The Hippocratic tradition will be briefly discussed later in this chapter, but I feel bound to declare at the outset that until recently my knowledge of Hippocratic writings was derived mainly from the splendid edition prepared by Emile Littré, the tenth volume of which contains an elaborate index.⁹⁰⁹ Philologists laboriously preparing the nth edition of a Hippocratic text may speak ill of Littré, but such criticisms do not decrease his gigantic stature nor increase their own dwarfish one by a single inch. During the last thirty years many Hippocratic editions, translations, and monographs have passed through my hands and some of them have been analyzed in Isis. As I was plotting out this chapter, in order to refresh my knowledge I examined very carefully the selected writings edited in Greek and English for the Loeb Classical Library by William Henry Samuel Jones and Edward Theodore Withington.⁹¹⁰ Littré was not a pedantic philologist, but he knew Greek and medicine very well and at his best he is an excellent guide. Jones and Withington had the advantage of doing their bit of work three-quarters of a century later. I am much in sympathy with them and generally willing to accept their guidance in controversial questions, for example, Jones’s theory on the deleterious and far-reaching effects of malaria in the ancient world. As to Withington, I am indebted to him directly for many of his studies on the history of medicine and indirectly for his medical contributions to the revision of Liddell and Scott.⁹¹¹
COMPLETE OR PARTIAL GENUINENESS OF THE HIPPOCRATIC WRITINGS
The books to which Plato and Menon refer cannot be identified with certainty and hence skeptics may claim that “Hippocrates” is a “name without writings” and that no Hippocratic work can be considered absolutely genuine. The general question of Hippocratic genuineness is thus essentially different from that concerning Platonic or Aristotelian genuineness, for there are enough books of Plato or Aristotle the genuineness of which is as certain as can be and which can be used as standards; it is more like the question concerning the authorship of the Iliad and theOdyssey. We can accept the authenticity of many of the Hippocratic writings in the same spirit and with the same reservations as we accept the authenticity of the Homeric poems; the personality of Hippocrates, however, is far more tangible than that of Homer.
For practical purposes that is sufficient; yet we should be careful. The Hippocratic spirit and method are defined on the basis of a group of writings; we cannot claim then that certain of these writings are necessarily genuine, because they reflect Hippocratic qualities, without arguing in a circle. The statements made by Plato and Menon are sufficient, however, to define the essential characteristics of Hippocratism and may help to put the Hippocratic writings in a certain order of probable genuineness. We cannot do more, but that is enough for our main purpose.
Independently of the probability of their genuineness, the Hippocratic works available to us are in various stages of composition and preservation. Some are well written, others not so well; others are in the form of a sketch or rough notes that have not been properly edited. The composition of certain books (for example, the one on Humors) is exceedingly casual. Moreover, some writings have not reached us in their original integrity. The earliest books were in the shape of rolls (volumina), more fragile than those whose shape we are familiar with; the end parts of a roll were especially frail and were easily broken off. This explains why so many of the old manuscripts (not simply Hippocratic) are either headless or tailless. In the case of literary texts, that condition was recognized and generally respected; in the case of medical writings, of which the librarians or editors did not always understand the meaning and the structure, the missing parts were sometimes replaced by another text; a volumen might be cut into two or more parts, or the fragments of diverse volumina might be fastened together. The composition of certain Hippocratic writings cannot be explained otherwise. In short, some texts were badly composed; in the case of other texts the original composition, whether good or bad, was not transmitted to us; the volumina were accidentally torn to pieces, then the odds and ends were put together by careless people.
The contents of the Hippocratic books vary as much as their form. Some of the books were written for physicians or medical students, others for laymen; others are notes scribbled by teachers to guide their lecturing or by apprentices to strengthen their memory; some are notebooks wherein a physician jotted down the results of his experience, others are essays carefully written for polemical or rhetorical purposes. Most of the books represent the doctrines of the school of Cos, but some reflect those of the neighboring and rival school of Cnidos, others still contain the views of outsiders. This is easy enough to understand if we assume that the collection that has come down to us was originally the library of Cos (or part of it, with possible accretions from outside). The temple, school, or guild of Cos would have a library and that library would include not only the local writings, but others given to it by the authors, or obtained for it by the Coan doctors for the sake of study or curiosity.
In the presence of such a variety of form and content one realizes the enormous difficulty, or rather the impossibility, of establishing the genuineness of each item.
Can this or that one be credited to Hippocrates, or to an immediate disciple or a later one, or was it written by a sophist interested in medicine, or by a philosopher who cared less for medicine than for general ideas? In the last case, a definite coloration, say Epicurean or Stoic, may prove the lateness of its composition. The question of personal genuineness is relatively unimportant. We are more concerned in distinguishing the writings that are Hippocratic from others that represent other schools, and then in placing them in a rough chronologic sequence. Some of the writings are obviously ancient, pre-Hippocratic; others, whether written by Hippocrates himself or not, belong to his age and school; others still are definitely post-Hippocratic, yet continue the Hippocratic teachings. The problem is aggravated by the fact that a late writing may very well incorporate a nucleus of early doctrine. Many ancient books are like monuments various parts of which were built and rebuilt at different periods. The question, “What is the date of that monument?” becomes almost meaningless; one must determine as far as possible the dates of various layers. Even so, when one tries to date Hippocratic books complete and accurate solutions are out of reach; we should not attempt the impossible but do our best and be satisfied with it.
Philologists hope to solve such questions by the methods of textual criticism, that is, by investigations of the language, but this involves uncertainties of the same kind, for how can we be sure that the language that has come down to us is the original language? The idea of reproducing exactly every linguistic peculiarity of a text is a modern conceit; the early (say the Hellenistic) editors were more concerned with the substance than with the form of medical texts⁹¹² and did not hesitate to modernize them if they felt like it. Happily, they were often too lazy or too busy to do so, and they reproduced more or less the original text because they followed the path of least effort.
There is one peculiarity that has been preserved in every ancient medical text: they are all written in the Ionian dialect. This is very remarkable, because Cos (and also Cnidos) had been invaded and governed by Dorians, yet the intellectual prestige of the Ionian colonies nearby was so great that the Ionian dialect symbolized learning and elegance. Remember that Herodotos, who was not more of an Ionian than Hippocrates, also wrote in Ionian. This is of some help, but not very much. The fact that a medical book is written in Ionian does not necessarily prove that it belongs to the Hippocratic age, for the language, having been associated with a certain genre, continued to be used for other writings of the same class.⁹¹³ The Ionian language of various Hippocratic texts is not by any means the same; there are variations from the Ionian norm, even as there are variations in Herodotos, because that language was somewhat artificial to the writers, being different from the language that they actually spoke.⁹¹⁴ The writers living in that southwest corner of Asia Minor were submitted to so many influences (Dorian, Cretan, Carian, Ionian, Attic) that their dialect might easily take various colorations.
Our study of the Hippocratic writings is facilitated by that of the early commentators, but unfortunately the earliest of them all, Herophilos of Chalcedon (III-1 B.C.), is already late, too late to enable us to separate the fourth-century writings from those of the preceding century. Moreover, Herophilos was not a commentator pure and simple, but an anatomist, the greatest of antiquity. Next to him came two of his pupils, Bacchios of Tanagra⁹¹⁵ and Philinos of Cos.⁹¹⁶ Bacchios edited Epidemic III, annotated three other Hippocratic writings, and compiled a glossary; Philinos (considered to be the founder of the Empirical school of medicine) is said to have written Hippocratic commentaries and six books directed against Bacchios. It would be instructive to read the divergent views of Hippocratic commentators of the third century, but those texts are lost.
Three distinguished commentators flourished in the first half of the first century B.C. — Heraclides of Tarentum, Glaucias of Tarentum, and Apollonios of Cition. In the first century of our era, the Hippocratic writings were much used by Celsus (I–1),⁹¹⁷ and glossaries were collected by Erotianos (1–2) and Herodotos of Rome (I–2).⁹¹⁸ The most important as well as the most copious of the ancient commentators was Galen (II–2). Galen wrote so many commentaries on Hippocrates that their names are united, and many scholars (unfamiliar with the history of medicine) speak of them together — Hippocrates-Galen — as if they were twin brothers, representatives of a single period and a common school. That is silly; six centuries are stretched between them. Galen was about as close to the father of medicine as we are to the father of English poetry, Geoffrey Chaucer.
One of the writings of Galen is a study of the books of Hippocrates that are genuine and those that are not, De genuinis scriptis Hippocratis. That text is lost, but we know from the catalogue of unain ibn Ishaq (IX–2),⁹¹⁹ that Hunain had a manuscript of it and had prepared a Syriac translation and summary of it for ’ s ibn Ya y . The Syriac text was translated into Arabic by Hunain’s son, Is q ibn unain (IX–2) for ‘Al ibn Ya y .⁹²⁰ The Arabic title was Kit b fi kutub Buqr al- ah a wa ghair al- ah a; the recovery and edition of that text in Arabic or in translation is highly desirable.
Some twenty-three of the Hippocratic writings were known to Bacchios and forty-nine to Erotianos; the Littré edition contains seventy items. If Erotianos knew as many as forty-nine works, this suggests that there was already in his time a kind of Hippocratic canon. The word canon is perhaps a little too strong, for there can hardly be a canon without a canonizing authority. It is probable that the Hippocratic collection was hardly more in ancient times than a group of volumes such as would be found in a library, where all the books had been classified roughly by subject. Some such collection was known to the Byzantine scholars of the seventh century, or perhaps long before,⁹²¹ and the whole, or a part of it, was eventually translated into Syriac and into Arabic.
To return to the Greek tradition, the manuscripts should give us the best kind of information, but unfortunately those extant are very late, none prior to the tenth century. The early manuscripts contain lists of Hippocratic writings; the earliest one, Vindobensis med. iv, tenth century, contains only a dozen writings; the Marcianus Venetus 269, eleventh century, lists fifty-eight items; the Vaticanus Graecus 276, twelfth century, lists sixty-two.⁹²²
Printed editions. The first printed editions of Hippocrates were Latin translations of separate treatises, or a few treatises, the best example being the editions of the Articella (1476–1500).⁹²³ For other incunabula see Klebs or some of my notes below. The Hippocratic writings were among the most popular scientific incunabula, “Hippocrates being the third author in popularity; the first two, far ahead of him, were Albert the Great and Aristotle.⁹²⁴
The first general editions of Hippocrates were the Latin one prepared by Fabius Calvus (723 pp.; Rome, 1525) and the Greek Aldine (233 pp.; Venice, 1526), both folio volumes, the second being the true princeps (Fig. 70). This was the beginning of a very long series. The most important of the early editions are the second Greek one by Janus Cornarius (Basel, 1538) (Fig. 71), the Greek-Latin one by Anuce Foes (folio; Frankfurt, 1595; very often reprinted), to be used together with Foes’ dictionary Oeconomia Hippocratis alphabeti serie distincta (folio; Frankfurt, 1588) (Fig. 72), and the Greek-Latin one by Joan. Antonides Van der Linden (2 2 vols., octavo; Leiden, 1665).⁹²⁵ Among later editions it will suffice to mention the Greek-French one by E. Littré (10 vols.; Paris 1839–1861) (Fig. 73), the Greek one by Franciscus Zacharias Ermerins (3 vols.; Utrecht, 1859–1864), and the Greek one by Hugo Kühlewein (2 vols.; 1894–1902). (1928)].
