Raffaele Passarella, Ambrogio e la medicina: le parole e i concetti. Il Filarete 262. Milano: LED Edizioni Universitarie di Lettere Economia Diritto, 2009. Pp. 511. ISBN 9788879164214. €47.00 (pb).
Reviewed by Alberto J. Quiroga Puertas, University of Granada
As part of his in depth study, Raffaele Passarella examines the influence of medical terminology in the work of Ambrose of Milan, surveying texts from classical antiquity and approaching the bishop's works from both a literary and socio-religious perspective. Passarella explores how Ambrose's concept of medicine was formed and analyses the extent to which the acknowledgement of technical vocabulary relied upon its assimilation into the Christian cultural milieu.
The introduction and first chapter ("Aspetti storico-letterari") set out to explain the problems that accompany classical medical texts, that is, the "mancanza di lessici di termini medici greci e latini" (p. 11). Notably, the Christianization of language and the inclusion of medical terminology in texts outside the medical field serve to hinder somewhat the compilation and further analysis of original texts. Two main issues, however, are worth considering in this first chapter: first, that Ambrose´s knowledge of medicine is derived mainly from Philo of Alexandria, although evidence suggests that the texts and theories of Pliny and Galen also had some influence. Second, it is understood that medicine was part of classical paideia and thus became a key element in the process of Christianization. In this respect, Passarella is perhaps somewhat justified in confronting the real implications of medicine for both Imperial power ("manifestazione di evergetismo e filantropia") and for the Church ("l´assolvimento di un dovere morale") p. 33.
The second chapter ("La medicina, il medico e il paziente") focuses on the means by which Ambrose came to familarise himself with medicine. His attitude to the discipline was pragmatic, yet what still remains a contentious issue is just how theoretical his knowledge actually was. We cannot for instance rely solely upon the account of his biographer, Paulinus, as he provides us only with a brief clarifying edoctus liberalibus disciplinis (Vita Ambr. 5). What we do know, however, as is the case in fields like rhetoric, for example, is that both knowledge and skill were essential for commanding the art of medicine; yet as Ambrose himself takes care to remind us (Expl. Ps. XXXVII, 7), this art would be fruitless without the decisive intervention of God himself. Incidentally, in the last pages of the chapter, Passarella makes reference to Ambrose´s Christian interpretation of medicine, citing the bishop's constant use of the metaphor "doctor/God" as part of the process of healing/redeeming mankind from its sins/illnesses.
The third chapter ("Anatomia") is a comprehensive study of the human body from a Christian perspective. However, where a sociological analysis into the Christian´s understanding of the importance of the human body might be expected, Passarella instead opts for a more literary and exegetical approach. Some methodological notes are included, however: notably Ambrose´s description of the human body featuring an array of a capite ad calcem in his works De Noe and Exameron, as well as references to the influence of Philo of Alexandria and Hippocrates´ humoral theory and his tendency to digress "senza un intervento critico" (p, 75).
"La carne e il corpo", the first subchapter, offers a philological insight into the human head and numerous body parts (nose, mouth, forehead, face, etc.) However, it is Passarella's interest in the mouth and the eyes that perhaps attracts particular attention in this chapter, since it serves almost to epitomize his methodology in general. In the first instance, a literary commentary of Ambrose´s choice of words dens and lingua is supplemented by a physiognomic reading of the teeth according to which "è possible distinguere il peccatore dal giusto" (p. 107). The discussion of the eyes centres around a philological commentary which seeks to re-affirm Ambrose´s lexical precision (notably a number of synonyms for oculi are given here); this is coupled with a philosophical observation of the stoic influence surrounding the treatment of his eyes. A brief examination of the vocabulary concerning the membra and artus (i.e. arms, hands, legs) is preceded by a catalogue of the viscera, that is, the internal and external organs of the human body. Passarella´s study at this stage appears to be largely descriptive. Nevertheless, some insightful conclusions can be drawn from this section: namely the influence of authors such as Cicero, Galen, Philo of Alexandria and Basil of Caesarea in Ambrose's medical vocabulary, the evidence for which is nothing short of overwhelming at times.
