Parts and their roles in Hippocratic medicine.

NOTES AND DOCUMENTS PARTS AND THEIR ROLES IN HIPPOCRATIC MEDICINE

By Beate Gundert*

It constitutes a communis opinio that Hippocraticphysiology and pathology are essentially humoral.While health depends on the propermixtureand balance of the fluids that are thoughtto constitute the body, disease is relatedto disturbance of this balance and the dominance of one or more fluids. It is therefore not surprisingthat studies dealing with physiological and pathologicalprocesses as depicted in the Hippocraticwritingshave addressedmainly the question of what precisely these humorsare and how they affectthe body. Hippocraticideas about the body itself and about its parts-if they receive any attentionat all-are considered in subordinationto Hippocraticideas about fluids, the parts' main roles being to serve as receptacles or passages for the humors. Thus the speculative element in Hippocraticanatomy, especially of the inner parts of the body, generally finds an explanationas the immediateresult of humoraltheory.1 The intent of this paper is not to deny that anatomicaldescriptionsoften serve the requirementsof humoraltheory but, rather, to see this relationshipfrom the parts' point of view: What are the general Hippocraticassumptions about the parts of the body, their structure,and the roles they play in health and disease? What follows, then, is an attempt to summarize Hippocratic views about the structuresof the parts, the actions they perform,2and the relationshipbetween structureand action in physiological and pathologicalprocesses, and to explore the general principlesbehind these views. With regardto the structureof the inner parts of the body, it must be kept in mind that the anatomicalexperience of Hippocraticphysicians was limited and their descriptions consequently sketchy.4 The brain, for example, is said to be * 592 Maitland Street, London N6B 2Z7, Ontario, Canada. 1 See esp. Owsei Temkin, "Der systematische Zusammenhang im Corpus Hippocraticum," Kyklos,

1929, 1:9-43, on pp. 27-31; and Robert Joly, Le niveau de la science hippocratique (Paris: Belles Lettres, 1966), pp. 75-81, 163-167. 2 I speak throughout of "parts of the body" and their "roles" or "actions," since the expressions "organ" and "function" might imply teleological associations that are not present in Hippocratic thought. Cf. Helene loannidi, "Les notions de partie du corps et d'organe," in Formes de pensee dans la Collection hippocratique, ed. Franqois Lasserre and Philippe Mudry (Geneva: Librairie Droz, 1983), pp. 327-330; and Simon Byl, "Note sur la polysemie d' OPrANON et les origines du finalisme," L'Antiquite Classique, 1971, 40:121-133. 3 Although the Hippocratic writings do not present a worked-out system of homogeneous medical belief (statements are isolated and often implicit), and despite disagreement on specific points, there is, in my opinion, an undeniable nexus of general, underlying assumptions. My study is based on all relevant Hippocratic texts that can be dated with some security to between 450 and 350 B.C.; excluded are works that for reasons of language or content are now generally considered to be post-Aristotelian (Alim. [Nutrition], Cord. [Heart], Anat. [Anatomy], and Septim. [Seven Months' Child]). 4 Although there are some hypothetical statements in the Hippocratic writings of what might be found if one could see inside the body, actual dissection was carried out only some hundred or so years later in Hellenistic Alexandria.

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divided by a thin membrane5;the fissures and lobes of the liver are mentioned,6 as well as the lobes of the lung.7 Usually, however, only the name of a part is given, occasionally with its location in the "upper"or "lower cavity"8; sometimes the only descriptionis a part's appearanceor location: the epiglottis is said to be "like an ivy leaf,"9 the gallbladder "the place upon the liver."'10More attention is given to the various channels that link the parts. There are general descriptions of the vascular system'1 and occasional mentions of channels through which food reaches the "cavity,"12 air the lungs,13 urine the bladder,14 seed the penis,15 and milk the breasts,16 as well as of the passages that connect the sense organs to the outside and to the brain.17 As for the more accessible parts of the body, clinical experience providedan intimatepracticalknowledgeof the structure and position of the bones and joints, the muscles, ligaments, and tendons.18 5 Morb. Sacr. [Sacred Disease] 3 (6.366.7-9). Hippocratic works are cited by their Latin abbreviations as given in Henry G. Liddell and Robert Scott, A Greek-English Dictionary, 9th ed. rev. by Henry S. Jones (Oxford: Clarendon Press, 1940). References are made in parentheses to volume, page, and line number of tmile Littre, Oeuvres completes d'Hippocrate, 10 vols. (Paris, 1839-1861). My study, however, is based upon more recent editions, where they exist, as recorded in Paul Potter, Short Handbook of Hippocratic Medicine (Quebec: tditions du Sphinx, 1988), pp. 11-12, 15-31. Not included in Potter are the editions by Jacques Jouanna of Flat. [Breaths], de Arte [Art], and VM [Ancient Medicine]: Hippocrate 5.1 and 2.1 (Association Guillaume Bude) (Paris: Belles Lettres, 1988, 1990). 6 E.g., Epid. [Epidemics] 2 4.1 (5.122.15), cf. Oss. [Bones] 10 (9.180. 1); Epid. 6 8.28 (5.354.4); Oss. 1 (9.170.10-11). In Nat. Mul. [Nature of Woman] 52 (7.394.5) reference is made to the "pipes" of the liver; cf. Mul. [Diseases of Women] 1.78 (8.196.5-6). ' E.g., Loc. Hom. [Places in Man] 14 (6.304.4-5); Coac. [Coan Prenotions] 394 (5.670.22-672.3); Oss. 14 (9.186.18). 8 E.g., Mul. 1.61 (8.122.12-13); Carn [Fleshes] 7 (8.594). The terms "upper" and "lower cavity" refer, respectively, to what is held to be above or below the diaphragm inside the body's trunk; see, e.g., Aph. [Aphorisms] 4.18 (4.506.14-15); Morb. [Diseases] 1 19 (6.198.21-24); Nat. Hom. [Nature of Man] 12 (6.62.12-18). 9 Morb. 4 56 (7.608.24). 1o Morb. 4 40 (7.560.7). The term chole for gallbladder occurs in the Hippocratic Collection only at Oss. 1 (9.168.11-12). Another circumlocution occurs in Loc. Hom. 2 (6.278.19), where the connection between the nasal passages and the meninges is described as "something porous ... like sponges"; cf. Carn. 16 (8.604.10-11). " See C. R. S. Harris, The Heart and the Vascular System in Ancient Greek Medicine (Oxford: Clarendon Press, 1973), pp. 29-96. 12 E.g., Morb. 4 56 (7.608.22-23); Loc. Hom. 20 (6.312.4). 13 The meanings of the various terms applied to the different parts involved in respiration can be determined only from their particular contexts. Flat. 10 (6.106.6-8) and Morb. 3 10 (7.130.7-8) seem to refer to the throat (pharynx), Acut. (Sp.) [Regimen in Acute Diseases (Appendix)] 6 (2.416.1-3) and Acut. [Regimen in Acute Diseases] 5 (2.262.7-10) to the bronchial tube(s) (arterie or bronchia); in Loc. Hom. 14 (6.306.8-10, 14-15) the bronchial tubes (aortai) are said to connect the windpipe (bronchos) and the lung. 14 E.g., Loc. Hom. 8 (6.290.19-20); Aph. 7.54 (4.594.3-4); Morb. 4 37 (7.554.9-11); Oss. 4 (9.170.15). 15 Genit. [Generation] 1 (7.470.5-6); cf. Aer. [Airs, Waters, Places] 22 (2.78.10-1 1). 16 Nat. Puer. [Nature of the Child] 21 (7.512.19-20, 514.1-4) and Gland. [Glands] 16 (8.572.3-7) refer to vessels passing from the omentum to the breasts via the uterus. A connection between uterus and breasts is implied in Mul. 2.133 (8.280.17-18, 282.3) and Aph. 5.50 (4.550.5-6). 17 Carn. 16 (8.604.7-9): nasal passage; Carn. 15 (8.602.19) and Gland. 13 (8.568.7-8): outer ear. In Loc. Hom. 2 (6.278.14-18) the ear is connected to the outside and to the brain; ibid. 2 (6.278.21-23) and Carn. 17 (8.604.21-22) the eye is connected to the brain. Carn. 4 (8.588.20-21), Morb. 2 5 (7.14.4), and Int. [Internal Affections] 13 (7.198.25-200.2) refer to a connection between the spinal cord and the brain. 18 Explicit anatomical descriptions are found in Art. [Joints] and Fract. [Fractures], passim; VC [Wounds in the Head] 1-2 (3.182.1-192.15); Epid. 2 4.2 (5.124.9-126.3), cf. Acut. (Sp.) 14 (2.470.4-6). Cf. also Mochl. [Instruments of Reduction] 1 (4.340.1-344.13) and Loc. Hom. 6 (6.285.16-290.7).


