The Art is Long: Primary Texts on Medicine and the Humanities

The Art Is Long: Primary Texts on Medicine and the Humanities gathers introductory texts in the growing field of medical humanities. This unique volume presents a lens with which to examine the intersection of literature and medicine with diverse selections that span time and the globe. With authors from Sushruta to Hippocrates, Margery Kempe to John Donne, and Susie King Taylor to Sigmund Freud, the volume also highlights the voices of women, people of color, and those who have been overlooked or marginalized by the medical establishment.

The Art Is Long aims to expand the medical humanities canon. In addition to more traditional works, readers will find snippets of literary and narrative encounters with medicine by writers who are neither doctors nor nurses, including professional caretakers and people who might be labelled “quacks” today but whose contributions represent a part of medical history.

This anthology also includes medical reportage and philosophy, fiction and nonfiction, image and poetry. The shifts in genre, style, and perspective provide a wealth of opportunities to reflect on medical history and literary techniques, focusing on narratives that highlight a personal context for medical subjects in a single volume.

• Language: English
• Publisher: Chemeketa Press
• Release date: Aug 27, 2021
• ISBN: 9781943536948

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Sushruta’s Compendium

(Sushruta Samhita)

*

SUSHRUTA

(Indian, ca. sixth century BCE)

Sushruta Samhita translates literally as Sushruta’s Compendium. It was composed at some point during the sixth century BCE by the Indian physician Sushruta, who was renowned as a physician and is called by some the father of surgery. His compendium is a foundational text of ancient Ayurvedic medicine, one of the oldest systems of health in the world. Ayurveda means knowledge of life in Sanskrit and is still widely practiced in its modern form, although Western practitioners have labeled it an alternative medicine. The Ayurvedic system understands health to rely upon a harmonious balance of three Doshas (vata, pitta, and kapha). These Doshas govern the functions, movement, and growth of the body. As you read, consider these excerpts’ descriptions of the various branches of Ayurvedic medicine, its theory of disease, and the practices and oaths required of new students.

[On the Origin and Types of Ayurveda]

The Áyurveda (which forms the subject of our present discourse), originally formed one of the subsections of the Atharva Veda;¹ and even before the creation of mankind, the self-begotten Brahmá² strung it together into a hundred thousand couplets (Shlokas³), divided into a thousand chapters. But then he thought of the small duration of human life on earth, and the failing character of the human memory, and found it prudent to divide the whole of Áyurveda into eight different branches such as, the Salya-Tantram, the Sálákya-Tantram, the Káya-Chikitsá, the Bhuta-Vidyá, the Kaumár-Bhritya, the Agada-Tantram, the Rasáyana-Tantram and the Vájeekarana-Tantram. Now about the characteristic features of each of these branches of the Science of Áyurveda:

The Salya-Tantram⁴—The scope of this branch of the Medical Science is to remove (from an ulcer) any extraneous substance such as, fragments of hay, particles of stone, dust, iron or bone; splinters, nails, hair, clotted blood, or condensed pus (as the case may be), or to draw out of the uterus a dead fetus, or to bring about safe parturitions in cases of false presentation, and to deal with the principle and mode of using and handling surgical instruments in general, and with the application of fire (cautery) and alkaline (caustic) substances, together with the diagnosis and treatment of ulcers. The Shálákya-Tantram⁵—embraces as its object the treatment of those diseases which are restricted to the upward (lit: region above the clavicles) fissures or cavities of the body, such as the ears, the eyes, the cavity of the mouth, the nostrils, etc.

The Káya Chikitsá (General diseases)⁶—treats of diseases, which, instead of being simply restricted to any specific organ, or to any particular part of the body, affect the entire system, as Fever, Dysentery, Hemoptysis,⁷ Insanity, Hysteria, Leprosy, unnatural discharges from the urethra, etc.

The Bhuta-Vidyá (Demoniacal diseases)—lays down incantations and modes of exorcising evil spirits and making offerings to the gods, demons, Gandharvas, Yakshas, Rakshas⁸, etc. for cures of diseases originating from their malignant influences.

The Kaumára-Bhritya (Management of children)—deals with the nursing and healthy bringing up of infants, with purification and bettering of mothers’ milk, found deficient in any of its characteristic traits, and also with cures for diseases peculiar to infant life and due to the use of vitiated mother’s milk or to the influences of malignant stars and spirits.

The Agada-Tantram (Toxicology)—deals with bites from snakes, spiders, and venomous worms, and their characteristic symptoms and antidotes. It has also for its object the elimination of poison whether animal, vegetable, or chemical (resulting from incompatible combinations) from the system of a man, overwhelmed with its effects.

