Tuesday, July 24, 2018


Petros Bouras-Vallianatos, Sophia Xenophontos (ed.), Greek Medical Literature and its Readers: From Hippocrates to Islam and Byzantium. Publications of the Centre for Hellenic Studies. King's College London. London; New York: Routledge, 2018. Pp. x, 239. ISBN 9781472487919. $144.95.

Reviewed by Timothy S. Miller, Salisbury University (tsmiller@salisbury.edu)

Version at BMCR home site

[Authors and titles are listed at the end of the review.]

The common theme of these essays, assembled by Petros Bouras-Vallianatos and Sophia Xenophontos is so broad that it is very difficult to review the volume as a whole. Rather, I will address each article and try to discern common themes among some of them as well as to indicate subjects which the editors failed to address in their own essays or for which they were unable to find contributors.

In the first section, "The Classical World," dealing with Greek medical writers before the Roman period, two articles, one by Stavros Kouloumentas and the other by Chiara Thumiger, emphasize the empirical nature of Classical Greek medicine. Thumiger discusses the well-known case studies of the Epidemics to emphasize that at this stage in Greek medical science physicians were following Herodotus's advice to those who pursued science: describe everything; it might turn out to be relevant. Thus, the medical descriptions include details on the patients' constitutions, diets, and daily habits as well as on the course of the individual ailments. At this stage in Greek medicine, no firm position had as yet emerged as to whether diseases were entities, alien to the human body, or simply imbalances in the healthy human constitution.

In his article, Kouloumentas maintains that the early physician Alcmaeon's On Nature also emphasized careful observation of patients—i.e., collecting τεκμήρια—as the sole way to acquire medical knowledge. Alcmaeon rejected any place for mystical experiences or divine revelation in the practice of medicine. According to Kouloumentas, Alcmaeon designed his On Nature to counter certain mystical currents in a Pythagorean circle of southern Italy, a group to which Alcmaeon belonged.

Laurence Totelin's article discussing the Hippocratic text On Winds has some interesting comical aspects related to the problem of farting and whether some readers might have found this otherwise serious text amusing. He also introduces the link between On Winds and later Pneumatist writing, but he never develops this theme. In fact, Pneumatism and its practitioners are never discussed by any author in the collection.

The second section, "The Imperial World," seems to me to be the major weakness of the whole collection. The article by Sophia Xenophontos on Galen's Exhortation to the Study of Medicine states the obvious. Galen wrote this text to convince teenage boys to take up medicine. Her discussion of Galen's arguments against extreme sports does address a more important point, but she does not connect his comments to the general decline of physical education across the Greco-Roman world, even though sports training had initially been at the core of Greek liberal education.

Michiel Meeusen's article on medical puzzles and natural problems attributed in the manuscript tradition to Alexander of Aphrodisias, again states the obvious, i.e., that the questions were written for students of medicine, not so much to teach them answers to puzzling aspects of the natural world, but to provide examples of how to approach such perplexing problems.

One glaring omission of "The Imperial Period" is the lack of an article on Aretaios of Cappadocia. Recently, scholars have been calling attention to his excellent descriptions of internal lesions and blockages, descriptions that could only be possible if he had conducted not simply dissections of the human body, but autopsies of specific human bodies belonging to patients who had died under Aretaios's care. In other words, he had conducted post-mortem pathological autopsies, or at least that is one possible explanation. Such a paper might seem to fall outside the question of intended readers, but Aretaios's text does pose another interesting issue which is related to who his readers were. Why did he write his medical treatise in Ionic Greek? Was this an antiquarian quirk, or did he have a more precise reason? Did he want to limit access to his work? And if so, was the reason for obscuring what he said linked to his practice of post-mortem dissections? Or was the Ionic idiom linked to Pneumatism, the school to which Aretaios seems to have belonged? Who knows? But, an article dealing with Aretaios seems to me a necessity for a collection dealing with the relationship between medical writers and their intended audience.

The third section, "The Islamic World," focuses on translations of Galen's works into Arabic. First, Uwe Vagelpohl demonstrates how the eighth- century Christian physician, Hunayn ibn Ishaq, did not provide a simple translation of Galen's texts. Rather, he rephrased the original Greek to make the meaning clear, sometimes using several Arabic words to translate a single Greek technical term, sometimes adding several clauses to make Galen's points absolutely clear to his Arabic-speaking readers. It is important for medical historians to remember that with medical texts, the goal is never to guarantee an accurate reproduction of an archetype or a translation that preserves the elegance of the original Greek, but to communicate most effectively how to heal the patient.