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That certain parts play certainroles within the body, and that bodily processes are located in certain parts, seems to be a generally held assumption. Thus, to give some examples, the nails of the fingers and toes prevent the vessels that terminatethere from growingfurther,19and the kneecap keeps the fluidfrom the flesh from getting into the joint when this is extended. The lips and the tongue articulatesound into speech.21The glands, located in the partsof the body where most fluid collects, drain off excessive moisture.22The lung draws in air and sends it out again.23The spleen, the gallbladder,the heart, and the head, according to one theory, serve as reservoirsfor water, bile, blood, and phlegm, respectively, which they receive, via the vessels, from the food and drink collected in the "cavity," and which they pass on in turnto the body as nourishmentthrough the vessels.24 The "cavity" or fluid in tdigests ("cooks") the food and passes it off26; the bladder sends out filtered urine through the urethra.27The uterus, finally, draws or receives the seed,28 whereupon the uterine orifice closes29and the fluid that is normallydischargedas menses is sent to the breasts as milk.30That there is seen to be a relationshipbetween part and physiological process is further borne out by the naming of some parts after their specific action: urethrameans "thatwhich urinates"31; in the Sacred Disease the vessels are called anapnoai, which denotes the action of breathing,since, according to this treatise, they breathein air, distributeit throughthe body, therebycooling its differentparts, and send it out again.32The outer ear and the pupil are on occasion called "hearing"33and "vision,"34respectively, and the epiglottis is once 19Nat. Puer. 19 (7.506.19-20). Loc. Hom. 6 (6.288.21-23). 21 Carn. 18 (8.608.2-6); Morb. 4 56 (7.606.3-4). 22 Gland. 3 (8.556.18-558.7). Similarly, hair grows by collecting excess fluid that has been expelled to the extremities: Gland. 4 (8.558.10-14), cf. Nat. Puer. 20 (7.506.23-508.2). 23 Morb. 1 12 (6.160.4-6). 24 Morb. 4 39 (7.556.15-560.7). Ibid. (7.558.6-8); Nat. Hom. 11 (6.60.10-14): food is distributed by the vessels through the whole body. At the same time, the body draws nourishment directly from the "cavity": Morb. 4 33 (7.544.7, 17-20); cf. Aff. [Affections] 47 (6.258.12-14); Epid. 6 6.1 (5.322.7). 25 E.g., Vict. [Regimen] 3.74 (6.614.21-22); Salubr. [Regimen in Health] 7 (6.82.14-15); VM 11 (1.594.11); Aff. 47 (6.258.6-7). In Morb. 4 42 (7.564.2-4) the fluid in the "cavity" cooks (digests) the food and turns it into blood. 26 E.g., Morb. 4 45 (7.570.1-3); ibid. 46 (7.572.19); Aff. 10 (6.218.7), 37 (6.246.17). For the whole process of nutrition, digestion, and evacuation see, e.g., Morb. 4 42 (7.562.20-564.15); Aff. 47 (6.256.20-258.3); Carn. 13 (8.600.4-10). 27 E.g., Morb. 4 45 (7.570.2-3); Loc. Hom. 8 (6.190.19). In Morb. 4 55 (7.600.15-24) the formation of urine out of fluid received from the "cavity" seems to be located in the bladder. Elsewhere urine is said to reach the bladder: Nat. Hom. 14 (6.66.3-4). A connection between urine and the kidneys is implied, e.g., in Int. 14-17 (7.202.1-13; 202.24-204.4, 20-21; 206.10-22); Aph. 4.76 (4.530.6-7), 4.78 (4.530.10-11), 7.34 (4.586.1-2); Nat. Hom. 14 (6.66.5-7); Coac. 578 (5.718.16-19). In Oss. 4 (9.170.15-20) fluid attracted to the kidneys is filtered by the kidneys themselves as well as by the vessels that lead from there to the bladder; by this process urine is separated out of the blood. 28 E.g., Mul. 1.18 (8.58.3-4), 2.137 (8.308.18), 2.154 (8.330.1-3). 29 Aph. 5.51 (4.550.7-8), cf. Superf. [Superfetation] 1 (8.476.8-10); Genit. 5 (7.476.19-23). 30 Mul. 1.73 (8.152.22-154.5), cf. Nat. Puer. 21 (7.510.24-514.4). See lain M. Lonie, The Hippocratic Treatises "On Generation," "On the Nature of the Child," "Diseases IV" (Berlin: De Gruyter, 1981), pp. 203-206. Elsewhere the breasts are said to change the fluid they receive to milk themselves: Gland. 16 (8.572.3-4). 31 See Jean Irigoin, "La formation du vocabulaire de l'anatomie en grec: du mycenien aux principaux traites de la Collection hippocratique," in Hippocratica, ed. Mirko D. Grmek (Paris: 1Editionsdu Centre National de la Recherche Scientifique, 1980), pp. 247-257, on p. 250. 32 Morb. Sacr. 4 (6.368.1-4). Elsewhere anapnoe, diapnoe, and pnoe denote ventilation, i.e., the movement of air inside the vessels, e.g., Morb. 4 57 (7.612.3-6), or within the body, e.g., Mul. 1.7 (8.32.10-12), 1.32 (8.76.7). 33 E.g., Carn. 15 (8.602.23); Flat. 10 (6.106.2); Loc. Hom. 3 (6.282.1-2). 34 E.g., Loc. Hom. 2 (6.278.22), 3 (6.280.16); Flat. 10 (6.106.1); VM 19 (1.616.7). 20


