Diphilus of Siphnos and Hellenic medical dietetics

History of Medicine and Allied Sciences, 25:2 (1970:Apr.) Extracted from PCI Full Text, published by ProQuest Information and Learning Company. — SCARBOROUGH J., Diphilus of Siphnos and Hellenistic Diphilus Siphnius. | The fragments of Diphilus' work medical dietetics : JHM XXV 1970 194-201. was based on common sense and was in Athenaeus reveal that his medicine intelligible to patients. He was one of the Hellenistic physicians who elaborated theories of diet having a long history. du SEE S Medical Dietetics JOHN SCARBOROUGH : E A CHOLARLY medicine came into its own with the <8 creation of the Alexandrian Museum under the first and S second Ptolemies, but the emphases of medical studies in the Hellenistic world under the impact of the Mu- ESE a seum are far from clear. The Ptolemies established the SS Museum attempting to make Alexandria the cultural center of the Hellenistic kingdoms. They hoped to enhance their prestige by attracting scholars to Egypt. From the first the Museum functioned less as a research institution than it did as a showpiece of the Ptolemies’ wealth and learning. Ptolemy Philadelphus bought all the books formerly in the collections of Aristotle and Theophrastus, as well as many which he procured from Athens and Rhodes. The scholars who flocked to Alexandria found a huge storehouse of scrolls available for their perusal, but they did not use the Library for ‘research’ in the modern definition. The acquisition of learning and erudition did not produce free questioning nor experimentation,’ but rather long-winded quarrels among literary pedants who reminded Timon of Philus of ‘well-fed bookish birds in a gilded cage.’? Philadelphus continued his father’s design for the Museum, and he encouraged work in zoology because he had some half-learning in this area.? His dilettantism in zoology led to the encouragement of the efforts of such as Herophilus and Erasistratus, but these two famous names were exceptions to the general rule of literary study in the Museum. The important labor of the Museum consisted in establishing correct and reliable texts of the major Greek authors. Hippocrates was among those studied, and a certain Mnemon of Side (Pamphylia) brought a rare manuscript of Hippocratic writings for the collection in the Library.* Ptolemy Euergetes obtained the official texts of the three great Athenian tragedians through deception as related in a delightful anecdote by Galen.5 1. E. G. Turner, ‘L'érudition alexandrine et les papyrus,’ Chronique d'Égypte, 1962, 37, 135-152. 2. Athenacus, Deipnosophistae, 1, 22d. In further notes, references without citation are to Athenaeus. 3. Diodorus Siculus, m, 36, 3 f. 4. Galen (ed. Kühn), xvn, 1, 606. s. Galen, xvm, 1, 607. [ 194 ] \ SCART RI CA, Diphilus of Siphnos and Hellenistic

Diphilus of Siphnos and Hellenistic Medical Dietetics JOHN SCARBOROUGH LOOX ¿E CHOLARLY medicine came into its own with the 12 09005 98 S creation of the Alexandrian Museum under the first and fa} second Ptolemies, but the emphases of medical studies @} in the Hellenistic world under the impact of the Muof seum are far from clear. The Ptolemies established the orOS Museum attempting to make Alexandria the cultural center of the Hellenistic kingdoms. They hoped to enhance their prestige by attracting scholars to Egypt. From the first the Museum functioned less as a research institution than it did as a showpiece of the Ptolemies’ wealth and learning. Ptolemy Philadelphus bought all the books formerly in the collections of Aristotle and Theophrastus, as well as many which he procured from Athens and Rhodes. The scholars who flocked to Alexandria found a huge storehouse of scrolls available for their perusal, but they did not use the Library for ‘research’ in the modern definition. The acquisition of learning and erudition did not produce free questioning nor experimentation,! but rather long-winded quarrels among literary pedants who reminded Timon of Philus of ‘well-fed bookish birds in a gilded cage.’? Philadelphus continued his father’s design for the Museum, and he encouraged work in zoology because he had some half-learning in this area.3 His dilettantism in zoology led to the encouragement of the efforts of such as Herophilus and Erasistratus, but these two famous names were exceptions to the general rule of literary study in the Museum. The important labor of the Museum consisted in establishing correct and reliable texts of the major Greek authors. Hippocrates was among those studied, and a certain Mnemon of Side (Pamphylia) brought a rare manuscript of Hippocratic writings for the collection in the Library.* Ptolemy Euergetes obtained the official texts of the three great Athenian tragedians through deception as related in a delightful anecdote by Galen.® 1. E. G. Turner, ‘L’érudition alexandrine et les papyrus,’ Chronique d’ Egypte, 1962, 37, 135-152. 2. Athenaeus, Deipnosophistae, ı, 22d. In further notes, references without citation are to Athenaeus. 3. Diodorus Siculus, mm, 36, 3 f. 4. Galen (ed. Kühn), xv, 1, 606. $. Galen, XVII, 1, 607. [ 194

