What the World’s First Medical Records Tell Us About
Robin Lane Fox on the History of Epidemics
The Hippocratic books now known as the Epidemics are entitled in Greek epidemiai. This title does not refer to epidemics as we now painfully recognize them, individual diseases which are spread widely through a population, whether by touch, inhaling, contact with wildlife, eating, drinking, kissing (which the elder Pliny, c. AD 70, recognized to be a means of transmitting diseases) or sex, while remaining one and the same disease. In the mid-fifth century BC, the amiable Ion, a poet and author from the island of Chios, composed Epidemiai which referred to his visits to the demos, or people, of individual city-states around the Greek world. His title has sometimes misled readers of the medical Epidemiai into thinking that their title, too, refers to traveling doctors’ visits to particular places. They refer to such visits, but their use of the verb epidemein shows that for them the word epidemia referred to the presence of a disease in a community. It was not necessarily a rampant disease in our sense of the word “epidemic,” and it was not contrasted with diseases which were endemic, a category the authors did not distinguish, but it was certainly a disease at large. This meaning was still correctly understood in later ancient commentaries on the Epidemic books.
By the mid-first century AD, seven books were grouped under this title: the grammarian Erotian referred then to “seven books of Epidemics” in the list of works which he considered, over-optimistically, to be by Hippocrates himself. The title went back to earlier editors, probably at least as early as the third century BC, but it may not have been used by any of the books’ original authors. All seven books share a distinctive feature. Whereas the other texts in the Hippocratic Corpus refer to patients in general, and only once, in passing, name an individual, the Epidemic books are quite different. They contain individual case histories, most of which specify the very place where the named patient lived, even the house or location. They are the very first observations and descriptions of real-life individuals during a number of days which survive anywhere in the world. In Babylonia written case histories of named individuals are unknown.
In China none survives until c. 170 BC, and even then they were presented for a different purpose, to defend their doctor-author’s reputation. In ancient Egypt, cases were discussed individually in the now-famous medical papyri whose contents date back into the second millennium BC, but they never name patients or describe observations of them day after day, let alone locate them at an exact address. The great Edwin Smith papyrus dates to c. 1600 BC, though the contents may be even older, and sets out advice on 43 surgical cases. A typical one begins as follows:
Practices for a sprain in a vertebra of his neck. If you treat a man for a sprain in a vertebra of his neck and you say to him, ‘Look at your shoulders and your middle’ and when he does so it is hard for him to look because of it, then you say about him: ‘One who has a sprain in a vertebra in his neck: an ailment I will handle’.
You have to bandage him with fresh meat the first day. Afterwards you should treat him with alum and honey every day until he gets better.
The case histories in the Epidemic books are personalized, detailed and completely different: they never prescribe an application of useless raw meat. They refer individually to all manner of patients, to adults and children, women of varied status, and even to slaves, both male and female. In her personal poetry Sappho, c. 600 BC, had referred to the rapid sequence of physical effects which were induced in her by the sight of a girl with a man. The Epidemic case histories record carefully observed effects too, but always in other people. They draw on implicit medical thinking and cover a much wider range than Sappho’s self-presentation. Of the 120 case histories, here are seven examples, necessarily some of the shorter ones: the interpretation of a few of the Greek words is still uncertain.
In the seventh book we learn about Parmeniscus, on whom even before, bouts of despondency used to fall and a desire to be rid of life, but at times, a good mood again. In Olynthus [a city in the Chalcidice in northern Greece] once during autumn he was lying in bed, voiceless, keeping quiet, trying just a little to begin to speak: he did just say something and again [became] voiceless. Bouts of sleep occurred but at times, insomnia. Tossing around in silence and distress and a hand on the abdomen as if he was in pain, but at other times, turning away, he lay in silence; without fever [the original Greek text is disputed here, crucially] on through to the end; breathing good; he said later he was recognizing those who came in. As for drink, sometimes he did not want it during the entire day and night when offered it; at other times he would suddenly seize the jar and drink all the water from it. Urine thick like a cart-animal’s. Towards the fourteenth day, that ceased.
Parmeniscus has been diagnosed retrospectively as a clear case of a melancholic attack, attested here before c. 350 BC. However, that diagnosis requires the text in the manuscripts to be emended at a crucial point: the manuscripts read “the fever on through to the end,” but his modern diagnosers change one letter in order to read “without fever to the end.” If they are wrong to do so, Parmeniscus becomes a fever patient, not a plain case of depression: the question remains open.
In the third book we learn:
In Cyzicus [a Greek city-state on the coast of what is now north-west Turkey], for a woman who had given birth to twin daughters and had had a difficult labour and had not been fully cleansed [presumably, a reference to her afterbirth], on the first day, fever with shivering, acute; heaviness of head and neck, with pain. Sleepless from the beginning but silent and sulky and not obedient. Urine thin and colourless. Thirsty, generally nauseous, bowel disturbed and all over the place but then drawn together again.
