Medicine and the Making of Roman Women: Gender, Nature, and Authority from Celsus to Galen [1 ed.] 0199240027, 9780199240029

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MEDICINE AND THE MAKING OF ROMAN WOMEN

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Medicine and the Making of Roman Women Gender, Nature, and Authority from Celsus to Galen

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REBECCA FLEMMING

1

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3

Great Clarendon Street, Oxford ox2 6dp Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide in Oxford New York Athens Auckland Bangkok Bogota Buenos Aires Calcutta Cape Town Chennai Dar es Salaam Delhi Florence Hong Kong Istanbul Karachi Kuala Lumpur Madrid Melbourne Mexico City Mumbai Nairobi Paris SaÄo Paulo Shanghai Singapore Taipei Tokyo Toronto Warsaw with associated companies in Berlin Ibadan Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York # Rebecca Flemming 2000 The moral rights of the author have been asserted Database right Oxford University Press (maker) First published 2000

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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organisation. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this book in any other binding or cover and you must impose this same condition on any acquirer British Library Cataloguing in Publication Data Data available Library of Congress Cataloging in Publication Data Flemming, Rebecca. Medicine and the making of Roman women: gender, nature, and authority from Celsus to Galen/Rebecca Flemming. p. cm. Includes bibliographical references and index. 1. Medicine, Greek and Roman. 2. Women in medicine Rome. 3. Women patients Rome. 4. General identity Rome. 5. Women Rome Social conditions. 6. Galen Views on women. I. Title. R138.5.F54 2000 610 '.82'0937 dc21 00-062390 ISBN 0-19-924002-7 1 3 5 7 9 10 8 6 4 2 Typeset in Imprint by Joshua Associates Ltd., Oxford Printed in Great Britain on acid-free paper by Biddles Ltd., Guildford & King's Lynn

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PREFACE

T h i s is a book about women and medicine in the ®rst centuries of the Roman imperial era. It is about the women who practised medicine and the women who had it practised on them; about the contribution women and their place in society made to medical discourse, and the contribution medical discourse made to women's place in society; about the ways women were described and located in that discourse, and about the e€ects it had. It is about how all these interrelate and interact in their broader context. This is, therefore, a book not just about a speci®c and integral aspect of the Roman empireÐ about its concerns with, its literary and organizational responses to, health and disease, and how these played out around womenÐbut also about knowledge and power, about the historical con®guration of gender, nature, and authority, more broadly. It is thus hoped that it will be of interest to all those concerned with these wider themes in whatever time and place, as well as those with more particular interests in antiquity. The workings of the classical world in these respects are illuminating of far more than that world alone. Certainly it was an interest in these wider questions that prompted the research that has led to this book. This research was originally undertaken as a graduate student in University College London, and this book began as a Ph.D. thesis completed there. It thus owes a very considerable debt to my supervisors, Riet van Bremen and Michael Crawford, for all their good advice and generous assistance, then and since. Among the many other people who have also contributed to the thesis and helped its subsequent development in innumer able ways, I must particularly thank Vivian Nutton, who has given so freely of his great expertise in the area; Ann Ellis Hanson, who has provided such valuable encouragement and guidance; Helen King and Simon Price, for all their comments as examiners and after; and Jason Davies, John North, Bob Sharples, Adam Sutcli€e, and Rosalind Thomas who have all

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vi

Preface

also given various versions of various chapters the bene®t of their attention at various times. I am also very grateful to Charles Burnett for devoting his Arabic Reading Class at the Warburg Institute to Rhazes' Doubts about Galen; to Christina Alverez MillaÂn for further assistance with Arabic materials; to Irene Zwiep for sorting out for me bits of Galen preserved only in medieval Hebrew; and to my brother, William Flemming, for his help with several more modern European languages. My parents, Jean and John Flemming, have been most sup portive of my e€orts in a whole host of ways, and, I must also acknowledge a more distant debt (though none the less deep for it) to Sarah Roelofs, Peter Purton, and Tom Loucas, in whose comradely company many of the questions were raised that I am still trying to answer. Associated with these individual debts are various institu tional ones: to the Wellcome Trust for its continuing support of my research and, together with UCL, for providing my current home in the Wellcome Institute for the History of Medicine; to the Friends of UCL and the Tsangadas Fund and International Partnerships Program of the University of Michigan for enabling me to work with Ann Ellis Hanson at Michigan and consult with other US scholars in the winter and spring of 1997; to the Warburg Institute where I was a Frances Yates Fellow in the autumn of 1996; and to the British Academy for its grant of a graduate studentship, from 1993 to 1996, which I enjoyed in the stimulating atmosphere of UCL history department, with frequent forays to the Institute of Classical Studies. Last, but certainly not least, I would like to record my gratitude to all the librarians in whose libraries I have had the privilege to work over the last few years. I am most especially grateful to those in the libraries of the Institute for Classical Studies, the Warburg Institute, and the Wellcome Institute for the History of Medicine; and also to those in Oxford University's Radcli€e Science Library, the manuscript room of Cambridge University Library, the Medical Library of Yale University, and the Graduate Library of the University of Michigan. R.E.F. Wellcome Institute for the History of Medicine, London June 1999

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CONTENTS

Notes to the Reader Abbreviations Introduction: Medicine and the Historical Relations of Gender, Nature, and Authority

1

part i

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a b r i e f in t r o d u c t i o n t o r o ma n m e d i c i n e 1. The Social and Cultural Formation of Roman Medicine 2. A Rough Guide to the Conceptual World of Roman Medicine

viii xi

part i i b efore galen 3. The Medical Woman between Folk Tradition and Philosophy 4. Sects and the Medical Woman part i i i g alen 5. Women, Power, and Knowledge in the World of Galen's Works 6. Galen's Woman

33 80

129 185 255 288

Conclusion: Medicine and the Making of Roman Women 359 Appendix 1: Listing of Medical Authors, Works, Editions, Translations, and their Abbreviations Appendix 2: Medicae and Iatrinai in Inscriptions

375

Bibliography Glossary Index Locorum General Index

393 421 427 443

383

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NOTES TO THE READER

S i n c e this book is intended to be accessible to those who are not classical scholars, and who may be unfamiliar with classical languages and the various conventions of scholarly presenta tion in the ®eld, and also both deals with some material that may well not be familiar even to those in the discipline, and takes some liberties with those conventions, it is worth out lining the various presentational principles and practices adopted here in more detail than is usual.

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Terminology and Translation Any study of ancient medicine, or any associated ancient discip line, confronts the problem of how to deal, in a way that is clear and accessible but not misleading, with the Greek and Latin technical vocabulary involved, and the long dead, but vitally important, concepts which are signi®ed by it. Throughout the book I provide both the original text and my own translation of any quotations from ancient works, as both are equally essential; but there is also the question of how certain words or phrases are to be rendered, and how they are to appear outside the context of speci®c citation. I have, therefore, largely opted to preserve the most important of such terms, and the ones most prone to modernizing distortion in translation, in something like their original form: to transliterate from the Greek, or keep the Latin as appropriate, and to explain the meaning at the ®rst occurrence, but simply reproduce the original term thereafter. These key terms, their meanings and derivation, are then collected, for reference, in the Glossary. Authors, Titles, and their Abbreviation The titles of ancient works, particularly medical works, are often rather unsettled, appearing in various versions in di€er ent manuscripts, none, or all, of which may accord with the

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Notes to the Reader

ix

author's designation(s) of the text. The translations of these titles are similarly varied, and greatest standardization is achieved in the customary scholarly abbreviation of these titles. These abbreviations are, however, in Latin, regardless of the language of the work to which they refer, and as this is somewhat confusing to the uninitiated but hard to escape from, I have not used these abbreviations in the main text itself, but con®ned them to the footnotes. For the medical writings with which this book is centrally concerned, therefore, when a work initially appears (in either main text or footnotes) I provide my preferred version of the full title in both its original (or earliest surviving) language(s) and its English translation (a number of Greek medical texts survive only in Arabic and/or Latin translation, Arabic titles are transliterated throughout, and some texts survive untitled, in which case descriptive titles in English may be provided alone). Thereafter a shortened form of the English appears in the main text, and the Latin abbreviation in the footnotes. This abbreviation is also intro duced in such a way as to make the work (and/or author) to which it refers as clear as possible; however, a full listing of such abbreviations, together with the authors and works to which they apply, is to be found in Appendix 1. These abbreviations are, moreover, largely the standard ones, taken, like most of the other abbreviations of authors and titles used, from H. G. Liddell, R. Scott, and H. S. Jones, A Greek± English Lexicon, 9th edn. with Suppl. (Oxford: Oxford Uni versity Press, 1968) and S. Hornblower and A. Spawforth (eds.), The Oxford Classical Dictionary, 3rd edn. (Oxford: Oxford University Press, 1996). In the case of Galen, I follow the abbreviations suggested by R. J. Hankinson (trans. and comm.), Galen: On the Therapeutic Method, Books I±II (Oxford: Oxford University Press, 1991). Citations and Editions Speci®c references to ancient works are, in the cases of the key medical texts which this book is centred around and a handful of other instances where it is necessary, followed by references to the edition of the text I have used, and to the page, and usually, line numbers of the passage or treatise referred to.

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x

Notes to the Reader

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Most of these citations refer simply to the name of the editor, and further details of publication may be found in the biblio graphy, but I have found it convenient to abbreviate some of these, and also to follow common practice in referring to some editions that are volumes in certain key series as such. All these abbreviations are listed below, and Appendix 1 also provides the means by which these volumes may then be located in the bibliography.

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ABBREVIATIONS

This is a list of abbreviations used to refer to editions and other modern works, which are either of particular importance in this book, or not to be found in the standard reference works, such as those mentioned in Notes to the Reader above, and L'AnneÂe philologique (for periodicals).

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AMSCC

Ancient Medicine in its Socio Cultural Context, 2 vols., ed. Ph. H. van der Eijk, H. F. J. Horst mansho€, and P. J. Schrijvers (Amsterdam: Rodopi, 1995) Anec. Anecdota Graeca et Graecolatina: Mitteilungen aus Handschriften zur griechischen Wissenschaft, 2 vols., Valentin Rose (Berlin: Duemmler, 1864±70) ANRW II Aufstieg und Niedergang der roÈmischen Welt: Geschichte und Kultur Roms im Spiegel der neueren Forschung (Principat), ed. H. Temporini and W. Haase (Berlin: de Gruyter, 1974± ) CAAG Collection des Anciens Alchimistes Grecs, 3 vols. (Paris: Steinheil, 1887±8) CAG Commentaria in Aristotelem Graeca, 23 vols. (Berlin: Reimeri, 1882±1909) CCAG Catalogus Codicum Astrologum Graecorum, 12 vols. (Brussels: Lamertin, 1898±1936) CMG Corpus Medicorum Graecorum (Berlin±Leipzig, 1908± ; Berlin, 1947± ) CML Corpus Medicorum Latinorum (Berlin±Leipzig, 1915± ) Dgr Karl DeichgraÈber, Die griechische Empirikerschule: Sammlung der Fragmente und Darstellung der Lehre (Berlin: Weidmann, 1930; repr. with additional material, 1965) Dox. Gr. Hermann Diels, Doxographi Graeci (Berlin: de Gruyter, 1879)

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xii DR F FW H K L M RE S

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SC609

SM W Z

Abbreviations Ch. Daremberg and C. E. Ruelle (ed. and trans.),  pheÁse (Paris: BaillieÁre, 1879) êuvres de Rufus d'E Hans Veit Friedrich (ed.), Thessalos von Tralles (Meisenheim am Glan: Hain, 1968) David Furley and J. S. Wilkie (ed. and trans.), Galen: On Respiration and the Arteries (Princeton: Princeton University Press, 1984) Georgius Helmreich (ed.), Galeni De Usu Par tium, 2 vols. (Leipzig: Teubner, 1907±9) C. G. KuÈhn (ed.), Galeni Opera Omnia, 20 vols. (Leipzig, 1821±33) E. Littre (ed. and trans.), Oeuvres compleÁtes d'Hip pocrate, 10 vols. (Paris, 1839±61) Carolus Mayho€ (ed.), C. Plinii Secundi Naturalis Historiae, 6 vols. (Leipzig: Teubner,1892±1909) Real EncyclopaÈdie der classischen Altertumswis senschaft, ed. A. Pauly and G. Wissowa (Stuttgart: Metzler, 1893± ) Sergio Sconocchia (ed.), Scribonii Largi Composi tiones (Leipzig: Teubner, 1983) `Seminar Classics 609', State University of New York (ed. and trans.), Agnellus of Ravenna, Lec tures on Galen's De Sectis (Arethusa Monographs, 8; Bu€alo, NY, 1981) Galeni Scripta Minora, 3 vols., ed. Johannes Marquardt, Iwanus MuÈller, and Georgius Helm reich (Leipzig, 1884±93) Max Wellmann (ed.), Pedanii Dioscuridis De Materia Medica, 3 vols. (Berlin: Weidmann, 1907±14) SkeÂvos Zervos (ed.), Aetii Sermo Sextidecimus et Ultimus (Leipzig: Mangkos, 1901)

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Introduction Medicine and the Historical Relations of Gender, Nature, and Authority M e d i c i n e has now become an accepted, even favoured, area of enquiry for those interested in the history of women, and in past interpretations and organizations of sexual di€er ence more broadly.1 It is asked of an increasing number of historical societies, whether, for instance, there were female healers, and how they related to other contemporary medical practitioners, both individually and institutionally. How female patients fared, how women's bodies were conceived and comprehended both when sick and well, and why. How these situations and conceptions interrelate, and what broader sets of circumstances are also at stake in all this. The answers o€er enriching insights into both the particular times and places of study, and the wider ways in which women, medicine, and society have variously coalesced in human history. Classical scholars have been no exception. Investigations into women and medicine in the ancient world have prolifer ated over the last decade or so, and this topical conjunction has become a standard component of surveys and syllabuses.2 The 1 Such studies, at least of book length, are concentrated in the modern(ish) period, from the 18th cent. onwards, e.g. Barbara Duden, The Woman Beneath the Skin: A Doctor's Patients in Eighteenth-Century Germany, trans. Thomas Dunlap (Cambridge, Mass.: Harvard University Press, 1991); Ludmilla Jordanova, Sexual Visions: Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries (Madison: University of Wisconsin Press, 1989); and Ornella Moscucci, The Science of Woman: Gynaecology and Gender in England 1800 1929 (Cambridge: Cambridge University Press, 1990). Joan Cadden, Meanings of Sex Di€erence in the Middle Ages (Cambridge: Cambridge University Press, 1993) is one of the rarer works that cover the earlier period. 2 There are more articles and essays on the subject than monographs, but

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2

Introduction

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present study attempts to extend both the chronological range of this work and its lines and methods of enquiry, by asking new questions of a relatively neglected collection of materials. Attention has thus far centred on the classical Greek rather than the imperial Roman period. Even Soranus, who is the most discussed of the later authors, is considered more in comparison with earlier Hippocratic writers than in his own right, and treatment of Galen's úuvre lags far behind that demanded by his signi®cance in the history of western medi cine.3 Since the medical writings of the imperial era are part of a tradition which constantly refers back to, and is constantly engaged with, past authorities, this is undoubtedly the right way round for research to have proceeded, but it is certainly now time for a full and detailed study of the constructions of Lesley Dean-Jones, Women's Bodies in Ancient Greek Science (Oxford: Oxford University Press, 1994) certainly counts among the latter, and Helen King, Hippocrates' Woman: Reading the Female Body in Ancient Greece (London: Routledge, 1998) almost does, while Danielle Gourevitch, Le Mal d'eÃtre femme: La Femme et la meÂdecine dans la Rome antique (Paris: Les Belles Lettres, 1984) is more of a sourcebook. Most recent collections of essays on classical women, such as Richard Hawley and Barbara Levick (eds.), Women in Antiquity: New Assessments (London: Routledge, 1995), and sourcebooks, such as Elaine Fantham et al., Women in the Classical World: Image and Text (Oxford: Oxford University Press, 1994) contain medical pieces; and articles also continue to appear in journals. 3 Articles treating Soranus and the Hippocratics include e.g. Ann Ellis Hanson, `The medical writers' woman', in David Halperin, John Winkler, and Froma Zeitlin (eds.), Before Sexuality: The Construction of Erotic Experience in the Ancient Greek World (Princeton: Princeton University Press, 1990), 309 38, and Paola Manuli, `Donne mascoline, femmine sterile, vergini perpetua: ginecologia greca tra Ippocrate e Sorano', in Silvia Campese, Paola Manuli, and Giulia Sissa, Madre materia: sociologia e biologia della donna greca (Turin: Boringhieri, 1983), 147 92; while those more focused on Soranus himself tend only to deal with a part, rather than all, of his work, e.g. Jody Rubin Pinault, `The medical case for virginity in the early second century C.E.: Soranus of Ephesus, Gynecology 1. 32', Helios, 19 (1992), 123 39. To ®nd any very substantial discussion of Galen and women it is necessary to go back to Johann Lachs, Die Gynaekologie des Galen: Eine geschichtliche-gynaekologische Studie (Breslau: Kern, 1903), which is scholarship of rather a di€erent kind than that mentioned thus far; and though there are some more recent articles on the subject, e.g. Christine Bonnet-Cadilhac, `Connaissances des Galien sur l'anatomo-physiologie de l'appareil geÂnital feminin', History and Philosophy of the Life Sciences, 10 (1988), 267 91, they remain largely descriptive.

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Introduction

3

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women within these later texts, a study that is systematic rather than selective.4 It is also time for further methodological re¯ection: for a reconsideration of the approaches to ancient medical materials adopted thus far, and the assumptions on which they rest, in the light of much recent work in the ®elds of the history of medicine and science, and developments within feminist schol arship, both separately and together. Though whiggish notions of medical history have been long banished to the margins of classical studies of the subject, other forms of presentism have proved more tenacious.5 In particular, in investigating relations between women and medicine in antiquity, it has been widely presumed that classical medical texts occupied roughly the same kind of social and cultural space, and did roughly the same kind of conceptual and ideological work, as their modern counterparts. This view is expressed most explicitly by Lesley Dean Jones, who states that: After the beginnings of natural philosophy in Ionia in the sixth century bc mythology was no longer universally accepted as giving a true explanation of the world, and so, as in our own society, science assumed the task of bolstering the traditional dichotomy between men and women.6 4 The problems of selectivity are particularly manifest in Aline Rousselle, Porneia: On Desire and the Body in Antiquity, trans. Felicia Pheasant (Oxford: Blackwell, 1988); problems exacerbated by her preference for citing Galen through Oribasius, rather than quoting his own words. 5 `The whig historian', as Herbert Butter®eld so famously put it, `stands on the summit of the twentieth century and organises his scheme of history from the point of view of his own day.' (The Whig Interpretation of History (London: Bell, 1931), 13). This scheme is an essentially progressive one, which looks for (or creates) points of likeness between past and present, and arranges them in lines of success in order to produce a story which is the `rati®cation if not the glori®cation' of current circumstances. Whiggishness persisted in the histories of science and medicine long after Butter®eld put it into retreat elsewhere, indeed A. Rupert Hall, `On whiggism', History of Science, 21 (1983), 45 59 argues that Butter®eld's own ventures in these ®elds might well be labelled whiggish. 6 Dean-Jones, Women's Bodies, 43, my emphasis; see also her, `The cultural construct of the female body in classical Greek science', in Sarah Pomeroy (ed.), Women's History and Ancient History (Chapel Hill, NC: University of North Carolina Press, 1991), 112; and Helen King, `Producing woman: Hippocratic gynaecology', in LeÂonie Archer, Susan Fischler, and Maria

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4

Introduction

This classical `science' is, for her, represented most promin ently by Aristotle and the Hippocratics, and it achieves this bolstering, she claims, through grounding the cultural para digms of male and female in nature. This picks up, of course, on the theme of `naturalization'Ð the forti®cation of what is customary, conventional, and historically contingent by its presentation as given and nat uralÐthat has emerged as central to studies of both women and science, past and present. The social position of women has been, and continues to be, made natural in various ways and respects. The echoes of the particularly loud and blatant late nineteenth and early twentieth century claims that women are biologically ®tted for domestic life and service centred around motherhood, and dangerously un®tted for higher education, paid work, and the vote, can, for instance, still be heard today, however soft and subtle they have become. Science (or, at least, the scienti®c establishment) continues to be a powerful agent, not only of this naturaliza tion of women's role (indeed it was physicians who were at the forefront of controversies at the turn of the century, mostly on the side of reaction), but also of a range of other historically contingent cultural circumstances. Though many disciplines, or discourses, may participate in patterns and processes of naturalization, as Ludmilla Jordanova notes, `the special relationship long forged between science and nature gives its naturalizing potential special signi®cance', and she could have added a number of more institutional factors that make this signi®cance still greater.7 Moreover, while a whole host of social phenomena may be validated by their presentation as natural, the situation of women has, through the work of the feminist movement and feminist scholars, become, in many ways, the paradigm case. It was, after all, in order to contest the naturalization of sexual di€erence that the concept of `gender' was developed, to refer to all those things about women and men that are Wyke (eds.), Women in Ancient Societies: `An Illusion of the Night' (Basingstoke: Macmillan, 1994), 104, and `The daughter of Leonides: reading the Hippocratic corpus', in Averil Cameron (ed.), History as Text (London: Duckworth, 1989), 13. 7

Jordanova, Sexual Visions, 5.

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Introduction

5

culturally and relationally constructed rather than biologically given; this bodily residue being left as `sex'.8 Questions have been raised, however, about the extent to which this notion of naturalization, and its particular realiza tion by science, can be pushed back beyond the nineteenth century, beyond the boundaries of modernity. Lorraine Daston, for instance, points out that, as notions of nature have changed over time, both in themselves and in their relations with the opposing and/or complementary notions of non nature (such as the variously construed concepts of the arti®cial, cultural, supernatural, and praeternatural), so strat egies of naturalization have also changed; so much so that she asks whether it is appropriate to use, `a single term to blanket a multitude of meanings, of very di€erent political valences'.9 One such change occurred, moreover, precisely in the passage from early to full modernity, and Daston uses what happened to naturalizations of the female intellect at this time to demon strate the ways in which these historical shifts matter. While beliefs in speci®cally female intellectual traitsÐin women's pleasing delicacy and sensitive sociability of mindÐand in their naturalness remained relatively constant over the centu ries, the meanings and rami®cations of these interpretative and ideological strategies altered as nature was ®rst understood normatively and then descriptively, ®rst within the framework of the natural laws of jurisprudence and then of the natural laws of mechanics. The rational and providential design of early modern nature revealed, even prescribed, to the reason able, the ideal social order; whereas nineteenth century nature was indi€erent and inexorable, determining simply what could and could not be, regardless of any moral judgement. So, while 8 For a brief outline of this development, and more recent debates on the subject, see e.g. Donna Haraway, ` ``Gender'' for a Marxist dictionary', in her Simians, Cyborgs, and Women: The Reinvention of Nature (London: Free Association Books, 1991), 127 48. 9 Lorraine Daston, `The naturalized female intellect', Science in Context, 5 (1992), 210; and also, `The nature of nature in early modern Europe', Con®gurations, 6 (1998), 149 72. The understanding that nature has a changing history of this kind is, of course, not new, see e.g. Arthur Lovejoy, ` ``Nature'' as an aesthetic norm', Modern Language Notes, 42 (1927), 444 50, and R. G. Collingwood, The Idea of Nature (Oxford: Oxford University Press, 1945).

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6

Introduction

the education of women was initially to be approached with careÐfor nurture should follow, should strengthen not sub vert, natureÐlater it became a matter of economy, as women's inferior intelligence rendered much educational e€ort futile. Similarly, female intellectuals themselves moved from being viewed as somewhat ridiculously and reprehensibly disobedi ent to wise nature's decrees to being deemed downright impossible. Thus, at the end of the nineteenth century, the Italian physician Cesare Lombroso concurred with Goncourt that, `There are no women of genius; the women of genius are men.'10 This marks a shift not just in what is thought to go on within nature as such, but also in its relations with other parts or aspects of the world and the ways they are understood. A nature su€used with cultural values, intended to lead to a culture su€used with natural values, thus became devoid of all value, just a set of unalterable, brute facts, with which a quite distinct culture had to live. The careful collaboration of nature and nurture was broken up, the two were forcibly separated, rendered entirely immiscible. So, confusing or con¯ating the two categories became a serious mistake, but a mistake that, in certain circumstances, there were (and still are) clear incentives to make. For, in smuggling the cultural across the border into the natural, what was changeable and contingent, value laden and contested, becomes immutable and inevitable, an objective and neutral fact; but falsely so, as those who have variously attempted to reverse this trac point out. Thus the debates about sex and gender, about limitation and possibility in life and its collective organization, were ®rst framed. They continue in numerous, increasingly complex ways. In so far, however, as the contest between those who have translated gender into sex, who have been in the business of the making natural, and those who have objected, who have tried to force a recognition of the cultural and historical constitution of women's role and place in society, has been a contest between science and feminism (with, of course, some crossover between the two), the odds have been far more unevenly stacked than the arguments themselves. The asymmetrical social and polit 10

Cesare Lombroso, The Man of Genius (London: Scott, 1891), 138.

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Introduction

7

ical positions of the two, their discrepant degree of organ ization, of institutionalization, and mismatched economic weights, have all contributed to the unequal distribution of power between them. Moreover, science today lays claim to the highest (or, at least, truest) form of knowledge, in the sense that both the ®xity and neutrality of nature itself, and of the methods used to enquire into it, are held to lead to a certain and objective knowledge of the kind that no humanistic know ledge project, especially one so compromised by open political commitments as feminism, can even dream of; and that claim still commands broad assent, if not such unwavering allegiance as it once did.11 Naturalization thus has the upper hand on all fronts. It is not only an appeal to the authority of nature itself, but is also an appeal made by people with authority (scientists, or the scienti®c establishment), and made authoritatively (in the language of science, of scienti®c truth). But science too has been labelled a relatively recent historical arrival, for example by Andrew Cunningham, who places its `invention' in the period between about 1780 and 1850.12 Until then, he argues, people did (and largely said they were doing), `natural philosophy'. They investigated nature as an enactment of divine providence, as a way to knowledge of god (in whatever sense). It is only when people began to study nature as a thing in its own right and for its own sake, indeed to view it precisely as something neutral rather than normative, as just a set of unalterable, brute facts, that it is then possible to speak of them doing `science' as it is presently understood. Certainly, it is only from the late nineteenth century onwards that `science' begins to take its now familiar institutional forms, and begins to acquire the kind of power and prestige which characterizes the present `scienti®c establishment', even if it can trace its methodological and epistemological roots back as 11 Of course, feminists and others have, with varying degrees of success, attempted to controvert science's claims to epistemic supremacy on several fronts; both in terms of revealing the gaps between the stories it tells about itself and its actual practice, and of challenging the epistemological validity of these stories themselves, see e.g. Sandra Harding, The Science Question in Feminism (Milton Keynes: Open University Press, 1986). 12 Andrew Cunningham, `Getting the game right: some plain words on the identity and invention of science', Studies in the History and Philosophy of Science, 19 (1988), 365 89.

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8

Introduction

far as the `scienti®c revolution' of the seventeenth century. Moreover, while there has been a scholarly tradition which has sought to ®nd classical pre®gurations of the new experimental approach to knowledge promulgated by, for instance, Francis Bacon and Robert Boyle, most have been far more wary of claiming any kind of wider social or cultural equivalence between ancient and modern scienti®c endeavours. In particu lar, the lowly status of medicine and its practitioners in antiquity has been one of the most obvious barriers to this kind of assimilation. I. E. Drabkin, for example, though generally very positive about the degree to which a range of ancient knowledge projects meet modern `scienti®c' standards, was none the less keen to stress that classical medical practice rarely rose above the status of `craft', and a chronically disparate and disorganized one at that.13 The claims for ancient `science' have become considerably more muted since Drabkin was writing in the 1940s. Indeed Ludwig Edelstein contradicted him almost immediately, arguing instead that there was a distinctive classical approach to investigating the world, characterized, for instance, by a failure to demarcate clearly between what would now be called `science' and `philosophy' on the one hand, and between `science' and `pseudo science' (such as astrology and alchemy) on the other.14 Certainly, most scholars now stress the distance between, rather than proximity of, ancient and modern approaches to studying nature, and use the term `science' only equivocally in a classical context: as referring to any organized body of knowledge, rather than one organized on modern, strictly `scienti®c', lines.15 Nor has ancient medicine moved any closer to its more contemporary counterparts, either in terms of organization or social status. Recent studies speak of a `medical market place' in the classical world, a 13 I. E. Drabkin, `On medical education in Greece and Rome', BHM 15 (1944), 333 4; cf. I. E. Drabkin and Morris Cohen, A Source Book in Greek Science (New York: McGraw-Hill, 1948). 14 Ludwig Edelstein, `Recent trends in the interpretation of ancient science', JHI 13 (1952), 573 604. 15 See, for instance, the `General series introduction' to the notably named Routledge series Sciences in Antiquity, in e.g. Tamsyn Barton, Ancient Astrology (London: Routledge, 1994), pp. ix xxii.

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Introduction

9

pluralistic and competitive place, fractious and fragmented, not subject to ocial control or internal policing.16 This has served to put the spotlight on how, within this unregulated framework of diversity and dispute, Greek and Roman physicians con structed their authority, formulated and articulated their ideas in order to gain paying patients as well as the esteem and respect of a wider audience.17 None of these points provides much reason to equate, at least in any social or epistemological sense, the pronouncements of ancient doctors on women (or indeed anything else) with those of today, or even the nineteenth century. Power and prestige have been quite di€erently distributed in di€erent times and places and this must be taken fully into account in any discussion of historical relations between women and medicine, both on a practical and ideological level. Appeals to the authority of nature may vary not just in terms of the notion of nature being appealed to, but also in terms of the position and rhetorical purchase of the people making the appeal. Indeed, the character of nature itself was also hotly disputed and very variously construed in the classical world. From the beginnings of natural philosophy in sixth century bc Ionia itself, men such as Thales and Anaximenes may have shared in an enterprise that involved the separating out of the natural and the supernatural far enough for them to tell stories about the world that were not (like those of Hesiod and the other mythographers who had preceded them) stories about the gods, but about the world as something in itself, something natural; they may even have agreed on the narrative structure of their stories, but not on much else.18 Thales famously held, for 16 Vivian Nutton,`Healers in the medical market place: towards a social history of Graeco-Roman medicine', in Andrew Wear (ed.), Medicine in Society: Historical Essays (Cambridge: Cambridge University Press, 1992), 15 58. 17 Good examples of this present trend include e.g. Heinrich von Staden, `Author and authority: Celsus and the construction of a scienti®c self ', in M. E. VaÂzquez BujaÂn (ed.), TradicioÂn e innovacioÂn de la medicina latina de la antiguÈedad y de la alta edad media: Actas del IV Coloquio Internacional sobre los `textes meÂdicos latinos antiguos' (Santiago de Compostela: Universidade de Santiago de Compostela, 1994), 103 17, and `Anatomy as rhetoric: Galen on dissection and persuasion', JHM 50 (1995), 47 66. 18 This, at least, is the story as Aristotle tells it, about 200 years later, see

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Introduction

instance, that everything, in its irreducible essence, is water, that is to say that water is the nature (fy3siw in Greek, usually anglicized as physis) of all things, while Anaximenes preferred air for this elemental role, and other Presocratic thinkers interpreted the constitution of the cosmos still more di€erently. On several occasions various driving forces, or moving prin ciples, joined the various stu€s, the more material principles, out of which the universe was made: such as Empedocles' opposing powers of love and strife, Anaxagoras' all pervasive mind, and, ®nally, Diogenes of Apollonia's designing intelli gence, which did not just work with its materials but was oneÐ that is, air. Whether or not Diogenes considered this intelligent organizing force or entity to be divine, he thus opened the way for divinity to re enter nature in a more controlled, philo sophical way; though more strictly materialist cosmologies, such as those of the atomists Democritus and Leucippus, also persisted.19 Roughly contemporary with Diogenes, in the second half of the ®fth century bc, intellectualsÐsophistsÐat Athens were arguing about another aspect of relations between the natural and non natural, that is between physis and nomos (no3mow, a complex term variously rendered as `law' or `custom', `convention' or `norm': that is, as designating a range of human prescriptive endeavours).20 Here disputes centred on the con stitution of human society, on how it was and should be regulated, rather than the constitution of the physical world. None the less, di€erent understandings of nature, in its broad est sense, were involved in these arguments about whether or not physis was an adequate, even ideal, basis for nomos, whether current social norms and organization surpassed or contravened nature, and how individuals should conduct themselves. esp. Met. 983b7 987a28 and 1000a9 19, and it is on his account, and other even later ones, that scholars must now rely. Certainly most of the information presented here derives from these passages. 19 There is a debate about whether the somewhat odd, but not impossible, ``e5 uow/custom or habit'' that appears in most manuscripts of Simplicius, In Phys. 1. 4 (CAG ix. 152. 24), where Diogenes' views are outlined in most detail, should in fact be rearranged as, ``ueo3w/god''. 20 Here we are mostly reliant on Plato's characterization of these debates, though fragments of sophistic writings do also survive, see e.g. G. B. Kerferd, The Sophistic Movement (Cambridge: Cambridge University Press, 1981), esp. 111 30, for fuller discussion.

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11

Medicine was party to many of these discussions and con troversies. Indeed, G. E. R. Lloyd has suggested that it is Hippocratic writings which hold the key to understanding this turn to nature in early Greek thought, revealing that it should be seen as an essentially antagonistic move, `notably as the underpinning to the claims made by new styles of wisdom in their attempts to outbid more traditional kinds'.21 This is clearest in the argument of the author of the Hippocratic treatise On the Sacred Disease (Peri4 th9w i2 erh9w noy3soy) that all diseases have natural not divine causes, an argument which must be placed in the context of competition with healers who invoked the gods rather than nature in the presentation of their practice, as they based their cures on puri®cations and incanta tions.22 Nor does physis (or its Latin equivalent, natura) ever escape from the framework of di€erence and dissent in which it was forged. In the half millennium between these pioneering thinkers and writers and the period of concern in the present study, the terms of these disputes shifted and settled down, but they were never resolved, either philosophically or medically. The diverse philosophical and medical systems and schools that were established and variously developed and dissolved in the intervening centuries each had their own methodologies and understandings of the world, their own epistemologies and (as far as was then allowed) their own physics, together with the either ethically or more corporeally therapeutic programmes with which they were associated.23 Stoicism, the philosophical current that most successfully made the transition from the Hellenistic to the Roman world, advocated one approach to, and had one comprehension of, nature (that is, what nature is, what the nature of the cosmos is, and what human nature consists of, as well as how all these interrelate), while Epicur eanism, for instance, had another, and Scepticism adopted an approach that led more towards non comprehension. Nor are 21 G. E. R. Lloyd, `The invention of nature', in his Methods and Problems in Greek Science (Cambridge: Cambridge University Press, 1991), 432. 22 Hp. On the Sacred Disease 1 and 18 (vi. 352 64, 394 6 L). 23 For a discussion of the development of these various philosophical schools which focuses on their therapeutic approach, see Martha Nussbaum, The Therapy of Desire: Theory and Practice in Hellenistic Ethics (Princeton: Princeton University Press, 1994).

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Introduction

the possibilities of philosophical adherence and world view available to the educated Roman thus exhausted, without even starting on the medical possibilities which will be dealt with in more detail in the course of this book.24 This was a strikingly pluralistic world in many respects, and nature parti cipated fully in this plurality and in all the disputes within it, less as an impartial arbiter than as a committed, and so contested, partisan. Perhaps, then, naturalization has a history but not an ancient history. This is certainly what Thomas Laqueur seems to suggest in his in¯uential book Making Sex, at least in respect to the speci®c issue of sexual di€erence, for he says in the context of antiquity:

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There is no e€ort to ground social roles in nature; social categories themselves are natural and on the same explanatory level as what we would take to be physical or biological facts. Nature is not therefore to culture what sex is to gender, as in modern discussions; the biological is not, even in principle, the foundation of particular social arrange ments.25

There is no naturalization because everything is already nat ural. The physical and social con®gurations of the world are all on a level, so nothing is gained (or lost) in terms of security, in moving between them. Sex and gender do not map onto nature and culture in the now familiar manner (or vice versa). Indeed, in his general introduction, Laqueur takes this further.26 He argues that the pre enlightenment era is characterized not just by a failure to map sex and gender onto nature and culture in this way, but also by a reverse mapping; that modern expecta tions of historical sameness in this respect are not just con founded, but also inverted. Before the seventeenth century, sex (that is body) was in fact aligned with culture, it was conven tional, and gender (that is role) was aligned with nature, it was part of the given order of things. This system would then allow for meaningful movement, even smuggling, between the two categories, but it would be unnecessary if the aim was to 24

See esp. Chs. 2 and 3 below. Thomas Laqueur, Making Sex: Body and Gender from the Greeks to Freud (Cambridge, Mass.: Harvard University Press, 1990), 29. 26 Ibid. 8. 25

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Introduction

13

strengthen and secure aspects of social organization. Natur alization is then a theoretical possibility, but it would be in order to fortify, not the historically but the materially con tingent, not the arbitrary arrangements of society but of matter; and this, perhaps, is to stretch the term too far, to render it nonsensical. Certainly Laqueur is not interested in this angle, indeed is not much interested in nature as such at all, but rather in relations between corporeality and the social order, between sex and gender, and, most of all, in the parvenu status of the idea that the latter is based on the former, the notion that the last (or indeed ®rst) word on what men and women do in the world rests with the body. This focus on the failure of the past to conform to the present is, however, maintained at the expense of its successes of self conformity, the various ways the past has worked in its own terms, with its own orderings of its own concepts and categories.27 These are concepts and categories which, more over, approximate only poorly to sex and gender, even in an analytical sense (Laqueur is not claiming that ancient writers distinguished sex and gender per se, but that he can make that distinction out of the ideas and associations they did form), and which depend on their internal ordering, on the wider patterns they are part of, for their functioning. Such points, the prob lems into which Laqueur runs as he moves beyond simply noting historical di€erence to trying to describe the speci®c qualities of that di€erence, can be clearly illustrated by a brief discussion of Aristotle's notorious theory of natural slavery. This is not, of course, an argument about sexual di€erence as such, though relations between men and women do feature in it, but Laqueur should have examined it none the less, in the course of his promotion of Aristotle as a key proponent of the equal and undi€erentiated naturalness of both social and physical arrangements, and of the priority of gender over sex. For Aristotle is here clearly in the business of making a controversial social situation natural, and thus securing it. Moreover, his method of doing so also reveals that, though Laqueur is certainly right to emphasize change over time in 27

A similar criticism is raised in Katherine Park and Robert Nye's review of Laqueur, `Destiny is anatomy', New Republic, 18 Feb. 1991, 53 7.

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14

Introduction

these respects, he is on shakier ground in ®nding reversal, particularly in so far as that depends on forcing ancient explanatory tools and ways of understanding the world into modern straitjackets. Indeed, the way Aristotle's theory emerges out of argument and dispute suggests more broadly that any attempt to ®nd unity or homogeneity in all this, to compare the ancient view with the modern, as if there were only one, would be mistaken. It is at the beginning of the Politics that Aristotle sets about refuting those who have asserted that slaveryÐa fundamental component of the polis (po3liw, that is the Greek city state), which Aristotle is here engaged in analysingÐis merely con ventional, merely a matter of nomos.28 Indeed, these opponents have apparently suggested that the master±slave relationship is actually contrary to nature, for there is no di€erence in nature between the two, and thus no basis for so asymmetrical a relationship, which must, therefore, be founded on force, and so be unjust as well as unnatural. Against such views, and in defence of this basic feature of ancient society, Aristotle attempts to establish the naturalness of slavery. He proceeds by ®rst establishing what the nature, that is the essence, of being a slave is, and then that there are people who are, in their own nature and in the nature of things, of this character; so that it is then natural, just, and proper that they should be slaves. There are, he argues, human beings who, by nature (fy3sei), belong not to themselves but to another; that is, who are natural slaves. For the natural order is just that: relations of domination and subordination are characteristic of existence itself, of all things in the world. So, as the soul rules the body in every living creature, as human beings rule the other animals, as the superior male rules the inferior female, so necessarily there are other hierarchical di€erences within humanity of a similar kind and degree, and those that thus di€er from the rest are, by nature, slaves, that is, belong, by nature, to others. The particular form of slavish divergence from the norm is that they lack e€ective reason, they lack the deliberative part of the soul (whereas women have this part, but it lacks authority). This 28 Arist. Pol. 1253b15 1255b40 and 1259a3 1260b26; and see the discussion in Peter Garnsey, Ideas of Slavery from Aristotle to Augustine (Cambridge: Cambridge University Press, 1996), esp. 107 27.

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Introduction

15

means that it is both just and advantageous to all concerned that these people are ruled, though the governance of women is not so absolute as that of slaves. Injustice may be caused by a mismatch in practice between the category of natural slaves and the actual slaves in a society, those who are enslaved by law, but so long as Greeks enslave barbarians this disjunction will be kept to a minimum; and these are problems which can all be resolved within the operations of the institution of slavery anyway. Presumably for Laqueur the most salient feature of this account is where the nature that is being used to justify slavery in this way is not to be found. It is Aristotle's failure to locate natural di€erence, the di€erence between slave and master, in the body, which is most signi®cant; his failure to locate di€erence in biology in the manner, for example, of nineteenth century scienti®c racists and their successors. In fact he did try and look to the body in this respect, stating that nature wants to distinguish the bodies of slaves and free, ®tting the former for hard labour and the latter for the political life, but is thwarted in practice as the opposite occurs more often; the basic point is valid none the less.29 Though Aristotle is here trying to ground social categories in nature, he does so on his own terms, in a way that di€ers considerably from current forms of naturaliza tion. His appeal to nature is lodged less in the material arrangement of the cosmos than in its conceptual order, in the principle of hierarchy that governs all things, and in the soul that governs the body; and it is an appeal to good order and justice. For him nature is less about matter than the principles on which it is organized, though the two are inseparable. It is, to borrow Laqueur's already twisted ter minology and twist it still further, less about the slavish equivalent to sex than gender. And it should be said that, though slaves and masters are, as Aristotle insists and Laqueur would presumably not disagree, only analogous to and not identical with women and men, it is exactly these same items, these same principles, that Laqueur equates with gender in talking about the latter. By these means, therefore, even though he might have to concede that in antiquity everything is not 29

Arist. Pol. 1254b28 40.

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16

Introduction

always already natural, he could still hold onto the stronger claim that, however counter intuitive it may sound, the ancient appeal to nature is an appeal to gender. It might also be objected that it is only slavery that has been thus called into question, that has been thus caught up in disputes between physis and nomos, not patriarchy, not the rule of men over women. Male superiority and female inferiority are so safely assumed to be natural that their relative positioning may be brought forward to support, by analogy, the assertion that slavery is similarly natural. This last point is undoubtedly a valid one, that is indeed what Aristotle is doing, that is the distribution of challenge and certainty in the Politics. However, no less than Plato, his teacher, had labelled current conventions regulating the activ ities of men and women as unnatural, based on no relevant di€erence in nature between male and female, and contra vening, therefore, their basic similarity.30 If Aristotle had taken up this argument, he would most likely have proceeded as he did in the case of slavery, realigning nature with the existing social order; the question is, however, if nature were thus to be appealed to in this respect, could, or should, that be understood as an appeal to gender?31 For, just as the Aristotelian body is not the body of modern sex in any number of ways (anatomic ally, materially, epistemologically, and aetiologically, to name just a few) so that which bears down on this bodyÐbe it the soul, the position in any hierarchy, the functions to be performed, or the requirements of justice and expediency, either jointly or severally (and these are, of course, all inter related)Ðis hard to think of as gender, even in an analytical sense. There are some similarities to current notions of the cultural roles of men and women in terms of content, but they are overshadowed by di€erences in how that content has been constituted, its framings and associations. The conceptual 30

Pl. Resp. 451b9 457b6. There are, at least according to Marguerite Desaguliers, `Sex and essence in Aristotle's Metaphysics and biology', in Cynthia Freeland (ed.), Feminist Interpretations of Aristotle (University Park, Pa.: Pennsylvania State University Press, 1998), 138 67, good reasons why Aristotle did not take up this argument, since he is implicitly philosophically committed to a position not far from Plato's. Some of these points should, however, also have restrained Aristotle's comments about slavery. 31

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Introduction

17

order of the ancient world is so far away from the modern that it is very dicult to cut up in this way without doing it considerable violence.32 Better to leave such an appeal to nature as it is and then to look at what aspects of human existence, as it was then understood, are implicated in this appeal, are thus made natural, and which remain outside it, are considered conventional, or otherwise non natural in some way. To investigate also what the particular implications of this making natural are, what kind of nature is being appealed to, by whom, and so forthÐholding onto the one constant amidst all these variables: that, whatever else it may be, whatever else may be involved, nature is always about givenness, as con trasted with construction. What nature has consisted in has, as already indicated, varied widely, both diachronically and, at least in the case of the classical world, synchronically also; but one thing has stayed constant, and that is the constancy of nature itself. Nature is givenness, it is what is objectively so. It is this quality which unites the natures of early modern and modern Europe, which translates fy3siw and natura into nature, which all the renditions of the two o€ered in antiquity have in common. It is this which gives nature its inherent causal ecacy and authority, of whatever precise kind and in whatever exact quantity. It is how that givenness is substantiated which alters. Indeed, there is a sense in which the European history of nature can very roughly be described as the history of its increasing, and increasingly stable and signi®cant, substantiation. There is an overall shift from the multiple, competing natures of anti quityÐeach substantiated according to the circumstances in which they occur, the purposes they serve: that is to say, substantiated within the systems of which they are such a fundamental partÐto the single, more or less agreed, nature of modernity that has become, by common consent, so sub stantial, so strong and certain in its substance, that it stands on its own, outside the discourses which deal with it. 32 Laqueur's use of the term `ontological' (e.g. Making Sex, 8 and 29) is particularly unfortunate in these respects, since he is only prepared to see a modern, materialist ontology as properly ontological, and thus fails to understand that it is often when ancient authors are being least materialist that they are, in their own terms, being most ontological.

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18

Introduction

The uses of nature in early Greek philosophy and medicine, as described by Lloyd, amply illustrate this ancient starting point, and Julia Annas, for instance, elaborates it further in her discussion of the shape and structure of Hellenistic ethical theories.33 An important feature in the formation of these theories is the way each system, each school, appeals to nature in roughly the same way, to roughly the same ends, but appeals to a di€erent nature, a nature that indicates, or serves to found, a di€erent vision of the way human life should be lived, a di€erent version of the life lived according to nature which all take to be ideal. Each operates, therefore, with a notion of givennessÐa notion of what the human being really, objectively, is and should thus strive towards beingÐwhich provides the basis for self examination, the means by which human beings may `locate and correct the merely conventional element in our moral thinking', those things unre¯ectively acquired from the social environment; but the items which turn out to be natural and conventional in each case, and hence to be developed and discarded respectively, diverge.34 The appeal to nature thus `gives shape to a demand to come to terms with ourselves from the ethical point of view', but does not, in itself, determine the content of those terms.35 Nature brings order and understanding, it helps to illuminate and clarify the moral theories of which it is an integral part, and is itself illuminated and clari®ed in turn. It functions in a similar manner in Aristotle's political theories (which are, in any case, connected to his ethics). Physis provides the means of coming to terms with questions of governance, of social organ ization and activity, of sorting out what is preferred and what should be rejected in these respects. Aristotle's arguments are in many senses directed at giving a particular content to, as well as putting a particular spin on, a shared assumption that naturalness is the aim in politics as in everything else; indeed, and even more famously, an assumption that politics is, for humanity, natural, that the polis is a natural formation.36 The dispute about slavery is essentially a dispute about the content of nature in this way; about whether the slave±master 33 Lloyd, `The invention of nature'; Julia Annas, The Morality of Happiness (New York: Oxford University Press, 1993). 34 35 36 Ibid. 217. Ibid. 219. Arist. Pol. 1252b32 1253a40.

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Introduction

19

relationship is to be counted in or out of this category, a decision with various social and organizational repercussions. Plato's arguments about women are similarly formulated. Annas thus emphasizes that, though these ancient ethical appeals to nature do not work in the same way as the same appeals nowÐthat is, as the appeals made by modern `ethical naturalism'Ðsince ancient theories are not appealing from value to fact, or from controversial to uncontroversial facts, in the current manner, they do still work in their own way.37 The concept of nature performs real justi®catory functions within their ancient framings none the less. `Within' is perhaps the key word here. The point is that Aristotle, the Stoics, Epicureans, and others appeal, not to a shared notion of a separate domain of nature as an already substantive domain of brute facts, but to a shared notion of nature as a vital set of certain qualities and values which each then substantiates according to their own demands. Competing natures are thus established that stand or fall with the systems in which they have their life, rather than a neutral, independent nature which is meant to adjudicate between rival theories. In the classical world, judgement was acknowledged to be a more human a€air, and the audience for these ideas had to make up their own minds about them. Indeed judging in these kinds of situations was an important part of being properly human. The ancient approach should not, therefore, be considered as weak and ine€ectual in its failure to conform to present standards, but strong and e€ective in its conformity with contemporary expectations and needs, in its good ®t with the world in which it operated. It arose within its own particular patterns of relative frailty and security in thinking about the world, both descriptively and prescriptively, its own patterns 37 Ethical naturalism, broadly speaking, is the position that, contrary to those who consider moral properties to be irreducible and impossible to de®ne in non-moral terms, moral properties can be so reduced and de®ned. A strong version of this is expressed, e.g. by Gilbert Harman in his The Nature of Morality: An Introduction to Ethics (New York: Oxford University Press, 1977), 18. He states, `An ethical naturalist holds that there are moral facts and that these can be ``reduced'' to natural facts of a sort that might explain [moral] observations in the way that facts about color might be reduced to facts about physical characteristics of objects, the properties of light and the perceptual apparatus of the observer.'

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20

Introduction

of how those categories of frailty and security were themselves constituted and deployed, as well as its own categories and structures of thought, its own methods of argument and per suasion. Ancient approaches to philosophical (or more broadly ideative) system building were, after all, much more open, holistic, and integrative than the rigidly hierarchical and complete structures dictated by the now dominant scienti®c paradigm, on which various philosophical naturalisms, not to mention political naturalizations, are modelled, or which they more simply enact. Indeed, it has been suggested, most notably by Pierre Bourdieu, that the more modern, hierarchical methods of justi®cation, the establishment of two realms of di€erential certainty and security between which there is constant trac, are in fact symptoms of systemic weakness rather than strength.38 The strongest system, the one that conceals its own arbitrariness most e€ectively, is the one that admits of no di€erence at all. It is one in which there is no opposing, or contrasting, term to the natural, where everything is equally self evident, nothing is questioned; and through this sameness, through the way in which every aspect of the world is a re¯ection of all the others, every aspect o€ers more of the same, the possibility of otherness is closed o€. The idea that things could be otherwise, could be done or made di€erently, on which the notions of arbitrariness and construction are predicated, just did not arise. This Bourdieu designates the world of `doxa', to be distinguished from the world of ortho doxy and its signi®cant other, heterodoxy, a world of di€erence and dispute, where competing visions and opinions must ®ght for dominance, must work for their legitimacy and position; and where, however powerful an orthodoxy becomes, it is always assailable, never absolutely incontrovertible. Once lost, the primal innocence of `doxa' can never be recovered. Classical antiquity cannot, of course, be classi®ed as `doxic' in this way. There were areas of life that were simply taken for granted or subject to broad consensus, but also plenty of others which lacked even an orthodoxy. Bourdieu's basic point is salutary none the less. World views, in part or whole, may be 38

Pierre Bourdieu, Outline of a Theory of Practice, trans. Richard Nice (Cambridge: Cambridge University Press, 1977), 164 71.

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Introduction

21

elaborated, embedded, in their worlds in a variety of ways, and to varying degrees, and they must be judged from inside as well as outside. Otherwise there is a tendency to mistake stability for vulnerability, function for failure; to confuse, for instance, the absence of challenge with an inability to meet challenges, or valuable and e€ective ¯exibility with a lack of sucient ®xity. Bourdieu is happy to refer to the work any (indeed every) established order does to conceal its own arbitrariness as naturalization, while recognizing that this takes, and indeed has taken, many forms. In doing so, he completely empties the nature in this global naturalization of any content, leaving it simply as the opposite of arbitrariness and its associates. Annas too argues more for an extension of the term `naturalism', so that it may encompass ancient philosophical appeals to nature, than for any attempt at a more exclusive de®nition. Both are implicitly responding positively to Daston's question about whether it is appropriate to designate such a polysemous and polyvalent phenomenon as naturalization by a single term. They suggest that, so long as the nature of nature is properly understood, and its continuous core is ®rmly grasped, while allowing all its associated variables to move freely, then it is useful to collect all the versions of its most common application under a single rubric. Moreover, as Daston also hints, this is a matter which bears directly on enquiries into the meaning and e€ects of being male or female in any society. The distinction from which the notion of nature arises and which is at the heart of all these deployments, its contrast with the arbitrary and arti®cial, also underlies the distinction between sex and gender itself. If stripped back to its essentials, the sex±gender model is simply a way of distributing sexual di€erence, however that is conceived and constituted, over, and investing it in, the cat egories of givenness and construction, of cause and e€ect, and the like, however conceived and constituted; and, nature, together with its various companions, will inevitably be involved in this latter part of the equation. Indeed, the variable notion of nature may, in this way and as already suggested, o€er a better path into past forms of organizing and under standing sexual di€erence than notions of sex and gender do, for these must be imposed from the outside, rather than found within.

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Introduction

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Questions of propriety and imposition have also been raised about sex and gender now, as well as then. It is not just the location (and identity or meaning) of the boundary between the two that is presently disputed, but whether there is any such boundary at all. Elizabeth Grosz, for instance, considers it to be an artefact of a residual dualism, a failure to get to grips with what the body really is and could be, and thus a failure to realize that it is over this corporeal terrain, within the domain of sex itself, that sexual di€erence is produced and enacted.39 Judith Butler, on the other hand, considers this boundary to be an artefact of gender.40 It is actually impossible to disentangle sex from gender, to extract something pure and pristine from the ideologically charged, contested, and variable discourse about it, from its socially and politically embedded under standings and organization. All claims about sex are also about gender, are, indeed, already gendered. Thus, as Butler says: Gender ought not to be conceived merely as the cultural inscription of meaning on a pregiven sex (a juridical conception); gender must also designate the very apparatus of production whereby the sexes themselves are established . . . This production of sex as the prediscursive ought to be understood as the e€ect of the apparatus of cultural construction designated by gender.41

For all its much vaunted post modernism, Butler's apparatus of gender, therefore, manifests a certain structural homology with the ancient ethical systems discussed by Annas.42 Both 39 Elizabeth Grosz, Volatile Bodies: Towards a Corporeal Feminism (Bloomingston, Ind.: University of Indiana Press, 1994); and see also her `Experimental desire: rethinking queer subjectivity', repr. in her Space, Time and Perversion: Essays on the Politics of Bodies (New York: Routledge, 1995), esp. 211 14. 40 Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1990). 41 Ibid. 7; this move is not a unique one, cf. Moira Gatens's attempt to `shift the conceptual ground from the question ``How is the body taken up in culture?'' to the more pro®table question ``How does culture construct the body so that it is understood as a biological given?'' ', in her `Towards a feminist philosophy of the body', in Barbara Caine, Elizabeth Grosz, and Marie de Lepervanche (eds.), Crossing Boundaries: Feminisms and the Critique of Knowledges (Sydney: Allen and Unwin, 1988), 62. 42 Indeed, there are a number of ways in which the post-modernist challenge to Enlightenment certainties, categorical separations, and hierarchies has taken

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Introduction

23

constitute their originary sites, the grounds on which they claim to stand, within themselves. The di€erence is, of course, that while, in the classical context these procedures are openly followed, without challenge, they have now fallen into disrepute, and must be actively concealed. What was then a valid invocation of nature has now become invalid. A di€erent sort of reintegration is performed by Grosz, but it too has classical parallels, and her terminological preference in this respect might also be said to have a historical foundation that Butler's (and Laqueur's) lack. Latin, after all, uses the word sexus to signify the condition of being either male or female tout court, and it is this usage that has, more or less, been followed by English through most of its history. On the other hand, Greek has no equivalent term at all, but refers directly to men and women, male and female, and, among other phrases, also to the male or female `race' (or `class'), the `race' (or `class') of men or women. The word used is ge3 now/genos, which primarily designates a group de®ned by common des cent and kinshipÐrelated as it is to other words concerned with generationÐbut spreads outward to encompass any distinct class of persons, any type of thing, including types of words themselves.43 For all the distance it has since travelled, `gender', in all its modern English manifestations, thus has roots in ge3 now and its Latin equivalent genus.44 The terminological case could, therefore, go either way in respect to historical ®delity. In respect to historical utility, however, `gender' more clearly has the upper hand. It is increasingly used, following Joan Wallach Scott, as the most e€ective means of assembling and analysing the whole of any society's dealings with the sexual di€erence it ®nds in its midst, however those dealings are labelled or construed.45 All known distinctly pre-modern forms. This challenge has often tried, quite literally, to look behind these established assumptions; reaching for pre-Enlightenment ways of doing things as an aid to thinking di€erently about the present and future, and indeed about the business of thinking itself. 43 For use of ge3 now in respect to men and women see e.g. Pl. Resp. 453a1 and 454d7 8, and in respect to words, e.g. Arist. Rh. 1407b7. 44 It is, of course, genus and not sexus which applies to the `gender' of words in Latin, see e.g. Quint. Inst. 1. 6. 5 and 9. 3. 6 for the interplay between the two. 45 Joan Wallach Scott, `Gender: a useful category of historical analysis',

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societies have been (and still are) concerned, in di€erent ways and to di€erent degrees, with the categories of male and female, with what it is, what it means, to be a woman or a man; all societies have been continuously engaged in the work of making men and women in whatever is deemed to be their proper relation. It is this inevitable but variable facet of social organization that Scott designates, in its entirety, as gender: an organization which enacts, is enacted in, society's understand ings, knowledge, of sexual di€erence. It is this all encompass ing concept, as given further depth by Butler, that will be adopted in the present study, which locates the particular enquiry it pursuesÐinto the contribution of medicine to the making of women in the Roman imperial worldÐwithin the broader framework of the overall contribution of medicine to gender in this world. The reference to Butler is not intended to suggest, after all, that the apparatus of gender will function in the Roman context as it does now, that it will produce a coherent and foundational notion of a pre given, pre discursive `sex'. It may not function to produce any kind of coherent, foundational notion at all, at least not beyond a range of rather vague, and undoubtedly divergent, invocations of `female nature', in the ancient sense. What is intended, however, is to emphasize the general point that may be taken from Butler's more speci®c argument: that is the wider notion of gender as apparatus, as including within itself certain principles of organization, of arrangement and structure, dependent as they may be on the wider orderings of knowledge and society. Gender is always possessed of form as well as content, and its constituent parts may be put together, interrelated, and given a certain overall shape, in a variety of ways. This needs to be emphasized because, as has beeen indicated, it is the organ izational side of a€airs which has tended to be neglected in studies of historical relations between gender and medicine AHR 91 (1985), 1053 75; and repr. in her collection of essays, Gender and the Politics of History (New York: Columbia University Press, 1988), 28 50, with additional discussion in the introduction, 1 11. Scott's ideas have come in for a fair amount of criticism, see e.g. June Purvis, `From women worthies to poststructuralism? Debate and controversy in women's history in Britain', in the collection of essays she edited, Women's History in Britain 1850 1945 (London: UCL Press, 1995), 1 22, though much of it is based on misunderstanding.

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Introduction

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thus far. Insucient variablity has been allowed for in this respect, insucient distance has been achieved from modern presuppositions and priorities. The present study also leaves the question of the force of Roman medicine's contribution to the making of Roman women as open as its form and content. For the numerous reasons that have already been given, it is not assumed that medicine will, by right and de®nition, have contributed any thing particularly authoritative to the meaning and patterning of sexual di€erence in the Roman empire, but only that it will have contributed something, as be®ts its own position and aspirations within that world. Medicine is a site of social negotiation, where men and women may meet and interact, both with each other and among themselves, in a range of guisesÐas practitioners and patients, providers and purchasers of servicesÐand a site of discursive production, where men and women may variously act as producers and reproducers, and feature as products and recipients of the discourse itself; all this being, of course, intermeshed. The making of medicine is thus inevitably and multiply bound up with the making of gender; what is not inevitable, however, is the signi®cance of medici ne's part in this, as well as the way it is played out. This signi®cance will depend, primarily, on how medical practi tioners fare in any society's distribution of power and prestige and what discursive resources medicine has at its disposal, factors which are interrelated and also bring a host of other cultural circumstances into play. The point is, however, not to prejudge the issue but to include it in the investigation; and that is what is attempted here. There is, moreover, a further question which bears on the forcefulness of medicine's contribution in this respect, a ques tion about demand rather than supply. The stability of the Roman gender system (and social order more broadly), the pressures and challenges it was subject to, its various adaptive and recuperative resources, are all relevant to considerations of the kind of role medicine may have played within it. Much of what societies do in giving meanings and values to, in ordering and arranging, sexual di€erence is mundane, repetitive, and implicit almost to the point of invisibility. Some of it is less ordinary, more open and direct, and the balance between the

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26

Introduction

two will vary, as di€erent societies work more or less hard, in di€erent circumstances, and with di€erent precise goals. Par ticular moments of crisis, of radical or rapid social change, of sexual slippage or revolt, will, moreover, bring forth particular responses, including both the simply reactionary, strongly defensive of existing patterns, and the more conciliatory, o€ering the possibility of a more reciprocal renegotiation of the rules. Certainly the turn of the nineteenth into the twenti eth century, which is often taken as paradigmatic in establish ing an essentially (and often self consciously) oppressive pattern of relations between women and medicine, was a time of sexual radicalism. Doctors' pronouncements about the dangers of female education and employment, or the biological basis for women's disenfranchisement, were made in the face of demands for just these things, and not just demands either. In comparison, women's place in Roman society seems much more settled, more taken for granted by everyone concerned, both women and men. It should be remembered, however, that the battle of Actium and the constitutional settlements that followed brought to an end a period of protracted and profound social and cultural upheaval in which gender was inevitably implicated; and concern with the behaviour of their women folk, allegations of moral decline, seem to have been one of the constants of eÂlite Roman existence. This then is the terrain negotiated by Roman medicine; these too are all issues which must be taken into consideration in this context. This study is, therefore, intended to be as full as possible within its chronological and geographical remitÐthat is the Roman empire over a little more than the ®rst two centuries adÐand the limits of the evidence. It examines women as medical practitioners and patients, authors and audience, and any other female activity in the `medical market place' of the early imperial era; investigates their treatment in contemporary medical literature from Celsus to Galen, paying attention to both its form and content; and tries to situate all of this within the wider patterns of the Roman world in an appropriately dynamic way, understanding that the medical enterprise takes from other aspects and attributes of the culture in which it has its life and gives something back in return. This is therefore an enquiry not only into the medical woman who is e€ected in

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these texts and practices, but also into what she is the e€ect of and what wider ideological e€ects she might then have, the traces and trajectories of which extend beyond the strictly medical. All aspects of the medical contribution to the making of Roman women are investigated, including as these women may have helped to make themselves. It is, however, not possible to investigate all aspects of this medical making equally. The limits of the evidence are, as ever in this kind of undertaking, acutely felt at times. Though the worlds in which Celsus and Galen lived and worked are better documented than those of the Hippocratics, or even Aristotle, there are none the less the predictable and considerable gaps between, for instance, what can be ascertained about learned and literate medical traditions and those involved with them and more popular forms of healing and care, and between what was written about women in these traditions and what women themselves thought or did about it. Much more can be said about women as objects of medical knowledge (and a number of other male medical attentions) than as medical subjects or agents; female experience itself remains elusive. This study, therefore, contributes more to understanding gender as a system, as an apparatus, than anything lived by individuals; more to the `historical critique of gender formation' than to `women's history' per se, to use Mariana Valverde's formula tions.46 It does so, however, on the assumption, shared by Valverde (and others), that the two cannot be disconnected. The medical texts and other artefacts here examined, their assumptions, expositions, and prescriptions, all participate in the formation of the categories of men and women in the Roman empire, their shape, texture, and meaning, the under standing and articulation of their interrelationship; and, how ever then complex and now obscure the relations of real women and men to this ordering and organization, they certainly could not ignore it, just as it could not ignore them. It is, therefore, on the basis of these general principles of historical entanglementÐof women, medicine, and society; of gender, nature, and authority; of ideology and practiceÐthat 46 Mariana Valverde, `Comment', Journal of Women's History, 5 (1993), 123 8; this also being part of a round-table discussion on the debate sparked by Scott, `Gender' (n. 45 above).

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this book proceeds. Proceeds, moreover, without prejudice as to the precise character and content of these interlocking intricacies that may emerge in the rich and varied course of the ®rst two centuries of the Roman imperial era.

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PART I

A Brief Introduction to Roman Medicine

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Part I: Introduction Any discussion of women and medicine in the Roman world must begin by outlining the shape and place of medicine in that world more broadly. The ®rst part of this book attempts to do just that, starting with the social formation of Roman medicine and then moving onto its basic conceptual framework. The aim is to identify and locate female medical practitioners and patients within the wider patterns of Roman medical activity, and to describe the context in which medical texts about women were produced, the purposes they may have served, and the e€ects they may have had. These texts, moreover, arise and operate not only within a particular social situation, but also within a particular ideative frame. Medical discourse of the imperial era inherited a well established set of approaches to health and human existence, to disease and cure, which were then variously embraced or rejected, extended and elaborated, or condemned and contradicted. The constitution of woman as an object of medical knowledge is as deeply embedded within these processes as within the wider workings of Roman medical practice, indeed the two are inseparable.

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1 The Social and Cultural Formation of Roman Medicine T h e multiple strands of the historical record furnish an impressive array of persons and institutions to whom indi viduals in the Roman imperial world might turn if they deemed their state of health or somatic functioning to be in need of attention. There were diverse physicians, both male and female (i1 atroi3 /iatroi and i1 atri3 nai/iatrinai in Greek, medici and medicae in Latin); midwives (mai9 ai/maiai and obstetrices); medical attendants and trainers (i1 atralei3 ptai, usually latinized as iatra liptae; or just a1lei3 ptai, rendered as aliptae; and also gymnastai3 / gymnastai); root cutters, herbalists, and other dealers in medi cal materials (r2izoto3moi/rhizotomoi and herbarii); various work ers in magic (ma3goi, latinized as magi); astrologers (mauhmatikoi3 , latinized as mathematici); dream interpreters (o1neirokritai3 / oneirokritai, who seem to have no real Latin equivalent); a number of old women (gra9ew/graes and aniles); and, in a rather di€erent class, numerous temples and sanctuaries with their own personnel. Roman society, or at least parts of it, vested in each of these groups of practitioners the authority to intervene in a medical context, and designated certain religious sites as points of access to divine intervention in the same healing context, recognizing in all the activities they enacted or accom modated, di€erent aspects of the cultural understandings of health and the workings of the body, and of illness and cure. These are the persons (and places) involved in Roman medical practice, but it is not clear that they should all be described as medical practitioners per se. While the medici, obstetrices, iatraliptae, and herbarii are all principally con cerned, however broadly and diversely, with matters of health, as medicine is their business, for the magi, mathematici, oneirokritai, and, somewhat di€erently, the aniles, health counts as only one of many concerns they may address, as

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Introduction to Roman Medicine

their business is magic, dream interpretation, or whatever. This is not a judgement about professionalism as such, nor about whether these characters plied their trades full or part timeÐfor many (if not most) must have combined these practices with a range of other economic and domestic activ itiesÐbut about wider issues of identity and work. It is about how these groups of people were de®ned in relation to their activities. It is the more strictly de®ned medical practitioners who are the focus of this book, but they can only be understood against the background of this broader and looser aggregate of medical practice. For the wider pictureÐthe plentiful patterns into which understandings of sickness and health might ®t and the multiplicity of people who claimed expertise, who were deemed to be e€ective, in the areaÐis crucial for getting to grips with any of its parts. Each medical service or interpreta tion was o€ered and accepted as one among many, each individual who o€ered such services or interpretations was also part of a crowd, and this a€ected all these activities and transactions. All these features contributed to the shape and substance of medical practice in the Roman world, to the authority and impact of its proponents; as did the broader social patterns in which they participated. The exploration of the Roman medical heartland that follows is, therefore, to be taken in this way; not as the description of an isolated island, but a territory interlocked with others. The aim is to provide a rough guide to the identity, interrelations, and activities of the practitioners and patients involved, both male and female, which also locates them within wider social and cultural net works of power and prestige, knowledge and practice. The particular pattern of medical provision by and for women will be drawn out from this broader background, and matters set up so that when women's role in the texts generated within this framework come to be examined in more detail, it can be done with a proper sense of their contexts of production and distribution, their place in the world. The intention is, there fore, to describe the social formation of Roman medicine as it relates to gender, in all its dimensions.

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IDENTIFYING ROMAN MEDICAL PRACTITIONERS It is the ®gure of the medicus or iatros who stands at the centre of the Roman medical formation. The processes of social negotiation through which his identity was constructed were complex, but their results are reasonably clear. The medicus was de®ned, and acquired his pivotal position, by the provision of recognized health care services of a general nature for some kind of remuneration.1 This is, however, less clear in the case of the medica. The latter appears in a far more restricted range of sources than the former, making it hard to discern much about her actual practice. There certainly are a number of women in the imperial world, from the Iberian peninsula to Asia Minor, who lay claim to the title of female physician, or have it applied to them by those who commemorate them, but the paucity of their recorded activities beyond this has led some to question whether this title is really earned.2 There are two particular problems. First, medicae are glimpsed providing medical services to other women only, while male medical practice appears not to be bounded by sex.3 Secondly, there was another group of women who catered 1 See Vivian Nutton, `Murders and miracles: lay attitudes to medicine in antiquity', in Roy Porter (ed.), Patients and Practitioners (Cambridge: Cambridge University Press, 1985), 23 53, for a general survey of the evidence concerning the identity of the medicus. 2 The imperial inscriptions referring to medicae and iatrinai are collected in App. 2; and for further, di€ering, discussions of the meaning of the title see esp. Louis Robert in Nezih Firatli, Les SteÁles funeÂraires de Byzance greÂcoromaine (Paris: Maisonneuve, 1964), 175 8, and Jukka Korpela, Das Medizinpersonal im antiken Rom: Eine sozialgeschichtliche Untersuchung (Annales Academiae Scientiarum Fennicae, Dissertiones Humanarum Litterarum, 45; Helsinki: Suomalainen Tiedeakatemia, 1987), 18 20. 3 The leading empiricist physician of the early ®rst cent. bc, Heraclides of Tarentum, however, dedicated a collection of recipes, apparently of entirely generic content, to one Antiochis, who is usually taken to be the same Antiochis honoured for her medical skills by the council and people of her native Tlos (App. 2, no. 29); though Heraclides' ¯oruit is generally placed rather earlier than the most likely date for the honori®c inscription. See Karl DeichgraÈber, Die griechische Empirikerschule: Sammlung der Fragmente und Darstellung der Lehre (Berlin: Weidmann, 1930; repr. with additional material, 1965), 172 3, 188 92, for Heraclides' chronology and fragments of the

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Introduction to Roman Medicine

medically to a female clientele, the obstetrices or maiai. The terms are sometimes used interchangeably, and a hybrid wordÐ iatromeaÐalso appears in the course of the imperial era.4 So, it is suggested, perhaps medica is just another word for midwife. This argument, however, cuts both ways. If obstetrix and medica are synonomous, then perhaps the former should not be translated as `midwife', a designation (on the modern under standing at least) too narrow to cover the full range of female care that seems to be at issue here. Certainly obstetrices as well as medicae ranged far beyond assistance at childbirth.5 On the other hand, perhaps the translation is valid in the sense that the current division between doctor and midwife is crucially one of hierarchy and that may be what was at stake in the ancient world also. Medicae may have been trying precisely to position themselves closer to the medici than the obstetrices, stressing the more encompassing quality of their art rather than its limita tions. And, while top physicians may not have recognized these aspirations, the decurions of early imperial Lyons, for instance, who provided public space for a monument to Metilia Donata medica and donor, may well have felt di€erently about the matter.6 Indeed, Metilia may have ministered to them herself, just as it seems possible, if not likely, that the slave medicae of large households will have served both its male and female members on occasion, if not their actual masters.7 That the eÂlite of Rome itself, with the largest choice of practitioners before them and the greatest economic ability to choose, fostered a deeper division of labour and more restrictive female practice than elsewhere would not be surprising. The key point is, however, to recognize that titular distinctions may work to Antiochis; Galen's On Compound Pharmaka according to Place/Peri4 synue3 sevw farma3kvn tv9n kata4 to3poyw (Comp. Med. Loc.) 9. 2 and 10. 1 (xii, 250, 341 K) also preserves a recipe (again generic) from Antiochis herself. 4 For this interchangeability see e.g. Gal. On the A€ected Parts/Peri4 tv9n peponuo3tvn topv9n (Loc. A€.) 6. 5 (xii, 414, 420, 424 5, 428, 434 K). Iatromeae appear at Rome in the second and third cents. ad, see Korpela, Medizinpersonal, nos. 276, 280, and 281, and later in Christian Corycus, see MAMA iii, 292a. 5 On the general point see e.g. Helen King, `Agnodike and the profession of medicine', PCPhS n.s. 32 (1986), 53 77. 6 App. 2, no. 14. 7 For such medicae see e.g. App. 2, nos. 4 and (probably) 3.

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be meaningful whether or not they map very precisely onto distinctions of activity; and, therefore, to leave the medicae in the particular category they claimed for themselves and in which they achieved at least some acceptance. The general nature of the health care services provided by Roman physicians does need to be stressed, however. It is their speci®c but broad focus on matters of health that is crucial to their identity. Their practice, or, more abstractly and auto nomously, their artÐmedicina or iatrike techne (i1 atrikh3 te3 xnh, from which the techne/art could also be omitted)Ðwas essen tially teleologically de®ned, encompassing the generality of things considered to contribute to its goalÐhuman healthÐa generality which included resources which might, equally, be utilized by a magus, mathematicus, or oneirokrites. For these latter ®gures themselves, however, such resources are con tained within the di€erently constituted generality of their own arts. Thus, a medicus might, for instance and amongst other possibilities, prescribe a charm against some ailment, or employ planetary and lunar conjunctions or dreams as diag nostic and prognostic aids, all within the teleological frame of medicina; whereas the artistic frame within which the same action might be performed by a magus, mathematicus, or oneirokrites was an aetiological one, working forwards from, rather than back towards, a certain aspect or feature of the cosmic order within which human existence was contained. Spells and incantations, including of kinds not found in more speci®cally medical milieus, might be deployed for much more than healing, as could the interpretation of the heavens and dreams.8 Similar actions may occur in quite distinct contexts. Medical practitioners could also eschew such resources, and each individual medicus drew on the generality of the art in a particular way, following certain precedents even if they decided not to align themselves with a more clearly demarcated collective tradition. The principles of this composition always remained the same none the less. Everybody was engaged, in 8 The type of spells which predominate in the Greek Magical Papyri, that is those which explicitly invoke divine, daemonic, or angelic agency, are not found in dedicatedly medical contexts, the particular magic of which is discussed by Richard Gordon, `The healing event in Graeco-Roman folk medicine', AMSCC ii. 363 74.

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their own way, in constituting a body of knowledge requisite to the goal of health, however much the contents of their par ticular body of such knowledge varied from others'. In these principles the identity of medicina and its practitioners resides, and thus it can be divided, interpreted, and con®gured in a great variety of ways and still retain its categorical unity and de®nition. To profess an astrological medicine, for instance, was to adopt a somewhat eccentric position in relation to the medical art, but not to fall outside its boundaries.9 Similarly, though on a rather di€erent level, therapeutic specializations, such as that of the surgeon (chirurgus in Latin, from the Greek xeiroyrgo3w), or specializations based on the object of practice, such as the ear doctor (auricularius in Latin) and women's doctors (referred to as gynaikei9 oi i1 atroi3 in Greek), were frowned upon in some quarters as contravening the principle of the unity of the art and wider ideals of learning, but generally accepted within the ranks of the medici.10 Arranged rather di€erently around the central ®gure of the medicus or iatros, though also in a sense overlapping with parts of this generality from the outside, were the obstetrix or maia, the iatraliptes, alipta, and gymnastes, and the herbarius or rhizotomos. All of these persons both cooperated and competed with the medicus on common ground, forming, in e€ect, the second tier of the professional hierarchy. As has been men tioned, the identity of the obstetrix was shaped by childbirth, an event of considerable cultural as well as medical signi®cance, but her sphere of action extended out from this de®ning moment to encompass the overall care of female health. Her inferior relationship with the generality of the physician's art, and her subordination to its representatives, is assumed and 9 See e.g. Ptol. Tetr. 1. 3, and Pliny, Natural History/Historia Naturalis (HN) 29. 5. 9 (ii. 371. 6 11 M). 10 These specialists appear at e.g. Celsus, On Medicine/De Medicina (Med.) 7 pr. 3 (CML i. 301 20 5): Roman surgeons; CIL ii. 8908 and 377523: auricularii; Soranus, Gynaecology/Gynaikei3 a (Gyn.) 3. 3. 1 (CMG iv. 95. 7): women's doctors; and are assimilated to general physicians at Dig. 50. 13. 1. 3. See e.g. Ralph Jackson, `The composition of Roman medical instrumentaria as an indicator of medical practice: a provisional assessment', AMSCC i. 189 207, for a general discussion of specialization in Roman medicine; and Philippe Mudry, `MeÂdecins et speÂcialistes', Gesnerus, 42 (1985), 329 36, for the particular point about their ambiguous position.

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asserted in the writings of male doctors and re¯ected in wider understandings of her as a kind of iatros, or as practising a kind of medicina.11 This should not obscure, however, the import ance of this strand of medical provision, by and for women, in the Roman world, among both the masses and the eÂlite. The prominent role of midwives in the so called `infancy gospels' probably composed in the late second century ad, where they attend on the births both of Mary and then of Jesus (and also certify Mary's virginity after the birth), may be taken as indicative of the former; while the latter is con®rmed by the ways in which male medici report their dealings with the obstetrices of richer households, making it clear with whom the primary responsibility for care resides.12 A further question then arises about the relationship between these female practitioners, both obstetrices and medicae, and literary production. For, though women's names do not appear on the title pages of any complete extant works from this period, they are invoked in various texts in such a way as to suggest that this might be a mere accident of transmission. The parade of authorities with which Pliny the Elder opens his Natural History written around ad 78, includes several female namesÐElephantis, Lais, Olympias of Thebes, Salpe, and SotiraÐwhich then appear in the medical books of the main body of the text more or less as advertised.13 Indeed, Olympias 11 Even Soranus, whose idealized account of the qualities, skills, and training required of maiai (Gyn. 1. 2 3: CMG iv. 3. 13 4. 11) is often quoted as evidence for their valued and educated status, clearly casts the iatros in the role of teacher, director, and overseer to the maia. See Hsch. Lexicon m 64, and Dig. 50. 13. 1. 2 for the maia or obstetrix as a kind of iatros or medicus. 12 See esp. The Infancy Gospel of James (entitled simply, Birth of Mary/ Ge3 nesiw Mari3 aw, in its earliest surviving Greek recension) 5. 2, 18. 1, and 19. 1 20. 4, for midwives among the poor; and e.g. Gal. On Venesection against the Erasistrateans in Rome/Peri4 flebotomi3 aw pro4w ¸Erasistratei3 oyw toy4w e1 n ¹Rv3mW (Ven. Sect. Er. Rom.) 1 (xi. 188 K) and On Prognosis/Peri4 toy9 proginv3skein (Praen.) 8 (CMG v. 8. 1. 110. 13 112. 23) for the rich. 13 Elephantis: [28] HN 28. 23. 81 (i. 96, iv. 204 M); Lais: [28] 28. 23. 81, 82 (i. 96, iv. 304 M); Olympias: [20 28] 20. 89. 226, 28. 77. 246, 253 (i. 64, 70, 77, 81, 86, 89, 96, iii. 366, iv. 360, 362 M); Salpe: [28, 32] 28. 7. 38, 23. 82, 80. 262, 32. 47. 135, 51. 140 (i. 96, 109, iv. 289, 304, 365, v. 94 5, 96 M); Sotira: [28] 28. 23. 83 (i. 96, iv. 304 M). On Pliny and the HN more generally see Ch. 3 below.

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is placed in the medici section of the authorial registers and both Salpe and Sotira have the epithet obstetrix attached to them. However, Lloyd's assumption that these were the real writers of works covering medical topics is somewhat unsafe for, though it is the case that Pliny relied on literary material in his composition of the Natural History, this does not neces sarily imply either that he was drawing on whole texts claiming to be authored by these women, or that any such claims were true.14 Looking elsewhere for reference to these female ®gures and their possible úuvres is of only limited assistance in trying to clarify the matter. The name Elephantis is found in Galen in connection with a remedy for alopekia (a1lvpekia3, a scalp prob lem) possibly drawn from a Kosmetikon (Kosmhtiko3n, a work on things for a beautiful and well ordered body), and rather more frequently in other works in connection with an illustrated guide to sexual positions.15 The name Cleopatra is also found in Galen, much more clearly marked as the author of a Kosmetikon from which Galen takes several recipes, but at second hand, as selected from a previous compilation rather than the work itself.16 That this, along with the numerous other treatises on a range of subjects which also bear her name, was actually written by the Egyptian queen seems most unlikely; it is, surely, an indication of the potency of the name rather than of any female literary endeavour.17 Salpe is found in Athenaeus since it is the name of a ®sh which was also attached to the authorship of a text entitled Paignia (Paigni3 a)Ðeither because that was indeed the name of the Lesbian woman who compiled it or because its creator, one Mnaseas, became known as such on 14 G. E. R. Lloyd, Science, Folklore and Ideology (Cambridge: Cambridge University Press, 1983), 60 n. 6, 63 n. 11. 15 Gal. Comp. Med. Loc. 1. 2 (xii. 416 K): Kosmetikon; and Mart. 12. 43; Priap. 4; Suda A 4261; Suet. Tib. 43, and Tatian, Ad Gr. 34. 3: sex manuals. 16 Gal. Comp. Med. Loc. 1. 2, 1. 22, 1. 3, and 1. 8 (xii. 403 5, 433 4, 445, 492 K). Other women also appear as the creators of recipes, but not in such an explicitly literary sense. 17 For a list of ancient texts ascribed to Cleopatra, with particular attention to the gynaecological tradition which bears her name see Monica Green, `The Transmission of Ancient Theories of Female Physiology and Disease through the Early Middle Ages', Ph.D. diss. (Princeton University, 1985), 156 61 with 185 9.

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18

account of associations between the work and the ®sh. Paignia is a very vague title, however, and the contents of such a work are unclear (indeed have been recently contested), but could well have included various medical and sexual recipes.19 Lais, Sotira, and Olympias are otherwise unknown as writers, and the ®rst two appear only in close proximity to Elephantis and Salpe, though Olympias enjoys a more independent existence. Thus, while it is likely that there were texts circulating under the names of Cleopatra, Elephantis, and Salpe in antiquity, they were in traditions in which pseudonymity was rife, if not de rigueur, and in which the creation of a ®ctional female voice had a particular allure. There were certain types of knowledge, especially some concerned with women's bodies, which were most appropriately represented in a female literary form, or at least where such a representation was one of the rhetorical strategies open to the author. That such an author was male is probable, though not certain, but that some of the knowledge thus articulated was actually derived from women, from obstetrices and aniles, is surely a similar likelihood. Such a derivation might also be acknowledged, or more creatively conjured up, by writers who did not otherwise present themselves in any sort of literary drag.20 Thus, the ways in which women's names might be textually attached to opinions and remedies appearing in a treatise clearly written by a man (like the books of Pliny or Galen) range from the precise quotation of a female authored work (large or small) to the imaginary inscription of a kind of medical lore considered to be typically female and folksy, and cover various points in between, including borrowing from a similarly constructed tract already in existence. This is of particular relevance given that both the Natural History and Galen's treatises on compound remedies were composed primarily through a selective unpicking and rearranging of others' works, so that 18

Ath. 7. 321f 322a. See for discussion: James Davidson, `Don't try this at home: Pliny's Salpe, Salpe's Paignia and magic', CQ 45 (1995), 590 2, and David Bain, `Salpe's PAGNIA: Athenaeus 322A and Pliny H.N. 28. 38', CQ 48 (1998), 262 8. 20 I use the word `drag' because I think that these men `dressed themselves up as women' less with an intention to deceive than in order to do certain things constructed as female but which women themselves would not do. There is a sense of parody in all this, in which the audience were presumably complicit. 19

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these female citations are quite possibly at least second hand, obscuring their origins still further.21 The di€erence between the medicus and the alipta, according to both the layman Cicero in the ®nal years of the Republic and the physician Caelius Aurelianus towards the end of the imperial age in the West, is that the former is concerned with the health of the body, the latter with its strength and appearance.22 These two goals are, however, clearly connected and many of the same, dietetic, methods were employed in pursuit of both. So it was in these regions of coincidence that the iatraliptes seems to have come into being as a special sort of alipta, but in a context where the general practitioners continued to do medical work in a variety of situations.23 The writings of the medici delineate the approved boundaries for the activities of such persons. They are to be called in to oversee and carry out certain therapeutic or invigorating regimens which have been prescribed by a medicus, such as regular anointing, massage, or types of exercise, and might have an ongoing role in the care and cultivation of the body, but they are not to usurp the commanding, overall position of the medicus himself.24 This hierarchy is con®rmed in the Copyright © 2001. Oxford University Press, Incorporated. All rights reserved.

21

For the way Pliny relied on previous compilations but individually cited the authors they contained, see John Scarborough, `Pharmacy in Pliny's Natural History: some observations on substances and sources', in Roger French and Frank Greenaway (eds.), Science in the Early Roman Empire: Pliny the Elder, his Sources and In¯uence (London: Croom Helm, 1986), 59 85; and for Galen see Cajus Fabricius, Galens Exzerpte aus aÈlteren Pharmakologen (Berlin: de Gruyter, 1972). 22 Cic. Fam. 1. 9. 15; Cael. Aurel. On Rules for Health/De Salutaribus Praeceptis 6 (ii. 196 7 Anec.). 23 Terminological imprecision is one result of this. The title iatraliptes, I think, attempts, through its medical specialization, to pull rank on the alipta. It appears in funerary inscriptions (e.g. CIL vi. 8981 and I. Ephesos 629), in a legal text (James H. Oliver, Greek Constitutions of the Early Roman Emperors from Inscriptions and Papyri (Memoirs of the American Philosophical Society, 178; Philadelphia: American Philosophical Society, 1989), no. 38), and in a range of literary contexts, complimentary (e.g. Plin. Ep. 10. 5), hostile (e.g. Petr. Sat. 28), and neutral (e.g. Cels. Med. 1. 1. 1: CML i. 29. 26 7). 24 Cael. Aurel. Chronic A€ections/Tardae Passiones (TP) 1. 97 and 169, 2. 179, and 5. 130 (CML vi. 1. 1. 486. 3 16, 530. 20, and 652. 30 654. 2, vi. 1.2. 932. 24 7). Galen's treatise To Thrasyboulus on whether Healthiness is a part of Medicine or Gymnastics/Urasy3boylow: po3teron i1 atrikh9w h6 gymnastikh9w e1 sti to4 y2gieino3n (Thras.: SM iii. 33 100) is an attack on this kind of gymnastic general practice.

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Younger Pliny's letters to the emperor Trajan asking that those who have helped him through a recent and severe illness in Egypt be rewarded: for his iatraliptes, an Egyptian freedman named Harpocras, he requests Roman citizenship; for his medicus, Postumius Marinus, that the citizenship he already enjoys be extended to various of his friends and relatives.25 The area of overlap between the herbarius and the medicus involves a di€erent, but just as important, section of the latter's therapeutic repertoireÐremedies based on plant materialsÐ another key component of their generality. However, though the recipes of a herbarius or rhizotomos might also be prescribed by a medicus, and the works of Crateuas, the root cutter attached to the court of Mithridates VI, were widely consulted, it was the manual labour of the collection of the plants that remained fundamental to their identity.26 Thus rhizotomos appears among the terms of abuse hurled by Hercules at Asclepius in the exchange of insults between them imagined by the second century ad satirist, Lucian.27 These root cutters presumably played a role in supplying dealers in a range of goods and materials associated with all aspects of the care of the body: perfumes, oils, unguents, and salves, among many other items.28 Such trading networks must have been, for the most part, of a mundane and functional character, and inscriptions record the worthy civic activities of various collegia formed within them, but it was their connotations of luxury and reputation for fraud and deceit that attracted outside com ment.29 These are also the elements out of which the ®gure of 25

Plin. Ep. 10. 5 7 and 11. Galen, for example, includes remedies of the rhizotomoi Pharnaces and Antonius in his pharmacological works (xiii. 205 and 935 K, respectively); he also refers to Crateuas (e.g. xi. 795, 797 K), as do Dioscorides (On Medical Materials/Peri4 y7lhw i1 atrikh9w (MM) pr. 1: i. 1 W) and Pliny (HN 25. 4. 8 and 25. 26. 62: iv. 118. 19 22, 137. 1 2 M) among others. On Crateuas himself see E. Kind, `Krateuas (2)' in RE xi.2 (1922), 1644 6. 27 Lucian, DDeor. 15. 28 For enumeration of these various dealers and their wares see Alfred Schmidt, Drogen und Drogenhandel im Altertum (Leipzig: Barth, 1924), 75 99. 29 See generally Vivian Nutton, `The drug trade in antiquity', Journal of the Royal Society of Medicine, 78 (1985), 138 45; and, for discussion of these collegia at Rome, see Jukka Korpela, `Aromatarii, pharmacopolae, thurarii et ceteri: Zur Sozialgeschichte Roms', AMSCC i. 101 18. 26

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the pharmacopoles (farmakopv3lhw, latinized as pharmacopola), the last member of this collectivity, is constructed; for he is a ¯attering and dishonest pro®teer, a pedlar of worthless pro mises and poisons. The pharmacopoles, as the second century ad philosopher physician Sextus Empiricus put it, stands in the same relationship to the iatros as the demagogue (dhmagv go3w) does to the statesman (politiko3w); and, a century earlier, Scribonius Largus, less philosophical but more professionally committed, described this relationship as antithesis masquer ading as similarity.30 The rhetorical ¯ourish of these formula tions serves only to highlight what it is intended to conceal, that the distinction between the medicus and the pharmacopola is a matter of perspective and judgement; they are two possible outcomes of the same social negotiation. The point is under lined by the fact that invective against medici, as such, is cast in very similar terms.31

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REGULATING ROMAN MEDICAL PRACTITIONERS The medicus or iatros, and some associates, received a certain ocial recognition within the Roman empire, but this followed rather than led their cultural de®nition. Roman systems of law and governance participated in and elaborated on, rather than regulated, the ongoing and informal processes of social nego tiation. Julius Caesar had granted citizenship to all who resided and practised medicina, or taught the liberal arts, at Rome, echoing the continuing practice in the cities of the Greek East, instituted in the Hellenistic period, of granting physicians various ®nancial bene®ts and civic honours in order to attract and retain their services.32 This was, however, only the opening move in a long process of entanglement between imperial and 30 Sext. Emp. PM 2. 41 2, and Scrib. Larg. Compounds/Compositiones (Comp.) 200 (92. 1 4 S). 31 See e.g. Pliny, HN 29. 8. 15 28 (iv. 373. 15 f M). 32 Suet. Caes. 42. 1 (this grant would, of course, have been restricted to those legally eligible that is, who were free). For a discussion of the Hellenistic institution of the civic physician and its development in the Roman era, see Vivian Nutton, `Archiatri and the medical profession', PBSR 45 (1977), 191 226.

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municipal systems of privileges in which medici, among others, were implicated, and which was not clari®ed until the e€ective establishment of a single, uni®ed structure by Antoninus Pius in the mid second century ad.33 The triumviral edict from Ephesus and Vespasian's rescript to Pergamum both seem to represent the stage of central intervention in support of existing local immunities, and, in the Pergamene case, the right of medical practitioners to meet and collectively organize.34 The edict of Hadrian, which con®rmed that philosophers, rhetors, teachers, and medici should be exempt from liturgies and priesthoods, as well as a range of other civic and provincial duties and obligations, legislated for the whole empire; and Antoninus Pius, perhaps alarmed at the generosity of his predecessor, restricted the number of medici who could be granted immunities in each city or town (those included in this numberÐnumerusÐbeing called archiatri), thus ensuring that this became the sole system of privileges in operation for physicians.35 Until the rescript of Antoninus Pius these mea sures, whatever their precise ambits and interrelationships, simply incorporated preformed categories of persons (at Per gamum both iatroi and iatraliptae, otherwise only the former) into various patterns of legal privileges. They did not engage in any way with issues of professional identity or competence, a point which is underlined by a second century ad papyrus which suggests that these privileges automatically accrued to 33 For a general discussion of the pattern into which this process ®ts see Fergus Millar, `Empire and city, Augustus to Julian: obligations, excuses and status', JRS 73 (1983), 76 96. 34 K. Bringmann, `Edikte der Triumvirn oder Senatsbeschluû? Zu einem Neufund aus Ephesos', EA 2 (1983), 47 76, and Oliver, Greek Constitutions, no. 38. The Vespasianic rescript was, in line with general interpretative trends, later treated as of general application (Dig. 27. 4. 18. 30: Arcadius Charisius), but its actual formulation implies speci®city. Cassius Dio (53. 30. 3) also reports an earlier grant of tax exemption to Antonius Musa and his `fellow practitioners' (o2mote3 xnoi), present and future, by a recently cured Augustus and grateful senate, but the context suggests that the fellow practitioners referred to are a group in some way associated with Musa, rather than comprising all doctors. 35 Dig. 27. 1. 6. 1 11. Archiatroi had previously denoted physicians at Hellenistic courts, and continued to be the title of physicians serving the imperial household as well as these successors of the Hellenistic `public physicians' (dhmo3sioi i1 atroi3 ): see Nutton, `Archiatri'.

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all who declared themselves to be iatroi to the appropriate magistrate.36 Thereafter, the underlying class of medici passed out of the administrative view of the local authorities, except as a pool from which to select the numerus of archiatri, but the acquisition of immunities and assessment of professional com petence became entwined, as the Severan jurist Ulpian states:

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medicorum intra numerum prae®nitum constituendorum arbitrium non praesidi provinciae commissum est, sed ordini et possessoribus cuiusque civitatis, ut certi de probitate morum et peritia artis eligant ipsi, quibus se liberosque suos in aegritudine corporum committant. The decision on the medici to be included within the prescribed numerus is not entrusted to the governor of the province but to the ordo and landowners of each community, so that they themselves, being certain about the uprightness of their character and skill in the art, may choose persons to whom, in bodily sickness, they may entrust themselves and their children.37

The governors of provinces did, however, give judgements on the fees of medici and teachers of the liberal arts.38 In this too they operated with categories of medical practitioners which were formulated entirely outside the ambit of the law. Ulpian's treatment of the subject simply assumes the meaning of the terms medicus (into which some subsume those who treat a particular part of the body or disease) and obstetrix when he states that the fees of specialists and obstetrices, `who seem to practise a kind of medicina', come under the jurisdiction of the governor on the same basis as those of the medici do.39 Those who use incantations, imprecations, and exorcisms, however, have no such access, for these are not `types of medicina' (genera medicinae) however e€ective they may be. This ®nal exclusion re¯ects a general contrast between the position of the medicus and that broadly shared by the mathematici, oneirokritai, and magi in relation to the formal structures and systems of the empire, a contrast between an attitude of positive integration and of negative segregation. It was not that any of the practices 36 Herbert Youtie, `A reconsideration of P. Oxy I. 40' in Festchrift Oertel (Bonn: Rudolf Habelt Verlag, 1964), 20 9. The juristic discussion on the subject suggests, however, that the matter was not unproblematic (see e.g. Dig. 27. 1. 6. 1 9). 37 38 Dig. 50 . 9. 1. Dig. 50. 13. 1. 39 `quae utique medicinam exhibere videtur', Dig. 50. 13. 1. 2.

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of the latter were illegal in themselves, but the ends to which they could be employed were constrained by law; just as it was not that their identities were legislatively condemned but that they were somewhat compromised by their omission from important socio legal networks. The Pergamene rescript can be placed together with other inscriptions recording the existence and activities of other associationsÐcollegia and synodoi (sy3nodoi)Ðof medici and iatroi; though it is only here that they appear alongside those of iatraliptae, their formation explicitly authorized by the emperor.40 In the circumstances, it seems likely that this represents the broadly favourable attitude of the authorities towards the formal self organization of medical practitioners at a local level. However, these associations, like most others, seem to have concerned themselves with the generic interests of their members as part of Roman societyÐtheir religious obligations, funerary arrangements, and social lifeÐrather than anything speci®c to them as medical practitioners.41 There is a very fragmentary inscription from Ephesus which seems concerned with fees, or at least money in some sense, but that is the closest any group comes to following a more genuinely professional path; and questions of recruitment, of whether most, all, or only a select few of the physicians in any city were members of the local collegium remain unclear.42 These collegia were, therefore, implicated in the constitution of the category of medici, but, again, rather after the fact. They were one of this category's localized and partial forms, o€ering 40 For the legal position of collegia, and the privilege of being explicitly authorized to form them, see P. W. Du€, Personality in Roman Private Law (Cambridge: Cambridge University Press, 1938), 95 158. 41  tude historique sur On the role of collegia in general see J.-P. Waltzing, E les corporations professionelles chez les Romains, 4 vols. (Louvain: Peeters, 1895 1900), esp. i. 161 333; and Onno van Nijf, The Civic World of Professional Associations in the Roman East (Amsterdam: Gieben, 1997). On doctors in particular see Vivian Nutton, `The medical meeting place', AMSCC i. 3 25. 42 I. Ephesos 1386. For discussion of the possible involvement of women in collegia see John Kloppenborg, `Collegia and thiasoi: issues in function, taxonomy and membership', in John Kloppenborg and Stephen Wilson (eds.), Voluntary Associations in the Graeco-Roman World (London: Routledge, 1996), 25, 30.

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an ocial civic identity both to their members and to the public. This latter presentation must have acted as a kind of social guarantee, certifying the group's participatory status in the life of the community, but not their validity as medical practitioners. Asclepius is the divine patron most often invoked in these collegial inscriptions, and his patronage, in a sense, extended over the whole medical art itself, as well as occasionally taking on a more personal dimension for individual physicians.43 Asclepius was variously described as the inventor, promulga tor, or systematic improver of medicina; providing, in whatever form, a divine legitimation for its profession.44 He also had a certain medical practice of his own, to which the various healing sanctuaries dedicated to him (such as the major ones at Epidaurus, Cos, and Pergamum) o€ered access.45 These were an intrinsic part of the Roman medical landscape, recognized as such by the various iatroi who make reference to the cures and prescriptions of the gods in a number of contexts, and even, on at least one occasion, publicly comme morated their own divine healing.46 The partisans of Asclepius, on the other hand, seem to be slightly less equable with regard to the medici and their activities. Or they seem, at least, to be more insistent on a hierarchy of success, though not one that denies e€ectiveness to mortal medical practice, just puts it in 43 See e.g. CIL v. 6970 and Gal. On his own Books/Peri4 tv9n i1 di3 vn bibli3 vn (Lib. Prop.) 2 (SM ii. 99. 8 13), for collective and individual relations between medici and Asclepius. 44 See Emma and Ludwig Edelstein, Asclepius: A Collection and Interpretation of the Testimonies, 2 vols. (Baltimore: Johns Hopkins University Press, 1945; repr. with new introd. 1998), i. 179 94, for connections between the god and the art. 45 See Edelstein and Edelstein, Asclepius i. 194 7, 370 452, for literary and epigraphic testimonies for these healing sanctuaries, and Asclepius ii. 232 57, for a general discussion of the sites. Much archaeological work has since been done on many of these sites, and an additional bibliography and commentary is included in Gary Ferngren's introduction to the 1998 reprinting, pp. xix xxi. 46 See e.g. Rufus ap. Oribasius, Medical Collections/Synagvgoi4 i1 atrikoi3 (Coll. Med.) 45. 30. 10 14 (CMG vi. 2.1. 191. 38 192. 14), and Gal. On Healthful Conduct/Peri4 y2gieinv9n (San. Tu.) 1. 18. 19 21 (CMG v. 4.2. 20. 11 22); and the pair of inscriptions erected in the 2nd cent. ad at Rome by Nicodemus, a physician from Smyrna, IG xiv. 967a and b.

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its place. Their most vocal representative, the eminent second century ad sophist Aelius Aristides, involves doctors in his autobiographical Sacred Tales largely so that they may be eclipsed by what the god has to o€er, both in terms of healing and more general support; and the limitations of mortal physicians are also sometimes stressed in dedicatory inscrip tions at these sites.47 The distinctive legal patterning into which the collegia and their gods ®t helps to locate, rather than de®ne, the Roman medical professions. It situates them in the administrative grid that was placed over the geography of the empire, a grid which brought into existence or adaptively assimilated, and then ordered, a whole series of juridical and political rela tions. The medicus was ®xed in a framework of general legal privilege, in which, by association, some other groups of medical practitioners were partially incorporated, while others remained outside. This position was also shared more widely, placing the medicus in a loose, horizontal relationship with other persons collectively in receipt of similar immunities and honours, organized in authorized, but private, collegia, or having their fees fall within the jurisdiction of the provincial governor. The system was also overseen and orchestrated, so a more concrete vertical rela tionship was established between medicus, local magistrates, ordo, and governor. These relationships were speci®cally constituted and circumscribed, by law, but they are part of what might be called, more globally, the social structure of Roman medicine. This structure was a particular formation within the wider world, a vast and variegated empire in which the conquerors had a special relationship with some of the culture and history they had conquered, and the interlocking dyad of wealth and power was fundamentally based on the ownership of land and the exploitation of slave labour. This basic con®guration underlies and underpins the network of social relations within which medical knowledge was pro duced and deployed. This pattern is perhaps most pro nounced in the manifest Greekness of Roman medicine, but 47

Aristid. Sacred Tales ( Or. 47 52 Keil), e.g. 1. 62 8, 2. 38 45, and 3. 18 19; and see also e.g. IG ii2. 4514.

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it also shows in the connected complications of the status of its practitioners, and the way this was played out in their practice.

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SOCIALLY SITUATING ROMAN MEDICAL PRACTITIONERS The overwhelming majority of the medici and iatroi who appear in the epigraphic and literary records of the imperial period came from the Greek East.48 This di€usion of Hellenistic medicine was the product of Roman expansion, which overlaid and massively extended the networks of Archaic Greek colonization and Macedonian conquest. The establishment of the empire as a geographical unit, loosely bound together on a number of levels, facilitated and, through slavery, compelled, the movement of people and ideas, inside and around its borders. The cultural and intellectual map was redrawn alongside the political, and the imperial capital was its focus. Rome was the centre of medical and philosophical demand, the place where reputations and fortunes could be made, disciples gathered, and your clientele include the emperor himself. In particular, Octavian's victory at Actium increased the ¯ow of scholarly migration (including physicians) from Alexandria to Rome, which had begun under Caesar.49 All these iatroi were heir to the various strands of Hellenistic medicine but they deployed and developed them in the speci®c social and cultural context of the Roman empire, often at the heart of that great edi®ce. Their public and patients, colleagues and rivals, were Romans, Greeks, Italians, and provincials of both East and West, with indigenous healing traditions of their own. The process of romanization thus included a medical component, while the composition of the new soils into which Hellenistic physicians were transplanted a€ected how they grew. Only at Rome itself does this transaction 48 Almost 90% of doctors in the 1st cent. ad, 75% in the 2nd, and 66% in the 3rd, are from the Greek East: see Vivian Nutton, `The Medical Profession in the Roman Empire from Augustus to Justinian', Ph.D. diss. (Cambridge University, 1970), for a survey of the evidence and detailed discussion. 49 P. M. Fraser, Ptolemaic Alexandria, i (Oxford: Oxford University Press, 1972), 810.

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generate any real, or at least recorded, con¯ict, though, except for the ®rst century ad diatribes of Pliny the Elder, there is little indication that the issue was a live one among Roman literary circles of the imperial era.50 Hostility to the medical professions in general continued to be vigorously expressed, and things Greek were deeply implicated in the rhetoric of decadence, but the conjunction of the two seems to have been of no particular potency. Thus, across the Roman empire a Hellenistic medical koine, a communal conceptual and practical holding, was estab lished and developed, subject to regional variation but recog nizably of the same stock. The Greek origins of the great majority of physicians in the Roman empire had considerable consequences for their social situation, above and beyond the issue of Roman chauvinism. According to the calculations of Vivian Nutton, in the ®rst century ad eighty per cent of all medici and iatroi appearing in the inscriptions of the Roman West were freed, slaves or peregrines, the ®gure falling to ®fty per cent in the second, and twenty ®ve per cent in the third century.51 Except for slaves, however, juridical status was not necessarily a barrier to the acquisition of wealth, and even power, as the careers of various imperial physicians amply demonstrate; though pres tige and respectability were rather more elusive. Both Antonius Musa, who won fame and fortune by curing Augustus with cold baths in 23 bc, and Tiberius Claudius Tyrannus, who attended the emperor Claudius and was publicly welcomed and enter tained on returning to his native city of Magnesia on the Meander, were freedmen.52 Outside this select courtly circle, however, the surviving commemorated achievements connected to the medici of the West are much less impressive. Only one medicus is recorded as having held municipal oce, and only a dozen as having become seviri Augustales, that is ocials con nected to the imperial cult.53 One of these seviri, P. Decimus 50 Pliny, HN 29. 8. 15 28 (iv. 373. 15 f M); and see Vivian Nutton, `The perils of patriotism: Pliny and Roman medicine', in French and Greenaway (eds.), Science in the Early Roman Empire, 30 58, and `Roman medicine: tradition, confrontation, assimilation', ANRW ii 37.1 (1993), 49 78. 51 Nutton, `Healers in the medical market place', 39. 52 Suet. Aug. 59, and Cass. Dio 53. 30: Musa; I. Magn. 113: Tyrannus. 53 CIL viii. 11345: aedile from Sufetula in Africa Byzacena; medical seviri are collected in Fridolf Kudlien, Die Stellung des Arztes in der roÈmischen

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P. Merula Eros, died leaving 800,000 sesterces, despite gener ous benefactions and the purchase of this position as well as his freedom; and riches without great honour accrued to an archiater in third century ad Beneventum who quali®ed as an eques but attained no oce.54 Some of the funerary monuments erected to medicae also speak of wealth and distinction, but those of obstetrices testify mainly to their freed, or sometimes slave, status.55 The epigraphic record in the East portrays a rather di€erent situation, both in terms of its mobility and the points at which medical professionals collected. Here there is a layer of settled medical families, swelled by those returning from success at Rome, who have acquired Roman citizenship and an almost hereditary right to the title of archiatros, and who overlapped to a considerable degree with the local eÂlites.56 The Statilii of Heraclea Salbace, for example, are celebrated by honorary inscriptions, by statues, and on the city's coins during the second century ad.57 Interestingly also, inscriptions to iatrinai seem to outnumber those to maiai; the status of these women is, however, unclear.58 Gesellschaft: Freigeborne RoÈmer, Eingeburgerte, Peregrine, Sklaven, Freigelassene als Arzte (Stuttgart: Steiner Verlag, 1986), 35 6, though I cannot accept his accompanying argument that these were not freedmen. 54 CIL ii. 5399/5400: Merula; CIL ix. 1655 and 1971 for the Beneventan the former honours the local magistracy of his son. 55 Metilia's monument from Lyons (App. 2, no. 14) would have been impressive, for instance, as is that of an anonymous medica from Metz (App. 2, no. 15). Plates and descriptions of both can be found in Bernard ReÂmy, `Les Inscriptions de meÂdecins en Gaule', Gallia, 42 (1984), 115 52. The fact that most inscriptions commemorate freed midwives cannot be taken to signify that most midwives were valued and paid enough to be freed in the course of their career, as Valerie French argues in `Midwives and maternity care in the Roman world', in Marilyn Skinner (ed.), Rescuing Creusa: New Methodological Approaches to Women in Antiquity (Special issue of Helios, n.s. 13/2; Lubbock, Tex., 1987), 72; it speaks only to patterns of commemoration themselves. 56 See Nutton, `The Medical Profession', together with the comments of H. W. Pleket, `The social status of physicians in the Graeco-Roman world', AMSCC i. 27 34, who points out that 65% of archiatroi did not hold magistracies that fell within the ambit of the city council. 57 Nutton, `Archiatri', nos. 40 2. 58 For iatrinai see App. 2, nos. 19 28; in comparison my searches have unearthed only two maiai from the imperial East: MAMA iii. 605 (Corycus), and I. Parion 40.

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A rather more humble situation must be supposed, however, for the vast majority of medical practitioners in both East and West. A layer of physicians below the more eÂlite stratum, but nevertheless comfortably o€, make their mark on the papyr ological remains of Roman Egypt, appearing in census lists, tax assessments and land registers, estate and other accounts, distribution lists and contracts, as well as private correspond ence.59 That is, they appear in all the places where people who head households, own some property, and render some remu nerative services to the community should; but not much more. This middling level is further represented by many of the funerary inscriptions of medici elsewhere, and is the likely milieu of the collegia also; but there must also have been medical practitioners who made still less impact on the histor ical record. The patients of these more modest medici were not the emperor, or the Roman eÂlite, but other city, town, and country folk, such as artisans or teachers, estate workers and administrators, who had sucient means to pay for medical services on occasion, but not at anything approaching the extravagant levels which allowed Merula to accumulate such a fortune; and those still poorer, or living in places without doctors, would have had to make do with less professional medical care.60 The social position of practitioners and patients would have been similar, their livelihoods not rising much above the respectable. Though there are indications of literacy amongst some of these physicians and their patientsÐsuch as a letter from one Chairas to his iatros Dionysius, requesting further details of a prescription already sent and that some additional remedies also be passed onÐthese people cannot, in general, have possessed the degree of technical competence required for literary production on any larger scale, thus falling 59 A very useful listing of papyri pertaining to iatroi can be found in CPR xiii. 89 100, to which some recent publications such as P. Oxy. lxi. 4122 and lxiii. 4366 must now be added. 60 It is worth noting in this respect the remarks of Margaret Pelling that in Early Modern England, `Poverty did not inhibit the consumption of certain forms of medicine; in periods of economic crisis, loss of health or mobility was more threatening than ever' (`Medical practice in Early Modern England: trade or profession?', in Wilfred Prest (ed.), The Professions in Early Modern England (London: Croom Helm, 1987), 101). And P. Strassb. i. 75 also indicates that more might be spent on health care than that could be a€orded.

