A Reconstruction of the Hippocratic Humoral Theory of Health Author(s): W. Balzer and A.

Eleftheriadis Source: Journal for General Philosophy of Science / Zeitschrift fr allgemeine Wissenschaftstheorie, Vol. 22, No. 2 (1991), pp. 207-227 Published by: Springer Stable URL: http://www.jstor.org/stable/25156549 . Accessed: 08/04/2011 11:37
Your use of the JSTOR archive indicates your acceptance of JSTOR's Terms and Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp. JSTOR's Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the JSTOR archive only for your personal, non-commercial use. Please contact the publisher regarding any further use of this work. Publisher contact information may be obtained at . http://www.jstor.org/action/showPublisher?publisherCode=springer. . Each copy of any part of a JSTOR transmission must contain the same copyright notice that appears on the screen or printed page of such transmission. JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.

Springer is collaborating with JSTOR to digitize, preserve and extend access to Journal for General Philosophy of Science / Zeitschrift fr allgemeine Wissenschaftstheorie.

http://www.jstor.org

A RECONSTRUCTION OF THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

W. BALZER and A. ELEFTHERIADIS

humoral the hippocratic The model theory, as well as the corre underlying terms. Stress in precise, is reconstructed structuralist part of hippocratic aetiology sponding are suppressed. derivations historical and philological of the model, is laid on the presentation as are described in which diseases the different The global net structure of humoral theory features is worked metatheoretical of the basic model out, and the particular specializations are exemplified as contrasted to 'descriptive' and stated of 'therapeutical' theories, theories, SUMMARY. in general. Key words: medical theory, theoretical medicine, humoral pathology, axiomatization, struc

turalism,

model

theory.

INTRODUCTION of what may be called the theory This paper presents a logical reconstruction in parti of the four humores as laid down in the Corpus Hippocraticum, cular in the work 'Nature of Man'.1 The paper emends and simplifies the account given in (Eleftheriadis, 1991). It is intended to serve several purposes. a consistent, account of this theory is given and comprehensive First, in axiomatic form. This cannot be achieved, of course, by mere abstraction or historical from the original hippocratic texts, nor by mere philological links to be introduced, inconsistencies studies: gaps have to be filled, missing to be eliminated. Reconstruction involves construction. We tried to stick on the Corpus as close as possible, to the historical material concentrating in this paper we do not want to go into the However, Hippocraticum2. and historical of our model which would fill a 'derivations' philological the resulting model paper of its own. Rather, we concentrate on presenting as well as some derived meta-theoretic features in a way as clear and precise as possible. humoral theory exem Second, we want to make clear that Hippocratic plifies all features which have been regarded in general according to the general meta-theory to theories.3 On of 'structuralist' approach in fact, may be regarded medical theories, On the other hand this yields a further
structuralist meta-theory.

essential to empirical theories now known under the label the one hand this shows that as proper successful empirical application theories. of the

Thirdly, discussion

to the continuing this work is intended as a contribution on the methodological status of medical theories.4 The example

1991. 22: 207-227, Journal for General Philosophy of Science in the Netherlands. Printed 1991 Kluwer Academic Publishers.

208 studied

W. BALZER AND A. ELEFTHERIADIS

all the properties of empirical theories in general, that exemplifies humoral theory has to be regarded as an empirical is, hippocratic theory to the 'normal' form in Sec. IV, an important distinction proper. Moreover, of theories in the natural sciences is pointed out and exemplified. I. THE BASIC PICTURE to 'The Nature of Man'5 four humores or cardinal fluids exist According state of 'mixture' (krasis), 'bulk' (plethos) and in the human body whose he enjoys the most 'power' (dynamis) is decisive for health and disease.6'... to one another perfect health when these elements are duly proportioned in respect of compounding, power and bulk, and when they are perfectly of his Thus a person's health depends on three characteristics mingled'.7 body's humoral state: first, it depends on the mixture of the humores; health can obtain only in case they are mixed. Second, intensity' of 'qualitative the humores, and third, their quantities have to obtain in the 'right measure'. humoral standard (eukrasia) is not the same This ideal mixture-balance in every individual, it makes up the special nature of a person's body8, of his health. If this standard obtains and the special humoral condition we say that the state of the person is eukratic. Now the person may be exposed to causes which destroy the optimally humoral state, so that either one of the four humores increases proportioned more or is in lack or becomes intense than the others, and qualitatively some sense. The person then becomes is isolated in sick.8 Therapy consists in finding out which of the humores have run out of their range of equilibrium or mixture so or increasing their quantities, and in diminishing qualities, that equilibrium is restored. Of course, the notion of a chemical substance was not available at these of times (about 450 BC), so the humores represent a rough typification or 'juices' being present different qualitatively liquids directly observable, in the body, being produced by it, or leaving it. Not every kind of body liquid is regarded as a different humor, this label is reserved for only four of them: yellow bile, black bile, blood and phlegm. These four humores are intimately connected with the four elementary qualities of the human body: warm, cold, moist and dry. Yellow bile is warm and dry, black bile is cold and moist, is warm and moist, blood phlegm is cold and moist. We say that each humor is the 'carrier' (cpopefc) of two qualitative intensities (dynamies).9 These qualities may be present in different dregees10, ad they vary with the quantities of their corresponding
humores.11

the different quantities and qualities of the humores numerical Concerning seem natural from a modern such representations standpoint. However, a representation We have would conflict with the historical background. to be aware that the concept of a quality still was in its process of formation, the concept of a real valued function used today to represent qualitative

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH orderings

209

no strict ways of measuring the did not exist. Furthermore, were known, and no attempts at measuring the quantities of the qualities the hippocratic formulations humores were made. Consequently, concerning There is only 'more or remain very qualitative. mixture and equilibrium - in accordance with what could less' of some humor or of some quality and stick be observed. For these reasons we avoid numerical representation to a qualitative treatment of humores and qualities. This yields an apparent From a logical point in our reconstruction. of these notions complication and 'more basic'. of view, however, our treatment is less complicated, The basic models comprise two parts. First, there is a statical part which attempts at clarifying the concept of a state of equilibrium or health. Sec a picture of how certain factors may ond, the dynamical part provides how equilibrium the states of a pearson over time, and consequently change and how the latter may may change into disequilibrium (illness), (health) be treated. II. PRIMITIVES AND POTENTIAL MODELS The central notion of a humor we represent by a weak order, i.e. by a structure < D, ^> consisting of a set D of abstract 'degrees' and a relation is transitive, ^ on D which reflexive, and connected. We introduce four into two such orders, one for each humor. The four qualities we comprise and one for moist-dry. Though Hippocrates weak orders, one for warm-cold, seperate, nothing gets lost by combining always keeps the four qualities of each pair into one respective weak order. the two opposite qualities to the following list: We abbreviate the humores according (1) hx = yellow bile, h2 = = black bile, h3 blood, hA = phlegm,

