The Hippocratic On the Sacred Disease
I do not propose to address the entire Hippocratic corpus in this chapter. That, on its own, would be at least the work of another book. The Hippocratic Corpus is a group of between 60 and 70 treatises, most of which were written between 430 and 330 bce, though some are later.1 Which, if any of these, were written by Hippocrates is a matter of ongoing debate.2 They cover a wide range of medical subjects and are diverse in style, ranging from detailed observations of patients, to textbooks on procedure, to more theoretical works.
The first Hippocratic work I wish to look at is On the Sacred Disease, dating to the late fifth century or the early fourth century bce. The ‘sacred’ disease in question is epilepsy, which was seen throughout the ancient near east as a clear case where either gods or demons had caused the disease. On the Sacred Disease is important for this chapter in that while it appears to reject the non-natural causation of disease, whether On the Sacred Disease rejects the non-natural altogether has been a matter of debate. Gomperz is the classic statement for naturalist tradition,3 while Edelstein is the classic statement of the non-natural view with many contributions following on from these.4 Miller puts the issue like this:
The attempt of the author of the ‘Hippocratic’ work, De Morbo Sacro,5 to destroy the popular belief in the supernatural causation of the ‘sacred’ disease has long, and justly, been regarded as one of the earliest and most significant expressions of the self-consciously rational spirit in early Greek medical thought.6
While Porter praises the Hippocratics for
A healing system independent of the supernatural and built upon natural philosophy.7
On the other hand, Edelstein’s view is that
It seems impossible to contend that every form of supernaturalism was rejected by the Hippocratic physicians.8
Fowler comments that
On the Sacred Disease, is justly celebrated for its rationalistic rejection of spells and other magical procedures. It heaps scorn upon charlatans who claim to be able to cause eclipses of the sun or make it rain. Surely, one might say, this is proof that magic was beginning to be regarded merely as the activity of unenlightened, superstitious peasants. Yet this same doctor is quite willing to believe that sleeping in the sanctuary of Asklepios can cure you, and the writers of these treatises elsewhere display a willingness to call upon divination, dreams, and other quite irrational resources to work their wonders.9
At stake here is not just the local issue of whether On the Sacred Disease entirely rejected the non-natural. One of the themes for this book is presocratic targeting of non-natural belief, where there are difficult or important cases, and targeting of non-natural beliefs in Homer and Hesiod. Epilepsy might be thought to be a difficult and important case for natural explanation.10 The idea that diseases in general are caused by the gods was common in the ancient world and prominent in famous passages of Homer and Hesiod, the plague in the opening passage of the Iliad and Pandora’s box in Works and Days.11 I will argue that there are several other interesting instances of targeting non-natural belief, particularly in relation to Homer.
As I want to suggest that the Hippocratics, like the Milesians target important non-natural beliefs,12 I will also be looking at ways in which there are other commonalities of interests and approaches between the Hippocratics and the Milesians. On Regimen I/10, examined in the next chapter, is important here but there will be other considerations as well. Second, I want to explore some possibilities for religious belief for the ancient Greeks. The debate concerning On the Sacred Disease can polarise into two camps. The author mentions piety. Those who take him literally then ascribe to him a belief in a non-natural god. Those who take him to be polemical and metaphorical do not. Question: can a pantheist be pious? If the answer to that is yes, then there is the possibility that the author can be taken literally and have an entirely natural view of the world, which may go a good way to resolve the debate.
A final comment before we begin looking at On the Sacred Disease. Is the Hippocratic corpus entirely consistent in how it uses key terms for our discussion such as ‘divine’? No, it is not, not on this nor on several other issues. As the Hippocratic corpus was written by many authors over many years, quite probably without many of the authors realising their work would end up as part of this corpus, it is hardly surprising that there are inconsistencies between works. Do I wish to claim that all the Hippocratic writers entirely rejected the non-natural? I will certainly look at that claim. Whether it fully succeeds may depend on quite how we understand what can be done with pantheism and what we understand by the non-natural. Even if this claim is not fully successful, in my view the Hippocratics come remarkably close to disposing of the non-natural entirely. Does it matter if not every Hippocratic writers entirely rejected the non-natural? No, I do not think that it does. The claim of this chapter is not that all Greeks rejected the non-natural cause of diseases, but at least some of them did, in line with the claim of this book is not that all Greeks rejected the non-natural, but at least some of them did.
