Rufus of Ephesus on Sexual Health

On Sexual Activity from the works of Rufus (of Ephesus).

Sex is indeed a natural act, while nothing natural is harmful. But intimacy becomes harmful when it is immoderate and frequent and when it is engaged in at inappropriate times. Frequent intimacy is especially harmful for those who have weakness in the nerve-like parts, such as the chest, kidneys, lower back, hip region, or legs. Here also are some indications [it is harmful]: a person's whole strength becomes weaker during intimacy, but strength is the innate heat within us, hence concoction does not happen as well for those engaging in intercourse, and they become extremely pale and do not see or hear as they should, nor do they have any other strong sensation. Indeed, such people are forgetful and trembling, their joints painful, especially in the hip area; some also develop kidney disease, others have illness in the bladder, some develop thrush-like sores around the mouth, tooth pain, or inflammation of the tonsils; many men ejaculate blood after excessive sexual activity, some due to the violent retention and tension of pneuma, some due to the interaction of the veins and arteries running from the chest to the testicles. Women however ejaculate very little blood during intercourse due to the overall moistness of their bodies, due to the fact that they do not exert themselves as much during intercourse, and due to their regular discharges below, so that even if a woman happens to ejaculate blood, the discharges are a great healing factor for her. For these reasons, the good doctors will recommend that if any of the illnesses mentioned are present or if they are anticipated due to the natural weakness of the person, that they should abstain from sexual activity.

So far, I have spoken about the harms and co-affections (lit. sympathies) of sexual activity, to the extent that as I was able to do so succinctly. Now, we must speak about its benefits. For sexual activity is not always harmful if one takes into consideration the timing, measure, and overall health of the person engaging in intimacy. The benefits of sexual activity are these: to relieve fullness, to provide the body with lightness, to stimulate growth, and to bring about a more manly appearance. And for those in a hardened (tense) state, intimacy at regular intervals is beneficial: it softens (relaxes?) the organs, widens the pores, and removes some phlegm; it breaks up coagulated thoughts and relaxes intense desires. Hence, for a melancholic, depressed, and misanthropic person, sexual intercourse can serve as the most significant and suitable remedy. It can bring to a more moderate state of mind those driven mad in other ways, halt some epileptic symptoms, and relieve those suffering from a weary head and those with pains brought about during puberty. Hippocrates said, in a word, that sexual activity, “is the best remedy for illnesses from phlegm.” Many weakened people have been restored to health from illnesses due to intimacy, with some people’s breathing becoming easier instead of more difficult, and some people's appetite becoming better instead of worse. Some have even been freed from frequent nocturnal emissions. Natures suitable for sexual activity are warmer, more moist, and more actively disposed to intimacy than others, while least suitable are dry and cold; and the nature of those in their prime is right for it, but not the nature of those in their old age.

In terms of seasons, spring is appropriate, while autumn and summer are inappropriate. Winter is not too good either because it is cooling. Moreover, a warmer and moister diet is productive for sexual activity, while a drying and cooling diet is unproductive. Diets suitable for intercourse are appropriate for those who are unable to perform during intercourse. Therefore, the diet should be moist and warm, exertion should be moderate, and food should be plentiful. Wine therefore should be tawny in color and light in body, breads should be freshly baked and pure, meats, of young goats, lambs and pigs, poultry such as hens, thrushes, partridges, geese, and duck; of fish, octopus and whichever are called soft-bodied; of vegetables, sage, erysimon, rocket and turnip that is difficult to cook and has become tender (for these are also given as drugs); of legumes, bean, chick-peas, ochroi, phasiloi, pissoi, and loboi that are full of pneuma and provide plenty of nutrition. I also encourage adding the extremely excellent grape into the current diet; for it moistens and fills the body with blood and pneuma. But someone about to engage in sexual activity must avoid doing it on a full stomach, or with indigestion, drunkenness, or a lack of food. For it is bad to have intercourse when there are residues, one should avoid fatigue from the gym and bath, and recent vomiting and diarrhea from the belly. For these can be chronic when sexual activity causes dryness. The best intercourse happens with food but not after becoming full. For it contributes to strength and the chilling that occurs become less. If someone eagerly desires sex after breakfast, they should wait until the food settles; but if after dinner, it is necessary to sleep for a while. I do not encourage intense desires, and I rather recommend one resist them, especially those for whom it is an illness and are easily harmed by intimacy.

Περὶ ἀφροδισίων ἐκ τῶν Ῥούφου. Φυσικὸν μὲν ἔργον ἡ συνουσία ἐστίν, οὐδὲν δὲ τῶν φυσικῶν βλαβερόν· παρὰ δὲ τὴν ἄμετρόν τε καὶ συνεχῆ χρῆσιν καὶ κατὰ καιρὸν τὸν οὐ προσήκοντα παραλαμβανομένη βλαβερὰ γίγνεται, πολλῷ δὲ μᾶλλον βλαβερὰ ἡ συνεχὴς χρῆσις γίγνεται τοῖς τὸ νευρῶδες ἀσθενὲς ἔχουσιν ἢ θώρακα ἢ νεφροὺς ἢ ὀσφὺν ἢ ἰσχιάδα ἢ πόδας. ἔστω δέ σοι τεκμήρια καὶ τάδε· σύμπασα γὰρ ἡ ἰσχὺς τοῦ ἀνθρώπου ἀσθενεστέρα γίγνεται ἐν τῇ χρήσει· ἡ δὲ ἰσχύς ἐστι τὸ ἐν ἡμῖν ἔμφυτον θερμόν· ὅθεν αἱ πέψεις οὐκ ἀγαθαὶ τῷ μισγομένῳ καὶ ἔξωχροι γίγνονται καὶ οὔτε δεόντως ὁρῶσιν οὔτε ἀκούουσιν, ὡς χρή, οὐδὲ ἄλλην τινὰ αἴσθησιν ἐρρωμένην κέκτηνται καὶ μὲν δὴ καὶ ἐπιλήσμονες οἱ τοιοῦτοι καὶ τρομώδεις εἰσὶ καὶ τὰ ἄρθρα ὀδυνηροί, μάλιστα τὰ τῶν ἰσχίων, καὶ οἱ μὲν νεφριτικοὶ γίγνονται, οἱ δὲ καὶ κατὰ κύστιν νόσημα ἔχουσιν, τοῖς δὲ καὶ στόματα ἀφθώδη γίγνεται καὶ ὀδόντων πόνοι καὶ γαργαρεώνων φλεγμοναί· πολλοὶ δὲ ἄνδρες ἐπὶ τοῖς πολλοῖς ἀφροδισίοις καὶ αἷμα ἔπτυσαν, τὸ μέν τι τῇ βιαίῳ κατοχῇ τε καὶ ἐντάσει τοῦ πνεύματος, τὸ δέ τι τῇ κοινωνίᾳ τῶν ἀπὸ τοῦ θώρακος ἐπὶ τοὺς ὄρχεις φερομένων φλεβῶν καὶ ἀρτηριῶν. γυνὴ δὲ ἥκιστα ἐπὶ ταῖς μίξεσι πτύει αἷμα τῇ τε ἄλλῃ τοῦ σώματος ὑγρότητι καὶ τῷ ἧσσον πονεῖσθαι ἐν τῇ μίξει, καὶ διὰ τὰς εἰωθυίας κάτω καθάρσεις, ὥστε κἂν τύχῃ γυναῖκα πτύσαι αἷμα, μέγα ἴαμα αἱ καθάρσεις αὐτῇ γίγνονται. διὰ ταῦτα μὲν δὴ τὰ εἰρημένα παρακελεύονται τῶν ἰατρῶν οἱ ἀγαθοί, ἤν τε πάρεστι τι τῶν εἰρημένων νοσημάτων, ἤν τε προσδόκιμον ᾖ διὰ τὴν φυσικὴν ἀσθένειαν τοῦ ἀνθρώπου, ἀπέχεσθαι τῶν ἀφροδισίων.

