phrase οὐχ ὑπὸ ξηρότητος emphasizes that this retention is not caused by dryness, as one might be inclined to think by the fact that retention is often connected to a dryness of the bowels which hinders the waste products from leaving the body easily.841 The statement that “it has much moisture” (ἔχει γὰρ ὑγρὸν καὶ πολύ) probably refers back to the noun κοιλία, understood as the waste products of the body which reside in the bowels and are about to be excreted as feces. These residues are actually moist in patients suffering from katalepsis and would, therefore, be excreted easily842 but are not because of the lack of sensation (διὰ τὴν ἀναισθησίαν). This is a highly interesting claim insofar as it implies that bodily functions such as excretion might be impeded by a disturbance of sensation, which is, according to Galen, a capacity of the soul (see on this issue p. 254 f., commentary on p. 132.2–3 and p. 167 f., commentary on p. 125.10–15). The patients obviously do not recognize that they need to excrete the waste products and therefore suffer from retention. In Galen’s treatise De motu musculorum, excretion is ranked among actions which occur through impulse (καθ’

836 See e.g. Galen, De loc. aff. 5.4 (8.332.2 f. K.), De diff. resp. 1.19 (7.808.17 f. K.), De diff. resp. 2.10 (7.878.13 f. K.). 837 See Galen, De loc. aff. 5.4 (8.331.18–332.2 K.). See also Galen, De diff. resp. 1.19 (7.808.17 f. K.), De diff. resp. 2.10 (7.878.12–14 K.). 838 See for κοιλία in this meaning e.g. also Galen, De cris. 1.14 (109.2 f. Alexanderson = 9.613.10–12 K.), Paul 3.10.1 (Vol. 1, 149.11 Heiberg). 839 For examples of ἐποχή in this meaning, see e.g. Aetius Amid., Libri med. 6.7 (Vol. 2, 134.29 Olivieri), Pseudo-Galen, Introd. s. medic. 8.3 (16.15 Petit = 14.692.4 K.), Introd. s. medic. 13.35 (64.14 Petit = 14.750.5 K.). For examples of ἐπέχεσθαι in this meaning, see e.g. Aetius Amid., Libri med. 6.7 (Vol. 2, 134.27 Olivieri), Libri med. 6.8 (Vol. 2, 137.29 Olivieri). 840 See Paul 3.10.1 (Vol. 1, 149.11 f. Heiberg), Caelius Aurel., Cel. pass. 2.68 (172.13 Bendz), Cel. pass. 2.69 (172.23 Bendz). 841 For a connection between retention and dryness see e.g. Galen, De alim. fac. 2.44 (151.22–152.1 Wilkins = 6.631.4–5 K.), Alexander, Therapeutica 9.2 (Vol. 2, 405.13–15 Puschmann). 842 In Galen, In Hipp. Prorrh. comm. 2.2 (52.30 f. Diels = 16.591.1 f. K.), Galen explains the phrase ὑγρὰ κοιλία as λέγοιτο δ’ ἂν οὕτως, ἐφ’ ἧς ὑγρὰ διαχωρεῖται.

258 | Commentary

ὁρμήν).843 This type of action is subdivided into those which are free (ἐλεύθερα) and those which are slaves to the conditions of the body (τοῖς τοῦ σώματος παθήμασι δουλεύοντα) and excretion is, in this context, ranked among the latter group, as it is not possible to hold the excretion for days or even months.844 On the Galenic distinction between natural activities happening without impulse and psychic activities happening through impulse, see also p. 167 f., commentary on p. 125.10–15. According to these Galenic remarks, it is indeed possible that urine and feces are held because of a lack of sensation, although not for an indefinite period of time. p. 132.8–9: λῆμαι – προσπεπήγασιν: The noun λήμη is used elsewhere in ancient medical texts and describes a substance which adheres to the eye.845 According to Galen’s In Hippocratis Prognosticum commentaria III, these substances are generated either through an affection of the instruments (scil. of sight probably) in ophtalmia or through a weakness of the natural capacity which manages the area around the eye and which is unable to concoct the nourishment of the eyes.846 Interestingly, several texts connect the appearance of these substances to phrenitis: in his De locis affectis, Galen, for example, states that those who are about to suffer from phrenitis have dry eyes, shed sharp tears and afterwards have substances adhering to their eyes (λῆμαι), and the veins in the eye are full of blood.847 In Alexander’s account of phrenitis, it is stated that patients who are on the verge of suffering from phrenitis stare, their eyes are red and have substances adhering to them (λῆμαι), and tears flow out of both eyes.848 For further discussion of the similarities between katalepsis and phrenitis, see p. 248 f., commentary on p. 131.17. In his Quod animi mores, Galen compares the failure to recognize oneself or one’s relatives, which occurred during the Athenian plague, to the impairment of sight through substances adhering to the eye (τῷ μὴ βλέπειν διὰ λήμην), although the power of sight itself is not affected.849 p. 132.9–10: ἐνίοτε – τοίχων: The touching of nearby walls is one indication of the deranged mind mentioned at the beginning of the chapter (for further discussion, see p. 249, commentary on p. 131.17–18).850 It is similar to the moving of the hands around the head discussed previously (on this issue, see p. 255 f., commentary on p. 132.3–5). 843 See Galen, De motu musc. 2.6 (36.30 f. Rosa = 4.449.5–7 K.). I owe this reference to Julien Devinant and Ricardo Juliao. 844 See Galen, De motu musc. 2.6 (36.30–37.5 Rosa = 4.449.5–15 K.). 845 See e.g. Hippocrates, Prorrh. 2.18 (256.2–4 Potter = 9.44.3 f. L.), Galen, De usu part. 10.10 (Vol. 2, 89.22 f. Helmreich = 3.807.17 f. K.), Quod animi mor. 5 (34.1 f. Bazou = 4.788.16 f. K.). 846 See Galen, In Hipp. Progn. comm. 1.10 (223.1–4 Heeg = 18b.47.16–48.3 K.). 847 See Galen, De loc. aff. 5.4 (8.330.10–15 K.). 848 See Alexander, Therapeutica 1.13 (616.24–27 Guardasole = Vol. 1, 511.7–10 Puschmann). 849 See Galen, Quod animi mor. 5 (33.14–34.3 Bazou = 4.788.12–17 K.). See on this passage also Thumiger 2017a, 410. 850 I owe special thanks to Chiara Thumiger who helped me understanding this passage and showed me the parallel passages.

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

| 259

p. 132.10–11: καὶ ἁπλῶς – ληθάργοις: This statement probably functions as a concluding remark to the description of the symptoms of patients suffering from katalepsis. It takes up the claim from the very beginning of the chapter that katalepsis is midway between phrenitis and lethargia (see p. 248 f., commentary on p. 131.17) but emphasizes that it is still an affection in its own right, despite sharing some aspects in common with the other two affections. Since the following lines deal with the cause of the affection and no longer with the symptoms, the present phrase is obviously meant to frame the first half of the chapter, insofar as both the very beginning and end of this half deal with katalepsis and its relation to phrenitis and lethargia. On this issue, see also p. 246. p. 132.11–13: γίγνεται – ταύτην: These lines deal with an overflow of blood in the head as a cause of katalepsis. However, the use of the phrase γίγνεται δ’ ἐνίοτε τὸ πάθος καὶ suggests that this is not the only possible cause of the affection and that one might think of other causes as well. How else might one understand the restriction to “sometimes” (ἐνίοτε) and “also” (καὶ)? These restrictions probably indicate the fact that the melancholic humor has been mentioned at the very start of the chapter as being somehow involved in katalepsis (on this issue, see p. 250 f., commentary on p. 131.19). In general, the notion that substances which fill the head have a detrimental effect on the patient’s health is a very common one851 and blood, in particular, is elsewhere said to fill the head and thereby cause damage to it.852 In Aetius’ chapter on mania, blood in the brain is also mentioned as the cause of the affection (p. 136.18–21). Caelius and Paul do not claim that katalepsis is brought about by blood but they do state that the patient’s face is red.853 According to Aetius’ chapter on phrenitis, a reddened face is a sign of a great amount of blood. See p. 178, commentary on p. 126.9. p. 132.13–17: ὥσπερ – ἀπηλλάγη: It is not clear whether this report on the young man who was full of blood was originally contained in the text of Aetius’ source or whether he himself added the story in order to provide an example and make the information given more reliable. The use of the first person plural (ἐθεασάμεθα) is especially important in this regard, insofar as it is an explicitly personal statement of the author himself, whoever that may be. It is derived from the author’s practical experience. If it does not originate from Aetius himself, he still adopted it and incorporated it into his compilation, probably because he was of the opinion that it fits very well in the context.854 Interestingly, the phrase θεᾶσθαι νεανίσκον/νεανίσκους 851 See e.g. Hippocrates, De morb. 2.4b.1–2 (135.15–136.6 Jouanna = 7.12.6–15 L.) Galen, De instr. odor. 4.8 (46.26–28 Kollesch = 2.869.15–870.2 K.), De sympt. caus. 2.4 (7.172.14–15 K.). 852 See e.g. Galen, In Hipp. De diaeta acut. comm. 2.44 (204.6 Helmreich = 15.598.16–18 K.), In Hipp. Aph. comm. 7.7 (18a.107.11–13 K.). 853 See Paul 3.10.1 (Vol. 1, 149.7 f. Heiberg), Paul 3.10.2 (Vol. 1, 150.3 Heiberg), Caelius Aurel., Cel. pass. 2.59 (166.24 Bendz), Cel. pass. 2.68 (172.11 Bendz), Cel. pass. 2.68 (172.15 Bendz). 854 For more on the use of the first person in Aetius’ compilation and the problems related to it, see Debru 1992.

260 | Commentary

is often used in Galen’s works and in one Galenic passage we even find the characterization of a young man as being full of blood.855 Probably Aetius wrote this example following a Galenic model. Specifications of time such as τρεῖς ἡμέρας (for three days) or τῇ δὲ τετάρτῃ (on the fourth day) are found all over ancient medical literature from the “Hippocratic” writings onwards.856 The symptoms mentioned here are very similar to those previously ascribed to patients who suffer from katalepsis: the young man did not close his eyelids (see p. 131.21–22, 132.1–2; see p. 253 f., commentary on p. 131.21–132.1; p. 254, commentary on p. 132.1–2), he did not move his eyes even when there was loud shouting, and he did not answer (see p. 132.2–3, p. 132.3; see p. 254 f., commentary on p. 132.2–3). All these symptoms which are related to the eyes and to speech are associated with the excess of blood in the head in the case of the young man. It is, thus, implied that in this case the blood impedes the natural functioning of the eyes and the speech. The same must apply to katalepsis since the author introduces the case of the young man as an example of a possible origin for the affection (see p. 132.13: ὥσπερ). The occurrence of a hemorrhage through the nose (αἱμορραγία … διὰ ῥινῶν) is presented as a release of the patient’s troubles (πάντων τῶν ὀχληρῶν ἀπηλλάγη)857 insofar as it evacuates the blood in the head which has caused the symptoms. The idea that a hemorrhage through the nose can bring release to a suffering patient is reflected in other writings as well.858 Aetius dedicates two chapters to hemorrhages through the nose859 and deals therein with the signs that precede a hemorrhage, including spots in front of the eyes, dimness of vision, the eyes tearing up, a red face and a headache.860 The similarities to the symptoms mentioned in our present passage are obvious insofar as most of them also pertain to the functioning of the eyes. Interestingly, Aetius also mentions παραφροσύναι as one possible preceding sign of a future hemorrhage861 and, in doing so, he clearly reflects “Hippocrates” who in De diaeta in morbis acutis deals with indications of a deranged mind (παραφροσύνη) and states that patients who have a hemorrhage through the nose recover while others

855 See Galen, De cur. rat. per venae sect. 17 (11.299.17 f. K.): θεασάμενος οὖν ἐγὼ τὸν πάσχοντα, νεανίσκον ὄντα πολύαιμον. See e.g. also Galen, De sympt. caus. 2.2 (7.157.4 K.), Meth. med. 10.3 (20.9 f. Johnston & Horsley = 10.673.17 f. K.). 856 See e.g. Hippocrates, De diaeta in morb. acut. 40.1 (53.10 f. Joly = 2.308.4 f.L.), Soranus, Gyn. 2.18.3 (65.8 Ilberg), Alexander, Therapeutica 1.16 (Vol. 1, 583.12 Puschmann). 857 In the present passge, the verb ἀπαλλάττω is used. For the use of the noun ἀπαλλαγή in the meaning “release of an affection” see e.g. Stephanus, In Hipp. Progn. comm. 3.4 (250.25 f. Duffy), Galen, De cris. 3.7 (186.1 Alexanderson = 9.731.6 K.), Galen, Meth. med. 1.2 (12.18 Johnston & Horsley = 10.8.4 K.). 858 See e.g. Galen, De sympt. diff. 6.9 (254.21–256.1 Gundert = 7.82.7–11 K.), Aetius Amid., Libri med. 5.48 (Vol. 2, 29.15 f. Olivieri). 859 See Aetius Amid., Libri med. 5.48 (Vol. 2, 28.23–29.21 Olivieri), Libri med. 6.94 (Vol. 2, 242.15– 244.11 Olivieri). 860 See Aetius Amid., Libri med. 5.48 (Vol. 2, 28.25–29.2 Olivieri). 861 See Aetius Amid., Libri med. 5.48 (Vol. 2, 29.3 f. Olivieri).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius |

261

do not.862 These statements are especially remarkable in light of the description of katalepsis at the very beginning of our chapter as a form of derangement of the mind (p. 131.17–18: εἶδος παρανοίας ἢ παρακοπῆς; see p. 249 f., commentary on p. 131.17– 18). p. 132.17–19: ὅθεν – δύναμιν: By using the phrase εἰ μὲν the text takes into account that a great amount of blood was only one possible cause of katalepsis and the phrase ἐπὶ δὲ τῶν ἄλλων (p. 132.19) refers to the cure which is suitable for patients suffering from katalepsis which has some other cause. On these issues, see p. 259, commentary on p. 132.11–13 and p. 261 f., commentary on p. 132.19–22. The text does not give clear instructions as to how those whose katalepsis is caused by blood should be distinguished from those whose is not. This lack of instruction is problematic insofar as most of the symptoms which are mentioned in the example of the young man who was full of blood also appear as symptoms of katalepsis: if the symptoms of katalepsis caused by blood are similar to those of katalepsis not caused by blood, it is difficult to distinguish the cause of the affection. For a discussion of phlebotomy, see p. 178 f., commentary on p. 126.11–12. It is a standard approach to recommend phlebotomy when the affection one wants to cure is caused by a great amount of blood. For further discussion of the advice to take account of the patient’s strength (πρὸς δύναμιν), see p. 225, commentary on p. 129.23–24. Precise descriptions on where to cut a vein (in our context it is recommended to cut the upper vein at the elbow) are commonly given in ancient medical texts.863 Paul also recommends phlebotomy for patients who suffer from katalepsis and he does so especially in those cases when their face is red (on this issue, see also p. 259, commentary on p. 132.11–13).864 p. 132.19–22: ἐπὶ – πιτύροις: On the relation between εἰ μὲν and ἐπὶ δὲ, see also p. 261, commentary on p. 132.17–19. The phrase ἐπὶ δὲ τῶν ἄλλων refers to those patients who are not full of blood (πολύαιμον) and whose katalepsis is therefore obviously not caused by blood. I have discussed the likelihood that the text probably refers to the melancholic humor at the beginning of the chapter. On this issue, see p. 259, commentary on p. 132.11–13. For a closer look at the application of enemata, see p. 181, commentary on p. 126.17–19. The characterization of the enema as being very simple (ἁπλουστέροις) thereby refers to its rather gentle effect on the human body: this should be understood in contrast to a drastic (δραστικόν) enema which is probably compounded of sharp ingredients and whose effect is therefore more intense.865 Caelius Aurelianus likewise recommends the application of a sim-

862 See Hippocrates, De diaeta in morb. acut. 42.3 (54.13–17 Joly = 2.314.8–12 L.). 863 See e.g. Hippocrates, De diaeta in morb. acut. 12.2 (45.23 f. Joly = 2.272.8–10 L.), Galen, Meth. med. 5.8 (54.15 f. Johnston & Horsley = 10.341.11 K.), De venae sect. adv. Erasistratum 4 (11.160.17 K.). 864 See Paul 3.10.2 (Vol. 1, 150.2 f. Heiberg). 865 On the juxtaposition of a simple and a drastic enema, see e.g. Aetius Amid., Libri med. 6.19 (Vol. 2, 159.4–7 Olivieri).

262 | Commentary

ple enema (clyster simplex) to patients suffering from katalepsis866 and Paul also says that enemata should be used.867 The recommendation to use a very simple enema is probably owed to the fact that the text distinguishes between enemata which should be applied in the beginning (πρῶτον μὲν) and those which should be applied afterwards (ἔπειτα): the therapy should start with the gentle treatment and only ascend to more drastic measures if it becomes necessary. The juice of bran (πιτύρων χυλός), native soda (ἀφρόνιτρον) and honey (μέλι) are mentioned as ingredients of the enema and these are likewise regarded as suitable ingredients in Aetius’ chapter on phrenitis (for further discussion, see p. 181, commentary on p. 126.17–19). This might be owed to the fact that katalepsis is understood to be midway between phrenitis and lethargia (on this issue, see p. 248 f., commentary on p. 131.17). For a closer look at the capacities of bran, native soda and honey, see p. 181, commentary on p. 126.17–19. The root of polypody (πολυπόδιον) is also said by Dioscorides to have a cleansing capacity.868 Given that it is mentioned as an ingredient that one has to add afterwards (ἔπειτα), we should understand that its effect on the body is slightly more intense than that of the ingredients of the first enema. The same recommendations are also given in the chapter on the therapy of melancholia. On this issue, see p. 470, commentary on p. 147.7–11. p. 132.22–24: τὴν δὲ – ἕρπυλλον: Both in the chapter on phrenitis and in that on lethargia it was recommended that embrocations be applied to the head (see p. 126.19–127.3; see p. 130.5–8). For a closer look at embrocations, see p. 181 f., commentary on p. 126.19. In Paul’s chapter on katalepsis he recommends the moistening of the head (τὴν κεφαλὴν ἐπιτέγγειν).869 Interestingly, the present passage shares some striking similarities with the corresponding passage in the chapter on phrenitis. Both passages deal with the temperature of the remedies and of the head to which they should be applied. In the chapter on phrenitis it is recommended that lukewarm rose oil (ῤόδινον [scil. ἔλαιον]) be applied (see p. 126.19) while the present passage recommends the application of lukewarm sweet oil. Our passage also deals with the consequences for the therapy if the patient’s head is warmer or colder, while in the chapter on phrenitis there is a general discussion about what effect cold and warm substances have on the head (see p. 126.20–127.1). For more detail, see p. 182 f., commentary on p. 126.20–127.1. The adjective χλιαρόν (lukewarm) is thereby understood to be midway between hot and cold.870 In general, as I have discussed previously (see p. 189, commentary on p. 127.20–23), sleeplessness is connected to heat while deep sleep is connected to coldness. Lethargia is, thus, an affection associated with coldness, while phrenitis (probably also due to the fact that it is under866 See Caelius Aurel., Cel. pass. 2.79 (180.7 f. Bendz). 867 See Paul 3.10.2 (Vol. 1, 150.3 f. Heiberg). 868 See Dioscorides, De mat. med. 4.186 (Vol. 2, 335.1 f. Wellmann). 869 See Paul 3.10.2 (Vol. 1, 150.13 f. Heiberg). 870 See e.g. Galen, Meth. med. 1.7 (90.23–25 Johnston & Horsley = 10.58.8 f. K.), Alexander, Therapeutica 1.13 (626.11 f. Guardasole = Vol. 1, 521.7 f. Puschmann).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

|

263

stood as an inflammation of the meninges) is associated with heat. The fact that our passage deals with the case of a warmer (εἰ μὲν θερμοτέρα) or a colder head (εἰ δὲ ψυχροτέρα) should, then, probably be understood against the background of the statement that katalepsis is midway between phrenitis and lethargia (see p. 248 f., commentary on p. 131.17). This assumption finds confirmation in the fact that our passage recommends cooking poppyhead (κωδία) together with the oil when the head seems warmer (i.e. corresponding to phrenitis) and cooking tufted thyme (ἕρπυλλος) with the oil if it seems cooler (i.e. corresponding to lethargia). The application of poppyhead was recommended in the chapter on phrenitis (p. 127.4–5, p. 127.9–11), while the application of tufted thyme was recommended in the chapter on lethargia (p. 130.5). For a closer look at the properties of tufted thyme see p. 229, commentary on p. 130.5–6. The poppyhead or poppy itself (μήκων) are generally understood as having a cooling capacity and therefore as promoting sleep.871 See also p. 183, commentary on p. 127.4–5. Thus, the present passage takes into account that some patients suffering from katalepsis might be more similar to those suffering from phrenitis (their head would be warmer) and others to those suffering from lethargia (their head would be colder), recommending that the treatments be adapted accordingly. p. 132.24–25: καὶ εἰ – αὐτοῖς: The phrase εὔλυτος κοιλία is commonly used in other writings as well872 and denotes a condition in which the stomach is relaxed and the excretions do not trouble the patients, but are passed easily. The passage refers back to the discussion of the retention of excrement (see p. 257 f., commentary on p. 132.7–8) and the phrase ἐπὶ τοῖς εἰρημένοις κλύσμασιν clearly refers to the earlier recommendation that enemata be applied (see p. 261 f., commentary on p. 132.19–22). p. 132.25–133.1: εἰ – πιτύροις: The εἰ δὲ that introduces this sentence indicates its correspondence with the previous sentence, introduced by εἰ μὲν. See also p. 263, commentary on p. 132.24–25. The phrase συναφεψεῖν τοῖς πιτύροις clearly refers back to the section dealing with enemata, where nearly the same wording is to be found (see p. 261 f., commentary on p. 132.19–22) and offers a further substance which may be cooked with the bran in order to end the retention in case the previous recommendations have not had the desired effect. The black hellebore (μέλας ἑλλέβορος) offered here is said to have a warming and cleansing capacity in Aetius’ first book.873 It is worth mentioning that the text recommends a bodily treatment for the retention, although it earlier claims that the retention does not occur because of dryness (i.e. it does not have a distinct bodily cause, if one may say so) but due to 871 See e.g. Aetius Amid., Libri med. 1.276 (Vol. 1, 109.10–17 Olivieri), Galen, De alim. fac. 1.31 (80.20–22 Wilkins = 6.548.12 f. K.). 872 See e.g. Galen, De san. tuenda 6.10.31 (189.27 Koch = 6.432.7 K.), De cris. 3.11 (204.3 Alexanderson = 9.757.3 f. K.), Alexander, Therapeutica 4 (Vol. 2, 141.18 Puschmann), Aetius Amid., Libri med. 5.118 (Vol. 2, 97.4 Olivieri). 873 See Aetius Amid., Libri med. 1.140 (Vol. 1, 70.14 f. Olivieri).

264 | Commentary

the lack of sensation. On this issue, see also p. 257 f., commentary on p. 132.7–8. One might have expected a different treatment here, for example reminding and encouraging the patients to pass feces and urine, that specifically addresses the lack of sensation. However, encouraging excretion by means of enemata also seems likely to have been an effective treatment. p. 133.1–3: πόμα – ὥραν: According to Dioscorides μελίκρατον, ὑδρόμελι and ἀπόμελι are all different names for substances made out of honey.874 Apomeli and honey-water are commonly mentioned in the ancient medical literature and very often recommended to be used in the treatment of all sorts of affections and in some texts they are even referred to as promoting evacuation (κένωσις).875 This claim would fit with the cure for retention given previously. The advice to cook certain substances for a long time (ἐπὶ πολὺ ἑψημένον) appears in other writings as well.876 The phrase πρὸς τὴν ὥραν suggests that one needs to take into account the season of the year when cooking apomeli and honey-water: this claim is comparable to Aetius’ statement in his chapter on phrenitis about adjusting the temperature of the remedies to the season (see p. 262 f., commentary on p. 132.22–24). A similar notion probably also informs the present passage. p. 133.3–4: εἰ δὲ – διδόναι: The fact that urine might be thick is commonly mentioned in medical texts.877 According to Aetius’ fifth book, urine which remains thick reveals a fermentation of thick humors.878 In the present context this is understood as a condition which the physician needs to cure by applying appropriate substances. Several texts put forward the notion that dill (ἄνηθον) and celery (σέλινον) promote urination.879 p. 133.4: τροφαὶ – παραπλήσια: In both the chapter on phrenitis and that on lethargia, our author deals with the appropriate food (τροφή) for the affections. See also p. 212, commentary on p. 128.22. An important part of the therapy is the application of food which is suitable for the particular affection. The juice of barley-gruel (πτισσάνης χυλὸς) is also mentioned in the chapter on phrenitis.880 See also p. 181, commentary on p. 126.17–19. p. 133.5–6: ὕδωρ – παύει: The adjective πολέμιον (hostile) is used in medical contexts to indicate that substances or treatments are counterproductive for the

874 See Dioscorides, De mat. med. 5.9 (Vol. 3, 12.15–13.10 Wellmann). 875 See e.g. Galen, Meth. med. 11.9 (144.18–22 Johnston & Horsley = 10.756.11–14 K.), Paul 2.17 (Vol. 1, 97.31–98.1 Heiberg), Oribasius, Synops. ad Eustath. 6.8.3 (189.22 f. Raeder). 876 See e.g. Galen, De alim. fac. 1.19 (65.10 Wilkins = 6.529.16 K.), De san. tuenda 4.6.14 (121.20 Koch = 6.275.3 f. K.). 877 See e.g. Hippocrates, De morb. popul. 1.2 (182.8 f. Kühlewein = 2.608.6 f. L.), Galen, De diff. resp. 3.9 (7.934.9 K.). 878 See Aetius Amid., Libri med. 5.35 (Vol. 2, 22.10–14 Olivieri). 879 See e.g. Paul 2.19.1 (Vol. 1, 99.11 f. Heiberg), Oribasius, Synops. ad Eustath. 6.10.2 (191.8 f. Raeder), Aetius Amid., Libri med. 5.80 (Vol. 2, 57.21 f. Olivieri). 880 See Aetius Amid., Libri med. 6.2 (Vol. 2, 126.18 Olivieri).

VI 4 On katalepsis from (the books of) Archigenes and Posidonius

|

265

pursuit of a given condition, such as health.881 The participle πινόμενον has a conditional force here. The notion that water can cause flatulence and splashing is found in other texts as well. Galen, for example, states in his Methodus medendi that, due to its coldness, water remains in the hypochondrion for a long time and thus causes splashing (κλύδωνες) and fills it with wind (πνευματοῦν).882 In De symptomatum causis, he claims that no splashing occurs in the stomach without drinking.883 In this treatise he explains that splashing occurs when there is nothing in the stomach which may be turned into vapor or when the stomach has been vehemently cooled, since this condition produces no vapors.884 According to the “Hippocratic” De morbis IV, the spleen partakes mostly of water.885 When a human drinks, the spleen draws water to itself and if it draws more water than the due measure the human suffers immediately.886 Our present passage is probably informed by a similar understanding of the spleen and, consequently, states that water stirs up the spleen. The claim that water does not stop the thirst is striking to our modern view, since we would naturally be inclined to say the contrary, an attitude mirrored in other ancient texts which also put forward the notion that one may drink water in case of thirst.887 However, Aetius says in his third book that water of all drinks excites thirst (διψῶδες).888 It remains unclear why the present passage puts forward this unusual notion and I assume that we should understand this claim not generally, but as being specific to patients suffering from katalepsis. p. 133.7: ἀλειφέσθωσαν – χειμῶνος: The advice to anoint a patient’s body (ἀλείφειν σῶμα) as part of the treatment is given in other texts as well.889 The adjective ἀνηθίνῳ here obviously goes with ἐλαίῳ.890 The fact that dill is said to have a warming capacity891 might explain why it should be applied especially in winter. For further discussion on the relation between the outside temperature and a remedy see p. 262, commentary on p. 132.22–24.

881 See e.g. Galen, Meth. med. 6.2 (128.19 f. Johnston & Horsley = 10.392.2 f. K.), Oribasius, Synops. ad Eustath. 7.22.3 (226.6 f. Raeder), Aetius Amid., Libri med. 9.30 (343.32 Zervos). 882 Galen, Meth. med. 7.6 (278.18–21 Johnston & Horsley = 10.485.8–11 K.). 883 See Galen, De sympt. caus. 3.2 (7.215.13 K.). 884 See Galen, De sympt. caus. 3.2 (7.215.10–12 K.). 885 Hippocrates, De morb. 4.40.2 (94.22 f. Joly = 7.560.17 L.). 886 See Hippocrates, De morb. 4.37.1 (90.11–17 Joly = 7.552.20–554.1 L.). 887 See e.g. Galen, De loc. aff. 4.8 (8.265.16 f. K.), Galen, Meth. med. 7.8 (308.9 Johnston & Horsley = 10.505.5 K.), Oribasius, Coll. med. rel. 5.27.11 (Vol. 1, 144.30 Raeder). 888 See e.g. Aetius Amid., Libri med. 3.165 (Vol. 1, 338.7–9 Olivieri). Similar, but only about warm water: Aetius Amid., Libri med. 9.30 (343.31 Zervos). 889 See e.g. Hippocrates, De affect. 42 (64.20 f. Potter = 6.252.1 f. L.), Aetius Amid., Libri med. 5.84 (Vol. 2, 66.6 f. Olivieri), Oribasius, Ad Eunap. 4.53.11 (458.3 Raeder). 890 See e.g. Paul 3.18.2 (Vol. 1, 162.5 Heiberg), Aetius Amid., Libri med. 6.21 (Vol. 2, 159.22 Olivieri) for this phrase. 891 See e.g. Aetius Amid., Libri med. 1.37 (Vol. 1, 39.19 Olivieri).

266 | Commentary

p. 133.7–9: ἐφ’ ὧν – στόματι: Exactly the same advice is given in the previous chapter on lethargia. See p. 238, commentary on p. 131.5–6. The occurrence of trembling was not mentioned in the chapter on katalepsis but it might be another similarity that patients suffering from katalepsis share in common with those who suffer from phrenitis.

VI 5 On karos from Posidonius Introduction to the disease concept karos The Greek noun κάρος and its derivatives καροῦν and καρῶδες are used in various ancient medical writings, although only a very small number of texts, such as the present chapter, deal with the disease concept in a systematic fashion. However, some characteristics of the affection are mentioned in almost all the texts that deal with karos, regardless of whether the discussion of karos is extensive or only occupies a few sentences. The first remarkable characteristic is the frequent connection of karos to the ventricles of the brain, to a blow to the head, or to an injury of the temporal muscles (in the present chapter, however, only the brain is mentioned as the locus affectus without further specifications). As early as the “Hippocratic” writings, which do not suggest a conceptual use of the noun, the adjective, or the verb, we find the notion that injuries of the head or, more precisely, of the temporal muscles may lead to karos.892 Galen, whose most extensive account of karos is found in De locis affectis and In Hippocratis Prorrheticum I commentaria III, further elaborates this idea, stating that karos is brought about by an affection of the temporal muscles,893 although he connects it to the ventricles of the brain894 or a blow to the head in other texts.895 Alexander’s Therapeutica does not dedicate a separate chapter to karos but treats it instead in the chapter on lethargia, in which karos is located in the anterior part of the brain.896 Paul’s chapter on lethargia also connects karos to damage done to the anterior ventricles.897 As these two examples show, karos and lethargia are often compared and said to be similar,898 and a comparison of this sort takes up most of the present chapter (see p. 133.14–20). Both affections consist in one way or another in a certain sleepiness or motionlessness, two important symptoms that 892 See e.g. Hippocrates, De art. 30 (147.1 f. Kühlewein = 4.142.6 f. L.), Hippocrates, De cap. vuln. 11.8 (76.8 f. Hanson = 3.220.16 L.). See also Galen, De loc. aff. 4.3 (8.231.15–17 K.) who cites Hippocrates in this regard. 893 See Galen, De loc. aff. 4.3 (8.231.15 f. K.). 894 See Galen, De loc. aff. 4.3 (8.232.3–6 K.). 895 See Galen, De loc. aff. 2.10.16 (374.17–20 Gärtner = 8.128.14–17 K.). 896 See Alexander, Therapeutica 1.14 (640.2–6 Guardasole = Vol. 1, 533.20–24 Puschmann). 897 See Paul 3.9.2 (Vol. 1, 147.18–24 Heiberg). 898 See e.g. also Soranus, Gyn. 4.6.1 (135.10 Ilberg). Other texts also compare karos to katalepsis: see Galen, De loc. aff. 4.3 (8.232.13–15 K.).

VI 5 On karos from Posidonius

|

267

are connected to karos in several texts. According to Galen, karos is a paralysis of the imaginative capacity899 that brings about damage to the reasoning capacity900 and causes the patient to lack sensation (ἀναίσθητος) and motion (ἀκίνητος).901 Other texts highlight the speechlessness of the patients902 or their sleepiness.903 An overview of the Galenic understanding of karos is provided by Siegel 1973, 256–258, Gundert 2009 in Galeni De symptomatum differentiis, 293 f. and Gärtner 2015 in Galeni De locis affectis, 829. When comparing modern concepts to the ancient account of karos, a loss of consciousness stands out for its similarity, especially in light of the fact that karos is often said to be brought about by a blow to the head, an injury of the temporal muscles, or during trepanation.904

Structure of the chapter p. 133.10–12: Περὶ – βληχροῦ: The origin of karos Paraphrase: The beginning of this chapter is concerned with the origin of karos: it is said to be brought about by cold, moist and phlegmatic humors which befall the brain. It is also said to occur together with fever. p. 133.12–14: παρέπεται – ὀφθαλμοί: Accompaniments of karos Paraphrase: These lines are concerned with the accompaniments of karos: the patients are said to be without sensation and without motion and their leading faculties are said to be impaired. Their eyes are also said to be closed the whole time. p. 133.14–18: διαφέρει – ὀφθαλμούς: Distinction between karos and lethargia Paraphrase: These lines deal with the distinction between karos and lethargia: patients suffering from lethargia are said to answer questions and not to be completely without speech, while patients suffering from karos are seized by the deepest sleep and do not utter any sound nor open their eyes. p. 133.18–21: θεραπεύειν – δυνάμεως: Therapy for karos Paraphrase: These lines deal with the appropriate treatment for patients suffering from karos, which is said to be similar to that which should be applied to patients who suffer from lethargia. The text mentions a thinning and cutting approach as well as the application of poultices and coverings for the stomach.

899 See Galen, De sympt. diff. 3.9 (224.10 f. Gundert = 7.60.4–6 K.). 900 See Galen, De loc. aff. 4.3 (8.231.6 f. K.). 901 See Galen, De loc. aff. 4.3 (8.231.7 f. K.). 902 See e.g. Hippocrates, Prorrh. 1.123 (93.2 Polack = 5.552.8 L.), Rufus, De corp. hum. appell. 210 (163.10 Daremberg & Ruelle). 903 See e.g. Galen, In Hipp. Prorrh. comm. 2.28 (78.1–3 Diels = 16.646.9–12 K.). 904 See e.g. Gundert 2009 in Galeni De symptomatum differentiis and Gärtner 2015 in Galeni De locis affectis who both translate κάρος with “Bewusstlosigkeit”.

268 | Commentary

Rationale of the chapter The chapter on karos presents a brief account of the disease concept, which includes discussion of its origin (i.e. cold, moist and phlegmatic humors which befall the brain, see p. 133.10–12), its accompaniments (lack of sensation, motionlessness, damage to the leading faculties, closed eyes, see p. 133.12–14), its differences to lethargia (patients suffering from lethargia answer to a question and are not completely speechless, patients suffering from karos are seized with the deepest sleep, utter no sound, do not open their eyes: see p. 133.14–18) and its appropriate treatment (it should be similar to the treatment of lethargia: see p. 133.18–21). The opening lines of the chapter present the origin and the accompaniments of the affection in a very brief but clear manner. The damage to the leading capacities which occurs in karos is only mentioned and not explained further. A reader of the chapter would probably like to find out more about the manifestation of the impairment of the leading capacities, but, as we have seen on other occasions, such further explanations are rarely given (see e.g. p. 164 f., commentary on p. 125.4–6) and an ancient recipient of Aetius’ compilation was probably thought not to be in need of such explanations. The section on the distinction between karos and lethargia poses some questions, insofar as one wonders why katalepsis, which has been dealt with in the previous chapter of Aetius’ compilation, is not mentioned at all in this context, despite there being some striking similarities between karos and katalepsis (on this issue in detail, see p. 273 – 276, commentary on p. 133.14–18). In fact, the first two symptoms of karos that are mentioned, namely lack of sensation and motion, are also found in the chapter on katalepsis. Similarly, the condition of the eyes was also dealt with there and patients suffering from katalepsis were even said to not answer in response to a question and to be speechless, two features that are used to compare karos and lethargia in the present chapter. By contrast, the characteristics of lethargia which are used to compare it to karos are not mentioned in the chapter on lethargia. These issues become more complicated when we consider that all three chapters on lethargia, katalepsis and karos are claimed to draw on quotations from Posidonius. It is, thus, natural to ask whether the similarities between the chapters might be traced back to the Posidonian source. However, if this is the case then one must wonder why the similarities between katalepsis and karos are not mentioned. I discuss in detail (see p. 273 – 276, commentary on p. 133.14–18) the possibility that the author(s) of the present chapter deemed it more important to compare karos to lethargia and the need to differentiate the two could be due to the fact that both affections are associated with sleep. However, apart from the fact that katalepsis is not mentioned (which might only be significant for modern readers), the chapter itself presents a coherent and brief account of the affection and continues with the similarities between karos and lethargia in the section on therapy, stating that the treatment in each case should be similar.

VI 5 On karos from Posidonius

|

269

Considering the chapter as a whole, it is also interesting to ask why the chapter was organized and structured in this particular way and why the information presented here was selected. First of all, one might want to know whether the information contained in the chapter does indeed stem from Posidonius and whether Archigenes, who is claimed as a source in other chapters of the sixth book, had nothing to say about karos, or at least not in a way which was convincing to Aetius as a compiler. It is interesting to note that, in dealing with accompaniments such as lack of sensation and motionlessness, as well as with the condition of the eyes, the chapter on karos makes use of the same or similar phrases as were used in the previous chapter on katalepsis (see p. 272 f., commentary on p. 133.12–13; see p. 273, commentary on p. 133.13–14). This raises the question of whether these similarities might indicate that these lines have the same author(s). However, despite the obvious similarities between the chapters, I would be cautious about tracing them back to Posidonius. Nouns such as ἀναισθησία or ἀκινησία or their derivatives are also used to describe karos in other writings (see p. 272 f., commentary on p. 133.12–13) and it is possible that they were commonly used in these contexts. The fact that the chapter on karos refers to a treatment which is similar to that for lethargia and thus mentions approaches which were dealt with in the chapter on lethargia (see p. 276, commentary on p. 133.18–20), is best interpreted as evidence for the chapters on lethargia and on karos having been put together by the same author(s). The therapy for karos is not actually spelled out in other writings and a similarity between those two chapters could indeed indicate that Posidonius was the author of both sections. It could likewise support the idea that Aetius, as skillful compiler, added certain aspects of the chapter on lethargia to that on karos even though they were not spelled out in the text of his source. Secondly, one might ask why Aetius decided to use just the information about karos that he presents in the chapter and nothing more or less. In order to discuss this question, it is necessary to compare Aetius’ account of the affection with other accounts. I do so throughout the commentary but, to sum up, it is first of all remarkable that Aetius is a member of the very small group of authors who deal with karos in detail, giving it a separate and distinct chapter, while most other authors merely mention karos a few times within their treatises (see p. 266). It is clear from this that he attached considerable importance to the affection. As regards the contents of the chapter, most aspects are also referred to in other texts (e.g. the statement that karos is accompanied by lack of sensation and motionlessness is also reflected in Aretaeus, several Galenic passages and Alexander: see p. 272 f., commentary on p. 133.12–13) but, as I have pointed out previously, the fact that within Aetius’ chapter some aspects of the treatment of karos are spelled out also appears to be unique. Paul, who also deals with karos, albeit not in a chapter of its own but in a chapter together with other affections, refers to the treatment of lethargia in the context of treating karos but does so without further elab-

270 | Commentary

orating on it.905 Even later authors, such as Theophanes Nonnus or Leo Medicus, who deal with karos in a separate chapter, merely state that its treatment is similar to that for lethargia.906 In general, the comparison between karos and lethargia seems to be an important part of Aetius’ understanding of karos.

Commentary p. 133.10: Περὶ – Ποσειδωνίου: For a detailed discussion of Posidonius as a source for the sixth book see p. 23 – 25. p. 133.10–12: ψυχρῶν – βληχροῦ: The notion that the occurrence of karos is connected to coldness is very common in the ancient medical literature: Galen mentions coldness as a cause of karos in several of his treatises,907 Paul states that moisture together with coldness causes karos908 and Alexander states that the cause of karos is not very different from the cause of lethargia,909 which was said to occur due to a great amount of phlegm and was thus connected to moisture and coldness.910 In his De locis affectis, Galen also mentions a phlegmatic humor alongside coldness as a cause of karos911 and in another passage of the same work he refers not only to a cold humor, but also to a thick and sticky humor as causes of karos.912 Moisture is also referred to as causative of karos in Galen’s In Hippocratis Prorrheticum I commentaria III.913 For a discussion of the connection between coldness and sleep, which is also said to occur in karos a bit further down (p. 133.16), see p. 189, commentary on p. 127.20–23. The brain is likewise frequently mentioned as the cause of karos in other texts as well: in his De locis affectis, Galen states that, in karos, the ventricles of the brain are affected (αἱ κοιλίαι) and especially the anterior ventricles (τὰ πρόσω).914 He thereby also distinguishes karos from katalepsis, which is said to be an affection of the posterior ventricles (see p. 255, commentary on p. 132.2–3).915 The notion that the ventricles of the brain are impaired in cases of karos

905 See Paul 3.11.2 (Vol. 1, 151.18–21 Heiberg). 906 See Theophanes 28 (112.10 Bernard), Leo 7 (115.23 f. Ermerins). 907 See e.g. Galen, De sympt. caus. 1.8 (7.143.17–144.7 K.), De loc. aff. 2.10.20 (378.7 f. Gärtner = 8.131.10 f. K.), De loc. aff. 4.3 (8.232.1–3 K.), De temp. 3.2 (95.16–19 Helmreich = 1.661.3–6 K.), De caus. morb. 3 (7.14.3–6 K.). 908 See Paul 3.11.1 (Vol. 1, 150.22–25 Heiberg). 909 See Alexander, Therapeutica 1.14 (640.2 f. Guardasole = Vol. 1, 533.21 f. Puschmann). 910 See Alexander, Therapeutica 1.14 (634.5 f. Guardasole = Vol. 1, 527.23 f. Puschmann), Therapeutica 1.14 (634.9 Guardasole = Vol. 1, 529.1 Puschmann). 911 See Galen, De loc. aff. 2.10.27 (382.10–12 Gärtner = 8.135.2–4 K.). 912 See Galen, De loc. aff. 4.3 (8.232.1–3 K.). 913 See Galen, In Hipp. Prorrh. comm. 2.28 (78.1–3 Diels = 16.646.9–12 K.). 914 See Galen, De loc. aff. 4.3 (8.232.3–6 K.). 915 See Galen, De loc. aff. 4.3 (8.232.6–9 K.). See also De loc. aff. 2.10.27 (382.5–7 Gärtner = 8.134.13– 15 K.) where the brain is also referred to as the cause of karos.

VI 5 On karos from Posidonius

| 271

is also reflected in De instrumento odorato, where the occurrence of karos is connected to a filling of the ventricles of the brain (τῶν κοιλιῶν αὐτοῦ πληρωθεισῶν).916 In other Galenic passages, we find that blows (πληγαί) to the head may also cause karos.917 In De instrumento odorato, it is explicitly stated that karos may occur during trepanation if the surgeon’s assistant immoderately compresses the ventricles of the brain,918 and a similar notion is also reflected in De locis affectis.919 Other Galenic passages point to an affection of the temporal muscles (κροταφιτῶν μύες) as bringing about karos,920 citing “Hippocrates” who states in his De articulis that blows to the temporal muscles can cause the condition.921 The temporal muscles are, according to Galen’s De usu partium, important in this regard insofar as the roots of several nerves lead to them.922 In De symptomatum causis, it is stated that karos, amongst other conditions, occurs when the arche is co-affected in respect to the brain and the nerves (see also p. 266 f.).923 Alexander also states that in karos the anterior parts of the head are more involved than are other parts and he also mentions the occurrence of karos after a failed trepanation and the resulting pressure on the bone and ventricles.924 Similarly, Paul identifies the brain as the cause of karos by stating that the condition may occur due to pressure upon the brain, such as is found when the bone fractures or when the protector of the meninges (μηνιγγοφύλαξ) compresses the anterior ventricles of the brain (τὴν ἐμπροσθίαν τοῦ ἐγκεφάλου κοιλίαν).925 In his chapter on loss of memory and reasoning, and on karos and morosis, Paul mentions that the ventricles of the brain and the temporal muscles are places in the body where a dyskrasia of substances may cause such affections.926 The Greek verb ἐπιγίγνεσθαι is commonly used in medical contexts to refer to affections or symptoms that supervene upon927 other affections or processes in the body. The term is used in precisely this way in the passage of Galen’s De symptomatum causis cited above, in the context of the occurrence of karos (see note 923), and in Paul’s account of the occurrence of karos.928 The adjective βληχρόν is commonly used to characterize

916 See Galen, De instr. odor. 6.8 (62.25 Kollesch = 2.885.14 f. K.). 917 See Galen, De loc. aff. 2.10.16 (374.18 f. Gärtner = 8.128.14 f. K.). 918 See Galen, De instr. odor. 6.8 (64.1–3 Kollesch = 2.885.15–886.3 K.). 919 See Galen, De loc. aff. 4.3 (8.232.15–233.1 K.). 920 See e.g. Galen, De loc. aff. 4.3 (8.231.15–17 K.), De usu part. 11.3 (Vol. 2, 118.3–5 Helmreich = 3.849.7–9 K.), De usu part. 11.3 (Vol. 2 118.21–23 Helmreich = 3.850.6–8 K.), In Hipp. Prorrh. comm. 2.28 (78.8–10 Diels = 16.647.2–4 K.). 921 See Hippocrates, De art. 30 (147.1 f. Kühlewein = 4.142.6 f. L.). 922 See Galen, De usu part. 11.3 (Vol. 2, 118.12–16 Helmreich = 3.849.15–850.1 K.). 923 See Galen, De sympt. caus. 1.7 (7.137.5–9 K.). 924 See Alexander, Therapeutica 1.14 (640.3–10 Guardasole = Vol. 1, 533.22–535.3 Puschmann). 925 See Paul 3.9.2 (Vol. 1, 147.21–23 Heiberg). 926 See Paul 3.11.1 (Vol. 1, 150.27–30 Heiberg). 927 See e.g. Galen, De sympt. caus. 3.1 (7.205.5 f. K.), Galen, De loc. aff. 1.1.22 (240.21 f. Gärtner = 8.13.14 f. K.), Paul 3.11.2 (Vol. 1, 151.19 Heiberg). 928 See Paul 3.9.2 (Vol. 1, 147.21 Heiberg).

272 | Commentary

fever929 and in the present context it clearly indicates a slight fever.930 A relation between karos and fever is mentioned in other writings as well: a passage of the “Hippocratic” Coacae praenotiones suggests that the occurrence of karos during fevers that arise from pain in the hypochondria is a bad sign;931 Galen in his De locis affectis states that patients may suffer from karos during the beginning of paroxysms of fever;932 and in De usu partium an affection of the temporal muscles is connected to the occurrence of spasm, fever, karos and derangement of the mind933 (this passage is also cited in Oribasius).934 In Methodus medendi the opposite picture is drawn when it is stated that apoplexia, karos and katalepsis occur without fever.935 Paul’s account of karos is most informative in this regard. He states that karos may be distinguished from lethargia by the fact that fever precedes karos and is more vehement while it follows lethargia.936 Along similar lines, he also states quite generally that karos may follow other symptoms, for it often supervenes (ἐπιγίνεται) upon paroxysms of fevers.937 p. 133.12–13: παρέπεται – ἐνεργειῶν: The notion that karos is accompanied938 by lack of sensation and motionlessness (ἀναισθησία καὶ ἀκινησία) is found in other writings as well: Aretaeus merely mentions lack of sensation and karos as possibly occurring together939 while Galen, in De locis affectis, In Hippocratis Prorrheticum I commentaria III, and in De placitis Hippocratis et Platonis, explicitly claims that karos is connected to the patients being without sensation (ἀναίσθητον) and motion (ἀκίνητον).940 In De symptomatum causis, Galen connects karos to lack of sensation (ἀναισθησία) and to a malfunction of sensation (δυσαισθησία),941 while he mentions in De diebus decretoriis that patients suffering from karos are without sensation

929 See e.g. Hippocrates, De morb. 2.8.1 (139.3 f. Jouanna = 7.16.7 L.), Galen, De diff. febr. 1.12 (7.327.16 f. K.), Aetius Amid., Libri med. 5.97 (Vol. 2, 84.10 f. Olivieri). 930 See e.g. Hippocrates, De affect. 10 (18.14–18 Potter = 6.216.21–24 L.) where a πύρετος βληχρός is contrasted with a πυρετός ἰσχυρότερος. See also the Latin translations of Aetius’ passage: Montanus, 238: cum lenta febri, Cornarius, 297: cum debili febre. 931 See Hippocrates, Coac. 32 (114.2 f. Potter = 5.592.12–594.1 L.). 932 See Galen, De loc. aff. 2.10.27 (382.5 f. Gärtner = 8.134.13 f. K.). 933 See Galen, De usu part. 11.3 (Vol. 2, 118.3–5 Helmreich = 3.849.7–9 K.). The same idea is reflected in Galen, De praesag. ex puls. 4.8 (9.406.13–16 K.). 934 See Oribasius, Coll. med. rel. 25.29.4 (Vol. 3, 64.33–35 Raeder). 935 See Galen, Meth. med. 13.21 (404.4 f. Johnston & Horsley = 10.931.6–8 K.). 936 See Paul 3.9.2 (Vol. 1, 147.18–20 Heiberg). 937 See Paul 3.9.2 (Vol. 1, 147.20 f. Heiberg). 938 The verb παρέπεσθαι refers to accompanying symptoms of the affection: see, for example, Diocles fr. 135.4 f. van der Eijk, Galen, De sympt. caus. 3.8 (7.250.8 K.), Aetius Amid., Libri med. 6.9 (Vol. 2, 143.17 Olivieri). 939 See Aretaeus 2.11.2 (33.6 f. Hude). 940 See Galen, De loc. aff. 4.3 (8.231.7 K.), In Hipp. Prorrh. comm. 2.28 (78.7 Diels = 16.646.16 K.), De plac. Hipp. et Plat. 2.6.14 (150.25 f. de Lacy = 5.266.1–3 K.). 941 See Galen, De sympt. caus. 1.8 (7.143.18–144.2 K.).

VI 5 On karos from Posidonius

|

273

(ἀναίσθητοι) and speechless (ἄφωνοι).942 In In Hippocratis Aphorismos commentarii, Galen explicitly states that karos in its proper sense refers to a sudden lack of sensation and a lack of motion in the whole body (ἡ παντὸς τοῦ σώματος αἰφνίδιος ἀναισθησία τε καὶ ἀκινησία).943 According to Alexander, the capacities belonging to sensation (τὰς αἰσθητικὰς … δυνάμεις) are very much impaired in karos.944 For a detailed discussion of lack of sensation and motionlessness, which are also mentioned as symptoms of katalepsis and which may be connected to the ventricles of the brain, see p. 254 f., commentary on p. 132.2–3. On p. 167 f., commentary on p. 125.10–15, I discuss what, according to Galen, the phrase ἡγεμονικαὶ ἐνέργειαι refers to: it subsumes the imaginative faculty, the reasoning faculty and the recollective faculty (for a discussion of these terms see p. 171 – 174, commentary on p. 125.20– 24).945 In De locis affectis, it is stated that in karos the reasoning capacities are damaged (βλάπτεσθαι δὲ καὶ τὰς διανοητικὰς αὐτῶν ἐνεργείας),946 while in De symptomatum differentiis karos is, together with katalepsis, referred to as a paralysis of the imaginative capacity (τῆς φανταστικῆς … παράλυσίς τις).947 On this issue, see p. 249 f., commentary on p. 131.17–18. Given that in the further course of the chapter the patients suffering from karos are said to fail to answer a question, to be speechless and to utter no sound (see p. 273 – 276, commentary on p. 133.14–18), it is likely that these observations point to a complete loss of imagination, reasoning and memory: all of these three leading capacities are obviously not working in patients suffering from karos. p. 133.13–14: μεμύκασι – ὀφθαλμοί: The condition of the eyes of patients who suffer from katalepsis has been discussed in detail in the previous chapter (see p. 253 f., commentary on p. 131.21–132.1; p. 254, commentary on p. 132.1–2) and some of the same words are used there (μύειν, ὀφθαλμός). The difference between katalepsis and karos is that the eyes of the patients remain open in katalepsis while they are closed in karos. This is stated explicitly in Galen’s De locis affectis as a distinctive feature.948 The observation that the patients’ eyes are closed may also be connected to the motionlessness of the whole body (ἀκινησία τοῦ παντὸς σώματος). On this issue, see p. 272 f., commentary on p. 133.12–13. p. 133.14–18: διαφέρει – ὀφθαλμούς: The fact that the author only compares karos with lethargia is remarkable for two reasons. To begin with, there are also considerable overlaps between karos and katalepsis. I have already pointed out that

942 See Galen, De diebus decr. 1.4 (9.785.13–15 K.). 943 See Galen, In Hipp. Aph. comm. 5.5 (17b.788.9–11 K.). See also Gärtner 2015 in Galeni De locis affectis, 829. 944 See Alexander, Therapeutica 1.14 (640.5 f. Guardasole = Vol. 1, 533.23 f. Puschmann). 945 On the term ἡγεμονικόν, see also de Lacy 2005 in Galeni De placitis Hippocratis et Platonis, 631; Gundert 2009 in Galeni De symptomatum differentiis, 284. 946 See Galen, De loc. aff. 4.3 (8.231.6 f. K.). 947 See Galen, De sympt. diff. 3.9 (224.10 f. Gundert = 7.60.4–6 K.). 948 See Galen, De loc. aff. 4.3 (8.232.13–15 K.).

274 | Commentary

the lack of sensation and motion is discussed as a symptom of both katalepsis and karos (see p. 273, commentary on p. 133.12–13) and I have noted the similar choice of words in describing the condition of the patients’ eyes (see p. 273, commentary on p. 133.13–14). In addition, the features which are said to be observed in patients suffering from karos, in contrast to those who suffer from lethargia, are actually discussed in the chapter on katalepsis. Patients suffering from katalepsis are said to be speechless and not to answer (see p. 254 f., commentary on p. 132.2–3) and these characteristics are now said to be distinctive of karos in comparison to lethargia. In general, the three affections lethargia, katalepsis and karos are commonly mentioned together, since they are understood as belonging to the same class of affections.949 Paul also explicitly compares karos to lethargia stating that they have the same matter but differ in the fact that fever precedes karos and follows lethargia (see also p. 272, commentary on p. 133.10–12). In comparing katalepsis with lethargia Caelius Aurelianus actually states that patients suffering from katalepsis share some characteristics with those suffering from lethargia and he, amongst others, refers in this context to the fact that it takes a long time for both types of patients to answer a question (see also p. 248, commentary on p. 131.17).950 Of course, it is also possible to detect the comparison between lethargia and karos in the framework of Aetius’ sixth book: the patients suffering from lethargia are said to utter unusual sounds (see p. 214, commentary on p. 128.24–26), which implies that they are not speechless and that they may possibly be able to give an answer to a question. However, the fact that katalepsis is not mentioned at all in the present chapter, despite the similarities between the chapter on katalepsis and that on karos, is remarkable. Given that both chapters share Posidonius as a claimed source, it is reasonable to assume that the similarities can be traced back to him. However, he is also claimed as a source for the chapter on lethargia. Thus, if we assume that all three chapters are indeed taken from Posidonius, in part at least, the question remains as to how best to explain this obviously missing reference to the chapter on katalepsis. It is, I think, not unreasonable to expect that, Aetius would, as a compiler, have tracked down such inconsistencies and amended the text accordingly. However, the fact that the comparison between lethargia and karos is spelled out in the present chapter may suggest that the author of the text (i.e. Aetius’ source and/or Aetius himself) regarded the two affections as being similar enough to make differentiation between them a priority. It is important to also keep sight of the fact that katalepsis is referred to as being midway between phrenitis and lethargia (see p. 248 f., commentary on p. 131.17) and is thus regarded as being similar to lethargia, which in turn is said, in the present chapter, to be similar to karos in the present chapter. When trying to identify exactly why karos is compared to lethargia (and not to katalepsis), the phrase

949 See e.g. Galen, De loc. aff. 3.5 (8.156.15 K.), De loc. aff. 4.3 (8.232.12–15 K.), De sympt. caus. 1.8 (7.142.14 f. K.), Soranus, Gyn. 4.6.1 (135.10 Ilberg). 950 See Caelius Aurel., Cel. pass. 2.68 (172.6–10 Bendz).