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short of the basic threshold of possibility across which ambi tion might have propelled them.61 More abstract cultural evaluations of the medicus appear in a range of literary forms. Perhaps the most famous is contained in Cicero's much quoted discussion of the livelihoods appro priate to the paradigmatic free Roman gentleman in his On Duties, a work which only narrowly precedes those under scrutiny here.62 Medicina, architecture, and teaching the right things are not truly gentlemanly (liberalis) and thus inappropri ate, but, as arts involving a considerable amount of practical intelligence (prudentia) and being of considerable utility (utili tas), they provide perfectly respectable modes of making a living for those whose social rank they do be®t. The art (ars) itself has an intrinsic value, but gaining a livelihood through its practice is, as Cicero puts it, base (sordidus); though he would, presumably, have no objection to, indeed might even praise, its practice by a gentleman in a context unsullied by economic interests. Similar sentiments are expressed in the literature of the empire, concerning both the priority of non professional determinants of social standingÐthe sense in which certain ways of earning a living are said to be appropriate to, rather than constitutive of, a certain layer in societyÐand the moral and intellectual qualities of the profession of the medicus, though this positive assessment continues to coexist with a much more damning one.63 Martial summarizes this hostility in one of his epigrams: nuper est medicus, nunc est vispillo Diaulus: quod vispillo facit, fecerat et medicus. Lately a doctor, Diaulus is now an undertaker; What the undertaker does, the doctor did too.64 61

P. Merton, i. 35 (dated 29 Aug. ad 58). Cic. O€. 1. 150 1. 63 Dio Chrysostom's Euboean discourse, for example, addresses the issue of which occupations are appropriate to the free poor (Or. 7. 103 32) and is discussed, in the context of other treatments of the issue, by P. Brunt, `Aspects of the social thought of Dio Chrysostom and of the Stoics', PCPhS n.s. 19 (1973), 9 34. For positive views on doctors in particular see e.g. Quint. Inst. 7. 38, and Plut. Mor. 122d e. 64 Mart. 1. 47; and see for a Greek equivalent e.g. Nicarchus' epigram at Anth. Pal. 11. 115. 62

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The point is both about the lethal qualities of the medical care provided, and its lowly status. Cicero's more ambivalent verdict is further corroborated by the epigraphic remains of the more successful medical practitioners, both in their general failure to attain the most potent markers of social status, and in their betrayal of a certain movement from the bedside to the country estate. L. Staius Rutilius Manilius, archiater and eques of third century ad Beneventum, celebrates the magistracy of a son who seems to have left the profession of his father; and the families of archiatri in the East may retain the title but are increasingly honoured for general public service rather than anything speci®cally medical.65 A di€erent angle on the social placement of medical practice and practitioners emerges from some of the surviving astro logical treatises of the imperial era, the Greek works of Ptolemy and Vettius Valens in the mid second century ad and the Latin tract of Firmicus Maternus written about two hundred years later.66 In contrast to the clarity and economy of Cicero's discussion, here medici and their associates appear in an over crowded and chaotic landscape, and they must be judged more by the company they keep, under various heavenly disposi tions, than through explicitly drawn out internal evaluation. Tracking the medical professions through the continually shifting, assembling and reassembling of groupings of celestial conjunctions and groupings of terrestrial occupations which constitute substantial sections of these texts is richly revealing none the less. The medicus appears in three main sorts of company: that of priests, magicians, and astrologers; that of orators, teachers, and lawyers; and that of craftspersons, artists, and manufac turers, with Mercury usually implicated in some way.67 The ®rst assemblage emphasizes the performative and predictive nature of Roman medical practice, and the sense in which a 65

200. 66

12.

CIL ix. 1655: Manilius; for trends in the East see Nutton, `Archiatri', Also discussed in Nutton, `The medical meeting place', AMSCC i. 11

67 See e.g. Firm. Math. 3. 7. 6 and 19: priests, etc.; Vett. Val. Anth. 1. 1. 39, and Firm. Math. 4. 15. 8: orators, etc.; Ptol. Tetr. 4. 4, and Firm. Math. 8. 28. 3: craftspersons, etc.

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physician requires intuition and ingenuity, not just teaching; the second highlights its intellectual and learned facets; and the third stresses its technical and productive dimensions.68 Medici are, more broadly, classi®ed among those who make a living from an ars, or those involved in learning and human service.69 The fates speci®cally foretold for medici range from riches and renown to violent death, and include having `the a€airs of powerful persons' (`res potentium hominum') depend on them.70 Around the medici, chirurgi consort not only with technicians and artists, but also with athletes and soldiers, linked by earning a living through ®re and sword.71 Herbarii, and other makers of medicines, are found among snake charmers, and the devisers and sellers of perfumes, pigments, and jewellery, as well as mimes and dancers.72 They slip easily into the world of arti®ce, deceit, and luxury that also laps at the heels of the medici. The obstetrices and their relatives hardly get an astrological look in, since these treatises assume, almost exclusively, that the birth charts mathematici will be drawing up are for males.73 Similarly, the ethical expositions about the proper forms of making a living, and the examples which support them, concern only men; the question of occupations suitable for women is not addressed. Indeed, women's work is generally discussed in a rather di€erent frame, in terms of those activities (quintessentially spinning and weaving) which become a wife. That many of the funerary monuments to medicae and iatrinai are erected by husbands (and other family members) certainly suggests that medical practice was not deemed entirely unbe coming in this respect, but getting a ®rmer grip on contem porary views of female medical activity is dicult.74 Obstetrices' 68 Some of these points are explicitly brought out, see Firm. Math. 3. 7. 20 for physicians' ingenuity, and 3. 8. 3 for their classi®cation among those who always predict the future. 69 See e.g. Firm. Math. 3. 7. 19 20, and Ptol. Tetr. 4. 4, respectively. 70 Firm. Math. 5. 2. 17; and also 3. 9. 2: wealth and fame; 8. 25. 10: violent death. 71 Ptol. Tetr. 4. 4; Firm. Math. 4. 10. 3. 72 Ptol. Tetr. 4. 4; Firm. Math. 4. 14. 17 and 7. 17. 7. 73 The one mention of an obstetrix is at Firm. Math. 8. 23. 4. 74 Medicae and iatrinai commemorated by their husbands include App. 2, nos. 2, 10, 16, and 28.

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access to provincial governors for the resolution of matters of payment and their role in deciding cases of disputed pregnancy and contentious birth after divorce or widowing ocially acknowledges their worth in some respects.75 This should not be taken too far, however, for this acknowledgement is clearly more for their usefulness than their moral or social standing, for the midwives' expert examinations are overseen by more respectable women (honestae matronae) and other freeborn female witnesses may also be involved. It is thus only with considerable diculty that it is possible to speak of `the status' of `the physician' in the Roman world. The only universal statement that can be made on the subject is that, in so far as they earned their living through their art, medici were excluded from the highest echelons of the Roman social hierarchy as ideally conceived, though the value placed on their art mitigated to some extent the harshness of this exclusionary judgement. Beyond this, diversity, not univers ality, was the rule; diversity in juridical status, wealth, and standing. It was not the profession itself that decided these issues, but circumstances of birth and biography, with dramatic changes being wrought on the inherited and historical position through the agency of success with a powerful patient (most especially the emperor). Indeed, it is, in some sense, the social status of the patients that determines, within the bounds of possibility, the rank and fortunes of their doctor.76 This rank was actively, but not undisputedly, maintained as higher than the rest of the complex that coalesced around the medicus. CONSTRUCTING THE AUTHORITY OF ROMAN MEDICAL PRACTITIONERS The scene is now set for an examination of the mechanics, and the substance, of the negotiations through which this con®g uration of medical professions was constituted. The sediment 75

Dig. 25. 4. 1. This segmented, patient-determined situation shares many features with the 18th-cent. mode of production of medical knowledge termed `Bedside Medicine' by N. D. Jewson in his `The disappearance of the sick-man from medical cosmology, 1770 1870', Sociology, 10 (1976), 225 44. 76

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of centuries of their evolving repetition was a pattern of loosely drawn and internally fragmented categories of medical practi tioners. The administration of the empire inserted into this pattern some of the lineaments of its own, adding to its complexity and mosaic quality through the institution of various nodes of formalization, but not altering its basic orientation, shape, or regulatory machinery. Actual and intending medical practitioners laid claim to the authority to intervene on which their medical practice was, or would be, based, according to this pattern, and, according to the same pattern, the public, individually and in a range of collectivities, responded. Their response was decisive; authority was estab lished through their consent, and once that consent had been given suciently often, or by a broad or powerful enough group of people, a medicus had come into being. This identity never became incontrovertible. It might be disputed, consent might be given by some and not others, or, more sharply, one person's medicus might be another's pharmacopola; and, of course, consent could always be withdrawn, even after it had become a habit. These negotiative features only become visible in so far as they exceed this pattern. Those whose claim to the authority to intervene medically was vested entirely and implicitly in what had gone beforeÐwho, for instance, publicly learned their trade from their father or mother and then stepped into their shoes; who, if interrogated as to how their remedies worked (a question their patients never needed to ask) would have been unable to o€er any explanation, only the solid statement that `this is how it's always been done'Ðparticipated in processes too sedimented to surface, too much taken for granted to be recorded. It is only when a more elaborate and explicit justi®cation is o€ered, expressed, or responded to in textual form, that it becomes a possible object of historical enquiry rather than speculation; and this is precisely what is happening in most of the extant imperial medical literature. Almost all the surviving treatises (rather than isolated recipes) are indissolu bly bound up with the articulation and grounding of medical authority. They are the most durable strand in a web of medical persuasion, a web mostly spun out of oral performance and expository display, such as the public lectures, debates,

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anatomical exhibitions, and iatric contests that occurred in the gymnasia, theatres, forums, and agoras of many imperial cities, and the bedside consultations to which admission was some what more restricted.77 Authority was established in an essen tially competitive and hierarchical framework. It had to be bigger and better than that of others; not only to win the, quantitative and qualitative, battle for patients, and the wealth and prestige they brought with them, but also to achieve, more broadly, satisfaction and success in an agonistic and epideictic culture. Involved in a distinct, but complementary, form of per suasion are texts produced on the other side of the physician± audience divide, by members of the Roman eÂlite who were already possessed of a secure social authority, and were now engaged in its cultural consolidation. The Latin encyclopedists were not concerned with establishing the authority for medical intervention, for this, in so far as it was appropriate to persons of their standing, was contained within their power as pater familias or slave owner. Instead, they were engaged in the exhibition and promulgation of the mastery of the domain of useful knowledge (of which medical knowledge was an accepted part) that marked the educated Roman man. This man was, importantly, neither an intellectual nor a profes sional, but commanded a wide ranging learning, the practi cality of which was perhaps more idealized than realized, but none the less rooted in his responsibility for those in his power. The paterfamilias had to make medical decisions, even if not perform medical acts. He had to decide who would provide medical services to his household, both on a long term and more occasional basis, and he then had to interact with those selected. Thus he needed to know enough to be able to choose the best medicus or obstetrix, and to be able to maintain appropriate relations with them thereafter. The textual construction of medical authority, by those for 77 For physicians' public performances and competitions, see e.g. Dio Chrys. Or. 33. 6 7; Plut. Mor. 71a; Gal. Anatomical Procedures/¸Anatomikai4 e1 gxeirh3seiw (AA) 7. 16 (ii. 694 700 Garofalo) and On Examining the Best Physicians/Fõ mihnat afdal al-atibba' (Opt. Med. Cogn.); and I. Ephesos 1160 9 Ç Ç at theÇ bedside see e.g. Gal. Ven. Sect. Er. Rom. 1 (xi. and 4101. For arguments 188 93 K), and Opt. Med. Cogn. 7. 2 (CMG Supp. Or. iv. 86, 8).

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whom it was a professional prerequisite, was a complex a€air. In the absence of any sites of absolute and incontrovertible certi®cation, strategies of legitimation proliferated, and were intermeshed in any work according to principles of plenitude rather than economy. These strategies may, arti®cially but heuristically, be separated out into those concerned with the legitimation of the person of the medicus, and those concerned with the legitimation of the technical knowledge they possessed, the two combining to form a solidly convincing image of a commendable and capable practitioner of the healing art. The whole project is essentially, and sometimes self consciously, rhetorical, in terms of both its objective and methods. The medical persona was usually compounded from several elements: moral character, educational pedigree, and profes sional history. Each of these was, in turn, a complex and variable mixture, and each contributed to the establishment of trust between the medici and their public, a trust which was simultaneously the ®rst step towards persuasion and the ®rst step towards medical intervention. The moral aspect of this may be implicit, positively or negatively exempli®ed in case studies and parables from medical mythology, or explicit, expressed in the formulation of systems of medical ethics or of the single minded pursuit of truth and learning.78 Educa tional pedigree might be given in a detailed narrative form, or marked only when the names of those involved appear in other contexts.79 It is consistently assumed, however, that it is individuals, not institutions, who are the repositories and purveyors of knowledge, though certain geographical locations 78 Perhaps the most elaborate system of medical ethics is o€ered by Scribonius Largus, Comp. epist. (1. 1 5. 28 S), and the most ascetic image of the medicus by Galen, Opt. Med. Cogn. esp. 9. 2 3 (CMG Supp. Or. iv. 100. 11 102. 3). 79 Galen o€ers an elaborate, if segmented, narrative in his Lib. Prop. (SM ii. 91 124) and On the Order of his own Books/Peri4 th4w ta3jevw tv9n i1 di3 vn bibli3 vn (Ord. Lib. Prop.: SM ii. 80 90), supplemented at On the Diagnosis of the A€ections and Errors particular to Each (Soul)/Peri4 tv9n i1 di3 vn e2 ka3stQ pauv9n kai4 a2marthma3tvn th9w diagnv3sevw (A€. Dig.) 8. 1 8 (CMG v. 4.1. 1. 27. 20 29. 19) and AA 1 (i. 80 2 Garofalo). The author of the text known as the De Virtutibus Herbarum (On the Powers of Herbs) o€ers a similar, and similarly elaborate, educational pedigree to Galen's but with a twist the knowledge he acquires through his medical studies at Alexandria proving useless until he arranges a revelatory divine encounter (further discussed in Ch. 3).

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(most famously Alexandria) had a reputation as places in which such individuals were concentrated and of a particularly high calibre.80 Moreover, there was only the most general reference to the content of what had been taught or learnt: it was simply the prior existence of a pupil±teacher relationship that was paraded, and which went towards securing the ex pupil's status as educated and knowledgeable, rather than securing any of the things they actually claimed to know. Education shades into experience, and the professional history that was part of the self presentation of a medicus was composed from successful episodes in a medical career, episodes which might include dramatic cures, periods of favour with the rich and powerful, and the public humiliation of rivals.81 This demonstrated personal competence, the recognized ability to deploy skills and learning in a range of circumstances. The medicus needed to be able to convince an audience that he knew enough, of a sucient quality, so that, confronted with a sick person, he would arrive at the correct diagnosis, then give an accurate prognosis and prescribe an e€ective therapy. This knowledge could simply be claimed, or laid out before the public for its inspection, or, in some way, expressly justi®ed. This justi®cation provided an answer to the (spoken or unspo ken) question of why, given the goal of medicine, this particular knowledge was appropriate. This question could be answered on many di€erent levels and in many di€erent ways, but three main lines of legitimation are discernible. Knowledge might be justi®ed as teleologically ®tting, ®rstly because it was know ledge of what had worked, secondly because it was knowledge of what should work (a `should' which might rest on physiolo gical, pathological, and therapeutic explanation, on the internal logic of a complete method, or on implicit cultural intellig ibility), and thirdly because it was knowledge that had the weight of personal or divine authority, even revelation, behind it. Variations on these legitimating lines were invoked as 80 For discussion of medical education in antiquity see I. E. Drabkin, `On medical education in Greece and Rome', BHM 15 (1944), 333 51, and Fridolf Kudlien, `Medical education in classical antiquity', in C. D. O'Malley (ed.), The History of Medical Education (Berkeley and Los Angeles: University of California Press, 1970), 3 37. 81 All of these features are found in particular abundance in Gal. Praen. (CMG v. 8. 1).

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guiding principles, underlying and organizing an entire body of knowledge, or might be invoked on a case by case basis. Such systematizations involved a fusion between teleological propri ety and epistemological validity, and, therefore, tended towards exclusivity. For, inherent in this kind of strong justi®cation of a given body of knowledge is the imputation, articulated or not, that all di€erently formed bodies of know ledge are not only inappropriate to, and inadequate for, achieving the goals of medicine, but that they are not even knowledge, merely belief. The exclusive nature of any prin ciple of formation did not mean, however, that the other techniques of legitimation could not be deployed in a supple mentary role. The mechanics of these constitutive negotiations, as they took a now discernible form, are thus revealed as generic; it is their substance that is speci®c. The use of public, domestic, and textual space as a platform for complex acts of persuasion in which the audience is simultaneously persuaded of some thing about the world and something about the performer in such a way that the two cannot be prised apart, and in which didacticism and display are equally inextricably intertwined, was characteristic of the classical world. It took, moreover, a particularly heightened form under the Roman empire, with the cultural phenomenon known as the Second Sophistic. The basic techniques of persuasion were also common property, part of the educational fabric of the societyÐa society in which individual, and competitive, self presentation was an ongoing process. The medicus simply occupied these recognized rhet orical loci, mobilized the available resources, and employed the familiar language for a particular purpose. The means of per suasion were fundamentally the same, the audience and arbi ters too, but that of which they were (or were not) persuaded changed. The speci®city of the way in which Roman medical discourse was framed resided in the principles of initial engagement with its objects, and their subsequent thematic organization, rather than in its enunciative modalities. The securing of the authority for medical intervention was, of course, not the only concern of Roman medical literature. These texts had to justify themselves as such, and to ful®l, through description, explication, or refutation, the terms of

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that justi®cation. Their location in this particular and perman ent process of competitive persuasion is none the less crucial to their interpretation as historical documents, vital to the under standing of their internal logic and external signi®cance, each as the extension of the other. This is just the generic textual trajectory, a delineation of where these writings are coming from and going to in Roman society, together with some indications of the kind of routes that might be taken, in so far as they are medical texts. It is the preliminary to more detailed and individual analysis, providing the basic terms within which woman's constitution within Roman medical discourse must be understood.

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PLACING THE ROMAN PATIENT It has, of course, been impossible to delineate the medical practitioners of the Roman empire without making reference to the consumers of their services; and it is worth now addressing this latter category more directly. Unfortunately, though many contemporary writers are eager to reveal all about their health and its vicissitudes, to describe in detail their relationship with their doctor and other medical personnel, they almost exclu sively reveal and describe eÂlite male attitudes to illness and well being, and relations between men. They are, however, discoursing on, and in, the same world in which women lived, were healthy and sick, and interacted with the medical art and its proponents; so it is none the less possible to say something which is of relevance to, if not exactly about, women too. A broad concern with health is a characteristic of classical culture. Verbal greetings and the opening and closing formulae of personal letters in both Greek and Latin make reference to it, wish it on the recipient, and correspondence and conversa tions frequently also contain more concrete enquiries and disclosures on the subject.82 Health (y2gi3 eia/hygieia in Greek, salus in Latin) is customarily praised, toasted, and even 82

Parts of salveo and valeo both referring to a person's health and wellbeing, and the commonest forms of greeting and leave-taking in Latin and variations on ey5xomai se y2giai3 nein/e1 rrv9suai (`I pray for your health/well-being') appear in many of the private letters surviving from Egypt.

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hymned at social occasions.83 It was further pursued, or at least not neglected, in the gymnasium and baths, as well as within the broader patterns of individual activity. The construction and practice of the arts of health, and the experience of disease and cure, were, moreover, amongst the hardest worked of analogies and metaphors in the classical rhetorician's reper toire.84 Only the helmsman or pilot was in any position to vie with the physician for popularity and utility as an expository, explanatory, or just plain persuasive, ®gure. It has to be asked, however, what this signi®es, and how it relates to the cultural formation and practical workings of the speci®cally medical realm in Roman society. For, while medicine is about health, health is not necessarily about medicine, and its relations with medical practitioners may be even more attenuated and am biguous. Of course, people in any society will show a degree of interest in their own functionality. Fluctuations in an individual's ®tness for life's aims and tasks, its requirements and aspira tions, are always going to be of concern at some level. But it has been argued both that classical society goes far beyond this basic necessity of careÐthat being healthy emerges here as a positive ideal to a greater extent than elsewhereÐand that the ways then chosen to pay more than minimal attention to health are richly revealing of classical forms of subjectivity, of its relations of the self. Thus Edelstein claims that `ancient man' regarded health `as the greatest of all goods', and was therefore willing to accede to physicians' demands that he live for his health.85 Michel Foucault, on the other hand, understands 83 Athenaeus, for example, has ®rst a cup drunk for, then a popular scolion on, and ®nally Ariphron's famous hymn to, Hygieia at his dinner party: 15. 692f 693a, 694e, and 701f 702b. 84 This analogy is most fully developed in philosophical contexts, on which see e.g. Nussbaum, The Therapy of Desire; and its status as a commonplace can also be seen in e.g. Cassius Dio's rendition of Augustus' speech to the unmarried equites in ad 9, where the strictures of the marriage law are compared to the physician's recourse to ®re and the knife when all else fails (56. 4). 85 Ludwig Edelstein, `The dietetics of antiquity', translated in the collection of his papers edited by Owsei and C. Lilian Temkin, Ancient Medicine: Selected Papers of Ludwig Edelstein (Baltimore: Johns Hopkins University Press, 1967), 314.

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health less as the ultimate ancient end in itself than as a practice which constitutes one axis of a more complex classical self formation, the axis that has to do with the body, with physically equipping the individual for a rational mode of behaviour. Health is then practised, produced, through `form ing onself as a subject who [has] the proper, necessary, and sucient concern for his body'; it is a re¯ective and active relationship with the body.86 Foucault notes an `intensi®cation' of this concern, an increase in apprehension about and atten tion to the body, in the Roman imperial period, but not a di€erent way of perceiving oneself as a physical individual; and Edelstein was already thinking along similar lines, with shifts in emphasis but not radical change occurring in attitudes to health over the centuries of antiquity.87 Judith Perkins, how ever, sees health and well being being eventually eclipsed by disease and su€ering as the focus of the self under the empire.88 The discourse of a su€ering subjectivity that developed in the second century ad in both pagan and Christian contexts became increasingly integrated and consolidated by trium phant Christianity. All three scholars are responding to the same set of circum stances. First, to the wealth of medical texts that survive from the Roman imperial epoch, especially from the late ®rst to early third centuries ad, and the richness of the descriptions, instructions, and interpretations they o€er. Secondly, to the greater currency of medical notions, language, and issues that is evinced in the literature of the period; to the interest in, and mastery of, medical subjects demonstrated by such litteÂrateurs of the empire as Plutarch, Athenaeus, and Aulus Gellius. Finally, to the long lists of complaints and symptoms, the harping on health and its loss, that characterizes, for example, the correspondence of Fronto, the orator and tutor of the future emperor Marcus Aurelius, and the autobiographical writings of another of his pupils, Aelius Aristides. But these 86 Michel Foucault, The Use of Pleasure: The History of Sexuality, II, trans. Robert Hurley (London: Penguin, 1986), 108. 87 Michel Foucault, The Care of the Self: The History of Sexuality, III, trans. Robert Hurley (London: Penguin, 1988), 103. 88 Judith Perkins, The Su€ering Self: Pain and Narrative Representation in the Early Christian Era (London: Routledge, 1995).

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scholars have all read and reacted to these phenomena di€er ently, as have still others. Moreover, while Perkins's physicians participate unproblematically in the broader construction of the su€ering self, for both Edelstein and Foucault the position of the medicus in all this is rather more awkward and ambigu ous. This is most clearly articulated by the latter, for the ideal of self mastery which Foucault's Greeks and Romans are all striving after allows for external advice and assistance, while ®nding any deeper dependence or subjection much more dicult; but Edelstein also notes the importance of the ideal of independence, of real freedom, in the ancient world. Both ®nd ample support for this tension over the authority of the medicus in the sources, and the argument can be taken beyond the area of regimen for the healthy, which they are mainly interested in, and into the region of actual treatment of the sick, where the patient's ability to control the situation would seem to be most compromised. The debilitations of disease would appear to pose a particular challenge to self mastery, if not to signal that it has already become unstuck and is in need of restoration, like the health of the patient itself. In fact the plentiful discussions of how a patient, a sick man (and it is men who are at the centre of these discussions), should behave manifest an obvious concern with this very issue.89 That the patient must submit to his medici, and follow their orders even when they are disagreeable, is taken for granted; indeed, it is the de®ning feature of the relationship. However, not only is this submission itself ®gured as a type of self control, most especially when it is disagreeable orders that are being followed, but it is surrounded by circumstances that serve to specify and limit this mode of subjection. Submission to your doctor is something very particular and exceptional. It is an inversion of the normal chain of command as it follows the order of the social hierarchy to meet speci®c exigencies. Thus the Younger Pliny writes, to encourage his sick friend and colleague Rosianus Geminus in the proper attitude to his condition, of how he himself had, when su€ering from a serious fever, actually refused a drink and a bath which he 89 Instructions on how a sick man should bear his disease seem to have been a philosophical topos. Epictetus provides the fullest and ®ercest set of injunctions (Arr. Epict. 3. 10); cf. e.g. Plin. Ep. 1. 22, and Gell. 16. 3.

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was looking forward to and which his medici would have allowed him, albeit with misgivings.90 Thus he shows that his discipline is even greater than that of his doctors: it is he who is in control. The future emperor Marcus Aurelius also writes to Fronto about how hard he is working at being a patient, at full compliance with the orders of his medici.91 Submission itself is something which requires self mastery. Both refer to their medical attendants simply in the anonymous plural, making it clear that this is a professional rather than a personal relationship, and certainly not one between equals. Marcus also quotes with approval Epicurus' claim that, even on his sick bed, he did not permit his iatroi to give themselves airs, to think too highly of themselves or their work.92 He could have cited Epictetus, the Stoic philosopher who died not long after Marcus was born and who exerted the greatest in¯uence over his thinking, to the same e€ect. The admonition not to ¯atter your physician is one repeated in Arrian's rendition of Epicte tus' thoughts and teachings.93 Both Pliny and Marcus, there fore, shift the focus onto their own conduct, onto the demands illness and its treatment makes on them; and they are encour aged to do so by those who sought to prescribe more generally how the sick man should behave. It is they who determine, through their own actions and attitude, relations with their physicians, even though that relationship is one of obedience; and this is assisted by their social superiority over any medical professional. A medicus might become a friend, however. He might earn the a€ection (caritas) and respect (reverentia) of his patient as well as his fee, but only in so far as he exceeded his art, his professional duties. At least this is what, in the late ®rst century ad, the Younger Seneca writes in his detailed discussion of the network of mutual obligations that constituted such an import ant part of the Roman social fabric, the services that might and should be rendered, and debts incurred, in the course of life.94 If a physician does no more than add you to his list of patients, 90 91 92 93 94

Plin. Ep. 7. 1. Fronto, Ad M. Caes. 4. 8 (van den Hout). M. Ant. 9. 41. 1. Arr. Epict. 3. 10. 15, and 3. 20. 14. Sen. Ben. 6. 15 17.

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just includes you among those he visits regularly, taking your pulse and instructing you on what to do and what to avoid, without any feeling (adfectus), then he is owed no more than his fee. If, on the other hand, he provides more than the bare minimum: if he is motivated by concern for the patient, not his own reputation, if he does not just name remedies but actually administers them, takes his place among the solicitous bedside visitors, hurrying there whenever danger threatens, if no service is too burdensome or distasteful, if he does not ignore your groans, if, though many others make demands on him, he consistently prioritizes you, only giving them attention when your health allows it, then you owe him more; but, `not as a doctor but as a friend' (`non tamquam medico sed tamquam amico'). The medicus, like the teacher, sells his art but can also o€er more, that is, his personal devotion; and while, in the ®rst instance, the medicus receives only payment, in the second he is more richly rewarded. There is a problem with the basic transaction, the exchange of medical skills and services for money, a problem which besets the the highest arts (optimi artes) as much as the most base trades (sordidissimi arti®cii); but it is one that can, with sucient e€ort and dedication, be overcome. Whether Seneca ever found a doctor who met his most exacting standards of care, and was thus promoted to the status of friend, is not revealed; but, at least as depicted by their patients rather than by themselves, physicians do appear as remarkably tolerant of those they are attending. Certainly some of the iatroi who consorted with Aelius Aristides are much more forbearing and obliging than might be expected. Theo dotus in particular seems to have functioned more as a friend than a physician. In the Sacred Tales he not only o€ers almost no professional opinion except to yield it to Asclepius with good grace, but even organizes a choir of children to sing one of Aristides' own poems to its author whenever he fell ill.95 However much it is obfuscated, the matter of payment, and of who is paying whom, remains an issue none the less. It is this, in both speci®c and general terms, that is pivotal in the inequal ity between patient and physician in these eÂlite scenarios. Not just in the sense that the purchaser gets to choose whose services 95

Aristid. Sacred Tales e.g. 1. 57, and 4. 38.

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to buy and retains economic control of the encounter, but that exercising choice, paying people, is his lot in life, whereas a medicus is the kind of person who is chosen, is paid for doing certain things.96 Seneca recognizes this when he describes the pure, minimal relationship between physician and patient, one lacking in any personal feeling, as one in which the patient is seen as a commander (imperator); and Epictetus also notes this, in the breach as it were, when he criticizes iatroi at Rome for actively seeking out patients rather than waiting to be called in as they should.97 This is also a useful reminder that the physicians themselves will have viewed things rather di€er ently, will have had their own aims and approaches in all this. And the medical texts which will be examined later provide much of the other side of the picture: they reveal some of the ways in which doctors tried to even things up, to shape the medical encounter according to their own image and interests. But, staying with the consumer for the moment, it is further worth stressing that, as Seneca's assimilation of his ideal medicus with his sollicitiÐthe concerned friends who surround the sick bedÐsuggests, it is not just medical practitioners whom people interact with when ill, but also their family and wider social network, and there is a certain amount of inter action between these groups around the patient also. The scene at the bedside, the sick room crowded with people, is a common one in the literature. Such calls were a requirement of friend ship, an occasion for care and compassion, an opportunity for discussion, for the patient to show how well he was coping, and for his acquaintances to show how much they knew about medicine, for both to con®rm this about each other and pass it on.98 This public dimension to illness, the support provided by friends, might be to the detriment of the medical profession. The philosopher Calvisius Taurus and his entourage were, for 96 This would not hold true, of course, lower down the social scale, where the relation between physican and patient will have been much more equal. 97 Sen. Ben. 6. 16. 2; Arr. Epict. 3. 23. 17. 98 The basic requirements of friendship in this respect are set out at Sen. Ben. 3. 9. 2, and see also e.g. Plin. Ep. 1. 22; Gell. 12. 5, and 16. 3. Of course, such solicitousness might be motivated by hopes of inheritance, see e.g. Plin. Ep. 2. 20, and Sen. Ben. 4. 20. 3.

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example, shocked at the looseness of the language used by a medicus in attendance on an indisposed Aulus Gellius when he remarked that the improvement in his charge's condition would be con®rmed if any of the visitors cared to touch his vein.99 He meant, of course, and as Taurus painstakingly and patron izingly pointed out, his artery. For everyone knows that pulsa tion is the exclusive property of the latter. So, not even the claims to special knowledge of the medicus are incontrovertible. Superiority is not assured even here. In a sense, moreover, the medical content of much imperial literature could be taken in this rather more competitive than complimentary fashion. That medicine ®nally takes its place in the high culture of the empire may be as much because it has been wrenched from its practitioners as because they themselves put it there. After all, the second century ad `taste' or `fashion' for things medical noted by G. W. Bowersock was not, by and large, accompanied by a taste for the medical professions.100 Even without any overt sense of contestation, the point is that eÂlite and erudite men like Celsus and Plutarch were not at all daunted by the morass of medical theory, or the concept of medical expertise, but were rather in a position to dominate it, to encompass it within a wider, and hence fuller and better formed, body of knowledge. Thus, Gellius' sick bed experience has him running to books on medicina suitable for his instruction. For he judges it to be shameful that a free and well educated man does not know at least that about his body which is reasonably obvious, access ible, and relevant to human health. He does not want to know too much or delve too deeply, that which is obscure and abstruse can be left to the professionals, but he wants to learn enough to gain a respectable working knowledge of his own physical existence. His reading allows him to produce credit able de®nitions of veins, arteries, and the pulse, such as are found in a number of medical texts.101 Thus he places himself in a position where he is not only better able to look after his own 99

Gell. 18. 10. G. W. Bowersock, Greek Sophists in the Roman Empire (Oxford: Oxford University Press, 1969), 59 75 (a chapter constructed around the exception to this rule provided by Galen). 101 Compare with e.g. [Galen], Medical De®nitions/¾Oroi i1 atrikoi3 (Def. Med.), nos. 73 4 and 110 (xix. 365 6, 375 6 K). 100

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well being, but also better able to show o€ his medical know ledge at any bedside he visits. Finally, what is to be made of the long sequences of letters exchanged between Fronto and Marcus Aurelius that consist of almost nothing but symptoms and treatments, and of Aelius Aristides' obsession with his ailments and their cure? Is this just a particularly extensive and substantial elaboration of a well accepted idiom of intimacy in the ancient world? Does Aristides simply take to an idiosyncratic extreme the physical performer's inevitable concern with his ®tness? Or are these instead indices of an alarmingly advanced cultural `hypochon dria', brought on by excessive re®nement and over delicacy, part of a wider `age of anxiety', or signs of a recon®guration of the self?102 Certainly the contrast between Marcus' correspond ence and his MeditationsÐthat is, between his writings to others and those to himselfÐwould suggest that discussions of illness and recovery are elements of external rather than internal relations. A single reference to problems with his health appears in the latter, and in the context of their control rather than any complaint; and he further cites his adoptive father, the emperor Antoninus Pius, as providing an exemplary attitude to his body, being neither over attentive nor neglectful, so avoiding exces sive reliance on doctors.103 Cassius Dio's abbreviated third century ad account of Marcus' reign does note that he was unfairly plagued by ill health, which makes his achievements all the more admirable in the historian's eyes; and has him mention illness only once, in a speech to troops prior to putting down the revolt of Avidius Cassius in ad 175, the point being both that the reports of his death which have sparked the revolt are greatly exaggerated, and that he is expecting the troops to make no greater e€ort on behalf of the state than he himself is making, despite his weakened condition.104 This also underlines the fact that the health of the emperor mattered in very concrete ways, 102 The diagnosis of hypochondria is Bowersock's, Greek Sophists, 71 5, and E. R. Dodds includes Aristides and Marcus Aurelius amongst those who most prominently display the anxieties of their decaying age in his Pagan and Christian in an Age of Anxiety (Cambridge: Cambridge University Press, 1965), esp. 39 45. 103 M. Ant. 1. 17. 20, 1. 16. 19 20. 104 Cass. Dio, 72. 36. 2 4, 72. 24. 4.

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and the same can be said of Fronto and Aristides. Both were orators, and like Libanius, whose ill health is a prominent feature of his autobiographical discourse and letters two centu ries later, they were therefore people whose professional success and identity depended on physically demanding public per formance. A certain level of ®tness was thus a prerequisite for their work, and its ¯uctuations might also become part of that work, their performance. They could be presented, or enacted, as part of a story of triumph over adversity, of risk taking and commitment to their calling. Certainly both Aristides and Libanius made the connection between their health and their careers, their public practice of oratory and the recognition it brings, explicit; and both used this to help fashion their lives into patterns of struggle, of achievement despite the odds.105 What is also interesting about this group of individuals, and has been emphasized in the scholarship, is that, except for Fronto, all make some reference to Asclepius in their battles for health; and in a sense Marcus ®lls this gap by writing to Fronto that he is praying to the god for his mentor's health on his birthday.106 Other imperial authorities can also be cited for the continuing medical role of the god, and Libanius, a committed pagan in an age of increasing Christianization, goes further in displaying the diversity of responses to illness and distress still possible in the late fourth century by also consulting various soothsayers (ma3nteiw) at times of sickness, and holding aggressive magic aimed against him responsible for one of his later debilitating bouts of disease.107 Aristides' devotion to Asclepius is the main feature of his autobiography, but it should also be remembered that the basic provision of medical services remains the province of the medici in all these writings, including those of Aristides, and relations between Asclepius and the profession he patronizes remain close to the point of con¯ation.108 All this is a 105

Aristid. Sacred Tales, 4. 15 29 and 63 70; Lib. Or. 1. 17, 91 and 139 43. Fronto, Ad M. Caes. 3. 10 (van den Hout); cf. M. Ant. 1. 17. 20, 5. 8. 1. 107 Lib. Or. 1. 139 43 and 200 3 (Asclepius); 172, 177 8, and 243 50 (soothsayers and magic). He does make it clear that his use of these methods of healing is part of his religious commitment (or vice versa). And see generally the later testimonies collected in Edelstein and Edelstein, Asclepius, i. 108 Not only does Aristides name Asclepius as the true iatros (Sacred Tales, 1. 57), but Libanius considers the work of iatroi to be that of the god (Ep. 1303. 1). 106

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good illustration of the range of curative possibilities that people in the Roman empire continued to live and work with rather than signalling any more decisive development. This more pragmatic interpretation of these phenomena is not, however, meant to detract from their interest. That such displays of frailty and dependence were acceptable, even favoured, forms of communication and self presentation in certain circumstances, is something that still needs to be taken note of; albeit in a rather more mundane way than has been done hitherto. There is, moreover, one particular feature of all this which is of special relevance to this study but has not yet received much attention. That is the fact that it is displays of male frailty and su€ering which have been discussed thus far. There is no foreshadowing here of the ways in which illness was to become and remain, at least in the West, feminized: the ways in which the image of the sick and the image of women were to be considered congruent and complementary, perhaps most emphatically in the Victorian era, but not without precedents, and continuing in various more vestigial forms.109 There are, of course, no ancient statistics or surveys that can be compared with those of today which consistently show that, though women generally live longer than men, they feel less well, make more use of health services, and are recorded by those services as showing higher levels of chronic and acute illness.110 The same is true, however, of the nineteenth century, a lack which has contributed to debates about the interplay of sub jective and objective factors at work in its widely perceived 109 The ways in which an image of women as frail and sickly was encouraged and esteemed in 19th-cent. Britain and America is a recurrent theme in literary and historical studies of the period (see for a summary of the issues e.g. Diane Price Herndl, Invalid Women: Figuring Feminine Illness in American Fiction and Culture, 1840 1940 (Chapel Hill, NC: University of North Carolina Press, 1993), 20 42); and these themes of gender di€erentials in matters of health and disease continue to be live ones: see e.g. Lesley Doyal, What Makes Women Sick: Gender and the Political Economy of Health (Basingstoke: Macmillan, 1995), and Marge Koblinsky, Judith Timyan, and Jill Grey (eds.), The Health of Women: A Global Perspective (Boulder, Colo. Westview Press, 1993). 110 See e.g. summary in Doyal, What Makes Women Sick, 10 14; and Sally MacIntyre, Kate Hunt, and Helen Sweeting, `Gender di€erences in health: are things really as simple as they seem?', Social Science and Medicine, 42 (1996), 617 24, for some quali®cations to this orthodoxy.

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crisis of female health, and there are areas which do bear comparison over time, areas of discourse rather than hard data, but where the di€erences are none the less striking. Despite its unhesitating categorization of women as the weaker sex, there is no sign in contemporary writing or other representations that Roman society, or at least its male eÂlite, thought that women were particularly sickly or that sickness was particularly female. Indeed, quite the reverse, and the two may be related: for if Marcus Aurelius, Aelius Aristides, and the rest had any inkling that by openly expressing their ill health and incapacities they were behaving in ways characteristic of and appropriate to women they would undoubtedly have conducted themselves di€erently. Nor is it solely in the Roman world that the sick role appears less a challenge to, than a privilege of, maleness. Studies of South Asia show that, despite numerous physiological and pathological indicators to the contrary, women there consistently report their health as `®ne' whereas the `objectively' ®tter men are much more likely to complain of sicknesss and debility; `inaction and neglect are pervasive among women' in respect to their health, reports one commentator.111 The low female expectations of, and activity around, their health also correlates with a female life expectancy that is lower than that of males, and with high levels of male mediation and control of access to health services within the household; both of which may be paralleled in the Roman empire, where the ways in which the patient could dominate the medical encounter would have further helped to maintain the male prerogatives in illness.112 It is not that men in the Roman empire did not report on the 111 T. K. Sundari Ravindran, `Women's health in a rural poor population in Tamil Nadu', in Monica Das Gupta, Lincoln Chen, and T. N. Krishnan (eds.), Women's Health in India: Risk and Vulnerability (Bombay: Oxford University Press, 1995), 204; and see also Amartya Sen, Commodities and Capabilities (Amsterdam: N. Holland, 1985), 81 104. 112 Roger Bagnall and Bruce Frier consider that male life expectancy in Roman Egypt did not much exceed that of females (The Demography of Roman Egypt (Cambridge: Cambridge University Press, 1994), 86 110), a view with which Tim Parkin, Demography and Roman Society (Baltimore: Johns Hopkins University Press, 1992), 102 5, also generally agrees. Countries in South Asia are amongst the few on the globe yet to reverse this historical position.

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diseases which may have a‚icted members of their household, including its womenfolk. Marcus Aurelius, for instance, unem barassedly wrote to Fronto on one occasion that his sister had been suddenly seized by such pain in the female parts (muliebres partes) that it was horrible to behold, that in all the excitement his mother ran into a wall, while he himself found a scorpion in his bed; and he relates with reasonable frequency various illnesses of his wife (whom he describes as a most compliant patient) and daughters.113 A more humble but no less graphic corrrespondent in third century ad Egypt writes to his (prob able) wife to catalogue the a‚ictions that have beset him since he has been attending his sick father, adding in rather more summary fashion that everybody in the household has been unwell, including his mother and the slaves, so that there has been no one to attend to the stricken.114 Nor is it that knowledge of diseases speci®c to women was deemed to fall outside the realm of useful learning that the well educated paterfamilias should acquire, for the works of Celsus and Pliny both cover this ground.115 Even more abstruse physiological knowledge, for instance, about the bodily constitution of women and whether it was hotter or colder than that of men, was considered suitable for men to display at symposia such as those depicted by Plutarch at the turn of the ®rst into the second century ad, and by Macrobius some three hundred years later.116 No one, however, delineates the ®gure of the female patient in a distinctive fashion. It is suggested neither that being female might bring something distinctive to being ill and the recipient of medical treatment, nor that being a patient might bring something distinctive to, might help shape, being female. The satirist Juvenal, writing in the early years of the second century ad, casts women at Rome as particularly prone to incorporating astrological methods into their approaches to illness and cure, consulting their horoscopes before applying even an eye salve and regulating their convalescent diet accord ing to the propitiousness of the heavens.117 His target is, however, female susceptibility to all disreputable forms of 113 114 116 117

Fronto, Ad M. Caes. 5. 23, 5. 26, and 4. 11 (van den Hout). 115 PSI 229. On Celsus and Pliny see Ch. 3. Plut. Mor. 650f 651e; closely followed by Macr. Sat. 7. 7. 1 12. Juv. 6. 578 81.

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private divination and dubious foreign cults, the way women allow these things to dominate all areas of their lives, rather than their susceptibility to physical disease. Juvenal's older contemporary and fellow satirist Martial joins him in viewing visitations by male medici, visitations which may be encouraged by deceit, as opportunities for female sexual misconduct; but the problem is again women's characteristically insatiable lusts not their typically poor health or malingering.118 So even those most eager to ®nd every conceivable fault with contemporary womanhood do not criticize her health or her conduct towards it. Nor are there any indications in the scant surviving traces of women's own concerns that the states of their own bodies rank particularly highly.119 Moreover, the worry on the physicians' side is of female reticence about, rather than enthusiasm for, their ailments, especially those speci®c to them; of a tendency to su€er in silence rather than seek the necessary assistance.120 Marcus' sister would undoubtedly be morti®ed to learn that she is known to posterity for having been stricken with excruciating pain in her genitals. THINKING THINGS THROUGH Roman medicine is, therefore, a complex social formation with many cultural entanglements. It is certainly of some signi®c ance in the more literary sections of Roman society, in that 118 Juv. 6. 235 7; Mart. 11. 17. 7. If J. H. Oliver (`Two Athenian poets', Hesperia Supp. 8 (1949), 243 6) is corrrect in his interpretation of the Serapion monument from the Asclepieum on the Athenian Acropolis, then we also have a guide to the ideal conduct of the physician written by a layman which pays attention to his sexual behaviour to go with the Hippocratic Oath's strictures on the subject, con®rming that this was an area of concern. 119 The editors of the Vindolanda writing tablets would like to interpret one of the letters to Lepidina, the wife of a prefect stationed at the fort ad 95 105 (Alan Bowman and J. David Thomas, The Vindolanda Writing Tablets: Tabulae Vindolandenses, ii (London: British Museum Press, 1994), no. 294), from another woman as concerning some remedies, but this is the closest any such correspondence comes to being about health and disease. 120 See e.g. Gal. Praen. 8. 2 3 (CMG v. 8. 1. 110. 18 22), and discussion in Ch. 5 below. There are good reasons, of course, why physicians might want to make heads of households think their womenfolk are liable to conceal illness and not ask for their help when they should.

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basic concerns about health and sickness, the experience of being ill, of being treated by a medical practitioner, were broadly shared and broadly agreed to be of import. On this foundation was then built, with some help, the image of the medicus or iatros as someone who could meet these concerns and needs, and a further interest in medical knowledge which ¯ourished most strongly as part of that general e‚orescence of learning and its display that is known as the Second Sophistic. Alongside these developments, and interwoven with them, came a stock of common medical analogies and metaphors, means of understanding and communication, that were deployed increasingly far and wide. The image of the proper medicus went hand in hand with an image of the proper patient, or rather the proper medical subject, the human being as someone who moves between sickness and health. The way in which you were meant to behave towards your body, and the ways in which you were meant to behave as an inhabitant of the Roman empire more broadly, put certain demands on the ®gure of, and shaped relations with, the physician. Other practitioners too were called up as required, in response to more particular needs. This was in many senses a patient led system. Here, however, any sense of unity ends. What has been described is largely an eÂlite male construction, which not only leaves patterns of practice among the lower orders of society unclear, but also under represents aspects of medical activity even at the eÂlite level. For those who were able to exercise choice in these matters, the impressive array of options with which this chapter opened continued to exist, though certainly not in an unchanging way, throughout the period. None of these types of health care provision achieved any kind of ascendancy, and competition seems to have been ®ercest within, rather than between, the professions. This pluralism, and its durability, rested on the constitution of the Roman cosmos, which provided multiple avenues for acting upon the human being in health and sickness, few of which were counterposed. Some may have been, more or less strongly, preferred or excluded by some individuals, or groups, or in particular circumstances. Women's choices may have been more circumscribed than those of the men who might choose

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for them, and the one explicit reference to this female selection is highly critical. But this was still a world without orthodoxy. So also, the more strictly medical practitioners were a loosely de®ned and fragmented bunch. The ongoing historical nego tiation of the identity of the medicus or iatros and the various categories clustered around it, rather than their institutionali zation, has emerged clearly in this discussion, together with the compromised social status of the paid practitioner, and the segmented, if not individuated, profession that results. It is these features, within this plurality of medical services, that most strongly characterize the social formation of Roman medicine, and they must all be taken into account in reading the textual remains of medicinaÐthat is, those literary com positions securely located within the teleological frame of the medical art itself rather than simply treating medical matters. These are not texts that were ignored by wider society, or restricted in their readership to a handful of professionals; and they were certainly not intended to be. The concepts and understandings articulated within them circulated widely among the educated eÂlite, who were active participants in medical discourse in a range of ways. However, there is a sense in which this very engagement with their audience, the particular set of relations within which these works were produced, serves to compromise, or at least complicate, their authority, including the authority with which they pronounced on women. For these are not the utterances of a clearly demarcated, well organized, high status group of recognized experts in a highly regarded ®eld, but the writings of a some what amorphous, unregulated, and fractious group of ques tionable standing, experts in a culture which esteemed generalists above specialists, and whose expertise had to cover the acquisition and retention of their clientele, the skill of telling them in various subtle and not so subtle ways things they wanted to hear. Roman medici and iatroi did not have the weight of an imposing institution behind their views and prescriptions; they spoke rather on the basis of their personal reputation and position, they spoke to a goalÐhealthÐthat everybody agreed to be of value, and they worked hard at speaking well and persuasively. These, then, are the implications of historical circumstances

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for the authority with which the medical woman, in herself, was invested by those in the Roman world who came into contact with her; at least in so far as that authority was derived from the situated persona of an author writing in the pursuit of health. The next step in trying to locate Roman medical accounts of woman on the social hierarchy of truth is to move from the distribution of power and prestige amongst medical practitioners and the wider public to the discursive resources medicine had at its disposal. That is, to move onto the ways in which medical knowledge was constructed and legitimated, produced and presented in the Roman world, to the broader set of truth claims within which it formulated its particular claims to tell the truth about women.

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2 A Rough Guide to the Conceptual World of Roman Medicine I n the Roman world, then, the medical art was a practical and discursive formation constituted, according to its goal, within a certain set of social and economic relations. It was a discourse and praxis concerned with, and marshalled towards, the attainment and maintenance of human health, encompass ing whatever was deemed to be requisite to that end, together with an assortment of criteria, varied in form and content, for judging that requisiteness. Some description and analysis of what was thus encompassed, of the domain of knowledge textually presented as appropriate to the goal of medicina (or iatrike) during the period under scrutiny here, of its organ izational principles, its basic concepts, and modes of articula tion, is now necessary in order to support the kind of detailed examination of this domain's female subjects which is to come. For the medical woman needs to be understood as a product of, and productive within, her ideative as well as more strictly social context, needs to be understood as fully caught up in this wider discursive web. It is the basis for this deeper understanding which this chapter seeks to provide. Since it is a segment of the Roman imperial eraÐroughly its ®rst two centuriesÐthat is at issue, this survey will be more synchronic than diachronic. The material is arranged in an internal order that is more contemporaneous than develop mentalÐthough medical discourse is historically cumulative, and Roman medici and iatroi clearly identi®ed themselves as part of various medical traditions, so a certain amount of temporal depth will be required.

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MEDICINA AS A WHOLE Appropriately translated, the rough de®nition of the medical art outlined above would have been, in essence, recognizable to Roman professionals and public alike, for similar formulations are found in contemporary texts. Cicero, for instance, describes medicina as the art of health, and the pseudo Galenic treatise Medical De®nitions contains the following short, pithy state ment among its selection on the subject: `The medical art (iatrike techne) is productive of health'.1 Most practitioners, however, were not prepared to be so open and inclusive, preferring locutions based on what they deemed requisite to health in a more positive and circumscriptive way. For instance, one view attributed to Hippocrates, the much mytho logized father of classical medicine, was that the medical art is `supplement and removal; supplement of what is lacking and removal of what is excessive in human bodies'.2 These are, in a sense, second order de®nitions, delineating a species or par ticular conception of medicina rather than the whole genus to which all these more speci®c entities belong. It is, moreover, no accident that lay persons were more content with the open ended, generic description than were the actual providers of medical services themselves. All the factors enumerated in the previous chapter as implicated in the speci®c social formation of Roman medicineÐin particular, the continual need to claim the authority to intervene in an acutely competitive contextÐ established a clear dynamic towards elaborating de®nitions of the medical art which were distinctive and exclusive, serving to di€erentiate rather than unify the profession. These de®nitions, and their particularities, might also acquire a historical dimension. Part of medicine's identity was its past: its emergence, or creation, to meet the human need for healing, and its subsequent development. The medical 1 i1 atrikh3 te3 xnh e1 sti peripoihtikh4 y2giei3 aw, [Gal.] Def. Med. 9 (xix. 351 K); Cic. Fin. 5. 16. Detailed discussion of this pseudo-Galenic text and other medical writings from the period mentioned in this chapter can be found in the following chapters. 2 pro3suesiw kai4 a1fai3 resiw, pro3suesiw me4 n tv9n e1 lleipo3ntvn, a1fai3 resiw de4 tv9n pleonazo3ntvn e1 pi4 a1nurvpi3 vn svma3tvn, [Gal.], Introduction/Ei1 sagvgh3 (Intro.) 6 (xiv. 687 K).

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art had as many foundation myths as any other comparable aspect of classical society. It could, through Asclepius, claim divine origins; or a more human story might be told, in which Hippocrates and his associates would inevitably play the major role, or the two might be combined in a range of di€erent ways.3 More detailed narratives could be elaborated in which not just medicine, but the author's particular brand of the healing art might trace its roots, stake its claim to authenticity and e€ectiveness. Tradition was an important resource in the construction of medical authority, both on a general and speci®c level. There were, of course, those for whom these discussions were an irrelevance, for whom healing was simply a matter of practice and not re¯ection on that practice. That is, those who might loosely be described as `folk healers', who acquired their skill and knowledge within less formal family and community networks, and who operated with a tacit understanding of illness and cure which was held in common with the people they treated and so never needed to be spelt out. These medical practitioners shared the same goal none the less, and though they might well have baulked at the term techne or ars, would probably have conceded that the most generic descriptions of the medical art did ®t what they were doing. This category itself falls short of the threshold of historical visibility, but what has passed over it is still di€erentiated to some extent by the degree of self consciousnessÐof explicitness over implicit ness, of re¯exive elaboration rather than simple enactment of constitutive principlesÐthat is exhibited. Some writings, such as those of the Elder Pliny, Dioscorides, and their lost pre decessors, stay reasonably close to these folk traditions; while others work harder at distancing themselves from popular wisdom, at articulating their medical identity more clearly and distinctly, at explaining and justifying what they say in more complex fashions. Developments and debates in philo sophy, as well as more pragmatic considerations, helped shape the forms these e€orts at explicit self de®nition and justi®ca tion took, the way this work was done. Most notably, of course, the more self conscious and theoretical texts came to o€er an 3

See e.g. Cels. Med. pr. 2 11 (CML i. 17. 4 19. 3), and [Gal.] Intro. 1 (xiv. 674 6 K).

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account of medical knowledge that was concerned not just with what counted as medical (what was to be included and what excluded in pursuit of the goal of health), but also with what counted as knowledge itself.4 From the earliest Presocratics onwards, philosophical attempts to explicate the universe in a uni®ed form included human beings as both knowing subjects and objects of (possible) knowledge, thus generating and dispersing ways of thinking and consciously constituted bodies of knowledge which had potential medical applications.5 When exactly this potential began to be realized by practising healers: when, that is, a process of inter action was initiated between those whose starting point was the sick person and the need to cure them, and those whose starting point was the normally functioning person in their cosmic context and the need to explain them, is unclear; but it is certainly visible in the earliest surviving Greek medical texts of the Hippocratic corpus, dating largely from the late ®fth and early fourth centuries bc.6 The complexity of this interaction is immediately apparent in the range of Hippocratic responses to 4 The epistemologization of classical medicine has attracted considerable scholarly attention: for the most recent discussion of the phenomenon as a whole, see, G. E. R. Lloyd, Adversaries and Authorities (Cambridge: Cambridge University Press, 1996), esp. 47 73. 5 It is important to understand this process in this way, and not to describe these thinkers as producing speci®cally medical knowledge; though this was how later Hellenistic and Roman commentators often categorized it, as well as applying the label of iatros to, for example, Empedocles (Diog. Laert. 8. 61 2). These interpretations are interesting and revealing in themselves, but are unsupported to the point of contradiction by the evidence. As W. K. C. Guthrie says of Alcmaeon, `He lived before the age of specialisation', when, `The study of the human body was still only a part of philosophy as a whole' (A History of Greek Philosophy, i: The Earlier Presocratics and Pythagoreans (Cambridge: Cambridge University Press, 1962), 344). See also, Jaap Mansfeld, `Alcmaeon: ``physikos'' or physician?', in J. Mansfeld and L. M. de Rijk (eds.), Kephalaion: Studies in Greek Philosophy and its Continuation O€ered to Professor C. J. de Vogel (Assen: van Gorcum, 1975), 26 38. 6 There were, obviously, practising physicians around long before this, one of the more famous of whom Democedes is alleged (Suda D 442: ii. 42 3 Adler) to have written a book (or, perhaps more precisely, a medical work circulated under Democedes' name at some point in antiquity), as is Acron of Acragas, a contemporary/colleague of Empedocles (Suda A 1026: i. 94 Adler); both reports and the various traditions around them are, however, highly dubious.

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these intellectual developments. For some the transaction with philosophy was unproblematically appropriative. The author of On Regimen (Peri4 diai3 thw) i, for instance, builds his dietetic precepts on a theory of the fundamental constituents of the human being, which are, in his view, ®re and water. For other Hippocratic writers, however, the process is less straightfor ward; medical learning from philosophy must not lose sight of its ultimate objective. Not all this knowledge of fundamental constituents, ®rst principles, and so forth is necessary for, or even relevant to, the medical art; moreover, traditional, experi ential knowledge has an essential part to play in the healing endeavour, and indeed, has a few things to teach the philoso phers. The treatise On Ancient Medicine (Peri4 a1rxai3 hw i1 atrikh9w) takes this a step further, arguing that the knowledge produced by these general enquiries concerning nature has nothing to con tribute to the medical art, indeed that it lacks the kind of clarity and certainty needed to make it useful for anything. The common ground which is being variously negotiated in these texts is none the less reasonably clear. With their goal of human health in mind, and the adjoining aim of creating and consolidating iatrike as a distinct and de®nite techneÐas an identi®able and valuable specialized branch of knowledge and attendant group of skills (a status which the Romans took for granted), all in a ®ercely competitive contextÐthese physicians engaged with the fruits and frameworks of a range of philo sophical knowledge projects; and, through this process, rede ®ned themselves and invented their art as such. The epistemological turn these events took, evident in the Hippo cratic corpus and, even more so, in the Hellenistic period, was, in part, inherited from this philosophical discourse and, in part, came from the business of inheritance itself. Its sub sequent elaboration to the point of systematization resulted from the social conditions within which knowledge was trans mitted and deployed. Most critically, the medical practitioners of the Classical and Hellenistic Greek world dealt with bodies of knowledge, constituted according to principles often expli citly expressed and argued, but which were not their own creation. However much they refashioned them in their own image, they could not establish absolute ownership; the overlap with natural (and other) philosophy persisted. The authority of

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these physicians, therefore, could not be entirely internally constructed, it could not rest solely on the claims they made about themselves, but also had to refer to an external epistemic area, judgeable by external criteria. Hence the dynamic of epistemologization, fuelled by the climate of contestation. Moving into the Hellenistic period, it seems that the dominant perspective on these issues was one that embraced philosophical modes of enquiry into somatic composition and processes, including those of disease and cure, but with circumspection.7 The amount of knowledge about the human beingÐin health, sickness, and in transition between the twoÐorganized under a medical rubric, expanded, epistemological tentativeness not withstanding. The situation shifted, however, and the epistemic di€erences re¯ected in the Hippocratic corpus took a sharper, de®nitional, and organizational turn in early third century bc Alexandria when a pupil of the great anatomist Herophilus of ChalcedonÐPhilinus of CosÐleft his teacher's circle to initiate the foundation of a rival school or `sect' (ai7 resiw/hairesis) which developed a radically divergent conception of the medical art.8 This grouping became known as the empirikoi (e1 mpirikoi3 , or `empiricists'), and those he had broken with were to be characterized, almost by default, as the logikoi (logikoi3 , or `rationalists'). The epistemological dichotomy which thus crystallized has been succinctly summarized by Michael Frede: Very roughly speaking, the empiricists were called `empiricists' since they took the view that knowledge is just a matter of a certain complex kind of experience (in Greek empeira), whereas the rationalists were so called since they assumed that mere experience, however complex, 7 This is, at least, the dominant perspective in the scanty surviving evidence, see e.g. James Longrigg, Greek Rational Medicine (London: Routledge, 1993), 104 76, for further discussion. 8 Although, according to Galen, Outline of Empiricism/Sub®guratio Emperica (Subf. Emp.) 11 (86. 1 9 Dgr), Serapion of Alexandria claimed for himself the title of `®rst undogmatic doctor (`primus medicorum indogmaticus') and was clearly a major theoretician, most listings of the leaders of this grouping, including the fullest and most descriptive (that is [Gal.] Intro. 4: xiv. 683 K), put Philinus' name before his. Since they also sometimes start with Acron of Acragas (e.g. Agnellus of Ravenna, Lectures on Galen's De Sectis 4: 22. 31 SC609), who can only be described as a precursor, presumably recruited as part of the invention of a tradition, it is perhaps best to see Philinus as starting something that Serapion consolidated into the form which was to persist.

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does not amount to knowledge, that knowledge crucially involves the use of reason (logos in Greek, ratio in Latin), for example to provide the appropriate kind of justi®cation for our belief.9

Born in apostasy, the empirikoi were a much more strongly uni®ed and self de®ned group than the logikoi, though never entirely homogeneous.10 Indeed, it has been justi®ably ques tioned to what extent the term `rationalist sect' really has any historical validity.11 Certain key tenets of a theory of knowledge were, implicitly or explicitly, shared, but the engagement of the cognitive powers of reason with the workings of the body engendered a range of medical theories and lineages, often clearly contradictory. The Herophileans, from whom Philinus split, were, for example, a much more clearly de®ned group than the rationalists at this juncture.12 Both empiricist and rationalist positions, and the currents within which they were elaborated, evolved over time, and they were joined by a third groupingÐthe methodikoi (meuodikoi3 , or `methodists')Ðin the ®rst century bc. The initial impetus came from Themison of Laodicea, a pupil of Asclepiades of Bithy nia, the innovative rationalist physician and thinker of the late second century bc.13 Themison gradually separated himself from his teacher and formulated an alternative `method' 9 Michael Frede, `An empiricist view of knowledge: memorism', in Stephen Everson (ed.), Epistemology (Cambridge: Cambridge University Press, 1990), 225. 10 For further discussion of empiricism, including its internal debates, see Michael Frede, `The Empiricist attitude towards reason and theory', and Mohan Matthen, `Empiricism and ontology in ancient medicine', both in R. J. Hankinson (ed.), Method, Medicine and Metaphysics: Studies in the Philosophy of Ancient Science (Apeiron, 21/2; Edmonton, Alberta, 1988), 79 97, 99 121; also R. J. Hankinson, `The growth of medical empiricism', in Don Bates (ed.), Knowledge and the Scholarly Medical Traditions (Cambridge: Cambridge University Press, 1995), 60 83. 11 Heinrich von Staden, `Hairesis and heresy: the case of the haireseis iatrikai', in Ben Meyer and E. P. Sanders (eds.), Jewish and Christian SelfDe®nition, iii: Self-De®nition in the Graeco-Roman World (London: SCM Press, 1982), 76 100. 12 On Herophilus and the Herophileans see Heinrich von Staden, Herophilus: The Art of Medicine in Early Alexandria (Cambridge: Cambridge University Press, 1989). 13 For Asclepiades see J. T. Vallance, The Lost Theory of Asclepiades of Bithynia (Oxford: Oxford University Press, 1990).

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(me3 uodow), centred on the observation of certain common char acteristics of disease, in which the medical art was encom passed; this methodic system was subsequently developed, and most ¯amboyantly promoted, by Thessalus of Tralles under the emperor Nero.14 The methodikoi, by both combining and, more often, rejecting, elements of both empiricist and rational ist epistemology, occupied a distinctive position on the issue of knowledge per se.15 They also, by drawing a very clear and austere line around the knowledge requisite for curative practice, reasserted the issue of the teleological propriety of medical knowledge in particular, which had become somewhat subsumed under broader arguments. The pseudo Galenic Medical De®nitions, for example, de®nes the methodic system as `knowledge of manifest generalities which are proximate and necessary for the goal (telos) of the medical art'.16 The doubly polemic promulgation of their own doctrines also allowed the methodikoi ®rmly to establish their own sectarian identity in opposition to both those of the logikoi and empirikoi, though not without a degree of internal debate and dissent. A fourth sectarian categoryÐeklektikos, episynthetikos, or hektikos (e1 klektiko3w, which roughly translates as `eclectic'; e1 pi synuetiko3w, which is more like `synthetic'; and e2 ktiko3w, `cohesive', respectively)Ðalso appears in some Roman imperial taxonomies of medicine. Its status is, however, ambiguous. One account speci®cally refers to a sect, a hairesis, founded by Agathinus the Spartan, and which may be called eklektike, episynthetike, or hektike, and is thus classi®ed as comparable to the big three.17 14 For a description of the doctrines of Themison and his followers see Cels. Med. pr. 54 7 (CML i. 26. 9 29); the relationship between Thessalus and Themison is described in e.g. [Gal.] Intro. 4 (xiv. 684 K). The whole question of the de®nition and evolution of methodism is discussed in detail in Gary Rubinstein, `The Riddle of the Methodist Method: Understanding a Roman Medical Sect', Ph.D. diss. (University of Cambridge, 1985). 15 For a version of methodic epistemology see Michael Frede, `The method of the so-called Methodical school of medicine', in Jonathan Barnes et al. (eds.), Science and Speculation: Studies in Hellenistic Theory and Practice (Cambridge: Cambridge University Press, 1982), 1 23. 16 gnv9siw fainome4 nvn koinoth3tvn prosexv9n kai4 a1nagkai3 vn tQ9 th9w i1 atrikh9w te3 lei, [Gal.] Def. Med. 17 (xix. 353 K). 17 Ibid. 14 (xix. 353 K) has Agathinus as the founder of a sect. Agathinus, and the other medical ®gures from the period named in this chapter, are discussed in more detail in the following chapters.

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Others distinguish eklektikoi, such as Archigenes of Apamea, from episynthetikoi, such as Leonides of Alexandria, and impli citly locate these individuals outside the main tripartite divi sion.18 Agathinus and Archigenes are also alternatively classi®ed as rationalists and important participants in one of its particular strands or schoolsÐthe pneumatikoi (pneymatikoi3 , or `pneuma tists') founded in the ®rst century bc by Athenaeus of Attaleia, a pupil of the Stoic philosopher PosidoniusÐthough Agathinus is further described as having followers among the methodikoi and empirikoi, which perhaps explains why he could then be placed at the head of a hairesis of his own.19 Given that it is unclear to what extent these labels were created or even used by those to whom they were applied, rather than being the products of external categorization, some slippage and dispute is only to be expected in these areas, especially if what was being attempted was some kind of synthesis or reconciliation of competing systems. More over, whether or not any coherent grouping of eclectic physicians was ever formed, there certainly are eclectic tendencies apparent in various parts of Roman medicine, especially its rationalist quarters. The distinct and divergent theoretical lineages, which had endowed rationalism with whatever form it had, dissolved, or were at least diluted, during the imperial era. The Herophi leans ceased to be a discrete entity around ad 50, and the main evidence of the durability of the Erasistrateans, the followers of the other most prominent medical man of Hellenistic Alexan dria, Erasistratus, is Galen's late second century ad polemic against their number at Rome.20 The original theories of Asclepiades of Bithynia have been dispersed, mainly into 18 [Gal.] Intro. 4 (xiv. 684 K), and Cael. Aurel. Acute A€ections/Celeres Passiones (CP) 2. 7 8 (CML vi. 1. 1. 134. 14) 19 Anonymus Bambergensis (Anon. Bamb.) 6r (66. 6 Stoll) calls them rationalists; and e.g. Galen, On the Di€erence between Pulses/Peri4 diafora4w sfygmv9n (Di€. Puls.) 3. 6 (viii. 674 K), pneumatikoi. For Athenaeus, his education, and school, see Galen, On Containing Causes/Fõ l-asbab-l-masika/ De Causis Contentivis (CC) 2. 1 (CMG Supp. Or. ii. 54. 3 6, 134. 3 6); Agnellus, Lectures 20 (78. 1 80. 6 SC609); and Anon. Bamb. 6r (66. 6 Stoll). On Agathinus' following among the methodikoi and empirikoi see John of Alexandria, Commentary on Hippocrates' Epidemics VI (Comm. Hipp. Epid.) 12 (CMG xi. 1. 4, 52. 6 7; cf. 87. 19 20 Pritchett). 20 That is, Gal. On Venesection against the Erasistrateans at Rome (xi. 187 249 K); and see, on the Herophileans, von Staden, Herophilus, 445 578.

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methodism, rather than being maintained by an independent following. And the pneumatikoi, the most recently founded school of this kind, neatly encapsulates in their own develop ment this kind of blurring of identity and doctrine. This loose sectarian structure, therefore, corresponds to (at least) three constructions of the knowledge requisite to the medical endeavour. The empirikoi considered the requisite knowledge to be, simply, what has been bene®cial for what condition in the past. All that was required was to remember sequences of repeated, observable events; that, for example, recovery had followed upon the application of a particular remedy in a particular situation a number of times. This memory could be direct and personal, based on autopsy, or transmitted then personalized, based on the critical assimila tion of the reports of others (i2 stori3 a); and, more controver sially, these memories could be applied to cases closely resembling but not identical to those remembered, a process known as `transition to the similar' (meta3basiw toy9 o2moi3 oy). The methodikoi considered the requisite knowledge to be knowledge of the relevant manifest generalities; that is, the generalities of `stricture' (stegno3n, or strictura in Latin), `¯ux' (o1rrv3dhw, or solutio in Latin), and `mixture' (e1 pipeplegme3 non, or complexio in Latin), which a physician needed to be able to recognize in any sick individual and to take as, in themselves, indicative of their treatment. The logikoi considered the requisite knowledge to be an understanding of how and why people become ill and are cured, which demanded an understanding of the human being able to sustain these kind of aetiological and processual enquiries. These understandings took a range of di€erent forms, built around coherent, and more or less totalizing, explanatory frameworks based on speculative reasoning about bodily functioning as part of the functioning of an anthropo centric physical world. Both empiricists and rationalists held, more or less strongly, that this requisite knowledge was the only justi®ed medical knowledge, all the rest was mere belief; and the methodists made a similar claim, though it was a subordinate one and they could, therefore, treat ideas about things other than the manifest generalities as interesting but irrelevant as well as downright fanciful. Other approaches to the healing endeavour were formulated,

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or simply enacted, around, along, or more clearly outside, the external boundaries of this sectarian structure; approaches which maintained a greater continuity, of form as well as content, with folk medicine. In particular, more speci®cally materially based traditions thrived in this period, Dioscorides, for instance, wrote what was to become the standard work on medical simples at this time, and collections of compound recipes also abounded. Here well ordered knowledge of these curative materials, the ways they should be gathered and applied, was requisite to the medical enterprise either in the sense of being simply indispensable or more exclusively con stitutive, though this was rarely explicitly stated as such. This exclusivity, or at least the superiority sometimes claimed for these healing materials and their use, was grounded in the inherence of these healing possibilities in the con®guration of the cosmos itself. And this inherence was either so open that knowledge about these possibilities developed almost automa tically, growing into a tried and tested, open and expansive tradition which required only recognition and respect, or was considered to be somehow concealed, requiring a kind of revelation by one already privy to its secrets, leading to a more restricted and occult tradition. Practitioners operating within these kind of frameworks, at least as they gave them literary expression, were certainly not una€ected by the con cerns and debates of the sects, but maintain their own orienta tion to the goal of medicina none the less. Moreover, it must be said that practice on the ground was undoubtedly di€erentiated much less than these various constitutive divisions might suggest. THE PARTS OF MEDICINA The various sectarian constructions of the medical art were divided into parts, according both to the logic of their con stitutive principles and to the di€erential drive of competition. Divisive typologies, and the genera, species, and subspecies they produced, thus proliferated. The type that appears most dominant in the imperial period, however, was modal, based on modes of medical knowledge and activity rather than their

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21

objects: that is, particular areas or states of the body. The empirikoi, in the main, made a primary partition into the `constitutive' (constitutivas) and `perfective' (®nales) portions.22 In the former they placed autopsy, reports, and, more con troversially, `transition to the similar'; and in the latter were the semeiotikon (shmeiotiko3n or semiotic, comprising diagnosis and prognosis), the therapeutikon (uerapeytiko3n or therapeutic, com prising pharmacology, surgery, and, less securely, regimen), and the hygieinon (y2gieino3n or healthful, variously comprising preservative, convalescent, and ®tness measures, including some regimen). Some rationalists seem to have made a compar able initial division into theory (uevri3 a) and practice (pra9jiw), the former leading to the latter; but, until its later elaboration in total taxonomies of the medical art, the relationship between these categories and the more speci®c sections which received most of the attention is obscure.23 At this more speci®c level, various logikoi added the physiologikon (fysiologiko3n, that is concerning the nature of the human being) to the empiricist tripartition, sometimes together with the aitiologikon or patho logikon (ai1 tiologiko3n or pauologiko3n, concerning the causes and courses of diseases) and sometimes with a more substantial shu‚ing of parts.24 The traditions outside this sectarian structure mostly made no such divisions. There was a certain amount of borrowing and overlap in the way they organized their bodies of knowledge, but it was usually all contained within the therapeutikon. These almost in®nite partitive permutations will here be reduced to their, more or less, common constituents, starting 21 For a discussion of all the di€erent ways iatrike could be divided up see Galen, On the Parts of Medicine/Fõ 'ajza'-l-tibb/De Partibus Artis Medicativae Ç (Part. Art. Med); and also von Staden, Herophilus, 89 114. 22 Gal. Subf. Emp. 5 (51. 12 53. 27 Dgr), and Part. Art. Med. 2. 1 and 6. 3 4 (CMG Supp. Or. ii, 26. 9 15, 40. 2 10, and 120. 7 15, 125. 3 12). And see DeichgraÈber, Die griechische Empirikerschule, 288 91. 23 For theory and praxis as the `highest parts of iatrike ' (ta4 a1nvta3tv me3 rh th9w i1 atrikh9w) see [Gal.] Def. Med. 10 (xix. 351 K); for its intricate elaboration see e.g. Agnellus, Lectures 5 6 (24. 9 30. 8 SC609), who has three parts of the former and two parts of the latter, each further subdivided and exhaustively enumerated. 24 See e.g. [Gal.] Intro. 7 (xiv. 689 90 K) for the former, and [Gal.] Def. Med. 11 (xix. 351 2 K) for the latter.

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with conceptions of the nature of the human being, then the nature of the diseases with which they are a‚icted, their diagnostic recognition and prognostic evaluation, and, ®nally their treatment, by surgical intervention, material application, or prescribed regimen. A further, gynaecological, part will then be added for the particular purposes of this study; looking at the extent to which dealing with women was a distinct area of the medical art, and the various ways in which they were dealt with prior to the Roman imperial period. While the ®rst two belong properly only to the logikoi, it is important to remember that the empirikoi and methodikoi operated in the same world and shared many of the same assumptions. They rejected this kind of knowledge as medically inappropriate and epistemolo gically unjusti®ed, but did not disengage themselves from it altogether. Had they been called upon to describe, for example, the most probable composition of the human body as a purely intellectual exercise, it is more than likely they would have relied on rationalist models. Some of the same assumptions are also implicit in the traditions of folk medicine, in the concep tion of the relationship between humanity and the world around them on which they are tacitly based. Concerning the nature of the human being A common starting point for an account of the nature of the human being is the elements from which they, at least in so far as they are material entities, are constituted. These elements (or element) are the primary, least, and simplest phenomena from which human beings are composed and into which ultimate, least, and simplest phenomena they are dissolved. They are that behind and beyond which there is only more of the same. There are essentially two types of systemic con tenders for this role in human construction. The ®rst is the qualities or substances model, the second the particles and void combination. In the former, the elements take two, intercon nected, forms. One is as `qualities', most fundamentally and consistently in the medical context the two pairs of contrariesÐ the hot and the cold, the wet and the dryÐas implicit in the late ®fth century bc Hippocratic treatise On the Nature of Man (Peri4 fy3siow a1nurv3poy), and in theories like those of Petron of

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Aegina not long thereafter, and of Athenaeus of Attaleia rather later.25 Or they are the four `root' substances postulated by Empedocles in the early ®fth century bc, that is, ®re, air, earth, and waterÐmost famously, but distinctly, elaborated by Plato and Aristotle successively in the fourth century bc, and by Galen, six hundred years later. However, these are, in a sense, di€erent routes to the same destination, for ®re, air, earth, and water are essentially manifestations of quali®ed matter. This is clearest in systems such as those of the fourth century bc physician, Philistion of Locri, and the Stoics, where each elemental body possesses a single quality, but it is also apparent in the Aristotelian schema which identi®es each element with a pair of qualities.26 Moreover, none of the medical theorists seem to have envisaged either species of primordial entity actually existing in their pure state in any living being. The qualities are expressed in multifarious human constituent substances, and the Empedoclean `roots' have been variously compounded to the same end. The primacy of the qualitiesÐespecially the hot and the cold, the wet and the dryÐin all these schemata emphasizes that the elements are not just about simplicity, but also play a role in de®ning human substance through its essential proper ties, and connecting it to the wider cosmic con®guration. These two concerns are also re¯ected in the alternative elemental hypothesis, which constructed the universe and the human being from fundamental, dynamic, and spatially separated particles. The precise nature of the particles, their behaviour, and the space with which they coexisted was variable within the broad theoretical framework. For example, the atoms of Democritus, the ®fth century bc Abderite philosopher whose writings covered a range of topics later organized under 25 The concept of `element' is not explicitly used in On the Nature of Man (Nat. Hom.), but the four qualities are clearly fundamental, prior and posterior to any human substance none the less. For Petron see Anonymus Londinensis (Anon. Lond.) 20. 1 24 (78 80 Jones); for Athenaeus see e.g. [Gal.] Def. Med. 31 (xix. 356 K). See generally G. E. R. Lloyd, `The hot and the cold, the dry and the wet in Greek philosophy', JHS 84 (1964), 92 106. 26 Anon. Lond. 20. 25 6 (80 Jones): Philistion; Diog. Laert. 7. 137: the Stoics; both adhere to the system, ®re hot; air cold; earth dry; water wet. And see Arist. GC 330a30 330b7, where ®re hot + dry; air hot + moist; earth cold + dry; water cold + wet.

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medical rubrics, were essentially indivisible, while the corpus cles of Asclepiades of Bithynia were crucially frangible.27 However, in all the systems, the properties of all compounds, including the human being, depend on the size, shape, weight, position, and arrangement of its particles. The real di€erence between these two systems, however, lies less in the contrast between their elemental entities than in the explanatory role the elements play in the understandings of the cosmos of which they are a part. For the proponents of particulate cosmologies, their particles possess explanatory priority. Whole beings or objects, such as humans, are com prehended through their reduction into their component parts. This reduction may be multi layered, passing through several layers of decreasing complexity before it reaches the ®rst bodies, but each level is explained by the presence and proper ties of the simpler level, and ultimately the simplest explains all. In the alternative cosmological schema, the elements are subordinated to the explanatory priority of the whole entity they substantiate. The human being may be reducible to successively simpler compositional layers until its primary constituents are reached, but each is explained by the more complex level rather than vice versa, and ultimately it is the whole that explains all. Thus, instead of certain sorts of corpuscles combining in a particular way to produce, for example, blood, bone, muscle, and so forthÐwhich then combine in a particular way to form a human beingÐa human being, to be what it is, requires a particular combina tion of blood, bone, muscle, and so on, which, in turn, need to be formed from certain sorts of substances or qualities to be able to ful®l their function. Either way, between the elements and the full complexity of the whole lie a number of intermediate stages, or reductive classi®cations. These move the hierarchy on from composition towards organization, from the de®nition of human substance to human structure. The most theoretically developed in the extant sources is the distinction between the homoeomerous and anhomoeomerousÐuniform and non uniformÐparts of 27 Diogenes Laertius (9. 46 and 48) lists Democritus' works as they were known to him, and see also Longrigg, Greek Rational Medicine, 66 8. For Asclepiades' corpuscles see Vallance, Asclepiades of Bithynia.

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the body. The homoeomeries are divisible into like pieces, and include bodily constituents such as blood, bile, cartilage, bone, veins, and arteries, while the anhomoeomeries divide into unlike pieces, and include such organs as the hand, eye, heart, and liver.28 The latter were, broadly speaking, composed from the former. This categorization might be further sub divided and elaborated, or various other somatic schemata might be adopted. These could be more simply enumerative, or based on di€erent qualitative criteria: for instance, the division into solids, like bones, nerves, arteries, and veins; liquids, which were basically the humours, that is blood, the various kinds of bile, and so forth; and pneumata (pney3mata), types of hot air which have been integrated into bodily functioning.29 Both these systems operate solely on the level below that of the organs themselves, occupying roughly the same territory as the homoeomeries, and for many physicians this was the limit of the knowledge of the body requisite to the medical art. To enquire into elements and ®rst principles was unnecessary. Classical medicine, in a sense, operated largely at this lower level of somatic organization. The Hippocratic body was essen tially a ¯uid entity. The organs were, with a few notable exceptions, generic structures of containment for the humours and pneumata which did most of the physiological and patho logical work. Even after the organs emerged clearly as indi vidually identi®ed entities, after Aristotle and the remarkable anatomical researches that Herophilus and Erasistratus con ducted on the bodies of the living and the dead in the early Hellenistic era, they remained for many the passive sites, rather than active agents, of somatic happenings. It is this under standing that informs the conception of the human body as, at some basic level, containing solids, ¯uids, and pneumata. The contrast this emphasizes is between the stability and immobility 28 This type of distinction appears in e.g. Arist. PA, esp. 646a20 4; Anon. Lond. 21. 18 22. 5 (82 4 Jones); and Gal. On the Doctrines of Hippocrates and Plato/Peri4 tv9n ¹Ippokra3toyw kai4 Pla3tvnow dogma3tvn (PHP) 8. 4. 9 12 (CMG v. 4. 1. 2. 500. 8 26). See also John Forrester, `The homoeomerous parts and their replacement by Bichat's tissues', MedHist 38 (1994), 444 58. 29 See e.g. [Gal.] Def. Med. 33 (xix. 356 7 K), and [Gal.] Intro. 9 (xiv. 696 7 K).

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of the solid structure, and the variability and dynamism of the liquids and vapours. It is these latter components that essen tially account for somatic change. Alterations can occur either within the broad boundaries of the ongoing processes of life, or exceed them in some way, leading to organic dysfunction and disease. The agents of these transmutations are the qualities these substances, and the whole bodily fabric, possess, most crucially the two pairs of contraries, but also a range of other properties. Since the cosmos is saturated with these same qualities, the air humans breathe, the food they eat, the locations they inhabit can all be characterized in the same terms, making people vulnerable to all kinds of environmental in¯uences. Thus, while the anatomical architecture is secure and static, the ¯uid and gaseous constituents of the body make it a fundamentally dynamic and unstable entity, subject to con siderable amendment from a range of causes. Qualitative change is, in many senses, synonymous with substantial change. The seasonal shifts in somatic composition outlined in the Hippocratic treatise On the Nature of Man illustrate this total intertwining of quality and substance, humanity and environment, in a pattern that recurs, with endless variation, throughout the territory of classical medi cine.30 The cycle commences in winter, the coldness and dampness of which ®lls the body with phlegm, the most frigid of humours. In spring this is increasingly displaced by hot, moist blood, corresponding to the rainy warmth of the transition into summer, where hot, dry yellow bile dominates, turning to black bile as it cools into autumn. The continuous presence of all four humours, and therefore all four elemental qualities, is necessary for life, but their relative quantities alter over the course of the year. This proportionality is played out over a constant material substratum, across which the qualities ebb and ¯ow, bringing transubstantiation in their wake. A body cannot simply sustain modulations in temperature or humidity, but is actually recomposed by the experience. Phlegm, for example, does not heat up, but is transformed into, or replaced 30

Nat. Hom. 7 (CMG i. 1. 3. 182. 4 186. 12). It is the four humours of this treatise blood, phlegm, yellow and black bile that were eventually to become canonical, with Galen; but considerable variation in number and qualities of humours occurred in the meantime.

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by, hot blood. Subtle gradations of characteristics are achieved, not by the evocation of a qualitative continuum, but by the in®nite proportional possibilities of substantial mixture. The development of a more precise anatomical atlas did produce more speci®c elucidation of organs as functional nodes. As the intricate interior of the human body was brought more clearly into focus, a corresponding clari®cation occurred on the physiological plane. The broad outlines did not change, for they were externally anchored; but the provision of internal counterparts for such obvious human activities as nutrition, respiration, locomotion, and, of course, falling ill, became a more complicated business. The narrative became longer and more detailed, the number of characters increased and became more individually developed, but the plot was the same. It could also still be read in di€erent ways. Thus the explication of organic operation might be entirely mechanistic, or make reference to the essential nature of the whole organism. So, for example, Asclepiades de®ned the bladder as analogous to a sponge or piece of wool, its composition and arrangement enabling the vapours produced from ¯uids drunk to pass inside and there condense back to liquid form; and Erasistratus considered that bile was separated from blood in the liver by means of the di€erential stomatal diameter of the bile ducts and hepatic venules.31 Galen, however, in his accounts of the same organs and events, invokes the exercise of certain dynameis (dyna3meiw, faculties or capacities) the human being has by virtue of the kind of being it is, and which have been designed speci®cally for the purpose.32 The bladder possesses the four fundamental organic facultiesÐof attraction, retention, altera tion, and expulsionÐin a particular combination and form. Most importantly, its attractive dynamis is speci®c to urine, or its immediate bodily precursors. Similarly, bile is separated from blood in the liver, not by morphological means, but by the power of the gall bladder to attract yellow bile. Galen is interested in providing a material explanation for the operation 31 Gal. On the Natural Faculties/Peri4 fysikv9n dyna3mevn (Nat. Fac.) 1. 13 and 2. 2 (SM iii. 122. 17 133. 10, 157. 5 159. 4). 32 The following details are drawn from Galen's two major physiological treatises: On the Usefulness of the Parts/Peri4 xrei3 aw mori3 vn (UP; Helmreich) and Nat. Fac. (SM iii. 101 257).

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of the faculties, correlating them to particular arrangements of the ®bres in the walls of the organs and, ultimately, the krasis (kra9siw, that is blending or mixture) of the four qualities in the whole part. This approach, however, has limits, for there are certain activities for which he is unable to give a precise physical explanation, but it is still useful to speak of a capacity which causes it, and which the speci®c organ possesses by virtue of its nature, and of the being of which it is a part. It is useful, not just practically, but also because this understanding operates at a higher level of the explanatory hierarchy. Less speci®cally, the three somatic networks of the arteries, veins, and nerves, were mutually distinguished in the Hellen istic period and cast in a number of transmissive and transpor tational roles essential to the general, unlocalizable, functioning of the human being.33 Two substances were centrally involved in these activities, the blood and the pneuma, though other humours might also be found in the blood vessels. Blood was universally conceived of as the main intermediate stage in the transformation of food into ¯esh, and it travelled outwards from its source (the blood producing liver) to be assimilated by the tissues and organs it reached; some might be further concocted to form the generative seed, though this might also come from the nourishment more directly.34 The actions of the pneuma were more variously and elusively understood. Some physicians of the imperial era, such as Aretaeus the Cappado cian, operated with a loose, Hippocratic, notion of the pneuma as something which made an indispensable but largely unde ®ned contribution to life. Others, following in the footsteps of Herophilus and Erasistratus, deployed a much more elaborate and clearly delineated pneumatic model in which, in the arteries and/or veins pneuma was called physikon (fysiko3n, that is natural) and/or zotikon (zvtiko3n, vital, or pertaining to life) and implicated in the basic vitalization of the body, in the underlying maintenance of life; while, in the nerves, it was 33 See Friedrich Solmsen, `Greek philosophy and the discovery of the nerves', MH 18 (1961), 150 97. 34 Galen, for example, agrees with Aristotle and Athenaeus in espousing a haematogenous theory (e.g. On the Seed/Peri4 spe3 rmatow (Sem.) 2. 5. 3: CMG v. 3. 1. 178. 23 4); whereas the Anon. Lond. 25. 41 5 (98 Jones) presents a food-based one.

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named psychikon (cysiko3n, of the soul, or psychical) and implic ated in perception and action.35 A third, hektikon (e2 ktiko3n, sustaining or cohesive) pneuma might also be responsible for ensuring the coherence and unity of the body which it was su€used throughout.36 Erasistratus, and his adherents, con troversially con®ned blood to the veins, asserting that the arteries contained only vital pneuma (keeping the psychical pneuma in the nerves); but most considered that both veins and arteries contained a mixture of blood and pneuma.37 These pneumata, integrated as they were into somatic func tioning, were generally described as innate (e5 mfyton), or con nate (sy3mfyton); however, it was often considered that they were in some way nourished or replenished by inspired air, either directly or after a process of alteration in the lungs analogous to the alteration of food to blood in the liver.38 The other commonly conceived function of respiration was concerned with a close relative of the pneuma, the `innate heat' (e5 mfyton uermo3n). This was a speci®c, connate form of the quality heat, or of ®re, and an amorphous vital principle, tightly bound to the essence of life. For it was the innate heat that shaped the course of life, the processes of maturation and then ageing, in Aristotle, Galen, and, by implication, others also.39 It was, at least according to Galen, the agent of the material losses continuously sustained by all living things and, therefore, requiring replacement in the form of food, drink, 35 These pneumatic typologies appear, not entirely consistently, in e.g. the pseudo-Galenic Def. Med. and Intro. and the work of Anonymus Parisinus (Anon. Paris.), and was obviously common currency in the early imperial era. For Galen himself see Owsei Temkin, `Galen's pneumatology', Gesnerus, 8 (1950), 180 9. 36 See [Gal.] Intro. 13 (xiv. 726 K), and Gal. CC 1. 3 (CMG Supp. Or. ii. 52. 12 14, 133. 5 16). The origins of this are Stoic rather than Alexandrian. 37 For Erasistratus' views on this matter see esp. Gal. Whether, according to Nature, Blood Is Contained in the Arteries/Ei1 kata4 fy3sin e1 n a1rthri3 aiw ai¥ ma perie3 xetai (144 83 FW). 38 See Gal. On the Usefulness of Respiration/Peri4 xrei3 aw a1napnoh9w (Ut. Resp.) 1. 2 (80 FW) for discussion of theories about the function of respiration, including those concerning the pneuma. 39 See e.g. Arist. Juv. and Gal. On Marasmus/Peri4 marasmoy9 (vii. 666 704 K) for heat and ageing (marasmus is a kind of wasting disease); and for a general discussion see Friedrich Solmsen, `The vital heat, the inborn pneuma and the aether', JHS 77 (1957), 119 23.

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and inhalation, and it also governed the transformation of nourishment into blood, and air into pneuma, in the most important parts of this replenishment.40 It was itself main tained in a stable state by respiration.41 Each of these somatic networks had an arche (a1rxh3, that is origin or source): for the veins, the liver, the central site of conversion of nourishment into blood; for the arteries the heart, a site of pneumatic processing, heat, and pulsative power; for the nerves, the brain, in whole or part. This last, said Herophilus, Erasistratus, and many others, was the site of the hegemonikon (h2gemoniko3n, the ruling or authoritative part) of the soul, into which (along the sensory (ai1 suhtika3) nerves) went perception, out of which (along the deliberative (proairetika3) or motor (kinhtika3) nerves) went intentional movement, and within which, in some sense, occurred thoughts and feelings and all their conscious cognates.42 The soul (cyxh3/psyche) itself was, of course, more than its hegemonikon, for it was not only these kind of conscious activities that depended on it, but also life itself. Human beings are what they are, that is both alive and human in such a way that the latter inextricably quali®es the former, by virtue of being a particular complex of a particular body and a particular soul; so, in reality, the psyche has been in this account all along. The classical problematiza tion of what it was to live as a human proceeded, in both medical and philosophical discourse, through ®rst bringing into being, and then arranging in a hierarchical order, certain vital units. Activities such as growth, nutrition, and reproduc tion which were common to all living things ranked below activities like locomotion and perception which di€erentiate animals from plants, and even further below peculiarly human activities like rationality and speech. This correlated to a (variously constructed) compartmentalization and hierarchical 40

Gal. San. Tu. 1. 3. 1 (CMG v. 4. 2. 5. 35 6. 3). Gal. Ut. Resp. 5. 8 (132 FW). 42 Or, to be precise, Erasistratus located the hegemonikon in the meninx of the brain, and Herophilus in its ventricle; these opinions becoming part of the doxographical tradition on the subject, see e.g. AeÈt. Placit. iv. 5 (Dox. Gr. 391. 1 392. 7). There were also those, such as Asclepiades and Andreas the Herophilean, who denied the existence of a hegemonikon psyches altogether (Tert. De Anima 15. 2). 41

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ordering of the soul in which the parts might be more or less distinct and separated, and the hegemonikon was the ruling part. There are hints that Herophilus and Erasistratus considered the psyche to be pneuma (or at least closely connected the two), perhaps thinking that its di€erent types, in their di€erent systems and spaces, accounted for the di€erent sorts of activ ities in which the soul was implicated.43 The Stoics certainly held this view, and Alexandrian medical theories contributed to its most important elaboration by Chrysippus, the third head of the Stoa.44 This, in turn, in¯uenced subsequent medical thinking, most directly that of the pneumatikoi (though Posi donius, Athenaeus' teacher, rather diverged from Chrysippean orthodoxy on some points), but also in a more general and di€use way.45 Even Galen, whose voluminous writings on the soul are ethical as well as more strictly medical, attempts to adapt a Stoicized version of the Alexandrian model to an explicitly Platonic notion of the tripartite (though not neces sarily incorporeal or immortal) soul, picking up various ideas from Aristotle on the way. This adumbration of classical modes of understanding of the human being kata physin (kata4 fy3sin, that is in a state according to nature) is now complete. All the manifest human attributes and activities have been accounted for in a range of more or less uni®ed explanatory frameworks. It was, in the rationalist and Galenic tradition, a necessary prelude to the equivalent eluci dation of the human being para physin (para4 fy3sin, in a state contrary to nature), or ill; necessary both in order to distin guish between the two and to understand what lay behind that distinction. There was considerable debate in classical anti quity, as today, concerning the de®nitions of, and interrelation ship between, health and disease, but whatever subsequent elaborations occurred, health was kata, and disease para, physin. 43 See the rather confused reports at Gal. On my own Opinions/De Sententiis (Sent.) 7. 4 (CMG forthcoming, 78. 23 80. 6, with commentary). 44 For discussion see e.g. Julia Annas, Hellenistic Philosophy of Mind (Berkeley and Los Angeles: University of California Press, 1992), 17 70. 45 See e.g. [Gal.] Intro. 13 (xiv. 726 K), also discussed in Ch. 4 below. Even the methodic Soranus, with his corporeal, seven-part soul looks suspiciously Stoic (Tert. De Anima 6. 6, 14. 2).

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All about disease Galen develops his de®nition of disease starting from the universal conception of being ill agreed by all Greeks.46 When there is no impediment of any of the natural activities of all the parts of the body, people both consider themselves, and are considered by others, to be healthy (y2giai3 nein); whereas, when some natural function is impaired, or ceases, they are similarly, re¯exively and socially, described as diseased (nosei9 n). Many Romans also seem to have shared this understanding, including some jurists who, in discussing the legal require ments of openness about the condition of slaves o€ered for sale, including whether they have any disease (morbus) or defect (vitium), stated that, `Disease is any contrary to nature state of the body which impairs its usefulness', adding that this state might be of the whole body or just a part.47 Behind this conventional comprehension, according to Galen, is a threefold distinction between the natural activities, which are or are not damaged, the somatic diathesis (dia3uesiw, that is disposition) which underlies this function or dysfunction, and the causes of the disposition. On this deeper level it is permissible to designate either the unnatural disposition, or the impaired activity, as the disease, so long as consistency is maintained in the delineation of health. Galen himself preferred to cast health and illness as dispositions, and he was not alone in his choice. Asclepiades considered health to be a balance (symme tri3 a) of corpuscles and pores, and disease its opposite.48 Other dispositional de®nitions revolve around the mixture or balance of the humours, or the hot, the cold, the wet, and the dry, 46 Gal. Therapeutic Method/Meuo3dow uerapeytikh3 (MM) 1. 5 (x. 40 1 K); the rest of this outline is drawn from the following chapters of the same book, and the opening sections of book 2. Medical anthropologists and sociologists today draw a distinction between illness (what the individual experiences) and disease (the way medical professionals interpret and reformulate this experience); Galen implicitly minimizes this di€erence, and there are other indications that lay and professional understandings were closer together in the Roman empire than today. Whatever the precise relationship, however, all the various terms for sickness and disease will be used interchangeably here. 47 `morbus est habitus cuiusque corporis contra naturum, qui usum eius facit deteriorem', Gell. 4. 2. 3, and Dig. 21. 1. 1. 7. 48 Gal. PHP 5. 3. 18 (CMG v. 4. 1. 2. 308. 27 9), and MM 4. 4 (x. 268 K).

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49

either as, or inherent in, the primary bodies. Soranus of Ephesus, the notable methodic physician active under the emperor Trajan, operated in a more shadowy physiological world and identi®ed the diseased disposition with a quality of part of the body.50 For the empirikoi, however, disease was a linguistic rather than somatic disposition. It accorded with both common Greek usage and the exigencies of learning to call a whole aggregate of symptoms which synchronically arose, grew, steadied, declined, and dissolved, a disease or a€ection (as well as by the more technical name of pauognvmonikh3 syndromh3, that is `pathognomonic syndrome'); but this was simply a communicative convenience, the word denoted a collection of symptoms and nothing more.51 What confronted the practising physicians, however, was not disease in itself but individual cases of speci®c ailments, and their initial task was diagnosis, the determination of the identity of the ailment in question. To this end they scrutinized the sick person for signs (shmei9 a) of the disease; that is, phenomena proper to, and de®ning of, the disease itself, as distinct from both the incidental features of instantiation and the physiological idiosyncrasies of the patient. Ill people exempli®ed diseases such as pneumonia (pneymoni3 a in Greek, that is a severe a‚iction of the lungs), phthisis (fui3 siw, dissolu tion or wasting of the body), and melancholia (melagxoli3 a, severe psychical distress); this exempli®cation was a compound of a common core and a variable periphery of particularities.52 Thus Caelius Aurelianus, in his late antique latinization of Soranus' works on acute and chronic diseases, states: Intelligimus lethargum ex obtrusione atque hebetudine sensuum, pressura etiam atque febre acuta sive iugi sive dimissionibus inter 49 See e.g. [Gal.] Def. Med. 129 and 133 (xix. 582 3, 586 K) which also includes a functional de®nition; Gal. PHP 5. 3. 18 (CMG v. 4. 1. 2. 308. 29 34), and [Alex. Aphr.] Quaest. 1. 9. 50 See Rubinstein, `The Riddle of the Methodist Method', 123 39, for a discussion of this and other methodic de®nitions of disease. 51 Gal. Subf. Emp. 6 (56. 12 57. 25 Dgr). 52 The continuity in the names of diseases disguises both the changing conceptualization of disease itself and the shifting contours of individual diseases, sometimes slightly and sometimes radically. So names here are transliterated and explained in the ®rst instance, and also appear in the Glossary.

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capedinata, pulsu magno, tardo, inani et in¯ato. sine his enim neque esse hnequej intelligi lethargus potest. nam quaedam praeterea alia sequentur multa vel pauca secundum passionis magnitudinem vel generalem temporis atque specialem di€erentiam. We recognize lethargus from the blockage and dullness of the senses, stupor, acute fever either continuous or remittent, and a large, slow, hollow, and in¯ated pulse. For without these, lethargus can neither exist nor be recognized. Also, in addition, certain other [symptoms] may follow, many or few depending on the magnitude of the a€ection, or on general and speci®c di€erences of circumstances.53

The pattern of clearly delineating the generalities of each disease is repeated in the other extant pathological treatises of the imperial eraÐthose on acute and chronic diseases by Aretaeus the Cappadocian and the unknown author Anonymus ParisinusÐas well as being encapsulated in the empiricist concept of the pathognomonic syndrome. Since there was a relatively small set of phenomena which quali®ed as signs of illness, diagnosis thus became a process of classi®cation under certain agreed headings, the permutations being arranged in a total nosological taxonomy of manageable proportions. This taxonomy was, in outline, shared property. Even Caelius, whose exposition is most polemically doxographical, rejects the e€orts of Soranus' predecessors to de®ne diseases more on grounds of insuciency and imprecision than complete mis conception. Those outside the sectarian structure are also clearly engaged in curing the same ailments, but to them their recognition seems unproblematic and obvious, presum ably re¯ecting the real consensus underlying much of this ®ner di€erentiation. The meaning of the diagnosis, what might be described as the diagnostic product, varied with the divergent meanings of disease. Agreement on the name of the ailment in question did not imply agreement on how it was understood. For the empirikoi, diagnosis meant the recognition of repetition; all that the name denoted was a collection of symptoms with a remembered history of concurrence. For the logikoi, the signs signi®ed something more than a label for their precedented congregation: they revealed a diseased disposition, and its 53

Cael. Aurel. CP 2. 13 14 (CML vi. 1.1. 138. 9 14).

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causes. Diseases thus acquired a certain depth and materiality as they were integrated into the substance, structure, and processes of the human body. This continuity of pathology and physiology produced divergent results, depending on the di€erent conceptions of human composition and functioning. The form, however, remained constant as the content shifted. Finally, the methodikoi equivocated. There was an epistemolo gically, and therefore diagnostically, stronger framework to which the observed patterns were subordinate, but it was of a limited character, and never took the physician very far from the somatic surface. A diseased disposition was signi®ed, but of a generic and physiologically imprecise nature. The interplay of the common and the particular, the gen erally agreed and the disputed, in the product of diagnosis is easily illustrated. An empiricist de®nition of a disease is simply an enumeration of the symptoms which constitute it. Thus the synchronicity of a cough, fever, dyspnoea, stabbing pain, tension, and a vehement, infrequent pulse forms pleuritis (pleyri9 tiw).54 The methodist adds an additional component to this delineation, the characterization of the underlying diseased disposition as a constricted, ¯uid, or mixed state of the body: Est igitur secundum Soranum pleuritis dolor vehemens interiorum laterius partium cum febris acutis et tussicula, qua variae qualitatis liquor excluditur . . . aliquando sola ex strictura confecta, aliquando admixta solutione ob plurimum tussiculae liquorem. Thus, according to Soranus, pleuritis is a severe pain in the internal lateral parts with acute fever and a cough, in which liquid of various kinds is brought up . . . [it is] sometimes produced solely from stricture, but at other times in combination with ¯ux, hence the large amount of liquid coughed up.55

Though there are some physiological assumptions implicit in this understanding of the diseased disposition, the conception of somatic construction does not become explicitly determinant until the diagnostic formulations of rationalists such as Ascle piades: `Phrenitis' inquit `est corpusculorum statio sive obstrusio in cerebri membranis frequenter sine hconjsensu cum alienatione et febribus.' 54 55

See e.g. Gal. Subf. Emp. 6 (59. 21 60. 2 Dgr). Cael. Aurel. CP 2. 89 90 (CML vi. 1.1. 188. 8 17).

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`Phrenitis', he [Asclepiades] said, `is an impaction or blockage of corpuscles in the cerebral membranes, frequently without any sym pathetic a€ection but with mental alienation and fever.'56

This is an explanatory de®nition, casting the visible signs of the disease as a result of a pathological process. The process is a speci®c form of imbalance (a1symmetri3 a) of the Asclepiadean body. The location of the impactionÐin the meningesÐcauses the mental a‚iction, and within it, blockage of large corpuscles (probably in liquid form) produces fever. Any extrinsic a€ec tions are the result of the repulsion of particles from the congested membranes to other parts of the body. The notion of `sympathy' (sympa3ueia), of which this is a particular mani festation, is also an important one in classical pathology. Diseases are only poorly localized, and even when they are organically anchoredÐas in ileos (i1 leo3w, severe intestinal twist ing) or nephritis (nefri9 tiw, kidney complaints)Ðsomatic disrup tion di€uses outwards from these focal points, transmitted by the movement of bodily ¯uids and pneumata, by the vascular and nervous networks, and by the contiguity and mutual resemblance of various organs. Asclepiades also goes a stage further in his de®nition of phrenitis. For, underneath the diseased disposition, the block age or impaction, are its causesÐin this case, the heating of the cerebral membranes which, according to the principles of Asclepiadean physics, generates disruptive corpuscular move ment in this direction. This is an internal cause, an inferred pathological occurrence, which might, in turn, be linked to an external cause, such as the general pursuance of, or speci®c episodes in, a ¯awed lifestyle (in terms of diet, activity, habits, and environment) as well as events outside this everyday rubric, such as being bitten by a snake or hit over the head with a blunt instrument. Galen illustrates the distinction by a paradigmatic sequence in which overeating is the external cause, humoral plethora the internal cause, leading to an in¯ammation (a diseased disposition) which results in the impairment of various functions, together with some incidental symptoms such as redness and swelling.57 The neatness of this 56

Cael. Aurel. CP 1. 6 (CML vi. 1.1. 24. 17 19); and see also Vallance, 57 Gal. MM 1. 8 (x. 66 7 K). Asclepiades of Bithynia, 93 122.

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schema is, however, rarely replicated and, of course, these are just two examples of internal causation. The variation in internal pathology according to variation in physiology is succinctly illustrated in a passage from the pseudo Galenic Introduction:

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oi2 me4 n mo3noiw toi9 w xymoi9 w tv9n te kata4 fy3sin th4n sy3stasin kai4 tv9n para4 fy3sin th4n ai1 ti3 an a1ne3 uesan, v2w Prajago3raw kai4 ¹Hro3filow . . . oi2 de4 peri4 ¸Auh3naion kai4 ¸Arxige3 nhn mo3nQ tQ9 dih3konti di¸ ay1tv9n pney3mati kai4 ta4 fysika4 synesta3nai te kai4 ta4 nosh3mata pa3nta. Some people attributed both the constitution of things that are in accordance with nature and the causes of things that are contrary to nature to the humours alone, as did Praxagoras and Herophilus . . . But those associated with Athenaeus and Archigenes declare that both the natural [things] and all the diseased [things] are constituted and controlled by the all pervading pneuma alone.58

Asclepiades' singular view has already been referred to, and Erasistratus famously considered all disease to arise from `the transference of blood into the arteries'.59 Medical aetiology was a complex and disputed territory, both as theoretically con ceived and practically applied. Diagnosis is the subordinate activity in the semiotic triad. It was the ®rst step towards the more professionally prestigious prognosis, and the ultimate objective of the art, that is therapy. Prognosis is one of the most distinctive features of the classical medical landscape. The prediction of the course and outcome of illness was a crucial part of the physician's performance, and also enabled the further re®nement of the nosological taxon omy. Now the doctor's gaze was cast more widely, encompass ing a range of phenomena outside the classi®catory core of the disease. This extension of perspective might be restricted to an investigation of the individual example of the illness, or it might also incorporate the individual nature of the sick person. The methodikoi focused on the former, while both empirikoi and logikoi considered both. Caelius Aurelianus explains: Aliarum vero principes sectarum iuxta aetatis di€erentiam gravius aci dicunt iuvenes a ceteris aetatibus, iuxta sexum et naturam . . . 58 [Gal.] Intro. 9 (xiv. 698 9 K); cf. [Soranus], Medical Questions/Quaestiones Medicinales 103 (ii. 259 Anec.). 59 pare3 mptvsiw ei1 w ta4w a1rthri3 aw toy9 ai7 matow, [Gal.] Intro. 13 (xiv. 728 K).

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nos vero dicimus communiter graviter laborare, quos passionis acit magnitudo. illud enim semper in aegritudine magis acithurj, quod a natura plurimum recesserit. Now the leading men of the other sects say that the seriousness of the a‚iction varies according to age, and according to sex and nature . . . However, we say generally it is the magnitude of the disease which a‚icts those who su€er more seriously. For it is always those more greatly a‚icted in their illness who will have departed further from their natural state.60

The magnitude of the disease was indicated by the number, quality, type, and sequence of its intrinsic and extrinsic signs. In this particular caseÐphrenitisÐthe list of these accidental symptoms is almost endless, ranging from speaking to the dead to gnashing of teeth. This prognostic typology was understood and justi®ed rather di€erently by the empirikoi and logikoi. Experience had shown the empiricists that, for example, phrenitis is more dangerous in young people, whereas for the rationalists, such a statement is validated by its explicability. There is something inherent in youthÐits hotter nature, mental vigour, or whateverÐwhich correlates with something inherent in phrenitisÐits fever, e€ect on mental activity, or whateverÐto produce a particular vulnerability. Both combined this with an assessment of the speci®c features exhibited by the sick individual in the course of their a‚iction. The empirikoi called concurrent sets of these features, such as `a sharp nose, hollow eyes, and sunken temples' (a moderate indication well into an illness, but indic ative of imminent death at its outset), prognostic `syndromes', whereas Galen produced a formula through which the actual balance of forces in the sick body could be evaluated.61 All the indications should be collected under two headingsÐthe strength of the disease and the strength of the diseased personÐwhich may then be directly measured against each other. The conclusions are obvious. Prognosis is not simply about predicting the ultimate out come of an illness, and distinguishing the curable from the 60

Cael. Aurel. CP 1. 40 1 (CML vi. 1.1. 44. 15 25). `nasus acutus, oculi concavi, tempora concisa', Gal. Subf. Emp. 6 (60. 7 61. 3 Dgr); Gal. Therapeutics to Glaucon/Pro4w Glay3kvna uerapeytikh3 (MMG) 1. 9 (xi. 31 K). 61

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incurable, but also about elucidating the temporal dimension of disease, of which there are two aspects. First, as has already been alluded to, the sequence and force of pathological events re¯ected the course of the illness, its emergence, ascendence, and decline. Each stage could be mapped and its sequels projected. More importantly, diseases did have a certain chronological substructure. Thus the basic division between acute and chronic diseases is temporal. Acute illness arrives and departs, into death or recovery, swiftly. Chronic illness persists, a concatenation of sharp attacks and intervals of remission which may continue almost inde®nitely. The key concept of krisis (kri3 siw, a word generally meaning distinction or judgement), the moment at which the disease is resolved either way, expresses this pathological periodicity more specif ically.62 A krisis is the occurrence of certain critical symptoms on a critical day; the same phenomena appearing at another time do not contain the same meaning. The symptoms centre around the segregation of harmful matter from the body and the days are calculated numerically, according to the disease and the particular system being operated. The typology of fevers illustrates both the general and speci®c chronological considerations. In an elaboration of the acute/chronic dichot omy, fevers may be continuous, intermittent, or remittent, and their critical days fall in a three day cycle (counting inclusively) in tertian fevers, four day in quartans, and various other permutations and combinations, except for the dangerously irregular hectic fever. The notion of the krisis and critical days provided not only a prognostic focus, but was also the closest classical medicine came to the formulation of speci®cally pathological laws. Therapeutics The other essential medical activity for which diagnosis pro vided the point of departure was therapy. In many ways it is this that is at stake in the di€erent conceptions of the diagnostic product. On what basis does the physician prescribe treatment: 62 Asclepiades denied the existence of critical days (Cael. Aurel. CP 1. 108 9: CML vi. 1.1. 82. 23 5) but this was remarkable, and he accepted the more general periodicity of disease.

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from symptoms, syndromes, diseased disposition, or causes? Here the lines of division drawn across classical medicine crystallize most clearly. For the methodists, external causes were a therapeutic irrelevance; the remedy was essentially taken from, and directed at, the diseased quality of the body.63 Their irrelevance results from an uncertain relation ship to the illness. External causes are neither the same as the disease, nor even predictive of it, since each a€ection has a range of causes, of a largely generic though disputed character, but does not inevitably follow any of them.64 The diseased disposition, however, may be securely grasped and is the problem that needs to be solved for normal healthy functioning to be restored. Empiricists remain uninvolved in the somatic interior, but do give credence to external causes, in a semiotic rather than aetiological sense. Certain observed events preced ing illness, such as drunkenness or exposure to a cold atmo sphere, are part of the pattern of that ailment, which experience has shown is best met by a particular therapeutic pattern.65 For rationalists pathology and aetiology are completely inter twined. Treatment is indicated by, and arrayed against, the internal causes, the unnatural changes in the fundamental state of the body.66 These are inferred from the outside, on the basis of both the past and present signs. The key here is under standing. The recurrent correlations of the empiricists are woven into an explanatory narrative and thus epistemologically secured. The mode of communication between the therapeu tically loaded segment of the pathological pathway or pattern and the physician is similarly divergently constructed. For the empirikoi it was the associative action of the memory, as the recognition of repetition in symptoms and situation led to 63 See e.g. Sor. Gyn. 1. 4. 2 (CMG iv. 5. 10 16); Cael. Aurel. CP 2. 65 (CML vi. 1.1. 170. 13 23). Internal causes (broadly construed) do seem to have played a role in Soranus' pathology: see Rubinstein, `The Riddle of the Methodist Method', 123 39. 64 See e.g. Cael. Aurel. CP 1. 22 3, 2. 64 (CML vi. 1.1. 34. 10 18, 168. 33 170. 11). 65 Gal. On Medical Experience/Fõ l-tajriba l-tibbiya (Med. Exp.) 6 (91 Walzer); but compare CC 10. 4 5 (CMG Supp.Ç Or. ii. 70. 19 72. 2 and 141. 12 25). 66 See e.g. Cels. Med. pr. 13 26 (CML i. 19. 11 21. 32); Gal. On the Sects for Beginners/Peri4 ai2 re3 sevn toi9 w ei1 sagome3 noiw (SI) 3 4 (SM iii. 4. 18 9. 3).

