Food as Therapy. Elements of the History of Nutrition in and Rome

TEATRO VOCALI

Collana Fiori di Cactus 11

ISSN 22407782

Francesco Perono Cacciafoco

Food as Therapy

Elements of the History of Nutrition in Ancient Greece and Rome

Tiratura limitata /130

Proprietà letteraria ed artistica riservate 1ͣ edizione stampata nel mese di Ottobre del 2012 Edizione fuori commercio

Editore: Walter Zollino Direttore Editoriale: Francesco Perono Cacciafoco Direttore Artistico: Barbara Battistella

walterzollino.eu [email protected]

Walter Zollino casella postale n° 15 c.a.p. 15073 Castellazzo Bormida

1 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome

2 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome

Francesco Perono Cacciafoco

Food as Therapy

Elements of the History of Nutrition in Ancient Greece and Rome

Mural painting showing and Galen (XII century, St. Mary's Cathedral, Anagni, Italy)

Università degli Studi di Scienze Gastronomiche University of Gastronomic Sciences Pollenzo 2012

TEATRO VOCALI

3 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome

4 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome

- Acknowledgments -

I would like to express my thanks, here, to Prof. Alessandro Lami (University of Pisa, Department of Greek Philology), who introduced me – many years ago, by now – to the study of the History of Greek Medicine. This book owes much, for what concerns the part about Galen of Pergamon, to the formidable Prof. Mark Grant's essays. Come ideally to him, for this reason, all my gratitude. This work is dedicated to all those who have remained at their places when the storm came.

Semper Fi.

5 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome

6 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome

I will apply dietetic measures for the benefit of my patients according to my ability and judgment; I will keep them from harm and injustice

The Hippocratic Oath, 2

- The Works of the Corpus Hippocraticum and the Origins of Dietetics and Dietotherapy in Western Medicine -

The theory and practice of medicine in ancient Greece are initially inserted into the groove of the more archaic Eastern (from Old Egyptian and Babylonian origins) tradition, then introduce some new elements, mainly assuming a technicaltherapeutic peculiarity. Innovative features were added, therefore, to aspects of archaism. The concept of disease is less static than that of older Eastern texts and the same disease now is represented as a phenomenon that has its evolution and its development in relation to which must be oriented the physician's therapeutic intervention. The chronologically marked nature of the illness produces in the specific treatises a section dedicated to the symptoms and to the therapy and a parallel part addressed to the prognosis. The “philosophical” category of the same prognosis is not certainty, but, rather, probability. In front of the schematism of the Old Egyptian and Babylonian medicine emerges, then, by the Greek physicians, a more problematic relationship to the disease, characterized by a lesser degree of certitude. This aspect introduces the criterion of the doctor's discretion. In this way, the Authors of the medical treatises don't provide their readers (the physicians) with the most absolute precepts, leaving them quite free to choose whether to follow their instructions, introducing a new criterion of responsibility. The art of medicine, on the other hand, grew close to Hellas as early as the Minoan civilization (Aegean – not Greek – people), reaching a high level of development, also from the social point of view, remaining, in any case, on types of Eastern area. There were, in Knossos, toilets and bathrooms and medical practice was carried on by paid experts. Like the traditional Oriental medical art, the origins of Greek medicine were linked to magical and mystical aspects. Apollo was considered the founder of the same medical art, Pallas Athena was the legislating and medical goddess. Chiron the centaur appeared to be, in mythology, the starter and the teacher of medicine among the humans. Another legendary figure of the ancient world linked to the medical art is Iapige the Trojan, the Aeneas' physician, to whom Apollo, overwhelmed by love for that young,

7 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome according to tradition gave him the mastery of his art, but Iapige, in order to save his dying father, preferred to learn medicine. In Thessaly Asclepius, a demigod pupil of Chiron, after being struck down by a Zeus' lightning – because he perfected his medical art so much, until the point of being able to resurrect the dead –, transfigured in divinity, became a “mystical simulacrum” for the miraculous recoveries that literary sources tell have occurred during sleep by contact with the god or with the sacred serpent in many temples dedicated to the same Asclepius in different regions of Greece, places of worship always located near pure sources or thermal waters with gymnasiums and sanatoriums. The cult of Asclepius was introduced in Athens in 429 BC, then was moved to Rome (in 291 BC) where, in the Tiber Island, the first temple of Aesculapius (the Latin name of the god) was founded. The ancient Greeks developed, from the VI century BC, a medical art practiced by pragmatic physicians together with the beginning of the scientific medicine, spread from philosophical schools (because medicine and philosophy, in the ancient Greek world, were always closely linked. We may think, among others, exempli gratia, to the Crotonian philosophical and medical School). The works of many great Greek physicians and philosophers of Antiquity such as Alcmaeon of Croton, Philolaus of Taranto and Empedocles of Agrigento – regarded, this one, as a miraculous healer, hygienist and “ruler of epidemics”, the first theoretician of concepts such as the survival of the strongest in nature and the possibility of an exchange of substances through the pores on the skin – derived from the biological conception and from the harmony doctrine of the Pythagorean School. From this scientific and philosophical boost the most important medical schools of Ancient Greece and of Mediterranean gave birth, the Schools of Cyrene, Rhodes, Kos and Cnidus. The oldest known Greek physician is the just mentioned Alcmaeon of Croton (VI century BC), Author of the first treatise on anatomy. The most famous and important exponent of Greek medicine was Hippocrates of Kos (Kos, about 460 BC Larissa, 377 BC, terminus ante quem), who, in accordance with some literary sources, would have drawn his knowledge directly from the Asclepiads. According to Hippocrates – on the basis of the antecedent and contemporary philosophical theories – the cosmos is composed of four physical elements, air, earth, water and fire. Each of these contains a quality, cold, dry, damp and warm. The combination of these same elements originates, in the human being, four humours, black bile, yellow bile, phlegm and blood. The perfect harmony of these same humours in the human body maintains health. If one of these is, instead, in excess or failing or isolated or mixed, this situation engenders

