Athenaeus of Attaleia On The Elements of Medicine

apeiron 2024; aop
David Leith*
Athenaeus of Attaleia on the Elements of
Medicine
https://doi.org/10.1515/apeiron-2023-0079
Received August 23, 2023; accepted February 14, 2024; published online March 11, 2024
Abstract: Athenaeus of Attaleia (fl. mid-first century BC) offers a fascinating

example of the interest among Graeco-Roman physicians in marking out the
boundaries between medicine and philosophy. As founder of the so-called Pneu-
matist medical sect, he was deeply influenced by contemporary Stoicism. A number
of surviving ancient testimonia tell us that he held a distinctive view on the question
of how far medicine should analyse the composition of the human body. Rather than
having recourse to the Stoic cosmic elements fire, air, earth and water, he maintained
that in the context of the medical art, the relevant elements were the elemental
qualities hot, cold, wet and dry. This paper is an attempt to pin down Athenaeus’
position on these issues, and his motivations for holding it, despite a number of
conflicting and problematic claims in the surviving evidence.
Keywords: Athenaeus of Attaleia; Stoicism; medicine; philosophy; elements; Galen
1 Introduction: The Elements of Medicine

Graeco-Roman theoretical medicine, from the Classical period through to Late
Antiquity, owed a great deal to contemporary philosophical theories.1 Yet even, or
1 For accessible overviews of the influence of philosophy on medicine in the Classical period
especially, see the introduction to van der Eijk (2005), van der Eijk (2008), Frede (1987); for the Roman
period, see Leith (2023).
I am especially grateful to Sean Coughlin for discussing Athenaeus with me on many occasions and for
very helpful feedback on a penultimate draft, as well as for the initial opportunity to develop the paper for
a workshop on the Pneumatists in Berlin in 2015. I would also like to thank Inna Kupreeva for an invitation
to speak in Edinburgh in 2017, and Alessia Guardasole and Julien Devinant for inviting me to give the paper
for their Paris seminar in 2021. I am grateful, too, to them and the various audiences for important
suggestions, to Peter Singer for discussing many relevant issues over the years, and finally to Apeiron’s
anonymous referees for their feedback.
*Corresponding author: David Leith, Classics, Ancient History, Religion and Theology, University of
Exeter, Amory Building, Rennes Drive, Exeter, EX4 4RJ, England, E-mail: d.b.leith@exeter.ac.uk
Open Access. © 2024 the author(s), published by De Gruyter. This work is licensed under the
Creative Commons Attribution 4.0 International License.
2 D. Leith
perhaps especially, where this influence was very substantial, it is clear that doctors
were often concerned to mark out precisely the boundaries between medicine and
philosophy. Athenaeus of Attaleia (fl. mid-first century BC) offers a fascinating
example of this tendency.2 As founder of the so-called Pneumatist medical sect, he
was deeply influenced by contemporary Stoicism. A number of surviving ancient
testimonia tell us that he held a distinctive view on the question of how far medicine
should analyse the composition of the human body. Rather than having recourse to
the Stoic cosmic elements fire, air, earth and water, he maintained that in the context
of the medical art, the relevant elements were the elemental qualities hot, cold, wet
and dry. This paper is an attempt to pin down Athenaeus’ position on these issues,
and his motivations for holding it, despite a number of conflicting and problematic
claims in the surviving evidence.
Before turning to the relevant testimonia, however, it will be helpful to fill in
some more details on Athenaeus’ philosophical background and its significance for
his medical theory. As Galen tells us, Athenaeus had been a pupil of Posidonius of
Apamea, and developed a medical system influenced directly by Stoic physics.3
T1 As for Athenaeus of Attaleia, he founded the medical sect known as that of the
Pneumatists. It suits his doctrine to speak of a ‘sustaining’ cause in illness since he
bases himself upon the Stoics and he was a pupil and disciple of Posidonius. …
Athenaeus’ three types [of causes] are as follows: first that of the sustaining
[i.e. συνεκτικά] causes, then that of the preceding [i.e. προηγούμενα] causes while the
third type is comprised of the antecedent [i.e. προκαταρκτικά] causes. This latter
term is applied to externals whose function it is to produce some change in the body.
… Alterations are produced in the innate pneuma by these causes together with
those that are external, leading to moisture, dryness, heat or cold, and these are
known as the sustaining causes of disease. For, in Athenaeus’ view, the pneuma,
having penetrated the homoeomerous parts of the body, changes them through its
own change and assimilates them to itself … The sustaining cause of the disease is
the pneuma, which has gone too far towards either heat, cold, dryness or moisture.
What the adherents of this school call antecedent causes are the fluids produced in
our bodies when these are too hot, cold, moist or dry … Of this type [i.e. of antecedent
causes], in their view, are the poisons of venomous creatures, such as that of rabid
dogs, and all drugs.
2 Sean Coughlin is currently preparing a collection of the surviving testimonia on Athenaeus. For
Athenaeus’ significance in the first century BC, see Flemming (2012, 75–77). For recent studies on
particular aspects of his medicine, see Coughlin (2018); Manetti (2019). A more comprehensive,
though out-of-date, study on the Pneumatist sect as a whole is in Wellmann (1895).
3 See now Tieleman (2022).
Athenaeus of Attaleia on Elements 3
Galen, De Causis Contentivis 2 [CMG Suppl. Or. II pp. 54–6 (Arabic and English trans.), p. 134
(Latin)], trans. after Lyons (1969)4
We do not know exactly where Athenaeus studied or practised, but given that his
home town Attaleia in Pamphylia is not far from Rhodes, where Posidonius estab-
lished himself not long after 100 BC, it seems a plausible guess that he studied with
him in Rhodes for some time during the first half of the first century BC.5 The absence
of any reference to Athenaeus or his doctrines in Roman medical writings of the
early Principate, especially Celsus, has suggested to some that his influence may
not have immediately extended to Rome, though his later followers Agathinus of
Sparta and Archigenes would certainly have a powerful impact on medicine in Rome
in the mid-to later first century AD.6
The role of pneuma was central to Athenaeus’ physiology and pathology, and of
course his followers were later to be referred to as ‘Pneumatists’.7 As the passage
above also indicates, Athenaeus was influenced specifically by the Stoic theory of
pneuma as a substance characterised by a dynamic tension, that permeates, holds
together, and sustains the cosmos and everything it contains.8 Athenaeus held that
this pneuma, which for the Stoics constitutes the substance of animals’ souls, is also
fundamentally responsible for all disease, for it permeates and regulates all of the
uniform parts of the animal body, affecting them directly. The elemental qualities
hot, cold, wet and dry can alter the quality of this pneuma, and when it departs from
its natural state to such an extent that the body’s functioning is impaired, disease
results.9 The pneuma can be altered either directly by the external environment, for
example being heated by the sun or chilled by a cold bath, or internally through
excessively hot, cold, wet or dry fluids which can come to be within the body, such as
drugs, venoms, or a surplus of blood.10 We can see from the beginning, then, that the
elemental qualities hot, cold, wet and dry, which Athenaeus named as the elements
of medicine, are central to his pathology, and of course therefore his therapeutics.
The fundamental importance of physics for Athenaeus’ medical system is
further emphasised by the pseudo-Galenic author of the so-called Introductio sive
4 Lyons’ (1969) translation is based on the Arabic text, which diverges from the Latin in a few places,
but the overall sense of the passage is not in doubt.
5 Tieleman (2022, 209–210).
6 Flemming (2012, 75–76).
7 On the conception of pneuma held by the Pneumatist sect’s various members, see Coughlin and
Lewis (2020).
8 See also ps.-Gal. Int. 9.6 [xix 699 K. = p. 22 Petit], as well as a relevant unpublished testimony from
Galen’s commentary on the Hippocratic Airs, Waters, Places, preserved only in Arabic translation,
quoted and discussed by Coughlin and Lewis (2020, 209–211).
9 For Athenaeus’ influential analysis of causation in general, see Hankinson (1987; 1999).
10 See the full passage at Gal. CC 2 [pp. 54–6, 134 CMG Suppl. Or. II], from which T1 is excerpted.
4 D. Leith
Medicus (Int.). He is said to have maintained that the study of nature (ἡ φυσικὴ
θεωρία) should be the starting point of the exposition of medicine:
T2 ἀρχαὶ οὖν τῆς ἰατρικῆς τρεῖς· ἡ μὲν εὑρέσεως, ἡ δὲ ἐκ τοῦ συστήσασθαι τὴν
τέχνην, ἡ δὲ ὑφηγήσεως. εὑρέσεως μὲν οὖν ἁπλῆς τῶν ἐν τῇ ἰατρικῇ ἡ παλαιοτάτη καὶ
ἄνευ λόγου ἀρχὴ καὶ πεῖρα, ὡς παρὰ Αἰγυπτίοις καὶ πᾶσι βαρβάροις. τοῦ δὲ εἰς
σύστημα τέχνης ἀγαγεῖν τὴν τῶν Ἀσκληπιαδῶν ἰατρικὴν, ταύτης δὲ ἀρχὴ λόγος καὶ
πεῖρα. ὑφηγήσεως δέ, ὥς φησιν Ἀθήναιος, ἢ παραδόσεως, καθώς τινες λέγουσιν, ἀρχὴ
ἡ φυσικὴ θεωρία. ἁπλῶς δὲ καὶ Ἱπποκράτης ἔφη, ἀρχὴ τοῦ ἐν ἰατρικῇ λόγου ἡ φύσις
πρῶτον· ἀπὸ γὰρ τοῦ φυσιολογεῖν ἄρχονται οἱ δογματικοὶ, ἐπειδὴ ἐκ τῶν κατὰ φύσιν
καὶ τὰ παρὰ φύσιν δύνανται εἰδέναι, ἄνευ δὲ τοῦ γνῶναι τὸ κατὰ φύσιν, τὸ παρὰ τοῦτο
ἔχον οὐχ οἷόν τε ἐπίστασθαι.
There are three starting points in medicine: one is the starting point of discovery,
a second is the starting point from the constitution of the art, and a third the starting
point of exposition. In the case of simple discovery of what belongs to medicine, the
oldest starting point is experience without reason, such as among the Egyptians
and all barbarians. The starting point for organising the medicine of the Asclepiads
into the system of an art is reason and experience. The starting point of exposition,
as Athenaeus says, or of instruction, as certain others say, is the study of nature.
Hippocrates said simply: ‘The starting point of the logos in medicine is nature first
of all’ [cf. Places in Man 2.1]. For the Dogmatists begin from natural science, since
from what is in accordance with nature they are able to know what is contrary
to nature, but without knowledge of what is in accordance with nature it is not
possible to understand what is contrary to this.
Ps.-Galen, Introductio sive Medicus 2.1 [xix 676-7 K. = p. 4 Petit]
Hence the student of medicine must be trained in physics first of all, in Athenaeus’
view. It is worth noting that Athenaeus’ teacher Posidonius made the parallel, though
rather different, claim that philosophy should begin with physics, before logic and
ethics, where earlier Stoics like Zeno and Chrysippus had started with logic.11 As far
as Athenaeus’ claim for medicine is concerned, on the other hand, this of course
raises the question of how much physics exactly is required for the medical art, and
I suggest that Athenaeus’ distinctive position on the elements of medicine is intended
to address this question directly.
The focus of this paper, then, will be Athenaeus’ elemental theory, or rather the
sense in which he can be said to have had one. As we have seen, he put a lot of
11 Posidonius fr. 91 Edelstein-Kidd (1972) (= D.L. 7.40–41). White (2007, 36–39), argues that the sort of
priority Posidonius had in mind will have included priority in order of instruction, but most
importantly will have emphasised explanatory priority.
emphasis on the distinction between the ultimate, cosmic elements fire, air, earth
and water on the one hand, and the elemental qualities, hot, cold, wet and dry, on the
other. In particular, he claimed that medicine should be concerned only with the
elemental qualities, and not the cosmic elements. Our surviving sources do not
clearly describe what exactly he meant by this, nor his precise motives for making
this distinction.
Posidonius should be mentioned again in this specific connection, for he also
reflected seriously on the relationship between physics and adjacent or overlapping
disciplines, though most of our surviving evidence pertains to mathematical as-
tronomy. According to him, while the physicist and the astronomer often investigate
the same subjects, they use different methodologies: the physicist will appeal to the
substances or powers of the subjects concerned (e.g. the fiery nature of the sun), their
generation and transformation, and teleological principles; the astronomer, on the
other hand, will appeal only to spatial or temporal attributes of these subjects, using
mathematical models.12 Athenaeus, however, certainly appealed to the substances
and powers of the relevant subjects (notably the elemental qualities) in a way that
seems at least partially comparable to Posidonius’ physicist, so the relationship
between physics and medicine will presumably have been conceived quite differ-
ently from what Posidonius sets out here in connection with astronomy.13 But we
may suppose that Posidonius’ reflections on this general issue of what other disci-
plines may borrow from physics, and what they do differently, will have played their
part in the development of Athenaeus’ views.
The principal sources for Athenaeus’ elemental theory can be divided into two
groups. On the one hand, we have testimonia from two pseudo-Galenic treatises, the
Definitiones Medicae (Def. Med.) and the Introductio sive Medicus quoted from above.
The Definitiones Medicae may originally have been compiled somewhere around AD
100, while the Introductio sive Medicus is thought to have been written perhaps about
50–100 years later, probably during Galen’s lifetime.14 The other major source is a
lengthy critique of Athenaeus’ theory found in chapter 6 of Galen’s treatise On the
Elements According to Hippocrates. In this work, Galen aims to prove that the treatise
12 Posidonius fr. 18 Edelstein-Kidd (1972) (= Simpl. In Phys. 2.2, 292.3–31). For discussion, see White
(2007, 54–62).
13 In Diogenes Laertius’ overview of Stoic physics, there are clear parallels with Posidonius’ account
of the relationship between physics and astronomy (D.L. 7.132–133), but he also refers in passing to
the way in which physics and medicine have overlapping interests within the ‘aetiological’ part of
physics, specifically in their shared investigation of the ruling part of the soul, what occurs within the
soul, seed, etc. (D.L. 7.133); see again White (2007, 60–61). It is not clear to me what relevance this
might have to Athenaeus’ position.
14 For the Def. Med., see Kollesch (1973, 33), and her new edition of the text in Kollesch (2023). For a
recent discussion of the authorship and date of Int., see Petit (2009, xxxvi-li).
6 D. Leith
On the Nature of the Human Being (Nat. Hom.), which at some point came to be
included within the Hippocratic Corpus, is the earliest text which sets out the basi-
cally Aristotelian theory of elements that Galen himself adopts.15 In the course of his
exposition, Galen rejects other elemental theories, most prominently those of the
atomists and related theories, but also Athenaeus’ conception of the elemental
qualities as the elements proper to medicine. As we shall see, Galen’s choice to attack
Athenaeus here may have been motivated in part by Athenaeus’ own rival inter-
pretation of the Hippocratic On the Nature of the Human Being, which contradicted
Galen’s. My principal contention is that a lot of what Galen says about Athenaeus’
approach to the elements is highly misleading, and that we must read carefully
between the lines in understanding what Athenaeus had to say. Once Galen’s
polemical strategies are better understood, it is possible to reconstruct a plausible
theory that fits well with the rest of the evidence. In particular, an interesting and
(partly) original approach to scientific methodology emerges.
Given the difficulties with Galen’s evidence, I shall begin by looking at the
pseudo-Galenic evidence separately, attempting to bring to light the nature of
Athenaeus’ debts to Stoic elemental theory, and in particular the relationship
between the elements of medicine on the one hand and the elements in general on
the other. Section 3 will focus on Galen’s account in light of this. Finally, section 4 will
consider a broadly parallel approach to the role of elements in medicine taken by
Athenaeus’ Hellenistic predecessors Herophilus of Chalcedon and Erasistratus of
Ceos. Like Athenaeus, these two ground-breaking physicians believed that the in-
quiry into the ultimate elements was irrelevant to medicine, though unlike him they
picked out the uniform or homoeomerous parts as the most basic level at which
medicine should analyse the body’s composition. I will suggest that Athenaeus was
directly influenced by these physicians, which in turn helps to illuminate Athenaeus’
general perspective on these issues and the intellectual context in which he was
working.
2 Pseudo-Galenic Testimonia
We may begin with the relevant passage from the Definitiones Medicae. This text may
actually preserve some verbatim material from Athenaeus, and it is worth empha-
sising that the author of this compilation had indicated in his preface to the entire
work that Athenaeus was one of the main sources he had drawn on when gathering
15 For Galen’s Hipp. Elem., and in particular his distinctive reading of Nat. Hom. in relation to his
own theory of elements, see Kupreeva (2014); Leith (2014); Hankinson (2021); Singer (2021).
his definitions.16 Among the text’s hundreds of definitions, there is one for the term
‘element’, στοιχεῖον, and Athenaeus is the only authority mentioned in the entry:
T3 τί ἐστι στοιχεῖον; στοιχεῖόν ἐστιν ἐξ οὗ πρώτου καὶ ἁπλουστάτου τὰ πάντα

