GENERAL INTRODUCTION TO HIPPOCRATES by W. H. S. Jones

1. Greek Medicine and Hippocrates

WE have learned to associate, almost by instinct, the science of medicine with bacteria, with chemistry, with clinical thermometers, disinfectants, and all the apparatus of careful nursing. All such associations, if we wish even dimly to appreciate the work of Hippocrates and of his predecessors, we must endeavour to break ; we must unthink the greater part of those habits of thought which education has made second nature. The Greek knew that there were certain collections of morbid phenomena which he called diseases ; that these diseases normally ran a certain course ; that their origin was not unconnected with geographical and atmospheric environment ; that the patient, in order to recover his health, must modify his ordinary mode of living. Beyond this he knew, and could know, nothing, and was compelled to fill up the blanks in his knowledge by having recourse to conjecture and hypothesis. In doing so he was obeying a human instinct which assures us that progress requires the use of stop-gaps where complete and accurate knowledge is unattainable, and that a working hypothesis, although wrong, is better than no hypothesis at all. System, an organized scheme, is of greater value than chaos. Yet however healthy such an instinct may be, it has added considerably to the difficulties of the historian in his attempts so to reconstruct the past as to make it intelligible to modern readers.

Primitive man regards everything he cannot explain as the work of a god. To him the abnormal, the unusual, is divine. The uncharted region of mysterious phenomena is the peculiar realm of supernatural forces. “It is the work of heaven” is a sufficient answer when the human intelligence can give no satisfactory explanation.

The fifth century B.C. witnessed the supreme effort of the Greeks to cast aside this incubus in all spheres of thought. They came to realize that to attribute an event to the action of a god leaves us just where we were, and that to call normal phenomena natural and abnormal divine is to introduce an unscientific dualism, in that what is divine (because mysterious) in one generation may be natural (because understood) in the next, while, on the other hand, however fully we may understand a phenomenon, there must always be a mysterious and unexplained element in it. All phenomena are equally divine and equally natural.

But this realization did not come all at once, and in the science of medicine it was peculiarly slow. There is something arresting in the spread of an epidemic and in the onset of epilepsy or of a pernicious fever. It is hard for most minds, even scientific minds, not to see the working of a god in them. On the other hand, the efficacy of human means to relieve pain is so obvious that even in Homer, our first literary authority for Greek medicine, rational treatment is fully recognized.

As the divine origin of disease was gradually discarded, another element, equally disturbing, and equally opposed to the progress of scientific medicine, asserted itself. Philosophy superseded religion. Greek philosophy sought for uniformity in the multiplicity of phenomena, and the desire to find this uniformity led to guesswork and to neglect of fact in the attempt to frame a comprehensive theory. The same impulse which made Thales declare that all things are water led the writer of a treatise in the Hippocratic Corpus to maintain that all diseases are caused by air. As Daremberg says, “ the philosophers tried to explain nature while shutting their eyes.” The first philosophers to take a serious interest in medicine were the Pythagoreans. Alcmaeon of Croton, although perhaps not strictly a Pythagorean, was closely connected with the sect, and appears to have exercised considerable influence upon the Hippocratic school. The founder of empirical psychology and a student of astronomy, he held that health consists of a state of balance between certain “ opposites,” and disease an undue preponderance of one of them. Philolaus, who flourished about 440 B.C., held that bile, blood, and phlegm were the causes of disease. In this case we have a Pythagorean philosopher who tried to include medical theory in his philosophical system. Empedocles, who flourished somewhat earlier than Philolaus, was a “ medicine-man “ rather than a physician, though he is called by Galen the founder of the Italian school of medicine. The medical side of his teaching was partly magic and quackery.

This combination of medicine and philosophy is clearly marked in the Hippocratic collection. There are some treatises which seek to explain medical phenomena by a priori assumptions, after the manner of the philosophers with their method of ὑποθέςεις or postulates ; there are others which strongly oppose this method. The Roman Celsus in his preface asserts that Hippocrates separated medicine from philosophy, and it is a fact that the best works of the Hippocratic school are as free from philosophic assumptions as they are from religious dogma. But before attempting to estimate the work of Hippocrates it is necessary to consider, not only the doctrine of the philosophers, but also the possibly pre-Hippocratic books in the Corpus. These are the Prenotions of Cos and the First Prorrhetic, and perhaps the treatise — in Latin and Arabic, the Greek original having mostly perished — on the number seven (περὶ ἑβδομάδων). The Prenotions of Cos and the First Prorrhetic (the latter being the earlier, although both are supposed to be earlier than Hippocrates) show that in the medical school of Cos great attention was paid to the natural history of diseases, especially to the probability of a fatal or not fatal issue. The Treatise on Seven , with its marked Pythagorean characteristics, proves, if indeed it is as early as Roscher would have us believe, that even before Hippocrates disease was considered due to a disturbance in the balance of the humours, and health to a “ coction “ of them, while the supposed preponderance of seven doubtless exercised some influence on the later doctrine of critical days. The work may be taken to be typical of the Italian-Sicilian school of medicine, in which a priori assumptions of the “ philosophic “ type were freely admitted. Besides these two schools there was also a famous one at Cnidos, the doctrines of which are criticised in the Hippocratic treatise Regimen in Acute Diseases. The defects of this school seem to have been : —

(1) the use of too few remedies ;

(2) faulty or imperfect prognosis ;

(3) over-elaboration in classifying diseases.

We may now attempt to summarize the components of Greek medicine towards the end of the fifth century B.C.

(1) There was a religious element, which, however, had been generally discarded.

(2) There was a philosophic element, still very strong, which made free use of unverified postulates in discussing the causes and treatment — especially the former — of diseases.

(3) There was a rational element, which relied upon accurate observation and accumulated experience. This rationalism concluded that disease and health depended on environment and on the supposed constituents of the human frame.

Now if we take the Hippocratic collection we find that in no treatise is there any superstition, in many there is much “ philosophy “ with some sophistic rhetoric, and among the others some are merely technical handbooks, while others show signs of a great mind, dignified and reserved with all the severity of the Periclean period, which, without being distinctively original, transformed the best tendencies in Greek medicine into something which has ever since been the admiration of doctors and scientific men. It is with the last only that I am concerned at present.

I shall make no attempt to fix with definite precision which treatises are to be included in this category, and I shall confine myself for the moment to three — Prognostic, Regimen in Acute Diseases, and Epidemics I. and III. These show certain characteristics, which, although there is no internal clue to either date or authorship, impress upon the reader a conviction that they were written by the same man, and at a time before the great period of Greece had passed away. They remind one, in a subtle yet very real way, of Thucydides.

The style of each work is grave and austere. There is no attempt at “ window-dressing.” Language is used to express thought, not to adorn it. Not a word is thrown away. The first two treatises have a literary finish, yet there is no trace in them of sophistic rhetoric. Thought, and the expression of thought, are evenly balanced. Both are clear, dignified — even majestic.

The matter is even more striking than the style. The spirit is truly scientific, in the modern and strictest sense of the word. There is no superstition, and, except perhaps in the doctrine of critical days, no philosophy. Instead, there is close, even minute, observation of symptoms and their sequences, acute remarks on remedies, and recording, without inference, of the atmospheric phenomena, which preceded or accompanied certain “epidemics.” Especially noteworthy are the clinical histories, admirable for their inclusion of everything that is relevant and their exclusion of all that is not.

The doctrine of these three treatises may be summarised as follows : — (1) Diseases have a natural course, which the physician must know thoroughly, so as to decide whether the issue will be favourable or fatal.

(2) Diseases are caused by a disturbance in the composition of the constituents of the body. This disturbance is connected with atmospheric and climatic conditions.

(3) Nature tries to bring these irregularities to a normal state, apparently by the action of innate heat, which “ concocts “ the “ crude “ humours of the body.

(4) There are “ critical “ days at fixed dates, when the battle between nature and disease reaches a crisis.

(5) Nature may win, in which case the morbid matters in the body are either evacuated or carried off in an ἀπός1τας1ις2, or the “ coction “ of the morbid elements may not take place, in which case the patient dies.

(6) All the physician can do for the patient is to give nature a chance, to remove by regimen all that may hinder nature in her beneficent work.

It may be urged that this doctrine is as hypothetical as the thesis that all diseases come from air. In a sense it is. All judgments, however simple, attempting to explain sense-perceptions, are hypotheses. But hypotheses may be scientific or philosophic, the latter term being used to denote the character of early Greek philosophy. A scientific hypothesis is a generalization framed to explain the facts of experience ; it is not a foundation, but is in itself a superstructure ; it is constantly being tested by appeals to sense-experience, and is kept, modified or abandoned, according to the support, or want of support, that phenomena give to it. A “philosophic” hypothesis is a generalization framed with a view to unification rather than to accounting for all the facts ; it is a foundation for an unsubstantial superstructure ; no efforts are made to test it by appeals to experience, but its main support is a credulous faith.

Now the doctrine of the Epidemic group is certainly not of the philosophic kind. Some of it was undoubtedly derived from early philosophic medicine, but in this group of treatises observed phenomena are constantly appealed to ; nor must it be forgotten that in the then state of knowledge much that would now be styled inference was then considered fact, e. g. the “coction” of phlegm in a common cold. Throughout, theory is in the background, observation in the foreground. It is indeed most remarkable that Hippocratic theory is hard to disentangle from the three works on which my argument turns. It is a nebulous framework, implied in the technical phraseology — πέψις2, κρίς1ις2, κρᾶς1ις2 — and often illustrated by appeal to data , but never obtrusively insisted upon.

In 1836 a French doctor, M. S. Houdart, violently attacked this medical doctrine on the ground that it neglected the physician’s prime duty, which is to effect a cure. Diagnosis, he urges, is neglected in the cult of prognosis ; no attempt is made to localize the seat of disease ; the observations in the Epidemics are directed towards superficial symptoms without any attempt to trace them to their real cause. The writer is an interested but callous spectator who looks on unmoved while his patient dies.

In this rather rabid criticism there is a morsel of truth. The centre of interest in these treatises is certainly the disease rather than the patient. The writer is a cold observer of morbid phenomena, who has for a moment detached himself from pity for suffering. But this restraint is in reality a virtue ; concentration on the subject under discussion is perhaps the first duty of a scientist. Moreover, we must not suppose that the fatally-stricken patients of the Epidemics received no treatment or nursing. Here and there the treatment is mentioned or hinted at, but the writer assumes that the usual methods were followed, and does not mention them because they are irrelevant.

The charge of callousness may be dismissed. More serious is the attack on the fundamental principle of Hippocratic medicine, that “ nature “ alone can effect a cure, and that the only thing the physician can do is to allow nature a chance to work. Modern medical science has accepted this principle as an ultimate truth, but did the writer of the three treatises under discussion do his best to apply it ? Did he really try to serve nature, and, by so doing, to conquer her ? Houdart says that practically all the author of the Epidemics did was “ to examine stools, urine, sweats, etc., to look therein for signs of coction, to announce crises and to pronounce sentences of death,” in other words that he looked on and did nothing. I have just pointed out that the silence of the Epidemics on the subject of treatment must not be taken to mean that no treatment was given, but it remains to be considered whether all was done that could have been done. What remedies were used by the author of Regimen in Acute Diseases ? They were : —

(1) Purgatives and, probably, emetics.

(2) Fomentations and baths.

(3) ( a ) Barley-water and barley-gruel, in the preparation and administering of which great care was to be taken.

（ b ) Wine.

（ c ) Hydromel, a mixture of honey and water ; and oxymel, a mixture of honey and vinegar. (4) Venesection.

(5) Care was taken not to distress the patient.

If we take into account the scientific knowledge of the time, it is difficult to see what more the physician could have done for the patient. Even nowadays a sufferer from measles or influenza can have no better advice than to keep warm and comfortable in bed, to take a purge, and to adopt a diet of slops. Within the last few years, indeed, chemistry has discovered febrifuges and anaesthetics, the microscope has put within our reach prophylactic vaccines, and the art of nursing has improved out of all recognition, but nearly all these things were as unknown to M. Houdart as they were in the fifth century B.C.

