CHAPTERlWO

HIPPOCRA1ES AND TI1E PLAGUE

In the plague year of 1665, as the Black Death raged in London town, the July 13
issue of the Newes carried an advertisement for a remedy against the epidemic,
"wherewith Hippocrates, the Prince of all Physitians, preserved the whole land of
Greece."! Two months earlier that same year the College of Physicians in London
had recommended in its Certain Necessary Directions for the Cure of Plague that
fires be lit in the streets to correct the "infectious air."2 It was also helpful to strew
aromatic substances on these smoking bonfires. William Boghurst, in
Loimographia: an Account of the Great Plague of London in the Year 1665,
suggested the burning of "pitch, resin, turpentine ... frankincense ... sulpher,
benjamin, mirrhe, also some aromatic things as nutmeg, cloves, bayberries." These
could be burned alone or with wood with "gums, spices, roses, or any sweet
flowers being added to them."3
That these anti-plague treatments were related to each other and to Hippocrates
emerges from A Dialogue Against the Pestilence, written a century earlier in 1564.
William Bullein described Hippocrates' use of fire to save the citizens of Athens
during the famous epidemic that decimated that city at the beginning of the
Peloponnesian War, and he even cited his source, Theriac to Piso, written by Galen
in the late second or early third century A.D.4
Now Thucydides' account of the devastating so-called plague at Athens in 430
B.C. needs no introduction today, nor did it in the sixteenth century. Thucydides
clearly stated that physicians were helpless against the disease and were often
themselves the first victims. 5 Yet Bullein, the College of Physicians, and the

1 W.G. Bell, The Great Plague in London in 1665 (London, 1924; rptd. New York, 1979), p.
97.
2 Bell, p. 237.
3 W. Boghurst, Loimographia: An Account of the Great Plague of London in the Year 1665,
ed. J.F. Payne (London, 1894; rptd. New York, 1979), pp. 62-63.
4 G. Watson, Theriac and Mithridatium: A Study in Therapeutics (London, 1966), pp. 118-
119. For the authorship and dating of Theriac to Piso, see nn. 77, 78.
5 Plague is the traditional term used for the epidemic at Athens in 430 B.C., that Thucydides
described in The Peloponnesian War 2.47-54. Although objections have been raised to the noun,
plague, and its adjectival form, pestilential, because they have inescapable associations with
bubonic plague, which is caused by a specific organism (Yersinia pestis), the word plague is
traditionally used in translations and scholarship in English to refer both to the mysterious
epidemic recorded in the Hellenistic pseudepigrapha, as well as to the highly infectious disease in
Thucydides' fifth-century B.C. account. For this reason I do use plague in this chapter, but when
I do not qualify the word by the adjective bubonic, the term means no more than epidemic, that is,
any widespread outbreak of a disease, especially one with a high death rate.
Although the consensus today is that the Athenian epidemic was definitely not bubonic plague,
the identity of the disease remains problematic. The symptoms of the outbreak, as described by
Thucydides, do not match exactly those of any known modem disease, though many candidates

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36 HIPPOCRATIC LIVES AND LEGENDS

opportunistic advertiser mentioned above all accepted the ancient tradition that there
was one physician who could, indeed, cure epidemics like the one that struck
Athens-a report that flatly contradicted Thucydides' History of the Peloponnesian
War. That doctor was Hippocrates. Pliny, Galen, and Aetius described how he
fought the epidemic by building a great fire, which corrected the unhealthy
atmosphere that caused the outbreak. Thucydides' silence about this remarkable
achievement of Hippocrates and the late date of the sources reporting it provide
strong evidence against its historicity. The tradition itself, however, as we have
seen, had a long history, outlasting antiquity to spring up in both Western and
Eastern medicine whenever fear of plague-bubonic or other-stalked the land.
Where did this fabulous story come from that Hippocrates stopped the epidemic
at Athens by burning a fire? What was the relationship between this later report and
the Hellenistic tradition about Hippocrates and the epidemic that threatened all
Greece, mentioned in the Embassy, Speech from the Altar, Decree of the Athenians,
and The Life of Hippocrates According to Soranus (VHSS)? None of these
accounts mentions Hippocrates' use of fire in connection with this panhellenic
epidemic that swept down on Greece from the northwest lands of Illyria and
Paeonia. Since the mid-nineteenth century Hippocrates' modern biographers have
also kept their silence about the later report that he cured the Athenian epidemic with
fire, probably because it is worthless as historical evidence for his life. 6 This

have been proposed. Until 1984 two "diagnoses" stood out in the scholarly literature on the
Athenian plague-smallpox and endemic typhus. For summaries of the arguments, see R.J.
Littman and M.L. Littman, "The Athenian Plague: Smallpox," Trans. Proc. Am. Philo/. Assoc.
100 (1969) 261-275, and J. Scarborough, "Thucydides, Greek Medicine, and the Plague at
Athens," Episteme 4 (1970) 77-90 (typhus, with summaries of other diagnoses). More recent
contributors to the debate included J.C.F. Poole and A.J. Holladay, "Thucydides and the Plague at
Athens,"CQ, n.s. 29 (1979) 282-300, and J. Longrigg, "The Plague of Athens," Hist. Sci. 18
(1980) 209-225 (both essays deny that any diagnosis is possible), and J. Wylie and H. Stubbs,
"The Plague of Athens: 430--428 B.C., Epidemic and Epizootic," CQ, n.s. 33 (1983) 6-11. Then
an interdisciplinary conference in 1984 at the University of Arizona on the identity of the plague of
Athens resulted in the controversial article by A. Langmuir et al., ''The Thucydides Syndrome: a
New Hypothesis for the Cause of the Plague of Athens," N Engl J Med 313 (1985) 1027-1030.
There they diagnosed the epidemic as a staphylococcus infection similar to that which produced
TSST-1 (Toxic Shock Syndrome) superimposed on influenza. This diagnosis was subsequently
challenged in a letter to the editor of the N Engl J Med 314 (1986) 855, by D. Morens and M.C
Chu, who found that reservoir diseases like Rift Valley Fever most closely fit the symptoms
described by Thucydides. Most recently a panel on the topic at the 1987 meeting of the Society for
Ancient Medicine and Pharmacy at New York City, Dec. 29, 1987, seemed to concur with Dr.
Morens' paper, which concluded that only reservoir diseases, which included anthrax, typhus, and
arbo-viruses, such as Rift Valley Fever, could meet the criteria of persistence (the epidemic
continued for two to four years) and nonexportability, as well as match Thucydides' symptoms
(summaries of the papers in the Society for Ancient Medicine and Pharmacy Newsletter 16 (1988)
6-8).
6 One could attempt, therefore, to preserve the historicity of the Hippocratic plague by
dissociating it from the Athenian epidemic of 430 B.C., as did C. Petersen, "Zeit und
Lebensverhliltnisse des Hippokrates," Philologus 4 (1849) 234-237. Petersen's hopeful theory was
easily demolished. See the reply by E. Littre in Littre 7.xl-xliv.

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 HIPPOCRATES AND THE PLAGUE 37
chapter will break that silence by studying this later legend in conjunction with the
earlier one.7 I will examine how the later story, that Hippocrates burned wood and
aromatics to stop the epidemic, grew out of the Hellenistic tradition, which does not
mention fire and is vague about his preventive and therapeutic measures. Also, the
earlier legend stated clearly that the epidemic came from the northwest, Illyria and
Paeonia, while versions of the later legend that specified the origin of the disease,
such as Galen's Theriac to Piso, said the sickness came from the south, from
Ethiopia. A careful examination of the later legend, focusing on the way the idea
developed that burning bonfires was a credible medical response to epidemic
outbreaks and the way it was linked to Hippocrates and the Hellenistic legend of his
epidemiological prowess, provides important insights into how ancient biographers
put together their accounts of medical men and how ancient readers interpreted
them.

The Earliest Strata of the Legend: Hellenistic Pseudepigrapha

The story of Hippocrates and the plague reaches back to the earliest level of
biographical fiction created about the figure of Hippocrates, namely the Embassy. 8
In this fictional speech Hippocrates' son, Thessalus, is trying to dissuade the
Athenian assembly from attacking Cos. 9 Thessalus' argument rests on four great
services that his family has rendered to the Athenians. He relates in chronological
order how his ancestors, Chrysos and Nebros, helped the Athenians and the
Amphictyons in their war against the Criseans---Nebros by poisoning the Criseans'
water supply; 10 how his ancestors caused the Coans to resist the Persians and side
with the rest of the Greeks during the Persian wars; 11 how Hippocrates helped the

7 To date no other scholar has examined the later tradition that Hippocrates used fire to cure
epidemics. Earlier versions of this chapter appeared in J. Rubin [Pinault], "Biographical Fiction in
the Lives of Hippocrates" (Ph.D. diss., U. of Penn., 1983), pp. 76-l23, and J. Rubin Pinault,
"How Hippocrates Cured the Plague," JHMAS 41 (1986) 52-75. My thanks to the editors of the
JHMAS for allowing me to reprint substantial parts of the latter in this chapter.
8 For Greek text and translation, see W.D. Smith, Hippocrates: Pseudepigraphic Writings
(Leiden, 1990), pp. 110-125.
9 On the mixture of fiction and anachronistic facts in the Embassy, see S.M. Sherwin-White,
Ancient Cos (Gottingen, 1978), p. 15, and R. Herzog, Koische Forschungen und Funde (Leipzig,
1899), p. 215. On the fictional nature of the Coans' refusal to submit to the Persians, see
Sherwin-White, p. 15; on the "apparently wholly mythical" plan of Athens to attack Cos and the
plague that threatened all Greece, see W.D. Smith, The Hippocratic Tradition (Ithaca, 1979), pp.
215-216. See Herzog, p. 215, n. 2; J. Bousquet, "Inscriptions de Delphes," Bulletin de
Correspondance Hellenique 80 (1956) 579-593; and H. Pomtow, "Delphische Neufund, III.
Hippokrates und die Asklepiaden in Delphi," Klio 15 (1918) 303-338, for arguments based on
archaeological evidence that support the historical authenticity of the Embassy. For a review of
this position and a rebuttal, see Smith, pp. 216-218. The most recent assessment is by Smith in
Pseud, pp. 6-18.
10 Littre 9.406-414; Pseud, pp.111-115.
11 Littre 9.414-418; Pseud, pp. 114-117.

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38 HIPPOCRATIC LIVES AND LEGENDS

Athenians and other Greeks when they were threatened by an epidemic; 12 and how
Thessalus provided medical services to the Athenians during the Sicilian expedition
at Hippocrates' request. 13 Hippocrates' efforts against the epidemic are described as
follows:

I come now to present to you, who know it well, the good service of my father,
Hippocrates. And in recounting it I would be speaking only the truth.

