Diocles of Carystus

Greek physician

  • Born: c. 375 b.c.e.
  • Birthplace: Carystus, Greece
  • Died: c. 295 b.c.e.
  • Place of death: Athens?, Greece

Diocles was a Greek physician who was regarded in antiquity as second only to Hippocrates. He wrote several medical works, including the first separate treatise on anatomy and the first herbal. His best-known contributions to medicine are in the area of hygiene.

Early Life

Not much is known of the early life of Diocles of Carystus (DI-uh-kleez of kuh-RIHS-tuhs). His father’s name was Archidamos, and Diocles was a native of Carystus, a small town on the southern tip of the island of Euboea, off the eastern coast of mainland Greece. According to the Roman writer Pliny, Diocles was second in age and fame to the famous physician Hippocrates (c. 460-370 b.c.e.). He has traditionally been placed in the first half of the fourth century b.c.e. It has been observed, however, that the language of his extant writings points to the later rather than to the earlier half of the fourth century b.c.e. It is likely that he was a younger contemporary of Aristotle (384-322 b.c.e.) and thus was active until 300 or perhaps later. Diocles is the only physician between Hippocrates’ time and the Hellenistic period about whom very much is known.

Diocles probably learned his trade from his father, who was a physician, for medicine in the ancient world was a craft that was often passed from father to son. The ordinary physician acquired his skill and knowledge through an apprenticeship in which he learned the elements of traditional practice. Diocles wrote a work titled Arkhidamos (date unknown), dedicated to his father’s memory, in which he argued against his father’s condemnation of the practice of rubbing the body down with oil because he believed that it overheated the body. Diocles suggested instead that in the summer a mixture of oil and water be employed, while in the winter only oil be used.

There is good evidence, on the basis of Diocles’ language and thought, that he was a pupil of the philosopher Aristotle, who founded his philosophical school, the Lyceum, in Athens in 334. Whether Diocles came to Athens specifically to study at the Lyceum or had earlier established residence there is not known. He was the first Greek to write medical treatises in Attic Greek rather than in Ionic, which was the dialect normally employed by medical writers. He seems to have belonged to the same generation of Aristotle’s pupils as Theophrastus and Strato, who provide the earliest evidence for Diocles’ work.

Diocles employs Aristotelian terminology and shows the influence of Aristotle’s ethics, for example, in his use of the ideas of proportion and suitability in his theory of diet. On the other hand, it is quite possible that Diocles in turn influenced his master, perhaps as a source for Aristotle’s zoological works. Although Diocles was apparently closely associated with the Peripatetic school, which was the chief center of scientific research in the Greek world until the founding of the Museum at Alexandria, Aristotle was not the only source of his ideas. He apparently had access to a collection of Hippocratic treatises and may, in fact, have been the first medical writer to assemble such a collection. His indebtedness to Hippocratic medicine is indicated by his treatises, some of which resemble Hippocratic works in title and subject matter. Diocles’ thought also shows a debt to the Sicilian school of medicine, which was dominated by the philosopher and physician Empedocles (c. 490-430 b.c.e.). A later member of the school, Philistion of Locri (427-347 b.c.e.), who was a contemporary of Plato, also influenced him. Nevertheless, Diocles was no slavish follower of Aristotle or of any medical or philosophical system. He borrowed elements from Hippocratic medicine, from the Sicilian school, and from Aristotle, all the while maintaining his own independence and making original contributions.

