Soranus of Ephesus

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SORANUS OF EPHESUS

(fl. Rome, second century)

medicine.

Soranus of Ephesus can be considered one of the major Greek physicians in the Roman Empire at the beginning of the second century. According to Suidas he was the son of Meandros and Phoibe, but a second article of the lexicographic collectaneum, “Sōranọs Ephesios, iatrọs neọ̄teros,” does not justify a belief that two physicians with the same name had historical importance.1 Scheele’s careful research has confirmed this opinion; and even the fact that many other physicians were named Soranus and that in the families of physicians a name often was given to the son or the grandson, is not sufficient reason for new doubts.2 Some of the statements about his life and sites of activity from late antiquity and from Byzantine literature are legends.3 But it is certainly correct that he was a member of the methodist sect, that he practiced at Rome during the reigns of Trajan and Hadrian, and that he had studied in Alexandria.4

Although there is no direct evidence, priority must be given to Ephesus as the site of Soranus medical training and scientific development: for in the first two centuries of the Christian era it gradually became necessary to offer the professional studies, as taught at Alexandria, in schools and academies throughout the Roman Empire.5 And in this respect Ephesus was of special importance for the whole of Asia Minor.6 Soranus thus was trained primarily at the medical school of Ephesus: and if his references to medical experience in Egypt and Rome are taken as proof for his training and activity there, serious consideration must likewise be given to his remarks concerning Caria.7 It must be left undecided if he only took his training there—perhaps under Magnus Ephesius. Whom he repeatedly cites8—or was a lecture, His numerous textbooks. obviously meant for practical instruction, and the fact that he had pupils are evidence for such a supposition. In any case. he ranks among the important physicians of the Ephesian school.9

These statements are not meant to diminish Soranus’ merits of the methodist school. The method ist doctrine rejected the theory of humors and, influenced by Epicurus’ philosophy and its skepticcism, had developed ideas stating that the body consists of movable and immovable interlaced by fine pores, the tension of which responsible for health and sickness. This cellular pathological structure allowed certain vaguely defined communities of the human organism — ( “communities micraculous” as Galen caustically called them)10 This type of structure provided the opportunity to classify diseases into three conditions according state of the pores: status laxus (grossly relaxed),Status strictus(grossly contracted), and status mixtus(mixed),11 Thus the method basically renounced any etiology and pathology, as bask anatomical and physiological knowledge,and was guided in its practice by observing “communities of sicknesses,”12 This kind of thinking made it possible for Thessalus of Tralles, soranus’ predecessor, to develop the distinction be tween acute and chronic illnesses, which successful where the old theory of the eras failed.13

Such a simplified method impressed the Romans —and thus imperial physicians were predominantly representatives of methodism— bu “method” could not satisfy the advanced. developed, and occasionally contradictory dard of knowledge attained after the early andrian epoch. It was therefore Soranus’ main contribution “to have reestablished the ‘method’ordering its principles,” and Caelius Aurelianus called him “methodicorum princeps.”14 From the existing theoretical suppositions he had to his attention to consolidating diagnostics, an in his work differential diagnostics gained importance for the first time. Soranus also sought place the vague and extremely hypothetical “communities”on a firm basis and to give them a distinct definition; and the strict separation of and chronic diseases was made with remarkable clarity and excellent power of clinical observation in his practical nstruction on diseases.15 In his time the “method” became a genuine alternative to the older theories, especially for those who did cling slavishly to the details and had a solid medical training.