γέγονεν καὶ εἰς ὃ ἁπλούστατον τὰ πάντα ἀναλυθήσεται. Ἀθήναιος δὲ ὁ Ἀτταλεὺς ἐν τῷ
τρίτῳ βιβλίῳ φησὶν οὕτως. τίνα ἐστὶ τῆς ἰατρικῆς στοιχεῖα; τῆς ἰατρικῆς στοιχεῖά
ἐστιν, ὥς τινες τῶν ἀρχαίων ὑπέλαβον, θερμὸν καὶ ψυχρὸν καὶ ξηρὸν καὶ ὑγρόν, ἐξ ὧν
πρώτων φαινομένων καὶ ἁπλουστάτων καὶ ἐλαχίστων ὁ ἄνθρωπος συνέστηκεν καὶ
εἰς ἃ ἔσχατα φαινόμενα καὶ ἁπλούστατα καὶ ἐλάχιστα τὴν ἀνάλυσιν λαμβάνει.
What is an element? An element is the first and simplest thing from which
everything has come to be, and the simplest thing into which everything will be
resolved. Athenaeus of Attaleia speaks thus in the third book. What are the elements
of medicine? The elements of medicine are, as some of the ancients believed, hot,
cold, dry and wet – the first, apparent, simplest and least things from which the
human being has been put together, and the last, apparent, simplest and least into
which (the human being) has its resolution.
Ps.-Galen, Definitiones Medicae 29 (31 K.) [xix 356 K. = p. 18.1–7 Kollesch (2023)]
The attribution to Athenaeus is sandwiched between the two definitions, the first
pertaining to elements in general, the second to the elements of medicine in
particular. It seems clear enough, however, that the οὕτως in the third line is meant
to look forwards, so that it is the second definition that is intended to be attributed to
him.17 And given our other surviving evidence, it is certainly this second definition,
on the elements of medicine, which can be associated with Athenaeus: both Galen
and the pseudo-Galenic author of the Introductio likewise tell us that he believed the
elements of the human being are the qualities hot, cold, wet and dry (see below).
Indeed, Jutta Kollesch in her recent edition of the text puts the second definition in
quotation marks, including the introductory question ‘What are the elements of
medicine?’, taking this as a direct extract from Athenaeus’ works. Nevertheless, there
are very close parallels in formulation between the two definitions, each framed by
the cycle of generation out of and dissolution once again into the different kinds of
element, reinforced by the repetition of the adjectives πρῶτος and ἁπλούστατος.
They very much look as if they are meant to form a pair.
16 Def. Med. pref. 3–4 [xix 347.14–348.7 K. = pp. 4.19–6.9 Kollesch (2023)]. Note too that the author
claims to be quoting at least some of his sources verbatim: ibid. [p. 4.7–8 Kollesch], τοὺς εἰρ-
ημένους μὲν ὑπὸ τῶν προγενεστέρων ὅρους αὐταῖς λέξεσιν ἀναγράψομεν.
17 Cf. also Def. Med. 169 (155/157 K.) [xix 392.10–16 K. = p. 68.4–9 Kollesch (2023)].
8 D. Leith
It is also important to observe that there is clear Stoic influence on both defi-
nitions, i.e. of elements in general, and of the elements of medicine in particular. The
standard Stoic definition of element as preserved by Diogenes Laertius shows
evident verbal parallels:
T4 ἔστι δὲ στοιχεῖον ἐξ οὗ πρώτου γίνεται τὰ γινόμενα καὶ εἰς ὃ ἔσχατον ἀνα-

