Hippocrates On Ancient Medicine and On the Sacred Disease

To further elaborate on the role of the Hippocratic Writings in early Greek medicine and an early Greek thought more broadly, we introduce you in this appendix to two other very important works from the Hippocratic Corpus, Perites Archaes Iatriches on Ancient Medicine and Perihieres Nussu on the Sacred Disease. Like AWP and all the other works in the Hippocratic Corpus, On Ancient Medicine and On the Sacred Disease are anonymous. Both are polemical. They are directed against opponents who, with one exception, go unnamed. As such, they provide veiled but tantalizing glimpses into the agonistic medical and philosophical milieu of the late 5th century. We got just a whiff of this in AWP when the speaker, arguing in his introduction that the aspiring medical student must know seasonal changes and the stellar phenomena that mark them, said, but if one should dismiss these things as belonging to meteorology, evidently there was a debate among, well, among who, as to the role of meteorology and astronomy in the techne of medicine, with the pejorative-sounding meta-autologa, the speaker may also be alluding to the emerging social criticism of intellectual airheads, such as we saw in Aristophanes' Clouds. So, to get the flavor, let's start by looking at how each of these works begins. In the Chapter 8 appendix, we pointed out the similarity between the AWP author's explanation of the formation of rainwater and the theories of the natural philosophers Anaximander, Xenophanes, Anaximenes, and Anaxagoras. This raised the broader question of the influence of the 6th and 5th century pre-Socratics on the Hippocratic writers. Now, there was something about the impact of the natural philosophers on medicine that the author of On Ancient Medicine did not like. Here's how he begins. And I'm going to take the English translation of On Ancient Medicine from the edition of Mark Shiefsky. All those who have undertaken to speak or write about medicine, there is a good chance, as with AWP, that this work was originally an epideictic speech intended for oral delivery. Having laid down as a hypothesis for their account, hot or cold, or wet or dry, or anything else they want, narrowing down the primary cause of diseases and death for human beings, and laying down the same one or two things as the cause in all cases, clearly go wrong in much that they say. In keeping with this project's goal of presenting equivalent Greek and Latin, I'm going to include Latin translations of parts of On Ancient Medicine and On the Sacred Disease, namely those by the same Yanis Konarius whose Latin translation of AWP we've been using. As is the case with AWP, Konarius' Latin rendering doesn't always follow the Greek construction precisely, usually because of variance in the manuscripts. In this appendix, I'll simply be providing the Latin translation as found in Konarius, usually without comment. The speaker's target? Some unnamed contemporaries who have been speaking or writing about medicine, and insisting that medicine requires a hypothesis. For example, a handful of the elementary qualities, hot or cold, wet or dry, etc., that should make you think of the pre-Socratic natural philosophers. The speaker's evident objection? That this grossly understates the complexity of the etiology of disease. On the Sacred Disease also wastes no time in letting you know the author's opinion, or speaker's. Again, there's every chance this piece was originally intended for oral delivery. On the disease called Sacred, here is how it is. The Sacred Disease is epilepsy, though at this time it meant a set of conditions including but not limited to epilepsy as we know it. For the English translation, I would have used WHS Jones's Loeb edition, but its Greek text sometimes differs significantly from the later and definitive 2003 Boudet edition of Jacques Juana, so I'm muddling through Juana's French instead. My chapter citations are also from the Boudet, which also differ from the Loeb. It does not seem to me, in any way, more divine than the other diseases, nor more sacred. But just as all the other diseases have a natural origin from which they come about, this disease has a natural origin and a triggering or exciting cause. What the speaker might mean here by saying diseases have a pusis, and why we translated propasine as triggering or exciting cause, Juana's cause déconchante, we'll discuss when we return to Sacred Disease in greater detail. We'll skip a sentence and proceed. In my opinion, those who first attributed a sacred character to this disease were people comparable to those who still today are magicians, purifiers, mendicant preachers, and charlatans, all people who affect extreme piety and a special knowledge. The speaker's target? What we will call the magico-religious healers, contemptuously dismissed here as magoi, katsartai, agirtai, alastones. Much of what we know about these types of healers comes from this work. Hopefully your curiosity is aroused. But let's come back to On Ancient Medicine and look at it in a little more detail. We saw that the speaker disliked the assertion by some that the ieitrike tekne requires a hypothesis, like hot or cold, wet or dry, etc. We'll skip a sentence here too, but proceed with the speaker's introductory statement. For the reason given, i.e. in the sentence we skipped, I have deemed that medicine has no need of a new-fangled hypothesis, as do obscure and dubious matters. Concerning these things, it is necessary to make use of a hypothesis if one undertakes to say anything at all about them, for example about things in the sky or under the earth. If anyone should recognize and state how these things are, it would be clear neither to the speaker himself nor to his listeners whether what he says is true or not, for