* copy editor: Adam Christian von Wald The Symptoms of Health and Illness * Karl Bühler 1. Hippocrates. There is a score of reasons why physicians admire Hippocrates and call him the father of medicine. A holy oath formulating the moral and financial attitude of an ideal physician toward his patients is not the only feature which is admirable in the Hippocratic school of doctors. But leading more directly to our theme is the fact that out of this school sprang symptomatology as we know it. From where they lived, on the little island of Cos in the Mediterranean, these ancient Greek physicians could see the coast line of Asia minor, the habitat of other Greeks and of another school of physicians, the physicians on the peninsula of Knidos. Philosophers were the doctors there, Hippocrates was not. Epidauros was a third medical center on the main peninsula of Greece; Epidauros was a place of pilgrimage for patients. Inscriptions on excavated stones there now tell a vivid story of healings in temples. The doctors of Epidauros were not friends of Hippocrates though. A pamphlet of his, possibly written by one of his pupils, expresses better than anything else the background of his opposition against Epidauros. A pamphlet written about ‘epilepsy’; or better said, on mental diseases (the term being vague and by no means restricted to what we would call epilepsy). Even mental diseases were claimed a natural phenomena by Hippocrates. The very word ‘nature’ (physis) is his in the history of medicine; it is his as a specific idea and scientific term. Unlike philosophy, meaning the kind of philosophy which his colleagues in Knidos applied, or spiritism, the Hippocratic medicine was principally based on simple observation and the collection of facts at the patient’s bedside. These observations were the symptoms that one picks up with watchful eyes, ears, nose, touch and even taste at the bedside of a patient; Hippocrates did all this in a scientific way and trained his pupils to do likewise. If science is critical, purified, and organized (logically generalized) knowledge, then the Hippocratic physicians were striving for science in medicine. The other side of the ledger, however, was neglected by them, though this is also extremely important. On the under side of a sign, that which is perceptible, is always its significance. In the medical sense of the word ‘significant’ perceptible things are symptoms. Illnesses have had names, of course, since times immemorial; but Hippocrates was a revolutionary and image breaker (iconoclast) in matters of illnesses. By the ‘simple’ means of case studies and writing down case-histories his pupils learned to revise again and again the whole picture gallery of diseases; and this, one would think, once started should have gone on forever. But it has never been that simple in any sector of the history of science. It couldn’t happen this way for many reasons. One of them is that no iconoclast, after tearing down an K O D I K A S / C O D E Ars Semeiotica Volume 28 (2005) No. 1-2 Gunter Narr Verlag Tübingen Karl Bühler 32 old theory, could ever help but to erect a new picture gallery that would soon be fixed and then need to be torn down in it’s own time too. In matters of signs and signified things, symptoms and what they originally symptomized were unabridged and far apart from one another. What symptoms symptomize is that single something we have in mind when naming certain evil happenings of health. What is behind it’s perceptible symptoms? For instance in scarlatina? Well, the experts have ideas about it nowadays and since time immemorial have had their general ideas about illness and some more concrete ideas about this or that impressive group of them. The impressive group of acute, infectious diseases was given special attention by the Hippocratic physicians. It is generally known that they speculated on fever, finding more evidence for the belief that fever was a beneficial factor rather than a detrimental one in infectious diseases; though not (so they restricted) when the fever was excessively high. It is also generally known that the Hippocratic doctors were able to separate some acute diseases from one another in their diagnoses and that they had certainly noticed the critical days; for instance in pneumonia. But more important from the viewpoint of symptomatology are the following general ideas in their doctrine of illness. The difference between health and illness was looked upon and illustrated by things the Greeks were familiar with in nature. The Greeks studied harmony and disharmony in music and arts and gained some of the first mathematical insight into which combinations of tones were harmonious; furthermore, they speculated over a possible application of the law of harmony to other phenomena. The marvelous regularity in the movements of stars was seen as a kind of harmony. The ‘spheric harmony’ of the well-ordered cosmos (universe) above us was seen in contrast to many chaotic things one finds on earth. Now this same idea of harmony and disharmony, so dear to mathematically and art minded people, was applied by Hippocrates to the field of health and disease. Diseases are disorders while health means harmony, he believes. A fundamental assumption, no doubt; but beware of going further and filling it with more than it really was; it was a model conception and couldn’t have been more during Hippocrates’ time. Today we think in terms of mechanics and say the harmony of health is a kind of equilibrium, from which deviations (diseases) can be measured. The physics at that time provided no means for Hippocrates to take such a decisive step in his theories. He knew that fever arises in some bodily disharmonies from his hands-on treatment of patients; also breathing and pulse were within the realm of his observations. And sweating and those other observable things such as changes of urine in fever and characteristic profusions of shine. Taken all together one understands the second great concept developed by the father of medicine; it is the fluids of the body, he thought, where those disharmonies occur. Therefore, he payed attention to and studied the humors of the body and speculated so far on this ground that eventually even the phenomena of temperature in health or disease came under the headline of humors. In English humor is both a liquid or merriment (‘the tendency to look at things from the mirthful side’ according to Webster). Humor was both for Hippocrates as well or rather there was a connection between the two in his speculative medicine; he made no definite distinction between body and mind. It belonged, he thought, to human nature (physis in his words) even in healthy days to have a surplus either of blood, slime, bile or black-bile and that meant one had one of the four temperaments into which he divided his patients. What is physis? A word that came in handy but was not defined in the several volumes of pamphlets and fundamental works written by the master himself or one of Hippocrates’ The Symptoms of Health and Illness 33 family members/ pupils. Nowhere in this Corpus Hippocraticum of publications that were preserved and traditionally ascribed to him, is there a definition or elaborate discussion on what physis means. To say it meant the organism as a whole probably is the best interpretation. For, Hippocrates was the kind of a doctor to whom it seemed clear as the day that the whole frame is involved if somebody is earnestly ill. So he doesn’t explain what ‘physis’ means exactly, saying only what physis does. It’s physis that obviously heals in many cases; a good doctor is but the helper of physis. In another section Hippocrates says even more about it. Physis does, he teaches, the right thing when healing not due to experience, not after a special training and not by insight (apeiros, apaidendos, ouk ek dianoias are the words in Greek). Physis, according to this statement, was certainly not meant as a kind of little creature, ghost or homunculus within the patient; nor as the beneficial result of good or bad experiences. Furthermore, physis was not successful because a teacher had trained him as he does with children, or by reasoning as we adults. If Hippocrates, in giving this formula, had thought of animals and how they do things beneficent to themselves, we would say he speaks of instinct. But he certainly had his patients in mind, and not animals like Aristotle who learned from Hippocrates in many points and framed the term instinct (in Greek: horme).