When was Hippocrates?

The doctor​ who first urged his colleagues to ‘do no harm’, and also instructed them, less memorably, to ‘observe all concretions of excreta’, was a pioneering Greek practitioner of the fifth century BCE. We don’t know much about him, not even his name, but the writings he left behind helped lay the foundations of Greek medical science. He was probably a contemporary of Hippocrates, the shadowy figure who was later largely credited with those foundations, or perhaps, as Robin Lane Fox suggests in The Invention of Medicine, may even have been Hippocrates himself, just as the Greeks suspected.

Doctors today speak not only of a Hippocratic oath but a Hippocratic face (distorted by the approach of death), a Hippocratic bench (used for setting broken bones) and a Hippocratic manoeuvre (for popping dislocated arms back into shoulder sockets). Yet the man himself is known only from scattered remarks by Plato and later authors. A vast body of writings goes under his name but, in almost every case, the texts date from a later era. The Hippocratic corpus includes between 51 and 72 prose treatises (depending on which edition you consult) dealing with a welter of topics, some as specialised as fistulas or haemorrhoids, others broader and more theoretical, such as On the Sacred Disease, an attempt to dispel the widespread Greek notion that epilepsy had a uniquely divine origin, or Airs, Waters, Places, a general study of the effects of climate and geography on health.

These two treatises are among a handful of Hippocratic texts that are sometimes assigned to the ‘real’ Hippocrates (which recalls the joke that the Iliad was written either by Homer ‘or another poet of the same name’). The language and style, and some of the patterns of thought, resemble Herodotus, who wrote in the second half of the fifth century BCE. It’s a fair guess that the treatises date to that time, and therefore belong to what has been considered the oldest stratum of the Hippocratic corpus; other texts are clearly much later, some by centuries. The biographical tradition gives Hippocrates a birth date of 460, often with a qualifying ‘circa’. But reliable information is lacking. The work called Horkos (‘oath’), the basis of today’s Hippocratic oaths, is even harder to date, and it’s impossible to confirm the attribution to Hippocrates.

The Invention of Medicine is concerned, in particular, with the person behind Books 1 and 3 of the fifth-century Hippocratic text Epidemics. This person may or may not have been Hippocrates, but he certainly enjoined his fellow doctors to ‘tell what has already come to pass’ to a patient, ‘understand what is happening now, forecast what is to come; take care of these things. And make two things your practice when it comes to diseases: to help or to do no harm.’ The author lays unusual stress on prognosis rather than treatment. The text consists of close observations of symptoms, whether in the general population or in individuals, 42 of whom are profiled in terse case histories. Few treatments are discussed and none is recommended. ‘The physician is acting not qua physician but qua scientist,’ as W.H.S. Jones, the translator of the Loeb edition, put it. ‘He has laid aside the part of healer to be for a time a spectator.’ This echoes Thucydides, who in Book 2 of his History of the Peloponnesian War describes a plague that afflicted Athens in 430 BCE and which he himself contracted. Thucydides begins a close description of the plague’s many manifestations by saying: ‘I will tell how it was, so that if it ever should occur again, someone judging from my account might be best able to gain foreknowledge and not be in the dark.’ Again, the emphasis is on recognition, not remedy.

The Epidemics doctor gives exacting details about his suffering patients, glimpses into the lives of ordinary Greek citizens far beyond those afforded by literary texts. Almost half the reports concern women (most of whom are referred to as ‘the wife of X’ or ‘the daughter of Y’). The wife of Philinus, for instance, is said to have fallen ill two weeks after giving birth, experiencing fever, insomnia and genital pain, which was relieved by the insertion of a pessary. Within a week she had begun to rave at night, but always recovered her reason by morning. Then convulsions set in, followed by twitchings all over her body; lucid intervals ended with a return to delirium. Her urine went from thin and clear to thick and whitish, ‘like the urine of pack animals, as I myself observed’. Seventeen days after the onset of illness she lost the power of speech, and three days later she was dead. The doctor’s toneless account allows us to observe a harrowing month inside Philinus’ home.

