linked for the first thousand years of their existence. Both took root in the
sixth
century B.C.E., a period when the Greeks first struggled to free themselves
from
irrationality and superstition (Farrington 1966: 80-81).
1 . The use of
argument and
dialectic to draw conclusions concerning man's constitution and place in the
universe is common to both philosophy and medicine (Lloyd 1979: cap. 2).
Moreover,
right down to late antiquity, both professions continued to borrow ideas
and
methodology from each other. Not only was there a reciprocal influence
between
philosophy and medicine, but many an ancient thinker expounded on both
these
sciences in his writings. The second century C.E. medical writer, Galen, even
thought
that Hippocrates was the first of philosopher-doctors who discoursed on
the subject
(Galen (1952): I.ii.4). In this paper, I intend to examine a few specific
points from the
intertwining relationship between ancient medical theory and philosophy
during
the fifth-fourth century B.C.E. After discussing basic problems concerning
the
corpus of medical writing surviving from this period, I will examine the
central issue
of rationality and irrationality in ancient medical writings and their
relationship to
contemporaneous philosophical problems. I am mainly concerned with
issues raised
in the corpus of writing associated with Hippocrates of Cos, whose life-span
was
roughly coeval with that of Socrates of Athens (469-399 B.C.E.).2 .
Illustration 1: (slide 1992 I32)
known for certain to have been written by Hippocrates, it does include a
number of
early documents that were actually composed in his life-time.3 . The bulk
of the
Hippocratic corpus comprises about sixty compositions that are possibly
the remnants
of book collections from a variety of sources: some emanating from ancient
medical
centres from the eastern Aegean, some comprising general medical works
of a
popular nature, and others composed by individual doctors from various
parts of the
Greek world. Most of these works had probably already been gathered
together and
edited in the Library of Alexandria (Farrington 1966: 66-67). This may
account for the
variety of sources involved. However, in basic essentials, the Hippocratic
corpus
probably originated in the island of Cos, although some of it may also
reflect the
teaching of the rival medical school in neighbouring Cnidos.4 . Traditionally,
the
keeper of these writings was the guild of Coan physicians known as the
'Asclepiadae',
or 'Sons of Asclepius', God of Healing 5
. During the classical and the
Hellenistic period,
Cos had long served as a cult and healing centre dedicated to the worship
of Apollo the
Physician (Ietros), Asclepius, his son - as well as to the latter's daughters,
the
Goddesses Hygieia ('Health') and Panacea ('Complete Recuperation' or
'Recuperation
for All'). However, there are very few references to this cult in the
Hippocratic
corpus itself.6 . For
the moment, we may note that the Hippocratic collection
is
scientific, rather than cultic in tenor and none of these practices form part
of its
discussions.
Nonetheless, the works of the corpus do not advocate any single medical
method -
nor do they all subscribe to the same physiological theory. Let us take as
an example
two early works that examine the issue of medical theory each in
markedly different
way:
1) On Ancient Medicine (peri Archaies Ietrikes) is edited in Hippocrates
1923-1931: I
pp. 12-64.7 . It is in effect an attack on those physicians (ietroi) and
philosophers
(sophistai) who claimed that no one could acquire the medical art who did
not first
know what man is himself (cap. 20).8 . However, something very like the
hypothesis
criticised here was ascribed by Plato to Hippocrates himself.9 In place of
the
application of philosophic hypotheseis to medical science (cap. 1-2), the
author
proposes to return to the empirical methods of "ancient medicine (archaia
ietrike)"
(cap. 3-4), hence the title of his composition. For him, 'ancient medicine'
represents medical art before philosophers and theoreticians like
Empedocles
interfered with it. The author admits that ancient medicine did not achieve
accuracy (akribeia), but adds that we need not abandon its procedure of
inquiry
because of this (cap. 12). For him, ancient medicine belonged, as it were, to
a golden
age in the past, but, at the same time, bequeathed a methodology that the
author
applies to the empirical school of his own day. This methodology consisted
mostly in
the diagnosis, prognosis and record of the course of the disease; any
treatment was
of a mostly palliative nature.
2) On the Nature of Man (peri Physios Anthropou) is edited in Hippocrates
1923-1931:
IV. 2-41. It advocates a medical theory completely contradictory to the
previous
work: the author believes in the influence of the humours on the physical
constitution (caps. 1, 8), in a theory of the relationship between mind, body
and
disease (cap. 9), and in the influence of climate and environment on health
(cap.
