Introduction About fourteen hundred years ago, one or several professors of medicine in Egypt prepared epitomes in Greek to accompany the sixteen works of Galen that constituted the larger part of the standard syllabus of medi- cine in the medical schools of Alexandria. These epitomes were study guides, similar to the CliffsNotes of modern American students. In con- trast to the rambling and argumentative style of Galen’s original works, the epitomes are full of the lists, tables, and systematic categorizations of concepts, symptoms, diseases, and organs that medical students have always had to memorize. Besides the Alexandrian students, others must have found them useful, for they were translated into Arabic—suppos- edly by the famous Christian translator Ḥunayn ibn Isḥāq—and then into Hebrew. Arabic manuscripts of these epitomes are about as com- mon as manuscripts of the Arabic versions of the corresponding original works of Galen. Citations of them, or signs of their influence, are not difficult to find in Arabic medical literature. Thus they are historically important and worthy of closer study than they have received so far. They are also an admirably clear, if sometimes tedious, survey of Galenism as it was understood at the very end of antiquity. The Alexandrian medical curriculum The medical school in Alexandria Greek medical education probably took place most often in the con- text of a master-apprentice relationship, commonly within a family. In the Hippocratic oath, the physician vows to pass on the art only to his sons, the sons of his own master, and sworn apprentices. Nevertheless, the oath itself is evidence that this system was changing, at least to the extent that those wishing to acquire a medical education could do so by – xix – xx Introduction paying a teacher and attending his classes. In all likelihood, the most common pattern was for aspiring doctors to study locally, either in their family or with local teachers, and then—if their ambition, talent, and financial resources allowed—go on to attend lectures of internationally known teachers at one or more of the famous centers of medicine. This was how Galen himself acquired his education. He was the son of what today we might call a real estate developer, who was able to pay for his son to become a doctor. Galen studied with local teachers in Pergamon and Smyrna before going off for several years of advanced study in Alexandria.1 From the time of the Ptolemies up to the fall of the city to the Arabs, Alexandria had a reputation as the best place for advanced medical edu- cation. Since we do not know the institutional details of medical instruc- tion, it is wise to resist reifying the “Medical School of Alexandria,” as has been done with the “University of Gondeshapur.” Certainly, instruc- tion was offered there under something like official auspices, with one or more salaried professors; but beyond that we know little. When Galen was there in the middle of the second century, Alexandria was still living off its reputation for instruction in anatomy, acquired four centuries earlier.2 We know still less about Alexandrian medical instruc- tion in the century or two before the Arab conquest, when even the names of the teachers are unknown, garbled, or unhelpfully common. The medi- cal textbooks do not say much about actual medical practice, so the social role of doctors and medical students has to be pieced together from frag- mentary data—notably from the smug accounts of Christian saints whose miraculous cures humiliated proud pagan doctors.3 By the fifth and sixth centuries, the triumph of Galenism in the Roman world was complete.4 Galen had successfully tilted with his rivals: Empiricists, Methodists, Pneumatists, and other Rationalists. 1. On the role of formal medical instruction, see Duffy, “Byzantine Medicine.” 2. Galen, On Anatomical Procedures, trans. Singer, 3; cited in Iskandar, “Attempted Reconstruction,” 235. 3. Nutton, “From Galen to Alexander,” 5–7. 4. On medicine in late antiquity and Byzantium, see Nutton, Ancient Medicine; Nutton, “From Galen to Alexander”; Prioreschi, History of Medicine, vols. 3–4. Documentation for the period is fragmentary. On the philosophical rele- vance of Galenic medicine, see Pellegrin, “Ancient Medicine.” On the increasing Introduction xxi The professors of medicine in Alexandria had now settled down to ex- pounding a common system based mainly on the works of Galen, with his characteristic polemics largely removed and inconsistencies ironed out by drawing together passages from across his writings. This instruc- tion seems to have had a decidedly bookish quality, leading to the pro- fessors being called “iatrosophists.” The best evidence for instructional practices in late antique Alexandria comes from Arabic sources, which in turn allow us to make sense of the fragmentary