In 1879 it was revealed to the learned world that the poet Homer had composed his Iliad while serving as deputy chief of the medical staff with Agamemnon’s army before Troy. That he was a doctor was evident from the poem’s remarkable emphasis on wounds and other matters medical; and his position as a staff officer was proved by his access to detailed information on the activities taking place on both sides of the front line. His vantage point, a little above the daily round of the actual fighting, showed that he was not serving on the battlefield itself, although he had seen corpses and casualties, and the position as chief of the medical staff would have denied him the leisure for writing available in a post only a little less senior. Although this conclusion reveals more about the organisation and prejudices of the Royal Saxon Army in which Oberstabsarzt Frölich served than it does about Homer, it points to one undeniable fact: the poet chose to include many medical details and to treat them in a sophisticated way.1 It is important to begin with Homer, not just because the Greeks themselves did, or because in his description of Machaon as ‘a healer (iatros) worth many other men in cutting out arrows and spreading soothing drugs’ he provided later doctors, neglectful of both the qualification in the second line and the military context, with a warrant for their sense of general superiority over the rest of mankind.2 The Homeric poems afford us a glimpse of medical ideas and practices long before any of our strictly medical literature, and although their information cannot be taken back to the heroic days of Agamemnon and Odysseus, it can be used to illustrate what the poet’s audience would have expected or taken for granted in the late eighth century. We may note the complex vocabulary for types of wound with which Homer expected his readers to be familiar, and the graphic descriptions of injuries, not all of which are the result of poetic imagination.3 Frölich’s belief that only a doctor could have written with such accuracy and technical precision underestimates both the necessity for a rapport between poet and audience, and, although he could not have known this in 1879, the methods of oral composition that lie behind the Iliad and Odyssey as we have them. Far from an acquaintance with medical terms and situations being the preserve of professionals alone, the poems

demonstrate that many others had access to and understood this information. That there were already individuals recognised as healers with specific skills should not obscure the equally important fact that their knowledge was not kept entirely secret. According to Homer, Machaon and his brother Podalirius come from a medical family and their knowledge of drugs descends, via their father Asclepius, from Chiron the Centaur. But in the Iliad both Machaon and Podalirius are portrayed in the first instance as warriors, chieftains leading their contingent from Tricca, Ithome and Oechalia, and playing their part in the fighting like other heroes.4 Machaon’s role in leading his men as ‘shepherd of his people’ does not depend on his medical abilities alone, and the adjectives that are applied to him are also given to other chieftains.5 As a healer, he removes arrows, sucks out poisonous blood and applies ‘soothing drugs’ to the wounded Menelaus, with immediate success.6 One might also imagine him bandaging the wounded, as other heroes do for their wounded comrades.7 Podalirius, by contrast, is not seen in action, an omission rectified by a later epic poet, Arctinus, in his Sack of Troy.8 While his brother attends to the wounds of Ajax, Podalirius, who can ‘recognise the invisible and cure the incurable’, observes the glint in the patient’s eye that reveals the burdensome thoughts that will end in suicide.9 We need not go as far as Alexandrian scholars who made the one into the prototypical surgeon and the other into the prototypical physician, for the poet’s differentiation serves an artistic rather than a professional purpose. But Arctinus’ divergence from Homer was noted, and easily explained: since wounds were what doctoring in warfare was largely about, it was hardly surprising that Homer should have concentrated on what was most relevant to his epic conflict. More significant is the fact that both Machaon and Podalirius perform their actions without recourse to the gods: Machaon applies his dressings and Podalirius diagnoses Ajax’s incipient madness without any mention of them. Indeed, when Apollo comes to treat the gods who have themselves been wounded in skirmishes he does so in the same manner and is described in the same words as Machaon.10 Although this argument should not be pressed too far in dealing with a poem that relies heavily on formulaic language in its depiction of both gods and heroes, there is not a little humour in having the immortals treated by a god with the same means as Machaon used for his human patients. But the gods are not entirely absent from the human battlefield at the moment of healing. At Iliad 16,523, Glaucus, having just witnessed the death of Sarpedon, prays to Apollo to be healed of his own wound, and his prayer is answered.11 The role of Apollo in the plague that opens the first book of the Iliad is much more complex. He is the agent of both destruction and its cessation. He sends his arrows with the ‘evil illness’ to strike animals and men alike, because he is angry with the Greeks for roughly rejecting the request of his priest, Chryses, for the return of his daughter captured by Agamemnon. Apollo acts