The Rasáyana-Tantram (Science of Rejuvenation)—has for its specific object the prolongation of human life, and the invigoration of memory and the vital organs of man. It deals with recipes which enable a man to retain his manhood or youthful vigor up to a good old age, and which generally serve to make the human system invulnerable to disease and decay.

The Vájeekarana-Tantram (Science of Aphrodisiacs)—treats of measures by which the semen of a man naturally scanty or deficient in quality becomes shorn of its defects; or is purified, if deranged by the vitiated humors of the body (such as wind, etc.); or is invigorated and increased in quantity (if pure and healthy); or acquires its healthy and normal consistence (if thinned and enfeebled by indiscretions of youth). [In short, it deals with things which increase the pleasures of youth and make a man doubly endearing to a woman].

*

Thus the entire science of Áyurveda is classified into the eight preceding branches. Now tell me, which of them is to be taught and to which of you? Said the disciples:—Instruct us all, O Lord, in the science of surgery (Shalya) and let that be the chief subject of our study. To which replied the holy Dhanvantari: Be it so. Then the disciples again said:— We are all of one mind in the matter, O Lord, that Sushruta shall be our spokesman and ask you questions conformably to the general trend of our purpose. All of us will attentively hear what you will be pleased to discourse to Sushruta, [and that will save you the trouble of teaching us individually]. To which replied the venerable sage—Be it so. Now listen, Sushruta, my dear child. The object or utility of the science which forms the subject of our present discussion, may be grouped under two distinct sub-heads such as (1) the cure of diseased persons, and (2) the preservation of health in those who are not afflicted with any sort of bodily distempers.

[On the Definition and Nature of Disease]

Disease: Its Definition:—The Purusha (man)⁹ is the receptacle of any particular disease, and that which proves a source of torment or pain to him, is denominated as a disease. There are four different types of disease such as, Traumatic or of extraneous origin (Ágantuka), Bodily (Shárira), Mental (Mánasa) and Natural (Svábhávika). A disease due to an extraneous blow or hurt is called Ágantuka. Diseases due to irregularities in food or drink, or incidental to a deranged state of the blood, or of the bodily humors acting either singly or in concert, are called Shárira. Excessive anger, grief, fear, joy, despondency, envy, misery, pride, greed, lust, desire, malice, etc. are included within the category of mental (Mánasa) distempers; whereas hunger, thirst, decrepitude, imbecility, death, sleep, etc. are called the natural (Svábhávika) derangements of the body. The Mind and the Body are the seats of the abovesaid distempers according as they are restricted to either of them, or affect both of them in unison.

Samshodhanam (Cleansing),¹⁰ and Samshamanam (Pacification of the deranged or agitated bodily humors giving rise to the disease), and the regimen of diet and conduct are the four factors which should be duly employed in order to successfully cope with a disease….

Physicians should look upon these four factors of food, conduct, earth and time, as the accumulators, aggravators and pacifiers of the deranged bodily humors and of the disease resulting therefrom in man. Diseases due to causes which are extraneous to the body may affect the mind or the body. When it would affect the body in the shape of any traumatic disease (such as an inflammation due to a blow or sword cut), it should be treated medicinally like the rest of the physical maladies, while the remedy should consist in the enjoyment of pleasurable sounds, touch, sights, taste or smell where the mind would be found to be the seat of the distemper….

The term Purusha should be interpreted to include within its meaning the combination of its five material components, and all things resulting therefrom, such as the limbs and members of the body, as well as the skin, the flesh, the blood, the veins and the nerves, etc. The term Disease signifies all distempers incidental to the several or combined actions of the three deranged bodily humors and blood. The term Medicine signifies drugs and their virtues, tastes, potency, inherent efficacy (Prabháva) and reactionary properties (Vipáka). Appliances (kriyá) denotes such processes as, surgical operations, injections, emulsive measures, lubrications, etc. The term Time signifies all opportune moments for medical appliances.

[On the Initiation of a Student into Ayurvedic Study]

Now we shall discuss the Chapter which deals with the rites of formal initiation of a pupil into the science of Medicine (Shishyopanayaniya-madhyáyam).