When the plague ran through the land of the barbarians that lies above the Illyrians and
Paeonians, when this evil came to this land, the kings of the inhabitants there sent down
for my father in Thessaly (for he had and still has his residence there) due to his reputation
as a physician, which, because it is true, became known all over. Calling on him for
assistance, they said they would not send him gold and silver and other wealth, but, if he
assisted them, he should carry off as much as he wished.

But he inquired what son of movements occurred in succession in the atmospheric heat
and winds and mists and other factors that by nature disturb the accustomed state, contrary
to what is normal. When he had learned by inquiry everything, he answered, ordering them
[the ambassadors] to return and declaring that it was not possible for him to go to their
country.

And as soon as he was able, he himself prepared to prescribe to the Thessalians what
measures were necessary to avoid the approaching danger. Writing down the treatment, he
publicly exhibited it around the cities.

And he sent me to Macedonia, where we have a hereditary guest-friendship with the

Heracleidan kings, who rule there. And I went where my father ordered me, leaving
Thessaly to help those who lived there. And he also ordered me to lend help to your city
[Athens]. He ordered my brother, Dracon, to sail to the Hellespont, starting from Pagasae
in Thessaly, and gave him therapeutic instructions different from those that he himself
was using; for not all regions produce the same diseases, since the atmospheric conditions
are not the same all over. But he sent out Polybius, his son-in-law and my brother-in-law,
and other students of his to travel along the different land and sea routes to different parts
of Greece to help as many people as possible.

And when he had finished in Thessaly, he moved on, helping the neighboring people.
When he came to Thermopylae, he assisted the Dorians, together with the Phocians. And
when he arrived at Delphi he prayed to the god on behalf of the Hellenes, and after he had
sacrificed, he began to make his way toward the land of the Boeotians. After he had helped
in a comparable manner those who lived there, he came to your land and told you straight
from his heart what measures were suitable for your safety-the ones that I am recalling
now.

And I expect that many of you recognize I speak the truth, for it was not long ago that
these things happened; it is only nine years since I passed through and was ordered to the
Peloponnese to assist those living there.

Everywhere we went we were duly honored in word and in deed, so that we did not
regret that we had not accepted the lucrative offer of the Illyrians and Paeonians. And in

12 Littre 9.418-420; Pseud, pp. 117-121.

13 Littre 9.422-424; Pseud, p. 121.

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 HIPPOCRATES AND THE PLAGUE 39
contrast to the other cities [of Greece], what you gave us was great, for your city
surpassed the rest. That is so because Athens is somewhat loftier in reputation than other
cities, and the gold crown awarded in your theatre led us to the peak of glory. But you
surpassed even this fair honor by initiating my father and me into the secret rites of
Demeter and Kore at public expense. 14

The Embassy's account of Hippocrates and the plague (in contrast to that of the
Decree, below) emphasizes the involvement of Hippocrates' family-his sons,
Thessalus and Dracon-as well as his students. The story does not appear to have
any historical basis, as do the other "services" Thessalus credits his family as
having performed on behalf of the Greeks, and especially the Athenians. 15 For this
reason the Embassy, including its story of Hippocrates and the plague, is best
viewed as a local Coan product, the "fruit of Coan rhetorical writings of the
Hellenistic period." 16 As to its purpose, the Embassy in a narrower sense can be
seen as "an attempt by a family from a minor state to place itself in history."17 In a
larger sense the story promoted local patriotism after the synoecism or political
unification of Cos in 366 B.C. 18 And following the foundation of the sanctuary of
Asclepius on Cos in the late third century B.C., such a story would be in the
interest of the priests, who were trying to associate Hippocrates with the
Asclepeion, and in the interest of Coan physicians, probably because any story that
promoted Hippocrates' prestige would indirectly increase theirs.19
From internal evidence, the Embassy's story about Hippocrates and the plague
can also be seen to represent the earliest of the three great legends developed about
Hippocrates, which are treated in this and the following two chapters. In the
Embassy there is no mention of Artaxerxes or Perdiccas. And yet, I suggest, the
virtues of Hippocrates that are emphasized in the Embassy's account of Hippocrates
and the plague pointed the way for the creation of the stories about Artaxerxes and
Perdiccas. Hippocrates' reputation, which caused the barbarian kings of Illyria and
Paeonia to approach him and offer him great material rewards in the Embassy if he
helped them with the epidemic ravaging their lands, is paralleled in the Artaxerxes
story. So is Hippocrates' patriotic refusal in this incident to use his talents to help

14 Embassy 7. For the passage above I offer my own translation of the newly edited Greek text
by W.D. Smith, Pseud, pp. 116, 118, 120; for an alternative translation, see Smith, Pseud, pp.
117, 119, 121.
15 Smith, Pseud, p. 3. For example, Chrysus and Nebrus' aid to the Athenians and
Amphictyons in besieging the Criseans is based on an incident in the Amphictyonic War; for a
different version, see Pausanias 10.37.6-7. The second service, about how the Coans resisted the
Persians, reads like a patriotic corrective of Herodotus 6.49, 7.99, which implies the Coans'
submission to the Persians; and the fourth connects Hippocrates and Thessalus with the Athenians'
Sicilian Expedition of 415-413 B.C. during the Peloponnesian War (Smith, Pseud, pp. 2-4).
16 Sherwin-White, Ancient Cos, p. 15, following Herzog, p. 215.
17 Smith, Pseud, pp. 2, 5--6, 17.
18 Smith, Hippocratic Tradition, p. 221.
l9 L. Edelstein, RE, supp. vol. 6, col. 1302.60 ff.

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40 HIPPOCRATIC LIVES AND LEGENDS

Greece's enemy. 20 To a lesser extent the Embassy's plague story influenced the
Perdiccas story. The Embassy's location of Hippocrates' home in northern Greece
placed Hippocrates near Macedonia, where Perdiccas ruled. Again, Hippocrates'
fame brought him to the attention of a powerful monarch.21 Although Perdiccas as a
Macedonian was not a barbarian, his location at the extreme north of the Greek
world fitted him into a role parallel to that of the kings of Illyria and Paeonia and of
Artaxerxes. In all three stories Hippocrates established his ethical superiority by not
limiting his practice to the wealthy court of a king. 22
It is also easy to see that the Embassy's version of the story about Hippocrates
and the plague was written before (if it was not the inspiration for) the other
pseudepigraphic document that records the story, namely the Decree of the
Athenians.23 This fictional decree confers various honors on Hippocrates for the
services he has rendered to the Hellenes. The first service to be recounted is
Hippocrates' effort against the plague. Not only does the Decree commend
Hippocrates for sending his students (no mention of his sons here) all over Greece
to teach people what measures to use to protect themselves from the approaching
epidemic; in addition the Decree praises Hippocrates for publishing his medical
writings in order that physicians could be trained to save people from the epidemic.
There was nothing in the Embassy about Hippocrates' writings. The Decree's
addition, then, presupposes an acquaintance with the Hippocratic Corpus, which
the Embassy does not, and requires us to date the Decree after the formation of the
Hippocratic Collection in Alexandria, which began to be assembled at the beginning
of the third century B.C. 24 Also indicative of a date later than the Embassy is the
Decree's addition of Hippocrates' refusal to help Artaxerxes, when the latter's
troops were struck by an epidemic;25 although this story would have suited the
argument of the Embassy very nicely, it is not mentioned in that document. The
most plausible explanation is that the story about Artaxerxes had not yet been
developed. Here, without further delay, is the Decree:

Decree of the Athenians. The Council and the People of Athens have decreed:

20 See the VHSS, sect. 8, ed. Ilberg, CMG IV, p. 176, 11. 18-22; for Eng. trans., see Chapter
1 of this study, for discussion, Chapter 4.
21 See the VHSS, sect. 5, ed. Ilberg, CMG IV, p. 176, 11. 4-11; for Eng. trans., see Chapter 1,
for discussion, Chapter 3.
22 The parallel is brought out more clearly in Galen's version of the Perdiccas story in That the
Best Physician is also a Philosopher 3: "If there is such a man [the ideal philosopher-physician],
he will look down on Artaxerxes and Perdiccas; he will never even see the former, while he will
treat the latter when he is ill and needs Hippocrates' art but surely will not think it right to stay
with him forever; and he will treat the poor of Cranon, Thasos, and other small towns." Grk. text
ed. J. Marquardt, I. Millier, G. Helmreich, Claudii Galeni Pergameni scripta minora, 3 vols.
(Leipzig, 1884-1893; rptd. Amsterdam, 1967), 2.5. See Chapter 3, pp. 73-74, of this study.
23 Smith, Pseud, p. 4.
24 Smith, Pseud, p. 5.
25 The Decree does not explain why Artaxerxes was requesting Hippocrates' help; presumably
the story was well known.

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 HIPPOCRATES AND THE PLAGUE 41
Whereas Hippocrates of Cos, being a physician and descended from Asclepius, has
shown great concern for the safety of the Greek people,

And whereas on the occasion of a plague coming from the land of the barbarians
towards Hellas, he sent out his pupils to different places to proclaim what therapies they
had to use to keep themselves safe from the imminent plague, and, in order that medical
science bequeathed to the Greeks would preserve safe those that were ill from it he
generously published his writings on medical science because he wanted there to be many
physicians who saved people,

And when the Persian King sent for him on condition of honors equal to his own, and
on condition of whatever gifts Hippocrates chose, he scorned the promises of the barbarian
because he was a foe and the common enemy of Greeks,

Therefore, so that the Athenian people may show itself to desire the best always for the
Greeks and so that they may show proper gratitude to Hippocrates for his beneficent acts,

It is decreed by the people to initiate him into the great mysteries at public expense as
was done with Heracles, the son of 2.eus,

And to crown him with a gold crown worth one thousand gold pieces, and to proclaim
the crown at the great Panathenaia at the athletic competition,

And that it be permitted to all sons of the Coans to be ephebes in Athens, since their
country has begotten such a man,

And that there be for Hippocrates citizenship, and sustenance in the Prytaneum for his
lifetime. 26

Dating the Embassy and Decree of the Athenians

In trying to date the Embassy, the earliest version of the story about Hippocrates
and the plague, scholars have looked for political contexts that have suited its
patriotic pro-Greek, anti-barbarian tone. The terminus post quern would have had to
be the synoecism of Cos, since before that date the Coans would not have had the
sense of themselves as a nation that is shown in the Embassy.21 The bias against
Athens that is present in the Embassy had a historical basis in the years 357 to 355
B.C., when the oligarchical party on Cos, greatly aided by Mausolus, gained
power. 28 A few years earlier, in 359 to 358 B.C., Philip II of Macedon conquered
the Paeonians and Illyrians, who were considered barbarians and enemies of
Greece. The patriotism engendered by this political alignment of Greeks and
barbarians fits the situation of the Embassy. 29 The political realities, then, of the

