‘CONJURERS, PURIFIERS, VAGABONDS AND QUACKS’? THE CLINICAL ROLES OF THE FOLK AND HIPPOCRATIC HEALERS OF CLASSICAL GREECE 1 Leanne McNamara The Pluralistic Medical System Hippocratic medicine is widely acknowledged as one of the most important and influential of the intellectual developments originating from classical period Greece, and with just cause. Yet Hippocratic iatroi were practising alongside a great variety of folk healers from purifiers to diviner-healers, some of whom they characterised as quacks.2 This paper investigates the clinical roles these folk healers played in an attempt to challenge this depiction by their Hip- pocratic rivals. For heuristic convenience, the multitude of folk practitioners can be subdivided on the basis of their principal methods of healing.3 There were folk healers who principally used pharmaka (materia medica such as herbs) to heal their patients, including the rhizotomoi (rootcutters) and pharmakopolai (drugsellers) as well as the pharmakeis/pharmakides (male and female witches). Other practitioners relied principally on the healing power of the hand, including the various purifiers (kathartai, perikathartai, hagneutriai, hagnitai, hagnistai and phoibetriai) and the maiai (midwives) and other obstetric practitioners. The goai (sorcerers) focused on the healing word, primarily using oral and inscribed incantations. Finally the manteis and iatromanteis (diviners and diviner-healers) employed divination as their principal healing method. This taxonomy is not to suggest that the distinctions between the different healers were clear-cut. On the contrary, there was undoubtedly a great deal of overlap be- tween the different groups of folk healers and also to some extent between the folk and Hip- pocratic sectors.4 Nevertheless, the categorisation provides a framework within which to in- vestigate how the myriad of folk and Hippocratic healers contributed to the overall medical system, in which health care could be sought and provided, and in which health and illness were defined.5 With so many healers operating within the one medical system, how did an individual who fell sick determine which healer(s) he/she should visit or summon to the bedside? Anthropo- logical studies of cultures with pluralistic medical systems indicate that the choice of healer is 1 µãgoi te ka‹ kayãrtai ka‹ égÊrtai ka‹ élazÒnew Hp. Morb. Sacr. 2. Translations are my own unless otherwise stated. I am indebted to the anonymous reviewers for many helpful suggestions. 2 I will use the Greek term iatros to refer to the Hippocratic healer throughout this paper in an attempt to avoid anachronistic connotations that invariably accompany English terms such as doctor or physi- cian. Iater and akester are also occasionally used by the Greeks to refer to healers falling within the Hippocratic sector. 3 The following classification is my own variation of the 5 categories of Graeco-Roman traditional practitioners proposed by Gordon (1995), 363. 4 On the overlap of Hippocratic and folk healers, see, for example, Theophr. Hist. pl. 9.16.8, where Theophrastus notes that Alexias, the pupil of the pharmakopoles Thrasyas, is skilled in medicine gen- erally. 5 On the competitive nature of the ancient medical marketplace, see Lloyd (1995), 25-40, and Lloyd (1992), 116f. Cf. Nutton (1995), 11f. 2 Iris: Journal of the Classical Association of Victoria n.s. 16-17 (2003-04): 2-25 ISSN 1448-1421 FOLK AND HIPPOCRATIC HEALERS an extremely complex behaviour.6 Patients who decide to seek medical care may consult one practitioner, a number of different types of healers simultaneously, or a succession of practi- tioners. Some individuals habitually consult the same practitioner, practitioner-type, or group of practitioners each time they become ill, while others alter their health care seeking behav- iour with each illness episode. One factor influencing the choice is the perceived differences in the type of services offered by various groups of practitioners. This paper contends that while folk and Hippocratic practitioners fulfilled the same general healing roles, there were important differences in the specific details of how these roles were performed.7 I will argue that the specific differences in the healers’ clinical functions, including which aspects of the clinical roles were emphasised and which nosoi (maladies) were dealt with, played an import- ant role in influencing which healer(s) an individual and his/her family might choose to con- sult when illness struck. Folk medicine is a largely oral tradition and there are no extant sources written by the folk practitioners themselves from the classical period. As a consequence this paper relies on the references to these healers, which frequently appear as brief, incidental asides, in a wide vari- ety of classical