Fig. 70. Title page of the Greek princeps of the Omnia opera Hippocratis, containing the Greek text of 59 Hippocratic writings without Latin translation, edited by Franciscus Asulanus, and printed by the illustrious Aldine firm Aldus and Andreas Asulanus (Aldo Manuzio and Andrea Torresani of Asola) in Venice, 1526. This splendid folio volume begins with a letter addressed by Clement VII (Giulio de’ Medici, pope, 1523–1534) to the sons of Andrea Torresani and the heirs of Aldo Manuzio (1449–1515). [From the copy in the Harvard College Library.]
Fig. 71. Title page of the second Greek edition (folio) of Hippocrates by Janus Cornarius (Johann Hagenblut of Zwickau), printed by Frobenius (Johann Froben) in Basel, 1538. The humanists of Basel were always competing with their Venetian rivals. [From the copy in the Harvard College Library.]
The Corpus medicorum graecorum sponsored by the German academies naturally includes Hippocrates, but only one part of the Hippocratic edition has appeared, twelve works, edited by Hermann Diels and J. L. Heiberg, vol. 1, 1 (158 pp.; Leipzig, 1927).⁹²⁶ The Corpus medicorum graecorum reproduces Littré’s pagination and thus pays to it a fine homage.
The two outstanding English translations are the one by Francis Adams (2 vols.; London: Sydenham Society, 1849) and the recent one by W. H. S. Jones and E. T. Withington (4 vols.; Loeb Classical Library, 1923-1931), to which reference has already been made.
In short, there is no Hippocratic canon, only collections the composition of which varies from manuscript to manuscript and from one edition to another. The genuineness of each work must be discussed separately; it is never certain, but many writings are certainly apocryphal; the probability of a work’s being genuine thus varies from zero to less than 100 percent.
When we were dealing with men like Herodotos and Thucydides, who have each but one book to his credit, all the generalities applied necessarily to that single book. The case of Hippocrates is very different; a great many books are ascribed, rightly or wrongly, to him and to his school, and these books vary in so many ways that we must consider them separately — not all, for that would be too long and unnecessary, but some thirty of them. The reader who follows me in the brief analysis of these books will have a sounder idea of the Hippocratic corpus than could be conveyed in a general way.
Fig. 72. Title page of the first Hippocratic encyclopedia and dictionary by Anuce Foes of Metz (1528–1595), a monument of medical learning, which is still a valuable tool for the study of Greek medicine (folio, 33 cm, 700 pp., printed in small type in 2 cols.; Frankfort, 1588). In spite of its size the work was reprinted in Geneva, 1662. [From the copy in the Harvard College Library.]
Fig. 73. Title page of the first volume of Littré’s Greek-French edition of Hippocrates (10 vols.; Paris, 1839-1861). [From the copy in the Harvard College Library.]
One should not attach too much importance to the order in which they are dealt with. A chronologic sequence, which would be the most natural one, is impossible to establish. Some writings are probably pre-Hippocratic, namely De hebdomadibus (see p. 215), Prorrhetic (Praedicta),Coan prenotions, and the substance of the Oath. We shall consider thirty works, divided roughly as follows: 1-6, Main medical writings; 7–11, Surgical; 12–20, Medical philosophy and essays; 21–24, Aphoristic; 25–29, Deontology; 30, Epistles.
MAIN MEDICAL WRITINGS⁹²⁷
1. The sacred disease; De morbo sacro; Peri hier s nosu.⁹²⁸ This is not by any means the most popular of the Hippocratic writings, but it is one of the outstanding ones from the point of view of medical historians. It is probably genuine, and it is certainly of Hippocrates’ time. The sacred disease is epilepsy (the falling sickness), but the treatise deals also with other seizures and other forms of mental illness. The disease is said to originate in the brain, the immediate cause of the seizures being the stoppage of air in the blood vessels by phlegm coming from the head; this pneumatic explanation was perhaps derived from Hippocrates’ contemporary, Diogenes of Apollonia. The brain (and not the heart or midriff) is considered to be the seat of consciousness; this may have been derived from Alcmaion (VI B.C.); it was accepted by Plato but rejected by Aristotle (this was one of Aristotle’s worst errors) and therefore it took considerable time to rediscover it.
The most startling feature of this book is the rejection of the name commonly given to epilepsy, the “sacred disease.” Hippocrates⁹²⁹ claims that there are no two kinds of diseases, natural and sacred, or human and divine; all are natural and in a sense all are divine. Here are his own amazing words:
I am about to discuss the disease called “sacred.” It is not, in my opinion, any more divine or more sacred than other diseases, but has a natural cause, and its supposed divine origin is due to men’s inexperience, and to their wonder at its peculiar character. Now while men continue to believe in its divine origin because they are at a loss to understand it, they really disprove its divinity by the facile method of healing which they adopt, consisting as it does of purifications and incantations. But if it is to be considered divine just because it is wonderful, there will be not one sacred disease but many, for I will show that other diseases are no less wonderful and portentous, and yet nobody considers them sacred. For instance, quotidian fevers, tertians, and quartans seem to me to be no less sacred and god-sent than this disease, but nobody wonders at them. Then again one can see men who are mad and delirious from no obvious cause, and committing many strange acts; while in their sleep, to my knowledge, many groan and shriek, others choke, others dart up and rush out of doors, being delirious until they wake, when they become as healthy and rational as they were before, though pale and weak; and this happens not once but many times. Many other instances, of various kinds, could be given, but time does not permit us to speak of each separately.
My own view is that those who first attributed a sacred character to this malady were like the magicians, purifiers, charlatans, and quacks of our own day, men who claim great piety and superior knowledge. Being at a loss, and having no treatment which would help, they concealed and sheltered themselves behind superstition, and called this illness sacred, in order that their utter ignorance might not be manifest.⁹³⁰
The anatomy of the blood vessels is very poor; there are good clinical observations, but the definition of epilepsy is insufficient. We should be indulgent however, for in spite of very sophisticated methods of approach (electroencephalography), we have not yet succeeded in explaining the “sacred disease”; nor are we yet able to cure its victims or to give them much help.
We seldom forget our first impressions. This treatise was the first Greek scientific treatise that I read and the spirit animating it moved me deeply. This was my initiation as a historian of science. My fellow students and I at the University of Ghent read it in the (partial) edition included in the Griechisches Lesebuch of Wilamowitz, under the wise direction of Joseph Bidez.⁹³¹
2. Prognostic; Prognostica sive praenotiones; Progn sticon.⁹³² This is traditionally ascribed to Hippocrates without dissenting voice. The development of acute diseases is described in order to enable the physician to foretell it once it has begun. This work remained in practical use until the middle of the seventeenth century, and therefore is represented by a large number of manuscripts and editions in many languages.
Latin editions of the Prognostica appeared very early, in the six editions of the Articella (1476 to 1500) and separately by Henri Estienne (Paris, 1516). I am not sure whether the Latin-German edition of the Prognostica Ypocratis cum aliis notatis (Memmingen, 1496?; Klebs, 521) is really the same text.
The first chapter reads:
I hold that it is an excellent thing for a physician to practice forecasting. For if he discover and declare unaided by the side of his patients the present, the past, and the future, and fill in the gaps in the account given by the sick, he will be the more believed to understand the cases, so that men will confidently entrust themselves to him for treatment. Furthermore, he will carry out the treatment best if he know beforehand from the present symptoms what will take place later. Now to restore every patient to health is impossible. To do so indeed would have been better even than forecasting the future. But as a matter of fact men do die, some owing to the severity of the disease before they summon the physician, others expiring immediately after calling him in — living one day or a little longer — before the physician by his art can combat each disease. It is necessary, therefore, to learn the natures of such diseases, how much they exceed the strength of men’s bodies, and to learn how to forecast them. For in this way you will justly win respect and be an able physician. For the longer time you plan to meet each emergency the greater your power to save those who have a chance of recovery, while you will be blameless if you learn and declare beforehand those who will die and those who will get better.
The very last sentence seems to have been written in opposition to the Cnidian physicians:
Do not regret the omission from my account of the name of any disease. For it is by the same symptoms in all cases that you will know the diseases that come to a crisis at the times I have stated.
3. Regimen in acute diseases; De diaeta (or De ratione victus in acutis); Peri diait s oxe n nos mat n.⁹³³ The genuineness of this treatise has never been doubted. It is a kind of supplement to Prognostic. The acute diseases dealt with, characterized by high fever, are chest complaints and remittent malaria. The treatment prescribed is very mild, with insistence on diet (as the title indicates). Hippocrates recommends the use of a gruel or ptisan of barley, hot fomentations, baths and rubbings, various wines and honey drinks, and so on; very few drugs are mentioned. ⁹³⁴
I should most commend a physician who in acute diseases, which kill the great majority of patients, shows some superiority. Now the acute diseases are those to which the ancients have given the names of pleurisy, pneumonia, phrenitis, and ardent fever, and such as are akin to these, the fever of which is on the whole continuous. For whenever there is no general type of pestilence prevalent, but diseases are sporadic, acute diseases cause many times more deaths than all others put together.⁹³⁵
The Latin text was included in every incunabula edition of the Articella, six of them (from before 1476 to 1500; Klebs 116). The first separate edition of the Greek text was that of Haller (Paris, 1530). There were many other editions, chiefly in Latin.
The work was known also under other titles, On the ptisan (De ptisana), because of the importance attached to ptisan, and Against the Cnidian sentences, because Cnidian teachings are criticized in the first three chapters.
4. Prorrhetic II; Praedicta II; Prorrh ticon b′.⁹³⁶ We place this book here in spite of the fact that ancient critics like Erotianos and Galen did not consider it genuine. It has all the appearances, however, of belonging to the early Hippocratic period. We place it here because it is in some respects comparable to Regimen in acute diseases; it might have been entitled Regimen in chronic diseases.
It is very different from Prorrhetic I which is a collection of 170 aphorisms. Prorrhetic II is divided into forty-three chapters, some of which are fairly long. It contains a good many medical observations, and two curious statements. In chap. 3 one reads, “Touching the belly and veins with one’s hands one is less likely to be deceived than by not touching them;” this must be a reference to pulsations. The Hippocratic physicians did not know much about the pulse, but pulsations had been observed by them (how could they have failed to observe them?). In chap. 17 there is a reference to a leech (bdella) hidden in the throat, which may be the cause of bleeding. The Hippocratic physicians did not use leeches, but they had recognized the harm that leeches could cause accidentally; this was a correct observation in a country where these animals occur,⁹³⁷
5. Epidemics I and III; Epidemiorum libri I et III; Epid mi n biblia a′, g′.⁹³⁸ This work is one of the masterpieces of Greek science; it is not well written, for the author was hardly thinking of form. It is a collection of “constitutions” (catastasis), and of particular clinical histories. The “constitutions” describe the general circumstances of climate and disease in definite places; three of them refer to the island of Thasos, with which we must assume that the author (Hippocrates?) was very familiar. The clinical cases are forty-two in number, twenty-five of them ending in death.