26 Greek text and Eng. trans., Pseud, pp. 106-107.

27 See, e.g., 111tatplc; 1111µetEP11 (Pseud, p. 116, I. 1), 11 xroP11 (p. 116, I. 29).
28 Herzog, p. 216.
29 Smith, Pseud, p. 4

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42 HIPPOCRATIC LIVES AND LEGENDS

Greek world in the mid fourth century B.C. may be reflected in the fiction of
Hippocrates and the plague.30
Other factors strengthen a mid to late fourth-century date for the story of
Hippocrates and the plague in the Embassy. The Embassy was first mentioned by
name in Erotian's first-century catalogue of Hippocratic writings. 31 These medical
works, together with the pseudepigraphic Embassy and Speech from the Altar, had
probably been assembled into a collection in Alexandria under the Ptolemies, which
brings the date of these fictional speeches back to the beginning of the third century
B.C. 32 Although we cannot prove that the Embassy was in the catalogue of
Hippocratic writings in the Alexandrian library, Wesley Smith has raised the
intriguing possibility that the Embassy and Speech from the Altar, with their
biographical fiction about Hippocrates, offered the only biographical and historical
information about Hippocrates in the collection of anonymous medical works being
assembled at Alexandria. 33 For this very reason these biographical documents may
have supplied the name and identity of an author for the growing collection of
anonymous medical documents.34 This theory, although ultimately unprovable,
would certainly explain why the legend flourished in the early third century, at the
time the Hippocratic Collection was being formed in Alexandria; the story of
Hippocrates and the plague provided curious readers with a stirring exemplum of
the character and deeds they would have expected of the author of this first
collection of medical treatises.
Dating the Decree is no easier. We have already established that the Decree was
written after the Embassy. The honors described in the Decree can, perhaps, be
dated. There is historical precedence in fifth-century decrees for the presentation of
a gold crown to Hippocrates,35 and a fourth-century decree grants the physician

30 On the other hand, the most famous medical historian of the nineteen thirties, Ludwig
Edelstein, found that the historical and political circumstances of the early second century best
accounted for the origin of this legend. Not until 190 B.C., when Ptolemaic sovereignty over Cos
ended, could these stories, with their strong anti-barbarian prejudice, have developed. During the
preceding period, Edelstein explained, Cos had close associations with Ptolemaic Alexandria, where
official policy favored the doctrine that Greeks and barbarians were equal (RE, supp. vol. 6, cols.
1301.44-51). For his other arguments see Rubin, "Biographical Fiction," pp. 81-82.
Of course there is no reason why a story that portrayed Hippocrates as a friend of the Greeks and
an enemy of the barbarians could not have arisen while Cos was under Ptolemaic rule (Smith,
Tradition, 216). Nor is it even necessary to assume a historical basis for the Coan bias against
Athens in the Embassy. See Rubin,"Biographical Fiction," p. 83.
31 See Erotiani vocum Hippocraticum collection, ed. E. Nachmanson (Uppsala, 1918), p. 9.
Cf. Smith, Hippocratic Tradition, p. 222; Edelstein, RE, supp. vol. 6, col. 1305.2.
32 Herzog, p. 215. Smith (Pseud, p. 6) cautiously follows Herzog's use of Erotian to place the
two speeches in Alexandria at the last quarter of the third century. For the Speech from the Altar
(Epibomios), see Smith, Pseud, pp. 4-5; text and Eng. trans., pp. 108-109.
33 Smith, Pseud, p. 8.
34 Smith, Pseud, pp. 8-9.
35 See, e.g., M.N. Tod, Greek Historical Inscriptions, 2 vols. (Oxford, 1946, 1948), vol. 2,
no. 97; cf. Herzog, Koische Forsch., p. 215, n. 2.

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 HIPPOCRATES AND THE PLAGUE 43
Evenor, from Amphilochian Argos, a gold crown and Athenian citizenship. 36 The
grand scale of the rewards with which the Athenians honored Hippocrates in the
Decree is more typical of a later period, when the language of honorary decrees
"tended to become more elaborate and fulsome ... and the gratitude was often
displayed in greater material rewards.''3 7 For example, in an Athenian decree of
283/2 B.C. honoring the poet, Philippides, it is proposed to praise him, "to crown
him with a gold crown according to the law, and to proclaim the crown during the
Great Dionysia at the competition of tragedians, and to erect a bronze statue of him
in the theatre, and to grant to him and to whomever in the future is his eldest
descendant public maintenance in the prytaneion and prohedria at all the contests
that the city puts on.''38 Some of the honors, then, in the Decree are historically
plausible for the Hellenistic period: the crowning of Hippocrates with a gold crown
made from a thousand pieces of gold, proclaiming the crown at the Great
Panathenean festival in the gymnastic contest, and granting him citizenship and
meals at public expense in the prytaneion for life. Also precedented in Hellenistic
honorary decrees is the extended description of Hippocrates' services, which justify
the honors that he is being granted. 39 Although the third century has been proposed
for the Decree on stylistic grounds, there is no certainty that the style and formulas
of the Decree, even if they could be securely identified as characteristic of the third
century, were not imitated from third-century documents at a later date.40
Furthermore, there is some evidence that the Decree may have been composed after
the pseudepigraphic letters telling the story about Hippocrates and Artaxerxes King
of Persia, documents which were composed between the mid second to mid first
century B.C.41
The most, then, that can be definitely said about the documents containing the
earliest versions of the legend of Hippocrates and the plague is that they were first
written down sometime after the synoecism of Cos in 366 B.C. and before the first
century B.C. That is when Varro made the earliest datable reference to the material

36 I.G. II 186 (322/1 B.C.).

37 A.G. Woodhead, The Study of Greek Inscriptions, 2nd ed. (Cambridge, 1981), p. 39.
38 SJG3 374, trans. R.S. Bagnall and P. Derow, Greek Historical Documents: the Hellenistic
Period (Chico, 1981), p. 28.
39 SJG3 943 (Cos, third century B.C.), SJG3 374 (Athens, 283/2 B.C.). Cf. Herzog, p. 215, n.
2. For other historical decrees honoring physicians, compare: JG II 186, 187; S/G2 491, SJG3 943.
40 Herzog argues, for example, p. 215, n. 2, that the phrase in the Decree, a-teq>avcoom au1ov
a1eq,avcp xpuaip a1to xpuawv xv..irov, although historically justifiable for the fifth century B.C.,
could have been copied in the third century B.C. from some contemporary Attic honorary decree in
the Coan archives. Could not his own argument be turned against him, to claim that the copying
took place in the second century B.C.? There seems no way to be sure.
41 See Smith, Pseud, p. 5. He finds that the Decree's phrase ltOA.Eµtoi; ical !COtvoi; ix8poi;
i>m\PXE 1oii; "EUTJaw ("common enemy of the Greeks")(Pseud, p. 106, 11. 21-22) "seems to
reflect" the wording of letter 5: ix8poi)c; t6V'tai; 'EU11vcov (Pseud, p. 52, I. 4). It is just as possible
that the letter is echoing the Decree, of course. For the dating of the pseudepigraphic letters, see
Rubin, "Biographical Fiction," p. 149, n. 44.

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44 HIPPOCRATIC LIVES AND LEGENDS

in the legend in De re rustica 1.4.5. Not until the first century A.D., however, is the
Embassy actually attested by name.42

The Spread and Transfonnation of the Legend

By the first century B.C. the story of Hippocrates and the plague was well
known among the Romans. Varro's allusion to the legend occurs in a discussion
about the risk in buying a farm that is unwholesome due to a miasma from the land
or water or that is too hot or that is affected by unhealthy winds. Varro's speaker,
Gnaeus Tremelius Scrofa, claims that these drawbacks can be corrected by
knowledge and the outlay of money. He stresses that attention must be given to the
orientation of the buildings on their sites. Then he asks rhetorically, "Did not that
famous physician, Hippocrates, during a great pestilence save not one farm but
many cities by his skill?"43
In the first century A.D. Pliny included in his Natural History 7.37 a list of
physicians who had been honored for their extraordinary skill. Hippocrates heads
the list:

.. .in medicine Hippocrates, who foretold a plague that was coming from Illyria and
dispatched his pupils round the cities to render assistance, in return for which services
Greece voted him the honors that it gave to Hercules.44

After Hippocrates Pliny lists Cleombrotus of Ceos, Critobulus of Cos, and

Asclepiades of Prusa. The primary organizing principle of the list seems to be
chronology, although the second and third entries are out of chronological order.
The third man on the list, Critobulus, whose famed deed of extracting an arrow
from the eye of Philip II of Macedon occurred at Methone in 354 B.C., should be
placed before the second man on the list, Cleombrotus, who used the same scientia
as Hippocrates, according to Pliny, to cure King Antiochus Soter (280-261 B.C.)
of an epidemic disease. 45 The reason for the interruption of chronological order

42 See footnote 31.

43 Varro, De re rustica 1.4.5. Latin text and Eng. trans. W.D. Hooper, rev. H.B. Ash, Marcus
Porcius Cato on Agriculture, Marcus Terentius Va"o on Agriculture (Cambridge, Mass., 1934), p.
187: An non ille Hippocrates medicus in magna pestilentia non unum agrum, sed multa oppida
scientia servavit?
44 Pliny, Nat. hist. 7.37 (123). Latin text ed. C. Mayhoff, C. Plini Secundi Natura/is historiae
libri xxxvii, 5 vols. (Leipzig, 1892-1909), 2.30; Eng. trans. H. Rackham (vols. 1-5, 9), W.H.S.
Jones (vols. CHl), and D.E. Eichholz (vol. 10), Pliny: Natural History, 10 vols. (Cambridge,
Mass., 1938-1962), 2. 589: Hippocrates medicina, nam venientem ab Illyriis pestilentiam
praedixit discipulosque ad auxiliandum circa urbes dimisit, quod ob meritum honores illi quos
Herculi decrevit Graecia.
45 Critobulus also treated Alexander, when he was badly wounded by an arrow in his chest
(Quintus Curtius Rufus, IX 5.25). See E. Kind, s.v. Kritobulos, RE, vol. 11.2, cols. 1927-8.
This Cleombrotus is, no doubt, Cleombrotus of Ceos, father of Erasistratus, who, the Suda
reports, saved the life of King Antiochus I (280-261 B.C.) by detecting from his pulse that his

