Philosophy and Dietetics in the Hippocratic On Regimen: a delicate balance of health. By Hynek Bartos. Leiden: Brill 2015. Pp. ix + 340. $175.00 (paperback). ISBN-13:978-9004289215. Monte Ransome Johnson Hynek Bartos does the field of ancient philosophy a great service by detailing the influence of early Greek thinkers (such as Heraclitus, Empedocles, Anaxagoras, Democritus, and Diogenes of Apollonia) on the Hippocratic work On Regimen, and by demonstrating that work's innovative engagement with contemporary scientific and philosophical concepts as well as its direct influence on Plato and Aristotle. His study usefully counteracts the lamentable tendency among ancient philosophers to ignore or downplay the influence of medical literature on philosophy in general, and to heap scorn on this text in particular, which Kirk, Raven, and Schofield considered 'an eclectic and very superficial quasiphilosophical treatise' and Barnes famously called 'a silly farrago of ill-digested Presocratic opinions' (5). In chapter 1, 'The discovery of Dietetics', Bartos outlines the development of 'dietetics' before introducing the text that is the focus of his study. He defines dietetics as a 'therapeutic approach aiming at recovering and maintaining health by moderating one's way of life' (14) and argues that in Greek medicine it was a relatively late development for which there is hardly any evidence before the second half of the fifth century (16). That is when the first Hippocratic treatises began appearing, and when theories about elements and their qualities began to be applied to the treatment of internal diseases. The earliest clear external reference to dietetic therapy is found in Thucydides (37). The older medical approaches were essentially limited to drugging and surgery. The term hygieia, Bartos points out, does not appear in Homer or Hesiod, nor does any other term indicating a general concept of health. Hesiod's speculation about the divine or spontaneous origin of diseases, and Homer's depictions of the strength of warriors being restored by mixtures of food and drink or of treatment of wounds indicate that epidemiology, drugging, and surgery (and hence medicine itself) extends far back into the archaic period. But the idea of health as 'an independent value which should be revered for its own sake and which was attainable by human means, i.e. not only as a result of a god's blessing or a piece of good fortune' (17) is in fact a later development. Maxims asserting that 'health is the best thing' appear in Theognis and are quoted by Plato and Aristotle, and 'during the sixth and fifth centuries BCE health became one of the most appreciated and widely accepted values of human Ancient Philosophy 40 (2020) ©Mathesis Publications 1 Uncorrected Proofs life, and once its value was recognized its validity remained more or less unchallenged throughout antiquity' (17). Dietetics was presented as a uniquely effective technique for promoting this novel and compelling value of health, and was developed on the basis of current scientific theories about the elements and their qualities, and employed terms from the mathematical and scientific lexicon, especially summetriê, which means symmetry, proportion, or balance (thus the 'delicate balance of health' of the subtitle). Specifically, the dietetic approach to health hypothesizes 'a balanced mixture of opposing qualities, at the most general level hot, cold, dry and wet. This balance depends on the specific constitution and age of the individual and is strongly influenced by seasonal changes and other weather and climatic conditions' (20). Bartos acknowledges that a virtual consensus of scholars attributes this development to Pythagoreans working in Croton (24), but he rejects this account. He emphasizes the precedents for dietetic theory in early Hippocratic treatises, including one of the very earliest, Airs, Waters, and Places. Here one can find the idea of bad diet as a cause of disease, and even the idea of a summetriê or appropriate mixture of qualities as the underlying physical cause of health. But the work contains no hint of a dietetic therapy (38-39). The earliest theory of dietetic therapy is found in On Regimen in Acute Diseases, whose author promises that his own account 'has great power to bring health in all cases of sickness, preservation of health to those who are well, good condition to athletes in training, and in fact realization of each man's particular desire' (41). Here we apparently have the first in a long line of advertisements massively exaggerating the benefits of following a certain diet, a line that can be traced from antiquity to the present day. A momentous development here is that 'dietetic care can also be understood as a self-therapy and even as preventive self-care, which is the main topic of On Regimen in Health' ( 46). As I will argue below, this idea of self-therapy or selfcare is a truly revolutionary idea with implications that reach far behind the history of dietetics and medicine into the history of ancient philosophy and literature in general. And so it is well worth trying to get clearer on the origin of these ideas. Turning from dietetics in general to the specific text on which Bartos' study is focused, the !"