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The Cnidian Treatises of the Corpvs Hippocraticvm

Published online by Cambridge University Press:  11 February 2009

I. M. Lonie
Affiliation:
University of Sydney

Extract

Galen in a celebrated passage remarks that there were three ‘choirs’, in early Greek medicine: the choirs of Cos, of Cnidus, and of Sicily. The word is vague and suggestive, and we do well to keep it so. If we look in the Hippocratic Corpus for schools of medical theory, with distinct sets of doctrine marked off clearly from the doctrines of rival schools, we shall be lucky indeed if we can find them, and, having found them, succeed in convincing others of their existence. But we shall find, now and again, an individual voice proclaiming itself from among its impersonal surroundings with clarity and vigour: some treatises in the collection have their author's personality stamped on them as distinctly as on a work of art.

Type
Research Article
Copyright
Copyright © The Classical Association 1965

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References

page 1 note 1 X, 6 K.

page 1 note 2 Ilberg, J., ‘Die medizinische Schrift über die Siebenzahl and die Schule von Knidos’ (Festschrift für Lipsius [1894], pp. 33 ff)Google Scholar; ‘Die Ärzteschule von Knidos’ (Berichte über die Verhandl. d. Sächs. Akad. Wiss. lxxvi. 3 [1924]).Google Scholar

page 1 note 3 und die Sammlung der hippocratischen Schriften (Berlin, 1931), p. 159 and note.Google Scholar

page 1 note 4 Observation et experience chez les midecins de la collection hippocratique (Paris, 1953), pp. 5053.Google Scholar

page 1 note 5 Op. cit., p. 159 n.: ‘Zur sicheren Identifikation als knidisch reicht nur das objektive Moment der Zählung der Krankheiten aus’.

page 2 note 1 e.g. Berichte über die Verhandl. d. Sächs. Akad. Wiss. lxxvi. 3 (1924), 9Google Scholar: ‘Die Abhängigkeit der genannten sechs Bücher [i.e. and von den steht auβer Frage, ihre nahe Verwandtschaft wird durch viele Parallelbilder von Krankheiten bewiesen, die oft wörtliche Übereinstimmung zeigen.’

page 2 note 2 XVII A, 886 K.

page 2 note 3 For the unity of with the remainder of the treatise, see Regenbogen, O., ‘Probleme urn die hipp. Schrift De Victu Acutorum’ in Studies Presented to D. M. Robinson II (St. Louis 1953), pp. 624 ff.Google Scholar

page 2 note 4 Cf. Edelstein, op. cit., pp. 154 ff.Google Scholar Among the reasons which E. advances is the author's acceptance of (I, p. 110,8 Kuehlewein); that passage, however, is ambiguous, and a number of interpretations are possible. Against that of Edelstein, see, e.g., Diller, H., Gnomon xiv (1938), 303.Google Scholar In any case, the author's attitude to medicine and to the nature of disease is fundamentally different from what we can reasonably conjecture of the attitude of the Cnidian school; and in the second part of the treatise (on the genuineness of which see Blum, R., ‘La composizione dello scritto ippocrateo [Rend. d. Acc. d. Lincei (1936), 3984]Google Scholar) there are some striking correspondences in doctrine with Epidemics I and III,. and Epidemics II, IV, and VI.

page 3 note 1 Cf. the characterization of the two schoob in Sudhoff, K., Kos und Knidos (Munich, 1927). p. 97.Google Scholar

page 4 note 1 It does not appear with full explicitness until the Alexandrian period, in the debate between the empirics and the dogmatics. Cf. Deichgräber, K., Die griechische Empirikerschule (Berlin, 1930), pp. 308 ff.Google Scholar

page 4 note 2 Cf. the view of the empirical school, as described by Celsus (De Med. Proem. 36): nec post rationem medicinam esse inventam, sed post inventam medicinam rationem esse quaesitam. Contrast the attitude implied by Kühn, J.-H., System- und Methodenproblem im Corpus Hippocraticum (Hermes Einzelschrift xi [1956]), pp. 2930Google Scholar: ‘Wer in seinem Tun Tag für Tag vor die Frage nach der Krankheitsursache gestellt war, um richtig handeln zu können, der muβte sich für die Krankheitserklärungseiner Gegner zuerst interessieren.’ (My italics.) This attitude is true enough for the treatise K. is discussing, but we cannot take it for granted everywhere in the Corpus.

