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Hellenistic Medicine

Hellenistic medical specialists based their ideas about the body and their handling of illness on observation, and also on the writings ascribed to the Greek physician Hippocrates and his followers. These were copied, recopied, edited, and expanded over the centuries, so it is impossible to say who wrote any specific work, but they contain ideas that were widely shared. How did Hellenistic physicians view the healthy body, and what did they recommend to maintain good health and treat sickness?

The human body contains blood, phlegm, yellow bile and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with the others. . . .

Now the quantity of the phlegm in the body increases in winter because it is that bodily substance most in keeping with the winter, seeing that it is the coldest. . . . The following signs show that winter fills the body with phlegm: people spit and blow from their noses the most phlegmatic mucus in winter; swellings become white especially at that season and other diseases show phlegmatic signs. . . .

And just as the year is governed at one time by winter, then by spring, then by summer, and then by autumn; so at one time in the body phlegm predominates, at another time blood, at another time yellow bile and this is followed by a preponderance of black bile. In these circumstances it follows that the diseases which increase in winter should decrease in summer and vice versa. . . .

Some diseases are produced by the manner of life that is followed; others by the life-giving air that we breathe. That there are these two types must be demonstrated in the following way. When a large number of people all catch the same disease at the same time, the cause must be ascribed to something common to all and which they all use; in other words to what they all breathe. In such a disease, it is obvious that individual bodily habits cannot be responsible because the malady attacks one after another, young and old, men and women alike.

It seems to be highly desirable that a physician pay much attention to prognosis. If he is able to tell his patients when he visits them not only about their past and present symptoms, but also to tell them what is going to happen, as well as to fill in the details they have omitted, he will increase his reputation as a medical practitioner and people will have no qualms in putting themselves in his care. . . .

The signs to watch for in acute diseases are as follows: First, study the patient’s face; whether it has a healthy look and in particular whether it is exactly as it normally is. If the patient’s normal appearance is preserved, this is best; just as the more abnormal it is, the worse it is. . . .

Rapid breathing indicates either distress or inflammation of the organs above the diaphragm. Deep breaths taken at long intervals are a sign of delirium. If the expired air from the mouth and nostrils is cold, death is close at hand. . . .

The most helpful kinds of vomiting is that in which the matter consists of phlegm and bile, as well-mixed as possible, and is neither thick nor particularly great in quantity. If it is not well-mixed, it is less good. The vomiting of dark green, livid or dark material, no matter which of these colours, must be considered a bad sign.

In all disease of the lungs, running at the nose and sneezing is bad.

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First cut the skin between the ribs with a knife with a rounded blade. Then take a sharp-pointed knife wrapped in a strip of cloth with its tip exposed a thumb-nail’s length and make an incision. Next, having drained away as much pus as seems appropriate, drain the wound with a drain of raw linen, attached to a cord. Let out the pus once a day. On the tenth day, after having let out all the pus, drain the wound with a piece of fine linen. Then inject warm wine and oil through a small tube, so that the lung accustomed to being moistened by the pus might not suddenly be dried out. Let out the morning’s infusion toward evening, and the evening one in the morning. When the pus becomes thick like water, sticky to the finger when touched, and scanty, insert a hollow tin drainage tube. When the [pleural] cavity is completely drained, gradually cut the drain shorter, and allow the wound to heal until you finally take out the drain.

People with a fleshy, soft, or ruddy appearance are best kept on a dry diet for the greater part of the year as they are constitutionally moist. Those with firm and tight-drawn skins, and those with tawny and dark complexions should keep to a diet containing plenty of fluids most of the time, as such people are naturally dry. The softest and most moist diets suit young bodies best as at that age the body is dry and has set firm. Older people should take a drier diet most of the time, for at that age bodies are moist, soft, and cold. Diets then must be conditioned by age, the time of year, habit, country and constitution. They should be opposite in character to the prevailing climate, whether winter or summer. Such is the best road to health. . . .

Fat people who want to reduce should take their exercise on an empty stomach and sit down to their food out of breath. . . . [T]hey should take only one meal a day, go without baths, sleep on hard beds and walk about with as little clothing as may be. Thin people who want to get fat should do exactly the opposite. . . . A wise man ought to realize that health is his most valuable possession and learn how to treat his illnesses by his own judgment.

ANALYZING THE EVIDENCE

PUTTING IT ALL TOGETHER

Using the sources above, along with what you have learned in class and in the chapters in this book, write a short essay that analyzes ideas about health and illness in the Hellenistic world, and the treatments that resulted from these. What characterized a healthy body, and how was good health to be regained in the case of illness? Many of the ideas and treatments may seem strange, given how we understand the body today, but do any sound familiar?

Sources: (1) Hippocratic Writings, ed. G. E. R. Lloyd, trans. J. Chadwick and W. N. Mann (Harmondsworth, U.K.: Penguin, 1983), pp. 262, 264. Reproduced by permission of Penguin Books Ltd; (2) Hippocratic Writings, pp. 170–171, 172, 177; (4) James Longrigg, Greek Medicine: From the Heroic to the Hellenistic Age: A Source Book (London: Duckworth, 1998), 139; (5) Hippocratic Writings, p. 274.