Rufus of Ephesus (c. first century a.d.) was the author, among other things, of a treatise On Melancholy which was to have a powerful influence on thinking about melancholy and madness in Europe and the Islamic world. Despite its popularity, the treatise survives only in fragments (in Greek, Latin, and Arabic), which are presented here in up-to-date editions (many edited anew) and provided with facing English translation, introduction and detailed commentary by Peter Pormann. There is also an appendix containing texts and translations (by Pormann and Philip van der Eijk) of the relevant portions of Galen, who was much indebted to Rufus in his analysis of melancholy, and (by Pormann) of selected other Arabic sources. As an additional bonus, the volume includes seven essays on Rufus and his influence, which situate the treatise in its historical context and examine the tradition to which it gave rise.

Rufus followed the Hippocratic tradition in understanding disease principally according to the doctrine of four humors: melancholy results from an excess of black bile. But black bile itself comes in two varieties, and there are also other factors that determine the nature of the disease, for example the part of the body affected (rib-cage, brain, whole body). Thus, the symptoms of melancholy may vary widely. Aristotle (or more likely a member of his school) had already observed (Problemata 30.1) that melancholy was associated with outstanding ability and intellectual genius: Hercules, Socrates and Plato are cited as suffering from this affliction. The text goes on to state that black bile may be either hot or cold: the former produces good cheer and, in excess, frenzy, whereas the latter causes fear and despondency. Peter Toohey argues that Aristotelian melancholy may be associated with what is today called bipolar or manic-depressive behaviour. Rufus, however, is best known for the view that an excess of thinking is what produces melancholy: whereas Aristotle speaks of genius as a product of melancholy, Rufus rather sees melancholy as arising from too much study. Whether or not this was his chief emphasis, it is what the later tradition ascribed to him, and it found expression, for example, in Albrecht Dürer's famous engraving, Melencolia I, to which Peter-Klaus Schuster and Jörg Völlnagel devote a chapter in the book. But the tradition remained complex and in part contradictory, and ‘Dürer's engraving encompasses the contradictions inherent in the antique ideas about melancholy’ (218).

Philip van der Eijk situates Rufus within the ancient philosophical tradition. Although Rufus was primarily a practical or clinical physician, with little interest in philosophical ideas as such, his description of the symptoms of melancholy harks back to the Aristotelian problema (e.g., lisping and an excess of gas), even to the point of adopting a question-and-answer style (165); implicitly, however, he was indebted to the earlier philosophical tradition for concepts concerning the relation between body and soul and other abstract notions. Vivian Nutton focuses on Rufus in relation to the contemporary medical schools, emphasizing that there was much exchange of ideas among them; rather than see them merely as contending sects, Nutton speaks of ‘the medical marketplace’. Simon Swain, in turn, offers a description of the intellectual social world in which Rufus operated, which in part explains why he should have been concerned with the ill effects of lucubration: ‘Rufus observed the pressure on the educated classes of his day. His genius was to recognise their interest in melancholy by giving the disease a makeover and providing it with an up-to-date and full length account which subsequent generations would take as the starting point for their own discussions’ (137–8).

Peter Pormann examines the idea of melancholy in the medieval Jewish, Christian, and Muslim traditions, where Rufus — or, as Toohey has it, the Rufus tradition — was a major point of reference. Later Christians associated melancholy with acedia or ‘sloth’, one of the seven deadly sins, and extreme asceticism could be seen as the kind of intellectual excess that, according to Rufus, was a cause of melancholy. The Muslim practioners, above all Ar-Rāzi, ‘the single most important source of fragments from Rufus' On Melancholy’ (190), and Al-Kaskarī, had experience in hospitals, which were ‘highly sophisticated institutions where the most advanced physicians looked after their patients, be they poor or powerful’ (194), and this gave them a broader empirical understanding of madness and melancholy. Finally, Thomas Rütten explores Rufus' legacy in modern times, offering a fascinating account of how the association between the classicist Hellmut Flashar and the psychiatrist Hubertus Tellenbach helped to resurrect Rufus' approach to melancholy just at the time (the 1970s and 1980s) when a new diagnostic of ‘hidden or smiling depression, a depressive disorder masked by physical complaints’ (250), came to dominate the modern debate; as Rütten observes (251), ‘Rufus allowed the new diagnosis to be historically legitimised, as it were — a not unimportant factor given hidden depression's problematic conceptualisation’.

I have only touched on a few of the insights that these essays offer. Taken together with the excellent quality of the edition and translation and the valuable notes, this volume will be of interest not only to those specializing in the history of medicine, but to classicists generally and indeed to all those interested in the history of ideas.