Such an initiation should be imparted to a student, belonging to one of the three twice-born castes such as, the Bráhmana, the Kshatriya, and the Vaishya,¹¹ and who should be of tender years, born of a good family, possessed of, a desire to learn, strength, energy of action, contentment, character, self-control, a good retentive memory, intellect, courage, purity of mind and body, and a simple and clear comprehension, command a clear insight into the things studied, and should be found to have been further graced with the necessary qualifications of thin lips, thin teeth and thin tongue, and possessed of a straight nose, large, honest, intelligent eyes, with a benign contour of the mouth, and a contented frame of mind, being pleasant in his speech and dealings, and usually painstaking in his efforts. A man possessed of contrary attributes should not be admitted into the sacred precincts of medicine….

Then having thrice circumambulated the sacrificial fire, and having invoked the firegod to bear testimony to the fact, the preceptor should address the initiated disciple as follows:—"Thou shalt renounce lust, anger, greed, ignorance, vanity, egotistic feelings, envy, harshness, niggardliness, falsehood, idleness, nay all acts that soil the good name of a man. In proper season thou shalt pair thy nails and clip thy hair and put on the sacred cloth, dyed brownish yellow, and love the life of a truthful, self-controlled anchorite and be obedient and respectful towards thy preceptor. In sleep, in rest, or while moving about—while at meals or in study, and in all acts thou shalt be guided by my directions. Thou shalt do what is pleasant and beneficial to me, otherwise thou shalt incur sin and all thy study and knowledge shall fail to bear their wished for fruit, and thou shalt gain no fame. If I, on the other hand, treat thee unjustly even with thy perfect obedience and in full conformity to the terms agreed upon, may I incur equal sin with thee, and may all my knowledge prove futile, and never have any scope or display. Thou shalt help with thy professional skill and knowledge, and Bráhmanas, thy elders, preceptors and friends, the indigent, the honest, the anchorites, the helpless and those who shall come to thee (from a distance), or those who shall live close by, as well as thy relations and kinsmen [to the best of thy knowledge and ability], and thou shalt give them medicine [without charging for it any remuneration whatever], and God will bless thee for that. Thou shalt not treat medicinally a professional hunter, a fowler, a habitual sinner, or him who has been degraded in life; and even by doing so thou shalt acquire friends, fame, piety, wealth and all wished for objects in life and thy knowledge shall gain publicity.

* Reprinted from An English Translation of The Sushruta Samhita, Based on Original Sanskrit Text, 3 vols. trans. and ed. Kaviraj Kunja Lal Bhishagratna (Calcutta, 1907), 1: 2–5, 10–14, 16–19. Internet Archive.

1  Atharva Veda: One of the four Vedas, which are major books of Hindu scripture, and the one most dedicated to practices of daily life.

2  Brahmá: In Hinduism, the creator god.

3  Shlokas: Literally, songs; a shloka is a traditional verse form in Sanskrit, composed of two lines of sixteen syllables each.

4  Salya-Tantram: Salya refers to a sharp, painful object; the Salya-Tantram is the practice of removing factors causing pain.

5  Shalakya-Tantram: Shalakya refers to a small, sharp instrument, such as a needle or a tool, used in surgery; Kaviraj Kunja Lal Bhishagratna, the translator of this edition (the first in English), asserts that the branch is named for the instrument because of its frequent use in treating conditions of the head and neck.

6  Káya Chikitsá: Literally, this refers to medical treatments of the body, so it is best understood as generalized medicine.

7  Hemoptysis: Coughing up blood.

8  Gandharvas, Yakshas, Rakshas: Classes of supernatural entities in Hindu mythology.

9  The Purusha: The text elsewhere defines this as a self-conscious organic individual composed of the soul and the five primary material principles [earth, water, fire, air, and sky (or ether)] (9). Translator Bhishagratna further notes that Purusha, so defined, seems to signal that the body rather than the Self or Ego (which is, per the translator, above all human concerns) is thus the purview of Ayurvedic medicine.

10  Translator Bhishagratna notes that this cleansing takes two forms: external (by way of surgical methods or topical treatments) and internal (by way of purgatives like emetics, enemas and bloodletting).

11  The Brahmana, the Kshatriya, and the Vaishya: Hinduism classified society into four Varnas (or castes); The Brahmana was the class of scholars, teachers, and priests; the Kshatriya was the class of leaders and warriors; and the Vaishya was the agricultural class. Left out of medical study entirely were the Shudra (the labor class) and the Avarna, or those outside of the caste system.

