Key words : Crafts, De Diaeta, Heraclitus, Metaphors, Renal tubule

Introduction

Where was Hippocrates educated and by whom? When we say Hippocrates, we mean the author(s) of the Hippocratic corpus. Generally, it is accepted that “he” studied at Cos and Ephesus, and he travelled to Egypt and the area around the Black Sea (Scyhia) and all over Greece, accumulating knowledge. It is also accepted that he was influenced by the Pre-Socratic philosophers. This latter influence is regarded as responsible for the use of metaphors in his writings. The Pre-Socratics used metaphors freely, as the principle of nature as a living entity, whose acts could be understood only by a metaphorical juxtaposition to the already acquired experience of everyday life, was central to their philosophy.

Plato used metaphors, more characteristically the sun, the divided line, and the allegory of the cave.¹ Aristotle was ambivalent. In the Rhetoric, III 10, he endorsed metaphors as a useful rhetorical and pedagogical tool because it allows a speaker to communicate new and complex ideas easily. However, in general, he believed that metaphors lacked the clarity required for philosophical discourse: “everything said metaphorically is unclear,”² a view endorsed by Galen. The Anaxagorean (DK 59 B21a) stated “phenomena are the sight of the hidden,” which best encapsulates this method of inferring conclusions by appealing to analogies from a different, more comprehensible field. The same view (that metaphor makes words more easily understood) is also expressed by Plutarch in Cicero, 40.2, and metaphor is described here as a tool for familiarization, for embracing the unfamiliar and turning it into familiar and known.³

There has been widespread use of medical metaphors in both politics⁴ and religion.⁵ However, Hippocrates lived in the era after the Persian Wars when, starting from Athens, the fundamental ideas of the “Old Regime” were cautiously challenged by the sophists’ movement who were asking for logical and empirical explanations. Plato opposed them fiercely, although not always objectively. One of his main accusations was that the sophists were paid big money to teach philosophy and rhetoric to their students, in contrast with noble philosophers like himself, who taught because of love of teaching and provided it free of charge, as befitting a free Athenian citizen who considered paid labor a disgrace. This is slightly akin to historians of medicine (mainly medical doctors) who are not employed by a university and spend a considerable part of their time and efforts on writing and lecturing on the history of medicine because they love the topic. Needless to say, they, like Plato, have a side source of income.

Broadly speaking, the Ionian tradition was scientific in spirit, whereas the Western Greek philosophy from the start was ethical-religious in its aims.⁶ We suggest that Hippocrates stood physically and intellectually in the middle of the 2 groups, as can be asserted by his treatise On Dreams, in an attitude between Homer, who almost deified dreams, Plato, who cautiously accepted part of them, and Aristotle, who altogether rejected any prognostic value of dreams. Contrary to the common belief that Hippocrates was antireligious, he believed in gods like the philosophers of old, but he was very conscientious, like the sophists, in believing unconditionally all of the “therapies” effected by charlatans in the name of faith.

The present article discusses Hippocrates’ use of the metaphor of the sawing of a tree to explain the function of a human organ. Although this specific example concerns the renal tubule, it can also be used for other organs. It is a common tendency for historians of medicine, and historians in general, to provide evidence of innovation by any person or group they love to study. They go so far as to suggest that tinkerers have always fueled innovation, which is a notion not very far from what Hippocrates suggested via a different path of thought.

The use of knowledge by the outside world, in particular human crafts and tools, offered philosophers and physicians a means of conceptualizing internal processes in the body through analogies and metaphors. Digestion, for example, was compared to cooking and described as a process in which the stomach heated and concocted the food as if it were a cauldron or an oven.⁷ However, crafts do not only indicate to us the function of the body and indirectly of the universe. This is because arts and crafts are socially constructed in certain historical periods.⁸

The merging of crafts and arts was much later exemplified in the Arts and Crafts philosophy in the 19th century. In contrast to the overpowering effects of industry and machinery (what we could now call technology), it insisted on the merits of independent workers who designed the things that they made. Their followers believed factory-made works to be “dishonest” and that handwork and craftsmanship merged dignity with labor.⁹ The same idea reemerged, claiming that craft is a form of resistance. Elsewhere, the increasing popularity of what is called “fabriculture” and craft work was reported as anticapitalist and antiauthoritarian craftivist projects (Cast Off, Craftivism, Anarchist Knitting Circle, MicroRevolt, Anarchist Knitting Mob, Revolutionary Knitting Circle). Thus, crafting never died; it simply spun out into multiple spaces via diverse forms.¹⁰

Contemporary technology borrowed terms from crafts to apply them to other meanings (eg, digits, black hole, the web, knot). In the De diaeta, to limit the scope of this article into a juxtaposition of the sawing movements with the function of the renal tubule, it may suffice as an impressive rhetorical Bengal light but would not illuminate the depth of Hippocrates’ thought in using such a metaphor. This may comply with today’s rhetorical practice to refer to Hippocrates just by recalling some of his quotes without elaborating on their meanings: “It is still unfortunately necessary to argue that metaphor is more than a decorative literary device and that it has cognitive implications whose nature is a proper subject of philosophic discussion.”¹¹

Galen’s concept and appreciation of metaphors are similar to Aristotle’s. The metaphorical thinking entails ambiguity, as explicitly set forth by Aristotle.¹² Hence, metaphor should be banished from the realm of science.

