Apeiron Volume 0 Issue 0 2013 [Doi 10.1515%2Fapeiron-2013-0002] Berrey, Marquis -- Early Empiricism, Therapeutic Motivation, And the Asymmetrical Dispute Between the Hellenistic Medical

Marquis Berrey

Early Empiricism, Therapeutic Motivation,and the Asymmetrical Dispute Betweenthe Hellenistic Medical Sects1

Abstract: Galen and the doxographical tradition portray the dispute betweenthe Hellenistic medical sects as a symmetrical argument about the role ofknowledge. I show a divide between doxographical accounts and surviving tes-timonia of the Hellenistic Empiricists. I argue that the dispute between themedical sects was asymmetric: for the Rationalists, it was a dispute about med-ical methodology; but for the Empiricists, the dispute concerned the conceptionand therapeutic purpose of medicine.

Keywords: Medical history, Hellenistic culture, Empiricism

Marquis Berrey: University of Iowa Department of Classics, 210 Jefferson Building, Iowa City,Iowa 522421418 United States; E-mail: [email protected]

The Empiricists and Rationalists dispute numerous things of this type with each other,although they apply the same therapy in the case of the same afflictions, at least thosewho have been trained rightly in each sect.2

In this famous passage from On Sects for Beginners Galen states that the disputebetween Hellenistic medical sects, the Empiricists and the Rationalists, waspurely methodological. For Galen disagreements over methodology ended

1 This paper is a revised version of a chapter from a dissertation supervised by Lesley Dean-Jones at the University of Texas at Austin. I thank her and the rest of the supervising committeefor their guidance and support. I also thank David Riesbeck, David Depew, John Finamore, andthe anonymous reviewer for their helpful comments. Remaining errors are mine alone.2 Galen Sect. Int. 1.79K = 12.58 Helmreich. I cite the titles of Galenic treatises according to theLatin abbreviations of Hankinsons (2008: 39197) appendix 1, followed by a reference to thevolume number and page of Khns edition; I include an additional cross-reference for treatiseswhich exist in a critical edition. For fragments (I use the term fragment in a loose sense sincethe collections of Hellenistic sectarian medicine compile testimonia and only rarely quote aHellenistic authors writings verbatim), I cite the fragments of the Empiricists according toDeichgrber (1965) = D, I cite the fragments of Heraclides of Tarentum according to Guardasole(1997) = Gu, and I cite the fragments of the individual Herophileans according to von Staden(1989) = vS. All translations are my own.

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where therapy began. Galens doxography of the dispute between the Hellenis-tic medical sects has been enormously influential, not least because Galenswritings preserve most Hellenistic medical fragments and shape our perceptionof Hellenistic medicine. Commentators following Galen have construed the dis-pute between the sects as a dispute strictly about methodology: how physiciansobtain and justify their claims to medical knowledge. But the claim that thesects held therapy in common is an over-simplification: Galens proviso in-dicates that many doctors worked outside of the guidelines of their sect andthat, even for those who worked within the guidelines of their sect, some dis-agreed about the possibility of treatment. The problem has not yet been recog-nized, namely that the evidence is at odds with itself: fragmentary evidencefrom sectarian physicians does not wholly bear out the doxographic evidencefrom Galen.

I attempt to provide a fuller picture of the dispute between the sects by fo-cusing on the early Empiricist sect of the 3rd, 2nd, and 1st centuries BCE. I arguethat, contrary to Galen, the dispute between sects was asymmetric: for Galenand the Rationalists, the sectarian dispute concerned medical methodology; butfor the Empiricists, the sectarian dispute concerned the conception and purposeof medicine. In section 1 I lay out the historical sources for Empiricism and iden-tify the importance of Celsus Praefatio; in section 2 I define a sect as an ideologi-cal medical social group; in section 3 I show that by the criteria of section 2 theEmpiricists must have had a positive program of scientific investigation; in sec-tion 4 I use the sources identified in section 1 to lay out the positive methodolo-gical program of Empiricism; in section 5 I show that the ideology of Empiricistmethodology was solely therapeutic, in distinction from the Rationalists; in sec-tion 6 I examine how Hegetor the Herophilean and Apollonius of Citium, an Em-piricist, dispute from their sectarian positions about the dislocation of the femur;and finally in section 7 I argue that the example of Hegetor and Apolloniusshows that the asymmetrical sectarian dispute concerned methodology for theRationalists but the conception and purpose of medicine for the Empiricists.

I Empiricist Historiography

The Empiricists were a Greek medical sect () of the Hellenistic and Imper-ial periods. The word sect refers to a group of individuals with common beliefsand practices, not necessarily an institution or a school building. As their namesuggests, they valued experience () above all else in medical practice.The sect seems to have had wide success and been as long lived as other Helle-

2 Marquis Berrey



nistic medical schools.3 While Empiricist sect began in the Hellenistic period,founded by Philinus of Cos, a student of Herophilus, we at once face textualproblems: no fragments from Philinus survive, only testimonia.4 This is typicalof the primary sources of Empiricism. In fact, only one Empiricist text of theHellenistic period, Apollonius of Citiums Treatise on Hippocrates On Joints, iswholly extant. We do have numerous testimonia and verbatim quotations of theEmpiricists, collected in Deichgrber (1965), as well as testimonia for Empiricistdoctrines without ascription to any individual Empiricist author in Celsus andGalen who, although somewhat critical of all sects, are more sympathetic to theRationalists than the Empiricists.

In spite of the historiographical problems involved in working with Empiri-cist material, Deichgrber (1965) emphasizes the state of preservation of the

3 The ancient evidence assembled by Deichgrber (1965) knows twenty-one Empiricists, com-parable in number to the number of physicians from other major Hellenistic medical sects.(Keyser and Irby-Massie (2008: 460) point out that there is an Empiricist physician Kalliklesmentioned by Galen unknown to Deichgrbers (1965) collection. Von Staden (1997) doubts theEmpiricist affiliation of Cassius fl. 30 CE, assigned by Deichgrber to the Empiricists on thebasis of his known Skepticism. Adding Callicles and subtracting Cassius from Deichgrbersoriginal list still leaves twenty-one known Empiricist physicians.) Von Stadens (1989:445578) collection of fragments of the Herophileans lists nineteen Herophileans. The medicalindex of names of physicians in Keyser and Irby-Massie (2008: 10061011) lists eighteen Erasis-trateans but conflates the students of Cleophantus (Erasistratus brother) with the Erasistra-teans.4 Deichgrber (1965: 333): Die Zeit des Philinos von Kos ist auf etwa 250 v. Chr. bestimmtdurch die the Nachricht der [Ps.-Galen] [sc. Int. 14.683K = Empiricist fr. 6 D], da erpersnlicher Schler des Herophilos gewesen ist. Von Stadens (1989: 3550) dates for Hero-philus life extend to 260/250 BCE. If Deichgrbers date for Philinus is correct, he will havebeen among Herophilus last students. There is an additional testimonium, Erotian 4 = Empiri-cist fr. 311 D, that Philinus and the Herophilean Bacchius of Tanagra (on whom see von Staden(1989: 484500)) were contemporaries, but this piece of evidence has been used to date Bac-chius rather than Philinus. In general the earliest history of the Empiricist school is very lacu-nose and Deichgrbers (1965: 16368) datings for the earliest Empiricists Philinus of Cos,Serapion of Alexandria, and Glaucias of Tarentum seem to be based on a rough span of25 years (i.e. a generation) between individuals, with only the dating of Philinus somewhatsecure. Serapion of Alexandria does cite Andreas of Carystus, a Herophilean murdered in 217BCE. On the basis of his citation of Andreas (Galen Comp. Med. Loc. 13.3434K = Andreas fr. 29vS = Empiricist fr. 151 D) von Staden (1989: 474) dated Serapions floruit to 200 BCE but in alater article (1997: 941) returned to Deichgrbers dating. Evidence of citation does not necessa-rily imply that Serapion is a generation later than Andreas: Deichgrbers dating of Serapion islikely correct. Yet Deichgrbers schema of the dates of the early Empiricists is of course with-out evidence apart from the date of Philinus. Unfortunately we are not likely to do better withthe evidence currently at our disposal: Fabio Stok in Keyser and Irby-Massie (2008) more orless follows Deichgrbers dates of the early Empiricists.

Early Empiricism, Therapeutic Motivation 3



Empiricist methodological fragments: Aus allem sieht man, wie stark sein In-teresse an den Lehren dieser Schule ist. Es ist der wichtigste Faktor in der ber-lieferung der empirischen Fragmente geworden.5 Deichgrber maintained thatEmpiricist methodology did not change from its founding but subsequent scho-lars have corrected Deichgrbers analysis.6 For example, in On Medical Experi-ence Galen is arguing against the soritic argument which Asclepiades of Bithy-nia, a Pneumatist, had leveled against the Empiricists. The claims Galen makesfor the Empiricists in On Medical Experience make it clear that the sect of Ga-lens time had become considerably less dogmatic about denying the role ofreason () in medicine than at its founding. Thus any attempt to representthe doctrines of the Empiricist school is constrained by our extant sources andthe fact that the doctrines of the school seem to have changed over time. If adiachronic presentation of the doctrines of the earliest Empiricists to 100 BCEeludes us, we can still recover a synchronic presentation of the doctrines of thesect by the time of our first extant text, Celsus Praefatio. At the minimum I willtherefore aim to present a picture of Empiricist doctrine informed by Celsus andthe fragments of pre-Celsian Empiricists collected by Deichgrber.

