In ancient Greek medicine, as the Hippocratic author of On Ancient Medicine famously claimed, it is physicians and not philosophers who understand best the nature of man. In ancient Greece, fat as a pathological category appears in texts ascribed to Hippocrates (440-340 bce). Hippocrates, or at least as attributed to him in the approximately sixty texts of the Hippocratic corpus, based his notion of health and illness on the balance of the humors, the chymoi. According to this view, these four crucial bodily fluids—blood, yellow bile, black bile and phlegm—were found in all individuals and produced health when in balance and illness when one dominated over the others. They also produced the visible aspects of the body that could be measured by the physician: Blood made the body hot and wet, choler hot and dry, black bile cold and dry and phlegm cold and wet. They were also correlated to the four ages of man—infancy, youth, adulthood, and old age—and to the essential
aspects of the world, air, fire, earth, and water. The physician could impact the domination of one or the other humors by intervening, often with lifestyle or regimen changes, which entailed changing the food or activities of the patient. But the humors were also the key to bodily shape and physique. Thus, if one had a natural predisposition to phlegm, it resulted in fat. Each humor also determined temperament: The phlegmatic person (who was also fat) was pale, lazy, inert, and cool in character— as well as, of course, phlegmatic. Phlegm was "naturally" of water and of old age.
In humoral theory, fat could either be a sign of indisposition with the domination of phlegm to be treated by hot and dry foods or a constitutional status (as in aging) in which one's phlegmatic nature could be mitigated but not altered. In the first case, one was a fat patient but not in the latter. Greek medicine was rooted in the practice of diatetica, the diet as the primary therapy or, to use a more modern phrase, "eating as healing." The Greek physicians therefore also believed that there was a one-to-one relationship between foods and their effects. Dionysus of Carystus (in Euboea), who practiced in the fourth century bce and was known to the Athenians as the "younger Hippocrates," argued like Hippocrates for a completely causal relationship in dietetics (van der Eijk 2000: 246-9). Certain foods were not only healthful but also curative; just as a surfeit of others was the cause of illness, and central among those illnesses was obesity.
For the followers of Hippocrates, fat and thin could be either "natural" antitheses or signs of illness in terms of the balance and unbalance of the humors. Thus, fat reflects the pathological state of the body caused by imbalance. For the sufferer from fat as a sign of disease, there is also a clear distinction between fat men and fat women: "When unnaturally fat women cannot conceive, it is because the fat presses the mouth of the womb, and conception is impossible until they grow thinner" (Jones 1931: V, XLVI). But men "who are constitutionally very fat are more apt to die quickly than those who are thin" (Jones 1931: II, XLIV), abandoning their families and their role in society, both paramount responsibilities in the ancient world. In all cases, extreme fat falls in the realm of medicine: "Repletion too, carried to extremes, is perilous," he observes (Jones 1931: I, IV). Hippocrates does acknowledge that corpulence gave one a slight advantage against febrile diseases, but it was greatly outweighed by the pathological effects. The cure was eating after "exercise and while still panting from fatigue and with no other refreshment before meals except wine, diluted and slightly cold. They should, moreover, eat only once a day and take no baths and sleep on a hard bed and walk naked as long as possible" (Shell 2001: 25). Quite literally a Spartan regime, as this was the way that the Spartan society deemed its citizens to act!
Greek medicine, in seeing the dominance of phlegm as pathology, also evolved the concept of polysarkia, too much flesh. This is a term reintroduced into Roman medicine by the North African Caelius Aurelianus in the fifth century ce in his De morbis acutis et chronicis. Polysarkia was the result of the imbalance of the humors but also a quality of temperament. Thus the lazy, phlegmatic person also consumes too much food. They live in a concomitant state of slothfulness and stupidity (Orth i960). Such people violated the principle of constraint in all things. Constraint, Socrates frequently reminded his listeners, is the greatest good and in complex ways the obese male violates this dictum (Fox 1998).
The line that the Hippocratic corpus assumes between acceptable fat and excessive fat (extreme repletion) is the difference between life and death. In Aristotle's essay on longevity, fat is the quality that preserves warmth. Animals (including human beings) are "naturally moist and warm, and life too is of this nature, whereas old age is cold and dry, and so is a dead body" (Aristotle 1936: 403). He continues: "Fatty things are not liable to decay because they contain air . . . air like fire does not become corrupt" (Aristotle 1936: 403). Animals which are "bloodless" are protected by their fat: "In animals the fat is sweet; for this reason, bees are longer lived than other larger animals" (Aristotle 1936: 407). Here too the line is assumed between acceptable "fatness" and pathological obesity.
Strength, health, and beauty are the "virtues" of the classical Greek body. It is no accident that one of the most important commentators on diet of the ancient world was Herodicus of Selymbria, a trainer of athletes, who used gymnastics to cure his own fat body (Jaeger 1944: 3 and 34). Hippocrates had stressed that in athletes a perfect condition that is at its highest pitch is treacherous. Such conditions cannot remain the same or be at rest, and, change for the better being impossible; the only possible change is for the worse. For this reason it is an advantage to reduce the fine embonpoint quickly, in order that the body may make a fresh beginning of growth.
Here it is the professional athletae, who competed in the games, rather than the agonistae—those who sought health and strength through gymnastics—who need to be thin. And that cure for the fat body was diet and exercise.
See also Roman Medicine and Dieting; Sports
Aristotle (1936) "Aristotle: on Length and Shortness of Life," in W.S. Hett (trans.) Aristotle: Volume VIII. On the Soul. Parva Naturalia. On Breath, Cambridge, Mass.: Harvard University Press. Fox, Matthew (1998) "The Constrained Man," in Lin Foxhall and John Salmon (eds), Thinking Men: Masculinity and Its Self-Representation in the Classical Tradition, Routledge: London and New York, pp. 6-22. Grottanelli, Cristiano and Milano, Lucio, eds. (2004) "Food and Identity in the Ancient World," History of the Ancient Near East Studies 9. Padova: S.A.R.G.O.N. editrice e libreria. Jones, W.H.S. (trans. and ed.) (1931) "Hippocrates. Aphorisms," Nature of Man. Regimen in Health. Humours. Aphorisms. Regimen 1-3. Dreams. Heracleitus. On the Universe, Vol. IV of Hippocrates. Cambridge, Mass.: Harvard University Press, pp. 97-222.
Jaeger, Werner (1944) Paideia: The Ideals of Greek Culture, 3 vols, trans. Gilbert Highet, New York: Oxford University Press. Orth, H. (i960) "Die Behandlung der Fettleibigkeit in der griechisch-römische Antike," Medizinischer Monatsspiegel 9: 193-8. Shell, Ellen Ruppel (2001) The Hungry Gene: The Science of Fat and the Future of Thin, New York: Atlantic Monthly Press. van der Eijk, Philip J. (2000) Diocles of Carystus: A Collection of the Fragments with Translation and Commentary, Vol. I, Leiden and Boston, Mass.: Brill.
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