Airs, Waters, Places: Exhaustive Study Notes on the Hippocratic Treatise
Historical Context and Attribution of Airs, Waters, Places
Uncertain Authorship: Although the text is attributed to Hippocrates, the true authorship remains uncertain, as is common with the Hippocratic corpus.
Scholarly Timeline: Scholars identify similarities between this text and others in the corpus, specifically On the Sacred Illness (Text ). The text likely dates to the mid- to late century BCE.
Intended Audience: The author was a physician writing for other medical professionals, particularly those traveling both within and beyond the Greek world.
Etymological Notes: Plato references a point regarding aesthēseis (sensations) in this context, possibly incorrectly linking it to a#######ssein (“to shake”).
Fundamental Principles of Medical Topography
Necessity of Environmental Observation: For a correct medical investigation, a physician must evaluate several key factors upon arrival in an unfamiliar city:
Seasonal Effects: The cause and effects of each season of the year, noting that seasons are neither similar to each other nor to their transitions.
Winds (Pneumata): Evaluation of hot and cold winds, including those common to all humanity and those specific to the local land.
Water Properties: Waters must be examined for their taste, weight, and general properties, which differ significantly between sources.
Geographic Position: The city’s orientation relative to the winds and the rising of the sun. Orientation impacts city conditions deeply; for example, a city facing north differs drastically from one facing south.
Water Source Quality: Whether inhabitants use marshy and soft waters, hard waters from rocky heights, or salty/harsh waters.
Soil and Vegetation: The state of the land—whether bare and waterless or thick with vegetation and well-watered, and whether it is low-lying/stifling or elevated/cold.
Lifestyle and Regimen: The habits of the inhabitants, such as their preference for drinking versus eating, their frequency of meals, and their inclination toward exercise/hard work versus idleness.
Predictive and Diagnostic Value of Topographical Knowledge
Prevention of Failure: A physician who masters these factors will not be at a loss when treating local illnesses. Without this knowledge, a physician is prone to prejudging illnesses and failing in treatment.
Forecasting Seasonal Illness: By observing the year and the cycles of the stars (risings and settings), a physician can foresee what sort of year is coming and which general illnesses will afflict the city in summer or winter.
Astronomy in Medicine: The author asserts that astronomy contributes a great deal to medicine because changes in seasons cause corresponding changes in the body’s cavities.
Clinical Profiles of Cities Based on Orientation and Winds
Cities Facing Warm Winds (Southeast to Southwest):
Climate: Protected from northern winds; normal winds are warm. Waters are brackish, near the surface, warm in summer, and cool in winter.
Physique: Inhabitants have moist heads full of phlegm. Body cavities are troubled by descending phlegm. Generally untoned, poor eaters, and poor drinkers (drunkenness causes severe headaches).
Endemic Disorders:
Women: Sickly, suffer unhealthy discharges, frequently barren/miscarrying due to sickness.
Children: Convulsions, shortness of breath, and the “sacred illness” (epilepsy).
Men: Dysentery, diarrhea, shivering fits, long-lasting winter fevers, nighttime pustules, and hemorrhoids.
Exceptions: Pleurisy, lung inflammation, and ardent fevers are rare because moist cavities do not allow these “severe” illnesses to take hold.
Aging Inhabitants: Those over suffer paralyzing catarrhs from the head triggered by sudden sun exposure or chilling.
Cities Facing Cold Winds (West Northwest to East Northeast):
Climate: Protected from southern/warm winds; normal winds are cold. Waters are hard, cold, and mostly sweet.
Physique: Inhabitants are lean and in good shape. Hard cavities prone to constipation below the diaphragm. More prone to bile than phlegm. Healthy, hard heads, but prone to internal ruptures.
Endemic Disorders:
General: Pleurisy, severe illnesses, and abscesses due to the tenseness and dryness of the body. Men under suffer severe summer nosebleeds.
Women: Many are barren due to hard, cold water. Periods are small, insufficient, and painful. Birth is difficult, though miscarriage is rare. Inability to nurse because milk dries up. Wasting ailments or ruptures often follow delivery.
