Greek Rational Medicine: Philosophy from Alcmaeon to the Alexandrians
by James Longrigg London and New York: Routledge, 1993. Pp. ix, 296. US$59.95 ISBN 0-415-02594X
Reviewed by: Mark Timmins, Dept. of Classics, University of Toronto, Ontariio, Canada.
Much recent scholarship on Greek medicine emphasises the influence of social ideologies in shaping its development and minimises its rational or scientific component.<1> James Longrigg's book, Greek Rational Medicine, offers a refreshing alternative view of the ancient evidence and its value. In assessing the contribution of the ancient Greeks to the early development of medical science he stresses the rational aspects of their project, judiciously presenting both the positive and negative features of the early marriage between natural philosophy and medical research. There is no comparable work in English which treats this range of material with such a balanced handling of the philosophical and medical authors. Only G.E.R. Lloyd's work displays a similar breadth.
The book has a comprehensive bibliography, a full set of endnotes and a solid index locorum. The general index is helpful, although somewhat limited by the absence of the modern authors cited in the text and notes. There is a useful table on pages 54-57 and a number of helpful diagrams.<2>
Longrigg's main theme is the inter-relation between philosophy and nascent medical theory; from a consideration of pre-rational views of medical matters in early classical Greece down to the striking discoveries of early Hellenistic Alexandria. He proceeds chronologically, offering an overview of the parallel and sequential developments in the philosophers' and physicians' theories and demonstrates that the influences moved in both directions.
His introduction sets the terms of his approach: he distinguishes the originality and rational nature of Greek medicine in its development of natural modes of explanation concerning the causation and character of disease and health. Its evolving liberation from supernatural accounts, Longrigg maintains, originates from and proceeds in company with parallel developments in natural philosophy: the two "subscribed largely to the same general assumptions ... the same concepts, categories and modes of reasoning" (2-3). Yet this alliance came at considerable cost, as Longrigg points out: the dominance of a priori reasoning adopted from natural philosophy largely overshadows any incipient tendencies to empiricism in early medical theory. Nevertheless, he counters the criticism that such speculative, `rational' approaches represent virtually no advance over explanations based on religious hypotheses: as he notes, the rational system is subject to empirical verification, modification or replacement over time (5).<3>
The range of authors and topics which Longrigg handles is impressive as is evident in the outline below. The chapter titles are informative, the first six being balanced pairs, the seventh a unit by itself:
Chapter 1, " Pre-rational and irrational medicine in Greece and neighbouring cultures", is the first of two sketching the climate of thought against which the medical genre of writing developed. In this chapter Longrigg discusses the classical Greeks' popular belief in supernatural causation and cure of diseases. He also argues against the view that the Egyptians and Babylonians preceded the Greeks in the development of rational medicine. By contrast he emphasises the originality of the Hippocratic conception of disease as "a natural process, a disturbance of the equilibrium of the constituents of the body" (14). He concludes by challenging modern theories about the origin of the Hippocratic tradition out of the Asclepian healing cult and the nature of the Hippocratics' professional association.
In chapter 2, "Ionian natural philosophy and the origins of rational science", Longrigg turns his attention to what he regards as the genuine, philosophical source. He illustrates the gradual emergence of the naturalistic mode of explanation, for instance in Thales and Anaximenes, and examines similar tendencies evident in a number of the later, Hippocratic works. Finally, he notes the gradual shift in philosophical interest from macrocosm to microcosm, from cosmology to the human plane, a development which presaged the outburst of biological and medical theories to come.
Chapters 3 and 4 focus from two different perspectives on the subordination of early medical theory to philosophy. In chapter 3, "Alcmaeon and the pre-Socratic philosophers", he studies Alcmaeon, Democritus, Empedocles and Diogenes of Apollonia, the four pre-Socratics with pronounced biological interests. He shows how each contributed conceptions which would prove profoundly influential in subsequent medical theory. A handy table (54-57) illustrates how the empirically- minded Alcmaeon raised the physiological issues taken up by the other three.