Greek literature, from drama though to philosophy, from forensic oratory to the Hippocratic texts. I am also making use of some material predating the 5th and 4th centu- ries BCE, including the Homeric poems, as evidence for earlier precedents. Each genre, in- deed each text brings its own challenges of interpretation and must be read within context, most particularly the philosophical and Hippocratic texts, which are often hostile towards folk healers. In addition, because folk practices are strongly rooted in tradition and relatively static over time, I will also refer to some later texts, most significantly book 9 of Theophrastus’ En- quiry into Plants and the Greek and Demotic magical papyri.8 Folk healers (particularly rhi- zotomoi and pharmakopolai) were an important source for Theophrastus’ herbal and the pa- pyri were written by magico-religious practitioners themselves, hence these texts provide a unique insight into the beliefs and clinical practices of folk healers.9 However, it must be noted that although the magical papyri contain many parallels with earlier Greek magico- religious literature, they originate from Graeco-Roman Egypt, and also contain Babylonian, Jewish and even Christian features.10 The use of such syncretic material to investigate Greek practices of the classical period is fraught with difficulty. Nevertheless, provided we employ only those segments of the papyri for which there are clear classical Greek attestations and in- terpret them in conjunction with this earlier Greek evidence, the papyri can provide invaluable supplementary detail with which to flesh out our knowledge of folk practice, including the various healing roles the practitioners performed. The paper will consider each of the four major clinical healing roles or responses to illness that any healer, including the ancient Greek practitioner, may typically fulfil. First, healers 6 Staino (1981), 317-32; Kleinman (1980), 80-82 and 187-89; Feist and Brannon (1988), 80-85; Kelner and Wellman (1997), 203-12; Young and Garro (1982), 1453-65. 7 For the purposes of this paper, I am defining ‘healing’ as the practitioner’s clinical response to illness or affliction within an individual who presents to him/her. This restricted definition is not to suggest that the term ‘healing’ has no wider meaning than what occurs between a healer and patient in a consul- tation, nor that healing in its broader sense is unimportant. The roles of iatroi and folk healers alike ex- tend beyond their specific medical duties to broader social healing. 8 On the static nature of folk practices, see Faraone (1999), esp. 30-39. 9 On Theophrastus’ sources see Scarborough (1978), 355-57. 10 On the essentially Egyptian nature of the papyri see Ritner (1995), 3333-79; Nock (1972), 176-94; Frankfurter (1998), 11-15. On exotic features see Brashear (1995), 3422-29. On the use of the papyri as a source for Greek folk magico-religious practice see Betz (1992), xlv. 3 LEANNE MCNAMARA may have a prophylactic role, acting to prevent illness and to maintain good health. Second, healers may be diagnosticians. They may give a label to the patient’s symptoms, determine the underlying aetiology of the disease, or both. Third, healers may have a therapeutic role. This may involve curing the patient’s disease, controlling the disease without curing it, or treating the symptoms alone. Finally, healers may have a prognostic function and predict the course of the illness, including the likelihood and extent of recovery. These four roles are not entirely distinct. For example, labelling the disease that is causing the patient’s symptoms may itself lead to the patient feeling better for having identified their illness or for having taken some form of action. Similarly, the news that an illness is trivial rather than chronic or life threatening as the patient feared, can also lead to symptomatic improvement. Thus the di- agnosis or prognosis of an illness can constitute an important part of the therapeutic process.11 Nevertheless, different healers place different emphases on the various clinical roles. The spiritual healers of modern Mexico, for example, almost never provide their patients with a diagnosis.12 Hippocratic iatroi, on the other hand, are well known for their focus on progno- sis. The various Greek folk healers also emphasise different aspects of the healing roles. Prevention Although it is often overlooked, one of the primary concerns of medicine is the mainte- nance of good health by the prevention of disease. Today, vaccination programmes or no- smoking campaigns are considered less glamorous and receive less media attention than ad- vances in transplant surgery or heroic cancer treatments, yet we still believe that ‘prevention is better than cure’. This belief was perhaps even more strongly