Children: Dropsies of the testicles occur in youth but disappear with age; reached puberty late.
Character: People tend to be aggressive rather than tame.
Cities Facing the Rising Sun (East):
Condition: Healthiest position; moderation in heat and cold. Waters are clear, sweet-smelling, and soft.
Physique/Character: Healthy complexion, vibrant appearance, clear voice, superior disposition, and higher intelligence.
Reproduction: Women are quite fertile and give birth easily.
Cities Facing the Setting Sun (West):
Condition: Unhealthiest setting. Mist destroys water clarity because the sun does not shine directly on the city until late morning. Inhabitants experience morning cold/dew followed by scorching afternoon heat.
Physique: Pale and sickly inhabitants. Subject to all aforementioned illnesses with no unique ones. Deep, hoarse voices due to impure, damp air.
Classification and Medical Impact of Water Sources
Swampy, Stagnant, and Marshy Waters:
Summer Qualities: Warm, thick, stinking, and productive of bile.
Winter Qualities: Icy, cold, and cloudy; cause phlegm and sore throats.
Effects on Inhabitants: Large/hard spleens; thin, hot stomachs; withered shoulders, collarbones, and faces (flesh dissolves to benefit the spleen). Large appetites. Prone to deadly dropsy, summer dysentery, and winter lung inflammation.
Reproductive Effects: Women are prone to white, bloated skin and false pregnancies (where the womb fills with dropsy and then vanishes).
Mineral Waters: Waters from earth containing iron, copper, silver, gold, sulfur, alum, bitumen, or sodium carbonate are hard, cause fevers, and obstruct excretion/urination due to the power of heat used in their formation.
Spring Waters from High Places: These are the “best.” They are sweet, clear, and require little wine. Flowing from deep springs, they are warm in winter and cold in summer. Waters bursting toward the summer rising of the sun are especially praised for being light and bright.
Use Based on Constitution:
Hard Cavities: Benefit from sweet, light, clear waters.
Soft/Phlegmy Stomachs: Benefit from hard, harsh, brackish waters to dry them out.
Laxative Misconception: Contrary to common belief, brackish waters are NOT laxative; they are harsh and contract the cavity.
Rain Water:
Properties: Lightest, sweetest, and thinnest because the sun draws up the finest components of moisture (as seen in the way salt remains while brine evaporates).
Sun’s Extraction: The sun draws moisture not just from water, but from people. Cloaks preserve sweat that would otherwise be evaporated by the sun.
Drawback: Putrefies quickest and smells bad due to its mixed origin; requires boiling to prevent sore throats and coughing.
Snow and Ice Waters:
Properties: The “worst” for all purposes. Freezing causes the light, sweet components to disappear, leaving the heaviest and thickest parts behind.
Experimental Proof: A measured volume of water will decrease in quantity after being frozen and subsequently melted.
Bladder Stones and Mixed Waters
Mixed Rivers/Lakes: Using waters from various sources or foreign waters causes stones, kidney disorders, strangury, sciatica, and hernias.
Conflict of Waters: When sweet and brackish waters mix, they “conflict,” and the strongest prevails depending on the prevailing north or south winds.
Mechanism of Stone Formation:
In a feverish cavity, the bladder warms unnaturally, and its opening becomes inflamed.
The bladder “cooks” the urine; the pure part passes out, while the thick, turbid components solidify.
These solids accumulate, grow, and are rolled by the urine into stones.
Demographic Differences in Stones:
Gender: Stones are rare in women because the female urethra is short and wide. Women also drink more than boys, aiding expulsion.
Children and Diet: Stones in children may be caused by milk that is too warm/bilious, heating the bladder. Children should be given diluted wine to avoid drying the veins.
Seasonal Signs and Predictive Forecasting
The Ideal Healthy Year: Rule-based star cycles, autumn rain, moderate winter (neither calm nor excessively cold), and seasonable spring/summer rains.
Predictive Warnings:
Dry Winter/Rainy Spring: Leads to a summer of fever, eye inflammation, and dysentery. Heat is “doubled” when the sun hits soaked earth.
Dog Star Rising: If a rainstorm occurrs with the Etesian wind, the autumn will be healthy. If not, high mortality among children and women.