in response to Chryses’ prayer for assistance, and, from then on, the ending of the plague is a matter for negotiation solely with the god. The reaction of the Greeks after nine days of death is to ask advice from a seer, priest or dream interpreter as to the precise cause of his anger.12 There is no place for the iatros here, for the poet makes it clear that everyone believes in the divine origin of this affliction, and, as a consequence, that it is not an iatros but someone skilled in understanding the gods who is required.13 Achilles, the spokesman for the Greeks, is in no doubt of the reasons for the god’s anger: there has been some offence directly committed against Apollo. The Greeks have broken a vow, or have offered an unacceptable sacrifice.14 At this stage, a more complicated chain of causation is not envisaged. Nevertheless, once the actual cause has been revealed to them by their own seer, there is both universal acceptance of this reasoning and agreement that only an appropriate apology to the god will persuade him to end what he has begun. Agamemnon’s insistence on his right to compensation for giving up the girl obscures, but does not contradict, his willingness to concur with this explanation and this advice. The final expiation is twofold: the return of the girl to her father and sacrifice to the god. Only when both are completed does Apollo relent. This belief that a disease affecting so many must have a cause that goes beyond the merely individual and must relate to the anger of some divinity or other can be found elsewhere in the Mediterranean, particularly in the Old Testament. When God is angry he looses his bolts against the sinful; when the Israelites, or their leaders, break their convenant with Jehovah they are punished with terrible diseases, which are only ended when satisfaction has been made.15 Even in modern Western societies, familiar with the effects of pollution, malnutrition, infectious diseases, viruses, bacilli and the like, a religious or moral dimension is not entirely absent from discussions of epidemic disease, as the initial reactions to the spread of AIDS in the 1980s demonstrated.16 But the consensus of the Greeks before Troy that their epidemic was the result of divine anger does not prove that Homer and his audience attributed all illnesses to the gods. The assumption that Apollo, Artemis, Zeus or some other god might have sent a sickness on to a community or on individuals is one that was widely shared.17 But there are traces of another view. The stinking and excruciatingly painful ulcer that led to the Greeks leaving Philoctetes behind on Lemnos is ascribed to an apparently natural cause, the bite of a water-snake.18 At Odyssey 11, 171-3, the poet makes Odysseus juxtapose a religious and a non-religious reason when he asks his mother in the Underworld whether her death has been due to a long sickness or to being struck down by the arrows of Artemis. Hesiod in his Works and Days also offers alternative explanations. Misery, famine and plague may be sent from heaven by Zeus in order to punish those who act violently or cruelly, but the poet also conjures up a vivid picture of diseases roaming around the world, silently bringing mischief to mortals. Zeus might be in overall control, for he took away speech from these beings, but they move spontaneously, as and

where they want.19 There is no Greek Book of Job, pondering the causes of individual human suffering and prosperity before reaching the conclusion that the inscrutability of God’s purpose in allowing these disparities is but one part of His majesty. Instead, we find a series of explanations that overlap with each other and that are chosen as appropriate to a given situation. Some involve the gods directly, others indirectly, others not at all. The development of medicine in the ancient world has frequently been seen as the extension of the last category at the expense of the others, and there are good reasons, both ancient and modern, for adopting this interpretation. So, for example, when a comic dramatist c.420 BC displays a chorus of semi-divine heroes, ‘the stewards of good and evil’, threatening the unjust with a variety of diseases – coughs, bad spleen, dropsy, catarrh, scab, gout, madness, lichens, swellings and agues – we may suspect that part of the humour lay precisely in the conjunction of divine punishment for thieves and minor criminals with a sophisticated medical differentiation of types of disease.20 But, as