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Abstract
Alcmaeon, a philosopher-cum-doctor from Croton, offers the earliest known definition of health and disease. The aim of this paper is to examine the formulation of his medical theory in terms of political organization, namely the polarity between one-man rule (monarchia) and egalitarianism (isonomia), by taking into account contemporary philosophical and medical texts, as well as the historical context. The paper is divided into four sections. I first overview the compendium in which this medical theory is reported, trace the doxographical layers, and analyse the terminology employed (I). I then focus on the key aspects of this medical theory, including the constitution of the body, the interaction of opposites, and the aetiology of disease (II). I suggest that Alcmaeon's notion of equality can be understood in various ways, and discuss the possible interpretations in the light of early Greek philosophy and medicine. The most likely interpretations are that there exists a kind of equilibrium between pairs of opposites, in addition to the equilibrium reached within each of them, and that the bodily constituents remain in a state of permanent equilibrium (III). Finally, I argue that Alcmaeon has in mind an egalitarian model of distribution of shares to the bodily constituents, which are depicted as the citizens of a tiny state whose antagonistic or collaborative tendencies affect its functioning (IV).
Notes
1This paper was presented at seminars in Humboldt – Universität zu Berlin and University College London. I am grateful to all participants for their suggestions, as well as Chloe Balla, Geoffrey Lloyd, Anna Marmodoro, Malcolm Schofield, David Sedley, James Warren, and the anonymous referees of the BJHP who commented on the earlier versions of this paper. Its completion was possible, thanks to the generous support of the research programme ‘Medicine of the Mind – Philosophy of the Body: Discourses of Health and Well-Being in the Ancient World’ which is funded by the Alexander von Humboldt Foundation and is directed by Philip van der Eijk.
2Lloyd, Polarity and Analogy, 210–303. Presocratic testimonies (A) and fragments (B) are quoted from the handbook of Diels and Kranz.
3There are several controversies concerning Alcmaeon: whether he is a member of the Pythagorean sect or not; when he was active; whether he is a ‘natural philosopher’ or a doctor. I cannot examine these vexed issues here, but it may be useful to summarize my position. The extant sources indicate that Alcmaeon was familiar with some Pythagorean doctrines, but it is clear that he put forward his own system and that most ancient reporters did not present Alcmaeon as a Pythagorean. The sole chronological indication, which is probably an interpolation in the Metaphysics (DK 24 A3), suggests that he was born or flourished when Pythagoras was old. It is reported that Pythagoras arrived at Croton around 531 when he was forty (Arist. fr. 16 Wehrli), and so Alcmaeon was born or flourished around 510. He might have written his treatise at any time between the ages of thirty and seventy, but it is reasonable to assume that it was composed at a late stage of his career. Although most ancient reporters present him as a ‘natural philosopher’ or an author of a treatise On Nature, his deep interest in the functioning of plants, animals and humans indicates the considerable overlap and continuous interaction between philosophy and medicine in early Greek thought. In this respect, he can be compared to Hippo and Diogenes of Apollonia who contributed to both intellectual fields.
4Diels, Doxographi Graeci. A critical assessment of Diels's reconstruction of the doxographical tradition can be found in Mansfeld and Runia, Aëtiana I.
5Aët. V.30.1. The text printed above is based on Runia (‘The placita Ascribed to Doctors’, 245–50). It was first reconstructed by Diels (Doxographi Graeci, 442–3) in the light of a group of kindred texts which draw from the Placita, and a slightly different version was printed in the B-section of Die Fragmente der Vorsokratiker. The witnesses to the Αlcmaeon lemma are the following: (i) ps.-Plutarch who quotes an epitomized version of the text in the Opinions of the Philosophers 911a; (ii) Stobaeus who divides the text in two sections found in the Selections ΙV.36.29 and ΙV.37.2; (iii) Qustā Ibn Lūqā, a translator of ps.-Plutarch's treatise into Arabic who offers a different version from the extant Greek text (Daiber, Aetius Arabus, 246–7; cf. Mansfeld and Runia, Aëtiana I, 157); (iv) Michael Psellus who is based on ps.-Plutarch and cites the text in an extract entitled ‘Explanations to various questions’ and in the On Omnifarious Doctrines 117.
