PHILOSOPHICAL THEMES IN GALEN 

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PHILOSOPHICAL THEMES 
IN GALEN 
 
 
 
EDITED BY 
PETER ADAMSON 
ROTRAUD HANSBERGER 
& JAMES WILBERDING 
 
 
 
 
 
 
 
 
 
 
 
 

  INSTITUTE OF CLASSICAL STUDIES 
  SCHOOL OF ADVANCED STUDY 
  UNIVERSITY OF LONDON  

  2014 

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 TABLE OF CONTENTS
Introduction 1

P. N. Singer Galen and the philosophers: philosophical engagement,

shadowy contemporaries, Aristotelian transformations 7

Todd Curtis Genre and Galen’s philosophical discourses 39

Riccardo Chiaradonna Galen on what is persuasive (pithanon)

and what approximates to truth 61

Philip van der Eijk Galen on the nature of human beings 89

Glenda McDonald Galen on mental illness:

a physiological approach to phrenitis 135

Inna Kupreeva Galen’s theory of elements 153

Peter Adamson Galen on void 197

David Leith Galen’s refutation of atomism 213

Katerina Ierodiakonou On Galen’s theory of vision 235

James Wilberding The secret of sentient vegetative life in Galen 249

Caroline Petit What does pseudo-Galen tell us that Galen does not?
Ancient medical schools in the Roman Empire 269

Index of subjects and persons 291

Index locorum 299

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Offprint from BICS Supplement-114 © The Institute of Classical Studies University of London 2014
 WHAT DOES PSEUDO-GALEN TELL US
THAT GALEN DOES NOT?
ANCIENT MEDICAL SCHOOLS
IN THE ROMAN EMPIRE 1

CAROLINE PETIT
The problems of the origins and of the longevity of ancient medical schools in the
Hellenistic period and later, in the Roman Empire, have not yet been solved. The key
assumptions forming the basis of each of the main schools (Dogmatist, Empiricist, and
Methodist) are relatively well-known thanks to several ancient testimonies, such as Galen’s
work On medical schools (de Sectis) and a number of anonymous (such as the Anonymus
Londinensis) or pseudepigraphical works; nevertheless, some features of the complicated
relationships between minor and major medical schools are still obscured by the lack of firm
evidence to support the claims of outdated scholarship that still pervade modern studies,
such as the classification of several Greek medical authors under the label ‘Pneumatist’. This
paper focuses on the relevance of the Pseudo-Galenica, by contrast with genuine Galenic
works, for our understanding of the boundaries of ancient medical schools; in particular, this
paper re-examines the evidence provided by the pseudo-Galenic Introduction, or the
physician, better known under its Latin title, Introductio sive medicus, especially its fourth
chapter about the ‘heads of the three schools’. After a brief introduction to pseudo-Galenic
works, I approach the pseudo-Galenic chapter from three angles: the controversial reference
to Sextus Empiricus, the definition of Methodism and related schools, and Pneumatism, in
order to demonstrate that our evidence is more problematic than conclusive in assessing the
author’s doctrinal preferences, and the very nature of ancient medical schools in the Roman
Empire.

The pseudo-Galenica in ancient Greek thought

The relatively important group of pseudo-Galenic works do not attract much attention
from historians of ancient thought. 2 They nevertheless often appear in footnotes, for they
provide crucial evidence, especially in the area of doxography.

1
I wish to thank Peter Adamson for his useful comments on a preliminary version of this paper; I
am also indebted to the distinguished audience of the weekly ‘Colloquium on ancient medicine’
held at the Humboldt-Universität (Berlin) in February 2011, for their favourable comments and
constructive criticism. I would like to thank more particularly Philip van der Eijk, Roberto Polito,
Roland Wittwer, and Georgia Petridou for their contribution.
2
A notable exception is J. Mansfeld and D. T. Runia, in the series on Aëtiana, especially in the first
volume (1997), where the method and techniques of citation of the Pseudo-Galenic Historia

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270 PHILOSOPHICAL THEMES IN GALEN

The Pseudo-Galenic texts are relevant to the history of ancient thought, especially in
defining Galenism and medicine through time; the variety of this ‘corpus’ must not be
overlooked. 3 Naturally, ancient physicians explored the links of medicine with many other
areas of knowledge, such as astrology: for example, the Prognostica de decubitu
infirmorum ex mathematica scientia ascribed to Galen, of uncertain date, which associates
astrology with prognosis, was considered authentic and useful in the middle ages, when
‘astro-medicine’ was popular and Galen was seen as one of its founders. 4 For obvious
reasons of scope, this paper will focus on one aspect of the story, namely the boundaries
and the significance of Greek medical schools in the Galenic and pseudo-Galenic
material, with special emphasis on the pseudo-Galenic Introduction, or the physician. 5

Philosopha are discussed. They quote on a regular basis three Pseudo-Galenic works: [Def.Med.],
[Int.] and [Hist.Phil.]. See J. Mansfeld and D. T. Runia, Aëtiana. The method and intellectual context
of a doxographer (Leiden, 1997 (vol. I: The sources); 2009 (vol. II, in two tomes: The Compendium);
2010 (vol. III: Studies in the doxographical traditions of ancient philosophy). In addition, a recent
collection on ancient embryology arises from the collective work of the CNRS unit ‘UPR 76’ around
the pseudo-Galenic Ad Gaurum quomodo animetur fetus: L’embryon: formation et animation.
Antiquité grecque et latine, traditions hébraïque, chrétienne et islamique, eds L. Brisson,
M.-H. Congourdeau, and J.-L. Solère (Paris 2008). This text has been ascribed to Porphyry for
decades, which explains why it is being scrutinized by a group of specialists of ancient philosophy. An
English translation of ad Gaurum has now appeared: Porphyry, To Gaurus on how embryos are
ensouled and what is in our power, trans. J. Wilberding (London 2011).
3
For example, the treatise called ad Gaurum broaches a topic that matters to both philosophers and
physicians, namely the problem of human conception and the status of the embryo. As it happens, this
text is a carefully crafted piece in clear, elegant Greek and stands out in terms of style among the
Pseudo-Galenica. A debate has occurred about the possible authorship of the Neo-Platonist Porphyry;
although it seems widely accepted now that this is the best interpretation of our evidence – an issue
recently reviewed in an article by Tiziano Dorandi, this debate may not be closed (see T. Dorandi,
‘Pour une histoire du texte du traité ad Gaurum attribué à Galien’, in L’embryon: formation et
animation (n.2, above); see also K. Kalbfleisch, Die neuplatonische, fälschlich dem Galen
zugeschriebene Schrift ‘Pros Gauron peri tou pôs empsychoutai ta embrya’ (Berlin 1895)). At any
rate, it is one of the most striking examples of Greek medical-philosophical items to be found in the
pseudo-Galenica.
4
See V. Nutton, ‘Greek medical astrology and the boundaries of medicine’ in Astro-medicine.
Astrology and medicine, East and West, eds A. Akasoy, Ch. Burnett, and R. Yoeli-Tlalim (Florence
2008) 17-31; G. Toomer, ‘Galen on astronomers and astrologers’, Archive for the History of Exact
Science 32 (1985) 193-206; T. Barton, Ancient astrology (Abingdon and New York 1994). Indeed,
some of Galen’s statements on the importance of celestial movements for diagnosis and prognosis were
interpreted as a strong justification of astrology – which was a pretty different science from what we
understand as ‘astrology’ – as a part of medicine. Such cross-fertilization gradually appeared less
legitimate to physicians in the Renaissance, until astrology was clearly banned from medical discourse.
In the mid-seventeenth century, some nevertheless continue to state that medical astrology is beneficial
to the art (for example René Chartier, the physician who published Galen’s and Hippocrates’ complete
works in Greek and Latin in thirteen volumes).
5
On which see my edition in the Budé series, Galien. Oeuvres, III. Le médecin. Introduction (Paris
2009).

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 CAROLINE PETIT: PSEUDO-GALEN AND MEDICAL SCHOOLS 271

The pseudo-Galenic works, or works assumed to be wrongly ascribed to Galen, are

many. The list, however, has varied considerably over time, for at least three reasons:
firstly, a systematic concern for authenticity appeared relatively late in the history of
Galen’s works, not before the early Renaissance; 6 secondly, new works ascribed to Galen
are still found nowadays – and others will no doubt be found in the future, in Greek, Latin
or Arabic to mention but the main three languages in which Galenic material has been
transmitted; thirdly, criteria of authentication have changed over time (and they are not
very firm yet, since the authenticity of some works is still a matter of discussion). 7
Exploring linguistic and stylistic features is a potentially fruitful approach in order to
differentiate between genuine and inauthentic Galenic works, but only a convergence of
various elements (including the language) can provide us with solid evidence of
authenticity versus inauthenticity. 8 The textual transmission, ideas, style, and vocabulary,
and the names of the authorities cited, are some of the reliable criteria.

