Heart, brain, blood, pneuma 131
ventricle would not;^31 this maintains contact with the blood by means of a
process of ‘evaporation’ and ‘radiation’.
3 three approaches to epilepsy
I will conclude by discussing an example of the way in which various pre-
suppositions about body and mind and about the location of the mind
played a part in the medical debate on the disease of epilepsy. As we have
seen before, the medical authors of the period we are discussing do not
consider the question of the seat of the mind an isolated issue, but a matter
that becomes relevant when treating diseases which, although they have a
somatic cause like other diseases, also manifest themselves in psychic disor-
ders. Of the four classic psychosomatic diseases,mania(a chronic disorder),
phrenitis,melancholiaand epilepsy, epilepsy was by far the most dreaded.
It was also known as ‘the big disease’ or ‘the sacred disease’; possession by
the gods seemed the obvious explanation, but at the same time the physical
aspects of the disease were so prominent that there could be no doubt as to
its pathological status (as opposed tomaniaandmelancholia, which were
considered to manifest themselves in positive forms as well).^32
The author of the Hippocratic writingOn the Sacred Diseasefiercely
opposes the view that epilepsy is sent by the gods and can only be cured
by applying magic (incantations, rituals involving blood, etc.) [see chap-
ter 1 in this volume]. After a long philippic against those adhering to this
view he expounds his own theory. Epilepsy is the result of an accumu-
lation of phlegm (phlegma) in the passages that divide themselves from
the brain throughout the body and enable the distribution of the vital
pneuma(this air is indispensable for the functioning of the various organs).
This accumulation is a result of insufficient prenatal or postnatal ‘purifi-
cation’ (katharsis) of phlegm in the brain – according to the author this is
a hereditary phenomenon. This obstruction can occur in different places
in the body and, accordingly, manifest itself in different symptoms. Near
the heart, it will result in palpitations and asthmatic complaints; in the
abdomen, in diarrhoea; in the ‘veins’, in foaming at the mouth, grinding
of teeth, clenched hands, rolling eyes, disorders in consciousness, and a
lack of bowel control. This way the author explains the various symptoms
that can present themselves during epileptic fits and which he describes in
considerable detail in chapter 7 of the treatise.
(^31) On this experiment see Harris ( 1973 ) 93 ff.
(^32) The classical, still very useful monograph on the history of epilepsy is Temkin ( 1971 ). Another useful
book is Stol ( 1993 ). See also the discussion in ch. 1 above.