6The structure of the chapter suggests that Alcmaeon is ‘an archegete, a sort of Thales of medicine’, but this interpretation is probably based on a strand in the doxographical tradition (Mansfeld, ’The Body Politic’, 93). Alcmaeon's medical theory is not included in the extant part of the doxography on the aetiology of disease preserved in the Anonymus Londiniensis, which mostly draws from the Iatrika of Meno, Aristotle's disciple, and records the doctrines of twenty doctors and philosophers of the fifth and fourth centuries BC (Anon. Lond. IV.18-XXI.9).
7Diels, Doxographi Graeci, 31. Cf. the formulation of two lemmata dealing with the division of causes: Aët. Ι.11.2 and I.11.4.
8Cf. Diels, Doxographi Graeci, 223–4; Zhmud, Pythagoras and the Early Pythagoreans, 357–8; Mansfeld, ‘The Body Politic’, 79. On the Stoic division of causes into ‘initiating’, ‘sustaining’ and ‘auxiliary’ see SVF II.346, 351–2, but the source authors attribute various typologies of causes to the Stoics (Hankinson, Cause and Explanation in Ancient Greek Thought, 238–52). According to Galen, the Stoics were the first to speak about the ‘sustaining’ cause (SVF II.356 = Gal. Syn. Puls. IX.458), namely the breath which consists of the active elements, fire and air, and holds all things together (Gal. CC 1.1–3). The doctor Athenaeus, who was influenced by the Stoics, suggests that the ‘sustaining’ cause of disease is the excessive elemental changes of the breath (Gal. CC 2.1–4).
9Cf. Ostwald, Nomos and the Beginnings, 99–100; Jouanna, Hippocrate, 460; Sassi, ‘Ordre cosmique et isonomia’, 198. However, Mansfeld (‘The Body Politic’) has recently challenged the Alcmaeonian origins of the two terms by arguing that they were inserted to the Alcmaeon lemma by a doxographer who was influenced by the debate regarding the best constitution in Herodotus' Histories, the earliest known text in which these terms are sharply opposed to each other, and thus reformulated the definition of health and disease. There are several objections to this interpretation. First, Alcmaeon could not have invoked a polarity which was unfamiliar to his contemporaries to illustrate the functioning of the body. The polarity between one-man rule and egalitarianism was a salient feature of the political history of Magna Graecia, as argued below (cf. n. 11–12). Second, Alcmaeon often draws analogies between microcosmic processes and visible phenomena in order to illustrate the structure and functioning of the former. For example, the eternal movement of the soul is patterned on the perfect orbits of the celestial bodies (DK 24 A12) and the absorptive capacity of the embryo is likened to a sponge (DK 24 A17). A political analogy may well be part of his project, inasmuch as this was common in early Greek thought (cf. n. 2). Third, the various doxographers who shape the Placita in its extant form occasionally preserve verbatim quotations, especially when they record paradoxical ideas (e.g. Aët. I.3.4, II.20.1, III.10.2). As far as Alcmaeon is concerned, a lemma dealing with the sterility of mules contains the bizarre terms thorēs and anachaskein (DK 24 B3) which go back to Alcmaeon (Mansfeld and Runia, Aëtiana II, 214).
10On the limited use of the term nomos and its derivatives in early Greek philosophy see Gagarin, ‘Greek Law and the Presocratics’. Although Anaximander (DK 12 B1) uses an analogy that invokes the regularity of legal procedure and is formulated in the terminology of civic laws (Sassi, ‘Anassimandro e la scrittura della “legge” cosmica’), he makes no explicit reference to the existence of natural laws. Encroachments and retributions take place ‘in accordance with the ordinance of time’, which is either a personified force that restores balance in the long run or a poetical way of talking about an established pattern of behaviour inherent in cosmic opposites. Likewise, Heraclitus (DK 22 B114) and Empedocles (DK 31 B135) mention a kind of universal law, but offer no clues as to whether it regulates the workings of the cosmos and how it is connected with other directing forces. An exception is the statement ‘all things are governed by law’ (Genit. 1) which is found at the very beginning of a Hippocratic treatise dealing with the production and origin of sperm. However, it is clear that the author of On Generation uses a stock phrase to attract the attention of his readers and refers to mechanical necessity in order to explain a series of microcosmic processes (Lonie, The Hippocratic Treatises, 103–4).
