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NEW FRAGMENTS OF RUFUS OF EPHESUS’ ON THE RETENTION OF MENSES
Published online by Cambridge University Press: 24 March 2023
Abstract
Rufus of Ephesus (fl. c.100 c.e.) was a prolific medical author and practitioner in the Imperial period whose historical importance has been obscured by the loss of most of his works. One of the largest gaps in our knowledge of Rufus’ corpus is his gynaecological writings, none of which survives in full. This article assembles and comments on several fragments from Rufus’ lost gynaecological work On the Retention of Menses (perhaps Περὶ τῶν ἐπεχομένων ἐμμήνων). Comparison of overlapping passages from the authors Ibn al-Jazzār (tenth century) and Aëtius of Amida (sixth century) reveals that more fragments of this work in Arabic and Greek have survived than previously thought. These fragments provide new evidence for the analysis of Rufus’ medical thought, and further our understanding of gynaecology in the Roman empire.
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- Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of The Classical Association
Footnotes
We thank Aileen Das for generous assistance, as well as Gerrit Bos and Brill for granting the permission to use Bos's edition and translation of Ibn al-Jazzār.
References
1 Greek and Latin translations are ours unless otherwise noted. The most recent edition of Rufus’ corpus is Daremberg, C. and Ruelle, E., Œuvres de Rufus d’Éphèse: texte collationé sur les manuscrits, traduits pour la première fois en français, avec une introduction (Paris, 1879)Google Scholar, though their coverage of fragments in Arabic relies on problematic Latin translations. Other major studies of Rufus’ corpus include: Ilberg, J., Rufus von Ephesos: ein griechischer Arzt in trajanischer Zeit (Leipzig, 1930)Google Scholar; Sideras, A., ‘Rufus von Ephesos und sein Werk in Rahmen der antiken Medizin’, in Haase, W. (ed.), ANRW 2.37.2 (Berlin and New York, 1994), 1077–253Google Scholar; Ullmann, M., ‘Die arabische Überlieferung der Schriften des Rufus von Ephesos’, in Haase, W. (ed.), ANRW 2.37.2 (Berlin and New York, 1994), 1293–349Google Scholar. For the sources in Arabic, see also Sezgin, F., Geschichte des arabischen Schriftums (Leiden, 1970), 3.64–7Google Scholar; A. Abou-Aly, ‘The medical writings of Rufus of Ephesus’ (Diss., University of London, 1992). A list of Rufus’ works analogous to the Fichtner bibliography for Galen (hosted on the Corpus Medicorum Graecorum/Latinorum website) is a desideratum.
2 For Galen's life and rhetoric, see Nutton, V., Galen: A Thinking Doctor in Imperial Rome (London, 2020)CrossRefGoogle Scholar. For an example of Galen's approval of Rufus, see Rufus, On Melancholy fr. 3 Pormann (P. Pormann [ed.], Rufus of Ephesus On Melancholy [Tübingen, 2008]).
3 The online Corpus Medicorum Graecorum provides open access critical editions for Oribasius and Paul of Aegina. As for Aëtius of Amida, not all the books after the eighth have appeared in reliable critical editions: A. Garzya, ‘Problèmes relatifs à l’édition des livres IV–XVI du Tétrabiblon d'Aétios d'Amida’, REA 86 (1984), 245–57. Sideras (n. 1) covers Rufus in the Oribasian corpus but not all the books of Aëtius.
4 Abou-Aly (n. 1) comments on the parallel text between Aët. 16.50–1 and Ibn al-Jazzār, Provisions 6.9 but not on the subsequent chapters in Aëtius mentioned above. Bos, G., Ibn al-Jazzār on Sexual Diseases and their Treatment (London, 1997), 263Google Scholar nn. 19–20 is apparently unaware of Aët. 16.50 and the other passages addressed above.