λύεται. … εἶναι δὲ τὸ μὲν πῦρ τὸ θερμόν, τὸ δ’ ὕδωρ τὸ ὑγρόν, τόν τ’ ἀέρα τὸ ψυχρόν,
καὶ τὴν γῆν τὸ ξηρόν.
An element is the first thing from which what comes to be comes to be, and the
last thing into which it is resolved. … Fire is the hot (element), water the moist, air the
cold and earth the dry.
Diog. Laert. 7.136–7 (SVF 2.580)
Chrysippus’ analysis as reported by Stobaeus also shows important points of contact:
T5 τὸ δὲ κατ’ ἐξοχὴν στοιχεῖον λέγεσθαι διὰ τὸ ἐξ αὐτοῦ πρώτου τὰ λοιπὰ

συνίστασθαι κατὰ μεταβολὴν καὶ εἰς αὐτὸ ἔσχατον πάντα χεόμενα διαλύεσθαι, τοῦτο
δὲ μὴ ἐπιδέχεσθαι τὴν εἰς ἄλλο χύσιν ἢ ἀνάλυσιν.
The element par excellence is so called because the remainder are composed out
of it in the first place by alteration and into it lastly everything is diffused and
dissolved, but it does not admit of diffusion or resolution into something else.
Stobaeus 1.129–130 (SVF 2.413), trans. Long & Sedley 47A
In both Athenaeus’ and the Stoics’ definitions, the element is ‘the first thing out of
which things come to be’ (ἐξ οὗ πρώτου γίνεται or γέγονε), and ‘the last thing into
which they are resolved’, each using a form of the verb ἀναλύω.18 Of particular
18 Cf. also Aristotle’s description of early philosophers’ conception of material principles at Metaph.
1.3, 983b 8–13, ἐξ οὗ γάρ ἐστιν ἅπαντα τὰ ὄντα καὶ ἐξ οὗ γίγνεται πρώτου καὶ εἰς ὃ φθείρεται
τελευταῖον, τῆς μὲν οὐσίας ὑπομενούσης τοῖς δὲ πάθεσι μεταβαλλούσης, τοῦτο στοιχεῖον καὶ ταύτην
ἀρχήν φασιν εἶναι τῶν ὄντων, καὶ διὰ τοῦτο οὔτε γίγνεσθαι οὐθὲν οἴονται οὔτε ἀπόλλυσθαι, ὡς τῆς
τοιαύτης φύσεως ἀεὶ σωζομένης (‘that of which all things that are consist, and from which they first
come to be, and into which they are finally resolved (the substance remaining, but changing in its
modifications), this they say is the element and the principle of things, and therefore they think
nothing is either generated or destroyed, since this sort of entity is always conserved’, rev. Oxford
trans.); and his own definition at Metaph. 5.3, 1014a 26ff., στοιχεῖον λέγεται ἐξ οὗ σύγκειται πρώτου
ἐνυπάρχοντος ἀδιαιρέτου τῷ εἴδει εἰς ἕτερον εἶδος, οἷον φωνῆς στοιχεῖα ἐξ ὧν σύγκειται ἡ φωνὴ καὶ
εἰς ἃ διαιρεῖται ἔσχατα, ἐκεῖνα δὲ μηκέτ᾿ εἰς ἄλλας φωνὰς ἑτέρας τῷ εἴδει αὐτῶν (‘We call an element
that which is the primary component immanent in a thing, and indivisible in kind into other kinds,
e.g. the elements of speech are the parts of which speech consists and into which it is ultimately
divided, while they are no longer divided into other forms of speech different in kind from them’, rev.
Oxford trans.).
importance, too, is the way that all the definitions of the cosmic elements appear to
reflect the Stoic doctrine of the conflagration.19 According to this, the universe is
periodically reduced to a state in which all compounds and all the elements no longer
have a separate existence. After this conflagration, the other three elements are
successively separated out of an elemental and originary fire, and as these four
elements subsequently blend together they generate all the things in the universe.
Everything terrestrial is a compound, while the sun, for example, is made of a single
pure element, namely fire, and the moon a combination of fire and air.20 The life
cycle of the universe then proceeds in precisely the same, perfect way as it had
previously until all the elements are reduced once again into the originary fire and
everything (except god and matter) is consumed by the conflagration. In Athenaeus’
definition of the elements of medicine, on the other hand, there is an implied par-
allel between the cycle of cosmic generation and dissolution between conflagrations,
and the life cycle of the human being. Just as the cosmos is created from the elements
at the beginning of the cycle, and ultimately resolved into them again before the next
conflagration, similarly humans are generated at first from hot, cold, wet and dry,
and ultimately resolved into these again after death.
So, whether or not the Definitiones Medicae text means to associate the first
definition with Athenaeus as well, there are strong indications that the elements
of medicine are to be understood generally against the background of the Stoic
theory of elements. This is suggested not only by the firm conceptual links between
them, but also of course by the fact that Athenaeus was a pupil of the most prominent
Stoic of his age, Posidonius. It is also corroborated by Athenaeus’ Stoicising theory
of causation, and his conception of pneuma as a permeating and regulating
substance in the body, both described above in T1.
The other pseudo-Galenic testimony, from the Introductio sive Medicus,
emphasises the distinction between cosmic elements and the elements of human
beings in a similar manner:
T6 κατὰ δὲ τὸν Ἀθήναιον στοιχεῖα ἀνθρώπου οὐ τὰ τέσσαρα πρῶτα σώματα, πῦρ

