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Sleep and Dreams in Ancient Medical Diagnosis and Prognosis Maithe Armido Aroesja Hulskamp

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Sleep and Dreams in Ancient Medical Diagnosis and Prognosis Maithe Armido Aroesja Hulskamp Sleep and Dreams in Ancient Medical Diagnosis and Prognosis Maithe Armido Aroesja Hulskamp NEWCASTLE UNIVERSITY LIBRARY ---------------------------- 207 32526 8 ---------------------------- Newcastle University © M. A. A. Hulskamp 2008 IIEpi 8E -ni)v TeKµopiwv Tciývev Toiviv ümolo"iv ooTrs opiws eyvcoKE,µeyaýýv exovTa>, uvaµiv Eup9Jvesrrpos anav-ta.ý Hip. Vict.IV. 86 Sleep and Dreams in Ancient Medical Diagnosis and Prognosis (thesis abstract) This thesis aims to improve our understanding of sleep and dreams in ancient medicine, and allot dreams their own place among ancient diagnostic and prognostic procedures. First, a systematic overview of Hippocratic and Galenic diagnostic and prognostic procedures is provided. As yet, no such overview is available for the Hippocratic Corpus. To form a diagnosis or prognosis, the Hippocratics and Galen apply observation and semiotic inference, combining universal, external information concerning matters like the weather and the environment, with individual information such as a patient's symptoms and regimen and, occasionally, his dreams. Secondly, the (physiological) processes, which, according to the Hippocratics, Galen and Aristotle pertain to sleep and waking, are described in detail. A systematic account of Galen's theory of sleep is offered here for the first time. In Galen and Aristotle's accounts especially, digestion takes a central position. In all three approaches, the primary qualities - hot, cold, wet, and dry - play an important role. Lastly, the discussion of the Hippocratic and Galenic approaches to dreams is taken beyond the standard treatises, and Aristotle's views are also examined in detail. The various Hippocratic ideas on dreams show much greater consistency than has previously been suggested. In a broad spectrum of views, On Regimen most strongly emphasises the role of dreams as significant indicators of the dreamer's physical condition. Galen, elaborating Hippocratic ideas, prominently includes factors outside of the dream in the medical interpretation of dreams. Aristotle offers the most fully fledged physiological account of the occurrence of dreams. As in On Regimen, he provides a theoretical basis for the use of dreams as a source of information about the condition of the body. This thesis shows that sleep and dreams were duly considered in ancient medical thought. iii Acknowledgements Firstly, I would like to acknowledge the financial support of my PhD research by the Wellcome Trust. Secondly,I would like to thank a great number of people, both in the Netherlandsand in the UK, who have guided, supported, encouraged, and sympathised with me during my nearly four years of work on this thesis. They have been indispensable to my ability to finish it. I owe a debt of gratitude to all members of the staff of the Newcastle University Classics department, for making the time I spent in Newcastle so enjoyable, and in particular to the the following people: Philip van der Eijk, for his belief in my aptitude for academia, his inspiring guidance, and his willingness to discuss my work for hours on end; Sarah Francis, for her ability to make me laugh, her readiness to help, and for being a friend from the start; Glenda McDonald, for being a comrade in arms, and for her infinitely kind assistance in matters involving paper copies; Thomas Rütten, for his hawk-eye view and his invaluable feedback; Jerry Paterson, for assuring me that I will make a good academic; Jenny & Brad Gane, for their ongoing friendship and hospitality (and Jenny especially, for her indispensable and kind aid in final binding matters); Todd Curtis, for always trying to make me feel smart; Vicky Hedley, Susan Walker, Don Miller, Sonja Lapraik, Claire Nesbitt, Claudia Dörrwächter, Corabeth Fraser, Andy Smith, Roberto LoPresti, Nadine Metzger, and Thijs Hasselaar for giving the Newcastle postgrad community its lively and pleasantly unique character; and of course the school office staff, especially Pat Harrison and Sandra Fletcher, for their endless patience. In Leiden, my special thanks go to Mariska Leunissen, Juliette Kars, and Carolien Trieschnigg, for their friendship and support, and for regenerative shopping trips. I would also like to thank Casper de Jonge, for discussing Galen with me; Robert Lankamp, for his linguistic advice; Kim Beerden, for tea and motivating conversation; the library posse, especially Hugo Koning, Joelle Bosscher, and Edward Koning, for even being there at weekends; Ineke Sluiter, for