THE RISE OF METHODISM

When, around AD 70, the Elder Pliny surveyed the development of medicine in his Natural History, he composed a devastating indictment of his fellow Romans and their Greek doctors. As we have seen, he saw the transplantation of Greek medicine to Rome as an index of moral decline, the triumph of luxury over old Roman virtues.1 Now, blown along by every passing fancy, his fellow citizens put their faith in healers who offered novelty rather than sound prospects of health. Cold-water cures were succeeded by astrological dietetics as the fashionable therapy of the day and this, in turn, by cold baths.2 Each healer put forward his own pet theory in order to gain patients. Most notorious of all in Pliny’s eyes was Thessalus of Tralles, the Methodist whose memorial among the select graves on the Appian Way bore the epithet iatronikes, ‘champion physician’. Whether in public or at the bedside, confrontation took over from co-operation, disagreement from shared diagnosis, and public morality collapsed along with private health.3 Pliny’s rhetoric had a basis in reality: the expanding population of the capital allowed a ready market for any and all medical theories and practices. Democriteans, Asclepiadeans, Pneumatists, Hippocratics and Empiricists vied for attention with Tiberius Claudius Menecrates, who proclaimed his own creation of a ‘clear and logical sect’, and with Leonides of Alexandria, whose soubriquet, the ‘Episynthetic’, implied that he was bringing together all that was best in others’ teaching.4 But by concentrating on individuals and their failings, and by implying a constant instability, Pliny’s account obscures the rise to prominence of widespread medical groupings, or sects, with long-lasting traditions, especially the Methodists.5 His denunciation of Thessalus, allied to the disdain of others for various features of Methodism and its practitioners, has had a lasting effect. By contrast with Hippocratism, and its claim to go back to the great age of Greece, Methodism is often viewed as an upstart, a Roman parvenu, born in a society that knew little and cared less about proper medicine. This chapter’s reassessment of the most important Roman contribution to medicine will take the arguments of the Methodists themselves seriously. It will suggest that their major theories were the result of a reasoned

response to a new situation, namely the sheer size of the city of Rome, and a dissatisfaction with both the Hippocratic and the Empiricist approaches to diagnosis. They offered a new epistemology of medicine as an ongoing process of knowledge, based on an evident correlation between observations and a small range of possible underlying conditions. Although their opponents accused them of doctrinaire adherence to a fixed system that failed to consider the individual patient, their therapeutic practices did allow for a considerable degree of latitude, and several of their treatments differed only slightly from those of their adversaries. Methodism, so called because of its claim to follow a uniquely successful method of healing, was arguably the dominant medical theory throughout the Roman world for at least three centuries, despite Galen’s somewhat slighting reference to it as ‘the third sect’.6 Although its origins can be located among Greek-speaking doctors in Rome and Italy, and although both Pliny and Galen imply that it became successful only by appealing to the lowest and less sophisticated groups there, its influence stretched across the Empire. At Alexandria in the 150s, Julian, a pupil of Apollonides of Cyprus, was composing his forty-eight books (of lectures?) on the Hippocratic Aphorisms as well as his Philo, a large exposition of Methodist doctrine.7 Galen’s rival as an imperial physician in the Rome of the 170s, Statilius Attalus, was a Methodist who belonged to the same family from Asia Minor as Statilius Crito.8 Attalus’ teacher, Soranus, although he had had experience of Rome, viewed it disparagingly from the perspective of a leading physician of Asia Minor and a native of Ephesus, one of the most wealthy, vibrant and cultured cities in the entire ancient world.9 His contemporary, Marcus Modius Asiaticus, ‘Champion of the Method’ and ‘Methodist doctor’, gazes out from his beautifully carved bust with all the hauteur of a leading intellectual at Smyrna (Izmir, W. Turkey), the neighbour and rival of Ephesus in matters cultural as well as political.10 Methodism was bilingual. Of the major surviving monuments of Methodism, the huge treatise on Chronic and Acute Diseases by the North African Caelius Aurelianus was written in Latin, Soranus’ Gynaecology in Greek. It was also long lasting, flourishing in N. Africa in Late Antiquity with Caelius and influencing early mediaeval medicine in the West to a far greater extent than Galenic Hippocratism. The origins and general doctrines of Methodism remain controversial, largely because, apart from Soranus and Caelius, no large-scale treatise written by a Methodist has come down to us. As a consequence, the early Methodists on the whole speak only through their detractors, even ones so courteous as Celsus. The advantages of their system of medicine are minimised, not least through being placed in an aridly intellectual environment. Even if modern scholars no longer repeat the facile denunciations of Methodism put forward by Pliny and Galen, they have not entirely freed themselves from these old assertions of its weaknesses. In trying to defend Methodism they have often unwittingly fallen into the trap of fighting on