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 HIPPOCRATESANDTHEPLAGUE 45

seems to be associative-both Hippocrates and Cleombrotus know how to cure

epidemics.
Later in his Natural History (36.69) Pliny again mentions Hippocrates in
connection with epidemics. This time Hippocrates and Empedocles are associated;
in their writings, Pliny claims, they reported the practice of lighting fires to relieve
outbreaks of disease:

Fire even by itself has a curative power. It is well established that epidemics caused by
an eclipse of the sun are alleviated in many ways by the lighting of bonfires. Empedocles
and Hippocrates have proved this in various passages of their writings.46

Pliny's passage marks a new direction in the legend; this is the first extant
evidence that Hippocrates used fire to fight the epidemic. Also significant is Pliny's
having Hippocrates share the credit for this fire cure with Empedocles, the famous
pre-Socratic philosopher of the fifth century B.C. Unfortunately, none of these
writings of Empedocles or Hippocrates has been found. There probably were none.
How then did Hippocrates become mixed up with this strange medical procedure-
and with Empedocles? Before we can suggest an answer, we must move ahead to
the early second century A.D. when Plutarch wrote an essay on Isis and Osiris. In
speaking of the Egyptian habit of burning incense, Plutarch mentioned how fires
were used by physicians to purify the air:

Again at noon, when they perceive that the sun draws up by force from the earth a very
large and heavy exhalation and mingles it with the air, they burn incense of myrrh; for its
heat loosens and disintegrates the turbid and muddy mass which gathers in the atmosphere.
In fact doctors believe that it is helpful in treating pestilential conditions, to make a big
fire in order to rarefy the air; this is done more effectively if fragrant wood is burnt, such
as that of the cypress, juniper, and pine. Certainly Acron the doctor is said to have gained
fame at Athens during the feat plague by ordering a fire to be kindled near the sick; for he
thus benefitted not a few.4

illness was really caused by desire for his stepmother, Stratonice (Suda 2.402-403). See Chapter 3
of this study.
46 Pliny, Nat. hist. 36.69. Latin text ed. C. Mayhoff, C. Plini, 5.379; Eng. trans. Eichholz,
Pliny, 10.159: Est et ipsis ignibus medica vis. Pestilentiae quae obscuratione solis contrahitur,
ignes si fiant, multifariam auxillari certum est. Empedocles et Hippocrates id demonstravere
diversis locis.
47 Plutarch, Isis and Osiris 383 c-d. Ed., trans., comm. by J. G. Griffiths, Plutarch's De /side
et Osiride (Cambridge, 1970), pp. 244-245 (text and trans.), 566-568 (commentary). Plutarch's
source probably was Manetho, an Egyptian priest at Heliopolis, who fl. 304-246 B.C. (Griffiths,
pp. 78 and 99). Cf. Plutarch, Pericles 34, ed. C. Lindskog and K. Ziegler, Plutarchi Vitae
Paral/elae, 4 vols. in 7 fasc. (Leipzig, 1964-1980), 1 (2), 41; there Pericles' enemies are blamed
for spreading the belief among the people that an unhealthy atmosphere, from overcrowding and
summer heat, caused the epidemic. Plutarch gives no indication that any remedy or doctor was
effective in stopping or alleviating the outbreak.

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46 HIPPOCRATIC LIVES AND LEGENDS

Leaving aside the medical theory behind this therapy for the moment, note the
new elements. Acron of Acragas (a contemporary ofEmpedocles and from the same
city) is also associated with using fire to cure epidemics, and not epidemics in
general, but the most famous epidemic in ancient history, the so-called plague at
Athens in 430 B.C. Henceforth, in the later accounts of Hippocrates and the plague,
such as those by Galen, Oribasius, Aetius, and extending all the way to the
seventeenth century, as we have seen, the epidemic Hippocrates "cured" was
identified with the plague at Athens in 430 B.C.

Biographical Fiction and the Earlier and Later Legends

At this point we can ask the questions, how did Hippocrates, Empedocles, and
Acron become associated with the epidemic at Athens in 430 B.C. and how were
they credited with burning bonfires to combat it? The Embassy, Decree, Pliny's
report in Natural History 36.69, and Plutarch's in Isis and Osiris show several
important features of ancient biographical reports that can help to elucidate the
development of both the Hellenistic and the later legend involving Hippocrates and
epidemic outbreaks: the tendency to blur the line between fact and fiction;48 to
establish connections between famous men, or in this case, between a famous man
(Hippocrates), a famous city (Athens), and a famous disease (the outbreak at
Athens in 430 B.C.); 49 to interpret "contemporary" very loosely; 50 and to infer
details of a biographical report from an author's works. 51 Underlying the first three
tendencies was a desire for symmetry and a belief that eikos ("probability") was
adequate historical reasoning.52
Hippocrates' involvement with the epidemic at Athens could be considered
analogous to the meetings and teacher-student relationships that ancient biographers
constructed to establish ties between famous men. That Hippocrates was only thirty
years old, according to the chronology of the VHSS when the epidemic struck in
430 B.C., too young to have won the great reputation that he is accorded in the
tradition or to have grown sons and a son-in-law,53 did not hinder this process of

48 For a recent survey of the types of fiction in ancient biography, see J.A. Fairweather,
"Fiction in the Biographies of Ancient Writers," Ancient Society 5 (1974) 231-275. See also A.
Momigliano, The Development of Greek Biography (Cambridge, Mass., 1971), pp. 46, 47, 60;
M.R. Lefkowitz, "The Poet as Hero: Fifth-century Autobiography and Subsequent Biographical
Fiction," CQ 28 (1978) 459-469. Lefkowitz, The Lives of the Greek Poets (Baltimore, 1981), p.
viii, takes the position that "virtually all the material in all the lives is fiction;" see pp. 19, 20,
88, 92-93 for examples.
49 Fairweather, Ancient Society 5 (1974), pp. 256-261; Lefkowitz, "The Quarrel Between
Callimachus and Apollonius," ZPE 40 (1980) 8, 14; Lefkowitz, Lives, pp. 64-65, 125, 131-132.
50 Fairweather, Ancient Society 5 (1974), p. 248; Lefkowitz, ZPE 40 (1980), p. 8, Lives, pp.
64-65, 125.
5l See Momigliano, Greek Biography, p. 70; Lefkowitz, "Fictions in Literary Biography,"
Arethusa 9 (1976) 181-189, and Lefkowitz, Lives, pp. viii-ix, 83-84, 88, 102, 120--121.
52 Lefkowitz, CQ 28 (1978), p. 465.
53 Littre 1.41.

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 HIPPOCRATES AND THE PLAGUE 47

making biographical fiction. The Platonic dialogues contain anachronistic

conversations, such as that between Socrates and Parmenides; Hermesianax told a
chronologically incredible story about Sappho and Anacreon; and, of course,
Herodotus was not troubled by the chronological difficulties in having Croesus and
Solon meet. 54
The procedure that Hippocrates follows in the Embassy in making his prognosis
about the epidemic could have been inferred from works in the Hippocratic Corpus.
Hippocrates predicts the course of the epidemic by analyzing the atmospheric heat
and moisture and winds "and other factors that by nature disturb the accustomed
state, contrary to what is normal."55 A model for Hippocrates' procedure can be
found in Airs, Waters, Places, which describes the effects on human health of
climate and local terrestrial phenomena, such as the wind, water, and soil. The
work begins with directions for a traveling physician: "Therefore, on arrival at a
town with which he is unfamiliar, a physician should examine its position with
respect to the wind and to the risings of the sun."56 Such knowledge will permit the
physician to become familiar with local ailments and more widely prevailing ones
and will allow him "to achieve the greatest triumphs in the practice of his art. " 57 In
addition, three detailed descriptions of the year's climatic and meteorological
constitution (katastasis) precede the case histories in Epidemics 1; Epidemics 3 also
contains katastaseis, as do Epidemics 2, 4, and 6.
Although details in the Hellenistic story about Hippocrates and the panhellenic
epidemic may have been based on medical procedures recommended in Airs,
Waters, Places and implied in the Epidemics, it is important to note the differences
between the epidemic in the pseudepigraphic legend, on the one hand, and the
epidemic diseases in the Hippocratic medical treatises Airs, Waters, Places and
Epidemics, on the other. The diseases in Airs, Waters, Places and in the Epidemics
are determined by the cumulative events of the local environment. The accounts are
characterized by detailed observation. In contrast, the outbreak described in the
Hippocratic legend suddenly appears, almost magically, to attack all Greece.
Neither its etiology nor its symptoms are given; there is no katastasis, nor are the
procedures for recognizing its course or taking measures against it clearly stated.
The pseudo-Hippocratic plague remains a mysterious affliction, belonging more to
the realm of myth than to medicine.

54 For Plato, see Fairweather, Ancient Society 5 (1980), p. 248; for Hennesianax, see
Lefkowitz, ZJ'E 40 (1980), p. 8, Lives, p. 125; for Herodotus, see Histories 1.30.
55 Greek text, Pseud, p. 118, 11. 7-10: o 6e epomiow 1t0lTJOllµEVoc; OlCO\O(l\ 'tWEc; EV µepEl
a
lC\Vc;TJO\Ec; y{vovtm lC(lt(X tE lCllUµata lC(l\ aveµouc; lC(l\ axi..uac; lC(l\ "CClA.A.a 1t£1p\)1CE ii~iac; lC\VElV
1tllftCX tO 1Ca8EOtTJ1COc;.
6 Hippocrates, Airs, Waters, Places 1. Greek text ed. Littre 2.12; reedited by H. Diller, CMG I
1,2, p. 24; Greek text with Eng. trans. W.H.S. Jones (vols.1-2, 4), E.T. Withington (vol. 3), P.
Potter (vols. 5--6) Hippocrates, 6 vols. (Cambridge, Mass., London, 1923-1988), 1.71.
57 Hippocrates, Airs Waters, Places 2.20-21. Littre 2.14; Diller, CMG I 1,2, p. 26; Jones,
Hippocrates, 1.73.

