Вы находитесь на странице: 1из 19

HIPPOCRATIC EXPLANATIONS

Jane Barton

Summary

This paper considers VM’s largely unrecognised contribution to a debate which


spanned philosophy and medicine concerning the demands an adequate explana-
tion must meet in the operation of a craft. VM’s special contribution consists
in indicating a means to an understanding of a mutual interdependence of the-
ory and practice which acknowledges the strengths of a theoretical explanatory
framework, but also recognises that practical success should inform that theory.

In this paper, I shall consider some of the most developed views of


what demands must be met by an explanation of what health, dis-
ease and the operation of the medical craft are within the Hippocratic
Corpus, concentrating on the work On Ancient Medicine (Per‹ érxa¤hw
fihtrik∞w, De vetere medicina, VM ). The purpose of this investigation is
to bring to light some of the explanatory problems which would
have faced philosophers who sought to provide a coherent theory of
the nature of medical science, and to highlight the difficulties faced
by the Hippocratics in answering one of the challenges posed by
philosophers. The particular challenge with which I am concerned
focuses on the search for an adequate explanation: how an adequate
explanation would be structured, and, further, how an adequate
explanation would be recognised as such.
The philosophical challenge, as it emerged from the works of
Presocratics such as Empedocles, was based on Presocratic frame-
works of explanation.1 Empedocles’ explanatory framework was seen

1
Those belonging to the Empedoclean school of medicine seem to have made
the four chief elements, earth, air, fire and water, as the basic constituents of the
cosmos, also the basic constituents of disease: disease was the excess of one of these
constituents (see Menon’s account of Philiston (Anon. Lond. XX), cf. Plato, Timaeus
86 a). For the opposing and widespread acceptance of a four humour theory see,
e.g., Nature of Man 3–5 (pp. 170,8–176,9 Jouanna; 6.36,17–42,8 L.); cf. Sacred Disease
16 (6.390,10–392,3, 394,9–396,9 L.).
30 jane barton

as reductive by the author of VM in that any phenomenon could


be reduced to, and so exhaustively explained by, the fundamental
physical elements of earth, air, fire and water (or these elements
expressed through their qualities of the hot or cold or wet or dry).2
A reductive explanatory scheme is attractive in that it appears to
offer a complete understanding of all phenomena: when such analy-
sis has been completed at the level of elements and their combina-
tion, the structure of all nature is taken to be exposed. Such analysis
and understanding would encompass health and disease as much as
any other area of phusis. It thus is a necessary condition for a full
understanding of all subject matters and all phenomena.
In the particular case of medicine, a reductive explanatory scheme
offers the possibility of total control over the maintenance of health
and the eradication of disease, on the assumption that all matters
can be controlled in practice.3 Even if a reductive explanatory scheme
were obtained, however, it is a further matter to know how actu-
ally to achieve that control. VM makes this abundantly clear when it
asks: what should be prescribed for someone suffering as a result of
a poor diet: hot or cold or dry or wet?4 The response of the prac-

2
That the explanations of Empedocles himself were not reductive, or elimini-
tivist (for the latter claim see Sauve Meyer (1992) 791–825), is shown by Empedocles
as preserved in the Strasbourg Papyrus, ensembles a (esp. a(ii) 17) and d, with DK
B 17, which emphasise not only the importance of the powers of Love and Strife
for the different combinations of the elements in the creation and destruction of
the cosmos, but also the central, if obscure, role of the daimones in that process (see
also Martin and Primavesi (1998) 61–64, 83–86, 90–95, 283–284).
3
In itself, a reductive explanatory scheme does not offer the possibility that all
diseases are curable in theory, as it could expose the incurable nature of a disease.
Although not reductionist, the possibility of such total control is the position adopted
by On the Art 11 (per‹ t°xnhw, de Arte), in which all diseases are seen as in theory
curable, and the ability to achieve that level of cure is limited only by the evidence
available to the practitioner, and the point in the development of the disease at
which he becomes acquainted with the case (De arte 11.1, p. 237,7–9 Jouanna;
6.18,17–20,1 L.).
4
VM 13.2 (p. 133,19–134,1 Jouanna; 1.598,13–14 L.): t¤ de› toigaroËn boÆyhma
paraskeuãsasyai œdÉ ¶xont‹ yermÚn, μ cuxrÚn, μ jhrÚn, μ ÍgrÒn; cf. VM 15.1
(p. 137,15–17 Jouanna; 1.604,14–16 L.): oÈ gãr §stin aÈt°oisin, …w §gΔ o‰mai,
§jeurhm°non aÈtÒ ti §fÉ •vutoË yermÚn, μ cuxrÚn, μ jhrÚn, μ ÍgrÚn, mhden‹ êllƒ
e‡dei koinvn°on. “No-one has discovered absolute hot, cold, wet or dry, rather all
is compounded, and so such absolutes are of no use in medical treatment.” These
absolutes are clearly the postulated ontological absolutes of the opponents of VM,
and are not “used . . . in their ordinary sense (it feels hot)” as Hankinson (1998, 67;
1990, 64) suggests as a possible interpretation of VM 15.1. All texts reproduced are
those of Littré, unless otherwise stated. All translations are my own.
hippocratic explanations 31

titioner is that the explanation of the reductionist philosopher is of


no use in treatment or diagnosis. Further, such explanations rest on
mere postulates. That nature is composed of such elements is no
more than a proposed answer, and any such proposed or postulated
answer should be rejected:
ıkÒsoi §pexe¤rhsan per‹ fihtrik∞w l°gein μ grãfein, ÍpÒyesin sf¤sin
aÈt°oisin Ípoy°menoi t“ lÒgƒ, yermÚn, μ cuxrÚn, μ ÍgrÚn, μ jhrÚn, μ
êllÉ ˜ ti ín §y°lvsin, §w braxÁ êgontew tØn érxØn t∞w afit¤hw to›sin
ényr≈poisi t«n noÊsvn te ka‹ toË yanãtou, ka‹ pçsi tØn aÈt°hn, ©n μ
dÊo proy°menoi, §n pollo›si m¢n ka‹ oÂsi l°gousi katafan°ew efis‹n
èmartãnontew: mãlista d¢ êjion m°mcasyai, ˜ti émf‹ t°xnhw §oÊshw, √
xr°onta¤ te pãntew §p‹ to›si meg¤stoisi ka‹ tim«si mãlista toÁw égayoÁw
xeirot°xnaw ka‹ dhmiourgoÊw. efis‹ d¢ dhmiourgo‹, ofl m¢n flaËroi, ofl d¢
pollÚn diaf°rontew: ˜per, efi mØ ∑n fihtrikØ ˜lvw, mhdÉ §n aÈt°˙ ¶skepto,
mhdÉ eÏroito mhd¢n, oÈk ín ∑n, éllå pãntew ín ımo¤vw aÈt°hw êpeiro¤
te ka‹ énepistÆmonew ∑san, ka‹ tÊx˙ ín pãnta tå t«n kamnÒntvn diƒk°eto.
nËn dÉ oÈx oÏtvw ¶xei, éllÉ Àsper ka‹ t«n êllvn texn°vn pas°vn ofl
dhmiourgo‹ pollÚn éllÆlvn diaf°rousi katå xe›ra ka‹ katå gn≈mhn,
oÏtv dØ ka‹ §p‹ fihtrik∞w. diÚ oÈk ±j¤oun ¶gvge ken∞w aÈt°hn Ípoy°siow
d°esyai, Àsper tå éfan°a te ka‹ époreÒmena: per‹ œn énãgkh, ≥n tiw
§pixeiro¤h l°gein, Ípoy°sei xr°esyai: oÂon per‹ t«n mete≈rvn μ t«n ÍpÚ
g∞n efi l°goi tiw ka‹ gin≈skoi …w ¶xei, oÎtÉ ín aÈt°ƒ t“ l°gonti oÎte
to›sin ékoÊousi d∞la ín e‡h, e‡ te élhy°a §st‹n e‡te mÆ: oÈ går ¶sti
prÚw ˜ ti xrØ §panen°gkanta efid°nai tÚ saf°w.
VM 1.1–3 (pp. 118,1–119,11 Jouanna; 1.570,1–572,8 L.)

