Dogmatism in the Hippocratic Corpus
We must begin with a fairly detailed review of the modalities and manifestations of dogmatism in the medical writers, since it is against that background that what I have called anti-dogmatism must be evaluated. The treatise On the Art , which we have considered before as an example of authorial egotism,[26] shows to what lengths some writers went to protect themselves and the medical profession against any possible charge of incompetence or even of fallibility. Chapter 3 sets out what the author hopes to demonstrate, the word used being apodeixis . Medicine is first defined in terms of its aims, which include "the complete removal of the sufferings of the sick" and the "alleviation of the violences of diseases," and the writer claims that medicine achieves
[25] Some aspects of this problem have been discussed by Di Benedetto 1966, and by R. Joly 1966, pp. 240ff., 1980, pp. 287f.
[26] See above, Chap. 2 at nn. 45ff.
these ends and "is ever capable of achieving them."[27] Against those who demolish the art of medicine by citing the misfortunes of those who die from their illnesses, he counters with a passage that is worth quoting at length:
As if it is possible for doctors to give the wrong instructions but not possible for the sick to disobey their orders. And yet it is far more probable that the sick are not able to carry out the orders than that the doctors give wrong instructions. For the doctors come to a case healthy in both mind and body; they assess the present circumstances as well as past cases that were similarly disposed, so they are able to say how treatment led to cures then. But the patients receive their orders not knowing what they are suffering from, nor why they are suffering from it, nor what will succeed their present state, nor what usually happens in similar cases. . . . Which is then more likely? That people in such a condition will carry out the doctors' orders, or do something quite different from what they are told—or that the doctors, whose very different condition has been indicated, give the wrong orders? Is it not far more likely that the doctors give proper orders, but the patients probably are unable to obey and, by not obeying, incur their deaths—for which those who do not reason correctly ascribe the blame to the innocent while letting the guilty go free?[28]
Chapter 9 proceeds to distinguish between two main classes of diseases, a small group in which the signs are easily seen—where the disease is manifest to sight or to touch, for instance—and a larger one where they are not so clear. In the former group "in all cases the cures should be infallible, not because they are easy, but because they have been discovered."[29] So far as the second group goes, "the art should not be at a loss in the case of the unclear diseases too."[30] The difficulty in achieving cures stems largely from delays in diagnosis, but this is more often due to the nature of the disease and to the patient than to the physician. The patients' own descriptions of their complaints are unreliable, for they have opinion rather than knowledge.[31] "For if they had understood [their diseases], they would not have incurred them. For it belongs to the same skill to know the causes of diseases and to understand how to treat them with all the treatments that prevent diseases from growing worse."[32] Again the writer's naive optimism comes out: the nature of our bodies is such that where a sickness admits of being seen, it admits of being healed.[33]
The breathtaking self-confidence of this treatise is far from unique. Drastically oversimplified pathological, therapeutic, and physiological doctrines—stated with apparently total self-assurance despite the manifest controversiality of the subjects in question—figure not just in
[31] De arte 11, CMG 1.1.16.23f.
[33] De arte 11, CMG 1.1.17.5f.
[34]other exhibition pieces, such as On Breaths ,[34] but also, for example, in On Affections ,[35]On Diseases 1,[36]On the Sacred Disease ,[37]On Fleshes ,[38]On Regimens 1,[39] and so on. On the Places in Man , for instance, is a work chiefly devoted to a quite detailed account first of certain anatomical topics and then of a range of morbid conditions and their treatments. Towards the end of the treatise as we have it[40] we find a chapter that announces: "The whole of medicine, thus constituted,
[35] Aff. 1 (L) 6.208.7ff.: "in men, all diseases are caused by bile and phlegm. Bile and phlegm give rise to diseases when they become too dry or too wet or too hot or too cold in the body."
[36] Morb. 1.2 (L) 6.142.13ff.: "all diseases come to be, as regards things inside the body, from bile and phlegm, and as regards external things, from exercise and wounds, from the hot being too hot, the cold too cold, the dry too dry, the wet too wet."
