760-370 B.C.: Hippocrates redefines medicine

Hippocrates (460-370  B.C)

In the course of time there are but a few figureheads who make such an important impact on mankind they
are later worshiped as a diety, and their writings studies as the words of a deity.  Such credit may not be worthy of any one man, yet such was the world Hippocrates was born into.

He became the father of medicine, the man who single handedly transformed medicine from a profession based on superstition to one based on philosophy and theory.  The ancient world gave him credit for it all, althoug we know he was not alone in redefining medicine, that it was a task several hundred years in the making.

Who was Hippocrates?

Most of what we know about Hiippocrates comes from biographies written after his life.  From these we learn he was born on the Island of Cos around 460 B.C., and was the "scion of a family which had followed the pursuit of medicine at least 300 years (6, page 21)

While this is debated among historians, he is said to be of a direct descendant of Aesclepius.  It was for this reason, perhaps, that Galen often referred to Hippocrates as a deity, and "his writings shoudl be reverenced as the voice of a deity." (6, page 21)

He was actually Hippocrates II, as his grandfather had the same name.  (6, page 21) His father was Heraclides, and it was from his father Hippocrates learned much of his skill, technique and work ethic.  As a child he also had access to the "ablest masters in science and philosophy,"  and some of the best physicians in the world, according to John Watson in his 1856 book "The Medical Profession in Ancient Times. (4, page 46)  

After the death of his father he traveled many countries before pursuing his profession in Macedonia, Thrase and other parts of Greece before settling in Thesally where he spend the later portion of his career.  He's also believed to have taught at the School of Cos. In fact, some accounts have him starting the School of Cos.  (4, page 46)

According to Plinio Prioreschi,  in his book, "A History of Medicine," historians don't know his size, stature, or even his personality.  In fact, they don't even know if all the treaties attributed to him in the Corpus were even his ideas.  Likewise, most of the statues of him weren't even created until after his demise.  (1)

This pretty much opens the door for much speculation about his life and work.  Regardless, what we do know is he became a very skillful physician who was sought after by many, both as a physician and teacher.  He quickly grew to be among the most respected physicians of his day and for all time. 

What influenced the Hippocratic writings?

Hipppocrates is credited with writing over  60 treaties on various medical conditions, their causes, symptoms and possible remedies.   His works were worshiped by the medical community for thousands of years.  So what influenced the men who created the Corpus Hippocraticum?

Prioreschi explains there were many medical schools when Hippocrates walked the earth, the two most relevant to our history being the school of Con and the school of Cnidian, which were near each other (about 20 miles apart) and were competing "in knowledge and effectiveness in curing disease." (1)  It's also essential to note both were associated with an Asclepion.

Prioreschi mentions one theory where each school was stuck in it's own paradigm about diseases and their treatment. The Corpus Hippocraticum was the result of a koinon, or an association between the two schools.  It is thus a Treaties whereby the two schools compromised on how to treat medical conditions.  (1)

Whether Hippocrates was influenced by or created the school of Cos, the Cos believed health was based on the four elements mentioned by Empodocles of Agigentum, who lived from 490-430 B.C., in the following poem:  (3, page 45)

Listen, first, while I sing the four-fold root of creation,
Fire, and water, and earth, and the boundless height and the aether,
For therefrom is begotten what is, what was, and what shall be.

Withington explains by "Substituting air for aether, this is the doctrine of the four elements, which Empedocles introduced into philosophy, and which, with the co responding four qualities, heat, cold, moisture, and dryness, and the four humours, blood, phlegm, black and yellow bile, lies the basis of Greek medical theories." (3, page 45)

A natural process usually worked to maintain a balance of the elements and humors, but at times the physician may need to intercede with a remedy to maintain the balance, or re-establish the balance.  And in health the goal was similia similibus:  "preserve normal heat with heat, moisture with moisture, etc." (5)

Pathologies were the result of an excess or depletion of one or more of the elements or humors.  To re-establish the balance Hippocrates recommended contraria contrariis:  "disease is overcome by opposing contraries... thus cold to be cured by heat, moisture by dryness, cold moistuer by dry warmth, etc.  Having extended the doctrine of primitive qualities to medicinal agents, the medicaments supposed to possess the qualities opposite to the diseases were those selected to produce the desirable change. " (5)

Hippocrates once wrote that he wasn't sure what remedies would provide heat, cold, moist or dry properties, so he preferred to leave this to nature.  This is why he generally prescribed natural remedies such as a good diet, exercise, massage and cleanliness to maintain or re-establish balance and health, as opposed to risky remedies like bleeding and purging. 

This was a main difference from the Cnidron.  Withington explains that a Cnidron motto was: "accurate diagnosis and vigorous treatment."  He mentions a case described by Caelius Aurelianu in which a prominent physician named Euryphon at the school of Cnidus "tries to show that pleurisy is an affection of the substance of the lung."  (3 ,page 52)

Aurenlianu described the patient as being "thin as a skeleton, his legs like reeds, his chest still full of pus, and his ribs covered with scars from the cautery irons of Euryphon." (3, page 52) 

On the contrary, the Cos preferred the philosophy of looking out for the best interest of the patient, of first doing no harm. Physicians were educated to evade risky treatment, and if possible allow nature to be the remedy. 

