Hippocrates of Cos

(b Cos, 460 b.c.; d. Larissa, ca. 370 b.c.)

medicine.

Little is known about the life of Hippocrates, although it may be stated with a fair degree of certainty that he was the son of Heraclides and Phenaretes; that he studied with his father and with Herodicus (probably of Cnidus); and that he was an Asclepiad, although there is no agreement about the term, which may either indicate a particular group of physicians or simply be synonymous with “physician.” It is equally certain that he taught at Cos, traveled widely in Greece, and enjoyed exceptional fame in his life time. He contributed to a significant body of medical writings, but it is difficult to determine precisely which works of the corpus are actually his.

Even these few data are not indisputable. of four surviving biographical accounts, two are Lives, one apparently by Soranus¹ and the other by an unknown writer of late Latin.² Both are brief and late; also short and even later are the biography in the Suda Lexicon and that by Tzetzes.³ The four texts are marked by bumerous disparities and divergent views; all are corrupted by the legend that began early to surround Hippocrates and continued to grow throughout antiquity and the Middle Ages.⁴ The task of the historian is thus to distill fact from these writings, in part through comparing them with the little that remains of more ancient information; it is not surprising that philologists have reached no conclusive result. of more recent scholarship, an extreme, and excessively skeptical, view of Hippocrates is presented by L. Edelstein in the Real-Encyclopädie. Following an erudite and relentless examination of Hippocratic writings Edelstein, going even further than Wilamowitz’ statement that Hippocrates is a name without a book, asserts, “It is a name lacking even any accessible historical reality.” A consideration of the ancient references to Hippocrates may serve to modify this statement.

Some idea of Hippocrates’ renown at Athens may be had from Plato’s early dialogue Protagoras (311b-c), which also reveals that he took paying students:

“Tell me, Hippocrates,” I said, “as you are going to Protagoras, and will be paying your money to him, what is he to whom you are going? and what will he make of you? If, for example, you had thought of going to Hippocrates of Cos, the Asclepiad, and were about to give him your money, and someone had said to you: ’You are paying your money to your namesake Hippocrates, O Hippocrates; tell me, what is he that you give him money?,’ how would you have answered?"

“I should say,” he replied, “that I gave money to him as a physician.”

“And what will he make of you?"

“A physician,” he said.

“And if you were resolved to go to Polycletus of Argos or Phidias of Athens...”

This would clearly indicate that the celebrity of Hippocrates as a physician was as great as that of Polycletus and Phidias as artists, although Edelstein counters this analogy with an example from Plato’s Phaedrus (268c-d) in which Eryximacus and Acoumenes, two very obscure physicians, are named with Sophocles and Euripides. of course, one is not expected to infer from this that these two physicians are as famous as the two great dramatists; they are mentioned in the dialogue only because of their intimacy with Phaedrus, Socrates’ interlocutor, while in Protagoras nothing links Hippocrates to the young man seeking Socrates save that they are namesakes. Moreover the shortness of the passage cited in Protagoras places the names of Hippocrates and the artists close together, while no such close juxtaposition exists in the passage from Phaedrus.

Some fifty years later, Aristotle wrote in Politics (VII, 1326a15–16): “Concerning Hippocrates, one could assert that the physician, and not the man, is greater than he who exceeds him in bodily size.” Edelstein finds in this only a confirmation of the statement in the Brussels Life that Hippocrates was short of stature, but it is also clear from this sentence that the name Hippocrates, here used alone, denotes a real person, one celebrated in the medical world.

Even were it possible to deny the extraordinary fame of Hippocrates during his own lifetime, it would still be necessary to explain why he, rather than anyone else, early became legendary. It is reasonable to assume that the tenacious and varied legend, analyzed skillfully by Edelstein, became attached to a person of some prominence, rather than to a mere physician. The legendary Hippocrates appears variously as a heroic sage; as a Greek patriot who spurns the offers of Artaxerxes I; and as a friend of Democritus of Abdera, who, being thought mad by his fellow townsmen, convinces Hippocrates of his sanity. An apocryphal decree further credits him with having saved Athens from the plague. None of these stories has any basis in historical fact; indeed, it is not known whether Hippocrates ever met Democritus, for example.

Not only must it be concluded that the legend is based on a real person, and a famous one, but it must also be accepted that that person was the author of a number of famous books. It was certainly not true for his contemporaries that Hippocrates was a name with no writings attached to it, and it is true for us to only a limited degree, since we possess many medical works from the time and from the school of Cos. It is very probable that some of the most outstanding of these are by Hippocrates. Plato suggests that he wrote and circulated medical books (Phaedrus, 270b-c), while Diocles of Carystus (end of the fourth and beginning of the third century b.c.) would seem to allude to certain of these treatises and Ctesias of Cnidus, at the beginning of the fourth century, certainly criticized Hippocrates for an operation described in that part of the Hippocratian corpus now called Fractures (Claudii Galeni Opera Omnia, Kühn ed., XVIII, I, 731).

It is now necessary to examine the Hippocratic corpus to determine which works might actually be attributed to Hippocrates himself. The corpus, or Collection, consists of about sixty medical works, the great majority of which date from the last decades of the fifth century b.c. and from the first half of the fourth. They were probably brought together in Alexandria; although the exact circumstances of their collection is unknown, we do know from Galen (Kühn ed., XVII, 1, 619) that Baccheius published the third book of the Epidemics there, and from Erotian that Baccheius had compiled a Hippocratic lexicon. Fragments of the latter are quoted in Erotian’s own lexicon, and show that he used some twenty-three treatises from the collection.

The problem of dating the treatises is aided by internal evidence, as well as by the testimony of Diocles of Carystus and Ctesias of Cnidus. For example, the Collection contains a great many echoes of pre-Socratic philosophy and explicit citations of Empedocles (Ancient Medicine 20) and Melissus of Samos (Nature of Man 1), but almost nothing that shows post-Socratic thought, except in a few of the later works. The people and places mentioned in Epidemics are also helpful. Moreover, one of the most important of the treatises, Nature of Man, which is very closely connected to other works of the corpus, can confidently be attributed to Polybius, the disciple and son-in-law of Hippocrates, through the testimony of Aristotle (History of Animals III, 3, 512b-513a). One may also note that a more general reading of Aristotle’s biological works leads to the conviction that they often implicitly refer to writings in the Collection.

Although the date of the majority of the works in the Collection may thus readily be established, not all of the treatises fall within this period; some are known to be of certain later date, while a few of the texts, such as the Oath and Nature of Man, may be slightly earlier, although this is more difficult to determine. of the later additions, Law, Nutriment, Heart, Physician and the first part of Hebdomades are Hellenistic; Precepts and Decorum are from the first or second century of the Christian era. In sum, however, it is certain that most of the Collection should be placed between 430 and 380 b.c., for a number of cultural, linguistic, and historical reasons. This period is that of Hippocrates’ maturity and old age, which is certainly significant, but does not by itself serve to connect him with the Collection.

We must next examine the relationship between the Collection and Hippocrates’ school. A number of the treatises certainly belong to the school of Cnidus, and not to that of Cos. For example, Galen (Kühn ed., XVII, 1, 888) cites a passage from the Cnidian Maxims that is duplicated by one in Diseases (II, 68); other data and parallels must lead us to catalog as Cnidian Diseases I, II, and III, Internal Affections, and Affections. All the gynecological treatises, too, as well as the single work Generation-Nature of the Child-Diseases IV, must be supposed to be at least para-Cnidian, while the philosophical presuppositions of Regimen, Breaths, and On Flesh, are incompatible with the school of Cos. Another group of treatises may with equal confidence be considered to be Coan, however. These include Polybius’ Nature of Man and the appropriately named Coan Prenotions, both of which have close ties with Epidemics I and III; Prognostic; Airs, Waters, Places and The Sacred Disease; the originally combined Fractures, Joints; Wounds of the Head; Regimen in Acute Diseases, with its polemical introduction against the Cnidians and its’ appendix; Aphorisms; the two Prorrhetics; Humors; and several less important treatises.⁵

We thus arrive at a series of writings contemporary with Hippocrates, belonging to his school, and attributed to him—together with many others—by a tradition going back to the Hellenistic school. It would indeed be surprising if one or another of these works were not written by him, but because of the lack of adequate documentation this final attribution is the most difficult to make. It is, of course, tempting to assign to Hippocrates the finest of the writings—Epidemics I and III; Prognostic; Airs, Waters, Places; The Sacred Disease; Fractures, Joints; and Regimen in Acute Diseases. Although linguistic arguments have been advanced against a common authorship of these works, they are not compelling given the variety of subjects treated and the length of Hippocrates’ career. In light of these considerations, vocabulary can undoubtedly vary. These six works readily fall into pairs, moreover, and it is hard to assume other than a single authorship of Epidemics I and III and Prognostic; of Airs, Waters, Places and The Sacred Disease; or of Fractures, Joints and Regimen in Acute Diseases.

There is almost unchallengeable evidence to show that of these Hippocrates wrote at least Prognostic and Joints. We know from Galen (Corpus Medicorum Graecorum V, 9, 2, p. 205, 6 and 270, 23) that in the third century b.c. Herophilus devoted, if not a whole book, certainly a paragraph in one of his works, “against Prognostic by Hippocrates.” The testimony of Ctesias, moreover, supports Hippocrates’ authorship of Joints. Galen (Kühn ed., XVIII, 1, 731), commenting on chapter 51 of Joints, states that Ctesias was the first to criticize Hippocrates on a specific point when he declared that the reduction of a luxation of the thigh is of little use. If we accept this evidence to show that the two works in question are by Hippocrates, it is implicit that several others must also be by him. It is further possible that he may have written other treatises that are now lost, since the Collection frequently mentions works that are no longer extant and the beginning of the Regimen, in particular, tells us that there existed a vast medical literature, of which the Collection is only a fraction.

A further complication in assigning specific works to Hippocrates lies in that the problem of individual authorship was undoubtedly not as acute for the Asclepiads as it is now. One may assume that literary ownership was a hazier and generally less important concept than it is today; it should be noted that chapter 1 of Regimen in Acute Diseases attributes the two editions of the Cnidian Maxims to a group of authors, which is not merely a figure of speech. There can be no doubt that the Coans adhered to the same practice. It is certain, however, that the great Coan works that Hippocrates did not write himself nevertheless reflect his thought and his teaching.

Two important documents remain to be examined; unfortunately, neither serves to clarify Hippocrates’ identity or authorship. The first of these, a passage from Plato’s Phaedrus (270c), attributes a medical doctrine to Hippocrates, but is open to two fundamentally different interpretations:

Socrates: And do you think you can know the nature of the soul intelligently without knowing the nature of the whole?

Phaedrus: Hippocrates the Asclepiad says that the nature of the body can not be understood without it.

Socrates: Yes, friend, and he was right. Still, we ought not to be content with Hippocrates, but we should examine by reason and see whether its answer agrees with his conception of nature.

Phaedrus: I agree.

Socrates: Then consider what reason as well as Hippocrates says about nature.

It is the “whole” that is subject to different interpretations. Philologists understand it to mean the entirety of the matter in question, while platonists, basing their arguments upon the profundity of Plato’s concerns in this dialogue and such others as the Timaeus, consider it to mean the Whole, that is, the universe. The first interpretation is unacceptable; it is then therefore necessary to determine if the doctrine implicit in the platonic interpretation is easily deductible from Coan writings, or whether it contradicts the doctrine of Cos. It is the author’s opinion that it is contradictory to them.

What one finds in the Coan writings is an emphasis on the importance to the body of such ambient effects as heat, winds, and rain, a doctrine radically different from the micro-macrocosmic philosophical system (similar to that found in the para-Cnidian Regimen) that Plato attributes to Hippocrates. I would suggest that this is the result of Plato’s own interpretation of the Coan doctrine of ambient factors as a macrocosmic doctrine. Indeed, several passages in the extant writings could appear ambiguous in this way to a philosopher, and such distortions in no way invalidate the writings as being genuinely Hippocratic.