Soranus retained his own views, which some times diverged from those of the methodist school. Even if he considered the science of the be body, including anatomical and physiological knowledge, to be useless, as a scholar at Ephesus and Alexandria he frequently used it and declared the former to be necessary.16 His gynecological works demonstrate to what extent he values He-rophilus’ teachings on obstetrics, so that it is incorrect to call hims—as did Diepgen—merely a Vertreter methodischer Gynäkologie (“representative of Methodist gynecology”)17 who added nothing to the development of this specialty. His knowledge comprised the whole of medicine and even extended to philosophy and grammar, field in which he also was outstanding. Therefore Galen, who expressed contempt for the master of “method,” never attacked Soranus; on the contrary, he recommend some of his prescriptions. Even Tertullian, a theorlogian not at all on friendly terms with the physicians, characterized him as “methodical medicine instructissimus autor.‘18

Soranus’ works deal with many fields of medical science and are noted for their clarity and the rigorous treatment of the stated problems; they also give the reader a more comprehensive biological view by using vivid comparisons from zoology and agriculture.19 Both his manner of citing the sources and his exact observance of their chronological sequence in mentioning the doctrines and theories of older physicians, to whom he gave considerable attention, were remarkable.

Soranus’major extant work, Gynaecia, comprised four books.20 Book I records the necessary qualities of a prospective midwife (integrity, zest for work and strong constitution, smooth hands, good theoretical knowledge and practical experience, refusal to perform a criminal abortion) and her work (gynecological physiology with exact representation of the anatomy; feminine hygiene, including comments on menstruation and conception; how to have healthy children; hygiene during pregnancy and abortion). Book II deals with obstetrics (symptoms of and preparations for delivery, parturition, complications, nursing by women in childbed, the nursing of the baby and the choice of a wet nurse, confinement and infant hygiene, and childhood diseases). Books III and IV deal with women’s diseases. In Book III, Soranus concedes that women have diseases that men cannot a controversial thesis in antiquity, and comments on diseases to be treated dietetically; and Book IV deals with diseases that can be treated surgically and pharmaceutically. Although the Gynaecia was a comparatively complete work in the original text, it is necessary to warn against the prevalent view that Soranus was “the‘ gynecologist of antiquity. His work would have been impossible without the preliminary studies of the Herophileans, however, independent and superior his mastery and exposition of the subject; in addition, his knowledge far surpassed this specialty.

A shorter compendium, a sort of catechism for midwives, has been lost in its original edition; but it may be preserved in Muscio’s sixth—century translation, as well as in a Greek retranslation that was formerly considered the original edition, by the Greek physician Moschion. 21 on sperm and the genesis of creatures, now lost, counts in the same interrelation.22 Parts of the work were translated into Latin in a treatise by Vindicianus.23

Soranu’s magnum opus, on acute and chronic diseases, also was lost; but there is a sufficient substitute in Caelius Aurelianus’ Celerum sive acutarum passionum, Books I—III, and Tardr um sive chronicarum passionum. Books 1–V, because Caelius made a faithful translation into Latin and introduced very few of his own ideas.24 This work is solidly grounded in the Methodist doctrine; and when treating each of the major “internal “diseases, it quite distinctly shows, even in the Latin, the disposition, systematic manner, and wording of Soranus. This work also regularly cites the doctrines of earlier authors, although Soranus nearly always agrees with the views of his own school; and when there are divergences, he takes a conciliatory standpoint. He is as critical of every sort of medical superstition as he was in the Gynaecia, a practice that was no longer a matter of course in science; but when searching for the natural causes of diseases, he reaches beyond both the therapeutic frame of the work and the intentions of his school.

The lost work on causes of diseases, seems to treat that subject exclusively; and on the “communities,” apparently seeks a more distinct definition of that vague concept.25 Soranus also wrote containing instructions for treating fever, and on medical resources, both of which are probably supplements to the work on acute and chronic diseases that have been lost.26 Caelius Aurelianus often quoted the latter in such a way that one is inclined to consider it as a systematic description of nursing, bloodletting, purgations, and physical therapy.27

