Context

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Before the fourth and fifth centuries b.c.e., there was no written record of medical practices in the Western world. Medicine was largely the job of healers who used herbal remedies; women who had knowledge of the healing powers of certain plants were often consigned to caring for the sick. In ancient Greece, however, healing became a profession, and the mostly male, literate doctors recorded their experiences with patients and their theories of how diseases spread in numerous essays, some of which were quite polemic as the writers defended their common mode of practice against possible detractors. About seventy of these essays (only sixty still exist), all anonymous, were collected and are known as the writings of Hippocrates, a physician who practiced during the time of Plato.

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The writings in the Hippocratic collection were revolutionary because they usually attributed disease to natural causes and not, as was commonly held to be true, to the influence of demons or evil forces. When the cause of a disease could not be determined or when traditional remedies were not effective, early peoples turned to religious healing. This consisted of amulets and talismans to ward off the evil, prayer, and ceremonial requests to the gods. Healing also relied on incantations and the playing of music for the sick. Another method of treatment was dream healing, in which the cure was revealed to the patient in a dream or the patient was miraculously healed by a god while dreaming. In Greek culture, however, the power of divine forces was trivialized by many philosophers and physicians. This was even reflected in Greek mythology, in which the god of medicine Asclepius was granted the power to heal the sick, yet he did so not by supernatural means but by incantations, drugs, bandages, and surgery.

The Corpus Hippocraticum contains about sixty essays, including the Hippocratic oath and a collection of aphorisms. Greek language experts are certain that the essays were written from the fifth to third century b.c.e. and hence cannot have a single author. Beginning in the second century, scholars have tried to determine which of the essays were written by Hippocrates, but these efforts have not provided a definite answer. Fewer than a dozen essays are usually claimed to be the product of Hippocrates. The essays can be categorized according to topic: the nature of and the means of curing the human body, the characteristics of a good doctor and an ethical medical practice, case histories and treatments of illness, prognostics, and environmental factors of health.

The Art of Medicine and Ethics

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Some of the Hippocratic writings consist of essays that attempt to establish a theory of medicine as it pertains to the practice of healing, the composition of the human body, and the causes of disease. Peri archais itriks (Ancient Medicine, 1849) explains the origin of medicine as a means to cure the sick. It discusses diet, body fluids, and the effects of applying heat and cold to the patient. Peri techns (The Art of Medicine, 1923) is less concerned with practice and cynically notes the patient’s desire for the relief of distressing symptoms rather than true health and the patient’s tendency to ignore the doctor’s orders. It also points out the limitations of medicine, which cannot treat all known disorders and therefore must treat only curable ones. Peri diaits (Regimen, 1931) delves into the nature of the human body, pointing out sexual differences, reproduction, embryology, and the four humors: blood, phlegm, yellow bile, and black bile. Other essays of this type discuss the nature of the universe, the soul, and the composition of living things.

The most famous Hippocratic work, Orkos (The Oath, 1849), deals with ethics. The first part of the oath highlights the important, almost sacred, nature of medical training, the value of the medical teacher, and the need to teach the art to those bound by the oath. The second part states that a physician under the oath should not hurt, deliberately kill, seduce, or reveal any confidential matter concerning a patient. Other essays dedicated to ethics are concerned with the characteristics of a good doctor. The brief article Nomos (The Law, 1849) discusses the difficulty of maintaining the reputation of the medical profession if a practicing physician does not have knowledge, schooling, and experience of the sacred, noble science of medicine. Peri itrou (The Physician, 1923) asks that a doctor be clean, dignified, just, thoughtful, and caring. Peri euschmosyns (Decorum, 1923) says that a physician must dress simply, be patient, be self-controlled, be able to express himself or herself, accept the limitations of healing, and be able to get along with diverse types of people. The last two articles also discuss the proper equipment needed for a doctor’s office and a clinic and how to outfit a portable bag to be taken on house calls. Parangeliai (Precepts, 1923) discusses fees, quacks, professional consultation with other physicians, and the need for a doctor to be charitable, honest, open to helpful knowledge, and kind and reassuring to patients.

