II
In the Indian Caraka Samhitā the emergence of
diseases prompts the great sages, compassionate doers
of good, to acknowledge that “Health is the supreme
foundation of virtue, wealth and enjoyment, and salva-
tion,” and that “diseases are the destroyers of health,
of the good of life, and even of life itself.” They send
a messenger to Indra to ask him how to remedy dis-
eases, whereupon the god teaches the messenger the
science of life, which begins with general speculations
on the world, on causality, on man and his components,
viz., mind, spirit, and body. Body and mind are the
dwelling places of health, as well as of disease. Wind,
bile, and phlegm are the three “dosa” responsible for
disease in the body, while passion and delusion cause
disease of the mind. Somatic and spiritual remedies
help in the former, whereas the latter must be ap-
proached through “religion, philosophy, fortitude, re-
membrance and concentration” (Sutrasthana, Ch. I).
Both health and disease thus have their place in a
religious, philosophical, and medical sphere. Diseases
originate from a wide range of external or internal
causes of a somatic or psychological nature; but
demons are still one of the possibilities.
In India, medicine, ayurveda, is the veda of
longevity. Similarly, in China, health and disease are
incorporated into the philosophy of the Tao and the
two polar principles, the yin and the yang. Health and
disease are now states of the human microcosm, which
has its parallel in the macrocosm. In accordance with
the role played in Tao philosophy and practice by the
notion of prolonging life, health and longevity tend
to be identified. However, there is a gulf between the
natural association of good health and long life on the
one hand, and the association of health and potential
immortality on the other. Western religions and, until
the eighteenth century at least, prevailing Western
philosophy too, thought of death as man's unavoidable
fate (Gruman, 1966). The same is true of Buddhism.
“So this is life! Youth into old age, health into disease”
(Dhammapada). This was the insight that started Prince
Siddhartha on the long journey leading to his illumina-
tion as Buddha. His four noble truths have been com-
pared with the questions an Indian physician would
ask himself when confronted with a patient: Is he ill,
what is the nature and cause of his illness, is the dis-
ease curable, what treatment is indicated? (Zimmer,
1948). But Buddha's goal of treatment was not im-
mortality; it was Nirvana, eventual extinction.
For the Greeks, too, health was one of the greatest
goods. To be healthy, said Theognis (frag. 255), is the
“most desirable” thing. The high level of Greek med-
icine is, in itself, a sign that disease was abhorred.
Hygiene, the maintenance of health, played a very
great role, above all for the well-to-do, who were
expected to devote much of their time to it. For the
philosopher, health had its value as the necessary basis
for the practice of virtue. But since health does not
altogether depend on man's actions, the Stoic philoso-
phers did not declare health an absolute value. The
sage was superior to all disease, of body as well as of
soul (Cicero, Tusculan Disputations, III, xxxiv, 82), but
this did not prevent Stoic philosophers from taking
great interest in the minute classification and subdivi-
sions of disturbances (perturbationes; ibid., IV, x, 23ff.).
They thought of disturbances of the mind, discussing
them in analogy to bodily diseases. For since early
times, disease, to the Greeks, was a somatic disturbance
with manifestations that could be somatic or psychic.
The causes of disease could be many; gods, too, could
send diseases and could cure them, as they could cause
or alleviate any disaster. But Greek physicians and
philosophers agreed that disease was a natural process,
so that the secularization of the concept of disease was
limited only by the divinity of nature herself. A Greek
physician of about 400 B.C. could, therefore, say that
all diseases were divine and all were human (Hip-
pocrates, On the Sacred Disease, Ch. XXI), thereby
meaning that all diseases had their roots in the body
and in human actions and were influenced by external
agencies which, like cold, sun, and winds, were divine.
Epidemic diseases were attributed to pollutions
(miasmata) in the air inhaled by all the people of an
afflicted region. The miasmata might be caused by the
action of the sun, which replaced the sun god Apollo,
who, according to the myth, had inflicted a plague
upon Thebes which was polluted by the deeds of
Oedipus (Sophocles, Oedipus the King, 96-98).
Medical speculations on the origin of disease paid
little attention to divine or magic interference, but all
the more to mistakes in the way of life, above all in
diet (Hippocrates, On Ancient Medicine, Ch. III). Some
four hundred years later, the Latin author Celsus be-
lieved that in Homeric times health had been generally
good. Indolence and luxury had later spoiled man and
led to much disease. Therapy fell into the hands of
physicians who treated by means of diet, and who
became interested in natural philosophy (De medicina,
prooemium, 1-5 and 9).
On the practical side, dietetic treatment paralleled
practices of the athletic trainers. On the theoretical
side, it went together with a view of health as balance,
harmony, symmetry, and of disease as their disturbance.