ἄχρι μὲν δὴ τούτων τὰς βλάβας καὶ τὰς συμπαθείας, ἐφ' ὅσον δυνατὸν ἦν ἡμῖν διὰ βραχέων εἰπεῖν, εἰρήκαμεν· ῥητέον δὲ νῦν καὶ τὰς ὠφελείας· οὐ γὰρ παντάπασι κάκιστα τὰ ἀφροδίσιά ἐστιν, ἐὰν καὶ τὸν καιρὸν τῆς χρήσεως καὶ τὸ μέτρον καὶ τὴν ὑγιεινὴν κατάστασιν τοῦ χρωμένου σκοπεῖν ἐθέλοις. ὠφέλειαι δὲ αἱ ἐκ τῶν ἀφροδισίων εἰσὶν αἵδε· πλησμονήν τε κενῶσαι καὶ ἐλαφρὸν παρασχεῖν τὸ σῶμα καὶ εἰς αὔξησιν προτρέψαι καὶ ἀνδρωδέστερον ἀποφῆναι. καὶ τῇ δὲ σκληρᾷ ἕξει ἐκ διαλειμμάτων πλειόνων ἡ χρῆσις ὠφέλιμος· μαλάσσει γὰρ τὰ ὄργανα καὶ ἀνευρύνει τοὺς πόρους καί τι τοῦ φλέγματος ἐκκαθαίρει, καὶ συνεστηκότα δὲ λογισμὸν διαλύει καὶ ὀργὰς μεγίστας ἐπανίησι. διὸ καὶ τῷ μελαγχολικῷ καὶ κατηφεῖ καὶ μισανθρώπῳ ὄντι ὥς τι μέγιστον ἴαμα ἐπιτηδειότατον μίσγεσθαι. καθίστησι δ' εἰς τὸ σωφρονέστερον καὶ τοὺς κατ' ἄλλον τρόπον ἐκμανέντας καί τινας ἐπιλήπτους ἔπαυσε καὶ βαρυνομένους τὴν κεφαλὴν καὶ ἀλγοῦντας μεταβολῇ τοῦ ἡβάσκειν. Ἱπποκράτης δὲ ἑνὶ λόγῳ “τοῖς ἀπὸ φλέγματος νοσήμασιν εἶναι κράτιστα” ἀφροδίσια ἔφη. πολλοὶ δὲ καὶ ἐκ νόσων ἄτροφοι ἀνεκομίσθησαν ἐπὶ τῇ χρήσει· οἱ δὲ καὶ εὐπνούστεροι ἀντὶ δυσπνουστέρων ἐγένοντο, καὶ εὐσιτότεροι ἀντὶ ἀποσίτων· οἱ δὲ καὶ ὀνειρωγμῶν συνεχῶν ἀπηλλάγησαν. φύσεις δὲ πρὸς ἀφροδίσια ἐπιτήδειοι αἱ θερμότεραι καὶ ὑγρότεραι καὶ πλέον τῶν ἄλλων εἰς τὴν χρῆσιν εὔφοροι, ἥκιστα δὲ αἱ ξηραὶ καὶ ψυχραὶ καὶ ἡ μὲν τῶν ἀκμαζόντων εὔθετος, ἡ δὲ τῶν γερόντων οὐδαμῶς.

ὥρα δὲ τὸ μὲν ἔαρ ἐπιτήδειον. ἄθετον δὲ τὸ φθινόπωρον καὶ τὸ θέρος. ἀλλ' οὐδὲ ὁ χειμών ἐστιν ἀγαθὸς τῷ ψύχειν. καὶ δὴ καὶ δίαιτα ἡ θερμοτέρα καὶ ὑγροτέρα εἰς λαγνείαν εὔφορος, δύσφορος δὲ ἡ ξηραίνουσα καὶ ψύχουσα. αἱ γὰρ δίαιται πρὸς μίξεις τῷ ἀδυνάτῳ μίσγεσθαι ἐπιτήδειοι. χρὴ τοίνυν τὴν μὲν δίαιταν ὑγρὰν καὶ θερμὴν ὑπάρχειν· εἴη δ' ἂν πόνων μὲν μετριότης καὶ σίτου εὐωχία. οἶνος μὲν οὖν ἔστω κιρρὸς τῇ χροιᾷ, λεπτὸς δὲ τῇ συστάσει, ἄρτοι καθαροὶ ἰπνῖται πρόσφατοι, κρέα ἐρίφων καὶ ἀρνῶν καὶ χοίρων, πτηνὰ ἀλεκτορίδες ἀτταγῆνες πέρδικες χῆνες νῆσσαι· ἰχθύων δὲ οἱ πολύποδες καὶ ὅσα μαλακόσαρκα λέγεται· λαχάνων δὲ ὅρμινον ἐρύσιμον εὔζωμον γογγυλὶς δύσεφθος καὶ τακερὰ γενομένη (ταῦτα γὰρ καὶ ὡς φάρμακα δίδοται), ὀσπρίων δὲ κύαμοι ἐρέβινθοι ὦχροι φάσιλοι πισσοὶ λοβοὶ πνεύματός τε ἐμπιπλῶντες καὶ ἀφθονίαν τροφῆς παρασκευάζοντες. μεγάλως δὲ ἐπαινῶ καὶ τὴν καλλίστην σταφυλὴν εἰς τὴν νῦν δίαιταν· ὑγραίνει γὰρ καὶ αἵματος καὶ πνεύματος ἐμπίπλησι τὸ σῶμα. τὸν δὲ μέλλοντα ἀφροδισίοις χρῆσθαι πλησμονὰς προσφάτους φυλάττεσθαι χρὴ καὶ ἀπεψίας καὶ μέθας καὶ ἐνδείας. κακὸν γὰρ ἐπὶ περιττώμασι μίσγεσθαι καὶ ἀπὸ γυμνασίων καὶ λουτρῶν καὶ κόπους δὲ φυλακτέον καὶ ἐμέτους γεγενημένους καὶ διαρροίας γαστρὸς προσφάτους. τὰς γὰρ χρονίους ἐστὶν ὅτε ξηραίνει τὰ ἀφροδίσια. κάλλιστον δὲ τὸν μισγόμενον ἐπὶ σίτοις μίσγεσθαι μὴ ἐμπλησθέντα· καὶ γὰρ πρὸς ἰσχὺν συμφέρει καὶ αἱ γιγνόμεναι ψύξεις ἧσσον γίγνονται καὶ εἰ μὲν ἐπὶ τῷ ἀρίστῳ τις προθυμηθείη, ἀναπαύσασθαι χρὴ μέχρι καταστῇ τὸ σιτίον, εἰ δὲ ἐπὶ τῷ δείπνῳ ὑπνοῦν ἀνάγκη πρὸς ὀλίγον. καὶ τὰς σφοδρὰς δὲ ἐπιθυμίας οὐκ ἐπαινῶ ἀλλὰ κελεύω δὴ πλέον ἀντέχειν καὶ μᾶλλον οἷς νόσημά ἐστι ῥᾷον ἐκ τῆς χρήσεως βλαπτόμενον.

Rufus of Ephesus, quoted in Aetius of Amida, Medical Books, 3.8, 265,13–268,12 Olivieri

Also in Daremberg’s Oeuvres de Rufus d'Ephèse, pp. 318–325

Pseudo-Alexander on why oil doesn't mix with water, how the soul is joined to the body, and why the head is like a little heaven

Why doesn't oil combine together with other liquids?

Because, since it is viscous and dense and unified and not cut up into fine parts like other liquids, it does not have space for another liquid to move into it and combine with it.

Some things that are joined, however, are joined with one another by mixture, like the qualities of the elements. They have primary qualities that are completely concealed and that produce other [qualities], but are able to be separated and liberated by nature once again. Honey-wine and sour-wine imitate nature, since to our perception they seem to exist as a mixture. In truth, however, and with respect to their substantial nature, they are not like the elements.

Other things are joined by juxtaposition, like water and oil; still others are joined by combination, like barley with wheat; others by cementing, like stone with stone; others by adhesion and similar processes, like blood with flesh or marrow or bone; others by nailing, like wood to wood because some nails were fitted between them; others, by attachment and weaving together, like links in a chain.

But in the case of ensouled things, as in the case of wrestlers*, the soul is not joined with the body in any these ways. That would be too absurd. Instead, the soul joins the body through a kind of suitable medium, which is to some extent receptive of the nature of both. And it [sc. the medium] embraces both a created and contrived thing and combines the incorporeal with the corporeal, the immortal with the corruptible, the pure with the impure, the divine with the earthly, as the discussion will show.

For when the blood is concocted in the liver and changed by the localized balanced proportion of heat and moisture, it generates a vapory pneuma. When this rises with the blood through the hollow-vein towards the heart, as it is heated and refined more, it [sc. the pneuma] becomes air-like. And again, when it is sent up through the carotid artery towards the base of the brain, being guided there by nature’s providence, casting off the immoderate boiling in accordance with a certain peculiar natural quality accompanying the coldness of the brain, the pneuma becomes aitherial, which is the soul’s instrument for activity.