6
Perfunctory remarks or concerns about authenticity, such as those found in Hunayn ibn Ishāq
about some treatises he had to hand in his own time (ninth century AD), did not result in any
substantial or systematic classification of Galen’s works regarding their authenticity. In the West,
the first key step was taken by the editors of the Aldina edition of Galen’s complete works in 1525,
as they were the first to gather in a separate group of (only) thirteen treatises the works they deemed
‘nôtha’ (in volume IV). More elaborate criticism appeared in the following years (J. Dubois, 1538)
and scholars and editors adopted varying attitudes towards the allegedly inauthentic works.
7
Treatises whose authenticity has been discussed in recent years include the famous Ars Medica (those
who still argue against its authenticity, however, are a small minority): see J. Kollesch, ‘Anschauungen
von den ἀρχαί in der Ars medica und die Seelenlehre Galens’ in Le opere psicologiche di Galeno, eds
P. Manuli and M. Vegetti (Naples 1988) 215-29; V. Boudon, ‘l’Ars medica de Galien est-il un traité
authentique?’, Revue des études grecques 109 (1996) 111-56. Galen’s Theriac to Piso was recently
reintegrated into the corpus of the genuine works, after decades of suspicion (S. Swain, Hellenism and
Empire (Oxford 1996) 430-32, with further literature cited there; V. Nutton, ‘Galen on Theriac:
problems of authenticity’, in Galen on pharmacology: philosophy, history, and medicine. Proceedings
of the Vth International Galen Colloquium, Lille, 16-18 March 1995, ed. A. Debru (Leiden 1997) 133-
51), but a certain amount of uncertainty remains, especially about the language of the treatise.
Similarly, the De motibus dubiis just edited by V. Nutton was long perceived as pseudo-Galenic and is
now considered as authentic. Most recently the De dignotione ex insomniis was deemed spurious by V.
Boudon-Millot (‘Le De dignotione ex insomniis (Kühn VI, 832-35) est-il un traité authentique de
Galien?’ Revue des études grecques 122 (2009) 617-34) who argues that the text was not written by
Galen himself and must be based on a compilation of genuine works by Galen; similar views were
expressed previously by W. V. Harris, Dreams and experience in classical antiquity (Cambridge MA,
and London 2009) 210 n.520, and beforehand in ‘Roman opinions about the truthfulness of dreams’,
Journal of Roman Studies 93 (2003) 18-34 (32 n.94); see also G. Demuth, ‘Ps. Galeni De dignotione ex
insomniis’ (unpublished doctoral thesis, University of Göttingen 1972). Thus pseudo-Galenic works
raise continuing suspicion and controversy.
8
One of the secondary aims of my Wellcome project on ‘Galen’s Greek’ was to bring evidence of
stylistic differentiation between Galenic and Pseudo-Galenic treatises: in fact, such differences do
exist (both in vocabulary and syntax) but they are nuanced by the fact that, within the same literary
form or genre, the differences tend to disappear for generic constraints. For example, Galen’s works
on anatomy for beginners hardly differ in style and language from works by others designed for
beginners. Some tiny nuances can still be drawn, such as the use of the dual, of perspective, of some
particles, and of the optative mood. The vocabulary, sentence elaboration and tone, however, are as

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272 PHILOSOPHICAL THEMES IN GALEN

Our current perception of the pseudo-Galenic works is obscured by the fact that a
majority of them are scattered across the twenty volumes of the Kühn edition (1821-33)
and as such may appear in the TLG with no formal distinction. Also, some of the texts,
either in Arabic or in Latin, do not appear at all in that edition, which many believe to be
the ultimate collection of Galenic works. 9 More importantly, the available information on
each of the treatises is scanty and of unequal freshness and reliability, as some of the texts
have hardly been studied in a century. 10
Most pseudo-Galenic works behave just like any genuine Galenic text, although it
would be wrong to believe that they were deliberately crafted as imitations of Galen’s
works. While Galen develops some relatively personal philosophical ideas, pseudo-
Galenic works merely pass on the ideas of others. They are valuable historical sources, if
not always the most exciting material to read.

The pseudo-Galenic Introduction, or the physician

The Introduction, a treatise of uncertain date and authorship, slipped into the Galenic
corpus at a relatively early date, for all our Greek manuscripts (the oldest being a twelfth-
century manuscript) ascribe it to Galen; 11 the text cites an impressively large number of

representative of ‘simple’ style (as defined by Demetrios and the Pseudo-Aristides) in Galen’s
treatises as in works of similar purpose by other authors. In Galen’s four treatises of anatomy for
beginners (recently published in the Budé series by I. Garofalo and A. Debru), the sentences are
short and simple; the vocabulary is technical and plain; there is no polemical statement or
discussion; hardly any earlier controversial fact or authority is mentioned at all; the first person
hardly appears, while the texts are written in the third person. Such a low profile is rare among
Galen’s works; it is in fact characteristic of the genre of works for beginners, which is why Galen’s
style is only faintly detectable. Works for beginners are exemplified in many surviving texts,
ranging from rhetoric to science. For earlier attempts to use linguistic investigation in order to
differentiate between Galenic and non-Galenic works, see notably about the authenticity problem of
Theriac to Piso: Philippe Labbé, Claudii Galeni chronologicum elogium (Paris 1660); S. Swain,
Hellenism and Empire (Oxford 1996) 430, lists the relevant literature on the same issue.
9
Such as the pseudo-Galenic commentary on Hippocrates’ Sevens, preserved only in Arabic (Pseudo-
galeni in Hippocratis de septimanis commentarium ab Hunaino q. f. Arabice versum, ed., trans. into
German G. Bergsträsser (Leipzig 1914)). The Latin material is more consequent and extremely diverse.
See also J. Jouanna, ‘Un Galien oublié: Caractéristiques propres à Hippocrate (Stobée, Anthologie
4.37.14), avec une nouvelle édition’ in Histoire de la tradition et édition des médecins grecs – Storia
della tradizione e edizione dei medici greci, Atti del VI Colloquio internazionale sull’ecdotica dei testi
medici, Parigi aprile 2008, ed. A. Roselli et al. (Naples 2010) 199-230.
10
The only substantive study of the Introductio sive medicus until my edition (2009) was Emil
Issel’s 1917 Dissertation (Marburg); the treatise An animal sit quod in utero est has not been
researched since Hermann Wagner’s edition (1914). A remarkable exception among the Pseudo-
Galenica is Jutta Kollesch’s monograph titled Untersuchungen zu den pseudogalenischen
Definitiones medicae (Berlin 1973), but her long-awaited edition of that important text has not
appeared yet.
11
Two elements support the view that the Introductio was considered as authentic at an early date.
A Latin manuscript of the tenth century, containing a brief fragment of the text in a Late Latin
translation, ascribes it clearly to Galen. In addition, the archetype of our Greek manuscripts is likely

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 CAROLINE PETIT: PSEUDO-GALEN AND MEDICAL SCHOOLS 273

philosophers and physicians: some accompany a quotation, or an opinion; some are

mentioned for their historical role; finally, some are mentioned next to a remedy, an
instrument, or a disease. Since the use of authorities constitutes a notoriously useful tool
to characterize an author’s intellectual background, and sometimes even to date his work,
then clearly, the pseudo-Galenic Introduction invites such analyses. As it would be
tedious and confusing to go through all the cited names one by one, 12 I shall focus on a
few privileged figures or groups, and on related historical issues.
An obvious figure to study, Hippocrates is by far the most frequently mentioned –
thirty-one times, and the highest authority in the Introduction. Hippocrates is presented as
‘divine’ and the real founder of the medical art, together with a proper mythological
figure, Asclepius. As I have shown in another study, the Hippocratic material is in fact
diverse, and many discrepancies appear between the Hippocratic collection and the
quotations found in the pseudo-Galenic Introduction. In this handbook devised for
beginners (although this, too, deserves discussion), the Hippocratic material is somewhat
misrepresented; it is altered and rearranged in order to make Hippocrates’ ideas simpler,
and thus help the students remember the information better (even if the exact signification
is not entirely preserved). For example, two consecutive aphorisms by Hippocrates are
reduced to a single quotation. Indeed, the aphoristic form was privileged in the literature
for students, especially in medicine. 13 More interestingly, the Hippocratic works that one
can reconstruct from Pseudo-Galen differ clearly from the canon of authentic Hippocratic
works identified by Galen; they also differ from those cited in another ancient pseudo-
Galenic text, the Medical definitions ([Def.Med.] XIX.346-462 K). Interestingly, it is
clear that there was a diverse perception of what counts as genuinely Hippocratic in the
Roman Empire. Overall, the quotations from Hippocrates in the pseudo-Galenic
Introduction show that, as a historical source, Pseudo-Galen is relatively reliable – and yet
certainly not all quotations can be considered as an accurate, word for word reflection of
the original. By comparison with Galen, whose posture as the legitimate heir to
Hippocrates is well-known and has been thoroughly studied, the pseudo-Galenica seem to
offer a simplified view of Hippocratic words and ideas, but they also concur with Galen
into producing a hagiographic picture of the ‘divine’ Hippocrates, which casts doubt on
Galen’s originality in this respect. 14 For a historian of medical ideas and training in the
Roman Empire, such nuances are not entirely negligible.

to date back to the ninth century because of the existence of a few typical uncial mistakes in both
branches of the text.
12
I append a list at the end of this article.
13
C. Magdelaine, ‘La littérature médicale aphoristique: paradoxes et limites d’un genre’, in La
médecine grecque antique, eds J. Jouanna and J. Leclant (Paris 2004) 71-94.
14
I am summarizing here views that were previously presented in my article ‘Hippocrates in the
pseudo-Galenic Introductio sive medicus: how was medicine taught in the Roman era?’, in
Hippocrates and medical education, ed. M. Horstmanshoff (Leiden 2010) 243-60. A slightly
different version of this article has appeared in French: ‘La place d’Hippocrate dans un manuel
médical d’époque romaine: l’Introductio sive medicus du Pseudo-Galien’, Les études classiques 77
(2009) 295-312.