All who attempt to speak or write about medical matters posit their
own hypothetical postulate for their argument, hot or cold or wet or
dry, or whatever else they wish to adopt, reducing the first principle
of the cause of diseases and death to mankind, and this is the same
in all cases, as they propose one or two postulates, and in many things
they say5 they are clearly mistaken; but they are most open to blame
concerning a craft that exists, which all use in connection with the
most important circumstances, and they especially honour good crafts-
men and practitioners. Some practitioners are poor, others outstand-
ing; which would not be the case at all, if there were, in general, no
medical science,6 nor if there had been no inquiry into it, nor if nothing

5
ka‹ A M, Jouanna, Jones, L.: kaino›si Kühlewein after Schöne “in their new
theories’“ see Jouanna note ad loc. for a discussion of these and further possible
(minor) emendations.
6
It is not clear whether efi mØ ∑n fihtrikØ ˜lvw at VM 1 (p. 118,11–12 Jouanna;
1.570,10 L.) refers to (the existence of ) a medical science at all or to a universal
science of medicine: I have tried to keep the translation as neutral as possible
between these alternatives. The resolution of this issue is tied to a textual matter:
32 jane barton

had been discovered, but all would be equally inexperienced and with-
out knowledge, and all treatment of the sick would be by chance. But
now this is not the case, but just like all the other crafts, so in the
case of medicine, practitioners differ a great deal from one another in
dexterity and understanding. The result is that I myself do not think
there is any need of any empty7 postulate, as is the case with not vis-
ible and mysterious issues, about which it is necessary, if anyone tries
to give an account, that they make use of a postulate; as for instance,
concerning matters in the sky or below the earth, if anyone were to
give an account and understand how these things are, it would not
be apparent either to the speaker himself or his listeners whether what
he said was true or false; for there is nothing by reference to which
it is necessary that one would know clearly.
VM is questioning the basis upon which medical understanding should
be founded: should that basis be a hypothetical postulate or postu-
lates, such as the hot, the cold, the wet and the dry, and if not,
what? But before those questions can be examined, it is necessary
to consider the use of the term hupothesis, ÍpÒyesiw in this work.8 It

VM 2.2 (p. 120,1–2 Jouanna; 1.572,15–16 L.): §gΔ peirÆsomai §pide›jai, l°gvn ka‹
deiknÁw tØn t°xnhn ˜ ti §st¤n. ˜ti §st¤n: A, Jouanna; “that the science exists”: ˜
ti §st¤n: M, Jones, L.; “what it is”. To follow MS. A is to set the agenda of VM
as primarily concerned with establishing the existence of medicine as a technê. To fol-
low MS. M sets the agenda of VM as primarily concerned with what sort or type
of technê medicine is. The reading of MS. A pursues a justification of medicine as
worthy of craft-status, as does De arte, although VM employs different arguments to
that treatise, for instance that lack of precision is permissible within the operation
of a technê. The reading of MS. M is preferable as it takes the existence of the med-
ical technê to be established by VM 1.1–2 (pp. 118,7–119,4 Jouanna; 1.570,6–572,2
L.), and then continues to explain what type of technê medicine is, specifically exam-
ining what level of precision the medical technê properly displays (VM 9.3, pp. 128,
9–17 Jouanna; 1.588,13–590,4 L.; VM 12; pp. 132,18 ff.; 1.596.8 ff. L.). The read-
ing of MS. M is also supported by the parallel with VM 20.1 which addresses the
question whether anyone can know medicine who does not know ˜ t¤ §stin ênyrvpow
(pp. 146,2 Jouanna; 1.620,11 L.).
7
ken∞w M, Jones, L.: kain∞w A, Jouanna; “a new postulate”. The reading of MS.
M here, and of MSS. A and M as set out in n. 7 above, is to be preferred as it
is not the novelty of any postulate employed in such theories with which the author
disagrees, but that the theory is grounded by postulate(s). See Jouanna note ad loc.
8
ÍpÒyesiw is found only once outside VM in the Hippocratic Corpus, in the last
chapter of the probably contemporary On Breaths (per‹ fus«n, De flatibus, Flat.), 15.2
(p. 125,1 Jouanna; 6.114,18 L.), and, coming at the end of the treatise, it points
to the main theory of the work (that air is the fundamental constituent of the world,
and so also the primary cause of health and disease). The use of this term to refer
to the positive theory of the author clearly contrasts with the use of the term in
VM, where it is reserved for the postulated first principles of his opponents (as noted
by Lloyd, 1963, 110 n. 2). For textual issues (ÍpÒyesiw M L.: ÍpÒsxesiw A), see
Jouanna (1988) 150–1. On the date of On Breaths, see Jouanna (1999) 378. Ípoy°syai,
however, is found in Vict. 1.2 (6.470,22 L.), Carn. 1.3 (p. 188,3 Joly; 8.584,3 L.),
hippocratic explanations 33

is clear that the author of VM is concerned with postulated assump-


tions of some sort, as is clear in his reference to the hot, cold, wet
and dry derived from philosophy, but his are physical, not mathe-
matical, postulates.9 The adoption, however, of the term hupothesis
may have been influenced by the mathematical use of hupothesis.10
What we know from the text of VM is that the term is used of the
theory of his opponents, the hupothesis is introduced by them in order
to make an inference to a conclusion and the hupothesis itself is not
apparent or self-evident (oÎtÉ ín . . . d∞la ín e‡h). This echoes Karas-
manis’ claim about hupothesis in Plato that, “Platonic Definitions defined
a hupothesis as an ‘undemonstrated principle’ (archê anapodeiktos). But
in Plato’s dialogues, the usual meaning of the word hupothesis is
‘starting point for the discussion’ . . . The hypothesis is always posited
provisionally,” and the suggestion is that Plato’s use of hupothesis is
one derived at least partially from Hippocratic texts.11 But there is
a difference in attitude towards hypotheses between Plato and VM.
In Plato, hypotheses are set down as propositions to be proved or
refuted.12 Hypotheses in VM indicate that the assumptions made by
the author’s opponents cannot be proven or refuted in this way, for
they are accepted by the author only in cases, such as matters below
the earth or in the sky,13 where it would “not be apparent either to
the speaker himself or his listeners whether what he said was true
or false”. It is necessary, therefore, not to look to Plato or to other
philosophical or mathematical writers, but within the text itself for
further information on these hypothesised postulates.14
In attempting to fix the author’s objections as precisely as pos-
sible, a textual matter is crucial: instead of the discussing ‘empty’