we shall see, this extension of the space occupied by non-theological explanation does not lead to a total exclusion of other possibilities, even among rationalist physicians, and many of the prejudices and reactions of the pre-Hippocratic Greeks continued to exert an influence on medical thinking and practice for many centuries.21 The Homeric poems also throw important light on the social situation of the doctor. Along with the seer, the armourer and the bard, the doctor is one of the craftsmen, ‘servants of mankind at large’, whose country ‘knows no bounds’, and who move from place to place as and when their services are required.22 It is a way of life familiar from other documents from the contemporary Levant, particularly relating to royal households. Hittite, Babylonian and Egyptian texts show doctors moving from court to court, being summoned (or sent as part of a diplomatic exchange) to heal rulers and their relatives.23 Against such a background, it is tempting to associate the grant of land to an ijate at Pylos in the Mycenean period with an attempt by a local lord to secure the residence of a healer among his dependants.24 The career of Democedes of Croton in the sixth century can be in part interpreted in the same way, as he moved from S. Italy to Aegina, to Athens and then to the court of Polycrates of Samos in the 520s BC. He was taken as a captive to Persia on the overthrow of Polycrates, but he gained his freedom and great wealth by curing King Darius of a foot injury when his Egyptian healers had failed and, later, by treating Queen Atossa for a long and painful disease of the breast.25 Two generations later, Apollonides of Cos became a court doctor to Artaxerxes I for thirty years, before being buried alive for having had intercourse with the queen’s sister, a story told by yet another Greek doctor in Persian service, Ctesias of Cnidus.26 Egypt is seen as a major source of such healers.27 Homer talks of it being the home of the ‘race of Paion’, where ‘everyone is a healer’ and ‘the bountiful land produces many drugs’.28 It is there that Helen goes to obtain from Polydamna, the wife of Thon, nepenthes and acholon, herbs to chase away the

sadness of Menelaus and Telemachus. Archaeology confirms the general existence of a traffic in medicinal substances between the Aegean and the Levant, although beginning much earlier. Aromatic resins, opium, coriander, cyperus and many other substances entered the Greek world from Egypt and the Near East well before the time of the Homeric poems.29 Many of the gynaecological recipes in the Hippocratic Corpus contain Near Eastern ingredients, and it is possible that we should seek a similar origin for the practice of fumigation, applying sweet-smelling scents, in gynaecological disorders.30 When and how this transfer occurred is unclear in our present state of knowledge, for Greek doctors themselves do not acknowledge any borrowing. And the traffic is far from being one way, for there are references in Egyptian medical texts to Cretan beans and other remedies that come from the Greek world.31 Whether an acquaintance with remedies also involved more than a casual understanding of the theories behind them is a controversial question.32 Homer’s exaggerated view of the ubiquity of Egyptian medical practitioners hardly suggests direct acquaintance, and a reminiscence of this Homeric passage may lie in part behind Herodotus’ comment that the Egyptians had numerous doctors, each of them specialising in one sort of disease.33 The fourth-century writer Isocrates was doubtless not alone in tracing the origin of medicine and pharmacology back to the Egyptians, although we may wonder how much his rhetorical tour de force in praise of a long-dead Egyptian monarch was acknowledged by his audience to have a basis in historical fact.34 Still more puzzling is Herodotus’ claim that the Babylonians had no doctors at all, but merely brought the sick out into the streets for them to receive helpful advice from passers-by. If this is the testimony of an eyewitness, it would appear to involve a whole series of misunderstandings and misapprehensions, as recent publications of cuneiform medical texts amply demonstrate.35 Babylonian medicine, it is clear, was still flourishing in the fourth century in the Levant, if not for some time later.36 Herodotus’ references to Egyptian and Babylonian medicine as somehow distinct from the Greek form one piece of evidence in the complex debate about their interrelationship and the ways in which a specifically ‘Western’ medicine came to develop within sixth-, fifth-and fourth-century Greece. To prove conclusively dependence or, still more, non-dependence is impossible in the present state of our knowledge, and the arguments used on both sides often derive their colouring from a conviction of the superiority of one civilisation over another.37 To refuse to believe in a Nubian Hippocrates is seen as denying all value to Egyptian medicine; to raise the possibility of Babylonian influence on Greek medicine is considered tantamount to questioning the existence of the Greek miracle. Merely to remark upon the difficulty of devising appropriate criteria for judging interdependence is to risk an accusation of small-mindedness.38 It is, of course, likely that the Greeks took over some medical ideas and practices from their neighbours, just as they took over some of their plants