13-18). The nature of man is thus to be understood as part of the same
cosmological
and physiological principle that governs all living creatures. In contrast to
the
previous work, On the Nature of Man presupposes a medical hypothesis
independent of the examination of individual cases.
The book of Regimen (peri Diaites) I - edited in Hippocrates 1923-1931:
IV. 224-295 -
embodies the type of philosophy attacked in On Ancient Medicine since it
claims that
to discuss a healthy way of life properly "we need first understand the
nature of man
as a whole" (cap. II). It attaches importance to philosophical terminology
(caps. IV),
but its hypothetical assumptions are different from those of On the Nature
of Man,
since it upholds a theory of health as a balance in temperature (hot-cold),
fluidity
(cap. III) and diet-activity (cap. II).
Other works in the Hippocratic corpus are devoted less to medical theory
per se, as to
the question of rational and empirical treatment of diseases and wounds -
e.g., On
Affections (peri Pathon) and On Diseases (peri Nouson) I-II . Nonetheless,
advice on
practical methodology is sometimes raised in their discussion. In On
Affections, the
first duty of the doctor is to question the patient about his symptoms
before
beginning the examination (Hippocrates 1923-1931: I cap. 37). In On
Diseases I, even
questions of medical ethics are raised:
"The following are correctly and incorrectly done: incorrectly done is
to tell (the patient) that the disease is one thing when it is another; to
say that it is serious when it is minor - or minor when it is serious; to
deny that (a patient) will survive when he will - and to one about to
die, to deny that he will die" (Hippocrates 1923-1931: I 'On Diseases I'
cap. 6).
Other works in the Hippocratic collection discuss causes of specific disease
and ill-
health. The early composition, On the Sacred Disease (peri Hieres Nousou) ,
for
instance, discusses mistaken and superstitious notions about the causes of
epilepsy. It
is edited in Hippocrates 1923-1931: II pp. 138-183. Yet other works, like
the first and
third books of Epidemics, comprise mere notes of case histories, but of a
purely
empirical and descriptive nature with little, or no suggestions for
treatment (edited
in: Hippocrates 1923-1931: I pp. 146-211, 218-287). Not always is the
purpose of
composition of these works totally clear: they sometimes resemble lists
and
procedural notes written by the doctor for his own use - e.g., Epidemics I
and III
(Jones in: Hippocrates 1923-1931: I pp. 141-142). Others resemble
fragments
reassembled out of the accumulated written experience recorded in a
school's
archive.10 . Yet other texts may be lecture notes - and not all of them
addressed to a
professional medical audience.11 .Some of them are composed with the
well-read
layman chiefly in mind - the sort of person who was interested in learning
about
health and disease.12 .
Illustration 3 (computerised map)
Text to illustration 3: [Map showing the area of scientific and philosophical
achievements in the vicinity of the Island of Cos: the Ionian colonies are to
the
north-east and the Doric states of the Hexapolis to the east and south-
east.]
The Hippocratic Tradition and the Beginnings of Rationalism
It is not pure chance that the Hippocratic tradition developed in Cos along
the lines
that it did. There are two aspects that need be noticed: first the indigenous
Doric
society in the island; secondly, its Ionic literary affiliation. Like its rival,
Cnidos, its
medical school was situated in an area that was linguistically and socially
part of a
Doric tradition (Schmitt 19912: 43-45). The original Doric Hexapolis once
embraced
cities in the islands of Cos and Rhodes, as well as mainland Cnidos and
Halicarnassus
on the opposite shores. However, the proximity of the Ionic cultural
centres at
Miletus, Samos, Ephesus and Colophon, meant that not only did Ionic
scientific and
philosophic thought reach Cos, but also a tradition of composing medical
writings in
an artificial Ionic language. Close to Cos, there had also evolved a tradition
of
preserving and analysing factual records, that culminated in the Histories
of
Herodotus from neighbouring Halicarnassus (c. 484-420 B.C.E.). However,
by classical
times, his native city of Halicarnassus had left the Hexapolis, no longer
maintaining
its Doric religious and social obligations (Herodotus 1967: I. 144) and had
adopted the
cultural traditions of Ionia (Schmitt 19912: 98-99). Consequently, it was in
this dialect
that Herodotus composed his works.13 . To a certain extent, the Ionic dialect
and factual
descriptions of the Hippocratic corpus can be said to have been preceded
by prose
writers like Herodotus.