An Observation-Based Medicine

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Case histories appear in Epidemin (The History of Epidemics, 1780). The author typically gives the name of the patient if known, along with the sex and age. The condition of the patient during the first visit is recorded, followed by a description of symptoms as well as the day they each first occurred. The case history ends with either the death or the recovery of the patient. If the patient recovers, the cause of the relief is then explained, usually by a release of body fluids. Peri diaits oxen (Regimen in Acute Diseases, 1849) provides the ancient physician with advice concerning diet, exercise, bloodletting, purgation, and bathing for the seriously ill patient. Peri nousn (Diseases, 1988), Peri pathn (Affections, 1988), and Peri tn entos pathn (Internal Affections, 1988) continue to offer advice for medical disorders such as lung inflammation, ulcers of the head, water on the brain, fever, colic, nasal polyps, dysentery, diarrhea, arthritis, tumors, hepatitis, and jaundice. Notably, many times the symptoms of the disease are described, but no steps for treatment are given. Other articles discuss treatment of wounds to the head, broken bones, dislocated joints, ulcers, fistulae, hemorrhoids, and epilepsy. The last is noteworthy to modern scholars because it denies any divine nature to the disease and provides a careful description of a disorder that is not as physically observable as, for instance, a wound.

Prognostikn (Prognosis, 1597) advises the physician to observe the patient as much as possible. This includes learning the medical history of the patient and the circumstances surrounding the onset of the disease or injury and determining symptoms and other necessary information the patient does not tell the doctor out of inability to speak, willfulness, or forgetfulness. The article then lists explanations of various symptoms. Aphorismoi (The Whole Aphorismes of Great Hippocrates, 1610; commonly known as Aphorisms), a list of more than four hundred pithy statements of medical observations and treatment divided into seven sections, was the first essay of Hippocratic writings to appear in English. These aphorisms continue the advice of the Prognosis and provide observations about human health in general. For example, one aphorism warns that overweight people are more likely to die suddenly than people of normal weight. Some aphorisms are trivial or have since proven to be untrue, including the beliefs that sneezing cures hiccups and that women cannot be ambidextrous. Many of the aphorisms concern the characteristic health problems of each stage of life, from childhood to old age, and they include observations about the effects of weather and environment on illness.

Peri aern hydatn topn (Airs, Waters, Places, 1597) continues these observations about external forces, which scholars find significant because they show that ancient physicians were able to understand that environmental elements caused illnesses, a fairly sophisticated observation. They were not able, however, to determine the exact causes of disease this way, as they lacked knowledge of viruses and microorganisms. Airs, Waters, Places hence appears to modern readers to be highly speculative, erroneous, and even racist compared to the more empirical articles dedicated to the precise observation of symptoms. The first part of the article describes the effect of the wind and the location of dwellings on health. A city facing east, for example, provides the best situation for good health. A subsequent section explains the best places to procure drinking water, pinpointing which water is cleanest, such as rain water, and which water is to be avoided, such as water from melted snow. Times of the year, such as the equinox or the rising of Sirius, determine how severe certain illnesses will be if they occur at these times. The rest of the article discusses the personality and physical characteristics of the known races of the world, based on the climate in which they are located.

Impact on Medical Ethics

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Hippocratic writings founded Western medicine. Since the time of Hippocrates, advances in medicine have depended on clinical observation, treatment of specific illnesses, and prescribed regimen. The name of Hippocrates and any writings associated with him quickly became sacrosanct. In the years 200 b.c.e. to 100 c.e., the works were acknowledged as fine examples of empirical medical practice, and Diocles, a significant Greek physician, collected the works to assist him in his practice.

The Roman physician Galen based his theory of medicine on Hippocrates, and Galen’s works remained influential for centuries afterward. He criticized those physicians who lost sight of Hippocratic methods of medicine; in particular, he complains of his contemporaries Asclepiades and Erasistratus for not observing the true effects of disease and for rejecting the theory of humors as espoused in Hippocratic writings.

During the medieval period in Europe, Greek medical manuscripts were preserved. A few of the Hippocratic works remained as medical textbooks until the nineteenth century. The theory of humors remained in the popular culture until the seventeenth century, as personalities were classified as one of four types. Sanguine, phlegmatic, choleric, or melancholic people existed according to which of the four humors, blood, phlegm, choler (yellow bile), or melancholy (black bile), dominated their bodies.