there's nothing by referring to which one would necessarily attain clear knowledge. A postulate or premise is needed, the speaker acknowledges, when making a claim about things invisible and apodaomena, an important Greek word. Again, for obscure and dubious matters in the sky and under the earth, think of Aristophanes' clouds. For the speaker's epistemological skepticism concerning what is knowable by man, compare this verse fragment of the pre-Socratic Xenophanes. As for certain truth, no man has known, nor will any know it, concerning the gods and everything about which I speak. For even if one might chance to say what is the case, still he himself does not know. Opinion, dokos, has been set over all things. Let's follow the speaker's introductory statement just one step further. But medicine has long since had everything it needs, both a starting point in principle and a discovered method by which many admirable discoveries have been made over a long period of time, and those that remain will be discovered, if one who is adequate to the task and knows what has been discovered sets out from these things in his investigation. Medicine doesn't need a new-fangled hypothesis. It has long since had its starting point in principle, arche, and long since discovered a method that has been fruitful and will continue to be so. This is the ancient medicine of the title. If you make a study of On Ancient Medicine, you'll see that its author clearly had training in rhetoric, and following the scholar Elizabeth Craik, the structure of the work can be seen as consisting of a poem, which we have just excerpted, and exposition, arguments, and conclusion. Partly by way of summarizing them, partly by excerpting, let's look at these remaining sections. The exposition spells out what the ancient medicine is. This section has been dubbed an archaeology of medicine by way of analogy with the so-called archaeology in book one of Thucydides, and with the method by which Thucydides projected the present onto the past in order to reconstruct what he calls a likely history of early Greece. It was not a god or a mythological hero that gifted man with the art of medicine. It was necessity itself that caused it to both be sought for and discovered by human beings. Projecting the present onto the past, our speaker says man began to take note that the sick did not benefit from the same regime as the healthy, and this led to the search for a regime more beneficial to the sick. This started by reducing the number of solid foods, and later, if this was inadequate, the preparation of gruels, and later still, if even this was inadequate, a liquid-only diet. This was the beginning of medicine, though in fact you can go back further, all the way to primitive man. Primitive man used to eat the same raw and unblended fruits, brush, and grasses as an ox or a horse, and suffered greatly for it. But over a long period of time, man arrived at our current regime for the healthy, more suitable for the weaker human constitution, through a process of discovery and artful elaboration. For example, by moistening and winnowing raw wheat grains, grinding them, sifting, netting, and baking them into bread. In short, the ultimate discovery of medicine was really the discovery of cooking, even if, since everyone now cooks, we don't think of this as a techne, the speaker says, in the sense of a profession defined as having a limited number of appropriately trained experts. But going back to the acknowledged art of medicine, the one concerned with discovering beneficial regimes for the sick, a further point is that it is a complex business. It necessitates precision, measure, and timing. Take this interesting passage, for example. For this reason, the doctor's tasks are much more varied and require more precision. For one must aim at a measure, but you will find no measure, nor number, nor weight besides, by referring to which you will know with precision except the feeling of the body. Hence, it is difficult to acquire knowledge so precise that one errors only slightly in one direction or the other. And I would strongly praise this doctor, the one who makes only small errors. Perfect accuracy is rarely to be seen. At the end of the archaeology, the speaker returns to this theme. He is wrapping up a discussion about why some people suffer if they skip a meal, some don't. And he says that a man with a weak constitution, even more a sick man, is more apt to suffer from any deviation from the due measure. And he concludes, It is difficult when such precision is required by the art always to attain perfect accuracy. So I deny that the ancient art should be cast aside on the ground that it does not exist, or that it is not being investigated in an admirable way if it does not possess precision in everything. Rather, since it has been able to come, by means of reasoning, from profound ignorance, close to perfect accuracy, I think it is much more appropriate to marvel at its discoveries as having been made admirably, correctly, and not by chance. Contrast the speaker's illustration of the complexity and frank admission of the inherent imperfection of the ancient medicine with the willingness of his opponents to reduce all medicine to a simplistic premise of hot versus cold, wet versus dry, etc. With chapter 13, the speaker returns to his attack and makes arguments against those seeking to establish the technique of medicine on the basis of a newfangled hypothesis. He demonstrates the therapeutic consequences of their line of thinking. If it is something hot or cold, or dry or wet, that makes the human being sick, and if the healer must render aid with the hot against the cold, the cold against the hot, and so forth, then give me a man whose constitution is not among the strong but rather the weak. Let this person eat wheat he picks