and herbs.39 Greek trading posts and so-called colonies were established around the Levant from the eighth century BC onwards, and scholars have pointed to influences, particularly from Babylonia, on Greek literature, art and religion in this early period.40 There were Greeks who had visited these regions, even staying there for some time, and who were impressed enough by what they saw or heard to transmute it into a Greek form. One may not wish to place too much faith in the claim of Diodorus Siculus, writing his Universal History at the end of the first century BC, that the practice of incubation, a prime feature of many Greek healing cults, including that of Asclepius, originated in the cult of Isis in Egypt, but offerings made at the shrine of Hera on Samos (in the sixth century BC) do include figurines of a type associated with a Babylonian goddess of healing.41 There are also parallels, to put it no stronger, between some Greek medical ideas and those found elsewhere in the Near East. The Egyptian belief that disease was caused by residues rotting within the body and that they required removal through purgation has its analogues in Greek medical texts, as has the emphasis in Babylonian medicine on the body’s fluids (corresponding to ‘humours’) as a major determinant of illness.42 Nor is it entirely fair to dismiss either type of medicine as lacking in rationality or devoted to supernatural explanations. Although both Egyptian and Babylonian doctors saw the workings of the gods in illness, the author of the Edwin Smith surgical papyrus offers his treatments without referring to the gods. Writers of cuneiform texts clearly differentiated between the two types of therapy by including on the same tablet instructions for the cure of a disease by an incantation priest or by pharmaceutical remedies and allowing for some choice between them. Even types of psychological distress could be treated in Babylonia with ordinary drugs and recipes, and eye diseases are frequently discussed in texts that contain both magical and medical remedies.43 But against this evidence for possible influence must be set the notorious unwillingness of the Greeks to learn other languages. Even Herodotus’ account shows how even an intelligent man could be led astray by his own eyes and by his interpreters. Hence, there is no guarantee that a visit to the East would have resulted in anything but the most superficial acquaintance with non-Greek medical theory. The exchange of substances need not have involved any deep exchange of ideas beyond the most obvious instructions for use, and by the fifth century many foreign substances were so common that they had lost any links with their original Near Eastern medical context. Similarly, the two comparable doctrines are so broad that they could easily have been fashioned in more than one place, and, with one little-noticed exception, no Greek medical author either acknowledges dependence on or a possible derivation from a non-Greek source. Anonymus Londinensis cites Ninyas the Egyptian for the belief that there are two types of affection, congenital and acquired. The former are innate, the latter the result of residues and of the body’s heat working on nutriment that has remained in the body without being properly absorbed.44 This theory is certainly to be found in

Egyptian medical papyri, and one would like to know more about this mysterious Ninyas and when he lived. But it is equally significant that he is singled out as the holder of an opinion differing only in a minor detail from others held by doctors who were Greeks, and that his general approach is not recognised as being specifically Egyptian.45 His presence in this list of medical opinions, however, does indicate a possible conduit of information, whether he wrote in Greek or was a native Egyptian whose views were transmitted through Greek intermediaries.46 Ninyas’ theory is reported as merely one of a series of variants on the same theme. He is included among those who believe that diseases arise from the residues of nutriment (as opposed to some change in the body’s elements). The list begins with Euryphon of Cnidus and Herodicus of Cnidus in the mid-fifth century BC, and includes names drawn from all over the Greek world, from S. Italy to the N. Aegean. Although it is possible, as has been suggested, that this idea of disease as the result of some form of residue came from Egypt, found a home among the doctors of Cnidus and was then transmitted around the Greek world, the geographical range of the doctors named and the variety of ideas they put forward suggest rather that this type of explanation need not have had