Hippocrates, Ancient Medicine, introduction
W. H. S. Jones, Ed.

INTRODUCTION

AMONG ancient writers Erotian is the only one who expressly ascribes this little treatise to Hippocrates himself. Modern critics generally regard it as old, but as not by Hippocrates, the chief exception being Littré. Adams is uncertain, but is inclined to think that Hippocrates was not the author.

Thus the external evidence in support of the view that Hippocrates was the author of this treatise is very slight indeed. The internal evidence is considerably stronger.

(1) The writer, like Hippocrates,¹ holds that health is caused by a "coction" of the "humours."

(2) He recognises the importance of "critical" days in an illness.

(3) He holds that medical science is founded on observation and reasoning, not on speculation.

(4) He attaches great importance to the use of "slops" of various degrees of consistency.

All these doctrines are in conformity with the views expounded in the works assigned to Hippocrates. On the other hand, no stress is laid upon prognosis, which Hippocrates considered of primary importance. Again, it would be impossible to show from the works of Hippocrates that the father of

[p. 4] medicine thought little of the power of heat and cold in producing health or disease ; our author, however, rates them very low. Moreover, like the Pythagorean physician Alcmaeon, he holds that there is an indefinite number of "opposites," the harmony or crasis of which produces health. The historical Hippocrates is said to have reduced the number of the humours to four, although I can find no trace of this limitation to four in any treatise earlier than the one on the Nature of Man, which is not generally considered authentic.

It may be said that, were the external evidence stronger, the treatise would be accepted as an authentic work of Hippocrates.

Littré² argues that the well-known passage in the Phaedrus,³ where "Hippocrates the Asclepiad" is mentioned as holding a theory that a knowledge of the human body is impossible without a knowledge of the universe--interpreted to mean an examination of the δύναμις2 (or δυνάμεις2) of a body according to its inter-relations with other things--refers to Chapter XX of the περὶ ἀρχαίης2 ἰητρικῆς2, and not, as Galen maintains, to the treatise On the Nature of Man. Littré⁴ also points out that a passage in our treatise⁵ is very similar to one in Regimen in Acute Diseases, the authenticity of which is undoubted.

[p. 5] Littré may have shown that there is a resemblance to our author in the Phaedrus passage. Resemblances, however, show merely that the writer was Hippocratic, not that he was Hippocrates.

The reference, in Chapter XV, to participation (κοιννωεῖι) in εἴδη and to "absolute existences" (αὐτό τι ἐΦ᾽ ἑωυτοῦ) might lead a critic to infer that the writer lived in the age of Plato. But there are two insuperable difficulties to this hypothesis. One is that in Chapter XX the word ς1οΦις1τής2 is used in its early sense of "philosopher," which implies that the writer lived before Plato attached to the word the dishonourable meaning it has in later Greek. The other is that the writer attacks the intrusion of philosophic speculation into the science of medicine, and the speculation he has constantly in mind, as being, apparently, the most influential in his day, is that of Empedocles,⁶ who is actually mentioned in Chapter XX as a typical writer περὶ Φύς1εως2. There is a sentence in Chapter XIV which closely resembles, in both thought and diction, the fragments of Anaxagoras.⁷ It certainly looks as though the writer of Ancient Medicine was not unfamiliar with the works of this philosopher. All this evidence tends to fix the date as approximately 430-420 B.C., and to suggest as the writer either Hippocrates or a very capable supporter of the medical school of which Hippocrates was a contemporary member.

The author of Ancient Medicine in Chapter II asserts

[p. 6] that empiric medicine was in his day an old art, and that the attempt to foist the method of philosophy upon it was comparatively modern. He is obviously correct. Hippocratic science must have been the ripe fruit of a long period of active inquiry ; philosophy began early in the sixth century B.C., and it was late in that century that medicine and philosophy were combined in the persons of prominent Pythagoreans.⁸ It was only natural that, as the main interest of philosophy shifted from cosmology to biology, philosophy should occupy itself with medical problems. The union was closest in Empedocles, thinker, seer, and "medicine-man," but by the end of the fifth century philosophy had discarded medicine, although to its great loss medicine did not discard philosophy.⁹

Several recent critics, notably Professor A. E. Taylor,¹⁰ have pointed out the importance of this little work in the history of thought. It has even been urged that it proves that the technical phrases, and perhaps the doctrine also, of the theory of Ideas, usually ascribed to Plato, were well-known to educated men a generation at least before Plato. The language used in Chapter XV is, indeed, strikingly like the terminology of Plato, far too much so to be a mere coincidence.