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48 HIPPOCRATIC LIVES AND LEGENDS

The chief difference between this Hellenistic legend and the later one first
evidenced by Pliny centers on what treatment Hippocrates actually used to stop the
epidemic. In the Embassy Thessalus states only that Hippocrates "gave Dracon
therapeutic instructions different from those that he himself was using."5 8 This
silence of the Hellenistic legend about how Hippocrates fought the epidemic was,
perhaps, the greatest impetus to the development of a report about his medical
technique, since ancient biographers had a tendency to generate biographical
incidents from the writings of famous men, particularly to "explain" undetailed,
general statements. 59
I suggest that all the elements were present by Pliny's time for the development,
through the processes of ancient biographical fiction, of the story that Hippocrates,
Empedocles, and Acron responded to the epidemic at Athens by building fires.
Hippocrates, who was said to have lived in the fifth century B.C., was reported to
have stopped an epidemic. The most famous epidemic of the age was the epidemic
at Athens in 430 B.C., as described by Thucydides. Acron and Empedocles, Pliny
reported elsewhere, were associated with founding the Empiric medical sect in
Sicily. 60 Hippocrates was considered an Empiric, at least by the Empirics.6 1 The
writer of the Hippocratic treatise Ancient Medicine mentioned Empedocles.62 The
ancient biographical impetus to connect famous men may have linked Hippocrates,
Acron, and Empedocles even at this early date. Much later there is, of course, the
notice in the tenth-century Suda that Acron "lectured in Athens together with
Empedocles, who is then older than Hippocrates."63 As for the tradition that
Empedocles was a physician, Empedocles' own statement in the Katharmoi
provided one hint. 64 Diogenes Laertius stated: "Heraclides [of Pontus, fourth
century B.C.] called him both a physician and seer, inferring both from these lines

5 8 Greek text, Pseud, p. 118, 11. 19-20; In my translation here I have followed the text of
Littre, 9.418, 420, who added an ou ("not"), so that the whole sentence read: "He [Hippocrates]
ordered my brother, Dracon, to sail to the Hellespont, starting from Pagasae in Thessaly, and gave
him therapeutic instructions different from [literally: "not comparable to"] those that he himself
was using; for not all regions produce the same diseases, since the atmospheric conditions are not
ou
the same all over." Littre's added makes Hippocrates' directions to Dracon accord better with the
relativistic principle of Hippocratic medicine that follows.
59 Lefkowitz, Lives, p. 122.
60 Pliny, Nat. hist. 29.1.5: alia factio ab experimentis cognominans empiricen coepit in
Sicilia, Acrone Agragantino Empedoclis physicii auctoritate commendato.
61 See Smith, Tradition, pp. 205-212, for a sketch of the Empirics' use of Hippocratic
writings to confirm their position in their polemic with their rival medical sect, the Dogmatists.
For Galen's solid testimony, see Smith, pp. 76, 79, nn. 13 and 14, and p. 165. Also see Smith,
pp. 96, 178, 182, and 224.
62 Hippocrates, Ancient Medicine 20. Greek text ed. A.I. Festugiere, Hippocrate: L' Ancienne
Medecine (Paris, 1948; rptd. New York, 1979), p. 17; Eng. trans. Jones, Hippocrates, 1.53.
63 Suda 1.94. But cf. M. Wellmann, Die Fragmente der sikelischen Arzte Akron, Philistion
und des Diokles von Karystos (Berlin, 1901), pp. 108-109.
64 M.R. Wright, Empedocles: The Extant Fragments (New Haven, 1981), p. 20. Wright
suggests that the tradition may also have developed from "the influence that his work had on
subsequent medical theory," the anecdotes about him, and Ancient Medicine's attack on him. For
Wright's evaluation ofEmpedocles as a healer, see pp. 9-14.

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 HIPPOCRATESANDTHEPLAGUE 49
also."65 By Pliny's time Empedocles was firmly associated with medicine. Earlier
in the first century A.D., Celsus, tracing the development of medicine in the
Prooemium of his De medicina, explained that philosophers, weakened by "quiet
thinking" and staying up late, especially needed medicine. "Hence we find that
many who professed philosophy became expert in medicine, the most celebrated
being Pythagoras, Empedocles, and Democritus."66
The report in Pliny's Natural History, mentioned earlier, illustrates a technique
common to biographical reports. An anecdote is given first, then the writer's work
(in this case, Hippocrates' and Empedocles') is cited as proof. The anecdote is as
follows: "It is a well established fact that epidemics caused by an eclipse of the sun
are alleviated in many ways by the lighting of bonfires." In reality, the "well
established fact" (certum est) that fire counteracts epidemics was probably an
inference from their writing. What the hint was in Empedocles' or Hippocrates'
work that inspired the story cannot be determined from their extant writings. In the
Hippocratic works fumigation is prescribed for a number of conditions, primarily
gynecological, but never anywhere for epidemics and never for the air itself.67 Fire
and air were two of Empedocles' four elements, and Empedocles distinguished the
misty air close to earth (118' uypo<; a11p) from the clear upper air (Tti-av 118'
a.i0r1P), 68 but it is not possible to reconstruct how Empedocles' theories contributed
to Pliny's report. More influential, possibly, was the anecdote attributed to
Diodorus of Ephesus by Diogenes Laertius that Empedocles cured an epidemic at
Selinus caused by the foul smells from the nearby river. Diverting the waters of two
neighboring streams, he sweetened the water, which presumably freshened the
surrounding air and eliminated the source of the disease. 69 If Empedocles stopped
one epidemic by altering the course of a river, it may have seemed reasonable to
ancient biographers and readers that he could stop another epidemic in an equally
dramatic fashion-by altering the atmosphere through the kindling of fires.

65 Diogenes Laertius, Lives of the Philosophers (henceforth DL) 8.61. Cf. Empedocles,
Fragment B 112, ed. H. Diels, Die Fragmente der Vorsokratiker (hereafter DK), 6th ed., ed. W.
Krantz, 3 vols. (Berlin, 1960--1961), 1.354----355.
66 Celsus, De medicina, Prooemium 7-8. Ed. F. Marx, A. Corne/ii Celsi quae supersunt
(Corpus Medicorum Latinorum I) (Leipzig, 1915), p. 18: scilicet iis bane maxime requirentibus,
qui corporum suorum robora quieta cogitatione nocturnaque vigilia minuerant. Ideoque multos ex
sapientiae professoribus peritos eius fuisse accipimus, clarissimos vero ex iis Pythagoran et
Empedoclen et Democratium. Eng. trans. by W.G. Spencer, Celsus: De medicina, 3 vols.
(Cambridge, Mass., 1935-1938), 1.5.
67 E.g., Diseases of Women, Book 1,11 (Littre 8.44, 46); Diseases of Women, Book 2, 134
(Littre 8.302), and Diseases 3 (Littre 7.130). See Rubin, "Biographical Fiction," pp. 119-120, n.
76.
68 Empedocles, Fragment B38, DK 1.329. See Wright, Empedoc/es, p. 197. For Empedocles'
four elements in Greek medicine, see pp. 26-27.
69 DL 8.70. For an evaluation of this legend, see Wright, Empedocles, p. 12.

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50 HIPPOCRATIC LIVES AND LEGENDS

Ancient Medical Theory and the Later Legend

We have explored how the processes of ancient biographical fiction contributed

to the development of the story about Hippocrates' use of fire against epidemics.
What role did established medical theory have in shaping and perpetuating the
story? Let us begin with Plutarch's Isis and Osiris, which reflects a long tradition of
much earlier practices in both the Greek and Egyptian worlds. Plutarch's account
suggests that Hippocrates' use of fire originated in the kind of purifying and
sanitizing measures common to both religious ritual and medical practice; but
Plutarch's account also seems to imply that Plutarch himself and other later writers
who used the legend, such as Galen and Aetius, as we shall see, tried to bring these
measures more closely into line with current medical theories. An earlier example of
such a purification ritual with both religious and medical benefits is found in the
Athenian tragedy, Oedipus the King, written by Sophocles very probably between
429 and 425 B.C. In the opening scene altars throughout Thebes are burning with
incense as a supplication to the gods to stop the epidemic and, probably, also as a
public health measure.7° Earlier, Homer in the eighth century B.C. has Odysseus
call for fire and sulphur to cleanse the hall after the slaughter of the suitors.71 There
seems to be no clear differentiation in the Homeric poems between physical and
spiritual cleansing. Writing about related traditions among the Egyptians, Plutarch
added theories to account for practices that had flourished for ages without benefit
of the explanations of Greek medicine. He did this when he mentioned how the
Egyptians burned myrrh on their altars during certain unhealthy atmospheric
conditions, as much to improve the atmosphere as for piety. 72 He also theorized in
his subsequent statement that physicians burned fires to thin the air. 73 Plutarch then
named Acron as a physician who successfully used this therapeutic measure during
the great epidemic at Athens. What we see in Plutarch's account is an attempt to
explain in "scientific" terms practices that had long existed in the realms of religion
and medicine; and the famous epidemic of 430 B.C., coupled with the name of
Acron, provided the perfect illustration for Plutarch's theory.

70 Sophocles, Oedipus the King, lines 4-5.

71 Homer, Odyssey 22, lines 481-482. I am accepting the eighth century as the time the poem
was written down; the practice, of course, may have gone back to the Mycenaean age or earlier.
72 Plutarch, Isis and Osiris 383 a-c. Trans. Griffiths, De /side, pp. 244-245: "If I need speak
also of the daily burnings of incense, as I promised, it should be first noted that the men [of Egypt]·
take the greatest care about habits conducive to health. Especially in their religious rites,
purifications and rules of dietetic regimen, the hygienic consideration is present no less than that of
this holiness itself... Now since the air which we constantly use and live in does not always have
the same composition and temper, but by night grows dense and oppresses the body and induces
the soul to a state of gloom and anxiety as though it becomes clouded over and heavy, when they
get up they instantly worship by burning incense of resin. Thus they purify the air with the
secretion and revive the spirit which is inbred with the body and which has become enervated, the
smell of resin having something violent and disturbing about it."
73 Plutarch, Isis and Osiris 383 c--d.