#$% &$'$()*+ or On Regimen (also referred to as De diaeta or De victu) consists of four books in modern editions and belongs to the longest of the so-called Hippocratic writings (3). Its authorship by 'Hippocrates' was already disputed in antiquity, as Galen reports (3). Speculation about dating ranges from the end of the fifth century to 350 BCE. Bartos stays within that range, proposing a terminus post quem around 420 BCE and using Plato's Timaeus as a sufficiently reliable terminus ante quem (4). Other Hippocratic treatises, including Airs, Waters, Places, On Regimen in Health, On the Nature of Man, On Regimen in Acute Diseases, and On Ancient Medicine can be supposed to be written before this treatise or at about the same time (15). Contrary to the historians of philosophy quoted above, Bartos describes On 2 Regimen as 'a text with remarkably strong unity in its structural composition, with precision in its details, and with a coherent theoretical stance pervading all four books' (5). Bartos provides a comprehensive survey of the work in this and the following two chapters, and the level of detail he provides often approaches that of a commentary. Although the book is not formatted as commentary, Bartos does provide a complete index locorum in addition to an index nominem and a general index. Bartos' account of the intended audience of On Regimen holds great interest. Although 'it is often presupposed that On Regimen addresses professionals, i.e. physicians in general, or more specifically dieticians or gymnastic trainers' (48), Bartos points out that, aside from a single passage in chapter 2, 'the author never addresses physicians nor does he...say anything instructive about the relationship between physician and patient. There are no references to his medical practice and no case studies' (47). But if this medical text is not intended for professional doctors, trainers, or dieticians, then who was its audience? Bartos interprets the 'dietetic treatise as a means of direct communication between its author and his laymen readers, for whom it provides a kind of manual for dietetic self-care' (49). Bartos calls this idea the 'manual hypothesis' (49). The manual hypothesis I am advocating presupposes that dietetic self-care was viewed as a legitimate alternative to professional medical care, for which we have some evidence especially in the philosophical literature of the day. The idea that everyone may and should take full responsibility for his/her own health and even can be his/her own best doctor is attested for all three most important Athenian philosophers: Socrates, Plato and Aristotle. (53) I will return to a discussion of the origin of this idea of dietetic self-care, which, as Bartos says, had so much influence on those famous Athenian philosophers. But I consider the origin of self-care literature as a somewhat distinct issue from the hypothesis that the work On Regimen was intended as a 'manual', which is a genre very familiar to modern readers, but not as clear with reference to ancient texts. An established literary genre not mentioned by Bartos, but which is worth thinking about in relation to this text is protreptic or exhortation, that is, speech designed to encourage someone to do something. Protreptics to philosophy, such as those referred to in Plato's Euthydemus and Clitophon and authored by members of the Socratic circle and Aristotle, although lost, in their fragments bear a strong resemblance to the rhetorical strategy of the author of On Regimen, since, as Bartos says, 'he appeals to their wisdom, intelligence and capacity to acquire correct knowledge, and warns them against accepting the views of ordinary men. Moreover, he promises that they will achieve the best possible intelligence and memory if they correctly apply the suggested dietetic instructions' (53). In other words, the author of On Regimen offers a classic protreptic to dietetic therapy. Other medical texts can be fruitfully interpreted as protreptics, leading up to and including Galen's famous protreptikos ep' iatrikên (Opera 1.1-39), and I think it 3 would be very useful in general to investigate the protreptic aspects of On Regimen and other ancient medical writings. Such an investigation might also help explain an apparent problem for the 'manual' hypothesis: the apparent uselessness of giving dietetic instructions so general that they can be written down. As Bartos says: 'the impossibility of defining accurate symmetry may reflect the fact that in the written treatise only general instructions can be provided and these always need appropriate adjustments to individual situations. Accordingly...it is not possible to provide an exact diagnosis "without being present" and therefore it is impossible to write it down in a treatise'. In connection