5 On menstruation, see Dean-Jones, L., Women's Bodies in Classical Greek Science (Oxford, 1994)Google Scholar; Gourevitch, D., Le mal d’être femme. La femme et la médecine dans la Rome antique (Paris, 1984)Google Scholar; S. Verskin, ‘Barren women: the intersection of biology, medicine, and religion in the treatment of infertile women in the Medieval Middle East’ (Ph.D. Diss., Princeton University, 2017). Some Greek doctors disputed the health value of menstruation: Sor. Gyn. 1.27–9.
6 The term ‘amenorrhea’ is sometimes used as a translation for menstrual retention; though derived from Greek roots, it is a modern coinage.
7 Dodge, E., The Fihrist of al-Nadīm: A Tenth-Century Survey of Muslim Culture (New York, 1970), 687Google Scholar: ‘Repression of menstruation’. E. Savage-Smith, S. Swain, G.J. van Gelder (edd.), A Literary History of Medicine – The ʿUyūn al-anbāʾ fī ṭabaqāt al-aṭibbāʾ of Ibn Abī Uṣaybiʿah (Brill Online Edition), 4.1.10.2, title §40: ‘The treatment of amenorrhea’ (M. Fī iḥtibās al-ṭamth).
8 Abou-Aly (n. 1), 159 n. 176.
9 It is unclear if this work, mentioned by Ibn Abī Uṣaybiʿa (Savage-Smith, Swain, van Gelder [n. 7, title §53]), corresponds to the short passage in Libri incerti 19 (Περὶ κυήσεως), given that al-Nadīm (Dodge [n. 7]) and Ibn Abī Uṣaybiʿa (Savage-Smith, Swain, van Gelder [n. 7, title §38]) also mention a work on childbirth by Rufus. On the Libri incerti, see n. 10 below.
10 See Abou-Aly (n. 1), 158. Daremberg and Ruelle (n. 1) include additional gynaecological titles based on chapters from Oribasius and the Libri incerti (a Byzantine compilation thought to contain portions from the lost books of Oribasius’ Medical Collections), even when the chapters are attributed to a different author or lack attribution. Some of their attributions are clearly incorrect, such as Libri incerti 30 (page 121 Raeder), which is derived from Galen's De sanitate tuenda. All passages cited from Oribasius and the Libri incerti in this article follow Raeder's numbering.
11 Rufus, De renum et uesicae morbis 7.4 (page 140 Sideras) promises a discussion of haemorrhages in ‘the gynaecological works’ (ἐν τοῖς γυναικείοις).
12 On the Hippocratic Corpus, see E. Craik, The ‘Hippocratic’ Corpus: Content and Context (London, 2015). The gynaecological texts are now available in translation: Potter, P., Hippocrates Volume IX (London, 2010)Google Scholar; Potter, P., Hippocrates Volume X (London, 2012)Google Scholar; Potter, P., Hippocrates Volume XI (London, 2018)Google Scholar.
13 See P. Burguière et al. (edd.), Soranos d’Éphèse. Maladies des femmes (Paris, 1988), 1.preface VII–XLVI; L. Bolton, ‘An edition, translation and commentary of Mustio's Gynaecia’ (Ph.D. Diss., University of Calgary, 2015), 21–47. On Soranus and his corpus, see A. Hanson and M. Green, ‘Soranus of Ephesus, methodicorum princeps’, in W. Haase (ed.), ANRW 2.37.2 (Berlin and New York, 1994), 968–1075.
14 On Soranus’ doxographical practices, see P. van der Eijk, ‘Antiquarianism and criticism: forms and functions of medical doxography in Methodism (Soranus and Caelius Aurelianus)’, in P. van der Eijk (ed.), Ancient Histories of Medicine. Essays in Medical Doxography and Historiography in Classical Antiquity (Leiden, 1999), 397–452.
15 On women in Galen, see Flemming, R., Medicine and the Making of Roman Women: Gender, Nature, and Authority from Celsus to Galen (Oxford, 2000)Google Scholar; Mattern, S., Galen and the Rhetoric of Healing (Baltimore, 2008), 112–14CrossRefGoogle Scholar.
