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Big Hospitals: the Methodism of Caelius Aurelianus and rapid-access medical knowledge

Katherine van Schaik

Harvard University

The practical application of medical knowledge is inflected by several challenges, two of which are especially significant. First, the practitioner must rely upon and interpret the subjective experience of a patient who is (in most cases) unfamiliar with medical theory and practice; in other words, there is a gap between the one who possesses knowledge (the physician) and the body of the one suffering (the patient). Second, medical knowledge frequently needs to be used in a range of diverse and urgent settings, such as childbirth, acute illness, or battle. Over the centuries, practitioners from the classical Greek to Roman Imperial to late antique periods developed many ways of ordering medical knowledge, arranging old and new data in cognitive frameworks meant to grapple with these challenges.

Methodism stands out among the medical sects for its apparent insistence on the accessibility and simplicity of medical knowledge, claims which drew Galen’s scorn and contributed to the fraught preservation and transmission of many relevant texts. Yet the popularity of Methodism, at least in the Roman Imperial period, is well documented (Frede 1987, Leith 2008, Nutton 2012, Pigeaud 1991, Webster 2015); Celsus, for example, highlighted the utility of Methodism in Rome’s ampla valetudinaria (De Med. Pr.64-65). Among extant Methodist texts, Caelius Aurelianus’ On Acute Diseases and On Chronic Diseases are notable for their length and organization. Diseases are classified by acuity (acute/chronic) and anatomic location (with some variation for more systemic processes); further subdivisions provide information about identification and treatment and report earlier practitioners’ recommendations (van der Eijk 1999, 2005).

Of particular interest to a study focused on the structuring of medical knowledge is Caelius’ use of the concepts of affectiones (‘affections’; Gk. πάθη) and coenotetes (‘generalities’; Gk. κοινότητες). Taking Caelius’ discussion of pleurisy as a case study, I demonstrate how his organizational system attempts to simplify medical decision making by using ‘branch points’ that (1) circumscribe the information required for diagnosis and (2) limit the number of therapeutic categories into which a given affection could fall. These ‘branch points,’ or therapeutic categories, were precisely the three Methodist generalities (κοινότητες), and while the kinds of treatments employed might have varied, their application was always dependent on the generality according to which the affection was classified. Once the generality was grasped, therapeutic options became available in an organized, sequential way, reducing the potentially bewildering variety of treatment options at the practitioner’s disposal. Re-evaluation of the patient to determine disease progression and treatment efficacy was also systematized through employment of the διάτριτος, an approach to treatment that was universal yet still allowed for individual variation and flexibility in therapy.

In conclusion, I argue that the Methodists in general, and Caelius Aurelianus in particular, deliberately and systematically introduced a clinically relevant flexibility into their structures of medical knowledge. By organizing medical knowledge in this way, Methodism allowed for the simplification of decisions at crucial junctures in extended decision-making processes, enabling practitioners to mitigate the complicating effects of patient subjectivity and to apply medical knowledge efficiently in urgent settings.

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Ordering Information in Greco-Roman Medicine

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