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remedial repetition. The condition announced its own cure to the methodikoi, the link between the two being inherent and obvious in the same way as the link between thirst and drinking, or hunger and eating; whereas the logikoi exercised their reason, and thought about what needed to happen in the sick body for it to be healed and how best to bring it about through intentional intervention. Despite these divergent lines of approach, as Galen repeat edly comments, rationalists and empiricists arrive at the same therapeutic conclusions, and the methodists also follow suit.67 The therapeutic arsenal at the disposal of all these physicians was a collective holding; and so also were both the way it was understood, irrespective of the explicit articulation, implicit agreement, or active avowal of any such interpretative activity, and its practical deployment. This arsenal contained three departmentsÐregimen, pharmacology, and surgeryÐand though not all practitioners used all of them equally, writers in the sectarian traditions certainly felt they had to cover the entire range. Those outside it tend to cluster around the pharmacological. Regimen (di3 aita) classically comprised prescriptions con cerning `exertion, food, drink, sleep, and sexual activity', though it had broadened out further by the Roman period.68 Programmes of exercise, of massage and bathing, and the regulation of diet all came under this heading, together with a whole host of other measures. Pharmacology involved phar maka (fa3rmaka, that is medicaments) composed from a wide range of materialsÐanimal, vegetable, and mineralÐand which were applied either internally or externally in a variety of ways. Its ecacy depended on the continuity between humans and their environment, either in an explicit, material, sense, or a more implicit, associative, one. Plants, animals, and minerals could be qualitatively characterized, as hot or cold, wet or dry, and many other things, and could e€ect human beings as such; and since the cosmos was saturated not just with these qualities but also with sense and meaning, rendered manageable and coherent by patterns of resemblance and sets of associations, 67

See e.g. Gal. SI 4 (SM iii. 7. 16 18). po3noi, siti3 a, pota4, y7pnow, a1frodi3 sia, Hp. Epidemics/¸Epidhmiai3 (Epid.) 6. 6. 2 (v. 324 L). 68

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these too could be brought into a medically e€ective relation ship with a human being. Surgery involved both division (diai3 resiw) or separation and composition (sy3nuesiw).69 The quintessential remedy of classical medicineÐvenesectionÐ came under the former rubric (if it was con®ned to surgery at all) as did such procedures as the excision of abscesses or amputation, while the repair of fractures, stitching of wounds, and restoration of organic order were placed under the latter. Pharmacology and surgery were both techniques of inter vention, with the patient being just that, and they were directed speci®cally and instantaneously against the disease, or at a speci®c bodily aspect; regimen was interactive, requiring the patient to behave as the physician instructed, and directed more di€usely towards health. Indeed, health can in a sense be de®ned in terms of these compartments of human activity and, therefore, their regulation is a constant concern. Regimens may be prescribed and pursued therapeutically, prophylactically, or positively, and their elements and modes of operation were identical throughout. Foucault takes this contrast a step further. Regimen was interactive not so much between physi cian and individual, but between self and body: `Diet was not thought of as an unquestioning obedience to the authority of another; it was intended to be a deliberate practice on the part of an individual, involving himself and his body.'70 This autonomous practice was `a whole art of living' and therefore only derivatively therapeutic.71 Dietetics thus constituted the corporeal component of self mastery. The guiding principle of treatment, theoretically elaborated by the logikoi but simply enacted in practice by the empirikoi, methodikoi, and beyond, was that of reversing the pathological process to return the body to its kata physin state. `Contraries are the cures of their contraries', as Galen frequently states.72 A plethora required evacuation, a dyskrasia (dyskrasi3 a, that is a wrong or ¯awed mixing) of heat demanded cooling, somatic stricture must be relaxed, and so on. It is through this 69 70 71 72

This distinction is described in detail at [Gal.] Intro. 19 (xiv. 780 91 K). Foucault, The Use of Pleasure, 107. Ibid. 101. ta4 d'e1 nanti3 a tv9n e1 nanti3 vn [e1 sti4 n] i1 a3mata, e.g. Gal. SI 3 (SM iii. 6. 9 10).

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consensus, together with a degree of convergence on the characteristics of diseases and the properties of the particular curative components, that a certain therapeutic uniformity was maintained. Considerable variation was, of course, possible in the precise methods of achieving the agreed ends. Evacuation might, for instance, be obtained by exercise, bathing, phlebot omy, cupping, and a range of purging pharmaka. Selection between them depended on availability, the exact understand ing of the diseaseÐboth in itself and as it was instantiated in each particular caseÐthe doctor's preference, and the patient's circumstances. The order of treatment was also crucial. The therapeutic programme recommended by Anonymus Parisinus in cases of lethargos, for instance, begins with bleed ing, if the patient can bear it and the necessary conditions are met; if not, evacuation is to be achieved by a clyster.73 Initial embrocations should be of vinegary rose oil, changing, after the fever declines, to castor ones. A whole range of phlegm purging measures, including drugs, cupping, and leeching, may be e€ective and should be applied to di€erent parts of the body as the disease causing matter moves around in the course of the illness; and various forms of stimulationÐodoriferous, manual, and sternutatoryÐmay also be required. Then, as the symp toms begin to subside, shaving, `passive exercise' (ai1 v3ra: classically, being rocked in a hammock but also, for instance, being carried in a litter or something similar), and baths become appropriate. It was in the area of the interaction between disease and diseased person that there was real divergence in, rather than mere modulation of, therapeutic perspective between the sectarian groupings. The methodikoi kept the two separate and further divided the disease itself into its generalities and speci®cities. Thus there are three distinct elements in the enormously detailed prescriptions recorded by Caelius Aure lianus: the curative core is directed against the underlying a€ection (stricture, ¯ux, or a mixture), around that are mea sures directed against its concomitant symptoms, and alongside both are the e€orts to sustain or build up the strength and vitality of the patient. None of this would be altered according 73

Anon. Paris. 2. 3. 1 10 (12. 17 18. 7 Garofalo).

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to the sex, constitutional idiosyncrasies, or geographical loca tion of the person concerned. For the logikoi and empirikoi, however, such matters were of considerable importance, on the basis of understanding and experience respectively; and they saw the disease and diseased person in a much closer relation ship, combining together to constitute the case to be cured.

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Gynaecology Though considerations of sexual di€erence run through these various parts of medicina, to varying degrees and with some dispute, they are never, at least in any surviving discussion, brought together to form their own part. There is no such thing as `gynaecology' within these formal divisions of the art, though Galen does refer to paediatrics and geriatricsÐthat is to parts of medicine based on particular categories of humanity, either children or the elderlyÐin this context, and specialist `women's doctors' are reported as practising at Rome.74 There certainly were, however, medical texts devoted to women. The extant Hippocratic corpus contains a set of closely related gynaecological works variously entitled Diseases of Women (Gynaikei3 ai noy3soi), On the Nature of Woman (Peri4 gynaikei3 hw fy3siow), On Sterile Women (Peri4 a1fo3rvn), and On Superfoeta tion (Peri4 e1 pikyh3siow), as well as one On the Diseases of Young Girls (Peri4 parueni3 vn), together with a number of more general treatises on reproduction and birth, such as On Generation/On the Nature of the Child (Peri4 gonh9w/Peri4 fy3siow paidi3 oy), and On the Excision of the Foetus (Peri4 e1 gkatatomh9w e1 mbry3oy).75 Diocles 74 Gal. Part. Art. Med. 1. 3 and 5. 6 8 (CMG Supp. Or. ii. 24. 9 11, 36. 23 38. 9); Sor. Gyn. 3. 3. 1 (CMG iv. 95. 7 8). 75 Titles of Hippocratic treatises, as well as their organization and interrelationships, are all somewhat unsettled. Nature of Woman seems to be a further redaction of parts of Diseases of Women 1 and 2, Superfoetation appears to reuse bits of On Sterile Women, which itself should probably be thought of as Diseases of Women 3. On Generation and On the Nature of the Child are parts of the same original text, perhaps also with Diseases 4. For detailed discussion see Hermann Grensemann, Hippokratische GynaÈkologie: Die gynaÈkologischen Texte des Autors C nach den pseudoHippokratischen Schriften de Mulieribus I, II und de Sterilibus (Wiesbaden: Steiner Verlag, 1982), together with the comments of Ann Ellis Hanson (who is preparing an edition of Diseases of Women) in `Continuity and change: three case studies in Hippocratic gynecological therapy and theory', in Pomeroy (ed.), Women's History, 73

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of Carystus, the notable physician of the fourth century bc, wrote a treatise called simply Gynaecology (Gynaikei3 a) as did Cleophantus, the brother of Erasistratus; while Herophilus preferred to operate under the remit of the Maiotikon (Maiv tiko3n, that is things pertaining to the maia, or `midwifery').76 Around the beginning of the imperial era the Herophilean Alexander Philalethes added another Gynaecology to the col lection, and a little over a century later Soranus followed suit with the only such text still surviving.77 Philumenus, a second or third century ad physician linked with the pneu matikoi, seems to have authored the last Greek Gynaecology as such, though various Latin texts, including translations of Soranus, succeed him, and writing about women does not cease in the eastern half of the empire either.78 The more philosophically minded of these iatroi could also engage with the disquisitions on sexual di€erence and reproduction in Plato's Timaeus and, more especially, Aristotle's Generation of Animals, not to mention numerous other treatments of the subject. Prior to the period and texts examined here it is therefore only the Hippocratic woman who still emerges with any clarity from this range of medical writing, accompanied in the philo sophical ®eld by Aristotle's woman. It is worth brie¯y sketch ing out these female ®gures as background to the later material. It should be emphasized, however, both that constructing a uni®ed view of woman from the great diversity of the Hippo cratic corpus is an undertaking fraught with diculties and dangersÐthough many scholars have seen enough agreement within this body of texts to take up the challenge with gustoÐ and that a great deal happens in the gynaecological domain between the fourth century bc and the beginnings of the 110, and `Fragmentation and the medical writers', in Glenn Most (ed.), Collecting Fragments (Aporemata, 1; GoÈttingen: Vandenhoeck and Rupprecht, 1996), 289 314. 76 All of these are mentioned in Sor. Gyn. 3. 2. 1, 3. 29. 3, 4. 1. 2, and 4. 36. 9: Diocles; 4. 1. 3: Cleophantus; 3. 3. 4 and 4. 1. 4: Herophilus (CMG iv. 94. 19 20, 112. 18, 129. 11, 149. 17 18; 129. 20; 95. 17 and 130. 9 10). 77 Sor. Gyn. 3. 43. 1: Alexander (CMG iv. 122. 3 4). 78 Scholion on Orib. Coll. Med. lib. inc. 13 (CMG vi. 2. 2. 100. 16) and see further discussion in Ch. 4. For the further history of classical gynaecology see Monica Green, `Transmission'.

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Roman imperial era which is now unfortunately lost.79 In particular, the anatomical work of Herophilus is enormously in¯uential, and becomes a canonical point of reference for successive generations of physicians unable or unwilling to repeat his investigations on human subjects. Some e€ort will therefore be made to indicate the directions in which things were moving in the Hellenistic era; for it creates a false impression to compare, for instance, Soranus and the Hippo cratics directly and in isolation, without consideration of the intervening years. The medical writers of the Roman empire none the less considered themselves part of a tradition that extended back to Hippocrates and beyond. They were perma nently engaged with the past in a range of ways, and so it makes sense to map out some of its most salient features. The Hippocratic author of Diseases of Women presents his treatise as a necessary corrective to physicians who, sometimes fatally, overlook sexual di€erentiation in illness. For, he says, `The healing of the diseases of women di€ers greatly from the healing of men's diseases', and he elaborates, in the course of the work, a distinct (if somewhat sketchy) female pathology and physiology to support this claim.80 The view he attacks is articulated, or just assumed, in some other Hippocratic texts, but so are his understandings of the particularities of the female body, its functioning and malfunctioning.81 This Hippocratic woman diverges from her male counterpart primarily in the texture of her ¯esh, which is loose and spongy and thus possesses a particular anity for moisture. Her propensity to collect ¯uid requires that women menstruate in order to evacuate the surplus continually accumulated, or, even better, this surplus should go ®rst to nourish a foetus in the womb and then, after the birth, to feed a baby with milk. If menstruation does not occur then a dangerous excess of liquid will build up 79 For example, as most heavily relied upon here, Manuli, `Donne mascoline'; Hanson, `The medical writer's woman'; King, Hippocrates' Woman; and Dean-Jones, Women's Bodies; these, though di€ering in detail and emphasis broadly agree on the points covered here. There are, however, some rather di€erent interpretations of Hippocratic writings on women to be found. 80 diafe3 rei ga4r h2 i5 hsiw pollQ9 tv9n gynaikhi3 vn noshma3tvn kai4 tv9n a1ndrv9n, Diseases of Women (Mul.) 1. 62 (viii. 126 L). 81 For the contrary view that men and women should be treated alike see e.g. On the Eight Month Child/Peri4 o1ktamh3noy 9 (vii. 446 52 L).

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in the woman's body, causing a range of diseases and even death. This eventuality might be met by a range of measures to provoke menstruation, or other forms of evacuation, from alterations in diet through vapour baths and fumigations to pessaries and fomentations. Pregnancy also solves the problem of excess, and should restore menstrual regularity thereafter too, hence the repeated therapeutic advice that women should sleep with their husbands, for `if she becomes pregnant she is healthy'.82 Intercourse with a man is also an activity that helps maintain the reproductive parts in good order, keeping the paths by which the menstrual blood leaves and male seed enters clear, and keeping the womb wet enough to prevent it from moving elsewhere in the body in search of moisture. Such a `wandering womb' may have very serious e€ects, in particular it may lead to choking and su€ocation as the activities of other organs are interfered with. It is treated with `odour therapies' in which the womb is returned to its proper position through being attracted by pleasant smells and repelled by fetid ones. Thus, for the Hippocratics, woman's health depends on her reproductive activity; ful®lling her social role makes her healthy. Linked with moisture, with ¯uid excess, the Hippocratic woman is certainly wetter than the man, and she may be similarly colder too; but since blood is hot, and her liquid surfeit is essentially sanguineous, she may alternatively be understood as hotter.83 For Aristotle, on the other hand, it is the female lack of heat which is critical, not the texture of her ¯esh and resultant excesses of her ¯uid economy; and he reaches this conclusion by di€erent means than those adopted by Hippocratic authors. For Aristotle writes not as a practising physician but as a philosopher building a system. He is interested in sexual di€erentiation as a rather more cosmic than therapeutic problem. It is something in the way the world is organized that requires description and explanation as part of a complete programme of understanding, rather than a practical issue. The relations of male and female, what 82

kh6n e1 n gastri4 i5 sxh, y2gih4w gi3 netai, Mul. 2. 119, cf. e.g. Mul. 2. 121 (viii. 260, 264 L). 83 See Mul. 1. 1 (viii. 12 L); and e.g. Arist. PA 648a28 30 and GA 765b where this view is attributed to Parmenides and others.

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distinguishes and de®nes them, never become the centre of Aristotle's attention, being primarily subordinated to an exam ination of the phenomenon of generation among living things, but his treatment is still more systematic than that of any Hippocratic writer in several ways. Aristotle's progression from generation to women's lack of heat is an aetiological one, since he holds that it is through understanding the causes of something, all the reasons why it is what it is, that knowledge itself is attained.84 Thus Generation of Animals opens with an outline of his four causes (ai5 tia): the telos (te3 low, that is the goal or end of a thing), that on account of which it is formed; its essential logos (lo3gow, its reason or form), what it is; its hyle (y7lh, its matter), that out of which something is formed; and its moving arche (its ®rst principle or origin), that by which it is formed.85 This is swiftly followed by the assertion that it is the male and female that are the archai of generation; the male being the moving and forming principle, the animal that generates in another, and the female being the material principle which is moved and formed, the animal that generates in itself. Later it turns out that while male and female thus count as causes of generation, they are also caused by it; brought into being so that mortal creatures may none the less attain a certain continuity of species, if not number. They are the motive and material contributions to this higher end. And, just as continuity of species is better than discontinuity, being better than not being, so also it is better that the archai of male and female are separate in their existence: hence the distinct male and female animals among the higher life forms, such as human beings. For the active male that provides the logos in generation is superior to the passive female who supplies only the hyle, and it is always better that superior things are separate from their inferiors. It is in the course of this separate embodiment of the male and female archai that the two sexes end up with certain particular and di€erent bodily parts to serve their di€erent reproductive roles, and make di€erent Arist. Phys. 194b17 23. These are what have become known as his `®nal', `formal', `material', and `ecient' or `motive' causes respectively; translating the terms involved is somewhat problematic, and Aristotle himself is not entirely consistent in his formulations or usage. 84 85

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concrete contributions to the process of reproduction itself. In the human case this latter distinction consists in the female failure to produce generative seed. She is marked by a critical inability, an inability to complete the concoction of nourish ment to form seed, leaving her with menstrual ¯uid, nourish ment moved not much beyond blood, and which contributes only matter, not any kind of formative principle, to any o€ spring. Moreover, since concoction is driven by heat, this female failure shows that she is colder than the male, further underlining her inferiority since being hotter is better than being colder. So, while Aristotle draws on some of the same conceptual resources as the Hippocratics, his project produces a woman distinguished primarily at a functional rather than physiologi cal or pathological level; and who thus cannot be separated from her male counterpart, the other, dominant, half of the reproductive pair. Aristotle's woman is a `deformed male' (a5rren pephrvme3 non), de®ned by an inability that contrasts with a crucial male ability, by her material rather than for mative role in generation, a role which requires a certain somatic con®guration, all of this resting on her lack of innate heat, and all being manifestations of her inferiority.86 It is not so much that the female is inferior as that the inferior is female; that is simply the way Aristotle sets his system. It has thus been argued that, though the predominant Hippocratic view is that both men and women produce procreative seed and contribute equally to their o€spring, thus establishing a reproductive equivalence between male and female absent from Aristotle's schema, it is actually the latter who brings the sexes together most consistently.87 For, while the Hippocratic notions of generation are moments of convergence between two radically distinct sexes, possessed of di€erent textured ¯esh and di€er ent ¯uid economies, Aristotle constantly measures the female against the male, ranks them on a single scale of ability, heat, and so forth. Indeed, Laqueur holds Aristotle up as the most austere ancient exponent of what he calls the `one sex model', in which: 86 87

Arist. GA 737a28. See e.g. Dean-Jones, Women's Bodies, 225 6.

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At least two genders correspond to but one sex, where the boundaries between male and female are of degree and not of kind, and where the reproductive organs are but one sign among many of the body's place in a cosmic and cultural order that transcends biology.88

Laqueur thus sees Aristotle as exemplifying a world in which a single human body exists in male and female versions, separated only by possessing more or less, o€ering better or worse renditions, of the same. Moreover, it is because the male is the ecient and the female the material cause of reproduc tion that their bodies are di€erentiated to the limited extent they are, rather than having divergent reproductive roles because they have distinct physical forms. To Laqueur's mind, therefore, gender, in the form of Aristotelian aetiology, here determines the somatic order; culture bears down on the body rather than the reverse. As has already been discussed, this latter interpretative move is most distinctively Laqueur's own; in other respects, however, his readings remain closer to those of classical scholars working with the same texts. There is, none the less, a di€erence between the increasing assimila tion of the medical woman to the male paradigm traced by, for instance, Ann Ellis Hanson or Lesley Dean Jones from the radical sexual distinctions of the Hippocratic gynaecology through Aristotle and Hellenistic Alexandria into the Roman imperial eraÐa progression in which Hippocratic notions none the less continue to feature in various waysÐand Laqueur's account of a `one sex model' that dominates ancient medical and philosophical discourse from ®rst to last, leaving no space for historical development or dissonant voices.89 All stress the convergence of male and female, the absence or erosion of di€erence or `otherness', but they con®gure and construe it di€erently, within di€erent larger narratives. Not only is there the question of whether this one sex/male model has a begin ning, whether something else precedes it, but also, and inter 88

Laqueur, Making Sex, 25, 28. See esp. Ann Ellis Hanson, `The restructuring of female physiology at  coles meÂdicales aÁ Rome', in Philippe Mudry and Jackie Pigeaud (eds.), Les E Rome: Actes du 2eÁme colloque international sur les textes meÂdicaux latins antiques, Lausanne, septembre 1986 (Geneva: Droz, 1991), 255 68; DeanJones, `The cultural construct of the female body', in Pomeroy (ed.), Women's History, 111 37; and the remarks of King, Hippocrates' Woman, 8 11. 89

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relatedly, what kind of `dominance' it attains or possesses, how homogeneous the ancient world really was in this respect? It is in this latter area, furthermore, in the uniformity he imposes on his sources and periods, that Laqueur has been perhaps most consistently criticized by historians of pre modern societies. Joan Cadden prefers to speak of the medical discourse about sexual di€erence in the Middle Ages as characterized by `diversity, eclecticism, and alternatives', for instance, and Katharine Park talks of `complexities, confusions and contro versies', in the early modern medical tradition, of `hybrids' and `contradictions'.90 Certainly, if the story of the historical creation of this one sex model of humanity were to be told, then Herophilus would have as large a role to play as Aristotle (and an even larger one in its propagation), and could also be used to show up its incompleteness and complications. His decision to name the seminal vessels he discovered in his dissections of women after those of men, thus establishing that both females and males have didymoi (di3 dymoi, literally `twins', but here `testicles') represents a crucial anatomical episode within this tale.91 It should also be noted, however, that this move seems to have been accompanied by a location of the most critical stages of seminal manufacture in associated structures that the female lacked, and a denial that women's seed contributed to her o€spring. Moreover, the insistence on the production of female seed as such, ine€ective as it is, also returns the menstrual ¯uid to its pre Aristotelian, Hippocratic, position of having no analogue within the male body, of being quint essentially female, and it is perhaps to minimize this disparity that Herophilus held that menstruation may be as harmful to some women's health as it is bene®cial to others'. For this implies that, rather than all being creatures of such inevitable excess as automatically to require regular purgation, some 90 Cadden, Sex Di€erences, 4 and 3; Katharine Park, `The rediscovery of the clitoris: French medicine and the tribade, 1570 1620', in David Hillman and Carla Mazzio (eds.), The Body in Parts: Fantasies of Corporeality in Early Modern Europe (New York: Routledge, 1997), 174 5, and see also, Park and Nye, `Destiny is anatomy', 54. 91 See for this and the following points, von Staden, Herophilus, 165 9, 211 20, 296 301, 365 74.

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women do in fact have a somatic economy so like men's that they do not need to menstruate, and may become ill if they do since they are presumably then getting rid of essential rather than surplus ¯uid. That is, Herophilus seems to bring men struation within the scope of broader bodily regulation, as engaged in by both women and men, if not entirely equally or symmetrically. No longer essential for female well being, menstruation none the less appears to remain necessary for reproduction, and so Herophilus breaks with the Hippocratic con¯ation of the two. This new possibility of women not menstruating but being healthy further ties in with the one area in which Herophilus is explicitly reported to have brought women closer to men. For he, together with Erasistratus, Asclepiades, and most, but not all, of their followers, asserted, contrary to the Hippocratic author of Diseases of Women, Diocles of Carystus, and others after him, that there are no peculiarly female diseases or therapies.92 Bodies are uniformly composed and controlled (however that was imagined), thus preventing the possibility of real di€erentiation in the causa tion, course, and cure of illness, including (at least implicitly) as any of these might involve menstruation or its cessation. These subjects remained controversial, however, both in terms of the conclusions reached and the methods of reaching them. While the majority of the logikoi appear to have agreed that there were no diseases special to women, and most empirikoi seem to have held the opposite view, there were some dissenting voices and rather more discord about why this should be the case. Erasistratus and most Erasistrateans, Asclepiades and most of his followers, for instance, argued according to their own, divergent, notions of the composition and workings of the body, not Herophilus'; while some methodikoi rejected the validity of this kind of reasoning altogether. They doubted that there was any connection between physiology, on the one hand, and pathology and therapeutics on the other. Woman is thus caught up in a whole host of ongoing disputes in the ¯uid and changeable conceptual world of Roman medicine. 92

Sor. Gyn. 3. 4 (CMG iv. 96. 3 20).

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MEDICINA WHOLE AGAIN It is these continuing medical debates about woman, her ideative form and content, her speci®c and shared features, that will be analysed in detail in the rest of this study, bearing in mind also the continuing debates in the secondary literature. For now it is sucient to note these various dynamics and tensions, discussions and trends, and to return to the wider picture of medicina (or iatrike) as a whole, within which the object of all this enquiry is situated. Indeed, the lack of a proper gynaecological part of medicine serves to underline the importance of this position; for it is, therefore, within the whole medical art, across all its parts and particular versions, that the medical woman is constituted. The question of how she ®ts into that wholeÐof how, when addressing itself to the goal of human health, medicina addresses itself to the division of humanity into men and womenÐis thus clearly posed. Not that there is any doubt about the basic mode of address, or where the burden of that division lies. Humanity's unity breaks down around women, not men, as the emergence of Hippo cratic gynaecology indicates. It is the female who thus di€ers from the male rather than the reverse, and no one was to disagree about that for a long, long time. This assumption is one of many shared by the whole medical community, part of the common holding that underlies, or frames, the more prominent disputes and controversies which characterize classical medicine. Most importantly, all agreed on the teleological formation of the medical art, thus providing an implicit unity that was not disrupted by the many disagree ments about the appropriate means to that end. Not only the various medical sects and schools, but also many less elaborate and self conscious versions of medicina could therefore be contained within this unity. None the less, what is distinctive about the particular compound of consensus and contention that marks the conceptual world of classical medicine is that, in contrast to current scienti®c norms, it is the contention that is emphasized, made explicit, its extent and depth exaggerated rather than diminished, while the consensus is left largely implicit, unspoken, and underplayed. Even if this is to reverse

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the real relations between the two, the sense in which open disagreement and polemic depends, in many ways, on tacit agreement and shared presuppositions, it is still a signi®cant feature of the Roman situation; one which undoubtedly made its own particular contributions to the wider construction and character of medical authority in antiquity, and has thus to be taken into account in thinking about women in this context. The coexistence of so many competing versions of the medical art, so many alternative medical theories, must have had numerous e€ects on the persuasive ability of all of them, in both qualitative and quantitative senses. Not, of course, that multiplicity and competition were otherwise unfamiliar to the inhabitants of the Roman world, quite the reverse; medicine would not have looked much di€erent from other disciplines, other areas of activity, in this respect. From the perspective of the present, however, it should have stood out, it should have been a less pluralistic formation than say politics, ethics, or even something like music. It should have been less a matter of personal preference or judgement, and more a matter of the operation of `objective' and `neutral' criteria. The rami®cations of classical medicine's failure in this regard, indeed the sense in which classical ideas in the arena of constitutional politics might lay claim to broader consensus and fewer challenges than ideas about the constitution of the human body, are perhaps now hard to comprehend fully, given the distance that has been travelled from this point. There is, however, an obligation at least to tryÐto try and think seriously about a world in which medical knowledge, in both its form and content, was fundamentally disputed, and always involved a range of alternatives, of competing individuals and systems; and to consider what it thus meant to produce and propagate, to encounter and assimilate, medical knowledge about women in such a world.

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PART II

Before Galen

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Part II: Introduction This second part examines woman as she is constructed in a set of medical texts roughly spanning the period between the inauguration of the Augustan political system and the inaugu ration of the Galenic medical system. It continues also to keep the wider context of these writings in view: the social and intellectual factors which may have shaped them, and the impact they may have had on those who lived with them, both male and female. This set of texts, though only a fraction of a much greater original whole, is large and diverse, requiring careful arrangement to make it analytically tractable. A series of organizational principles have thus been employed, exploit ing the internal distinctions, structures, and patterns within this body of material that most easily and usefully lend themselves to a clear and thorough exposition of the subject under investigation here. This is, therefore, only one way of ordering this rich and varied literary collection, inevitably obscuring some of its divisions and aliations while high lighting others. The ®rst organizational device is to separate the texts that are located within the sectarian tradition of Hellenistic iatrike from those outside it, and to use the tripartite division between the empirikoi, logikoi, and methodikoi to arrange the material for which it is thus apposite. The identi®cation of the tradition within which a text stands is not unproblematic, since no extant work gives its own position a proper name. Most, however, make their location reasonably clear by means of the authorities they cite, both positively and negatively, by the de®nite lines of aliation and repudiation they draw for themselves, and by the type of knowledge they present and itsÐimplicit or explicitÐ constitutive principles. This internal situation can occasionally also be correlated with some external labelling. The vast majority of surviving texts are then found to place themselves either loosely in the rationalist tradition or in traditions out side, but neither unrelated to nor una€ected by, the sectarian structure.

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The second step is to order these parts, and it is the non sectarian that here takes precedence. This is partly for chrono logical reasons, since, despite there being some overlap and considerable uncertainty, the centre of temporal gravity for the texts within the sectarian framework lies in the mid second century ad, and that of those outside it, almost one hundred years earlier. It is also due to the presence of Latin texts in the latter category, texts which stand at various points of intersec tion between the Greek and Roman medical traditions, and more or less explicitly articulate their stance, thus providing a certain cultural orientation for the rest of the material. Thirdly, though the infrastructural patterns of each chapter are dictated by those of the works which they cover, there is a continuous attempt to align them, both with each other and with the whole discursive formation of medicina as it has been outlined.

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3 The Medical Woman between Folk Tradition and Philosophy I t is a varied assortment of texts which come under scrutiny in this chapter; none the less, the features they share make their juxtaposition productive. The literary works of members of the Roman aristocracy rub shoulders with those of Greek freed men, favoured court physicians, and an ex soldier, as well as those claiming to be written by kings or dictated by gods. Each was composed at a particular point within a wider pattern of complex cultural interactions. None the less, almost all these texts were written primarily for the same audience, the edu cated eÂlite of the Roman empire as it was concentrated in its capital, though some of their authors do so from inside that eÂlite and others from a more or less distant outside. All were also attempting to organize and present forms of medical knowledge, drawing for the main part on the traditions of Hellenistic iatrike again, either from somewhere within those traditions themselves, or somewhere outside them. Woman is caught up in this exchange, is part of these projects, in a number of di€erent ways. TEXTS, AUTHORS, AND WOMEN The text with the broadest medical scope in this assortment is that of A. Cornelius Celsus, written most probably during the reign of Tiberius.1 Originally part of a much larger work entitled simply, The Arts (Artes), the eight books On Medicine were intended to provide a synthetic account of all that men of the Roman eÂlite should know about the medical art, alongside 1 For a general introduction to author and text, with further bibliography, see e.g. Guy Serbat's introduction to vol. i of the Bude edition of Celsus (Paris: Les Belles Lettres, 1995), pp. viii lxxv.

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similar accounts of agriculture, rhetoric, and other bodies of technical knowledge. Celsus is following an established Roman encyclopedic model, most closely that of Varro whose nine book The Disciplines (Disciplinae) preceded Celsus' Artes by about half a century, and also encompassed medicina and architecture together with the more customary components of a Roman gentleman's cultural formation.2 Celsus, however, diverged from Varro on at least one important point, namely in his attitude to Greek ideas and practices. Unlike his predeces sor, Celsus made no polemical attempt to de®ne himself against Greek intellectualism and its products, but rather used this existing structure and substance to shape his own, individual, version of medicina, the romanitas of which was largely implicit. He refashioned parts of the Hellenistic tradition in a recogniz ably Roman idiom, and was able to do so because of the space opened up by the development of the concept of the ars itself and its place in eÂlite culture. Celsus' position is initially set out in the prooemium to On Medicine. He outlines a history of the medical art from its rude Asclepian beginnings to the complexities of the present day, a history which he readily admits has been essentially Greek, though this is because it was in Greece that indolence and luxury ®rst began to wreak havoc upon human health (with Rome not far behind); and it is in relation to this Greek history, or at least its most recent phase, that he locates himself. This most recent phase is that of the sects, and Celsus presents his interpretation of the views of the empirici, those who profess a `rational medicine' (rationalis medicina), and those who follow the method (methodos), in order that he may steer a sensible middle course between them, and elaborate his own perspect ive as an independent seeker after truth.3 He reclaims reason from the rationalists, basing it solely on manifest causes and forcing it into an awareness of its own inevitable fallibility, to establish a medical art which is both `rational' and `conjectural' 2

See H. Dahlmann, `M. Terentius Varro', RE Supp. vi (1935), 1255 69. Cels. Med. pr. 45 (CML i. 24. 24 30). And see Heinrich von Staden, `Media quodammodo diversas inter sententias: Celsus, the ``rationalists'', and Erasistratus', in Guy Sabbah and Philippe Mudry (eds.), La MeÂdecine de  tienne: PublicaCelse: Aspects historiques, scienti®ques et litteÂraires (Saint-E  tienne, 1994), 77 101, as well as his `Author tions de l'Universite de Saint-E and authority'. 3

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(coniecturalis), and to which experience, knowledge of the general and particular, and considerations of hidden causes must be added by the `artist' (artifex) for its good practice.4 Applying these principles, Celsus proceeds to provide pre scriptions for the preservation of health, as well as an ordered description of types of diseases, and their treatment by regi men, pharmacology, and surgery; all of which imply a certain understanding of the way the body works and interacts with its environment that is never really made explicit, at least not systematically. He draws on Hippocratic and rationalist models in this respect, but in a partial way, subordinated to practical therapeutic needs. He operates, therefore, not within the framework of any one sect, but within the framework of medicina as it was constructed and contested by all the sects, and within the wider frame of Roman culture. A text with a rather di€erent range and attitude, but produced for similar purposes from a similar social position is the Natural History of Pliny the Elder. Pliny was an eques whose career combined the customary military and adminis trative services, ending when, while commander of the ¯eet at Misenum, he got rather too close to the eruption of Vesuvius in ad 79.5 The Natural History had been dedicated to the emperor Vespasian's son and heir, Titus, about a year pre viously, and before that Pliny had written a number of technical treatises, on grammar, oratory, and javelin throwing from horseback, a biography of his patron, Pomponius Secun dus, and both speci®c and general historical works, all now lost.6 The subject of the Natural History is, as Pliny puts it, `the nature of things' (rerum natura), or life itself, and he begins by describing this in its entirety, delineating the all encompassing and divine union of world (mundus) and ®rma ment (caelum) which is, `at once the work of the nature of things and the nature of things herself '.7 He then proceeds through the various parts of this whole, its terrestrial and 4 See esp. Cels. Med. pr. 46 8, 66, and 74 (CML i. 24. 30 25. 15, 28. 4 7, 29. 15 27). 5 For a full discussion of Pliny's career see Ronald Syme, `Pliny the procurator', HSCPh 73 (1969), 201 36. 6 Plin. Ep. 3. 5. 3 6. 7 `idemque rerum naturae opus et rerum ipsa natura', Pliny, HN 2. 1. 2; and see also pr. 13 (i. 128. 20; also 4. 14 15 M).

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heavenly structure, their internal and interactional patterns, rhythms, and less regular phenomena, followed by its con tents: that is the lands as they are lived in, and their peoples, animals, plants, and minerals. Knowledge about these latter items is ordered primarily according to their utility for humanity, and most prominent among these uses is the medical. Not only is this a recurring theme throughout, but thirteen of the thirty seven books are primarily devoted to medicines derived from living things and waters. In one sense, this arrangement is a product of Pliny's literary project. This is an essentially practical account of the way things are, it is an elucidation of the world as it was engaged with by a member of the Roman eÂlite, presented in order to improve the terms of that engagement. But Pliny frequently goes further, claiming that the world, in whole or part, has actually been established for the purpose of this engagement, and that the Roman gentleman, the cultivated man of action, somehow sees it and understands it as it really is.8 Pliny's rerum natura is not conceived of as something in itself, but something in relation to (a part of) humanity. Pliny's account of the nature of things is uni®ed and direct, not broken up into pieces by, and interpreted through, separate disciplines as in the encyclopedias, though he sees himself as covering much of the same ground. Indeed, in a sense he casts the arts, and the medical art as it is currently construed by its practioners in particular, as an obstacle to the practical under standing of things he wishes to purvey.9 This present version of the healing discipline he sees as the creation of Greek physi cians, out to pro®t by murder, who have discarded the use of the easily accessible and intrinsically appropriate remedies provided by the world in which humans live, for theoretical over elaboration and obscurantism, abstruse arguments, and irrelevant divisions. In contrast with Celsus' nuanced account of the development of the medical art, Pliny's is thus one of 8 For fuller discussion of these issues see Mary Beagon, Roman Nature: The Thought of Pliny the Elder (Oxford: Oxford University Press, 1992), 26 54. 9 Pliny's diatribes on these issues are concentrated at HN 29. 1. 1 29. 8. 28, cf. 26. 6. 10 26. 8. 17 (iv. 367. 10 377. 23, and 177. 13 180. 2 M); and see also Nutton, `The perils of patriotism'; Johannes Hahn, `Plinius und die grieÈ rzte im Rom: Naturkonzepten und Medizinkritik in der Naturalis chischen A Historia', Sudho€s Archiv, 75 (1991), 209 39; Beagon, Roman Nature, 202 39.

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straightforward degeneration, driven by Greek greed and ambitionÐa degeneration to which his fellow citizens, with the exemplary exception of Cato the Censor, have been insu ciently resistant, colluding in their own decline. His vision of healing practice as it should be is also distinctive, based, he claims, not on selection from, but complete rejection of, all this, and a return to what he presents as the traditional Roman reliance on the medicine chest that is the rerum natura, a reliance unmediated by medici. The story of Roman deteriora tion under the in¯uence of luxury and indolence, mixed up with Greek ideas and values, is of course a familiar one, as is the reactionary response to it; it is just given a particular medical twist here. Also familiar is the fact that Pliny's position (rather like Cato's before him) is somewhat compromised by the dominance of Greek names in the lists of sources for each book he ostentatiously presents at the beginning of the work, a dominance that is particularly striking for the medical books. Pliny is certainly as dependent on Greek learning as on any thing else. It is not just almost every previous medical writer of any stature, from Hippocrates onwards, who appears in these lists, but also various representatives of more occult forms of knowledge that span the medical, such as `Orpheus' and, most especially, `Democritus', whose name was heavily used in the formation of a literary tradition of wisdom about the powers and properties of things that claimed to come ulti mately from Persian or Egyptian priests, Chaldean astrologers, or Babylonian seers.10 Pliny places himself not only in opposi tion to a learned Greek medicine alleged to have abandoned simple, material based healing, but also to those who have stuck to those materials but worked them into a di€erent pattern of practical knowledge, dressed in even more foreign clothes.11 He prefers the long accumulated understandings of the curative powers of plants, animals, and minerals to be 10 On the formation of this tradition see Richard Gordon, `Quaedam veritatis umbrae: Hellenistic magic and astrology', in Per Bilde, Troels Engberg-Pedersen, et al. (eds.), Conventional Values of the Hellenistic Greeks (Aarhus: Aarhus University Press, 1997), 128 58. 11 See P. M. Green, `Prolegomena to the Study of Magic and Superstition in the Natural History of Pliny the Elder', Ph.D. diss. (University of Cambridge, 1954), for elaboration of this point mainly in relation to the magi.

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presented more or less as such, in a plain and homespun fashion, with all due respect given to the nature of which they are a part and product, rather than credit falsely being claimed by overreaching individuals. This means, however, that Pliny often distinguishes between, praises, or blames di€erent versions of the same thing; that it is frequently only the cultural positioning of the author or tradition, and the packaging that diverges, not the substance. Nevertheless he clearly found this a most important distinction, and he makes, from a mixture of open hostility, unattributed indirect speech, concessive clauses, and exclamations of amazement, the means to achieve completeness of coverage without completeness of commitment. Rather than omit any information, even if it comes from the Persian magi or some other disreputable source, he arranges everything in a hierarchy of security, of credibility: a hierarchy based on consistency with his own world view, not just in respect of what the truth should look like, but also who can speak it and how it may be spoken. He uses these preliminary lists of authorities and all the citations scattered in the text, the breadth of scholarship and learning thus displayed, to support his own position, to establish his own authority as an adjudicator between them, to advocate his own version of events. One ®nal question, then, is whether being female a€ects positioning in this hierarchy of security and credibility? How does Pliny treat Salpe and the other female authorities who appear in his work? The answer is neither completely straight forward, nor that di€erent from the way he treats the masculine majority of his sources; that is, there are women and there are women, some are more believable than others. Thus he approvingly recounts the story of the discovery of a cure for the bite of a rabid dog, made in a dream by a soldier's mother, an apparently respectable matron; but deals more suspiciously with Salpe, Elephantis, and the rest.12 He repeats what they have to say, but not without emphasizing that, for instance, Lais and Elephantis disagree on the e€ects of a whole range of substances, so that `it is better not to believe them'; and also that some of the same things are said `not only by midwives but 12

HN 25. 6. 17 18 (iv. 121. 22 122. 4 M).

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also by prostitutes', a far from creditable group of woman.13 Moreover, the fact that the recommendations made are in areas about which both midwives and prostitutes might well be expected to be particularly knowledgeableÐmeasures a€ecting fertility and the medicinal use of the female body, for ex ampleÐseems to hinder rather than help their cedibility. Expertise in itself cannot overcome the problems posed by the social status of either the informant or the information itself. To a limited extent, therefore, Pliny was willing to draw on female traditions in compiling the medical knowledge that Roman men should possess, and both he and Celsus clearly included women as proper objects of that knowledge, to be incorporated in their encyclopedic compilations. This stands in contrast to the only comparable extant work from the Greek worldÐPlutarch's Instructions for Health (¹Ygieina4 paragge3 l mata)Ðwritten perhaps not long after the death of the emperor Titus in ad 81 by that cultivated litteÂrateur and local dignitary from Chaeronea in Boeotia.14 In this treatise Plutarch does organize and present medical knowledge to other men pursuing a similar mode of existence to his own, but this is medical knowledge of a narrower, more focused, kind.15 What these men are told is to know their own bodies and the way they may be healthfully lived in, that being essentially through habitual moderation. Women provide examples of, and temptations towards, immoderation, but no more; there is no suggestion that any knowledge about them as such is necessary or useful.16 This is regimen for individual men who have a role to play in society as individuals, and like similar texts by physicians it attempts to regulate relations between male self and body; but 13 `melius est non credere', HN 28. 23. 81; `non obstetrices modo verum etiam ipsae meretrices', ibid. 28. 20. 70 (iv. 304. 2 9, 300. 3 4 M). 14 For Plutarch's biography and the dating of his works see D. A. Russell, Plutarch (London: Duckworth, 1972). He had considerable interests in medical matters, see generally Richard Durling, `Medicine in Plutarch's Moralia', Traditio, 50 (1995), 311 14, and Jacques Boulogne, `Plutarque et la meÂdecine', ANRW II 37. 3 (1996), 2762 92. 15 Plutarch describes his discourse as aimed at, `men of learning and state' (a5ndrew filo3logoi kai4 politikoi3 ), Mor. 137c. 16 See e.g. Plut. Mor. 134b: women as negative example; 125a: women as temptation.

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it goes no further, does not recognize that male responsibility may extend to others' (even women's) bodies. It has not the all encompassing, imperial ambition of the encyclopedia. Presenting a similar sort of medical knowledge to Pliny in a similar sort of way, but from a di€erent perspective, is Dioscorides' On Medical Materials, probably written in the decades just before the Natural History.17 This too is an ordering of things in the world for medical purposes that strives to be comprehensive, and which organizes its volumi nous material primarily by its worldly type, that is as it is derived from animals, herbs, trees, minerals, and so forth. For Dioscorides, however, it is the next organizational step he takesÐthat of arranging the items within these primary classes according to their dynameis, their properties or powersÐthat is crucial, distinguishing him (so he claims) from his predeces sors. Dioscorides was born in Cilicia, probably studied at Tarsus and may have served as a soldier in the legions, becoming a Roman citizen at some point in the process. He locates himself ®rmly within the pharmacological tradition of which he speaks in the preface to On Medical Materials, he is critically engaged with it from the inside, and is writing primarily for an audience that is similarly positioned. In his prefatory remarks, Dioscorides' justi®es his work to its ded icatee, Arius of Tarsus (a noted physician and perhaps Dioscorides' teacher), by listing the shortcomings of this tradition thus far: the omissions, imprecisions, confusions, lack of autopsy, greater interest in cause than e€ect, and mistaken organizational strategies which mar its literatureÐ 17 An impressive array of spurious works cluster around Dioscorides' name, in which group I would include On Simples or Easily Accessible Remedies (Peri4 a2plv9n farma3kvn or Ey1po3rista) , the only such text some still claim to be authentic. Like M. Wellmann, `Dioskurides (12)' (RE v.1 (1903), 1140), I see this treatise as a later reworking of Dioscoridean material, standing in roughly the same relation to Dioscorides as the Medicina Plinii does to Pliny. For a survey of pseudo-Dioscoridean works, and the scholarly debate over On Simples (spanning over four centuries and including Wellmann's reversal of his position cited above) see John Riddle, `Dioscorides', in F. Edward Cranz and Paul Kristeller (eds.), Catalogus Translationum et Commentariorum, iv (Washington: Catholic University of America Press, 1980), 116 43. See also John Riddle, Dioscorides on Pharmacy and Medicine (Austin, Tex.: University of Texas Press, 1985), 1 24, for Dioscorides' life and dates.

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faults which his compendium remedies; but, after this, Dioscorides' text is the least rhetorical and sparest in style in this assortment.18 The eÂlite of the empire are, however, addressed indirectly, as the reference to Arius' friendship with the consular Laecanius Bassus illustrates.19 Dioscorides' reputation among them is to be established less through actual encounters with his work than through a more di€use aware ness of its achievements in systematizing an established form of medical knowledge on which many of their medical encounters do depend. The methodological strictures of the preface to On Medical Materials, in particular its stress on practical experience, on autopsy and testing, and the sniping at the Asclepiadeans' obsession with causes and corpuscles, should not be mistaken for a systematic or sectarian allegiance to the empirikoi. For this broadly empirical strand is enmeshed in various assumptions that might be described, equally loosely, as rationalist. Dioscor ides is clearly, though rarely explicitly, engaged in mapping the dynameis of his materials onto a range of pathological and physiological processes and states.20 The vector he employed is now only dimly discernible, but that the correlation contained an explanatory dimension of the kind empiricism found anti thetical is obvious; moreover, these dynameis play a central role in his order of knowledge as a whole. John Riddle's verdict, that Dioscorides is `not easily categorized within the swirl of his period's controversies', seems, therefore, fair, though it must also be emphasized that this `swirl' certainly a€ected him.21 Dioscorides, like others before (and after) him, brought some of the methodological concerns and persuasive premisses that animated the foundational debates of the sectarian strands of Hellenistic iatrike to bear on the layers of knowledge concerning curative substances which had accumulated on and around folk 18 For Arius and this preface generally see John Scarborough and Vivian Nutton, `The preface of Dioscorides' Materia Medica: introduction, translation and commentary', Transactions and Studies of the College of Physicians of Philadelphia, 5th ser., 4 (1982), 187 227. 19 For Bassus see Dsc. MM pr. 4 (i. 2. 23 3. 4 W) and PIR2 5. 1, no. 31. He was consul in ad 62 and, ironically, is reported by Pliny (HN 26. 4. 5: ii. 175. 23 176. 4 M) to have died from an ill-advised self-help approach to a carbunculus on his left thumb. 20 21 See discussion in Riddle, Dioscorides, 32 40. Ibid. 13.

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traditions. He refashioned parts of these traditions so that they conformed more closely to the conception of medical knowledge now being jointly constructed by the social eÂlite and their physicians. Dioscorides shares sources with Pliny, though he is con siderably more reticent about them. A somewhat limited number of his predecessors appear in the preface, where Dioscorides concentrates on their failings as much as their achievements; and still fewer feature in the text itself. Hippo crates himself is cited only twice, and the half dozen mentions of Crateuas make him the most prominent voice of previous tradition.22 Dioscorides relies more on the strength of the methodological claims he makes than the strength of names and precedent for the persuasive force of his project; though the substance of what he says may well be more dependent on others than advertised. Wherever it comes from, however, he has forced his material into a uni®ed and coherent structure of his own, rather than leaving it as a more or less organized sequence of excerpts. Within this largely uniform presentation he then makes occasional use of indirect speech to distance himself from some of his information, thus establishing a hierarchy of knowledge and, by implication, of curative e cacy. Of most things Dioscorides is certain and he is able to state them without quali®cation, but about some he is su ciently uncertain to include them only as the beliefs of unnamed others. In the realm of certainty healing actions are assured, outside it they remain only a possibility. Between these two categories are his reports of the practices of women. He records women's particular use of certain plants and stones as simple facts, but in recording them as facts speci®cally about women he is calling into question, if not denying, their more general utility or applicability. Women undoubtedly use these things for their skin, as depilatories and perfumes, even, in the case of Thessalian women, as love potions; but whether anyone should follow their example is less obvious.23 These are, there 22 Dsc. MM 3. 59. 1 and 4. 168: Hippocrates (ii. 71. 7, 316. 8 W); 1. 29, 2. 127 and 156. 2, 3. 125, 4. 35 and 74: Crateuas (i. 33. 10, 201. 4, and 223. 7; ii. 136. 2, 195. 5, and 233. 1 W). 23 Dsc. MM 1. 30. 5, 5. 146, and 4. 131 (i. 35. 25 6; iii. 102. 2 3; ii. 277. 3 4 W). Thessalian women were perennially cast as providers of love charms

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fore, quali®ed statements of a somewhat di€erent sort, contain ing their own distribution of certainty and uncertainty, in which e€ectiveness is not the only issue at stake. The questionable, or at least limited, status of women's use of these substances as a guide to others is clear, as is the urge to completeness. The wider claim that, through these kinds of distancing techniques, Dioscorides systematically distin guished `magical elements' from `rational processes', or `the supernatural' from `the natural', is rather less so.24 For, items of the same kind as those that Dioscorides tends not to commit himself toÐmainly amuletsÐare also sometimes fully and unconditionally incorporated into the text, and he articulates no concept of `nature' or `the natural' (and thus of anything contrasting to it), using the term physis solely to denote the individual essence of a thing, and then only rarely.25 So, if its interpretation is guided by the internal contours of the work rather than current concerns, Dioscorides' reported speech can be taken rather more literally: as presenting uncon®rmed stories that he is, therefore, epistemologically unable to utter in his own voice. He is simply applying the medical and compositional programme he announced at the outset, with its twin goals of fullness and investigative rigour. He is constructing a complete record while not following those he criticizes for simply repeating tales told to them or words read. Con®rmation of the truth of an assertion might come either from Dioscorides' own experience or from its ®t with his general explanatory framework and understandings. This latter path is less open to the parts of the folk tradition furthest from the more theoretical currents of medical thinking, but it is certainly not closed and could always be circumvented by direct observation. A focus on the dynameis inherent in things, for instance, means that the move from the conviction that, as the main ingredient of a poultice, dock dissolves scrofulous swellings, to the idea that it might be equally e€ective in an amulet is not a great one and requires no shift and potions, as well as more aggressive kinds of magic, see e.g. Juv. 6. 610 13, and Lucan, 6. 434 506. 24

See e.g. Riddle, Dioscorides, 84, for these kinds of claims. See e.g. Dsc. MM 4. 74 and 119 (ii. 241. 6 9, 269. 6 9 W): amulets; 1. 14. 3 and 3. 62. 1 (i. 20. 5, ii. 73. 7 W): natures. 25

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26

of explanatory registers. It is simply the scrofula dissolving power of the plant, an aspect of its physis, that is at work in both cases. Thus, both are `natural' in the sense of `in the nature' of the plant, and `rational' in the sense of being within the frame of reasoning Dioscorides (and others) employed, but not in the sense of being counterposed to modern perceptions of `the supernatural' and `the magical'. In taking the contents and categories of the world that human beings inhabit as their guide to organizing medical knowledge, both Pliny and Dioscorides were largely limited to dealing with `simples', that is medicaments derived from a single constituent. Remedies requiring many ingredients, coming from di€erent classes of things, are not classi®able in this scheme, and knowledge about them was generally arranged either according to the part of the human body they were directed at (kata4 to3poyw, that is according to place) or according to an internal typology (kata4 ge3 nh, according to type), rather than as they emerged from sorts of things in the world. Collections of such compound pharmaka seem to have been one of the main manifestations of medical writing in early imperial Rome, undertaken by a wide group of, largely Greek and often unsectarian, mediciÐsuch as Heras the Cappadocian, Scribonius Largus, Servilius Damocrates, Andromachus the Younger, Asclepiades Pharmakion, and T. Statilius CritoÐ who ministered to the eÂlite of that city, including the emperor himself.27 The only such complete work to survive is Scribonius Largus' Compounds, in which the recipes are ordered ®rst by location, running from head to toe as was customary, then, 26

Dsc. MM 2. 114. 3 (i. 189. 15 19 W). These collections mostly survive only as fragments embedded in Galen's massive pharmacological treatises, more or less clearly labelled, and having been more or less substantially reorganized and reworked in the process of their extraction and incorporation, so see Fabricius, Galens Exzerpte, 183 5 and 242 6: Heras; 189 90: Damocrates; 185 9: Andromachus; 192 8 and 246 53: Asclepiades; 190 2: Crito, for works and biographical notes; and see also, on Crito, John Scarborough, `Crito, physician to Trajan: historian and pharmacist', in John Eadie and Josiah Ober (eds.), The Craft of the Ancient Historian: Essays in Honor of Chester G. Starr (Lanham, Md.: University of America Press, 1985), 387 405. Heras' wider signi®cance is also con®rmed by his appearance in the Michigan Medical Codex, P.Mich. 758 (E recto). 27

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after an interlude incorporating theriacs, antidotes, and sim ples, ordered by type, covering emplastra (plasters), malagmata (emollients), and acopa (for pain relief and general refresh ment). The collection was dedicated to Gaius Julius Callistus, a freedman of the emperor Claudius, around ad 47, by a man who, whatever his own origin, followed the model for a successful medical career at Rome which had been established by Greeks, both freed and free.28 Scribonius locates himself broadly within the Hellenistic medical tradition, and describes both Apuleius Celsus of Centuripae in Sicily and Tryphon of Cretan Gortyn as `teachers' (praeceptores); and, though Com pounds is written in Latin, this seems to have been done specially for its intended imperial readership, and wider resultant circulation.29 He speci®cally expresses his gratitude to Callistus for passing on to the emperor `my Latin medical writings', and Greek citations from some of his other works (one with a Greek title), in Galen and elsewhere, suggest that this speci®cation is to be taken in the context of an úuvre which was generally Greek.30 Scribonius' Latin certainly cannot be taken as an act of patriotism, a rebellion against the tyranny of the Greek language as the only legitimate vehicle 28 Most have labelled Scribonius a Greek freedman (see Wilhelm Schonack, Die Rezeptsammlung des Scribonius Largus (Jena: Fischer, 1912), 7 19, and Karl DeichgraÈber, Professio medici: Zum Vorwort des Scribonius Largus (Abhandlungen der Akademie der Wissenschaft und der Literatur, Mainz, geistes- und sozialwissenschaftliche Kl., 9; Wiesbaden: Steiner Verlag, 1950) for the fullest discussion of his biography), but this is challenged by Michael Kaplan, Greeks and the Imperial Court, from Tiberius to Nero (New York: Garland, 1990), 100 4; and Vivian Nutton `Scribonius Largus, the unknown pharmacologist', Pharmaceutical Historian, 25/1 (1995), 5 9, has suggested that he was a Sicilian who bridged both worlds; in a sense, however, it is his indeterminacy that is of most historical interest. Callistus' career is, somewhat extravagantly, discussed by Barry Baldwin, `The career and work of Scribonius Largus', RhM 135 (1992), 76. 29 Scrib. Larg. Comp. 171 and 175 (81. 22, 83. 8 S): Apuleius and Tryphon. Scribonius' Tryphon praeceptor is probably Tryphon the Elder, who ended his career at Rome (see Diller, `Tryphon (28)', RE viia.1 (1939), 745). 30 `scripta mea Latina medicinalia', Scrib. Larg. Comp. epist. 13 (5. 5 S). Quotes in Galen include Comp. Med. Loc. 3. 3 and 4. 4 (xii. 683, 764 K). Galen came to Scribonius through previous Greek compilations which may on occasion have incorporated (or even translated) Latin material (see e.g. the citation of Aelius Gallus at xii. 625 K), but the vast bulk of this tradition was Greek and this is the most likely place for Scribonius to ®t into it.

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for the presentation of medical knowledge denounced by Pliny, for there is no intimation that the rest of the text, with its essentially Greek technical vocabulary sometimes not even translated, is part of such a project.31 In addition to ¯attering Callistus, Scribonius uses the ded icatory epistle which prefaces his Compounds to set out and commend his approach to the medical art in general, an approach in which the art is ethically constituted, with phar macology playing a central role on account of its proven ecacy in bringing the `compassion' (misericordia) and `assist ance' (auxilia) to humanity that medicina promises. Scribonius' twin starting points are the Hippocratic oath's injunction against giving or demonstrating to a pregnant woman any medicament by which an embryo would be expelled, and Herophilus' dictum that `drugs are the hands of the gods'.32 From the ®rst he constructed a broader and more elaborate `medical humanism' in which the greatest care of the physician is due to everyone in equal measure, for: qui enim nefas estimaverit spem dubiam hominis laedere, quanto scelestius perfecto iam nocere iudicabunt. How much more evil would they judge it to harm a fully formed [human being] who consider it wicked to injure the uncertain hope of a human being.33

From the second he concludes that the mission of medicina demands that more attention should be given to pharmacology than some were willing to allow, and, in particular, to those drugs which have been tested by use and experience but 31 Pliny, HN 29. 8. 17 (iv. 374. 3 9 M). This is Kaplan's interpretation in Greeks and the Imperial Court, 100 1; but for discussion of Celsus' e€orts to forge a Latin medical vocabulary, which stand in contrast to Scribonius' lack of interest in this area, see David Langslow, `The development of Latin medical terminology: some working hypotheses', PCPhS n.s. 37 (1991), 106 30. Langslow has also suggested to me that Greek syntactical and grammatical tendencies are discernible in Scribonius' Latin. 32 Compare Scribonius' rendition of this part of the oath at Comp. epist. 5 (2. 20 3 S) and the surviving Greek text of the oath itself (CMG i.1. 4. 16 17); Herophilus' comment that `medicamenta divum manus esse' is at epist. 1 (1. 2 S), and see von Staden, Herophilus, 400, 416 18. 33 Scrib. Larg. Comp. epist. 5 (2. 23 5 S). See Ludwig Edelstein, `The professional ethics of the Greek physician', BHM 30 (1956), 391 419, and DeichgraÈber, Professio medici, for discussion of his ethics.

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overlooked in the excitement of current theoretical debates.34 Within this overall framework, this guarantee of his methods, Scribonius deploys both the creators and previous recipients of his recipes to secure their individual e€ectiveness. Most of the former are practising medici and chirurgi, but they are joined by `a certain respectable Roman matron' and `a certain little lady from Africa'; and the latter are drawn from the imperial household, past and present, with particular prominence being given to its women.35 Antonia, Octavia, Livia, and Messalina all appear as habitually employing some of the concoctions Scribonius presents, from tooth powders to salves for nervous conditions.36 Scribonius' rhetoric is neither of systematization nor com pleteness, but of the selection of the best. Nor does he o€er explanations for his cures, which include amulets and are, in general, composed of a number of exotic ingredients which are sometimes speci®ed in such a way as to produce a rich range of possibilities regarding what it is about the item that is being harnessed for healing. Sexual di€erence plays a part in this prescriptive pluralism. The respectable Roman matron's remedy for the morbus comitialis (epilepsy), for instance, com prises ivory scrapings and Attic honey mixed together with blood from a tortoise and a wood pigeon, recently captured.37 If the epileptic to be treated is a girl, the animals should be female, and if a boy, male. There are, here, aspects both of an alignment between therapeutic substance, patient, and illness, and of procedural power, laid over any curative properties which may inhere in these materials in themselves. There is, however, also an implicit understanding of somatic functioning and the systems of disease and its removal in this work. The ®nal text, or set of texts, to be examined simultan eously stands apart from, and has much in common with, both the simple and compound pharmacological traditions 34 These references to use and experience should not, however, be taken in a sectarian sense and to label Scribonius as an empiricist; he clearly falls outside or between those divisions, see Schonack, Rezeptsammlung, 67 9. 35 `Romae quandam honestam matronam', Scrib. Larg. Comp. 16 (20. 8 S); `muliercula quaedam ex Africa', ibid. 122 (65. 5 6 S). 36 See e.g. Scrib. Larg. Comp. 271, 59, 70, and 60 (116. 12, 35. 10, 39. 15, 37 Ibid. 16 (20. 8 25 S). and 35. 20 1 S).

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already outlined. This is the astrological herbal usually known by the Latin title, De virtutibus herbarum (On the Powers of Plants), which appears in the incipit of some of its surviving manuscripts. It was probably originally a Greek Hermetic composition, announcing itself as having been transmitted from Hermes Trismegistus to his disciple Asclepius; but this opening was subsequently replaced by an introduction in the form of an autobiographical letter from one Thessalus to `Germanicus Claudius, King and God eternal', and the text then seems to have circulated in the imperial period in both versions, as well as being translated into Latin before the end of antiquity.38 At least one late antique medical commentator confused this Thessalus with the ¯amboyant methodic phy sician Thessalus of Tralles, though no ethnic, nor even designation as iatros or medicus, appears in any of the surviving recensionsÐthe author instead being referred to with the more general term for a man of learning (philosophus) in the Latin.39 It may be that this confusion was intentional, or at least that the name Thessalus was chosen as appropriate for the author of a medical text in a looser sense, but any closer connection with the Trallian seems most unlikely.40 This work is, in a sense, simply the most distinctive and best studied representative of a larger constituency of astro bota nical and iatromathematical treatises that survive both in their Greek originals and in later Latin translations, mostly cast in a Hermetic mould, but which remain too shadowy in terms of date and context to be included here.41 However, the exist 38 The initial grouping together of the Greek and Latin Thessalus manu crits hermeÂtiques II. Le MeÂdecin scripts was made by Franz Cumont, `E Thessalus et les plantes astrales d'HermeÁs TrismeÂgiste', RPh 42 (1918), 85 108, and they are edited, together with the more straightforwardly Hermetic versions of the same basic text, by Hans-Veit Friedrich, Thessalos von Tralles (Meisenheim am Glan: Hain, 1968). The best preserved version of the dedication reads `Thessalus Philosophus Germanico Claudio regi et deo eterno salutem et amorem' (46. 4 5 F). The emperor addressed could thus be Claudius or Nero: whether the letter was actually sent to either of them is dubious, but its composition is likely not to be too far removed from this time. 39 John of Alexandria, Comm. Hipp. Epid. VI 42 (CMG xi. 1.4. 104. 4 9; cf. 404. 2 6 Pritchett). 40 See Alan Scott, `Ps.-Thessalus of Tralles and Galen's De Methedo Medendi', Sudho€s Archiv, 75 (1991), 106 10. 41 Two versions of a single, Hermetic, iatromathematical treatise in which

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ence of such works in so many, so variously ascribed, manifestations suggests that these kinds of treatises circulated widely in antiquity, and serves to emphasize the diverse ways in which medical knowledge was constituted, authenticated, and transmitted in this era. Thessalus adopts and adapts almost all the modes of claiming medical authority employed in the wider constituency which he represents here, and can thus be used to illustrate them. First there is the address to the emperor, for which there are good precedents in a range of traditions of knowledge, including the medical: a letter purporting to be from Hippocrates to King Demetrius survives, as does one from Diocles to Antigonus, for instance, and King Philip apparently receives missives of astrological import from Dionysius and Sextus the `master of the hours' (v2rokra3tvr).42 In many of these cases an authoritative authorial persona is also assumed, and Thessalus may be playing that game too; but the main thrust of his authoritative strategy is rather di€erent. His authority is vested less in his name than in his narrative, his account of the special circumstances in which he came to acquire the knowledge he is now advocating, in which he himself came to gain authority, and through which he intends to regain it in each reading. The climax of this narrative is Thessalus' encounter with the divine, in which the god reveals to him that which makes the knowledge he presents particular parts of the body are assigned to speci®c heavenly bodies are printed in Julius Ideler (ed.), Physici et Medici Graeci Minores, i (Berlin: Reimeri, 1841), 387 96, 430 40. A more complex Hermetic text in which body parts, plants, and stones are arranged according to the thirty-six decans, has been edited by C.E. Ruelle, `HermeÁs TrismeÂgiste: le livre sacre sur les deÂcans', RPh 32 (1908), 247 77. More speci®c astro-botanical treatises, in which therapeutic herbs are organized according to the signs of the zodiac and the planets, are catalogued and transcribed from various manuscripts in CCAG: e.g. iv. 134 6 and vi. 83 4 (two versions of the same unattributed herbal); vii. 231 6 (Hermetic herbal); ix.2. 129 35 (attributed to King Alexander); xii. 126 55 (unattributed). These are what I would describe as the dedicated medical treatises of these various traditions, as distinct from works such as the Cyranides which cover medical objectives amongst a range of others. 42 Wesley Smith (ed., trans., and introd.), Hippocrates: Pseudepigraphic Writings (Leiden: Brill, 1990), 104 6, and Paul of Aegina (Paul. Aeg.), 1. 99 (CMG ix.1. 68. 25 72. 12); CCAG v.3. 76 and vii. 188, and see A.-J. FestugieÁre, La ReÂveÂlation d'HermeÁs TrismeÂgiste, i, 2nd edn. (Paris: Gabalda, 1950), 324 31.

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and powerful, that guarantees its absolute and complete ecacy; and this moment occurs also in the Hermetic versions of this text and is encapsulated in the formula of divine transmission from Hermes Trismegistus to his discipleÐAsclepius, Ammon, or whoeverÐwhich opens many other such treatises. In the lead up to this climax, however, Thessalus draws, sometimes subver sively, on both the aretalogical tradition and that of iatric biography.43 Thessalus' prefatory story begins with him following the usual path of the intending iatros as he travels from his home in Asia Minor to study medicine at Alexandria. He then turns o€ down a rather di€erent, but just as well trodden, path to knowledge as he discovers in a library a treatise by the legendary Egyptian King Nechepso containing twenty four cures for the whole body and all diseases, using herbs and stones and organized according to the zodiac; but, as in stories of the transmission of occult alchemical knowledge, the moment of triumph turns into humiliating defeat as all his e€orts to make practical use of this work meet with failure.44 Driven out of Alexandria by the ridicule of his fellow students, and too ashamed to return home, Thessalus wanders Egypt in search of some contact with, or from, the gods, which he eventually achieves in Thebes, through the oces of an old priest. The meeting with Asclepius/HermesÐwho reveals that the missing element in Nechepso's system is the times and places in which the herbs must be gathered, and promises Thessalus immortalityÐis shared by both versions of the text, and prefaces in each case the same catalogue of medically e€ective herbs arranged under their zodiacal sign or planet, and in which the best time for collection precedes a listing of the conditions for which they are therapeutically useful, either alone or in compounds. There is then an epilogue in which the recipients of the text are advised to guard, even encrypt, its 43 See Jonathan Smith, `The temple and the magician', repr. in his Map is not Territory: Studies in the Histories of Religions (Leiden: Brill, 1978), 172 89, for detailed discussion of the aretalogical aspects. 44 Nechepso was a well-known astrological authority, and ®gures in a number of other traditions of occult knowledge also, see W. Kroll, `Nechepso', RE xvi (1935), 2160 7. For similar stories in the alchemical tradition see e.g. [Democritus], Natural Secrets (Fysika4 kai4 mystika3) 3 (CAAG ii. 42 3).

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contents, for its advantage will be lost if it passes into too many hands. `No longer will people dedicate themselves to the di€erent sects of iatrike nor will they yearn to be among the texts of the ancient physicians', instead they will be attracted to the present work as it holds out the possibility of curing the diseases of the whole body.45 It is perhaps not surprising, given the extravagant claims made about the completeness and absolute power of this knowledge, and the denigration of both the tradition of Hellenistic iatrike and other astro botanical systems, as rep resented by the inadequacies of King Nechepso, that the zodiacal and planetary herbal which makes up the bulk of the text is actually rather unremarkable. It is similar to other examples of the genre, and together they all recommend applications of the same kind as those of the other authors introduced so far. The treatise is distinct only in so far as it actually passes into the pharmacological traditions represented by those such as Dioscorides and Scribonius Largus, whereas the others remain more on its borders. In On the Powers of Plants the celestial order is basically an organizational device which imparts a sense of totality and completeness, rather than providing a richly associative framework on which every thing else hangs. The focus has become more technical, concentrating almost exclusively on named conditions rather than the problems of everyday life; and compounds predomi nate over simples, often elaborately discussed with reference to the qualities involved, or the movement of liquids (y2gra3) and pneumata through the poroi (po3roi, that is passages or channels) of the body.46 All these writers engaged with di€erent parts of the ®eld of medical knowledge in di€erent ways and for di€erent purposes, 45 oy1ke3 ti ga4r oy5te diafo3royw ai2 re3 seiw i1 atrikh9w a1skh3soysin a5nurvpoi oy5te mh4n ta4 tv9n a1rxai3 vn i1 atrv9n synta3gmata pouh3soysin metie3 nai, Thessalus, 2 epil. 4 (263. 7 12 F). 46 Thessalus, 2. 3. 1 3 (a1ei3 zQon, that is the houseleek, herb of Jupiter): qualities; 1. 9. 4 5 (a1nagalli3 w, the scarlet pimpernel, herb of Sagittarius): passages (215. 2 12 and 155. 2 15 F). The identi®cation of ancient plants is far from secure, especially since the terms of classi®cation have changed so radically over the centuries, and these names, and those o€ered subsequently, should be seen as rough guides to the type of plants concerned, no more. Sometimes not even this is possible, and no modern name can be o€ered.

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the three being inextricably intertwined in the production of their works. Woman is thus constructed as an object of medical knowledge through the interaction of these three dimensions; she is constituted from and in the content, form, and orientation of the texts. It is the results of this complex constitutive process in these particular cases, the sexual structure and substance of these literary remains, which must now be examined in detail. The structure, as well as the substance, is particularly important since none of these texts contain any separate and sustained treatment of woman, instead she appears episodically, dealt with piecemeal as and when it seems appropriate and necessary in the work. Her absence as well as her presence thus becomes signi®cant, and the pattern of her exclusion and inclusion helps shape her positivity.

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SEXUAL STRUCTURE AND SUBSTANCE The diversity of these texts makes their ordered alignment for any analytical purposes rather awkward. Celsus, while not devoting much attention to physiology as such, establishes by means of a discussion of the condition of health and various anatomical accounts a certain human norm as a clear point of reference for the medical enterprise, and also covers the fall from health, and diseases in themselves, before going on to the main business of their prevention and cure. On the other hand, those solely engaged in various kinds of cataloguing, or organ ization into groups, of medically e€ective things in the world, take this norm, and deviations from it, for granted. It is whole, living, human beings, in sickness and in health, who give these works purpose, and shape their endeavours, but they do not appear as such. It is only their medically a€ected aspects, segments, or points, the speci®c targets of these materials and actions, that are manifest. And Pliny then adopts both approaches, but separately and in his own distinctive manner. He ®rst establishes a human norm, though as a point of reference for an enterprise rather more than medical, and then switches to cataloguing medically e€ective things in the world, as part of a wider classi®cation of things according to the e€ect they have on humans more generally. For him the link

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between the two lies in the proper, epistemic and ethical, relationship between humans and their world, not in the mechanisms of disease, so he largely omits these from con sideration. The order followed in this chapter re¯ects this basic division in orientation. First, woman's relationship to the human norm established by Celsus and Pliny is examined, and then her relationship to disease, to the passage into certain sorts of abnormality, mostly as described by Celsus. In a sense this progression is then repeated, or at least paralleled in the third and fourth sections of the chapter. These trace, ®rst, the targets of medical e€ectiveness, or intervention, that are regular features of women's existence (largely concerned with men struation and reproduction), and then those features that are de®nitely pathological and their cures; and they attempt to place all these aspects in relation to the whole human being who, implicitly, stands behind and gives meaning to all the speci®c parts, as well as to the general patterns of intervention. In these sections, Dioscorides and Pliny predominate initially, then everybody joins in towards the end. The normal woman? Celsus establishes his human norm right away. The ®rst book of On Medicine opens: sanus homo, qui et bene valet et suae spontis est, nullis obligare se legibus debet, ac neque medico neque iatroalipta egere. hunc oportet varium habere vitae genus: modo ruri esse, modo in urbe, saepiusque in agro; navigare, venari, quiescere interdum, sed frequentius se exercere. The healthy person, who is well and his own master, should not be constrained by rules, and should have need for neither a medicus nor an iatroalipta. He should lead a varied kind of life: sometimes in the country, sometimes in the city, and mostly on his estate; he should sail, hunt, rest sometimes but more often exert himself.47

The notionally generic `healthy person' is, therefore, a man of the Roman eÂlite who is able to live and act appropriately without recourse to professional medical attention. This speci®cation 47

Cels. Med. 1. 1. 1 (CML i. 29. 26 30).

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becomes even clearer as Celsus proceeds to outline the correct conduct for the maintenance and intensi®cation of this state, not just in terms of the contents of that conduct, but in the very assumption of individual control over all these facets of exist ence. The tacit exclusivity of the narrative, and its maleness in particular, is, however, explicitly contradicted at two points within it. For Celsus states that considerations of `changes, somatic type, sex, age, and time of year' are all relevant in formulating and following a healthy lifestyle.48 He then pro ceeds, however, to treat all these variables except sex, though he does allow a womb to appear in a list of body parts badly a€ected by cold.49 In this initial establishment of a human norm, this descrip tion of what medicina is all about maintaining and restoring, there is, therefore, a gap between the way in which Celsus conceives of, and actually carries out, his project, a gap which is re¯ectively invisible and into which women fall. His concep tion is of humanity in general, his execution is limited to males of the leisured classes, and the di€erence between the two passes unnoticed. Later on, as the social and idealistic dimen sion of human health, the sense in which to be healthy is to be socially functional in accordance with a certain ideal, fades into the background and more narrowly somatic considerations come to the fore in the discussions of diseases and their cure, this gap closes and the human body clearly comes in two types. That the gap has closed from the female side, that she has now joined a narrative and a humanity generally assumed to be male continues to be apparent, however, in the periodic appearances she makes. This is what Heinrich von Staden has labelled Celsus' `reluctant construction of the female body', the way in which the male is the model and: `The female appears as an obligatory detour, as a reluctant yet necessary afterthought, and as a phenomenon requiring description and explanation outside the normal categories of bodily things.'50 48 `novae res et corpora genera et sexus et aetates et tempora anni', Med. 1. 49 Med. 1. 9. 3 (CML i. 41. 16 17). 3. 1 (CML i. 32. 8 9). 50 Heinrich von Staden, `Apud nos foediora verba: Celsus' reluctant construction of the female body', in Guy Sabbah (ed.), Le Latin meÂdical: La  tienne: Publications de l'UniConstitution d'un langage scienti®que (Saint-E  tienne, 1991), 272. versite de Saint-E

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Pliny initially o€ers a much more broadly conceived de®ni tion of humanity in which its sexed nature is never in question. This breadth comes from the shape of his overall project, from the fact that he is describing human beings as types of things in the worldÐspecial types of things, but things like the other animals, plants, and minerals none the lessÐnot as speci®cally medical objects of any kind. His main concern is to place humanity in its proper, pre eminent, place in the world, in its proper set of relations with its surroundings and their inhabitants, which leads to human action about health through the understanding of that relationship, not through the under standing of humanity in and of itself. Pliny begins book 7 of the Natural History with the features he considers most quintessentially human, and these are the misery and helplessness of the newborn baby (whose only innate activity is to weep, all else having to be learned).51 Both these characteristics continue through life in the sense that grief, greed, and internal strife are exclusively human and that humans must mobilize external resources, which they do not possess of themselves, to live. The de®nitional strategy then pursued is basically one of the exempli®cation of extremes, organized, after a kind of introductory preamble, roughly in the sequence of birth, reproduction, life, and death. The limits of collective human existence, of human society, are established ®rst, by enumerating the exotic peoples who cluster around the edge of the known world, like the Sciapodas (umbrella footed people) of India and the Ethiopian Menis mini (who live on apes' milk), and Pliny then proceeds to the limits of individual human existence, its beginnings and their production, its lived potentialities, and its endings.52 The narrative is partially normative, making general statements about such things as human generation, proportions, and signs of impending death, but largely illustrative. General izations are instantiated, and, more often, a collection of instantiations stands in the place of a generalization. What it is to be human is essentially demonstrated by example, by lists of persons known to have been born after pregnancies of exceptional length or brevity, or feet ®rst, or resembling 51 52

Pliny, HN 7. pr. 1 5 (ii. 1. 1 3. 14 M). HN 7. 2. 23: Sciapodas; 7. 2. 31: Menismini (ii. 9. 6 7; 12. 3 7 M).

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Pompey the Great; or known to have possessed exceptional size, strength, sight, memory, courage, or intellectual ability; or known to have been exceptional achievers in a range of artistic, scholarly, military, or political spheres; or known to have met remarkable deaths; or known for any number of other things. There is a general, though non linear, progression in the narrative from what are bad examples of humanity to particu larly good ones, from those which delineate its boundaries to those which are paradigmatic of its positivity. Women are more often bad examples of humanity than good; indeed, it is questionable whether they can be good examples of humanity, rather than womanhood, at all. They help de®ne limits far more than they provide paradigms. A properly human society needs women, as the androgynous Machyles indicate, but their peculiarities, particularly reproductive ones such as bearing children at the age of ®ve or only once in their lifetime, can easily make a society liminal.53 It is women who are responsible for prodigious births: Pliny mentions no fathers in this context; and only females are subject to complete sexual change, their occasional transformation into males being well attested by reliable witnesses, suggesting that femaleness is somehow a less stable human state than maleness.54 These sections lead into a general treatment of reproduction, in which Pliny is concerned to describe its most prominent features as they were seen by a man of the Roman eÂlite involved in the production of legitimate heirs, and in so doing to point up the singularity of humanity; a singularity which rests mainly on the un®xity and variety of human generation. He starts by pointing out that only humans have no set season for intercourse and birth, and that pregnancy may last from six to over ten months, with even a thirteen month pregnancy having been deemed possible in law for the purposes of inheritance.55 Other relevant regions of variation include the 53 HN 7. 2. 15: Machyles; 7. 2. 30 and 7. 2. 23: reproductive oddities (ii. 6. 15 17; 11. 15 17 and 9. 2 4 M). 54 HN 7. 3. 33 5: prodigies; 7. 3. 36: becoming male (ii. 12. 15 13. 16; 13. 17 14. 4 M). Males may be castrated, but this is a rather di€erent kind of transition, since eunuchs are like women but not actually women and it occurs through active intervention, not by spontaneous somatic alteration. 55 HN 7. 4. 38 40 (ii. 14. 11 15. 9 M).

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fact that children may resemble their parents (in respect of scars and mutilations as well as general appearance), their more distant ancestors, somebody entirely di€erent, or none of these, their fate being in part decided by the thoughts and circum stances of the reproductive partners during conception.56 About the ability to produce children, the only certainty is that it is impossible for women over 50 (though men are subject to no such age limit), otherwise it too varies, in respect of number, sex, timing, and ease of children born; its variation being largely a property of the woman, though sometimes of a partnership, such as that of Livia and Augustus.57 There are, however, some ®xed points in this ¯exible scheme. A male foetus is always recognized by the good health and colour of the pregnant woman, and movement in the womb from the fortieth day of pregnancy, whereas `everything is the opposite in the other sex': the load is burdensome, it is accompanied by some swelling, and movement only begins on the ninetieth day.58 Girls are generally carried in the left side of the womb, boys in the right, and girls develop more quickly but are delivered with greater diculty.59 Perhaps most distinctive, however, is the fact that woman is the only animal to menstruate, and there is `nothing more monstrous' than this monthly female ¯ux.60 It sours wine, ruins crops, dulls mirrors and the edges of blades, corrodes metal, kills bees, and maddens dogs, among other things, but also provides the material for generating humans.61 Pliny provides a very compressed, and somewhat unclear, Aristotelian account of the respective reproductive roles of the menstrual ¯uid and the male seed, the former being acted on by the latter, in the manner of rennet, to ensoul and embody the resultant conglobation. In contrast to this rich female involvement in the earlier part of the book, only a few of the subsequent categories of exceptional individuals admit women as well as men, and 56

HN 7. 10. 50 2 (ii. 18. 6 19. 6 M). HN 7. 11. 57 7. 12. 62 (II. 21. 4 22. 11 M). 58 `contraria omnia in altero sexu', HN 7. 5. 41 (ii. 15. 10 15 M). 59 NH 7. 3. 37 and 7. 5. 41 (ii. 14. 7 10, 15. 13 M). 60 `nihil . . . magis monstri®cum', HN 7. 13. 63 4 (ii. 22. 12 19 M); cf. 28. 23. 77 8 (iv. 302. 12 303. 9 M). 61 HN 7. 13. 64 7. 14. 66 (ii. 22. 19 23. 17 M). 57

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then the two usually compete separately. The smallest woman is not the same as the smallest human (homo), the longest lived women are listed as such, the woman most outstanding in her resistance to torture has a male counterpart, and, in the ®eld of prophecy, the Sibyl has two.62 Women are able to compete on equal terms in the realm of dutifulness (pietas), and have their own class of `most chaste woman' (pudicissima femina) in contrast to the male equivalent of being simply `best man' (vir optimus), and also of being related to three distinguished men.63 All these qualities, from smallness to prophecy, from pietas to pudicitia are typically female, there is no encroach ment on the male domains of public life, or cultural achieve ment. Pliny then returns to humanity in the latter part of book 11 of the Natural History, where he presents a comparative survey of all the component parts of animals, including humans. This is paralleled by Celsus' adumbration of the internal parts of the human being prior to discussing their individual ailments in the opening sections of book 4 of On Medicine, and his description of the con®guration of the bones before discussing their repair in book 8. All these accounts proceed from head to toe, but while Celsus' do so with economy, simply presenting the information he considers to be therapeutically requisite, Pliny's rambles expansively, plentifully illustrating its delinea tion of the particular place of humanity among the animals. The theme of di€erentiation and similarity, within and between sorts and types of living things, is thus central for Pliny but incidental for Celsus. Human beings, reports Pliny, are distinguished from the other animals by the hairiness of their heads, a feature shared by men and women, except that women are less prone to hair loss (and eunuchs completely immune).64 In case this situation should be misinterpreted as meaning that women and eunuchs are, by virtue of their permanent hirsuteness, somehow more 62 HN 7. 16. 75: smallest woman; 7. 48. 158: longest lived; 7. 23. 87: most enduring; 7. 33. 119: most prophetic (ii. 26. 14 15; 54. 21 55. 7; 31. 3 8; 41. 10 13 M). 63 HN 7. 35. 120: pudicissima femina; 7. 41. 133: multiple relations (ii. 41. 18 22; 46. 18 47. 3 M). 64 HN 11. 47. 130 1; cf. 11. 94. 230 (ii. 325. 1 14; 357. 12 15 M).

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distinctively human than men, Pliny adds that baldness is also exclusive to humanity. Moving inside the head, the human brain is described as proportionately the largest amongst those creatures so endowed, with the man's being bigger than the woman's.65 Teeth are also more numerous in males than females, not only among humans but also among cattle and pigs.66 Pliny's account of the thoracic interior is entirely generic, except that, appended after the discussion on the bladder, is a chapter which opens:

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Feminis eadem omnia praeterque vesicae iunctus utericulus, unde dictus uterus; quod alio nomine locos appellant, hoc in reliquis animalibus vulvam. There are in women likewise all of these things and, in addition, a little vessel joined to the bladder, from which it is called `uterus'; which is also called by a di€erent name, `the places', and, in the rest of the animals, `vulva'.67

It is mainly this latter item which features, largely in a culinary context, in the rest of the passage, though Pliny does add that in women the womb has two cavities, and, whenever it moves, it fatally hinders the breathing. It is at a similar juncture in Celsus' ®rst, organic, narrative that sexual di€erentiation makes its sole appearance.68 The point of divergence is here, however, the bladder itself, which is of a unitary constitution but placed di€erently in men and women. It is on the left side in the former, but situated centrally, above the genitals and supported by the womb (vulva), in the latter. The urinary passage that descends from the bladder is longer and narrower in men, shorter and wider in women, and passes into the penis (colis) and the neck of the womb (vulvae cervix) respectively. While the colis requires no further elucidation, the vulva does, in terms of its size, morphology, and orientation. It is described as being pretty paltry in young girls (`in virginibus'), and not 65

HN 11. 49. 133 (ii. 325. 22 326. 1 M). HN 11. 63. 167; cf. 7. 15. 71 (ii. 336. 17 18; 25. 8 M). Aristotle makes the same statement at HA 501b19 20, and much else in these sections has Aristotelian parallels. 67 HN 11. 84. 209 (ii. 350. 20 351. 1 M). 68 Cels. Med. 4. 1. 11 13 (CML i. 151. 18 30), and see von Staden, `Apud nos foediora verba', 276 84. 66

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much larger than a ®st in mature women, unless they are pregnant. It begins with a straight, narrow neck and widens into a larger vessel, turns slightly to the right before passing over the rectum, and is attached to the ilia. This too is the region of osteological di€erence between the sexes, for, though the hip bones themselves provide undi€erentiated protection for the womb, bladder, and rectum, the pecten (pubis) is straight in men but curved outwards in women, `so as not to impede birth'.69 This is one of the very few functional argu ments in Celsus' anatomy. Pliny discusses the generic constituents of bodies, such as fat, marrow, and bones, immediately following his enumera tion of parts, and then examines the joints and terminations of limbs, the breath and the voice, and, ®nally, nutrition. Here it is reported that the blood of males is darker than that of females, that females have ®ner hair, narrower feet, are (except in leopards and bears) weaker, and have (except in cattle) a thinner (exilior) voice than males.70 However, it also seems that men and women are more like each other than the males and females of other animals. Men are, for example, the only male creatures to be subject to bloody ¯uxes (sometimes regularly) and to have breasts, and in a few women there is a prodigious (prodigiosa) genital similitude to men.71 In these anatomical passages, both authors demonstrate the `reluctance' of their construction of the female body most clearly. Celsus' delineations divide at the analytic points where it becomes impossible to maintain the unitary character of the human being as an object of medical knowledge, but the division is by way of a digression from the main story, which it then rejoins. In Pliny's account, the womb is a corporeal and textual appendage, an extrinsic addition to the main, tacitly male, body of the narrative. The whole human being who stands behind these dissections, however, is of a rather di€er 69

`ne partum prohibeat', Cels. Med. 8. 1. 23 (CML i. 372. 10 11). HN 11. 90. 221: blood; 11. 94. 229: hair the section also repeats and re®nes the previous remarks about female resistance to baldness (though they may lose hair from their head and gain some around the mouth after the cessation of menstruation); 11. 105. 253: feet; 11. 110. 263: strength; 11. 112. 269: voice (ii. 354. 16; 357. 5; 365. 13 14; 369. 10 11; 371. 12 13 M). 71 HN 11. 90. 223: bloody ¯uxes; 11. 95. 232: breasts; 11. 109. 262: genitals (ii. 355. 7 14; 358. 9 10; 368. 18 19 M). 70

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ent character in the two texts, formed by their di€erent overall constitutions. For Celsus the whole human being is a norma tive entity, providing the standard for medicina, and this whole human norm is exactly the same in a medical context as it is in a social or political one, indeed it is this coincidence that gives purpose to his work. Thus the sanus homo is a physically and culturally functional man of the Roman eÂlite. For Pliny the whole human being is an example of, and largely subsumed within, humanity, which provides a kind of cosmic norm against which the rest of the world can be measured, ordered, and made sense of. Humanity, as a species, crucially contains two types of human beings, and though only one can really represent it as such, when humanity is being measured against itself, the external standard is set by both together, and this typology radiates outwards as an important element in Pliny's anthropocentric method of simultaneous classi®cation and comprehension of things in the cosmos. This radiation re¯ects back on its centre, arranging and explicating the world in relation to humanity, humanity in relation to the world, and humanity in relation to itself, in a single, mutually reinforcing and implicatory, web. This outward sexual spread passes ®rst through the other animals in which there is also conceived to be a division of reproductive roles and thus a direct line of comparison with humanity, then into those plants and minerals which, though not understood to procreate sexually, were nevertheless divided into females and males and thus bound up and ranked in a familiar relationship of hierarchical sameness and di€erence with themselves.72 Continuity is maintained in the categorization despite the loss of reproductive signi®cation. Male plants are larger and rougher than females; and, among the carbunculi (red gemstones), sandastroi (transparent stones containing glittering particles), and sarda (reddish stones), for instance, the male stone is characterized by the brilliance and 72 For general discussion of the sexual division of plants see e.g. C. Gorm Tortzen, `Male and female in Peripatetic botany', C&M 42 (1991), 81 110. It should also be noted that sexual reproduction was thought to be radically more restricted among the animals than it is today, was only considered to occur in the date palm among the plants, and not at all among minerals, though some stones were thought of as spawning new ones.

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vitality of its lustre, compared to the weaker, softer glow of the female, and impotent magnetite is also female.73 All this, however, falls within a knowledge project which is coextensive with the world, not narrowly medical like Celsus', though in some ways woman is positioned similarly within both. She is part of what is being comprehendedÐthat is, an object of knowledge, part of the system of comprehension, the mode of knowledgeÐbut not truly counted among the comprehenders, the knowing subjects who, for both Celsus and Pliny, must also be knowing agents, must act on their knowledge; for agency, in its full sense, is exclusively male.

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Diseases and women Celsus' coverage of diseases is much more semiotic than aetio logical. His project is nosographical, descriptive of the indicators of illness in its many forms, both future and present, not pathological, and he rejects more sophisticated classi®catory schemes for a simple division between diseases of the whole body and those of its parts, which are discussed individually. He clearly subscribes, however, to a loosely Hippocratic model of sickness as generated through the interaction between body, lifestyle, and environment, a generation that has a regularity and predictability which implies causal connection within the frame work of a qualitative, and a€ective, continuity between human beings and their world. Indeed, he is more directly dependent on various Hippocratic works, particularly the Aphorisms (¸Afor ismoi3 ) for much of what he has to say about disease. Women have a particular relationship to the conditions of their existence in this pathogenic context, as the paradigmatic possessors of softer (molliora) bodies. This means that they are usually prone to lippitudo (in¯amed and running eyes), tormina (the gripes), and fevers in a dry winter with north winds or a wet spring with south winds, but enjoy good health in a dry autumn with north winds.74 Men, as a group, are not referred 73 HN 16. 62. 145 and 24. 92. 143: male plants tougher; 37. 25. 92 3: carbunculi; 37. 28. 101: sandastroi; 37. 31. 106: sarda; 36. 35. 128: magnetite (iii. 38. 6 9 and iv. 101. 12; v. 421. 18 422. 5; 425. 2 5; 427. 11 13; 353. 12 13 M). 74 Cels. Med. 2. 1. 13 and 16 (CML i. 48. 4 7, 17 20); cf. Hippocrates, Aphorisms (Aph.) 3. 11 and 14 (iv. 490, 492 L).

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to in this way, though they may implicitly be included among the tougher (duriora) who fare rather badly in this same kind of autumn.75 All women are molliora, but there are a number of other variables, such as age, which must also be taken into consideration.76 One aspect of this is that the infant illnesses which cease `neither with puberty nor with the ®rst sexual acts nor, in the female, with the ®rst menses' may become more deep seatedÐa formulation in which the (doubly) sexually speci®c nature of the ®nal phrase calls into question the genericity of its predecessors and thus establishes physical maturation as di€erentially marked between the sexes.77 Lastly, a woman may or may not be pregnant, and in the latter case it is not only her own health which is at issue, but also the health of the pregnancy and that which she bears, both of which are adversely a€ected by wet winters and cold, dry springs.78 She herself is especially threatened by acute diseases and tormina.79 Pliny too considers that di€erent groups of the population may be di€erentially a€ected by diseasesÐfor ex ample, stating that lichena (a dis®guring skin complaint) left women, slaves, and the lower orders untouched when it arrived in Italy during the reign of Tiberius.80 Celsus makes no subsequent reference to the quality of the female body as such; instead a particular feature of her somatic economy emerges as being of special pathological signi®cance. Not only is a girl's ®rst period the marker of her maturation, but menstrual regularity thereafter is integral to her well being. The cessation of the menses forebodes acute pains in the head, or disease in another part of the body; it removes the protection women otherwise have against podagra and chiragra 75

Cels. Med. 2. 1. 16 (CML i. 48. 20 2). Ibid. 2. 1. 17 22 (CML i. 49. 1 50. 10); cf. Hp. Aph. 3. 18 (iv. 494 L). 77 `neque pubertate neque primis coitibus neque in femina primis menstruis', Cels. Med. 2. 1. 20 (CML i. 49. 18 21); cf. Hp. Aph. 3. 28 (iv. 500 L). In general pubertas seems to refer speci®cally to the passage to manhood rather than the more generic English `puberty'. See also Pliny, HN 28. 10. 44 (iv. 291. 7 9 M), where `primo coitu' is an alternative to `primoque feminarum mense' as the dissolver of youthful disease. 78 Cels. Med. 2. 1. 14 (CML i. 48. 7 10). 79 Ibid. 2. 6. 8 and 2. 8. 13 (CML i. 57. 10 14, 69. 5 13); cf. Hp. Aph. 5. 30, and Prediction/Prorrhtiko3n (Prorrh.) 2. 22 (iv. 542; ix. 50, 52 L). 80 HN 26. 3. 3 (iv. 175. 7 10 M). 76

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(gouty a‚ictions of the feet and hands respectively) and against a weakness in the eyes which a€ects night vision; and if it supervenes upon tabes (a wasting sickness) complications occur which make these women (and virgines) the most dicult to cure.81 Women's lesser susceptibility to the morbus comitialis is not so quali®ed, but the disease itself may be lifted by the ®rst sexual act in boys or the ®rst period in girls.82 Scribonius, by contrast, picks up this same point in a di€erent way; women are less easily cured of epilepsy than men, and both boys and girls may be released from this disease through sexual activity.83 This sexual activity is, however, described in sexually di€er entiated terms: boys engage in sexual embrace (complexus), girls in devirgination (devirginatio). That, for Celsus (as for the Hippocratic writers he is often following), these are facets of a conception of female corpore ality as intrinsically unstable and excessive, requiring a recur rent out¯ow of blood in order to maintain its precarious internal balance and therefore health, is con®rmed by the explicit linkage between menstruation and other forms of blood loss. A woman is freed from vomiting blood by men strual discharge or a nosebleed; the perilous conjunction of menstrual stoppage and tabes is relieved by a sudden haemor rhage or the bloody bursting of a sore; non menstruating women should be bled intermittently; and, there is a correla tion between non menstruation and sanguineous expectora tions.84 Other aspects of this ¯uid economy are suggested by a connection between lactation and menstrual failure outside the context of childbearing, and the fact that blood su€used breasts are predictive of furor (derangement), though Celsus 81 Cels. Med. 2. 7. 7 (cf. Hp. Prorrh. 2. 26: ix. 58 L): menstrual stoppage; 4. 31. 1 (cf. Hp. Aph. 6. 28 30: iv. 570 L): podagra and chiragra (eunuchs and boys before having had sex with a woman are similarly infrequently a€ected); 6. 6. 38: night vision; 2. 8. 7 and 25 (cf. Hp. Prorrh. 2. 7: ix. 24 6 L): tabes (CML i. 60. 12 13; 183. 22 3; 274. 10 12; 67. 21 68. 3 and 72. 17 19). 82 Cels. Med. 3. 23. 1 (CML i. 138. 13 17). 83 Scrib. Larg. Comp. 18 (21. 1 3 S). 84 Cels. Med. 2. 8. 16 (cf. Hp. Aph. 5. 32 and 33: iv. 452, 544 L): vomiting blood; 2. 8. 7: tabes; 6. 18. 9c: venesection; 4. 11. 2: spitting blood (CML i. 70. 2 4; 67. 21 68. 3; 295. 22 3; 162. 15 16). Intermittent bleeding is also advised for men, who may become dependent on a regular ¯ux of haemorrhoidal blood, so bringing the sexes somewhat closer.

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never discusses the role of menstruation in reproduction, or in normal female functioning more generally, as such.85 This narrow, corporeal, understanding of female health contrasts starkly with the cultural well being of the sanus homo.

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The normal woman revisited Menstruation also enjoys pride of place in Dioscorides' and Pliny's orderings of points of medically e€ective contact between various types of things in the world and women, but this profusion is the product of quite a di€erent set of attitudes and concerns from those of Celsus, illustrating the reversal of perspective between the two. The vast majority of these medically and menstrually e€ective materials, which total well over a hundred in Dioscorides and just under this ®gure in Pliny, are described simply as having the power to put the menses in motion.86 Dioscorides most frequently uses the verb `to drive' (a5gein) and its derivatives in this connection, along side `to move' (kinei9 n) and other words invoking drawing down and expulsion, and the theme is so persistent that it sometimes appears in the initial listing of the dynameis of an item, before the delineation of any more speci®c applications.87 The plant kostos (ko3stow), for instance, has `heating, diuretic, and menses driving power'.88 Pliny uses `to move' (ciere) and its cognates, as well as the more vigorous `to pull' (trahere), and `to drive' 85 Cels. Med. 2. 8. 41 (cf. Hp. Aph. 5. 39: iv. 544 L): lactation; 2. 7. 27 (cf. Hp. Aph. 5. 40; iv. 544 L): furor (CML i. 76. 19 20, 64. 1 3). 86 By my calculations, Dioscorides mentions the menses 137 times, and Pliny explicitly mentions the menses, as something to be a€ected only, 91 times (excluding the vaguer references to female purges (purgationes) or purging (purgare) and the speci®c references to the female ¯ux (pro¯uvia), which are indiscriminately translated as menstrual in the Loeb). The references are (almost all) collected in Isidor Fischer, Die GynaÈkologie bei Dioskurides und Plinius (Vienna: Springer, 1927), who helpfully classi®es them according to the precise formulations in which they appear. By contrast, despite his concern, Celsus provides only a single remedy for driving menstruation (Med. 5. 21. 1b: CML i. 207. 15 18). 87 See Fischer, GynaÈkologie, 8 9, for references to each formulation. 88 dy3namin de4 e5 xei uermatikh3n, dioyrhtikh3n, e1 mmh3nvn a1gvgo3n, Dsc. MM 1. 16. 1 (i. 22. 6 W). On the identi®cation of kostos see Fred Rosner (ed.), Moses Maimonides' Glossary of Drugs (Memoirs of the American Philosophical Society, 135; Philadelphia: American Philosophical Society, 1979), 235 6.

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(pellere), together with a number of even vaguer formulations about `helping' (adiuvare or prodesse) the menses.89 Within this horde there are a few explicit references to cases of menstrual retention, and there are also substances that check or restrain menstruation, which is occasionally speci®ed by Pliny as excessive, but otherwise left unadorned.90 Pliny comes closest to Celsus, particularly in the cases in which the menses themselves drop out, leaving `women's excess' (`abundantiam mulierum') as the object of treatment.91 The most striking aspect of all this, however, is the basic independence of menstruation, and the ability to a€ect it, from any pathological concerns; and though the only recipe targeted at the menses by Scribonius is for cases of their retention, Thessalus includes one that simply `brings down' (katagei9 n) the menstrual ¯uid (katamh3nia in Greek, from which the somewhat archaic English `catamenia') as well as one compound for stopping them if their ¯ow is contrary to nature.92 Isidor Fischer suggested some seventy years ago that the primary purpose behind moving the menses was, in fact, abortion, since pregnancy was an obvious cause of their cessation, and, more recent scholars have generally con curred.93 Riddle concludes, for instance, that `Dioscorides intended an emmenagogue action to be interchangeable with an abortifacient action'.94 However, modern preoccupations should not be allowed to distort the ancient order of things, 89 See Fischer, GynaÈkologie, 10 11, for references. Pliny is, of course, often translating or paraphrasing a Greek original, a version of which may also sometimes be found in Dioscorides. 90 Dsc. MM 3. 24. 2 and 55 (ii. 35. 2, 69. 4 5 W), and 5. 54. 2 and 61 (iii. 31. 18, 33. 15 W): menstrual retention; 1. 125. 2 (i. 114. 12 W), 3. 43 (ii. 55. 10 W), and 5. 146 (iii. 102. 3 5 W): stopping the menses. Pliny, HN 20. 96. 258, 21. 89. 156, 22. 71. 147 and 74. 156, 27. 13. 30 (iii. 377. 13 14, 430. 2 3, 486. 12 13, 489. 10 11; iv. 239. 4 M): menstrual retention; and e.g. 23. 71. 138: stopping excess; 23. 32. 66 and 23. 60. 112: just stopping (iv. 44. 14 15; 22. 6 7 and 35. 21 M). 91 HN 24. 42. 72 (iv. 78. 14 15 M). 92 Scrib. Larg. Comp. 106 (57. 11 S); Thessalus 1. 5. 3 (kykla3minow, that is cyclamen, the herb of Leo), `brings down', and 1. 4. 1 (sy3mfyton, comfrey, the herb of Cancer), stopping (108. 11 13 and 104. 8 9 F). 93 Fischer, GynaÈkologie, 8. 94 John Riddle, Contraception and Abortion from the Ancient World to the Renaissance (Cambridge, Mass.: Harvard University Press, 1992), 50.

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and it must be remembered that women are just as likely to have brought down the menses in order to have children as the reverse. Menstruation was, after all, understood to be an essential prerequisite for conception even more clearly than it was understood to mark the premature end of a pregnancy. What is being presented is a range of menses regulating potentialities inherent in the world which, because of the link between menstruation and childbearing, might be humanly employed in a number of ways; but these possibilities are left entirely open, and that is important. There is also little indication that this regulation was seen as the practical result of a conception of menstruation as the key to female health; it seems more likely that, in so far as these authors draw on popular medical traditions, the number of entities that are classi®ed as potentially regulative of menstruation must re¯ect a general concern of women, their wish to be able to a€ect these processes, but for reasons as much reproductive as healthful, and more habitually homoeostatic than actively therapeutic.95 An examination of the speci®c points of medically e€ective contact with the reproductive process itself that appear in these texts, and the patterns they make, helps to clarify these matters, as well as being signi®cant in its own right. The ®rst point of potential intervention into the procreative process is syllepsis (sy3llhciw, or, in Latin, conceptus), that is the taking hold of the seed and any other necessary ¯uids in the womb.96 In Dioscor ides, only three items (hare rennet, darnel, and carrot) have a particular application which `assists towards syllepsis'.97 Pliny suggests that rather more substances (also including the carrot) help (or occasionally cause) conceptus, though some of these suggestions remain unendorsed.98 He also describes a number 95 See Amy Richlin, `Pliny's brassiere', in Judith Hallet and Marilyn Skinner (eds.), Roman Sexualities (Princeton: Princeton University Press, 1997), 197 220, for discussion of this point. 96 Conceptus can also mean that which has been conceived, that which is carried in the womb, though Pliny usually uses partus (also meaning birth) in this case. 97 Dsc. MM 2. 75. 1 and 100 (i. 150. 12 13, 175. 6 8 W); 3. 52. 2 (ii. 66. 8 9 W). All are variations on syllh3cei synergei9 . 98 HN 20. 3. 6 and 15. 32, 22. 40. 83, 24. 6. 12, 27. 40. 63, 28. 27. 97 and 77. 255, 30. 43. 125 and 126, 31. 7. 10 (iii. 304. 5 6, 312. 5 6, 466. 2 3; iv. 58. 6 7, 248. 17 19, 308. 25 309. 2, 363. 13 14, 466. 6 and 7 8; v. 5. 3 4 M). He

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of things which more generally promote female fertility (fecun ditas), or are good for barrenness (sterilitas) in women; there is only one equivalent male application.99 Celsus includes only one remedy for non conception.100 The proportions in these works, however, are reversed with the results. Pliny mentions only one item (an amulet made from the worms out of a hairy spider and deerskin) which prevents conceptus, which he excuses on account of the existence of women of excessive fecunditas, but otherwise refers to things that cause sterilitas primarily in order to prevent their being given to women, and even, on occasion, to men.101 In Dioscorides, on the other hand, procreative prohibitors are plentiful and discussed in some detail. Most frequent is the simple statement that a given substance is atokios (a1to3kiow, that is an infertility agent), while drug actions may be described as `extinguishing generation' or `producing non conception'.102 Methods of application may be left entirely open or the speci®cations may include not just vehicle and quantity but also timing. Several are taken or applied before intercourse (one after), or they may follow the purging of the womb or childbirth.103 In the former instances it is clear that it is only a temporary measure that is being taken (however often), while others indicate a more long term per spective. Where the sex of the users of the material is speci®ed, either explicitly or implicitly, they are always female, but this also includes a Magian recipe for forcing an unwilling woman to conceive: 30. 49. 142 (iv. 472. 4 5 M). 99 See e.g. NH 20. 22. 48, 28. 77. 248, 30. 44. 130, and 30. 45. 131: fecunditas (iii. 316. 11 13; iv. 361. 6 8, 467. 20 1, 468. 7 M); 28. 13. 52, 31. 4. 8: sterilitas (iv. 293. 6 8; v. 4. 11 12 M); 28. 77. 249: male (iv. 361. 8 9 M). 100 Cels. Med. 5. 21. 7 (CML i. 207. 32). 101 Examples include HN 29. 27. 85: `ne concipiant' (iv. 398. 13 M); 20. 44. 114 and 31. 7. 10 (iii. 335. 6 7; v. 5. 6 7 M); 27. 17. 34 and 27. 55. 80 (iv. 240. 12 13, 253. 18 19 M): the ®rst two concern sterilitas generally, the second pair are speci®c to women; 24. 47. 78 (iv. 80. 14 15 M): ivy makes even men `sterile', this obviously being a tougher job than having the same e€ect on women. 102 See e.g. Dsc. MM 1. 77. 2 and 1. 179. 3: a1to3kion e1 sti (i. 77. 7, 250. 5 W); 3. 45. 1 and 58: gonh4n sbe3 nnysin (ii. 57. 10, 71. 2 3 W); 4. 185 and 5. 80: a1syllhmci3 an poiei9 (ii. 334. 6 7; iii. 52. 18 W). 103 Examples include Dsc. MM 1. 77. 2: before intercourse (i. 77. 7 W); 1. 159. 3: after intercourse (i. 225. 10 11 W); 4. 19: after purging (ii. 184. 10 12 W); 2. 120. 3: after birth (i. 194. 5 W).

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occurs in only half the cases. Moreover, `it is reported that drinking [honeysuckle (perikly3menon) leaves in olive oil] for thirty seven days makes [people] seedless', and similar things are said of the lower part of the gladiolus (jifi3 on) root, suggesting that the physical part of the control of reproduction was not popularly assumed to be an exclusively female occupa tion.104 Also focused around this reproductive starting point, though extending some way to either side of it, are various items that may be utilized in order to a€ect the type of procreative outcome there will be, not just to assist in its achievement per se. These are, overwhelmingly, measures to determine the sex of any progeny. Syllepsis itself may be sexed, or interven tion may take place shortly afterwards (a conceptu or circum conceptum), relying perhaps on the ongoing moulding by the womb of what it contains, as suggested by the phrase `it forms males' (mares ®gurat) in one such case.105 Pliny provides the largest number of these substances, while Dioscorides is more selective. The former reports that the thistle, birthwort (aris tolochia), and persicaria (crataeogonon) plants, the uterus, testicles, or rennet from a hare, and cock's testes, if used appropriately (usually taken internally), are said to produce male o€spring; while various mercuries and orchids o€er the full choice.106 The two options are covered either through a 104 e1 pi4 h2me3 raw de4 tria3konta e2 pta4 poue3 nta a1go3noyw poiei9 n i2 storei9 tai, Dsc. MM 4. 14. 2 (ii. 180. 9 10), and 4. 20. 2 (ii. 185. 12 13 W). Whether the people saying these things had a one- or two-seed model is, of course, not revealed. 105 See e.g. Dsc. MM 4. 189. 2: sy3llemcin uh3levw poiei9 suai (ii. 337. 8 W); Pliny, HN 26. 91. 162: feminam concipi (iv. 229. 1 M); 28. 77. 248: mares concipi (iv. 361. 5 M); 25. 18. 39 and 30. 43. 123: a conceptu (iv. 128. 23 and 465. 10 M); 28. 77. 254: circa conceptum (iv. 363. 6 M); 25. 54. 97: a conceptu . . . mares ®gurat (iv. 148. 21 2 M). 106 HN 20. 99. 263: thistle; 25. 54. 97 and 28. 77. 254: birthwort; 27. 40. 62: persicaria; 28. 77. 248: hare products; 30. 43. 123: cocks' testes; 25. 18. 39 40 and 27. 100. 125: mercuries; 26. 63. 97 and 27. 42. 65: orchids; and see also 26. 91. 162: thelygonon/arsegonon (iii. 379. 14 15; iv. 148. 21 2 and 363. 6 7; 248. 13 16; 361. 4 5; 465. 9 11; 128. 20 129. 4 and 268. 11 12; 207. 11 13 and 249. 12 13; also 229. 1 3 M). Interestingly, though birthwort (and the English name follows the meaning of the Greek name a1ristoloxei3 a that is `good birth') is the herb of Pisces in Thessalus (1. 12. 1 11: 175. 1 187. 15 F), reproduction does not appear anywhere in the substantial chapter enumerating its properties.

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correlation between the sex of the plant employed and that of the child generated or through a similar correlation with a part of the root, the larger part always being linked to males and the smaller to females. In the case of the dog orchid, the sex of the procreative partner consuming the root section must also be appropriately aligned with that of the progeny. In that of persicaria, both partners must take it in wine for forty days before conceptus, otherwise only the woman seems to be involved. Dioscorides' greater discrimination is demonstrated in his repetition of this motif only in his accounts of one mercury (lino3zostiw), persicaria (krataio3gonon), and the orchid (o5rxiw/orchis, which is also a word for `testicle'), though he is clearly drawing on the same sources as Pliny for many of the other entities listed above.107 Neither author fully commits himself to that which he reports, but the multiple connections between things that enrich the traditions upon which they rely are again revealed none the less. The recognition of a morpho logical resemblance between the tubers of the orchis and the human testicles, for instance, was re¯ected in their homonymy and the cluster of properties inhering in the plant.108 The next procreative period is also open to the in¯uence of a whole host of materials, and here the di€erences between the approaches of Dioscorides and Pliny to intervention in the reproductive process become even clearer. One aspect of this di€erence is that, while the pregnant woman herself is almost excised from Medical Materials, she appears reasonably regularly in the Natural History, though what she carries still receives most of the attention. The only exceptions to the invisibility of the female body which sustains the embryon (e5 mbryon, that is the embryo or foetus) in Dioscorides are his reports of two plants (kykla3minow, probably cyclamen, and the unidenti®ed o5nosma, or onosma) which are said to cause mis carriages if stepped over by a pregnant woman, and his more straightforward statement that if a pregnant woman takes a 107 MM 3. 124: persicaria; 3. 126. 2: orchis; 3. 189. 2: mercury (ii. 135. 3 7; 137. 1 3; 337. 6 9 W); but compare, for instance, 3. 128 (ii. 138. 5 139. 8 W) with HN 27. 100. 125 (iv. 268. 11 12 M), both on the same plant. 108 See on this point more generally, John McMahon, Paralysin Cave: Impotence, Perception and Text in the Satyrica of Petronius (Leiden: Brill, 1998), esp. 99 174.