weak orders in the form <| |ht\ |,<,->, and we denote the corresponding Index / in the following will always for i = 1, 2, 3, 4, so ht = <11 ht \ | ,^,>. over these four humores. Similarly, the two weak orders for the qualities range are denoted by (2) where ql temperature, q2 = moisture

each ql has the form ql = <| ^| |,^'*>, and index i will always | and strict range over 1,2 in the following. As usual, we define equivalence order in terms of ^ by: (a ? b iff a ^ b and b ^ a) and (a < b iff (a < b and not b ^ a)). the four degrees A person at each time has a distinct state comprising to these of its humores, the eight degrees of the qualities corresponding humoral degrees (two for each humor), and one further item indicating are in mixture or not. So each state s(t) at time t

the humores whether is a 13-tuple

1y(/)=<Cz1,...,z4,z5,...,z8,Z9,...,z12,z13Z>

210
where are

W. BALZER AND A. ELEFTHERIADIS

of the humores are of

zx,...,zA

degrees

hu...,hA,

z5,...,zs

degrees

the quality q1, z9,...,zn degrees of quality q2, and z13 is one signs V (for separated) and '?1 s' (for not separated). Defining

of

the two

St

= \W\\\ ^Hl<72ll4, = ||Ail|x...x||A4||. ^

= SQ StxSw

and

X {s, ?\s}. each such state is an element of the 'state space': SH x Sq of SH we will call humoral states, and elements of Elements Sq qualitative
states.

Whereas the information that the humores are in mixture is expressed the symbol'?15', the notions of quantitative of the humores by equilibrium and of qualitative qualities afford further equilibrium of the corresponding We use two sets primitives.

POSCS^
to contain

and

BALCSg

that the humoral degree u 'has' degree v of quality 11<72lI ?t(u) a given degree of blood has a certain temperature), and 0w(w) = ql (e.g. v means that the humoral degree u has degree v of quantity q2. Further states to humoral more, we employ a function core to assign qualitative states. corQ can be explicitly defined with the help of 0t and 0W:
core (zl5...,z4) = <0/ {zx),...,%t(zA), ^w{zx),...,^w{zA)>.

by two functions 0,: 11 |U...U| |hA\\ h{\ ""**

= v means

humoral exactly those tuples of degrees which are in quantitative, and are balanced with respect to their qualitative (7roo6rrjTa) equilibrium intensities, respectively. These two notions have a rather theoretical status. The assignment of degrees of qualities to degrees of humores is captured

\ \ql\ | and &w: 11 |U ...U 11 \ hx\ hA\

to these notions In addition central for the theoretical of concept over time. First, there are others concerning the description equilibrium, of course, time itself is needed. We represent it by a linear order <T,< >, to be a finite, non-empty set (representing where T is supposed points of If t* is and connected. time) and < C T x T is transitive, anti-reflexive the maximal element of T with respect to <, then by T* we denote T\ {t*}, and for each t e T* we denote by t+\ the unique t' e T such that t < /' and there are no /" e T such that t < t" < f. The function s(t) already then may be typified precisely by s:T ? SHx mentioned ?1 s}. SqX {s, state of health of a person is described by a function: The 'observational' ? g:T {healthy,ill}. Finally, we use a set F of 'factors' and a function a how these factors affect the different humores, their qualities, describing and the state of mixture. We write a(tf)=<h, a, q, b, c>, to be read as 'at /, factor / affects humor h in direction a, quality q in direction b, and mixture of humores in direction c. a, b, c range in the sets {+,-,0}, {+,-,0} '+' and '-' indicate the directions and {s,0}, respectively where express ed by 'greater' and 'smaller' in the natural reading of the orderings < D, we may and '0' neutrality. Altogether ^ >, s indicates '/ is seperating',

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH define, DI in structuralist x is exist and a> format, the class of potential models as follows.

211

Mp

(1) (2) (3) (4)

a potential model of hippocratic iff there theory (x eMS) ,s,g, POS, BAL, 0? %w hl9 ..., h4, q\ q2 and T, H, Q, F, < a such that x=<T, H, Q, F, <,s, g, POS, BAL, 0? %, and <T, < > is a finite, linear order and each ht is a finite weak order H={hu...,hA] and each ql is a finite, weak order Q={<l\ 42} s:T-+ SHxSQ x{s, ?i s}

(5) (6) (7) (8) (9)

(10) (11) We may

g.T- {healthy,111} POS C SH BAL C SQ 0,:||/*J|U...U||/*4||HI<71II 0W:||/*J|U...U||/*4||HI<72II

F is a non-empty a:TxF-(Hx set {+,-,0} x Q x {+,-,0} x {j,0})

are finite because the means of that all orderings suppose the degrees in antiquity were very limited so that only few differentiating Elements of T, H, Q, and F are interpreted degrees could be distinguished. s of time, humors, qualities and factors, respectively. Function by points over time, while g the states of humores, qualities and mixture describes over time of whether the person is healthy or yields a direct description not. Elements of POS and BAL may be called humoral states in quantitative in intensities, respectively. and states of qualities balanced equilibrium, St and 0^ to each humoral degree assign its corresponding (degrees of the) a describes which factors are effective and moisture, qualities temperature at what time, and how they affect the humores and their qualities. Each potential model comprises the concepts necessary to describe one per son, whether healthy or sick. Different persons being captured by different po tential models, there is no need to mention the person in the potential models.
III. THE MODELS

some auxiliary In order to state the axioms characterizing the models, are helpful. We say that a function 3>:D ? D' mapping definitions the on each other is order sets from two structures <D, ^> and <D', ^'> order reversing) iff, for all a, b e D: a ^ b iff <!>(#) preserving (respectively a ^ b iff $(b) ^'&(a)). for all week orders <D, ^'<l>(&) (resp. Clearly, and <D', ^> the following holds: ^> (3) if <b:D? D' is order preserving (resp. order reversing) then the same holds with respect to < (as defined above). Moreover, for all a,b eD: not (a < b and b < a).

212
If z=<zlv..,z8> e

W. BALZER AND A. ELEFTHERIADIS

we Sq define and

a1(z)=<z1,...,z4>

o2

(z)=<z5,...,

z8>.