page 4 note 3 It is significant that in the earliest of them, treatment of conditions other than acute was confined to the application of a limited number of purgatives ( I, p. 109, 15–17 Kuehlewein). Moreover, it is no objection to the antiquity of this system to suppose, as I think we must, that what was purged according to the earlier were the humours bile and phlegm. These are not, as Fredrich, (Hippokratische Untersuchungen [Berlin, 1899], pp. 34 ff.Google Scholar) conjectured, a development of the ‘opposites’ of Alcmaeon, made by Euryphon and his followers, but are probably much older: there is good reason for supposing that the Cnidian theory is Egyptian in origin (cf. Steuer, R. O. and Saunders, J. B., Ancient Egyptian and Cnidian Medicine [Berkeley, 1959]Google Scholar, though their arguments are open to criticism in a number of places). Euryphon was familiar with the term (Galen, XVII A, 888 K.), but the term itself in its medical application is older than Euryphon (Archilochus 96 Diehl); while appears to have been familiar to Hecataeus (cf. Heinimann, F., Nomos und Physis [Basel, 1945], p. 180.Google Scholar Heinimann also credits H. with a knowledge of dietetic medicine [ibid. 177–8], but the grounds here are less certain; while his suggestion that Herodotus' remark [2. 77] about Egyptian medicine reflects purely Greek ideas is unlikely to be true: cf. Steuer, and Saunders, , op. cit., p. 5).Google Scholar I would suggest tentatively that Cnidian aetiology as we possess it is a combination of two originally distinct ideas: the bile-phlegm pathology, and the theory of , on which Cnidian dietetics are based. It is significant that bile and phlegm in the Cnidian treatises show distinct signs of a double and inconsistent use: on the one hand they are treated as , while on the other they are opposed to the , which act upon them (cf. I). It is in the latter case that they show their original character, while the dietetic use is to be traced back to Alcmaeon (cf. the historical sketch given by Palm, A., Studien zur Hippokratischen Schrift [Tübingen, 1933], pp. 110 ff.)Google Scholar. It is possible that Euryphon was the first to combine these two elements, and that the differences between the earlier and later editions of the , noted by the author of , are to be traced to the importation by Euryphon of dietetic medicine into the Cnidian tradition. This would account for his importance in that tradition.

page 5 note 1 Cf. Joly, R., Recherches sur le traitépseudo-hippocratique du régime (Paris 1960), pp. 109 ff.Google Scholar

page 5 note 2 ‘Die Epidemien und das Corpus Hippocraticum’ (Abh. d. Preuss. Akad. d. Wiss., Phil.- hist. Kl. 1933), pp. 60 ff.Google Scholar, particularly p. 63. Herodicus, however, is unlikely to have been the first to do so: cf. Palm, op. cit., p. 111.Google Scholar

page 5 note 3 It is clearly stated in 25 (VI, p. 236 L.). ‘Dysentery and leientery and diarrhoea are akin, and must be treated by preventing or diverting the flow from the head and upper cavity: ’ The same author says in 37 (p. 246) that the first question the physician must ask himself, after discovering the symptoms from the patient, is whether the disease is caused by bile or by phlegm or by both. Cf. also 9 (VI, p. 54 L.): . It is perhaps significant that a remark on dietetics has preceded: . The thought is similar in (VI, p. 20 L.): . The treatise is entirely governed by this attitude: see especially the initial and final chapters, and cf. the remarks of Pohlenz, M., Hippokrates (Berlin, 1938), pp. 85 ff.Google Scholar

page 6 note 1 Cf. 35 (VII, p. 252 L.): . The relation between cause and symptom is not usually stated so clearly in these works.