So, just as wild horses are chastened by a bridle, so this [pneuma] is bridled by a certain irrational natural capacity. Furthermore, it is indeed through respiration that the air that has come into the heart is refined and goes up through the arteries towards the head, and it is made nourishment of the aetherial and psychic pneuma. If [the air] meets a body, let it strengthen the body; but if it meets finest, purest, most radiant [pneuma], then [let it strengthen] the rational soul, being somehow a corporeal incorporeal, an intermediate bound between extremes of contrary substance.

When this pneuma is properly stable, in everything it does, it manages, with the soul, to act rationally [κατὰ λόγον]. But when it is cooled immoderately and compressed and thickened, it becomes unsuitable for the intense activity of the soul [and] makes the activities idle and sluggish. When it has been cooled and thickened extremely immoderately, the generated body also causes the soul to depart due to the unsuitability of the substance, as in the case of lethargy, torpor and a draught of cold poison. On the other hand, when it is heated immoderately and is moved more than is needed, it causes the soul to act immoderately in accordance with the soul’s displacement [κατὰ τὰς ἐκστάσεις τῆς ψυχῆς] in [cases of] phrenitis. When this affection becomes even stronger, after it is exhausted, it will make the soul depart again by not preserving their being bound together.

Consider with me a different work of god. For since it was fated that it [sc. the soul] be confined from the heavenly and divine body to an earthly body, [the god] contrived the descent in shape, structure and colour. For the head itself it formed into a sphere, just like a little heaven. It arranged the brain—bright and without excess, having given seven passages to it representing the number of the movers of the stars—to rise above the whole body. For heaven, too, rises above everything in the world of coming to be and passing away.

*the image is of two people embracing and holding on to one another.

Διὰ τί τὸ ἔλαιον οὐδενὶ τῶν ὑγρῶν ἀναμίγνυται;

ὅτι γλίσχρον ὂν καὶ παχυμερὲς καὶ ἡνωμένον καὶ μὴ τεμνόμενον εἰς λεπτὰ μόρια καθάπερ τὰ ἄλλα ὑγρά, οὐ δίδωσιν χώραν ἑτέρῳ ὑγρῷ ἐγκαταβληθῆναι εἰς αὐτὸ καὶ ἀναμιχθῆναι αὐτῷ·

τὰ δὲ ὁμιλοῦντα ἑαυτοῖς ὁμιλεῖ τῶν κατὰ τὴν κρᾶσιν, ὡς αἱ ποιότητες τῶν στοιχείων παντελῶς ἔχουσαι τὰς πρώτας ποιότητας ἀφανιζομένας καὶ ἑτέρας γεννωμένας, δυναμένας δὲ πάλιν ὑπὸ φύσεως χωρισθῆναι καὶ σωθῆναι. τὸ δὲ μελίκρατον καὶ τὸ ὀξύκρατον μιμεῖται τὴν φύσιν, τῇ αἰσθήσει μὲν νομιζόμενα κατὰ κρᾶσιν, εἶναι μὴ ὄντα δὲ κατὰ ἀλήθειαν· καὶ πρὸς τὴν φύσιν οὐσιωδῶς, ὥσπερ τὰ στοιχεῖα.

τὰ δὲ κατὰ παράθεσιν, ὡς ὑδρέλαιον· τὰ δὲ κατὰ μῖξιν, ὡς κριθὴ πυροῖς· τὰ δὲ κατὰ κόλλησιν, ὡς λίθος λίθῳ· τὰ δὲ κατὰ πρόσφυσιν καὶ ὁμοίως, ὡς αἷμα σαρκὶ ἢ μυελῷ ἢ ὀστῷ. τὰ δὲ κατὰ γόμφωσιν, ὡς ξύλον ξύλῳ διὰ γόμφων τινῶν ἐν μέσῳ βαλλομένων. τὰ δὲ κατὰ ἀντοχὴν ἑαυτῶν καὶ περιπλοκήν, ὡς κρίκος κρίκῳ.

ἐπὶ δὲ ἐμψύχων, ὡς ἐπὶ παλαιόντων, κατ' οὐδένα τούτων τῶν τρόπων μίγνυται ἡ ψυχὴ σώματι. διὰ τὸ πολλὴν ἐπάγεσθαι ἀτοπίαν [mss. ἀντοπίαν], ἀλλὰ μᾶλλον κατ' ἐπιτηδειότητα ὁμιλεῖ σώματι ψυχὴ διὰ μέσου τινός, ὅπερ ἀμφοτέρων ἀναδεχόμενον φύσιν ποσῶς· καὶ προσφιλεῖ γινόμενον καὶ σοφιζόμενον, ἀμφότερον μίγνυσι τὸ ἀσώματον τῷ σώματι, τὸ ἀθάνατον τῷ φθαρτῷ, τὸ καθαρὸν τῷ ἀκαθάρτῳ, τὸ θεῖον τῷ γηΐνῳ, ὡς ὁ λόγος δείξει·

ἐν γὰρ τῷ ἥπατι τοῦ αἵματος πεττομένου καὶ μεταβαλλομένου ὑπὸ τῆς αὐτόθι συμμέτρου θερμότητος καὶ ὑγρότητος, γεννᾶται πνεῦμαἀτμοειδές· τοῦτο δὲ διὰ τῆς κοίλης φλεβὸς ἀνιὸν μετὰ τοῦ αἵματος πρὸς καρδίαν, καὶ ἐπὶ πλέον θερμαινόμενον καὶ λεπτυνόμενον, γίνεται ἀεροειδές· καὶ πάλιν ἀναπεμπόμενον διὰ τῶν καρωτίδων ἀρτηριῶν πρὸς τὴν βάσιν τοῦ ἐγκεφάλου κατὰ πρόνοιαν φύσεως ἐκεῖσε παιδαγωγούμενον κατ' ἰδιότητά τινα φυσικὴν ὑπὸ τῆς τοῦ ἐγκεφάλου ψυχρότητος ἀποβαλὸν τὴν ἄμετρον ζέσιν, γίνεται πνεῦμα αἰθεροειδές, ὅπερ ὄργανόν ἐστι ψυχῆς πρὸς ἐνέργειαν·

ὥσπερ ἄγριος ἵππος ὑπὸ χαλινοῦ σωφρονιζόμενος, οὕτω δὲ τοῦτο χαλιναγωγούμενον ὑπό τινος ἀρρήτου φυσικῆς δυνάμεως· ἔτι γε μὴν διὰ τῆς ἀναπνοῆς ὁ εἰσιὼν ἀὴρ ἐν τῇ καρδίᾳ λεπτυνόμενος καὶ ἀνιὼν διὰ τῶν ἀρτηριῶν πρὸς ἐγκέφαλον, καὶ αὐτὸ τροφὴ καθίσταται τοῦ αἰθεροειδοῦς καὶ ψυχικοῦ πνεύματος· ὅπερ εἰ μὲν σῶμα τυγχάνει, προσωκείτω τῷ σώματι, εἰ δὲ λεπτότατον καὶ καθαρότατον καὶ διαυγέστατον φιλιοῦται, ψυχῇ λογικῇ σῶμα ἀσώματόν πως ὑπάρχον καὶ δεσμὸς ἔμμεσος τυγχάνει τῶν ἄκρων ἐναντίαν οὐσίαν ἐχόντων·

τοῦτο τὸ πνεῦμα καλῶς μὲν εὐσταθοῦν διάγει ψυχῇ πάντα κατὰ λόγον ἐνεργεῖν· ἀμέτρως δὲ ψυχόμενον καὶ πιλούμενον καὶ παχυνόμενον καὶ ἀνεπιτήδειον γινόμενον πρὸς ἐνέργειαν σύντονον ψυχῆς ποιεῖ τὰς πράξεις ἀργοτέρας καὶ νωθροτέρας· ἀμετρότατα δὲ ψυχθὲν καὶ παχυνθὲν καὶ σῶμα γενόμενον παρασκευάζει ταύτην ἀφίστασθαι διὰ τὸ ἀνεπιτήδειον τῆς οὐσίας, ὡς ἐπὶ ληθάργων καὶ κάρων καὶ πόσεως ψυχρῶν δηλητηρίων· πάλιν δὲ θερμανθὲν ἀμέτρως καὶ πλέον τοῦ δέοντος κινούμενον, παρασκευάζει ψυχὴν ἀμετρότερον ἐνεργεῖν κατὰ τὰς ἐκστάσεις τῆς ψυχῆς ταῖς φρενίτισιν· ἔτι δὲ πλέον τοῦτο παθὸν καὶ ἐκδαπανηθὲν ποιήσει πάλιν ψυχὴν ἀφίστασθαι τῷ μὴ εὐπορεῖν τοῦ δεσμοῦντος ἀμφότερα.