The seventeenth century was also the period of the Enlightenment. Hippocratic medicine had been revived in the sixteenth century by Paracelsus, who disparaged the theory that sickness was caused by sin, who invented chemical drugs to cure illnesses, and who discovered causes and effective treatments of physical disorders.

During the seventeenth century, advances were made as vivisection was once more allowed and thinkers such as Francis Bacon advocated a Hippocratic approach to medical science. Following such discoveries as William Harvey’s explanation of the circulation of the blood and his inconclusive study of reproduction, both based on experimental investigation, medical researchers reverted to seeking out magical or simplified methods of curing illnesses, such as a “magic touch” to cure scrofula, as advocated by English physician Richard Wiseman. This approach was roundly criticized by Thomas Sydenham, “the English Hippocrates,” who supported a return to the clinical observation of Hippocrates.

Since the Enlightenment, medical science has advanced so rapidly that ancient medicine has become more the province of history and philosophy than of practicing physicians. Hippocrates, however, remains a familiar name because of the continuing existence of the Hippocratic oath, which modern physicians acknowledge as a useful ethical guide to the practice of medicine.

Bibliography

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Additional Reading

Amundsen, Darrel. Medicine, Society, and Faith in the Ancient and Medieval Worlds. Baltimore, Md.: The Johns Hopkins University Press, 1996. A scholarly yet accessible history of ethical issues in medicine in the ancient and medieval worlds, including the ethics of the Hippocratic oath. Comprehensive footnotes and index.

Coulter, Harris L. Divided Legacy: A History of the Schism in Medical Thought. Vol. 1 in The Patterns Emerge: Hippocrates to Paracelsus. Washington, D.C.: Wehawken, 1975. The subtitle of the first volume refers to two patterns of thought, rational and empirical, dominating medical history. The author places Hippocrates in the empirical tradition. Provides an extensive bibliography and index. Lists quotations from original writings.

Edelstein, Ludwig. The Hippocratic Oath: Text, Translation, and Interpretation. Baltimore, Md.: The Johns Hopkins University Press, 1943. This monograph argues that the Hippocratic oath represented the opinion of a small segment of Greek medical society, was based on Pythagorean principles, and served as a voluntary oath of conscience between teacher and student.

Heidel, William Arthur. Hippocratic Medicine: Its Spirit and Method. New York: Columbia University Press, 1941. Heidel discusses the close connections among science, philosophy, history, and medicine in the period of Hippocratic medicine. Provides notes and sources.

Journal of the History of Medicine and Allied Sciences 51, no. 4 (October, 1996). This issue is dedicated to the Hippocratic oath and its influences. It opens with a new translation of the oath, with a commentary by Heinrich von Staden, and continues with a history of the oath’s influence during the Middle Ages (by Carlos Galvão-Sobrinho), the Renaissance (by Thomas Rütten), and modern times (by Dale Smith). Each article is extensively footnoted, and the citations provide a comprehensive overview of recent scholarship on the Hippocratic oath and its influence on later ages.

Levine, Edwin Burton. Hippocrates. New York: Twayne, 1971. Levine introduces the problems of scholarship in identifying authorship of the Hippocratic writings. The discussion focuses on ideas presented in various selected essays. Includes notes, an index, and an extensive annotated bibliography.

Moon, Robert Oswald. Hippocrates and His Successors in Relation to the Philosophy of Their Time. 1923. Reprint. London: Longmans, Green, 1979. A series of lectures delivered by a physician to physicians, this work briefly categorizes the philosophies underlying the practice of ancient medicine before and after Hippocrates. Index.

Phillips, E. D. Greek Medicine. London: Thames and Hudson, 1973. Phillips traces practical and theoretical achievements of Greek medicine up to Galen. Includes selected references to the Hippocratic collection, an appendix on the cult of Asclepius, illustrations, an extensive bibliography, and indexes.

Tempkin, Owsei. Hippocrates in a World of Pagans and Christians. Baltimore, Md.: The Johns Hopkins University Press, 1991. Authoritative scholarly analysis of the construction of Hippocrates’ biography in the Greco-Roman world and of the transformation that occurred to Hippocratic ideas and ideals as the Greco-Roman world converted from pagan to Christian. Provides notes, sources, extensive bibliography, and index.

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