a battlefield already determined by its opponents.11 Yet, as this chapter will show, the Methodists, once allowed to speak for themselves, present a system of therapeutics that is far from philosophically naive, and that relates neatly to the problems and consequences of medical practice in an urban environment.12 What Galen saw as evidence of uncertainty and confusion, they considered matters of indifference when treating the patient; much of what he thought essential in a physician they regarded as peripheral in the struggle against disease. Moreover, the desire of Methodism’s opponents to tar all its members with the same brush obscures historical developments within Methodism. Even apparently neutral lists, for example, of the succession of leaders of the sect turn out on closer inspection to be untrustworthy, both because of what they leave out and because of their tendency to create a neat line of authority that is intended to carry weight because of a direct succession of distinguished names going back to the founder. Differences and hesitations are smoothed out to suggest a tight coherence that, in reality, was never there. This chapter thus seeks to rehabilitate Methodism by attempting to see it through the eyes of its own adherents over two centuries or more. The ancient doxography of Methodism tells a simple story: as in a biblical genealogy, name follows name in an apparent succession. ‘Themison of Laodicea began the sect, taking his cue from the rational Asclepiades; Thessalus of Tralles completed it; then followed Mnaseas, Dionysius …’13 But this apparently unbroken sequence of masters and pupils is intended to give the authority of age to the views of modern Methodists far more than to present a history of Methodism.14 Not only does it suggest an unchanging body of doctrine, shared by all Methodists, but it appears to skate over difficulties of chronology and geography. If Asclepiades was already dead by 91 BC, as some have thought, the gap between him and Thessalus, whose triumphs in Rome are securely located in the 50s and 60s, cannot be bridged by one man, Themison, especially if he was a direct pupil of Asclepiades.15 Even on a chronology that puts Asclepiades’ main activity forty years or more later the gap between Themison and Thessalus is still uncomfortably wide. Second, Cornelius Celsus, our best contemporary evidence for first-century Methodism, appears to dissociate Themison from what the Methodists of his own day believed, even though they claimed him as their founder and the authority for their doctrines.16 Celsus himself never mentions Thessalus by name, either because he was writing just before Thessalus became prominent or because he did not wish to be seen to indulge in a polemic with him. Certainly, his references to modern Methodism imply that it was already flourishing even before Thessalus came on the scene. Thessalus himself was notoriously self-assertive, preaching against all other doctrines but his own, and there is little doubt that he introduced changes to what Themison had taught.17 Indeed, Galen, our single most informative source for early Methodism, takes Thessalus as the object of his attack against Methodism and Methodists (‘Thessalian asses’) in general. Although he admits that

Themison’s ideas were at the root of Thessalian Methodism, especially the doctrine of commonalities, he qualifies this admission by attributing far-reaching changes to Thessalus. In this way he can treat Methodism as something created effectively de novo by Thessalus and thus associate all later Methodists, including his competitors, with the bombast and bluster of a man he saw as a great charlatan.18 The humbler author of the Introduction to Medicine offers a similar, if less polemical, schema: Themison broke with Asclepiades to found the Methodist sect, but it was Thessalus who brought it to perfection. But neither Galen’s rhetorical strategy nor the anonymous author’s apparent precision offers a solid basis for granting (or denying) Thessalus the role of the founder of Methodism, or for choosing between him and Themison.19 This debate over founding fathers can be placed within the broader context of the influence of Asclepiades of Bithynia in advocating a mechanistic, corpuscular theory of medicine (see p. 172). His followers spread over the Roman world, from the Rhone valley