VI 5 On karos from Posidonius

|

275

ὕπνῳ βαθυτάτῳ κατέχεσθαι is highly suggestive (patients suffering from karos are said “to be seized by a very deep sleep”). Sleep as a (main) symptom of lethargia is discussed in detail in the chapter on lethargia (see p. 208, commentary on p. 128.15– 16 and note 462 with a list of passages within the chapter on lethargia which deal with sleep as its symptom), whereas there is only one small reference to sleep in the chapter on katalepsis (see p. 252 f., commentary on p. 131.21). One should probably assume that, in the case of katalepsis, sleep is not regarded as the main constituent, but that it is for lethargia and karos. The fact that the chapter distinguishes between lethargia and karos and not, as one might expect, between katalepsis and karos, might thus be attributed to the observation that both lethargia and karos are associated with sleep and therefore it is important to find a way to differentiate between them. In using the superlative βαθυτάτῳ the author probably intends to distinguish karos from lethargia in terms of the depth of the sleep in each case: the sleep of patients suffering from karos is the deepest while patients suffering from lethargia do not sleep quite as deeply, a fact which may also be reflected in the statement that the latter group is still able to answer questions and is not completely speechless. There are other writings which also connect karos to sleep. In De symptomatum causis, Galen, for example, lists karos, lethargia and koma as affections which are connected to the occurrence of sleep that is contrary to nature (πᾶσι τοῖς παρὰ φύσιν ὑπνώδεσι νοσήμασιν)951 and in In Hippocratis Prorrheticum I commentaria III he refers to karos as deep sleep (ὕπνος βαθύς)952 and makes use of the same adjective to characterize that sleep as is used in the present passage. The subclause ὡς νυττομένων αὐτῶν αἰσθάνεσθαι μέν, μὴ μέντοι φθέγξασθαι μηδ’ ἀνοίγειν τοὺς ὀφθαλμούς having consecutive force here953 adds to the explanation of the deepest sleep: the patients’ sleep is so deep that they do not utter any sound nor open their eyes even when they are pricked. The verb νύττειν is also used in the context of karos in Galen’s In Hippocratis Prorrheticum I commentaria III. There he states that one may refer to the condition of a human who is without movement and without sensation, even if one pricks him (κἂν νύττῃς αὐτὸν) or strikes him (κἂν πλήττῃς) or shouts at him (κἂν ἐμβοᾷς), as karos.954 The phrase αἰσθάνεσθαι μέν is slightly odd in the present passage, since it is said at the beginning of the chapter that the patients are without sensation (ἀναισθησία; see p. 272 f., commentary on p. 133.12–13). Given that both Latin translations also understand the subclause as having a consecutive force (ut), and given that both also translate the verb αἰσθάνεσθαι (sentiant quidem),955 there do not appear to be any good grounds for thinking that Olivieri’s edition presents a corrupt variant of the text. It thus remains unclear as to how the

951 952 953 954 955

See Galen, De sympt. caus. 1.8 (7.142.14 f. K.). See Galen, In Hipp. Prorrh. comm. 2.28 (78.2 f. Diels = 16.646.11 f. K.). See Smyth § 3000. See Galen, In Hipp. Prorrh. comm. 2.28 (78.7–9 Diels = 16.646.16–647.2 K.). See Cornarius, 298; Montanus, 238.

276 | Commentary

αἰσθάνεσθαι should be understood here but it is not, in my opinion, intended to stand in contrast to the deepest sleep. p. 133.18–20: θεραπεύειν – ποιουμένους: These lines continue the comparison between karos and lethargia by stating that the treatment of patients suffering from karos should be nearly identical to the treatment of those who suffer from lethargia. This again highlights the fact that the author understood the two affections as being similar to one another. For a discussion of the application of thinning and cutting substances see p. 226, commentary on p. 129.26. The fact that the author suggests the application of substances which are even more thinning and cutting opens up the possibility that there is a greater quantity of colder and more phlegmatic humor present in the brain of patients suffering from karos than there is in those suffering from lethargia. This might, again, be the reason for the deepest sleep which occurs in karos (for a discussion of the connection between coldness and deep sleep, see p. 189 f., commentary on p. 127.20–23). p. 133.20–21: μετεχέτω – δυνάμεως: The application of poultices (καταπλάσματα) is also recommended in the chapter on lethargia in the context of an inflamed hypochondrion (for further discussion, see p. 231 f., commentary on p. 130.10–12). The noun ἐπίθεμα is not mentioned in the chapter on lethargia but it may correspond to the advice to not leave the parts of the body which have been covered with the poultice naked after its application (see p. 233, commentary on p. 130.16– 18). The recommendation that the poultices and coverings should be warming (θερμαίνειν) probably follows from the view that coldness is the cause of karos. The mention of a strengthening capacity (τῆς τονωτικῆς δυνάμεως) is also linked with a warming capacity in other texts956 and sometimes connected to being good for the stomach (εὐστόμαχος).957

VI 6 On koma from (the books of) Posidonius Introduction to the disease concept koma The Greek noun κῶμα and its derivative κωματώδες are used in various medical writings, although few texts deal as systematically with the disease concept as does the present chapter in Aetius’ compilation. While our chapter states that koma can be diagnosed when “sleep occurs to a higher degree than is in accordance with nature” (p. 133.25–26), other texts connect koma to deep sleep but also to sleeplessness and to light sleep. In several “Hippocratic” treatises, koma is related both to

956 See e.g. Aetius Amid., Libri med. 1.130 (Vol. 1, 65.2 f. Olivieri), Libri med. 1.131 (Vol. 1, 65.28–66.1 Olivieri). 957 See e.g. Paul 7.3 (Vol. 2, 270.20 Heiberg), Alexander, Therapeutica 4 (Vol. 2, 131.23 Puschmann).

VI 6 On koma from (the books of) Posidonius

|

277

sleep958 and to temporary sleeplessness (ἀγρυπνία, ἄγρυπνον).959 According to several Galenic treatises, patients suffering from koma are not able to stay awake with open eyes, they sometimes doze, and they sometimes suffer from deep sleep or light sleep or even from sleeplessness.960 While these texts seem to suggest that koma involves phases of both sleep and sleeplessness, other texts rather seem to suggest the existence of a separate form of the disease, which they call “wakeful koma”. Alexander of Tralleis, for example, mentions the noun koma in the context of phrenitis, stating that if phlegm is mixed with yellow bile, the so-called “false phrenitis” occurs along with the “wakeful koma” (ἄγρυπνον κῶμα).961 In a further explanation of the symptoms of this “false phrenitis”, Alexander mentions the adjective κωματώδες again to describe the kind of sleep these patients endure. It becomes clear from this description that the patient is temporarily sleepless and temporarily suffers from deep sleep,962 which is very similar to what we read in the other accounts of koma. Paul makes comparable statements in his chapter on phrenitis, where we read that if phlegmatic humor is mixed with bilious humor, this affection is called “wakeful koma”.963 However, in a different chapter it becomes clear that Paul takes katalepsis and “wakeful koma” to be synonyms.964 Common to most of the texts dealing with koma is the claim that the cause of this affection is found in the head or the brain and that it is brought about by coldness and moisture,965 though, strangely, the present chapter mentions moist and warm vapors as causative of koma (for more detail see p. 281 f., commentary on p. 133.22–24). With regard to the origin of koma, Galen is quite detailed in De symptomatum differentiis when he states that koma occurs “at the first sensory organ” (κατ’ αὐτὸ τὸ πρῶτον αἰσθητικὸν),966 which is the brain,967 and that it is a defective and weak movement (κίνησις … ἐλλιπὴς καὶ ἄτονος) of the imaginative capacity (τῆς φανταστικῆς).968 The latter information likewise applies to lethargia.969 In De symp958 See e.g. Hippocrates, De morb. popul. 7.39.7 (76.17 Jouanna = 5.408.4 L.), De morb. popul. 7.5.6 (54.1 Jouanna = 5.374.12 f. L.), Coac. 177 (146.1 Potter = 5.622.7 L.). 959 See e.g. Hippocrates, De morb. popul. 3.3. (225.4 f. Kühlewein = 3.70.8 f. L.), De morb. popul. 3.17.αʹ (232.23 f. Kühlewein = 3.104.1 L.), De morb. popul. 3.ιαʹ (222.15 f. Kühlewein = 3.62.1 f. L.). 960 See Galen, In Hipp. Epid. III comm. 1.11 (36.8–11 Wenkebach = 17a.540.3–7 K.), In Hipp. Prorrh. comm. 3.1 (106.7–10 Diels = 16.705.10–706.4 K.). See also Galen, De com. sec. Hipp. 2.10–12 (187.10– 188.6 Mewaldt = 7.652.14–654.10 K.). 961 See Alexander, Therapeutica 1.13 (618.21–24 Guardasole = Vol. 1, 513.6–8 Puschmann). 962 See Alexander, Therapeutica 1.13 (618.29–620.2 Guardasole = Vol. 1, 513.13–15 Puschmann). 963 See Paul 3.6.1 (Vol. 1, 144.28–31 Heiberg). 964 See Paul 3.10.1 (Vol. 1, 149.1–31 Heiberg). 965 See e.g. Galen, De sympt. caus. 1.7 (7.137.5–9 K.), De sympt. diff. 3.6 (222.1 f. Gundert = 7.58.9–11 K.), De loc. aff. 2.10.27 (382.5–7 Gärtner = 8.134.13–15 K.), Ars med. 8.10 (298.10 f. Boudon = 1.329.3 f. K.), De sympt. caus. 1.8 (7.143.8–10 K.). 966 See Galen, De sympt. diff. 3.6 (222.1 f. Gundert = 7.58.9–11 K.). 967 See Gundert 2009 in Galeni De symptomatum differentiis, 289. 968 See Galen, De sympt. diff. 3.9 (224.9–13 Gundert = 7.60.3–8 K.). 969 See Galen, De sympt. diff. 3.9 (224.10 Gundert = 7.60.8 K.).

278 | Commentary

tomatum causis, koma is listed alongside karos, katalepsis, and others as an affection which is connected to stomach problems and to co-affection of the brain and nerves.970 A similar origin is also suggested in the present chapter, where vapors that are carried up from the lower parts to the head are said to be causative of koma (see p. 282 f., commentary on p. 133.22–24). Despite the fact that modern medical terminology uses the term “coma” to describe complete unconsciousness, the concept that underlies the Greek κῶμα is not characterized by such a state. Rather, it consists in deep sleep with potential phases of sleeplessness or light sleep and strange utterances.971 For short discussions of koma see Thumiger 2017a, 178 f., Gärtner 2015 in De locis affectis, 828, Gundert 2009 in Galeni De symptomatum differentiis, 289 and Siegel 1973, 257.

Structure of the chapter p. 133.22–24: ἀτμοὶ – κῶμα: The origin of koma Paraphrase: The beginning of this chapter is concerned with the origin of koma, which is said to be brought about by the moist and warm vapors which are carried to the head during fevers and fill it up. p. 133.25–134.3: διάγνωσις – ἔχουσι: The diagnosis of koma Paraphrase: These lines are concerned with the diagnosis of koma and identify the symptoms of the affection which allow the physician to recognize its presence: the patients sleep more than is in accordance with nature, they make strange utterances during sleep, their bodily condition is irregular, their lower jaw is slackened during sleep and they often fall asleep again instantaneously and have a moist head. p. 134.3–10: θεραπεία – ἀπομέλιτι: Therapy for koma Paraphrase: These lines are concerned with the appropriate therapy for koma. It is recommended that embrocations made of rose oil be applied to the head and also claimed that embrocations made of dill should be applied if the head is cooler than it should be. Finally, the application of suppositories is recommended and information on suitable foodstuffs is given.

Rationale of the chapter The chapter on koma presents a brief account of the disease concept which includes: a discussion of its origin (i.e. moist and warm vapors which are carried up to the head from lower parts of the body: see p. 133.22–24); remarks on the diagnosis of

970 See Galen, De sympt. caus. 1.7 (7.137.5–9 K.). 971 Making strange utterances is one of the symptoms that is mentioned in the present chapter: See Aetius Amid., Libri med. 6.6 (Vol. 2, 133.26 Olivieri).

VI 6 On koma from (the books of) Posidonius

|

279

koma, which consist of a list of symptoms and accompaniments which are typical of the affection (more sleep than is in accordance with nature, strange utterances during sleep, “uneven condition of the body”, slackened lower jaw during sleep, falling asleep again instantaneously after having been woken up, having a moist head: see p. 133.25–134.3); and the appropriate therapy (see p. 134.3–10). The opening lines of the chapter present the origin of koma in a clear way and are similar to those of the previous chapter on karos: both openings mention substances which affect the brain or the head or are carried up to them and thus bring about the affection. As far as the substances which are mentioned as being causative of koma are concerned, it is striking that warm (and moist) vapors are referred to, since koma is usually connected to coldness (see p. 281, commentary on p. 133.22–24), as are all affections which are related to sleep. Even if one might be surprised about this statement in the beginning, it becomes clear in the section on the appropriate therapy for the affection that the therapeutic remarks are, indeed, oriented towards warmth as one cause of koma, insofar as the recommended substances aim to counteract this warmth (see p. 286 f., commentary on p. 134.3–4). This is a nice example of how the author(s) of the text and Aetius himself, the compiler, create a coherent account of the disease concept in which the cause of, and therapy for, koma are perfectly aligned. The lack of remarks the reader finds here concerning the differential diagnosis between similar affections is notable in other contexts as well (see p. 268; see p. 245 f.). In the section on the diagnosis of koma one misses, in particular, any concrete information regarding the differentiation between lethargia and koma, since symptoms such as making strange utterances or the slackening of the lower jaw have also been mentioned in the chapter on lethargia. Given that the strange utterances of the patients suffering from lethargia are connected to their waking up, while the patients suffering from koma are said to make strange utterances during sleep, one might assume that this is a distinctive feature of the two affections, but, if that is the case, it is not spelled out in the chapter on koma (see p. 285, commentary on p. 133.26). The statement that the physician may recognize that a patient is suffering from koma if sleep occurs “to a higher degree” than it naturally would, is rather vague. The question remains as to how one is supposed to distinguish sleep which occurs to a higher degree than it naturally would from the deepest sleep, which Aetius discusses in his previous chapter on karos. Which of the two affections causes the patients to sleep more? Does the characterization of sleep as being the deepest only refer to its intensity, perhaps, while the sleep that occurs to a higher degree than it naturally would refers to its length and to the overall amount of time that the patients are asleep? How is the sleep of patients suffering from lethargia related to that which occurs in karos and koma? These are questions which arise when one compares the chapter on koma to the preceding chapters. No answers to these questions are provided within the chapter. One must, of course, not lose sight of the fact that there are also clear differences between the affections and these may help to distinguish them (e.g. the causes of

280 | Commentary

the affections are different). However, some aspects remain similar and the differences between the affections would be much clearer if the similarities and differences were addressed within the chapter and spelled out explicitly. The author claims to have taken the chapters on karos and koma from Posidonius while that on lethargia is said to be taken from Posidonius and Archigenes. One wonders, then, to what extent the information contained in these chapters does indeed stem from the same author, Posidonius, and how he dealt with the similarities between the affections and whether he even perceived them as striking (see on this issue also p. 268). As far as the first question is concerned, it may be that the similarities between the symptoms of lethargia and koma (strange utterances, slackening of the lower jaw) derive from Posidonius but it is also possible that they reflect Aetius’ own choice of words. Apart from these different clusters of questions, the chapter on koma presents a brief but coherent account of the affection. As I have stressed earlier in this section, the therapeutic recommendations given at the end of the chapter perfectly match the information on the cause of the affection which is provided at the beginning of the chapter. On these issues, see p. 286 f., commentary on p. 134.3–4, p. 288 f., commentary on p. 134.9–10. Taking the chapter as a whole, it is also worth asking how the information within it was selected and why the particular form of organization and structure was chosen. To begin with, we can ask whether the information contained in the chapter does indeed stem from Posidonius and whether Archigenes, who is said to be cited in other chapters of the sixth book, did not deal with koma or at least not in a way that was convincing to Aetius as compiler. I have partly addressed this question above, but what needs to be added here is that Aetius makes the striking claim that the chapters on karos and koma are both cited from Posidonius only. Both chapters are comparable in their brevity and conciseness and one might reasonably assume that these aspects can be traced back to Posidonius’ original arrangement. Secondly, we can ask why Aetius decided to include only and all the information on koma that we find in this chapter. In order to discuss this question it is necessary to compare Aetius’ account of the affection with other accounts. Detailed discussion of this issue will be found throughout the commentary below but, in short, it is remarkable that Aetius deals with this affection in one distinct chapter, since not many other authors do so (see p. 276 – 278). He obviously attached some importance to the affection. As regards the contents of the chapter, some aspects are also referred to in other texts (e.g. the notion that koma is connected to sleep is also reflected in many other texts: see p. 283 – 285, commentary on p. 133.25–26), whereas other aspects appear to be connected to koma explicitly only in Aetius’ chapter (e.g. the strange utterances, on which see p. 285, commentary on p. 133.26, or the slackening of the lower jaw, see p. 285 f., commentary on p. 134.1). What is clearly remarkable in Aetius’ chapter is the statement that koma is brought about by warm (and moist) vapors (see p. 281 f., commentary on p. 133.22–24), as discussed above.

VI 6 On koma from (the books of) Posidonius | 281

Another notable feature of Aetius’ account of koma is the importance he also attaches to the discussion of its appropriate therapy. This makes it plain that Aetius wanted to ensure that the user of his handbook was able to access all the important information that would be needed in order to cure a patient suffering from koma.

Commentary p. 133.22: Περὶ – Ποσειδωνίου: For a general discussion of Posidonius as a source for the sixth book, see p. 23 – 25. p. 133.22–24: ἀτμοὶ – ἐργάζονται: The beginning of the chapter is striking insofar as it mentions warm vapors in the context of the onset of koma. This departs from the norm, in that koma is usually connected to coldness, as are all affections related to sleep (on this issue, see p. 189, commentary on p. 127.20–23; see also p. 270, commentary on p. 133.10–12).972 In the fourth book of his compilation Aetius himself cites Galen in saying that cold and moist mixtures of the brain (αἱ δὲ ὑγραὶ καὶ ψυχραὶ κράσεις τοῦ ἐγκεφάλου) bring about koma.973 It is tempting to assume that the adjective θερμοὶ was not originally contained in Aetius’ text, but Olivieri’s critical apparatus does not list any alternative readings here and an examination of the manuscript Parisinus suppl. gr. 1240 (Pa) confirms that it transmits this reading.974 Given that the section on the therapy for koma recommends the application of rose oil, which is generally regarded as cooling (see further on this issue p. 287, commentary on p. 134.3–4), it is, indeed, most likely that θερμοὶ was the original reading. A possible explanation for the assumption that warm vapors are causative of koma could be that, as well as being related to sleep, within Aetius’ chapter koma is also related to waking up again and other texts even put forward the notion that it might be associated with phases of sleeplessness (these issues will be discussed further on p. 284, commentary on p. 133.25–26). In a passage of Galen’s In Hippocratis Epidemiarum librum sextum commentaria I–VI, patients whose heads are heavy and full of vapors and warm humors (ἡ κεφαλὴ βαρεῖα καὶ πλήρης ἀτμῶν τε καὶ θερμῶν χυμῶν) are said to be vulnerable to koma.975 In this Galenic passage some of the same words (ἀτμός and θερμός) are used as in Aetius’ chapter. In contrast to the connection between warmth and koma, the involvement of moisture in

972 See e.g. Galen, De loc. aff. 2.10.20 (378.5–8 Gärtner = 8.131.7–11 K.), Ars med. 8.10 (298.10 f. Boudon = 1.329.3 f. K.), De temp. 3.2 (95.16–19 Helmreich = 1.661.3–6 K.), De sympt. caus. 1.8 (7.143.8–10 K.), Paul 1.63 (Vol. 1, 43.19–21 Heiberg), Oribasius, Synops. ad Eustath. 5.46.15 (175.13 f. Raeder). 973 See Aetius Amid., Libri med. 4.72 (Vol. 1, 400.3 f. Olivieri). 974 See Pa, folio 247v. 975 See Galen, In Hipp. Epid. VI comm. 1.2 (10.21f . Wenkebach = 17a.806.16–807.1 K.).

282 | Commentary

the onset of koma is commonly mentioned in other texts as well.976 Moisture is also regarded as being involved in the onset of lethargia and karos (see p. 225 f., commentary on p. 129.24–26; see p. 270, commentary on p. 133.10–12). The head or the brain are commonly referred to as playing a crucial role in the onset of koma: I have already cited at the beginning of this entry the passage of Aetius’ fourth book which puts forward the notion that koma is brought about by cold and moist mixtures of the brain.977 This is a quote from Galen’s Ars medica,978 which is also cited in Paul and Oribasius.979 In Galen’s De symptomatum causis the brain is said to be burdened (βαρύνηται) in koma980 and a similar statement is found in De comate secundum Hippocratem.981 To give just two examples, in De locis affectis koma is connected to a cooling of the brain982 and in De symptomatum differentiis it is stated that koma occurs at the first sensory organ (κατ αὐτὸ τὸ πρῶτον αἰσθητικόν), which is the brain.983 At least as early as the “Hippocratic” writings koma is connected to conditions of the head such as heaviness or pain.984 The expression τὰ ὑποκείμενα is used here to refer to bodily parts, which are located somewhere beneath the head.985 This bodily region is not further specified but, given that ancient medical texts often mention that substances are carried up to the brain or the head from the abdominal region986 or deal with a co-affection between the abdominal region and the head (see on this issue p. 201 – 203, commentary on p. 128.6–9), one might assume that the expression refers to this region here as well. See also p. 288 f., commentary on p. 134.9–10, for a discussion of therapeutic recommendations which support this interpretation. Phrases such as ἐπὶ τὴν

976 See e.g. Galen, Ars med. 8.10 (298.10 f. Boudon = 1.329.3 f. K.), De sympt. caus. 1.8 (7.143.8–10 K.), In Hipp. Epid. III comm. 3.17 (119.15 f. Wenkebach = 17a.665.16–666.1 K.), Paul 1.63 (Vol. 1, 43.19–21 Heiberg), Oribasius, Synops. ad Eustath. 5.46.15 (175.13 f. Raeder). 977 See Aetius Amid., Libri med. 4.72 (Vol. 1, 400.3 f. Olivieri). 978 See Galen, Ars med. 8.10 (298.10 f. Boudon = 1.329.3 f. K.). 979 See Paul 1.63 (Vol. 1, 43.19–21 Heiberg), Oribasius, Synops. ad Eustath. 5.46.15 (175.13 f. Raeder). 980 See Galen, De sympt. caus. 1.8 (7.143.8–10 K.). 981 See Galen, De com. sec. Hipp. 4.2 (193.3 f. Mewaldt = 7.664.1 f. K.) See also Galen, De com. sec. Hipp. 4.2 (193.8–10 Mewaldt = 7.664.7–9 K.). 982 See Galen, De loc. aff. 2.10.27 (382.5–7 Gärtner = 8.134.13–15 K.). 983 See Galen, De sympt. diff. 3.6 (222.1 f. Gundert = 7.58.9–11 K.). For this interpretation see Gundert 2009 in Galeni De symptomatum differentiis, 289. 984 See e.g. Hippocrates, De morb. popul. 3.ιαʹ (222.15 f. Kühlewein = 3.62.1 f. L.), Hippocrates, Prorrh. 1.1 (75.2–4 Polack = 5.510.2–4 L.), Coac. 175 (144.16 f. Potter = 5.622.1 f. L.), Hippocrates, De morb. 2.25.1 (158.10–13 Jouanna = 7.38.19–21 L.). 985 See e.g. Galen, De temp. 2.6 (74.8 Helmreich = 1.627.6 K.), De usu part. 9.5 (Vol. 2, 18.14 Helmreich = 3.707.14 f. K.), De usu part. 4.9 (Vol. 1, 211.11 Helmreich = 3.288.8 K.) for the use of ὑποκεῖσθαι in the meaning “to be located beneath”. 986 See e.g. Galen, De loc. aff. 1.6.2 (282.9–13 Gärtner = 8.48.16–49.4 K.), Pseudo-Galen, Def. med. 127 (19.382.1–3 K.), Aetius Amid., Libri med. 5.118 (Vol. 2, 96.13 f. Olivieri).

VI 6 On koma from (the books of) Posidonius

|

283

κεφαλὴν ἀναφέρεσθαι are commonly used in ancient medical texts987 and are also mentioned in the further course of Aetius’ sixth book (see p. 296 f., commentary on p. 134.11–13; see p. 455 – 457, commentary on p. 146.8–13). The present chapter posits a connection between fever and koma and such a connection is also referred to in other treatises. Many “Hippocratic” writings mention fever and koma in the same context and as occurring together988 and Galen states in his De locis affectis that patients suffer from koma (and karos) during the beginning of the paroxysm of a fever when the brain has been heavily cooled.989 We also find a passage in Oribasius in which fever and koma are said to occur together.990 All affections dealt with in the previously discussed chapters of Aetius’ sixth book, namely lethargia, katalepsis and karos, are associated with fever as well: see p. 205 f., commentary on p. 128.12–13, p. 252, commentary on p. 131.20–21, and p. 271 f., commentary on p. 133.10–12. p. 133.24: ὅπερ – κῶμα: This subordinate clause is similar to a clause in the chapter on katalepsis, where the author also referred to οἱ ἰατροὶ in the context of the labeling of the affection. See p. 250, commentary on p. 131.18–19. The reference to “the physicians” is obviously meant to highlight, on the one hand, that they have a name for the affection, and, on the other, that they all have the same name for it. p. 133.25: διάγνωσις – ἔσται: The phrase διάγνωσις σαφής is used mainly in Galenic writings.991 For a discussion of the Galenic use of διάγνωσις in general see, for example, Gärtner 2015 in Galeni De locis affectis, 453 and Fortuna 2001. For an overview of the “Hippocratic” use of the noun, see Preiser 1978. For a general overview of diagnosis in ancient medical literature, see Potter 2005. In the present context the phrase διάγνωσις σαφής is used to indicate that one determines whether a patient is suffering from koma or not by comparing his or her symptoms with those listed (p. 133.25–134.3). p. 133.25–26: ὕπνου – φύσιν: The notion that koma is connected to sleep is reflected in many other texts as well. The “Hippocratic” writings already suggest a connection between koma and sleep992 while in Galen’s De causis pulsuum koma is referred to as a condition which is contrary to nature (παρὰ φύσιν διαθέσεις) and connected to sleep.993 In In Hippocratis Aphorismos commentarii it is described as 987 See e.g. Galen, De usu part. 11.14 (Vol. 2, 155.8 f. Helmreich = 3.901.5 K.), Galen, De loc. aff. 1.6.5 (286.5 Gärtner = 8.51.12 f. K.), Aetius Amid., Libri med. 1.385 (Vol. 1, 138.22 Olivieri). 988 See e.g. Hippocrates, De morb. popul. 3.6 (227.3f . Kühlewein = 3.80.6 f. L.), De morb. popul. 3.11 (229.14–16 Kühlewein = 3.90.14–92.2 L.), Prorrh. 1.74 (84.1 f. Polack = 5.528.11 f. L.). 989 See Galen, De loc. aff. 2.10.27 (382.5–7 Gärtner = 8.134.13–15 K.). 990 See Oribasius, Coll. med. rel. 45.30.26 (Vol. 3, 193.13–15 Raeder). 991 See e.g. Galen, De loc. aff. 1.1.9 (230.21–232.1 Gärtner = 8.5.13 f. K.), De loc. aff. 5.8 (8.374.2 f. K.), Meth. med. 14.16 (504.28 Johnston & Horsley = 10.1000.1 K.). 992 See e.g. Hippocrates, De morb. popul. 4.46 (130.19–20 Smith = 5.188.5 f. L.), De morb. popul. 7.39.7 (76.17 f. Jouanna = 5.408.4 f. L.), Coac. 177 (146.1 Potter = 5.622.7 L.). See also e.g. Aretaeus 2.1.4 (16.9 Hude). 993 See Galen, De caus. puls. 3.10 (9.140.12–14 K.).

284 | Commentary

sleep which goes beyond the natural due proportion (τὴν κατὰ φύσιν συμμετρίαν),994 in De comate secundum Hippocratem Galen discusses several interpretations of the Hippocratic understanding of koma and all of these are related to sleep,995 and in In Hippocratis Epidemiarum librum tertium commentaria III Galen states that Hippocrates understood koma as falling asleep (τὴν εἰς ὕπνον καταφοράν; for further discussion of the noun καταφορά see also p. 210, commentary on p. 128.18–19).996 Many more examples could also be mentioned. Later medical authors, such as Leo Medicus and Theophanes Nonnus, also refer to koma as deep sleep which is contrary to nature (ὁ βαθὺς καὶ παρὰ φύσιν ὕπνος).997 Koma is not exclusively associated with sleep in other medical writings but is also connected with phases of sleeplessness. In the “Hippocratic” writings we find connections between koma (κῶμα /κωματώδες) and sleeplessness (ἀγρυπνία / ἄγρυπνον)998 and Galen discusses, especially in In Hippocratis Epidemiarum librum tertium commentaria III and in In Hippocratis Prorrheticum I commentaria III, that patients suffering from koma can hardly be roused, cannot keep their eyes open, and may sleep deeply or lightly or even be sleepless at times.999 Paul, as well as later medical authors such as Leo Medicus and Theophanes Nonnus, uses the phrase τὸ ἄγρυπνον κῶμα as a technical term to refer to an affection of its own. Paul’s chapter on katalepsis is entitled περὶ κατόχου ἤγουν ἀγρύπνου κώματος and in the course of the chapter he suggests that it is a single affection that has two different names.1000 Both Leo and Theophanes present a chapter on koma and another, separate one, on “wakeful koma” (ἄγρυπνον κῶμα), in which latter they state that patients suffering from “wakeful koma” are between being sleepless and asleep and that the affection is brought about by phlegm and bile.1001 There is also at least one passage in Galen’s De locis affectis which suggests a technical use of the phrase ἄγρυπνον κῶμα.1002 Sleep is also mentioned as a symptom of lethargia and karos (see p. 208, commentary on p. 128.15–16 and especially note 462; see p. 274 – 276, commentary on p. 133.14–18). Given that these three affections are all related to sleep, one might wish to learn more about the distinction between them but nothing is provided on this

994 See Galen, In Hipp. Aph. comm. 2.3 (17b.457.9 f. K.). 995 See Galen, De com. sec. Hipp. 1.1 (181.2–7 Mewaldt = 7.643.4–10 K.). 996 See Galen, In Hipp. Epid. III comm. 1.11 (36.7 f. Wenkebach = 17.540.2 f. K.). 997 See Leo 8 (117.3 Ermerins), Theophanes 29 (114.3 f. Bernard). 998 See e.g. Hippocrates, De morb. popul. 3.3. (225.4 f. Kühlewein = 3.70.8 f. L.), De morb. popul. 3.17.αʹ (232.23 f. Kühlewein = 3.104.1 L.), De morb. popul. 3.ιαʹ (222.15 f. Kühlewein = 3.62.1 f. L.), Prorrh. 1.74 (84.1 f. Polack = 5.528.11 f. L.). 999 See Galen, In Hipp. Epid. III comm. 1.11 (36.8–11 Wenkebach = 17a.540.3–7 K.), Galen, In Hipp. Prorrh. comm. 3.1 (106.7–10 Diels = 16.705.10–706.4 K.). See also Galen, De com. sec. Hipp. 2.10–12 (187.10–188.6 Mewaldt = 7.652.14–654.10 K.). 1000 See Paul 3.10.1 (Vol. 1, 149.22 f. Heiberg). 1001 See Leo 9–10 (117.11–22 Ermerins), Theophanes 31 (118.6–14 Bernard). 1002 See Galen, De loc. aff. 3.6 (8.163.16 K.).

VI 6 On koma from (the books of) Posidonius |

285

issue in the present chapter. For further remarks on the similarity between koma and lethargia, see p. 285, commentary on p. 133.26 and p. 279. p. 133.26: φθέγγονται – ἀλλόκοτα: The expression ἀλλόκοτα φθέγγονται appears already in the chapter on lethargia, where it is said that patients make strange utterances when waking up (see p. 214, commentary on p. 128.24–26). Here we see a difference between lethargia and koma, although it is not explicitly spelled out in the chapter: in lethargia patients make unusual utterances when awake (διεγειρόμενοι), in koma they do so during sleep (ἐν τοῖς ὕπνοις). p. 133.26–134.1: τὸ – ἔχουσι: This part of the sentence is difficult to grasp because it is not further explained how the noun σῶμα and the adverb ἀνωμάλως are thought to be interrelated. It is unclear whether the sentence deals with the inner or the outer constitution of the body, and so whether we are to envisage that the extremities are in some way uneven or that some inner bodily parts or even their mixture is uneven. In his De sanitate tuenda Galen deals with two kinds of bad conditions of the body and he thereby says that the elementary and primary parts of the body may either be evenly (ὁμαλῶς) or unevenly (ἀνωμάλως) mixed.1003 He further explains that he speaks of “evenly” if all bodily parts equally turn to one dyskrasia and thus become colder, warmer, more dry or more moist than is befitting1004 and that he speaks of “unevenly” if they do not equally turn to the same dyskrasia, but if one part becomes warmer, the other one colder, etc.1005 Parts of this Galenic passage are also cited in Aetius’ fourth book.1006 Along similar lines one might assume that the present passage also refers to an uneven mixture (the uneven dyskrasia is a common Galenic concept).1007 One might likewise assume that the reference to an uneven body in the present passage refers to its outer appearance, meaning that, for example, one arm is in a different condition than the other arm or the upper part of the body is in a different condition than the lower part of the body, and so on. Unfortunately, these assumptions cannot be verified because we lack further information on the topic but, given that the following statement is concerned with the slackened lower jaw of the patients (see p. 285 f., commentary on p. 134.1) and thus also deals with the condition of outer bodily parts, I incline towards accepting this assumption, despite the lack of comprehensive proof. p. 134.1: τὴν – χαλωμένην: The observation that the lower jaw of the patients is slackened is also discussed in the chapter on lethargia (see p. 220 f., commentary on

1003 See Galen, De san. tuenda 6.2.1 (169.8–10 Koch = 6.384.1–4 K.). 1004 See Galen, De san. tuenda 6.2.2 (169.11–20 Koch = 6.384.5–11 K.). 1005 See Galen, De san. tuenda 6.2.2 (169.16–20 Koch = 6.384.5–11 K.). 1006 See Aetius Amid., Libri med. 4.52 (Vol. 1, 393.9–16 Olivieri). 1007 Galen devoted a treatise to the uneven dyscrasia which is entitled περὶ ἀνωμάλου δυσκρασίας βιβλίον (Galen, De inaequ. intemp. (142–173 García Novo = 7.733–752 K.)). García Novo 2010 in Galen On the anomalous dyskrasia, 117 summarizes the concept as follows: “In the homogeneous dyskrasia, the whole body gets uniformly sick, while in the anomalous dyskrasia either a part, a humour in the whole body, or the body in a disontinuous way, gets sick in a heterogeneous way.”

286 | Commentary

p. 129.13–15) where it is part of a list of abnormal bodily conditions observable in patients suffering from lethargia, including a corpse-like appearance of the whole body, an uncontrolled movement of arms and legs, a mouth that does not shut, and intense wheezing. The phrase ἐν τῷ καθεύδειν is comparable to the previously used phrase ἐν τοῖς ὕπνοις (see p. 285, commentary on p. 133.26) insofar as both highlight that what happens to the patients or the way they behave (in the present context the slackening of the lower jaw, in the previous context their strange utterances) occurs during sleep. These phrases thus emphasize that koma is an affection in which the patients sleep more than they naturally would (see p. 283 – 285, commentary on p. 133.25–26). p. 134.1–2: καὶ διεγερθέντες – ὕπνῳ: A similar statement is also made in the chapter on lethargia, where the participle διεγειρόμενοι and the phrase πάλιν εἰς ὕπνον ἕλκονται are used (see p. 218 f., commentary on p. 129.7–9). In the present passage the use of the adverb ἀθρόως emphasizes the sudden change between being awake and falling asleep again. This passage of Aetius is the only one in Greek medical literature where the verb ἐπικαταφέρεσθαι is used. Given that it is part of the phrase ἐπικαταφέρονται τῷ ὕπνῳ, it is clear that it is used in the same sense as καταφέρεσθαι (εἰς ὕπνον), which, as I discuss above, frequently appears in ancient medical literature (see p. 210, commentary on p. 128.18–19). The phrase εἰς ὕπνον καταφορά is also used by Galen in the context of koma: he repeatedly states that Hippocrates refers to the falling asleep (εἰς ὕπνον καταφορά) as koma.1008 For a discussion of the assumption that koma is connected both to phases of sleeplessness and of sleep, see p. 283 f., commentary on p. 133.25–26. See also p. 281, commentary on p. 133.22–24 where I have discussed the possibility that this assumption might be the reason why warm vapors are mentioned as causes of koma in the beginning of the chapter. p. 134.2–3: καὶ τὴν – ἔχουσι: This passage refers back to the beginning of the chapter, where it was stated that moist and warm vapors (ἀτμοὶ ὑγροὶ καὶ θερμοὶ) being carried up to the head are the cause of the disease (see p. 281 f., commentary on p. 133.22–24). For an overview of other passages which highlight the importance of moisture in the onset of koma, see especially note 976. The statement that the patient has a very moist head probably indicates what the physician can see or feel when he looks at or touches the head. The line of thought which underlies this statement might then be that the rising of vapors from lower (inner) bodily parts to the head (i.e. the brain) also has an impact on the outside of the head. p. 134.3–4: θεραπεία – ὄξους: The use of the noun θεραπεία clearly refers to the topic of the following lines. On other more explicit announcements of the compiler’s “program”, see p. 212, commentary on p. 128.22. The advice to apply embrocations to

1008 See e.g. Galen, In Hipp. Prorrh. comm. 3.1 (106.7 f. Diels = 16.705.11–706.2 K.), In Hipp. Epid. III comm. 1.11 (36.6–8 Wenkebach = 17a.540.2–4 K.). See also Galen, De com. sec. Hipp. 1.1 (181.2 f. Mewaldt = 7.643.4 f. K.).

VI 6 On koma from (the books of) Posidonius

|

287

the head is common in the medical literature and has also been given in the previous chapters on lethargia (p. 130.5–10) and on katalepsis (p. 132.22–24). For further discussion of embrocations, see p. 181 f., commentary on p. 126.19. For a closer look at rose oil and its cooling capacity, see p. 181 f., commentary on p. 126.19. Given that rose oil is mentioned at the beginning of the chapter on koma which is said to be brought about by moist and warm vapors being carried up to the head (see p. 281 f., commentary on p. 133.22–24), the recommendation to apply rose oil needs to be understood on the basis of its capacity to counteract a warm head and thus to cool. Its use thus, as I have adumbrated on p. 281, commentary on p. 133.22–24, strongly supports the uncommon statement that koma is brought about by warm vapors (see p. 281 f., commentary on p. 133.22–24). Vinegar (ὄξος) is commonly used as an ingredient in remedies (see p. 229, commentary on p. 130.5–6). The phrase τὸ εἰκοστὸν μέρος provides measurements concerning the amount of vinegar that needs to be added to the rose oil. Such phrases are commonly used in ancient medical literature.1009 p. 134.4–5: μὴ – ὄξει: The genitive absolute offers an alternative substance which may be applied when the rose oil is not at hand (μὴ παρόντος). Like the adjective ῥόδινον, the adjective χαμαιμήλινον also needs to be understood with ἔλαιον. For more on camomile oil see p. 183, commentary on p. 127.1–3. In the chapter on phrenitis the application of camomile oil to the head is also recommended in the same context as the application of rose oil to the head (see p. 127.1–3). This confirms the assumption that both substances should be understood as having similar properties. See also p. 287, commentary on p. 134.3–4. p. 134.5: ἔστω – ὄξος: According to Galen’s De compositione medicamentorum per genera the sharpest vinegar is very fine in its substance (λεπτομερέστερον).1010 For further discussion on the meaning of λεπτομερές see p. 239, commentary on p. 131.9–11. p. 134.5–7: εἰ δὲ – ἔμβρεχε: The conditional clause confirms that the therapeutic recommendations which were given earlier referred to cases in which the head is (rather) warm and thus supports the interpretation of the previous lines (see p. 286 f., commentary on p. 134.3–4). As discussed above (see p. 281 f., commentary on p. 133.22–24), koma is usually connected to coldness and not to warmth as it is at the start of this chapter. Thus, the mention of coldness here fits with other medical literature on koma. For an explanation as to why koma might be connected in this chapter to both warmth and coldness, see p. 281 f., commentary on p. 133.22–24. Like the adjectives ῥόδινον and χαμαιμήλινον, the adjective ἀνήθινον also needs to be understood with ἔλαιον: according to Aetius’ first book, dill oil is warmer than camomile oil and is suitable for those who are suffering as a result of “a cold

1009 See e.g. Hippocrates, De morb. 3.17.17 (98.23 Potter = 7.160.2 L.), Galen, De san. tuenda 4.8.15 (128.3 Koch = 6.289.8 K.), Paul 3.45.11 (Vol. 1, 249.5 Heiberg). 1010 See Galen, De comp. med. per gen. 3.2 (13.567.3 f. K.).

288 | Commentary

cause”.1011 These statements fit perfectly with the present passage insofar as camomile oil was recommended earlier on (as was rose oil) for patients with a rather warm head (see p. 287, commentary on p. 134.4–5; see also p. 287, commentary on p. 134.3–4), whereas dill oil is now explicitly suggested for patients with a rather cold head. For further discussion of dill’s warming capacity, see p. 240, commentary on p. 131.9–11, and p. 265, commentary on p. 133.7. The warming of the dill oil (θερμάνας) might further contribute to its warming capacity. p. 134.7–8: καὶ συντόμως – ἐπιτείνειν: The expression συντόμως εἰπεῖν introduces a general and brief statement on the important aspects one has to bear in mind when treating patients who suffer from koma. The structure and style of this sentence contribute to its conciseness. On the one hand, the author uses the correlative pronouns ὅσον … τοσοῦτον in order to highlight the quantitative relation between subordinate clause and main clause. On the other hand, he uses the same verb twice (ἐπιτέταται and ἐπιτείνειν), thus casting into relief the fact that the two nouns, ἡ ψῦξις and τὰ θερμάσματα respectively, are not the same in the subordinate clause and the main clause: the colder the head, the warmer the therapeutic approaches need to be. This sentence ties in with the previous conditional clause εἰ δὲ ψυχροτέρα ἡ κεφαλὴ φαίνοιτο (see p. 287 f., commentary on p. 134.5–7) and puts it on a general level. p. 134.8–9: ὥστε – ἐλαίῳ: This consecutive clause presents a consequence of the previous general statement regarding the need to increase the warmth of the therapeutic approach depending on the degree of coldness of the head (see p. 288, commentary on p. 134.7–8): pennyroyal (γλήχων) and rue (πήγανον) are two examples of substances which are capable of warming.1012 They are thus substances which the physician may apply to patients whose heads become colder. p. 134.9–10: βαλανιστέον – δυναμένοις: The application of suppositories (βάλανος) is also recommended in the chapter on lethargia: for a closer look at suppositories, see p. 228 f., commentary on p. 130.3–4. It is commonly said in the ancient medical literature that suppositories are capable of “provoking” (ἐρεθίζειν) and the verb ἐρεθίζειν is thereby connected with objects such as τὴν κοιλίαν, τὰ ἔντερα, τὴν ἔκκρισιν or the like.1013 A consideration of these objects makes it clear that “provoking” refers to the provocation of excretions. One may assume that the recommendation that suppositories be applied refers back to the beginning of the chapter, where it was stated that moist and warm vapors are carried up from the lower parts (τὰ ὑποκείμενα) to the brain. I have already discussed on p. 282 f., commentary on p. 133.22–24, that the phrase τὰ ὑποκείμενα might refer to the abdominal region of the

1011 See Aetius Amid., Libri med. 1.115 (Vol. 1, 59.26–30 Olivieri). 1012 See e.g. Aetius Amid., Libri med. 1.81 (Vol. 1, 49.20 Olivieri), Libri med. 1.321 (Vol. 1, 121.16 f. Olivieri). 1013 See e.g. Aetius Amid., Libri med. 8.48 (Vol. 2, 469.26 Olivieri), Libri med. 3.23 (Vol. 1, 279.12 Olivieri), Paul 7.10.5 (Vol. 2, 292.16 Heiberg).

VI 6 On koma from (the books of) Posidonius

|

289

body and indicate that this region is troubled and co-affects the head. It may be that the suppositories are intended to soothe this bodily region. p. 134.10: τρέφειν – ἀπομέλιτι: For a closer look at the properties of barleygruel (πτισσάνης χυλός), see p. 181, commentary on p. 126.17–19. For a discussion of apomeli, see p. 264, commentary on p. 133.1–3.

VI 7 On those who suffer from skotoma (from the books of) Archigenes and Posidonius Introduction to the disease concept skotoma According to Caelius Aurelianus, the scotomatica passio takes its name from one of its symptoms, the overcoming of the eyes by a sudden darkness (repentinas oculis ingerat tenebras).1014 The Anonymus Parisinus emphasizes that skotoma is the same affection as ἴλιγγος,1015 and highlights that “the ancients” (οἱ ἀρχαῖοι; i.e. Diocles, Hippocrates, Erasistratus, and Praxagoras)1016 did not give a direct account of the cause of skotoma.1017 These statements introduce an important terminological issue for the discussion of the disease concept: the problem is that what is discussed under the name of σκότωμα in Aetius’ chapter was not always called by this term. The terms σκότωμα or σκοτωματικόν are, for example, not used in the “Hippocratic” corpus. Instead, we find there nouns such as σκοτοδινία, σκοτοδινίασις, σκοτόδινος, σκότωσις, or ἴλιγγος and related verbs and adjectives.1018 These terms, however, are not discussed systematically and they do not seem to be used to denote a clearly defined concept.1019 A passage of De capitis vulneribus highlights that the two characteristics of “darkness” (σκότος) and “whirling” (δῖνος), which are taken together in terms such as σκοτοδινία, are also used separately in “Hippocratic” texts1020 to describe “discrete symptoms”.1021 For a closer look at the “Hippocratic” usage of terms such as σκοτοδινία, σκοτοδινίασις, σκοτόδινος, σκότωσις, and ἴλιγγος and cognates, see Thumiger 2017a, 291–295 and Hanson 1989, 303–305. The noun σκότωμα later appears for the first time in authors such as Aretaeus, Dioscorides, and Soranus,1022 while the adjective σκοτωματικόν is used in the Anonymus 1014 See Caelius Aurel., Tard. pass. 1.51 (458.6 f. Bendz). 1015 See Anon. Par. 17.1 (110.6 Garofalo). 1016 See van der Eijk 2001 in Diocles of Carystus Vol. 2, 167. 1017 See Anon. Par. 17.1 (110.5 f. Garofalo). 1018 On this issue, see also van der Eijk 2001 in Diocles of Carystus Vol. 2, 167. 1019 See e.g. Hippocrates, De morb. 2.4b.1–2 (135.19–136.6 Jouanna = 7.12.9–15 L.), Coac. 157 (140.17–20 Potter = 5.618.4–7 L.), Aphor. 3.17 (404.9–12 Magdelaine = 4.494.4–7 L.). 1020 See e.g. Hippocrates, De cap. vuln. 11.8 (76.6–9 Hanson = 3.200.13–17 L.). 1021 Hanson 1999 in Hippocratis De capitis vulneribus, 108. 1022 See Aretaeus 3.3.1 (37.27 Hude), Dioscorides, De mat. med. 3.78.1 (Vol. 2, 91.1 f. Wellmann), Soranus, Gyn. 1.48.4 (35.18 Ilberg).

290 | Commentary

Parisinus.1023 Of these authors, Aretaeus and the Anonymus Parisinus devote separate chapters to this disease concept, while the others merely mention the noun. Later, we find accounts of skotoma in, for example, several treatises of Galen, Caelius Aurelianus, and Paul’s compilation,1024 while the present chapter in Aetius’ compilation is another example of an extensive account of skotoma. Several elements recur with some frequency in the various texts dealing with skotoma. To begin with, nearly all of the texts connect skotoma to the head, some even explicitly to the brain (as does the present chapter; see p. 134.12–13), and it is sometimes also connected to a co-affection with the stomach, as is reflected in the present chapter (see p. 302, commentary on p. 134.15–16).1025 In some accounts of the affection, pneuma is said to play an important role in its onset,1026 as it does in Aetius’ account, in which pneuma is especially prominent (for more detail, see also p. 295). Two elements – “darkness” and “whirling” – seem to be particularly characteristic of skotoma given that they are mentioned in most of the texts dealing with the affection. Both are mentioned already in the “Hippocratic” accounts, as is discussed earlier in this introduction. In Aretaeus, skotoma is connected to darkness (ζόφος) around the eyes while whirling (δῖνος) is said to occur around the patients’ heads.1027 Similarly, the Anonymus Parisinus states that patients seem to see everything whirling around (περιφέρεσθαι) and to see darkness (σκότος) instead of light.1028 A little later in the same chapter it is stated that the sparkling in front of the patients’ eyes causes them to see circles and feel that everything is whirling around.1029 In Galen’s De locis affectis, we read that patients suffer easily from a darkening of vision (σκοτοῦνται),1030 and that they sometimes fall down, especially when they move around in a circle or when they see something or someone else whirling around.1031 Similar symptoms are also described in other accounts of skotoma, such as in Caelius Aurelianus, where the feeling that everything is whirling around is discussed alongside the intensification of the affection from which the patients are said to suffer when they look at the current of a river or the rotation of a

1023 See Anon. Par. 17 (110.3 Garofalo). 1024 See e.g. Galen, De loc. aff. 3.12 (8.201.17–204.8 K.), In Hipp. Aph. comm. 4.17 (17b.677.4–11 K.), Pseudo-Galen, Def. med. 251 (19.417.10–16 K.), Caelius Aurel., Tard. pass. 1.51–53 (458.5–460.3 Bendz), Paul 3.12 (Vol. 1, 151.22–152.16 Heiberg). 1025 See e.g. Anon. Par. 17.1 (110.7 Garofalo), Galen, De loc. aff. 3.12 (8.201.18 K.), De loc. aff. 3.12 (8.203.6–8 K.), Caelius Aurel., Tard. pass. 1.53 (460.1–3 Bendz), Paul 3.12.1 (Vol. 1, 151.23 f. Heiberg), Galen, De loc. aff. 3.12 (8.203.10–12 K.), Paul 3.12.1 (Vol. 1, 152.3 Heiberg). 1026 See e.g. Anon. Par. 17.1 (110.6 f. Garofalo), Galen, De loc. aff. 3.12 (8.203.6–8 K.), Paul 3.12.1 (Vol. 1, 151.26–28 Heiberg). 1027 See Aretaeus 3.3.1 (37.24 f. Hude). 1028 See Anon. Par. 17.1 (110.6–8 Garofalo), Anon. Par. 17.1 (110.10 Garofalo). 1029 See Anon. Par. 17.2.1 (110.13–15 Garofalo). 1030 See Galen, De loc. aff. 3.12 (8.202.2 K.). 1031 See Galen, De loc. aff. 3.12 (8.202.3–6 K.).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

| 291

potter’s wheel,1032 or in Paul.1033 As far as the “whirling” is concerned, it is remarkable that three main shapes of this recurring symptom are discussed in the texts: on the one hand, patients are said to see everything whirling around, on the other hand, looking at a whirling object is said to abet the affection, and furthermore, the same consequences are to be expected if the patients themselves turn around in a circle. All three of these shapes of the “whirling” are also discussed in the present chapter, which offers a detailed explanation of this theme (see p. 310 f., commentary on p. 134.22–24; p. 311 – 314, commentary on p. 134.24–25; p. 314 f., commentary on p. 134.25–27). These two main symptoms – the darkening of vision (σκότος) and the “whirling”-complex – are particularly important for the attempt to identify skotoma with a modern affection. Hanson, for example, argues that the nouns σκοτόδινος and σκοτοδινίη, which contain the nouns σκότος (darkness) and δῖνος (whirling), refer, at least in “Hippocrates”, to the “confusing mixture” that can be observed in syncope of the darkening of vision and the vertigo.1034 Siegel, by contrast, interprets skotoma as referring to what today is known as Menière’s disease.1035 Most translators, however, understand skotoma as meaning “dizziness” or “vertigo”.1036

Structure of the chapter p. 134.11–16: Περὶ – ὕπνου: The development of skotoma Paraphrase: The beginning of the chapter is concerned with the rise of warm and sharp vapors to the head. This process is said to change the psychic pneuma in the brain, and to lead to dimness of vision, ringing in the ears, and hardness of hearing. These processes are, furthermore, said to occur especially during the digestion of food and when one rises up from sleep. p. 134.16–19: ἐπιτεινομένου – τινός: Intensification of the affection Paraphrase: These lines are concerned with the consequences of an intensification of the affection. In this context, the occurrence of iliggoi and skotomata are mentioned and it is further explained that these lead the patients to see everything whirling around. These processes are said to happen when one suddenly rises from a seated position and when indigestion precedes.

1032 See Caelius Aurel., Tard. pass. 1.51 (458.6 f. Bendz), Tard. pass. 1.51–52 (458.14–17 Bendz), Tard. pass. 1.52 (458.22–24 Bendz). 1033 See Paul 3.12.1 (Vol. 1, 151.24–26 Heiberg). 1034 Hanson 1999 in Hippocratis De capitis vulneribus, 108. 1035 See Siegel 1970, 138. 1036 See e.g. Sharples 2003 in Theophrastus of Eresus On dizziness; Adams 1844, Vol. 1 in The seven books of Paulus Aegineta, 374.

292 | Commentary

p. 134.19–27: χρονίζοντος – ἐργάζεται: Consequences of the affection having already lasted for some time Paraphrase: These lines are concerned with what happens when the affection has already lasted for some time. As a consequence, the patients are said to suffer easily from a darkening of the vision, and, thus, to sometimes fall down, especially when they are turning around, when they see someone else turning around, or when they look at an object which whirls around, such as a wheel. These processes are explained in terms of the optical pneuma, which is said to fall upon the whirling object, to be whirled around with it, and, thus, to bring about an irregular, troubled, and disordered movement of the humors and pneuma. p. 134.27–135.5: εὐάλωτοι – ἐπιληψίαν: Liability to the affection, further causes of the affection, accompaniments of the affection Paraphrase: These lines present people who hold back the usual excretions as being prone to skotoma. They furthermore list indigestion, being continuously exposed to heat, and drunkenness as preceding or antecedent causes. These lines go on to deal with the accompaniments of the affection and in this regard mention retention, flatulence, passing of thin and little urine, and becoming weak and sluggish easily. They also deal with the fact that patients suffering from skotoma may see the things which appear in front of their eyes in certain colors. Those who see these appearances as blood-colored are said to have a tendency to mania, while those who see the appearances as purplish have a tendency to epilepsia. p. 135.5–13: τῆς – καιρόν: Therapy for skotoma I (phlebotomy, embrocations, compressions) Paraphrase: These lines open the section dealing with the appropriate therapy. We are first told to conduct phlebotomy if the various conditions for phlebotomy are fulfilled. It is also emphasized here that one needs to act cautiously in phlebotomizing the patients, since they fall down easily. During phlebotomy, embrocations be applied to the head and compressions to the stomach. p. 135.13–22: εἰ δὲ – λόγῳ: Therapy for skotoma II (enemata, holy remedy, stronger purgatives) Paraphrase: These lines are concerned with the approach to be selected if the various conditions for phlebotomy are not fulfilled. In such a case, one should purge the stomach with enemata and administer the holy remedy. If the symptoms persist, the application of stronger purgatives is advised. p. 135.22–26: καὶ ἀποφλεγματισμοῖς – κάθαρσιν: Therapy for skotoma III (phlegm purging remedies, gargles, purging through the nose) Paraphrase: These lines deal with the application of phlegm purging remedies and with gargles. They also present substances which are capable of purging through the nose. p. 135.26–136.8: μετὰ – βαλανείοις: Therapy for skotoma IV (bathing) Paraphrase: These lines are concerned with the bathing of the patients. They provide a recipe for a trimmation which needs to be applied to the head. They then

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

293

provide information on the approaches that need to be applied if the patients have very warm heads. p. 136.8–12: εἰ μὲν – ῥηθησομένοις: Therapy for skotoma V (good and bad response to the treatment) Paraphrase: These lines provide information on what the physician should do if the patient responds well to the treatment and the affection ceases. Information is also given on the approach to follow if the affection persists in spite of the previously recommended therapy. In the former case the procedure should be stopped while, in the latter case, one needs to conduct an arteriotomy after having evacuated the bowels. p. 136.12–15: τροφαὶ – λουτρά: Therapy for skotoma VI (food, drink, baths) Paraphrase: These lines are concerned with the appropriate food, which should be beneficial for the stomach and for digestion, and with the wine which the patients may drink. It also states that natural, astringent baths are good for the patients. p. 135.15–17: μεγίστη – γυναικῶν: General remarks on prophylaxis and therapy Paraphrase: These lines conclude the chapter with a general statement about the best prophylaxis and therapy for skotoma: for both purposes one should try to provoke the excretions which are held back. This is said to be especially important in women.