and Praec. 4 (ÍpoyÆseiw R: ÍpoyÆs˙ p. 31,19 Heiberg: Ípoy°syai; 9.256,1 L.). See
further Kühn & Fleisher (1989) 829 under Ípot¤yhmi.
9
As pointed out by Lloyd (1979) 135 and n. 50, and Hankinson (1990) 57.
10
For the mathematical uses of ÍpÒyesiw, see Lloyd (1963) and (1979) 111–115,
and Karasmanis (1987) chs. 2, 7–8.
11
Karasmanis (1987) 9 and n. 18.
12
For instance, Plato, Meno 86 e–87 c; Phaedo 92 d, 101 d 2; Republic 388 e, 437
a; Sophist 237 a; Timaeus 61 d.
13
Matters “in the sky” seem to refer to the astronomical, rather than the atmos-
pheric (such as lightening). See Plato, Apol. 23 d 6 (tå met°vra ka‹ tå ÍpÚ g∞w).
14
Lloyd (1963) suggests that, as far as evidence allows, it seems that the doc-
trines attacked in VM are those of Philolaos of Croton. This suggestion has been
taken up by Huffman (1993) 78–92, who stresses the theoretical precision sought
in his theory of érxa¤ (cf. VM 2.1, p. 119,13 Jouanna; 1.572,10 L.; VM 7.3,
p. 126,16 Jouanna; 1.586,1–2 L.). Whether the author is attacking a single author,
or many, his target is postulate-grounded theories of medicine.
34 jane barton

postulates, VM could be read as rejecting the adoption of “new”


postulates.15 However, it is unclear how a ‘new’ postulate, or a series
of them, would fall foul of the author’s objections. For a ‘new’ pos-
tulate might actually give us the answers in medicine, as much as
in matters below the earth and in the sky, and be shown to be true
or false.
What is of interest is why the postulated theories of those such as
Empedocles are considered ‘empty’. ‘Empty’ can be understood in
three ways:
(1) On the strictest reading, ‘empty’ could be taken as ‘without con-
tent’: as such, postulated theories would mean nothing as they
say nothing, in a manner comparable to the rejection of all the-
ory and theoretical reasoning by later strict Empiricists.16
(2) ‘Empty’ could be taken as ‘unsubstantiated,’ that is, the postu-
lated theory would have content, but there would be no evi-
dential support for the theory, for it would not be supported by
the consideration of either past cases or ongoing or future suc-
cess. This would be illustrated by the case of the patient with a
poor diet, for whom reference to the hot, the cold, the wet and
the dry is of no use. In such a case, reference to the hot, the
cold, the wet and the dry is ‘empty’ since reference to postulates
does not explain the progress of past or present cases. Nor does
a postulate-grounded theory offer the possibility of prediction, for
no perceptual or observational evidence links cases to theory at
any level. It is observational evidence which needs to be referred to
(prÚw ˜ ti . . . §panen°gkanta)17 in order that one is compelled of
necessity (xrØ) to know clearly (efid°nai tÚ saf°w).18

15
See notes 5 and 7 above.
16
As for instance in Galen, Subfiguratio empirica 4, 48,8 ff., 65.5 ff. (ed. Deichgräber
(1930). See also Frede (1990).
17
Cf. prÚw ˘ énaf°rvn (VM 9.3, p. 128,11 Jouanna; 1.588,14 L.) quoted and
discussed below, where the author claims that the only metron, or measure, to which
one can refer is the inexact one of perception.
18
Cf. Aristotle’s use of kenos in relation to theories not connected to appropriate
archai which are too (lian) general and unconnected to the facts, Arist. GA 748 a
7–11: otow m¢n oÔn ı lÒgow kayÒlou l¤an ka‹ kenÒw: ofl går mØ §k t«n ofike¤vn
érx«n lÒgoi keno¤, éllå dokoËsin e‰nai t«n pragmãtvn oÈk ˆntew. ofl går §k t«n
érx«n t«n g°vmetrik«n g°vmetriko¤, ımo¤vw d¢ ka‹ §p‹ t«n êllvn: tÚ d¢ kenÚn
doke› m¢n e‰na¤ ti, ¶sti dÉ oÈy°n. cf. Met. 992 a 28: diå ken∞w l°gomen. See fur-
ther Bonitz (1955) ad loc.
hippocratic explanations 35

(3) ‘Empty’ could be taken as ‘without possible proof ’. This read-


ing could be supported by the manner in which the author dis-
cusses the theories of matters below the earth and in the sky:
the postulated theory has content, but due to the domain or type
of subject matter (the not visible, the mysterious), no possible
proof of truth or falsity can be provided. It is a proof which is
required in order that one is compelled of necessity to know
clearly.
Clearly position (3) rests on a more demanding view of what is
required than that of (2): where (3) speaks of proof, (2) only requires
some evidential link between perceived medical cases and an under-
lying theory.
Position (1), however, where ‘empty’ is taken as ‘without content’,
would be a self-contradictory position for the author to have taken:
what he criticises as empty in the case of medicine would similarly
be without content in the case of matters under the earth or in the
sky, in which case also they could not claim to give any account at
all. VM I states that the use of postulates, which gives an ‘empty’
account in the case of medicine, is ‘necessary’ in the case of mat-
ters under the earth or in the sky. Thus, position (1), where ‘empty’
would be taken as ‘without content’ is to be rejected. What remains
to be seen is whether VM is concerned with the demand for an evi-
dential link (that which ‘empty’ accounts do not provide in position
(2) or for proof of truth or falsity (that which ‘empty’ accounts do
not provide in position (3).
To clarify this, VM’s discussion of matters under the earth and in
the sky needs to be considered again. In that domain, since postu-
late-grounded accounts are said to be “necessary” if any account is
to be given of such matters, the only type of account available is one
based on such postulates. The difficulty with any such account is
that its subject matter is “not visible” and “mysterious”, that is, it
is remote, and so in general inaccessible. As a result, the account
can not be substantiated, as there is no means by which such sub-
stantiation could be reached. The account is ‘empty’, but neverthe-
less some sort of account is given in such cases. It seems that the
only account which can be given or expected in such ‘not visible’
and ‘mysterious’ cases is a consistent one. A consistent account would
give an explanation of sorts for the phenomena witnessed, but would
do so without any evidential link to the phenomena discussed.
36 jane barton