Life’s Work

Diocles was a prolific writer. The titles of seventeen of his medical treatises are known, including Peri puros kai aeros (On Fire and Air), Anatomē (Anatomy), Hugieina pros Pleistarkhon (Directions on Health for Plistarchus), Peri pepeseōs (On Digestion), Peri puretōn (On Fevers), Peri gunaikeiōn (On Women’s Diseases), Peri epideomōn (On Bandages), Peri tōn kat iētreion (On the Equipment of a Surgery), Prognōstikon (Prognostic), Peri therapeiōn (On Treatment), Pathos aitia therapeia (Sickness, Causes, and Treatment), Rhizotomika, Peri lakhanōn (On Vegetables), Peri thanasimōn pharmakōn (On Lethal Drugs; this and all preceding titles translated in 2000), Arkhidamos, and Dioklēs epistolē prophulaktikē (Epistle of Diocles unto King Antigonus, c. 1550). Of these works, more than 190 fragments have been preserved by later medical writers. Diocles’ style is polished, with some literary pretensions, and shows the influence of rhetorical devices (for example, the avoidance of hiatus), while maintaining a deliberately simple style that reflects the influence of Aristotle.

According to the physician Galen (129-c. 199 c.e.), Diocles’ Anatomy was the first book written on that subject. In it, he described the heart, lungs, gall bladder, ureters, ovaries, Fallopian tubes, and ileocecal valve. Diocles’ Anatomy was based on the observation of animals and not human beings (he is said to have dissected animals). Nevertheless, his work marked a significant turning point in the study of human anatomy, and other writers after him began to produce treatises on the subject. Diocles was indebted to Empedocles for his views on embryology. He believed that both the male and the female contributed seed, which originated in the brain and spinal marrow, to the embryo. The embryo, he believed, required forty days to develop fully; boys, who he said developed on the warmer, right side of the uterus, grew more quickly than girls. Diocles was interested in the problem of sterility and dissected mules to determine the causes of infertility. He also wrote on gynecology. From Empedocles he adopted the view that menstruation began at fourteen and lasted until sixty in all women. He also described signs of expected miscarriage and suggested causes of difficult birth.

In physiology, Diocles was also indebted to Empedocles, perhaps by way of Philistion. Like Empedocles, he believed that there were four elements (fire, air, water, and earth), which he equated with the four qualities (heat, cold, moisture, and dryness) that were responsible for the processes of the body. The body, possessing an innate heat, altered food that was consumed, producing the four humors (blood, phlegm, yellow bile, and black bile). Health was the result of an equilibrium of the four qualities, while disease was the result of an excess or deficiency of one of them.

Diocles wrote that health and disease also depended on external factors (for example, wounds, nourishment, or sores) and on pneuma (air), inhaled or absorbed into the body through the pores in the skin. Pneuma then went to the heart, the central organ, from which it was distributed throughout the body by means of veins. Pneuma was essential to life, and if its passage was blocked, a humor disease or death would result. The heart was believed to be the chief organ of sensation and thought and the source of blood in the body. Diocles’ theory of pneuma was also taken over from Empedocles and came to exercise much influence in Greek medical thought. Diocles recognized that fever was not itself a disease but rather the symptom of a disease. He also distinguished between pneumonia, which is a disease of the lungs, and pleurisy, which is an inflammation of the pleura (the lining over the lung).

Diocles wrote as well on botany and pharmacology. He compiled the first Greek herbal, Rhizotomika, which described the nutritional and medical value of plants. This treatise was widely used by later writers on the subject until replaced in the first century c.e. by the definitive work of Pedanius Dioscorides. While herbal drugs had been mentioned in the Hippocratic treatises, before Diocles no descriptions had been given of the plants themselves. Diocles’ work on botany was no doubt influenced by his teacher’s interest in the subject, and his work was apparently known to Theophrastus, a fellow student at the Lyceum and Aristotle’s successor, who founded scientific botany.

It was in dietetics and hygiene that Diocles made his greatest contribution to Greek medicine. In the late fifth century, dietetic medicine had become a means of maintaining health rather than (as it had been earlier) a method of treating disease by restoring the proper balance to the body. Treatises appeared on hygiene containing detailed instructions for a daily regimen that regulated food and drink, rest and sleep, swimming, massage, gymnastic exercise, physical cleanliness, and sexual activity. Diocles treated the subject of hygiene in several partially extant works. In Directions on Health for Plistarchus (written after 300), addressed to a Macedonian prince who was the son of Antipater, a general of Alexander the Great, Diocles reproduced (with some variations) the recommendations of earlier Hippocratic works on the subject of regimen. In an earlier work, Dioklēs epistolē prophulaktikē (c. 305-301), addressed to King Antigonus, another of Alexander’s generals (which is quoted by the Byzantine writer Paul of Aegina), Diocles discussed, among other subjects, the matter of diet, advising that food and drink be adjusted to the seasons in order to counteract the effects of seasonal variation.