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concoction of thelypteris (uhlypteri3 w, a fern) the result will be no di€erent (this also causes non conception in non pregnant women).109 Pliny records similar sayings about the onosma and ferns (®lices, including that called thelypteris by the Greeks), and adds reports that stepping over a vipera or amphisbaena (both snakes), or a raven's egg, or smelling the arum (dracunculus) plant, or setting eyes on a female sea hare has the same e€ect (abortum facit).110 Pliny's phrasing is often admonitory, warning or enjoining pregnant women not to come into contact with these things, something which Dioscor ides seems entirely unconcerned about, and he also instructs that rue (ruta) and watercress (sisymbrium) are plants that should be similarly eschewed, for the embryo (partus) is killed by the former and expelled by the latter.111 There are a couple of other items which Pliny advises should be simply avoided by pregnant women, and there are other things that may be of equally vague assistance to them; the bene®ts which may accrue to the partus itself are, however, more elaborately expressed.112 It may be `held fast' (continere), `preserved' (custodire), either unquali®edly or speci®cally against miscar riage (contra abortum), or `quickened' (maturare).113 Dioscorides makes no reference to this kind of e€ect, listing only things that move or harm, rather than hold or shelter, the embryon. It can be driven (a5gein), drawn/drawn down/attracted (e7 lkein/kataspa9n/e1 fe3 lkein/e1 pispa9n), cast or shaken out (e1 kba3llein/ e1 ktina3ssein).114 The vocabulary is forceful, the force being 109 MM 2. 164. 1: cyclamen; 3. 131: onosma; 4. 185: thelypteris (i. 229. 13 14; ii. 141. 4 5, 334. 6 7 W); cf. the story that o1jya3kanua (a hawthorn) has a similar e€ect if it gently strikes the belly of a pregnant woman three times (MM 1. 93: i. 85. 14 16 W). 110 HN 27. 86. 110: onosma; 27. 55. 80: ®lices; 30. 43. 128: vipera and amphisbaena; 30. 44. 130: raven's egg (causes miscarriage through the mouth); 24. 92. 143: dracunculus; 32. 3. 8: sea-hare (iv. 263. 8; 253. 18 19; 467. 2 3; 101. 10; v. 51. 5 6 M). 111 HN 20. 51. 143 and 20. 91. 248 (iii. 343. 26 344. 1, 374. 1 2 M). 112 See e.g. HN 23. 80. 153 and 25. 34. 71: to be avoided; 23. 26. 53 and 28. 77. 247 (iv. 49. 18 19 and 140. 1 2; 17. 20 18. 1 and 360. 15 16 M). 113 Examples include HN 28. 27. 99: continere; 28. 77. 246: custodire; 30. 43. 124: custodit partus contra abortus; 30. 43. 123: maturat (iv. 309. 8 9; 360. 14; 465. 16 17; 465. 11 12 M). 114 See e.g. MM 1. 19. 4: a5gei (i. 25. 19 20 W); 3. 44. 2: e7 lkei (ii. 56. 8 10 W); 1. 20. 2: kataspq9 (i. 27. 2 W); 1. 67. 2: e1 fe3 lkei (i. 61. 8 W); 2. 109. 1:

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apparently exerted on the embryon not by the woman, and there is no indication given of whether the embryo survives these actions. This is not, however, due to Dioscorides' reticence on such matters, and absolutely no ambiguity attends the sub stances which destroy (fuei3 rein) or kill (ktei3 nein) the embryo, or extract it after death.115 He is concerned only to describe the dynameis of things, the results of their various applications to the human body, endorsing their ecacy without passing comment on anything else. Pliny, however, having earlier announced that, unlike the wicked Greeks, he will not mention abortifacients (abortiva), love potions (amatoria), or any other ominous magic (magica portenta)Ðindeed, having suggested that abortiva are worse than poisons since there are some circumstances in which the latter may be bene®cially employedÐpresents much of the same material in a quite di€erent way.116 With four exceptions, he quali®es any move ment of the partus with the condition that it is already dead, though the language remains otherwise similar.117 His disem bodied references to putting it in that state are as discouraging as those addressed to the pregnant woman, and so are his reports of substances abstractly productive of miscarriage (abortum facere), except for a couple of statements clearly ascribed to others.118 Dioscorides thus pursues a policy which e1 pispastiko3n (i. 184. 6 7 W); 2. 24. 1: e1 kba3llei (i. 129. 9 W); 2. 80. 4: e1 ktina3ssei (i. 163. 12 W). 115 See e.g. MM 1. 6: fuei3 rei; 1. 78. 2: ktei3 nei; 3. 32. 1: teunhko3ta e5 mbrya e1 ktina3ssei (i. 11. 6; 78. 19; ii. 42. 6 W). These also help to clarify the meaning of the other measures, which should be taken precisely as Dioscorides formulates them and not construed more narrowly as simply abortifacients. `Driving' the embryon might be part of a birth in which its position badly impeded its exit, for example, as well as being something which might occur at an earlier stage (see e.g. Pliny, HN 26. 90. 153: iv. 226. 7 8 M). 116 HN 25. 7. 24 5 (iv. 124. 5 17 M). 117 The exceptions are HN 20. 40. 105, 23. 53. 99, 24. 97. 154 (iii. 333. 2; iv. 31. 15, 105. 5 6 M); and 26. 90. 153 for a dead or stuck partus (iv. 226. 7 8 M). References to extracting the dead foetus number twenty-®ve and can be found, together with a discussion of their relationship with Dioscorides, in Fischer, GynaÈkologie, 6 7. 118 Examples include, HN 21. 84. 146, 27. 113. 139, and 28. 77. 251: warnings against killing the partus or miscarriage (iii. 427. 7 8; iv. 273. 1 2, 362. 3 4 M); 20. 84. 226: neutral report of causing miscarriage from Olympias (iii. 366. 17 18 M).

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may be described as pro knowledge, o€ering a reproductive regulation which is numerically weighted towards prevention; Pliny pursues a pro natalist policy and edits his information accordingly. The strength of Pliny's opposition to the promotion of miscarriage in this way is striking, and Dioscorides is more representative of the medical tradition as it dealt with the e€ects of various materials on the human body in this respect. As Scribonius was aware, the Hippocratic oath prohibited giving women certain abortive prescriptions, and this was part of an ongoing medical debate on the matter.119 None the less, Scribonius' use of this text to stress the greater protection due to the certain life of a fully formed human being (such as a pregnant woman) than to a foetus that has not yet reached, and might never reach, that stage, represents the dominant view in these discussions; discussions that others chose to ignore entirely. Pliny's perspective is quite di€erent from, almost the reverse of, all these. For him, abortion is a particularly cruel reminder of the frailty of human life, of its uncertain beginnings; a cruelty emphasized by the fact that it is women's invention and business, that it is women who thus have proud men's futures in their hands.120 This does, however, tie in with wider concerns in Roman society, where abortion was deemed problematic only when it became a woman's means to obstruct a man's acquisition of legitimate heirs and pursue instead her own priorities, most dangerously (and characteristically in the eyes of the moralists) adultery and vanity; indeed, a rescript of Severus and Caracalla, made it a punishable o€ence for a woman to abort a potential heir without the consent of the man whose heir was in question.121 Other laws condemned 119 Scrib. Larg. Comp. epist. 5 (2. 20 3 S, and quoted above). See Sor. Gyn. 1. 60. 2 4 (CMG iv. 45. 8 18, also discussed in Ch. 4 below, p. 239); John of Alexandria, Commentary on Hippocrates' On the Nature of the Child 18 (CMG xi. 1.4. 146. 16 32), and Theodorus Priscianus, Gynaecia 6. 23 (241. 4 15 Rose) for evidence of these debates. 120 HN 7. 5. 43 4 and 10. 83. 172 (ii. 16. 1 12 and 270. 21 3 M). 121 Such a dispute was most likely to arise after a divorce, see Dig. 48. 19. 39, and also 47. 11. 4, together with the discussion in Jane Gardner, Women in Roman Law and Society (London: Croom Helm, 1986), 158 9. On vain and adulterous abortions see e.g. Sen. ad Helv. 16. 3; Gell. 12. 1. 8; and Tac. Ann. 14. 62 3.

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those who provided abortifacients or love potions, and even drugs `for conception' (ad conceptionem), which, however unintentionally, killed the recipient.122 Celsus avoids all this as he provides only two recipes, and describes a surgical operation for drawing out a dead foetus.123 He claims this surgical process is among the most dicult there are, attended by great danger but revealing the amazing (mirabilis) nature of the vulva. It is this, therefore, that may have caused its detailed inclusion, rather than any other considerations. Thus, more striking than the content and direction of his references to reproduction is their relative paucity, a reticence Scribonius, and Thessalus take even further. Despite the manifest di€erences in how they present knowledge about it, both Dioscorides and Pliny see the world around them as richly provided with materials a€ecting, or e€ective in, human generation, largely, but not exclusively, as it was undertaken by women; whereas Celsus, Scribonius, and Thessalus either see no such thingÐperhaps because they are looking the wrong way, at the human being rather than at the world through the human beingÐor choose to ignore it, for whatever reason. Celsus certainly considered that there were limits to the proper and necessary male medical knowledge, and that `modesty' (pudor) and the `principles of the art' (artis praecepta) may make con¯icting demands which are only partially alleviated by using Greek technical terminology rather than words of homespun coarseness.124 Scribonius may also have been mindful of his audience, and it is interesting to note that he never attaches the name of any lady of the imperial household to a speci®cally female remedy. Thessalus' silence on these matters emphasizes the technical, specialized, char acter of his text: how distant it is from the broader engagement with everyday life (of which reproduction is an essential element) that is so evident in tracts that super®cially seem to share many features with it, such as the Cyranides, with its 122 Dig. 48. 8. 3. 2 (where it is also assumed that the donor is a woman) and 48. 19. 38. 5. 123 Cels. Med. 5. 21. 5 and 5. 25. 13: recipes; 7. 29. 1 10: surgery (CML i. 207. 28 9, 214. 15 16, 356. 5 358. 16). 124 Med. 6. 18. 1 (CML i. 290. 12 17); and see von Staden, `Apud nos foediora verba'.

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similar correlations of stars, herbs, and stones. Indeed, perhaps this technical ambition and concomitant disengagement from the mundane occurrences of childbearing is also part of Scribonius' and Celsus' agendas, in contrast to the more inclusive approach of Dioscorides and Pliny. Whatever the case, however, the attitudes to the relationship between med icina and reproduction evinced in these texts are clearly di€erent in several ways. For birth itself, both Dioscorides and Pliny o€er a range of materials which may be generally bene®cial, assisting or speed ing it up, or speci®cally helpful in a dicult case.125 Both include a number of amulets for these purposes, and Pliny also records some rather more complex procedures, such as suc cessfully concluding an arduous birth by throwing a light cavalry spearÐpulled from a human body without its touching the groundÐover the house in which the woman is in childbed.126 Following this, the removal of the afterbirth, general post parturient purging, and the bringing on, or halting, increasing, or improving, of lactation may all be achieved pharmacologically.127 Pliny also refers to treatment of hairiness of the breasts resulting from giving birth, and this is also a more generally actionable problem.128 Similarly, a range of materials and recipes are variously o€ered for keeping the breasts ®rm and upstanding, or preventing them from growing.129 These latter 125 See e.g. Dsc. MM 3. 14. 2: speedy birth (ii. 180. 8 9 W); Pliny, NH 22. 44. 89: helping (iii. 467. 20 M); MM 1. 47. 2 (i. 45. 11 12 W) and HN 24. 13. 22 (iv. 61. 14 15 M): for dicult birth. Pliny and Celsus also provide for the pains of giving birth: HN 28. 77. 249 (iv. 361. 14 M) and Med. 5. 25. 14 (CML i. 214. 17). 126 See e.g. Dsc. MM 5. 142 and 154, and Pliny, HN 28. 9. 42 (iii. 100. 16 17 and 105. 2 3 W; iv. 290. 11 13 M): amulets; HN 28. 6. 34: missiles (iv. 287. 5 10 M). 127 Examples include MM 3. 4. 4 and 31. 1, and HN 27. 94. 120: afterbirth (ii. 7. 20 8. 3 and 40. 14 W; iv. 267. 3 4 M); MM 3. 71, and HN 20. 81. 214: purging (ii. 82. 6 7 W; iii 363. 16 17 M); MM 1. 103. 2, and HN 24. 59. 100: increase milk (i. 95. 78 W; iv. 87. 11 M); MM 4. 78. 2, and HN 23. 32. 67: stop milk production (ii. 240. 10 12 W; iv. 22. 9 M). 128 See e.g. HN 26. 92. 163: hairiness from birth; 32. 46. 129: general mammary hairiness (iv. 229. 9; v. 93. 3 4 M). 129 See e.g. HN 25. 95. 154 and 30. 45. 131 (iv. 166. 17 18, 468. 5 M): keeping breasts ®rm; 27. 53. 76 and 32. 46. 129: stopping breasts from

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substances may be operative speci®cally in young girls rather than being of general application, and on one occasion Dioscor ides pro€ers a male parallelÐnon development of the didymoi in boysÐand there are other things that have a more global power to keep boys (or possibly children of both sexes) imma ture (a5nhbow) or, in Pliny's Latin, inhibit pubertas (maturity).130 Pliny says quite plainly that knowledge of these pubertas preventing powers is of interest to slave dealers and, though he does not say it, being able to make the female body more marketable would have been similarly appealing. The market in women, of course, extended, in a more metaphorical sense, far beyond the edges of the auction block, and it may be that the comparative reticence on this point re¯ects the rather more blurred boundaries between aspects of female servitude and the overall cultural construction of womanhood than between their male counterparts. It is also the case, however, that the normal woman is consistently characterized by a profound concern with her appearance more generally. The vast majority of cosmetic measures are speci®cally labelled for women, and not only does Pliny constantly inveigh against female vanity, but the far more rhetorically restrained Celsus complains that `to treat pimples, spots, and freckles is almost absurd, but it is not possible to tear women away from care for their appearance'.131 Therapeutics and women There is also a distinctive pattern of female pathological conditions and cures that emerges across all these texts, focused on the regions around the womb and breasts. It is the former that enjoys the most popularity and variety in terms of diseased dispositions which may be materially alleviated. The womb growing (iv. 252. 17 18; v. 93. 4 5 M); Dsc. MM 4. 19 and 78. 2, 5. 149 (ii. 184. 9 12 and 240. 11; iii 102. 14 15 W): stopping breasts from growing. 130 MM 4. 78. 2 (ii. 240. 11 12 W): male parallel; 2. 105. 1 and 4. 62 (i. 179. 16 180. 1; ii. 216. 12 13 W), a5nhbow; HN 21. 97. 170 (iii. 434. 10 11 M): pubertas. 131 `paene ineptiae sunt curare varos et lenticulas et ephelidas, sed eripi tamen feminis cura cultus sui non potest', Cels. Med. 6. 5. 1 (CML i. 257. 30 258. 1); and see e.g. Pliny, HN 21. 88. 153, 21. 91. 159, 22. 47. 98, and 32. 27. 84 (iii. 429. 9 10, 430. 19 20, 471. 6 7; v. 77. 21 M).

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and its surrounding area may become: cold, ¯uid or haemor rhagic, in¯amed, distorted, constricted, lax, in¯ated or swollen, closed, ulcerated, ®stulated, subject to growths or malignan cies, indurated, painful, irritated or prolapsed; all states which are relieved by any number of remedial substances.132 These are all common diseased dispositions, to which most parts of the body are susceptible; though the womb's attraction of the whole gamut of such conditions in Dioscorides and Pliny is organically distinctive, and not replicated by other authors. Celsus somewhat compensates for his reluctance over these common conditions with his detailed discussion, under the general heading of internal wounds, of the wounded womb.133 The e€ects of such a piercing of the uterus are notable, they include pain, profuse bleeding, vomiting, speechlessness and mental derangement, and disorientation. Celsus himself draws attention to the experiential similarity between dying from a wound in the womb and one in the heart, and otherwise this collection of symptoms most clearly resembles that following a wound in¯icted on the brain or its covering, both heart and brain being particularly critical for life.134 He also speaks of the surgical repair of abdominal rupture from uterine exit, and 132 Examples include Dsc. MM 1. 4. 2 (i. 10. 6 W): cold; MM 1. 70. 2 (i. 67. 2 W): ¯uid; MM 4. 36 (ii. 196. 7 8 W): haemorrhagic; MM 1. 7. 4 (i. 12. 16 W), Pliny, HN 28. 13. 50 (iv. 293. 7 M), Cels. Med. 5. 25. 3 (CML i. 213. 10): in¯ammation; MM 1. 32. 2 (i. 37. 12 W), HN 24. 13. 22 (iv. 61. 15 16 M): distorted; MM 1. 23 (i. 28. 6 W): stricture; MM 1. 13. 3 (i. 18. 12 W): laxity; MM 3. 31. 2 (ii. 41. 10 11 W), HN 29. 11. 44 (iv. 383. 12 13 M): in¯ated; MM 1. 58. 2 (i. 53. 23 4 W), HN 24. 120. 184 (iv. 115. 1 M): swollen; MM 2. 149. 1 (i. 215. 5 W), HN 20. 22. 48 (iii. 316. 12 M): closed; MM 1. 45. 2 (i. 44. 15 16 W), HN 22. 65. 134 (iii. 482. 8 M), Med. 2. 7. 10 (CML i. 61. 5 6): ulcerated; Med. 5. 28. 12b (CML i. 243. 14): ®stulated; MM 1. 72. 2 (i. 70. 24 W): growths; MM 3. 92 (ii. 106. 9 W): malignancies; MM 1. 50 (i. 47. 5 6 W), HN 21. 104. 176 (iii. 436. 7 M), Med. 5. 20. 2 (CML i. 207. 19): hardness; MM 2. 81. 2 (i. 165. 2 3 W), HN 21. 85. 148 (iii. 427. 20 M): painful; MM 2. 124. 3 (i. 197. 3 W), HN 28. 28. 110 (iv. 312. 23 4 M): irritated; MM 1. 101. 2 (i. 93. 11 12 W), HN 22. 15. 31 (iii. 449. 20 450. 1 M), Med. 6. 18. 10 (CML i. 296. 24): prolapse. The total references in Dioscorides and Pliny each reach into triple ®gures, and this includes, in Pliny, many materials simply labelled `for ills of the womb' or something similar, e.g. 21. 73. 123 (iii. 421. 1 2 M); and Thessalus also includes a compound plaster from kalli3 trixon (Venus' herb) that cures all diatheseis in the womb (2. 6. 5: 243. 6 7 F). 133 Cels. Med. 5. 26. 13 (CML i. 217. 29 34), cf. 5. 26. 3a (CML i. 216. 4 7). 134 Med. 5. 26. 14: wounded brain (CML i. 218. 1 7).

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Pliny mentions damage to the womb following parturition, but the vast majority of these myriadal uterine disorders are with out cause or context, being simply one point of useful pharma cological purchase suspended among others.135 In Dioscorides and Pliny the breasts are susceptible to a similar, if smaller, group of common conditions: in¯ammation, swelling, induration or hardening, and various kinds of ulcera tion and malignancy, and some of these conditions may result speci®cally from giving birth.136 Celsus is again more referen tially reluctant, noting only that cankers (carcinomata) and growths (strumae) may appear on the breasts as well as other places.137 Mammary hardness (duritia), accompanied by per sistent pain, is also the only speci®cally female ailment to which Scribonius devotes a whole chapter, and therefore recipe, though this is due to a dispute about its curability.138 He treats suppurations of the breasts like any other break of ¯eshly continuity, including war wounds.139 Distinct from the other conditions of the womb, and organ ically and sexually unique, is hysterike pnix (y2sterikh4 pni3 j, that is uterine su€ocation, or, in Latin, strangulatio vulvae), which starts from the womb, and can be treated as such, or as some thing a€ecting the whole woman, who may then require reviving after an attack, like an epileptic, and can be classi®ed according to her condition.140 Thus, in Dioscorides, the phrase `hysterikai pniges' (that is women su€ering from uterine su€ocation) is equivalent, for example, to `asthmatikoi' (a1sumatikoi3 , those 135 Med. 7. 17. 1 (CML i. 334. 13 14); Pliny, HN 26. 90. 151 (iv. 225. 15 16 M). 136 See e.g. Dsc. MM 3. 44. 2 and 122 (ii. 56. 13 14, 133. 7 W): in¯ammation; MM 4. 68. 4 (ii. 226. 12 W), and Pliny, HN 21. 77. 132 (iii. 423. 24 5 M): swelling; MM 5. 3. 2 (iii. 3. 4 5 W), and HN 20. 44. 114 (iii. 335. 10 M): hard; HN 27. 40. 63 and 30. 43. 125 (iv. 249. 1, 465. 21 466. 1 M), and MM 3. 92 (ii. 106. 9 W): ulceration and malignancy. 137 Med. 5. 28. 2a and 5. 28. 7a (CML i. 236. 16 18 and 240. 14 16). There are more references to the breasts as good indicators of the status of pregnancy. 138 Scrib. Larg. Comp. 102 (54. 17 55 S). 139 Ibid. 206 (95. 18 S). 140 Examples include Dsc. MM 1. 33. 2 and 2. 81. 2 (i. 37. 25 38. 1, 165. 2 3 W), and Pliny, HN 20. 57. 162 and 21. 86. 149 (iii. 349. 22 3, 428. 3 4 M): womb/woman; MM 2. 154. 2 and 5. 128. 1 (i. 220. 12; iii. 96. 4 W), and HN 20. 87. 238 (iii. 370. 11 12 M): rousing su€erer.

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su€ering from respiratory disorders) or `nephritikoi' (nefritikoi3 , those with kidney problems) in delineating a class of sick persons, and in Pliny strangulatio vulvae is the only disease that attains any kind of independent existence, escaping from a purely therapeutic context to appear in both his holistic and piecemeal descriptions of humanity.141 Celsus, in his head to toe enumeration of the ailments a€ecting each part, opens the chapter following that on the intestines and bowels: `From the womb of a woman there arises a violent malady', a malady which knocks its su€erers down and out in a manner comparable to epilepsy (through there are di€erences of detail).142 Celsus also, implicitly, rejects the notion that any actual movement of the womb is involved in this ailment, as it is on the Hippocratic model, while the terminology Pliny uses about the uterine state underlying strangulatio (conversione and versa) is ambiguous as to whether change in location or just con®guration has occurred; and Dioscorides makes no explicit reference to the condition of the womb at all, but drops contradictory hints about it: on the one hand, sometimes connecting su€ocation and uterine distor tion (diastrofh3), and, on the other, occasionally employing fumigation as a remedy (though more often to rouse the victim than to in¯uence the womb itself).143 Thessalus also recom mends sitting over boiling mugwort or wormwood (a1rtemisi3 a, the herb of Scorpio) as a therapy for a woman having su€ocation of the womb, but without further explanation.144 Similarly, the female ¯ux (r2oy9w gynaikei9 ow, or in Latin, pro¯uvia feminarum) presumably starts from the womb, but has spread outwards, becoming attached to women generally rather than any par ticular part of them.145 141 See e.g. MM 1. 1. 3 and 72. 2 (ii. 2. 12, 83. 12 3 W), and HN 7. 52. 175 and 11. 84. 209 (ii. 61. 7 19, 351. 3 4 M). 142 `Ex vulva quoque feminis vehemens malum nascitur', Med. 4. 27. 1a (CML i. 180. 7 12). 143 On Celsus see von Staden, `Apud nos foediora verba', 274 6. For Pliny, see HN 7. 52. 175 and 11. 51. 209 (ii. 61. 7 11, 351. 3 4 M); for Dioscorides, MM 1. 33. 2 (i. 37. 25 38. 1 W): diastrofh3; 1. 73. 2 and 2. 7 (i. 73. 9 10, 124. 102 W): fumigation. 144 Thessalus, 1. 8. 6 (147. 1 3 F). 145 See e.g. Dsc. MM 1. 93 and 97. 2 (i. 85. 12 3, 88. 6 W), and Pliny, HN 24. 42. 70 (iv. 78. 2 M). Dioscorides also refers to the white ¯ux (3. 56: ii. 70. 1 2 W), and the red ¯ux (e.g. 3. 140. 3: ii. 150. 9 W), as well as the blood-¯ow

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Scribonius makes no direct reference to the womb at all, though it may be included among the `female places' (muliebria loca), the duritia of which may be softened by an antidote for lower back pains and paralysis.146 It is more likely, however, that this is a designation for the female genitalia, not reaching as far as the womb. Pliny also speaks of the muliebria loca (or muliebres partes/female parts) on occasion (though he more often mentions the male parts, or virilia), and Dioscorides uses the even vaguer designation `gynaikeia' (gynaikei3 a, that is just `female things').147 Celsus is rather more expansive on at least one treatment a€ecting this area, describing the surgical procedure in cases where agglutination of the female genital opening does not allow intercourse, a condition which a female child may be born with or develop later from ulceration and subsequent symphysis.148 This comes after his almost complete inability to mention the female genitalia in his pharmacological books, where an apology for the medical need to deal with the obscene parts (partes obscenas) introduces a passage that is almost exclusively male.149 This genital manoeuvre and the embryotomy that immedi ately follows it are labelled as peculiarly (proprie) female operations, and come after instructions covering most shared or exclusively male procedures. Prior to this, Celsus had noted sexual variations in essentially the same technique for the removal of bladder stone, and also the manual drawing o€ of urine which may be necessary in similar conditions.150 Or, rather, he had speci®ed the ways in which the treatment of women diverged from the male standard just outlined, re¯ect ing the di€erence in their external and internal somatic con ®guration. This di€erence is broadly bene®cial, and women require shorter, less curved catheters, which are easier to insert from the womb already discussed. Pliny also makes one reference to white ¯ux (22. 38. 81: iii. 465. 11 M), and Scribonius one to the red (121: 64. 9 11 S). 146

Scrib. Larg. Comp. 156 (77. 4 5 S). See e.g. Pliny, HN 28. 9. 41 (iv. 290. 8 M): muliebrium locorum; 32. 46. 134 (v. 94. 17 M): muliebri parte. Dsc. MM 1. 15. 2 (i. 21. 12 W). 148 Cels. Med. 7. 28. 1 2 (CML i. 355. 16 356. 4). 149 Med. 6. 18. 1 11 (CML i. 290. 12 297. 8); woman appears only brie¯y in sections 9 and 10. 150 Med. 7. 26. 1a c: urine; 7. 26. 4: stone (CML i. 345. 32 346. 25; 350. 29 351. 9). 147

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and manipulate, and are more easily rid of their smaller bladder stones. If a more complex operation is necessary, the surgeon should insert his ®ngers into the anus in virgines (as in males) and through the vagina (per naturale) in women, and his incision is also di€erentially located between the two. Finally, there is no need to be alarmed `if more blood ¯ows out of a female body'.151 Similarly, Dioscorides' pessaries are presum ably, like Celsus', an exclusively female form of pharmacolo gical application, inserted in the vagina, and injections and fumigations may also be, implicitly, similarly directed.152 Therapeutic variation also occurs on account of the delicacy of the female body in Scribonius and Pliny. As a general principle, Scribonius considers that medicaments may be more or less e€ective on account of `the variety of bodies and the di€erences of ages, times, and places', and makes particular reference, among this variety, to the delicate bodies (tenera corpora) of women and children.153 This requires a special, slower application of some eye salves and may also be why there is a speci®c salve labelled as `more useful for women'.154 Pliny separates the category of those with mollia or tenera bodies (or souls) from women; he even separates the somati cally womanly from women, though the pairs are clearly connected.155 Hellebore is not prescribed for the former, while being prescribed less for the latter than for men. Celsus himself advises that massage (frictio, one of the uni versal aids (communia auxilia), used in both sickness and health) be provided in di€erential quantities (measured by the number of times the hand passes over the body) to men and women, and according to age, on account of their di€er ential strength (vires).156 He does not hold, however, with the traditional prohibition against employing an even more uni versal aid, venesection, in pregnant women, or the old or 151 `si plus ex muliebri corpore sanguinis pro¯uit', Med. 7. 26. 4 (CML i. 351. 9). 152 See Cels. Med. 5. 21. 1 (CML i. 207. 11 12). 153 `corporum varietatem di€erentiaque aetatum temporumve aut locorum', Scrib. Larg. Comp. coda (117. 20 1 S). 154 `magis mulieribus prodest', Scrib. Larg. Comp. 34 and 20 (26. 17 18, 21. 23 4 S). 155 HN 25. 25. 61 (iv. 136. 13 17 M). 156 Cels. Med. 2. 14. 9 (CML i. 85. 10 11).

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157

young. Experience has shown that there is no unvarying rule in such cases, and that a woman who is pregnant and healthy may be bled safely (with good aftercare to ensure that there is still enough nourishment for two), whereas a woman who is not pregnant but weak will be in greater danger from such a treatment. This, then, is the pattern of medically a€ectable female parts that emerges from all these texts, despite their compositional variation; but it is the very existence of this pattern, its outline as it is discernibly threaded through the textual fabric, and threaded through in a particular way, that is its most distinctive feature, overshadowing the rather assimilative colours and textures that ®ll it out. The breasts, womb, and other pecu liarly female parts of the body become diseased and cured largely in the same way as any other somatic area, and though there are some points of speci®cation, these are not much elaborated as such. Childbirth as a cause of various ailments is obviously unique to women, and the sheer range of things that can go wrong with the womb is almost as impressive as its ability to put women into a state closely resembling death. It is this uterine su€ocation that is made the most of, but its femaleness and singularity is somewhat undermined by com parisons and connections with epilepsy. The subtlety of this speci®city, the slightness of the distinctively female, is, how ever, less signi®cant than its very being. This is a pattern that stands out from the rest of the text, where, though there is the occasional inkling of a pattern for children, the elderly, or even men, the ®rst two patterns are mere shadows of the female, and the last is simply the basic textual material showing its true colours. Celsus' nosography clearly follows his outline of anatomy in this respect and, in his description of diseases which a€ect a particular part of the body, the medical ®ction of the unitary human being breaks down in the lower abdomen, but is soon restored. The elision between the ®ctional unit and the male is then emphasized in the passage on seminal ¯ux which comes shortly after that on the uterus, for this condition cannot be assumed to apply to both men and women, but Celsus gives no 157

Med. 2. 10. 1 4 (CML i. 77. 22 78. 12).

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158

indications on the issue. That it de®nitely does apply to men is sucient for its incorporation in the main narrative. Simi larly, the female surgical operations in this area are marked either as minor amendments to, or major deviations from and thus placed after, the dominant, implicitly or explicitly, male model. These techniques are either similar (similes) in women, or peculiar (proprie) to women; in both cases women must be speci®ed away from the rest of humanity. Pliny articulates the same order slightly di€erently in each of the multiple strands which are woven into his work and world. In the books where organization by type of disease plays a major role, while male ailments such as those of the testicles (always external and therefore tacitly male in the Natural History) appear in their proper place, female conditions and complaints are excluded from this textual tour, and thus from the body it travels. Men's diseases occur in their correct location in the head to toe sequence of parts, and without either introducing any break in the continuity of the narrative, or requiring any sexual labelling or any suggestion that this is any di€erent from the coverage of the bladder or whatever else has preceded it, but women's do not. Instead, they are collected together and appended in a chapter which comes after all the main disease types have been dealt with, after all the somatic pieces have been enumerated, and together with chapters on other extraneous subjects such as infant illnesses, sopori®cs, depilatories, and aphrodisiacs.159 Where Pliny organizes his material by types of things in the world, as he does predominantly and Dioscorides does completely consistently, woman appears throughout: she is one of the categories into which they sort medical knowledge about the contents of the world; indeed, for Pliny she is also a category within the contents. There are medically e€ective items `derived from the bodies of women' as distinct from those taken from humanity in general.160 It is, moreover, this 158 Med. 4. 28. 1 2 (CML i. 182. 8 18); cf. Med. 4. 26. 11: pain descends to groin and testicles following wound to kidneys (CML i. 217. 24 5). 159 The female chapters are HN 26. 90. 151 26. 92. 163, 28. 77. 246 56, 30. 43. 123 30. 45. 131, and 32. 46. 129 34 (iv. 225. 11 229. 13, 360. 7 364. 2, 465. 6 468. 10; v. 92. 23 94. 19 M). 160 `ex mulierum corporis traduntur', HN 28. 20. 70 (iv. 300. 1 M) and see Richlin, `Pliny's brassiere'.

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distinction that marks the speci®city of the female category within the medical e€ects also, in both Dioscorides and Pliny. For each entity the listing of its powers and particular e€ects may include, for instance: heating or purging, driving of the urine or menses, bene®t to the in¯amed kidneys or breasts, and help for the pleuritic or su€erer from uterine su€ocation; from which range a category that might be called `speci®cally relev ant to women' emerges, and these measures are often named as such. However, while comparable classi®cations also emerge from this sorting, they are all along the lines of something like `speci®cally relevant to the kidneys' (a cluster which could be formed from references to the organs themselves, their func tions, and people characterized as nephritikoi), not anything like `speci®cally relevant to men'. Pliny provides a handful of explicitly and exclusively male remedies and Dioscorides none at all. Rather, it is the category of `implicitly relevant to men' that stands behind, and imparts coherence to, these otherwise discontinuous units of e€ective contiguity between external things and the human being as a medical construct. It is a category which comes so close to being coterminous with Dioscorides' project as a whole, and with a central chunk of Pliny's, indeed with the medical project itself, that its cat egorical status is concealed. There is, however, a small gap between the male and the human as an object of medical knowledge who de®nes the boundaries of these endeavours; for the di€erence between this category `speci®cally relevant to women' and any other kind, like that comprising everything connected to the kidneys, is that it is additional rather than integrative. It is this that cannot be integrated into the whole medical man standing behind the order of knowledge presented in the text but must be added to him to make a woman and thus complete humanity. There is no suggestion, however, that this supplement would in any way change the nature of what was being supplemented, and the units themselves are all presented as commensurate. As an abstract process, driving the menses is homologous to driving the urine, but the framework which gives these processes meaning places them on either side of the fundamental divide between the generic/male and the speci®c/ female.

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Scribonius and Thessalus also operate with two categories, the generic and the female, but the selectivity of their texts reduces the impact of this division, as does Scribonius' par ticular deployment of imperial women. Both aspire to a certain sort of completeness, of wholeness, and woman is a necessary part of this, but they do not attempt exhaustivity. Their selectivity, moreover, shares a certain technical preference for the diseased, rather than the normal or reproductive, woman.

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ROMAN SOCIETY AND THE MEDICAL WOMAN Taking a step back from the structure and substance of these texts, and returning to their overall shape and orientation, it is now possible to outline in a broader sense the trajectory that these literary projects, and the woman in them, describeÐto think more generally about how these works are positioned in imperial society as it includes women, as it organizes sexual di€erence, and as they both take from and give to that organization. This positioning is largely implicit, but it is none the less clear. All the authors of these works are, to di€ering degrees, engaged with women as sources of medical knowledge, as medical practitioners, and, of course, as recipients of a range of medical attentions. Women in each of these roles contribute to these literary products and the medical projects they articu late, but in a strictly subordinate sense. This subordination derives most strongly from the orientation of these texts to a male audience, an orientation both made explicit in their dedications and modes of address and emerging tacitly from their shape and substance; so that what women are contribut ing to are versions of what men should know about the medical art. They are, in this context, unusual and often dubious sources of knowledge, lesser practitioners, and, except where it comes to demanding cosmetic measures, largely passive and indirect recipients of medical services. Women's medical char acteristics, their particular patterns of health and disease, the appropriate treatments for them, are described not for their bene®t, but for the bene®t of their men. Women are not excluded from the body of medical knowledge itself, nor even

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from its construction, but from the ranks of those to whom this knowledge was presented, who were intended to act on it. This exclusion, indeed, seems in some senses to be an active removal of knowledge from women's grasp. First, there is the way in which women appear to put more into these texts than they get out. The actual practice of folk medicine, or rather folk medicines in all their undoubted plurality, in the Roman empire is of course obscure. What happened beyond the remit of the iatros or medicus, in areas geographically or economically separated from professional medical services, is largely unrecoverable; but all the indications there are point to a higher level of female participation than in more learned medicine. Hints of this female provision and practice also appear in the literary medical tradition itself, in Pliny and Dioscorides as well as elsewhere, thus heightening the contrast between the two. Of course, women's medical activity on the ground probably continued largely una€ected by literary developmentsÐafter all, few in the Roman world could read these kind of writings; but the changes that the literary presentation, the more philosophical reworking, of traditional knowledge wrought are none the less noteworthy. Secondly, there is the way these texts promise inclusivity and empower ment rather than the reverse. The organized knowledge they o€er is cast as enabling, and, at least inasmuch as they describe a world of medicines largely accessible to all, they purport to o€er that enablement as widely as the written word can. People can use what is around them to promote health and cure disease, to shape their reproductive lives, without much inter vention from doctors. Wealth may restrict access to the more exotic ingredients and complicated compounds, but much can be found in the local environment. No text can really promote the direct encounter between humanity and the healing poten tial that surrounds it, however: written words can only mediate it; and despite their rhetoric, this particular set of texts under stand and exploit their mediating role fully. They aim, in the broadest sense, to regulate the relationship between their audience and the medical art, and that regulation takes a particular form as well as content. Sexual di€erentiation is an intrinsic part of this regulation, in all these senses. It is both e€ortlessly assumed and more

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actively proposed as such, with the weight falling on the former. This is collusion rather than conspiracy, reiteration rather than innovation. The Roman sexual order exists prior to these texts and their authors certainly do not stand outside it, but live and work within it. The notion of writing for anybody other than their fellow men, of the eÂlite or the profession, probably never occurred to them, and their audience would have had similar expectations. It was men who mattered, who were the crucial customers and competitors both, who con trolled access to medical services in the household, who dom inated their provision. It was men, as the authors themselves could attest, who acted in the world, who required knowledge for that action, who joined knowledge and action in the shaping of full subjectivity. It was to their better exercise of this subjectivity, their control of themselves and others (including women), to their mastery of self as such and in relation to their surroundings, that these texts variously and broadly o€ered to contribute; and to contribute as much by their complete recognition and articulation of this state of a€airs as any practical suggestions. The simple, shared assumption that the male is the measure of all things is as e€ective in this respect as any more speci®c dietetic prescriptions, or Pliny's e€orts to prevent women from using the world around them to exert their own control over childbearing. So, woman is not the starting point or standard for anything; she does not give de®nition, purpose, or meaning to any of these works, but is engendered in their realization. She is included within the version of medicina presented by Celsus to Roman gentlemen, within the worlds organized by Pliny and Dioscorides, within the curative programmes of Scribonius and Thessalus; but she does not provide shape or structure to their projects, she provides neither coherence nor identity. Woman, rather, is a creation of the second order within these frameworks, a subordinate strand; and, as such, the extent to which she can diverge from her male principal is limited. Though di€erence itself is, in this scheme, a female property, however wide or full that di€erential gap becomes, the female is still, structurally, a variation on the male.161 The gap is here 161

Whether these authors should then be seen as proponents of Laqueur's `one-sex' model depends somewhat on whether you want to stress the unity or

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®lled with some distinction in somatic texture, in bodily parts and processes (particularly reproductive ones), in illness and cure, but none of these becomes anything more than a gap, none are developed into a coherent system of di€erence, let alone something sucient to support separation, to give woman an independent and positive identity in herself. Celsus perhaps o€ers some pointers towards (or away from) such a system based on menstruation, but otherwise, even reproduction, which is presented as the most sexually separateÐindeed, at points verges on being exclusively femaleÐis not treated systematically. The disembodied, synecdochal, way in which it is dealt with militates against its identi®cation with woman hood in any deeper or holistic sense. Indeed, in many ways, it is fragmentation that is the lot of the medical woman in this set of texts. However, while the male audience no doubt found all this comfortably reassuring, a medical patterning of pre existing suppositions which served to con®rm and elaborate the familiar hierarchy, how any woman who came into contact with these works would have read, or put together, these fragments, is unknown. The ways in which these texts, and the practices associated with them, made women for, or at least in relation to, men, are much clearer than the ways they might have made women for themselves. the maleness of the system, its somatic or social elements (or their indivisibility), and its coherence or lack thereof. Aspects of what Laqueur describes are certainly apparent, but they are perhaps better arranged di€erently.

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4 Sects and the Medical Woman T h e original hairesis, that of the empirikoi, and the more recent, but just as committed hairesis of the methodikoi, remained robustly intact in the early Roman empire. Empiri cist medical writing, however, is only fragmentarily preserved in the works of others, and only one substantial methodist treatise is extant. Instead, the largest group of texts surviving from this period locate themselves ®rmly in the rationalist tradition, but generically rather than speci®cally, and impli citly rather than explicitly.1 The distinct and divergent theoretical lineagesÐsuch as the Herophilean or Erasistratean schoolsÐonto which rationalism was foisted by their rivals, seem to have dissolved into a much broader and looser familial grouping, still reluctant to embrace the label logikoi for themselves, though happy to apply it to their antecedents. Living lines of orthodoxy have been replaced by a common canon of ancient authorities. A shared theoretical framework has been assembled, or perhaps arrived at by process of accretion and assimilation, from all these sources, and some others. The internal aetiological singularity of the pathology of, for example, Herophilus or Erasistratus, has been super seded by a multifactorial analysis. Doctrinal irreconcilability has become di€erence of emphasis. The question then arises whether the members of this group are, in fact, best labelled as logikoi, or as bearers of the newest sectarian title, that is as eklektikoi or episynthetikoi. Do these texts, in whole or in part, represent, or did they represent to their authors and audience, a new, homogenized rationalism, which had become not just a shared theory of knowledge, but 1 This pattern of transmission is partly shaped by the di€erential compatibility of these traditions with Galenism; and though di€erent conditions in the Western empire and its successor states led to a distinctive pattern of transmission which favoured methodist texts more, it favoured them in later Latin versions, not the Greek original.

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also a shared conceptual vocabulary and understanding, or do they similarly represent eclecticism? Indeed is this what eclecticism is? In the absence of any self re¯ective or self representational discussion on the subject, the issue cannot be resolved; and it may be that neither of these terms is one that the authors of these works would themselves have embraced. What remains clear, however, is that the texts in this group have much in common with each other, and all collectively refer back to rationalist traditions, so they are here maintained as a unit, under a somewhat blurred rubric. The sectarian categories with which all these texts operate, however they locate themselves, provide therefore, a conveni ent organizational device for this chapter, as they did for those who originally lived and wrote them; but their rei®cation or monumentalization should be resisted. They were essentially ¯exible tools for the ordering of tradition, the forging of identity and authority, in the complex and competitive world of Roman medicine; not a ®xed or unchanging structure. Moreover, this is not the only area of doubt and diculty in dealing with a set of texts that are often anonymous or pseudonymous (or as good as), and where the chronology is largely vague and relative. It should be stressed, therefore, that it is only the most plausible reconstruction of a series of dynamic processes which is elaborated here. RATIONALISTS AND ECLECTICS The literary corpus of early imperial rationalist or eclectic medicine proposed and examined here comprises four sets of texts. These are: the fragmentary writings ascribed to Rufus of Ephesus; the four surviving works of Aretaeus the Cappado cian; the pseudo Galenic treatises, Introduction and Medical De®nitions; and the texts whose authors are designated as Anonymus Londinensis and Anonymus Parisinus respectively. Other scattered shards of recorded medical knowledge will also be incorporated where possible. The uncertain and disputed nature of much of the evidential terrain requires detailed discussion of the whole collection, which also allows the overall shape and texture of the corpus to be described.

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Rufus' biography is obscure, but his most active and productive period was under Trajan.2 Only traces of his huge literary output remain, but they have been sucient to estab lish his rationalist credentials.3 The eclecticism of his rational ism has also been noted. A handful of extant, independent treatises are supplemented by a range of more or less dislocated fragments preserved in the Byzantine encyclopedias, medieval Arabic compilations, and Latin translations. Partly encouraged by this fractured existence, some anonymous texts were sub sequently attached to Rufus' name, but are now rejected as pseudepigraphica.4 One of this groupÐOn the Anatomy of the Parts of the Human Being (Peri4 a1natomh9w tv9n toy9 a1nurv3poy mori3 vn)Ðis relevant to the subject of this survey. Its structure and scope closely parallel Rufus' On Naming the Parts of the Human Being (Peri4 o1nomasi3 aw tv9n toy9 a1nurv3poy mori3 vn), with variation in the detail of style, substance, and emphasis. This correspondence is the only real clue to its date and provenance. So, though this work must be returned to its nameless state, its points of contact with Rufus (and with the pseudo Galenic treatises) establish a clear rationale, both analytic and heuristic, for treating the three together in the framework of this study. Aretaeus the Cappadocian is even more of a mystery ®gure. The only source of information about him is his surviving work: two pathological treatises, On the Causes and Signs of 2

Suda P 291 (iv. 301. 32 302. 2 Adler). See Johannes Ilberg, Rufus von Ephesos: Ein griechischer Arzt in trajanischer Zeit (Abhandlungen der philologisch-historischen Klasse der saÈchischen Akademie der Wissenschaften, 41/1; Leipzig: Hirzel, 1930); Amal Abou-Aly, `The Medical Writings of Rufus of Ephesus', Ph.D. diss. (University College London, 1992); and Alexander Sideras, `Rufus von Ephesos und sein Werk im Rahmen der antiken Medizin', ANRW II 37.2 (1994), 1077 1253, for general discussion. 4 The creation of a Ru®ne corpus was largely the work of Ch. Daremberg  pheÁse (Paris: BaillieÁre, 1879), and the and C.-E. Ruelle in êuvres de Rufus d'E judgements of Ilberg on the authenticity of these works have been mostly followed since. Greater attention has been given to Rufus' transmission in Arabic more recently, and new works have been ascribed to the Ephesian (Manfred Ullmann (ed., trans., and introd.), Rufus von Ephesos: Krankenjournale (Wiesbaden: Harrassowitz, 1978) ); while I share Fridolf Kudlien's doubts about this identi®cation (`A new testimony for Erasistratus?', Clio Medica, 15 (1981), 137 42), these studies have generally helped to give Rufus greater solidity and de®nition. 3

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Acute A€ections (Peri4 ai1 ti3 vn kai4 shmei3 vn o1je3 vn pauv9n) and On the Causes and Signs of Chronic A€ections (Peri4 ai1 ti3 vn kai4 shmei3 vn xroni3 vn pauv9n); and two therapeutic, Therapeutics of Acute Diseases (¸Oje3 vn noysv9n uerapeytiko3n) and Therapeutics of Chronic Diseases (Xroni3 vn noysv9n uerapeytiko3n)Ðbut their inter pretation in this respect is controversial. Their ionicizing language, their style, and structure are generally agreed to place them somewhere in the ®rst two centuries ad, and that will suce for the present study.5 There is also broad con sensus on Aretaeus' pneumatism, with more or fewer quali®ca tions.6 This also would suce here, except that the label is mistaken. The two lines of argument advanced to support this viewÐthat Aretaeus' extant work is dependent on the pneu matic Archigenes of Apamea, or independently expresses a clearly pneumatic perspectiveÐare weak and fallacious re spectively. The dependence on Archigenes is not proven, and, even if it were, would not be conclusive on the point of Aretaeus' school allegiance. The question of the theoretical shape of Aretaeus' writings is more decisive. It is the conception of the eponymous pneuma itself, as presented in Aretaeus' works, which is the insurmountable barrier to his identi®cation with the pneumatikoi, about whom little is known beyond the fact that they considered both all things according to nature and all disease to be `constituted and controlled by the all pervading pneuma alone'.7 The Aretaean pneuma, however, lacks systematic elaboration of any kind. It is most often just the inhaled breath, essential to life, but without any active physiological role, while on other occasions it is a 5 The arguments about chronology are reviewed, not entirely happily, in Steven Oberhelman, `On the chronology and Pneumatism of Aretaios of Cappadocia', ANRW II 37.2 (Berlin: de Gruyter, 1994), 941 66. 6 Debate has centred around the question whether Aretaeus represents `orthodox' or `eclectic' Pneumatism: see e.g. Max Wellmann, Die pneumatische Schule bis auf Archigenes (Berlin: Weidmann, 1895), which remains the basic work on pneumatism, though many of its conclusions have since been questioned, and also Fridolf Kudlien, Untersuchungen zu Aretaios von Kappadokien (Abhandlungen der Akademie der Wissenschaften und der Literatur, Mainz, geistes- und sozialwissenschaftlichen Kl., 11; Mainz: Akademie Verlag, 1963). 7 mo3nQ tQ9 dih3konti di' ay1tv9n pney3mati . . . synesta3nai te kai4 dioikei9 suai, [Gal.] Intro. 9 (xiv. 699 K, and discussed in Ch. 2 above); cf. Gal. CC 2. 1 6 (CMG Supp. Or. ii. 54. 3 576. 5 and 134. 3 36).

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8

general term for any vapour in the body. It resembles the loosely conceived pneuma of the Hippocratic corpus more than the sophisticated creation of Hellenistic medicine and philo sophy, and this vague nature simply does not permit the pneuma to play the determining role in disease. Instead, it is one possible participant among many in the patterns of illness, generally eclipsed by organic in¯ammation or ulceration.9 The one situation in which pneuma does have a primary causal role in disease clearly underlines its limitations. There are two forms of synanche (syna3gxh, an acute and complex type of su€ocation): one arises from in¯ammation of the respiratory organs, the other from the pneuma itself.10 This latter sugges tion, however, requires justi®cation, which it receives in the form of a statement that bad breath, from the Charonaean caves or a rabid dog, is already known to cause illness.11 The point is not the amazing properties of pneuma, but that `diseases resemble deleterious substances, and people vomit from phar maka just as from fevers'.12 It is possible for the symptoms of an ailment to be generated from a substance, taken internally like pneuma, rather than from an underlying disposition of the body, like in¯ammation of the respiratory organs. Thus, Aretaeus is no pneumatist, but is instead drawing on a common rationalist vocabulary of theoretical concepts, and arranging them in an individually distinctive way. The pseudo Galenic Introduction and Medical De®nitions have led a more varied scholarly life. Their most recent treatment is by Jutta Kollesch, in a study focused on the latter, but with its general conclusions partially extended to the former.13 For she includes them both in a group of ancient 8 Pneuma as result of respiration, e.g. On the Causes and Signs of Acute A€ections (SA) 2. 1. 1 and 2. 3. 3 (CMG ii 15. 4 5, 22. 16 17); pneuma as noxious vapour in the gut, e.g. SA 2. 6. 1 (CMG ii. 25. 10 13). 9 Organic in¯ammation is the underlying diseased disposition in most of the acute a€ections, e.g. pleuritis (SA 1. 10. 1: CMG ii. 12. 13 18); peripneumonia (SA 2. 1. 2: CMG ii. 15. 16 19). 10 Aret. SA 2. 7. 1 (CMG ii. 7. 25 8). 11 SA 1. 7. 2 (CMG ii. 8. 13 17). 12 a1ta4r kai4 noy9soi farma3koisi dhlhthri3 oisi i5 kelai, kai4 a1po4 farma3kvn e1 me3 oysi, o1ikoi9 a pyretv9n ei7 neka, SA 1. 7. 3 (CMG ii. 8. 20 1). 13 Jutta Kollesch, Untersuchungen zu den pseudogalenischen De®nitiones Medicae (Berlin: Akademie Verlag, 1973).

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`medizinischen LehrbuÈcher' surviving complete, or in frag ments, and sharing a common structure and method of composition; they are, however, not identical in form. The Medical De®nitions is, as its title suggests, a collection of de®nitions relevant to medicine, while the Introduction is a more uni®ed text, combining catechistic foundational sections with descriptive substantive parts. Both contain, to varying degrees, loose and indeterminate aggregations of a range of divergent, or even contradictory, opinions, alongside univocal segments. Kollesch advances two central arguments concerning the Medical De®nitions: one about its chronological position, the other about the character of the text. She uses the scanty internal evidence to place the treatise between the reigns of Nero and Marcus Aurelius, the boundaries being furnished by the reference to Agathinus the Spartan, and the omission of Galen respectively.14 Within that span, the late ®rst century is preferred, as eminent physicians of the early second century, such as Soranus of Ephesus and Archigenes of Apamea, are also absent. These temporal indicators are all weak, but Kollesch's conclusion is the best in the circumstances, and is somewhat strengthened by the fact that the Medical De®nitions contains a lengthy treatment of pulse lore, a subject on which both Archigenes and Galen wrote copiously and in¯uentially. For any work following them to fail to mention their views would be surprising. This dating is somewhat quali®ed by the rest of Kollesch's thesis. For she considers the Medical De®ni tions to be a collection of doxographic fragments, drawn from diverse locations and combined without any attempt at syn thesis or reconciliation, within the overall structure of a medi cal handbook. As with the rest of that genre, it will have been subject to continuous revisions, both acquiring new material, and reformulating and shedding the old, across the generations of users.15 Thus the late ®rst century ad is the date for the 14

Kollesch, Untersuchungen, 60 6. A key moment in the life of this text must have been its entry into the Galenic corpus, which seems to have involved at least a tampering with the prooemium. This is the most likely explanation for the appearance of Theuthras as dedicatee, in imitation of the Teuthras to whom Galen's On the Pulse for Beginners/Peri4 tv9n sfygmv9n toi9 w ei1 sagome3 noiw (Puls.) and his 15

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initial compilation, the starting point for subsequent gains and losses, with the production continuing to be source driven, expressing no perspective of its own. The question of sectarian aliation is, therefore, misguided; instead, this work o€ers a glimpse of a ¯uid process of medical learning which valued inclusive totality over systemic unity. Kollesch's assessment of the Introduction is along similar lines, though neither so stringent nor so thorough.16 Kollesch's scepticism is extreme, though her detailed survey of the material, and, in particular, the manuscript tradition, remains invaluable. To equate heterogeneity with either ran domness or completeness is a mistake, and almost all of the late antique accretions to the Medical De®nitions she identi®es could have arrived earlier. On the contrary, a process of selection is clearly implicated in the composition of both this work and the Introduction. Its objective may not have been theoretical coherence or clarity, but it was still selection. The empiricists receive little space in either work, and the metho dists are similarly short changed. An eclectic rationalism dom inates, either implicitly or explicitly. This is re¯ected in both shape and content. The epistemological and foundational introductory segments of both texts make this particularly clear, and both expound a rationalist division of the parts of medicine. The Introduction promotes a ®ve fold partition into the physiologikon, aitiologikon/pathologikon, semiotikon, hygiei non, and therapeutikon, while the Medical De®nitions prefers Athenaeus of Attaleia's version, with medical materials repla cing semiotics.17 These schemata structure the rest of the treatises, providing a sustained rationalist framework. The eclectic way in which this framework is ®lled out is also obvious. A comparison between the sections of the Introduction out lining the rival medical systems with their adherents, and the Hippocratic glossary are dedicated (viii. 453 and xix. 62 K). Its dubious ascription to Galen is referred to in a scholion on Orib. Coll. Med. 47. 5 (CMG vi. 2.1 250. 29) which predates the 6th cent. ad. The pseudo-Soranic Medical Questions, a late antique Latin text which draws heavily on the Def. Med. tradition, has a di€erent prooemium (ii. 243. 1 247. 5 Anec.). 16 17

Untersuchungen, 30 5. [Gal.] Intro. 7 and 8 (xiv. 689 95 K); [Gal.] Def. Med. 11 (xix. 351 2 K).

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authorities subsequently cited, con®rms this conclusion and adds a greater self consciousness to the rationalist label for this work; for the names that occur within the text are overwhel mingly those listed as leading logikoi.18 This chapter also contributes to establishing tentative chronological co ordinates for the treatise. A de®nite terminus post quem is provided by two physicians active in the reign of Trajan, namely Soranus and Archigenes, and a much more uncertain one by the inclusion of Sextus Empiricus. This latter ®gure is traditionally placed in the late second century ad, but the most thorough recent examination of the evidence concludes that `one cannot do any more than set a limit on the possible dates of Sextus which range from ad 100 to the ®rst part of the third century'.19 Thus his appearance here in a listing which is relatively full and otherwise weighted towards an earlier time frame may a€ect views on his dating as much as that of the treatise in question. The work certainly, however, omits any reference to Galen, itself no ®rm guide but of some signi®cance here on account of the theoretical orientation of the work. So, all this would suggest the second half of the second century ad, over ®fty years after the Medical De®nitions, as the most plausible, but by no means certain, date.20 Greater precision regarding theoretical provenance is not really possible, for the reasons Kollesch enumerates. No coherent system or clearly dominant layer emerges from the heterogeneity of these texts. However, some of the strands woven into them are identi®able. Stoicism, mediated to some extent by pneumatism, is a strong contributor to the Medical De®nitions, and the combination of an Egyptian colouring with detailed doxography and Hippocratism in the Introduction speaks of reliance on the Alexandrian rationalist tradition.21 However, these in¯uences may have been indirect and have 18

[Gal.] Intro. 4 (xiv. 683 4 K). D. K. House, `The life of Sextus Empiricus', CQ 30 (1980), 231. 20 Vivian Nutton suggests c. ad 170 in his, `Therapeutic methods and Methodist therapeutics in the Roman empire', in Yosio Kawakita, Shizu Sakai, and Yasuo Otsuka (eds.), History of Therapy: Proceedings of the 10th Symposium on the Comparative History of Medicine East and West (Tokyo: Ishiyaku, 1990), 15. 21 See Ann Ellis Hanson, `Papyri of medical content', YClS 28 (1985), 25 37, for discussion of the Egyptian element. 19

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certainly been supplemented from other directions. It is there fore more useful to classify both treatises as generically rationalist or eclectic, while containing material that provides more speci®c information. This composite character does reveal something about developments in early imperial medi cine. The untitled work of Anonymus Londinensis and Anon ymus Parisinus' treatise perhaps originally entitled On Acute and Chronic Diseases (Peri4 tv9n oje3 vn kai4 xroni3 vn noshmatv9n) are two quite di€erent texts, linked by the vexed question of medical doxography. The former exists in a single papyrus, and it is unclear whether it was ever intended for publication.22 It dates from the ®rst or second century ad. The last authority cited is Alexander Philalethes, a pupil of Asclepiades of Bithynia who went on to become head of the Herophilean school in Asia Minor at the end of the ®rst century bc.23 The ®nal, physiological, portion of the work is largely engaged with the ideas of Alexander and those who in¯uenced him. The middle section, on the aetiology of disease, has its origin in the Peripatetic collection of medical opinions, which was in some sense a parallel undertaking to Theophrastus' compilation of natural philosophical doctrines.24 Its structure, method, and restriction to authorities from the ®fth and fourth centuries bc 22 Daniela Manetti, `Doxographical deformation of the medical tradition in the report of the Anonymus Londinensis on Philolaus', ZPE 83 (1990), 219 30, challenges the traditional classi®cation of the text as something akin to lecture-notes and argues that this is rather the author's own copy, showing the process of his work. 23 For Alexander see von Staden, Herophilus, 532 9. The upper limit is palaeographical see F. G. Kenyon, `A medical papyrus in the British Museum', CR 6 (1892), 237 40. 24 The precise attribution of the Peripatetic source is not important here (see Hermann Diels, `Ueber die Excerpte von Menons Iatrike in der Londoner Papyrus 137', Hermes, 28 (1893), 407 34, and Daniela Manetti, `Note di lettura dell'Anonimo Londinese prologomena ad una nuova edizione', ZPE 63 (1986), 57 74, for discussion), nor is the exact form of anonymous' access to it (though Diels' suggestion of transmission through Alexander Philalethes is completely unsubstantiated). For Peripatetic doxography generally see e.g. Jaap Mansfeld, `Physikai doxai and problemata physika from Aristotle to Aetius (and beyond)', in William Fortenbaugh and Dimitri Gutas (eds.), Theophrastus: His Psychological, Doxographical and Scienti®c Writings (New Brunswick, NJ: Transaction, 1992), 63 111.

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re¯ect that source. The opening of the text is lost, and the few introductory de®nitions that remain give little clue to authorial identity and intentions. The work of Anonymus Parisinus is a much more polished product. It survives in a minor manuscript tradition and is a systematic work on acute and chronic diseases.25 It is rigidly structured, containing sections on the causes, signs, and therapy for each ailment. Attention has focused on its aetiology, for these sections are largely doxographic, citing, wherever avail able, the causal explanations of Hippocrates, Diocles of Car ystus, and Erasistratus for each disease. The source of this material is unclear, but despite the fact that the last authorityÐ ErasistratusÐis from the early third century bc, all the indica tions are that the text is of a much later date. Caelius Aurelianus states that Themison was the ®rst to write systematically about chronic, as well as acute, diseases in the ®rst century bc, and the organization of such texts then seems to have become standard ized.26 Anonymus Parisinus presents, generally speaking, the same diseases in the same order as in the equivalent treatises by Aretaeus and Soranus, and is thus best chronologically aligned with them in the early imperial period also.27 The similarity to Soranus is, however, largely restricted to matters of arrange ment. The aetiological substance of the text places it ®rmly within the rationalist tradition. There are a range of other medical remnants surviving in an even more disembodied and dicult state. The Byzantine encyclopedists, beginning with Oribasius in the mid fourth century ad, selected, arranged, and, to some degree, edited excerpts from the works of earlier physicians, many of whose opinions and prescriptions are preserved only in this ®ltered form.28 Most of these authors ®t into wider patterns of citation, 25 See Ivan Garofalo's introduction to his recent edition of this text, Anonymi Medici De Morbis Acutis et Chroniis (Leiden: Brill, 1997), pp. vii xxviii, for a general discussion of the work and its transmission. 26 Cael. Aur. CP 2. 44, and TP 1. 3 (CML vi.1.1 156. 21 2, 426. 25 428. 7). 27 Soranus' works on acute and chronic diseases are preserved only in the Latin version of Caelius Aurelianus, their structure is, however, unlikely to have undergone much change in the process. 28 The degree of editing increases with time, but comparison between encyclopedic excerpts and the originals from which they were taken (where they survive) indicates that this editing was competently carried out.

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allowing some parts of the background to be ®lled in. The `pneumatic' lineage, which started with Athenaeus of Attaleia, passed into the imperial period with Agathinus the Spartan and then proceeded to his pupil Archigenes of Apamea, who ¯ourished under Trajan, is relatively well attested and repres ented in the sources.29 This line continued with Herodotus, and perhaps also Apollonius of Pergamum, Philumenus, and Antyllus, the last two of whom probabaly overlapped, tempo rally, with Galen.30 More likely to be outside, but not uncon nected with, this descent group are Leonides the Episynthetic and Heliodorus, both of whom are best placed before, or roughly contemporary with, Archigenes.31 All these physicians, however, are clearly located within the rationalist tradition and require integration into this survey as far as possible. More over, some of them, despite the dilapidated condition of their extant writings, were pre eminent ®gures on the stage of early imperial medicine. Archigenes and Heliodorus, for instance, were of suciently wide renown for their names to appear metonymically representing their profession in the satires of Juvenal.32 The evidential foundations having been laid, substantive building may now commence. It will proceed according to a 29 Suda A 4107 (i. 376. 1 3 Adler) refers to Archigenes and Agathinus; and e.g. Gal. Di€. Puls. 3. 6, and On Diagnosis from the Pulse/Peri4 diagnv3sevw sfygmv9n 1. 3 (viii. 674 and 787 8 K), and Anon. Bamb. 6r (66 Stoll) to the larger lineage. 30 For Herodotus see Gal. Di€. Puls. 4. 11 (viii. 750 1 K), and On the Kraseis and Dynameis of Simple Pharmaka/Peri4 krasev9w kai4 dyna3mevw tv9n a2plv9n farma3kvn (SMT) 1.39 (xi. 432 K). Apollonius and Antyllus have no existence outside the encyclopedias, though Antyllus has quite a substantial one inside them. A manuscript of Philumenus' work on poisonous animals survives (published in CMG x. 1.1), providing some indication of date and genealogy as it refers to Archigenes, Soranus, and Herodotus. Herodotus, Philumenus, and Antyllus appear in the rationalist section of the sectarian listing of the Anon. Bamb. 6r (66 Stoll), in that order and after Archigenes and Agathinus. 31 Soranus knew of Leonides (Cael. Aur. CP 2. 7: CML vi. 1.1 134. 14) and Juvenal knew of Heliodorus (Juv. 6. 373). 32 Juv. 6. 236, 13. 98, 14. 252: Archigenes; and 6. 373: Heliodorus. Extensive paraphrases of and, on occasion, quotations from Archigenes' works on the pulse appear in Galen's treatises on the same subject, and papyri fragments of Heliodorus' Surgery (Xeiroyrgoyme3 na) have also been found.

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simpli®ed version of the ®ve part division of rationalist med icine outlined above. First is the de®nition, description, and functional conceptualization of woman's body contained in physiology. Second, the perspectives on female diseases pro vided by pathology. Third, the speci®cities of the regimens and therapies recommended for women. It is technical knowledge of all these areas, knowledge vital for the medical art, itself vital for the well being of humanity, which all these texts variously articulate. All these writers expound medicine from the inside, from within its most theoretically developed rationalist strand; and their exposition is often openly didactic. They present themselves as masters of this tradition, as heirs of the author ities they cite. They take, therefore, their learning from other men, as well as from themselves and their own practice. They produce in this way, the best medical knowledge to be had.

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Physiology: the medical woman kata physin Fundamentally, there is no physiological distinction between the sexes. The various compositional schemata outlined by Anonymus Londinensis and in the pseudo Galenic treatises are entirely generic.33 At its most basic material levelÐ whether expressed in terms of substantial or qualitative elements, humours, corpuscles, solids and liquids and pneu mata, or anything elseÐhumanity is a unity. It is not until these constituents take their ®nal form in the human being that sexual di€erentiation enters the picture. Fortunately, it is here that the evidence is concentrated, as Rufus' On Naming and pseudo Rufus' Anatomy may be combined with the relevant sections of the pseudo Galenic works. All these texts are perhaps best understood as derived, however indir ectly, from commentaries on anatomical demonstrations. They are thus only part of a process of corporeal elucidation and interpretation, but the bodies have gone and only their literary projections remain. The distance they have travelled away from these missing bodies varies. The de®nitions of organs in the Medical De®nitions contain no indication of their somatic location, but rather explain, in an interlocked way 33

Anon. Lond. 4. 26 22. 5 (32 85 Jones); [Gal.] Def. Med. 31 and 33 (xix. 356 7 K); [Gal.] Intro. 9 (xiv. 695 9 K).

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their construction and function. Greater bodily proximity, however, is evident in On Naming, where Rufus is mainly concerned to correlate terminology and topography, though function is never far away. The anatomical texts share a certain structure. All separate the study of the observable exterior of the body from its concealed interior, and both sets of descriptions descend from head to toe.34 Since the outside is the point of departure, where both sides are included, it is in the region of the chest that sexual di€erentiation ®rst enters the narratives. Only Rufus refers to this, as the external part of his pseudonymous parallel is lost and the Introduction provides a more curtailed account. He remarks simply that the words which distinguish between the ®rst growth of the breasts at puberty (`bean', ky3amow) and the ®nished product (`swelling', a5skvma) are properly applied only to women.35 The rest of the vocabulary is unsexed. More detail appears further down the somatic chart, and Rufus provides a revealing description of the female genitalia which follows a clearly labelled description of their male counterparts of almost twice the length: th9w de4 gynaiko4w to4 ai1 doi9 on, ktei4 w me4 n to4 tri3 gvnon pe3 raw toy9 y2pogastri3 oy a5lloi de4 e1 pi3 seion kaloy9sin. sxi3 sma de4 , h2 tomh4 toy9 ai1 doi3 oy. to4 de4 myv9dew e1 n me3 sQ sarki3 on, ny3mfh, kai4 my3rton oi2 de4 y2podermi3 da, oi2 de4 kleitori3 da o1noma3zoysi, kai4 to4 a1kola3stvw toy3toy a7ptesuai kleitoria3zein le3 goysin. myrto3xeila de4 ta4 e2 kate3 rvuen sarkv3dh tay9ta de4 Ey1ryfv9n kai4 krhmnoy4w kalei9 oi2 de4 ny9n ta4 me4 n myrto3xeila, pterygv3mata, to4 de4 my3rton, ny3mfhn. The genitals of women: some call the ®nal triangle of the lower stomach the `comb' (kteis), others the `epision'. The cut in the genitals is called the `cleft' (schisma). The ¯eshy muscle in the middle is the `rosebud/young bride' (nympheÅ) or `myrtle berry' (myrton). Some name it the `hypodermis', others the `kleitoris', and say that lascivious touching of this part is `to clitorize' (kleitoriazein). The `myrtle lips' (myrtocheila) are on either side of this piece of ¯esh. These Euryphon also calls `overhanging banks' (kremnoi). Nowadays, the myrtle lips are called `wings' (pterygoÅmata), and the myrtle berry is called the `rosebud/young bride'.36 34 The exterior/interior distinction is discussed at [Gal.] Intro. 11 (xiv. 709 K). 35 Ruf. Onom. 91 2 (145. 6 8 DR); cf. Pollux, Onomasticon 2. 163. 36 Ruf. Onom. 109 12 (147. 5 11 DR). I have tried to show the linguistic links that are being made in the translation, and chose `rosebud/young bride'

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Contrary to post Freudian expectations, the centrepiece of this exposition is the clitoris. It has accumulated the most names, generated a verb which recognizes it as a locus of erotic stimulation and pleasure, and de®nes the position of, and one word for, the labia. The nymphe maintains its presence in the truncated, and rather unclear, sketch of the female pudenda in the Introduction.37 It is accompanied only by the kolpos (ko3lpow, that is `cavity' or `sinus', generally used of the vagina but confusingly here a synonym of kteis) and the `wings', but has acquired an additional quali®cation. For, the anonymous author reports, this `small piece of ¯esh . . . on account of its great protrusion, requires excision in girls among the Egyptians'.38 The richness of the vocabulary is also striking. Rufus' project in On Naming is to establish a complete anatomical nomenclature. The terms he collects seem largely to be drawn from common, presumably including sexual, usage, and even when they have been coined speci®cally by ancient physicians such as Euryphon, it is on the same, metaphorical, basis as most of the others.39 Parts of the body are named according to their resemblance to, and broader associations with, other parts of the world. The most current word for the clitoris, nymphe, works on both these levels, evoking a similarity of form between the clitoris and a rosebud, together with the coy image and erotic connotations of the young bride. The sexual focus of this particular somatic region gives the multiplicity of linguistic links an added dimension, but simply accentuates the general way in which the body is semantically woven into the broader physical and cultural fabric. This involvement in from amongst the many signi®cations of nymphe on the basis of a scholion on this text which explains that the nymphe resembles a rosebud (240. 8 9 DR), and on Soranus' reference to young brides in this context (Gyn. 1. 18. 2 (CMG iv. 12. 20 2), discussed below). See also P. Iand. v. 82, and Pollux, Onomasticon 2. 174. 37

[Gal.] Intro. 10 (xiv. 705 6 K). sarki3 dion . . . o8 kai4 dia4 to4 proky3ptein e1 pi4 poly4 e1 ktomh9w a1jioy9ntai par¸ Ai1 gypti3 oiw e1 pi4 tv9n parue3 nvn, [Gal.] Intro. 10 (xiv. 706 K). 39 Euryphon of Cnidos was the reputed author of the Hippocratic Cnidian Sentences/Kni3 diai gnv3mai (Gal. Commentary on Hippocrates' Epidemics/Ei1 w to4 ¹Ippokra3toyw e1 pidhmiai3 y2pomnh3mata (Hipp. Epid.) 6 1. 29: CMG v. 10.2. 2. 54. 1 3) and appears in the Anon. Lond. (5. 1: 32 Jones) and is therefore located somewhere in the late 5th or early 4th cent. bc. 38

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terminology is also re¯ected in the other anatomical texts, and pseudo Rufus takes the relationship between word and referent a step further when he announces in his introductory section that he will now proceed to outline `the disposition and naming that nature provides for the parts'.40 The hidden depths of the human interior contain a single di€erentiated zone, that of the generative organs. Rufus again presents the fullest account, and one which carefully circum scribes the limits of that di€erentiation. Unlike its external counterpart, the internal narrative does not simply divide into parallel male and female versions, but maintains a generic/male line, from which the female is only occasionally separated. The passage is preceded by an unsexed description of the organs below the diaphragm and opens: ta4 de4 spermatika4 a1ggei9 a e5 sti me4 n te3 ssara, dy3o me4 n kirsoeidh9, dy3o de4 a1denoeidh9 e1 kaloy9nto de4 kai4 go3nimoi fle3 bew. kai4 tv9n kirsoeidv9n, ta4 pro4w toi9 w didy3moiw, parasta3tai e1 ni3 oiw de4 kai4 pa3nta parasta3taw kalei9 n diafe3 rei oy1de3 n. skepte3 on de4 kai4 ei1 toi9 w uh3lesi ta4 ay1ta4 pepoi3 htai, v7sper kai4 toi9 w a5rresin ¹Hrofi3 lQ me4 n ga4r oy1 dokei9 to4 uh9ly kirsoeidei9 w e5 xein parasta3taw e1 n de4 prosba3toy y2ste3 rq ei5 domen e1 k tv9n didy3mvn pefyko3ta ta4 a1ggei9 a kekirsvme3 na e2 kate3 rvuen synete3 trhto de4 tay9ta ei1 w to4 koi3 lvma th9w y2ste3 raw, a1po4 v¥n y2po3myjon y2gro4n piezoy3ntvn a1pekri3 neto kai4 h¤n pollh4 do3khsiw spermatika4 tay9ta ei¤ nai, kai4 toy9 ge3 noyw tv9n kirsoeidv9n. toy9to me4 n dh4 oi¥ o3n e1 stin, ai2 a1natomai4 ta3xa dei3 joysin. The seminal vessels are four in number, two being varix like, two glandular. They also used to be called `generative veins'. And the parts of the varix like ones that are adjacent to the `twins' (didymoi) are [called] `supporters'(parastatai), but to some people it makes no di€erence to call all the seminal vessels parastatai. One must examine whether in females, too, the same vessels have been constructed as in males. For, while Herophilus thinks that the female does not have the varix like parastatai, we have seen, in the case of the uterus of a ewe, vessels which have become varix like growing out of the didymoi, from both sides. These opened directly into the cavity of the uterus, and when they were compressed, a somewhat mucous liquid was excreted from them. And there was a widespread belief that these vessels are seminal, and belong to the varix like kind. Dissections will perhaps show of what nature these are.41 40 h8n pare3 sxe toi9 w me3 resin h2 fy3siw ue3 sin te kai4 o1nomasi3 an, [Ruf.] Anat. 2 (168. 7 169. 2 DR). 41 Ruf. Onom. 184 7 (158. 15 159. 10 DR).

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A generic section on the muscles of the groin and lower back is then followed by: th9w de4 gynaiko4w to4 gennhtiko4n mo3rion, mh3tra, kai4 y2ste3 ra ¹Ippokra3thw de4 kai4 delfy4n, kai4 gonh4n kalei9 . kai4 ai2 e1 pi4 ta4 a5nv e5 nuen kai4 e5 nuen e1 kfy3seiw, kerai9 ai, kai4 plekta3nai, kai4 ta4 a1ne3 xonta ay1th4n a1ggei9 a e1 kto3w. kai4 to4 me3 son kai4 a1nata3tv, pyumh3n kai4 ta4 e2 kate3 rvuen, v¤moi kai4 to4 a5kron, ay1xh4n kai4 tra3xhlow traxh3loy de4 to4 sto3ma, o2 prv9tow po3row ¹Ippokra3thw de4 kai3 a1mfi3 dion o1noma3zei a1po4 tv9n kykloterv9n sidhri3 vn tv9n pro4w toi9 w a1ro3troiw. ei¤ ta to4 koi3 lvma to4 e1 fejh9w, gynaikei9 ow ko3lpow, kai4 ai1 doi9 on to4 sy3mpan sy4n toi9 w e1 pifane3 sin. peri4 de4 toy4w didy3moyw ei1 si4 xitv9new e1 lytroeidei9 w kai4 dartoi4 , kai4 ney9ron ei1 w to4n di3 dymon kauh9kon koi9 lon, o8 kai4 a1orth4r kai4 kremasth4r kalei9 tai, kai4 flebi3 a dia4 v¥n tre3 fontai oi2 di3 dymoi. The reproductive part of women is [named] `meÅtra' or `hystera'. Hippocrates calls it both `delphys' and `goneÅ '. The projections onto the upper parts of both sides of it are [called] `horns' or `tentacles', as are the supporting vessels outside it. Its central and upper parts are the `base', on both sides are `shoulders', and the summit is the `throat' or `neck'. The `mouth' of the `neck' is the ®rst opening. Hippocrates names this `the amphidion', from the circular rings of the plough. Then, the adjacent cavity is the `female sinus', and together with the visible parts [comprises] the whole genitals. Around the didymoi are the sheath like and ¯ayed (dartoi) tunics, and a nerve comes down into the double cavity which is called `aorteÅr' and `kremasteÅr', and small veins [also come down], through which the didymoi are nourished.42

The ¯ow of the narrative is interrupted only twice. The ®rst time is to debate the presence of the varix like parastatai in females. A not insigni®cant question, since in the Herophilean model which Rufus is here reworking, the varix like parastatai play the most important role in the manufacture of generative seed.43 However, on this point Rufus contradicts the great Alexandrian anatomist by suggesting complete equivalence between the sexes. The second time, the exclusively female organs of reproduction are clearly signalled and described. Thus, internally the female emerges as a variation on the male theme. She has, in some form, everything that he hasÐ parastatai, didymoi, and seedÐplus a womb, with accompani ments. The accounts of the human generative organs in the pseudo 42 43

Ruf. Onom. 193 8 (160. 6 161. 3 DR). Gal. Sem. 1. 16. 5 (CMG v. 3.1 134. 5 6).

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Ru®ne work and the Introduction occupy a rather uneasy position between sexual similarity and separation.44 Both commence with an unmarked passage containing di€erent con®gurations of seminal vessels, described in more or less detail, which implicitly hints at being more male than generic and is followed by a speci®cally female section. Pseudo Rufus is more structurally ambiguous, a point which is underlined by the Herophilean heritage of the contents, but the Introduction links the two halves of its disquisition with the statement that `in women the uterus is similar to an inverted scrotum'.45 It then passes on to embryol ogy, pausing only to relate that it is through the many veins anastomizing with the womb that the blood retained on concep tion and contributing to the nourishment and formation of the foetus is otherwise purged. This oblique reference to menstrua tion is the only one in the entire treatise. The delineation of the uterus by pseudo Rufus is almost as terse, partly as a result of textual corruption. It gives a location, an analogy to the shape of a physician's cupping glass, and an announcement that this is `where sexual intercourse is accomplished'.46 Even further ambiguity is produced by the compositional method of Medical De®nitions. None of its three entries for the didymoi, parastatai, and metra makes any direct reference to the sex of the bodies containing them; though the priority of the parastatai, in terms of seed production, is clear, whoever has them.47 Seed (spe3 rma, go3now, gonh3, or uorh3) appears as a general somatic constituent as well as being localized in the seminal vessels. Rufus includes it in a list of perissomata (perissv3mata, that is residues), alongside such other items as saliva, mucus, sweat, earwax, milk, and both menstrual ¯uid and the female ¯ux.48 Whereas milk is produced solely from nourishment, seed is concocted from nourishment together with pneuma. A similarly nutritive origin for seed is presented by Anonymus 44 [Ruf.], Anat. 56 64 (182. 1 183. 11 DR), and [Gal.] Intro. 11 (xiv. 719 20 K). 45 tai9 w de4 gynaiji4 n h2 y2ste3 ra e5 oiken o1sxW9 a1nestramme3 nW, [Gal.] Intro. 11 (xiv. 719 K). 46 e5 nua kai4 ai2 synoysi3 ai peraioy9ntai, [Ruf.] Anat. 64 (183. 7 11 DR). 47 [Gal.] Def. Med. 58 60 (xix. 362 K, as amended by Jutta Kollesch, `Rene Chartier Herausgeber und FaÈlscher der Werke Galens', Klio, 48 (1967), 183 n. 2). 48 Ruf. Onom. 222 6 (165. 5 14 DR).

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49

Londinensis. Medical De®nitions o€ers a series of variations on the theme of semen as moisture containing an ontologically generative faculty, either logos, pneuma, or part of the soul.50 The message that the human body kata physin is a reproductive body is also underlined by a whole sequence of de®nitions in Medical De®nitions that could be headed `procreation', and by the discussion of the co ordination and classi®cation of human functioning in the Introduction. Medical De®nitions does not provide a continuous narrative, outlining the process of reproduction from start to ®nish, but a series of explanations collected around points where the story requires elaboration. It draws structural and material support for this from the doxographical tradition of natural philosophy. However, this is far from being its only source or in¯uence, and the shared substance has been adapted in a number of ways. The point of departure for this sequence is the seed, not this time its ontological status but its mode of production. The pangenesis debate is reworked, not entirely successfully.51 Then, `it is asked if the female seminates just as the male does?'52 The rigidly male parameters of the discourse are again manifest. The question is not an open one, such as: what does the female contribute to generation? But, rather, whether she is, in this particular respect, the same as the male. The response to this enquiry is positive: kai4 ga4r to4 uh9ly th4n ay1th4n o5rejin e5 xei kai4 koinvnei9 tv9n ay1tv9n noshma3tvn kai4 fanerv9w dia4 th9w a1natomh9w dei3 knytai toy4w spermatikoy4w e5 xon po3royw kai4 to4 me3 giston toy9 spermai3 nein marty3rion ai2 o2moio3thtew tv9n genome3 nvn pro4w ta4w tekoy3saw o7ti de4 symba3lletai martyrei9 ¹Ippokra3thw le3 gvn e1 n tQ9 peri4 pai3 dvn fy3sevw h6n gonh4 mei4 nW a1p¸ a1mfoi9 n e1 n tW9si mh3trWsi th9w gynaiko4w, pro3teron me4 n mi3 sgetai o2moy9 a7te th9w gynaiko4w oy1k a1tremeoy3shw, a1uroi3 zetai de4 kai4 paxy3netai uermaino3menon, e5 peita pney9ma i5 sxei. For the female has the same desire (orexis) and shares the same diseases, and it has been clearly demonstrated through dissection that she has the seminal channels; and, the greatest testimony to her semination is the resemblance of o€spring to their mothers. That [the 49

Anon. Lond. 25. 41 5 (98 Jones). [Gal.] Def. Med. 94 and 439 (xix. 370 1, 449 50 K). 51 Ibid. 439 (xix. 449 K); cf. AeÈt., Placit. v. 3 (Dox. Gr. 417. 1 17). 52 e1 zh3thtai ei1 spermai3 nei to4 uh9ly v7sper to4 a5rren spermai3 nei, Def. Med. 440 (xix. 450 K). 50

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seeds] are combined, Hippocrates testi®es to, saying in the work On the Nature of the Child: `If the seed from both [parents] remains in the uterus of the woman, ®rst it is mixed together, seeing as the woman does not keep still, and it is gathered together and thickened by heating. Then she holds back the pneuma.'53

This rather cryptic argumentation requires some elucidation. There are ®ve items of evidence deployed. The ®rst, that women experience the same desire (orexis) as men, only works on the basis of an essentially spermatic model of this desire. The orexis in question requires semen. Women experience this orexis, therefore they must have semen. Any more precise content is left unclear, as orexis is the most general philosophical term for desire or appetency. It is neither speci®cally sexual nor intrinsi cally located at any particular point in the interlocking realms of body, nature, soul, or mind.54 The simplest way to meet the requirements of being seminally driven and identical in both sexes would be to understand this orexis as a physical desire for the expulsion of seed, caused by its somatic presence, that is a physical desire for some kind of sexual act.55 It need not be a reproductive act, but a reproductive act needs this orexis, and, in a two semen model, needs it in both participants. Second, the diseases women share with men are presumably satyriasis (satyria3siw, permanent tension of the generative organs) and gonorrhoia (gono3rroia, permanent seminal ¯ow), both of which involve the dysfunctional emission of seed.56 To be a‚icted with satyriasis or gonorrhoia requires seed. Women are so a‚icted, therefore they must produce seed. The third proposition is a simple proof from anatomy, though many would have found it unconvincing.57 Fourth is the genetic testimony. The resem blance of children to their mothers indicates not just the existence of female semen, but its active contribution to the 53 Def. Med. 440 (xix. 450 K); cf. AeÈt. Placit. v. 5 (Dox. Gr. 418. 3 22), which treats the same subject but with none of the same material. 54 Indeed orexis is de®ned earlier in the treatise (Def. Med. 97: xix. 372 K) as a longing for food and drink. 55 Similar models appear at e.g. Pl. Ti. 86c d and 91a b: for men only; and Gal. Sem. 2. 1. 32: for women (CMG v. 3.1. 152. 2 7). 56 See Def. Med. 288 9 (xix. 426 K) for these diseases. 57 Athenaeus of Attaleia, for instance, is reported to have considered the female seminal vessels as analogous to male nipples in their functional redundancy (Gal. Sem. 2. 1. 28: CMG v. 3.1. 150. 14 18).

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o€spring. Finally, Hippocrates is called as a witness.58 Though neither the most coherent, nor convincing, argument for the existence and function of female seed, the overall impact of the section is to emphasize the analogy, even unity, between men and women. The next segment of the sequence covers conception and foetal formation, development and status. The ®rst stage is explained:

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ai1 ti3 a syllh3cevw h2 th9w mh3traw sy3mmetrow uermasi3 a kai4 h2 pro3sfatow tv9n e1 mmhni3 vn ka3uarsiw kai4 o5rejiw tay9ta ga4r o2moy9 syneluo3nta kate3 sxe to4 spe3 rma. The causes of sylleÅpsis are the balanced heat of the uterus, the recent passage of the monthly purges, and desire (orexis). For when these combine simultaneously, the seed is retained.59

These causes, it seems, are necessary conditions, not active agents, the conjunction of which results in the retention of any seed that arrives. Syllepsis is that retention, understood separ ately from the arrival, and therefore entirely female. On this interpretation, however, the presence of the orexis appears incongruous. If the previous assertion of sexual symmetry in this respect is to be maintained, the orexis belongs to the expulsion of semen, not its reception. Its reallocation repre sents, instead, the need to maintain reproductive asymmetry. In the two seed model, women both excrete and retain semen (her own and others'), but these two actions are con¯ated, and the latter treated as determining. Thus, a contrast with the purely ejaculatory male role is emphasized. However, that conception requires a female orexis which precedes, and is therefore independent of, the arrival of the male semen, is none the less noteworthy. An individual woman's womb might be incapable of attain ing this retentive state, through excess coldness, fattiness, or another malformation, just as an individual man might be unable to get generative semen to its required destination, on account of congenital deformation, castration, or disease.60 58

Hp. On the Nature of the Child 1 (cf. vii. 486. 1 3 L). [Gal.] Def. Med. 451 (xix. 454 K); cf. AeÈt. Placit. v. 6 (Dox. Gr. 418. 23 419. 9). 60 Def. Med. 442 (xix. 451 K); cf. AeÈt. Placit. v. 13 (Dox. Gr. 424. 1 27). The problem with eunuchs, as pseudo-Rufus explains (Anat. 58: 182. 10 13 DR), is 59

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Foetal formation is the product of the interaction of uterus and seed, a process analogous to the pouring of molten lead into a mould.61 There are a number of variables on both sides of this equation which a€ect its outcome. Sex is seminally deter mined.62 According to some, seed from the right produces males, from the left females; for others it is the temperature that counts, the hotter seed making males, the colder females. Twins and triplets are caused by the excessive heat of the womb.63 Monsters result from either uterine ¯exure or the wrong quantity of semen.64 All these de®nitions are formally ambiguous about the origins of the seed involved; however, the underlying structure is clearly derived from a one seed model. A polarity of reproductive role again prevails over any theoret ical symmetry. The ®rst speci®c formation of the conceptus is the chorion (xo3rion), the enveloping tunic through which it is nourished.65 The material for this nourishment is provided by the menstrual ¯uid.66 This is usually evacuated for the woman's health, but its real function occurs after this has been halted by conception, and it then passes to the foetus and the production of milk. Once formed, the foetus poses the problem of its existential status. What is conceived is a distinct entity, not just part of the mother, but its location on the scala naturae is more controversial.67 Some consider it to be an animal, since it moves, others classify it as a plant, since it does not move itself, and Asclepiades considers it to be like a sleeping animal, possessing capabilities which remain dormant until birth. Finally, childbirth may be impeded by the that, lacking didymoi, they ejaculate only a watery, ungenerative liquid during intercourse. 61

Def. Med. 449 (xix. 453 4 K). Ibid. 446 (xix. 453 K); cf. AeÈt. Placit. v. 7 (Dox. Gr. 419. 10 420. 18), and Hp. Superfoetation 31 (viii. 500 L). 63 Def. Med. 447 (xix. 453 K); cf. AeÈt. Placit. v. 10 (Dox. Gr. 421. 23 422. 12). 64 Def. Med. 449 (xix. 453 4 K); cf. AeÈt. Placit. v. 8 (Dox. Gr. 420. 19 421. 5). See also the discussion of this passage in Christian Bien, ErklaÈrungen zur Entstehung von Miûbildungen im physiologischen und medizinischen Schrifttum der Antike (Sudho€s Archiv Beihefte, 38; Stuttgart: Steiner Verlag, 1997), 71, 77. 65 Def. Med. 444, 452 (xix. 451, 454 K); cf. AeÈt. Placit. v. 16 (Dox. Gr. 426. 15 427. 2). 66 Def. Med. 454 (xix. 455 K). 67 Ibid. 443, 445 (xix. 451 2 K); cf. AeÈt. Placit. v. 15 (425. 14 426. 14). 62

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condition of the mother, the foetus, or the external environ ment.68 The problems attending the woman are twofold: psy chical or somatic. The former included being in a state of jealousy, grief, pain, or some other a€ection. The latter com prises narrowness of passages, excess fat, ®rst pregnancy, or atrophy of the womb. Other diculties result from the death, multiplicity, or monstrosity of the foetus, and the climate. This episodic explanation of procreation reveals a basically mechanical process. Humans are essentially reproductive, and the substance of this essence is seed. This essence demands its own expulsion and may then be materially embodied in the woman's womb. Sex is determined in this moment of expul sion; semen and uterus then interact to provide foetal form and de®nition, which is ®lled out by the nourishing properties of the catamenia. The details of the mode of foetal exit are left vague, but seem to be pneumatically prompted.69 There are certain necessary conditions for the successful accomplishment of the key stages, but, if ful®lled, progress is automatic. The mechanistic quality of the conspectus o€ered is emphasized by its largely synecdochal rendition. This is centrally a tale of the conjunction of womb and seed to produce an embryo, in which the whole beings involved rarely feature. Moreover, the occa sional appearances are somewhat shadowy, and, given the partial protagonists, almost entirely female. Tellingly, she achieves most substance during parturition. The man's role in reproduction remains assumed and unspoken throughout, it is the woman's that requires explication. There is asymmetry of both place and perspective. Reproduction makes a rather briefer appearance in the Introduction, in the course of a summary description of the hierarchy of human functioning.70 At the top of this hierarchy are the psychikai dynameis of sensation and deliberative choice (proai3 resiw); next are the physikai activies of generationÐ comprising conception and foetal formation; the management 68

Def. Med. 457 (xix. 455 6 K). Def. Med. 453 (xix. 455 K). The use of the term `sally forth' (e1 kdromh3) to describe the birth, also suggests that the foetus, not the mother, takes the active role in this event. Such an understanding of parturition was commonplace, see Ann Ellis Hanson, `Continuity and change', 87 95. 70 [Gal.] Intro. 13 (xiv. 726 7 K). 69

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of the bodily economyÐcomprising appetite (orexis), ingestion, concoction, distribution, conversion into blood, and separation of excretions (including milk); and growth; and after that comes the hektikon function of simply maintaining somatic unity. Some deliberative choices are made by the psyche aloneÐto reason and considerÐothers are (like sensation) joint undertakings of psyche and bodyÐthat is, movement from place to place or for the reception or evacuation of something. Since this latter category, presumably, includes sexual intercourse of any kind, reproduction would, in its totality, seem to be a complex activity, involving both psychical and natural faculties, both body and soul. Moreover, the division between the di€erent parts of the process is interest ing. Sexual activity is a matter of deliberation, in which the psyche is implicated. Procreation is just something that hap pens: it is a simple matter of bodily mechanics, of physis. This division places a Stoic gloss on a con®guration that most probably originated in the medical schools of Hellenistic Alexandria. For, though the author starts with the pneumatic tripartition of the StoaÐinto the psychikon, physikon, and hektikon pneumataÐthis last does little work thereafter, and the centring of the ®rst two pneumata in the brain and heart respectively also re¯ects Alexandrian anatomical understand ings, in contrast to the unitary conception of the soul in Stoicism and its location of the hegemonikon in the heart.71 It is basically the separation of the nervous and vascular systems which seems to be elaborated here.72 The koine of rationalist or eclectic physiology is thus apparent. This set of texts, despite their divergent modes and purposes of production, utilize a collective conceptual vocabulary to represent the human being according to nature. This common understanding and expression rests on a common system of knowledge, composed not just of a formal epistemology, but also a Foucauldian episteme, `in which knowledge, envisaged apart from all criteria having reference 71 `Vital' (zvtiko3n), not `natural' (fysiko3n), pneuma would be more decisively Alexandrian, but the two terms are used interchangeably in the Def. Med.; and see also Calcidius, Timaeus 246. 72 The brain and nerve part of this picture is con®rmed at Intro. 11 (xiv. 710 K).

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to its rational value or to its objective forms, grounds its positivity'.73 That is, there are whole hosts of implicit asump tions and attitudes that exist prior to the formulation of any explicit epistemological rules, or the actual articulation of any statement, any claim about the world made within them. There are, however hidden, always certain conditions which make a particular discourse possible; every discursive forma tion has its regulatory framework embedded within it. For Roman medical discourse in the rationalist tradition, this epistemic underbelly is shaped and ordered, made coherent, by the logic of resemblance and analogy and the principle of hierarchy. Within this, sexual di€erence has its life; indeed sexual di€erence helps give life to this ordering of the world. Thus there emerges from these texts a shared approach to the fact that there are two types of human being kata physin. An approach that automatically places men and women in a hierarchical relationship which itself contains the terms of their mutual resemblance and divergence. The hierarchy in this case is that of the absolute over the relative, which also provides a location on the abstract scale of similitude. The unmarked, unquali®ed, and unspeci®ed human being is male, or, more precisely, the male is the human being unmarked, unquali®ed, and unspeci®ed. He is absolute humanity. The female is the marked, quali®ed, and speci®ed version. She is relative, and it is, therefore, entirely with her that the measure of both similarity and disparity resides. The name of sexual di€erence is woman, but so is the name of sexual sameness. This fundamental formation in the ®eld of knowledge is most clearly visible in the structure of the anatomical narratives and the formulation of the repeated question, are women the same as men? The positivity it grounds is elaborated along this line of questioning. The enquiry is targeted, not universal. Di€er ences of external appearance are obvious, as is the unity of the basic material constituents and what it is that makes human beings what they are. The areas of uncertainty cluster around the physiology of reproduction. Answers tend towards arm ing the correspondence of men and women, achieving varying degrees of proximity and even complete parallelism. However, 73

Michel Foucault, The Order of Things: An Archaeology of the Human Sciences, trans. Alan Sheridan (London: Routledge, 1986), p. xxii.

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the story does not end there, for outside the common/male core are the quali®cations and modi®cations. These are not insig ni®cant, for it is the woman's womb, not her parastatai, seed, or orexis, that determines her role in the physical process of reproduction, and it is very di€erent from that of a man. Nevertheless, it is only in this vicinity, beyond physiological con®guration and physical desire, that deep disjunction between the sexes really appears.

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Pathology: the medical woman para physin Within the rationalist or eclectic medical system, physiology and pathology are continuous. Diseases proceed along causal and somatic pathways which have already been mapped out in the explanatory description of the human being kata physin. Thus, the extent to which a speci®cally female pathology is delineated in this context will be shaped by the patterns of physiological di€erentiation between men and women. The expectation, therefore, is di€erences of detail not kind: the circumscription of some female space in the common framework of the under standing and classi®cation of human illness. Susceptibility to, and the precise manifestation of, diseases might vary between the sexes, but not their fundamental character or nature. This projection can be thoroughly examined and tested both in the several treatises entirely devoted to diseases, either comprehen sively or selectively, and in the relevant portions of the general pseudo Galenic texts. This investigation should also, by virtue of the linkage it is exploring, further illuminate female physiol ogy, seen through its patterns of illness. Sexual variation in the susceptibility to, and seriousness of, the same diseases is not infrequent in the more detailed pathological treatises, though they disappear when the accounts become more abbreviated.74 The two variables are often linked, and appear alongside similar distinctions between young and old. They are of most interest when accompanied by causal explanations. Aretaeus states, for example, that women 74

The pathological part of the pseudo-Galenic Intro., for example, is entirely generic. And Rufus' Medical Questioning/¸Iatrika4 e1 rvth3mata barely registers that female patients might have to be dealt with (see 47 8 and 72: 11. 15 22, 16. 4 GaÈrtner, for the exceptions).

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are more disposed to tetanos (te3 tanow, a convulsive stretching) than men, because they are cold, but recover more easily, because they are wet.75 Rufus reports that women are less prone to kidney stones than men, since their passages are wider and sexual activity is less hard work for them.76 In a similar vein, Philumenus o€ers the lower frequency, and easier cure, of elephantiasis (e1 lefantia3siw, a very severe skin disorder) among women and eunuchs as a sure sign (tekmh3rion) that sexual intercourse is especially damaging in this disease.77 This scale of susceptibility may be recreated, or just extended, within the female sex. Thus, an extract from Archigenes and Leonides on karkinomata (karkinv3mata, crablike tumours) in the breasts preserved by Aetius of Amida, remarks that these are more common in women than men, especially women with large, well ¯eshed breasts.78 The di€erence between male and female breasts is simply quantitative, and the likelihood of karkinomata increases with size across this divide. Also, according to Aretaeus, abscesses around the tonsils are common in prepubertal girls, but not adult women, a distinc tion which also a€ects male relationships to diseases such as epilepsia (e1 pilhci3 a, epilepsy).79 The ways in which diseases negotiate the zones of speci®c, and qualitative, anatomical and physiological di€erentiation between men and women are more complex. There is some simple local variation within a disease type. Thus, for ex ample, the basic diseased states such as in¯ammation, ulcera tion, and swelling may a‚ict both the uterus in women and the scrotum in men.80 Similarly, tetanos, which is generally caused by a blow or a wound, may, in women, result from a miscarriage, and bladder a€ections may be generated by 75 Aret. SA 1. 6. 3 (CMG ii. 6. 2 3); old people are similarly susceptible on account of their coldness. 76 Ruf. On Diseases in the Kidneys and Bladder/Peri4 tv9n e1 n nefroi9 w kai4 ky3stei pauv9n (Ren. Ves.) 3. 8 10 (CMG iii. 1. 116. 6 10). 77 Philum. ap. Orib. Coll. Med. 45. 29. 79 (CMG vi. 2.1. 190. 34 6). 78 Archig. and Leonid. ap. AeÈtius of Amida (AeÈt.), Medical Writings/Lo3goi i1 atrikoi3 (Tet.) 16. 42 (60. 5 8 Z). 79 Aret. SA 1. 9. 4, and On the Causes and Signs of Chronic A€ections (SD) 3. 4. 1 2 (CMG ii. 11. 22, 38. 12 21). 80 See e.g. [Gal.] Def. Med. 298 9, 303 4, and 429 32 (xix. 428 30, 448 K); Aret. SA 2. 11. 6 (CMG ii. 34. 8 10).

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in¯ammation, or numbing, of the womb, as well as conditions of the rectum.81 The bringing up of blood may be produced by a diversion of menstruation, as from a diversion of a habitual nosebleed.82 However, that failure of the menses may, alongside various excesses of lifestyle, lead to mania (mani3 a, chronic psychical derangement), seems less propor tionate and the womb is also marked out as special, patholo gically, and therefore physiologically.83 This singularity is expressed most graphically by Aretaeus, who devotes separate chapters to its acute and chronic a€ections, in contrast to Anonymus Parisinus, who makes no reference to diseases of the womb in his work. In Aretaeus, the womb is distinguished both quantitatively, being a focus for generic pathological activity, and qual itatively, being the source of three uniquely female a‚ictions. The ®rst, and most dramatic, is uterine su€ocation, an acute and dangerous condition produced by a sustained upward movement of the wombÐthe `female heart', but also `a living thing within a living thing'.84 This movement violently compresses the intestines and other internal organs, causing sluggishness, choking, and loss of speech, which may lead to complete insensibility, imperceptible breathing, and death. It resembles epilepsy, without the convulsions, and is similar to katoche (katoxh3, another form of su€ocation), except in its aetiology. It is, however, distinctively female, as Aretaeus stresses, while both these similar conditions, and others to which the womb is susceptible, are shared with men. It is also more common in young women who are more ¯ighty than their older, steadier sisters, and hence have wombs more prone to `wandering'. The second speci®c a‚iction of the uterus occurs when it moves downwards, resulting in pro lapse.85 Last is the female ¯ux, an irregular, but sustained, 81 Aret. SA 1. 6. 2 and 2. 10. 2 (CMG ii. 5. 27 8, 31. 12 3); Ruf. Ren. Ves. 11. 1 (CMG iii. 1. 160. 15 17). 82 Aret. SA 2. 2. 3 and 9 (CMG ii. 17. 19 20, 19. 11 16). 83 Aret. SD 1. 6. 4 (CMG ii. 42. 4 8). 84 spla3gxnon gynaikh3ion . . . o2koi9 o3n ti zv9on e1 n zv3Q, Aret. SA 2. 11. 1 (CMG ii. 32. 22, 33. 1); the whole of this chapter (2. 11) deals with hysterike pnix and see also [Gal.] Def. Med. 300 (xix. 428 K). For wider discussion see King, Hippocrates' Woman, 205 46. 85 Aret. SD 2. 11. 9 11 (CMG ii. 81. 25 82. 16).

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¯ow of material of varied colour, consistency, and volume from the uterus.86 A second set of di€erentiated diseases starts out from the male side of the equation. The two most important are satyr iasis, an acute, continuous, and painful tension of the genitals, and gonorrhoia, a chronic, involuntary ¯ow of seed. Aretaeus categorically denies that women can be a€ected by the former:

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lo3gow de4 o7ti kai4 gynai9 kew pa3sxoysi toy9to to4 pa3uow, kai4 h7 te e1 w ta4 a1frodi3 sia o2rmh4 o2moi3 h kai4 ta4 loipa4 jy3mpanta ta4 ay1ta3. e1 gv4 de4 maxlosy3nhn me4 n gyniaji4 y2grW9si pei3 uomai gi3 gnesuai, e1 w e5 kxysin toy9 plh3ueow toy3tvn satyri3 hsin de4 h7kista. oy5te ga4r h2 fy3siw ay1te3 vn e1 toi3 mh cyxrh3 ga4r a1ll¸ oy1de4 mo3ria e1 w o1rui3 hsin, o7kvsper sa3tyrow, i5 sxei gynh3, v7sper to4 pa3uow e1 pv3nymon. oy1de4 ga4r oy1de4 pni3 ga th4n a1po4 y2ste3 rhw nose3 oysi a5ndrew, oy7neken oy1k i5 sxei y2ste3 rhn a1nh3r. It is said that women also su€er from this a€ection, and that both the impulse to sexual activity and all the other things are the same. I, however, believe that great lust occurs in moist women, for evacua tion of their excess; but satyriasis not at all. For their nature, being cold, is not arranged [for it], nor has woman the parts for erection, like a satyr, from which the a€ection is named. For neither do men become diseased from su€ocation from the uterus, as man does not have a uterus.87

He also draws a clear distinction between the sexes in terms of gonorrhoia: nose3 oysi de4 kai4 gynai9 kew th3nde th4n noy9son, a1ll¸ e1 pi4 knhsmoi9 si tv9n mori3 vn kai4 h2donW9 proxe3 etai tW9si h2 uorh3, a1ta4r kai4 pro4w a5ndraw o2mili3 W a1naisxy3ntQ a5ndrew de4 oy1d¸ o7lvw o1da3jontai. Women also sicken with this disease, but the seed is poured forth by them with titillation of the parts and pleasure, and in shameless intercourse with men, but men are not at all irritated [in this way].88

Instead, male gonorrhoia completely robs its victims of all vitality: kai4 h2me3 aw a5ndraw poie3 ei zvoy9sa h2 uorh3, uermoy3w, e1 na3ruroyw, lasi3 oyw, ey1fv3noyw, ey1uy3moyw, krataioy4w noh9sai3 te kai4 r2e3 jai dhloy9si oi2 a5ndrew. oi¥ si de4 oy1k e5 nesti zvoy9sa h2 uorh3, r2iknoi3 , a1suene3 ew, o1jy3fvnoi, a5trixew, a1ge3 neioi, gynaikv3deew dhloy9si oi2 ey1noy9xoi. 86

Aret. SD 2. 11. 1 5 (CMG ii. 80. 3 81. 6); [Gal.] Def. Med. 301 (xix. 429 K) and Archig. ap. AeÈt. Tet. 16. 63 (89. 3 20 Z). 87 Aret. SA 2. 12. 4 (CMG ii. 35. 5 12). 88 Aret. SD 2. 5. 1 (CMG ii. 71. 13 16).

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For the seed, being alive, makes us men hot, ®rm limbed, hairy, well voiced, well spirited, mighty in thought and deed, as men demon strate. But when the living seed is not present, they are shrivelled, feeble, shrill voiced, hairless and beardless, womanish, as eunuchs demonstrate.89

The other texts are less clear. Anonymus Parisinus de®nes satyriasis as tension, `of the seminal vessels, and of the neck (of the bladder), and of the penis, and of the genitals (aidoion)', arising from in¯ammation.90 The text's editor, Ivan Garofalo, and his translator, Brian Fuchs, argue that unless the genitals are female then this term is redundant, so the author envisages satyriasis as a generic disease. Certainly a Byzantine annotator held this view as he added a case of a woman with satyriasis to the end of this chapter.91 However, this is not the only way this passage could be interpreted, and given the strength of opinion on both sides of the debate and the clarity with which they are expressed elsewhere, it might seem that Anonymus is hedging. Men can certainly be a€ected by the disease, about women he is unconcerned. Both Rufus and the author of Medical De®nitions also use ambiguous language, referring only to the aidoion in both a€ections, but while the latter is elsewhere committed to women being a€ected by diseases of seminal dysfunction as much as men, Rufus is giving nothing away.92 There are also minor diseases which are clearly exclusively male, such as hypospadias (y2pospadi3 aw), in which the urethra opens onto the underside of the penis.93 The initial expectations have, therefore, largely been sub stantiated. A speci®cally female pathology comes into focus only occasionally, and it is mostly discernible only in the detail. Disease types are usually generic, but with space for variation, including by sex, within their de®ning parameters. 89

Ibid. 2. 5. 3 4 (CMG ii. 71. 24 8). tv9n spermatikv9n a1ggei3 vn kai4 toy9 traxh3loy kai4 toy9 kaloy9 kai4 toy9 ai1 doi3 oy, Anon. Paris. 16. 1 (106. 17 18 Garofalo, see also trans. and notes on facing page). 91 Anon. Paris. 16. 10 (See apparatus at 108. 24 Garofalo). 92 Ruf. On Satyriasis and Gonorrhoia/Peri4 satyria3smoy kai4 gonorroi3 aw (64 84 DR); Def. Med. 288 9 and 440 (xix. 426, 450 K). 93 See e.g. Def. Med. 413 (xix. 445 K). 90

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This variation can be of susceptibility and seriousness, or locality and instance of cause and symptoms. Even where variation becomes disjunction, and the sexes separate, it is really only at the extremes of this spectrum. Uterine su€oca tion, for all its drama, is, in a sense, simply a magni®ed case of di€erential causation. Moreover, it is only Aretaeus who gives the condition real prominence, and he clearly stands on one side of a debate about the existence of peculiarly female diseases. The other texts tend to the opposite view, a position which Aretaeus himself recognizes. Soranus of Ephesus also refers to this dispute, and lists various authorities on either side, of whom Lucius the Asclepiadean, who thinks that there are a€ections unique to women, and Alexander Philalethes and Apollonius Mys, who do not, are all rationalists of around the Augustan era.94 Indeed, the fact that satyriasis was extended to women by some medical authors of this period is a striking example of the strength of the analogy between the sexes, or the continued assimilation of women into the male model. The male appropriation of generic or absolute humanity is also evident more generally. The physiological perspective is also revealing. A mechan istic model of female sexual desire is again assumedÐmoist women are more lustful since the seed expelled in sexual activity relieves their excessÐand several new areas of sexual di€erentiation also emerge. First, Aretaeus' judgement that women are, in some global sense, colder and wetter than men. Second, the womb appears as possessing unique physiological properties of movement; it is the only exception to the general applicability of the same basic pathological processes to both sexes. Third, Aretaeus suggests that maleness, at least in many of its characteristics, is generated and maintained by the presence of living seed in the male body. This situation is superimposed on a pre existing physis, and the interaction of physis and levels of vital seed, which can be altered by sexual self control, or its lack, and by castration, produces a con tinuum of maleness. The more living seed, the more male, the better, and eunuchs are so little male as to be non men. Where this conception leaves women, to whom Aretaeus grants seed, 94

Sor. Gyn. 3. 2. 1 (CMG iv. 94. 21 95. 4). For Apollonius and Alexander see von Staden Herophilus, 532 54; Lucius' chronology is more conjectural.

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but without any speci®c physiological function except a loose connection with erotic pleasure, is unclear. The implication may be that female seed, unlike male, is not `vital' or gen erative, but merely titillating. If so, femaleness would result from a lack, rather than any positive seminal action. This would again supervene on an underlying physis that is itself unsexed, but by its particular conditionÐbeing cold or hot, for instanceÐestablishes a predisposition towards femaleness or maleness.

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Therapeutics: the cure of the medical woman Rationalist therapeutics traverses the continuity between phy siology and pathology in the opposite direction, aiming to return the human being para physin to a kata physin condition by travelling back along roughly the same route as the original journey. Its guiding principle is that `opposites cure opposites', and it has three operational modes: surgery, pharmacology, and regimen (in reverse order of preference). Textual accounts of therapeutics might, in this period, follow this structure or adopt a di€erent organizational strategy. One repeated division is into works On Performative Remedies (Peri4 poioyme3 nvn bohuhma3tvn), On Evacuative Remedies (Peri4 kenoyme3 nvn bohuh ma3tvn), and On Externally E€ective Remedies (Peri4 tv9n e5 jvuen prospipto3ntvn bohuhma3tvn); and another is by disease.95 The early imperial therapeutic arsenal thus arrayed comprises almost endless variation on a restricted number of central themes, not only concerning the main lines of active interven tion against the diverse a€ections, but also in the whole panoply of ancillary measures. Each category of concern and class of treatment is carefully subdivided and often described in exhaustive detail. This survey follows the primary, tripartite classi®cation and uses it to explore sexual di€erentiation in both the actual administration of the basic therapeutic elements and the applicability of treatments. Other, wider, patterns in the medical conceptualization of woman are inevitably illumi nated in the process. Classical surgery consists of a small set of basic techniques 95

The former pattern is preferred by the pneumatikoi.