The History of the Peloponnesian War

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THUCYDIDES

(Greek, ca. 460–400 BCE)

The historian Thucydides’s The History of the Peloponnesian War (ca. 431 BCE) recounts twenty-one of the actual conflict’s twenty-eight years (431–404 BCE), and his style has influenced the genre of historical writing ever since. The work discusses the so-called Plague of Athens, which struck the city in 430 BCE and wiped out roughly one-quarter of its inhabitants. Thucydides’s work has been praised not just as history but also as medical narrative and as literature. It’s unclear the extent to which Thucydides paints a complete picture of the epidemic, for which scholars have never determined a precise cause. As you read, consider his attempt to trace a devastating disease’s path and its impact on those in that path.

[The Plague at Athens]

In the first days of summer the Lacedaemonians¹ and their allies, with two-thirds of their forces as before, invaded Attica, under the command of Archidamus, son of Zeuxidamus, King of Lacedaemon, and sat down and laid waste the country.² Not many days after their arrival in Attica the plague³ first began to show itself among the Athenians. It was said that it had broken out in many places previously in the neighborhood of Lemnos and elsewhere; but a pestilence of such extent and mortality was nowhere remembered. Neither were the physicians at first of any service, ignorant as they were of the proper way to treat it, but they died themselves the most thickly, as they visited the sick most often; nor did any human art succeed any better. Supplications in the temples, divinations, and so forth were found equally futile, till the overwhelming nature of the disaster at last put a stop to them altogether. It first began, it is said, in the parts of Ethiopia above Egypt, and thence descended into Egypt and Libya and into most of the King’s country. Suddenly falling upon Athens, it first attacked the population in Piraeus—which was the occasion of their saying that the Peloponnesians had poisoned the reservoirs, there being as yet no wells there—and afterwards appeared in the upper city, when the deaths became much more frequent. All speculation as to its origin and its causes, if causes can be found adequate to produce so great a disturbance, I leave to other writers, whether lay or professional;⁴ for myself, I shall simply set down its nature, and explain the symptoms by which perhaps it may be recognized by the student, if it should ever break out again. This I can the better do, as I had the disease myself, and watched its operation in the case of others. That year then is admitted to have been otherwise unprecedentedly free from sickness; and such few cases as occurred all determined in this. As a rule, however, there was no ostensible cause; but people in good health were all of a sudden attacked by violent heats in the head, and redness and inflammation in the eyes, the inward parts, such as the throat or tongue, becoming bloody and emitting an unnatural and fetid breath. These symptoms were followed by sneezing and hoarseness, after which the pain soon reached the chest, and produced a hard cough. When it fixed in the stomach, it upset it; and discharges of bile of every kind named by physicians ensued, accompanied by very great distress. In most cases also an ineffectual retching followed, producing violent spasms, which in some cases ceased soon after, in others much later. Externally the body was not very hot to the touch, nor pale in its appearance, but reddish, livid, and breaking out into small pustules and ulcers. But internally it burned so that the patient could not bear to have on him clothing or linen even of the very lightest description; or indeed to be otherwise than stark naked. What they would have liked best would have been to throw themselves into cold water; as indeed was done by some of the neglected sick, who plunged into the rain-tanks in their agonies of unquenchable thirst; though it made no difference whether they drank little or much. Besides this, the miserable feeling of not being able to rest or sleep never ceased to torment them. The body meanwhile did not waste away so long as the distemper was at its height, but held out to a marvel against its ravages; so that when they succumbed, as in most cases, on the seventh or eighth day to the internal inflammation, they had still some strength in them. But if they passed this stage, and the disease descended further into the bowels, inducing a violent ulceration there accompanied by severe diarrhea, this brought on a weakness which was generally fatal. For the disorder first settled in the head, ran its course from thence through the whole of the body, and, even where it did not prove mortal, it still left its mark on the extremities; for it settled in the privy parts, the fingers and the toes, and many escaped with the loss of these, some too with that of their eyes. Others again were seized with an entire loss of memory on their first recovery, and did not know either themselves or their friends.

But while the nature of the distemper was such as to baffle all description, and its attacks almost too grievous for human nature to endure, it was still in the following circumstance that its difference from all ordinary disorders was most clearly shown. All the birds and beasts that prey upon human bodies, either abstained from touching them (though there were many lying unburied), or died after tasting them. In proof of this, it was noticed that birds of this kind actually disappeared; they were not about the bodies, or indeed to be seen at all. But of course the effects which I have mentioned could best be studied in a domestic animal like the dog.