I first want to emphasise the background of how epilepsy was seen as a disease in the ancient world.13 Wilson and Reynolds, in their paper on a Babylonian tablet which deals with epilepsy, say that:
The first point to be made is that to Babylonian science, as to the Babylonian as’ipu – the ‘doctor’ and ‘scholar’ most closely involved – it was clear that the manifestations of epilepsy were the work of demons and ghosts.14
To quote the opening line of this tablet:
If epilepsy falls once upon a person or falls many times, it is as the result of possession by a demon or a departed spirit.15
The tablet also says that ‘If an epilepsy demon has fallen once upon him’ and wants to generate a contrast with cases where ‘If an epilepsy demon falls from time to time upon him’ and ‘If an epilepsy demon falls many times upon him’.16 Slightly later on in the tablet, again in reference to epilepsy, we get: ‘If the possessing demon has been possessing him again and again.’17 This fits well with the more general Babylonian background that all diseases are due to the intervention of gods or demons.18
Also important here is the background of Homer and Hesiod. While neither mention epilepsy specifically, both subscribe to the notion that the gods inflict diseases on humankind. This passage from the Iliad is notable as it is the opening passage of the work:
Sing, goddess, the wrath of Achilles Peleus’ son, the ruinous wrath that brought on the Achaians woes innumerable, and hurled down into Hades many strong souls of heroes, and gave their bodies to be a prey to dogs and all winged fowls; and so the counsel of Zeus wrought out its accomplishment from the day when first strife parted Atreides king of men and noble Achilles. Who among the gods set the twain at strife and variance? Apollo, the son of Leto and of Zeus; for he in anger at the king sent a sore plague upon the host, so that the folk began to perish, because Atreides had done dishonour to Chryses the priest.19
To relieve the plague,20 there is no question of any cure, except trying to assuage the anger of the gods.21 This passage from Hesiod does not occur in quite such a prominent position in his works, but his view is clear enough:
But for those who practise violence and cruel deeds far-seeing Zeus, the son of Cronos, ordains a punishment. Often even a whole city suffers for a bad man who sins and devises presumptuous deeds, and the son of Cronos lays great trouble upon the people, famine and plague together, so that the men perish away, and their women do not bear children, and their houses become few, through the contriving of Olympian Zeus.22
If we want another sample view from the ancient near east, we can also look to the Bible, where in the New Testament Mark tells us that:
14 And when they had come to the multitude, a man came to Him, kneeling down to Him and saying, 15 ‘Lord, have mercy on my son, for he is an epileptic and suffers severely; for he often falls into the fire and often into the water. 16 So I brought him to Your disciples, but they could not cure him.’ 17 Then Jesus answered and said, ‘O faithless and perverse generation, how long shall I be with you? How long shall I bear with you? Bring him here to Me.’ 18 And Jesus rebuked the demon, and it came out of him; and the child was cured from that very hour.23
The idea that illness in general, and epilepsy in particular is caused by gods or demons is then widespread in the ancient world. On the Sacred Disease, in typically aggressive fashion, explains the origins of the idea that epilepsy is divine by saying:
In my opinion the first men to consider this disease to be sacred were like those we now call mages, purifiers, vagabonds and quacks. These people claim for themselves great piety and much knowledge. They used the divine as a cloak, having no treatment or anything useful to offer, and in order that their lack of knowledge should not be evident, they called this condition sacred. 24
The author is clearly aware of the background here and is in no doubt who his targets are.25
The Hippocratics
The positive case for the author of On the Sacred Disease is then that they reject the idea that epilepsy is caused by the gods and emphatically state that it has a natural cause. One can put this rather more strongly though. It is not just epilepsy which is natural, but all diseases are natural. It is also interesting and significant that the Hippocratic author takes on what might well have been considered to be the hardest case in attempting to demonstrate that all diseases have a physical cause and none have their origin with the gods. This, in line with one of the main themes of this book, can be seen as an example of presocratic targeting. That in turn can be seen in two ways. First, the most difficult case is being taken on. Second, while Homer and Hesiod do not specifically mention epilepsy, their view on disease in general is clear and the Hippocratic author puts forward the view that all diseases, which would include the plague, have a natural origin.26 The author bluntly denies that the sacred disease is caused by the gods or that its nature is different from that of other diseases. The opening passage of On the Sacred Disease is:
Concerning the disease which is called ‘sacred’. In my view it is no more divine or sacred than any other disease, but has a nature and a definite cause. Men have called it divine due to their inexperience and great wonder, it being unlike other diseases.27
