MEDICINE AND PHILOSOPHY IN CLASSICAL ANTIQUITY

The preceding cause of this disease [i.e. hydrophobia] is the bite of a mad dog

or, as some people record, of other animals... It is also possible that this disease

originates in the body without a visible cause, when a constricted state similar to

that produced by a poison occurs spontaneously.

( 19 ) Nos autem iuxta Sorani iudicium hac quaestione nullis commodis curationes

adiuuari probamus, sed dicimus tres esse differentias fluoris sanguinis, hoc est

eruptionis, uulnerationis et putredinis siue lacerationis ex tussicula uenientis, si-

cut operantium manus iugi fricatione lacessiti uulnerantur; item sudationis sine

uulnere siue ex raritate uiarum effectus fluor osculationis differentiam tenet siue

expressionis uel cuiuslibet alterius causae. (Chron. 2. 10. 125 )

We, however, in accordance with Soranus’ judgement, believe that the treatment

is in no way advanced by this dispute [sc. about various kinds of haemorrhage];

instead, we say that there are three different kinds of haemorrhage, namely erup-

tion, wound and decomposition or abrasion caused by coughing, just as the hands

of workmen are injured by constant rubbing; and a flow which involves a sweating

without a wound or which is caused by a narrowness of channels can be distin-

guished as [flow caused by] anastomosis, or diffusion, or another cause.

How are these seemingly conflicting attitudes to be explained? Once again,

it seems that the relevance of causal explanations to diagnosis and treatment

varies from one disease to another. In the majority of cases, Caelius believes,

the causal explanation of a disease, whether by reference to hidden or to

observable causes, is not necessary: in many cases it is irrelevant and thus

to be avoided, as it may even lead to errors in treatment.^62 It is irrelevant

because it does not affect the present nature of the disease and thus does

not affect the way the disease is treated, as was stated in passage ( 14 ) quoted

above.^63 The present nature of the disease is different from the causes which

brought it about;^64 causes may differ from case to case, but the nature of

(^62) E.g.Acut. 3. 4. 45 : ‘Furthermore, it is ridiculous that he says that those who have got the affection
synanche as a result of a cold should not be venesected; [in doing so], he does not pay attention
to present things but inquires after the causes of things that are past’ (denique ridendum est etiam
quod eos qui ex prefrictione synanchici fuerint effecti phlebotomandos negat [sc. Heraclides] non aduertens
praesentia et inquirens factorum causas) andAcut. 3. 17. 154 : ‘[Hippocrates is led here] by a suspicion of
the causes: for he thinks, or rather it is his firm belief, that the affection is caused by a burning heat
of the upper parts and a chilling of the lower parts’ (suspicione causarum sollicitatus [sc. Hippocrates]:
existimat enim uel constituit fieri passionem incendio superiorum et frigore inferiorum).
(^63) See also Soranus,Gyn. 1. 52.
(^64) Acut. 3. 6. 64 – 5 : ‘But against all these one common answer should be given: the cause of an affection is
very different from the affection itself. One therefore has to state not what the cause of tetanus is, but