Rationale of the chapter The chapter on skotoma presents an account of the disease concept which includes discussion of the development of the affection (i.e. the rise of warm and sharp vapors which change the psychic pneuma in the brain: see p. 134.11–13); of the consequences of an intensification of the affection (i.e. the occurrence of iliggoi and skotomata: see p. 134.16–19) and of the affection having already been present for some time (darkening of the vision and falling down in connection with turning around or watching any whirling object: see p. 134.19–27); and information on what conditions make people particularly prone to the affection and information on its accompaniments (retention of excrements, indigestion, being exposed to heat, drunkenness, flatulence etc.: see p. 134.27–135.5), as well as its therapy (see p. 135.5–136.17). In contrast to the openings of the previous chapters in the sixth book, the chapter on skotoma does not start with an explicit mention of the affection. One needs to infer from the general arrangement of the information that the rise of the warm and sharp vapors to the head is understood as the process which brings about skotoma. I argue that the adverbs πρῶτον (p. 134.13) and ἔπειτα (p. 134.14), and the genitive absolutes ἐπιτεινομένου δὲ τοῦ πάθους (p. 134.16) and χρονίζοντος δὲ τοῦ πάθους (p. 134.19), all refer to skotoma and discuss different phases of the affection (see p. 299, commentary on p. 134.13–14). However, at first sight one might be inclined to understand the rise of vapors to the head and the subsequent change of the psychic

294 | Commentary

pneuma in the brain as merely explaining the occurrence of dimness of vision, ringing in the ears and hardness of hearing. It is only by taking a synoptic approach to the text that it becomes clear that these are the first indications, or even symptoms, of skotoma. This issue becomes even more complicated in light of the fact that on p. 134.17, a few lines after the opening of the chapter, it is stated that skotomata (σκοτώματα) occur when the affection is intensified. We do not receive any further explanation as to whether the noun σκότωμα is, in this context, understood as a symptom of the affection or as the affection itself. Although we do not receive any comments on this usage, I interpret the use of the noun σκότωμα in this context as a reference to a symptom of the affection, whose occurrence, however, might also be the reason that the whole affection is named as such (see p. 303 f., commentary on p. 134.16–17). In general, the terminology of the affection is often difficult to grasp: besides this unique mention of the noun σκότωμα, the verb σκοτοῦσθαι recurs twice in the chapter (p. 134.20, p. 134.23), and further information on the exact implications of this verb would be highly desirable. There are good grounds for assuming that the verb does not refer merely to “seeing darkness in front of the eyes” but that it also includes some additional features (see p. 308 f., commentary on p. 134.19– 20). If we look again at the first part of the chapter, which, as we have seen, deals with the development of skotoma, and provides information on its different phases, one structural point sticks out: the phrase τοῦτο συμβαίνει is used twice within a few lines to introduce a sentence (p. 134.15, p. 134.17–18), once in reference to the first indications, or possibly even symptoms, of the affection (i.e. dimness of vision, ringing in the ears, hardness of hearing), which are introduced by the adverbs πρῶτον (p. 134.13) and ἔπειτα (p. 134.14), and once in reference to the symptoms (i.e. the occurrence of skotomata and iliggoi) mentioned under the rubric of “intensification of the affection” (p. 134.16: ἐπιτεινομένου δὲ τοῦ πάθους). The information contained in the two sentences, which are introduced by τοῦτο συμβαίνει, concerns bodily processes (probably “preceding causes”; see p. 305 f., commentary on p. 134.17–19), which are said to be linked to the symptoms mentioned previously (dimness of vision, ringing in the ears, hardness of hearing on the one hand, and the occurrence of skotomata and iliggoi on the other). In both cases, these bodily processes are very similar and concern digestion or indigestion and rising from sleep or from a seated position (see p. 305, commentary on p. 134.17–19). These parallels, paired with the similar introductory phrases (p. 134.15: μάλιστα δὲ τοῦτο συμβαίνει, p. 134.17–18: καὶ τοῦτο δὲ συμβαίνει) provide a good example of how intricately structured the text is. One part of the chapter on skotoma (p. 134.19–27) is found more or less verbatim also in Galen’s De locis affectis (see p. 307, commentary on p. 134.19–27). This is particularly interesting because, according to the heading, Aetius cites Archigenes and Posidonius in this chapter, and gives no further indication within the text that this part derives from Galen. It is possible that Aetius does indeed cite Galen here without saying so. However, it is also worth taking into account the possibility that

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

295

Galen might actually cite Archigenes in this part of his text without indicating this citation. Aetius could then either have used Archigenes’ original text or the version that is transmitted in Galen. See further on these issues, p. 22 f. The questions are in equal parts interesting and important, on the one hand, and challenging and difficult to answer, on the other. However, it is worth noting here that Galen also explicitly cites Archigenes elsewhere in his section on skotoma (see p. 312, commentary on p. 134.24–25), and one is thus inclined to assume that he might also have done so in the passage in question, albeit without indicating it. But even this gives no definite indication that Galen draws on Archigenes in the passage adopted in Aetius’ chapter on skotoma. In spite of the similarities to Galen on p. 134.19–27, these lines also contain one sentence which is remarkably different from Galen’s text (see p. 311 f., commentary on p. 134.24–25). This sentence starts with a statement which is not found in Galen but concludes with remarks which do appear in the passage of Galen’s De locis affectis. Again, one wonders how to account for this observation, and, again, an answer to this question is difficult to give (see p. 311 f., commentary on p. 134.24–25). It is, however, clear from this observation that Aetius either did not use Galen, used him only at second-hand, or changed Galen’s version according to his own opinions. In spite of these questions about the source of the sentence, it still gives a reasonable account of the physiological processes that are dealt with here. Pneuma plays an important role throughout the chapter, with the noun appearing three times (p. 134.13, p. 134.24, p. 134.26). It is noteworthy that specific kinds of pneuma are mentioned, namely the psychic pneuma and the optical pneuma. The sentence containing the reference to the optical pneuma appears in a section of the text, which is, as a whole, similar to a passage of Galen’s De locis affectis. However, this sentence stands out from the surrounding text because the first part of the sentence is remarkably different to that which appears in Galen. That is to say, in Galen’s remarks, the optical pneuma is not mentioned. One might conclude from the weight given to pneuma in the chapter on skotoma that it is derived from an author belonging to the Pneumatist tradition, and such assumption would lead back to Archigenes, who is mentioned in the heading of the chapter. As I argue in the commentary (see p. 312, commentary on p. 134.24–25), such conclusions are tempting but cannot be verified. The remarks on the therapy for skotoma take up a great deal of the chapter. They include information on alternative approaches which can be undertaken if the bodily constitution forbids the primary recommended therapy (see p. 324, commentary on p. 135.13–14), and they even take into account what the physician needs to do when the symptoms persist in spite of the therapy (see p. 325, commentary on p. 135.16–17, p. 332, commentary on p. 136.9). The recommendations which are given in the chapter mostly aim to purge the body, either by phlebotomizing (p. 135.5–13), by administering enemata (p. 135.13–16), or by applying purgative remedies (p. 135.16–26), and we also receive information on bathing the patients (p. 135.26– 136.8), as well as on the appropriate foodstuff to be given to them (p. 136.12–15).

296 | Commentary

These remarks are in line with the information we receive in other chapters on curing affections that have their origin in the head. In the part of the chapter which deals with therapy, the text even directs the reader twice to another chapter of the Libri medicinales, where further information on a certain topic is said to be found (see p. 326, commentary on p. 135.20–22, p. 333, commentary on p. 136.11–12). Such cross-references show how thoroughly Aetius composed his compilation and demonstrates that each chapter has a place of its own in the structure of the work. Considering the chapter as a whole, it is worth asking how the information within was selected and why the particular forms of organization and structure were chosen. I have already addressed the intricate question of the sources for the chapter and the fact that one part of the chapter appears nearly verbatim in Galen’s De locis affectis. In addition, we might also ask why Aetius decided to include in this chapter this information on skotoma and this information only. Comparing Aetius’ account of the affection with other accounts casts light on this question and I discuss these comparisons throughout the commentary. In summary, many issues which are discussed in Aetius’ chapter are also reflected in other writings and this pertains especially to the involvement of pneuma in the development of the affection (see p. 298 f., commentary on p. 134.11–13), to the role of the stomach (digestion, indigestion, retention etc. are prominently mentioned in the text) in the occurrence of skotoma (see p. 302, commentary on p. 134.15–16), to the connection between rising from a seating position and suffering from skotoma (see p. 302 f., commentary on p. 134.15–16), and to seeing things whirling around and to suffering from skotoma when whirling around or when watching something or someone else turning around quickly (see p. 304 f., commentary on p. 134.16–17, p. 310 f., commentary on p. 134.22–24). Although the basic information on skotoma also appears in other texts, the way Aetius deals with this affection still differs from the approach taken by other writers. I have already noted the important role that pneuma plays in Aetius’ account but it is especially significant that Aetius’ discussion of skotoma is much more detailed than those provided by most other writers. He not only distinguishes between the different phases of the affection but he also provides detailed information on the therapy, which goes far beyond what we read elsewhere. Even Aretaeus, who also gives detailed information on the therapy for skotoma does not stress the same aspects of the therapy that we find in our text.

Commentary p. 134.11: Περὶ – Ποσειδωνίου: For a detailed discussion of Archigenes and Posidonius as sources for the sixth book, see p. 23 – 26. p. 134.11–13: ἀτμῶν – πνεῦμα: The previous two chapters, on karos and koma, also dealt with vapors (or alternatively humors), which are carried up to and affect the head or the brain, and these processes were said to cause the two affections (see

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius | 297

p. 270 – 272, commentary on p. 133.10–12, and p. 281 – 283, commentary on p. 133.22– 24).1037 Indeed, in the chapter on koma precisely the same expression is used, ἐπὶ τὴν κεφαλὴν ἀναφέρεσθαι.1038 As I have emphasized above (see p. 281 – 283, commentary on p. 133.22–24), the notion that vapors which are carried up to the head may have a detrimental effect, is found throughout ancient medical literature. In the previous chapter on koma, the phrase ἐκ τῶν ὑποκειμένων was connected to the expression ἐπὶ τὴν κεφαλὴν ἀναφέρεσθαι. In this context, the phrase τὰ ὑποκείμενα, referring to bodily parts located beneath the head, might, more specifically, refer to the abdominal region (see p. 282 f., commentary on p. 133.22–24). As we will see, there are good grounds for assuming that, in the present passage, we should also understand that the warm and sharp vapors are carried up to the head from the abdominal region (see p. 302, commentary on p. 134.15–16). In the present passage we receive precise information about the impact the vapors have on the head: they change the psychic pneuma in the brain. Diocles, Erasistratus, Praxagoras and Hippocrates are reported to have already been concerned with the psychic pneuma1039 but one needs to be very cautious about attributing this term to these ancient physicians, since there is no clear proof available on the question. It may very well be that the term πνεῦμα ψυχικόν reflects a concept which only emerged later on.1040 According to the testimony of the Anonymus Parisinus, Diocles seems to locate it in the heart, which is referred to as the ruling part of the body, and also mentions its presence in the brain.1041 Diocles is also said to be of the opinion that the psychic pneuma plays a role in the occurrence of lethargia and headache.1042 For Diocles, this psychic pneuma seems “to be responsible for the distribution of consciousness and voluntary movement over the body”.1043 As for Erasistratus, Galen states that he locates the psychic pneuma in the head1044 and the Anonymus Parisinus, in his section on epilepsia, reports that Praxagoras thinks that phlegmatic humors “block the passage of the psychic pneuma coming from the heart and this thus shakes the body and causes spasm”.1045 The Anonymus Parisinus goes on to report Hippocrates’ view that, in epilepsia, the brain is filled with 1037 See Aetius Amid., Libri med. 6.5 (Vol. 2, 133.10 f. Olivieri), Libri med. 6.6 (Vol. 2, 133.22 f. Olivieri). 1038 See Aetius Amid., Libri med. 6.6 (Vol. 2, 133.23 Olivieri). 1039 See e.g. Erasistratus fr. 112B Garofalo, Praxagoras fr. 25.2–5 Lewis, fr. 31.2–6 Lewis, fr. 32.2–6 Lewis, Anon. Par. 3.1.1 (18.11–14 Garofalo), Anon. Par. 3.1.3 (18.21 f. Garofalo), Anon. Par. 4.1.2 (26.4– 7 Garofalo). 1040 See van der Eijk 2001 in Diocles of Carystus Vol. 2, xxviii note 62; Lewis 2017 in Praxgoras of Cos, 166 f., 256 note 15. 1041 See Diocles fr. 78.5–7 van der Eijk, fr. 80.4–6 van der Eijk. 1042 See Diocles fr. 78.5–7 van der Eijk, fr. 80.2–6 van der Eijk. See also van der Eijk 2001 in Diocles of Carystus Vol. 2, xxviii. 1043 Van der Eijk 2001 in Diocles of Carystus Vol. 2, xxviii. 1044 See Erasistratus fr. 112B Garofalo. 1045 See Praxagoras fr. 25.2–5 Lewis; I quote Lewis’ translation here.

298 | Commentary

moist phlegm blocking the psychic pneuma,1046 and that, in apoplexia, the brain is filled with cold phlegm so that the nerves coming from the brain cannot “take” the psychic pneuma.1047 Galen also deals extensively with the pneuma, and it will only be possible to give a very brief overview of his usage. In De usu partium, Galen states that “from the outside air, pneuma is drawn in by the rough arteries and receives its first elaboration in the flesh of the lungs, its second in the heart and the arteries, […], and then a final elaboration in the ventricles of the brain which completes its transformation into psychic pneuma”.1048 In De placitis Hippocratis et Platonis, Galen remarks that the psychic pneuma functions as the soul’s first instrument (πρῶτον ὄργανον) for sense-perception (αἴσθησις) and voluntary movement (καθ̕ ὁρμὴν κίνησις).1049 For further information on the concept of psychic pneuma in ancient medical thought, see e.g. van der Eijk 2001 in Diocles of Carystus Vol. 2, xxviii; Rocca 2003, 201–237; Rüsche 1930, 143–164, 297–301. For a discussion of the broader term πνεῦμα, which was commonly used in both ancient medical literature and in philosophical texts, and which did not have one uniform definition, see e.g. Lloyd 2007, Verbeke 1945, or Rocca 2003, 60–66. The involvement of pneuma in the development of skotoma is also mentioned in other texts. To begin with, Theophrastus opens his treatise on iliggos with the remark that one way in which the affection is brought about is when “strange pneuma” (πνεῦμα ἀλλότριον) is around the head.1050 The Anonymus Parisinus states that skotoma occurs due to a blockage of both the moisture in the head and of pneuma (ἐνανείλησις τῶν ὑγρῶν τῶν ἐν τῇ κεφαλῇ, καὶ τοῦ πνεύματος).1051 In Galen’s De locis affectis we read that vaporous and warm pneuma which rises and fills the brain (ἀτμώδους καὶ θερμοῦ πνεύματος … ἀναφερομένου καὶ πληροῦντος τὸν ἐγκέφαλον) is involved in the onset of the affection.1052 In Galen’s In Hippocratis Aphorismos commentarii, we read that iliggos is skotodinia, which occurs when moist and thick pneuma moves around the head (ὑγροῦ μετὰ παχέος πνεύματος κινουμένου κατὰ τὴν κεφαλὴν).1053 In Paul’s compilation, skotoma is said to be brought about by cold and sticky humors befalling the brain but the fact that the patients easily fall down may come about for a number of reasons, including the 1046 Anon. Par. 3.1.3 (18.21–23 Garofalo). 1047 See Anon. Par. 4.1.2 (26.4–7 Garofalo). 1048 See Galen, De usu part. 7.8 (Vol. 1, 393.23–394.6 Helmreich = 3.541.14–542.2 K.): τὸ δ’ ἐκ τῶν τραχειῶν ἀρτηριῶν πνεῦμα τὸ ἔξωθεν ἑλχθὲν ἐν μὲν τῇ σαρκὶ τοῦ πνεύμονος τὴν πρώτην ἐργασίαν λαμβάνει, μετὰ ταῦτα δ’ ἐν τῇ καρδίᾳ τε καὶ ταῖς ἀρτηρίαις […] τὴν δευτέραν, ἔπειτα τὴν τελεωτάτην ἐν ταῖς τοῦ ἐγκεφάλου κοιλίαις, ἔνθα δὴ καὶ ψυχικὸν ἀκριβῶς γίγνεται [πρότερον]. The translation is quoted from Rocca 2003, 201. 1049 See Galen, De plac. Hipp. et Plat. 7.3.21 (444.4–8 de Lacy = 5.606.7–11 K.). 1050 See Theophrastus, De vertig. 1 (184.2 f. Sharples). 1051 See Anon. Par. 17.1 (110.6 f. Garofalo). 1052 See Galen, De loc. aff. 3.12 (8.203.5 f. K.). This phrase is also cited by Paul of Nicea 17 (74.4 f. Ieraci Bio), in his section on skotoma. 1053 See Galen, In Hipp. Aph. comm. 3.17 (17b.611.4–6 K.).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

299

movement of humors and pneuma in the head (κινουμένων τῶν ἐν αὐτῇ χυμῶν ἢ καὶ τοῦ πνεύματος).1054 None of these texts, however, mention πνεῦμα ψυχικόν but only πνεῦμα. This is remarkable insofar as Archigenes is concerned, since he was one of the major pneumatists (see p. 25 f.) and is claimed to be a source for this chapter, together with Posidonius. It is tempting to suppose that the specification of pneuma as psychic pneuma indicates that the text, or this part of the text, derives from him. Such an assumption would be further supported by the fact that, later in the chapter, the ὀπτικὸν πνεῦμα is also mentioned (p. 134.24; see p. 311 – 314, commentary on p. 134.24–25). However, there is no direct evidence for such a claim and it should, therefore, be treated with caution. p. 134.13–14: πρῶτον μὲν – δυσηκοΐαι: These lines present the consequences of the previously discussed changing of the psychic pneuma which resides in the brain. These consequences are dimness of vision (ἀμβλυωγμοί), ringing in the ears (ὤτων ἦχοι), and hardness of hearing (δυσηκοΐαι). I take it that the form συνηχεῖς which, in fact, is the second person singular to the verb συνηχεῖν, actually needs to be read as συνεχεῖς (nominative plural of the adjective συνεχές, meaning “continuous”), and I translate it accordingly. There is no syntactically correct option for reading the verb form here, since the sentence lacks an object, containing instead two subjects (i.e. ἦχοι and δυσηκοΐαι). For a closer look at the general usage of the verb ἐπιγίγνεσθαι, see p. 271, commentary on p. 133.10–12. The changing of the psychic pneuma in the brain is said to affect sense-perception, strictly speaking sight and hearing. It is, thus, possible to understand the present text as indicating that the psychic pneuma usually plays a significant role in sense-perception. This would, then, be very similar to the way in which Galen conceived of the psychic pneuma (see p. 298, commentary on p. 134.11–13). For further discussion of the fact that, according to Galen, sensation is an activity belonging to the soul, see p. 254 f., commentary on p. 132.2–3 and p. 167 f., commentary on p. 125.10–15. The adverbs πρῶτον and ἔπειτα are used here to denote the chronological order of events which follow upon the rise of vapors to the head and the changing of the psychic pneuma. Later in the chapter, they are followed by the genitive absolutes ἐπιτεινομένου δὲ τοῦ πάθους and χρονίζοντος δὲ τοῦ πάθους (see p. 303, commentary on p. 134.16–17, and p. 306, commentary on p. 134.19). The noun ἀμβλυωγμός is not as commonly used in ancient medical literature1055 as related terms such as ἀμβλυωσμός, ἀμβλυσμός, ἀμβλυωπία, ἀμβλυώσσειν, which

1054 See Paul 3.12.1 (Vol. 1, 151.24–27 Heiberg). 1055 According to the TLG, it is evidenced eleven times in Greek medical literature. See e.g. Hippocrates, Coac. 128 (132.10 Potter = 5.610.2 L.), Galen, De loc. aff. 1.2.2 (250.10 Gärtner = 8.21.9 K.), In Hipp. Epid. I comm. 2.57 (78.16 Wenkebach = 17a.153.16 K.), Aetius Amid., Libri med. 5.48 (Vol. 2, 28.26 Olivieri).

300 | Commentary

appear in the medical literature from “Hippocrates” onwards.1056 Some of them are also listed in Olivieri’s critical apparatus as variants which are found in some manuscripts.1057 According to Aetius’ seventh book, dealing with diseases of the eyes, ἀμβλυωπία is a dimness of seeing (ἀμυδρότης τοῦ ὁρᾶν)1058 which can occur due to a number of causes: either the optical pneuma becomes thick (τοῦ ὀπτικοῦ πνεύματος παχυνομένου), or the membranes become dense and thick (τῶν χιτώνων πυκνουμένων καὶ παχυνομένων), or the moisture in the eyes becomes thick and sticky (τῶν ἐν τῷ ὀφθαλμῷ ὑγρῶν παχέων καὶ γλίσχρων γιγνομένων).1059 It may also occur in patients who have been suffering from an affection for a long time (τοὺς πολυχρονίᾳ νόσῳ συσχεθέντας) or who are in a state of great grief (ἐπὶ λύπαις ἰσχυραῖς).1060 This description does not fully match the discussion in the present passage but it does indicate that pneuma plays a role in the onset of dimness of vision. Thumiger has observed that these terms in the “Hippocratic” corpus are often used “in contexts of obvious mental disturbance”.1061 For a closer discussion of this language in the “Hippocratic” writings, see Thumiger 2017a, 289–291. For an overview of Galenic passages dealing with these terms, see Gärtner 2015 in Galeni De locis affectis, 519 f. As for the question of whether and how such terms are used in other texts in the context of skotoma, Caelius Aurelianus states in his chapter De scotomaticis that patients suffering from skotoma are seized with a darkening of the sight (visus tenebratio) and a haze in front of the eyes (nebula).1062 A few lines further down, he mentions that patients have the impression that there are marmoreal spots in front of their eyes (marmorum maculis), which the Greeks call marmarygai.1063 The appearances of such sparks in front of the eyes (μαρμαρύγαι) are listed as symptoms of skotoma in, for example, Aretaeus,1064 the Anonymus Parisinus,1065 and the pseudoGalenic Definitiones medicae.1066

1056 See e.g. Hippocrates, Prorrh. 1.18 (77.4 f. Polack = 5.514.13 L.), Dioscorides, De mat. med. 4.169 (Vol. 2, 317.16 Wellmann), Soranus, Gyn. 1.27.3 (18.5 Ilberg), Galen, De sympt. caus. 1.4 (7.104.17 K.), Oribasius, Synops. ad Eustath. 8.50 (267.4–20 Raeder). 1057 See Olivieri’s critical apparatus to p. 134.13. 1058 For similar definitions, see e.g. Plato, Resp. 6 (508c5–7) where the verb ἀμβλυώττειν is used in comparison to τυφλοῦν or Galen, De sympt. caus. 1.5 (7.108.11 f. K.), where ἀμβλυωπία is mentioned in one line with τυφλότης and παρόρασις or Hippocrates, De loc. in hom. 13.3 (54.11 f. Craik = 6.300.15 f. L.), where ἀμβλυώσσειν is contrasted with ὀξὺ ὁρᾶν. 1059 See Aetius Amid., Libri med. 7.49 (Vol. 2, 303.9–12 Olivieri). 1060 See Aetius Amid., Libri med. 7.49 (Vol. 2, 303.13 Olivieri). 1061 Thumiger 2017a, 289. 1062 See Caelius Aurel., Tard. pass. 1.51 (458.14 f. Bendz). 1063 See Caelius Aurel., Tard. pass. 1.52 (458.16 f. Bendz). 1064 See Aretaeus 3.3.2 (38.6 Hude). 1065 See Anon. Par. 17.2.1 (110.13 f. Garofalo). 1066 See Pseudo-Galen, Def. med. 251 (19.417.18 K.). For a general overview of the “Hippocratic” usage of this term, see Thumiger 2017a, 294. For an overview of the Galenic understanding of this term, see Gärtner 2015 in Galeni De locis affectis, 520.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

301

Later in Aetius’ sixth book, we find two chapters entitled περὶ τῶν ἐν ὠσὶν ἤχων and πρὸς δυσηκοῖας καὶ κωφώσεις.1067 In the former chapter, it is said that ringing in the ears occurs due to “flatulent” pneuma (φυσώδους πνεύματός εἰσιν ἔκγονοι) or because of a sensitivity to acoustic sensations that comes from the rising of vapors (δι’ ἀκρίβειαν τῆς ἀκουστικῆς αἰσθήσεως ἐκ τῶν ἀναθυμιάσεων).1068 The chapter on hardness of hearing is concerned with therapeutic issues.1069 Again, the discussion here differs from that found in our present chapter but, again, pneuma is said to play a role in causing the ears to ring. The phrase ὤτων ἦχοι is also used in Galen’s De locis affectis, and in Paul, in the context of skotoma.1070 Aretaeus, in his chapter on skotoma, states that the ears make a loud noise (ὦτα βομβέῃ),1071 and Caelius mentions aurium tinnitus as a symptom of patients who suffer from skotoma.1072 Apart from these references to ringing in the ears in passages dealing explicitly with the disease concept skotoma, there are also many more passages in ancient medical literature where ringing in the ears is loosely used in connection to nouns such as σκοτισμός, σκοτόδινος, σκοτοδινία or ἴλιγγος.1073 For a discussion of references to symptoms affecting degrees of hearing in “Hippocratic” texts, see Thumiger 2017a, 312–314. p. 134.15–16: μάλιστα – ὕπνου: It remains unclear whether the pronoun τοῦτο is supposed to refer back to the whole process discussed in the previous lines or only to the occurrence of the symptoms which were just dealt with. To be precise, it may either refer to both the vapors rising to the brain, changing the psychic pneuma and to the subsequent dimness of vision, ringing in the ears, and hardness of hearing, or it may refer only to the list of symptoms. Given that the symptoms and the processes which lead to their occurrence are, in the end, interwoven, it is naturally difficult to distinguish them and the use of τοῦτο probably reflects this difficulty. The codex Athous Λαύρας 719 Ω 64 (At) transmits the reading ταῦτα1074 instead of τοῦτο. However, given that, on the one hand, this codex is, according to the apparatus, the only one which transmits this reading and, on the other hand, the phrase τοῦτο συμβαίνει is repeated again a few lines further down within a sentence that shows many similarities to the present sentence (see p. 305, commentary on p. 134.17–19), it seems more likely that τοῦτο is the original reading.

1067 See Aetius Amid., Libri med. 6.79–80 (Vol. 2, 223.7–226.14 Olivieri). 1068 See Aetius Amid., Libri med. 6.79 (Vol. 2, 223.8 f. Olivieri). 1069 See Aetius Amid., Libri med. 6.80 (Vol. 2, 224.12–226.14 Olivieri). 1070 See Galen, De loc. aff. 3.12 (8.203.18 K.), Paul 3.12.1 (Vol. 1, 152.1 Heiberg). 1071 See Aretaeus 3.3.1 (37.25 Hude). 1072 See Caelius Aurel., Tard. pass. 1.52 (458.20 Bendz). 1073 See e.g. Paul 1.100.2 (Vol. 1, 69.9 f. Heiberg), Aetius Amid., Libri med. 5.23 (Vol. 2, 15.3–5 Olivieri), Diocles fr. 183a.20 f. van der Eijk, Galen, De cris. 3.2 (168.7 f. Alexanderson = 9.704.4–6 K.), Oribasius, Coll. med. rel. 7.26.15 (Vol. 1, 228.22 f. Raeder). 1074 See Olivieri’s critical apparatus to p. 134.15.

302 | Commentary

The reference to the digestion of food (περὶ τὰς τῶν σιτίων πέψεις) in the context of dealing with processes and events which may promote the rise of vapors, the changing of the psychic pneuma, and the occurrence of dimness of vision, ringing in the ears, and hardness of hearing, may be due to the common notion that vapors rising from the abdominal region to the head can have a detrimental effect (see p. 296 f., commentary on p. 134.11–13). Since the stomach plays a prominent role in digestion,1075 it is reasonable to suppose that the mention of the digestion of food in the present passage alludes to the rise of vapors, especially because the rise of vapors was already mentioned in the beginning of this chapter (see p. 296 f., commentary on p. 134.11–13). Several other medical passages suggest a connection between the rise of vapors from the abdominal region and an impairment of the eyes,1076 and this is also reflected in our passage. In Aristotle’s treatise De somno et vigilia, vapors are said to rise (ἀναθυμίασις) during nutrition (περὶ τὴν τροφὴν) and, a few lines later, it is stated that this rise of vapors happens to a great extent due to (the eating of) food (πολλὴ γὰρ ἡ ἀπὸ τῶν σιτίων ἀναθυμίασις), and even later in this text, these vapors are said to rise to the head from the stomach (κοιλία).1077 Here we also find a connection between food intake, and the subsequent bodily processes (i.e. the digestion of such food), and the rise of vapors. Interestingly, a number of other texts dealing with skotoma suppose that it may occur due to a primary affection of the brain or due to a co-affection (of the brain) with the stomach (γαστήρ or κοιλία are the nouns used).1078 It seems as if our text also tends towards such an understanding of skotoma. The reference to rising from sleep (ἀνισταμένοις ἐξ ὕπνου), which is mentioned in the present passage as a potential factor that promotes the rise of vapors, the changing of the psychic pneuma, and the occurrence of dimness of vision, ringing in the ears, and hardness of hearing, has parallels in other texts dealing with skotoma. The Anonymus Parisinus states that the patients suffer more intensely if they stand up (ἀνιστάμενοι).1079 In a passage of Paul’s fifth book, it is stated that skotodinos occurs especially during the process of standing up (ἐν τῷ ἐξανίστασθαι).1080 The “Hippocratic” treatise De morbis presents the case of a patient with moisture in the brain, who is said to be seized by skotodinia when he stands up (καὶ ἢν ἀναστῇ). The same process is mentioned a few chapters later (καὶ ἐπειδὰν ἀναστῇ, σκοτοδινίη μιν

1075 See e.g. Galen, De const. art. med. 14.3 (98.8 f. Fortuna = 1.272.16 K.), Aetius Amid., Libri med. 1.379 (Vol. 1, 135.26–136.1 Olivieri). 1076 See e.g. Galen, De loc. aff. 1.2.3 (250.13–16 Gärtner = 8.21.14–18 K.), De sympt. caus. 1.2 (7.97.4– 7 K.). 1077 See Aristotle, De somn. et vigil. 3 (456b18–19), De somn. et vigil. 3 (456b33–34). I am grateful to Stephen Menn for adverting to this Aristotelian passage. 1078 See Paul 3.12.1 (Vol. 1, 151.30 Heiberg), Paul 3.12.1 (Vol. 1, 152.3 Heiberg), Galen, De loc. aff. 3.12 (8.203.10–12 K.), Pseudo-Galen, Def. med. 251 (19.417.15 f. K.). 1079 See Anon. Par. 17.2.2 (110.15 f. Garofalo). 1080 See Paul 5.46 (Vol. 2, 33.22 Heiberg).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

| 303

ἴσχει) in a report about a patient whose veins in the head were full of blood.1081 In the pseudo-Aristotelian Problemata,1082 in the pseudo-Aristotelian/pseudo-Alexandrinian Supplementa Problemata,1083 as well as in Theophrastus’ treatise De vertigine,1084 it is similarly stated that iliggos affects people when they stand up (ἀνίστασθαι). These similarities may be explained by the fact that all of these texts discuss the condition of moisture in the head (τὸ ὑγρὸν ἐν τῇ κεφαλῇ); when the people do not move, this moisture “gathers together in larger quantity” (πλέον);1085 when they stand up, “it becomes apparent [scil. that the moisture was in this condition when the people were at rest] and, inclining all together to a single part”1086 (εἰς ἓν μόριον ἀθρόον ἀποκλινᾶν) then brings about iliggos. Important for this explanation is the assumption, which is made explicit in the pseudo-Aristotelian Problemata and in the pseudo-Aristotelian/pseudo-Alexandrinian Supplementa Problemata,1087 that people are more inclined to suffer from iliggos when they stand up (after having been at rest) than when they sit down (after having been in motion); the reason for this is that, when they have been in motion, the moisture in the head is evenly distributed and the changing of position is, then, not as dangerous as in the case of the uneven distribution of a great amount of moisture, which occurs when the individual is in a resting position.1088 p. 134.16–17: ἐπιτεινομένου – περιστρεφόμενα: The genitive absolute ἐπιτεινομένου δὲ τοῦ πάθους provides information on the chronology of the events. It, thereby, seems to form a single structural unit together with the adverbs πρῶτον (p. 134.13) and ἔπειτα (p. 134.14), as well as with the subsequent genitive absolute χρονίζοντος δὲ τοῦ πάθους (p. 134.19). On this issue, see also p. 299, commentary on p. 134.13–14. These terms all deal with different stages, so to say, of the affection. The present passage contains the first mention of the noun σκότωμα in the chapter and no further explanation is given as to how to understand the relation between the appearance of skotomata and the fact that the affection as a whole is referred to as 1081 See Hippocrates, De morb. 2.15.1 (149.5 f. Jouanna = 7.28.4 L.), De morb. 2.18.1 (152.10 Jouanna = 7.32.3 f. L.). 1082 See Pseudo-Aristotle, Probl. 6.4 (885b35–36). 1083 See Pseudo-Aristotle/Pseudo-Alexander, Suppl. probl. 2.49 (148.4–7 Kapetanaki & Sharples). For a discussion of the question of whether this treatise stems from Aristotle or from Alexander of Aphrodisias, and for a discussion of the different editions of this treatise and of the Pseudo-Aristotelian Problemata, which overlap, in parts, see Kapetanaki & Sharples 2006 in Pseudo-Aristotle (Pseudo-Alexander) Supplementa Problematorum, 1–28. 1084 See Theophrastus, De vertig. 13 (196.101–104 Sharples). 1085 I cite Sharple’s translation of Theophrastus here. See Sharples 2003 in Theophrastus, On Dizziness, 197. The text appears nearly verbatim in the Pseudo-Aristotelian Problemata and in the Pseudo-Aristotelian/Pseudo-Alexandrinian Supplementa problematorum as well. 1086 I cite Sharple’s translation of Theophrastus here. See Sharples 2003 in Theophrastus, On Dizziness, 197. 1087 See Pseudo-Aristotle, Probl. 6.4 (885b37–886a2), Pseudo-Aristotle/Pseudo-Alexander, Suppl. probl. 2.49 (148.5–7 Kapetanaki & Sharples). 1088 On this issue, see also Sharples 2003 in Theophrastus, On Dizziness, 231 f.

304 | Commentary

skotoma in the heading (p. 134.11: περὶ σκοτωματικῶν; to be precise, the heading says that it deals with those who suffer from skotoma). For, in the present passage, the usage of this noun suggests that it is understood as a symptom. According to the Anonymus Parisinus, patients suffering from this affection are called σκοτωματικοὶ because they seem to see darkness instead of light.1089 There is a similar description in the pseudo-Galenic Definitiones medicae1090 and, in Galen’s De locis affectis, it is said that the name makes clear the nature of the affection, namely that the patients easily see darkness in front of their eyes (σκοτοῦνται).1091 Caelius Aurelianus opens his chapter on skotoma with the remark that the affection skotoma (scotomatica passio) derives its name from the fact that it involves sudden darkness in front of the eyes (repentinas oculis … tenebras).1092 It becomes clear from these passages that the naming of the affection ultimately derives from one of its symptoms. Keeping this in mind, it is easier to understand why the author might have both referred to the whole affection by the name skotoma and used the noun here to signify a symptom of this affection. We do not, therefore, have to assume that the discussion of the affection, which was announced in the heading, only starts in the present passage. The affection itself, I claim, was already under discussion when dimness of vision, ringing in the ears, and hardness of hearing were mentioned (see p. 299 – 301, commentary on p. 134.13–14), but the symptom skotoma, which gave the affection its name, only occurs when the affection intensifies (ἐπιτεινομένου δὲ τοῦ πάθους). The interpretation of the noun σκοτώματα as referring to a symptom in the present passage is further supported by the fact that it is used in the plural here. The reference to ἴλιγγοι in direct proximity to σκοτώματα is also worth noting since it is not easy to grasp how we should understand the distinction between these two nouns here. I have discussed the various approaches to naming the affection on p. 289 – 291, noting that some texts use both nouns synonymously. Given that the present passage deals with skotoma and iliggos as symptoms, it is plausible to interpret them as referring to different aspects of the same concept, i.e. darkening of vision together with the occurrence of dizziness, although they are, elsewhere, often used as synonyms for one and the same affection. The noun ἴλιγγοι then refers to the fact that the patients see things whirling around, whereas the noun σκοτώματα refers to the darkening of vision. See also p. 308 f., commentary on p. 134.19–20. As I discussed at p. 290 f., the notion that the patients see everything whirling around (περιστρεφόμενα) is commonly discussed in texts which deal with skotoma. The Anonymus Parisinus states that the patients seem to see everything whirling around (περιφέρεσθαι) and a few lines later he repeats that they seem to see circles, that nothing seems to stand still, and that everything whirls around (περιφέρε1089 See Anon. Par. 17.1 (110.8–10 Garofalo). 1090 See Pseudo-Galen, Def. med. 251 (19.417.10 f. K.): σκοτωματικοὶ καλοῦνται οἷς παρακολουθοῦσι σκοτώσεις (…). 1091 See Galen, De loc. aff. 3.12 (8.202.2 K.). 1092 See Caelius Aurel., Tard. pass. 1.51 (458.6 f. Bendz).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

305

σθαι).1093 In the pseudo-Galenic Definitiones medicae, we read that what is seen seems to whirl around (περιδινεῖσθαι)1094 and Caelius Aurelianus writes that the patients believe everything around them is in motion (ut omnia secum moveri existiment).1095 The crucial element of this notion is that an object seems to move in a certain way but in fact does not. Both our text and the Anonymus Parisinus, as well as the pseudo-Galenic Definitiones medicae, use the verb δοκεῖν in this regard while Caelius Aurelianus makes use of the Latin existimare. p. 134.17–19: καὶ τοῦτο – τινός: This sentence reminds us of another found earlier in the chapter (p. 134.15–16). Both are introduced by remarkably similar phrases: while the earlier sentence starts with μάλιστα δὲ τοῦτο συμβαίνει, the present one opens with καὶ τοῦτο δὲ συμβαίνει. They are also similar with regard to their contents: both deal with the patients rising up either from sleep, as in the first (p. 134.15–16: ἀνίστασθαι ἐξ ὕπνου), or from their seats, as in the present passage (ἐξανίστασθαι ἐκ τῶν καθεδρῶν), and with digestion (p. 134.15: πέψις σιτίων) and indigestion (ἀπεψίας προηγησαμένης). For a more detailed discussion of these processes, see p. 302 f., commentary on p. 134.15–16. The role of indigestion in the emergence of the affection is dealt with again later on in this chapter. See p. 315 f., commentary on p. 134.27–28. I do not read the genitive absolute in the present passage as dependent on ἀθρόως ἐξαναστῶσιν ἐκ τῶν καθεδρῶν (in the sense of “the symptoms are linked to suddenly rising up from a sitting position, under the condition that indigestion preceded”). Rather, I read it as presenting another case to which the previously discussed symptoms may be linked. The similarities between this sentence and the previous sentence (p. 134.15–16) are obvious. Digestion and rising up are connected through the use of καί, and no direct interdependence between these two is suggested, so there is no reason to think that rising up is dependent on digestion. The fact that, in the beginning, it was suggested that the occurrence of the symptoms (dimness of vision, ringing in the ears, hardness of hearing) is linked to rising up from sleep, whereas, now, it is suggested that the occurrence of the symptoms (iliggoi, skotomata) is linked to the rising from their seats, may reflect that the affection intensified. Even rising up from a sitting position suffices to bring about the symptoms. The similarities between these two sentences show that the author(s) of these lines takes up what has already been said and applies it to the intensification of the affection. The similarities also show that the bodily processes, which are linked to dimness of vision, ringing in the ears, hardness of hearing, on the one hand, and to iliggoi and skotomata, on the other, are similar in nature. It is worth noting that the term προηγούμενα αἴτια can be used as a technical term in the discussion of causal explanation, as this may help us to understand the use of the verb προηγεῖσθαι in the present passage. According to Hankinson, “the

1093 See Anon. Par. 17.1 (110.7 f. Garofalo), Anon. Par. 17.2.1 (110.14 f. Garofalo). 1094 See Pseudo-Galen, Def. med. 251 (19.417.12 f. K.). 1095 See Caelius Aurel., Tard. pass. 1.51 (458.15 f. Bendz).

306 | Commentary

distinction in antecedent causes between αἴτια προκαταρκτικά and προηγούμενα originated in the medical schools”,1096 probably in Athenaeus of Attaleia,1097 and not, as such, in the Stoics, who were extremely interested in the study of causal explanations.1098 Galen deals with these terms as well throughout his œuvre, explaining in his treatise Methodus medendi that those causes which arise in the body are preceding causes (προηγούμενα αἴτια), while those which fall upon the body from outside are procatarctic causes (προκατάρχοντα αἴτια).1099 In De causis pulsuum, Galen gives a vivid example: when coldness falls upon the body from outside the skin becomes denser, and its natural capacity for transpiration is damaged. This leads ultimately to fever which, in turn, changes the pulse.1100 In this example, the coldness falling upon the body is the procatarctic cause (προκαταρκτικὸν … αἴτιον), while everything else up to the change of the pulse are preceding causes (προηγούμενα).1101 However, it is significant that Galen does not “consistently employ the terminology of preceding causes”.1102 The use of the verb προηγεῖσθαι in the present passage may or may not reflect this theoretical framework. p. 134.19: χρονίζοντος – πάθους: For a discussion of the technical term “chronic affections” (νοσήματα/πάθη χρόνια and similar phrases), as distinct from “acute affections” (νοσήματα/πάθη ὀξέα and similar phrases), see p. 204, commentary on p. 128.9–10. It is ambiguous whether the verb χρονίζειν is actually used in this technical sense here or whether it is just supposed to express the idea that the affection has already existed for a certain period of time. It may, then, just be in line with the chronological phrases which were used earlier (πρῶτον, ἔπειτα, ἐπιτεινομένου δὲ τοῦ πάθους), see p. 299, commentary on p. 134.13–14 and p. 303, commentary on p. 134.16–17. It is interesting in this regard that other writings discuss skotoma under the rubric of chronic affections. In Aretaeus’ work, the affection appears in the book περὶ αἰτίων καὶ σημείων χρονίων πάθων,1103 in Caelius Aurelianus it is discussed in the books dealing with tardae passiones,1104 and the Anonymus Parisinus deals with skotoma immediately after stating that he wants to end the discussion about acute diseases (τῶν ὀξέων) and move on to chronic diseases (τῶν χρονίων).1105 Given that our text does not explicitly suggest classifying skotoma as a chronic affection, the 1096 See Hankinson 2004 in Galen On Antecedent Causes (= De caus. procat.), 24 note 104. 1097 See Hankinson 2004 in Galen On Antecedent Causes (= De caus. procat.), 43–45; Hankinson 1987, 88. 1098 For a look at the Stoic discussion, see e.g. Hankinson 2004 in Galen On Antecedent Causes (= De caus. procat.), 20–27. 1099 See Galen, Meth. med. 1.8 (102.13–16 Johnston & Horsley = 10.65.16–66.2 K.). 1100 See Galen, De caus. puls. 1.1 (9.2.15–3.2 K.). 1101 See Galen, De caus. puls. 1.1 (9.3.2–4 K.). 1102 See Hankinson 2004 in Galen, On Antecedent Causes (= De caus. procat.), 43. See also Hankinson 1987, 89–92. 1103 See Aretaeus 3.1 (36.4–18 Hude). 1104 See Caelius Aurel., Tard. pass. 1.51–53 (458.5–460.3 Bendz). 1105 See Anon. Par. 16.3.10 (108.22 f. Garofalo).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

307

use of the verb χρονίζειν in the present context should not be over-interpreted. Still, the author(s) of our text is surely aware of the classification of skotoma as it appears in other texts. p. 134.19–27: καὶ ἐπὶ – ἐργάζεται: Most of these lines appear more or less verbatim in the third book of Galen’s De locis affectis.1106 For a closer discussion of the questions of how reliable the references to the sources in the headings indeed are, how we have to conceive of the fact that Aetius claims to cite Archigenes and Posidonius in this chapter but obviously uses Galen, and how we have to conceive of the relation between different sources, which all arise from the observation that our text has a parallel in Galen, see p. 14 and p. 20 – 23. p. 134.19–20: καὶ ἐπὶ – σκοτοῦνται: The noun πρόφασις is another term that is also applied in a technical sense in discussions of causal explanations. According to Galen’s De causis procatarcticis, which survives only in Latin, many of the ancients (multi antiquorum) use the term occasiones (whose Greek equivalent is προφάσεις, as Hankinson has pointed out)1107 for what he refers to as antecedent causes (procatarcticis causis).1108 On this term, see p. 305 f., commentary on p. 134.17–19. The ancients (i.e. “Hippocratic” writers)1109 are further said to employ this term for people who, qua being weaker than is natural (imbecilliora) or in a bad condition (male fuerunt disposita), are more prone to certain affections than they otherwise would be: “the ancients thought it appropriate to call this sort of cause πρόφασις because it showed up an existing weakness of the body”.1110 This explanation is based on the fact that the noun πρόφασις is derived from the verb προφαίνειν, which basically means “bringing to light”.1111 According to Johnston, Galen “makes no attempt to define it as he does with the other causal terms”1112 and the TLG lists only 180 occurrences of πρόφασις in Galen’s œuvre, in comparison to 2005 occurrences of αἴτια, for example. Johnston therefore deems it appropriate to translate the noun simply as

1106 See Galen, De loc. aff. 3.12 (8.202.2–14 K.): σκοτοῦνται γὰρ ἐπὶ σμικραῖς προφάσεσιν οἱ πάσχοντες, ὡς καὶ καταπίπτειν ἐνίοτε, μάλιστα μὲν ὅταν αὐτοί ποτε ἐν κύκλῳ περιστραφῶσιν· ὅπερ γὰρ τοῖς ἄλλοις ἐπὶ πολλαῖς περιστροφαῖς συμβαίνει, τοῦτο ἐκείνοις ἐπὶ μιᾶς. κᾂν ἕτερον δέ τινα περιστρεφόμενον ἴδωσι, σκοτοῦνται, κᾂν τροχὸν, ἤ τι τοιοῦτον περιδινούμενον, αὐτάς τε τὰς καλουμένας δίνας ἐν τοῖς ποταμοῖς. συμβαίνει δ’ αὐτοῖς ταῦτα μᾶλλον, ὅταν ἡλιωθῶσιν, ἤ πως ἄλλως θερμανθῶσι τὴν κεφαλήν. ἔοικεν οὖν ὅπερ ἐν τοῖς ἄλλοις ἐκ τοῦ περιστραφῆναι πολλάκις ἐν κύκλῳ συμβαίνει, τοῦτο ἐκείνοις ἄνευ τοῦ περιστραφῆναι γίγνεσθαι· τοῖς δὲ περιστρεφομένοις πολλάκις ἐν κύκλῳ ἀνώμαλός τε καὶ ταραχώδης καὶ ἄτακτος κίνησις τῶν τε χυμῶν καὶ τοῦ πνεύματος ὡμολόγηται γίγνεσθαι. 1107 See Hankinson 2004 in Galen, On Antecedent Causes (= De caus. procat.), 156. 1108 See Galen, De caus. procat. 1.6 (72.2–4 Hankinson). 1109 See Hankinson 1987, 86. 1110 Hankinson 2004 in Galen, On Antecedent Causes (= De caus. procat.), 157. 1111 See LSJ, s.v. προφαίνω: “bring to light, show forth, manifest”. On this issue, see also Hankinson 2004 in Galen, On Antecedent Causes (= De caus. procat.), 157. 1112 Johnston 2006 in Galen On Diseases and Symptoms (= De sympt. caus./De sympt. diff. et al.), 33.

308 | Commentary

“cause”.1113 The phrase ἐπὶ μικραῖς προφάσεσι, which is used in the present passage, is found elsewhere in ancient Greek medical literature, sometimes with a slightly different choice of words or a different arrangement of words. It is used in connection with terms that describe diseases or symptoms in order to express the notion that those diseases, symptoms or other (mostly detrimental) bodily processes, occur due to “very slight causes”, that is to say very easily.1114 In both Galen’s De locis affectis (see also p. 307, commentary on p. 134.19–27) and Paul’s compilation, this phrase is also used in a way that is explicitly connected to skotoma. Galen’s text is nearly identical to ours,1115 as discussed above, and in Paul’s compilation the phrase ὑπὸ σμικρᾶς προφάσεως is used in reference to the verb καταπίπτειν,1116 which immediately follows the present passage in our text (see p. 309 f., commentary on p. 134.20–21). As far as the actual meaning of the verb σκοτοῦσθαι in our passage is concerned, it is difficult to decide whether it is used here in its basic meaning or in its transferred meaning. In the former case, qua being related to the noun σκότος (darkness), it would mean something along the lines of “to see darkness in front of one’s eyes” (see also p. 303 f., commentary on p. 134.16–17), which would be similar to the German “jemandem wird schwarz vor den Augen”.1117 In the latter case it would mean “to become dizzy” or “to suffer from skotoma”. Hanson provides a clear overview of the usage of the verb σκοτοῦν and its derivatives in Greek literature.1118 One central issue he identifies is that “the problem [scil. with words such as σκότος, δῖνος, σκοτόδινος, σκοτοδινίη and their differentiation] here is not just semantic, but conceptual as well. Darkening or loss of vision can occur without vertigo, and vertigo without darkening of vision. Each symptom is discrete and has its own causes”.1119 In a similar way, Thumiger suggests that “sometimes the reference to the darkness is difficult to identify with ‘blindness’, a disturbance of a purely optical kind, and appears to indicate instead a greater sensory-motor difficulty, suggesting that we should rethink this sphere of symptoms more comprehensively to include the patient’s ability to move and stand”.1120 Given that on p. 134.16–17 the nouns ἴλιγγοι and σκοτώματα were used together to express two different aspects of the fact that the patients may suffer from darkening of vision together with the feeling of becoming dizzy (see p. 303 f., commentary on p. 134.16–17), I suggest the verb 1113 See Johnston 2006 in Galen On Diseases and Symptoms (= De sympt. caus./De sympt. diff. et al.), 33. 1114 See e.g. Galen, De plac. Hipp. et Plat. 5.2.9 (296.25 f. de Lacy = 5.434.13 f. K.), De san. tuenda 5.10.16 (156.16 Koch = 6.324.13 f. K.), De tum. praeter nat. 10 (20.2 f. Reedy = 7.724.17 K.), Galen, De loc. aff. 3.13 (8.204.13 K.), Paul 4.31.1 (Vol. 1, 352.19 f. Heiberg), Alexander, Therapeutica 1.11 (594.19 f. Guardasole = Vol. 1, 485.16 f. Puschmann). 1115 See Galen, De loc. aff. 3.12 (8.202.2 K.): σκοτοῦνται γὰρ ἐπὶ σμικραῖς προφάσεσιν οἱ πάσχοντες. 1116 See Paul 3.12.1 (Vol. 1, 151.24 f. Heiberg). 1117 See also Siegel 1976 in Galen, On the Affected Parts (= De loc. aff.), 212 note 69. 1119 Hanson 1989, 305. See also Hanson 1999 in Hippocratis De capitis vulneribus, 108. 1120 Thumiger 2017a, 292.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius | 309

σκοτοῦνται here should be read as referring to the same process, which would mean that it also includes both aspects. My claim rests on two facts. First, given that the genitive absolute χρονίζοντος δὲ τοῦ πάθους forms part of a structural unit with earlier phrases identifying chronological order (see p. 306, commentary on p. 134.19), the first of which appears in the discussion of initial symptoms, and which continue through to the passage dealing with intensification of the affection, it is reasonable to assume that the symptoms discussed in the present passage are at least as severe as those previously mentioned. This means that the σκοτοῦνται needs to include both elements. Secondly, the fact that καταπίπτειν (falling down) is presented as a consequence of the σκοτοῦνται (see p. 309 f., commentary on p. 134.20–21) suggests that dizziness or some other lack of control over the body comes first. However, in order to keep the etymology of the Greek verb, I translate σκοτοῦσθαι as “darkening of vision”. The verb σκοτοῦσθαι also appears in other texts dealing with skotoma. In Theophrastus’ De vertigine, it appears in a context similar to that in the current passage (see p. 311, commentary on p. 134.22–24).1121 Similarly, the Anonymus Parisinus mentions that patients see darkness in front of their eyes (ἐσκοτωμένοι) when they stand up, and that they, thus, fall down easily (πίπτουσι πρὸς ὀλίγον).1122 It is, of course, also used in the passage of Galen’s De locis affectis which is reproduced here (see p. 307, commentary on p. 134.19–27). p. 134.20–21: ὥστε – περιστραφῶσιν: The patients are said to fall (καταπίπτειν) as a consequence of the darkening of their vision (see p. 309, commentary on p. 134.19–20). The verb καταπίπτειν is also used in Paul’s chapter on skotoma, where it says that the patients readily fall down due to slight causes (ὑπὸ σμικρᾶς οὗτοι προφάσεως ἑτοίμως καὶ καταπίπτουσιν)1123 and it is evident that this passage shares striking similarities to our present passage. For a closer look at the interdependence between the compilers, see p. 33 – 35. In this special case it is interesting that both Aetius and Paul seem to use Galen’s text (see also p. 307, commentary on p. 134.19– 27), which also reads καταπίπτειν.1124 The Anonymus Parisinus states that patients suffering from skotoma fall down easily (πίπτουσι πρὸς ὀλίγον) and he also connects this falling with the darkening of vision (ἐσκοτωμένοι).1125 Caelius Aurelianus says that patients suffering from skotoma sometimes suddenly fall (repentinus casus) and get back to their feet again quickly (cum celerrima surrectione).1126 In his treatise De vertigine, Theophrastus mentions that patients suffering from iliggos are often thrown down (καταβάλλει πολλάκις) by certain processes.1127 The fact that several texts, as we have just seen, conceive of skotoma as involving the patients falling, is 1121 1122 1123 1124 1125 1126 1127

See Theophrastus, De vertig. 7 (190.60 Sharples). See Anon. Par. 17.2.2 (110.15 f. Garofalo). See Paul 3.12.1 (Vol. 1, 151.24 f. Heiberg). See Galen, De loc. aff. 3.12 (8.202.3 K.). See Anon. Par. 17.2.2 (110.16 Garofalo). See Caelius Aurel., Tard. pass. 1.52 (458.21 Bendz). See Theophrastus, De vertig. 1 (184.15 Sharples).

310 | Commentary

remarkable in light of the fact that patients suffering from epilepsia are also said to fall down (καταπίπτειν) in several medical texts.1128 This observation might be one reason why skotoma is also referred to as “small epilepsia”.1129 The phrase μάλιστα μὲν ὅταν αὐτοί ποτε ἐν κύκλῳ περιστραφῶσιν is another that is also found verbatim in Galen’s De locis affectis (see p. 307, commentary on p. 134.19–27). In Paul’s compilation we find the same notion: patients suffering from skotoma are said to fall down due to a slight cause, as, for example, when they themselves move around in a circle (ἢ καὶ αὐτοὶ στραφέντες).1130 In his De vertigine, Theophrastus also deals with turning around as one factor which brings about ἴλιγγος.1131 This issue is further examined in the following lines of our text (see p. 310, commentary on p. 134.21–22). p. 134.21–22: ὅπερ – μιᾶς: This sentence continues the previous statement about the effects of the spinning around in a circle (see p. 309 f., commentary on p. 134.20–21). By differentiating between ἄλλοις and ἐκείνοις the text clearly highlights the differences between patients suffering from skotoma (ἐκείνοις) and those who are not affected (ἄλλοις). While the latter would need to turn around many times in order to cause themselves to fall down, the patients suffering from skotoma just need to turn around once. Thus, this sentence specifies again what lies behind the statement that they suffer “from slight causes” (p. 134.19: ἐπὶ μικραῖς προφάσεσι). The sentence is to be found nearly verbatim in Galen’s De locis affectis (on this issue, see p. 307, commentary on p. 134.19–27). Galen uses the verb συμβαίνει, where in Aetius’ text we read γίγνεται. p. 134.22–24: κἂν – ὑπομένουσι: All the incidents mentioned in the present paragraph are further examples of situations which could lead the patients to suffer from darkening of vision (σκοτοῦνται). Falling down (καταπίπτειν) is not explicitly mentioned here but, given that the text still deals with the topic of whirling around, it is likely that one needs to take the previous subclause ὥστε καὶ καταπίπτειν ἐνίοτε (p. 134.20) as applying to the present section as well. This section introduces a new aspect in the discussion of darkening of vision. The patients are said to suffer from this not only when they themselves turn around but also when they watch someone or something else turning around (the physiological explanation is provided in the following lines [see p. 311 – 314, commentary on p. 134.24–25]). This focus on turning is a common feature in the discussion of skotoma. To begin with, in Galen’s De locis affectis we read the same lines about watching whirling objects (see p. 307, commentary on p. 134.19–27). Galen, however, adds the “so-called eddies in a river” (τὰς 1128 See e.g. Aetius Amid., Libri med. 6.15 (Vol. 2, 155.9 Olivieri), Libri med. 9.17 (309.5 f. Zervos), Alexander, Therapeutica 1.15 (664.10 Guardasole = Vol. 1, 559.19 Puschmann). 1129 See e.g. Caelius Aurel., Tard. pass. 1.51 (458.12–14 Bendz). See also Anon. Par. 17.2.2 (110.16–18 Garofalo). 1130 See Paul 3.12.1 (Vol. 1, 151.24–26 Heiberg). 1131 See Theophrastus, De vertig. 4 (186.30–188.1 Sharples). See also Theophrastus, De vertig. 1 (184.4 f. Sharples).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius |

311

καλουμένας δίνας ἐν τοῖς ποταμοῖς) to the list of whirling things which, when patients look at them, bring about a darkening of their vision.1132 Caelius Aurelianus states that the affection intensifies when the patients look at the current of a river (meatum fluminis) or at the rotation of a potter’s wheel (rotae vertiginem figuli).1133 In his list of “slight causes” which may cause the patients to fall down, Paul also says that this happens to patients who look at objects that whirl around, such as wheels or eddies (ποτὲ μὲν στρεφόμενά τινα βλέποντες ἔξωθεν, οἷον τροχοὺς ἢ δίνας).1134 According to Theophrastus’ De vertigine, people “who look at swings and wheels or actually rotate their sight with them quickly”1135 suffer from darkening of vision (καὶ οἱ τὰς αἰώρας καὶ τοὺς τροχοὺς θεωροῦντες ἢ καὶ συμπεριφέροντες τὴν ὄψιν ταχὺ σκοτοῦνται).1136 There are also a number of other texts which are generally concerned with rotary movements in the context of skotoma. In Galen’s In Hippocratis Aphorismos commentarii it is stated that skotodinos occurs when “that which is seen seems to be whirling around all together” (ἐπειδὰν ἅμα περιδινεῖσθαι δοκῇ τὰ βλεπόμενα),1137 and the same idea is echoed in the pseudo-Galenic Definitiones medicae.1138 The Anonymus Parisinus states that sparks in front of the patients’ eyes appear such that “they seem to see circles, and nothing seems to stand still, and everything is turning around” (ὥστε κύκλους ὁρᾶν δοκεῖν, οὐδὲν αὐτοῖς ἡδράσθαι φαίνεται, πάντα δὲ περιφέρεσθαι),1139 and Aretaeus says that “rotation whirls around the head” (καὶ δῖνος ἀμφὶ τὴν κεφαλὴν ἑλίσσηται).1140 Theophrastus states in this context that ἴλιγγος occurs due to a κίνησις τῆς ὄψεως, or “movement of sight”, as Sharples translates it.1141 The fact that people become dizzy when looking at a rotating wheel or waves is presented as an example of this statement. At the end of this paragraph, Theophrastus explains that the sight of the patients, since it moves in a circle, moves the interior parts [of the body] in an irregular way and thus causes trouble.1142 See also p. 315, commentary on p. 134.25– 27. p. 134.24–25: τὸ γὰρ – ἐκείνῳ: It is interesting that this part of the sentence is not contained in Galen’s De locis affectis (see p. 307, commentary on p. 134.19–27). This absence raises several questions about its origin and the way it is embedded in 1132 See Galen, De loc. aff. 3.12 (8.202.7 f. K.). 1133 See Caelius Aurel., Tard. pass. 1.52 (458.22 f. Bendz). 1134 See Paul 3.12.1 (Vol. 1, 151.25 f. Heiberg). 1135 I quote Sharples’ translation here. See Sharples 2003 in Theophrastus, On Dizziness, 191. 1136 See Theophrastus, De vertig. 7 (190.59–62 Sharples). 1137 See Galen, In Hipp. Aph. comm. 4.17 (17b.677.4 f. K.). 1138 See Pseudo-Galen, Def. med. 251 (19.417.12 f. K.). 1139 See Anon. Par. 17.2.1 (110.14 f. Garofalo). 1140 See Aretaeus 3.3.1 (37.24 f. Hude). 1141 See Theophrastus, De vertig. 7 (190.55 Sharples). 1142 See Theophrastus, De vertig. 7 (190.60–62 Sharples): συμβαίνει γὰρ κινουμένην κύκλῳ τὴν ὄψιν κινεῖν τὰ ἐντὸς ἀνωμάλως καὶ ταράττειν. Sharples’ translation: “for it comes about that as their sight moves in a circle it moves the inside parts unevenly and causes disturbance.”