This criticism of Hippocratic medicine has been considered, not because it is in itself worthy of prolonged attention, but because it shows that underlying the three treatises I have mentioned there is a fundamental principle, a unity, a positive characteristic implying either a united school of thought or else a great personality. All antiquity agreed that they were written by the greatest physician of ancient times — Hippocrates. Within the last hundred years, however, doubts have been expressed whether Hippocrates wrote anything. Early in the nineteenth century a doctor of Lille published a thesis intitled Dubitationes de Hippocratis vita, patria, genealogia, forsan mythologicis, et de quibusdam eius libris multo antiquioribus quam vulgo creditur. Wellmann and Wilamowitz hold similar views nowadays. As the Hippocratic writings are all anonymous, such a hypothesis is not difficult to maintain. But it is a matter of merely antiquarian interest whether or not the shadowy “ Hippocrates “ of ancient tradition is really the writer of the Epidemics. The salient and important truth is that in the latter half of the fifth century works were written, probably by the same author, embodying a consistent doctrine of medical theory and practice, free from both superstition and philosophy, and setting forth rational empiricism of a strictly scientific character. If in future I call the spirit from which this doctrine emanated “ Hippocrates “ it is for the sake of convenience, and not because I identify the author with the shadowy physician of tradition.

Similar in style and in spirit to the three treatises discussed above are Aphorisms and Airs Waters Places , along with two surgical works, Fractures and Wounds in the Head. The severely practical character of the last is particularly noteworthy, and makes the reader wonder to what heights Greek surgery would have risen had antiseptics been known. Aphorisms is a compilation, but a great part shows a close relationship to the Hippocratic group. The least scientific of all the seven treatises is Airs Waters Places , which, in spite of its sagacity and rejection of the supernatural, shows a tendency to facile and unwarranted generalization.

2. The Hippocratic Collection

We are now in a position to attempt a brief analysis of the Corpus Hippocraticum. For the moment the external evidence of Galen and other ancient commentators, for or against the authenticity of the various treatises, will be passed over. This evidence is of great importance, but may tend to obscure the issue, which is the mutual affinities of the treatises as shown by their style and content.

In the first place the heterogeneous character of the Corpus should be observed. It contains : —

(1) Text-books for physicians ;

(2) Text-books for laymen ;

(3) Pieces of research or collection of material for research.

(4) Lectures or essays for medical students and novices.

(5) Essays by philosophers who were perhaps not practising physicians, but laymen interested in medicine and anxious to apply to it the methods of philosophy.

(6) Note-books or scrap-books.

Even single works often exhibit the most varied characteristics. It is as though loose sheets had been brought together without any attempt at coordination or redaction. Epidemics I. , for instance, jumps with startling abruptness from a “ constitution “ of the diseases prevalent at one period in Thasos to the function of the physician in an illness, passing on to a few disjointed remarks on pains in the head and neck. Then follows another “ constitution,” after which comes an elaborate classification of the ordinary fevers, with their periods, paroxysms and crises. At the end come fourteen clinical histories.

I have already mentioned a pre-Hippocratic group and a Hippocratic group, and it has been noticed that the main task of Greek medicine was to free science from superstition and from philosophic hypotheses. The Corpus contains two polemical works, On Epilepsy and Ancient Medicine , which attack respectively the “ divine “ origin of disease and the intrusion into medicine of the hypothetical speculation of philosophers.

There is another group of works which, while they do not display to any marked degree the Hippocratic characteristics, are nevertheless practical handbooks of medicine, physiology or anatomy. The list is a long one, and includes works by different authors and of different schools : —

The Surgery.

The Heart.

Places in Man.

Glands.

Anatomy.

Nature of the Bones.

Sight.

Dentition.

Diseases I.

Diseases II. and III.

Affections.

Internal Affections.

Sores.

Fistulae.

Hemorrhoids. Prorrhetic II.

The Physician.

Crises.

Critical Days.

Purges.

Use of Liquids.

Seventh Month Child.

Eighth Month Child.

Generation.

Nature of the Child.

Diseases IV.

Diseases of Women.

Barrenness.

Diseases of Girls.

Nature of Women.

Excision of the Foetus.

Superfoetation.

Regimen in Health.

Regimen II. and III. with Dreams.

Another most important group of works consists of those in which the philosophic element predominates over the scientific, the writers being anxious, not to advance the practice of medicine, but to bring medicine under the control of philosophic dogma, to achieve in fact the end attacked by the writer of Ancient Medicine. These works are Nutriment, Regimen I. and Airs. The first two are Heraclitean ; the last is probably derived from Diogenes of Apollonia. Regimen I. , however, while strongly Heraclitean, is eclectic. Animals are said to be composed of two elements, fire and water, fire being a composite of the hot and the dry, water of the cold and the moist. Certain sentences are strikingly reminiscent of Anaxagoras, so much so that it is impossible to regard the resemblances as accidental. Take for instance the following : —

(1) ἀπόλλυται μὲν οὐν οὐδὲν ἁπάντων χορμάτων, οὐδὲ γίνεται ὅτι μὴ καὶ πρός1θεν ἠν. ξυμμις1γόμενα δὲ καὶ διακρινόμενα ἀλλοιοῦται. — Regimen I. IV.

(2) οὐδὲν γὰρ χρῆμα γίνεται οὐδὲ ἀπόλλυται, ἀλλ᾽ ἀπὸ ἐόντων χρημάτων ς1υμμίς1γεταί τε καὶ διακρίνεται. — Anaxagoras, fr. 22 (Schaubach).

To assign exact dates to these works is impossible, but they are probably much later than Heraclitus himself. The interesting fact remains that Heraclitus had followers who kept his doctrine alive, second-rate thinkers, perhaps, and unknown in the history of science, but hearty supporters of a creed, and ready to extend it to embrace all new know ledge as it was discovered. Particularly interesting is the work Nutriment. This not only adopts the theory of Heraclitus, but also mimics his sententious and mysterious manner of expression. A few examples may not be out of place.

φύς1ις2 ἐξαρκέει πάντα πᾶς1ιν. — Nutriment XV.

κρατέει γὰρ [sc. ὁ θεῖος2 νόμος2] . . . καὶ ἐξαρκέει πᾶς1ι. — Heraclitus apud Stob. Flor. III. 84.

μία φύς1ις2 εἶναι καὶ μὴ εἶναι. — Nutriment XXIV.

εἶμέν τε καὶ οὐκ εἶμεν. — Heraclitus Alleg. Hom. 24.

ὁδὸς2 ἄνω κάτω, μία. — Nutriment XLV. ὁδὸς2 ἄνω καὶ κάτω μία καὶ ὡυτή. — Heraclitus apud Hippolyt. IX. 10.

πρός2 τι πάντα φλαῦρα καὶ πάντα ἀς1τεῖα. — Nutriment XLV.

θάλας1ς1α ὕδωρ καθαρώτατον καὶ μιαρώτατον, ἰχθύς1ι μὲν πότιμον καὶ ς1ωτήριον, ἀνθρώποις2 δὲ ἄποτον καὶ ὀλέθριον. — Heraclitus apud Hippolyt. IX. 10.

χωρεῖ δὲ πάντα καὶ θεῖα καὶ ἀνθρώπεια, ἄνω καὶ κάτω ἀμειβόμενα. — Regimen I. V.

Similar to these philosophic treatises are the essays, ἐπιδείξεις2 or displays, which propound theses which are not the ὑποθές1εις2 of philosophers. These are The Art , the object of which is to show that there is an art of medicine, and Nature of Man , which combats the monist philosophers, and sets forth the doctrine of the four humours as the cause of health, by their perfect crasis , and of disease, through a disturbance of that crasis. To this group we may perhaps add the treatise Decorum , which deals (among other things) with bed-side manners, and Precepts , a work similar in style and subject.

The last two works are interesting for their introductory remarks. Decorum practically identifies medicine and philosophy, which term is used to denote the philosophic spirit, with its moral as well as its intellectual attributes, and recognises the working of an agency not human ; it is in fact typical of the ethical science, practical if occasionally commonplace, which came into vogue towards the end of the fourth century B.C. The introduction to Precepts is Epicurean. The first chapter, in fact, is a summary of Epicurean epistemology, and is full of the technical terms of that school. A single quotation will suffice : — ὁ γὰρ λογις1μὸς2 μνήμη τίς2 ἐς1τι ξυνθετικὴ τῶν μετ᾽ αἰς1θής1ιος2 ληφθέντων: ἐφαντας1ιώθη γὰρ ἐναργέως2 ἡ αἴς1θης1ις2, προπαθὴς2 καὶ ἀναπομπὸς2 ἐοῦς1α εἰς2 διάνοιαν τῶν ὑποκειμένων. — Precepts I.

This definition of λογις1μός2 is practically the same as that of the Epicurean πρόληψις2 given in Diogenes Laertius X. 33.

A few of the contents of the Corpus Hippocraticum remain unclassified. Of these, by far the most Hippocratic are Epidemics II., IV. VII. It is indeed remarkable that in antiquity they were not generally assigned to the “ great “ Hippocrates. The clinical histories are invaluable, although they are not so severely pertinent as those of Epidemics I. and III. , betraying sometimes an eye for picturesque but irrelevant detail.

The treatise curiously misnamed Fleshes contains, amid a variety of interesting anatomical and physiological detail, traces of Pythagoreanism in the virtue attached to the number seven, and of Heracliteanism in the view put forward that warmth is the spirit that pervades the universe.

Humours deals with the relations of humours to the seasons and so on.

The Oath and The Law are small but interesting documents throwing light on medical education and etiquette.

Finally, the Epistles and Decree , although merely imaginary essays, show what manner of man Hippocrates was supposed to have been by the Greeks of a later age. The Hippocratic collection is a medley, with no inner bond of union except that all the works are written in the Ionic dialect and are connected more or less closely with medicine or one of its allied sciences. There are the widest possible divergences of style, and the sharpest possible contradictions in doctrine. The questions present themselves, why were they united, and when did the union occur?

Littré’s problem, “When was the Hippocratic collection published?” cannot be answered, for it is more than doubtful whether, as a whole, the collection was ever published at all. The publication of a modern work must in no way be compared with the circulation of a book in ancient times. Printing and the law of copyright have created a revolution. As soon as an ancient author let go out of his possession a single copy of his book, it was, to all intents and purposes, “published.” Copies might be multiplied without permission, and a popular and useful work was no doubt often circulated in this way. Now at least one hundred, perhaps three hundred, years separate the writing of the earliest work in the Corpus from the writing of the latest. Diocles knew the Aphorisms , Ctesias probably knew Articulations , and Menon certainly knew two or three treatises. Aristotle himself quotes from Nature of Man , though he ascribes it to Polybus. It is surely impossible to suppose with Littré that there was anything approaching a publication of the Corpus by the Alexandrian librarians. Even if they had published for the first time only a large portion of the collection, such a momentous event would scarcely have passed unnoticed by the long series of commentators culminating in Galen. The librarians of Alexandria could not have done more than establish a canon, and if our present collection represents their work in this direction it was done very badly, as the most superficial critic would not fail to notice that a great part of its contents is neither by Hippocrates himself nor by his school.

The Hippocratic collection is a library, or rather, the remains of a library. What hypothesis is more probable than that it represents the library of the Hippocratic school at Cos? The ancient biographies of Hippocrates relate a fable that he destroyed the library of the Temple of Health at Cnidos (or, according to another form of the fable, at Cos) in order to enjoy a monopoly of the knowledge it contained. The story shows, at least, that such libraries existed, and indeed a school of medicine, like that which had its home at Cos, could not well have done without one. And what would this library contain? The works of the greatest of the Asclepiads, whether published or not ; valuable works, of various dates and of different schools, bearing on medicine and kindred subjects ; medical records and notes by distinguished professors of the school, for the most part unpublished ; various books, of no great interest or value, presented to the library or acquired by chance.

The Hippocratic collection actually corresponds to this description. This is nearly all the historian is justified in saying. Beyond is mere conjecture. We can only guess when this library ceased to be the property of the Hippocratic school, and how it was transferred to one or other of the great libraries which were collected in Alexandrine times, to be re-copied and perhaps increased by volumes which did not belong to the original collection.