The early Ionic philosophers working in Miletus and Ephesus were
described by
Aristotle as physikoi and physiologoi, those who give an account of nature
(physis).14 . The research and theory developed at Miletus by the 6th-5th
century
physiologists, Thales, Anaximander and Anxaximenes, touched on
questions relating
to nearly every aspect of nature - ranging from cosmology to the origins of
the
humankind. However, there is no evidence that they examined questions
of a purely
medical nature. It is true that the 5th-4th century Pythagoreans did
develop a special
medical theory of their own, but it seems to have flourished in Italy,
rather than in
Pythagoras' native Samos. What characterised philosophy at its earliest
period was
the struggle to explain the universe in non-supernatural terms, by seeking
a cause
(aitia) for cosmological, meteorological and terrestrial phenomena in a
rationalistic and consistent manner.
Scholars have understood the concept of a gradually emergent
rationalism in a variety of ways. Many have equated this process with
the 'scientific' (i.e., speculative) spirit of Ionia, although these two
developments should be clearly distinguished as far as the early period
is concerned. Mythologists like Hesiod speculated on the order of cosmic
creation no less than 'thinkers' like Anaximander. Others have pointed
to the abandonment of personification in early cosmological and
theological discussions as an indication of the distinction between the
thought of the early Ionians and the poetry of Homer and Hesiod
(Cornford 1957: 15-16). This tendency to offer a humanly subjective,
rather than objective account of the universe does not in itself
contradict the presence of a logical and rational process even in
mythopoeic thought (Frankfort-Wilson-Jacobsen 1964: 18-20). Neither
does it maintain that philosophers were ever pure rationalists right
down to the Hellenistic period (Dodds 1966: 254). Both approaches are
necessary to explain an emergent rationalism: an objective account of
reality as well as a process of ratiocination of some fashion. For this
reason, it has been suggested that the rationalism characterizing both
Hesiod and Ionian thought begins not only with apersonalization of
speculative accounts, but also with the ability to analyze, synthesize and
systematize complex accounts of the universe (Kirk-Raven-Schofield
19832: 72-73). I have my doubts, however, concerning to what extent the
early thinkers were aware of the revolution that they were innovating
(Lloyd 1987: 49) since the first book of Aristotle's Metaphysics goes out
of its way to stress the continutiy with the older thought of the
mythological poets. But a revolution there was in medicine as well as
philosophy.
When Xenophanes (c. 570-478 B.C.E.) of Ionic Colophon said, "What they
call Iris
this too is by nature a bright, purple and yellowish cloud in appearance
(Diels -
Kranz 1969 14: I. 21 B32), he was rationalising the Goddess Rainbow as a
cloud and a
meteorological, cosmological principle (Kirk-Raven-Schofield 19832: Fr.
178). While
we hear of philosophers like Anaxagoras and Protagoras who were
punished and
exiled for questioning the role of the gods in the universe, we do not hear
of doctors
who suffered for seeking a rational rather than divine cause for disease.
The author
of On the Sacred Disease argued that "man's body is not defiled by a god"
(Hippocrates
1923-1931: II. cap. IV. 40-50) and that "this disease (scil. epilepsy) is in
my opinion no
more divine than any other" (cap. V. 61). Similarly, the author of On the
Art (peri
Technes) replies to "those who do not reason logically (ouk orthos
logizomenoi)"
concerning the art of medicine (edited in: Hippocrates 1923-1931: II. pp.
190-217).15 .
He thus denies that the cause of recovery is spontaneous (automaton; cap.
vi.10) or
due to chance (tyche; cap. vii). In his opinion, "the cures should be
infallible, not
because they are easy, but because they have been discovered" (cap.
ix.10).
Illustration 4 (Cos slide a):
Text to Illustration 4 ["The arrival of the
God Asclepius at Cos, greeted by a
Coan
and showing Hippocrates seated at a school exedra (2nd-3rd century A.D.
mosaic). Cos
Museum. Photo: S. Stournaras"]
Cult Practice and the Medical Art
While much of On the Art set itself to reply to public criticism of the
medical art, we
should not forget that the professional physicians of Cos also found
themselves
competing with an 'alternative medical treatment'. Folk remedies for
illness had
always been popular at a domestic level - and may even have sometimes
employed
concoctions similar to those found in the corpus (Lloyd 1979: 45). In such
terms, early
'rationalistic' medical theories were never far from their soothe-saying
past, even
deriving such medical terms as 'prognosis' from it. Ancient, like modern,
patients expected their doctors not only to diagnose their disease, but
also to predict its outcome as well as 'divine' its course during the period
before the doctor had encountered them (Lloyd 1979: 45). During the
classical
period especially, there evolved within the sacred enclosures of Asclepius
a religious
alternative to Hippocratic medical treatment.16 .This was a tradition
dominated by cult
ceremonies and offerings intended to prevent - or cure - the diseases of
the faithful.