VM claims that medicine is a completely different type of case to


astronomy, since the phenomena in medical cases are accessible. The
author of VM states that those who consider postulate-based accounts,
as are necessary in astronomy, sufficient or even useful in medicine
“are clearly mistaken” (katafan°ew efis‹n èmartãnontew). Medicine is
said by VM 2.1 to have found a “first principle”, an archê (érxØ . . .
eÍrhm°nh, VM 2.1, p. 119,12–13 Jouanna; 1.572,9 L.), other than
the postulates adopted in astronomy and by Presocratic philosophers
such as Empedocles.19 The archê is tied to the method (ka‹ érxØ ka‹
ıdÚw eÍrhm°nh, VM 2.1, p. 119,12–13 Jouanna; 1.572,9 L.), which
VM states must be pursued in order to inquire or give an account.20
The archê and the method must focus on the point of view of the
lay person,21 in order that an account is given of the craft of medicine:
mãlista d° moi dok°ei per‹ taÊthw de›n l°gonta t∞w t°xnhw gnvstå l°gein
to›si dhmÒt˙sin.
VM 2.3 (p. 120,3–5 Jouanna; 1.572,18–19 L.)

And especially, it seems to me that the person giving an account of


this craft must give an account of things which are familiar to ordi-
nary people.
The archê will be shown to be the perceptible phenomena, accessi-
ble to lay people as much as practitioners, since the choice and the
success of treatment given in the exercise of the craft of medicine
must be able to be evaluated by all. The method by which medical
knowledge is acquired will be shown to be through reflection on the
actual treatment of cases, a pragmatic progress of regular success
with certain types of treatment.

19
VM may have been interested in Empedocles in particular not only because
he employed the postulated hot, cold, wet and dry in his medical accounts, but
also because he employed these same postulates in his cosmological and astronomical
accounts.
20
oÈ går per‹ êllou tinÚw oÎte zht°ein prosÆkei oÎte l°gein, VM 2.3 (p. 120,5–6
Jouanna; 1.572,19–20 L.)
21
VM 2.3 (p. 120,3–5 Jouanna; 1.572,18–19 L.): mãlista d° moi dok°ei per‹
taÊthw de›n l°gonta t∞w t°xnhw gnvstå l°gein to›si dhmÒt˙sin. cf. Vict. 3.68 (6.594,3
ff. L.) addresses itself to ‘the many’; Morb. 1.1 (6.140,1 ff.) seems to include lay peo-
ple as much as practitioners in questioning proposed treatment; per‹ t°xnhw, De arte
4.1 (p. 227,7 Jouanna; 6.6,7 L.) states that the starting point should be accepted
by “all”, which presumably also includes lay people as well as theorists; Nat. Hom.
1–2 discusses epideixis competitions concerning the elemental constitution of the body:
such a debate called on lay people as much as theorists through the universal applic-
ability of reason.
hippocratic explanations 37

It could be claimed that the adoption of a perceptually-graspable


starting-point opens up VM to the objection that medicine is left
without any theoretical underpinning if it rejects the philosophers’
postulates. The objection would be that, without a theoretical under-
pinning such as is given by a postulate-grounded theory, medical
accounts can demonstrate no causal basis for regularity of symptoms
over cases of disease, or success over a number of cases with a certain
medicine, and so on. VM’s claim, however, is that it is not hypothe-
sised postulates that one needs for that underpinning, but rather one
needs to get to know the operative causal bases of health and disease,
and these bases are to be accessed from the starting point of per-
ceptible phenomena. Since the archê of VM is perceptual phenom-
ena, as opposed to postulates, VM’s method is inductive, as opposed to
the deductive method pursued by those who adopt hypothesised, pos-
tulated archai derived from Presocratic philosophy, such that the archê,
the ‘first principle’, is the ‘starting point’ of discovery in medicine.22
As a result of his phenomenon-grounded inductive method, the
author of VM concentrates in particular on human interaction with
those foods which are regularly perceived to be fitting for the human
constitution, and those which are regularly too strong for the body
to cope with.23 This information, and an operative understanding of
it, is gained through the continued development of human regimen
(VM 7.2, p. 126,8–14 Jouanna; 1.584,11–16 L.), which is the result
of the many fine discoveries which have come about over time and
will continue to do so in the future (tå eÍrhm°na pollã te ka‹ kal«w
¶xonta eÏrhtai §n poll“ xrÒnƒ, ka‹ tå loipå eÍreyÆsetai. VM 2.1,
p. 119,13–15 Jouanna; 1.572, 10–11 L.). Consideration of this focus
on foods and regimen will make clear the crucial points: what it is
to know clearly (efid°nai tÚ saf°w) and how this relates to the method
and the archê of the medical craft.
In VM there is a recognition of the needs of the practitioner to
look to an assessment of a right amount in his prescriptions (of cer-
tain foods, and in certain preparations), together with an acceptance

22
Archê can be translated “first principle” as well as “starting point”; see Lloyd
(1987) 129, n. 93 and LSJ ad loc.
23
VM 14.3 (p. 136,3–5 Jouanna; 1.602,4–6 L.): éllå tÚ fisxurÚn •kãstou ka‹
tÚ kr°sson t∞w fÊsiow t∞w ényrvp¤nhw: o mØ ±dÊnato krat°ein, toËto blãptein
≤gÆsanto, ka‹ toËto §zÆthsan éfel°ein. cf. VM 10.1–9 where it is discussed that
it is necessary to match the prescribed diet to the constitution of the individual. cf.
20.1 (pp. 146,17–147,1 Jouanna; 1.622,7–10 L.).
38 jane barton

of the idea that accuracy in medicine is rarely obtainable in prac-


tice. The medical practitioner is classed as a craftsman, even though
he does not deal with exact quantities, assessable on an accurate
scale of measurement. The author of VM is aware that his dismissal
of exactitude, whilst maintaining the craft-status of medicine has to
be justified, since general lack of accuracy would tend to speak against
the operation of a craft:
m°tron d¢, oÈd¢ staymÚn, oÈd¢ ériymÚn oÈd°na êllon, prÚw ˘ énaf°rvn
e‡s˙ tÚ ékrib¢w, oÈk ín eÍro¤hw êllÉ μ toË s≈matow tØn a‡syhsin: diÚ
¶rgon oÏtv katamaye›n ékrib°vw, Àste smikrå èmartãnein ¶nya μ ¶nya:
kín §gΔ toËton tÚn fihtrÚn fisxur«w §pain°oimi tÚn smikrå èmartãnonta.
tÚ dÉ ékrib¢w Ùligãkiw §st‹ katide›n: §pe‹ ofl pollo¤ ge t«n fihtr«n taÈtã
moi dok°ousi to›si kako›si kubernÆt˙si pãsxein.
VM 9.3–4 (p. 128,11–18 Jouanna;1.588,14–590,5 L.)