held in the ancient Greek world, where a healthy body was thought to reflect a healthy soul.13 Someone could only be kalos kai agathos if his (or possibly her) external appearance indicated a respectable moral character. So even Plato, notorious for turning popular ideas on their heads, debates whether it is the healthy body that produces a healthy soul or vice versa, but does not question the notion that the one reflects the other.14 This belief in the relationship between a healthy appearance and character was so deep that evident illness could even affect a man’s ability to take part in the political life of the polis. Thus in the case On the Refusal of a Pension, Lysias’ defendant laments that his crippled leg has prevented him from being eligible for selection as one of the city’s archons.15 So prevention of illness, and especially disfiguring disease, was of the utmost significance and an integral aspect of Greek medicine. The most important prophylactic weapon in the Hippocratic armoury was regimen. Diet, exercise, bathing, sleep patterns, the use of emetics and purges, and other aspects of lifestyle were all considered to be intimately related to health and disease. Regimen was certainly used as a therapeutic measure: no less than six Hippocratic treatises deal primarily with its use in treating illness.16 Yet regimen was even more frequently used preventively, as the means of 11 Csordas and Kleinman (1990), 12. 12 Finkler (1994), 178-97. 13 Sigerist (1961), 234f. and 290. 14 Pl. Rep. 403d. 15 Lys. 24.13. 16 Regimen I, II, III, Regimen in Acute Disease, Affections, Ancient Medicine and Nature of Man 17. Regimen IV contains advice concerning the appropriate regimen to follow as indicated by the types of 4 FOLK AND HIPPOCRATIC HEALERS maintaining good health, the focus of yet another Hippocratic treatise, Regimen in Health. In fact, Plato argues that the prophylactic use of regimen is its only proper use, as its therapeutic applications are so time consuming, and only serve to delay the inevitable: death!17 So the use of regimen by iatroi had a significant role in the prevention of disease. However regimen was not the sole preserve of the Hippocratic healers. Gymnastic trainers also made extensive use of regimen to maximize the health of their clients, so much so that the iatros and gymnastikos (gymnastic master) or paidotribes (physical trainer) are often treated as virtually synonymous by philosophical (non-medical) authors where preventative regimen is being discussed.18 But more significantly for this paper, regimen was also used by folk healers. In fact it seems probable that classical Hippocratic dietetic theory was derived from traditional folklore concerning food. The capacity to distinguish edible and poisonous substances, as well as the ability to recognise and utilise the physiological effects of foods, in- cluding medicinal effects, seems to be basic biological ability, which humans share not only with other mammals, but possibly even insects.19 In humans, knowledge of foodstuffs is not only a biological ability, but also a cultural practice.20 Learned effects of foods, including their medicinal uses, are transmitted within the society. Societies from hunter-gatherer groups to post-industrial communities develop lists, which are frequently informal and oral, of foods and their physiological effects. The Greeks too must have had such traditional lists. Some of the earliest Greek literature, the Homeric poems, which are replete with depictions of eating and drinking, indicate that the Greeks had knowledge of the relationship between food and health.21 This is reflected in Odysseus’ warning to Achilles that his soldiers' strength and cou- rage in battle depend on their eating and drinking beforehand.22 Similarly, Achilles is por- trayed as prone to rage because he was weaned on bile.23 Hecamede uses a draught of wine sprinkled with goat’s milk and white barley meal to revive the wounded Machaon.24 So, al- though the poems do not contain food lists or descriptions of regimen, which would hardly be appropriate in epic, the Homeric poems do represent diet as a determinant of physical strength and character. An additional indication of traditional food lists is the presence of similar cata- logues of foodstuffs in two Hippocratic texts, Regimen and Affections. Smith argues convin- cingly that the use of similar catalogues in these two texts, which have such differing aims and which use such markedly different methods to analyse the foods, suggests both authors were independently drawing from a long-standing, common-knowledge food list.25 It is clear that by the classical period, if not earlier, folk healers were employing the physio- dreams the patient is experiencing, while Diseases of Women I, II and III contain extensive prescrip- tions for regimen. 