Herophilus

Greek physician

• Born: c. 335 b.c.e.
• Birthplace: Chalcedon, Bithynia (now Kadiköy, Turkey)
• Died: c. 280 b.c.e.
• Place of death: Probably Alexandria, Egypt

The first systematic dissector of the human body, Herophilus made numerous anatomical discoveries, laying the foundation for subsequent Western anatomy. Herophilus’s analysis of the pulse and his dream theory also exercised a strong influence on medicine and psychology in later centuries.

Early Life

The sparse ancient evidence suggests that Herophilus (huh-RAHF-uh-luhs) left his native city of Chalcedon for an apprenticeship with the distinguished physician Praxagoras of Cos before settling in the recently founded North African city of Alexandria. An Athenian sojourn is implied by the report of Hyginus, a second century Roman mythographer, that a young Athenian woman, in guileful reaction against the exclusion of women from the medical profession, disguised herself as a man and completed an apprenticeship with Herophilus. As a consequence of her popularity with women patients, who alone knew that she was a woman, Herophilus’s pupil was brought before an Athenian jury on charges of seducing and corrupting her women patients. In court she raised her tunic and revealed her gender. After she received assertive support from women, Hyginus relates, “the Athenians amended the law so that free-born women could learn the art of medicine.” No independent evidence corroborates Hyginus’s account—which formally belongs to the genre of invention fables—but it is worth noting that Herophilus’s contributions to gynecology and obstetrics are richly attested.

Life’s Work

The first scientist to violate the entrenched Greek taboo against cutting open a human corpse, Herophilus made spectacular discoveries in human anatomy. From classical antiquity until the early Renaissance, anatomical accounts were mainly based on comparative anatomy—Aristotle and Galen, in particular, dissected numerous animals—and on chance observations of the wounded or injured. While Herophilus continued this practice of dissecting animals, he and his contemporary Erasistratus apparently were the only pre-Renaissance scientists to perform systematic dissections on humans. Furthermore, if the controversial but unequivocal evidence of several later authors is trustworthy, Herophilus also performed vivisectory experiments on convicted criminals.

Herophilus was able to break the spell of the taboo because of an exceptional constellation of circumstances in Alexandria. The combination of ambitious, autocratic patrons of science (the Ptolemies), bold scientists such as Euclid and Archimedes, a new city on foreign soil in which traditional Greek values initially were not accepted as intrinsically superior, and a cosmopolitan intelligentsia committed to literary, technological, and scientific frontiersmanship made it possible for Herophilus to overcome tenacious inhibitions against opening the human body. The native Egyptian practice of mummification, sanctioned by centuries of stable religious belief, might have been invoked as a precedent, although embalming was in fact very different from scientific dissection. The Egyptian embalmers, for example, scraped and drained the brain piecemeal through the nostrils of the corpse, mangling it beyond anatomic recognition, whereas Herophilus dissected the brain meticulously enough to distinguish some of its ventricles and to identify several of its smaller parts with unprecedented accuracy.

One of Herophilus’s more noteworthy discoveries was that of the nerves. He distinguished between sensory and “voluntary” (motor) nerves, described the paths of at least seven pairs of cranial nerves, and recognized unique features of the optic nerve. He also was the first to observe and name the calamus scriptorius, a cavity in the floor of the fourth cerebral ventricle. His careful dissection of the eye yielded the discovery not only of the optic nerve but also of several coats of the eye (probably the sclera, cornea, iris, retina, and chorioid coat), an achievement all the more remarkable in the absence of the microscope.

Like his other works, Herophilus’s main anatomical work, Anatomika (Anatomy, 1989), survives only in fragments and secondhand reports. From its second book, ancient sources have preserved the first classic description of the human liver: The shape, size, position, and texture of the liver as well as its connections with other parts are described with admirable accuracy. The pancreas and small intestine, or duodenum (a Latin version of the name Herophilus first gave it), are among the other parts in the abdominal cavity that he explored.

The third book of Anatomy appears to have been devoted to the reproductive organs. In the male, Herophilus distinguished between various parts of the spermatic duct system, meticulously identifying anatomical features previously unknown. As for the female, Herophilus seems to have abandoned the traditional theory of a bicameral human uterus, and, using the male analogy, to have discovered the ovaries (which he calls female twins or testicles), the Fallopian tubes (although he did not determine their true course and function), and several other features of female reproductive anatomy.

