N.P. Stathakou,MD, G.P. Stathakou,MD, S.G. Damianaki,MD,
E. Toumbis Ioannou,MD and N.G. Stavrianeas,MD

2nd Department of Dermatology and Venereology
National and Kapodistrian University of Athens
School of Medicine
“Attikon” General University Hospital, Athens, Greece


Empedocles, born in 490 ΒC (Diogenis Laertius), lived in Agrigento, Sicily. He died in 440 BC and was considered a physician and a philosopher. About 450 verses have been saved from his work, some of them have biomedical references. He observed that plants and animals, including man, are created from four basic elements, which he called «ριζ?ματα» (roots or elements). When combined in different ways, these succeed in producing all the varieties of vegetal and animal species on earth. Concrete mixtures of these four elements describe each organ or part of our body, thus proposing a genetic and hereditary biology based on the mixture of the four «ριζ?ματα». He had treated an endemic disease from Selinounta a nearby city,by opening a canal and emptying stagnating water to the sea. It has also been reported that he had cured plague from the city of Athens by using fire. He did the same at his birthplace with the method of disinfection by smoke: “δι’ αψεως πυρων καιυποκαπνισμων”.

Overall, his insight seen through his biomedical comments reveal an admirable

precursor of modern medicine.


Key words: Empedocles, Ancient Greece, philosopher, physician, roots, elements


Empedocles was born in approximately 490 BC (Diogenes Laertius)

in the Greek colony Akragas, Sicily. He died around 440 BC. Akragas

was a Greek colony founded in the 6th century BC.

Empedocles studied medicine (he is referred to as a doctor, a poet, an

orator and a philosopher) and had an insight into issues related to modern

biology, specifically genetic and molecular biology regarding to the

creation of beings, comparative and experimental physiology,

biochemistry and enzymology [1,3,4].

Philosophers made many references to Empedocles’ works and

thus, about 450 of his verses remain. They have been published by

Hermann Diels and Walter Krantz, but only make up a small part of his

original work [5].

The following extracts are of interest in terms of bio-medicine,

according to Hermann Diels and Walter Krantz and have been translated from

Ancient Greek [5]:“All beings have bloodless tubes over the outside of the body,

and at the openings of these outer layers of skin are pierced all over with close-set

ducts, so that the blood remains within, while a facile opening is cut for

the air to pass through. Then, whenever the soft blood speeds away from

these, the air speeds bubbling in with impetuous wave and whenever the

blood leaps back, the air is breathed out… Thus, when the soft blood

surging violently through the limbs rushes back into the interior, a swift

stream of air comes in with hurrying wave and whenever the blood leaps

back, the air is breathed out again in equal quantity” [1,5,7].

This extract reflects Empedocles’ approach to the histology of both the

skin and the respiratory epithelium of the lungs in connection with the

central and peripheral blood flow. He realized that blood flows into pores

beneath the skin which cover the whole body and that it is

not exposed to the air. Breathing occurs through both the lungs and the

skin pores. Today, we know that pores expand with heat and contract

with the cold [8].

“Refrain entirely from laurel leaves” [5]. Laurel leaves are

known to be poisonous. There is sufficient bibliography on this issue

and on the chemical identification of poisonous substances. Empedocles,

due to his origin from Akragas where laurel thrives, would have been

aware of that and following Pythagorean advice, he discourages

people from eating them.

Relevant simplistic verses have remained more easily through

tradition than those with obscure philosophical reflections.

“Miserable men, wholly miserable, restrain your hands from

beans “ [5]. The genetic lack of G6PD in red blood cells results in

hemolytic anemia in sensitive individuals, when they eat fava beans or

expose themselves to the flowers of this plant. The disease is common in

Sicily. Epidemiologic studies show occurrence frequency rating from 2%

to 30% of the population depending on the area.

Empedocles, probably based on epidemiologic observation and clinical

experience discourages his fellowmen from feeding on broad beans.

There are further, more psychodynamic explanations for this ban

of “beans”, if the word is replaced with “testicles”. In that case,

Empedocles, as a Pythagorean, denounces sexual hyperactivity,

a clue to the profound doctor’s morality [1,7].