However this may be, it is plain that in the fifth century B.C. there were thinkers, holding principles nearly akin to those of modern science, who were violently opposed to the application of philosophic

[p. 7] procedure to science. This procedure the writer calls the method of ὑποθές1εις2. The student of Plato is at once reminded of the Phaedo, Republic, and Sophist, in which dialogues a theory of knowledge is expounded which is stated to be the best possible method of inquiry until the Ideas have been apprehended. It should be noticed that a ὑπόθες1ις2 is something very different from a modern scientific hypothesis. The latter is a summary of observed phenomena, intended to explain them by pointing out their causal relationship. The former is not a summary of phenomena ; it is a postulate, intended to be accepted, not as an explanation, but as a foundation (ὑπο-τίθημι) upon which to build a superstructure. An hypothesis must by tested by further appeals to sense-experience ; a ὑπόθες1ις2 must not be so tested, it must be taken for granted as an obvious truth. Plato would have nothing to do with appeals to sense-experience. According to him, if a ὑπόθες1ις2 is not accepted, it must be abandoned, and a more general ὑπόθες1ις2 postulated, until one is reached to which the opponent agrees.¹¹ The writer of Ancient Medicine suggests,¹² as the proper sphere of ὑποθές1εις2, the celestial regions and those beneath the earth. Here, among τὰ ἀΦανέα τε καὶ ἀπορεόμενα, where we have no means of applying a satisfactory test, where in fact sense-perception fails us, is the proper place for ὑποθές1εις2. He would exclude them all from medicine, but he is constantly suggesting what we moderns call "hypotheses." The best examples of ὑποθές1εις2 are the axioms and postulates of geometry.

[p. 8] These are not tested or proved ; they are assumed, and upon the assumptions a whole science is built.

In place of ὑποθές1εις2 the author of Ancient Medicine relies, as a modern scientific thinker relies, on careful observation and critical examination¹³ of phenomena, hoping thereby to reach, not the complete and perfect knowledge Plato hoped to attain through his Ideas, but an approximation to truth.¹⁴

So the two methods, that of Greek philosophy and that of modern science, stand face to face. The struggle between them was, for the time being, short. Medicine, almost the only branch of Greek science scientifically studied, was worsted in the fight, and medical science gradually degenerated from rational treatment to wild speculation and even quackery and superstition.¹⁵ The transcendant genius of Plato, strong in that very power of persuasion the use of which he so much deprecated, won the day. The philosophic fervour which longed with passionate desire for unchangeable reality, that felt a lofty contempt for the material world with its ever-shifting phenomena, that aspired to rise to a heavenly region where changeless Ideas might be apprehended by pure intelligence purged from every bodily taint, was more than a match for the humble researches of men who wished to relieve human suffering by a patient study of those very phenomena that Plato held of no account.

[p. 9] So for centuries philosophy flourished and science languished, in spite of Aristotle, Euclid and Archimedes.

ANALYSIS.

(1) The rejection of ὑποθές1εις2 and the defence of the old method in medicine (Ch. I-III).

(2) The origin of medicine, and its connection with the art of dieting (III-XII).

(3) The comparative unimportance of the four "opposites" in health and disease (XIII-XV).

(4) The importance of certain secretions as compared with heat and cold (XVI-XIX).

(5) The correct method of studying medicine (XX-XXIV).

TEXT, ETC.

There has never been published any separate edition of this treatise, but of course it is included in all the great editions of Hippocrates. Not much was done to improve the text before Littré, who seems to have bestowed care and thought upon the little book. The edition of Kéhlewein introduced a radical reformation of the pseudo-ionic forms that disfigured earlier texts, and also several improvements in detail, but his changes are not always happy.

The chief manuscript authority is A,¹⁶ which seems infinitely superior to all the others. The next most important manuscript is M, the others being of very little help.

In this edition I have kept closely to the spelling of Kéhlewein, but the text itself is my own. It

[p. 10] follows the MS. A very closely, but on several occasions I have accepted (with acknowledgements) the emendations of Coray, Reinhold, Ermerins, Littré, Diels and Kéhlewein. One passage I have rejected on my own authority, and in another I have presented a new combination of readings which I think restores sense out of nonsense. I have generally noted readings only when the choice makes a decided difference to the translation.

The translator is often perplexed how to render semi-technical words which belong to a time when the ideas underlying them were in a transition stage, or when ideas were current which the progress of time has destroyed. "Hot" and "cold" were no longer bodies, but they were not yet qualities. As Professor Taylor¹⁷ shows, the word εἰδος2 is most elusive, referring to the form, appearance, structure of a thing, the physique of persons, etc., and yet it is becoming capable of being applied to immaterial reality. There are about half a dozen words to describe the process which we describe by the single word "digestion."¹⁸ These nice distinctions must be lost in an English version. The most difficult word of all is perhaps δύναμις2. Scientific thought in the fifth century B.C. held that certain constituents of the body, and indeed of the material world generally, manifested themselves to our senses and feelings in certain ways. These are their δυνάμεις2, "powers," or, as we may sometimes translate, "properties,"

[p. 11] "characteristics," "effects." Almost equally difficult is the word Φύς1ις2. This appears sometimes to have the meaning which Professor Burnet shows it has in early philosophy, "primordial matter," "primitive element or elements," the "stuff" of which the world is made. Often, again, it has its later meaning, "nature," while sometimes the two senses are combined or confused. In all these cases perfect consistency of rendering can only be achieved by sacrificing the thought. In my work I have been constantly impressed, and depressed, by the truth of the proverb, "Translators are traitors."

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