1. kas211@exeter.ac.uk Only skin deep: observations and dissections in ancient medicine Keith Stewart Classics and Ancient History Department University of Exeter

2. kas211@exeter.ac.uk Contents Timeline Early Philosophy The Skin as a Boundary Animal Dissection Observation Theory Theory and Observation How to obtain knowledge

3. kas211@exeter.ac.uk Timeline 600 BCAD 200 HIPPOCRATIC CORPUS GALEN SocratesAlexander the GreatAugustus PRESOCRATICS Thales Parmenides Empedocles Herophilus of Chalcedon Erasistratus of Ceos Marcus Aurelius Plato Aristotle STOICS EPICUREANS Celsus

4. kas211@exeter.ac.uk Early Philosophy (1) ‘Thales of Miletus, …, is said to have been the first to pursue natural philosophy.’ (Hippolytus, Refutation of All Heresies, 1.1.1-4) ‘Parmenides and some others say that women are hotter than men, since on account of heat and an excess of blood the menstrual flow comes about; …’ (Aristotle, Parts of Animals, 648a25-31) ‘Empedocles [says] the kinds of flesh were generated from a blend of the four elements in equal measure; …’ (Aëtius P, 5.22.1)

5. kas211@exeter.ac.uk Early Philosophy (2) There was some opposition to the use of philosophy within the Hippocratic Corpus – ‘… I have deemed that [medicine] has no need of an empty postulate, …, for example, things in the sky or below the earth.’ (Hippocratic Corpus, Ancient Medicine, 1.20-24) The Hippocratic Corpus consists of a number of different writers and contains different theories on what the fundamental substance consists of: – Humours or Fluids, Nature of Man and Diseases IV – Air, On Breaths – Fire and Water, On Regimen I

6. kas211@exeter.ac.uk Early Philosophy (3) In the second century AD, Galen promoted the use of philosophy in medicine – ‘one who has chosen to follow the best school of philosophy … which posits the existence of hot, cold, dry and wet as principles and elements … should not be led astray.’ (Galen, On Mixtures, I 590 K) – ‘For health and disease are simply bodily states. The body also serves, in a secondary and accidental way, as material for natural philosophy in that it is philosophy to investigate this class of things. ‘ (Galen, On the Parts of Medicine, 8)

7. kas211@exeter.ac.uk The Skin as a Boundary (1) The challenge for physicians was to determine what was wrong with a patient based on their knowledge of the physiology and anatomy of the body. In terms of dissection, there is evidence for a reluctance to dissect human bodies: – ‘In the first half of the third century BC, …, Herophilus of Chalcedon and … Erasistratus of Ceos, became the first and last ancient scientists to perform systematic dissections of human cadavers. … no ancient scientists ever seemed to have resumed systematic human dissection. (Heinrich von Staden, 1992: 223)

8. kas211@exeter.ac.uk The Skin as a Boundary (2) Without the use of systematic dissection of the human bodies, the ancient physicians are left with a number of choices to base knowledge of the inside of the human body on: – Information from the dissection of animals. – Observation of external features of the patient and any visible secretions. – Theoretical model of the inside of the body. – Combination of theory and empirical information.

9. kas211@exeter.ac.uk Animal Dissection In the Sacred Disease the brain of a goat is examined to investigate the cause of a specific illness, which is related to epilepsy – ‘If you cut open the [goat’s] head you will find the brain moist, very full of dropsy and of an evil odour, …’ (Hippocratic Corpus, On the Sacred Disease, XIV.14-18) In Galen’s view: – ‘… only through dissection could one gain a proper understanding of the organisation and workings of the body, …’ (Nutton, 2004: 230)

10. kas211@exeter.ac.uk Observation(1) ‘In all dangerous cases you should be on the watch for … the evacuations from all parts, …’ (Hippocratic Corpus, Epidemics I, XI.1-3) ‘Crito, in Thasos, while walking about, was seized with a violent pain in the great toe. He took to bed the same day with shivering and nausea; … black blisters; acute fever; mad delirium … discharges unmixed, bilious and rather frequent … he died on the second day …’ (Hippocratic Corpus, Epidemics I, Case X)