312 | Commentary

the present section of the chapter. Did Aetius use Galen via another source, which contained this part of the sentence? Did Galen use another source without any further indication and did Aetius also draw on this original source rather than on Galen? Assuming Aetius copied from Galen, why did he add this sentence and where did it come from? For a general discussion of this kind of problem, see p. 14, p. 22 f., and p. 27 f. As far as the present passage is concerned, it is interesting that it mentions the optical pneuma (ὀπτικὸν πνεῦμα), especially in light of the fact that the psychic pneuma (ψυχικὸν … πνεῦμα) was also mentioned at the beginning of the chapter (see p. 297 f., commentary on p. 134.11–13). Given that the text thus deals with two specific forms of pneuma, one may ask whether it is reasonable to assume that the text or these parts of the text stem from the pneumatist Archigenes. On this issue, see also p. 299, commentary on p. 134.11–13, where I note the importance of being cautious about over-interpreting this difficulty. However, given that this part of the text is not contained in Galen’s De locis affectis, and given that he explicitly claims that he cites Archigenes once within the section in which he deals with skotoma,1143 one might reasonably suspect that Galen cites more of Archigenes than he actually tells his readers. Aetius, then, might indeed have used Archigenes’ original version, which contained the present part of the sentence. It is, however, also possible to assume Aetius added this part of the sentence himself. For more on this, see also p. 314 f., commentary on p. 134.25–27. The ὀπτικὸν πνεῦμα is supposed to play a central role in the process of vision, as its name suggests. It would go beyond the scope of this study to provide an exhaustive overview of ancient theories of vision, but for more detail see e.g. Hirschberg 1899, 149–207; Haas 1907; Lindberg 1976, 1–17. In what follows, I will discuss those texts which can help us to gain a deeper knowledge of the process mentioned in the present passage of Aetius’ chapter on skotoma, and I will thereby concentrate on the Stoic and the Galenic theories. The fundamental question for me is, thus, whether the optical pneuma is thought to leave the eye, i.e. whether the προσπῖπτον is to be taken literally. According to Aetius the doxographer, Chrysippus was of the opinion that “we are able to see due to the tension of the intermediary air when it is hit by the visual pneuma [τοῦ μεταξὺ ἀέρος ὁρᾶν ἡμᾶς, νυγέντος μὲν ὑπὸ τοῦ ὀπτικοῦ πνεύματος], which spreads from its origin towards the pupil [ὅπερ ἀπὸ τοῦ ἡγεμονικοῦ μέχρι τῆς κόρης διήκει; the hegemonikon is the origin of the optical pneuma] and which, when the surrounding air shares the same nature, usually gives it a canonical shape when it encounters it [κατὰ δὲ τὴν πρὸς τὸν περικείμενον ἀέρα ἐπιβολὴν ἐντείνοντος αὐτὸν κωνοειδῶς, ὅταν ᾖ ὁμογενὴς ὁ ἀήρ]; fiery rays are projected during vision, not dark nor hazy ones. Thus, darkness becomes visible”.1144 According to the doxographer’s summary of Chrysippus’ theory, the optical pneuma is said

1143 See Galen, De loc. aff. 3.12 (8.203.12–17 K.). 1144 See Aetius Dox., De plac. rel. 4.15.3 (406.4–14 Diels). I quote Boudon’s translation here: Boudon-Millot 2012b, 558 note 27.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

313

to “hit” (νυγέντος) the air, to reach from the hegemonikon to the pupil and to have a certain impact on the air, “giving it a canonical shape”, by “falling upon” it (τὴν πρὸς τὸν περικείμενον ἀέρα ἐπιβολὴν). The usage of the noun ἐπιβολή does not allow definite conclusions about the question of whether the optical pneuma is thought to leave the eye or not. Several scholars have assumed that the pneuma is not thought to leave the eye,1145 or at least not to “proceed to the object”1146 but, as Hahm admits, the “precise relationship between the optic pneuma and the external air”1147 is not completely clear. For more on this topic, see Hahm 1978, 67. On the Stoic theory of vision, see e.g. Ingenkamp 1971; Haas 1907, 380–383; Lindberg 1976, 9 f.; Siegel 1970, 37–40; Hahm 1978, 65–68. In his De placitis Hippocratis et Platonis, Galen deals at length with the physiological processes that enable us to see. He begins his account by presenting two basic alternatives, which can be summarized as follows: either the object which is seen sends something to the person who sees it, in order to be seen and recognized in its peculiarity, or the person who sees it sends something to the object which is seen, in order to see it.1148 Galen excludes the first alternative, since “an image of the size of the mountain would have come from the mountain and entered our eyes, which is utterly absurd. It is also absurd that at one moment of time the image should reach every viewer, even though they are countless. And the optic pneuma cannot extend itself [ἐκτεινόμενον] and acquire such a stream as to envelop the whole object being viewed”.1149 A few lines further down we learn that Galen was of the opinion that the emission of pneuma (ὑπὸ τῆς τοῦ πνεύματος ἐκπτώσεως) has an effect on the surrounding air, which enables us to see.1150 Again, the noun ἔκπτωσις is unclear just like the verb προσπίπτειν in our present passage and does not allow definite conclusions to be drawn as to whether the pneuma is indeed thought to leave the eye. However, Galen compares the effect that the pneuma has on the air with the effect sunlight has. He writes that “sunlight, touching the upper limit of the air [ψαύουσα τοῦ ἄνω πέρατος αὐτοῦ], transmits its power to the whole [διαδίδωσιν εἰς ὅλον τὴν δύναμιν]; and the vision [ὄψις] that is carried through the optic nerves has a substance of the nature of pneuma [τὴν μὲν οὐσίαν ἔχει πνευματικήν], and when it strikes the surrounding air [ἐμπίπτουσα δὲ τῷ περιέχοντι] it produces by its first impact [τῇ πρώτῃ προσβολῇ] an alteration that is transmitted to the furthest distance [τὴν ἀλλοίωσιν ἐργαζομένη διαδίδωσιν ἄχρι πλείστου]”.1151 It seems, from this analogy, that Galen posited a very short contact

1145 See e.g. Ingenkamp 1971, 244; Hahm 1978, 67 f. 1146 Hahm 1978, 67. 1147 Hahm 1978, 67. 1148 See Galen, De plac. Hipp. et Plat. 7.5.1 (452.30–33 de Lacy = 5.618.3–6 K.). 1149 See Galen, De plac. Hipp. et Plat. 7.5.3–4 (454.1–6 de Lacy = 5.618.12–17 K.). I quote de Lacy’s translation here. 1150 See Galen, De plac. Hipp. et Plat. 7.5.5–6 (454.8–11 de Lacy = 5.619.2–6 K.). 1151 See Galen, De plac. Hipp. et Plat. 7.5.7 (454.11–15 de Lacy = 5.619.7–11 K.). I quote de Lacy’s translation here.

314 | Commentary

between the pneuma and the air, taking place in close proximity to the eye and being immediately able to transmit its effect to a great distance. In interpreting Galen’s theory of vision, von Staden speaks of Galen’s view of the relation between pneuma and air as follows: the pneuma is said to make the air sensitive (“un effet de sensibilisation instantané sur l’air extérieur”) and to affect it in a qualitative way (“affectant qualitativement cet air extérieur”).1152 These phrases convey the core of Galen’s theory. For further analysis of Galen’s theory of vision, see e.g. BoudonMillot 2012b, von Staden 2012, Ierodiakonou 2014, Lindberg 1976, 9–11. It is interesting that Galen, in another passage of his De placitis Hippocratis et Platonis, even uses the verb προσπίπτειν, which is also used in our passage, in his description of the function of pneuma,1153 and it is in general remarkable that the words which are used to describe what the pneuma is actually doing, are related to the verbs πίπτειν or βάλλειν (ἐπιβολή, ἔκπτωσις). Coming back to our present sentence, one might assume that it is influenced by the theories we have just dealt with. Sharples assumes that the author of our text “is employing the Stoic theory of vision, according to which vision was explained by a tensioned cone of πνεῦμα with its apex at the eye contacting the object at its base”1154 and I am sympathetic to this interpretation. However, even if one cannot be sure about the exact relation between pneuma and object, it is clear that, according to our text, looking at a rotating object is thought to have an influence on the movement of the pneuma. p. 134.25–27: καὶ οὕτως – ἐργάζεται: Unlike the previous section (p. 134.24–25: τὸ γὰρ – ἐκείνῳ; see p. 307, commentary on p. 134.19–27, see p. 311 f., commentary on p. 134.24–25), this part of the sentence is again found in a very similar form in Galen. The Galenic version contains further sentences that appear before the present sentence but which are not contained in Aetius’ chapter (see note 1106 for the complete Galenic text). Apart from the broader problems with the composition of the whole sentence, this part of the sentence poses several further questions, although these may be linked to the overall difficulties. To begin with, there is a text-critical issue with the phrase τόν τε χυμὸν, which the Parisinus Suppl. gr. 1240 (Pa) and the manuscript group χ read as τῶν τε χυμῶν.1155 Secondly, there is the question of how to deal with the fact that the noun πνεῦμα seems to be used both as subject and object of the sentence; the term ὀπτικὸν πνεῦμα appears to be the subject to the verb ἐργάζεται, which, in turn, takes τοῦ πνεύματος τὴν κίνησιν as its object. Thirdly, it remains unclear what lies behind the noun χυμός, which is used here for the first time in this chapter and does not receive further explanation. As for the first question, the reading of the Parisinus Suppl. gr. 1240 (Pa) and the manuscript group χ (on these man1152 1153 1154 1155

von Staden 2012, 135. See Galen, De plac. Hipp. et Plat. 7.5.41 (460.31–33 de Lacy = 5.627.8–10 K.). Sharples 2003 in Theophrastus of Eresus On Dizziness, 217. See Olivieri’s critical apparatus to p. 134.26.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

315

uscripts, see p. 15 f.) is the reading which is also found in Galen’s De locis affectis.1156 This reading is more reasonable here for several reasons. It better connects the remarks about the humors with the pneuma, it allows us to refer the adjectives ἀνώμαλον καὶ ταραχώδη καὶ ἄτακτον to the noun τὴν κίνησιν, and it solves the problem of the position of τε in the phrase τόν τε χυμὸν, which would, otherwise, have been hard to explain, if we had read the adjectives as predicative of χυμὸν. As for the second question, the problem with mentioning the pneuma twice, as both subject and object is indeed only problematic when assuming that it refers to the same pneuma in both cases, i.e. to the optical pneuma. If we, however, assume that the phrase τοῦ πνεύματος τὴν κίνησιν does not refer to the optical pneuma but to another form of pneuma, probably to the previously mentioned psychic pneuma (see p. 297 f., commentary on p. 134.11–13), the sentence is easier to understand. The movement of the optical pneuma (p. 134.25: κινεῖται, συμπεριφερόμενον) also leads to the irregular, troubled, and disordered movement of the psychic pneuma (and of the humors), which thus brings about the darkening of vision (σκοτοῦνται; see p. 308 f., commentary on p. 134.19–20), due to the disturbance of the natural balance. We find a very similar passage in Theophrastus’ De vertigine, which states that people who look at swings or wheels (οἱ τὰς αἰώρας καὶ τοὺς τροχοὺς θεωροῦντες) or carry around their sight with them (συμπεριφέροντες τὴν ὄψιν), soon suffer from darkening of vision (σκοτοῦνται).1157 The explanation therefore is that “as their sight moves in a circle [κινουμένην κύκλῳ τὴν ὄψιν] it moves the inside parts unevenly and causes disturbance [κινεῖν τὰ ἐντὸς ἀνωμάλως καὶ ταράττειν]”.1158 Theophrastus uses the adverb ἀνωμάλως here, which corresponds to ἀνώμαλον in our text, and the verb ταράττειν, which corresponds to ταραχώδη. He states that the movement of sight causes a movement and a disturbance of internal parts, and this suggests that there is a causal connection between the two motions. Our passage might understand the impact of the movement of optical pneuma on the movement of psychic pneuma in the same way. As for the third question, although we do not receive any explanation as to how to conceive of the humors here, it is reasonable to think of them as residing in the brain and as, when imbalanced, having an impact on the physiological processes of the patient. In spite of the fact that the first half of this sentence is not present in Galen, taken as a whole, the sentence gives a fairly reasonable account of the physiological processes that happen in the body of patients who suffer from skotoma when looking at rotating objects. p. 134.27–28: εὐάλωτοι – ἐκκρίσεις: The fact that people who hold back “the accustomed excretions” (τὰς συνήθεις ἐκκρίσεις, a phrase which is used quite a few

1156 See Galen, De loc. aff. 3.12 (8.202.13 f. K.). 1157 See Theophrastus, De vertig. 7 (190.59 f. Sharples). 1158 See Theophrastus, De vertig. 7 (190.60–62 Sharples). I quote Sharples’ translation here.

316 | Commentary

times in ancient medical literature, mostly in connection to retention)1159 are said to be liable to the affection (εὐάλωτοι δὲ τῷ πάθει),1160 is remarkable. Digestion and indigestion have already been mentioned in this chapter in connection with the occurrence of the affection (p. 134.15 and p. 134.18–19; see p. 302 f., commentary on p. 134.15–16 and p. 305, commentary on p. 134.17–19). All three processes, digestion, indigestion, and retention are connected to the stomach and the abdominal area, and, just as in digestion and indigestion, the occurrence of retention of excretions may set in motion some rising of vapors from the stomach to the brain, thus causing the affection. For further discussion of these issues, see p. 296 f., commentary on p. 134.11–13. p. 134.28–29: καὶ ἀπεψίαι – εἰσί: As is clear from the use of the phrase ἀποτελεστικαὶ τοῦ πάθους, the text provides us here with information concerning the causes of the affection.1161 It comes as a bit of a surprise that the text deals with causes at this point, since we have already received some information on this topic. The question of how the present information fits with the previous discussion must therefore be examined. For further discussion on the rise of vapors as bringing about dimness of vision, ringing in the ears, and hardness of hearing, see p. 299 – 301, commentary on p. 134.13–14; on the digestion of food and the rising from sleep as being especially linked to these processes, see p. 301 – 305, commentary on p. 134.15–16; on the sudden rise from a chair and preceding indigestion as being linked to the occurrence of iliggoi and skotomata, see p. 305, commentary on p. 134.17–19; and for further discussion of the optical pneuma as bringing about a disturbance of humors and pneuma, see p. 312 – 314, commentary on p. 134.24–25. All this seems to be on a different level of causality to the usage in the present passage. In our current text the list of nouns provided (ἀπεψίαι, ἐγκαύσεις, μέθαι) probably falls under the rubric of what, in Galenic terms, can be described as “antecedent causes” (αἴτια προκαταρκτικά), insofar as they are “external to the body affected”.1162 For further details on Galen’s understanding of causality, see p. 305 f., commentary on p. 134.17–19. The noun ἀπεψίαι, however, does not seem to fit on this list, since it is, strictly speaking, not external but internal. It was also mentioned previously in connection with the verb προηγεῖσθαι (see p. 134.18 f.), which, according to Galen’s understanding, describes an internal preceding cause, although Galen is not always

1159 See e.g. Galen, De sympt. caus. 1.5 (7.109.6 f. K.), Meth. med. 7.11 (318.21 f. Johnston & Horsley = 10.512.14 K.), Paul 2.9.3 (Vol. 1, 80.32 f. Heiberg). 1160 For further passages, which use the adjective εὐάλωτον in this meaning, see e.g. Galen, De venae sect. adv. Erasistratum 9 (11.180.7 K.), De plac. Hipp. et Plat. 5.2.19 (298.19 f. de Lacy = 5.436.16 K.). 1161 This usage of the adjective ἀποτελεστικός is, for example, also found in Aetius Amid., Libri med. 3.163 (Vol. 1, 335.2 f. Olivieri): οἱ δὲ ἀνατολικοὶ ἄνεμοι ἰσχυρότατοι σφόδρα καὶ τῶν κατὰ ξηρότητα συμβαινουσῶν νόσων ἀποτελεστικοί. 1162 Hankinson 1987, 88.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius |

317

consistent in his use of this terminology.1163 It seems that while ἀπεψίαι is understood as an internal preceding cause, ἐγκαύσεις and μέθαι are treated as external antecedent causes. All three set further physiological processes into motion and these then lead to skotoma. On the role that indigestion might play in the onset of skotoma, see p. 305, commentary on p. 134.17–19. Several parallel texts are illuminating in regard to the roles played by heat and drunkenness in the onset of skotoma. In the section on skotoma in Galen’s De locis affectis, we read that the head, when heated or when exposed to the sun, is especially prone to suffering from a darkening of vision (συμβαίνει δ’ αὐτοῖς ταῦτα μᾶλλον, ὅταν ἡλιωθῶσιν, ἤ πως ἄλλως θερμανθῶσι τὴν κεφαλήν).1164 Paul states that patients suffering from skotoma may fall down easily, for example when their head has been heated, and the humors and the pneuma in the head have thus been moved (ποτὲ δὲ καὶ θαλφθέντες τὴν κεφαλὴν κινουμένων τῶν ἐν αὐτῇ χυμῶν ἢ καὶ τοῦ πνεύματος).1165 Caelius Aurelianus mentions people who are prone to drinking (vinolentos) as prone to skotoma1166 and, in his treatise De vertigine, Theophrastus also mentions wine as playing a possible role in the onset of the affection.1167 The line of thought underlying the present passage is, most likely, similar to that put forward in Paul’s text, a view supported by the presence of vapors, pneuma, and the movement of humors and pneuma in both passages. The drinking of wine is often connected to a heating capacity1168 and drunkenness is even dealt with as one possible cause of headache in the sixth book of Aetius’ Libri medicinales, where it is stated that warm wines cause headaches insofar as they fill the head completely with vapors and sometimes also with warm humors.1169 With this evidence in mind, it is interesting that the present chapter opens by mentioning that warm vapors play a role in the onset of skotoma (see p. 296 – 299, commentary on p. 134.11–13). The influence of wine is probably thought to contribute to the presence of such vapors in the head, and thus to the onset of skotoma. p. 134.29–135.1: παρακολουθεῖ – ἐχούσης: The information contained here seems to be on a different level to that in the previous sentence. It seems to be concerned not with causal explanations but with accompaniments of the affection. In the present context, the verb παρακολουθεῖν is used to communicate that the patients are seized by certain accompaniments,1170 and the pronoun αὐτοῖς, therefore, 1163 See e.g. Hankinson 1987, 89–92. 1164 See Galen, De loc. aff. 3.12 (8.202.8 f. K.). 1165 Paul 3.12.1 (Vol. 1, 151.26 f. Heiberg). 1166 Caelius Aurel., Tard. pass. 1.51 (458.8 Bendz). 1167 See Theophrastus, De vertig. 1 (184.2–4 Sharples). 1168 See e.g. Galen, Quod animi mor. 10 (70.7–13 Bazou = 4.810.3–9 K.). 1169 See Aetius Amid., Libri med. 6.43 (Vol. 2, 185.15–17 Olivieri). 1170 See e.g. Aetius Amid., Libri med. 9.43 (390.5 f. Zervos): παρακολουθεῖ γὰρ τοῖς πάσχουσιν ἔκδοσις συνεχὴς ἀπέπτων; Libri med. 7.13 (Vol. 2, 265.3 f. Olivieri): προβαίνοντος δὲ τοῦ χρόνου καὶ ὑποφλεγμαίνει τὰ βλέφαρα καὶ νυγμοὶ παρακολουθοῦσι; Libri med. 8.57 (Vol. 2, 499.8 f. Olivieri): καί τισι μὲν ἀνορεξίαι παρακολουθοῦσιν, ἐνίοις δὲ ὀρέξεις παρὰ φύσιν, ἃς ὀνομάζουσι κυνώδεις.

318 | Commentary

refers to the patients. For further discussion of the phrase ἐποχὴ τῆς κοιλίας, denoting retention of excrement, see p. 257, commentary on p. 132.7–8. The fact that the patients suffering from skotoma suffer from retention of excrement was mentioned only a few lines above (see p. 315 f., commentary on p. 134.27–28). The reason it is listed here again is that it is not only a condition which makes people who suffer from it prone to skotoma but it is also an accompaniment of the affection. For a closer discussion of the flatulence (ἐμπνευμάτωσις) that is connected to this retention, see p. 234, commentary on p. 130.20–22. The excretion of small quantities of thin urine (οὔρων λεπτῶν καὶ ὀλίγων ἔκκρισις) together with a disturbance of the digestive tract, is also mentioned a number of times in the first book of the “Hippocratic” De morbis popularibus, though not in the context of skotoma.1171 In our passage the excretion of small quantities of thin urine seems to be connected to “the move of the material towards the head” (τῆς ὕλης ἐπὶ τὴν κεφαλὴν τὴν ὁρμὴν ἐχούσης). The noun ὕλη thus seems to refer to the warm and sharp vapors which were said to be carried up to the head in the opening of the chapter (p. 134.11–12: ἀτμῶν θερμῶν καὶ δριμέων ἐπὶ τὴν κεφαλὴν ἀναφερομένων; see also p. 296 f., commentary on p. 134.11–13). The phrase ἐπὶ τὴν κεφαλὴν is used both in the beginning of the chapter and in the present passage, which shows that the reference here indeed is to the warm and sharp vapors. The genitive absolute should probably be understood as denoting the point in time when the patients excrete small quantities of thin urine, namely when the affection is about to start. It is not entirely clear whether we should assume a causal connection as well between the excretion of small quantities of thin urine and the material moving to the head. One might think that the movement of the vapors to the head is the reason why there is only a little urine to excrete, since the movement to the head makes the vapors unavailable for excretion.1172 However, this would require certain hidden assumptions about the process of excreting urine and of the role played by vapors, and I have been unable to find any traces of such assumptions in the textual record. p. 135.1–2: ἰσχνοὶ – ἐπιβολήν: This sentence seems to reflect the general constitution of the patients, most of whom become weak (ἰσχνοὶ) and sluggish (νωθροὶ). The phrase πρὸς πᾶσαν ἐπιβολήν might thereby express the idea that the patients become weak and sluggish as a consequence of some external impulse.1173 For a closer look at the adjective νωθρόν, see p. 219, commentary on p. 129.11–12. The adjective ἰσχνόν is taken up again in the further course of this chapter (p. 135.14).

1171 See e.g. Hippocrates, De morb. popul. 1.18 (195.4 f. Kühlewein = 2.652.8 f. L.): ἐπὶ τούτοισιν οὖρα τούτοις ὀλίγα, μέλανα, λεπτά· καὶ κοιλίαι ἐφίσταντο, De morb. popul. 1.2 (182.6–9 Kühlewein = 2.608.4–7 L.): κοιλίαι ταραχώδεες, (…). οὖρα ἢ λεπτὰ καὶ ἄχρω καὶ ἄπεπτα καὶ ὀλίγα (…). 1172 I am grateful to Philip van der Eijk for suggesting and discussing with me this interpretation. 1173 I am grateful to Philip van der Eijk for suggesting and discussing with me this interpretation.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

319

p. 135.2–5: οἱ μὲν – ἐπιληψίαν: The fact that the perception of colors is mentioned here in the context of vision reflects a deep connection between the two.1174 I cannot dwell here on the history of the perception of colors in ancient thought (for an overview, see Hahm 1978, 69–88), but it will be worth citing two sample passages, one from Ptolemy’s Optica and another from Galen’s De placitis Hippocratis et Platonis, which show how one might think of color and vision. In his Optica, Ptolemy says that “color must be the proper sensible for sight, and that is why color is taken to be what is primarily visible after light”.1175 Galen states that “only color, and not form or size, can come to our eyes by reflection from the objects seen” (μόνου τοῦ χρώματος δυναμένου κατ’ ἀνάκλασιν ἀπὸ τῶν ὁρωμένων ἐπὶ τὴν ἡμετέραν ὄψιν ἀφικέσθαι, μορφῆς δ’ ἢ μεγέθους οὐκέτι).1176 These two passages illustrate that the perception of color was regarded as playing an important role in the process of vision in general. It seems plausible, then, that when vision is disturbed, as it is in skotoma, the perception of color should also be thought to be affected. In our present context, the perception of color is not addressed but it is argued that there is a correlation between particular mental states and the specific colors that patients seem to see in what appears in front of their eyes (τὰ προφαινόμενα τῶν ὀφθαλμῶν). Phrases such as προφαίνεσθαι τῶν ὀφθαλμῶν or πρὸ τῶν ὀφθαλμῶν προφαίνεσθαι are used in several texts in connection with the noun μαρμαρυγαί (sparks, flashes),1177 which are given as a symptom of skotoma by some authors.1178 In the present sentence, the phrase τὰ προφαινόμενα τῶν ὀφθαλμῶν may refer back to the previously mentioned disturbance of sight (dimness of vision, seeing everything whirling around). The adjective ἐναιμότερα and the participle πορφυρίζοντα, which is often used to describe the color of a flower or its blossom,1179 describe the colors of the things which appear in front of the patients’ eyes. Interestingly, in “Hippocratic” writings, but also for example in the Anonymus Parisinus, the fact that the eyes themselves are bloodshot (ὕφαιμον, δίαιμον and the like) is often mentioned in

1174 See e.g. Siegel 1970, 82–86, Hahm 1978, 69–88. I am grateful to Stephen Menn for pointing me in the direction of Ptolemy’s Optica on this point. 1175 See Ptolemy, Opt. 2.13 (17.3–10 Lejeune). I quote Smith’s translation here. See Smith 1996 in Ptolemy’s Theory, 75. See also Aristotle, De anima 6 (418a11–15): λέγω δ’ ἴδιον μὲν ὃ μὴ ἐνδέχεται ἑτέρᾳ αἰσθήσει αἰσθάνεσθαι, καὶ περὶ ὃ μὴ ἐνδέχεται ἀπατηθῆναι, οἷον ὄψις χρώματος καὶ ἀκοὴ ψόφου καὶ γεῦσις χυμοῦ (…). 1176 See Galen, De plac. Hipp. et Plat. 7.7.6 (470.24–26 de Lacy = 5.639.3–5 K.). I quote de Lacy’s translation here. 1177 See e.g. Hippocrates, Progn. 24.10 (74.6 f. Jouanna = 2.184.13–15 L.), Galen, In Hipp. Aph. comm. 1.12 (17b.396.14 f. K.), Aetius Amid., Libri med. 5.48 (Vol. 2, 28.25 f. Olivieri), Libri med. 6.8 (Vol. 2, 138.4 f. Olivieri). 1178 For textual evidence, see notes 1063, 1064, 1065, 1066. 1179 See e.g. Dioscorides, De mat. med. 2.164.1 (Vol. 1, 228.10 Wellmann), De mat. med. 3.36.1 (Vol. 2, 48.13 Wellmann), Paul 5.35 (Vol. 2, 29.17 Heiberg), Aetius Amid., Libri med. 1.22 (Vol. 1, 36.13 f. Olivieri), Libri med. 2.42 (Vol. 1, 169.4 Olivieri).

320 | Commentary

connection with mental illnesses.1180 The present report, however, is different from those found in “Hippocrates”, insofar as it is not the eyes that are colored in a certain way but, rather, what the patients seem to see. The main point in our passage lies in the connection between seeing the objects as either blood-colored or purplish and the tendency to1181 suffer from mania, in the former case, or from epilepsia, in the latter. Unfortunately, the text does not provide any explanation of this statement and nor does it elaborate any further on the connection between the two colors and the two affections. As far as the reference to mania is concerned, one can assume that seeing something as blood-colored is connected with mania because mania is said to be brought about by blood (see p. 343, commentary on p. 136.19). As regards the reference to epilepsia, it remains unclear why seeing something as purplish is connected with this affection in particular. There is a passage in Dioscorides’ De materia medica which states that the purplish part of the flower of the violet (ἴον) can, when drunk with water, help children who suffer from epilepsia.1182 But this is, to my knowledge, the only other passage in ancient medical literature which suggests a relation between epilepsia and a purplish color. It is, however, interesting that Aretaeus also mentions the proneness of patients suffering from skotoma to suffer from mania and epilepsia as well. In his chapter on skotoma, he says that when a patient vomits yellow bile (ἐπὶ μὲν ξανθῇ χολῇ) mania occurs, when he vomits black bile (ἐπὶ δὲ τοῖσι μέλασι) melancholia follows, and in cases where he vomits phlegm (ἐπὶ δὲ τῷ φλέγματι) epilepsia takes hold.1183 For further discussion of the connection between skotoma and epilepsia, see note 1129. p. 135.5: τῆς μὲν οὖν: In his critical apparatus, Olivieri lists an addition, which the Codex Parisinus Vaticanus Palatinus 199 (Px) adds between ἐπιληψίαν (p. 135.4– 5) and τῆς (p. 135.5). This addition reads as follows: Σκοτωματικῶν θεραπεία Ἀρχιγένους καὶ Ποσειδωνίου. τοὺς σκοτωματικοὺς ἐν ἐπιθέσει μὲν γενομένους διεγέρτεον τοῖς τε ἐπιτηδείοις ὀσφραντοῖς χρωμένους καὶ τρίψεσιν καὶ τοῖς τοιούτοις. ἐν ἀνέσει δὲ τυγχάνοντας πρὸς ἀνασκευὴν τοῦ πάθους1184 (“Archigenes’ and Posidonius’ therapy for patients suffering from skotoma. One needs to arouse patients suffering from skotoma during the attack of the affection by using suitable smelling remedies and rubbings and such like. During the abatement, for the sake of removing the affection…”). On the one hand, the codex explicitly announces the beginning of the section dealing with the appropriate therapy, and it repeats the names of Archigenes and Posidonius. On the other hand, it adds further information which is not 1180 See Thumiger 2017a, 92 f., especially note 34 with a list of text passages. See e.g. Hippocrates, De morb. popul. 7.11.2 (59.10 f. Jouanna = 5.382.23 f. L.), De morb. sacr. 15.5 (28.14–29.3 Jouanna = 6.390.5–9 L.). See e.g. also Anon. Par. 18.2.3 (114.14 Garofalo). 1181 For the use of the expression ἐπιτηδείως ἔχειν in this sense, see e.g. Galen, Meth. med. 7.11 (324.27 f. Johnston & Horsley = 10.517.2 f. K.), De alim. fac. 3.14 (204.5 Wilkins = 6.687.2 f. K.). 1182 See Dioscorides, De mat. med. 4.121 (Vol. 2, 270.9–11 Wellmann). 1183 See Aretaeus 3.3.2 (38.8–10 Hude). 1184 See Olivieri’s critical apparatus to p. 135.4–5.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius |

321

contained in the other manuscripts, according to Olivieri’s apparatus. It distinguishes between the beginning, the attack (ἐπίθεσις) of the affection, and its abatement (ἄνεσις), and recommends the use of smelling remedies and massages. The sentence starting with ἐν ἀνέσει is not complete but is probably supposed to be the beginning of the sentence starting with τῆς μὲν οὖν (p. 135.5). It is highly interesting that in the chapters on skotoma by Oribasius and Paul, we find the very same sentence as is transmitted by the Parisinus Vaticanus Palatinus 199.1185 The scribe of Px presumably not only had Aetius’ text at hand but also texts of Oribasius and Paul and he may have assumed that Aetius’ section on the appropriate therapy started with the same sentence as the therapeutic information found in the other two writers. The reason for such assumption may have been that, in general, the texts of Oribasius, Aetius, and Paul show many remarkable similarities, as discussed on p. 33 – 35. The scribe of Px probably took this fact as indicating that the present passage might have been similar in each of the three compilers as well. Given that there is, according to Olivieri’s apparatus, no other manuscript which transmits this reading, I do not think that it is likely that the addition of the Parisinus Vaticanus Palatinus 199 is Aetius’ original reading. p. 135.5–6: τῆς μὲν – φλεβοτομητέον: The two genitive absolutes τῆς μὲν οὖν δυνάμεως ἰσχυρᾶς ὑπαρχούσης and μηδενὸς ἑτέρου ἐναντιουμένου aim to highlight the importance of taking into account the strength of the patient and any potential bodily factors which might speak against undertaking phlebotomy. For further discussion of such common instructions in ancient medical texts, see p. 225, commentary on p. 129.23–24. For a closer look at phlebotomy, see p. 178 f., commentary on p. 126.11–12. The advice to phlebotomize patients suffering from skotoma is also given by the Anonymus Parisinus,1186 by Aretaeus,1187 by Oribasius,1188 and by Paul1189 in their chapters on skotoma. p. 135.6–7: ἄν τε – χρόνου: In order to make this subclause work, it is necessary to change the optative εἴη to the subjunctive ἦ (standing for ᾖ), a reading which is transmitted by the Codex Vaticanus Palatinus 199 (Px), the Codex Marcianus 291 (Mo) and the manuscript group ψ, according to Olivieri’s critical apparatus.1190 The phrase ἄν τε … ἄν τε, which we find here, is generally used with the subjunctive and corresponds to εἴτε … εἴτε, which is used with the indicative.1191

1185 See Oribasius, Synops. ad Eustath. 8.4.1 (247.22–24 Raeder), Paul 3.12.2 (Vol. 1, 152.6–9 Heiberg), who both read as follows: Τοὺς σκοτωματικοὺς ἐν ἐπιτάσει [Paul reads ἐπιθέσει] μὲν γινομένους διεγερτέον τοῖς τε ἐπιτηδείοις ὀσφραντοῖς χρωμένους καὶ τρίψεσι τῶν ἄκρων καὶ τοῖς τοιούτοις· ἐν ἀνέσει δὲ τυγχάνοντας πρὸς ἀνασκευὴν τοῦ πάθους φλεβοτομητέον πρῶτον (…). 1186 See Anon. Par. 17.3.1 (110.20 f. Garofalo). 1187 See Aretaeus 7.3.2 (149.18–21 Hude). 1188 See Oribasius, Synops. ad Eustath. 8.4.1 (247.24 f. Raeder). 1189 See Paul 3.12.2 (Vol. 1, 152.8 f. Heiberg). 1190 See Olivieri’s critical apparatus to p. 135.6. 1191 See Smyth § 2852a.

322 | Commentary

p. 135.7–9: ἐν δὲ – καταπίπτειν: The phrase ἐκ τῆς τυχούσης προφάσεως takes up the previously used ἐπὶ μικραῖς προφάσεσι (see p. 307 f., commentary on p. 134.19–20).1192 The fact that patients suffering from skotoma easily fall down is discussed above, see p. 309 f., commentary on p. 134.20–21. In the present passage, this fact lies behind the advice to not empty the veins all at once (μὴ ἀθρόον κενοῦν). In his De curandi ratione per venae sectionem, Galen deals in several passages with the question to what extent (ἀθρόος) and at what speed the evacuation of blood should be undertaken.1193 In this context, he also mentions the case of a feverish woman who was phlebotomized to the point of fainting (λειποθυμία) and he uses this incident to justify his advice to beware of carrying out sudden or complete evacuations (καὶ διὰ τοῦτο αὐτὸ βέλτιόν ἐστι φυλάττεσθαι τὰς ἀθρόας κενώσεις) unless it is absolutely necessary.1194 A similar line of thought presumably informs the present passage as well; evacuating the patients suffering from skotoma all at once would cause them to lose a great amount of blood in one go and this great blood loss would make them prone to falling down; it is necessary, therefore, to exercise caution. p. 135.9–10: ὅθεν – συμμετρίαν: This subclause deals further with the previous advice to not phlebotomize the patient all at once, instead providing an alternative approach. One should, the reader is told, undertake more removals of blood (πλείοσιν ἀφαιρέσεσι χρώμενοι),1195 and not just one. The phrase ἐκ διαστημάτων τινῶν1196 thereby indicates the need to leave intervals between the removals. These intervals allow for “filling up the due proportion” (ἀναπληρώσομεν τὴν συμμετρίαν), which is to say that after each removal blood is given time to gather in the veins again, thus preventing the patients from suffering to great a loss of blood, and thus from falling down. p. 135.10–11: ἐμβρεχέσθω – ὀξυροδίνῳ: For a closer look at the use of embrocations (ἐμβρέχειν) as a part of therapy, see p. 181 f., commentary on p. 126.19. The Anonymus Parisinus also recommends the application of embrocations made of rose oil mixed with vinegar (ὀξυρόδινον) to the head of patients suffering from skotoma.1197 In general, the application to the head of rose oil mixed with vinegar is a common therapeutical approach in several medical texts.1198 According to Galen’s 1192 See e.g. Galen, De plac. Hipp. et Plat. 5.2.3 (294.35 f. de Lacy = 5.432.13 f. K.) where the phrase ἐπὶ μικρᾷ καὶ τυχούσῃ προφάσει is used. 1193 See Galen, De cur. rat. per venae sect. 12 (11.287.4 K.), De cur. rat. per venae sect. 12 (11.289.3 f. K.), De cur. rat. per venae sect. 21 (11.312.4 K.). 1194 See Galen, De cur. rat. per venae sect. 12 (11.289.3 f. K.). 1195 For this meaning of ἀφαίρεσις, see also p. 135.13 Olivieri, where the phrase τὴν ἀφαίρεσιν τοῦ αἵματος is explicitly used. 1196 For this meaning of ἐκ διαστημάτων τινῶν, see e.g. Galen, De loc. aff. 3.9 (8.173.7 f. K.), Meth. med. 12.7 (294.3 f. Johnston & Horsley = 10.857.18 K.), Paul 3.32.2 (Vol. 1, 217.8 Heiberg). 1197 See Anon. Par. 17.3.2 (112.3 Garofalo). 1198 See e.g. Galen, De loc. aff. 2.10.19 (376.25 Gärtner = 8.130.17 K.), Meth. med. 13.21 (398.23 f. Johnston & Horsley = 10.928.7 f. K.), Paul 3.6.2 (Vol. 1, 145.8 f. Heiberg).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

323

De simplicium medicamentorum temperamentis ac facultatibus, rose oil, when mixed with vinegar (τὸ ξὺν ὄξει ῥόδινον), is called ὀξυρόδινον and is thought to be cooling (ψύχειν).1199 A cooling effect might be suitable for patients suffering from skotoma because the affection is brought about by warm vapors. For a closer look at the application of rose oil (ῥόδινον), see p. 262 f., commentary on p. 132.22–24. The phrase κατὰ τὸν καιρὸν τῆς φλεβοτομίας emphasizes that the embrocations to the head need to be applied at the same time as the phlebotomy is conducted.1200 p. 135.11: προσπλέκοντες – κισσοῦ: In the present passage, the verb προσπλέκειν is used in reference to the imperative ἐμβρεχέσθω, and mentions additional ingredients for the previously mentioned embrocations (see p. 322 f., commentary on p. 135.10–11).1201 According to Aetius’ first book, knotgrass (πολύγονον) belongs to the cooling substances,1202 and it is, thus, similar regarding its properties to the previously mentioned rose oil mixed with vinegar (see p. 322 f., commentary on p. 135.10–11). According to Aetius’ first book, ivy (κισσός) has the opposite capacities: it is astringent, and therefore cold, but also sharp, and therefore warm.1203 The juice of ivy, which is also recommended in the present passage, is said to be a sternutatory remedy (ἔρρινον φάρμακον).1204 For a closer look at the effect of sternutatories, see p. 224 f., commentary on p. 129.22–23. In Aetius’ chapter on mania the application to the head of embrocations made of rose oil mixed with vinegar or with the juice of knotgrass or of ivy is also recommended; see p. 386 f., commentary on p. 139.6–8. In Dioscorides’ De materia medica it is also stated that ivy is used as an embrocation together with rose oil and vinegar.1205 p. 135.11–13: καὶ – καιρόν: The noun πίλημα is used elsewhere in ancient medical texts and describes a compression which is mostly made of wool, as mentioned in the present context, and which in some other texts is also said to be applied to the stomach and to other bodily parts, such as limbs.1206 Rose oil (ῥόδινον) or wild-vine flower (οἰνάνθινον) are recommended as substances in which the compression should be soaked. According to Aetius’ first book, the wild-vine flower has the same properties as rose oil1207 and, according to Dioscorides’ De materia medica, it is 1199 See Galen, De simpl. med. temp. et fac. 3.9 (11.559.6–9 K.). 1200 For the use of the noun καιρός in the context of phlebotomy, see e.g. also Galen, De venae sect. adv. Erasistrateos 4 (11.212.10 f. K.), De venae sect. adv. Erasistrateos 4 (11.219.10 f. K.), De cur. rat. per venae sect. 9 (11.277.18–278.1 K.). 1201 For various constructions of the verb προσπλέκειν, see e.g. Aetius Amid., Libri med. 5.125 (Vol. 2, 102.13 f. Olivieri), Libri med. 6.88 (Vol. 2, 232.10 Olivieri), Libri med. 6.3 (Vol. 2, 130.14 f. Olivieri). 1202 See Aetius Amid., Libri med. 1.327 (Vol. 1, 124.11–13 Olivieri). 1203 See Aetius Amid., Libri med. 1.205 (Vol. 1, 90.9–11 Olivieri). 1204 See Aetius Amid., Libri med. 1.205 (Vol. 1, 90.16 f. Olivieri). 1205 See Dioscorides, De mat. med. 2.179.2 (Vol. 1, 249.9–11 Wellmann). 1206 See e.g. Galen, Meth. med. 8.5 (410.2–6 Johnston & Horsley = 10.572.13–17 K.), Paul 3.55 (Vol. 1, 267.12–14 Heiberg), Paul 3.64.2 (Vol. 1, 280.17–19 Heiberg), Aetius Amid., Libri med. 5.68 (Vol. 2, 40.13 f. Olivieri). 1207 See Aetius Amid., Libri med. 1.111 (Vol. 1, 57.7 Olivieri).

324 | Commentary

suitable for patients “suffering around the stomach” (κοιλιακούς).1208 Given that it is stated several times in the present chapter that the patients suffer from indigestion or flatulence (see p. 305, commentary on p. 134.17–19, p. 315 f., commentary on p. 134.27–28, p. 317 f., commentary on p. 134.29–135.1), it seems reasonable that remedies should be applied to the stomach. The expression κατὰ τοῦτον τὸν καιρόν refers back to the previously used κατὰ τὸν καιρὸν τῆς φλεβοτομίας (see p. 323, commentary on p. 135.10–11) and emphasizes that the compressions should be applied at the same time as phlebotomy and embrocations. p. 135.13–14: εἰ δὲ – εἰρημένων: I have discussed above the fact that ancient medical texts often recommend avoiding phlebotomy if the bodily condition of the patients militates against such an action. See p. 321, commentary on p. 135.5–6. p. 135.14–15: ὑποσυρέσθω – κοιλία: The phrase ὑποσύρεσθαι κοιλίαν describes the purging of the stomach and is used in this sense in other medical texts as well.1209 As becomes clear in the next lines, the purging of the stomach may be conducted by means of an enema (p. 135.15–16) but can also be accomplished through purgative remedies (p. 135.16). In Aetius’ chapter on phrenitis, the application of an enema is also presented as an alternative therapeutic approach to phlebotomy, which one should choose if the bodily requirements for phlebotomy (such as strength of the patient) are not fulfilled.1210 See also p. 181, commentary on p. 126.16–17. p. 135.15–16: πρῶτον μὲν – κλυστῆρι: The application of enemata to patients suffering from skotoma is also recommended by the Anonymus Parisinus,1211 in Oribasius,1212 and in Paul.1213 For further discussion of the ingredients of the enema, i.e. bran, honey, and native soda, see p. 181, commentary on p. 126.17–19. p. 135.16: ἔπειτα δὲ – συνεχῶς: The remedy which is mentioned here obviously circulated under a number of different names, a point which is mentioned in several Galenic treatises: in De sanitate tuenda, Galen talks about a remedy which some call the holy remedy made from aloe (ἱερὰν τὴν διὰ τῆς ἀλόης), others bitter (πικράν).1214 The same terminological considerations are reflected in other passages as well.1215

1208 See Dioscorides, De mat. med. 5.25 (Vol. 3, 21.11 Wellmann). 1209 See Galen, De comp. med. sec. loc. 4.9 (12.790.13 f. K.), De comp. med. sec. loc. 6.8 (12.975.15 f. K.), Paul 3.22.5 (Vol. 1, 173.3 f. Heiberg), Aetius Amid., Libri med. 6.8 (Vol. 2, 140.4 Olivieri), Libri med. 6.28 (Vol. 2, 173.3 Olivieri). 1210 See Aetius Amid., Libri med. 6.2 (Vol. 2, 126.16 f. Olivieri). 1211 See Anon. Par. 17.3.1 (110.21 f. Garofalo). 1212 See Oribasius, Synops. ad Eustath. 8.4.1 (247.25 f. Raeder). 1213 See Paul 3.12.2 (Vol. 1, 152.9 f. Heiberg). 1214 Galen, De san. tuenda 5.9.6 (153.10 f. Koch = 6.354.8–10 K.). 1215 See e.g. Galen, De loc. aff. 1.4.11 (272.1 f. Gärtner = 8.40.6 f. K.): καὶ ἡ διὰ τῆς ἀλόης ἱερὰ, καλοῦσι δ’ αὐτὴν ἔνιοι καὶ πικράν, Meth. med. 12.7 (292.28–294.1 Johnston & Horsley = 10.857.15 f. K.), De comp. med. sec. loc. 2.1 (12.539.8–10 K.).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

325

This remedy seems to have been regarded as purgative.1216 In Oribasius’ chapter on skotoma it is recommended to purge with the holy remedy (καθαρτέον τῇ ἱερᾷ)1217 and the same approach is mentioned in Paul’s chapter on skotoma.1218 For further discussion of the holy remedy, see Metzger 2021. p. 135.16–17: εἰ – συμπτώματα: According to Galen’s De symptomatum differentiis, everything what happens to an animal in a way contrary to nature (παρὰ φύσιν συμβαίνῃ τῷ ζώῳ) is called σύμπτωμα.1219 This statement is part of a larger discussion of the term νόσημα, which is defined as “that which primarily damages function” (τὸ πρώτως μὲν βλάπτον τὴν ἐνέργειαν).1220 Conditions which precede this damage of function are not to be called νόσημα yet, and if other conditions follow like shadows (οἷον σκιαί τινες παρακολουθοῦσαι), these are not be called νόσημα either but “symptoms” (συμπτώματα).1221 Phrases like εἰ δ’ ἐπιμένοι τὰ συμπτώματα are used a few times in Aetius’ compilation, and once in Alexander’s Therapeutica.1222 Here it is used to introduce a number of adjustments to the previously recommended therapy, which need to be undertaken if the symptoms of the affection still persist in spite of the application of the previous recommendations. See also p. 325, commentary on p. 135.17–18. p. 135.17–18: δεήσει – χρῆσθαι: The advice to use stronger purgatives (σφοδροτέροις καθαρτηρίοις)1223 reflects the fact that, as stated in the subclause εἰ δ’ ἐπιμένοι τὰ συμπτώματα, the symptoms persist (see p. 325, commentary on p. 135.16–17) and, therefore, stronger therapeutic approaches are needed. This statement also reveals that the previously recommended phlebotomy (see p. 321, commentary on p. 135.5– 6) and the application of enemata (see p. 324, commentary on p. 135.15–16) are not regarded as the most forceful means for the purging of patients. p. 135.18–19: ὁρῶν – φάρμακον: This sentence seems to be connected to the previous information on the use of stronger purgatives (see p. 325, commentary on 1216 See e.g. Oribasius, Coll. med. rel. 8.44.4 (Vol. 1, 294.9–11 Raeder): ἡ διὰ τῆς ἀλόης πικρὰ χρήσιμος, ἐκκαθαίρουσα τὴν ὑγρότητα·ἔχει μὲν γὰρ ἡ ἀλόη καθαρτικὴν δύναμιν, οὐ μὴν ἰσχυράν (…). See e.g. Galen, Meth. med. 12.7 (292.26–294.1 Johnston & Horsley = 10.857.13–16 K.): εἶτ’ ἰδὼν ὀδυνώμενον ἔγνων χρῆναι τὴν κακοχυμίαν ἐκκαθαίρειν. ὄντος δ’ ἀρίστου πρὸς τὰς τοιαύτας κακοχυμίας φαρμάκου τοῦ διὰ τῆς ἀλόης, ὃ καλοῦσιν ἤδη συνήθως πικρὰν […]. 1217 See Oribasius, Synops. ad Eustath. 8.4.1 (247.25 Raeder). 1218 See Paul 3.12.2 (Vol. 1, 152.9 Heiberg). 1219 See Galen, De sympt. diff. 1.20 (210.12–13 Gundert = 7.50.15 f. K.). 1220 See Galen, De sympt. diff. 1.19 (210.8 f. Gundert = 7.50.10 f. K.). 1221 See Galen, De sympt. diff. 1.20 (210.4–7 Gundert = 7.50.6–9 K.). For further discussion, see Gundert 2009 in Galeni De symptomatum differentiis, 276. See also Galen, Meth. med. 2.3 (140.24– 142.2 Johnston & Horsley = 10.90.12–16 K.). 1222 See Aetius Amid., Libri med. 4.50 (Vol. 1, 392.6 Olivieri), Libri med. 5.120 (Vol. 2, 98.9 f. Olivieri), Libri med. 9.10 (294.20 Zervos), Alexander, Therapeutica 1.13 (622.29–624.1 Guardasole = Vol. 1, 517.18 f. Puschmann). 1223 For passages in which the noun καθαρτήριον is used in connection with phlebotomy or terms such as κένωσις or κενοῦν, see e.g. Aetius Amid., Libri med. 12.36 (63.15 Kostomiris), Libri med. 8.34 (Vol. 2, 447.17 f. Olivieri).

326 | Commentary

p. 135.17–18). The reference to the prevailing humor (τὸν πλεονάζοντα χυμὸν) is striking insofar as it suggests that certain humors played a significant role in the explanation of the affection, and that it is clear to which humors the text refers. However, the noun χυμός is only mentioned once more in the present chapter and, as noted above, the object of this reference is not completely clear (see p. 314 f., commentary on p. 134.25–27). These difficulties cannot be solved but I understand the sentence as addressing the physician directly by the use of the imperative ἅρμοζε, and as requesting that he take into account the prevailing humor (whose concrete role in skotoma remains cryptic) and choose remedies which are most suitable to expelling the prevailing humor. p. 135.19–20: τῶν – ἔχει: The phrase δραστικωτέρων καθαρτηρίων takes up the previously used term σφοδροτέροις καθαρτηρίοις (see p. 325, commentary on p. 135.17–18). The characterization of a remedy or therapeutic approach as δραστικόν is commonly found in other medical texts as well.1224 For a closer look at the properties of fennel (μάραθρον) and oxymel (ὀξύμελι), see p. 227 f., commentary on p. 130.1–3. Both are referred to as καθαρτικά in Aetius’ third book.1225 p. 135.20–22: καὶ τὸ – λόγῳ: According to Aetius’ first book, the date palm (φοῖνιξ) has an astringent property (στυπτικὴ δύναμις)1226 while his third book tells us that scammony (σκαμμωνία) is a purgative (καθαρτικόν) that is especially bad for the stomach (κακοστόμαχον).1227 For a closer look at the properties of rue (πήγανον), see p. 229, commentary on p. 130.3–4. The subclause of this sentence is highly interesting because it contains a reference to another section of the Libri medicinales. For a closer look at this kind of cross-reference, which provides a valuable example of the underlying structure of Aetius’ composition, see p. 13. The reference to “the previous discussion of purgatives” (προείρηνται ἐν τῷ περὶ καθαρτηρίων λόγῳ), which is said to provide information on the “composition” (αἱ συνθέσεις) of the remedy made from date palm, scammony and rue, is probably to the section of the third book of the Libri medicinales, that deals with purgatives.1228 One chapter in this section deals with olive-tree purgatives (ἐλαῖαι καθαρτικαί) and rue, scammony and the date palm are mentioned amongst other substances as ingredients for these.1229 Another chapter in this section is entitled ὀξυπόριον διὰ φοινίκων1230 and date palm, scammony and rue are also mentioned here as ingredients alongside other substances. It is likely that Aetius refers to one of these chapters in the third book of his Libri medicinales. 1224 See e.g. Oribasius, Coll. med. rel. 8.24.58 (Vol. 1, 276.6 f. Raeder), Aetius Amid., Libri med. 11.32 (120.25 Daremberg & Ruelle), Galen, De simpl. med. temp. et fac. 1.29 (11.431.8 f. K.). 1225 See Aetius Amid., Libri med. 3.95 (Vol. 1, 296.6 Olivieri), Libri med. 3.77 (Vol. 1, 290.24 Olivieri). 1226 See Aetius Amid., Libri med. 1.406 (Vol. 1, 143.17 Olivieri). 1227 See Aetius Amid., Libri med. 3.25 (Vol. 1, 280.17–19 Olivieri). 1228 See especially Aetius Amid., Libri med. 3.75–112 (Vol. 1, 290.6–302.17 Olivieri). 1229 See Aetius Amid., Libri med. 3.90 (Vol. 1, 294.6–10 Olivieri). 1230 See Aetius Amid., Libri med. 3.92 (Vol. 1, 295.1–20 Olivieri).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

| 327

p. 135.22–23: καὶ ἀποφλεγματισμοῖς – ὀξυμέλιτος: The noun ἀποφλεγματισμός describes a remedy which is capable of purging phlegm. In his De compositione medicamentorum secundum locos, Galen devotes a whole chapter, which he claims to have taken from the books of Archigenes (Ἀρχιγένους περὶ ἀποφλεγματισμῶν),1231 to phlegm purging remedies and explicitly states that a phlegm purging remedy is “a remedy against troubling phlegm” (φλέγματος ἐνοχλοῦντός ἐστιν ἴαμα), as is already clear from its name (καθάπερ δὴ καὶ αὐτὸ τοὔνομα αὐτοῦ δηλοῖ).1232 In the present chapter, phlegm is not mentioned as a substance that is involved in the onset of skotoma but it is suggested that one should look at “the humor which is in excess” (τὸν πλεονάζοντα χυμὸν; see p. 325 f., commentary on p. 135.18–19), and it may be that this reference to humors also includes phlegm. Both Oribasius and Paul also recommend the application of phlegm purging remedies (τοῖς ἀποφλεγματισμοῖς) to patients suffering from skotoma,1233 and Aretaeus also states that one needs to expel phlegm (φλέγμα ἄγειν) by the application of sneezing remedies (on this issue, see also p. 327 f., commentary on p. 135.23–25).1234 In general, the two word families ἀποφλεγματισμός / ἀποφλεγματικός / ἀποφλεγματίζειν and ἀναγαργάρισμα / ἀναγαργαρισμός / ἀναγαργαρίζειν, which are mentioned in close proximity in the present passage, are also closely connected in other passages. For example, in a short section of Alexander’s Therapeutica, which is entitled περὶ ἀποφλεγματισμῶν, it is stated that the best phlegm purging remedies are those which one has to gargle,1235 while Dioscorides mentions that the juice of pimpernel purges the head of phlegm when it is gargled,1236 and Paul states in one passage that phlegm should be purged by gargling.1237 The substances which are mentioned here as ingredients of the gargles, namely oregano (ὀρίγανον), pennyroyal (γλήχων) and oxymel (ὀξύμελι) are referred to as such in other texts as well.1238 For further discussion of the properties of pennyroyal, see p. 288, commentary on p. 134.8–9; on oxymel, see p. 227, commentary on p. 130.1–3, especially note 614. p. 135.23–25: ἔπειτα – γάλακτος: For a discussion of the pouring of substances into the nose (ταῖς ῥισὶν ἐγχεῖν) as a therapeutic approach, see p. 236, commentary on p. 130.24–26, and p. 236 f., commentary on p. 130.26–27, where I have also dis1231 See Galen, De comp. med. sec. loc. 2.2 (12.565.16–568.5 K.). It is interesting that Galen claims to take the information from Archigenes, insofar as Aetius also claims to cite Archigenes in the present chapter. 1232 See Galen, De comp. med. sec. loc. 2.2 (12.566.5–7 K.) 1233 See Oribasius, Synops. ad Eustath. 8.4.2 (247.28 f. Raeder), Paul 3.12.2 (Vol. 1, 152.12 Heiberg). 1234 See Aretaeus 7.3.3 (149.25 f. Hude). 1235 Alexander, Therapeutica 3.6 (Vol. 2, 101.27–29 Puschmann). 1236 Dioscorides, De mat. med. 2.178.2 (Vol. 1, 248.1–3 Wellmann). 1237 Paul 1.100.2 (Vol. 1, 69.15 f. Heiberg). Paul claims to cite Diocles here. See also fragment 183a.28 van der Eijk. 1238 See e.g. Hippocrates, De morb. 2.26.4 (160.14 Jouanna = 7.42.7 L.), Alexander, Therapeutica 1.15 (654.10–12 Guardasole = Vol. 1, 549.8 f. Puschmann), Oribasius, Eclog. med. 133.1 (298.20–22 Raeder), Aetius Amid., Libri med. 6.8 (Vol. 2, 140.3 f. Olivieri).

