De morbis acutis et chroniis (review)

Anonymi Medici. De morbis acutis et chroniis. Edited with commentary by Ivan Garofalo. Translated by Brian Fuchs. Studies in Ancient Medicine, no. 12. Leiden: E. J. Brill, 1997. xxx + 375 pp. $112.50.

Sometime in the early Roman Empire a medical work was produced on acute and chronic diseases--chronic ones supposedly being untreatable. Although some ancients recognized a bifurcation of diseases, by the time this anonymous author wrote, both types received therapeutic intervention by physicians. In Chronic Diseases (I. praef. 3), Caelius Aurelianus (ca. 5th c.) said that Themison (late 1st c. bce) first set forth treatments for chronic diseases. This anonymous work and those by Caelius Aurelianus, Aretaeus of Cappadocia (second half of 2d c.), and, possibly, Archigenes (fl. under Trajan, 98-117) are the only ones known to have organized medical information under these distinctions. Indeed, the title "On acute and chronic diseases" was not in the Greek manuscript texts.

Ivan Garofalo employed the four mutually independent manuscripts to produce a critical text. Two manuscript texts are found in Paris, and one of these, BN suppl. graec. 636, is the most complete of the four; modern guides refer to its author as Anonymous Parisinus (AP). To guide his reconstruction, Garofalo chose readings from Oribasius, Aetios of Amida, and Paul of Aegina, all of whom excerpted from AP. Fragments preserved by Paul have contents not found in the four manuscripts, leading Garofalo to suspect that we do not have AP's full text.

As skillfully reconstructed by Garofalo, the text begins with sixteen acute diseases, followed by thirty-nine chronic diseases, with both sections arranged in the "from head to foot" format. The acute diseases affect the head (phrenitis, lethargy, epilepsy, apoplexy, cephalea), neck (angina, spasm), chest (pleuritis, peripneumonia, syncope), esophagus (bulimia, hydrophobia), peritoneum (cholera), intestines (ileus, colic), and sexual organs (satyriasis). Chronic diseases begin with vertigo, madness, fanaticism, and various forms of paralysis (for the head), and end with sciatica, arthritis, and gout (joints), and, finally, a new disease, elephantiasis (also described by Aretaeus). The latter, AP says, was described by "none of the ancient physicians," although he acknowledges that Democritus, the philosopher, wrote on it. Neither Garofalo nor Brian Fuchs, the translator, attempts to identify the ancient nomenclature for diseases with modern diseases. Thus, a modern reader should be cautioned not to automatically attribute to arthritis, for example, the same pathology as today's affliction by the same name (although, in this case, our arthritis was encompassed within the lexical range of the Greek term).

Each chapter follows an unusual format employed only later by Alexander of Tralles (525-605 ce): cause of disease, signs (or symptoms), and therapy. As stated earlier, both acute and chronic diseases offer therapeutic advice, thus causing moderns to wonder why the distinction. Celsus (De medicina 3.1.1) observed that diseases (morbori) do not conform to a dichotomy of acute and chronic. Indeed, AP's first acute disease, phrenitis, is described as some sort of inflammation of the brain or, closer to our term, a nervous disorder; but under phthisis (meaning "lice disease"), a chronic disease, AP quotes only Hippocrates as saying that "phrenitis is phthisis" (no. 27, pp. 148-49).

As a rule, AP cites four authorities for the causes of disease: Erasistratus, Praxagoras, Diocles, and Hippocrates; Garofalo identifies the reference in the surviving works of these authors when they are available. Fuchs's English translation is competently done. He refrains from translating botanical terms into modern scientific nomenclature. I quarrel with the editor's reconstruction of the text on pp. 83 and 257 where he supplies "silphium" as the "juice," and this on the basis of a reading in Archigenes. The helpful critical notes refer to comparable nosography in later authors, such as Oribasius and Paul, and near-contemporary authors such as Celsus and Rufus.

Garofalo regards AP as a master of the subject (p. x) and claims that "for certain diseases (such as angina, or...