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 HIPPOCRATES AND THE PLAGUE 51
In Plutarch's account, there is also already evident an attempt to relate
Hippocrates' use of fire to the established medical theory that "opposites cure
opposites."74 The term Plutarch used to describe the fire's pharmaceutical action,
A.£1tWV£tv ("to thin," "to reduce"), is found in the Hippocratic Corpus.75 The word
also occurs in a medical context in a poem written by Babrius at the end of the
second century, roughly contemporaneous with Plutarch's Isis and Osiris, which
was written early in that century. Babrius describes how a lion pretends "to thin"
(A.£1t-cuvcov) his "deep voice" (<pcovT) j3apeta) in order to imitate the enfeebling
effects of old age and sickness.76 What is significant in Babrius is that A.£1t-cuve1v
occurs as the opposite of the adjective, j3ap£ta ("deep," "heavy"). The same
adjective, j3apuc;, also occurs in Plutarch's passage to describe a heavy unhealthy
vapor (j3ape'ia ava0uµ{acnc;) that is dissipated by the burning of myrrh. In the next
sentence Plutarch used A.£1t-cuvouaa in the phrase, "in order to thin the air," to
explain why physicians burn fire during epidemic conditions. As the physicians'
use of fire is presented as a parallel to the priests' use of myrrh, presumably the
epidemic atmosphere the physicians were "thinning" was also "thick." The polarity
l3apuc;/A.£1t-cuve1v ("thick"/ "to thin") suggests that Plutarch thought of the fire's
effect on an epidemic atmosphere as a method of treatment by "opposites."
At this point it is necessary to examine two subsequent versions of the later
legend that Hippocrates stopped the epidemic at Athens in 430 B.C. by burning
fires--the one in Galen's late second-century or early third-century Theriac to Piso
and the one in Aetius' sixth-century Tetrabibloi. Both show further alterations of the
legend that seem to have been made to bring it into harmony with current medical
theory.
Although the work's authorship has been questioned by modern scholars,77 there
is no reason to doubt that Theriac to Piso was written during Galen's lifetime, in the

74 See J. Stannard, "Hippocratic Pharmacology," BHM 35 (1961) 497-518. See also J.

Scarborough, "Theoretical Assumptions in Hippocratic Pharmacology," in F. Lasserre and P.
Mudry, eds., Formes de Pensee dans la Collection Hippocratique: Actes du 1ve Colloque
International Hippocratique, Lausanne ...1981 (Geneva, 1983), pp. 307-325.
75 E.g., Aphorisms 2.7 (Littre 4.470); Aphorisms 5.46 (Littrt 4.548); Epidemics 6.1.5 (Lit~
5.268); Diseases 1.19 (Lit~ 6.174).
76 Babrius 103.5. Ed. 0. Crusius, Babrii Fabulae Aesopeae (Leipzig, 1897), p. 93.
77 Aetius, Paul of Aegina, and the Arabs all considered Theriac to Piso a genuine work of
Galen (J.C.G. Akermann, in his introduction to Kiihn's edition of Galen, "Historia Literaria Claudi
Galeni," in K l.xxxviii. Modern medical historians, however, have long questioned its
authenticity, e.g., Ackermann, K 1.xxxvii-xxxviii; K. Schubring, in his index to the 1964 reprint
of Kiihn's Galen (K 20.xlvii); H. Leitner, Bibliography to the Ancient Medical Authors (Bern,
1973), p. 37. Such objections, however, as its late date and style (Ackermann, K 1.xxxviii), do not
seem substantial. Recent publication of an Arabic version of Theriac to Piso by L. Richter-
Bernburg, "Ein arabische Version der pseudogalenischen Schrift De Theriaca ad Pisonem" (diss.,
GOttingen, 1969) and the availability of Galen's texts on computer tapes (to date there is no
concordance of Galen's works) call for a fresh evaluation of Theriac to Piso's authenticity. Cf. V.
Nutton, "The Seeds of Disease: An Explanation of Contagion and Infection From the Greeks to the
Renaissance," Med. Hist. 27 (1983) 6, with n. 21. Although the authorship of Theriac to Piso has
not yet been settled, we can now be much more confident in speaking of Galen as Theriac's author,

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52 HIPPOCRATIC LIVES AND LEGENDS

late second century, after A.D. 198, or in the first years of the third century A.D. 78
Hippocrates and his fire cure enter Theriac to Piso in Chapter sixteen, a discussion
of how galene, the multi-ingredient antidote, could counteract the disease-laden air
that a person would unavoidably inhale during epidemic-causing conditions. 7 9
Galene, a compound drug that contained some sixty-four ingredients, included the
flesh of various poisonous snakes (kerastes, echidna, aspis), pitch or bitumen,
castoreum, honey, wine, and the "juice" of the opium poppy. 80 Andromachus the
Elder, personal physician to the Emperor Nero (A.D. 54--68), had developed galene
from an earlier multi-ingredient antidote against poisons concocted by Mithridates
VI of Pontus (c. 12~3 B.C.). 81 It had many more uses than as an antidote against
poisons or as a remedy for the bites of venomous animals. Galene was equally
handy against lingering headaches, deafness, poor sight, kidney stones, ulcers, and
dysentery. It could also bring on the menses and dry up excesses of humors in the
body. 82

since it has been established rather well that Galen lived beyond A.D. 210, perhaps later than 213
(V. Nutton, "Galen in the Eyes of his Contemporaries," BHM 58 (1984) 324). For this reason,
while acknowledging that the question requires further study, I refer to Theriac to Pisa's author as
Galen.
78 From Galen's statement in Theriac to Pisa 2 (K 14.216-217), he was personally acquainted
with the Emperor Marcus Aurelius (A.D. 161-180). Also in this chapter Galen praises the
generosity of trov vuv µeyfotcov cx-iitoicpcxtopcov (K 14.217), who could be Severus and Caracalla,
for sharing galenewith Antipater when he was suffering from a painful kidney disease (K 14.218).
Antipater A!\lius, born in Phrygian Hieropolis (died c. A.D. 212), was the rhetorical master of
Septimius Severus' sons, Caracalla and Geta, and in charge of Greek letters under Severus. See H.-
G. Pflaum, Les Carrieres Procuratoriennes Equestres sous le Haut-Empire Romain, 3 vols. (Paris,
1960--1961), 2.610-612 (=No. 230). Nutton, Med. Hist. 27 (1983), p. 6, n. 21, dates Theriac to
Pisa between A.D. 198 and 212.
79 This use of galene to fight an epidemic had already been mentioned by its inventor, the
physician, Andromachus, in his elegiac poem on galene, addressed to Nero. Galen quotes it in
Antidotes 1.6 (K 14.35), as he does in Theriac to Pisa (K 14.233): "A drink of galene served up at
dawn heals noxious epidemics and all air not fit to breathe."
80 The recipe is given three times in Theriac to Piso-in Andromachus' poem (Chap. 6
=Galen, Antidotes 1.6), in his son's prose version (Chap. ?=Antidotes 1.7), and in Chapter 12. In
each the order of ingredients differs. Watson, Theriac and Mithridatium:a Study in Therapeutics
(London, 1966), pp. 45, 79, counts sixty-four ingredients; on p. 49, n. 4, however, he states that
"excluding honey the ingredients number 64 in Antidotes 1. . .in Theriake (Ch. 12) there are 63."
My count agreed-sixty-four ingredients, including honey, in the list of Andromachus the younger
and sixty-three items in Theriac to Pisa.
81 See G. Watson, Theriac, pp. 33-93, for a consideration of Mithridatium and galene.
Andromachus the Elder was personal physician to Nero (A.D. 54-68) and should not be confused
with his son, Andromachus the Younger, who also practiced medicine in the same period. Galen
makes this distinction clear (Antidotes 1.1, K 14.42: Tcxutcx µev o 1tpEcr~UtEpoc; 'AvSpoµaxoc;
eypmvev). C. Fabricius, Ga/ens Exzerpte aus iilteren Pharmakologen (Berlin, 1972), p. 201, with
refs.
82 Theriac to Pisa 15 (K 14.270--277).

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 HIPPOCRATES AND THE PLAGUE 53

In Chapter sixteen Galen argues for galene's efficacy during epidemic

conditions-both as a preventive drug and as a remedy for those already sick. The
method Galen uses to promote galene is analogy; he equates an epidemic
atmosphere, which one takes into the body by breathing, with a poison, which one
takes into the body by swallowing. His thought then turns to the fumigations of
herbs and incenses that physicians use to neutralize an epidemic atmosphere, either
potential or actual, in order to make the air safe to breathe. He refers to this practice
by citing one physician who successfully used it-Hippocrates. After describing
briefly how Hippocrates fumigated the epidemic atmosphere at Athens, Galen goes
on to compare the antidote, galene, to such a cleansing fire. Continuing to employ
the analogy, Galen then describes how galene "works" within the body. As fire is
an antidote to the poisoned air outside the body during epidemic conditions, galene
is an antidote to the poisoned air within the body once it has been inhaled. This
analogy between galene and fire-internal and external antidotes-will be useful
when examining the passage from Theriac to Piso below.
The employment of compound incenses, especially one called kyphi, may well
provide the historical context for Galen's conceptualization of galene as an internal
fumigant. Kyphi was a compound incense from Egypt that was considered of value
inhaled as an aromatic. In his Materia Medica, written about A.D. 65, Dioscorides
recorded a ten-ingredient recipe for kyphi, and kyphi recipes are preserved in more
or less complex versions in Plutarch and Paul of Aegina. 83 Kyphi was also edible.
In short, kyphi was considered an efficacious drug, whether it was ingested in solid
form or burned as an incense.
The passage inTheriac to Piso that discusses the use of galene during epidemic
conditions and Hippocrates' remedy occurs at the opening of Chapter sixteen:

83 Dioscorides, Materia Medica 1.25.1-2. Ed M. Wellmann, Pedanii Dioscuridis Anazarbei De

Materia Medica, 3 vols. (Berlin, 1906-1914, rptd. 1958), 1.28-29: ten ingredients. Other formulas
for kyphi-incense include that of Damocrates, quoted by Galen, Antidotes 2.2 (K 14.117-119):
fifteen ingredients; Plutarch, Isis and Osiris 383 e (80), ed. Griffith, De /side, p. 79: sixteen
ingredients; and Paul of Aegina, 7.22.4-5, ed. I.L. Heiberg, Paulus Aegineta, 2 vols, CMG IX
(Leipzig, 1921-1924), 2.393-394: two recipes of thirty-six and twenty-eight ingredients. For
Dioscorides, see J. Scarborough and V. Nutton, "The Preface for Dioscorides' Materia Medica:
Introduction, Translation, Commentary," Trans. Stud. Coll. Physic. Phila., n.s. 4 (1982) 187-
227. for Damocrates, see Fabricius, Ga/ens Exzerpte, pp. 189-190, with refs. Kyphi probably
originated in dynastic Egypt and retained an importance in both formal and folk medicine well into
Byzantine times, suggested by its inclusion as a "medicinal" in the Papyri Graecae Magicae
IV.1313-1314, ed. K. Preisendanz and A. Henrichs, Papyri Graecae Magicae: Die grieschischen
Zauberpapyri, 2nd ed., 2 vols. (Stuttgart, 1973-1974), 1.116. For an analysis of kyphi in
Hellenistic and Roman pharmacology, as well as an identification of the ingredients, see J.
Scarborough, "The Papyri and Byzantine Medicine on Multi-Ingredient Incense," appendix to
"Early Byzantine Pharmacology," in Scarborough, ed. Byzantine Medicine ( Washington, D.C.,
1985 [=Dumbarton Oaks Papers, vol. 38]), pp. 229-232.

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54 HIPPOCRATIC LIVES AND LEGENDS

And it appeared to us that this antidote84 [ga/ene] in fact would be effective by itself in
helping those afflicted during epidemic conditions, there being in this way no other
remedy to fight against the magnitude of the evil. For just like some beast, an epidemic
itself also destroys not some few men, but spreading over whole cities, destroys them
utterly; and this happens when in some wretched manner the air becomes capable of
corrupting and because men, due to the necessity of breathing, are not able to escape the
terror but draw the air into themselves just like some poison taken by mouth.