It may be urged that if the Hippocratic Corpus were originally a library, it is improbable that all the treatises composing it would be written in Ionic. But it is by no means certain when Ionic ceased to be the normal medium for medical science ; for all we know the dialect may have been in vogue until long after the κοινή established itself throughout the Greek world. Moreover, we do not know what levelling forces were at work among copyists and librarians, inducing them to assimilate the dialects of medical works to a recognized model. We do know, however, that as centuries passed more and more Ionisms, most of them spurious, were thrust upon the Hippocratic texts. The process we can trace in the later history of the text may well have been going on, in a different form, in the fourth and third centuries B.C.

It is because I regard the Hippocratic collection as merely a library that I do not consider it worth while to attempt an elaborate classification, like those of Littré, Greenhill, Ermerins, and Adams. A library is properly catalogued according to subject matter, date, and authorship ; it is of little use to view each separate volume in its relationship to a particular writer. The Hippocrates of tradition and the Hippocrates of the commentators may well be left buried in obscurity and uncertainty. What we do know, what must be our foundation stone, is that certain treatises in the Corpus are impressed with the marks of an outstanding genius, who inherited much but bequeathed much more. He stands for science and against superstition and hypothetical philosophy. The other contents of the Corpus are older or later than this nucleus, either in harmony with its doctrines or opposed to them. More than this we cannot hope to know for certain.

3. Means of Dating Hippocratic Works

The means of fixing the dates of the treatises composing the Hippocratic collection are twofold — external and internal.

The external evidence consists of the statements of Galen and other ancient authors.

The internal tests are : —

（ a ) The philosophical tenets stated or implied ;

（ b ) The medical doctrines ;

（ c ) The style of the treatise ;

（ d ) The language and grammar.

（ a ) When a philosophic doctrine is adopted, or referred to as influential, it is presumptive evidence that the treatise was written before that doctrine grew out of date. We cannot, however, always be sure when a doctrine did grow out of date. It is a mistaken idea to suppose that the rise of a fresh school meant the death of its predecessors. It is certain, for instance, that Heraclitus had followers, after the rise of other schools, who developed his doctrines without altering their essential character.

（ b ) Medical doctrines also are by no means a certain test. If we could be sure that a knowledge of the pulse was unknown to the writers of the chief Hippocratic treatises, we should be more confident in dating, e.g. , the work called Nutriment , which recognizes the existence of a pulse. It is a fact that no use is made of this knowledge in any treatise of the collection, but we must not infer from this that the Hippocratic writers were ignorant of pulses. We can only infer that they were ignorant of their medical importance.

（ c ) The style of a treatise is sometimes a sure test and sometimes not. Sophistic rhetoric is of such a marked character in its most pronounced form that a treatise showing it is not likely to be much earlier than 427 B.C., nor much later than 400 B.C., when sophistic extravagances began to be modified under the influence of the Attic orators. But a work moderately sophistic in general style and sentence-structure may be much later.

There is also a subtle quality about writings later than 300 B.C., an unnatural verbosity and tortuousness of expression, a suspicion of the “baboo,” that is as unmistakable as it is impalpable. A few of the Hippocratic treatises display this characteristic.

（ d ) In some respects grammar and diction are the surest tests of all. If the negative μή is markedly ousting οὐ it is a sure sign of post-Alexandrine date. A preference for compound words with abstract meaning, in cases where a simple expression would easily have sufficed, is a mark of later Greek prose. If any reader wishes for concrete evidence to support my rather vague generalisations, he has only to read Epidemics I. , then The Art or Regimen I. , and finally Precepts or Decorum , and try to note the differences.

4. Plato’s References to Hippocrates

In the Protagoras (311 B) Plato assumes the case of a young man who goes to Ἱπποκράτη τὸν Κῷον, τὸν τῶν Ἀς1κληπιαδῶν, to learn medicine. This passage tells us little except that Hippocrates took pupils for a fee. But in the Phaedrus (270 C — E) there is another passage which professes to set forth the true Hippocratic method. It is as follows : —

Socrates. Do you think it possible, then, satisfactorily to comprehend the nature of soul apart from the nature of the universe?

ΣΩ. Ψυχῆς2 οὐν φύς1ιν ἀξίως2 λόγου κατανοῆς1αι οἴει δυνατὸν εἶναι ἄνευ τῆς2 τοῦ ὅλου φύς1εως2;

Phaedrus. Nay, if we are to believe Hippocrates, of the Asclepiad family, we cannot learn even about the body unless we follow this method of procedure.

ΦΑΙ. Εἰ μὲν οὖν Ἱπποκράτει γε τῷ τῶν Ἀς1κληπιαδῶν δεῖ τι πείθες1θαι, οὐδὲ περὶ ς1ώματος2 ἄνευ τῆς2 μεθόδου ταύτης2.

Socrates. Yes, my friend, and he is right. Yet besides the doctrine of Hippocrates, we must examine our argument and see if it harmonizes with it.

ΣΩ. Καλῶς2 γάρ, ὦ ἑταῖρε, λἐγει. χρὴ μέντοι πρὸς2 τῷ Ἱπποκράτει τὸν λόγον ἐξετάζοντα ς1κοπεῖν εἰ ς1υμφωνεῖ.

Phaedrus. Yes.

ΦΑΙ. Φημί.

Socrates. Observe, then, what it is that both Hippocrates and correct argument mean by an examination of nature. Surely it is in the following way that we must inquire into the nature of anything. In the first place we must see whether that, in which we shall wish to be craftsmen and to be able to make others so, is simple or complex. In the next place, if it be simple, we must inquire what power nature has given it of acting, and of acting upon what ; what power of being acted upon, and by what. If on the other hand it be complex, we must enumerate its parts, and note in the case of each what we noted in the case of the simple thing, through what natural power it acts, and upon what, or through what it is acted upon, and by what.

ΣΩ. Τὸ τοίνυν περὶ φύς1εως2 ς1κόπει τί ποτε λέγει Ἱπποκράτης2 τε καὶ ὁ ἀληθὴς2 λόγος2. ἆρ’ οὐχ ὧδε δεῖ διανοεῖς1θαι περὶ ὁτουοῦν φύς1εως2; πρῶτον μέν, ἁπλοῦν ἢ πολυειδές2 ἐς1τιν, οὗ πέρι βουλης1όμεθα εἶναι αὐτοὶ τεχνικοὶ καὶ ἄλλον δυνατοὶ ποιεῖν, ἔπειτα δέ, ἐὰν μὲν ἁπλοῦν ᾖ, ς1κοπεῖν τὴν δύναμιν αὐτοῦ, τίνα πρὸς2 τί πέφυκεν εἰς2 τὸ δρᾶν ἔχον ἢ τίνα εἰς2 τὸ παθεῖν ὑπὸ τοῦ; ἐὰν δὲ πλείω εἴδη ἔχῃ, ταῦτα ἀριθμης1άμενον, ὅπερ ἐφ’ ἑνός2, τοῦτ’ ἰδεῖν ἐφ̓ ἑκάς1του, τῷ τί ποιεῖν αὐτὸ πέφυκεν ἢ τῷ τί παθεῖν ὑπὸ τοῦ; — Phaedrus 270 C, D.

It is obvious that if we could find passages in the Hippocratic collection which clearly maintain the doctrine propounded in this part of the Phaedrus we should be able to say with confidence that the Hippocrates of history and tradition was the author of such and such a treatise.

Galen maintains that Plato refers to the treatise Nature of Man. I believe that few readers of the latter will notice any striking resemblances between this work and the doctrine outlined by Plato. More plausible is the view of Littré, that Plato refers to Chapter XX of Ancient Medicine , which contains the following passage : —

ἐπεὶ τοῦτό γε μοι δοκεῖ ἀναγκαῖον εἶναι παντὶ ἰητρῷ περὶ φύς1ιος2 εἰδέναι, καὶ πάνυ ς1πουδάς1αι ὡς2 εἴς1εται, εἴπερ τι μέλλει τῶν δεόντων ποιής1ειν, ὅ τί τέ ἐς1τιν ἄνθρωπος2 πρὸς2 τὰ ἐς1θιόμενά τε καὶ πινόμενα, καὶ ὅ τι πρὸς2 τὰ ἄλλα ἐπιτηδεύματα, καὶ ὅ τι ἀφ᾽ ἑκάς1του ἑκάς1τῳ ς1υμβής1εται.

Here the resemblance is closer — close enough to show that the author of Ancient Medicine , if he be not the Hippocrates of history, at least held views similar to his. And here the question must be left. Few would maintain with Littré that the resemblance between the two passages is so striking that they must be connected ; few again would deny that Plato was thinking of Ancient Medicine. Ignorance and uncertainty seem to be the final result of most of the interesting problems presented by the Hippocratic collection.

5. THE COMMENTATORS AND OTHER ANCIENT AUTHORITIES.

About the time of Nero a glossary of unusual Hippocratic terms was written by Erotian, which still survives. Erotian was not the first to compose such a work, nor was he the last, the most famous of his successors being Galen. An examination of this glossary, combined with testimony derived from Galen, throws some light on the history of the Hippocratic collection. It will be well to quote a passage from Erotian’s introduction, which contains a fairly complete list of commentators.

Παρὰ ταύτην γέ τοι τὴν αἰτίαν πολλοὶ τῶν ἐλλογίμων οὐκ ἰατρῶν μόνον, ἀλλὰ καὶ γραμματικῶν ἐς1πούδας1αν ἐξηγής1ας1θαι τὸν ἄνδρα καὶ τὰς2 λέξεις2 ἐπὶ τὸ κοινότερον τῆς2 ὁμιλίας2 ἀγαγεῖν. Ξενόκριτος2 γὰρ ὁ Κῷος2, γραμματικὸς2 ὤν, ὥς2 φης1ιν ὁ Ταραντῖνος2 Ἡρακλείδης2, πρῶτος2 ἐπεβάλετο τὰς2 τοιαύτας2 ἐξαπλοῦν φωνάς2. ὡς2 δὲ κυὶ ὁ Κιτιεὺς2 Ἀπολλώνιος2 ἱς1τορεῖ, καὶ Καλλίμαχος2 ὁ ἀπὸ τῆς2 Ἡροφίλου οἰκίας2. μεθ̓ ὅν φας1ι τὸν Ταναγραῖον Βακχεῖον ἐπιβαλεῖν τῇ πραγματείᾳ καὶ διὰ τριῶν ς1υντάξεων πληρῶς1αι τὴν προθες1μίαν, πολλὰς2 παραθέμενον εἰς2 τοῦτο μαρτυρίας2 ποιητῶν, ᾧ δὴ τὸν ἐμπειρικὸν ς1υγχρονής1αντα Φιλῖνον διὰ ἑξαβίβλου πραγματείας2 ἀντειπεῖν, καίπερ Ἐπικλέους2 τοῦ Κρητὸς2 ἐπιτεμομένου τὰς2 Βακχείου λέξεις2 διὰ . . . ς1υντάξεων, Ἀπολλωνίου τε τοῦ Ὄφεως2 ταὐτὸ ποιής1αντος2, καὶ Διος1κορίδου τοῦ Φακᾶ πᾶς1ι τούτοις2 ἀντειπόντος2 δι᾽ ἑπτὰ βιβλίων, Ἀπολλωνίου τε τοῦ Κιτιέως2 ὀκτωκαίδεκα πρὸς2 τὰ τοῦ Ταραντίνου τρία πρὸς2 Βακχεῖον διαγράψαντος2, καὶ Γλαυκίου τοῦ ἐμπειρικοῦ δι’ ἑνὸς2 πολυς1τίχου πάνυ καὶ κατὰ ς1τοιχεῖον πεποιημένου ταὐτὸ ἐπιτηδεύς1αντος2 πρός2 τε τούτοις2 Λυς1ιμάχου τοῦ Κῴου κ’ βιβλίων ἐκπονής1αντος2 πραγματείαν μετὰ τοῦ τρία μὲν γράψαι πρὸς2 Κυδίαν τὸν Ἡροφίλειον, τριὰ δὲ πρὸς2 Δημήτριον. τῶν δὲ γραμματικῶν οὐκ ἔς1τιν ὅς1τις2 ἐλλόγιμος2 φανεὶς2 παρῆλθε τὸν ἄνδρα. καὶ γὰρ ὁ ἀναδεξάμενος2 αὐτὸν Ἐυφορίων πᾶς1αν ἐς1πούδας1ε λέξιν ἐξηγής1ας1θαι διὰ βιβλίων ς2´, περὶ ὧν γεγράφας1ιν Ἀρις1τοκλῆς2 καὶ Ἀρις1τέας2 οἱ Π̔όδιοι. ἔτι δὲ Ἀρίς1ταρχος2 καὶ μετὰ πάντας2 Ἀντίγονος2 καὶ Δίδυμος2 οἱ Ἀλεξανδρεῖς2. — p, 5 (Nachmanson).