The scientific nature and dispassionate tone of these medical notes are marvelous. Here are a few examples.
Epidemics I. First constitution. This is a description of epidemic parotitis (mumps); it is particularly interesting because it mentions the orchitis which may be one of the complications of mumps (orchitis parotidea).
In Thasos during autumn, about the time of the equinox to near the setting of the Pleiades, there were many rains, gently continuous, with southerly winds. Winter southerly, north winds light, droughts; on the whole, the winter was like a spring. Spring southerly and chilly; slight showers. Summer in general cloudy. No rain. Etesian winds few, light and irregular.
The whole weather proved southerly, with droughts, but early in the spring, as the previous constitution had proved the opposite and northerly, a few patients suffered from ardent fevers, and these very mild, causing hemorrhage in few cases and no deaths. Many had swellings beside one ear, or’both ears, in most cases unattended with fever, so that confinement to bed was unnecessary. In some cases there was slight heat, but in all the swellings subsided without causing harm; in no case was there suppuration such as attends swellings of other origin. This was the character of them: — flabby, big, spreading, with neither inflammation nor pain; in every case they disappeared without a sign. The sufferers were youths, young men, and men in their prime, usually those who frequented the wrestling school and gymnasia. Few women were attacked. Many had dry coughs which brought up nothing when they coughed, but their voices were hoarse. Soon after, though in some cases after some time, painful inflammations occurred either in one testicle or in both, sometimes accompanied with fever, in other cases not. Usually they caused much suffering. In other respects the people had no ailments requiring medical assistance.
Epidemics I. End of second constitution:
Pains about the head and neck, and heaviness combined with pain, occur both without and with fever. Sufferers from phrenitis have convulsions, and eject verdigris-colored vomit; some die very quickly. But in ardent and the other fevers, those with pain in the neck, heaviness of the temples, dimness of sight, and painless tension of the hypochondrium, bleed from the nose; those with a general heaviness of the head, cardialgia, and nausea, vomit afterwards bile and phlegm. Children for the most part in such cases suffer chiefly from the convulsions. Women have both these symptoms and pains in the womb. Older people, and those whose natural heat is failing, have paralysis or raving or blindness.⁹³⁹
Epidemics I ends with fourteen cases (arr stoi tessarescaideca). We quote the second in extenso;
Stlenus lived on Broadway near the place of Eualcidas. After overexertion, drinking, and exercises at the wrong time he was attacked by fever. He began by having pains in the loins, with heaviness in the head and tightness of the neck. From the bowels on the first day there passed copious discharges of bilious matter, unmixed, frothy, and highly colored. Urine black, with a black sediment; thirst; tongue dry; no sleep at night.
Second day. Acute fever, stools more copious, thinner, frothy; urine black; uncomfortable night; slightly out of his mind.
Third day. General exacerbation; oblong tightness of the hypochondrium, soft underneath, extending on both sides to the navel; stools thin, blackish; urine turbid, blackish; no sleep at night; much rambling, laughter, singing; no power of restraining himself.
Fourth day. Same symptoms.
Fifth day. Stools unmixed, bilious, smooth, greasy; urine thin, transparent; lucid intervals.
Sixth day. Slight sweats about the head; extremities cold and livid; much tossing; nothing passed from the bowels; urine suppressed; acute fever.
Seventh day. Speechless; extremities would no longer get warm; no urine.
Eighth day. Cold sweat all over; red spots with sweat, round, small like acne, which persisted without subsiding. From the bowels with slight stimulus there came a copious discharge of solid stools, thin, as it were unconcocted, painful. Urine painful and irritating. Extremities grow a little warmer; fitful sleep; coma; speechlessness; thin, transparent urine.
Ninth day. Same symptoms.
Tenth day. Took no drink; coma; fitful sleep. Discharges from the bowels similar; had a copious discharge of thickish urine, which on standing left a farinaceous, white deposit; extremities again cold.
Eleventh day. Death.
From the beginning the breath in this case was throughout rare and large. Continuous throbbing of the hypochondrium; age about twenty years.
Epidemics I, case 6:
Cleanactides, who lay sick above the temple of Heracles, was seized by an irregular fever. He had at the beginning pains in the head and the left side, and in the other parts pains like those caused by fatigue. The exacerbations of the fever were varied and irregular; sometimes there were sweats, sometimes there were not. Generally the exacerbations manifested themselves most on the critical days.
About the twenty-fourth day. Pain in the hands; bilious, yellow vomits, fairly frequent, becoming after a while like verdigris; general relief.
About the thirtieth day. Epistaxis from both nostrils began, and continued, irregular and slight, until the crisis. All the time he suffered no thirst, nor lack of appetite or sleep. Urine thin, and not colorless.
About the fortieth day. Urine reddish, and with an abundant, red deposit. Was eased. Afterwards the urine varied, sometimes having, sometimes not having a sediment.
Sixtieth day. Urine had an abundant sediment, white and smooth; general improvement; fever intermitted; urine again thin but of good color.
Seventieth day. Fever, which intermitted for ten days.
Eightieth day. Rigor; attacked by acute fever; much sweat; in the urine a red, smooth sediment. A complete crisis.
Epidemics I, case 11:
The wife of Dromeades, after giving birth to a daughter, when everything had gone normally, on the second day was seized with rigor; acute fever. On the first day she began to feel pain in the region of the hypochondrium; nausea; shivering, restless; and on the following days did not sleep. Respiration rare, large, interrupted at once as by an inspiration.
Second day from rigor. Healthy action of the bowels. Urine thick, white, turbid, like urine which has settled, stood a long time, and then been stirred up. It did not settle. No sleep at night.
Third day. At about midday rigor; acute fever; urine similar; pain in the hypochondrium; nausea; an uncomfortable night without sleep; a cold sweat all over the body, but the patient quickly recovered heat.
Fourth day. Slight relief of the pains about the hypochondrium; painful heaviness of the head; somewhat comatose; slight epistaxis; tongue dry; thirst; scanty urine, thin and oily; snatches of sleep.
Fifth day. Thirst; nausea; urine similar; no movement of the bowels; about midday much delirium, followed quickly by lucid intervals; rose, but grew somewhat comatose; slight chilliness; slept at night; was delirious.
Sixth day. In the morning had a rigor; quickly recovered heat; sweated all over; extremities cold; was delirious; respiration large and rare. After a while convulsions began from the head, quickly followed by death.
It is clear that the book was not ready for publication; it is doubtful whether it was ever meant to be published or to be used outside of the medical school. It may have been written for Hippocrates’ personal use, except that it is too well composed for that purpose.
The doctrine of temperaments is adumbrated in Epidemics III:
The physical characteristics of the consumptives were: — skin smooth, whitish, lentil-colored, reddish; bright eyes; a leu-cophlegmatic condition; shoulder blades projecting like wings. Women too so. As to those with a melancholic or a rather sanguine complexion, they were attacked by ardent fevers, phrenitis and dysenteric troubles. Tenesmus affected young, phlegmatic people; the chronic diarrhoea and acrid, greasy stools affected persons of a bilious temperament.⁹⁴⁰
6. Epidemics II, IV—VII; Epidemiorum libri II, IV, V, VI, VII; Epid mi n biblia b′, d′-z′.⁹⁴¹ We separate these five books of Epidemics from the other two (I, III) in agreement with an old tradition. They are supposed to be less genuine; the ancients ascribed I and III to the master himself and the other books to other Hippocratic physicians. Epidemics II, VI, and IV(?) were occasionally ascribed to Hippocrates’ son Thessalos; Epidemics VI was commented upon by one of the ancient physicians, Glaucias of Tarentum (I—1 B.C.).
In one essential respect, the five books that we are going to consider are similar to the other two: they all are collections of clinical cases and medical notes, in various degrees of elaboration. Epidemics I and III are closer to perfection; V and and VII less close; II, IV, and VI much more distant; but the general purpose of all books is the same.
The five books are a jungle of clinical notes of many kinds, some of them well written (at their best, like the cases in Epidemics I and III), others jotted down more rapidly; some notes were written down immediately after some observations had been made without waiting for the continuation and ending of the case; some items are ungrammatical and unclear, others are completely obscure. Some cases are recognizable to the modern physician (and Littré did recognize them), others are mysterious.
One’s impression is that these notes were originally the archives of a single physician or of many. They were written on separate pieces of papyrus. At some unknown time all these pieces were put together, and “edited” — if the word “edited” may be used for such careless work. My guess is that the edition was made relatively late (say in the third century), when the Hippocratic school had already attained considerable fame. The “editor” was too respectful of those fragments to modify them in any way and he published them just as they were. In that he was right; but he was wrong in leaving them in great disorder and in perpetuating such blunders as inserting Epidemics VI between V and VII, which obviously belong together.
It is perhaps a blessing that those rude notes were permitted to come down to us, because the study of them enables us to recreate the life and experience of the Hippocratic physicians. We watch these men at their work, and are given glimpses of their meditations. In Epidemics V there are many examples of self-correction; the physician concludes that his former judgment on this or that case and. the treatment which he prescribed were mistaken. In Epidemics IV, 6, relating a case of abortion the physician adds, “Did the woman speak the truth, I wonder.”
Three physicians are named, Herodicos,⁹⁴² whose methods are blamed, Pythocles,⁹⁴³ who gave his patients milk diluted in much water, and the consultant Mnesimachos. ⁹⁴⁴ Many other physicians are referred to anonymously.
The randomness of the collection is illustrated by the abundance of repetitions occurring in them, especially within the groups II, IV, VI and V, VII. It would seem that some notes were written more than once and were thus represented by various pieces of papyrus; each piece was left where it was and the scribe who copied them all on a single roll did not notice the duplications or did not bother about them.
The repetitions extend not only to the collection itself but to many other works of the Hippocratic corpus. Littré has carefully indicated all the fragments that are identical with, or very close to, passages that can be read in the Aphorisms, Prorrhetic I, Prognostic, Airs waters places, Regimen in acute diseases, The physician’s office, etc. This is extremely instructive. It shows that part of the Hippocratic corpus was available for reference when the physicians wrote these clinical notes, or that the same men wrote those notes and various other Hippocratic books. In other words, Epidemics helps us to realize the integrity of a good part of the Hippocratic corpus. This has been very well shown by Littré in the footnotes and in his introduction to Epidemics in general and to each book in particular. Littré’s argument has been restated with greater detail by Deichgräber,⁹⁴⁵ who confirmed Littré’s classification and ventured to give definite dates to each group. According to him, the dating could be represented roughly by the following scheme: I, III, c. 410; II, IV, VI, c. 399–395; V, VII, c. 360.
We need not discuss that precise dating, which seems a little bold to me, considering the disorder and heterogeneity of each book; it will suffice to accept the general conclusion that Epidemics represent in their totality the medical experience of a definite group of physicians, the Coan school, during a relatively short period, say half a century.
Deichgräber had the advantage of working almost a century later than Littré, but the disadvantage of being less able than Littré to deal with the realia, for he is simply a philologist, not a physician.