It is possible to find similar sentiments elsewhere in the Hippocratic corpus, for instance in On Airs, Waters and Places and in On Breaths.28 Throughout On the Sacred Disease one can find straightforward assertions like:
This disease is generated by and grows due to what comes into the body and what leaves it, it is no more difficult to cure or understand than other diseases, and is no more divine than the others.29
On the Sacred Disease also says that:
This is best seen with cattle who are attacked by the disease, especially goats. They are most commonly seized. If you cut open the head you will find that the brain is wet, full of fluid and foul smelling, so clearly one recognises that it is not a god which is harming the body, but the disease. So too with humans.30
Not being able to perform human post-mortems, the Hippocratics performed post-mortems on goats who appeared to suffer from a similar disease to epilepsy and concluded that the disease had a natural basis. We cannot be sure this actually took place,31 though the comment that the contents of the head were ‘foul smelling’ might well suggest that it did and we will find a similar investigation from Anaxagoras into a supposed unicorn.32 On the Sacred Disease Ch. XVI further tells us that:
This disease is born and grows from that which enters and leaves (the body), it is no more intractable than the others, nor is it incurable or unintelligible, and is no more divine than the others.33
The final section, XXI, of On the Sacred Disease opens on a thoroughly optimistic note by saying:
The so-called sacred disease is produced by the same causes as other diseases, from what enters and leaves the body, from cold, sun and the changing winds which are never resting. These things are divine, such that there is no need to distinguish this disease from the other diseases, they are all divine and they are all human. Each disease has its own nature and power and none are intractable or untreatable (ouden aporon … oude amêchanon).
These comments are best seen as programmatic and against the background of the final lines of On the Sacred Disease:
Anyone who knows how to produce in men dryness or wetness, cold or heat by means of regimen, can cure this disease as well, if he can distinguish the due times for treatment, without needing purifications or magic.34
General attack on magic
A further important aspect of On the Sacred Disease, as Lloyd has argued, is that it makes a general attack on magic and magicians.35 It is not just epilepsy which has a natural cause, but all diseases. It is not just that there are incompetent practitioners of magic in relation to healing, the whole practice is entirely unfounded. Although the main focus of On the Sacred Disease is medical, there is a parallel attack on other magical practices as well. The author says that:
If a human by magic and sacrifice can bring down the moon, eclipse the sun, make storm and good weather, I will not call these things divine, but human, since the ability of the god is overpowered and enslaved by the knowledge of humans.36
This is interesting for its breadth of attack on magical claims and practices. It is also interesting and highly significant that the Hippocratic author, even in this hypothetical example, will not allow something that is both non-natural and effective. If humans can achieve these things by magic and sacrifice, then these acts are human and not divine. The Hippocratic author interestingly does not distinguish between humans who are capable of this magic and humans who are not and does not seem to recognise the idea that some humans might have magical abilities and others not. The Hippocratic author continues from the passage above with the following acerbic remarks:
But perhaps this is not true and these men, being in need of a living,37 fashioned and embellished many tales of all types, about many things and about this disease in particular, placing the blame for each form of this condition on some god.38
This all looks very promising as an apparent rejection of magic and the non-natural. On the Sacred Disease continues in its sceptical manner:
They have instituted a mode of treatment which is safe for themselves, namely, by applying purifications and incantations, and enforcing abstinence from baths and many articles of food which are unwholesome to men in diseases … And they forbid to have a black robe, because black is expressive of death; and to sleep on a goat’s skin, or to wear it, and to put one foot upon another, or one hand upon another; for all these things are held to be hindrances to the cure. All these they enjoin with reference to its divinity, as if possessed of more knowledge, and announcing beforehand other causes so that if the person should recover, theirs would be the honour and credit; and if he should die, they would have a certain defence, as if the gods, and not they, were to blame, seeing they had administered nothing either to eat or drink as medicines, nor had overheated him with baths, so as to prove the cause of what had happened.39
