Food and diet in ancient medicine

Modern understanding of disease is very different from the way it was understood in ancient Greece and Rome. The way modern physicians approach healing of the sick differs greatly from the methods used by early general healers or elite physicians like Hippocrates or Galen. In modern medicine, the understanding of disease stems from the “germ theory of disease”, a concept that emerged in the second half of the 19th century, such that a disease is the result of an invasion of a microorganism into a living host. Therefore, when a person becomes ill, modern treatments “target” the specific pathogen or bacterium in order to “beat” or “kill” the disease. In Ancient Greece and Rome, disease was literally understood as dis-ease, or physical imbalance. Medical intervention, therefore, was purposed with goal of restoration of harmony rather than waging a war against disease.^[1] Surgery was regarded by Greek and Roman physicians as extreme and damaging while prevention was seen as the crucial first step to healing almost all ailments. In both prevention and treatment of disease in classical medicine, food and diet was central. The eating of correctly-balanced foods made up the majority of preventative treatment as well as to restore harmony to the body after it encountered disease.

Food and Diet in Ancient Greece

Humours and Causes of Disease

Ancient Greek Medicine is described as rational, ethical and based upon observation, conscious learning and experience. Superstition and religious dogmatism are often excluded from descriptions of ancient Greek medicine. It is important, however, to note that this rational approach to medicine did not always exist in the ancient Greek medical world, nor was it the only popular method of healing. Along with rational Greek medicine, disease was also thought of as being of supernatural origin, resulting from the unhappiness of the gods or from demonic possession. Exorcists and religious healers were among the ‘doctors’ that patients sought out when they became ill. Sacrifices, exorcisms, spells and prayers were then carried out in order to reconcile with the gods and restore health to the patient. It was not until the time of Hippocrates, between 450 and 350 BC, that rational, observation and the humoral theory of medicine began to become highly influential.^[2] The theory of the humours or “Humorism” understood the human body to be composed of fluid (humours) and regarded disease as a result of an imbalance of the four humors: yellow bile, black bile, phlegm and blood.

The four humours and their qualities

These humours contain qualities such as hot, cool, moist, dry, etc., which must also remain in balance.^[1]:337 Foods can be heating, cooling, or generative of one humour. Some foods produce good juices and others bad juices and often times cooking and preparation of the foods can change or improve the juices of the foods. In addition, foods may be easy to assimilate (easy to pass through the body), easily excreted, nourishing or not nourishing.^[1]:338 In Hippocratic medicine, the qualities in foods are analogous to the four humors in the body: too much of a single one is bad, a proper mixture is ideal.^[1]:347 Therefore, the consumption of correctly-balanced foods and life-style of the patient was crucial to the prevention and treatment of disease in Ancient Greece.

This brings us to the way in which seasonal food played an important role in the treatment of ancient disease. According to the Hippocratic author of “Airs, Waters and Places” (there remains debate as to whether Hippocrates himself wrote the Hippocratic Corpus), it is important that a physician learn astronomy because, “the changes of the seasons produce changes in diseases,”.^[3] In the same Hippocratic text, the author goes on to explain that villages facing east and that are exposed to winds from the north-east, south-east and west tended to be healthy and, “The climate in such a district may be compared with the spring in that there are no extremes of heat and cold. As a consequence, diseases in such a district are few and not severe,”.^[3]:151 As an example of the importance of seasonal food on maintaining balance of the humours and preventing disease is given by Hippocrates in “On Regimen” when the authors state that, “in winter, to secure a dry and hot body it is better to eat wheaten bread, roast meat, and few vegetables; whereas in summer it is appropriate to eat barley cake, barley meat and softer foods,” (qtd. in Wilkins et al., p. 346).

Food and Diet in the Hippocratic Aphorisms

Food and diet feature prominently in the aphorisms of the Hippocratic Corpus. For example, in one aphorism in the first section, Hippocrates states, “Things which are growing have the greatest natural warmth and, accordingly, need most nourishment. Failing this the body becomes exhausted. Old men have little warmth and they need little food which produces warmth; too much only extinguishes the warmth they have. For this reason, fevers are not so acute in old people for then the body is cold”.^[3]:208 Another aphorism says, “It is better to be full of drink than full of food”.^[3]:209 And finally, an aphorism that generally sums up treatment of disease in Hippocratic times states, “Disease which results from over-eating is cured by fasting; disease following fasting, by a surfeit. So with other things; cures may be effected by opposites,”.^[3]:210 This concept of treating diseases opposite to the way it manifests in the individual is concept that is carried over into Roman medicine.

Gout in Ancient Greece

Gout was called podagra in ancient Greek medicine and is a common arthritis caused by deposition of monosodium urate crystals within the joints.^[4] Gout usually affects the first metatarsophalangeal joint of the big tow and later the other joints of the feet and hands. Hippocrates considered gout to be the result of an accumulation of one of the body humours that distended the joint and caused pain.^[5] Hippocrates also believed gout to be a result from sexual excess or too rich a diet as alluded to in three of his aphorisms “Eunuchs do not take the gout nor become bald”, “A woman does not take the gout unless her menses has stopped”, and “A young man does not take the gout until he indulges coitus”.^{[4]:84[5]:14–15} As with other diseases, physicians in antiquity believed that diet was the best way to manage gout. Hippocrates recommended high doses of white hellebore because he believed that the best and most natural relief for gout was dysentery.^[4]:85 However, purging with white hellebore was probably for the more chronic cases due to the fact that wine and barleywater drinks were very strongly recommended.^[5]:16–17