11. kas211@exeter.ac.uk Observation(2) ‘… each individual makes use of his frequent observations … gains knowledge not obtained by another …’ (Galen, On Medical Experience, IX.5) ‘… all physicians say honey is bad in bilious diseases, but good in old age … Some discovered this through the indications afforded by its nature, and others simply through experiment. Empiricist physicians have made this observation … harmful for those that are bilious and serviceable for those who are phlegmatic.’ (Galen, On the Natural Faculties, II 124 K)

12. kas211@exeter.ac.uk Theory (1) In some parts of the Hippocratic Corpus, the theory of how the body functions in terms of health and disease is based on certain fluids or humours: – ‘The body of man has within itself blood, phlegm, yellow bile and black bile, these same things are the nature of the body, and on account of such things pain and health occurs.’ (Hippocratic Corpus, Nature of Man, IV.1-4) – ‘The fundamental forms are phlegm, blood, bile and watery fluid …’ (Hippocratic Corpus, Diseases IV, 1.7-8)

13. kas211@exeter.ac.uk Theory (2) Stewart, K. 2011, What is the basis for Galen’s Biology and Natural Teleology?, unpublished MA Thesis, University of Exeter

14. kas211@exeter.ac.uk Theory and observation ‘… identification of the different degrees of heat belonging to different ages. The best sort of test is to use one body only … that of an infant … remember the nature of the heat at two years old and compare it with the state after another two to three years … if a general change is detected in the direction of heat or cold … easy to infer the increase there will be up to the prime of life. If you wish to compare a number of children with a number of people in prime of life … best to compare similar types … thin children with thin people in the prime of life. When looking for differences due to age … most secure if the bodies are as similar as possible.’ (Galen, On Mixtures, I 591 K)

15. kas211@exeter.ac.uk How to obtain knowledge ‘… but in what manner does knowledge of those things that were discovered by experience without reason became technical knowledge in which you have confidence? Did you place confidence in it and accept it as technical just because you had seen each single one of these things take place once … or after you have discovered that it happened many times?’ (Galen, On Medical Experience, XV.2)

16. kas211@exeter.ac.uk Conclusion Without the detailed information from dissection or vivisections of the human body, the ancient physicians chose a range of methods to obtain knowledge of anatomy and physiology, which would be used to treat patients. The choice seemed to be either empirical or theoretical, or a combination of both. There seemed to be a choice about how much use (if any) could be made of the latest developments in natural philosophy. The same issues applied to both the fifth century BC and the second century AD. However, by the second century AD, physicians, such as Galen, could take advantage of the progress made in anatomy in the Hellenistic period.

17. kas211@exeter.ac.uk Bibliography Brock, A. J. (2006), Galen: On the Natural Faculties, Harvard University Press, Cambridge and London. Graham, D. E. (2010), The Texts of Early Greek Philosophy, Cambridge University Press, Cambridge. Jones, W. H. S. (1923), Hippocrates Volume I, Harvard University Press, Cambridge Massachusetts. Jones, W. H. S. (2005), Hippocrates Volume IV, Harvard University Press, Cambridge Massachusetts. Jones, W. H. S. (2006), Hippocrates Volume II, Harvard University Press, Cambridge Massachusetts. Lyons, M., Schoene, H., Kalbfleisch, K., Kollesch, J., Nickel, D. and Strohmaier, G. (1969), Galen: On the Parts of Medicine, On Cohesive Causes and On Regimen in Acute Diseases in Accordance with the Theories of Hippocrates, Akademie-Verlag, Berlin. Nutton, V. (2004), Ancient Medicine, Routledge, London. Potter, P. (2012), Hippocrates Volume X, Harvard University Press, Cambridge Massachusetts. Singer, P. N. (2001), Galen: Selected Works, Oxford. Von Staden, H. (1992), ‘The Discovery of the Body: Human Dissection and Its Cultural Contexts in Ancient Greece’, The Yale Journal of Biology and Medicine 65, pp. 223-241. Walzer, R. (trans.) (1946), Galen: On Medical Experience, Oxford University Press, Oxford.