It is worth noting that there are healing songs in Homer, though the attack on incantations is quite general.40 We are about to move on to discussing the Hippocratics and the divine. Something I tried to emphasise in the section on magic in the introductory chapter to this book was the gulf in world view and practice between the presocratic magicians and the presocratic philosopher/scientists. That gulf is sometimes forgotten when we debate the finer points of whether the philosopher scientists fully rid themselves of all aspects of magical or non-natural thinking. I would reiterate that here in relation to the Hippocratics on a smaller scale and I would emphasise two points. First, look at the gulf between the Hippocratic author here and the magical ideas and practices that they describe. Second, there are a great many Hippocratic texts where there is no issue that all explanation is done in an entirely natural manner. This is so for, e.g. the Epidemics, even where no cause is evident for a disease and in many works the divine is not even mentioned.41
It would be wrong though to see this rejection of the non-natural as an outright rejection of the divine. The Hippocratic author does not deny the existence of the divine, but On the Sacred Disease XXI says in relation to epilepsy that:
Therefore there is no need to distinguish this disease from others or consider it more divine, for they are all divine and all human.42
The contention throughout On the Sacred Disease is not that there is no such thing as the divine but that epilepsy is no more and no less sacred than any other disease. How are we then to understand this reference to the divine? One solution, which is attractive in many ways, is pantheism. Van der Eijk comments that:
In this theology the divine is regarded as an immanent natural principle (or as a certain group of concrete natural factors) and is no longer conceived as something supernatural. Consequently the influence, or the manifestations, of the divine are regarded as natural processes and no longer as supernatural interventions of gods within natural or human situations.43
As we shall see, van der Eijk does not think this quite fits all the author of On the Sacred Disease has to say, but it is a good characterisation of the pantheist interpretation.44 One objection to this pantheist view is what Hankinson has termed ‘The Explanatory Vacuity of Pantheism’.45 He says that:
One might argue, either on positivist or pragmatist grounds, that unless the hypothesis that there is a divine component to things can make some difference, either to what (in principle) verifiable predictions we can make or to our actual practice, then such suppositions are devoid of content.46
Certainly one might be concerned about what difference it makes whether the world about us is considered to be divine in the pantheist sense or not. Hankinson’s reply to this is that:
Nature is divine because of its intricacy, regularity and teleological structure; natural processes, in their goal-directedness and their striving for a type of immortality, seek to emulate the divine condition. Yet even if nature is divine in more than merely a metaphorical sense, there is still no point in appealing to it as one might a powerful patron. This sort of divinity, in sharp contrast with the angry, engaged, interventionist gods of epic and tragedy, is not open to plaint or suasion, much less magical coercion.47
I would add two points to this. First, we saw that there was explanatory import with Milesian panpsychism. Anaximander’s divine apeiron steered, having an important function in cosmogony and in the ongoing behaviour of the universe. A non-divine universe would not have this steering function, this ability to organise itself out of a condition of complete uniformity and to maintain itself. One might take the view that a non-divine world in this sense of steering would not have this degree of organisation or this degree of stability. Against this view one would have to say that it is not possible to tie Anaximander in directly with On the Sacred Disease. However, as we shall see in relation to the Hippocratic On Regimen, it is possible to tie similar themes from the Milesians in with the Hippocratic corpus.48 Second, there is the related point that the cosmos for ancient Greeks could be both aesthetically and morally good as well as displaying good order in the sense of law like behaviour.49 If it is perceived that this cosmos is indeed aesthetically and morally good, that sets it apart from arrangements which are not. While the term ‘cosmos’ is not found in On the Sacred Disease, the idea of the world as a cosmos, a well-ordered, aesthetically and morally good place would have been around at the time.
This second point is also important for another reason. If the world about us is perceived to be aesthetically and morally good, it may then be an object of adoration, veneration, reverence, even worship, even piety. It might also be an object to be honoured, a key notion in Greek religion being proper honour for the gods.50 One might hold that there are proper attitudes and proper actions towards a world so conceived. To have the proper attitudes and do the proper actions is pious. There is no reason, either generally or within Greek religious observance, that piety should be restricted to the relationship between a human and a god which exists independent of the natural world. So returning to our passage from On the Sacred Disease XXI, I would disagree with Martin who says that
Given such a straightforward statement, it is odd that so many modern interpreters have taken the writer to be arguing, on the contrary, that the gods and ‘supernatural’ forces have nothing to do with disease.51
With the pantheist option, the gods have nothing to do with the disease and there is nothing here that is either non-natural in the modern sense or non-natural for the presocratics.