Sixth day. At night she kept on saying much which rambled; she did not sleep. On the eleventh day she went out of her mind, but then began to make sense again. Urine black, thin and after brief intervals, oily again like olive oil. Bowel passed much which was thin and disorderly.
On the fourteenth day, many convulsions; extremities cold; she was no longer making sense; urine stopped.
On the sixteenth day she lost her voice. On the seventeenth, she died . . .
In the Epidemics’ sixth book, c. 360 BC, we meet two remarkable women, one in Abdera, the other on Thasos just across the sea. Some of the details pose problems of interpretation, but I take them to run as follows:
In Abdera, Phaethousa, wife of Pytheas, keeper of the household, having borne several children previously, but her husband having gone into exile, her periods were stopped for a long time; she then had pains and redness at her joints; when this happened, her body became masculinized and was hairy all over and she grew a beard, and her voice became rough and hard and although we busily did everything to try to draw down her period, it did not come, and she died, having lived for not very long afterwards.
Phaethousa had been looking after the household and had borne several children, an indication in the author’s view that she was a good woman. Though her body was masculinized, she is not implied to have changed sex. The author continues to refer to her in the feminine gender and appears to consider her condition to be an illness. Was she menopausal, a state the Epidemics never mention? To modern readers it may seem that she was transitioning, but the doctor appears to connect her inability to have a period to her husband’s absence and implicitly, therefore, to the interruption of her sex life. In other Hippocratic books, sex is assumed to be beneficial for various female conditions: when the doctors did “everything” to encourage a period, how far did they go?“A woman, who reacted badly to misfortunes, as a result of a grief which had had a cause, was remaining upright; not sleeping; off her food: she was also thirsty and nauseous.”
the same thing befell Nanno wife of Gorgippus; it seemed to all the doctors, among whom I too was present, that the one hope of making her fully female was if the ‘things according to nature’ [her period] were to come, but in her case too it was not possible for them to happen, although [we doctors] did everything, and she died, not slowly.
Again the author continues to refer to Nanno in the feminine gender throughout, and again the doctors did “everything.” He does not conclude that Nanno had changed sex.
Phaethousa and Nanno’s cases have been keenly studied and variously interpreted by Western doctors since the 15th century. They were, however, exceptional. On Thasos, we meet another woman, unnamed, in the Epidemics’ third book whose troubles also related to menstruation, but were traced to a psychological origin:
A woman, who reacted badly to misfortunes, as a result of a grief which had had a cause, was remaining upright; not sleeping; off her food: she was also thirsty and nauseous. She lived near Pylades’ property . . .
On the first day, as night was beginning, fears, talking a lot, discouraged, a slight little fever; early in the morning, many spasms; when most of the spasms left off, she began to talk nonsense and use disgraceful language; many pains, big ones, continuous.
Then on the third day: “the convulsions stopped but sleepiness and dejection set in between waking again; she kept on leaping up, could not contain herself, talked nonsense often.” Then she sweated copiously all over and the fever came to a crisis. Afterwards, she “completely regained her reason . . . around the third day, urine black, thin, with a deposit in it which was often cloudy; it did not settle down; around the time of crisis, she had a heavy period.” To the author’s way of thinking this period was a good sign, as it expelled excess blood. In his view, it outweighed the bad sign, the thin and black state of her urine, and so it helped her to recover.
Young men suffer memorably too. The Epidemics’ fifth and seventh books, c. 360 BC, present young Nicanor and his
affliction, whenever he set off for a drinking party: fear of the girl playing the pipe [the aulos]. Whenever the sound of the pipe was beginning and he heard it playing in the symposium, from the fears [which beset him] he was physically troubled. He said he could hardly abide it at night-time, but if he heard it by day, he was not troubled. This went on for a considerable time.
With Nicanor came Democles, who suffered from blurred vision and was terrified of “crossing a bridge or the slightest depth of a ditch”: he was Nicanor’s companion, coming to the doctor at the same time. Their cases, too, have fascinated modern readers. They have been diagnosed as neurotics suffering from phobia, that late-19th-century invention: were they intensifying each other’s anxieties? What scared Nicanor, the rasping sound of the pipe, not a flute but an instrument close to the type of triple pipe still played in Sardinia? If so, why was he only afflicted by it at night? Was the girl the problem too? A symposium was otherwise an all-male drinking party and it was only in that setting that fears beset him. Or was it the combination of the sound and the darkness?
Excerpted from The Invention of Medicine: From Homer to Hippocrates by Robin Lane Fox. Copyright © 2020 by Robin Lane Fox. Available from Basic Books.