page 6 note 2 As will be seen, I regard II. 1–11 and 12 ff. as two separate works, both depending upon a common source, which contained the aetiology (which is therefore early) of 1–11, and the symptoms and treatment of 12 ff.; 1–11, however, was probably composed later than 12 ff. Thus the relation is complicated, but seems to me to account for the facts best. For a different explanation, see Pohlenz, M., ‘Hippokratesstudien’, N.G.G. (1937), 91 ffGoogle Scholar; and the same author's Hippokrates (Berlin, 1938), p. 49 and p. 108, n. 4.Google Scholar P. regards the aetiology of 1–11 as (a) later than the source of the symptoms and treatment of 12 ff. (though these have been worked over by a later author on the basis of 1–11); and (b) largely dependent upon the treatise (cf. also Wellmann, M., ‘Die Schrift , Arch. Gesch. Med. xxi [1929], 304 ff.).Google Scholar The considerations which I advance in the text will indicate my grounds for not accepting (a); as for (b), in view of the considerable dissimilarities between the aetiology of II and of (which P. himself admits, N.G.G. [1937], 94–95; to what he says there I would add that the reason for the importance of the head [not the brain, which is not mentioned] in this section of II, is simply that the arrangement is a capite ad calcem; moreover, the head here is not regarded as the seat of phlegm only, as P. says it is), it seems to me that Wellmann's hypothesis of a common source for both works (op. cit., pp. 304 ff.) is at least likely to be nearer the truth, though based on somewhat tenuous grounds.

page 7 note 1 The beginning was also missing in Galen's text, of which the initial words coincided with ours: XVII A, 888 K. In view of the manner of composition in 2–11, in which symptoms are repeated, I cannot agree with Ilberg (Festschrift für Lipsius, p. 37, n. 1) that a comparison with 12 indicates that is complete.

page 7 note 2 For the term and its relation to phlegm, see Fredrich, C., Hippokratische Untersuchungen, p. 42, n. 2.Google Scholar For , cf. II. 2 (VII, p. 8 L.) . The water is a liquescence of phlegm: . Cf. 19 (VI, p. 228 L.), , and the change of phlegm to water in dropsy, 22 (VII, p. 220 L.). Precisely the same process is described in 4 (p. 210), . 4 is a compendium of the diseases of the head which are discussed in extenso in these chapters of II, and is presumably abbreviated from the equivalent section in the .

page 8 note 1 The word is clearly nonsense, and should be : cf. LSJ s.v. . Only then does the whole passage become intelligible. The author says, in effect: ‘It is ridiculous to talk of the veins having too much blood. What actually happens is that bile and phlegm enter the veins, and as evidence (, p. 12) that this is so, when you make an incision the blood is black and in a morbid state. Now if the expression were literally correct (, p. 12) the blood should be red, its pure colour, not black and muddy.’ For the phenomenon itself, cf. IO (VII, p. Igo L.), (with phlegm), and 18 (p. 210): II. 4 [VII, p. 12 L.]).

page 9 note 1 On phlegm as a cause of inflammation, see Fredrich, , op. cit., p. 38Google Scholar, and instances from the Cnidian works quoted there.

page 9 note 2 Ilberg, , Festschrift fiir Lipsius, p. 38, n. 1Google Scholar, conjectured that II. 1–11 might go back to the first edition of the , on the ground that the author of says that the composers of the second edition : ‘sie bildeten also die Therapie aus’. See, however, Galen's interpretation of : C.M.G. V. 9, 1, p. 268. It is certainly evident that the authors of the Cnidian works went their own way in treatment. It is aetiology which unites them.

page 10 note 1 Cf. Kühn, J.–H., op. cit., particularly pp. 39 ff.Google Scholar

page 10 note 2 It is a physician who possesses such an aetiology, one who can , that Plato has in mind in his portrait of the physician of free men (Laws, 790 d).

page 10 note 3 The author of freely admits that the discoveries of pharmacology are ‘more a matter of chance than of scientific reasoning’ (45, VI, p. 254 L). His contrast nicely expresses the difference between the traditional treatments in the Cnidian works and those which have been influenced by dietetic medicine. Indeed, it is precisely this difference that the author, himself familiar with the principles of dietetics, may have in mind.

page 11 note 1 Cf. the case histories in the epidemic of phrenitis recorded in Ep. III (III, pp. 60, 116, 136, 140, 142, 146 L.).