Against the naturalist view
Against the view that On the Sacred Disease gives us an entirely natural account of epilepsy, disease in general and perhaps natural phenomena in general as well, van der Eijk has commented that:
It has been recognized by several interpreters that the author’s criticism of the magicians, which occupies the entire first chapter of the treatise (and which is echoed several times later on in the treatise), reflects an authentic religious conviction … The religious conviction which apparently underlies these passages is far more traditional and less ‘advanced’ than the naturalistic theology which is reflected in the statements on the divine character of the disease, since it appears that the author of MS52 believes in a supreme divine power which cleanses men of their moral transgressions and which is accessible to cultic worship in sacred buildings by means of prayer and sacrifice. 53
There are two sorts of reply one might make to this. First, one might look to the hypothetical and ad hominem nature of the arguments in the early part of On the Sacred Disease. The author’s own beliefs are not the issue here. What is at issue here is the coherence of the beliefs of those who believe epilepsy to be sacred and other diseases to be non-sacred. They claim to be pious but their views lead to gross impiety. They claim a belief in god but their views actually lead towards atheism.
The second line of approach, which can be used independently of or in conjunction with the first approach, if that is not felt to clear up all the issues, is to ask whether the author commits themselves to anything which would be problematic for the pantheist interpretation? It should be clear that admitting the existence of the divine is unproblematic. If it is possible to have an attitude of reverence or piety for nature/the divine, as I have suggested above, then a claim to personal piety, rather than an attack on others’ views is not problematic for the pantheist interpretation either. Similarly a pantheist believes there to be a god, identical with nature and is in a position to criticise atheists, who do not believe in the divinity of nature.
There has been debate about the ‘religiosities’ of Airs, Water, Places and On the Sacred Disease, and whether they exhibit similar ‘religiosities’.54 I take the somewhat deflationary view that both Airs, Water, Places and On the Sacred Disease can be analysed in terms of the two approaches we have just looked at and both have pantheist ‘religiosities’, if that is an appropriate term to be applied to pantheism.55 I also think that van der Eijk’s talk here of a ‘supreme divine power’ pushes the evidence a little too far. I have suggested that pantheism may be the best way to understand On the Sacred Disease. That is different from an assortment of independent gods, but that is different again from the idea of a ‘supreme divine power’. The evidence might be thought to support multiple independent gods but I cannot see that it supports the idea of a single ‘supreme divine power’.
Polemical context
As the author of On the Sacred Disease contrasts the divine and the human and concludes that all diseases are both divine and human, some commentators have been concerned over what the difference between divine and human in relation to diseases is for the author.56 Some have sought to explain this in terms of the origin of the disease, looking to passages such as the beginning of Ch. XXI where ‘cold, sun and the changing winds’ are divine and are the cause of epilepsy. Alternatively, a disease may be divine because it has a phusis, a definite pattern of development.57 Here I follow Mansfeld’s suggestion that the context of the remarks about diseases being both divine and human is polemical.58 It is the opponents’ position is that some diseases are divine, some are human. It is the author’s view that there is no such distinction and as such all diseases are, in this terminology, both divine and human. It is important to recognise the polemical context of the Hippocratic works such that this attack on opponents is no surprise. The Hippocratics were not the only people offering cures in the fifth and fourth centuries bce. They were in direct competition with midwives, root-cutters, herbalists, purifiers, purveyors of charms and incantations, gymnastic trainers, drug sellers, bone-setters, exorcists and surgeons as well as the cults of Apollo and Asclepius.59
Van der Eijk has rightly pointed out though that the author of On the Sacred Disease makes some comments about the divine and about pollution which are separate from other remarks which could be considered hypothetical and polemical. Here is van der Eijk’s translation of what he considers to be the key passage, of which he says ‘It seems that if we are looking for the writer’s religious convictions we may find them here’:60