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274 PHILOSOPHICAL THEMES IN GALEN

Similarly, the way Erasistratus and Herophilus, two other major figures in the history
of medicine, are presented, shows that Pseudo-Galen can at times confirm Galen’s
affirmations or supplement genuine Galenic material, which is important, of course, given
the suspicion surrounding Galen’s impartiality when dealing with earlier authorities. The
two Hellenistic physicians, of whom we are fortunate enough to have fragments edited
respectively by I. Garofalo and H. von Staden, are often likely to be misrepresented in
Galen’s diatribes: this affects Erasistratus 15 more often than Herophilus, whom Galen
deemed more reliable (or at least, he sounds less aggressive towards Herophilus). In
Pseudo-Galen’s Introduction, too, there is a difference of treatment between Erasistratus
and Herophilus. The former is more often cited (ten times) and sometimes criticized (as in
5.1, XIV.684 K = p. 10 Petit, and 9.4, XIV.697 K = p. 21 Petit), while the latter receives
less attention: he is mentioned four times in passing, mainly for his role as head of the
Rationalists and, more importantly, for his threefold definition of medicine. 16 Unlike
Galen, the author of the Introduction (6.5, XIV.688 K = pp. 13-14 Petit) not only reports
the famous Herophilean definition, but clearly stresses that it is the most commonly
accepted definition of the art, and closes his chapter with it:
But for almost all those who came after Hippocrates, this definition by Herophilus
is right: medical science is the knowledge of things relating to health, of things
relating to disease, and of things that are ‘neither of these two’ (neutral). For
medical science possesses knowledge of these three: ‘relating to health’ are all
things that equip the parts in man to be such that, if they are harmoniously fitted
to each other, the state of being healthy is constituted as a result; ‘disease related’
are the things that dissolve the healthy, harmonious arrangement [sc. of the body],
while all the remedies applied in diseases and the substances of which they are
made [sc. materia medica] are ‘neutral’. 17
I am using here the exact terms of Heinrich von Staden’s English translation, albeit
slightly modified according to the text of the manuscripts: 18 at the beginning of the
passage, Pseudo-Galen in facts asserts that the definition was widely accepted as the right
definition of medicine. That is a significant difference in the text of the B manuscripts
which I follow here, versus the Kühn edition; the latter is remotely based on a part of the
manuscript tradition which ultimately derived from a damaged passage in manuscript V
(Vaticanus gr. 1845: the twelfth-century prototype of family A) and was later awkwardly
corrected by the seventeenth-century editor René Chartier through the addition of a

15
See for instance numerous passages in Galen’s treatises On black bile and On the natural
faculties. In Book I of the latter, Galen gives Erasistratus a lesson of good rhetoric (Nat.Fac.
II.60-62 K = 94-96 Brock).
16
About which see H. von Staden, Herophilus: the art of medicine in early Alexandria. Edition,
translation, and essays (Cambridge 1989) 108-12; V. Boudon, ‘Les définitions tripartites de la
médecine chez Galien’, ANRW 2.37.2 (1994) 1468-90; Galien. Exhortation à l’étude de la
médicine; Art médical, ed. and trans. V. Boudon-Millot (Paris 2002) 276 n.4.
17
Pseudo-Galen, [Int.] 6.5, XIV.688-89 K = pp. 13-14 Petit.
18
In his edition of the fragments of Herophilus of 1989, von Staden had no choice but to follow
Kühn’s text.

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 CAROLINE PETIT: PSEUDO-GALEN AND MEDICAL SCHOOLS 275

particle (dê) to connect the two sentences. Thus, instead of merely reporting Herophilus’s
definition, just like Galen does, Pseudo-Galen provides us with an additional detail of
importance for the reception of Herophilus. It is therefore no surprise that Galen should
report this definition by Herophilus, since it is acknowledged to be well known and
accepted, according to Pseudo-Galen.
Presumably, toward the end of the second century AD, Herophilus was a relatively
uncontroversial figure in the history of medicine, while Erasistratus was not – probably
because of his views on humours, which did not fit within the Hippocratic legacy heralded
by the likes of Galen. I am assuming here that the Introduction is roughly contemporary
with the Galenic writings, although this is an imprecise dating, and is a relatively
controversial hypothesis. 19 Firmly attributing a considerably later date to the Introduction
is in my view impossible, as I hope will become evident.
Following the above considerations, an obvious question to ask is whether all
authorities cited in the pseudo-Galenic Introductio sive medicus are accurately reflected.
Another question is whether those cited names are of any help to understand the historical
context in which the Introduction was written. In particular, can those names help to
establish the date and the origin of the text? The passages concerned display many
original features in the medical-philosophical context of the Roman period and not all will
be explained here. The pseudo-Galenic Introduction is an essential source for our
knowledge of several physicians, whose works are almost completely lost and whose
fragments are sometimes not yet edited, such as Athenaeus of Attalia, Archigenes of
Apamea, and Asclepiades of Bithynia, 20 who deserve a more thorough study. I shall
therefore concentrate on three problems in the history of philosophy and medicine in
which the pseudo-Galenic Introduction plays a role. Most of these issues arise from a
relatively famous and controversial chapter in the first part of the text: Chapter 4, on the
heads of the three schools.
In Ch. 4 of the Introduction, Pseudo-Galen reviews the chiefs of each medical school
(the dogmatists, the empiricists and the methodists – to whom he adds the eclectics, and
the so-called ‘episyntheticists’). This chapter is invaluable for the history of medicine, as
it provides a rich list of prominent doctors, as well as a unique chronology; besides, it is

19
For a number of reasons, there can be no definitive certitude as to the date of the treatise. Since
many cited authorities are known as second-century figures, including Antipater who was a con-
temporary of Galen, and since we have a late antique Latin translation of the last four chapters, the
Introduction must have been written between the second half of the second century AD and the fifth
or sixth century AD, when it was (probably) translated into Latin. I favour an earlier rather than a
later date and consider the Introduction roughly contemporary with the Galenic corpus, but others
may feel differently. The date issue has implications for other questions in the history of Greek
thought and gave me the incentive to write this article.
20
An edition of Asclepiades’ fragments is in preparation by David Leith. There is a partial edition
by Cesare Brescia of the Fragments of Archigenes (1957) based on the Pal. Gr. 199, which I failed
to mention in my book; it follows Olivieri’s study ‘Frammenti di Archigene’, in Memorie della
R. Accademia di archeologia, lettere e belle arti della Soc. R. di Napoli 6 (1938) 44-46. See also (in
Greek): A. Mavroudis, Archigenes Apameus: the life and work of a Greek physician in imperial
Rome (Athens 2000). By all means a modern edition of the fragments would be desirable. About
Athenaeus’s work and ideas, see V. Nutton, Ancient medicine (London 2004) 202-03.

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276 PHILOSOPHICAL THEMES IN GALEN

one of the very few Greek texts to mention the ‘episyntheticists’ (otherwise known only
through another pseudo-Galenic work and the late antique Methodist Caelius
Aurelianus). 21 It is unclear what links actually existed between the Eclectics, the
Episyntheticists, the Methodists and the Pneumatists: but the question needs to be
addressed, and our Pseudo-Galen provides crucial evidence. The Pneumatist school is
actually not mentioned in this chapter, but it appears at the end of Ch. 9:
Finally, those around Athenaeus and Archigenes have demonstrated that natural
elements are constituted from the pneuma that permeates them only, and that all
diseases derive from the primary affection of it; that is why they take the name of
‘Pneumatists’. 22
Indeed, the picture is slightly more complex than the superficial division into three
schools suggested in the title. I append an English translation of Ch. 4 based on my
edition:
Who were the heads of the three schools of medicine?
1. The Rationalist school was governed by Hippocrates of Cos, who both
governed and established the Rationalist school, and after him by Diocles of
Carystos, Praxagoras of Cos, Herophilus of Chalcedon, Erasistratus of Keios,
Mnesitheus of Athens, Asclepiades of Kios in Bithynia, also said: of Prousias, and
Athenaeus of Attalia in Pamphylia. 23 2. As for the Empiricist school, Philinus of
Cos first governed it, after separating it from the rationalist school according to
some principles he inherited from Herophilus, of whom he was a pupil.
Nevertheless, as they wanted to make their own school older, so that it becomes
older than the rationalist one, they say that Acron of Acragas established it. After
Philinus came Serapion of Alexandria, and the two Apolloniuses, from Antioch.
After them: Menodotus and Sextus, who governed it with care. 3. As for the
Methodist school, Themison of Laodicea in Syria was in charge, after being
supplied by the Rationalist Asclepiades on his way to the creation of the
Methodist school. Thessalus of Tralles then perfected the school. After those,
came Mnaseas, Dionysius, Proclus, Antipater. About some aspects of the doctrine,
there were dissensions in the school from Olympicus of Miletus, Menemachus of
Aphrodisias and Soranus of Ephesus. There were also some Episyntheticists, such
as Leonides of Alexandria, and some Eclectics, such as Archigenes of Apamea in
Syria. 24
Three problems, connected with the Introduction’s date and authorship appear to stand
out: the date of Sextus Empiricus; the Methodists in the history of medicine;
‘Pneumatism’ and the Stoics.