Why did Hippocrates become so famous?
Perhaps the reason Hippocrates became so famous was simply because he was seen as a deity. Although due scanty evidence to this claim, we must look elsewhere, as most historians appear to do as well.  

So as you can see the various schools of Greece had different ideas about medicine and how physicians should behave.  Similarly, many physicians during this era were known to accept bribes to kill their patients.  The Con frowned upon this act.

The Con also preached good bedside manner. They transformed the profession to one of dubious behavior to one of honor and respect.   Yet despite the teachings of the school, it's Hippocrates who is credited for changing medicine.

Watson writes that "according to Celsus, his (Hippocrates) principle credit is removing the teaching of medicine from the schools of philosophy, where it had always received some attention, and treating it as a distinct department of practical knowledge.  Pliny the elder supposes he was the first to institute clinical instruction."  (4, page 46, also see 3 page 42)

Yet Watson notes the era he was born into for his fame.  "He lived in an age of progress," Watson writes.  "And while other arts and sciences were thus springing into life, and rising at once to maturity, it is not surprising that some man of genius should appear in the ranks of medicine, to give to it's principles from the utterance.  This man was Hippocrates." (4, page 47)

Edward Withington, in his 1894 book "Medical history from its earliest times," suggests his most significant achievement was transitioning medicine away from superstition, He writes: 

It has been well said that great men illuminate the world by gathering into a focus the rays emanating from itself, and this is well seen in Hippocrates' third great service to medicine -- his rejection of supernatural heroes of disease.  The age was one of transition, and the simple faith in the old mythology was giving way in all direction."  (3, page 50)

Instead of speculating a disease was caused by some supernatural power, with the remedy being a prayer or incantation, Hippocrates believed, as he described in "Airs, Waters, and Places, "no one disease is either more divine or more human than another."  Physicians now concerned themselves with finding natural causes and cures.  (3, page 50)

Edward Meryon, in his 1861 book "A History of Medicine," simply suggests Hippocrates was so famous because he transformed medicine to one of superstition to one of speculation by 'vague hypothesis.'  (6, page 21)

The true reason for his legacy may never be known. 

So who wrote the Corpus?

Evidence suggests most of the Corpus was not written by Hippocrates.  In fact, there's no evidence any of it was written by him.  Parts are believed to have been written before he was born, some during his time, and others after his death.  

John Watson, in his 1856 book "Medical history in ancient times," writes that Galen, who lived in the 2nd century, believed all the Corpus was written by Hippocrates.  Yet evidence suggests Galen was wrong.  

Watson writes of Mercuriali who suggests "not more than fourteen treaties out of the whole collection were published by Hippocrates himself.  Five others... may have been left by him unfinished to be completed either by his son in law and successor, Polybius, by his sons Thessalus and Draco, by his grandson Hippocrates, or by other members of his family." (4, page 49)

Watson describes "a third portion, including about 22 treaties, though perhaps not even begun by Hippocrates, is in strict accordance with his doctrines, and is believed by Mercuriali to have eminated from the immediate descendents of Hippocrates or other desciples of the school of Cos.  The remaining portion of the collection, according to the same authority, consists of spurious writings, and as such as contains opinions not in accordance with the doctrines of Hippocrates, though published as his."

Meryon suggests Hippocrates was simply the benefactor of the era he was born in.  He was, after all, the son of a family of physicians who were all taught at the school of Cos.  Meryon explains:

Much of the information contained in his writings, and which has been transmitted to us, appears to have been the accumulated knowledge of his immediate ancestors; and it is supposed by competent judges in the matter, that many, if not most, of the numerous treaties which are commonly attributed to him, were simply collected and written by him; for he had the great advantage, which can scarcely be appreciated, since the introduction of printing, of acquiring a thorough knowledge of the observations of his predecessors; and having, moreover, access to all the records and votive tablets in the temple of Cos, he had peculiar facilities to achieve the honour which is universally accorded to him. (6, page 22)

Henry E. Sigerist, in his 1987 book, "A History of Medicine," suggests the entire works may be credited to Hippocrates because of his hard work, method of teaching, and skillful medical technique. It may have had nothing to do with Hippocrates being the superior physician at all, and mainly because later historians sought to credit someone for such important documents. (2, page 266)

One theory postulates that Hippocrates was not superior to, but respected equally among his fellow physicians, with Hippocrates being the most senior.  With later Alexandrian physicians viewing these anonymously written medical texts as extremely important, they sought to give someone credit, and Hippocrates seemed the most logical choice.  (2, page 266)

Whether Hippocrates wrote any of the Corpus is insignificant, as Greek medicine will forever be known as Hippocratic Medicine, and Hippocrates the Father of Medicine.

So what's our conclusion?

The Hippocratic writer influenced the medical community in a major way, whether accurate or not. His philosophy is a paradigm that shaped the way people thought about medicine, and for that he continues to have an influence on our modern medical profession, although modified into a new paradigm.

Legend has it he died in Thesally at the ripe old age of 80, or 85, or 90, or 105.  Sigerest suggests he died at the age of 90.  Perhaps the longevity of his life is due to his mythical legacy.

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