HIPPOCRATES THE UNKNOWN by John R. Coleman, M.D.
“Life is short, and art long; the crisis fleeting; experiment perilous, and decision difficult.”
The father of western medicine, Hippocrates of Cos (ca. 460 – 377B.C.), wielded enormous influence over the reform of medicine during the golden age of ancient Greece. He was one of the great luminaries of the time, sharing life’s stage with the likes of Sophocles, Euripides, Aristophanes, Socrates, Plato, Thucydides and Herodotus. The son of a physician, he studied the art and eventually became the leader of the famous school of medicine on the Greek island of Cos near Rhodes. His works and those of his students fill the leaves of seventy volumes of the Hippocratic Corpus.
Hippocrates worked to rid medical practice of the influence of superstition and magical thinking prevalent at the time. To this end he worked to give medicine an empirical foundation based on observation and judgment tempered by long experience. He advanced the art of physical diagnosis and urged his students to know their patients as well as possible. He collected case histories and emphasized the importance of prognosis. He believed that disturbances of nature’s equilibrium are the cause of much human disease and the return of health could be achieved by unlocking nature’s secrets and restoring that balance.
“The view of disease in the Hippocratic writings shows how strong was the influence of the philosophers, particularly of Empedocles and Pythagoras.
As in the Macrocosm there were four elements, fire, air, earth, and water, so in man, the Microcosm, there were four elements, blood, mucus, yellow bile, and black bile, of which the blood represented the heat, the mucus the cold, the yellow bile the dryness,the black bile the moisture. Health consisted in a harmony or due admixture of these humors, disease in a dyscrasia or imperfect admixture. This humoral pathology of the Hippocratic school dominated the profession for more than two thousand years.” (Osler)
Hippocratic treatments first required attention to proper diet and exercise, sleep and an environment conducive to effective recovery. It was only later, on a case by case basis, that he prescribed various (mostly herbal) salves and poultices, purogatives and diuretics. He made liberal use of medicated baths and massage therapy. Surgery was a violent means of last resort. His treatises on fractures and dislocations are remarkable for their sophistication, especially given his poor understanding of anatomy and lack of modern imaging techniques.
The most enduring contribution of Hippocrates and his school is the ethical standard set Fourth in:
Hippocrates would be proud of the strides medical research has made in the diagnosis and treatment of disease. He would be profoundly impressed with modern medical technology, pharmaceuticals and surgical techniques. But he would be disappointed with much that has been lost along the way.
Plato was a contemporary of Hippocrates. He described in The Laws two kinds of physicians working in his time. They are still working in our day.
“The slave-doctor prescribes what mere experience suggests, as if he had exact knowledge, and when he has given his orders, like a tyrant, he rushes off with equal assurance to some other servant who is ill. But the other doctor, who is a freeman, attends and practices upon freemen; and
he carries his inquiries far back, and goes into the nature of the disorder; he enters into discourse with the patient and with his friends, and is at once getting information from the sick man, and also instructing him as far as he is able, and he will not prescribe for him until he has first convinced him; at last, when he has brought the patient more and more under his persuasive influences and set him on the road to health, he attempts to effect a cure.”
Doctors need to teach their patients again. They need to master the arts of history acquisition and physical diagnosis. Their focus should be more on the patient before them and less on financial, legal or regulatory issues. Patients need to be more responsible and work with nature and their physicians to preserve and restore their health. Their expectations of quick cures with miracle drugs are often unrealistic. When their art fails and the prognosis is grim, physicians need to be angels of mercy in comforting, physically and spiritually, their suffering charges.
The myriad problems associated with bringing the benefits of modern medicine to the greatest number will not be solved easily. A reform of the medical education system would go a long way toward creating physicians who are capable of solving these problems. A rebirth of interest in the ideas and ideals of Hippocrates and other great thinkers of medicine is at the heart of such a reform movement. Physicians educated with such principles can make the best use of the miracles of modern medical technology while ensuring that patients can learn and flourish under their care.