Erudition and criticism, rather than spontaneous creativity, comprised the general activity within the Museum, and the first participants were poetscholars or philosopher-scientists with little specialized knowledge.® Later scholars made no pretence of being poets, although a tendency had developed for physicians to pursue poetry as well.” Their literary production at the Museum was phenomenal. In addition to the important work of Herophilus and Erasistratus, physicians wrote critical studies of Hippocrates, his influence and practice, and many vol. umes on the art of cookery, investigations of traditional superstition, 10 perfumes,!! proper arrangement of wreaths,12 banquets,13 drugs,14 the approaches of medical practice, and in particular, diet.15 Each category came within the province of what the physician was supposed to do, and we discern the influence of Diocles and Diphilus of Siphnos in many of these works.16 Diocles, Diphilus, and Praxagoras wrote much on medicine, but it appeared in the context of ‘investigation’ or ‘philosophy’ rather than as a category of ‘physician’s services. 17 These physicians remembered Hippocrates’ maxim on the limits of their art,18 yet attempted to bring as 6. Nicias, a physician and friend of Theocritus, wrote poetry as one of his major activities. Greek anthology (Loeb), VI, 122, 127, 270; VII, 200; IX, 315, 564. Cf. A. S. F. Gow, Theocritus (Cambridge, 1952), I, xix, n. 3; II, 210 (XI, 7). 7. Plutarch, Spartan sayings, 218F (in period of Archidamus III, son of Agesilaus, king of Sparta, 361-338 B.c.). The question is posed to Periander, the physician, ‘Why do you ardently desire to be called a bad poet rather than a good physician?’ 8. Apollonius of Citium wrote eighteen books refuting Heracleides’ commentaries on Hippocrates. Erotian (ed. Klein), 32, 1. Zenon, a Herophilean (c. 200 B.c.) wrote two books in commentary on medical histories in Hippocrates. Galen, xvın, 1, 618. 9. XII, 516d; vir, 324a [Erasistratus wrote a book, Art of cookery}. xu, 516c [Philistion of Locris (fl. c. 380 B.C.) wrote an Art of cookery]. 10. VII, 312€ [Andreas, physician to Ptolemy IV, killed at the Battle of Raphia, 217 B.c. (Polybius, v, 81. 6), wrote On popular superstitions.| 11. XV, 688e-689b; Pliny, xm, 1. 2 [Apollonius Mys wrote On perfumes]. 12. XV, 675a, 676c, 691f [Philonides wrote On perfumes and wreaths]. 13. 1, 5b [Dieuches taught Numenius of Heracleia who wrote On banquets]. 14. Caelius Aurelianus (ed. Drabkin), Chronic diseases, v, 1. 23 [Philistion of Locris wrote On remedies], vu, 312e; Dioscorides (ed. Wellmann), 1, pr. (1, 13), 111, 127, Iv, 64, 118 [Andreas wrote On poisonous animals and general drug treatises]. 15. XV, 665e-666a [Erasistratus wrote On general practice]. 16. 11, 59a [Menodorus wrote treatises on pumpkins, squash, cucumbers, and melons]. Caelius Aurelianus, Chronic diseases, 11, 8. 147 [Philistion of Locris wrote a book on when one should drink]. 111, 118b; xv, 681c [Hicesius wrote On materials for food]. Diphilus of Siphnos wrote many treatises on diet, as On salt fish, and On foodfor sick and well (vid. notes following on Diphilus in Athenaeus). Diocles of Carystos (fl. c. 360 B.c.) wrote On health [11, 61c], Art of cookery [xn, 516c], On deadly drugs [xv, 681b], works on fish [m, 110b, 116e; vu, 301c, 305b, 309c, 316c, 319b, 320c, 326a, 329f], crustaceans [m, 105b—c], nuts [m, 57b, 59b], the properties of water and wine [I, 32d; 11, 46d]. 17. Vid. F. Steckerl, Thefragments of Praxagoras of Cos and his school (Leiden, 1958), introduction and commentary on Praxagoras’ system of medicine. 18. L. Edelstein, The idea of progress in classical antiquity (Baltimore, 1967), pp. 27-40, 70-80, 105,