θεώρει δέ μοι ἕτερον ἔργον θεοῦ· ἐπειδὴ γὰρ ταύτην ἔμελλεν ἀπὸ σώματος οὐρανίου καὶ θείου κατακλείειν σώματι γηΐνῳ, σοφίζεται τὴν κάθοδον σχήματι, κατασκευῇ, χρώματι. αὐτὴν μὲν γὰρ τὴν κεφαλὴν σφαιροειδῆ διετύπωσε, καθάπερ μικρὸν οὐρανόν· τὸν δὲ ἐγκέφαλον λαμπρὸν καὶ ἀπέριττον ἔταξε δεδωκὼς αὐτῷ πόρους ἑπτὰ τῶν κινουμένων ἀστέρων τὸν ἀριθμὸν διατυπώσας. ὑπερέχειν δὲ τοῦ παντὸς σώματος· καὶ γὰρ ὁ οὐρανὸς ὑπερέχει πάντα τὰ ἐν γενέσει καὶ φθορᾷ.

Pseudo-Alexander, Problems, 2.67

"When the soul is inflamed", part II

... Galen discusses the opinions of Aristotle, Plato and the Stoics on the relationship between nature, soul, vital breath and innate heat. Some physicians, perhaps the Pneumatists, were interested in finding the Stoic view already articulated by Hippocrates, particularly in a work called On Sevens, and in Epidemics 6, which is being discussed here. I've added paragraph breaks to make the text easier to read. This is a continuation from part i...

---

In fact, some of those who wrote commentaries on the book under discussion say the word 'born' was written in the sense of 'becomes better'. They suppose it [sc. the soul] becomes better over time for those who are concerned about science and wisdom. This discussion, however, is neither medical nor is it consistent with what comes next, for it is clear from the following quotation that 'produced' is said about the substance of [the soul]: "when it is inflamed together with disease, the soul also consumes the body." The word 'inflamed' would seem to indicate Hippocrates thinks the substance of the soul is the innate heat, which he uses as a cause of natural activities in many other places.

On this point, there is also a great difference of opinion among philosophers. Some believe the substance of the soul and of nature are identical, some of these ones positing its existence in pneuma, others in a specific quality of the body. Certain people think it is not one substance, but claim each of them is distinct and differ not just in a small way in species, but wholly in kind. In this case, they think that the substance of nature is perishable, while that of the soul is imperishable.

Now, Aristotle and Plato introduce both capacities using one word, not only calling that by which we think and remember 'soul', but also the capacity in plants by which they are nourished, increased and preserved until they dry out over time. For the Stoics, on the other hand, it is customary to refer 'nature' to that by which plants are governed, 'soul' that by which animals are. They posit that the substance of both is the co-natural pneuma, and they think these differ from each other by quality: the pneuma of the soul is drier, that of nature more moist, but both require not only food in order to persist, but also air.

Whoever thinks the person who introduced this opinion is Hippocrates, according to what was mentioned in On Sevens, say the word 'born' is mentioned concerning the production in them of additional stuff from both substances, of food and air, since it is clearly observable and we know the usefulness of each of them. For it has been proven that respiration preserves the balance of the innate heat, while ingestion of food replenishes the flowing-out of bodily substance. Moreover, if the soul is a kind of form of the body, it would be appropriate to say that 'it is born until death.'  

Now, if there is some other substance, then concerning the one called 'nature', which Aristotle calls 'threptic', Plato 'epithumetic', what was said would be true; but it would not be true in the case of the 'dianoetic' soul. Certainly, that the innate heat, to which Hippocrates very often refers bodily functions, is inflamed, not only when it is no longer able to complete its previous activities or nourish us —which is its most important function—but also when it destroys and consumes like fire does, this is clear to us when we look carefully at the text and when we see the colliquesence of the body produced by excessively hot fevers.

Left out of the whole discussion is the third 'soul' or 'capacity' or whatever you might want to call it, which Plato called 'spirited'. It is good to mention this so that nothing is left out of our discussion about the soul. One kind of innate warmth, by which blood is produced, is contained in the liver. But a different, greater warmth has been received by the heart for the production of emotion. For if there is some use for it, as it has been pointed out in On the Opinions of Hippocrates and Plato, the one warmth needs respiration, the other transpiration. For thus it is customary for doctors to call what occurs through the artery along its whole body a 'double-activity', sending out residues at systole, drawing in outside air at diastole.

τῶν μέντοι γραψάντων ὑπομνήματα τοῦ προκειμένου βιβλίου τινὲς ἀντὶ τοῦ βελτίων γίνεται τὸ «φύεταί» φασιν εἰρῆσθαι. γίνεσθαι δ' αὐτὴν ἐν τῷ χρόνῳ βελτίονα νομίζουσι τοῖς προνοουμένοις ἐπιστήμης τε καὶ σοφίας, ἀλλ' οὔτε ἰατρικὸς ὁ λόγος οὔθ' ὁμολογῶν τοῖς ἐπιφερομένοις. ὅτι γὰρ ἐπὶ τῆς οὐσίας αὐτῆς εἴρηται τὸ «φύεται», δῆλον ἐκ τοῦ φάναι· «ἢν δ' ἐκπυρωθῇ, ἅμα τῇ νούσῳ καὶ ἡ ψυχὴ <καὶ> τὸ σῶμα φέρβεται». καὶ δόξειε δ' ἂν ἐνδείκνυσθαι τὸ «ἐκπυρωθῇ» ῥῆμα τὴν οὐσίαν τῆς ψυχῆς ἡγεῖσθαι τὸν Ἱπποκράτην τὸ ἔμφυτον εἶναι θερμὸν, ὃ καὶ τῶν φυσικῶν ἔργων αἰτιᾶται πολλαχόθι.

μέγιστον δ' ἐνταῦθα κινεῖται δόγμα διαπεφωνημένον καὶ αὐτοῖς τοῖς φιλοσόφοις. ἔνιοι μὲν ἡγοῦνται μίαν οὐσίαν εἶναι ψυχῆς τε καὶ φύσεως, οἱ μὲν ἐν τῷ πνεύματι τιθέμενοι τὴν ὕπαρξιν αὐτῶν, οἱ δ' ἐν τῇ τοῦ σώματος ἰδιότητι. τινὲς δὲ οὐ μίαν, ἀλλ' ἰδίαν ἑκατέρᾳ τὴν οὐσίαν εἶναί φασι καὶ οὐ σμικρῷ γ' <εἴδει> τινὶ διαφερούσας, ἀλλ' ὅλῳ τῷ γένει, ὅπου γε καὶ τὴν μὲν τῆς φύσεως φθαρτὴν εἶναι ἡγοῦνται, τὴν δὲ τῆς ψυχῆς ἄφθαρτον.

Ἀριστοτέλης μὲν οὖν καὶ Πλάτων ὑπὸ μίαν προσηγορίαν ἀμφοτέρας ἄγουσι τὰς δυνάμεις, οὐ μόνον ᾗ λογιζόμεθα καὶ μεμνήμεθα ψυχὴν καλοῦντες, ἀλλὰ καὶ τὴν ἐν τοῖς φυτοῖς, ᾗ τρέφεταί τε καὶ αὔξεται καὶ διασῴζεται, μέχρι περ ἂν ἐν τῷ χρόνῳ ξηρανθῇ. τοῖς Στωϊκοῖς δ' ἔθος ἐστὶ φύσιν μὲν ὀνομάζειν, ᾗ τὰ φυτὰ διοικεῖται, ψυχὴν δὲ ᾗ τὰ ζῷα, τὴν οὐσίαν ἀμφοτέρων μὲν τίθενται τὸ σύμφυτον πνεῦμα καὶ διαφέρειν ἀλλήλων οἴονται ποιότητι. ξηρότερον μὲν γὰρ πνεῦμα τὸ τῆς ψυχῆς, ὑγρότερον δὲ τὸ τῆς φύσεως εἶναι, δεῖσθαι δ' ἄμφω πρὸς διαμονὴν οὐ τροφῆς μόνον, ἀλλὰ καὶ ἀέρος.

καὶ ὅσοι γε τοῦ δόγματος τούτου νομίζουσιν ἡγεμόνα τὸν Ἱπποκράτην γεγονέναι, καθάπερ ἐν τῷ Περὶ ἑβδομάδων εἴρηται, τὸ «φύεσθαι» λέγουσιν εἰρῆσθαι κατὰ τῆς γινομένης ἐν αὐτοῖς προσθέσεως ἐξ ἀμφοτέρων τῶν οὐσιῶν, τῆς τε <τροφῆς καὶ> τοῦ ἀέρος, <ὡς> ἐναργῶς φαίνεται καὶ τὴν ἑκατέρου χρείαν ἐπιστάμεθα (δέδεικται γὰρ ἡ μὲν ἀναπνοὴ τὴν συμμετρίαν τῆς ἐμφύτου θερμασίας φυλάττειν, ἡ δὲ τῶν σιτίων προσφορὰ τὸ διαρρέον τῆς σωματικῆς οὐσίας ἀναπληροῦν) καὶ, εἴπερ εἶδός τι τοῦ σώματός ἐστιν ἡ ψυχή, προσηκόντως ἂν λέγοιτο «φύεσθαι μέχρι τοῦ θανάτου». 