up from the threshing floor, raw and unprepared, and the like, which will make him quite sick. A hypothetical interlocutor among his opponents asks, now what assistance should be prepared for a person in such a state? Hot or cold or dry or wet? One of these, clearly. But in this thought experiment, guess what? It wasn't hot or cold that made the hypothetical patient sick, nor the opposite that healed him. He was healed by restoring him to the regime of the bread made from wheat, boiled meat, wine. I think, the speaker concludes sarcastically, I have created a fine dilemma for the one who has asked this question. The thought experiment leads the author to a detailed exposition of his own theory of biochemistry, his own theory of the human pussies. The substances we eat each have their own nature, pussies, and their own capacity, dunamis, to affect the body. The different processes we use in mixing and blending these substances themselves also have their own pussies and dunamis. These substances and their mixes and blends have qualities like sweet, salty, bitter, acidic, astringent, insipid, etc. And these qualities are far more consequential than hot or cold. These qualities of sweet, salty, etc. also pre-exist within the body, in its humors. In our body's humors, as well as in properly prepared food we ingest, these different qualities are blended and harmless. It is when one of these qualities in the body or in the food we ingest separates off and becomes too strong for the human constitution to overcome that people get sick. This action of apocrisis, separating off, is the same we've seen and discussed in other biological, cosmological, and meteorological phenomena. Healing is the process of removing this separated off extremity through alteration of regime or purgation or drugs. The qualities of hot and cold, when they become dominant, do also harm the body. The big difference, the speaker explains in great detail and with many examples, is that in the body's chemistry, hot and cold, by contrast with sweet, salty, etc., are largely self-correcting. All this was discovered in its essentials by the pioneers of the ancient medicine. And now we get to what Joanna says is the most celebrated chapter in the work. The speaker's opponents up to now have been unnamed speakers and writers about medicine who have claimed that the techne of medicine requires a hypothesis. In chapter 20, the speaker extends his critique to sophists and philosophers. The speaker announces a change in direction. Perimen un tuton hikonos moi hegeumai epidedekthai. Epidedekthai as in this is an epideictic speech. Dehis igitur videor mihi abundae demonstrationem fecisse. Legus idetines, kai ietroi kai sophistai, hos ukeiae dunaton ietricaine edenai, hostis me oiden hoti estin anthropos. Alla tuto dekatamathein ton melonta orthos therapelsein tus anthropus. But some doctors and sophists say that it is impossible for anyone to know medicine who does not know what the human being is. Anyone who is going to treat patients correctly must they say learn this. Porro medici quidam etemque sophistai dicunt quod impossibil est medicinam cognoscere eum qui non noet quid sit homo. And here, for a reason I can't figure out, Cornarius drops a chunk of the Greek text. Tenei tae autoesin hologos es filosofiein, kathaper empedoclees e aloi hoi peripysios gegrapasin ex arcees hoti estin anthropos, kai hopos egeneto proton, kai hopoten sunepage. Their account tends towards philosophy, just like Empedocles or others who have written about nature from the beginning, what the human being is and how it originally came to be and from what things it was compounded. And the Cornarius text picks up at et quomodo primum factus et compactus sit. If the dating of on ancient medicine to the late 5th century is correct, what is the meaning in this passage of sophistai and filosofie in the interesting phrase tenei hologos es filosofiein? Although sophistai here seems to have a somewhat pejorative sense, it does not yet designate the professional class of itinerant teachers who afforded their instruction for a fee and who got such bad press in Plato. It seems to refer more generally to individuals with some claims to intellectual expertise of some sort, like the Empedocles named by the speaker and other natural philosophers called by Aristotle in the following century, Pusikoi. In fact, the pre-Socratic Diogenes of Apollonia, who was lampooned by Aristophanes in the clouds for his theories about air, is quoted by Simplicius as having himself used the term sophistais applied to the Pusiologoi. Translated in KRS as Diogenes himself mentioned in his work on nature, where he says that he had spoken against the physicists whom he called sophists, filosofie does not yet have the general meaning love of knowledge, says Mark Schiefke in his edition, but is here a reference to a specific kind of knowledge, namely the knowledge of the human Pusis the speaker associates with the natural philosophers. Schiefke quotes approvingly Werner Jaeger's remark on this passage, the word filosofie, intellectual work, study, was not yet clearly defined and Empedocles name is used in order to make it clearer. Our speaker speaks of physicians and philosophers in the same breath. On this pairing of sophistai and ietroi, compare another work from the Hippocratic Corpus, on the nature of man. The author of that work begins, As translated in the Loeb, he who is accustomed to hear speakers discuss the nature of man beyond its relations to medicine, will not find the present account of any interest. For I do not say at all that a man is air, or fire, or water, or earth, or anything else that is not an obvious constituent of a man. Such accounts I leave to those that care to give them. Notice again the reference to listeners and speakers. If you want, check