RUFUS OF EPHESUS

(first century CE), medicine. For the original article on Rufus of Ephesus see DSB, vol. 11.

Research over the last thirty years of the twentieth century has substantially altered historians’ understanding of Rufus of Ephesus in two ways. The revival of critical interest in Galen has led to a re-evaluation of his debts to his predecessors, among them Rufus, and, more importantly, many more writings by Rufus have been published for the first time. Most derive from translations made into Arabic that have been preserved in their entirety or in the form of substantial extracts, and more can be expected as major libraries in the Muslim world are made more accessible. Together they have thrown new light on the range of his medicine and on his therapeutic strategies.

Dates According to a Byzantine encyclopedia, Rufus of Ephesus was a contemporary of Statilius Criton in the time of the emperor Trajan, meaning he would have been active around 100 CE. However, Servilius Damocrates, writing fifty years earlier, cited a pharmacologist called Rufus, and another writer on pharmacology, Asclepiades, writing about 90 CE, gave a recipe composed by a Menius Rufus. That both or either of these citations should be attributed to Rufus of Ephesus is far from clear, and most scholars prefer the later date. He was dead by 140 CE.

Life This uncertainty about when Rufus lived mirrors the sparse biographical information provided in his writings, which provide little historical or geographical background to the cases he describes. Rufus spent considerable time in Egypt, probably studying at Alexandria and gaining a knowledge of anatomy, for he commented about the general health of the country and some specific diseases found there, such as guinea worm infestation. His other specific references to his patients or to what he saw all relate to the region around his home city of Ephesus (later in southwestern Turkey), and there is no evidence that he ever visited Rome, as did his contemporary, Soranus, or, later, Galen. His medical ideas place him firmly as a follower of Hippocrates and so a believer in the theory that health and disease were largely the result of a disturbance or imbalance in the four humors, or fluids, of the body— blood; bile; phlegm; and black bile, or melancholy—and that treatment should restore the individual’s balance. But he could be flexible, even using some ideas more often associated with the Methodist sect of doctors.

Writings What remains of his writings in Greek, whether in their original form or in quotations appearing in later works, gives only an idea of his enormous range. They include works on therapeutics— On Diseases of the Bladder and Kidneys and On Satyriasis and Gonorrhoea—as well as a treatise on anatomical nomenclature for those beginning medical study: “for the smith, the cobbler, and the carpenter first learn the words for metal, tools and such like. Why should it be any different in more noble arts?” (Oeuvres, p. 133, ed. Daremberg-Ruelle). His short treatise, Medical Questions, advising a doctor on how best to gain information from a patient by means of questions, offers a rare glimpse into the bedside skills of an ancient doctor. There are tantalizing fragments of a long botanical poem, in four books of hexameters, and of his views on plague, which may include a very early reference to plague buboes in North Africa. Other works survive only in translation: On Gout in Latin, On Jaundice in Latin and Arabic, and some of his case histories in Arabic. Even more, however, are known from citations in the medical encyclopedias of Late Antiquity or in the works of Arabic medical writers, for whom Rufus was second only to Galen as an authority.

What is most striking about Rufus’s writings as people today have them is that theoretical discussion and argument are almost entirely absent. His emphasis was on therapeutics, buttressed by his own successful treatments. His commitment to the theory of the four humors is justified by the results of his therapies rather than by physiological exposition. The basis of Rufus’s medicine can be briefly stated in his own words: “we are not naturally all the same; we differ very greatly from one another” (Brock, 1929, p. 115). Hence follows the need to discover the individuality of each patient by every possible means. A patient’s illness could be deduced simply from its external manifestations, but this should be a mere preliminary, for true therapy consists in fitting the remedy exactly to the patient. This takes considerable time and effort, and may involve questions about all aspects of his or her life, from food and drink to habits and dreams. Even when the doctor has found out what is wrong, and can foresee the likely outcome, he must ensure that the treatment is adapted precisely to the patient, for “no substance is so constant in its actions that the physician can place it in a single category” (Brock, 1929, p. 115).

