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The art of medicine in the ancient world developed to its highest point in Greece,
during the millennium between 500 B.C. and 500 A.D. However, right of wrong their
theories might have been, Greek physicians of this period showed great clinical
acumen. Early in this period, practitioners of Greek medicine generally made the
decisive turn (despite the cults of Asclepius) from supernaturalism to acceptance
of exclusively naturalistic and scientific explanations of and methods of, treatment
of disease. Medical principles established during this period dominated medicine
during the following one thousand years; and their influence on present on present-day
medicine is evidenced by the predominance of Greek terminology.
Centuries before this bright millennium, Greek medicine followed the usual pattern
of magi co-religious practices. Then came a period during which philosopher-physicians
transformed medicine to a some-what scientific, naturalistic, but highly speculative
and theoretical (and frequently inaccurate) profession. However, most Greek physicians,
unlike their contemporaries in some other nations, were not priest, but craftsmen.
Thus were combined empirical knowledge of craftsmen and speculative theories of
philosophers.
Best known of these pseudoscientific principles was the hum oral theory. The human
body was thought to consist basically of four humors: blood, yellow bile, black
bile, and phlegm. In a state of health these four humors were balanced. Unbalance
in their proportion resulted in disease and nature made efforts to restore this
balance by throwing off matter. It was the physician’s job to assist nature
in these efforts. Remnants of this old hum oral theory of more than 2,600 years
ago still survive in such everyday words as sanguine, melancholic, phlegmatic, and
bilious.
Greatly as philosophers influenced Greek medicine, early in the fifth century B.C.,
another change in course began in a swing from speculation to rationalism, with
increasing emphasis on clinical observation.
The greatness of this creative period of Greek medicine is symbolized by Hippocrates,
a contemporary of immortals such as Pericles, Sophocles, and Socrates. In his hands,
medicine became an art, a science, and a profession. Hippocrates name has been synonymous
with “Father of Medicine” for more than two thousand years. His name
has come to represent the beauty, value, and dignity of medicine for all time.
Very little is known about Hippocrates’ life history. He was born on the little
island of cos, in the Aegean Sea, about 460 B.C.Hippocrates seems to have bee4n
a relatively common Greek name; the great physician’s grandfather also bore
the name. Hippocrates was the second of seven sons of a physician named Heracleides,
who professed to be one of the Asclepiads, a group of physicians claiming Asclepius
as their patron. According to tradition, Hippocrates began the study of medicine
at the Asclepieion of Cos, later studying at the Asclepieia at Cnidus, at Thasos,
at Thessaly, and, according to some biographers, in Egypt, in Lydia, and in Scythia.
He is said to have returned to practice in his home community on the island of Cos,
but it is evident that he traveled widely. He visited many cities in Greece and
in foreign countries, practicing his profession and collecting ideas. His medical
reputation spread, and he soon came to be regarded as the outstanding representative
of the Coan School, which concerned itself primarily with prognosis and with treatment
of the patient as a whole. Hippocrates disapproved of the school at Cnidus, which
emphasized diagnosis, localistic explanation of disease, and active treatment of
individual organs. (The age-old question if the general practitioner versus the
specialist!) The writings of Aristotle and of Plato indicate that been a physician
of wide experience and of common sense. Hippocrates is reported to have died at
Larissa, a town near Thessaly, in the year 361 B.C., at the age of 99 years.
Hippocrates, it is recorded, had two sons, Thessalus and Draco, both of whom became
physicians of note, and a physician son-in-law, Polybus. They were founders of the
school of Dogmatism, based on Hippocrates’ aphorisms. They carefully preserved
Hippocratic principles, and their writings bore the name of their illustrious father.
While authenticity of Hippocrates as a person cannot be seriously challenged, authenticity
of collected writings known as the Hippocratic Corpus or Collection is subject to
considerable question. Which among three-score pieces of literature were written
by Hippocrates, and which by admires who, following the customs of the day, attributed
their work to their more famous predecessor, is debatable. These writings seem not
to have been those of one man, perhaps not even of one group. This circumstance,
however, does not invalidate the fact that they summarize the first great peak in
Greek medicine. Despite their variances, all Hippocratic manuscripts stress the
naturalistic approach and put great emphasis on the value of observation of disease
processes rather than on study of the cause of disease, relegating speculative theories
to a minor position. Therein also is to be found medicine’s first “Declaration
of Independence,” in the first lines of On the Sacred Disease (epilepsy):
“It is thus with regard to the disease called Sacred: It appears to me to
be nowise more divine nor more sacred than other diseases, but has a natural cause
from which it originates like other affections. Men regard its nature and cause
as divine from ignorance and wonder, because it is not at all like other diseases.”