In the fourth book, Herophilus dealt with the anatomy of the blood vessels. Accepting Praxagoras’s distinction between veins and arteries, he provided further anatomical precision and offered some basic observations on the heart valves, the chambers of the heart, and a variety of vessels and vascular structures. The torcular Herophili, a confluence of several great venous cavities or sinuses in the skull, was first identified by Herophilus and still bears his name.

In his physiopathology, Herophilus appears to have accepted the traditional theory of a balance or imbalance between humors (or moistures) in the body as the cause of health and disease, respectively, but he insisted that all causal explanation is provisional or hypothetical. One must start from appearances, or observation, he said, and then proceed on a hypothetical basis to what is not visible, including cause. The command center of the body is located in the fourth cerebral ventricle or in the cerebellum (which is indeed the center responsible for muscular coordination and maintenance of the equilibrium of the body). From the brain and spinal marrow, nerves—sensory and motor—proceed like offshoots. Neural transmission, at least in the case of the optic nerves, apparently takes place through pneuma, a warm, moist, airlike substance flowing through the nerves and ultimately derived from external air by respiration.

Among the involuntary motions in the human body (that is, ones for which the motor nerves are not responsible), Herophilus gave novel, detailed accounts of two: respiration, which he attributed to a natural tendency of the lungs to dilate and contract through a four-part cycle, and the pulse, which he attributed to a faculty that flows to the arteries from the heart through the arterial coats, causing the arteries to dilate and contract. His treatise Peri sphygmōn (On Pulses, 1989) is the first work devoted to the subject, and it became the foundation of all ancient and of much subsequent pulse lore.

Central to Herophilus’s vascular physiology is the theory that the arteries transport a mixture of blood and pneuma (similar to the modern view that the arteries carry blood and oxygen), whereas the veins contain only blood. Here he parted ways with his teacher Praxagoras and his contemporary Erasistratus, both of whom believed the arteries contain only pneuma. The arteries, Herophilus believed, pulsate in such intricate, differentiated patterns that the pulse is a major diagnostic tool. Deploying sustained analogies between musical-metrical theory and pulse rhythm, Herophilus described nature’s music in the arteries as successively assuming pyrrhic, trochaic, spondaic, and iambic rhythmic relations between diastole and systole as one passes through four stages of life—from infancy (pyrrhic) through childhood and adulthood to old age (iambic). Deviations from these rhythms indicate disorders.

Herophilus had such faith in the diagnostic value of the pulse that he constructed a portable water clock, or clepsydra, to measure the rate of his patients’ pulses. The device could be calibrated to fit the age of each patient. One example of its clinical application suggests that it also functioned as a protothermometer: “By as much as the movements of the pulse exceeded the number that is natural for filling up the clepsydra, by that much Herophilus declared the pulse too frequent, i.e., that the patient had either more or less of a fever” (quoted from the second century Marcellinus). Herophilus’s pulse theory represents an unusual attempt within ancient medicine to introduce measurement and quantification into nonpharmacological contexts. Besides rhythm and frequency, he used size, strength, and perhaps speed and volume to distinguish one pulse from another.

Reproductive physiology and pathology represent other strengths of Herophilus. He accepted, in general, Aristotle’s view that male seed is formed from the blood and, according to Saint Augustine’s acquaintance Vindician, Herophilus characteristically tried to defend this idea by arguments based on dissection. He wrote the first known treatise devoted only to obstetrics, Maiōtikon (Midwifery; also known as On Delivery), in which he tried to demystify the uterus, arguing that it is constituted of the same material elements as the rest of the body and is regulated by the same faculties. There is no disease peculiar to women, he asserts, though he concedes that certain “affections” are experienced only by women: menstruation, conception, parturition, and lactation. The causes of difficult childbirth, embryological questions (such as, is the fetus a living being, as it possesses involuntary but not voluntary motions?), and the normal duration of pregnancy are among the other subjects apparently explored by Herophilus. The church father Tertullian implied that the Alexandrian performed abortions and charged him with having possessed an instrument known as a “fetus-slayer” (embryo-sphaktes).