εἰ δ' ἐστὶν ἑτέρα τις αὐτῆς <ἡ> οὐσία, <περὶ ταύτης> τῆς φύσεως, ἣν Ἀριστοτέλης μὲν ὀνομάζει θρεπτικὴν, ἐπιθυμητικὴν δὲ Πλάτων, ἀληθὲς ἂν εἴη τὸ εἰρημένον, οὐκ ἀληθὲς δὲ ἐπὶ τῆς διανοητικῆς ψυχῆς. ὅτι μέντοι τὸ ἔμφυτον θερμόν, ᾧ μάλιστα ἀναφέρει τὰ σωματικὰ τῶν ἔργων ὁ Ἱπποκράτης, ἐκπυρωθὲν οὐ μόνον οὐκέτι δύναται τὰς ἔμπροσθεν ἐνεργείας ἐπιτελεῖν οὐδὲ τρέφειν ἡμᾶς, ὅπερ ἦν ἔργον αὐτῷ κυριώτατον, ἀλλὰ διαφθείρει τε καὶ τήκει καθάπερ τὸ πῦρ, εὔδηλόν ἐστι τῷ λόγῳ σκοπουμένοις ἡμῖν καὶ τὰς <γινομένας> ὑπὸ τῶν διακαῶν πυρετῶν συντήξεις τοῦ σώματος ἐναργῶς ὁρῶσι.

παραλελειμμένης δὲ κατὰ τὸν εἰρημένον λόγον ἅπαντα τῆς τρίτης ψυχῆς ἢ δυνάμεως ἢ ὅπως ἂν ἐθέλῃς ὀνομάζειν αὐτήν, ἣν ὁ Πλάτων ἐκάλει θυμοειδῆ, καὶ περὶ ταύτης ἄμεινόν ἐστιν εἰπεῖν ἕνεκα τοῦ μηδὲν ἔτι ὑπολείπεσθαι κατὰ τὸν περὶ ψυχῆς λόγον. θερμασία μέν τις ἔμφυτος ἐν ἥπατι περιέχεται, καθ' ἣν αἷμα γεννᾶται· θερμασία δὲ ἑτέρα πλείων ἐστὶ κατὰ τὴν καρδίαν εἰς θυμοῦ γένεσιν ἡμῖν δοθεῖσα. καὶ γὰρ <εἰ> χρεία τούτου τίς ἐστιν, ὡς ἐν τοῖς Περὶ τῶν Ἱπποκράτους καὶ Πλάτωνος δογμάτων ἐπιδέδεικται, δεῖται μὲν αὕτη ἡ θερμασία τῆς ἀναπνοῆς, ἡ δ' ἑτέρα τῆς διαπνοῆς. οὕτω γὰρ ὀνομάζειν ἔθος ἐστὶ τοῖς ἰατροῖς τὴν διὰ τῶν ἀρτηριῶν γινομένην καθ' ὅλον τὸ σῶμα διττὴν ἐνέργειαν, ἐκπεμπουσῶν αἰθαλῶδες περίττωμα κατὰ τὴν συστολὴν, ἑλκουσῶν δὲ τὸν πέριξ ἀέρα κατὰ τὴν διαστολήν.

Galen, Commentary on Hippocrates' Epidemics 6, 5.5 (272,10-274,11 Wenkebach = XVIIB 249-253 Kühn)

"When the soul is inflamed", part I

(edit: the sequel can be found here)

While I've been collecting the fragments of Athenaeus of Attalia, I've also been tracking down texts about the Pneumatist school of medicine. They are pretty elusive, and this makes me wonder whether it was a medical 'school' in the normal sense (like the 'Rationalists' , Empiricists', or 'Methodists'). I'm also curious about the idea of 'belonging to a school' and how what it meant to doctors changed during the first and second centuries.

Galen's commentary on Epidemics 6 is a good place to go to with these questions. It contains lots of discussions of people Galen disagrees with, and some of them sound pretty close to people he calls "Pneumatikoi" in other places. He never names them in the commentary, which means I need to file them away as possible testimonies. Still, whether or not the "τινές" – the "some people" – Galen talks about here are Pneumatists, this passage is further evidence that Epidemics 6 and its interpretation was an important locus for the revival of Hippocratean medicine, and for bringing medicine, natural philosophy and ethics closer together.

I'll post this comment on Epidemics 6.5.2 in two parts. The first part deals with medical views on the soul and its relation to pneuma (or spirit), as well as Galen's thoughts on the soul's importance for medicine. The second records the views of Platonists, Aristotelians and Stoics on the soul.

---

Lemma: A person's soul is ever born until death, but when the soul is inflamed with disease, it consumes the body.

Ἀνθρώπου ψυχὴ αἰεὶ φύεται μέχρι θανάτου· ἢν δὲ ἐκπυρωθῇ ἅμα τῇ νούσῳ καὶ ἡ ψυχὴ, τὸ σῶμα φέρβεται.

'Hippocrates', Epidemics 6.5.2 (V 314,14-15 Littré)

Galen's Commentary: One needs the power of prophecy more than any method, if one is going to figure out what the person who wrote [the word] "born" intended it to mean. One can take it in the sense of "begotten", like Asclepiades later understood it; or one can take it in the sense of "increased"; or, one can take it, as some people did, in the sense of "preserved", since we engage in nutrition and respiration—for all those who consider the soul to be pneuma say it is preserved by an exhalation of the blood and the air drawn through the trachea into the body during inspiration. Obviously, it is impossible for us to maintain that any of these claims are true, without first having identified the substance of the soul precisely. If, therefore, as in the case of On Sevens, in which the book's author clearly stated his opinion about the substance of the soul, it was likewise mentioned in some of the other books which are agreed to be the genuine works of  Hippocrates, then I would have to say something about the word "born". Since, however, Hippocrates nowhere in the genuine books states his opinion clearly [...Wenkebach marks a lacuna...] whatever the word "produced" means.

In addition to my ignorance about this, I myself am not convinced that I can know the substance of the soul with any certainty. That the brain controls perception and voluntary movement for all the parts of an animal, I have demonstrated in The Opinions of Hippocrates and Plato. I am convinced, moreover, that the pneuma in the ventricles [of the brain] is a primary kind of psychic instrument, which it would be rather rash for me to claim is the substance of the soul. Whether the whole nature of the brain arose out of the mixture of the four elements to form some specific quality of the substance, because of which it becomes the primary source of perception and voluntary movement in animals (and obviously also of imagination, memory and thought), or whether some further incorporeal capacity is fastened to us at the brain by a craftsman and then separated again from us when we are dying, I have no sound demonstration. But I also think that those who have an opinion about this have a larger share than mine of rashness rather than wisdom.

And in fact, I think it is superfluous for doctors to know the substance of the soul. For those who practice the art of medicine in a rational way, it is enough to know that as long as the natural mixture of the brain itself and the pneuma in its ventricles is preserved, then the animal is able to live. When the pneuma in the ventricles is completely destroyed, or is diverted a good deal from its natural mixture along with the substance in the brain, then either psychic disease or death necessarily follow. When the doctor knows these things, he will provide for their good-mixture and for the subsistence <of the pneuma>, always according to the methods we mentioned in the notes on Matters of Health (De sanitate tuenda) and The Therapeutic Method (Methodus medendi), all of which I showed Hippocrates had discovered first.

For this reason, then, I think the present passage is not genuine, but was written by someone, as it were, not too far removed, perhaps even his son Thessalus. They say he strung together his father's writings, which he found written on papyrus, parchment and writing-tablets, and inserted passages like these ones along with them.