Chapter 4, "Pre-Socratic philosophy and the Hippocratic corpus", studies the medical authors' perspective on the philosophical influence. Longrigg's discussion here is framed by a close analysis of De vetere medicina, where we find a polemic against the intrusiveness of dogmatic philosophical systems into medicine and an advocacy of empiricism and sceptical caution. Yet the author falls prey to the very a prioristic schematism which he criticises and his strain of sceptical empiricism may well be derived from Xenophanes by way of Alcmaeon, Longrigg argues (84, 100- 103). Thus for better or worse, it seems the philosophical influence on medical writing of the time was inescapable. Longrigg illustrates this general claim with passages from various Hippocratic texts which show principles of explanation at work distinctly similar to those of the pre Socratic `big four'.
Chapters 5 and 6 deal with post-Hippocratic medicine in relation to the interest of Plato and Aristotle in human biology. Here Longrigg considers how the medical authors may have influenced the philosophers. In chapter 5, "Medicine and the Academy", he traces the influence of the `Sicilian' medical tradition, particularly the work of Philistion (108-11), on Plato's Timaeus. Longrigg also argues that Plato's biological theory was intended as a serious contribution to the subject, a view supported by assertions made in other late Platonic dialogues (114-117) and by the tightly integrated teleological system within the Timaeus itself, which combines theology, cosmology, physical theory and human biology. While the medical theory offered in the dialogue is shown to have been patently influenced by Plato's tripartite psychology, Longrigg demonstrates how systematically Plato selects and synthesises features of `Sicilian' and other medical theories.
Chapter 6, "Medicine from Lyceum to Museum", deals largely with Aristotle and Diocles, concluding with a sketch of Praxagoras of Cos. The treatment of Aristotle is somewhat schematic, save for a close analysis of his physical principles (152-158). Longrigg notes the problematic inconsistency in Aristotle's characterisation of the elements in his physical and biological works and argues that the divergence may be the result of the influence of two different medical traditions (Hippocratic and `Sicilian') on Aristotle's thought (158-159, Appendix). Considering some of Aristotle's methodological statements about medicine, Longrigg draws attention to points of comparison and contrast with Plato (150-151, 159-162). He also emphasises Aristotle's outstanding achievement in the initiation of the practice of systematic animal dissection within the Lyceum. In the latter half of this chapter, Longrigg argues that the physician Diocles was both a contemporary of Aristotle and a major influence on his biological thought. Finally, he concludes with a brief discussion of the contact and similarity in outlook between Diocles and Praxagoras, the teacher of the two great Alexandrian physicians, Herophilus and Erasistratus.
In the final chapter, "Early Alexandrian medical science", Longrigg surveys and evaluates the intellectual environment, the innovations in methodology and the achievements of the two chief medical researchers of early Ptolemaic Alexandria. He stresses that the research there was part of an unbroken line of development from the Hippocratic tradition through Praxagoras and the Lyceum through Strato. Considering particularly the striking innovations in anatomy, he deals with the controversy about the veracity and reasons for the practice of human dissection and even human vivisection in Alexandria (184-190). Finally, Longrigg offers detailed studies of the advances of Herophilus and Erasistratus (190-217), showing how their physiological theories were often restricted by traditional influences so that they lagged behind their anatomical discoveries.<4>
As far as the substance of Longrigg's treatment is concerned, his general thesis seems to be well supported, particularly as he is careful to temper the positive claims for the benefits of the influence of philosophy on medicine with a sensitive awareness of the costs (45, 80-81, 98-99, 217). His definition and illustration of the terms of rationalism applicable here are well expressed in the introduction and first several chapters. His treatment of the philosophers' and physicians' gradual departure from the use of supernatural terms of explanation is impressive (27, 31-37).
The one serious limitation of the book, however, is Longrigg's chapter on Aristotle and Diocles. There is not enough detailed discussion of Aristotle's biology. Although Longrigg offers an interesting treatment of Aristotle's views on the heart in relation to his predecessors and contemporaries (164-172) and a passing reference to his pneuma doctrine in De motu animalium (174), what we really miss is any treatment of the many physiological functions discussed by Aristotle at length in the Parva naturalia, the De partibus animalium and the De generatione animalium. In another regard, Longrigg's claims for the influence of Diocles on Aristotle largely depend on his dating them as contemporaries, but the arguments he offers on this latter count are not entirely lucid or convincing (161- 164, 170-172).