16 Sor. Gyn. 3.11.1–2 (page 100, lines 10–18 Ilberg).
17 Gal. De curandi ratione per uenae sectionem 11.283 K. Cf. De tremore 7.604 K.
18 Gal. De uenae sectione aduersus Erasistrateos Romae degentes 11.187–90 K.
19 Hanson, A., ‘The restructuring of female physiology at Rome’, in Mudry, P. and Pigeaud, J. (edd.), Les écoles médicales à Rome: actes du 2ème Colloque international sur les textes médicaux latins antiques, Lausanne, septembre 1986 (Geneva, 1991), 255–68Google Scholar.
20 Rufus apud [Orib.] Libri incerti 20.3–6 (page 109, lines 28–35 Raeder, Ἐκ τῶν ῾Ρούφου. Δίαιτα γυναικῶν).
21 Aët. 16.50 (page 69 Zervos), 51 (page 72) and 73 (page 116). These chapters are absent from Daremberg and Ruelle (n. 1) and from Sideras (n. 1). S. Bravos, ‘Das Werk des Aetios v. Amida und seine medizinischen und nichtmedizinischen Quellen’ (Diss., Universität Hamburg, 1974), 151 includes a further chapter, ch. 73 (page 116 Zervos), among the fragments of Rufus in Aëtius, but the recipe contained in that chapter is attributed to ‘Rufus or Archigenes’ and the rest of the chapter lacks attribution.
22 It is not known for certain whether the chapter headings as they have been transmitted were included by Aëtius in the autograph, but that scenario seems likely. The rationale provided by Lucia, R. de, ‘Doxographical hints in Oribasius’ Collectiones Medicae’, in van der Eijk, P. (ed.), Ancient Histories of Medicine. Essays in Medical Doxography and Historiography in Classical Antiquity (Leiden, 1999), 473–89Google Scholar, at 483 n. 20 can be extended to Aëtius.
23 Ilberg (n. 1), 17 n. 4.
24 For Aspasia, see Bravos (n. 21), 78–80; Keyser, P.T. and Irby-Massie, G.L., Encyclopedia of Ancient Natural Scientists (London and New York, 2008)CrossRefGoogle Scholar, s.v. ‘Aspasia’.
25 On Aëtius in Arabic, see Sezgin (n. 1), 164–5.
26 On Oribasius, see S. Buzzi, Lexicon of Greek Grammarians of Antiquity, s.v. ‘Oribasius’. While there are chapters on the retention of menses in both Oribasius (Eun. 4.110; Eclogae 146) and Paul of Aegina (3.61), neither mentions Rufus in them. The Arabic translation of Oribasius’ Medical Collections no longer survives but the fragments contained within al-Rāzī's Kitāb al-Ḥāwī are collected in Buzzi, S. and Garofalo, I., ‘Gli estratti da Oribasio nel Continens di Rāzī’, Galenos 13 (2019), 131–312Google Scholar.
27 Aëtius elsewhere devises multiple chapters on the same subject with some devoted to treatment separately. Cf. Aët. 11.4, which deals with kidney stones, followed by 11.5, a chapter on the treatment of kidney stones, and later again 11.7 and 11.8, on regimens for handling kidney stones.
28 E.g. Aët. 11.32 (pages 121–2 Daremberg-Ruelle), which is attributed to Galen but also draws material from Rufus of Ephesus’ De satyriasmo et gonorrhoea and from other, unspecified, sources. This compilatory practice is not peculiar to Aëtius, though there has been little study of Aëtius’ methods. On the problem of double chapters, see Witt, M., ‘“Aus Antyllos und Heliodoros”: Zum Problem der doppelten Autorenlemma-Angaben in den medizinischen Sammelwerken des Oreibasios und Aëtios von Amida’, Sudhoffs Archiv 103 (2019), 141–74CrossRefGoogle Scholar.
29 Aët. 16.50 (page 69, lines 7–12 Zervos) closely resembles Sor. Gyn. 3.7.1 (page 97, lines 22–5 Ilberg). Related instances: in Philagrius, fr. 95 Masullo (R. Masullo, Filagrio. Frammenti [Naples, 1999]), drawn from Aët. 11.5, Aëtius puts a case history from Rufus’ De renum et uesicae morbis in the mouth of Philagrius (φησὶν ὁ Φιλάγριος). It is unclear if Philagrius himself earlier appropriated the case history without acknowledgement. Also, Aët. 11.1 is attributed only to Galen but mentions Aretaeus of Cappadocia after a few lines.