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called kleithron,"closer."35The "temporal"and "chewer"(masseter)muscles of the jaw, finally, derive their names, as is stated explicitly, from their attachment and use.36 Inversely, impairmentof normalprocesses is attributedto the damage of certain parts. Thus digestion does not take place if the "cavity" lacks heat,37 whereas if it is ailing38or its exit is obstructed39the normal passage of stool is interferedwith. Stranguryor retentionof urine is attributedto an affectionof the kidneys40or bladder,41respectively, or to blockageof the urethra.42Similarly,an affection of the uterus, or blockage or closing of the uterine orifice, leads to dysmenorrheaor amenorrheaor prevents conception. If, on the other hand, the uterine orifice is unnaturallyopen and menstruationabundant,or if the uterus is too moist or smooth, the seed is not retained but slips out again before it can congeal.43Obstruction or destruction of the spermatic passages, furthermore, leads to sterility in the male,44whereas cuttingor hardeningof the ligamentsthat raise and lower the penis results in impotence.45Injuryof the spinal cord leads to the loss of sensation in and control over certain parts.46 If joints become fixed47 or the cords (tendons, ligaments, or nerves) of the limbs are injured,48a person becomes lame in that part. Again, the fractureor dislocation of a bone or joint leads to loss of some or all of its normalactions.49Swellingsinside the mouthand throathinderrespiration,50swallowing,51and speech.52If the bronchialtubes are

3 Morb. 2 28 (7.46.1-2). Art. 30 (4.140.12-142.1). 37 Vict. 3.75 (6.616.17-21), 79 (6.624.5-9); Salubr. 7 (6.82.12-14, 15-17). 38 E.g., Aff. 23 (6.234.15, 23-26); Vict. 3.81 (6.628.4-1 1). 39 In Vict. 3.82 (6.630.14-18) and Aff. 21 (6.230.23-24, 232.8-10) the "cavity" is obstructed through the hardening of its contents and subsequent swelling of the intestines. Cf. Morb. 3 14 (7.134.8-11); Epid. 7 120 (5.466.4-6). In Mul. 1.2 (8.18.2-4) and Nat. Mul. 54 (7.396.8-9) the exit of the "cavity" is obstructed by the uterus falling against it. 40 E.g., Int. 14 (7.202.1-13); Aph. 5.58 (4.554.1-2); Coac. 578 (5.718.16-18). 41 Aph. 4.80 (4.530.14-532.2), 7.39 (4.588.5-7), 28 (6.240.5, 10-11); Fist. [Fistulas] 8 (6.456.5-7). 42 In Aer. 9 (2.38.10-16) the urethra is obstructed through inflammation; in Mul. 1.2 (8.18.3-4), 2.128 (8.274.15-16), 2.137 (8.310.18-20), and in Nat. Puer. 15 (7.494.26-496.2) through the uterus falling against it. Cf. Aph. 5.58 (4.552.13-554.2). 43 On female sterility in Hippocratic medicine see Simon Byl, "L'etiologie de la sterilite feminine," in La maladie et les maladies dans la Collection hippocratique, ed. Paul Potter, Gilles Maloney, and Jacques Desautels (Quebec: Editions du Sphinx, 1990), pp. 301-322, esp. pp. 312-322. 44 Genit. 2 (7.472.12-16); Aer. 22 (2.78.10-1 1). 45 Genit. 2 (7.472.5-12). 46 Weakness of the limbs, insensitivity to touch, and retention of urine and stool followed by incontinence are mentioned as consequences of an injury of the spinal cord in Prorrh. [Prorrhetic] 2 16 (9.42.9-16) and Art. 48 (4.212.6-17); cf. ibid. 48 (4.216.2-10), 46 (4.196.13-18); Mochl. 36 (4.378.14-17); Int. 13 (7.198.25-200.7). 47 E.g., Int. 41 (7.266.19-24): bile settles and congeals in the joint; cf. Prog. [Prognostic] 18 (2.160.7, 160.17-164.1); Coac. 390 (5.670.6, 9-10); Prorrh. 2 14 (9.40.8-9). Int. 51 (7.292.18-24): the synovial fluid dries out. Ibid. 51 (7.298.3-5): the cartilage grows together. Mul. 1.4 (8.26.13-19, 26.2128.2): unevacuated menstrual blood coagulates around the cords. 48 Morb. 1 3 (6.142.22-23); Coac. 498 (5.698.3-5); Prorrh. 2 15 (9.40.10-12). 49 Fract. 18 (3.478.1-480.8), 42 (3.552.3-4), 43 (3.554.6, 9), 44 (3.554.15-17). Cf. ibid. 19 (3.482.1, 9-12): loss of use as the result of bad treatment. Art. offers a detailed description of the part's diminished use in each kind of fracture or dislocation. 50 E.g., Aff. 4 (6.212.7-9) and Morb. 2 10 (7.18.3-11): uvula swollen; Morb. 2 29 (7.46.16-19): uvula and jaw swollen; Morb. 3 10 (7.128.16-18), Epid. 5 63 (5.242.7-9), cf. Epid. 7 28 (5.400.1-3): throat swollen; Acut. (Sp.) 6 (2.410.5-7): tongue swollen. 51 E.g., Morb. 2 28 (7.46.1-3): epiglottis swollen; Morb. 2 27 (7.42.21-23) and Morb. 3 10 (7.128.1618): throat swollen. 52 E.g., Morb. 2 27 (7.42.21-23): throat and jaw swollen. 36


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filled with sputum,53 or the lung with pus, phlegm, or swellings, a patient suffers from orthopnea or sufocates.i Again, if the throat (windpipe)is cut, a person loses his speech, since air cannot be drawninto the hollow spaces of the body but escapes throughthe cut.55 Obstructionof the nasal passage by a polyp56or wetness,57 finally, impedes breathing,and the voice loses resonance. In some of these cases a part's action is related to its specific structure or texture. The glands, for example, are said to be spongy and thus to draw off moisture58;respiration and speech occur by means of cavities in the chest.59 Furthermore,impairmentor loss of an action has been seen to be due to change in a part's texture or quality, its destruction, or, most frequently, obstruction. This link between action and specific structureis very explicit in the Hippocratic account of sense perception. Hearing is explained by the resoundingquality of the air-filledhollow space in the inner ear and of the hard, dry bone surrounding it.60 Obstructionof this space results in defective hearing, since sound is less clearly transmittedto the brain.61Seeing takes place by means of the reflecting quality of the clear and thin membranesof the eye.62 If these are injured,63or if the vessels that supply the eye with clear fluidfrom the braindry up64or are filled with extraneous material,65vision is lost or blurred, since objects are less distinctly reflected.66Sense perception itself is located in the brain, to which the sense organs are somehow connected.67The brain, in fact, accordingto the Sacred Disease, is responsible for consciousness by interpretingthe impulses it receives from the outer air.68This same air, then moving from the brainthrough vessels to the hollow spaces inside the body,69transmitsintelligence(phronesis) 53 Acut. (Sp.) 5 (2.260.3-262.13): suffocation. Cf. Loc. Hom. 14 (6.306.13-16): flux in the bronchial tubes-dyspnea. 54 Morb. 1 12 (6.158.21-160.8): phlegm and pus in the lung-suffocation; Int. 3 (7.174.19-176.1): tubercles and pus in the lung-orthopnea; Coac. 424 (5.690.3-7): pus in the chest-dyspnea; Int. 4 (7.178.3-5): varix in the lung-orthopnea; Morb. 2 58 (7.90.10-11), Morb 3 7 (7.124.18-20), Int. 7 (7.182.22, 184.2-3): swellings in the lung-orthopnea. Similarly, respiration and speech are impaired if normal growth of the cavities in the chest has been interfered with through cyphosis in childhood: Art. 41 (4.178.6-10). 55 Carn. 18 (8.608.16-21). 56 Morb. 2 34 (7.50.22-23), 33 (7.50.4-7).