Wet Winter/Dry Spring: Pregnant women miscarry in spring; newborns are sickly. Catarrhs result from heads failing to “cleanse” as they should.
Rainfall Patterns: If summer is dry, sicknesses are short; if rainy, they are prolonged, and wounds are prone to festering.
Critical Transitions in Medical Practice
Cautionary Windows: Physicians must be on guard during major seasonal transitions. One must not give drugs, cauterize, or cut into a cavity within days of these major events.
The Most Dangerous Transitions:
The winter and summer solstices (especially summer).
The equinoxes (especially autumnal).
The rising of the Dog Star (Sirius) and Arcturus.
The setting of the Pleiades.
Disease Crises: These specific days are when illnesses reach their crisis point, leading to death, abatement, or transformation.
Environmental Determinism: Asia vs. Europe
General Comparison: Everything in Asia is characterized as larger and more beautiful; the region is milder and the people more gentle/even-tempered.
The Cause of Asian Mildness: The blending of seasons where no single power dominates. Asia lies further from the cold than Europe and enjoys balanced heat and water.
Physiological Effects in Asia: Abundant harvests and sturdy animals lead to well-nourished, beautiful, and tall people with uniform appearances.
The Temperament Deficiency: The moderation of seasons in Asia results in a lack of manliness, hardiness, and industry. Pleasure tends to rule.
Geographic Case Studies
The Longheads: Originally shaped their children’s heads by hand/binding as a sign of nobility. Over time, the author argues this acquired trait became hereditary, claiming “the seed comes from everywhere in the body.”
People of Phasis:
Geography: Marshy, warm, watery land; people live in wooden dwellings in the water and travel by canal in dug-outs. Phasis is stagnant and the water is corrupted by the sun.
Physique: Tall and overly fat; yellowish skin (like dropsy); deepest voices due to wet air; inactive nature.
Scythian Nomads (Europe):
Environment: High, bare, cold plains (under “The Bears”/Rhipaean mountains). Continuous winter with only a few days of weak summer heat.
Lifestyle: Live in wagons ( or wheels) drawn by hornless oxen. Diet of boiled meat, mares’ milk, and hippakē (cheese).
Physique: Stout, fleshy, soft, and slack. Uniform appearance. Men and women are similar because the seed is not “corrupted” by seasonal variation. Red skin from cold burns.
The Anariees (Eunuch-like Men):
Condition: Many Scythian men become impotent and adopt women’s work and speech.
Alleged Cause: The natives believe it is divine, but the author attributes it to riding horses and the subsequent medical practice of cutting the veins behind the ears to cure hip pain, which destroys the seed.
Class Aspect: Wealthy Scythians suffer more because they ride more; the poor, who do not ride, are less affected.
Sauromatae Women: Virgins who fight in battle, hunt, and ride. They must kill enemies before marrying. Mothers cauterize the right breast of female infants so the strength is diverted to the right arm and shoulder.
The Link Between Climate, Constitution, and Political Autonomy
European Diversity: Frequent changes in European seasons (heat, cold, rain, drought) lead to varied appearances and characters.
Character and Hardship: Shocks to the temperament in Europe produce wildness, ferocity, and high spirit. Endurance is born from change, whereas complacency is born from consistency.
The Influence of Governance:
Kings/Despots: In Asia, most people are ruled by kings; this makes them cowardly and unwarlike, as they risk death for another’s gain.
Autonomy: Europeans (and some independent Asians) are more warlike because they take risks for themselves and reap the prizes of their own manliness.
Detailed Environmental Correlates for Human Nature
Mountainous/Well-watered Land: Large, hardy, manly, and ferocious people.
Stifling/Hollow Land (Warm winds): Broad, fleshy, dark-haired, and dusky people; less phlegm than bile; lack natural endurance.
Elevated/Windy Land: Large, uniform, but somewhat submissive people.
Thin/Waterless Soil: Lean, well-toned, fair-haired, willful, and stubborn people. Quick-witted and better at war.
Rich/Soft Land: Fleshy, moist people; intolerant of work; thick-headed and unrefined.