Empedocles, influenced once more by Pythagoreans, respected and

admired animals to such an extent that he refrained from meat-eating


Plutarch in his reports of Ethics (515 BC) writes that Empedocles

put up a wall across a gorge, through which a sickening, southern wind

was blowing [1,4,12,13]. He had recommended to the residents of

Selinunta certain sanitary measures, which called for the confluence of

three rivers nearby their town. Apparently, they formed swamps


Empedocles, according to Diodorus, managed to make Selinunta a

healthy town with irrigation works funded by him. By opening up two

mighty rivers to the sea, he channeled slack water and drained the

swamps making the water drinkable. Obviously, the area suffered from

malaria and contaminated water. Sanitary works resulted in sanitation

minimizing the scourge of the epidemic symptom of fever which afflicted

the people of Selinunta. This sanitation work may well be regarded as the

first known Public Health Project, which after detecting the cause of the

scourge (for Selinunta disease and slack water) yielded sanitation via

sanitary works [2,8,12,13,14].

According to Plinius Senior, Empedocles wrote in Doric dialect a

medical essay where we see him treating plague in Athens with fire. He is

believed to have used fire as a sanitary countermeasure to burn up rodents

and intermediate vectors of the disease successfully combining thus the

cause of the disease with the efficiency of sanitary measures. He

acted similarly in his hometown, Akragas, by using the method of

fumigation [1,2,3,9,12,13,14].

Empedocles, according to Aetius, believed that during human

embryogenesis, joints are formed on the 36th day and limbs on the 49th;

and that the heart is the first to form in the embryo, and nails the last and

that pregnancy lasts for 7-10 weeks. According to Soranus, Empedocles

reckoned that the umbilical cord has four blood vessels, two arteries and

two veins which supply the embryo with nutrients. Rufus from Ephesus

reports that Empedocles described the embryo surrounded by membranes,

one of which is thinner and called embryonic. For him sex is determined

by the prevalence of the hot or the cold of the parents during conception

and the offsprings’ resemblance to their parents is attributed to a bigger

quantity of sperm or of the woman’s fluids. Twins are the result of

exceeding sperm that reaches both ends of the womb. He also dealt with

the structure of bones, nails, sweat, and tears [2,8,9,12,13,14].

Empedocles’ theory that material and body interaction occur

through the penetration of particles in the pores is for Puccinotti

similar to the recent theory of endo-osmosis [2,9]. Moreover, he

concluded that circulation and breathing (inhalation - exhalation) are

interconnected and that blood runs back to the heart. He visualized the

heart being the center of the vascular system and carrier of “inherent

warmth”. A fall in warmth results in sleep and its lack in death

[1,3,4,8]. Indeed, he is the first physiologist to view blood as a carrier

related to the intake and outlet of air through breathing and the first to

find a connection between vascular and venous circulation, inspiring thus

later studies by William Harvey [2,10].

Empedocles believed that the elements that exist unaltered in all

beings (men, animals, and plants) are four, also known as “roots”. Number

four is fundamental for the Pythagorean School. The sum of the first four

integral numbers is ten, which for Pythagoreans is the essence of nature.

Deprived of the potential of modern scientific research and proof,

Empedocles who was interested in medical and philosophical issues, tried to explain

in his cosmology the constituents of life based on a theoretical mathematical

process armed only with his intelligence and senses. He believed that blends of

roots make up every organ or part of the body and considered

Zeus (fire), Hera (air), Aidoneus (earth) and Nestis (water)

the basic elements or molecules that comprise the common connection

that man may possibly have with all animals and plants.

These four elements are considered by Empedocles to have originally

created the “mold” of life after the Big Bang. He believed that every

entity (active or inactive) consists of fundamental particles/elements

in certain analogies, which connect not only with similar forces but

also rival forces, hence Love and Strife have existed since the birth of

things and life. Health is the product of the balance of the four elements;

imbalance results in disease [1,3].

What is remarkable about his insight is that today we know that the

nucleic acids of DNA are four, and that each consists of four kinds of

particles equally distributed (carbon, oxygen, hydrogen, nitrogen).

Furthermore, the particles in space are four (protons, neutrons,

electrons and neutrinos) and the fundamental particles

are four (quarks, electrons, neutrini, photons) [1,11].