In order to discuss more thoroughly various features of Hippocratic medicine it would be worth while to prepare a new edition of Epidemics, arranged as much as possible by topics. Inasmuch as the present text is accidental, one would have the right to disregard the casual sequences that it has crystallized and to assume that the original collection of pieces of papyrus has been given back to us in its initial disorder. We would proceed to reëdit it, but intelligently; that is, we would begin by classifying the fragments as well as possible, putting together those that belong together, for example, all those that deal with the curious epidemic which obtained in Perinthos⁹⁴⁶ in the winter of an unnamed year: ⁹⁴⁷ coughing combined with many other troubles such as angina, night blindness, paralysis of various members; the disease took different complexions according to the profession and experience of each patient, for example, town criers and singers suffered from angina, laborers using their arms had pains in the arms, and so forth. Compare this with a statement in Aphorisms: “If previous to an illness a part of the body has suffered pains, it is in that part that the disease will settle.” ⁹⁴⁸ The method of editing that I have suggested might be extended to other parts of the corpus; it should be undertaken not by a pedantic philologist but by an experienced physician who was also, but secondarily, a good Hellenist, an editor like Littré or Petrequin. Therealia, we should always remember, cannot be learned in books but only in the practice of a scientific profession.
Many of the observations recorded in Epidemics are singular and yet have all the appearance of being genuine. Here is one, perhaps the most singular of all:
In Abdera, Phaitusa, housekeeper of Pytheas, had had children, but her husband having abandoned her, she stopped menstruating for a long time, then she had pain in the joints and red patches upon them. These things being so, her body took on the appearance of a man’s body, and became covered with hair, she grew a beard, her voice became harsh. In spite of all our efforts to reestablish her menstruation it did not reappear, and she died not long afterward. The same thing happened to Nanno, the wife of Gorgippos, in Thasos. According to all the physicians whom I talked with, the only hope of restoring her female nature lay in the resumption of her courses; but in this case, also, their efforts failed, and she soon died.⁹⁴⁹
In spite of its singularity, this is a good example of the medical stories told in Epidemics (some 567 of them);⁹⁵⁰ some are much longer, many much shorter, reduced to aphorisms. The tone is strictly medical, scientific, irrelevant details being avoided, without nonsense.
THE SURGICAL BOOKS
The surgical books are quite as important for the formulation of Hippocratic medicine as the medical books that we have been thus far discussing, but they are a bit too technical for the general reader, and we cannot devote much space to them. Every intelligent person can appreciate the wisdom of Hippocratic medicine as revealed in the treatise Regimen in acute diseases, but it takes a surgeon to appreciate the fine points of Hippocratic surgery, and no amount of explanation would help other readers to judge them correctly.
In spite of their relative excellence, the surgical treatises are less astonishing than some of the other medical treatises, because we know that the surgical profession was very old in Greece (not to mention the Egyptian tradition, which was many centuries older). The Homeric poems reveal already the existence of much surgical knowledge. It is very interesting to compare them with the medieval romances of chivalry, “where there is no end of wounds and violence but an almost complete absence of definiteness or surgical interest.”⁹⁵¹ In the Iliad some 147 wounds are described so clearly that a surgeon can identify each of them. The Greeks obtained much surgical experience from the accidents not only of war but also of gymnastics and sport. For example, the shoulder was frequently dislocated in wrestling and a good surgeon should know all the ways of putting it in again. Surgical knowledge included not only the setting of broken and dislocated bones, but various forms of bandaging, the application of splints, chiropractic, the use of massage and ointments. The Hippocratic surgeons did whatever could be done with the means available to them; there was, of course, no antisepsis and no anesthesia, except the most rudimentary. The reputation of Greek surgeons had spread abroad as far as Persia before the end of the sixth century; witness the story of Democedes of Croton, who was called to the court of Darios (p. 215). The Hippocratic treatises mark the climax of a long tradition.
An admirable Greek-French edition of the surgical writings was prepared by the French surgeon Joseph Eleonore Petrequin (1810–1876), who devoted to it the leisure time of thirty years, Chirurgie d’Hippocrate (2 vols., 1222 pp.; Paris: Imprimerie nationale, 1877–78). Both volumes include very elaborate notes but the long introductions prepared for each treatise of vol. 1 are missing in vol. 2, which the author could not complete and which was edited posthumously by Emile Jullien.
7. Wounds in the head; De capitis vulneribus; Peri t n en cephal tr mat n.⁹⁵² This is one of the greatest Hippocratic treatises, dating probably from the end of the fifth century and generally ascribed to Hippocrates himself. It contains descriptions of various kinds of skulls (variations in the sutures) and the theory of fracture by contrecoup. There is a remarkably modern method of trephining and discussion of the cases when trephining is recommended and of those when it is better to abstain.
8. In the surgery; De oflicina medici; Cat’ i treion.⁹⁵³ This is a collection of notes dealing mainly with bandaging, and explaining how the surgeon should behave, which instruments to use, and so on. It may have been a notebook prepared by a teacher or by a student; there are many repetitions, but good teaching implies frequent rehearsing. The following extracts will give a better idea of it than any description.
2. Operative requisites in the surgery; the patient, the operator, assistants, instruments, the light, where and how placed; their number, which he uses, how and when; the [patient’s?] person and the apparatus; time, manner, and place.
3. The operator whether seated or standing should be placed conveniently to himself, to the part being operated upon, and to the light.
Now, there are two kinds of light, the ordinary and the artificial, and while the ordinary is not in our power the artificial is in our power. Each may be used in two ways, as direct light and as oblique light. Oblique light is rarely used, and the suitable amount is obvious. With direct light, so far as available and beneficial, turn the part operated upon toward the brightest light — except such parts as should be unexposed and are indecent to look at — thus while the part operated upon faces the light, the surgeon faces the part, but not so as to overshadow it. For the operator will in this way get a good view and the part treated not be exposed to view...
4. The nails neither to exceed nor come short of the finger tips. Practice using the finger ends especially with the forefinger opposed to the thumb, with the whole hand held palm downward, and with both hands opposed. Good formation of fingers: one with wide intervals and with the thumb opposed to the forefinger, but there is obviously a harmful disorder in those who, either congenitally or through nurture, habitually hold down the thumb under the fingers. Practice all the operations, performing them with each hand and with both together — for they are both alike — your object being to attain ability, grace, speed, painlessness, elegance, and readiness...
6. Let those who look after the patient present the part for operation as you want it, and hold fast the rest of the body so as to be all steady, keeping silence and obeying their superior.
This little treatise is certainly Hippocratic and relatively early. Thessalos, Hippocrates’ son, has been named as the author. Irrespective of its genuineness, there is perceptible in it the influence of a great, original teacher.
9–11. Fractures, Joints, Instruments of reduction; De fractis, De articulis re-ponendis, Vectiarius; Peri agm n, Peri arthr n, Mochlicon.⁹⁵⁴ These three treatises may be considered together; the first two, which were certainly written by the same physician, once formed a single work; the third (Mochlicon) is an abbreviation of the parts in 1 and 2 dealing with dislocations. All of them are too technical for the general reader.
The genuineness of Fractures and Joints has never been doubted, and Galen put them in his first group of Hippocratic writings, the most genuine. Curiously enough, some ancient commentators ascribed them not to Hippocrates himself but to his grandfather Hippocrates, son of Gnosidicos.⁹⁵⁵ This confirms the view that the surgical tradition was old and that Hippocrates did not originate it; at best he (if not his grandfather before him) standardized it. The two main works, Fractures and Joints, are not clearly separated from each other; the first contains a good deal (one quarter of it) about dislocations, while the second has some chapters on fractures. What is more surprising, both treatises contain rhetorical passages, such as are not found in the best Hippocratic works, but these passages may be due to the editorial care of a pedantic disciple.
In the treatise on Joints (chap. 9) the author discusses massage in surgical cases and announces his intention of devoting a special book to the subject (anatripsis); that book was not written, however, and no reference was made to it, except in that single passage.⁹⁵⁶
A commentary on the treatise on Joints was written by Apollonios of Cition (I–1 B.C.).⁹⁵⁷ That commentary has obtained a great importance, because of an accident in its transmission. A manuscript of it in Florence ⁹⁵⁸ is a Byzantine copy of the ninth century, including surgical illustrations (for example, with reference to reposition methods), which might go back to the time of Apollonios and even of Hippocrates. Iconographic traditions of this kind are very rare, because the copying of figures was far more difficult than the writing of the text and was often abandoned. Thanks to Apollonios, we have very clear notions of the ancient practice of surgery.
MEDICAL PHILOSOPHY AND ESSAYS
12. Ancient medicine; De prisca medicina; Peri archai s i tric s.⁹⁵⁹ This treatise is ancient, say the end of the fifth century, but could not have been written by the author of The sacred disease, Regimen in acute diseases, Epidemics, because its form is too literary. It was probably composed by an early disciple of the master who was a physician and also a sophist or rhetorician and who felt the necessity and duty of defending the medical art in a form acceptable to his colleagues.
It begins with a protest against philosophic speculation in medicine, a defense of the “ancient medicine,” that is, scientific (as against philosophic) medicine.
Long experience was needed to discover what kind of food was wholesome and what was not, how it should be prepared and how much of it should be taken to preserve the health of strong people or to increase the strength of weaker ones. Now the medical art is but the refinement of the art of nourishing oneself well. The discoveries of the good physicians were of the same kind as those of the early dietists (“My own view is that their reasoning was identical and the discovery one and the same.” ⁹⁶⁰). They had to find the kind of nourishment that would be suitable for sick people (diluted foods, paps or gruels, rhoph mata) and would restore their health instead of destroying what remained of it.
The four qualities (wet and dry, hot and cold) are comparatively unimportant; other qualities or virtues (dynameis), not limited to four, are probably more important — virtues such as strength, saltness, bitterness, sweetness, sharpness, sourness, moistness, and many others, plus their innumerable combinations. This was a very remarkable outburst of medical common sense against premature classification.
The burden of the polemical part of the treatise was a denunciation of irresponsible hypotheses; ⁹⁶¹ the physician must restrict himself to available and controllable evidence; he must be rational and modest; we would simply say scientific.
The author was acquainted with , Empedocles, Anaxagoras, but his main interest was technical.⁹⁶² His good appreciation of ancient medicine is somewhat misleading, for there was empirical medicine (and surgery) but little scientific medicine before Hippocrates, and pioneers like Alcmaion were led astray by Pythagorean hypotheses. He was perhaps too modest for his older contemporaries and too generous to their predecessors. He attacked the philosophers, the premature rationalists, but had nothing to say of the charlatanism that was flourishing in the sanctuaries. It may be that he did not discuss superstitions (even as our own physicians do not speak of them) because he considered them irrelevant and below contempt. His reference to bad physicians, “who comprise the great majority,”⁹⁶³ implies not charlatanry but incompetence.
Read the significant beginning:
All who, on attempting to speak or to write on medicine, have assumed for themselves a postulate (hypothesis) as a basis for their discussion — heat, cold, moisture, dryness, or anything else that they may fancy — who narrow down the causal principle of diseases and of death among men, and make it the same in all cases,postulating one thing or two, all these obviously blunder in many points even of their statements, but they are most open to censure because they blunder in what is an art, and one which all men use on the most important occasions, and give the greatest honors to the good craftsmen and practitioners in it. Some practitioners are poor, others very excellent; this would not be the case if an art of medicine did not exist at all, and had not been the subject of any research and discovery, but all would be equally inexperienced and unlearned therein, and the treatment of the sick would be in all respects haphazard. But it is not so; just as in all other arts the workers vary much in skill and in knowledge, so also is it in the case of medicine. Wherefore I have deemed that it has no need of an empty postulate, as do insoluble mysteries, about which any exponent must use a postulate, for example, things in the sky or below the earth. If a man were to learn and declare the state of these, neither to the speaker himself nor to his audience would it be clear whether his statements were true or not. For there is no test the application of which would give certainty.