11Robinson, The First Democracies, 73–80, 120–2. Robinson (The First Democracies, 126) summarizes the salient features of early democracies as follows: ‘These include mechanisms for the control of magistrates, low or nonexistent property qualifications, a representative council, and active popular participation in juries and legislative bodies'.
12A survey of the political history of each polis can be found in Fischer-Hansen, Nielsen, and Ampolo, ‘Italia and Kampania’.
13The use of concepts which bear political connotations, especially those of rule, strife and harmony, in a medical context is sufficiently documented. The author of On Breaths, for instance, believes that air is the lord of all beings (Flat. 3), and attempts to show that all diseases occur from it. While this image is patterned on monarchical and tyrannical constitutions, Menecrates of Syracuse argues that the body consists of two hot (blood and bile) and two cold (breath and phlegm) elements conceptualized as opposing factions. When they are not striving against each other and are mildly mixed (Anon. Lond. XIX.27), a human is healthy. An example of how harmony is achieved can be found in the author On Airs, Waters, Places who describes the temperate climate as the enforcement of the egalitarian norms in the seasonal cycle (Aër. 12). Cf. Cambiano, ‘Patologia e metafora politica’.
14For an approximate dating of each treatise, see Jouanna, Hippocrate, 527–63.
15Some examples include: phlegm and bile (Aff. 1); hot and cold (Carn. 2–3); fire and water (Vict. I.3); phlegm, blood, bile and water (Genit. 3); phlegm, blood, yellow bile and black bile (Nat. Hom. 4–7); a vast number of humours (VM 14). An exception to these pluralistic doctrines is the claim that all diseases are caused by the agency of air (Flat. 2–5).
16On these pairs of opposites, see Lloyd, ‘The Hot and the Cold’.
17Aristotle points out that it is unclear whether Alcmaeon's doctrine of opposites influenced a particular group of Pythagoreans or was based on their system, and then notes a significant difference in their method. Alcmaeon made extensive use of opposites, but, in contrast to these Pythagoreans who reduced the number of opposites to ten pairs, he picked some random examples to illustrate the polarities displayed in the human sphere.
18Ostwald, Nomos and the Beginnings, 101. The explanatory gloss ‘for the predominance of either power is destructive’ supports such an interpretation, but it should be credited to a doxographer rather than Alcmaeon himself. Cf. Mansfeld, ‘The Body Politic’, 79, n. 9.
19The idea that a single bodily constituent or pair of opposites plays the most significant role in the body is a key feature of several Hippocratic treatises. Τhe author of On Ancient Medicine, for instance, attacks those who reduce the primary cause of disease to the four main opposites (VM 1). Although there is no consensus among scholars regarding the identity of his opponents, it is clear that, in his view, several medical authors lay special weight to the effects of certain bodily constituents, thus depicting the body as a system whose members are ranked according to authority. Rather, he argues that hot and cold are the least powerful of the humours which comprise the body (VM 16–9). Cf. Schiefsky, Hippocrates, 55–62.
20It should be noted that the reading ‘heat or coldness’ is preserved by the authors of the ps.-Plutarchean tradition and is preferred by Diels and Runia, but Stobaeus refers to ‘heat or wetness’ (cf. Anon. Lond. XX.35–6 on Philistion of Locri). If we trust Stobaeus, then Alcmaeon appears to prioritize two powers which are active in different pairs of opposites.
21On this embryological theory, see Lonie, The Hippocratic Treatises, 124–32.
22The most pertinent studies include Vlastos, ‘Isonomia’, ‘Isonomia politikē’; Lévêque and Vidal-Naquet, Clisthène l'Athénien, 25–32; Ostwald, Nomos and the Beginnings, 96–173.
23Ehrenberg, ‘Origins of Democracy’, 530–4; cf. Vlastos, ‘Isonomia politikē’, 10, n. 1.
24Vlastos, ‘Isonomia’, 337–47, 351–2, 365–6, ‘Isonomia politikē’, 10–2.
25Raaflaub and Wallace, ‘People's Power’, 143–5, 153. On the significance of Cleisthenes see Lévêque and Vidal-Naquet, Clisthène l'Athénien.
26Robinson, The First Democracies, 76–7; Fischer-Hansen, Nielsen, and Ampolo, ‘Italia and Kampania’, 268.