On this account I also commend Hippocrates, who deserves great admiration for curing
the famous epidemic that first came to the Greeks from Ethiopia, merely by altering the
air so that it would no longer be inhaled in the same condition. He ordered fire to be
kindled throughout the whole city, not simply composed of kindling wood, but also of
the sweetest garlands and flowers. These, he advised, were to be the fire's fuel, and he
urged the richest of sweet-scented unguents to be burned so that men might inhale for
relief the air thus purified.

In the same way I believe that galene, since it is like a cleansing fire itself, allows
those who have drunk it ahead of time not to be wholly seized by the evil, while it is able
to cure completely those already suffering [from the epidemic]. Galene accomplishes this
by altering and turning about the harmfulness of the inhaled air and no longer allowing it
to corrupt the body's constitution.85

Galen thus explained the effectiveness of galene against epidemics by relating

galene to Hippocrates' successful use of fire during the epidemic at Athens. The
pivot of the analogy is -rov au-rov -rp61tov ("in the same way"): fire purifies the air
without and saves the entire city "in the same way" that galene purifies the air within
and saves the body of the individual. Galen used the tradition of Hippocrates and
his fire cure to clarify by analogy the employment of galene against epidemics. It
would appear that the tradition about Hippocrates was well enough known that
Galen could refer to it to explain the use of galene without fear of confusing his
readers.
Galen used the legend of Hippocrates and the plague to endorse a contemporary
medical therapy (multi-ingredient antidotes). He changed the version of the legend
we read in Pliny and Plutarch, specifying that Hippocrates burned not just "fragrant
wood," as Plutarch had it, but now "the sweetest garlands and flowers" and "the
richest of sweet-scented unguents."86 These additions of course made Hippocrates'

84 Watson, Theriac, pp. 4-5 distinguishes between an antidote, designed to counteract poisons,
and a theriac, a specific type of antidote intended to act against the bites of venemous snakes,
spiders, scorpions, and insects, as well as those of rabid dogs. Theriac to Piso does not make such
a nice distinction. In this passage, for instance, Andromachus' compound, galene, is referred to,
first, as an &.v1:t601:oi; (K 14.280), then as a 8Tipia1cr1 (K 14.282).
85 Theriac to Piso 16 (K 14.280-281).
86 Plutarch, Isis and Osiris 383 C, ed. Griffith, De /side, p. 78: A.mruVEt 6e ~EA'ttOV, £WI £'1)(1)611
~uA.a. 1Ca.icoow, ota.1C'l)1ta.pinou 1Ca.l a.p1Ceu8ou Ka.l 1tru1CT1i;, Galen, Theriac to Piso 16 (K 14.281):
to
1C£A,£U(l(li; O~V &.vex nJV ltOA.tv <>A.11V £~Cllt't£tl0a.t ,rup, oux <XltA.TIV ,:fii; llVCl'lfEmi; nJV 'UA.TlV £XOV,

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 HIPPOCRATES AND THE PLAGUE 55
fire seem more like the complex formula of galene. Similarly, later writers changed
the legend to assimilate Hippocrates' therapy to their own theories about the cause
and treatment of disease. For example, over three hundred years later, Aetius of
Amida, drawing on Galen's account of the legend of Hippocrates and the plague in
Theriac to Piso, Galen's Differences Among Fevers, and the account of epidemic
diseases in Oribasius' fourth-century Synopsis for Eustathius, reconciled
Hippocrates' fumigation during epidemic conditions most fully with classical
medicine's theory of treatment by opposites. 87
Aetius discussed epidemic diseases in the Tetrabibloi, a medical compendium
consisting of excerpts from earlier authors. 88 In his discussion of epidemic
diseases, Aetius attributed their cause to a common factor, such as air tainted by a
putrefying vapor caused by a great number of corpses, which happens in war, or
the unhealthy miasma released by swamps, marshes, or drainage ditches. Internal
factors, too, he noted, could lead to epidemics, such as an imbalance of humors
caused by a poor regimen. Armed with this knowledge, whenever the conditions
conducive to an epidemic began to appear, he tried to prevent the outbreak of
disease by a number of allopathic procedures:

I immediately attempted in every way to dry out as many people as I saw were moist,
while I maintained the original state in those who were more dry by nature. I treated with
purges as many bodies as I found were full of impurities, while I opened and cleansed
blocked passages. In a word, I kept people healthy by applying opposites, and sometimes
used cooling techniques, if this should be the case, and sometimes heating. And by
kindling a great fire one should be able to turn the air hot and dry as it is becoming moist
and cold, just as they say Hippocrates did among the Athenians and also Acron of
Acragas. 89

Although Plutarch's account suggests that he thought of the fire cure as a

treatment by opposites, it is Aetius' report that explicitly reconciles Hippocrates'
fumigation during epidemic conditions with the established medical theory that
"opposites cure." Aetius accomplishes this by positing cold, moist air (-.ov
cxepcx ... uypov ... Kat \JfUXp6v) as the cause of the epidemic at Athens instead of just
moist air ('tov cx£pcx ... uyp6v), which is the reading of Aetius' immediate source,
Oribasius, the physician of Julian the Apostate (A.D. 361-363).9° After explicitly

a'JJJJ. c:m:q,a.vcov 'tE KCll 'tOOV av8rov 't(X E\lCOOE<J't(l't(l, 'tOtClU'tCl c:rovE~OUA.t<JEV dvm 'tOU m>poc; 'tT\V
'tf)OIPTJV, Kill £'/tt<JltEUOEW cxiitqi 'tOOV µupcov 't<X A.uta.pCtYCa.'ta., 1ea.t 116eia.v 'tl'IV oOµTJV ~OV't(l...
87 For a detailed analysis of the relation of these texts, see J. Rubin Pinault, JHMAS 41(1986),
pp. 53-56.
88 Aetius, Tetrabibloi 5.95. Ed. A. Olivieri, Aetii Amideni Libri medicinales, CMG VIII 2
(Berlin, 1950), pp. 81-82.
89 Aetius, 5.95, ed. A. Olivieri, Aetii Amideni, pp. 81-82.
90 Aetius, Tetrabibloi 5.95, ed. Olivieri, Aetii Amideni, p. 82; Oribasius, Synopsis ad
Eustathium 6.24, ed. J. Raeder, Oribasii collectionum medicarum reliquiae, 5 vols., CMG VI
(Leipzig, 1926-33), 3.199=0ribasius, Libri ad Eunapium 3.1, in CMG VI, 3.397.

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56 HIPPOCRATIC LIVES AND LEGENDS

stating his medical strategy as the use of opposites, Aetius brings the chapter on
epidemic diseases to a dramatic close by speculating that it might be possible to
counteract a cold, moist epidemic atmosphere by kindling a fire to warm and dry the
air. Such a technique would, of course, constitute a method of treatment by
opposites, since the hot, dry properties of fire would neutralize the cold, moist
properties of the air. That such a procedure is purely theoretical to Aetius, indicated
by his use of the optative case, 6uvcmo ("one should be able"), does not daunt
him. In fact, such is Aetius' zeal for theoretical consistency, that here at the end of
his chapter on epidemic diseases he has apparently forgotten his addition of a
statement to Oribasius' text, to the effect that excessively moist and hot air causes
epidemics. 91 That addition is very similar to a sentence in Galen's Differences
Among Fevers, giving as an example of such an epidemic the very same outbreak at
Athens.9 2 Despite this serious inconsistency, Aetius had gone further than his
source, Oribasius, in reconciling the theory of opposites with the use of fire to
counteract epidemics. Aetius has also added Hippocrates as an authority for this
theoretical procedure to Oribasius' sentence, which named only Acron.93
Thus medical theorizing about both antidotes and the established medical theory
that "opposites cure" helped to shape and perpetuate the story that Hippocrates
stopped epidemics with fire. But these were not the only medical theories to inform
the story. The belief that miasma or "bad" air caused epidemics also contributed to
the positive reception accorded the legend in antiquity and beyond..
Ancient theorizing about the cause and spread of epidemic disease focused on
common environmental factors, such as the water and air. In a number of
Hippocratic writings, air and wind play an importaat role in causing and carrying
such diseases. For example, Breaths attributes epidemic disease to a corruption of
the atmosphere:

there are two kinds of fevers; one is epidemic, called pestilence, the other is sporadic,
attacking those who follow a bad regimen. Both of these fevers, however, are caused by
air ... So whenever the air has been infected with such pollutions as are hostile to the
human race, then men fall sick...94

91 Aetius 5.95, ed. Olivieri, Aetii Amideni, p. 81: Sometimes, when the air surrounding us
becomes too moist and warm, it can bring about condictions conducive to epidemics."( fon 6e 01:e
uycrepor;; 1ccxt 0epµo,;epor;;, 0 ltEP1£X(l)V fiµ&q, 001py1:yv6µevoq, AOtµcootl lCCl.'tOO'tCXOW q>epet.)
2 Galen, De febrium differentiis 1.6 (K 7.290): "And sometimes the excessive heat of the
surrounding air starts it [an epidemic], as in the case of the epidemic that attacked the Athenians,
just as Thucydides says."(fon 6' O'tE lCCl.'t<XPXEt µev aµe,:poq, 0epµa.aia. 'tOU ltEpt£XOV'tO',, c'or;; mt 'tOU
lCCl.'tCt.A.a.Pov,:or;; 'A!hiva.{our;; AOtµou, 1Ca.86. q,TIOW o0ou1ru6{6Jtr;;. ) For other examples of Aetius'
insertions from Galen's Differences Among Fevers in Tetrab. 5.95, see Pinault, JHMAS 41
(1986), p. 55, n. 8. These interpolations have not, to the best of my knowledge, been recorded.
93 Oribasius, Synopsis ad Eustathium 6.24, ed. Raeder, CMG VI, vol. 3.199: JCa.t ,rupav 6e
nr;; UVCl.lCCI.WV ltOA.Afl OOVa.t'tO &v µe,:a.Pa.A.Eiv £m 'tO 0epµov JCa.t 91pov 'tOV a.epa. 'tE(l)', {yypov OV'tCt.,
Ka.06.itep itoti\aa.{ ipa.ow "AKprova. 1:ov 'A1epa.ya.vnvov.
94 Hippocrates, Breaths 6 (Littre 6.96, 98; Eng. trans. Jones, Hippocrates, 2.233, 235). Cf. On
the Nature of Man 9, ed. J. Jouanna, Hippocrate, La Nature de /'Homme, CMG I 1.3( Berlin,
1975), p. 190; Eng. trans. Jones, Hippocrates, 4.27, which seems to identify the pathogenic