But medicine has long had all its means to hand, and has discovered both a principle and a method, through which the discoveries made during a long period are many and excellent, while full discovery will be made, if the inquirer be competent, conduct his researches with knowledge of the discoveries already made, and make them his starting point. But anyone who, casting aside and rejecting all these means, attempts to conduct research in any other way or after another fashion, and asserts that he has found out anything; is and has been the victim of deception.
And chapter xx:
Certain physicians and philosophers assert that nobody can know medicine who is ignorant what man is; he who would treat patients properly must, they say, learn this. But the question they raise is one for philosophy; it is the province of those who, like Empedocles, have written on natural science, what man is from the beginning, how he came into being at the first, and from what elements he was originally constructed. But my view is, first, that all that philosophers or physicians have said or written on natural science no more pertains to medicine than to painting. I also hold that clear knowledge about natural science can be acquired from medicine and from no other source, and that one can attain this knowledge when medicine itself has been properly comprehended, but till then it is quite impossible — I mean to possess this information, what man is, by what causes he is made, and similar points accurately. Since this at least I think a physician must know, and be at great pains to know, about natural science, if he is going to perform aught of his duty, what man is in relation to foods and drinks, and to habits generally, and what will be the effects of each on each individual. It is not sufficient to learn simply that cheese is a bad food, as it gives a pain to one who eats a surfeit of it; we must know what the pain is, the reasons for it, and which constituent of man is harmfully affected. For there are many other bad foods and bad drinks, which affect a man in different ways. I would therefore have the point put thus: — “Undiluted wine, drunk in large quantity, produces a certain effect upon a man.” All who know this would realize that this is a power of wine, and that wine itself is to blame, and we know through what parts of a man it chiefly exerts this power. Such nicety of truth I wish to be manifest in all other instances. To take my former example, cheese does not harm all men alike; some can eat their fill of it without the slightest hurt, nay, those it agrees with are wonderfully strengthened thereby. Others come off badly. So the constitutions of these men differ, and the difference lies in the constituent of the body which is hostile to cheese, and is roused and stirred to action under its influence. Those in whom a humor of such a kind is present in greater quantity, and with greater control over the body, naturally suffer more severely. But if cheese were bad for the human constitution without exception, it would have hurt all.⁹⁶⁴
There are two recent editions: by W. H. S. Jones, “Philosophy and medicine in ancient Greece,” Supplement 8 to the Bulletin of the History of Medicine (100 pp.; Baltimore, 1946) [Isis 37, 233 (1947)], including new edition of the text and English translation; and by A. J. Festugière,L’ancienne médecine (136 pp., Paris: Klinck-sieck, 1948), including Heiberg’s Greek text and a French translation. Both editors provide abundant notes and elaborate introductions.
13. The art; De arte; Peri techn s.⁹⁶⁵ This short treatise of the early Hippocratic age was written to prove that there is such a thing as the medical art, and to defend its practitioners against various kinds of detractors. The author may have been a layman; some scholars have tried to identify him with Protagoras or with Hippias; such attempts, proceeding from the common wish of finding an author for an anonymous work, are futile when there is little more than the wish to support them.
We gather from it that in Hippocrates’ time, as in our own, there were people who spoke ill of physicians, saying that cures were due to luck, that patients often recovered without medical help, that some died in the doctor’s hands, and that doctors refused to treat some diseases. The first three objections contained enough truth to be impressive. The fourth one would not be used today; physicians do not refuse any more to treat certain hopeless patients, though they sometimes wish they did not have to treat them.
14. Nature of man; De natura hominis; Peri physios anthr pu; ⁹⁶⁶ and Regimen in health; De salubri victus ratione; Peri diait s hygiein s.⁹⁶⁷ These two works are put together, because they formed a single work in ancient times and are joined together in manuscripts. Aristotle quoted a fragment from the Nature of man, which he introduced with the words “Polybos writes to the following effect.” On that basis that treatise has been ascribed to Polybos, son-in-law of Hippocrates, an ascription that is plausible ⁹⁶⁸and is partly confirmed by Menon.⁹⁶⁹
Taking both works together, they are not a well-organized whole but rather a collection of fragments, put together arbitrarily. Hence, the discussion of the authorship is somewhat futile; there may be many authors. Menon, ascribing chapter 9 to Aristotle and chapter 3 to Polybos, may be right in both cases. The beginning of the Nature of man is reminiscent of Ancient medicine, and there are points of contact with other books of the corpus.
The most important part of the Nature of man is the discussion of the theory of humors. It is the only Hippocratic work discussing seriously that theory, while the one ostensibly devoted to it (Peri chym n) does not deal with it. The author argues against philosophers who think that the universe is made of a single substance and extend that theory to medicine; if that were the case there would be but one disease and one remedy. The human body is constituted of four separate humors whose balance is the condition of health; yet different humors predominate in each season. There follow therapeutic rules derived from those premises. Chapter II contains a confused account of the vascular system (the oldest Greek descriptions of it were those of Syennesis of Cypros, Diogenes of Apollonia, and this one).
Regimen in health gives rules for diet and exercise according to the seasons, complexion, and age; how to become leaner or fatter; ⁹⁷⁰ when to use emetics and clysters; regimen of children, women, and athletes.
There are six incunabula of the Latin text (Klebs, 519, 644, 826), the earliest in Milan, 1481. The latest edition of the Greek text is by Oskar Villaret (88 pp.; Berlin, 1911).
15. Humors; De humoribus; Peri chym n.⁹⁷¹ This is perhaps the most chaotic and puzzling book of the corpus; Littré said that it deserved to be called Epidemics VIII (and he printed it immediately after Epidemics II, IV—VII) and Jones, going him one better, says, “It is obviously a scrapbook of the crudest sort; it has no literary qualities and it is obscure to a degree.” Yet it is a genuine Hippocratic scrapbook, known to the early commentators. Is it a collection of teacher’s or of student’s notes. Every guess is permitted and none can be substantiated.
It is full of puzzles, beginning with its very title, for it hardly deals with humors. The only Hippocratic work dealing with that is the Nature of man.
In spite (or because) of its obscurity it was frequently copied and printed.
16. Airs waters places; De aere locis aquis; Peri aer n hydat n top n.⁹⁷² Undoubtedly genuine (meaning ancient Hippocratic), this treatise is also one of the most astonishing fruits of the Hippocratic (or call it the Greek) genius. It is the first treatise in world literature on medical climatology (see our discussion of that in the preceding chapter) and it is also the first treatise on anthropology.
Hippocrates explains that the physician should pay full attention to the climate of each locality, and to the variations of that climate caused by changeable seasons, by different exposures, by the nature of the available water and food, and so on. Each medical case must be considered in its own geographic and anthropologic background. Diseases vary from place to place according to the difference in topography, climate, and human nature. The explanation is supported by a great many examples which the author had collected in his travels.
The second part of the book (chaps. 12–24) deals with the effect of climate upon character, and is a kind of anthropologic discussion of history. What is the difference between Europe and Asia, or between the Hellenes and the barbarians? Hippocrates ascribes those differences chiefly to physical (geographic) causes. So did his contemporary Herodotos, who put that teaching in the mouth of Cyros, the king of Persia, and thus gave to his History the most significant ending.
One of the most remarkable chapters in the Hippocratic anthropology is the twenty-second, discussing the case of the Scythian eunuchs or androgynes.⁹⁷³ We can hardly expect the author’s physical explanation of that mysterious situation to be correct, but it is very astonishing that he did try to give such an explanation, especially when we remember that the impartial discussion of sexual abnormalities is often believed to be a conquest of our own times.
The popularity of this treatise is witnessed by the number of manuscripts and editions. There are four incunabula of the Latin version, the first in 1481 (Klebs, 644.2, 826.1–3). Among modern editions of the Greek text, special mention should be made of the one prepared by the Greek scholar and patriot, Adamantos Coraes ( “Coray,” 1748–1833) with a French translation (2 vols.; Paris, 1800). There are at least five English translations, the first by Peter Low (London, 1597). See also Ludwig Edelstein, Peri aer n und die Sammlung der Hippokratischen Schriften (196 pp.; Berlin, 1931) [Isis 21, 341 (1934)], and Ame Barkhuus, “Medical surveys from Hippocrates to the world travelers, medical geography, geomedicine,” Ciba Symposia 6, 1986–2020 (1945).
For additional discussion of this treatise, see Chapter XIII.
17. Nutriment; De alimento; Peri troph s.⁹⁷⁴ Nutriment might be considered one of the aphoristic works, for it is divided into fifty-five chapters, eighteen of which are two lines long or less in the Greek text, twenty-nine covering from three to five lines, and only eight a little longer, though less than ten lines; thirty-five chapters out of the fifty-five are less than four lines long. It is unique in the Hippocratic corpus, because of its strong Heracleitean coloration. The dating of it is post-Heracleitos, probably prior to the fourth century, say the end of the fifth century.
The author was trying to explain the infinitely complex process of nutrition; as there could be no real understanding of that before the development of modern chemistry, it is not surprising that he was baffled and took refuge in obscure, sibylline utterances. In many chapters two opposite meanings are conveyed — take your choice. One thing he understood clearly, that food must be fluid to be assimilated,⁹⁷⁵ also the obvious fact, that food is essential to life (the dynamis of food replaces the Heracleitean fire). But again, how could anybody understand in the fifth century the mysterious chemistry of food transformed into flesh and bones, with blood and milk as “excess” (pleonasmos).⁹⁷⁶ No food is good absolutely, but only with regard to a definite person and a definite purpose; “all things are good or bad relatively.”⁹⁷⁷
Let us consider a few other examples: ⁹⁷⁸ (four chapters are quoted, each complete):
Nutriment and form of nutriment, one and many. One, inasmuch as its kind is one; form varies with moistness or dryness. These foods too have their forms and quantities ; they are for certain things, and for a certain number of things.
This is a form of the puzzle that exercised the mind of early Greek philosophers: the one versus the many. Many kinds of foods produce the same result, organic growth.
To illustrate the Heracleitean type of obscurity:
Nutriment is that which is nourishing; nutriment is that which is fit to nourish; nutriment is that which is about to nourish.
The beginning of all things is one and the end of all things is one, and the end and beginning are the same.
The best chapter is:
Pulsations of veins and breathing of the lungs according to age, harmonious and unharmonious, signs of disease and of health, and of health more than of disease, and of disease more than of health. For breath too is nutriment.
This is valuable not only because it is more concrete than the rest, but also because it is the earliest mention of pulse in Greek literature, and refers to air as food. The absence of other references to simple pulsations is one of the curiosities of the Hippocratic corpus.⁹⁷⁹ As to air, it was clearly indispensable to life, but to recognize it as food could then be only a guess or a metaphor.