In her article on the Arabic translation of Galen's On the Usefulness of the Parts, Elvira Wakelnig points out that translators from Hunayn's school routinely substituted 'God' and 'the Creator' where Galen had used nature, changes which made Galen's treatises more acceptable to both Arab-speaking Christians and Muslims. Turning her attention to two original treatises in Arabic concerning human anatomy and physiology, Wakelnig reveals that Galen's works entered the Arabic-speaking world not only through the translations produced by Hunayn and his students, but also through earlier translations of the Greek texts into Syriac, and subsequently into Arabic. She bases her claim on the use of Arabic terminology in these anatomical studies not found in the translations emanating from Hunayn's school.

The fourth section, "The Byzantine World," begins with an article by Erika Gielen concerning On the Constitution of Man by the ninth- century monk Meletios and the similar treatise by Leo the Physician. Gielen points out that Leo's work survives in only one manuscript, demonstrating that it was far less popular than Meletios's treatise which is preserved in more than sixty manuscripts. Gielen suggests that Meletios's work appealed to a wider audience because the author gave it a more Christian tone by including many reference to the Bible as well as quotes from the Fathers of the Orthodox Church. Leo, on the other hand, avoided theological discussions and streamlined his texts for students who were probably learning medicine in the hospitals of Constantinople.

Of greater significance would have been a discussion of why these two texts were written in the first place. Although Meletios's treatise depends on Galen for almost all of its scientific material, its attempt to weld anatomy to the physiology of the human body and discuss "the constitution of man" as a whole was an original idea. Moreover, another text with the same title, attributed to a Theophilos who appears to have worked in a hospital as an archiatros, takes the same approach. Why did these three studies, that of Meletios, of Leo, and also of Theophilos, all trying to present a complete picture of how the human body worked, appear at almost the same time in the ninth century? Was this linked to religious ideas of purposeful creation as in the Arab world, or was there a connection between these Byzantine treatises and the nearly contemporary anatomical studies among Arab-speaking physicians? (See Wakelnig's article.)

Bouras-Vallianatos's article demonstrates how Galen's Therapeutics to Glaucon evolved from serving as a self-help medical manual for liberally educated Greco-Roman aristocrats into an introductory teaching text for medical students. An important element in this evolution was the extensive commentary on Galen's original text prepared in late sixth-century Alexandria by a physician named Stephen. Bouras-Vallianatos also draws attention to the use of diagrams which frequently accompany Stephen's commentary in the Byzantine manuscript tradition, diagrams which were clearly designed to help students remember the material more easily.

Although Bouras-Vallianatos's article is ultimately concerned with medical education during the Byzantine centuries, he never refers to the hospitals of Constantinople, the only institutions that the sources identify as places where physicians were trained. This is especially strange because Brigitte Montrain has shown that the teaching diagrams which Bouras-Vallianatos mentions were still in use in the fifteenth century when Joannes Argyropoulos was teaching medicine in the Krales Hospital to both Greek and Italian students. 1

In conclusion, the editors have brought together some interesting articles. The shortcomings are errors of omission, but such omissions are inherent to this genre of collected essays, supposedly focused on a single question. Unfortunately, this genre seems to be replacing the traditional process of submitting articles to professional journals for review by anonymous peers in the field. These new collections of articles on a single topic have the advantage of making it easier for other scholars to locate relevant studies, but the disadvantage of dispensing with anonymous reader reports which help to refocus essays to include issues essential to covering the topic.

Authors and titles

Stavros Kouloumentas, Alcmaeon and his addressees: Revisiting the incipit, pp. 7-29.
Laurence M. Totelin, Gone with the wind: Laughter and the audience of the Hippocratic treatises, pp. 30-47.
Chiara Thumiger, The professional audiences of the Hippocratic Epidemics: Patient cases in Hippocratic scientific communication, pp. 48-64.
Sophia Xenophontos, Galen's Exhortation to the Study of Medicine: An educational work for prospective medical students, pp. 67-93.
Michiel Meeusen, An interpretation of the preface to Medical Puzzles and Natural Problems 1 by Pseudo-Alexander of Aphrodisias in light of medical education, pp. 94-109.
Uwe Vagelpohl, The user-friendly Galen: Ḥunayn ibn Isḥāq and the adaptation of Greek medicine for a new audience, pp. 113-130.
Elvira Wakelnig, Medical knowledge as proof of the Creator's wisdom and the Arabic reception of Galen's On the Usefulness of the Parts, pp. 131-149.
Erika Gielen, Physician versus physician: Comparing the audience of On the Constitution of Man by Meletios and Epitome on the Nature of Men by Leo the Physician, pp. 153-179.
Petros Bouras-Vallianatos, Reading Galen in Byzantium: The fate of Therapeutics to Glaucon, pp. 180-229.


1.   Mondrain, Brigitte, "Jean Argyropoulos professeur à Constantinople et ses auditeurs médicins d'Andronic Éparche à Démétrius Angelos, pp. 223-249," in C. Scholtz and G. Makris eds. Polypleuros Nous: Miscellanea für Peter Schreiner zu seinem 60. Geburtstag. Munich-Leipzig, 2000. ​

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