17 Pl. Rep. 406b-e. 18 For a representative example of texts where the two are treated synonymously see Arist. Eth. Eud. 1217b, 1220b, 1227b, Arist. Eth. Nic. 1096a, 1112b, 1143b, Arist. Metaph. 1063b, Arist. Pol. 1268b, 1287b, Pl. Amatores 134e, Pl. Cri. 47b, Pl. Rep. 357c, 389c, Pl. Symp. 186e, Pl. Grg. 464a, 517d, Pl. Prt. 313d, Pl. Plt. 289a, 295c, Pl. Phd. 94d, Pl. Alc. 1 131a. See Pl. Grg. 464b for Plato’s explicit divi- sion of the care of the body into therapeutic (iatrike) and preventative (gymnastike) branches. 19 For a summary of studies of the consumption of plants with therapeutic, analgesic or chemoprophy- lactic effects by mammals see Janzen (1978), 73-84. For the Danaine butterfly’s use of the cardiac gly- cosides ingested from milkweed to protect against predators, see Brower (1969), 22-29. For further an- ecdotal evidence and references see Johns (1990), 251-57. 20 See Johns (1990), 257-91 for further discussion. 21 For further discussion see Smith (1966), 547-56, esp. 552f. 22 Hom. Il. 19.154-71. 23 Hom. Il. 16.203. Cf. the murderous snake who has ingested kaka pharmaka at Il. 22.93f. 24 Hom. Il. 11.638-41. 25 See Smith (1980), 441-44. 5 LEANNE MCNAMARA logical effects of the foods on these sorts of lists to make similar dietary recommendations as iatroi. This is evident from On the Sacred Disease, in which the author lists the outlandish (in his opinion) methods of treatment that folk healers employ to treat epilepsy and related epi- leptiform disorders encompassed by the rubric ‘sacred disease’, including purifications, incan- tations, and various prohibitions such as forbidding the wearing of black or goatskin.26 How- ever, he tells us that these healers also employed regimen (in the form of prohibitions): loutr«n te ép°xesyai keleÊontew ka‹ §desµãtvn poll«n ka‹ ènepithde€vn ényr≈poisi nos°ousin §sy€ein: yalass€vn µ¢n tr€glhw, µelanoÊrou, kestr°ow, §gx°luow (o(cid:0) toi går ofl ‡xyuew efis‹n §pikhrÒtatoi), kre«n d¢ afige€ou ka‹ §lãfvn ka‹ xoir€vn ka‹ kunÚw (taËta går kre«n taraktik≈tatã §sti t∞w koil€hw), Ùrn€yvn d¢ élektruÒnow ka‹ trugÒnow ka‹ »t€dow, ¶ti d¢ ˜sa noµ€zetai fisxurÒtata e‰nai, laxãnvn d¢ µ€nyhw, skorÒdou ka‹ kroµÊou (driµÁ går ésyen°onti oÈd¢n juµf°rei).27 This regimen is very similar to the sort of dietetic and bathing recommendations Hippocratic iatroi may have advised. In Internal Affections, for example, the author recommends those with diseases of the spleen abstain from grey mullet, eel, roasted meat, pork, silphium and vegetables prepared without vinegar, many of which appear on the folk healers’ list above.28 The explanatory comments in parentheses appear to be the author’s rationalisations for the similarities, and are an indication that both groups of healers were using recommendations de- rived from common food lists. The author implies that quacks and charlatans may make the same dietary prescriptions as iatroi, but the regimen is successful because of phusis, entirely natural physiological reasons. Furthermore, the iatros can account for the success folk healers have with this treatment within his own theoretical framework. Thus the red meats prohibited by folk healers, for instance, are the ones that most interfere with digestion.29 It is this, rather than any explanation the folk healers may advance, that explains why the recommendation is a useful one. It seems that Hippocratic iatroi have adapted the folk healers’ traditional regi- men into their own theoretical paradigm, and the author of On the Sacred Disease is advertis- ing this fact. Hanson has described a similar process whereby Hippocratic iatroi adapted tra- ditional gynaecological recipes into their theory and practice.30 Similarly, Smith has argued that the author of Regimen has added a theoretical superstructure to a long-standing a- theoretical food list.31 Traditional food lists could not have been entirely a-theoretical, since no catalogue can be compiled without some underlying basis on which to found decisions about the items to include or exclude, and how items should be grouped. Nevertheless, Smith’s evidence does suggest that the Hippocratics changed or adapted the existing theoreti- cal basis for the food list. The superimposition of the Hippocratic theoretical framework onto 26 On the different diagnoses that could be labelled ‘sacred disease’ by doctors and others see Temkin (1971), 15-22. 27 ‘Ordering them to avoid baths and to avoid eating many foods that are unfit for sick men: from the oceans: red mullet, black-tail, hammer and the eel (for these fish are most dangerous); the meat of goats, deer, pigs and dogs (for these meats are most disturbing to the intestines); of poultry: the cock, pigeon and bustard, and all those believed to be very strong; of the vegetables: mint, leek and onion (for their pungency is not beneficial to the weak).’ (Hp. Morb. Sacr. 1.) 28 Hp. Int. 30. 29 Cf. Hp. Mul. 218 where strong foods are recommended to men in order to promote conception. 30 Hanson (1991), 73-110; Hanson (1998), 71-94. 31 Smith (1980), 439-48. 6 FOLK AND HIPPOCRATIC HEALERS the pre-existing traditional regimen is a parallel case. Nevertheless, as the very presence of advertisement in On the Sacred Disease indicates, it is clear that iatroi did not have a mo- nopoly on advice concerning regimen. Patients could equally consult folk healers as iatroi, and very possibly received similar lifestyle recommendations. It is in this context then, that the author’s pains to rationalise his rivals’ use of regimen needs to be interpreted. Yet disease prevention by regimen was difficult. Plato laments that excessive devotion to regimen is responsible for diverting people from their work, domestic responsibilities, and worst of all, in his eyes, from study.32 Exercise is equated with toil and pain: all are character- ised as ponoi by the Greeks. Regimen II even contains advice on treating the fatigue pains caused by exercise.33 In addition, as Craik points out, the emetics and purges that were part of regimen could not have been pleasant.34 So it seems likely that many Greeks would have pre- ferred a quick and easy method of prevention to following a complex regimen, just as many people today prefer to take vitamin and diet pills rather than follow dietary advice and exer- cise regularly. Folk healers were able to provide some quick preventative fixes. Rhizotomoi and pharmakopolai in particular, could use their expertise with pharmaka in just such a quick-fix preventative role. The most spectacular and best-known example of their prophylactic use of pharmaka is their prevention of poisoning. Rhizotomoi and phar- makopolai could provide their clients with antidotes to poisons, and were also expert in the process of tachyphylaxis, the gradual administration of increasing doses of poison to produce immunity. There are several accounts of these healers engaging in poison-consuming compe- titions with each other and with lay people, in order to demonstrate their professional skill in just this arena.35 Nor is it any coincidence that the best-known rhizotomos of antiquity, Kra- teuas, worked for Mithradates VI of Pontus, famous for having built up immunity to poisons from his youth.36 Yet poison prevention was not the only prophylactic role these practitioners filled. They also prescribed pharmaka to prevent illnesses. For example Asklepios, a form of All-heal, was used to prevent chronic illnesses.37 Pharmaka could also be used to prevent pest infestation.38 Significantly, Theophrastus also tells us that herbal pharmaka were used as alexipharmakoi or amulets against disease. Thus wearing (periapsetai) the root of the poly- pody plant was said to prevent polyps.39 Similarly, tripolion and squill could either be worn as personal amulets or placed near the threshold to protect the household.40 Amulets and phylacteries were an important preventative measure, used to avert a variety of misfortunes in the ancient world.41 The debate regarding their use in medical authors is evidence that their use against disease was widespread, although only a few clearly recognis- able material examples survive from the classical period.42 This apparent absence is due, at least in part, to the substances amulets were made from. Those manufactured from plant ma- 32 Pl. Rep. 407b. 33 Hp. Vict. 66. 34 Craik (1995), 344. 35 Theophr. Hist. pl. 9.17.1-3. 36 Riddle (1985), 18; Wellmann (1958), 139-46. 37 Theophr. Hist. pl. 9.11.2. 38 Theophr. Hist. pl. 9.11.11. 39 Theophr. Hist. pl. 9.13.6. 40 Theophr. Hist. pl. 9.19.2 and 9.13.4 respectively. 41 Deubner (1910) and Kotansky (1991), 107-37, summarise amulet usage. Faraone (1992), 54-73, dis- cusses the use of monumental apotropaic statues to protect whole cities from plague, which is beyond the scope of this study dealing with individual relationship with healers. 42 Lloyd (1979), 42, discusses the differing views of various medical authors concerning the therapeu- tic validity of amulets. 