But no there is no measure by reference to which can one know


exactly, neither of number nor weight nor of any other sort, other
than the perception of the body; and so it is laborious to make under-
standing exact to that degree that only small mistakes are made here
or there. I would strongly praise that doctor who made only small
mistakes. Accuracy is encountered on very few occasions: since the
majority of doctors seem to me to be in the same state in these respects
as poor helmsmen.
Small mistakes are often made by helmsmen, and these mistakes are
of no consequence in calm weather. It is when large mistakes are
made in serious circumstances, such as in a crisis at sea, that the
incompetence of the helmsman becomes evident. While these grave
mistakes call into question the ability, and craft-status, of an indi-
vidual, there is no hint that small mistakes threaten the craft-status
of helmsmanship. Each case to which a doctor is called, however,
is a crisis.24 So how accurate must the response of the doctor be to

24
Cf. On Diseases 1, which sets out a theory of disease based on the postulates
of bile and phlegm, but claims that there is no demonstrated beginning or princi-
ple (érxØ épodedeigm°nh) for medicine as a whole, as illustrated by the difference
in the kairo¤ (critical turning-points) between diseases, between one body and another
or between ages (Morb. 1.9, 6.156,14 L., cf. Morb. 1.5, 6.146,15 L.). As a result, it
is not possible to have exact knowledge (tÚ ékrib¢w efid°nai, Morb. 1.16, 6.168,23;
170,2–4 L; cf. Vict. 3.67, 6.592,1–594,2. L). Cf. De arte 7.2 (pp. 231,8–11 Jouanna;
6.10,21–23 L.) where mistakes made by practitioners are evidence for the existence
of the art of medicine, rather than the opposite proposed by medicine’s detractors:
for when medicines are properly applied the working of the craft is displayed, mis-
takes merely show the incorrect application of remedies. See also Lloyd (1987)
253–270 for further examples.
hippocratic explanations 39

the crises with which he deals in order to retain his craft-status?


At VM I.3 (p. 119,11 Jouanna; 1.572,8 L.) we are told that in
the case of postulate-grounded accounts (for instance, the astro-
nomical), there is nothing by reference to which one would neces-
sarily know clearly (oÈ går ¶sti prÚw ˜ ti xrØ §panen°gkanta efid°nai
tÚ saf°w). In the passage quoted above, VM 9.3–4, we are informed
about the nature of this point of reference (prÚw ˘ énaf°rvn). We
are told in VM 9.3–4 that there is no metron “measure” in medicine
by reference to which we could know accurately; nor is there such
a point of reference in astronomy. I suggest, therefore, that to know
accurately, both in medicine (efid°nai tÚ saf°w, VM 9.3–4) and in
astronomy (e‡s˙ tÚ ékrib¢w, VM 1.3) would require a metron such
that one would know an exact measure quantified in some way (num-
ber, weight, and so on). Strict accuracy would require the calcula-
tion of a precisely quantifiable measure. Such accuracy is not available
in astronomy or medicine, for any supposed quantifiable precision
would be without the evidential support of reference to the phe-
nomena. Even if someone were to grasp astronomical theory in a
way in which theory precisely and completely explained reality, VM
asserts that they could not know it to be true.25 Postulate-grounded

25
In the case of astronomy, as well as matters “under the earth”, the phenom-
ena are so remote that they are largely “not visible” and, as a result, “mysterious”
(“mystery” here is clearly concerned with the inability to perceive certain phe-
nomena, rather than any links to magic or mysticism). That only minimal phe-
nomena are grasped by humans makes a phenomenon-grounded account of the
sort that VM will be shown to propose for medicine “not possible”, in the sense of
“unavailable”. There seems no reason in theory why a phenomenon-grounded
account of these subject matters should not be able to be constructed, were the
phenomena to become accessible. The practical inconceivability of such access, how-
ever, leads the author to speak of the necessity of a postulate-grounded account in
such cases (per‹ œn énãgkh, ≥n tiw §pixeiro¤h l°gein, Ípoy°sei xr°esyai, VM 1.1).
Hankinson (1992, 58) claims that a similar distinction to that of VM is made by
Xenophanes DK B34:
ka‹ tÚ m¢n oÔn saf¢w oÎtiw énØr ‡den oÈd° tiw ¶stai
efidΔw émf‹ ye«n te ka‹ ëssa l°gv per‹ pãntvn:
efi går ka‹ tå mãlista tÊxoi tetelesm°non efip≈n,
aÈtÚw ˜mvw oÈk o‰de: dÒkow dÉ §p‹ pçsi t°tuktai.
where clear knowledge (tÚ m¢n oÔn saf¢w) of the truth about the gods could never
be known clearly by humans. This inability to attain knowledge also applies to the
other subject matter referred to here (ka‹ ëssa l°gv per‹ pãntvn): the lack of
sufficient context leaves it unresolveable whether the reference is to the subject mat-
ter of Xenophanes’ poem as a whole or to knowledge of the cosmos. Even if humans
came across the truth by chance, they would be unable to translate acquaintance
with this truth into knowledge, the best that humans can achieve epistemologically
is belief (dÒkow). Xenophanes, however, in his discussion of knowledge of tÚ saf¢w
40 jane barton

theories are ‘empty’ because they are based on arbitrary assump-


tions. This is not due to the ‘generality’ of the theory, as claimed
by Hankinson (1990, 58). It is rather, as Lloyd (1987, 280–1) points
out, because a precise account could also readily be assumed to be
an accurate one. He uses the example of the casting of horoscopes to
illustrate that the “mathematical rigour of an entire enquiry . . . could
be impeccable, but the inquiry remains with too little purchase, too
little grip on the phenomena. The appeal to the mathematical often
gave a spurious air of certainty, the precise being confused with the
accurate”.26 Instead, an observation-based assessment of balance and
harmony is central to the understanding of the work of the doctor.
The strength and amount of food required is grasped through the
doctor’s perception of the body of the patient (toË s≈matow tØn
a‡syhsin).27 The accurate measure, metron, must be aimed at (de› går
m°trou tinÚw stoxãsasyai, VM 9.3, p. 128,10–11 Jouanna; 1.588,14 L.),
but accuracy is rare in the operation of this craft (tÚ dÉ ékrib¢w Ùligã-
kiw §st‹ katide›n), due to the inexactitude of a perceptual measure.
Hence, accurate knowledge (e‡s˙ tÚ ékrib¢w) is unobtainable if the
demand is for precisely quantifiable accuracy (oÈd¢ staymÚn, oÈd¢
ériymÚn).
But why is accurate knowledge unattainable by the craft of med-
icine? VM 20.1 addresses the issue of the scope of the medical craft
in considering whether anyone can claim to know medicine without
knowing what man is, ˜ t¤ §stin ênyrvpow (pp. 146,2 Jouanna;
1.620,11 L.) even though, at VM 20.2, the author states that the
study of nature, phusis, is of no more relevance to the medical art
than it is to the graphic:28
l°gousi d° tinew ka‹ fihtro‹ ka‹ sofista‹ …w oÈk ¶ni dunatÚn fihtrikØn
efid°nai ˜stiw mØ o‰den ˜ t¤ §stin ênyrvpow: éllå toËto de› katamaye›n