18. The use of liquids; De liquidorum usu; Peri hygr n chr sios.⁹⁸⁰ This is a collection of notes concerning sweet and salt water, vinegar, wine, and the use of warm and cold liquids. It was possibly an abridgment of a larger treatise that is lost. Our only reason for listing it here is the fact that it is available in the Corpus medicorum graecorum.
19. Regimen I–IV; De victu (Book IV is often called Dreams, De insomniis, or De somniis) ; Peri diait s, Peri enypni n.⁹⁸¹ This work has been ascribed to Herodicos of Selymbria, to Hippocrates, to Philistion of Locroi, and to others. It dates probably from the Hippocratic age but is decidedly not Hippocratic in the good sense, for it is full of philosophic fancies and arbitrary “hypotheses.” One finds traces in it of the teachings of Heracleitos, Empedocles, Anaxagoras, and the Pythagoreans.
Modern editions include four books, the fourth having an alternate title, Dreams. Some of the early editions began with Book II; in Galen’s time the work was divided into three parts, Book IV being simply the end of Book III. At any rate, the four books are held together by what the author calls his “discovery” (heur- ma ): the two main factors of health are food and exercise; these two factors must be well balanced; if one of them predominates, precautions must be taken to reestablish the equilibrium. This gives the physician a method for treating his patients.
The author accepts the existence of the four elements but tries to reduce them to two — fire and water — and his physiology is then derived from the conflict between these two, which produces endless changes. The general conception is not clear, and its applications (for example, to embryology) are highly artificial and nebulous. In the first book such fancies are used to explain the composition of living bodies, the differences between ages and sexes, the nature of physical and mental health. The second deals with the properties of different countries, winds, foods and drinks, exercises. The third describes the signs revealing the imbalance of food and exercise and the onset of disease. The fourth explains how dreams may help to indicate the disorders that are brewing.
Embryologic problems are discussed in Book I, VI–XXXI. The author shows that the fetus is developed from the sperm, identified with the soul. The sperm-soul is a mixture of fire and water and is constituted of parts (merea) issuing from the bodies of both parents. Fetal development is compared with the execution of a piece of music, the fetus itself with a musical instrument. These musical-embryologic fantasies are obviously of Pythagorean origin. The obscurity of these ideas is increased by the corruption of the text.⁹⁸²
One of the most interesting parts for the modern reader is the description and comparison of different kinds of exercises (natural ones such as walking, and violent ones such as racing and wrestling) and their methods and results.⁹⁸³ Book IV, on dreams, is also very instructive; there are two kinds of dreams, those of divine origin, which concern oneiromancers, and those of physiologic origin, which give clues to the physicians. When the diviners venture to interpret the dreams of the second kind they are likely to fail.
They recommend precautions to be taken to prevent harm, yet they give no instruction how to take precautions, but only recommend prayers to the gods. Prayer indeed is good, and while calling on the gods a man should himself lend a hand.⁹⁸⁴
The four books combine fantastic notions with good observations. They illustrate the confusion that obtained even in the best minds when they tried to explain physical and physiologic complexities that were still hopelessly beyond their reach. Hippocratic common sense emerges here and there, in spite of the premature theories.
The book on dreams was the first “scientific” treatment of a subject that fascinated the people of antiquity and of the Middle Ages, and indeed the people of all ages. However strange and inadequate it may seem to the modern scientist, it represents the first attempt to explain rationally the mysteries of dreamland and to apply them to healing purposes. The author of that book was a distant ancestor of Freud.
Some of the dreams considered are relative to celestial phenomena (one may see the Sun or the Moon in one’s dream). It is striking that the author does not classify such dreams with those of divine origin, but with the physiologic ones. From that point of view alone it is not correct to suggest (as Jones did) ⁹⁸⁵ that De insomniis is the first occurrence in classical literature “of a supposed connection between the heavenly bodies and the fates of individual human lives.” Moreover, it is not certain that that treatise is older than the Epinomis of Plato, or even than its posthumous publication by Philip of Opus.
The De insomniis was one of the earliest Hippocratic books to appear in printed form, its Latin version being printed separately in Rome in 1481, then added to the early editions of the Aphorismi of Maimonides and of the Liber Almansoris of al-Razi (Klebs, 517, 644.2, 826.2–3); in all, four incunabula, ranging from 1481 to 1500.
20. On winds or Breaths; De flatibus; Peri phys n.⁹⁸⁶ This book, which dates probably from the early Hippocratic age, helps us to realize the high complexity of medical thought in that age. It is for that very reason that it is so useful to consider separately so many writings. The complexity of medical thought is not astonishing if one remembers that it was an age of great curiosity and intellectual effervescence. Medical observations were accumulating in certain favored places and intelligent physicians tried to put them in order on the basis of their philosophic conceptions. Their philosophic background was rarely, if ever, homogeneous, for by the end of the fifth century they had been submitted to many different influences. The thoughtful physician, facing insoluble problems, tried to solve them from the point of view that seemed the most promising to him.
Anaximenes had reached the conclusion that air (pneuma) was the original principle; this point of view had been applied to physiology by Diogenes of Apollonia. Of course the importance of air was obvious enough. Think of wind in all its varieties, the gentle breezes of spring, the sudden squalls of summer, the biting gales of winter, the deadly storms, think of earthquakes; ⁹⁸⁷ in the human body, a need of free air was as evident as the danger of a lack of it or of an imperfect circulation of it. The physician could observe the normal breathing of healthy people, the difficult breathing of sick ones, the agonies of incipient suffocation, he could observe also eructations, flatuses, borborygmus, crepitus ventris; he was familiar with the pains of flatulency. Truly air (pneuma) was one of the conditions of life, and when a man had given out his last breath, he died. Perhaps the soul (anima) was a kind of air?
The author of the book on Breaths was not a Hippocratic physician and perhaps he was not a physician at all; he was certainly a sophist, one especially interested in the facts of life and health. His book is a kind of discourse, the burden of which is that all the diseases are caused by air, and more particularly by the kind of air that is in living bodies (physa). It is possible that other Hippocratic treatises like the Nature of man and Ancient medicine were written partly to refute him (and his kind).
It is worth while to compare the pneumatic ideas represented by the De flatibus with similar ideas in early Sanskrit literature. The comparison has been made by Jean Filliozat,⁹⁸⁸ who quotes and translates relevant texts taken from Caraka, Bhela, and Su ruta. These texts establish the Hindu theory of pneumatism, the essential virtue of “winds” in the whole of nature as well as in living bodies, in short the same general conception as is crystallized in the various meanings of the words pneuma, anima, and spiritus. It is impossible, however, to prove any derivation from Sanskrit into Greek or vice versa. The main ideas are common, but many others are different; there are no textual identities. The alikeness of the Greek and Hindu traditions may be explained by a vague diffusion of ideas, for there were many contacts between India and Greece before Alexander, but it may be explained also by independent cogitations on facts of common experience: the need of “winds” in nature and in our own bodies, and the troubles that such “winds” may occasionally cause, are too obvious to escape observation.
The De flatibus was often published in Greek and Latin in the sixteenth century. The most recent edition of the Greek text, in addition to the Loeb and Corpus medicorum graecorum editions, is the one by Axel Nelson, Die Hippokratische Schrift Peri phys n (Uppsala, 1909). This includes two Renaissance Latin translations by Francesco Filelfo (1398-1481) and Janus Lascaris (1445–1535).
A number of books of the Hippocratic corpus may be grouped together because of their composition in the form of brief aphorisms that have been collected under a single title with very little or no order. We have already come across one of them, Nutriment.
The oldest of these writings was probably the Cnidian sentences, which is lost but the very title of which suggests that it was a collection of aphorisms, summarizing the wisdom of the Cnidian physicians (there are other Cnidian writings in the Hippocratic corpus, for the two schools of Cos and Cnidos were very close to each other, and thus Cnidian books would naturally be found in the Coan library). One might claim that aphoristic books must be early because the use of proverbs is a primitive form of expression. It is almost certain that some such collections are early but one must beware of generalization; the love of proverbs and aphorisms is common to all peoples and ages, with ups and downs perhaps, but with no stops. Jones ⁹⁸⁹ would place all the aphoristic books of the Hippocratic corpus in the second half of the fifth century, approximately in this order: Prorrhetic I, 440; Aphorisms, 415; Coan prerotions, 410; Nutriment, 400; Dentition, later(?). With the exception of Nutrimen which has already been dealt with, I shall consider them in that order.
Poetry and proverbs are ne earliest forms of literature in every nation. Aphoristic statements have the advantage of being easy to memorize, and the people repeating them give themselves without trouble an air of knowledgeableness and wisdom. The success of the medical aphorisms of the fifth century was caused not only by the popular love of proverbs but also by the aphorisms of Heracleitos and other philosophers, and the poems of Pindar and of other interpreters of Greek ideals. It was tempting to quote the most significant lines of a great poem, and such lines, often repeated, became aphorisms. Even so today, many people express their feelings by means of proverbs, or they quote a line of the Bible or of Shakespeare. That is easy enough, and it is pleasant.
21. Prorrhetic I; De praedictionibus; Prorrh ticon a′.⁹⁹⁰ This is a collection of medical aphorisms arranged without any order. It includes 170 short aphorisms, out of which only seventeen (one-tenth) are exclusive to it. Indeed, most of the collection was incorporated into the Coan prenotions.
One of the aphorisms ⁹⁹¹ has been the origin of considerable discussion: “Phrenetics drink little, are disturbed by noise and are quivering.” The word “drink little” (brachypotai) is the bone of contention. If it is understood as a reference to hydrophobia (rabies), then that disease is not new but very ancient. A passage of Aristotle refers clearly to hydrophobia, though it ends with an error.⁹⁹²
Prorrhetic I is very different from Prorrhetic II, the writing of the latter being as good as that of the former is poor. See sec. 4.
22. Aphorisms; Aphorismi sive sententiae ; Aphorismoi.⁹⁹³ This is the most popular book of the whole corpus, its popularity being partly due to the love of all peoples for “compressed wisdom,” wisdom in tablets that can be easily swallowed. Its popularity is attested by the abundance of manuscripts in many languages,⁹⁹⁴ and the number of commentaries, supercommentaries, and imitations. The most famous of the imitations was the Kit b al-fu l f -l- ibb of Maimonides (XII-2), which was itself the beginning of a new tradition.
The Aphorisms were first printed (in Latin) in 1476, and innumerable editions have appeared ever since in many languages. Until the eighteenth century, every educated physician owned a copy of the Aphorisms and used it as a kind of medical breviary.
The collection as we have it is divided into seven sections containing a total of 412 aphorisms, irregularly distributed ⁹⁹⁵ among them and without order, except that one sometimes comes across a small group related to the same subject. They deal with almost every medical subject except surgery. Some of the Aphorisms occur in other Hippocratic books; for example, sixty-eight of them may be read also in the Coan prenotions.
A work of this kind defies analysis and the best we can do is to quote a few specimens.
The first aphorism is generally known, not only to physicians but to educated people in general; most people know only the first sentence however. They do not know the second, which is independent of the first (perhaps two different aphorisms got stuck together in the manuscript tradition), and expressed one of the fundamental tenets of Hippocratic medicine.