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collected into operations by the physiological and pathological understandings that shaped the medical systems of which they were a part. Both the technical and operational sides are represented in the surviving literature, classi®ed and arranged in various ways. Sexual di€erentiation appears in a few of the delineations of basic techniques preserved in the Byzantine encyclopedias, and some of the operations described in these compilations, and in treatises structured by disease, are sex speci®c, but most surgical procedures are presented in a generic manner.96 The fractured nature of the material, with much of it uprooted from its original textual framework and so losing its organizational logic and nuances of expression, means that both surface con®gurations and the underlying patterns are dicult to discern. There are two surgical procedures where the method of application is described di€erentially for men and women. The ®rst is that most ubiquitous of remedies in imperial medicine, venesection. Antyllus' account of the preparation required prior to the actual incision contains two quali®cations to the main narrative.97 In `women and those who have ¯abby muscles' or are generally `delicate' the ligature is better posi tioned di€erently, and left looser, to prevent the appearance of compression marks on the arm, which may in some cases lead to erysipelas (e1 rysi3 pelaw, a skin disease) and apostemata (a1po3s thmata, abscesses).98 This structural pattern of divergence of women from the male absolute is now familiar. The particular form of divergence in this case seems to be a simple matter of lack of muscular development and general fragility, rather than a more global inferiority in the quality of the ¯esh. The second technique is that of setting dislocated joints. Heliodorus, the noted surgeon, outlines a threefold classi®cation of procedures 96 This may tend to the male, e.g. Antyllus' and Heliodorus' instructions for the surgical removal of apostemata is largely generic but also contains details of the operation in respect of the male genitals, prompting a later copyist to insert a female parallel (Orib. Coll. Med. 44. 5. 15 16: CMG vi. 2.1. 119. 16 23 with apparatus). 97 Antyll. On Evacuative Remedies (KB) ap. Orib. Coll. Med. 7. 9. 1 12 (CMG vi. 1.1. 210. 10 211. 22). 98 e1 pi4 de4 tv9n gynaikv9n kai4 tv9n toy9w my9w pladaroy4w e1 xontv9n . . . e1 pi4 gynaikv9n kai4 tv9n tryferv9n, Antyll. KB ap. Orib. Coll. Med. 7. 9. 3 4 (CMG vi. 1.1. 210. 21 22 and 28 29).

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99

to be followed in this situation. It is the ®rstÐthe, manual, `ways of the palaestra' (palaistrikoi4 tro3poi)Ðwhich are the most suitable for women and others with soft bodies, on account of their gentleness, whereas men are better treated by the secondÐthe `methodical settings' (meuodikoi4 katartis moi3 )Ðwhich also employ everyday implements and are thus more forceful. The thirdÐthe `instrumental settings' (o1rganikoi4 katartismoi3 )Ðinvolved the use of specially constructed instru ments. Again it is a general lack of strength that characterizes women. There was surgical intervention in the female body as part of the treatment for a number of conditions, ranging from the totally generic, through the anatomically and sexually speci®c exempli®cations of common disorders to those exclusive to women. Philumenus' ®nal resort to surgery for a variety of warty excrescences on the womb is simply a subset of the general surgical procedure to deal with such excrescences (uy3moi, myrmhki3 oi, and a1kroxordo3new) whenever necessary.100 It is only the topography that varies. Similarly Aretaeus prescribes venesection for melancholia that has appeared after either suppression of the menses in women or haemorrhoidal ¯ux in men.101 A homology between all these processes is thus estab lished. Menstruation and haemorrhoids perform the same physiological function (the di€erence being that this function is universally necessary among women and only selectively so among men), so their interruption has the same pathological result. They can both be replaced by phlebotomy which, as it forms part of a single pattern with either, may thus restore regularity as well as alleviating some immediate symptoms. Identity of healing mechanism is thus assumed despite any di€erences in application between the sexes. A more qualitative disjunction between men and women is illustrated in the inclu sion of venesection in the extensive curative programmes pro mulgated for uterine su€ocation by Aretaeus and Philumenus, and, even more clearly, in the latter's instructions for the surgical extraction, if necessary by dismemberment, of the 99

Heliod. ap. Orib. Coll. Med. 49. 1. 1 3 (CMG vi. 2.2. 4. 4 17). Philumenus ap. AeÈt. Tet. 16. 106 (154. 4 23 Z); he claims to have practised part of the procedure on his wife! 101 Aret. Therapeutics of Chronic A€ections (CD) 1. 5. 7 (CMG ii. 157. 14 19). 100

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foetus and for clitoridectomy (nymfotomi3 a) preserved in the encyclopedia of Aetius of Amida.102 This latter operation, which should be taken in conjunction with the comment about clitoral excision in the pseudo Galenic Introduction, stands out from its background in a number of respects and requires further examination. Philumenus provides an introduction to his fairly detailed technical description of clitoridectomy:

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h2 legome3 nh ny3mfh . . . megeuy3netai de3 tisin e1 pi4 ple3 on tv9n gynaikv9n ay5jhsin lamba3non, kai4 ei1 w a1pre3 peian kai4 ai1 sxy3nhn gi3 netai. a1lla4 kai4 paratribo3menon synexv9w y2po4 tv9n i2 mati3 vn e1 reui3 zei, kai4 th4n pro4w synoysi3 an o2rmh4n e1 pegei3 rei, dio3per pro4 th9w megeuopoih3sevw e5 doje toi9 w Ai1 gypti3 oiw a1fairei9 n ay1to4 to3te ma3lista, o2po3te pro4w ga3mon a5gesuai me3 lloien ai2 parue3 noi. The so called nympheÅ . . . increases its size more in certain women, taking part in their growth, and it tends towards unseemliness and shamefulness. But it is also aroused by being continually rubbed by the clothes and it excites the urge for sexual intercourse, on account of which the Egyptians decided to remove it, before the enlargement, especially at the time when the girls are about to be given in marriage.103

That is, he o€ers a justi®cation, or explanation, for what he casts as a general practice among the Egyptians, a practice which, by implication, has a wider applicability, before giving instructions on how to carry it out.104 This justi®cation, or explanation, operates according to two normative principles: the principle of the physical normality or conformity of women, and the principle of the sexual and social normality of the female role in marriage. These principles were so powerful that they could justify a pre emptive surgical strike of a kind otherwise unknown in the classical medical repertoire; 102 Aret. Therapeutics of Acute A€ections (CA) 2. 10. 1 6 (CMG ii. 139. 26 141. 19); Philum. ap. Orib. Synopsis/Sy3nociw (Syn.) 9. 45. 1 7 (CMG vi. 3. 305. 10 28), and ap. AeÈt. Tet. 16. 23 and 103 (30. 15 33. 30, 152. 15 153. 10 Z). 103 Philum. ap. AeÈt. Tet. 16. 105 (152. 15 153. 22 Z); and cf. [Gal.] Intro. 10 (xiv. 705 6 K, and cited above). This may be an extract from Philumenus' Gynaecology. 104 Other writers mention the Egyptian practice of female circumcision, such as Strabo (17. 2. 5) and Philo (Questions and Answers on Genesis 3. 47); but evidence from the inside is harder to come by, especially from the Roman period, see Dominic Monserrat, Sex and Society in Graeco-Roman Egypt (London: Routledge, 1996), 41 4 for discussion.

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and that means of a kind that has no male equivalent, though the practice of male circumcision, at least as practised by Jewish communities, was a familiar feature of the Roman world.105 The systematic mutilation of female genitalia was susceptible to explication; it could be completely reformulated in the language of imperial medicine as it declaimed to its audiences in a way that less radical alterations to the male genitalia could not. The pharmacological division of imperial medicine repeats a similar pattern. The extra exterior opening of the female body established a speci®cally female mode of application for a largely shared set of pharmaka, therapeutically deployed within a completely uni®ed framework. This was a simple question of topography, brought into focus by the signi®cance of the body's boundary in a curative system based on the intentionally instituted interaction of various parts of the external world with various parts of the human body. There were no apparent hierarchical connotations, and it provided an entrance both to the somatic interior generally and to a speci®c organ. Aretaeus urges that purging downwards is not neglected in the treatment of pleuritis, `in men injecting oil of rue into the gut, and, in women also into the womb', thus emphasizing again the universality of pharmacological mechanisms and the inter changeability of various bodily processes.106 More speci®cally, Antyllus asserts that `pessaries are only applied to the uterus' and the three typesÐemollient, astringent, and anastomizingÐ are used against a range of this organ's disorders, such as in¯ammation or ulceration.107 It is not just the disposition of the womb that may be addressed with drugs, but also its 105 Male circumcision does appear in the medical record as a therapeutic possibility in response to some serious, and already existing, diseases and thus as a quite distinct phenomenon from clitoridectomy (e.g. Orib. Coll. Med. 50. 7. 1 5: CMG vi. 2.2. 59. 12 23). Male castration is also described, but again the context is quite di€erent, for it is presented as a regrettable operation that unscrupulous persons purchase for slaves (Paul. Aeg. 6. 68: CMG ix. 2. 111. 19 112. 5). 106 a1ndra3si me4 n e1 w to4 e5 nteron phga3nion e5 laion e1 gxe3 onta, gynaiji4 de4 kai4 e1 w y2ste3 rhn, Aret. CA 1. 10. 16 (CMG ii. 117. 18 19). 107 pessoi4 de4 mo4nW me4 n y2ste3 rq prosti4 uentai, Antyll. On Externally E€ective Remedies (EPB) ap. Orib. Coll. Med. 10. 25. 1 4 (CMG vi. 1.2. 67. 33 68. 17); cf. Archig. ap. AeÈt. Tet. 16. 86 (133. 15 134. 11 Z).

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functions in menstruation, pregnancy, and parturition. According to Antyllus, for instance, kollyria (kollyri3 a, salves, usually for the eyes) may be administered to the uterus (unless in¯amed) to provoke the menses or expel the embryo, and the latter may also be achieved by sternutatory pharmaka.108 These are particular mobilizations of general therapeutic principles, as is clear from the author's explanation of his present exten sion of the use of kollyria from their exclusively opthalmo logical origins and the broad range of other applications attributed to sternutatories (including for the purpose of expelling items that have become lodged in the ears!). Antyllus, Aretaeus, and Philumenus all provide descrip tions of the classic Hippocratic fumigation therapy for those a‚icted with the most extreme and sexually divisive of uterine diseases, su€ocation.109 Sweet smelling fumes are introduced into the vagina through a reed while the woman simultan eously inhales fumes of an unpleasant odour, thus inducing the womb, through repulsion and attraction, to return to its position kata physin. The narrative is most graphic and fully explanatory in Aretaeus, who endows the uterus with explicitly animal like qualities of independent movement, while the rationale behind this method is left rather vague in the others, particularly since Antyllus also recommends some kind of fumigations for those su€ering from epilepsia and asthma (a¤suma, diculty in breathing). The realm of regimen is of considerably greater complexity, and requires renewed engagement with Foucault's history of sexuality and the self, and the important role ancient dietetics plays within it. In Foucault's account, while women occasion ally appear in his speci®c discussion of the place of sexual matters in regimen, they are completely omitted from the general introduction. It is, therefore, totally unclear whether the general principles established at the outset, the ways in which dietetics are meant to work as an art of living, are applicable to women and, thus, on what terms they enter the 108 Antyll. EPB ap. Orib. Coll. Med. 10. 23. 1 19 and 10. 30. 1 10 (CMG vi. 1.2. 64. 15 66. 34, 71. 31 72. 27). 109 Antyll. EPB ap. Orib. Coll. Med. 10. 19. 1 10 and 10. 20. 1 4 (CMG vi. 1.2. 61. 18 63. 8); Aret. CA 2. 10. 1 6 (CMG ii. 139. 26 141. 19); Philum. ap. Orib. Syn. 9. 45. 1 7 (CMG vi. 3. 305. 10 28).

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later narrative. This omission could be said to be a re¯ection of a similar absence in the medical and philosophical texts of classical Greece on which Foucault's fundamental analysis of regimen rests, and which are implicitly, but none the less clearly, designed for men only. This exclusivity is, however, part of the phenomenon which requires consideration. Moreover, the silence is decisively broken in the transition to the Roman era, something that Foucault fails to notice while remarking on the general `intensi®cation' of dietetic themes in the imperial period.110 Now there are speci®cally female regimens, as well as not infrequent inclusion of women in the general discussion of dietetic therapies. It is the portion of this material originating from the ®rst two centuries ad that will be examined here; and the question of woman's relationship to Foucault's construction of the male self will form part of that examination, for, despite its ¯aws, his overall vision remains compelling. Oribasius preserves two entirely female regimens from the imperial era, both created by Rufus of Ephesus.111 Since the simple, unadorned title `On Regimen' (Peri4 diai3 thw) signi®es a regimen for men, some quali®cation is necessary to clarify the situation in these cases and Oribasius provides `On Girls' Regimen' (Peri4 parue3 nvn diai3 thw) and `Women's Regimen' (Di3 aita gynaikv9n).112 Proceeding chronologically, On Girls' Regimen presents a regimen radically at variance with the Foucauldian model. The female self is entirely absent from a text that establishes a relationship between those in whose care and control the girls fall and the wayward and problematic bodies of their charges. The objective of this relationship is to ensure that the girl passes through puberty at the right age and without disaster so that a productive marriage may follow. As Rufus explains, modern girls who, unlike their Archaic 110 Foucault, The Care of the Self, 99 104. The problematic relationship between Foucault and women has been much discussed, most relevant here is Lois McNay, Foucault and Feminism (Cambridge: Polity, 1992). 111 Whether these were originally independent treatises or sections of a larger work is unclear: see Sideras, `Rufus von Ephesos', 1171 4 for discussion. 112 Ruf. ap. Orib. Coll. Med. lib. inc. 18. 1 32 and 20. 1 56 (CMG vi. 2.2. 106. 30 109. 15, 109. 25 112. 12).

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ancestors, enjoy an abundance of food and a shortage of physical activity build up a dangerous somatic excess which not only leads to disease but also hastens the onset of puberty and incites to sexual intercourse. The only solution to this problem is rapid marriage, for conjugal relations relieve the excess (both directly and indirectly), but childbearing at this age is fraught with danger. So the better course is to avoid this situation entirely by ensuring that puberty occurs `at the proper time of nature' and thus the girl is given in marriage late enough to survive childbearing and produce sound o€ spring.113 It is to this end that Rufus has designed this regimen, a regimen which does not have much to say about young girls but starts in earnest as puberty approaches. Now a girl's meals must be structured and moderated; meat and other strong foods are not to be provided. She is ordered to exerciseÐto walk, even run, or play with a ballÐvigorously enough to stir the innate heat and warm the bodily hexis (e7 jiw, that is its state or condition) while remaining female and not becoming manly. Wine is strictly forbidden, though it had been innocently enjoyed in infancy: v2w mh4 zeoy3sW th9 fy3sei to4 kau¸ e2 ayth4n kai4 to4 para4 toy9 oi5 noy sy3mmaxon gi3 nesuai. ai2 d¸ y2droposi3 ai kai4 ei1 w svfrosy3nhn synergoy9sin, o2 d¸ oi¤ now a1kolastote3 raw poiei9 . so that the seething in her nature and in that of the wine do not become allies. Drinking water contributes to moderation (soÅphrosyneÅ, wine makes [girls] more intemperate (akolastoterai).114

Particular care must be taken over the ®rst menstrual period, the course of which is inevitably arduous, and varies according to the nature and form of each girl. The intrinsic instability of the female body, its innate tendency to excess which is exacerbated at certain points in the life cycle and by certain aspects of lifestyle, is the starting point for this narrative. This instability is both a physical and a familial phenomenon; it is driven by a ¯awed interaction between the body and its environment, and produces a somatic reconstitution which is socially and medically dangerous. The 113 to4n oi1 kei9 on th9w fy3sevw xro3non, Ruf. ap. Orib. Coll. Med. lib. inc. 18. 8 (CMG vi. 2.2. 107. 20 3). 114 Ruf. ap. Orib. Coll. Med. lib. inc. 18. 16 17 (CMG vi. 2.2. 108. 10 12).

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process of stabilization is not in any way re¯exive; it is an external imposition, achieved initially by something perhaps better described as regimentation than as regimen, then mar riage and procreation. Even the opposition between sophrosyne and akolasia is presented, not in subjective terms but as an opposition between two substancesÐwater and wineÐand their interaction with a seething somatic state. The equation is also heavily weighted in favour of akolasia, which appears in an intensi®ed form and is the inevitable result of wine con sumption, while water only aids the attainment of sophrosyne, with the other factors involved left unspeci®ed. Some of the drama of the piece is rhetorical, designed to promote medical intervention in these areas of life, and Rufus' approach in particular, but this simply serves to accentuate the sharp contrast between this programme for the formation of a properly socially and physically constituted reproductive body and the male mainstream of the dietetic tradition. The tone of Women's Regimen is quite di€erent, and more commensurate with that of its male counterparts. It is clearly envisaged that the woman herself will institute the programme and thus a gap opens up between female body and female self which the regimen aims to organize. This resemblance of form breaks down, however, around the contents, for: ta4 sv3mata tv9n gynaikv9n y2gro3tera kai4 cyxro3tera ei¤ nai pa9w a6n o2mologh3seien. uermo3teron oy¤n diaita9suai ay1ta4w prosh9ken, o7pvw ta4w th9w kra3sevw pleoneji3 aw e1 paniv9sin ai2 di3 aitai. The bodies of women are wetter and colder, as everyone would agree. So it is appropriate for them to be given a hotter regimen, in order that the regimen might balance the excesses of their krasis.115

Thus, for women the struggle is to establish the somatic balance with which men are, by de®nition, endowed and so dietetically need only to maintain and reinforce. This inherent female disequilibrium is countered by physical activity (opti mally road walking and riding in carriages), massages, drying mineral baths, vocal exercises (the recitation of lyric poetry and declamation are best), and a careful diet, avoiding cold and wet foods (such as ®sh) in favour of those that are hot and dry (such 115

Ruf. ap. Orib. Coll. Med. lib. inc. 20. 1 2 (CMG vi. 2.2. 109. 26 8); Aretaeus would certainly agree about women being cold and wet.

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as honey) and eating always in moderation followed by a short period of post prandial repose. The male standard is a constant point of reference throughout this narrative, starting with the comparatives of its opening lines. A woman must engage in physical activity `no less than a man', while baths are `less suitable' for women than men, unless of a speci®cally drying quality, and excess, though a danger shared with men, is something quintessentially female.116 The ponoi (po3noi, that is activities, exercise, or work) most recommended for women are, however, clearly restricted in comparison to the range recommended for men, even if this contrast is not conceived of quantitatively. The classic exercises of the gymnasium, a place of social as well as functional signi®cance, are all missing in this case. Women's Regimen thus emerges as essentially corrective. The relationship it establishes between self and body is that the former is informed of, and thus able to compensate for, the excesses of the latter. For women this is the form that having a proper concern for the body takes, and it ¯ows from their relativity. The female somatic krasis is expressed purely comparatively, as wetter and colder and therefore excessive, and this comparison in itself compels a certain response. The link between excess and disease lurks under the surface throughout, but is nowhere made explicit. It is enough that women should deviate from the absolute standard for remedial action to be required. This means measures which contrive to approximate the female body more closely to the male model, at least in terms of its qualitative composition. Regimen is inherently processual, so whether this goal is attainable, even as a kind of dynamic equilibrium, is unclear. Several of these themes recur in the fragmentary texts treating dietetic elements in a therapeutic framework. There is again a di€erential distribution of prescribed ponoi. The performative remedies that Antyllus explicitly recommends for women are all at the softer end of the spectrum. Jumping and strolling, for example, are both e€ective in cases of retention of the menses, but no mention of female disorders 116 ponei9 n toi3 nyn xrh4 th4n gynai9 ka oy1k e5 lasson a1ndro3w, Ruf. ap. Orib. Coll. Med. lib. inc. 20. 3 (CMG vi. 2.2. 109. 28 9); loytra4 d¸ h¤sson gynaiji4 n e1 pith3deia, 20. 13 (CMG vi. 2.2. 110. 11 13).

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appears in the excerpts on such activities as running, swim ming, or wrestling.117 This pattern is con®rmed by the description of chironomic exercises (xeironomi3 a) as being `between dance and shadow ®ghting' and used in place of the latter in the case of women, children, old men, and those very weak and frail in body.118 The perceived antagonism between women and wine also ®nds further re¯ection in the inclusion of sex in Herodotus' list of variables that must be taken into consideration in therapeutic wine giving, with such a treatment being more suitable for men than women and requiring a particular form of administration (involving bread and warm water) in the latter case, as well as for children and the elderly.119 A new angle on the innate imperfections of women's somatic con®guration is provided by the lengthy passage `On Healthful Declamation' (Peri4 y2gieinh9w a1nafvnh3sevw) attributed to Antyllus by Oribasius.120 Here women, together with children and eunuchs, are described as inherently weak voiced on account of the narrowness of the passages which riddle the ¯esh. These poroi are part of an integrated pneumatic system within the body, of which the vocalization process is a part, so their dimensional de®ciency has a detrimental e€ect on the quality and tone of both voice and ¯esh as the ¯ow of pneuma is impeded. Vocal quality had a heightened signi®cance in the Roman world where oratory, and oral performance more widely, played such a fundamental role, and the various themes that converge around rhetorical display as a form of male self presentation in the Second Sophistic have been 117 Antyll. Performative Remedies (PB) ap. Orib. Coll. Med. 6. 31. 5: jumping; 6. 21. 2: strolling; 6. 22. 1 12: running; 6. 27. 1 5: swimming; and 6. 28. 1 4: wrestling (CMG vi. 1.1. 185. 2 4; 177. 14 16; 179. 29 180. 20; 183. 20 34, 183. 36 184. 8). 118 o1rxh3sevw kai4 skiomaxi3 aw metajy4 xeironomi3 a e1 sti3 n, Antyll. PB ap. Orib. Coll. Med. 6. 30. 1 (CMG vi. 1.1. 184. 17 22). 119 Herodotus ap. Orib. Coll. Med. 5. 27. 2 and 13 (CMG vi. 1.1. 144. 10 14, 145. 3 5). 120 Antyll. PB ap. Orib. Coll. Med. 6. 10. 1 25 (CMG vi. 1.1. 160. 11 164. 14). This attribution has been challenged by Hermann SchoÈne, ``PERI YGIEINHS ANAFVNHSEVS bei Oribasius Coll. Med. VI. 10'', Hermes, 65 (1930), 92 105, but his argument from inconsistency is unconvincing on such a small sample.

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explored illuminatingly by Maud Gleason.121 She is, however, overly pessimistic when she asserts that this intrinsic deforma tion of the poroi excludes the possibility of women achieving any bene®cial physiological reform through vocal exercise as men may do if they follow the suggested programme.122 Rather, this feature of the female body entrenches the sexual hierarchy; women can improve their general physical condition but they can never completely overcome the disadvantage with which they start, so men, with their innately pefect poroi, will always be ahead. Finally, regimen merges into what might be described as `nursing', for considerable attention was devoted by imperial physicians to the circumstances in which treatment occurred. The question that arises in this context is not whether distinc tions were made between the sexes regarding the best dis position and decoration of the sick room or similar recommendations, but whether, except in the cases of speci®c ally female diseases, the paradigmatic patient was conceived of as anything but male. For, while Antyllus remarks in the course of his discussion of beds that an inclining bed which places the feet higher than the head is good for those a‚icted with the female ¯ux, and Philumenus orders that a woman with an in¯amed womb be placed in a warm, dark room, kept quiet, and prevented from moving her legs, the details of the thera peutic narrative in generic a€ections seem often to assume a male subject.123 The substantial section devoted to the issue of sexual activity and the treatment of epilepsia by Aretaeus explicitly focuses on the transition to manhood, and he prob ably has male patients in mind when he describes intercourse with a woman as bad for the head and nerves in those su€ering from kephalaia (kefalai3 a, that is chronic headache); as also does Anonymus Parisinus when he suggests that the presence of their wives may be calming for phrenetics.124 121 Maud Gleason, Making Men: Sophists and Self-Presentation in Ancient Rome (Princeton: Princeton University Press, 1995). 122 Ibid. 91. 123 Antyll. EPB ap. Orib. Coll. Med. 9. 14. 6 (CMG vi. 1.2. 15. 21 4); Philum. ap. AeÈt., Tet. 16. 79 (123. 5 126. 4 Z). 124 Aret. CA 1. 4. 14 15 and 1. 2. 18 (CMG ii. 155. 20 3, 148. 28 149. 1); Anon. Paris. 1. 6 (6. 22 Garofalo; cf. 234. 21).

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So, while surgery and pharmacology largely track pathology in terms of the patterns of sexual di€erentiation that emerge, with only clitoridectomy really breaking new ground, regimen presents a distinct set of problematics. Here woman, or the female body, is treated holistically and, to some extent, in her social context, as opposed to the more partial and abstract approach of the other two therapeutic modes. As in the physiological texts, when the female body becomes more com plete, functional, and relational, its speci®city and disparity are accentuated. There is, then, a basic continuity between physiol ogy, pathology, and therapeutics which operates on several levelsÐon the level of woman's inferior relativity as well as some of its more speci®c somatic and social manifestations. Therapeutics thus concludes this exploration of the literary remains of the early imperial rationalist or eclectic medical system in pursuit of its constitution of woman as an object of medical knowledge, by con®rming the various trends that have been picked out so far. These texts share more than their rationalism, more than the group of authoritiesÐHippocrates, Herophilus, Erasistratus, and the restÐthat they all cite. This medical woman has been captured in a series of partial images, denied completeness by both the fragmentary nature of the material and its internal logic. Her partiality forms a coherent pattern. The medical subject is humanity, in sick ness and in health, a unitary category but exempli®ed only in sexed bodies. This unity underlies all these texts, represented in male form. There are, however, certain points at which men cannot stand for all humanity, therefore woman emerges, clarifying both her own being and the male character of the main narrative. This male arrogation of humanity is a general one in Roman society; its failure is more speci®c to medical discourse, which cannot maintain the ®ction of a unitary humanity without compromising its goal, its claim to encom pass all that is necessary for that goal. The product of this failure, female humanity is constructed as a composite of di€erence and identity with man. She emerges only episodi cally from behind the generic/male facËade, and to understand her it is necessary to read the whole text and interpret the generic as amended by the speci®c. Di€erence in this context is not a neutral or reciprocal relationship but hierarchical and

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unidirectional. Man occupies the absolute position from which, at times, woman diverges, and on which she is completely dependent, for the female sex is not explicable in its own right, but only in relation to the male. The substance of this di€erence is less ®xed than the structure in which it is formed, and its borders are disputed; each writer negotiates the terrain individually, though within a shared tradition. The speci®cally female territory, as it extends beyond, but remains anchored in, the unquali®ed human core, is primarily physiological, comprising aspects of anatomical con®guration, the dynamics of reproductive func tion, and a certain distinctive somatic quality, or qualities, linked to a distinctive somatic economy. The particularities of female pathology and therapeutics follow this basic formation with varying degrees of precision and elaboration, bringing a range of social considerations more clearly into focus. The persuasive power of each text, the authority of each author, is constructed from this mixture of basic agreement and more particular disagreement, both explicit and implicit. All ground their claims to truth, their claims to represent the best medical knowledge, most ®rmly (if not always most ostentatiously) in a common core of generally acknowledged truths, which can then support the more distinctive, and dissonant, patterns which may be laid over them. Indeed, such a common core can support a display of diversity itself, the presentation of an assortment of views, rather than any thing more singular or synthetic. Inclusiveness is a virtue too. All of this, however, serves to emphasize the real work done by the covert cultural consensus which underpins this appar ent plurality. METHODISM Methodism is the sectarian success story of early imperial Rome. Celsus, writing under the reign of Tiberius, refers to followers of Themison of Laodicea for whom the art of medicine is encompassed by a methodos, and Pliny the Elder alleges that `no actor, no charioteer was attended by greater crowds as he went out in public' than Thessalus of Tralles, the

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Neronian physician who vigorously reshaped and ¯amboyantly promoted the methodist creed.125 His account is undoubtedly exaggerated and intended to ridicule both Thessalus and the credulous masses, in whose esteem he was swiftly supplanted by a practitioner of astrological medicine, but Thessalus' impact was clearly impressive. The names of many other methodikoi appear in the medical literature, moreover, attesting to the vibrancy of the sect down to the end of the second century ad, when Galen composed his various polemics against them, including the monumental Therapeutic Method.126 Nor did doctrinal development and debates within methodism come to an end with Thessalus, and these doctrines also had a wider in¯uence on the contours of imperial medicine, contributing to the eclectic developments in the rationalist tradition. The scarce literary remains of methodism stand in some contrast to its popularity in early imperial Rome and present their own particular complex of methodological problems. The centrepiece of this study is the Gynaecology (Gynaikei3 a) of Soranus of Ephesus, an eminent methodist physician active at Rome in the reigns of Trajan and Hadrian, and the only methodist author of this period whose writings survive in any form.127 This text, however, has had to be reconstituted from a gynaecological miscellany contained in a single ®fteenth century manuscript, and is incomplete. Also extant in Greek, from amongst his substantial literary output, are treatises On Ban dages (Peri4 e1 pidesmv9n) and On the Signs of Fractures (Peri4 shmei3 vn katagmatv9n), perhaps from a larger, general surgical work, and an epitome of a life of Hippocrates probably ulti mately derived from Soranus' ten books on the Lives of the Physicians, their Sects and Writings (Bi3 oi i1 atrv9n kai4 ai2 re3 seiw kai4 synta3gmata).128 A sizeable selection of excerpts, overwhelmingly 125 `nullius histrionum equorumque trigarii comitatior egressus in publico erat', Pliny, HN 29. 1. 9 (iv. 371. 5 6 M); Cels. Med. pr. 11 and 54 7 (CML i. 18. 27 19. 3, 26. 9 29). 126 The fullest lists appear in [Gal.] Intro. 4 (xiv. 684 K), and Gal. MM 1. 7 (x. 52 3 K). 127 For an excellent biographical and bibliographical survey of Soranus see Ann Ellis Hanson and Monica Green, `Soranus of Ephesus: methodicorum princeps', ANRW II 37. 2 (1994), 984 1075. 128 The list of treatises attributed to Soranus compiled by Kind, `Soranos' RE iiia.1 (1927), 1113 30, remains authoritative; additional information and

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drawn from the Gynaecology, are preserved by the Byzantine medical encyclopedists and various other Greek fragments also survive. However, the main route of indirect transmission is through various stages of redaction in the later Western empire. In late fourth century or early ®fth century ad North Africa, the methodist physician Caelius Aurelianus latinized about ten of Soranus' works, but only his rendition of the tracts on acute and chronic a€ections remains virtually intact, accompanied by parts of his Gynaecology (Gynaecia) and several other texts which stand in a rather more attenuated relationship to both Caelius and Soranus. The Gynaecology survives as the main component of a compilation with the later and more abbre viated latinization by Mustio (or Muscio). Di€erent attitudes have emerged to the status of these texts as sources for Soranus. Some scholars have assumed the activity of transla tion to be transparent, perhaps combined with a certain editorial function, while others have conceived of the process as creative and interventionist.129 Ann Ellis Hanson and Monica Green take a more nuanced view, distinguishing between the various texts, and conclude that the Gynaecology is an adaptation not a translation, `Soranian' rather than `Soranus'.130 This line will be followed here. The focus will be maintained on the Greek text, supplemented by the frag ments from the Byzantine encyclopedias and the Latin in areas where the original is lacking or uncertain, and drawing on the wider range of Soranian material where this illuminates the central theme. Soranus' Gynaecology In writing a treatise speci®cally dedicated to woman as an object of medical knowledge, Soranus seems to be following a rationalist tradition rather than any methodist precedent. He himself refers to the Gynaecologies of Diocles of Carystus, discussion is provided by Hanson and Green, `Soranus of Ephesus', and Jody Rubin Pinault, Hippocratic Lives and Legends (Leiden: Brill, 1992), 28 34. 129 Compare, for example, Rubinstein, `The Riddle of the Methodist Method', 121, and Jackie Pigeaud, `Pro Caelio Aureliano', in G. Sabbah  tienne: (ed.), MeÂmoires, iii: MeÂdecins et meÂdicine dans l'antiquite (Saint-E  tienne, 1982), 105 17. Publications de l'Universite de Saint-E 130 Hanson and Green, `Soranus of Ephesus', 979.

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Cleophantus, and Alexander Philalethes, as well as the Maio tikon of Herophilus, and behind all these stand the various gynaecological texts of the Hippocratic corpus.131 His di€erent approach to the subject is, however, clearly demarcated and advertised in the opening sections of the treatise, which discuss the parts into which it should be divided. In his characteristic `hamartographic' manner he passes through a catalogue of others' errors in this area to arrive at his preferred, twofold, division into the part concerning the maia (understood as a provider of general medical services to women) and the part concerning the things which fall to her.132 The ®rst category consists in a descriptive evaluation of prospective and present midwives and the second is further subdivided into things kata physin and things para physin.133 The former comprises the physikon (the physical context, as it were, including the seed and generation) and the hygieinon (covering health more broadly), together with the maiotikon itself (which included the care of the pregnant and parturient woman together with the rearing of children), the latter comprising a€ections treated by regimen, surgery, and pharmacology. However, since the physikon contributes only to learning, and not to the present goal, it will, says Soranus, be omitted in this case. The treatise follows this arrangement. An examination of the midwife and the hygieinon (from which the physikon is not totally excluded) forms the ®rst book, the second is devoted to the maiotikon, the third to dietetically susceptible a€ections, and the fourth covers those which require surgical and pharmacological intervention. Soranus sets stringent standards of entry into, and excellence in, midwifery.134 The suitable woman must meet certain physical, educational, and ethical criteria, and to excel she must excel in all these departments and in the practice in which they are brought to bear. The best (a1ri3 sth) maia must be, for instance, robust, though not necessarily young; not only 131 Sor. Gyn. 3. 2. 1: Diocles; 4. 1. 2: Cleophantus; 3. 43. 1: Alexander (CMG iv. 94. 19 20; 129. 20; 122. 3 4). 132 Gyn. 1. 1. 1 1. 2. 3 (CMG iv. 3. 4 4. 11). For Soranus `hamartography' see Wesley Smith, The Hippocratic Tradition (Ithaca, NY: Cornell University Press, 1979), 224. 133 Gyn. 1. 2. 1 2 (CMG iv. 3. 13 4. 6). 134 Gyn. 1. 3. 1 5: suitability; 1. 4. 1 5: excellence (CMG iv. 4. 13 5. 3).

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literate, but also well versed in theory; disciplined, discreet, and modest; constant and reassuring in her care, unswayed by dreams or omens or anything similar. She must, moreover, be a follower of the methodos, not a rationalist or an empiricist, recognizing the common and particular features of each case, and taking the treatment from them rather than from causes or repeated observation of what usually happens. Soranus is quite explicit that he is describing an ideal, and it is, moreover, an ideal with a particular purpose; for it is this idealized ®gure that imparts de®nition and force to the work. Soranus uni®es his subject on a sociological rather than philosophical level, it is de®ned through the person and purview of the maia, not by any more fundamental markings on the ®eld of knowledge; but this is not just any midwife but the `best' midwife, and it is to a more general, concomitant, optimization that the text is ded icated. This treatise presents to the men of the Roman eÂlite the means by which their womenfolk may receive the best possible medical service from the best possible midwivesÐthe means being, basically, adherence to Soranus' instructions by all concerned. To what extent any of this was ever attained is another matter. The best midwife might be a methodist, but the adminis trative partition of her province deploys categories drawn from more traditional divisions of medicine, and, despite having rejected the relevance of the physikon to the present goal, Soranus now considers it necessary `to describe the nature of the female parts' before passing on to an account of the female hygieinon proper.135 Moreover, despite classifying the know ledge gained from dissection as medically `useless' (a5xrhstow), even though an addition to the general sum of human learning, he will include it in his teaching so that he cannot be accused of discounting its utility through ignorance.136 This reluctant description of the female parts then opens: h2 mh3tra kai4 y2ste3 ra le3 getai kai4 delfy3w mh3tra me4 n oy¤n, o7ti mh3thr e1 sti4 pa3ntvn tv9n e1 j ay1th9w gennvme3 nvn e1 mbry3vn, h6 o7ti ta4w e1 xoy3saw ay1th4n mhte3 raw poiei9 , kata4 de3 tinaw, o7ti me3 tron e5 xei xro3noy pro4w ka3uarsin kai4 a1pote3 jin y2ste3 ra de4 dia4 to4 y7steron a1podido3nai ta4 e2 ayth9w e1 nergh3mata, h6 dia4 to4 e1 sxa3thn 135 136

th4n fy3sin tv9n gynaikeiv9n dihgh3sasuai to3pvn, Gyn. 1. 5 (CMG iv. 6. 4 5). Gyn. 1. 5 (CMG iv. 6. 6 11)

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kei9 suai pa3ntvn tv9n spla3gxnvn, ei1 kai4 mh4 pro4w a1kri3 beian a1lla4 kata4 pla3tow delfy4w de4 dia4 to4 a1delfv9n ay1th4n ei¤ nai gennhtikh3n. The meÅtra (womb) is also called `hystera' and `delphys': `meÅtra' because it is the mother (meÅteÅr) of all those borne of it, or because it makes mothers of those who possess it, or, according to some people, because it has a measure (metron) of time for menstruation and parturition; `hystera' because it manifests its activities last (hysteron), or because it lies after all the viscera, if not precisely, at least broadly speaking; `delphys' because it generates siblings (adelphoi).137

Soranus then proceeds to describe the location, size, and form of the metra, all of which change with age, `being de¯owered' (diakoreyome3 nh), and childbearing.138 It is shaped like a cupping vessel, and exempli®es the principle of the nested body, whereby individual organs recall or replicate the structure of the whole; for the uterus has a `mouth' (sto3mion), `neck' (tra3xhlow), `throat' (ay1xhn), `shoulders' (v¤moi), and `sides' (pleyra3) before it reaches the `bottom' (pyumh3n). The `mouth', with its ability to dilate at certain times, is perhaps the most important of these; and in the as yet unde¯owered its texture is similar to the sponginess of the lungs or the softness of the tongue, whereas in women who have had children it becomes hard, so Herophilus says, like the head of an octopus or the top of the trachea. The body of the uterus as a whole is composed of two coats positioned in relation to each other like the layers of papyrus, one nervous the other ¯eshy, which are stretched and ®lled out by childbirth. Two arteries and two veins grow into the womb, one of each being linked to each of the didymoi attached near the uterine neck. These didymoi are loosely glandularЯatter, rounder, and broader than in malesÐand their spermatic channels empty into the neck of the bladder, so that `the seed of the female seems not to be retained for generation, as it is excreted to the outside'.139 This passage ends with an assertion that the metra is not `essential' (kyrio3thw) to life, since it not only prolapses, but can also be completely removed without causing death.140 In disease it 137

Gyn. 1. 6 (CMG iv. 6. 13 18); cf. [Gal.] Def. Med. 60 (xix. 362 K). Gyn. 1. 7 1. 15 (CMG iv. 6. 20 11. 6). 139 e5 nuen de4 dokei9 to4 toy9 uh3leow spe3 rma pro4w zQogoni3 an mh4 syllamba3nesuai tQ9 ei1 w to4 e1 kto4w e1 kxei9 suai, Gyn. 1. 12. 1 2 (CMG iv. 9. 11 18). 140 Gyn. 1. 15. 1 (CMG iv. 10. 23 6). 138

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may sympathetically a€ect the gullet and meninges, and, when healthy, it has a sympathic relationship with the breasts, as womb and breasts follow each other, act in concert, through the di€erent stages of productive female life. The size, formation, and placement of the female kolpos is described more brie¯y, but also alters over the course of a woman's life.141 The key moment of change here is that of de¯oration, when, as Soranus explains, the folds in the sinus or cavity are spread apart, bursting the vessels which held them together and causing pain and loss of blood; this understanding being contrary to the view that ascribes this pain and bleeding to a rupture of a membrane across the sinus.142 Ouside the female kolpos are the `wings', arranged as if they were its lips, and ending, anteriorly, in the so called nymphe. This is a small piece of ¯esh, like a muscle, that takes its name from the way it `hides similarly to newly wed brides' (nympheuomenai).143 Lastly is the opening of the neck of the bladder, a vessel which is di€erent in men and females in itself, being larger and with a curved neck in the former, and smaller and straight necked in the latter. Soranus is, then, loquacious in his reluctance. He o€ers a rich prose of the female ¯esh which fuses and emphasizes many of the features of anatomical writing already noted. Words slip seamlessly from explanandum to explanation, always ordered by the logic of resemblance, which links both parts of the language and parts, and processes, of the body, within and across their various registers, through the similarity and identity of their morphology and meaning. The physis of the female parts includes their nomenclature. Some of this voca bulary is, like the basic substance of the account, derived from Herophilus, but Soranus has clearly put a considerable e€ort into expanding this as fully as possible.144 The other most 141

Gyn. 1. 16. 1 1. 18. 4 (CMG iv. 11. 7 12. 27). Gyn. 1. 16. 4 1. 17. 3 (CMG iv. 11. 26 12. 4); and see Hanson, `The medical writer's woman', and Guilia Sissa, `Maidenhood without maidenhead: the female body in ancient Greece', in Halperin, Winkler, and Zeitlin (eds.), Before Sexuality, 324 30, 339 64 for further discussion. 143 ny3mfh de4 ei5 rhtai dia4 to4 tai9 w nymfeyome3 naiw o2moi3 vw y2poste3 llein, Gyn. 1. 18. 2 (CMG iv. 12. 20 2). 144 Soranus was the author of a lost work on the Etymologies of the Body of the Human Being/¸Etymologi3 aw toy9 sv3matow toy9 a1nurv3poy (Orion, Etymologicon 34. 9). 142

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notable features of this narrative are its procreative periodicity, the changing contours of all these parts over reproductive time, and the incursion of the male standard at all available points of comparison. This is, very de®nitely, the anatomy of a working, generative, woman; and behind her is the medical man. Soranus now proceeds to the actions of the uterus, namely: katharsis (ka3uarsiw, that is menstruation, or, more generally, purging or cleansing), syllepsis, pregnancy, and parturitionÐin that (that is the `natural') order.145 His discussion of the ®rst action also begins with terminology.146 Most of the names for the menstrual ¯ux (e5 mmhnon, katamh3nion, and e1 pimh3nion) derive from its regular, monthly, quality; whereas the term katharsis is applied because some consider it to be a purging of excess. Soranus himself de®nes the catamenia as `blood, or an ana logous liquid, excreted naturally at de®nite times, mostly through the metra', a de®nition that allows for the considerable variation he sees as characterizing this female phenomenon.147 Much of the rest of this section is taken up with outlining this variation in timing, quantity, and so forth, and censuring those who hold a too rigid view of the matter. This kata physin variation even encompassed non menstruation, not only in the young and old, but also among vocal competitors, those whose whole body is `mannish' (a1ndrv3dhw), the long term sick, and the pregnant.148 The common factor in all these cases is that there is no material to excrete, since it has all been used up. This point rather prejudges the discussion that follows on whether katharsis is `helpful' (symfero3ntow), in respect either to health or to childbearing.149 Views and arguments on the issue have varied, and Soranus reports the opinions of those who consider it helpful for both, or for neither, and good for the health of some women and bad for othersÐin order to refute them in favour of the position advocated by Themison and most `of us', that katharsis `does not contribute to health but only to childbearing, for syllepsis does not occur without 145

Gyn. 1. 18. 5 (CMG iv. 3. 1 4). Gyn. 1. 19. 1 (CMG iv. 13. 6 10). 147 e1 stin katamh3nion ai¥ ma h6 a1na3logon y2gro4n fysikv9w kata4 xro3noyw ey1ta3ktoyw a1pokrino3menon, ma3lista dia4 mh3traw, Gyn. 1. 19. 3 (CMG iv. 13. 14 15). 148 Gyn. 1. 23. 1 (CMG iv. 15. 22 7). 149 Gyn. 1. 27. 1 1. 29. 6 (CMG iv. 17. 18 19. 36). 146

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150

katharsis'. His only positive support for this is the evident existence of non menstruating women in the best of health. Soranus' methodist disdain for speculative physiology means that the processes of basic bodily functioning are not revealed; however, from this and the previous passage it is clear that he thinks of the female somatic economy as excessive but self regulating. Within the general framework of surfeit, each individual woman's body ®nds its own balance, and a men strual ¯ow that is essentially malleable is the main mechanism by which this is achieved. So Soranus, and other methodists, though they reject much of the Hippocratic model of men struation as essential to female health, still share the assump tion that the female body is, in general, a thing of excess.151 Syllepsis is next on Soranus' programme, but that is only because he missed out the business of de¯oration; so he now proceeds instead to an examination of the relationship between `perpetual virginity' (dihnekh3 parueni3 a) and health, set out in the same `hamartographic' fashion as that of menstruation.152 Soranus' conclusion is that permanent virginity is healthful (for women and men), which can be deduced from the fact that intercourse is harmful in itself, and is con®rmed by the lesser susceptibility to disease of women who, on account of service to the gods or legislation, have renounced intercourse. However, the continuation of the species, the `universal logic of nature', demands otherwise, so the next section deals with the time at which virginity should, in fact, be brought to an end.153 The rightness of this moment is determined solely by woman's procreative function, or, even more narrowly, the procreative 150 mh4 dh3pote me4 n pro4w to4 y2giai3 nein h2 ka3uarsiw oy1 symba3lletai, pro4w mo3non de4 to4 paidopoiei9 n: xvri4 w ga4r th9w kaua3rsevw sy3llhciw oy1 gi3 netai, Gyn. 1. 29. 6 (CMG iv. 19. 34 6). 151 For discussion of this and other relations between Soranus and the Hippocratic corpus see e.g. Monica Green, `Transmission', 11 36, and 55 64; Hanson, `The medical writer's woman'; and the rather di€erent views of Rousselle, Porneia, 24 46. 152 Gyn. 1. 30. 1 1. 32. 3 (CMG iv. 20. 2 22. 5); and see Paola Manuli, `Elogio della castitaÁ: la Ginecologia di Sorano', Memoria, 3 (1982), 39 49, and Pinault, `The medical case for virginity', for discussions of this passage that take a rather di€erent interpretative line. 153 tQ9 koinQ9 de4 th9w fy3sevw lo3gQ, Gyn. 1. 32. 3, and then 1. 33. 1 7 (CMG iv. 22. 1 5; 22. 7 23. 16).

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function of the womb. It is no good being guided by the impulses of the girl herself, for these may be prematurely aroused if she has not been properly brought up, but menarche is an infallible sign of the readiness of the womb to ful®l its reproductive role. It should not be too far exceeded either, as that also makes childbearing more dangerous. De¯oration should, therefore, be organized at the time at which the generative organs are perfected and able to sustain syllepsis, as signi®ed by menarche. The relentlessly reproductive message continues with a guide to recognizing women capable of conceiving, o€ered:

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e1 pei4 te3 knvn e7 neka kai4 diadoxh9w, a1ll¸ oy1xi4 cilh9w h2dypauei3 aw ai2 pollai4 ga3moiw sygkatazey3gnyntai, pantelv9w hd¸ j e1 sti4 n a5topon peri4 me4 n th9w progonikh9w ay1tv9n ey1genei3 aw e1 jeta3zein kai4 th9w tv9n xrhma3tvn perioysi3 aw, peri4 de4 toy9 po3teron dy3nantai syllamba3nein h5 mh3. Since most women are joined in marriage on account of children and inheritance, not merely for a pleasant life, so it is utterly absurd to enquire about the excellence of their lineage and the abundance of their wealth, but not about whether or not they are able to conceive.154

Soranus considers general health and a good, moderate, con stitution to be the best indicators, rather than recommending any more speci®c investigation.155 After marriage the issue is then the best timing of intercourse in order to achieve syllepsis. The ideal moment is when a menstrual purge is ending, the impulse and desire (orexis) for intercourse are present, and the body is in a globally balanced and pleasant condition.156 The woman should also not be drunk during intercourse; rather, her soul should be in a well balanced state, thus her children will not be somatically misshapen by her drunken fantasies, nor deranged in soul.157 Though the woman herself would be the best judge of much of this, and it is her condition that is cast as crucial, it is actually not clear that the judgement is hers. In particular, the analogy with the farmer taking care to throw his seed over good, sound land suggests that control rests with the man.158 Having gone through all this, it then seems rather late to 154 155 156 157 158

Gyn. Gyn. Gyn. Gyn. Gyn.

1. 1. 1. 1. 1.

34. 34. 36. 39. 39.

1 2 2 1 3

(CMG iv. 23. 18 21). 1. 35. 6 (CMG iv. 23. 23 25. 9). (CMG iv. 25. 16 21). 3 (CMG iv. 27. 28 28. 5). (CMG iv. 28. 1 5).

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ask whether syllepsis is actually healthful, and somewhat ironic to answer in the negative.159 However, completeness demands that the question be put, and the reply is cast as an injunction to care and control rather than desist. Not every thing that is useful is healthful, and it is the former that takes precedence. If, for the Hippocratic writers, to be a healthy woman is to be a reproductive woman, for Soranus (and others among the methodikoi), to be a woman is to be reproductive (the exceptions only serving to prove the rule), which is not healthy but useful; and it is towards this utilitarian end that Soranus directs his e€orts. Though this conceptual reordering means that the possibility of being a non menstruating, non generative, but healthy, female is opened up (in fact this is the optimal situation in terms of female health), she would be useless; and it should also be noted that there is little or no suggestion of any female choice or control over which category she will inhabit. So, for Soranus, the normal course of a woman's life involves menstruation, marriage, and childbearing and he intends his text to facilitate that progression; but, equally, he wishes to clear out clusters of false beliefs along the way, to de®ne his position and authority against these errors and their perpe trators, and a key false belief is the view that a woman's failure to conform to this norm is detrimental to her health. It is not: rather, it is detrimental to humanity. Soranus now proceeds more straightforwardly through the signs of syllepsis (rejecting any notion that the sex of the conceptus can be discerned at this point), the care of the woman having conceived (which is actually the care of what she has conceived, since her behaviour can damage it, in body or soul), the care of the woman during the period of kissa (ki3 ssa, when there are feelings of nausea and cravings for unusual foods), and from then up until birth.160 He also provides a sketchy account of events inside the woman follow ing syllepsis, and of the signs that this course of events is 159

Gyn. 1. 42. 1 5 (CMG iv. 29. 17 30. 8). Gyn. 1. 43. 1 1. 44. 3: signs; 1. 45. 1 3: non-discernment of sex; 1. 46. 1 1. 47. 4: care of woman having conceived; 1. 48. 1 1. 53. 3: kissa; 1. 54. 1 1. 56. 7: up till birth (CMG iv. 30. 10 31. 23; 31. 26 32. 13; 32. 15 34. 34; 35. 2 39. 5; 39. 7 41. 14). 160

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161

coming to a premature end. The book then concludes with a discussion of the use of phthoria (fuori3 a, things that destroy that which has been conceived) and atokia, which, by contrast, prevent syllepsis.162 Soranus sides with those who prescribe phthoria selectivelyÐin cases where giving birth would be particularly dangerous, not when its refusal is on account of adultery or vanityÐand who also prefer to employ atokia anyway. He then provides a range of instructions and recipes to achieve both outcomes. Here then are the ®rst real indica tions of female agency, for it is presumably adulterous and vain women who might make these demands, and all the directions and substances are for her. The second book covers the birth itself, its immediate after math, and many aspects of early child rearing; and it is the organizational and social elements of the account that are most interesting, and most revealing of the eÂlite milieu in which Soranus operated. Though Soranus is liberal and detailed in the instructions he gives, birth is the domain of the maia, together with her female helpers; there is no hint that any iatros should be present.163 It is also the responsibility of the maia to make an assessment of the newborn's physical ®tness for rearing, a report that would presumably be taken into con sideration by the man with whom the decision actually lay (that is the man in whose potestas the child would be).164 The next important decision, the selection of the wet nurse, is more the concern of the mother, if she has elected not to breast feed herself, as Soranus clearly expects will be the caseÐand he o€ers lengthy advice accordingly.165 One of the many char acteristics enumerated of a good wet nurse is her Greekness, so that the nursling may be accustomed to the `most beautiful speech' (kalli3 sth diale3 ktow), and Soranus later alleges that, in contrast to Greek women, Roman women are insuciently 161

Gyn. 1. 57. 1 1. 58. 4 and 1. 59. 1 2 (CMG iv. 41. 16 44. 4, 44. 6 18). Gyn. 1. 60. 1 1. 65 (CMG iv. 45. 2 49. 8). 163 Gyn. 2. 4. 1 2. 6. 5 (CMG iv. 52. 17 55. 10); and see Ann Ellis Hanson, `A division of labour: roles for men in Greek and Roman birth', Thamyris, 1 (1994), 157 202. 164 Gyn. 2. 10. 1 5 (CMG iv. 57. 18 58. 9). 165 Gyn. 2. 19. 1 2. 20. 3 (CMG iv. 66. 6 69. 5). He does say that, all things being equal, a mother's milk is best, but then goes on to make things pretty unequal, giving the mother plenty of good reasons not to breast-feed. 162

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dedicated to the bringing up of their childrenÐperhaps again a recommendation about who they should employ to do it for them.166 The shift from the kata physin to the para physin is then e€ected with a discussion of whether there are a€ections peculiar to females, this being the most programmatic treat ment of sexual di€erentiation in the work. Soranus' predeces sors are again divided on the issue, and their opinions and supporting reasoning can be elaborately hamartographically arranged. He rejects the positive answer to the question, includ ing the argumentation utilizing the view of Aristotle and Zenon the Epicurean that the female di€ers from the male `in nature' (fy3sei), the female being imperfect, the male perfect.167 Soranus accepts the contrary doctrine, while dismissing all the explana tions o€ered, for instance by Herophilus and the Asclepia deans, except those of Themison and Thessalus.168 He concludes: h2mei9 w me3 ntoi kata4 fy3sin i5 dia pa3uh le3 gomen gynaikv9n (oi¥ on to4 syllamba3nein kai4 a1poti3 ktein kai4 galaktoyrgei9 n, ei1 tay9ta boy3letai3 tiw ta4 e5 rga pa3uh prosagorey3ein) para4 fy3sin de4 kata4 ge3 now me4 n oy1damv9w, kat¸ ei¤ dow de4 kai4 kata4 me3 row. o7son me4 n ga4r e1 pi4 toi9 w a1nabebhko3si, koinv9w toi9 w a5rresi nosei9 to4 uh9ly stegnopauoy9n kai4 r2eymatizo3menon o1je3 vw h6 xroni3 vw ta3w te ay1ta4w tv9n kairv9n diafora4w y2pome3 non kai4 to4 me3 geuow th9w no3soy kai4 th4n a1toni3 an th9w dyna3mevw kai4 ta4w e1 n toi9 w a1llotri3 oiw, e7 lkesi te kai4 tray3masi, diafora3w o7son de4 e1 pi4 toi9 w kata4 me3 row kai4 ei1 dikh4n e5 xoysi th4n parallagh3n, i1 di3 oiw ke3 xrhtai pa3uesi, toy9t¸ e5 stin symptvma3tvn xarakth9rsi diafo3roiw. o7uen kai4 y2po4 th4n ay1th4n kata4 ge3 now a5getai uerapei3 an. Now we say that there are a€ections kata physin peculiar to womenÐ such as to conceive, give birth, and lactate (if one wishes to call these activities a€ections), but that there are no such para physin a€ections, in genus, but only in species and subspecies. For in respect to the former, the female su€ers disease in common with the males, being constricted or ¯uid, either acutely or chronically, and submitting to the same periodicity and magnitude of the disease, to collapse of strength, and to the di€erences in external thingsÐulcers and 166 Gyn. 2. 19. 15: Greek nurse; 2. 44. 1 2: Roman women (CMG iv. 68. 24 5; 85. 7 19). 167 Gyn. 3. 3. 1 3 (CMG iv. 95. 6 17). 168 Gyn. 3. 3. 4 3. 5. 2 (CMG iv. 95. 17 97. 4). Unfortunately the substance of Themison's and Thessalus' arguments is lost through corruption of the manuscript.

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wounds. Only in so far as they have variation in the species and subspecies, is she subject to peculiar a€ections, that is to say [the variations] in the di€erent characteristics of the [accidental] symp toms. Therefore she is subject to the same generic treatment.169

This ®nal distinction follows the contours of the methodos. Methodists consider the fundamental and therapeutically sig ni®cant features of the pathological landscape to be common to humanity, it is only in the accidental detail that speci®cally female aspects emerge. Di€erence is minimized but its one way character reinforced. The general principle of pathological and therapeutic iden tity between women and men is exempli®ed in the discussions of the various conditions contrary to nature a€ecting women that follow, and the more restricted de®nition of that state which had been formulated in the section on the healthy is reinforced. Thus, in beginning again with katharsis, Soranus stresses that non menstruation is not, in and of itself, a pathological state. The condition of menstrual retention is merely a contrary to nature subset of non menstruation more generally, and its diagnosis must proceed by discounting the other possibilities; then it may be treated.170 Treatment of non menstruation according to nature, on the other hand, is useless and dangerous, except in cases where katharsis is sought in order to allow syllepsis.171 The regimen of these women must be softened, as far as possible, so that the femaleness of their bodies may be intensi®ed. Much of the rest of book 3, on the diseases that are treated dietetically, is taken up with the recognition and cure of the now familiar, and always generic, diseased dispositions of the womb, such as in¯ammation, hardening, in¯ation, and so forth. Uterine su€ocation also makes an appearance, but less in the context of this larger grouping than in proximity with epilepsia, apoplexia (a1poplhji3 a, that is sudden collapse), kata lepsia (katalhci3 a, an acute, feverish seizure), lethargos, and aphonia (a1fvni3 a, speech loss) caused by worms; that is, the a€ections with which its identifying symptoms are shared, and 169 170 171

Gyn. 3. 5. 1 2 (CMG iv. 96. 22 97. 3). Gyn. 3. 6. 2 3. 8. 3 (CMG iv. 97. 12 98. 21). Gyn. 3. 9. 1 2 (CMG iv. 98. 22 31).

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from which it must be carefully distinguished.172 An in¯amed and retracted diathesis of the womb is part of this process, among other things, no more. In a sense, therefore, Soranus takes the focus away from the uterus, though the antecedents of hysterike pnix are linked to the female reproductive cycle and include recurrent miscarriages, long widowhood, and the end of childbearing.173 And he strongly condemns the use of odoriferous therapies and irritating applications, `for the uterus does not creep out, like a wild animal, from its lair, delighting in fragrant odours and ¯eeing unpleasant ones'.174 His curative programme is instead derived from his classi®ca tion of the a€ection as `constricted', violent, and either acute or chronic, with adaptations for local speci®cities.175 The book concluded with a chapter on various failures to produce children lost from the Greek manuscript, but preserved in the latinizations.176 Also included in this book were satyriasis and gonorrhoia, since Soranus considers that both occur in women as well as men.177 The former is more freqent in men but has a similar e€ect in women, by slightly di€erent mechanisms. It causes them to develop an unrestrainable urge for sexual intercourse and, on account of the sympathy between the in¯amed uterus and the meninges, produces a certain derangement of thought and shamelessness.178 In gonorrhoia the emission of seed has 172

Gyn. 3. 27. 1 4 (CMG iv. 109. 25 110. 19). Gyn. 3. 26. 2 (CMG iv. 109. 13 15). 174 oy1 ga4r v2w uhri3 on e1 k fvlev9n h2 mh3tra proe3 rpei, terpome3 nh me4 n toi9 w ey1v3desi, fey3goysa de4 hta4j dysv3dh, Gyn. 3. 29. 5 (CMG iv. 113. 3 5). 175 Gyn. 3. 28. 1 (CMG iv. 110. 20 3). 176 Cael. Aur. Gynaecology (Gyn.) 2. 64 (92 3 Drabkin); Mustio 2. 51 (75. 6 76. 19 Rose). 177 Sor. Gyn. 3. 25. 1 2: satyriasis; 3. 45. 1 3. 46. 5: gonorrhoia (CMG iv. 109. 2 8; 124. 8 125. 13). Soranus' work on acute and chronic a€ections also contained chapters on these diseases, though that on gonorrhoia is largely lost; see Cael. Aur. CP 3. 175 87 (CML vi. 1.1 394. 23 402. 5), and TP 5. 79 (CML vi. 1.2. 900. 16 902. 3). 178 The urge for sexual intercourse and the disturbance of reason occur as concomitants of this a€ection in both men and women in Caelius Aurelianus' treatise on acute a€ections (CP 3. 176 8: CML vi. 1.1. 396. 1 24). He adds that women are more violently a‚icted in these respects but, though the original Greek might have included some statement along these lines, the rhetorical elaboration Caelius provides is more idiomatic and cannot, in this 173

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become disjoined from intention (prouymi3 a) and tension (e5 ntasiw) of the parts, indeed the whole condition is characterized by the opposite of tension and results in a general weakness and dissolution of the body. Seed and sex have not become com pletely separated, however, and Soranus' therapy includes the injunction `not to show her comely images in paintings nor tell her stories about sex'.179 The last book, on diseases requiring pharmacological or surgical treatment, opens with a discussion of dicult labour, in which Soranus clearly expects an iatros not only to be consulted but also to take charge, and he covers all the various possible causes of such diculties together with their reme dies.180 The last resort in such cases is extraction by hooks or embryotomy, for `even if the foetus is destroyed, it is necessary to protect the pregnant woman'.181 After procedures for removing any parts of the afterbirth that may be retained, Soranus' attention shifts to various sorts of ulceration, growths, and so forth, that may a‚ict the uterus or genitals. Amongst these chapters was one entitled `on the excessively large clitoris' (peri4 y2permege3 uoyw ny3mfhw).182 Latinizations of the text that accompanied this chapter heading survive by Caelius and Mustio, as does a section in the seventh century ad Byzantine encyclopedia of Paul of Aegina which is suciently similar to the Latin versions to suggest strongly that, ultimately, it comes from the same source.183 All indicate that the treatment for this condition was clitoridectomy. It is, however, not possible to say whether the presentation of the operation as an organic part of the surgical repertoire in these later textsÐas a straightforward form, be ascribed to Soranus. For discussion of such problematics in Caelius see P. H. Schrijvers, Eine medizinische ErklaÈrung der maÈnnlichen HomosexualitaÈt aus der Antike (Caelius Aurelianus, `De Morbis Chronicis' IV. 9) (Amsterdam: GruÈner, 1985), esp. 1 3, 17 25. 179 mhde4 e1 n zvgrafi3 q xarakth9raw deikny3ein ey1mo3rfoyw, mhde4 toy4w peri4 tv9n symplokv9n lo3goyw dihgei9 suai, Sor. Gyn. 3. 46. 4 (CMG iv. 125. 4 5). 180 Sor. Gyn. 4. 1. 1 4. 13. 2 (CMG iv. 129. 4 144. 8). 181 kai4 ga4r ei1 to4 kyhue4 n diafuei3 rei, th4n kyoforoy9san threi9 n a1nagkaei9 on, Sor. Gyn. 4. 9. 1 (CMG iv. 140. 2 6). 182 Only the chapter headings of all these conditions are preserved in the Greek: see CMG iv. 146, 24 147. 7. 183 Cael. Aur. Gyn. 2. 112 (113 Drabkin); Mustio 2. 76 (106. 1 9 Rose); Paul. Aeg. 6. 70 (CMG ix 2.2. 112. 22 30).

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response to the medical problem of excessive growth of the nymphe in some women deployed after the factÐis Soranus' or, rather, a result of the loss of an original, Egyptian, frame of reference in the course of transmission. This kind of material is certainly most susceptible to loss in this way. More securely attributable to Soranus is the formulation, repeated in all the later adaptations, that describes the a€ected women as subject to tension of the part and sexual desires like those of men. Thus the issue of the control of female sexuality remains a real one, regardless of the universality or selectivity of the procedure. The ®nal chapter surviving in Greek is on the prolapse of the womb, a condition that may result from a psychical, as well as physical, blow or event, such as having children die or hearing of the approach of enemies; the womb then has to be excised if all else fails.184 In concluding this analysis of Soranus' Gynaecology, and in thinking more generally about the genre of dedicated gynaeco logical writing it represents, it is necessary to make some attempt to place it in the context of the úuvre as a whole, problematic as that is. For it then becomes apparent that woman's position in the domain of medical knowledge as it is articulated by Soranus is actually the same as that in the rationalist or eclectic corpus, despite the obvious di€erences in the kind of works that were composed, and have survived. Soranus has simply reached the point of textually separating the medical mainstream as it ¯ows from the man, but encompasses humanity, and its speci®cally female subsidiary, which is contained within its own borders and can represent no one else. His treatises with generic titles such as those books on acute and chronic a€ections, the original architecture of which is preserved in Caelius Aurelianus' latinization even if the substance has been reworked, take their shapes from absolute/ male humanity. They cover all the a€ections which befall man, noting in the narrative any peculiarities of their distribution between the sexes, and over the ages of man, but omit those that are exclusively female except in an entirely subordinate way. There are in the remains of Soranus' therapeutic and patholo gical works, no chapters on uterine su€ocation, for instance; it 184

Sor. Gyn. 4. 35. 1 4. 40. 1 (CMG iv. 147. 9 152. 21).

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appears only under other headings, so that its various, common, cognate a€ections may be distinguished from it.185 The unqua li®ed bulk of the narrative is the male representing humanity as an object of medical knowledge, and it is he who provides the de®nition for the medical project as a whole. The work clearly and speci®cally labelled Gynaecology is positioned as an adjunct to this generic majority of Soranus' oeuvre. It is a collection and elaboration of all the points at which man cannot stand for all humanity, the points at which the representational strategy breaks down and women become more than an annotation. Its speci®cation and organization through the ®gure of the best midwife, not the iatros, only serves to underline this subordin ate situation. The contents of this collection endow Soranus' woman with a certain positive character of her own, as well as crystallizing her relative, dependent status. This character is essentially repro ductive, and the fact that this is often at odds with her health, but wins every time, only serves to underline its signi®cance. The a€ections (or whatever they are called) kata physin peculiar to women are procreative processes, and these shape and order both the kata physin half of the work and the female body itself. Everything is geared towards the bearing and rearing of chil dren, though the woman herself hardly gets a look in, as it is her parents, her husband, her iatros, her maia, that must organize her for this purpose. But woman's essentially teleological existence remains physiologically vague. That these procreative processes are useful and should function as such (and not as the foundations of female health) is clear, but how they function is not. So it is this function itself, narrowly construed in terms of its goal and utility rather than any of the other somatic or existential rami®cations or dimensions it may have, that de®nes her; woman remains the largely sociological category she began as, observed in both her normal and abnormal manifestations. The austerity of the methodos, and the sharp line it draws between requisite knowledge and interesting erudition, between the evident and the questionable, engenders a similarly austere 185

Cael. Aur. CP 2. 77: catalepsis; 3. 54 5: apoplexia (CML vi. 1. 1 178. 6 10, 324. 22 9); TP 1. 71 2: epilepsia (CML vi. 1.1. 470. 17 21); 4. 109: worms (CML vi. 1. 2 836. 12 18). Anonymus Parisinus also excludes speci®cally female diseases from his work.

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medical woman. The female is the kind of human who per forms a certain kind of useful productive role; only that is absolutely evident and necessary.

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EMPIRICISM The roll call of empiricist physicians of the early empire is perhaps less impressive than that of the methodists but more than sucient to indicate that the current retained an integ rity and vitality throughout the period.186 Both lively internal debate and substantial literary production are detectable, if not recoverable, from this time. The most noted ®gure is Menodotus of Nicomedia, perhaps active in the early years of the second century ad and described by the pseudo Galenic Introduction as having (together with Sextus Empiricus) greatly strengthened the sect, as well as being listed by Diogenes Laertius as a prominent Pyrrhonean Sceptic, illus trating the links between that philosophical school and medi cal empiricism in this period.187 He authored a polemic against the doctrines of Asclepiades of Bithynia, presumably including a refutation of his attacks on empirical medicine, contributed to programmatic discussion on the legitimacy of certain forms of reasoningÐthe `transition to the similar' and generally accepted inference (e1 pilogismo3w)Ðand, so Galen alleges, stated that the telos of the doctor is fame or pro®t.188 These are, however, tantalizing glimpses of a system of medical thought and its population which is largely lost. No independent treatise survives and the most substan tial description of empiricism comes from the far from impartial stylus of Galen. The fragments that have been preserved in others' collections are largely of a therapeutic character, often simply recipes, though sundry other reports also occur more widely. The only such texts that deal with women are attributed to Lycus of Naples, placed by Karl 186

See DeichgraÈber, Die griechische Empirikerschule, 209 19. [Gal.] Intro. 4 (xiv. 683 4 K); Diog. Laert. 9. 116. His chronology, as for all his imperial empiricist colleagues, is entirely relative and very fragile. 188 Gal. Subf. Emp. 11; 4 and 12 (84; 49, 87 8 Dgr); PHP 9. 5. 6 (CMG v. 4.1.2. 564. 26 30). 187

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DeichgraÈber in the mid ®rst century bc, but there must have been many more.189 Two more general views concerning women as an object of medical knowledge and attributed to the empirikoi are also of relevance, though the indirect and vague nature of the reportage limits the work they can do. Soranus lists those of the empiric sect as assuming that there are a€ections peculiar to women, but does not specify which empirikoi or what arguments they deploy.190 Of those that he includes, conclusions based on the existence of `women's doctors' who treat women's ailments, and people's recourse to midwives in cases where women are a€ected by something not shared with men, would perhaps be most congenial to an empiricist.191 On a related subject, Galen derides the empirikos who prescribes di€erently for children, women, and the soft ¯eshed, on the one hand, and young men, farmers, and sailors on the other, but not on the basis of an understanding of the interaction between bodily krasis and pharmaka.192 Both perspectives re¯ect the distinct articulation of the general and the par ticular in empiricism, and the greater weight it gives to individuality in the exempli®cation of disease and other medical matters. Lastly, the empirikoi took a view on the vexed question of the eight month child (believing that some such children lived) which found its way into the doxographical tradition of natural philosophy, where it is reported as being the same as that of two rationalist physicians of the fourth century bc, Polybus and Diocles.193 This is, again, an indication of the wider ambit of empiricist medicine and the undoubted participation of its proponents in the central debates about women and reproduc tion that marked the classical medical landscape, but the contents of their contributions are now, regrettably, irrecover able. 189

DeichgraÈber, Die griechische Empirikerschule, 204 5. Sor. Gyn. 3. 2. 1 (CMG iv. 94. 17 19). 191 Ibid. 3. 3. 1 (CMG iv. 95. 6 10). 192 Gal. MM 3. 4 (x. 195 K); cf. 3. 3 and 7 (x. 183, 207 K); all are discussed in Ch. 6 below. 193 AeÈt. Placit. v. 18. 3 (Dox. Gr. 428. 8 15); for a general discussion of this problem see Ann Ellis Hanson, `The eight month child: obsit omen', BHM 61 (1987), 589 602. 190

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THE SECTARIAN WOMAN There is a certain continuity, if not uniformity, in the con stitution of woman as an object of medical knowledge across the two sects about which it is possible to say anything of substance, or at least across their literary remains; as there is also in the constitution of the medical authority they claim. These sects all describe a similar trajectory, guided by the assumption that women and men are positioned di€erently in relation to the medical telos of human health; the di€erence inheres less in any asymmetry between the respective relation ships between men and health on the one hand, and women and health on the other, than in the discrepant relationships between men and humanity and women and humanity respect ively. For it is from man's absolute grip on humanity that his normative and active grip on health derive, while woman is pushed to the margins on all counts. She is more female than human; her health is similarly relativized: it may be good in itself but still not up to the standard which is the real goal of the medical art, and its attainment is not taken to be primarily and essentially her own concern. This relativism is most explicit in Rufus' regimens, where women must continuously seek to approximate themselves to the perfection of the male, but for Soranus too, women's essential role compromises their health in a way that can have no male equivalent; and both have diculties with female agency.194 These basic positions are inherited from the traditions in which these texts stand, they are taken from the society in which these works were produced and had their e€ects, and they are similarly passed on and given back, in particular ways. In this transaction their authority rests. The ®lling out of these trajectories is more distinctive, as the hierarchy ®nds clear physiological expression among the rationalists or eclectics, but far less among the methodikoi. For the former, woman may be, by nature, constitutionally colder and wetter, unstable and excessive, as well as diverging 194 Presumably men too should not, for the good of the species, completely abstain from intercourse on account of their health, but this is a small burden compared to everything that women have to endure.

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from, or providing variations on, the male theme in a number of more speci®c ways. For the latter, these constitutional matters are a medical irrelevance, and though Soranus assumes women in general to have an excessive somatic economy (something closely bound up with their qualitative disadvant age for the others), the implicitness of this understanding re¯ects its lack of real importance in his system. Soranus takes, and works with, things as they are, without elaborating or elucidating them; indeed, he is very critical of such attempts and their results. There are variations too among the rational ists and eclectics in their characterization of the medical woman in disease and cure as well as according to nature, but within a common conceptual and comprehensive koine. For absolutely all, moreover, hierarchy means commensuration, means men and women are to be understood within a single framework or scale, the chronic imbalance of which reinforces rather than undermines its unity.

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PART III

Galen

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Part III: Introduction Even taken together, all the extant texts discussed thus far are equivalent to only a fraction of Galen's surviving literary legacy, but the imposing bulk of this legacy seems to have acted as an impediment rather than an invitation to its study. As Vivian Nutton acutely observed over two decades ago: `The twenty two volumes of the last edition of the collected works of Galen occupy a smaller place in the a€ections of classical scholars than on the library shelf ', and though these volumes have received more attention (if not a€ection) since, much more is still due.1 In particular, Galen has been relatively neglected in the substantial mobilization of medical writings for the study of women in antiquity over the same period; a neglect that owes much not only to the size, but also to the systemicity, of Galen's extant úuvre. Galen's treatment of the female portion of humanity cannot be separated from his treatment of the whole, from a treatment of a breadth and depth which few predecessors or contemporaries aspired to match, inside or outside the discipline of medicine. There is no discrete, synthetic treatise dedicated to gynaecology in this massive textual corpus, no clearly signposted or explicitly privileged path to the medical woman Galen constructs. It is necessary, instead, to encompass it all in search of this part or facet, to proceed by a kind of di€erential calculus on an integer that is as close to the original whole as possible. This holism, and the surviving breadth and depth of Galen's project should, however, act as incentives for investigation rather than their opposite. Here is a medical woman who is not just rich in description but also in explanation, who is part of a whole way of knowing about the world for medical purposes that remains substantially intact, not broken into tiny pieces. So the rather daunting task that is attempted 1

Vivian Nutton, `Galen and medical autobiography', PCPhS n.s. 18 (1972), 50. To put this further into perspective, it is worth noting that Galen is estimated to be responsible for about 10% of all surviving (nonChristian) Greek literature.

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254

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here is a full examination of woman as she is constructed by Galen in the course of forming and articulating a totalizing system of medical knowledge. This examination is based on having looked at everything, having gone through all twenty two volumes of KuÈhn's edition and the numerous subsequent publications of Galen's works and picked out everything that he says about women. Picked it out and then replaced it in the context of the speci®c treatise in which it occurs, of which it is a part. Of course, not every such reference can be included here, only a selective sample. The attempt is made none the less to produce a sample that is representative of the larger pattern of reference, and re¯ects its internal structure and emphasis. That includes, therefore, what announces itself as particularly sig ni®cant or fundamental, as well as what appears so through simple repetition. Undoubtedly there are other ways in which things could be arranged, there are other ways in which the extant whole could be distilled; but some such selection and ordering is necessary. There will be two phases to this distillation. The ®rst is to try and separate Galen's authorial and authoritative persona, the way he announces and justi®es himself and his project, from the body of knowledge which this persona sets out and secures. That is, to defer the investigation of the woman incorporated in this body of knowledge until after some of the terms and conditions of her textual existence have been established. The next two chapters follow this sequence, therefore, with the ®rst as preparation for the more substantial second.

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5 Women, Power, and Knowledge in the World of Galen's Works A t the core of Galen's literary project, as with those of the other medical authors of this period, is the public articulation of the authoritative version of the art of medicine, this author ity deriving from the ideal constitution, and conjunction, of both the art and its author/practitioner. For Galen the best constitution of the art is a relatively straightforward, and essentially teleological, matter. However, the body of know ledge he considers requisite to that telos is vast and elaborately regulated, both epistemologically and methodologically. It reaches right to the founding principles of both the cosmos itself and the speaking of truth about it. The ideal author or practitioner of this art is thus constituted as someone who is equipped by birth, education, and ethical formation to be able to grasp and utilize this great epistemic edi®ce, and who single mindedly dedicates themself to this (and its) goal. Galen's claim to medical authority, and for the authority of his medicine, is rooted in his, and its, conformity, even identity, with the twin ideals he establishes, and around this basic position he weaves a wider rhetorical web in which he seeks to entrap the assent of his audiences. The individual elements of this (and some of its combinations) are familiar, but Galen's persuasive pro¯igacy, his strident self promotion, the extreme to which he has taken the mutual dependency of the relation ship between art and practitioner, author and oeuvre, take everything at least a stage further than anything else extant. Galen lives his techne through his texts. He appears in his works as a moral and rational being, as a social and medical practitioner, as an epideictic advocate of his art, and appears in complete congruence, even unity, not only with the picture of the perfect iatros they contain, but also with their doctrinal content, their formulation of the external world.

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256

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This chapter of general introduction to Galen's constitution, justi®cation, and promotion of the iatrike techne, and of himself as its ideal exponent, starts, therefore, with Galen's biography as it embraces his concept of the perfect iatros, and then works outwards from it along various other lines of legitimation to the edges of the art itself. In both sections the particular purpose is that of locating the place of woman within this con®guration of art and authority, a place that is both relative to the whole and absolutely of it. Her relativity depends, on the one hand, on how Galen orders relations between men, women, and the goal of the medical enterpriseÐhuman healthÐin de®ning iatrike, and, on the other, on how he orders the set of relations between women as persuasive, persuadable, and persuaded (in respect to this de®nition and its realization) and the male arrangement of the same categorical patternÐthe two hands being clasped ®rmly together. That is, she may be positioned di€erently from man both within his conception of the medical art itself, and within his articulation and advocation of that conception, the ways he sets about selling it and to whom; and the two are inevitably intertwined. Whatever her relative position, however, Galen's woman is absolutely of a piece with the rest of the epistemic project; there is no distinction of claim: she is as authoritative, and authoritative in the same way, as everything else. AUTHORITY THROUGH BIOGRAPHY Galen's biography ought to begin, of course, with his birth and parentage, but, as has been mentioned, it is in a sense preceded by his concept of the perfect iatros, of his formation and action in absolute conformity with the demands of the iatrike techne.1 Or at least the two exist in such a close embrace that original and re¯ection, actual and ideal, have lost any distinguishability they may once have possessed. There are now simply two simulacra, both shaped by the realities of life as it was and 1 Whether the work Galen regarded as his most autobiographical, the revealingly entitled On Slander/Peri4 th9w diabolh9w (see Lib. Prop. 12: SM ii. 122. 2), began with his birth is not clear, as it has not survived; but plenty of other writings that are either largely or partly biographical do, allowing Galen's background and life to be reconstructed in some detail.

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should have been lived in order to meet certain expectations and attain certain objectives, each fashioned in the other's likeness. To start this account o€ on a properly circular trajectory, therefore, it is worth citing a passage from the treatise To Patrophilus on the Constitution of the Medical Art (Pro4w Patro3filon peri4 systa3sevw i1 atrikh9w), a propaedeutic work that aimed to instruct Patrophilus, an eager young student of medicine, in the proper order in which the medical art should be learnt, an order derived directly from its structure.2 In the course of his didactic exposition Galen summarizes the qual ities required for the completion of this learning, for someone not only to be able to set out on the road to truth but also to reach its end. These qualities, which are frequently referred to throughout his works, are seven: a quick nature; training from childhood, especially in arithmetic and geometry; attention to the best of his generation; studiousness; a desire for truth above all else in life, `despising all the other things that are sought after by most'; command of a method for separating truth from falsity; and the practice of that method.3 Thus the objective standard is set and the story about to unfold can be easily measured against it, or vice versa. Galen's realization of this iatric ideal, the life both on which it is modelled and which is modelled on it, begins with his birth in Pergamum in ad 129.4 It was his father, the architect and landowner Nicon, whom Galen described as having a formative in¯uence on his early years.5 Not only did he instruct his son in 2 To Patrophilus on the Constitution of the Medical Art (CAM), was originally the second section of a larger work On the Constitution of the Arts/Peri4 th9w texnv9n systa3sevw (see Lib. Prop. 1. 1: SM ii. 120. 17 18) which aimed to show that the structure of every art derived from its goal; see David Dean-Jones, `Galen ``On the Constitution of the Art of Medicine'': Introduction, Translation and Commentary', Ph.D. diss. (University of Texas, 1993), 67 8, and also Stefania Fortuna, `La tradizione del De Constitutione Artis Medicae di Galeno', BollClass 3.11 (1990), 48 77. See Dean-Jones, `Galen', 71 and 133 4, for discussion of the identity of Patrophilus. 3 katafronh3santa tv9n a5llvn a2pa3ntvn, a8 toi9 w polloi9 w diespoy3dastai, Gal. CAM 6 (i. 244 5 K). 4 For this, and other dates, see Vivian Nutton, `The chronology of Galen's early career', CQ 23 (1973), 158 71. 5 For Nicon see Suda G 32 (i. 506 Adler); Galen records his father's involvement in architecture at e.g. A€. Dig. 8. 5 (CMG v. 4.1.1. 28. 20) and

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arithmetic, logic, geometry, and grammar, as he had been instructed in turn by his father and grandfather, but he also provided his o€spring with moral guidance, through both direct advice and the shining example he set in his attitude to, and conduct of, life.6 It was the virtues of the philosophersÐ justice (dikaiosy3nh), manliness (a1ndrei3 a), sophrosyne, and intelli gence (fro3nhsiw)Ðthat Galen recalled his father advocating, to good e€ect; and it was his elevation of truth over glory, and, most especially, his control of the passions that set the ideal standard in behaviour for Galen to emulate.7 This noble perfection, however, was not matched by his wife. `But my mother', says Galen, `was so very prone to anger that sometimes she bit her handmaids; she constantly shrieked at my father and fought with him, more than Xanthippe did with Socrates.'8 This nicely contrasting picture ®ts admirably into familiar patterns of classical self formation and self presentation in which the maleness of self mastery and the femaleness of its lack were integral. A point Galen makes explicit with his evocation of Socrates and Xanthippe. It is also a theme to which Galen returns as he continues to assert his moral superi ority over his professional and social rivals, that is other iatroi and other members of his class who have chosen to pursue a di€erent course of life and thus, explicitly or implicitly, challenge the great value he places on his own.9 Women are his agricultural experiments at e.g. On the Powers of Foods/Peri4 trofv9n dyna3mevw 1. 37. 2 3 (CMG v. 4.2. 261. 6 24); IGRom. iv. 502 6 are inscriptions from Pergamum of two architects Aelius Nicon and Julius Nicodemus (also called Nicon) either of whom may have been Galen's father. 6 On his paternal instruction see Gal. Ord. Lib. Prop. 4 (SM ii. 88. 9 11), Lib. Prop. 11 (SM ii. 116. 22 6). 7 Gal. A€. Dig. 8. 1 2 and 6 8 (CMG v. 4.1.1. 27. 3 28. 8, 28. 25 29. 12). 8 mhte3 ra d¸ o2rgilvta3thn, v2w da3knein me4 n e1 ni3 ote ta4w uerapai3 naw, a1ei4 de4 kekrage3 nai te kai4 ma3xesuai tQ9 patri4 ma9llon h5 Xanui3 pph Svkra3tei, A€. Dig. 8. 1 (CMG v. 4.1.1. 27. 23 28. 1). 9 General treatises such as MM and Praen. contain strong strands of moral polemic directed against both these groups, see Vivian Nutton, `Style and context in the Method of Healing', in Fridolf Kudlien and Richard Durling (eds.), Galen's Method of Healing: Proceedings of the 1982 Galen Symposium (Leiden: Brill, 1991), 1 25, and `Galen and medical autobiography', PCPhS n.s. 18 (1972), 50 62, for discussion of both these. Entirely ethical works include A€. Dig. (CMG v. 4.1.1. 3 37), and On Morals/Peri4 h1uv9n, which survives only in an Arabic summary (edited by Paul Kraus in the Bulletin of

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never in direct competition with him in either of these cat egories, and are never addressed in any of his diatribes on the degenerate eÂlite who should know better, rather they are useful symbols of what he despises. The insatiable desire of women for pearls, other jewels, and the most elaborate and costly clothing, all for their personal adornment, stands as an example of the worst kind of bodily greed that must be completely excised through the discipline of the soul; and the women of Rome rarely appear without reference to their wealth, luxury (tryfh3), and vanity, even though these have bene®cial side e€ects in ensuring the presence in the city of various valuable medical materials.10 More elaborately, in the Exhortation to the Medical Art (Protreptiko4w e1 p¸ i1 atrikh3n), Galen sets up an opposition between Tyche and Hermes as representing the dichotomy between the contemptible and creditable ways of life.11 The followers of the former range from Croesus and Polycrates through the more ordinary idle and ignorant rich to dema gogues, prostitutes, and despoilers of temples, while those of the latter include Homer, Hippocrates, and Plato among the foremost of the honourable men (kosmi3 oi) who pursue the technai. Tyche's sex is, moreover, a clear sign of her wicked worthlessness and capricious lack of judgement. Her traditional depiction `in the form of a woman', Galen holds to be a `sucient indication of folly', the rudder, unstable pedestal, and covered eyes simply serving to reinforce the basic point.12 the Faculty of Arts of the University of Cairo, 5 (1937), 1 51, and see also J. N. Mattock, ``A translation of the Arabic epitome of Galen's book PERI HUVN'', in S. M. Stern, Albert Hourani, and Vivian Brown (eds.), Islamic Philosophy and the Classical Tradition: Essays Presented by his Friends and Pupils to Richard Walzer on his Seventieth Birthday (Oxford: Cassirer, 1972), 235 60). 10 Gal. A€. Dig. 9. 4 (CMG v. 4.1.1. 31. 15 20); and see e.g. MM 8. 5 and 13. 22 (x. 574, 934 K) and Comp. Med. Loc. 1. 22 and 2. 1 (xii. 434, 512 K). Some men may follow women down the path of dissipation, as those men who are shockingly imitating rich women in the unnatural practice of sleeping during the day and waking only at night in Commentary on Hippocrates' Prognostics/Ei1 w to4 ¹Ippokra3toyw prognostiko3n y2pomnh3mata (Hipp. Prog.) 2. 11 (CMG v. 9.2. 270. 10 12) show. 11 Gal. Exhortation to the Medical Art (Protr.) 2 5 (CMG v. 1.1. 116. 3 120. 23). 12 e1 n ei5 dei gynaiko4w . . . toy9u¸ i2 kano4n h¤n a1noi3 aw sy3mbolon, Protr. 2. 2 (CMG v. 1.1. 116. 5 9).

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At 14, after his convenient completion of what he prescribed as essential basic training for any aspiring iatros, Galen, who always learnt more quickly than everybody else, began to attend various philosophers at Pergamum, covering most of the major schools of the time.13 This non exclusivity was again at the behest of his father who investigated the lives and views of all these teachers, accompanied his son to them, and advised him to make up his own mind in an informed and critical manner about the di€erent groupings.14 And, again, both these thingsÐnon partisanship except for the truth and a thorough philosophical groundingÐwere, for Galen, indispensable aspects of the good physician.15 This grooming for a philo sophical life was, however, diverted when, a couple of years later, vivid dreams impelled his father to push Galen also towards the medical art.16 His ®rst teacher in this department was Satyrus, the pupil of Quintus, who was in Pergamum with Ru®nus while he oversaw the building of the temple of Zeus Asclepius; the orator Aelius Aristides also encountered both these men in the city.17 In Pergamum he also studied with Stratonicus, the pupil of Sabinus the Hippocratean, Aeschrion the Empiric, and perhaps also Aephicianus, another pupil of Quintus who leaned towards Stoicism.18 Here too Galen launched his proli®c literary career, giving one of his earliest 13 That is the Stoics, Platonists, Peripatetics, and Epicureans, omitting only the Sceptics, see Gal. A€. Dig. 8. 3 (CMG v. 4.1.1. 28. 9 17). His comparative quickness appears at Ord. Lib. Prop. 4 (SM ii. 88. 17 19). 14 A€. Dig. 8. 4 and 6 7 (CMG v. 4.1.1. 28. 17 19, 28. 25 29. 2). 15 See, for example, his attitude to the medical sects outlined in SI (SM iii 1 32), and the arguments enumerated in That the Best Physician is also a Philosopher/¾Oti a5ristow i1 atro4w kai4 filo3sofow (SM ii. 1 8 K). 16 Gal. Ord. Lib. Prop. 4 (SM ii. 88. 15 17); MM 9. 4 (x. 609 K); Praen. 2. 12 (CMG v. 8.1. 76. 29 77. 2). 17 Gal. Lib. Prop. 3 (SM ii. 87. 8 10); AA 1. 1 2 (i. 80 2, 90 2 Garofalo); the text names the temple builder as Kostounios Rouphinos but Hugo Hepding, ``ROYFINION ALSOS'', Philologus, 88 (1933), 90 103, identi®es him as L. Cuspius Pactumeios Ru®nus, consul in ad 142 and commemorated as a major builder in Pergamum, and also suggests a connection with Nicon. See also Aristid. Sacred Tales 3. 8 9 (where Aristides blames Satyrus' prescription for making him consumptive) and 4. 28, 43, 83, and 107 (Ru®nus). 18 Gal. On Black Bile/Peri4 melai3 nhw xolh9w 4. 12 CMG (v. 4.1.1. 78. 22 4): Stratonicus; SMT 11. 1.34 (xii. 356 7 K): Aeschrion; Ord. Lib. Prop. 3 (SM ii. 87. 14 5), and Hipp. Epid. 3 1. 40 (CMG v. 10.2.1. 59. 17 19): Aephicianus.

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works, On the Dissection of the Uterus (Peri4 mh3traw a1natomh9w), to an anonymous maia, an interesting gift of a treatise that itself betrays no sign that it was written for an audience any di€erent from that of his many other short anatomical treatises.19 Following his father's death in 148/9, and having obtained his inheritance, Galen left Pergamum to pursue his medical education with the most eminent teachers of the day.20 Nothing more is heard of his mother. He travelled to Smyrna, on account of Pelops, and to Corinth and then Alexandria, the most prestigious centre of medical learning, in search of Numisianius, Quintus' most esteemed living pupil.21 His familial wealth secured him a richly varied and lengthy period of medical study, despite his relatively late start; though one that is typical in its pursuit of individual instructors and its concern with their pedagogic lineage.22 On returning to Pergamum in 157 Galen was appointed physician to the 19 Lib. Prop. 2 (SM ii. 97. 8 20); cf. On the Dissection of the Veins and Arteries/Peri4 flebv9n kai4 a1rthriv9n a1natomh9w (Ven. Art. Diss.: ii. 779 830 K), which was dedicated to one Antisthenes, and On the Dissection of the Nerves/ Peri4 ney3rvn a1natomh9w (ii. 831 56 K) as later examples of such treatises. It unfortunately cannot be compared to the opthalmic work given to a young man at roughly the same time, as this does not survive. Johannes Ilberg, `Ueber die Scriftstellerei des Klaudios Galenos, II', RhM 47 (1892), 490 2, takes this lack of internal betrayal of the sex of its recipient, or rather its failure to lower itself to a woman's level of learning, as evidence that the form of the treatise as it survives is the product of a subsequent reworking. There is no justi®cation for this view, and even if Galen is recording what seemed in retrospect to be an appropriate fate for this tract, that is itself signi®cant. See also the comments of Diethard Nickel in his edition of the text, CMG v. 2.1. 60 4. 20 A€. Dig. 9. 10 (CMG v. 4.1.1. 32. 22) on his inheritance; the rest of the chapter also reveals the comfort of his economic position. 21 AA 1. 1 (i. 80 2 Garofalo), and Lib. Prop. 2 (SM ii. 97. 9 10): Smyrna; AA 1. 1 (ii. 217 18 K) for his pursuit of Numisianius to Corinth and Alexandria. See Vivian Nutton, `Galen and Egypt', in Jutta Kollesch and Diethard Nickel (eds.), Galen und das hellenistische Erbe: Verhandlungen des IV. Internationalen Galens-Symposium, veranstaltet vom Institut fuÈr Geschichte der Medizin am Bereich Medizin (Charite) der Humboldt UniversitaÈt zu Berlin, 18 20 September, 1989 (Sudho€s Archiv Beihefte, 32; Stuttgart: Steiner Verlag, 1993), 11 31, for a full discussion of Galen's Egyptian sojourn. 22 See Marc Kleijwegt, Ancient Youth: The Ambiguity of Youth and the Absence of Adolescence in Greco-Roman Society (Amsterdam: Gieben, 1991), 155 63, for funerary inscriptions of young doctors demonstrating the early age at which education and practice usually commenced.

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gladiators by the archiereus (a1rxierey3w, that is the high priest), a selection that he claims was based on a public anatomical demonstration where he confounded his more senior rivals, and the priest's observation of Galen's total dedication to his art.23 The con®dence of the archiereus in him was borne out, Galen records, by a much reduced death rate among his charges, and a complete cessation of fatalities during his continued tenure of the post under successive holders of the priestly oce. His next journey was to Rome, the centre of prestigious medical practice, if not scholarship, where he arrived in 162. Galen's initial stay at Rome was, as he tells it, one of unparallelled achievement, recognized for what it was by those that mattered, that is primarily by those in intellectual senatorial circles. He not only accomplished `most praise worthy predictions and cures in cases involving leading Romans', but also impressed those prominent citizens with his anatomical displays and theoretical disquisitions.24 In front of an impressive assembly of the intellectually curious that lasted several days, Galen demonstrated, by speaking to the dissection of pigs and goats, the muscles and nerves involved in producing respiration and the voice, for example, and he discoursed in regular public sessions on the books of the ancient physicians.25 His polemic against Erasistratus' opposi tion to venesection, starting from a passage in the Alexan drian's On Bringing up Blood (Peri4 ai7 matow a1nagvgh9w), was particularly successful in this series, prompting his friend Teuthras to have him repeat it to a trained speedwriter so 23 Gal. On Compound Pharmaka according to Kind/Peri4 synue3 sevw farma3kvn tv9n kata4 ge3 nh (Comp. Med. Gen.) 3. 2 (xiii. 599 600 K); Commentary on Hippocrates' On Fractures/Ei1 w to4 ¹Ippokra3toyw peri4 a1gmv9n y2pomnh3mata 3. 21 (xviiib 567 8 K); Opt. Med. Cogn. 9. 4 7 (CMG Supp. Or. iv. 102. 7 104. 13); and see Nutton, `Chronology', 162 5. 24 e1 pi4 tv9n prvteyo3ntvn e1 n tW9 ¹Rv3mW prorrh3seiw te kai4 uerapei3 aw e1 poihsa3mhn a1jia4w e1 pai3 noy mega3loy, Gal. Praen. 5. 4 (CMG v. 8.1. 94. 13 14); and see the rest of the ®rst eight chapters of this treatise for a fuller account of this sojourn. 25 This demonstration is described at Praen. 5. 9 21 (CMG v. 8.1. 96. 5 100. 6); the public discourses appear at Lib. Prop. 1 (SM ii. 95. 14 96. 1) and, with some variation, at Ven. Sect. Er. Rom. 1 (xi. 194 K). See generally Heinrich von Staden, `Anatomy as rhetoric', and Armelle Debru, `Les DeÂmonstrations meÂdicales aÁ Rome au temps de Galien', AMSCC i. 69 81.

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that he could make use of it himself, something which the Aristotelian ex consul Flavius Boethus also organized follow ing his anatomical orations. There is no reference to women being among the appreciative audiences at these epideictic exhibitions, but they were certainly among the bene®ciaries of his therapeutic practice. At least three such cases are clearly located within this period, illustrating the place of the encoun ter between male doctor and female patient in this self presentational narrative and some of the features of this encounter itself. As the conventions of the time required, none of these women are named: two are referred to by their husband's names, the wives of Justus and the consular Boethus, and the other simply by her age and symptoms. The wife of Justus is famously diagnosed as su€ering from lovesickness, in a case that recalls, but according to Galen surpasses, Erasistratus' legendary diagnosis of Antiochus' pas sion for the concubine of his father, King Seleucus.26 Galen is `called in' (pareklh3uhnÐthe impersonal verb making it unclear whose initiative this is) to see a woman restlessly unable to sleep, and hostile to questioning about her condition.27 Indeed, she has her maid deny Galen access on the following days, but from his initial visit and discussions with the maid, Galen decides she is su€ering from an a€ection of the soul rather than the body; a possibility lesser iatroi would not have been aware of. He then discovers the particular nature of this a€ection by good luck and quick thinking. One of those who follows him on his rounds happens to mention that Pylades is dancing that day and Galen notices a facial reaction to this which leads him to take the patient's pulse, ®nding it now very irregular. After getting members of his entourage to draw attention to other dancers in her hearing, with no a€ect on her pulse, and then recording the same response when Pylades name is repeated, Galen concludes that Justus' wife is sick with love for this man. He has come to this conclusion without any help from the 26 Praen. 6. 1 10 and 14 16 (CMG v. 8.1. 100. 7 102. 28, 104. 9 23); this is how Galen himself refers to the Erasistratus story, but Antiochus is more usually in love with his stepmother, Stratonice, and the concubine version is usually associated with Hippocrates and Perdiccas: see Nutton's commentary on this section (CMG v. 8.1. 194 6) and also Pinault, Hippocratic Lives, 61 77. 27 Praen. 6. 2 (CMG v. 8.1. 100. 15).

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patient, in fact the reverse, and in a situation in which the absence of the object of passion made the diagnosis more dicult than in the case of Antiochus and his beloved, whose interaction was readily observable by Erasistratus. His great skill is vividly demonstrated on all counts. Indeed, the close parallels with the story of Erasistratus, itself one of several versions of the same tale told about various physicians and in a variety of contexts, together with the vagueness of various circumstantial details and the lack of any involvement by the husband, create a strong suspicion that this narrative has been carefully constructed with exactly such an aim in mind.28 Detection of lovesickness from the pulse was the way in which diagnostic erudition was best displayed, and Galen was hardly going to miss such an opportunity. It is, then, interest ing that that he chooses to rework the story with a female patient, such as appear in novels, but not the deeds of more famous physicians.29 This may be seen, however, as helping to shift the emphasis of the tale, from one which is very much about relations between men to one which is much more starkly about relations between knowledge and the physician, about how knowledge can be acquired despite e€orts to conceal it. The identity of the patient becomes irrelevant, and that is easier in the case of a woman. The other two case histories are rather more solidly ®lled in. The wife of Boethus su€ered from female ¯ux, but was ashamed to reveal this to any iatros and so put herself in the care of her `customary (synh3ueiw) midwives', known to be the best in Rome.30 When no improvement occurred, her husband summoned all the top physicians (including Galen), who agreed on a Hippocratic drying treatment. This too failed, 28 This suspicion is strengethened when Galen later refers to the story again at Hipp. Prog. 1. 8 (CMG v. 9.2. 218. 17 219. 5), where the wife of Justus has been transformed back into a young man. The main objection to thinking of this sequence as largely invented is that this might generate problems of credibility which Galen would have been all too conscious of. However, the conventions of the genre of the classical case history may have allowed for a certain leeway in such matters, and the thing need not be entirely ®ctional. 29 For lovesick women treated by doctors in the novels see e.g. Heliodorus, 4. 7, and Apul. Met. 10. 2. 30 Praen. 8 (CMG v. 8.1. 110. 13 116. 23).

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resulting only in her belly swelling up to such an extent that her female attendants (but not the iatroi) thought she was pregnant. These women then began to bathe her daily, even tually occasioning a seizure, from which Galen rescued her by rubbing nard on her hands, feet, and belly, while all the women ran around uselessly, screaming. Galen then persuaded Boethus to put him in sole charge of the case, which he did. His wife was duly cured and Galen received 400 gold pieces in gratitude. The only decision made by the su€erer herselfÐto place herself in the care of her midwivesÐis thus a mistake, though they are unquestionably from the top of their profes sion. Galen himself deals with Boethus, not with his wife. A similar pattern is repeated, but this time more favourably for the maiai, in the case of the nameless 21 year old woman who is ¯ushed, coughing, and breathing with diculty on account of menstrual stoppage.31 Here the problem is her family iatroi, of good reputation and long standing service, who, being Erasistrateans, refuse to prescribe venesection, the usual and proven therapy in such cases. Galen, unable to dislodge them either from from their doctrinal position or from their place in the household's esteem, gets them to agree to pharmacological evacuation, only to discover that the woman's customary maia has been pursuing such a treatment, with the correct drugs, every time the menses were due for the last four months. Galen then realizes the situation is desperate and tries to force the doctors to phlebotomize, but without success and the woman dies. She dies, moreover, without apparently having done anything on her own account, seemingly without even encoun tering Galen directly. Control over her care is exercised else where, and if it is exercised badly, so be it. Many of the features of these cases are shared with male ones. It is the same skills that are on display, the same under standings of the human body and its diseases that are invoked. The same competitive drive informs everything, as rival physicians repeatedly fail in their tasks, sometimes with fatal 31 Ven. Sect. Er. Rom. 1 (xi. 187 90 K); and see discussion by Heinrich von Staden, ``Inecacy, error, and failure: Galen on do3kima fa3rmaka a5prakta'', in Armelle Debru (ed.), Galen on Pharmacology: Philosophy, History and Medicine; Proceedings of the Vth International Galen Colloquium, Lille, 16 18 March 1995 (Leiden: Brill, 1997), 61 3.

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consequences. But, while Galen establishes real relationships with his male patientsÐsuch as the philosopher Eudemus, who is actively engaged in his own prognosis and cureÐand is thus involved in these instances in constructing the role of ideal patient as well as ideal iatros, this he does not do with the women.32 He may have to interact with maids and midwives, who may be allies or obstacles, and with other members of the family, who can also behave more or less well; but not with the individual whose health, and life, is actually at stake. There is a di€erential distribution of authority and agency, in which women lose out. They become demonstrative objects, mar shalled as evidence in arguments that are not addressed to them, but to those around them. `My reputation stood high among all . . . great was the name of Galen', he crows, following these and other successes; but his rivals, disproved and humiliated at every turn, `vanquished by me in every aspect of their art', spread slanderous rumours abroad, alleging that Galen was just lucky, took great risks, and relied on divinatory rather than doctorly techniques.33 Indeed, after his cure of Boethus' wife he claims that his fame became such that he was fearful that he would be prevented from leaving Rome to return home after a stay of some four years, and therefore had to sneak away, leaving false trails as he went.34 A few years at Pergamum, which he passes over in virtual silence, seem to have changed his mind, however, and he was brought back by an imperial summons, such as he had earlier tried to avoid, ®rst to Aquileia and then to Rome and responsibility for young Commodus' health.35 He avoided accompanying Marcus Aurelius on his German campaign by pleading that Asclepius commanded otherwise, an instruction such a pious emperor could hardly contradict; and later cured 32

For Eudemus see Praen. 2 3 (CMG v. 8.1. 74. 12 88. 13). pollh4 do3ja para4 pa9sin h¤n . . . me3 ga toy5noma Galhnoy9 . . . e1 n panti4 me3 rei th9w te3 xnhw y2p¸ e1 moy9 nikvme3 nvn, Praen. 5. 4 5 (CMG v. 8.1. 94. 14 15, 16). 34 The implication in the account of this at Praen. 9. 1 4 (CMG v. 8.1. 116. 23 118. 15) is that his return home was motivated by the situation in Pergamum itself, by an end of unrest there, though later at Lib. Prop. 2 (SM ii. 96. 16 19) he claims to have ¯ed the plague. See Nutton, `Chronology', 164 5, for reasons to prefer something like the former version. 35 Praen. 9. 5 7 (CMG v. 8.1. 118. 16 33) and Lib. Prop. 2 (SM ii. 98. 11 99. 18). 33

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not only the son but also, and more remarkably, the emperor himself, who called him thereafter `®rst among physicians' (i1 atrv9n prv9ton).36 A number of vignettes from the domus Caesaris now join Galen's repertoire of self aggrandizing stories, reaching into the Severan age.37 This second, much longer, stay at Rome also di€ered from the ®rst in its focus on literary production rather than epideic tic performance. An indication of con®dence in an authority that had already been successfully claimed and a renown ®rmly established, which could then be extended and consolidated in writing and on terms more his own, though the competition with rivals never ceased and his position had to be constantly restated. Galen claims that he retired from public teaching and demonstration altogether, but friends persuaded him back before the crowds in defence of his great work On the Useful ness of the Parts and some anatomical commentaries.38 Con fronting his detractors over a collection of animals and a pile of books, he proceeded to prove that everything he had said was correct, and that whenever previous authorities disagreed they were in error, allowing members of the audience to nominate parts of the body for dissection and discourse. He continued, of course, to let the excellence of his practice speak for him, and two of the female case histories that are most plausibly placed in the earlier part of this period, in the 170s, are of particular interest here. Salutary is the case of the woman who miscarried in the fourth month, and whom Galen alone among all the maiai and iatroi attending her diagnosed from her pulse as having something still in the womb requiring expulsion and who then miscarried another putrid foetus sixteen days later.39 He did, in this instance, explain the situation to the woman, but she is far from being the centre of his attention; what is more important is that this diagnosis, while impressing the atten dants, failed to impress the husband, thus showing him to be 36 Lib. Prop. 2: Asclepius' intervention (SM ii. 99. 7 13); Praen. 12. 1 9: Commodus; 11. 1 10: Marcus (CMG v. 8.1. 130. 11 132. 23; 126. 16 130. 10). 37 See e.g. Gal. On Antidotes/Peri4 a1ntidotv9n 13 and 1 (xiv 63 6, 3 5 K) for remarks about the state of the cinnamon in the imperial storehouse under Septimius Severus and other comments about emperors' use of theriacs. 38 Lib. Prop. 1: retirement; 2: return (SM ii. 96. 2 16, 100. 18 102. 19); and see again the excellent article by von Staden, `Anatomy as rhetoric'. 39 Opt. Med. Cogn. 13. 6 8 (CMG Supp. Or. iv 130. 13 132. 11).

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utterly incapable of examining physicians and really little better than an animal. Galen's assumption that it is men who will choose physicians, and thus only men that he needs to appeal to and engage with, is manifest throughout the work On Examinations of the Best Physicians in which this account appears; but is contradicted by an equally anonymous Roman woman whose successful cure is described in exhaustive detail in the Therapeutic Method.40 She actively called Galen in to deal with her bloody, catarrhic expectorations, her decision being informed not just by his general reputation but by her having heard of his particular understanding and approach to the condition and the importance of catching it before the ulcer on the lung became in¯amed. She then submitted completely, however, to his prescription, starting with having her head shaved and a medicament made from doves' droppings applied to it, and if he revealed the reasons for his actions to her the ensuing discussion was not judged worth recording. If traditions and texts other than the Suda are followed, this glittering and most proli®c career came to an end in the early years of the third century ad, not in 199; and that this majority should prevail has been recently convincingly argued, to considerable agreement, by Vivian Nutton.41 What is also of interest is that, though Galen seems never to have journeyed far from Rome again, and shows increasing familiarity with Roman words and customs in his later works, his identity as a Pergamene Greek remained unchanged to his death. As Simon Swain has said, his `insulation' from the Roman world is `striking', as is his identi®cation with Hellenic culture and his loyalty to his home city.42 In his uses of the phrase `among us (par¸ h2mi9 n)', the `us' referred to is almost never located in Italy or Rome, and while the material advantages and achievements of Rome are noted, its cultural and intellectual traditions are either ignored or denigrated. With the exception of his mother, the women of Asia Minor seem also to get o€ relatively lightly 40

MM 5. 11 (x. 368 71 K). Vivian Nutton, `Galen ad multos annos', Dynamis, 15 (1995), 25 39, prefers the date of death given in the Arabic tradition of ad 216, but would settle for `after 209' or `after 204'. 42 Simon Swain, Hellenism and Empire: Language, Classicism, and Power in the Greek World, ad 50 250 (Oxford: Oxford University Press, 1996), 377 9. 41

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in comparison to those of Rome. The woman from one of the leading families of Pergamum who wanted a child so badly that she agreed to pay an extravagent sum to a young doctor recently returned from Alexandria who had approached her with a promise that she would conceive with his treatment, was led astray by her desire for o€spring rather than wealth and lifestyle.43 And the re®nement of her tastes, which cause her to baulk at the partially roasted, but still slimy, sea creature he orders her to eat, together with the fainting and vomiting which follow her taking two bites, for the sake of the promised child, re¯ect more badly on the remedy than they do on her.44 It is also the rustic women (a5groikoi) in the hills around Pergamum with their habitual and ample use of a hair dye called kedria (kedri3 a) mixed not only with oil but also liquid pitch who provide a point of contrast with the pampered (tryfv9sai) ladies who are liable to ¯ee at the smell of such a potent compound, or, if not thus prevented from trying it, may even die from its powerful chilling e€ect.45 One of the issues in the debate about the date of Galen's demise is the authorship of the treatise To Piso on the Theriac (Pro4w Pi3 svna peri4 th9w uhriakh9w), which cannot have been written before Septimius Severus' Secular Games of 204 since it refers to an injury sustained by Piso's son during them.46 Apart from its allegedly posthumous character, the main objection to its authenticity is the perceived distinctiveness of its rhetorical style: in particular its sycophantic attitude to the imperial household and other members of the Roman aristocracy is thought to sit unhappily with the high moral tone Galen more usually adopts, and its relative lack of self referentiality is certainly noticable. However, as has been pointed out more 43 Hipp. Epid. 2 5 (CMG v 10.1. 400. 43 402. 9); the real villain of the piece is the Hippocratean Metrodorus, the Alexandrian teacher of this young man, and his associates, who are condemned for the errors of their approach to Hippocrates, with the bad results for their disciples and patients that this tale illustrates. 44 This contrasts with the Roman ladies whose inability to bear stomatic pharmaka is on account of luxury (Comp. Med. Loc. 6. 6: xii 948 K). 45 Comp. Med. Loc. 1. 3 (xii. 440 2 K). 46 For the fullest discussion see Vivian Nutton, `Galen on theriac: problems of authenticity', in Debru (ed.), Galen on Pharmacology, 133 51, and also Swain, Hellenism, 430 2.

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recently, these are weak (even dangerous) arguments to make for such a proli®c and varied author as Galen, someone who manifestly did tailor texts to audiences, whose precise formula tions and theoretical elaborations altered with his focus, who was able, for instance, both to repudiate and to devote entire works to the literary and linguistic obsessions of the day, and whose attitude towards the eÂlite was always somewhat ambi valent. Though scathing about the unspeci®ed many who failed to live up to the exacting standards of their birth, he was not backward in praising the few who did. Equally, though eager to disassociate himself from the mass of iatroi who shamelessly pandered to the worst qualities of the rich in their search for lucrative patients, he did so from a position that is inside not outside this competition, it is simply that he appealed to their best qualities, to their reason, knowledge, and other shared values. Indeed, he boasts of his success in this department, and the whole process was one of mutual ¯attery. Both Galen and those for whom he provided medical services could feel grati®ed by the virtuous way in which their association had been formed, by the good taste and educated judgement of all parties. Galen's hostility to rich Roman women, as a class, has already been referred to, and he is similarly resentful and disparaging of the (unspeci®ed) royal women, whose demand for hair dyes and other such deceitful items cannot be refused and resulted in the collection of remedies which often fall on the wrong side of the important kosmetikon±kommotikon (kommvtiko3n) distinction (a distinction between the valid enhancement of what there is and the deceit of arti®cial embellishment) at the beginning of the On Compound Pharmaka according to Place.47 However, a more ambivalent attitude creeps in when he ®nds a formidable ally in an individual, named, imperial womanÐAnna Faustina, a relative of Marcus AureliusÐwho strongly supports him against the methodikoi in his treatment of Commodus.48 He allows her to speak e€usively in his praise, clearly considering this was the kind of judgement upon him that should be 47 Comp. Med. Loc. 1. 3 (xii. 443 5 K). He takes over this excuse of compulsion from Archigenes, and takes most of his recipes from Crito, including those of Heraclides of Tarentum, remarking that the luxury of women's lifestyles was not so great in his day as it is now. 48 Praen. 12. 5 9 (CMG v. 8.1. 130. 29 132. 23).