[38] The writer of Carn. sets out his version of a four-element theory in the opening two chapters as his own opinion, e.g., "it seems to me that what we call hot is immortal" (2 [L] 8.584.9), "the ancients seem to me to have called this aither" ([L] 8.584.12, and cf. 5 [L] 8.590.5). Yet in the sequel there are few signs of tentativeness as he develops some highly speculative physiological and embryological theories about, for example, the interaction of the two principles he calls the glutinous and the fatty in the formation of the main viscera: see, e.g., 3 (L) 8.584.18ff., 4 (L) 8.588.14ff., and the claims to demonstrate in 9 (L) 8.596.9 and 16. Cf. also 1 (L) 8.584.5.
[39] Vict. 1.3 (L) 6.472.12ff., for example, states: "All the other animals and man are composed of two things, different in power, but complementary in their use, I mean fire and water."
seems to me to have been discovered already. . . . He who understands medicine thus, waits for chance least of all, but would be successful with or without chance. The whole of medicine is well established and the finest of the theories it comprises appear to stand least in need of chance."[41]
On the Nature of Man , in particular, makes repeated claims to be able to demonstrate the theories it proposes.[42] While his opponents add to their speeches "evidences and proofs that amount to nothing,"[43] the author says that he will "produce evidences and declare the necessities through which each thing is increased or decreased in the body."[44] Yet his own positive evidences turn out to be very much of the same general type as theirs, even though their monistic conclusions are more extreme than his. He suggests that what influenced the monistic theorists he attacks was the observation that a certain substance may
[43] Nat.Hom. 1, CMG 1.1.3.164.14. His opponents in chap. 1 are monists who discourse about the nature of man beyond what is relevant to medicine and who claim that man is composed of air or water or fire or earth. In Nat.Hom. 2, CMG 1.1.3.166.12ff., he turns to attack monistic doctors who take blood, bile, or phlegm as the sole element of man. He has a general argument, against these, that if man were a unity he would never feel pain, since there would be nothing by which, being a unity, it could be hurt (Nat.Hom. 2, CMG 1.1.3.168.4f., with which compare Melissus fr. 7, para. 4). But against those who asserted that man consists of blood alone, for example, he demands that they should be able to show that there is a time of year or of human life when blood is obviously the sole constituent in the body (Nat.Hom. 2, CMG 1.1.3.168.9ff.).
[44] Nat.Hom. 2, CMG 1.1.3.170.6f.
be purged from the body when a man dies. In some cases where a patient dies from an overdose of a purgative drug he vomits bile, in others maybe phlegm, and the monists, seeing this, then concluded that the human body consists of this one thing.[45] But while destructively the author sets about demolishing monism with powerful dialectical arguments, constructively when he seeks to establish that the body consists of the four humours, blood, phlegm, yellow bile, and black bile, his own chief argument too depends on the simple observation that all four are found in the excreta. This shows, to be sure, that all four are present in the body, but spectacularly fails to demonstrate that they are the elements of which it is composed.[46]
Alongside the frequent use of the vocabulary of evidence and proof, one of the key terms this author employs is necessity,
[45] Nat.Hom. 6, CMG 1.1.3.178.11–14.
[46] Nat.Hom. 5, CMG 1.1.3.176.10ff.; 6, CMG 1.1.3.180.2ff.; 7, CMG 1.1.3.182.12ff. In 5, CMG 1.1.3.178.5ff., he claims that the humours are congenital, on the grounds that they are present at every age and in both parents. Yet even if that were conceded, it would still not show that they are the chief, let alone that they are the sole elemental, constituents of the body.
[48] Nat.Hom. 3, CMG 1.1.3.170.8–9; cf. also 2, CMG 1.1.3.168.6.