21
Pseudo-Galen, [Def.Med.] XIX.353 K; Caelius Aurelianus, Acute diseases II. 7, ed. and trans.
I. E. Drabkin (Chicago 1950) 124.
22
Pseudo-Galen, [Int.] 9.6, XIV.699 K = p. 22 Petit.
23
The name of Athenaeus of Attalia had disappeared from the Kühn edition.
24
Pseudo-Galen, [Int.] 4, XIV.683-84 K = pp. 9-10 Petit.

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Sextus Empiricus
Among the Empiricists (4.2, XIV.683-84 K = pp. 9-10 Petit), the last chief cited is
‘Sextus’. Whether this Sextus might be the famous sceptic philosopher is a debatable,
although more than tempting hypothesis: in fact, it is commonly accepted that Sextus
Empiricus and the Sextus, head of the Empiricist school are one and the same man. This
has been the case for over a century: the key study on the matter is a 1917 dissertation by
Emil Issel, 25 which also happens to be one of the very few useful studies on the pseudo-
Galenic Introduction. The fate and the date of Sextus and those of Pseudo-Galen are thus
inextricably tied together. For the date of the Introduction is crucial in the dating of Sextus
Empiricus, while the presence of Sextus (provided he is our famous Sceptic) is supposedly
a clue for the date of the Introduction! The logic is not satisfactory there. No significant
re-examination of the material has emerged, in order to make things look more certain. 26 I
shall summarize the evidence below.
Among our certainties is the fact that Sextus Empiricus was a physician. He himself
refers to his own medical writings, while mentioning Asclepius as the founder of his
profession – it has to be medicine. The evidence is well known, and can be found
conveniently gathered in an article by D. K. House. 27 Is this evidence sufficient to identify
the Sextus of the Empiricist school in the Pseudo-Galenic Introduction with Sextus
Empiricus? A chronological argument is difficult. Emil Issel rightly argues that evidence
for dating the floruit of Sextus Empiricus is very limited. 28 While locating the floruit of
Sextus before 230 AD sounds perfectly reasonable, it is difficult to argue in favour of an
earlier terminus ante quem. Issel then proceeds to his demonstration about the date of the
Introduction: according to him, it is demonstrable that the pseudo-Galenic manual is
contemporary of Galen’s works – if then Sextus appears in the text, then Sextus is also
contemporary of Galen (at the latest).
Issel’s demonstration relies on various arguments. While I happily retain his
arguments regarding the authorities cited in the text (some of them being known to Galen
as well: they include the Methodists Olympicus, Soranus and even Antipater, whom Galen
had to examine once), 29 I cannot entirely subscribe to his core hypothesis, however
tempting it may be. Issel argues that the Introduction, in fact titled ‘Iatros’, The physician
(a fact that is confirmed by all extant manuscripts), is the work mentioned by Galen at the
beginning of On my own books as a forgery bearing his name. 30 Since Galen, towards the

25
E. Issel, ‘Quaestiones Sextinae et Galenianae’ (unpublished doctoral dissertation, University of
Marburg 1917). M. Frede, for example, in his speculative attempt to reconstruct the intellectual
evolution of the Empiricists as a school, assumes that the Sextus mentioned in the pseudo-Galenic
passage is Sextus Empiricus (‘The ancient Empiricists’, in id., Essays in ancient philosophy
(Oxford, 1987) 243-60 (252)).
26
Pace J. Jouanna, ‘Médecine et philosophie: sur la date de Sextus Empiricus et celle de Diogène
Laërce à la lumière du corpus galénique’, Revue des études grecques 122 (2009) 359-90.
27
D. K. House, ‘The life of Sextus Empiricus’, Classical Quarterly 30 (1980) 227-38.
28
Issel, ‘Quaestiones Sextinae et Galenianae’ (n.25, above) 5-15.
29
Galen, Loc.Aff. VIII.293-94 K.
30
Galen, Lib.Prop. XIX.8-9 K = 134 Boudon-Millot = 2.91-92 Müller.

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end of the second century, does mention a forgery circulating under his name and titled
‘Iatros’, the Physician, exactly like our pseudo-Galenic text, it is indeed plausible that we
are dealing with one and the same text – but that is not demonstrable, for all we know
about the forgery Galen is talking about, is that, according to the educated man who
unmasked the fake while browsing new books in the Sandalarium, the first few lines
differed from Galen’s authentic works in terms of style:
I was recently in the Sandalarium, the area of Rome with the largest concentration
of booksellers, where I witnessed a dispute as to whether a certain book for sale was
by me or someone else. The book was titled: Galen, The physician [Galênos Iatros].
Someone had bought the book under the impression that is was one of mine; some-
one else, a man of letters, struck by the odd form of the title, desired to know the
book’s subject. On reading the first two lines he immediately cast the book away,
only adding the following words: ‘This is not Galen’s style – this title is a fake’. 31
Jacques Jouanna, however, has recently argued in favour of an earlier date for the floruit
of Sextus than is commonly accepted: this, if proven, would indeed potentially postpone
the date of the pseudo-Galenic Introduction, assuming that the Sextus mentioned by
Pseudo-Galen is Sextus Empiricus. 32 His argument arises from a simple idea: Galen does
not cite Sextus Empiricus anywhere in his extant works, nor in the known titles of the
works that have not survived, although he wrote a lot on the Empiricist movement. Many
an Empiricist appears in Galen’s arguments, including some relatively recent ones, such
as Theodas – but not Sextus. According to Jacques Jouanna, this is a clue to Galen’s
ignorance of Sextus’s work and position. He infers from Galen’s silence that Sextus is
posterior to Galen. Since Galen is now thought to have lived up to c. 216 AD, the floruit
of Sextus, he says, has to be postponed to somewhere between 216 and 230 AD.
Subsequently, Pseudo-Galen has to be postponed after that floruit. 33 An additional
element could support Jouanna’s case for a late date: we cannot be certain that all chapters
of the treatise are the work of one and the same man, or rather, it is probably the work of a
man who used a variety of sources, some of which may be much older than others (and
than the treatise itself). In theory then, the material for Ch. 4 could be much older than the
hypothetical ‘compiler’ of the Introduction. 34
But I would argue that Sextus and Pseudo-Galen do not really shed any light on each
other’s dates: any attempt to establish relative chronology will be inconclusive as long as
no argument stronger than the old ‘e silentio’ one is available.

31
I have slightly altered the translation by P. Singer, Galen. Selected works (Oxford 1997) 3.
32
Jouanna, ‘Médecine et philosophie’ (n.26, above).
33
‘Si Sextus est postérieur à Galien parce que Galien ne le cite pas, il est logique d’en conclure que
le Pseudo-Galien, du fait qu’il cite Sextus, est postérieur non seulement à Sextus, mais a fortiori
aussi à Galien’; Jouanna, ‘Médecine et philosophie’ (n.26, above) 384.
34
I have argued in favour of a carefully selected, consistent material gathered by one man; the
contents and the language do not particularly hint at a late date. A terminus is provided by the early
Latin translation (of Chs 16-20), which in turn is difficult to locate on the face of our evidence, but
cannot be much later than the fifth century AD.