in S. Gaul to Tarsus in S.E. Turkey.20 Some doctors well into the third or fourth century were still claiming to be followers of Asclepiades, although by then little Cibyra, in eastern Pamphylia (S. Turkey), where the Asclepiadean doctor Aurelius Varianus Pantauchus was commemorated, was hardly in the forefront of progress.21 But in the last years of the Roman Republic and the first years of the Empire the intellectual and social importance of Asclepiades’ adherents was considerable. M. Artorius was a court doctor to Augustus in 23 BC; Laecanius Arius of Tarsus the friend and mentor of Dioscorides, as well as being himself a celebrated writer on pharmacology.22 Julius Bassus, Niceratus, Petronius Musa, Diodotus and Sextius Niger, whom Dioscorides condemns in the preface to his Materia medica for their reluctance to test the herbs they described, were all respectable writers on pharmacology, and on much else.23 They shared with Asclepiades a belief in a material world made up of particles as opposed to the elements posited by the Aristotelians and Stoics. In this they may have been akin to the Democritean doctor Philo of Hyampolis, introduced as an interlocutor by Plutarch, who attributed thirst to changes in the shape of the relevant ‘channels’ (‘pores’) of the body.24 There are also links with the corpuscular philosophy of the Epicureans, best exemplified in the discussion of plague in Lucretius’ poem On the Nature of Things.25 It is against this philosophical and medical background that one must set Themison and his ideas. According to Celsus and Pliny, it was towards the end of his life that Themison, an immigrant to Rome from Laodicea in Syria, diverged somewhat from the teachings of his master Asclepiades, but neither author makes the nature of that divergence totally clear.26 It involved both a shift of clinical emphasis and a theoretical readjustment.27 Themison declared that good medicine was effective practice, no more, no less; there was no need for complex nosological classifications (though nosology and close observation of symptoms were essential), still less for any investigation into the hidden

causes of disease.28 But empirical observation by itself was not enough. What was required was the understanding that all diseases shared some general and plainly visible characteristics, ‘commonalities’, and that once these were recognised the choice of treatment followed easily. An examination of the patient would provide a good indication of the appropriate commonality. There was no need of repeated observation, logical demonstration or anatomical investigation:29 the patient’s condition itself gave an objective and immediate pointer to its classification. To go further and investigate precisely what caused these commonalities, as a Hippocratic might want to do, was irrelevant; to hunt for past cases comparable in every detail, as Empiricists advocated, was time consuming and, in the absence of any principle that would direct the search, merely random. In Themison’s view there were three major categories of disease, based on ‘stricture’, ‘looseness’ or an intermediate, mixed state. Asclepiades had used similar formulations, but the theoretical shift made by Themison was to extend Asclepiades’ view of disease as primarily dependent on the size and organisation of corpuscles to one in which the fault could lie equally with the corpuscles and with the pores through which they flowed. Sometimes the corpuscles were too big, at others the channels were too small; in either case, the result was the same, stricture.30 At the same time, he divided up diseases according to whether they were acute or chronic, the first being largely the result of stricture, the latter of looseness. Although the distinction is implicit in much earlier writing, it was Themison, according to Caelius Aurelianus, who was the first to write a treatise with this explicit organisation.31 Early Methodists also divided the treatment of all diseases according to three common and universal stages: an initial increase, a middle period when the level of the disease was constant, and a final stage in which it diminished.32 Themison may also have been among the first, if not the first, to have stressed the importance of the diatritos, each three-day period, as marking a significant stage in the treatment.33 Themison’s doctrines were open to attack on a variety of counts. Celsus accepted that they might have some medical usefulness, but derided them because they appeared to abolish what was, in his eyes, the crucial element in medical practice, the encounter between doctor and patient, which led to an understanding of, and therapy for, the sick individual. More than once Celsus draws a distinction between medicine in a valetudinarium or a big city practice, and the activity of the true doctor, able to diagnose and to prescribe for the ills of each patient. He acknowledges that, faced with many sufferers at one time, attention to general common features may be all that the doctor can offer, but, equally, he makes it clear that this is not the course that he himself would choose. Better, he thinks, to pay more attention to fewer patients, and have a potentially lower income, than to treat all and sundry with a therapy that might not be targeted precisely.34 Nonetheless, from the perspective of the patient, a Methodist physician who offered a swift diagnosis and a treatment that might