is concerned with the impossibility of the verification of (certain kinds or domains of )


truths; VM is concerned with the level of accuracy demanded for knowledge of tÚ
saf¢w. Cf. Gorgias, DK B11a10, 19–21; efidΔw ékrib«w μ dojãzvn: Gorgias DK
B11a136.
26
See also Lloyd (1987) 312–319 on the aims and assumptions of Greek astronomers.
27
See Bratescu (1983) 137–144 for a summary of previous interpretations of toË
s≈matow tØn a‡syhsin, noting especially those of Deichgräber (Hermes 68, 1933),
Muri (Hermes 71, 1936) and Diller (Hermes 80, 1952) who claim that aisthesis refers
to the “sensations” felt by the patient, not the perception of the doctor as argued
here. See also Jouanna (1990) 173–5 ad loc.
28
VM 20.2 (p.146,8–9 Jouanna, 1.620,13–14 L.): ∏sson nom¤zv tª fihtrikª t°xn˙
prosÆkein μ tª grafikª. It is unclear whether literature or writing skill is being
referred to here.
hippocratic explanations 41

tÚn m°llonta Ùry«w yerapeÊsein toÁw ényr≈pouw. te¤nei d¢ aÈt°oisin ı


lÒgow §w filosof¤hn, kayãper ÉEmpedokl∞w μ êlloi o„ per‹ fÊsiow gegrã-
fasin §j érx∞w ˜ t¤ §stin ênyrvpow, ka‹ ˜pvw §g°neto pr«ton ka‹ ˜pvw
junepãgh.
VM 20.1 (pp. 145,18–146,7 Jouanna; 1.620,7–12 L.)

Certain doctors and sophists29 say that it is not possible for someone
to know medicine who is ignorant of what a man is; but the one who
is going to treat people correctly must learn this thoroughly. But this
question of theirs tends to philosophy,30 just as for Empedocles or oth-
ers who have written about nature from a first principle [or: from the
beginning] what man is and how he first came into being, and how
he was constructed.31

29
tinew fihtro‹ ka‹ sofista‹ A: tinew ka‹ fihtro‹ ka‹ sofista‹ M; the reading of
MS. M makes a more distinct separation between the doctors and sophists; MS.
M is supported due to the parallel with 20.2, 146,7–8 Jouanna; 1.620,12–13 L.:
tin‹ μ sofistª μ fihtr“. Jouanna (1990) 20, is mistaken in taking this section as
separate to the previous attack on opponents to the method of VM, thereby taking
it that a discussion of what a human being is, is a completely unconnected topic
to that of debates covering the acceptability or otherwise of philosophical postulates
and methods of inquiry.
30
This is one of the earliest uses of the term filosof¤h in surviving Greek lit-
erature, and therefore should not point to a sharp distinction, if any at all, between
philosophers and “sophists”. The distinction seems to be between those working
with a hupothesis, such as “sophists”, Empedocles, and those who construct postu-
late-grounded theories, and those who are pursuing the method advocated by VM.
31
per‹ fÊsiow: it is clear that Empedocles was concerned with more than just
the status of human beings in the cosmos, and this suggests that per‹ fÊsiow in
VM should be read as referring to nature as a whole, generally understood (that
is, part of a general or universal account of nature). This translation is wider in
scope than that of Jouanna, who takes it as though the writer of VM is consider-
ing Empedocles as someone whose central concern was the understanding of human
beings, and all discussion of the nature as a whole is subordinate to understanding
the place of human beings within it. Even if that were the intended focus of
Empedocles (for instance through his emphasis on the daimones), and that focus is
echoed in VM, a human-focused reading can not be maintained (contra Jouanna
(1990) 208, who claims all occurrences of per‹ fÊsiow in this chapter are concerned
with human nature): for the nature of human beings was not the central concern of
other Presocratic philosophers (μ êlloi o„ per‹ fÊsiow gegrãfasin) who wrote about
medicine, such as Democritus and Pythagoras (Celsus, Proem. 7). See Jouanna (1990)
207, who conjectures te¤nousi from te¤nei in the main clause, to grammatically
complete the kayãper clause (rather than an understood repetition of gegrãfasin).
Jouanna’s reading would have VM claim that Empedocles and the other Presocratics
merely tend to philosophy, losing the distinction between those who erroneously write
like the philosophers by employing philosophical postulates when concerned with
medicine, as opposed to those who take the phenomena as their first principle in
medical explanation.
On possible copyist errors, in which 20.1 146, 2–5 Jouanna; 1.620,8–11 L.: éllå
toËto . . . §stin ênyrvpow is a marginal note which entered the text and as such
should be removed, see Jouanna in the Budé, 93–94. This would remove all mention
42 jane barton

It is made clear that although medicine can not be learned by means


of the study of nature, the study of nature can only be known from
the basis of the previous study of medicine and by means of its
methods. The craft of medicine is the means to understanding what
the nature of man is.32 In this way, the medical methods adopted
by VM do appropriately “tend to philosophy”, that is, medical under-
standing and the method of inquiry VM advocates are the only means
by which one can get to know about nature, but to go beyond the
scope of the medical craft is the work of philosophy. By exceeding
the scope of the medical craft one could, perhaps, come to under-
stand the whole of nature, that is, the cosmos. For it is by means
of observational archai, together with the method of reflection on
cumulative success, that one can come to know the nature of man.
From that point, extending medical understanding to the under-
standing of the science of nature, one could, perhaps, get to know
the nature of the cosmos. The method employed would be the med-
ical one which begins with the observable and reflects on successful
interaction with the observable to achieve an understanding, but one

of Empedocles and other Presocratics, and with it the force of VM ’s argument.