Animal sacrifices, especially a cockerel to Asclepius, were customarily
offered at
home or in the temple grounds - and were intended to procure a recovery,
or give
thanks for one achieved.17 . Offerings also include the dedication in the
temple
precincts of euchai - i.e., ex-voto figurines of the affected part of the body,
sometimes
made of precious metals. These could have been dedicated in accordance
with a vow
made either in an apotropaic prayer (euche), or in gratitude to the god
(Burkert 1990:
68-70).18 . As long as these practices were intended to pacify the faithful
following
recovery from a disease, they would have in no way interfered with the
Hippocratic
practice. However, when they were proffered to cure the patient, or
prevent disease
in place of the Asclepiad doctor, then there may have arisen some friction
(Lloyd
1987: 90-90 n. 144).
We hear very little about this from the corpus itself. However, Regimen IV
- also
called On Dreams (peri Enypnion) - closes its discussion of the
interpretation of
dreams with the politically correct remark: "Praying (euchesthai) is a good
thing, but
one should call on the Gods when one is taking oneself in hand in addition"
(Hippocrates 1923-1931: IV cap. LXXXVII fin.).
Illustration 5 (slide 1992J31)
Text to Illustration 5 ["Temple of
Asclepius, Cos. To the right is the bomos
or altar.
Photo: Menahem Luz"]
Illustration 6 (photo print b/w)
Text to Illustration 6 ["Stairway to the
Temple Complex, Cos: ground level -
cult
niches; middle level - Temple of Apollo (left), lesser Temple of Asclepius
(right);
upper level - greater Temple of Asclepius. Photo:Ý Menahem Luz"]
An imaginative description of sacrifice and prayer to Asclepius is depicted
by the
3rd century B.C.E. poet, Hero(n)das (Knox, E.D. 1953: 114-123). In Mime IV,
he depicts
two village women, Cynno and Coccale, on a supposed visit to the
Asclepium of Cos.
Cynno prays first to the Lord Healer (Asclepius) and then to a long list of
the god's
relatives. As is traditional in such ceremonies, each and every god and
goddess of the
healing pantheon must be named for the prayer to be effective:
and has taken up a dwelling in sweet Cos and Epidaurus.
Greetings too to Coronis, who bore you, as well as to Apollo
and to Health (Hygieia) whom you touch with your right hand.
Also to those, to whom your altars are honoured,
Panacea and Healing (Ieso) and
So also
once did sack, though
- to them, Podaleirius and Machaon, greetings.
So to all the Gods who inhabit your hearth
and Goddesses too, O Father Healer!"
Illustration 7 (computer drawing)
[Text to illustration 7: Fragment from an hexameter hymn to Asclepius
from the precinct of Epidaurus, dating from the third century A.D., but
possibly many centuries older (West 1994: 279). This musical
transcription
is adapted from an interpretation of the ancient notation of the fragment
in West 1994: 287-288 no. 11. ]
Cynno then offers a sacrifice of a cockerel as thanks to Asclepius while,
Coccale
places beside the statue of Hygieia a dedicatory plaque/painting (pinax;
line 19),
possibly an ex-voto euche that depicted the organ healed. The mime ends
with a
prayer to Father Healer led by the temple neophyte (neokouros; lines 82-
85), whom
Cynno repays with a drum-stick from the sacrifice (line 89), while Coccale
is bidden
to feed the sacred snakes some honey-cake and offer the barley-wafers
(lines 89-92).
Illustration 8 (slide 1992 H28):
Text to Illustration 8 ["The Goddess
Hygieia (Health) feeding the sacred
snake a
honey cake. Rhodes Museum. Photo:Ý Menahem Luz"]
It is apparent from the text, that these two women were meant to have
visited the
temple following a recovery from some unspecified disease in the family
(lines 16-
18). At any rate, there is absolutely no mention in the mime of their
having visited a
doctor in the town of Cos, or intending to do so. It would then seem that a
visit to the
doctor's surgery (iatreion) was a totally separate issue from their visit to
the temple -
and it is by no means certain that it was carried out. Even if certain doctors
maintained their practice in the vicinity of the temple, they would seem to
have been
acting in a completely separate capacity from that of the priests. As it is, at
Cos, the
Asclepium lies some kilometres outside of the polis, where presumably,
any public or
private iatros would have resided.