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 HIPPOCRATES AND THE PLAGUE 57

The works of philosophers of varying schools, as well as those of historians,

continued to reflect the belief that tainted air caused epidemics. In the first century
B.C. Lucretius prefaced his description of the great epidemic at Athens with an
explanation of air-borne diseases adapted to Epicurean atomic physics in On the
Nature of Things:

First I have shown before that there are seeds of many things which are helpful to our
life, and on the other hand it must needs be that many fly about which cause disease and
death. And when by chance they have happened to gather and distemper the sky, then the
air becomes full of disease.95

Diodorus Siculus cited an unhealthily overheated and moist atmosphere as one of

the causes of the Athenian epidemic of 430 B.C. in his historical account of it,
probably based on Ephorus' fourth-century account:

As a result of heavy rains in the previous winter the ground had become soaked with
water, and many low-lying regions, having received a vast amount of water, turned into
shallow pools and held stagnant water, very much as marshy regions do; and when these
waters became warm in the summer and grew putrid, thick foul vapours were formed,
which, rising up in fumes, corrupted the surrounding air, the very thing which may be
seen taking place in marshy grounds which are by nature pestilential.96

A century later Pliny's contemporary, Seneca, an adherent of Stoicism, attributed

the death of hundreds of sheep following an earthquake at Pompeii in A.D. 62 or
63, not to fear, but to poisoned air:

For they say that a plague usually occurs after a great earthquake, and this is not
surprising. For many death-carrying elements lie hidden in the depths. The very

element in the air as an a.1t61eptatc; ("unhealthy exhalation"). Cf. Nutton, Med. Hist. 27 (1983), p.
13.
95 Lucretius, De rerum natura 6.1093-1097, ed. and trans. C. Bailey, De rerum natura, 3 vols.
(Oxford, 1947), 1.570-571. See Nutton, Med. Hist. 27 (1983), pp. 9-10.
96 Diodorus Siculus, Bibliotheca historica 12.58.3, ed. M. Casevitz, Bibliotheque historique
(Paris, 1972), p. 61; Eng. trans. by C.H. Oldfather, C.L. Sherman, C.B. Wells, R.M. Geer,
F.R.Walton, Diodorus of Sicily, 12 vols. (Cambridge, Mass., 1933-1967), 5.47. Since
Thucydides was silent about the causes in his contemporary, fifth-century B.C. account, it is
unlikely that Ephorus over a century later had any new evidence. More likely, his "causes" of the
Athenian epidemic were explanations after the fact, as Gomme submits, in A.W. Gomme et al., A
Historical Commentary on Thucydides, 5 vols. (Oxford, 1956--1981), 2.149. The notion that a
warm, moist atmosphere caused epidemics, whether first formulated by Ephorus or added by
Diodorus, anticipated later statements in Galen (e.g., Defebrium differentiis l .6, K 7 .290) and was
probably developed from hints in the Hippocratic Epidemics, especially Epidemics 2.1 (Littre
5.72) and Epidemics 3 (Littre 3.66, 68). Cf. H. Gibaltus' commentary on Galen, De febrium
differentiis, in Cl. Galeni Pergameni libros defebribus commentarius (Lyons, 1561), p. 110.

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58 HIPPOCRATIC LIVES AND LEGENDS
atmosphere there, which is stagnant either from some flaw in the earth or from inactivity
and the eternal darkness, is harmful to those breathing it. Or, when it has been tainted by
the poison of the internal fires and is sent out from its long stay it stains and pollutes this
pure, clear atmosphere and offers new types of disease to those who breathe the unfamiliar
· 97
arr.

If we adopt this way of looking at epidemic diseases, as caused by some

corruption of the atmosphere-whether by weather, unhealthy vapors, or seeds of
disease-Hippocrates' use of fire to correct or purify the air bcomes an
understandable prophylactic or therapeutic response, whether viewed in the context
of antidotes (Galen's Theriac to Piso) or of the theory that "opposites are cured by
opposites" (Aetius). Thus the fire technique attributed to Hippocrates in the early
Empire and in the Byzantine era can be seen to reflect and, in turn, to be shaped by
established medical theories.
It is difficult to evaluate what antiquity thought of the report that Hippocrates
could counteract epidemics with fire. Wesley Smith suggests that, like us, the
ancients did not completely believe such stories but thought that there might be
"something behind them." For this reason Hippocrates' ability to stop epidemics
was mostly disregarded, whereas the names of Hippocrates' family, students,
wanderings, and patriotism were considered credible. Smith notes Owsei Temkin's
observation that Pliny is unusual when he mentions in Natural History how
Hippocrates was honored for his efforts against the panhellenic epidemic that
threatened all Greece. 98 The allusions in Theriac to Piso and Aetius, however,
suggest that antiquity's response to the report that Hippocrates specifically used fire
to fight epidemics was more complex. Hippocrates' bonfire helped Galen's
argument that galene could prevent or counteract epidemics. But besides his interest
in the report for its rhetorical value, Galen could have found the technique credible
in a general sense, without necessarily believing that Hippocrates himself actually
used it at Athens in 430 B.C. Aetius' allusion to the report reminds us that
antiquity's sense of the credible and incredible was different from ours. Aetius
introduced his allusion to the treatment with the optative case of the verb, ouvmto.
The optative suggests that, although he considered the procedure theoretically
plausible, he had never tried it himself or heard of any contemporary application.
Hippocrates' fabled treatment enjoyed a long career. An eleventh-century Latin
manuscript life of Hippocrates related how Hippocrates discovered that fire could
cure the epidemic at Athens,99 and Ioannes Actuarius included directions for the
preparation of the fire and unguents in his fourteenth-century De methodo medendi

97 Seneca, Natura/es quaestiones 6.27. Ed. P. Oltramare, Seneque questions naturelles, 2 vols.
(Paris, 1929), 2.284; Eng. trans. T.H. Corcoran, Natura/es quaestiones, 2 vols. (Cambridge,
Mass., 1971-1972), 2.205.
98 Pliny, Nat. Hist. 7.37. Smith, Tradition, p. 219.
99 R. Laux, Ars medicinae: einfriihmittelalterliches Kompendium der Medizin (Leipzig, 1930),
p. 419 (=Kyklos, vol. 3).

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 HIPPOCRATES AND THE PLAGUE 59
libri. 100 So long as the theory persisted that miasma, a corruption of the
atmosphere, caused epidemics, including bubonic plague, physicians continued to
recommend the lighting of fire to rectify the air. Fourteenth-century European
medical treatises, for example, written in response to the Black Death, urged that
aromatic wood be burned. 101 Ibn Abi Hajalah, writing about the bubonic plague
outbreak of 1362-63, recorded the tradition that fires were lighted to remove the
pestilential air from Cairo. 102 As late as 1546 Girolamo Fracastoro, reconciling the
classical miasma theory about the cause of epidemics with a fully developed
contagion theory in On Contagion, advised purging the air with fire when an
epidemic was caused by tainted air.1°3 And, as we have seen at the beginning of
this chapter, Hippocrates' fire cure continued to be recommended in seventeenth
century England during the bubonic plague epidemic of 1664 and 1665.
To sum up, the story that Hippocrates prevented or cured certain epidemic
outbreaks by burning fires to correct the air that caused them deserves our attention,
both for the information it yields about the processes of ancient biographical fiction
and for the ideas it preserves about the causes of epidemic disease and the medical
responses to them in antiquity. From the Hellenistic age, when the story first arose,
the legend was linked to specific medical measures. The earliest version of the
legend, which gave no specific details about how Hippocrates stopped a panhellenic
epidemic, featured Hippocrates' philhellenism and was linked to other biographical
anecdotes illustrating his virtues, such as his famed refusal to serve Artaxerxes,
King of Persia, and his equally renowned diagnosis and cure of King Perdiccas'
lovesickness.1 04 The absence of details about Hippocrates' procedure in the
Hellenistic legend was probably the greatest impetus for the development of the later
story that he used fire to stop epidemics. Ancient biographers, who liked to "flesh
out" statements about famous men and considered probability all the proof they
needed, would have found sufficient material in similar anecdotes about other
physicians and widespread beliefs about the cause and cure of epidemic diseases.
Once the details about his use of fire were added to the Hellenistic legend, by the
first century A.D., the story that Hippocrates could stop epidemic outbreaks became
differentiated from the anecdotes about Artaxerxes and Perdiccas. The later two
stories, established by Galen in That the Best Physician Is Also a Philosopher as an
emblem of the ethical physician, found their way into all the surviving Greek
biographies of Hippocrates and into a number of successive Byzantine, Syriac, and

lOO I. Actuarius, De methodo medendi 5.6. Trans. H. Mathisius, De methodo medendi libri 6
(Venice, 1554), p. 202.
101 R.J. Palmer, "The Control of Plague in Venice and Northern Italy, 1348-1600," (Ph.D.
diss. U. Kent, 1978), p. 13.
102 M.W. Dols, The Black Death in the Middle East (Princeton, 1977), p. 97.
103 G. Fracastoro, De contagione et contagiosis morbis et eorum curatione 3.7. Trans. W.C.
Wright, Hieronymi Fracastorii De Contagione ... (New York, 1930), p. 239. See Palmer, The
Control of Plague," pp. 96-97.
104 See Chapters 3 and 4 of this study.

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60 HIPPOCRATIC LIVES AND LEGENDS

Arabic compilations of anecdotes and sayings of wise men. 105 The story about
Hippocrates' use of fire, however, did not pass into this ethical-biographical
tradition but became firmly attached to therapeutic passages on epidemics and, later,
the bubonic plague. It was Galen, again, who set this Hippocratic legend on a
different path from those involving Artaxerxes and Perdiccas. In Theriac to Piso he
described how Hippocrates ordered the Athenians to kindle fires throughout the city
and to burn sweet-smelling unguents and wreaths to purify the air. The detail of the
directions and the story's context-in a pharmaceutical book-probably determined
the legend's destiny. Readers were more interested in recreating Hippocrates'
"plague-repellent" than in contemplating his altruism. Also, such was the authority
of Galen that his separation of the legends became canonical to succeeding
generations of physicians. The story about Hippocrates' use of fire to combat the
epidemic at Athens was included in Byzantine medical compilations, such as those
by Aetius and Actuarius. The Islamic tradition contains traces of the story, also in a
therapeutic context. In the West the story resurfaced again and again, well past the
Renaissance, surviving so long as the belief persisted that "bad" air caused plague
and that a physician could prevent or stop outbreaks by fumigating the atmosphere
with fire.

105 Galen, Quod optimus medicus sit quoque philosophus 3. See Chapters 5 to 7 of this study.

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