But I hold that the body of a man is not polluted by a god, that which is most corruptible by that which is not holy, but that even when it happens to be polluted or affected by something else, it is more likely to be cleansed from this by God and sanctified than to be polluted by him. Concerning the greatest and most impious of our transgressions it is the divine which purifies and sanctifies us and washes them away from us; and we ourselves mark the boundaries of the sanctuaries and the precincts of the gods, lest anyone who is not pure would transgress them, and when we enter the temple we sprinkle ourselves, not as polluting ourselves thereby, but in order to be cleansed from an earlier pollution we might have contracted. Such is my opinion about the purifications.61
Van der Eijk’s view on this passage is that ‘the author believes in the purifying and cleansing working of the divine’62 and more programmatically that:
He believes in gods who grant men purification of their moral transgressions and who are to be worshipped in temples by means of prayer and sacrifice.63 It is difficult to see how this conception of ‘the divine’ (to theion) can be incorporated within the naturalistic theology with which he has often been credited. 64
On this I disagree, as I believe all of this can be incorporated into a pantheist view. If there are proper attitudes and actions towards nature, as I suggested above, then there can be improper ones as well. If we have taken part in improper attitudes and actions, then we may need to make recompense. In doing so we re-assimilate ourselves to nature. That there should be places of worship for a divine nature is entirely unproblematic. The only problem I see here is the use of gods in the plural, but that may be a loose metaphorical use (meaning divine nature). So I would agree with Miller, who comments about On the Sacred Disease’s author that:
His remarks reflect, indeed, a genuine belief in the Divine, but, as perhaps in the case of a Socrates or a Euripides, it is not simply a belief in the gods as traditionally and popularly conceived.65
All phenomena natural?
We do need to be cautious though about any proposed identification of the natural and the divine in On the Sacred Disease. As van der Eijk has argued, this is not explicit in the text, nor is it explicit that all phenomena, in addition to all diseases, should be considered to be both natural and divine. That is so. However it is possible to make the case that all phenomena are both natural and divine in On the Sacred Disease. The first point to make here is that the task of On the Sacred Disease is to argue that epilepsy is no more divine than any other disease and more broadly that all diseases are equally divine. It is no great surprise that a more general view of all phenomena is omitted, whatever the author’s view. This is not a more general work of philosophy intended to argue that all phenomena
Having said that, there are passages which can be taken as asserting that more phenomena. One might well read On the Sacred Disease IV/1–5, as asserting that the activities of the sun and the moon, and meteorological phenomena such as storms and good weather, rain and drought are all natural phenomena. Certainly one should read On the Sacred Disease XXII as giving us ‘cold, sun and the changing winds’ as phenomena which are both divine and natural.
Two important points come out of this. First, given such a catalogue of important phenomena as natural, along with all diseases, the step to ‘all phenomena are natural’ is not very far. Second, we again see an insistence that meteorological phenomena are entirely natural and that meteorological phenomena are given prominence in discussions of the natural. This is important in tying the Hippocratics in with the presocratic philosophers in their assault on phenomena commonly taken to be non-natural. We might also consider two passages from other Hippocratic works. Firstly, from On Airs, Waters and Places:
I believe that these conditions are divine and so are all others, none being more divine or human than any other, all are alike and all divine. Each of them has its own nature and nothing occurs without a natural cause.66
Our second passage is from On the Art:
Under closer examination the spontaneous does not appear, as everything which occurs does so on account of something, and this ‘on account of’ shows that the spontaneous has no existence and is just a name.67
For each of these passages here is a deflationary and an expansive view. The deflationary view is that in each case the reference is to diseases and diseases only. They are natural, but other phenomena are not under consideration here. The more expansive view simply is that all phenomena, including but not only diseases are the subject here, and that all phenomena are natural. The great temptation is to assimilate these passages to a seemingly extremely strong and programmatic fragment of Leucippus:
Nothing happens at random (matên),68 but everything for a reason and by necessity.69
That should probably be resisted, as there is nothing so strong or clear in the Hippocratic corpus.70 I would add one theoretical consideration though, which is that if the author of On the Sacred Disease was a pantheist, we would indeed expect all phenomena, not just diseases to be natural and divine. I see nothing in On the Sacred Disease which contradicts that, even if we do not have a fully programmatic statement of it, which we would not expect in such a treatise.