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An explicit pre-requisite in Jouanna’s otherwise plausible reasoning is that Galen

reflects with genuine intellectual accuracy the debates of his own time. Building on
Galen’s alleged reliability, fairness, and accuracy (three qualities which many specialists
of Galen would in fact deny him), Jacques Jouanna believes that Galen cannot have
simply omitted to mention Sextus if Sextus had been alive at the same time as him or
shortly before him. According to a statement regularly made by scholars, however,
‘arguments ex silentio are notoriously insidious’. 35 Just like Caelius Aurelianus, late in the
fifth century AD, does not mention Galen, while it is impossible that he did not know him,
Galen may well have omitted to mention Sextus for reasons that we may never know. 36
It may well be that Galen did not hear of Sextus’s reputation or that he simply did not
wish to give it credit. While we know almost everything about Galen’s life and career
through his own tales and stories, neither Sextus Empiricus nor his eventual disciples have
left any clue about the place he was born and the place(s) he taught: some suggest Athens,
some Alexandria or Rome. 37 His works did not live in a complete lack of appreciation. 38
But his celebrity may well have been limited. It is thus not implausible that Galen may not
have heard of him or have read his works, despite his wide travelling around the
Mediterranean and his extensive knowledge of the intellectual world he lived in.
Furthermore, although Galen was well acquainted with contemporary intellectual
controversies in his youth, thanks to his training with various masters, and still during his
first stay in Rome, later in life he became an established elite physician and retired to
personal study, keeping himself aloof from the fierce competition between Roman
doctors. The Galen of the early third century was perhaps not so keen on reading every
new work of philosophy or medicine that appeared in the Empire. Thus, while it may well
be the case that Galen did not know Sextus whereas Pseudo-Galen did, this does not prove
that Sextus is later than Galen.
Be that as it may, further difficulties have to be taken into account when making
assumptions about a Greek author citing or not citing others:
(1) Galen is not known for being particularly reliable regarding his adversaries’
doctrines. Whether we can rely on him even to mention certain authors is doubtful. 39

35
See H. von Staden, Herophilus (n.16, above) 66, 69, 149, 267, and 295. On a different (Galenic)
matter, V. Boudon-Millot, too, acknowledges that arguments ‘e silentio’ are not reliable per se (‘Le
De dignotione ex insomniis’ (n.7, above) 619).
36
About this, see P. J. van der Eijk, ‘Antiquarianism and criticism: forms and functions of medical
doxography in Methodism (Soranus, Caelius Aurelianus)’ in Ancient histories of medicine,
ed. P. J. van der Eijk (Leiden 1997) 416-19.
37
D. K. House, ‘The life of Sextus Empiricus’, Classical Quarterly 30 (1980) 227-38. Let me quote
his conclusion: ‘The evidence on Sextus’ life is sufficient to provide a basis for endless conjecture.
The present paper has attempted to show the one undeniable fact on Sextus’ life which is easily lost
in the maze of possibilities. Namely, it is necessary to suspend judgment on Sextus’ life in almost
every detail’ (238).
38
His works are deemed ‘kallista’ at D.L. 9.116 (Marcovich 708).
39
Galen was an excellent polemicist and argued fiercely and constantly against fellow doctors and
philosophers on virtually every topic: his polemical style seriously undermines whatever trust we
may have in his accounts of the doctrines of others. About Galen misrepresenting his adversaries

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(2) Accurate quoting in the modern sense was not part of ancient intellectual practice
anyway. 40
(3) Galen deals primarily with his (preferably illustrious) predecessors, not with
obscure or irritating contemporaries whose names are not worth mentioning. 41
Galen’s mention of contemporary practitioners or fellow intellectuals is often
anecdotal and rarely substantial. At any rate, portraying Galen (or indeed any ancient
author) as a consciously objective compiler, in the fashion of a modern historian of
philosophy, does not make much sense given what we know of intellectual appropriation
of ideas and texts in antiquity.
In such a context, and given how little we know about Sextus’s life, work and
popularity, I don’t see why it should be taken for granted that Galen would have
mentioned and/or quoted Sextus Empiricus whether or not he had been aware of him. The
simple fact that we cannot be certain that Pseudo-Galen’s Sextus is Sextus Empiricus
invalidates in my view any attempt to reconstruct a relative chronology here; and the
possibility, which cannot be ruled out, that the pseudo-Galenic Introduction might well be
the forgery mentioned by Galen himself in On my own books, as rightly stressed by Issel,
makes it likely that the treatise is contemporary of Galen’s works. Obviously, the
argument is a case of likeliness and probability, not a matter of demonstration. I therefore
think that meanwhile we should stick to Fridolf Kudlien’s cautious conclusion that the
argument ‘e silentio’ is invalid. 42
While he seems to know a great deal about the Empiricists, Pseudo-Galen provides
yet other precious insights in the history of medical schools, namely the Methodists and
the Pneumatists.

and predecessors, see for instance T. Tielemann, Galen and Chrysippus on the soul (Leiden 1996)
32. G. E. R. Lloyd conveniently summarizes our evidence about Galen’s polemical approach in
‘Galen and his contemporaries’, in The Cambridge companion to Galen, ed. R. J. Hankinson
(Cambridge 2008) 34-48 (40-41, with further literature). Moreover, the simple fact of not naming
one’s adversaries is a standard rhetorical strategy which many have highlighted in recent years. The
evidence for this is plethoric: see for instance most recently H. von Staden, ‘Staging the past,
staging oneself: Galen on Hellenistic exegetical traditions’, and T. Tielemann, ‘Galen and the Stoics
or: the art of not naming’ in Galen and the world of knowledge, eds C. Gill, T. Whitmarsh, and
J. Wilkins (Cambridge 2009) 132-56 and 282-99 (283 n.9) respectively.
40
Cf. J. Whittaker, ‘The value of indirect tradition in the establishment of Greek philosophical texts,
or the art of misquotation’ in Problems in editing Greek and Latin texts, ed. J. N. Grant (New York
1995) 63-95; G. E. R. Lloyd, ‘Galen and his contemporaries’ (n.39, above) 42.
41
For example, Galen regularly argues against the Empiricist school in his pharmacological works,
while in such arguments he almost always fails to mention any specific contemporary Empiricist:
rather, he tends to either mention past authorities or refer to Empiricists as a group in order to
contrast those with his own views. Among the Empiricists allegedly active in the second century AD
and appearing (sporadically) in his works are Theodas and Menodotus (the latter also mentioned in
the pseudo-Galenic Introduction).
42
See F. Kudlien, ‘Die Datierung des Sextus Empiricus und des Diogenes Laertius’, Rheinisches
Museum 106 (1963) 251-54.

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Defining Methodism?
After the Dogmatists (or Rationalists) and the Empiricists, the Methodists are the third
main school mentioned by Pseudo-Galen – and presumably the last, if the title of his
fourth chapter is to mean anything.
Chronology is at the heart of Pseudo-Galen’s concern (or his source’s): while the
Empiricists are desperately trying to prove that their school is the oldest one, by
promoting Acron of Acragas as the real founder of their science (4.2, XIV.683-84 K = pp.
9-10 Petit), the Methodists in turn owe a lot to the Rationalists: indeed, Asclepiades
inspired Themison of Laodicea who discovered the Methodist doctrine thanks to
Asclepiades’ theoretical (I presume) tools (4.3, XIV.684 K = p. 10 Petit). Although the
exact meaning of the participle ephodiastheis is open to discussion (what ‘provisions’ –
ephodia – Pseudo-Galen has in mind is uncertain), it is clear that the two remarks,
respectively about the antiquarian claims of the Empiricists and about the debt of the
Methodists to the Rationalists, are to be connected. Presumably, they reflect the author’s
views on the history of the medical schools: while the Rationalists are the truly oldest
school of all, and the natural heirs to Hippocrates (although we know that the Empiricists
wrote many commentaries on the works of the Coan, nothing of this is mentioned by
Pseudo-Galen), the Methodists themselves owe most of their originality to a Rationalist.
The fact that this Rationalist, Asclepiades of Bithynia, was a controversial figure among
the Rationalists (he was vilified by Galen), is however not mentioned here. Further on in
the text, some opinions are attributed to him without any polemical comment: above all,
the history of medicine as presented by Pseudo-Galen is an irenic one, with inter-school
polemics relegated to the distant past. Unlike Erasistratus, none of the Methodists is
openly criticized. It is likely that, while believing in the Rationalists’ propaganda, Pseudo-
Galen does not see the Methodists as a methodological problem, least of all as a threat. In
this respect, his tone contrasts sharply with that of Galen.
What does this mean for us modern historians? Does this help us in any way to situate
Pseudo-Galen in the intellectual landscape of the Roman Empire? The difference in tone
could hint at a chronological discrepancy between Galen and Pseudo-Galen; what was
irritating for Galen in the second century might not have been so for a later author, at a
time when Methodist ideas were better digested and a legitimate part of medical
discourse; for the Methodists remained popular throughout antiquity. But that is pure
speculation. In fact, the apparent indifference displayed in Pseudo-Galen’s discourse is in
great part due to the genre of the text. An introduction to medicine for beginners, the
Introduction, or the physician fits rather well within the constraints of books designed for
students. Written in clear, simple style, as requested in rhetorical handbooks as well as in
appreciative comments found in literature on similar texts, 43 the Introduction displays a
technique of presentation that reflects the ‘doxographical method’ outlined by

43
About the characteristics of simple style, cf. Ps-Aelius Aristides, On simple style, and
M. Patillon’s illuminating introduction to his Budé edition (Ps.-Aelius Aristides, Arts rhétoriques,
ed. and trans. M. Patillon (Paris 2002); see also the relevant paragraphs in Demetrius, On style
(Démétrios Du style, ed. and trans. P. Chiron (Paris 1993)).