A good account of the commentators is given by Littré, vol. I., p foll. Herophilus (about 300 B.C. ） appears to have been the first ; Bacchius his pupil edited Epidemics III. , wrote notes on three other Hippocratic works, and compiled a glossary. A great number of short fragments of the works of Bacchius still survive. The most celebrated commentator, a medical man as well as a scholar, was Heraclides of Tarentum, who lived rather later than Bacchius.

Erotian in his introduction gives the following list of Hippocratic works : —

ς1ημειωτικὰ μὲν οὖν ἐς1τι ταῦτα: Προγνως1τικόν, Προρρητικὸν ά καὶ β´ (ὡς2 οὐκ ἔς1τιν Ἱπποκράτους2, ἐν ἄλλοις2 δείξομεν), Περὶ χυμῶν. αἰτιολογικὰ δὲ καὶ φυς1ικά: Περὶ φυς1ῶν, Περὶ φύς1εως2 ἀνθρώπου, Περὶ ἱερᾶς2 νός1ου, Περὶ φύς1εως2 παιδίου, Περὶ τόπων καὶ ὡρῶν. θεραπευτικὰ δέ: τῶν μὲν εἰς2 χειρουργίαν ἀνηκόντων: Περὶ ἀγμῶν, Περὶ ἄρθρων, Περὶ ἑλκῶν, Περὶ τραυμάτων καὶ βελῶν, Περὶ τῶν ἐν κεφαλῆ τραυμάτων, Κατὰ ἰητρεῖον, Μοχλικόν, Περὶ αἱμορροΐδων καὶ ς1υρίγγων. εἰς2 δίαιταν: Περὶ νούς1ων ά β̓, Περὶ πτις1άνης2, Περὶ τόπων τῶν κατὰ ἄνθρωπον, Γυναικείων ά β´, Περὶ τροφῆς2, Περὶ ἀφόρων, Περὶ ὑδάτων. ἐπίμικτα δέ ἐς1τι ταῦτα: Ἀφορις1μοί, Ἐπιδημίαι ζ. τῶν δ’ εἰς2 τὸν περὶ τέχνης2 τεινόντων λόγον: Ὅρκος2, Νόμος2, Περὶ τέχνης2, Περὶ ἀρχαίας2 ἰατρικῆς2. Πρες1βευτικὸς2 γὰρ καὶ Ἐπιβώμιος2 φιλόπατριν μᾶλλον ἢ ἰατρὸν ἐμφαίνους1ι τὸν ἄνδρα. — (Nachmanson).

The actual glossary, however, refers to more works than these, as will appear from the following table.

LISTS OF THE HIPPOCRATIC COLLECTION

[Works known to the authors, not necessarily attributed by them to Hippocrates.]

Littré vol.

Name.

Bacchius.

Celsus.

Erotian.

περὶ ἀρχαίης ἰητρικῆς2

περὶ ἀέρων ὑδάτων τόπων

“

προγνως1τικόν

“

περὶ διαίτης2 ὸξέων

“

ἐπιδημίαι 1

ἐπιδημίαι 3

“

περὶ τῶν ἐν κεφαλῇ τραυμάτων

“

κατ̓ ἰητρεῖον

“

περὶ ἀγμῶν

περὶ ἀρθρῶν

“

μοχλικόν

“

ὰφορις1μοί

“

ὃρκος2

“

νόμος2

ἐπιδημίαι 2

“

” 4

“

” 5

“

” 6

“

” 7

“

περὶ χυμῶν

“

προρρητικὸν 1

“

Κωακαὶ προγνώς1εις2

περὶ τέχνης2

“

περὶ φύς1ιος2 ἀνθρώπου

“

περὶ διαίτης2 ὑγιεινῆς2

“

περὶ φυς1ῶν

“

περὶ χρής1ιος2 ν̔γρῶν

“

περὶ νούς1ων 1

“

περὶ παθῶν

“

περὶ τόπων τῶν κατ ἄνθρωπον

“

περὶ ἱερῆς2 νούς1ου

“

περὶ έλκῶν

“

περὶ αἱμορροἴδων

“

περὶ ς1υρίγγων

Littré vol.

Name.

Bacchius.

Colsus.

Erotian.

περὶ διαίτης 1

“

” 2

“

” 3

“

περὶ ἐνυπνίων

περὶ νούς1ων 2

“

περὶ νούς1ων 3

“

περὶ τῶν ἔντος2 παθῶν

“

περὶ γυναικείης2 φύς1ιος2

“

περὶ ἑπταμήνου

“

περὶ ὀκταμήνου

“

περὶ γονῆς2

“

περὶ φύς1ιος2 παιδίου

“

περὶ νούς1ων 4

περὶ γυναικείων 1 and 2

“

περὶ ἀφόρων

“

περὶ παρθενίων

“

περὶ ἐπικυής1ιος2

“

περὶ ἐγκατατομῆς2 ἐμβρύον

“

περὶ ἀνατομῆς2

“

περὶ ὀδοντοφυΐῃς2

“

περὶ ἀδένων

“

περὶ ς1άρκων

“

περὶ ἑβδομάδων

προρρητικὸν 2

“

περὶ καρδίης2

“

περὶ τροφῆς2

“

περὶ ὄψιος2

“

περὶ ὀς1τέων φν´ς1ιος2

“

περὶ ἰητροῦ

“

περὶ εὐς1χημος1ύνης2

“

παραγγελίαι

“

περὶ κρις1ίων

“

περὶ κρις1ίμων

“

ἐπις1τολαί

“

πρες1βευτικός2

“

ἐπιβώμιος2

23 ?

Erotian knew also περὶ τραυμάτων καὶ βελῶν, now lost. The double XX means “by quotation, but not in the list.” N.B. — The list of Bacchius is made by noting where in the Hippocratic collection occur the strange words upon which he commented ; that of Celsus by a comparison of similar passages ; that of Erotian from his list, by noting where occur the γλῶς1ς1αι explained by him, and from fragments in scholia (see E. Nachmanson’s edition, p foll.). Of course the list of Celsus is dubious from its nature, and Bacchius may have known many more treatises than those we are sure he did know.

The recently discovered history of medicine called Menon’s Iatrica contains several references to Hippocrates. Diels is of opinion that they are very erroneous.

In V. the writer says that according to Hippocrates diseases are caused by “airs” (φῦς1αι), a statement which seems to be taken from περὶ φυς1ῶν, VI. 98 foll. Littré, and the doctrine is described in V. and VI. In VII. Hippocrates is said to hold doctrines which are taken from Nature of Man , VI. 52 foll. Littré. In VIII. occur references to Places in Man , VI. 276, 294 Littré, and Glands , VIII. 564 Littré. In XIX. occur references to Nature of Man , VI. 38 Littré, but the physician named is Polybus.

Galen

Galen is the most important of the ancient commentators on Hippocrates, and of his work a great part has survived. His writings are of value for two reasons : —

(1) They often give us a text superior to that of the MSS. of the Corpus. Sometimes this text is actually given in Galen’s quotations ; sometimes it is implied in Galen’s commentary.

(2) They sometimes throw light upon the interpretation of obscure passages.

Galen’s ideal of a commentator is beyond criticism. He prefers ancient readings, even when they are the more difficult, and corrects only when these give no possible sense. In commenting he is of opinion that he should first determine the sense of the text and then see whether it corresponds with the truth.

Unfortunately he is not so successful when he attempts to put his ideal into practice. He is intolerably verbose, and what is worse, he is eager so to interpret Hippocrates as to gain support therefrom for his own theories. A good example of this fault is his misinterpretation of Epidemics III. XIV. Littré gives as another fault his neglect of observation and observed fact.

Galen wrote commentaries, which still survive, on the following : —

Nature of Man.

Regimen of People in Health.

Regimen in Acute Diseases.

Prognostic.

Prorrhetic I.

Aphorisms.

One book in ancient times. Epidemics I., II., III., VI.

Fractures.

Articulations.

Surgery.

Humours.

Nutriment.

Airs, Waters, Places (only fragments survive).

We also have his Glossary.

Commentaries on the following are altogether lost : —

Sores.

Wounds in the Head.

Diseases.

Affections.

He also wrote (or promised to write) the following, none of which survive : — Anatomy of Hippocrates, Characters in Epidemics III., Dialect of Hippocrates, The Genuine Writings of the Physician of Cos.

Galen also knew : Coan Prenotions, Epilepsy, Fistulae, Hemorrhoids, Airs, Places in Man, Regimen, Seven Months’ Child, Eight Months’ Child, Heart, Fleshes, Number Seven, Prorrhetic II., Glands , and probably Precepts.

The most important of the Hippocratic treatises not mentioned by Galen are Ancient Medicine and The Art.

6. LIFE OF HIPPOCRATES.

We possess three ancient biographies of Hippocrates : one by Suidas, one by Tzetzes, and one by Soranus, a late writer of uncertain date. From these we gather that Hippocrates was born in Cos in 460 B.C.; that he belonged to the guild of physicians called Asclepiadae ; that his father was Heraclides, and his teachers were Herodicus and his own father ; that he travelled all over Greece, and was a great friend of Democritus of Abdera ; that his help was sought by Perdiccas king of Macedonia and by Artaxerxes king of Persia ; that he stayed the plague at Athens and in other places ; that his life was a long one but of uncertain length, the traditions making him live 85, 90, 104 or 109 years.

In these accounts there is a certain amount of fable, but in the broad outline there is nothing improbable except the staying of the Athenian plague, which is directly contrary to the testimony of Thucydides, who expressly states that medical help was generally unsuccessful.

The Epislles in the Hippocratic collection, and the so-called Decree of the Athenians , merely give, with fuller picturesqueness of detail, the same sort of information as is contained in the biographies.

Plato refers to Hippocrates in two dialogues — the Protagoras and the Phaedrus. The former passage tells us that Hippocrates was a Coan, an Asclepiad, and a professional trainer of medical students ; the latter states as a fundamental principle of Hippocratic physiology the dogma that an understanding of the body is impossible without an understanding of nature as a whole, in modern language, physiology is inseparable from physics and chemistry.

From Aristotle we learn that Hippocrates was already known as “the Great Hippocrates.”

Such is the ancient account of Hippocrates, a name without writings, as Wilamowitz says. There is no quotation from any treatise in the Corpus before Aristotle, and he assigns as the author not Hippocrates but Polybus. The Phaedrus passage, indeed, has been recognized by Littré as a reference to Ancient Medicine , but Galen is positive that it refers to Nature of Man.

In fact the connexion between the great physician and the collection of writings which bears his name cannot with any confidence be carried further back than Ctesias the Cnidian, Diocles of Carystus and Menon, the writer of the recently discovered Iatrica. Ctesias and Diocles belong to the earlier half of the fourth century, and Menon was a pupil of Aristotle.

7. THE ASCLEPIADAE.

Hippocrates was, according to Plato, an Asclepiad. This raises the very difficult question, who the Asclepiadae were. Its difficulty is typical of several Hippocratic problems. Certainty, even approximate certainty, is impossible owing to the scantiness of the evidence.

The old view, discarded now by the most competent authorities, is that the Asclepiadae were the priests of the temples of Asclepius, combining the functions of priest and physician. This view implied that Hippocratic medicine had its origin in templepractice. For a thorough refutation of it see Dr. E. T. Withington’s excursus in my Malaria and Greek History and his own book Medical History from the Earliest Times.

Another view is that the Asclepiadae were a guild, supposed to have been founded by Asclepius, the members of which were bound by rules and swore the Hippocratic “Oath.” Such is the view of Dr. Withington himself. It is one which is free from all intrinsic objections, but it is supported by the scantiest of positive evidence.