But the evidence allows us to go even further than this. Michael Frede(1987) has convincingly argued that changes in the doctrine of the Empiricistsought to be attributed to Heraclides of Tarentum, fl. 75 BCE.7 In a passage onthe resetting of the hip bone Galen quotes Heraclides, who argues that resettingthe hip is possible:

The many people who think that the femur when set does not stay in place on account ofthe fact that the tendon holding the femur to the socket of the hip separates, do not knowin a general way when they make their claim. For Hippocrates and Diocles would nothave written up their settings, as did Philotimus, Euenor, Neleus, Molpis and Nympho-dorus and certain others [if this were not possible]. We mastered the issue in the case oftwo boys. Frequently at least the joint on the end slips again and there is no need todetermine this event by reason, but since the bone sometimes stays fast it is necessary tosuppose that some separation of the tendon does not always happen but it relaxes andagain tightens since to investigate this is useful but not entirely necessary.8

5 Deichgrber (1965: 5).6 See Deichgrber (1965: 253) and Fredes correction (1987: 93).7 Frede (1987: 8996), approved also by Guardasole (1997: 25). I am not sure how Guardasoleintends to disagree with Fredes position, since Frede meets her reservations that Heraclidesremains ultimately an Empiricist and thus values experience above all: Fredes view is thatHeraclides values reason as a positive force only insofar as it contributes to therapy, Guarda-soles purch ci fosse utile per larrichimento delle possibilit terapeutiche.8 Heraclides apud Galen Hipp. Art. 18A.7356K = Empiricist fr. 175 D = Heraclides F43 Gu. Itranslate Deichgrbers text.

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Heraclides argues against those who claim that the hip cannot be reset; one ofthese critics we know to be Hegetor the Herophilean, a Rationalist doctor of themid-second century BCE discussed below. Hegetors arguments against reduc-tion of the hip concern inferences drawn from anatomy, a claim of deductivereason. Heraclides response to Hegetor and Rationalist critics shows many fea-tures encountered in other Empiricist authors: an appeal to personal experi-ence, arguments from authority, the contrast between reason and experience,and the notion of the useful. Still, Frede (1987) notes that Heraclides too offers adeductive inference: if the femur can sometimes be reset (as Heraclides knowsfrom personal experience and from the report of earlier doctors), perhaps thetendon which holds the femur in the hip socket does not invariably tear butsimply slackens so that the bone becomes dislocated, then tightens again allow-ing the bone to be reset. Heraclides draws an inference from the observablefacts to an alternative theoretical account of what happens;9 Heraclides theo-retical account concerns non-observable phenomena, going beyond the usualEmpiricist purview of observable causes. Furthermore, Frede argues that Hera-clides does not thereby adopt his theoretical account as a superior theoreticalaccount to that of the Rationalist critic; for Heraclides the account remains aninstrumental, provisional account of natural phenomena and not a condemna-tion of reason (). Heraclides addendum to investigate this is useful butnot entirely necessary importantly captures the nuance in his Empiricist posi-tion: Heraclides means to say that it is positively useful to have theoreticalviews of some kind, positively useful, but not necessary.10 Frede therefore dis-tinguishes between seeing a positive value in reason, a position which later Im-perial period Empiricists called epilogistic experience,11

and valuing theoretical entities per se. He finds that Heraclides sometimes didvalue theoretical entities in so far as they might be useful to advance the stateof the art.12 Whether Heraclides did in fact invent the process of epilogismos, aproductive reasoning about temporarily non-evident things that later Empiri-cists such as Theodas fl. 125 CE and Menodotus fl. 125 CE recognize, Fredes

9 Frede (1987: 91).10 Frede (1987: 92). Galens comment immediately after Heraclides quote shows an awarenessthat Heraclides is reasserting his Empiricism with the proviso that investigation is useful butnot necessary: At the end of the quote the Tarantine adds this, taking care thathis inclination remains Empiricist Galen Hipp.Art. 18A.736K.11 Galen Subf. Emp. 4 = Empiricist fr. 10b p. 50.3 D, where the context is the reason or justifica-tion used in transition from the similar. Galen attributes to Theodas ofLaodicea (fl. 125 CE), on whom see Deichgrber (1965: 21415).12 Frede (1987: 93).




reading demonstrates that some Empiricists attributed a positive value to reasonearlier than previously supposed.

Although Celsus seems to bypass this doctrine of Heraclides in his accountof the Empiricists, his own favored mediation between Empiricists and Rational-ists has surprising affinities with Heraclides position.

Therefore, to return to my subject, I think that medicine ought to be rationalist but con-structed from evident causes, with all hidden causes rejected not from the considerationof the practitioner but from the art itself. Moreover to cut into bodies of the living iscruel and superfluous, [but] it is necessary for learners [to cut into the bodies] of thedead, for they ought to know the position and arrangement, which a cadaver showsbetter than a living and wounded man. But as for the rest which can only be known inthe living, need itself will show in the very cures of the wounded, a little slower butsomewhat more gently.13

Celsus constructs a via media between the two medical camps of Rationalistsand Empiricists.14 He agrees with the Empiricists that vivisection is cruel andunnecessary and that only evident causes ought to be admitted into medicine.He agrees with the Rationalists that dissection is necessary to understand anat-omy, the arrangement and position of interior body parts. Celsus position oncausality is careful to insist on the potential practical value of considering hid-den causes, opposed to evident causes. Celsus claims about causality seem veryclose to Heraclides position that to investigate [hidden causes] is useful butnot entirely necessary. Nevertheless, Celsus claims this position as his own.

Frede finds it surprising that Celsus own position in the Praefatio is alignedwith Heraclides: clearly Celsus could not present this as his own view of thematter, as opposed to that of the Empiricists, if something like it already hadbeen the standard Empiricist view.15 Yet Mudry (1982), the standard commen-tary on Celsus Praefatio, supposes that Heraclides book On the Empirical Sect( ) was the probable source for Celsus discussionof Empiricist doctrines.16 If Heraclides did attribute positive value to reason, it

13 Celsus Praefatio 745 igitur ut ad propositum meum redeam, rationalem quidem puto med-icinam esse debere, instrui uero ab evidentibus causis, obscuris omnibus non ab cogitationeartificis, sed ab ipsa arte reiectis. incidere autem uiuorum corpora et crudele et superuacuumest, mortuorum discentibus necessarium, nam positum et ordinem nosse debent, quae cadauermelius quam uiuus et uulneratus homo repraesentat. sed et cetera quae modo in uiuis cognoscipossunt, in ipsis curationibus uulneratorum, paulo tardius sed aliquanto mitius, usus ipsemonstrabit. Latin citations from Celsus Praefatio are from the text of Mudry (1982).14 See Mudry (1993: 80204) and von Staden (1994a) for Celsus self-fashioning in this respect.15 Frede (1987: 94).16 There is a substantial literature devoted to Quellenforschung of Celsus; Schulze (2001:101135) presents an exhaustive bibliography to all aspects of Celsus, p. 141 for a bibliography

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would be difficult, as Frede argues, for Celsus to present an account of Empiri-cal knowledge at odds with his source and, further, for Celsus himself to pre-sent a view as his own which he took from the reforming Empiricist.17 While theimpasse seems to have broken further Quellenforschung in Celsus, Fredes caseagainst Heraclides of Tarentum being Celsus source for Empiricist doctrine im-

on the question of sources. For a discussion of the source question in the Praefatio see Deuse(1993). It is clear at least that Celsus read widely in Greek and knew a variety of medical litera-ture. While the picture of Celsus authorial persona is emerging from von Staden (1994a,1994b), the importance of the Praefatio for medical doxography of the sects invites a Quellen-forschung approach. Mudry (1982: 73, 84, 11516) argues for an Empiricist source for much of the Praefatio while

professing himself unable to give an exact source. In this evaluation Mudry is following a lineof commentators back to the position of Sepp (1893). Sepps argument concerned Celsus phi-losophical inclination in general and includes Celsus position vis--vis Empiricism, Skepti-cism, and Methodism, among others. While Sepps argument stands for Celsus interest inskepticism generally (given the Praefatios particular emphasis on kinds of causes), the evi-dence he brings to bear on his thesis that Heraclides of Tarentum was the Quelle of CelsusPraefatio is slim. Sepp (1893: 7) can offer no more evidence than the claim that Heraclideswas the first to use the name Empiricist. Sepp (1987: 8) cites Celsus Praefatio 10 for hisclaims: aliquanto post Heraclides Tarentinus et aliqui non mediocres viri secuti ex ipsa profes-sione se empiricos appellaverunt. Mudry (1982: 734) carefully agrees with Sepps thesis thatHeraclides was the first to use to describe himself and his style of medicine.