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David T. Runia, for example. 44 Brevity and clarity are the key aims to be achieved in
writing such a text and they are achieved in the Introduction. 45
This neutrality in tone has proven useful for the popularity of the pseudo-Galenic
Introduction; early on the text was used as a source for those interested in the history of
Greek medicine, particularly the historical role of the medical schools. 46 Methodism
attracted considerable attention as early as the Renaissance: Prospero Alpini (De medicina
methodica, 1611) explicitly uses the Pseudo-Galenic material to contrast it with Galen’s
diatribes against the school of Thessalos. J. Pigeaud was thus right to emphasize the
significance of the Introduction in his seminal paper on the theoretical grounds of
Methodism. 47
The description of Methodist principles in Ch. 3 of the Introduction is considered the
most reliable account of the period (3.5-8, XIV.680-83 K = pp. 6-9 Petit); the chronology
of the formation and development of the school outlined in Ch. 4.3 (XIV.684 K = p. 10
Petit) is also a key text for our understanding of the history of their ideas. 48 As put in a
nutshell by D. Gourevitch, the Methodist school does not have one ‘father’ but three:
Asclepiades, Themison, and Thessalus. 49 In addition, Gourevitch rightly stresses that the
genesis of the Methodist doctrine was completed over a long period of time: while
Asclepiades and Themison lived in the first century BC and died around 40 BC at the
latest, Thessalos of Tralles died around 55 AD. This of course raises questions as to the
original trend of Methodist ideas and their radicalism, as well as to the exact development
of those ideas – and who, between Asclepiades and Themison, is responsible for which
aspect of the doctrine? To what extent did Themison improve on Asclepiades’ original
ideas? Following the Pseudo-Galen, it is to be assumed that the original doctrine was
rather radical in the medical landscape of the time: without summarizing the entire body
of principles provided in the Introduction, the very idea that, unlike the Rationalists, ‘they
need no semeiosis’ (3.5, XIV.680-83 K = 6-9 Petit) encapsulates a resolutely challenging
approach to traditional medicine. Whereas the followers of Hippocrates known as the
Rationalists would look for the hidden causes of a disease through the interpretation of

44
Cf. D. T. Runia’s introductory chapter titled ‘What is doxography?’ in Ancient histories of
medicine (n.36, above) 33-55. See also his collaboration with Mansfeld, Aëtiana (n.2, above).
45
See Petit, Introduction (n.5, above) notice I (xv-xxi).
46
The pseudo-Galenic material is to be found in many an influential text on ancient medicine:
Prospero Alpini, Daniel Leclerc and Charles Daremberg have drawn on the Introduction (see Petit,
Introduction (n.5, above) cxxvi-cxxxii).
47
J. Pigeaud, ‘Les fondements du méthodisme’, Les écoles médicales à Rome. Actes du 2e colloque
international sur les textes médicaux latins, Lausanne 1986, ed. Ph. Mudry and J. Pigeaud (Geneva
1991) 8-50. Reprint in J. Pigeaud, Poétiques du corps. Aux origines de la médecine (Paris 2008)
199-245.
48
An English translation of these passages (and in fact of many pages of Chs 1-8) is available in
vol. I of Manuela Tecusan’s Fragments of the Methodists. Methodism outside Soranus (Leiden
2004). As I tend to depart on a number of points from her translation based on Kühn’s text, I found
it easier to provide my own translations in this article.
49
Soranos d’Éphèse, Maladies des femmes, eds, trans, comm. P. Burguière, D. Gourevitch, and
Y. Malinas, 4 vols (Paris 1988-2000) I, Introduction.

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signs (semeiosis), using the whole history of medical cases known to date, the Methodists,
on the contrary, rely on immediate observation and infer the treatment directly from the
conspicuous signs of the ailment (endeixis).
This core principle of the Methodist doctrine confirms, to some extent, the reasons
why Galen was so virulent against the Methodists, who appeared as cheaply trained
doctors who did not need any background in the history of medicine, and particularly did
not need to read Hippocrates or any of the other ‘ancients’. Methodism could be seen as a
threat (at least a sort of methodological scandal) for highly educated practitioners such as
Galen. As we have seen, however, Pseudo-Galen doesn’t convey the impression of an
invasive, dangerous, and revolutionary change in method and practice. Rather, Methodist
ideas are unproblematically integrated with Empiricist, Dogmatist and Pneumatist ideas.
They seem widely accepted and recognised in medical practice – and we know from
Galen himself that their brand of medicine was popular in Rome.
Generic style constraints may not be the only possible explanation for this; traces of
Methodist concepts do appear in the later chapters of the Introduction. We find several
mentions (13.7-8, XIV.731-32 K = pp. 49-50 Petit, and 20.4, XIV.793 K = p. 101 Petit) of
the famous ‘diatritos’, the period of forty-eight hours during which the methodists simply
observe the development of the disease and do not feed the patient. 50 Two allusions
appear in Ch. 13 (diseases and their treatment) and one in Ch. 20 (bone surgery). This
shows that the possible variety of sources used in the Introduction does not lead to any
incoherence in the medical views presented; quite the contrary. Similar ideas, such as the
importance of diatritos, seem to pervade different accounts of therapeutics, from the
general principles of treatment exposed in Ch. 13.7-8 to the preparation for bandaging a
wound. If this is not sufficient to label Pseudo-Galen a ‘Methodist’, it certainly hints at a
form of medical syncretism at the time when the Introduction was composed. Even if the
method could not satisfy all physicians for reasons of logic or tradition, and provoked
bitter criticisms from such elite doctors as Galen, some practical aspects of the doctrine
were incorporated into Roman medicine, and thus appear in manuals such as the Pseudo-
Galenic Introduction. 51

50
About the diatritos, see now D. Leith, ‘The diatritus and therapy in Graeco-Roman Medicine’,
Classical Quarterly 58 (2008) 581-600 (further literature there). Leith rightly emphasizes the
flexibility and attractiveness of the diatritos as a framework for practitioners of all allegiances and
well outside Methodism in the strict sense; he also rightly suspected (as the manuscripts now make
evident), at the time of writing his article, that Kühn’s text of the Introductio sive medicus might
well hide some explicit mentions of the diatritos, obscured by a faulty textual transmission (see
p. 597 of his article and n.45, although he does not mention the last occurrence of the diatritos in the
final chapter on surgery).
51
On the issue of Methodism in the Introduction, I should add that, in an article I did not know
about when writing up my doctoral thesis (‘Zu den AITOLOGOUMENA des Soran’, Hermes 36
(1901) 145-46), Max Wellmann argues, somewhat inconclusively, that several passages in this tract
derive from Soranus, the famous Methodist. See Mansfeld and Runia, Aëtiana (n.2, above) III 129,
n.16.

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Methodists, Eclectics, and Episyntheticists

As shown by the relatively long enumeration at the end of Ch. 4, however, Methodism as
a school was anything but unanimous. If the contents of the early Methodist doctrine are a
subject of scholarly debate, so should be the nature of imperial Methodism: we barely
know the names (provided by Galen and Pseudo-Galen) of some of Themison’s pupils,
such as Proclus, but finally Pseudo-Galen explicitly mentions ‘dissensions’ among them,
on the part of Olympicus, Menemachus, and Soranus. The first two, mentioned and
mocked by Galen while Pseudo-Galen is silent on the exact nature of their concerns
regarding the official line of Methodism, will not tell us much. Soranus, however, is a
major figure of imperial medicine recognized and respected even by Galen. But what is
even more interesting than Soranus’s independence of mind (which will appear to any of
his readers) is the last sentence:
There were also some Episyntheticists, such as Leonides of Alexandria, and some
Eclectics, such as Archigenes of Apamea in Syria.
The heading and the structure of the chapter indicate that we are to understand these
‘Episyntheticists’ and ‘Eclectics’ as Methodists of a (late?) kind; both school names
suggest a tendency to epitomize and comprehend various ideas or doctrines. Thus, more
than Methodist ‘dissidents’, Episyntheticists and Eclectics were probably drawing on
other ideas of the time, which they may have incorporated into the Methodist core of
knowledge. Naturally, the relationship (if any) between Methodism and Eclectics and
Episyntheticists is a problem for us, as it is not attested in our other sources.
The nature of such additions or alterations in the Methodist doctrine is not easy to
determine. We know little of Leonides of Alexandria, except for the fact that he was a
renowned ophthalmologist of the late first century AD – Caelius Aurelianus, who likewise
refers to him as ‘episyntheticus’, also mentions a few opinions of his without giving much
detail as to what this ‘Episynthetical’ affiliation means. 52 The Greek epi-suntithenai
suggests the idea of combining elements with additional features – hence pointing to a
combination of Methodist core ideas with additional material from other schools, for
example from the Empiricists or the Rationalists. This interpretation can be refined if we
look at the next school label – for what could then help distinguish between
‘Episyntheticists’ and ‘Eclectics’? The meaning of the latter, although more familiar
because of its persistence in modern languages, is not particularly well documented as to
its significance in ancient medicine.
While Leonides or Leonidas (both spellings are found in the texts) is little known to
us, Archigenes of Apamea of Syria is much more familiar to readers of ancient physicians.
Galen’s On the affected parts makes frequent mention of Archigenes, since Galen’s
starting point in this work is the latter’s misleading (!) terminology and confusing account
of the topic at hand. Yet Galen sees Archigenes as the author of many important books,
and he is one of the best-known pneumatists for whom we have preserved fragments and
opinions. The author of the Introduction is perfectly aware of his Pneumatist views, as is
clear at Ch. 9.6 (XIV.698-99 K = pp. 21-22 Petit):