work as well as any other could have many advantages over an expensive competitor who took his time in reaching any conclusion. Even Celsus was prepared to admit that if one was not already acquainted with the individual condition of the patient, proceeding by commonalities was sensible – but it was far better to have a friend as a doctor than a stranger.35 How coherent early Methodism was as a system of medicine is difficult to determine. There were certainly debates about the meaning of terms such as ‘fluid’ (did it refer to the fluid state of the whole body or of a part; was it to be judged by all bodily secretions or by a few?), but theoretical differences may have had little effect on practice.36 Similarly, Galen’s gleeful denunciation of Methodist inconsistency in talking indiscriminately about ‘diseases’ and ‘affections’ demonstrates merely that they had no place in their system for what to him was a fundamental distinction.37 In his turn, too, Thessalus exaggerated the differences between himself, Themison and other Asclepiadeans by his rhetorical claims to be the founder of his own sect and to be creating a novel type of medicine. His behaviour emphasised his singularity. He was accompanied by crowds wherever he went; he was the correspondent of the Emperor Nero; and he denounced with enthusiasm the follies of all the physicians who had preceded him.38 How he developed Themison’s ideas is unclear in the fog created by Galen’s scorn and his own propaganda. His origins, in the wealthy town of Tralles in Asia Minor, famous for its woollen industry, were turned against him by Galen to imply that he came from a humble family of workers in wool, traditionally a job fit only for women. Thessalus could thus be convicted of effeminacy, and his followers likewise.39 Their intellectual stupidity was compounded in Galen’s eyes by their low social and moral status. Their claim to be able to teach the whole of medicine in just six months to any who might want to learn, slaves, ex-slaves or those who could afford nothing better, seemed further proof of their lack of education and sense of social responsibility.40 Galen’s satirical picture of Themison’s horror at the subsequent transformation of his commonalities by Thessalus suggests that it was Thessalus who developed this central notion of Methodism in a variety of ways.41 These commonalities became more and more subdivided: those concerned with dietetics were distinguished from those to do with surgery; the surgical divided into abnormalities on the outside of the body – a thorn, for instance, to be removed by extraction – and those on the inside. The latter were further subdivided into those where there was an abnormality of place, for example a sprain or fracture, to be cured by repositioning; of size, such as a tumour or excrescence, to be removed by opening or extraction; and of insufficiency, for example a fistula or ulcer, which needed to be filled. A fifth surgical commonality, the prophylactic, dealt with poisons.42 Similar types of wounds demanded similar treatment; all those which failed to scar, for instance, required the removal of whatever prevented scarring.43 In dietetics, the commonalities were sub-

divided into active and passive according to whether they induced a flux and merely flowed.44 Once the indications or signs of these commonalities had been grasped, treatment followed a common route without deviation. But different parts of the body might require different treatments: inflammations of the hand or foot were dry diseases; those of the mouth or eyes were mixed. Variations in dosage depended not on the individuality of each patient but on the intensity of the disease, which might vary with the season, the age of the patient or the stage of the disease.45 In this way the Methodists gained a flexibility of treatment without having to resort to the – to them impossible – task of discovering the specific natural condition of the individual patient and the degree to which any illness diverged from that norm. At the same time, by claiming that a common collocation of symptoms required an identical form of treatment they reduced the range of potential therapies to manageable proportions. The result at times might come very close to the treatment advocated by a Hippocratic physician such as Rufus for the same condition, although the route whereby that decision was reached might be very different. The Methodist stressed a commonality of symptoms; his competitor proceeded from a