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publicized, and then ungraciously retorts, `You have made me even more reviled by the iatroi'.49 In To Piso on the Theriac itself, the nearest thing to an imperial woman is one Arria, whom Galen calls `the dearest thing in all the world to me', and reports that she was also lauded by the emperors (presumably Severus and Caracalla) `on account of her command of philo sophy and her particular partiality for the writings of Plato'.50 Not only did they praise her, but, most commendably, cared for her when dangerously ill `like the most experienced doctors', following Galen's advice, of course, in giving her absinthe to restore the complete loss of appetite that was threatening her life.51 The surprise of Galen's sole explicit expression of a€ection and respect for a woman is mitigated by her intellec tual achievement, her conformity with, at least some of, his idealsÐideals which, despite their open ®guration as male and as opposed to the female, it seems an individual woman could aspire to, and even attain to some extent. Arria, and to a lesser extent Anna Faustina, are, however, the only women who feature in Galen's life as he records it, who appear in his environment as he describes it, on something approaching the same terms as its most important male char acters, that is the likes of the consular Boethus, the philosopher Eudemus, and the emperor Marcus Aurelius. Galen's women are mainly passive objects in case histories, empty vessels into which points of medical interest may be poured, and around whom the drama of outstanding diagnosis, prognosis, and cure may be e€ectively performed. They are midwives whom he must deal with in the course of this performance, but as subordinates not equals, as attendants on someone else rather than associated with him himself; and they are symbols of decadence. There may be competent maiai and even aristocratic ladies with a passion for Plato, but the characteristic female lifestyle is one of luxury and lack of control. It is antithetical to his life and dedication to the medical art, his authority rests in part on its exclusion. It should be similarly antithetical to, and 49 e1 poi3 hsa3w me poly4 ma9llon h5 pro3suen y2po4 tv9n i1 atrv9n misei9 suai, Praen. 12. 10 (CMG v. 8.1. 132. 25 6). 50 th4n de4 pa3nta moi filata3thn ¸Arri3 an . . . dia4 to4 filosofei9 n a1kri9 bvw, kai4 toi9 w Pla3tvnow ma3lista xai3 rein lo3goiw, To Piso on the Theriac (Ther.) 1 (xiv. 218 K). 51 v2w oi2 e1 mpeiro3tatoi tv9n i1 atrv9n, Ther. 1 (xiv. 219 K).

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just as excluded by, his male audience. There are, of course, many men who fail to make it so. Indeed, it is this failure, rather than women's, that Galen is most interested in; but this is because men are more important, because what they do, as providers and recipients of medical services, matters more, not because their behaviour is, in some sense, worse. It is them Galen is writing for, including as they relate to women in a range of ways. Women can conduct themselves more or less well in these ancillary roles, but they never cease to be ancillary. However good, a maia is not an iatros, a female patient is neither a philosopher nor a paterfamilias, and a kinswoman of Marcus Aurelius is not the emperor. Within this pattern of authority Galen constructs his own.

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AUTHORITY BEYOND BIOGRAPHY In moving beyond biography to the art which it so closely tracks, and to its more methodological means of legitimation, it is ®tting to start by returning to The Constitution of the Medical Art, but this time to the best constitution of the iatrike techne from which the model of the ideal iatros is taken. Following the ancients, Galen takes the teleological structure of the medical art to be common to all the technai, which can then be divided, according to the form of their orientation to their goals, into four types: the theoretical, such as arithmetic and astronomy, have as their goal simply the study of their objects; the practical, such as dance and heraldry, aim to produce actions only; the productive, such as house building and sculpture, aim to produce something which remains after any activity has ceased; and the acquisitive, such as hunting and ®shing, aim not to produce but simply acquire things through their actions.52 Medicine, like house restoring or repairing shoes, 52 CAM pr. 1 (i. 227 30 K). The ancients certainly included the Stoics, who de®ned an art as a system of cognitions used together towards a goal useful in life (Olympiodorus, In Plat. Gorg. 12. 1. 4, attributes this to Zeno), and Galen agrees on the quali®cation of utility in life as he excludes tumbling, tightrope walking, spinning round rapidly without falling over, making tiny objects, and, also, athletics, from the ranks of the arts (Protr. 9: CMG v. 1.1. 130. 23 132. 6).

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is classi®ed as productive, or more precisely, restorative, of its goal, health. Health is de®ned as a somatic diathesis where all the natural activities are unimpaired, a state that admits to di€erence of degree without yet passing into disease: that is, a diathesis where some of the natural activities are impaired.53 Among these di€erences of degree are distinctions between the bodily kraseis of men and women, as well as between the old and young, the strong and weak, and so on. Health means di€erent things to di€erent people, since the diatheseis that work for men and women, old and young, are di€erent, based on di€erent kraseis; but all count as health. Thus Galen constitutes the medical art according to a goal that is a generic unity, speci®cally divided by sex, among other things. Sexual di€erentiation within a wider sameness is assumed from the outset. The Constitution of the Medical Art then goes on to outline the substance of the teleologically requisite knowledge, what it is necessary to know about in order to be able to restore human health, and that is a matter for the next chapter. It is a di€erent constitutive principle that is of concern now, that which regulates the border of knowledge itself, rather than the border of requisiteness, though the two are not really separ able, as the border of what is always medical knowledge rather resembles a MoÈbius strip in this respect. Proceeding in the more epistemological direction, however, Galen clearly articu lates a whole method of medical truth as well as presenting a body of medical truths, and though there is a certain discre pancy between the twoÐmethod and body are not in total accordÐit is still the former that is meant persuasively to secure the latter. So the method will be set out ®rst, and the practice then measured against it. Galen's major methodological treatiseÐOn Demonstration (Peri4 a1podei3 jevw)Ðis lost, so his logical method must, unfor tunately, be reconstructed rather piecemeal.54 It is clear, 53 CAM 9 (i. 256 7 K); cf. MM 1. 5. 4 and 2. 1. 5 (x. 41, 81 K) and the tortuous discussions of the de®nitions of health and medicine in Thras. (SM iii. 33 100). 54 Greek and some latinized Arabic fragments and testimonies are collected in Iwan von MuÈller, Ueber Galens Werk vom wissenschaftlichen Beweis (Abhandlungen der philosophisch-philologische Classe der koÈniglich bayerischen

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however, that to proceed methodically, for Galen, was to undertake a project in the right order, to begin at the beginning and go all the way through to the end.55 Logic was the means for discerning truth and falsehood.56 The logical method was the key to the systematic search for, and articulation of, truth, and it had two main components, diairesis (diai3 resiw, division) and apodeixis (a1po3deijiw, demonstration), though it also drew on classical logical traditions more widely. Division cuts genera into species and subspecies of decreasing magnitude until the in®mae species are arrived at and it is possible to proceed no further; it is about the correct conceptualization of things and their relationships.57 Demonstration ®nds the most funda mental propositions (experientially proven, agreed, or a priori) that entail the goal of the enquiry, and these are formulated in accordance with the essence (oy1si3 a) of the subject under investigation, both deriving from it and going right to it; it is about de®nitive solutions to problems.58 In On the Doctrines of Hippocrates and Plato, the apodeiktikon (a1podeiktiko3n, that is demonstrative) or epistemonikon (e1 pisthmiko3n, epistemic) pre Akademie der Wissenschaften, 20/2; Munich, 1895), 403 78, to which must be added the Arabic fragments preserved in Rhazes, Doubts about Galen/Shukuk ¹ala Jalõnus (3. 12 14. 10 Mohaghegh). These do not really help, however, in forming any real idea of how the ®fteen books of this work were ®lled, except in con®rming that it was certainly with more than demonstration. Rhazes never takes issue with Galen's logical method in itself (so it remains largely implicit), only with his failures to follow it in various ways, mainly concerned with the theory of vision. 55

See e.g. MM 1. 4 (x. 31 K). Stated at e.g. MM 1. 2 (x. 9, 18 K) and see for general discussion Jonathan Barnes, `Galen on logic and therapy', in Kudlien and Durling (eds.), Galen's Method of Healing, 50 102. 57 Galen frequently asserts the fundamental importance of correct division at e.g. MMG 1.1 (xi. 4 K), and works such as On the Di€erence between Diseases/ Peri4 diafora4w noshmatv9n (Morb. Di€.; vi. 836 80 K), On the Di€erence between Fevers/Peri4 diafora4w pyretv9n (vii. 273 405 K), and Di€. Puls. (viii. 493 765 K) are really built around it. See also Phillip De Lacy, `Plato and the method of the arts', in Luitpold Wallach (ed.), The Classical Tradition: Literary and Historical Studies in Honor of Harry Caplan (Ithaca, NY: Cornell University Press, 1966), 123 32, for the general application of division to the arts. 58 See Barnes, `Galen on logic and therapy', 69 72, and G. E. R. Lloyd, `Theories and practices of demonstration in Galen', in Michael Frede and Gisela Striker (eds.), Rationality in Greek Thought (Oxford: Oxford University Press, 1996), 255 77. 56

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miss (lh9mma) heads a fourfold classi®cation of such argumenta tive propositions.59 The dialektikon (dialektiko3n, dialectic) or gymnastikon (gymnastiko3n, educative) premiss shares the starting point of the apodeictic, but misses the projected target; the pithanon (piuano3n, persuasive) or rhetorikon (rhtoriko3n, rhetor ical) premiss does bear on the matter at issue but comes from an extrinsic source such as a poet, common gesture, or etymology; and the sophistikon (sofistiko3n, sophistic) premiss is really an abuse of these, consisting mainly in the fraudulent exploitation of homonyms and ®gures of speech. There is thus an interplay of degrees of certainty and requisiteness throughout. This method, or at least its practical approximation, can be seen in action in On the Doctrines of Hippocrates and Plato and, more appositely, in the opening sequence of On Seed. Galen here announces that he is to adjudicate between the views of Hippocrates and Aristotle on the chreia (xrei3 a, usefulness or function) and dynamis of the seed, not on the basis of competitive plausibility, but by de®nitely demonstrat ing that one is right and the other wrong.60 This demonstra tion will be based on what is both evident and relevant, and the ®rst step towards it is a speci®c investigation into whether the seed remains inside a female who is about to become pregnant; for, if it does, then it surely provides material for the embryo (as Hippocrates holds) rather than simply initiat ing the process of its formation (as Aristotle argues). This investigation may proceed in three ways.61 The ®rst approach is to observe whether there is a correlation in farm animals between retention of the seed and subsequent pregnancy, and Galen ®nds that there is, absolutely without fail. Secondly, not wanting to be unsupported in extending something apparent in irrational animals to their rational counterparts, Galen asks those women who seem to him more self attentive whether what happens to them is something similar to this. They answer that they feel a certain contraction of the uterus when they grasp (syllamba3nein) the seed, and Galen further supposes that women's use of this verb, and indeed of the 59

PHP 2. 3. 9 11 and 8. 1 2 (CMG v. 4.1.1. 110. 22 112. 2, 156. 27 158. 2). 60 Sem. 1. 1. 1 3 (CMG v. 3.1. 64. 4 14). 61 Sem. 1. 1. 2. 1 13 (CMG v. 3.1. 64. 15 68. 2).

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word syllepsis itself, derives from this retentive uterine action. Thirdly, he reads everything that has been written by physi cians on the subject and ®nds there to be a con®rmatory consensus there too. So, after further examining the clutching closure of the womb in pregnant animals by dissection, and checking that men too have experienced this grasping during intercourse, Galen is certain that the seed does indeed remain inside a female about to become pregnant. Galen has, therefore, established this premissÐthat the seed is retained by females about to become pregnantÐas demon strative. It is evidently true and it has already been decided that it goes to the heart of the matter of the chreia and dynamis of the seed. This truth is secured primarily through Galen's direct personal observation of the correlation of seminal reten tion and subsequent pregnancy, as he clearly states that this approach is best, but the reported experience of women, the opinions of other physicians, even etymological supposition, all help. So, though not of the ®rst rank, these female informants fare considerably better than the women adduced by the Stoic Chrysippus as witnesses to the location of the hegemonikon of the soul in the heart. They are attacked by Galen, who derides the value of this female testimony in On the Doctrines of Hippocrates and Plato, where he is arguing instead for its location in the brain.62 It is the female habit, `if something does not go down with them', of accompanying their statement to that e€ect with a movement of their ®nger to the region of the heart, that Chrysippus uses to support his case, and Galen characteristically both condemns this premiss as lying on the borderline between the rhetorical and sophistic, and turns it against its originator.63 He claims, instead, that the `going down' in question is not an act of understanding, that is, of the rational part of the soul, but an act of being a€ected by an insult or threat, that is, of the spirited part of the soul, which Galen is quite happy to have in the heart. Women are then listed, alongside poets and other non experts (i1 div9tai), as providing completely worthless testimony; however, that these are not commensurate categories is immediately appar 62

PHP 3. 5. 8 10 (CMG v. 4.1.2. 202. 14 26). ei1 ga4r mh4 katabai3 nei ay1tai9 w ta4 lego3mena, Chrysippus ap. PHP 3. 5. 8 (CMG v. 4.1.2. 202. 15 16). 63

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64

ent. It is women as a whole, rather than any particular sub group of them who have nothing of any epistemological worth to contribute, albeit to this speci®c discussion about the location of the hegemonikon, and in a context where they have been mobilized by an opponent.65 In the logical method, the opinions and ®gures of the iatroi can only ever be pithanon, never apodeiktikon, but Galen both displays and contravenes this principle in On Seed. His exhaustive reading must take second place to his direct obser vation, and neither Hippocrates nor Aristotle are to be taken merely on their own word, but the terms of this observation are in fact dictated entirely by what he has read, by these very words of Hippocrates and Aristotle. For, though there is no assumption about which of the two authorities is right, there is an assumption that it must be one or the other, so for any premiss to be demonstrative with regard to its essential relev ance, it must be formulated in accordance with this assumption and with the conceptual foreclosure it entails. Moreover, it is this relevant formulation that has priority, the activity of ascertaining whether it is evident or not is secondary. Thus the condition of requisiteness, as Galen conceives it, radically narrows down the possible premisses, poses questions that are almost entirely closed. His refusal to take things absolutely on trust actually ends up meaning that he is condemned to repeat the past, to go over the same arguments and evidence again, rather than being freed from it in any way. Furthermore, Galen's theoretical downgrading of the demonstrative ecacy of authorities per se, and his claim that he does not believe Hippocrates `as a witness' but is, rather, convinced by the soundness of his proofs, are some what contradicted in his practice.66 He more usually engages in the simple citation of names than the re presentation of 64

PHP 3. 5. 22 and 3. 8. 36 (CMG v. 4.1.2. 204. 30 4 and 232. 12 17). See also Galen's scorn for the attention paid to `old wives' tales' (my3uoi grav9n) by Pamphilius at SMT 6 pr. (xi. 792 8 K), and his quickness to exploit Chrysippus' own admission that his loose and lengthy presentational style lays him open to charges of being `old womanish' (grav3dhw) (PHP 3. 4. 15 18: CMG v. 4.1.2. 194. 36 196. 14). 66 v2w ma3rtyri, Gal., That the Dynameis of the Soul Follow the Kraseis of the Body/¾Oti tai9 w toy9 sv3matow kra3sesin ai2 th9w cyxh9w dyna3meiw e7 pontai 9 (SM ii. 64. 10 13). 65

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reasoning, and Hippocrates' is foremost among them. Indeed, the whole network of relationships he establishes with the authorities and authoritative traditions of the past has an existence that is basically independent of, though not separate from, the strictures of the logical method. These two de®ning and legitimating structures work together, they are corrobora tory and mutually implicatory, but neither is subordinated to the other. The divine persons of Hippocrates and Plato stand at the centre of this network of past physicians and philosophers, providing its de®ning points of reference and sanction.67 Beyond them, some iatroi are damned absolutely, in particular Thessalus of Tralles (accused, among many other things, of being raised in the women's quarters by a father who was, disgracefully, a woolworker), but most appear as both heroes and villains.68 They have contributed something to the con stitution of the medical art which Galen is able to draw out and elaborate, but have also made many mistakes in the process which Galen refutes and corrects. The balance between the positive and negative varies in individual cases and, overall, tends in favour of the latter; but Galen is, nevertheless, continuously engaged with the ideas and iden tities of his predecessors, tying them all together in such a way so as to, at once, produce, explicate, and underwrite his own. The past is moulded into an upward spiral. Developments since Hippocrates, particularly in anatomy, but also through the general widening and deepening of medical discourse, fallacy ridden as it has been, have allowed a man of Galen's talents and training to return to the Hippocratic point of departure but at a level above that at which the great man was forced by historical circumstances to operate. The ana logy Galen himself adopts is that of Trajan's Italian road building programme, with Galen taking the emperor's role in establishing a smooth, straight, structured system of stone roads over the rough, meandering, and sometimes wild beast 67 See Phillip De Lacy, `Galen's Platonism', AJP 93 (1973), 27 39, for a discussion of Galen's relationship with Plato in comparison to that with Hippocrates and other ®gures, such as Aristotle. 68 See Gal. On Kriseis/Peri4 Krisev9n (Cris.) 3 (136. 26 137. 1 Alexanderson), and MM 1. 2 and 3 (x. 10, 22 K) on Thessalus' childhood.

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infested, pathways that had grown up following Hippocrates' ®rst ®nding of the way.69 It is not just Hippocrates himself that Galen makes use of, but also his voluminous case histories. These cases are end lessly e€ective for Galen as evidence for his views, as items of medical lore that he can explain and elucidate better than anyone else, and as markers of his erudition and of the particular relationship he constructs with the great Hippocrates and his ideas, one that is superior to others'. They form part of a common heritage, collectively agreed to be authoritative; they constitute a shared past over which the battles of the present could be fought with ease and e€ect. The many women who appear in the annals of Hippocratic practice are no exception, and Galen uses them in all these ways, to illustrate points of both speci®c and general relevance.70 He also occasionally rehashes cases of disagreement in order to demonstrate the errors they contain. Erasistratus' treatment of the `girl of Chios' is a prime example of this, and it serves also to underline the strength of the rhetorical tradition in which he is following, to show that others made good use of case histories too.71 Galen thus clearly conforms to an ideal of manifest mastery of the tradition, demonstrated through its evident absorption and rearticulation in a new and more elaborate order. Devia tions from the paths of tradition needed special justi®cation. The unprecedented intrusion of mathematics into the ®nal portion of the ophthalmic book in On the Usefulness of the Parts has its origins in a divine command received in a dream.72 Galen was told that his task would not be complete until he explained why the nerves joining the brain and eyes cross over, forming a shape like the letter `X', a subject he would otherwise 69 MM 9. 8 (x. 632 4 K); and see V. Nutton, `The bene®cial ideology', in P. D. A. Garnsey and C. R. Whittaker (eds.), Imperialism in the Ancient World (Cambridge: Cambridge University Press, 1978), 218 19, and Swain, Hellenism, 365 6 for discussion. 70 See e.g. the use of female cases from the Hippocratic Epidemics in On Diculty in Breathing/Peri4 dy3spnoiaw (Di€. Resp.), only the last of which the cases of the wife of Nicostratus and the daughter of Agasis are used to illustrate peculiarly female respiratory diculties (vii. 957 9 K). 71 Ven. Sect. Er. Rom. 3 (xi. 199 206 K). 72 UP 10. 12 and 14 (ii. 92. 23 94. 9, 110. 7 24 H). The force behind this order is alternately described as a daemon and a god.

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have avoided since it involves the theories of geometry, some thing to which the public are strongly averse. His recourse to arteriotomy, something usually shunned on account of the risks involved, was also prompted by vivid dreams that impelled him to try cutting the artery between thumb and index ®nger and allowing it to bleed until it stopped to relieve a long standing pain in his side, a therapeutic experiment that was entirely successful.73 No deity is mentioned as appearing in these dreams, but since this account is immediately followed by a story of a servant of the god at Pergamum who was similarly instructed in a dream for a similar condition, that Galen's narrative was modelled on Asclepian incubation is made pretty plain. Dreams and divinity are ¯exible and subtle rhetorical instruments for Galen. Indeed, a certain ¯exibility characterizes the whole logical method, and, in particular, its notable integration of reason and experience.74 The basic framework rests on reason, the sub stance derives from experience, which Galen de®nes as ranging from simple sense perception through the everyday to the special experience of the arts. Reason dictates, for instance, that `where the arche of the nerves is, there too is the hegemonikon of the soul' is an epistemonikon premiss in repect to the question of the location of the hegemonikon, just as it dictates that the enquiry whether the seed is retained in females about to become pregnant is demonstrative in respect to the chreia and dynamis of the seed, but dissection (presumably a type of technical experience) proves that this source is in the brain and not the heart, and direct observation proves that the seed is so retained.75 This alliance is something Galen works out more thoroughly in articulating his position in relation to 73 Gal. On Curing by Venesection/Peri4 flebotomi3 aw uerapeytiko3n 23 (xi. 314 15 K). 74 See e.g. PHP 3. 8. 35 (CMG v. 4.1.1. 232. 3 12). A similar (and roughly contemporary) integration was accomplished by the polymath Ptolemy, see A. A. Long, `Ptolemy on the criterion: an epistemology for the practising scientist', in Pamela Huby and Gordon Neal (eds.), The Criterion of Truth: Essays Written in Honour of George Kerferd with a Text and Translation (with Annotations) of Ptolemy's On the Kriterion and Hegemonikon (Liverpool: Liverpool University Press, 1989), 151 78. 75 PHP 1. 3 (CMG v. 4.1.1. 66. 13 24); and Sem. 1. 1. 3 1. 2. 4 (CMG v. 3.1. 64. 11 66. 1).

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the sectarian traditions of Greek medicine, for he e€ectively o€ers his logical method as an alternative to this sectarianism, building on it and to it in order to encompass the constitution of the iatrike techne itself as an epistemologically secure body of knowledge, appropriately formed and organized in respect to its goal. In all his works Galen distances himself from all three sects, from the logikoi, empirikoi, and methodikoi, both separately and taken together. He is opposed to these kinds of haireseis in themselves, holding that individuals should determine their own position from a careful and critical consideration of all the issues, not from unquestioning loyalty to a particular schoolÐ loyalty that has been unre¯ectively inherited from fathers or teachers, or picked up from friends or locality.76 Furthermore, he has speci®c objections to the de®ning doctrines of each of these groupings, as he characterizes them.77 In this latter respect, however, he does not place himself equidistant from all three; but, completely rejecting methodism, takes a more nuanced view of rationalism and empiricism. The logikoi go speci®cally wrong both in so far as they exclude experience from the medical art altogther and in that the logical methods they adopt are ¯awed: they start from arbitrary and insecure premisses and construct weak and incomplete proofs. The empirikoi, on the other hand, operate with a stunted version of the iatrike techne, adequate for most practical purposes, but limited and imperfect none the less. It lacks the vital under standing and explanation that reason provides, thus imparting an order and coherence, both causal and categorical, to the medical art. So what is required is a combination of the best features of both, a rationalization of experience, an experien tialization of reason. That reason and rationalization should be the dominant partner in this alliance was inevitable, for it provided the 76

Ord. Lib. Prop. 1 (SM ii. 80. 11 82. 3). See esp. SI (SM iii. 1 32), Med. Exp. (Walzer), and Subf. Emp. (Dgr 32 90); and for a thorough discussion of Galen's epistemological position see Michael Frede, `On Galen's epistemology', in Vivian Nutton (ed.), Galen: Problems and Prospects: A Collection of Papers Submitted at the 1979 Cambridge Conference (London: Wellcome Institute for the History of Medicine, 1981), 65 86. 77

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structure and systematization. However, this was a rationalism of Galen's own making, a rational method not a sect, and built around a reason that was not so strong and self reliant that it could do without the support of experience. Galen did consider that the reason innate in human beings, the rational part of their soul, had a particular grip on the nature of things, but that this inherent ability, this comprehensive alignment between humanity and their world, could not simply be left at that, it had to be trained, disciplined, and used properly. This training was in the logical arts, in the means of discerning truth and falsehood, and in demonstration. This discipline was reason gaining ascendency over the passions and appetites, that is, over the other parts of the soul, so ensuring the correct orientation to life. Proper use came not only from putting these into practice but also from working in conjunction with experience, which provides an essential check and guide for reason. Indeed, reason itself demands that experience act in this corroborative and corrective manner. It is according to these principles, and to its goal, that the iatrike techne is constituted, and it is according to these same principles that Galen's life and work have been constituted; and it is on account of their combined congruity that truth, in theory and practice, word and deed, is guaranteed. Galen may have presented his commitment to, his embodi ment of, his logical method as total and totalizing, reaching right across and through his art and self, his life and work; its epistemic mechanisms may have been continuously reiterated and re enacted, their cogency to those not completely enslaved to unreasonable appetites and unethical lifestyles constantly paraded; however, he clearly did not consider it to be absolutely exclusive. Dialectical, persuasive, and even sophistic proposi tions were all integral, if subsidiary, elements of his legitimation strategy, and the authority of Hippocrates looms large. Com pulsive completeness ®lls every treatise with arguments that are interesting but not strictly relevant. Poetry has its place in most, both as ornament, as proof of the author's culture and erudition, and as load bearing, as proof of doctrine; and he was certainly not averse to wordplay where it served his purpose.78 The 78

See Phillip De Lacy, `Galen and the poets', GRBS 7 (1966), 259 66 for the poetry; and R. J. Hankinson, `Usage and abusage: Galen on language', in

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embodied character of this method is also striking: Galen himself, not his excision, is one of the means of ®rmly attaching the contents of texts, of the medical system they contain, to the way the world is, or perhaps rather, of attaching the way the world is to the contents of texts. His absolute dedication to, competence and ¯uency in, truth, as written in his history and present in his writing, are all crucial. Moreover, this is a moral stance, a social location, as much as it is an epistemic or technical one. It is from this pivotal position that Galen's claim to the authority for medical intervention is launched and pursued down every possible pathway, in both life and art, with authority in theory and practice, in general and in particular, over self and others, being maintained in mutually reinforcing and con®rmatory dialogue throughout. Women's position in this most authoritative construction of the art is somewhat equivocal. Excluded from it in some senses, they are none the less integral to iatrike in others. The medical art must encompass women too, and they have therefore a certain contribution to make to it. It is, in a discussion of conception, entirely appropriate to ask women (at least of the more re¯ective kind) about their experience and how they understand it. It is, however, not appropriate to take female conversation and conduct into account more generally, and least of all to pay attention to `old wives' tales' (my3uoi grav9n), the most useless and untrustworthy of reports. Women's participation is to be on Galen's terms, not their own. They have their place in the order the logical method brings to the world, or perhaps their place in the world is brought to the order of the logical method; and this place is subordinate and circumscribed. ART, AUTHORITY, AND WOMAN Galen has thus set up and secured woman as an object of medical knowledge both in the same manner to man and quite distinctly. Her sameness is technical, pertaining to the place of Stephen Everson (ed.), Language (Cambridge: Cambridge University Press, 1994), 166 87, and Heinrich von Staden, `Science as text, science as history: Galen on metaphor', AMSCC ii. 499 518, for di€erent aspects of his linguistic attitude.

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woman in the constitution of the art itself, her di€erence is social, pertaining to the place of women in the society in which this art is constituted; and this latter bears down hard on the former. Technically, woman's medical objecti®cation proceeds in the same way as that of man, or any other species of humanity that has a particular relationship with the telos of medicine, that is health. Exactly the same type of knowledge about her as about anyone else is required to attain that goal, but since the actual content of that goal is distinct, as women's health is di€erent from men's health, the possibility that the content of that knowledge will also be distinct arises too. This is a question of speci®c variation within a generic unity, of the proprieties of diairesis, not a divergence in form or kind. Male and female health may be di€erent, but they are both health, and similarly within the body of medical knowledge that accords with this goal. All this knowledge, of woman, man, or whoever, was also secured, as far as possible, in the same way. The logical method was applied across the board and was applicable far beyond the boundaries of the medical art. Galen was quite clear that technai were de®ned and distinguished by their goals, but that their constitutive and methodological principles were shared.79 Medical knowledge thus had a status essentially similar to all the other formations of technical knowledge, from astronomy to heraldry, and taking in all the acquisitive and productive arts in between. That is not to say there was no artistic hierarchy, but simply that truth value had a very small part to play in its organization. Galen is indeed somewhat wistfully aware that the theoretical arts, especially arithmetic and geometry, rank above medicine in any epistemic order, since the latter had a constant struggle to approximate to the simplicity, clarity, and certainty of the proofs of the former, but what it lacks in theoretical purity it makes up for in its practical necessity.80 The most clearly evaluative division of the 79 To demonstrate this was indeed the whole purpose of the two books On the Constitution of the Arts, which originally preceded CAM (see the Medical Art/¸Iatrikh4 te3 xnh (Ars. Med.) 1: i. 306 K), and it is repeated in the preface to this latter treatise (i. 226 7 K). 80 See the Arabic epitome of On Morals 3 (44 Kraus) for the clearest expression of the greater certainty and clarity of geometry and arithmetic. The

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arts Galen makes, however, is between those he classes as rational (logikai3 ) and digni®ed or honourable (semnai3 )Ðthat is, the medical, rhetorical, musical, geometrical, arithmetic, logical, astronomical, grammatical, legal, and, somewhat sneakily, the plastic and graphic technaiÐand those he calls banausic (ba3naysai) or manual (xeirvnaktikai3 ) technaiÐthat is, the rest.81 The superiority of the former is the superiority of soul over body, of leisure over labour, and it is a superiority of social not epistemic rank. It is not that knowledge of shoe making is less secure than knowledge about music, for instance, it is not that it is epistemologically inferior, but that it is less seemly, endowed with less prestige in society. Thus, while Galen does make continuous claims for the special validity of his medical knowledge (including that about woman), he makes far fewer for the special validity of medical knowledge (includ ing that about woman) as such, and those he does make refer always to its goal, not its basis. It is special because it aims towards health, not because it is grounded in a particular way; it is special on account of its utility rather than its truth. As women were located di€erently from men in the social formation of Roman medicine, however, so they were located di€erently in its discursive formation, and their relationship to woman as an object of medical knowledge was articulated quite distinctly from that between social men and medical man. Indeed, the process of medical objecti®cation might be described as being exclusive to women. With the exception of On the Dissection of the Uterus, Galen clearly addressed his writing, his whole endeavour, to men. The named dedicatees, and the audiences more collectively inscribed in his texts, are simply the clearest examples of those whose general orientation to life and to their body, and some of the particular choices they only explicit support for, rather than simple statement of, the artistic supremacy of medicine comes in a medieval Hebrew translation from the Arabic of the passage immediately following the point where the surviving Greek text of the Protr. breaks o€, and seems to be based on the indispensability of health for doing good deeds or pleasant things, within which two categories all life is contained (Mauro Zonta, Un interprete ebreo della ®loso®a di Galeno: gli scritti ®loso®ci di Galeno nell'opera di Shem Tob ibn Falaquera (Turin: Zamorani, 1995 ), 91 2; and my thanks to Irene Zwiep for help with the Hebrew). 81

Protr. 14. 4 (CMG v. 1.1. 150. 8 16).

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make about them, Galen sought to engage with and shape. These lifestyles and choices are, moreover, manifestly male. The decisions with which Galen was especially concerned were, of course, those about the medical art, mainly those made by the potential recipients of its many bene®ts (who were possible victims of its misconstrual too), but also by its potential practitioners, and these were essentially the same group. All men should cultivate an art, thus moving themselves away from the irrational animals and towards the gods with whom they share rationality, and the iatrike techne is best of them all. If this optimum objective was not attained, preference being given to wealth, reputation, and political power more or less exclusively, then the least that was to be expected was that a man would be of a suciently well formed character and suciently knowledgeable to be able to participate properly in various medical processes, to form the appropriate relation ships with the appropriate physicians. The hierarchy of com mendable behaviour thus stretched from the perfect embodiment of the art to the man with no more than the capability to recognize such a paragon. The scale was a single and uni®ed one, and the broadly shared values with which it worked established an e€ective means for Galen to formulate objectively the identity of the ideal iatros and the iatros as the ideal identity and then to measure himself against his own creation. All men needed, therefore, some kind of medical expertise and should place themselves as high up this hierarchy as possible; however, this single assessment of physician and layman does not obscure the real issues of choice and consent here, much as it tried to. For, in seeking men's assent to knowledge about their own bodies Galen constructed the role of the assentor as essentially active, not only because that was the ethical model of knowledge he had, one in which active understanding, working it through for oneself not taking it slavishly from others, is the key, but also because, in fact, the power did rest with them. What he wanted was for these men to exercise their power properly, he attempted to persuade them to do and think what he considered best, but for themselves, because they had considered the matter fully and grasped the correctness of Galen's character, approach, and

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views. He could not take the decision, the determination of his fate and that of the other iatroi, away from them, but he could make a virtue of necessity, without even noticing it, and privilege this very act of choice, make the really free and really reasoned choice, his choice. Thus, these men should be objects of medical knowledge only in so far as they actively understood themselves as such: that is, in so far as they were epistemic subjects, medical knowers, and, in so far as they were going to act on that knowledge, social agents. He presents them with knowledge about themselves, for themselves, and with knowledge about others, also for themselves; for being a man means acting on behalf of others. Women were simply not a part of this pattern, they just did not have the power and choice. Not that Galen actively sought to deny it to them absolutely, but that he assumed it as already denied and thus colluded in its continued denial. The few individual women who did occasionally make the kind of decisions Galen is interested in are insucient to shift the position of woman, either from her general cultural con®gura tion as foolish, particularly subject to unreasonable passions and appetites and thus rightly to a certain control by men, or from her speci®c medical con®guration as an object of male, not her own, medical knowledge, unable to become, therefore, a medical subject. It is not she who is intended to act on this knowledge about her, but others. Both con®gurations are, of course, interwoven, and both shape the contents of this woman, this object of medical knowledge, contents that will be unpacked in the next chapter.

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6 Galen's Woman T h e movement from the process of the constitution of woman as an object of medical knowledge to the contents of this constitution must pass through a more general transition from process to content. This means ®nally crossing the boundary of requisiteness and outlining the scope and struc ture of what it was the medical practitioner needed to know about human beings in all their variety in order to be able to restore and maintain their health. The formulation and application of this last constitutive principle was bound up, of course, with the other, more methodological, considerations already described; however, it makes its own distinct con tribution to shaping the medical knowledge of woman that Galen presents as an integral part of his whole domain of medical knowledge. Galen de®nes the scope and structure of medical knowledge by analogy with the other restorative (e1 panoruoy3menai) technai in the Constitution of the Medical Art. Just as the restorer of houses must know the parts of the house, their substance (oy1si3 a), formation (dia3plasiw), magnitude, number, and rela tionships with each other, so the medical practitioner must know the same about the simple or homoeomerous parts of the human body, and also about their activities, which then leads to the equivalent knowledge about the compound (sy3nueta) or instrumental (o1rganika3) parts.1 This knowledge is teleologically requisite because it is in these things that the excellence (a1reth3) 1 Gal. CAM 2 (i. 230 2 K). Galen's use of these classi®catory terms for parts of the body is rather ¯exible and the lists of them that appear in di€erent works are discordant, but basically, as outlined in Ch. 2 above, the homoeomeries are simple entities in the sense of being constituted of a single substance, such as bone, cartilage, ¯esh, and ®bres; compound parts such as the heart, lungs, and so on are compounded from these simpler elements and, at MM 1. 6 (x. 47 K) and Part. Art. Med. 3. 5 (CMG Supp. Or. ii. 30. 17 20, 121. 26 7), Galen de®nes an `organ' as a part to which is attributed a single and complete activity necessary or useful to the whole body.

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or failure (kaki3 a) of a complex entity such as a house or human being subsists.2 These conditions of excellence and failure, and their internal typologies, must, therefore, be recognizable, distinguishable from each other, and comprehensible, their workings understood so that they can be preserved or repaired as appropriate. Health and sickness are simply speci®c instances of these ¯awless and ¯awed states. Health is when all the bodily activities are unimpaired; health passes into disease when some bodily activity actually becomes impaired, though it may have sustained a certain degree of damage and deviation before that point.3 That disease may be one of six types, it may pertain to the elemental krasis of the simple or homoeomerous parts, to the formation, size, number, and con®guration of these in the compound parts or to a breakdown of unity or coherence in either simple or compound parts.4 These possible points of failure are shared by items such as houses, ships, and shoes which are also dependent on their parts and their continued relationship as required.5 In each of these cases disease is a disproportionate (a5metrow) disposition, an imbalance in the elemental krasis of the homoeomeries, or in the constitution of the organs, or in that in which continuity consists in either, whereas health is proportionate (sy3mmetrow).6 The return to due proportion is, therefore, achieved by application of the opposite disproportion; so the therapeutic mechanism, the particular form of restoration in this instance, is neatly summed up in the Hippocratic maxim `opposites cure opposites'. Each of these restorative arts, as Galen construes them, is thus coterminous with a knowledge project which encompasses the whole nature of the entity that may become defective and must then be repaired and maintained so that the goal of the art can be achieved. The method of knowledge and the way this 2

CAM 5 (i. 237 8 K). CAM 9 (i. 256 K); and e.g. MM 1. 5 (x. 41 K); San. Tu. 1. 5. 1 29 (CMG v. 4.2. 8. 14 14. 28). 4 MM 2. 6 (x. 125 6 K); San. Tu. 1. 1. 3 and 1. 4 (CMG v. 4.2. 3. 13 17, 7. 27 34). 5 CAM 5 (i. 237 40 K). 6 CAM 11 (i. 260 1 K); and cf. Commentary on Hippocrates' On the Nature of Man/Ei1 w to4 peri4 fy3sevw a1nurv3poy ¹Ippokra3toyw y2pomnh3mata (HNH) 1. 20 (CMG v. 9.1. 33. 4 13) and San. Tu. 1. 5. 11 (CMG v. 4.2. 9. 8 13). 3

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knowledge is internally ordered, following divisions of both logical and material interdependence, is essentially the same. Homes and human beings may be di€erent things, may have distinct natures, but what practitioners of the technai of their respective restoration need to know about them in order to be successful has a structural identity that admits only of variation in detail. Thus, since the human body is alive, the iatros must be concerned with activities, not just parts and their conjunctions, though the principle remains the same. And, while restorers of houses seek to put themselves in the epistemic position of the original builder, who fully comprehends his own creation because he knows what each part is for and has allowed that to guide him in his work, the restorer of human beings must aspire to the epistemic position of `divine nature', who stands in roughly the same relationship to her creation as the builder does to his building.7 This analogy does not obscure, however, the particularity of the way in which the physician usually works with nature, for health is kata physin and disease para physin and there is a certain innate reversion from the latter to the former which the medical practitioner must direct and assist.8 Homes and human beings di€er not only from each other but also in themselves, including in respect to that quality of their existence with which their respective restorative arts are concerned. All thingsÐhouses, ships, furniture, shoes, and clothes as well as peopleÐcan be constitutionally classi®ed as best (a5ristow), less good (fay9low), and diseased (nosoy9sa); the best being a singular condition and the rest admitting of countless multiplicity.9 However, irrespective of this breadth of health (or its inanimate equivalent) which contains the di€erence between men and women, young and old, and so on, as well as all the di€erences among them, the body of knowledge generated in its pursuit is of a de®nitely unitary character. This epistemic body shadows a human body that is of both sexes, all ages, all levels of ®tness, has all conceivable histories, every possible krasis, and every known disease, with space for more. It holds within it all human potential that has a bearing on health and its lack. 7 8 9

ueo4w . . . kai4 fy3siw, Gal. CAM 2 (i. 232 3 and 231 K). CAM 20 (i. 303 K); and e.g. San. Tu. 1. 5. 34 (CMG v. 4.2. 11. 21 5). CAM 9 (i. 257 K).

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The medical art was, however, a divided unity; and though one aspect of Galen's preferred partition pays no heed to these distinctions between kinds of people, the other follows and reinforces them to some extent. The relationship between these two approaches to the division of medicine is rather confused, as is indeed the picture of the whole endeavour. Galen articulates his compartmentalization of the iatrike techne somewhat inconsistently across his úuvre, and the treatise entirely dedicated to the subjectÐOn the Parts of MedicineÐat least in the Arabic and Latin versions in which it survives, does not greatly clarify matters.10 Exhaustivity is again Galen's objective here as he takes a number of initial starting points for a series of total diaireseis of the medical art, cutting it into smaller and smaller sections until its smallest particles are reached. The unwieldy multiplicity that results is ®ne as long as nothing has been missed out and each approach is carried through logically and completely. The primary and proper partition to which he returns most often, and which he sees as most heuristically e€ective, however, is that between the two fundamental states of the body, health and disease, and thus between the therapeutikon and the hygieinon parts of medicine.11 From these ®rst genera, diairesis downwards into the detail of their operations, and upwards into the detail of the physical knowledge on which they depend, ultimately encompasses everything, but still exhaustively rather than systematically. Galen also entertains the possibility that a third, inter mediate, state exists between health and disease. That is, he occasionally reports the existence of such an intermediate state as an opinion held by others without himself passing judge ment on the matter, more often clearly subsumes any such state within a broad concept of health, but once ®rmly installs it as a 10 The Arabic translation is associated with Hunain, the great 9th-cent. Baghdadi translator of Galen, but seems not to be his work in its entirety (see CMG Supp. Or. ii. 8 9), and the Latin is that of NiccoloÁ da Reggio, made from the Greek in the early 14th cent. (see Lynn Thorndike, `Translations of works of Galen from the Greek by NiccoloÁ da Reggio (c. 1308 1345)', Byzantina Metabyzantina, 1 (1946), 213 35). The two versions are very close, though a degree of coherence has been lost in translation. 11 See e.g. Part. Art. Med. 7. 1 5 (CMG Supp. Or. ii. 42. 5 44. 10, 126. 1 127. 11); SI 1 (SM iii. 1. 1 12); San. Tu. 1. 1. 1 (CMG v. 4.2. 3. 2 5).

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fundamental medical category.12 This last move is made in Galen's most succinct second order de®nition of medicine: that is, one that describes it more concretely, according to its content, rather than as a certain kind of techne constituted according to its particular goal. `Medicine', announces the Medical Art, `is knowledge of the health preserving, the diseased, and the neutral', and this consists in knowledge of bodies in these states, and knowledge of the causes and signs of all these.13 However, while the old and the young, as well as the convalescent and those on the verge of falling ill, appear in these various works among those somehow separated from health but not yet actually diseased, and therefore potentially contained within any intermediate category, women never do. There is, therefore, no signi®cant female category established in direct relation to the goal of the medical art: rather, pieces of woman are scattered right across these various divisions. This is re¯ected in the absence of any dedicated gynaecological treatise from Galen's úuvre and the presence, instead, of a whole raft of references in texts treating themes or topics that emerge more readily from the Galenic conception and partition of the medical art.14 Human reproduction is one such theme, as 12 San. Tu. 4. 2 3 (CMG v. 4.2. 103. 7 18), as completely agnostic; Part. Art. Med. 5. 4 7 where the possibility that there are those who are neither sick nor well is opened up, and 7. 2 3 for their location in a poorer subset of health (CMG Supp. Or. ii. 36. 13 38. 4 and 123. 29 124. 10; 42. 9 21 and 126. 6 18); and for variation on this latter view see also HNH 1. 20 (CMG v. 9.1. 33. 14 21) and CAM 9 (i. 256 7 K). 13 i1 atrikh3 e1 stin e1 pisth3mh y2gieinv9n kai4 nosvdv9n kai4 oy1dete3 rvn, Ars Med. 1 (i. 307 K); and see von Staden, Herophilus, 89 112, for the Herophilean background to this tripartition. The authenticity of the Ars. Med. has been challenged by Jutta Kollesch, `Anschauungen von der a1rxai3 in der Ars Medica und die Seelenlehre Galens', in Paola Manuli and Mario Vegetti (eds.), Le opere psicologiche di Galeno: Atti del terzo colloquio Galenico internazionale, Pavia, 10 12 settembre 1986 (Naples: Bibliopolis, 1988), 216 18, and robustly defended by VeÂronique Boudon, `L'Ars Medica de Galien est-il un traite authentique?', REG 109 (1996), 111 56. 14 Of course there are external as well as internal considerations involved in this failure: there is the matter of the audience for any gynaecological treatise, and of what it would say about its author. It was not the kind of thing to dedicate to a senatorial acquaintance, though it might be couched, as by Soranus, as instructive of the maiai who looked after their wives. That it was the role of the midwives themselves, as mediators between male physician and female patient, that acted as a barrier to Galen's writing of any such work, as

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On Seed, On the Formation of the Foetus (Peri4 kyoyme3 nvn diapla3sevw), and On the Dissection of the Uterus demonstrate, as well as the parallel passages in larger physiological and anatomical works and the Hippocratic commentaries. More over, this kind of multiple coverage typi®es the way in which these topics were repeatedly renegotiated in a range of over lapping but distinct treatises, each realizing a particular project in relation to Galen's overall constitution and communication of the iatrike techne and his own identity as an iatros. So, what is required is a full engagement with these female thematics, to ®nd the points at which, for Galen, the unity of the human being breaks down sexually and to follow the explicatory lines that run from and to these points, endowing the medical woman (and man) with a certain epistemic substance in the process. Thus the scattered pieces of woman can be gathered together, as far as possible, to see what is then produced, what kind of a whole they make, respecting Galen's basic division between the healthy, the kata physin, and their maintenance, and the diseased, the para physin, and their cure, and the order of parts within them. THE HEALTHY WOMAN The main mechanism through which Galen considers the epistemic substance of the medical art to be acquired is through dissection (a1natomh3), the diairesis of the ¯esh. It is through this that the knowledge of the simple and compound parts is gained and mapped onto the parts of medicine (and vice versa). In his most extensive anatomical work, Anatomical Procedures, Galen describes the uses of dissection as fourfold: as useful for the natural philosopher who loves knowledge for its own sake, for those who value it only to demonstrate that `nature does nothing in vain', for those who investigate the physikai and psychikai activities and functions of the human being, and for the practitioner who needs to conduct surgical operations.15 suggested by Lachs, Die GynaÈkologie des Galen, 12 13, seems implausible given the established tradition of male gynaecological authorship and the fact that Galen does cover the material, just not in a dedicated and distinct textual form. 15

mhde4 n ei1 kh9 gegono4w y2po4 th9w fy3sevw, AA 2. 2 (i. 182 Garofalo); cf. Arist. PA

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The stress in this work is on these latter two, on the more practical bene®ts of anatomical knowledge, but this is in part because a more theoretical treatment of the parts of the human body has already been produced in On the Usefulness of the Parts. Certainly Galen's commitment not only to the Aristo telian slogan that `nature does nothing in vain', but also to the notion that she does everything purposively and for the best, is as strong in this text as elsewhere in his úuvre. It is this that completes his system of medical understanding, which gives it the all encompassing quality that he sees as the only really sound platform for medical intervention. The purpose of Anatomical Procedures is to enable its audience to observe in detail the artistry of nature as it is outlined and explained in the Usefulness of the Parts as well as to restore anatomy to its proper place in the medical art as it is constituted in relation to its goal.16 Thus, dissection is a rather compromised starting point, with plenty of assumptions, even a whole interpretative frame work, behind it, impelling it forward, making it impelling; but it is worth following the course Galen himself prescribes, while keeping in view the process of its prescription as well as its presentation. The anatomical woman Anatomical Procedures instructs simultaneously on the techni ques and truths of anatomy, it is a practical guide to seeing the anatomical body as Galen sees it. The bodies dissected in it are those of various animals of both sexes, ideally humanoid apes, but also many kinds of common livestock and some rarities (such as an elephant), and one of the functions of the narrative is to synthesize this diversity into the shape of a single human being, subject to occasional sexual segregation and comparative digressions on other species.17 The work begins with the muscles of the hand and arm, and then proceeds through the 658a9. The ®rst eight and a bit books of AA survive in Greek, the rest only in an Arabic translation by Hunain. 16

AA 4. 1 (i. 370 Garofalo). It is their resemblance to humans that makes apes so desirable for dissection, see e.g. AA 1. 2 (i. 84 Garofalo), and see AA 7. 10 (ii. 662 4 Garofalo) for the elephant. 17

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rest of the body both thematically, dividing muscles from blood vessels and nerves, and sectionally, separating head, thorax, abdomen, and limbs; in this it broadly follows the pattern of the Usefulness of the Parts. The various shorter texts which are individually dedicated to these themes are essentially subsequent summaries of the relevant sequences of Anatomical Procedures, whereas those that are sectional, pre date the larger treatise and bear more varied relationships to its coverage of the same areas. On Bones for Beginners (Peri4 o1stv9n toi9 w ei1 sagme3 noiw), for instance, is an earlier treatment of a theme largely omitted in the later synthesis.18 To take the somatic themes ®rst: muscles are fundamentally male, or at least Galen primarily thinks about muscles in male bodies. In On the Dissection of Muscles (Peri4 myv9n a1natomh9w) , the only extant Galenic anatomical text that proceeds in the traditional head to toe fashion, a single narrative takes thin muscles (kremasthra3, or cremasters) down from the ¯anks to the orcheis (o5rxeiw, Galen's preferred word for testicles), their suspensory function and name suggesting that they are more appropriate for external, male testicles than internal, female ones, and delineates the small muscles of the aidoion, which wrap around it, holding it ®rm during erections (e1 kta3seiw) and are able to move it upwards and sideways.19 It is clearly the penis he has in mind; the female genitalia and womb are left apparently muscleless. It is noticeable too in Anatomical Pro cedures, which keeps both kinds of human body in view throughout, that when these two kinds really separate out in the book on the generative parts, the male organs are sur rounded with muscles while the female must make do with only the ligaments joining the uterus to the abdominal wallÐ ligaments analogous to the cremasters of the testicles in males.20 She is slightly better served by a whole panoply of uterine 18

Bones for Beginners (ii 732 78 K). On Dissection of Muscles 28, 29, and 31 (xviiib 995, 997 8, 998 9 K); cf. On the Movement of Muscles/Peri4 myv9n ki3 nesevw 3 (iv. 379 380 K). 20 Compare AA 12. 2 and 7 9 (i. 140. 6 144. 14 and 154. 7 166. 15 Simon). This twelfth book on the generative parts survives only in Arabic, and Simon's edition reproduces the text in its unbroken manuscript form; but I also include reference to the sections into which the book is broken in Duckworth's translation (Galen, On Anatomical Procedures, trans. W. L. H. Duckworth (Cambridge: Cambridge University Press, 1962) ). 19

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attachments, suspensions, interweavings, entwinements, and fusions in Dissection of the Uterus, but few have any pretensions to muscularity.21 Bones and nerves are entirely generic, but the blood vessels must be outlined bearing in mind the existence of both male and female bodies. In On Dissection of the Veins and Arteries, veins run to the orcheis and the aidoia, `whether the animal be male or female', though the female testicles are much smaller than the male, and the blood supply to the womb requires considerable elaboration.22 In Anatomical Procedures also, the sexually distinctive formation of the vascular system in the region of the generative parts is frequently referred to, and described in most detail in the book dedicated to the veins and arteries themselves.23 The asymmetry of the blood vessels as they descend di€erently down the left and right sides of the body, and the rich venous communication between reproduc tive organs and chest, are emphasized throughout. The con®guration of the female generative parts themselves, presented in Anatomical Procedures and Dissection of the Uterus, deserves to be examined more fully. These parts comprise, according to the former, the womb, testicles, vagina, and seminal ducts; and the fact that the female has testicles too, on which all anatomists (except the execrable Lycus) agree and which is visibly demonstrable, is strongly emphasized.24 They di€er considerably from those of the males, however, being smaller and ¯atter, and hard and solid in comparison to his sponginess and porosity.25 A web of blood vessels leads to them, and other vessels lead the seed from them, this structure being ®ner in the female and attaching to the `horns' (kerai3 ai) of the uterus.26 Concerning this organ itself, however, more substan tial di€erences open up between Galen's earliest account in 21

Ut. Diss. 4. 1 7 (CMG v. 2.1. 40. 3 42. 13). a5n te a5rren, a5n te uh9ly, to4 zv3on W¤, Gal. Ven. Art. Diss. 8 (ii. 809 10, 813, 812 13 K). 23 AA 13. 3 (i. 185. 1 190. 12 Simon). 24 AA 12. 1 (i. 137. 3 8, 139. 18 140. 1 Simon); cf. Ut. Diss. 9. 1 (CMG v. 2.1. 48. 5 6), where the existence of female testicles is simply stated as uncontroversial. Lycus had a particularly prominent place among Galen's opponents, receiving repeated passing criticism and the full force of at least two polemics. 25 AA 12. 1 (i. 138. 8 12 Garofalo); Ut. Diss. 9. 1 2 (CMG v. 2.1. 48. 5 11). 26 AA 12. 1, 2, and 3 (i. 139. 13 140. 6, 140. 18 141. 5, 145. 2 12 Simon); Ut. Diss. 5. 1 and 9. 4 7 (CMG v. 2.1. 42. 14 22, 48. 18 49. 11). 22

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Dissection of the Uterus and the later description in Anatomical Procedures, and still more variation appears in the descriptions in the Usefulness of the Parts and Natural Faculties, which are chronologically intermediate between the two. The ®rst repre sents the essentially Herophilean starting point from which Galen was to develop something more distinctively his own.27 In this initial exposition, the shape of the womb is compared to that of the bladder, with the addition of these lateral `horns', but though this imparted a certain binary quality to it, the uterine cavity was not actually divided.28 In Anatomical Procedures, however, the double constitution of the womb is crucial; and in conjunction with this, its two coats, more nervous on the outside, more vascular on the inside, have become a single, ®brous coat, and, separate from this, a peritoneal covering that envelops the two cavities then establishes and unites them as a single unit.29 The `neck' of the womb, ending in the pudenda, is a more constant featureÐsinewy and amazingly ¯exible in its ability to close so tightly on the seed and embryo, then to open so wide for the foetus to emerge.30 While the wonder this generates is expressed entirely generally in Dissection of the Uterus, it subsequently takes the form of admiration, and evidence, for its creator. The Dissection of the Uterus concludes with a section on what grows in the womb of a woman who has conceived, and Anatomical Procedures devotes most of its uterine space to the dissection and vivisection of pregnant goats, before going on to devote even more space to the male reproductive organs.31 While Procedures provides a simple description of 27 Herophilus appears by name, and to considerable praise even when being corrected, in this treatise (Ut. Diss. 3. 2, 5. 2, 7. 1, and 9. 5, CMG v. 2.1. 38. 3 6, 42. 22 9, 46. 1 2, 48. 22 4), and its overall shape also follows a similar pattern to that of previous accounts which depend on Herophilus, however indirectly. 28 Ut. Diss. 3. 1 3 (CMG v. 2.1. 38. 1 17). 29 AA 12. 2 (i. 141. 7 144. 3 Simon), and see also e.g. UP 14. 4 (ii. 290. 21 291. 2 H) on the divided uterus; Ut. Diss. 6. 1 3 (CMG v. 2.1. 44. 8 18), cf. [Gal.] Def. Med. 60 (xix. 362 K). 30 Ut. Diss. 7. 1 3 (CMG v. 2.1. 44. 19 46. 14); AA 12. 2 and 3 (i. 140. 13 141. 7, 145. 12 146. 1 Simon). 31 Ut. Diss. 10. 1 17 (CMG v. 2.1. 50. 12 58. 3); AA 12. 4 6 (i. 146. 1 154. 7 Simon).

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the three embryonic coveringsÐthe lambskin like coat or amnion (a1mnei9 on), the leathery coat or chorion (xo3rion), and the sausage shaped or allantoic coat (a1llantoeidh3w)Ðand the complex con®guration of the blood vessels that supply the embryo with its vital nourishment as it should appear to those who follow Galen's procedures, Dissection adopts a more processual approach. The process of syllepsis outlined is, moreover, almost entirely mechanistic. If seed arrives at the right time, when the mouths of the vessels anastomizing into the womb are open but leaking gently rather than copiously pouring out the monthly discharge, then the seed can adhere to the roughness in the uterine surface created by these openings, forming the chorion in preparation for the foetus itself.32 In subsequent accounts of this moment, the mechanics of the coming together of seminal/embryonic chorion and uterine coat are reworked on similar lines but within an understanding of syllepsis as primarily an activity of the attractive (e2 lktikh3) faculty or dynamis of the womb as it draws in and then closes around the seed, bringing its retentive (kathektikh3) faculty into play; and that this seed comes from both procreative partners is made clearer as the female seed performs a separate, ancillary role to that of the male.33 This conceptual shift means that syllepsis is no longer a strictly anatomical phenomenon, it is no longer accounted for by the irregularities of the uterine surface (and timing), but by something more than structure and conformation. It can thus escape the ambit of Anatomical Procedures, having already been discussed in a range of more physiological texts such as On Seed, Natural Faculties, and Usefulness of the Parts. This is not to say that the construction of the parts is irrelevant in this facultative conception, indeed the retentive and expulsive (a1pokritikh3) dynameis of the womb have a perceptible physical manifestation in the oblique and transverse ®bres of its coat, but it is to circumscribe the 32

Ut. Diss. 10. 4 5 (CMG v. 2.1. 50. 24 52. 14). See the rather long, convoluted, and polemical account at Sem. 1. 4. 1 7. 20 (CMG v. 3.1. 70. 25 90. 6) for all this. These faculties really become fully developed in the Nat. Fac. and thereafter, and all organs in the Galenic body now have attractive, assimilative, retentive, and expulsive faculties as well as more specialized ones. Indeed, the womb is the best example of the operation of the retentive and expulsive faculties (Nat. Fac. 3. 2 3: SM iii. 206. 4 211. 10). 33

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contribution dissection makes to the knowledge of the living human being who may require repair.34 This circumscription becomes clearer in Formation of the Foetus, one of Galen's last works, which claims to provide an account of foetal construction based on dissection, rather than the mere speculation of many philosophers, who have therefore fallen into error and disagreement.35 The treatise does contain a considerable amount of anatomical description and discus sion, though not all derived from direct observation; but when the crunch comes, on the controversial questions of the order of organic formation and the cause of embryonic construction, empirical evidence is rapidly left behind. Indeed, the work ®nishes up being as much about the limitations of experience and dissection, as about their neccesity. These things only take knowledge a certain way: they are indispensable, but insu cient to support a full description of somatic functioning, not only when confronted with great complexity, such as that involved in the tongue's use in speech, but also when con fronted with certain causal or controlling relationships within the body.36 Not just observation (ue3 a) but also reason (lo3gow), most especially division and distinction, are required to deter mine the faculties that manage the workings of the body, and even the combination of the two does not result in ®rm conclusions about the cause, the governing principle, of gen eration and foetal formation itself. The only thing Galen can assert with absolute con®dence is the great wisdom (sofi3 a), artistry (te3 xnh), and power (dy3namiw) involved in this generation, as indeed in the generation of humanity itself; but what exactly it is that possesses these qualities and capabilities he cannot say, he confesses ba‚ement on these matters both here and in his ®nal treatise, On my own Opinions.37 Furthermore, he is just 34 AA 12. 2 (i. 143. 8 11 Simon), and Nat. Fac. 3. 11 (SM iii. 231. 19 233. 9), where these ®bres are also joined by longitudinal ®bres (on which see also 3. 8: SM iii. 223. 6 224. 10), but the account is somewhat confused. It is clear, however, that the argument in the Nat. Fac. formulates faculties in response to the requirements of the manifest activities of the body and its organs and then ®nds their anatomical signs rather than vice versa. 35 On the Formation of the Foetus (Foet. Form.) 1 (iv. 652 3 K). 36 Foet. Form. 5 6 (esp. iv. 678 9, 689 98 K). 37 Foet. Form. 6 (iv. 687 702 K); cf. Sent. 2 and 11 (CMG forthcoming, 56. 14 58. 21, 90. 18 94. 16).

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as uncommitted on the substance of the soul (whether it is corporeal or incorporeal, perishable or imperishable), which is one of the possible contenders for being the cause of embryonic construction.38 Galen rejects this suggestion, for he considers the soul in the seed lacks the skill and forethought necessary to generate a foetus, as the rational soul emerges later, and cannot have been responsible for the formation of the body with which it is conjoined anyway, otherwise anatomical knowledge would be innate, rather than needing to be learnt through dissection. On the other hand, there is some kind of continuity, from the parents through the seed to the o€spring, otherwise there would be no resemblance between them, and this tends to contradict the idea that this cause is a more external one, more closely connected to the divine creator, an entity that certainly possesses all the right qualities and capabilities, but confronts more practical problems in terms of getting involved in the reproductive process itself. There are, then, clear limits to what dissection, even inte grated into the workings of the logical method, can demon strate, or explain. Galen, at least in these later treatises, admits that he is basically deducing cause from e€ect, and has no information, no investigations or demonstrations that bear directly on the cause, the causal entity itself. The wonders of the human constitution require some kind of divine entity to have acted so providentially in bringing humanity into being, but do not reveal anything more than power and providence about this creator. So also, as it follows the same design, reproduction requires a causal agent similarly endowed, but which has to work within the con®nes of the reproductive process itself, and generate o€spring that resemble parents. The mature human being requires a soul that makes it just that, makes it alive, rational, sensitive, and all the other things it is to be human; but that does not necessarily entail that the soul be corporeal or incorporeal, mortal or immortal. The default designation for these causal entities is physis. This is Galen's most common term for the divine creator, as it was for the Stoics, whose notion of provident nature comes closest to 38 Foet. Form. 6 (iv. 701 2K); Sent. 3. 1 2 and 7. 1 5 (CMG forthcoming, 58. 22 60. 11, 76. 25 80. 13); and see R. J. Hankinson, `Galen's anatomy of the soul', Phronesis, 36 (1991), esp. 201 4 for further discussion.

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Galen's, though there are some signi®cant di€erences between the two, and Galen also follows Plato in calling his creator the craftsman or demiurge (dhmioyrgo3w).39 The former term is interestingly feminine and polysemous, the latter de®nitely masculine, and the interchangeability of these and other terms serves to emphasize the unsettled and unformed char acter of this entity. Physis too is what the cause of foetal formation is commonly called; though as Galen remarks, this is simply by custom (synh3uhw), it says nothing about the identity of this cause itself, in what it actually consists.40 Physis can also refer to the lower parts or functions of the psyche, to the causes of things like nutrition, rather than conscious thought, within the body.41 These admissions of ignorance are, however, intended to strengthen rather than undermine, the certainty of the system's basic architecture. Distinguishing between the securely demon strable, the probable, and the entirely undecided helps to shore up the ®rst category, by means both of its openness and honesty, and of its de®nition against forms of uncertainty.42 These are none the less appeals lodged largely within the system, rather than ®rmly grounded in something external to it. While anatomy may collude in this certainty, dissection may reinforce this view of the world, it cannot prove it. It does not lead inexorably (or even reluctantly) to the conclusions drawn; as Galen recognizes. He actually attempts to demonstrate the providence (or economy) of nature no more in Anatomical Procedures than he does in the Formation of the Foetus, relying entirely on its consistent corroboration. Observed phenomena and explanatory schemes are mutually implicatory, Galen works towards achieving the best ®t between the maximum 39 On Galen's complex relations with Stoicism generally see Paola Manuli, `Galen and Stoicism', in Kollesch and Nickel (eds.), Galen und das hellenistische Erbe, 53 61; and, more particularly, compare Stoic accounts of nature and the creation of humanity such as that given at Cic. ND 2, esp. 32. 81 2 and 51. 127 60. 152, with those provided by Galen. On Galen and Plato in this respect see De Lacy, `Galen's Platonism', esp. 38. 40 Foet. Form. 6 (iv. 687 K). 41 See e.g. Nat. Fac. 1. 1 (SM iii. 101. 1 15). 42 See Sent. 1. 4 (CMG forthcoming, 56. 6 10), which recalls the division between the e1 pistemoniko3n, piuano3n, and sofistiko3n in the PHP 2. 3. 8 11 (CMG v. 4.1.2. 110. 15 112. 2).

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number of pieces he understands as being in play, either potentially or actually, and calls it proof. There is a methodical progression neither from sound ®rst principles, nor from sure experience, but a messy, dialectical, meeting between the two in which the most inclusive and well ordered circle of compre hension possible is formed, secure along its circumference, horizontally consistent and supportive, but resting on shaky axioms and undemonstrated assumptions. Objections might also be raised about the other end of Galen's cosmological programme, for the fundamental elemental com position of the parts, and whole, of the human body is similarly derived by a process of ®nding the best, or preferred, ®t between phenomena and presumptions. This mixture cannot actually be apprehended by the senses and so what lies beyond the homo eomeries, the `sensible elements' (ai1 suhta4 stoixei9 a) as Galen also terms them, must be logically deduced, by the formulation and testing of a series of propositions about these more fundamental elements which are consonant with their evident e€ects in the human body.43 In particular, their a€ectability or alterability, and the quality of these changes, as well as the existence of human reproduction means that the simple parts must consist in kraseis of the four elementsÐearth, air, ®re, and waterÐnot anything so singular and una€ectable as Democritean atoms, Asclepiadean corpuscles, or things of similar ilk.44 Not all agreed, however, and Galen was well aware that his mode of understanding was controversial, that it was indeed contro verted by those who held a particulate view of the cosmic substance. So his persistent failure to do much more than proceed both ways round a ring, to argue from the manifestly perfect aptness of that which exists, as revealed by dissection, to its intentional design and designer, as well as to argue from these latter to optimal aptness as the only correct exegetical strategy in anatomical explication, and his continued rebuttal rather than refutation of opponents are all rather more problematic than they might have been. However, the persuasive force of demon 43 Gal. On the Elements according to Hippocrates/Peri4 tv9n kau' ¹Ippokra3thn stoixei3 vn (Hipp. Elem.) 1. 1 2. 2 (CMG v. 1.2. 56. 3 58. 10), and Nat. Fac. 1. 6 (SM iii 109. 18 19). 44 See Hipp. Elem. and, more concisely, HNH 1. 10 14 (CMG v. 9.1. 24. 16 29. 17); and CAM 7 8 (i. 245 54 K).

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stration, not in the sense of logical proof but in the sense of enactment, of illustrating the smoothness and congruity, the totalizing capability, of his own approach, his own explanatory system, in action, should be no more underestimated than misconstrued. Galen's extant anatomical treatises as they contribute to this teleological exhibition, therefore, describe a humanity divided in the region of the reproductive parts, but otherwise united. The division is one of approach, and is not just restricted to the conformation of the organs themselves, but it has clear limits. There are also many more di€erences in the construction of the male and female body outside the con®nes of Galen's surviving anatomical úuvre. He does, for instance, pay attention to the divergence between the breasts of men and women elsewhere, and even sees the formation of such things as blood vessels and ¯esh as generally sexually di€erentiated on occasion, but what is systemized within these texts, what is directly revealed by dissection or what dissection is made to reveal directly, is none the less signi®cant.45 Some of these treatises further imply that there is an explanation for the anatomical di€erences they describe, as they suggest that bodies are formed according to a certain plan of optimization as realized by a provident and divine entity. The reason humanity is as it is, is divided as it is, is that this is for the best; and these treatises mainly refer to the Usefulness of the Parts for the elaboration of such an explanation (and to some other more speci®cally explicatory texts). Galen is, moreover, as good as his word; indeed, he delivers rather more than he promises since he o€ers not one explanation but several in the Usefulness of the Parts and its associates. He also makes it clear that these are not so much explanations as causes, or at least that he sees no distinction between the two. The aetiological woman Galen sets out his basic aetiology in the Usefulness of the Parts, and gives absolute precedence to the cause for the sake of whichÐthat is, Aristotle's ®nal cause. The ecient (that by which), the material (that from which), the instrumental (that 45

UP 7. 22: breasts (i. 437. 13 441. 22 H); MM 5. 7: arteries and ¯esh (x. 334, 336 K).

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by means of which), and the formal (that in accordance with which) causes all take second place.46 These causal categories may be deployed at a number of di€erent levels, and more or less completely, but they always maintain their internal hier archy and direction. Thus, for example, when confronted with the peculiar thinness of the arteries of the lungs, Galen rejects Asclepiades' view that they have become thin from overwork, in favour of its opposite, that these arteries are thin in order that they may work so hard.47 This formation and this function, this thinness and this industry, constitute, moreover, the best possible arrangement in the circumstances. On one level this formulation refers the structure of these blood vessels to their activities and their chreia, to the action they perform and to the role of that action in the overall functioning of the human being, for as Galen says `the action of a part is prior to its construction and generation, and usefulness comes ®rst and action second'; but it also refers their structure to nature's providence.48 The ultimate answer to the questionÐfor the sake of what (dia4 ti3 ) are things as they are?Ðis always because it is for the best; this is the `®nal Final cause' as Jim Hankinson puts it, the true `®rst' cause as Galen calls the forethought or providence (pro3noia) of the demiurge.49 This, to modern sensibilities, resembles an explanation rather than a proper cause. As Michael Frede says, `generally our use of causal terms seems to be strongly coloured by the notion that in causation there is something which in some sense does some thing or other so as to produce or bring about an e€ect', and being for the best is not that kind of a thing, but it is, none the less, for Galen the most important causal concept.50 46 UP 6. 12 (i. 229. 11 18 H); cf. On Antecedent Causes/De Causis Procatarticis (CP) 6. 67 (92. 17 21 Hankinson), and also Arist. Phys. 194b16 195a3 and Met. 983a25 €. The schema is basically an amended Aristotelian one, though it is not the only one Galen used; see R. J. Hankinson, `Galen's theory of causation', ANRW II 37.2 (1994), 1757 74 for further discussion. 47 This is to somewhat simplify the rambling argument to this e€ect, inter alia, at UP 6. 13 (i. 340. 5 347. 14 H). 48 tW9 me4 n kataskeyW9 kai4 gene3 sei tW9 kata4 to4 mo3rion h2 e1 ne3 rgeia prote3 ra, tQ9 d' a1jiv3mati prote3 ra me4 n h2 xrei3 a, deyte3 ra d' h2 e1 ne3 rgeia, UP 11. 13 (ii. 153. 20 3 H). 49 UP 6. 13 (i. 340. 6 7 H); Hankinson, `Galen's theory of causation', 1769. 50 Michael Frede, `The original notion of cause', in Malcolm Scho®eld,

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This immediately raises an issue about the criteria by which the best is de®ned, for the coherence of the whole edi®ce depends upon them. These criteria must either be consistent and self sucient, the inevitable internal products of the system itself, or absolutely transcendent. Implicitly Galen assumes there to be a coincidence between the two conceptual paths to the best that he need not bother to elaborate. It is clear, however, that he does not follow the shortest route to circularity and self conformity, which would be to take the actions of the demiurge as being for the best in themselves; he does think they can and should be shown to be for the best. A general principle of generosity is in operation, and the excuse of the limited ability of the human intellect to grasp the almost limitless providence of nature is used in cases where no good reason is readily apparent, but both rest on that which has already been accomplished in terms of revealing the workings of this optimization. The forethought of physis has been illustrated suciently for some things to be taken on trust and human modesty to be pleaded on occasion. So, the extent to which Galen is successful, the extent to which his vision is actually self regulating about what is for the best or must have recourse to extraneous considerations, is one of the things to be watched out for as this exposition proceeds because, ultimately, this is the substance in which Galen's woman (like everything else) is ®xed; this is the `®nal Final cause' of female existence as Galen describes it. Among the various reasons o€ered for why woman is best as Galen understands her to be is one that possesses a certain precedence, as it proves the most functional within his system, joining up the most points into the most satisfactory shape; and though it is never explicitly recognized as such, it seems to be the best place to start none the less. Physis, Galen explains in book 14 of the Usefulness of the Parts, would have liked to make her creation immortal, but was thwarted by the innate corrupt ibility of her materials.51 She did what she could towards her Myles Burnyeat, and Jonathan Barnes (eds.), Doubt and Dogmatism: Studies in Hellenistic Epistemology (Oxford: Oxford University Press, 1980), 217. 51 UP 14. 2 (ii. 285. 7 12 H). The basic understanding of the creator as materially constrained is one of the key points of contention between Galen (and others like him) and the Judaeo-Christian tradition in which the creator

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original objective none the less, imitating the good founder of a city who takes thought not only for the initial colonization but also its continuing maintenance. Thus nature has given to all creatures `instruments of reproduction' (o5rgana kyh3sevw) and has attached to them a remarkable faculty for producing pleasure, and to the soul which is to use them a marvellous longing to do so, so that she does not have to rely on humans' good judgement to preserve their genus.52 Thus far physis has not discriminated between the sexes, nor indeed have any of her actions necessitated the procreative di€erentiation of any species, but Galen now launches into a lengthy enumeration of the wonders of the womb and it is not until his exposition is well advanced that he realizes he has got somewhat ahead of himself and needs to recount `what kind the male is, and what kind the female, in respect of nature', because it is from this that much else ¯ows.53 The narrative that follows, however, makes no reference to the exigencies of humanity's approximation to immortality, but starts from what Aristotle rightly knew but did not develop fully, namely `that the female is less perfect than the male'.54 There are two aspects to this defective state: ®rst that she is colder, and colder animals are less perfect than warmer ones, and second that, though women have all the same parts as men, hers are inside the body and his are outside, which is the perfected position. In fact these turn out to be one, because the failure of her generative parts to emerge externally is itself due is entirely unconstrained; see e.g. UP 11. 14 (ii. 158. 7 159. 19 H), where Galen sets out his own view of the di€erence between his creator and Moses', and The Medical Aphorisms of Moses [Maimonides]/Fusul Musa f õ 'l-tibb 25. Ç and 40 (text and translation of this aphorism can be found in Joseph Schacht Max Meyerhof, `Maimonides against Galen, On Philosophy and Cosmogony', Bulletin of the Faculty of Arts of the University of Cairo, 5/1 (1939), 53 86) for a later interpretation from the other side of the debate. 52 UP 14. 2 (ii. 285. 27 286. 12 H). It should be noted that there is a certain slippage here, for generation is not the only use to which its instruments may be put, and it is clear from the model of sexual desire and pleasure elaborated later in this book (and elsewhere), that Galen considered that simply making sexual activity in itself enjoyable, without restriction on its mode or object, would ensure humanity's continuation. 53 oi¤ on me3 n ti to4 a5rren e1 sti4 th4n fy3sin, oi¤ on de4 to4 uh9ly, UP 14. 5 (ii. 295. 24 5 H). 54 o7ti me4 n oy¤n a1tele3 steron to4 uh9ly toy9 a5rrenow, UP 14. 5 (ii. 295. 27 296. 1 H); cf. Arist. GA 728a17 20.

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to her lack of heat, but this lack is functional, for, as Galen generously admits, `it is necessary for there to be a female too'.55 Indeed it would be an a€ront to the good oces of the demiurge to consider that he might make half the species imperfect and mutilated in this way without a good reason. The reason is that the foetus needs plenty of nourishment, which it must take either from that which sustains the woman carrying it or from something surplus to that sustenance; the ®rst being harmful to the woman carrying it, the second only possible if the female is too cold completely to concoct and disperse all the food she takes in. The internality of the female generative parts also provides the ideal match to the externality of the male's, she is optimally constructed to receive and retain seed, and to nourish and perfect what is thus conceived. It is on account of her thermal de®cit too that the woman has smaller, less perfect orcheis and generates scantier, colder, and wetter seed. Despite these failings, however, the female seed does contribute to what is generated, and is useful also in impelling the woman towards sexual activity and in opening the neck of the womb during intercourse with a man. Galen then claims, in the opening passage of the next book of the Usefulness of the Parts, that he has now demonstrated what everybody knows anyway.56 That it is better to have two generative beings; that this requires that one have parts for receiving, the other for expelling, seed; that these parts be optimally formed and arranged, and accompanied by the appro priate faculties for their use; and that physis has eciently provided humans with all this from a single source or archeÐ that is, `that the female is less perfect than the male'. That this is so clearly the starting point of his exposition, rather than any more abstract proof of the bene®ts of reproductive duality, and its ideal organization, is the main problem in an account that otherwise has the bene®t of being largely complete, and cer tainly coherent and cogent within the terms of Galen's medical system. The priority of this statement, and the value judgement in which it consists; the way in which the reasoning is directed by, and returns to, it rather than the dynamics and potentialities of human procreation as conceived more generally, is illustrated 55 56

e5 dei ga4r ei1 nai3 ti kai4 uh9ly, UP 14. 6 (ii. 299. 19 H). UP 15. 1; and see also14. 6 (ii. 337. 8 18, and 301. 14 16 H).

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most clearly by the weakest link in the explanation, that is as it deals with the location of the generative parts. For Galen fails, both in the Usefulness of the Parts and in the fuller elaboration of the same point in On Seed, to make a case for the absolute superiority of their externality, and fails to notice that, in his own terms, the case is unmakable.57 The argument proceeds by analogy with the imperfect eyes of the mole and evokes the whole notion of the scala naturae.58 Some animals, like shell®sh, departing only slightly from plants, have no eyes and so sight at all, others a step further up the scale of completion, like worms, have dim traces of both, still closer to the top the mole has well formed eyes which their nature is unable to push properly outside, and at the summit of perfection animals are born with full vision. Women are like moles, but better because of the bene®t derived from their incompletion. However, the analogy is invalid, for while it is possible for Galen to assert that the organs of vision are absolutely better on the outside, it is not possible to make such an argument for the organs of reproduction, where the ecacy of such a location is entirely predicated on the other procreative partner not following suit. Perfection of placement thus becomes relative, interdependent, and equally applicable to both sexes. The basic point about women's thermal de®cit, and the key importance of the innate heat in Galenic physio logy on which it depends, is not altered, but the suspicion that, for Galen, di€erence is essentially hierarchical, and that what ever applies to women will always be worse, is reinforced. As Galen basically confesses in his line that, `it is necessary that there is a female too', if the demiurge had been able to achieve human immortality, the combination of humanity and death lessness would have been an exclusively male preserve. Galen o€ers not only an explanation of why there are females in the human species, and in what it is that they consist, but also an explanation of how this sexual division is reproduced in the world; indeed the two are interwoven. This process of 57 UP 14. 6 (ii. 297. 26 299. 19 H), and Sem. 2. 5. 48 69 (CMG v. 3.1. 190. 6 194. 20). 58 The imperfect eyes of the mole, and their particular place in the order of nature, had already featured in Arist. HA 491b28 34 and 533a10 15; but Galen explains things slightly di€erently and very much for his own purposes.

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foetal di€erentiation is treated extensively in the Usefulness of the Parts, as well as in On Seed where Galen is more concerned with the refutation of various opposing perspectives, and it also appears in some of the Hippocratic commentaries which intimate that the driving force behind the whole explicatory edi®ce Galen erects here is the ubiquitous Hippocratic aphor ism: `male embryos mostly on the right, females on the left'.59 In all the accounts, two factors, or two causes, are at work: one residing in the seed, the other in the womb, importantly composed of two cavities. Behind them is the asymmetric con®guration of the blood vessels as they descend to these generative parts in both men and women. On the right side of the body, blood arrives at the uterine sinus and/or testicle having been puri®ed by the kidneys, on the left, it arrives still full of perittomata, watery and serous; and pure blood is hotter than its residue laden equivalent. Thus, as they assimilate the nourishing blood, and it a€ects their krasis, the organs on the right become hotter than those on the left, so seed coming from the right testicle is hotter than that from the left, it is received by a hotter or colder cavity of the womb; and everybody knows that males are made and stay hotter than females. Now Galen, against such heavyweights as Aristotle and Athenaeus of Attaleia, is insistent on female semination, that this is crucial to her sexual desire and sexual pleasure, and to the successful accomplishment of any reproduction, becoming mixed with its male counterpart in the womb where the two then move as one; however, in all this discussion of the interaction of womb and seed it is only the male who provides the latter. None the less, this does not serve to make the contest even, as Galen admits at the end of this sequence in the Usefulness of the Parts: 59 Sem. 2. 5. 1 76 (CMG v. 3.1. 178. 16 196. 21), and UP 14. 7 (ii. 302. 1 310. 7 H). The Hippocratic aphorism (Hp. Aph. 5. 48 (iv. 550 L) is discussed at Galen, Commentary on Hippocrates' Aphorisms/Ei1 w to4 ¹Ippokra3toyw a1forismoi3 y2pomnhma3ta (Hipp. Aph.) 5. 48 (xviib 840 1 K), and also appears at Hipp. Epid. 6 2. 46 (CMG v. 10.2.2. 119. 1 6); see too Hipp. Epid. 2 6 (CMG v. 10.1. 385. 31 386. 22), and UP 14. 4 (ii. 293. 2 4 H). This, and Galen's references to the treatment of the same subject in his (lost) treatise On the Anatomy of Hippocrates/Peri4 th9w ¹Ippokra3toyw a1natomh9w (see Sem. 2. 5. 38 (CMG v. 3.1. 186. 19 20), and UP 14. 4 (ii. 293. 13 16 H) ) suggest that this was where he ®rst provided such elaborate support for this aphorism.

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tQ9 toi3 nyn ditth4n me4 n a1rxh4n ei¤ nai th9w tv9n a1rre3 nvn gene3 sevw, e1 n me4 n toi9 w uh3lesi th4n dejia4n mh3tran, e1 n de4 toi9 w a5rresi to4n dejio4n o5rxin, i1 sxyrote3 ran d' v2w ta4 polla4 gi3 gnesuai th4n mh3tran e1 jomoioy9n e2 aytW9 to4 kyoy3menon, v2w a6n kai4 xro3nQ ple3 oni plhsia3zoysan, ey1lo3gvw v2w e1 pi4 to4 poly4 ta4 me4 n a5rrena tv9n e1 mbry3vn e1 n tay3tW, ta4 de4 uh3lea kata4 th4n a1ristera4n ey2ri3 sketai. Since there is a twofold archeÅ for the generation of malesÐthe right uterus in the females and the right testicle in the malesÐand since generally the uterus is the better able to make the foetus like itself because it is associated with it for a longer time, there is good reason for the fact that for the most part the male foetuses are found there and female [foetuses] in the left uterus.60

It is thus not so much the heat of the conceptus itself as the heat of its surroundings that is most e€ective in determining the sex of any o€spring, or as Galen primarily formulates it, in determining whether a male will be formed or not. In determining its sex, the hotter environment and internal essence of the male embryo also determines some of its other characteristics. It is more solid (sterev3teron)Ðthat is, stronger (i1 sxyrote3 ron) and more robust (ey1rv3steron)Ðand moves, is collected, and constructed more briskly (o1jy3teron); that is, its composition starts ®rst and proceeds more energetically but actually takes longer to complete because harder and drier bones, muscles, and so forth are formed.61 The softness and weakness of the female continue long after birth, they are somatic features which never cease to be shared with children and are features of both the bodily fabric and faculties.62 It is the weakness of her central physike dynamis which brings women's growth to an end before men's, and a lack of facultative force in the nerves and muscles which means that women cannot be ambidextrous, but `must be content to use the right hand only moderately'.63 There are, however, changes that do occur in the course of female life, in particular with the arrival of menstrua 60

UP 14. 7 (ii. 309. 18 25 H). Hipp. Epid. 6 2. 46 7 (CMG v. 10.2.2. 118. 23 123. 6); cf. Hipp. Epid. 2 3 (CMG v. 10.1. 297. 28 298. 39). 62 See e.g. Hipp. Epid. 6 2. 47 (CMG v. 10.2.2. 122. 15 123. 6); MM 5. 7 and 8 (x. 336, 342 K); GMM 2. 11 (xi. 137 K). 63 h¥ ge a1gaphto3n e1 sti th9 dejiq9 mo3nW xrh9suai metri3 vw, Hipp. Aph. 7. 43 (xviiia 147 9 K, where Galen also reports that this is why Amazons cut o€ their right breast, in order to release reserves of strength to the right hand); Hipp. Epid. 6 2. 47 (CMG v. 10.2.2. 122. 19 23): fysikh9 dy3namiw. 61

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tion and breasts, which parallels the testicular swelling, and deepening and roughening voice of maturing boys.64 The connection between these two, the menses and milk, the uteri and breasts, is crucial, as Galen endlessly emphasizes.65 In the absence of pregnancy, each month physis evacuates through the vessels attached to the womb the surplus accumulated on account of women's lack of heat, the same surplus that nourishes the embryo through the same vessels when she is pregnant, and is then, in the eighth month, diverted to the breasts through the veins which run directly to them from the womb, to become milk.66 This is the only reference Galen makes to menstruation in the Usefulness of the Parts, and a similar reticence marks the rest of his physiological canon, though the monthly purges are a prominent feature of his pathological and therapeutic writings. There is, of course, a considerable correspondence, not to say overlap between these genres, however, and it is of particular interest to ®nd Galen developing an argument from nature for physicians' use of phlebotomy centred around menstruation in the On Venesection against Erasistratus (Peri4 flebotomi3 aw pro4w ¸Erasi3 straton)Ðan argument that his target, Erasistratus, should have found persuasive, since he was counted among those who considered physis to be artistic or designing (texnikh3).67 Galen rhetorically demands: oy1x ay5th gynai9 kaw me4 n a2pa3saw e1 f¸ e2 ka3stQ mhni4 kenoi9 to4 peritto4n a1poxe3 oysa toy9 ai7 matow; e5 dei ga4r, oi¤ mai, oi5 koi to4 uh9ly ge3 now oy5t¸ e1 n i1 sxyroi9 w po3noiw diaitv3menon oy5u¸ o2miloy9n h2li3 Q kauarQ9, kai4 di¸ a5mfv tay9ta plh9uow y2potre3 fon i5 ama fysiko4n e5 xein toy9 plh3uoyw th4n ke3 nvsin . . . ei1 de4 kai4 ma3uoiw h2li3 kvn e1 k tay3thw th9w kenv3sevw a1polay3ei to4 uh9ly ge3 now a1gauv9n kai4 o7sa bla3ptetai mh4 kenoy3menon, oy1k oi¤ da pv9w y2pomenei9 w e5 ti mh4 panti4 tro3pQ spey3dvn kenv9sai pleona3zon ai7 ma. Does she [nature] not evacuate all women every month, by pouring forth the surfeit of the blood? For it is necessary, I think, that the female genus, who stays at home, neither leading a life of hard work 64 Hipp. Epid. 6 4. 28 (CMG v. 10.2.2. 245. 24 9); Hipp. Aph. 3. 28 (xviib 640 K); Hipp. Epid. 2 1 (CMG v. 10.1. 174. 16 24). 65 See e.g. Hipp. Aph. 5. 37 and 38 (xviib 827 9 K). 66 UP 14. 8 (ii. 310. 8 313. 7 H). 67 On Venesection against Erasistratus (Ven. Sect. Er.) 5 (xi. 164 K); but see also the remarks of I. M. Lonie, `Erasistratus, the Erasistrateans, and Aristotle', BHM 38 (1964), 441 2.

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nor coming into contact with direct sunlight, and because of both these things generating excess, should have a natural remedyÐthe evacuation of the excess . . . If you knew what great bene®ts the female genus enjoys as a result of this evacuation, and how she is harmed if not purged, I don't know how you could still hesitate and not eagerly evacuate surplus blood by all means.68

Indeed, phlebotomy not only imitates the good deeds of nature in respect to the menses, but also in respect to lactation, conceiving and carrying a foetus, and post parturitive purges; all of these are nature's way of relieving female excess.69 There is thus a blurring of causal sequence to the point where it is best to speak of correlation. Physis, exploiting the elision between her transcendence and her individual imman ence established by the repeated re enactment of any initial creation, responds, has responded, and will go on responding to a ¯awed female lifestyle which is so absolutely predictable, as it has been and will be, that the response persistently precedes the living. The dim inactivity of female domesticity is as inevitable as the build up of excess in a body unexercised and underexposed to the sun. Both domestic role and bodily surfeit are solid foundations on which to construct an explana tion for menstruation, as they are causally conjoined through the good intentions of a nature for whom everything is in the present tense, and in a potentially causal relationship with everything else. There is, moreover, nothing but this dual inevitablity standing behind this virtuous circle of excess and evacuation. There is no higher purpose to this surfeit sug gested, and this circle contains the best in itself: where there is regular surfeit it is best to have regular evacuation. In the Usefulness of the Parts, on the other hand, physis has her sights on a greater goal, the continuation of the species, and she has instituted both the excess and its relief to this end, and therein lies the best. Indeed, On Venesection against Erasistratus rather suggests that childbearing might itself result from the poor lighting and lack of hard work characterizing the homes in which women spend their days, being another cunning means of getting rid of any excess. Of course, this is an essentially polemical text, reputedly a written version of an extempore 68

Ven. Sect. Er. 5 (xi. 164 5 K).

69

Ven. Sect. Er. 5 (xi. 164 K).

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discourse on the subject, and it pre dates the Usefulness of the Parts.70 None the less, it illustrates nicely the assumptions with which Galen was working, the shape of his argumentation, and the interchangeability of many of its partsÐthe interchange ability of lines of reasoning, of bodily processes, of nature and habit, somatic and social circumstancesÐand gives a foretaste of further multiplicities to come. Lactation too is rather more than a prophylactic purge in the Usefulness of the Parts, and nature's optimization of the location of the breasts is fully explained in the book on the thorax.71 Created for the sake of milk, a highly elaborated nutriment, they are ideally placed near to the heart, the centre of the innate heat and somewhere well supplied with good blood, and so they are well provided with the power and material for milk production respectively. They also o€er protection and insulation to the heart in return, mostly and most usefully in the colder female. Neither this nor their non lactation is taken by Galen, however, as an adequate reason for the non elevation of the breasts in men, a problem he raises only to defer.72 This deferral seems to have been permanent, but its signi®cance lies in the unique formulation of a question in terms of the failure of the male to be like the female. There is, however, no mention of any female testicular development coinciding with the arrival of the breasts and menstruation, such as appears in the accounts of the male passage out of childhood, though there must have been some, for children in general were, by de®nition, without seed.73 This is another example of the way that, despite his protestations, Galen fails fully to integrate the female seed into his physiolo gical programme, it being particularly prone to vanishing where it threatens to encroach on the male reproductive role rather than merely bearing a passive and ¯attering resemblance to him. 70 On the production of the Ven. Sect. Er. see Gal. Ven. Sect. Er. Rom. 1 (xi. 194 K; and discussed in the previous chapter). 71 UP 7. 22 (i. 437. 13 441. 22 H). 72 UP 7. 22 (i. 441. 9 12 H); the male breasts and nipples should really have given Galen more diculty. 73 See e.g. Hipp. Epid. 6 1. 5 (CMG v. 10.2.2. 21. 3 4). The words belong to Herophilus, but they express a truism.

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The thermal de®cit of the innate female krasis which holds this vision together is overlaid and somewhat altered in a passage from On the Causes of the Pulse (Peri4 tv9n e1 n toi9 w sfygmoi9 w ai1 ti3 vn), one of the works that compose Galen's monumental treatment of the human pulse in all its variety and its medical relevance.74 For here he provides an exhaustive exegesis of a statement also made and referred to elsewhere in his sphygmological writings, namely that:

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a5ndrew me4 n oy¤n gynaikv9n v2w e1 pi3 pan mei3 zona pollQ9 kai4 sfodro3teron v2say3tvw pollQ9 kai4 brady3teron o1li3 gQ kai4 a1raio3teron i2 kanv9w to4n sfygmo4n e5 xoysin. Men have, in general, a far greater and similarly far more vehement, and slightly slower and appropriately less frequent pulse than women.75

The explication that follows starts with a restatement of the principle that the magnitude of the pulse depends on the magnitude of the innate heat, so men being not only hotter but also much hotter than women their pulse will be that much greater. However, the route to this much hotter male existence is not a simple one, and it is related to the crucial role of the qualifying `in general' in the proposition. For the actually existing krasis of any individual is a product not only of the particular mix with which they were born, but also their way of life. So, take a man very phlegmatic (that is cold and wet) by nature and a woman very choleric (that is hot and dry), have him dwell in Pontus and her in Egypt, and let him pursue an idle and dissipated lifestyle, and her, on the other hand, work hard in the open air and follow a moderate 74 For summaries of Galen's pulse-lore see C. R. S. Harris, The Heart and Vascular System in Ancient Greek Medicine: From Alcmaeon to Galen (Oxford: Oxford University Press, 1973), 397 431; and Tamsyn Barton, Power and Knowledge: Astrology, Physiognomics, and Medicine under the Roman Empire (Ann Arbor: University of Michigan Press, 1994), 152 63. 75 On the Causes of the Pulse/Peri4 tv9n e1 n toi9 w sfygmoi9 w ai1 ti3 vn (Caus. Puls.) 3. 2 (ix. 107 K), and also Puls. 9 (viii. 463 K). These are all technical terms of classical sphygmology: a classical pulse consists in a diastole (expansion), a pause, a systole (contraction), and another pause; both diastole and systole are separately possessed of magnitude, measured in all three dimensions of the artery, of force, and speed, while the length of the pauses determines the density or frequency of the pulse (being either dense/pynkno3w or rare/a1rai9 ow); it is also possessed of a number of other qualities, such as hardness/softness and regularity/irregularity.

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regimen, and the woman's pulse will be greater than the man's. However, this is the reverse of the normal course of events, because generally the di€erences in way of life between men and women widen rather than narrow their connate crasic gap. Thus, through female lassitude and male labours, the hotter natal krasis becomes far hotter and the pulse follows. So too with the vehemence of the pulse, where the innately better tone (to3now) of men's arterial coats is further improved by exercise while women's inferiority is worsened, their poorer arterial tone further relaxed, by an absence of exertion. But even this is not enough, and woman is now really punished for her earlier presumption. She is allotted a pulsative faculty only half the strength of a man's, something which has an impact on the size of the pulse which is additional to that of the innate heat, and she also has to su€er a somatic hexis which is completely clogged up with every sort of evil humour and was all squashed up anywayÐ all of which cancels out any advantage she might have gained from the soft pliability of her arterial coats, and thus her pulse must become quicker and more frequent in order to compen sate for its smallness and feebleness, though it only regains part of the ground previously lost. Thus Galen's initial generosity, his admission that his generalizations are just that and that the system is ¯exible enough for a woman to have a larger (and clearly better in Galen's view) pulse than a man, is buried under an avalanche of actual male superiority in every arena, a superiority which has to be worked on very hard in places, in particular to prevent women from gaining any bene®t from the softness of their arterial coats in comparison with the hardness of men's. It de®nitely is an avalanche rather than a carefully ordered descent, for krasis and somatic state, tone and dynamis, physis and habit are juxtaposed not articulated or interrelated. They are precariously piled one on top of the other until the man is so far above the woman that it is a wonder she manages to have a pulse at all. Perhaps most could be traced back to that moment of meeting between the relative heats of seed and womb, but that is not done as Galen seeks to multiply factors in response to the need to explain each di€erential quality of the pulse as distinctly as possible, and to accumulate degrees

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of superiority and inferiority. Moreover, in stressing the impact of habit and regimen, of lifestyle, the pulse becomes a moral issue, it is almost as if women have chosen to squander their natural resources, or at least may be censured for their forfeit. Galen should, in fact, shoulder rather more of the respons ibility for women's poor condition himself, for he makes no e€ort to improve it. His treatise Healthful Conduct, though couched in entirely generic terms, is clearly for men. In mapping out a healthy life course in which choices must be made about occupations, whether it be soldiering, farming, or something more cerebral and elevatedÐand such choices then a€ect the ability and inclination to form an ideal attitude to the body and follow an ideal regimen in which the gymnasium plays an integral partÐGalen clearly de®nes the sex of his audience.76 The inclusion of the menses among a list of habitual evacuations which may be retained in the lead up to fatigue and disease re¯ects a residual tendency to complete ness, nothing more.77 There are some women who appear in a more fully formed fashion, but these are the nurses who have oversight of the beginning of this male life course, and whose own regimen is as important as that of their charges, for it determines the quality of their diet.78 Galen follows common custom in demanding sexual abstention from these women, for, either by provoking menstruation or resulting in preg nancy, good blood that should be going into milk becomes diverted elsewhere.79 In the commentary on the Hippocratic treatise On Healthful Regimen (Peri4 diai3 thw y2gieinh9w), Galen cannot avoid the issue of a speci®cally female regimen, however, as the text states bluntly that: 76 San. Tu. 1. 12. 6 12: occupations; ibid. 2. 8. 1 2. 10. 12: gymnasium (CMG v. 4.2. 28. 32 29. 19; 59. 23 65. 5). 77 San. Tu. 4. 4. 6 and 24 (CMG v. 4.2. 107. 30, 109 25 6). 78 San. Tu. 1. 9. 1 9 (CMG v. 4.2. 21. 34 23. 3). 79 See Keith Bradley, `Wet-nursing at Rome: a study in social relations', in Beryl Rawson (ed.), The Family in Ancient Rome (London: Routledge, 1992), 201 29, for the social context of this.

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ta4w gynai9 kaw xrh4 diaita9suai tQ9 jerote3 rQ tro3pQ kai4 ga4r ta4 jhra4 siti3 a e1 pithdeio3tera pro4w th4n maluako3thta tv9n sarkv9n kai4 ta4 po3mata a1krhte3 stera a1mei3 nv pro4w ta4w y2ste3 raw kai4 ta4w kyotrofi3 aw. Women should employ a regimen of a rather dry character, for food that is dry is more suitable to the softness of their ¯esh, and less diluted drinks are better for the womb and for nourishing pregnancy.80

Perhaps emboldened by the fact that this section of the work was generally held to be by Polybus, Hippocrates' student and perhaps amanuensis, rather than the master himself (though Galen considered it to be in accordance with Hippocratic techne), the commentary contradicts the lemma, or at least quali®es it quite considerably.81 Women who are wet para physin, that is who have a dyskrasic nature or diseased dis position, do indeed require drying, but women are also wet kata physin and this natural wetness needs to be protected, though it may require moderation.82 Similarly, men, who are drier than women kata physin, only need to be moistened when they greatly exceed their proper dryness.83 Galen thus takes the opposite line, not only to this Hippocratic author but also to Rufus of Ephesus, and considers that women should not actively attempt to approximate their somatic krasis to men's, but should guard its imperfections, for that is what constitutes health for them. Galen has good reason for taking this approach, for without female imperfection reproduction would not be possible. This, then, is how the main explanation of why woman is, and is as she is, runs, it being for the best in the sense that humanity thus comes as close to immortality as possible; a sacri®ce was required and woman is it, continues to live and make it. Of course, that is rather to simplify matters, for this line of argument was an elaborate a€air, picked up and worked 80 HNH 3. 25 (CMG v. 9.1. 107. 3 6). Galen commented on a composite work consisting of the Hippocratic Nat. Hom. and On Healthful Regimen as we know them, acknowledging its uneven, multiple character at the outset (HNH pr.: CMG v. 9.1. 7. 21 8. 18). 81 HNH pr. and 3. pr (CMG v. 9.1. 8. 16 18, 89. 14). For further discussion of the ancient debates about the authenticity of Hippocrates' works, about which Galen is our main informant, see Smith, Hippocratic Tradition, esp. 123 76. 82 HNH 3. 25 (CMG v. 9.1. 107. 7 12). 83 HNH 3. 25 (CMG v. 9.1. 107. 12 16).

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with at many di€erent points, these points being recognizable as much through family resemblance as through actual advert isement of ancestry, and sometimes threatening to com promise, obscure, or otherwise alter each other, but a certain broad consistency has been apparent. Now come other ex planations that could be described as alternatives, except that Galen never saw it that way. They are parallel possibilities, parallel causal assemblages. One such parallel explanation is also presented in the Usefulness of the Parts, and might lay claim to a kind of formal precedence over all others, though it hardly ties in with the rest of Galen's writings. For, at the outset of this great teleological show piece, Galen lays down a set of criteria for optimization rather di€erent from the consistent compromise between the ideal and the attainable which results from having the material with which physis must work operate as a uni formly constraining principle upon her freedom of action. Instead he arbitrarily speci®es in advance that certain out comes are best by putting the psychai of animals prior to physis, and instituting them as goals at which she must aim in constructing their bodies; she should, and has, constituted bodies appropriate to their souls, that is optimal.84 The body is the `instrument' (o5rganon) of the soul, Galen announces at the outset of the Usefulness of the Parts, `and consequently animals di€er greatly in respect to their parts because their souls di€er'.85 As illustration of the principle that `in every case the body is adapted to the faculties and characteristics of the soul', Galen o€ers the hooves and mane of the horse, deriving from its swift, proud character, the teeth and claws of the brave, ®erce lion, and the unarmed ¯eetness of the timid hare and deer.86 To human beings (a5nurvpoi), clever (sofoi9 ), godlike 84 Of the rest no mention is made, though Galen is willing to countenance the calling of the nature or essence of plants a kind of soul, e.g. Nat. Fac. 1. 1 (SM iii. 101. 1 15). 85 kai4 dia4 toy9to poly4 dienh3noxen a1llh3lvn ta4 mo3ria tv9n zQ3vn, o7ti kai4 ai2 cyxai3 , UP 1. 2 (i. 1. 13 16 H). 86 pa9si d' oy¤n e1 pith3deion to4 sv9ma toi9 w th9w cyxh9w h5uesi3 te kai4 dyna3mesin, UP 1. 2 (i. 1. 18 2. 8 H); and also AA 6. 1 (ii. 544 6 Garofalo). This would appear to be directly contradicted by the title and argument of the treatise That the Dynameis of the Soul Follow the Kraseis of the Body (SM ii. 32 79), though the dynameis of the soul that feature in this work are rather di€erent from those of the UP.

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(uei3 oi), peaceful (ei1 rhnikoi9 ), and social (politikoi9 ) as they are, physis gave something rather di€erent; instead of dedicating the human body to a set and singular way of life, she invested it with enormous potential.87 Hence, just as reason is an `art for the arts in the soul', the means by which humanity may acquire a whole range of skills rather than be restricted to one innate capability, so the hand is `an instrument for instruments in the body', the means by which humanity constructs and makes use of a whole range of tools and implements for the full living of human life: building houses and city walls, weaving nets and cloaks, raising altars and statues to the gods, making lyres and spears, writing laws and commentaries on the theories of the arts.88 This picture has a certain appeal, but it clearly falls foul of the principle that this system should be self regulating, in its optimization above all else, for it immediately begs the ques tion of the design and realization of the psychai. Where do they come from if they are prior to physis and to bodies, and for the sake of what is, for example, the lion's soul ®erce, the hare's timid, and the human's clever, godlike, peaceful, and social? The implication is some sort of immortality of the soul, not individually but by species, the basic template for the soul of each kind of living creature has a permanent existence, though this does not explain the characteristics of each soul. This certainly was how Rhazes, the great Persian philosopher physician of the late ninth and early tenth century, understood this passage, and he also saw it as either compromising, or rendering untenable, Galen's assiduous agnosticism on the question of the soul's substance and relationship with death.89 Galen does have a defence to this. Following the kind of careful logical distinctions drawn in On my own Opinions, he might say that there is an important di€erence between making a statement which deals primarily and directly with the question of the immortality of the soul and which cannot but be based on unsound foundations, and making a statement that has an incidental bearing on the question, but 87

UP 1. 2 4 (i. 2. 11 6. 17 H). pro4 texnv9n e1 n tW9 cyxW9 kata4 lo3gon e1 n tQ9 sv3mati pro4 o1rga3nvn o5rganon, UP 1. 4 and 2 (i. 6. 15 17, 2. 11 3. 24 H). 89 Rhazes, Doubts about Galen (14. 10 15. 6 Mohaghegh). 88

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which is based on its own, sound, foundations, and he is prepared to make the latter but would be foolish to make the former. Some sympathy with Rhazes' criticism, and his general frustration with this as a way of proceeding, must remain, however.90 In the basic outline of the principle that `the body is adapted to the faculties and characteristics of the soul', there was no reference to the sexual di€erentiation of souls, only to di€er entiation by species. However, in the eleventh book of the Usefulness of the Parts, when it comes to explaining the hair on the head, and introducing the notion that, in her abundance, physis may aim at beauty as well as functionality of form, Galen says: kai4 ga4r oy¤n kai4 ai2 kata4 ta4 ge3 neia tri3 xew oy1 mo3non ske3 poysi ta4w ge3 nyaw, a1lla4 kai4 pro4w ko3smon synteloy9si. semno3teron ga4r to4 a5rren fai3 netai kai4 ma4lista e1 n tQ9 proie3 nai kata4 th4n h2liki3 an, ei1 pantaxv9uen ay1to4 kalv9w ay¥tai perike3 ointo. kai4 dia4 toy9to ta3 te mh9la kaloy3mena kai4 th4n r2i9 na cila4 kai4 gymna4 trixv9n h2 fy3siw a1pe3 lipen. a5grion ga4r a5n oy7tvw e1 ge3 neto kai4 uhriv9dew o7lon to4 pro3svpon, oy1damv9w oi1 kei9 on h2me3 rQ kai4 politikQ9 zQ3Q . . . a1lla4 mh4n kai4 gynaiki4 to4 a5llo sv9ma malako4n e1 xoy3sW kai4 paidiko3n a1ei4 kai4 gymno4n trixv9n oy1k e5 mellen oy1d¸ h2 toy9 prosv3poy cilo3thw a5kosmow e5 sesuai kai4 a5llvw oy1d¸ e5 xei toy9to to4 zQ9on oy7tv semno4n h¤uow v7sper to4 a5rren, v7st¸ oy1d¸ ei5 doyw ay1tQ9 semnoy9 dei9 . de3 deiktai ga4r h5dh polla3kiw, ei1 mh4 a5ra kai4 dia4 panto4w toy9 lo3goy, toi9 w th9w cyxh9w h5uesin oi1 kei9 on h2 fy3siw a1pergazome3 nh to4 toy9 sv3matow ei¤ dow. a1ll¸ oy1de4 ske3 phw me3 ntoi tino4w e1 dei9 to peritth9w to4 uh9ly ge3 now a1lejhthri3 oy pro4w kry3ow oi1 koyroy9n ta4 polla4, kefalh9w me3 ntoi komv3shw e1 dei9 to kai4 ske3 phw e7 neka kai4 ko3smoy, kai4 toy9t¸ ay1tai9 w h5dh koino4n pro4w toy4w a5ndraw. The hair of the beard not only protects the jaws but also contributes to their seemliness: for the male seems more august, especially as he grows older, if he has everywhere a good covering of hair. On this account also nature has left the so called `apples' (cheeks) and nose smooth and bare of hair; for otherwise the whole countenance would have become savage and bestial, by no means suitable for a civilized and social animal . . . On the other hand, for women, the rest of whose body is always soft and hairless like a child's, the bareness of the face would not be unseemly, and besides, this animal does not have an august character as the male has and so does not need an august form. For I have already shown many times, if not throughout the work, 90 P. Donini, `Galeno e la ®loso®a', ANRW II. 36.5 (1992), 3502 4, certainly sympathizes with Rhazes; though Hankinson (`Galen's anatomy of the soul', 203), describes this agnosticism as `remarkable and admirable'.

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that nature makes the form of the body appropriate to the character istics of the soul. And the female genus does not need any special covering as protection against the cold, since for the most part women stay at home, yet they do need long hair on their heads for both protection and seemliness, and this they share with men.91

The structure is all too familiar, the male is described as the standard from which the female then deviates, but the manner of her deviation is striking. Women, since they, like men, have bare cheeks and nose, are presumbly admitted to (or at least are not excluded from) the psychically civilized and social, the latter being one of the de®ning characteristics of the human soul as they appeared at the outset and the former having been subsequently cited as such (for example as the reason why humans have fewer canine teeth than lions and wolves).92 Unlike their male counterparts, however, they are not august in soul, and therefore need not be in body either. The basic unity of the human psyche might thus be preserved by con structing a hierarchy of its faculties and characteristics around Galen's rather casual approach to the matter, and understand ing there to be a ®rst order identity of soul between the sexes, in those qualities in which the essence of humanity consists, but a second order distinction, where, at the least, men are soulfully august and women are not, and there is space for further variation. The causal e€ect of women's housebound lifestyle seems to be separate from the qualities of the soul, this is physis demonstrat ing her forethought on her own account, and it recalls the explanation of menstruation in Venesection against Erasistratus. It is not that she has designed women for domesticity, but that, knowing in advance that this will be her lot in life, she has responded accordingly. So too in the case of the soul, the concealed cultural value judgement that classi®es women as not august is not caused by nature, but acts causally on her. Physis' knowledge that beards are better, a verdict with which not all Romans would have agreed, even under Marcus Aurelius, functions slightly di€erently, recuperating the optimization 91

UP 11. 14 (ii. 154. 4 155. 6 H); cf. Musonius Rufus, fr. 21 (Lutz), and Arr. Epict. 1. 16. 10 14, for similar, Stoic, interpretations of beards and their importance. 92 UP 11. 9 (ii. 138. 2 5 H).

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criteria for the system itself. She may be inherently correct either because of her own inherent correctness or because of the inherent correctness of her view itself; either way nothing else is required and Galen is unconcerned. The best lies in the beard itself, not in matching some aspect of human physical formation to some aspect of human social formation, the value of the latter being left outside the demiurgic circle. In none of these cases, however, is the concern to naturalize the conven tions of the Roman sexual order, but rather to bring these conventions to bear on nature, and through her, on the physical order of humanity. Thus the apparent arbitrariness of women's beardlesness is removed, it is rationalized by nature, by nature's providence, and so ®tted into a wider pattern. This is what Galen is interested in explaining, he wants everything about the parts of the human being, down to the last hair, to have a cause for the sake of which, and he considers that cultural con®gurations are available for use in this way. They too can be taken as given, and have the advantage of not being what he is trying to explicate. The relationship between this line of soulful and social division between the sexes and that of imperfection and coldness is expressed through the passage that immediately follows that just quoted: a1lla4 mh4n kai4 di¸ a5llhn tina4 xrei3 an a1nagkai3 an ai7 te tv9n genei3 vn ei1 si4 tri3 xew h2mi9 n ai7 te th9w kefalh9w. e1 peidh4 ga4r h2 e1 k tv9n xymv9n a1nauymi3 asiw e1 pi4 th4n kefalh4n a1nafe3 retai, ma3lista toi9 w paxyte3 roiw ay1th9w perittv3masin ei1 w trofh4n tv9n trixv9n h2 fy3siw kataxrh9tai. e1 pei4 d¸ a1ndra3sin, ei1 w o7son uermo3teroi gynaikv9n, ei1 w tosoy9ton kai4 tayti4 ta4 perittv3mata plei3 v, ditth4n kai4 toy3toiw ke3 nvsin e1 jey9ren h2 fy3siw, th3n t¸ e1 k tv9n th9w kefalh9w trixv9n kai4 th9n e1 k tv9n kata4 ta4 ge3 neia. But it is also on account of another necessary usefulness that we have hairs both on our jaws and head. For, since the exhalation from the humours is carried up to the head, physis employs the thicker residues especially for the nourishment of the hairs. So, in men, who have as much more of these residues as they are hotter than women, physis has devised these two evacuations, that from the hairs of the head and that from the hairs along the jaws.93 93 UP 11. 14 (ii. 155. 6 15 H). Note the use of the ®rst person, common in discussion of medical practice but rare in identifying author and object of medical knowledge, and surely not accidental in its appearance at this point.