Yet Sepp is mistaken that Heraclides was the first to use the term . In a Hercula-neum papyrus, P.Herc. 1012, Demetrius Lacon the Epicurean philosopher fl. 100 BCE attacksan Empiricist, Apollonius the Elder, fl. 175 BCE and names him (Empiricist fr. 164D). In my view, this is the strongest piece of evidence against Sepps thesis. If DemetriusLacons epithet is pejorative, it is difficult to believe that the later Empiricists should havenamed themselves after this term. Mudrys cautious reiteration of Sepps thesis against theevidence of the papyrus may be founded on his own observation (1977: 229.n14) that Poly-bius Empiricist view of medicine contains no word to refer to the medical sect.Yet the absence of the term in Polybius is no more striking than the lack of theterm in Apollonius of Citium; see Kollesch and Kudliens (1965) index: both Polybius andApollonius unproblematically draw the distinction between Rationalist or Empiricist types ofmedicine using descriptions based on the attributes of the Empiricist tripod. On the whole itseems more likely that Demetrius Lacon is using a pre-existing epithet for Apollonius theElder and that the name goes back to an early Empiricist, perhaps Serapion ofAlexandria, Zeuxis, Glaucias of Tarentum, or Apollonius the Elder. It is unfair to criticizeSepp at length since he did not have source collections for the Hellenistic medical sects i.e.Deichgrber (1965) on the Empiricists, von Staden (1989) on the Herophileans, Garofolo(1988) on Erasistratus. The source collections of Hellenistic medical sects demand at leastthat scholars reevaluate the doxographical evidence to which we have clung for a century.

17 Von Staden (1994a) on Celsus own views adds little directly to the problem, although hedoes point out that Celsus cites very few Empiricists including Heraclides outside of the Praefa-tio. This would complicate, rather than simplify, the theories of Celsian Quellenforschung.




plies that Celsus source adopted an Empiricist position different from Hera-clides: regardless of whether the source post-dated Heraclides, he will have pre-sented a view of Empiricist doctrine more traditional than the innovative Hera-clides. For this reason, Celsus presents a view of Empiricist doctrine whoseideas ante-date Heraclides, that is, largely a collection of views traditional forthe early Empiricists.

II What Is a Sect?

A Hellenistic medical sect is a group of individuals with a set of common beliefsand practices. Yet as Fredes analysis of Heraclides of Tarentum showed in sec-tion 1, the doctrines internal to the medical sects changed over time. What iscommon to members of a sect or ? Von Staden (1982) attempts to answerthe question of what unites the members of a sect; he argues that the Empiri-cists are united on the main issues whereas the Herophileans are not.18 He of-fers, as an example of the Herophilean disagreements, the many definitions andredefinitions of the pulse given by eight different Herophileans.

[E]ach Herophilean strove for a fresh and more viable definition of the essential natureof the pulse, attempting at the same time to meet objections raised to his precursorsformulations. What might, from a modern perspective, look like sophistic quibbling overminor differences concerning a definition, to most of the participants in this revisionaryprocess was anything but a mere exercise in patricidal and fratricidal eristic. Rather, itwas a search for a correct understanding of the essential nature of a major diagnostictool and, simultaneously, a reaffirmation of the value and relevance of theoretical inves-tigations for the clinician. What unites almost all followers of Herophilus is in fact pre-cisely their interest not only in clinical but also in scientific or theoretical medicine,and this is, of course, also what distinguishes them most sharply from their chief rivalsin the early period, the Alexandrian Empiricists, who radically reject anatomy and phy-siology as irrelevant for clinical purposes.19

Von Stadens broad sense of what constitutes a sect is correct: the general areaof action of physicians manifests a belief in certain kinds of methodologicalprocedures. If the Herophileans disagree about what the pulse is, it is not be-cause they find no value in it. Each individual physician reified their sectarianpredecessors definition of the pulse as an expression of their commitment tothe value of the pulse for theoretical Herophilean medicine. Von Staden canfurther show that Herophileans engaged in pharmacology and Hippocratic ex-

18 Von Staden (1982: 82, 8593).19 Von Staden (1982: 8788).

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egesis even as they abandoned Herophilus procedures and innovations in dis-section: pharmacology and Hippocratic exegesis are areas within medicine ex-pressing Herophileans commitment to their methodological views.

Paradoxically, social solidarity in a sect is defined by disagreement: that theHerophileans dispute with each other over the definition of the pulse is a sign oftheir belonging to a sect. Suppose then that there are two types of self-fashion-ing occurring in the Hellenistic medical sects. First, there is self-fashioning inter-nal to the sect. Herophileans argue against Herophileans; Empiricists argueagainst Empiricists: the difference between members of the same sect expressesthe search for the correct application of their methodological procedures. Sec-ond, there is self-fashioning of sect against sect. Herophileans argue againstEmpiricists; Empiricists argue against Herophileans: the difference betweenmembers of different sects expresses the sects ideological commitment to theirmethodological procedures in contradistinction to other scientific approaches.

Yet a reading of sect-fashioning along these lines is interpretatively overde-termined: any medical disagreement can be read as participating in sect debate.It cannot be the case that any disagreement is simultaneously an expression ofgroup solidarity and an expression of sectarian dispute. Rather, disagreementswithin the sect that is, internal self-fashioning exists only subsequent to aninterpretation of group solidarity in contrast to other sects. Herophileans strivefor the correct interpretation of the pulse because the Empiricists do not believeit is valuable: the Herophileans are not Empiricists; sect solidarity comes beforesect disagreement. Arguments between members of the same sect are ideologi-cally posterior to disputes between sects. The interpretation of social polemicsbetween Greek medical sects must give priority to ideological disputes betweensects. Thus, the correct analysis of medical sectarian debate starts first with asingle sects broad methodological position, contrasts that position to anothersects methodological position, and finally compares the methodological posi-tions of individual members within a sect.

And so von Stadens point stands: sectarian physicians agree, broadlyspeaking, about the methodological value of certain procedures. Therefore aGreek medical sect is an ideological group: individuals united by common be-liefs in the value of particular kinds of scientific methodologies and domains ofstudy. The Herophileans are united in the value of causation and they work inthe most common domains in the Hellenistic period of pharmacology, surgery,and Hippocratic exegesis. The Empiricists too work in these same areas butstrive to distinguish themselves from the Herophileans. Nonetheless, the Empiri-cists broad agreement on the values of certain domains and methodologiesdoes not preclude their disagreement about how to pursue those questions ofscientific knowledge and healing. There is no unanimous agreement among the




Empiricists on particular questions anymore than there is unanimous agreementamong the Herophileans.

III Writing the Sect Debate

Writing a history of the dispute between select Empiricists and Rationalists inthe third through first centuries BCE is only one part of the history of medicinefrom this period. There are good reasons not to read all Hellenistic medicine interms of sect affiliations:20 not all doctors working in the Hellenistic period be-longed to sects; focusing on the physicians that belonged to sects prioritizesliterary evidence over inscriptions, papyri, and other sources and thus paints apicture with only part of the evidence;21 and it creates an impression of medicalorthodoxy instead of doxical heterogeneity.22 These caveats warn against takingthe debate between Empiricists and Rationalists as the history of medicine inthe Hellenistic period.

Although these reasons caution against reading all of Hellenistic medicinewithin the framework of the quarrel between the sects, much of sectarian medi-cine can and ought to be read precisely within that framework. In section 2 Idefined a medical sect as an ideological group: each sect has ideological commit-ments to the value of a different scientific methodology whereby their externaldisagreements express their commitment to that domain of medicine or scientificmethodology. Not to write the debate between sects as a history of external sectself-fashioning neglects the ideological component of medical sect history.

A further difficulty confronting the writing of this ideological history is theexact nature of the dispute between Empiricists and Rationalists. Frede (1990)has summarized the ancient evidence:

What is in question in this dispute first of all is: what is it about a case of knowledgethat makes it a case of knowledge, rather than mere belief? The rationalists claim that itinvolves insight and understanding, and as a rule some kind of inference or proof,in short some achievement of reason. The empiricists deny this; for them to know some-thing is just to have observed it and to remember it in the appropriate way, to have thekind of experience of it, and with it, which makes us say that we know it. And technicalknowledge for them in principle is no different from this; it just involves a rather com-plex and specialised kind of experience.23

20 Von Staden (1982, 1989, 1997, 2006) has consistently resisted this move.21 For an overview of Hellenistic medicine see Nutton (2004: 12856).22 Von Staden (1997: 95859).23 Frede (1990: 22526).

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Frede follows Galens observation in On Sects for Beginners that the debate is anargument about the tools by which doctors advance to knowledge. The protago-nists are associated with a certain set of terms: the Rationalists proclaim thenecessity of reason; the Empiricists uphold experience at the expense of reason.It is difficult to go far into the debate without using these terms drawn fromancient accounts of the debate , , , reason, ex-perience, observation, indication at which point the redefinition and nuanceoffered of the key terms by modern scholarship is overwhelmed by the repeti-tion of the simple antithesis reason vs. experience.