Although Galen applauded Rufus’s profound knowledge of the Hippocratic corpus and respectfully referred several times to him as a commentator on Hippocrates, it is not certain whether Rufus wrote formal commentaries on select tracts or merely discussed particular passages in the course of other works. But Rufus’s “deep affection for the man and his art” did not mean that he could see no progress beyond Hippocrates. His treatise On Melancholy, considered by Galen the best work on the subject before his own, developed the brief sketch in the Hippocratic On the Nature of Man into a detailed exposition of the therapeutic consequences of an excess or deficiency of the mysterious “melancholy” humor. Similarly, the final section of Medical Questions is an extension, not a criticism, of Hippocrates’s views in Airs, Waters, and Places. Rufus argued that local circumstances are likely to provide local remedies as well as local diseases, and that hence, talking with the natives of an area would often lead to discoveries of great value.

Throughout, Rufus adopted a pragmatic rather than a confrontational approach. Criticism of others was muted or avoided. He regretted that internal anatomy was better taught “in the old days,” when one could use humans, but contented himself with recommending the dissection of animals closest to humans and the demonstration of surface anatomy on a slave. Although most of his treatises are addressed to his fellow doctors, Arabic authors have preserved a large number of quotations from what was a substantial and comprehensive manual of self-help, For the Layman, or, as some authors translated its title, For Those Who Have No Doctor to Hand. It covered a wide range of diseases, from headache and failing eyesight to kidney and bladder problems, and it gave advice for health as well as for sickness, for prophylactic dietetics was a Hippocratic speciality. Students wishing to develop a good memory were advised to avoid excessive drinking and eating lettuce, the bromide of antiquity. Rufus also considered groups in society whose particular needs were not always addressed in medical writings: travelers, the elderly, and the very young (with very sound advice on child care and pediatrics, including what the wet nurse should be able to deal with herself and when she must call in a doctor). He wrote a tract On Buying Slaves, in which he reported his examination of a slave with a congenital skull defect and warned against the risks of buying a slave with a suppurating discharge from the ear: this portended serious harm to the slave and a loss of investment to his or her owner. His sympathies with the sick are clear from his comments on those with sexual dysfunctions or with chronic conditions, where his stress on what is needed to eliminate their cause in each individual is the closest he came to an attack on the so-called Methodist doctors of his day, who preferred general diagnoses and remedies.

It was the misfortune of Rufus to have fallen under the shadow of Galen, who, while eloquent about his opponents’ beliefs, was far more reticent about the amount he appropriated from those with whom he agreed. His general approval scarcely allows us to appreciate all that Rufus did to earn the admiration of the Arabs. The material that has survived the filtration process of the centuries highlights his practicality as a physician in his dealings with patients of all kinds. The learning that lay behind all this, however, can be glimpsed only faintly in his advice in Medical Questions or the references (not all of them necessarily his own) he provided to explicate anatomical terminology in On the Names of Bodily Parts. Enough remains, however, to show his great strengths as a clinical observer and to make readers regret the loss of so great a proportion of his writings.

Legacy The fate of Rufus’s works and reputation is bound up with Galen and Galenism. Although Galen praised him highly, he never made clear the full extent of his debts to Rufus and took direct issue with him only rarely. That he was an influential figure in the Hippocratic tradition is obvious, but precisely in what that influence consisted can scarcely be gleaned from Galen’s self-centered comments. A better idea can be gained from the compilers of later Greek medical encyclopedias, Oribasius, Aetius, and Paul of Aegina, who all often cited him at length. He was, in the eyes of the Byzantines, one of the four great names in their medical literature. But increasingly, his individual voice was subsumed under that of Galen, even to the extent that some of his notions, and indeed experiences and writings, were credited to Galen. Arabic authors were still able to draw extensively on him from the ninth century onwards and possessed far more of his writings than survive today in their original Greek. They regarded his work on childcare highly, and his treatise On Melancholy formed the basis for many of their subsequent discussions of this puzzling illness. The medieval West knew much less of his works. Constantine the African quoted some of his ideas on melancholy through an Arabic intermediary, and many citations were to be found in the Continens, the Latin translation of the Kitab al-H?w? (the All-embracing Book) of Rhazes. But Rufus was largely known to the Latin West as the author of a purgative drug, the hiera Rufi.