30 Cf. Aët. 2.86 (Ἐκ τῶν Ῥούφου καὶ Γαληνοῦ περὶ γάλακτος) and Gal. De simplicium medicamentorum temperamentis ac facultatibus 12.263–4 K., though Galen may have drawn on Rufus for this information without acknowledgement. The final sentence in Aët. 2.86 (page 180, lines 11–12 Olivieri) was probably inserted for the sake of transition.
31 R. Romano, ‘Aezio Amideno’, in A. Garzya et al. (edd.), Medici bizantini (Turin, 2006), 253–553. The three manuscripts in Berlin that Zervos used were destroyed during World War II (Garzya [n. 3], 248).
32 Cf. Liber de sinthomatibus mulierum (Trotula), paragraph 6 (pages 72–4 Green), probably based on Constantine of Africa's Latin translation of al-Jazzār's Provisions, which lacks a critical edition. For the passage above, the Lyons 1515 edition prints rursus instead of Ruffus dixit. The medieval Greek translation of the Provisions, known as the Ephodia, has not been critically edited, but the corresponding passage can be found in Mercati, G., ‘Notizie varie di antica letteratura medica’, Studi e Testi 31 (1917), 37–8Google Scholar, at 38.
33 Cf. Sor. Gyn. 1.22.6 (page 15, lines 18–19 Ilberg): ταῖς μὲν <γὰρ> ἀργῷ βίῳ χρωμέναις πλεῖον, ταῖς δὲ γυμναστικῷ καθ’ ὁνδήποτε τρόπον ἔλαττον.
34 πᾶσιν Romano, πᾶσαν Zervos.
35 This is one of many instances where ancient medical theories were informed by cultural stereotypes about women. Cf. Hippocratic Corpus, Gland. 16 (page 122 Potter), where parts of the female body are said to be porous and soft ‘because of their inactivity’ (διὰ τὴν ἀργίην), and Sor. Gyn. 1.27.1–3 (pages 17–18 Ilberg), where reportedly one school of thought believed that menstruation is necessary for women because of their ‘domestic and sedentary’ (διὰ τὸ οἰκουρὸν καὶ καθέδριον) lifestyles.
36 Other gynaecological fragments of Rufus preserved in the Libri incerti provide a rationale for the composition's subject. Cf. Rufus apud [Orib.] Libri incerti 18.8 (page 107, lines 20–3 Raeder, ’Εκ τῶν ῾Ρούφου. Περὶ παρθένων διαίτης) ἵνα οὖν μήτε προακμάζωσιν αἱ παρθένοι, μήτε περιπίπτωσι νοσήμασιν, οἷς εἰκὸς ἁλῶναι τὰς τηλικαύτας, ἀναμένωσι δὲ τὸν οἰκεῖον τῆς φύσεως χρόνον, ἔδοξέ μοι καὶ ταύταις τρόπον τινὰ διαίτης ὑποθέσθαι. Rufus, apud [Orib.] Libri incerti 19.1–2 (page 109, lines 16 and 20–1 Raeder, Ἐκ τῶν Ῥούφου. Περὶ κυήσεως) ἐπειδὴ μάλιστα γυνὴ ταλαιπωρεῖται κύουσα, […] δοκεῖ μοι χρῆναι καὶ κυούσῃ γυναικὶ ὑπομνήματα εἰς δίαιταν γράψαι.
37 Rufus apud [Orib.] Libri incerti 20.1–2 (page 109, lines 26–8 Raeder, Ἐκ τῶν ῾Ρούφου. Δίαιτα γυναικῶν).
38 Rufus apud [Orib.] Libri incerti 20.6 (page 109, lines 34–5).
39 Dean-Jones (n. 5), 58: ‘no Hippocratic author recommends that an over-menstruating woman should work harder or increase her exercise, and nowhere in the Hippocratic Corpus is there a suggestion that a woman could overcome her inherently inferior physis to the extent that she could cease to menstruate altogether.’