Journal of the History of Medicine : April 1970 much knowledge as possible into the scope of their investigation. Nonetheless, their ‘research’ tended to be bookish rather than experimental, and the tradition of Hellenistic medicine—with the important but unusual exceptions of Herophilus and Erasistratus—formed around a series of physicians’ commentaries upon earlier works. Diphilus of Siphnos became famous for his works on diet while the Museum was in its heyday,1? and he influenced other Alexandrian authors. Although he appears to have exerted great influence on Alexandrian medical writing, we are puzzled that our sole source for the fragments of Diphilus is Athenaeus. Galen does not use Diphilus in his summation, but Athenaeus borrows heavily from him. Perhaps Diphilus’ work was superseded by Hicesius or Heracleides of Tarentum.?° Galen’s medicine varied greatly from Diphilus. From what is left of Diphilus’ work, from On Food for Sick and Well or On Salt Fish, to the extensive extracts Athenaeus gives us, we note that Diphilus fits well into the bookish, scholarly medicine characteristic of the Alexandrian doctors, but is opposite to Galen who sought to experiment on his own. Athenaeus recognizes the importance of Galen, but observed that he had “published more books on medicine and philosophy than any of his predecessors’ in contradistinction to another physician who possessed the necessary compassion to be a doctor.?! Herophilus’ work was in line with the desire of the Ptolemies for ‘practical discoveries’ at the Museum,?? and his tract On Dietetics was considered to be an important practical treatise.23 In contrast to Diphilus, Herophilus included much material on drugs, general hygiene, gymnastics, and anatomy in an attempt to formulate a system of medicine.?* Diphilus felt proper diet, and a knowledge of good and bad foods sufficed to give the doctor—and apparently the patient—a solid base for the preservation of health. 19. M. Wellmann, in Pauly-Wissowa-Kroll, v, pt. I, 1155. 20. Galen, x1, 795; xm, 583. Cf. Dioscorides, 1, pr. (I, 9). 21. 1, 1e-£. 22. T. W. Africa, Science and the state in Greece and Rome (New York, 1968), p. 50. 23. M.Wellmann, ‘Uber Träume,’ Sudhoffs Arch. Gesch. Med., 1924, 61, 70-72, and Pauly-WissowaKroll, xv, 1104-1110. In connection with his dietary concepts, Herophilus integrated the use of drugs. Drugs were ‘the hands of the gods’ to Herophilus [Galen, xm, 966], and drugs were the most important part of successful medical treatment, according to Herophilus [Celsus, v, Prooemium, 1. Caelius Aurelianus, Chronic diseases, 11, 13. 186]. 24. J. F. Dobson, ‘Herophilus of Alexandria,’ Proc. roy. Soc. Med. (sect. Hist.), 1924, 18, 19-32. Celsus, Prooemium, 23-27 (the story of human vivisection at Alexandria by Herophilus and Erasistratus), accepted by L. Edelstein, “The development of Greek anatomy,’ Bull. Hist. Med., 1935, 3, 235-248 [238; 246], and I. E. Drabkin, ‘On medical education in Greece and Rome,’ Bull. Hist. Med., 1944, 15, 333-351 [340]. Vid. J. Scarborough, Roman medicine (Ithaca, New York and London, 1969) Appendix mi [fragmentary evidence does not warrant definite conclusions].

Wellmann thinks Diphilus was the personal physician of Lysimachus,?5 but all Athenaeus says about him is ‘he lived during the time of King Lysimachus.'26 The study of botany and its relation to medicine was most important for Diphilus, and his fragments reflect this emphasis. He stood in the tradition of Aristotle and Theophrastus and carried their thoughts to the logical conclusion as he spoke of the various properties of given fruits, vegetables, nuts, and the like, so that the interested reader might consult such data for himself. He thus symbolizes the non-specialist approach to medicine in contrast to Herophilus, Erasistratus, and Galen. His experience with patients and their digestive problems makes Diphilus fascinating reading, even though we get but a faint shadow of his efforts through Athenaeus’ quotations. Athenaeus’ work was devoted to elucidating the pleasure of eating the right foods at the right time, and Diphilus provided a guideline upon which to build the proper concepts for the Deipnosophistae. Small fruits were cited by Athenaeus from Diphilus, and each fruit is given specific properties according to the ‘medical’ analysis of Diphilus and others. The damson27 was described as fairly juicy, perishable, easily urinated, and having little value as food.28 Cherries were wholesome, juicy, but had small nourishment. They were good uncooked, and the red, Milesian type were best and made a good diuretic.?? Mulberries were juicy, had little nourishment, but were easily digested and wholesome. The eating of unripe mulberries could expel worms.59 In regard to nuts, Diphilus wrote of ‘royal nuts’ (walnuts) and their use to the culinary epicure. Walnuts caused headaches and felt heavy when eaten but were good tasting. Young, sun-bleached walnuts were better since they were juicier, but roasted walnuts had little food value. Diphilus put almonds into his diuretic column and thought they were cathartics with small value as food. Nuts from Thasos and Cyprus were better, particularly if they were dried while young and tender. They, too, were easily excreted. Dried almonds caused flatulence and felt heavy when eaten, but less than green almonds which caused gas in the bowels and had little food value. Pontic nuts caused headaches but felt lighter in the stomach than walnuts.51 25. M. Wellmann, in Pauly-Wissowa-Kroll, v, pt. 1, 1155. 26. II, SIA. 27. The Damson is a small purple fruit of the plum Prunus institia, later introduced into Europe from Asia Minor. 28. 11, sob. 29. II, 514. 30. II, sıf. 31. II, $4a—b.