While I do not intend to deal with the entire Hippocratic corpus in this chapter, there are a couple of other passages which have been examined in the literature and thought problematic for a naturalist interpretation. The first is from On Prognosis:
One must understand the natures of such diseases, how far they exceed the power of the body [sc. to resist], + and also whether these diseases have anything divine in them, + and learn how to predict them.71
It is interesting to note here that the key phrase here, ‘and also whether these diseases have anything divine in them’, was considered suspect by editors of the text, and so placed between + marks, on the grounds that no Hippocratic would say such a thing. An interesting case of elision!72 In fact this passage is unproblematic, as Galen realised. He believed it referred to the atmospheres which gave rise to epidemics. That I think is generally correct, but I would also look to On the Sacred Disease XXI, where cold, sun and the changing winds which are never resting are reckoned to be divine.73 The following passage from On the Nature of Women is also thought to be problematic:
The divine is most particularly a cause for human beings; next come women’s natures and complexions. Some are too pale, moister, and more prone to flux; others dark, harder, and more rigid; while those who are tanned are in between the two. The same thing is true in regard to age. The young are moister and for the most part fuller of blood, the old drier and thin-blooded, those in middle age intermediate. He who wishes to treat them correctly must first begin with the divine, then understand women’s natures and ages, and the seasons and places they are in.74
On my view there is nothing problematic here at all. The final passage is programmatic. In order to understand women we must understand nature/the divine (which on my view are one and the same thing for the Hippocratics), then we must understand the nature of women. Understand the environment, understand the nature of man, understand the nature of women – standard Hippocratic stuff, nothing to get excited about. There is really no need for any more elaborate theory here.75 On Airs, Waters and Places could be argued to go in for a form of astrology. On Airs, Waters and Places X say that:
And respecting the seasons, one may judge whether the year will prove sickly or healthy from the following observations:— If the appearances connected with the rising and setting stars be as they should be; if there be rains in autumn; if the winter be mild, neither very tepid nor unseasonably cold, and if in spring the rains be seasonable, and so also in summer, the year is likely to prove healthy.76
On Airs, Waters and Places XI also tells us that:
Whoever studies and observes these things may be able to foresee most of the effects which will result from the changes of the seasons; and one ought to be particularly guarded during the greatest changes of the seasons, and neither willingly give medicines, nor apply the cautery to the belly, nor make incisions there until ten or more days be past. Now, the greatest and most dangerous are the two solstices, and especially the summer, and also the two equinoxes, but especially the autumnal. One ought also to be guarded about the rising of the stars, especially of the Dogstar, then of Arcturus, and then the setting of the Pleiades; for diseases are especially apt to prove critical in those days, and some prove fatal, some pass off, and all others change to another form and another constitution. So it is with regard to them.77
There is nothing problematic here though. There is no suggestion here that the heavens are in any way causative of medical conditions. Rather, the reference to the heavens is just a useful way of marking out the year. Later of course there would be medical astrology, one typical scheme had the planets with influences of hot, cold, wet or dry (or combinations thereof) affecting the humors, but we see no trace of anything like that here. On Decorum VI has multiple reference to the gods, but On Decorum is generally thought not to be a genuine Hippocratic work, there being linguistic grounds for placing it later and stylistic grounds for placing it outside the corpus.78
Further targeting?