[49] Nat.Hom. 3, CMG 1.1.3.172.2–3.
same chapter we find: "necessarily, each thing returns again to its own nature when the body of the man dies, the wet to the wet, the dry to the dry, the hot to the hot, the cold to the cold."[50] Chapter 4 argues that when the humours in the body are well mixed and in the right proportion, the body is healthy, but that pain occurs when one of them is in excess or defect or is separated off from the others. "Necessarily, when one of them is separated and stands by itself, not only the place from which it has come becomes diseased, but also that where it collects and streams together causes pain and distress."[51] Again in chapter 5, having suggested that blood, bile, and phlegm differ to sight, to touch, in temperature, and in humidity, he goes on: "necessarily, then, since they are so different from one another in appearance and power, they cannot be one, if fire and water are not one."[52]
Clearly, logical and physical, conceptual and causal, necessity are not here differentiated. Many instances represent a conflation of one or more ideas that we might distinguish. Often the underlying idea seems merely to be the claim that something is always or usually the case. At the limit, the addition of the term necessarily appears to reflect little more than the writer's desire to assert his point with emphasis.
Similar uses of the term
[50] Nat.Hom. 3, CMG 1.1.3.172.5–8.
[51] Nat.Hom. 4, CMG 1.1.3.174.3–6, cf. also 174.9f.
[52] Nat.Hom. 5, CMG 1.1.3.176.8–9. Cf. also 7, CMG 1.1.3.186.3; 8, CMG 1.1.3.186.17ff., and from after the main physiological section of the treatise (chaps. 1–8), e.g., Nat.Hom. 10, CMG 1.1.3.192.10; 12, CMG 1.1.3.198.5, 200.3 and 8.
[53] See, e.g., De arte 5, CMG 1.1.12.2 and 6; Flat. 7, CMG 1.1.95.7; 10, CMG 1.1.98.16; Aff. 37 (L) 6.246.20; Morb. 1.3 (L) 6.144.4, 17, 4 (L) 6.146.6, 9, 12, 13, 8 (L) 6.156.2, 4, 22 (L) 6.184.4, 186.10, 24 (L) 6.190.1, 7, 25 (L) 6.192.2; Morb.Sacr. 8 (L) 6.376.6, 13 (L) 6.386.7, 14 (L) 6.388.6ff., 17 (L) 6.392.19; Carn. 19 (L) 8.614.16; Vict. 1.4 (L) 6.474.15, 1.7 (L) 6.480.11, 1.9 (L) 6.484.4, 1.30 (L) 6.504.19, 1.36 (L) 6.524.7, 2.37 (L) 6.528.4; 2.38 (L) 6.530.14, 532.7, 2.40 (L) 6.538.4ff., 3.68 (L) 6.598.8, 3.71 (L) 6.610.9.
including some which, as we shall see later, are otherwise remarkable for their undogmatic or anti-dogmatic traits. Examples could be given from Aphorisms ,[55]On Ancient Medicine ,[56]Wounds in the Head, On Joints , and On Fractures .[57] The treatise On Airs Waters Places , too, frequently presents as matters of necessity the correlations it proposes
[56] See, for example, VM 22, CMG 1.1.54.6–10 ("as for what produces flatulence and colic, it belongs to the hollow and broad parts, such as the stomach and chest, to produce noise and rumbling. For when a part is not completely full so as to be at rest, but instead undergoes changes and movements, necessarily these produce noise and clear signs of movement"), and cf., e.g., VM 19, CMG 1.1.50.7ff., in the writer's general statement about causation (cf. below, Chap. 6 n. 14).