328 | Commentary

cussed the properties of elaterion with milk (ἐλατήριον μετὰ γάλακτος), and of the juice of cyclamen (χυλὸν κυκλαμίνου). According to Aetius’ first book, pimpernel (ἀναγαλλίς) has a cleansing capacity and its juice purges the head through the nose.1239 Beet (σεῦτλον or τεῦτλον) is likewise said to be cleansing when taken through the nose, and the cleansing capacity of the juice of beet is also explicitly highlighted.1240 The Anonymus Parisinus, Aretaeus, Oribasius, and Paul all recommend the application of sternutatories (πταρμικά) to patients suffering from skotoma.1241 Aretaeus uses this application as a means to expel phlegm (see also p. 327, commentary on p. 135.22–23) and he also recommends the pouring of the juices of cyclamen and pimpernel into the nose.1242 p. 135.25–26: καὶ νίτρον – κάθαρσιν: In the present passage sodium carbonate (νίτρον) is clearly regarded as having purgative qualities (ποιεῖται τὴν κάθαρσιν). On this issue, see also p. 229, commentary on p. 130.3–4. As is clear from the phrase διὰ τῶν ῥινῶν, the mixture (ἀναμιχθὲν) of sodium carbonate, black cumin (μελάνθινον) and oil (ἔλαιον παλαιόν) is supposed to be applied through the nose, as was the case with the previously mentioned remedies (see p. 327 f., commentary on p. 135.23–25). According to Aetius’ first book, black cumin is very useful for cleansing.1243 In a passage of Galen’s De compositione medicamentorum secundum locos, all three substances appear together as ingredients of a remedy.1244 Interestingly, this remedy is mentioned in a section of the treatise which is entitled Ἀρχιγένους περὶ ἀποφλεγματισμῶν καὶ ῥινεγχύτων (“On phlegm purging remedies and substances to be poured into the nose from Archigenes”).1245 Given that Aetius also claims to cite Archigenes (and Posidonius) in the present chapter, one might wonder whether the reference to the remedy here has Archigenes as its source. p. 135.26–27: μετὰ – διάγειν: In Aetius’ chapter on lethargia the bathing of patients was also recommended. On this issue, see p. 238 f., commentary on p. 131.6–9. Aretaeus also mentions the bathing of the patients in his chapter on skotoma, stating that bathing in cold water (ψυχρολουσίη) is better than not bathing at all (ἀλουσίης) and that not bathing at all is better than bathing in hot water (θερμολουσίης).1246 He further explains that bathing in cold water is very much able to contract (στῦψαι), make solid (πυκνῶσαι), and dry (ξηρῆναι) the head, which is said to be the healthy condition (ὑγείης ἡ κατάστασις).1247

1239 See Aetius Amid., Libri med. 1.34 (Vol. 1, 38.13–16 Olivieri). 1240 See Aetius Amid., Libri med. 1.387 (Vol. 1, 139.1–6 Olivieri). 1241 See Anon. Par. 17.3.2 (112.1–3 Garofalo), Aretaeus 7.3.3 (149.25 f. Hude), Oribasius, Synops. ad Eustath. 8.4.2 (247.29 Raeder), Paul 3.12.2 (Vol. 1, 152.12 f. Heiberg). 1242 See Aretaeus 7.3.3 (149.27 f. Hude). 1243 See Aetius Amid., Libri med. 1.271 (Vol. 1, 108.11 f. Olivieri). 1244 See Galen, De comp. med. sec. loc. 2.2 (12.585.14 f. K.). 1245 See Galen, De comp. med. sec. loc. 2.2 (15.582.1 f. K.) 1246 See Aretaeus 7.3.11 (151.18 f. Hude). 1247 See Aretaeus 7.3.11 (151.19 f. Hude).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

329

p. 135.27–136.1: τριμμάτιον – τοῦτο: The noun τριμμάτιον is a diminutive of the noun τρίμμα, which derives from the verb τρίβειν, meaning “to rub, to bruise”.1248 In medical texts, the diminutive τριμμάτιον is only used in the sixth book of Aetius’ Libri medicinales.1249 Since it is not entirely clear precisely what preparation the noun τριμμάτιον describes, I do not translate the term. However, the present context makes it clear that trimmation is meant to be a preparation which is rubbed or bruised, which is used in the bath, and which is applied to the head (see also p. 333, commentary on p. 136.11–12). It was probably the fact that it was used in the bath and applied to the head that prompted Liddell/Scott/Jones to translate τριμμάτιον as “shampoo powder”,1250 but this goes some way beyond the text. In the present context, the trimmation is said to have a strengthening effect (τονωτικὸν) on the head.1251 The reason for applying a preparation to strengthen the head to patients suffering from skotoma might be that the head was regarded as the cause of skotoma, as outlined in the first half of the chapter (see p. 296 – 299, commentary on p. 134.11–13), and that such a trimmation could assist in restoring the healthy state. p. 136.1–2: λίθου – βʹ: These lines provide a recipe for the trimmation.1252 The Asian stone (λίθος Ἄσιος) is mentioned elsewhere in medical literature as an ingredient of a remedy.1253 For the properties of native soda (ἀφρόνιτρον), see p. 181, commentary on p. 126.17–19; for the properties of iris (ἶρις), compare the discussion of iris oil on p. 230, commentary on p. 130.8. According to Dioscorides’ De materia medica, iris has a warming capacity, it purges thickness and bile and it is suitable for people suffering from headaches.1254 According to Aetius’ first book, the flower of rush (σχοίνου ἄνθος) has a moderately warming and contracting capacity.1255 As for roses (ῥόδα), these are said to cool and contract in Dioscorides’ De materia medica, with dry roses having a particularly contractive quality.1256

1248 See LSJ s.v. τριμμάτιον, LSJ s.v. τρίβω. 1249 Apart from the present occurrence of the noun, it is also found in the following passages: Aetius Amid., Libri med. 6.7 (Vol. 2, 136.11 Olivieri), Libri med. 6.8 (Vol. 2, 140.15 Olivieri), Libri med. 6.19 (Vol. 2, 159.5 Olivieri). 1250 See LSJ s.v. τριμμάτιον. 1251 For other passages which use the adjective τονωτικόν to describe a strengthening effect on bodily parts, see e.g. Galen, De alim. fac. 2.9 (105.25 Wilkins = 6.577.7 f. K.), De comp. med. sec. loc. 6.4 (12.920.16 K.), De comp. med. sec. loc. 8.3 (13.145.10 f. K.), Paul 1.76 (Vol. 1, 55.5 Heiberg), Aetius Amid., Libri med. 6.54 (Vol. 2, 198.22 Olivieri), Oribasius, Coll. med. rel. 6.32.10 (Vol. 1, 185.36–186.1 Raeder), Alexander, Therapeutica 7.5 (Vol. 2, 271.8 Puschmann). 1252 For a closer look at the problems connected to interpreting recipes in ancient medical texts, see e.g. Totelin 2011. 1253 See e.g. Galen, De comp. med. sec. loc. 4.8 (12.736.17 f. K.), De comp. med. sec. loc. 4.8 (12.737.2 K.), Paul 3.78.25 (Vol. 1, 309.16 Heiberg), Aetius Amid., Libri med. 3.136 (Vol. 1, 315.33 Olivieri). 1254 See Dioscorides, De mat. med. 1.1.2 (Vol. 1, 6.10–12 Wellmann), De mat. med. 1.1.3 (Vol. 1, 7.11 f. Wellmann). 1255 See Aetius Amid., Libri med. 1.384 (Vol. 1, 138.8 Olivieri). 1256 See Dioscorides, De mat. med. 1.99.1 (Vol. 1, 90.1 Wellmann).

330 | Commentary

p. 136.2: ἐκ – ἀρκοῦν: The phrase τὸ ἀρκοῦν is frequently used in medical literature in the context of recipes.1257 It seems to express the idea that the physician needs to measure out “the appropriate amount” of a remedy or of a substance when curing a patient. For example, one might think of making adjustments to the amount on the basis of the size or the age of a patient.1258 p. 136.2–3: ἐπίπασσε – κεφαλῆς: The verb ἐπιπάσσειν describes the application of the remedy by smearing it on the front part of the head. The verb is used elsewhere in medical literature to describe the application of remedies1259 and in this context it is sometimes connected to the head.1260 For further discussion of the question of why the remedy is to be applied to the head, see p. 329, commentary on p. 135.27–136.1. p. 136.3: ἐπιρραίνων – βραχύ: The verb ἐπιρραίνειν is used elsewhere in medical literature in connection with ὕδωρ in order to describe how water should be applied to a part of the body or be added to other substances.1261 It thus appears to be very similar in meaning to the use of the verb ἐπιπάσσειν discussed above (see p. 330, commentary on p. 136.2–3). The Anonymus Parisinus recommends bathing the head and the rest of the body of patients suffering from skotoma with warm and cold water.1262 p. 136.4: εἶτα λουσάμενος: The participle λουσάμενος needs to be understood with the participle ἐξελθὼν (p. 136.5). While the former describes the point in time during which the patient is still in the bath, the latter describes the point at which the patient leaves the bath (see also p. 331, commentary on p. 136.5). For this interpretation of the participles λουσάμενος and ἐξελθὼν, one needs to accept that the syntax of the sentence is unusual and does not follow the normal syntactical rules. The participle βρέχων with imperative force (p. 136.4) does not refer to the same subject as the participle λουσάμενος, although both being congruent one would normally expect them to refer to the same subject. The participles λουσάμενος and ἐξελθὼν seem to be used like temporal adverbs here. p. 136.4–5: καὶ μὴ – ἀποπλύνων: For a closer look at the phrase ἐμβρέχειν τὴν κεφαλήν, which is similar in meaning to the phrase βρέχειν τὴν κεφαλήν, see p. 181 f., commentary on p. 126.19. In the present context, the verb βρέχειν is used in 1257 See e.g. Galen, De comp. med. sec. loc. 1.2 (12.422.5 f. K.), De comp. med. sec. loc. 5.3 (12.844.1 f. K.), Paul 3.4.3 (Vol. 1, 138.15 Heiberg), Paul 3.37.1 (Vol. 1, 223.16 f. Heiberg), Aetius Amid., Libri med. 7.69 (Vol. 2, 318.27 Olivieri). 1258 I am grateful to Chiara Thumiger for suggesting this reading of τὸ ἀρκοῦν. 1259 See e.g. Galen, De alim. fac. 1.30 (80.9 Wilkins = 6.548.1 f. K.), De alim. fac. 1.31 (80.18 f. Wilkins = 6.548.10 K.), De simpl. med. temp. et fac. 11.1 (12.357.9 f. K.). 1260 See e.g. Paul 4.37.2 (Vol. 1, 358.18 f. Heiberg), Dioscorides, De mat. med. 1.64.4 (Vol. 1, 58.24 Wellmann), Oribasius, Synops. ad Eustath. 7.1.10 (212.15 f. Raeder), Aetius Amid., Libri med. 6.54 (Vol. 2, 198.10 f. Olivieri), Libri med. 1.370 (Vol. 1, 133.18 Olivieri). 1261 See e.g. Paul 3.18.2 (Vol. 1, 162.21 Heiberg), Paul 7.20.15 (Vol. 2, 384.25 Heiberg), Aetius Amid., Libri med. 2.120 (Vol. 1, 196.11 Olivieri). 1262 See Anon. Par. 17.3.3 (112.6 f. Garofalo).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

331

slight contrast to ἐπιπάσσειν (see p. 330, commentary on p. 136.2–3) and ἐπιρραίνειν (see p. 330, commentary on p. 136.3), insofar as it describes the drenching of the head with water. The negation μή does not apply to the drenching of the head in general but to the drenching of the head with warm water. Instead, it should be washed (ἀποπλύνων) with warm water. Given that the verb ἀποπλύνειν is often used in connection to nouns such as ἱδρώς (sweat), ἕλκος (wound), πύον (matter) or ἰχώρ (ichor) on the one hand, and with certain bodily parts on the other,1263 it seems to denote the process of purging by washing. p. 136.5: ἐξελθὼν – πλεονάκις: For a discussion of the way in which the participle ἐξελθὼν is used here in contrast to the participle λουσάμενος (p. 136.4), see p. 330, commentary on p. 136.4. Drenching the head with cold water might be recommended here in order to counteract the warm vapors which were mentioned in the opening of the chapter as causing skotoma (see p. 296 – 299, commentary on p. 134.11–13). p. 136.5–7: τοῖς – ἐπιβάλλειν: For a closer look at the cooling properties of rose oil (ῥόδινον), see p. 181 f., commentary on p. 126.19. Rose oil mixed with vinegar is commonly called ὀξυρόδινον and was recommended earlier in this chapter for patients suffering from skotoma. On this issue, see p. 322 f., commentary on p. 135.10– 11. p. 136.7–8: καὶ ψύχειν – βαλανείοις: This part of the sentence continues the discussion of what to do if the patient’s head is very warm. The phrase τῷ ἐκ τῶν κρουνῶν ὕδατι deals with the kind of water required to cool (ψύχειν) the patient’s head. The noun κρουνός probably refers to a watercourse from which the water should be taken. The reason that water should be taken from such a source might be because it would provide water that is cold enough to bring about the cooling of the head. As the phrase ἐν τοῖς βαλανείοις points out, the procedure needs to be undertaken while the patient is in the bath. On this issue, see p. 328, commentary on p. 135.26–27. p. 136.8: εἰ μὲν – πάθος: The formulation εἰ μὲν οὖν ἐπὶ τούτοις εἴκοι τὸ πάθος is contrasted with the expression εἰ δ’ ἐπιμένοι (p. 136.9). It discusses the possibility that the patients showed a good response to the recommended therapy. For further discussion of such phrases, see also p. 332, commentary on p. 136.9. p. 136.8–9: παύειν – προσαγωγήν: The physician is advised to end the aggressive approach (τὴν ὀχληρὰν προσαγωγήν), if the affection ceased due to its application. The noun προσαγωγή refers to the previously discussed therapeutics,1264 which are characterized as having been aggressive (ὀχληρόν). This reminds us of the “stronger purgatives” and the “more drastic purgatives” which were discussed 1263 See e.g. Galen, Meth. med. 6.3 (146.27 f. Johnston & Horsley = 10.404.10–12 K.), Meth. med. 5.11 (82.6 Johnston & Horsley = 10.359.13 K.), Aetius Amid., Libri med. 6.21 (Vol. 2, 159.24 f. Olivieri), Paul 3.58 (Vol. 1, 269.18 Heiberg). 1264 See e.g. Galen, De comp. med. sec. loc. 6.9 (12.1007.11 f. K.), Galen, Meth. med. 11.3 (124.4 f. Johnston & Horsley = 10.742.5 f. K.), Aetius Amid., Libri med. 8.69 (Vol. 2, 526.11 Olivieri).

332 | Commentary

earlier in this chapter. See p. 325, commentary on p. 135.17–18, and p. 326, commentary on p. 135.19–20. p. 136.9: εἰ δ’ – ἐπιμένοι: The phrase εἰ δ’ ἐπιμένοι recalls εἰ δ’ ἐπιμένοι τὰ συμπτώματα, which was used earlier in the chapter (see p. 325, commentary on p. 135.16–17). It contrasts with the phrase εἰ μὲν οὖν ἐπὶ τούτοις εἴκοι τὸ πάθος (see p. 331, commentary on p. 136.8) and it introduces further therapeutic approaches which need to be undertaken if the previous approaches have failed. p. 136.9–10: τέμνειν – ἀρτηρίας: In the beginning of the section on the therapy of patients suffering from skotoma, phlebotomizing the patients was recommended (see p. 321, commentary on p. 135.5–6). In the present passage, we receive very precise information concerning which arteries have to be cut if the affection does not cease by means of the previously discussed therapy. These are the arteries in the head, at the temples, above the ears. In a passage of Galen’s De curandi ratione per venae sectionem, which deals with arteriotomy and is also cited in a chapter of Aetius’ third book, it is stated that physicians cut the arteries behind the ears especially in patients who suffer from skotoma (τὰς δὲ ὄπισθεν τῶν ὤτων ἐπὶ τῶν σκοτωματικῶν).1265 Interestingly, the same idea is reflected in the section of Galen’s De locis affectis which deals with skotoma and in Paul’s chapter on skotoma. Galen’s statement that some patients benefit from deep cuts to the arteries behind their ears (τῶν ὀπίσω τῶν ὤτων ἀρτηριῶν) is embedded in his discussion of the movement of humors and pneuma, which might be a cause of skotoma.1266 A few lines later he says that not all patients benefit from this approach and that there are other arteries which go up to the brain through the rete mirabile, and that through these arteries the vaporous and warm pneuma is carried up to the brain and fills it.1267 Galen, thus, connects the arteriotomy to the pneuma which causes the affection. For further discussion of the way in which Aetius cites Galen’s De locis affectis in the first part of the chapter on skotoma, see p. 307, commentary on p. 134.19–27. The present passage might also reflect this Galenic influence. In Paul’s chapter on skotoma it is also recommended to apply arteriotomy behind the ears (τὴν ἀρτηριοτομίαν παραληπτέον ὄπισθεν τῶν ὤτων)1268 and this recommendation is also connected to the statement that very warm vapors are carried up through the arteries.1269 These passages are another indication that the texts of the compilers share similar ideas (on this issue, see p. 33 – 35).

1265 See Galen, De cur. rat. per venae sect. 22 (11.313.1 K.), Aetius Amid., Libri med. 3.18 (Vol. 1, 275.25 f. Olivieri). 1266 See Galen, De loc. aff. 3.12 (8.202.16–18 K.). 1267 See Galen, De loc. aff. 3.12 (8.203.5 f. K.). 1268 See Paul 3.12.2 (Vol. 1, 152.14–16 Heiberg), Galen, De loc. aff. 3.12 (8.202.16–18 K.). In his chapter on skotoma, Aretaeus also recommends cutting the right vein on the forehead, but he does not mention the ears. See Aretaeus 7.3.3 (149.23 Hude): […] φλέβα τὴν ἐπὶ τῷ μετώπῳ ὀρθὴν τάμνοντα […]). 1269 See Paul 3.12.2 (Vol. 1, 152.13 f. Heiberg).

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

333

p. 136.10–11: προκενώσας – κλυστῆρι: The notion that one has to empty the stomach first (προκενοῦν) before applying another remedy is discussed in other medical texts as well.1270 The application of enemata was recommended earlier in the chapter, see p. 324, commentary on p. 135.15–16. For further discussion of the noun ἱερά, see p. 324 f., commentary on p. 135.16. p. 136.11–12: μετὰ δὲ – ῥηθησομένοις: The application of trimmation was recommended earlier in the chapter, see p. 329, commentary on p. 135.27–136.1. The present remark about the application of stronger trimmatia (τριμματίοις ἰσχυροτέροις) is still part of the discussion of approaches which should be undertaken if the affection persists (see p. 332, commentary on p. 136.9). The comparative ἰσχυροτέροις might therefore refer to the previously mentioned trimmation highlighting that in the present case one should apply stronger trimmatia than in the previous case. The phrase τοῖς ἐπὶ τῶν μαινομένων ῥηθησομένοις is very interesting insofar as it refers to a passage which appears later in the sixth book. For detailed discussion of such references, and what they show about Aetius’ way of putting together his compilation, see p. 13. In the present passage, the reference is very precise insofar as it even mentions the chapter to which it refers (i.e. the chapter on mania, which is clear from the participle ἐπὶ τῶν μαινομένων) and it also emphasizes that the chapter is to be found after the present chapter by using the future participle ῥηθησομένοις. In the chapter on mania, which is indeed subsequent to the present chapter on skotoma, we find a passage which includes a recipe for a trimmation (p. 140.15) and this recipe differs from that which is presented in the present chapter. It is, therefore, very likely that the phrase τοῖς ἐπὶ τῶν μαινομένων ῥηθησομένοις refers to this passage in the chapter on mania. p. 136.12–13: τροφαὶ – εὐκοίλιοι: The phrase τροφαὶ δ’ ἔστωσαν was also used in the chapters on lethargia (see p. 239, commentary on p. 131.9–11) and on katalepsis (see p. 264, commentary on p. 133.4) to open the sections on appropriate foodstuffs. All adjectives which are used in the present sentence contain the prefix εὐ– (εὔχυμοι, εὐδιοίκητοι, εὐστόμαχοι, εὐκοίλιοι), except for one (ἄφυσοι). Furthermore, with the exception of the adjective εὔχυμος, all adjectives are closely connected to the process of digestion or to the stomach in general. The reason it is recommended that food which is good for the stomach and for digestion should be taken might be that digestion, indigestion, retention, and flatulence seem to play a prominent role in the chapter (see p. 302, commentary on p. 134.15–16, p. 305, commentary on p. 134.17–19, p. 315 f., commentary on p. 134.27–28, p. 316 f., commentary on p. 134.28– 29, p. 317 f., commentary on p. 134.29–135.1). The Anonymus Parisinus also recommends that patients suffering from skotoma should be given food which is easy to digest (εὐδιοικήτῳ τροφῇ).1271 The use of the adjective εὔχυμος in the present chap-

1270 See e.g. Galen, De comp. med. sec. loc. 2.1 (12.560.13 f. K.), Aetius Amid., Libri med. 6.42 (Vol. 2, 185.6 f. Olivieri), Libri med. 7.15 (Vol. 2, 266.12–14 Olivieri). 1271 See Anon. Par. 17.3.3 (112.4 Garofalo).

334 | Commentary

ter might be traced back to the previously discussed notion that the movement of the optical pneuma causes an irregular, troubled and disordered movement of the humors (see p. 314 f., commentary on p. 134.25–27). Food which is productive of healthy humors might counteract this disturbance or, at least, prevent it from becoming even worse. p. 136.13–14: οἶνος – παλαιός: The fact that the text recommends drinking just a little wine (ὀλίγος μὲν) might be due to the previous statement that drunkenness can be causative of the affection (see p. 317, commentary on p. 134.28–29). For a closer look at the properties of white (λευκόν) and thin (λεπτόν) wine, see p. 241, commentary on p. 131.11–14. According to Aetius’ first book, old wine (οἶνος παλαιός), which is not recommended here, has warming properties.1272 p. 136.14–15: ἁρμόδια – λουτρά: Baths are dealt with earlier in the chapter as discussed on p. 328, commentary on p. 135.26–27. It is not uncommon in the medical literature to describe a bath as having an astringent effect (στυπτηριώδης).1273 The third book of the Libri medicinales contains a chapter “on natural baths from Archigenes” (περὶ λουτρῶν αὐτοφυῶν Ἀρχιγένους) and astringent baths are discussed there under the rubric of natural baths.1274 According to Oribasius’ chapter on natural baths, they are stronger and more drastic than those which are artificial (ἐξ ἐπιτεχνήσεως).1275 p. 136.15–17: μεγίστη – γυναικῶν: According to Galen’s Methodus medendi, the therapy (θεραπεία) is concerned with what already exists (τῶν μὲν γὰρ ὄντων) while the prophylaxis (προφυλακή) is concerned with what will be in the future (τῶν δὲ ἔσεσθαι μελλόντων).1276 The adjective πρώτη might, therefore, refer to προφυλακή while the adjective ὑστάτη can be understood with θεραπεία.1277 By presenting all three adjectives in one list, which is followed by the two nouns προφυλακὴ καὶ θεραπεία, the author probably wants to highlight the importance of the subsequent information for both prophylaxis and therapy. The retention of excretions was both regarded as something which people who are prone to skotoma suffer from (see p. 315 f., commentary on p. 134.27–28) and as a symptom of the affection (see p. 317 f., commentary on p. 134.29–135.1), both of which aspects are reflected in the references to prophylaxis and therapy in the present context. The fact that the provocation of excretions which are held back is said to be especially important in women (μάλιστα ἐπὶ γυναικῶν) is remarkable since this fact has not been mentioned in the chapter until now. However, the text presumably refers to women who do not have 1272 See Aetius Amid., Libri med. 1.298 (Vol. 1, 115.1 f. Olivieri). 1273 See e.g. Galen, Meth. med. 8.2 (354.1 Johnston & Horsley = 10.535.9 K.), Oribasius, Ad Eunap. 1.6.1 (323.9 Raeder), Aetius Amid., Libri med. 3.167 (Vol. 1, 342.1 f. Olivieri), Libri med. 4.46 (Vol. 1, 389.5 Olivieri). 1274 See Aetius Amid., Libri med. 3.167 (Vol. 1, 342.1–343.5 Olivieri). 1275 See Oribasius, Coll. med. rel. 10.3.1 (Vol. 2, 45.22 f. Raeder). 1276 See Galen, Meth. med. 4.3 (368.23–25 Johnston & Horsley = 10.243.17 f. K.). 1277 I am grateful to Chiara Thumiger for suggesting this.

VI 7 On those who suffer from skotoma (from …) Archigenes and Posidonius

|

335

their regular menstruation and who are therefore also suffering from a retention. For further discussion of this being a factor which makes women prone to suffer from certain affections, see p. 368 f., commentary on p. 137.29–138.1.

VI 8 On mania from (the books of) Archigenes and Posidonius Introduction to the disease concept mania The noun μανία and its cognates, such as μαίνεσθαι and μανικός, are widely attested throughout the ancient literature. Indeed, the term seems to be “the most common expression for madness both in prose and poetry”.1278 Even in medical literature, μανία and its cognates are not consistently used to describe a specific disease but are often understood as broader terms for mental derangement in general.1279 Phrenitis, melancholia, and mania, so to say, constitute the “triptych that will later [i.e. after the classical period] become traditional”1280 when speaking of mental disorders. Terms such as μανία, μαίνεσθαι, or μανικός are already attested in the “Corpus Hippocraticum”,1281 where they are often used to describe symptoms rather than distinct affections. Looking at the evidence in the “Corpus Hippocraticum”, one may say that the noun μανία (or μανίη) and its cognates “appear to indicate a state of mental disturbance”1282 but are used as general terms that do not “entail a nosological entity”.1283 In contrast to medical texts from the fifth and fourth century BCE, authors such as Celsus, Aretaeus, and the Anonymus Parisinus deal with mania as an affection in its own right: Aretaeus and the Anonymus Parisinus discuss mania under the rubric of chronic affections1284 and both dedicate a separate section of their work to the disease concept mania,1285 in which they deal with the cause of the affection, its symptoms and its therapy. Celsus, meanwhile, discusses an affection which corresponds to what in other texts is referred to as mania, grouping it together with phrenitis and melancholia under the rubric of genera insaniae, three kinds of derangement (for more detail see p. 46 – 48).1286 Although the noun μανία 1278 Ahonen 2014, 31. Ahonen provides textual evidence from Homer. 1279 See e.g. in summary also Pigeaud 1987, 5–9, 221–229; van der Eijk 2001 in Diocles of Carystus Vol. 2, 153; Thumiger 2013, 61–70. 1280 Thumiger & Singer 2018, 2. 1281 For a list of passages see Thumiger 2013, 84–86. See e.g. Hippocrates, De morb. 1.30 (88.7–13 Wittern = 6.200.18–23 L.), Aphor. 6.56 (459.4–6 Magdelaine = 4.576.19–21 L.), De morb. sacr. 15.1 (27.6–10 Jouanna = 6.388.13–16 L.). 1282 Thumiger 2017a, 49. 1283 Thumiger 2017a, 49. See also, in summary, Pigeaud 1987, 7–9. 1284 See p. 361 f., commentary on p. 137.21–23. 1285 See Aretaeus 3.6 (41.12–44.4 Hude), Anon. Par. 18 (112.15–116.19 Garofalo). 1286 Celsus, De med. 3.18.19–23 (126.12–127.12 Marx).

336 | Commentary

and its cognates also appear throughout Galen’s writings, they do not seem to be discussed as systematically here as in other authors.1287 Later authors such as Caelius Aurelianus (who presents a Latin version of Soranus)1288 again offer us a detailed and coherent account of what the Greeks call mania and what he terms furor or insania,1289 while the present chapter in Aetius’ compilation is a further example of a detailed and systematic account of the disease concept. An important characteristic of mania is that it occurs without fever,1290 which in some accounts is also presented as a distinctive feature that marks it out from other derangements, such as phrenitis.1291 Aetius’ present chapter clearly treats the brain as the bodily part that is affected in mania (p. 136.18–19) and the same applies to other texts which either mention the brain or the head as important in the onset of mania. Already in the “Hippocratic” De morbo sacro the verb μαίνεσθαι (“suffering from mania”) is connected to a destruction of the brain (διαφθορή τοῦ ἐγκεφάλου),1292 while Aretaeus mentions the head as one cause of the affection1293 and Galen states that mania, being a derangement (παραφροσύνη), may arise from a hot dyskrasia of the brain.1294 Comparable to direct references to the head or the brain in the context of mania are references to the leading capacities (τὸ ἡγεμονικόν), for, in those authors who support encephalocentric theories, statements about an involvement of the leading capacities point to the involvement of the brain in which they localize these capacities (see also p. 43 f.). In this regard, statements such as the one found in Galen’s De locis affectis, where we read that mania is an “impairment of the leading capacities” (βλάβαι τῶν ἡγεμονικῶν ἐνεργειῶν),1295 can also be interpreted as referring to an impairment of the brain, as can the statement in Aetius’ present passage that the imaginative faculty and the reasoning faculty (two of three functions that were thought to constitute the leading capacities) are damaged in patients suffering from mania (see p. 137.3–4). Mania is frequently said to have several forms, and distinguishing between a form of mania which occurs along with a cheerful mood and a form which occurs along with an aggressive or sad mood

1287 Ahonen 2014, 159 puts it as follows: “Galen’s comments on medical mania are remarkably meagre.” See also Jackson 1969, 376. 1288 See p. 242, especially note 752. 1289 See Caelius Aurel., Tard. pass. 1.144–179 (514.27–536.29 Bendz). 1290 See e.g. Diocles fr. 74.6 f. van der Eijk, Aretaeus 3.6.1 (41.13 Hude), Galen, De sympt. caus. 2.7 (7.202.5–7 K.), De loc. aff. 3.7 (8.166.7 f. K.), Caelius Aurel., Tard. pass. 1.146 (516.19 Bendz). 1291 See e.g. Galen, De sympt. caus. 2.7 (7.202.5–7 K.), Caelius Aurel., Tard. pass. 1.146 (516.19 f. Bendz). 1292 See Hippocrates, De morb. sacr. 15.1 (27.5 f. Jouanna = 6.388.12 f. L.) 1293 See Aretaeus 3.6.7 (42.29 f. Hude). 1294 See Galen, De sympt. caus. 2.7 (7.202.6–10 K.). 1295 Galen, De loc. aff. 3.7 (8.166.7 f. K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

337

seems to be a recurring aspect in discussions of this disease concept.1296 The contrasting forms of mania are probably what led scholars such as Moog to suggest that the ancient concept might be identified with modern concepts such as schizophrenia or cyclothymia.1297 For further discussion of mania in ancient medical literature, see e.g. Pigeaud 1987; Stok 1996; Pigeaud 2006/11981, 100–112; Thumiger 2013; Ahonen 2014, 13–18; Siegel 1973, 272–274.

Structure of the chapter p. 136.18–23: Περὶ – τόποις: Origin of mania Paraphrase: The beginning of the chapter is concerned with the origin of mania, which is said to be brought about when blood flows to the brain. Two different possible characteristics of this blood are, then, distinguished, which later correspond to two different forms of mania: the blood may either be well-tempered but present in a great amount or it may be full of yellow bile. It is also said that mania is preceded by a diseased condition of the head. p. 136.23–137.4: ἐπὶ – λογιστικόν: Symptoms of the form of mania occurring due to blood alone Paraphrase: These lines are concerned with the symptoms which can be observed in patients who suffer from the form of mania, which occurs due to blood alone. Symptoms mentioned here are constant singing and ungovernable laughter occasioned by the appearance of images in front of the eyes. It is also said that ringing in the ears may occur, leading the patients to think that they hear flute players. It is said that the patients’ imaginative faculty and reasoning faculty are damaged, while their memory is preserved. p. 137.4–13: μιχθείσης – διεχειρίσαντο: Symptoms of the form of mania occurring due to blood mixed with yellow bile Paraphrase: These lines are concerned with the symptoms which can be observed in patients who suffer from the form of mania that occurs due to blood that is mixed with yellow bile. These patients become more inclined to anger, bold, turning into brawlers and insolent men. They are also said to suffer from beast-like derangements, to taste their own flesh, and to beat, wound and lay hands on the people in their house. In general terms, it is stated that the more bile is mixed with the blood, the more the unpleasant and high-spirited aspects of the affection increase.

1296 See e.g. Hippocrates, De morb. sacr. 15.1 (27.6–10 Jouanna = 6.388.13–16 L.), Aretaeus 3.6.4 (42.9–12 Hude), Anon. Par. 18.2.1 (114.6 f. Garofalo), Caelius Aurel., Tard. pass. 1.150 (518.27–31 Bendz). 1297 See Moog 1994 in Die Fragmente des Themison von Laodikeia, 280.

338 | Commentary

p. 137.14–21: ἐγχωρεῖ – γίγνεται: Physiology of different forms of mania occurring in one patient Paraphrase: These lines deal with the possibility that one and the same human being may at one time be seized by the form of mania associated with laughter and at another time by the form of mania associated with passions and anger. The underlying physiological processes are discussed, such as, for example, the eating of sharp food or movement and disturbance. These lines are also concerned with the underlying physiological processes which may cause a time interval during which the patient is free from derangement. p. 137.21–138.1: τισὶ – καταμήνια: Frequency of mania, age and gender of the patients, proneness to the affection Paraphrase: In these lines the text deals with the frequency with which mania occurs (i.e. periodically, once a year, twice a year, or more often), and with the age at which patients are usually caught by the affection (i.e. mostly during the prime of life), as well as with which gender is more likely to be affected with mania (i.e men). They also discuss character traits, habits, and physiological processes, which make people prone to suffer from mania, such as suffering from psychic affections, drinking a large amount of wine, suffering from indigestion or retention of excrements or, in females, of menstruation. p. 138.1–10: μυρίαι – ἐκστάσεως: Preceding signs and symptoms Paraphrase: These lines are concerned with “preludes” to mania, that is to say with signs and symptoms which may be observed in patients who are about to suffer from the affection. Among the list are symptoms such as ungovernable laughter, anger, sleeplessness or heaviness of the head. It is stated that, as time proceeds, all of these intensify, as do the patients’ desires and their willingness to engage in sexual intercourse. All of this is said to lead to complete derangement. p. 138.10–17: δεῖ – ἀπέχειν: Care for the patients Paraphrase: These lines deal with the way in which the physician needs to take care of the patient when mania is about to start or has already set in, concentrating on the appropriate regimen. p. 138.17–139.6: τριῶν – ἐπιθέσει: Therapy for mania I (phlebotomy) Paraphrase: These lines discuss the way in which patients suffering from mania should be phlebotomized. They include information on the veins which have to be cut and on the different reactions of each patient to phlebotomy. p. 139.6–9: ἐμβρέχειν – βρέγματι: Therapy for mania II (embrocations) Paraphrase: These lines deal with embrocations as one appropriate therapy for patients suffering from mania. p. 139.9–21: παντὶ – κλυστήρων: Therapy for mania III (hypnotic remedy, relaxing the stomach) Paraphrase: These lines discuss the importance of sleep for patients suffering from mania, since sleeplessness makes them sharper and wilder. It is recommended that a hypnotic remedy made of poppyhead should be applied. The application of this

VI 8 On mania from (the books of) Archigenes and Posidonius

| 339

remedy needs to be repeated and the physician is advised to apply it carefully, since it numbs sense-perception. These lines furthermore state that the stomach needs to be relaxed through the ingestion of suitable foods and the application of enemata. p. 139.21–140.4: τούτων – ὕσσωπον: Therapy for mania IV (local remedies) Paraphrase: These lines discuss local remedies which need to be applied once the previous therapeutic approaches have been undertaken. They deal with phlebotomizing veins in the face, with the application of the bitter remedy made of aloe, with purging the head through the nose, with the application of sternutatories, with phlegm-purging remedies, and with gargles. p. 140.4–14: ὑποσυρέσθω – προσάγειν: Therapy for mania V (enemata, purgatives, leeches, holy remedy, sternutatories) Paraphrase: These lines recommend the purging of the stomach by means of enemata and purgatives. Several remedies are discussed. It is furthermore stated that leeches should be applied to the head, that the menses should be set in motion in women, that Galen’s holy remedy should be applied, and that sternutatories should be used. p. 140.14–25: παρακμάζοντος – ψυχρῷ: Therapy for mania VI (bathing) Paraphrase: These lines deal with the bathing of the patients, which should be undertaken when the affection abates. They recommend the application of a trimmation and provide further information concerning the treatment of the head during bathing. p. 140.25–141.3: μετὰ – τούτων: Therapy for mania VII (irritation of the skin, phlegm-purging remedies, sternutatories, regimen, wine rarely) Paraphrase: These lines state that one needs to bring about irritation of the skin after the bath, that one should apply phlegm-purging remedies and sternutatories, that one should establish a very thinning regimen, which furthermore needs to be easily digestible, good for the stomach, cause no flatulence, and restore a healthy mixture. The drinking of wine needs to be restricted. p. 141.3–10: εἰ δ’ – ἐκκρίσεις: Therapy for mania VIII (prophylaxis after the therapy) Paraphrase: The last lines of the chapter deal with the time after the actual therapy. They provide information regarding the question of what needs to be done when there is a remnant of the affection and give advice about prophylaxis. The patients should stay away from anything which may produce bile, should be phlebotomized each spring, and it should be ensured that women menstruate regularly and that others excrete regularly.

Rationale of the chapter The chapter on mania presents an account of the disease concept which includes discussion of its origin (i.e. plenty of non-putrefied blood flows towards the brain,

340 | Commentary

either being well-tempered or full of yellow bile: see p. 136.18–21), the symptoms of both “forms” of mania (i.e. ungovernable laughter, images in front of the eyes, constant singing, ringing in the ears, preservation of memory, damage to the imaginative faculty and the reasoning faculty; being inclined to anger, bold, brawlers, insolent, beast-like derangement, wounding intimate people: see p. 136.23–137.13), the physiological processes which underlie the fact that one and the same patient may be seized by both forms of mania (i.e. eating sharp food, movement, disturbances, etc.: see p. 137.14–21), the frequency with which mania occurs, the age and the gender which are most frequently affected, the proneness to the affection (i.e. mania occurring periodically, once a year etc., male patients are more common than female, people suffering from psychic affections are especially prone, as are those suffering from indigestion, etc.: see p. 137.21–138.1), the preceding signs and symptoms (i.e. unreasonable laughter, anger, ringing in the ears, sparks in front of the eyes, sleeplessness, heaviness of the head, increasing sexual desires, “wet dreams”, etc.: see p. 138.1–10), how one has to care for these patients (i.e. a thinning regimen, keeping away from anything which may generate blood: see p. 138.10–17), and what an appropriate therapy should look like (see p. 138.17–141.10). The opening of the chapter presents a clear and precise account of the origin of mania as being caused by blood and includes a clear distinction between the two possible characteristics of the blood: the blood may either be well-tempered and abundant (see p. 343 f., commentary on p. 136.20–21) or full of yellow bile (see p. 345, commentary on p. 136.21). This distinction is taken up again in the discussion of the symptoms, which is introduced by two genitive absolutes which unmistakably refer to each of the two forms of mania (see p. 136.23–24: ἐπὶ μόνῳ τοίνυν τῷ αἵματι γιγνομένης τῆς μανίας, see p. 137.4–5: μιχθείσης δὲ τῷ αἵματι τῆς ξανθῆς χολῆς καὶ δακνῶδες αὐτὸ ἀποτελεσάσης). These precise references and the clear structure contribute greatly to the readability of the chapter. Even the comparison between mania and podagra (p. 136.21–23) is underpinned by parallels in the choice of words (see p. 136.19 and p. 136.23: ἐπιρρεῖν; see p. 347, commentary on p. 136.23), although it remains unclear why such comparison is needed and what it is supposed to add to the understanding of mania. The mention of the imaginative faculty, the reasoning faculty and memory in the section on the symptoms of the form of mania which occurs due to blood alone recalls Aetius’ chapter on phrenitis, where these three leading capacities are discussed in detail.1298 See p. 167 f., commentary on p. 125.10– 15, p. 168 – 171, commentary on p. 125.16–20, and p. 171 – 174, commentary on p. 125.20–24. Indeed, one might be inclined to interpret these similarities as indicating that this part of the chapter on mania is also taken from Posidonius, who is said to be cited in the chapter on phrenitis.1299 The remarks on the physiological processes which may lead to a patient being at one time seized by the “cheerful form” of ma-

1298 See Aetius Amid., Libri med. 6.2 (Vol. 2, 125.10–24 Olivieri). 1299 See Aetius Amid., Libri med. 6.2 (Vol. 2, 125.4 Olivieri).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

341

nia and at another by the “aggressive form”, are, in parts, difficult to understand (see p. 360 f., commentary on p. 137.18–21). This is especially striking since the previous remarks were comparatively precise and clear, and one may suspect that the differences in precision reflect their origins in different sources. This issue is especially noteworthy since the subsequent information on the frequency with which patients are affected with mania, and the age and gender of the patients who are suffering from mania, and the character traits, habits and physiology of people who are especially prone, is again rather precise (p. 137.21–138.1). These remarks also match what was said previously about mania (e.g. the statement that people are mostly affected during the prime of life, which in other texts is connected to yellow bile, fits well with the statement at the start of our chapter that mania is brought about by yellow bile: see p. 363 f., commentary on p. 137.23–25). The discussion of the preludes to mania is also very precise and mentions many items which also appeared previously as symptoms of the affection (see e.g. p. 370, commentary on p. 138.3, p. 370, commentary on p. 138.4). It even includes an explicit reference to “what was mentioned earlier” (τῶν προρρηθέντων; see p. 369 f., commentary on p. 138.2–3). I argue on p. 374 f., commentary on p. 138.10–12, that the remarks on p. 138.10–17, which are introduced by δεῖ οὖν τὸν ἐπιστήμονα ἰατρὸν ἐπιμελούμενον τοῦ κάμνοντος, deal with the general care of the patient, which should be applied as soon as the affliction announces itself. Discussion of the actual “therapy” then starts on p. 138.17. The remarks on the appropriate therapy for mania take up much of the chapter. They include very detailed information on phlebotomy (p. 138.17–139.6), on the application of embrocations (p. 139.6–9), hypnotic remedies (p. 139.9–21), and local remedies (p. 139.21–140.4), as well as on the bathing of the patients (p. 140.14–25), before concluding with some prophylactic remarks (see p. 402, commentary on p. 141.7). These therapeutic recommendations are in line with information we receive in other chapters on curing affections which have their origin in the head. Considering the chapter as a whole, it is worth asking how the information within it was selected and why the particular form of organization and structure was chosen. To begin with, we can ask whether the information contained in the chapter does indeed stem from Archigenes and Posidonius and which parts derive from each of the supposed sources. This question is, of course, difficult to answer, but, as noted above, the mention of imaginative faculty, reasoning faculty and memory reminds us of the chapter on phrenitis, which is claimed to be taken from Posidonius. One might assume that this similarity supports the idea that the section of the present chapter also derives from him. In general, I find it remarkable that the chapter on mania is, for the most part, precise and clear, and I wonder whether this might have something to do with the sources for the chapter. In addition, we might also ask why Aetius decided to include in this chapter this information on mania and this information only. Comparing Aetius’ account of the affection with other accounts casts light on this question and I make such comparisons throughout the

342 | Commentary

commentary. In summary, many of the details here are also discussed in other texts which deal with mania, in particular the role of blood and yellow bile in the onset of mania (see p. 343, commentary on p. 136.19, p. 345, commentary on p. 136.21) and the existence of different forms of mania, which are associated with cheerfulness and an aggressive mood (see p. 347 – 349, commentary p. 136.23–25). Although these characteristics commonly appear in other texts as well, it is worth noting just how much effort is expended here on distinguishing these forms and their subsequent symptoms. The section dealing with the physiological processes which underlie the fact that one patient may be seized by both forms of mania also concentrates on these two forms, and I have found no parallel to this section in other extant accounts of mania. As regards the therapy for mania, Aetius’ remarks are one of only a few surviving, detailed accounts and they show once more how important therapeutical information is for Aetius’ compilation. Given that the remarks on cause, forms, symptoms or preludes of mania are also comparably detailed, the chapter on mania similarly reveals the significance of these elements for Aetius.

Commentary p. 136.18: Περὶ – Ποσειδωνίου: For a detailed discussion of Archigenes and Posidonius as sources for the sixth book, see p. 23 – 26. p. 136.18–19: γίγνεται – πυρετοῦ: The notion that mania occurs without fever is a common one and can be found in many other texts as well; the Anonymus Parisinus reports that Praxagoras, Diocles, and Hippocrates held that mania does not involve fever.1300 Aretaeus states at the beginning of his chapter on mania that it occurs without fever (ἄνευθε πυρετοῦ)1301 and this notion is also reflected in several passages throughout Galen’s œuvre:1302 In De symptomatum causis, mania and phrenitis, which are both said to be false movements of the leading capacity, are differentiated through the fact that the latter occurs with fever (μετὰ πυρετῶν) and the former without (χωρὶς τούτων).1303 In De locis affectis, mania is also ranked among forms of damage to the leading capacities occurring without fever, in contrast to the identification of phrenitis as damage to the leading capacity occurring with fever.1304 In Alexander of Tralleis, the fact that mania is not accompanied by

1300 See Anon. Par. 18.1.1 (112.19 f. Garofalo), Anon. Par. 18.1.2 (112.22 f. Garofalo), Anon. Par. 18.1.3 (114.4 Garofalo), Praxagoras fr. 72 Steckerl, Diocles fr. 74.6 f. van der Eijk. For further discussion of this statement, see van der Eijk 2001 in Diocles of Carystus Vol. 2, 153. 1301 See Aretaeus 3.6.1 (41.13 Hude). 1302 See e.g. Galen, De loc. aff. 3.7 (8.166.7 f. K.), De loc. aff. 4.1 (8.217.9 K.), In Hipp. Epid. III comm. 3.46 (138.23–25 Wenkebach = 17a.699.5–7 K.), Pseudo-Galen, Def. med. 246 (19.416.8 K.), Galen, De sympt. caus. 2.7 (7.202.6 K.). 1303 See Galen, De sympt. caus. 2.7 (7.202.5 f. K.). 1304 See Galen, De loc. aff. 3.7 (8.166.7 f. K.), De loc. aff. 4.1 (8.217.7–9 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius |

343

fever (ἄνευ πυρετοῦ) is mentioned in his chapter on phrenitis as a feature that distinguishes between the two,1305 and Caelius Aurelianus also mentions that mania occurs without fever (sine febribus), through which it may be distinguished from phrenitis.1306 p. 136.19: αἵματος – ἐγκεφάλῳ: This genitive absolute presents the condition under which mania occurs; it happens due to blood (αἷμα) which flows to (ἐπιρρεῖν)1307 the brain. The notion that blood is involved in the onset of mania, is reflected elsewhere; according to the testimony of the Anonymus Parisinus, Diocles was of the opinion that mania is a “boiling of the blood in the heart” (ζέσις τοῦ ἐν τῇ καρδίᾳ αἵματός), “which occurs without obstruction” (χωρὶς ἐμφράξεως).1308 Aretaeus states that people who are of an age in which there is much heat or blood (τὸ θερμὸν καὶ αἷμα πουλὺ) are liable to suffer from mania.1309 Several “Hippocratic” passages claim that blood which gathers at the breast indicates mania.1310 In our present passage, the blood is characterized as ἀσαπές (non-putrefied). Interestingly, in his De differentiis febrium, Galen mentions the existence of a kind of fever which is brought about by putrefied blood (κᾀπὶ τῷ αἵματι σηπομένῳ)1311 and this idea is also reflected in Aetius’ fifth book.1312 One might read the use of the adjective ἀσαπές as an explanation for the absence of fever.1313 p. 136.20–21: ποτὲ – μεθυόντων: The phrase ποτὲ μὲν is contrasted with ποτὲ δὲ (p. 136.21). These phrases introduce two different possible features of the blood which can cause mania: it may either be well-tempered (εὔκρατος) or full of yellow bile (ξανθοχόλου; see p. 345, commentary on p. 136.21). The use of the adjective εὔκρατον reflects the importance of a “good mixture” for health; Galen’s De temperamentis opens with the statement that the bodies of animals are mixed of warm, cold, dry and wet (ἐκ θερμοῦ καὶ ψυχροῦ καὶ ξηροῦ καὶ ὑγροῦ … κέκραται).1314 Later in the treatise we learn that Galen conceives of nine different kinds of mixtures, one being well-tempered (εὔκρατον μὲν μίαν), the others being not well-tempered.1315 In

1305 See Alexander, Therapeutica 1.13 (618.19–21 Guardasole = Vol. 1, 513.3 f. Puschmann). 1306 See Caelius Aurel., Tard. pass. 1.146 (516.19 f. Bendz). 1307 The verb ἐπιρρεῖν is frequently used with this meaning (“flow towards something”) and also in connection with the brain. See e.g. Galen, De foet. form. 5.3 (82.28–84.1 Nickel = 4.679.13 f. K.), De foet. form. 4.5 (80.11 f. Nickel = 4.676.10 f. K.), De plac. Hipp. et Plat. 7.1.4 (428.19 f. de Lacy = 5.587.13–15 K.), De sympt. caus. 1.2 (7.89.13 f. K.), Aetius Amid., Libri med. 8.65 (Vol. 2, 521.6 Olivieri). 1308 See Diocles fr. 74.5 f. van der Eijk. I cite van der Eijk’s translation here. 1309 See Aretaeus 3.6.3 (41.31–42.1 Hude). 1310 See Hippocrates, Aphor. 5.40 (439.6 f. Magdelaine = 4.544.16 f. L.), De morb. popul. 2.sect.6.32 (84.20 f. Smith = 5.138.19 f. L.). 1311 See Galen, De diff. febr. 2.11 (7.374.8 f. K.). 1312 See Aetius Amid., Libri med. 5.77 (Vol. 2, 52.13–15 Olivieri). 1313 On the connection between putrefaction and the occurrence of fevers, see also van der Eijk 2001 in Diocles of Carystus Vol. 2, 129. 1314 See Galen, De temp. 1.1 (1.1–4 Helmreich = 1.509.4–8 K.). 1315 See Galen, De temp. 1.8 (31.27–32.4 Helmreich = 1.559.2–9 K.).

344 | Commentary

answer to the question of which human being has the best mixture, Galen states that “such a person must be placed in the middle [ἐν τῷ μέσῳ χρὴ τάξαντας] with respect to substance as a whole, let alone with respect to animals in general, and to men. He may be regarded as a kind of yardstick or standard [καθάπερ τινὰ κανόνα καὶ γνώμονα] by comparison with which all others will be called hot, cold, dry, or wet.”1316 Health is ultimately related to a “good mixture” (εὐκρασία).1317 The reason why, in spite of being well-tempered, the blood still causes mania, is its great quantity (τῷ πλήθει). The use of the adverb μόνον emphasizes the fact that the negative effect of the blood derives from its quantity and not its quality. A similar statement is found in the fortieth chapter of Aetius’ sixth book, which deals with headache (κεφαλαλγία), and claims to be cited from Galen;1318 in this chapter, different conditions (διαθέσεις) are distinguished according to which headaches may occur, and one of these conditions is ascribed to a certain quality of humors (ἐπὶ τῇ τούτων ποιότητι), while another is ascribed to a quantity (διὰ τὸ πλῆθος αὐτῶν μόνον γιγνομένη).1319 A similar notion is reflected in, for example, Galen’s De temperamentis, where he states that a living being may become warmer or colder either because of a quantitative increase of warm or cold humors or because of a qualitative change of these, while their proportion remains as it was.1320 The phrase ὡς ἐπὶ τῶν μεθυόντων seems to function as example of how a great amount (πλῆθος) may cause distress. One might, thus, think that the point is to stress that drinking a great amount of wine brings about drunkenness regardless of the wine’s quality. It may, however, also be reasonable to interpret this statement as referring to the fact that drinking a lot of wine produces substances in great quantity, oppressing the body or the head in particular. In a chapter of Aetius’ sixth book, which deals with headache occurring due to drunkenness, it is stated that warm wines bring about headaches because they completely fill (πληροῦντος) the head with vapors.1321

1316 See Galen, De temp. 1.9 (35.19–22 Helmreich = 1.565.5–9 K.). I cite Singer’s translation of De temperamentis here. See Singer 1997 in Galen. Selected Works (bibliographical information under Galen, De temperamentis), 228. 1317 See Galen, De temp. 1.4 (16.15 f. Helmreich= 1.534.1 f. K.). See e.g. also Galen, De plac. Hipp. et Plat. 5.2.31–32 (300.28–30 de Lacy = 5.440.1–4 K.), Pseudo-Galen, Def. med. 129 (19.382.6–10 K.): ὑγίειά ἐστι τῶν πρώτων κατὰ φύσιν ἡ εὐκρασία τῶν ἐν ἡμῖν χυμῶν ἢ τῶν φυσικῶν δυνάμεων ἀπαραπόδιστος ἐνέργεια. ἢ ὑγίειά ἐστιν εὐκρασία τῶν τεσσάρων πρώτων στοιχείων ἐξ ὧν τὸ σῶμα συνέστηκε, θερμοῦ, ψυχροῦ, ὑγροῦ, ξηροῦ. For further discussion of the Galenic concept of mixture, see e.g. Boudon-Millot 2011. 1318 See Aetius Amid., Libri med. 6.40 (Vol. 2, 183.9–184.2 Olivieri). 1319 See Aetius Amid., Libri med. 6.40 (Vol. 2, 183.14 f. Olivieri). 1320 See Galen, De temp. 3.4 (106.15–17 Helmreich = 1.679.9–11 K.). 1321 See Aetius Amid., Libri med. 6.43 (Vol. 2, 185.15–17 Olivieri). See also Galen, In Hipp. Prorrh. comm. 2.28 (78.1–3 Diels = 16.646.9–12 K.), In Hipp. Prorrh. comm. 3.1 (107.5 f. Diels = 16.707.1 f. K.), In Hipp. Aph. comm. 6.32 (18a.52.11–14 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

345

p. 136.21: ποτὲ – ξανθοχόλου: This part of the sentence discusses the possibility that blood that is full of yellow bile (ξανθοχόλου) causes mania. The notion that mania is connected with an accumulation of yellow bile is also reflected in other texts. Paul, for instance, states that mania occurs when yellow bile has been overheated and thus changed into black bile (τῆς ξανθῆς χολῆς ὑπεροπτηθείσης εἰς μέλαιναν ἡ μεταβολὴ γένηται).1322 In De symptomatum causis, Galen writes that mania follows biting and warm humors, of which yellow bile is a particular example,1323 and in the pseudo-Galenic Introductio sive medicus we read that yellow bile is the cause of mania.1324 In his chapter on skotoma, Aretaeus says that mania occurs in connection with yellow bile.1325 According to the Anonymus Parisinus, Hippocrates was of the opinion that mania occurs due to a “turning into bile” (κατὰ τὴν ἐκχόλωσιν) and a burning of the intellectual pneuma in the head.1326 It is worth noting here that our text conceives of the blood as being full of yellow bile, whereas the other texts just cited only mention the yellow bile (ξανθὴ χολή) and do not suggest a connection with blood. We should probably assume that our text understands the blood as the carrier of the humors. Such a notion was not uncommon in ancient medical thought. In De placitis Hippocratis et Platonis, Galen states that blood is composed of the four humors (blood, phlegm, yellow bile, black bile) (τὸ συγκείμενον μὲν ἐκ τῶν τεσσάρων χυμῶν) and is named in accordance with the prevailing humor (κατ’ ἐπικράτειαν δ’ ὠνομασμένον οὕτως).1327 A similar statement also appears in De inaequali intemperie.1328 Passages dealing with different colors of blood and explaining these differences as depending on its bilious, melancholic or phlegmatic character,1329 suggest that the blood is the carrier of these humors. See also Lonie 1981 in The Hippocratic Treatises [listed under De morbis 4]: p. 293–294; de Lacy 2005 in Galeni De placitis Hippocratis et Platonis, 686. p. 136.21–22: προηγεῖται – πάρεστι: For a closer look at the verb προηγεῖσθαι, which may be used as a technical term in discussions of causation, see p. 305 f., commentary on p. 134.17–19. Podagra (ποδάγρα) was obviously regarded as an affection of the feet.1330 It may be distinguished from χειράγρα, which befalls the hands, and from ἀρθρῖτις, which

1322 See Paul 3.14.1 (Vol. 1, 157.1–3 Heiberg). 1323 See Galen, De sympt. caus. 2.7 (7.202.6–8 K.). 1324 See Pseudo-Galen, Introd. s. medic. 13.24 (57.10 f. Petit = 14.740.16 f. K.). 1325 See Aretaeus 3.3.2 (38.9 Hude). 1326 See Anon. Par. 18.1.3 (114.2 f. Garofalo). 1327 See Galen, De plac. Hipp. et Plat. 8.4.4 (498.27 f. de Lacy = 5.672.6–8 K.). 1328 See Galen, De inaequ. intemp. 4 (154.21–23 García Novo = 7.741.16–18 K.). 1329 See e.g. Galen, De loc. aff. 2.10.5 (366.13–16 Gärtner = 8.122.5–10 K.). 1330 See e.g. Caelius Aurel., Tard. pass. 5.27 (870.4 f. Bendz): utraque passio [scil. articulorum passio, quam Graeci arthritin vocant, at de pedum dolore, quem podagram appelant] a parte corporis, quae patitur, nomen accepit, altera communiter ab articulis omnibus, altera specialiter a pedibus.