57

Carn. 16 (8.604.15-16).

Gland. 1 and 3 (8.556.2-5 and 556.19-558.7). 59 Morb. 4 56 (7.606.1-2); Art. 41 (4.178.6-10); Carn. 18 (8.608.9-21). 60 Loc. Hom. 2 (6.278.14-18); Carn. 15 (8.602.19-604.6). 61 Obstruction occurs when the brain is heated, swells up, and fills the air space of the inner ear: Morb. 2 4 (7.10.20-12.3). In Morb. 3 1 (7.118.3-7) defective hearing is attributed to a ringing in the ears caused by throbbing of the adjacent vessels; cf. Morb. 2 4 (7.10.18-22). 62 Loc. Hom. 2 (6.278.21-280.4); Carn. 17 (8.604.21-606.14). 63 Loc. Hom. 2 (6.280.4-9). 64 Loc. Hom. 2 (6.280.1-2). 65 Loc. Hom. 3 (6.280.21-26); Carn. 17 (8.606.13-16); Morb. 2 1 (7.8.6-10); Gland. 13 (8.568.4-5). 66 Loc. Hom. 3 (6.280.21-26). In Morb. 2 8 (7.16.12-14) temporary loss of sight is attributed to a swelling of the brain; cf. Morb. 3 3 (7.120.17-20). 67 Loc. Hom. 2 (6.278.16-18): ear; Loc. Hom. 2 (6.278.21-23) and Carn. 17 (8.604.21-22): eye; Carn. 16 (8.604.7-8): nose. 68 Morb. Sacr. 16 (6.390.10-14, 16-20), 17 (6.392.4). Since the brain is responsible for intelligence, sense perception, emotions (Morb. Sacr. 14 [6.386.15-22]), and movement (Morb. Sacr. 7 [6.372.21]), these are disturbed if the brain suffers any kind of change from its normal state: Morb. Sacr. 14 (6.386.22-388.11). Elsewhere, too, disturbances of mental activity, speech, and movement are attributed to an affection of the brain-e.g., Salubr. 8 (6.84.23-86.2); Aph. 7.58 (4.594.10-1 1); Coac. 489 (5.696.2-5), 490 (5.696.5-7); Morb. 1 4 (6.146.8-12); Gland. 12 (8.566.10-568.3)-or to parts of the head that involve the brain-e.g., Epid. 5 50 (5.236.11-20), cf. ibid. 60 (5.240.8-12); Prorrh. 2 14 (9.36.17-18, 40.3-5). 69 Morb. Sacr. 7 (6.372.20). I understand "cavities" here as the hollow spaces of each part. 58


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and movement to all the parts that can receive it.70The parts, on the other hand, perform what the brain determines.71If, then, the blood inside the vessels is cooled and arrestedby a sudden influxof cold phlegm, both the coagulatedblood and the thick phlegm block the free distributionof air throughthe vessels. As a result, the person becomes speechless and deranged,his movements are uncontrolled, and parts that are cut off completely from the air become weak and numb.72

That there is a clear conception of a connection between a part's shape and its particularaction is furtherwitnessed by explicit statementslike the following: "If the lung were not a cavity and there were no windpipe attached to it, animals would be voiceless; for it is from the lung's cavity to which the windpipe is attached that we emit sound." This the authortakes to be one of his proofs that drinkdoes not go to the lung, for "if drinkgoes to the lung, when the lung became full a man could not easily breathe, nor could he give voice, because there would be nothingto resonate in the lung if it were full." 3 On similarlines, the authorof the Sacred Disease rebuts the opinion that it is by means of the diaphragmthat we think, as was held to be the case in popularbelief: the diaphragmis thin and extended and has no cavity "into which it could receive anything good or bad"74-presumably air, which transmitsthought. So far, then, it has been shown that some physiologicalprocesses are held to be located in specific parts and to depend on the part's integrityor sound structure. Also, it has become evident that the kind of action located in or performed by each part is dependent on and explained by that part's specific structure, texture, or quality. Thus, for example, both the production75and the perception76 of sound are explained by the resounding capacity of enclosed space. Bodily movement depends on the structureof the joints-they must have cavities and be lubricated77-and the pliability of the ligaments.78Digestion is seen as coction and as such requiresheat providedby the "cavity"79;similarly,milk is produced when blood is sweetened by the heat of the uterus.80 Other physiological processes are described in terms of the attraction,recep-

70 Morb. Sacr. 7 (6.372.14-21), 16 (6.390.10-20).Vestiges of a differenttheory are presentin Flat. 14 (6.110.14-114.12);Morb. 1 30 (6.200.11-18), 34 (6.204.5-7); Morb. 2 3 (7.10.6-8); Virg. [Girls] (8.464-470): it is blood that provides the capacity to think (phronesis)and that is responsiblefor mentalderangementwhen it is affected. 71 Morb. Sacr. 16 (6.390.13-14). 72 For a discussion of the epileptic seizure as depicted in Morb. Sacr. see Owsei Temkin, The

Falling Sickness (1945; Baltimore: Johns Hopkins Press, 1971), pp. 51-55.

Morb. 4 56 (7.604.21-606.2, 8-11) (trans. Lonie). Morb. Sacr. 17 (6.392.5-7, 10). Morb.4 56 (7.606.1-2, 9-11): the hollow space in the lungresounds.In Carn. 18 (8.606.18-608.2) sound is producedby air being pushed out of the hollow spaces inside the body; what resonates, however, is the head. Cf. also Aph. 7.51 (4.592.3-6), where the sound producedin sneezing is explained by the narrownessof the exit throughwhich the air escapes from the hollow space in the head. 76 In Morb.2 4 (7.12.1-3) resonanceis producedby the air inside the hollow space of the innerear. In Carn. 15 (8.602.19-604.6)resonance is producedby the hard, dry bone surroundingthe hollow space of the inner ear. 77 If the joint cavity disappearsbecause it is obstructedby congealed bile, because the synovial fluid is dried up, or because the cartilage of the two bones meeting at the joint grows together, movementis prevented;cf. the passagesquotedin note 47. For lubricationcf. Loc. Hom. 7 (6.290.873 74 75

10). 78 79

E.g., Mul. 1.4 (8.26.21-28.2);cf. note 45. See notes 25 and 37.