If z=<zlv.., z12, z13> e SHX {s,?]s} then /}(z)=<z1,...,z4> and, for SqX k <: 13: nk{z)=zk. Finally, are weak orders, and if, for i ^ 4, </),, sg,>
v=<vlv..,v4>, w=<wu...,w4> e Dx X ... X Z>4 then w is a one-sided deviation

of v iff (for all i ^ 4: v, ^ tWt and there is i ^ 4 such that vz < f w,-) or (for all /^ 4: wf ^ t vz and there is /^ 4 such that { vt). wt < Now the axioms for the basic models of hippocratic theory may be The central axiom formulated. is concerned with the mixture-balance condition of health as described above, and says that a state s(t) of a healthy is such that it's 'humoral part' /? (s(t)) is a state of quantitative person (noooTriTa) equilibrium of the humores (i.e. element of POS), it's 'qualitative balance (i.e. an element of BAL), and it's component part' is in qualitative mixture indicates that the humores indeed are mixed (i.e. in state describing in D2-1 below. We do not require the reverse This is formalized ?\s). direction expressing that if a state s(i) satisfies the mixture-balance condition, the person is healthy at t. The basic reason is that this would make the 'observational' of health, g, explicitly definable and thus representation in a certain sense redundant. Our weaker version allows for observed illness even if all theoretical conditions for health are satisfied. Axiom
the humores

D2-2

regulates
Hippocrates

the 'directions'
does not

in which
combine

the qualities
'warm' and

vary when
'cold', nor

vary.

'dry' and 'wet' into a single scale, respectively,

assignement12

as we do. He uses the following

yellow bile black bile blood phlegm

warm cold warm cold

dry dry wet wet

to vary in degree with variation of Any humor's qualities are supposed that humor. Thus increase of blood, for instance, leads to increase of warmth and moisture, that we deal with weak orders so and conversely.13 Note that 'increase' includes 'no change'. By combining the qualities 'warm' and 'cold' to one scale 'temperature' we have to be careful about directions to of qualitative change. If phlegm, for instance, increases then according So that is: temperature decreases. list coldness also increases, is order reversing when restricted to the degrees in ||A4||. Proceeding 0, in the same way for all the four humores we obtain the eight requirements stated in D2-2. on the notions of qualitative D2-3 below imposes a strong condition of humors. It says that two balance and of quantitative equilibrium 'qualitative' states such that one is a one-sided deviation of the other cannot both be balanced, and the same for humoral states. It draws Axiom D2-4, finally, captures the dynamical part of the model. a and corresponding a connection the affect-function between changes of humoral or quality degrees. For example, 2-4-b.3 states that if a assignes the above

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

213

a pair <ql,+> at time t to factor / where ql is a quality of humor ht, then to ht will increase, i.e. will be greater at the degree of ql corresponding time f+1. The j4+/'s projection of the just picks out the right component states s(t), s(t+l), namely the component the degree of quality describing and qi of hj. For i=2 and j=2, for example, h2 is black bile, ql moisture, to the above definition of core qrs degree has to occur in position according number 10 (= /4+/) of a state s(t). 4-a states that a factor causing separation is not mixed at the following leads to a humoral state which instant, and 4-c says that 'neutral' factors do not yield any change of the corresponding
degrees.

D2

x is a model ofhippocratic theory (xeM) and T,H,Q,F, <,s,g,?OS,BAL,@t,@w <s,g,?OS,BAL,?t,%>

such

iff there exist hx,...,hA,qv,q2 that x =<T,H,Q,F,

(0) (1) (2)

(3.1) (3.2) (4) (a) (b.l) (b.2) (b.3) (b.4) (c.l) (c.2)

xeMp for all t e T: if g(t)=healthy then fi(s(t)) e POS, corQ (p(s(t)))

e BAL and ttu (s(t)) = ?\s

0/|

|hx\ + 0/| |

|h3\ |, 0^/11 h3\ |, 0W/| |h4\ | are order preserving

and for k=\, 2 and for all z,zf e if ok{z) is a one-sided deviation Sq. of ok(z!) then not (z e BAL and z' e BAL) for all z,z' e SH, if z is a one-sided deviation of z' then not (z e POS and z' e POS) for all te T*, i^ 4 andy ^ 2: for all r e F and a,b: if a(tf)= <hi,a,qJ,b,s> then not /?(,$(*+1)) ePOS (there are/,Z?,c such that a(tf)= <ht, +, ^, Z?,c>) b,c>) iff ttj (s(t)) iff tt,W/+1)) iff iff nj4+i 7Tj4+i

</7r/(s(t+l))
(there zrtfb,c (there are f,a,c (there are f,a,c

such that a(f,t) = <hi9 -, ^, such such that a(tf) that a(tf) = = <ht, <ht,

a, qi, +, c>) a, qi, -, c>)

(s(t))<J7rJ4+i(s(t))

for all/,*,c: a(tf) for all f,a,c: a(tf)

(s(t+l))<i7rJ4+i(s(t)) =

iff nt (s(t)) ? tt{ (s(t+\)) <ht, 0, qi, b,c> = iff c> <ht, a, qi, 0, tt^,- (s(t)) ^7r-4+/

W/+1))
IV. DISEASE The models introduced do not characterize disease by themselves, they just a conceptual model in which health as well as disease may be provide the development to the of disease. According described, together with structuralist meta-theory, consists any empirical theory (theory-element) of at least classes M M and a set of intended applications, i.e. a set of of those real systems to which one intends to non-theoretical descriptions

214

W. BALZER AND A. ELEFTHERIADIS

theories this minimal scheme needs emendation. apply the theory. Inmedical the models which describe the 'normal' or 'healthy' cases or are Besides neutral with respect to health and disease there is definite need for the introduction of another set of structures, which we call S in the following, disease. The argument the elements of which characterize for introducing S is this. On the one hand, it is clear that the intended applications for a medical theories are theory are given by cases of sick persons. Medical intended to explain sickness and thus to guide therapy. On the other hand, we cannot simply take as models of a medical theory only those structures loose any standard which characterize disease. For if we did so, we would of health. In general we would risk to 'systematize sickness' without caring to keep about how to cure it. In order to satisfy both these requirements: a standard of health, and to characterize there seems only one disease, way. We to emend the general structuralist picture, and add another S, to those making up a medical theory. component, Thus the basic theory-element of hippocratic theory takes the form have <Mp,M, S,I>

of intended cases14 where and M are as before, / is a set of descriptions Mp and S C M is a class the potential models, in the vocabulary given by
of structures characterizing sickness.

inM. the general models be characteried by specializing are added separating sick those models Further assumptions describing may be stated at the obser persons from the others. These assumptions vational level of g, or alternatively on the theoretical level involving reference a person captured by some model to mixture and balance. Observationally, = ill in that model. A theoretical is sick at time t just when g(t) corresponding Sickness may is this. characterization D3 (a) x is a model
T,...,a (1) such x=<T,...,a>

of a person
that and teT

sick at t

iff there exist hx,...,q2,

M (2) x e not: s(t) e POS X BAL X { -n j} (3)

(b) x is a model of a sick person (x e S) iff there existx / such that x is a model of a person sick at t The idea here is, of course, that the set POS X BAL X {?\s] characterizes exactly those states in which the person is healthy. Instead of the existential for t in (b) we might also work with a universal quantification. condition In the light of the previous discussion we note the importance of condition If this were omitted we had no standard for justifying condition D3-a-2. to express illness. By virtue of D2-1 we obtain (3) Tl The
by an

If x=<T,...,g,...> reverse of Tl does

is a model not hold

of a person

sick at t then g(t)=il\ iff D2-1 is replaced

in general.