with this, Bartos quotes the remarkable opening of book 3: 'As I have said above, it is impossible to write about the regimen of men with such precision as to make the exercises proportionate to the amount of food. There are many things to prevent this' (Vict. 3.67)' (64-65). The sentence exhibits a surprising and admirable scientific humility even as it employs the technical scientific terminology of summetriê. Although On Regimen does contain numerous technical discussions that go beyond what one would expect to find in a straightforward protreptic, it seems possible to interpret those technical discussions as attempts to convince the reader of the scientific validity or credibility of this novel form of medical treatment. At any rate, it seems to me that the author of On Regimen is at least as concerned to exhort his readers to dietetic therapy as he is to provide them with a practical manual to it. I will have to outline the contents of the remaining chapters much more briefly. Chapters 2 and 3 discuss the appearance of philosophical concepts in On Regimen. In chapter 2, 'Philosophy of the Nature of Man', Bartos discusses the author's use of the concept of mimêsis, his application and development of a unique elemental theory, and his extensive employment and development of analogies between macrocosm and microcosm, and between physis and technê. Bartos' discussion of the analogy between physics and technê in On Regimen i 12-24 in particular is fresh and brimming with insight. In chapter 3, 'Therapy of Body and Soul', Bartos discusses the unique theory of the relation between body and soul in On Regimen, which he had already described as 'the most profoundly elaborated account of the body-soul relationship available in the extant pre-Platonic literature' (8). As for the origin of the idea of a 'therapy of body and soul', Bartos rightly locates the origin of the idea in Democritus (going on to discuss its presence in Gorgias and the Xenophontic Socrates as well), although he does not discuss the exact relationship between Democritus and the author of the On Regimen. In fact, his method of treating Democritus I think somewhat downplays Democritus' importance to the history of dietetics. I will digress here to try to offer a brief corrective to this by summarizing the relevant facts about Democritus, some of which can be found in Bartos' book, but some of which cannot. Democritus was a contemporary of Hippocrates and is associated with him in the biographical literature on Hippocrates (175-176). Democritus holds that human beings are responsible for their own health, and 4 they should blame themselves, not the gods, for destroying their own health (B234, referred to in passing on 18n36). According to the list of titles found in Diogenes Laertius ix 48, Democritus authored at least 4 works on medical topics, including Prognôsis, Peri diaitês ê diaitêtikon, Hê iatrikê gnômê, Aitiai peri akairiôn kai epikairiôn (176n67). The earliest known work on dietetics, then, is attributable to Democritus: the Peri diaitês ê diaitêtikon (On Regimen or Dietetics). Bartos does not explain this fact or speculate about the nature or contents of this work. Bartos also does not discuss the fact that among the fragments of Democritus we have direct and specific dietetic recommendations, for example: Those whose pleasures are produced out of their belly, exceeding the due measure in eating, drinking, or sex, all produce brief and minor pleasures, and lasting as long as they are eating or drinking, but also many pains. For because the desire is always present, and when they get that which they desire the pleasure quickly passes by, they have nothing themselves except a brief feeling of joy, and they need the same things again. (68B235, my translation) This extremely early specimen of dietetic therapy is incredibly interesting: it seems to be the earliest, and a very clear description of the phenomenon we call addiction: excessive indulgence in food, drink, and sex produces less and less satisfaction with the same objects for which one unfortunately gains an increasing desire. Here is a piece of advice offered from its author to his audience that aims to change their soul in such a way that will in turn improve their health. Bartos does acknowledge that in general, 'unlike the medical authors Democritus clearly distinguishes soul-therapy from therapy of the body' (176), referencing DK 68B31: 'medicine heals diseases of a body, but wisdom removes passions from a soul'. Bartos notices that Democritus takes therapy of the soul and therapy of the body to be 'two alternative (and occasionally even competing...) therapeutic approaches and Democritus argues compellingly in favor of the therapy of the soul' (176-177, referencing 68B187, according to which improving the soul improves the body, but improving the body does not necessarily improve the soul. Democritus argues that the soul should be held responsible for the bad condition of the body, because the soul uses the body like a tool