The intimacy and particularities of these case studies carry Epidemics beyond simple medical history. Lane Fox draws attention to the case histories that illuminate what is sometimes called ‘the other Greece’, the settlements, far smaller than Athens or Sparta, ignored by ancient writers, who focused on the superpower states. A youth from Meliboea, on the coast of Thessaly, appears several times in The Invention of Medicine; he fell ill ‘after many bouts of drinking and sex’, produced various ill-omened excreta and died, raving mad, after 24 days. His story, Lane Fox writes, ‘is the first surviving glimpse of an individual in Meliboea’, a place otherwise known only from surviving coins – some of which depict the god Dionysus or bunches of grapes.

The records in Epidemics 1 and 3 of people struck down in their prime, of madness, suffering and death (most of the patients don’t recover), would seem to give them much in common with Attic tragedy, another product of fifth-century Greece. But, as Lane Fox observes, the two genres stand apart on matters of causation. We may infer that the young Meliboean’s lifestyle is connected to his illness, but there is no suggestion that Dionysus brought about his downfall, as he does that of Pentheus in Euripides’ Bacchae. Insanity comes and goes unbidden in the Epidemics, not inflicted by vengeful gods as in Sophocles’ Ajax or Euripides’ Heracles. Diseases multiply in step with changes of weather, not because a guilty member of the community has gone unpunished, as at the start of Oedipus Rex. (No one in the Greek world theorised infectious transmission, though Thucydides came close when he noted in his plague account that those who approached the sick themselves became sick.)

The Epidemics doctor no doubt believed in traditional gods – atheism hadn’t yet emerged as a possible mode of thought – but neither he nor his patients appear to regard them as means of cure or causation. We hear nothing of Asclepius or of the practice, attested by countless archaeological finds, of leaving effigies of afflicted body parts at his shrines. The text’s elision of the gods goes beyond even that of On the Sacred Disease, which claims only that epilepsy is no more ‘sacred’ than any other illness, while also affirming that all diseases arise from ‘divine’ phenomena such as changes of temperature and wind direction. ‘All are divine and all are human,’ the author concludes, apparently unwilling to push his thesis too far. The Epidemics doctor, by contrast, never uses the Greek words for ‘divine’, ‘holy’ or ‘god’ (theios, hosios, theos) and employs ‘sacred’ (hieros) only in discussing a girl who became feverish and fell deaf after her first period. She lived ‘by the Sacred Way’ in the town of Abdera.

Such radical rationalism has long been thought to belong to the late fifth century BCE and again to overlap closely with Thucydides, who expunged from his historical narrative (and especially from his description of the plague) all notions of divine intervention. Other evidence, too, has led scholars to situate the Epidemics author in the same decades as the atomic theories of Democritus and the rise of the sophists. Lane Fox, however, is determined to challenge these assumptions, and builds a case for shifting the date of the Epidemics doctor some six decades earlier. Such a move has huge implications. If accepted, it would support the grand claim implied by Lane Fox’s title: that we can pinpoint the emergence of scientific medical practice and credit it to the Epidemics doctor.

Lane Fox’s argument leads us to Thasos, once a wealthy and populous island state in the north Aegean. The Epidemics doctor conducted most of his research there or in places nearby, and his text contains many incidental details about the region and its ailing inhabitants. Scholars have long tried to match these details with the history and prosopography of Thasos, known either through ancient historical writings, which document the island’s two rebellions from (and forced returns to) the Athenian naval empire, or through modern excavations. The data from this second source are extensive, since French researchers have been digging on Thasos for more than a century and have published many of their finds, including a vast corpus of stone inscriptions. Perhaps no other ancient Greek city except Athens is so well documented.

