Alexander of Tralles

Alexander of Tralles was a sixth-century Byzantine physician who combined thorough Galenic training with a willingness to disagree with Galen, use folk remedies, and include charms and incantations alongside rational therapy. He traveled widely with the emperor’s troops through North Africa, Italy, Gaul, Spain, and Armenia, collecting remedies from peasants and local healers wherever he went. His major work, the Therapeutica, is organized by disease rather than by theoretical system, and it records his own clinical experience alongside what he drew from books. He stands out among late antique physicians for his independence of mind and his insistence that truth matters more than the authority of any master.

Life and Context

Alexander of Tralles (c.560 CE) traveled widely, to North Africa, Italy, and further west with the emperor (Nutton, 2023). He sought out remedies from peasants in Tuscany, Gaul, Spain, and Armenia, employing chants, charms, and peasant remedies alongside his Galenic knowledge (Nutton, 2023). This habit of gathering knowledge from non-literate sources reflects the oral transmission of medical knowledge; Nutton notes that much Greek and Roman medicine was transmitted orally and that the peasants from whom Alexander gained information were part of that tradition, with literacy restricted to higher social echelons (Nutton, 2023).

Stapley dates Alexander to 525–605 and describes him as writing twelve books on medicine that combined his own clinical experience with the works of Galen and Dioscorides, recording some 600 drugs with precise dosages and demonstrating knowledge of far-eastern medicines unusual for Byzantine practitioners of his era.(Stapley, 2024) Walsh places Alexander in a triad of early medieval physicians from Asia Minor, alongside Aetius of Amida and Paul of Aegina, whose compilations preserved classical medicine for later centuries (James J. Walsh, 1920). But Alexander fits uneasily in the category of “compiler.” Where Aetius and Paul assembled extracts with minimal commentary, Alexander wrote from personal experience and was willing to argue with his sources.

Temkin groups Alexander with Stephanus and Paul of Aegina as the three representatives of Hippocratic medicine at the very end of antiquity, each illuminating a different aspect of the art: the classroom lecture (Stephanus), the medical manual (Paul), and the work of the experienced practitioner (Alexander) (Temkin, 1991). The distinction matters. Alexander’s writing is recognizably that of a physician who has treated patients, not that of a teacher or compiler.

Like Paul and Stephanus, Alexander can be assumed to have been Christian, though Temkin notes that the positive indications are weak, and for all practical purposes his works could have been written by a pagan (Temkin, 1991).

Truth over Authority

Alexander’s intellectual temperament is best captured in his treatment of Galen: Temkin reports that Alexander valued truth over authority, quoting the proverb “Plato is my friend, but so is truth” to justify disagreeing with “the most divine Galen” (Temkin, 1991). He considered it sinful to keep silent when truth was at issue (Temkin, 1991). Yet Temkin adds an important qualification: Alexander’s actual disagreements with Galen remained within the framework of Galenic pathology (Temkin, 1991); he challenged specific conclusions while accepting the system (Temkin, 1991).

This is not unusual for the period. Temkin notes that the Arabic physician Rhazes similarly invoked Galen’s own insistence on truth to justify diverging from Galen’s conclusions (Temkin, 1973). Alexander and Rhazes both represent a pattern in which the most independent-minded physicians within Galenism used Galen’s own rhetoric of free inquiry to create space for disagreement — without ever leaving the Galenic framework itself.

Therapeutic Pragmatism

Nutton describes Alexander as exemplifying resistance to rigid Galenism (Nutton, 2023). He contrasted his own willingness to employ a variety of therapies with the reluctance of the book-bound, ineffective, and even murderous Galenist to depart from his master’s words (Nutton, 2023).

Walsh reports that Alexander taught that the physician’s duty is “to cool what is hot, to warm what is cold, to dry what is moist, and to moisten what is dry” and to “look upon the patient as a besieged city, and try to rescue him with every means that art and science placed at his command” (James J. Walsh, 1920).

Occult Remedies and Incantations

The most striking and controversial feature of Alexander’s practice is his inclusion of charms, amulets, and incantations alongside rational therapy. Temkin describes how Alexander justified this: there are persons incapable of adhering to a strict regimen or of tolerating drugs, who “therefore compel us to use occult remedies and amulets.” He cited pseudo-Galenic authority for the efficacy of incantations and argued that it was sinful to discard any possible helpful remedy. Conjuring, even by the name of the Biblical God, was magic, “but Alexander justified this sin by contending that it avoided the sin of allowing a patient to die” (Temkin, 1991).

Ullmann places this in a broader intellectual context. He argues that Alexander’s turn toward magical remedies was not born of superstition but reflects a rational epistemological stance: since the ultimate secrets of natural faculties are hidden, no available remedy — however inexplicable — can be dismissed. The turning toward magic “is almost necessarily the result of the boundaries which were set to medieval man’s desire for knowledge” (Ullmann, 1978). Ullmann compares Alexander to Arnald of Villanova and Paracelsus, who made similar arguments centuries later (Ullmann, 1978).