When prescribing remedies Soranus used only medicaments approved by his teachers and friends—or so Galen said—and recorded them in ( “Instruction on Medicaments”) and in a pharmaceutical booklet, . 28He largely agreed with the the ories of his school in pharmaceutical practice but disagreed in matters of surgery and the closely related techniques of bandaging. Here the methodist doctrine was unable to support him because it was opposed to anatomy and consequently to surgery as well.29 Although his great work on surgery, is lost, an apparently extant fragment, ( “On the Symptoms of Fractures”), reveals not only an exact knowledge of the normal skeletal anatomy but also a precise conception to the anatomicopathologic misposition of the fragments of bones,30 It is characteristic that Demetrius, a Herophillean, is the only physician quoted in this fragment.31 Soranus’ completely extant ( “On Ban-dages”) gives numerous examples of conformity with the pseudo–Galenic instruction on bandages and with that of Heliodorus, as it is presented in Oribasius work.32 Two other lost works on medical practice are on ophthalmology, and a general work on hygiene. The latter was also translated by Caelius Aurelianus, but the Latin edition has not survived.33 In addition to hygiene Soranus was deeply concerned with the human psyche and wrote the four-book on the human soul.34 Although this work has not survived, idea is possible to obtain an idea of its contents because Tertullian used it as the main source of his De anima.35 There will always be uncertainty, however, whether Soranus really composed commentaries on Hippocratic writings.

The work on the soul extends into philosophical as well as allied fields of medicine, as do his last two works. The first is ten books containing biographies of physicians and information on their schools and writ ings.36 This biographical work, together with the doxographic description of the existing medical groups and their writings on theoretical and practical problems, is Soranus’ main contribution to medical history. An extant fragment is ( “The Noble Origin and the Life of Hippocrates According to Soranus’ Statements”).37 Written many centuries after the death of Hippocrates. Soranus’ statement must necessarily contain some traces of legend.38 Nevertheless, apart from occasional remarks in Plato and later authors, it is the oldest extant complete biography of him. The second work, on the origin of bodily terms, concerns the nomenclature for the parts of the human body and its linguistic origin.39 Its loss is less serious, for later etymologists made extensive use of it; thus a judgment is still possible concerning its I lion, range, and quality.40

The extent of Soranus’ work demonstrates with Galen, he was the greatest medical author of late antiquity. That almost all his works were lost, whereas Galen’s were widely preserved, is result of the fact that Galen and his theory of crasis dominated medical thought during the following 1,500 years and deprived the atomistic and cellular pathological approach of my chance of acceptance. And yet these latter theories exerted a decisive effect.In addition to the works of translators and physicians of the Western Empire, of etymologists of lexicographers, and of theologians,important chapters of Soranus’ works appeared compilations of Byzantine medical science;41 even Galen used parts of them, Soranus surviving works reveal a physician with an unprejudiced view of the substance of a medical science was threatened with being swamped by its own abundance of knowledge. Essential parts work show that he was a master of “method” —but by no means indoctrinated in a way that prevent him from looking beyond the limit school. His liberal views permitted Soranus to use the Herophileans as a base in obstetricsand ostion of a liberated mind was characteristic of the school—for instaleology and to accept principles of other set for instance, in matters of bandaging. This lion of a liberated mind was characteristic school of Ephesus, and Soranus proves I belonged to it through his use of terminolog only this school produced such personages as Rufus and enlarging the circle a bit, Charmides, who wrote the Onomasticon.42 Galen, on the other deliberately neglected distinct diction in the menclature. 43

Soranus’ moral and intellectual freedom also enabled him to write about Hippocrates a followers in a way that presented an anal their doctrines without advocating a ret: them. If we knew more about him. we wot doubtedly conclude that Soranus was Galen great intellectual antagonist, intellectually his peer —if we are allowed to use Tertullian’s De anima—and in character his superior. His pupil Statilius Attalus, unjustly defamed by Galen, held and eminent place at the court of the emperor at Ephesus.44

NOTES

1. Suidas, Lexicon, T. Gaisford, ed., rev. by G. Bernhardy 11 (Halle-Brunswick, 1853), 850.

2. L. Scheele. De Sorano Ephesio medico etymologo (Strasbourg, 1886),3 ff, (Ph.D. diss.); also see R. Fuchs, ‘Geschichte der Heilkunde beiden Griechen,” in T.Puschmann, M. Neuburger. and J. Pagel, eds., Handbuch der Geschichte der Medizin . I (Jena, 1902), 340.