Life is short, the Art long, opportunity fleeting, experience treacherous, judgment difficult. The physician must be ready, not only to do his duty himself, but also to secure the co-operation of the patient, of the attendants and of externals.⁹⁹⁶
The following aphorism deals with the regimen of athletes; it is not quoted completely.
In athletes a perfect condition that is at its highest pitch is treacherous. Such conditions cannot remain the same or be at rest, and, change for the better being impossible, the only possible change is for the worse. For this reason it is an advantage to reduce the fine condition quickly, in order that the body may make a fresh beginning of growth. But reduction of flesh must not be carried to extremes, as such action is treacherous; it should be carried to a point compatible with the constitution of the patient . . .⁹⁹⁷
Here are a few others, taken almost at random:
Old men endure fasting most easily, then men of middle age, youths very badly, and worst of all children, especially those of a liveliness greater than the ordinary.
Bodies that are not clean, the more you nourish the more you harm.
It is a good thing when an ophthalmic patient is attacked by diarrhoea.
Such as become hump-backed before puberty from asthma or cough, do not recover.⁹⁹⁸
Such a collection is like a building the stones of which have not been cemented together. There are many variations in the editions and translations, because it was easy enough to interpolate new aphorisms or to leave out those for which the editor did not care.
See the last section of this chapter, on the medieval tradition of Hippocrates.
23. Coan prenotions; Praenotiones Coacae; C acai progn seis.⁹⁹⁹ This work is divided into seven sections, like Aphorisms, and contains 640 aphorisms arranged without any order. Many of them invite medical commentary, and Littré quotes medical cases of his own time to illustrate those referred to by the Coan physician.
24. Dentition; De dentitione; Peri odontophyi s.¹⁰⁰⁰ This collection of thirty-two aphorisms deals with the hygiene and treatment of infants and especially with teething. It may be divided into two parts, the first (1–17) concerned with dentition (odontophyia), the second (18–32) with ulceration of the tonsils (paristhmia ), uvula, and throat. It may be that Dentition has been extracted from a larger collection by an editor whose interest was narrowed to pediatrics. As such, it is the earliest treatise restricted to that branch of medicine, though there are of course pediatric remarks in many other books of the corpus.
It is natural to group together a number of texts concerned with the duties of physicians and the proper way of dealing with patients. The composition of those books seems to suggest that the physicians were beginning to organize themselves into a professional body having definite obligations and privileges. We have no other proof of the existence of such a body and hence it is impossible to say how far the organization went. It may have been a guild, or more probably an informal group, of the elder physicians, their younger associates, and apprentices. The earliest and most significant of these texts is the famous Oath of Hippocrates.
25. The oath; Iusiurandum; Horcos.¹⁰⁰¹ This is the oath that was taken by the apprentices before they were accepted as members in the guild or society of Coan physicians. According to the first sentence, it was not only an oath but an indenture (syngraph ); the apprentice undertook to treat the children of his master as if they were his brothers, to share his livelihood with his teacher and help him in case of need, to teach his master’s children without fee or indenture, to give full instruction to his own children, his master’s children, to a few other students who had taken the oath and signed the indenture, and to no others. That is, not only was the profession organized but also its continual monopoly was protected. Thus was medical teaching established on a guild basis.
It is impossible to determine the date of the Oath, but it was probably administered from the golden days of the Coan school.
One passage is very puzzling: “I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.” It has been suggested that it was not lithotomy that was forbidden but castration; Greek physicians were not afraid, however, of using the proper word. The idea that surgery should not be permitted to the physician, but abandoned to inferior assistants, does not tally with what we know of Hippocratic surgery. The prejudice against surgery is not ancient, but medieval. In modernized editions this passage is generally left out.
The Oath is the fundamental document of medical deontology. Its popularity was enormous, for it always was an intrinsic part of the corpus, and what is more, the ideals that it defended were accepted by almost all the medical schools in the Greco-Arabic-Latin tradition down to our own day. For the history of it, see W. H. S. Jones, The doctor’s oath (61 pp.; Cambridge, 1924) [Isis 11, 154 (1928)]; Ludwig Edelstein, The Hippocratic oath. Text, translation, and interpretation (70 pp.; Baltimore: Johns Hopkins University Press, 1943) [Isis 35, 53 (1944)], and various queries inIsis: 20, 262 (1933–34); 22, 222 (1934–35); 32, 116 (1947-49); 38, 94 (1947–48). As to the perpetuation of the oath, with necessary modifications, to our own day, see Isis 40, 350 (1949). There are some nine incunabula of the Latin text (see Klebs), and the first edition of the Greek text appeared in 1524, together with the text of Aisopos ¹⁰⁰² and with Latin translations by Niccolò Perotti of Sassoferrato (1430-1480).
26. Law; Lex; Nomos.¹⁰⁰³ This text, which is not much longer than the Oath (less than two pages in Greek), is much younger than the latter, for it shows traces of Stoic influence. It was known to Erotianos. It is less matter-of-fact or businesslike than the Oath, but more philosophic, and it is elegantly written. It aims to delineate the education of a good physician, and suggests that by the time it was written the medical guild had become a kind of secret brotherhood.
Let us quote the first and the two final sections:
Medicine is the most distinguished of all the arts, but through the ignorance of those who practice it, and of those who casually judge such practitioners, it is now of all the arts by far the least esteemed. The chief reason for this error seems to me to be this: medicine is the only art which our states have made subject to no penalty save that of dishonor, and dishonor does not wound those who are compacted of it. Such men in fact are very like the supernumeraries in tragedies. Just as these have the appearance, dress and mask of an actor without being actors, so too with physicians; many are physicians by repute, very few are such in reality ...
These are the conditions that we must allow the art of medicine, and we must acquire of it a real knowledge before we travel from city to city and win the reputation of being physicians not only in word but also in deed. Inexperience on the other hand is a cursed treasure and store for those that have it, whether asleep or awake; it is a stranger to confidence and joy, and a nurse of cowardice and of rashness. Cowardice indicates powerlessness; rashness indicates want of art. There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.
Things however that are holy are revealed only to men who are holy. The profane may not learn them until they have been initiated into the mysteries of science.
There are eight incunabula of the Latin version (Klebs).
27. The physician; De medico; Peri i tru.¹⁰⁰⁴ This book was not mentioned by the ancients, such as Erotianos and Galen, but it has many affinities with writings of the corpus. Only the first chapter is deontologic; it describes the character of a good physician for the body and the soul. There are fourteen chapters in all, explaining principles of medical practice, how to arrange the surgery and all instruments and other objects that are needed in it, how to dress and bandage wounds, how to cup patients, and so on; the last chapter is devoted to military surgery, which can be learned only in the field. It is very practical. The anatomic basis is very poor, which suggests an early Hippocratic date.
28. Decorum; De decenti habitu; Peri eusch mosyn s.¹⁰⁰⁵ The poor language of this text as well as its affectations (use of rare words) suggests that it is relatively late. Moreover, it is colored with Stoic ideas, and some chapters (out of eighteen) are artificial and (intentionally?) obscure, all of which is not Hippocratic in the good sense. Nevertheless, the subject is interesting. The author explains how the physician should behave at the bedside for the patient’s good and for his own reputation. The physician should be not a sophist but a wise man, gracious and truthful. “A physician loving wisdom is godlike” (i tros gar philosophos isotheos).¹⁰⁰⁶ In chapter VI, which is unfortunately marred with obscurities, the author insists on the importance of religion; this passage is unique in the corpus. Many practical details are given concerning the observations to be made in the dispensary or at the bedside, the preparation of drugs, and so forth. It is necessary to visit patients frequently, and sometimes to leave an apprentice in charge during the physician’s absence.
29. Precepts; Praecepta; Parangeliai.¹⁰⁰⁷ This seems to be a late compilation, as late perhaps as the Roman age, though pre-Galenic. It is full of obscurities and the style is at once poor and pretentious; the first two chapters have an Epicurean coloration.
The largest part (chaps. 3–13, out of fourteen) is deontologic, dealing with medical etiquette, the avoidance of charlatanry and of quack’s patter. (Maybe the itinerant quacks had already learned the art of haranguing the people and puffing their wares when they reached a village.) Chapters 1 and 2 constitute a kind of introduction: the medical art must be based on observations, not “hypotheses.” The last chapter is a collection of unrelated sentences; these may be notes which the author had no opportunity of working out.
Chapter 6 of Precepts has been quoted in full in Chapter XIII (see p. 345).
30. Apocryphal letters. The ninth volume of Littré’s edition (pp. 308–466) contains letters and other documents that are apocryphal yet interesting for the study of the development of the Hippocratic legend. Some of the letters tend to show that Hippocrates saved Athens and Greece from the plague, and this would have been known otherwise if it had been true. Among the correspondents are the great King Artaxerxes, Hystanes, Persian governor of the Hellespont, the citizens of Cos and of Abdera, Hippocrates’ son Thessalos, King Demetrios. Long letters between Hippocrates and Democritos deal with the alleged madness of the latter.
It is noteworthy that the ancient scholars wanted to complete the opera omnia of great men with “authentic” letters (cf. Plato, Aristotle); they could not have the documents that modern editors can so easily collect, but they found it permissible to “create” the letters that they needed. After all, writing a plausible letter, or one that seemed plausible to them, could not be much worse than writing “speeches,” as was the accepted habit of the ancient historians, including so truthful a man as Thucydides.
Latin translations of some of the letters were printed as early as 1487 and 1492 (Klebs, 337) together with letters of Diogenes of Sinope, the Dog (c. 400–325), founder of the Cynic sect.
The reader who has been patient enough to follow me in this examination of the most significant Hippocratic writings will realize the richness and complexity of their contents. The mass of them was written in the fifth century; others were later by a century or more, yet continued a great tradition, one of the noblest traditions in the history of mankind.
THE MEDIEVAL TRADITION OF HIPPOCRATES
The greatness of a man can be deduced from the size of the shadow that he casts ahead of him throughout the ages. In order to understand the greatness of Hippocrates it is necessary to appreciate the influence that he exerted upon his posterity. We attempt to give an account of the events in their chronologic order, and in that order “Hippocrates” appears in the second half of the fifth century, but we should realize that what Hippocrates, whoever he was, did in that period was only the beginning of a very long story. If that story were written it might be entitled “The life of Hippocrates from the fifth century B.C. until to-day,” and if it were told with any completeness it would fill an enormous book. Great men are truly immortal ; they may be more alive after their death than before.¹⁰⁰⁸
The study of Hippocratic traditions is peculiarly complex, because the Hippocratic writings do not form a single solid block, like those of Herodotos and Thucydides, or like the Iliad or the Odyssey. The many writings, genuine or not, are not closely integrated by a rigid canon, as is the case for the Bible. One has to consider the tradition of each item, or of each group of items. Some items were brought together by the care of early librarians, copyists, and editors, and also by the curricula of medical schools. For example, the Aphorismi, Prognosticum, and Regimen acutorum(De diaeta in acutis) were often combined, as was the case in the school of Montpellier in 1309 and 1340.¹⁰⁰⁹
For the sake of illustration we shall outline the tradition of a single book, the most popular of all, the Aphorisms.