Such then, if we pass over the varieties of particular cases which were many and peculiar, were the general features of the distemper. Meanwhile the town enjoyed an immunity from all the ordinary disorders; or if any case occurred, it ended in this. Some died in neglect, others in the midst of every attention. No remedy was found that could be used as a specific; for what did good in one case, did harm in another. Strong and weak constitutions proved equally incapable of resistance, all alike being swept away, although dieted with the utmost precaution. By far the most terrible feature in the malady was the dejection which ensued when any one felt himself sickening, for the despair into which they instantly fell took away their power of resistance, and left them a much easier prey to the disorder; besides which, there was the awful spectacle of men dying like sheep, through having caught the infection in nursing each other. This caused the greatest mortality. On the one hand, if they were afraid to visit each other, they perished from neglect; indeed many houses were emptied of their inmates for want of a nurse: on the other, if they ventured to do so, death was the consequence. This was especially the case with such as made any pretensions to goodness: honor made them unsparing of themselves in their attendance in their friends’ houses, where even the members of the family were at last worn out by the moans of the dying, and succumbed to the force of the disaster. Yet it was with those who had recovered from the disease that the sick and the dying found most compassion. These knew what it was from experience, and had now no fear for themselves; for the same man was never attacked twice—never at least fatally. And such persons not only received the congratulations of others, but themselves also, in the elation of the moment, half entertained the vain hope that they were for the future safe from any disease whatsoever.

An aggravation of the existing calamity was the influx from the country into the city, and this was especially felt by the new arrivals. As there were no houses to receive them, they had to be lodged at the hot season of the year in stifling cabins, where the mortality raged without restraint. The bodies of dying men lay one upon another, and half-dead creatures reeled about the streets and gathered round all the fountains in their longing for water. The sacred places also in which they had quartered themselves were full of corpses of persons that had died there, just as they were; for as the disaster passed all bounds, men, not knowing what was to become of them, became utterly careless of everything, whether sacred or profane. All the burial rites before in use were entirely upset, and they buried the bodies as best they could. Many from want of the proper appliances, through so many of their friends having died already, had recourse to the most shameless sepultures:⁵ sometimes getting the start of those who had raised a pile, they threw their own dead body upon the stranger’s pyre and ignited it; sometimes they tossed the corpse which they were carrying on the top of another that was burning, and so went off. Nor was this the only form of lawless extravagance which owed its origin to the plague. Men now coolly ventured on what they had formerly done in a corner, and not just as they pleased, seeing the rapid transitions produced by persons in prosperity suddenly dying and those who before had nothing succeeding to their property. So they resolved to spend quickly and enjoy themselves, regarding their lives and riches as alike things of a day. Perseverance in what men called honor was popular with none, it was so uncertain whether they would be spared to attain the object; but it was settled that present enjoyment, and all that contributed to it, was both honorable and useful. Fear of gods or law of man there was none to restrain them. As for the first, they judged it to be just the same whether they worshiped them or not, as they saw all alike perishing; and for the last, no one expected to live to be brought to trial for his offenses, but each felt that a far severer sentence had been already passed upon them all and hung ever over their heads, and before this fell it was only reasonable to enjoy life a little.

Such was the nature of the calamity, and heavily did it weigh on the Athenians; death raging within the city and devastation without. Among other things which they remembered in their distress was, very naturally, the following verse which the old men said had long ago been uttered:

A Dorian war shall come and with it death. So a dispute arose as to whether dearth and not death had not been the word in the verse; but at the present juncture, it was of course decided in favor of the latter; for the people made their recollection fit in with their sufferings. I fancy, however, that if another Dorian war should ever afterwards come upon us, and a dearth should happen to accompany it, the verse will probably be read accordingly. The oracle also which had been given to the Lacedaemonians was now remembered by those who knew of it. When the god was asked whether they should go to war, he answered that if they put their might into it, victory would be theirs, and that he would himself be with them. With this oracle events were supposed to tally. For the plague broke out as soon as the Peloponnesians invaded Attica, and never entering Peloponnese (not at least to an extent worth noticing), committed its worst ravages at Athens, and next to Athens, at the most populous of the other towns. Such was the history of the plague.

* Reprinted from Thucydides, The History of the Peloponnesian War, trans. Richard Crawley (London: Longmans, Green, 1874), chap. 7, 129–34, Internet Classics Archive.

1  Lacedaemonians: Inhabitants of the region of Greece that included the city of Sparta.

2  Laid waste the country: A reference to the Peloponnesian War (431–405 BCE), fought between Athens and Sparta.

3  Plague: Although most translations use the term plague, some translators have opted for less limiting terms to avoid conclusively linking the epidemic to bubonic plague Helen King and Jo Brown, Thucydides and the Plague, in A Handbook to the Reception of Thucydides, eds. Christin Lee and Neville Morley (Hoboken, NJ: Wiley, 2014), 452.