The second major document is a papyrus in the British Museum, which was described by Sir Frederic Kenyon in 1892 and published by H. Diels in 1893. It contains approximately 1,900 lines and dates from the second century of the Christian era. Lacunae, oversights, and errors in the text suggest that it represents a collection of notes made by a medical student for his personal use; it is certain, however, that the second section of the papyrus, which is devoted to the etiology of disease, reproduces the work of Meno, the disciple of Aristotle whose existence and writings were known to Galen. Meno gives us the doctrines of twenty physicians, seven of whom are not known to us from any other source. Although difficult of interpretation, Meno’s material concerning Hippocrates is more explicit than Plato’s and may prove to be easier for specialists to agree upon.

Meno allots more space to Hippocrates (V, 35-VII, 40) than to anyone save Plato, who receives the greatest share because of the important of the Timaeus for even the school of Aristotle. Moreover, like Aristotle in the Politics, Meno designates Hippocrates by name alone, as he does Polybius, thus confirming the eminent position that Hippocrates held in the medicine of the time. According to Meno, Hippocrates explained diseases as the result of bad air or bad diet. Air is essential for health and must circulate freely in the body; its impairment results in epidemics. Defective nourishment produces a variety of diseases; an excessive quantity or a poor quality of food leads to a tumult in the stomach and the generation of waste products from which winds arise and spread into the body to cause illness.

Resemblances between this text and Breaths are strong, but for our purposes they must be considered coincidental, since there is no way in which that work may be attributed to Hippocrates. Breaths is based on a system of cosmology such as is never present in Meno’s work, but in Nature of Man, on the other hand, air and diet are said to be the cause of diseases, while other Coan works readily confirm the importance of food and ambient factors. It thus becomes necessary to assume that Meno is drawing upon one or more works by Hippocrates that have since been lost (as suggested by, among other things, his allusion to the plant stratiotes, which is not mentioned in the Collection). The doctrine of ambient factors is pronounced in the works that survive, and it is likewise possible to speculate that Breaths, too, draws upon lost treatises.

We must conclude, therefore, that we do possess a number of great medical works from the school of Hippocrates, and that Hippocrates himself was almost certainly the author of at least several of them. It would then ideally be possible to determine the nature and degree of Hippocrates’ originality as a scientist, but given the limitations of our attribution, such a determination is not practicable. The essential step, therefore, is to define the contribution of the school of Cos, which is difficult in itself given the symbiosis that may be assumed to have existed among the members of a medical school and among the schools themselves.

A review of those themes which seem to be fundamental to the school of Cos should begin with its essential concept of disease processes. In an internal disease, such as is often caused by fluxes of indigestible humors, coction— a kind of slow cooking that restores equilibrium and normal properties to the disturbed humors—may occur. The disease reaches a crisis, “the decisive transformation which takes place at a given moment in the development of the disease and orients its course in a favorable direction” (Bourgey, Observation, p. 237). The crisis is marked by critical signs and symptoms and occurs on certain critical days in the course of the disease, although Coan speculations on these matters are more or less hazy and vary from treatise to treatise. A less frequently found notion is that of the deposit, a localized complaint that may be the forerunner of or sequel to a disease. The deposit can metastasize— travel from one part of the body to another— which may mark the trasnformation of one disease into another. The Coans also recognized the phenomenon of recurrence or relapse.

These basic concepts are not, however, peculiar to the school of Cos. Practically all of them may also be found in Cnidian writings, employed in a way that suggests established usage.⁶ Indeed, if there is a difference on these points between the two schools, it lies in occasional differences in vocabulary; the ideas of deposit and metastasis, for example, are often differently named in Cnidien writings, although the phenomena described are obviously the same.

The doctrine of humors is found in the teachings of both schools, as it is throughout medical teachings of the times; it undoubtedly antedates Hippocrates The Coan writings would seem to imply the four humors specified in Nature of Man—phelgm, blood yellow bile, and black bile. The Cnidian treatises also embrace a theory of four humors, being in this instance those set forth in Diseases IV, namely water, blood, phlegm, and bile, various forms of the latter two being dominant in matters of nosology. It is thus in detail that the two schools differed.

As we have seen, ambient factors and diet are fundamental to the medical teachings of Cos; of the treatise Airs, Waters, Places, for example, being devoted to the role of such factors as air, location, climate, and season. Cnidian writings also allude to these factors in the description and treatment of certain diseases, although unlike the Coan corpus no them ⁷. The importance of diet is stated in the Coan Regimen in Acute Diseases, Nature of Man, Prognostic, and even in Fractures, Joints. It is also mentioned in the non-Coan (or para-Cnidian) Regimen. The Cnidian treatises proper contain a discussion of diet as the greater part of the section devoted to therapy of each disease. The two schools are here so close in theory that despite the direct anti-Cnidian polemic of the Regimen in Acute Diseases, it can easily be shown that the essential elements of the dietary rules presented in this treatise are all advocated in the Cnidian writings.

Coan prognosis consisted in stating the past and present state of the disease and predicting its course after making an examination of the current symptoms but before questioning the patient (perhaps as a rationalization of shamanistic medicine). ⁸ This practice too, was current at Cnidus, although we do not have a Cnidian book (such as the famous Prognostic) devoted to it. At any rate, the Cnidains described, often in rather different terms, a very similar procedure. ⁹ Bopth schools showed a further concern in the psychology of the patient and the effect of the pysche on the organsim. ¹⁰ So. too, was the idea of the organism as an interdependent whole, which is often implicit in Coan writings (and see Epidemics VI, 3, 23), present in Cnidian works, as in Diseases of Women, where a gynecologist advises his readers “to look at the entire body” in order to decide on treatment. There was also a common concern for the study of health itself and for prophylaxis, as is evident at Cos in both Regimen in Acute Diseases IX and XXVIII, I, and the last section of Nature of Man, but also in Regimen II, 4, and LXVII, where the author considers it to be one of his fundamental “discoverise.”

The Schools of Cos and Cnidus are also united in their repudiation of a medicine based directly on philosophical principles. The Coan writers polemicized agaist such tendencies in both Nature of Man and Ancient Medicine; while no such open polemic is extant among the Cnidian writings, Cnidus would seem to be as far from espousing a cosmological medicine as its rival. For this reason Celsus’ remark that it was Hippocrates who separated medicine from philosophy should be taken very cautiously; this characteristic was not specific to the school of Cos. Both schools also rejected any sort of magico-religious medicine. This sort of medicine was vigorously attacked in Coan writings. especially The Sacred Disease, while in their practice the Cnidians would appear to have been equally hostile to it, as is made explicit in Diseases of Girls l (VIII, 468, 20–21). Both are nevertheless influenced by pre-Socratic ideas in certain of their aspects. For example, the Coan Nature of Man diplays a philosophical orientation in many of its arguments, while the Cnidian Generation-Nature of the Child presents embryological conceptions similar to those of several pre-Socratic thinkers. The influence of Democritus, in particular, is certain.

A frequent generalization is that the medicine of Cos was more sensitive to the patient, while that of Cnidus was more greatly concerned with the disease. In light of this it is said that the notion of the individual and the complexity of individual cases were more respected at Cos,¹² while Coan medicine placed less emphasis on therapy and Coan nosology was more apt to be general than that of Cnidus (which is said to be more concerned with the localization of the disease). Once again, this contrast is more apparent than real. It can be sustained only by taking as gospel the polemics of Regimen in Acute Diseases and by insisting upon the very real differences specifically between EpidemicsI and III and DiseasesII. A further examination of the extant works from the two schools must, however, lead to a different conclusion.

There remain to us from the school of Cos treatises devoted to one aspect or concept of medicine or to individual cases of disease; nothing comparable remains from Cnidus, which has left us only treatises on diseases. It is difficult to compare works so dissimilar in subject matter. If, for instance, there were a Coan treatise dealing explicity with the same material as dealt with in Disease II, we might arrive at legitimate conclusions. The only Coan work dealing with a specific malady is Fractures, Joints, and it is immediately apparent that a luxation or fracture does not have an etiology comparable with a case of phthisis or gout, and that the symptoms and treatment must be just as different. It is thus difficult to generalize about the fundamental difference in medicine as practiced at Cos and Cnidus when only the subject matter of the extant works would seem to be at issue.

Indeed, when the subject matter is similar, as in the Coan writings that present some data concerning etiology, dietetics, and therapy in specific diseases, One is struck by the resemblances between the two schools. For example, Aphorisms and Epidemics reveal the same rash positions as Cnidian gynecological writings (see Joly, Niveau, pp. 64–66). The appendix to Regimen in Acute Diseases, too, appears Cnidian in many places, while the same is true of EpidemicsII, V, VI , and VII —which let it be noted, differ from EpidemicsI, III, and IV only in that thye are not always restricted to noting the symptoms in the case history of one patient.

The point is often made that while fluxes of the humors were a frequent consideration in Cnidian etiology, the physicians of Cos made little use of them. Bourgey writes,

It is very characteristic that while the most typical treatises, prognostic, Regimen in Acute Disease, Fractures, Joints and Aphorisms, contain precise references to the existence of the humors, they do not speak of their circulation through the organism and do not attempt to construct on these foundations an arbitrary nosology [op. cit., p. 249, n. 7].

Yet there is no reason for the author of these tracts to take up the fluxes of the humors, since they are irrelevant to his subjects (especially Fractures, Joints). Such fluxes are introduced most naturally into the explanation of disease in the appendix to Regimen in Acute Disease (see I; IX) and the doctrine is implied even in Aphorisms (see, for example, IV, 22–24) and the portions of Epidemics other than I, III, and IV. It is, moreover, by the flux of a humor that the author of The Sacred Disease explains epilepsy, while that of Airs, Waters, Places mentions in chapter VIIa flux that comes from the head and upsets the stomach, and the nosology stated in chapter IV of Nature of Man is predicted on the same idea.

One ought not, however, to conclude that in these instances—and many others—the school of Cos was actually actually influenced by the school of Cnidus. Such influence would mean that a Coan physician would have had to consult a Cnidian whenever he considered the etiology of a disease; in therapy, too, each time a Coan describes a drug, the similarity to Cnidian texts is evident. The very number of the similarities between the schools makes such a thing unlikely.

Despite these similarities, a qualitative difference between the medicine of Cos and Cnidus has been assumed by, among others, Bourgey, who elaboratthe philosphical medicine ed his opinion in great detail and with utmost conviction. In Bourgey’s view, the medicine of Cos was an unequaled success that surpassed both the philosophical medicine embodied in Breaths and Regimen and the purely empirical and routine medicine of the Cnidians. It is my opinion that he thus overvalues Coan medicine and thereby exaggerates the differences that actually existed between it and other schools. Certainly there are analyses to be found in the philosophical medical literature that a Coan physician would be able to endorse without stricture since, for instance, the list of foods and exercise of book II of Regimen displays the same approach and intelligence as the best Coan medicine. The same is true of the essential elements of RegimenIII and IV .

Bourgey further finds that Cnidian medicine was characterized by “fidelity to rather primitive practices, by the importance given to a primarily descriptive analysis—by a strict submission to facts and customs with little evidence of the intervention of critical or intelligent thought. One can find an indication of this intellectual insufficiency on the purely literary plane” (op. cit., pp. 52–53). In brief, in Cnidian medicine he sees only “a crude empiricism uncontrolleld by intelligence” (ibid., p. 55). At Cos, on the other hand, observation was freed from routine to become discerning and methodical. It was, moreover, effectively combined with active and critical thought—“a superior judgment” regined there, and “the scope of its intelligence and the penetration of its observation are manifest in ahigh degree” (ibid., p. 63). All of this seems to me to be thrusting Cnidian medicine into the shadows so that Coan may shine brighter, since I am convinced that the two schools shared essentially the same spirit. But in order to clarify this issue it is necessary to approach the problem of evaluating the medicine of the collection, and particularly that of Cos, in a somewhat different way.

Since we have seen that the two schools of Cos and Cnidus (and undoubtedly others, if we knew more about them) were similar in a number of fundamental points, we must assume that the rivalry between the schools was the result of divergences of detail. Indeed, these divergences must be grossly magnified to achieve any significance, and it is tempting to say that from the point of view of modern medicine, that great rivalry was very minor indeed. Still, it is necessary to consider these small differences in an attempt to identify the originality of the school of Cos and of Hippocrates.