3. See F. E. Kind, “Soran,” in Pauly-Wissowa, 2nd ser., III A, pt. 1, 1114.

4. For Rome, Suidas, loc, cit.: Soranus, Gynaeciorum libri quattuor, II , 44, edited by J. Ilberg, in Corpus medicorum Graecorum, IV (Leipzig-Berlin, 1927), 85; Caelius Aurelianus, De morbis acutis,II . 130, edited and translated by J. E. Drabkin (Chicago, 1950), 218; and M. Albert, “Les médecins grecs à Rome,”in Les grecs à Rome (paris, 1894), 197 ff. For Alexandria, see Suidas, loc, cit.; Soranus, op, cit., II, 6, Ilberg, ed., p. 55; Caelius Aurelianus, De morbis chronicis, V, 30, J. E. Drabkin ed., 924.

5. See U. Kahrsledt. Kulturgeschichte der römischen Kaiserzeit, 2nd ed. (Bern, 1958), 276.

6. Concerning Ephesus at this time see Kahrstedt. op. cit., 169 f. For the medical school and the association of the physicians, see J. Keil “Ärzteinschriften aus Ephesos,” Jahreshefte des österreichischen archäologischen Instituts Wien, 8 (1905) and 23 (1926); and Forschungen in Ephesos,. IV . pt. 1 (Vienna. 1932)

7. See Kind, loc, cit.; and Fuchs. Loc. Cit. Cf. Caelius Aurelianus, De morbis acutis, III , 124; and De morbis chronicis, V, 30, Drabkin, ed., 378, 924.

8. M. Wellmann. following H Haeser, placed Magnus, among others, in the Pneumatic school because he was a pupil of Athenaeus; and he has remained uncontradicted. M. Well mann,. “Die pneurnatisehe Schule,” in Philogische Untersuchungen, A. Kiessling and U. v. Wilamowiu-Moellendorrff eds.. XIV (Berlin. 1895), 178 ff., 187; H. Haeser, Lehrbuch der Geschichte der Medinziu und der epidemischen krankheiten (Jena, 1875; repr. Hildesheim-New York, 1971). 1. 334 ff. At first this view gives the impression that a connection between Magnus and Soranus would be incompatible. There is no doubt that the investigation and intellectual definition performed by the medical schools of late antiquity were important and instructive; but the classic science of antiquity and the historians of medicine of the past century, influenced by Galenic polemics, have attached too much importance to the differences among these schools; and in doing so they have failed entirely to notice the importance of the schools’ belonging to the same academy and its physicians’ association. Haeser. referring to Athenaeus, the teacher of Magnus, said, “The methodists had made him make so many concessions that they could call him one of theirs” Thus it is not necessary so state that belonging to a school separates more strongly than belonging to an academy can bind. It seems that this statement becomes valid with Magnus, for Galen sees Magnus’ view concerning the cause, origin, and importance of the pulse in total contrast with that of Archigenes, who was a faithful follower of the Pneumatic school. Only a few page later in Galen’s work there is this statement: “... ...” ( “...and he himself makes us believe that he is”—or, to put it more distinctly, “...and he himself claims to be “— “a member of the Pneumatic school”), Galen, De pulsuum differentiisIII , 1, in Galen’s Opera omnia. C. O, Kühn, ed., VIII (Leipzig, 1824), 640, 646. Therefore, even if Magnus styled himself a follower of the Pneumatic school, he must have remained much more of a methodist than his master. This view is also proved by the title ( “[Medical] Discoveries After the Time of the Methodist Themison”), ibid., 640. It seems impossible that in such a work a qualified follower of the Pneumatic school would base his chronology on such a confirmed methodist. Thus it is not astonishing that we find Magnus thoroughly incorporated into the school of the methodists by Caelius Aurelianus in De morbis acutis, II , 58, Drabkin, ed., 160.