out the text that follows in On the Nature of Man, which in the interest of time we're not going to show, for a picture of what these lively public debates on such weighty topics were like. Man is air, or fire, or water, or earth. These are the accounts of the natural philosophers like Empedocles and Diogenes. But after a few comments about these philosophical accounts that the author says he's not going to comment about, he turns to the physicians. About these men I have said enough, but I will turn to physicians. Some of them say that a man is blood, others that he is bile, a few that he is phlegm. But returning to ancient medicine, our speaker now turns the argument inside out. But I hold that whatever has been said or written about nature by a sophist or doctor pertains less to the art of medicine than to the art of writing, and also that it is impossible to have any clear knowledge about nature from any other source than medicine. That's clever. Now there are textual and interpretative challenges in this paragraph. The speaker says this kind of thinking belongs more to the technē grāpike than to the technē ietrike. Does grāpike refer to the art of writing or of painting? That's in dispute. Šísky voted for writing. Cornarius clearly thought painting, since he translates it as pictoriae. But in either interpretation, what does the contrast mean? And with the phrase that appears three times in chapter 20, is the speaker referring to big picture cosmological nature or more narrowly to human nature? That too is in dispute. But these questions are beyond our scope here. To continue, This knowledge can be acquired when one has correctly grasped medicine itself in its entirety. But until then, it is impossible. I mean the science that consists in knowing what the human being is and by what causes it comes to be and all the rest with precision. For this, I think, is what it is necessary for a doctor to know about nature and to make every effort to know, if he is going to do any of the things that he must, what the human being is in relation to foods and drinks and what it is in relation to other practices and what will be the effect of each thing on each individual. Not simply that cheese is harmful food for it causes trouble to one who has eaten too much of it, but rather what trouble and why? And which of the things in the human being is it inimical to? With this famous cheese passage, our speaker is again saying you have to dig deeper than do his opponents. And a bit further on, the author uses the cheese example to make the point that cheese is not bad for everyone, even when eaten in large quantity. Individual constitutions differ, further complicating the business of medicine. Diaperos in un tuton haipusias. Hence the natures of these people differ, meaning those who can stuff themselves with cheese with no ill consequence and those who can't. Diaperos inda kata tuto, hoper en toi somati enasti polemion tyroi, kai hypo tutu egeretai te kai kineitai. Hois hotoyutos kyumos tyunkane pleon enaon, kai malon en dyunasteon en toi somati, tutus malon kai kakopathein ekos. And the difference concerns the very thing in the body that is hostile to cheese and is stirred up and set in motion by it. Those in whom such a humor happens to be present in greater quantity and to exert more power in the body will naturally suffer more. Classifying this cheese-resistant substance in the body as a kyumos, juice or humor, gives another interesting glimpse into the author's biochemistry as well as perhaps the flexibility of this term. Porum vero naturae differunt. Differunkwe etiam yuxta hoc quod est in corpore casa o contrarium. Nam a casa o excitatur et comovetur in his quibus eius modi humor multus in corpore existet, et quo magas hic potest, eo magas vera simil est ipsos male affligi. There is no one nature of man. Biochemically, each person's constitution differs. In the final three chapters, the speaker says the physician must have knowledge not just of the body's humoral powers, but of its organs and their structures, for they are another source of these. Dende moedoke kaitaud edenei hosatoi anthropoi pathemata apo dynamion ginetai kai hosa apo schematon. Lego de ti tuto, dynamin menenei ton kyumon tas akrotetaste kai iskyun schemata de lego hosa enestine intoi anthropoi. I hold that one must also know which affections come upon the human being from powers and which from structures. What do I mean by this? By power, I mean the acuity and strength of the humors. By structures, I mean all the parts inside the human being. He distinguishes nine structures according to their shape, texture, and orientation, and result in capacity to attract and retain liquids, and to be affected by other substances in the body, such as air. The body parts representing these nine structures are the bladder, head, womb, spleen, lung, breasts, belly, chest, liver, and diaphragm. In sum, on ancient medicine, a skillfully composed piece of Ionian prose from the late 5th century that has come down to us in the manuscript tradition as part of the Hippocratic Corpus, and that was most likely originally an orally delivered epideictic speech, provides us a veiled but intriguing glimpse into the intellectual milieu of that time, and into the state at that time of Greek medical theory and practice. Was it actually written by Hippocrates? Is the dating to the late 5th century accurate? Are its opinions and theories representative of and consistent with other writings in the corpus? To answer these types of questions requires a study of the Hippocratic Corpus itself. We can't do that in any depth, but before we return to On the Sacred Disease, that disease which, in its author's opinion, is no more sacred than any other, let us look briefly at what constitutes the corpus and introduce you to three essential figures.