The personal originality of Hippocrates is elusive. We know from Meno’s testimony that he was not the founder of rational medicine, nor did he bring about a revolution in medical practice; although, as we have seen, Meno gives him more space than any other physician, he attributes to him no doctrines essentially different from those of his contemporaries. In order to account for Hippocrates’ importance, one must take into consideration his prestige as a teacher, his talent as a practitioner, and his authorship of a number of treatises—which are, incidentally, a great deal more engaging than the rather monotonous writings of the Cnidinas, and must have attracted a wider readership by their style and topicality. It is clear that Hippocrates did not stand alone as a genius in an intellectual desert; it is equally clear that, for reasons that we do not know precisely, he was in the front rank of the medicine of his age, as the primus inter pares.

We must now determine the level—and the value—of Hippocratic medicine. This pursuit is not universally acceptable, since many scholars, basically philologists and not historians of science, refuse to do so a priori, while others prefer not to apply critical methodology to a figure as highly respected as Hippocrates—even if it is not an act of actual lèse-majesté to judge Hippocratec’ medicine in the light of our own, it at least seems to imply a lack of historical understanding. The Hippocratic Collection has not yet received the sort of systematic scholarly treatment that Alexandre Koyré for example, gave to the work of Galileo. In trying to establish what was truly valuable in Hippocratic medicine, I shall confine myself to examples drawn from the school of Cos, although we have seen that there is little point in making distinctions between the medicine of Cos and that of Cnidus.

Let us first consider the excellent intentions of the followers of Hippocrates. They wished to promote a strictly scientific medicine, and they clearly thought that they had succeeded in doing so. While magic and medicine may have coexisted peacefully in Egypt, Mesopotamia, and, indeed, ancient Greece, the rational medicine of the Hippocratics (who did not necessarily invent it, although they may have thought that they did) attacked magic relentlessly. The medicine that the Hippocratics advocated, on their own example, was a rigorous rational technique and clearly a great step forward beyond its predecessors.

A number of sound Coan directives derived from this desire for rationality. Practitioners of this school were advised that “Examining the body requires sight, hearing, smell, touch, taste, and reason” (Epidenics VI, 8, 17) and told “To consider what can be seen, touched, and heard—what can be learned through sight, touch, hearing, smell, taste, and the understanding— what one can perceive through all the means at our disposal” (in the Surgery 1). In short, the Hippocratic physician was urged “To examine by reason and fact” (Loeb ed., III, 22, 2–3), a system which a late work sums up in the happy phrase “rational practice” (Precepts 1). (These notions of scrupulous observation were further put into a long, detailed program; see Epidemics 1, 10.) There is little doubt that a great many of the Coan observations made on this basis, beginning with the famous facies hippocratica of Prognostic, were exact. In the interest of coordinating these observations, Epidemics envisages a rather elaborate method, reminiscent of Plato, “to make a synthesis of all the data concerning an illness in order to determine the similarities, then to establish between the latter new differences in order to arrive finally at a unique similarity” (Bourgey, op. cit., p. 96; Epidemics VI, 3, 12).

This rational approach to observation and synthesis allowed the Hippocratic physicians to recognize their errors and to be aware of the methodological value of admitting and analyzing them. After having described an unsuccessful treatment, for example, the author of Joints adds, “I relate this on purpose, for it is also valuable to know what attempts have failed and why they have failed” (ch. XLVII; cf. Diseases III, 17). The same rationality led them to a firm principle of causality, one that permitted of no exception. Coan writers stated that “Each disease has a nature of its own, and none arises without its natural cause” (Airs, Waters, Places 22) and that “It is demonstrated that chance does not exist, for everything that occurs will be found to do so for a reason; in the face of a reason, chance visibly loses all reality” (The Art 6). They further accepted as self-evident the unity of the animal kingdom, man being one species among others (Joints 8; The Sacred Disease 14).

We should also briefly review the series of valuable notions previously discussed in the comparison of the Coan and Cnidian schools. These include the refusal to tie medicine to philosophical or cosmological principles, the importance of environment, and the interest taken in prophylaxis and in the psychology and mental constitution of the patient.

We must still examine Hippocratian deontology, and in this field the scholl of Cos set forth principles that are still valid. “To help, or at least to do no harm,” writes the authors of Epidemics I. 11; and the Oath known to all physicians makes this explicit:

In whatever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrongdoing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.

One should also consider the medical ethics stated in chapter 6 of Precepts, which are worthy of consideration even though it is a late work:

I urge you not to be too unkind, but to consider your patient’s wealth and resources. Sometimes you will give your services for nothing, calling to mind a previous benefaction or your present reputation. If there should be the opportunity to serve a foreigner or a poor man, give full assistance to him; for where there is love of man there is also love of the art.

Let us now see what sort of reservations must be held concerning Hippocratic medicine. This is a subject that has occupied critics only in recent years; see, for example, F. M. Cornford’s sound criticism in Principium sapientiae (Cambridge, 1952) and the highly skeptical remarks by L. Edelstein in Ancient Medicine (Baltimore, 1967), pp. 124, 405. G. Vlastos makes more concrete points, especially in a review of Cornford’s book which appeared in Gnomon in 1955 (pp.66–73), reprinted in Studies in Presorcratic philosophy, edited by Furley and Allen(London-New York, 1970) I myself discovered this review only in the later edition, after having written on the same subjects and having reached practically the same conclusions in my own Le niveau de la science hippocratique (Paris, 1966). Charles Lichtenthäler carries the discussion further in his Études hippocratiques; although he makes some pertinent analyses, his work is burdened by debatable opinions, such as that there are two divergent but complementary methods in medicine, that of Hippocrates and ours—an idea that I, for one, cannot accept.

Kudlien critical concern is more specific. He is convinced that the medicine of the Hippocratic Collection was not entirely rational, and he proposes to show in it rationalized vestiges of ancient thought. He is plainly inspired in this by E. R. Dodd’s the Greeks and the Irrational (Berkeley-Los Angeles, 1951), from which he takes in particular Gilbert Murray’s notion of “inherited conglomerate.” This method yields kudlien good results, as when he discovers the mythical basis of the use of honey as a remedy for the “withering disease” (Der Beginn, pp. 100–106) or for the “deadly disease” mentioned in Diseases II, 66–67(“Early Greek Primitive Medicine,” in Clio medica, 3 [1968], 320–330). One can cite other instances of such survivals without referring to Dodds, as, indeed, I myself did in 1966(Niveau, pp. 39, 191, 208, and 223). It is, for example, certain that the therapeutic use of excrement reveals the archaic mentality that prizes all living being and their products. The preference for right over left is also archaic(see Aphorism V, 48, and Epidemics VI, 2, 25).

Let us examine the preference for the right over the left as it appeared in conjunction with the idea, evident in the Collection, as well as in Aristotle and other Greek writers, that women are inferior. The Coan writers stated, among other things, that “When a woman is pregnant with twins, should either breast sag, she will lose one child... if it is the right breast, it is a male child that will be lost; if it is the left breast, a female child” (Aphorism V, 38), since “the male fetus is usually on the right, the female on the left” (ibid., V, 48). “At puberty, depending on which testicle develops first, the individual will father boys if it is the right one, girls if it is the left” (Epidemics V, 4, 21). “[The male fetus] is in the warmest place, the most solid, at the right [of the womb]; that is why males are darker and formed earlier; they move about earlier; then movement stops and they grow more slowly. They are more solid, more passionate, and more full-blooded because the location in the womb where they take form is hotter” Epidemics VI, 2.25). These errors were elaborated by Cnidian gynecologists. We cannot be sure, of course, that the belief in the inferiority of women was itself a survival of an archaic belief; indeed, it would seem more likely that it was a reflection of the society of the time.

What are certainly archaic ideas were further manifested in imitative errors. A confusion of medical and visual properties persists when the dietician of Regimen asserts that only white wine is diuretic (LII, 2) or that beef is less digestible than pork (XLVI, 1–2). Likewise, when he says that the eel is indigestible because it lives in the mud (XLVIII, 2), he postulates an unprovable connection between the animal and its environment. It would be arbitrary, however, to seek in these instances the survival of magical practices, particularly in light of the conscious hostility of the Hippocratic physicians to any sort of magical medicine. We may thus see that Murray’s concept of “inherited conglomerate” is inadequate to deal with what is irrational in the Hippocratic Collection. The cataloging of the surviving evidences of an archaic mentality is not sufficient; to accept it as such leads further to an exaggeration of the truly scientific value of this school of medicine.

It is necessary to seek a broader irrationality, for which purpose we possess an excellent tool in the method of Gaston Bachelard’s Formation de I’esprit scientifique (Paris, 1938). Although this study is devoted to biological and medical texts of the sixteenth, seventeenth, and eighteenth centuries, Bachelard’s technique of psychological analysis is also fruitful in the earlier period that concerns us. This implies no criticism of Dodds’s The Greeks and the Irrational; it is merely that in this instance Bachelard’s concerns are, by analogy, more nearly our own. The methods of the two authors are by no means incompatible, moreover, and from them we may deduce that it is inevitable that survivals from the past become psychological realities. Bachelard’s method is able to encompass such survivals and to couple them with psychoanalysis, in the strictest Freudian sense.

Given this persistence of a broad irrationality, the view put forth by Kudlien, among others, that a school of medical thought is necessarily truly scientific when it is clearly divorced from the magicoreligious sphere, is unconvincing. I would suggest that rational medicine (an ambiguous term) is indeed one clearly separated from magic—it being understood that there is a big gap between “rational” and “scientific” medicine. This medicine is rational when compared with magico-religious medicine, but remains irrational compared to a more refinedly scientific practice. Rationality, subject to epistemology, undergoes real changes in the course of history; whether one chooses a view based on continuity or discontinuity, an acceptance of the historical nature of reason is essential.

Rather than trying to present a synthesis of the different irrational elements in Hippocratic medicine, however, I shall deal with further concrete examples. Let it be noted before we proceed that it is difficult, at this distance in history, to criticize Hippocratic statements from observed experience, since we cannot always be sure of circumstances that may have affected such observations. With this in mind, we may note that certain Hippocratic observations would seem to be questionable. For example, the Nature of Man states that dysentery and nosebleeds occur primarily in the spring and summer, the seasons in which bodies are hottest and reddest. Certain critics think this assertion to be the sum of long and patient observations—a technique that might almost be called statistical— but this would seem to be unlikely, since dysentery is more often a disease characteristic of late summer and autumn than of spring. The Hippocratic author has previously explained that one humor is dominant for each of the seasons. According to him, it is in spring that the blood flows most freely (a statement worthy of psychological analysis), and it is necessary for him to support this thesis. We must therefore question whether deduction has not supplanted observation.

The same Hippocratic author wrote, “If you give a man a medicine that withdraws phlegm, he will vomit up phlegm; if you give him one that withdraws bile, he will vomit up bile” (Nature of Man V). This argument is advanced to prove the specificity of humors, but here theory rather clearly influences observation, for it is obvious that the author believes that he sees the particular humor for which his medicine is reputedly effective. He thus combines two prejudices; his observation is short-circuited by a priori thinking, and he sees what he wishes to see.

The same tendency to make observed facts conform to prestablished convictions had a deleterious effect upon experiment. In the conscious intention of the Coan physician, experiment might have played a part comparable to the one it has today, but his results were, once again, apt to confirm his preconceptions. The author of Airs, Waters, Places, for instance, believes that water from melted ice or snow is bad because freezing has caused it to lose its “clear, light, sweet part.” He continues, “The following experiment will prove it. In winter, pour a measured amount of water into a vessel and set it in the open, where it will freeze best; then on the next day, carry it to a sheltered place where the ice will melt best. After it has melted, measure the water again, and you will find that it has greatly diminished” (ch. VIII). Although one can accept some diminution of quantity because of evaporation, it is hard not to believe that the “greatly diminished” amount of water found by the author was the result of his desire to find just such a thing. The expansion produced by the freezing, upon which one might expect any attentive observer to remark, passes unnoticed; indeed, the author’s explanation of the experiment precludes this phenomenon, since he writes, “This shows proof that freezing evaporates and dries the lightest and finest part [of the water], not the heaviest and densest part, which would be impossible” (ibid,; and see Vlastos, op. cit., p.44).