Ullmann further notes that magical remedies played a large role in Alexander’s work, and that he called them physika — “natural remedies” — a terminological choice that reframed magic as part of the natural world rather than as a departure from it (Ullmann, 1978). This reframing allowed Alexander to include folk remedies without explicitly violating the Hippocratic-Galenic commitment to naturalistic explanation.

Influence on Arabic Medicine

[GAP: The claim that Alexander was among the Greek medical authors translated into Arabic during the ninth-century translation movement is unsupported.] Pormann notes that the late antique Alexandrian medical curriculum was transmitted to the Arabic tradition via Syriac and Pahlavi intermediaries (Pormann, 2007). Wilder identifies the Nestorian Christians, driven out of Constantinople by Catholic authorities, as the critical human link in this transmission: expelled from their university at Edessa, they carried Greek medical and philosophical learning eastward, and their work as physicians and translators made them the principal conduits between the learning of Greece and the Arabic East (Wilder, 1901).

His influence on Arabic pathology is specific and traceable. Ullmann notes that al-Majusi’s classification of melancholy by the humour causing it — blood producing euphoria, yellow bile producing anger, black bile producing brooding — was derived from Alexander of Tralles, not al-Majusi’s own innovation (Ullmann, 1978). Alexander’s classification thus passed through Arabic medicine into the standard medieval understanding of mental illness.

Porter notes that Oribasius played an important role as mediator and synthesizer, preserving excerpts from many authors otherwise lost and shaping the package of Galenism that dominated later centuries (Porter, 1997). Temkin’s broader argument is that medieval Western Galenism was not Galen as he wrote but a medical philosophy twice removed from him, filtered through Byzantine and Arab intermediaries (Temkin, 1973).

Influence on Anglo-Saxon Medicine

Archbishop Theodore of Tarsus, appointed to Canterbury in the late seventh century, established a school where medicine was taught alongside theology, astronomy, and arithmetic; as a Greek from Tarsus he would have been familiar with Hippocratic and Galenic medicine, making his Canterbury school an early conduit for classical medical knowledge in England.(Stapley, 2024) The author of Anglo-Saxon Leechcraft reports that the monasteries at Winchester, Malmesbury, and Glastonbury, founded in the eighth century, contained the works of Aretaeus, Alexander of Tralles, and Paul of Aegina (Henry S. Wellcome, 1912). The Leech Book of Bald, written around 900-950 CE, shows the influence of Alexander of Tralles, Paul of Aegina, and Rhazes clearly traceable in its prescriptions (Henry S. Wellcome, 1912).

Assessment

Alexander occupies an unusual position in the history of medicine. He was neither a system-builder nor a simple compiler. He worked within Galenism but argued with it. He valued book-learning but also gathered remedies from illiterate peasants. He practiced rational medicine but included incantations. These apparent contradictions dissolve when Alexander is understood on his own terms: as a physician committed to helping patients by whatever means worked, regardless of whether those means fit neatly into any single theoretical framework.

The anonymous author of Medicine in the Middle Ages places Alexander alongside Aetius and Paul as the last Greek physicians to practice before the fall of the Alexandrian school (Unknown, undated). But Alexander was different from his contemporaries in kind, not only in time. His Therapeutica is the work of a man who had seen too much of the world — too many patients, too many local remedies, too many failures of orthodox treatment — to believe that any single authority had all the answers.

See Also

• Galen
• Hippocrates
• Paul of Aegina
• Aetius of Amida
• Oribasius
• Rufus of Ephesus
• Byzantine Medicine
• Arabic Medicine
• Leech Book of Bald
• Folk Medicine

Sources

Primary evidence for this page comes from:

• Nutton, V. (2023). Ancient Medicine (3rd ed.). London: Routledge. [Source ID: nutton-ancient-medicine-2023]
• Temkin, O. (1991). Hippocrates in a World of Pagans and Christians. Baltimore: Johns Hopkins. [Source ID: temkin-hippocratespagans-1991]
• Temkin, O. (1977). The Double Face of Janus. Baltimore: Johns Hopkins. [Source ID: temkin-doublefacejanus-1977]
• Temkin, O. (1973). Galenism: Rise and Decline of a Medical Philosophy. Ithaca: Cornell. [Source ID: temkin-galenism-1973]
• Walsh, J. J. (1920). Medieval Medicine. London: Black. [Source ID: walsh-medieval-medicine-1920]
• Porter, R. (1997). The Greatest Benefit to Mankind. London: HarperCollins. [Source ID: porter-greatestbenefit-1997]
• Ullmann, M. (1978). Islamic Medicine. Edinburgh: Edinburgh UP. [Source ID: ullmann-islamicmedicine-1978]
• Pormann, P. E. & Savage-Smith, E. (2007). Medieval Islamic Medicine. Edinburgh: Edinburgh UP. [Source ID: pormann-medievalislamic-2007]
• Payne, J. F. (1912). Anglo-Saxon Leechcraft. London. [Source ID: anglo-saxon-leechcraft-1912]
• Wilder, A. (1901). History of Medicine. New Sharon, ME: New England Eclectic Publishing. [Source ID: wilder-historymedicine-1901]