a single point of origin.47 A more compelling argument for the independent development of Greek medicine is that the type of medical literature found in Greece differs considerably from that known elsewhere. While some treatises in the Hippocratic Corpus can be categorised as lists of drugs and therapies, many others are in the nature of exploratory arguments, debating with and criticising other authors. They raise theoretical as well as practical problems while seeking to establish some of the fundamentals of their art, and often range widely in their argumentation. They employ sophisticated reasoning, and, for the most part, within the sphere of medicine as they define it, there is no place for divine causation or divine cures.48 While some of the material is clearly intended for private use, whether by an individual alone or in a small group of colleagues and pupils, other parts are equally clearly intended for a wider audience, if they are not in fact transcriptions of speeches delivered in public. This plurality of debate about first principles is not confined to the Hippocratic Corpus as we have it. The middle section of the Anonymus Londinensis papyrus takes the form of a list of the competing explanations for disease put forward in the fifth and fourth centuries BC.49 Nor was a medical text something fixed and unalterable. One of the earliest written texts of which we have record, the so-called Cnidian Sentences, was already circulating in a revised form when the author of Regimen in Acute Diseases took issue with it in the late fifth century.50 It is, of course, possible that these confrontational features were also present in Babylonian or Egyptian medical texts, and that their non-appearance is simply the result of chance, for, indeed, one could produce many Greek lists of recipes and surgical techniques that resemble closely the arrangement and organisation of Near Eastern texts and that leave out any argumentative

discussion of their underlying theory.51 But the increasing number of tablets becoming available from Babylonia, and not least the very late commentary texts from Uruk, weakens this argument from silence, and nothing that we know of Egyptian medicine and Egyptian society leads us to expect the vigorous debates found in Greece. If there is influence, it is more likely to have been in specific remedies and practices than in theories, and the ‘style’ of Greek medicine, like that of Greek science in general, appears radically different from that known from elsewhere.52 To say this, it should be emphasised, is not to denigrate non-Greek medicine in a priority dispute over the invention of medicine and medical thinking. In our present state of knowledge, proof of non-Greek influence is extremely difficult to find, and, if there was influence, its effects developed in a very different way from what is securely known about Babylonia or Egypt. This competitiveness is related to a further feature of Greek medicine that marks it out from medicine in many other cultures – its openness. Although, as we shall see, there were guild-like groupings of doctors and constant attempts to define the constituents of the true art of medicine (and consequently to exclude those whose beliefs and practices did not fit this definition), the boundary between medicine and other investigations was, and remained, remarkably fluid. Medical ideas were discussed freely whether among a small group of acquaintances or in a public place, and once writing had become widespread, by 500 BC, medical books were available in towns such as Athens, Corinth or Miletus for any who wished to buy them. ‘Physicians have written much’, commented Xenophon somewhat snootily in the early fourth century.53 Important contributions to the theories and methods that should govern medical practice were not confined to those who bore the title ‘iatros’, ‘doctor’. Anyone who wished could join in the debate. Nor was the exchange of profitable ideas always in one direction, or to the liking of all parties. The Art of Medicine was written to defend medicine against those who disputed its effectiveness, while the author of Ancient Medicine strongly attacked those who introduced into medicine philosophical hypotheses.54 One cannot imagine that he would have been greatly impressed by the attempt of his contemporary Metrodorus of Lampsacus, a pupil of Anaxagoras, to interpret Homer’s Iliad as a giant physiological and cosmological allegory, in which gods and heroes represented parts of the universe or of the human body: Apollo, for instance, stood for bile; Demeter for the liver; Dionysus for the spleen.55 The early participants in these debates are often called the pre-Socratic philosophers, a somewhat misleading name, since many were the contemporaries of Socrates (469-399) and few were philosophers in the modern sense of the word. The earliest of them, in the sixth century, attempted to explain how the world came to be, pursuing ‘an inquiry into nature’. For the historian of medicine their conclusions, which often stressed a single original substance, are less important than their method of approach and their