In a similar manner the author of Nature of the Child presents in chapter 29 a quite fantastic account of human embryology, then proposes to verify it experimentally by observing the development of a chick up to the time of hatching through the daily examination of an egg taken from the nest of a setting hen. The design of the experiment itself is brilliant; it represents the best example of a plan for methodical observation in the Collection. The author, however, learned nothing from following it, since he used it only to confirm his ideas as already stated, a point that some critics have missed. He never displays any doubt of his results, whereas if he had carefully conducted the experiment he describes, he would surely have had sufficient opportunities to be perplexed. Indeed, one may even wonder if he actually followed the procedure he discusses.

One can thus see how misleading it may be to judge Hippocratic medicine solely on the basis of its declared intentions and directives. Their often rather vague formulation allows of several interpretations (for which reason it is sometimes stated that they display a truly modern mentality), so it is necessary to put them back into their context to see what they yield in actual practice.

Chapter 10 of Nature of Man provides a good opportunity to examine a departure in practice from the declared Hippocratic intention of observation. In its emphasis on qualities, too, it illustrates a major concern of Hippocratic medicine. Its author states that the most serious illnesses are those that affect the strongest part of the body, although what part that is nowhere specified. If that strongest part is stricken, the entire body is affected; if the disease moves, its force will easily overcome the weaker parts. If, on the other hand, the disease occurs in a weaker part of the body, it must itself be weak, and should it move to a stronger part it will quickly be neutralized.

The author of Airs, Waters, Places prefers to emphasize the role of the location of a city. Here, too, what might appear to be the result of systematic observation in truth represents a deduction from a preliminary postulate. The author begins with the premise that a site exposed to hot winds has an abundance of water (ch. 3), then asserts that people living in such a site of necessity have moist heads. It is therefore to be expected that fluxes coming from the head upset their stomachs. Women, who are already moist by nature, when they live in such a locale are subject to excessive menses and sterility (since the fluxes drown semen), while frequent miscarriages are a logical corollary of sterility. Both sexes, moreover, suffer from convulsions, asthma, and epileptic fits. (It is interesting to note in this context that the author of The Sacred Disease states that epilepsy is the result of phlegm, which is moist, attacking the brain or throat.)

The same work further emphasizes the notion of qualities and their values in a discussion of mixed waters in chapter 9:

People suffer especially from the stone, from gravel from strangury, from sciatica, and from hernias when they drink waters of different kinds, or from large rivers into which other rivers empty, or coming from a lake fed by many streams of various sorts, and whenever they consume foreign waters brought from a great distance. For one water cannot be like another; some are sweet, others are salty and taste of alum, and others flow from hot springs; these waters, in a mixture, combat each other and the strongest always prevails. The strongest is not always the same; sometimes it is one, sometimes another, depending on the winds. One has its strength from the north wind, another from the south wind, and the same is true for the others.

We may here note that the concept of mixture had great importance in prescientific thinking, especially in pharmacy. Therica, for instance, is compounded of some 150 ingredients and represented, in Bachelard’s felicitous phrase, the “sum of the sums” of substances. All pharmaceutical masters had to make it, moreover, and to share the product obtained among themselves; it is thus a mixture of the second power, the efficacy of which is multiplied by this very fact.

The passage from Airs, Waters, Places on the mixture of waters is of further particular interest since it illustrates the ambivalence of an intuitively valued idea. Here mixture is fundamentally bad; the substantial qualities must therefore war with each other instead of cooperating or blending into a beneficial whole. In language similar to that already noted in Nature of Man, the strongest quality wins.

It is now necessary of review the Coan theory of the four humors in a critical perspective. Although the Coan physicians again thought that their system was based on attentive observation, We must call the quality of that observation into question once again. It is more apparent that their theory of the humors represented a deduction based on a philosophical system of four elements; that of Empedocles comes immediately to mind. It might also have in it elements of a rationalized ancient belief, but these are topics that require further scholarly research.

The Hippocratic physicians explained most diseases by fluxes of humors, as we have seen in passing in our discussion of Nature of Man and Airs, Waters, Places. Epidemics, more specifically, states that such humoral fluxes can start spontaneously (V, 19 and 64); the concept of flux, however, was scarcely subjected to analysis, although it is employed as primary evidence. In addition to spontaneity, the flux seems to have great freedom in direction and destination. It affects the internal organs as vessels that can absorb it, be distended by it, overflow with it, or reject it. The mechanical functions of the organs form a physics of the receptacle which, together with the qualities of the humors in motion, define the entire physiology and internal pathology of the schools of both Cos and Cnidus.

It is here important to note the role of analogy in this medical thought, a role that cannot be overemphasized. The functioning of the organism is conceived of in terms familiar from elementary mechanics, from such devices as the pump, the cupping glass, and communicating vessels. This tendency is most consciously expressed in Generation-Nature of the Child-Diseases IV, but it exists everywhere. ¹³ This use of analogy in no way parallels the use of models in contemporary science, although it is sometimes mistakenly thought to do so. The concept of model, as, for example, it is employed in nuclear physics, puts into concrete form the sum of scientific data available at given time and is an a posteriori synthesis, essentially capable of correction. The analogy of the Hippocratic authors, on the other hand, was a priori, an image that was imposed tyrannically and that rendered observation sterile. It was not subject to emendation; rather, it selected and modified available data, shaping them to itself. It was not a hypothetical resemblance; it was a fundamental identity.

Although the Hippocratic emphasis on diet and regimen was in principle sound in regard to modern medicine, here, again, contrary to what is often supposed, there is little evidence of strictly objective observation. The most striking aspect of the dietetics presented in Regimen in Acute Diseases, for instance, is the horror of change, perhaps the transposition of a social conservatism. The author dramatizes the least departure from the diet. He likewise exaggerates the distinctions to be made between products, giving primary importance to the differences between infusions made directly from a berry or leaf and those that have been filtered or otherwise processed. It is not difficult to guess at the psychology involved here.

The physician was limited in the therapeutic possibilities available to him, in the face of common and often fatal diseases, and needed to make the most of what little he had. With only a small number of potions, he had to confer almost miraculous powers upon them. The dietetics are marked by a wide range of subtle distinctions, necessitated by their major limitations.

As for the pharmacopoeia, we know it chiefly from Cnidian works, although the traces that remain in Coan books (such as Epidemics II, 6, 29) indicate that here again the two schools were in close agreement. In this area what is particularly notable is a want of specificity, long lists of recipes prescribe a host of substances for a single malady and, conversely, a single substance is recommended for a host of ills. Certain of the prejudices that we have already discussed are present in the pharmacopoeia, too—such as the particular value of products made from living matter, or of human products (including “milk of a woman nursing a male baby,” which was also recommended in Egypt), or rare or exotic substances.

Several Coan works are, however, less subject than others to the failings cataloged above. of these, EpidemicsI and III and Fractures, Joints are the most notable. We should not make the mistake of assuming that the author or authors of these works were more scientific in the modern sense; it is pertinent to mention that the author of EpidemicsI and III , for example, avoided the traps into which his contemporaries fell only by drastically circumscribing his subject. His technique is to record climatic data and to follow day by day the signs and progressions of certain diseases, confining himself to external observation. One can admire the precision of this observation, but it does not go far enough. In a great many cases, the author does not even define the disease in question; in his self-imposed restriction he systematically refuses to hazard any interpretation or causal hypothesis. Since it is in the latter pursuit that the scientific mentality most readily reveals itself, one may say that if a physician limits himself to listing such factors as the place where the patient becomes ill, his vomitings the color and consistency of his stools, his perspiration, and the fluctuations of his fever, he will perhaps attain new heights of objectivity but his work will be of little significance from the point of view of science (see Vlastos, op. cit., p. 45) While we should certainly admire the author’s submission to facts in this case, we must remember that this external and necessarily qualitative observation is only a very modest starting point for science per se.

The same sort of basic limitations apply to Fractures, Joints and Wounds of the Head. The works are by the nature of their subject matter confined to the questions of ascertaining fractures or luxations, and of dressing or reducing them. This is virtually the only area of medicine in which the techniques of the time—observation such as existed in this period combined with sufficient mechanical ingenuity to perfect devices for reduction or trepanning (or, simply, splints and bandages)—are adequate to produce very satisfactory results. In limiting himself to these tasks, some of which are, nonetheless, delicate, the author of these works, too, avoided the errors made by others. The author does not, for instance, consider the histological problem of the healing of broken bones; he nowhere presents an explanation of the reduction of a fracture that he describes.

In sum, then, we might say that Hippocratic medicine was rational, but that its reason was not the scientific reason of today. Indeed, I prefer to adopt Bachelard’s term “prescientific.” There is no question here of reproaching the physicians of the time; they brilliantly constructed an inevitable stage of medicine that we must further analyze and inventory. But to identify their medicine with ours is surely to display a lack of historical understanding. Even as prescientific medicine, however, the medicine of the Hippocratics represented a knowledge infinitely more valuable than the magic which it supplanted.

As to Hippocrates himself, if he is not all of medicine, and if we do not even know with certainty exactly what he wrote, we should nevertheless consider him to be the eminent representative of a significant stage of medicine—the stage in which war was waged on all magico-religious medical practice, and in which medicine consciously sought to become fully scientific and at least succeeded in becoming partially rational. To go further in one’s praise is to fall back into hagiography, but we must note the difficulty and enormousness of the task that the Hippocratics assumed. The proof of their success may be found in that for two millennia no better work was accomplished, and often worse was done. Hippocratic medicine traversed the centuries somewhat like Aristotelian logic; and if, since the nineteenth century, the errors of the physician have been seen to be more profound than those of the logician, it is because the domain that he explored was much the more complex.

NOTES

1. Ilberg’s ed. is in Corpus Medicorum Graecorum (1927), pp. 175–178.

2. Published by Schöne in Rheinisches Museum, 58 (1903), 56–66.

3.Chiliades VII, 944–989.

4. The same thing is true of the Letters and of the other apocryphal texts of vol. IX of Littré’s ed.; a recent study by H. de Ley emphasizes the diversity of inspiration among these writings.

5. It is understandable that a few of the works, among them such brief texts as Child of Eight Months and Use of Liquids, cannot easily be identified as belonging to a definite school. To them I would add the major treatise Ancient Medicine, which is often considered purely Coan.

6. Among such references for coction, for example, are Diseases I, 19 (Littré VI, 174) and III, 16 (VIII, 52, II); for the crisis, Diseases I, 72 (VI, 158, 22); II, 40 (VII, 56, 10), 71 (VII, 108, 24); Internal Affections 21 (VII, 220, 19), 27 (VII, 238, 13 and 24), 28 (VII, 240, 19); for the deposit, Diseases II, 27 (VII, 44), 57 (VII, 90, 7–8); Internal Affections 18 (VII, 212), 28 (VII, 240); for metastasis, Diseases 1, 18 (VI, 172, 17) and 22), 29 (VI, 220, 2); Affections 9 (VI, 216, 16), 12 (VI, 220, 7), 19 (VI, 228, 19); Diseases III, 6 (VII, 124, 8): Diseases of Women I, 26 (VIII, 70, 9), 29 (VIII, 72, 14); and for relapse, Diseases II, 1 (VII, 8, 10), 12 (VII, 20, 6), 41 (VII, 58, 20); Internal Affections 1 (VII, 170, 15), 2 (VII, 174, 12 and 14), 44 (VII, 278, 2–4).

7. See Diseases II, 54 (VII, 84, 2), 55 (VII, 86, 13–14 and 22), 64 (VII, 98, 21), 66 (VII, 100, 21); Affections 6 (VI, 214, 8–9); Nature of Woman 1 (VII, 312, 10–11); Diseases of Women I, 11 (VIII, 42, 21), II, 111 (VIII, 238, 17); but note that the para-Cnidian Regimen (II, 37–38; III, 68) does so explicitly.

8. See Kudlien, “Early Greek Primitive Medicine,” p. 309.

9. See Diseases II, 47 (VII, 72, 1), 48 (VII, 72, 16), 63 (VII, 96, 21); Diseases III, 15 (VII, 140, 24); Internal Affections 2 (VII, 172, 23), 20 (VII, 216, 18), 22 (VII, 220, 21), 27 (VII, 238, 14), 39 (VII, 262, 13); and Diseases of Women I, II (VIII, 42, 22).

10. For this aspect of Coan medicine, see Epidemics VI, 5, 5 and 6, 14; for Cnidian, see Diseases II, 72 (VII, 108–110); Internal Affections 48 (VII, 284–286); Diseases of Women I, 62 (VIII, 126); and Diseases of Girls 1 (VIII, 466–470).