The infeasibility of biological experimentation and the lack of research

tools did not prevent Empedocles from assuming, via the Pythagorean

thought process, the existence of a common factor in all beings, the four

roots, which in various combinations, generate life [3,5].

Empedocles embracing Parmenidean views, differentiates the

mortal from the wise man, who is closer to Sferos, his notion of God, and

therefore has the potential for great achievements. It is remarkable that

the public sense of the time and the following centuries was impressed by

Empedocles’ work, mostly by his conviction that he possessed

supernatural and magical powers including bringing a dead man back to

life [1,3,7].

Hermippes mentions that he cured Panthea, on whom every other doctor

had given up. According to others, he resurrected Panthea from death.

Apparently, it was a case of a hysterical woman’s apparent death [12,13].

Heracledes memorizes Empedocles’ achievement to keep a woman alive

who had no pulse or breathing for 30 long days. He called the disease

“Apnoun” (not sleeping) [1,3,12,13].

Reports about his death talk about a magnificent procession to the

volcano of Etna and Epedocles’ claim that he would walk on lava. As is

usually the case for every mystic, excessive admiration was followed by

sarcasm and irony. Empedocles is supposed to have failed to walk on the

lava and burnt in the volcano.

From the few preserved extracts regarding the initial work of

Empedocles, the speculator is bound to admire his insight, his

multifarious talents and the potential of the Greek way of thinking to act

as a precursor to modern science.


1. M. ΞΥΛΙΝΑΣ, Η προσωκρατικ? φιλοσοφ?α και οι σ?χρονες φυσικ?ς επιστ?μες

(Εκδ?σεις Δωδ?νη, Αθ?να-Ιω?ννινα 1997), 13-15, 19-40, 42-44, 47.

2. A. CASTIGLIONI, Ιστορ?α της Ιατρικ?ς, vol Ι ( Εκδ?σεις Γερ?λυμπος Ι.,

Αθ?να, 1961), 138, 143-145.

3. J. BOLLACK, Empedocle, vols ΙΙ, Les originies, gallimard (Les Editions de

Minuit, 1969), 100-101.

4. J.P. DUMONT, D. DELATTRE, J.L. POIRER, Les Presocratiques,

Bibliotheque de la Pleiade (NRF Editions Gallimard, 1998), 10-20.

5. DIELS HERMANN, KRANZ WALTER: Die Fragmente der Vorsokratiker

(Weidmannsche Vergals-buchandlung, Berlin, 1903, 1906, 1912), 193-282.

6. J.C. SOURNIA, Histoire de la medicin (Editions la decouverte, Paris 1992),


7. Γ. ΤΖΑΒΑΡΑΣ, Η πο?ηση του Εμπεδοκλ? (Εκδ?σεις Δωδ?νη, Αθ?να - Ιω?ννινα,

1998), 51-67, 72-77, 79-81, 84-87, 118-119, 122-125, 134-139, 152-161, 164-

175, 208-211.

8. L. STERPELLONE, Dagli dei al DNA, vols ΙΙ (Editore Delfino A., Roma 1984),


9. M.T. MALTATO, Coll: Storia della Medicina, vols Ι and ΙΙΙ (Editore delfino

A., Roma, 1984), 48,107-111,120,128,706.

10. Σ. ΜΑΡΚΕΤΟΣ., Η Ιστορ?α της Ιατρικ?ς (εκδ?σεις Ζ?τα, Αθ?να, 1993), 52, 211.

11. B. LEWINIl, gene (Edizioni Zanichelli, Bologna, 1998), 23-32, 46-48, 247-249,

431, 435-436, 460-465, 487-489.
12. Γ.Κ. ΠΟΥΡΝΑΡΟΠΟΥΛΟΣ, Ιστορ?α της Ιατρικ?ς (δια μ?σου των αι?νων)

(Εκδ?σεις «ο Κορα?ς», Αθ?να, 1928),39-40.

13. Α.Π. ΚΟΥΖΗΣ, Ιστορ?α της Ιατρικ?ς (Εκδ?σεις Πυρσ?ς, Αθ?να, 1929), 85-86.

14. A.S. LYONS, R.G. PETRUCALLI, History of medicine (Edition Abrams H.N.,

New York, 1978), 187-189, 194-195.

First Published April 2007

Copyright © Priory Lodge Education Limited 2007

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