While the antithesis reason vs. experience describes the epistemologicalground of the debate, the internal self-fashioning of the Empiricists adds an-other tenor to the debate. In the usual story of the debate between medical sectsthe Empiricists are cast as reacting against the Rationalists; the Empiricists areseen as carping critics with purely philosophical reservations against a scientifi-cally superior program. Yet the usual formulation of Hellenistic sectarian medi-cal history the Empiricists criticized the Rationalists denies to the Empiricists apositive program of scientific exploration. It cannot be that Empiricist treatiseswere purely anti-Rationalist; in point of fact we know almost nothing about theEmpiricist treatises usually identified as anti-Rationalist.24 What motivated doc-

24 Mudry (1982: 113) argues, for example: nous savons que, ds les dbuts de lempirisme(vers 250 avant J.-C.), ses reprsentants se sont attachs fonder leur doctrine et attaquer ledogmatisme dans des traits au caractre habituellement polmique et agressif. Mudry de-scribes the , qui consiste dans la presentation de la doctrine empiri-que en meme temps que dans la refutation, par le procd de la contradiction point par point,des positions dogmatiques, known as, [une] mthode que Galien dcrit et dont il reprocheaux empiriques lemploi systmatique quils en font dans leur crits. Mudry suggests that boththe of Serapion and the of Heraclides of Taren-tum were structured in this way; in fact he suggests that the method of point by point contra-diction sinspire directement de la mthode ordinaire de ces traits empiriques. Mudry isprobably right to see Serapions treatise as an anticategoretic work at least from the title knownas ad sectas = from Caelius Aurelianus and Galen (Deichgrber unhelpfullydoes not add Galens testimony about Serapions title, cf. Empiricist fr. 1 D,in his collection of Serapion testimonia frr. 144153 D); see also von Staden (1982: 78) on Sera-pions . But I am not persuaded that Heraclides of Tarentums - was an anticategoretic treatise. Deichgrbers (1965) collection of the directlyattested fragments of both of these books is very thin: Empiricist fr. 144 D is an off-hand refer-ence in Caelius Aurelianus to Serapions ; and there are no directly attestedfragments from Heraclides . Deichgrber (1965) Empiricist fr. 1 isGalens list of his books written , in which Galen statesthat he has written two books on Serapions and a synopsis in eight bookson Heraclides , itself seven books long. See also Deichgrbers(1965) respective introductions to the individual fragments of Serapion and Heraclides, in




tors to train and practice as Empiricists? The Empiricist movement was reason-ably successful and long-lasting over four or five centuries; it cannot merelyhave held a negative and antagonistic stance toward its rivals as its sole doc-trine.

IV Positive Empiricism

I argued above in section 2 that before entering into an analysis of the debatebetween sects we needed to identify the methodological program of sect medi-cine. The positive program of the Empiricists was called the tripod. In the threelegs of the of Serapion of Alexandria, experience, research, and transition of the similar are themeans by which medical knowledge is obtained.25 Other accounts of the Empiri-cist tripod have focused on the causal system underlying the Empiricist ac-count;26 I will emphasize the visual element.

Now Celsus presentation of the Empiricists lays particular stress on the firstprinciple, empeiria.27 He introduces Serapion as the first Empiricist, whoplaced medicine only in need and experience.28 Von Staden (1975) has con-vincingly argued that empeiria in Empiricist doctrine does not mean experiment

which he suggests that these works were Quellen for certain Galenic works. In fact, Galens listof his works in Empiricist fr. 1 D indicates nothing about the contents of these works; andGalens propensity for longwindedness notwithstanding, eight books would be a long synopsisof a work which was exclusively an anticategoretic treatise. Empiricist doctrine and Empiricistmethodological works if Serapions and Heraclides treatises were of this sort were notsolely designed to contradict Rationalist points.25 Von Staden (1975: 188). The Empiricists regarded Serapion of Alexandria as the inventor ofthe tripod but in fact debated among themselves the extent to which he used ; see Deichgrber (1965: 1645) and Hankinson (2001: 31314). Serapions book wascalled ; a later Empiricist, Glaucias of Tarentum fl. 175 BCE wrote a book called -. What relationship Serapion had to Philinus of Cos, the first known Empiricist, is unclear.26 Much of the discussion concerns the precise identification of the causes allowed by Empiri-cist theory. Primary sources include Celsus Praefatio 13, 18, 27; Galen Sect.Int.; Galen Subf.Emp. 7, Empiricist fr. 10b D = Deichgrber (1965: 6263.26) = Frede (1985: 323). See Mudry(1982: 8788), Hankinson (1991: xxviii), Hankinson (1998: 24; 2001: 306318).27 Celsus discusses empeiria in Praefatio 32.28 Celsus Praefatio 10 in usu tantum et experimentis eam posuit. Celsus presents a differentversion of the founding of Empiricism from Pseudo-Galen, who identifies Philinus as the foun-der: see Mudry (1982: 7071) and Stok (1993: 62026) on the historical problem of the founderof Empiricism. Stok (1993: 621) rightly dismisses the evidence about Acron of Acragas and Ti-mon of Phlius as Imperial-period fictions.

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but refers to the passive observation of nature.29 This may come in the form ofhappenstance or a natural event. Von Staden offers the examples of a headachecured, respectively, by an accidently cut forehead or by a nosebleed. In neithercase is the cure for the headache a process of trial and error but rather an eventwith attendant circumstances. The tracing of the connection between the event(e.g. the cut forehead or the nosebleed) and the cure (e.g. the disappearance ofthe headache) is the work of sign-association. Von Stadens example of empeiriaimplies self-inspection: the visual element comes to the fore. Galensays that Empiricists equate empeiria with seeing: for experience is observationof things seen to happen in a similar manner on multiple occasions.30 That is,it is not enough that the association between the sign (e.g. the cut forehead orthe nosebleed) and the signified (e.g. the cured headache) happen only once,but it must happen multiple times and be observed by the doctor. It was a mat-ter of notorious dispute just how often an event needed to happen for the infer-ence to the signified to count as experience;31 but, whatever the frequency, theprocedure of observation and association between visible sign and signified isclear. From the basic tool of empeiria, correlation of events, the Empiricistgained most of his understanding of medicine.

Now historia research, the second leg in the Empiricist tripod, was theaggregate collected experience of previous physicians cures and their atten-dant visible circumstances that have been written down.32 mpeiria required theobservation and inspection of the individual physician but clearly no physiciancould possibly observe all attendant circumstances for the same disease, muchless for all diseases. Thus historia served as a supplement to the individual Em-piricists own experience, the record of other physicians experiences of the vi-sual tracing of associated signs and signifieds. These other physicians do notnecessarily need to be Empiricists, although Galen records that Empiricists de-

29 Von Staden (1975: 187192).30 Von Staden (1975: 190) .31 Galens On Medical Experience 9397 sets out the soritic argument of Asclepiades againstthe Empiricists on the very matter of just how often an event needed to happen for the infer-ence to count as experience and thus be used as the basis for treatment. The Asclepiadianbackers of the soritic argument think they are improving on the Platonic opposition of /, which had been the earlier Rationalist objection to an empirical ; see Schiefsky(2005: 34559). Galen for his part rejects Asclepiades argument (On Medical Experience 87)but the point remains that opponents of Empiricism took the notion of frequency seriously. TheEmpiricists of course took frequency seriously but refused to be drawn into the debate aboutthe precise number of times an event must reoccur.32 Celsus discusses historia only once in Praefatio 36; most of the evidence for its use comesfrom Galens Outline of Empiricism and the fragments of individual Empiricists.




bated about this point.33 Naturally not all historia was reliable but the Empiri-cists are not without recourse to judge the truth or falsity of previous doctorshistoria: the primary criterion was always ones own empeiria.34 We should takeseriously the notion of a research program in historia: the greater the individualdoctors accumulated associations between signs and signifieds the better ex-pectation of the course of the case at hand the individual physician had. Empiri-cist historia was always tied to the employ of the individual doctor.

The third leg of the tripod is, in its full form, , transition from the similar to the similar.35 This is the most dis-puted element of Empirical doctrine; the Empiricists themselves debatedwhether it was rightly attributable to Serapion and whether it might be rightlyused by a strict Empiricist. Hankinson (2001) has pointed out that the effective-ness of this notion of transition depends on the extent to which a doctor mightconstrue this notion whether it might embrace causality, reason, or the non-visible.36 Hankinson shows that the Empiricists used transition in a heuristicmanner, part of the element of discovery rather than justification.37 Galens Out-line of Empiricism shows Empiricists using transition from the similar on ele-ments that are visually similar, such as a hand and a foot, or similar in location,as in the belly, or similar in their effects, such as quince and medlar on diar-rhea.38 All these elements can be understood to be similar in either a visual ornatural way.39 The appropriateness of transitioning from one element to anotheris itself justified only by its effectiveness, the of the self-in-spection of ones experience.