perception of the individual make-up of the patient that required restoration.46 A second innovation that may be attributed to Thessalus is the notion of ‘metasynkrisis’, the modification of the pores of the body, whether in illness or in the process of recovery through the application of drugs. It is this process that requires closest attention during treatment, and which, in turn, permits the modification of the treatment in accordance with the particular visible common condition.47 The fixed plan of treatment proposed by the Empiricists or the Hippocratics, which, once decided upon, should be followed throughout the illness, is thus avoided by the Methodists, who preferred instead to modify it as appeared best to them. Apparently opposed methods may thus be used consecutively if that is what the common conditions suggest.48 Galen has great fun with this idea, and particularly with Thessalus’ insistence that the patient should be kept without food for the first diatritos – that is, until the third day. The idea that the patient can be first starved and then stuffed strikes him as stupid, a perversion of method, and in his own dealings with Methodists he delights in pointing out the folly and even dangers of adhering to such a rule.49 But the notion of the diatritos as a general guideline is far from foolish. It breaks down the management of a condition into time periods that are long enough to show some change, or absence of it, while not being so extended as to allow potentially serious developments to take hold. It forms a balance between constant attendance and a Hippocratic doctrine of critical days that might impose many days or even weeks between important changes that required careful attention from the doctor. On the Hippocratic scheme, observing these crises should merely confirm the truths of a diagnosis already made and of a pattern of treatment already decided upon; the Methodist diatritos requires a constant process of

observation and decision. Both procedures can be accused of a certain degree of inflexibility, but it is far from clear that the Methodists’ diatritos put their patients in greater danger than the belief of their opponents that, once made, the diagnosis of the cause of a disease imposed a course of treatment that stood in no need of modification. Galen’s objections to the Methodists are also epistemological.50 Their claim that their commonalities are self-evident he derides as simplistic as well as inconsistent, for there are debates within Methodism as to which commonality is responsible for this or that condition, or whether a particular disease manifesting itself in one part of the body is in fact affecting the whole body.51 But while such arguments might seem shocking to their opponents, Methodists such as Soranus and Caelius could dismiss them as peripheral or irrelevant to treatment. To them it made little difference whether one part alone was diseased or it merely manifested the signs of illness to a greater extent than others; many of their drugs, although they were generally applied directly to the affected part, did not change their active power when they were applied elsewhere or affected only the point of application.52 A similar attitude was taken by Methodists towards definitions. For Galen the inability of Methodists to arrive at a clear and certain definition of a disease was a mark of failure, yet no one reading the careful descriptions of diseases in Caelius Aurelianus, who based himself often explicitly on Soranus, could fail to note the similarity between them and what other authors from a variety of sects put forward.53 The key to this divergence lies in the underlying attitude to the acquisition of knowledge. For Galen, and for many others in the Hippocratic tradition, medicine was a science, a firm constellation of acquired data and principles; for the Methodists, although they were prepared to use the word ‘science’, it was more a process of understanding, open to modification in accordance with sensory phenomena.54 Their science was provisional, although in practice they were prepared to follow some doctrines and procedures, and to accept some chains of cause and effect. In this, compared with Empiricists, they could be considered dogmatists, for they did invoke reasoning. Yet at the same time they refused to grant total certainty to that reasoning, giving priority to the indications from clearly visible phenomena that obviated the need for a logical analysis.55 It is this provisionality that made them, as the philosopher Sextus Empiricus noted, suitable companions for Sceptical philosophers, and which, at the same time, infuriated those who demanded certainty or who saw inconsistencies between what Methodists claimed to believe and their, at times more rigid, practice.56 In his frequent polemics with Methodists Galen condemned their adherence to tenets that might be inappropriate in an individual case, and he scornfully derided their efforts to treat all instances of the same disease in the same way, like those who wished to fit the same shoe to every foot. Their philosophical defences struck him as naive and foolish, and, most notably in the first two books of his own Method of Healing, he had little

