THE HIPPOCRATIC TRADITION Electronic edition, revised, 2002 Copyright by Wesley D. Smith All rights reserved. Except for brief quotations, this book, or partsthereof, must not be reproduced in any form without permission in writing from the author. First published 1979 by Cornell University Press International Standard Book Number 0-80 1 4 12 909'9 Library of Congress Catalog Card Number 78-20977 Librarians: Library of Congress cataloging information NOTE FOR THIS ELECTRONIC EDITION I have made small corrections throughout from the original text as published. Mostly I have corrected various typographical errors, including an embarrassing number of misprints in numbers that I did not find and correct before the first publication. I have also corrected a few misstatements. However, the pagination of this version is is the same as that of the original, and the index is unchanged, so all references to the book should be valid. The process of digitizing may have introduced new errors, but not many, I hope. This remains the same book it was when it was published in 1979. I am still confident that my approach is useful. I am pleased with the reception it has gotten. It has been out of print for too long, and I am gratified to be able to make the work available through the courtesy of BIUM and their ambitious website. Wesley Smith, Philadelphia, Pa., October 2002 CONTENTS PREFACE THE MODERN HIPPOCRATIC TRADITION From the Medical Men to the Historians 14 Littré and the Modern Hippocratic Question 31 Hippocrates, Author of Regimen 44 GALEN'S HIPPOCRATISM Early Medical Training 62 Galen's First Residence in Rome 77 Galen's Second Residence in Rome 97 Galen's Hippocratic Scholarship 123 FROM HIPPOCRATES TO GALEN From Hippocrates to Alexandria 179 The Collection of the Corpus and Early Work on It 199 The Empirics and Hippocratic "Doctrine" 204 The Myth 215 Greek Medicine in Rome 222 BIBLIOGRAPHY 247 INDEX 257 5 PREFACE This book is concerned with thought about medicine, not with medical practice, and I have not addressed the subject of medi- cal ethics as related to Hippocrates and the Oath. Particularly, I am interested in the creation of ways of thinking and talking about history, in modern and in ancient times. Traditions of interpretation are often most clearly recognizable for what they are when they are demonstrably wrong. Hence, there is consid- erable emphasis on aberrations that the Hippocratic tradition has produced. When the shape and substance of the tradition become clear, one can then accept what in it is worth accepting and learn much from the errors one is trying to overcome. I intend this book to serve as a prolegomenon to a new reading of the Hippocratic collection. Hippocrates has been a hero to the people of several cul- tures. Consequently, his interpreters and admirers have emu- lated, or in some cases one is tempted to say imagined, in him qualities that reflected their own ideals. This present book comes out of my own need to make sense of the cacophony in the subject and to determine why Asclepiades, Rufus, Galen, Boerhaave, and Sprengel responded to him as they did, and whence came their passions on the subject. In the process I have tried to seek out and assess all relevant evidence relating to in- terpretations of Hippocrates. The several new theses I advance will, I hope, seem compelling in the perspective of the whole tradition. I have chosen to begin with modern views of the Hippocratic tradition (1500 to the present ), to deal with their bases in Galen's 7 8 Preface interpretation of the ancient tradition (material written ca. 150 to 200 A.D.), and then to reconsider that ancient tradition (ca. 400 B.C. to 200 A.D.). My discussion of modern views assumes that the reader has some preliminary understanding of the ma- terial I will deal with, explain, and even refute in my subsequent chapters. Reversing the order would not have solved the prob- lems. I have had to rely on the reader to pursue what needs clarification, either in this book through the use of the index or elsewhere in the works suggested in the bibliography. I have hoped that the audience would be a broad one, and hence have not discussed technical material that was not immediately rele- vant. My argument is cumulative. The treatment of post- Renaissance attitudes, in the first chapter, is 'intended to show how constrictive intellectually this tradition has been and how readily scholarship can become the factory of evidence for the current faddish view. The second chapter, on Galen's Hippocratism, examines simi- lar phenomena at an earlier stage in the tradition and develops the information necessary for rewriting the earlier history of medical thought in its relation to the Hippocratic Corpus. In order to pursue Galen's notions of the history of medicine through his numerous and complex writings I