After considering On Breaths’ “Gorgianic” style and the disputed attribution of this text to Hippocrates, this chapter argues that the author’s attribution of all diseases to pneuma is not as revolutionary as it initially appears. By relying on widely attested views about what pneuma tends to do within the body, this author is in fact remarkably conservative when constructing his own theories of pathogenesis. This chapter then turns to the more important question of why this author felt compelled to identify a single cause of all diseases. On the one hand, we can point to the same interest in remote and proximate causes that we see in On the Nature of the Human Being. At the same time, this author seems to be driven by a separate “cosmological impulse,” the belief that high-level commonalities, whatever their applicability, are inherently desirable and directly relevant to the medical art.

During the fifth and fourth centuries bce, a number of Greek doctors attempted to base the art of healing on the first principles of all things in general. These “cosmological doctors” included such thinkers as Eryximachus, Philistion, Petron, the unnamed opponents of On Ancient Medicine, and the authors of On the Nature of the Human Being, On Breaths, On Flesh, and On Regimen. Previous studies have approached these thinkers under the rubric of medicine's interactions with “philosophy.” This book, by contrast, will approach them from a medical point of view, arguing that the best way to understand these systems is to view them as responses to preexisting modes of medical thinking.

This chapter uses three secondhand reports (the testimonies on Petron and Philistion in the Anonymus Londiniensis, the speech of Eryximachus in Plato’s Symposium, and the treatise On Ancient Medicine) to point out that an interest in cosmological principles does not preclude more traditional explanations of health and disease. Petron, Philistion, and Eryximachus all combine their first principles with lower-level discussions of the humors, pneuma, and the “powers” of food and drink. Instead of replacing humors with cosmic principles, these doctors constructed multitiered narratives of pathogenesis, placing humors and cosmic principles at different points in the causal chain. After making this point, this chapter then demonstrates that the polemical On Ancient Medicine is an unreliable witness to what the cosmological doctors were doing. Whereas the author of this text claims that the prioritizing of such principles as the hot and the cold is incompatible with the attribution of diseases to the humors, the cosmological doctors were in fact more than comfortable with combining first principles with more traditional beliefs about the body.

This chapter proposes solutions to some longstanding problems surrounding the anthropogony of On Flesh. First, it shows how the author’s three main principles of the hot, the cold, and the wet reflect widely attested beliefs about the effects of heat and cold on bodily fluids. After that, it argues that the author’s two supplementary principles of the “fatty” and the “glutinous” are derived from a traditional dichotomy between bile and phlegm. The upshot of these observations is that the author of On Flesh uses the microcosm of the body as a tool for understanding the macrocosm of the universe. For this author, the natural world is primarily a reflection of the body (not the other way around), and it is specifically medical knowledge that gives him insight into the cosmos. Just as Eryximachus claims to have acquired his awareness of the universal power of eros “from medicine, our art” (ἐκ τῆς ἰατρικῆς, τῆς ἡμετέρας τέχνης, Pl. Smp. 186a), so the other cosmological doctors viewed medicine as a privileged starting point for contemplating the universe as a whole.

This chapter is devoted to On Regimen, the longest and by far most complex work by a cosmological doctor to have survived from the Classical period. Topics discussed include the “self-sufficiency” (autarkeia) of fire and water, the pendular movement of various cycles, the two-way “resemblance” (apomimesis) between the body and the cosmos, and the use of both cosmological principles and “prodiagnosis” as a solution to the problem of individualization. This chapter also considers On Regimen’s theories about the soul, which is concentrated in the sun and separates off into other, smaller souls to give movement, life, intelligence, and divinity to everything it inhabits.

In On the Nature of the Human Being, Polybus claims that the humors, like everything else, are composed of four substances: the hot, the cold, the dry, and the wet. He also discusses humoral flux – the idea that a single humor, after gathering in one part of the body, can create a wide range of effects by flowing to different parts. This chapter argues that Polybus’s thinking about cosmological principles is closely tied to his interest in humoral flux. Both concepts are motivated by an interest in tracing diseases to their “source” (arche), and both ultimately establish a two-pronged approach to treatment, wherein doctors are expected to target both the proximate cause of a disease (i.e., a concentrated humor) and its remote cause (i.e., the factor(s) that initially caused that humor to separate out). This chapter further argues that an interest in individual differences does not preclude a coexisting interest in cosmological principles. Instead, Polybus presents his cosmological principles as a solution to the problem of individual variation, identifying the shared “nature” (phusis) of human beings as a high-level commonality that transcends individual differences.

In Chapter 1, we encountered the following testimony for Alcmaeon of Croton, a nebulous figure who seems to have been active at some point in the fifth century bce (DK 24 B4).

This chapter argues that the cosmological doctors arose as the result of a much wider realignment in Classical Greek medicine. As some doctors grew increasingly concerned about the many variables that can change from one case to the next, they rejected older forms of diagnostic handbooks in favor of new methods for organizing medical knowledge. We see this anxiety over individual differences not only in the works of the cosmological doctors but also in texts such as On Regimen in Acute Diseases, Prognostic, Airs Waters Places, and the seven books of Epidemics. In all of these texts, medical inquiry is defined, quite generally, as a search for commonalities. Doctors in this period were gathering together multiple accounts, noting the similarities and differences between those accounts, and isolating high-level generalizations that can unite and govern them all. Although the cosmological doctors took their search for commonalities farther than some of their contemporaries might have been willing to follow, they nevertheless responded to the same pressures that transformed nearly all the medical literature that survives from this period.

The account of the best life for humans, that is, of happy or flourishing life, was the central theme of ancient ethics. This book addresses other important questions about the value of life that likewise received much discussion in antiquity: What does it take to have a life that, if not happy, is at least worth living, in comparison to being dead or never having come into life? Does every human life have some non-instrumental value that makes it worth living? And do all lives that are worth living for those who live them also have to be meaningful, in the sense of making a positive contribution to other humans or world at large? In reconstructing, for the first time, philosophical engagements with these questions from a range of ancient philosophers, from Socrates to Plotinus, the work offers a fresh narrative of ancient ethics. It explores these views against the background of the pessimistic outlook on the human condition adopted by the Greek poets, but also points out continuities and contrasts between the ancient perspective and modern philosophical debates about related themes in biomedical ethics and in the ethics of procreation.