καὶ ἀὴρ καὶ ὕδωρ καὶ γῆ, ἀλλ’ αἱ ποιότητες αὐτῶν, τὸ θερμὸν καὶ τὸ ψυχρὸν καὶ τὸ
ξηρὸν καὶ τὸ ὑγρόν, ὧν δύο μὲν τὰ ποιητικὰ αἴτια ὑποτίθεται, τὸ θερμὸν καὶ τὸ
ψυχρόν, δύο δὲ τὰ ὑλικά, τὸ ξηρὸν καὶ τὸ ὑγρόν, καὶ πέμπτον δὲ παρεισάγει κατὰ τοὺς
Στωικοὺς τὸ διῆκον διὰ πάντων πνεῦμα, ὑφ’ οὗ τὰ πάντα καὶ συνέχεσθαι καὶ
διοικεῖσθαι.
19 On the Stoic conflagration, see e.g. Plut. Stoic. Rep. 1052C-D, 1053B (SVF 2.604–605); Hahm (1977,
185–195); Salles (2009); Cooper (2009).
20 Confirmed also for Athenaeus’ teacher Posidonius in frr. 17 and 122 Edelstein-Kidd (1972) (= D.L. 7.
144, Aët. Plac. 2.25.5).
10 D. Leith
According to Athenaeus the elements of the human being are not the four
primary bodies fire, air, water and earth, but their qualities hot, cold, dry and wet, of
which he posits that two are productive causes, hot and cold, and two are material,
dry and wet. He introduces a fifth (element), in accordance with the Stoics, namely
the pneuma which permeates everything, by which everything is held together and
regulated.
Ps.-Galen, Introductio sive Medicus 9.5 [xiv 698 K. = p. 21 Petit]
I shall set aside for the moment this new idea of pneuma as a fifth Stoic element. For
now, I want to focus on what exactly this distinction between the cosmic elements
and the elements of medicine consists in, and why it was felt so important. How are
we meant to understand the relationship between the elements of everything in
general and those of medicine in particular?
A key initial point is that the elements of medicine are specifically the elements
of human beings. Of course, this is unsurprising given that the goal of medicine is
generally taken to be human health. But in the second part of the definition as
preserved in the Definitiones Medicae (T3), Athenaeus picks out a number of further
characteristics which the elements of medicine have. Just like the cosmic elements,
they are ‘first’ and ‘last’ (πρῶτα and ἔσχατα): that is, they are the first things from
which their compound bodies (in this case humans) are generated, and the last things
into which they are finally resolved. Also like the cosmic elements, the elements of
medicine are described as ‘simplest’ (ἁπλούστατα). This is of course an appropriate
characteristic for an element, and we may suppose that the further description of
them as ‘least’ (ἐλάχιστα), which is not found in the definition of the cosmic elements,
merely amplifies this aspect of their nature. However, the fourth characteristic
with which Athenaeus describes the elements of medicine seems much more
important: as he tells us, they are φαινόμενα, which I have translated here as
‘apparent’. That is, the elements of medicine are not the simplest and least of all
physical constituents in general, as the cosmic elements are; rather, they are merely
the simplest and least among apparent constituents.
Now the sense in which these constituents might be ‘apparent’ is perhaps not
itself apparent. In the context of Athenaeus’ definition and the Stoic background, it
seems clear that their status as φαινόμενα marks out an important difference
between the cosmic elements and the elements of medicine. In general, the simplest
and most basic constituents of everything are fire, air, earth and water, as the author
of the Introductio confirms in T6 above – but apparently these need not be
φαινόμενα. In medicine, on the other hand, the simplest and most basic constituents
that are φαινόμενα turn out to be the hot, the cold, the dry and the wet. The most
obvious meaning for φαινόμενα which would make sense of this distinction is
‘perceived’ or generally ‘sense-perceptible’. For the Stoics, the cosmic elements are
differentiated by the single perceptible quality they each possess, fire being hot, air
cold, water moist and earth dry (see T4 above). Athenaeus’ point may have been that
when the doctor is treating human beings, the ultimate, cosmic elements are not
actually directly perceived in the patient – they are not φαινόμενα to him – whereas
the qualities hot, cold, wet and dry are perceived by the senses, and indeed they
represent the most basic level of analysis at the perceptible level. As we shall see in a
passage quoted later (T10), Galen reports that Athenaeus made much of the fact that
none of the cosmic elements – earth, air, fire and water – are found in a pure state in
our bodies. It is part of his justification for excluding them as elements proper to
medicine that the doctor cannot put these cosmic elements into the body or remove
them from it in an unmixed form. Given Athenaeus’ tutelage under Posidonius and
the general influence of Stoic physics on his medical system, it is natural to see the
Stoic theory of mixture at work here, according to which any compound body has
its elements mixed together through-and-through.21 The Stoic category of
through-and-through blending, or κρᾶσις δι’ ὅλου, represented the sort of mixture
whereby the parts of a compound entirely interpenetrate each other throughout. The
components are not merely juxtaposed in the way that different types of grain in
a sack might be, but rather are totally blended with one another and mutually
coextended throughout the blend. Within such a blend, there is no part, however
small, that does not contain portions of all the constituents, so that it is a straight-
forward impossibility in the Stoic system for any constituent element of the body to
be directly perceived by itself.
It must also be borne in mind that for the Stoics the qualities of hot, cold, wet and
dry are not incorporeal, but corporeal entities in their own right, since they can act
and be acted upon.22 If we may jump ahead once again to a passage to be discussed
later (T7), we see that Galen explicitly states that Athenaeus referred to hot, cold,
wet and dry both as qualities and as bodies. This is an important point for under-
standing Galen’s critique, since for him the elemental qualities are strictly incor-
poreal. For now, the point is that, according to Stoic doctrine, at a perceptible level
hot, cold, dry and wet would indeed be the simplest and most basic physical items
into which the human body can be analysed, as Athenaeus concluded.
It is important to emphasise that Athenaeus’ focus on the perceptible elements
need not involve a denial that the cosmic elements are the ultimate constituents of
humans. He merely restricts his scope, in a particular context (in this case the
21 For the Stoic theory of mixture, see esp. Alex. Aphr. Mixt. 3–4, with Todd (1976), esp. 29–73; Long &
Sedley (1987, 290–294); White (2003, 146–149).
22 See e.g. Long & Sedley (1987, 272–274); White (2003, 128–136); Brunschwig (2003, 210–212); Cooper
(2009); and in the context of Pneumatist medicine, Kupreeva (2014, 187–188).
12 D. Leith
medical art), to what is perceptible. We shall see some evidence from Galen later that
suggests Athenaeus in fact accepted that everything is composed of the cosmic ele-
ments, and of course we saw above too that he believed the inquiry into nature
should stand at the beginning of the exposition of medicine.23 We should also bear in
mind that the cosmic elements can in certain cases be directly perceptible, though
not in the case of compounds such as humans. It may be helpful to consider bodies
which, unlike animals, are not composed of a mixture of elements. As noted earlier,
the principal example is the sun, which the Stoics, including Posidonius, held to be
made of a single element, pure fire.24 In the sun’s case, we can clearly perceive the
fire of which it is solely constituted; here there is no through-and-through blending of
the elements. Therefore, it ought to be perfectly permissible to say that the most basic
perceptible, or φαινόμενον, element of the sun also happens to be its cosmic element.
In this case, these distinct levels simply collapse into one another. But of course in a
medical context, given that medicine is concerned with human beings, it follows that
it will be concerned only with bodies compounded of multiple blended elements.
A further point is that it is hard to see why, without some Stoic or comparable
framework in the background, Athenaeus should have focused on just these four
qualities in the first place. After all, there was a whole range of perceptible bodily
qualities that physicians by this time had thought relevant to the aetiology and
therapy of disease: Praxagoras of Cos, for example, ca. 300 BC, had pointed to the
pathological importance of the qualities sweet, salty, acidic, bitter, and so on, in the
body;25 and in the later fifth century BC, the author of the Hippocratic treatise On
Ancient Medicine believed that the mixture of qualities such as saltiness, bitterness,
sweetness, acid, etc., was more important to human health than the hot, cold, wet and
dry.26 Since such qualities are capable of acting and being acted upon, they would
have been just as corporeal as the elemental qualities for the Stoics and Athenaeus.
Accordingly, the priority given by Athenaeus to the qualities hot, cold, wet and dry is
23 Singer (2021, 130–133, 146), argues that Athenaeus took an anti-theoretical or theoretically mini-
malist approach, ‘motivated by a desire to confine oneself to discussion of what is empirically evident
and relevant to medical practice’ (146). While I agree that it was important for Athenaeus that the
elements of medicine be sense-perceptible, I do not think it was motivated by fundamentally
empiricist epistemological commitments: his conception of pneuma, for example, as a substance
composed of hot and cold, permeating and holding together the body’s uniform parts, seems beyond
what would be available to empirical observation.
24 See above n. 20.
25 See esp. Rufus of Ephesus, Onom. 226–227 [pp. 165–166 Daremberg = fr. 22 Steckerl (1958)], along
with Galen’s more tendentious overview at Nat. Fac. 2.9 [ii 140 K. = fr. 21 Steckerl (1958)], which
attempts to assimilate Praxagoras’ theory to Galen’s own Hippocratic humoralism.
26 See VM 14 [i 600–604 L.], with discussion in Schiefsky (2005, 238–254).
difficult to account for without some prior physical apparatus of the sort provided by
the Stoic theory of elements.
In this regard, the second pseudo-Galenic report, from the Introductio sive
Medicus (T6), seems to be misleading. The author attributes to Athenaeus a
straightforward denial that the elements of the human being are the cosmic elements
fire, earth, water and air. As noted, we shall see evidence from Galen later that he did
not actually deny this. His claim was merely that the cosmic elements are not
appropriate for medicine, and should be ignored by the doctor, not that they need to
be rejected entirely. Relatedly, I think that it is also inaccurate to state that pneuma is
a fifth element on the same level as the other four, and indeed the way pneuma is
introduced in T6 clearly sets it apart from them.27 In an important testimony which
survives only in Arabic translation, Galen tells us explicitly that for Athenaeus
pneuma is a mixture of the active qualities hot and cold, which are themselves
described as ‘primary basic components’.28 This is precisely the view that Galen
elsewhere attributes to Chrysippus, where Galen (characteristically, as we shall see
in the next section) also says that this is equivalent to the view that pneuma is a
mixture of the elements fire and air.29 So Galen clearly believed that Athenaeus
adhered to an orthodox Stoic view, according to which pneuma is a composite of two
elemental entities, but not an element itself.30 Moreover, in T6, the pseudo-Galenic
author also implies that the Stoics believed that pneuma was a fifth element, which
was not the case, but reflects the same misunderstanding as with Athenaeus.31
Pneuma was certainly a main component of the human body in Athenaeus’ system,
27 Coughlin and Lewis (2020, 211–212), however, suggest that we might take ps.-Galen’s claim for
pneuma as a fifth element more seriously, ‘as something analogous to the fifth or celestial element
but present within a living thing’, perhaps with Aristotelian influence in the background.
28 In Galen’s (unpublished) commentary on the Hippocratic Airs, Waters, Places. I borrow the
following quotation from Coughlin and Lewis (2020, 209–210): ‘Athenaeus claimed that he and his
adherents followed Hippocrates with this statement and that the pneuma is composed of the primary
basic components, the hot and the cold, and that the pneuma, when balanced, makes the bodies of
living creatures grow, and that Hippocrates calls it “the innate heat.”’.
29 Gal. PHP 5.3.8 [CMG V 4,1,2 p. 306.23–27 de Lacy], τοῦτ’ οὖν τὸ πνεῦμα δύο μὲν κέκτηται μόριά τε
καὶ στοιχεῖα καὶ καταστάσεις, δι’ ὅλων ἀλλήλοις κεκραμ[μ]ένα, τὸ ψυχρὸν καὶ θερμόν, εἴπερ δ’ ἑτέροις
ὀνόμασι καὶ ἀπὸ τῶν οὐσιῶν ἐθέλοι τις αὐτὰ προσαγορεύειν, ἀέρα τε καὶ πῦρ (‘Now (sc. according to
Chrysippus) this pneuma has two parts, elements, or states, that are intermingled throughout, the
cold and the hot, or, if you wish to use different appellations and give them the names of their
substances, air and fire’, trans. de Lacy).
30 For the Stoics’ conception of pneuma, see recently Hensley (2020).
31 Lapidge (1973, 277–278), however, argued on the basis of T6 that some Stoics did in fact conceive of
pneuma as a fifth element (my thanks to Sean Coughlin for drawing my attention to this), but our
other sources state unambiguously that the Stoics posited four stoicheia.
14 D. Leith
and of course it played a crucial role in his theory (his followers were named
‘Pneumatists’ after all), but it was not an element on all fours with the qualities.
For Athenaeus, then, medicine does not proceed to a level of analysis beyond
what is sense-perceptible. In the human body, the most basic perceptible constitu-
ents are the hot, the cold, the wet and the dry, which are themselves corporeal. These
four constituents are not the most basic perceptible elements in all objects, one
obvious counter-example being the sun. However, medicine is not concerned with
the nature of entities such as celestial bodies, but only with that of human beings, in
which, as the Stoic theory of blending entails, the cosmic elements fire, air, earth and
water are not directly sense-perceptible.
3 Galen’s Testimonia (Hipp. Elem. 6)

This basic picture can be further filled out using Galen’s extended critique of
Athenaeus’ views in chapter 6 of his On the Elements According to Hippocrates.
For context, as noted above, Galen is concerned to defend an idiosyncratic inter-
pretation of the Hippocratic treatise On the Nature of the Human Being, according
to which it set out a theory of the ultimate, cosmic elements and derived its pa-
thology and therapeutics from this.32 Athenaeus is brought in as someone who has a
misconceived notion of the elements, one that threatens Galen’s own belief in the
importance of the cosmic elements to medicine.33
We can begin with two relevant excerpts:
T7 οὐ παρακολουθοῦντες δὲ οἱ πολλοὶ τῇ κατὰ τὸν λόγον ὁμωνυμίᾳ συγχέονται