In his treatise Pros tas koinas doxas (Against Common Opinions, 1989), Herophilus also dealt with gynecological and obstetrical issues, attacking the common opinion that menstruation is good for every woman’s health and for childbearing, and, characteristically, adopting a more discriminating view: Menstruation is helpful to some women, harmful to others, depending on individual circumstances. For all of his emphasis on the hypothetical nature of causal explanations, Herophilus tried to determine the causes of many individual disorders, including fevers, heart diseases, and pneumonia. He also described the symptoms of several physical and mental disorders and developed a semiotic system known as a “triple-timed inference from signs,” which used a combination of the patients’ past signs or symptoms, the present signs, and the “future signs” (inferences from what has happened to other similarly afflicted patients) for diagnostic, prognostic, and therapeutic purposes.

In Die Traumdeutung (1900; The Interpretation of Dreams, 1913), Sigmund Freud recognized Herophilus’s importance in another area: dream theory. Dreams, Herophilus believed, belong to one of three classes by origin: “godsent” dreams occur inevitably or by necessity; “natural” dreams arise when the soul forms for itself an image of what is to its advantage; and “compound” or “mixed” dreams arise when one sees what one desires. Freud acknowledged Herophilus’s emphasis on the fulfillment of sexual and other wishes in dreams as an important anticipation of his own theory. With modifications, Herophilus’s tripartite classification of dreams reappears in the works of several pagan and Christian authors, thus representing another influential part of his legacy.

Significance

The frequent lag between scientific discovery and clinical application, between theory and therapy, also characterized Herophilus’s work. Despite his brilliant discoveries in anatomy and physiology, he was a traditionalist in practice. In his works Diaitētikon (Regimen, 1989) and Therapeutika (Therapeutics, 1989), Herophilus prescribed a preventive regimen, bloodletting, various simple and compound drugs (with at least some innovative ingredients), and a limited amount of surgical intervention (with a felicitous emphasis on checking hemorrhages).

He perhaps also prompted the influential Alexandrian tradition of exegesis of Hippocratic texts, to which several of Herophilus’s adherents made major contributions by taking a keen, critical interest in Hippocratic works. One of Herophilus’s pupils, Philinus of Cos, broke with him and became a leader of the powerful Empiricist school of medicine, but many others continued proclaiming themselves his followers. As the old taboos against human dissection reasserted themselves after Herophilus’s death, the Herophileans abandoned this central part of the founder’s legacy. However, the rich history of his school, both in Alexandria and in Laodicea-on-Lycus (Turkey), can be traced for at least three centuries after Herophilus’s death. Through Galen’s detailed acclaim of Herophilus’s dissections and of his pulse theory, the Alexandrian’s fame survived the polemics of those Christians and pagans who believed that what had been concealed by God or nature should not be revealed by humans.

Bibliography

Fraser, P. M. Ptolemaic Alexandria. 3 vols. Oxford, England: Clarendon Press, 1972. An excellent comprehensive treatment of Alexandria at the time of Herophilus. Chapter 7 offers a good introduction to Herophilus and other Alexandrian physicians.

Lloyd, G. E. R. Greek Science After Aristotle. New York: Norton, 1973. Chapter 6 offers a useful general introduction to Hellenistic biology and medicine, with a valuable assessment of Herophilus’s place in the history of science.

Lloyd, G. E. R. Science, Folklore, and Ideology. Indianapolis: Hackett, 1999. Excellent observations throughout, especially on Herophilus’s contributions to reproductive theory and the standardization of anatomical terminology.

Longrigg, James. “Superlative Achievement and Comparative Neglect: Alexandrian Medical Science and Modern Historical Research.” History of Science 19 (1981): 155-200. A solid overview of the scientific views of Herophilus and Erasistratus by a classicist and historian of medicine.

Potter, Paul. “Herophilus of Chalcedon: An Assessment of His Place in the History of Anatomy.” Bulletin of the History of Medicine 50 (1976): 45-60. A physician and historian of medicine subjects Herophilus’s anatomical descriptions to thoughtful, informed scrutiny.

Von Staden, Heinrich. Herophilus: The Art of Medicine in Early Alexandria. New York: Cambridge University Press, 1989. The first comprehensive collection, translation, and evaluation of the ancient evidence concerning Herophilus. Part 1 includes extensive essays on his anatomy, physiopathology, therapeutics, and theory of method; part 2 traces his followers from 250 b.c.e. to 50 c.e.