 Hi, I'm Peter Adamson and you're listening to the History of Philosophy podcast, brought to you with the support of King's College London and the Liverhume Trust. Today's episode? Good Humour Men – Early Greek Medicine and Ancient Philosophy. First of all, do no harm. This fundamental precept of medical ethics goes back to the man known as the father of medicine, Hippocrates of Kos. Well, more or less. The phrase is found in a work called the Epidemics, a fascinating text which gives detailed medical observations about outbreaks of disease in the ancient world. It instructs the medical practitioner to help, or at least not to harm. And this phrase has come down to us along with the idea that doctors should take an oath. Even today, we talk about doctors taking their Hippocratic oath, and in fact we do have an ancient Greek text called the oath, which like the epidemics, is ascribed to Hippocrates. These are just two of the more than 60 writings ascribed to Hippocrates in antiquity. We now call them the Hippocratic Corpus. But the way Hippocrates relates to this body of texts is a bit like the way Homer relates to the Iliad and the Odyssey. Hippocrates certainly did exist, in fact we're more sure of this than we are that Homer existed. But we can't say which if any parts of the Corpus Hippocrates wrote. Not only did Hippocrates exist, but he became famous very quickly. It's because of his fame that all these writings about medicine were attached to his name. Plato and Aristotle already refer to him as a preeminent doctor. Plato also says that he accepted students for a fee, and taught them medicine. As with most pre-Socratics, we don't have a firm idea of when Hippocrates lived, though of course he must have been on the scene in time for Plato to have referred to him. For our purposes, it's enough to say that he was younger than Socrates, perhaps a rough contemporary of Plato's. Was he the father of medicine? Definitely, in the sense that the Hippocratic Corpus, that is, the work supposedly written by Hippocrates, represent our first really important medical literature from the Greeks. As we'll see in a minute, there is plenty of evidence that there was medical activity before Hippocrates, or perhaps we should say before even the earliest works from his Corpus were written, but it's in the Hippocratic Corpus that we have our earliest surviving treatises on medicine. They discuss everything from the way a doctor should behave, as in the oath, to theories about the causes of disease, to the techniques that the doctor should use to cure and prevent diseases. Now, I know what you're thinking. This is a podcast about the history of philosophy, so why am I talking about medicine? Well, as I said at the end of the episode about Empedocles, philosophy and medicine were very closely related in the Greek world. In part, this is just an example of something I've mentioned before, that philosophy and science in general were very closely related in the Greek world. But medicine makes a particularly good example, because it was a preoccupation of so many philosophically-minded authors, and because we can actually trace the impact of philosophy on medical ideas. Medicine and philosophy in the Greek world went hand in hand, especially in the generations leading up to the time of Socrates, Plato, and Aristotle, the same period that gave rise to the understanding of medicine enshrined in the Hippocratic Corpus. Medicine, in the sense of a technical expertise claimed by certain experts, goes way back in the Greek world, in fact pretty much as far as our evidence does. In the Iliad, Homer depicts the gods' healing wounds, and also includes two human characters who are both soldiers and healers. They learned their art of medicine from their father, Asclepius. In Homer, Asclepius seems to be a human, albeit one whose father was a centaur. Later on in Greek history, though, Asclepius will be seen as a god of medicine. So this is one way that medicine is like philosophy. The seeds of a tradition are already planted in the Homeric poems. Another striking parallel is that Greek medicine is associated with the same region of the Greek world that gave birth to philosophy, the far eastern Mediterranean. Hippocrates hailed from the island of Kos, off the coast of Ionia, where the Milesians and Heraclitus devised the first philosophical thoughts. It's revealing that, even though the dialect of Greek spoken in Kos was Doric, the kind of Greek they spoke in Sparta, for instance, the Hippocratic Corpus is written entirely in the Ionic dialect. So that's another hint of the connections between Hippocratic medicine and Presocratic philosophy. We can also point to the attitude that Hippocratic authors take towards religion. As with Presocratic philosophy, it's commonly said that Greek medicine distanced itself from religion and thus became scientific and rational, but also as with Presocratic philosophy, the situation is actually a bit more complicated. An