καὶ ταράττονται, καθάπερ καὶ Ἀθήναιος ὁ Ἀτταλεύς, ἅμα μὲν στοιχεῖα τιθέμενος
32 On the tendentiousness and distortive nature of Galen’s interpretation of Nat. Hom., see esp.
Singer (2021).
33 See Kupreeva (2014) for a detailed analysis of Galen’s theory of elements as expounded in Hipp.
Elem. Kupreeva addresses Athenaeus’ theory esp. at 172–188, but develops a rather different inter-
pretation than the one I set out here, in particular taking Galen’s comments more at face value than I
would prefer. She argues that one of the distinctions that Athenaeus made between the cosmic
elements and the elements of medicine is that the latter are derivatively produced by the body’s
pneuma (172–177): while this might perhaps work in the case of the body’s vital heat, it is much less
easy to see how the moist, the dry and the cold in the body could be conceived as the products of the
pneuma; in any case, there is no trace of this conception in the testimonia on the Pneumatists, and it
would seem to be in conflict with the description of Athenaeus’ elements in the Def. Med. passage
above (T3). By contrast, I would maintain that the hot, cold, wet and dry in the body derive directly
from each of the cosmic elements to which the Stoics assigned them. Kupreeva also takes it that the
elements of medicine belong only to organic bodies, but I think this idea is due to Galen’s misleading
polemic (see below).
τἀνθρώπου τὸ θερμὸν καὶ τὸ ψυχρὸν καὶ τὸ ξηρὸν καὶ τὸ ὑγρόν, ἅμα δ’ ἐναργῆ
φάσκων εἶναι τὰ στοιχεῖα καὶ ἀποδείξεως μὴ δεῖσθαι, καὶ ποτὲ μὲν ὀνομάζων αὐτὰ
ποιότητας καὶ δυνάμεις, ἐνίοτε δὲ σώματα συγχωρῶν ὑπάρχειν, εἶτα δεδιὼς ἀέρα καὶ
πῦρ καὶ ὕδωρ καὶ γῆν ὁμολογῆσαι.
But most men, not understanding this, are confused and upset by the verbal
ambiguity; thus Athenaeus of Attaleia made hot, cold, dry and wet the elements of the
human being, and at the same time he claimed that the elements are clearly visible
and do not require proof, sometimes calling them qualities and powers, on occasion
granting that they are bodies, then afraid to agree that they are fire, air, water and
earth.
Gal. Hipp. Elem. 6.1 [p. 102 De Lacy (1972)], trans. after De Lacy
T8 ἀλλ’ ἴσως φήσουσιν οἱ ἀπ’ Ἀθηναίου μηδ’ αὐτοὶ περί γε τούτων ἀποφαί-
νεσθαι μηδέν, ἐπέκεινα γὰρ εἶναι τῆς ἰατρικῆς τέχνης, ἀρκεῖν δ’ αὐτοῖς τὸ θερμὸν καὶ
ψυχρὸν καὶ ξηρὸν καὶ ὑγρόν, ἃ κἀν τοῖς ζῴοις ἐναργῶς δεῖξαι δύνανται, στοιχεῖα καὶ
τῶν σωμάτων ὑποθέσθαι καὶ τῆς ὅλης ἰατρικῆς. τὸ μὲν οὖν ὥσπερ ζῴου τῆς ἰατρικῆς
τέχνης ὑποθέσθαι στοιχεῖα τὸ θερμὸν καὶ τὸ ψυχρὸν καὶ τὸ ξηρὸν καὶ τὸ ὑγρὸν ὅσης
ἀλογίας ἔχεται, τί ἂν ἐγὼ νῦν ἐπεξίοιμι; κεκωμῴδηται γὰρ ὑπὸ πολλῶν ἤδη τὸ δόγμα
καὶ ψόγον καὶ καταγέλωτα οὐ σμικρὸν ἔτι τε πρὸς τούτοις ἀπιστίαν οὐκ ὀλίγην τῷ
παλαιῷ προσετρίψατο λόγῳ.
Perhaps the followers of Athenaeus will say that they themselves make no
statement about these things because they are outside the medical art; they are
content to make hot, cold, dry and wet, which they can clearly point to also in
animals, the elements both of bodies and of the whole of medicine. Why should I now
dwell on the utter absurdity of making hot, cold, dry and wet the elements of the
medical art, as if it were an animal? It is a view that has been ridiculed by many
before now and has subjected the ancient account to no small amount of blame and
derision, and no little distrust besides.
Gal. Hipp. Elem. 6.10–12 [p. 104 De Lacy (1972)], trans. De Lacy
There are a number of familiar points in these two passages: as we have learned from
the pseudo-Galenic sources, Athenaeus refused to analyse bodies in terms of the
elements fire, air, earth and water; rather, he focused on the elements of medicine,
which are the elements of living things, namely hot, cold, wet and dry. Importantly,
these medical elements are marked out as being in some sense apparent or clearly
perceptible. So in the first passage we are told that ‘Athenaeus of Attaleia made hot,
cold, dry and wet the elements of man, and at the same time he claimed that the
elements are clearly visible (ἐναργῆ)’; and in the second passage, we are told that his
16 D. Leith
followers ‘are content to make hot, cold, dry and wet, which they can clearly point to
also in animals, the elements both of bodies and of the whole of medicine’. Galen also
says that ‘perhaps Athenaeus and his followers will say that they themselves make no
statement about’ the cosmic elements ‘because they are outside the medical art’. I
assume that they in fact did say this, and that Galen’s vagueness here is just part of his
rhetoric.
But there are at least two more problematic points that we have not found
evidence for in the pseudo-Galenic testimonies. In the first passage, as noted, Athe-
naeus is made to claim that the elements are evident (ἐναργῆ; De Lacy translates
‘clearly visible’ here, though presumably sight is not the particular focus) and that,
moreover, they do not require proof (ἀποδείξεως μὴ δεῖσθαι). In the second passage,
Athenaeus is portrayed as intending that his claims about the elements of medicine
are about what medicine itself is actually made of. As Galen says, ‘Why should I now
dwell on the utter absurdity of making hot, cold, dry and wet the elements of the
medical art, as if it were an animal?’ We are meant to think that Athenaeus believed
that medicine, i.e. the medical art, was literally made of the hot, the cold, the wet and
the dry. In my view, Galen is just being deliberately obtuse here, trying to score a
cheap point, so that this second claim of Galen’s is an obvious and deliberate mis-
construal of Athenaeus’ definition. By ‘elements of medicine’, just to spell it out,
Athenaeus evidently meant the elements which belong to medicine, which pertain to
it or are proper to it, not the elements of its composition. The elements which belong
to medicine are of course the elements which compose human beings, as we have
seen. This is an important reminder of the level at which Galen can be willing to
operate in his polemics.34
As for Galen’s first claim, that the elements do not require proof, I suggest that it
is a similarly deliberate misconstrual of Athenaeus’ position, though this time less
obviously so. In the text immediately after the first passage quoted, Galen asks
what precisely this claim, that the elements are evident and do not require proof,
amounts to.35 He suggests that it means either (1) that the elements themselves are
evident to sense-perception – i.e. that the existence of hotness, coldness, wetness and
dryness does not require proof; or (2) that the status of these qualities as elements
does not require proof – i.e. it is self-evident that hot, cold, wet and dry are the
elements of humans. Then, in what follows, Galen attributes to Athenaeus this sec-
ond, much stronger, claim, that no proof is required in identifying the elements of the
human being as hot, cold, wet and dry.
34 For such distortions as a feature of Galen’s polemic, see e.g. Tieleman (1996); von Staden (1997);
Allen (2001); Tecusan (2004, 29–36).
35 Gal. Hipp. Elem. 6.4–9 [pp. 102.12–104.6 De Lacy (1972)].
First of all, however, it seems highly doubtful that Athenaeus would have left
such a central claim so ambiguously stated in his original writings as to allow Galen
to wonder about what he actually meant. There is a prima facie likelihood that
Galen is making some sort of dialectical move here. Secondly, we have seen that the
first interpretation is certainly a claim made by Athenaeus. As he set out in his
definition, the elements of medicine are to be φαινόμενα, ‘apparent’, which may be
taken to be equivalent to ἐναργῆ, ‘evident’, in this context. As we saw, too, it was their
perceptible and evident nature that set them apart from the cosmic elements,
and this presumably was an important part of what made them particularly
appropriate for medicine. Thirdly, the second claim, that the status of hot, cold, wet
and dry as the elements of humans does not require proof, would be an extremely
surprising one for Athenaeus to have made. It should have been impossible for him to
take such a claim for granted, since it was denied by all of his contemporary medi-
cal rivals: not only the obvious examples such as the Empiricists and the Asclepia-
deans, but also, as we shall see below, the Herophileans and Erasistrateans.36 We
have also seen how Athenaeus did not take the claim for granted at all, based as it was
on a considerable amount of underlying Stoic physics – and again, I would emphasise
how Athenaeus maintained that physics should stand at the beginning of the expo-
sition of medicine (Τ2).
I suggest then that once more Galen has misrepresented Athenaeus’ words.
Specifically, I suggest that ‘not requiring proof’ is Galen’s own gloss on Athenaeus’
requirement that the elements of medicine be evident to sense-perception. Athe-
naeus certainly spoke of them as φαινόμενα, and there is no reason to think he might
not also have described them as ἐναργῆ, but speaking of them as ‘not requiring proof’
is the basis for Galen’s obvious objection.
The next testimony contains some further distortions along the same sorts of
lines:
T9 ἐθαύμαζον δὲ καὶ πῶς οὐκ αἰσθάνεται συγχέων ἑαυτὸν ὁ Ἀθήναιος, ὃς