Illustration 9: (slide 1992 H27)
Text to Illustration 9 ["The God Asclepius
grasping his rod of healing,
entwined
with a sacred snake and symbol of healing. Rhodes Museum. Photo:Ý
Menahem Luz"]
Cult treatment could also involve incubation (enkoimiesis), i.e. a night of
sleep
either in the temple abaton, or in a special dormitory (enkoimetrion)
included within
the temenos area. Even prior to the expansion of Asclepius' cult, incubation
seems to
have been long common practice at other Greek shrines (Dodds 1966: 110-
111). The
intention was to achieve a cure from ailment in sleep, or receive
instruction from
the god in dream. Aristophanes has an amusing, although obviously
fabricated
account of one such night's incubation in the Asclepium of Athens:-
following the
sacrifices and cake offerings to the god, the blind Plutus' friends lay him
down to
sleep in the temenos buildings (Aristophanes 1907: Plutus lines 659-663);
in the
middle of the night, there emerges a priest who sets about stealing the
offerings
(lines 676-681), smears the eyes of the afflicted with a concoction that
does more
harm than good (lines 714-723); and contrives to restore Plutus' sight by
getting the
sacred snakes lick his eyes (lines 727-738). Although there may have
been some
chicanery at every temple, regular treatment by incubation would have
been based
on interpretation of dreams and apparitions. Although obviously there
occurred, as
today, the odd cases of faith healing, that dutifully left their record in
stone
inscription (Grant 1953: 55-59; Rice-Stambaugh 1979: 69-75). Some have
even
supposed that incubation was in all essentials a sincere religious
experience even
though the real success rate may have been low (Dodds 1966: 114-
115).
In contrast to this, the author of the Hippocratic Regimen IV or On Dreams
attempts
to utilise dreams as a means to restore mental and physical health, but in a
more
rational fashion. In his opinion, dreams reflect not only the activity of the
mind
when the body is insentient, but also can indicate a person's health
(Hippocrates
1923-1931: IV cap. 86). In this, the author tactfully leaves aside those
supposedly
prophetic and divine dreams to be judged by those (priests) that may have
that craft
(cap. 87). He is interested in "dreams that reflect a man's actions or
thoughts in the
day" - if they have the appearance of being true to reality, the patient is
said to be in
good health, but otherwise, they indicate a bodily disturbance (cap. 88).
The same is
true for dreamt observations of reality that may indicate the state of the
body
affecting the mind of the dreamer. A comparison has often been drawn
between this
rational little composition and Aristotle's theory of dreams and reality
(Aristotle,
19752:'On Dreams' 461b), although the chronological priority of the two is
still
undetermined (Lloyd 1987: 32-33). Nonetheless, Aristotle still presupposes
the
existence of some earlier medical theory for he remarks that "the gifted of
doctors
state that one ought to pay great attention to dreams" (Aristotle, 19752:'On
Prophecy
in Sleep' 463a5-8). If he does not refer to the Regimen IV itself, he may be
referring
to an earlier literary tradition that this work follows.
The Relationship between Vth Century Medicine and Philosophy.
Although extended discussions of anatomical and physiological problems in
philosophical text begins with Plato's Timaeus and Aristotle's biological
works, there
was obviously much reciprocity of interest in medical and philosophical
works of the
fifth and early fourth century. Aristotle's famous division of Pre-Socratic
philosophy
into Ionian (eastern) philosophy and Italian (western) philosophy, may be
said to
hold for the history of ancient medicine as well:
1) an eastern medical school centred in Cos, Cnidos and other sites that was
influenced by the Ionian philosophy;
2) a western school, influenced and examined by the philosophers of Sicily
and
south Italy - especially, the Pythagoreans but also including such
physiologists as
Empedocles.
1) Eastern Philosophy and Medicine
The short work, On Nutriment (per Trophes), was probably written by
some late 5th
century B.C.E. physician, or thinker (Hippocrates 1923-1931: I pp. 342-
361). There is
good reason to suppose that the philosophical tradition on which he drew
was a late
development of the physiological theories of the sixth century philosopher,
Heraclitus of Ephesus.19 . Both use the same philosophical principle of
cyclical flux,
expressed in the same epigrammatic, non-sequential style. We certainly
know of
philosophers like Cratylus who revived Heraclitus' doctrine at the very the
period
when 'On Nutriment' was being composed. It is possible that the author
simply
adapted aspects of this Heraclitean revival in order to construct his
medical theory.
