It all started with Hippocrates

 

 

by Suneet Sood, Professor of Surgery, Faculty of Medicine, UiTM, Malaysia

A famous writer, giving a light-hearted account of the history of medicine, titled his book “It all started with Hippocrates”.1 And, truly, the science of medicine probably did. What better way to start a column on the history of medicine than with Hippocrates?

In Hippocrates’ time it was not terribly fashionable to maintain accurate records. Though his fame was such that as early as 10 BC he was in the Suda2 (already!), information about him is unreliable. This article, therefore, is factually weak. It may be less about Mr Hippocrates, and more about myth Hippocrates.

Kos with inset-2Hippocrates was born in 460 BC on Greece’s Kos, one of the Dodecanese3 islands that lie southwest of Turkey. Kos is tiny but beautiful, and is now prominently displayed in Greece’s tourist advertisements. It is shaped rather like a whale, and young Hippocrates had a good time there. Hippocrates’ parents were Heraclides and Praxitela. Heraclides was himself a physician, and taught Hippocrates. In those days the curriculum of medical education included more magic and less science. “Diseases are God’s punishment for our sins, son,” taught Heraclides. “Hardly,” said young Hippocrates, but wisely only to himself. Even as he rejected Daddys ideas, however, Hippocrates never rejected his ancestry, which he traced all the way back to Asclepius, the God of Healing from his father’s side, and to Hercules, the warrior, from Praxitela’s. History records that not everyone believed him.

Despite his education and remarkable ancestry, Hippocrates’s beliefs differ from those of modern-day biologists. Hampered by an ignorance of anatomy, since the law forbade dissection, he taught that the body was governed by four humors. Hippocrates used humors in the sense of secretions and energies rather than entertainment or osseous tissue. He taught, “The world is made of four elements: air, water, fire, and earth. The body is governed by four qualities: hot, cold, moist, and dry. There are four humors that influence these qualities: red blood, white phlegm, yellow bile, and, and…” here he paused, searching for a fourth with the desperation of a bridge player. Then inspiration struck, and he added, “and black bile! Diseases arise from dyscrasis4 of these humors.”

Hippocrates used observation and rational thought to make accurate predictions, and preferred passive, largely diet-based, treatment. Democritus, the famous philosopher, laughed excessively, went to Hippocrates to be cured of his madness. Hippocrates used his knowledge of humors to predict that he would be well, because he was simply happy. Democritus since earned the name "the laughing philosopher". Another patient was not so lucky. Seeing him smiling mockingly, Hippocrates declared that the patient had a risus sardonicus, due to advanced tetanus.

Hippocrates was able to describe several signs and symptoms, some now eponymous with his name. “Ah, look,” he would say, “this patient has a pinched nose, sunken Hippocrates_rubenseyes, dry and cold skin, and livid complexion. This appearance is characteristic of Peritonitis.” The students, who could hear the capital P, named this look the “Hippocratic face”, and medical teachers use this eponym to this day. “What will happen to this patient, O revered teacher?” asked a student, looking respectfully at the teacher’s wrinkled face, the flowing hair, and the broad and intelligent forehead. 5 “He will Die,” said Hippocrates. “Feed him the diet I have written, however, till that happens.” Hippocrates was best at prognostication, at diet therapy, and at prescribing lots of rest. Usually he would wait for the patient to treat himself, unwilling to treat aggressively for fear of worsening the condition. “At least, do no harm,” was his motto.

Hippocrates was thus the first person to put medicine firmly on a scientific footing, and for this reason he is justly called the Father of Medicine.

In time, Hippocrates wrote a book, the Hippocratic Corpus. This book is a testimony to his scientific approach. Disease, he said, was not a punishment inflicted by the gods, but rather the result of environmental factors, diet, and living habits. He denied that magic, spirits, religion, and other supernatural ideas were the cause of any disease. Indeed, there is no mention of any disease attributed to magic in the Hippocratic Corpus. Considering that he grew in an environment of mysticism, this is truly remarkable. However, Hippocrates was a firm believer in dreams. Students often heard him say to patients,   “What did you dream of last night? Fish? Ah, fish swim in water. Drink plenty of water. Maybe you will get better.”

The Hippocratic Oath

I swear by Apollo, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath.

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art. I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug nor give advice which may cause his death. Nor will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my arts. I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art. In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

In the Hippocratic Corpus is the Hippocratic Oath (see the box), still respected today. Note that the words “I will enter only for the good of my patients” do not mean that the physician should not take money. Hippocrates took money for his treatments, and in generous quantities. To the patient who begged for discounts he would say, “There is no skill where there is no reward.”

Hippocrates was a sensible man.

References

  1. Richard Armour, It All Started with Hippocrates, 1966
  2. A huge 10th century Greek historical encyclopedia, the Encyclopedia Brittanica of the ancient Mediterranean.
  3. There are twelve main islands, therefore collectively called Dodecanese
  4. Dyscrasia = bad mixture of humors, dys + Greek krasis mixture (krater = mixing bowl) from kerannynai to mix (from Sanskrit srinati he mixes)
  5. Every doctor in Greece those days looked like this. Apparently Asclepius looked like this, and they wanted to mimic him.