or instrument. As Bartos remarks, 'Democritus thus introduces an instrumental conception of the relationship between psuchê and sôma, which is considerably different from that found in the Hippocratic accounts' (177, referencing 68B159; cf. B212, referenced on 176). Bartos also recognizes that Democritus attributes a good condition of the soul, which he calls euthumie, to 'feelings of joy in moderation and by proportion in way of life' (metiotêti terpsios kai biou summetriêi), and a bad condition of the soul to 'things excessive and deficient', which 'tend to fluctuate and induce great motions in the soul' (B191, referenced on 177-178). But Bartos does not reflect much on the fact that this shows that Democritus already had a conception of health as a 'balance' (summetrie), one that could be affected by moderation, etc. Democritus also seems to be the first author who claims that his 5 words can directly affect the condition of his auditor or reader, removing her passions and making her better. He does so in the continuation of the fragment quoted just above: 'by holding fast to this thought, you will live with more euthumia, and will drive away those not small defects in your life: envy, jealousy, and ill-will' (B191); and also: 'These thoughts of mine, if someone attends to them with sense, he will work many things worthy of a good man and will not do many bad things' (68B35). Putting this network of evidence together, it is clear that Democritus is the originator of the self-therapy or self-care literary genre, and that he had developed an account of how reasoning applied to the soul could lead to an improvement in the body (but not vice versa), thus enabling an author to directly improve the audience without the mediation of a professional such as a medical doctor, whose effectiveness is limited to curing diseases of the body. Democritus offered specifically dietetic advice about avoiding augmenting desires and addiction, and he did so in connection with the apparently earliest developed conception of the healthy condition as a balance or summetriê in soul and body, which could be effected by moderation and avoidence of excesses and deficiencies. Being one of the earliest authors of medical treatises, and early on associated with Hippocratic literature, it is Democritus who authored the original work on dietetic therapy. In light of these facts, I think that it would be useful to interpret his work as much in light of Democritean fragments as Heraclitean ones, although both previous commentators and Bartos pays the most attention to those (e.g., 111-128). In chapter 4, 'The Philosophical Legacy of On Regimen', Bartos argues that both Plato and Aristotle were directly acquainted with On Regimen (11 and passim). Specifically, Bartos demonstrates the influence of On Regimen on Plato's Timaeus and on Aristotle's theory of innate heat (crucial to his account of animal and human physiology in his biological works). But Bartos also discusses more general interactions between ideas in On Regimen and Aristotle's theory of health and natural teleology. I found these discussions interesting, useful, and convincing. As he pointed out already in the introduction: 'Few ideas have been accepted by ancient Greek thinkers with such consensus as the concept of health understood as a kind of balance between opposing elements in the human body. This notion, which is comparable with the modern concept of homeostasis, was prominent not only in the domain of medical theory but also in general discussions of human nature, cosmology, ethics and politics' (1). These ideas were earlier discussed by Tracy in Physiological Theory and the Doctrine of the Mean in Plato and Aristotle (1969), who included 50 pages of discussion of medical authors. But Tracy devoted only four pages to On Regimen, while Bartos takes this text as his 'main part of departure in the reconstruction of the early history of the concepts of balance, health, soul and other topics related to the nature of man' (3). These ideas about health as a balance, as well as the idea of a kind of selfhelp literature that enables self-therapy and self-care by focusing on exhorting the soul to moderate its diet so as to bring about this balance, is a fascinating 6 development in the medical literature, parallel to the earlier developments of surgery and drugging as therapy for the body that could be provided by a professional doctor. If anything this idea of self-help for the soul grew in importance after Plato and Aristotle in the Hellenistic era, when the Epicureans, Stoics, and even Pyrrhonians developed practical ethics as a kind of therapy of the soul, which they all explicitly compared to medicine for the body. I have argued that Democritus is the most important influence on these ideas, but Bartos has certainly made the case that the Hippocratic author of On Regimen is also an early and key influence on this kind of philosophy. Department of Philosophy University of California, San Diego La Jolla CA 92093 monte@ucsd.edu