9. To the list of Rufus of Ephesus, Titus Statilius Kriton, and Statilius Attalus given by J. Benedum in his archaeologically oriented essay “Statilios Attalos.” in Medizinhistorisches Journal, 6 (1971), 274, we can add from the literature— besides Soranus and Magnus —Heraclides of Ephesus as a traumatologist. See M. Michler, Die Hellenistische Chirurgie, 1. Die Alexnadrinischen Chirurgen (Wiesbaden, 1968), 89, 132 ff.. 148 f. A recommendation of the school can be seen in the fact that the author Athenaeus of Naucratis makes an Ephesian physician join the discussions in his Deipnosophistae (“The Learned Banquet”). From this. G. Kaibel, in his pref. to the Teubner ed. (Stuttgart. 1965). iv. expressed the idea that Athenaeus might have derived the names of the two physicians who had been the interlocutors — Daphnus Ephesius and Rufinus Nicaeensis—from Rufus of Ephesus. In any case, during the discussions about medical problems the two physicians are referred to as “the Ephesians and the like-minded persons”: Lib III , Sec. 33 (87 c), Kaibel, ed., 1, 202.

10. Galen, De methodo medendi 1, 4. in his Opera omnia. C, G. Küuml;hn. ed., X, 35.

11. See T, Meyer—Steineg, “Das medizinisehe System der Method iker,1” in Jenaer medizin-historische Beiträge, nos. 7–8 (1916). 23.

12. See Celsus, De medicina, “Prooemium” 54, edited and translated by W. G. Spencer. I , 30.

13. Until then only the acute diseases were distinguished from the rest. See Meyer— Steineg. op, cit., 33.

14. Caelius Aurelianus, De morbis acutis, II , 46, Drabkin, ed., 150 f.

15. See Meyer-Steineg, op. cit., 38 ff.; and Fuchs, op, cit., 341 f.

16. Soranus, Gynaeciorum libri quattuor, 1, 2, 3, p. 4, Ilberg, ed., and I , 5, p. 6.

17. See Michler, op. cit., 142 f.; and Wellmann, op. cit., 118. See also P. Diepgen. “Geschichte der Frauenheilkunde. I: Die Frauenheilkunde der Alten Welt,” in W. Stoeckel, Handbuch der Gynäkologie. XII , pt. 1 (Munich, 1937). 107.

18. Tertullian, De anima 6.

19. See I. Ilberg, “Die Überliefemng der Gyniäkologie des Soranus von Ephesos, “in Abhandlungen der Königlich-Sächsischen Gesellschaft der Wissenschaften, Phil,-hist. Kl., 28 , no. 2 (1910), 36, 76 ff.

20. The ed. by J. Ilberg, Corpus medicorum Graecorum, IV , 3–152, is still the authoritative one: an Fnglish trans, is O. Temkin, Soranus’ Gynecology (Baltimore, 1956). For a systematic order other than Ilberg’s, see Kind, op, cit., 1118 ff.

21.Gynaecia ex Muscionis ex Graecis Sorani in Latinum translatum sermonem, Valentin Rose , ed. (Leipzig, 1882); the Greek retrans. is See llberg, op, cit., 102 ff.: and Diepgen. op, cit,. 108.

