Hippocrates

History has bestowed on Hippocrates (Ἱπποκράτης) (c. 460–c. 370 BCE), practicing physician, student and teacher of medicine in ancient Greece, the honorific cognomen, "The Father of Medicine", inasmuch as his contributions to medicine known through his writings, and those of his disciples (the 'Hippocratics') of about 200 years following his death, influenced the practice of Western scientific medicine to the present day (first decade 21st century CE).

According to tradition, Hippocrates came into the world on the island of Cos (or Kos), located in the Aegean Sea off the west coast of Ionia (Asia Minor, present day Turkey). Hence historians often refer to him as 'Hippocrates of Cos'. His father, Heraclides, practiced medicine employing ancient ideas of supernatural causation and treatment of disease according to the tradition of the Greek mythical god of healing, Asclepius. Hippocrates, though known also as 'Hippocrates Asclepiades', possibly a family name, sparked a revolution in medicine leading to a non-supernatural Western scientific medicine. He lived during the Golden Age of Greece (~500 – ~300 BCE). His life overlapped that of Empedocles (ca. 495-435 BCE), Socrates (469–399 BCE), Plato (429-347 BCE) and Aristotle (384-322 BCE).

Historians know little of his personal or professional life, excepting in the latter case they know he reasoned rationally and taught and practiced a holistic ideal of medicine that regarded health and disease as manifestations of body and mind as a whole.

Because historians know so little about the life of Hippocrates, and because of the great influence he and his disciples have had on medicine for millennia, his fame as a physician has led to a plethora of writings about him that have the character of legend:

We still know very little about Hippocrates. And yet, like the physicians of Imperial Rome, the doctors of our days want to know all about the life of the "Father of Medicine." Where there are no historical sources available, imagination will step in, and the poet will replace the historian.

Hippocrates founded a school of medicine known by his name, and advocated a basic approach to the diagnosis and treatment of disease that still has applications in modern medicine. [For example, see Pappas et al.]  History gave his name to an oath of medical ethics called the Hippocratic Oath. "The code of conduct for doctors outlined in the Hippocratic Oath, a vow commonly taken by modern doctors", remains an ethical guideline in medicine.

The emergence of Hippocratic medicine

Early Greek medicine operated as a supernatural, magical art. The god of healing, Asclepius (Aesculapius in Roman terminology), whose priests and temples flourished in ancient Greece at least from the Homeric era, appeared in the dreams of the sick who came to the temple for 'sleep therapy'. Asclepius gave advice to the dreamer, which the priests interpreted. The priests prescribed baths, diets, exercises, changes in occupation or living locales, and other routines, and those prescriptions received credit when cures occurred. The cult of ‘therapeutic dreaming’ persisted in various places even into Christian times.

Hippocratic medicine developed as the "naturalistic counterpart" of the Asclepian supernaturalistic tradition. By the 6th century BCE (the 500s BCE) Greek philosophers emerged and began to theorize about the natural causes of the way the world worked. Empedocles (ca. 495-435 BCE), characterized as a physician and philosopher, postulated earth, air, fire and water as the primordial elements of which everything in the world consisted, in differing combinations and kinds of combinations, including the human body. 

The development of Hippocratic medicine, its [Aesculapian medicine’s] naturalistic counterpart, is considered a turning point in the history of the healing arts although, as we have seen, at about the same time, naturalistic medical paradigms were developing in other ancient civilizations as well. The importance of Hippocratic medicine rests on the fact that it is the first comprehensive naturalistic medical system of the Western world and therefore the source from which scientific medicine would eventually originate.

Indeed, the development of Hippocratic medicine may have influenced changes in the persisting Asclepian practice.

Likely inspired by Empedocles’ concept of four elements making up natural things, the concept of four humours (blood, yellow bile, black bile, phlegm) as constituent elements of the human body emerged as part of the Hippocratic tradition, the individual humours in various combinations determining state of health and personality:

• excess blood makes a person ‘sanguine’, full of energy, optimistic, ruddy complected
• excess yellow bile makes a person ‘bilious’, ‘choleric’, bad tempered, quick to anger, irritable
• excess black bile makes a person ‘melancholic’, deeply and long-lastingly sad
• excess phlegm makes a person ‘phlegmatic’, unemotional, temperamentally slow, calm

Historians have not identified an individual who originated the four humours theory, nor have they excluded the possibility that the theory gradually emerged into a formal theory.