Using political metaphors, Alcmaeon of Croton (fifth
century B.C.) taught that health was maintained by the
balance (isonomia) of such powers as moist, dry, cold,
hot, bitter, sweet, whereas disease was caused by single
rule (monarchia) (frag. 4). Other explanations were
offered in terms of elements, body fluids (humors), or
atoms. In the second century A.D. Galen, in the tradi-
tion of Hippocratic, Platonic, Aristotelian, and Stoic
ideas, elaborated a doctrine which was schematically
systematized in late antiquity and then remained
dominant till the seventeenth century. Four basic
qualities in binary combinations characterized four
elements which had their analogues in the four princi-
pal humors of the body. Hot and dry corresponded
to fire and yellow bile, hot and moist to air and blood,
cold and dry to earth and black bile, cold and moist
to water and phlegm. These analogues could be ex-
tended to the ages of man, the season, and winds, so
that man in health and disease was explicable in terms
of natural philosophy. The humors were products of
digested food and of metabolism, and man's functions
were regulated from the anatomical centers of liver,
heart, and brain, from which veins, arteries, and nerves
originated, and in which the natural soul, the vital soul,
and the rational soul, respectively, had their seats. The
soul had somatic, as well as psychological, functions:
the natural soul represented man's appetites and regu-
lated his nutrition; the vital soul represented the pas-
sions, especially anger, and regulated the body heat
through the
pneuma of the arteries; the rational soul
accounted for thinking, feeling, and willing, receiving
messages and imparting its commands via the nerves.
Man was in good health if his body, its parts and
humors, had the temperament proper to them, and
when the structure and functions of the organs were
intact. Otherwise there was disease, as a consequence
of which all possible symptoms could befall the patient.
In view of the labile condition of the body, ideal health
was rarely attained. But only when there was pain,
and when a man was impeded in the functions of his
personal and civic life, was actual disease considered
to be present. There existed a borderland of relative
health between perfection and actual disease.
Such a concept of health and disease rests on a
teleologically conceived biology. All parts of the body
are built and function so as to allow man to lead a
good life and to preserve his kind. Health is a state
according to Nature; disease is contrary to Nature. It
is thus possible to speak of disease as a disturbance,
and of health as good, as deteriorating, or as improving.
In its medical aspect the Galenic doctrine grew out
of a particular set of ideas found in the works of
Hippocrates, whose name was given to some seventy
Greek medical writings of about 400 B.C. Many of these
writings, allegedly associated with the island of Cos,
the birthplace of Hippocrates, reveal a strongly indi-
vidualizing approach to disease. It is left to the physi-
cian to combine the many physical and mental symp-
toms into a diagnosis of the particular case.
But that did not exclude recognition of diseases as
entities. The Hippocratics spoke of consumption,
pneumonia, pleurisy, the sacred disease, i.e., epilepsy.
On the last there even exists a monograph which dis-
cusses causes, development, course, and major symp-
toms; it illustrates that a disease was thought of as a
process developing in time. On the other hand, rather
than arrange symptoms into disease pictures, Hippo-
cratic physicians often associated symptoms with the
constitution of their patients, usually expressed in
humoral terms. The four temperaments, phlegmatic,
sanguine, choleric, and melancholic, still spoken of
today, echo a psychosomatic classification of human
constitutions according to the Hippocratic-Galenic
tradition.
In some books of the Hippocratic collection, as-
cribed to the medical center of Cnidos, disease enti-
ties stand in the foreground. Four “diseases” are con-
nected with the kidneys; there is a dropsy coming from
the spleen; the disease “hepatitis” is attributed to the
black bile flowing into the liver. In short, diseases are
classified, ascribed to organs, and, together with their
symptoms, explained in humoral terms. After the ad-
vances made in anatomy from the early third century
B.C., anatomical considerations were given increased
space, for instance in Galen, Rufus of Ephesus, and
Aretaeus.
Not all ancient physicians thought it necessary to
give anatomical and physiological explanations for
disease. The “empiricist” sect, relying on experience
only, tried to assemble the syndromes of diseases but
refrained from dealing with any causes other than such
evident ones as cold, hunger, fatigue. The “methodist”
sect, though it had developed from the atomistic spec-
ulations of Asclepiades (first century B.C.), according
to which the pores of the body could become too wide
or too narrow, was satisfied with acknowledging the
existence of three conditions: constriction, relaxation,
and a mixture of both, conditions recognizable from
the symptoms without recourse to speculation
(Edelstein, 1967).
At the end of antiquity, these sects all but disap-
peared in the Greek-speaking East. The Galenic system
predominated and was inherited by Syrians, Arabs,
Persians, and Jews, to make its entrance into the West
from the eleventh century on. The biological basis of
the Galenic system was little changed. But it was
transferred into a world that looked upon health and
disease otherwise than did the pagans.
