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WHAT YOU NEED TO KNOW
- Hippocrates’ contribution to medicine
- The Four Humours
- Corpus Hippocraticum
KEY FACTS AND INFORMATION
Let’s know more about Hippocrates
- Hippocrates was a Greek physician and teacher of medicine whose name is associated with the famous oath which symbolises the high ethical standards of Western medicine. Called the “Father of Medicine,” Hippocrates is reputed to be the author of a large collection of Greek medical writings. He is usually portrayed as the paragon of the ancient physician, and the Hippocratic Oath is still in use today. His teachings are also still relevant to students of pulmonary medicine and surgery.
- Biographical details are scant and unreliable, since the earliest existing biography of Hippocrates is that written by Soranus of Ephesus in the 3rd century A.D.
- It is impossible to evaluate Soranus’ sources, but much of his information is clearly fictitious. He dates the birth of Hippocrates as the year 460 B.C., and places Hippocrates’ period of activity around the time of the Peloponnesian War (431 to 404 B.C.); he also quotes varying estimates of Hippocrates’ age at his death.
- However, all authors have attributed to Hippocrates a very long life (the lowest being ninety). This is chronologically supported by a contemporary source – Plato’s Protagoras.
- Hippocrates is referred to as alive and teaching medicine for a fee. This dialogue, written in the early fourth century, is set in the year 428 B.C. Aristotle refers to Hippocrates as ‘the Great’.
- The only other contemporary reference is again Plato, in his Phaedrus; this suggests that Hippocrates held medicine to depend upon satisfactory theory rather that purely empirical observation, a view hard to reconcile with some of the surviving works.
- Although a native of the island of Cos, Hippocrates seems to have travelled extensively and practiced his job in other parts of the Greek world. The ancient authorities imply that he had to abandon Cos due to a fire for which he was blamed. Most of the medical cases in the two books of Epidemics are considered to be authentic and are located on Thasos, a small island in the north of the Aegean Sea, and at Abdera, a town on the adjacent mainland; but there are also references to Cyzicus, on the south coast of the Sea of Marmara, and to Larisa and Meliboca in Thessaly. According to tradition, Hippocrates died at Larisa.
Contribution in the field of Medicine
- Hippocrates is credited as being the first to believe that diseases were actually caused naturally, and not because of superstition and gods. He was also credited by the disciples of Pythagoras in philosophy and medicine. He believed and argued that disease was not a punishment from the gods but a product of environmental factors, diet and living habits.
- He is also given credit as being the first to describe the clubbing of fingers, which is sometimes called “Hippocratic fingers”, lung cancer and cyanotic heart disease.
- He was also the one to describe the Hippocratic face, changes in face by excessive hunger, long-term illness, impending death and the like.
- Hippocrates also began to categorise illnesses as acute, chronic, endemic and epidemic.
- He also made major contributions to symptomatology, physical findings, surgical treatment and the prognosis of thoracic empyema.
- Hippocrates was the first documented chest surgeon and his teachings, findings and techniques are still relevant today.
- Knowledge of physiology during this period was rudimentary. Although the existence of blood vessels was well known, they were thought to carry other substances as well as blood, and the function of the heart and the distinction between arteries and veins were unknown. The word arteria was in use, but it referred to any large vessel, and included, for instance, the tracheae (tubes of the air system). The blood vessels were particularly thought to carry air, the vital function of which was recognised, to all parts of the body.
- The author of the work on the Sacred Disease (epilepsy) makes use of this idea to explain the onset of an epileptic attack as due to the choking of the blood vessels by phlegm.
- ‘The air’ he writes, ‘which goes to the lungs and blood vessels thus enters the body cavities and the brain, and has a further purpose. It induces intelligence and is necessary for the movement of the limbs.’ However, for the most part, physiology was developed in the light of philosophical theories about the composition of matter.
- The most difficult problem was to explain how the food consumed by the body turned into tissues, blood, bone, and so forth, and it is not surprising that no satisfactory theory was ever devised.
- One favourite explanation was that food, such as bread, contained minute and invisible particles of all the body’s tissues, and these were separated out and concentrated by the body.
- Anatomy was known chiefly through the study of injuries. There were a number of works on surgery, dealing mostly with wounds of various kinds, but these works have suffered badly in transmission. The two works called Fractures and Joints are probably parts of a major work which has been lost in its complete form.
- The section on Joints is concerned with the reduction of dislocations, and the invention of the Hippocratic bench, that may date back to the early days of Greek medicine.
- The most famous surgical work is Wounds in the Head, which is remarkable for its accurate account of sutures, and for the surprising advice to trephine (to perforate and remove part of the skull) in all cases of contusion or fissure of the skull.
- This advice has worried surgeons ever since, but the author’s tone is so firm and definite that it cannot be doubted that this was his personal practice.
- Gynaecology and obstetrics are not neglected, and a series of works is devoted to such topics as Women’s Diseases, Girls’ Diseases, the Seventh-month Child and the Eight-month Child. These works display a great deal of empirical knowledge; however, their accounts remain naive and erroneous.
- The authors were clearly at the forefront of the rationalist movement of the times, and must have run some risk of charges of atheism and impiety such as the ones Socrates was assigned.
- The relationship between medicine and religion in the Hippocratic Corpus is at once a fascinating and a difficult subject.