4  The speculation Thucydides mentions here has yet to be resolved. Although bubonic plague has been considered, a wide range of other causes have also been suggested, including (but not limited to) smallpox, typhus, influenza, and strains of viral hemorrhagic fever.

5  Sepultures: Burials. Thucydides refers here to people failing or refusing to adhere to traditional burial customs, which included careful preparation of the body and either burial or individual cremation.

The Hippocratic Corpus

*

VARIOUS AUTHORS

(Greek, compiled ca. fourth century BCE)

Hippocrates of Cos (ca. 460–ca. 375 BCE) was a Greek physician who some now call the father of medicine. His legacy includes a collection of around sixty texts known as the Hippocratic corpus. This collection was written over the course of the fifth and fourth centuries BCE by a range of mostly unidentified authors—the debate about how many Hippocrates wrote himself continues. Below are excerpts from the Corpus. As you read, consider how The Law approaches the status of medicine and its requirements for those who wish to study it. In the The Oath, which has, through various translations and revisions, come down to us as the Hippocratic oath, consider the ethical foundations being laid. And in On the Nature of Man,¹ which is here presented in the form of an epitome, or abstract, rather than a full translation, consider the Hippocratic description of the theory of the four humors, which would come to be a dominant system of medicine in the second century CE and remain influential well into the nineteenth century.

The Oath

I swear by Apollo the physician, and Aesculapius, and Health, and Allheal,² and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.³ With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work.⁴ Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

The Law

Medicine is of all the Arts the most noble; but, not withstanding, owing to the ignorance of those who practice it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts. Their mistake appears to me to arise principally from this, that in the cities there is no punishment connected with the practice of medicine (and with it alone) except disgrace, and that does not hurt those who are familiar with it. Such persons are like the figures which are introduced in tragedies, for as they have the shape, and dress, and personal appearance of an actor, but are not actors, so also physicians are many in title but very few in reality.

Whoever is to acquire a competent knowledge of medicine, ought to be possessed of the following advantages: a natural disposition; instruction; a favorable position for the study; early tuition; love of labor; leisure. First of all, a natural talent is required; for, when Nature opposes, everything else is in vain; but when Nature leads the way to what is most excellent, instruction in the art takes place, which the student must try to appropriate to himself by reflection, becoming an early pupil in a place well adapted for instruction. He must also bring to the task a love of labor and perseverance, so that the instruction taking root may bring forth proper and abundant fruits.

Instruction in medicine is like the culture of the productions of the earth. For our natural disposition is, as it were, the soil; the tenets of our teacher are, as it were, the seed; instruction in youth is like the planting of the seed in the ground at the proper season; the place where the instruction is communicated is like the food imparted to vegetables by the atmosphere; diligent study is like the cultivation of the fields; and it is time which imparts strength to all things and brings them to maturity.

Having brought all these requisites to the study of medicine, and having acquired a true knowledge of it, we shall thus, in traveling through the cities, be esteemed physicians not only in name but in reality. But inexperience is a bad treasure, and a bad fund to those who possess it, whether in opinion or reality, being devoid of self-reliance and contentedness, and the nurse both of timidity and audacity. For timidity betrays a want of powers, and audacity a want of skill. There are, indeed, two things, knowledge and opinion, of which the one makes its possessor really to know, the other to be ignorant.

Those things which are sacred, are to be imparted only to sacred persons; and it is not lawful to import them to the profane until they have been initiated in the mysteries of the science.

On the Nature of Man

Now the body of man contains blood, pituita, and two kinds of bile— yellow and black;⁵ and his nature is such that it is through them that he enjoys health, or suffers from disease. He enjoys the former when each is in due proportion of quantity and force, but especially when properly commingled. Disease takes place if either is in excess or deficient, or if not duly united. For when separate, not only the part in which there is deficiency must be affected, but the part to which it goes being surcharged, will experience pain and uneasiness. When more than a mere superfluity is discharged from the system, the void occasioned thereby is productive of pain; but if this void is caused by the separation of the humors in one part, and being carried by metastasis to another, the pain is twofold, viz.: that induced by the vacuity of the part it leaves, and the repletion of that to which it is conveyed. I have stated that I would show, that those things of which man is composed remain always the same, both from their nature, and their true intent. Now I say that blood, pituita, and yellow and black bile are invariable the same and at all times so considered, since none of those terms are at all equivocal, or liable to any obscurity; and moreover, the things themselves are in their nature entirely distinct—for pituita in no respect resembles blood, nor does blood resemble bile, nor bile pituita….