It should be noticed that the term “Asclepiadae” means literally “the family of Asclepius,” and it is at least possible that the Asclepiads were a clan of hereditary physicians who claimed to be descended from Asclepius. It would be very easy for such a family to develop into something like a guild by the admission, or rather adoption, of favoured outsiders. In this way the term might readily acquire the general meaning of medical practitioner, which it apparently has in e.g. Theognis 432 : —

εἰ δ᾽ Ἀς1κληπιάδαις2 τοῦτό γ᾽ ἔδωκε θεός2, ἰᾶς1θαι κακότητα καὶ ἀτηρὰς2 φρένας2 ἀνδρῶν, πολλοὺς2 ἂν μις1θοὺς2 καὶ μεγάλους2 ἔφερον. I do not think that it has been noticed what an interesting parallel is afforded by the term “Homeridae.” A family of poets tracing their descent from Homer finally could give their name to any public reciter of the Homeric poems.

8. THE DOCTRINE OF HUMOURS.

The doctrine of the humours probably had its origin in superficial deductions from obvious facts of physiology, but it was strongly coloured by philosophic speculation, in particular by the doctrine of opposites. Indeed it is impossible to keep distinct the various influences which acted and reacted upon one another in the spheres of philosophy and medicine; only the main tendencies can be clearly distinguished.

Even the most superficial observer must notice ( a ) that the animal body requires air, fluid, and solid food; ( b ) that too great heat and cold are fatal to life, and that very many diseases are attended by fever; ( c ) that fluid is a necessary factor in digestion; ( d ) that blood is in a peculiar way connected with life and health.

These simple observations were reinforced by the speculations of philosophers, particularly when philosophy took a biological or physiological turn, and became interested in the organs of man and their functions.

The second of the Greek philosophers, Anaximander, taught that creation was made up of “opposites,” though it is not clear how many he conceived these opposites to be. Many later thinkers, working on lines similar to those of Anaximander, made them four in number — the hot, the cold, the moist and the dry. These were the essential qualities of the four elements, fire, air, water, earth.

There was, however, no uniformity among thinkers as to the number of the opposites, and Alcmaeon, a younger contemporary of Pythagoras and a native of Croton, postulated an indefinite number. Alcmaeon was a physician rather than a philosopher, and asserted that health was an ἰς1ονομία of these opposites and disease a μοναρχία of one. This doctrine had a strong influence upon the Coan school of medicine, and indeed upon medical theory generally.

But the opposites are not χυμοί: they are only δυνάμεις2. The humoral pathology was not fully developed until for δυνάμεις2 were substituted fluid substances. In tracing this development the historian is much helped by Ancient Medicine. It is here insisted that the hot, the cold, the moist and the dry are not substances; they are only “powers,” and, what is more, powers of merely secondary importance. The body, it is maintained, has certain essential χυμοί, which χυμοί have properties or “powers” with greater influence upon health than temperature. The number of the χυμοί is left indefinite. If the body be composed of opposite humours, and if health be the harmonious mixture or blending (κρᾶς1ις) of them, we shall expect to see one or other “lording it over the others” (μοναρχία ） in a state of disease.

The two commonest complaints in ancient Greece, chest troubles and malaria, suggested as chief of these humours four : phlegm, blood (suggested by hemorrhage in fevers), yellow bile and black bile (suggested by the vomits, etc., in remittent malaria).

That the humours are four is first clearly stated in Nature of Man , which Aristotle assigns to Polybus, though Menon quotes a portion of it as Hippocratic. The passage in question runs : τὸ δὲ ς1ῶμα τοῦ ἀνθρώπου ἔχει ἐν ἑωυτῷ αἷμα καὶ φλέγμα καὶ χολὴν ξανθήν τε καὶ μέλαιναν, καὶ ταῦτα ὲς1τὶν αὐτῷ ἡ φύς1ις . . . ὑγιαίνει μὲν οὖν μάλις1τα ὁκόταν μετρίως ἔχῃ ταῦτα τῆς πρὸς ἄλληλα κρής1ιος καὶ δυνάμιος καὶ τοῦ πλήθεος, καὶ μάλις1τα μεμιγμένα ἠ´̂ κ.τ.λ. (Littré VI. 38 and 40).

Some thinkers, belonging to the school of Empedocles, and being more inclined towards philosophy than towards medicine, made the four chief opposites, materialized into fire, air, water and earth, the components of the body, and disease, or at any rate some of the chief diseases, an excess of one or other. We see this doctrine fairly plainly in Menon’s account of Philistion, and it is copied by Plato in the Timaeus.

The doctrines I have described admitted many variations, and in Menon’s Iatrica , which is chiefly an account of the origins of disease as given by various physicians, the most diverse views are set forth. Petron of Aegina, while holding that the body is composed of the four opposites, stated that disease was due to faulty diet, and that bile was the result and not the cause of disease. Hippon thought that a suitable quantity of moisture was the cause of health ; Philolaus that disease was due to bile, blood and phlegm ; Thrasymachus of Sardis that blood, differentiated by excess of cold or heat into phlegm, bile, or τὸ ς1ες1ηπός (matter or pus), was the cause ; Menecrates that the body is composed of blood, bile, breath and phlegm, and that health is a harmony of these.

The Hippocratic collection shows similar diversity of opinion. Diseases IV. 51, gives as the four humours bile, blood, phlegm and ὕδρωψ (not water, but a watery humour). Affections I. ascribes all diseases to bile and phlegm. Ancient Medicine recognizes an indefinite number of humours.

The great Hippocratic group imply the doctrine of humours in its phraseology and outlook on symptoms, but it is in the background, and nowhere are the humours described. It is clear, however, that bile and phlegm are the most prominent, and bilious and phlegmatic temperaments are often mentioned in Airs Waters Places and Epidemics I. and III. There are signs of subdivision in πικρόχολοι and λευκοφλεγματίαι.

Amid all these differences, which by their very variety indicate that they belonged to theory without seriously affecting practice, there is one common principle — that health is a harmonious mingling of the constituents of the body. What these constituents are is not agreed, nor is it clear what exactly is meant by “mingling.”

The word ἄκρητος, which I have translated “unmixed” or “uncompounded,” is said by Galen to mean “consisting of one humour only.” It is more likely that the word means properly “showing signs that crasis has not taken place.”

Coction

The course of our inquiry has brought us to the doctrine of “coction” (πέψις). Familiar as a modern is with the difference between chemical blending and mechanical mixture, it is difficult for him to appreciate fairly theories put forward when this difference was unknown, and the human mind was struggling with phenomena it had not the power to analyse, and trying to express what was really beyond its reach. We must try to see things as the Greek physician saw them.

We have in Chapters XVIII and XIX of Ancient Medicine the most complete account of coction as the ancient physician conceived of it. It is really the process which leads to κρᾶς1ις as its result. It is neither purely mechanical nor yet what we should call chemical; it is the action which so combines the opposing humours that there results a perfect fusion of them all. No one is left in excess so as to cause trouble or pain to the human individual. The writer takes three types of illnesses — the common cold, ophthalmia and pneumonia — and shows that as they grow better the discharges become less acrid and thicker as the result of πέψις.

In one respect the writer of Ancient Medicine is not a trustworthy guide to the common conception of πέψις. He attached but little importance to heat, and it can scarcely be doubted that the action of heat upon the digestibility of foods, and the heat which accompanies the process of digestion itself, must have coloured the notion of πέψις as generally held. It is true that we read little about innate heat in the Hippocratic collection, but that is an accident, and it certainly was thought to have a powerful influence upon the bodily functions.

A disease was supposed to result when the equilibrium of the humours, from some “exciting cause” or other (πρόφας1ις), was disturbed, and then nature, that is the constitution of the individual (φύς1ις), made every effort she could through coction to restore the necessary κρᾶς1ις.

Crisis

The battle between nature and the disease was decided on the day that coction actually took place or failed to take place. The result was recovery, partial or complete, aggravation of the disease, or death. The crisis (κρίς1ις) is “the determination of the disease as it were by a judicial verdict.”

After a crisis there might, or might not, be a relapse (ὑπος1τροφή), which would be followed in due course by another crisis.

The crisis, if favourable, was accompanied by the expulsion of the residue remaining after coction and κρᾶς1ις of the humours had occurred. This expulsion might take place through any of the ordinary means of evacuation — mouth, bowels, urine, pores — and the evacuated matters were said to be concocted (πέπονα), that is to say, they presented signs that coction had taken place.

But nature was not always able to use the ordinary means of evacuation. In this case there would be an abscession (ἀπός1τας1ις). When the morbid residue failed to be normally evacuated, it was gathered together to one part of the body and eliminated, sometimes as an eruption or inflammation, sometimes as a gangrene or tumour, sometimes as a swelling at the joints.

An abscession did not necessarily mean recovery ; it might merely be a change from one disease to another. The Hippocratic writers are not clear about the point, but apparently the abscession might fail to accomplish its purpose, and so the disease continued in an altered form. In other words there was abscession without real crisis.

To trace the course of a disease through its various stages, and to be able to see what is portended by symptoms in different diseases and at different stages of those diseases, was an art upon which Hippocrates laid great stress. He called it πρόγνως1ις, and it included at least half of the physician’s work.

Critical Days

Crises took place on what were called critical days. It is a commonplace that a disease tends to reach a crisis on a fixed day from the commencement, although the day is not absolutely fixed, nor is it the same for all diseases. The writer of Prognostic and Epidemics I. lays it down as a general law that acute diseases have crises on one or more fixed days in a series.

In Prognostic Chapter XX the series for fevers is given thus: — 4th day, 7th, 11th, 14th, 17th, 20th, 34th, 40th, 60th.

In Epidemics I. XXVI. two series are given: —

（ a ) diseases which have exacerbations on even days have crises on these even days: 4th, 6th, 8th, 10th, 14th, 20th, 24th, 30th, 40th, 60th, 80th, 120th.

（ b ) diseases which have exacerbations on odd days have crises on these odd days: 3rd, 5th, 7th, 9th, 11th, 17th, 21st, 27th, 31st.

A crisis on any other than a normal day was supposed to indicate a probably fatal relapse.

Galen thought that Hippocrates was the first to discuss the critical days, and there is no evidence against this view, though it seems more likely that it gradually grew up in the Coan school.

What was the origin of this doctrine? Possibly it may in part be a survival of Pythagorean magic, numbers being supposed to have mystical powers, which affected medicine through the Sicilian-Italian school. But a man so free from superstition as the author of Epidemics I. was unlikely to be influenced by mysticism, particularly by a mysticism which left his contemporaries apparently untouched. More probably there is an effort to express a medical truth. In malarious countries, all diseases, and not malaria only, tend to grow more severe periodically ; latent malaria, in fact, colours all other complaints. May it not be that severe exacerbations and normal crises were sometimes confused by Hippocrates, or perhaps a series of malarial exacerbations attracted the crisis to one of the days composing it? The sentence in Epidemics I. XXVI. is very definitely to the effect that when exacerbations are on even days, crises are on even days ; when exacerbations are on odd days, crises are on odd days. Evidently the critical days are not entirely independent of the periodicity of malaria.

9. CHIEF DISEASES MENTIONED IN THE HIPPOCRATIC COLLECTION.

Diseases were classified by ancient physicians according to their symptoms ; they are now classified according to the micro-organisms which cause them. Accordingly it often happens that no exact equivalent in Greek corresponds to an English medical term and vice versa. The name of a Greek disease denotes merely a syndrome of symptoms.

Perhaps the most remarkable point arising in a discussion of Greek diseases is the apparent absence of most infectious fevers. Plagues, vaguely referred to by the term λοιμός, occurred at intervals, but the medical writings in the Hippocratic collection are occupied almost entirely with endemic disease and do not describe plagues, not even the great plague at Athens. There is no mention of smallpox or measles ; no certain reference occurs to diphtheria, scarlet fever, bubonic plague or syphilis. It is extremely doubtful whether typhoid was present in Greece, for although it is similar to severe cases of καῦς1ος and φρενῖτις, the latter were certainly in most cases pernicious malaria, which is often so like typhoid that only the microscope can distinguish them. It is expressly stated by pseudo-Aristotle that fevers were not infectious, and it is difficult to reconcile this statement with the prevalence of typhoid. The question must be left open, as the evidence is not clear enough to warrant a confident decision.