instructional litera- ture in Greek. Ḥunayn ibn Isḥāq reports: They read only these books [the sixteen books of the Alexandrian curriculum] in the place of medical instruction in Alexandria. They read them in the order that I have mentioned them, assembling each day to hear one of the authoritative texts read and explained, just as our Christian brethren do to this day in the places of instruction called schole, where they read from the book of one of the authorities, either one of the Ancients or one of the other books. [The Alexandrians] would read the specialized books individually after study of these books that we have mentioned, just as our brethren today read com- mentaries on the books of the Ancients. Galen, however, did not intend for his books to be read in this order. Instead, he specified that after his book The Medical Sects, his books on anatomy should be read.5 In a chapter on judging the qualifications of physicians, the ninth-century physician Isḥāq ibn ʿAlī al-Ruḥāwī writes: Galen undertook to determine each one of these natural principles, without which there can be no real knowledge of the states of the human body. Having distinguished them, he wrote a book about each one of these principles, attributing it to that principle and naming the book by it, seeing that it contained that principle and its branches. He continued in this manner until he had covered all the principles of medicine. Now, the Alexandrians were those most knowledgeable about this art, and when they met and gathered the students of the art of medicine, they realized that most of the young men of their day lacked the enthusiasm to read all of these books, especially those that Galen had composed. Wishing to make the art of medicine accessible tendency for philosophers and medical professors to be the same people, see Westerink, “Philosophy and Medicine.” 5. Ḥunayn ibn Isḥāq, “Risālah,” 18–19. xxii Introduction to the students, they selected sixteen of Galen’s books, also making epitomes of most of them, seeking greater concision thereby. They introduced them into the schole—that is, the place that they had for teaching. Thus it is that nowadays anyone who claims to know the nature of the human body and that he is able to preserve health and treat diseases must know these books well in their order and must have read them with a knowledgeable teacher. Anyone who claims to know them ought to be questioned about the first of them, which is Galen’s On the Medical Sects [ for Beginners].6 The thirteenth-century medical historian Ibn Abī Uṣaybiʿah says much the same: These Alexandrians confined themselves to reading sixteen books of Galen in the medical school in Alexandria ( fī mawḍiʿ taʿlīm al-ṭibb bi-al-Iskandarīya). They read them systematically (ʿalá al-tartīb) and met every day to read and understand a part of them. Then they turned to abridgments and epitomes (al-jumal wa-al-jawāmiʿ) to make it easier to memorize and understand them, each one of them being assigned to comment on the sixteen books.7 The medical autodidact ʿAlī ibn Riḍwān (d. 453/1061) condemned the popularity of the resulting compendia and commentaries for having made them substitutes for the original texts of Hippocrates and Galen: In the time of Oribasius, when kingdoms had become dominated by Christianity, Oribasius thought of reviving the art [of medicine] and compiled his popular Compendium [Kunnāsh] for the laity, thus familiarizing the Christian kings with medicine. Paul [of Aegina] fol- lowed his path, and when their successors saw these two compendia, they continued to compile their own up to the present day. Even Abū Bakr al-Rāzī ordered each physician to compile a compendium for himself! Accordingly, medical books became abundant, and each doctor acquired a compendium for his own use. Galen wrote his commentaries in order to bring the medical works of Hippocrates to perfection. His abstracts and commentaries have left nothing out. Consequently, later books are superfluous, and 6. MS Edirne, Selimiye 1658, 97a–b, reprinted in facsimile in al-Ruḥāwī, Conduct of the Physician, 193–94; al-Ruḥāwī, Adab al-ṭabīb, 255–56, trans. M. Levey in al-Ruḥāwī, Medical Ethics of Medieval Islam, 84; and Gutas, Greek Thought, Arabic Culture, 93. 7. Ibn Abī Uṣaybiʿah, 1:103–4. Introduction xxiii to transcribe or reflect on their contents would hinder students from studying medicine. Studied closely, later compendia and similar works are found to represent the doctrine of the Methodists, whose art was rejected by Galen, for he informed us of their harmful influ- ence on medicine. According to their tradition, the Methodists described each disease, saying that it ought to be treated with a spe- cial [group of] drugs. This is precisely what is done by the compilers of compendia, which are, therefore, as harmful to medicine as the doctrine of the Methodists.