80 Nat. Puer. 21 (7.512.16-17).


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tion, and passing on of fluids and air. The lungs, for example, attract air,81 the gullet or the "cavity" food and drink,82 and the vessels and tissues in the body or the "reservoirs" what is suitable as nourishment.83 The bladder attracts84 or receives what is to be filtered out,85 and the breasts what is or will be changed into milk.86 Similarly, conception takes place if the vessels in the uterus, the uterus itself, or its orifice attracts87 the seed and receives it.88 The specific structures, textures, and qualities to which attraction, reception, and discharge are linked are best exemplified in a curious chapter at the end of the treatise On Ancient Medicine. Here the author points out the importance of both "internal and external forms of bodily structure" with regard to the "experience of a sick and healthy man" (Ch. 23).89 I quote from the beginning of Chapter 22: It seems to me that it is necessary to know also which affectionsarise for man from "powers"(dynameis)and which from "structures"(schemata). What do I mean by this? Power is the intensity and strengthof fluids; structureI call what is found in man. Some are hollow and contractingfrom wide to narrow, some [hollow and] expanded, some hard and round, some broad and suspended, some stretched, some long, some dense, some of loose texture and swollen, some spongy and porous.90 The author then goes on to assign certain roles to these structures and to relate them to certain parts of the body: (1) Hollow and taperingstructuresof the shape of cuppinginstrumentsattractand draw fluid to themselves and are always full of fluid from without (bladder,uterus, head). (2) Hollow and expandedparts are best suited to receive fluidthat has flowed into them but have less attractiveforce. (3) Solid and roundparts neither attractnor hold fluid, since this would slip round and find no place to stay. (4) Soft, spongy parts of loose texture (spleen, lung, breasts) "will drinkup readily what is in contact with them," whereuponthey enlargeand become hard and dense and, unlike hollow parts, do not dischargethe absorbedfluid. (5) What is broad and dense suffers most from blows of air falling against it, on account of its unyieldingand resisting nature, and if such a structureis also tender and swollen and full of blood (liver), it is very susceptibleto any kind of pain. This extended description of the inner parts of the body in terms of geometrical shapes and textures, on account of which they assume active and passive roles, is the attempt by one author to systematize explanations not only of physiological 81 See note 23.

E.g., Mul. 1.50 (8.108.13-14), 2.171 (8.352.6-7). Cf. note 24 and Carn. 13 (8.600.4-9). Morb. 4 55 (7.600.18-19), if Joly's conjecture is right: R. Joly, Hippocrate (Association Guillaume Budd) (Paris: Belles Lettres, 1970) p. 117. 85 See note 27. 86 Gland. 16 (8.572.4); in Nat. Puer. 21 (7.514.1-4) the vessels attract the milk and pass it on to the breasts. 87 E.g., Mul. 1.18 (8.58.3-4), 1.24 (8.64.3), 2.137 (8.308.18), 2.146 (8.322.6), 2.166 (8.344.14); Aer. 21 (2.76.3-4). 88 E.g., Mul. 2.154 (8.330.3), 2.158 (8.334.17); Steril. [Barrenness] 213 (8.408.5-7); Genit. 5 (7.476.20). 89 VM 23 (1.634.5-7). 90 VM 22 (1.626.6-13) (Jones's translation adapted to the text of Jouanna). 82 83 84


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but also of pathological processes that involve fluids or air.91For fluids need passages in which to flow, spaces into which they can be received,92and some force that sets them in motion and makes them flow where they do. It is to this conception that the assignmentof certain roles to particularstructureshas to be related. If, then, parts and passages are said to be hollow or solid, wide or narrow, thick or thin, porous or dense, and empty or full, it is obvious that it is the first of each pair that is suited to receive fluids, namely the hollow, wide, thick structureof porous texture that is open and empty.93 These structuresassume active roles in that they attractfluidsby virtue of their empty spaces.9 The fluids follow as long as the passages are wide enough for them to be received and to pass through easily.9 Once filled by the fluids attracted, the parts usually pass them off into adjacentparts or passages that are empty and thus ready to receive them.96If the fluids so attractedare proper to that part,97and if they are eventually evacuated, proper balance and health are maintained.98If, however, the fluids attracted are in excess or harmful, and if they are not evacuated, they affectthe parts,99or they spreadand flow wherever there is a passage open to them, and where they settle they cause disease. Or, again, if the parts, when filled, retain the fluid, this causes obstructionof whatever normallyflows throughthem,100or-especially if these parts are spongy91 Cf. Joly, Niveau (cit. n. 1), pp. 163, 167. 92 Joly coined the phrase "physique du recipient" to describe this phenomenon: Niveau, pp. 46, 75-81. Cf. Temkin, "Zusammenhang" (cit. n. 1), p. 30. 93 Examples are the head, because it is hollow and has much space: Morb. 4 40 (7.560.27-29), Gland. 7 (8.360.22-362.1); and the spleen, the lung, and the tongue, on account of their porosity: Morb 4 (7.560.27-29); Int. 33 (7.250.16), 10 (7.190.4-5); Acut. (Sp.) 6 (2.412.1-3). Similarly, when after menstruation the uterus and the vessels in it are empty and open, seed is attracted and received: Nat. Puer. 15 (7.494.15-20); Mul. 1.17 (8.56.21-22), 1.24 (8.64.1-5). 94 E.g., Morb. 1 15 (6.168.13-16), Morb. 4 35 (7.548.18-19), Gland. 7 (8.560.22-23): head (hollow). Vict. 2.62 (6.578.3-5), 2.66 (6.588.7); Morb. 4 33 (7.548.18-19): "cavity" (empty). Nat. Puer. 19 (7.506.5-6): bones (hollow). Morb. 4 40 (7.560.17-19), 55 (7.600.15-16); Nat. Puer. 21 (7.514.1-5); Acut. (Sp.) 6 (2.408.10-410.2): vessels (wide), cf. Mul. 1.24 (8.64.1-5): vessels (empty). Mul. 1.61 (8.122.11-13), Morb. 4 57 (7.610.9-10): spleen (porous). Loc. Hom. 14 (6.304.1-2); Morb. 1 22 (6.186.12-16), cf. Int. 3 (7.174.19-20), 7 (7.182.23-184.1): lung (porous). Gland. 1 and 3 (8.556.2-5 and 558.1-2): glands (porous). Morb. 2 1 (7.8.14-15), Mul. 1.1 (8.12.6-8, 17-18): tissue (porous). Inversely, when full these parts attract less: Mul. 1.24 (8.64.3-5): vessels; Aff. 61 (6.268.17-18): "cavity." On attraction in general see Lonie, Hippocratic Treatises (cit. n. 30), pp. 266-268; and Michel Roussel, "La notion de traction dans le Corpus hippocratique: Vers une etude globale," in Formes de pensee, ed. Lasserre and Mudry (cit. n. 2), pp. 423-426. See also Jacques Jouanna, Hippocrate: Pour une archeologie de l'ecole de Cnide (Paris: Belles Lettres, 1974), p. 351, n. 1. 95 E.g., Morb. 4 35 (7.548.19-20), 40 (7.560.17-20); Gland. 2 (8.556.14-15). 96 Nat. Puer. 21 (7.514.3-4); Morb. 4 33 (7.544.4-6), 39 (7.556.15-560.7); cf. ibid. 41 (7.562.15-17). See Lonie, Hippocratic Treatises, pp. 296-298. This principle of a continuous exchange of fluids among parts, stated in a general form in Mul. 1.61 (8.122.19-20), finds its expression in numerous passages where the disease process is related to the movement of fluids, e.g., Int. 23 (7.224.5); Aph. 7.55 (4.594.5-6); Loc. Hom. 1 (6.276.13-15), 24 (6.314.20-316.1). 97 E.g., Morb. 4 40 (7.560.11-12), 33 (7.544.7-9). For the idea that certain fluids are proper-or not-to a given part see also Loc. Hom. 7 (6.290.8-10); Gland. 4 (8.558.8-10); de Arte 10 (6.16.22-23, 18.6-7); Vict. 2.66 (6.584.2-3). 98 E.g., Morb. 4 41 (7.562.7-12), 37 (7.554.1-3), 38 (7.554.26-556.7); cf. Mul. 1.61 (8.122.13-14). Normally, the evacuation of excessive fluids takes place through the "cavity," the bladder, the nose, the mouth, the uterus, or the skin; cf. the passages quoted above and Mul. 1.1 (8.12.19-21, 22-23). In Gland. 3 (8.558.1-7) the glands contribute to health by absorbing excess moisture. 99 E.g., Morb. 4 40 (7.560.24-27); Gland. 7 (8.562.3-5); Vict. 2.66 (6.582.2); Int. 3 (7.174.19-22). 100 E.g., Fist. 8 (6.456.6-7): phlegm, attracted by the bladder, causes strangury; Steril. 213 (8.412.11-13): unevacuated menstrual blood fills the vessels in the uterus and prevents reception of the seed; Loc. Hom. 14 (6.306.13-15): a flux retained in the bronchial tubes obstructs the passage of air; cf. Acut. (Sp.) 6 (2.410.1-5); Morb. Sacr. 7 (6.373.22-374. 1).