Galen wrote commentaries on some seventeen Hippocratic books,¹⁰¹⁰ and Aphorisms is one of them; thus in this case, as in many others, the Galenic tradition is combined with the Hippocratic and reinforces it. The early medieval tradition of Galen is fortunately well known because of a treatise written by one of the greatest philologists of the Middle Ages, unain ibn Ishaq al-’Ib d (IX–2), called in Latin Joannitius, who flourished in Jund sh p r, then in Baghd d, and died in 877. unain was a Nestorian, a physician, a translator from Greek into Syriac and into Arabic; he himself translated many of the scientific classics written by Hippocrates, Plato, Aristotle, Dioscorides, Ptolemy, and Galen, directed a school of translators, and transmitted to them an admirable discipline. The treatise of his to which I just referred is a survey of the Syriac and Arabic translations of Galen, wherein he appreciates the comparative value of those translations and does not hesitate to criticize severely some of his own.¹⁰¹¹
Here is what he says of the Aphorisms:
Hippocrates’ explanation of the book of Aphorisms (Tafs r li kit b al-fu l). This book is divided into seven parts.¹⁰¹² It was poorly translated [into Syriac] by Ayy b; [Syriac] translation possible, and added the text of Hippocrates’ own words. A mad ibn Mu ammad al-Mudabbir had asked me to translate it for him. I translated a single part into Arabic. He then proposed to me not to begin the translation of another part, before having read to him the part already translated; he was kept busy otherwise, however, and therefore my translation was interrupted. Yet as Muhammad ibn M s examined each part he begged me to continue my work and thus have I completed my translation of the whole.¹⁰¹³
unain does not refer to a translation by Sergios of Resaina (VI–1), who was one of the earliest and greatest translators from Greek into Syriac. Sergios had studied in Alexandria and died at Constantinople in 536; he was not a Nestorian like unain but a Monophysite.¹⁰¹⁴ He may have translated the Aphorisms (not Galen’s explanation of them), but that is doubtful.¹⁰¹⁵
Curiously enough, I find no trace of special interest in the Aphorisms for the period of almost one and one-half centuries from unain’s death in 877 to about 1025. By the middle of the eleventh century, at least two Arabic commentaries were written, the first by the Egyptian ’Al ibn Ridw n (XI–1) and the second by the Persian ’Abd al-Ra m n ibn ’Al ibn ab diq,¹⁰¹⁶ both of whom died about 1067.
A century later the Spaniard Y suf Ibn asdai (XII–1) wrote another Arabic commentary entitled Shar al-fu l. After this the translations and commentaries increase in number, so much so that it will be convenient to deal with them in successive half century periods.
Second half of the twelfth century. One of the dominating personalities of this age is another Spaniard, the Jew Maimonides (XII–2). The most important as well as the most famous of his medical works is another collection of aphorisms, generally called Fu l M s , derived almost exclusively from Galen.¹⁰¹⁶, ¹⁰¹⁷ His commentary on the Aphorisms of Hippocrates is a different work, much less known. Though the Fu l M s are derived from Galen, it is probable that they include here and there remarks concerning directly or indirectly the Aphorisms of Hippocrates.
Both Ibn asdai and Maimonides spent the best part of their lives not in Spain but in Egypt. A third Spaniard, or more exactly a Catalan, Joseph ben Meïr ibn Zabara (XII–2), who studied in Narbonne but resided mostly in his native city, Barcelona, may be the author of a satiric parody of the Aphorisms in Hebrew, Momeri ha-rofe’im.
In the meanwhile Burgundio of Pisa (XII–2) translated the Aphorisms directly from Greek into Latin, and the anatomist Maurus of Salerno (XII–2) wrote a Latin commentary on them. As Maurus died some 20 years after Burgundio (1214 compared with 1193), he might have used Burgundio’s translation instead of previous ones made from the Arabic, but this is not clear from his text without deeper study of it than was possible to me.¹⁰¹⁸
First half of the thirteenth century. My notes on the first half of this century concern only Arabic writings, written in Damascus, or at least by physicians who flourished in that city.
Three commentaries on the Aphorisms were written by two Muslim physicians, Ibn al-Dakhw r, who died in Damascus in 1230,¹⁰¹⁹ and Ibn al Lub d of Aleppo (XIII-1), who was educated in Damascus and died after 1267, and by the Samaritan physician adaqa ben Munaja’ al-Dimishq (XIII-1); adaqa’s commentary is entitled Shar fu l Buqr .
Second half of the thirteenth century. In the second half of the century, the Aphorisms attract the attention of every physician west of India and are discussed in Arabic, Hebrew and Latin.
Arabic commentaries were written in Arabic by two Eastern physicians, the Christian, Ab -1-Faraj, called Barhebraeus (XIII–2),¹⁰²⁰ and the Muslim, Ibn al-Nafis (XIII–2).
In Latin, commentaries were given to us by the Portuguese Peter of Spain of Lisbon (XIII–2), who died as Pope John XXI in 1277, and by the Italian Taddeo Alderotti of Florence (XIII–2), who lived until 1303.
There are at least five Hebrew translations of the Aphorisms.¹⁰²¹ The most interesting is the one that was completed in Tarascon in 1267 by Shem- ob ben Isaac of Tortosa (XIII–2). This affords a good illustration of the vicissitudes of literary tradition. Shem-tob’s Hebrew text includes commentaries by Palladios the Iatrosophist (V-1), which are unknown in the Greek original. Moses ibn Tibbon of Marseille (XIII-2), one of the greatest medieval translators, translated Maimonides’ commentary from Arabic into Hebrew in 1257 or 1267. Nathan ha-me’ati of Cento (XIII-2), who flourished in Rome c. 1279-1283, translated the Aphorisms from Arabic into Hebrew, together with Galen’s commentary.
First half of the fourteenth century. The last Arabic commentaries known to me date from this period and we owe them, curiously enough, to two Turkish physicians, ‘Abdall h ibn ‘Abd al-‘Az z of S w s (XIV–1) and A mad ibn Mu am-mad al-K l n (XIV-1). ‘Abdall h’s commentary, dating from the beginning of the century, is entitled ’Umdat al-fu l fi sharh al-fu l. Ahmad’s was written somewhat later, because it was dedicated to J n Beg Ma m d, who was kh n of the Blue Horde of western Qip q in 1340–1357.
The production of Latin editions and commentaries was naturally increased by the growing needs of medical schools, especially the most important one of that time, the school of Montpellier in Aragon. The Aphorisms was one of the texts that medical students were expected to con.¹⁰²² Thus, we have Latin commentaries by Bartholomew of Bruges (XIV–1) who obtained his M.D. in Montpellier before 1315, by Berenger of Thumba (XIV–1), who was in Montpellier in 1332, and (perhaps) by Gerald de Solo (XIV–1), who was professor there and died c. 1360.
The medical school of Bologna was almost as important as that of its Aragonese rival, and we have two commentaries prepared by Bolognese professors, Niccolò Bertuccio (XIV–1) and Alberto de’ Zancari (XIV–1). Alberto’s commentary was rather a new edition, wherein the aphorisms were arranged for the first time in logical order: Anforismi Ypocratis per ordinem collecti.
Second half of the fourteenth century. The activities of Hebrew commentators seem to peter out like those of their Arabic rivals. I can quote only one Jewish commentator, the Catalan Abraham Cabret (XIV–2).
For the sake of curiosity we may mention also the summary of the Aristotelian Organon, Min at Judah, written by the Judeo-Greek philosopher and mathematician, Joseph ben Moses ha-Kilti (XIV-2), in the form of aphorisms, this being almost certainly a conscious or unconscious imitation of the Hippocratic work. Joseph flourished at the end of the fourteenth century or in the beginning of the fifteenth.
Martin de Saint Gilles (XIV–2), who was flourishing in Avignon in 1362, made a French translation of the Aphorisms together with Galen’s commentary.¹⁰²³ This introduces a new tradition and suggests that we might explore all the vernaculars of Europe into which the Aphorisms were translated sooner or later, but that would take us too far out of our own field. None of those vernacular traditions concerns the average historian of science, though they may be of very great interest to particular ones. For example, the story of the Polish translations is significant for the students of Polish science and of Polish letters.
The learned people of Western Europe did not need vernacular translations and looked down on them; the Latin text was more desirable to them and remained so for many centuries.
Marsiglio of Sancta Sophia (XIV–2), professor at Padua, wrote Quaestiones in aphorismos which were printed in Padua in 1485 and many times afterward.¹⁰²⁴ Marsiglio died c. 1405.
This brings us into the fifteenth century, of which I have not made a sufficient study. Yet two commentators of the early part of that century may be quoted, Giacomo della Torre, and Ugo Benzi.¹⁰²⁵ Both are children of the fourteenth century and their commentaries were very influential, because they were frequently printed.
The commentary of Giacomo della Torre, alias Jacopo da Forli (c. 1350—1413), was first printed in Venice in 1473 and there are six incunabula editions of it;¹⁰²⁶ the one by Ugo Benzi of Siena (c. 1370–1439) was first printed in Ferrara in 1493 and reprinted only once before the sixteenth century.¹⁰²⁷
Fig. 74. Hippocrates’ Aphorisms, the first independent edition, a Latin translation of the Aphorisms and of Galen’s commentary by Laurentius Laurentianus of Florence, printed by Antonio Miscomini in Florence, 1494. It is a volume of 98 leaves without title page; we reproduce the colophon [Osiris 5, 100 (1938)]. [Courtesy of the British Museum.]
Independently of the commentaries by Marsiglio da Sancta Sophia, Giacomo della Torre, and Ugo Benzi, the Latin text of the Aphorisms was printed at least eight times before the sixteenth century, six times in the Articella, 1476 to 1500, and in two other editions, 1494, 1496 (Fig. 74).¹⁰²⁸
Later editions in many languages are innumerable. Very long yet incomplete lists of them may be found in Littré ¹⁰²⁹ and in the catalogues of the British Museum and of the Bibliothèque Nationale of Paris.
Our own account of the tradition of the Aphorisms is also very incomplete for many reasons. To begin with, we could speak only of the Hippocratic commentators, of whom we know definitely that they have either translated the Aphorisms or commented upon them. The translations and commentaries here mentioned should be considered simply as specimens of a large class. A deeper cause of error lies in the fact that the indirect and hidden commentators were probably more numerous than the direct and obvious ones. To put it otherwise, many so-called commentaries or supercommentaries are more original than books that are supposed to be independent. That is true in all ages: the tradition of X cannot be deducted from the books definitely devoted to X, or even from those that quote X. Not only the plagiarists but mediocre minds in general are often as anxious to hide their sources as the river Nile; the more they steal the less are they inclined to confess their indebtedness.
A similar article could be written concerning the tradition of the other Hippocratic books, and indeed concerning the tradition of any scientific book of antiquity. One would discover great differences in popularity. The Aphorisms were one of the most popular; other books, which were early lost or forgotten, represent the other extreme. The pattern of each story would be the same, though the names of the actors would vary considerably. The tradition was international, interracial, interreligious. The main linguistic steps were Greek, Syriac, Arabic, Latin, Hebrew, vernaculars; the main religious steps were pagan, Muslim, Christian, Jewish.