52
Caelius Aurelianus, Acute diseases II.7 (n.21, above) 124.

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… and finally those around Athenaeus and Archigenes have stated that natural
elements are constituted and organised through the pneuma alone, which
permeates them, and that all diseases arise from its primary affection.
The mention of Archigenes under the label ‘Eclectic’ at 4.3 (XIV.684 K = p. 10 Petit)
followed at 9.6 (XIV.698-99 K = pp. 21-22 Petit) by a sentence where he is associated
with Athenaeus (another famous Pneumatist) and strongly committed to pneumatist
views, suggests that the ‘Eclectics’ were to some extent inspired by Pneumatism 53 .
More importantly, our other sources on these schools, rare though they are, invite us
to compare closely the ‘Episyntheticists’ and the ‘Eclectics’: indeed, for another Pseudo-
Galen, the author of the Definitiones Medicae, ‘episynthetikê’, and ‘eklektikê’ are but two
names for the same school (XIX.353 K):
The first two medical schools are the Empiricist and the Rationalist; the third one
is the Methodist, but Agathinus of Lakedaimon seems to have discovered a fourth
one, which he called ‘Episyntheticist’, and some ‘Eclectic’, and yet others
‘Hectic’.
While the distinction between ‘Episyntheticist’ and ‘Eclectic’ is a purely formal one for
the author of the Medical definitions, a text that is considered somewhat earlier than
Galen, 54 the third label, ‘Hectic’ is a hint at Pneumatism and Stoicism. Indeed, the
‘pneuma hektikon’ is a core concept of the Pneumatists, which can easily be traced in
Stoic texts. Though the exact meaning of the noun hexis is sometimes difficult to pin
down, as it has shifted from the philosophical to the medical context, the pneuma hektikon
(which holds together even inanimate bodies, such as stones) is a fairly straightforward
notion that supplements the other two crucial pneumata, the zootikon (of animals) and the
phytikon (of plants). The pseudo-Galenic Introduction is particularly clear on this matter
(9.2, XIV.696-97 K = p. 20 Petit; 13.1 and 3, XIV.726 and 727-28 K = pp. 45 and 46
Petit).
In order to confuse us a bit more, Agathinus of Lakedaimon is said to have been
Archigenes’ master. Might thus Archigenes have created the ‘Eclectic’ school after
Agathinus’s teaching in the ‘Episyntheticist’ school? Or is it all a matter of wording, and
do Agathinus and Archigenes simply belong to the same movement? In other words,
should we reject Pseudo-Galen’s distinction here between the two school labels and,
instead believe another Pseudo-Galen, the author of the Medical definitions, who claims
that episynthetikos, eklektikos, and hektikos are very close denominations of the same
Stoic-inspired movement in medicine? At any rate, a comparison between the two pseudo-
Galenic works suggests that the ‘Episyntheticists’ and ‘Eclectics’ are not to be identified
as some of the ‘dissidents’ of the Methodist school that the Introduction mentions earlier
in Ch. 4 – an interpretation I once considered possible.

53
There is further evidence for the connection between Eclectics and Pneumatism; see for example
von Staden, Herophilus (n.16, above) 106-08.
54
Kollesch, Untersuchungen zu den pseudogalenischen ‘Definitiones medicae’ (n.10, above) 33.

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Medicine, the Stoics, and the pneuma

It is now clear that the problematic connections between Pseudo-Galen and the medical
schools of his time tie in with more general questions about the fate of the same schools:
the Methodists are not the only group to be misused by Galen, or about which our sources
are both scanty and contradictory. Pneumatism is another intellectual movement in
medicine whose origins, purpose and influence deserve extensive investigation. Max
Wellmann produced a considerable volume about the Pneumatists at the end of the
nineteenth century, but most of his conclusions should now be revised in the light of new
evidence and of more recent research. 55
How did the Pneumatist school emerge, and how exactly does it relate with the
Rationalists? Many highly regarded physicians were labelled ‘Pneumatists’, but little or
nothing of their works has survived. As a result, Galen’s scarce accounts of their doctrine
and the methods of Quellenforschung have long been the main sources for our
understanding of Pneumatism. 56
It is not even certain that the Pneumatists ever constituted a ‘school’ in the full sense
– it might be more adequate to talk of a Pneumatist ‘movement’.57
On the grounds of part of the evidence, and guided by methodological principles of
his time, Wellmann (followed by Issel) argued that the pseudo-Galenic Introduction was
probably written by a Pneumatist. 58 This is in fact not so likely, as it is not even certain
that Pseudo-Galen drew on one and the same body of knowledge. Rather, he probably
used various sources and ideas, devising a coherent account on a number of medical
subjects. 59 More interesting, perhaps, than the unanswerable question of whether Pseudo-
Galen was a Pneumatist is what the text tells us about Pneumatism. This seems a more
stimulating track to explore, especially if we compare the Introduction with other works,
particularly Galen’s.
There is some evidence of Pneumatist doctrine in the Introduction. As already
suggested earlier, many ideas connected with the pneuma and the living harmony devised
by the Stoics appear in the Introduction in different areas of the text (dealing with either
theory or practice). Let us go back to the sentence quoted earlier:

55
M. Wellmann, Die pneumatische Schule bis auf Archigenes (Berlin 1895).
56
One must add Aretaeus of Cappadocia and Pseudo-Galen’s Definitiones Medicae, and later
sources such as Oribasius and Aetius of Amida.
57
Cf. Nutton, Ancient medicine (n.20, above) 206: ‘the fluidity of Pneumatist doctrines and the
obvious tendency towards eclecticism manifested, among others, by Agathinus and Archigenes
place difficulties in the way of any clear estimate of the extent and influence of Pneumatism. Indeed,
one may have considerable doubts about its very existence as a sect in any strong sense of the
word.’ Nutton adds an explanatory note to this passage (n.30): ‘Pneumatism could, on this
argument, be merely an ahistorical, classificatory term’.
58
Wellmann, Die pneumatische Schule (n.55, above) 15; see also Issel, ‘Quaestiones Sextinae et
Galenianae’ (n.25, above) 47-52.
59
See Petit, Introduction (n.5, above) notice V (especially lxv-lxvii).

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Finally, those around Athenaeus and Archigenes have stated that natural elements
are constituted from the pneuma that permeates them alone, and that all diseases
derive from the primary affection of it; that is why they take the name of
‘Pneumatists’. 60
This is no affirmation of belief in the truthfulness of the Pneumatist doctrine, but a mere
acknowledgement of the pneumatist ideas; besides, if the author were a Pneumatist, how
come that Ch. 4 does not refer to Pneumatism as a main or the key sect of his time? Some
elements scattered in the text nevertheless show the role ascribed to the pneuma in its
various forms in the physiology presented by Pseudo-Galen (XIV.696-97 K = 9.2-3 and 5-
6; 13.1 Petit), particularly about vision (XIV.701-02 K = 10.4 Petit, and XIV. 710-11 K =
11.3 Petit) and in the aetiology of several diseases in the text, for example about some eye
diseases (XIV.752 K = 13.36 Petit). The problem of excessive tension or relaxation of
pneuma also appears at XIV.728-29 K = 13.4 Petit as a general cause of disease (or rather
as a consequence of the real cause of diseases, the change in the environment).
As is well established, the roots of Pneumatism in medicine are most likely to be
found in Stoicism: the role of the pneuma as a life-force pervading all things and living
beings, from stones and plants to animals, including man, is central in Stoic physiologia as
well as in the Pneumatist doctrine. The role of Stoicism in medical discourse on
physiology and in the causes of diseases is therefore vital, as acknowledged by Pseudo-
Galen. But we do not have a good understanding of how the Stoics relate to Pneumatism;
Pseudo-Galen notes that Athenaeus has been inspired by the Stoics’ views, but the rest of
the story is not known. 61 The core principle at the heart of the Pneumatists’ doctrine is the
pneuma: the ‘vital breath’ that permeates every living body can be affected in various
ways such as tension, distension, weakening, etc. Such transformations of the pneuma, in
turn, explain the genesis of numerous diseases and induce their treatment: how to
strengthen or restore the pneuma is the aim of the Pneumatist physician.
It could be argued that the roots of the doctrine lie, not only in Stoicism as already
explained but also, to some extent, in the Hippocratic legacy. An obvious example of a
stoicizing text ascribed to Hippocrates is the treatise On aliment (de Alimento). Here more
precisely my interest lies in the later interpretations of some Hippocratic writings. 62 The
reception of an aphorism at Epid. VI.8.7 (Manetti-Roselli 170) displays evidence of
common opinions, expressed in Galen’s time and beyond, about the meaning of ta
enhormônta as some sort of abstract equivalent of ta pneumata. The text reads as follows:
Τὰ ἴσχοντα, ἢ ἐνορμῶντα, ἢ ἐνισχόμενα.
Bodies that restrain or stimulate, or are restrained. 63

60
See above p. 276 n.22.
61
Pseudo-Galen, [Int.] XIV.698 K = 9.5 Petit.
62
See Pseudo-Galen, [Int.] XIV.696-97 K = 9.2 Petit. I have analysed the evidence in n.5 to my
translation of the passage, but did not broach this topic in my articles (n.14, above) on the presence
of Hippocrates in the text.
63
I am quoting the text in Ippocrate. Epidemie libro sesto, ed. and trans. with intro. and comm. by
D. Manetti and A. Roselli (Florence 1982). The translation is the one available in the Loeb edition

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It is likely that this brief Hippocratic sentence was interpreted with a Stoic twist (hormê,
in Stoic philosophy, is the moving faculty of the soul); but the pneumatists may well be
responsible for the widespread tendency to ‘stoicize’ the doctrine in the Roman period.
For not only Galen and Pseudo-Galen, but also Alexander of Aphrodisias, Palladius,
Stephen of Athens, and Stephen of Alexandria agreed on the fact that the Hippocratic
phrase ta enhormônta acknowledged the living force of the pneumata. The
correspondence between Pseudo-Galen’s paragraph 9.2 and Galen’s repeated analysis of
the same aphorism 64 is striking; the rest of the tradition makes it all the stronger.
This brings us back to the relatively unresearched enigma of the Pneumatists’
contribution to Galen’s oeuvre. As suggested by R. Flemming, there is more there than
one should expect from Galen’s acknowledged influences. 65 But that would be the subject
of another paper.