33 Empiricist fr. 10b D = Deichgrber (1965: 66).34 Empiricist fr. 10b D = Deichgrber (1965: 65.2869.28) = Frede (1985: 3639).35 Celsus discusses transition in Praefatio 3336; the best summary of its use comes from Ga-lens Outline of Empiricism.36 Hankinson (2001: 31213).37 Hankinson (2001: 311).38 Empiricist fr. 10b D = Deichgrber (1965: 70.2031) = Frede (1985: 37).39 However, Galens Empiricist in Outline of Empiricism warns against transitioning from ele-ments based on a shared common property Empiricist fr. 10b D = Deichgrber (1965: 70.2031)= Frede (1985: 37). For example, in the case of drugs it is not simply enough that aloe andcopper flakes are astringent in taste for the Empiricist to mark them as similar. The doctor hadto consider what is called toti proprietati que est in ipsa, the entire individuality of an itemEmpiricist fr. 10b D = Deichgrber (1965: 72.157), which Deichgrber backtranslates as ; Frede (1985: 38) offers put ones mindto the peculiar character of the taste as a whole. The Empiricists hesitation to consider somefeature as designating a class e.g. all astringent drugs is a mark of how attuned to indivi-dual detail Empiricists could be by refusing the logical inferences that come with classes ofobjects.

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It is then clear how an Empiricist could decide how to treat a disease by thethree elements of the Empiric tripod. So much then for knowledge of the past.But how could an experientially reasoning person have future knowledge? Moreto the point, how could an Empiricist doctor predict the course of disease?Frede (1990) has shown that Empiricists talk about prediction in terms of sub-jective expectation of the individual doctor.40 The subjective experience of aphysician is therefore of critical importance in Empirical medicine. An indivi-dual doctors personal experience is composed of the many associative signs hehas observed and the amount of research he has read and considered. It is be-tween these two legs of the tripod that the Empiricist must create his own ex-pectation of the future and test them by the third leg of the tripod.

V Therapeutic Motivation

Since we have examined the positive methodological program of early Empiri-cism, we are now able to analyze some of the ideological commitments of theirprogram without reference to Rationalism. The Empiricist doctor was constantlyat work. There were commemorative signs to be noticed, there were historiai tobe read. Now the Empiricist could not just passively absorb this information. Hehad to associate the commemorative signs and the historiai to transition fromsimilar to similar if his therapy was to be efficacious. Galens picture of the Em-piricists is of an active physician:

For having imitated the previous help not only twice or three times but often, then dis-covering the same effect for the most part in the same diseases they call such a memorya datum and think that it is already trustworthy and part of the techne. After many suchdata have been gathered by them, medicine is the entire collection and the doctor is theone collecting them.41

The Empiricist doctor was very far from an inactive and passive physician;rather, the Empiricist constantly tried to associate and improve his ability to di-agnose the illness and predict disease from his own experience. The Empiricistdoctor was only as good as his ability in his constant tracing of associations.

40 Frede (1990: 246).41 , . , . Galen Sect.Int. 2,1.67K = 3.915 Helmreich = Empiricist fr. 15 D.




It has long been recognized that Empiricist critiques of Rationalism drawextensively on the contemporary skepticism of the New Academy.42 From acertain point of view, skepticism challenges most sources of authority and in-stead re-authorizes the subject as the judge of truth and falsehood. The re-authorization of the subjects cognitive ability is an epistemological move thatplaces the primary onus and responsibility on the individual skeptic. The epis-temological responsibility the skeptic adopts for himself complements the de-mands the commemorative-sign theorist places on himself to associate newand old signs. For doctors who demand of themselves the ability to associateever more signs, the reauthorization of the individual subjects epistemologicaljudgment that skepticism offers is attractive. We should therefore see in Em-piricist doctrines an affirmation of the independent role of the individual doc-tor. The positive doctrine of sign-association that Empiricism offers sets theindividual person of the physician in the central role. The goal of these trac-ings of associations was not to build a systematic understanding of nature butrather to provide the doctor a route to successful therapeutics. In short, then,Empiricism aimed to provide the healing physician with tools for his healingpractice.

There is strong evidence that the Empiricists were concerned with the ther-apy of the individual patient and his circumstances.43 The Empiricists were dis-tinguished particularly in the clinical branches of medicine, namely therapeu-tics and pharmacology. Deichgrbers (1965) collection of fragments for theearliest Empiricists finds books on therapeutics ascribed to numerous individualEmpiricists: Serapion of Alexandria fl. 225 BCE wrote in 3 books,44

Apollonius of Citium fl. 9070 BCE wrote in 2 books,45 Heraclidesof Tarentum fl. 75 BCE wrote in at least 4 books and in at least 4 books.46 Deichgrber (1965) collects material onpharmacology from numerous early Empiricists, some of which may belong inunattested books titled . Philinus of Cos fl. 250 BCE wrote drug re-

42 See von Staden (1975), Frede (1985: xxxxxiv), Stok (1993: 60812), Allen (1993), Hankin-son (1998: 3643), Allen (2010).43 See especially Schiefsky (2005: 34474) who, although relying on the doxographical evi-dence of Galen to trace the dispute between medical sects to the epistemological concerns ofPlato and Aristotle, well draws attention to the individualism of patients and the conjectural,stochastic nature of medical therapeutics.44 Empiricist frr. 145148 D. Deichgrber (1965: 16465); Keyser and Irby-Massie (2008: 733).45 Empiricist frr. 27880 D.46 For Heraclides External Therapeutics see Empiricist frr. 174175 D = Heraclides T28,F4347 Gu; for Heraclides Internal Therapeutics see Empiricist frr. 179187 D = HeraclidesF4864 Gu.

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cipes for headaches, asthma, and productive pus.47 Serapion of Alexandriafl. 225 BCE wrote drug recipes for lesions, tumors, patients with pus and sto-mach disorders.48 Glaucias of Tarentum fl. 175 BCE wrote on complex bandagetypes and drug recipes for stomach ills, lung problems, and skin pustules.49

Ptolemaeus of Cyrene fl. 100 BCE wrote drug recipes for headaches;50 Zophyrusof Alexandria fl. 100 BCE wrote antidotes for poisons;51 Diodorus fl. 60 BCEwrote pharmacological recipes for joint pain, skin diseases, and spleen trou-ble;52 Lycus of Naples fl. 60 BCE wrote drug recipes for snake bites.53 Heraclidesof Tarentum fl. 75 BCE was particularly famous for his pharmacological booksand wrote at least four different works on the subject.54 Clearly therapeutic in-terests are well attested for the pre-Celsian Empiricists.

Since as a general matter Empiricists valued the individuality of the patientand wrote widely on therapeutics and pharmacology, it seems likely that thehealing ability of the physician was a primary Empiricist concern. This is not anaccident; it is in direct opposition to contemporary developments in early Helle-nistic medicine. Herophilus and Erasistratus, the founders of the major Hellenis-tic Rationalist sects, secured wide anatomical knowledge through dissection andlikely vivisection. Since Herophilus and Erasistratus attested medical interestssurvive only as fragments, it is always possible that mere chance has preservedmore of their epistemological interests than therapeutic ones but certainly thelater doxographical tradition of Celsus and Galen perceived a Rationalist empha-sis on scientific epistemology. The Rationalist emphasis on knowledge aboutphysis over healing offered the impetus for Empiricist critiques of Rationalism.

The traditional view of the origin of medical Empiricism emphasizes the pri-macy of knowledge. Frede (1990) summarizes the traditional viewpoint for thegenesis of the Empirical school offered primarily by the Galenic treatises on Em-piricism.

47 Empiricist frr. 13537 D. Deichgrber (1965: 163); Keyser and Irby-Massie (2008: 6456).48 Empiricist frr. 15052 D.49 Empiricist frr. 155160 D. Deichgrber (1965: 16869); Keyser and Irby-Massie (2008: 348).50 Empiricist fr 167 D. Deichgrber (1965: 172); Keyser and Irby-Massie (2008: 704).51 Empiricist fr. 267 D. Deichgrber (1965: 205); Fabio Stok in Keyser and Irby-Massie (2008:851) offers a date 13070 BCE. See also Fischer (2010: 149.n9) for further bibliography on Zo-phyrus and more fragments collected from Latin sources.52 Empiricist frr. 25255 D. Deichgrber (1965: 203); Keyser and Irby-Massie (2008: 248).53 Empiricist fr. 259 D. Deichgrber (1965: 204). Keyser and Irby-Massie (2008: 514) offers adate 13070 BCE.54 The titles of Heraclides pharmacological books were (at least 2 books), (1 book), (1 book), (1 book). Deichgrber (1965) collectsthese fragments as Empiricist frr. 20346 D = Heraclides T26, F138a, F6572a Gu.