geographical origin. Many of them were associated with the rich and, at that time independent, cities of Ionia (W. Turkey), and medical, historical and scientific texts from then on were often written in their local dialect of Greek, Ionic. Even though the inhabitants of Cos, the home of Hippocrates, used another dialect, Doric, and many of the writers in the Hippocratic Corpus appear to be associated with regions of Greece remote from Ionia, the works in the Corpus are all in Ionic.56 In its turn, the language of the Hippocratic Corpus continued to be employed for medical writing for many centuries to come, and doctors often used the Ionic form of iatros, ietros, to describe their profession on their tombstones, even though the rest of their epitaphs were in the standard koine, ‘common’ Greek.57 The method of approach of these early thinkers was to look for natural explanations for phenomena; that is, explanations that did not involve the somewhat arbitrary intervention of divine powers. They were interested in causes, and in seeking to explain what they perceived around them. By using reason and argument they believed they could penetrate, like Arctinus’ doctor, behind the visible to observe the invisible.58 They assumed, also, that human beings, as part of the natural world, were made from the same material and behaved according to the same rules as everything else within it, although the parallels between the macrocosm of creation and the microcosm of mankind were not yet made fully explicit.59 Their desire to find a single explanatory cause for the universe was vigorously criticised by Parmenides (c.515-450 BC), one of a number of thinkers from the Greek-speaking areas of S. Italy and Sicily who contributed to debates across the Greek world.60 Parmenides’ vigorous logic in denying all motion and change, all coming into being and passing away in the physical world, compelled those who wished to defend empirical data either to produce a more subtle approach to monism or to argue for a plurality of eternal and immutable entities whose combinations and recombinations explained the mutability and diversity of all that could be seen around. Some of the favoured hypotheses predated Parmenides: the Pythagoreans, for example, believed that the basis of the universe was number, while the cryptic Heraclitus (fl. 500 BC), in whose system fire played the essential role, implied the permanent necessity of change. But the thinkers who followed Parmenides were more aware of the problems involved in any explanation involving change, and widened the scope of their investigations to look closely at the human body. So, for example, Melissus of Samos (fl. 450 BC) argued strongly, in part from the evidence of physiology, that everything was differentiated out of ‘One-being’, and that pluralistic explanations only involved additional (and unnecessary) bases of exactly the same kind as his own One-being. In so doing, he was almost certainly attacking the views of Empedocles (fl. 460 BC), who thought of the world as built up from four stable elements – earth, air, fire and water – whose potentially unstable combinations produced everything that could be perceived.61 For Leucippus

(fl. 435 BC) and Democritus (fl. 420 BC) the world was made up of atoms (‘the uncuttable’) and void. Anaxagoras, their slightly older contemporary, argued that the original mixture of the universe contained an immense diversity of ingredients, coming together in the form of seeds, each containing a part of everything else, and hence with the potentiality for growth and change. By the mid-fourth century the belief that disease was the result of some inadequate combination of ‘elements’ was extremely common, and no longer limited to philosophers. Although the list of such believers preserved in the Anonymus Londinensis papyrus begins with Plato and Philolaus of Croton, it also includes the doctors Polybus of Cos, Philistion of Locris and Petron(as) of Aegina, as well as Menecrates, a controversial and somewhat eccentric savant of the mid-fourth century, who wrote a treatise, On Medicine.62 These links between philosophy and medicine can be traced back at least to Parmenides, if not earlier to the Pythagoreans, whose ideas on appropriate living included a ban on eating beans.63 The Pythagorean doctrine of numbers may have also contributed to the later medical doctrine of critical days, days of particular importance during the course of an illness, which were often expressed in terms of numbers from the starting point of the illness and which, at least in the higher numbers, would seem to have been based on very little clinical evidence. Parmenides himself was later honoured at his native Elea with a beautiful bust set on an inscribed base that declared him to be a ‘student of nature’ (‘physikos’). It stood in a building with an unusual underground portico, and was erected to him by a medico-religious group, a