Μαντείας δεῖ μᾶλλον ἤ τινος μεθόδου, καθ' ἣν εὑρήσει τις, ὅ τί ποτε σημαίνειν βουληθεὶς ἔγραψε τὸ «φύεται». δύναται μὲν γὰρ ἀκούεσθαι καὶ <ἀντὶ> τοῦ "γεννᾶται", καθάπερ ὁ Ἀσκληπιάδης ὕστερον ὑπέλαβε, δύναται δὲ καὶ <ἀντὶ> τοῦ "αὐξάνεται", δύναται δ', ὥσπερ τινὲς ἤκουσαν, ἀντὶ τοῦ "διασῴζεται", τροφῇ καὶ ἀναπνοῇ χρωμένων ἡμῶν· ὅσοι γὰρ οἴονται τὴν <ψυχὴν> εἶναι πνεῦμα, διασῴζεσθαι λέγουσιν αὐτὴν ἔκ τε τῆς ἀναθυμιάσεως τοῦ αἵματος καὶ τοῦ κατὰ τὴν εἰσπνοὴν <ἀέρος> ἑλκομένου διὰ τῆς τραχείας ἀρτηρίας εἴσω τοῦ σώματος. οὐκ ἄδηλον δ' ἐστὶ καὶ ὡς οὐδὲν ὧν εἶπον ἀποφήνασθαι δυνατὸν ἡμῖν ἐστι διατεινομένοις, ὡς ἀληθὲς εἴη, μὴ πρότερον οὐσίαν ψυχῆς ἀκριβῶς ἐξευροῦσιν. εἰ μὲν οὖν, ὥσπερ ἐν τῷ Περὶ ἑβδομάδων ὁ γράψας τὸ βιβλίον ἐκεῖνο σαφῶς ἀπεφήνατο περὶ ψυχῆς οὐσίας, οὕτως καὶ κατ' ἄλλο τι τῶν ὁμολογουμένων γνησίων Ἱπποκράτους συγγραμμάτων ἦν εἰρημένον, εἶχον ἄν τι κἀγὼ λέγειν περὶ τοῦ «φύεται» ῥήματος. ἐπεὶ δ' οὐδαμόθι τῶν γνησίων βιβλίων Ἱπποκράτης ἀπεφήνατο σαφῶς ***, ὅ τί ποτε σημαίνει τὸ «φύεται» ῥῆμα.

πρὸς δὲ τῷ τοῦτ' ἀγνοεῖν οὐδ' αὐτὸς ἐμαυτὸν πέπεικα ψυχῆς οὐσίαν ἐπίστασθαι βεβαίως. ὅτι μὲν γὰρ ὁ ἐγκέφαλος αἰσθήσεώς τε καὶ κινήσεως τῆς καθ' ὁρμὴν ἡγεμών ἐστι τοῖς τοῦ ζῴου μορίοις ἅπασιν, ἐν τοῖς Περὶ τῶν Ἱπποκράτους καὶ Πλάτωνος δογμάτων ἀποδέδειγμαι. πέπεισμαι <δὲ> καὶ πρός γε τούτῳ τὸ κατὰ τὰς κοιλίας αὐτοῦ πνεῦμα πρῶτόν τι τῶν ὀργάνων εἶναι τῶν ψυχικῶν, ὅπερ ἦν μοι προπετέστερον ἀποφηναμένῳ ψυχῆς οὐσίαν εἰπεῖν. εἴτε δὲ ἡ ὅλη τοῦ ἐγκεφάλου φύσις ἐκ τῆς τῶν τεττάρων στοιχείων κράσεως εἰς τοιαύτην <τῆς> οὐσίας ἦλθεν [ἢ] ἰδιότητα, καθ' ἣν αἰσθήσεώς τε καὶ κινήσεως τῆς καθ' ὁρμὴν ἀρχηγὸς ἔσται τῷ ζῴῳ καὶ δηλονότι <καὶ φαντασίας> καὶ μνήμης τε καὶ νοήσεως, εἴτε τις ἄλλη δύναμις ἀσώματος ὑπὸ τοῦ δημιουργήσαντος ἡμᾶς ἐνδεῖταί τε τῷ ἐγκεφάλῳ καὶ χωρίζεται πάλιν ἀποθνῃσκόντων, οὐδεμίαν ἔχω ἀπόδειξιν βεβαίαν, ἀλλὰ καὶ τοὺς ἀποφηναμένους περὶ τούτων ἡγοῦμαι πλεονεκτεῖν ἐμοῦ προπετείᾳ μᾶλλον ἢ σοφίᾳ.

καὶ μέντοι καὶ περιττὸν εἶναι νομίζω τοῖς ἰατροῖς ἐπίστασθαι ψυχῆς οὐσίαν. ἀρκεῖ γὰρ γινώσκεσθαι τοῖς τὴν ἰατρικὴν τέχνην λογικῶς μεταχειριζομένοις, ὡς, ἡ κατὰ φύσιν κρᾶσις αὐτοῦ τοῦ ἐγκεφάλου καὶ τοῦ κατὰ τὰς κοιλίας αὐτοῦ πνεύματος ἄχρι περ ἂν διασῴζηται, ζῆν δυνάμενον τὸ ζῷον. ἐὰν δὲ ἤτοι τὸ κατὰ τὰς κοιλίας πνεῦμα διαφθαρῇ παντάπασιν ἢ τῆς κατὰ φύσιν κράσεως ἐπὶ πλεῖστον ἐκτραπῇ, μετὰ τῆς κατὰ τὸν ἐγκέφαλον <οὐσίας ἀναγκαῖον αὐτῇ ἢ ψυχικὴν νόσον ἢ θάνατον> ἀκολουθῆσαι. ταῦτα γὰρ γινώσκων ὁ ἰατρὸς τῆς τ' εὐκρασίας αὐτῶν καὶ τῆς ὑπάρξεως προνοήσεται <τοῦ πνεύματος> ἀεὶ κατὰ τὰς εἰρημένας μεθόδους ὑφ' ἡμῶν ἔν τε τοῖς Ὑγιεινοῖς καὶ τοῖς Θεραπευτικοῖς ὑπομνήμασιν, ἃς ἔδειξα πάσας Ἱπποκράτην πρῶτον εὑρηκότα.

διὰ τοῦτ' οὖν οὐδὲ γνησίαν νομίζω τὴν προκειμένην ῥῆσιν εἶναι, παρεγγεγράφθαι δ' ὑπό τινος ὥσπερ καὶ ἄλλας οὐκ ὀλίγας, ἴσως δὲ καὶ τὸν υἱὸν αὐτοῦ Θεσσαλόν, <ὃν> ἀθροῖσαί φασι τὰς ὑπογραφὰς τοῦ πατρὸς εὑρόντα γεγραμμένας ἐν χάρταις τε καὶ διφθέραις καὶ δέλτοις, καὶ τοιαύτας τινὰς παρεντεθεικέναι ῥήσεις.

Galen, Commentary on Hippocrates' Epidemics 6, 5.5 (270,21-272,9 Wenkebach = XVIIB 246-249 Kühn)

Solids, Liquids, Gases

On the style of Epidemics 6, Wesley Smith (who translated the text for the Loeb Classical Library) writes: 

“[The Epidemics] are technical prose from a time when prose was coming into being and authors were realizing its potential: unique jottings by medical people in the process of creating the science of medicine.”

Hippocrates VII: Epidemics 2 & 4-7, Harvard University Press, 1994, p.2

The Epidemics is a text without a model, an attempt to capture in writing the experience and practice of medicine. The style, Smith thinks, manifests this naivety. He refers to it as the text’s “innocence” — innocent from later conventions and styles that would come to characterize medical and scientific writing. This innocence makes the Epidemics (like other Hippocratic writings) quite unique; it also makes it quite difficult to read.

Later medical texts look almost nothing like the Epidemics. Medical writers pretty quickly developed standards of exposition that made their writing easier to follow, and one of the effects of this standardization was that a medical text came to be recognizable as such, a distinct form of writing with its own questions, rules, vocabulary and order.

This innovation is already evident in the fourth century, in Diocles’ writings. He had structured his writing on regimen according to times of day, with each time divided into parts dealing with appropriate foods and exercises. Writers on disease, too, began to structure their works: some, according to the location of diseases from head to toe; some, by diseases according to whether they were acute or chronic; some into sections on cause and treatment. And a standard form of medical text, called Remedies  (Peri Boêthêmatôn) was developed by the Pneumatist school, which divided remedies according to the way they acted on the body.

Certainly some authors were not as clear as all this. Dioscorides’ Materia Medica (Peri Hulês) follows a notoriously obscure structure, something later authors complained about. It would have been easier, they thought, if he had ordered things alphabetically. But this just shows that doctors were thinking about the form medical writing should take, and began to adopt standards to avoid the type of obscurity we find in the Epidemics. 

Epidemics 6, however, was also canonical, at least to those sympathetic to Hippocratic medicine. The style of the text may have been obscure, but most everyone who practiced Hippocratic-style medicine would have been familiar with it. And interpreting the text became a way of debating new ideas about what medicine is and how it should be practiced.