Colds, “with and without fever,” were common enough in ancient times, but whether influenza prevailed cannot be stated for certain. Its all too frequent result, pneumonia, was indeed well known, but it is puzzling that in the description of epidemic cough at Perinthus, the nearest approach to an influenza wave in the Hippocratic collection, it is expressly stated that relapses into pneumonia were rare.

Consumption (φθίς1ις) is one of the diseases most frequently mentioned in the Corpus , and it is remarkable that in the very passage where we are told that fevers are not infectious it is also stated that consumption is so. To consumption are added “ophthalmias,” which term will therefore include all contagious inflammations of the eyes.

The greatest plague of the Greek and of the ancient world generally was malaria, both mild and malignant, both intermittent and remittent.

The intermittents (διαλείποντες πνρετοί) are : —

ἀμφημερινὸς πυρετός (quotidians)

τριταῖος πυρετός (tertians)

τεταρταῖος πυρετός (quartans)

The remittents (often ς1υνεχεῖς πυρετοί) included : —

καῦς1ος, so called because of the intense heat felt by the patient, a remittent tertian often mentioned in the Corpus.

φρενῖτις, characterized by pain in the hypochondria and by delirium. It generally had a tertian periodicity.

λήθαργος, characterized by irresistible coma. It bore a strong likeness to what is now known as the comatose form of pernicious malaria.

ἡμιτριταῖος, semitertian, was pernicious remittent malaria with tertian periodicity.

τῦφος or τῖφος, of which five different kinds are mentioned in the Cnidian treatise περὶ τῶν ἐντὸς παθῶν (Littré VII. 260 foll.), was in at least two cases a species of remittent malaria.

In connexion with the question of malaria it should be noticed that malarial cachexia, the symptoms of which are anaemia, weakness, dark complexion and enlarged spleen, is often described in the Hippocratic collection. Especially vivid is the description in Airs Waters Places. This is further evidence of the malarious condition of the ancient Greek world.

μελαγχολία

This word is closely connected both with the doctrine of the humours and with the prevalence of malaria. It is fully discussed in Malaria and Greek History , p-101. Generally it means our “melancholia,” but sometimes merely “biliousness.” In popular speech μελαγχολία and its cognates sometimes approximate in meaning to “nervous breakdown.” Probably the name was given to any condition resembling the prostration, physical and mental, produced by malaria, one form of which (the quartan) was supposed to be caused by “black bile” (μέλαινα χολή).

ἐρυς1ίπελας

See Foes’ Oeconomia , , where quotations are given which enable us to distinguish ἐρυς1ίπελας from φλεγμονή. Both exhibit swelling (ὄγκος) and heat (θερμας1ία), but whereas ἐρυς1ίπελας is superficial and yellowish, φλεγμονή is internal also and red.

διάρροια and δυς1εντερία

The former is local, and causes merely the passing of unhealthy excreta. The latter is accompanied by fever, and is a dangerous disease, in which the bowel is ulcerated, with the passing of blood. See περὶ παθῶν 23 and 25 (Littré VI. 234, 235), and more especially περὶ διαίτης2 74 (Littré IV. 616) : —

τοῦτο γὰρ (διάρροια) ὀνομάζεται ἕως2 ἂν αν̓τὴ μόνη ς1απεῖς1α ἡ τροφὴ ὑποχωρῆ. ὁκόταν δὲ θερμαινομένου τοῦ ς1ώματος κάθαρς1ις δριμέα γένηται, τό τε ἔντερον ξύεται καὶ ἑλκοῦται καὶ διαχωρεῖται αἱματώδεα, τοῦτο δὲ δυς1εντερίη καλεῖται, νός1ος χαλεπὴ καὶ ἐπικίνδυνος.

“Dysentery” would include what is now called by this name and any severe intestinal trouble, perhaps typhoid and paratyphoid if these were diseases of the Greek world, while “diarrhoea” means merely undue laxity of the bowels.

Delirium

The Hippocratic collection is rich in words meaning delirium of various kinds. It is probable, if not certain, that each of them had its own associations and its own shade of meaning, but these are now to a great extent lost. Only the broad outlines of the differences between them can be discerned by the modern reader. The words fall into two main classes : —

(1) Those in which the mental derangement of delirium is the dominant idea ; e.g. παραφέρομαι, παραφρονῶ (the word common in Prognostic ), παρανοῶ, παρακρούω (the most common word in Epidemics I. and III. ), παρακοπή, ἐκμαίνομαι, μανία.

(2) Those in which stress is laid upon delirious talk; e.g. λῆρος, παράληρος, παραληρῶ, παραλέγω, λόγοι πολλοί. It is more difficult to say exactly which words in each class signify the greater degree of delirium. Of class (1) ἐκμαίνομαι is obviously the most vigorous word, meaning “wild raving,” μανία comes next to it, and παρακοπή is apparently slightly stronger than the others. Of class (2) λῆρος or παράληρος seems to be the strongest, then παραλέγω, and finally λόγοι πολλοί.

Pain

There are two common words for pain in the Corpus , πόνος and ὀδύνη. They seem practically synonymous. Perhaps πόνος is more commonly used of violent pains, and ὀδύνη of dull, gnawing pains, but I think that no reader would care to pronounce a confident opinion on the matter.

Ague

There are two words commonly used to describe the chilly feeling experienced in fevers, especially in malarial fevers. These are ( a ) ῥῖγος and its derivatives, and ( b ) φρίχη and its derivatives. The former lays stress upon the chilly feeling, the latter upon the shivering accompanying it. But in this case also it is possible to discriminate too finely; see e.g. in Epidemics III. Case II. (second series), φρικώδης is followed by μετὰ τὸ γενόμενον ῥῖγος, referring apparently to the same occasion.

The reader should note the extreme care with which symptoms are described in the Hippocratic group of treatises. It has been pointed out, for instance, that in Epidemics I. Case I., and Epidemics III. Case XV. (second series), there are possibly instances of Cheyne-Stokes breathing. Noticed by the writer of these works, this important symptom was overlooked until the eighteenth century.

10. πολύς AND ὀλίγος IN THE PLURAL.

It is at least curious that one of the translator’s greatest difficulties is to decide what are the meanings of πολύς and ὀλίγος (also of ς1μικρά) when used in the plural. The reader is at first sight inclined to think that ῥεύματα πολλά ( Epidemics III. IV.) means “many fluxes,” and so possibly it may. But just above we have ῥεῦμα πολύ, “a copious flux,” and so the plural may well mean “copious fluxes.” The ambiguity becomes more serious when the words are applied to the excreta. Is frequency or quantity the more dominant idea? It seems impossible to say for certain, but the evidence tends towards the latter view. From Prognostic Chapter XI it seems that quantity is the more important thing, and in the same passage πυκνόν is the word used to denote frequency. The usage in Epidemics I. and III. bears out this view. “Frequently shivering” is φρικώδεες πυκνά ( Epid. III. XIII.). In the same chapter occurs the sentence, αἱ δὲ βῆχες ἐνῆς1αν μὲν διὰ τέλεος πολλαί, καὶ πολλὰ ἀνάγους1αι πέπονα, where πολλαί means “many” and πολλά “copious.” In Epid. III. Case II. (second series) βῆχες ς1υνεχέες ὑγραὶ πολλαί means “continued coughing with watery and copious sputa.” In Case IX. of the same series “frequent, slight epistaxis” is ᾑμορράγει . . . . πυκνὰ κατ̓ ὀλίγον. After long consideration of this difficult question I conclude that πολύς and ὀλίγος in the plural, when used of excreta, etc., should be translated “copious” or “abundant” unless the context makes the other meaning absolutely necessary.

The case is somewhat similar with the word ς1μικρά. Used adverbially this word means “slightly,” “a little,” more often than it does “in small quantities.” ς1μικρὰ κατενόει is almost certainly “lucid intervals,” and ς1μικρὰ ἐκοιμήθη is “snatches of sleep,” but I do not feel sure that ς1μικρὰ παρέκρους1ε means more than “slight delirium,” nor ς1μικρὰ ἐπύρεξε ( Epid. III. XIII.) more than “slightly feverish.”

11. THE IONIC DIALECT OF THE HIPPOCRATIC COLLECTION.

The later MSS. of the Corpus exhibit a mass of pseudo-ionic forms which are not to be found, or are only rarely found, in the earlier MSS. The uncontracted forms, too, are more common in the later authorities. If we follow closely the earlier MSS. we have a text which is very like Attic, with a mild sprinkling of Ionic forms. These facts seem to show that, when Ionic became the medium of scientific prose, it lost touch gradually with the spoken speech and assimilated itself to the predominant Attic, and later on possibly to the κοινή. It retained just enough Ionic to keep up the tradition and to conform to convention. The later scribes, under the mistaken impression that the texts before them had been atticized, restored what they considered to be the ancient forms, often with disastrous results. Many of their ionisms are sheer monstrosities.

In 1894 A. W. Smyth discussed the dialect of the Corpus in his work The Sounds and Inflections of the Greek Dialects : Ionic. He pointed out, however, that the labours of Littré had left much to be done in this department of Hippocratic study, and that the material for a sound judgment was not yet available.

The collection of this material is not yet complete, but a good start was made by Kéhlewein, who in Chapter III of the Prolegomena to the first volume of the Teubner Hippocrates ( de dialecto Hippocratica ） laid down the principles followed in the present edition.

12. MANUSCRIPTS.

None of our MSS. are very old, but the oldest are far superior to the later, both in readings and in dialect. There is no regular canon, and no recognized order; each independent MS. seems to represent a different “collection” of Hippocratic works. This fact fits in well with the theory that the nucleus of the Corpus was the library (or the remains of it) of the Hippocratic medical school at Cos.

θ Vindobonensis med. IV., tenth century. Our oldest MS., containing : περὶ τῶν ἔντος παθῶν. περὶ παθῶν. περὶ ἱερῆς νον´ς1ου. περὶ νούς1ων. περὶ νούς1ων ?? περὶ νούς1ων ??. περὶ διαίτης ??. περὶ διαίτης ??. περὶ διαίτης ?? (with περὶ ἐνυπνίων). περὶ γυναικείων ??. περὶ γυναικείων ??. περὶ γυναικείης φύς1ιος. Of some books parts are missing.

A Parisinus 2253, eleventh century. It contains: Κωακαὶ προγνώς1εις. περὶ τροφῆς. περὶ πτις1άνης. περὶ χυμῶν. περὶ ὑγρῶν χρής1ιος. ἐπιβώμιος. περὶ τέχνης. περὶ φύς1ιος ἀνθρώπον. περὶ φυς1ῶν. περὶ τόπων τῶν κατὰ ἄνθρωπον. περὶ ἀρχαίης ἰητρικῆς. ἐπιδημιῶν ??. An excellent MS., the use of which has transformed our Hippocratic text. There are four or five correcting hands.

B Laurentianus 74, 7, eleventh or twelfth century. It contains: κατ̓ ἰητρεῖον. περὶ ἀγμῶν. περὶ ἄρθρων. περὶ τῶν ἐν κεφαλῆ τρωμάτων. Two correcting hands.

V Vaticanus graecus 276, twelfth century. It contains: ὅρκος. νόμος. ἀφορις1μοί. προγνως1τικόν. περὶ διαίτης ὀξέων. κατ̓ ἰητρεῖον. περὶ ἀγμῶν. περὶ ἄρθρων. περὶ τῶν ἐν κεφαλῇ τρωμάτων. περὶ ἀέρων, ὑδάτων, τόπων. ἐπιδημιῶν ??. περὶ φύς1εως ἀνθρώπου. περὶ φύς1εως παιδίου. περὶ γονῆς. περὶ ἐπικυής1εως. περὶ ἑπταμήνου. περὶ ὀκταμήνου. περὶ παρθένων. περὶ γυναικείης φύς1ιος. περὶ ὀδοντοφυἲας. περὶ τόπων τῶν κατὰ ἄνθρωπον. γυναικείων ??. περὶ ἀφόρων. περὶ ἐπικυής1ιος (again). περὶ ἐγκατατομῆς παιδίου. περὶ ἰητροῦ. περὶ κρίς1εων. περὶ κραδίης. περὶ ς1αρκῶν. περὶ ἀδένων οὐλομελίης. περὶ ἀνατομῆς. ἐπις1τολαί. δόγμα Ἀθηναίων. ἐπιβώμιος. πρες1βευτικός.