[57] In the surgical treatises, among the types of consequences and connections that are sometimes presented as matters of necessity are (1) the real or assumed consequences of lesions, (2) real or assumed anatomical facts and their consequences, and (3) the consequences of treatments, especially of faulty treatments. As examples of (1) we may cite VC 4 (L) 3.196.1f. (if the bone in the head is fractured when wounded, then necessarily contusion occurs), and Art. 63 (L) 4.272.14ff. (the doctor must bear in mind that in certain severe dislocations of the bones of the leg, when they project right through the ankle joint, the patient will necessarily be deformed and lame), and cf., e.g., VC 7 (L) 3.204.8f., 11 (L) 3.220.7f., 15 (L) 3.244.1ff.; Art. 13 (L) 4.116.23ff., 38 (L) 4.168.9f. As examples of (2): Fract. 3 (L) 3.424.10ff. (bending of a fractured arm necessarily causes a change in the position of the muscles and bones) and Art. 47 (L) 4.200.15ff. (in curvature of the spine one of the vertebrae necessarily appears to stand out more prominently than the rest) and cf.,e.g., Fract. 23 (L) 3.492.7ff. As an example of (3) we may cite Fract. 25 (L) 3.498.8ff., criticising bandaging that leaves the wound exposed ("the treatment, too, is itself evidence: for in a patient so bandaged the swelling necessarily arises in the wound itself, since if even healthy tissue were bandaged on this side and that, and a vacancy left in the middle, it would be especially at the vacant part that swelling and discoloration would occur. How then could a wound fail to be affected in this way? For it necessarily follows that the wound is discoloured with everted edges, and has a watery discharge devoid of pus"), and cf., e.g., Art. 14 (L) 4.122.16ff., Fract. 7 (L) 3.442.7ff., 16 (L) 3.476.11ff., 34 (L) 3.536.9ff.
between the aspect of a city and the character of its water, or between both of those and the constitutions and endemic diseases of the inhabitants, or even between the political constitution and the character of the people. We may again illustrate very selectively from the rich fund of examples.
Thus we are told that in a city sheltered from the northerly winds but exposed to warm prevailing southerly ones, the water is "necessarily plentiful, brackish, surface water, warm in the summer and cold in the winter,"[58] while in a city that faces the risings of the sun, the water is "necessarily clear, sweet-smelling, soft, and pleasant,"[59] As for the effects of waters of different types, the writer states, for instance, that "stagnant, standing, marshy water is in summer necessarily warm, thick, and of an unpleasant smell, because it does not flow. But by continually being fed by the rains and evaporated by the sun it is necessarily discoloured, harmful, and productive of biliousness."[60] Dealing with physical constitutions and endemic diseases, the writer claims, for instance, that in northerly-facing cities that generally have hard, cold water, the inhabitants are "necessarily vigorous and lean."[61] Pleurisies and acute diseases are common, "for this is necessarily the case when bellies are hard."[62] Correlating the character and changes of the seasons with the diseases to be expected in them, the writer says:
[58] Aër. 3, CMG 1.1.2.26.23ff., 28.2f.
[59] Aër. 5, CMG 1.1.2.32.10ff., 13ff.
[60] Aër. 7, CMG 1.1.2.34.19–23, cf. also 36.25, 38.7f.; and 9, CMG 1.1.2.44.15f., 20f.
[61] Aër. 4, CMG 1.1.2.30.4.
[62] Aër. 4, CMG 1.1.2.30.8f., cf. 12f.; and 6, CMG 1.1.2.34.1f.
"If the winter be dry, with northerly winds prevailing and the spring wet, with southerly winds, the summer will necessarily be feverish and productive of ophthalmia."[63] Finally, correlating political constitutions and characters, the second half of the treatise suggests, for example, that "where men are ruled by kings, there necessarily they are most cowardly. . . . For their souls are enslaved and they are unwilling to run risks heedlessly for the sake of another's power."[64]
Even though other generalisations in this treatise are quite often explicitly qualified as holding only "for the most part" or just as being "likely,"
[64] Aër. 23, CMG 1.1.2.78.3–5; cf. 16, CMG 1.1.2.62.20ff. Physiological and pathological correlations claimed as necessary also occur in the second part of the treatise, e.g., Aër. 19, CMG 1.1.2.68.15ff., and 24, CMG 1.1.2.80.3ff.
[65] See, for example, from the first part of the treatise, Aër. 3, CMG 1.1.2.28.5f.; 4, CMG 1.1.2.30.3, 7, 18, and from the second, Aër. 14, CMG 1.1.2.58.23; 24, CMG 1.1.2.78.15.
[66] As, for example, in the texts from Aër. 7, CMG 1.1.2.34.19ff.; 4, CMG 1.1.2.30.12f; and 10, CMG 1.1.2.46.22ff., quoted at notes 60, 62, and 63 above.