On the Holy Sickness, thymus, aer, and phrenes

[Paul Derouda]

I read the Hippocrates' On the Holy Disease the other day, and something reminded of an old discussion about the meaning of the word φρενες in Homer (either "lungs" or, more traditionally, "diaphragm"). Personally, I think that the scholar Richard Janko was right: when φρενες has an anatomical sense, it's best translated "lungs" - but most often it has an abstract sense as the seat of intellect/emotions, like "heart" in English. I argued that the line Od. 5.458 ἀλλ᾽ ὅτε δή ῥ᾽ ἄμπνυτο καὶ ἐς φρένα θυμὸς ἀγέρθη proves this very concretely; I'd translate this "but when he'd caught his breath and breath/air had was gathered in his lungs".

Now there's no doubt that φρενες means "diaphragm" in Hippocrates. The text is very intelligent and contains many acute observations on the normal and abnormal functioning of the brain, especially epilepsy - and, what's most important, the actual observation that the brain is behind all this. However, since the text was written something like 400 BC, there are some misconceptions - some of which Hippocrates shares with Homer. One of them is what breathing air does to us: both basically think that air is a vital substance that provides us with intellect - Homer calls it θυμος, Hippocrates αηρ.

This is the earlier post: http://www.textkit.com/greek-latin-foru ... 22&t=63041

On the Holy Disease, section 16:

κατὰ ταῦτα νομίζω τὸν ἐγκέφαλον δύναμιν πλείστην ἔχειν ἐν τῷ ἀνθρώπῳ: οὗτος γὰρ ἡμῖν ἐστι τῶν ἀπὸ τοῦ ἠέρος γινομένων ἑρμηνεὺς, ἢν ὑγιαίνων τυγχάνῃ: τὴν δὲ φρόνησιν αὐτῷ ὁ ἀὴρ παρέχεται.
οἱ δὲ ὀφθαλμοὶ καὶ τὰ οὔατα καὶ ἡ γλῶσσα καὶ αἱ χεῖρες καὶ οἱ πόδες οἷα ἂν ὁ ἐγκέφαλος γινώσκῃ, τοιαῦτα πρήσσουσι: γίνεται γὰρ παντὶ τῷ σώματι τῆς φρονήσιος, ὡς ἂν μετέχῃ τοῦ ἠέρος.

ἐς δὲ. τὴν ξύνεσιν ὁ ἐγκέφαλός ἐστιν ὁ διαγγέλλων: ὁκόταν γὰρ σπάσῃ τὸ πνεῦμα ὥνθρωπος ἐς ἑωυτὸν, ἐς τὸν ἐγκέφαλον πρῶτον ἀφικνέεται, καὶ οὕτως ἐς τὸ λοιπὸν σῶμα σκίδναται ὁ ἀὴρ, καταλιπὼν ἐν τῷ ἐγκεφάλῳ ἑωυτοῦ τὴν ἀκμὴν καὶ ὅ τι ἂν ἔῃ φρόνιμόν τε καὶ γνώμην ἔχον: εἰ γὰρ ἐς τὸ σῶμα πρῶτον ἀφικνέετο καὶ ὕστερον ἐς τὸν ἐγκέφαλον, ἐν τῇσι σαρξὶ καὶ ἐν τῇσι φλεψὶ καταλελοιπὼς τὴν

διάγνωσιν ἐς τὸν ἐγκέφαλον ἂν ἴοι θερμὸς ἐὼν καὶ οὐχὶ ἀκραιφνὴς, ἀλλ᾽ ἐπιμεμιγμένος τῇ ἰκμάδι τῆ ἀπὸ τῶν σαρκῶν καὶ τοῦ αἵματος, ὥστε μηκέτι εἶναι ἀκριβής.

In these ways I am of the opinion that the brain exercises the greatest power in the man. This is the interpreter to us of those things which emanate from the air, when it (the brain) happens to be in a sound state. But the air supplies sense to it. And the eyes, the ears, the tongue and the feet, administer such things as the brain cogitates. For in as much as it is supplied with air, does it impart sense to the body. It is the brain which is the messenger to the understanding. For when the man draws the breath (pneuma) into himself, it passes first to the brain, and thus the air is distributed to the rest of the body, leaving in the brain its acme, and whatever has sense and understanding. For if it passed first to the body and last to the brain, then having left in the flesh and veins the judgment, when it reached the brain it would be hot, and not at all pure, but mixed with the humidity from flesh and blood, so as to be no longer pure.