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they become hardand diseased'0' or dilate and thus disturbother parts by touching them.102 Not only empty space but also heat plays a role in attraction.103The model for the attractiveforce of void and heat is the cuppingglass, a bell-shapedinstrument that was warmed and placed on the surface of the body to draw fluids.104Thus the head, which is "hollowand situatedin the superiorposition," attractsphlegm from the body when it is heated by the "cavity' 5; and with explicit reference to the cuppinginstrument:the head, "whichis hollow and sits upon the body like a cuppinginstrument,"attractsphlegmfrom the "cavity."106 The analogy with the sucking force of the cupping glass also explains why, when the head attracts, fluids move upward,whereas normally,as is stated elsewhere, it is not easy for a fluid to progress in that direction.107 Pathological change in a part's structure toward emptiness or heat can also initiate the attractiveprocess. Parts, for example, that are dilated throughexcessive strain or fluids attract on account of their capacity to receive,108 swellings and wounds on account of their heat due to inflammationand, especially if they have given off pus, on account of their empty space and dryness.V09 Since fluids not only nourish the body, but when in excess or themselves in a pathologicalstate also harmit, it follows that the parts that attractmost and that are most suited as receptacles are also most prone to disease. Thus the head and the spleen, on account of their respectively hollow and spongy structure, accept-according to one theory-not only the fluid proper to them (i.e., phlegm and water, respectively) but also other fluids, and are thus thought to be most 101 Acut. (Sp.) 6 (2.412.1-4): tongue; Int. 31 (7.248.1), 33 (7.250.16-17): spleen; Int. 7 (7.182.23184.1): lung; ibid. 26 (7.232.10-11, 18-19), 40 (7.264.6-7), cf. Loc. Hom. 10 (6.296.5-6): flesh; Nat. Puer. 15 (7.494.23-26): vessels. 102 Acut. (Sp.) 6 (2.410.8-412.5): vessels touch the tongue; Loc. Hom. 47 (6.344.15-20): the uterus touches the groin; Int. 48 (7.284.8-11, 21-22): the liver touches the diaphragm; cf. also Aph. 5.58 (4.252.13-254.2). 103 Morb. 2 3 (7.10.9-10), 11 (7.18.14-15); Morb. 1 13 (6.160.17-18); Aff. 2 (6.210.6-7); Mul. 1.36 (8.84.8-9): head. Vict. 3.81 (6.628.6-7); Morb. 4 55 (7.592.16): "cavity." Morb. 1 29 (6.198.23-24, 200.2-3): "upper cavity." Fist. 8 (6.456.5-6): bladder. Flat. 10 (6.106.10-11): windpipe. Morb. 2 8 (7.16.8-9), Haem. [Hemorrhoids] 1 (6.436.4-5): vessels. Morb. 1 13 (6.160.16-17), 27 (6.104.20-22): lung. Morb. 1 20 (6.176.24-178.1, 8-9): tissues. Attraction by heat is usually pathological; exceptions are Vict. 2.62 (6.576.10-12, 578.3-5): "cavity"; and ibid. 64 (6.580.13-14): flesh. 104 VM 22 (1.626.22-628.3); Aristotle, GA [Generation of Animals] 2.4.739b9-13. 105 Morb. 1 15 (6.168.12-16) (trans. Potter). 106 Morb. 4 35 (7.548.18-19) (trans. Lonie). Cf. also Gland. 7 (8.560.22-561.1). 107 Flat. 10 (6.106.17-18). The natural movement of fluids is downward: Loc. Hom. 9 (6.292.21-25); cf. Nat. Hom. 12 (6.62.16-18); Morb. 4 (7.554.3-8); Gland. 8 (8.562.15-16). Other causes for the ascent of fluids are vaporization or pressure. For vaporization see Antoine Thivel, "Flux d'humeurs et cycle de l'eau chez les presocratiques et Hippocrate," in Maladie, ed. Potter et al. (cit. n. 43), pp. 279-302. In Gland. 7 (8.562.1-5) the phenomena of attraction and vaporization are combined; cf. Morb. 1 15 (6.168.14-16); Morb. 2 11 (7.18.16-17). For pressure see Nat. Puer. 21 (7.512.16-18); Gland. 16 (8.572.4-7). For the drawing force of the cupping instrument see Aph. 5.50 (4.550.5-6); Epid. 2 6.16 (5.136.7-8); Aff. 4 (6.212.11-13); cf. Nat. Puer. 21 (7.512.23-514.1). The cupping instrument analogy may also explain why the head can draw fluids from a distance, whereas otherwise attraction occurs between adjacent parts: e.g., Morb. 1 (6.166.17); Haem. 1 (6.436.3-4); Mul. 1.61 (8.122.11-13). 108 E.g., Morb. 1 15 (6.166.11-12); Morb. 2 1 (7.8.14-15). In Morb. 4 51 (7.588.12-14), 50 (7.582.1316), and Flat. 11 (6.108.8-10) blood or air rushes into the empty space caused by dilation. 109Morb. 1 13 (6.160.13-16), 15 (6.166.1-2, 16-17, 18-20); Morb. 2 10 (7.18.6-8); Flat. 10 (6.106.10-11); Acut. (Sp.) 5 (2.406.2-4); cf. Loc. Hom. 29 (6.233.13-15). Dryness as an attractive force is related to empty space: a part becomes dry when it loses moisture, e.g., Morb. 1 27 (6.194.2425); Vict. 2.62 (6.576.13-18). For attraction on account of dryness see, e.g., Morb. 1 18 (6.172.1-4); Morb. 4 37 (7.554.10-12); Acut. (Sp.) 1 (2.394.2-8); Mul. 1.7 (8.14.4-6, 15-16).