346 | Commentary

possibly befalls (all) joints.1331 It seems to consist in pain (ἄλγος), numbness (ναρκώδεις) and insensibility (δυσαίσθητοι) of the affected region.1332 As part of the comparison between podagra and mania, we read that a diseased condition of the feet (ἡ ἀσθένεια τῶν ποδῶν) occurs along with podagra. A similar idea is found in other writings as well: in a chapter dealing with podagra and arthritis, Aetius states that in both affections “there is a chronic diseased condition of the joints, which involves flux” (ἀσθένειά ἐστι τῶν ἄρθρων χρονία ῥευματική). When this diseased condition pertains to the feet it is called podagra, when it pertains to the hip-joints, ischias, and when it pertains to other joints of the body, it is called arthritis.1333 Similar connections between podagra and a diseased condition (ἀσθένεια) of the feet are suggested in other texts as well.1334 In a passage of Galen’s In Hippocratis Aphorismos commentarii we even find the statement that the feet must necessarily be “weaker” (ἀσθενεστέρους) when someone is about to be seized by podagra, just as the brain (has to be weaker) when someone is about to suffer from epilepsia.1335 The comparison in the present passage is between the diseased condition of the head which precedes (προηγεῖται) mania, and the diseased condition of the feet, which is always present (πάρεστι) in podagra. One should probably not assume a difference between προηγεῖται and πάρεστι in the sense that the diseased condition of the head only precedes mania but disappears after its onset. We should, rather, assume that the diseased condition of the head also lasts at least as long as the patient suffers from mania. The position of the particle μέν in the sentence is striking; one might be tempted to accept the reading of the Codex Athous Λαύρας 718 Ω 63 (A), which transmits the relative pronoun ἥτις in front of ἀεί.1336 However, given that reading the sentence without ἥτις is the lectio difficilior,1337 one should read the text as Olivieri suggests. The ἀεὶ μὲν, then, corresponds to the τότε δ’ (see p. 347, commentary on p. 136.23), and one can therefore replace Olivieri’s full stop after πάρεστι with a comma in order to improve the readability of the sentence. Descriptions of the head as being in a diseased condition (ἀσθένεια τῆς κεφαλῆς) are not uncommon in the medical literature. In the seventh book of the Libri medicinales it is, for example, said that night-blindness (νυκταλωπία) occurs due to a diseased condition of the head (διά τινα ἀσθένειαν περὶ τὴν κεφαλήν).1338 In the fortieth chapter of Aetius’ sixth book, dealing with different forms of headache, it is 1331 See e.g. Anon. Par. 50.2.2 (250.17 f. Garofalo), Caelius Aurel., Tard. pass. 5.27 (870.9–11 Bendz), Tard. pass. 5.28 (870.16–18 Bendz). 1332 See e.g. Anon. Par. 50.2.1 (250.12 f. Garofalo), Caelius Aurel., Tard. pass. 5.30 (872.5 f. Bendz). 1333 See Aetius Amid., Libri med. 12.2 (30.16–31.3 Kostomiris). 1334 See e.g. Paul 3.78.1 (Vol. 1, 299.9 f. Heiberg), Galen, In Hipp. Aph. comm. 6.28 (18a.41.7 f. K.), Meth. med. 11.20 (214.1–3 Johnston & Horsley = 10.803.15–18 K.). 1335 See Galen, In Hipp. Aph. comm. 6.28 (18a.41.7–9 K.): ἀναγκαῖον μὲν ἀσθενεστέρους ἔχειν τοὺς πόδας, μέλλει τις ἁλῶναι ποδάγρα, καθάπερ τὸν ἐγκέφαλον, εἰ μέλλει τις ἐπιληπτικὸς ἔσεσθαι. 1336 See Olivieri’s critical apparatus to p. 136.22. 1337 I am grateful to Philip van der Eijk for pointing this out. 1338 See Aetius Amid., Libri med. 7.48 (Vol. 2, 301.8 f. Olivieri).

VI 8 On mania from (the books of) Archigenes and Posidonius

| 347

said that one form of headache occurs when, due to a diseased condition (δι’ ἀσθένειαν), vaporous pneuma is produced in parts of the head (ἔν τισι τῶν κατὰ τὴν κεφαλὴν μορίων).1339 In Methodus medendi, Galen deals with patients who are “weak” as regards the head (ἀσθενὴς τὴν κεφαλὴν) and are easily filled by warm wines,1340 and in De locis affectis he deals with a diseased condition of the head in the context of chronic headache.1341 In the present context, the diseased condition of the head is probably thought to make the patient prone to being affected by the blood, which flows towards the brain and thus causes mania. p. 136.23: τότε – τόποις: This sentence still refers to podagra. I have discussed above the connection of the phrase τότε δ’ with ἀεὶ μὲν (see p. 346, commentary on p. 136.21–22). We also read in other texts that podagra involves a flow of substances in the body and some of these texts even use the verb ἐπιρρεῖν or the noun ἐπίρροια to indicate this flow.1342 Interestingly, the verb ἐπιρρεῖν was also used in the opening of the chapter to state that blood flows to the brain (see p. 343, commentary on p. 136.19) and the repeated use here emphasizes the comparison between podagra and mania. While, in the previous passage, the verb ἐπιρρεῖν took the brain (τῷ ἐγκεφάλῳ) as its object, in the present passage its object is τοῖς τόποις, literally “the parts”; given that the text is concerned with podagra here, these parts presumably need to be understood as referring to the feet. Thus, both τῷ ἐγκεφάλῳ (in the context of mania) and τοῖς τόποις (in the context of podagra) refer to the affected part in each case. The sensation of pain (ὀδυνῶνται) in podagra is connected to the flow of the material (ἡ ὕλη) to the feet and the noun ὕλη presumably refers to substances such as humors, which are involved in the onset and development of podagra. In light of the comparison between mania and podagra, the noun ὕλη would correspond to the blood, which was discussed in the opening of the chapter as the substance which causes mania (see p. 343, commentary on p. 136.19). This interpretation is reinforced by the fact that the subclause ὁπόταν ἡ ὕλη ἐπιρρεύσῃ τοῖς τόποις is, then, completely parallel to the previous genitive absolute αἵματος πολλοῦ ἀσαποῦς ἐπιρρεύσαντος τῷ ἐγκεφάλῳ (p. 136.19). Not only is the verb ἐπιρρεῖν used in both cases, and not only do the nouns ἐγκεφάλῳ and τόποις correspond, but the phrase αἵματος πολλοῦ ἀσαποῦς also corresponds to ἡ ὕλη. p. 136.23–25: ἐπὶ – πάσχουσι: This sentence introduces the list of symptoms, which is provided in the following lines (p. 136.25–137.4). The phrase ἐπὶ μόνῳ τοίνυν τῷ αἵματι thus refers back to p. 136.20, where it was stated that one possible characteristic of the blood that causes mania is its good mixture paired with its abundance (see p. 343 f., commentary on p. 136.20–21). The subsequent list of symptoms only pertains to this form of mania, while the symptoms which can be ob1339 See Aetius Amid., Libri med. 6.40 (Vol. 2, 183.16–18 Olivieri). 1340 See Galen, Meth. med. 12.4 (260.21 f. Johnston & Horsley = 10.835.11 f. K.). 1341 See Galen, De loc. aff. 3.13 (8.205.6 f. K.). 1342 See e.g. Galen, In Hipp. Aph. comm. 6.28 (18a.41.16 f. K.), Aetius Amid., Libri med. 12.10 (36.5 f. Kostomiris), Alexander, Therapeutica 12 (Vol. 2, 519.19 Puschmann).

348 | Commentary

served in the second form of mania, brought about by blood mixed with yellow bile (see p. 345, commentary on p. 136.21), are discussed from p. 137.4 onwards (see p. 352, commentary on p. 137.4–5). It is clear from the differentiation in the text that two different forms of mania are conceived of here, with the different effects on the patient being due to the fact that they are brought about by different substances. The fact that different forms of mania are distinguished is also reflected in other texts. In the “Hippocratic” De morbo sacro, people who suffer from mania because of phlegm (οἱ μὲν γὰρ ὑπὸ τοῦ φλέγματος μαινόμενοι) are distinguished from those who suffer from mania due to bile (οἱ δὲ ὑπὸ χολῆς).1343 The former are said to be quiet, they do not shout nor cause uproar (ἥσυχοί τέ εἰσι καὶ οὐ βοῶσιν οὐδὲ θορυβέουσιν), while the latter are said to be brawlers, malefactors and lacking in calm (κεκράκται καὶ κακοῦργοι καὶ οὐκ ἀτρεμαῖοι).1344 A very similar notion is also reflected in the “Hippocratic” letter De mania.1345 Aretaeus states that countless forms of mania do exist (μανίης τρόποι εἴδεσι μὲν μυρίοι) but they are one in genus (γένει δὲ μοῦνος εἷς).1346 Later in the chapter he associates one form with pleasure (ἡδονὴ) and the other with anger (ὑπὸ ὀργῆς ἐκμαίνονται).1347 The Anonymus Parisinus does not explicitly state that there is more than one form of mania but he distinguishes between those who are mad with cheerfulness (μετὰ ἱλαρότητος) and those who are mad with gloominess (μετὰ στυγνότητος).1348 In the passage of his De medicina which deals with the different kinds of insania (see p. 46 – 48), Celsus states that the third kind of insania (tertium genus insaniae), which probably corresponds to what in other texts is referred to as mania, has two forms (species duae sunt).1349 Some patients are said to be misled through images (imaginibus … falluntur), the others are said to have a deranged mind (animo desipiunt).1350 Caelius Aurelianus cites Plato’s account of mania as well as the Stoic account and that of the followers of Empedocles, who are all said to assume the existence of different forms of mania.1351 Later in the chapter, Caelius reports that mania (he uses the noun furor) may govern the mind through anger (iracundia), cheerfulness (hilaritate), sadness (maestitudine), falseness (vanitate) or through fear (timore).1352 For a closer look at sadness 1343 See Hippocrates, De morb. sacr. 15.1 (27.5 f. Jouanna = 6.388.12 f. L.). On this issue, see also Jouanna 2013, 98–100. I am grateful to Chiara Thumiger for this Hippocratic reference. 1344 See Hippocrates, De morb. sacr. 15.1 (27.6–9 Jouanna = 6.388.13–15 L.). 1345 See Hippocrates, De man. (62.5 f. Diels = 9.384.10 f. L.). On the two different versions of this letter, as discussed by Diels, see Diels 1918 [bibliographical information under Hippocrates, De mania]. 1346 See Aretaeus 3.6.1 (41.12 f. Hude). The statement that there are numberless forms of mania is repeated later in the chapter; see Aretaeus 3.6.5 (42.14 f. Hude). 1347 See Aretaeus 3.6.4 (42.9–12 Hude). 1348 See Anon. Par. 18.2.1 (114.6 f. Garofalo). 1349 See Celsus, De med. 3.18.19 (126.12–14 Marx). 1350 See Celsus, De med. 3.18.19 (126.14–16 Marx). 1351 See Caelius Aurel., Tard. pass. 1.144–146 (514.29–516.18 Bendz). 1352 See Caelius Aurel., Tard. pass. 1.150 (518.27–29 Bendz).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

349

and negative moods, on the one hand, and cheerfulness and the “positive mood” as parts of pathological conditions, on the other, see Thumiger 2017a, 361–370. p. 136.25–26: γέλως – ἄξια: The form of mania which is dealt with here occurs due to a great amount of blood. As we learn from the present sentence, it is accompanied by laughter, amongst other symptoms, and seems to correspond to the form of mania, which, in other texts, is said to go along with pleasure or joy or cheerfulness (see p. 348, commentary on p. 136.23–25). However, it needs to be highlighted that the “positive mood” of the patients is in itself already extreme, and therefore not a good sign. As Thumiger notes, “laughter is never positive in our sources [i.e. the “Hippocratic” sources]”.1353 Similarly, Aretaeus also reports that those whose mania is connected to pleasure (ἡδονή) laugh (γελᾶν).1354 The fact that the laughter is characterized as ἄσχετος in the present passage classifies it as “abnormal”, as something which cannot be controlled (the adjective is compounded from the ἀ-privativum and the verb ἔχειν, thus denoting “something which one cannot get hold or control of”). This adjective is used twice in Aretaeus’ chapter on mania, once to express the ungovernable desire for sexual pleasures (ἀφροδισίων δὲ ἄσχετος ἐπιθυμίη)1355 and once to show that the patients run around in an uncontrollable manner (οἱ μὲν θέουσι ἀσχέτως) and come back again without knowing how.1356 In our present passage, the passive construction αὐτοῖς κινεῖται underlines that the laughter overwhelms the patients. The images (εἴδωλα) that the patients see in front of their eyes seem to be intrinsically tied to the laughter; the participle θεωμένοις has causal force here, and explains that the laughter is set in motion, because the patients see images in front of their eyes, which are worth laughing at (γέλωτος ἄξια). The noun εἴδωλον describes false images here, that is to say appearances which are not actually there.1357 The appearance of images in front of the patient’s eyes is also mentioned in other texts as a symptom of mania: Aretaeus states that strange appearances occur (γίγνονται δὲ καὶ ἀλλόκοτοι φαντασίαι)1358 and later in the chapter he again states that images appear in front of the patient’s eyes (πρὸ τῶν ὀφθαλμῶν ἰνδάλματα).1359 As I have discussed above (see p. 348, commentary on p. 136.23–25), Celsus writes that some patients who suffer from the third kind of insania are misled by images (imaginibus … fallun-

1353 Thumiger 2017a, 366. According to Pseudo-Aristotle, Probl. 35.6 (965a14) “laughter is a form of derangement and fraud” (ἔστι δ’ ὁ γέλως παρακοπή τις καὶ ἀπάτη). 1354 See Aretaeus 3.6.4 (42.9 f. Hude): καὶ οἷσι μὲν ἡδονὴ ᾖ ἡ μανίη, γελῶσι, (…). 1355 See Aretaeus 3.6.10 (43.20 Hude). In the chapter on satyriasis, Aretaeus also uses the adjective ἄσχετος to highlight the uncontrollable desire for sex: see Aretaeus 2.12.1 (34.15 Hude). 1356 See Aretaeus 3.6.10 (43.23 f. Hude). 1357 One of the most prominent examples from ancient Greek literature is Euripides’ Helena. In this tragedy, Paris took an εἴδωλον of Helen to Troy, without knowing that it was not the actual Helen. See e.g. Euripides, Helena 34. 1358 See Aretaeus 3.6.5 (42.18 f. Hude). 1359 See Aretaeus 3.6.9 (43.15–17 Hude).

350 | Commentary

tur).1360 In Caelius’ account of mania, it is said that the patients are seized by an alienation of all senses (omnium sensuum alienatione).1361 In general, the appearance of images in front of a patient’s eyes is a recurring sign or symptom of certain affections which befall the brain and the senses.1362 On this issue, see, for example, Thumiger 2017a, 295–297. See also p. 319 f., commentary on p. 135.2–5. p. 136.26–27: φαιδρόν – πρόσωπον: The fact that the patient’s face is cheerful (φαιδρόν πρόσωπον) is another indicator that the form of mania which is discussed here is accompanied by cheerfulness (see p. 347 – 349, commentary on p. 136.23–25). p. 136.27: καὶ – συνεχῶς: The fact that patients who suffer from mania sing (ἄδουσιν) is also reflected in a later source, Paul of Nicea.1363 It recurs a few lines later in our chapter (see p. 351 f., commentary on p. 137.2–4). A connection between the previously mentioned laughter and singing is also suggested in some “Hippocratic” passages, albeit not in the context of mania.1364 p. 136.27–137.1: ἐνίοτε – συνεδρεύουσιν: The noun ἀναθυμίασις is a recurring term in ancient medical literature that is used to describe the rise of vapors, with the head or the brain often mentioned as parts of the body to which the vapors rise.1365 Vapors which are carried up to and affect the head or the brain were previously discussed in Aetius’ sixth book (see p. 281 – 283, commentary on p. 133.22–24, p. 296 – 298, commentary on p. 134.11–13). In the present context, we also need to understand the vapors as rising to the head or the brain, since the rise of vapors is connected to the occurrence of ringing in the ears (ἦχοι περὶ τὰ ὦτα). In the previous chapter on skotoma it is said that ringing in the ears occurs when warm and sharp vapors are carried up to the head and change the psychic pneuma in the brain (see p. 296 – 299, commentary on p. 134.11–13, p. 299 – 301, commentary on p. 134.13–14). Aretaeus also mentions that patients suffering from mania sometimes hear ringing in their ears and booming (ἦχοι ὤτων καὶ βόμβοι).1366 For further information on the usage of the verb συνεδρεύειν see p. 217, commentary on p. 129.6–7. p. 137.1–2: ὡς - ἀκροᾶσθαι: Introduced by the conjunction ὡς, this sub-clause deals with a consequence of the ringing in the ears that was mentioned in the main clause: the patients seem (δοκεῖν) to hear flute players (αὐλητῶν). The verb δοκεῖν is crucial in the present context, insofar as it highlights that there are actually no flute players. For a closer look at a passage in which the verb δοκεῖν has a similar impor1360 See Celsus, De med. 3.18.19 (126.14 f. Marx). 1361 See Caelius Aurel., Tard. pass. 1.151 (520.9 f. Bendz). 1362 Several different nouns are used in this respect, such as εἴδωλον, φάντασμα or ἴνδαλμα etc. See e.g. Galen, De sympt. caus. 1.2 (7.96.4–6 K.), Aetius Amid., Libri med. 6.24 (Vol. 2, 164.23 f. Olivieri), Aretaeus 5.1.1 (91.18 f. Hude). 1363 See Paul of Nicea 22 (82.9 Ieraci Bio). 1364 See Hippocrates, De morb. popul. 1.β’ (203.23–204.1 Kühlewein = 2.686.6 f. L.). See Thumiger 2017a, 366. 1365 See e.g. Galen, De loc. aff. 5.6 (8.342.15 K.), De loc. aff. 3.1 (8.137.15 K.), Aetius Amid., Libri med. 6.42 (Vol. 2, 185.4 f. Olivieri), Libri med. 6.9 (Vol. 2, 141.26 f. Olivieri). 1366 See Aretaeus 3.6.8 (43.10 Hude).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

351

tance, see p. 304 f., commentary on p. 134.16–17. In the present passage it seems that the patients interpret the ringing in their ears as the sound of a flute. In Aretaeus’ chapter on mania, we find the same connection between ringing in the ears and the sound of musical instruments. Aretaeus states here that some patients suffer from ringing and booming in the ears, “even up to the sound of trumpets and flutes” (μέχρι δή γε σαλπίγγων τε καὶ αὐλῶν).1367 The fact that patients who are deranged in their minds hear flute players that are not actually there, is a common sign of mental disturbance. In his De symptomatum differentiis, Galen discusses as an example of damage to the imaginative capacity (φανταστικὴ ἐνέργεια) the story of Theophilus;1368 Theophilus was still able to communicate reasonably (σωφρόνως ὑπῆρχε διαλέγεσθαί) with the attendees and to recognize them (γνωρίζειν ἀκριβῶς τοὺς παρόντας), but a consequence of the damage was that he thought flute players were occupying the corner of his room and constantly playing the flute; he even screamed at them and told them to leave the house.1369 In this passage, Galen uses verbs such as νομίζειν and οἴεσθαι, which express belief, in order to emphasize that the flute players are a mere illusion and not reality. The verb δοκεῖν is used in the present passage along these same lines. In In Hippocratis Prorrheticum I commentaria III, Galen tells us a similar story when stating that patients suffering from phrenitis hear flute players that are not there, and he connects this to a damaged sense of hearing (ἀκουστικὴ αἰσθησις).1370 p. 137.2–4: σῴζεται – λογιστικόν: The statement that the patient’s memory is preserved (σῴζεται δ’ αὐτοῖς ἡ μνήμη) but that imagination and reasoning are harmed (βέβλαπται δὲ τὸ φανταστικὸν καὶ τὸ λογιστικόν) reminds us of Aetius’ chapter on phrenitis, where these issues were discussed using very similar phrases (such as βλάπτειν, σῴζεσθαι, φανταστικὸν, λογιστικόν, μνήμη). For more detail see p. 166 f., commentary on p. 125.9–10 and p. 167 f., commentary on p. 125.10–15. Given that the chapter on phrenitis was claimed to be taken from Posidonius (see p. 125.4), these parallels speak in favor of the assumption that the present section might also be derived from Posidonius, who is, together with Archigenes, claimed as the source for the present chapter on mania (see p. 342, commentary on p. 136.18). In the present chapter, no further explanation is provided as to how one should conceive of an affection of the imaginative faculty, the reasoning faculty and memory. In the chapter on phrenitis, it was said that those whose imaginative faculty is affected, “see obscure things in front of their eyes” (p. 125.21: φαντάζονται δὲ ἀλλόκοτα) and those whose reasoning faculty is affected, “do not judge correctly” (p. 125.22: κρίνουσι δὲ οὐκ ὀρθῶς). For a detailed discussion of the functions of the imaginative faculty, the reasoning faculty and the recollective faculty see p. 171 – 1367 See Aretaeus 3.6.8 (43.10 Hude). 1368 See Galen, De sympt. diff. 3.9 (224.9 f. Gundert = 7.60.3 f. K.). 1369 See Galen, De sympt. diff. 3.11 (224.18–226.5 Gundert = 7.60.14–61.5 K.). 1370 See Galen, In Hipp. Prorrh. comm. 1.27 (40.20–23 Diels = 16.565.15–18 K.). See on this issue also Gundert 2009 in Galeni De symptomatum differentiis, 296.

352 | Commentary

174, commentary on p. 125.20–24. The fact that patients suffering from mania were said to see amusing images (εἴδωλά τινα) in front of their eyes (see p. 349 f., commentary on p. 136.25–26), might be one example of damage to the imaginative faculty, and the laughter and the constant singing (see p. 350, commentary on p. 136.27) may be examples of the impaired reasoning faculty. As far as the preservation of memory is concerned, the present passage claims to present a proof: the patients sing what they are accustomed to sing (ᾄδουσι συνήθη αὐτοῖς ὄντα). The underlying assumption is presumably that the patients would not be able to sing customary tunes if their memory was not intact as they would not be able to remember them. The phrase τεκμαίρεσθαι ἔκ τινος is commonly used in medical texts to express that something can be judged or inferred from another thing.1371 p. 137.4–5: μιχθείσης – ἀποτελεσάσης: The genitive absolute refers back to p. 136.21, where it is said that the blood, which causes mania, may be full of yellow bile (ποτὲ δὲ ξανθοχόλου). This was discussed as one of two possible characteristics of the blood in the context of it causing mania. The symptoms which can be observed in patients suffering from the form of mania, which is brought about by a great amount of blood, were discussed previously (see p. 347 – 349, commentary on p. 136.23–25). The following lines discuss the symptoms which can be observed in the second form of mania, brought about by blood mixed with yellow bile. The statement that yellow bile causes the blood it is mixed with to become biting (καὶ δακνῶδες αὐτὸ ἀποτελεσάσης), suggests that yellow bile is thought to have a biting property, a notion that is also reflected in other texts.1372 Interestingly, Galen’s De symptomatum causis claims that mania may occur due to “biting and warm humors” (τοῖς δακνώδεσι καὶ θερμοῖς ἑπόμεναι χυμοῖς), of the kind that yellow bile (τῆς ξανθῆς χολῆς) particularly exemplifies (see p. 345, commentary on p. 136.21).1373 The biting property of yellow bile is worth mentioning in connection with mania, and it may even be the case that the nature of the symptoms that follow in the text can be explained by reference to this biting property. For further discussion of words denoting wildness in the context of affections, see Jouanna 2012a. p. 137.5–6: οἷον – μηνίγγων: This metaphor, introduced by οἷον, is understood by reference to the adjective δακνῶδες, which was used to characterize the blood after it has been mixed with yellow bile (see p. 352, commentary on p. 137.4–5). The phrase ἐξ αὐτῆς refers to the yellow bile, the substance which, according to the metaphor, “pricks” (κεντουμένου) and “stabs” (νυττομένου) the brain and the meninges, presumably on account of its biting property (p. 137.4: δακνῶδες). The notion that yellow bile may cause a feeling of pricking or stabbing is also reflected 1371 See e.g. Galen, Meth. med. 8.7 (426.9 f. Johnston & Horsley = 10.583.11 f. K.), Aetius Amid., Libri med. 3.163 (Vol. 1, 334.22 f. Olivieri), Aetius Amid., Libri med. 9.35 (361.21 f. Zervos). 1372 See e.g. Pseudo-Galen, Def. med. 65 (19.364.1 f. K.), Galen, De comp. med. sec. loc. 2.1 (12.538.18– 539.1 K.), De sympt. caus. 2.7 (7.202.6–8 K.), De alim. fac. 1.1 (13.17–18 Wilkins = 6.467.2 f. K.). 1373 See Galen, De sympt. caus. 2.7 (7.202.6–8 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

353

in other passages.1374 In Aetius’ eighth book, it is explicitly said that a pricking pain (τὸ νυγματῶδες ἄλγημα) accompanies yellow bile.1375 In general, the idea that a biting substance (such as yellow bile in our passage) may cause the feeling of pricking or stabbing is reflected in a number of other passages. In Galen’s De symptomatum causis, for example, it is said that patients feel that they are stabbed (νύττεσθαι) by many spines which are stuck in them and this occurs because biting moisture (δακνώδους … ὑγρότητος) has brought about the symptoms.1376 In another passage of the same work, we find that the stomach is irritated and pricked (κεντουμένης) as by something biting (ὡς ὑπὸ δάκνοντος).1377 In our passage, the brain and the meninges are said to be pricked and stabbed, which shows that the brain is the part to which the blood, which occasions mania, must flow (see p. 343, commentary on p. 136.19). As far as the meninges are concerned, according to Galen’s De usu partium, because the brain and the skull (κρανίου) are far different in their substances (πόρρω ταῖς οὐσίαις διεστηκότων), nature placed two meninges (i.e. ἡ παχεῖα μῆνιγξ and λεπτὴ μῆνιγξ, that is Dura mater and Pia mater) between brain and skull.1378 These are referred to as covering (σκέπασμα) and protective barrier (ἀμυντήριόν τι πρόβλημα) of the brain.1379 The adverb ἔνδοθεν emphasizes the fact that the pricking and stabbing comes from inside, because the blood, which is mixed with yellow bile is, thus, biting, resides in the brain and there is no external cause responsible for the sensations. It is important to keep in mind that the whole genitive absolute is a metaphor; when the blood mixed with yellow bile enters the brain, it is as if it is pricked and stabbed. The pricking and stabbing effect of the yellow bile literally goads the patients, as is clear from the kind of symptoms which are said to afflict those who suffer from this form of mania (see p. 353 f., commentary on p. 137.6–7, p. 354 f., commentary on p. 137.7–8, p. 355 f., commentary on p. 137.9). Given that pricking and stabbing are corrosive actions, it is reasonable to think of corrosive symptoms as a consequence of this effect of yellow bile. p. 137.6–7: ὀργίλοι – ὑβρισταί: These lines begin the discussion of the behavior of the patients who suffer from the second form of mania. For a closer look at these two forms and their general characteristics, see p. 348 f., commentary on p. 136.23– 25. The following behavior contrasts with that described in relation to the first form of mania.

1374 See e.g. Paul 2.18 (Vol. 1, 98.18–20 Heiberg), Oribasius, Synops. ad Eustath. 6.9.1 (190.13–16 Raeder), Aetius Amid., Libri med. 5.79 (Vol. 2, 56.11–14 Olivieri). 1375 See Aetius Amid., Libri med. 8.34 (Vol. 2, 447.24 f. Olivieri). 1376 See Galen, De sympt. caus. 2.5 (7.178.16–18 K.). 1377 See Galen, De sympt. caus. 3.5 (7.236.4 f. K.). 1378 See Galen, De usu part. 8.9 (Vol. 1, 478.14–17 Helmreich = 3.659.12–14 K.). For a closer look at the terms dura mater and pia mater, see Strohmaier 1970. 1379 See Galen, De usu part. 8.9 (Vol. 1, 478.3–7 Helmreich = 3.659.1–5 K.).

354 | Commentary

The adjective ὀργίλος (inclined to anger) is also used twice to characterize the patients in Aretaeus’ chapter on mania.1380 In Caelius Aurelianus’ account of mania, it is said that mania may govern the mind through anger (iracundia).1381 The second adjective, θρασύς (bold), which is used to describe the patients in the present passage is to be found in close connection with ὀργίλος in other writings as well:1382 in the pseudo-Galenic De humoribus it is explicitly said that yellow bile makes the soul more inclined to anger or bolder or fiercer or both (ἡ δὲ ξανθὴ ὀργιλωτέραν ἢ θρασυτέραν ἢ γοργοτέραν ἢ καὶ ἀμφότερα).1383 This account clearly corresponds to our present passage, which assumes that yellow bile is the reason for the occurrence of this kind of behavior. As far as the noun πλήκτης (brawler) is concerned, it is interesting that the reading of one manuscript, which contains the pseudo-Hippocratic letter De mania, transmits the noun πλῆκται in a list of symptoms which can be observed in those who suffer from mania because of bile (ὑπὸ χολῆς).1384 In the pseudo-Galenic Introductio it is stated that yellow bile is the cause of mania and patients, therefore, cause disturbance (ταραχώδεις), are extroverted (ἔκφοροι) and ordinary insolent men (πρόχειροι ὑβρισταί).1385 p. 137.7–8: ἐφ’ ὅσον – θυμικά: This sentence puts the previously given information about the blood, which is mixed with yellow bile, in an explicitly quantitative relation by using the correlative phrase ἐφ’ ὅσον … ἐπὶ τοσοῦτον. The phrase τὰ τερπνὰ presumably refers to the first form of mania, which does not involve bile (see p. 343 f., commentary on p. 136.20–21), and which was said to be accompanied by symptoms such as laughter and singing (see p. 349 f., commentary on p. 136.25–26, p. 350, commentary on p. 136.27). The more bile is in the blood, the more are increased the unpleasant (τὰ ἀηδῆ) and high-spirited (θυμικά) aspects of the affection. This sentence builds on the remarks that yellow bile has a biting property (see p. 352, commentary on p. 137.4–5), that it causes the brain and the meninges to be as if they were “pricked” and “stabbed” (see p. 352 f., commentary on p. 137.5–6), and that it makes the patients inclined to anger, bold, and that they turn into brawlers and insolent men (see p. 353 f., commentary on p. 137.6–7). Bile (χολή) is clearly said to be the cause of an alteration of pleasures, and of an increase in unpleasantness. This statement reflects an idea which is very old, going back as far as the Homeric epics. One exemplary passage is found in the Ilias, where we read that “Hera could not hold her anger in her chest” (Ἥρῃ δ’ οὐκ ἔχαδε στῆθος χόλον);1386 the noun that

1380 See Aretaeus 3.6.3 (41.27 Hude) and 3.6.8 (43.5 Hude). 1381 See Caelius Aurel., Tard. pass. 1.150 (518.28 Bendz). 1382 See e.g. Galen, In Hipp. Aph. comm. 4.2 (17b.659.17 K.), Aetius Amid., Libri med. 6.9 (Vol. 2, 144.31 Olivieri), Alexander, Therapeutica 1.13 (616.22 Guardasole = Vol. 1, 511.5 Puschmann). 1383 See Pseudo-Galen, De hum. 9 (12.2 f. Schmidt = 19.492.17 f. K.). 1384 See Diels’ critical apparatus to p. 62.8 in Hippocrates, De man. On this letter, see also note 1345. 1385 See Pseudo-Galen, Introd. s. medic. 13.24 (57.11 f. Petit = 14.740.17 f. K.). 1386 See Homer, Ilias 4.24, Ilias, 8.461.

VI 8 On mania from (the books of) Archigenes and Posidonius |

355

is used here (and in other verses)1387 to describe the anger is the Greek χόλος. For a more detailed discussion of the history of bile, see, for example, Müri 1953; Kudlien 1967, 77–88. It is noteworthy that in our text the adjective θυμικόν is used in the context of the effect bile has on the patient. Given that θυμικόν may be used as a synonym for θυμοειδές,1388 which Plato uses to refer to the spirited part of the soul,1389 one may wonder whether the author of the present passage had this Platonic theory of the three parts of the soul in mind when writing the text. Certainly, the connection must have occurred to at least some ancient readers. A similar connection between θυμοειδές and χόλος is suggested by Chrysippus in a passage that is also cited in Galen’s De placitis Hippocratis et Platonis.1390 Galen reports Chrysippus’ use of the previously discussed Homeric verse (Ἥρῃ δ’ οὐκ ἔχαδε στῆθος χόλον) to put forward the assumption that Homer located the “spirited part of the soul” (τὸ θυμοειδὲς) in the heart. In his comment on Chrysippus’ citation, Galen explains that Chrysippus is indicating that he understands anger (χόλος) as an affection (πάθος) of the “spirited power” (δυνάμεως … τῆς θυμοειδοῦς).1391 One cannot deny that a similar understanding of the effect that bile has on the patient is also present in our text but, while this is certainly suggestive, it does not prove that the author also had the Platonic tripartition of the soul in mind. p. 137.9: ὑπεροπτωμένης – παχυνομένης: In a chapter of Paul’s compilation which deals with melancholia, mania, and “the inspired”, it is said that when yellow bile is overheated (τῆς ξανθῆς χολῆς ὑπεροπτηθείσης) and a change into black bile occurs (εἰς μέλαιναν ἡ μεταβολὴ), this brings about the so-called mania (τὴν καλουμένην μανίαν).1392 It is further stated that people suffering from mania do so in a beast-like manner (θηριωδῶς).1393 This is very similar to what we read in our text and also connects with the claim a few lines further down that the overheating of yellow bile causes beast-like derangement (p. 137.11–12: τὰς θηριώδεις παραφροσύνας). See also p. 357, commentary on p. 137.11–12. For a closer look at the relation between the compilers, see p. 33 – 35. In Alexander’s Therapeutica, it is said that a form of phrenitis, which is called beast-like (θηριώδης), is brought about when yellow bile is overheated (αὐτῆς τῆς ξανθῆς χολῆς ὑπερθερμανθείσης καὶ ὑπεροπτηθείσης).1394 In Aetius’ subsequent chapter on melancholia, the overheating of yellow bile (ἐξ ὑπεροπτήσεως τῆς ξανθῆς χολῆς) is also mentioned and connected to the occurrence of derangement.1395 This derangement, which is occasioned by yellow

1387 1388 1389 1390 1391 1392 1393 1394 1395

See e.g. Homer, Ilias, 9.646, Ilias, 4.42, Odyssea 4.583. See e.g. Aristotle, De anima 9 (432a25). See e.g. Plato, Resp. 4 (441a1–3), Resp. 4 (441e4–6). See Galen, De plac. Hipp. et Plat. 4.1.10 (236.9–11 de Lacy = 5.363.5–8 K.). See Galen, De plac. Hipp. et Plat. 4.1.12 (236.26–28 de Lacy = 5.364.6–9 K.). See Paul 3.14.1 (Vol. 1, 157.1–3 Heiberg). See Paul 3.14.1 (Vol. 1, 157.3 Heiberg). See Alexander, Therapeutica 1.13 (616.12–14 Guardasole = Vol. 1, 509.21–23 Puschmann). See Aetius Amid., Libri med. 6.9 (Vol. 2, 144.30 Olivieri).

356 | Commentary

bile, is further said to cause the patients to become bolder (θρασύτεροι) and more inclined to anger (ὀργιλώτεροι) and to turn them into brawlers (πλῆκται).1396 See also p. 448, commentary on p. 144.29–145.1. These lines from Aetius’ subsequent chapter share three similarities with our text: first, they use the verb ὑπεροπτᾶσθαι or the cognate ὑπερόπτησις; secondly, they use the same adjectives (p. 137.6–7; see p. 353 f., commentary on p. 137.6–7); and thirdly, they mention the noun παραφροσύνη (p. 137.11–12; see p. 357, commentary on p. 137.11–12). The same notion is also reflected in Galen’s De locis affectis, where it is said that beast-like (θηριώδης) and melancholic (μελαγχολικὴ) derangement occurs when yellow bile is overheated (κατοπτηθείσης τῆς ξανθῆς χολῆς).1397 We also find a similar statement in Galen’s In Hippocratis Prorrheticum I commentaria III, where a beast-like melancholic distraction of the mind (μελαγχολικὴν ἔκστασιν […] θηριώδη) is said to occur when yellow bile is overheated (ξανθῆς χολῆς κατοπτηθείσης).1398 A number of other texts suggest a connection between mania and heat (see p. 343, commentary on p. 136.19). According to the Anonymus Parisinus, Diocles said that mania is a boiling (ζέσιν) of blood in the heart and that this is clear from customary language, because one says that those suffering from mania “are in a state of heat” (τεθερμάνθαι).1399 The Anonymus Parisinus also reports that Hippocrates held that mania occurs when the intellectual pneuma in the head “is mixed with bile and heated” (πύρωσιν).1400 Aretaeus states that people who are of an age in which there is much heat and blood (τὸ θερμὸν καὶ αἷμα πουλὺ) are prone to suffer from mania.1401 p. 137.10–11: καὶ οἷον – διασπώσης: Embedded in the genitive absolute here is a metaphor (introduced by οἷον), the aim of which is to illustrate the effect of yellow bile on the brain. A very similar metaphor appears earlier in the text, also in reference to yellow bile (see p. 352 f., commentary on p. 137.5–6). The expression προσπλάττεσθαι ἰξωδῶς is supposed to highlight the intense way in which the yellow bile adheres to the brain and the meninges. It is also used in Aetius’ ninth book, where it characterizes the way in which a bad humor, which brings about nausea (αἱ ναυτίαι), is attached to the membrane of the stomach and is hard to tear away (δυσαποσπάστως).1402 In Galen’s œuvre, the phrase σῶμα τοῦ ἐγκεφάλου (“body of the brain”) seems to be used “to refer to the brain excluding the ventricles and the cra-

1396 See Aetius Amid., Libri med. 6.9 (Vol. 2, 144.31 Olivieri). 1397 See Galen, De loc. aff. 3.9 (8.178.5–7 K.). 1398 See Galen, In Hipp. Prorrh. comm. 1.14 (30.17 f. Diels = 16.545.1–3 K.). 1399 See Diocles fr. 74.5–8 van der Eijk, Anon. Par. 18.1.2 (112.21–114.1 Garofalo). I quote van der Eijk’s translation of τεθερμάνθαι here. 1400 See Anon. Par. 18.1.3 (114.2–4 Garofalo). 1401 See Aretaeus 3.6.3 (41.31–42.1 Hude). 1402 See Aetius Amid., Libri med. 9.10 (288.27–29 Zervos). See also Dioscorides, De mat. med. 1.97.3 (Vol. 1, 88.14–16 Wellmann).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

357

nial nerves”.1403 On various occasions, he states that one should assume that the soul resides in the body of the brain.1404 For a closer look at the term μήνιγγες, see p. 353, commentary on p. 137.5–6. Given that τῶν μηνίγγων is a genitive, it should be understood as also referring to αὐτῷ τῷ σώματι. There is at least one other passage in the medical literature in which the phrase τὸ σῶμα τῆς μήνιγγος is used.1405 We should probably understand this as denoting the actual substance of the meninges. The verb νύττειν was also used in the previous metaphor (for further discussion, see p. 352 f., commentary on p. 137.5–6). In Galen’s De locis affectis, the verb διασπᾶν is used to describe a certain type of pain (διασπῶντας πόνους) which is said to be labeled as such by Archigenes.1406 It is interesting in this regard that the present chapter is claimed to be taken from Archigenes and Posidonius, although this alone is not sufficient for an ascription of the current passage to Archigenes to be secure. p. 137.11–12: τὰς – ἐργάζεται: I have already dealt with parallel passages in which an overheating of yellow bile is also connected to the occurrence of beast-like (θηριώδες) behavior (p. 355 f., commentary on p. 137.9). The “stabbing” and “pricking” of the yellow bile obviously goads the patients to becoming beast-like. See also p. 352 f., commentary on p. 137.5–6. The following lines illustrate how one should conceive of “beast-like derangement”. See p. 357 f., commentary on p. 137.12–13. p. 137.12–13: ἤδη – διεχειρίσαντο: These lines illustrate what one should understand by the phrase τὰς θηριώδεις παραφροσύνας (beast-like derangement). On this phrase, see p. 357, commentary on p. 137.11–12. The patients are said to taste their own flesh (τῆς ἰδίας σαρκὸς ἐγεύσαντο), and to beat (ἐτύπτησαν) or wound (ἐτραυμάτισαν) or lay hands on (διεχειρίσαντο) the people in their house as if these were plotting against them (τοὺς οἰκείους ὡς ἐπιβούλους). The similarity to a wild animal (θηρίον), which is suggested by the use of the adjective θηριώδεις, presumably lies in the acts of beating and wounding and acting against one’s own people, a behavior that can be ascribed to animals rather than to humans. This kind of behavior of patients suffering from mania is also dealt with in other texts; Aretaeus states that those who are suffering from mania through anger (ὑπὸ ὀργῆς ἐκμαίνονται) rip up their clothes (ἐσθῆτάς τε ἐρρήξαντο), kill their attendants (θεράποντας ἀπέκτειναν) and lay hands on themselves (ἑωυτέοισι χεῖρας ἐπήνεγκαν).1407 Paul says that those who suffer from mania in a beast-like manner (θηριωδῶς; see p. 355, commentary on p. 137.9) carelessly lay hands on those who come near them (τοὺς ἀμελέστερον

1403 Rocca 2003, 258. See e.g. Galen, De loc. aff. 4.3 (8.232.3–7 K.), De plac. Hipp. et Plat. 7.3.20–21 (444.2–6 de Lacy = 5.606.4–8 K.). See e.g. also Alexander, Therapeutica 1.17 (Vol. 1, 595.3 Puschmann). 1404 See e.g. Galen, De loc. aff. 3.9 (8.174.16–18 K.), De plac. Hipp. et Plat. 7.3.21 (444.4–6 de Lacy = 5.606.7 f. K.). 1405 See Galen, De anat. admin. 9.1 (Vol. 2, 555.23 f. Garofalo = 2.711.12 f. K.). 1406 See Galen, De loc. aff. 2.8.2 (330.13 Gärtner = 8.91.8 K.). 1407 See Aretaeus 3.6.5 (42.12–14 Hude).

358 | Commentary

προστυγχάνοντας αὐτοῖς διαχειρίζεσθαι).1408 The Anonymus Parisinus mentions that some mania patients maltreat themselves in several ways (ἑαυτοὺς ἔσθ’ ὅτε λωβᾶσθαι ποικίλως).1409 Aretaeus, furthermore, deals separately with a special form of mania (μανίης εἶδος ἕτερον), which is said to consist in the fact that the patients cut off their limbs as if they thus gratify the gods.1410 This mania is characterized as being “divine” (ἔνθεος).1411 Also noteworthy is a passage from Aristotle’s Ethica Nicomachea, in which he deals with beast-like (θηριώδεις) conditions, mentioning those which occur due to diseases (αἳ δὲ διὰ νόσους γίνονται) or mania (καὶ διὰ μανίαν ἐνίοις).1412 He provides there the example of a person who sacrificed his mother and ate her, as well as another example of someone who ate the liver of his fellowslave.1413 All these passages deal with the violent behaviour of the patients, which is directed either at themselves or at other people, especially those who are familiar. The expression ὡς ἐπιβούλους in the present passage illustrates that the patients act against intimates as if these were plotting against them, that is to say as if there was a concrete reason for their behavior. One should, presumably, assume that the patients’ beliefs are a result of their deranged imaginative and reasoning faculty (see p. 351 f., commentary on p. 137.2–4). In a passage of Galen’s In Hippocratis Prorrheticum I commentaria III we read that beast-like derangements (θηριώδεις … παραφροσύνας) are those in which the patients eat and kick and bite and provoke those who enter, because they think that these are plotting against them (ὡς ἐπιβούλους τοὺς εἰσιόντας νομίζοντες).1414 The use of the verb νομίζειν clearly suggests that the patients indeed believe that someone wishes them harm. p. 137.14–15: ἐγχωρεῖ – ὀργαῖς: These lines aim to assert that one and the same person (τὸν αὐτὸν ἄνθρωπον) can be seized by two different forms of mania. The correspondent ποτὲ μὲν and ποτὲ δὲ thus acknowledge that at one time one form of mania prevails, at other times the other. For further discussion of the fact that mania may have different forms, see p. 347 – 349, commentary on p. 136.23–25. The phrase γέλωτι παραλόγῳ obviously refers to γέλως ἄσχετος, which was mentioned as a symptom of the form of mania which occurs due to blood alone (see p. 349 f., commentary on p. 136.25–26). The nouns θυμοῖς and ὀργαῖς refer to the adjectives ὀργίλοι (p. 137.6) and θυμικά (p. 137.8), which, amongst others, were used to describe the form of mania that occurs when yellow bile is mixed with the blood (see p. 352, commentary on p. 137.4–5, p. 353 f., commentary on p. 137.6–7, p. 354 f., commentary on p. 137.7–8).

1408 See Paul 3.14.1 (Vol. 1, 157.3 f. Heiberg). 1409 See Anon. Par. 18.2.1 (114.8 Garofalo). 1410 See Aretaeus 3.6.11 (43.30 f. Hude). 1411 See Aretaeus 3.6.11 (44.2 Hude). 1412 See Aristotle, Eth. Nic. 7.5 (1148b24 f.). 1413 See Aristotle, Eth. Nic. 7.5 (1148b25–27). 1414 See Galen, In Hipp. Prorrh. comm. 1.25 (39.5–7 Diels = 16.562.11–13 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

359

p. 137.15–18: ἐν γὰρ – αἷμα: Given that this sentence is introduced by the particle γὰρ, it should be understood as providing an explanation for the previously discussed fact that one and the same patient can be seized by different forms of mania (see p. 358, commentary on p. 137.14–15). This explanation may have been deemed appropriate because each form is said to be brought about by different mixtures of the blood (see p. 343 f., commentary on p. 136.20–21, p. 345, commentary on p. 136.21), and this calls for additional information as to how the symptoms of both of these forms still can occur in one and the same patient. An answer to this question seems to lie in the assumption that the mixture of the blood may change in accordance with certain conditions of the body or the food; the first half of the sentence (p. 137.15–17) thus describes the conditions under which the blood becomes sharper than it usually is (δριμύτερον ἑαυτοῦ), the second half of the sentence (p. 137.17–18) deals with the condition under which the blood becomes milder (ἠπιώτερον). Both parts of the sentence correspond to one of the two previously mentioned groups of symptoms (see p. 358, commentary on p. 137.14–15). Yellow bile, which, when mixed with the blood, causes the form of mania accompanied by passions and anger (θυμοῖς καὶ ὀργαῖς) and the like (see p. 353 f., commentary on p. 137.6–7, p. 354 f., commentary on p. 137.7–8), and is said to make the blood biting (δακνῶδες; see p. 352, commentary on p. 137.4–5). Given this, it is reasonable to assume that those conditions which cause the blood to become sharper are thought to occasion passions and anger, since the adjectives δακνῶδες (biting) and δριμύ (sharp) are generally understood as being comparable.1415 On the other hand, those conditions which are said to make the blood milder are thought to bring about unreasonable laughter, because it is a symptom of the form of mania which is brought about by a great amount of well-tempered blood (see p. 343 f., commentary on p. 136.20–21). The statement that sharper (δριμυτέραις) and saltier (ἁλυκωτέραις) food1416 causes the blood to become sharper is easily understood; it is far less clear in what way abstinence from food (ἀσιτία), movement (κίνησις), and disturbance (ταραχή) may cause the blood to become sharper. According to Galen’s De venae sectione adversus Erasistrateos Romae degentes, abstinence from food causes the blood to become dry and thicker (παχύτερον ἑαυτοῦ).1417 Although this statement does not describe the idea of the blood becoming sharper, it does clearly show that abstinence from food may change the mixture of the blood. Galen also uses the genitive of comparison ἑαυτοῦ, which refers to the blood. The reflexive pronoun of the third person is commonly used in comparisons to express the “usual” point of refer-

1415 See e.g. Galen, De alim. fac. 1.1 (13.17 f. Wilkins = 6.467.3 K.), Meth. med. 6.3 (144.19 f. Johnston & Horsley = 10.402.14 K.), Alexander, Therapeutica 8.2 (Vol. 2, 367.19 Puschmann). 1416 For other passages which suggest a rough comparability of sharp and salty, see e.g. Galen, De loc. aff. 5.5 (8.337.7 K.), De alim. fac. 2.3 (93.23 f. Wilkins = 6.561.14 f. K.), Aetius Amid., Libri med. 16.112/121 (526.23 f. Romano = 158.16 Zervos). 1417 See Galen, De venae sect. adv. Erasistrateos 3 (11.205.1 f. K.).

360 | Commentary

ence.1418 According to Alexander’s Therapeutica, patients suffering from colic become bad-tempered (δύσκρατοί) and sharper (δριμύτεροι γίνονται) when they do too much bodily exercise (ἐπειδὰν ἐπὶ πλέον τοῖς γυμνασίοις χρήσωνται).1419 A similar notion presumably underlies the present statement, according to which movement and disturbance cause the blood to become sharper. The phrase ἐν δὲ τῇ ἐναντίᾳ refers to the opposite conditions, that is to say, to eating in contrast to abstinence from food (ἐν … ταῖς ἀσιτίαις), to eating milder and sweeter food in contrast to eating sharper and saltier food (ταῖς δριμυτέραις καὶ ἁλυκωτέραις τροφαῖς), and to moderate movements and disturbances in contrast to greater movements and disturbances (ἐν ταῖς πλείοσι κινήσεσι καὶ ταραχαῖς). Given that the form of mania, which is said to bring about unreasonable laughter, is occasioned by a great amount of well-tempered blood (see p. 343 f., commentary on p. 136.20–21), we presumably need to assume that the comparative ἠπιώτερον does not refer to a mixture of the blood which is milder than usual, since such a mixture would not be well-tempered anymore. Rather, I suggest that the comparative is used in reference to the first half of the sentence, and points to a mixture, which is milder than the previously mentioned sharper mixture. p. 137.18–21: πολλάκις – γίγνεται: This sentence deals with a period of time that is free from derangement (διάλειμμα καθαρὸν τῆς ἐκστάσεως). The genitive absolutes present the conditions under which such a period of time may occur. The noun ἔκστασις is used in other texts to define mania. Aretaeus, for example, states that mania is a chronic derangement (ἔκστασις) without fever;1420 in the pseudoGalenic Definitiones medicae, mania is characterized as a derangement of thinking (ἔκστασις τῆς διανοίας);1421 and the same notion is also reflected in the pseudoGalenic Introductio sive medicus.1422 In the present passage, ἔκστασις also seems to refer to mania in general. For further discussion of the possibility that one may also observe phases of intermissions in patients suffering from mania, see p. 361 – 363, commentary on p. 137.21–23. The first genitive absolute καὶ μηδενὸς βοηθήματος προσαχθέντος ταῖς ὀλιγοσιτίαις is difficult to understand. The noun ὀλιγοσιτία reminds us of the previously used ἀσιτία (see p. 359 f., commentary on p. 137.15–18) but it remains unclear how one should conceive of the relation between the previous and the present sentence. While ἀσιτία describes the complete abstinence from food, the noun ὀλιγοσιτία

1418 See Galen, De sympt. caus. 1.5 (7.110.11 K.), De temp. 3.4 (106.25 f. Helmreich = 1.680.1 f. K.), Oribasius, Coll. med. rel. 7.2.3 (Vol. 1, 195.24 Raeder), Aetius Amid., Libri med. 8.21 (Vol. 2, 431.18 Olivieri). 1419 See Alexander, Therapeutica 8.2 (Vol. 2, 371.4 f. Puschmann). 1420 See Aretaeus 3.6.1 (41.13 Hude). 1421 See Pseudo-Galen, Def. med. 246 (19.416.7 K.). 1422 See Pseudo-Galen, Introd. s. medic. 13.24 (57.6 f. Petit = 14.740.16 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

361

describes the eating of a little food.1423 Eating only a little food is frequently treated in the medical literature as an appropriate remedy for a number of affections1424 but, in the present passage, it rather seems to describe the opposite, namely a condition which has to be acted against. It is, thus, presumably in line with the previous sentence, in which abstinence from food (ἀσιτία) was also not dealt with as part of therapy but was said to cause the blood to become sharper than usual (see p. 359 f., commentary on p. 137.15–18). The first genitive absolute, however, states that “no remedy or help is applied to eating only little food” (although it might be harmful for the patients, if my interpretation is correct). However, in the second genitive absolute, ἐπιτηδείαις τροφαῖς ἀναλωθέντος τῷ χρόνῳ τοῦ παρενοχλοῦντος, we learn that eating appropriate food (ἐπιτηδείαις τροφαῖς) is beneficial, for it “eats up” (ἀναλωθέντος) that which causes trouble (τοῦ παρενοχλοῦντος). The verb ἀναλίσκειν seems to point to the elimination of what causes trouble; interestingly, it is occasionally used to denote the consumption of nourishment1425 and such a meaning fits perfectly with the fact that, in the present passage, it is indeed the eating of suitable food, which eliminates that which causes trouble; the troublesome is, thus, literally “eaten up”. The verb παρενοχλεῖν is also used in other texts to refer to things such as humors which cause trouble, in the sense of bringing about an affection or symptoms.1426 It is used in the same way a few lines later in the present chapter (see p. 362 f., commentary on p. 137.21–23). In the present passage, the τοῦ παρενοχλοῦντος presumably refers either to yellow bile, which, when mixed with blood, was said to be the cause of the second form of mania (see p. 345, commentary on p. 136.21), or to the sharpness of the blood, which, according to the previous two sentences, can bring about the same symptoms as yellow bile (see p. 359 f., commentary on p. 137.15–18). If these are eliminated through suitable food, the patient may be free of derangement for a certain amount of time. The third genitive absolute μένοντος τοῦ ἐγκεφάλου ἀπερίττου seems to refer to the first form of mania, which was said to be brought about by an excess of well-tempered blood (see p. 343, commentary on p. 136.19). If there is no such excess of blood, that is to say, if the brain is without superfluity (ἀπέριττον), a period of time occurs which is free of derangement. p. 137.21–23: τισὶ – ἐνοχλοῦντος: Taking up what was said in the preceding sentence about a time interval that is free from derangement (see p. 360 f., commen-

1423 See e.g. Galen, Meth. med. 4.6 (436.12 f. Johnston & Horsley = 10.288.2 f. K.), De venae sect. adv. Erasistrateos 8 (11.240.4 K.), De comp. med. sec. loc. 8.1 (13.124.5 K.), Paul 3.71.3 (Vol. 1, 289.9 Heiberg). 1424 See e.g. Galen, Meth. med. 4.6 (436.12 f. Johnston & Horsley = 10.288.2 f. K.), Paul 3.28.2 (Vol. 1, 206.20–22 Heiberg), Aetius Amid., Libri med. 8.57 (Vol. 2, 500.10 f. Olivieri). 1425 See e.g. Galen, De usu part. 16.14 (Vol. 2, 434.10 f. Helmreich = 4.341.12 f. K.), De venae sect. adv. Erasistrateos 4 (11.215.1 K.), Hippocrates, De diaeta 1.29.2 (146.15 Joly & Byl = 6.504.12 L.). 1426 See e.g. Alexander, Therapeutica 7.1 (Vol. 2, 249.7 Puschmann), Therapeutica 5.6 (Vol. 2, 217.19 Puschmann), Paul 2.45 (Vol. 1, 116.4 Heiberg), Aetius Amid., Libri med. 9.10 (288.24 f. Zervos).