[RandyGibbons]

I read the Hippocrates' On the Holy Disease the other day

Hi Paul. I happen to be reading the same right now, so I'm delighted to have company. The only difference is that what you can apparently do in a day is taking me weeks .

What edition are you reading? (Because you cite as section 16 the text you quote, I guess it's not the Jones/Loeb?) Possibly the 2003 Jouanna/Budé, which is the edition I'm reading? I'm going through it slowly, every footnote included, and I'm only up to section 7 right now.

Since I haven't gotten to the discourse on the brain at the work's end yet, your (and Jouanna's) section 16 and the following section in which the author discusses the alternative theories of the φρένες or the καρδίη as the seat of thought, I can't comment on the what-body-part-is-the-φρένες-in-Homer issue (man, that was an exhausting thread you linked to!). But in case it is not the Budé you are using, I draw your attention to

• + Jouanna's note (p. 123, note 3) on the continuity from Homer to Attic tragedy of the notion of the φρένες as the seat of thought, the traces of this concept in the Hippocratic corpus, and on this particular Hippocratic author's interesting critique (section 17) of his fellow Greeks' notion of the etymological and semantic relation between φρήν and φρονεῖν
  + and to Jouanna's full discussion in section IV of his Introduction (kicked off with this excerpt from Socrates' recollection in the Phaedo 96b of the intellectual issues that consumed him in his youth: καὶ πότερον τὸ αἷμά ἐστιν ᾧ φρονοῦμεν, ἢ ὁ ἀὴρ ἢ τὸ πῦρ; ἢ τούτων μὲν οὐδέν, ὁ δ’ ἐγκέφαλός ἐστιν ὁ τὰς αἰσθήσεις παρέχων τοῦ ἀκούειν καὶ ὁρᾶν καὶ ὀσφραίνεσθαι, ἐκ τούτων δὲ γίγνοιτο μνήμη καὶ δόξα, ἐκ δὲ μνήμης καὶ δόξης λαβούσης τὸ ἠρεμεῖν, κατὰ ταῦτα γίγνεσθαι ἐπιστήμην;).

Speaking of this early and fascinating rational-rather-than-sacred dissection (so to speak) of a disease (epilepsy), did you happen to get to the plague yet in your Thucydides project?

Randy

[Paul Derouda]

I read the text very quickly and rather casually without any commentary a couple of weeks ago. I used the Loeb edition, because I happened to find it on the web. And yes, I did it during a single evening, although I confess I partly skimmed through the part about blood heating and cooling, because it didn't interest me. For this post, I copy-pasted what I found on Perseus, it's not the text I read. But I found the text so interesting that I actually borrowed Jouanna's edition from the library a couple of days ago; I haven't read a single page yet.

I read the text mostly to see how much Hippocrates had gotten right about epilepsy. EEG interpretation is part of my job, so I have a sort of professional interest in the topic... The parts (like blood heating and cooling) where H. didn't have a clue were not so interesting, so I skimmed them through - but they were in minority. I'd say that as far as his observations concering symptoms are concerned, they are largely correct; it's the explanations that are flawed. For instance, H. notes that hyperventilation (children crying) provokes seizures. Hyperventilation is routinely used today in EEG testing to diagnose certain epilepsies. And this is just one observation, there are many more, many of which are better known and can be read about on Wikipedia etc.

φρένες seems to have a different meaning in Homer and Hippocrates. In Homer, I think it means "entrails contained in the thoracic cavity" (probably excluding the heart); this is almost same as "lungs" but other parts such as the diaphragm might be included as well. In Hippocrates, it's a more scientific terms that means "diaphragm"; my guess is that at some stage, the application of a rather vague (poetic?) word was given a more definite meaning for the purpose of theoretic anatomical discussion.

My Thucydides reading project has completely stalled for the present. No plague yet.

[RandyGibbons]

I'd say that as far as his observations concerning symptoms are concerned, they are largely correct; it's the explanations that are flawed.

It would be pretty amazing if this were not the case!