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subject to be affected."10Parts, on the other hand, that cannot receive too much fluidsufferless from disease: the heart, because it is solid and dense, and because thick vessels start from it into which it immediatelypasses off any excess, isaccordingto the same theory-free from disease."' So is the gallbladder,since it has no space into which to receive any fluidexcept the one properto it (i.e., bile), which is also the only one that its thin and weak vessels are capable of attracting.112 Similarly, the male body, being dense and solid, attracts only as much blood from the "cavity"as is necessary for its nourishment,whereas the woman, owing to the loose texture of her flesh, draws so much fluid from the "cavity" that she must evacuate some of it every month as menses in order to avoid plethora."13 Once diseased, however, dense and narrow parts hinder recovery, since the healing mechanism,which involves evacuatingor dissipatingthe harmful substance, is interferedwith. Young people, whose flesh is dense and strong, suffermore from tears in the chest than do older people, and their recovery is less likely, since the evacuation of pus does not take place adequatelybecause their lung, being dense, does not draw sufficientlyand their bronchial tubes, being narrow, have no space into which to receive the pus."14 The same reasoning is behind the explanationof why epilepsy is less fatal in adults than in children:the thin vessels of childrenhave no space to accommodatethe influxof thick phlegm, which immediatelyfreezes and coagulatesthe blood, whereas the wide vessels of adults are full of warm blood that reduces the effect of the cold phlegm.'15 Disease management,too, reflects clearly the importanceof the parts. In general, therapy aims at reversing the pathologicalprocess, removing the harmful substance, restoring the disturbedbalance, and repairingphysical damage. It is thus directed at parts as well as at fluids. Therapy can influence a part's structure, texture, or quality directly. If the "cavity," lacking heat, does not digest, it is to be providedwith warmththrough diet and exercise"6; if, because the flesh and the vessels are dense, food is not absorbedby the body, cure includes an exercise of the voice that, by takingaway the moisture in the flesh, loosens its texture.117 If the uterus does not enlarge in response to the growth of the embryo, treatmentconsists of insertingpessaries that expand it.1 '8 Similarly,when the "cavity" is obstructed, air is blown into it by means of a bellows in order to distend it, thereby creating space for the reception of an enema.119If a patient chokes because his throat is swollen, tubes are inserted into the throat behind the jaw so that air can be drawn into the lung.120 110

Morb. 4 40 (7.560.24-562.5). "' Morb. 4 38 (7.554.18-23), 40 (7.560.20-24). At the same time, solid and dense parts are less likely to be affected by irritating fluids than are thin and tender parts; see Morb. 4 56 (7.606.21-24); Flat. 10 (6.106.5-6). 112 Morb. 4 40 (7.560.7-14). 113 Mul. 1.1 (8.12.6-9, 12.17-14.5), cf. Gland. 16 (8.572.12-14). In Gland. 9 (8.564.2-7) the intestines are said to be generally free from disease because their many glands are stretched out and not hollow, so that any fluid is distributed equally among them in small amounts. 114 Morb. 1 22 (6.184.18-186.3, 186.5-16); cf. Coac. 393 (5.670.16-18). 115 Morb. Sacr. 8 (6.374.23-376.2), 9 (6.376.18-378.1). 116 Vict. 3.75 (6.616.17-618.3); Salubr. 7 (6.84.8-15). 117 Vict. 3.78 (6.622.18-19), 2.61 (6.576.4-6). The amount of food that can be absorbed by the body depends on the texture of its tissues; see Salubr. 7 (6.82.21-84.4, 84.6-7). 118 Superf. 27 (8.490.14-15, 18-19). If the uterine orifice is closed or disoriented, it is to be opened or straightened with a tin probe: Steril. 217 (8.418.23-420.3), cf. Mul. 1.11 (8.44.1-2). If the uterus is too moist it must be dried: Mul. 1.11 (8.44.2-3). 119 Aff. 21 (6.232.3-6); Morb. 3 14 (7.136.1-3), cf. Epid. 7 120 (5.466.4-6). 120 Morb. 3 10 (7.130.7-8). This content downloaded from 129.219.247.033 on August 22, 2016 04:37:34 AM All use subject to University of Chicago Press Terms and Conditions (http://www.journals.uchicago.edu/t-and-c).


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Another therapeuticstrategy is to make use of a part's normalaction by artificially stimulatingit. In a case of overindulgence,the head draws the excessive moisture upward to itself, in opposition to the normal downwardmovement of digested food, and thereby constipates the "cavity." Throughlaxatives the "cavity" is stimulatedto reverse the pathologicalprocess by drawingwhat has been attractedupward down again.12'Similarly,in a case of angina caused by a flux from the head to the jugularvessels, part of the treatmentconsists of shavingthe head: to regrow the hair will use up moisturethat before descended as a flux.122 In anothercase of anginathe downwardflux is reversed by the applicationof two cuppinginstrumentsat the back of the head.123 These last two parallelexamples demonstrate nicely how medical interventionmeant to affect the movement of fluids may be directed either at parts, by stimulatingthem to act on the fluids, or directly at the fluids themselves.124 To conclude. For the Hippocraticphysicianthe parts of the body are an essential element in his thinkingabout health and disease. To be sure, his interest is not usually centered on the parts as such-any more, for that matter,than on the fluids that are held to constitute the body-but ratheron the bodily process as a whole that he is trying to understand.Of these processes, according to the requirementsof each instance, differentphases may be stressed to the exclusion of others,125 or the same process may be explainedby different-complementary'26 or even alternative127-theories. Nevertheless, from numerouspassages, including in particularthe description of physiological and pathologicalprocesses as well as therapeutic procedures, the underlyingHippocraticbeliefs about parts and their roles can be abstracted.These are: (1) Parts have particularstructures. (2) Physiologicaland pathologicalprocesses are often located in specific parts. (3) The roles parts play are dependenton and determinedby their specific structure, texture, and quality.

To describe and explain the parts' actions, ideas and models of differentprovenance are used. Hearing and speaking are based on the phenomenon of resonance in an empty space, smellingand seeing on the idea of the perceptionof like by like. Thought and movement are attributedto the medium of an intelligent pneuma or air, which travels to the brain and from there, by means of the vascular system, to the differentparts of the body. These explanations of sense perception and speech have counterpartsin contemporaryphilosophical specu121

Vict. 3.73 (6.612.17-18, 22-23; 614.1-4). For a similar procedure see ibid. 2.66 (6.586.2-588.11). Acut. (Sp.) 6 (2.408.8-10, 412). Cf. R. Joly, Hippocrate 6.2 (Association Guillame Bude) (Paris Belles Lettres, 1972), p. 72, n. 2. 123 Aff. 4 (6.212.11-13). 124 An enumeration of therapeutic interventions directed at either parts or fluids is found in Epid. 6 2.1 (5.276.4-278.2). 125 With regard to the mechanism of fluxes, e.g., the emphasis may be on the fluids being set in motion; on the parts attracting or receiving the fluids and retaining them or passing them on; or on the fluids flowing to certain parts, settling there, and causing disease. 126 See, e.g., Gland. 7 (8.562.1-5), where the ascent of fluid is explained by both vaporization and attraction. 127 Attraction, e.g., is attributed to the pull of empty space, heat, or dryness, or to the principle of "like to like." In Morb. 4 35 the attraction of phlegm from the "cavity" to the head is first explained by the head's hollow and cupping-glass-like shape (7.548.18-19), and then by the attraction of likes (7.550.13-15). Cf. Lonie, Hippocratic Treatises (cit. n. 30), p. 268. 122