362 | Commentary

tary on p. 137.18–21), this sentence provides information about the frequency with which mania occurs. It distinguishes between patients who are afflicted1427 periodically (κατὰ περίοδόν; on this phrase, see p. 208, commentary on p. 128.15–16), those who are afflicted once a year (ἅπαξ τοῦ ἔτους), and those who suffer from it twice a year or more (δεύτερον ἢ πλεονάκις). In other authors, such as Aretaeus, the Anonymus Parisinus, and Caelius Aurelianus, mania is explicitly discussed among chronic diseases (on this term, see p. 204, commentary on p. 128.9–10).1428 In Aretaeus’ chapter on mania, it is said that mania sometimes intermits (μανίη δὲ καὶ διαλείπει)1429 and it is dealt with an “incomplete intermission” (διάλειψις … ἀτελής), which is said to occur due to the climate of the season or when the affection was not suitably cured.1430 The Anonymus Parisinus says that some patients completely return to their natural condition (οἱ μὲν αὐτῶν παντελῶς εἰς τὸ κατὰ φύσιν καθίστανται), some are unmoved (οἱ δέ εἰσιν ἀσαύλετοι), and others suffer from mania for their whole life (μεμήνασι γὰρ ἔνιοι εἰς ὅλον τὸν βίον).1431 According to Caelius Aurelianus, mania is sometimes continuous (nunc iugis) and sometimes eased through intermissions (nunc temporis interiecti requie levigatus), so that the patients sometimes forget their affection (ut aegri nunc non meminerint sui laboris) and sometimes do not know that they have forgotten it (nunc oblivionem nesciant suam).1432 The genitive absolute ἀθροιζομένου κατὰ βραχὺ δηλονότι τοῦ ἐνοχλοῦντος seems to present the condition under which the affection occurs. It occurs when that which causes the trouble – probably yellow bile, a great amount of blood or the previously mentioned sharpness – gathers and manifests itself within a short time. It is not clear whether this statement is supposed to refer to mania in general or only to those patients who suffer from mania periodically, once a year, twice a year, or more often. If it refers to patients suffering from mania periodically, then we need to ask how often other patients are seized by mania, and whether there are actually other possible chronologies of the affection, as the text does not give any further information on this topic. The phrase κατὰ βραχὺ ἀθροίζειν is also frequently used in other texts to indicate that something gathers within a short time.1433 This seems to be part of the negative effect on the body of that which gathers within a short time. In a passage of Galen’s De symptomatum causis, the phrase κατὰ βραχὺ ἀθροίζειν is also connected with the adverb δηλονότι: as part of a genitive absolute, Galen 1427 The verb ἐπιπίπτειν is commonly used in medical texts to indicate that an affection befalls someone. See e.g. Aetius Amid., Libri med. 6.3 (Vol. 2, 128.9 Olivieri), Libri med. 7.50 (Vol. 2, 304.10 Olivieri), Galen, De cur. rat. per venae sect. 6 (11.270.2 K.). 1428 See Aretaeus 3.1 (36.4–18 Hude), Caelius Aurel., Tard. pass. liber primus cui haec insunt (430.1–9 Bendz), Anon. Par. 16.3.10 (108.22 f. Garofalo). 1429 See Aretaeus 3.6.2 (41.22 f. Hude). 1430 See Aretaeus 3.6.2 (41.23–25 Hude). 1431 See Anon. Par. 18.2.1 (114.8–10 Garofalo). 1432 See Caelius Aurel., Tard. pass. 1.151 (520.7–9 Bendz). 1433 See e.g. Galen, De usu part. 2.7 (Vol. 1, 82.23 f. Helmreich = 3.113.5 f. K.), De motu musc. 1.10 (24.19 Rosa = 4.419.9 f. K.), Aetius Amid., Libri med. 6.12 (Vol. 2, 152.24 Olivieri).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

363

states that the moisture which flowed out previously gathered (again) and manifested itself within a short time (ἀθροισθείσης δηλονότι κατὰ βραχὺ τῆς πρότερον ἐκρυείσης ὑγρότητος).1434 p. 137.23–25: ἁλίσκονται – γυναικῶν: This sentence provides information about the age at which patients are usually seized by the affection (ἁλίσκονται δὲ τῷ πάθει),1435 as well as about the gender which is generally more prone. The crucial noun regarding the information on the age of the patients is ἀκμή, which describes the prime of life. In the pseudo-Galenic Definitiones medicae, four ages (ἡλικίαι) are distinguished: the first is that of the young people (ἡ τῶν νέων), the second that of those who are in the prime of life (ἡ τῶν ἀκμαζόντων), the third is that of those who are in the midst of life (ἡ τῶν μέσων), and the fourth is the age of those who are old (ἡ τῶν γερόντων).1436 Those who are in the prime of life are said to be warm and dry in their mixture (θερμοὶ καὶ ξηροὶ) and to have the same mixture as the summer.1437 It is also stated that yellow bile is the humor which prevails in those who are in this phase of their life.1438 The prime of life is defined as the age at which the people are fully grown.1439 The reason why people in their prime of lives are said to be especially affected by mania might be that this age is associated with yellow bile and heat, for yellow bile is the humor responsible for the origin of the second form of mania (see p. 345, commentary on p. 136.21), and the overheating of yellow bile is said to further intensify the affection (see p. 355 f., commentary on p. 137.9). An age in which yellow bile is already prevalent and which consists in a warm mixture is, therefore, especially prone to mania. In Aretaeus’ chapter on the affection, it is said that those around the years of youth (ἀμφὶ ἥβην) and the young people (νέοισι) and those who are generally in the prime of life (οἷσι πάντων ἡ ἀκμή) are prone to mania.1440 Aretaeus links this information to certain bodily constitutions which can be observed in exactly these periods of life, namely heat (τὸ θερμὸν) and a large quantity of blood (αἷμα πουλύ).1441 Thus, in Aretaeus’ account of the affection, the relation between the general characteristics of the age and the cause of mania, which is also warm according to his account, becomes clear.1442 Caelius Aurelianus also states that mania frequently occurs in young (in iuvenibus) and middle-aged men (ac mediis aetatibus), rarely in old men (difficile in senibus), and even more rarely in 1434 See Galen, De sympt. caus. 1.2 (7.100.7 f. K.). 1435 For the very common use of the verb ἀλίσκεσθαι in connection to πάθος, πάθημα, νόσημα or the like see e.g. Galen, De sympt. caus. 2.2 (7.158.8 K.), Meth. med. 13.16 (382.17–19 Johnston & Horsley = 10.917.8 f. K.), Aetius Amid., Libri med. 6.19 (Vol. 2, 158.25 f. Olivieri), Libri med. 6.39 (Vol. 2, 181.11 f. Olivieri). 1436 See Pseudo-Galen, Def. med. 104 (19.373.18–374.2 K.). 1437 See Pseudo-Galen, Def. med. 104 (19.374.3–5 K.). 1438 See Pseudo-Galen, Def. med. 104 (19.374.8 K.). 1439 See Pseudo-Galen, Def. med. 106 (19.374.17–19 K.). 1440 See Aretaeus 3.6.3 (42.1 f. Hude). 1441 See Aretaeus 3.6.3 (41.31–42.1 Hude). 1442 See Aretaeus 3.6.2 (41.20 f. Hude).

364 | Commentary

children or women (atque difficilius in pueris vel mulieribus).1443 These remarks also match Aretaeus’ account and the account given in our text. Interestingly, Caelius also states that men are more prone to mania than women, a notion which is reflected in our text. Aretaeus also mentions women in his chapter on mania, stating there that women are sometimes also affected (ἐμάνησάν κοτε καὶ γυναῖκες).1444 The reason why men are said to be more prone to mania than women may lie in the fact that women are regarded as being colder in their mixture.1445 They are, thus, not as easily affected by a warm affection as men. p. 137.25–27: καὶ τούτων – φιλάργυροι: The pronoun τούτων presumably refers to the men (ἄνδρες) who were said to be more frequently affected by mania (see p. 363 f., commentary on p. 137.23–25). The reference to men who are troubled (ἐνοχλούμενοι)1446 by “psychic affections” (παθήμασί τισι ψυχικοῖς) is remarkable insofar as it is one of the rare occurrences in Aetius’ sixth book of words that are related to the soul (ψυχή or cognates).1447 Given that Aetius deals with mental illnesses here (on the terminology, see p. 39 – 43), we, as readers, may ask how he conceived of the relation between the occurrence of such illnesses and the soul, especially because faculties as the reasoning faculty (λογιστικόν) and the imaginative faculty (φανταστικόν), which were previously said to be damaged in mania (see p. 351 f., commentary on p. 137.2–4), may be understood as activities of the soul (see p. 167 f., commentary on p. 125.10–15). One may be tempted to read the term ψυχικὰ παθήματα as an explicit reference to the soul’s involvement in mania. This would, however, be too rash a conclusion. For the phrase ψυχικὰ παθήματα is, rather, used to refer to what can be called character tendencies or emotions and it does not refer to affections such as phrenitis, mania, melancholia and the like. I have discussed this issue in more detail on p. 55 f., where I also highlight Galen’s use of this phrase in his “ethical”1448 treatises. The list of examples of such psychic affections, which is provided in our text, is, thus, remarkably similar to lists we find in Galen. For example, in his treatise Ars medica, Galen refers to nouns such as ὀργή, λύπη, θυμός, φόβος,

1443 See Caelius Aurel., Tard. pass. 1.146 (516.25 f. Bendz). 1444 See Aretaeus 3.6.3 (42.5 Hude). 1445 See e.g. Aretaeus 1.6.3 (6.2 Hude), Galen, De temp. 2.4 (61.19–21 Helmreich = 1.606.14 f. K.), Oribasius, Coll. med. rel. libri incerti 20.1 (Vol. 4, 109.26 f. Raeder). 1446 For a closer look at the verbs ἐνοχλεῖν and παρενοχλεῖν, see p. 361, commentary on p. 137.18– 21. It is interesting that the verb ἐνοχλεῖν is used here, as it is not restricted to the context of affections but has wider meanings. This is the first indicator that the phrase ψυχικὰ παθήματα is not used in the sense of psychic “diseases”. 1447 There are a few other occurrences of the noun ψυχή or the adjective ψυχικός within the sixth book. See Aetius Amid., Libri med. 6.9 (Vol. 2, 143.8 f. Olivieri), Libri med. 6.9 (Vol. 2, 143.12 Olivieri), Libri med. 6.23 (Vol. 2, 163.13 Olivieri), Libri med. 6.23 (Vol. 2, 163.19 Olivieri), Libri med. 6.7 (Vol. 2, 134.12 f. Olivieri), Libri med. 6.23 (Vol. 2, 161.2 Olivieri). 1448 Singer 2013, 25 uses this adjective to characterize Galen’s treatises De indolentia, De moribus, De proprium animi cuiuslibet affectuum dignotione et curatione, De animi cuiuslibet peccatorum dignotione et curatione.

VI 8 On mania from (the books of) Archigenes and Posidonius |

365

φθόνος and φροντίς as ψυχικὰ πάθη, “psychic” affections.1449 In De propriorum animi cuiuslibet affectuum dignotione et curatione similar nouns are mentioned under the heading of πάθη ψυχῆς, namely θυμὸς, ὀργὴ, φόβος, λύπη, φθόνος and ἐπιθυμία σφοδρά.1450 This is even said to be common knowledge (ἅπερ ἅπαντες γινώσκουσι).1451 A few pages later, Galen repeats this list of nouns (leaving out φθόνος) and again describes them as πάθη ψυχῆς.1452 At another point in the work, he mentions that φιλονεικία, φιλοδοξία and φιλαρχία are also affections of the soul (πάθη τῆς ψυχῆς).1453 Not only does Galen suggest such meaning for ψυχικὰ παθήματα but similar statements are also found in other authors. In Aretaeus, it is, for example, said that ἐκπλήξιες, φόβοι and δυσθυμίαι are intemperate affections of the soul (ψυχῆς ἀκρατέα πάθεα), as are δείματα in children.1454 In Paul’s chapter on sleeplessness, λύπη and φροντίς are classified as psychic affections (ψυχικὰ παθήματα);1455 in a chapter on people who are in love, it is explicitly said that φροντίς is an affection of the soul;1456 a chapter on gout presents λύπη, φροντίς and ἀγρυπνία as affections of the soul and explains furthermore that they cause a bad mixture of humors (κακοχυμία).1457 Alexander of Tralleis also relates λύπη and φροντίς to psychic affections,1458 to mention just a few examples of similar listings. Another passage, which is interesting in the context of psychic affections, is worth citing. In Soranus’ Gynaecioum libri it is stated that a prolapse of the uterus might also occur through a psychic affection (διὰ ψυχικὸν πάθος), for example when the loss of a child is announced to that woman.1459 This passage is cited in the compilations of both Aetius and Paul1460 and reflects the idea that a strong emotion, such as the grief one feels when losing a child, is ranked among psychic affections. Let us return to the list of psychic affections in our text. It has become clear from the parallel passages that anger (referred to by οἱ ὀργίλοι) and anxiety (referred to by οἱ φροντιστικοὶ) are commonly included. The use of the terms οἱ φιλογέλωτες (those who love to laugh) and οἱ φιλάργυροι (those who are fond of money) reminds us of the nouns φιλονεικία (love of victory), φιλοδοξία (love of glory) and φιλαρχία (love of power) in Galen’s De propriorum animi cuiuslibet affectuum dignotione et 1449 See Galen, Ars med. 24.8 (351.3–5 Boudon = 1.371.11 f. K.). 1450 See Galen, De an. aff. dign. et cur. 3.1 (7.2 f. de Boer = 5.7.13–15 K.). 1451 See Galen, De an. aff. dign. et cur. 3.1 (7.2 de Boer = 5.7.14 K.). 1452 See Galen, De an. aff. dign. et cur. 5.5 (17.9 f. de Boer = 5.24.6 f. K.). 1453 Galen, De an. aff. dign. et cur. 7.2 (24.10 f. de Boer = 5.35.10 f. K.). See also Galen, De an. aff. dign. et cur. 9.18 (34.18 f. de Boer = 5.51.15 f. K.) for a very similar listing. 1454 See Aretaeus 3.7.8 (46.9 f. Hude). 1455 See Paul 1.98 (Vol. 1, 67.27 f. Heiberg). 1456 See Paul 3.17 (Vol. 1, 160.11 Heiberg). On this chapter, see Thumiger 2018, 267. 1457 See Paul 3.78.4 (Vol. 1, 300.11–13 Heiberg). 1458 See Alexander, Therapeutica 1.17 (Vol. 1, 605.23 f. Puschmann). 1459 See Soranus, Gyn. 4.35.3 (148.3–6 Ilberg). 1460 See Aetius Amid., Libri med. 16.72/71 (434.17–20 Romano = 109.23–26 Zervos), Paul 3.72.1 (Vol. 1, 289.26 f. Heiberg).

366 | Commentary

curatione,1461 which all express the notion that someone is especially fond of something, such as laughing, money, victory, glory, or power, presumably to an even greater extent than is usual. The noun σκώπτης (scoffer) only occurs this once in ancient medical texts and the adjective ἀκαιρόγελως appears nowhere else in Greek literature at all, according to the TLG. It is noteworthy that this list of psychic affections which make people prone to mania is comparable to the list of symptoms which was provided earlier in the chapter (see p. 353 f., commentary on p. 137.6–7, p. 358, commentary on p. 137.14–15). The adjective ὀργίλοι (p. 137.6) was also used earlier in the chapter, as was the noun ὀργή (p. 137.15). The use of the adjectives φιλογέλωτες and ἀκαιρογέλωτες strongly reminds us of the ungovernable laughter (p. 136.25: γέλως ἄσχετος) and the unreasonable laughter (p. 137.14: γέλωτι παραλόγῳ) which were mentioned as symptoms of mania (see p. 349 f., commentary on p. 136.25–26, p. 358, commentary on p. 137.14–15). The assumption which underlies the statement that people who suffer from psychic affections – such as the scoffers, those who love to laugh, those who laugh at the wrong moments, the disobedient, those inclined to anger, those who overthink things, and those who are fond of money – are prone to suffer from mania might be that these character tendencies and emotions consist in a general bodily mixture of the patient, which is more likely to turn to mania. According to Galen’s Quod animi mores, the soul is slave to the mixtures of the body (ψυχὴν … δουλεύειν αὐτὴν ταῖς τοῦ σώματος κράσεσιν), which also cause it to suffer from derangement, memory loss and the loss of intelligence and to make the soul more sorrowful (λυπηροτέραν), cowardly (ἀτολμοτέραν) and without spirit (ἀθυμοτέραν).1462 A similar notion presumably also informs the present passage. In Caelius’ account of mania it is said that it may occur through, for example, love (amor), anger (iracundia), sadness (maestitudo), fear (timor) and also through searching for money or glory (quaestum pecunialem aut gloriam).1463 This list is, in parts, similar to that which we find in our text. p. 137.27–29: ἤδη – ἐπεσχημένοι: These lines deal with further conditions under which people may suffer from mania, and, thus, continue the sentence which started with ἄνδρες δὲ μᾶλλον γυναικῶν καὶ τούτων. Whereas the previous lines were concerned with people suffering from psychic affections (see p. 364 – 366, commentary on p. 137.25–27), the present passage deals with those who have certain dietary habits (οἱ πολυπόται) or suffer from certain bodily conditions (οἱ συνεχῶς ἀπεπτοῦντες καὶ οἱ τὰς συνήθεις ἐκκρίσεις ἐπεσχημένοι). The noun πολυπόται presumably takes up the reference to those who are drunk (p. 136.20–21: ὡς ἐπὶ τῶν μεθυόντων), which was used as an example in the context of the form of mania, which occurs due to a great amount of blood. For further discussion of this passage and the physiological implications which may lie behind the connection between drunkenness 1461 See Galen, De an. aff. dign. et cur. 7.2 (24.10 f. de Boer = 5.35.10 f. K.). See also Galen, De an. aff. dign. et cur. 9.18 (34.18 f. de Boer = 5.51.15 f. K.) for a very similar listing. 1462 Galen, Quod animi mor. 3 (21.15–22.7 Bazou = 4.779.11–17 K.). 1463 See Caelius Aurel., Tard. pass. 1.147 (516.30–518.1 Bendz).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

367

and mania, see p. 344, commentary on p. 136.20–21. Interestingly, the noun πολυπότης is mentioned in connection to mania in Athenaeus’ Deipnosophistes. There it is said that Philip, on the one hand, suffered from mania (μανικός) by nature (φύσει) and was prone to danger, while, on the other hand he suffered this because of drunkenness (διὰ μέθην), for he was hard drinking (πολυπότης) and often marched out when he was drunk.1464 In Aretaeus’ account of mania it is said that wine (οἶνος) inflames the drinker to delirium (ἐς παραφορὴν) in drunkenness (ἐν μέθῃ), but this is explicitly distinguished from mania and said to be never called such.1465 Later in the text, drunkenness (μέθη) is listed as one possible condition which leads to mania.1466 Caelius also refers to frequent and immoderate drunkenness (vinolentia frequens atque immodicus) as one possible cause of mania.1467 He also deals with the connection between drunkenness and mania in his section on the appropriate therapy. In this context, he criticizes those who recommend making the patients drunk (inebriandos aiunt aegrotantes), although mania often develops out of drunkenness (ex vinolentia generetur).1468 As far as the mention of indigestion (οἱ συνεχῶς ἀπεπτοῦντες) and retention of excrement (οἱ τὰς συνήθεις ἐκκρίσεις ἐπεσχημένοι) is concerned, see p. 315 f., commentary on p. 134.27–28 and p. 296 f., commentary on p. 134.11–13, where I have discussed the fact that retention and indigestion are commonly regarded as factors which may lead to an affection of the brain, and that such a notion may also be linked to the assumption that vapors rise from the abdominal region to the head or to any other form of co-affection of the brain with the abdominal region. A rise of vapors (ἐκ τῶν γιγνομένων ἀναθυμιάσεων) was also said to occur in patients suffering from mania earlier in the chapter (see p. 350, commentary on p. 136.27–137.1). Interestingly, in his treatise De constitutione artis medicae, Galen provides a list of causes which are capable of corrupting health (τὴν ὑγείαν αὐτὴν διαφθεῖραι δυνήσονται); indigestion (ἀπεψίαν), drunkenness (μέθην), grief (λύπας), anger (ὀργὰς) and spirit (θυμὸν) appear on this list.1469 These factors are also mentioned in the present chapter as possibly promoting mania; see also p. 364 – 366, commentary on p. 137.25–27. In Aetius’ previous chapter on skotoma, indigestion and drunkenness were also said to be causes of the affection and they were presumably understood there as antecedent causes (for further discussion, see p. 316 f., commentary on p. 134.28–29). In his account of mania, Aretaeus states that the head and the hypochondria are the causes of the affection and a few lines further down he says that the inward parts (σπλάγχνα) are the main origin (τὸ κῦρος) in cases of mania and melan1464 See Athenaeus, Deipn. 10.46 (446.12–14 Kaibel). 1465 See Aretaeus 3.6.1 (41.15 f. Hude). See also Adams’ translation: Adams 1856 in The extant works of Aretaeus, 103. 1466 See Aretaeus 3.6.3 (42.4 Hude). 1467 See Caelius Aurel., Tard. pass. 1.147 (516.28 f. Bendz). 1468 See Caelius Aurel., Tard. pass. 1.175 (534.9 f. Bendz). 1469 See Galen, De const. art. med. 19.4 (126.22–24 Fortuna = 1.302.8–10 K.).

368 | Commentary

cholia, while the head and the senses are the main origins of phrenitis.1470 In the further course of the chapter it is stated that patients suffering from mania suffer from flatulence (φυσώδεες).1471 Aretaeus, thus, also conceived of an influence of the inward parts on mania. Caelius Aurelianus explicitly states that indigestion (indigestio) is one of many causes which may lead to mania,1472 and his list also contains factors such as drunkenness, as well as the love, anger, sadness and fear discussed above (see p. 364 – 366, commentary on p. 137.25–27). p. 137.29–138.1: διὰ τοῦτο – καταμήνια: The expression ἐπίσχηται τὰ καταμήνια denotes the absence of a woman’s menses and is used frequently as such in medical literature.1473 The present passage links the retention of excrement (οἱ τὰς συνήθεις ἐκκρίσεις ἐπεσχημένοι; see p. 367 f., commentary on p. 137.27–29) to the absence of a woman’s menstruation, thus suggesting a similarity between the two. Our text is not unique in this regard and there are a number of other medical texts which deal with retention of excrement, and the absence of a woman’s menses in the same context and as comparable processes.1474 In a chapter of Aetius’ eighth book, we read that patients suffering from thickness of the lips should be cured either by phlebotomizing or purging them or by “setting into motion the excretions which are held back, such as the menses in women and the accustomed excretions in men” (τὰς συνήθεις ἐκκρίσεις ἐπεσχημένας κινῶν, οἷον καταμήνια γυναιξὶ καὶ ἀνδράσι τὰς συνήθεις ἐκκρίσεις).1475 This passage treats menstruation as a subclass of excretion. For further discussion of the retention of menses as the cause of an affection, see DeanJones 1996, 125–144. See also p. 334 f., commentary on 136.15–17, p. 451 f., commentary on p. 145.17–19, p. 468, commentary on p. 147.3–5. The reference to the retention of menses in the present passage also takes up the previous statement about the likelihood with which women are affected by mania (see p. 363 f., commentary on p. 137.23–25), and provides one bodily factor which makes women possibly prone to the affection. In Aretaeus’ account of mania, it is said that a woman may suffer from mania because of the impurity of her body (ὑπὸ ἀκαθαρσίης τοῦ σκήνεος)1476 and this statement may also refer to the absence of menstruation. In Caelius’ chapter on mania, the absence of menstruation in women (abstinentia in feminis solitae

1470 See Aretaeus 3.6.7 (42.29–43.1 Hude). 1471 See Aretaeus 3.6.9 (43.11 Hude). 1472 See Caelius Aurel., Tard. pass. 1.147 (516.28 Bendz). 1473 See e.g. Galen, De loc. aff. 6.5 (8.417.8 f. K.), Paul 3.47 (Vol. 1, 254.24 f. Heiberg), Alexander, Therapeutica 10 (Vol. 2, 441.11 Puschmann), Oribasius, Coll. med. rel. 7.2.25 (Vol. 1, 199.10 Raeder), Aetius Amid., Libri med. 1.135 (Vol. 1, 69.7 Olivieri). 1474 See e.g. Aetius Amid., Libri med. 8.18 (Vol. 2, 429.24 f. Olivieri), Galen, De alim. fac. 2.51 (157.20–158.1 Wilkins = 6.637.11 f. K.), De simpl. med. temp. et fac. 6.5 (11.877.13 K.), Dioscorides, De mat. med. 3.157.1 (Vol. 2, 164.1 Wellmann), Paul 7.3 (Vol. 2, 211.22 Heiberg). 1475 See Aetius Amid., Libri med. 8.18 (Vol. 2, 429.24 f. Olivieri). 1476 See Aretaeus 3.6.4 (42.5 f. Hude).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

369

purgationis) is also presented as one possible factor which might bring about mania.1477 p. 138.1–2: μυρίαι – περιττόν: For further discussion of the fact that mania is commonly thought to have different forms, see p. 347 – 349, commentary on p. 136.23–25, and especially Aretaeus’ statement that numberless (μυρίοι) forms of mania do exist but that they are just one in genus (note 1346). I have discussed previously that our text seems to present two forms of mania, one that is brought about by a great amount of well-tempered blood (see p. 343 f., commentary on p. 136.20– 21) and another that is brought about by blood which is mixed with yellow bile (see p. 345, commentary on p. 136.21). By stating that there are numberless forms of mania, the text presumably refers to the great number of symptoms and the different peculiarities of the affection in each patient, rather than to numberless forms that are each brought about by a completely different physiological process. I am thinking here, for example, of lists such as that provided by Caelius in his account of mania. Caelius states that one patient thinks he is a sparrow (se passerem existimavit), one that he is a rooster (gallum gallinaceum), another that he is a pottery vessel (fictilem), and so on.1478 The author of our text seems to consider it unrewarding to discuss every little peculiarity of mania, preferring to concentrate instead on the main information about the cause, symptoms and therapy of the affection. p. 138.2–3: τοῖς μὲν – προρρηθέντων: These lines introduce a list of what we might call preludes, which precede the symptoms of mania. For further discussion of the use of the verb προηγεῖσθαι, see p. 305 f., commentary on p. 134.17–19. The same verb was already used near the beginning of the chapter (see p. 345 – 347, commentary on p 136.21–22), where it appeared in the context of a metaphor and was applied to more general information on the condition of the head. The noun προοίμιον, which is frequently used to denote the beginning or the introduction of a treatise,1479 is used here metaphorically to refer to the signs and the behavior which can be observed in people who are about to suffer from mania, a usage that is also reflected in a number of other passages.1480 Given that the subsequent list of symptoms features items that have been discussed earlier in the chapter (see p. 370, commentary on p. 138.3, p. 370, commentary on p. 138.4, p. 370 f., commentary on p. 138.5–6), it seems likely that the participle τῶν προρρηθέντων refers back to the earlier discussion. This would, then, be another example of cross-referencing with the chapter, which contributes to its readability and shows how thoroughly it was put together (see also p. 13). In his account of mania, Caelius also provides a list of signs (signa), which are said to appear before the affection completely manifests 1477 See Caelius Aurel., Tard. pass. 1.147 (518.3 f. Bendz). 1478 See Caelius Aurel., Tard. pass. 1.152 (520.11–15 Bendz). 1479 See e.g. Galen, De loc. aff. 3.5 (8.150.8 K.), In Hipp. Epid. III comm. 3.33 (131.3 Wenkebach = 17a.684.10 f. K.), Paul proem (Vol. 1, 3.1 Heiberg). 1480 See e.g. Aetius Amid., Libri med. 6.12 (Vol. 2, 152.14 Olivieri), Oribasius, Coll. med. rel. libri incerti 62.44 (Vol. 4, 171.4 f. Raeder), Oribasius, Synops. ad Eustath. 8.2.1 (245.3 f. Raeder).

370 | Commentary

itself (priusquam morbus enitescat);1481 he continues by stating that these signs can be remembered by taking them out of what was mentioned previously (ex ante dictis sumenda).1482 This is very similar to what we read in our text. p. 138.3: οἷον – εἰθισμένοις: The οἷον introduces the list of preludes (προοίμια) which may be observed in patients who are about to suffer from mania. The mention of unreasonable laughter (γέλως παράλογος) picks up what has twice been described as a symptom of the affection earlier in the text. At the start of the chapter, the phrase γέλως ἄσχετος is used (see p. 349 f., commentary on p. 136.25–26), but later in the chapter we find the same phrase as appears in the present passage, namely γέλως παράλογος (see p. 358, commentary on p. 137.14–15). Thus, it is one of those things ranked among “what was mentioned previously” (τῶν προρρηθέντων) (see p. 369 f., commentary on p. 138.2–3). The phrase οὐχ οὕτως εἰθισμένοις explicitly qualifies the unreasonable laughter as something that the patients are not used to, and thus emphasizes the “pathological” nature of this sign. Syntactically, this phrase refers to the dative τοῖς … μέλλουσι, which was used to refer to the patients who are about to suffer from mania. The fact that the laughter is referred to on one occasion as a symptom of the affection and on another as a prelude of the affection should not surprise us. Rather, this should be understood as indicating that what are referred to as preludes (προοίμια) here are already part of the affection and are a consequence of its initial onset. The unreasonable laughter is already present at the very beginning of the affection and later, when the affection progresses, becomes established as a symptom. Such an interpretation finds support in the fact that the appearance of ungovernable laughter was earlier linked to physiological processes in the body, more precisely to the great amount of well-tempered blood which may bring about mania (see p. 349 f., commentary on p. 136.25–26). Given that the preludes are the beginning of the affection, we should understand that the physiological processes which lead to mania are already set in motion when they are present. p. 138.4: καὶ ὀργίζονται – ὤτων: Both anger (ὀργίζονται) and ringing in the ears (ἦχοι ὤτων) were mentioned previously as symptoms of mania (see p. 350, commentary on p. 136.27–137.1, p. 353 f., commentary on p. 137.6–7, p. 358, commentary on p. 137.14–15). For further remarks concerning the question of how one should conceive of the fact that the same behavior is mentioned as both a symptom and a prelude of the affection, see also p. 370, commentary on p. 138.3. p. 138.4–5: καὶ μαρμαρυγαὶ – προφαίνονται: The appearance of sparks in front of one’s eyes (μαρμαρυγαὶ πρὸ τῶν ὀφθαλμῶν προφαίνονται) is commonly mentioned together with ringing in the ears; for a closer examination, see p. 299 – 301, commentary on p. 134.13–14. p. 138.5–6: ἀγρυπνίαι – ἀλλόκοτοι: The fact that one can observe intense sleeplessness (ἀγρυπνίαι … σύντονοι) in those who are about to suffer from mania is also

1481 See Caelius Aurel., Tard. pass. 1.148 (518.5–7 Bendz). 1482 See Caelius Aurel., Tard. pass. 1.148 (518.7 f. Bendz).

VI 8 On mania from (the books of) Archigenes and Posidonius

| 371

mentioned in Caelius Aurelianus’ account of the affection; in his list of obvious causes (ex manifestis causis) of mania, he uses the phrase vigiliae iuges as an example.1483 A bit later in the chapter, Caelius deals with signs (signa) that can be observed before the affection manifests itself completely (priusquam morbus enitescat), and these signs are said to be linked to what was discussed previously (see p. 369 f., commentary on p. 138.2–3); in the list of such signs, light and little sleep (somni … leves atque parvi) is said to indicate mania.1484 In Aretaeus’ account of mania, sleeplessness (παραλόγως ἄγρυπνοι, ἀγρυπνέουσι) is mentioned twice as a symptom of the affection.1485 The phrase φροντίδες ἐπάλληλοι καὶ ἀλλόκοτοι presumably refers back to the mention of οἱ φροντιστικοὶ, which was listed earlier in the chapter among psychic affections that make people prone to suffer from mania (see p. 364 – 366, commentary on p. 137.25–27). In Caelius’ account of mania, animi anxietas (anxiety of the mind) is listed among the signs which appear before the affection manifests itself completely (see also p. 369 f., commentary on p. 138.2–3),1486 and something along these lines should probably be understood by the phrase φροντίδες ἐπάλληλοι καὶ ἀλλόκοτοι in the present passage. The adjective ἀλλόκοτον is also used in other chapters of Aetius’ sixth book;1487 see also p. 213 f., commentary on p. 128.24–26, p. 285, commentary on p. 133.26, p. 171 – 174, commentary on p. 125.20–24. For further remarks concerning the question of how one should conceive of the fact that the same behavior is mentioned as both a symptom and a prelude of the affection, see also p. 370, commentary on p. 138.3. p. 138.6: βάρος – κεφαλῆς: Heaviness of the head (βάρος … τῆς κεφαλῆς) is commonly mentioned as accompanying affections which are localized in the head; see e.g. p. 224 f., commentary on p. 129.22–23, p. 237, commentary on p. 131.1, where I discuss a passage, in which heaviness of the head appears in connection with ringing in the ears, and p. 281 f., commentary on p. 133.22–24. In Aretaeus’ account of mania, heaviness of the head (βάρος τῆς κεφαλῆς) and suffering from headaches (κεφαλαλγέες) are mentioned as symptoms of the affection,1488 and Caelius Aurelianus lists an implementum capitis (overfilling of the head) as one sign that can be observed in patients before mania completely manifests itself (see also p. 369 f., commentary on p. 138.2–3).1489 According to Galen’s De symptomatum causis, the noun παλμός describes a dilatation contrary to nature (διαστολὴ παρὰ φύσιν) that

1483 See Caelius Aurel., Tard. pass. 1.147 (516.27–30 Bendz). 1484 See Caelius Aurel., Tard. pass. 1.148 (518.9 f. Bendz). 1485 See Aretaeus 3.6.8 (43.7 Hude), 3.6.9 (43.12 Hude). 1486 See Caelius Aurel., Tard. pass. 1.148 (518.13 Bendz). 1487 See Aetius Amid., Libri med. 6.2 (Vol. 2, 125.21 Olivieri), Libri med. 6.3 (Vol. 2, 128.25 Olivieri), Libri med. 6.6 (Vol. 2, 133.26 Olivieri), Libri med. 6.9 (Vol. 2, 142.13 Olivieri), Libri med. 6.9 (Vol. 2, 142.25 Olivieri). 1488 See Aretaeus 3.6.8 (43.8 f. Hude) 1489 See Caelius Aurel., Tard. pass. 1.148 (518.11 Bendz).

372 | Commentary

can occur in all bodily parts which can be dilated.1490 In De placitis Hippocratis et Platonis, it is said that the movement of the heart regarding pulsation (σφυγμός) is an activity (ἐνέργεια), while the movement of the heart regarding palpitation (παλμός) is an affection (πάθος) and is not in accordance with nature (οὐ κατὰ φύσιν).1491 In the present passage, heaviness and palpitation of the head might even pick up on the diseased condition of the head, which was referred to as ἀσθένεια τῆς κεφαλῆς at the start of the chapter (see p. 346 f., commentary on p. 136.21–22). p. 138.6–7: προκόπτοντος – χρόνου: A very similar phrase also appears in Aetius’ chapter on skotoma, see p. 135.6–7. It denotes that time has passed and, thus, ties in with the phrase τοῖς μὲν οὖν μέλλουσι περιπίπτειν τῷ πάθει προηγεῖταί …, which was used previously to introduce the preludes of mania (see p. 369 f., commentary on p. 138.2–3). The information which follows the present genitive absolute deals with signs which can be observed in patients when time has passed. p. 138.7: πάντα – ἐπιτείνεται: This is a general remark on the development that the previously mentioned preludes (see p. 369 f., commentary on p. 138.2–3), which are referred to here by the phrase πάντα ταῦτα, undergo as time passes, they intensify (ἐπιτείνεται). It recalls a statement made earlier in the chapter, that the more bile is mixed with the blood, the more the pleasures are altered and the more unpleasant and high-spirited aspects of the affection intensify (ἐπιτείνει); for further discussion, see p. 354 f., commentary on p. 137.7–8. The intensification of the preludes should be understood as a further step in the progression of the affection. p. 138.7–8: καὶ – προθυμίαι: These lines continue to provide information on the development of mania which can be observed as time passes. Not only the intensity of the preludes mentioned previously (see p. 372, commentary on p. 138.7), but also the patients’ desires (ὀρέξεις) and their willingness to engage in sexual intercourse (πρὸς τὰ ἀφροδίσια προθυμίαι) become “more raging” (λυσσωδέστεραι). The adjective λυσσώδες only appears three times in the medical literature, according to the TLG,1492 but Aretaeus also makes use of it in the context of sexual desire (Ἀφροδίτης ἐπιθυμίη λυσσώδης).1493 The observation that patients suffering from mania are given to an increase in sexual desire is also reflected in Aretaeus’ account of the affection, where he uses the phrases ἔρωτες ἀφροδισίων and ἀφροδισίων δὲ ἄσχετος ἐπιθυμίη.1494 Caelius mentions that mania is sometimes caused by a love potion1495 and he criticizes those who, in spite of this fact, recommend that one should

1490 See Galen, De sympt. caus. 2.2 (7.159.18–160.1 K.). See also Pseudo-Galen, Def. med. 207 (19.403.15–17 K.). 1491 See Galen, De plac. Hipp. et Plat. 6.1.10–11 (362.11–13 de Lacy = 5.508.2–5 K.). See also Praxagoras fr. 5.4–8 Lewis, fr. 6.18–26 Lewis, fr. 8.12–16 Lewis. 1492 Besides the present passage it is also to be found in Aretaeus 4.13.18 (89.23 Hude) and Aelius Promotus, Περὶ τῶν ἰοβολῶν θηρίων 9 (47.5 Ihm). 1493 See Aretaeus 4.13.18 (89.23 Hude). 1494 See Aretaeus 3.6.3 (42.5 Hude) and Aretaeus 3.6.10 (43.20 f. Hude). 1495 See Caelius Aurel., Tard. pass. 1.147 (518.1 f. Bendz).

VI 8 On mania from (the books of) Archigenes and Posidonius |

373

cure mania patients by making them fall in love, since in many patients it is love that is the cause of the affection (amor fuerit causa).1496 He also states that it is not at all clear whether one should prohibit or allow sexual intercourse (utrumne prohibendus sit usus venerius an admittendus).1497 If the physician prohibits sexual intercourse, the patient will be even more angry when the desired appears (cum desiderata producuntur) but he is not allowed to act on it. However, if the physician allows the patients to give in to their desires, this may also be detrimental because “the substance of the soul is also troubled through an exhausted body”.1498 p. 138.8–9: διὰ – συνεχεῖς: This statement is closely connected to the previous discussion about the intensification of sexual desires (see p. 372 f., commentary on p. 138.7–8). According to Aetius’ eleventh book, the verb ὀνειρώττειν is applied to those who secrete semen during sleep (ὅσοι ἐν τῷ καθεύδειν γονὴν ἐκκρίνουσιν).1499 Both the verb and the nouns ὀνειρωγμός or ὀνείρωξις are commonly used with this meaning.1500 In his explanation of the occurrence of such “wet dreams”, Aetius also mentions a “purposive fantasy” (μετά τινος προαιρετικῆς φαντασίας) which occurs in sleep as one possible cause of the emission of semen.1501 Such a notion is reflected elsewhere; in Caelius’ account of wet dreams, the emission of semen is also linked to fantasies (phantasia) which appear in the dreams of people who have a desire for sexual intercourse (ob desiderium veneriae voluptatis),1502 to give just one example. In Aretaeus’ account of mania the emission of semen during sleep (ὀνειρώττουσι) is also mentioned and connected with an ungovernable sexual desire (ἀφροδισίων δὲ ἄσχετος ἐπιθυμίη).1503 p. 138.9–10: ὀφθαλμοί – ἵστασθαι: The statement that eyes may become hollow (ὀφθαλμοί … κοιλαίνονται) is found in other texts as well1504 and the Greek language even has a verb for this condition, namely κοιλοφθαλμιᾶν.1505 For a discussion of hollowness of the eyes as a symptom of mental illnesses, see Thumiger 2017a, 92. In the pseudo-Galenic Introductio sive medicus, the hollowness is said to occur at the 1496 See Caelius Aurel., Tard. pass. 1.176 (534.24–26 Bendz). 1497 See Caelius Aurel., Tard. pass. 1.178 (536.8–10 Bendz). 1498 See Caelius Aurel., Tard. pass. 1.178 (536.10–13 Bendz). 1499 See Aetius Amid., Libri med. 11.34 (123.1 Daremberg & Ruelle). 1500 See e.g. Hippocrates, De gen. 1.3 (148.2–10 Giorgianni = 7.470.24–472.4 L.), Rufus, De sat. et gon. 30 (76.1 Daremberg & Ruelle), Dioscorides, De mat. med. 2.136.3 (Vol. 1, 208.13 Wellmann), Paul 3.55 (Vol. 1, 267.9–26 Heiberg), Aetius Amid., Libri med. 3.8 (Vol. 1, 266.4 Olivieri), Aetius Amid., Libri med. 11.34 (123.1 Daremberg & Ruelle), Oribasius, Synops. ad Eustath. 9.38 (300.6–12 Raeder). See also Thumiger 2017a, 232–234. 1501 See Aetius Amid., Libri med. 11.34 (123.6 Daremberg & Ruelle). 1502 See Caelius Aurel., Tard. pass. 5.80 (902.9–11 Bendz). 1503 See Aretaeus 3.6.10 (43.20 Hude). 1504 See e.g. Hippocrates, Coac. 396 (202.2 f. Potter = 5.672.18 L.), Galen, Meth. med. 8.2 (366.24 Johnston & Horsley = 10.544.12 f. K.), Aetius Amid., Libri med. 7.50 (Vol. 2, 304.28 f. Olivieri), Libri med. 7.56 (Vol. 2, 311.6 Olivieri). 1505 See e.g. Galen, De san. tuenda 6.14.1 (194.32 Koch = 6.444.6 f. K.), Aetius Amid., Libri med. 11.34 (123.12 Daremberg & Ruelle), Oribasius, Ad Eunap. 1.13.6 (329.34 Raeder).

374 | Commentary

roots of the eyes (κατὰ τὰς ῥίζας) and it is linked to pain (ἀλγῶν), to the eyes becoming small (μικρός τε γίνηται), and to dimness of vision (ἀμυδρῶς).1506 In a passage of Galen’s De sanitate tuenda, which is cited in Oribasius and in Aetius’ account of the emission of semen during sleep, hollowness of the eyes (κοιλοφθαλμιῶντες) is said to occur during such wet dreams.1507 The phrase μετὰ τοῦ ἀτενῶς ἵστασθαι also describes a condition of the eyes; the phrase ἀτενὲς ὁρῶσι was also used in the chapter on katalepsis to describe a stiff gaze (see p. 253 f., commentary on p. 131.21– 132.1). p. 138.10: καὶ – ἐκστάσεως: The pronoun ταῦτα presumably refers to the information which was given about both the preludes (προοίμια) of mania (see p. 369 f., commentary on p. 138.2–3), and its intensification (introduced by προκόπτοντος δὲ τοῦ χρόνου; see p. 372, commentary on p. 138.6–7, p. 372, commentary on p. 138.7). The noun ἔκστασις here again stands for mania in general (see p. 360, commentary on p. 137.18–21). This nicely closes the section dealing with the development of the affection, which started with the preludes before moving on to the intensification of these signs and leading up to the actual mania itself. p. 138.10–12: δεῖ – πρᾶξαι: This sentence introduces, in a particular interesting manner, the section of the text that deals with the appropriate care for patients suffering from mania, indirectly addressing the remarks that follow to a “wise physician” (ἐπιστήμονα ἰατρὸν). This seems to be a rhetorical move, a form of “advertisement”, for the following section dealing with therapy. It is worth noting the characterization of the physician as wise (ἐπιστήμονα) here since such rhetorical ornaments are usually absent in Aetius’ chapters. I wonder whether the use of the adjective ἐπιστήμων reflects any peculiarity in the therapeutic approach, either in comparison to other approaches (“the wise physician needs to do the following in contrast to what all the others say”), or in respect to the cure of mania in general (“the wise physician should do the following in mania, which is a difficult case and hard to get under control”). As for the former assumption, I have discussed the differences between Aetius’ therapeutical recommendations and others on p. 342. However, I do not think that the differences between the recommendations found in Aetius and those found in other extant texts are of such a kind that they could have motivated this emphasis. As for the latter assumption, I wonder whether the use of the verb ἐπιμελεῖσθαι might reflect a peculiarity of the therapy for mania since it is, according to the TLG, considerably rarer in the medical literature than the verb θεραπεύειν, for example.1508 Given that ἐπιμελεῖσθαι is often used with general

1506 See Pseudo-Galen, Introd. s. medic. 16.3 (80.3–5 Petit = 14.770.1 f. K.). 1507 See Galen, De san. tuenda 6.14.2 (194.35 f. Koch = 6.444.10 f. K.), Oribasius, Coll. med. rel. libri incerti 26.1 (Vol. 4, 118.7 Raeder), Aetius Amid., Libri med. 11.34 (123.12 Daremberg & Ruelle). 1508 The TLG lists 2932 occurrences of the verb θεραπεύειν in medical texts, whereas it lists only 97 occurrences of the verb ἐπιμελεῖσθαι in the same corpus.

VI 8 On mania from (the books of) Archigenes and Posidonius

|

375

words such as σῶμα,1509 one might suspect that it rather expresses a general care for, or attention to, something than an actual (potentially successful) cure. Is mania an affection which cannot actually be cured but whose patients need a special form of care, probably focused on the relief of symptoms? This is a tempting suggestion but in the following sections on therapy no definite indications are found that would allow us to interpret them as having an aim that differs from that given in the context of other affections. We should, presumably, understand the use of ἐπιμελεῖσθαι in close connection to the genitive absolute τούτων προφανέντων ἤ τινων αὐτῶν, which refers to the previously discussed preludes (προοίμια) and to the intensification of these that occurs as time passes (see p. 369 f., commentary on p. 138.2–3, p. 372, commentary on p. 138.6–7, p. 372, commentary on p. 138.7). It is at this point in time that the physician needs to start to “care for the patient”, even if what one would refer to as actual “therapy” probably starts later. This assumption is reinforced by the fact that the following lines start with a discussion of the appropriate regimen (δίαιτα; see p. 375 f., commentary on p. 138.13–14), while approaches such as phlebotomy are discussed a few lines further down (see p. 378 – 380, commentary on p. 138.18–20). The phrases ἐπιστήμων ἰατρός and τὰ δέοντα πρᾶξαι are also used in other texts. Aetius, for example, opens his fifth book with a small chapter on the necessity that a physician should have knowledge (ἰατρὸν ἐπιστήμονα) about the works of nature, and in this chapter he also mentions that a physician undertakes what needs to be done (τὰ δέοντα ποιοῦντα).1510 p. 138.12–13: προσημαίνοντος – ἐνεστηκότος: I interpret this genitive absolute as being similar in meaning to the previous genitive absolute τούτων προφανέντων ἤ τινων (see p. 375, commentary on p. 138.10–12). It refers to the earlier discussion about the preludes of mania and the intensification of these preludes that occurs as time passes. The first part of the genitive absolute (προσημαίνοντος τοίνυν τοῦ πάθους) thus presumably refers to the preludes, while the second part (ἢ καὶ ἤδη ἐνεστηκότος) either refers to the intensification of these preludes or to an even further step in the development of the affection. The verbs προσημαίνειν and ἐνιστάναι are also used in other medical texts to denote that an affection “is indicated” or “present”.1511 p. 138.13–14: τὴν μὲν – εὐκοίλιον: The verb ἁρμόζειν seems to be used here in a slightly different sense than usual; it expresses the idea that the physician needs to conduct a certain regimen and the infinitive has imperative force. Such a meaning of ἁρμόζειν is also reflected in the Latin translations of Cornarius and Montanus. While

1509 See e.g. Galen, Meth. med. 4.4 (394.27 f. Johnston & Horsley = 10.260.18 K.), Aetius Amid., Libri med. 7.33 (Vol. 2, 283.13 Olivieri), Aetius Amid., Libri med. 8.35 (Vol. 2, 448.7 f. Olivieri). 1510 See Aetius Amid., Libri med. 5.1 (Vol. 2, 6.15–23 Olivieri). 1511 See e.g. Hippocrates, Coac. 84.2 (124.1 f. Potter = 5.602.5 f. L.), Diocles fr. 183a.19 van der Eijk, Aetius Amid., Libri med. 6.23 (Vol. 2, 160.21 f. Olivieri).

376 | Commentary

Cornarius translates victum tenuem exhibere convenit,1512 Montanus translates victum tenuem adhibere.1513 The particle μὲν is taken up on p. 138.17 by the use of the correspondent δὲ (see p. 378, commentary on p. 138.17–18). The phrase δίαιτα λεπτή presumably refers to a regimen which has a thinning effect on the human body. For further discussion of such a “thinning diet”, see p. 226, commentary on p. 129.26. In the present context, the recommendation of a thinning regimen might be explained by the thickness of the yellow bile, which was mentioned earlier in the chapter (see p. 137.9). The adjective ῥοφηματώδες is not often used in the medical literature: there is just one use of it in Galen, and a few more in Soranus, Oribasius, the Anonymus Parisinus, Paul and Aetius.1514 It is mainly used to characterize food (τροφή) and it seems to describe a gruel-like consistency. The recommendation to apply a moist regimen to patients suffering from mania might be based on the fact that yellow bile is thought to be dry.1515 A moist regimen would then counteract the dryness of the yellow bile. The adjective ἄπληκτον (not irritating) presumably needs to be understood in close connection to εὐκοίλιον, which refers to a regimen that eases the gastro-intestinal tract. This recommendation presumably takes up the previous information that people who suffer from indigestion and retention are likely to be seized by mania (see p. 367 f., commentary on p. 137.27–29). p. 138.14–16: οἷον – ἁρμόζειν: According to Olivieri’s critical apparatus,1516 these lines are not transmitted in the manuscript groups χ, ψ and ω, which implies that only the manuscripts contained in the manuscript group φ, which Olivieri regards as codices optimae notae, transmit these lines. For further discussion of the manuscripts which Olivieri takes into account in his edition, see p. 15 f. Neither Latin translation translates the lines in question.1517 An explanation for the absence of these lines in three manuscript groups might be that the verb ἁρμόζειν appears twice in close proximity (p. 138.13, p. 138.16) as does the noun δίαιτα (p. 138.13: τὴν μὲν δίαιταν λεπτὴν, p. 138.16: τὴν δίαιταν). Some problems might have occurred during the process of copying the text, although this is no actual saut du même au même. It might also be the case that some scribes did not regard these lines as authentic.

1512 See Cornarius, 300. 1513 See Montanus, 240. 1514 See e.g. Galen, De san. tuenda 4.4.16 (109.3 Koch = 6.247.4 K.), Soranus, Gyn. 3.11.4 (100.28 Ilberg), Paul 3.18.3 (Vol. 1, 163.9 Heiberg), Aetius Amid., Libri med. 5.134 (Vol. 1, 110.27 Olivieri). 1515 See e.g. Pseudo-Galen, Def. med. 65 (19.364.1 K.), Galen, De fac. nat. 2.11 (195.3 f. Helmreich = 2.129.9 K.), Diocles fr. 27.78 van der Eijk. 1516 See Olivieri’s critical apparatus to p. 138.14–16. 1517 See Cornarius, 300; Montanus, 240.

VI 8 On mania from (the books of) Archigenes and Posidonius

|

377

p. 138.14–16: οἷον – ἀκρατομέλιτος: The content of these lines is difficult to understand. The noun σεμίδαλις is used elsewhere in medical texts1518 and presumably denotes a wheaten flour. According to Galen’s De victu attenuante, σεμίδαλις is sufficiently nourishing (ἱκανῶς τρόφιμα),1519 an idea which is probably also reflected by the use of the participle τρέφουσαν in the present passage, and thick-humored, sticky, and not suitable for being applied during the thinning diet.1520 The two words which Olivieri excludes in his edition, θασίφορον and θασύγαλα, and which are, according to Olivieri’s critical apparatus, only transmitted in the Codex Parisinus Suppl. gr. 1240 (Pa), are unclear in their meaning. While the word θασίφορος is not listed in the LSJ but does appear in the LBG,1521 the word θασύγαλα is not listed in either of these lexica. The LBG does not give a translation of θασίφορος but suggests that it might denote a potion and cites our present passage in support. The word σεμιδαλιθάσιος is again not listed in the LSJ but in the LBG. However, instead of a translation we are faced with a question mark here.1522 The part of the text is clearly difficult to understand and we cannot be sure what these words actually refer to or what they are supposed to mean. For a discussion of the properties of barley gruel (χυλὸς πτισσάνης), see p. 181, commentary on p. 126.17–19. As far as the word τρόγαλα is concerned, there is again no entry in LSJ or LBG. In his apparatus, Olivieri wonders whether one should instead read τρωγάλια, although this word does not occur in any medical text according to the TLG. The noun ψίξ mostly denotes crumbs of bread.1523 In medical texts, the noun ἀκρατόμελι is only found in this very passage of Aetius according to the TLG, and it seems to denote honey which has not been mixed with any further substances. On the properties of honey, see p. 181, commentary on p. 126.17–19. Apart from these difficulties, we can only conclude that this list of words is supposed to present examples of the previously recommended thinning regimen (see p. 376, commentary on p. 138.13–14). p. 138.16–17: τοιαύτην – δυναμένην: The pronoun τοιαύτην refers to the previously recommended regimen, which was said to be thinning, gruel-like, moist, not irritating, and easing the gastro-intestinal tract (see p. 375 f., commentary on p. 138.13–14). The present passage adds that the regimen should produce the least blood possible. This recommendation seems to be motivated by the fact that blood plays an important role in the onset of mania (see p. 343, commentary on p. 136.19). According to Galen’s De facultatibus naturalibus blood is said to be produced when nourishment is altered in the veins due to an innate heat which is well-balanced, 1518 See e.g. Hippocrates, De diaeta 2.42.3 (166.9 Joly & Byl = 6.542.2 L.) Galen, De alim. fac. 1.2 (27.8 Wilkins = 6.483.17 K.), Paul 7.3 (Vol. 2, 227.14 Heiberg). 1519 See Galen, De vict. att. 6.34 (438.35 Kalbfleisch). 1520 See Galen, De vict. att. 6.34 (438.36 f. Kalbfleisch). 1521 See LBG s.v. θασίφορος: “ein Getränk?”. 1522 See LBG s.v. σεμιδαλιθάσιος: “?”. 1523 See e.g. Paul 3.42.6 (Vol. 1, 235.21 Heiberg), Aetius Amid., Libri med. 5.78 (Vol. 1, 53.16 Olivieri).