For those who aren't familiar with this work but might be interested in it, it breaks down into three parts:

1. A detailed polemic (section 1 in the Budé = sections 1-4 in the Loeb) against those physicians who regard and treat epilepsy as a "sacred disease". ("Epilepsy" in this work and at the time of this writing - as Paul says, probably around 400 BCE - didn't mean exclusively epilepsy as we know it today, but it's close enough that we can call the "sacred disease" epilepsy without being misleading.) It begins: Περὶ τῆς ίερῆς νούσου καλεομένης ὧδ᾿ ἔχει. οὐδέν τί μοι δοκεῖ τῶν ἄλλων θειοτέρη εἶναι νούσων οὐδὲ ἱερωτέρη, ἀλλὰ φύσιν μὲν ἔχει καὶ πρόφασιν, οἱ δ᾿ ἄνθρωποι ἐνόμισαν θεῖόν τι πρῆγμα εἶναι ὑπὸ ἀπειρίης καὶ θαυμασιότητος, ὅτι οὐδὲν ἔοικεν ἑτέροισι· I don't know about you, but that definitely got my attention. It levels specific, bitter charges against the μάγοι, the καθάρται, the ἀγύρται, the ἀλαζόνες claiming special knowledge about the alleged sacred nature of this disease and how to treat it. Who are these μάγοι, καθάρται, ἀγύρται, and ἀλαζόνες? This part is a major source on the intersection of medicine and magic in the Greek world of the time.
2. "La partie positive." The author's own, rational explanation of the symptoms and the cause of the disease (Budé sections 3-13, Loeb 5-16). A very detailed anatomy, physiology, and pathology that some will find interesting and some, like Paul and I (though I don't have Paul's background for this), will want to compare to what we know today.
3. The part Paul is quoting from, a parenthetical eulogy (as it's been called) on the brain (and not, the author argues, the φρένες or the καρδίη) as the seat of human affection and intellect - an excursus some found foreign to the rest of the work (e.g., Wilamowitz, 1901, but as far as I can tell not followed by any other editor). Jouanna: "Cette parenthèse est d'un grand intêrét pour l'histoire des idées biologiques. C'est la premiere fois que la pensée est explicitement située dans le cerveau, et non dans le diaphragme ou le cœur."

I find the work fascinating as a whole, but any of these three parts can really be read independently depending on your interests.

[Paul Derouda]

I'd say that as far as his observations concerning symptoms are concerned, they are largely correct; it's the explanations that are flawed.

It would be pretty amazing if this were not the case!

I didn't mean just an obvious description of symptoms, but causal relationships. For example, hyperventilation, as I mentioned above, or noting that goats with epilepsy have abnormal brains on autopsy (I'm not a veterinary, so have no idea what the disease might have been). It's also interesting how Hippocrates tries to find an explanation for diffent observations concerning neurological diseases - like the fact that they are often lateralized. The explanations are not correct, but I think he deserves credit for asking the right questions.

Hippocrates wasn't the only one who questioned the idea that epilepsy is a "holy" disease - Herodotus, who wasn't a medical writer, does it as well (Hdt 3.33). It must have been an idea current among Ionian intellectuals.

[RandyGibbons]

Thanks for that very à propos Herodotus citation. But question: What is your reason for saying Herodotus himself is skeptical about the sacred character of the disease? Is it because he says "which certain ones call sacred" (καὶ γὰρ τινὰ ἐκ γενεῆς νοῦσον μεγάλην λέγεται ἔχειν ὁ Καμβύσης, τὴν ἱρὴν ὀνομάζουσι τινές)?

In his introduction (XXII ff.), Jouanna discusses the history of the name "sacred disease" (and the common qualifier in the Hippocratic Corpus "sacred disease so-called") and "epilepsy". In the fifth century "sacred disease" was a specialist term among doctors, he says. And the τινές in Herodotus are probably these Hippocratic doctor-writers. So is Herodotus simply channeling these physicians, implicitly perhaps including their skepticism, or expressing his own opinion? If you have a chance to read these couple pages in Jouanna's intro, please let me know what you think.

In footnote 32 (XXIII), Jouanna references a book by Rosalind Thomas, Herodotus in Context: Ethnography, Science and the Art of Persuasion (2000), without describing her opinion on the subject. I can see from the Google Books preview that she has a section on 'Herodotus and Medicine' but - the gods be damned! - my preview cuts off right at the two pages (34-35) on Cambyses. Again if you or anyone else happens to have her book, I'd like to know what she has to say.

[Paul Derouda]

Herodotus: τὴν ἱρὴν ὀνομάζουσι τινές seems skeptical to me, even if does leave some ambiguity. It seems to me that it's with phrases of this kind that Herodotus usually expresses skepticism. Besides, the text goes on οὔ νύν τοι ἀεικὲς οὐδὲν ἦν τοῦ σώματος νοῦσον μεγάλην νοσέοντος μηδὲ τὰς φρένας ὑγιαίνειν - the so-called sacred disease is clearly called a disease of the body (σῶμα), not some kind of possession.

Let's see if I manage to read Jouanna!