Journal of the History of Medicine : April 1970 Chickpeas were hard to digest, performed the duties of purgative and diuretic, and caused flatulence. Chestnuts were easily digested if roasted and caused less bowel gas than those not cooked as long. Lupines were a purgative, particularly if they were soaked and sweetened for a time in good wine. Olives were worthless as food and caused headaches.32 Pine kernels soothed the bronchi and cleared the diaphragm since they contained the ‘resinous principle.’3? Mallow could ‘soften’ the bronchi as well as carry off the bitter humors on the top of the stomach, and could be used to soothe irritations of the bladder and kidneys.34 Colocynths were easily digested, easily excreted, contained a good amount ofjuice, and added moisture to the body. Combined with honey and vinegar, colocynths were more nourishing.35 Diphilus classed mushrooms as laxatives which caused flatulence.3° Mushrooms were dangerous for the amateur food-fancier since there were various types; the black, brightly-colored, or hard varieties were poisonous. If mushrooms became tough on cooking, they were to be avoided. Diphilus prescribed antidotes for the harmful ones: hydromel, or honey in vinegar, or soda and vinegar.37 Ormenos, or ‘cabbage-asparagus, was nourishing and easily excreted. It functioned as a diuretic but was hard on the kidneys and bladder, and did grave harm to the eyes.3® Bulbs, in general, were high in food value and were excellent purgatives but dulled the eyes. They had the power to rouse sexual desire.?? Lettuce caused bowel gas, checked sexual desire, helped bring on sleep, and had general cooling properties. The tuber colocasium, or the Egyptian bean, was a laxative and caused much flatulence.4! Cucumbers had cooling properties, as had lettuce, and provoked bile while inhibiting desire for sexual intercourse.42 Figs were easily digested and easily excreted.43 Green apples were not good for any purpose unless one wanted to make his guests sick. Ripe apples had good juices which were easily excreted.** Persian apples (peaches) were more nourishing than apples.45 Diphilus’ book, On Salt Fish, seems to have been written to prove that salt water food was generally not desirable. Sea nettles eased the bowels 32. II, $4c-56a. 33. 11, 57C: Aldudos è’ 6 Zipriôs pnow: ‘oi orpoBidror moNdrpopor pev elcı, Acavrırol de àprnpias Kai Owpaxos kadaprırol da TO Exeıv mapeumren‘eyuevov TO ónTivOdes.' 34. II, S8e-£. 40. 11, 69e-£. 35. 11, s9b. 41. IH, 732. 36. n, 61d-e. 37. 11, 61d. 38. 11, 62 f. 42. III, 74C. 43. In, 8ob-c. 44. 111, 80e. 39. 11, 64b.