Evidence of a tradition of interpretation exists, preserved for the most part by Galen, but also in earlier authors like Dioscorides and Athenaeus and later ones like Palladius. For these Hippocratic doctors, the Epidemics could not simply be read. It needed to be deciphered. And part of the game of interpretation seems to have been to show that, whatever new idea they were promoting, the insight was already present in the writings of Hippocrates (or by showing, especially in the case of Epidemics 6, that parts of it were not by Hippocrates at all, and so could be ignored).

Now, one passage from Epidemics 6 was generally agreed to be a kind of keystone for the whole work. It is found at Epidemics 6.8.7:

“Things from the small tablet to be observed. Regimen consists in repletion and evacuation of foods and drinks. Changes of these: what from what, how it is. Odors: pleasant, noxious, filling, tempting. Changes, from what kinds of things, how they are. The pneumata that come in or go out, [solid] bodies also. Better sounds, and those that harm. And of the tongue, what things are evoked by what. Pneuma, what is hotter to the tongue, colder, thicker, thinner, dryer, wetter, filled up, less and greater. From what come changes, what out of what kinds of things, how they are. Things that contain, impart impulse, or are contained. Speech, silence, saying what one wishes. The words, what one says, either loud or many, truthful or fraudulent. (Smith trans., modified)”

τὰ ἐκ τοῦ σμικροῦ πινακιδίου σκεπτέα. δίαιτα γίνεται πλησμονῇ, κενώσει, βρωμάτων, πομάτων· μεταβολαὶ τούτων, οἷα ἐξ οἵων, ὡς ἔχει. ὀδμαὶ τέρπουσαι, λυποῦσαι, πιμπλῶσαι, πειθόμεναι· μεταβολαὶ, ἐξ οἵων οἵως ἔχουσιν. τὰ ἐσπίπτοντα, ἢ ἐξιόντα πνεύματα, ἢ καὶ σώματα. ἀκοαὶ κρείσσονες, αἱ δὲ λυποῦσαι. καὶ γλώσσης, ἐξ οἵων οἷα προκαλεῖται. πνεῦμα, τὸ ταύτη θερμότερον, ψυχρότερον, παχύτερον, λεπτότερον, ξηρότερον, ὑγρότερον, πεπληρωμένον, μεῖόν τε καὶ τὸ πλεῖον· ἀφ' ὧν αἱ μεταβολαὶ, οἷαι ἐξ οἵων, ὡς ἔχουσιν. τὰ ἴσχοντα, ἢ ὁρμῶντα, ἢ ἐνισχόμενα. λόγοι, σιγὴ, εἰπεῖν ἃ βούλεται· λόγοι, οὓς λέγει, ἢ μέγα, ἢ πολλοὶ, ἀτρεκεῖς, ἢ πλαστοί. (V 344-6 Littré)

(I’ve adopted some of the changes suggested by Smith in the Loeb text and ignored others. Notably, I’ve left out “σώματα” after “ἐνισχόμενα”, following Littré, since as Littré pointed out, no one in antiquity mentions it being there.)

This text has puzzled interpreters for a long time. It is elliptical, confident, and somewhat mysterious. But later doctors saw in it the basis of a system: a list of observations that need to be made in order to assess the health of a patient. 

Two aspects of the list were to become especially important in later medical writers. One is the distinction of pneuma into hot, cold, thick, thin, wet or dry. This distinction has an interesting history that I hope to come back to. But here I want to focus on the distinction of things into “containing, imparting impulse, and contained (τὰ ἴσχοντα, ἢ ὁρμῶντα, ἢ ἐνισχόμενα).” 

We have been working on tracing this distinction for a paper we’re writing on the Pneumatist school. It came to be associated with a way of understanding human physiology that would have a long influence: the division of the constituents of the body into solid parts, humours, and pneuma. It is explicitly mentioned in Galen, the pseudo-Galenic Introduction, pseudo-Alexander on Fevers. It might be in Nicolaus of Damascus On Plants. And in De causis contentivis, especially in chapter 4, Galen hints that it played some role in Pneumatist physiology and causal theory. 

This left us with a bit of a puzzle. How did a distinction of the body into containing parts, parts imparting impulse, and contained parts come to be identified with solids, liquids and gases? This is far from obvious and there is nothing in the text of the Epidemics that suggests it. Why would anyone have interpreted the text this way? Why did it become widely accepted? And how is it related to other ways of describing human physiology, for example, in terms of the elements (...interesting that the distinction is absent from the Definitiones...)?

We looked through the literature, but didn’t find anything substantial. So I thought I would gather all the texts here to make them available. Some of them are still untranslated, and there are likely more texts than the ones below. I will continue to translate and add more as we find them. But hopefully it will be something of a start to sorting out how this interpretation of Epidemics 6 came about and why it became so influential.

I
The Pseudo-Galenic author of Introduction or The Physician

“Others say the human is in fact composed out of three compounds, as well, from wet things, dry things and pneumata. Hippocrates calls them things containing, things contained and things which impart impulse. Containing are whatever are solid bodies—bones, nerves, veins and arteries—out of which muscles, flesh, and every mass of the body are compounded, both internal and external structures. Contained are the wet things carried in the channels and scattered through the whole body, what Hippocrates calls the four humours previously mentioned. Things which impart impulse are the pneumata. According to the ancients, there are two pneumata: psychic and natural. The Stoics also add a third: hectic, which they call a state.”

οἱ δὲ ἐκ τῶν τριῶν καὶ συνθέτων τὸν ἤδη γενώμενον ἄνθρωπον ἐκ τῶνδέ φασι συγκεῖσθαι, ἔκ τε τῶν ὑγρῶν καὶ ξηρῶν καὶ πνευμάτων. καλεῖ δὲ αὐτὰ Ἱπποκράτης ἴσχοντα, ἰσχόμενα καὶ ἐνορμῶντα. ἴσχοντα μὲν οὖν ἐστιν ὅσα στερεὰ, ὀστᾶ καὶ νεῦρα καὶ φλέβες καὶ ἀρτηρίαι, ἐξ ὧν οἵ τε μύες καὶ αἱ σάρκες καὶ πᾶς ὁ τοῦ σώματος ὄγκος πέπλεκται, τῶν τε ἐντὸς καὶ τῶν ἐκτὸς τὰ συγκρίματα. ἰσχόμενα δέ ἐστι τὰ ὑγρὰ τὰ ἐν τοῖς ἀγγείοις ἐμφερόμενα καὶ κατὰ πᾶν τὸ σῶμα διεσπαρμένα, ἅπερ καλεῖ Ἱπποκράτης χυμοὺς τέσσαρας τοὺς προειρημένους. ἐνορμῶντα δέ ἐστι τὰ πνεύματα. πνεύματα δὲ κατὰ τοὺς παλαιοὺς δύο ἐστὶ, τό τε ψυχικὸν καὶ τὸ φυσικόν. οἱ δὲ Στωϊκοὶ καὶ τρίτον εἰσάγουσι τὸ ἑκτικὸν, ὃ καλοῦσιν ἕξιν.

[Galen] Introductio 9, 14.696.14-697.8 K

“Hippocrates, then, put forward three, saying the elements of man are things contained, containing and imparting impulse, through which he included all the elements of those who came after him, as well as elemental physiology and the aetiology of things contrary to nature. But those after him, I don't know why, divide this divine and truly Asclepian medicine into three, although it is really a unity, and they dispersed the parts that make it up. (i) Some referred only to the humours [when explaining] the composition of things according to nature and the cause of things contrary to nature, as Praxagoras and Herophilus [did]. Others posited the solid bodies as the primary and elemental things, and believed that things are composed out of these and the causes of diseases originate from them, as Erasistratus and Asclepiades [did]. And those around Athenaeus and Archigenes claim that all the natural things are created only by means of the pneuma pervading through them and that all the diseases are governed by it, because it [sc. the pneuma] is the thing affected first – for this reason they are called Pneumatists.”