It holds

equivalence.

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

V. THE THEORY-NET

215

If this were all about disease then the hippocratic theory would not have it interesting, and influence. The crucial point which makes gained much in which it exemplifies the situation typical for mature theories in the natural described up to now forms the basis is that the theory-element sciences, each specialization for many being connected interesting specializations, with a special kind of disease. The general picture of mature empirical studies15 is that of a theory net, theories which emerged from structuralist , M, S, /> described above) (like <M consisting of one basic theory-element of that basic element. This is why we used the and many specializations
term 'theory-element' above.

described above A specialization of the basic theory-element in three steps. First, new terms are added to those used to define are added to those defining second, new requirements models, to narrow down the set I of intended it is necessary Third, for the new assumptions made in step two will not hold in all

is obtained the potential the models. applications applications and models

The classes of potential models of the basic theory-element. are left unchanged. of <M So a specialization M, S, I> is an entity <Mp, M, S*, I* > where S* C S and 7* C I.16 we may introduce special ways of disease corresponding to Abstractly, state s(t) from a virtual state s*(t) of a person's of deviations possibilities a state s(t) which deviates from a state of health of health. Considering < is a state of sickness (i.e. 13, and which just in one component zt, i x {?\s} we may say that a person in state s(t) yields not in POS X BAL a model indi for a disease due to, or 'caused by', the humor or quality and k < 13 let us write s(t) [zk/zk*] cated by index i. If s(t)=<zu...,zn> to denote the result of replacing tk in s(t) by zk*. In the same way, we of zt that causes the it is lack or abundance further specify whether may
disease. D4 Letx=<T,...,a>eM.

< I (a) For / 4, x is a mode for a disease caused by lack of (abundance iff there is some t e T and some z^zi such that s(f) of) ht e/POS x BAL x {?is}, s(t) [Zj/z*]* POS x BAL x {?\s} and zi<izi*(zi*<izi) For / < 4 and j < 2, x is a model for a disease caused by (b) lack of (abundance of) qi with respect to ht if there is some t e T and z^zt such that s(t) t POS X BAL X {?\s}, s(t) e POS X BAL x {-.s}, and zJ4+i <j [zj4+i /zj4+i\ zj4+i (Z*j4+i<JZj4+i) < 4, x is a model for a disease caused by humor ht iff (c) For / x is a model for a disease caused by lack or abundance of ht For / < 4 and j < 2, x is a model for a disease caused by (d) for a disease caused qi with respect to ht iff x is a model lack or abundance of q- with respect to ht by

216

W. BALZER AND A. ELEFTHERIADIS caused by separation iff there is

(e) x is a model for a disease t eJsuch that oX3(s(t))=s

In D4, the states are possible states of health which are different j(Otz/^/*] from the actual states given by s(t). As the actual states deviate from these 'standards of health' they represent states of illness. We do not require that x in D4 be a model of a sick person. This can be proved. T2 All special models defined in D4 are models of sick persons.

The proofs of the theorems are given in the appendix. Each clause in D4 defines several specializations Sr in the formal sense of subsets of S. By intersections we obtain further specializations diseases taking characterizing in which several humores or qualities are out of equilibrium simultaneously. cover the cases In this way we obtain which ultimately specializations in the Corpus Hippocraticum. As a concrete consider example, to Hippocrates this disease is caused by some affection epilepsy. According of phlegm and blood in which reported
be copious and thick, it. If the flow congeals cut off respiration; be less, at the first it is master, but in course of time, when it having warm is dispersed the copious, if in this way the veins and mixed with blood, throughout it be mastered, the veins admit the air and intelligence returns.17 for it masters the blood by its coldness and ...the phlegm flows is immediate, cold into the blood which is warm, ... If the flow

death

phlegm
which,

In the first case, basically, blood here gets too cold by the coldness of which flows in. It is easy to define a specialization of S in Sp
at some t, the person's phlegm and blood are too cold. We even

S further may go further and introduce a specialization pi by introducing In this with their help, stating the symptoms of epilepsy. concepts and, we arrive at a rather specific theoretical (and observational) way description of the disease. Similarly, we may proceed for many other diseases found in the Corpus each of which and we obtain a whole net of specializations, Hippocraticum, a subclass of S. Writing for diseases caused by humor hif and given by Sj St: for diseases caused by quality cflof humor hf, and St+, Sf etc. for diseases or lack of caused by abundance ht, respectively, we obtain various knots in the theory-net depicted in Figure 1 on the next page. This is concerned with prognosis. specialization is a bit involved so that we can sketch it only very already specialization 'secretion' briefly. It refers to four new concepts: 'critical days', 'maturation', and 'improvement the state of health)'. Critical days in a process of (of in some sense are crucial for the further course disease are those which of the disease. For fevers, for instance, the critical days are: the 7th, 9th, 11th, 14th, 17th and 20th day.18 Specific events on these days indicate whether In the case of 'pains of the lungs and the patient will get better or worse. ribs', for instance, 'sputum should be quickly and easily brought up, and with the sputum; for the yellow should appear thoroughly compounded second kind of A

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

M(HP)

217

_^

^^^

diseases

of the 4

prognosis

humores// ^"^^ y^
Sf. yellow S2: black

\ ^*\. \ I improvement
S4: \ phlegm^

S3: blood

bile .bile

I VV \\

\\

\ \ \ \ ardent \ \ \ \fever

Ny. N.

\ N.