θερμὸν μὲν καὶ ψυχρὸν καὶ ξηρὸν καὶ ὑγρὸν ὀνομάζων ἀπαξιοῖ πῦρ εἰπεῖν καὶ ἀέρα
καὶ γῆν καὶ ὕδωρ. ναί φησι. τὰ γὰρ προσεχῆ λαμβάνω τῶν ζῴων, οὐχὶ τὰ κοινὰ πάντων
σωμάτων στοιχεῖα. καλοῦσι δὲ προσεχῆ τὰ οἷον ἴδια καὶ μηδενὸς ἄλλου τῶν ἁπάντων.
36 The Empiricists, of course, rejected all dogmatic theorising into hidden natures, while Asclepiades
of Bithynia developed a theory of matter which posited invisible particles called onkoi, moving
around in void space, as the elements, based ultimately on Epicurean atomism (see Leith (2009)). As
we shall see below in section 4, Herophilus and Erasistratus, like Athenaeus, believed that the inquiry
into the elements fell outside the medical art, but they maintained that the perceptible elements were
the uniform or homoeomerous parts of the body.
18 D. Leith
ἐμοὶ δὲ καὶ κατ’ ἀρχὰς εὐθὺς εἴρηται πάμπολυ διαφέρειν τὰ φαινόμενα στοιχεῖα τῶν
ὄντως στοιχείων. ἔοικα δὲ καὶ νῦν ἐρεῖν ὑπὲρ αὐτῶν διὸ μακροτέρων. εἴπερ
ἐλάχιστόν τι καὶ ἁπλούστατόν ἐστι μόριον τὸ στοιχεῖον, εἴη ἂν ὡς πρὸς τὴν αἴσθησιν
ὀστοῦν καὶ χόνδρος καὶ σύνδεσμος καὶ ὄνυξ καὶ θρὶξ καὶ πιμελὴ καὶ σὰρξ καὶ νεῦρον
καὶ μυελὸς ἶνες τε καὶ ὑμένες καὶ ἁπλῶς εἰπεῖν ἅπαντα τὰ ὁμοιομερῆ στοιχεῖα τῶν
ἀνθρωπίνων σωμάτων. ἆρ’ οὖν ὁ Ἀθήναιος ἔθετό που ταῦτα στοιχεῖα; καὶ μὴν αὐτός
ἐστιν ὁ γράφων ἕκαστον μὲν τῶν ὁμοιομερῶν ἐκ τῶν πρώτων γεγονέναι στοιχείων,
ἐκ δὲ τῶν ὁμοιομερῶν ἤδη τἆλλα συγκεῖσθαι τοῦ ζῴου μόρια.
I was amazed that Athenaeus does not see that he is confusing himself when he
names hot and cold and dry and wet but avoids naming fire and earth and water and
air. ‘Yes,’ he says, ‘because I am taking the proximate elements of animals, not the
elements common to all bodies’ – and by proximate they mean ‘peculiar to’ and ‘of
nothing else at all’. But I said right at the start that apparent elements are far different
from true elements; it seems to me that this is the time to discuss this difference at
greater length. If the element is some least and simplest part, it would be on the
visible level bone, cartilage, ligament, nail, hair, fat, flesh, nerve, marrow, fibres too,
and membranes, and in a word all the homoeomerous parts would be elements of
human bodies. But did Athenaeus make these the elements? He is the very one who
writes that each of the homoeomerous parts has come into being from the first
elements, and that the other parts of the animal are then formed from the homoe-
omerous parts.
With regard to Athenaeus’ claim that he is taking the proximate elements of ani-
mals, not the elements common to all bodies, Galen comments that by ‘proximate’,
Athenaeus means ‘peculiar to’ and ‘of nothing else at all’, so that Athenaeus was
actually claiming that his elements are the elements of living beings, but not of any
other kind of thing. Again, this is an absurdly uncharitable reading. It would be very
strange if Athenaeus had really believed that there was one set of elements for
animals, and an entirely different set for inanimate things. Moreover, if Athenaeus
had wanted to say that the elements he was concerned with were elements peculiar
to animals, and not shared by inanimate things, he would scarcely have chosen the
word ‘proximate’, προσεχής, to describe them. Galen is obviously exploiting the
contrast that Athenaeus draws between the proximate elements (which are
perceptible, namely the hot, cold, etc.), and the true, cosmic elements which compose
everything (namely fire, etc.): Galen misleadingly takes the contrast to be between
‘proximate’ and ‘common to all’, and hence pretends that ‘proximate’ is to be
understood as the opposite of ‘common to all’, that is, ‘belonging to animals and
to nothing else’. But this is just not what the Greek word προσεχής means, and it is
clear that Athenaeus did not think it did. For him, προσεχής evidently had its usual
sense of ‘proximate’, reflecting his awareness that the true elements were the cosmic
elements fire, air, water and earth, while the perceptible elements of humans were
less fundamental than these, but should stand in as ‘proximate’ elements in the
context of medicine. Erasistratus, too, had used the term προσεχής in just the same
way to describe the perceptible elements (see part 4 below).
Galen then argues in T9 that Athenaeus should have named the uniform or
homoeomerous parts of the body as the most basic perceptible elements of humans
(which is, as we shall see, what Herophilus and Erasistratus had done). Clearly
Athenaeus did acknowledge the uniform parts as constituents of the human body
(see also T1 above), but he believed that the bodies hot, cold, wet and dry represented
a more fundamental, yet still perceptible, level than substances such as flesh or bone.
There is little difficulty in seeing why he should have thought so, given his Stoic
background.
The last testimony is the most important, because it preserves two arguments for
Athenaeus’ view that the ultimate, cosmic elements fall outside the medical art:
T10 τὸ δὲ διὰ τοῦτο δεδιέναι ταῦθ’ ὁμολογεῖν εἶναι στοιχεῖα, διότι μήτ’
ἐξαιροῦμεν ἐκ τοῦ σώματος αὐτῶν τι μήτ’ ἐντίθεμεν, ἐσχάτως ἠλίθιόν ἐστι· τὰ γὰρ ἐκ
τῶν στοιχείων γεγονότα προσφερόμενοι πάντως δήπου καὶ τὰ στοιχεῖα τοῖς σώμασιν
ἡμῶν ἐντίθεμεν. ἀλλ’ οὐκ εἰλικρινῆ, φασίν, οὐδὲ μόνα. κακῶς οὖν ἐλέγετο <τὸ> μήτ’
ἐξαιρεῖν μήτ’ ἐντιθέναι στοιχεῖον· ἐχρῆν γὰρ οὐχ ἁπλῶς οὕτως εἰπεῖν, ἀλλ’
ὅτι μὴ μόνον μηδ’ ἄμικτον μηδ’ αὐτὸ καθ’ αὑτό. καίτοι καὶ τοῦτ’ αὐτὸ τί ποτε βούλεται
περαίνειν αὐτοῖς; οὔτε γὰρ ἄχρηστος ἡ περὶ τῶν στοιχείων θεωρία διὰ τοῦτ’ ἂν
εἰκότως νομισθείη, διότι μηδὲν αὐτῶν ἄμικτον ἑτέρου τοῖς σώμασιν ἡμῶν
προσφέρομεν, οὔτε διὰ τοῦτο πῦρ καὶ ἀὴρ καὶ ὕδωρ καὶ γῆ κακῶς εἴρηται στοιχεῖα,
διότι τοῖς μὲν ἐξ αὐτῶν χρώμεθα γεγονόσι, μόνον δ’ αὐτῶν ἕκαστον ἰδίᾳ καὶ καθ’
ἑαυτὸ παντάπασιν ἄχρηστον ὑπάρχει.
To be afraid to grant that they are elements for the reason that we neither take
any of them out of the body nor put any of them into it is utterly stupid; for when we
eat and drink the things that have been generated from the elements we most
certainly put the elements too into our bodies. But not in a pure form, they say, and
not alone. Then it was incorrect to say that we neither take out nor put in an element;
this statement should not have been made without qualification in that way, but
with the qualification ‘not alone or unmixed or itself by itself’. And yet even with
this qualification what does it aim to achieve for them? It is not reasonable that
speculation about the elements be considered useless because we do not take into
our bodies any one of them unmixed with another; and it was wrong to deny that fire
20 D. Leith
and air and water and earth are elements for the reason that we use things that have
been generated from them, but each of them alone, separate and by itself, is
completely useless.
In the final sentence, Galen reports his opponents as claiming, firstly, that ‘specu-
lation about the elements is useless because we do not take into our bodies any one of
them unmixed’, and, secondly, that ‘we use things generated from the ultimate
elements, but each alone, separate and by itself, is completely useless’. These are the
only reported arguments I am aware of for Athenaeus’ position on these matters.
Significantly, there is absolutely no denial, or even doubt, concerning the existence of
the ultimate, cosmic elements fire, air, earth and water. Indeed, there is explicit
acknowledgement in both arguments that the things which we take into our bodies or
use more generally are indeed made of the ultimate elements. There is no scepticism
that the cosmic elements are the ultimate constituents of things. For Athenaeus, the
only issue is that these cosmic elements are not of a sort to be actually useful in a
medical context. This is because we as humans cannot manipulate them – the doctor
is unable to prescribe pure fire for their patient, or heal them by directly increasing
the quantity of pure earth in their basic constitution. Rather, the most basic level at
which we can alter, regulate or even observe the state of the human body is by
administering the hot, the cold, the wet and the dry, whether through food, baths,
fomentations, and so on. This must all take place at a perceptible level, with the
corollary that the most basic elements which are relevant to medicine will be the
most basic perceptible elements. It may be that prescribing a hot bath for a patient
does affect the pure fire which is one of the ultimate constituents of their body, but it
does not actually help the doctor to know that, since it is only by testing the
perceptible hotness of the patient’s body that its temperature can be determined and
acted upon.
Again, it is natural to assume, given the general importance of Stoic physics to his
medical system, that Athenaeus was appealing here to the Stoic theory of mixture
in particular. As discussed above, the Stoics hold that when things are blended
through-and-through, as the cosmic elements are in compound bodies, they totally
interpenetrate each other so that there is no portion of the blend that does not
contain all constituents. They can in principle be separated out from one another, but
it is only when this is achieved that they can be perceived separately and on their
own. This is precisely the reason that Athenaeus offers for his disregard for the
cosmic elements: it is because the cosmic elements in human beings are necessarily
mixed that they cannot be used in medicine.
It is important to emphasise again that this is all perfectly in keeping with