§j érx∞w: it is not clear whether §j érx∞w should be taken with §stin or gegrã-
fasin. Placement would make it be read most naturally with gegrãfasin, with ˜
t¤ §stin ênyrvpow as complement. Yet this would give a temporal sense to §j érx∞w,
either in the sense of “from the beginning of their works”, or “from the origin of
man”. The latter would repeat the sense of the indirect questions with which the
author immediately continues, and the former would contradict what is known about
the beginning of Empedocles’ poem, that it began with a discussion of general
causal principles in the cosmos, rather than a discussion of human anatomy, phys-
iology, etc. (see Martin and Primavesi (1998) 103–11). Further, either of the above
translations would not capture the crux of the disagreement discussed, which is
between those who begin their speculation from a philosophically-postulated first
principle and those who begin from the phenomena. The greatest support, there-
fore, is for the reading of §j érx∞w with §stin and the translation “first principle”,
in the sense of “starting point in argument”.
32
VM 20.2 (p. 146,9–15 Jouanna; 1.620,14–622,5 L.): nom¤zv d¢ per‹ fÊsiow
gn«na¤ ti saf¢w oÈdamÒyen êlloyen e‰nai μ §j fihtrik∞w. toËto d¢, oÂÒn te kata-
maye›n, ˜tan aÈt°hn tiw tØn fihtrikØn Ùry«w pçsan perilãb˙: m°xri d¢ tout°ou
polloË moi dok°ei de›n: l°gv d¢ tØn flstor¤hn taÊthn efid°nai ênyrvpow t¤ §sti,
ka‹ diÉ o·aw afit¤aw g¤netai, ka‹ têlla ékrib°vw. VM allows both gn«siw and
§pistÆmh to be qualified by both ékribÆw and safÆw. The only way in which one
can understand anything clearly about nature is from the basis of medicine, VM
20.2 (p. 146,9–11 Jouanna; 1.620,14 L.): nom¤zv d¢ per‹ fÊsiow gn«na¤ ti saf¢w
oÈdamÒyen êlloyen e‰nai μ §j fihtrik∞w. It is in this way that one will gain accu-
rate knowledge (efid°nai tÚ saf°w, VM 1.3 p. 119,11 Jouanna; 1.572,8 L.; e‡s˙ tÚ
ékrib¢w 9.3, 128,12 Jouanna; 1.588,15; efid°nai . . . ékrib°vw 20.2, 146,14–15;
1.622,4–5 L.). See further Kühn & Fleisher (1989) ad loc.
hippocratic explanations 43

which extends beyond its origins in the medical craft, and so is not
the work of the medical craft.33
The author of VM has been shown to have three major and dis-
tinct areas of concern (though these are interwoven in the text). In
each of these areas he makes apparent a criticism of postulate-
grounded medicine, and replies to it. His three major areas of con-
cern are:
(1) the type of starting points for explanation upon which an account
of medicine must rely have to be accessible to the subject in
some way (Philosophy: hypothesised postulates; VM: the perceptual
evidence of phenomena),
(2) the method of inference to be employed in inquiry/working out
what to do in a particular case (Philosophy: deduction; VM: induc-
tion), and
(3) the level of accuracy demanded of an explanatory account in
medicine (Philosophy: the precisely quantifiable; VM: that which
can be perceived in practice to remove symptoms/restore the
patient to health, not precisely-quantifiable).34
It is clear, therefore, that the author of VM is seeking to distance
himself not only from the postulate-driven theories which derived
from Presocratic philosophy, but also the methods of such theorists
in general: as a result of his concentration on (1), points (2) and (3)
are raised in the text. Since they could not be substantiated, such
postulate-based theories opened up an explanatory gap between prac-
tice and theory, where practice and theory do not inform one another.
But in trying to bridge this practice-theory gap, it is also clear that
the author of VM is no strict empiricist who rejects all theory and
theoretical reasoning.35 For he is committed to the use of reasoning,

33
Perhaps philosophy would be able to grasp the accurate metron, but it would do
so as the work of the philosophy, not as work in any way relevant to the medical
craft. cf. Nat. Hom. 1, CMG I.I.3, p. 164,14. The opponents of Nat. Hom. are those
who extend their arguments about the nature of man beyond that which is rele-
vant to the craft of medicine: they claim that man is composed of earth, air, fire
or water.
34
VM does not separate, either in his account or in his criticism of his oppo-
nents’, accuracy of quantification from testability through success, even though these
aspects are conceptually distinguishable.
35
Hankinson (1998, 65) claims that VM is concerned with “empirically-based
medical practice”, and in the next paragraph that “medicine is a respectable empir-
ical science”. These are two distinct claims and Hankinson seems unclear about
44 jane barton

logismos, to uncover causes, as explicitly stated in VM 1 and 21,36


and this use of reasoning is contrasted with chance (tuchê ), for instance
at VM 12 (pp. 132,18–133,6 Jouanna; 1.596,8–598.2 L.).37 Most
importantly his is not the deductive reasoning which descends from
the postulates of the philosophers, but the inductive reasoning which
has the phenomena as its first principle and starting point. The
author of the VM is making inferences to causes for health and dis-
ease just as much as the Empedoclean school of medicine and other
Presocratics, and just like them he reasons to a disruption of the
normal balance and functioning of the body. The inferential results
the author reaches, however, are not theory-driven ones concerning
a precisely quantifiable disruption of the balance of the postulated
hot, cold, wet and dry, which it is the job of medical theory to cal-
culate. His concern is with the perceptible balancing of the strengths
of foods, as excessive strength in foods is seen to cause imbalances
in the body, a theory constructed by inductive inference from the starting
point of observation. His method of reasoning proceeds from the ear-
liest discoveries that some foodstuffs are too strong, ischuron, and need
to be blended or weakened to be made palatable. It is by consid-
eration of each case from that general basis that all humans, with
their many different individual constitutions, can gain mastery over
their regimen and so achieve health (VM 3.4, pp. 122,13–123,3
Jouanna; 1.578,2–7 L.).38 It seems that this method explains the use

which claim(s) he is making for VM (idem, 68), “The causal assumptions in play
here [he has just quoted 15. 18–25] are not . . . obviously compatible with the
strictest empiricism. But at least his account is empirically motivated”. It is clear
that VM is advocating an empirical basis for medical practice, but the treatise is
in no way claiming that medicine is “compatible with the strictest empiricism”. For
if medicine were a strict empirical science, then it would have to conform to strict
empiricist claim that no more than visible signs are admissible as the bases for treat-
ment. Strict empiricism would constitute the rejected position 1 discussed above.
36
VM 1 (pp. 118,14 Jouanna; 1.118,14 L.); VM 21, (p. 148,7 Jouanna; 1.570,6 L.).
37
Cf. De arte is concerned with the craft-status of medicine, as opposed to cures
being due to luck, for instance, see 4.1 (p. 227,8–12 Jouanna; 6.6,7–10 L.), and
sets up as central the use of reasoning, logismos, to reason to that which is not openly
observable, êdhla, 11.1 (p. 237,5 Jouanna; 6.18,16 L.), that is, the doctor should
use the “eye of the mind”, 11.2 (p. 237,11–13 Jouanna; 6.20,2–3 L.): ˜sa går tØn
t«n Ùmmãtvn ˆcin §kfeÊgei, taËta tª t∞w gn≈mhw ˆcei kekrãthtai: De arte 9.4
(p. 235,3–8 Jouanna; 6.16,10–14). Illnesses which are external (i.e., have apparent
and observable causes) should be cured infallibly, because their cures have been
discovered. The doctor needs to be naturally clever enough and properly educated,
however, for this to come about, cf. Loc. hom. 46.1. (p. 84,17–20 Craik; 6.344,4–9 L.).
38
The emphasis is on different foods, such as cheese, VM 20.6 (pp. 147,16–148,1
Jouanna; 1.624,5–9 L.), producing different effects on different people in different
hippocratic explanations 45