Certainly, the concept of the constant flow (syrrhoia) of nutriment through
the body
(Hippocrates 1923-1931: I cap. 23) can be explained by Heraclitus' original
'flux'
hypothesis - that reality is in a constant state of flow (rhein) changing
unceasingly
(Diels - Kranz 196914: I Fr. 22 B12; Kirk-Raven-Schofield 19832: 194-195).
Furthermore, according to Heraclitus, even individual physical objects are
in a state
of constant change between opposite qualities, passing from hot to cold and
cold to
hot, from disease to health and health to disease (22B 61). There is no
absolute or
determined natural characteristics, which change in relation to the
subject:
"Sea: pure and impure waters - drinkable and healthy for fish, but
undrinkable and noxious to man" (22B 61).
In this way, Heraclitus propounded the theory that "there is one way that
is the same
both upwards and downwards" (22B 60). Following this, the author of 'On
Nutriment'
speaks of the 'road up and down' (45) and describes purging as "upward
and
downward, neither upward nor downward" (18). He also describes
nutriment as like a
stream reaching all parts of the body (7, 21, 24). Its flux turns solid to
moist for
"Moisture is the vehicle of nutriment" (cap. 55). Furthermore, this flux is a
constant
cycle: "The great principle (arche) will reach the final part (of the body),
and from
the final part it will reach the great principle, for one nature is to be and
not to be"
(24). In this way, nutriment is like a stream that is born to every body
part along
with the blood, the phlegm and air (cap. 48). Like Heraclitus, the author
bases his
arguments on relativistic principles, here applied to clotting blood and thin
blood:
"Blood is moist, blood is solid. Moist blood is good, moist blood is bad. Solid
blood is
good, solid blood is bad. Everything is good and everything is bad by
relation"
(44).
Hence he draws the conclusion that "Nature is sufficient in everything for
all" (15).
The tradition that he follows was not only influenced by philosophy, it also
influenced it in its turn. The author based his medical theory on the
principle of
corporeal 'powers' (dynameis), or potencies:
"(Nutriment) resemble a power (dynamis) when it enters (the body)
and takes control - and the (nutriment) found there previously is
controlled (by it)" (3).
The author thus understands nutriment as a holistic power, on which all
the body
parts are dependent:
"The power of nutrition reaches the bone and all its parts, as well as to
the sinew, the artery, muscle, membrane, flesh, fat, blood, phlegm,
marrow, brain, spinal marrow, the intestines and all their parts - as
well as to the heat, breath and moisture (7).
We may then assume that the power of nutriment is prior even to the four
elements of heat, cold, moisture and solid that are fed by it. This
hypothesis is totally
different from that of On Ancient Medicine, where it is assumed that the
four
elements are corporeal powers in themselves. Moreover, it is mentioned as
Hippocratic in Plato's Phaedrus (270d), where Socrates attempts to adapt
medical
methodology for the dialectic in hand. Furthermore, the hypothesis of
dynamis in On
Nutriment seems to reappear in the Aristotle's theory of 'potentiality'
(dynamis). The
latter is inherent in every substance whose potential (en dynamei)
characteristics
have the power to change to actuality (energeia). Aristotle's standard
example is that
of a seed that has the potentiality to grow into a tree. Moreover, as the
author of On
Nutriment, Aristotle also holds that potentiality is prior to the four basic
elements (De
Generatione et Corruptione 329a25-30). Finally, this work also employs
three terms
that became basic concepts in Platonic and Aristotelian philosophy: genus,
species
and form (idea):
"Nutriment and the species of nutriment are one and yet many: one
in as much they form a single genus - but their species (is many)
in dryness and moisture. In these too, their forms are also
quantity, into which they aim and to which (aims) they aspire."
(cap. 1)
The terms 'species' and 'genus' are used very similarly by Plato and
Aristotle, but without their methodology of genus, species and
individuum interlinked in a descending order. Moreover, the medical
use of 'form' (idea) is far from Plato's ideological sense. It can be argued
that the medical use of this term followed that of earlier fifth century
philosophical discussions, rather than leading directly to Plato.
2) Western Philosophy and Medicine
Towards the close of the sixth century B.C.E., the physiologist doctor,
Alcmaeon of
Croton had connections with the Pythagorean communities of southern
Italy (Diels -
Kranz 1969 14: I Fr. 24A 3; Kirk-Raven-Schofield 19832: 338-339). Besides
his
enlightened guess that the brain was responsible for thought, he suggested
that
health was dependent on the "a balance of forces (isonomia dynameon),
that act on
the body and are reduced to "a "proportional mixture" (symmetros krasis)
of elements
(Diels - Kranz 1969 14: I Fr. 24 A13, B4). These last included not only the
four
traditional elements, but also a number of additional 'forces': "the moist,
the dry, the
cold, the hot, the bitter, the sweet and the rest" (24 A4). In this way,
disease was said to
be caused by the 'monarchia' of one force over the others, thus preventing
proper
nourishment and hindering isonomy because of the excess of one of them.