- The rivalry and mistrust between the medical profession and the spiritual healers already existed, for the temples of Asclepius were well known for their miraculous cures.
- The patients spent varying periods under the chart of the priests, usually sleeping for at least one night in the temple itself, during the course of which the god appeared in a dream and prescribed the treatment.
- No doubt the priests were competent to interpret dreams in a manner likely to benefit the patients and themselves. The temple of Asclepius at Epidaurus was especially famous, and, like Lourde today, drew pilgrims from far and wide.
The Four Humours
- Hippocrates is also known for the theory of the four humours, or fluids. Philosophers Aristotle and Galen also made their contribution to this theory. After a few centuries, William Shakespeare incorporated the four humours into his works regarding human qualities.
- According to The World of Shakespeare’s Humors, the four fluids were yellow bile, black bile, blood and phlegm, and each of these was associated with an element (earth, water, air or fire), two qualities (cold/hot, moist/dry), body organs and ages (childhood, adolescence, maturity, old age). These associations, together with the influence of the seasons and planets, determined an individual’s physical and mental health.
- Yellow bile – associated with fire, summer, the gallbladder and childhood. It is also connected to the choleric disposition and the qualities of hot and dry.
- Black bile – associated with earth, winter, the spleen and old age. It is also connected to the melancholic disposition and the qualities of cold and dry.
- Blood – associated with air, spring, the heart and adolescence. It is also connected to the sanguine disposition and qualities of hot and moist.
- Phlegm – associated with water, winter, the brain and maturity. It is also connected to the phlegmatic disposition and the qualities of cold and moist.
- According to the National Institute of Health, the differences in age, emotions and disposition could affect the interaction of the four humours. The theory said that the key to good health was to keep the humours in balance. One of the most famous quotes of Hippocrates was to “Let food be thy medicine and medicine be thy food.”
- The Hippocratic Corpus, as preserved, contains about seventy separate works, though some of these are clearly parts of a single original work. There is also a considerable amount of overlapping and repetition. It has always been known that the collection contained works by other authors as well as those of Hippocrates, but no absolute test has yet been devised to distinguish between them, and it is clear that the problem of authorship is extremely complicated.
- In fact, what we possess is a collection of the works of a number of authors of differing dates and abilities. The only bonds that unite them are the use of the Greek Ionic dialect and a preoccupation with medicine and allied sciences.
- According to some historians, such works represent the remains of a medical library, rather than the work of a school of authors, because of the differences of style and doctrine.
- Certain works are recognised as showing advanced scientific thought and skill in clinical observation, and are therefore regarded as more authentic than the rest. But even here, there is little agreement, and there are scholars who doubt, especially in view of Plato’s testimony, whether the works are from the pen of the historical Hippocrates.
- The corpus would appear to have been in existence and attributed to Hippocrates by the 1st century A.D., when Erotian, a doctor of the Neronian age, compiled a glossary of Hippocratic terms. From the 5th century A.D. is the controversial treatise known as Ancient Medicine which discusses the way the art of healing is studied. Its author rejects the ascription of disease to the interaction of the fundamental qualities of the philosophers (heat, cold, moisture, dryness), and demonstrates the importance of diet and certain secretions.
- Airs, Waters, and Places, also from the 5th century B.C., is framed as a ‘golden book’ which has a secure place in the annals of science. Here, an experienced and practical mind sets forth, with examples and arguments, the effects of three environmental factors upon general health.
- Diseases or proneness to disease may be caused by the weather – a particularly hot summer, or a rainy winter, for example.
- The local climate conditions, such as the prevailing winds or the aspect of a town, are shown to be a factor in health.
- The nature of the water supply is blamed for certain conditions, and advice is given on what sources to prefer.
- The physician who comes to a new time will thus know what to expect. The latter part of the work discusses climatic effects on a larger sale in forming national characters.
- In this, the author demonstrates a profound knowledge of non-Greek ethnicities such as the nomadic Scythians of Southern Russia, who must have been known to the Greeks through their trading posts on the Black Sea.
- He seems also to have described the Egyptians and Libyans from this point of view, but this section is unfortunately lost. The whole work is remarkable for its sturdy good sense and scientific detachment.
The Oath of Hippocrates
- The Oath, which is contained in the Hippocratic Corpus, at least represents the practice of an early Greek medical school. It has some puzzling features; not least in the promise not to practice surgery. But it is remarkable in the moral standards it seeks to establish for the profession: the physician swears to use his knowledge only to save life, never to take it; not to cause abortion; to avoid improper relations with his patients.
- The Hippocratic Oath is the earliest expression of the ethics in medicine in the Western world, these comprising the principles of medical confidentiality and non-maleficence.
- The known phrase “first do no harm,” was believed to be derived in the oath as similar interpretations appear but the exact translation of the phrase does not.
- There is no direct punishment in breaking the Hippocratic Oath but medical malpractice shoulders a wide range of punishments, form the legal action to civil penalties.
- Hippocratic teaching has profoundly influenced modern as well as ancient practice. In antiquity, Hippocratic books were translated into Latin, Syriac and Arabic. After the Renaissance, the rediscovery of the Greek originals provided generations of medical students with their best textbooks. Even today, much can be learned from the careful observation and scientific method first established by these Greek writers.