Bull.lnd.Hist.Med Vol. XXVIII - 1998 pp 111 to 118 CORPUS HIPPOCRATICUM 'ON THE SACRED DISEASE'
SISIR K.MAJUMDAR
ABSTRACT
The Hippocratic Corpus was attributed to all branches of healing including internal medicine, surgery, and obstetrics. The Hippocratic collection of treatises (or corpus) was mostly written between 430 and 330 B.C. and some are later works. Some 600 years after Hippocrates, the Corpus were further systematized by Galen and later still by the Persian Islamic physician Avicenna and others. The Corpus provides an insight into the origin and development of rational medicine in the west.
Introduction aphorism that is derived the famous Hippocrates (460 - 356 B.C.) has quotation - "Vita breva, are uero longa" been called "the Father of Modern (Life is short, art long). Medicine." The Hippocratic Corpus was The Corpus is an historical attributed to all branches of healing, reconstruction over a period of time. including internal medicine, surgery and Some 600 years after Hippocrates, the obstetrics. How much of the Hippocratic Corpus were further systematized by Corpus was genuinely by Hippocrates Galen (130 - 200 A.D.) and later still by himself and how much was written later the Persian Islamic physician Avicenna by others is a matter of conjecture. The (980 - 1037 A.D.) and others, and their Hippocratic Collection of treatises (or version of Corpus Hippocraticum was to Corpus) was mostly written between 430 influence European medical thought and and 330 B.C. and some are later works; practice for the next thousand years. The it comprises some 60-70 books, the Corpus provides an insight into the origin most famous being "OF THE and development of rational medicine in EPIDEMICS," "THE BOOK OF the West. Most authors agree that the PROGNOSTICS," "ON THE SACRED great significance of Hippocratic medicine DISEASE (Epilepsy)" and "ON AIRS, was its alternative account of the magic WATERS AND PLACES." "THE and sorcery of the priest healers of the APHORISMS" is a collection of brief Asklepian cult (the Temple Medicine). generalizations. Magico - religious practice and It is from the initial phrase of the first recognition of divine miracle were
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prevalent in the Greek society at that be seen only with supernatural sight are time. Greek Physicians were itinerant excluded. This injunction to turn a blind healers. The Corpus emphasized the eye to the possibility of a deity or importance of observing carefully mystical influence in causes and phenomenon of the disease, attempting treatment of disease was the greatest a rational approach to diagnosis while the contribution of the Hippocratic school. treatment relied on the healing power of The Swiss medical historian Erwin Nature (of course, not God or any Ackerknect has calied it "Medicine's supernatural force) and was directed at Declaration of Independence." the patient as a whole - physical, mental The Greeks were the first to believe and spiritual. The Corpus may be said that the universe functions by rational and to have introduced a rational approach reasonable rules and the nature is the to modern clinical medicine (Greek word sole regulator of man in health and - ;kline' meaning 'bed' or 'couch'). disease and his environment in order to Prognosis or informed guess about the maintain the equilibrium. In disease, natural process of the disease was the each set of symptoms has a specific most important part of the whole cause or causes, and treatment must be exercise. Physicians were not interested directed towards correcting the to treat somebody who was going to die circumstances or environs in which they and thereby not taking the blame or appear, and not only the consequences discredit. of their presence. Thus, the setting in The probable "Evolution" of which the illness-takes place should be Hippocratic Medicine is outlined in considered as important a factor as the Table I. manifestations of sickness themselves. The dates of the treatises in the Again, the individual and his environment Hippocratic Corpus cannot be fixed claim the priority. Man is the product of precisely. An approximate or suggested his environment. Thus, the Hippocratic chronology is given in Table II. Corpus is a treasure house containing Greek Culture the earliest extant treatises in any Authors agree that individualism was language. a dominating feature in the Greek society. Fundamental Basis of Hippocratic It was the man as a whole that mattered. Medicine The idea was reflected in the practice of Nature seeks to maintain a condition Greek medicine as well. The Hippocratic of stability; its forces are constantly Corpus deals with man's relationship to adjusting and readjusting the normal man and to another power outside constituents of the body to preserve a himself. In Greek writings, that power is balance among them. V\lhen this balance Nature; God and other forces that can exists, we are healthy; imbalance leads Corpus Hippocraticum -Majumdar 113
to sickness. According to Galen, Nature means of the food which is eaten and restores the state of equilibrium. Disease digested. The blood was thought to is caused by an imbalance among the originate in the heart, yellow bile in the four humours - blood, yellow bile, black liver, the black bile in the spleen, and the bile and phlegm. These four primary fluids phlegm in the brain. The humours bore are said to be constantly renewed by a direct relationship to the four "elements"
Yellow Bile (Warm/Dry)
FIRE
Blood Black Bile (Hot/Wet) (Cold/Dry)
Phlegm (Cold /Wet)
- fire, air, earth and water, and therefore predominance of the four basic humours to the four "qualities" of hot, dry, cold and - blood, black bile, yellow, bile and phlegm wet. Because of the role of the qualities, respectively. the body's equilibrium was influenced by "The Sacred Disease" (Falling the seasons as follows (postulated by Sickness) Galen): Falling Sickness may be termed as The basal state of humoural "Epilepsy" in modern medical interaction affected personality and terminology. In view of the above character of the individual. People's perspectives, it is a good piece to dispositions were described as illustrate various aspects of Hippocratic sanguine, melancholic, bilious or Medicine. phlegmatic, representing the This treatise attacks on the popular 114 Bull. Ind. lnsi. Hist, Med. Vol. XXVIII - 1998