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There is thus a conspiracy of causes, ®nal, ecient, material, and instrumental, all producing male beards and their female lack, and there are now a number of reasons why, ultimately, this is for the best. It is better in respect to the soul, way of life, and internal economy of the body, and physis mediates between all of them, obviating the need for any more precise articulation. All may coexist and collaborate, none are counterposed; this aspect of human existence can be ®tted into a multiplicity of patterns. Outside the Usefulness of the Parts another, testicular, avenue to sexual di€erentiation is opened up in On Seed where Galen refutes those who considered the testicles to contribute nothing to the production of seed but allocated this task among the surrounding vessels instead.94 He does not stop at merely proving the contrary position but goes on to demonstrate that the testicles have a power that greatly extends beyond this manufacture.95 For it is not just semination that ceases on castration, but males lose their manliness (a1ndrei3 a) and male ness (a1rreno3thw) and females their femaleness (uhly3thw). Now in what exactly each of these things consists is unclear, for the passage is primarily polemical rather than positively construc tive and Galen has particular diculty maintaining some kind of symmetry in the matter. If (as he does at one point) he describes castration as a kind of cooling and feminization, then where does this leave those who started o€ female, for instance?Ðand lacking in any sexual impulse seems to be the only speci®c answer given. However, it is plain that, whatever they are, maleness and femaleness depend on the presence of the orcheis and a dynamis dispersed by them throughout the whole body, as sensation and motion are dispersed by the brain to the whole body through the nerves. As Galen summarizes: h7tiw dy3namiw e1 n me4 n toi9 w a5rresin ey1rvsti3 aw te kai4 a1rreno3thtow, e1 n de4 toi9 w uh3lesin ay1th9w th9w uhly3thto3w e1 stin ai1 ti3 a. kai4 dia4 toy9to o2moioy9tai to4 uh9ly zQ9on e1 ktmhue4 n toy4w o5rxeiw ey1noyxisue3 nti tQ9 a5rreni. ta4 me4 n ga4r a5lla sy3mpanta mo3ria ta4w ay1ta4w e5 xei dyna3meiw e1 n a1mfote3 roiw o7per de4 e1 jai3 reton h¤n e1 n e2 kate3 rQ di¸ o8 to4 me4 n a5rren ay1tv9n y2ph9rxe, to4 de4 uh9ly, toy9to a1pole3 santa 94

Sem. esp. 1. 13 16 (CMG v. 3.1. 114. 22 140. 17). Sem. 1. 15. 28 1. 16. 35 (CMG v. 3.1. 120. 28 140. 17); cf. AA 12. 1 (i. 137. 8 138. 8 Simon) and Hipp. Epid. 2 (CMG v. 10.1. 185. 1 22) on the e€ects of castration. 95

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to4 kata3loipon e2 aytQ9 e5 sxe tay1to3n, v2w ei1 kat¸ a1rxa4w e1 gego3nei mh3te uh9ly, mh3t¸ a5rren, a1lla3 ti tri3 ton, diafe3 ron me4 n a1mfoi9 n, oy1de3 teron de4 e1 kei3 nvn. This dynamis is the cause of robustness and maleness in males and of femaleness in females. And on account of this the female animal whose testicles have been excised becomes similar to the castrated male. For all the other parts have the same dynameis in both, and when they have lost what was special to each, that part by virtue of which one of them was male and the other female, what they have left is identical, just as if at the start they had been generated neither female nor male but some third kind, di€erent from both, and not the same as either of them.96

He returns to the same point at the very end of the work, taking pride in having demonstrated that the orcheis alter the whole body, and that on account of them `it becomes male and female, being, according to its own nature, neither male nor female'.97 Again the male is the standard, either castrated or complete, and he has one positive characteristic, robustness, whereas the female has nothing except her femaleness. This is also a very emphatic formulation in which everything except the orcheis and their dynameis is the same in men and women and their removal produces a kind of reversion to a unitary, sexless substratum, to a body that is, as it itself once was, neither male nor female; and objections can be raised within the Galenic framework, for the testicles are not so peculiar to each sex elsewhere, and what about the krasis and its heat? On Seed does pre date book 14 of the Usefulness of the Parts, which makes reference back to it, both to reinforce and rely on its contents, but it post dates the lost work On the Anatomy of Hippocrates in which the thermal di€erential between men and women was certainly elaborated, so the divergence is not simply developmental, and Galen clearly considered that there was room for both understandings within the broad compass of his system, without making any particular e€ort at their reconciliation.98 Indeed, this is part of a general pattern 96

Sem. 1. 16. 16 19 (CMG v. 3.1. 136. 11 19). gi3 gnesuai di' ay1toy4w a5rren te kai4 uh9ly, kata4 th4n e2 aytoy9 fy3sin oy5t' a5rren y2pa3rxon oy5te uh9ly, Gal. Sem. 2. 6. 31 (CMG v. 3.1. 204. 19 21). 98 UP 14. 11 and 14: references to Sem. (ii. 320. 3 and 13, 336. 22 H); Sem. 1. 7. 12 and 2. 5. 38: references to On the Anatomy of Hippocrates (CMG v. 3.1. 88. 12, 186. 19). 97

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in which his treatises were basically juxtaposed to, or super imposed on, rather than actively integrated with, each other. He admits error on one point only, that is on the order of formation of heart and liver in the foetus, though he did recognize more frequently, if somewhat grudgingly on occa sion, that his sprawling textual network required a certain amount of summarizing.99 Otherwise there is basically a pro cess of accumulation in which nothing is rejected, but some things are reiterated, rewrought, and expounded upon more than others, creating a kind of sedimented centre and more ¯uid periphery. Galen's woman, therefore, inhabits a world of, is a product of a system of, aetiological abundance. Her existence, her char acteristics, or her characteristic lack, as it and they appear scattered across his rendition of the medical art, can be assembled in an explanatory form in a number of ways. In the end, she is, and is as she is, because it is for the best, but the best is inconstant in its constancy, always attained but di€ering in the means to its attainment and in what that attainment actually consists. A permanent form is ®lled with variable substance. Galen's most successful explanatory schemeÐgathering up most of the phenomena in its embrace, consistent not just with them but with the key concepts and themes of his system more widely, cosmologically congruous and socially sympatheticÐwas that which cast the sexual division of human ity as necessitated by an approximation to immortality which preferred duality and embodied it according to a hierarchy of heat, which is to say a hierarchy of perfection. The others have a more limited ambit, in the works and the world, they do not join up so much, are less consistent and congruous, but they should not, therefore, be ignored. In this abundance, Galen's aetiology corresponds perfectly with the requirements of the persuasive programme on which he is permanently embarked. He operates in a cultural context in which completeness and comprehensiveness were virtues that far outweighed the strictures of succinct singularity, of clarity and focus, of well ordered precedence; in which good 99

Sent. 11 (CMG forthcoming, 90. 17 94. 17, and see Nutton's commentary at 177 8).

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systems of thought were systems of plenitude and proliferation, not austerity and restriction, in the medical art as much as anywhere else. Winning arguments was a question of quantity as much as quality, it involved being able to make more divisions, cite more authorities, give more reasons than an opponent, as well as the appropriateness and force of the points themselves. Galen's works and ideas jostle together in a crowd, a jostling that later readers became uncomfortable with, while contemporary audiences concentrated on the crowdedness. Basic unity and control had to be maintained, and there were further gains to be made in degree of cohesion and respectability of appearance, but maximization was the real name of the game. Galen met all these criteria, and bound them up together in a package of added potency and personality through the agency of provident or foresightful physis; the product of her own historical plausibility, she also rendered her own product all the more historically plausible. Under her auspices, diversity and multiplicity powerfully ¯ourished in a uni®ed and regulated environment where coherence, recur rence, and the synonymity of extension and inclusivity were all rewarded, and her auspices were attractive in themselves, accessible and comprehensible to the Roman eÂlite. Provident nature enables and empowers a uni®ed and regulated aetiological abundance by means of her temporal and locational ambiguity, her outstanding causal ecacy, and her stubborn optimization of her given material circum stances. She mediates between, mutually implicates and explicates, all the parts of what is (including all the causes) and in doing so she holds everything on a single, synchronous surface, as it waits for her to make her selections, to pick up some of the pieces before her and construct causal assem blages from them. For her, everything is simultaneously contiguous, that is in a potentially causal relationship with, everything else, and the aetiological arrangement is hers to make, according to her guiding principle. Through the fore sight of the demiurge, female domesticity and beardlessness become contemporaneous, causally conjoined, and placed alongside the compromised immortality of human reproduc tion and woman's imperfection, with its thermal de®cit and lesser need to extrude humoral residues through the headÐ

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alongside also the failures of the female soul, the dynameis of the orcheis, and much else. All can coexist and collaborate as ways in which physis has wired up the world for the best, and it is, in a sense, Galen's duty to enumerate them all, his duty both to that divine providence, to truth, and to the more mundane providence with which he wished to surround himself in his life and career. And though some parts of this plenitude may be privileged more than others, the e€ects of some causal assemblages dispersed further than others, con nections more closely and repeatedly made, this produces a certain overall pattern of stress and signi®cance, but not any kind of absolute, or actually vertical, order. The wider attraction of these same auspices, the power of provident nature, resides in what drew Galen, the overedu cated son of a culturally ambitious Pergamene landowner, to them in the ®rst place; for they are the means of his own projection of the world he absorbed. Galen and his demiurge are very much each other's creationsÐnot from nothing, but out of the substance of tradition, in particular the Stoic philo sophical tradition. In his search to make the cosmos intelligible to himself and others, Galen (like his demiurge) had to make do with the material provided, with the world as he found it. He was thus forced to acknowledge its arti®cer and, at the same moment, to endow that entity with the same rationality as he had just exercised, and was still exercising. The foreknowledge of physis is Galen's hindsight, worked out in personally and culturally satisfying ways which his audience would also ®nd comprehensible and reasonable, if not so absolutely compulsive as their author. That what is is for the best is a sensible and fecund founding principle, especially for an aristocracy; it is not the only way of understanding things, but it is a rather pleasant one. The regulative rationality in which Galen, his demiurge, and his audience all collude is perhaps particularly evident in the constitution of woman as an object of medical knowledge. Here a hindsight further removed in time and social situation sees a cluster of unjusti®ed assumptions patently protruding through the edges of this world view, of o€ences perpetrated against the principle of self conformity (even as loosely interpreted as it was by Galen). Absolute arbitrariness has become consistently

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constitutive. Several things are left, naked but completely unembarrassed, behind Galen's totalizing thinking as he articulates it, are deeply embedded in the discursive matrix through which his rendition of the medical art is produced, without any kind of explanatory gesture. They are simply the givens of Galen's medical cosmology. Female inferiority, her imperfection in the face of male perfection, is one of these. It would be a reading against the text of the Usefulness of the Parts to suggest that what he explains is why there has to be one perfect and one imperfect partner in any procreative enterprise, and it just so happened that the lot of imperfection fell to the female. The identity of perfection and maleness, of imperfec tion and femaleness, was clearly there all along, shaping the structure of the argument, met halfway by the exigencies of the reproductive duality it has itself called into being in a messy corroborative embrace, no more. The male standard, superior in his absolute humanity, is all pervasive, and institutes women as essentially embodiments of lack. Galen ®nds it hard to name any positive female qualities, not positive in the sense of their worth, but positive in the sense of having actual substance, of not being the mere negation or diminution of something male. She lacks heat, is not august (semno3w), has no beard, is unexercised, underexposed to the sun, and globally de®cient in perfection. Even her excess is really about lack, as is the con®guration of her generative parts. The dynamis dispersed from her orcheis is entirely devoid of any content except femaleness itself. She is wetter than the male, however, and exceeds him also, less explicitly but perhaps more importantly, in her ®xity. Wetness is an obvious dis advantage, and ®xity no less so given Galen's conception of humanity as a bounded set of potentials, unique and pre eminent in all creation for their ¯exibility. Thus both what she is ®xed as, and that ®xture itself, take her towards the brute animals on the scala naturae. Men are confronted with certain life choices, choices in which their bodies are inevitably implicated; women are not. Such variation is dangled enticingly before her in the On the Causes of the Pulse only to be cruelly whipped away and returned to the man with devastating e€ect. Mostly women's ®xity of life is such, at least in respect to her domesticity, that it

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takes on an explanatory force. Galen evinces no interest in justifying women's circumscribed existence, it is already so ®xed that he uses it to justify other, less self evident things, things about her physical makeup and functioning. Lack of self evidence should not be confused, however, with lack of ®xity as such. Women's lack of beards is no less certain than their domesticity, but it requires an explanation while the latter does not. This di€erential requirement resides in the remit of Galen's discourse, its medicality, its particular teleological formation. Given the terms and objects of his project, Galen needs to explain beards and their absence (or at least gains through such an explanation), but has no such need to explain why women stay at home, and instead can take this generally acknowledged, self evident truth of female existence, that they do, as explicative.100 There are thus two lines of rupture between then and now: ®rst, that it did subsequently become the business of medicine to explain why women stay at home, in a certi®catory sense, and, second, that domesticity and circumscription ceased to be an acknowledged, self evident truth of female existence among the people that matter; and the two are surely, but surely not simply, linked. For the moment, however, Galen must be kept within the con®nes of his own world. THE DISEASED WOMAN To be diseased, as all Greeks know, is to have some bodily activity that is impaired. This impairment itself arises from a diseased diathesis of the body, in whole or part, which in turn arises from certain causes, and it may be accompanied by a number of other somatic alterations not actually involved in the damage itself; all these conditions and occurrences are, how ever, de®nitely para physin.101 These four key categories are subject to considerable discussion and the inevitable diairesis in Galen's extensive pathological writings. Causes may be ante cedent (prokatarktika3), that is external to the body, like the 100 This general acknowledgement need only be among the people he is addressing and may be entirely at odds with actual female lifestyles. 101 Gal. MM 1. 8 (x. 63 7 K).

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heat of the sun, or preceding (prohgoy3mena), that is an internal somatic state brought about by these antecedents, such as some kind of excess, and themselves activating the third, containing (synektikta3) causes, which are present simultaneously with that caused, such as the tightening of the choroid coat that produces looseness of the pupil in the eye.102 Diseased dispositions are initially sixfold, since activities depend on the krasis of the relevant homoeomerous body, the formation, number, magni tude, and con®guration of the parts composing the particular organ, and the cohesion of both these simple and compound bodies, and may be further classi®ed in a variety of ways, one of the most important of which was periodicity.103 In a more concrete sense they are things like in¯ammation, a dyskrasia of heat, and ulceration, a breakdown of continuity.104 Symptoms are di€erentiated not just according to the key distinction between those that are activity based, such as not being able to see and having immoderate bodily excretions, and those that are not, such as redness and pallor; but also according to the type of activity impaired, and according to their own causes.105 It is the disposition that Galen prefers to think of as the disease itself, and to a certain extent that then puts him at odds with patterns of common linguistic usage and understanding about illness, at least in respect to conceptions of individual diseases rather than disease as an undi€erentiated concept.106 Familiar ailments such as pleuritis, phrenitis, and fever are compound entities, conglomerations of feelings and indica 102 Caus. Puls. 1.1 (xi. 2 3 K); MM 1. 8 (x. 65 7 K); On the Causes of Symptoms/Peri4 ai1 ti3 vn symptvma3tvn (Sympt. Caus.) 1. 2 (vii. 93 K); and the aetiological treatises CC (CMG Supp. Or. vii. 52 72 and 133 41 ) and CP (Hankinson). See also R. J. Hankinson, `Evidence, externality and antecedence', Phronesis, 32 (1987), 80 100, and `Galen's theory of causation', for discussion of this complex, and inconsistently articulated, area of Galenic thinking. 103 MM 2. 6 (x. 125 6 K); San. Tu. 1. 1. 3 and 1. 4 (CMG v. 4.2. 3. 13 17, 7. 27 34). 104 MM 2. 3 (x. 86 K). In¯ammation is a key concept in Galenic pathology which is very hard to pin down, whatever else may also be involved, however, it always means an excess of heat. 105 MM 2. 3 (x. 86 K); and see also On the Di€erence between Symptoms/ Peri4 tv9n symptvma3tvn diafora9w (Sympt. Di€.: vii. 42 84 K) and Sympt. Caus. (vii. 85 272 K). 106 MM 1. 2 (x. 78 81 K). His preference is heuristic rather than absolute.

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tions, and likely to remain so in the popular imagination even if Galen were able to reduce their complexity to a singular diseased disposition in each case. He wants categorical purity, however, not miscegenation. If disease were seriously considered as an aggregate of causes, bodily states, and symp toms, then it would be a terrible muddle and the thing called disease would be e€ectively rendered causeless and symptom less. Proper understanding requires that these things be kept separate, and this is not just purity for its own sake but with a de®nite purpose, for it is at the diseased disposition that therapy must be directed to achieve the goal of the medical art. This means, none the less, that the classi®cation Galen develops from his notion of disease itself is essentially analyt ical rather than identi®catory, it produces not diagnosis as customarily conceived ofÐas a kind of labellingÐbut an account of all the elements contained in each of the categories he employs, which can then be regrouped under these diag nostic labels. There is thus a certain mismatch between Galen's more abstract nosological texts, with their division starting from the concept of disease itself, and his more practical diagnostic texts, as they work towards a synthesis of signs taken from a body pre divided by anatomy and preconceived physiologically. It is with these works, however, that this account must start, before moving on to their therapeutic counterparts. Female pathology In his most abstract elaborations of the diairesis of disease, Galen is able on occasion to assume the human subject of his nosological exposition, to be male; or at least to display a preference for male examples of any given type of condition or event. On the Di€erence between Diseases, as it works out its classi®catory schema, for example, makes reference to the foreskin and a generative and genital con®guration which is incapable of properly inseminating a female, but to no womanly features; while the short treatise On Swellings contrary to Nature (Peri4 tv9n para4 fy3sin o5gkvn), which covers a signi®cant subgroup of diseased dispositions, treats the terminology of various swellings and hardenings of the scrotum and its contents in

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some detail, even commenting on points of pronunciation, but omits to mention any manifestations of these things on pecu liarly female places.107 This is not universally the case, however. The female ¯ux makes a ¯eeting appearance in the work On the Di€erence between Symptoms, for instance, and in On Tromos, Palmos, Spasmos, and Rigos (Peri4 tro3moy kai4 palmoy9 kai4 spasmoy9 kai4 r2i3 goyw), which is a rather fuller typological text on these di€erent kinds of involuntary body movements, women occur more than once, mostly via Hippocratic cases and comments, but also because they are the main representatives of a form of mild, phlegmatic rigos (a disease of involuntary shivering, usually associated with chills), especially if they lead an indolent life and take baths after meals.108 However, there is a clear contrast between these texts and those which track the contours and contents of the human body more closely. In these it seems to be a point of principle that this body should be a composite of all the parts, activities, and functions present in either sex that might be implicated in disease. Not only do things female appear at the appropriate places in the various somatic sequences in On the Causes of Symptoms, for instance, but it is also implied that to omit them or otherwise gloss over humanity's sexual division would be fallacious and leave any work incomplete.109 In the coverage of symptoms consisting in the quality or quantity of various excretions, Galen remarks that while excretions of blood are generally qualitatively para physin and therefore indicative of disease, this is not true of the womb, where the relation of out¯ow of blood to the norm of nature must be judged quantitatively, suggesting that to ignore the existence of female peculiarities is to fall into error.110 This point is reinforced in the Hippocratic commentaries, where Galen has a tendency to ®ll in gaps left by the assumption of a male object of medical interest. For instance, in the commentaries on On 107 Morb. Di€. 8 and 10 (vi. 863, 870 K) and On Swellings contrary to Nature 15 (vi. 729 K). 108 Sympt. Di€. 1. 6 (vi. 80 K); On Tromos, Palmos, Spasmos, and Rigos 5, 6, and 8: Hippocratic case history of female slave; Hippocratic aphorism; women as more susceptible with a local female case (vii. 602 4; 613; 635 and 636 K). 109 Sympt. Caus. 1. 6 and 7, 2. 3, 3. 11 (vii. 126 7, 132 4, 139, 166 9, 264 6 K). 110 Sympt. Caus. 3. 9 (vii. 252 3 K).

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Regimen for Acute Diseases (Peri4 diai3 thw e1 pi4 tv9n o1je3 vn noshma3tvn), another treatise held by Galen and others to be Hippocratic rather than by Hippocrates, Galen adds the womb and a bleeding nose to a lemma's list of the mouth, bowels, bladder, and sweating as possible routes to the resolution of disease in order to endow it with the universality and exhaustivity it had falsely claimed.111 The most substantial work of this latter type is On the A€ected Places, an essentially diagnostic work which advises how the particular part which is diseased may be identi®ed from the disparate symptoms displayed in any case; an espe cially dicult procedure when it entails an inward reading, linking visible outward signs of sickness to their invisible, internal sites of origin. The treatise is organized in a more orthodox, head to toe manner, and includes a whole section on the womb as the generic narrative divides after the bladder. This passage pulls, or at least puts, together various themes that appear in a more abbreviated or dispersed form in other works and is thus worth examining in some detail. Indeed, it has been suggested that it pulls them together according to a basically Hippocratic pattern, making a woman's health de pendent on her reproductive functioning, that is on a ®t uterus, regular menstruation, and childbearing. Monica Green cer tainly argues that there is, for Galen, a very close correspond ence between generation and health in women, citing a passage from A€ected Places as implying that `when the womb is healthy so is the woman, and when the woman is healthy so must be the womb'.112 The sequence in A€ected Places opens with an expression of indi€erence over whether `the organ given to women by physis for reproduction' is called hystera/y2ste3 ra or metra/mh3tra, either in the singular or plural, or whether a certain a€ection of it is called hysterike `pnix' (that is uterine `su€ocation') or hysterike `apnoia' (a5pnoia, uterine `cessation of breathing'); it is, how ever, this a€ection which he then proceeds to discuss.113 The 111 Gal. Commentary on Hippocrates' Regimen for Acute Diseases/Ei1 w to4 peri4 diai3 thw o1je3 vn ¹Ippokra3toyw y2pomnh3mata (HVA) 4. 80 (CMG v. 9.1. 337. 30 338. 2). 112 Monica Green, `Transmission', 46. 113 Loc. A€. 6. 5 (viii. 413 14 K).

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®rst problem is whether it is really possible for the women most seriously a‚icted by this condition actually to cease breathing and still survive; and Galen concludes, by analogy with hibernating animals, that it is. These women have become so cold that they have stopped respiring through the mouth and do so only through the arteries; or they have almost stopped respiring through the mouth, rendering their radically reduced breathing just as imperceptible. The second problem is, then, how the body gets so cold in these cases, which requires an investigation of the preceding causes of the a€ection. On this Galen says: v2molo3getai toy9to to4 pa3uow gi3 gnesuai tai9 w xhreyoy3saiw e1 pi4 poly4, kai4 ma3lisu¸ o7tan e1 n tQ9 pro3suen xro3nQ kauairo3menai3 te kalv9w kai4 kyisko3menai, kai4 tai9 w pro4w toy4w a5ndraw synoysi3 aiw xrv3menai, sterhuv9sin a2pa3ntvn ay1tv9n. ti3 a6n oy¤n tiw e1 k toy3tvn e5 xoi syllogi3 sasuai piuanv3teron toy9 dia4 th4n e1 pi3 sxesin tv9n katamhni3 vn h6 toy9 spe3 rmatow e1 pigi3 gnesuai tai9 w gynaiji4 tay3taw ta4w y2sterika4w o1nomazome3 naw diaue3 seiw, ei5 t¸ a5pnoiai3 tinew, ei5 te pni3 gew, ei5 te kai4 synolkai3 tinew ty3xoien oy¤sai; kai4 ma9llon i5 svw dia4 th4n toy9 spe3 rmatow e1 pi3 sxesin, e1 peidh4 toy9to mega3lhn te dy3namin e5 xei kai4 tai9 w gynaiji4 n y2gro3terh3n te kai4 cyxro3tero3n e1 stin, a1pokri3 nesuai3 te dei9 tai tai9 w fy3sei polyspe3 rmoiw, v7sper kai4 toi9 w a5rresi. It is generally agreed that this a€ection occurs, for the most part, in widows, and especially when those who previously used to menstruate and bear children well, and who were accustomed to sexual inter course with men, are deprived of all these things. And so, what more persuasive conclusion could be drawn from these things than that these so called uterine dispositions occur in women because of the stoppage of the menses or the seed, whether [the dispositions] happen to be apnoic, su€ocatory, or convulsive?Ðand probably more through a stoppage of the seed, because this has a great dynamis and is both wetter and colder in women, and it is necessary for women who abound in seed by nature, to excrete [it], just as it is for men also.114

These men have also become ill through a sudden change in sexual habits, when abstention follows regular relations, and particularly so when the men in question are, in nature, replete 114 Loc. A€. 6. 5 (viii. 417 K); cf. Comp. Med. Loc. 9. 10 (xiii. 319 20 K). Di€. Resp. 3. 13 (vii. 959 K) suggests, following Hippocrates, that women who have never borne children as well as widows are prone to apnoia, and at Hipp. Epid. 6 8 (CMG v. 10.2.2. 506. 21 38) Galen generalizes from a case in which a husband's exile following proli®c child production has lethal consequences.

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with bad humours and lead an indolent lifestyle. So Galen is driven to the view that the seed itself demands its own expulsion in some kind of sexual act, that this is especially so for those rich in seed by constitution or habit, and thus it is especially dangerous when they fail to meet these demands. Moreover, he considers it to be this need to remove the irritation of accumulating seed, not pleasure, that should regulate the sexual activity of the wise (sofro3n). That it is the retention of bad seed rather than the catamenia that is most harmful is further demonstrated by the story of the long term, but implicitly menstrually regular, widow who, when treated by a maia for a contracted womb and various other ailments, responded to the manual application of the customary remedies to her genitals by ejaculating an abund ance of thick seed; an ejaculation accompanied simultaneously by `the pain and the pleasure of sexual intercourse', and which released her from the discomfort a‚icting her.115 Indeed, not only can menstrually sound widows develop uterine symptoms, but they do so more severely than non widows whose men struation has become suppressed. Galen also reinforces the point that a very small amount of something can drastically a€ect the whole body, by reference to the stings of scorpions, bites of rabid dogs, and poisonous pharmaka. The category of the merely menstrually suppressed, how ever, poses a further problem, which is whether any movement of the womb is implicated in these a€ections, in particular whether it is causally implicated in the interruption of respira tion. Galen accepts that the neck of the uterus becomes demonstrably distorted in many such cases but absolutely denies either a Platonic (and Arataean) vision of the womb as an animal eager to bear children and dangerously mobile when frustrated, or a more mechanistic notion of the womb being put into motion by its own desiccation and subsequent need to obtain moisture from other vessels.116 This is nonsense, says 115 po3noy te a7ma kai4 h2donh9w o7moiai tai9 w kata4 ta4w synoysi3 aw, Loc. A€. 6. 5 (viii. 420 K); the same story is told to di€erent e€ect at Sem. 2. 1. 25 6 (CMG v. 3.1. 150. 6 11). The coyness and circumlocutions used in Galen's telling of this tale contrast with the openness with which, just above it, he tells the story of Diogenes' public masturbation while awaiting a prostitute. 116 Galen only refers to Plato, citing Ti. 91b7 c7.

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Galen: even those ignorant of anatomy must see that the expansion of the uterus during pregnancy causes no such massive disruption, and that the womb is amply supplied with blood and located in a moist region so it has nothing to gain by moving, especially to the dry diaphragm. Rather, the uterus is subject to torsion when the ligaments holding it in place are unevenly shortened by the congestion in the blood vessels that abut them, this congestion being the result of menstrual retention, as the catamenial material is unable to gain access to the womb and the outside world. This kind of lateral displacement of the uterus is, therefore, not a cause of anything, but a symptom of an underlying menstrual disorder, the other signs of which include heaviness, nausea, lack of appetite, shivering, back and head pains, fever, and urinary problems. And here comes the passage cited by Green: o7t¸ a6n oy¤n ti toioy9ton i5 dWw e1 pi4 gynaikv9n, y2po3pteye kata4 ta4w mh3traw ei¤ nai th4n oi¥ on r2i3 zan ay1tv9n. e1 a3n de4 kai4 kat¸ a5llon tina4 to3pon toy9 sv3matow e5 kkrisiw ai7 matow h5 flegmonh3 tiw W¤, h6 e1 rysi3 pelaw ge3 netai, pynua3nesuai xrh4 peri4 th9w e1 mmh3noy kaua3rsevw oy1de4 n ga4r toy3tvn gi3 gnetai tai9 w a1me3 mptvw kauairome3 naiw. tai9 w me4 n oy¤n e1 pisxe3 sesi th9w e1 mmh3noy kaua3rsevw toiay9ta toy1pi3 pan e1 pigi3 gnetai symptv3mata. And so when you see something of this kind in women, suspect the root of it to be in respect of the womb. And even when an excretion of blood or phlegm [occurs] from some other part of the body, or erysipelas develops, it is necessary to enquire about the monthly purges, for no one with perfect menstruation is a€ected by these things. And so, on the whole, these symptoms follow upon stoppage of the monthly purges.117

Galen completes the chapter by describing the `female ¯ux', which he sees as a means of general somatic purging, like that through the kidneys, to which soft ¯eshed and phlegmatic women are particularly prone, and thus usually entirely inde pendent of any a‚iction of the womb; he also discusses some kinds of miscarriage.118 The following (and ®nal) chapter covers priapism and gonorrhoia as both implicitly and exclu 117 Loc. A€. 6. 5 (viii. 435 K); my translation is slightly di€erent from M. Green's (`Transmission', 45), which is dependent on Daremberg's French. 118 Loc. A€. 6. 5 (viii. 436 7); cf. Sympt. Caus. 3. 11 (vii. 265 K) on the female ¯ux.

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sively male, and it involves Galen in a lengthy disquisition not just on the ideal arrangement of the (male) genitals, but also the innateness of their in¯ationary faculty.119 The penis, as an organic structure subject to a peculiar diseased condition, is clearly of much greater interest than the womb. Here again changes in habit may have a harmful e€ect on health, priapism may result from sexual abstinence contrary to customary conduct. That it is the change not the abstinence itself that does the damage is illustrated by those who, on account of athletic or vocal training, have lived entirely unacquainted with sexual activity, either real or imaginary, and have not su€ered any ill health as a result, though their genitals become weak and shrivelled. Those who launch themselves eagerly on their sexual career early in life, on the other hand, broaden the blood vessels ¯owing to these parts and increase the sexually appetetive dynamis. What is most striking about this uterine section is that it is actually not about the womb at all. There is virtually nothing in it about the classic diseased dispositions of the uterus itself, such as in¯ammation or ulceration; instead, the narrative focuses on two, overlapping, sets of symptoms which have been labelled `uterine' but which Galen wants to re®gure in terms of the failure of certain kinds of material, seed and menstrual ¯uid, ever to reach the womb and the somatic exit it provides. Retention of seed is entirely related to having a sexual history but no sexual present, and, though in Causes of Symptoms the constitution of the body of the uterus itselfÐif it is too dense and hardÐis cited as a potential cause of cata menial containment, it is only the two other possible areas of failure, the substance of the menstrual ¯uid itselfÐif it is too thickÐand the formation or condition of the blood vessels anastomizing into the wombÐif they are too narrow or closedÐwhich appear in A€ected Places.120 The womb may become symptomatically distorted, but it seems actually to be the root of nothing; it may be a barometer of female health, but no more. Galen's precise formulation, however, traces the range of symptoms he outlines in connection with menstrual 119 120

Loc. A€. 6. 6 (viii. 437 52 K). Loc. A€. 6. 5 (viii. 429 K), and Sympt. Caus. 3. 11 (vii. 264 5 K).

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suppression back to somewhere or something `in the region of, or relating to, the wombs' (kata4 ta4w mh3traw), rather than the wombs themselves, and he clearly does consider the processes for which the uterus was a channel or vessel to be of vital importance in women's health. Female seed is deeply danger ous; and even when the structure of A€ected Places is taken into accountÐfor it is about attributing multiple signs to a single source, and the list of symptoms of catamenial contain ment, long as it is, pales in comparison (and has some items in common) with the list of indications of, for example, a diseased liverÐthe correlation between female health and perfect men struation is strongly stated.121 This correlation can also be reinforced from elsewhere in Galen's úuvre. He makes his most extravagant claims in Venesection against Erasistratus, where the `well purged woman' (gynh4 kalv9w kauairome3 nh) is una€ected by podagra, arthritis (a1ruri3 tiw, joint problems), pleuritis, peripneumonia, epilepsia, apoplexia, apnoia, aphonia, phrenitis, lethargos, spasmos, tromos, tetanos, melancholia, mania, spitting and vomiting blood, kephalaia, synanchic su€ocation, and any other major and serious disease.122 There is not much left, and at other times he is more circumspect and stipulates also that this immunity is additionally dependent on leading a decent life.123 The basic point is a valid one, however, as, in conceptualizing health as a balance, and excess as the main form of imbalance, Galen obviously opens the way for men strual immunity to most, if not all diseases of this kind.124 This, of course, depends on understanding the monthly purges as essentially ¯exible, evacuating what needs to be evacuated in any particular situation not the same each time regardless, but 121 On the symptoms of a diseased liver see Loc. A€. 5. 7 (viii. 348 9 K). All of this must be understood in the context of the classical doctrine of sympathy, so, for example, Galen speaks of stomachic su€ocation, in which an a€ection of the gullet may cause epileptic ®ts, fainting, mania, and melancholy (Sympt. Caus. 1. 7: vii. 137 K). 122 Ven. Sect. Er. 5 (xi. 165 6 K). 123 See e.g. Hipp. Epid. 6 7, where female immunity to chest and lung diseases is attributed to the ¯uid taken directly from this region by the monthly purges as long as they do not squander this good fortune through indolence (CMG v. 10.2.2. 394. 36 395. 21). 124 As Hippocrates had before him, see Dean-Jones, Women's Bodies,136 46.

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Galen, with his notion of the nature immanent in each indi vidual, clearly has no problem in doing so, and thus actually suggests that the menstrually regular female is in a stronger position in respect to disease than the ordinarily perfect male. There is, however, an obvious downside to all this, for, as creatures of intrinsic, of ineluctable, excess, female fortunes are tied to the regularity of their monthly purges in a way that male dependance on regular exercise, habitual haemorrhoidal evacuations, customary venesection, or the like can only arti® cially approximate.125 This reliance, and the particular serious ness of accumulating cold and wet menstrual ¯uid, or colder and wetter seed in an already colder and wetter body, all stems from woman's essential imperfection, her crucial contribution to the generic immortality of humanity; but it is really only at this aetiological level that reproduction enters the equation. For though it is the cessation of childbearing as much as anything else that bears down on these sickness prone widows, this is childbearing as a habit not as a constitutional necessity, as a sign that this surplus system was working not that it should work, and it is something that could have been avoided if the women had not embarked upon the reproductive road in the ®rst place. While Galen implicitly acknowledges this possibility, he does not seem to entertain the further one that a widow might, remedially, become sexually active again, at least beyond the odd midwifely rub. Even this story of the ejaculating widow is o€ered as visible proof that retained seed lies at the root of the problem, not as possessing a therapeutic moral. For Galen, widowhood and seminal containment are as coterminous in women as marriage and seminal expenditure, and since he does not ever suggest remarriage he certainly cannot advise women directly on their attitude to, and use of, sexual activity as he does with men.126 Here too he manifestly parts company 125

See Gal. On Habits (Peri4 e1 uv9n) 5 (SM ii. 29. 5 31. 5). Galen o€ers concrete advice to a male friend trying to give up sex without sickening at Loc. A€. 6. 6 (viii. 451 K), and a more general advocacy of sexual restraint characterizes his ethical writings (see especially the Arabic epitome of his On Morals 1 2: 25 42 Kraus), but cannot be directed at women since he clearly thinks their sexual activity to be simply a function of their marital status, nothing more. The general line pursued in these works is the same as that in the Loc. A€. Ideally, sexual desire should be so far 126

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with Hippocrates, who explicitly articulates the direct relation ship between reproductive functioning and female health in his `constant refrain', as Ann Ellis Hanson puts it, that `if she becomes pregnant she is healthy', combined with the therapeu tic injunction to `have her go to her husband'.127 Moreover, Galen's strategy of expanding upon and explaining Hippocrates' pithy, and often enigmatic, sayings and writings and, similarly, his interpretation of the Hippocratic case his tories as examples of general rules, produces an understanding of pregnancy and birth as systematically dangerous to women rather than as states or events in which dangerous things can, and do, happen. For it is in the Hippocratic corpus that Galen confronts childbearing as something involving a whole, living, woman, rather than an abstracted interaction between womb and seed which initiates an interesting process of foetal forma tion, and the confrontation is not particularly positive. In the commentaries on the Epidemics it emerges that pregnancy, miscarriage, parturition, the failure of lochial purging, and nursing are all harmful to the woman, though this harm may be more or less contained. In his discussion of the case of a Thasian woman whose lochial purges failed to arrive after the birth of a daughter, and who then fell fatally ill, Galen clearly explains the basic problem pregnancy causes: fai3 netai d¸ oy¤n e1 pisxeuei3 shw th9w meta4 to4n to3kon kaua3rsevw h2 no3sow gene3 suai tW9 gynaiki3 . nosv3dhw me4 n ga4r kai4 h2 tv9n katamhni3 vn e1 pi3 sxesiw, a1ll¸ oy1x o2moi3 vw blabera4 tW9 meta4 to4n to3kon, o7ti mh4 mo3non ay7th plh9uow a1lla4 kai4 kakoxymi3 an i2 kanh4n e1 rga3zetai. to4 me4 n ga4r xrhsto3teron ai¥ ma to4 e5 mbryon e7 lkon ei1 w e2 ayto4 trofh9w e7 neka, kata3loipon de4 to4 faylo3teron ai5 tion gi3 gnetai th9w kakoxymi3 aw tai9 w kyoy3saiw, h8n meta4 to3kon h2 fy3siw e1 kkenoi9 . For it seems that the disease was engendered in the woman by the retention of the post partum purge. For the retention of the menses tends to produce disease, but is not as damaging to the woman as subordinated to the rational part of the soul that sexual activity occurs only when the accumulation of seed demands it; just as moderation requires eating only when hungry, making do with plain, wholesome stu€, and then stopping when satis®ed, so too sex. 127 Hanson, `The medical writers' woman', 318, which also provides a long list of Hippocratic references. There is a hint that Galen agreed with Hippocrates that the young girl cured of a paralysing cough by menstruating in Epid. 2 needed to be married (Hipp. Epid. 2 1: CMG v. 10.1. 204. 16 36), but without publication of the Arabic text it must remain a hint.

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[retention] after birth, since not only is [this retention] itself an excess, but it also produces considerable cacochymy (i.e. evil humours). For the embryo attracts the most useful blood to itself, as nourishment, and the poorer remainder becomes the cause of cacochymy in the pregnant, which physis evacuates after birth.128

This inevitable disproportion of the wrong humours in preg nant women may also cause miscarriage and dicult birth; and can be continued by nursing, which is a similar drain on female resources, and may therefore result in a body covered in pustules, as the excess of bad humours escapes through the skin.129 Furthermore, though it might have been thought that the quicker forming, less solid and substantial, girls might be less trouble in these respects, this is far from being the case. The colder female foetus has a more detrimental e€ect on the appearance and robustness of the woman who bears her, and a harder, more disturbing time getting out.130 It is also in the Hippocratic commentaries that Galen grapples further with sexual di€erentiation in the susceptiblity to certain diseases not tied directly to menstruation. Interest ingly also, in moving from the monthly purges themselves to the particular somatic krasis that underlies them, only dis advantages accrue. The greater female susceptibility to rigos is on account of her greater coldness; while her greater wetness makes her more liable to seasonal dysenteria (dysenteri3 a, that is intestinal ¯ux) than men (except very wet men) and solely (but not dangerously) prone to pustules like millet grains during summer fevers, as excess phlegm is usefully purged by erupt ing through the skin in this way.131 Only in the case of a condition which mainly a€ected youths and men in their prime, particularly those who frequented the palaestra and gymnasium, does women's imperfect constitution and lifestyle 128

Hipp. Epid. 3 3. 77 (CMG v. 10.2.1. 167. 6 12). For miscarriage, etc. see e.g. Hipp. Epid. 3 2. 12 (CMG v. 10.2.1. 97. 19 98. 20), and Hipp. Aph. 5. 55 (xviib 851 2 K); for nursing see Hipp. Epid. 2 2 (CMG v. 10.1. 223. 25 224. 30). 130 Hipp. Epid. 2 2 (CMG v. 10.1. 230. 31 231. 6), and Hipp. Aph. 5. 42 (xviib 834 5 K). 131 Hipp. Aph. 5. 69 (xviib 883 4 K), and Hipp. Epid. 2 3 (CMG v. 10.1. 292. 37 293. 23): rigos; Hipp. Aph. 3. 11 (xviib 577 82): dysenteria; Hipp. Epid. 2 2 (CMG v. 10.1. 254. 26 36): pustules; and see also Hipp. Epid. 3 3. 72 (CMG v. 10.2.1. 155. 7 19). 129

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seem to be prophylactic in itself; those few females who did succumb being those `manifestly young and hotter in nature and not living a dull and lazy life'.132 Woman is thus as distinctive pathologically as she is phy siologically, and for roughly the same reasons. This is a distinction that is not really about organs, nor even about the reproductive process as such; but about the somatic economy, in which all organs participate in some sense, as a whole, and about the reproductive needs of a mortal species that have shaped it. Galen has focused attention away from the womb, e€ectively making it, in the context of disease and its absence, a point of collection and then departure from the body, and thus similar to other organs that play a similar bodily role. There are no sui generis diseases here; Galen works hard to establish patterns of family resemblance right across the nosological ®eld, on top of the basic aetiological point. Periodicity and critical days are something that all diseases have, and though the crisis itself may manifest itself through speci®cally female forms of evacuation, or segregation, the principles involved are exactly the same; menstrual or other ¯ows from the uterus simply take their place alongside all other ¯uxes and excre tions.133 Susceptibilities too vary along common axes, and though male health is innately superior to its female equivalent in itself, it is not more secure in relation to illness. These are all distinctions of degree not kind, a large degree perhaps, su cient for Galen to conceive it as crystallizing into the imperfect kind, but on a uni®ed scale and single system. This is, of course, only the sedimented centre, and there is much that lies outside it, and in a more or less discordant relationship with that inside. The Hippocratic commentaries taken as a whole (and entirely unsurprisingly) have a tendency to follow the master in allowing diseases to settle in and radiate out from the womb itself, even casting uterine distortion as a cause of menstrual retention rather than vice versa at one point.134 Even more strikingly, a short passage in the commentary on 132 tai9 w dhlono3ti ne3 aiw te kai4 fy3sei uermote3 raiw kai4 mh4 pa3ny ti bi3 on a1rgo4n e1 zhkyi3 aiw, Hipp. Epid. 1 1. 12 (CMG v. 10.1. 32. 1 3). 133 Cris. 3. 7, 11 (180. 3 4, 211. 12 Alexanderson), and On Critical Days/ Peri4 krisi3 mvn h2merv9n 1 (ix. 770 K). 134 Hipp. Aph. 5. 28 (xviib 817 19 K).

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Epidemics 1 very neatly encapsulates the position that Galen has otherwise steadily undermined, or at least avoided. The lemma reads: gynaiji4 de4 kai4 tay9ta kai4 a1po4 y2stere3 vn po3noi (`In women these [a whole range of symptoms] too and pains from the womb').135 The comment is:

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kai4 ta4 proeirhme3 na pa3nta gi3 netai tai9 w gynaiji3 n, v2w kai4 toi9 w a5rresi, kauo3son a5nurvpoi3 te3 ei1 si kai4 pa3nta e5 xoysi tay1ta4 toi9 w a5rresi mo3ria. kauo3son d¸ ay1tai9 w e1 jai3 reton y2pa3rxei mo3rion h2 mh3tra, kata4 toy9to kai4 toi9 w e1 kei3 nhw a2li3 skontai nosh3masi kai4 ma3list¸ e1 f¸ v¥n tQ9 stoma3xQ sympa3sxei. Everything previously mentioned also occurs in women, as in males, in so far as they are human beings and have all the same organs as males; but in so far as there exists in them a special organ, the womb, thus they fall prey also to the diseases of it, especially those in which it is a€ected together with the gullet.136

Except for the `special organ' though, this is a succinct, even brutal, summary of Galen's (and others') view of a sexually divided humanity. Males are the absolute human beings (a5nurvpoi), and females the relative, quali®ed sort. In so far as they are human, women are the same as men; but there is also something more (or less) to them, opening up a distinctive gap between women and human beings which does not exist for men. Female therapeutics The road back from disease is, as Galen was fond of saying, the same as that travelled on the outward journey; there is a therapeutic retracing of the steps to health.137 Regardless of its great truth, however, `opposites cure opposites' is a prin ciple of the most general kind, and it has to acquire a much more solid and intricate form if any actual healing is to be accomplished. This task of solidi®cation through detailed exempli®cation is undertaken in Galen's therapeutic works. It is here that he identi®es the appropriate opposites for all diseased dispositions, and outlines their appropriate applica tion. As Galen explains at the beginning of Therapeutics to 135 136 137

Hipp. Epid. 1 2. 60 (CMG v. 10.1. 80. 14 15). Hipp. Epid. 1 2. 60 (CMG v. 10.1. 80. 16 20). See e.g. CAM 11 (i. 261 K).

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Glaucon, a treatise produced in response to Glaucon's request for global therapeutic guidance, knowledge of a comprehensive remedial method consists in knowledge of all the remedies available and of the mode, quantity, and timing of their administration.138 While the ®rst part is absolute knowledge, and the modes of application inhere in the remedies them selves, the questions of how much and when must be decided in relation to each individual instantiation of illness itself. Practical healing is, therefore, about the articulation of the general and the particular, and the key to this is diairesis, not only of disease and cure but of the patient also. Someone's medical individuality may be usefully approximated in a process of classi®cation under various headings of division: ei1 ga4r diori3 saito3 tiw prv9ton me4 n th4n kata4 ta4w h2liki3 aw diafora3n, e1 fejh9w de4 th4n kata4 ta4w kra3seiw kai4 ta4w dyna3meiw kai4 ta5lla ta4 toi9 w a1nurv3poiw y2pa3rxonta, xroia4w le3 gv kai4 uermasi3 aw kai4 sxe3 seiw kai4 sfygmv9n kinh3seiw kai4 e5 uh kai4 e1 pithdey3mata kai4 ta4 th9w cyxh9w h5uh, prosuei3 h de4 toy3toiw kai4 th4n v2w a5rrenow pro4w uh9ly diafora3n, o7sa te kata4 ta4w xv3raw kai4 ta4w v7raw toy9 e5 toyw kai4 ta4w a5llaw toy9 perie3 xontow h2ma9w a2e3 row katasta3seiw, v2w xrh4 diori3 sasuai, plhsi3 on a6n h7koi th9w i1 di3 aw toy9 ka3mnontow fy3sevw. For if one properly de®nes, ®rst the di€erence in ages, then in kraseis, dynameis, and the other things existing in human beingsÐI mean colours, heats, habits, arterial motions, customs, occupations, and characteristics of soulÐand add to these the di€erence between male and female, and between lands, and seasons, and the other circum stances of our surrounding air, as they di€er, one will come near the peculiar nature of the patient.139

It looks rather as if Galen started with the distinctions between local men and then added the other di€erences for the sake of completeness, leaving it rather unclear how the two sorts of divisions he is making relate to each other. Certainly the implication is that the therapeutically relevant di€erence (diafora3) between male and female is not reducible to a matter of kraseis, dynameis, and the other listed facets of human 138 Gal. MMG 1. 1 (xi. 1 2 K). For the identity of Glaucon, probably the philosopher of that name who appears elsewhere in Galen's oeuvre, and a discussion of the project represented by the MMG see Donald Peterson, `Galen's ``Therapeutics to Glaucon'' and its Early Commentaries', unpub. Ph.D. diss. (Johns Hopkins University, 1974), 25 46. 139 MMG 1. 1 (xi. 5 K).

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existence but consists in something else, something more. What exactly that might be, indeed whether sexual division is actually more than a title that simply rests upon a certain arrangement of much more precise divisions that do real curative work, remains, however, unclear throughout the Therapeutics to Glaucon. It is not that Galen restricted himself to things with a direct bearing on Glaucon's own personal well beingÐhe did not, assuming instead that Glaucon was inter ested in the restoration of human health as a wholeÐbut that the place of the female in this whole is never really resolved. This ambiguity extends beyond the boundaries of the Thera peutics to Glaucon, but it is worth using this text as its representative here, given its synoptic intent and the way Galen sets up the problem in it, and bringing in the similar sections of his most monumental therapeutic work, the Ther apeutic Method, where appropriate. Though there is consider able convergence between the two in terms of the rather uncertain ways in which female elements appear within them, there is a considerable divergence between the two as literary projects. Even by Galen's standards the Therapeutic Method is expansive, rambling, and ®ercely polemical, while the Thera peutics to Glaucon is summary, shorn of case histories and social commentary, and hardly mentions the villainous methodikoi.140 In the Therapeutic Method, also, though Galen is absolutely insistent on taking the particularities of the patient into account in the healing enterprise, contrary to the absurd universalism of Thessalus and his followers, sexual di€erentiation never makes its way into any list of such particularities, as it does so prominently in the Therapeutics to Glaucon. Therapeutics to Glaucon starts with fevers, and Galen has got through ephemeral fevers and tertian, quartan, quotidian, and continuous fevers kindled `in the humours' (e1 pi4 xymoi9 w) but unaccompanied by other symptoms, to reach the more cura tively complex humorally kindled fevers with attendant symp toms before anything vaguely sexually di€erentiated appears, though issues of age have already been in the foreground.141 140

On the MM generally see Nutton, `Style and context in the Method of Healing'. It was written in two parts; its completion certainly post-dates the MMG. 141 MMG 1. 2 1. 15 (xi. 6 42 K). Ephemeral fevers are not deep-seated in

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Then female ¯ux and immoderate lochial purging are listed, alongside a whole range of similarly ¯uid but generic condi tions such as cholera (xole3 ra, looseness/¯ux of the nutritive organs), dysenteria, and various kinds of haemorrhage, as possible causes of leipothymia (leipouymi3 a, sudden collapse), a possible feverish concomitant which is introduced in an exem plary kind of way to illustrate the therapeutic complications in such cases.142 Leipothymia may also be associated with uterine su€ocation and the ascent (a1nadromh3), ¯exure, or in¯ammation of the womb, along with apoplexia, epilepsia, and almost every other conceivable ailment.143 The point of this is that the treatment of each symptom must take all of these variables of cause and e€ect into account, as well as being ordered by their relative seriousness. So Galen outlines the appropriate ther apeutic response in each case, including those pertaining to female ¯uxes and diseased conditions of the womb itself: kai4 ta4w e1 f¸ y2ste3 raiw de4 peponuyi3 aiw e1 klyome3 naw v2say3tvw i1 a9suai, plh4n o1jyme3 litow, kai4 diadei4 n kai4 tri3 bein ske3 lh ma9llon h6 xei9 raw. kai4 v7sper e1 p¸ e1 kkri3 sei pollW9 para4 toy4w tituoy4w siky3aw e1 piti3 uemein, oy7tvw ai¥ w a1ne3 spastai kai4 pare3 spastai, boybv9si te kai4 mhroi9 w prosa3jomen. kai4 tai9 w me4 n r2isi4 n o1sfranta4 dysvde3 stata, tai9 w de4 mh3traiw ey1v3dh. kai4 ta4 xalq9n kai4 uermai3 nein dyna3mena fa3rmaka prosoi3 somen. Cure those who collapse from a€ections of the womb in the same way, except for the oxymel, and bind and rub the legs more than the hands. And, just as in [cases caused by] excessive ¯ow we applied cupping vessels to the breasts, so also in women [when the womb] has been drawn up and distorted, we apply them to the groin and thighs. Also in these women [apply] very foul smelling odours to the nose and pleasant odours to the womb; and administer pharmaka with powers to loosen and heat.144

This nicely illustrates the point of therapeutic variation on general themes to meet speci®c causal circumstances. Galen the body, and arise from fatigue, drunkenness, anger, and the like, so they are easily cured through the re-establishment of regular routines; kindled (a1na3ptein) fevers are more deep-seated and those kindled in the humours are diseases in themselves not symptoms of other diseases, coming either with or without concomitant symptoms of their own. The rest of the typology is essentially about periodicity. 142 143 144

MMG 1. 15 (xi. 47 K). MMG 1. 15 (xi. 47 50 K). MMG 1. 15 (xi. 54 K).

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does not explain here why oxymel (a mixture of vinegar and honey) is not to be given to drink in these cases; but Hippocrates had already condemned vinegar as bad for the womb, and Galen had justi®ed this verdict with reference to vinegar's cold and ®ne properties, which make it particularly damaging to the nerves and nervous organs such as the uterus.145 The attention given to the legs rather than the hands, like the cupping of the same area, is to create a downwards movement, towards the application, rather than the upwards movement required to stop excessive ¯ux or purging. The ®nal implementation of this principle is, how ever, somewhat disconcerting, given that Galen held that the womb was not like an animal and was ®rmly ®xed in place; for this is the Hippocratic odour therapy in its classic form, predicated on the womb being attracted or repulsed by the nice or nasty smells and moving accordingly. Indeed, this inconsistency had already been noted, and exploited, by the time Stephanus came to write his commentary on this work, sometime in the late sixth century.146 Stephanus constructs an ingenious defence for Galen, arguing that the foul odours act on the brain, and through it other parts of the body, not directly on the uterus itself, and that the pleasant odours are simply helpful as such. Whether Galen thought that much about it, rather than simply succumbing to therapeutic con servatism, is unclear; but even with this particular addition, the treatment of cases involving the uterus, and its ¯uxes, is no more distinctive than those involving, for instance, the stomach and its ¯ows. The existence of women as well as men, with their particular organic constitution and somatic eco nomy, increases the scope of the variability Galen needs to encompass, but it is simply a quantitative, not a qualitative, increase. Items are added to lists without altering their character; each organ and its associations requires essentially the same attention. Galen next proceeds to in¯ammations (flegmonai3 ), in which symptomatic fevers may be kindled, but which also have a complex typology of their own, further complicated by the 145

HVA 3. 39 (CMG v. 9.1. 251. 19 252. 6). Stephanus, Commentary on Galen's Therapeutics to Glaucon/¸Ejh3ghsiw ei1 w th4n toy9 pro4w Glay3kvna uerapeytikh3n 1. 198 (234. 19 238. 4 Dickson). 146

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nature of the part in which they arise.147 Their cure is thus not only determined by their type but also modi®ed by the krasis, formation (dia3plasiw), position (ue3 siw), and dynameis of the a€ected part. In¯ammations, at least those of the wet kind which involve a material in¯ux into the a‚icted area, require evacuating: the o€ending matter needs to be drawn away from the point where it is causing trouble. There are various modes of evacuation, all of which need to be locally deployed in a particular relationship with the position of the diseased part itself in order to achieve their desired e€ect, a point which Galen reiterates more variously in Therapeutic Method.148 Galen uses the example of the womb to illustrate this crucial consideration, in ways that echo the various treatments of leipothymia. For a revulsive evacuation (a1nti3 spasiw) from the womb, that is, an evacuation used when the excessive material is still collecting and which draws it away towards the furthest point of the body, open a vein at the elbow, or apply cups to the breasts, or warm, rub, or bind the hands.149 For a derivative evacuation (paroxe3 teysiw), when the excess has already collected and needs to be drawn o€ nearby, open veins in, cup, warm, rub, or bind the legs on the same side as the side of the womb a€ected.150 There are other examples, but this is the ®rst, perhaps to Galen's mind the clearest and most accessible. Certainly the womb here is not representing the woman but a general therapeutic principle. That this principle demands that diseased parts be identi®ed and curatively distinguished does not compromise its generality: these parts are segregated within a wider web of commensurability and community. The womb exempli®es something rather di€erent, however, in the discussion of the dynameis in the context of this business of taking the nature of the a€ected part fully into therapeutic account.151 Dynameis are either innate or in¯owing, from which it follows that some organs are the sources, or archai, of their own dynameis and others depend on archai elsewhere, sharing in a common dynamis. A remedy, while relieving a speci®c 147 148 149 150 151

MMG 2. 1 4 (xi. 71 101 K). See e.g. MM 5. 8 and 7. 13 (x. 342 3, 351 9 K). MMG 2. 4 (xi. 91 2 K); cf. MM 13. 11 (x. 903 4 K). MMG 2. 4 (xi. 92 K). MMG 2. 4 (xi. 96 7 K).

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a€ection, may harm the innate dynamis of that part, and if it is the arche of a common dynamis, or if its action (e5 rgon) is generally useful, then this harm will be dispersed through the whole body. The liver, heart, brain, and testicles are archai of common dynameis, but the innate dynameis of the stomach and womb are shared by no other; while the stomach has the consolation that its action is of general utility, the womb does not. The conclusions, therapeutic or otherwise, to be drawn from this are unclear. It seems like another downgrading of the importance of the womb, putting it in proportion, and, perhaps, it needs to be treated with less caution as a result. Again a set of parts are gathered together, a set in which the womb is the sole but unnominated representative of woman hood or sexual division, and then distinguished according to the same principles that assembled them in the ®rst place, principles of ostensible human genericity. Returning then to in¯ammations, Galen completes the Theapeutics to Glaucon with an extensive treatment of the various swellings (o5gkoi, a kind of mixture of ulceration and tumescence) with which they may be associated. These are entirely generic except the crablike (karkinv3deiw) kind which occur especially on women's breasts, the result of the collection of retained black bilious residues in one of the weakest parts of the body, accumulating in the veins to form a thick, dark mass in the shape of a crab.152 Unsurprisingly, this is a disease that does not a‚ict the well purged woman, and which is cured in its early stages by venesection or moving the menses; later, surgical intervention is the only hope. What is rather more surprising is that this is the fullest account Galen gives of an a€ection of the breasts and its removal, for they usually appear either as indicators of the health of a pregnancy (since they are so directly linked to the uterine region) or as the best mode of application of their own remedy, women's milk being most ecacious in wasting diseases and, ideally, suckled straight from the breast by the patient.153 It is also in the section on gangrenously ulcerated in¯amma tions that the Therapeutics to Glaucon ®nally echoes Galen's 152

MMG 2. 12 (xi. 139 43 K). See e.g. Hipp. Aph. 5. 37 and 38: pregnancy (xviib 827 9 K); MM 6. 6: women's milk (x. 474 5 K). 153

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most repeated refrain of therapeutically relevant sexual divi sion:

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a1groi3 koy me4 n ga4r o5ntow ay1toy9 kai4 sklhroy9 fy3sei, tv9n i1 sxyrota3tvn dei9 tai farma3kvn to4 sv9ma gynai3 oy de4 a1palosa3rkoy, tv9n a1sueneste3 rvn. oy7tv de4 kai4 tv9n a1ndrv9n o7soi leykoi3 te kai4 a1palo3sarkoi kai4 filo3loytroi kai4 a1gy3mnastoi malakv9n de3 ontai farma3kvn. dh9lon d¸ o7ti kai4 ta4 paidi3 a. The body of a rustic, since it is itself hard in nature, requires very strong pharmaka; [the body] of a tender ¯eshed woman [requires] weaker ones. Similarly, [the bodies] of men who are white, tender ¯eshed, bath loving, and unathletic require soft pharmaka. Clearly that [holds for] children too.154

Though this may initially look like the kind of thing promised in that opening diairetic sequence, closer inspection proves otherwise. This is not a simple division between male and female, but an enumeration of divergence from a concealed norm which the body of the rustic exceeds and the bodies of women, children, and bath loving men fail to come up to in the opposite direction. It is, of course, the moderate man who is hidden at the centre, for whom the unquali®ed pharmaka are appropriate, but tabulating deviations from him, as much by other men as anyone else, rather obscures, or cuts across, any di€erence between male and female. The situation is made even worse by the related discussions in the Therapeutic Method, in one of which Galen derides the empirikoi for using di€erent medicaments for children, women, and the delicate bodied on the one hand, and for rustics, sailors, and youths on the other, without understanding that this is because they di€er in respect to their kraseis, leaving the empiricists unable to generalize, unable to adapt to new circumstances.155 So, this continuum of somatic hardness and softness, rough ness and delicacy, as it falls away from its moderate male midpoint turns out to be a crasic continuum anyway. This point is repeatedly reinforced in Galen's pharmaco logical writings; however, since these outnumber, on a roll for roll or page for page basis, the rest of his therapeutic writings combined, they really need to be examined more fully before returning to this speci®c issue. These are, as has been men 154 155

MMG 2. 11 (xi. 137 K). MM 3. 3; see also 5. 8 (x. 181 4; 342 K).

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tioned in previous chapters, basically compilations made from earlier works, but they are complete treatises none the less, and there are some striking patterns that emerge from looking at their structure as a whole, both in relation to the rest of Galen's úuvre and in relation to the rest of the preceding pharma ceutical tradition. The ®rst major opus in the series is the On the Kraseis and Dynameis of Simple Pharmaka, the opening ®ve books of which are dedicated to a prolix and convoluted explanation and justi®cation of the pharmacological system that was to be one of his most in¯uential and long lasting institutions; the following six contain sequences of simples as they are derived from plants, earths, and animals.156 The basis of this system is Galen's understanding of the elemental composition of the cosmos and its contents, including pharmaka and human beings. Pharmaka are de®ned by their relationship with human beings: unlike foodstu€s which are mastered by, and assimilated to, the body which they nourish, pharmaka master and alter the body which they come into a€ective contact with, and their form of action is determined by their elemental krasis.157 The primary properties are then those of the qualities themselvesÐheating, drying, cooling, moisteningÐsingly or in pairs and each to a certain degree; and the more speci®c, secondary properties are derived from this.158 These secondary properties are the more familiar dynameis such as the emetic, menses or urine driving, or those productive or extinctive of milk or seed, or directed against a particular disease, grouped by Galen into larger categories so that the ®rst three are, for instance, purgative, and the seed and milk go together, though there is constant crossover and overlap in all this.159 The main thing, however, is the rational understanding of the primary, qualitative, properties and their degrees, not the empirically gathered scatterings of secondary speci®cities. 156 For a summary of Galen's pharmacology and its early evolution see John Scarborough, `Early Byzantine pharmacology', in John Scarborough (ed.), Symposium on Byzantine Medicine (Dumbarton Oaks Papers, 38; Washington: Dumbarton Oaks Library, 1984), 213 32. 157 SMT 5. 1 (xi. 704 6 K). 158 See Georg Harig, Bestimmung der IntensitaÈt im medizinischen System Galens: Ein Beitrag zur theoretischen Pharmakologie, Nosologie und Therapie in der Galenischen Medizin (Berlin: Akademie Verlag, 1974). 159 SMT 5. 20 5 (xi. 768 88 K).

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None the less, simples for moving the menses and the embryo, for treating a€ections of the womb and breasts, for generating seed and milk, for preserving prepubescent girlhood and urging to sexual activity, and for achieving a host of other such familiar ends, do all appear in the catalogues of Simple Pharmaka, albeit in smaller numbers than in, say, Dioscorides (one of Galen's acknowledged sources), and in a much more predictable collective and correlative pattern.160 The greatest loss is in respect to the womb: a tenfold diminution in refer ences to the cure of uterine a€ections occurs between Dioscor ides and Galen, and pathological pre eminence now passes to the female ¯ux.161 Movement of the menses maintains its dominant position, but also a certain amount of ambiguity.162 It is rarely directly linked to menstrual retention on the one hand, and rather more frequently explicitly joined with the drawing down of a dead embryo or destruction and expulsion of a living one on the other, but that suggests that moving the menses and the foetus are two separate, but related, things attainable through the same substance.163 In general also, Galen is far from coy about the abortive properties of things, and provides no promoters of syllepsis or protectors of pregnancy to counterbalance either these substances or pharmaka preventing fertility.164 While the sex of the plants from which these pharmaka are derived has become almost entirely irrelevant, occasionally mentioned but of no actual import, this is not the case with those derived from animals, where it is crucial to realize that, 160 See e.g. SMT 6. B. 3 and 15, and 6. D. 2 and 3: menses (xi. 852, 862 K); 8. O. 7, and 8. S. 30: embryo (xii. 89, 127 K); 7. K. 55: womb (xii. 45 6 K); 9. 1. 4: breasts (xii. 182 K); 6. A. 22 and 6. E. 1: seed and milk (xi. 821, 876 K); 9. 2. 7: girlhood (xii. 206 K); 7. K. 16: aphrodisiac (xii. 17 18 K). Galen discussed about half the number of simples as did Dioscorides, but these reductions are also proportional. On the relationship between Dioscorides and Galen generally see Riddle, Dioscorides, 168 76. 161 I have counted only eight such references in the SMT, compared to the over one hundred in Dioscorides. In the SMT the female ¯ux appears nineteen times (e.g. 6. D. 11 and 6. I. 1: xi. 865, 887 K), compared to thirty-one times in Dioscorides. 162 Fifty references against 137 in Dioscorides. 163 See e.g. SMT 7. K. 11: stoppage; 7. K. 17 and 7. I. 42 and 60: embryo (xii. 13; 19, 35 and 51 K). 164 SMT 6. E. 15 and 7. K. 1: atokia (xi. 876 and xii 17 18 K).

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for all the animal products from all speciesÐfrom lion bile to goose greaseÐthat from the male will be hotter and drier than that from the female, and that from castrated animals will resemble the latter.165 It is also in the area of animal simples that Galen has the most problems reconciling, at least part of, the pharmacological tradition with his sense of explanatory and behavioural propriety in respect of the medical art. Thus, while emory powder, for instance, prevents the breasts of young girls and the orcheis of boys from growing for a time, because it shares in a manifestly coldening dynamis, Galen rejects the claim that bat blood does the same as a downright lie.166 He does not say why, but the surrounding discussion hints that it is both because blood is generally hot not cold, and because it is nasty and linked with the worst kinds of magic and charla tanry.167 He has already refused to contemplate the medical consumption of menstrual ¯uid considering it only slightly less outrageous and disgusting than the similar consumption of human faeces, though these and other abominations are recom mended by Xenocrates.168 Sexual di€erentiation in application as well as composition, indeed a clear correlation between the two, emerges in the course of the discussion in Simple Pharmaka of the relative heat and dryness of animal simples; however, this whole matter comes more clearly into focus in the two works on compound pharmaka organized according to somatic location and pharma ceutical genus respectively.169 First it must be said that, in Galen's pharmacological system, compounding is a means for producing a new elemental and qualitative krasis and thus a new set of dynameis; of taking the properties that simply present themselves in the world, waiting only for their recogni tion, and making something else. That this brings about a further diminution in the number and range of speci®cally 165

SMT 10. 2. 13 and 11. 1. 2 (xii. 277, 326 7 K). SMT 9. 2. 17: emory; 10. 2. 4: bat blood (xii. 206, 258 K). 167 He says, for example, that he refrained from testing the alleged properties of crocodile blood to sharpen the sight, and mouse blood to remove warts, both because he had other remedies for these things and because he had already been accused of using mantic not iatric arts in the context of his prognostic predictions (SMT 10. 2. 6: xii. 263 K). 168 SMT 10. 1 (xii. 248 50 K). 169 See e.g. SMT 10. 2. 10 and 22; 11. 1. 2 (xii. 273, 298, 328 K). 166

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female properties listed in these tracts is thus rather interest ing.170 The design of nature has more points of medically e€ective contact with the female body than the design of human healers, or at least the written tradition that developed around the former has more points of such contact than that around the latter, for it may be assumed that Galen basically re¯ects his sources in this respect. The a€ections of the womb do make something of a comeback in this more explicitly pathological context, but this is in purely relative terms. There is a whole chapter in Compound Pharmaka according to Place dedicated to uterine su€ocation, which follows ones on the diseased disposition of the aidoia and priapism at the end of a downwards sequence in book 9.171 The diseased dispositions of the genitals are a mixed bunch, the womb, scrotum, and penis all appearing alongside vaguer organic terminology, and priapism maintains a generic front while being implicitly male, but no such uncertainty attaches to the last item. Uterine su€ocation is not only organically speci®c but also clearly evokes the whole woman to which it attaches in its enumera tions of the damaging losses of widowhood.172 It is necessary, however, to return to the basic and recurring point about adapting pharmaka to di€erent kinds of bodies, and whether this leads to the elusive therapeutic di€erence between male and female. It is clear that, at least to a certain extent, Galen found this pharmacological somatic division already formulated in the recipes he compiled, but also that he considered that extent to be insucient, and this was one of his ways of imposing his own order, of systematizing, this collection of material.173 In his introduction to the book on 170 I reckon that the menses are moved six times in the ten books of the Comp. Med. Loc. and once in the seven books of the Comp. Med. Gen.; the diseased womb appears ®fteen and nine times respectively; the female ¯ux three times and not at all; the breasts twice and thirteen times, with most of the other relevant references being cosmetic. 171 Comp. Med. Loc. 9. 8 10 (xiii. 316 20 K). 172 Comp. Med. Loc. 9. 10 (xiii. 319 20 K). 173 See e.g. Damocrates ap. Gal. Comp. Med. Gen. 1. 19 (xiii. 436 K) and Archigenes ap. Gal. Comp. Med. Loc. 6. 8 (xii. 1003 4 K). The latter formulation is much closer to Galen's own, but Galen might well have made it that way himself, whereas Damocrates' own words are protected by his metre.

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green plasters in the Compound Pharmaka according to Kind, for instance, Galen states that the compounding of remedies must take into account the di€erence between bodies, stronger bodies requiring stronger pharmaka and weaker ones not, and he provides a de®nition of the two types:

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i1 sxyro3tera de4 le3 gv sv3mata ta4 jhro3tera tai9 w kra3sesin, o2poi9 a ta3 te tv9n gevrgv9n e1 sti4 kai4 naytv9n kai4 kynhgetv9n. a1suene3 stera de4 ta4 malakv3tera kata4 fy3sin h6 e5 uow, o2poi9 a ta4 tv9n gynaikv9n, ey1noy3xvn te kai4 pai3 dvn, o7soi t¸ ei1 si4 n y2groi4 fy3sei tai9 w kra3sesi leyko4n kai4 malako4n e5 xontew to4 sv9ma. I say stronger bodies are those that are drier in their kraseis, as those of farmers, sailors, and hunters are. The weaker are the softer according to nature or habit, such as [the bodies] of women, eunuchs, and children who are wet in their kraseis by nature and have a white and soft body.174

He then goes on to berate Andromachus for not having done as he himself instructs, and repeats these injunctions in opening other chapters to reinforce their structural signi®cance.175 Regardless of whether the words are marked as Galen's own or those of others, the message is a pretty consistent one: women, eunuchs, children, and anyone else with a soft, delicate, white body require especially gentle treatment, while the most hardened men of soil and sea require especially rough treat ment, treatment otherwise being automatically geared to the moderate man.176 The explanation for this appears to be exclusively Galenic, and is a matter of the innate krasis overlaid by the e€ects of the environment and lifestyle: living in cold countries, luxury, lack of exercise, domesticity, and excessive bathing (especially in drinking water) all increase wetness, softness, and whiteness; whereas living in hot countries like Egypt and Arabia, exertion, and exposure to the sun all have the reverse e€ect.177 Men can, therefore, join the women, eunuchs, and children by abandoning `manly activities' (e1 nergeiv9n 174

Comp. Med. Gen. 2. 1 (xiii. 467 8 K). Comp. Med. Gen. 2. 15: Andromachus; and see 4. 1 and 7. 1 (xiii. 530; 657, 949 K). 176 See e.g. Comp. Med. Loc. 1. 8: Apollonius; 2. 1 and 3. 2: Archigenes (xii. 475; 507, 670 K); Comp. Med. Gen. 1. 5 and 7. 11 (xiii. 399, 1009 K), as well as passages already cited. 177 Comp. Med. Gen. 4. 1: lands; 7. 1: luxury, domesticity, exercise, and baths; 2. 21: sun (xiii. 662; 949; 554 K). 175

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a1ndrikv9n) and `living womanishly' (gynaikei3 vw bioy3ntvn) but there is no suggestion that the reverse is true, whether because women simply never do take up `manly activities' or because it has little e€ect never being stated.178 Indications from else where, in particular the Causes of Pulses, suggest that it must be the former, or at least that women's lack of control over their activities makes them an uninteresting and undi€erentiated category, while men's choice produces divergence and the need for moral exhortation. In the end, therefore, Galen leaves open three main lines of interpretation for the therapeutically relevant di€erence (diafora3) between male and female, none of which are particu larly clear or satisfactory. The di€erence might be that she has a womb, which is a vital but precarious centre of evacuative excellence, and breasts, which are attached to the same reg ulative process, while he, despite his occasionally priapic penis, lies closer to genericity; so the di€erence between the two stretches over one constant and unavoidable deviation from the standard and one slight tremor within it. This is a version of the adjoining woman manifest in earlier authors, and Galen does sometimes tend that way in his therapeutic treatises, but that tendency is counterbalanced by the overall unity of his curative programme, both in itself and as it grows from the rest of his system, expressed most acutely in the use of the womb as exemplifying a general principle. The impression that the human being who stands behind the parts that Galen largely deals with is a man with a female extension, that the consistent commensurability of all his analytical pieces cannot quite conceal the unevenness of their distribution, is contradicted by the ability of the womb to represent this whole being without quali®cation. Or the di€erence might lie in the relative frailty of female ¯esh, again a divergence more than a di€erence as such, though to Galen the two are synonymous. This popular distinction, however, turns out not only to be reducible, but also actually reduced, to other factors, as well as being far from a simple male/female division. The one item left over as separating women (with eunuchs and children) from men, and not 178

Comp. Med. Gen. 2. 21 and 7. 1 (xiii. 554, 949 K).

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resoluble into the smaller elements of krasis and its compa nions, is that while she is inevitably condemned to ¯eshly frailty, he is only condemned if he elects to embrace such frailty. Thus these labels take on a certain judgemental char acter, and perhaps that is what actually lies at the heart of it, male and female are aggregates of other di€erences to which a certain relative value is attached. So, thirdly, this di€erence can be seen as a ¯awed attempt by Galen to give his often rather abstract, synecdochal, approach a familiar human form; to reconcile the parts with the whole people, men and women, with whom the iatros is actually confronted in practice, by the addition of ethical or social worth.

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EPILOGUE Galen's woman is no simple formation, and the thematic treatment here has not encompassed all her intricacies. It has concentrated on her most emphatic, most richly repetitive, and cogently coherent features, overlooking the fascination of the ®ner detail. The range and depth of Galen's response to the sexual division of humanity is both unparalleled in the surviv ing literature of antiquity, and most revealing of that in the literature which does not survive; for this is a response less to sexual division itself than to its previous interpretations. So, in all this, and in the very essentials of its articulation, Galen's account resists easy summary. By way of epilogue rather than conclusion, therefore, I close this chapter with some more of Galen's own words. In a passage in the Doctrines of Hippocrates and Plato he o€ers a brief account of the relationship between men and women, as he considers it to have been didactically employed by Plato in the Republic in order to illustrate the art of comparison, of recognizing similitude and di€erence. It is a passage that con¯icts with many of the ideas he propounds elsewhere, and that have been described here, and, as it does so, it clearly contradicts Laqueur's vision of the hegemonic, ancient one sex model, with its privileging of role over body. It points instead, both to the more fundamental hierarchy of Galen's world, and to its pluralism:

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gynai9 kew ga4r a1ndra3sin o7moiai me3 n ei1 sin kauo4 kai4 ay1tai4 y2pa3rxoysi logika4 zQ9a, toyte3 stin e1 pisth3mhw dektika3, kauo3son de4 to4 me4 n tv9n a1ndrv9n ge3 now i1 sxyro3teron y2pa3rxei kai4 ei1 w a7pan e5 rgon te kai4 ma3uhma be3 ltion, ai2 gynai9 kew d¸ a1suene3 sterai3 te kai4 xei3 royw, a1no3moiai3 ge kata4 toy9t¸ ei1 si3 n, v7sper ge pa3lin e1 nanti3 vw e5 xoysi kauo3son ay¥tai me4 n y2pa3rxoysi uh3leiai kai4 dia4 toy9to pro4w ky3hsin e1 pith3deiai tai9 w me4 n ga4r gynaiji3 n e1 sti mo3ri¸ a5tta toy9 sv3matow ei1 w ky3hsin a1po4 th9w fy3sevw paraskeyasme3 na, toi9 w d¸ a5rresin oy1k e5 stin. v7st¸ a1lhuv9w a5n tiw fai3 h kata3 ti me4 n o2moi3 vw diakei9 suai ta4w gynai9 kaw toi9 w a1ndra3si, kata3 ti d¸ e1 nanti3 vw. For women are similar to men to the extent that they too are rational animals, that is, capable of acquiring knowledge; but to the extent that the genus of men is stronger and superior in every activity and learning, and women are weaker and inferior, in this they are unlike; and again, women are opposite [to men] in so far as they are female and, on account of this, adapted for childbearing, for women have certain parts of the the body prepared for childbearing by their nature, while men do not. So it is correct to say that in one respect women are similar to men, in another they are opposite.179

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179 PHP 9. 3. 25 6 (CMG v. 4.1. 556. 28 37). The Platonic passage is that in Republic 5 where Socrates famously argues in favour of female guardians (451d4 456b11).

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Conclusion Medicine and the Making of Roman Women R e l a t i o n s between women and medicine in the Roman imperial era were, therefore, manifold and complex. There certainly were female medical practitioners operating in this world: ranging from old women who continued folk medical traditions in the villages of the empire, through midwives whose expertise might be acquired in more varied ways, and whose activities might extend far beyond childbirth, to those who claimed (or had claimed for them) something still more general and prestigious, indeed that they were female physi cians. None of these made it into the ranks of eÂlite practi tioners.1 They are not the authors of noted medical texts, nor do they have their careers discussed by the litteÂrateurs of the day; rather, they have their existence simply recorded in a number of inscriptions, mainly funerary, but occasionally more public, across the empire. But this too is the lot of most male practitioners, whose fame and fortune is more comparable to that of other local craftsmen, like shoemakers and carpenters, than to the physicians of the imperial court, or the most renowned teachers of Alexandria. For these men also, the slight impact they have made on the annals of history creates similar problems in trying to pin down their actual practice, their relations with writing, and their professional identities, as are confronted in connection with their female counterparts. Informality, diversity, a certain looseness of organization and de®nition: all these are characteristics of Roman medicine across the board. Perhaps the least controversial conclusion that can be drawn about these female practitioners is that they ministered medi cally to other women; though they may also have treated men, 1 Though Antiochis of Tlos may have come close, if she was indeed the recipient of Heraclides of Tarentum's treatise.

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and male medical practitioners certainly treated women. Unfortunately not much can be said about relations between the women who provided medical services and the women who received them, except that they seem both close and signi®cant. It was women who provided the bulk of medical care for women. This much, but little more, is conveyed in the reports of male doctors, such as Galen, who had to deal with both, usually together, in the course of their practice amongst the aristocracy of Rome. Indeed, this is part of what marks the male physician's encounter with a female patient as di€erent from that with another man. Rather than the therapy or the disease itself, it is the human relationships and interactions around them that diverge in these instances. Where the patient is female, it is not just other iatroi who will, for good or (more likely) ill, play a role in the unfolding drama of cure or death, but also various maiai; and there is a further shift in the dramatic structure of these stories, for whereas the male patient is the centre of attention, this is then split between the sick woman and her husband, father, or other male presence. It is the latter who makes the decisions, even though it is the former they most a€ect. As the hierarchy of medical practice meets the hierarchy of the household, women lose out on both accounts; they lose control of their patients, and their patients lose any control of their treatment they might have had when dealing with another woman, and one likely to be of lower status than themselves. All these women are left with is a certain reticence, or reluctance; but even that can be turned to the physician's advantage, as his triumph increases in inverse proportion to the help given. Cases involving women make up the minority of those recorded by Galen, or Rufus of Ephesus, even counting their use of Hippocratic case histories, and those belonging to other notable iatroi. Though this latter inclusion does have the e€ect of giving problems connected with childbirth a numerical pre eminence within this female case load that it would not otherwise possess. Several reasons can be suggested for this imbalance, associated with patterns of both the actual activity of male doctors and their self presentation. What is, however, not suggested in any of this, is that women are more sickly than men. Nor are there any other indications to this e€ect, despite

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all the physical disadvantages they labour under. On all counts, therefore, women are somewhat peripheral to the ancient medical market place, at least as it is historically visible, and so too in surviving medical literature more generally, as it moves beyond presentation of practice to presentation of the knowledge on which that practice is based. This knowledge may come from women, or at least may be alleged as such. They provide pharmacological recipes, and sometimes even knowledge about their own bodies, though it is not always to be relied on. Predominantly, however, woman is simply an object of medical knowledge; she is the product of that knowledge, not a full participant in its formation. Crucial to this constitution of woman as an object of medical knowledge is the assumed asymmetry of the relationship of women and men to the goal of the medical art itself, that is human health. Man has an absolute hold on humanity, while woman is concomitantly relegated to a position of inferior relativity, and this hierarchical asymmetry tacitly orders all the texts analysed here. Indeed, in a sense it appears in them twice, once in relation to the telos of the art itself, and once in relation to the telos of the text and its author in relation to the art, for there is a sexual asymmetry in humanity both as it is medically addressed and as it is medically expressed; the two are di€erent sides of the same coin. This hierarchy of the human is never argued for as such, but it is both explicitly articulated and more implicitly elaborated in various ways. It may be only Galen who cites Aristotle's statement that `the female is less perfect than the male' as his founding premiss; but everybody operates with this as a basic presupposition. The notion that sexual di€erence might be just that, might be a reciprocal relationship within which questions of value do not arise, was never entertained for a moment. Women di€ered from men, not vice versa; and that di€erence was inevitably damaging, it made women worse than men. Whatever precise content that di€erence takes on in these writings, however sketchy or substantial, these terms precede it, give it shape and meaning. This is a structural constant across the sectarian and non sectarian divisions of medical knowledge. It is the one certainty in a world in which there is no agreement about the elemental stu€ of the cosmos, or the nature of the human soul,

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or how the latter could or should get to know the former for the purposes of health. In much of the medical writing that has been outlined here, sexual di€erence acquires no other shape than this hierarchical one. It is this alone which gives a disparate group of speci®c distinctionsÐin respect, for example, to anatomical detail, prevalence of diseases, and therapeutic ecacyÐany sense of cohesion. On her own, the medical woman easily lapses into incoherence. She is an incomplete set of pieces which only really add up to something when taken as amending the standard, male, model of humanity. Furthermore, that amend ment itself lacks any clear organizing principle, it is a rather more cumulative a€air. There is little attempt to pull together the various elements of women's divergence which may be enumerated in any given text, to treat them as a unity, let alone provide them with any real order, causal or otherwise. A number of loose links may be established, explanations may be o€ered for individual features, and everything should ®t into the various patterns that inform the work as a whole; but the partial female ®gure thus sketched out has no positive, for mative, pattern of her own, just a negative one of inferiority and dependency. Moreover, in his Gynaecology, Soranus expli citly collects all these points of female existence together on the basis that they have no coherence, or unifying principle, beyond being the business of the maia. Unity must be imposed from without, rather than arising from within. Other authors, such as Aretaeus and Rufus, make more of an organizational e€ort. Their explanations for the sexually dif ferentiated patterns of disease and cure, health and regimen, often end up, however haphazardly, referring to women's di€erence from men, `by nature' or `in their nature' (fy3sei); that is, referring to their generally naturally wetter, colder, and otherwise inferior constitutions. They create no very clear causal hierarchy in all this, but a somewhat looser, more ¯exible, web of explanatory connections, mutual dependencies, and implications, held in place by the joining of the quality of givenness with the qualities of coldness and wetness at its centre, in the constitutional heartlands of the female medical subject. The precise character of these heartlands, in what exactly women's constitutional essence consists beyond these

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qualities, is left vague: that is part of the point of using the term physis to designate it. However, it is in this way that the abstract, moral property which de®nes what it is to be female, that it is worse than being male, takes a physical form, enters and shapes the constitution of the female human being, and may then in®ltrate all aspects of female existenceÐ physiological, pathological, psychical, therapeutic, or what everÐas required. The work these notions of nature thus do within the medical systems of which they are a part is then pretty clear. They provide a certain unity and coherence, stability and security, to the distribution of sexual di€erence. Patterns of divergence and inferiority can then be elaborated in more concrete form, safe in the knowledge that it is simply a feature of the way the world is that, all things being equal, women are colder and wetter than men; that is just objectively so. This invocation of nature also acts to conceal the arbitrari ness of the system more broadly. With the exception of Galen, no one, at least in any extant text, o€ers any reasons why women were colder, and, indeed, it remained possible to argue the reverse, to put the qualities of givenness and essence together with heat instead; but even then the underlying hierarchy remains in place: hotness too can shift from being preferred to being the unfortunate result of an excess of blood.2 It is, moreover, the arbitrariness of this hierarchy that is both most important and most ignored, or most obscured. Galen illustrates this most clearly as he takes matters further than Aretaeus and Rufus. Behind woman's natural coldness and wetness, behind (or perhaps more closely allied with) the particularities of her administrative or organizational nature, he places a provident nature who has made her thus, for a good reason. That is in order that humanity may reproduce and attain a certain immortality. The invocation of a provident nature is, of course, the ultimate exclusion of arbitrariness from the system. Now there is a good reason for everything, except, as it happens, for woman's subordinate position. Even on the most generous reading, Galen provides only a partial explana tion for this, indeed does not really even attempt much more. 2 See Plut. Mor. 650b 651c, and following him, Macr. Sat. 7. 7. 2 7; Aristotle (PA 648a28 32) attributes the argument, and its basis on women's excess of hot blood, to Parmenides.

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Conclusion

He might claim, in a sense, that women become imperfect for exactly the same reasons they become cold, with internal reproductive organs, and the rest; the two are more or less synonymous. Only, his argument actually starts from the premiss of female imperfection, not vice versa; and, while the justi®cation for the speci®c synonymity of coldness and its trappings with imperfection is weak, the justi®cation for the introduction of the notion of imperfection, of asymmetry and inequality, into the equation at all is non existent. Each di€erence of female from male that Galen notes has equal claim to being seen as a deviation of male from female, as a series of male de®ciencies and failures, unable as they unfortu nately are to menstruate, to bear children, or breast feed, with their genitals in such a manifestly inferior position, their fragility and vulnerability signifying their slight value. Or, again, questions of value might be banished from the domain of sexual di€erence altogether. There are some further areas of strain and failure in Galen's medical cosmology (even on its own terms), and the notion of a provident physis was a controversial one in antiquity, as Galen acknowledges and Soranus also stresses. None the less plenty of people in the Roman world would have seen how this injection of rational planning strengthens Galen's system, adding extra explanatory force and consistency, not to mention value, to his entire exposition. To current sensibilities, how ever, this nature appears so justi®catory and value laden as to be downright unnatural. Galen's physis lacks or inverts almost all the key qualities of modern, scienti®c, nature: that is, substance, structure, neutrality, objectivity, and incontrovert ibility; for it is, above all, a divine subjectivity, designing everything for the best, the rest is uncertain, and nothing is uncontested. So also, Galen is able to invert or rearrange the current causal order in various ways, in particular by explicitly giving women, in certain respects, the kinds of bodies their social situation, their domesticity, demands. This is not the only direction in which explanations may run, but it is a strategy available to him. For there are multiple centres of comprehensive stability and security in this world, in the realms of what would now be construed as both nature and culture, which provident physis may interweave at will. The

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point is to link as many things as possible into these centres, and to link them with each other, and to do so in as many ways as possible, so that the density of discernible patterning in the cosmos and its explication is maximized. Thus the most cogent understanding of humanity is achieved. This aetiological inversionÐthe proposition, for instance, that women do not have beards because (among other things), as the demiurge who made her was and is aware, neither their dignity nor their lifestyle demands itÐalso underlines another very important point about all the texts discussed here. For Galen, the reasoning runs this way in this particular instance because he is interested in explaining why women do not have beards, not why they lack dignity and an active, outdoor, life. Neither he, nor any other surviving author, is really in the business of explicating or justifying women's role in society, or any particular aspect of contemporary culture.3 They do not even actively attempt to persuade people that the female is a relatively worse human being than the male: rather, they are making that already existing situation medically manifest in a number of ways, ranging from the subtle to the emphatic. They do so, moreover, more or less cognizant of the fact that such a manifestation may itself be persuasive in terms of their own authority and excellence; which is, after all, what they are after in trying to explain why women do not have beards, or are best cured in certain ways, or whatever. They cannot help but re¯ect certain common assumptions, which, in so far as they are shared by their audience, will be tacitly reassuring about the extent to which potential practitioner resembles potential patient; but they can also go further than that: they can expressly con®rm, elaborately exemplify, even elucidate these assumptions, they can try and impress not just reassure, as their broader rhetorical and epistemic strategies allow. Thus these literary medici and iatroi o€er their public, not arguments for an inferior relativity of woman that is in any doubt, but illustrations, elaborations, and explanations of a general pre sumption to that e€ect, in pursuit of human health and their 3

Rufus perhaps came closest to this with the, somewhat incidental, justi®cation he o€ers in On Girls' Regimen for the custom of young girls being married to much older men: Ruf. ap. Orib. Coll. Med. lib. inc. 18. 2 (CMG vi. 2.2. 106. 34 107. 4).

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own professional success. They state these things not so much with, as in the hope of, authority. The essentially individual and competitive nature of these claims to medical authority should also be remembered. It is their own person and practice that these authors make claims for, not medical practitioners as a whole, and claims for the medical art per se are usually actually claims for their own version of it rather than anything more inclusive. There is no possibility of, or e€ort towards, claiming to belong to an already authoritative collectivity; instead, individuals must place themselves within broadly established patterns of per sonal authority, and, more narrowly, locate themselves in a particularly powerful position in relation to the goal of medicina itself. In doing so they might follow more or less clearly in the footsteps of selected predecessors, and rely more or less heavily on certain traditions (especially more so if they had sectarian or school allegiances), but in the end it is the individual's relation ship to the medical art that is established and advocated, that is repeatedly reiterated. So, little, if any, authority can have been automatically vested in Roman medical writing in itself and as a whole, except that which inhered in its technical status, which was, of course, far from unique. This also marks a major line of rupture from the present, where the institutionalization of a medical profession in conjunction with a certain sort of scienti®c medical orthodoxy means that medical pronounce ments made within that framework have their basic authority assured by virtue of their very medicality. Whereas the scienti®c status of orthodox modern medicine today endows it with the highest truth value, the technical status of medicina had few such connotations in the Roman period. The arts were primarily conceived of in relation to their goals, not to truth. It is the delimitation of a coherent body of understanding uni®ed through its practical applicability to a certain telos that is their essential characteristic. Various attempts were made, of course, to secure this understanding more ®rmly in the medical context, to overlay the criterion of teleological requisiteness with the criterion of epistemological validity, but no kind of consensus was ever reached on the issue. Controversy and contradiction prevailed here as else where. Medicina has no epistemic ecacy in itself, but more or

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less ambitious claims are made for speci®c versions of it. The turn to what might initially appear to be a more external, objective source of certi®cation ends up simply raising the internal, individual stakes, as it is conviction not just consent that is now played for, but still basically at the expense of rival claimants. Thus, even if women's inferior relativity had been in any doubt, if their subordination had, in some sense, been under threat in the Roman imperial world, it is far from clear that physicians were the right people to shore it up. They might have displayed a certain willingness to act as ideologues in this respect, to increase their standing in this way, but their e€ectiveness would have been limited. The distribution of power and prestige in Roman society, their own organizational situation, and the particular discursive resources at their disposal all contribute to these limitations. More speci®cally, though they could have argued, as Aristotle did in the case of slavery, for the naturalness of women's rule by men, or could have developed notions of the female body which were more clearly intended to be restrictive of her activity, such argu ments would never have had great weight, especially if, as is inevitable, every physician elaborated them di€erently, amidst mutual recriminations. Opponents of the more explicitly nat uralizing strategy might have responded either, following Plato, that by nature women actually possessed roughly the same set of abilities and potentials as men, and should be treated accordingly; or, following some of the sophists, that the point of human society is to rise above the bare necessities of nature, to use nomos to construct something better than mere physis. The ®rst century ad Stoic philosopher Musonius Rufus adopted something like the ®rst approach to support his call for girls to be educated in much the same way as boys, to do philosophy too; and something like the second approach is rehearsed by the proponents of boys as more laudable objects of male sexual desire than women in the various debates on the subject that appear in imperial literature.4 None of these persuasive strategies, nor any attempt at mobilizing a more 4

Muson. frs. 3 and 4 (Lutz); and for a sophistic argument that raises nomos over physis see esp. [Lucian] Am. 31 6.

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Conclusion

reductionist understanding of the body, would ever have been in a position to do anything other than intervene into a series of ongoing debates, into a climate of ¯ourishing cosmological and rhetorical competition; nothing of this kind was ever decisively settled. Musonius Rufus is also something of a lone voice in this respect. According to his pupil Epictetus, Plato's Republic proved popular with the ladies of imperial Rome, not because it argued that women possessed the same innate qualities and abilities as men, but because they misunderstood his proposals about holding women in common.5 These female readers apparently thought, to their delight but Epictetus' deep dis approval, that Plato was advocating widespread adultery. This, moreover, is the central issue in imperial moralizing discourse as it dealt with women. It was neither reported nor alleged that women were demanding greater political or legal rights, that they were encroaching on male prerogatives in public life. The accusations levelled against them focus rather on their domestic misconduct, the sense in which they were corrupting the household from within, encroaching on male prerogatives, powers, and needs within the family.6 Marriage was now only the basic prerequisite for adultery, in a multitude of forms; wives disdained their husbands' governance in other things too; and the burden of bearing heirs was being system atically avoided. Medical practitioners did respond to these concerns. They sought, more or less explicitly, to reassure the patresfamilias they hoped to serve that they would neither commit adultery with their womenfolk themselves, nor connive in its concealment by procuring an abortion for an erring wife; they could o€er advice and practical assistance in the business of producing both properly constituted brides and legitimate heirs. They repeatedly pointed out the deleterious e€ects on 5

Epict. fr. 15. Of course, public and private, domestic and civic, cannot be so easily separated in this way, and that is part of what is at stake in concerns with women's conduct generally; moreover, women are repeatedly made to stand for wider complaints about the moral degeneration of Roman society, so trying to extract any sense out of what was really going on is extremely dicult. The point is again simply to underline the historical particularities of the Roman context. 6

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Conclusion

369

health of an indolent and pleasure loving lifestyle, especially (but not exclusively) for women. They remain somewhat coy, however, about women's sexual misdemeanours; and the most savage and speci®c condemnation of female misconduct in terms of the bodily damage it does belongs not to a medical man, but to a philosopher and politician, well bred and well educated as he is.7 Once, according to the Younger Seneca and the most ancient physicians, women were immune from hair loss and gouty a‚ictions of the feet, now many are bald and podagricÐnot because the nature of women has changed but because it has been conquered by bad habits.8 Now women not only party as hard as men, drinking as much and sleeping as little, carousing and vomiting with the best of them, but they have abandoned the sexual passivity which is their birthright in favour of the active, male, sexual role. Hence they now su€er from men's diseases. In comparison with this, medical writers and practitioners of the Roman period have generally been judged as accommodat ing shifts in female behaviour and outlook, rather than taking up arms against them. Soranus' Gynaecology may be a book primarily directed at the production of heirs, but it is also one which recognizes that women have a choice in the matter: that being a non reproductive, even non menstruating, woman is a perfectly healthy, if somewhat anti social, option. The greater assimilation of women to men in the medical texts of the imperial era compared to those of the Hippocratic corpus may also re¯ect the expanding scope of female activities, the sense in which the distance between the two was narrowing in various respects. Certainly it can be said that medicine parti cipated in the various renegotiations that occurred in the Roman eÂlite family, and perhaps beyond, in the ®rst two centuries of the empire. This period (and that immediately 7 Soranus comes closest by repeating, but rejecting, the allegation that children at Rome are particularly prone to skeletal deformation because of the excessive sexual activity of Roman women (Sor. Gyn. 2. 44. 1 2: CMG iv. 85. 7 19). The real reason according to Soranus is that Roman (in contrast to Greek) women are insuciently attentive to their children. 8 Sen. Ep. 95. 20 1; this comes as part of a larger diatribe about the way in which the amount of illness around, and the concomitant amount of medicine, re¯ects the moral degeneration of the age, a popular rhetorical line not really available to physicians themselves.

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370

Conclusion

preceding it) is marked by certain changes in, for instance, the amount of property women held and what they could and did do with it, in their role in civic life, the duties and services they might perform, and have publicly recognized, and their legal position within the family structure.9 None of these alterations can be described as radical, and the actual areas of confronta tion between women and men are very few, even if male anxieties were more widespread; but medicine is undoubtedly party to whatever shifts and recon®gurations are afoot, party to the whole complex of change. More importantly, however, Roman medicine was also party to a great deal of non change. Just as the basic principles of women's relativity and inferiority remain constant across the whole corpus of imperial medical writing, so also in the social and political body. The quiet collusion between the two continued throughout. Medicine contributes a speci®cally medical take on certain common themes, a speci®cally medical, rather than, say, legal or philosophical, elaboration of common assumptions; no more, but also no less. Indeed, the signi®cance of this commonality in which medicine partakes cannot really be overstated. It marks the sense in which the commitment to the hierarchy of the human precedes everything, and maintains degrees of mutual alignment, re¯ection, and homology across a range of diverse disciplines. The sense, therefore, in which this hierarchy is pre discursive is located amongst the classical conditions for discourse itself. Moreover, rather than emphas izing and substantiating this originary matrix, calling it sex, the body, genes, or whatever, the inhabitants of the classical world simply obscured and dissolved it. That is one of the roles the various natures which appear in medical discussions perform, but they can never become properly foundational in the modern sense. Roman cosmological discourses, and the dis ciplines which overlap with them, did not extrude from themselves a hard and fast external domain of nature; rather, 9 On changing civic and economic roles of women in the Roman East see Riet van Bremen, The Limits of Participation: Women and Civic Life in the Greek East in the Hellenistic and Roman Periods (Amsterdam: Gieben, 1996); and on the family in general see e.g. Susan Treggiari, Roman Marriage: Iusti Coniuges from the Time of Cicero to the Time of Ulpian (Oxford: Oxford University Press, 1991).

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Conclusion

371

they kept within themselves the properties of hardness and fastness, the property of being natural, which they could then invest or discover in various aspects of their own arrangement, thus ®nding the natural within themselves. This fastness is, therefore, always relative in the sense that there is nothing actually holding it fast as such, but the movement around it, the other things that depend on it, determine its immobility.10 This hardness is also of a particular variety. For it is more often the product of internal distillation, of getting to the essence of a thing, than of external crystallization, coming from the con struction of a thing. This essence is also more materialized than materialist (though the atomists are, of course, exceptions to this too), and thus admits of a greater constitutive ¯exibility, changeability, than modern physics permits. All of this, then, is an attempt to delineate the particularities of Roman medicine's contribution to the gendering of society, to the making of Roman women in the appropriate mould, not to deny that it had any such e€ects, or made any such e€orts at all. It is an attempt to think about gender within the conceptual and political world of imperial Rome, with its own cosmolo gies, ontologies, epistemologies, and aetiologies, not to mention its own family and social structures, its own cultural fabric and moral values. This book has, therefore, been in many senses a parallel undertaking to Laqueur's Making SexÐone which has ended up running on such separate lines that, even though some of the same points have been passed through, or even arrived at, it has been from such a di€erent direction, with such a divergent outlook, that real engagement has been elusive. Rather more has been taken from speci®c studies of classical medicine, from bringing (even forcing) together their broad outlines of its social and cultural formation, and their detailed involvement in its particular dealings with women. From all this it can be said that Roman medical discourse, and the practice that accompanied it, clearly enacted, elaborated, in its own speci®c ways, the founding principles of the Roman understanding and organization, of sexual di€erence; it 10

I borrow the terminology and many of the insights here (and elsewhere) È ber Gewissheit/On Certainty, ed. G. E. M. from Ludwig Wittgenstein, U Anscombe and G. H. von Wright, trans. D. Paul and G. E. M. Anscombe (Oxford: Blackwell, 1974).

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372

Conclusion

brought them to bear on a particular area of human enquiry and endeavourÐthat concerned with human healthÐand by that route brought them to bear on society more broadly. This is, in a sense, therefore, simply an act of repetition, a bringing into line of yet another area of life with all the others; but in so far as it is successful, repetition becomes reinforcement. In so far as the necessary ground is e€ectively covered without fundamental challenge, as long as satisfactory descriptions and plausible explanations are o€ered, and controversy rages only over which elaboration of the hierarchy of the human is to be preferred, aligned with which particular physics or episte mology, not over that hierarchy itself, then things not only make sense, but make more sense than before. More facets of the world are thus tied together, mutually implicated, and explicated, in an increasingly extensive, dense, and satisfying set of patterns. Everywhere there is more of the same, and nowhere arbitrariness. The medical texts discussed here do thus loosely bind the sexual constitution of Roman society as it might appear to a member of the Roman eÂlite together with the sexual constitu tion of the human being as an object of medical knowledge in a series of overlapping virtuous circles. Each author formulates things more or less di€erently, indeed the same author may formulate things slightly di€erently at various points in his úuvre; but all describe roughly the same circle, whichever way round they decide to go. Through these connections and correlations, re¯ections and repetitions, the arrangement of men and women in Roman society is e€ectively reinforced, even if the intention is primarily to reinforce the (or more precisely, a particular) medical understanding of men and women. The congruities and consistencies of Roman gender are thus multiplied and thickened, patterns of meaning are extended and developed. Other, more speci®c, sources of authority are drawn on, and into, this enveloping web of persuasion through sameness, reassurance, and con®rmation. This discourse both arises from, and is applied in, the circum stances of medical practice; doctors' relations with male and female patients, their negotiations within the household, the care they give, all ®t into, and strengthen, the same patterns. Medicine may not have worked very hard at its contribution to

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Conclusion

373

Roman gender, but it undoubtedly worked e€ectively in what was, after all, a much more collaborative than confrontational venture. If this reinforcement, this repetition and elaboration, was the general e€ect of medical activity, both discursive and practical, on the world in which Roman women lived, and of which they were an integral part, can anything further be said about that part in particular? To what extent did women recognize themselves in this discourse? To what degree did they locate themselves in a position of inferior relativity, or understand themselves to be colder and wetter, creatures of abundance and excess? These are questions which attach both to the under standing of female practitioners and patients, and the relations between the two; but they are, of course, also very hard to answer. While there might have been alternative female medi cal cultures existing outside the male dominated milieu of eÂlite and learned medicine, there is no actual indication of such separate spheres. Rather, what scanty evidence there is sug gests the reverse: that male and female practitioners were operating with roughly the same basic conceptual and compre hensive models, had similar backgrounds and aspirations (indeed, might belong to the same family); and that patients of both sexes also shared many of these starting points. At a fundamental level, there is an impressive consensus on the principles of therapy. None of this material, however, bears directly on how women understood themselves as women, as di€erent and/or the same as men, or on the medical contribu tion to this understanding, or, rather, these understandings. Comparative studies of better documented times and places certainly suggest that women's relations with medical discourse of even the most male sort, that is neither derived from nor addressed to them, are always complex.11 Women's identi®ca tion with the versions of their bodies provided in these kinds of texts tend to be partial, not so much in the sense that they explicitly reject some things and accept others, but that there 11 See, most notably, Duden, The Woman Beneath the Skin, esp. 104 78, for a historical study of such relations; and also Emily Martin, The Woman in the Body: A Cultural Analysis of Reproduction (Milton Keynes: Open University Press, 1989), for a more contemporary study of women's bodily self-perception.

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374

Conclusion

are aspects which seem to them more relevant and important than othersÐmore appropriate and e€ective in terms of self knowledge and action directed towards attaining health and well being for themselves. There is a certain common percep tion, with di€erences of emphasis and aims, that is organized and used di€erently. Women thus work, in various ways, with the material they have, and work actively, rather than simply being passively worked upon, even if their subjectivities are now completely irrecoverable. Medicine thus contributes to the making of Roman women in a variety of ways, and Roman women also help to make that medicine. These interactions are both objective and subjective, both individual and collective; and always complex and multi faceted. They are also historically speci®c. It is within a particular set of social and economic relations, a particular cultural and ideative context, that Roman medicine has its life. It is these circumstances that make it the kind of medical formation it is, that provide the basis for what it makes of itself and the world, for how these makings work out more widely, have their own e€ects on society, its patterns, and populations. The Roman empire thus o€ers an interesting illustration of the general rule of involvement of medicine in the gendering of any society, in its understanding and ordering of sexual di€erence. An illustration which serves both to emphasize the mutual implication, the universal entanglement, of all the parties and processes concerned, and to extend the variation in the ways this may be organized, the con®gurations of medicine and women, of gender, nature, and authority, possible in time and space.

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appendix 1

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Listing of Medical Authors, Works, Editions, Translations, and their Abbreviations

This listing is intended largely as a key to the (mostly Latin) abbreviations used to refer to medical authors and their works in this book, but also as a bridge between the abbreviations used to refer to the editions cited and the Bibliography. It lists, alphabetically, author, abbreviation, (where possible) full title of the work in the original (or closest to original) language(s), with an English transla tion, and the edition of the text used. This last listing is by editor, and further details of the publication can then be found under this name in the Bibliography; this includes the names of those who have edited texts referred to in the notes by series or collection. Also in this ®nal column are the names of any translators of the text into English, so that details of these too can then be located in the Bibliography. It should be said, by way of disclaimer, that these translations are of very varied standards and styles, based on a range of di€erent editions and di€erent notions of how ancient medical texts should be inter preted. Some are excellent, with perhaps the most impressive achievement being that of Margaret Tallmadge May with her transla tion of Galen's monumental On the Usefulness of the Parts, others, however, do not come anywhere near this level: Rudolf Siegel's rendering of Galen's On the A€ected Parts, for example, is especially full of both anachronisms and inaccuracies. I include James Ricci's translation of the gynaecological book of Aetius of Amida, for instance, even though it is a translation of a Renaissance Latin version not the original Greek, and also John Goodyer's 1655 `englishing' of Dioscorides (edited by Gunther), which I consider to be a highly ecient translation (helped by the fact that he is still operating, medically, in the same conceptual world as Dioscorides, though this may cause the modern reader diculties), but of a deeply ¯awed text, with all its many interpolations still intact.

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376

Appendix 1

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Author and abbr. Full title and translation Aetius of Amida Tet. Lo3goi i1 atrikoi3 /Medical Writings Agnellus of Ravenna Lectures (Incipit, but no title in mss.) Lectures on Galen's De Sectis Anonymus Bambergensis Anon. Bamb. (Untitled) Anonymus Londinensis Anon. Lond. (Untitled) Anonymus Parisinus Anon. Paris. [Peri4 tv9n o1je3 vn kai4 xroni3 vn noshmatv9n/On Acute and Chronic Diseases] Antyllus EPB Peri3 tv9n e5 jvuen prospipto3ntvn bohuhma3tvn/On Externally Applied Remedies KB Peri4 kenoyme3 non bohuhma3tvn/On Evacuative Remedies PB Peri4 poioyme3 nvn bohuhma3tvn/On Performative Remedies Aretaeus the Cappadocian CA ¸Oje3 vn noysv9n uerapeytiko3n/Therapeutics of Acute Diseases CD Xroni3 vn noysv9n uerapeytiko3n/Therapeutics of Chronic Diseases SA Peri4 ai1 ti3 vn kai4 shmei3 vn o1je3 vn pauv9n/On the Causes and Signs of Acute A€ections

Edition used Zervos (Z); trans. from the Latin by Ricci `Seminar Classics 609' (SC609) (ed. and trans.) Stoll Jones (ed. and trans.) Garofalo, with trans. by Fuchs

ap. Oribasius, CMG vi. 1.1±vi. 2.1, ed. Raeder ap. Oribasius, CMG vi. 1.1±vi. 2.1, ed. Raeder ap. Oribasius, CMG vi. 1.1±vi. 2.1, ed. Raeder CMG ii, ed. Hude; trans. Adams CMG ii, ed. Hude; trans. Adams CMG ii, ed. Hude; trans. Adams

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Appendix 1 Author and abbr. SD

Full title and translation Peri4 ai1 ti3 vn kai4 shmei3 vn xroni3 vn pauv9n/On the Causes and Signs of Chronic A€ections Caelius Aurelianus CP Celeres Passiones/Acute A€ections Gyn. Gynaecia/Gynaecology TP Tardae Passiones/Chronic A€ections Celsus Med. Dioscorides MM

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Galen AA

A€. Dig.

Ars Med. CAM

Caus. Puls.

377 Edition used CMG ii, ed. Hude; trans. Adams

CML vi. 1.1, ed. Bendz; trans. Drabkin Drabkin and Drabkin CML vi. 1.1±2, ed. Bendz; trans. Drabkin

De Medicina/On Medicine

CML i, ed. Marx; trans. Spencer

Peri4 y7lhw i1 atrikh9w/On Medical Materials

Wellmann (W); trans. Goodyer

¸Anatomikai3 e1 gxeirh3seiw/ Anatomical Procedures

Garofalo (Greek), Simon (Arabic); trans. C. Singer (Greek), Duckworth (Arabic) CMG v. 4.1.1, ed. de Boer; trans. P. Singer

Peri4 tv9n i1 di3 vn e2 kastQ pauv9n kai4 a2marthma3tvn th9w diagnv3sevw/On the Diagnosis of the A€ections and Errors particular to Each (Soul) ¸Iatrikh4 te3 xnh/The Medical Art Pro4w Patro3filon peri4 systa3sevw i1 atrikh9w/To Patrophilus on the Constitution of the Medical Art Peri4 tv9n e1 n toi9 w sfygmoi9 w ai1 ti3 vn/On the Causes of the Pulse

KuÈhn (K) i; trans. P. Singer KuÈhn (K) i; trans. D. Dean Jones

KuÈhn (K) ix

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378 Author and abbr. Galen (cont.) CC Comp. Med. Gen. Comp. Med. Loc. CP Cris. Di€. Puls. Di€. Resp.

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Foet. Form. Hipp. Aph.

Hipp. Elem.

Hipp. Epid.

Hipp. Prog.

Appendix 1 Full title and translation

Edition used

De Causis Contentivis/FõÅ l asbaÅb al maÅsika/On Containing Causes Peri4 synue3 sevw farma3kvn tv9n kata4 ge3 nh/On Compound Pharmaka according to Kind Peri4 synue3 sevw farma3kvn tv9n kata4 to3poyw/On Compound Pharmaka according to Place De Causis Procatarcticis/ On Antecedent Causes Peri4 krisev9n/On Kriseis Peri4 diafora4w sfygmv9n/ On the Di€erence between the Pulses Peri4 dy3spnoiaw/On Diculty in Breathing Peri4 kyoyme3 nvn diapla3sevw/On the Formation of the Foetus Ei1 w to4 ¹Ippokra3toyw ¸Aforismoi3 y2pomnh3mata/ Commentary on Hippocrates' Aphorisms Peri4 tv9n kau¸ ¹Ippokra3thn stoixei3 vn/On the Elements according to Hippocrates Ei1 w to4 ¹Ippokra3toyw e1 pidhmiai3 y2pomnh3mata/ Commentary on Hippocrates' Epidemics Ei1 w to4 ¹Ippokra3toyw prognostiko3n y2pomnh3mata/ Commentary on Hippocrates' Prognostics

CMG Supp. Or. ii, ed. and trans. Lyons et al. KuÈhn (K) xiii

KuÈhn (K) xii±xiii

Hankinson (ed. and trans.) Alexanderson KuÈhn (K) viii KuÈhn (K) vii KuÈhn (K) iv, trans. P. Singer KuÈhn (K) xviib± xviiia CMG v. 1.2, ed. and trans. De Lacy CMG v. 10.1±10.2.3, ed. Wenkebach et al. CMG v. 9.2, ed. Diels et al.; trans. (partial) Jenner

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Appendix 1 Author and abbr. HNH

HVA

Lib. Prop. Loc. A€. Med. Exp. MM

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MMG Morb. Di€. Nat. Fac. Opt. Med. Cogn. Ord. Lib. Prop. Part. Art. Med.