Conclusion
As a conclusion I shall attempt to answer at least partially some of the questions posed in
this paper.
1) What if anything can we learn about the identity of the author of the Introduction from
its doxographical contents?
Despite the famous names sprinkled liberally throughout the text, it is difficult to go
beyond or even as far as Emil Issel’s conclusions in 1917: neither Sextus Empiricus nor
any other leading authority support postponing Pseudo-Galen to the period after Galen’s
death (at the latest around 216 AD). Equally, this hypothesis cannot be ruled out. While it
is highly tempting to identify our ‘Iatros’, the real title of the Introduction according to the
Greek manuscripts, with the fake ‘Iatros’ ascribed to Galen in his own lifetime, as
recorded in his On my own books, no further evidence (either of style or contents) can
support such claims beyond the title of the work itself. The only terminus for locating the
Introduction in time is the late antique Latin translation (unknown to Issel) that was made
of (at least) the four last chapters, on eye diseases and surgery. This translation could be of
the fifth or sixth century, but it is not possible to establish a more precise date for its
completion: once again, our evidence is not sufficient, as we rely mainly on one
manuscript of the ninth century in very poor Latin.

by W. D. Smith, vol. VII (Cambridge, Mass. and London 1994) 281. The text is slightly different
(Loeb has an additional σώματα; and no prefix on the second participle).
64
See Galen, Diff.Feb. VII.278 K and Trem.Palp. VII.597 K.
65
See R. Flemming, in Galen and the world of knowledge (n.39, above) 59-84. Studying the
demiurge figure in Galen’s works on providence, Flemming suggests that Galen gathered much of
his Stoic, ‘providential’ views from those who had already successfully ‘imported’ Stoicism into
medicine: the Pneumatists. With the exception of Flemming’s analysis, ‘Pneumatism’ and the
Pneumatists are remarkably absent or discrete in the volume on Galen and the world of knowledge
(n.39, above) and from other recent collective volumes. Nevertheless, see C. Gill, Naturalistic
psychology in Galen and Stoicism (Oxford 2010) esp. 155-59 about the status of the pneuma in
Galen’s thought in the light of Stoicism; see also L. G. Wilson, ‘Erasistratus, Galen, and the
pneuma’, in Bulletin of the History of Medicine 33-34 (1959) 293-314.

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The possible connections between the author of the Introduction and the schools of his
(hypothetic) time hint at something like a Rationalist doctrine, but with no clear allegiance to
any school. Some clues scattered throughout the text seem to converge towards an eclectic
mix of Hippocratic, Pneumatist, and Methodist views. This may or may not coincide with
what Pseudo-Galen himself calls ‘eclectic’, in a context where the boundaries between
medical schools are more fluid and problematic than usually assumed.

2) What does Pseudo-Galen tell us that Galen does not?

Pseudo-Galen does provide us with some useful information on the chronology of medical
schools and the succession of their leaders (or dissidents). Constant reference in scholarship
to Ch. 4 and some other passages shows how significant this testimony is to the history of
Greek thought: and while Pseudo-Galen seems to refer to Sextus Empiricus as a significant
figure in the history of medicine, at least for the Empiricists, Galen does not. As shown by
the example of the Hippocratic material, however, historians would be better advised to deal
with it cautiously, for the text is not without obvious (and at times presumably less obvious)
simplifications. The doxographical material, in particular, is too schematic to be perfectly
accurate: the views of paired authorities like ‘Erasistratus and Asclepiades’ or ‘Athenaeus
and Archigenes’ in Ch. 9 are too conveniently organized and summarized to reflect the
complexity of each individual’s thought. Besides, the intellectual context is too broad to
reflect any genuine ideological identity – in other words, it is difficult to label the author as
‘Pneumatist’, or ‘Eclectic’, or anything specific. In this context, all the passages mentioning
‘corpuscules’ (onkoi), the ‘vital breath’ (pneuma), or the four humours only help to obscure
the potential ‘school identity’ of the author, and it is, in my view, rash to label the author a
‘Pneumatist’ (pace Wellmann) or indeed anything else: his own insistence on the complex
and, ultimately, hybrid beliefs of the latest schools he mentions in Ch. 4 make us cautious
here.
Rather than merely providing us with bits of positive information, then, I should say
that Pseudo-Galen’s main merit is to draw attention to the problematic nature and
connections of the medical teaching and doctrines of the Roman Empire. Reading Pseudo-
Galen, Pneumatism suddenly becomes a very interesting movement, at the crossroads of
Stoicism in philosophy and Methodism in medicine, with ramifications into – possibly –
several schools of medicine of the Roman Empire.
Besides, reading Galen between the lines tends to confirm that the boundaries
between the official schools, such as Rationalists and Empiricists, are not as clear as we
might hope. 66 The obvious doctrinal blurring between medical schools of Galen’s (and
Pseudo-Galen’s) time is an invitation to reconsider much of the early twentieth century
approach to Hellenistic and Roman medicine, namely that of Wellmann and his peers, in
spite of all their important contributions.

66
See Frede’s analyses about the significance of empiricism in Galen’s thought – and hence, in
medical practice among the Rationalists: M. Frede, ‘The Ancient Empiricists’; ‘On Galen’s
Epistemology’, all in M. Frede, Essays in Ancient Philosophy (Oxford 1987) 243-60 and 279-98
respectively.

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3) Can we extend such conclusions to the pseudo-Galenica as a whole?

As indicated at the beginning of this article, the pseudo-Galenica are diverse texts, written
by different authors in a wide range of periods, from the first century AD to the sixteenth
century and perhaps later. This can lead to misunderstandings: the pseudo-Galenic de
Optima Secta, for example, is often taken as a reliable source for the study of the
Methodists and of other medical schools, even though it is a Renaissance forgery. 67
The questions surrounding the genesis, significance, and fate of the Pseudo-Galenic
texts, just like those of Galen’s, bring us back to the basic issue of textual transmission.
Consideration of this issue will lead to a better (if not entirely satisfying) understanding of
these books. These texts are not by Galen, yet neither are they anti-Galenic: they support
and confirm much of what we consider as ‘Galenic’ information on medical schools and
their leading figures. The gaps and apparent inconsistencies between Galen and the
Pseudo-Galenic works stand in need of further research, research that will require
studying each pseudo-Galenic work individually.

A list of names in Pseudo-Galen (excluding gods and mythological characters)

Athenaeus of Attalia Leonides of Alexandria
Acron of Acragas Menemachus of Aphrodisias
Antipater Menodotus
Apollonius (father and son) of Antiochus Mnaseas
Apollonius of Memphis Mnesitheus
Aristoteles Olympicus of Milesus
Archigenes of Apamea Philinus of Cos
Asclepiades of Bithynia Plato
Bissinus Praxagoras
Ctesiphon Proclus
Diocles of Carystos Serapion of Alexandria
Dionysius Sextus
Erasistratus Soranus of Ephesus
Herodotus (hist.) The Stoics
Herophilus of Chalcedon Themison of Laodicea
Hippocrates Thessalus of Tralles
Homer Xenophon

67
See M. Tecusan in her edition of the fragments of the Methodists (n.48, above) 692-744. Among a
number of misunderstandings about the Pseudo-Galenic material: L. H.Toledo-Pereyra, ‘Galen’s
contribution to surgery’, Journal of the History of Medicine and Allied Sciences 28 (1973) 357-75
(using the Introduction, or the physician as his main source for Galen’s surgery!); S. Hübner, in her
otherwise excellent article on clitoridectomy in Egypt, quotes the pseudo-Galenic Introduction to
support her (mistaken) claim that Galen was aware of clitoridectomy in Egypt: ‘Female
circumcision as a rite de passage in Egypt – continuity through the millennia?’, Journal of Egyptian
History 2 (2009) 149-71.

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