Hippocrates: Difference between revisions
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Hippocratic medicine developed as the "naturalistic counterpart" of the Asclepian supernaturalistic tradition.<ref name=prioreschi>Prioreschi P. (1996) [http://books.google.com/books?id=HaX733MnZZ4C The History of Medicine.] Volume II: Greek Medicine. 2nd ed. Horatius Press, Omaha. ISBN 1888456027</ref> By the 6th century BCE (the 500s BCE) Greek philosophers emerged and began to theorize about the natural causes of the way the world worked. Empedocles (ca. 495-435 BCE), characterized as a physician and philosopher, postulated earth, air, fire and water as the primordial elements of which everything in the world consisted, in differing combinations and kinds of combinations, including the human body.<ref>Scoon R. (1928) [http://www.questia.com/read/5427557?title=Greek%20Philosophy%20before%20Plato Greek Philosophy before Plato.] Princeton University Press. Princeton, NJ.</ref> <ref>Parry, Richard, "Empedocles", The Stanford Encyclopedia of Philosophy (Spring 2005 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/spr2005/entries/empedocles/>. </ref> | Hippocratic medicine developed as the "naturalistic counterpart" of the Asclepian supernaturalistic tradition.<ref name=prioreschi>Prioreschi P. (1996) [http://books.google.com/books?id=HaX733MnZZ4C The History of Medicine.] Volume II: Greek Medicine. 2nd ed. Horatius Press, Omaha. ISBN 1888456027</ref> By the 6th century BCE (the 500s BCE) Greek philosophers emerged and began to theorize about the natural causes of the way the world worked. Empedocles (ca. 495-435 BCE), characterized as a physician and philosopher, postulated earth, air, fire and water as the primordial elements of which everything in the world consisted, in differing combinations and kinds of combinations, including the human body.<ref>Scoon R. (1928) [http://www.questia.com/read/5427557?title=Greek%20Philosophy%20before%20Plato Greek Philosophy before Plato.] Princeton University Press. Princeton, NJ.</ref> <ref>Parry, Richard, "Empedocles", The Stanford Encyclopedia of Philosophy (Spring 2005 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/spr2005/entries/empedocles/>. </ref> | ||
:'''<font color=#330066><i>"The development of Hippocratic medicine, its [Aesculapian medicine’s] naturalistic counterpart, is considered a turning point in the history of the healing arts although, as we have seen, at about the same time, naturalistic medical paradigms were developing in other ancient civilizations as well. The importance of Hippocratic medicine rests on the fact that it is the first comprehensive naturalistic medical system of the Western world and therefore the source from which scientific medicine would eventually originate."</i> —Plinio Prioreschi'''<ref name=prioreschi>Prioreschi P. (1996) [http://books.google.com/books?id=HaX733MnZZ4C The History of Medicine.] Volume II: Greek Medicine. 2nd ed. Horatius Press, Omaha. ISBN 1888456027</ref></font> | :'''<font color=#330066><i>"The development of Hippocratic medicine, its [Aesculapian medicine’s] naturalistic counterpart, is considered a turning point in the history of the healing arts although, as we have seen, at about the same time, naturalistic medical paradigms were developing in other ancient civilizations as well. The importance of Hippocratic medicine rests on the fact that it is the first comprehensive naturalistic medical system of the Western world and therefore the source from which scientific medicine would eventually originate."</i> —Plinio Prioreschi'''<ref name=prioreschi>Prioreschi P. (1996) [http://books.google.com/books?id=HaX733MnZZ4C The History of Medicine.] Volume II: Greek Medicine. 2nd ed. Horatius Press, Omaha. ISBN 1888456027</ref></font> |
Revision as of 21:48, 29 July 2008
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In ancient Greece many men shared the name, Hippocrates — a common Greek name like ‘Edward’ or ‘Lawrence’ in English — and many of these distinguished themselves in Greek history in one way or other; but one man, Hippocrates of Cos (ca. 460 – 370 BCE),[1] earned such respect and honor that his ideas flourished during Western history to the present day. He inspired a revolution in medicine that so changed the course of Western civilization that the health and welfare of all humanity has benefited.
Hippocrates of Cos revolutionized the practice of medicine by transforming it from its mythical, superstitious, magical and supernatural roots to roots based on observation and reason — the roots of scientific objectivity — roots that have nourished an ever-growing evolutionary tree of Western scientific medicine still flourishing. For that reason History has bestowed on Hippocrates of Cos the honorific cognomen, “The Father of Medicine”, medicine’s progenitor. We might call him more accurately "The Progenitor of Western Rational Medicine".
Because historians know only a little about the life of Hippocrates, and because of the great influence the works associated with his name have had on medicine for millennia, his fame has led to a plethora of writings about him that have the character of legend:
We still know very little about Hippocrates. And yet, like the physicians of Imperial Rome, the doctors of our days want to know all about the life of the "Father of Medicine." Where there are no historical sources available, imagination will step in, and the poet will replace the historian.[2]
The details — even basic facts — of Hippocrates' life remains contentious among modern classics scholars, to say the least. An unfortunate dearth of contemporary 5th and 4th century BCE historical information makes many questions about about the historical Hippocrates particularly knotty, and vexes the question of the relationship between the writings that have come down in Hippocrates' name, the Hippocratic corpus, and those among the corpus that Hippocrates himself, rather than his followers, may have written.