The inscriptional evidence includes a fairly intact set of stone slabs listing Thasians who held political office. Lacking numbers for years, the Greeks relied on records of magistracies or of victors in past Olympic games to establish chronology. The Athenian magistrate lists are very useful, since we usually know the modern calendrical year that a given archon held office. But we have no such certainty regarding Thasos. French scholars have tried to establish a correlation, but Lane Fox argues that their estimates are half a century too late. This is important to him because some of the people observed by the Epidemics doctor may also be named in the magistrate list. One Antiphon, for example, is identified in both the doctor’s narrative and the inscribed list as ‘son of Critobulus’ (such patronymics are as close as the Greeks came to modern surnames). The name Critobulus is rare enough that the two Antiphons may well be the same person, or perhaps, since male names were often passed down in families but skipped a generation, grandfather and grandson. Lane Fox’s back-dating of the list of magistrates thus also back-dates the Epidemics doctor but, should his arguments be challenged or refuted by future finds, he argues that ‘Antiphon the patient’ would then be ‘the grandfather of Antiphon the magistrate’ and so ‘the central argument of this book still stands.’

Lane Fox tries a number of ways to close the two-generation gap between the consensus date for the Epidemics doctor and his own. The doctor speaks occasionally of visiting patients ‘beside the new wall’: at the behest of imperial powers, the Thasians pulled down portions of their wall on three occasions in the fifth century; each time, it was rebuilt once conditions stabilised. Ever since Galen’s commentaries on Epidemics 1 and 3 in the second century CE, the term ‘new wall’ has been attached to one or another of these rebuildings. Modern scholars, presuming that the doctor lived in Thucydides’ time, have settled on the rebuilding done soon after 413; Lane Fox prefers the one c.470.

Disputes over the dates of anonymous ancient texts may seem recondite, but Lane Fox leads us down intriguing paths of epigraphy, political history, philology and archaeology. Divagations along the way introduce us to Thasians such as Theogenes, an all-star athlete whose son, Disolympios, is named in the magistrate lists. Theogenes, as we know from other sources, won contests in both boxing and pankration, a type of extreme fighting, in the Olympic games of 480 and 476, making him the first ever victor in more than one Olympic event. He advertised the feat by naming his son ‘Double Olympian’. Lane Fox again shifts the list back in time, placing Disolympios’ birth soon after 476, far earlier than others have dated it.

Not all Lane Fox’s arguments would hold up to rigorous scrutiny. We can’t, after all, know when Theogenes fathered Disolympios, even if it’s appealing to think he did so right after his great Olympic feat (‘perhaps after the sexual abstinence which competing athletes sometimes observed,’ Lane Fox throws in for good measure). Similarly, we can’t know whether there were two Antiphons two generations apart, each with a father named Critobulus, and even if we could, we’d have no clue as to which of them was named on the magistrate list. Lane Fox’s tone sometimes takes on the stridency of special pleading, even when the evidence is reasonably firm, and he has a habit of introducing speculative suggestions, then later restating them as something more substantial. Early on, for example, he proposes that the Epidemics doctor, properly restored to an early fifth-century context, may be the authentic Hippocrates, though he concedes there’s little to support the assertion. By his final chapter he refers to the man as ‘Hippocrates (if he is indeed the doctor-author)’, then twice awards him the name without qualification.

Lane Fox does at several points make clear, however, the scope of what is revealed if we grant his re-dating scheme. Epidemics 1 and 3 – originally a single treatise, divided in two by later scribes – becomes ‘the earliest datable example of a medical text for practitioners and students … It even becomes the first Greek prose text which survives in full.’ With its observational approach, Epidemics throws into confusion our assumptions about when Greek rationalism parted ways with archaic modes of thought, and also undermines the commonly held notion that rationalism only flourished under democracy (Thasos was at that time governed by oligarchs). Where others have assumed that the Epidemics doctor learned from Thucydides, Lane Fox suggests that perhaps it was the other way round. Thucydides may have learned from Epidemics 1 and 3 the way to describe a sudden illness without reference to the gods, to chart its progress and its symptoms, relate it to climatic and seasonal factors, and prepare future readers for what they might expect under similar circumstances. If Lane Fox is right, it was the Epidemics doctor who first created, as Thucydides claimed to have done, ‘a possession for all time’.