7 LEANNE MCNAMARA terials, as described by Theophrastus, animal products, wood, leather or other organic sub- stances would have perished.43 In addition, amulets made from precious metals may well have been melted down for re-use.44 Furthermore, in the absence of an inscription, it is virtually impossible to distinguish objects worn as amulets from decorative jewellery or ordinary household objects. In the absence of many identifiable extant examples, it is difficult to ascer- tain whether the majority of amulets were supplied by professionals or made individually by lay people for their personal use. However there are some indications that professionals were involved in the supply of amulets. An amulet’s effectiveness did not lie wholly in the object, but also in the incantation, purification or other ritual acts which accompanied its production and wearing.45 Thus the process of producing an effective amulet was extremely complex, suggesting the involvement of professionals. Katadesmoi (binding tablets) may also provide indirect evidence that amulets were professionally manufactured. These objects differ from amulets in that they were designed to harm rather than protect, and that they were not worn, but placed in wells, rivers, graves or other locations.46 However, the modes of action of the two groups of objects rely on the same basic principles.47 In addition, Plato tells us that katadesmoi were made by the same wandering folk healers who claimed to be able to cure their patients with incantations and sacrifices.48 As Gager points out, the well-written scripts of the 3rd century BCE katadesmoi excavated from the Athenian agora and those from Bath dating to the Roman period, indicate that professional scribes were involved.49 These later Roman binding tablets and dolls also seem to have been mass-produced.50 It is likely that many amulets were similarly mass-produced. Furthermore, Kotansky has shown that when amulets were used to treat (rather than prevent) existing disease, a specific medical diagnosis was required.51 This suggests that healers were involved in the supply of therapeutic amulets at the very least, and given the general opposition of iatroi to amulets, these healers were presumably the folk healers. So while it is certainly possible that some amulets were privately made, many were probably produced by professionals and supplied on the recommendation of folk healers. Folk healers had one additional quick-fix weapon in their prophylactic armamentarium: prayer. As is well known, the Hippocratic corpus makes no appeals to supernatural deities or forces to explain the existence or aetiology of disease. The Hippocratics did not deny the exis- tence of the gods. Indeed, the author of On the Sacred Disease claims that all nature is di- vine.52 Nevertheless, diseases are portrayed as subject to the same laws of cause and effect that govern all other physical processes.53 In this sense the Hippocratic theories are rational- ised, however patently absurd or fanciful the specific explanations may be. Interestingly, given this rationality, prayer was not confined to the folk sector, but was also employed by 43 There is literary evidence of these substances being used. See Homeric Hymn to Hermes 37f. for the use of tortoise against bewitchment. See Anxilas fr. 18 for Ephesian grammata contained in a leather pouch. 44 For the use of a metal ring as an amulet, see Antiph. fr. 177 and Ar. Plut. 883f. 45 See Kotansky (1991), 108-10, on the combined use of incantations and amulets. 46 For an overview of their use in the ancient world see Gager (1992). 47 Gager (1992), 218-20. 48 Pl. Rep. 364b-c. 49 Gager (1992), 5 and 32 nn. 24 and 25. 50 See Faraone (1991), 4. 51 Kotansky (1991), 116f. 52 Hp. Morb. Sacr. 1 and 2 . 53 For further discussion of the author's conception of a naturalistic explanation, see Jouanna (1999), 182; Van der Eijk (1991), 168-76; Lloyd (1975), 1-16; Lloyd (1979), 15-27. 8 FOLK AND HIPPOCRATIC HEALERS Hippocratic iatroi. The Hippocratic treatise Regimen IV complains of manteis fulãssesyai d¢ paraineËntew µÆ ti kakÚn lãb˙ who oÈ didãskousin œ xrª fulãjesyai, éllå yeo›sin eÎjesyai keleÊousi.54 Nevertheless, the author does not dismiss prayer, but goes on to list the appropriate deities to pray to.55 He does, however, take some pains to point out that, although prayers are useful in combination with other measures, prayers alone are of scant benefit.56 Further preventative changes to regimen, including diet, exercise, sleep and bathing patterns, are also required, which only iatroi, not manteis, undertake. The inclusion of prayer in the Hippocratic corpus confirms that this was a mainstream method of prophylaxis, so common that even the Hippocratic author accepts it, although he does not pass up the oppor- tunity to point out that his competitors’ methods are inferior to his own. So prevention of illness was an important aspect of the clinical function of Hippocratic and folk healers alike. Like iatroi, some folk healers seem to have employed regimen, but in addi- tion, many also used pharmaka, amulets or prayer in a preventative role. Given that many of these prophylactic measures would have been much simpler and less objectionable to follow than complex dietary, exercise, bathing and purgative routines, it is easy to explain their ap- parent popularity. Diagnosis But when prevention fails and one falls ill, it is usual to seek out a healer for a diagnosis. Diagnosis encompasses two