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lations. Other processes are apparentlyunderstoodin terms of everyday experience: the attributionof milk productionto heat may be based on the analogy of fruit being ripened by the sun,128whereas coction as a model for digestion probably arises from the experience of food preparation.The dischargeof fluid from the bladder is often described with verbs that suggest the action of a filter or percolator; this action is once likened to that of a new vessel, presumablybecause of the vessel's porosity.129Parts are also compared to vessels in their capacity to receive fluids when they are spacious and empty.130 Medical experience, finally, might have suggested the cupping instrument,'13 as well as the sponge and wool, 132 as models for the theory of the attractiveforce and absorbing quality of conical shapes and loose textures. Furthermore,it has become evident that parts are not the mere passive sites of bodily processes that take place throughthe actions of fluids or air, but rather that there is a reciprocal, active interrelationshipbetween parts and fluids. Indeed, it is from their particularaptness in delineating the interaction between parts and fluids that the two dominantactions "attraction"and "reception"noted above derive their wide applicability.If processes are described in terms of the movement of fluids, the attractionexerted by certain parts and their receptive capacity provide an explanationfor the directionthis movementtakes within the body. The fluids, once set in motion, flow to partsthat attract133 or are capable of receiving them,134 or that are weak and yield to them,135 and throughchannels or passages that are open136 and tissues that are permeable.137 Finally, it is worth noting that the more precise nature of the relationship between a part's structureand role in the workingsof the body does not seem to have been an object of direct interestfor the Hippocraticwriters. That parts play, on account of their structure,certain roles in the properworkingsof the body is often expressed, and borne out by the fact that the breakdownof normal processes is frequently attributedto the affectionsof parts. This link between part and role is sometimes expressed by saying that a part has a "use" within the 128

Cf. Lonie, Hippocratic Treatises, p. 207. Hum. [Humours] 11 (5.492.4-6); cf. G. E. R. Lloyd, Polarity and Analogy (Cambridge: Cambridge Univ. Press, 1966), p. 367. For the absorptive quality of terra cotta see Vict. 2.42 (6.540.13-14). 130 Cf. de Arte 10 (6.18.6); Morb. 4 39 (7.556.17-558.6). In Morb. 4 40 (7.562.1-3) the analogy of the vessel as receptacle is applied to the head and the spleen, in Genit. 9 (7.482.14-22) to the uterus, in Morb. 4 55 (7.600.21-24) to the bladder (cf. Acut. 7 [2.268.10-11]; Mul. 2.193 [8.376.10-12]), and in Morb. 4 37 (7.554.5), Epid. 6 3.1 and 3.11 (5.292.4 and 298.3), and Vict. 1.36 (6.524.1) to vessels or channels within the body. 131 Cf. Lonie, Hippocratic Treatises, pp. 209-210. 132 For the capacity of the sponge and wool to absorb and retain fluid see Morb. 4 51 (7.588.14-15); Art. 38 (4.168.13-15); Mul. 1.1 (8.12.9-16); Gland. 16 (8.572.10-12). In Morb. 4 51 and Gland. 16, as in VM 22 (1.630.2-5), the emphasis is on the fact that parts of loose texture retain absorbed fluid; cf. also Int. 3 (7.174.19-20), 26 (7.232.10-11). In reality, however, such parts are often said to discharge the fluid again, when full; e.g., Loc. Hom. 24 (6.314.23-24), Mul. 1.61 (8.122.16-17), Int. 32 (7.248.1516): spleen; Int. 23 (7.224.5): lung; Aph. 7.55 (4.594.5-6): liver. 133 E.g., Morb. 1 29 (6.198.7-10), 20 (6.178.1-5); Flat. 10 (6.106.10-12); Gland. 3 (8.558.1-2); Int. 30 (7.244.6-8); Mul. 1.7 (8.32.13, 15-16); Acut. (Sp.) 6 (2.408.8-410.1). 134 Loc. Hom. 24 (6.314.23-25); Int. 10 (7.190.4-5), 24 (7.228.1-2). 135 Loc. Hom. 9 (6.292.10), 10 (6.292.13-14), 22 (6.314.13-14). 136 Nat. Hom. 12 (6.62.11-12); Loc. Hom. 10 (6.292.22); Morb. 4 40 (7.560.27-29). 137 E.g., Loc. Hom. 9 (6.292.7-9): moisture permeates through the tissues after it has been thinned by heat. Cf. Morb. 4 45 (7.570.3): moisture vaporizes through the internal porosity of the body. Nat. Puer. 21 (7.512.2-3, 12-14): in women whose flesh is of a loose texture the percolation of fluid from the "cavity" into the omentum and the appearance of milk occur earlier than in those with dense tissues; see ibid. 30 (7.536.2-5) and Mul. 1.73 (8.454.5-8). VC 18 (3.250.9-12): in the soft and porous bones of children, wounds suppurate faster than in older people. 129



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body138;inversely, parts may be called "useless" when, owing to damageto their structure, they fail to fulfill their normal role.139Or, a part may be said to be affected "with regardto" its specific contribution.140 When occasionally the relationshipbetween part and process is characterized in terms of cause, it is always one of consequence-for example, "We speak from the lung, because it is hollow and the windpipe is attached to it"'141;"from [the spinal cord] there extend passages, with the consequence that fluid can travel both to and from it' 142-never of finality or purpose.143 Parts may performparticularroles because they have given structures;there is never any hint that they have particularstructuresin order to fulfill given roles.144 138 Gland. 7 (8.560.22); Art. 11 (4.108.7-9), 58 (4.254.5-9). Cf. also Mochl. 23 (4.366.5-7); Vict. 4.86 (6.640.4-15); Art. 11 (4.108.7-9), 45 (4.190.7-1 1); Fract. 15 (3.472.6-7). 139 Art. 34 (4.158.2-3), 55 (4.242.12-14); Prorrh. 2 19 (9.46.14-15), cf. 20 (9.48.3-4). 140 Steril. 217 (8.422.13-14); Virg. (8.468.1-2). In Morb. Sacr. 17 (6.393.13-15) the auricles of the heart (in Greek, "ears") are said to be misnamed since they do not contribute to hearing. 141 Morb. 4 56 (7.606.1-2). 142 Genit. 1 (7.470.18-19). 143 See note 2. 144 A teleological explanation of parts and their structure, however, is found in the two postAristotelian treatises Anat. and Cord. (see note 3): e.g., Anat. (8.538.17-18); Cord. 1 (9.81.5-6), 6 (9.84.11-12), 11 (9.90.2-3, 9-10). Cf. I. M. Lonie, "The Paradoxical Text 'On the Heart,'" Medical History, 1973, 17:1-15, 136-153, on pp. 143-147.


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