superstition about epilepsy, to bitterly for the treating physician to find out the criticize witch-doctors, faith-healers, cause and to offer relevant treatment. quacks, charlatans who called this Aetio Pathology disease - "sacred" and to be of divine "The brain is the seat of this disease, origin (Ch, 1 & 2) and also to give an as it is of other very violent diseases" account of the natural history of the (Ch. 6). It goes on describing the disease. It tried to expose the ignorance structure and functions of the brain of those who tried to implicate a (Ch. 17. The disease arises from the supernatural or divine element in the phlegmatic discharge that blocks the causation of this disease, with various vessels communicating with the brain as illustrations. postulated by the humoural theory. It Exposition of Pseudo-Physicians attacks only those of phlegmatic The book begins with an attack on disposition (Ch.5). It explains the the ignorance, evil intentions of pseudo disease as arising from a discharge from physicians in calling "epilepsy" - the the brain and to support this theory, it Sacred Disease. "It is my opinion that suggests examining an animal, such as those who first called this disease goat that has suffered from the disease "sacred" were the sort of people we now (Ch.14): call witch-doctors, faith-healers, quacks "If you cut open the head, you will and Charlatans. These are exactly the find that the brain is wet, full of fluid and people who pretend to be very pious and foul-smelling, convincing proof that to be particularly wise. By invoking a disease and not the deity is harming the divine element they were able to screen body." It is significant that the authors their own failure to give suitable treatment suggest empirical enquiry by opening the and so called this a "sacred" malady to skull of a diseased goat to contribute to conceal their ignorance of its nature." their knowledge. (Ch.2). The book highlights their The author of the "Sacred Disease" opportunism as well. ".. if he dies, they believes that epilepsy is more likely to can excuse themselves by explaining occur when there is a change in the wind that the gods are to blame while they and he devotes Chapter 16 for describing themselves did nothing wrong. "(Ch.2). the effects of the north and south winds, The book totally rejected the sacred or both outside and inside the body. This divine nature of the disease. "I do not malady affects children as well (Ch.11). believe that the sacred disease is any Prognosis more divine or sacred than any other It is an important aspect of disease but on the contrary, has specific Hippocratic medicine. "Adults neither die characteristics and definite cause." from an attack of this disease, nor does (Ch.1). The cause of the disease is it leave them with palsy" ... "Attacks of physical and is of organic nature. It is this disease in the aged are not fatal, nor Corpus Hippocraficum -Majumdar 115
do they cause paralysis" (Ch. 12). These madness and delirium " Insomnia, words of observations are interesting. memory, panic etc. are all attributed to "Like other diseases, it is hereditary." It the brain. At the end it is again balance seems that familial predirection of this and equilibrium that matter -." So long disease did not escape the author's as the brain is still, a man is in his right observation. The practice of prognosis mind." which included not only foretelling the Affliction of brain by phlegm and by outcome of a disease, but also bile would give different types of disorders describing its past natural history, was related to memory loss, vomiting, pain, an important psychological weapon. behavioural disorders, etc. (Ch. 18). Functions Of The Brain Guidelines For Management Functions and dysfunctions of the The author gives elaborate guidelines brain are described in Ch.17 in about how to treat this condition at the understandable language. "It ought to be right time (Ch.21) - "A man with the generally known that the source of our knowledge of how to produce by means pleasure - merriment, laughter and of a regimen dryness and moisture, cold amusement - as of our grief, pain, anxiety and heat in the human body, could cure and tears, is none other than the brain. this disease too, provided he could It is specially the organ which enables distinguish the right moment for the us to think, see, hear and to distinguish application of the remedies. He would the ugly and the beautiful, the bad and not need to resort to purifications and the good, the pleasant and unpleasant." magic spells." Mental disorder was also considered - Here lies the essence of the rational "It is the brain too which is the seat of basis of Hippocratic Medicine. 116 BUll. Ind. Inst.Hist, Med. Vol.XXVIII- 1998
TABLE - 1 : EVOLUTION OE HIPPOCRATIC MEDICINE
IO"NI)""N PHll050PH'I' Vl th.. crnl:~ , . I MWICAL KHOOL<;" or C05 }""ND (""NIDO,) Vll:h c<.n~
,IC'I lIAN SCHOOL Feur elenents I HI PPOCR;>' nc Pnquma.licl:hror~ MEDICINE. DU~
SOURCE: Singer, C. & Underwood, E.A.: A short history of Medicine. 2nd Ed. 1962, Clarendon Press, Oxford. Corpus Hippocraticum -Majumdar 117
TABLE II CHRONOLOGY OF HIPPOCRATIC CORPUS
430 - 380 B.C. 400350 B.C. AFTER 330 B.C
1. "On Airs, water Places" 1. "On Diseases IV" 1. "On the Heart"
2. "On Ancient Medicine" 2. "On Generation" 2. "Precepts"
3. "On Breaths" 3. "On the Nature of the Child"
4. "Epidemics I & III
5. "On Fractures"
6. "On Joints"
7. "On the Nature of Man"
8. "Prognostic"
9. "On Regimen in Acute Disease"
10. "On the Sacred Disease"
SOURCE: Lloyd, G.E.R. (1970): Early Greek Science: Thales to Aristotle. Norton & Co. New York/London. 118 Bull. Ind. Inst.Hist, Med. Vol. XXVIII - 1998 fll ,(I~I
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