11. See I, 11 (VIII, 42, 19 and 22), 66 (136, 2), and II, 138 (312, 3 and 7).

12. See Joints 8; but see also Diseases I, 16 (VI, 168, 25), 22 (184, 3–5), III, 17 (VII, 156, 7–8); Nature of Woman I (VII, 312); Diseases of Women I, 11 (VIII, 42, 21), II, 111 (VIII, 238–240); and On Sterile Women (VIII, 230, 444, 1–4).

13. O. Regenborn devotes an important essay to this ancient use of analogy, which he compares with modern hypothesis. I do not think that the comparison is valid, however; see Niveau, pp. 73–75.

BIBLIOGRAPHY

I. Original Works. The complete critical ed., with French trnas. is Émile Littré, Les oeuvres complètes d’Hippocrate, 10 vols. (Paris, 1839–1861), also available in photocopy (Amsterdam, 1961). This ed. has supplanted its contemporary rival: F. Z. Ermerins, ed., Hippocratis et aliorum medicorum veterum reliquiae, 3 vols. (Leipzig-Paris, 1859–1864).

The Story of the MS tradition has since made great progress and the later eds. are better from the philological point of view, but they are far from complete. The Teubner ed. stopped after the 2 vols. edited by H. Kühlewein. Vol. I (Leipzig, 1895) contains Ancient Medicine; Airs, Waters, Places; Prognostic; Regimen in Acute Diseases and its Appendix; and Epidemics I and III. Vol. II (Leipzig, 1902) contains Wounds of the Head; In the Surgery; Fractures, Joints; and Mochlicon.

The Corpus Medicorum Graecorum began the ed. of the Collection with a volume by J. L. Heiberg (Leipzig-Berlin, 1927) which contains the Oath; On Law; The Art; The Physician; Decorum; Precepts; Ancient Medicine; Airs, Waters, Places; Nutriment; The Use of Liquids; and Breaths. Recent eds. are A. Grensemann, On the Child of Eight Months. On the Child of Seven Months (Spurious) (Berlin, 1968) and H. Diller, Airs, Waters, Places (Berlin, 1970). Other volumes are expected, notably Nature of Man by J. Jouanna.

The publishing unit of the universities of France has also undertaken the complete ed. The first 3 vols. to be published are by R. Joly; Regimen (Paris, 1967); Generation-Nature of the Child-DiseasesIV and The Child of Eight Months (Paris, 1970); Regimen in Acute Diseases and its Appendix, Nutriment, The Use of Liquids (Paris 1972).

An early partial ed. is J . E . Petrequin, ed., La chirurgie d’Hippocrate, 2 vols. (Paris, 1878), with French trans. and very interesting notes. Vol. I contains the Oath; The Physician; Wounds; Fistulas; Hemorrhoids; and Wounds of the Head. Vol. II contains In the Surgery; Fractures, Joints; and Mochlicon.

The Loeb Library published 4 vols. with English trans. (Cambridge, Mass., 1923–1931). Vol. I, W. H. S. Jones, ed., contains Ancient Medicine; Airs, Waters, Places; EpidemicsI and III ; the Oath; Precepts; and Nutriment. In vol. II, W. H. S. Jones, ed., are Prognostic; Regimen in Acute Diseases; The Sacred Disease; The Art; Breaths; Law; Decorum; The Physician; and vol. III, E. T. Withington, ed., contains Wounds of the Head; In the Surgery; Fractures, Joints; and Mochlicon. In vol. IV, W. H. S. Jones, ed., are Nature of Man; Humors; Aphorisms; Regimen; and Dreams (and fragments of Heraclitus). The critical apparatus is greatly reduced in this edition.

There are also eds. of individual works, often with comentary: The Art: T. Gomperz, Die Apolgie der Heilkunst (Vienna, 1890); On Flesh: K. Deichgraeber, Hippokrates, über Entstehung und Aufbau des menschlichen Körpers (Leipzig-Berlin, 1935); Prognostic: B. Alexanderson, Die Hippokratische Schrift Prognostikon (Göteborg, 1963); Ancient Medicine: A. J. Festugière, Hippocrate, L’Ancienne médecine (Paris, 1948); The Heart: J. Bidez and G. Leboucq, “Une anatomie antique du coeur humain,” in Revue des études grecques,57 (1944), pp. 7–40; Breaths: A. Nelson, Die Hippokratische Schrift Περì ϕυσωˆν (Uppsala, 1908); the Oath: L. Edelstein, The Hippocratic Oath (Baltimore, 1943), repr. in his Ancient Medicine, pp. 3–63; and The Sacred Disease: H. Grensemann, Die Hippokratische Schrift über die heilige Krankheit, vol. II, pt. 1, of Ars Medica (Berlin, 1968).

Recent anthologies are H. Diller, ed., Hippokrates Schriften (Hamburg, 1962); R. Joly, ed., Hippocrate médecine grecque (Paris, 1964); and M. Vegetti, ed., Operedi Ippocrate (Turin, 1965).

II. Secondary Literature. On Hippocrates himself, see L. Edelstein, “Hippokrates. Nachträge,” in Pauly Wissowa, Real-Encyklopädie, supp. VI (1935), cols. 1290–1345.

The Collection is discussed in the following (listed chronologically): C. Fredrich, Hippokratische Untersuchungen (Berlin, 1899); H. Gossen, “Hippokrates,” in Pauly Wissowa, Real-Encyklopädie, VIII (1913), cols. 1780–1852; L. Edelstein, Περϭ άέρων und die Sammlung der Hippokratischen Schriften (Berlin, 1931); L. Bourgey, Observation et experience chez les médecins de la Collection hippocratique (Paris, 1953); R. Joly, Le niveau de la science hippocratique (Paris, 1966); and P. Lain Entralgo, La medicina hipocrá (Madrid, 1970).

On the school of Cos, see K. Deichgraeber, Die Epidemien und das Corpus Hippocraticum; Voruntersuchungen zu einer Geschichte der Koischen Arztschule (Berlin, 1933); and H. Pohlenz, Hippokrates und die Begründung der wissen schaftlichen Medizin (Berlin, 1938).

Among studies on special topics are the following (listed chronologically): H. Diller, Wanderarzt und Aitiologe. Studien zur Hippokratischen Schrift Περì άέρων, ύδάτων, τóπων (Leipzig, 1934): U. Fleischer, Untersuchungen zu den pseudohippokratischen Schriften Παραγγελίαι, Περì ιητρουˆ und Περì ευσχημοσύνης (Berlin, 1939); R. Joly, Recherches sur le traité pseudo-hippocratique Du régime (Paris-Liège, 1961); N. Van Brock, Recherches sur le vocabulaire medical du grec ancien (paris, 1961); G. H. Knutzen, Technologie in den Hippokratischen Schriften Περì διαίτηςόξέων, Περì άέρων Περì άρθρων έμβολής (Wiesbaden, 1963); J. Schumacher, Antike Medizin (Berlin, 1963), for its extensive bibliography; H. Flashar, Melancholie und Melancholiker in den medizinischen Theorien der Antike (Berlin, 1966); L. Edelstein, Ancient Medicine (Baltimore, 1967); F. Kudlien, Der Beginn des medizinishcen Denkens bei den Griechen (Zurich-Stuttgart, 1967); G. Lanata, Medicina magica e religione popolare in Grecia fino all’etá di Ippocrate (Rome, 1967), and J. Mansfeld, The Pseudo-Hippocratic Tract Περì ‘εβδομαδων Ch. 1–11 and Greek Philosophy (Assen, 1971).

A very short list of articles is the following (presented chronologically): O. Regenbogen, “Eine Forschungsmethode antiker Naturwissenchaft,” in Quellen und Studien zue Geschichte der Mathematik, Astronomie und Physik,1. no. 2 (1930) 130–182; W. Nestle, “Hippocratica,” in Hermes,73 (1938), 1–38 W. Müri, “Der Massgedanke bei griechischen Ärzten,” in Gymnasium,57 (1950), 183–201; K. Abel, “Die Lehre vom Blutkreislauf im Corpus Hippocraticum,” in Hermes,86 (1958), 192–219; R. Joly, “La question hippocratique et le témoignage du Phédre,” in Revue des ètudes grecques, 74 (1961), 69–92; E. Wickerscheimer, “Légendes hippocratiques du moyen âge,” in Sudhoffs Archiv Für Geschichte der Medizin und der Naturwissenschaften, 45 , no. 2 (1961), 164–175; H. Flashar, “Beiträge Zur Spätantiken Hippokratesdeutung,” in Hermes, 90 (1962), 402–418; H. Herter, “Die Treffkunst des Ärztes in Hippokratischer und platonischer Sicht,” in sudhoffs Archiv für Geschichte der Medizin und der Naturwissenschaften, 47 (1963), 247–290; G. E. R. Lloyd, “Who Is Attacked in On Ancient Medicine?,” in Phronesis, 8 (1963), 108–126; H. Diller, “Ausdruckformen des methodischen Bewusstseins in den Hippokratischen Epidemien,” in Archiv für Begriffsgeschichte, 9 (1964), 133–150; I. M. Lonie, “The Cnidian Treatises of the Corpus Hippocraticum,” in Classical Quarterly, 15 (1965), pp. 1–30; M. Vegetti, “1I De locis in homine fra Anassagoraed Ippocrate,” in Rendiconti dell’Istituto lombardo di scienze e lettere, 99 (1965), 193–213; F. Kudlien, “Early Greek Primitive Medicine,” in Clio medica3 , (1968), 305–336; J. Jouanna, “Le médecin Polybe est-il l’auteur de plusieurs ouvrages de la Collection hippocratique?,” in Revue des études grecques, 82 (1969), 552–562; H. de Ley, “De samenstelling van de Pseudo-Hippokratische brieven-versameling en haar plaats in de traditie,” in Handelingen der K. Zuidnederlandse Maatschappij voor Taal-en Letter-kunde en Geschiedenis, 23 (1969), pp. 47–80; F. Kudlien, “Medical Ethics and Popular Ethics in Greece and Rome,” in Clio medica, 5 , no. 2 (1970), 91–121; and G. Vlastos, “Cornford’s Principium Sapientiae,” in D. J. Furley and R. E. Allen, eds., Studies in Presocratic Philosophy (London-New York, 1970), pp.42–55, repr. from Gnomon, 27 (1955), 65–76.

Robert Joly

HIPPOCRATES OF COS

(b. Cos, 460 BCE; d. Larissa, c. 370 BCE),

medicine.

For the original article on Hippocrates of Cos see DSB, vol. 6.

Since the middle of the twentieth century, many changes have taken place in the standard picture of Hippocrates, the Father of Medicine, so that in the early twenty-first century even those few details of his life and writings that the majority of scholars once accepted are disputed. Meanwhile, alongside the production of better editions of the texts, and their translation into a range of modern languages, the focus of Hippocratic studies has moved away from identifying which treatises most accurately represent the thinking of Hippocrates toward examining the social context of ancient medicine more generally. As well as trying to gain a better picture of physicians other than Hippocrates who were active in the classical world, this also involves a shift away from individual physicians named in the sources, toward the theories and therapies that patients would encounter. In the process, it has become possible to identify many different versions of “Hippocrates,” which have chosen to place their emphasis on different parts of the Hippocratic corpus.

Galen’s . Construal. Possibly the most significant shift in scholars’ understanding of Hippocrates has come about as a result of Wesley Smith’s book The Hippocratic Tradition(1979), in which the contribution of many ancient as well as modern writers to the construction of “Hippocrates” was demonstrated: above all, 0. that of Galen (129–c. 216). Smith showed how the great nineteenth-century editor of the corpus, Émile Littré, had assembled ancient sources in order to impress the reader with the sheer quantity of evidence for the historicity of Hippocrates, but noted how Littré “seems to mention all suggestions by anyone in antiquity about Hippocrates’ reality and importance, with little emphasis on the contradictions in ancient tradition and little emphatic skepticism about the quality of the evidence” (p. 34).

