Реферат: Hippocratic Medicine Essay Research Paper Introduction Hippocratic

Empedocles and the Four Roots

Empedocles( c. 495-435 BC) marked an important step in the evolution of humoral theory with his belief that the cycle of change depended upon the interplay of four equal roots: earth, fire, water, and air. Empedocles is the first Presocratic to see the elements as equal.(19) The four roots are influenced by the warring entities of Love and Strife. Love and Strife behave in the same manner as Anaximander’s pairs of opposites; when Love dominates, Strife is correspondingly weaker, and vice versa. Love is in harmony with the roots, while Strife is in discord.(20) Empedocles believed in a dual process made up of the creation of one from many (Love), and then many from one (Strife). The process would repeat itself endlessly; Empedocles understood this repetition as a sort of changelessness. This system allows for continual change and global stability at the same time, a theme previously stated by Heraclitus.

Empedocles evidently felt he had to justify his theory of the four roots; he argued that the four roots were intrinsic in nature and that man could identify them. Physicians who practiced humoral theory, with its emphasis upon the seasons of the year, adopted a similar method in justifying their course of treatment. Empedocles also asserted that his four element system could produce the stunning variety that man saw in the world through his painter analogy. Both of these efforts marked the progression of the new style of reasoning, started by Thales, that de-emphasized metaphysical explanation in favor of more concrete terms.

Empedocles’ four root theory of change became the cornerstone of humoral theory. Because he also reinforced the theme that man and nature are governed by the same rules, physicians could now attribute disease to the domination of one of the previously equal roots(humors) in the body. His theory provided for treatment as well: simply devise a way for the offending humor to escape or balance itself out and the patient is cured. The theory was appealing because it was based on natural phenomena that were easy to understand; witness Empedocles’ justifications of his theory above.

Empedocles’ later poem Purifications may have suggested the Presocratic theme that the rules governing the heavens also apply to man. Empedocles believed that all men, once divine spirits, were condemned to be mortal, but that divinity was again possible after the cycle of incarnation.(21) The cycle of incarnation is described in similar terms as the formation of the heavens; in particular, strife is seen again as the disruptive force in the system, paralleled to sin. This is a tenuous conclusion to draw from such sparse evidence, but if it were indeed the case, then Empedocles was echoing previous philosophers in his belief that natural laws applied to both men and the world.

Evaluating the Influence of Presocratic Thought upon the Physician

Hippocratic medicine was indebted to those Presocratics who provided the assumptions upon which humoral theory was based. Hippocratic medicine evolved along with Presocratic thought. The question which remains is to what extent the typical physician was aware of such Presocratic material: did the physician have any cross-discipline knowledge which influenced his practice of medicine, or is this simply an example of two fields of science arriving at the same conclusions via independent means? We know the Hippocratic physician was literate and had some cross-discipline knowledge; he took account of astronomical events because these events helped him to distinguish the seasons of the year.(22) Professor Phillips’ research has indicated that the physician had a comprehensive understanding of the solstices and equinoxes, as well as knowledge of the rising and setting of the Dog Star and Pleiades.(23) He read parapegmata, astronomical calendars engraved on stone..(24) These calendars listed astronomical phenomena on a month-by-month basis. The parapegmata suggest that the physician was acutely aware of another field of study which could impact his profession. The introduction to the Hippocratic treatise The Nature of Man bears this out as it alludes to "theorists" who have rival monistic explanations for the creation of the cosmos. The unknown author even mentions Melissus by name, a fifth century Presocratic. While the author does not hold the Presocratics in high regard, this is nevertheless undisputable evidence of the typical Hippocratic physician’s awareness of Presocratic philosophical teachings.

A Final Application of Presocratic Thought to Hippocratic Medicine

Before I conclude my paper I want to examine an area of personal interest. Consider what follows to be a more leisurely discussion. We have seen how Presocratic thought influenced humoral theory and the treatment for chronic disease; by chronic disease I mean an illness of some kind. But Presocratic influence extended into other areas of medicine, like acute wound treatment, as well. This is an especially gruesome and interesting area of study. I will outline the steps by which a Hippocratic physician would treat such a wound to show that the Presocratic influence upon Hippocratic medicine was truly pervasive.

One of the most interesting cases is that of the boy who was kicked in the head by a horse.(25) The physician would first examine the wound with a metal probe; a sanitary procedure if the probes were kept clean. He attempts to determine if the impact of the hoof fractured the skull or merely dented it. In order to determine if a fracture exists, he must shave the patient’s head, enlarging the superficial skin wound in the process. He packs this with a concoction made of vinegar and barley flour, and covers the now-gaping wound with a bandage.(26) The next day he removes the wound ointment, and covers the bare skull with a black pasty substance.(27) The third day he scrapes the skull with a knife; the black paste will come off everywhere except from fractures.(28) If the skull is fractured, he will not operate; if the skull is not fractured, he will drill a hole! (29)

The physician drills when there is no apparent need to do so because humoral theory dictates that the blow to the head causes humors to accumulate around the injury. Pus will form if the humors are allowed to accumulate, so the humors need a way out; hence the physician’s decision to drill a hole in the skull. The physician puts his patient on a regimen and treats the open wound with a cathartic, a harsh mustard-seed based cream that is used to draw out the excess humors.(30) Then he sends the patient on his way, quite possibly in worse shape than when he first arrived!

Most sick people would have been better off not visiting the physician who practiced Hippocratic medicine. Yet this physician was a learned and scholarly man who practiced his craft in accordance with the prevailing theory of disease, humoral theory. Humoral theory held that the key to health was the successful balancing of the four humors present in the body. This theory was based upon the philosophical contributions of the Presocratics, who first reasoned that man and nature were of the same ilk and followed the same laws, and then reasoned that because of this similarity, the rules for change in the outside world applied to man as well. When these two themes were interpreted by physicians, the humoral theory was created. We know today that the physician did indeed come into contact with such material, and that some were even skeptical and critical of it. Ultimately the humoral theory was an educated guess about the inner workings of the body which was based upon Presocratic assumptions about natural phenomena.

Goold, ed., Hippocratic Treatises. Cambridge: Harvard University Press,

1984.

Kirk, G.S., Raven, J.E., and Schofield, M., The Presocratic Philosophers.

Cambridge University Press, 1957.

Lloyd, G. E. R., ed. Hippocratic Writings. London: Penguin Books Ltd.,

1983.

Majno, Guido., The Healing Hand: Man and Wound in the Ancient World.

Cambridge: Harvard University Press, 1975.

Phillips, J. H. , "The Hippocratic Physician and Astronomie," Actes du

IVe Colloque International Hippocratique, Lausanne, Switzerland, 1981

(Geneva: 1983).

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