Athenaeus’ pathology as reported by Galen in his De Causis Contentivis (T1). There it
is indeed the qualities hot, cold, wet and dry acting upon the innate pneuma that are
the causes of disease.
In fairness to Galen though, it is not difficult to see how, from his point of view,
the distinctions which Athenaeus made might look completely unnecessary and
unwarranted. For Galen, as I have noted, qualities are incorporeal. Indeed, he
describes a dispute on the issue he had held as a young man with his teacher who
was a follower of Athenaeus.37 If the task, then, is to identify the corporeal constit-
uents of human beings, it would hardly make sense to name incorporeal qualities,
instead of the corporeal elements which they qualify. This essentially seems to be the
nature of much of Galen’s critique in On the Elements according to Hippocrates. But of
course Athenaeus and the Stoics believed that the qualities are corporeal. Nor did
Galen accept the Stoic theory of blending through-and-through on which Athenaeus’
position appears to be founded, and in this respect too he was not prepared to engage
with Athenaeus on his own terms.
3.1 Athenaeus and the Hippocratic Corpus
Given the broader context of Galen’s criticisms, namely his interpretation of the
Hippocratic treatise On the Nature of the Human Being, it is worth looking at the
extent to which Athenaeus himself was also engaging with this ancient text. Peter
Singer has recently shown that Athenaeus posed a particularly acute threat to Galen
because of his alternative and conflicting interpretation of the beginning of On the
Nature of the Human Being, which Athenaeus saw as being in line with his own
theory of the elements of medicine.38 Since this Hippocratic text was Galen’s most
favoured – ‘the foundation of the whole art of Hippocrates’ – the threat was all the
greater.39
Firstly, Galen says explicitly that Athenaeus is among those who are confused
by a verbal ambiguity in On the Nature of the Human Being, whereby Athenaeus
made the mistake of reading its mention of the hot, cold, wet and dry as referring only
to the elemental qualities, and not to the elements themselves. This criticism clearly
implies that Athenaeus’ own exposition of his theory made reference to this treatise:
37 Hipp. Elem. 6.14–26 [pp. 104–110 De Lacy (1972)]; see Kupreeva (2014, 181–192), for analysis.
38 Singer (2021), esp. 115, 130–133, 146.
39 For the quotation, see Gal. HNH pref. [xv 11 K. = p. 8.19–20 Mewaldt CMG V 9,1], τὸ μὲν ὅλον τὸ
βιβλίον ἐκ τούτων σύγκειται, τὸ δὲ πρῶτον αὐτοῦ μέρος ἁπάσης τῆς Ἱπποκράτους τέχνης ἔχει τὴν οἷον
κρηπῖδα.
22 D. Leith
T11 καὶ Ἱπποκράτης οὐ μόνον, ὅτι ταῦτά ἐστι στοιχεῖα πάντων τῶν ἐν τῷ κόσμῳ,
προϊων αὐτὸς ἀποφαίνεται κατὰ τὸ Περὶ φύσεως ἀνθρώπου βιβλίον, ἀλλὰ καὶ τὰς
ποιότητας αὐτῶν, καθ’ ἃς εἰς ἄλληλα δρᾶν καὶ πάσχειν πέφυκεν, αὐτός ἐστιν ὁ πρῶτος
ὁρισάμενος. [6.1] οὐ παρακολουθοῦντες δὲ οἱ πολλοὶ τῇ κατὰ τὸν λόγον ὁμωνυμίᾳ
συγχέονται καὶ ταράττονται, καθάπερ καὶ Ἀθήναιος ὁ Ἀτταλεύς, ἅμα μὲν στοιχεῖα
τιθέμενος τἀνθρώπου τὸ θερμὸν καὶ τὸ ψυχρὸν καὶ τὸ ξηρὸν καὶ τὸ ὑγρόν, … κτλ.
(see T7)
And not only did Hippocrates himself lead the way by affirming in his book On
the Nature of the Human Being that (sc. earth, air, fire and water) are the elements of
all things in the cosmos, but he was also the first to define the qualities that they have
by virtue of which they can mutually act and be acted upon. [6.1] But most men, not
understanding this, are confused and upset by the verbal ambiguity; thus Athenaeus
of Attaleia made hot, cold, dry and wet the elements of the human being, … etc.
(see T7)
Gal. Hipp. Elem. 5.32–6.1 [pp. 100.20–102. De Lacy (1972)], trans. after De Lacy
Furthermore, there are a number of significant points of contact between his own
views and what the author of On the Nature of the Human Being has to say. As its
author (in fact the fifth century physician Polybus) says in the opening lines of the
text:
T12 ὅστις μὲν οὖν εἴωθεν ἀκούειν λεγόντων ἀμφὶ τῆς φύσιος τῆς ἀνθρωπίνης
προσωτέρω ἢ ὅσον αὐτῆς ἐς ἰητρικὴν ἀφήκει, τούτῳ μὲν οὐκ ἐπιτήδειος ὅδε ὁ λόγος
ἀκούειν· οὔτε γὰρ τὸ πάμπαν ἠέρα λέγω τὸν ἄνθρωπον εἶναι, οὔτε πῦρ, οὔτε ὕδωρ,
οὔτε γῆν, οὔτε ἄλλο οὐδὲν ὅ τι μὴ φανερόν ἐστιν ἐνεὸν ἐν τῷ ἀνθρώπῳ.
Whoever is accustomed to hearing people speak about human nature in a way
which goes beyond its relevance to medicine, this speech is not appropriate for them
to hear. For I say that the human being is not entirely air, nor fire, nor water, nor
earth, nor any other thing that is not manifest in the human being.
Polybus, On the Nature of the Human Being 1.1 [vi 32 L. = p. 164 Jouanna (2002)]
There are two controversial points of interpretation in this passage, namely (1)
whether to understand ‘οὔτε … τὸ πάμπαν’ in the sense of ‘not entirely’, taken closely
with ἠέρα, as I understand it, or ‘not at all’, taken closely with λέγω;40 and (2) whether
to read ἐνεόν (literally ‘being in’), which was clearly the accepted reading before
40 Jouanna (2002, 225–226), understands it in the latter sense, and translates ‘Car je ne déclare
nullement que l’homme est air, feu, eau, terre’ (p. 165 CMG I 1,3). He lists numerous examples showing
that (τὸ) πάμπαν with negative can mean ‘not at all’, but he does not mention counter-examples,
which show that it need not, such as Eur. fr. 196: τοιόσδε θνητῶν τῶν ταλαιπώρων βίος· / οὔτ’ εὐτυχεῖ
Galen, or ἓν ἐόν (literally ‘being the one thing’), which Galen introduced, as his
overall interpretation of the text demanded.41 However, neither of these points
impact seriously on the question of Athenaeus’ engagement with the text, and I leave
them aside: in particular, we can safely assume that he did not know Galen’s reading
ἓν ἐόν. So firstly, in the text we clearly have the idea that the inquiry into nature can
go beyond a point at which it is profitable for medicine. More importantly, within this
inquiry, the perceptibility of the human body’s constituents seems to mark the limit
of what is relevant for medicine: hence specifying the constituents of the body that
are not manifest (φανερόν) in it will form no part of the author’s account. There is
also the general implication that the analysis of the body in terms specifically of the
fundamental elements fire, air, earth and water will no longer be relevant for
medicine. Later in the text, we in fact find the enumeration of the elemental qualities
hot, cold, wet and dry as the constituents of the body, but in a way which suggests that
these are an acceptable part of the author’s medical account:
T13 καὶ πάλιν γε ἀνάγκη ἀναχωρεῖν ἐς τὴν ἑωυτοῦ φύσιν ἕκαστον, τελευτῶντος
τοῦ σώματος τοῦ ἀνθρώπου, τό τε ὑγρὸν πρὸς τὸ ὑγρὸν καὶ τὸ ξηρὸν πρὸς τὸ ξηρὸν
καὶ τὸ θερμὸν πρὸς τὸ θερμὸν καὶ τὸ ψυχρὸν πρὸς τὸ ψυχρόν. τοιαύτη δὲ καὶ τῶν
ζῴων ἐστὶν ἡ φύσις, καὶ τῶν ἄλλων πάντων· γίνεταί τε ὁμοίως πάντα καὶ τελευτᾷ
ὁμοίως πάντα.
It is also necessary for each (of the body’s constituents) to return to its own
nature when the human body dies, the wet to the wet, the dry to the dry, the hot to the
hot, and the cold to the cold. Such is the nature of animals, and of everything else.
Everything comes to be in the same way, and everything comes to an end in the same
way.
Polybus, On the Nature of the Human Being 3.3 [vi 38 L. = p. 172 Jouanna (2002)]
Furthermore, the idea of the cyclical coming-to-be and eventual destruction not only
of animals, but of everything, also seems to recall the Stoic doctrine of conflagration,
which looks to be implied in Athenaeus’ definition of element, as we saw earlier.
These specific correspondences, together with the wider context of Galen’s
critique, suggest that Athenaeus himself claimed that his own Stoicising account of
the elements was compatible with at least some claims found in On the Nature of the
Human Being, presumably with a view to eliciting ancient support for his views.
τὸ πάμπαν οὔτε δυστυχεῖ (‘Such is the life of wretched mortals: a man is neither completely fortunate
nor unfortunate’, trans. Collard/Crop, Loeb).
41 For further analysis, see esp. Jouanna (2002, 225–226, 229–230); Hankinson (2016, esp. 425–426);
Singer (2021, 142–146); and Gal. HNH 1.1 [xv 20 K. = p. 12–13 Mewaldt CMG V 9,1].
24 D. Leith
Greater significance could then be assigned to the fact that in Athenaeus’ definition of
the elements of medicine as reported in the Definitiones Medicae passage (T3), we
find the added remark that ‘some of the ancients’ shared his view. I think it highly
likely that this reference to ‘the ancients’ was ultimately to On the Nature of the
Human Being in particular. It is also worth noting that, in the passage regarding
Athenaeus’ views on where to begin the exposition of the medical art, there is also a
(tweaked) quotation from the Hippocratic treatise Places in Man, which is supposed
to support Athenaeus’ view that exposition should begin from the study of nature
(Τ2). Moreover, in his Commentary on Airs, Waters, Places, Galen noted that Athe-
naeus explicitly claimed to be following Hippocrates in his conception of pneuma,
and noted that Hippocrates referred to pneuma as ‘innate heat’, very likely having in
mind the instances of this phrase in Aphorisms.42
So Galen would have had all the more reason to attack Athenaeus for his views
on the elements of medicine in his own On the Elements According to Hippocrates
(and, it may be noted, nowhere else in his surviving corpus): it was not just that
Athenaeus got it wrong about the elements; he also claimed that his wrong views
were to be found in Galen’s most cherished Hippocratic treatise. It was of the greatest
importance to Galen to make those views look as absurd as possible.
4 Hellenistic Background (Herophilus and