In particular, nineteenth-century editors such as Littré were putting too much credence in Galen, failing to recognize that Galen’s account of Hippocratic science and its tradition should instead be recognized as being “in large part his own, a projection of his concerns onto history” (Smith, 1979, p. 175). The quest to identify the “genuine works of Hippocrates,” a phrase used in Francis Adams’s edition of those works he singled out as by the historical Hippocrates (1849), continues to be based on judgments of literary merit and sufficiently rational content. But Smith showed how Galen created Hippocrates in his own image, by regarding as the “genuine works” of Hippocrates those that most closely approximated to his own views; for example, Galen favored Nature of Man, and as a result its four-humor theory came to be seen as genuinely Hippocratic. Nor was this the first construction of Hippocrates, as the rise of empiricism from around 225 BCE had also seen a surge of interest in the Hippocratic writings, in which they were seen as precursors of an approach to medicine that eschews theory.

Since Smith, historians have become far more aware of the need to avoid taking any of the ancient evidence at face value. This even applies to the two short texts that were once claimed as the sole primary sources for the historical Hippocrates, Plato’s references to him in the Protagoras and the later Phaedrus. In Medical Theories in Hippocrates: Early Texts and the “Epidemics” (1990), Volker Langholf showed that, despite their chronological proximity to the period in which Hippocrates is supposed to have lived, these should instead be considered as secondary sources, in the sense that they use the image of Hippocrates to make specific points central to Plato’s own argument.

In this new climate, in which sources are read with greater attention to their own reasons for mentioning Hippocrates, the “Hippocratic question”—which, if any, of the works in the corpus is by the historical Hippocrates—still continues to hold a fascination for scholars. The best summary of the history of the question remains that by G. E. R. Lloyd (1975; updated 1991). In 1893, when the Anonymus Londinensis papyrus, acquired by the British Museum in 1890, was first published, it caused a stir because it suggested that Aristotle’s view was that Hippocrates regarded “breaths” arising from residues in the body as being the origin of disease. Yet the extant medical treatise under the title of Breaths had previously been rejected as an inferior work by a “second-rate

HULTON ARCHIVE/GETTY IMAGES .

Sophist, indeed .....a mere gossipmonger” (Jouanna, 1999, p. 60), and under no circumstances to be linked with the historical Hippocrates. Such a response was also an ancient one: The writer of the papyrus himself disagreed that this theory was Hippocratic, instead looking to Nature of Man and Diseases1. Nutriment, one of the treatises that Galen considered most genuinely Hippocratic, has been shown conclusively to be from the Hellenistic period, on the grounds of vocabulary and its Stoic roots. The debate is certainly not over yet, as Jaap Mansfeld (1980) has reexamined what Plato meant by attention to “the whole” as a characteristic of Hippocratic medicine, and even Smith (1979) argues that one work of the corpus, Regimen, is genuine.

Reading the Texts . Discussions of the vocabulary and dating of the different treatises in the Hippocratic corpus has been facilitated by better editions of many of the texts of the Hippocratic corpus; the manuscripts available to Littré were limited, and improved readings are now possible. In addition, the Index Hippocraticus, completed by the Hamburg Thesaurus Linguae Graecae in 1989, allows a far better understanding of variant readings, and provides an insight into the structure and development of the texts. As of 2007 it was being enhanced by a further set of volumes collecting the citations of the Hippocratic corpus in later writers, beginning with Galen. One result of these improved resources, new reference works, and also of computer-based analysis of the vocabulary and syntax of the texts, is a reassessment of what it means to write of “authors” for these materials; this in turn has led to a more detailed awareness of the different strata represented even within a single treatise.

For example, Hermann Grensemann (1975, 1982) has argued for several different stages being represented within the gynecological works. Whatever one thinks of his identification of authors A, B, and C and his arguments for their relative dating, study of the gynecological theories and remedies shows how much of this material was shared, and reworked (King, 1998). Other treatises provide slightly different versions of the same material; Aphorisms repeats sections from the gynecological treatises, while some books of the Epidemics have material in common with Diseases of Women and On the Nature of Woman. Papyri have also been discovered which give further variations on the recipes in these texts, showing that this was a developing tradition (Marganne, 1981).

More of the Hippocratic corpus is now available in translation, most notably the Budé French edition, while the Loeb Classical Library translations into English extended to eight volumes by 2007. A series of international conferences under the title “Colloques hippocratiques” has been held, the first at Strasbourg in 1972, whereas another more general conference in Leiden in 1992 led to two volumes of essays under the title Ancient Medicine in its Socio-Cultural Context (van der Eijk et al., 1995). The choice of title is significant: Whereas some scholars (most notably James Longrigg, 1993) still emphasize what sets Hippocratic medicine apart from other aspects of Greek thought, regarding the treatises as showing the birth of “rational” medicine, others would now stress how the theories offered are best situated within the specific social and cultural contexts of classical and Hellenistic Greece. In a similar vein, the most recent Colloque hippocratique was entitled “Hippocrates in Context” (proceedings edited by van der Eijk, 2005).

Instead of seeing Hippocratic medicine as being characterized by a rejection of superstition and religion, scholars are now arguing that even a treatise such as On the Sacred Disease, which gives a natural explanation for epilepsy, does not represent a complete break with non-medical accounts of disease and its treatment (van der Eijk, 1991; Laskaris, 2002). Rather than rejecting therapies involving apparently disgusting substances, such as animal dung, as regrettable survivals of pre-Hippocratic ideas, modern scholars look at the pharmacology of the treatises in terms of the relationship with the symbolism of plants, as seen in magic and myth (von Staden, 1992a and 1992b). Rather than measuring Hippocratic medicine against modern Western medicine, it is increasingly compared to medical writing in other literate cultures (Lloyd, 1996; Lloyd and Sivin, 2002; Dean-Jones, 1995) or to other aspects of ancient science (Ferrari and Vegetti, 1983; Nutton, 2004). The context within which Hippocrates worked has been further illuminated by collections of the significant number of fragments of other ancient Greek medical writers, such as Diocles of Carystos and the third-century BCE Herophilos and Erasistratos, as well as by looking at the position of medicine in ancient Near Eastern societies (Horstmanshoff and Stol, 2004). Hippocratic texts have been studied in relation to a wide range of other types of evidence, among them epigraphy (Deichgräber, 1982).

Treatises as Texts . The nature of the treatises as texts has been a particularly fruitful area of study, acknowledging that they were composed for very different audiences: fellow physicians, laypeople, and even for the writer himself. They represent the earliest surviving examples of Greek prose, and the existence of lists, and the practice of grouping together similar items, can be seen as entirely typical of such early literacy (Lonie, 1983). The seven books of case histories known as the Epidemics, rather than being understood as evidence of the role of observation in recording case histories, can be reinterpreted as showing “a tendency to present reality in conformity with theory” (Langholf, 1990, p. 210), and as “notes to self” enabling a physician to identify emerging patterns; what they miss may be as significant as what their writers choose to include.

In “Literacy and the Charlatan in Ancient Greek Medicine” (2003), Lesley Dean-Jones has argued that literacy may have led to disputes between those physicians relying on the written word, and others whose training originated in the family. The Oath famously sets medical training in a quasi-familial structure in which the person swearing it says that he will treat those who teach him as if they were his family. These distinctions are even present in the claims surrounding the education of Hippocrates himself; some later writers suggest that his mother was a midwife, and that his grandfather had written medical treatises, but this biographical tradition may simply reflect a time when medical training normally passed through families, providing a further example of the creation of Hippocrates in the image of those who wrote about him. But alongside this story of “family” education, the sources also name a range of teachers for Hippocrates, among them Gorgias of Leontini, Democritus of Abdera, and the physician Herodicus; however, there is no reliable evidence to link any of them to Hippocrates’s training.

Cos and Cnidos? . Following Antoine Thivel’s study Cnide et Cos?(1981), the distinction between Coan and Cnidian medicine was no longer seen as important; even Robert Joly in the original DSB came to the conclusion that “the two schools shared essentially the same spirit.” Instead of dividing the corpus into “Coan” medicine associated with Hippocrates and his family and students, and inferior “Cnidian”—or even “para-Cnidian”—medicine showing a primitive and more empirical approach, the broad similarities in theories of disease causation and treatment have come to be emphasized, and disagreement is understood to have occurred between individuals rather than “schools.” These points have been fruitfully linked to the idea, taken from early modern medical history, of a “medical marketplace” in which not only different types of healer, but also fellow Hippocratics, were in competition for patients. This approach also has the effect of dethroning Hippocrates, looking instead at ancient medicine as a field of equals from which the name of Hippocrates happens to have survived.

But why was there a need for a single founding figure? Some of the impetus may have come from those physicians who continued to be based on Cos, who gave authority to their medical tradition by promoting their “founder.” This process may be seen in the Hippocratic pseudepigrapha, part of a wider practice in antiquity of creating letters from famous individuals, and imagining contexts in which they may have met; for Hippocrates, this included encounters with the philosopher Democritos, and the kings of Persia and Macedonia (Smith, 1990; Pinault, 1992). These stories may come from the local traditions of Cos or may have been newly created. In fleshing out the character of Hippocrates, these stories drew attention to his imagined virtues; firstly, patriotism, as he was described as refusing his help to the king of Persia on the grounds that he was an enemy of the Greeks, and secondly his lack of interest in financial rewards—an answer to those who claimed that physicians were only interested in making money out of their patients.

The Afterlife of Hippocrates . The Hippocratic corpus was translated into Latin in sixth-century CE Ravenna, then into Syriac and Arabic; the tenth-century Byzantine encyclopedists added more material to the biographical tradition, while in the twelfth century Joannes Tzetzes traced Hippocrates’s ancestors back to the healing god Asklepios. Galen’s work remained the basis of Western medicine until the sixteenth century, when a movement back to Hippocrates was triggered by the publication of the full corpus in Latin translation in 1525.

In all periods, subsequent generations continued to create Hippocrates in the image of whatever type of medicine they considered best. Precisely because the corpus is not the work of a single man in a single lifetime, it can supply models and precedents for virtually any medical development. This means that different versions of Hippocrates can be found throughout history, including a chemical Hippocrates, an iatromechanist Hippocrates, a vitalist Hippocrates, a holistic Hippocrates, and so on (Cantor, 2002). This does not only apply to “orthodox” medicine; alternatives such as homeopathy have also claimed Hippocrates as their father. Hippocrates could be the champion of observation, opposed to the dry theories of Galen: or the champion of dogma, with Galen merely as a commentator on his work. In French medicine, Hippocrates was associated with Montpellier, Galen with Paris. Different treatises have moved in and out of fashion according to changes in medicine; for example, Thomas Sydenham (1624–1689), the “English Hippocrates,” promoted the value of observation and therefore emphasized the Epidemics, while a century later Airs, Waters, Places became fashionable because of the rise of climatology. Even the Oath is not exempt from use and abuse (Flashar and Jouanna, 1997). Heinrich von Staden (1996) has tried to uncover the original meaning of clauses later interpreted as prohibiting abortion and euthanasia, and protecting patient confidentiality, but it is also clear that many variations on it have existed over time, including its use by National Socialism and at the Nuremberg trials (Leven, 1998).

Rather than Joly’s “eminent representative of a significant stage of medicine” (original DSB), Hippocrates can thus be seen as a rich resource on which a changing medical science has been able to continue to draw. Yet even while the medical theories of Galen dominated, it was Hippocrates—represented as patriotic, modest, and calm—who remained the model of the ideal physician.

SUPPLEMENTARY BIBLIOGRAPHY

WORKS BY HIPPOCRATES OF COS’

The Genuine Works of Hippocrates, Translated from the Greek with a preliminary discourse and annotations by Francis Adams. London: Sydenham Society, 1849.

Hippocrates. Cambridge, MA: Harvard University Press, Loeb Classical Library, 1923–. Volumes continue to be added.

Corpus Medicorum Graecorum. Available from http://www.bbaw.de/bbaw/Forschung/Forschungsprojekte/cmg/de/Publikationen.

Index Hippocraticus. 4 vols. Edited by Josef Hans Kühn and Ulrich Fleischer. Gottingen: Vandenhoeck and Ruprecht, 1986–1999.

OTHER SOURCES

Cantor, David, ed. Reinventing Hippocrates. Aldershot, U.K.: Ashgate, 2002. A valuable collection of essays on the different versions of Hippocrates created by medical writers.