Materials and Methods

We examined the treatise “On Regimen” (also called De diaeta) in Corpus Hippocraticus and the 19th and 20th century works on renal functions. The On Regimen was written at the end of the 5th century /beginning of the 4th century BC. This treatise is not technical or addressed to physicians only. It is addressed to a wider public (“most people”), with the educational goal of enlightening those who care for their health. The first book of the treatise De diaeta and the treatise De hebdomadibus undoubtedly are the most “philosophical” and thus were subjected to devastating criticism by the representative of the empirical school, author of the“treatise On Ancient Medicine,¹³ who considers that speculative theories on human nature and diseases are “cute” past times, like drawing. Although it is Empedocles’ medical philosophy that ultimately inspires the humoral doctrine of human nature, it is Alcmaeon’s theory that underpins the medical therapeutic doctrine proposed in On Ancient Medicine.

The criticisms in Ancient Medicine are echoed in David Gregory’s (17th/18th century) criticism on Kepler’s search for the “archetypal causes, however beautiful,” in which Kepler “seemed more to aspire to and desire a path to Olympus than to scale the heavens with the help of geometry.”¹⁴ Various scholars have found that De diaeta was importantly influenced by only 2 thinkers: Heraclitus and Anaxagoras.^15,16

Hippocrates suggested that the functions of the body echo the functions of the Universe, as organized by gods, and the works of manual workers imitate the same human functions without consciously knowing what they imitate. “Because only the wizers can discern the non phenomena from the phenomena.” This “copy-paste” technique was instilled in them by the divine, unbeknownst to them. Centuries later, Saint Paul repeated a similar view: “By faith we understand that the world was framed by the word of God: that from invisible things visible things might be made.”¹⁷ The descriptions of technical procedures are intended as empirical proof (tekmeria) of Hippocrates’ main fundamental theoretical principle “art imitates nature,” the ancestral principle of the modern ideas on iatromechanics and Iatrophysics, the medical application of physics. These provide an explanation for medical functions using mechanical principles (Figure 1).

Proponents of iatromechanics thought that physiological phenomena in the human body followed the laws of physics. Twenty of the 24 examples of crafts and other human practices that “imitate nature” in the Hippocratic De diaeta book 1 are attested either by authentic fragments from Heraclitus or by their reminiscences. Thus, the influence of Heraclitus on the Hippocratic treatise De diaeta book 1 should be considered doctrinal and comprehensive. However, differences exist between Empedocle’s and Hippocrates’ approach. The Hippocratic author takes the analogies between the various crafts and the cosmic law of harmony, which Heraclitus used as an argument in his ethical-political doctrine, and transfers them into the field of medical dietetics. Hence the original Heraclitean analogy between human craft and universal nature is replaced by the analogy between craft and human nature (that is, the physiology of the human body). In medical texts, even now, a metaphor is used in a technical sense, unfolding a comparison between a known and perceptible phenomenon and another that is latent and unknown.

Results

The occupations referred to in De diaeta book 1 include, inter alia, cooks, ironmongers, goldsmiths, basket makers, sculptors, and lumberjacks. In general, Hippocrates described the characteristic activities of each craftsman and then attempted to show how these resemble macrocosmic and microcosmic processes, as well as how apparent oppositions are in fact different aspects of the same process. Central to the subject of this article are the lines, “Men saw a log; the one pulls and the other pushes, but herein they do the same thing, and while making less they make more. Such is the nature of man. One part pushes, the other pulls; one part gives, the other takes. It gives to this and takes from that, and to one it gives so much the more, while that from which it takes is so much the less.” (Figure 2).

When we focus on the ion exchange in the tubules, we recall that from the Bowman’s capsule to the collecting system, water, sodium, potassium, chloride, glucose plus other minor substances enter and/or leave the proximal convoluted tubule, the Loop of Henle, the distal convoluted tubule to and from the interstitial space and the peritubular capillaries, leading to an increase and then decrease of urine gravity in order to balance it in the normal range for urine specific gravity. This compares to the words quoted above from De diaeta.

Conclusions

There is an intriguing resemblance between the De Diaeta’s hypothesized role of sawing as a prototype of one’s body-function and the work of the renal tubules. More generally, the ancient Greek scientific thought, at least in the periods before and soon after Hippocrates, was keen to produce hypotheses without laboring to support them with strict scientific data.¹⁸ In the past, imagination ruled free, offering the benefit of a bright vision of the mega icon; today, evidence-based medicine glorifies mega data, limiting our visual field.

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