Hippocrates of Cos, On the Sacred Disease (400 B.C.E.)

Science was yet another forum for innovation and change during Greece’s Golden Age. Hippocrates of Cos (c. 460–377 B.C.E.) gained fame across the Hellenic world as an exceptional medical teacher and practitioner who helped to transform contemporary theories regarding the cause and treatment of disease. Traditional Greek medicine looked to religion and magic to understand and heal illness. By contrast, Hippocrates emphasized the need to view disease as a physical ailment rooted in the natural world. The text excerpted below, On the Sacred Disease, is one of the earliest of the many treatises attributed to Hippocrates. The “sacred disease” in question is epilepsy. Although scholars cannot prove definitively that Hippocrates wrote the work, they agree that its advocation of rational, observation-based medicine represents a key feature of his scientific legacy.

From Hippocrates, vol. 2, trans. W. H. S. Jones (Cambridge, MA: Harvard University Press, 1959), 139, 141, 143, 145, 153, 175, 179, 181, 183.

The Sacred Disease

I am about to discuss the disease called “sacred.” It is not, in my opinion, any more divine or more sacred than other diseases, but has a natural cause, and its supposed divine origin is due to men’s inexperience, and to their wonder at its peculiar character. Now while men continue to believe in its divine origin because they are at a loss to understand it, they really disprove its divinity by the facile method of healing which they adopt, consisting as it does of purifications and incantations. But if it is to be considered divine just because it is wonderful, there will be not one sacred disease but many, for I will show that other diseases are no less wonderful and portentous, and yet nobody considers them sacred. For instance, quotidian fevers, tertians, and quartans seem to me to be no less sacred and god-sent than this disease,¹ but nobody wonders at them. Then again one can see men who are mad and delirious from no obvious cause, and committing many strange acts; while in their sleep, to my knowledge, many groan and shriek, others choke, others dart up and rush out of doors, being delirious until they wake, when they become as healthy and rational as they were before, though pale and weak; and this happens not once but many times. Many other instances, of various kinds, could be given, but time does not permit us to speak of each separately.

My own view is that those who first attributed a sacred character to this malady were like the magicians, purifiers, charlatans, and quacks of our own day, men who claim great piety and superior knowledge. Being at a loss, and having no treatment which would help, they concealed and sheltered themselves behind superstition, and called this illness sacred, in order that their utter ignorance might not be manifest. They added a plausible story, and established a method of treatment that secured their own position. They used purifications and incantations; they forbade the use of baths, and of many foods that are unsuitable for sick folk . . . [they forbade] the wearing of black (black is the sign of death); not to lie on or wear goat-skin, not to put foot on foot or hand on hand. . . . These observances they impose because of the divine origin of the disease, claiming superior knowledge and alleging other causes, so that, should the patient recover, the reputation for cleverness may be theirs; but should he die, they may have a sure fund of excuses, with the defense that they are not at all to blame, but the gods. Having given nothing to eat or drink, and not having steeped their patients in baths, no blame can be laid, they say, upon them. So I suppose that no Libyan dwelling in the interior can enjoy good health, since they lie on goat-skins and eat goats’ flesh, possessing neither coverlet nor cloak nor footgear that is not from the goat; in fact they possess no cattle save goats. But if to eat or apply these things engenders and increases the disease, while to refrain works a cure, then neither is godhead² to blame nor are the purifications beneficial; it is the foods that cure or hurt, and the power of godhead disappears.

Accordingly I hold that those who attempt in this manner to cure these diseases cannot consider them either sacred or divine; for when they are removed by such purifications and by such treatment as this, there is nothing to prevent the production of attacks in men by devices that are similar. If so, something human is to blame, and not godhead. He who by purifications and magic can take away such an affection can also by similar means bring it on, so that by this argument the action of godhead is disproved. By these sayings and devices they claim superior knowledge, and deceive men by prescribing for them purifications and cleansings, most of their talk turning on the intervention of gods and spirits. . . .

The fact is that the cause of this affection, as of the more serious diseases generally, is the brain. . . .

Men ought to know that from the brain, and from the brain only, arise our pleasures, joys, laughter, and jests, as well as our sorrows, pains, griefs, and tears. Through it, in particular, we think, see, hear, and distinguish the ugly from the beautiful, the bad from the good, the pleasant from the unpleasant, in some cases using custom as a test, in others perceiving them from their utility. It is the same thing which makes us mad or delirious, inspires us with dread and fear, whether by night or by day, brings sleeplessness, inopportune mistakes, aimless anxieties, absent-mindedness, and acts that are contrary to habit. These things that we suffer all come from the brain, when it is not healthy, but becomes abnormally hot, cold, moist, or dry, or suffers any other unnatural affection to which it was not accustomed. . . .

In these ways I hold that the brain is the most powerful organ of the human body, for when it is healthy it is an interpreter to us of the phenomena caused by the air, as it is the air that gives it intelligence. Eyes, ears, tongue, hands, and feet act in accordance with the discernment of the brain; in fact the whole body participates in intelligence in proportion to its participation in air. To consciousness the brain is the messenger. For when a man draws breath into himself, the air first reaches the brain, and so is dispersed through the rest of the body. . . .

. . . As therefore it is the first of the bodily organs to perceive the intelligence coming from the air, so too if any violent change has occurred in the air owing to the seasons, the brain also becomes different from what it was. Therefore I assert that the diseases too that attack it are the most acute, most serious, most fatal, and the hardest for the inexperienced to judge of.

This disease styled sacred comes from the same causes as others, from the things that come to and go from the body, from cold, sun, and from the changing restlessness of winds. . . . Each has a nature and power of its own; none is hopeless or incapable of treatment. Most are cured by the same things as caused them. One thing is food for one thing, and another for another, though occasionally each actually does harm. So the physician must know how, by distinguishing the seasons for individual things, he may assign to one thing nutriment and growth, and to another diminution and harm. For in this disease as in all others it is necessary, not to increase the illness, but to wear it down by applying to each what is most hostile to it, not that to which it is conformable. For what is conformity gives vigor and increase; what is hostile causes weakness and decay. Whoever knows how to cause in men by regimen moist or dry, hot or cold, he can cure this disease also, if he distinguish the seasons for useful treatment, without having recourse to purifications and magic.

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