For better or worse, Alcmaeon's hpothesis of physiological 'isonomy' was
very
influential on the later development of medical theory. The same may also
be said for
the cosmological extension of this idea that there exists a symmetrical
parallelism
between man and the rest of nature. A later thinker from this area who
developed
these ideas was Empedocles of Agrigentum (c. 493-433 B.C.E.; Jones 1979:
10-14). In his
work on nature, Empedocles examined the concept of health in regard to
the struggle
of the cosmic elements. Empedocles reduced Alcmaeon's original elements
to the
traditional four 'roots': fire, air, water, earth (i.e., heat, cold, moisture,
solid), that
were locked in a perpetual struggle and reduced to harmony through the
power of
love. In this way, he tried to explain that like every other cosmic balance,
health was
dependent on an internal balance, maintained by nurture. Change in this
balance
was the cause of ill-health and disease (Diels - Kranz 1969 14: I Fr.. 31
B17, 109). For
better or worse, Empedocles' concept of disease as an 'excess' (hyperbole)
was very
influential in the development of the medical theory of humours over the
next two
thousand years.
However, by the fifth century B.C.E., medical theorists had begun to
criticise him.
The author of On Ancient Medicine, as we have seen, attacked Empedocles'
theory of
four elements specifically (cap. 1, 20). Under attack too were also medical
writers who
held a holistic approach to understanding man as if one could not
understand his
physiology without first understanding what man is conceptually (cap. 20).
His own
method can be best described as individualistic and can be exemplified in
his
discussion on the effects of wine and cheese on the human frame (cap. 20).
Undiluted
wine has a certain recognised effect on the drinker for that is its power
(dynamis);
however, if we examine cheese we see that effects are not universal, for
constitutions
(physies) of different people are affected in different ways, depending on
whether
there is something in them that is averse (polemion) to cheese. Thus in
opposition to
the holistic 'Empedoclean' approach, the author draws the conclusion that:
"all that has been written about Nature by any philosopher (sophistes) or
physician pertains, in my opinion, less to the medical art than to painting"
(20).
In his opinion, the physician needs rather study man and his food in
relation to
"what results from each
the powers of humours on disease (22, 24), we must study their effect on
each man,
rather than turn them into a universal theory.
Practically contemporaneous with these late 5th century works is On Airs,
Waters
and Places (Hippoc. I pp. 70-137), where it is suggested that geographical
environment is paramount for determining both the health of the
individual as well
as the spread of epidemic in populations. Basically, the author wishes to
show that as
soon as a doctor arrives in an unfamiliar city, he should consider the site in
relation
to the wind, seasons and nature of the water-supply (cap. 1). Because there
are
different characteristics in different topographies:
1) the medical art (ietrike) should entail a study of the effects of the
different
seasons of the year upon the health of the inhabitants;
2) secondly, the doctor should study the effect of the winds on the
environment,
both of those that are peculiar to specific regions, as well as those that
occur
universally;
3) finally, he should pay attention to the characteristics (dynamies) of the
waters
in the region. (cap. 1).
The relativistic conclusions of the first half of this work (cap. 1-11) and the
ethnographic comparisons of the second half (caps. 12-24) recall the works
of
sophists like Protagoras. It is true that the latter makes man the measure
for all
things, but his avowed aim is to prove the relativity of all customs and
opinion. As the
other Hippocratic works, Airs, Waters and Places likewise left its
impression on later
literature. In this case, Vetruvius' source seems to have been inspired by
caps. 1-11
for his advice in selecting the correct topography for building and town-
planning
(Vitruvius 1991: I.6.1 pp. 23-24).
In the above, I we have examined a few of the early examples of
Hippocratic
writings, dating mostly from the end of the fifth century B.C.E. Their
struggle to
apply or criticise philosophical concepts and methodology is typical of their
rationalist understanding of human nature, whereby explanations of the
cause
of disease and health are given in non-theological terms as well as in a
consistent, logical fashion. However, just as much as these works were
influenced by philosophical thought, they to no less extent affected
philosophical
writers like Plato and Aristotle, as well as their more contemporaneous
Sophists.
Although some of the authors may have been disgruntled, the intertwining
nexus
between philosophical and medical writing was impossible to cut prior to
modern
times.