Diocles also wrote a treatise on diet that is preserved in fragments quoted by Oribasius, who was the physician to the Roman emperor Julian from 361 to 363 c.e. The treatise describes a complete routine, from rising to bedtime, for one typical day of each of the four seasons of the year. Gymnastic exercise in both morning and evening plays an important part in Diocles’ regimen. This work reveals the influence of Aristotle’s concepts of the mean and suitability to the individual and his circumstances. Although Diocles prescribes an ideal regimen, chiefly intended for a man of means and leisure, it is one that can be adapted to the needs of those who have less time as well as to those of different ages.

Significance

Diocles was an important medical figure in his own day, as his reputation as a “second Hippocrates” indicates, and he forms a significant link between Hippocratic and Hellenistic medicine. He was indebted to the Sicilian school, particularly in his pneumatic pathology, but his work also shows the influence of Hippocratic medicine in hygiene and therapeutics. No mere compiler, he synthesized and improved on the work of his predecessors. Like the Hippocratics, he realized the importance of prognosis. Some later writers considered Diocles to have been a leading member of the Dogmatic sect, which sought “hidden causes” in medicine and supplemented experience with reason and speculation. He lived too early to be labeled a Dogmatic, however, and his independent and synthetic approach to medicine would in any event seem to rule out this possibility.

Diocles wrote on a number of medical subjects: dietetics, embryology, anatomy, botany, pharmacology, and gynecology. He also invented a device, called the “spoon of Diocles,” for extracting barbed arrows. He influenced subsequent medical writers, beginning with his own pupil, Praxagoras of Cos, who became head of the Hippocratic school, and he is quoted by Galen, Oribasius, Caelius Aurelianus, and Paul of Aegina. Galen praises him as a “physician and rhetorician” and credits him with having arranged Hippocratic medicine in a more logical form. Diocles appears as well to have been, like many of the early Peripatetics, something of a Renaissance man, whose interests extended beyond medicine to botany, meteorology, zoology, and even mineralogy.

Bibliography

Edelstein, Ludwig. Ancient Medicine: Selected Papers of Ludwig Edelstein. Edited by Owsei Temkin and C. Lilian Temkin. Translated by C. Lilian Temkin. Baltimore: The Johns Hopkins University Press, 1994. This work includes discussions of the dates of Diocles and the importance of dietetics to Greek ideas of health and medicine.

Jaeger, Werner. Aristotle: Fundamentals of the History of His Development. 2d ed. Oxford, England: Oxford University Press, 1962. A detailed argument for dating Diocles in the late fourth and early third centuries and a discussion of Aristotle’s influence on Diocles.

Jaeger, Werner. The Conflict of Cultural Ideals in the Age of Plato. Vol. 3 in Paideia: The Ideals of Greek Culture. 3 vols. Translated by Gilbert Highet. New York: Oxford University Press, 1969. A fine discussion of the Greek ideal of health and the place of Diocles and his views on dietetic medicine in the context of the Greek emphasis on health.

Phillips, E. D. Aspects of Greek Medicine. Philadelphia: Charles Press, 1987. A summary of Diocles’ medical doctrines. Includes a list of the titles of his known works.

Sigerist, Henry. Early Greek, Hindu, and Persian Medicine. Vol. 2 in A History of Medicine. New York: Oxford University Press, 1967. A summary of Diocles’ views on diet and hygiene, set against the background of Greek views of hygiene.

Van der Eijk, Philip J., ed. Diocles of Carystus. 2 vols. New York: Brill, 2000. The collected fragments of Diocles, translated. Includes commentary.