This vision of a medical practice, firmly grounded in theoretical insight into the natureof the reality underlying the phenomena of disease, had lost a great deal of its originalappeal by the time we come to the third century B.C. By that time there was an abun-dance of theories, unfortunately all in conflict with one another Unfortunately thesedisputes did not lead to a resolution of the points of contention, but only to more so-phisticated reformulations of the old positions It could also easily seem that all thesedisputes did little or nothing to advance the ability of the doctor to cure patients, toincrease the knowledge he could rely on in actual practice. Empiricism arose as a reac-tion to this situation. The empiricists decided that the quest for a medical theory whichsupposedly one day would supply medical practice with a firm basis had, at least so far,proved futile and perhaps was fundamentally mistaken, because reason does not havethe power to provide us with such theoretical knowledge.55

For Frede the genesis of the Empirical school is the skeptical epistemologicalarguments that the Empiricist advances against the Rationalist, which is cer-tainly the Rationalist point of view. But, on the other side, in the Rationalistinvestigation of physis the doctors role as caregiver virtually disappears: thesedisputes did little or nothing to advance the ability of the doctor to cure pa-tients. Where, after all, is the role of the doctors interaction with the patient inHerophilean anatomical dissection or Erasistratean physiological experiments?This is the polemic that the Empiricists considered important in their argumentsagainst the Rationalists. We esteem the Rationalist practices of third centuryBCE because they resemble what we expect from our medical science experi-ment, investigation. The Rationalist investigation of physis may have been in-tended to secure a medical practice, firmly grounded in theoretical insight intothe nature of the reality, but in the investigation of physis the Herophilean orErasistratean has become a research scientist, not a caregiver. It is true that theEmpiricists disagreed with the Rationalist program of medical knowledge, butthis dispute between Empiricists and Rationalists went beyond their symmetri-cal dispute about how the doctor achieves knowledge: the cultural role of thephysician is also at stake. From the Empiricist point of view, the quarrel be-tween schools was about the type of role that the doctor plays: the Empiricistsemphasize the doctor as clinician and healing practitioner in contrast to theRationalist emphasis on the doctor as researcher and scientist.

Galen preserves a revealing anecdote about the increasing distance of thedoctor from the patient in the middle of the third century BCE in a passage dis-cussing the behavior and professional etiquette of the physican.

For some of them are exceedingly stupid some people being of this sort, as Zeuxis saysthat Callianax the Herophilean was portrayed to have been by Bacchius in Memoirs ofHerophilus and Those from His House: for when some sick person said to Callianax Im

55 Frede (1990: 229).

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going to die, they said that he replied with the following verse: Unless Leto of beauti-ful children bore you. And they say that he said to another person saying the samething: Patroclus too died, who was much better than you.56

Bacchius and Callianax were Herophileans, likely direct students of Herophilus,the exemplar of the research-scientist physician, and both likely lived andworked in Alexandria in the first half of the third century BCE.57 Callianaxshowed careless insensitivity toward his patients, each of whom fears that he isdying. Callianax cited lines from an unknown tragedian and the Iliad in a mis-guided attempt to reassure his patients of his intellectual knowledge. While it ispossible that Callianax intended to demonstrate his understanding of the hu-man conditions, i.e. we are mortal unlike the gods,58 his clumsy choice of allu-sions does not inspire the patients confidence that Callianax will sympatheti-cally treat his mortal state. Furthermore, while the demonstration of wideknowledge in science and literature is typical of the Alexandrian intelligentsia,59

this particular event was too much for the Empiricist Zeuxis, who calls Callianaxstupid, as Galen reports. I suggest that the Empiricist Zeuxis draws attention tothe excesses of Callianaxs attitude: demonstration of literary competence doesnot demonstrate ones caregiving abilities and in this case even harms them.Perhaps Zeuxis argued that if even Bacchius, a Herophilean, agrees that Callia-naxs behavior was uncouth (Galens text is unclear whether Bacchius sym-pathetically portrays Callianax or agrees with the Empiricist Zeuxis against hiscolleague), Rationalists at large ought to agree with the Empiricists that caregiv-ing and professional decorum are more important in being a doctor than spu-rious knowledge.60

56 , , [] - , . , . Ga-len Hipp. Epid. VI 17B.145K = 203.1826 Wenkebach = Empiricist fr. 357 D = Callianax fr. 1 vS =Bacchius fr. 78 vS. Von Staden (2006: 31.n72) deletes : while the particle might be part of thedirect quotation of Zeuxis or Bacchius book, von Staden correctly points out that the particledoes not make sense within the context of Galens passage.57 For Bacchius see von Staden (1989: 484500); for Callianax see von Staden (1989: 4789).58 Both Deichgrber (1971: 33) and Roselli (2009) see in Callianaxs response a contemptusmortis and, perhaps, a statement on the limits of medical knowledge.59 See Netz (2009: 174229).60 Pace von Staden (2006: 32). Von Staden (1989: 479) ties this anecdote to the increasingliteracy of the Herophileans: It might also be indicative of a growing emphasis on high literacyand philology within the Herophilean school a trend to which Pliny later attributes the de-cline of the Herophilean schoool.




Polybius too confirms that the Hellenistic Empiricists charged Rationalistsphysicians with an inability to practice medicine. In his critique of the historianTimaeus at Historiae 12.25d, Polybius compared history to medicine insofar asboth are divided by subject matter into three parts.61 Although the text has sev-eral lacunae, Polybiuss description of the parts of medicine was likely inspiredby Empiricist critiques of Rationalist practice.62 The logical part, which comeslargely from Alexandria, was begun by the Herophileans, the leading Rational-ist sect; its physicians appear to have mastered the field but faced with a patientthey are as useless as people who have not read a single medical book.63 Adher-ents of the logical sect spend all their time in libraries and gather their experi-ence from books.64 The part of medicine concerned with surgery and pharma-cology, by contrast, applies the true condition in each aspect of practice.65

The logical part of medicine lives in books and wows the crowd; the surgicaland pharmacological part is concerned with individualities and practical imple-mentation. Polybius contrast between the theoretical and practical parts ofmedicine is a thinly disguised contrast between the sectarian practitioners ofmedicine, Rationalists and Empiricists.66 In Polybius comparison of medicineto history, a discussion about knowledge of medicine has given way to a discus-sion about the cultural role of the physician.

Finally, Celsus also testifies to the Empiricist critique of Rationalism thatscientific progress comes from progress in therapy, not knowledge. In the culmi-nating passage of his presentation of positive Empiricism at Praefatio 3839Celsus has the Empiricist reject Rationalist physiological speculations in arhetorical threefold colon of digestion, respiration, and pulse (corresponding toCelsus exposition of Rationalist doctrines of these bodily activities at Praefatio1922).

because it does not matter what causes disease, but what removes it, nor does it per-tain to the subject how, but rather what best digests [sc. food], or whether concoction

61 See Mudry (1977) and von Staden (1989: 116, 135, 480) on Polybius discussion of medicine.62 The specifics of Polybius analogy division of subject matter into three parts, two groupsof practitioners correspond to the dispute between Rationalists and Empiricists, although thecontrast between experientially gained knowledge and knowledge gained from book learninghas roots in the Classical period; see Schiefsky (2005: 34559).63 Polybius Historiae 12.25d.64 Polybius Historiae 12.25e. Polybius adds in the proverb - for good measure, Polybius Historiae 12.25d, 212.2324 Bttner-Wobst.65 , Poly-bius Historiae 12.25d, 213.68 Bttner-Wobst.66 Mudry (1977: 22829). It is noteworthy that pharmacology and surgery are reserved for theEmpiricists alone, despite the Herophileans attested interest in these parts of medicine.

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happens for this reason or that, or whether that is concoction or only digestion. Norought it to be asked how we breathe, but rather what removes heavy and slow breath-ing; nor what moves arteries, but rather what each kind of motion means. Moreover allthese matters are known by experience. In considerations of this kind one can be drawnin either direction [sc. of theory]. Thus [sc. with theory] cleverness and eloquence win,but diseases are not cured by eloquence but by cures.67

Celsus presentation shows the Empiricist rejection of knowledge for therapy.The Empiricists charge Rationalists with abstruse speculations which belongmore to rhetoric and philosophy than medicine. While Celsus frames the Empiri-cist rejection of Rationalism according to Skeptical isosthenia, equivalence be-tween doctrines,68 the presentation of the Empiricists nonetheless lays value onthe practical and therapeutic to cure diseases is more important than to pro-pose the most knowledgeable account. The Empiricist physician adopts a skep-tical and ambivalent position towards Rationalist theories, urging instead thatdoctors direct attention to therapeutic practice.69

What motivated a Greek to train and practice as an Empiricist? Surely itwas these elements of a positive doctrine an authorization of the role of care-giver, a re-authorizing of the primacy of vision in knowledge, a reassertion ofthe uniqueness of the patient and his circumstances and a complimentaryskepticism of the numerously posited natural forces and the taboo practice ofdissection. All in all, Empiricism was a reassertion of very traditional cultural

67 Celsus Praefatio 3839 quia non intersit quid morbum faciat, sed quid tollat, neque adrem pertineat quomodo, sed quid optime digeratur, siue hac de causa concoctio incidat siueilla, et siue concoctio sit illa siue tantum digestio. neque quaerendum esse quomodo spiremus,sed quid grauem et tardum spiritum expediat; neque quid uenas moueat, sed quid quaequemotus genera significent. haec autem cognosci experimentis. et in omnibus eiusmodi cogitatio-nibus in utramque partem disseri posse. itaque ingenium et facundiam uincere, morbos autemnon eloquentia sed remediis curari. Mudry (1982: 132) notes that Celsus account of Empiricistinterest in the pulse conflicts with fragmentary evidence from individual Empiricists.68 Mudry (1982: 13233) notes Celsus ring composition and refers back to Praefatio 2729.69 I use the term ambivalent instead of instrumentalist. In Celsus Praefatio 29 we find Empiri-cists accepting that all Rationalist theories are not unreasonable and that all Rationalist physi-cians have, in fact, cured patients: si rationes sequi velit, omnium posse videri non inproba-biles; si curationes, ab omnibus his aegros perductos esse ad sanitatem. That Rationalistphysicians do cure is a surprising admission but should be understood as an argument by iso-sthenia. Both Deichgrber (1965: 283) and Mudry (1982: 119120) read Praefatio 29 as anotherexample of Skeptical isosthenia closely following the previous sections. An instrumentalist ac-ceptance of Rationalism would have Empiricists using Rationalist theories for therapeutic pur-poses, believing on the one hand that they cure but on the other hand that they are not true.The Empiricists simply maintain that we fundamentally do not know why cures work. It seemsbetter to say that Empiricists remain ambivalent about the therapeutic power of Rationalists,while deploring their useless and contradictory theories about the natural world.




elements in the Greek intellectualism of the 5th century BCE. From the Empiricistpoint of view, it is the Rationalists who are the scientific radicals.