have ventured an intellectual biography of him focused on his relation to Hippoc- rates. Information he offers about his life and about the compo- sition of his works can shed much light on his presentation of matters of historical fact and can resolve many of his notorious contradictions. Furthermore, precise and thorough assemblage of Galen's historical statements provides the basis for a number of novelties in the reconstruction of the early history, of medical thought. In the third chapter, I have attempted a continuous synthetic account of thought about the history of medicine and about the Hippocratic Corpus in the pre-Galenic period. My corrections of traditional versions of that history, follow from the revelations in the first two chapters. It will be apparent how indebted I am to the people with whom I disagree: Deichgräber, Diller, Bardong, Ilberg, Preface 9 Wellmann, Jaeger, Edelstein, Lonie, and many others, includ- ing, of course, Galen, the fount of false as well as true medical history. I wish to acknowledge here also debts to people with whom I have not ventured to disagree: Volker Langholf for many corrections of the manuscript; Owsei Temkin for his be- nign encouragement; Lloyd Stevenson, Janet Koudelka, and others at the Institute of the History of Medicine in Baltimore; Phillip DeLacy, colleague, friend, and exemplar; and Bernard Knox and the Institute for Hellenic Studies, where I conceived this book after I had set out to write another one. I also thank the John Simon Guggenheim Foundation for support of my leisure for writing, and my wife, Karen, for help such as only she could give. Wesley D. Smith Philadelphia, Pennsylvania THE HIPPOCRATIC TRADITION 1 THE MODERN HIPPOCRATIC TRADITION When the Renaissance brought renewal of direct knowledge of the ancient Greek medical texts, Hippocrates became known both through the writings of the Hippocratic Corpus and through the works of Galen. There were no obvious reasons to disbelieve Galen's claims that he followed the teachings of Hip- pocrates accurately and that he understood the works of the Corpus and knew which were "most genuine" and which were spurious and unlike the outlook of Hippocrates. Renaissance scholarly work took Galen's views of Hippocrates and Hippocra- tic medicine as its guide, and took for its object the better under- standing and emulation of the Divine Galen as well as the Divine Hippocrates. Since the early Renaissance had seen a considera- ble improvement in scientific medicine as a result of the impor- tation of Greek learning as translated and refracted through Arabic sources, one of the concerns of Galenists and Hippoc- ratists in the later Renaissance was to use the original Greek sources to correct and purify Greek medicine in its Arabian dress. However when, little more than two centuries afterward, Emile Littré produced his fine edition and translation of the Hippocratic Corpus which has been the basis for virtually all modern work, entirely different assumptions are obvious. Ga- len's reputation as scientific medical man had sunk drastically and with it Galen's credibility as interpreter and guide to scholars in Hippocratic studies. Littré considered the spirit of Hippocrates quite antithetical to that of Galen, and the works on 13 14 The Hippocratic Tradition which his interpretation of Hippocrates rests are different from those on which Galen's opinions were based. The change in opinion about Hippocrates and the Hippocra- tic writings did not occur as the result of new information, nor is it clear that people were aware, or are now aware, how extensive it had been. The reversal in point of view is almost completely obscured in Littré's discussion of the preceding scholarly tradi- tion, where he assumes that the point of view he brings to criticizing his predecessors is the natural one. Indeed, it was natural in Littré's time and still is insofar as we are the in- tellectual children of the Enlightenment. I shall try to determine by what process the change of view occurred and to estimate its significance for our understanding of the ancient texts and an- cient medical tradition. I will conclude that the medical men led the way, generating medical "history" out of their own current scientific interests instead of out of historical study and that subsequently philologists and historians, infected by the pro- gressive attitude and euphoria of the scientists, set out to find the evidence with which to sustain the medical men's views. FROM THE MEDICAL MEN TO THE HISTORIANS The crucial first step in the process was dissociation of Hip- pocrates from Galen in "spirit" and doctrine. In that, it appears, the alchemist and mystic Paracelsus (1493-1541) led the way when he claimed that Hippocrates had had the true medical spirit but that Galen and other sophists had perverted his views.