The human body has, therefore, constantly, all the above humors; but they increase or diminish, each according to the season, as it may be conformable or otherwise to their nature respectively. As, throughout the year, there is always present both heat and cold, dryness and moisture, and as nothing in nature could for an instant exist without their presence; if one alone was wanting, universal destruction would be the result; for the same law that subserved the creation of all things, is equally required for their preservation. It is the same with man; if one of those things that are essential to his constitution, were destroyed, he could not possibly exist.

* The Oath and The Law reprinted from The genuine works of Hippocrates, trans. Francis Adams (New York: W. Wood, 1886), 278–80, 283–85. "On the Nature of Man" reprinted from The Writings of Hippocrates and Galen, Epitomised from the Original Latin Translations, trans. John Redman Coxe (Philadelphia: Lindsay and Blackiston, 1846), 150–51, 153. Internet Classics Archive.

1  The author of On the Nature of Man has been identified as Polybus, a student and son-in-law of Hippocrates himself.

2  Aesclepius: The son of Apollo and god of medicine who was the father of five daughters, all associated with medicine. The author mentions Health, or Hygieia (goddess of hygiene) and All-heal, or Panacea (goddess of universal remedy).

3  Hippocrates only forbids one of several known abortion methods. While some legal restrictions on terminating pregnancy existed at the time, the practice was legally allowed and medically condoned. In other texts, Hippocrates offers some approved methods. Hippocrates rejected the use of the pessary—essentially a rigid block infused with herbs and/or chemicals inserted directly into the vagina to induce abortion—because of its potential to cause serious infection in the pregnant woman.

4  For centuries, physicians and surgeons were very different professions, and they had little overlap in training and practice, though they would share some knowledge. Here, the author promises not to perform lithotomy, which is surgery to remove calculi (stones) from kidneys, bladders, or gallbladders.

5  Pituita: Typically translated as phlegm, which would become most common in the English-language discussion of the four humors. Yellow bile is also known as choler, and black bile is known as melancholy.

On the Nature of Things

(De rerum natura)

*

LUCRETIUS

(Roman, ca. 94–55 BCE)

Titus Lucretius Carus’s life is largely a mystery: only one contemporary account of the poet and philosopher exists, in a letter by Cicero.¹ Lucretius’s one surviving work written in 50 BCE is a long didactic (educational) poem of Epicurean philosophy and Natural Philosophy, an early term for science. Epicureanism sought happiness through the absence of pain and anxiety, and it offered a detailed theory of knowledge and nature. Lucretius’s work takes on some of these concerns, covering theories of physics (including early notions of atoms), the nature of the human soul, and cosmic and natural phenomena. Though popular in its own time, the poem was lost for several centuries. It was rediscovered by Renaissance humanist scholar Poggio Bracciolini in a German monastery in 1417. As you read these excerpts, drawn from William Ellery Leonard’s influential 1916 translation, consider the description of the relationship between the body and the mind, as well as the work’s understanding of plagues and disease.

Book III

Then, too, we see, that, just as body takes

Monstrous diseases and the dreadful pain,

So mind its bitter cares, the grief, the fear;

Wherefore it tallies that the mind no less

Partaker is of death; for pain and disease

Are both artificers of death,—as well

[5]

We’ve learned by the passing of many a man ere now.²

Nay, too, in diseases of body, often the mind

Wanders afield; for ’tis beside itself,

And crazed it speaks, or many a time it sinks,

With eyelids closing and a drooping nod,

[10]

In heavy drowse, on to eternal sleep;

From whence nor hears it any voices more,

Nor able is to know the faces here

Of those about him standing with wet cheeks

Who vainly call him back to light and life.

[15]

Wherefore mind too, confess we must, dissolves,

Seeing, indeed, contagions of disease

Enter into the same….

And, since we mark the mind itself is cured,

Like the sick body, and restored can be

[20]

By medicine, this is forewarning to

That mortal lives the mind. For proper it is

That whosoe’er begins and undertakes

To alter the mind, or meditates to change

Any another nature soever, should add

[25]

New parts, or readjust the order given,

Or from the sum remove at least a bit.

But what’s immortal willeth for itself

Its parts be nor increased, nor rearranged,

Nor any bit soever flow away:

[30]

For change of anything from out its bounds

Means instant death of that which was before.