VI The Dislocation of the Femur

Since I have now shown the positive program of Empiricism and the ideologicalgenesis of the sect, I now turn to show a particular example of Hellenistic sectdebate and compare the mutual critique of the Herophileans and the Empiri-cists. In section 1 I showed that Heraclides of Tarentum was responding to cer-tain Rationalist critics who denied that the femur could be reset; one of thesecritics we know to be Hegetor the Herophilean. Apollonius of Citiums Treatiseon Hippocrates On Joints preserves a lengthy quotation from the Herophileandoctor Hegetor. Apollonius provides a terminus ante quem for Hegetors dating,implying that Hegetor worked either in the 2nd or early 1st century BCE.70

I am amazed at the Herophileans who embrace the notorious dissection, especially Hege-tor. For in On Causes he speaks thus about the dislocation of the femur making clear thesubject at hand: And why do they not try to seek some other setting of the head of thefemur besides those Ive rejected,71 so that whenever it dislocates it remains reduced inplace? Those who only employ experience itself perceive by an analogy that areset in and remain in place, [I mean] the lower jawbone and the head of the arm andmoreover the elbow and knee and each of the fingers and nearly the majority of jointswhich usually dislocate. For they cant explain72 to themselves why this joint alone,when dislocated and again reduced, cannot remain in place. And when they apply that-which-has-happened-frequently in the case of the remaining joints, they will come tothink it reasonable that there will not be a better reduction so that the joint will remainin place, because they hold to what happens for the most part in the remaining joints.But [they would know] if they considered the cause from anatomy, that the ligamenthappens to process out of the head of the femur which is inserted into the middle of thejoint socket. When it remains, it is impossible for the femur to dislocate; but when it issundered it cannot be fused. And since a fusion has not happened, it is again impossiblefor the joint to remain in place. Therefore, once the cause is clear, avoid in generalreducing a dislocated femur and do not proceed in impossible attempts.73

70 Von Staden (1989: 513) does not offer a date, but Fredes (1987) argument about Heraclidesof Tarentums response to Hegetor (explored above in section 1) makes it likely that both Hera-clides and Apollonius were responding to a recent author or a near contemporary.71 There is an untranslatable pun here on the Greek terms reject and dislocate.72 A pun on epilogismos, an Empiricist methodological principle.73 Hegetor apud Apollonius of Citium In Hipp. Art. Comm. 3.23, 78.2480.14 Kollesch and Ku-dlien (1965) = Empiricist fr. 276 D = Hegetor fr. 3 vS. , .

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Hegetor mocked the Empiricists, referring to them never in name but onlyby the first element of the Empiricist tripod: those who only employ experience itself. He claimed thatknowledge of anatomy shows that it is impossible to reset a dislocated hip,although the joint of the hip is similar to the elbow and knee and each of thefingers. The Empiricists, Hegetor implied, transitioned from similarity to simi-larity based on the joint as a shared part; but they had no understanding ofwhy analogical reasoning does not work in the case of the hip joint. Hegetorscriticism of the Empiricists deliberately ignored their focus on individual cir-cumstances: it is not the nature of the thing that Empiricists use in transitionfrom the similar but rather similarity in location and effect. Hegetors exag-gerations of the Empiricists methodologies add rhetorical lustre to his po-lemic.

For his own part Hegetor believed in the usefulness of anatomy to medi-cine. He argued that it is in fact impossible to reset a dislocated hip due to theprocesses of the femur bone. He claimed that the ligament connecting the femurto the hip joint will normally prevent dislocation; but if the ligament is severed,the hip cannot be reset because the ligament will not fuse like bone. Everythingin Hegetors discussion revolves around the existence and position of the liga-ment connecting femur and hip socket. Since this ligament does not exist inother joints like the hands and fingers doctors had better understand its rolein the dislocation of the hip. The problem with the Empiricists is that they didnot know about bodily interiority and tried to avoid it, Hegetor claimed,whereas what medicine needs is to consider anatomy.

I find it difficult to decide whether Apollonius ought to be translated as the notorious anatomy or the notorious dissection,

, , , , , , ; , , , , , . , , , , - , .




which I have chosen.74 Whether Hegetor practiced dissection in imitation ofHerophilus, earns Apollonius opprobrium for its active investigationinto the interior parts of the body. It is tempting to speculate that Hegetorsinsistence on , the cited book title , and Hegetors assumedopponents, the Empiricists, imply that Hegetors book was an ideological po-lemic about how dissection contributed direct knowledge to causes of woundsand injuries, such as hip dislocation.

The polemical tone Hegetor adopts shows the asymmetry of debate betweenHellenistic sects. By exaggerating and ridiculing Empiricist methodological prin-ciples, Hegetor the Rationalist emphasized knowledge in his critique.75 Still, He-getors insistence that a dislocated hip cannot be reset is a triumph of reasoningbut is discomforting to a patient. His conclusion, avoid in general setting adislocated thigh and do not proceed in impossible attempts, is a warning tothe physician to not practice what is impossible. The apparent lack of concernfor the patient in this warning leaves a cultural opening for Empiricist rebuttal.

As was said in the beginning, almost no Empiricist works are extant exceptfor one, Apollonius of Citiums fl. 9070 BCE76 Treatise on Hippocrates OnJoints.77 Although it is not a treatise engaging in a point-by-point refutation ofthe Rationalists,78 Apollonius does occasionally take sides in the debate be-

74 Kollesch and Kudlien (1965: 79) translate Anatomie but can equally refer to dis-section, as I have translated.75 Von Staden (1989: 513).76 The dating of Apollonius is vexing. He refers to Hegetor in the body of the treatise, as wehave seen, but his introduction provides the best evidence of his time frame: here he refers to a who ordered him to write the text. From the rough date of Apollonius lan-guage this Ptolemy is one of four possibilities from two generations: of the first generationPtolemy IX Lathyrus or Ptolemy X Alexander I (both variously ruling 10781 BCE); of the sec-ond generation Ptolemy XII Auletes, who began ruling in 80 BCE, or Auletes brother Ptolemyof Cyprus who ruled 8158 BCE. In his introduction Apollonius also mentions his teacher, Zo-pyrus of Alexandria, and a witness of Zopyrus competence, Posidonius. Kudlien (1962: 427)believed that this Posidonius was Posidonius of Apamea, the Stoic, but Kidd (1988: 9293)denied this. Deichgrber (1965: 206) gives Apollonius a floruit of 70 BCE but Nutton (2004: 142)gives a more conservative floruit of 90 BCE. Schne (1896: xxivxxv) argues for a date between8158 BCE at the court of Ptolemy of Cyprus. I incline toward the traditional date c. 70 BCE butcannot decide whether Apollonius dedicatee is Ptolemy XII Auletes or Ptolemy of Cyprus.77 See Deichgrber (1965: 2069) for the few other fragments and testimonia about Apolloniusbeyond the Treatise on Hippocrates On Joints. I translate the title with treatisebecause, as von Staden (2006: 15.n3) points out, Apollonius treatise is not really a commentaryin the later lemmatized sense of Galens Hippocratic commentaries, for which the usual titlesare or .78 See footnote 24.

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tween Hellenistic schools. Immediately after his quotation of Hegetor, Apollo-nius attempts an initial rebuttal.

In these things Hegetor not only raves but also has confused friends of medicine asmuch as he is able. Still he has in no way overcome what was said by Hippocrates in OnJoints, but constructs his attack in the previous passage rather sillily from un-agreed-upon points. In order that we not write too much, we will make summary notes againsthim. For those employing only experience itself, remaining on what has been observedempirically, neither agree that in general a femur dislocated and set right again dislo-cates, nor disregard a reduction again when the previous did not take. If what he wantswere true, those using observation could not be [as they are] but, in the same way theyunderstood the situation in the case of the remaining joints, so too is it reasonable thatparticular consequences in the case of the femur be understood. Therefore those whoseek by reason do not want a better reduction to be understood but remain in theirpractice on the theorized point. Neither the fact nor the report of the ancients presentsthis [claim], that the thigh, when dislocated and set in, dislocates again by necessity.For if it was known to this one person or another, it would be a concern for Hippo-crates too about the joints. And being such a lover of truth and making clear his particu-lar views on remaining subjects he has explained about the thigh that in no way onecould not overcome it in general, but contrawise he was [so] inspired somehow in thecase of reductions of the femur that he made an instrumental invention.79

Apollonius continues his rebuttal of Hegetor for several more pages. In the pas-sage quoted, Apollonius stood firmly on Empiricist ground and reiterated theneed for experience in medicine. The text continually emphasizes Empiricist -: empirically, experience. Apollonius refused

79 Apollonius of Citium In Hipp. Art. Comm. 3.245, 80.1482.6 Kollesch and Kudlien (1965) =Empiricist fr. 276 D. Compare also the translation of Smith (1979: 21314). , , - , . , , , , , . , , , , , , . , . , , , , - .




to consider Hegetors speculative claim that there is a ligament in the hip socketwhich, when cut, prevents resetting of the joint.