^v \ >s^ \
NA

deterioration pneumonia

S.+: jaundice

\ \ >v\ \ phrenitis \ \ \

inflammation continued |

blood/phlegm

fever

tumor / \

quartan / \ fever / \
erisypelas Fig. 1 sacred disease

if longer after the beginning of the pain yellow sputum should be coughed or not thoroughly or causing much coughing, up, or reddish-yellow, it is a rather bad sign'.19 'Especially should the empyema compounded, the disease has reached the begin from sputum of this character, when seventh day, the patient may be expected to die in the fourteenth day unless some good symptoms happen to him'.20 Maturation and secretion mainly of a humor h. If is caused by abundance refer to the case where disease or is secreted on a critical day, an improvement of the patient's h maturates state will follow. Otherwise, things will get worse. some way of blurring In order to deal with prognosis is adequately, a probability states needed. We may introduce space of the set of possible to this end, and thus finally obtain various specializations PROGj capturing various different ways of secretion, and in particular the two main cases of 'improvement' them to the net of diseases and 'deterioration'. Adding we obtain some picture like that in Figure 1. VI. THE MECHANISM OF DISEASE to providing In addition contain a precise picture a basis for a theory-net the models introduced and be cured. of how diseases may originate,

218

W. BALZER AND A. ELEFTHERIADIS

at some time /, some factor / affects sickness occurs whenever, Roughly, the person such that the effect of / is not counterbalanced by any other to change while factor at t. So / causes some humores or their qualities the others stay as they are. the result is some deviation from equilibrium
and balance, and disease comes up.

of two factors step we define the notion of supplementarity same direction'. By a cause of a disease (D5-a below) by their acting 'in the we understand a set of factors all of which are supplementary. By requiring a set covers all the factors effective at some instant t we are that such sure that no counterbalancing factors are present (D5-c).
D5 Letx=<T,...,a>eMp, t e T.

In a first

eF, i,k < 4 and j,r < 2. (a) Let// are supplementary iff, for all a,b,c,a',b\c': /and/ if a(tf)=<ht,a,qi,b,c> and a(tf)=<hk,a'9qr,b'9cJ> (1) if i=k then a-a' and c=c'

then

(2) if J=r then b=b' (b) Ft, the set of factors effective at t in x, is defined by there are h,q,a,b,c such that a(tj) = <h,a,q,b,c> Ft= {feF/ and (a^O or b^O or c^O)} (c) Ft is a cause of disease in x iff (1) Ft is the set of factors effective at tin x (2) Ft is not empty 6 are supplementary (3) for all// Ft:f and/
We now can prove that in models of the hippocratic theory causes of

In this sense, the theory may be said to in fact, lead to disease. disease, level. 3 states this on an abstract explain the origin of disease. Theorem to various of particular combinations factors this account Specializing leading to particular diseases, we obtain another theory-net of specializations covering the field of anamnesis. T3 Let x=<T9...9a> cause of disease In particular, eM and t e T*. If #(/)=healthy in x then x is a model of a person and Ft is a sick at f+1.

g(t+\)=\\\. VII. THEORETICAL TERMS

Most theories, at least the more comprehensive ones, allow for a classification terms. Our idea of a of their terms into theoretical and non-theoretical T should offer at least some ways terms in theory T is that theoretical This the term is T^non-theoretical. for determining that term. Otherwise, to the present example will can be formalized21 but application distinction term has to be determined 'outside' be in informal terms. A T^non-theoretical of T, i.e. before Tis applied. If other theories are used in order to determine a T^non-theoretical term, then this term may be said to be presupposed T. Our idea of theoreticity therefore is closely linked with the way theories by

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH are

219

interrelated with each other in a hierarchical way. We will consider terms here, those terms referring to the basic sets of the relational only objects usually turning out as non-theoretical. in time (<) clearly is non-theoretical. The relation of precedence Hippo cratic theory does not contribute to establish any means to determine which instants are later than others. The same is true for the relations of compa risons (^)between degrees of humores and qualities. They also have to before the present theory is applied - either by qualitative be determined or by some primitive means like direct human devices of sensation, measurement. This also holds for function s. The states in which the person is at various times are given by different degrees (of humores, qualities, The beforehand. and 'mixture'), and these degrees have to be determined a also is non-theoretical. In order to find out which humor affect-function is affected by some factor (and in what direction) we do not use Hippocratic and perhaps reasoning theory. Rather, we use observation involving other, scientific or everyday, 'theories'. From what we said about our interpretation The values of g are observed without recourse of g, g also is non-theoretical. to Hippocratic it seems that the functions 0r and 0^ are theory. Finally, non-theoretical. In order to determine the degree of a quality present in a given degree of a humor we may resort to direct qualitative sensation. terms are those used to characterize health: POS, BAL, The remaining In order to see that they are theoretical which are theoretical. {s, ?\s} we must ask whether they can be determined without recourse toHippocratic are used to define states of health, theory. Now POS, BAL and {s, ?\s} some i.e. elements of POS x BAL x { ?\s }. In order to find out whether state s(t) is in that set we have to use this definition, of course, and thus to refer to the theory. More locally: in order to find out whether a humoral state is in quantitative equilibrium (i.e. in POS) we have to see whether the theoretical assumptions put forward in D2 are satisfied, for these are the only criteria we have for POS. One step in checking whether a humoral state is in equilibrium and by always will be to see whether g(/)=healthy, means of D2-1 accept the assumption if no other facts point of equilibrium to the contrary. This step clearly involves reference to the theory. So no POS seems to exist, and POS of determining theory independent method to be ^theoretical. This does not mean, of course that checking whether a state is in POS or not amounts to nothing else than the step just described. A typical means of determination is comparison among different persons. of one person's humores is inferred from their being similar Equilibrium to those in other persons which all were healthy. But this detour leads to the same kind of situation for the 'other' persons: at some point there are no others, and we are thrown back to the theoretical model. a qualitative In order to see whether state The same holds for BAL. in BAL) we have to check, among other things, whether is balanced (i.e. the person is healthy in terms of g and to use D2-1 to infer that balance we come into is acceptable in this case. Even in case of the set {s, ?\s]

220

W. BALZER AND A. ELEFTHERIADIS

a state is mixed or not we For in order to see whether that situation. cannot simply refer to the observed facts, at least in 'initial' cases where there are no standards of comparison with other cases. Even in the presence of dramatic observational evidence with respect to mixture we have to check whether the person is ill in terms of g, and then reason by means of D2
1, as before.