page 11 note 2 Berichte über die Verhandl. d. Säkhs. Akad. Wiss. lxxvi. 3 (1924) p. 7.Google Scholar: ‘diese beiden ergänzen sich inhaltlich in der Reihenfolge der Krankheiten a capite ad calcem und weisen auf einen gemeinsamen Archetypus, das waren zweifellos die .’

page 11 note 3 Op. cit., pp. 162–3.Google Scholar

page 12 note 1 In any case, the first eleven diseases in II are not exclusively caused by phlegm: cf. 2 (VII, p. 8 L.) (= 13, pp. 22–24), and 6 (p. 14) (= 22, pp. 36–38): .

page 13 note 1 Cf., e.g., 18 (p. 210); 22 (pp. 220–2); 23 (p. 224); 25 (p. 230); 40 (p. 264); 48 (p. 284), and many more. The order, however, is not invariable.

page 13 note 2 XVII A, 888 K. It is clear that Galen quotes the passage from the beginning, since the rubric is given: .

page 14 note 1 On , see Fredrich, , op. cit., p. 39 n.Google Scholar

page 14 note 2 Contrast . It is difficult to tell which represents the correct version, but reads more naturally: .

page 17 note 1 On this treatise, see Ilberg, , Festschrift fur Lipsius, pp. 3435.Google Scholar

page 17 note 2 For Egypt, cf. Sigerist, H. E., A History of Medicine, i (New York, 1961), p. 354Google ScholarPubMed, where the author suggests a religious origin; for Babylonia, ibid. p. 419 and notes.

page 17 note 3 C.M.G. V. 9,1, p. 118.

page 17 note 4 No argument can be based upon the order of Galen's citations: he had no reason for citing them in the order in which they may have appeared in the .

page 17 note 5 The obscure remark in 18 (VI, pp. 226–8 L.) may point to such a

page 17 note 6 Cf. the of Ep. IV. 20 (V, p. 156 L.).

page 18 note 1 might = ‘forms of disease caused by phlegm’ rather than ‘forms of phlegm’; cf. 21 (p. 218) where in refers to the appearance of the symptoms. See, however, Fredrich, p. 47. In any case the author's main interest is in the different forms of disease which different kinds of phlegm cause.

page 18 note 2 Op. cit., p. 162.

page 19 note 1 Treatment in both works is fairly similar: white wine, parsley, and incision of the blackened veins, but there are, as usual, considerable differences in detail. Cf. also III. II (VII, p. 130 L.), where the two symptoms of itching caused by the patient's clothes, and his irritation at being spoken to, reappear in the second and first forms of respectively.

page 20 note 1 It is interesting that Ep. II. I. to (V, p. 82 L.) recognizes two varieties of icterus, one coming from the liver, which produces a pallid complexion, and which is classified with dropsy and ; and the other coming from the spleen, which produces a dark complexion. The first corresponds to the fourth variety in 7r. Tetl V evTas. ra04 38 (VII, p. 260 L.) (not to the first: though the complexion there is described as oixpaeutcov, the disease in Ep. II is definitely phlegmatic); and the second perhaps to the first variety in 7T. votkraw II. 38 (VII, P. 54 L.).

page 20 note 2 In discussing these classifications, it is necessary to remember that their practical importance was the prime consideration. They were not embarked upon as exercises in logic, like Plato's divisions, nor as exhaustive descriptions of a field, like Aristotle's; but as means towards the twofold end of teaching, and of medical practice.

page 20 note 3 Since most of the organs recognized by Cnidian anatomy are in the lower , this sufficiently explains the predominance of classification by organ in , which is mainly concerned with this region.

page 20 note 4 For the expression cf. also (I, p. 149,11 Kuehlewein); 28, p. 240; the Cnidian-influenced 45 (VI, p. 340 L.); Ep. VI. 4.12 (V, p.310 L.); and 5. 15 (V, p. 322 L.). It is coupled with heat and cold in the last passage, on which see Deichgräber, op. cit., pp. 54–55.

page 21 note 1 , which may have been characteristic of the , (cf. II. 11, p. 18) is of course particularly suited to such descriptions. The author of I has imposed a later literary elegance on his source, but the structure of the thought remains.