of opposites in 14.5 (p. 136,19–20 Jouanna; 1.602,16–17 L.), which


seems no more than general practical guidance to veer away from
the extremes of bitterness and sweetness,39 as being bad for the
human constitution in general, corresponding to Aristotle’s practical
advice over the doctrine of the mean: if you find yourself tending
to one excess, aim for the other.40
‘Empty’ postulates are rejected in medicine not only because the
hypothesised explanations of philosophers are of no use in diagno-
sis and treatment, but also because such postulates ignore the progress
made as a result of the operation of the craft of medicine and the
work of practitioners. The perceptual starting-point of VM, however,

states of health and disease. The effects of these foods are the graspable phenom-
ena from which starting point any understanding of medicine proceeds and which
an account must explain. The qualities of foods, however, are not referred to by
means of a single technical term, suggesting that the understanding of them is not
central to an explanatory account (the qualities are often referred to as “powers”
dunãmeiw, or as “humours” xumo¤ or by means of the article and neuter adjective).
Since the qualities of foods are not the graspable phenomena from which an account
must proceed, the qualities do not constitute hypothesised postulates as dismissed
by the author in the first chapter of the treatise. Hankinson (1998, 66) appears to
suggest that VM is objecting to hupothesis-based theories as the author’s concern with
foods is “not supposed to be an a priori conceptual truth”, but he does not make
it clear how we should understand this suggestion in connection with VM. In his
1990 paper, however, Hankinson (1990, 59–60), with reference to Lloyd (1976,
146–149), notes the claim that “in spite of his aversion to arbitrary hypotheses . . . our
author apparently makes use of assumptions no less arbitrary and speculative”.
Hankinson proposes that the “author nowhere suggests that a food’s strength or
weakness can be inferred a priori from its colour, or its weight, or its name—although
empirical connections can be established”. That the strengths of some foods can in
general be predicted to be harmful “is something that has been discovered, not some-
thing that has been inferred”. Although Hankinson does not explain the distinction
he is relying on between discovery and inference, he is correct to read VM as con-
cerned with empirically-based investigation, rather than substituting the postulates
he rejects with others pertaining to foods. Edelstein (1967, 352), on the other hand,
notes the concern of the author of VM about “how the uniqueness of existing phe-
nomena can ever be comprehended by any general theory” but is mistaken in his
claim that “he therefore rejected generalizations altogether.” VM proposes that the
mapping of empirically-accessed likenesses over similar individual cases permits
the formation of general understandings which can be employed in prognosis and
the justification of treatment.
39
As Hankinson (1990, 64) points out, the bitter and the sweet are not postu-
lates of the sort rejected, rather they are “phenomenal properties” which are accessed
empirically and are seen to be causally operative in cases of health and disease.
Even if the hot, the cold, the wet and the dry were considered as phenomenal
properties rather than ontological absolutes, at VM 15.1 (discussed above) they are
said to be of no therapeutic, and so no causal, relevance.
40
Arist., EN 1109 a 34–1109 b 7.
46 jane barton

is not ‘empty’ as the explanations of the craft of medicine eviden-


tially refer back to these perceptual phenomena, as postulates do
not. It is at the level of everyday success and failure that medicine
is relevantly understood by both lay people and experts, not at the
level of postulates which are evidentially unsupported. VM is there-
fore concerned with the demand for an evidential link (that which
‘empty’ accounts do not provide in position (2), not proof of truth
or falsity (position (3).
The study of VM has opened up a major issue with which the
Hippocratics wrestled: should an understanding of health and dis-
ease, and of the workings of the craft of medicine, be founded on
postulates such as the hot, the cold, the wet and the dry, such as
were taken to be employed by Presocratic philosophers as their fun-
damental explanatory elements, or should medicine be based on con-
sideration of the day-to-day observations of doctors and the accumulated
successes of their practice? Such a debate seems to have arisen partly
from the concern that accumulated success alone fails to detect or
engage with an underlying causal basis for disease which the postu-
lates of the philosophers would have provided. But the latter’s pos-
tulates were precisely that—postulates—as a result there seemed no
way in which they could tie together theoretical explanation and
practice into a single coherent theory. Of course, many details are
lacking of the ways in which VM ’s observationally-assessed correct-
ness together with inductive inferential thought in practice makes
progress stage-by-stage to a unified and complete science. The spe-
cial contribution of VM, however, is that it sought to bridge that
explanatory gap between theory and practice by championing an
observation-up, not postulate-down, theory for gaining knowledge.

Bibliography

Bonitz, H. (1955) Index Aristotelicus, Berlin.


Bratescu, G. (1983), ‘Le problème de la mesure dans la Collection Hippocratique’, in:
F. Lasserre, P. Mudry (eds.), Formes de la pensée dans la Collection Hippocratique,
Geneva, 137–144.
Craik, E.M. (1998) Hippocrates: Places in Man, Oxford.
Deichgräber, K. (1930) Die griechische Empirikerschule, Berlin.
Edelstein, L. (1967), ‘The Relation of Ancient Philosophy to Medicine’, in: L. Edel-
stein, Ancient Medicine, Baltimore, 349–366.
Frede, M. (1990), ‘An Empiricist view of knowledge’, in: S. Everson (ed.) Epistemology,
Cambridge, 225–250.
hippocratic explanations 47

Hankinson, R.J. (1998) Cause and Explanation in Ancient Greek Thought, Oxford.
——. (1992), ‘Doing without hypotheses: the nature of Ancient medicine’, in: J.A.
López Férez (ed.), Tradatos hipocráticos: actas del VIIe Colloque international hippocra-
tique, Madrid, 55–67.
Heiberg, I.L. (ed.) (1928), Hippocratis Indices librorum, Iusiurandum, etc. C.M.G. Vol.
I.1, Berlin.
Huffman, C.A. (1993), Philolaos of Croton, Cambridge.
Joly, R. (1967), Hippocrate. Du régime, Paris.
——. (1970), Hippocrate. De la génération, etc. Paris.
——. (1972), Hippocrate. Du régime des maladies aiguës, etc., Paris.
——. (1978), Hippocrate. Des lieux dans l’homme, etc., Paris.
——. (1984), Hippocrate, Du régime, Berlin.
Jouanna, J. (1987), Hippocrate. La nature de l’homme, Berlin.
——. (1988), Hippocrate. Des vents, De L’art, Paris.
——. (1990), Hippocrate. De l’ancienne médecine, Paris.
——. (1999), Hippocrates, Baltimore.
Karasmanis, V. (1987), The Hypothetical Method in Plato’s Middle Dialogues, unpublished
doctoral thesis, Oxford.
Kühlewein, H. (1894, 1902), Hippocratis Opera, vols. I & II, Leipzig.
Kühn, J.-H. & Fleischer, U. (1989), Index Hippocraticus, Göttingen.
Lloyd, G.E.R. (1963), ‘Who is attacked in On Ancient Medicine?’, Phronesis 8, 108–26.
——. (1979), Magic, Reason and Experience, Cambridge.
Martin, A. and Primavesi, O. (1998), L’Empédocle de Strasbourg, Berlin.
Meyer, S.S. (1992), ‘Teleology and Necessity’, Philosophical Review 101, 791–825.