40 Rufus apud [Orib.] Libri incerti 20.3 (page 109, lines 28–9 Raeder, Ἐκ τῶν ῾Ρούφου. Δίαιτα γυναικῶν).
41 See Dean-Jones (n. 5), 116.
42 συνεδρεύουσαι Romano: συνεδρεύουσί τε Zervos.
43 Cf. Gal. De symptomatum causis 7.264 K. ἔσται δέ ποτε καὶ διὰ τὴν ὕλην αὐτὴν ἐπίσχεσις τῶν καταμηνίων, ὅταν ἤτοι παχὺ τὸ κενούμενον, ἢ γλίσχρον γένηται.
44 Nosebleeds in place of menstruation is an ancient medical topos: cf. Hippocratic Corpus, Aph. 5.33 (page 166 Jones) τῶν καταμηνίων ἐκλειπόντων, αἷμα ἐκ τῶν ῥινῶν ῥυέν, ἀγαθόν; Celsus, Med. 4.27 si uero sanguis, qui ex inferiore parte erumpere solet, is ex naribus eruperit incisis inguinibus adponenda est cucurbita idque per tres uel quattuor menses tricesimo quoque die repetieris: tunc scias hoc uitium sanasse. So too is blood flowing to other parts of the body: cf. Gal. De symptomatum causis 7.266 K. ἀλλ’ ἐνίοτε διὰ τὴν ῥώμην, εἰς ἕτερα μόρια κατασκήψαντος τοῦ αἵματος, αἱ κατὰ τὰς μήτρας ἴσχωνται καθάρσεις.
45 Cf. Celsus, Med. 4.11.2 saepe feminae, quibus sanguis per menstrua non respondit, hunc expuunt; Gal. In Hippocratis Epidemiarum librum II commentariorum I–VI 3.18 (page 517 Vagelpohl).
46 Gal. De locis affectis 8.435 K. Cf. 8.433 K.
47 On the dating of the De locis affectis, see Gärtner, F., Galeni De locis affectis I–II (Berlin, 2015), 193–4Google Scholar. There is no convincing evidence that Rufus’ and Galen's lives overlapped.
48 See Appendix 1 in Pormann (n. 2); Pormann, P., ‘New fragments from Rufus of Ephesus’ On Melancholy’, CQ 64 (2014), 649–56CrossRefGoogle Scholar, at 653.
49 For instance, Celsus, Med. 4.11.1 compares blood spat up during coughs with ‘water in which fresh meat has been washed’ (simile aquae quiddam, in qua caro recens lota est).
50 Some of these symptoms appear in the Hippocratic Corpus, Aph. 5.61 (page 174 Jones); Sor. Gyn. 1.27.3 (page 18, lines 4–8 Ilberg); Celsus, Med. 2.7.7.
51 Ḥunayn ibn Isḥāq (ninth century) gives an account of this process of misattribution. For an English translation of his remarks as preserved in Ibn Abī Uṣaybiʿa, see Savage-Smith, Swain, van Gelder (n. 7), 5.1.38.
52 Cf. Sor. Gyn. 3.9.3 (page 98, line 31 – page 99, line 1 Ilberg): τὰς δὲ διά τι πάθος μὴ καθαιρομένας ἀκολούθως τῷ πεποιηκότι πάθει τὴν ἐποχὴν τῶν ἐμμήνων θεραπευτέον.
53 The final sentence of Romano's chapter 61 (ὅπως … ῥηθήσεται), omitted above, was probably inserted by Aëtius as a transition to the subsequent batch of chapters.
54 Cf. the passages from Soranus and Galen discussed above and Celsus, Med. 6.18.9.
55 Lines 10–15 of this chapter (τὰς δὲ πιμελωδεστέρας … γίνεται) are probably a parenthetical reference to Aët. 2.239 and 3.136.