VIII. INTENDED APPLICATIONS 'anchor' the theory Any empirical theory is applied to real systems which in experience. Those systems are difficult to characterize precisely. Usually, In the development 'autodetermination'. they are given by 'paradigms'plus of the theory over time, first some real systems are pointed out ostensively that is, intended systems iff they yield models, and called 'paradigmatic' iff the theory can be successfully applied to them. The set of all descriptions of intended systems is called the set / of intended applications of the theory (to which we referred already). All the concrete cases described in the Corpus and all cases of sick persons may be regarded as paradigmatic, Hippocraticum sufficiently similar to these yield intended applications. are supposed to the structuralist scheme intended applications According to have the structure of partial potential models. Partial potential models
can be introduced in two ways, a more liberal, and a more narrow one.

to the liberal version, is just any potential model According of a potential model.22 restricted version in addition substructure to denote terms from those structures. We use M cuts off all theoretical in the more liberal sense. the class of all partial potential models
Here Meton are was two seized examples. of heaviness with fever and painful well moved. of water had his bowels day. General stools the loins. Second a fairly day. After in the head; Heaviness twice from slight epistaxis rather day. black', Violent

a partial A more

draught copious stools thin, bilious, rather red. Fourth the right nostril. An uncomfortable had a rather black cloud floating from blood

Third

day.

of unmixed sleeplessness; epistaxis The restored. urine thin and rather black. His head was bathed; sleep; reason wandering; suffered no relapse, but after the crisis bled several times from the nose.23 patient

day; urine in it, spread out, which did not settle. Fifth the crisis the left nostril; sweat; crisis. After night;

exacerbation; as on the third

stools is indicated by the occurrence of humores: bilious Disequilibrium black urine, unmixed blood; and by some (indicating yellow bile), epistaxis, qualitites being out of their usual range: fever, sweat.
lived by the wall. He took to his bed with acute fever on the first day and sweating; the bowels later a small clyster moved Second day. General exacerbation, night uncomfortable. to have lost the fever; he appeared well. A restful night. Third day. Early and until mid-day but towards evening acute fever with sweating; thirst; dry tongue; black urine. An uncomfortable out of his mind. Fourth day. All symtoms black urine; a more exacerbated; night; completely Philiscus comfortable semen; scanty of unmixed mid-day slight expistaxis night, and urine of a better colour. Fifth day. About in it, resembling round particles blood. Urine scattered, varied, with suspended of a suppository the patient passed, with flatulence, they did not settle. On the application of sleep, irrational excreta. A distressing snatches talk; extremities everywhere night,

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

not get warm again; black cold, and would cold sweat; extremities livid. About mid-day

221

urine; snatches of sleep towards dawn; speechless; on the sixth day the patient died24 (italics ours).

the italicized expressions indicate the humores and qualities which Again, are out of balance and equilibrium. like these may be formatted in the vocabulary of Sec. II. Descriptions Essentially, they contain data about time, g9 s9 and a, sometimes also about So we obtain a partial potential model, whether the state of mixture. in the wide or more narrow sense. Proceeding like this for all other cases we obtain the set of all paradigm intended applications. IX. CONSTRAINTS Constraints of a theory. Such capture relations among different models relations usually express features of stability of nature without which the theory simply would not work. In hippocratic theory there are at least two
constraints.25

The first may be expressed by the slogan 'similar cause, similar effect'. In our vocabulary this may be made precise by reference to the affect function a. If two potential models x, y represent two persons which at two instants t (in x) and /' (in y) are in the same state then a factor / will affect both persons in the same way. In order to express this in precise us write, for potential models x, y: T*, V, sx9 ^ etc. to denote terms, let the components of x and y respectively. The constraint then may be as in D6-a below. Note formulated that if the two states sx(t) and sy(t) in x and y are the same then some of the humoral and quality degrees in x and y also must be identical. We also note that this constraint in is used to characterize Hippocrates epidemics as diseases caused at the same time or period by the same or similar factors in many persons. This points to a second constraint which is still more fundamental than the first. Roughly, it says that the sets of degrees of humores and of qualities are (approximately) In a very strict formulation the same for all persons. this means that all these sets are identical in any two potential (D6-b below) A similar constraint may be contemplated models. for the set of labels but this set is already identical in all potential {s9 ?\s} indicating separation,
models qua syntax.

D6

LctXQMp. iff for all x9y e (a) X satisfies the constraint for a (X e Ca) X, all // and all/: if sx (t)=sy (/') then ax(t,f)=ay (t',f) iff (b) X satisfies the constraint for degrees (X e CJ) /^ 4 and j ^ 2: for all x9y eX9 all

(90*11=11(^11 ||Af|| =||^|| and 11

sets X satisfy in the real world these constraints only Due to the individual differences of body and surrounding, approximately. the same factor (if we could identify it) will affect two persons in slightly Of course,

222

W. BALZER AND A. ELEFTHERIADIS

different ways. However, from the standpoint of hippocratic theory the humores and their qualities provide a complete description of a person's state. If this were so, then strict identity of states would not leave room for any other relevant differences of the two persons - relevant with respect to a - and D6-a would hold strictly indeed. This shows that the approxi to make mation the constraints to the 'true' is 'proportional' necessary states s(i) describe a person. of completeness with which In case degree of the constraint for degrees, one might say that different persons' being different even quantitatively, the humoral and quality degrees cannot be the same for them. However, this constraint may also be read as an analytic statement about the notions of humor and quality. We simply choose one set of degrees for each humor and each quality such that the degrees maximal in that set. This set is entirely unproblematic, of all persons are contained and satisfies Ca in a trivial way. Further constraints are used in connection with the various specializations some special which capture different diseases. In many such specializations, some particular diseases in one model constraint is at work. A factor/causing in other models. x, for instance, will cause the same disease (approximately) a major It has to be emphasized that constraints role in the play of the theory. They allow to reason from one case (or from appplication a set of similar cases) to another, new one. If symptoms (state) xyz are the same for person p and all persons from a set Q, and if all persons in Q got disease XYZ in the past when exposed to factor j, then we will infer that/? also will get this disease when exposed to factor/. This is just a verbal reformulation of D6-a. Without this constraint The theory would have developed. (whether assumed or 'true') no medical same is true for but on a more basic level. If the degrees of humores Cd, and qualities were not roughly the same for different persons, we could anew in each not compare them, and our knowledge had to be assembled case (with poor results of course). X. EMPIRICAL CLAIMS terms has some rele The distinction between theoretical and non-theoretical vance in the context of applying in order to test whether it is the theory, some concrete cases, in fact, yield models true. If we want to see whether and relations the sets, functions of sick persons we have to determine introduced in Section II. But if we use the theory in order to do so which is very likely in the case of theoretical terms, and impossible for non-theo it. In the context of retical we already use (and in this sense: presuppose) to determine an empirical test of the theory it therefore is recommendable values of non-theoretical functions. In order to check whether the axioms only are true in a given system it then is sufficient to check whether the values are compatible with the theoretical that is, determined picture, actually and {s,?is} which whether there exist theoretical augmentations POS, BAL,