22. See Ilberg, op, cit., 38. and n. 1.

23. Bruxeilensis, 1342–1350 (12th century).

24. The ed. and trans, by Drabkin is the authoritative publication today, but for reliability of text one should also consult G. Bendz, “Caelktna, Textkrilische und spradiliche Studten zi Caelius Aurelianus,” in Acta Universitatis lundensis, n.s, 38 , no. 4 (1943); and “Emendationen zu Caelius Aurelianus,” in Publications of the New Society of Letters at Lund, 44 (1954). For Caelius Aurelianus, see M. Wellmann. in Pauly-Wissowa, II. 1257 ff.; and Meyer— Steineg, op. cit., 42 ft On the treatment of paralysis, see M. Michler, “Die physikalische Behandlung der Paralysis bei Caelius Aurelianus,” in Sudhoffs Archiv....48 (1964), 123.

25. On , see Caelius Aurelianus, De morbis chronicis, I, 55, Drabkin, ed., 474. To the overcoming doxographic reports from this work, see Kind, op, cit., 1127. Referred to as , see Soranus, Gynaeciorum libri quattuor, I, 29. 3, Ilberg, ed., 19.

26. See Caelius Aurelianus, De morbis acutis, II, 177, Drabkin. ed.. 254: and Sorunus. Gynaeciorum libri quattuor, 111 , 28, f. Ilherg. ed.. 112,

27. See Kind, op. citi,. 1128.

28. Galen, De compositione medicamentorum secundum locos,in his Opera omnia, 1, 7, C, G. Kuhn. ed., XII. 493 f.

29. See M. Michler.Das Spezialisierungsproblem und die antike Chirurgie (Bern– Stuttgart– Vienna. 1969),37.

30. Cited from Soranus. Gynaeciorum libri quattuor,1,7,4[76], llberg. ed,. 56. See also Soranus, De signis fractuarum, J. llberg, ed.. in Corpus medicorum Graecorum, IV, 155–158

31.ibid,§9.p.156.

32. Soranus, De fasciis, J.Ilberg, ed.. in Corpus medicorum Graecorum IV, 159–171. See also Pseudo-Galen,De fasciis, in Galen’s Opera omnia, C. G. Kühn. ed.. XVIII A(Leipzig. 1829), 768–827; for Heliodorus. see Oribasius,Collectiones, XLVIII. J. Raeder, ed.,in Corpus medicorum Graecorum VI, 2, I (repr. Amsterdam, 1964).

33. Cited from Soranus.Gynaeciorum libri quattuor, I, 32. I. and 40. 4, Ilberg. ed.. 21. 28. For the Latin trans, by Caelius Aurelianus, Salutaria pracepta, see Wellmann, in Pauly-Wissowa loc,cit.

34. Tertullian loc cit.

35. See H. Diels. Doxographi Graeci (repr. Berlin, 1958), 206 ff.

36. See Suidas, loc. cit.

37.Vita Hippocratis secundum soeanum, J. Ilberg,ed., in Corpus medicorum Graecorum,Iv 175–178: on the origin of this see the pref. to IV Xiv f.

38. See also H. E, Sigerist, Anfänge der Medizin (Zurich 1963) 697 ff. This is a trans. of A History of Medicine (New York. 1955).

39. See Orion. Etymologicon, F. W. Sturz. ed.(Leipzig. 1820),34,II.9 f.;also 131. II 4 f.,and 159.1. 18.

40. Such a judgment is possible from Orion, who cites him some twenty times, occasionally in long and detailed passages; there ;are also citations from him in Etymologicum magnum, Gudianum, and other Greek etymological dictionaries. Fragments are in Pollux. OnomasticonII Sec also Kind. op. cit.. 1117.

41. For instance in works, of Philumenus of Alexandria. Aëtius of Amida. and Paul of Aegina; see Fuchs,op.cit.. 341.

42. See Rufus of Ephesus. Daremberg and Ruelle. eds., (repr Amsterdam 1963), 237 ff. For Charmenides and his Onomasticon, see J.Benedum. “Channemodes” in Pauly-Wissowa, Supp. XIV (1974),96.

43. See E.Marchel. Galens anatomische Nomenklatur(Bonn. 1951), 117(M.D.diss.).

1. See J.Benedum. “Statilios Attalos,” 264 ff.

Markwart Micher