Ἱπποκράτης μὲν οὖν διὰ τριῶν κεχώρηκεν, εἰπὼν στοιχεῖα ἀνθρώπου ἴσχοντα, ἰσχόμενα, ἐνορμῶντα, δι' ὧν τὰ πάντα τῶν μετ' αὐτὸν περιείληφε στοιχεῖα καὶ τὴν κατὰ στοιχείων φυσιολογίαν τε καὶ αἰτιολογίαν τῶν παρὰ φύσιν· οἱ δὲ μετ' αὐτὸν οὐκ οἶδ' ὅπως μίαν οὖσαν τὴν θείαν ταύτην καὶ ἀληθῶς Ἀσκληπιοῦ ἰατρικὴν τριχῇ διανειμάμενοι καὶ διασπάσαντες τὰ ἐν αὐτῇ συμφυῆ μέρη, οἱ μὲν μόνοις τοῖς χυμοῖς τῶν τε κατὰ φύσιν τὴν σύστασιν καὶ τῶν παρὰ φύσιν τὴν αἰτίαν ἀνέθεσαν, ὡς Πραξαγόρας καὶ Ἡρόφιλος. οἱ δὲ τὰ στερεὰ σώματα τὰ ἀρχικὰ καὶ στοιχειώδη ὑποθέμενοι, τά τε φύσει συνεστῶτα ἐκ τούτων καὶ τῶν νόσων τὰς αἰτίας ἐντεῦθεν λαμβάνουσιν, ὡς Ἐρασίστρατος καὶ Ἀσκληπιάδης· οἱ δὲ περὶ Ἀθήναιον καὶ Ἀρχιγένην μόνῳ τῷ διήκοντι δι' αὐτῶν πνεύματι καὶ τὰ φυσικὰ συνεστάναι τε καὶ διοικεῖσθαι καὶ τὰ νοσήματα πάντα, τούτου πρωτοπαθοῦντος γίνεσθαι ἀπεφήναντο, ὅθεν καὶ πνευματικοὶ χρηματίζουσι.

[Galen], Introductio 9, 698.12-699.10 K

II
Nicolaus of Damascus, Plants (distinct tradition?)

“A plant has three powers, the first derived from the element of earth, the second from that of water, the third from that of fire. From the earth the plant derives its growth, from water its cohesion, and from fire the union of the cohesion of the plant. We see much the same thing in vessels of pottery, which contain three elements—clay, which is, as it were, the material of pottery; secondly, water, which binds the pottery together; and, thirdly, fire, which draws its parts together, until it completes the process of manufacture.”

Τὸ δένδρον τρεῖς ἔχει δυνάμεις, πρώτην ἐκ τοῦ γένους τῆς γῆς, δευτέραν ἐκ τοῦ γένους τοῦ ὕδατος, τρίτην ἐκ τοῦ γένους τοῦ πυρός. ἀπὸ τῆς γῆς γάρ ἐστιν ἡ ἔκφυσις τῆς βοτάνης, ἀπὸ τοῦ ὕδατος ἡ σύμπηξις, ἀπὸ τοῦ πυρὸς ἡ ἕνωσις τῆς συμπήξεως τοῦ φυτοῦ. Βλέπομεν δὲ πολλὰ τούτων καὶ ἐν τοῖς ὀστρακώδεσιν. Εἰσὶ γὰρ ἐν τούτοις τρία, πηλός, ἐξ οὗ γίνεται πλίνθος ὀστρακώδης, δεύτερον ὕδωρ, ὅπερ ἐστὶ τὸ στερεοῦν τὰ ὀστρακώδη, τρίτον τὸ πῦρ τὸ συνάγον τὰ μέρη αὐτοῦ, ἔστ’ ἂν δι‘ αὐτοῦ πληρωθείη ἡ τούτου γένεσις.

[Aristotle], De Plantis 2.1

III
The Pseudo-Alexandrian author of Fevers

Φανερὸν μὲν οὖν διὰ τούτων καὶ ὡς τρία μόνα τὰ ἐν ἡμῖν, ἐν οἷς ἡ παρὰ φύσιν θερμότης, μόρια, χυμοί, πνεύματα· τὰ αὐτὰ δὲ καὶ παρ' Ἱπποκράτει ἴσχοντα, ἰσχόμενα καὶ ἐνορμῶντα καλεῖται, ἴσχοντα μὲν τὰ μόρια, ἃ καὶ στερεὰ προσαγορεύεται, ἰσχόμενα δὲ οἱ χυμοί, ἐνορμῶντα δέ γε τὰ πνεύματα, ἕκαστον ἐκ τῆς ἰδίας δυνάμεως τὴν προσηγορίαν ἁρμόζουσαν εἰληφός. 

Ἴσχει μὲν γὰρ καὶ κατέχει τὰ στερεά, ἐνίσχεται δὲ καὶ ἐμπεριέχεται ὑπὸ τούτων τὰ ὑγρά τε καὶ διαρρέοντα, ταὐτὸν δὲ εἰπεῖν οἱ χυμοί, ὁρμᾷ δὲ τὰ ἐν ἡμῖν πνεύματα, λεπτομερεστάτης οὐσίας ὄντα καὶ θερμοτάτης, καὶ ῥᾷστα διὰ πάντων χωροῦντα τῶν μορίων τοῦ σώματος.

[Alexander], De febribus 17.1-2

IV
Galen, Differences of Fevers

νῦν δὲ ἀρκεῖ τό γε τοσοῦτον γινώσκειν, ὅπερ, οἶμαι, καὶ ὁ Ἱπποκράτης ἐνδεικνύμενος ἔλεγε, τὰ ἴσχοντα καὶ τὰ ἐνισχόμενα καὶ τὰ ἐνορμῶντα· ἴσχοντα μὲν αὐτὰ τὰ στερεὰ μόρια τοῦ σώματος, ἐνισχόμενα δὲ τὰ ὑγρὰ, ἐνορμῶντα δὲ τὰ πνεύματα προσαγορεύων.

Galen, De differentiis febrium, 7.278.11 K

V
Galen, On Tremor, Palpitation, Spasm and Rigor

μέμνηται δέ πως αὐτῶν ὧδε, τὰ ἴσχοντα λέγων, καὶ τὰ ἐνισχόμενα, καὶ τὰ ἐνορμῶντα· ἴσχοντα μὲν τὰ στερεὰ καλῶν, περιέχει γὰρ καὶ ἀποστέγει τὰ ὑγρά· ἐνισχόμενα δὲ, τὰ ὑγρὰ, περιέχεται γὰρ ὑπὸ τῶν στερεῶν· ἐνορμῶντα δὲ τὰ πνεύματα, πάντῃ γὰρ ἐξικνεῖται τοῦ σώματος ἐν ἀκαρεῖ χρόνῳ ῥᾳδίως τε καὶ ἀκωλύτως.

Galen, De tremore, palpitatione, convulsione et rigore, 7.597.3-9 K

VI
Galen, Commentary on Epidemics 6
(only available in Pfaff’s German translation of the Arabic summary, online at the CMG)

(V 346, 5.6 L[ittré]) Hippocrates: Das Enthaltende und das Eindringende und das Enthaltene.

Galen: Auch diese Worte erklärt jeder von den Kommentatoren anders. Die beste Erklärung ist nach meiner Meinung die Erklärung derjenigen, welche sagen, daß er unter ‘das Enthaltende’ die festen Grundkörper [solid parts] und unter ‘das Eindringende’ oder ‘das Durchdringende’—diese Worte werden auf diese beiden Arten geschrieben—die Winde [pneumata] und unter ‘das Enthaltene’ die Feuchtigkeiten [humors], die die Körper enthalten, verstehe. Hippokrates verlange also, daß man von diesen drei Dingen aus, aus denen jeder lebende Körper bestehe, untersuche und erforsche, welches die Natur und die Kraft eines jeden von ihnen sei.

Galen, In Hippocratis Epidemiarum librum VI commentaria I-VI, CMG V 10,2,2 p.446 Wenkebach

VII
Palladius, Overview of on Fevers

Ἰστέον ὅτι τῶν πυρετῶν τρία εἰσὶ τὰ γένη· τὰ μὲν γὰρ αὐτῶν ἐπὶ ὑγροῖς γίνονται καὶ ἐξάπτονται, τὰ δὲ ἐπὶ στερεοῖς, τὰ δὲ ἐπὶ πνεύμασι, περὶ ὧν ὁ Ἱπποκράτης λέγει ἴσχοντα, ἰσχόμενα καὶ ἐνορμῶντα, ἴσχοντα μὲν καλῶν τὰ στερεά, ἰσχόμενα δὲ τὰ ὑγρά, ἐνορμῶντα δὲ τὰ πνεύματα. Ὁ δὲ Γαληνὸς ἀναφέρει ὅτι ἀναμέμικται ἔν τε ταῖς ἀρτηρίαις ἁπάσαις διὰ πολλῶν ὀπῶν ἅμα πνεούσαις ἡ ἀερώδης οὐσία τῷ αἵματι καὶ κατὰ τὴν καρδίαν οὐδὲν ἧττον, ὡς ἂν σύρρους ὑπάρχουσα πάσαις αὐταῖς.

Palladius, Synopsis de febribus, 4.1-2