Ancient Medicine, Future Bodies

Calloway Scott // I want to make a case for looking back to the Corpus Hippocraticum—the Hippocratic Corpus—as a valuable site for thinking about the medical humanities and its future. The 60 odd medical treatises which make up the Corpus are really the works of many hands working at different times and places over the course of the 5th and 4th centuries BCE (it’s likely some were written still later). As early as the 3rd century BCE the Alexandrian librarians were assembling various “Hippocratic Corpora” and over the ensuing centuries individual texts would slip in and out of these compilations. In fact, the Corpus only settled into something like its current, canonical form at the Aldine press in Venice in 1526. Its various writers held different theories about the nature of health, illness, and the body and they wrote for different publics with different agendas. While his contemporaries Aristophanes and Plato ensure for us that such a historical person in fact existed, we have no direct evidence for Hippocrates’ theoretical or therapeutic inclinations. This means we will almost assuredly never know which of the surviving writings—if any—were authentic works of the so-called “father of medicine,” including his eponymous “Oath.”

The problem of “authenticity” was an issue that vexed medical scholars from antiquity until the 20th century. Over the last several decades, however, classicists and historians of medicine have generally granted that attempts to identify the “true” works of Hippocrates simply reflect what individuals—from Aristotle and Galen on—thought best said or done in ancient medical writings, or, more cynically, whatever furnished authoritative precedents for pet theories. The quest to identify the “real” works has been abandoned and the texts of the Corpus have been opened up to new questions and directions. Scholars look now to the literary, intellectual, and socio-cultural conditions of these texts’ production and interrelation, as well as to the role they may have played in paving the way for new ethics (and politics) of self-care (Holmes 2010). These fresh perspectives suggest some points of contact between ancient and modern medical practice and thought, a couple of which I want to focus on for their implications for the medical humanities.

In the first place, a large number of these texts share a concern for defining medicine as an art or science (techne) with a method, and defending the knowledgeable physician as the only legitimate authority over the care of the body. The cornerstone of this methodological legitimacy was an articulation of universally valid systems of material causes and effects (here we can see that ancient medicine was tangled up with ancient physics and metaphysics early on). Indeed, the philosopher Anaxagoras’ dictum, “the phenomenal makes visible what is invisible,” became the methodological slogan of this new empirical medicine, as it put to work analogies taken from the perceptible world to gain insight into the hidden workings of the body. These authors thus hypothesized links between the symptoms and signs erupting on the exterior of the body from which knowledge could be gleaned about the mysterious processes of disease as they unfolded within it.

As a result, the Hippocratic practitioner increasingly came to see the patient as an ensemble of bodily signs over which he wielded technical mastery. Indeed, a number of these texts make the suppression of the patient’s voice and the narration of their bodily experience an important aspect of a physician’s rhetoric of expertise. For instance, the author of the text Prognosis begins his treatise with a recommendation to “declare unaided the past, the present, and the future of the disease.” That is, the physician ought to avoid asking the patient questions in order to impress his potential clientele by his diagnostic prowess.  As Webster (2015) shows, still other texts developed interrogative strategies meant to further reduce the patient’s participation by limiting questions concerning the patient’s history to simple a simple “yes or no” format (“Were your stools hard? Did you vomit bile?”). Still other texts go further, evaluating and testing the patient’s voice like other bodily excreta like vomit and spittle, shit and piss, as a kind of “sonic effluvia.” Rufus of Ephesus, writing in the first century of our era, stands out as a telling exception in his recommendation that the physician ought to politely and thoroughly enquire about the patient’s suffering. In short, the Hippocratic practitioner dismissed patients’ subjective accounts of their bodily suffering (and the meanings attached to it) tending instead to treat the body as a passive object to be penetrated and scrutinized by his learned gaze.

I don’t want to belabor the commonalities shared between this characterization of the Hippocratic practitioner and the most negative stereotypes of modern doctors, but there are clear and useful lessons to be had here for physicians interested in more meaningful interactions with their patients. More than this, however, in a recent post, Roanne Kantor tugged at some of the paradoxical snarls of the “utility of empathy” when teaching literature with an eye to the medical humanities. Her essay gave elegant voice to a creeping worry that my teaching and thinking about the history of medicine was too narrowly oriented to growing empathic awareness in a future generation of physicians. I began to worry about my own acts of reductionism, boiling down Hippocratic texts down to warnings about present behaviors and the cultures and institutions which, knowingly or not, encourage them.

I still believe this historical comparison is a valuable one. But I think we can also see beyond it to further aspects of these texts that might appeal to the medical humanist. The Hippocratic body resists narratives of individuality and autonomy (even as the Hippocratic authors formulated ethical technologies for its control). The very strands of causality the physician professed authoritative knowledge about implicated the body into the environment in profound ways. Take a programmatic passage from the author of Regimen 1:

[It is necessary that the physician know] also the seasons of the year and the changing of the winds; he must know the situation of the country in which patients reside, as well as its weather that year. It is essential that he be familiar with the risings and settings of the stars, that he might know how to guard against changes or extremities in food, drink, winds, and in short, the whole of the cosmos from which matters all ailments arise for humankind.

For the author of this text and others like it, the cosmos and body are tightly knit together in a web of sympathy because they are essentially composed of the same matter and subject to the same forces. Here the body waltzes with its world: unseasonable storms precipitate waterlogged bodies and leaky diseases; sudden droughts parch and blast it with fever. In reading the texts of the Hippocratic Corpus, it can be difficult to know where the embodied self ends and the wider world begins as both are shuffled into an overarching, cosmic ecology.

The requirement of the Hippocratic physician was to know the nature of this ecology, and the task he set himself was to keep bodies in harmony with it. In the time of the Anthropocene, the call for sympathy between bodies and environments is ever more urgent. It makes clearer the entanglement of human health and the environment—cultural and physical—in ways that erode the myth that we are somehow siloed from a world of our own creation. The antique vision of a porous and permeable body, caught between and shaped by factors internal and external, offers a timely reminder that there exist, have always existed, alternative ways of imagining the embodied self in the world. Indeed, it even chimes with new perspectives on organismic integrity and subjectivity offered by a growing literature on the microbiome and holobionts. Now, I’m not trying to make a positivist claim that Greek medicine seeded the ground for contemporary medical practice much less innovations in microbiology. What I do think is that these texts can help to attune us to historical rhymes between the past and present that help us to think the human future.

Works:

Holmes, B. 2010. The Symptom and the Subject: the Emergence of the Physical Body in Classical Greece. Princeton.

Webster, C. 2015. “Voice Pathologies and the ‘Hippocratic Triangle.’”  In Petridou, G., and C.  Thumiger, eds. 2015. Homo Patiens: Approaches to the Patient in the Ancient World. Leiden: 166–201.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s