Some additions might also have strengthened this otherwise rich and full discussion. A few more tables would have been helpful, particularly one to illustrate the theme of continuity between Aristotle, Diocles, Praxagoras and the Alexandrians - a line which is not always clear in the discussion (chapters 6 and 7). >More might also have been said about the dating of works within the Hippocratic corpus. Longrigg pays attention to the putative dates of certain Hippocratic treatises and avoids any glaring anachronisms<5>, but more attention should be drawn to the fact that the authorship is diverse and the time range of composition is considerable. Some discussion of the status of the corpus in these regards should be made in the introduction or in the Hippocratic chapter.
Longrigg's skillful handling of the metaphysical dimension of the Timaeus in connexion with Plato's efforts to demonstrate a moral order conjoining cosmology, physics and human biology (114- 121) illustrates well how indiscernible the line may be between the rational and the theological perspectives. Yet Longrigg might also have said something about the apparent absence of Hippocratic conceptions in the Timaeus despite Plato's evident acquaintance with that tradition.<6> While Longrigg reasonably addresses Plato's selection of medical doctrines on the basis of his tripartite psychology, I wondered at the absence of any reference to his doctrine of eros. This should have some relation to the connexion Plato draws in the Timaeus between brain, marrow and semen. The eros doctrine may well also bear upon Plato's psychosomatic analysis of sexual incontinence in Timaeus 86bff. Nevertheless, Longrigg does well to raise consciousness that Plato's psychopathology here is "fuller and of more detailed application than any other previous exposition of this idea" (147). More generally, he performs a like service in his serious evaluation of Plato's interest in human biology<7> and points out that in fact the Timaeus offers a more comprehensive and coherent account in this regard than any single Hippocratic treatise (147).
Longrigg's treatment of the Alexandrians might have benefitted by more direct reference to the discussions of Garofalo and von Staden in their editions of Erasistratus and Herophilus. The issue of human dissection and vivisection is particularly well examined in von Staden's book on Herophilus (op.cit.,139-153) and it would have been interesting to see Longrigg's response to it. More generally, however, Longrigg's final chapter here seems to fade out with some balancing of the accounts of the Alexandrian medical achievement and cautious speculation about the abandonment of the practice of human dissection after Erasistratus. A more desirable finale would have been an epilogue or concluding chapter summing up his survey and balancing the accounts between philosophy and medicine overall.
But it may be rather demanding to expect every topic that comes to mind to be covered in what is in many ways already an impressive treatment of the very complex relationship between Greek philosophy and medicine over a formidable time range. Longrigg's authoritative book is well worth the reading for anyone interested in the rational nature of Greek medical science, both for the questions it answers and for the curiosity it raises.
<1> e.g. G.E.R. Lloyd, Science, Folklore and Ideology. Cambridge, 1983 and L. Dean-Jones, Women's Bodies in Classical Greek Science. Oxford, 1994.
<2> One unfortunate error has occurred at press: pages 50 and 51 have been reversed.
<3> Also cf. 241 n.41 where Longrigg quotes J. Mansfeld: "It is the enlightened theoretical attitude which makes the enlightened empirical attitude possible."
<4> As Longrigg points out, the study of these physicians is assisted by the recent publication of the first complete editions of their fragments, i.e. H. von Staden, Herophilus: The Art of Medicine in Early Alexandria. Cambridge, 1989 and I. Garofalo, Erasistrati Fragmenta. Pisa, 1988.
<5> Note the care with which he introduces the Hippocratic works for comparison with the much earlier Ionian natural philosophers (32-33).
<6> As seen in Protagoras 311b-c and Phaedrus 270b-d.
<7> A recent contribution in a similar vein is C. Joubaud's Le Corps Humain dans la Philosophie Platonicienne. Paris, 1991.
COPYRIGHT NOTE: Copyright remains with authors, but due reference should be made to this journal if any part of the above is later published elsewhere.
Electronic Antiquity Vol. 3 Issue 1 - June 1995 edited by Peter Toohey and Ian Worthington firstname.lastname@example.org ISSN 1320-3606