8 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome the disease. The medical theory of Hippocrates and his school (the socalled School of Kos) is configured, then, as “humoral”. Nature is the ultimate healer (vis medicatrix naturae, fever is considered a form of body's defense, as the crisis by increased secretion). The physician may try to restore health in the patient balancing the humours through the diet. The medicine, in ancient Greece, indeed, coincides in many aspects with the dietetics. The disease is treated through the targeted use of food and by the prescription of a therapeutic diet. In the medical practice of ancient Greece, therefore, nutrition plays a vital and fundamental role, by giving origin to the scientific discipline of dietotherapy. The central principle of belief of Hippocrates and of the Dogmatists 1, as mentioned, was that health depended on the proper proportion and action, in the human body, of the four elements, earth, water, air and fire, and of the four cardinal humours, blood, phlegm, yellow bile and black bile. The due combination of these was known as crasis and existed in health. If a disease were progressing favorably, these humours became changed and combined (coction), preparatory to the expulsion of the morbid matter (crisis), which took place at definite periods known as “critical days”. Hippocrates also asserted the theory of fluxions, which were conditions in the nature of congestion. The Hippocratic medicine draws from philosophy and from logic the cosmic, universal and biological concept that forms the basis of medical theory and from observation of the patient (the socalled facies hippocratica) the clinician trend. For the first time in the history of ancient medicine the physician understands the need to conserve the sick person's energies and to seek the causes of the disease without losing sight of the art of medicine's goal, that is to heal the patient. Hippocratic medicine is, therefore, science, art, experience and reasoning without preconceptions or superstitions. In dietetics, Hippocrates displays close observation and sound judgment. The views held generally at the present day coincide closely with his instructions on food and feeding. In the treatise De veteri medicina (On Ancient Medicine) he states that men had to find from experience the properties of various vegetable foods and discovered that what was suitable in health was unsuitable in sickness and that the accumulation of these discoveries was the origin of the art of medicine. The Corpus Hippocraticum is a collection of approximately sixty works,

1 The School of Dogmatists (based mainly on the teaching and on the aphorisms of Hippocrates) was founded by and , the two Hippocrates' sons (Thessalus was physician to Archelaus, king of Macedonia, Draco was physician to the wife of ).

9 Food as Therapy. Elements of the History of Nutrition in Ancient Greece and Rome written in the Ionic dialect, which cover various subjects, among which medicine stands out in high prevalence, developed over several centuries and aggregated together in an unknown period 2. The attribution of every single work is extremely complicated. Some of these are directly related to Hippocrates, but many more of them surely derive from the scientific influence he had over the centuries and they are, therefore, due to his medical school. The Corpus Hippocraticum presents a truly innovative content in relation to Eastern medicine of ancient Egypt and Babylon and Hippocrates is rightly considered the founder of Western medical science, having assigned for the first time independent and specific nature to a hitherto empirical practice. Hippocrates believed, in fact, that any disease should be approached rationally. The core of this writings anthology is composed of works that date back probably between the last decades of the V century BC and the early IV century BC (some of these are older and they correspond to the chronology of the life of Hippocrates and their contents are characterized by more archaic traits). The primary task of the Hippocratic medical School is to rebalance the humours in the patient in order to free him from disease, “purifying” his body. In this sense, in the technicaltherapeutic treatises, the Authors use the term katharsis, “purification”, employed by Aristotle in relation to the theater performances' effects on public. One of the most commonly used food drugs was the melikreton, a mixture of water and honey. The infusions were widespread. The khylos ptisanēs 3, based on filtered barley, was the most frequently used. Millet and lentils were also abundantly utilized. The prescription of buttermilk and milk was similarly habitual. The body's “purification” aim was, therefore, pursued by the administration of proper diet in the context of an environment that avoids effort and discomfort to the patient. The diet's problem was, accordingly, essential to the ancient physician. The procedure consisted, at least in the initial stage of the disease, in prescribing a light diet (or even an almost total fast). In the case of a fever called phonodes, “murderess” 4, for example, it was necessary the prohibition of solid foods and infusions for the first seven days of the disease (if the patient was too weak, he was able to ingest a little barley infuse twice a day), after which, with the lowering of the fever, the patient

2 The codes contain, under the Hippocrates' name, about one hundred thirty writings, many of which are false and late works. 3 The term is still attested in the word “tisane”, tisana in Italian. Barley as a substance provided with therapeutic properties is already outlined in the medical texts of ancient Egypt. 4 De morbis II 67.

10