related but distinct aspects. The first facet of diagnosis is the de- termination that symptoms are due to disease, rather than some other misfortune. The second is the more specific determination of the nature of the illness. The first aspect of diagnosis, that the problem is a reflection of disease, is significant because in most societies the diagno- sis of illness serves an important exculpatory function.57 Those who are sick are not usually held responsible for their symptoms.58 In fact, even in those cultures where disease is re- garded as a divine punishment, including modern rural Greece, the sufferer may be con- sidered guilty of a ritual infringement, but morally blameless for their illness.59 This view also seems to have been current among lay people in classical Greece, perhaps unsurprisingly, given the capricious, petty and somewhat pedantic nature of the gods as they are portrayed in ancient Greek literary genres. In addition, the sick are often excused from their customary social roles as parents, spouses, employees and so on.60 Instead they take on a new role, the sick role, with its own obligations and privileges.61 In many cases, self-diagnosis may be en- ough to take on this sick role, for example in the case of ‘a 24 hour virus’. But in some situa- tions, families, employers or other members of the community may demand a healer’s diag- 54 Hp. Insomn. 87: ‘They advise taking precautions against anything bad occurring, [but] they do not explain how to take precautions but recommend praying to the gods.’ 55 Hp. Insomn. 89. See Jouanna (1999), 194, for further discussion of this recommendation. 56 Hp. Insomn. 87. 57 See Parsons (1951), 428-79. 58 Of course there are exceptions. Those with HIV/AIDS today, for example, are frequently blamed for having brought their illness upon themselves by following an immoral lifestyle. 59 Blum and Blum (1965), 125-27. 60 Although once again, sickness is not automatically exculpatory. See Freidson (1970), 224-43, for further discussion. 61 See Parsons (1951), 436-39, for the original formulation of this term. See Cockerham (1998), 146- 63, for a summary of more recent scholarship. 9 LEANNE MCNAMARA nosis of illness to legitimate someone’s assumption of the sick role. This was as true in Greece during the classical period, where medical certificates were unknown, as it is in the West today. So in Aristophanes’ Wasps, when Philokleon does not join his friends at court, they ask whether he has sprained his ankle or has a tumour in his groin.62 This would excuse him from his duty (in their eyes) of sitting on the jury and convicting as many defendants as possible. Similarly, when Aeschines delayed joining the embassy to Macedonia, he made an affidavit to the boule, claiming the reason was his ill-health. Significantly in this instance, Aeschines produced an iatros as a witness to the fact he was ill.63 It seems that folk healers could also validate the sick role. Thus, the nurse in Euripides’ Hippolytus, when confronted with Phaedra’s lethargic behaviour, determines that Phaedra must be ill, since her mistress’s hands are clean of blood, and no enemy has cast a spell on her.64 She gives her the following, oft-quoted advice: kefi µ¢n nose›w ti t«n éporrÆtvn kak«n, guna›kew a·de sugkayistãnai nÒson: efi d' ¶kforÒw soi suµforå prÚw êrsenaw, l°g', …w fiatro›w prçgµa µhnuyª tÒde.65 It seems then that ‘the women’ may be just as qualified to legitimate and treat her illness as the iatroi are, depending on the sort of nosos she is suffering. In fact it is the female nurse who not only diagnoses that Phaedra is ill, but also, through her persistent questioning, estab- lishes the nature of the disease: lovesickness.66 She then takes it upon herself to treat her mis- tress with philtra thelkteria (love charms) which require some of her beloved’s hair or cloth- ing, a folk rather than a Hippocratic remedy.67 The nurse herself acts as a folk healer, albeit an ultimately unsuccessful one, in attempting to diagnose and treat a nosos that may not have been legitimated by Hippocratic iatroi. An important difference between the healing role of folk healers and iatroi is that the folk healers often dealt with a greater array of conditions as nosoi. The term nosos has a wide range of meanings.68 Nosos can refer to physical, psychological or emotional upset, as well as events or conditions that may cause or be associated with such distress. Nosoi include condi- tions we would recognise as biological disease, such as Philoctetes’ suppurating ulcer, Alces- tis’ wasting or even Ajax’ madness.69 Equally, nosoi include some disturbances which mod- ern Westerners might not view as disease, but were commonly regarded as such in the ancient Greek world.70 Perhaps the best example is that of eros, particularly unrequited eros. Hence Euripides is not merely using a literary metaphor when he has Andromache and the chorus re- 62 Ar. Wasps 273-277. 