Full title and translation Ei1 w to4 peri4 fy3sevw a1nurv3poy ¹Ippokra3toyw y2pomnh3mata/Commentary on Hippocrates' On the Nature of Man Ei1 w to4 peri4 diai3 thw o1je3 vn ¹Ippokra3toyw y2pomnh3mata/ Commentary on Hippocrates' Regimen for Acute Diseases Peri4 tv9n i1 di3 vn bibli3 vn/ On his own Books Peri4 tv9n peponuo3tvn topv9n/On the A€ected Places FõÅ l tajriba l tibbiya/On Ç Medical Experience Meuo3dow uerapeytikh3/ Therapeutic Method Pro4w Glay3kvna uerapeytiko3n/Therapeutics to Glaucon Peri4 diafora4w noshmatv9n/ On the Di€erence between Diseases Peri4 fysikv9n dyna3mevn/ On the Natural Faculties FõÅ mihnat afdal al Ç atibbaÅÇ'/On Examining the Ç Best Physicians Peri4 th4w ta3jevw tv9n i1 di3 vn bibli3 vn/On the Order of his own Books De Partibus Artis Medicativae/FõÅ 'ajzaÅ' l tibb/On the Parts of ÇMedicine

379 Edition used CMG v. 9.1, ed. Mewaldt; trans. Lewis CMG vi.9.1, ed. Westenberger

SM ii, ed. Marquardt et al.; trans. P. Singer KuÈhn (K) viii; trans. Siegel Walzer (ed. and trans.) KuÈhn (K) x; trans. (partial) Hankinson KuÈhn (K) xi KuÈhn (K) vii SM iii, ed. Marquardt et al.; trans. Brock CMG Supp. Or. iv, ed. and trans. Iskander SM ii, ed. Marquardt et al.; trans. P. Singer CMG Supp. Or. ii, ed. and trans. Lyons et al.

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380 Author and abbr. Galen (cont.) PHP

Praen. Protr. Puls. San. Tu. Sem. Sent.

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SI SMT

Subf. Emp. Sympt. Caus. Sympt. Di€.

Ther.

Appendix 1 Full title and translation

Edition used

Peri4 tv9n ¹Ippokra3toyw kai4 Pla3tvnow dogma3tvn/On the Doctrines of Hippocrates and Plato Peri4 toy9 proginv3skein/On Prognosis Protreptiko4w e1 p¸ i1 atrikh3n/ Exhortation to the Medical Art Peri4 tv9n sfygmv9n toi9 w ei1 sagome3 noiw/On the Pulse for Beginners Peri4 y2gieino3n/On Healthful Conduct Peri4 spe3 rmatow/On the Seed De Sententiis/On my own Opinions Peri4 ai2 re3 sevn toi9 w ei1 sagome3 noiw/On the Sects for Beginners Peri4 krasev9w kai4 dyna3mevw tv9n a2plv9n farma3kvn/On the Kraseis and Dynameis of Simple Pharmaka Sub®guratio Emperica/ Outline of Empiricism Peri4 ai1 ti3 vn symptvma3tvn/On the Causes of Symptoms Peri4 tv9n symptvma3tvn diafora9w/On the Di€erence between Symptoms Pro4w Pi3 svna peri4 th9w uhriakh9w/To Piso on the Theriac

CMG v. 4.1.1±3, ed. and trans. De Lacy CMG v. 8.1, ed. and trans. Nutton CMG v. 1.1, ed. Barigazzi; trans. P. Singer KuÈhn (K) viii; trans. P. Singer CMG v. 4.2, ed. Koch; trans. R. Green CMG v. 3.1, ed. and trans. De Lacy CMG forthcoming, ed. and trans. Nutton SM iii, ed. Marquardt et al.; trans. Frede KuÈhn (K) xi±xii

DeichgraÈber (Dgr); trans. Frede KuÈhn (K) vii KuÈhn (K) vii

KuÈhn (K) xiv

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Appendix 1 Author and abbr. Thras.

UP Ut. Diss. Ut. Resp. Ven. Art. Diss.

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Ven. Sect. Er.

Ven. Sect. Er. Rom.

[Galen] Def. Med.

Full title and translation Urasy3boylow po3teron i1 atrikh9w h6 gymnastikh9w e1 sti to4 y2gieino3n/To Thrasyboulus on whether Healthiness is a Part of Medicine or Gymnastics Peri4 xrei3 aw mori3 vn/On the Usefulness of the Parts Peri4 mh3traw a1natomh9w/On the Dissection of the Uterus Peri4 xrei3 aw a1napnoh9w/On the Usefulness of Respiration Peri4 flebv9n kai4 a1rthriv9n a1natomh9w/On the Dissection of the Veins and Arteries Peri4 flebotomi3 aw pro4w ¸Erasi3 straton/On Venesection against Erasistratus Peri4 flebotomi3 aw pro4w ¸Erasistratei3 oyw toy4w e1 n ¹Rv3mW/On Venesection against the Erasistrateans in Rome

381 Edition used SM iii, ed. Marquardt et al.; trans. P. Singer

Helmreich (H); trans. May CMG v. 2.1, ed. Nickel; trans. Goss Furley (FW) and Wilkie (ed. and trans.) KuÈhn (K) ii; trans. Goss KuÈhn (K) xi; trans. Brain KuÈhn (K) xi; trans. Brain

¾Oroi i1 atrikoi3 /Medical De®nitions

KuÈhn (K) xix

Ei1 sagvgh3 (h5 ¸Iatro3w)/ Introduction (or The Physician)

KuÈhn (K) xiv

Hippocrates Aph.

¸Aforismoi3 /Aphorisms

Epid.

¸Epidhmiai3 /Epidemics

Mul.

Gynaikei3 a noy3soi/On the Diseases of Women

Littre (L) Jones Littre (L) Jones and Littre (L)

[Galen] Intro.

iv; trans. v; trans. Smith viii

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382 Author and abbr. Nat. Hom. Prorrh.

Appendix 1 Full title and translation Peri4 fy3siow a1nurv3poy/On the Nature of Man Prorrhtiko3n/Prediction

John of Alexandria Comm. Hipp. (Untitled in Greek, Epid. incipit in Latin) Commentary on Hippocrates' Epidemics Oribasius Coll. Med. Synagvgoi4 i1 atrikoi3 / Medical Collections Syn. Sy3nociw/Epitome Paul of Aegina Paul. Aeg.

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Pliny HN

Edition used CMG i, ed. Jouanna; trans. Jones. Littre (L) ix; trans. Potter CMG xi. 1.4, ed. and trans. Du€y (Greek fragments); ed. Pritchett (Latin) CMG vi. 1.1±2.2, ed. Raeder CMG vi. 3, ed. Raeder

(Untitled)

CMG xi. 1±2, ed. Heiberg; trans. Adams

Historia Naturalis/ Natural History

Mayho€ (M); trans. Rackham et al.

Rufus of Ephesus Onom. Peri4 o1nomasi3 aw tv9n toy9 a1nurv3poy mori3 vn/On the Naming of the Parts of the Human Being Ren. Ves. Peri4 tv9n e1 n nefroi9 w kai4 ky3stei pauv9n/On A€ections of the Kidneys and Bladder [Rufus] Anat. Peri4 a1natomh9w tv9n toy9 a1nurv3poy mori3 vn/On the Anatomy of the Human Being Scribonius Largus Comp. Compositiones/Compounds Soranus Gyn. Gynaikei3 a/Gynaecology

Daremberg and Ruelle (DR); trans. (partial) Brock CMG iii, ed. Sideras

Daremberg and Ruelle (DR)

Sconocchia CMG iv, ed. Ilberg; trans. Temkin

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appendix 2

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Medicae and Iatrinai in Inscriptions

Included in this appendix are texts and translations of all the imperial inscriptions known to me which refer to medicae, iatrinai, or their orthographical variants. This is not, therefore, a collection of all inscriptions which link women with medical knowledge or skill, but only those which use these titles, in whatever way. The strict application of this criterion, and a closer reading of several of the texts concerned in their most recently published versions, means that the number of inscriptions included here is somewhat less than appear in most other epigraphic listings of female physicians (e.g. Ernst KuÈnzl, `Ein archaÈologisches Problem: GraÈber roÈmischer Chirurgin nen', AMSSC i. 310±11), and, as will also become apparent, not all the inscriptional iatrinai themselves can be classi®ed as female physicians either (though all the medicae can). I have, however, added the honori®c inscription to Antiochis of Tlos to the end of this sequence, though the word iatrineÅ does not appear in it, since it is directly referred to in the book (p. 35 n. 3 above). I have, furthermore, adopted a somewhat minimalist approach to this presentation overall. Descriptions are perfunctory, and largely taken, along with the datings, from existing publications, which are listed in summary form (if no date is given, that means the inscription is considered to be imperial, without further re®nement). Nor are all doubtful readings and suggested restorations noted, and commentary is kept to a minimum. It is restricted to comments on the meaning of the texts themselves, rather than their wider signi®cance. My aim is to provide texts and translations in an accessible form, together with the appropriate references for further research. For these references, the following abbreviations are used in addition to the customary ones: È rztestand im roÈmischen Gummerus Herman Gummerus, Der A Reiche nach den Inschriften, i (Helsinki: Akademische Buchhandlung,1932). Korpela Jukka Korpela, Das Medizinpersonal im antiken Rom: Eine sozialgeschichtliche Untersuchung (Annales Academiae Scientiarum Fennicae, Dissertationes Humanarum Litterarum, 45; Helsinki: Suomalainen Tiedeakatemia, 1987).

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384 Nutton ReÂmy (a) ReÂmy (b)

Appendix 2 Vivian Nutton, `Archiatri and the medical profession in antiquity', PBSR 45 (1977), 191±226. Bernard ReÂmy, `Les Inscriptions de meÂdecins en Gaule', Gallia, 42 (1984), 115±52. Bernard ReÂmy, `Les Inscriptions de meÂdecins dans les provinces romaines de la peÂninsule ibeÂrique', REA 93 (1991), 321±64.

I would also like to thank Riet van Bremen, Michael Crawford, Henrik Mouritsen, John North, David Noy, and Benet Salway for their help with this compilation. Rome 1. Melitine Columbarium; late 1st cent. bc±early 1st cent. ad. CIL vi. 6851; Gummerus no. 29; Korpela no. 42

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Melitine / medica Appulei Melitine, physician of Appuleius. 2. Primilla Columbarium; 2nd cent. ad. CIL vi. 7581; Dessau 7804; Gummerus no. 32; Korpela no. 256 Deae sanctae meae / Primillae medicae / L. Vibi Melitonis f(iliae) / vixit annis xxxxiiii / ex eis cum L. Cocceio / Apthoro xxx sine / querela fecit / Apthorus coniug(i) / optimae castae / et sibi To the sacred spirits of my Primilla, physician, daughter of L. Vibius Melito, she lived 44 years, 30 of them with L. Cocceius Apthorus, without complaint, Apthorus made (this) for his best and chaste wife and himself. 3. Secunda Livilla Funerary inscription; 1st cent. ad. CIL vi. 8711; Dessau 7803; Gummerus no. 42; Korpela no. 140 Secundae Livillae medicae / Ti. Claudius Caesaris l(ibertus) Celer aeditu(u)s a Vesta To Secunda Livilla, physician, Ti. Claudius Celer, freedman of Caesar, attendant in the temple of Vesta, (made this).

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4. Anonyma Marble funerary inscription; 1st or 2nd cent. ad. CIL vi. 8926; Gummerus no. 59; Korpela no. 176 [Dis] Manibus / [Crescen]ti a frumento / [minist]ratorum Aug(usti) / [Anonyma] Caesaris medica / [ex familia c]astrensi coniugi / [optimo f]ecit et sibi posterisque suis To the divine spirits of [Crescentius], attendant on the imperial food supply, [Anonyma], (freedwoman) of Caesar, physician of the imperial household, made (this) for her excellent husband and herself and their descendants. On the domestic nature of the familia castrensis see e.g. Otto Hirschfeld, Die kaiserlichen Verwaltungsbeamten bis auf Diocletian (Berlin: Weidmann, 1905), 313±17. I take `ex familia castrensi' from CIL viii. 5234; though the more usual description is `familiae castrensis'. 5. Iulia Pye Marble funerary inscription; 1st cent. ad. CIL vi. 9614; Gummerus no. 111; Korpela no. 135. Iulia / Pye / medica Copyright © 2001. Oxford University Press, Incorporated. All rights reserved.

Julia Pye, physician. 6. Minucia Asste Funerary inscription; 1st cent. ad. CIL vi. 9615; Gummerus no. 112; Korpela no. 43 Minucia / (mulieris) l(iberta) Asste / medica Minucia Asste, freedwoman of a woman, physician. 7. Terentia Prima Funerary inscription; 1st cent. ad. CIL vi. 9616; Gummerus no. 113; Korpela no. 203 D(is) M(anibus) / Terentiae / Niceni Terentiae / Primaes medicas li/ bertae fecerunt / Mussius Antiochus / et Mussia Dionysia / ®l(ii) m(atri) b(ene) m(erenti) To the divine spirits of Terentia Nice, freedwoman of Terentia Prima, physician. Mussius Antiochus and Mussia Dionysius, her children, to their well deserving mother.

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8. Venuleia Columbarium inscription; 1st cent. ad. CIL vi. 9617; Gummerus no. 114; Korpela no. 46 Venuleia / (mulieris) l(iberta) Sosis / medica Venuleia Sosis, freedwoman of a woman, physician. 9. Naevia Clara Grave stele; late 1st cent. bc±early 1st cent. ad. Unpublished but cited in Vivian Nutton's review of Korpela (Medical History, 32 (1988), 285) L. Naevius (mulieris) l(ibertus) Philippus / medicus chirurgus / Naevia (mulieris) l(iberta) Clara / medica philologa / in fron(te) ped(es) XIV / in agr(o) ped(es) XVII L. Naevius Philippus, freedman of a woman, physician, surgeon; Naevia Clara, freedwoman of a woman, physician, scholar; 14 feet in breadth, 17 feet in depth.

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Italy 10. Iulia Sabina Funerary inscription; Osimo (Auximum, Picenum); 1st±2nd cent. ad. CIL ix. 5861; Gummerus no. 203 Deis manib(us) / Iuliae Q. l(ibertae) / Sabinae / medicae / Q. Iulius Atimetus / coniugi bene merenti To the divine spirits of Iulia Sabina, freedwoman of Quintus, physician, Quintus Iulius Atimetus (made this) for his well deserving wife. 11. Sentia Elis Funerary inscription; Verona (Venetia); 1st cent. ad. CIL v. 3461; Gummerus no. 273. C. Cornelius / Meliboeus / sibi et / Sentiai / Elidi medicai / contuber(nali) / Sentiai Aste C. Cornelius Meliboeus (made this) for himself and Sentia Elis, physician, his partner, (and for) Sentia Aste. 12. Iulia Sophia Columbarium; Capri (Capreae, Campania); 1st cent. ad. AnnEpigr. 1972 no. 83

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Iulia Sophia / Isidori Ti(berii) Caesaris / Augusti l(iberti) l(iberta) medic(a) / vixit annos xxii Iulia Sophia, freedwoman of Isidorus, freedman of Tiberius Caesar Augustus, physician, she lived 22 years. Gaul 13. Flavia Hedone Funerary inscription; NõÃmes (Colonia Augusta Nemausus, Gallia Narbonensis); end of the 1st cent. ad. CIL xii. 3343; Gummerus no. 343; ReÂmy (a) no. 5 Flaviae Hedones / medicae / ex testa/[mento] Of Flavia Hedone, physician, according to (her) will.

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14. Metilia Donata Honori®c inscription, probably from a building or monument; Lyons (Lugdunum, Gallia Lugdunensis); 1st / 2nd cent. ad. CIL xiii. 2019; ReÂmy (a) no. 18 Metilia Donata medic[a] / de sua pecunia dedi[t] / l(oco) d(ato) d(ecreto) d(ecurionum) Metilia Donata, physician, gave (this) from her own money, the place having been given by decree of the decurions. 15. Anonyma Funerary stele showing a standing, draped female ®gure; Metz (Mediomatrici, Gallia Belgica); 1st cent. ad. CIL xiii. 4334; Gummerus no. 2562; ReÂmy (a) no. 24 [ ]S A[ ]/ini f(ilia) medica [Anonyma], daughter of A[ ]inus, physician. Iberian Peninsula 16. Iulia Saturnina Marble funerary inscription; MeÂrida (Colonia Augusta Emerita, Lusitania); late 2nd±early 3rd cent. ad. CIL ii. 947; ReÂmy (b) no 3. D(is) M(anibus) s(acrum) / Iuliae Saturninae / ann(orum) xxxv / uxori incompara/bili me[dic]ae optimae / mulieri sanctissimae / Cassius

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Philippus / maritus ob meritis / H(ic) s(ita) e(st) S(it) t(ibi) t(erra) l(evis) Sacred to the divine spirits of Iulia Saturnina, 35 years old, incomparable wife, excellent physician, most pious woman, Cassius Philippus, her husband, (made this) on account of her merits. She is laid here. May the earth be light on you. 17. Ambata Funerary inscription; Lara de los Infantes (Hispania Tarraconensis); late 1st cent. ad or after. ReÂmy (b) no. 19 Ambate me/dicae Placi/di f(iliae) an(norum) LXXV To Ambata, physician, daughter of Placidus, 75 years old. Africa

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18. Asylla Polia Tomb of the familia Augusta; Carthage Proconsularis); late 1st±late 2nd cent. ad. CIL viii. 24679; Gummerus no. 316

(Carthago,

Africa

Asylla L. f(ilia) Polia / medica h(ic) s(ita) e(st) / vixs(it) a(nnis) LXV / Euscius l(ibertus) d(e) s(uo) f(ecit) Asylla Polia, daughter of Lucius, physician, is laid here, she lived 65 years; Euscius, (her) freedman, made (this) from his own money. Greece 19. SoÅsanna Marble funerary inscription; Attica; 4th cent. ad or after. IG iii. 3452 [koimhth3rio]n Svsa3nnaw i1 at[r]i3 nhw / [ Burial place of SoÅsanna, physician, [ of) the archangel.

]hn plhhsji3 on toy9 a1rxagge3 loy ] a neighbour of (the shrine

20. Mother of the Gods Marble statue base; Piraeus; statue of a female ®gure, without its head; beginning of the Augustan era. IG ii2. 4714

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e1 pi4 ¸Epikra3toyw a5rxontow Megi3 sth / ¸Arxiti3 moy Sfhthtji3 oy uyga3thr Mhtri4 / uev9n ey1anth3[tQ] i1 atri3 nW ¸Afrodi3 tW / a1ne3 uhken In the archonship of EpikrateÅ, MegisteÅ, daughter of Architimos of Sphettos, set this up to the mother of the gods, the gracious iatrineÅ Aphrodite. 21. Mother of the Gods Marble statue base; Piraeus; 2nd cent. ad. IG ii2. 4759 ¾Imertow Marauv3niow / y2pe4 r ¹Ime3 rtoy Marauvni3 oy / Mhtri4 uev9n ey1anth3tQ / ei1 atrei3 nW Himertos of Marathon, on behalf of Himertos of Marathon, to the Mother of the Gods, gracious iatrineÅ. 22. Mother of the Gods Marble altar; Piraeus; 1st/2nd cent. ad. IG ii2. 4760

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Polyni3 kh Mosxi3 vn/ow Fila3doy / gynh4 Mhtr/i4 uev9n ey1anth3 // tQ i1 atrei3 /nW ey1xh3n PolynikeÅ, daughter of MoschioÅn, wife of PhiladeÅ, to the Mother of the Gods, gracious iatrineÅ, a prayer. Black Sea 23. Anonyma Marble fragment; Constanza (Tomi, Moesia Inferior); 2nd±3rd cent. ad. Inscriptiones Daciae et Scythiae Minoris Antiquae, ii2. no. 333 (169) [ ]mark[ ]/[ ]ei1 atre3 inh[ ] / [ a1]llh3loyw[ ] / [ s] ynghra3san[tew ] / [ ]e2 ayto[i9 w ] . . . mark . . . physician . . . each other . . . having grown old together . . . to themselves . . . Asia Minor 24. Basilous Christian funerary inscription; Corycus, Cilicia. CIG iv. 9164 MAMA iii. 269 svmatouh3kh / Basi3 lo(y9)tow i1 [a]/tri3 nhw Sarcophagus of Basilous, physician.

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25. Thekla Christian funerary inscription; Silifke (Seleucia, Cilicia). CIG iv. 9209 uh3kh Ue3 klhw ei1 atri3 nhw Tomb of Thekla, physician. 26. Empeiria Funerary inscription; Bithynia. CIG ii. 3736 Ga3iow ¸Ioy3liow / Bettiano4w / zv9n e2 aytQ9 / kai4 ¸Empeiriq3 e1 iatrei3 nW tW9 / e2 aytoy9 gy/naiki4 zhsa3sW / e5 th mu¸ kateskey3asen Gaius Iulius Vettianus, while alive, erected (this) for himself and Empeiria, physician, his wife, who lived 49 years.

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27. Treboulia IatrineÅ Funerary inscription; Ankara (Ancyra, Galatia). Archaeologisch epigraphische Mittheilungen aus Oesterreich Ungarn, 9 (1885), no. 84 Tre[b]oyli3 a ¸Iatrinh4 zv9sa fronoy9sa / kateskey3asa to4 peri3 fragma e2 aytW9 / §kai4 Ai1 l(i3 q) ¸Aga3uh ma3mmW kai4 Ai1 l(i3 q) Pvsfo3/ridi mhtri4 kai4 Statvri3 Q Gai3 oy pa3ppQ / kai4 Ai1 l(i3 Q) Levni3 dq a1ndri4 kai4 meta4 to4 / e1 me4 katateuh9nai parori3 zv mhde3 na /e5 xein e1 joysi3 an e1 pisene3 gkai e7 teron / sv9ma e1 a4n de3 tiw tolmh3sei tQ9 tamei3 Q dv3sei / * my3ria pentakisxi3 lia Treboulia IatrineÅ, being alive and of sound mind, erected this enclosure for herself and Ailia AgatheÅ, her grandmother, and Ailia PoÅsphoris, her mother, and StatoÅrios, son of Gaios, her grandfather, and Ailios Leonidas, her husband; and, after my burial, I lay down that no one will be allowed to bring in another body, and, if anyone dares to do so he is to give to the treasury 15,000 denarii. 28. Augusta Christian funerary stele; C Ë esmeli Zebir (Phrygia); 4th±6th cent. ad. MAMA vii. 566; Nutton, no. 24 Ay1r. Ga3iow a1rxi/ei3 atrow a1ne3 s/thsa ei1 sth3lhn / uh9hwj symbi3 oy moy // Ay1goy3sthw a1rxieia3trhna h7tiw / follv9n sv3ma/[si]n a1[r]rvsuv9n / [i7 as]in de3 dv//[ke h¥w] dv3si ay1tW9 s/[(vth4)r ¸I(hsoy9)w] Xr(isto4)w a1m[oi]/[bh4n . . .] Aurelius Gaius, archiatros, set up a stele of my life partner, Augusta, who, as an archiatrineÅ, brought healing to the bodies of many sick people, in return for which the saviour Jesus Christ will give her . . .

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29. Antiochis Statue base in forum; Tlos, Lycia; late 1st cent. bc±early 1st cent. ad. TAM ii. 595.

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¸Antioxi4 w Diado3to[y] / Tlvi3 w martyrhuei9 /sa y2po4 th9w Tlve3 vn / boylh9w kai4 toy9 dh3/moy e1 pi4 tW9 peri4 / th4n i1 atrikh4n te3 /xnhn e1 npeiri3 q / e5 sthsen to4n a1n/ dria3nta e1 ayth9w Antiochis, daughter of Diadotos, of Tlos, marked by the council and people of Tlos for her experience in the medical art, erected this statue of herself.

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This contains details of all works referred to in the text, as well as other relevant items consulted in the course of writing this book. Editions and/or translations of classical works are listed under the name of the editor and/or translator. Abou Aly, Amal, `The Medical Writings of Rufus of Ephesus', Ph.D. diss (University College London, 1992). Adams, Francis (trans. and comm.), The Seven Books of Paulus Aegineta, 3 vols. (London: Sydenham Society, 1844±7). ÐÐ (ed. and trans.), The Extant Works of Aretaeus the Cappadocian (London: Sydenham Society, 1856). Adams, J. N., The Latin Sexual Vocabulary (London: Duckworth, 1982). Adler, Ada (ed.), Suidae Lexicon, 6 vols. (Leipzig: Teubner, 1928± 38). È berlieferung und Alexanderson, Bengt (ed.), PERI KRISEVN: U Text (Studia Graeca et Latina Gothoburgensia, 23; GoÈteborg: Elanders, 1967). Allen, James, `Pyrrhonism and medical Empiricism: Sextus Empiri cus on evidence and inference', ANRW II 37.1 (Berlin: de Gruyter, 1993), 646±90. Anderson, Graham, The Second Sophistic (London: Routledge, 1993). AndreÂ, Jacques, Les Noms de plantes dans la Rome antique (Paris: Les Belles Lettres, 1985). Annas, Julia, Hellenistic Philosophy of Mind (Berkeley and Los Angeles: University of California Press, 1992). ÐÐ The Morality of Happiness (New York: Oxford University Press, 1993). AusbuÈttel, Frank, Untersuchungen zu den Vereinen im westen des roÈmischen Reiches (Frankfurter althistorische Studien, 11; Kall munz: Lassleben, 1982). Bagnall, Roger, and Frier, Bruce, The Demography of Roman Egypt (Cambridge: Cambridge University Press, 1994). Bain, David, `Salpe's PAIGNIA: Athenaeus 322A and Pliny H.N. 28. 38', CQ 48 (1998), 262±8.

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Thomssen, Henrik, and Prost, Christian, `Die Medizin des Rufus von Ephesos', ANRW II 37.2 (Berlin: de Gruyter, 1994), 1293± 349. Thorndike, Lynn, `Translations of works of Galen from the Greek by NiccoloÁ da Reggio (c. 1308±1345)', Byzantina Metabyzantina, 1 (1946), 213±35. Toomer, G. J., `Galen on the astronomers and astrologers', Archive for the History of the Exact Sciences, 32 (1985), 193±206. Tortzen, C. Gorm, `Male and female in Peripatetic botany', C&M 42 (1991), 81±110. Treggiari, Susan, Roman Marriage: Iusti Coniuges from the Time of Cicero to the Time of Ulpian (Oxford: Oxford University Press, 1991). Ullmann, Manfred, `Zwei spaÈtantike Kommentar zu der Hippok ratische Schrift De morbis mulieribus', Medizinisches Journal, 12 (1977), 243±62. ÐÐ (ed., trans., and introd.), Rufus von Ephesos: Krankenjournale (Wiesbaden: Harrassowitz, 1978). È berlieferung der Schriften des Rufus von ÐÐ `Die arabische U Ephesos', ANRW II 37.2 (Berlin: de Gruyter, 1994), 1293±349. Vallance, J. T., The Lost Theory of Asclepiades of Bithynia (Oxford: Oxford University Press, 1990). Valverde, Mariana, `Comment', Journal of Women's History, 5 (1993), 123±8. Vegetti, Mario, `Modelli di medicina in Galeno', in Vivian Nutton (ed.), Galen: Problems and Prospects. A Collection of Papers sub mitted at the 1979 Cambridge Conference (London: Wellcome Institute for the History of Medicine, 1981), 47±63. ÐÐ `L'immagine del medico e lo statuto epistemologica della med icina in Galeno', ANRW II 37.2 (Berlin: de Gruyter, 1994), 1672± 717. Â tude historique sur les corporations professionelles Waltzing, J. P., E chez les Romains, 4 vols. (Louvain: Peeters, 1895±1900). Walzer, Richard (ed. and trans.), Galen: On Medical Experience (London: Oxford University Press, 1944). ÐÐ Galen on Jews and Christians (Oxford: Oxford University Press, 1949). ÐÐ `New light on Galen's moral philosophy', CQ 63 (1949), 82±106. ÐÐ `A diatribe of Galen', in his Greek into Arabic (Oxford: Cassirer, 1962), 164±74. Weaver, P. R. C., Familia Caesaris: A Social Study of the Emperors' Freedmen and Slaves (Cambridge: Cambridge University Press, 1972).

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Wellmann, Max, Die pneumatische Schule bis auf Archigenes (Berlin: Weidmann,1895). ÐÐ `Zur Geschichte der Medicin im Altertum', Hermes, 35 (1900), 349±84. ÐÐ `Dioskurides (12)', RE v. 1 (Stuttgart: Metzler, 1903), 1131±42. ÐÐ (ed.), Pedanii Dioscuridis De Materia Medica, 3 vols. (Berlin: Weidmann, 1907±14). Wenkebach, Ernst (ed.), Pfa€, Franz (trans.), Galeni In Hippo cratis Epidemiarum libros I±II, CMG v. 10.1 (Leipzig: Teubner, 1934). Wenkebach, Ernst (ed.), Galeni In Hippocratis Epidemiarum librum III, CMG v. 10.2.1 (Leipzig: Teubner, 1936). Wenkebach, Ernst (ed.), Pfa€, Franz (trans.), Deichgraeber, Karl, Deller, Karl Heinz (eds.), Galeni In Hippocratis Epide miarum librum VI (i±viii), CMG v. 10.2.2 (Leipzig: Teubner, 1956). Wenkebach, Ernst, Schubring, Konrad (eds.), Galeni In Hippo cratis Epidemiarum librum VI (i±viii), CMG v. 10.2.3 (Berlin: Teubner, 1955). È ber Gewissheit/On Certainty, ed. G. E. M. Wittgenstein, Ludwig, U Anscombe and G. H. von Wright, trans. D. Paul and G. E. M. Anscombe (Oxford: Blackwell, 1974). Youtie, Herbert, `A reconsideration of P. Oxy I. 40', Festschrift Oertel (Bonn: Rudolf Habelt Verlag, 1964), 20±9. Zervos, SkeÂvros (ed.), Aetii Sermo Sextidecimus et Ultimus (Leipzig: Mangkos, 1901). Zonta, Mauro, Un interprete ebreo della ®loso®a de Galeno: gli scritti ®loso®ci di Galeno nell'opera di Shem Tob ibn Falaquera (Turin: Silvio Zamorani, 1995).

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GLOSSARY

aidoion genitals, either male or female (transliteration of the Greek, ai1 doi9 on) aitiologikon part of medicine dealing with the causes of diseases (transliteration of ai1 tiologiko3n) alipta, pl. aliptae athletic or medical trainer or attendant (latiniza tion of a1lei3 pthw) anilis old woman (Latin) aphoÅnia disease of loss of voice (transliteration of a1fvni3 a) apopleÅxia, apoplexia disease of sudden collapse (transliteration and latinization of a1poplhji3 a, respectively) archeÅ origin, source, or ®rst principle (transliteration of a1rxh3) archiater, archiatros court physician or one included in the numerus of those in receipt of various civic privileges (latinizations of a1rxiath3r and a1rxiatro3w, respectively) ars art, that is a body of knowledge combined with a set of skills (Latin) atokios infertility agent (transliteration of a1to3kiow) chirurgus surgeon (latinization of xeiroyrgo3w) collegium voluntary association (Latin) conceptus grasping of the seed in the womb, and then also what results from that grasping, i.e. an embryo (Latin) diairesis division, either logical or physical (transliteration of diai3 resiw) diathesis disposition (transliteration of dia3uesiw) didymoi testicles (transliteration of didy3moi, literally `twins') dynamis faculty, capability, or power (transliteration of dy3namiw) dyskrasia bad mixture or krasis, imbalance of qualities in the body,

or a part thereof (transliteration of dyskrasi3 a)

eklektikos `eclectic' in respect to sectarian or school allegiance (transliteration of e1 klektiko3w) empirikoi, empirici `empiricists', members of the empiricist sect (transliteration and latinization of e1 mpirikoi3 , respectively) epileÅpsia, epilepsia epilepsy (transliteration and latinization of e1 pilhci3 a, respectively) episynthetikoi `synthetic' in respect to sectarian or school allegiance (transliteration of e1 pisynuetiko3w)

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422

Glossary

eques, pl. equites member of the equestrian order, must meet census requirement of 400,000 sesterces (Latin) erysipelas severe skin complaint (transliteration of e1 rysi3 pelaw) gonorrhoia disease of permanent ¯ow of seed (transliteration of gono3rroia) graus old woman (transliteration of gray9w) gymnasteÅs usually athletic, but also medical, trainer (transliteration of gymnasth3w) hairesis `sect' or grouping (transliteration of ai7 resiw) heÅgemonikon ruling or authoritative part of the soul (transliteration of h2gemoniko3n) hektikos `cohesive', when applied to medical allegiance roughly synonomous with `eclectic' or `synthetic'; also refers to a type of pneuma which sustains and coheres uni®ed objects, and to a type of cause, which most immediately sustains what is being caused (transliteration of e2 ktiko3w) herbarius herbalist, supplier, and applier of medical materials (Latin) hexis state or condition of the body (transliteration of e7 jiw) hygieinon part of medicine that deals with the maintenance of health, or simply things concerned with the maintenance of health more widely (transliteration of y2giei3 non) hyleÅ material (transliteration of y7lh) hysterikeÅ pnix disease of uterine su€ocation (transliteration of y2sterikh4 pni3 j) iatraliptes, pl. iatraliptae medical trainer or attendant (latinization of i1 atralei3 pthw; variants include iatralipta and iatroalipta) iatrikeÅ the medical art (transliteration of i1 atrikh3, with which is understood texnh3) iatrineÅ female iatros or physician (transliteration of i1 atrinh3) iatros physician (transliteration of i1 atro3w) kata physin according to nature (transliteration of kata4 fy3sin) katharsis purging or cleansing, also used of menstruation (trans literation of ka3uarsiw) kephalaia chronic headache (transliteration of kefalai3 a) kolpos cavity or sinus, used to refer to the vagina and other parts of the female generative organs or genitalia (transliteration of ko3lpow). kosmeÅtikon work on making the most of your body and appearance (transliteration of kosmhtiko3n) krasis constitutional mixture of qualities, elements, or humours (transliteration of kra9siw) krisis moment when disease is resolved (transliteration of kri3 siw)

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Glossary

423

leÅthargos, lethargus disease of dullness, stupor, and fever (transli teration and latinization of lhua3rgow, respectively) logikoi `rationalists', members of the `rationalist sect' (transliteration of logikoi3 ) logos reason, account, or form (transliteration of lo3gow) magus, pl. magi worker with magic (latinization of mago3w, term derived from the Persian priestly caste) maia midwife (transliteration of mai9 a) maioÅtikon part of medicine that is the business of the maia, midwifery (transliteration of maivtiko3n) mania disease of chronic psychical derangement (transliteration of mani3 a) mathematicus astrologer (latinization of mauhmatiko3w) medica female medicus or physician (Latin) medicina medical art (Latin) medicus physician (Latin) melancholia disease of severe psychical distress (transliteration of melagxoli3 a) methodikoi `methodists' or `methodics', members of the `methodist sect' (transliteration of meuodikoi3 ) meÅtra standard Greek term for the womb or uterus (transliteration of mh3tra) morbus comitialis epilepsy (Latin, literally `disease of the comitia or assembly', referring to the postponement of business which traditionally followed on from the witnessing of epileptic seizures) natura nature (Latin) nephritis disease centred on kidneys (transliteration of nefri9 tiw) nomos custom, law, norm, or convention (transliteration of no3mow) numerus number included in a grant of civic privileges (Latin) nympheÅ clitoris, also the word for rosebud or young bride (trans literation of ny3mfh) obstetrix midwife (Latin) oneirokriteÅs interpreter of dreams (transliteration of o1neiroktith3w) orcheis testicles, and orchids (transliteration of o5rxeiw) ordo local senate (Latin) orexis desire or appetency (transliteration of o5rejiw) para physin contrary to nature (transliteration of para4 fy3sin) parastatai `supporters', seminal vessels connected to the didymoi or orcheis, where some place the main site of seminal production (transliteration of parasta3tai) partus embryo, foetus, or birth (Latin) pathologikon part of medicine dealing with disease, especially its causes (transliteration of pauologiko3n)

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424

Glossary

perissoÅmata, perittoÅmata residues, that part of food, drink, and other stu€s taken in, that cannot be fully assimilated by the body (transliteration of perissv3mata) pharmaka medicaments applied internally or externally (translitera tion of farma3ka) pharmakopoÅleÅs, pharmacopola quack or pedlar of poisons (trans literation and latinization of farmakopv3lhw, respectively) phrenitis disease of feverish psychical disturbance (transliteration of freni9 tiw) physikon `natural', adjective relating to physis applied to a type of pneuma and types of bodily function or activity (in contrast to the psychikon), and to knowledge about them (transliteration of fysiko3n) physiologikon part of medicine dealing with the body according to nature (transliteration of fysiologiko3n) physis nature (transliteration of fy3siw) pleuritis disease involving severe pains in the side, fever, and coughing (transliteration of pleyri9 tiw) pneuma hot air integrated into bodily functioning (transliteration of pney3ma) pneumatikoi `pneumatists', members of the `pneumatic school' (transliteration of pneymatikoi3 ) pneumonia severe a€ection of the lungs (transliteration of pneymoni3 a) podagra gouty complaint a€ecting the feet (latinization of poda3gra) polis Greek city state (transliteration of po3liw) ponoi work, activity, or exercise (transliteration of po3noi) poroi passages or channels of the body (transliteration of po3roi) psycheÅ soul (transliteration of cyxh3) psychikon pertaining to the soul, psychical (transliteration of cyxiko3n) rhizotomos root cutter, supplier, and applier of medical materials (transliteration of r2izotomo3w) satyriasis disease of permanent tension of the generative organs (transliteration of satyria3siw) seÅmeiotikon semiotic part of medicine, dealing with diagnosis and prognosis (transliteration of shmeiotiko3n) sylleÅpsis grasping of the seed in the womb (transliteration of sy3llhciw) techneÅ art, body of knowledge joined to a set of skills (transliteration of texnh3) telos goal or end (transliteration of te3 low) tetanos disease of convulsive stretching (transliteration of te3 tanow)

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Glossary

425

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therapeutikon therapeutic part of medicine, dealing with cures (transliteration of uerapeytiko3n) vulva standard Latin word for the womb or uterus

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INDEX LOCORUM

Non-standard abbreviations used are to be found in Appendix 1, otherwise the English title is given in full. Where neither published text nor translation are broken down into books, chapters, or sections, I have had to cite passages in terms of page and line of the edition used; this information may otherwise be obtained by locating the passage as listed.

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AETIUS Placit. iv. 5 100 n. 42 v. 3 202 n. 51 v. 5 203 n. 53 v. 6 204 n. 59 v. 7 205 n. 62 v. 8 205 n. 64 v. 10 205 n. 63 v. 13 204 n. 60 v. 15 205 n. 67 v. 16 205 n. 65 v. 18. 3 247 AETIUS OF AMIDA See Archigenes; Philumenus AGNELLUS OF RAVENNA Lectures on Galen's De Sectis 4 85 n. 8 5 6 91 n. 23 20 88 n. 19 [ALEXANDER OF APHRODISIAS] Quaest. 1. 9 103 n. 49

ANONYMUS PARISINUS 1. 6 226 2. 3. 1 10 113 16. 1 213 16. 10 213 ANTHOLOGIA PALATINA 11. 115 54 n. 64 (Nicarchus) ANTYLLUS EPB (ap. Orib., Coll. Med.) 9. 14. 6 226 10. 19. 1 10 220 10. 20. 1 4 220 10. 23. 1 19 220 10. 25. 1 4 219 n. 107 10. 30. 1 10 220 KB (ap. Orib., Coll. Med.) 7. 9. 1 9 216 7. 9. 3 4 216 PB (ap. Orib., Coll. Med.) 6. 10. 1 25 225 6 6. 21. 2 224 5 6. 22. 1 12 224 5 6. 27. 1 5 224 5 6. 28. 1 4 224 5 6. 30. 1 225 6. 31. 5 224 5

ANONYMUS BAMBERGENSIS 6r 88 n. 19, 195 n. 29 & 30

APULEIUS Met. 10. 2 264 n. 29

ANONYMUS LONDINENSIS 4. 26 22. 5 196 5. 1 198 n. 39 20. 1 24 93 n. 25 20. 25 6 93 n. 26 21. 18 22. 5 95 n. 28 25. 41 5 98 n. 34, 201 202

ARCHIGENES ap. AeÈt., Tet. 16. 42 210 (and Leonides) 16. 63 212 n. 86 16. 86 219 n. 107 ap. Gal., Comp. Med. Loc. 6. 8 354 n. 173

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428

Index Locorum

ARETAEUS THE CAPPADOCIAN CA 1. 2. 18 226 1. 4. 14 15 226 1. 10. 16 219 2. 10. 1 6 217 18, 220 CD 1. 5. 7 217 SA 1. 6. 2 211 n. 81 1. 6. 3 209 10 1. 7. 2 189 1. 9. 4 210 1. 10. 1 189 n. 9 2. 1. 1 189 n. 8 2. 1. 2 189 n. 9 2. 2. 3 211 n. 82 2. 2. 9 211 n. 82 2. 3. 3 189 n. 8 2. 6. 1 189 n. 8 2. 7. 1 189 2. 7. 3 189 2. 10. 2 210 n. 81 2. 11 211 n. 84 2. 11. 1 211 2. 11. 6 210 n. 80 2. 12. 4 212 SD 1. 6. 4 211 n. 83 2. 5. 1 212 2. 5. 3 4 212 213 2. 11. 1 5 212 n. 86 2. 11. 9 11 211 3. 4. 1 2 210 AELIUS ARISTIDES Sacred Tales 1. 57 68, 72 1. 62 8 49 2. 38 45 49 3. 8 9 260 n. 17 3. 18 19 49 4. 15 29 72 4. 28 260 n. 17 4. 38 68 4. 43 260 n. 17 4. 63 70 72 4. 83 260 n. 17 4. 107 260 n. 17 ARISTOTLE GA 728a17 20 306 n. 54

737a29 119 765b 117 n. 83 GC 330a30 330b7 93 n. 26 HA 491b28 34 308 n. 58 501b19 20 155 n. 66 533a10 15 308 n. 58 Met. 983a25 304 n. 46 983b7 987a28 9 n. 18 PA 646a20 4 95 n. 28 648a28 30 117 n. 83, 363 n. 2 658a9 293 n. 15 Phys. 194b16 195a3 304 n. 46 194b17 23 118 n. 84 Pol. 1252b32 1253a40 18 1253b15 1255b40 13 15 1259a3 1260b26 13 15 Rh. 1407b7 23 n. 43 ARRIAN Epict. 1. 16. 3. 10 3. 10. 3. 20. 3. 23.

10 66 15 14 17

14 321 n. 91 n. 89 67 67 69

ASTROLOGICAL MANUSCRIPTS CCAG iv. 134 6 144 n. 41 v. 3. 76 145 vi. 83 4 144 n. 41 vii. 188 145 vii. 231 6 144 n. 41 ix. 2. 129 35 144 n. 41 xii. 126 55 144 n. 41 ATHENAEUS 7. 321f-322a 40 1 15. 629f-693a 64 n. 83 15. 694a 64 n. 83 15. 701f-702b 64 n. 83 CAELIUS AURELIANUS CP 1. 6 105 6 1. 22 3 110 n. 64 1. 40 41 107 8

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Index Locorum

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1. 108 9 109 n. 62 2. 7 8 88 n. 18 2. 7 195 n. 31 2. 13 14 103 4 2. 44 194 2. 64 110 n. 64 2. 65 110 n. 63 2. 77 245 n. 185 2. 89 90 105 3. 54 5 245 n. 185 3. 175 187 242 n. 177 3. 176 8 242 n. 178 Gyn. 2. 64 242 2. 112 243 4 De Salutaribus Praeceptis 6 42 TP 1. 3 194 1. 71 2 245 n. 185 1. 97 42 n. 24 1. 169 42 n. 24 2. 179 42 n. 24 4. 109 245 n. 185 5. 79 242 n. 177 5. 130 42 n. 24 MARCUS AURELIUS (M. Ant) 1. 16. 19 20 71 1. 17. 20 71, 72 5. 8. 1 72 9. 41. 1 67 CALCIDIUS Timaeus 246 207 n. 71 CASSIUS DIO 53. 30 51 n. 52 53. 30. 3 45 n. 34 56. 4 64 n. 83 72. 24. 4 71 72. 36. 2 4 71 CELSUS Med. pr. 2 11 82 n. 3 pr. 11 228 9 pr. 13 26 110 n. 66 pr. 45 130 pr. 46 8 130 1 pr. 54 7 87 n. 87, 228 9 pr. 66 130 1 pr. 77 130 1

429

1. 1. 1 42 n. 23, 149 1. 3. 1 150 1. 9. 3 150 2. 1. 13 158 2. 1. 14 159 2. 1. 16 158, 159 2. 1. 17 22 159 2. 1. 20 159 2. 6. 8 159 2. 7. 7 159 60 2. 7. 10 173 n. 132 2. 7. 27 161 2. 8. 7 159 60 2. 8. 16 160 2. 8. 23 159 60 2. 8. 13 159 2. 8. 41 161 2. 10. 1 4 177 8 2. 14. 9 177 3. 23. 1 160 4. 1. 11 13 155 6 4. 11. 2 160 4. 26. 11 179 n. 158 4. 27. 1a 175 4. 28. 1 2 178 9 4. 31. 1 159 60 5. 20. 2 173 n. 132 5. 21. 1 177 n. 152 5. 21. 1B 161 n. 86 5. 21. 5 170 5. 21. 7 164 5. 25. 3 173 n. 132 5. 25. 13 170 5. 25. 14 171 n. 125 5. 26. 3A 173 n. 133 5. 26. 13 173 5. 26. 14 173 5. 28. 2A 174 5. 28. 7A 174 5. 28. 12B 173 n. 132 6. 5. 1 172 6. 6. 38 159 60 6. 18. 1 11 176 6. 18. 1 170 6. 18. 9C 160 6. 18. 10 173 n. 132 7 pr. 3 38 n. 10 7. 17. 1 173 4 7. 26. 1A-C 176 7. 26. 4 176, 177 7. 28. 1 2 176 7. 29. 1 10 170 8. 1. 23 156

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Index Locorum

CICERO Fam. 1. 9. 15 42 Fin. 5. 16 81 ND 2. 32. 81 2 301 n. 39 2. 51. 127 2. 60. 152 301 n. 39 O€. 1. 150 151 54 DAMOCRATES ap. Gal., Comp. Med. Gen. 1. 19 354 n. 119 [DEMOCRITUS] Natural Secrets 3 146 n. 44

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DIO CHRYSOSTOM Or. 7. 103 132 54 n. 63 33. 6 7 59 n. 77 DIOGENES LAERTIUS 7. 137 93 n. 26 8. 61 2 83 n. 5 9. 46, 48 94 n. 27 9. 116 246 DIOSCORIDES MM pr. 1 43 n. 26 pr. 4 137 1. 1. 3 175 n. 141 1. 4. 2 173 n. 132 1. 6 168 n. 115 1. 7. 4 173 n. 132 1. 13. 3 173 n. 132 1. 14. 3 139 n. 25 1. 15. 2 176 n. 47 1. 16. 1 161 1. 19. 4 167 n. 114 1. 20. 2 167 n. 114 1. 23 173 n. 132 1. 29 138 n. 22 1. 30. 5 138 1. 32. 2 173 n. 132 1. 33. 2 174 n. 140, 175 1. 45. 2 173 n. 132 1. 47. 2 171 n. 125 1. 50 173 n. 132 1. 58. 2 173 n. 132

1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 4.

67. 2 167 n. 114 70. 2 173 n. 132 72. 2 173 n. 132, 175 n. 141 73. 2 175 77. 2 164 n. 102 & 103 78. 2 168 n. 115 93 167 n. 109, 175 n. 145 97. 2 175 n. 145 101. 2 173 n. 132 103. 2 171 n. 127 125. 2 162 n. 90 159. 3 164 n. 103 179. 3 164 n. 102 7 175 24. 1 167 n. 114 75. 1 163 80. 4 167 n. 114 81. 2 173 n. 132, 174 n. 140 100 163 105. 1 172 109 167 n. 114 114. 3 139 40 120 164 n. 103 124. 3 173 n. 132 127 138 n. 22 149. 1 173 n. 132 154. 2 174 n. 140 156. 2 138 n. 22 164. 1 167 4. 4 171 n. 127 14. 2 171 n. 125 24. 2 162 n. 90 31. 1 171 n. 127 31. 2 173 n. 132 32 168 n. 115 43 162 n. 90 44. 2 167 n. 114, 174 n. 136 45. 1 164 n. 102 55 162 n. 90 56 175 n. 145 58 164 n. 102 59. 1 138 n. 22 62. 1 139 n. 25 71 171 n. 127 92 173 n. 132, 174 n. 136 122 174 n. 136 124 166 125 138 n. 22 126. 2 166 128 166 n. 107 131 167 140. 3 175 n. 145 14. 2 165

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Index Locorum 4. 4. 4. 4. 4. 4. 4. 4. 4. 4. 4. 4. 4. 4. 5. 5. 5. 5. 5. 5. 5. 5. 5.

19 164 n. 103, 171 n. 129 20. 2 165 35 138 n. 22 36 173 n. 132 62 172 68. 4 174 n. 136 74 138 n. 22, 139 n. 25 78. 2 171 n. 127 & 129, 172 119 139 n. 25 131 138 146 138 168 138 n. 22 185 164 n. 102, 167 189. 2 165 n. 105, 166 3. 2 174 n. 136 54. 2 162 n. 90 61 162 n. 90 80 164 n. 102 128. 1 174 n. 140 142 171 n. 126 146 162 n. 90 149 171 n. 129 154 171 n. 126

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EPICTETUS Fr. 15 368 FIRMICUS MATERNUS Math. 3. 7. 6 55 n. 67 3. 7. 19 20 56 n. 69 3. 7. 19 55 n. 67 3. 7. 20 56 n. 68 3. 8. 3 56 n. 68 3. 9. 2 56 n. 70 4. 10. 3 56 n. 71 4. 14. 17 56 n. 72 4. 15. 8 55 n. 67 5. 2. 17 56 7. 17. 7 56 n. 72 8. 23. 4 56 n. 73 8. 25. 10 56 n. 70 8. 28. 3 55 n. 67 FRONTO Ad M. Caes. (van Hout) 3. 10 72 4. 8 67 4. 11 75 5. 23 75 5. 26 75

431

GALEN AA 1 60 n. 79 1. 1 2 260 1. 1 261 1. 2 294 n. 17 2. 2 293 4. 1 294 6. 1 318 n. 86 7. 10 294 n. 17 7. 16 59 n. 77 12. 1 3 296 7 12. 1 296, 323 n. 95 12. 2 295, 297, 299 12. 4 6 297 12. 7 9 295 13. 3 296 A€. Dig. 8. 1 8 60 n. 79 8. 1 2 258 8. 1 258 8. 3 260 8. 4 260 8. 5 257 n. 5 8. 6 8 258 8. 6 7 260 9. 4 259 9. 10 261 On Antidotes 1 and 13 267 n. 37 Ars Med. 1 284 n. 79, 292 On Black Bile 4. 12 260 CAM pr.-1 272 pr. 284 n. 79 2 288, 290 5 288 9 6 257 7 8 302 9 273, 289, 290 11 289, 343 n. 137 20 290 Caus. Puls. 1. 1 329 30 3. 2 314 16, CC 1. 3 99 n. 36 2. 1 6 188 n. 7 2. 1 88 n. 19 10. 4 5 110 n. 65 CP 6. 67 304 n. 46

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432

Index Locorum

GALEN (cont.) Commentary on Hippocrates' On Fractures 3. 21 261 2 Comp. Med. Gen. 1. 5 355 n. 176 1. 19 354 n. 173 2. 1 354 5 2. 15 355 2. 21 355 6 3. 2 261 2 4. 1 355 7. 1 355 6 7. 11 355 n. 176 Comp. Med. Loc. 1. 2 40 1. 22 40, 259 n. 10 1. 3 40, 269, 270 1. 8 40, 355 n. 176 2. 1 259 n. 10, 355 n. 176 3. 2 355 n. 176 3. 3 141 n. 30 4. 4 141 n. 30 6. 6 269 n. 44 6. 8 354 n. 178 9. 2 35 n. 3 9. 8 10 354 9. 10 334 n. 114, 354 10. 1 35 n. 3 Cris. 3 278 3. 7 and 11 342 On Curing by Venesection 23 280 Di. Dec. 1 342 Diagnosis from the Pulse 1. 3 195 n. 29 Di€. Puls. 3. 6 88 n. 19, 195 n. 29 4. 11 195 n. 30 Di€. Resp. 3. 13 334 n. 114 On Dissection of the Muscles 28, 29, and 31 295 That the Dynameis of the Soul follow the Kraseis of the Body 9 277 Foet. Form. 1 299 5 6 299 6 299 301 On Habits

5 339 n. 125 Hipp. Aph. 3. 11 341 3. 28 310 11 5. 28 342 5. 37 8 311, 349 n. 153 5. 42 341 5. 48 309 n. 59 5. 55 341 n. 129 5. 69 341 7. 43 310 Hipp. Elem. 1. 1 2. 2 302 Hipp. Epid. 1 1. 12 341 2 1 2. 60 342 3 2 323 n. 95 2 1 310 11, 340 n. 127 2 2 341 2 3 310 n. 61, 341 2 5 269 2 6 309 n. 59 3 1. 40 260 3 2. 12 341 n. 129 3 3. 72 341 n. 131 3 3. 77 340 1 6 1. 5 313 n. 73 6 1. 29 198 n. 39 6 2. 46 7 310 6 2. 46 309 n. 59 6 2. 48 310 11 6 7 338 n. 123 6 8 334 n. 114 Hipp. Prog. 1. 8 264 n. 28 2. 11 259 n. 10 HNH pr. 316 n. 80, 317 1. 10 14 302 1. 20 289 n. 6, 292 n. 12 3.pr 317 3. 25 316 17 HVA 3. 39 347 4. 80 332 3 Lib. Prop. 1 262, 267 1. 1 257 n. 2 2 48 n. 43, 260 1, 261, 266 7 3 260 11 258 n. 6 12 256 n. 1 Loc. A€.

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Index Locorum 5. 7 338 n. 121 6. 5 36 n. 4, 333 8 6. 6 336 7, 339 n. 126 Med. Exp. 6 110 n. 65 MM 1. 2 274 n. 56, 278, 330 1. 3 278 1. 4 274 n. 55 1. 5 102 n. 46, 273 n. 53, 289 n. 3 1. 7 229 n. 126 1. 8 106, 329 30 2. 1 273 n. 53 2. 3 330 2. 6 289, 330 3. 3 247 n. 192, 350 3. 4 247 3. 7 247 n. 192 4. 4 102 n. 48 5. 7 303, 310 n. 62 5. 8 310 n. 62, 348 n. 148, 350 n. 155 5. 11 268 6. 6 349 n. 153 7. 13 348 n. 148 8. 5 259 n. 10 9. 4 260 9. 8 278 9 13. 11 348 n. 149 13. 22 259 n. 10 MMG 1. 1 274 n. 57, 343 5 1. 2 1. 15 345 1. 9 108 n. 61 1. 15 346 7 1. 15 346 2. 1 4 347 8 2. 4 348 9 2. 11 310 n. 62, 349 50 2. 12 349 On Morals 1 2 339 n. 126 3 284 Morb. Di€. 8 and 10 331 2 On Movement of the Muscles 3 295 n. 19 Nat. Fac. 1. 1 301, 318 n. 84 1. 6 302 1. 13 97 n. 31 2. 2 97 n. 31 3. 2 3 298 n. 33

433

3. 8 298 n. 34 3. 11 298 9 Opt. Med. Cogn. 7. 2 59 n. 77 9. 2 3 60 n. 78 9. 4 7 261 2 13. 6 8 267 8 Ord. Lib. Prop. 1 281 3 260 4 258 n. 6, 260 Part. Art. Med. 1. 3 114 n. 74 2. 1 91 n. 22 3. 5 288 n. 1 5. 4 7 291 2 5. 6 8 114 n. 74 6. 3 4 91 n. 22 7. 1 5 291 n. 11 7. 2 3 291 2 PHP 1. 3 280 2. 3. 8 11 301 n. 41 2. 3. 9 11 274 5 2. 8. 1 2 274 5 3. 4. 15 18 277 n. 65 3. 5. 8 10 276 3. 5. 8 276 3. 5. 22 276 7 3. 8. 35 280 n. 74 3. 8. 36 276 7 5. 3. 18 102 n. 48, 103 n. 49 8. 4. 9 12 95 n. 28 9. 3. 25 6 357 8 9. 5. 6 246 On the Powers of Foodstu€s 1. 37. 2 3 257 n. 5 Praen. 2 3 266 2. 12 260 5. 4 5 266 5. 4 262 5. 9 21 262 6. 1 10 263 4 6. 2 263 6. 14 16 263 4 8 39 n. 12, 264 5 8. 2 3 76 n. 120 9. 1 4 266 n. 34 9. 5 7 266 11. 1 10 266 7 12. 1 9 266 7 12. 5 9 270

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434 GALEN (cont.) 12. 10 270 1 Protr. 2 5 259 2. 2 259 9 272 n. 52 14. 4 284 5 Puls. 9 314 n. 75 San. Tu. 1. 1. 1 291 n. 11 1. 1. 3 4 330 1. 3. 1 100 n. 40, 289 1. 4 289 1. 5. 1 29 289 n. 3 1. 5. 11 289 n. 6 1. 5. 34 290 n. 8 1. 9. 1 9 316 1. 12. 6 12 316 1. 18. 19 21 48 n. 46 2. 8. 1 2. 10. 12 316 4. 2 3 291 2 4. 4. 6 316 4. 4. 24 316 Sem. 1. 1. 1 3 275 6 1. 1. 2. 1 13 275 1. 1. 3 1. 2. 4 280 1. 4. 1 1. 7. 20 298 1. 7. 12 324 1. 13 16 323 1. 15. 28 1. 16. 35 323 1. 16. 5 200 n. 43 1. 16. 16 19 323 5 2. 1. 25 6 335 n. 115 2. 1. 32 203 n. 55 2. 2. 28 203 n. 57 2. 5. 1 76 308 10 2. 5. 3 98 n. 34 2. 5. 38 324 2. 6. 31 324 3. 5. 38 309 n. 59 2. 5. 48 69 308 Sent. 1. 4 301 n. 42 2 299 n. 37 3. 1 2 299 300 7. 1 5 299 300 7. 4 101 n. 43 11 299 n. 37, 325 SI 1. 1 291 n. 11

Index Locorum 3 4 110 n. 66 3 112 4 111 SMT 1. 39 195 n. 30 5. 1 351 5. 20 25 351 6 pr. 277 n. 65 6.A. 22 352 n. 160 6.B. 3 & 15 352 n. 160 6.D. 2 & 3 352 n. 160 6.D. 11 352 n. 161 6.E. 1 352 n. 160 6.E. 15 352 6.I. 1 352 n. 161 6.I. 42 & 60 352 n. 163 7.K. 1 352 7.K. 11 & 17 352 n. 163 7.K. 16 & 55 352 n. 160 8.O. 7 352 n. 160 8.S. 30 352 n. 160 9. 1. 4 352 n. 160 9. 2. 7 352 n. 160 9. 2. 17 353 10. 1 353 10. 2. 4 353 10. 2. 6 353 n. 167 10. 2. 10 & 22 353 n. 169 10. 2. 13 352 3 11. 1. 2 352 3, 353 n. 169 11. 1. 34 260 Subf. Emp. 4 246 5 91 n. 22 6 103 n. 51, 105 n. 54, 108 11 85 n. 8, 246 12 246 On Swellings contrary to Nature 15 331 2 Sympt. Caus. 1. 2 329 30 1. 6 332 1. 7 332, 338 n. 121 2. 3 332 3. 9 332 3. 11 332, 336 n. 118, 337 Sympt. Di€. 1. 6 332 Ther. 1 271 On Tromos, Palmos, Spasmos, and Rigos 5,6, and 8 332

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Index Locorum UP 1. 2 4 318 19 1. 2 318 1. 4 319, n. 88 6. 12 303 4 6. 13 304 7. 22 303, 313 10. 12 279 10. 14 279 11. 9 321 11. 13 304 11. 14 305 n. 51, 320 3 14. 2 305, 306 14. 4 297 n. 29, 309 n. 59 14. 5 306 14. 6 306 7, 307 n. 56, 308 14. 7 308 10 14. 8 311 14. 11 324 14. 14 324 15. 1 307 Ut. Diss. 3. 1 3 297 4. 1 7 295 6 5. 1 296 5. 2 297 n. 27 6. 1 3 297 7. 1 3 297 9. 1 2 296 9. 1 296 n. 24 9. 4 7 296 9. 5 297 n. 27 10. 1 17 297 10. 4 5 298 Ut. Resp. 1. 2 99 n. 38 5. 8 100 n. 41 Ven. Art. Diss. 8 296 Ven. Sect. Er. 5 311 13, 338 Ven. Sect. Er. Rom. 1 39 n. 12, 59 n. 77, 262, 265, 312 13 3 279 [GALEN] Def. Med. 9 81 10 91 n. 23 11 91 n. 24, 191 14 87 n. 17 17 87

435

31 93 n. 25, 196 33 95 n. 29, 196 58 60 201 60 233 n. 137, 297 n. 29 73 4 70 n. 101 94 202 97 203 n. 54 110 70 n. 101 129 103 n. 49 133 103 n. 49 288 9 203 n. 56, 213 298 9 210 n. 80 300 211 n. 84 301 212 n. 86 303 304 210 n. 80 413 213 n. 93 429 432 210 n. 80 439 202 440 202 3, 213 442 204 443 205 444 205 445 205 446 205 447 205 449 205 451 204 452 205 453 206 454 205 457 205 6 [GALEN] Intro. 1 82 n. 3 4 85 n. 8, 87 n. 14, 88 n. 18, 191 2, 229 n. 126, 246 6 81 7 91 n. 24, 191 8 191 9 95 n. 29, 107, 188, 196 10 198, 218 n. 103 11 197 n. 34, 201, 207 n. 72 13 99 n. 36, 101 n. 45, 107, 206 7 19 112 n. 69 AULUS GELLIUS 4. 2. 3 102 12. 1. 8 169 n. 121 12. 3 69 n. 98 16. 3 66 n. 89, 69 n. 98 18. 10 69 71

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436 HELIODORUS ap. Orib., Coll. Med. 49. 1. 1 3 216 17 HELIODORUS Ethiopian Story 4. 7 264 n. 29 HERODOTUS ap. Orib., Coll. Med. 5. 27. 2 225 5. 27. 13 225

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HESYCHIUS Lexicon m 64 39 n. 11 HIPPOCRATES Aph. 3. 11 158 n. 74 3. 14 158 n. 74 3. 18 159 n. 76 3. 28 159 n. 77 5. 30 159 n. 79 5. 32 33 160 n. 84 5. 39 161 n. 85 5. 40 161 n. 85 5. 48 309 6. 28 30 160 n. 81 On the Eight Month Child 9 116 n. 81 Epid. 6. 6. 2 111 Nat. Hom. 7 96 7 Mul. 1. 1 117 1. 62 116 2. 119 117 2. 121 117 n. 82 On the Nature of the Child 1 204 n. 58 Prorrh. 2. 7 160 n. 81 2. 22 159 n. 79 2. 26 160 n. 81 On the Sacred Disease 1 11 18 11 Superfoetation 31 205 n. 62

Index Locorum INSCRIPTIONS CIL ii. 5399/5400 51 2 v.6970 48 n. 43 vi.8908 38 n. 10 vi. 8981 42 n. 23 vi. 377523 38 n. 10 viii. 11345 51 ix. 1655 52, 55 ix. 1971 52 IG ii2 4514 49 xiv 967a/b 48 n. 46 IGR iv. 502 6 257 n. 5 I. Ephesos 629 42 n. 23 1160 9 59 n. 77 1386 47 4101 59 n. 77 I. Mag. 113 51 I. Parion 40 52 n. 58 MAMA iii. 292a 36 n. 4 iii.605 52 n. 58 INFANCY GOSPEL OF JAMES 5. 2 39 18. 1 39 19. 1 20. 4 39 JOHN OF ALEXANDRIA Commentary on Hippocrates' Epidemics vi 12 88 n. 19 42 144 Commentary on Hippocrates' On the Nature of the Child 18 169 n. 119 JUSTINIAN Dig. 21. 1. 1. 7 102 25. 4. 1 57 n. 75 27. 1. 6. 1 11 45 n. 35 27. 1. 6. 1 9 46 n. 36 27. 4. 18. 30 45 n. 34 47. 11. 4 169 n. 121 48. 8. 3. 2 170 48. 19. 38. 5 170

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Index Locorum 48. 50. 50. 50.

19. 39 169 n. 121 9. 1 46 13. 1 46 n. 38 13. 1. 2 39 n. 11, 46

JUVENAL 6. 235 7 76 n. 118 6. 236 195 6. 373 195 6. 578 81 75 6. 610 613 138 n. 23 13. 98 195 14. 252 195 LIBANIUS Ep. 1303. 1 72 n. 108 Or. 1. 17 and 91 72 1. 139 143 72 1. 172, 177 8 72 1. 200 203 72 1. 243 250 72

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LUCAN 6. 434 506 138 n. 23 LUCIAN DDeor. 15 43 [LUCIAN] Am. 31 6 367 MACROBIUS Sat. 7. 7. 1 12 75 7. 7. 2 7 363 n. 2 MARTIAL 1. 47 54 11. 17. 7 76 12. 43 40 n. 15 MUSONIUS RUFUS Fr. (Lutz) 3 & 4 367 21 321 n. 91 MUSTIO 2. 51 242 2. 76 243 4

437

OLYMPIODORUS In Plat. Gorg. 12. 1. 4 272 n. 52 ORIBASIUS Coll. Med. 44. 5. 15 16 216 n. 96 50. 7. 1. 5 219 n. 105 See also Antyllus; Heliodorus; Herodotus; Philumenus; Rufus. ORION Etymologicon 34. 9 234 n. 144 PAPYRI P.Iand. v. 82 197 n. 36 P.Mert. i.35 54 P.Mich. 758 140 n. 27 P. Oxy. lxi.4122 53 n. 59 lxiii.4366 53 n. 59 PSI 229 75 P. Strassb. i. 75 53 n. 60 PAUL OF AEGINA 1. 99 145 6. 68 219 n. 105 6. 70 243 4 PETRONIUS Sat. 28 42 n. 23 PHILO Questions and Answers on Genesis 3. 47 218 n. 104 PHILUMENUS ap. AeÈt., Tet. 16. 23 217 18 16. 79 226 16. 103 217 18 16. 105 218 16. 106 217 ap. Orib., Coll. Med. 45. 29. 79 210 ap. Orib., Syn. 9. 45. 1 7 217 18, 220

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438

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PLATO Resp. 451b9 457b6 16 451d4 456b11 358 n. 179 453a1 23 n. 43 454a7 8 23 n. 43 Ti. 86c-d 203 n. 55 91a-b 203 n. 55 91b7 c7 335 PLINY THE ELDER HN pr. 13 131 n. 7 2. 1. 2 131 7.pr 1 5 151 7. 2. 15 152 7. 2. 23 151, 152 7. 2. 30 152 7. 2. 31 151 7. 3. 33 6 152 7. 3. 37 153 7. 4. 38 40 152 7. 5. 41 153 7. 5. 43 4 169 7. 10. 50 2 153 7. 11. 57 7. 12. 62 153 7. 13. 63 4 153 7. 13. 64 7. 14. 66 153 7. 15. 71 155 n. 66 7. 16. 75 154 7. 23. 87 154 7. 33. 119 154 7. 35. 120 154 7. 41. 133 154 7. 48. 158 154 7. 52. 175 175 10. 83. 172 169 11. 47. 130 1 154 11. 49. 133 155 11. 63. 167 155 11. 84. 209 155, 175 11. 90. 221 156 11. 90. 223 156 11. 94. 229 156 11. 94. 230 154 n. 64 11. 95. 232 156 11. 105. 253 156 11. 109. 262 156 11. 110. 263 156 11. 112. 269 156 16. 62. 145 157 8 20. 3. 6 163

Index Locorum 20. 20. 20. 20. 20. 20. 20. 20. 20. 20. 20. 20. 20. 21. 21. 21. 21. 21. 21. 21. 21. 21. 21. 22. 22. 22. 22. 22. 22. 22. 22. 23. 23. 23. 23. 23. 23. 23. 24. 24. 24. 24. 24. 24. 24. 24. 24. 25. 25. 25. 25. 25. 25.

15. 32 163 22. 48 164 n. 99, 173 n. 132 40. 105 168 n. 117 44. 114 164 n. 101, 174 n. 136 51. 143 167 57. 162 174 n. 140 81. 214 171 n. 127 84. 226 168 n. 118 87. 238 174 n. 140 89. 226 39 40 91. 248 167 96. 258 162 n. 90 99. 263 165 73. 123 173 n. 132 77. 132 174 n. 136 84. 146 168 n. 118 85. 148 173 n. 132 86. 149 174 n. 140 88. 153 172 n. 131 89. 156 162 n. 90 91. 159 172 n. 131 97. 170 172 104. 176 173 n. 132 15. 31 173 n. 132 38. 81 175 n. 145 40. 83 163 44. 89 171 n. 125 47. 98 172 n. 131 65. 134 173 n. 132 71. 147 162 n. 90 74. 156 162 n. 90 26. 53 167 n. 112 32. 66 162 n. 90 32. 67 171 n. 127 53. 99 168 n. 117 60. 112 162 n. 90 71. 138 162 n. 90 80. 153 167 n. 112 6. 12 163 13. 22 171 n. 125, 173 n. 132 42. 70 175 n. 145 42. 72 162 47. 78 164 n. 101 59. 100 171 n. 127 92. 143 157 8, 167 97. 154 168 n. 117 120. 184 173 n. 132 4. 8 43 n. 26 6. 17 18 134 7. 24 5 168 18. 39 40 165 25. 61 177 26. 62 43 n. 26

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Index Locorum 25. 34. 71 167 n. 112 25. 54. 97 165 25. 95. 154 171 n. 129 26. 3. 3 159 26. 4. 5 137 n. 19 26. 6. 10 26. 8. 17 132 n. 9 26. 63. 97 165 26. 90. 151 26. 92. 163 179 n. 159 26. 90. 151 173 4 26. 90. 153 168 n. 115 & 117 26. 91. 162 165 n. 105 & 106 26. 92. 163 171 n. 128 27. 13. 30 162 n. 90 27. 17. 34 164 n. 101 27. 40. 62 165 27. 40. 63 163, 174 n. 136 27. 42. 65 165 27. 53. 76 171 n. 129 27. 55. 80 164 n. 101, 167 27. 86. 110 167 27. 94. 120 171 n. 127 27. 100. 125 165, 166 n. 107 27. 113. 139 168 n. 118 28. 6. 34 171 n. 126 28. 7. 38 39 40 28. 9. 41 176 n. 147 28. 9. 42 171 n. 126 28. 10. 44 159 n. 77 28. 13. 50 173 n. 132 28. 13. 52 164 n. 99 28. 20. 70 134 5, 176, 179 28. 23. 77 8 153 n. 60 28. 23. 81 39 40, 134 28. 23. 82 39 40 28. 23. 83 39 40 28. 27. 97 163 28. 27. 99 167 n. 113 28. 28. 110 173 n. 132 28. 77. 246 56 179 n. 159 28. 77. 246 39 40, 167 n. 113 28. 77. 247 167 n. 112 28. 77. 248 164 n. 99, 165 28. 77. 249 164 n. 99, 171 n. 125 28. 77. 251 168 n. 118 28. 77. 253 39 40 28. 77. 254 165 28. 77. 255 163 28. 80. 262 39 40 29. 1. 1 29. 8. 28 132 3 29. 1. 9 228 9. 29. 5. 9 38 n. 9

439

29. 8. 15 28 44 n. 31, 51 29. 8. 17 141 2 29. 11. 44 173 n. 132 29. 27. 85 164 n. 101 30. 43. 123 30. 45. 131 169 n. 159 30. 43. 123 165, 167 n. 113 30. 43. 124 167 n. 113 30. 43. 125 6 163, 174 n. 136 30. 43. 128 167 30. 44. 130 164 n. 99, 167 30. 45. 131 164 n. 99, 171 n. 129 30. 49. 142 163 n. 98 31. 4. 8 164 n. 99 31. 7. 10 163, 164 n. 101 32. 3. 8 167 32. 27. 84 172 n. 131 32. 46. 129 34 179 n. 159 32. 46. 129 171 n. 128 & 129 32. 46. 134 176 n. 147 32. 47. 83 39 40 32. 51. 140 39 40 36. 35. 128 157 8 37. 25. 92 3 157 8 37. 28. 101 157 8 37. 31. 106 157 8 PLINY THE YOUNGER Ep. 1. 22 66 n. 89, 69 n. 98 2. 20 69 n. 90 3. 5. 3 6 131 n. 6 7. 1 66 7 10. 5 7 43 10. 5 42 n. 23 10. 11 43 PLUTARCH Mor. 71a 59 n. 77 122d e 54 n. 63 125a 135 n. 16 134f 135 n. 16 137c 135 n. 15 650f 651e 75, 363 n. 2 POLLUX Onomasticon 2. 163 197 n. 35 2. 174 197 n. 36 PRIAPEA 4 40 n. 15

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440

Index Locorum

THEODORUS PRISCIANUS Gynaecia 6. 23 169 n. 119 PTOLEMY Tetr. 1. 3 38 n. 9 4. 4 55 n. 67, 55 n. 69, 56 n. 71 & 72 QUINTILIAN Inst. 1. 6. 5 23 n. 44 7. 38 45 n. 63 9. 3. 6 23 n. 44

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RHAZES Doubts about Galen (Mohaghegh) 3. 12 14. 10 273 n. 54 14. 10 15. 6 319 RUFUS Medical Questioning 47 8, 72 209 n. 74 Onom. 91 2 197 109 12 197 184 7 199 193 8 200 222 6 201 Ren. Ves. 3. 8 10 210 11. 1 211 n. 81 ap. Orib., Coll. Med. lib. inc. 18. 1 32 221 4 18. 2 365 n. 3 18. 8 222 18. 16 17 222 20. 1 56 221 4 20. 1 2 223 20. 3 223 20. 13 223 [RUFUS] Anat. 2 199 56 64 201 58 204 n. 60 64 201 SCHOLIA on Orib., Coll. Med. 47. 5 190 n. 15

lib. inc. 13 115 n. 78 on Rufus, Onom. 109 112 197 n. 36 SCRIBONIUS LARGUS Comp. epist. 60 n. 78 epist. 1 142 epist. 5 142, 169 n. 119 epist. 13 141 16 143 18 160 20 177 34 177 59 143 n. 36 60 143 n. 36 70 143 n. 36 102 174 106 162 121 175 n. 145 122 143 156 176 171 141 175 141 200 44 206 174 271 143 n. 36 coda 177 SENECA THE YOUNGER Ben. 3. 9. 2 69 n. 98 4. 20. 3 69 n. 98 6. 15 17 67 8 6. 16. 2 69 Ep. 95. 20 21 369 ad Helv. 16. 3 169 n. 121 SEXTUS EMPIRICUS PM 2. 41 2 44 SIMPLICIUS In Phys. 1. 4 10 n. 19 SORANUS Gyn. 1. 1. 1 1. 2. 3 231 1. 2 3 39 n. 11 1. 2. 1 2 231

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Index Locorum 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 2. 2. 2. 2. 2. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3. 3.

3. 1 5 231 4. 1 5 231 4. 2 110 n. 63 5 232 6 232 3 7. 1 1. 15. 2 233 12. 1 2 233 15. 1 233 16. 1 1. 18. 4 234 16. 4 1. 17. 3 234 18. 2 197 n. 36, 234 18. 5 235 19. 1 235 19. 3 235 23. 1 235 27. 1 1. 29. 6 235 29. 6 235 6 32. 3 236 33. 1 7 236 34. 1 237 34. 2 1. 35. 6 237 36. 2 237 39. 1 3 237 39. 3 237 42. 1 5 237 8 43. 1 1. 44. 3 238 45. 1 3 238 46. 1 1. 47. 4 238 48. 1 1. 53. 3 238 54. 1 1. 56. 7 238 57. 1 1. 58. 4 238 9 59. 1 2 238 9 60. 1 1. 65 239 60. 2 4 169 n. 119 4. 1 2. 6. 5 239 10. 1 5 239 19. 1 2. 20. 3 239 19. 15 239 40 44. 1 2 239 40, 369 n. 7 2. 1 115 n. 76, 214, 230 1, 247 3. 1 3 240 3. 1 38 n. 10, 114 n. 74, 247 3. 4 3. 5. 2 240 3. 4 115 n76 4 122 n. 92 5. 1 2 240 1 6. 2 3. 8. 3 241 9. 1 2 241 25. 1 2 242 26. 2 242 27. 1 4 241 2 28. 1 242 29. 3 115 n. 76

3. 3. 3. 3. 4. 4. 4. 4. 4. 4. 4.

441

29. 5 242 43. 1 115 n. 77, 230 1 45. 1 3. 46. 5 242 46. 4 243 1. 1 4. 13. 2 243 1. 2 115 n. 76, 230 1 1. 3 115 n. 76 1. 4 115 n. 76 9. 1 243 35. 1 4. 40. 1 244 36. 9 115 n. 76

[SORANUS] Quaestiones Medicinales 103 107 n. 58 STEPHANUS Commentary on Galen's Therapeutics to Glaucon 1. 198 347 STRABO 17. 2. 5 218 n. 104 SUDA A 1026 83 n. 6 A 4107 195 n. 29 A 4261 40 n. 15 G 32 257 n5 D 442 83 n. 6 R 291 187 n. 2 SUETONIUS Aug. 59 51 n. 52 Caes. 42. 1 44 n. 32 Tib. 43 40 n. 15 TACITUS Ann. 14. 62 3 169 n. 121 TATIAN Ad Gr. 34. 3 40 n. 15 TERTULLIAN De Anima 6. 6 101 n. 45

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442 TERTULLIAN (cont.) 14. 2 101 n. 45 15. 2 100 n. 42

2. 3. 1 3 147 2. 6. 5 173 n. 132 2. epil. 4 147 VETTIUS VALENS Anth. 1. 1. 39 55 n. 67 VINDOLANDA TABLETS (Bowman and Thomas) 294 76 n. 119

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THESSALUS De virtutibus herbarum epist. 144 1. 4. 1 162 1. 5. 3 162 1. 8. 6 175 1. 9. 4 5 147 1. 12. 1 11 165 n. 106

Index Locorum

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GENERAL INDEX

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Classical names are listed as they appear in the text, beginning alphabetically from the beginning, not by gentilician or anything similar. Where there is a choice, preference is given to the English or Latin form of medical terms, titles, etc. abortion 142, 162 3, 167 170, 239, 352, 368 see also foetus; miscarriage Actium 26, 50 adultery 76, 169, 239, 368 9 Aelius Aristides (sophist) 49, 65, 68, 71 2, 74, 260 Aephicianus (physician) 260 Aeschrion the Empiric (physician) 260 Aetius of Amida (medical writer) 210, 218 Africa 143, 230 Agathinus the Spartan (physician) 87, 88, 190, 195 age 99, 114, 225 for beginning medical training 260 1 and disease 108, 159, 209, 210, 211, 341 2 e€ects on womb of 155 6, 233 4 and health 150, 273, 290, 292 for intercourse 236 7 and regimen 221 3 and therapeutics 177 8, 225, 247, 344, 350, 355 alchemy 8, 146 alipta, see iatraliptae alopeÅkia 40 Alexander Philalethes (physician) 115,193, 214, 231 Alexandria 50, 85 as centre of medical education 60 1, 146, 261, 269, 359 medical theories/models of 101, 120, 192, 207 see also Erasistratus; Herophilus Anaxagoras (philosopher) 10 Anaximenes (philosopher) 9, 10 Andromachus the Younger (physician) 140, 355

Anna Faustina (relative of M. Aurelius) 270 1 Annas, Julia 18 9, 21, 22 Anonymus Londinensis (medical author)193 4 physiology of 196, 201 2 Anonymus Parisinus (medical author) 104, 193 4, 226 pathology of 211, 213 therapeutics of 113 Antigonus (king) 145 Antonia (d. of Marc Antony) 143 Antoninus Pius (emperor) 45, 71 Antonius Musa (imperial physician) 51 Antiochis of Tlos (physician) 35 n. 3 Antiochus (king) 263, 264 Antyllus (physician) 195 On Healthful Declamation 225 6 therapeutics of 216, 219 220, 224 5, 226 aphonia 241, 338 apnoia 338 Apollonius Mys (physician) 214 Apollonius of Pergamum (physician) 195 apoplexia 241, 338, 346 aposteÅmata 216 Apuleius Celsus (physician)141 Aquileia 266 Arabia 355 archai 100, 309 10, 348 9 of generation 118 19, 307 of the nerves 280 archiatri 45 6, 52, 55 Archigenes of Apamea (physician) 188, 190, 192, 210 sectarian identity of 88, 107, 195 Aretaeus the Cappadocian (physician) 98, 104, 194 female pathology of 209 12, 214

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444

General Index

Aretaeus the Cappadocian (cont.) on sexual formation 212 13, 214 15, 362 therapeutics of 217, 219, 220, 226 writings and approach of 187 9 Aristotelians 263 see also peripatetics Aristotle (philosopher) 4, 27, 95, 101, 153, 275, 277 aetiology of 118, 303 construction of female 117 19, 240, 306 Generation of Animals 115, 118 and nature 13 16, 18 19, 294, 367 and `one-sex model' 119 21 physics and physiology 93, 99 Politics 16 Arius of Tarsus (physician)136, 137 Arria (Platonist) 271 2 arthritis 338 arts 44, 54, 68, 132, 286 Celsus' 129 30 classi®cation of 272, 284 5 teleological structure of 272, 284, 288 9, 366 see also medical art Asclepiadeans 122, 137 see also Lucius the Asclepiadean Asclepiades of Bithynia (physician) 86, 88 9, 193, 246 denies existence of female diseases 122, 240 and foetus 205 pathology of 102, 105 6 physiology of 94, 97, 304 Asclepiades Pharmakion (physician)140 Asclepius (divinity) 43, 146, 266 relationship with medicine 48 9, 68, 72, 82 temples/sanctuaries of 48, 260, 280 Asia Minor 146, 193, 314 women of 268 asthma 220 astrological medicine 144, 146 7, 229 astrology 8, 55 6, 145 practitioners of 33, 37, 46 7, 56, 133 and women 75 6 Athenaeus of Attaleia (physician) 93, 107, 191, 195 denial of female semination 309 pupil of Posidonius 88, 101

Athenaeus of Naucratis (litteÂrateur) 40 1, 65 Athens 10 Augustus (emperor) 51, 153 Aulus Gellius (litteÂrateur) 65, 70 1 Bacon, Francis 8 Beneventum 52, 55 Bourdieu, Pierre 20 1 Bowersock, G.W 70 Boyle, Robert 8 breasts 160, 197, 234, 303, 310 11, 352 appearance of 171 breast-feeding 239, 316, 341 cupping of 346, 348 diseases of 174, 178, 210 location/function of 313 male 156, 303, 313 preventing development of 171 2, 353 and womb 234, 311 see also lactation, milk Butler, Judith 22 3, 24 Cadden, Joan 121 Caelius Aurelianus (physician) 42, 194 pathology in 103 4, 107 8 therapeutics in 113 14 as translator of Soranus 230, 243, 244 Calvisius Taurus (philosopher) 69 70 Caracalla (emperor) 169, 271 carcinomata 174, 210, 349 Cassius Dio (historian) 71 castration 152 n. 54, 219 n. 105, 323 4, 353 Cato the Censor (magistrate/moralist) 133 Celsus (writer on medicine) 26, 27, 70, 75, 228 and female diseases 173 6 and female vanity 172 `reluctant construction of the female body' 149 50, 170 1 and reproduction 156, 159, 160, 164, 170, 177 and sexual di€erence 155 6, 158 61, 176 8, 178 9 writings and approach 129 31, 148 9, 154, 156 8, 170 1 Chaeronea 135 childbirth 116, 156, 164, 240

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General Index assistance in 171 as cause of disease 171, 174, 178, 340 1 diculties of 153, 205 6, 243 e€ect on womb 253 mechanics of 206 and midwives 36, 38 9, 57, 239, 360 peculiarities of 152 3 purging after 171, 340 1 chiragra 159 60 cholera 346 Christianity 65, 75 Chrysippus (philosopher) 101, 276 Cicero (politician/philosopher) 42, 54 5, 81 Cilicia 136 Claudius (emperor) 51, 141, 144 Cleopatra (queen/medical writer) 40 1 Cleophantus (physician) 115, 231 clitoridectomy 198, 218 19, 243 4 clitoris 197 8, 218, 234, 243 collegia 43, 47 8, 49, 53 Commodus (emperor) 266 7, 270 conception 206, 237, 240, 275 6 best time for 237 dependant on menstruation 163, 235 6, 241 and determination of sex 165 6 e€ect on appearance of o€spring 153, 237 and health 237 8 mechanics of 204, 298 9 prevention of 164 5, 157, 239 promotion of 163, 170, 269, 352 Corinth 261 Cos 48 cosmetics 40, 138, 172, 269, 270 Crateuas (root-cutter) 43, 138 critical days 109, 342 Croesus (king) 259 Cunningham, Andrew 7 Cyranides 170 1 Daston, Lorraine 5 6, 21 Dean-Jones, Lesley 120 DeichgraÈber, Karl 246 Demetrius (king) 145 Democritus (philosopher) 10, 93 4, 302 didymoi, see testicles Diocles of Carystus (physician) 145, 247

445

Gynaecology 114, 122, 194, 230 Diogenes of Apollonia (philosopher) 10 Diogenes Laertius (litteÂrateur) 246 Dioscorides (physician) 82, 90 biography and writings 136 40 methodology of 137 40 and women 161 72, 173 7, 179 80 doctors, see medicae; medical practitioners; medici Drabkin, I.E. 8 dreams 34, 260, 279 80 interpreters of 33, 37, 46 7 dynameis 97 8, 310, 344, 346 of compound pharmaka 353 4 of seed 275 6, 334 sexual 337 of simples 136, 137, 139 40, 161, 168, 351 3 of testicles 323 4, 328 of womb 298 9, 348 9 dysenteria 341, 346 eclectics (medical `sect') 87 8, 185 6 `eclectic woman' 248 9 and female physiology 196 209 and female pathology 209 15 surviving writings of 186 96 see also Agathinus; Archigenes; Leonides Edelstein, Ludwig 8, 64 6 Egypt 75, 146, 192, 314, 355 medici in 53 4 practice of clitoridectomy in 198, 218, 244 eklektikoi, see eclectics elements 92 4, 196, 302, 351 elephantiasis 210 Elephantis (female pseudonym) 39 41, 134 5 embryo, see foetus Empedocles (philosopher) 10, 93 empiricists (medical `sect') 85 6, 89, 91 2, 130, 185 de®nitions of disease 103, 105 and diagnosis 104 Dioscorides and 137 Galen on 246 7, 281 and prognosis 107 8 therapeutics of 110 11, 112, 114, 350 and women 122, 246 7 see also Lycus of Naples;

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446

General Index

empiricists (cont.) Menodotus; Philinus; Sextus Empiricus Ephesus 45, 47 Epictetus (philosopher) 67, 69, 368 Epicurus (philosopher) 11, 19, 67 Epidaurus 48 epilepsy 210, 226 therapies for 143, 220 and uterine su€ocation 174, 178, 211, 241, 346 women less susceptible to 160, 338 episyntheÅtikoi, see eclectics Erasistrateans 88, 122, 265 see also Lucius the Erasistratean Erasistratus (physician) 88, 95, 194, 227 diagnosis of lovesickness 263 4 Galenic polemics against 262 and heÅgemonikon of soul 100 and nature 311 12 pathology of 107 physiology of 97, 98 9, 101 therapeutics of 279, 311 12 erysipelas 216, 336 ethics 60, 142 3 `ethical naturalism' 19, 21 Galenic 258 9, 269 70, 286 7, 316 Hellenistic ethical theories 18 19, 22 Eudemus (philosopher) 266, 271 eunuchs 204 n. 60, 214 immunities of 154, 210 weaknesses of 212 13, 225, 355 Euryphon (physician) 197 8 female ¯ux 175, 211 12, 332, 336 therapies for 226, 264 5, 346 female seed 200, 204, 212, 214 15, 298, 309 contributes to o€spring 119, 202 4, 307 diseases of 212, 242 3, 334 5, 337 9 does not contribute to o€spring 121, 233 see also seed fevers 109, 345 7 Firmicus Maternus (writer on astrology) 55 Fischer, Isidor 162 Flavius Boethus (consular) 263, 265 cure of wife 264 5

foetus 205 coverings of 205, 297 8 destruction of 167 8 e€ects on health of mother 153, 340 1 expulsion of 142, 167 8, 170, 352 formation of 153, 205 6, 275, 299 300, 325 nourishment of 116, 201, 205 6, 307, 340 1 sexual di€erentiation of 205 6, 308 11, 341 surgical extraction of 217 18, 243 see also abortion; conception; miscarriage folk medicine 82, 90, 92 Dioscorides and 137 8, 139 and women 182 Foucault, Michel 64 6, 112, 207 8, 220 1 Frede, Michael 85 6, 304 Fronto (orator) 65, 67, 71 2, 75 Fuchs, Brian 213 furor 160 Gaius Julius Callistus (imperial freedman) 141, 142 Galen (physician) 40, 88, 253 358 aetiology of 303 5, 323, 325 7, 329 30 and Arria 271 biography/career of 256 72 on causes of woman 305 13, 317 29 construction of his authority 253 87 de®nitions of health 273, 289 de®nitions of the medical art 272 3, 288 92 on dissection 293 5, 297, 299 303 ethics of 101, 255, 258 9, 269 70, 286 7, 301 on female anatomy 295 9, 303, 306 7 female case histories of 263 6, 267 8, 360 1 and female knowledge 275 7, 283, 358 on female lack of control 258 9, 272 on female luxury 258 9, 269 70, 355 general pathology of 102, 106 7, 108, 289, 329 31 general physiology of 93, 97 8, 99, 302

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General Index and imperial household 266 7, 270 1 logical method of 273 7, 280 3, 284, 301 3 modern scholarship on 2, 253 on the medical sects 111, 229, 246 7, 281 2 on parts of medicine 114, 291 3 pharmacology of 350 8 and provident nature 290, 300 1, 304 5, 312 13, 321 2, 326 8, 363 5 sexual di€erence in disease 331 43 sexual di€erence and the pulse 314 16 sexual di€erence in therapeutics 344 57 on the soul 101, 276 7, 299 300, 318, 319 20 Galen's writings 253 4 On the A€ected Places 333 8 On the Anatomy of Hippocrates 309 n. 59, 324 Anatomical Procedures 293 4, 295 8, 301 On Bones for Beginners 295 On Bringing up Blood 262 3 On the Causes of the Pulse 314 15, 328, 356 On the Causes of Symptoms 332, 337 On Compound Pharmaka according to Kind 354 6 On Compound Pharmaka according to Place 270, 354 On Demonstration 273 4 On the Di€erence between Diseases 331 On the Di€erence between Symptoms 332 On the Dissection of Muscles 295 On the Dissection of the Uterus 261, 285, 293, 296 8 On the Dissection of the Veins and Arteries 296 On the Doctrines of Hippocrates and Plato 274, 275, 276, 357 8 On Examining the Best Physicians 268 Exhortation to the Medical Art 259 On the Formation of the Foetus 293, 299 301 On Healthful Conduct 316

447

Hippocratic Commentaries 293, 309, 316 17, 332 3, 340 3 On the Kraseis and Dynameis of Simple Pharmaka 351 4 On the Medical Art 292 On the Natural Faculties 297, 298 On my own Opinions 299, 319 20 On the Parts of Medicine 291 To Patrophilus on the Constitution of the Medical Art 257, 272, 273, 288 To Piso on the Theriac 269, 271 On the Seed 275, 277, 293, 298, 308, 309, 323 4 On Swellings contrary to Nature 331 2 Therapeutic Method 268, 345, 348, 350 Therapeutics to Glaucon 343 50 On Tromos, Palmos, Spasmos, and Rigos 332 On the Usefulness of the Parts 267, 279, 294, 295, 297 8, 303 13, 318 23, 328 On Venesection against Erasistratus 311 313, 321, 338 Garofalo, Ivan 213 gender 23 5, 27 relationship with sex 4 5, 6, 12 16, 21 2, 120 Roman system of 25 6, 371 4 Gleason, Maud 226 gonorrhoia 203, 212 13, 242 3, 336 7 Green, Monica 230, 333, 336 Grosz, Elizabeth 22, 23 Gynaecologies 114 15, 229 30 Hadrian (emperor) 45, 229 hair 154 5, 156, 320 3, 369 Hankinson, Jim 304 Hanson, Ann Ellis 120, 230 health 63 5 de®nitions of 102, 149, 273, 289 of emperors 71 as goal of medicine 37 8, 273, 281 of orators 71 2 of women 73 6, 117, 235 8, 245, 273 Heliodorus (physician) 195, 216 17 Heraclea Salbace 52 Heras the Cappadocian (physician) 140 herbalists 33, 38, 43, 56 see also Crateuas

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448

General Index

Hermes Trismegistus (divinity) 144, 146 Herodotus (physician) 195, 225 Herophileans 86, 88, 115 see also Alexander Philalethes; Apollonius Mys Herophilus of Chalcedon (physician) 85, 95, 116, 142 and anatomy of womb 227, 233, 234, 240, 297 female physiology of 200, 201, 297 and heÅgemonikon of soul 100 MaioÅtikon 115, 231 and `one-sex model' 121 2 pathology of 107 and pneuma 98 9, 101 Hesiod (poet) 9 Hippocrates (father of Greek medicine) 81, 82, 145, 229, 259 cited as authority 133, 138, 194, 200, 227 Galen's use of 277 9, 282 Hippocratic medicine 4, 95, 98, 131, 158, 192, 264 nature in 11 seed in 117, 119, 275 Hippocratic Oath 142, 169 Hippocratic woman 116 17, 119 22, 160, 236, 238, 333, 340 Hippocratic writings 83 5, 114 15, 231 On Ancient Medicine 84 Aphorisms 158, 309 On the Diseases of Women 114, 116, 122 On the Diseases of Young Girls 114 Epidemics 340 1, 343 On the Excision of the Foetus 114 On Generation/Nature of the Child 114, 202 4 On Healthful Regimen 316 17 On the Nature of Man 92, 96 7 Nature of Women 114 On Regimen 84 On Regimen for Acute Diseases 333 On the Sacred Disease 11 On Superfoetation 114 On Sterile Women 114 Homer (poet) 259 homoeomeries 94 5, 289, 302, 330 humours 95 7, 98 and disease 107, 340 1, 345 hypospadias 213

iatraliptae 33, 38, 149 de®nitions of 42 3 legal recognition of 45, 47 iatrikeÅ techneÅ, see medical art iatrinai, see medicae iatroi, see medici iatromeae, see midwives ileos 106 India 151 innate heat 99 100, 117 119, 314 315 Introduction (ps.-Galen) 107, 246 anatomy in 197, 198, 200 1 dating and character of 189 90, 190 3 generic pathology of 209 n. 74 physiology in 206 7 Ionia 3, 9 Jordanova, Ludmilla 4 Julius Caesar (dictator) 44, 50 Justus, wife of 263 4 Juvenal (poet) 75 6, 195 kataleÅpsia 241 katocheÅ 211 kephalaia 226, 338 Kollesch, Jutta 189 92 krasis 98, 247, 273 diseased 289, 330 of drugs 351, 353 4 e€ect on pulse 314 316 female 223 4, 316 17, 341 2 355 6 therapeutic signi®cance of 344, 348, 350, 355 L. Staius Rutilius Manilius (archiater) 55 lactation 160, 171, 240, 312 see also breasts; milk Laecanius Bassus (consular) 137 Lais (female pseudonym) 39, 41, 134 5 Laqueur, Thomas 12 14, 15 16, 23, 371 and `one-sex model' 119 21, 357 Leonides of Alexandria (physician) 88, 195, 210 lethargus 103 4, 113, 241, 338 Libanius (orator) 72 lichena 159 lippitudo 158 Livia (wife of Augustus) 143, 153 Lloyd, G.E.R 11, 18, 40

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logikoi, see rationalists Lombroso, Cesare 6 Lucian (sophist) 43 Lucius the Asclepiadean (physician) 214 luxury 56, 130, 133, 258 9, 269 70, 355 Lycus of Macedon (physician) 296 Lycus of Naples (physician) 246 Lyons 36 maiai, see midwives Macrobius (prefect/litteÂrateur) 75 magic 34, 72, 353 Dioscorides and 139, 140 Pliny and 133 4, 168 practitioners of 33, 34, 46 7, 55 Magnesia on the Meander 51 mania 211, 338 Marcus Aurelius (emperor) 190 concerns about health 65, 67, 71 2, 75 and Galen 266 7, 271, 272 marriage 218 219, 222, 237, 238, 339, 368 Martial (poet) 54, 76 Mary (mother of Jesus) 39 mathematikoi, see astrology medicae 33, 35 7, 359 60 status of 26, 46, 56 and writing 39 42 medical art 37 8, 46, 129 30, 132 3, 366 7 Cicero on 54, 81 de®nitions of 80 2, 272 3, 292 as eÂlite accomplishment 59, 70 1, 135 6, 285 7 epistemologization of 84 7, 89 formation of 82 90, 123 4, 288 92 as invention of Asclepius 48, 82 parts of 90 2, 114, 191, 231, 291 3 medical attendants, see iatraliptae Medical De®nitions (ps.-Galen) 81, 87 anatomy in 196 7, 201 dating and character of 189 93 disease in 213 reproduction in 202 6 medical education 60 1, 260 1 see also Alexandria `medical market place' 8, 26, 361 medical practitioners (Roman) 33 79 authority of 57 63, 78 9, 253 87, 365 7

449

comparison with modern practitioners 8 9, 366 8 de®nitions of 35 44 female 181 2, 359 60 legal position of 44 50 plurality of 33 4, 76 9 relations with patients 63 76 social status of 50 57 see also herbalists; iatraliptae; medicae; medici; midwives; pharmacopolae medical terminology 198 9, 234 5 medical woman: cannot be ambidextrous 310 colder 117 19, 210, 223, 306 8, 314 15, 322 3, 339, 362 domesticity of 313 313, 320 2, 328 9, 355 6 excessive 116 17, 160, 236, 311 13, 328, 339 hotter 117, 363 imperfect 117 19, 306 8, 317, 328, 358, 362 lacks augustness 328 lacks beards 320 3, 328 9 lacks choice 286 7, 328 9 made for childbearing 357 8 relativity of 208 9, 343, 361 2 softness of 158, 177, 216 17, 310, 316 17, 350 5 sponginess of 116 17 thinner voiced 156, 225 weakness of 156, 177, 225 wetter 117, 210, 223, 328, 339, 355, 362 medici 33 authority of 57 62, 66 71, 78, 365 7 collective organization of 47 8 geographical origins of 50 51 identity of 35, 37 8, 42 4, 76 7 legal recognition of 44 8, 49 50 relations with female patients 76 social position of 51 7, 64, 67 71 medicina, see medical art melancholia 103, 217, 338 menarche 159, 222, 237, 310 11, 313 Menodotus of Nicomedia (physician) 246 menstrual ¯uid 201, 345 as failed seed 119 medical application of 353 monstrous 153

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450

General Index

menstrual ¯uid (cont.) quintessentially female 121 reproductive role of 153, 205 6 retention of 316, 335, 337, 339, 352 menstruation 153, 201, 211, 232 3, 238 and conception 163, 235 6, 237, 241, 298 as evacuation of surplus 116, 160, 235 6, 311 13, 338 9 and health 121 2, 159 60, 163, 235 6, 333 protects from disease 336, 338 9, 349, 352 provoking 117, 161 3, 180, 220, 316, 351, 352 stopping 162 suppression of 116 117, 159 60, 162, 211, 217, 241, 265 and uterine su€ocation 334 8 and venesection 217, 265, 311 12 Mercury (divinity) 55, 259 Messalina (wife of Claudius) 143 methodists (medical sect) 86 7, 89, 92, 185 Celsus on 130 Galen's polemics against 281, 345 gynaecological tradition of 229 46 methodist woman 248 9 and prognosis 107 8 at Rome 228 9 therapeutics of 111, 112, 113 14 understandings of disease 105, 122 see also Soranus; Themison; Thessalus of Tralles Metilia Donata (physician) 36 midwives 33, 52, 59, 266, 271 2, 360 activities of 239, 245, 264 6, 267, 335 ideal 231 2 identity of 36, 38 9 knowledge of 134 5 legal recognition of 44, 56 7 and writing 39 42, 231 2, 260 1 milk 116, 201, 205, 207, 311, 313, 316, ape's 151 stimulating production of 351 2 therapeutic use of 349 see also breasts; lactation miscarriage 166 9, 210, 238 9, 267, 340 1 see also abortion; foetus

Misenum 131 Musonius Rufus (philospher) 367 8 Mustio (medical writer) 230, 243 naturalization 4 7, 12 17, 20 1, 322, 367 nature 17, 21, 300 1 changing/contested character of 5 6, 9 12, 19 20, 364 disease contrary to 102, 107, 240 1, 317, 329, 332 as distinct from convention (nomos) 10, 14, 16, 302, 367 as distinct from psycheÅ 98, 206 7, 301, 310 female 212, 222, 306, 387 8 of the female parts 232 3 gender of 301 health according to 101, 107, 240 41, 317 individual 107 8, 334, 338 9, 340 1 men and women di€erent in 240, 350, 355, 362 3 physiological 91, 214 15, 362 3 provident 5 6, 290, 300 1, 304 5, 312 13, 321 2, 326 8, 363 5 of things 131 2, 139 40, 282 and words 199, 234 work of in ancient world 14 17, 18 20, 362 5, 367 8, 370 1 Nechepso (king) 146 7 nephritis 106 Nero (emperor) 87, 190, 229 Nicon (architect) 257 Numisianus (physician) 261 Nutton, Vivian 51, 253, 268 Octavia (sister of Augustus) 143 odour therapies 117, 175, 220, 242, 346 7 old women 33, 41 old wives' tales 277 n. 65, 283 Olympias of Thebes (`physician') 39 41 On the Powers of Plants (Thessalus) 144 7 gynaecological reticence of 170, 181 therapies of 162, 175 orcheis, see testicles Oribasius (medical writer) 194, 221, 225 Orpheus (mythical ®gure) 133

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General Index P. Decimus P. Merula Eros (physician) 51 2, 53 parastatai 199 200, 201 Park, Katherine 121 paterfamilias 59, 75, 272, 368 pathology 91, 101 female 116 17, 121 2, 158 61, 172 6, 209 15, 240 5, 331 43 general outline of 102 9, 329 31 see also individual diseases patients 53, 66 71, 113 14 female 75 6, 263 6, 267 9, 271, 359 61, 373 4 ideal conduct of 66 7 power of 57, 68 9, 74, 286 7 Paul of Aegina (medical writer) 243 Pelops (physician) 201 peripatetics 193 see also Aristotelians Pergamum 45, 47, 48, 280 Galen at 257, 260 2, 266, 268 women of 269 Perkins, Judith 65 6 Petron of Aegina (physician) 92 3 pharmacology 111 12, 113, 136 47, 350 3 women and 219 20, 161 84, 354 6 pharmacopolae 44, 58 Philinus of Cos (physician) 85, 86 Philip (king) 145 Philistion of Locri (physician) 93 Philumenus (physician) 195, 210 Gynaecology 115 therapeutics of 217 18, 218 19, 220, 226 phrenitis 105 6, 108, 338 physicians, see medicae; medical practitioners; medici physiology 91 female 155 6, 196 209, 296 326 general outline of 92 101 relation to pathology 101, 209 physis, see nature Plato (philosopher) 16, 19, 101, 259, 335, 367 and demiurge 301 Republic 357 8, 368 Timaeus 115 pleuritis 105, 219, 338 Pliny the Elder (writer on medicine) 39 40, 41, 51, 75, 82, 132 4 biography and writings 131 5, 148 9 female sources of 134 5

451

hostility to Greek medicine 50 1, 132 3, 142 and nature 131 2 sexual di€erence in 154 5, 156 8, 179 80 and women 152 4, 158, 161 172, 173 7 Pliny the Younger (politician) 43, 66 7 Plutarch (politician/litteÂrateur) 65, 70, 75, 135 6 pneuma 95 6, 98 100, 147, 207, 225 in Aretaeus 188 9 as cause of disease 107 and reproduction 201 3 as soul 101 pneumatists (medical school) 88 9, 101, 188 9, 192, 195 see also Agathinus; Archigenes; Athenaeus of Attaleia; Herodotus pneumonia 103, 338 podagra 159 60, 338, 369 Polybus (physician) 247, 317 Polycrates (tyrant) 259 Pompey the Great (politician/general) 151 2 Posidonius of Apamea (philosopher) 88, 101 Praxagoras of Cos (physician) 107 pregnancy 156, 159, 265, 275 6, 297, 311, 318 length of 152 as pathological 340 1 protection of 166 7 signs of health of 153, 349 as therapy 117, 340 venesection and 177 8 see also conception; foetus Presocratics 10, 83 see also Anaxagoras; Anaximenes; Democritus; Diogenes of Apollonia; Empedocles; Thales pseudo-Democritus 133 pseudo-Galen, see Introduction, Medical De®nitions pseudo-Rufus (medical writer) 187, 196, 199, 200 1 phthisis 103 Ptolemy (writer on astrology) 55 puberty 159, 210, 221 2, 310 11, 313 inhibition of 172, 352 pulse-lore 190, 263 4, 314 16 Pylades (dancer) 263

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452

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Quintus (physician) 260, 261 rationalists (medical sect) 85 6, 89, 91 2, 130 1, 137, 281 2 and eclectics 185 6, 229 on female physiology 196 209 on disease and sexual di€erence 209 215 gynaecological tradition of 230 1, 247 pathology of 104 8, 122 `rationalist woman' 248 9 surviving literature of 186 96 therapeutics of 111, 112, 114 on therapeutics and sexual di€erence 215 28 see also Agathinus; Antyllus; Anonymus Londinensis; Anonymus Parisinus; Apollonius; Archigenes; Aretaeus; Asclepiades; Athenaeus of Attaleia; Erasistratus; Heliodorus; Herodotus; Herophilus; Leonides; Philumenus; Praxagoras; Rufus regimen 111, 112, 215 female 220 4, 241, 248, 316 17 Plutarch's 135 6 Rhazes (philosopher/physician) 319 20 rhizotomoi, see herbalists Riddle, John 137, 162 rigos 332, 341 Rome 44, 50, 52, 69, 88, 114, 140 Galen at 262 6, 266 71 methodists at 228 9 women of 75, 259, 270 1 root-cutters, see herbalists Ru®nus (consular) 260 Rufus of Ephesus (physician) 187, 360 anatomy of 196, 197 200 and disease 210, 213 and female regimens 221 4, 248, 317 and seed 201 Sabinus the Hippocratean (physician) 260 Salpe (`midwife') 39 41, 134 5 satyriasis 203, 212 13, 214, 242 Satyrus (physician) 260 Scepticism (philosophical current) 11, 246 science 4, 6 7, 7 8, 20

Scott, Joan Wallach 23 4 Scribonius Largus (physician) 140 approach to medicine 142 3 approach to women 170 1, 181 ethics of 142, 169 female therapeutics of 177 women and disease 160, 162, 176 second sophistic 62, 77, 225 seed 98, 119, 200 2, 206, 296, 307, 326 children lack 313 and conception 204, 275 6, 297, 298 determines sex 205, 212 13, 214 15, 309 10 diseases of 212 213, 242 3 drugs a€ecting 165, 351 2 male 117, 119, 153, 204, 298, 309 10 see also female seed Seleucus (king) 263 seminal vessels 199, 201, 202 3, 233 Seneca the Younger (politician/ philosopher) 67 8, 69, 369 Septimius Severus (emperor) 169, 269, 271 Servilius Damocrates (physician) 140 Sextus Empiricus (physician/ philosopher) 44, 192, 246 Sicily 141 slavery 49, 59, 75, 102, 159, 172 and medical practitioners 36, 51, 52 natural 13 16, 18 19, 367 Smyrna 261 Socrates (philosopher) 258 sophists 10, 367 Soranus of Ephesus (physician) 190, 192, 194, 214, 249, 364 Gynaecology 115, 231 46, 362, 369 life and writings 229 30 pathology of 103, 105 Sotira (`midwife') 39 41 soul 14, 100 1, 207, 237 determines body 318 22 female 321 heÅgemonikon of 100, 207, 276 7, 280 and nature 301 and reproduction 202, 299 300 spasmos 332, 338 von Staden, Heinrich 150 Stephanus (medical writer) 347 Stoicism 11, 197, 207, 260 Stoics 19, 93, 101, 300, 327

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see also Calvisius Taurus; Chrysippus; Epictetus; Marcus Aurelius; Musonius Rufus Stratonicus (physician) 260 Suda 268 surgeons 38, 56, 143 surgery 111, 112 and women 215 19, 243 4 Swain, Simon 268 sympathy 106, 234, 242, 343 T. Statilius Crito (imperial physician) 140 tabes 160 Tarsus 136 technai, see arts testicles 166, 179, 399 development of 311, 313 female 121, 199 200, 201, 295, 296, 307 male 179, 295 not productive of seed 121, 199 200, 201 preventing development of 172, 353 productive of seed 233, 323 right hotter 309 10 sexually di€erentiate bodies 323 4 see also parastatai; seed; seminal vessels tetanos 210 11, 338 Teuthras (dedicatee) 262 3 Thales (philosopher) 9 Themison of Laodicea (physician) 86 7, 194, 228, 235, 240 Theophrastus (philosopher) 193 therapeutics 91 female 172 8, 215 28, 345 57 general outline of 109 114 and patient 113 114, 334 and understanding of disease 109 111, 215 Thessalian women 138 Thessalus (philosophus), see On the Powers of Plants Thessalus of Tralles 87, 228 9, 240, 345 not the author of On the Powers of Plants 144 raised in the women's quarters 278 Tiberius (emperor) 159, 228 Tiberius Claudius Tyrannus (imperial physician) 51

453

Titus (emperor) 131, 135 tormina 158, 159 Trajan (emperor) 43, 103, 187, 195, 229, 278 tromos 332, 338 Tryphon of Gortyn (physician) 141 Tyche (divinity) 259 Ulpian (jurist) 46 uterine su€ocation 117, 174 5, 211, 214, 241 2, 333 6, 346 men cannot su€er from 212 therapies for 117, 175, 220, 242, 354 see also womb Valverde, Mariana 27 Varro (antiquarian) 130 Vespasian (emperor) 45 Vettius Valens (astrological writer) 55 virginity 39, 236 7, 337 whig history 3 widows 242, 343 5, 339 40 womb 117, 150, 178, 199, 343 anatomy of 155 6, 170, 200 1, 232 3, 295 7 not an animal 242, 335 6, 347 determines sex of o€spring 309 10 diseases of 172 4, 210 12, 233 4, 241, 243, 332 3 key to female health 335, 337 8 reproductive role of 204 5, 206, 297 9 treatments for 217, 219 20, 226, 242, 346 7, 348 see also uterine su€ocation women 373 4 contribution to medical knowledge 134 5, 181 2, 361 as source of medical materials 179, 249, 353 see also medical woman Xanthippe (wife of Socrates) 258 Xenocrates (writer on medical substances) 353 Zenon the Epicurean (philosopher) 240

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