Hippocrates

• 1. Introduction

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  Hippocrates of Kos has been called the Father of Medicine for more than two thousand years, yet almost nothing concrete is known about what he actually thought, wrote, or did. He was born around 460 BC on the Greek island of Kos. The man himself dissolves into the work of the school that carried his name and the writers of the collection called the Hippocratic Corpus. His achievements were so often confused with theirs that the historical figure blurs at the edges. What survives is a reputation, a set of ideas, and an oath still spoken by medical graduates today. So who was the person behind the name, and why did a single physician from a small Greek island reshape what medicine could even be? The answers run through humble bedside care, a stubborn refusal to blame the gods, and a legend about a dragon.

• 2. The Vanishing Man

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  Soranus of Ephesus, a 2nd-century Greek physician, was Hippocrates's first biographer and the source of most personal details we have. According to Soranus, Hippocrates's father was Heraclides, himself a physician, and his mother was Praxitela, daughter of Tizane. He learned medicine from his father and grandfather, Hippocrates I, and studied other subjects with Democritus and Gorgias. He was probably trained at the asklepieion of Kos and took lessons from the Thracian physician Herodicus of Selymbria. His two sons, Thessalus and Draco, and his son-in-law Polybus, were among his students. The physician Galen later judged Polybus to be Hippocrates's true successor. Two contemporaries mention him only in passing. Plato names him in the dialogues Protagoras and Phaedrus, calling him "Hippocrates of Kos, the Asclepiad," while Aristotle refers to him in the Politics. He taught and practiced throughout his life, traveling at least as far as Thessaly, Thrace, and the Sea of Marmara. Several accounts of his death exist, placing it probably in Larissa at the age of 83, 85, or 90, though some claimed he lived to be well over 100.

• 3. Disease Without Gods

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  Hippocrates is credited as the first person to believe that diseases were caused naturally, not by superstition and gods. He argued that illness was not a punishment from the gods but the product of environmental factors, diet, and living habits. There is not a single mention of a mystical illness in the entirety of the Hippocratic Corpus. This separation of medicine from religion is what revolutionized ancient Greek medicine. It established the field as a discipline distinct from theurgy and philosophy, and turned medicine into a profession. The disciples of Pythagoras acknowledged him for allying philosophy and medicine. Greek schools of the period split into two camps, the Knidian and the Koan, over how to handle disease. The Knidian school focused on diagnosis, but it knew almost nothing of human anatomy because a Greek taboo forbade the dissection of humans. As a result it often failed to recognize when one disease produced many different symptoms. The Koan or Hippocratic school instead applied general diagnoses and passive treatments, focusing on patient care and prognosis rather than diagnosis. Not everyone admired the approach. The French doctor M. S. Houdart called the Hippocratic treatment a "meditation upon death."

• 4. The Healing Power Of Nature

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  "To eat when you are sick, is to feed your sickness," Hippocrates once said, capturing a therapy built on restraint rather than intervention. His approach rested on the healing power of nature, the idea that the body holds within itself the power to re-balance the four humours and heal itself. The physician's job was simply to ease that natural process. Rest and immobilization, he held, were of capital importance. Treatment was gentle and emphasized keeping the patient clean and sterile. Only clean water or wine were ever used on wounds, though a "dry" treatment was preferred, and soothing balms were sometimes applied. Reluctant to administer drugs that might prove wrongly chosen, Hippocrates leaned on generalized remedies such as fasting and a mix of honey and vinegar. Potent drugs were reserved for certain occasions. The passive method worked well on simpler ailments like broken bones, which required traction to stretch the skeletal system, achieved with the Hippocratic bench and similar devices. Fever in his time was thought to be a disease in itself, so he treated feverish patients by starving them, believing that starving the fever neutralized it. He may therefore be the originator of the saying "Feed a cold, starve a fever."

• 5. Reading The Critical Day

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  A crisis, in Hippocratic medicine, was the turning point in a disease where the patient would either succumb to death or recover. After a crisis a relapse might follow, then another deciding crisis. The doctrine held that crises tend to occur on critical days, a fixed time after the disease was contracted. A crisis falling far from a critical day signaled that a relapse should be expected. Galen believed this idea originated with Hippocrates, though it may have predated him. Because medicinal therapy was still immature, the most valuable thing a physician could often do was predict an illness's likely course from detailed case histories. That emphasis on prognosis was one of the school's great strengths. It demanded careful, regular notes on symptoms including complexion, pulse, fever, pains, movement, and excretions. Hippocrates is said to have measured a patient's pulse during a case history to discover whether the patient was lying. He extended his observations into family history and environment. As one summary put it, "To him medicine owes the art of clinical inspection and observation."

