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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.
DOI 10.1515/apeiron-2013-0002 Apeiron 2013; aop
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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-
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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.
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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).
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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.
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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
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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
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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.
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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.
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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.
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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.
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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.
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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,
, , , , , , ; , , , , , . , , , , - , .
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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). , , - , . , , , , , . , , , , ,
, . , . , , , , - .
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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.
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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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