378 | Commentary

while the other humors are produced when nourishment is altered in the veins because of innate heat which is imbalanced.1524 This view is also attributed to Hippocrates, Aristotle, Praxagoras and Philotimus.1525 p. 138.17: καὶ – ἀπέχειν: For further discussion of the role that drinking wine might play in the development of mania, see p. 344, commentary on p. 136.20–21, p. 366 f., commentary on p. 137.27–29. p. 138.17–18: τριῶν – ἄνθρωπον: The verb διαιτᾶν takes up the previously used noun δίαιτα, and the particle δὲ ties in with the previously used μὲν, which appeared in connection with the appropriate regimen (see p. 375 f., commentary on p. 138.13–14). The text now turns to what one may call the actual “therapy” of mania. On this interpretation, see p. 374 f., commentary on p. 138.10–12. The phrase τριῶν ἡμερῶν is a very precise instruction regarding the question of how long the physician is supposed to administer this kind of regimen before turning to phlebotomy. I have dealt previously with the fact that such instructions are common in medical texts; see p. 225, commentary on p. 129.23–24. In his account of mania Caelius also states that one may phlebotomize patients on the third day (in ipsa diatrito).1526 The Anonymus Parisinus says that one should phlebotomize on the second day (τῇ … δευτέρᾳ) and take blood again on the third day (τῇ τρίτῃ).1527 See also p. 378 – 380, commentary on p. 138.18–20. p. 138.18–20: τέμνε – κάτω: For a closer look at phlebotomy as one of the most common therapies in ancient medicine, see p. 178 f., commentary on p. 126.11–12. The recommendation to phlebotomize patients suffering from mania is also given by the Anonymus Parisinus,1528 Caelius Aurelianus1529 and Paul.1530 On the precise chronological instructions for phlebotomy, see p. 378, commentary on p. 138.17–18. Caelius criticizes those who claim that in patients suffering from mania one should carry out phlebotomy on both arms, even up to the point of fainting (usque ad animi defectionem), and he states that this view should be ignored.1531 The question of which vein should be used for phlebotomy is discussed in many other texts as well; Galen, in his De curandi ratione per venae sectionem, for example, explicitly demonstrates which veins should be chosen in the case of different affections.1532 Our text regards the veins in the elbow (τῶν ἐν ἀγκῶνι φλεβῶν) as those to use for phlebotomy as a treatment for mania and it further distinguishes

1524 See Galen, De fac. nat. 2.8 (186.15–18 Helmreich = 2.117.11–14 K.). 1525 See Galen, De fac. nat. 2.8 (186.12 f. Helmreich = 2.117.9 f. K.). 1526 See Caelius Aurel., Tard. pass. 1.159 (524.11 f. Bendz). 1527 See Anon. Par. 18.3.1 (114.22 Garofalo). 1528 See Anon. Par. 18.3.1 (114.22 Garofalo), Anon. Par. 18.3.3 (116.1 f. Garofalo). 1529 See Caelius Aurel., Tard. pass. 1.158–159 (524.9–12 Bendz), Tard. pass. 1.174 (532.30–534.2 Bendz). 1530 See Paul 3.14.3 (Vol. 1, 158.16 Heiberg). 1531 See Caelius Aurel., Tard. pass. 1.174 (532.30–534.2 Bendz). 1532 See e.g. Galen, De cur. rat. per venae sect. 16 (11.296.16–299.9 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

379

between the upper vein in the elbow (τὴν ἄνω), the middle vein in the elbow (τὴν μέσην) and the lower vein in the elbow (τὴν κάτω). In general, the elbow is commonly recommended as the area where the physician should conduct the phlebotomy.1533 In his De curandi ratione per venae sectionem, Galen distinguishes between three approaches to conducting phlebotomy at the elbow: an inner, an outer and a middle approach.1534 Some texts also refer to veins in the elbow as outer, inner or middle.1535 In other passages of his work, Aetius states that the upper vein in the elbow is called ὡμιαία (φλέψ).1536 Given that other texts refer to inner, middle and ὡμιαία (φλέψ) as types of veins in the elbow,1537 it becomes clear that what is called the upper vein in our text corresponds to what is called ὡμιαία (φλέψ) or the outer vein in other texts, while what is called lower vein in our text corresponds to what is called inner vein in other texts. From a modern point of view, one can assume that the lower or inner vein corresponds to what today is called the vena basilica, whereas the upper or outer vein corresponds to what is called the vena cephalica, and the middle vein corresponds to the vena mediana.1538 This correspondence is confirmed by the fact that the modern Latin medical terms vena basilica and vena cephalica are derived from the Arabic words al-basilik (inner) and al-kifal (outer). Our text does not explain why it is preferable to cut the upper or outer vein or ὡμιαία (φλέψ), but a number of other texts identify this as the vein which should be cut in order to treat affections of the head.1539 This was probably common knowledge and the author of our text deemed it appropriate to cut this upper vein when treating mania precisely because mania is an affection of the head. Although the upper vein is the preferred vein, the present passage also mentions the possibility of cutting the middle or the lower vein under certain circumstances: the middle vein 1533 See e.g. Galen, De cur. rat. per venae sect. 16 (11.298.10 f. K.), Paul 3.6.2 (Vol. 1, 145.2 Heiberg), Aetius Amid., Libri med. 6.25 (Vol. 2, 169.21 f. Olivieri). 1534 See Galen, De cur. rat. per venae sect. 16 (11.298.10 f. K.). 1535 See e.g. Galen, Meth. med. 13.11 (358.26–360.1 Johnston & Horsley = 10.902.6 f. K.), Meth. med. 13.11 (362.12–14 Johnston & Horsley = 10.904.4–7 K.), Aetius Amid., Libri med. 4.44 (Vol. 1, 387.12–15 Olivieri), Oribasius, Eclog. med. 89.3 (267.9 Raeder). 1536 See Aetius Amid., Libri med. 8.34 (Vol. 2, 447.6 f. Olivieri), Libri med. 8.68 (Vol. 2, 525.30 f. Olivieri), Libri med. 7.8 (Vol. 2, 260.17 f. Olivieri). 1537 See e.g. Galen, Meth. med. 13.11 (358.26–360.1 Johnston & Horsley = 10.902.4–7 K.), Meth. med. 13.11 (362.13 f. Johnston & Horsley = 10.904.5–7 K.), Aetius Amid., Libri med. 4.44 (Vol. 1, 387.12–15 Olivieri), Oribasius, Eclog. med. 89.3 (267.9 Raeder). 1538 See Brain 2009 in Galen On Bloodletting [listed under De curandi ratione per venae sectionem], 91 note 69; Johnston & Horsley 2011 in Galen, Method of Medicine, Books 10–14 [listed under Methodus medendi], 358 note 19. 1539 See e.g. Paul 6.40.2 (Vol. 2, 79.2 f. Heiberg): καὶ ἐπὶ μὲν τῶν περὶ τὴν κεφαλὴν νοσημάτων τὴν ὠμιαίαν τέμωμεν, Galen, De cur. rat. per venae sect. 16 (11.298.12 f. K.): ὁ δὲ ἐκτὸς ἐπὶ τῶν ὑπὲρ τούτων ἢ προσώπου ἢ κεφαλῆς, De const. art. med. 16.10 (110.16 Fortuna = 1.287.3 f. K.): ὅσα δὲ κατὰ κεφαλήν τε καὶ τράχηλον ἐκ τῆς ὠμιαίας, Aetius Amid., Libri med. 4.44 (Vol. 1, 387.12 f. Olivieri): εἰ μὲν οὖν κατὰ κεφαλὴν καὶ τράχηλον μᾶλλον ἐρείδουσιν αἱ ὀδύναι τὴν ὠμιαίαν, καλουμένην φλέβα τέμνειν δεῖ.

380 | Commentary

should be cut in case the upper vein is not visible (εἰ δὲ μὴ φαίνοιτο), and the lower vein can be cut if the middle vein is not visible. Phrases such as εἰ δὲ μὴ φαίνοιτο are also used in other writings as an indication that one has to choose a vein other than that which is actually preferred.1540 In his De curandi ratione per venae sectionem, while dealing with phlebotomy at the veins in the elbow, Galen states quite generally that sometimes one of the veins is distinct (σαφῆ) and the other indistinct (ἀσαφῆ);1541 if the vein which is recommended, is very indistinct and thus cannot be cut then one ought to cut one of the middle veins instead.1542 p. 138.20: μὴ – τούτων: For further discussion of the use of the verb φαίνεσθαι in the context of phlebotomy, see p. 379 f., commentary on p. 138.18–20. Being introduced by this genitive absolute, the following remarks provide information about what the physician is supposed to do if none of the three veins (upper, middle, lower) in the elbow are visible. p. 138.20–21: τὰς – γυναικῶν: The veins near the ankles are also commonly mentioned in other texts as being suitable for phlebotomy.1543 In the present text, this instruction is probably closely connected to the phrase καὶ μάλιστα ἐπὶ γυναικῶν, for we also have evidence in other texts that phlebotomy of the veins near the ankles was regarded as especially beneficial for women. For example, in De curandi ratione per venae sectionem Galen claims that retention of a woman’s menses can be cured by phlebotomy at the ankles (κατὰ τὰ σφυρὰ) or the legs1544 and in De venae sectione adversus Erasistrateos Romae degentes he provides a similar remark when saying that women’s menses are set in motion when phlebotomy is performed near the ankle (παρὰ σφυρὸν).1545 Aetius makes a similar observation in his chapter on the therapy of melancholia, in which he says that in women whose menses are held back one should cut a vein in the ankle (ἐν τῷ σφυρῷ); see p. 468, commentary on p. 147.3–5. The present passage seems to be a further example of this notion that phlebotomy of the veins near the ankles is something to be performed on women who suffer from menstrual retention. Earlier in the chapter it was said that women whose menses are held back are likely to be seized by mania (see p. 368 f., commen1540 See e.g. Galen, Meth. med. 13.11 (362.13 f. Johnston & Horsley = 10.904.4–6 K.): εἰ μὲν ταῦτα πεπόνθοι, τὴν ὠμιαίαν ἐν χειρὶ, καὶ ταύτης μὴ φαινομένης τὴν μέσην, Oribasius, Eclog. med. 89.3 (267.8 f. Raeder): τέμνειν δεῖ τὴν ὠμιαίαν φλέβα· μὴ φαινομένης δὲ ταύτης, τὴν μέσην, Eclog. med. 103.2 (282.31–33 Raeder): δεῖ τέμνοντας ἐν τῷ ἀγκῶνι τὴν ὠμιαίαν καλουμένην φλέβα (εἰ δὲ μὴ φαίνοιτο αὕτη, τὴν εὑρισκομένην), Aetius Amid., Libri med. 12.23 (46.10–12 Kostomiris): φλέβα τεμεῖν, μάλιστα μὲν τὴν κάτω, παραφυλαττομένους τὴν ὑποκειμένην αὐτῇ ἀρτηρίαν, ταύτης δὲ μὴ φαινομένης, τὴν μέσην. 1541 See Galen, De cur. rat. per venae sect. 16 (11.298.17 f. K.). 1542 See Galen, De cur. rat. per venae sect. 16 (11.298.18–299.2 K.): ὅταν οὖν ἀσαφεστέρας οὔσης τῆς οἰκείας τῷ πάσχοντι μορίῳ φλεβὸς, ἐπί τινα τῶν μέσων ἥκῃς, (…). 1543 See e.g. Galen, De trem., palp., convuls. et rig. 5 (61.4 f. Konstantinides = 7.604.4 f. K.), Galen, De cur. rat. per venae sect. 18 (11.305.2 K.), Paul 3.43.4 (Vol. 1, 238.19 Heiberg). 1544 See Galen, Galen, De cur. rat. per venae sect. 11 (11.283.8–10 K.). 1545 See Galen, De venae sect. adv. Erasistrateos 3 (11.204.14–16 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

381

tary on p. 137.29–138.1). In the following sentence it is even explicitly stated that the flow of blood (p. 138.21: τῇ ῥοπῇ) at the ankles brings about menstruation. Bringing about menstruation is beneficial for women because holding it back may cause mania and if one wants to cure women who are already suffering from mania, one should make sure that her menses are not held back. p. 138.21: προτρέπεται – καταμήνια: For further discussion of this issue, see p. 380 f., commentary on p. 138.20–21, and p. 368 f., commentary on p. 137.29–138.1. p. 138.22: εἰ – φαίνοιντο: The pronoun αὗται refers back to the veins near the ankles (see p. 380 f., commentary on p. 138.20–21); for further discussion of the verb φαίνεσθαι in the context of phlebotomy, see p. 379 f., commentary on p. 138.18–20. p. 138.22: τὰς – ποδῶν: Cutting the veins in the hand or the feet (τὰς ἀπ’ ἄκρων χειρῶν ἢ ποδῶν) is also discussed in other texts.1546 In the present passage we receive no further explanation for this choice of veins but it is clear from the order of the listing of veins that the physician should cut that those in the hands or the feet ought to be the last choice for the physician. p. 138.22–23: σπουδαστέον – γενέσθαι: This sentence emphasizes that one should start (πρότερον) the therapy for mania with an evacuation (κένωσιν) which is brought about by cutting a vein (ἀπὸ φλεβὸς), that is to say, by phlebotomy. This statement needs to be understood against the background of the fact that there are also other possible means of evacuation, such as the application of enemata (see p. 181, commentary on p. 126.17–19). In Paul’s account for the therapy of mania, it is explicitly stated that one should purge the patients by applying the bitter holy remedy, after having phlebotomized them first (προφλεβοτομήσαντες).1547 In our passage, the phrase ἀπὸ φλεβὸς (…) κένωσιν does not refer to any specific vein but to the evacuation that follows the opening of any vein quite generally. This statement also explains why the text deals in detail with the different veins the physician ought to cut if the preferred veins are not visible (see p. 379 f., commentary on p. 138.18–20); phlebotomy seems to be regarded as an important starting point of the therapy for mania. The phrase γενναίαν κένωσιν probably denotes an “excellent” evacuation in the sense of an evacuation which perfectly, i.e. sufficiently, evacuates what it is supposed to. There seems to be no parallel of characterizing an evacuation as γενναῖον in other medical texts. p. 138.23–24: καὶ – ποιεῖσθαι: The noun ἐπιμέλεια takes up the verb ἐπιμελεῖσθαι which was used earlier in the chapter (see p. 374 f., commentary on p. 138.10– 12). For a general discussion of the term πεπονθὼς τόπος, see Gärtner 2015 in Galeni De locis affectis, 453 f. It is interesting that Archigenes, who is claimed to be cited in the present chapter (see p. 342, commentary on p. 136.18), is said by Galen to have written a treatise dealing with “affected parts”.1548 One might be inclined to think

1546 See e.g. Galen, De cur. rat. per venae sect. 14 (11.295.5 K.), Aretaeus 6.2.5 (121.25–28 Hude). 1547 See Paul 3.14.3 (Vol. 1, 158.16 Heiberg). 1548 See Galen, De cris. 2.8 (145.1 f. Alexanderson = 9.670.10 f. K.).

382 | Commentary

that the mention of the affected parts in the present passage can be traced back to him. However, the present use of the phrase τῶν πεπονθότων μερῶν is difficult to understand, given that there has been no explicit discussion of affected parts in the chapter so far. We only learned in the opening of the chapter that mania is brought about by processes in the brain (see p. 343, commentary on p. 136.19), which leads to the conclusion that the brain is thought to be the affected part in mania. In the present passage, the focus is not on the assumption that phlebotomy is taking care (ἐπιμέλεια) of the affected parts but, rather, that it is taking care of the processes which are linked to them. p. 138.24–25: τέμνοντα – χρή: For a closer look at phrases such as πρὸς δύναμιν in the context of phlebotomy, see p. 225, commentary on p. 129.23–24. p. 138.25–26: ἀποσβεννυμένου – φλογώδους: The genitive absolute ἀποσβεννυμένου γὰρ τοῦ φλογώδους metaphorically describes the process of cooling down that which is very hot. The adjective φλογώδης describes something as being as hot as a flame (φλόξ) and is used elsewhere in medical texts, for example to characterize nouns such as θερμότης or θερμασία (heat, warmth).1549 Both Latin translations of our text use the noun fervor in their translations of τοῦ φλογώδους.1550 In the present passage, the noun φλογώδης presumably refers to blood and yellow bile, which were said to cause mania (see p. 343, commentary on p. 136.19, p. 343 f., commentary on p. 136.20–21, p. 345, commentary on p. 136.21), and which are commonly thought of as being hot.1551 As regards yellow bile, it is even said to be “overheated” (ὑπεροπτωμένης) in the present chapter (see p. 355 f., commentary on p. 137.9). Interestingly, in the Aristotelian Physiognomonica it is stated that patients suffering from mania (μανικοί) are recognizable by their complexion, which is said to be “fiery-red” (φλογοειδές).1552 The position of the genitive absolute in the present chapter and the use of the particle γὰρ together suggest that the quenching (ἀποσβεννυμένου) of that which is very hot (i.e. the reduction of the effect blood and yellow bile, which are both hot, have on the human body) is thought to be brought about by the previously discussed phlebotomy (p. 138.18–25). The notion that phlebotomy is capable of “quenching” can be found in other texts as well. In Galen’s In Hippocratis Aphorismos comentarii it is, for example, said that in very warm fevers, phlebotomy that is carried out until the point of fainting immediately causes cooling (κατάψυξιν) of the whole condition and “quenches” (σβέννυσι) the fever.1553 In Theophilus’ Scholia in 1549 See e.g. Galen, De loc. aff. 4.10 (8.278.12 K.), In Hipp. Aph. comm. 2.47 (17b.551.14 K.), Paul 2.14 (Vol. 1, 95.21 Heiberg). 1550 See Cornarius, 300; Montanus, 240. 1551 See e.g. Diocles fr. 27.77 van der Eijk, Galen, De inaequ. intemp. 4 (154.9 f. García Novo = 7.741.1–3 K.), Pseudo-Galen, Def. med. 65 (19.364.1 K.). 1552 See Pseudo-Aristotle, Physiogn. 6 (812a22–25 = chapter 69, 74.11–14 Foerster). For further discussion of this passage, see also Ahonen 2014, 93. 1553 See Galen, In Hipp. Aph. comm. 1.23 (17b.445.18–446.3 K.).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

383

Hippocratis Aphorismos it is even said that phlebotomy “quenches” (κατασβέννυσι) the flame-like (φλογώδη) and sharp quality.1554 p. 138.26: παραχρῆμα – γίγνονται: According to the TLG, the adjective ἐπιστατικός or the adverb ἐπιστατικῶς only appear twice in the medical literature apart from the usage in the present passage.1555 Here it seems to denote that the patients regain control of themselves (they literally “preside over themselves”) and are “sound of mind” again. Such a meaning is also suggested by both Latin translations; Cornarius translates considerantes fiunt,1556 while Montanus translates confestim recreant.1557 In Galen’s Linguarum seu dictionum exoletarum Hippocratis explicatio, the adjective ἐπιστατικὴ appears in a list of adjectives which explain the adjective ἐπίστημος (knowing, wise).1558 In the present passage, the line of thought is presumably that through counteracting the heat of blood and yellow bile (see p. 382 f., commentary on p. 138.25–26), some of the symptoms that make patients mentally deranged when they are suffering from mania subside. p. 138.26–27: ἅμα – βοηθήμασιν: This part of the sentence presents a further consequence of the “quenching of that which is hot as a flame”, that is to say of phlebotomy (see p. 382 f., commentary on p. 138.25–26). The phrase τοῖς ἄλλοις βοηθήμασιν refers to other therapeutical approaches besides phlebotomy and the noun χώρα expresses that there is “room for”1559 such approaches. This seems to refer to the previous statement that one should conduct phlebotomy first (see p. 381, commentary on p. 138.22–23). According to the present passage, phlebotomy is obviously thought of as putting the patient in a condition in which he is susceptible to other treatments as well. p. 138.27–29: ἐπειδὴ – ἁλίσκεσθαι: The pronoun τινες refers to the patients suffering from mania. For further discussion of the noun ἀφαίρεσις (removal of blood), see p. 322, commentary on p. 135.9–10. The “first removal of blood” (ἐν μὲν τῇ πρώτῃ ἀφαιρέσει), that is to say the first time that phlebotomy is conducted on a patient, is contrasted with further removals (ἐν δὲ ταῖς μετὰ ταῦτα ἐπαφαιρέσεσιν). The noun ἐπαφαίρεσις is a technical term for any further removal of blood.1560 Aetius dedicates a chapter of his third book to these “further removals” and claims to cite Galen in this regard.1561 The Anonymus Parisinus also uses the verb ἐπαφαιρεῖσθαι

1554 See Theophilus, Scholia in Hippocratis Aphorismos (Vol. 2, 291.18–20 Dietz). 1555 See Ioannes Actuarius, De spiritu animali proem 1.5 (Vol. 1, 313.17 Ideler), Galen, Ling. s. dict. exolet. expl. ε 65 (200.11 Perilli = 19.99.15 K.). 1556 See Cornarius, 300. 1557 See Montanus, 240. 1558 See Galen, Ling. s. dict. exolet. expl. ε 65 (200.11 Perilli = 19.99.15 K.). 1559 See also the Latin translations of this passage. Cornarius, 300: simul autem atque locus aliis auxiliis datur. Montanus, 240: simulque reliquis praesidiis locus relinquitur. 1560 See e.g. Galen, De cur. rat. per venae sect. 1 (11.251.17–18 K.): ἐπὶ τινῶν μὲν ἅπαξ ἀφαιρεῖν ἄμεινον, ἐπὶ τινῶν δὲ τὴν καλουμένην ἐπαφαίρεσιν ποιεῖσθαι προσήκει (…). 1561 See Aetius Amid., Libri med. 3.17 (Vol. 1, 275.11–22 Olivieri).

384 | Commentary

in the context of phlebotomy in his section on the therapy of mania1562 and Caelius states that one may remove blood repeatedly (aliquoties adhibita detractione) in patients suffering from the affection.1563 The first half of the present sentence is dedicated to the first removal of blood, which the patients are said to endure (φέρουσι τὴν κένωσιν)1564 “excellently” (γενναίως). The adjective γενναῖον was also used previously in the context of evacuation (see p. 381, commentary on p. 138.22– 23); in the present context it seems to denote that the patients endure the removal of blood excellently. This is contrasted with the fainting (λειποθυμίαις ἁλίσκεσθαι) that occurs as a consequence of further removals of blood. Indeed, it may even be the case that “to endure excellently” means no more than to remain conscious. For a closer look at the usage of the noun λειποθυμία in the context of phlebotomy see p. 179 f., commentary on p. 126.12; see further on this issue p. 322, commentary on p. 135.7–9. p. 138.29–139.1: προσήκει – ἀπαιτεῖ: It is clear from this part of the sentence that the author of our text does not aim to phlebotomize the patients to the point of fainting (see p. 179 f., commentary on p. 126.12). Rather, he recommends only a single phlebotomy for those patients who might become unconscious during any further removal of blood and to remove as much (blood) as is necessary (ὅσον ἡ χρεία ἀπαιτεῖ) during this first removal. Phrases such as ὅσον ἡ χρεία ἀπαιτεῖ are also used in other medical texts1565 and they take into account the notion that the physician should act in accordance with each individual case rather than taking a generalized approach. p. 139.1–2: συγκενοῦνται – πνεύματος: The verb συγκενοῦσθαι is not frequently used in medical texts;1566 in the present passage, its subjects are, presumably, the patients, since Olivieri’s reading συγκενοῦνται is the lectio difficilior in comparison to the reading συγκενοῦται, which is found in the Codex Parisinus Suppl. gr. 1240 (Pa), Codex Vaticanus Palatinus 199 (Px), Codex Athous Λαύρας 718 Ω 63 (A) and the manuscript group ω, according to Olivieri’s critical apparatus,1567 and which would fit better with πολὺ. However, the πολὺ should probably be understood as an accusative of respect here. The phrases πνεῦμα φυσώδης and πνεῦμα ἀτμῶδες are very similar in meaning; a passage in Galen’s De symptomatum causis even uses them synonymously: in this passage, Galen explains that the vaporous pneuma is pro-

1562 See Anon. Par. 18.3.1 (114.22 Garofalo). 1563 See Caelius Aurel., Tard. pass. 1.158 (524.10 f. Bendz). 1564 For other passages, which use this phrase to denote that the patients “endure the evacuation”, see e.g. Galen, De cur. rat. per venae sect. 21 (11.312.4 K.), Alexander, Therapeutica 1.17 (Vol. 1, 595.10 Puschmann), Aetius Amid., Libri med. 5.99 (Vol. 2, 87.16 f. Olivieri). 1565 See e.g. Paul 6.40.1 (Vol. 2, 78.9 f. Heiberg), Aetius Amid., Libri med. 3.181 (Vol. 1, 353.7 Olivieri), Oribasius, Coll. med. rel. 45.18.5 (Vol. 3, 172.19 Raeder). 1566 See e.g. Galen, An in art. 4 (6.24 f. Albrecht = 4.712.16 f. K.), Alexander, Therapeutica 1.17 (Vol. 1, 595.9 Puschmann), Therapeutica 1.17 (Vol. 1, 595.20 Puschmann). 1567 See Olivieri’s critical apparatus to p. 139.1.

VI 8 On mania from (the books of) Archigenes and Posidonius

|

385

duced in the stomach (κατὰ τὴν γαστέρα) when “certain phlegmatic humors or foods are dissolved to vapors right there by deficient heat”.1568 Later in this passage, he uses the phrase “flatulent pneuma”.1569 In the present context, the evacuation of vaporous and flatulent pneuma is presumably thought to be beneficial because it was mentioned earlier in the chapter that a rise of vapors (ἐκ τῶν γιγνομένων ἀναθυμιάσεων) brings about symptoms of mania (see p. 350, commentary on p. 136.27– 137.1) and that those who suffer from indigestion or retention are prone to suffer from mania (see p. 367 f., commentary on p. 137.27–29). A similar idea is discussed in Alexander’s account of melancholia, in which he states that when the physician evacuates all at once (ἡ ἀθρόα κένωσις) this causes something of the pneuma which sends up the vapors (τι … τοῦ ἀναπέμποντος τοὺς ἀτμοὺς πνεύματος) to be emptied as well (συγκενοῦσθαι) and to be dispersed (διαπνεῖσθαι).1570 p. 139.2–3: δεῖ – αἷμα: The phrase ἅπτεσθαι τῶν σφυγμῶν is used elsewhere in medical texts to denote feeling and observing the pulse.1571 In a chapter of his fifth book dealing with indications that can be gleaned from the pulse of the patients, Aetius explicitly states that it is important to feel the pulse (πρὸ πάντων ἅπτεσθαι δεῖ τῶν σφυγμῶν).1572 When feeling the pulse, it is possible to notice irregularities or abnormalities which may be harmful for the patient or an indication of an affection. The phrase ἐν τῷ ῥεῖν τὸ αἷμα in the present passage presumably refers to the flowing of blood caused by the opening of a vein during a phlebotomy. See further on this issue also p. 385 f., commentary on p. 139.3–4. p. 139.3–4: καὶ εἰ – ἐπαφαιρέσεις: The conditional clause εἰ καταπίπτοιεν denotes a possible change of the pulse, namely its falling. The verb καταπίπτειν is used in relation to the pulse in some other medical texts where it denotes the falling of the pulse.1573 In a discussion of physicians who “limit the amount of the evacuation [τὸ ποσὸν τῆς κενώσεως] by the signs [ἐπὶ σημείοις]”,1574 Galen also mentions the falling of the pulse to atonia (εἰ καταπίπτοιεν εἰς ἀτονίαν οἱ σφυγμοὶ) as one of these signs.1575 In the present passage, the falling of the pulse is presented as an indication for a further removal of blood (ταμιεύεσθαι εἰς ἐπαφαιρέσεις; on the term ἐπαφαίρεσις, see p. 383 f., commentary on p. 138.27–29). Accordingly, the physician is supposed to stop the first removal and to continue at later time. The verb ταμιεύε1568 See Galen, De sympt. caus. 3.6 (7.239.9–12 K.). I quote Johnston’s translation here. See Johnston 2006 in Galen On Diseases and Symptoms, 286. 1569 See Galen, De sympt. caus. 3.6 (7.240.4 K.). 1570 See Alexander, Therapeutica 1.17 (Vol. 1, 595.8–10 Puschmann). 1571 See e.g. Galen, De loc. aff. 4.11 (8.293.13 K.), Aetius Amid., Libri med. 5.27 (Vol. 2, 18.16 Olivieri), Paul 6.40.4 (Vol. 2, 80.16 Heiberg). 1572 See Aetius Amid., Libri med. 5.27 (Vol. 2, 18.16 Olivieri). 1573 See e.g. Paul 2.9.1 (Vol. 1, 80.1 Heiberg), Galen, De venae sect. adv. Erasistrateos 4 (11.217.2 f. K.), Ad Glauc. 1.16 (438.23 f. Johnston = 11.67.1 K.). 1574 See Galen, De venae sect. adv. Erasistrateos 4 (11.216.18–217.1 K.). I quote Brain’s translation here; see Brain 2009 in Galen On Bloodletting, 52. 1575 See Galen, De venae sect. adv. Erasistrateos 4 (11.217.2 f. K.).

386 | Commentary

σθαι is also used in other texts in the context of phlebotomy; in Galen’s De curandi ratione per venae sectionem the expression προσήκει ταμιεύεσθαι τὴν κένωσιν is used1576 and a very similar phrase (ταμιεύεσθαι δεῖ τὴν κένωσιν) is also found in Paul’s compilation,1577 to mention just two examples. See also p. 386, commentary on p. 139.4–6. p. 139.4–6: πολλάκις – τρίτῃ: This sentence is linked to the previous one, insofar as it implicitly explains in what sense the falling of the pulse is an indication for a further removal (see also p. 385 f., commentary on p. 139.3–4). The falling of the pulse is obviously linked to a loss of the patient’s strength (δύναμις) as it is the restoring (ἀνακτησάμενοι)1578 of the patients’ strength that makes it possible to undertake a further removal on the second or the third day. For further discussion of the importance of the patients’ strength for undertaking therapeutical approaches, see p. 225, commentary on p. 129.23–24. For further discussion of specifications of time in medical literature, as τῇ δευτέρᾳ τῶν ἡμερῶν and τῇ τρίτῃ in the present passage, see p. 225, commentary on p. 129.23–24. p. 139.6: φυλάξαντες – ἐπιθέσει: The theoretical framework that underlies this statement is presumably the application of salt as a kind of plaster. Such a notion is reflected in, for example, Galen’s De compositione medicamentorum per genera, which deals with sharp plasters (δριμέων ἐμπλάστρων) to which kind the “so-called (plasters) out of salt” (αἱ καλούμεναι δι’ ἁλῶν) also belong.1579 In a chapter of Aetius’ second book, when dealing with salts (ἅλες), he writes that salts prevent decay (ἄσηπτα φυλάττουσι) of that which would otherwise rot because of great moisture.1580 Along these lines, we should assume that the application of salt in the present passage is recommended for disinfectant purposes. p. 139.6–8: ἐμβρέχειν – μηλίνῳ: For a closer look at the application of embrocations, see p. 181 f., commentary on p. 126.19. The Anonymus Parisinus also recommends applying embrocations of rose oil to patients suffering from mania1581 and Paul states that one should apply rose oil and rose oil mixed with vinegar (ὀξυρόδινον).1582 For a closer look at the properties of rose oil (ῥόδινον), see p. 181 f., commentary on p. 126.19, and for rose oil mixed with vinegar (here: ῥόδινον σὺν ὄξει), see p. 322 f., commentary on p. 135.10–11. For a closer look at the properties of knotgrass (πολύγονον) and ivy (κισσός), see p. 323, commentary on p. 135.11. For the 1576 See Galen, De cur. rat. per venae sect. 12 (11.286.12 K.). 1577 See Paul 6.40.3 (Vol. 2, 79.21 Heiberg). 1578 The verb ἀνακτᾶσθαι is often used in medical texts. See e.g. Galen, De loc. aff. 1.6.9 (288.19 f. Gärtner = 8.54.8 K.),De cur. rat. per venae sect. 6 (11.269.14 f. K.), Dioscorides, De mat. med. 3.31.2 (Vol. 2, 41.3 f. Wellmann), Paul 6.50.3 (Vol. 2, 89.7 Heiberg), Oribasius, Coll. med. rel. 8.6.37 (Vol. 1, 260.33 f. Raeder). 1579 See Galen, De comp. med. per gen. 2.5 (13.501.11–13 K.). 1580 See Aetius Amid., Libri med. 2.43 (Vol. 1, 169.16 f. Olivieri). 1581 See Anon. Par. 18.3.1 (114.20 Garofalo): ἐμβρεκτέον δὲ τὴν κεφαλὴν ῥοδίνῳ. 1582 See Paul 3.14.3 (Vol. 1, 158.15 f. Heiberg): ἰδίως δὲ τῇ κεφαλῇ τούτων ῥόδινόν τε καὶ ὀξυρόδινον προσοίσομεν.

VI 8 On mania from (the books of) Archigenes and Posidonius

|

387

properties of wild-vine flower (οἰνάνθινον), see p. 323 f., commentary on p. 135.11– 13, and for a general look at oil (ἔλαιον) as part of a remedy, see p. 229, commentary on p. 130.5–6. On quinces (μῆλον), see p. 232, commentary on p. 130.10–12. p. 139.8–9: ῥυπαρὸν – βρέγματι: The phrase ῥυπαρὸν ἔριον (greasy wool) seems to be a technical term for a special kind of wool, since it is also used as such in other texts;1583 Aetius dedicates one chapter of his second book to this kind of wool, where he states that wool which is called ῥυπαρόν or οἰσυπηρόν is useful for ἐπιβροχαί (“wetting”;1584 probably something like the embrocations which are recommended in the present passage), in part at least, because of the dirt (διὰ τὸν ῥύπον) it still carries.1585 In his Methodus medendi, Galen refers to unwashed wool (ἔριον ἄπλυτον) as “that which is called greasy wool (οἰσυπηρόν)”.1586 In Dioscorides’ De materia medica, it is stated that one calls οἴσυπος (grease) the animal fat (λίπος) that is taken from greasy wool (ἐκ τῶν οἰσυπηρῶν ἐρίων).1587 The advice to continuously renew (συνεχέστερον νεαροποιεῖσθαι) the wool that one applies to the head is found in other texts as well.1588 p. 139.9–10: παντὶ – μηχανητέον: The reason it is advised that the physician needs to provide for sleep (ὕπνος) by all means (παντὶ δὲ τρόπῳ) is explained in the following lines (see p. 387 f., commentary on p. 139.10–12). The use of the verbal adjective μηχανητέον is interesting here, because in other texts this verb and its derivatives are used to express urgency. In a few other texts, as well as in the present passage, the verbal adjectives μηχανητέον or ἐπιμηχανητέον are connected with phrases such as ἐκ παντός1589 or πάντα τρόπον1590 which all express the urgency of the advice that one should follow “by all means” or “in every way”. The phrase μετὰ τὴν κένωσιν refers to the time after the actual removal of blood. p. 139.10–12: κενωθέντος – ἀποτελεῖ: The genitive absolute κενωθέντος γὰρ τοῦ αἵματος refers to the previous discussion about the removal of blood (see p. 138.17–139.6). The present passage explains the previous statement that one should ensure that the patients sleep (see p. 387, commentary on p. 139.9–10). Sleeplessness is said to make the patients sharper (δριμυτέρους) and wilder (ἀγριωτέρους). 1583 See e.g. Galen, De comp. med. sec. loc. 2.2 (12.567.12 f. K.), De comp. med. sec. loc. 2.2 (12.578.5 K.), De comp. med. per gen. 2.19 (13.545.17 f. K.), Paul 4.44.6 (Vol. 1, 364.20 Heiberg), Alexander, Therapeutica 5.4 (Vol. 2, 185.1 Puschmann), Aetius Amid., Libri med. 2.159 (Vol. 1, 210.31 Olivieri). 1584 LSJ s.v. ἐπιβροχή. 1585 See Aetius Amid., Libri med. 2.159 (Vol. 1, 210.31–211.3 Olivieri). 1586 See Galen, Meth. med. 14.7 (454.10 f. Johnston & Horsley = 10.965.7 f. K.). 1587 See Dioscorides, De mat. med. 2.74.1 (Vol. 1, 148.22 f. Wellmann). 1588 See e.g. Aetius Amid., Libri med. 6.28 (Vol. 2, 172.29–173.1 Olivieri): δεῖ δὲ πολλάκις νεαροποιεῖν τὴν ἐμβροχήν, Libri med. 8.77 (Vol. 2, 554.3 f. Olivieri): ἡ δὲ τῷ θώρακι προσαγομένη κηρωτὴ καθ’ ἑκάστην δεύτερον νεαροποιείσθω, Libri med. 12.1 (11.7 f. Kostomiris): νεαροποιεῖν δὲ χρὴ τὴν ἐμβροχὴν καθ’ ἡμέραν. 1589 See Anon. Par. 12.3.2 (86.18 f. Garofalo). 1590 See Aetius Amid., Libri med. 16.10 (286.19 f. Romano = 14.8 f. Zervos): καὶ πάντα τρόπον μηχανητέον ἀλύπως καὶ δίχα σπασμοῦ ἐκκενωθῆναι τὸ λυποῦν.

388 | Commentary

The adjective δριμύς was used earlier in the chapter to characterize the blood that causes mania (see p. 359, commentary on p. 137.15–18). In general, the remark that the patients become sharper and wilder when they are sleepless, seems to refer to the previous discussion about the form of mania that is brought about by blood being mixed with yellow bile, and which was said to cause the patients to become more aggressive (see p. 353 f., commentary on p. 137.6–7, p. 354 f., commentary on p. 137.7–8, p. 357, commentary on p. 137.11–12, p. 357 f., commentary on p. 137.12– 13). Sleeplessness was also mentioned as one possible prelude of mania (see p. 370 f., commentary on p. 138.5–6). For a discussion of further texts that connect mania to sleeplessness, see p. 370 f., commentary on p. 138.5–6. p. 139.12–14: διὸ – ὕδατι: The participle θαρροῦντες is also used in other medical passages in connection with the recommendation to apply or administer remedies.1591 Its purpose seems to be to encourage the physician to accept that the therapeutic approach recommended here is the right way to proceed. The application of the hypnotic remedy made of poppyhead (τὸ διὰ τῶν κωδιῶν ὑπνωτικὸν φάρμακον) is a very common method for inducing sleep in patients; it was also recommended in the chapter on phrenitis (p. 127.10–11). The reference to the chapter on phrenitis is made explicit in the reading of the Codex Vaticanus Palatinus 199 (Px), which, according to Olivieri’s critical apparatus, actually adds the phrase καὶ προεγράφη ἐν τῶ περὶ φρενίτιδος λόγω after the mention of the ὑπνωτικὸν φάρμακον.1592 For a closer look at the properties of poppyhead (κωδία), see p. 183, commentary on p. 127.4–5. For a closer look at the juice of barley-gruel (χυλὸς πτισσάνης), see p. 181, commentary on p. 126.17–19, and for a discussion of the juice of rice-wheat see p. 193, commentary on p. 128.1–3. The participle πινομένῳ presumably means that water needs to be drunk; the same phrase was also used in Aetius’ chapter on phrenitis.1593 p. 139.14–15: ἀσμενὲς – ὑπνωτικοῦ: This sentence is not entirely clear. According to the TLG, the adjective ἀσμενές is only used twice in the extant Greek literature, once in the present passage and once in the Aristotelian Physiognomonica.1594 Much more common is the adjective ἄσμενος, from which ἀσμενές probably derives as a corrupted form.1595 In the present context, it might imply that the following conditional clause has a positive effect, but even on this reading the meaning is not entirely clear. It is likewise unclear to what the phrase μετὰ ταῦτα is supposed to refer, since it could refer either to phlebotomy (see also p. 387, commentary on p. 139.9–10) or to the application of the hypnotic remedy (see p. 388, commentary on 1591 See e.g. Galen, De comp. med. per gen. 1.4 (13.391.4 f. K.), Aetius Amid., Libri med. 9.30 (340.18 Zervos), Alexander, Therapeutica 8.2 (Vol. 2, 357.29 f. Puschmann). 1592 See Olivieri’s critical apparatus to p. 139.13. 1593 See Aetius Amid., Libri med. 6.2 (Vol. 2, 127.19 Olivieri). 1594 See Pseudo-Aristotle, Physiogn. 3 (807b35). In his edition of this text Foerster reads ἀσθενής instead of ἀσμενὲς (see chapter 18, 32.2 Foerster). 1595 See also LSJ s.v. ἀσμενής.

VI 8 On mania from (the books of) Archigenes and Posidonius |

389

p. 139.12–14). Given that it is stated that most patients defy all hypnotics (περιφρονοῦσι παντὸς ὑπνωτικοῦ), one might assume that μετὰ ταῦτα indeed refers to the application of the hypnotic remedy: if the patient does not immediately respond well to the remedy, it is also good if sleep occurs after the application. However, the main point of this sentence is that it is important to bring about sleep. The verb περιφρονεῖν is used to denote defying either an illness or a remedy in a few other medical passages.1596 p. 139.15–17: διὸ – κοχλιάριον: One should presumably add δόσιν to τὴν πρώτην; the text, thus, deals with the first dose of the hypnotic remedy made of poppyhead. This sentence is still concerned with the fact that patients often defy the hypnotic remedies (see p. 388 f., commentary on p. 139.14–15) and this is the reason why the physician is advised to administer the remedy again, even if it seems to have already taken effect after the first dose. For further discussion of the verb διαλείπειν, which is similar in meaning to the noun διάστημα, see p. 322, commentary on p. 135.9–10. For a closer look at the remedy made of poppyhead, see p. 388, commentary on p. 139.12–14. For further passages which use the common phrase ὅσον κοχλιάριον (“as much as fits on a spoon”) see p. 186, commentary on p. 127.10–12. p. 139.17–19: εἴωθε – διαίτης: It is difficult to understand to what the μόνη here is supposed to refer. Given that the hypnotic remedy made of poppyhead is discussed in detail around these lines (see p. 388, commentary on p. 139.12–14), it seems reasonable to read μόνη as referring to κωδία (poppyhead) being the main ingredient of the hypnotic remedy. The phrase τέλεια ἀποκατάστασις is used a few more times in Aetius.1597 In the present context, it probably does not refer to recovery from mania but, rather, to recovery from sleeplessness (ἀγρυπνία), which is discussed in detail in this section (see p. 387 f., commentary on p. 139.10–12, p. 388, commentary on p. 139.12–14, p. 388 f., commentary on p. 139.14–15, p. 389, commentary on p. 139.15–17). Indeed, the treatment of mania includes far more approaches than just the application of the hypnotic remedy made of poppyhead and the phrase τέλεια ἀποκατάστασις does not, therefore, seem to refer to mania in general. The phrase μετὰ τῆς προσηκούσης διαίτης does not receive any further explanation but it might even refer to the regimen that was discussed at the beginning of the section on the appropriate therapy; see p. 375 f., commentary on p. 138.13–14. p. 139.19–20: παραφυλάττεσθαι – αἴσθησιν: One would expect μή or ὅπως μή after the infinitive παραφυλάττεσθαι, which is also the construction Aetius applies

1596 See Theophilus, Scholia in Hippocratis Aphorismos (Vol. 2, 267.1 f. Dietz): περιφρονεῖ τοῦ νοσήματος, Alexander, Therapeutica 1.15 (658.24 Guardasole = Vol. 1, 553.22 f. Puschmann): ὥστε περιφρονεῖν τῶν ἐπιεικεστέρων βοηθημάτων. 1597 See Aetius Amid., Libri med. 6.28 (Vol. 2, 175.21 Olivieri), Libri med. 7.103 (Vol. 2, 359.1 Olivieri), Libri med. 7.112 (Vol. 2, 378.17 Olivieri), Libri med. 15.15 (96.7 Zervos).

390 | Commentary

in other parts of his work.1598 The pronoun αὐτὴν here presumably again refers to the poppyhead (κωδία) and thus to the hypnotic remedy made from it (see also p. 389, commentary on p. 139.17–19). The reason one should be careful in administering this remedy continuously is the numbing effect it is said to have on sense-perception (ναρκοῖ γὰρ τὴν αἴσθησιν). A similar notion is also reflected in a passage of Galen’s Methodus medendi, in which he says that one should apply embrocations made of poppyhead, and a little later this is said to be necessary because one has to make the ἡγεμονικόν sleep (καρῶσαι) and numb it (ναρκῶσαι).1599 In Alexander’s account of phrenitis, it is said that one should not apply the remedy which is made of poppyhead, or any other of those which are able to bring on sleep or to numb (ἢ ἄλλο τι τῶν καρῶσαι καὶ ναρκῶσαι δυναμένων), if the patient is not suffering from the real phrenitis.1600 The reason for being careful in the present passage might be that the aim of the remedy is not to numb the patient’s senses but to prevent them from being sleepless insofar as sleeplessness might cause mania to intensify. p. 139.20–21: σπουδαστέον – κλυστήρων: For further discussion of the term εὔλυτος κοιλία, see p. 263, commentary on p. 132.24–25. The application of enemata is discussed in more detail on p. 181, commentary on p. 126.17–19. In the present context, the recommendation to make the stomach relaxed (εὔλυτον) could be read in the light of the link made between mania and indigestion and retention earlier in the chapter (see p. 367 f., commentary on p. 137.27–29). The advice to use enemata in patients suffering from mania is also found in the Anonymus Parisinus’ and in Caelius’ account of the affection.1601 p. 139.21–22: τούτων – ἐνθένδε: The genitive absolute τούτων προγεγενημένων seems to refer to the fulfillment of all the therapeutic recommendations given so far in the present chapter, starting from p. 138.10. Cornarius translates the genitive absolute with the Latin ablative absolute his autem factis1602 while Montanus translates his peractis.1603 Given that the text mentions the application of local remedies (τῶν τοπικῶν βοηθημάτων) after the fulfillment of the previously mentioned therapeutic approaches, one might assume that the remarks so far were supposed to be taking into account the complete body of the patients, while the local remedies are concerned specifically with the affected part. The phrase τοπικὰ βοηθήματα already appears in Soranus.1604 Galen explicitly states that such local remedies are to be

1598 See e.g. Aetius Amid., Libri med. 7.64 (Vol. 2, 317.1 Olivieri), Libri med. 7.93 (Vol. 2, 339.27 f. Olivieri), Libri med. 16.16 (292.20 f. Romano = 18.4 f. Zervos). 1599 See Galen, Meth. med. 13.21 (402.22–404.1 Johnston & Horsley = 10.930.15–931.4 K.). 1600 Alexander, Therapeutica 1.13 (624.4–8 Guardasole = Vol. 1, 517.22–26 Puschmann). 1601 See Anon. Par. 18.3.2 (114.24 f. Garofalo): ὑπακτέον δὲ καὶ τὴν κοιλίαν δριμεῖ κλυσμῷ, Caelius Aurel., Tard. pass. 1.159 (524.16 f. Bendz): proluendus denique etiam clystere simplici, si passio poposcerit. 1602 See Cornarius, 301. 1603 See Montanus, 241. 1604 See Soranus, Gyn. 3.15.4 (103.31 Ilberg), Gyn. 3.19.1 (106.18 Ilberg).

VI 8 On mania from (the books of) Archigenes and Posidonius

|

391

applied to the affected part (ὁ πεπονθὼς τόπος). The following advice to cut a vein in the patient’s face (see p. 391, commentary on p. 139.22–23) which is close to the brain, matches the remark put forward in the opening of the present chapter that the brain is the part of the body which is affected by mania (see p. 343, commentary on p. 136.19). p. 139.22–23: αἷμα – μεσαιτάτης: For further discussion of the reason why the text turns to phlebotomy once again, when it had already been discussed in detail previously, and recommends taking blood from veins in the forehead (ἐν μετώπῳ), see p. 390 f., commentary on p. 139.21–22. The participle κυρτουμένων, characterizing the veins to be cut, refers to those veins which are visible because they stick out. In Alexander’s Therapeutica, this verb is used to describe veins in the face which bulge after the physician ties the throat with a string,1605 and in Galen’s Methodus medendi it is said that arteries are made to bulge (κυρτωθῆναι) when the physician binds the arm.1606 p. 139.23–25: φλεβοτόμῳ – τρωθέντος: The nouns φλεβότομον and ἐπικρουστικόν seem to describe two different kinds of surgical instruments, which can be used in order to carry out the incision of the vein from which one wishes to take blood. While the noun φλεβότομον is used in other texts as well in order to denote a surgical instrument,1607 the TLG lists no further occurrences of the noun ἐπικρουστικόν in the extant Greek literature. This fact makes it difficult to trace back the clause ὥς τινες ποιοῦσι to specific authors. Cognates of ἐπικρουστικόν, such as ἐπικρούειν, ἐπίκρουσις or ἐπίκρουσμα do appear in the medical literature and are often used in relation to words such as σφύρα or δάκτυλος, as well as in phrases such as ἐπικρούοντες τῇ σφύρᾳ1608 (“tapping with a hammer”) or ἐν τῇ τῶν δακτύλων ἐπικρούσει1609 (“tapping of the fingers”). It has been suggested that these phrases refer to the socalled medical percussion,1610 which is a practice still used in medicine today. In a passage of Galen’s Methodus medendi the verb ἐπικρούειν is used in the context of dividing the cranium, and the physician is advised to “tap it [the dura mater] with a small hammer [ἐπικρούων τῇ μικρᾷ σφύρᾳ ] and, in this way, divide the cranium [διαιρεῖν οὕτω τὸ κρανίον]”.1611 I have doubts about whether this tapping is actually 1605 See Alexander, Therapeutica 1.13 (622.4 Guardasole = Vol. 1, 515.17 f. Puschmann). 1606 See Galen, Meth. med. 5.7 (44.5–7 Johnston & Horsley = 10.334.9–11 K.). 1607 See e.g. Galen, Ling. s. dict. exolet. expl. μ 10 (232.12 Perilli = 19.120.9 K.), Ling. s. dict. exolet. expl. π 57 (250.21 Perilli = 19.133.3 K.), Paul 6.40.6 (Vol. 2, 81.5 f. Heiberg), Paul 6.5 (Vol. 2, 48.19 Heiberg), Aetius Amid., Libri med. 7.87 (Vol. 2, 333.6 Olivieri), Oribasius, Coll. med. rel. 50.5.4 (Vol. 4, 58.14 Raeder). 1608 See e.g. Paul 6.90.4 (Vol. 2, 139.19 Heiberg), Paul 6.90.6 (Vol. 2, 140.18 Heiberg), Galen, Meth. med. 6.6 (222.11 Johnston & Horsley = 10.448.16 f. K.). 1609 See e.g. Paul 3.69 (Vol. 1, 286.25–287.1 Heiberg), Paul 3.70 (Vol. 1, 287.20 f. Heiberg). 1610 See Johnston & Horsley 2011 in Galen, Method of Medicine, Books 10–14 [listed under Methodus medendi], 503. 1611 See Galen, Meth. med. 6.6 (222.11 f. Johnston & Horsley = 10.448.16 f. K.). I quote Johnston’s and Horsley’s translation here.

392 | Commentary

the meaning underlying the noun ἐπικρουστικόν in the present passage, since dividing a vein by tapping it with a hammer would be a very brutal way to proceed. However, this might be the reason why Aetius rejects this method. For, the genitive absolute provides an explanation why he rejects using an epikroustikon; it is said to lead to the greatest inflammations of the pericranial membrane (see p. 353, commentary on p. 137.5–6) which was injured. The injury of the pericranial membrane may be due to the brutal use of an epikroustikon. p. 139.25–26: ἀφαιρεῖν – αἵματος: For more on this kind of instructions see p. 192, commentary on p. 127.27–128.1. See also p. 384, commentary on p. 138.29–139.1. The ὡς is thereby used in correspondence with a demonstrative pronoun such as τοσοῦτον, which was omitted here. p. 139.26–27: μετὰ – αἷμα: The demonstrative pronoun ταύτην refers back to the removal of blood from the forehead which was discussed previously (see p. 391, commentary on p. 139.22–23). The phrase ἐπὶ τῶν χολερικώτερον ἐχόντων τὸ αἷμα is used in reference to the group of patients who suffer from mania because of blood that is mixed with yellow bile (see p. 345, commentary on p. 136.21). p. 139.27: διαστήσαντα – πέντε: For further discussion of phrases such as διαστήσαντα ἡμέρας πέντε, see p. 322, commentary on p. 135.9–10, p. 186, commentary on p. 127.10–12. p. 139.27–28: διδόναι – μελικράτῳ: For a closer look at the remedy, which is referred to here as “the bitter one made of aloe” and which is also known as “holy remedy” (ἱερά), see p. 324 f., commentary on p. 135.16. Paul also recommends treating patients suffering from mania by purging them with “the bitter antidote” (διὰ τῆς πικρᾶς ἀντιδότου καθάρωμεν) after having phlebotomized them first.1612 In his account of the treatment of mania, the Anonymus Parisinus also recommends purging with the holy remedy (καθαρτέον αὐτοὺς τῇ ἱερᾷ).1613 For further discussion of phrases such as κοχλιαρίου μεγάλου πλῆθος, see p. 389, commentary on p. 139.15– 17. As was highlighted previously (see p. 264, commentary on p. 133.1–3), the administration of honey-water (μελίκρατον) is a very common therapeutical approach. p. 139.28–140.1: εἶτα – γάλακτι: It is commonly recommended in ancient medical texts that the head be purged through the nose; for further details, see p. 224 f., commentary on p. 129.22–23. How the head can be purged through the nose is explained in the further course of the sentence, namely through the participle ἐγχέοντα which explains that certain substances have to be poured into the nose. For further discussion of this verb, see p. 236 f., commentary on p. 130.26–27. For further discussion of the properties of beet (σεῦτλον), see p. 328, commentary on p. 135.23– 25; for further discussion of the properties of elaterion (ἐλατήριον) together with milk, see p. 236 f., commentary on p. 130.26–27. Copper sulphate (χάλκανθον) is

1612 See Paul 3.14.3 (Vol. 1, 158.16 Heiberg). 1613 See Anon. Par. 18.3.4 (116.5 Garofalo).

VI 8 On mania from (the books of) Archigenes and Posidonius

| 393

explicitly mentioned in a chapter of Aetius’ third book in a list of substances that are able to purge the head through the nose (διὰ ῥινῶν δὲ καθαίρει τὴν κεφαλὴν…).1614 p. 140.1–2: καὶ – στρουθίου: The recommendation to apply sternutatories (πταρμικόν) is closely connected to the previously mentioned purging of the head through the nose (see p. 392 f., commentary on p. 139.28–140.1). See further on the application of sternutatories p. 224 f., commentary on p. 129.22–23. I have discussed the properties of white hellebore (ἐλλεβόρου λευκοῦ) and soapwort (στρουθίου) on p. 236, commentary on p. 130.24–26. The Anonymus Parisinus also recommends the application of πταρμικά as therapy for patients suffering from mania.1615 p. 140.2–4: καὶ ἀποφλεγματίζειν – ὕσσωπον: For further information on the verb ἀποφλεγματίζειν, see p. 327, commentary on p. 135.22–23. The Anonymus Parisinus also recommends the application of phlegm-purging remedies (ἀποφλεγματισμοί) in the context of mania.1616 Mastic (μαστίχη) and stavesacre (στάφις ἄγρια) are mentioned together as purgative of phlegm in other passages as well,1617 and in a chapter of Dioscorides’ De materia medica it is explicitly stated that stavesacre purges “much phlegm” (φλέγμα ἄγει πλεῖστον).1618 Using gargles (ἀναγαργαρίσματα) is often recommended together with the application of phlegm purging remedies, as was discussed in greater detail on p. 327, commentary on p. 135.22–23, where I also addressed the properties of oxymel (ὀξύμελι) and pennyroyal (γλήχων). Hyssop (ὕσσωπος) is also commonly referred to as ingredient in gargles.1619 p. 140.4–5: ὑποσυρέσθω – γεντιανῆς: For a discussion of the phrase ὑποσυρέσθω ἡ κοιλία, see p. 324, commentary on p. 135.14–15. In the present context, the purging of the stomach is to be conducted by means of enemata (κλύσμασι) and purging remedies (καθαρτηρίοις). The application of enemata in patients suffering from mania was recommended earlier in the chapter (see p. 390, commentary on p. 139.20–21). In the present passage they are supposed to be sharp (δριμέσι), that is to say they should have an even stronger effect. Centaury (κενταύριον), which is mentioned as an ingredient of the purging remedies is explicitly referred to as purging (καθαίρει) in Aetius’ first book1620 and gentian (γεντιανή) is said to purge thoroughly (διακαθῆραι).1621

1614 See Aetius Amid., Libri med. 3.140 (Vol. 1, 319.21–24 Olivieri). 1615 See Anon. Par. 18.3.7 (116.13 Garofalo). 1616 See Anon. Par. 18.3.7 (116.13 Garofalo). 1617 See Paul 2.47 (Vol. 1, 118.14 f. Heiberg), Alexander, Therapeutica 1.16 (Vol. 1, 587.23 f. Puschmann), Aetius Amid., Libri med. 6.96 (Vol. 2, 246.25 f. Olivieri). 1618 Dioscorides, De mat. med. 4.152.2 (Vol. 2, 297.10 Wellmann). 1619 See e.g. Paul 3.27.2 (Vol. 1, 204.25 Heiberg), Pseudo-Galen, De remed. parab. 2.11 (14.437.3–5 K.), Oribasius, Eclog. med. 73.24 (239.40 f. Raeder). 1620 See Aetius Amid., Libri med. 1.193 (Vol. 1, 86.17 Olivieri). 1621 See Aetius Amid., Libri med. 1.77 (Vol. 1, 49.6 Olivieri).

394 | Commentary

p. 140.6–7: καὶ αὐτὴ – μελικράτῳ: For information on the properties of gentian (γεντιανή), see p. 393, commentary on p. 140.4–5. The wording αὐτὴ δὲ καθ’ ἑαυτὴν highlights that the root of gentian is also useful when taken alone, not being mixed with further remedies, although honey-water is also added to the potion; on honeywater, see p. 264, commentary on p. 133.1–3. Honey-water is probably understood here as that which makes the potion drinkable, and not so much as an actual remedy with a special effect on the patient. The phrase δραχμῆς μιᾶς ὁλκῆς gives the precise amount of gentian to be taken as a drink (προποτιζομένη). Given that the nouns δραχμή and ὁλκή are actually synonyms,1622 we should probably assume that the inclusion of both here is repetitious. p. 140.7: δίδοται – ὡσαύτως: The adverb ὡσαύτως presumably refers to the previously discussed application of the root of gentian (see p. 394, commentary on p. 140.6–7) and suggests that birthwort (ἀριστολοχία) should again be administered as a drink, together with honey-water. Both plants, gentian and birthwort, are mentioned together (also as alternative remedies) in other passages as well, which suggests that their properties are thought to be similar.1623 According to Aetius’ first book, birthwort also has a cleansing property (τῆς ῥυπτικῆς … δυνάμεως).1624 p. 140.8–9: μάλιστα – αʹ: It is remarkable that these lines are found nearly verbatim also in the accounts of the cure for mania given by Oribasius, Paul and Paul of Nicea.1625 This observation again raises questions about the interdependence between the compilers; for a detailed discussion, see p. 33 – 35. It is interesting that Oribasius claims to cite Philumenus in this regard, whereas Aetius claims to cite Archigenes and Posidonius in the present chapter. A remarkably similar statement is even found in Dioscorides’ Euporista vel De simplicibus medicinis, where he states that the root and the seed of horse-fennel are useful for patients suffering from mania when drunk with water, as is one drachme of the root of bryony with water every day or with honey-water.1626 Given that this idea is already present in Dioscorides, it is tempting to assume that what we read in Oribasius, Aetius, Paul and Paul of Nicea goes back to Dioscorides, although this does not necessarily imply that all these authors took the idea from Dioscorides directly. 1622 See Hultsch 1864, 171. 1623 See e.g. Galen, Meth. med. 14.15 (498.5 f. Johnston & Horsley = 10.994.15 f. K.), De comp. med. sec. loc. 9.1 (13.229.11–13 K.), Paul 1.57.1 (Vol. 1, 37.25 f. Heiberg). 1624 See Aetius Amid., Libri med. 1.43 (Vol. 1, 42.2 f. Olivieri). 1625 See Oribasius, Synops. ad Eustath. 8.7 (249.28–30 Raeder): μάλιστα δ’ αὐτοὺς ὠφελεῖ ἱππομαράθρου ἡ ῥίζα καὶ τὸ σπέρμα πινόμενον ἐν ὕδατι καὶ βρυωνίας ῥίζης