interesting case here would be a Hippocratic work on epilepsy, which the Greeks called the Sacred Disease. Epilepsy was thought to be sent by the gods, and sometimes to involve inspired visions on the part of the epileptic person, hence the Sacred Disease. But the author of the Hippocratic treatise titled The Sacred Disease doesn't have much time for this notion. He explains that epilepsy, like other diseases, has natural causes. It isn't a curse, or for that matter a blessing, that comes willy-nilly from the gods. He makes fun of people who claim that certain kinds of epileptic fits are caused by certain gods. Instead, he says, epilepsy is no more sacred than any other disease. But, he goes on to add that epilepsy is no less sacred than any other disease. In a sense, all diseases are sacred because they are brought about in our bodies by natural forces like the winds or the sun, and these forces are themselves divine. He concludes with an aphorism worthy of Heraclitus, "...all diseases are divine, and all are human." If anything, the author is claiming to be more pious than those who blame epilepsy on the gods. Respect for the gods doesn't mean thinking that they intervene randomly in human life to strike certain people down with an illness. It means seeing all of nature as divine, or as having a divine source. This might remind us of Xenophanes, who attacked Homer and Hesiod for making the gods too much like humans, with human emotions and irrationality. Xenophanes, like the author of the Sacred Disease, saw rationality as the correct religious attitude, not as a complete departure from religion. In fact, Greek medicine was closely related to religious practice. There were elaborate cults which involved asking the gods for healing. An example would be the cult of Asclepius, which was introduced in Athens in the late 5th century BC. At this point Asclepius is seen as a god. He has a dedicated temple with a staff of priests, who are apparently also doctors. When you're sick, you go sleep in or near the temple. If you are favored by the god you will have a dream, during which the god will either heal you, or give you instructions on how to be cured. Asclepius's cult became strongly associated with Hippocrates' island of Kos, and a large temple was built there in his honor. In the ancient world, there was a legend that Hippocrates learned his medical wisdom by reading the walls of the temple, but this is impossible for chronological reasons. Still, there's every reason to think that Hippocrates himself, and the sort of doctors who wrote and read the Hippocratic treatises, would have accepted the religious practices around disease. At the same time, they sought to bring human understanding to bear on the causes and cures of those diseases. As one Hippocratic author says, "'Prayer is good, but in addition to calling on the gods, one should lend a hand.'" So religion was one part of the world that generated Hippocratic medicine. But a still bigger influence came from pre-Socratic philosophical and scientific ideas. In previous episodes, we've seen philosophers making claims that border on the medical, for instance Heraclitus saying that drunkenness relates to being moist, or Anaxagoras explaining nutrition with his theory of universal mixture. Remember how your body is restored by cheese because there's bone and flesh in the cheese? But for medicine in the proper sense, Empedocles was the most important of the famous pre-Socratics. He claimed that wherever he went, people asked him to cure them, and also that he had knowledge of drugs. These medical interests are borne out by other fragments. I mentioned last time that for Empedocles, everything is made up of the four elements air, earth, fire, and water. I also mentioned that he gave an analysis of bone, as well as a detailed description of the structure of the eye. In both cases, he explains how these body parts arise out of the four elements, and for Empedocles, blood and flesh are made of nearly equal proportions of the four elements. That makes blood and flesh something like an ideal physical stuff from Empedocles' point of view. The medical application for this idea is obvious. If you're sick, it's because your proportions are out of whack. We find another thinker, the much more obscure Philistion of Locri, making precisely this point. Locri is at the tip of the Italian boot, so not far from Empedocles' home in Sicily, and he takes up Empedocles' four element theory. Philistion says that since your body is made up of those four elements – fire, air, earth, and water – we get sick because some of the elements dominate so that our bodies become too hot, cold, dry, or wet. The trick is to get these qualities into balance. What Philistion says is based on Empedocles' theory, but it also has some common sense plausibility. Just think of what it's like when you have a fever. The idea will be applied for centuries and centuries to come. For instance, Hippocratic doctors already