Dean-Jones, Lesley. “Autopsia, Historia, and What Women >Know: The Authority of Women in Hippocratic Gynaecology.” In Knowledge and the Scholarly Medical Traditions: A Comparative Study, edited by Don Bates. Cambridge, U.K.: Cambridge University Press, 1995.

———. “Literacy and the Charlatan in Ancient Greek Medicine.” In Written Texts and the Rise of Literate Culture in Ancient Greece, edited by Harvey Yunis. Cambridge, U.K.: Cambridge University Press, 2003.

Deichgräber, Karl. Die Patienten des Hippokrates: Historischprosopographische Beiträge zu den Epidemien des Corpus Hippocraticum. Wiesbaden: Franz Steiner, 1982.

Ferrari, Gian A., and Mario Vegetti. “Science, Technology and Medicine in the Classical Tradition.” In Information Sources in the History of Science and Medicine, edited by Pietro Corsi and Paul Weindling. London: Butterworth Scientific, 1983.

Flashar, Hellmut, and Jacques Jouanna, eds. Médecine et Morale dans l’Antiquité. Geneva: Fondation Hardt, 1997.

Garofalo, Ivan. Erasistrati Fragmenta. Pisa: Giardini, 1988.

Grensemann, Hermann. Knidische Medizin, vol. I. Berlin: de Gruyter, 1975.

———. Hippokratische Gynäkologie: Die gynäkologischen Texte des Autors C nach den pseudohippokratischen Schriften De muliebribus I, II und De Sterilibus. Wiesbaden: Franz Steiner, 1982.

Horstmanshoff, H. F. J., and Marten Stol, eds. Magic and Rationality in Ancient Near Eastern and Graeco-Roman Medicine. Leiden: Brill, 2004.

Jouanna, Jacques. Hippocrates, trans. M.B. DeBevoise. Baltimore, MD: Johns Hopkins University Press, 1999.

King, Helen. Hippocrates’ Woman: Reading the Female Body in Ancient Greece. London: Routledge, 1998. Study of the context of Hippocratic gynecology and its reception up to the nineteenth century.

Langholf, Volker. Medical Theories in Hippocrates: Early Texts and the “Epidemics.” Berlin: Walter de Gruyter, 1990.

Laskaris, Julie. The Art Is Long: On the Sacred Disease and the Scientific Tradition. Leiden: Brill, 2002.

Leven, Karl-Heinz. “The Invention of Hippocrates: Oath, Letters and Hippocratic Corpus.” In Ethics Codes in Medicine: Foundations and Achievements of Codification since 1947, edited by Ulrich Tröhler and Stella Reiter-Theil. Aldershot, U.K.: Ashgate, 1998.

Lloyd, G. E. R. Magic, Reason and Experience: Studies in the Origin and Development of Greek Science. Cambridge, U.K.: Cambridge University Press, 1979.

———. Science, Folklore and Ideology: Studies in the Life Sciences in Ancient Greece. Cambridge, U.K: Cambridge University Press, 1983.

———. “The Hippocratic Question.” Classical Quarterly 25, no. 2 (1975): 171–192. Reprinted in Methods and Problems in Greek Science. Cambridge, U.K.: Cambridge University Press, 1991.

———. Adversaries and Authorities: Investigations into Ancient Greek and Chinese Science. Cambridge, U.K.: Cambridge University Press, 1996.

———. “Literacy in Greek and Chinese Science: Some Comparative Issues.” In Written Texts and the Rise of Literate Culture in Ancient Greece, edited by Harvey Yunis. Cambridge, U.K.: Cambridge University Press, 2003.

Lloyd, Geoffrey, and Nathan Sivin. The Way and the Word: Science and Medicine in Early China and Greece. New Haven, CT: Yale University Press, 2002.

Longrigg, James. Greek Rational Medicine: Philosophy and Medicine from Alcmaeon to the Alexandrians. London: Routledge, 1993.

Lonie, Iain M. “Literacy and the Development of Hippocratic Medicine.” In Formes de pensée dans la Collection hippocratique: Actes du Colloque hippocratique de Lausanne1981, edited by François Lasserre and Philippe Mudry. Geneva: Droz, 1983.

Mansfeld, Jaap. “Plato and the Method of Hippocrates.” Greek, Roman, and Byzantine Studies 21 (1980): 341–362.

Marganne, Marie-Hélène. Inventaire analytique des papyrus grecs de médecine. Geneva: Droz, 1981.

Nutton, Vivian. Ancient Medicine. London: Routledge, 2004. A full and detailed survey.

Pinault, Jody Rubin. Hippocratic Lives and Legends. Leiden: Brill, 1992.

Smith, Wesley D. The Hippocratic Tradition. Ithaca: Cornell University Press, 1979.

———. Pseudepigraphic Writings. Leiden: Brill, 1990.

Thivel, Antoine. Cnide et Cos? Essai sur les doctrines médicales dans la Collection hippocratique. Paris: Les Belles Lettres, 1981.

Van der Eijk, Philip J., H. F. J. Horstmanshoff, and P. I. Schrijvers, eds. Ancient Medicine in its Socio-Cultural Context. 2 vols. Amsterdam: Rodopi, 1995.

Van der Eijk, Philip J. “Airs, Waters, Places and On the Sacred Disease: Two Different Religiosities?” Hermes 119 (1991): 168–176.

———. Diocles of Carystus. A Collection of the Fragments with Translation and Commentary. 2 vols. Leiden: Brill, 2000–01.

Van der Eijk, Philip J., ed. Hippocrates in Context. Leiden: Brill, 2005.

Von Staden, Heinrich. Herophilus. The Art of Medicine in Early Alexandria. Cambridge, U.K.: Cambridge University Press, 1989.

———. “Spiderwoman and the Chaste Tree: The Semantics of Matter.” Configurations 1 (1992a): 23–56.

———. “Women and Dirt.” Helios 19 (1992b): 7–30.

———. “‘In a Pure and Holy Way:’ Personal and Professional Conduct in the Hippocratic Oath?” Journal of the History of Medicine and Allied Sciences 51 (1996): 404–37.

Helen King

HIPPOCRATES

HIPPOCRATES (460?–380? bce) was a celebrated Greek physician, called the "father of medicine." In spite of his reputation as the founder of scientific medicine, the embodiment of medical wisdom, and the exemplar of the ideal physician, little is known with certainty about Hippocrates' life. There are only a few contemporary or near-contemporary references to him. He is mentioned by Plato (Protagoras 311b–c, Phaedrus 270c), Aristotle (Politics 1326a14), and Aristotle's pupil Menon (in Anonymous Londinensis 5–6). He is said to have been a native of the island of Kos, off the southwestern coast of Asia Minor, and to have been an Asclepiad (the term may refer to a family or a guild of physicians that traced their origin to Asklepios, the god of healing, or may simply mean "physician"). He was, according to these sources, a teacher of medicine whose fame Plato compared to that of the sculptors Polyclitus and Phidias. He taught that one cannot understand the body without taking into account the whole, and he explained disease as the result of air that forms in the body during the process of digestion.

A biographical tradition that began long after his lifetime incorporated additional details, many of them anecdotal and legendary. Four short biographies are extant. The earliest is attributed to Soranus, a medical writer of the second century ce, while the others were recorded in the Suda, a tenth-century encyclopedia; by the twelfth-century Byzantine poet and scholar Tzetzes; and by an unknown late Latin writer. It is uncertain how much of the information they contain is trustworthy. They relate that Hippocrates learned medicine from his father Heraclides, who was a physician; that he studied under the atomist Democritus and the Sophist Gorgias; that he traveled extensively in Greece, visiting Athens, northern Greece, and the Propontis (the present-day Sea of Marmara); that he taught medical students on Kos; and that he died at an advanced age at Larissa in Thessaly, where he was buried. Additional biographical material contained in a collection of spurious epistles attributed to Hippocrates is almost certainly fictitious.

There has come down to the present, under the name of Hippocrates, a large and heterogeneous collection of medical books, the so-called Hippocratic treatises, which consist of some sixty different works, all written in the Ionic dialect. Most of them date from the late fifth or fourth centuries bce, but some are much later. The collection may have originated as the library of a medical school (perhaps that of Kos) that was brought to Alexandria in the third century bce where it came to be attributed to Hippocrates. All the works are anonymous and exhibit differences of style and approach. It is widely held today that none can be attributed with certainty to Hippocrates. It is possible that he wrote some of them, but there is no agreement on which, if any, are authentic. The Hippocratic treatises are the work of many hands and represent a variety of points of view, both lay and professional. They include clinical, theoretical, and ethical writings.

The best known of the Hippocratic writings is the so-called Hippocratic Oath. Exactly when it was written is uncertain. Although the earliest mention of it is in the first century ce, it may date from as early as the fourth century bce. There is no evidence of its use in the pre-Christian era. Those who took the oath swore by Apollo, Asklepios, and other gods and goddesses of healing to guard their life and art "in purity and holiness." Its religious tenor and some of its injunctions (e.g., prohibition of abortions, euthanasia, and perhaps surgery) suggest that it originated among a restricted group of physicians (perhaps the Pythagoreans, a philosophical sect that emphasized moral purity, asceticism, and piety) who lay outside the mainstream of Greek medicine. The oath was later adopted by Christians, Jews, and Muslims, and (with necessary changes) it gained wide use.

According to popular Greek opinion, disease and death were sent by gods or demons. The Hippocratic writers, influenced by the pre-Socratic philosophers, for the most part rejected this supernatural etiology of disease. Hippocratic medicine was both empirical and rational. It was empirical in being based on meticulous clinical observation (its case histories remained unparalleled until the sixteenth century), and rational in rejecting magic and superstition and viewing disease as the result of natural causes. The Hippocratic treatise On the Sacred Disease exhibits this rational approach to medicine. The writer does not accept the traditional view that epilepsy is caused by divine possession. It is, he believes, no more sacred than any other disease, and has a natural cause. In rejecting a magico-religious etiology for a natural one, Hippocratic writers did not display an antipathy to religion. Instead, they regarded all things (including disease) as both natural and divine. Medicine itself was a divine art, in which the physician sought the assistance of the gods. "Prayer indeed is good, but while calling on the gods a man should himself lend a hand" (Regimen 87). The Hippocratic physicians recognized the healing force of nature (vis medicatrix naturae ) and attempted to assist the body to heal itself.

There existed alongside Hippocratic medicine a tradition of religious healing centered in the cults of various gods, demigods, and heroes. The most notable was the cult of Asklepios, who by the fourth century bce came to be the chief healing god of Greece, eclipsing all others as his cult spread throughout Greece. Sanctuaries of Asklepios were later established throughout the Mediterranean world and attracted the sick, who sought miraculous healing from the god. Hippocratic medicine and temple-healing coexisted apparently without antagonism. Temple-healing by Asklepios was regarded as complementing secular medicine, particularly in chronic cases for which medicine could do little. Both secular and religious healing came from the same god, who assisted physicians as well as the sick. Asklepios was the patron of physicians. Galen called himself a servant of Asklepios, and in Athens physicians offered sacrifices to the god for themselves and their patients.

The deontological treatises of the Hippocratic collection are the earliest writings on medical etiquette. They seek to create a distinct identity for the physician and to lay down guidelines for professional conduct. In establishing a standard of behavior by defining the obligations of the physician, they created both a tradition of medical ethics and an ideal of dedicated and compassionate practice, which were subsequently adopted in late antiquity and the Middle Ages by Christian, Jewish, and Muslim physicians. They have continued to influence the Western medical tradition down to the present day and they remain the greatest legacy of Hippocratic medicine.

Bibliography

The complete critical edition of the works attributed to Hippocrates, with French translation, remains Émile Littré's Les œuvres complètes d'Hippocrate, 10 vols. (1839–1861; reprint, Amsterdam, 1961). There is no English translation of the entire Hippocratic corpus. For a translation of many of the most important treatises with accompanying Greek text, see Hippocrates, vols. 1–4, edited by W. H. S. Jones and E. T. Withington (Cambridge, Mass., 1923–1931); vols. 5, 6, 8, edited by Paul Potter (Cambridge, Mass., 1988–1995); and vol. 7, edited by Wesley B. Smith (Cambridge, Mass., 1994).