In this respect, Passarella´s efforts to trace many of Ambrose´s countless influences and compare them to instances within his own works deserves rightful recognition and praise. In addition, Passarella is also to be commended for pointing out Ambrose's ability to create an almost metaphorical language using specialized vocabulary ("quanto più il discorso si fa specialistico dal punto di vista medico, tanto più è favorite l`impiego di immagini creates in quell medesimo àmbito", p. 154). It is somewhat surprising, however, to witness a notable absence of references to F. Skoda´s Médicine ancienne et métaphore: le vocabulaire de l´anatomie et de la pathologie en Grec ancien (Paris, 1988). One can perhaps feel only that the inclusion of such a seminal work would have extended the scope for discussion and potentially added to the overall density of this book. This third chapter, however, illustrates Ambrose´s richness of vocabulary in discussions of the skin, muscles, hair, and skeleton.
The fourth chapter ("Fisiologia") opens with an essay concerning the digestive process and its allegorical reading in Ambrose´s De Noe 9.27-29 which was, in turn, borrowed from Philo´s Quaestiones in Genesim. Pasarella´s remarkable aptitude for philological analysis (see pp. 205-210 on the difference between concoquere and digerere) serves almost to depict Ambrose as a paradigmatic figure standing at a linguistic crossroad: "la coscienza di trovarsi di fronte ad una fase di transizione della lingua medica latina (…) lo induce ad utilizzare quei vocaboli che dovevano riuscire comprensibili al magior numero di fedeli" (p. 224). The respiratory system and the circulatory and aging processes though evident are all dealt with in less detail in this chapter.
A list of abundant terms Ambrose used to refer to illness (morbus, valetudo, aegritudo, debilitas, languor, imbecilitas, offensio, infirmitas, passio) and a short commentary on their usage constitute the beginning of chapter five ("Patologie"). Indeed, this chapter provides a useful vademecum which refers to numerous diseases, with many of the discussions substantiated by biblical examples. It consists of an array of different categories in accordance with fourth century A.D. medical standards (mental disorders such as love, sadness, auditory and ocular conditions, for example). Yet in spite of the inclusion of pages detailing certain diseases from the bible and the originality of such an idea, the internal coherence of the book seems somewhat compromised as many other chapters contain both pagan and Christian texts without internal divisions.
"Terapie" is the sixth chapter and one within which the author adopts Celsus´ division (Prooem 9) concerning the different types of therapy, namely, diet, medicaments, and surgery. Diet in this context, however, refers not only to food itself but also to the social implications of eating. Following a concise review of what food meant to certain authors (Philo, Augustine) in the Christian and Graeco-Roman context, Passarella shows Ambrose revealing his attitude towards food and dieting and advocating fasting and abstinence (Hel. 4.6: ubi cibus coepit, ibi finis factus est mundi) whilst encouraging people to take the word of God as the essential ingredient (Expl. Ps. I, 33: Bibitur scriptura divina et devoratur scriptura divina, cum in venas mentis ac vires animae sucus verbi descendit aeterni; denique non in solo pane vivit homo sed in omni verbo Dei).
The final chapter ("Ginecologia") opens with a lexicographical study into female sexual organs which appears somewhat surprising given the extensive usage of such terms (genitalis, secretum, genatorium, uterus, venter, matrix) that patterns much of Ambrose's work. The chapter goes on to explore physiological issues relating to gynecology (menstruation, pregnancy, menopause, virginity, abortion, giving birth and breastfeeding) paying special attention to the religious and social implications of these processes. Virginity for one, according to the Church Fathers, exceeds the merits of widowhood and marriage since it was considered, first and foremost, the most righteous of virtues to be upheld amongst women.
The book arrives at its conclusion by summarizing three main aspects of Ambrose´s approach to medicine. First, the bishop´s broad knowledge of his discipline was supported by his bookishness and personal experience. Second his knowledgedid not keep him from developing his own theories or acquiring information in order to write a compendium; on the contrary, references to medicine are scattered throughout his works. Third and finally, it is significant that in a period of religious struggle "Ambrogio non strumentalizza la medicina (…) sembra piuttosto interessato agli aspetti concreti della vita quotidiana" (pp. 408-409).
To conclude, little in the way of criticism can perhaps be directed towards a book that combines both a thorough textual analysis of Ambrose´s works with a deep knowledge and understanding of sources from classical antiquity (both in Greek and in Latin). Passarella clearly stated in the first chapter that the objective of his work was "lo stile, le strategie compositive o le modalità di rielaborazione" (p. 26); hence in this respect, he cannot be blamed for his attempts to try to disentangle and separate Ambrose´s use of medical terminology from its religious setting. If anything, one might argue, he fulfills his promise in drawing upon several references within each section, detailing countless authors from whom Ambrose drew his inspiration. Nevertheless, we can only guess how much additional substance and potential this already excellent book might have possessed had the author delved further into the historical and religious setting.