page 22 note 1 by drying and of the fluid in the joints. It must be admitted, however, that is not confined to the Cnidian treatises, though its use there is systematic. Cf. Ep. IV. 35 (V, p. 178 L.); VI. 2. 6 (V, p. 280 L.). It is related to the doctrine of , a doctrine characteristic of the Epidemics, in 7 (V, p. 488 L.) and in (I, p. 162, 9 Kuehlewein). Thucydides uses the term, presumably as a familiar one, in 2. 49.

page 22 note 2 notes pain in the , particularly on the right side towards the liver. Cf. the case of Apollonius, Ep. III (III, p. 136 ff. L.); tension of the belly on the right side in Ep. IV. 45 (V, p. 186 L.).

page 23 note 1 The pathological principle of is behind the frequent recommendation in these works of fomentations, , as a means of relieving pain. Cf. 16 (VI, p. 224 L.): bile and phlegm, when , cause pain, but on the application of fomentations, they become , and the pain disappears. (Contrast 42 [VI, p. 334 L.], where pain is explained as the effect of heat and cold on their contraries.) The remedy itself is of course traditional, even instinctive; certainly much older than the aetiology which explains it.

page 23 note 2 The difference was noted by Wellman, , Fragments der sizilischen Aerzte (Berlin, 1901), pp. 17 ff.Google Scholar, who argued that I goes back to the ‘Sicilian’ doctrine that blood is the seat of , while represents the view that its seat is in the . This, if true, is another instance of the eclectic character of I. But we should have to conclude that II. 3 (VII, p. IO L.) also goes back to the same doctrine: (Incidentally, this passage contradicts the doctrine of , and therefore weakens Pohlenz's theory about the source of the aetiology of II. 1–11.)

page 23 note 3 Each of these works has its own characteristics: III, while it gives no aetiology as such, is noticeably careful to give an explanation for every stage of the treatment it recommends. With the present passage, compare the account of pleuritis in 16 (VII, p. 142 L.). The clarity and logical consequence with which the author of III describes treatment are reminiscent of the style of .

page 24 note 1 For the vascular system to which the author refers, cf. Fredrich, , Hippokratische Untersuchungen, pp. 57 ff.Google Scholar and his remark on p. 61: ‘Ein Unterschied zwischen koischer und knidischer Schulanschauung lässt sich nicht feststellen.’ The author of 3 (VI, pp. 280–2 L.) appears to have a system of his own (cf. also Fredrich, p. 60); in this respect it is significant that the aetiology which this work gives for peripneumonia (VI, p. 302 L.) and pleuritis (ibid. and p. 316 L.) is quite different from the aetiology which appears in I, and which is implied in and II. In these works, the pain associated with the disease is caused by a of blood in the hepatitic and splenitic veins, where they touch the side; on the other hand says nothing about here. Peripneumonia occurs when the lungs swell so as to touch the sides; if one side only is touched, the disease is pleuritis; ‘dry’ pleuritis is caused when the lung collapses and sticks to the side. It is interesting that a remark in Polybus' account of the vascular system implies the same aetiology of pain as in the Cnidian works:

page 24 note 2 Apart from this passage, the actual name is not used elsewhere in the Corpus, so far as I am aware; although apart from later writers, such as Rufus of Ephesus, Aristotle uses it in connexion with Diogenes of Apollonia (Hist. An. 3. 3, 512a 5–6).

page 25 note 1 Cf. Littré, VI, p. 142 n. 17.Google Scholar

page 25 note 2 Op. cit., p. 161, n. 1.Google Scholar

page 26 note 1 The four humours of IV are also connate (VII, p. 542 L.), but they are as well taken in with food and drink (ibid., p. 544: for the differences in doctrine in this respect between IV and , cf. Hornstein, S., ‘Untersuchungen zum hippokratischen Corpus’, Primitiae Czernovicienses ii [1911], pp. 7677).Google Scholar This may represent a combination of two originally distinct doctrines; traces of both are found in the Cnidian works.