Notes
1 However, some see no connection between the origins of philosophy and
medicine
(Jones 1979: 1-2). I would like to thank Dr. Giora Hon (Haifa University),
for his generous advice on reading this paper.
2 Citations from the Greek of the corpus are sometimes in the original
Ionic dialect of
the texts (e.g., ietros instead of iatros). All translations are the author's
unless
otherwise stated.
3 The relationship of the corpus to the historic Hippocrates is problematic
since the
testimonies of Plato and Aristotle concerning Hippocrates' medical theories
do not
conform closely to the corpus. For general discussions, see: L. Edelstein
19792, s.v.
'Hippocrates'; Singer-Wasserstein 19792, s.v. 'Medicine VII'; Lloyd 1978,
9-12, 21-37.
4 Nonetheless, the opinions of the Cnidians are attacked in the early
Hippocratic
work, Regimen in Acute Diseases (Hippocrates 1923-1931: II, caps. I-
III).
5 On the various theories concerning the meaning of the term Asclepiadae,
see: Jones,
in: Hippocrates 1923-1931: I pp. xliv-xlvi, II p. 335.
6 Exceptions are: 1) the famous Hippocratic Oath (text in: Hippocrates
1923-1931: I pp.
298-301) addressed to Apollo the Physician, Asclepius, Hygieia and
Panacea - but as
an oath it is sui generis and not part of a treatment process; 2) the late
pseudo-
Hippocratic Letter xv, written as a report of a supposed epiphany
recounted by
Hippocrates.
7 This is an old composition (c. 430-420 B.C.E.), whose author is presumed
to be "either
Hippocrates or a very capable supporter" (Jones, in: Hippocrates 1923-
1931: I p. 5).
8 Of the philosopher-medical writers that the author has in mind, he
names only
Empedocles specifically. A later product of this school is Regimen I
(discussed
below).
9 Plato 1964: Phaedrus 270c. For background, see: Hackforth 1952: 151.
This, of course,
would mean that On Ancient Medicine was composed by one of
Hippocrates'
opponents.
10 As in the book of Precepts (Parangeliai) - edited in: Hippocrates 1923-
1931: I. pp.
312-333. In the editor's opinion, it represents a collection of jottings
derived from
works of differing methodologies and theories (Jones in: Hippocrates 1923-
1931: I.
pp. 305-307). We may also compare the more famous seven books of
Aphorisms
(Hippocrates 1923-1931: IV, pp. 98-221), with their gnomic parabolizing
form,
famous for the saying 'Life is short, the (medical) art is long etc.' (cap.
I).
11 The early composition, On Breaths (peri Physon) is described by its
editor as "a
sophistic essay, probably delivered to an audience" (Jones in: Hippocrates
1923-
1931: II p. 221).
12 Cf. On Affections cap. 1 (Hippocrates 1988: V p. 6), that opens in this
fashion: "An
intelligent man who considers health of importance to humans, will have
an
understanding of disease. He need understand what doctors tell him and
what they
intend to do to his body, having a lay knowledge of these matters".
13 The question of the actual spoken language of Halicarnassus - as
opposed to its
Ionian literary and inscriptional veneer - is still undetermined since many
of the
inhabitants were of mixed Carian stock. The spoken language may well
have been
some patois.
14 The original application of these Greek terms is thus much broader than
the
modern derivations of 'physiologist' and 'physician'.
15 Many consider this work to be the product of a sophist who had studied
some
medicine.
16 Traditionally, Asclepius was born in Thessalian Tricca, taking up
'residence' (i.e.
founding a cult-site) the cult sites of Epidaurus and Cos only later. The cult
reached
Athens as late as about 420 B.C.E. (Guthrie 1968: 246-7; Dodds 1966: 111-
112).
17 More sumptuous offerings are listed in the inscriptions listed and
translated in:
Rice -Stambaugh 1979: 75-76. For background, see: Burkert 1990: 147,
267-268.
18 Translations of selected dedications and euchai are listed in: Rice-
Stambaugh 1979:
78-80; Guthrie 1968: 249-253.
19 Its opening chapters are even included in the standard Diels - Kranz
1969 14: I Fr. Although often assigned a much later date, there are good reasons for accepting its older original sections as reflecting a 5th century milieu (see my article on this web site: The Philosophical Background of Hippocrates' On Nutriment
22 C2 as 'imitation' of Heraclitus; included also are sections from the
Hippocratic
work On Nutrition (Fr. 22C1).
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Menahem Luz
In origin and development, ancient Greek philosophy and medicine were
closely