M Marcianus Venetus 269, eleventh century. It contains: ὅρκος. νόμος. περὶ τέχνης. περὶ ἀρχαίης ἰητρικῆς. παραγγελίαι. περὶ εὐς1χημος1ύνης. περὶ φύς1εως ἀνθρώπου. περὶ γονῆς. περὶ φύς1εως παιδίον. περὶ ἄρθρων. περὶ χυμῶν. περὶ τροφῆς. περὶ ἑλκῶν. περὶ ἱερῆς νούς1ου. περὶ νούς1ων ??. περὶ νούς1ων ??. περὶ νούς1ων ??. περὶ νούς1ων ??. περὶ παθῶν. περὶ τῶν ἐντὸς παθῶν. περὶ διαίτης ??. περὶ διαίτης ??. περὶ διαίτης ??. περὶ ἐνυπνίων. περὶ ὄψιος. περὶ κρις1ίμων. ἀφορις1μοί. προγνως1τικόν. περὶ διαίτης ὀξέων. περὶ φυς1ῶν. μοχλικόν. περὶ ὀς1τἑων φύς1ιος. περὶ ἀγμῶν. κατ̓ ἰητρεῖον. περὶ ἐγκατατομῆς ἐμβρύου. περὶ γυναικείων ??. περὶ γυναικείων β. περὶ ἀφόρων. περὶ ἐπικυής1ιος. περὶ ἑπταμήνου. περὶ ὀκταμήνου. περὶ παρθενίων. περὶ γυναικείης φύς1εως. Part of ἐπιδημίων ??, ἐπιδημιῶν ??. ἐπιδημιῶν ??. ἐπις1τολαί. ὁ περὶ μανίης λόγος. δόγμα Ἀθηναίων. πρες1βευτικός (mutilated).

C’ Paris 446 suppl. Tenth century.

D Paris 2254

E Paris 2255. Fourteenth century.

F Paris 2144

H Paris 2142. Thirteenth century.

I Paris 2140

J Paris 2143. Fourteenth century.

K Paris 2145

S’ Paris 2276

R’ Paris 2165. Sixteenth century.

R Barberinus I. 5. Fifteenth century.

13. CHIEF EDITIONS AND TRANSLATIONS, ETC., OF THE HIPPOCRATIC CORPUS.

1525 Hippocratis Coi medicorum longe principis octoginta volumina, quibus maxima ex parte annorum circiter duo millia latina caruit lingua, Graeci vero, Arabes et prisci nostri medici, plurimis tamen utilibus praetermissis, scripta sua illustrarunt, nunc tandem per M. Fabium Calvum, Rhavennatem, virum undecumque doctissimum, latinitate donata, Clementi VII pont. max. dicata, ac nunc primum in lucem edita, quo nihil humano generi salubrius fieri potuit.

Romae ex aedibus Francisci Minitii Calvi Novocomensis. 1 vol. fol.

1526 “Απαντα τὰ τοῦ Ἱπποκράτους. Omnia opera Hippocratis. Venetiis in aedibus Aldi et Andreae Ansulani soceri. Fol.

1538 Ἱπποκράτους Κὥου ἰατροῦ παλαιοτάτου πάντων ἄλλων κορνφαίου βιβλία ἅπαντα. Hippocratis Coi medici vetustissimi, et omnium aliorum principis, libri omnes ad vetustos codices summo studio collati et restaurati. Froben, Basileae. Fol.

This edition was edited by Janus Cornarius.

1545 Hippocratis Coi medicorum omnium facile principis opera quae extant omnia. Iano Cornario medico physico interprete. Venet. Oct. Apud I. Gryphium.

1588 Hippocratis Coi opera quae extant, graece et latine veterum codicum collatione restituta, novo ordine in quatuor classes digesta, interpretationis latinae emendatione et scholiis illustrata ab Hieron. Mercuriali Foroliviensi. Venetiis industria ac sumptibus Juntarum. Fol.

1588 Oeconomia Hippocratis alphabeti serie distincta, Anutio Foesio authore. Francofurti. Fol.

1595 Τοῦ μεγάλου Ἱπποκράτονς πάντων τῶν ἰατρῶν κορυφαίου τὰ εὑρις1κόμενα.

Magni Hippocratis medicorum omnium facile principis opera omnia quae extant in VIII sectiones ex Erotiani mente distributa, nunc recens latina interpretatione et annotationibus illustrata, Anutio Foesio Mediomatrico medico authore. Francofurti apud Andreae Wecheli haeredes. Fol.

Reprinted 1621, 1624, 1645 and at Geneva 1657.

1665 Magni Hippocratis Coi opera omnia graece et latine edita et ad omnes alias editiones accommodata industria et diligentia Joan. Antonidae van der Linden. Lugduno-Batav. 1665. 2 vol. octavo.

1679 Hippocratis Coi et Claudii Galeni Pergameni ἀρχιατρῶν opera. Renatus Charterius Vindocinensis, plurima interpretatus, universa emendavit, instauravit, notavit, auxit . . . Lutetiae Parisiorum, apud Jacobum Villery. 13 vol. fol.

1743 Τὰ Ἱπποκράτους1 ἅπαντα . . . studio et opera Stephani Mackii. Viennae. 2 vol. fol.

1825 Τοῦ μεγάλου Ἱπποκράτους ἅπαντα. Magni Hippocratis opera omnia. Editionem curavit D. Carolus Gottlob Kéhn. Lipsiae. 3 vol. octavo.

1834 Scholia in Hippocratem et Galenum, F. R. Dietz. 2 vols.

1839-1861 Œuvres complétes d’Hippocrate, traduction nouvelle, avec le texte grec en regard . . . Par. é. Littré. Paris. 10 vol.

1846 Article “Hippocrates” in Smith’s Dictionary of Greek and Roman Biography and Mythology , by Dr. W. A. Greenhill.

1849 The genuine works of Hippocrates translated from the Greek with a preliminary Discourse and Annotations by Francis Adams. London. 2 vol.

1859-1864 Hippocratis et aliorum medicorum veterum reliquiae. Edidit Franciscus Zacharias Ermerins. Trajecti ad Rhenum. 3 vol.

1864-1866 Ἱπποκράτης κομιδῇ Car. H. Th. Reinhold. Ἀθήνἡς1ι. 2 vol.

1877, 1878 Chirurgie d’Hippocrate, par J. E. Pétrequin. 2 vols.

1894 Hippocratis opera quae geruntur omnia. Recensuit Hugo Kéhlewein. Prolegomena conscripserunt Ioannes Ilberg et Hugo Kéhlewein.

The second volume appeared in 1902.

1913 Article “Hippokrates (16)” in Pauly-Wissowa Real-Encyclopédie der classischen Altertumsrvissenschaft. The early editions are learned but uncritical, being stronger on the medical side than in scholarship. Special mention should be made of the Oeconomia of Foes, a perfect mine of medical lore, and it is supplemented by the excellent notes in Foes’ edition. Such a work could have appeared only in an age when Hippocrates was a real force in medical practice.

The first scholarly edition was that of Littré, and only those who have seriously studied the works of Hippocrates can appreciate the debt we owe to his diligence, or understand why the task occupied twenty-two years. Unfortunately Littré is diffuse, and not always accurate. His opinions, too, changed during the long period of preparation, and the additional notes in the later volumes must be consulted in order to correct the views expressed in the earlier.

As a textual critic he shows much common sense, but his notes are awkward to read, and his knowledge was practically confined to the Paris MSS.

He is at his best as a medical commentator, and he was the first to explain Hippocratic pathology by proving that the endemic diseases of the Hippocratic writings must be identified, not with the fevers of our climate, but with the remittent forms of malaria common in hot climates. It is not too much to say that without keeping this fact in view we cannot understand a great part of the Corpus. It is curious to note that Hippocrates was a medical text-book almost down to the time (about 1840) when malaria ceased to be a real danger to northern Europe.

The most useful critical edition of Hippocrates is that of Ermerins. He was a scholar with a lucid and precise mind, and his critical notes are a pleasure to read. The introductions, too, are stimulating, instructive and interesting, written in a style full of life and charm. As a philologist he was very deficient.

The edition in the Teubner series, edited by Kéhlewein, of which two volumes have appeared, marks a distinct advance. Fresh manuscripts have been collated, and the text has been purged of the pseudo-ionisms which have so long disfigured it.

A word should perhaps be said about Reinhold, whose two volumes of text give us more plausible conjectures than the work of any other scholar.

Of the scholars who have worked at parts of the Corpus mention should be made of Gomperz and Wilamowitz, but especial praise is due to the remarkable acuteness of Coray, whose intellect was like a sword. He always instructs and inspires, even when the reader cannot accept his emendations.

Adams’ well-known translation is the work of a man of sense, who loved his author and was not without some of the qualifications of a scholar. The translation is literal and generally good, but is occasionally misleading. The medical annotation is far superior to the scholarship displayed in the work.

HIPPOCRATES by Charles McRae

From ‘Fathers of Biology’

Owing to the lapse of centuries, very little is known with certainty of the life of Hippocrates, who was called with affectionate veneration by his successors “the divine old man,” and who has been justly known to posterity as “the Father of Medicine.”

He was probably born about 470 B.C., and, according to all accounts, appears to have reached the advanced age of ninety years or more. He must, therefore, have lived during a period of Greek history which was characterized by great intellectual activity; for he had, as his contemporaries, Pericles the famous statesman; the poets Æschylus, Sophocles, Euripides, Aristophanes, and Pindar; the philosopher Socrates, with his disciples Xenophon and Plato; the historians Herodotus and Thucydides; and Phidias the unrivalled sculptor.

In the island of Cos, where he was born, stood one of the most celebrated of the temples of Æsculapius, and in this temple — because he was descended from the Asclepiadæ — Hippocrates inherited from his forefathers an important position. Among the Asclepiads the habit of physical observation, and even manual training in dissection, were imparted traditionally from father to son from the earliest years, thus serving as a preparation for medical practice when there were no written treatises to study.

Although Hippocrates at first studied medicine under his father, he had afterwards for his teachers Gorgias and Democritus, both of classic fame, and Herodicus, who is known as the first person who applied gymnastic exercises to the cure of diseases.

The Asclepions, or temples of health, were erected in various parts of Greece as receptacles for invalids, who were in the habit of resorting to them to seek the assistance of the god. These temples were mostly situated in the neighbourhood of medicinal springs, and each devotee at his entrance was made to undergo a regular course of bathing and purification. Probably his diet was also carefully attended to, and at the same time his imagination was worked upon by music and religious ceremonies. On his departure, the restored patient usually showed his gratitude by presenting to the temple votive tablets setting forth the circumstances of his peculiar case. The value of these to men about to enter on medical studies can be readily understood; and it was to such treasures of recorded observations — collected during several generations — that Hippocrates had access from the commencement of his career.

Owing to the peculiar constitution of the Asclepions, medical and priestly pursuits had, before the time of Hippocrates, become combined; and, consequently, although rational means were to a certain extent applied to the cure of diseases, the more common practice was to resort chiefly to superstitious modes of working upon the imagination. It is not surprising, therefore, to find that every sickness, especially epidemics and plagues, were attributed to the anger of some offended god, and that penance and supplications often took the place of personal and domestic cleanliness, fresh air, and light.

It was Hippocrates who emancipated medicine from the thraldom of superstition, and in this way wrested the practice of his art from the monopoly of the priests. In his treatise on “The Sacred Disease” (possibly epilepsy), he discusses the controverted question whether or not this disease was an infliction from the gods; and he decidedly maintains that there is no such a thing as a sacred disease, for all diseases arise from natural causes, and no one can be ascribed to the gods more than another. He points out that it is simply because this disease is unlike other diseases that men have come to regard its cause as divine, and yet it is not really more wonderful than the paroxysms of fevers and many other diseases not thought sacred. He exposes the cunning of the impostors who pretend to cure men by purifications and spells; “who give themselves out as being excessively religious, and as knowing more than other people;” and he argues that “whoever is able, by purifications and conjurings, to drive away such an affection, will be able, by other practices, to excite it, and, according to this view, its divine nature is entirely done away with.” “Neither, truly,” he continues, “do I count it a worthy opinion to hold that the body of a man is polluted by the divinity, the most impure by the most holy; for, were it defiled, or did it suffer from any other thing, it would be like to be purified and sanctified rather than polluted by the divinity.” As an additional argument against the cause being divine, he adduces the fact that this disease is hereditary, like other diseases, and that it attacks persons of a peculiar temperament, namely, the phlegmatic, but not the bilious; and “yet if it were really more divine than the others,” he justly adds, “it ought to befall all alike.”