and were good as a diuretic, but only moderately nourishing. They were extremely bothersome to gather as they caused grievous itching to those who gathered them up.46 Oysters were usually wholesome and digestible, but the larger ones were difficult to digest. Mussels were diuretic, and ‘razor-fish’ were good only for those who had bladder stones or who suffered ‘strictures.’47 Saltfish were generally purgative and gave little nourishment.48 The last glimpses (through Athenaeus) of Diphilus’ system of dietary medicine are of turnips, cabbage, beets, carrots, and leek. Turnips were hard to digest and caused flatulence. The best cabbage came from Cyme, but the bitterest from Alexandria. Beets were juicier than the cabbage and, boiled with mustard, could aid in expelling worms. Red beets were good as a diuretic. The carrot was pungent and nourishing and could be used to increase sexual desire. The leek caused bowel gas.*? Athenaeus reproduced some of Diphilus’ writing because it touched on subjects his learned diners could discuss and what they would be interested in learning. The diseases or discomforts mentioned along with the discursive topics were those suffered by the aristocratic classes in the Roman Empire of Athenaeus’ day, and the discussion and relevant quotations from the various authors—medical and non-medical—remind us of the general concepts of ancient dietetics as a whole. The problem was simply how a healthy man could remain healthy.5° Such questions were asked in antiquity only by those who could afford the time to consider them—that is, the upper class with leisure to plan a day of healthy activity and pleasing food. In the Roman Empire, with its nobility that worked as a part of the imperial bureaucracy or lived in the tradition of the well-to-do gentleman farmer, the concern was basically limited to good diet. The proper Roman aristocrat was already known for his activity and diligence in government and legal activities. The contrast with the ideal Greek or Hellenistic upper class is apparent. Plato expressed the idea that medicine cures a patient by reorganizing his life, but the wealthy could become invalids and indolent by devoting their full efforts to the preservation of health.5! Athenaeus borrows that part of Diphilus’ dietetics which harmonized with the re46. IH, 90a. 47. 11, 90c-d. 48. 11, gıe-f; 106c-d. 49. IH, 120f-121a; VII, 3554-3572. 50. Celsus, 1, 1. L. Edelstein, “The dietetics of antiquity,’ in O. and C. Lilian Temkin, eds., Ancient medicine: Selected papers of Ludwig Edelstein (Baltimore, 1967), pp. 303-316. $1. Plato, Republic, m, 406c.

Journal of the History of Medicine : April 1970 molded Hellenistic medical ideal in the Roman Empire. A knowledge of diet, particularly of the vegetable variety, was an important part of ‘how to stay healthy.’ The problems which dietary medicine sought to answer were those troubling the rich with their varied banquets and elaborate cuisine.52 Diphilus believed proper diet was the major path to good health, and borrowed many of his ideas from earlier writers, particularly those of Attic origin.53 The Athenian influence upon Hellenistic dietetic medicine can be traced through Aristotle to Diocles of Carystos, and perhaps back to Plato who presented some dietary ideas couched in ethical considerations. The Hippocratic corpus notes that diet is necessary to promote health and that without health, one’s wealth and leisure are useless.5 The study of dietetics was a concern of Praxagoras of Cos, who was one of the physicians to bring the study of “dietetics to perfection.'36 Athenaeus lumps Diocles, Praxagoras, and Diphilus together as he uses them to describe dietary theory,57 and Galen borrows from Praxagoras and Phylotimus on diet, but not from Diphilus.58 Praxagoras, like Plato, linked the study of gymnastics to diet,59 but Diphilus developed diet as a sole means to health and probably influenced Hicesius, whom Rufus of Ephesus, Galen, and Caelius Aurelianus remembered for his special plaster rather than his dietary methods. Athenaeus reflects opinions about the philosopher-physician in his own time. His ‘Galen’ quotes Diphilus,°! and ‘Galen’ was widely published, but not noted for medical practice. The fragments of Diphilus’ writings represented in Athenaeus allow a few general conclusions about his concept of dietary medicine. Diphilus had a layman’s command of anatomy, that is, he displayed a general knowledge of the major internal organs. His medicine could be understood by his patients, and they followed his suggestions about diet because 52. Plutarch’s essay, Advice about keeping well, shows this. Cf. Apicius, The art of cooking (The Roman Cookery Book’), text and trans., B. Flower (London, 1958). 53. u, 62f. 54. Plato, Gorgias, 464A-465C. W. Jaeger, Diokles von Karystos (Berlin, 1963), pp. 45 ff. ss. Hippocrates, Regimen in health [Loeb], 1, passim. 56. Steckerl, Fragments of Praxagoras, fr. 36. $7. 11, 46d. Steckerl, fr. 41. 58. Steckerl, fr. 42. 59. Steckerl, frs. 43, 44. 60. M. Wellmann, ‘Diphilus und Hikesios,’ Jb. Philol., 1888, p. 364 ff. Rufus, 284. Galen, m, 787. Caelius Aurelianus (n. 14), pp. 611, 787, 915. 61. m, 115e. [On qualities of bread from Diphilus’ Foodfor sick and well (wheat bread most nourishing; bread of refined flour best; bread of ordinary wheat second choice; bread from unsifted flour third choice; bread from barley last choice)]. Cf. L. A. Moritz, Grain-mills and flour in classical antiguity (Oxford, 1958), pp. 160-161, 208-209.

they made good sense, not because they were a part of a mysterious store of information possessed only by the doctor. He was one of the Hellenistic physicians who elaborated upon theories of diet which had a long history from the time of Pythagoras to his own day. Diphilus’ medicine contrasted sharply with the anatomical or physiological approach of Herophilus and Erasistratus, but his medicine was more typical of his age. Department of History University of Kentucky Lexington, Kentucky