Furthermore, Apollonius rejected Hegetors view because theoretical viewsfailed to improve treatment. Here an Empiricist is making an argument aboutprogress: unlike the Rationalist promise of medical progress grounded in knowl-edge of physis, Apollonius vision of progress is improved therapy. In the rheto-ric of scientific progress Empiricism fastened on therapy, Rationalism on knowl-edge: the debate between sects was asymmetrical even in their views ofscientific progress. The Rationalists, Apollonius insisted, do not want a bettersetting to be understood but remain in their practice on the theorized point. Abetter setting of the dislocated femur is an improved therapy for the patient butthe denial of this very possibility simply on the basis of theory offers no thera-peutic progress.

In addition to the expected Empiricist focus on experience and therapy,Apollonius repeatedly invoked Hippocrates views and observations against He-getor. He used Empiricist language: the report of theancients where report, the second leg of the tripod, refers to the re-corded observations of earlier doctors. Frede (1987) suggests that Apolloniusinsistence that a dislocated hip does in fact reset may be drawn from the reportsof his earlier contemporary, Heraclides of Tarentum, who had also taken issuewith Hegetors views, as we have seen in section 1 above.80 (Heraclides listedseven previous physicians, including Hippocrates, who recorded their that they had successfully reset a dislocated hip joint.) Apollonius said that Hip-pocrates did not record that a dislocated hip joint could not be reset, as Hegetorclaimed. Smith (1979) has memorably doubted Apollonius Empiricism: Apollo-nius may have been an Empiric, but more likely he stepped forth as a Hippocra-tean.81 While it is true that Apollonius nowhere identifies himself as an Empiri-cist, there are many indications that he was an Empiricist and, simultaneously,a Hippocratean. Apollonius continuously invoked the contrast between Ration-alists those who seek by reason and Em-piricists those employing only ex-perience itself, those using observation.Apollonius aligned Hippocrates with the Empiricists against the Rationalists, forHippocrates has recognized that the dislocated femur can be reset and even de-vised an instrument to accomplish that. By aligning Hippocrates with the Em-piricists, Apollonius explicitly brought a respected ancient authority over to theEmpiricist side in the dispute between medical schools and thereby aligned the

80 Frede (1987: 94).81 Smith (1979: 215).

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Empiricist vision of medicine with Hippocrates. Apollonius thereby establishedEmpiricist continuity with the fifth-century Hippocratic tradition of medicine, asif to suggest Empiricism is scientific traditionalism and Rationalism scientificradicalism. These are ideological moves appropriate to a debate between medi-cal sects.

Hippocrates was not simply a traditional authority for Apollonius: he wasalso an Empiricist authority and, perhaps, an early Empiricist. Galen recordedthat some Empiricist doctors did claim that Hippocrates was an Empiricist.82 Insection 5 I argued that Empiricism shared elements reminiscent of 5th centuryBCE medical thought with its authorization of the role of caregiver, a re-author-izing of the primacy of vision in knowledge, a reassertion of the uniqueness ofthe patient and his circumstances. Since Empiricism was as much a culturalargument about the role of the doctor in medicine as an intellectual movementabout the manner by which a doctor advance to knowledge, it is not surprisingthat Empiricists would try to appropriate Hippocrates, the great doctor of 5th

century BCE science.83 The Empiricists claim that Hippocrates was an Empiri-cist is a serious claim, not because it is verifiably true or false,84 but because ofthe cultural argument the Empiricists were thereby making against the Rational-ists. The Empiricists argued that physicians ought to be healers and caregivers,just like Hippocrates was; and Hippocrates established medicine.

VII The Asymmetry of the Sect Debate

Galens passage summarizing the dispute between Hellenistic sects stated thatthe Rationalists and Empiricists arrive at the same therapy from different start-ing points. But the dispute between Hegetor and Apollonius on the dislocationof the femur shows that the sect debate was asymmetrical; Rationalists and Em-piricists were arguing past each other in matters of therapy. Rationalists, suchas Hegetor, are arguing for a methodological inquiry to medicine: to dissect thebody, to understand the facts of anatomy, to dismiss reported evidence of thera-pies if it contradicts the visible evidence of anatomy. Empiricists, on the other

82 Galen Hipp.Art. 18A.524 [Galens commentary on Hippocrates Anatomy] . = Empiricistfr. 310 D.83 For Hellenistic and Imperial medical attitudes towards Hippocrates see Smith (1979), Lloyd(1993), Jouanna (1999: 34857), and von Staden (2006).84 The Hippocratic Corpus has many voices. See Smith (1979: 20414) for the argument thatHippocrates can neither be shown to be a Rationalist nor Empiricist.




hand, value therapy above all else. Apollonius argument against Hegetors per-sonal inspection of the facts of anatomy relies on reports of previous therapies:anatomy is to be dismissed if it contradicts trustworthy reports of therapy.

Galens quote also stated that the dispute was purely methodological. Butthe evidence of the therapeutic motivation shows that sect debate was asymme-trical; the Rationalists and Empiricists are arguing past each other in their con-ception of medical science. Rationalists, such as Hegetor, thought that medicalscience ought to be concerned with knowledge. Grounded in the facts of anato-my, medicine could advance its understanding of physis to achieve better ther-apy by discriminating possible from impossible therapies. Empiricists, however,denied that knowledge of anatomy alone led to better therapeutics. For the Em-piricists, medicine concerned the practice of healing, not a body of knowledge.Apollonius indicates that medicine progresses only when patients are healed.

Labeling the sectarian debate asymmetrical draws attention to the appar-ent non-conformity of Rationalists and Empiricists to observe Galens statementthat medicine was a unified whole, differing only in its methodological ap-proach. In a very real sense the Rationalists and the Empiricists did not jointheir argument upon a single issue: the point of contention could not even beagreed upon. Instead there were a series of charged issues anatomy, therapy,scientific progress, Hippocrates which each side had included in their concep-tion of medicine but which played differing parts in their corresponding sectar-ian paradigms.

Furthermore, individual Rationalists and Empiricists can hold asymmetricalviews. In section 2 above I argued that disputes between individual members ofthe sect must be subsequent to sectarian disputes. This holds true in the disputeabout the dislocation of the femur. As discussed in section 1, the EmpiricistHeraclides of Tarentum seemed to dispute with Hegetors claim that the femurcould not be reset: However many people think that the femur when set doesnot stay in place on account of the fact that the tendon holding the femur to thesocket of the hip separates, they do not know in a general way when they maketheir claim. Both Empiricists, Heraclides and Apollonius, agreed that the femurcan be reset against Hegetor, the Rationalist. The Empiricists agreed that Hippo-crates had recorded testimony that the femur bone could be reset but differedon the reasons: Heraclides argued that the tendon sometimes slackens andtightens, a provisional use of ; Apollonius argued that the testimony ofHippocrates was unimpeachable and allowed therapeutic progress.85 Heraclides

85 Apollonius extensive argument against Hegetor 82.6.94.9 Kollesch and Kudlien (1965)quotes Hippocrates On Joints at length to argue that Hippocrates testimony shows that posi-tive therapy can be effected for a dislocated femur.

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made an argument about anatomy, Apollonius about therapy. Each Empiricisthas his individual view of Empiricist doctrine which each uses to pursue a mainpoint, that Hegetor and the Rationalists are mistaken. What would have Hera-clides and Apollonius said to each other? They probably would have agreedthat Hippocratess historia was valuable and that their own treatments wouldprovide therapy for the dislocated hip, but they probably would not have agreedon why Hegetor was wrong. Heraclides and Apollonius emphasized differentmethodologies, but their intra-sect disagreement remains only subsequent tothe dispute with Hegetor. Disputes between individual members of the sect wereposterior to sectarian disputes.

The asymmetry of the sect dispute shows the heterogeneity, ferocious in-dependence, and motley individualism of Hellenistic sectarian medicine.86 Ga-lens reductive division of sectarian medicine into a purely methodological dis-pute obscures the deep divisions between Hellenistic medical sects. Sectariandivisions concerned not only methodology but also the possibility of scientificprogress and the very conception of medicine.

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Apeiron Volume 0 Issue 0 2013 [Doi 10.1515%2Fapeiron-2013-0002] Berrey, Marquis -- Early Empiricism, Therapeutic Motivation, And the Asymmetrical Dispute Between the Hellenistic Medical