pholeon, that traced its formation back to his lifetime. Some of its leaders bore the family name of Parmenides, Ouliades (which may be connected with the cult title of Apollo Oulios), and inscriptions on their (much later) statues also indicate that these men were also doctors. Another inscription may reveal the presence of a ‘medical prophet’ (‘iatroma[ntis]’), a term otherwise first attested in the playwright Aeschylus.64 Whether this apparent combination of philosophy, religion and medicine goes back to Parmenides himself is uncertain, but far from impossible, as our evidence for Empedocles shows. Even if we discount as happy invention later stories of his cure of the plague at Selinus, enough remains to indicate that Empedocles was himself involved in medicine at a practical as well as theoretical level.65 Not only did he promise in one poem to teach its addressee to ‘learn all the drugs that are a defence against ills and old age’, but he claimed that wherever he went he was followed by large crowds, ‘some desiring oracles, while others, long pierced by grievous pain, demand to hear the word of healing for all sorts of illnesses’.66 He was credited with a medical treatise in verse, and with another in prose, and the fragments of his surviving poetry show a deep interest in matters medical.67 Empedocles is one of the philosophical authors attacked by the writer of Ancient Medicine for leading contemporary ‘doctors and sophists’ to believe that a sound grasp of medicine required speculative investigation into what mankind is.68 According to one modern reconstruction of his

career, he resembled a shamanistic wonder-worker far more than a frockcoated physician or a calmly contemplative philosopher, an interpretation that, even if exaggerated, challenges preconceptions as to how each of these activities might have been carried on in ancient Greece.69 The new Strasbourg fragments also show how he managed to include within a single poem ideas that have often appeared to historians sufficiently disparate or disjointed as to warrant the editorial obelus as incomprehensible or at least a distribution between different works.70 Empedocles’ theories covered the whole of human physiology and its changes from cradle to grave. He believed in four basic elements – earth, air, fire and water – whose different proportional relationships to each other explained the differences between substances. Blood was an almost perfect balance of the four elements, and from blood was formed flesh. Bone and sinews had different proportions, the latter being formed without any air whatsoever.71 The eye contained all four elements, but vision depended largely on fire and water alone.72 Digestion was, in part, a mechanical process: food was cut and ground by the teeth before passing to the stomach, where it then underwent a process of putrefaction, probably under the influence of the body’s natural heat, before being sent to the liver, where it was turned into blood.73 Heat, which Parmenides had equated with life, played a major role in Empedocles’ view of the human body, being used to account for the differences between the sexes (males are hotter and better cooked than females) and to explain sleep (as a cooling process).74 Blood was the agent of nutrition, and maternal milk was the result of the decomposition of superfluous blood. Although Aristotle later criticised him for his choice of metaphor, describing the process as one of cooking rather than putrefaction, Empedocles’ basic idea that milk was formed from residual blood was widely accepted.75 It is probable that he thought that semen was also formed in this way, although we have no clear picture of how he pictured the internal organisation of the body.76 In his considerable interest in and knowledge of medicine, Empedocles has a counterpart in another philosopher from among the western Greeks, Alcmaeon of Croton (S. Italy). Whether he flourished in the late sixth century BC or a generation or so later, in the second quarter of the fifth, is disputed. Tradition claimed him as a pupil of Pythagoras ‘in his old age’, but the textual and historical basis for this assertion is far from sound, and Alcmaeon’s interests and the sophistication of some of his methods are better suited to the later date.77 His medical interests can be best seen in his theory of health, which deserves quotation at length, even though its wording may not be entirely his own:

What preserves health is the equal distribution of its forces – moist, dry, cold, hot, bitter, sweet, etc. – and the domination of any one of them creates disease: for the dominance of any is destructive. Disease comes about on the one hand through an excess of heat or cold: on

the other hand through surfeit or lack of nutriment; its location is the blood, marrow or brain. Disease may also sometimes come about from external causes, from the quality of the water, local environment, overwork, hardship or something similar. Health, by contrast, is a harmonious blending of the qualities.78