Erasistratus)
Lingering questions perhaps remain, however, about why exactly Athenaeus was
concerned to distinguish the elements of medicine so sharply from the cosmic
elements in the first place. I find it unlikely that the inspiration came from the
Hippocratic treatise itself. The use of isolated extracts from various Hippocratic
treatises such as Aphorisms and Places in Man suggests to me a more piecemeal
approach, intended generally to produce an impression of ancient support wherever
areas of compatibility could be identified. My own view is that Athenaeus was not
engaging in a more systematic analysis or interpretation of On the Nature of the
Human Being: there is little sign, for example, that he had much use for the theory of
four humours, the dominant idea in that treatise. More likely Athenaeus developed
his views on the elements, under Posidonius’ tutelage, and subsequently pointed to
42 See above n. 28, and esp. Coughlin and Lewis (2020, 209–211), identifying Aph. 1.14 and 1.15 as the
likely sources of the Hippocratic reference to ‘innate heat’.
parallels he had found in various ancient Hippocratic texts, including On the Nature
of the Human Being. I want to finish by pointing briefly to some Hellenistic pre-
cedents which anticipated Athenaeus’ approach in important respects.
It is likely that direct influence on Athenaeus came from the early Hellenistic
doctors Herophilus and Erasistratus. As I have argued in an earlier paper, both of
these influential doctors maintained, similarly, that the ultimate elements are
irrelevant to the medical art, which should limit itself to the perceptible constituents
of the human body; in their case, the perceptible constituents were its uniform, or
homoeomerous, parts.43 The main evidence comes from Galen and the so-called
Anonymus Londinensis papyrus. In a key text in his Method of Healing, Galen reports
that Erasistratus, very much like Athenaeus, thought that medicine should not
concern itself with the inquiry into the ultimate elements, which is the proper
domain of physiologia, or natural science.44 Instead, medicine can make do with
‘proximate’ (προσεχεῖς) principles or elements, and Galen lists artery, vein and
nerve, which must be representative of the uniform or homoeomerous parts of the
body in general. Elsewhere Galen repeatedly makes the point that the uniform parts
are the most basic perceptible elements in the body, and that some doctors – he
sometimes calls them ‘semi-Dogmatists’45 – believe that the medical art should make
use of these as proximate elements, and refrain from inquiring into the ultimate
elements. Galen also has the Erasistrateans claiming that they do not care about
processes involving the basic elements, and do not require knowledge of them
specifically for treatment.46 Galen then observes that these opponents cite a slogan of
Herophilus in support of their position. Herophilus apparently said: ‘Let these things
be primary, even if they are not primary’, where ‘these’ must refer in the context to
the proximate elements artery, vein and nerve. Here there is an explicit recognition
that what are to be taken as primary are not what are actually primary, which of
course reflects perfectly the distinction which Erasistratus wanted to make between
43 Leith (2015); note 487 n. 57 on Athenaeus.

44 Gal. MM 2.5 [x 107 K.], ἀποχωρεῖν τῆς ἄκρας φυσιολογίας κελεύοντες καὶ μὴ ζητεῖν οὕτω φύσιν
ἀνθρώπου καταμαθεῖν ὡς οἱ φιλόσοφοι καταμανθάνουσιν, ἄχρι τῶν πρώτων στοιχείων ἀνιόντες τῷ
λόγῳ, καὶ τοῦτο ὑμῖν ἀπόχρη μόνον εἰπεῖν, ὡς ἀρτηρίαν καὶ φλέβα καὶ νεῦρον ἀρχὰς προσεχεῖς καὶ
οἷον στοιχεῖα χρὴ τίθεσθαι τῆς περὶ τὸν ἄνθρωπον φυσιολογίας (‘You tell us (sc. Erasistratus) to
abandon the high peaks of natural science and not to seek to understand the nature of man in the way
the philosophers understand it – that is, advancing by reason as far as the primary elements – and
that it is sufficient for you to say this alone, namely that one should designate artery, vein and nerve
as proximate principles and elements, so to speak, of the natural science that pertains to man’, trans.
after Johnston & Horsley, Loeb).
45 E.g. Gal. MM 3.3 [x 184–186 K.].
46 See Leith (2015, 471–472).
26 D. Leith
the real elements sought by philosophers, and the proximate elements which are the
concern of doctors.
The Anonymus Londinensis reports a very similar form of Herophilus’ slogan,
this time in support of his own comparable view that the human body should not be
analysed below the level of sense perception:
T14 τοῦ σ]ώ̣ ματος | [μ(ὲν) ο]ὖν τὰ μ(ὲν) (ἐστι) ἁπλᾶ μέ̣ρη, τ̣ὰ̣ δὲ̣ σύνθετα· | ἁπλᾶ δὲ
καὶ σύνθετα λαμβάνομ(εν) π(ρὸς) αἴσ|θησιν καθὼς καὶ Ἡρόφιλος ἐπισημειοῦ|ται
λέγων ο̣(ὕτως)· “λεγέσθω δὲ τὰ φαινόμενα | π[ρ]ῶ̣ τα καὶ ̣ εἰ μή (ἐστιν) πρῶτα”. …
ἁπλᾶ μ(ὲν) οὖν (ἐστι) τὰ ὁμοιο|μερῆ, κ(ατὰ) τὰς τομὰς διαιρούμενα | εἰς ὅμ̣[οι]α μέρη
ὡς ἐγκέφαλός τε καὶ νεῦ|ρον καὶ ἀρτηρία, φλὲψ καὶ τὰ ὑγρά.
Some parts of the body are simple, some composite. We take ‘simple’ and
‘composite’ in relation to sense perception, as Herophilus also marks out when he
speaks as follows: ‘Let the apparent things be called primary, even if they are not
primary’… Simple are the uniform (parts), which when cut are divided into similar
parts, such as brain, nerve, artery, vein and the fluids.
Anon. Lond. xxi 18–23, 32–35 [pp. 45 Manetti (2022)] = T50a von Staden
Hence the Anonymus stipulates that the simple parts of the body must be taken to be
the perceptibly simple parts. This is what he evidently takes Herophilus’ slogan to
state as well – and here we have the same term as used by Athenaeus, φαινόμενα. So
in medicine it is entities that are sense-perceptible that should be called primary,
even if/even though they are not primary.47 The Anonymus then specifies that these
perceptibly simple parts of the body are the homoeomerous or uniform parts, and
he lists artery, vein and nerve among his examples, in much the same way as Galen
had in his statement concerning Erasistratus’ proximate elements.
I suggest, then, that Athenaeus’ approach was fundamentally similar. Like
Herophilus and Erasistratus, he believed that in medicine it is not necessary to
inquire into the nature of the ultimate or cosmic elements. Instead, the most basic
elements in medicine should be taken to be the most basic that can be perceived
directly by the senses. Galen uses the word ‘proximate’ (προσεχής) to describe both
Athenaeus’ and Erasistratus’ elements of medicine, entirely appropriately given
their acknowledgement that there are more fundamental elements. Likewise both
Athenaeus and Herophilus described the most basic elements proper to medicine as
φαινόμενα, to pick out the fundamental criterion according to which they are to be
47 Note that in Galen’s version of Herophilus’ slogan at MM 2.5 [x 107 K.], it reads εἰ καὶ μή ἐστιν
πρῶτα, where εἰ καί usually means ‘even though’ (as opposed to καὶ εἰ, ‘even if’), suggesting further
that Herophilus had no doubt that the uniform parts were not in fact primary.
identified. For all these doctors, it seems to have been the fact that the ultimate
elements are of no therapeutic value that made them irrelevant to medicine.
Nevertheless, Athenaeus did not follow Herophilus and Erasistratus in identi-
fying the elements of medicine as the uniform parts of the body, but chose rather the
qualities hot, cold, wet and dry. And in fact we have seen, in the third passage from
Galen (T9), that Galen took Athenaeus to task for not naming the homoeomerous
parts of the body as the elements of medicine. Athenaeus’ divergence from his
Hellenistic predecessors on this point will have been due, as I have suggested, to Stoic
doctrine, according to which these qualities themselves are actually corporeal.
Hence for Athenaeus, of what is perceptible in the human body, the most funda-
mental corporeal entities will be the elemental qualities. But the basic principle is the
same for Herophilus, Erasistratus and Athenaeus.
According to Galen, Erasistratus articulated the idea that medicine is subordi-
nate to natural science as practised by philosophers: the philosophers’ inquiry into
nature goes deeper than is necessary for medicine, but this is of course not to say
that there is anything illegitimate about the inquiry itself, as long as it is located
within its proper field of study.48 Similarly, Athenaeus took Stoic physics as a given:
he is not sceptical about it; rather, his medicine is built upon it, and this explains why
he focuses on the four qualities hot, cold, wet and dry in the first place. As we saw
above, Athenaeus believed that the study of nature, or natural science, should come
at the outset of the exposition of medicine (Τ2). But of course this does not mean that
the whole of the physical inquiry will be relevant to medicine. It will be only the parts
of physics that contribute to our understanding of health and diseases and the
powers of remedies that will fall within the scope of the medical art. The cosmic
elements, and the accompanying theory and difficulties that go with them, can thus
be excluded according to Athenaeus. This is a methodological framework for med-
icine: the limits of medical inquiry are set only by its therapeutic aims.
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Athenaeus of Attaleia On The Elements of Medicine

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apeiron 2024; aop

Abstract: Athenaeus of Attaleia (fl. mid-first century BC) offers a fascinating

Keywords: Athenaeus of Attaleia; Stoicism; medicine; philosophy; elements; Galen

1 Introduction: The Elements of Medicine

Ps.-Galen, Introductio sive Medicus 2.1 [xix 676-7 K. = p. 4 Petit]

T3 τί ἐστι στοιχεῖον; στοιχεῖόν ἐστιν ἐξ οὗ πρώτου καὶ ἁπλουστάτου τὰ πάντα

T4 ἔστι δὲ στοιχεῖον ἐξ οὗ πρώτου γίνεται τὰ γινόμενα καὶ εἰς ὃ ἔσχατον ἀνα-

Diog. Laert. 7.136–7 (SVF 2.580)

Chrysippus’ analysis as reported by Stobaeus also shows important points of contact:

T5 τὸ δὲ κατ’ ἐξοχὴν στοιχεῖον λέγεσθαι διὰ τὸ ἐξ αὐτοῦ πρώτου τὰ λοιπὰ

Stobaeus 1.129–130 (SVF 2.413), trans. Long & Sedley 47A

T6 κατὰ δὲ τὸν Ἀθήναιον στοιχεῖα ἀνθρώπου οὐ τὰ τέσσαρα πρῶτα σώματα, πῦρ

Ps.-Galen, Introductio sive Medicus 9.5 [xiv 698 K. = p. 21 Petit]

3 Galen’s Testimonia (Hipp. Elem. 6)

T7 οὐ παρακολουθοῦντες δὲ οἱ πολλοὶ τῇ κατὰ τὸν λόγον ὁμωνυμίᾳ συγχέονται

T9 ἐθαύμαζον δὲ καὶ πῶς οὐκ αἰσθάνεται συγχέων ἑαυτὸν ὁ Ἀθήναιος, ὃς

It is important to emphasise again that this is all perfectly in keeping with

3.1 Athenaeus and the Hippocratic Corpus

4 Hellenistic Background (Herophilus and

43 Leith (2015); note 487 n. 57 on Athenaeus.

48 See above n. 44.

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