difficulty in pointing out what seemed to him to be gross errors in logic. But the Methodists could in turn argue that from their viewpoint Galen’s own recommendations were oversophisticated, overlong and largely irrelevant to what was most needed, the effective treatment of the diseased patient. That Galen was distorting the ideas of Methodism for his own polemical purposes is clear from what survives of Methodist writings, particularly those of Soranus of Ephesus. Although Galen elsewhere admits that there had been changes in Methodism over the years, especially with Menemachus, Olympicus and Soranus at the end of the first century, when indulging his passion for controversy he takes the Methodism of Thessalus as normative.57 He can thus convict his opponents of slavish adherence to erroneous and outmoded doctrines when they agree with Thessalus, and of inconsistency when they do not. The one Methodist for whom Galen retained any respect was Soranus – and rightly so, to judge from what remains of his writings.58 Few details are preserved of the life and career of Soranus.59 The entry in the Byzantine Suda lexicon gives his parents’ names and his place of birth, Ephesus, and states that he lived in Rome under Trajan and Hadrian – that is, in the first quarter of the second century. That he knew Rome is clear from a reference to the practice of venesection there in cases of pleurisy and from his disparaging comment on the reasons for the prevalence of bow-legged children in Rome: they are encouraged to walk too early on the paved and unyielding streets; the water is extremely cold; and their mothers take far less care of their children than do the Greeks.60 Other passing remarks suggest an acquaintance with Caria, Crete and Egypt: a stay in Alexandria for his medical education would be appropriate – other young men from Asia Minor, including Galen, made that journey – and account for his anatomical knowledge.61 A later report, by Marcellus of Bordeaux, claims that he settled in Aquitaine, S.W. France, to care for 200 people suffering from a contagious skin disease. But Marcellus’ source is unknown, and may be as untrustworthy as the even later stories that link Soranus with Queen Cleopatra as a specialist in cosmetics.62 His writings ranged widely, from works on philosophy, grammar and etymology to specialised medical tracts on bandaging, semen, clystering or the commonalities. Alongside general treatises on surgery (of which a section on fractures survives) or hygiene, he also wrote a series of biographies of earlier physicians and their writings, of which the extant Life of Hippocrates According to Soranus may be one.63 His historical interests can also be seen in the careful recording of the opinions of earlier writers as preserved by Caelius Aurelianus in his own treatises on Acute and Chronic Diseases.64 Caelius was avowedly drawing on a large work of the same name by Soranus, for he cites him frequently and in a manner that shows that he was consulting him in the Greek original. How closely he followed Soranus is more controversial. Most scholars now allow Caelius a certain degree of independent thought while accepting that the general outlines and organisation of his work

mirror that of Soranus. He made a redaction, not a translation, of Soranus, although in the first book of Acute Diseases, which is the only one concerned with a single disease, phrenitis, he may have stayed closer to the Greek original than elsewhere.65 But it is for his Gynaecology, or The Diseases of Women, that Soranus is, and was, most renowned.66 Not least because, except for the short gynaecological texts in the Hippocratic Corpus and the enigmatic chapters of Metrodora, it is the only treatise on the subject that has come down to us from the classical period.67 Galen dealt with specific gynaecological topics, especially in his On Seed, On the Formation of the Foetus and On the Anatomy of the Womb, but from a restricted and very theoretical point of view. Later authors, most notably the encyclopaedist Aetius, Caelius Aurelianus in the fragments of his Gynaecology and the influential Mustio/Moschion, have preserved a few more details of ancient practice, but they are for the most part heavily dependent on Soranus.68 Without Soranus, then, we should be almost totally ignorant about ancient childbirth and obstetrics, compelled to create a narrative from scattered finds of instruments, such as vaginal specula, and passing comments on abortion, child-rearing and the dangers of letting a male doctor anywhere near the female members of the household.69 Soranus begins his book with a sketch of the ideal midwife – literate, sharp-witted, hardworking and robust (because she has to bear a ‘double burden’ of both mother and child). She must have a good memory and be sound in both mind and limb; neat and tidy, and, so some recommend, with long thin fingers and short nails to avoid damaging the womb on any internal examination. This ideal, he implies, is not always achieved, and he draws a distinction between an accomplished midwife, satisfactorily skilled in all aspects of practical obstetrics, and her superior, who knows all necessary theory as well as wider aspects of medicine, surgery and pharmacology. He refuses to be drawn on the ideal age for the midwife or whether she should herself have had children. Vigour and sympathy are not confined to any one group, and it is far better to look for moral qualities, honesty, sobriety, tact and an abhorrence of greed and superstition – and also of wool-working, for this makes her hands rough.70 Soranus’ recommendations raise two major questions immediately: how far do they correspond to the reality of midwives in the ancient world? And what was the relationship of the midwife to Soranus and similar male doctors? Inscriptions record the names of many women who are called ‘obstetrix’, ‘medica’ or their Greek equivalents, but, as in the Greek world of the Hippocratic Corpus (see p. 102), deciding the precise meaning of these overlapping terms is impossible.71 Not every obstetrix will have confined her attentions to pregnancy and childbirth; nor will every female doctor have treated only women and young children. The social standing and education of Antiochis of Tlos, the correspondent of Heraclides of Tarentum honoured for her medical services by her native town of Tlos in Lycia, will have been vastly superior to

those of Hygia, a freedwoman obstetrix in the household of Marcella, a relative of the Emperor Augustus, or of Restituta, who set up a monument in Rome to her husband and teacher, Ti. Claudius Alcimus.72 The tombstone of Valeria Berecunda proclaimed that she was the ‘first medical midwife of her precinct’ within Rome, an advertising slogan rather than an official position; others, more humble still, have left no memorial at all.73 The women who attended the wife of Flavius Boethus possessed enough knowledge and experience to gain the respect of Galen when he was finally called in to treat her for what at first appeared to be an incomplete spontaneous abortion. That he would have been so respectful of the barmaid-cum-midwife who assisted at the birth of the great philosopher and sophist Ablabius is less easy to believe.74 The gulf between the servants of a senatorial household and the average citizen, let alone his wife or daughter, was enormous. Yet the midwife-barmaid, breaking off from her other activities to be present at a birth, may well represent the norm in most communities in the ancient world.75 Sometimes the midwife may have picked up her knowledge from attending births with other women and being part of ‘women’s networks of knowledge’. But the constituents of this knowledge are entirely lost to us, along with much of the learned gynaecological tradition, and it would be foolish to assume any greater precision and accuracy than is visible in our surviving male sources. The wide range of answers to queries on conception and the possible length of pregnancy, themes that had an importance well beyond narrowly medical circles, does not encourage belief in the superior accuracy of any group’s notions, male or female.76 That is not to say that male writers such as Soranus and Galen did not regard the midwife as subordinate to the doctor. According to Soranus, she might attend to the actual birth, but under the supervision of the doctor, who takes over as soon as things become difficult.77 Galen’s descriptions of his gynaecological cases naturally place him clearly in charge. Soranus’ sources, from Euryphon of Cnidus in the fifth century, through Diocles and Herophilus, to other Methodists such as Dionysius and Mnaseas, are resolutely male, and the implication of his prescriptions for the ideal midwife is that she should be as like a male doctor as possible. Even believing that there were specific women’s diseases differing in nature from those affecting men did not entail accepting also that the treatment of such diseases should be left in the hands of women.78 General treatises on hygiene and recipe collections, written by men, included sections on amenorrhoea as well as on baldness, and uterine problems as well as those of the penis. A theoretical acquaintance with the female body is universally assumed in male treatises, and there is little doubt that some doctors gained their knowledge also from practice.79 But it is unlikely that many devoted all, or even most of, their time to midwifery. C. Julius Epianax and Heliconias from the Greek island of Paros, who called themselves ‘maioi’ when making a dedication to the goddess of childbirth, were probably relatives responsible for the baby’s nurture.80