07 - HIPPOCRATES: MEDICINE BECOMES A SCIENCE
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.
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.