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH can be added

223

to the observed data such that the axioms are satisfied. that all intended applications yield such partial potential By assuming i.e. the empirical claim associated with the theory-element models, IQMpp, like this: T> may be formulated <Mp, M, S, for all y e I there exists some x e S such that x is an extension (4) of y In one concrete case this means that the data which are known about a person in non-theoretical which can be expressed (and terms) fit into a model of the theory in which, for some suitable sets POS, BAL and are satisfied. In other words: for given (empirically {s, s} all axioms functions <, s,g,<dt,?w and a there exists sets POS, BAL and determined) such that all these entities together (and together with the sets {s, ?\s} that (4) refers to S rather T,H> Q,F) form a model of a sick person. Note to our than to M. If S were replaced by M then (4) would not contribute that the persons considered are sick. understanding the constraint the claim (4) may be considerably Adding strengthened. Let us write C=Ca D Cd, and add C to the theory-element introduced before which yields an extended theory-element T=<Mp,M9S9C9I> where M and S are as before, C C and I C needs Mp9 Mpp. Mpp Po(Mp) not to be mentioned in (5) because it is explicitly defined. The claim (4) then may be replaced by a claim for whole combinations (i.e. sets) of intended have to satisfy (4) above, but in addition systems. All intended applications the extensions used in order to make (4) true have to satisfy the two constraints. We thus arrive at the following definition. D7 The empirical claim of the hippocratic S9 C, I> is that there exists some X C M such that theory-element <M M9 (5)

(1) XQS
(2) each y el has some extension inX

(3) XeC
In words: there exists a set X of extensions of the intended applications are models such that all these extensions and the set of them satisfies the
constraints.25

Of course,

a realistic version

of such a claim has to be blurred.26

APPENDIX ^POS x BAL x {?i*}, k < 13 and zk* Proof of T2: Let s(t)=<z,,...,zl3> such that s(t) [zk/zk*] e POS x BAL x {s}. If A:=13 then zl3*zl3*= ?is, so zl3=s, and x is a model of a sick person. If 5 < k < 8 then <z5,...,z8>
is a one-sided deviation of < z5,...,z8 > [zk/zk*], and so, by D2-3, < z12,...,z12>

224 not

W. BALZER AND A. ELEFTHERIADIS

in BAL. So s(t) e/POS X BAL X {?\s}. The same result we obtain 12. If k < 4, then <zlv..,z4> of for 9 < k < is a one-sided deviation is not in and from D2-3 we obtain that <zlv..,z4> <zlv..,z4> [zk/zk*]

POS#
disease.

Proof

of T3: Let x be given,

Let s(t)=<zx,...,zX2> and

f e T, g(0=healthy,
^(/+l)=<z/1,...,z,12>.

and Ft be a cause

of

From D5-b-l (1)

Case T. c^O,

and D5-a we obtain there are a,b,c,ij and/e

not i.e. a=b=c=0 c=s.

Ft such that a{tf)-<hi,a,qfb,c>

and

By M-5a,
Case

j3(.y(f+l)) j POS,
Subcase 2.1:

so by M-l,
a=+.

g(t+\)=ill.

2: a^O,

FromM-5-b.l:(2)z/</z'/. Subcase 2.1.1: i= l,j=\. From (2) and M-2: (3) z5 <l z/5. Now let k e {6,7,8}. Suppose zfk <l zk. Since k has the form 1 i+l, we obtain from M-5-b.4: from which, by D5, there are d,e and/ such that a(tf)=<hx,d,ql,-,e>, e and D4, together with (1) andy=l, From D5-b-3 / e Ft. So/and/ Ft. from which, by M it follows that b=-. So (1) reads a(tfl)=<hx,+,ql,-,c>, III and (3) 5-b.4 we obtain z/5<1 z5, which together with (3) in Section is false, and therefore (4) zk<1 So the assumption yields a contradiction. we obtain (5) < z'5,...,z,8 > is a one sided deviation z*k. From (3), (4) and D2-e that it follows From the of <z5,...,z8>. general assumptions e BAL. This, by (5) and M-4 implies that <z5,...,z12>=cor(<z1,...,z4>) it follows from M BAL. Since this is just cor(/$(s(t+1))), ? <zfx,...,zfX2> 1 that #(/+l) = ill.
Subcase 2.1.2: i=l,j=2.

The

proof

goes
of<^1',

as

in Subcase

2.1.1 with

'9' instead

of

'5', {6,7,8},

and

'^'instead

The Subcases
Subcase 2.2:

/=2,3,4 are proved

a=-.

similarly.

Subcase

2.2.1:

a=l,j=\.

By M-5-b.2, (6) z,x <x zx. From this and M-2, (7) z/5 <l z5. we obtain let k e {6,7,8} and suppose that zk <1 fk. From M-5-b.3 Now and so, by D4 and D5, and hx, a(tf)=<hl,d,q1,+,e>, that for some d,ef, to (7). So b=+. But then (1) and M-5-b.3 yield z5<2 z/5, in contradiction
zfk ^ z!k, and therefore <z'5,...,z/8> a one sided deviation of <z5,...,z8>.

As before,

thies yields #(H-l)=ill.

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH The

way.

225 in the same

Subcases

i=l, j-2,

and

similarly

for /=2,3,4

are treated

Case 3: b^O. Subcase 3.1: b=+. Subcase 3.1.1: i= l,j=l. By M-5-b.3: (8) z5 <l z*5. Let k e {6,7,8} and suppose z!k <{ zk. Since From M-5-b.4 this yields, for some d,ef,l, a(tf)=<hl9d9ql9-9e>. are supplementary, b=-9 so by (1) and M-5-b.4 z'5<l z5, in contradiction // to (8). As before, we conclude that g(t+\)=i\\. The cases y=2, and /=2,3,4 are treated in the same way.#

NOTES
) The Corpus is no unanimity or picture. We by concentrating 'humoral' part 'Ancient is available in different (Littre, 1923). There 1962) and (Hippocrates, common the Corpus reveals one underlying 'core' we solve in this issue here which for our purposes a consistent In particular, the text providing the picture. the ideas stated in 'The Nature comprises and part is based on 'Airs,Waters,Places', of Man' and the examples survey of the in (Schoner, in (Temkin, editions:

whether among historians to take side do not want on of our those basic the parts of model

Medicine',

from 'Epidemics V and 'Epidemics IIP. A (intended applications) is found in the Corpus dealing with, or containing works part of, the humoral model of humoral medicine is described theory for hippocratic 1964). The importance

'dynamical' are drawn

1928).
on 'Prognostic', 'Nature of Man' to Polybos, 'The Sacred Disease', (ascribed 2) In particular son in law of Hippocrates), I and IIP, 'Airs, Waters, Places', and 'Ancient Medicine'. 'Epidemics sources is found in (Sarton, about historical Morse 1970), pp. 348-84, (Schoner, 1964), (Temkin, in more detailed links to the historical 1963). The reader interested 1928) and (Schumacher, sources is referred 3) See (Balzer, 4) Compare et al., to (Eleftheriadis, 1991). 1987) for a survey. (Westmeyer, theory 1972) and