63 The story is told from opposing viewpoints in Aesch. 2.94f. and Dem. 19.24. 64 Eur. Hipp. 315-18. 65 ‘And if you a sick with one of the unmentionable troubles, here are the women to treat the disease. But if the problem may be divulged to men, speak so that the matter may be revealed to the iatroi.’ Eur. Hipp. 293-96. 66 Eur. Hipp. 267-350. 67 Eur. Hipp. 509-515. 68 LSJ (1968) includes among the definitions of nosos sickness, disease, plague, distress, anguish, bane, mischief, and diseases of the mind, especially those caused by madness, passion, or vice. 69 Soph. Phil. 7, 174, 259, 267, 281, 463, 521, 734, 764, 795, 1044, 1330, 1379, 1438, Eur. Alc. 203, 23, Soph. Aj. 59, 66, 186, 271, 274, 452. 70 On culture bound syndromes, see Hahn (1995), 40-56. 10 FOLK AND HIPPOCRATIC HEALERS fer to sexual desire as a nosos.71 Emotional desire was clearly linked to physical ill health, particularly as both a cause and a result of fever.72 Like other febrile illnesses, eros could be treated. Literary pharmakeis/ides in particular are frequently depicted as ministering to those with unrequited desire. Thus Deianeira applies the ‘love potion’ (which turns out to be a terri- ble poison) given to her by the pharmakeus Nessos to rekindle Herakles’ passion.73 Simaetha is similarly depicted concocting an erotic spell to bind her straying lover to her in Theocritus’ second Idyll, which is sometimes entitled Pharmakeutria (a later variant of the term phar- makis). Aristotle also remarks that hippomanes (a substance said to be found on a new-born foal’s forehead) is prized by pharmakides.74 This is surely a reference to its use in love po- tions or spells, and thus evidence that it was not only fictional practitioners who were con- sulted for erotic magic.75 Midwives, in their role as matchmakers, may also have contributed to the treatment of lovesickness.76 It seems that rhizotomoi and pharmakopolai too could sup- ply pharmaka to treat unrequited passion.77 In addition, practitioners could provide a desirer with katadesmoi (binding tablets closely related to the binding doll Simaetha uses) to elimi- nate amatory rivals who may be preventing access to the affections of the beloved.78 So unre- quited love was treated by a wide variety of folk practitioners, the same practitioners who treated nosoi we more easily recognise as diseases today, and using the same methods they applied to cure those other nosoi. Nevertheless there is, to my knowledge, no reference to the treatment of unrequited love, or even any recognition that it may constitute a nosos, in the Hippocratic corpus.79 There are, of course, implicit references to the dangers to the health of young women who develop sexual desire but are left unmarried.80 However, there is no sug- gestion that passion for a particular person is a disease. Thus in this instance, folk healers seem to have diagnosed, legitimated and treated at least one condition unrecognised by iatroi. The second aspect of diagnosis is the determination of the nature of the illness. Today this sort of diagnosis usually consists of a disease name or label. We are diagnosed with 'pneu- monia' or 'cancer'. However, in the ancient world, there was less emphasis on nosological la- belling. In tragedy, for example, the unwell are usually suffering from an ill-defined nosos. Phaedra, Ajax and Heracles are three well-known protagonists of Greek tragedy whose symp- toms are described in detail, but not given a name.81 Furthermore, there was no clear distinc- tion made between disease as an ontological entity on the one hand, and symptoms and signs, the physical manifestations of disease, on the other.82 This is to a large degree a consequence of the fundamental theoretical basis for disease in the Hippocratic medical system. Disease, in essence, is viewed as a disturbance in the patient’s own physiology, whether that physiology 71 Eur. Andr. 220, 955. 72 LiDonnici (1998), esp. 69-88. 73 Soph. Trach. 1140. 74 Arist. Hist. An. 577a. 75 Watson (1993), 842-47. 76 Pl. Tht. 149d. 77 Theophr. Hist. Pl. 9.9.3. 78 Faraone (1991), 13f. 79 I am excluding the Vita Hippocratis Secundum Soranum, the 2nd century CE or later biography of Hippocrates included in some manuscripts of the corpus from the 11th century CE onwards, which con- tains a fictional account of Hippocrates curing Perdiccas of lovesickness. For further discussion see Pinault (1992), 61-77. 80 Hp. Virg. is the prime example. 81 Eur. Hipp., Eur. HF, Soph. Aj. 82 See Pearcy (1992), 595-616, esp. 595-97, and Clarke Kosak (2002) for further discussion. See King (1981), 107-18 for the disease/symptom distinction and summary of nominalist and realist positions on ontological status of disease. 11