allowing me to participate in OIKOS; all the members of OIKOS, for letting me take part in the Dutch classical community; and Manfred Horstmanshoff, for starting me on the study of ancient medicine. I would also like to thank Jesse de Metz and Sanne de Metz, for sharing with me their medical insights. iv Finally, I want to thank my family, especially of course my father, my mother and Jan, and Ragnar and Roeline for their unfailing support and belief in me. There is one person for whom I really cannot possibly expresssufficient gratitude, for his rock- steadylove and support, for taking care of me when I did not have (or take) the time for it, for sharing in all my laughs and tears, and for putting up with my moods. Marco: Einstein-de Sitter. V Contents Introduction 1 1 Diagnostic and Prognostic Procedures 7 1.1 The Hippocratic Corpus 8 1.1.1 Universal vs. individual 13 1.1.2 Universal 20 1.1.3 Individual 31 1.1.4 The five senses 40 1.1.5 Intellectual Activity 44 1.1.6 Practice: an overview 49 1.2 Galen 50 1.2.1 The five senses 52 1.2.2 Intellectual Activity 63 1.2.3 Practice: an overview 68 2 Sleep 70 2.1 The Hippocratic Corpus 72 2.1.1 Basics of sleep 72 2.1.2 Cause of sleep 78 2.1.3 Sleepand Hippocratic medicine 83 2.1.3.1 Effects of sleep 83 2.1.3.2 Sleepand insomnia as symptoms 86 2.1.3.3 Treatment 90 2.2 Galen 94 2.2.1 Basics of Sleep 95 2.2.2 Causeof Sleep 99 2.2.2.1 Qualities & Humours 99 2.2.2.2 Sleepand SensePerception 104 2.2.2.3 Sleepand pepsis 108 2.2.2.4 Mechanics of sleep: synopsis 116 2.2.3 The Soul in Sleep 117 2.2.4 Sleep & Galenic medicine 121 2.2.4.1 Treatment 121 2.2.4.2 Can sleepbe harmful? 125 2.3 Aristotle: On Sleep and Waking 131 2.3.1 On Sleep and Waking: introduction 132 2.3.2 Sleepand senseperception 132 2.3.3 Sleep and digestion 137 2.3.4 Soporifics and sleep inducing circumstances 144 2.3.5 Types of people and their sleeping behaviour 144 2.3.6 Sleepand its causes 145 2.4 Conclusions to chapter 2 148 2.4.1 Hippocratics 148 2.4.2 Galen 149 2.4.3 Aristotle 151 2.4.4 Sleep in relation to diagnosis and prognosis 152 2.4.5 Sleep in relation to dreams 152 3 Dreams and Dream Interpretation in Medical Practice 155 3.1 The Hippocratic Corpus 155 3.1.1 On Regimen 156 vi 3.1.2 Epidemics VI 177 3.1.3 On the SacredDisease 181 3.1.4 On Breaths 187 3.1.5 WetDreams 188 3.1.6 Imagery 192 3.1.7 Dreams as symptoms 197 3.2 Galen 199 3.2.1 On Diagnosisfrom Dreams & Galen's Commentaryon Epidemics1 200 3.2.2 Galen's Commentaryon the Hippocratic EpidemicsVI 206 3.2.3 On the Preservation of Health 208 3.2.4 The Art of Medicine 210 3.2.5 Phrenitis 211 3.2.6 Dreams and the Stomach 218 3.3 Aristotle: On Dreams & On Divination in Sleep 220 3.3.1 Sense-perceptionrevisited: aisthesisand phantasia 221 3.3.2 Aristotle's dream theory: the mechanics 226 3.3.3 Dreams and melancholy 234 3.3.4 The usefulnessof dreams 236 3.4 Conclusions to chapter 3 244 3.4.1 Hippocratics 244 3.4.2 Galen 246 3.4.3 Aristotle 248 Conclusion 250 Appendix A: Diagnosis versus Prognosis 256 Appendix B: Abbreviations of Primary Sources Used 273 Bibliography 275 Primary Sources: Editions and Translations 275 Secondary Sources 278 vii Introduction In antiquity, the importance of dreams as a means of communication for the gods, divine indicators of present or future events, or in a role of guidance was widely accepted: dreams and ' their content were associated with almost every aspect of ancient society. In medicine, too, dreams played a role. On the one hand, the religious approach to healing included the practice of 2 incubation - the cult of the healing god Asclepius is the most famous example of this. Patients came to sleep in the sanctuary of their healing god, hoping to have a dream in which the god would, in some miraculous way, heal them or at least give advice on how to become healthy 3 again. The cult of Asclepius has received ample attention in past scholarship, 4 and will not be discussed in this thesis, which focuses on the more `rational' medical approach to dreaming. On hand, based the other then, rationally medicine also made regular use of dreams - at least, according to previous scholarship: Hanson, for example, is convinced that "medicine, for all its rational and empirical methods, made regular use of the dream as a diagnostic tool"; 5 Oberhelman contends that "the ancient physician accepted dreams for their diagnostic and prognostic utility. While we would classify medical diagnosis through dreams as superstitious quackery, if not magic, the ancients did not. (... ) The significance of the reality of diagnostic and 'Cf. e.g. van der Eijk (2004), 192; Oberhelman(1993), 122; Winkler (1990), 25; Del Corno (1982), 55; Kessels (1969), 390; Dodds (1951), 108; Björck (1946), 307.
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