On the problem of determining which treatises, if any, were written by Hippocrates, see G. E. R. Lloyd's paper, "The Hippocratic Question," Classical Quarterly, n.s. 25 (1975): 171–192; and Ludwig Edelstein, "The Genuine Works of Hippocrates," in Ancient Medicine: Selected Papers of Ludwig Edelstein, translated and edited by Owsei Temkin and C. Lilian Temkin (Baltimore, 1967), pp. 133–144. The volume contains several important papers by Edelstein on Hippocratic medicine, the Hippocratic Oath, the religious outlook of the Hippocratic treatises, and Hippocratic medical ethics. A good general treatment of Hippocrates and all aspects of Hippocratic medicine can be found in Jacques Jouanna, Hippocrates, translated by M. B. DeBevoise (Baltimore, 1999). On the Hippocratic tradition see W. D. Smith, The Hippocratic Tradition (Ithaca, N.Y., 1979); and Owsei Temkin, Hippocrates in a World of Pagans and Christians (Baltimore, 1991).

Gary B. Ferngren (1987 and 2005)

Hippocrates

The ancient Greek physician Hippocrates (ca. 460-ca. 377 B.C.), the father of medicine, put a definitive stamp on the whole character of Greek medicine.

Only the barest outline of the biography of Hippocrates emerges from the ancient writings. He was born on the Aegean island of Cos, just off the Ionian coast near Halicarnassus. He is called Hippocrates Asclepiades, "descendant of (the doctor-god) Asclepios, " but whether this descent was by family or merely by his espousing the medical profession is uncertain. His teachers in medicine are said to have been his father, Heracleides, and Herodicos of Selymbria. Hippocrates certainly was known in Athens, for Plato mentions him twice, on each occasion calling him Asclepiades. It is also clear that the height of his career was during the Peloponnesian War (431-404 B.C.).

The lack of knowledge concerning Hippocrates may seem strange in view of the great volume of writings attributed to him, the Corpus Hippocraticum (Hippocratic Corpus), the first known edition of which is from the time of the emperor Hadrian (reigned A.D. 117-138). It is clear, however, that this body of writings contains material of many different kinds and includes differences in standpoint toward medicine. This disparity was recognized even in ancient times, and Alexandrian scholars differed about the authentic Hippocrates, though none rejected every work.

Any notion of the nature of Hippocrates's medical procedure must be based on pre-Alexandrian texts, that is, on texts dating more closely to Hippocrates's lifetime and reflecting an untainted direct tradition. Two excellent sources are Plato's Phaedrus (270C-D) and Meno's account of Hippocrates in his history of medicine. There is sufficient evidence in these works to establish with certainty the main outlines of Hippocratic medicine.

In antiquity, some works in the Hippocratic Corpus were recognized as having been written by persons other than Hippocrates, but acceptance and rejection depended on a number of subjective stances. More modern scholarship has used as its touchstone the genuine doctrine of Hippocrates as found in Plato and Meno. This mode of investigation, while common to all scholars, has not produced general agreement. It is well to point out that neither Plato nor Meno quotes word for word from Hippocrates's works; they seem in fact to summarize him in their own words, which of course have overtones from their own particular philosophy. So although there is a body of doctrine connected with Hippocrates, modern scholars have no inkling of his prose style, against which the Hippocratic Corpus could be tested.

Nowhere in the Hippocratic Corpus is the entire Hippocratic doctrine to be found. However, these numerous works are so multifarious that here and there parts of the doctrine come to light. It is worth noting that, since Plato and Meno discussed the work of Hippocrates, it is reasonable to assume that they had at their disposal medical books written by him. This makes the problem even more intriguing. Hippocrates's fame, though it was at such a height during his lifetime, still could not ensure the preservation of his works.

Hippocratic Corpus

The body of writing attributed to Hippocrates, the Hippocratic Corpus, is a collection of roughly 70 works that show no uniformity in teaching or in prose style. With a few exceptions the dates of these works range between 450 and 350 B.C.; they are the oldest surviving complete medical books. It would be unfair to allege deception as the motive behind attributing the entire collection to Hippocrates; nor was it the result of ignorance and carelessness, since Galen and those before him did not regard every work as genuine. A reasonable hypothesis holds that these works were gathered together to form the basis of the medical library of some school, probably at Alexandria.

An essential orientation to the Corpus is an appreciation of the audience for which the various works were intended. Some books are directed toward the physician, for example, the surgical treatises, Prognostic, Airs Waters Places, Regimen in Acute Disease, Aphorisms and Epidemics i, in which descriptions of symptoms employ sense data, though they surpass mere descriptions. There are books with complicated pharmacy mixtures, and equally complicated preparation and administration, aimed, no doubt, at the professional physician. Other books, however, are directed more at the layman, for example, Regimen in Health, Regimen ii-iv, and Affections, in which the introduction stresses the importance for the layman of understanding something of medical questions.

One must remember that in antiquity doctors wrote treatises for the educated public, who in turn discussed medical problems with their doctors. The aim of these books is not to advise on self-treatment or even first aid, and so to dispense with the need for a doctor; rather, it is to teach the layman how to judge a physician.

The Hippocratic Corpus also contains polemical works. The Sacred Disease attacks superstition, and On Ancient Medicine opposes the intrusion of speculative philosophy into medicine. The latter work also protests against "narrowing down the causes of death and disease." But there are indeed attempts to apply to medicine the speculative method of early Greek philosophy, as in Regimen i and Nutrition. Occasionally there is no carefully written treatise but a series of jottings—research material in notebook form: Humors and Epidemics i-vii.

Experimentation obviously played its role in the Hippocratic view of medicine, because the individual approach to disease as exemplified in the case histories of Epidemics i, though basic and undeveloped, is nothing more than experimentation. It is obvious, too, that first-hand experience, as opposed to theorizing, played a part, since in scattered references throughout the Corpus the botanical ingredients of remedies are described by taste and odor. There are also instances of very rudimentary laboratory-type experiments. The Sacred Disease describes dissections of animals, the results of which permitted analogies to the human body to be drawn. Further, in their attempts to describe the body, the Hippocratics made use of external observation only. In On Ancient Medicine, the internal organs are described as they can be seen or palpated externally. It is most unlikely that dissection of the human body was practiced in the 5th century.

In Epidemics i the patient's comfort is noted as a matter of concern to the physician, because he was given water when thirsty and cooled when feverish. E. A. Ackerknecht, in A Short History of Medicine, summed up: "For better or worse Hippocrates observed sick people, not diseases." This attitude is a timely antidote to those who formerly insisted on the coldly scientific approach of the Hippocratic physician, who seemed to be so callous toward his patient, particularly in the blunt descriptions of the countenance before death in certain diseases, still known as facies hippo-cratica.

The above illustrations are meant to clarify the most fundamental concerns of the Hippocratic physician. Yet a too enthusiastic and uncritical attitude has been attached to the area of medical ethics also. Ludwig Edelstein commented in his important work on the oath (The Hippocratic Oath, 1943) that the high morality and ethics of this document were not true of the 5th century B.C. but were the result of the infusion of philosophical precepts (mainly Pythagorean) of the end of the 4th century B.C. and later. As a result, the ethic of the medical craftsman was renewed to conform with the various systems of philosophy. This was furthermore not an oath taken by all physicians, if in fact it was sworn by any doctor before the end of antiquity; its fame is more modern than that.

Further Reading

Several Hippocratic treatises are translated in the Loeb Classical Library, Hippocrates (4 vols., 1923-1931). The best treatment of Hippocratic problems is in Oswei Temkin and C. Lilian Temkin, eds., Ancient Medicine: Selected Papers of Ludwig Edelstein (1967). See also William A. Heidel, Hippocratic Medicine: Its Spirit and Method (1941). Background information is in G. E. Lloyd, Early Greek Science: Thales to Aristotle (1971). □

Hippocrates

Born: c. 460 b.c.e.
Cos, Greece
Died: c. 377 b.c.e.
Larissa, Greece
Greek physician

The ancient Greek physician Hippocrates is called the father of medicine. He changed the course of Greek medicine with his certainty that disease was not caused by gods or spirits but was the result of natural action.

Early life

Hippocrates was born on the Aegean island of Cos, just off the Ionian coast near Halicarnassus (island of Greece) during the end of the fifth century b.c.e. He is called Hippocrates Asclepiades, "descendant of (the doctor-god) Asclepios," but it is uncertain whether this descent was by family or merely by his becoming attached to the medical profession. Legend likewise places him in the family line of the hero Hercules.

Son of Heracleides and Praxithea, Hippocrates's family's wealth permitted him to have a good educational beginning as a child. After nine years of physical education, reading, writing, spelling, music, singing, and poetry, he went to a secondary school, where he spent two years and had very thorough athletic training. It is likely that he went on to study medicine under his father in a form of apprenticeship (arrangement to learn a trade through work experience). This involved following his father and another doctor, Herodicos, from patient to patient and observing their treatment. It is believed that his training included traveling to the Greek mainland and possibly to Egypt and Libya to study medical practices.

Adult talents

Hippocrates is credited with healing many, including the king of Macedonia whom he examined and helped to recover from tuberculosis (disease of the lungs). His commitment to healing was put to the test when he battled the plague (a bacteria-caused disease that spreads quickly and can cause death) for three years in Athens (430–427 b.c.e.). It is also clear that the height of his career was during the Peloponnesian War (431–404 b.c.e.).

His teaching was as well-remembered as his healing. A symbol of the many students he encouraged is the "Tree of Hippocrates," which shows students sitting under a tree listening to him. In time he apprenticed his own sons, Thessalus and Draco, in the practice of medicine. The teacher and doctor role combined well in 400 b.c.e., when he founded a school of medicine in Cos.

Hippocratic Corpus

The body of writing attributed to Hippocrates, the Hippocratic Corpus, is a collection of roughly seventy works—the oldest surviving complete medical books. In ancient times some works in the Hippocratic Corpus, the first known edition of which are from the time of the emperor Hadrian (reigned c.e. 117–138), were recognized as having been written by persons other than Hippocrates. Modern scholars have no knowledge of his writing style to prove which of the works Hippocrates wrote. Nowhere in the Hippocratic Corpus is the entire Hippocratic set of guidelines found. Each subject was written with a particular reader in mind. Some books are directed toward the physician, some for the pharmacist, some for the professional physician, and some are directed more at the layman (person who is not an expert in the field).

In Hippocrates's time doctors wrote treatises (written arguments) for the educated public, who in turn discussed medical problems with their doctors. The aim of these books was to teach the layman how to judge a physician—not to advise on self-treatment or even first aid in order to avoid seeing a doctor.

These medical treatises made up the Hippocratic Corpus. Modern readers can see that experimentation played its role in the Hippocratic view of medicine, because the individual approach to disease is nothing more than experimentation. It is obvious, too, that firsthand experience played a part, since throughout the Corpus the plant ingredients of remedies are described by taste and odor. There are also instances of very basic laboratory-type experiments. The Sacred Disease, one treatise of the Hippocratic Corpus, describes dissections (the act of being separated into pieces) of animals, the results of which permitted comparisons to the human body to be drawn. Further, in their attempts to describe the body, the Hippocratics made use of external (outside) observation only. In On Ancient Medicine the internal organs are described as they can be seen or felt externally. It is most unlikely that dissection of the human body was practiced in the fifth century b.c.e.

Hippocrates favored the use of diet and exercise as cures but realized that some people, unable to follow such directions, would need medicine. His writings teach that physical handling could cure some physical troubles, like a dislocated hip, by the doctor moving it back into place. In A Short History of Medicine E. A. Ackerknecht summed it up: "For better or worse Hippocrates observed sick people, not diseases." This attitude is a timely solution to those who formerly insisted on the coldly scientific approach of the Hippocratic physician, who seemed to be so callous toward his patient.

Little is known of Hippocrates's death other than a range of date possibilities. Different sources give dates of either 374 b.c.e., the earliest date, or 350 b.c.e., the latest date. What lives on in modern medicine is his commitment to the treatment of disease.

For More Information

Cantor, David, ed. Reinventing Hippocrates. Burlington, VT: Ashgate, 2002.

Jouanna, Jacques. Hippocrates. Baltimore, MD: Johns Hopkins University Press, 1999.

Levine, Edwin Burton. Hippocrates. New York: Twayne Publishers, 1971.

Lloyd, G. E. R. Early Greek Science: Thales to Aristotle. New York: Norton, 1971.