I have suggested that the author of On the Sacred Disease targeted epilepsy as a difficult and interesting case and as a key instance against the views of Homer and Hesiod that diseases are sent by the gods. I now want to investigate some other targets that the author may have in mind. As Jouanna has pointed out,79 there are some interesting affinities in the way in which Hesiod classifies cities in Works and Days,80 and the way in which the Hippocratic author of On Airs, Waters and Places classifies them. Both have two types of city, one where people prosper and another where they waste away, while the Hippocratic author has salubrious and insalubrious cities. In Hesiod’s Works and Days, the aetiology is straightforward:
For those who practise violence and cruel deeds far-seeing Zeus, the son of Cronos, ordains a punishment. Often even a whole city suffers for a bad man who sins and devises presumptuous deeds, and the son of Cronos lays great trouble upon the people, famine and plague together, so that the men perish away, and their women do not bear children, and their houses become few, through the contriving of Olympian Zeus.81
On Airs, Waters and Places on the other hand has no mention of divine influence or intervention, only environmental factors. I would wholeheartedly agree with Jouanna in that:
For the poet, it is a question of the relation in each case between men and gods. For the physician, it is the relationship between men and their environment that must be taken into account.82
A second important contrast which Jouanna makes is this.83 What is the provenance of human skills? Are they gifts from the gods, as they are in Homer and Hesiod, or are they something that humans have discovered for themselves? The Hippocratic On Ancient Medicine is quite clear on the topic:
So that the first inventors, pursuing their investigations properly, and by a suitable train of reasoning, according to the nature of man, made their discoveries, and thought the Art worthy of being ascribed to a god, as is the established belief.84
So the discovery of medicine is a natural phenomenon for the Hippocratics. That is hardly surprising of course, but it is significant that they point that out in contrast to other views. In the Iliad, Asclepius is taught about drugs by Chiron, a centaur.85 A further important point here is that On Airs, Waters and Places attributes barrenness in women to environmental factors where this had often been put down to the intercession of a god.86
Van der Eijk has also made the important point that On the Sacred Disease not only attacks magical views and practices associated with epilepsy, it removes disease, including mental illness from religion and ethics.87 People do not become ill, or mentally ill because they have transgressed against the gods or because they have acted immorally. They cannot be cured by making recompense to the gods or by ritual purification. If you are ill there is something natural wrong with your body, if you are mentally ill there is something natural wrong with your brain.88 Van der Eijk says of the author of On the Sacred Disease:
His project to ‘naturalize the mind’ is related to a wider tendency of Greek thought of his time to provide natural explanations for phenomena hitherto explained by reference to divine action – not only thunder or earthquakes, but also manifestations of madness and epileptic fits. Like other Greek thinkers he is looking for the phusis of things and like other medical writers he is seeking the nature of man.89
I would add here that this is also hugely important in relation to the Homeric idea that gods intervene not only in the physical world but in human mental states as well. The classic example, as we saw in the introduction to this book is Agammemnon attributing his behaviour to the intervention of a god who robbed him of his understanding.90 We find nothing of this sort in the Hippocratics but it is widespread throughout both Odyssey and Iliad.
Meteorology in the Hippocratic corpus
One theme for this book is presocratic meteorology as a reaction to Homer and Hesiod. That meteorological phenomena are entirely natural in the Hippocratic corpus is no great surprise, but it is important to note it nevertheless. On Airs, Waters and Places II tells us that:
For knowing the changes of the seasons, the risings and settings of the stars, how each of them takes place, he will be able to know beforehand what sort of a year is going to ensue. Having made these investigations, and knowing beforehand the seasons, such a one must be acquainted with each particular, and must succeed in the preservation of health, and be by no means unsuccessful in the practice of his art. And if it shall be thought that these things belong rather to meteorology, it will be admitted, on second thoughts, that astronomy contributes not a little, but a very great deal, indeed, to medicine. For with the seasons the digestive organs of men undergo a change. 91
As Homer and Hesiod have rainfall as a non-natural phenomenon, it is also worth quoting On Airs, Waters and Places VIII on rainwater:
I will now tell how it is with respect to rain-water, and water from snow. Rain waters, then, are the lightest, the sweetest, the thinnest, and the clearest; for originally the sun raises and attracts the thinnest and lightest part of the water, as is obvious from the nature of salts; for the saltish part is left behind owing to its thickness and weight, and forms salts; but the sun attracts the thinnest part, owing to its lightness, and he abstracts this not only from the lakes, but also from the sea, and from all things which contain humidity, and there is humidity in everything; and from man himself the sun draws off the thinnest and lightest part of the juices.92
So it would seem that On Airs, Waters and Places has an entirely natural account of the meteorological phenomena it deals with and there is no evidence that suggest any other sort of attitude in the Hippocratic corpus.
Conclusion
If we take the view that the author of On the Sacred Disease was a pantheist, then the view that they had an entirely natural account of epilepsy, of diseases and in all probability of all natural phenomena as well is unproblematic, as long as we are willing to accept the idea that a pantheist can have a reverence for nature. There is a certain economy to this position in that we avoid some other debates. We do not need to worry about whether the author is being polemical or metaphorical when he mentions piety and atheism as a pantheist can be pious and can attack atheism. We do not need to worry to what extent the author hides their religious views. There is no concern about the relation of science and religion. On the Sacred Disease has an important attack on magic in general. It targets the ‘sacred disease’ as an important case for natural explanation but also has further important targets, not least the naturalisation of the mind and all types of mental illness.