The medical corollary of Empedocles' theory is the identification of the traditional humours with constituent elements: what made this possible was the presence, in the traditional view of humours, of positive characteristics. Because of these characteristics it was easy to conceive the humours as the ingredients of man, upon which his normal or healthy state, as well as his very existence, depended….It is not the recognition of this or that humour as existing which counts, but the theoretical use to which that humour is put. One would therefore also have to find evidence….that the humours were regarded as constituent parts of the human body. There seems no a priori reason why this should not have been the case, in any writer working after say 450. But in the absence of such evidence, the question of the precise originator of the four-humoral theory is formally insoluble….What is perhaps of more interest is the way in which the theory of four humours exemplifies the stimulating effects of Greek philosophy on Greek medical science. It may be described in this way: the philosopher provides the categories within which the medical scientist can order his experience.” Page 61

Abstracts of recent articles showing diversity of scholarly views of Hippocrates

Some Abstracts paragraphed for ease of reading

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• Grammaticos PC, Diamantis A. (2008) [From Emeritus professors, Thessaloniki, Macedonia, Greece]

“Hippocrates is considered to be the father of modern medicine because in his books, which are more than 70. He described in a scientific manner, many diseases and their treatment after detailed observation. He lived about 2400 years ago. He was born in the island of Kos and died at the outskirts of Larissa at the age of 104. Hippocrates taught and wrote under the shade of a big plane tree, its descendant now is believed to be 500 years old, the oldest tree in Europe-platanus orientalis Hippocraticus- with a diameter of 15 meters.”

“Hippocrates saved Athens from a plague epidemic and for that was highly honored by the Athenians. He considered Democritus-the father of the atomic theory- to be his teacher and after visiting him as a physician to look after his health, he accepted no money for this visit.”

“Some of his important aphorisms were: "As to diseases, make a habit of two things -to help or at least to do no harm". Also: "Those by nature over weight, die earlier than the slim.", also, "In the wounds there are miasmata causing disease if entered the body". He used as a pain relief, the abstract from a tree containing what he called "salycasia", like aspirin. He described for the first time epilepsy not as a sacred disease, as was considered at those times, but as a hereditary disease of the brain and added: "Do not cut the temporal place, because spasms shall occur on the opposite area". According to Hippocrates, people on those times had either one or two meals (lunch and dinner). He also suggested: "...little exercise...and walk...do not eat to saturation". Also he declared: "Physician must convert or insert wisdom to medicine and medicine to wisdom". If all scientists followed this aphorism we would have more happiness on earth.”

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• Smith CM. (2005) [From School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York]

Author asserts: "Many writers, if not the majority, believe incorrectly that the author of this aphorism was Hippocrates; many believe, also incorrectly, that it will be found in the Hippocratic Oath."  [For example see Introduction section of article by Pappas et al. , who assert "....(primum non nocere) Hippocrates’ advice, meaning "first do no harm"."].

Smith's Abstract reads:

The so-called Hippocratic injunction to do no harm has been an axiom central to clinical pharmacology and to the education of medical and graduate students. With the recent reexamination of the nature and magnitude of adverse reactions to drugs, the purposes of this research and review were to discover the origin of this unique Latin expression. It has been reported that the author was neither Hippocrates nor Galen. Searches of writings back to the Middle Ages have uncovered the appearance of the axiom as expressed in English, coupled with its unique Latin, in 1860, with attribution to the English physician, Thomas Sydenham. Commonly used in the late 1800s into the early decades of the 1900s, it was nearly exclusively transmitted orally; it rarely appeared in print in the early 20th century. Its applicability and limitations as a guide to the ethical practice of medicine and pharmacological research are discussed. Despite insufficiencies, it remains a potent reminder that every medical and pharmacological decision carries the potential for harm.

References and notes cited in text

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