Ergo, the mind, whether in sickness fallen,

Or by the medicine restored, gives signs,

As I have taught, of its mortality.

[35]

So surely will a fact of truth make head

’Gainst errors’ theories all, and so shut off

All refuge from the adversary, and rout

Error by two-edged confutation.

And since the mind is of a man one part,

[40]

Which in one fixed place remains, like ears,

And eyes, and every sense which pilots life;

And just as hand, or eye, or nose, apart,

Severed from us, can neither feel nor be,

But in the least of time is left to rot,

[45]

Thus mind alone can never be, without

The body and the man himself, which seems,

As ’twere the vessel of the same—or aught

Whate’er thou’lt feign as yet more closely joined:

Since body cleaves to mind by surest bonds.

[50]

Again, the body’s and the mind’s live powers

Only in union prosper and enjoy;

For neither can nature of mind, alone of itself

Sans body, give the vital motions forth;

Nor, then, can body, wanting soul, endure

[55]

And use the senses.

Book VI

Now, of diseases what the law, and whence

The Influence of bane upgathering can

Upon the race of man and herds of cattle

Kindle a devastation fraught with death,

I will unfold.³ And, first, I’ve taught above

[5]

That seeds there be of many things to us

Life-giving, and that, contrariwise, there must

Fly many round bringing disease and death.⁴

When these have, haply, chanced to collect

And to derange the atmosphere of earth,

[10]

The air becometh baneful. And, lo, all

That Influence of bane, that pestilence,

Or from Beyond down through our atmosphere,

Like clouds and mists, descends, or else collects

From earth herself and rises, when, a-soak

[15]

And beat by rains unseasonable and suns,

Our earth hath then contracted stench and rot.⁵

Seest thou not, also, that whoso arrive

In region far from fatherland and home

Are by the strangeness of the clime and waters

[20]

Distempered?—since conditions vary much.

For in what else may we suppose the clime

Among the Britons to differ from Egypt’s own

(Where totters awry the axis of the world),⁶

Or in what else to differ Pontic clime

[25]

From Gades’⁷ and from climes adown the south,

On to black generations of strong men

With sun-baked skins? Even as we thus do see

Four climes diverse under the four main-winds

And under the four main-regions of the sky,

[30]

So, too, are seen the color and face of men

Vastly to disagree, and fixed diseases

To seize the generations, kind by kind:

There is the elephant-disease⁸ which down

In midmost Egypt, hard by streams of Nile,

[35]

Engendered is—and never otherwhere.

In Attica the feet are oft attacked,⁹

And in Achaean lands the eyes.¹⁰ And so

The divers spots to divers parts and limbs

Are noxious; ’tis a variable air

[40]

That causes this.¹¹ Thus when an atmosphere,

Alien by chance to us, begins to heave,

And noxious airs begin to crawl along,

They creep and wind like unto mist and cloud,

Slowly, and everything upon their way

[45]

They disarrange and force to change its state.

It happens, too, that when they’ve come at last

Into this atmosphere of ours, they taint

And make it like themselves and alien.

Therefore, asudden this devastation strange,

[50]

This pestilence, upon the waters falls,

Or settles on the very crops of grain

Or other meat of men and feed of flocks.

Or it remains a subtle force, suspense

In the atmosphere itself; and when therefrom

[55]

We draw our inhalations of mixed air,

Into our body equally its bane

Also we must suck in. In manner like,

Oft comes the pestilence upon the kine,¹²

And sickness, too, upon the sluggish sheep.

[60]

Nor aught it matters whether journey we

To regions adverse to ourselves and change

The atmospheric cloak, or whether Nature

Herself import a tainted atmosphere

To us or something strange to our own use

[65]

Which can attack us soon as ever it come.

* Reprinted from Lucretius, De Rerum Natura, trans. William Ellery Leonard (New York: E. P. Dutton, 1916), 109–12, 293–95. Perseus Digital Library.

1  The most enduring biography of the author, by Jerome, is short, fairly unreliable, and claims that Lucretius was driven mad by a love potion, wrote only during brief moments of lucidity, and eventually committed suicide before completing On the Nature of Things.

2  Lucretius argues, in book III, that the human mind and spirit are composed of physical matter, like the body, and that they are therefore also mortal and subject to the experience of sickness (like the body). In this excerpt, he explores this idea.

3  The final part of this poem takes on the Athenian plague of 431 BCE. Lucretius’s description is based entirely on the account provided by the historian Thucydides; see The Plague at Athens, pp. 20–25). This excerpt immediately precedes that description,