made extensive use of drugs, and this sort of theory, in its general outlines, if not in its details, could provide a theoretical basis for how the drugs worked. As the medical tradition carries on, theories about pharmacology tend to explain that the ingredients in the drugs will adjust the heat, cold, moisture, or dryness of your body. The same thing goes for another major area of ancient medicine – diet. If you consulted a doctor in the ancient world, whether in 4th century Greece or a millennium later in the late Roman Empire, the doctor would almost certainly give you advice about what to eat, how much exercise to get, and so on. The advice was based on long observation and on trial and error. But, if you pushed the doctor to give a theoretical explanation for why these things worked, they would most likely say something involving Empedocles' 4-element theory. Empedocles gave more to medicine than this general theory, though. I just mentioned that he was a big believer in blood, with its perfectly balanced proportions. He also put a lot of emphasis on breath. The Greek word for breath is pneuma, which is where we get words like pneumatic. A long testimony in Aristotle explains that according to Empedocles, there's a kind of interplay between breath and blood. There are passages through the flesh of our bodies which fill with blood and then with air, in alternation. To judge from other authors like Philistion, the point of this was apparently that taking in air keeps the innate heat of our bodies more moderate. Again, it's all about proportion and balance. Another pre-Socratic philosopher who was fascinated by breath was Diogenes of Apollonia. He isn't going to quite rate his own episode. Even ancient authors tended to see him as somewhat derivative of other thinkers. His big thing was the principle of air, which seems to be a throwback to good old Anaximenes, the Milesian philosopher we looked at way back in episode 2. Diogenes was more influenced by Anaxagoras than Empedocles, and identified his airy principle with the cosmic mind of Anaxagoras. Air is an intelligent principle flooding the universe, and it becomes the other elements when it changes in density. As a proof of this, he points to the fact that the intelligent beings of the cosmos, namely we humans and other animals, live by taking in air as we breathe. Dying is, quite literally, running out of breath, and being intelligent is basically a matter of having more air in your physical makeup, so that he explains the fact that plants can't think in terms of their not taking in and retaining air. Again, there are medical, or at least anatomical, applications. For instance, he has a theory of reproduction, which I'll describe delicately, since this is a family podcast. The basic idea is that the human seed produced by men is blood which has been thinned and made foamy by mixing with, you guessed it, air. He even made observations about the network of blood vessels which were supposed to support this theory. Diogenes was not a major thinker, but his idea that there is a close association between life and breath or pneuma is almost irresistible, at least once someone else has thought of it. After all, it can't be a coincidence that living people breathe and dead ones don't, right? Many later thinkers will go further, and say that the soul itself is made of some kind of breath, which pervades the body and perhaps even circulates through what we now know to be blood vessels or nerves. These theories will get quite sophisticated. For instance, the second century AD doctor Galen, the most important figure in the entire history of medicine, distinguished several different types of pneuma which animate the body. I'm not saying we should try to trace all this directly back to Diogenes of Apollonia or to Anaximenes, but certainly the foundations of the idea were laid by the pre-Socratics. Now, these sorts of theoretical considerations were certainly not the main concern of the authors of the Hippocratic corpus. The treatises cover a range of issues, from medical ethics to drugs, gynecology, you name it. One text called On Ancient Medicine actually defends what it considers to be traditional medicine against these newfangled theories which invoke hot, dry, cold, and wet. In fact, the author of On Ancient Medicine refers explicitly to Empedocles. Instead of these simplistic theories, the Hippocratic author says, we must follow the teachings of the medical tradition which are gleaned from long and careful experience. Medicine is a large and complex body of knowledge which is especially required in order to prescribe the correct diet for each patient. The author thus anticipates arguments in the late ancient world where we will find Galen criticizing rival schools for saying that medicine is easy and simple to learn on the basis of a few theoretical principles. To quote another famous Hippocratic saying, life is short, but the art is long. And yet, the Hippocratic corpus does