Legumes in Ancient Greece

The importance of legumes in ancient Greek diet and medical practice is often disregarded. However, legumes improved the quality of the soil and were considered very important to the agriculturalists of the time. Additionally, legumes contain a high amount of albumen, which led them to be a critical dietary supplement in countries where meat was in short supply and difficult to store. Such was the case with Greece. People in the Graeco-Roman world consumed less meat than we do today and therefore, legumes were a necessary source of protein.^[6] Of all legumes, the lentil

The lentil plant

appears most frequently in Greek and Roman literature. Medicinally, Hippocrates recommends lentils as a remedy for ulcers and hemorrhoids.^[6]:376 Bitter vetch, or Vicia ervilia, was also an important legume in ancient Greek medicine. The extensive medicinal qualities of the bitter vetch were thought reliable enough to later administer to Roman emperors such as Augustus.^[6]:379 Bitter vetch was thought to heal pimples, prevent sores from spreading and sooth spots or sores when they appear on the breasts. It was also reported to relieve painful urination, flatulence, liver problems, and indigestion when roasted and mixed with honey and Hippocrates cautioned that when eaten boiled or raw, the consumption of bitter vetch may cause more flatulence or pain.^[6]:379

Food and Diet in Ancient Rome

Humours, Anatomy and the Causes of Disease

At the heart of Roman Medicine and central to the development of Western Medicine is Galen

The Eminent Galen of Pergamum

of Pergamum (AD 129–c. AD 210).^[7] Galen was a prolific writer from whose surviving works comes what Galen believed to be the definitive guide to a healthy diet, based on the theory of the four humours.^[8] Galen understood the humoral theory in a dynamic sense rather than static sense such that yellow bile is hot and dry like fire; black bile is dry and cold like earth; phlegm is cold and moist like water; and blood is moist and hot.^[9] He also understood the humours to be produced by food through digestion and it is with digestion, and respiration, that Galen applies his knowledge of anatomy. According to Galen, digestion begins in the mouth because this where food comes into contact with the saliva. The chewed food is then pulled into the stomach where the heat of the stomach cooks the food into chyle. The chyle is then carried to the liver where the nutrients are converted to blood and transported throughout the body,.^{[9]:420–421} With this understanding of the humours as being dynamic, and his knowledge of anatomy, Galen was able to categorize illnesses as hot, cold, dry or moist and attribute the causes of these illnesses to specific types of foods. For example, in Galen’s own “On the Causes of Disease”, as cited by Mark Grant, Galen says when describing hot diseases that, “[one cause of excessive heat] lies in foods that have hot and harsh powers, such as garlic, leeks, onions, and so on. Immoderate use of these foods sometimes sparks a fever,”.^[8]:48 Galen believed that a good physician must also be a good cook.^[8]:11 Therefore, in Galen’s dietary treatise “On the Powers of Foods”, recipes are often given in addition to descriptions of foods as being salty or sweet, sour or watery, difficult or easy to digest, costive or laxative, cooling or heating, etc. Galen insists that the balance of the four humours can be beneficially or adversely effected by ‘diet’ which in Galenic medicine includes not just food and drink but also physical exercise, baths, massage, and climate^[10]

Food and the Treatment of Disease in Ancient Rome

As mentioned, certain types of food can affect the balance of the humours in different ways. According to Galen’s “On Humours,” as referenced by Wilkins et al., beef, camel, and goat meat, snails, cabbage, and soft cheeses produce black bile; brains, fungi, and hard apples cause phlegm; bitter almonds and garlic reduce phlegm.^[1]:377 Additionally, for the treatment of gout, Galen suggested a range of dressings to be applied to the affected area made of mandrake, caper, and henbane and for the acute phase, creams made of seeds of conium, mushroom, and deer brain were administered.^[4]:86

References

1. Wilkins, John; et al. (1995). Food in Antiquity. University of Exeter Press. p. 345. ISBN 0-85989-418-5.
2. Nutton, Vivian (1999). "Healing and the healing act in Classical Greece". European Review. 7 (1): 30.
3. Chadwick, edited with an introduction by G.E.R. Lloyd ; translated [from the Greek] by J.; al.], W.N. Mann ... [et (1983). Hippocratic writings ([New] ed., with additional material, Repr. in Penguin classics. ed.). Harmondsworth: Penguin. p. 149. ISBN 0-14-044451-3.
4. Gritzalis, Konstantinos C. (2011). "Gout in the Writings of Eminent Ancient Greek and Byzantine Physicians". Acta med-hist Adriat. 9 (1): 83.
5. Porter, Roy; Rousseau, G.S. (2000). Gout: The Patrician Malady. Yale University Press. p. 14. ISBN 0-300-08274-6.
6. Flint-Hamilton, Kimberly B. (1999). "Legumes in Ancient Greece and Rome: Food, Medicine, or Poison?". Hesperia: The Journal of the American School of Classical Studies at Athens. 68 (3): 374. JSTOR 148493.
7. Conrad, Lawrence I. (1998). The Western medical tradition, 800 BC to AD 1800 (Reprinted. ed.). Cambridge: Cambridge University Press. pp. 58–70. ISBN 0-521-47564-3.
8. Grant, Mark (2000). Galen on Food and DIet. London: Routledge. p. 10. ISBN 0-415-23232-5.
9. Prioreschi, Plinio (1998). A History of Medicine: Roman medicine. Edwin Mellen Press. p. 360. ISBN 978-1-888456-03-5.
10. Singer, P.N (1997). Galen selected works. England: Oxford University Press. p. X. ISBN 978-0-19-158627-9.