1986), (Sadegh-Zadeh, 1980), (Fleck, 1980), (Kliemt, to this discussion. 1975) for major contributions (Wieland, is the only one in the Corpus discussing the humoral 5) This work way, compare 1970), p. 368. (Sarton, 6) (Littre,

in a systematic

IV, p. 38. 1962), Vol. 6, Chap. 1923), Vol. 4, (repr. 1959, transl. by Jones), Ch. IV, p. 11. 7) (Hippocrates, and ages differ greatly' (Hippocrates, 1923), Vol. 3 (repr. 1959, 8) '...for both constitutions Ch. VII, p. 113. (Littre, 1962), Vol. 3, Ch. VII, p. 440. transl. by Withington), word instead of the hippocratic 'dynamis' for a direct translation 9) We use the term 'quality' would used It is characteristic connotations. that the hippocratics load it too much with physical - to to speak about of the humores the word VA^Ao-?' express the 'how much' 'quantity' - to denote the 'how strong, intensive' for 'quality' -, and the word 'Svvaijus' (^0167779), of them. 10) Today one would like instead say 'quantities' of a quality'. 'the quantity of We 'degrees', but this is likely therefore systematically to lead to confusing speak of 'degrees'

expressions of the four qualities. n) (Littre, 1962), Vol. 12) (Littre, 1962), Vol.

6, Chap. VII. See also (Schoner, 1964), p. 20. 6, Ch. VII, p. 46, and (Schoner, 1964), p. 20. 13) (Hippocrates, 1923), Vol. 4, (repr. 1959, transl. by Jones), Ch. XII, of I will be said in Section VIII. M) More on the structure of members

p. 20.

226

W. BALZER AND A. ELEFTHERIADIS

to bind all it is formally necessary new terms introduced in step one in the definition of S* by existential This version quantifiers. a new class of potential models M * such that members may easily be liberalized by introducing of M * contain as substructures. those from M In the following, informal sketch of a theory net we implicitly use this more liberal version. 17) See (Littre, 1962), Vol. 6, Ch. VII, p. 374, or (Hippocrates, 1923), Vol. 2, (repr. 1959, transl. by Jones), Ch. X, pp. 161-3. (Littre, 1962), Vol. 2, Chap. XX, p. 168. 18) Prognostic, 19) (Littre, 1962), Vol. 2, p. 146 and (Hippocrates, 1923), Vol. 2, (repr. 1959, transl. by Jones), Ch. XIV, p. 29. 20) (Littre, 1962), Vol. 2, p. Ch. XV, p. 31. 21) See (Balzer, 1985a). 22) See (Balzer, definition. 23) (Hippocrates, 199-201. 148 and (Hippocrates, 1923), Vol. 2, (repr. 1959, transl. by Jones),

IV. (Balzer et al, 1987), Chap. 15) Compare is perfectly i.e. it takes the 16) This definition general, theories. In order to achieve that S* be a subset of S

same

form

in the context

of other

1985) for the general, 1923), Vol.

and

(Balzer, 1957,

et al., by

1987), Chap. Jones),

2, for the more

restricted

1, (repr.

transl.

Epidemics

I, case VII, I, p. 187.

pp.

1, (repr. 1957, transl. by Jones), Epidemics I, case 1923), Vol. 24) (Hippocrates, (Balzer, et al., 1987), Chap. 2 for details. 25) Compare of approximation. 26) See (Balzer, et al., 1987), Chap. 7 for a general account

REFERENCES
Balzer, W.: Balzer, W.: 1985, Theorie undMessung, 1985a, 'On a New Definition C. U., and Berlin, Springer, of Theoreticity', J. D.: etc. 127-45. for Science, Reidel,

Balzer, W.: Moulines, Dordrecht.

Sneed, der

Dialectica 39, 1987, An Architectonic

A.: Eleftheriadis, 1991, ,Die Struktur Aufbau und dynamische Entwicklung Verlag. L.: 1980, Entstehung Fleck, Frankfurt/Main.

der Medizin: Theorie logischer hippokratischen etc.: Peter Lang der Humoral-Pathologie', Frankfurt, einer wissenschaftlichen Translation Tatsache, by Jones, Suhrkamp, Withington

und Entwicklung

Works, With 1923, Hippocrates: Hippocrates: London. and Potter, Vols. 1-6, Heinemann, Vol. 1 transl. by W. H. S. Jones, repr. 1957. Vol. Vol. Vol. Vol. Vol. Kliemt, by W. H. S. Jones, by E. T. Withington, 4 transl. by W. H. S. Jones, 2 transl. 3 transl. 5 transl. 6 transl. H.: by P. Potter, by P. Potter, Grundzuge G. Fischer, repr. 1959. repr. 1959. repr. 1959. 1988. 1988.

an English

first printing first printing

1986,

Pharmazeuten, Littre, E.: 1962, Oeuvres 1939-1861, K.: Sadegh-Zadeh, Handbuch tingen. G.: Paris

der Wissenschaftstheorie. York. Stuttgart-New d'Hippocrate, Amsterdam. Trad.

Eine

Einfuhrung avec

fur Mediziner le texte grec,

und

completes A. M. Hakkert,

Nouv.

T.l-10,

Probleme der Medizin*, 1980, ,Wissenschaftstheoretische der wissenschaftstheoretischen Band 2, Vandenhoek Begriffe, Norton Library, New York. in der antiken Humoralpathologie', Berlin.

in U. Speck & Ruprecht,

(ed.), Got

1970, A History of Science, E.: 1964, ,Das Viererschema Schoner, Beiheft 4, Steiner, Wiesbaden. J.: 1963, Antike Medizin, Schumacher, Sarton,

Sudhoffs

Archiv,

de Gruyter,

THE HIPPOCRATIC HUMORAL THEORY OF HEALTH

O.: Temkin, 1, 9-43. Westmeyer, 1928, ,Der systematische Zusammenhang Grundlagen zur Medizin, im Corpus einer Hippocraticum', Diagnostik, York.

227
Kyklos Kohl

H.: 1972, Logik Berlin-Koln-Mainz. hammer, W.: 1975, Diagnose, Wieland, Universitat Seminar Miinchen

der Diagnostik. Uberlegungen

normativen

de Gruyter,

Berlin-New

fiir Philosophic, 31 Ludwigstrasse

Logik

und Wissenschaftstheorie

8000Miinchen 22