page 26 note 2 The category of external cause is common. Alcmaeon seems to have been the first to distinguish it (Diels-Kranz 14 B 4: , which are then specified as waters, places, fatigue, and ), followed by Philistion (Anonymus Londiniensis, xx. 30 ff. Diels: diseases arise where the last are further specified as wounds, excess of temperature or change of temperature, and change to an unsuitable and harmful diet). Alcmaeon's other causes are (‘Ursache’ and ‘Veranlasstmg’: Diels). The first is described as operating ‘by excess of heat or cold’, which corresponds to the explanation given by Menon for Philistion's (xx. 35). The second operates through ‘surfeit or deficiency of nutriment’. But neither Alcmaeon nor Philistion has the dichotomy of external and internal cause which is characteristic of, and used systematically in, I. There are three classes of cause according to Philistion-Menon, while two different principles of classification are used by Alcmaeon (since and cannot be regarded as subdivisions of ‘internal causes'). On the other hand, it must be admitted that in I. 23 (VI, p. 188 L.) there is something like the of Alcmaeon: (wounds, fatigue, excessive heat and cold). Contrast , where and are definitely external causes. Here, as in other matters, I shows a certain eclecticism.

page 26 note 3 θ omits the words in brackets. Connate heat is not mentioned elsewhere in the Cnidian works.

page 27 note 1 Hornstein, however (op. cit., p. 68), attempts to distinguish from I on the ground that the former does not explicitly mention the distinction of causes in its first chapter. But it is clearly implied in the wording of that passage, just as it is actually used in the passage I have mentioned. Cf. also 7 (VI, p. 214 L.) where the author, discussing pleuritis, remarks Here the external cause is given without the internal cause, as it occasionally is in these works. The internal cause, however, is implied by what the author has said earlier in the same passage. The parallel passage on pleuritis in I. 26 (VI, p. 192 L.), which I have already quoted, distinguishes more clearly between external and internal cause (the latter being bile and phlegm). This precision appears most clearly, of all these works, in : e.g. 28 (VII, p. 240 L.) (sc.viously the author has given a long account of the disease in terms of its internal cause, in the passage (p. 280) beginning . Clearest of all is the passage on in 51 (p. 292), which begins , the causes being sunbathing and the consequent drying (: cf. I. 2 and 1) of the fluid in the joints. So much for the external cause. Then, shortly after, the author says (p. 294) .

It must be admitted that occasionally the two categories of cause seem to be confused: , I. 20 (VI, p. 176 L.): a minority. A similar distinction of causes is pointed to by the remark in Ep. II. 4. 5 (V, 126 L.): . I suspect that it was from this distinction that the later and developed: on these, see Wellmann, M., Die pneurnatische Schtde (Berlin, 1895), pp. 153 ff.Google Scholar, and the definitions from Dioscorides quoted there.

page 28 note 1 Cf. also I. 19 (VI, p. 174 L.): . If we should look for verbatim fragments of the common stock of these works, we might do worse than find one in this passage from II, which leaps to the eye from its surroundings. It is all the more significant that it is detailed and full (contrast the inferior aetiological remarks of ); and it observes clearly the distinction between external and internal cause.

page 29 note 1 Moreover, in I. 18 (VI, p. 172 L.) blood is in fact the cause of erysipelas in the lung: . Hornstein (op. cit., p. 73) argued that the doctrine of was distinct from that of I, since in the former blood is regarded, analogously to the other humours, as a humour causative of disease, while in the two latter it is regarded as normally preserving health, though liable to corruption by bile and phlegm. In view of the passages cited above, I do not think that this distinction between the treatises can be maintained.

page 30 note 1 iv. 31 ff. Diels. When the same author contrasts ‘Aristotle's’ report of Hippocrates' doctrine with that of ‘Hippocrates’ himself, it is precisely upon the decisive difference between the humours as , and as innate ingredients of the body, that he lays his emphasis (vi. 42 ff.): what follows, the Anonymus is relying upon , I. 2, and it is interesting to see, even without the supplements suggested by Fredrich, (De libro pseudippocrateo, pp. 2831)Google Scholar that precisely the two points of internal and external cause, and the congenital nature of the humours, are emphasized by the abstracter (vii. 5): (bile and phlegm) ibid. II: . In these passages the author is of course following out his own doxographic principle (iv. 26–28: ). On the other hand, it was surely the ease with which I.2 fits into this doxographic scheme that led the author to select it as characteristic of ‘Hippocrates’.