Rufus’s rehabilitation was long in coming. Some of his extant Greek works were edited with a Latin translation by Jacques Goupyl in Paris in 1554, and a few other fragments were published in Latin translation in the sixteenth century, but many treatises had to wait until the appearance of the standard edition of Charles Daremberg and Emile Ruelle, published in Paris in 1879. Although this edition also contained many of the fragments preserved in the later Byzantine encyclopedias and, to a lesser extent, the Continens, and allowed scholars to see why he was so highly regarded by Galen, it gave only a partial picture. Researches since the 1960s among Arabic writers, notably by Manfred Ullmann, have brought to light many new texts, some of them translated into Arabic in their entirety. They have confirmed Rufus’s great strengths as a medical observer and writer who could produce a clear synthesis of Ab?ndant information from the past for therapeutic purposes.

SUPPLEMENTARY BIBLIOGRAPHY

WORKS BY RUFUS OF EPHESUS

Oeuvres de Rufus d’Ephèse. Edited by Charles Daremberg and

Emile Ruelle. Paris: Imprimerie Nationale, 1879. Reprint, Amsterdam: Hakkert, 1963. The standard edition of Rufus’s writings.

De podagra. Edited by Henning Mørland. Symbolae Osloenses. Supplement 6. Oslo: A. W. Brøgger, 1933.

Quaestiones medicinales. Edited by Hans Gärtner. Berlin: Akademie Verlag, 1962. Includes an excellent commentary.

De renum et vesicae morbis. Edited by Alexander Sideras. Berlin: Akademie Verlag, 1977.

Krankenjournal. Edited by Manfred Ullmann. Wiesbaden, Germany: Harrassowitz, 1978. Contains case histories, not all of which may be by Rufus.

De cura icteri. Edited by Manfred Ullmann. Abhandlungen der Akademie der Wissenschaften in Göttingen. No. 138. Göttingen: Vandenhoeck & Ruprecht, 1983.

OTHER SOURCES

Aly, Amal Abou. The Medical Writings of Rufus of Ephesus. PhD diss., University of London, 1992.

Brock, Arthur J. Greek Medicine. London: J. M. Dent, 1929. Includes a partial translation of Rufus’s Quaestiones medicinales.

Kowalski, Georg. De corporis humani appellationibus. PhD diss., University of Göttingen, 1960. Lloyd, Geoffrey E. R. Science, Folklore, and Ideology: Studies in the Life Sciences in Ancient Greece. Cambridge, U.K.: Cambridge University Press, 1983. See the pages on anatomy.

Pormann, Peter E. “Paul of Aegina’s Therapy of Children.” BPhil diss., Oxford University, 1999.

Sideras, Alexander. “Rufus von Ephesos und sein Werk im Rahmen der antiken Medizin.” In Aufstieg und Niedergang der römischen Welt, edited by Hildegard Temporini and Wolfgang Haase. Vol. 37. Berlin: W. De Gruyter, 1994.

Smith, Wesley D. The Hippocratic Tradition. Ithaca, NY: Cornell University Press, 1979. Discusses Rufus’s Hippocratism.

Thomassen, H., and Christian Probst. “Die Medizin des Rufus von Ephesos.” In Aufstieg und Niedergang der römischen Welt, edited by Hildegard Temporini and Wolfgang Haase. Vol. 37,2. Berlin: W. De Gruyter, 1994.

Ullmann, Manfred. “Neues zu den diätetischen Schriften des Rufus von Ephesos.” Medizinhistorisches Journal 9 (1974): 23–40.

———. “Die Schrift des Rufus ‘De infantium curatione.’” Medizinhistorisches Journal 10 (1975): 165–190

———. Islamic Medicine. Translated by Jean Watt. Edinburgh, U.K.: Edinburgh University Press, 1978. A short survey in English of the new Arabic material.

———. “Die arabische Überlieferung der Schriften des Rufus von Ephesos.” In Aufstieg und Niedergang der römischen Welt, edited by Hildegard Temporini and Wolfgang Haase. Vol. 37,2. Berlin: W. De Gruyter, 1994. The best account of the new Arabic material.

Vivian Nutton