According to Celsus, Hippocrates was first to emancipate medicine from trammels
of superstition and delusions of philosophy.
In Hippocratic aphorism are to be found such important statements as “Fat
persons are more exposed to sudden death than the slender”; “Spasm supervening
upon a wound is fatal’ (tetanus); “Spinal deformity often coexists with
cough and tuberculosis is a mortal symptom.’ Among his sayings, which later
became favorites with physicians, were these: “Life is short, the art long,
the occasion fleeting, experience fallacious, and judgment difficult,” and
“You must not only do the proper thing, but do it at the right time.”
For those who aspired to become physicians, Hippocrates had this advice: “Whoever
is to acquire a competent knowledge of medicine ought to have the following advantages:
a natural disposition; instruction; favorable position for study; early tuition;
love of labor; leisure. First of all, a natural talent is required, for when Nature
opposes, everything else is in vain; but when Nature leads the way to what is most
excellent, instruction in the art takes place, which the student must appropriate
to himself by reflection, early becoming a pupil in a place well adapted for instruction.
He must also bring to the task a love of labor and perseverance, so that the instruction,
taking root, may bring forth proper and abundant fruits…. Physicians are
many in title, but very few in reality…”
Greek physicians were apprentice trained, and the oath by which they were bound
to their masters reflects the high ethical standards of the profession. Though it
has borne his name for more than two thousand years, scholars seriously question
whether the Oath of Hippocrates was actually written by the great physician himself.
Revered though it is and has been by physicians down through the years, evidence
seems to indicate that this document was the product of medical groups that developed
in the century following Hippocrates’ lifetime. Nevertheless, it is certain
that this document embodies principles and precepts of the great physician, and
that it deserves wide acceptance as the oath to be taken by all who are about to
enter upon practice in the profession of medicine.
Hippocrates and Greek physicians who followed him believed that treatment was intended
primarily to assist nature. Therefore, it was mild and, in the light of present-day
thinking, considerably more reasonable than were methods used by medical men in
later periods. Of primary importance both in health and in disease was diet. Only
when diet failed were drugs used, and only when drugs failed was surgery applied.
Greek books on surgery reveal that great skill was used in treatment for wounds,
fractures, and dislocations. Operations for fistula of the anus and for hemorrhoids
were prescribed and daring operations, such as trephining of the skull and opening
of empyemata, were reported.
Material medica of Hippocrates was limited; he employed few drugs, but he did use
cathartics and sedatives.
Development of prognostics in all likelihood rose through the social status of Greek
physicians as traveling craftsmen who could not afford to assume responsibility
for treatment of incurables. For prognosis, Greek physicians often referred to climatic
data: disease and health were thought to be dependent to a large extent on local
climate.
Observation became the physician’s most useful tool- observation based on
inspection and examination of the patient. Palpation was employed- innumerable patients
with large spleens caused by malaria provided ample reason for use of this technique.
Ausculation in crude form also was employed. Greek medical writings abound with
valuable observations on such well-known diseases as malaria, pulmonary tuberculosis,
mumps, pneumonia, anthrax, and apoplexy. Diabetes, diphtheria, leprosy, plague,
tetanus, as well as mental and dermatologic diseases, were described later. Some
facts and observations cited in these early writings were not rediscovered by medical
men of the Western World until many centuries later.
From Hippocrates through Rufus and Aretaeus to Galen, Greek physicians remained
great observers.
The second great peak of Greek medicine was reached in the third century B.C. in
Alexandria, the city founded by Alexander the Great. Hum oral theories of disease
were less predominant at that time than in earlier and in later periods, and disease
was explained as due to changes in solids of the body. The study of anatomy also
was actively pursued.
The third great peak in Greek medicine developed in Rome in early centuries of the
Christian era. This period is symbolized by Galen, physician and pharmacist, who
served two emperors. Under Galen’s influence, science prevailed over art in
the concept of medicine. While politics of the world became Roman, medicine remained
Greek. Great as Romans were as conquerors and administrators, they never reached
comparable levels in medicine. Greek physicians led in practice and development
of medicine in Rome, as they did elsewhere, during the great millennium that began
with Hippocrates.
THE PICTURE
Hippocrates, great Greek physician of the fifth century B.C., is pictured palpating
a young patient. Kindliness and concern, embodied in his aphorism, “Where
there is love for mankind, there is the love for the art of healing,” are
reflected in Hippocrates’ face. This revered practitioner, scientist, and
teacher, well deserved the title, “Father of medicine,” which has been
associated with his name for more than 2,000 years.
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