• 6. The Disciplined Physician

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  Well-kempt, honest, calm, understanding, and serious: that is how the Hippocratic work On the Physician says a doctor should carry himself. The school was notable for its strict professionalism, discipline, and rigorous practice. In the ancient operating room the physician followed detailed specifications for lighting, personnel, instruments, the positioning of the patient, and techniques of bandaging and splinting. He even kept his fingernails to a precise length. The school also prized the clinical doctrines of observation and documentation. Physicians were to record their findings and methods clearly and objectively, so the records could be passed down and used by others. This insistence on rigor distinguished Hippocratic medicine sharply from the superstition it had broken away from. So revered did the method become that, after his death, his teachings were largely taken as too great to be improved upon. According to Fielding Garrison, "after the Hippocratic period, the practice of taking clinical case-histories died out."

• 7. Naming The Body's Signs

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  Clubbing of the fingers, an important diagnostic sign in chronic lung disease, lung cancer, and cyanotic heart disease, was first described by Hippocrates, which is why clubbed fingers are still called "Hippocratic fingers." He was the first to describe the Hippocratic face in his work Prognosis, a description Shakespeare famously alludes to when writing of Falstaff's death in Henry V. He and his followers were the first to describe many diseases and conditions. He began to categorize illnesses as acute, chronic, endemic, and epidemic, and introduced terms such as exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence. His account of thoracic empyema, the suppuration of the lining of the chest cavity, covered its symptoms, physical findings, surgical treatment, and prognosis, and remains relevant to students of pulmonary medicine today. As the first documented chest surgeon, he used crude but valid techniques such as lead pipes to drain a chest wall abscess. The Hippocratic school described the ailments of the human rectum and their treatment in advanced ways, despite its poor theory. Hemorrhoids, though believed to come from an excess of bile and phlegm, were treated by ligating them and drying them with a hot iron, alongside cautery, excision, and various salves. The Corpus even discusses the rectal speculum, the earliest recorded reference to endoscopy. In neurology he analyzed hemiplegia, paraplegia, apoplexy, and epilepsy, helping move epilepsy away from being seen as a divine affliction toward a common brain disorder. In urology he linked stone formation to the quality of drinking water and to inflammation of the bladder neck, an observation still true in modern urology. He also used antiseptic techniques, cleaning the surgical field with boiled water, salt, seawater, and natural perfumes, and insisted a surgeon keep an organized medical bag of instruments.

• 8. The Corpus And The Oath

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  Around seventy early medical works, written in Ionic Greek and gathered in Alexandrian Greece, make up the Hippocratic Corpus. Their variety of subjects, writing styles, and apparent dates means no single person could have written them; Ermerins numbers the authors at nineteen. The collection likely carried Hippocrates's name because of his fame, possibly classified under him by a librarian in Alexandria, with the volumes themselves produced by his students and followers. The works were written for both specialists and laymen, sometimes from opposing viewpoints, and significant contradictions run between them. Among the treatises are The Hippocratic Oath, The Book of Prognostics, On Regimen in Acute Diseases, Aphorisms, On Airs, Waters and Places, Instruments of Reduction, and On The Sacred Disease. The Oath, the most famous document in the Corpus, is a seminal text on the ethics of medical practice. It was attributed to Hippocrates in antiquity, though new information suggests it may have been written after his death. Rarely used in its original form now, it still serves as the foundation for similar oaths and laws taken by medical graduates entering practice.

  "The Great Hippocrates" was how Aristotle's testimony described him, and his image hardened over time from a "kind, dignified, old country doctor" into a figure "stern and forbidding." The busts that survive show large beards on wrinkled faces, but they may be unreliable. Many physicians of the era wore their hair in the style of Jove and Asklepius, so the busts could be altered portraits of those deities. Francis Adams called him "strictly the physician of experience and common sense," while Fielding Garrison praised him as "the exemplar of that flexible, critical, well-poised attitude of mind." The Travels of Sir John Mandeville spun a stranger image, wrongly naming him ruler of the islands of "Kos and Lango" and telling of his daughter, transformed by the goddess Diana into a hundred-foot dragon. She emerged three times a year, the tale said, and would become a woman again if a knight kissed her, but each knight fled at the sight of her and soon died, a version of the legend of Melusine. His name endures in places real and remembered. Galen, who lived from AD 129 to AD 200, carried his tradition forward, and later figures such as Thomas Sydenham, William Heberden, Jean-Martin Charcot, and William Osler revived his rigorous clinical techniques. Today a lunar crater bears his name, and the Hippocratic Museum on Kos is dedicated to the physician whose legendary genealogy traced his paternal line directly to Asklepius and his maternal line to Heracles.