Again, speaking of a disease common among the Scythians, Hippocrates remarks that the people attributed it to a god, but that “to me it appears that such affections are just as much divine as all others are, and that no one disease is either more divine or more human than another, but that all are alike divine, for that each has its own nature, and that no one arises without a natural cause.”

From this it will be seen that Hippocrates regarded all phenomena as at once divine and scientifically determinable. In this respect it is interesting to compare him with one of his most illustrious contemporaries, namely, with Socrates, who distributed phenomena into two classes: one wherein the connection of antecedent and consequent was invariable and ascertainable by human study, and wherein therefore future results were accessible to a well-instructed foresight; the other, which the gods had reserved for themselves and their unconditional agency, wherein there was no invariable or ascertainable sequence, and where the result could only be foreknown by some omen or prophecy, or other special inspired communication from themselves. Each of these classes was essentially distinct, and required to be looked at and dealt with in a manner radically incompatible with the other. Physics and astronomy, in the opinion of Socrates, belonged to the divine class of phenomena in which human research was insane, fruitless, and impious.

Hippocrates divided the causes of diseases into two classes: the one comprehending the influence of seasons, climates, water, situation, and the like; the other consisting of such causes as the amount and kind of food and exercise in which each individual indulges. He considered that while heat and cold, moisture and dryness, succeeded one another throughout the year, the human body underwent certain analogous changes which influenced the diseases of the period. With regard to the second class of causes producing diseases, he attributed many disorders to a vicious system of diet, for excessive and defective diet he considered to be equally injurious.

In his medical doctrines Hippocrates starts with the axiom that the body is composed of the four elements — air, earth, fire, and water. From these the four fluids or humours (namely, blood, phlegm, yellow bile, and black bile) are formed. Health is the result of a right condition and proper proportion of these humours, disease being due to changes in their quality or distribution. Thus inflammation is regarded as the passing of blood into parts not previously containing it. In the course of a disorder proceeding favourably, these humours undergo spontaneous changes in quality. This process is spoken of as coction , and is the sign of returning health, as preparing the way for the expulsion of the morbid matters — a state described as the crisis . These crises have a tendency to occur at certain periods, which are hence called critical days . As the critical days answer to the periods of the process of coction, they are to be watched with anxiety, and the actual condition of the patient at these times is to be compared with the state which it was expected he ought to show. From these observations the physician may predict the course which the remainder of the disease will probably take, and derive suggestions as to the practice to be followed in order to assist Nature in her operations.

Hippocrates thus appears to have studied “the natural history of diseases.” As stated above, his practice was to watch the manner in which the humours were undergoing their fermenting coction, the phenomena displayed in the critical days, and the aspect and nature of the critical discharges — not to attempt to check the process going on, but simply to assist the natural operation. His principles and practice were based on the theory of the existence of a restoring essence (or φύσις) penetrating through all creation; the agent which is constantly striving to preserve all things in their natural state, and to restore them when they are preternaturally deranged. In the management of this vis medicatrix naturæ the art of the physician consisted. Attention, therefore, to regimen and diet was the principal remedy Hippocrates employed; nevertheless he did not hesitate, when he considered that occasion required, to administer such a powerful drug as hellebore in large doses.

The writings which are extant under the name of Hippocrates cannot all be ascribed to him. Many were doubtless written by his family, his descendants, or his pupils. Others are productions of the Alexandrian school, some of these being considered by critics as wilful forgeries, the high prices paid by the Ptolemies for books of reputation probably having acted as inducements to such fraud. The following works have generally been admitted as genuine: —

On Airs, Waters, and Places.
On Ancient Medicine.
On the Prognostics.
On the Treatment in Acute Diseases.
On Epidemics [Books I. and III.].
On Wounds of the Head.
On the Articulations.
On Fractures.
On the Instruments of Reduction.
The Aphorisms [Seven Books].
The Oath.

The works “On Fractures,” “On the Articulations,” “On Injuries to the Head,” and “On the Instruments of Reduction,” deal with anatomical or surgical matters, and exhibit a remarkable knowledge of osteology and anatomy generally. It has sometimes been doubted if Hippocrates could ever have had opportunities of gaining this knowledge from dissections of the human body, for it has been thought that the feeling of the age was diametrically opposed to such a practice, and that Hippocrates would not have dared to violate this feeling. The language used, however, in some passages in the work “On the Articulations,” seems to put the matter beyond doubt. Thus he says in one place, “But if one will strip the point of the shoulder of the fleshy parts, and where the muscle extends, and also lay bare the tendon that goes from the armpit and clavicle to the breast,” etc. And again, further on in the same treatise, “It is evident, then, that such a case could not be reduced either by succussion or by any other method, unless one were to cut open the patient, and then, having introduced the hand into one of the great cavities, were to push outwards from within, which one might do in the dead body, but not at all in the living.”

His descriptions of the vertebræ, with all their processes and ligaments, as well as his account of the general characters of the internal viscera, would not have been as free from error as they are if he had derived all his knowledge from the dissection of the inferior animals. Moreover, it is indisputable that, within less than a hundred years from the death of Hippocrates, the human body was openly dissected in the schools of Alexandria — nay, further, that even the vivisection of condemned criminals was not uncommon. It would be unreasonable to suppose that such a practice as the former sprang up suddenly under the Ptolemies, and it seems, therefore, highly probable that it was known and tolerated in the time of Hippocrates. It is not surprising, when we remember the rude appliances and methods which then obtained, that in his knowledge of minute anatomy Hippocrates should compare unfavourably with anatomists of the present day. Of histology, and such other subjects as could not be brought within his direct personal observation, the knowledge of Hippocrates was necessarily defective. Thus he wrote of the tissues without distinguishing them; confusing arteries, veins, and nerves, and speaking of muscles vaguely as “flesh.” But with matters within the reach of the Ancient Physician’s own careful observation, the case is very different. This is well shown in his wonderful chapter on the club-foot, in which he not only states correctly the true nature of the malformation, but gives some very sensible directions for rectifying the deformity in early life.

When human strength was not sufficient to restore a displaced limb, he skilfully availed himself of all the mechanical powers which were then known. He does not appear to have been acquainted with the use of pulleys for the purpose, but the axles which he describes as being attached to the bench which bears his name ( Scamnum Hippocratis ) must have been quite capable of exercising the force required.

The work called “The Aphorisms,” which was probably written in the old age of Hippocrates, consists of more than four hundred short pithy sentences, setting forth the principles of medicine, physiology, and natural philosophy. A large number of these sentences are evidently taken from the author’s other works, especially those “On Air,” etc., “On Prognostics,” and “On the Articulations.” They embody the result of a vast amount of observation and reflection, and the majority of them have been confirmed by the experience of two thousand years. A proof of the high esteem in which they have always been held is furnished by the fact that they have been translated into all the languages of the civilized world; among others, into Hebrew, Arabic, Greek, English, Dutch, Italian, German, and French. The following are a few examples of these aphorisms: —

“Spontaneous lassitude indicates disease.”

“Old people on the whole have fewer complaints than the young; but those chronic diseases which do befall them generally never leave them.”

“Persons who have sudden and violent attacks of fainting without any obvious cause die suddenly.”

“Of the constitutions of the year, the dry upon the whole are more healthy than the rainy, and attended with less mortality.”

“Phthisis most commonly occurs between the ages of eighteen and thirty-five years.”

“If one give to a person in fever the same food which is given to a person in good health, what is strength to the one is disease to the other.”

“Such food as is most grateful, though not so wholesome, is to be preferred to that which is better, but distasteful.”

“Life is short and the art long; the opportunity fleeting; experience fallacious and judgment difficult. The physician must not only do his duty himself, but must also make the patient, the attendants and the externals, co-operate.”

Hippocrates appears to have travelled a great deal, and to have practised his art in many places far distant from his native island. A few traditions of what he did during his long life remain, but differences of opinion exist as to the truth of these stories.

Thus one story says that when Perdiccas, the King of Macedonia, was supposed to be dying of consumption, Hippocrates discovered the disorder to be love-sickness, and speedily effected a cure. The details of this story scarcely seem to be worthy of credence, more especially as similar legends have been told of entirely different persons belonging to widely different times. There are, however, some reasons for believing that Hippocrates visited the Macedonian court in the exercise of his professional duties, for he mentions in the course of his writings, among places which he had visited, several which were situated in Macedonia; and, further, his son Thessalus appears to have afterwards been court physician to Archelaus, King of Macedonia.

Another story connects the name of Hippocrates with the Great Plague which occurred at Athens in the time of the Peloponnesian war. It is said that Hippocrates advised the lighting of great fires with wood of some aromatic kind, probably some species of pine. These, being kindled all about the city, stayed the progress of the pestilence. Others besides Hippocrates are, however, famous for having successfully adopted this practice.

A third legend states that the King of Persia, pursuing the plan (which in the two celebrated instances of Themistocles and Pausanias had proved successful) of attracting to his side the most distinguished persons in Greece, wrote to Hippocrates asking him to pay a visit to his court, and that Hippocrates refused to go. Although the story is discarded by many scholars, it is worthy of note that Ctesias, a kinsman and contemporary of Hippocrates, is mentioned by Xenophon in the “Anabasis” as being in the service of the King of Persia. And, with regard to the refusal of the venerable physician to comply with the king’s request, one cannot lose sight of the fact that such refusal was the only course consistent with the opinions he professed of a monarchical form of government.

After his various travels Hippocrates, as seems to be pretty generally admitted, spent the latter portion of his life in Thessaly, and died at Larissa at a very advanced age.

It is difficult to speak of the skill and painstaking perseverance of Hippocrates in terms which shall not appear exaggerated and extravagant. His method of cultivating medicine was in the true spirit of the inductive philosophy. His descriptions were all derived from careful observation of its phenomena, and, as a result, the greater number of his deductions have stood unscathed the test of twenty centuries.

Still more difficult is it to speak with moderation of the candour which impelled Hippocrates to confess errors into which in his earlier practice he had fallen; or of that freedom from superstition which entitled him to be spoken of as a man who knew not how to deceive or be deceived (“qui tam fallere quam falli nescit”); or, lastly, of that purity of character and true nobility of soul which are brought so distinctly to light in the words of the oath translated below: —

“I swear by Apollo the Physician and Æsculapius, and I call Hygeia and Panacea and all the gods and goddesses to witness, that to the best of my power and judgment I will keep this oath and this contract; to wit — to hold him, who taught me this Art, equally dear to me as my parents; to share my substance with him; to supply him if he is in need of the necessaries of life; to regard his offspring in the same light as my own brothers, and to teach them this Art, if they shall desire to learn it, without fee or contract; to impart the precepts, the oral teaching, and all the rest of the instruction to my own sons, and to the sons of my teacher, and to pupils who have been bound to me by contract, and who have been sworn according to the law of medicine.

“I will adopt that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and will protect them from everything noxious and injurious. I will give no deadly medicine to any one, even if asked, nor will I give any such counsel, and similarly I will not give to a woman the means of procuring an abortion. With purity and with holiness I will pass my life and practise my art.... Into whatever houses I enter I will go into them for the benefit of the sick, keeping myself aloof from every voluntary act of injustice and corruption and lust. Whatever in the course of my professional practice, or outside of it, I see or hear which ought not to be spread abroad, I will not divulge, as reckoning that all such should be kept secret. If I continue to observe this oath and to keep it inviolate, may it be mine to enjoy life and the practice of the Art respected among all men for ever. But should I violate this oath and forswear myself, may the reverse be my lot.”

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The ancient theatre at Larissa, the largest city of Thessaly — Larissa is recorded as being Hippocrates’ place of death