recognize certain theoretical principles. Of course, given that the various Hippocratic treatises aren't all by the same person, the theoretical basis can change from one text to another. But something we find in a lot of the Hippocratic material is that idea that what makes our bodies healthy is the same thing that preserves the cosmos as a whole, balance and proportion. In particular, the Hippocratics talk about the well-balanced proportion of bodily humours, meaning the various fluids in the body. You may well have heard of the four humours, blood, phlegm, yellow bile, and black bile. The parallel with the four elements is not a coincidence, and the humours could likewise be associated with the elemental properties – heat, cold, and so on. This version of the four-humour theory was in the process of developing at the time the Hippocratic corpus was produced. So, we don't find the corpus consistently referring to these as the canonical four humours, but we do often find the idea of keeping the humours in balance, that is, whichever humours are recognized in a given treatise. The humours are already starting to be associated with specific diseases. The best example is melancholy. The word melancholy comes from the Greek words for black and bile. The meanings of the English words sanguine and phlegmatic also refer to humours recognized by ancient and medieval thinkers. Sanguine is an allusion to blood and phlegmatic to, well, phlegm. The fact that these English words refer to personality traits and not diseases shows that the tradition extended the humoral theory to explain not just disease, but a wide range of human behaviour. Some of the notorious practices we associate with medieval medicine, like bloodletting, can also be explained as an attempt to restore balance to the body by draining out one humour that has become excessive. Hippocratic doctors did practice bloodletting as well as cupping, which is where you make a small incision and place a heated glass over it. When the glass cools, this creates negative pressure inside the glass, which draws out the blood. But the Hippocratic authors caution us to use such techniques sparingly. In general, they show an admirable reluctance to engage in what we would now call invasive procedures. They knew that their art had serious limits. The oath has the doctor promise to avoid using the knife, though the idea here may just be that surgery should be left to real specialists, whereas the oath was for doctors who were what we might call general practitioners. It's possible to look back at Hippocratic practices and see many attractive features that make an interesting contrast to modern medicine. For instance, there is not only their reluctance to intervene, but also their attention to preventative medicine, especially in the form of dietary advice. There is the Hippocratic insistence that medicine is an art and not a set of rules to be applied automatically, so that the doctor must learn to size up each patient as an individual case. There is the commitment to Holism, which is mentioned as a signature doctrine of Hippocrates by none other than Plato. Hippocrates taught that one should treat the whole body, not just the one part of the body where we find an ailment. But before I start to sound like Prince Charles, let's leave to one side the implications of Hippocratic practices for modern medicine and ask instead where all this leaves us in terms of early Greek philosophy. For one thing, it reminds us that the Presocratics applied their general theories to very specific problems. As I mentioned in an earlier episode, they saw the body as a microcosm, a little version of the whole universe. The rules that apply to the cosmos apply to the human body as well, an idea which is used to explain even things like respiration and the ingredients of blood and bone. Something else we've learned is that the Presocratics managed to influence their culture more broadly. They didn't see philosophy as a narrow, cloistered discipline, and their breadth of vision meant that they could influence authors with other interests, like these doctors, who took Presocratic ideas seriously and put them to use. This integration of philosophy into wider Greek culture is only going to become more important as we turn our attention to the big three, Socrates, Plato, and Aristotle. In fact, before we get to Socrates in two weeks, I want to spend one more episode on this wider cultural context. Next week, I'll be looking at a group of thinkers who fascinate and infuriate in equal measure. Plato will make them a foil for Socrates and for true philosophy. He will make their very name synonymous with dubious, devious argument. Yet among these same authors, we'll find the roots of some fundamental philosophical ideas, such as relativism. Who are these many-faced, slippery characters? If you haven't already guessed, you'll just have to tune in next week to find out, here on The History of Philosophy Without Any Gaps.