The legends about Hippocrates, whether completely imagined or evolved elaborations of reality, by their hero-generating nature, attest to the esteem bestowed on Hippocrates for nearly two and one-half millennia.[3]
Sources for the life of Hippocrates
Though Hippocrates looms large in the imagination and in historical tradition, unambiguous evidence for a satisfactorily full account of his life remains elusive. The evidence closest in time to Hippocrates' life comes to us from the writings of the philosopher Plato (429-347 BCE), a contemporary of Hippocrates. Plato has Socrates mentioning Hippocrates in the Protagoras and Phaedrus. These passages help us to locate Hippocrates in the context of Greek culture in the 5th century BCE. The latter reference (which has inspired a large body of scholarship) comments on Hippocrates' methodology. Together, Plato's works give us reliable evidence of the existence of Hippocrates as a physician, as a citizen of Cos, of the Asclepiad family, who had achieved fame beyond his homeland during his lifetime.[4] [5]
A passage in the Politics of Aristotle, a near contemporary of Hippocrates, also attests to Hippocrates' existence in a way that suggests his fame as a scientist physician.
Hippocrates' life and work are discussed in the writings of Aulus Cornelius Celsus (d. ca. 50 CE). An anonymous, mystifying papyrus tries to differentiate the real teachings of Hippocrates from those merely attributed to him.
Furthermore, it was recognized in antiquity that the Hippocratean corpus, the collection of writings attributed to Hippocrates, could not be the writings of one man. Later commentators, including the influential Galen, attempted to separate the genuine Hippocratean teachings from the spurious and included biographical detail when they did so.
One Life of Hippocrates, a short work attributed to Soranus of Ephesus (a 2nd century CE physician), provides many details concerning Hippocrates' life. Jacques Jouanna refers to it as "the canonical source", as it appears introductory to the earliest compiled editions of the Hippocratic corpus.[6] Jouanna asserts that it "draws upon more ancient sources, the most outstanding of which is the director of the library of Alexandria during the Hellenistic era, Eratosthenes ofCyrene.
Given the lack of unambiguous contemporary evidence, many modern scholars have concluded that the real, historical Hippocrates is unknowable. In recent years, the research of Jacques Jouanna has re-opened the debate on the life of Hippocrates, and on many points of Hippocratean scholarship.[6]
Hippocrates’ life on the island of Cos
Hippocrates entered the world into an aristocratic family on the Ionian island of Cos (or Kos), located in the Aegean Sea off the southwest coast of then called Ionia (Asia Minor, present day Turkey).[7]
Hippocrates' father, Heraclides, and his father's father, also called Hippocrates, practiced medicine employing ancient ideas of supernatural causation and treatment of disease according to the tradition linked to Asclepius, considered a deity.[8] In fact, Heraclides traced his ancestry through the male line back to Asclepius in the era of the Trojan war, when Asclepius, a physician, had not yet received divine status. Heraclides descended through the male from Asclepius’s son, Podalirius, who fought in the Trojan war, moved to Asia Minor, and whose descendants eventually settled on Cos. The tradition of Asclepian medicine passed from son to son down the generations, eventually reaching Heraclides. The family from Podalirius onward called themselves Asclepiads, their family name. Hippocrates belonged to the Coan branch of the family, settling on Cos; a second branch, splitting off from from Podalirius, settled on the nearby peninsula of Cnidus, referred to as the Cnidian branch, also continued to practice medicine.
At the time of Hippocrates’ birth, Cos paid tribute to Athens as a member of the Athenian federation created to defend against Persian aggression.
Hippocrates, though known also as 'Hippocrates of Cos, the Asclepiad', and though reared in the family tradition of Asclepian medicine, rejected the supernatural ethos, substituting a naturalistic ethos, thereby sparking a revolution of principles and practice in medicine that present day non-supernatural Western scientific medicine acknowledges as its parentage and heritage.[9] Scholars have found no evidence of Hippocrates ever practicing as a physician priest of Asclepius.
Hippocrates’ education within the family probably included, in addition to medicine, philosophy and rhetoric and other subjects that gave him knowledge of the world of reality. He remained on Cos well into maturity, married and had two sons and a daughter. His new practice of medicine according to the tenets of observation and reason gained him fame in and beyond Cos. One plausible story has him rejecting an invitation to court of the current king of Persia. [10]
The emergence of Hippocratic medicine
The Greeks invented rational medicine. |
Our earliest evidence of Greek medicine reveals, then, that, as in ancient Egypt and Mesopotamia, the causation of disease and the operation of the remedies applied to the sick were so linked with superstitious beliefs in magic and supernatural causation that a rational understanding of disease, its effect upon the body, or of the operation of remedies applied to it was impossible. The sixty-odd works of the Hippocratic Corpus, however, provide a striking contrast and are virtually free from magic and supernatural intervention.[citation] Here, in this collection, for the first time in the history of medicine complete treatises have survived which display an entirely rational outlook towards disease, whose causes and symptoms are now accounted for in purely natural terms. The importance of this revolutionary innovation for the subsequent development of medicine can hardly be overstressed. This emancipation of (some) medicine from magic and superstition, was the outcome of precisely the same attitude of mind which the Milesian natural philosophers were the first to apply to the world about them. For it was their attempts to explain the world in terms of its visible constituents without recourse to supernatural intervention which ultimately paved the way for the transition to rational explanation in medicine, too. —James Longrigg[9] |
Hippocratic medicine reflected the emerging philosophy that things and events in the world resulted from natural causes, a philosophy that began with the Ionian philosopher, Thales of Miletus (c. 625-546), whose speculation about the natural world philosophers regard as an important turning point in Western scientific thought. Classicist and historian of medicine, James Longrigg elaborates that point in the accompanying sidebox to the right.
The Hippocratic treatise, On Ancient Medicine, asserts that the practice of medicine does not derive from a priori first principles, as does the practice of some branches of philosophy, but from the findings in individual cases. Medicine does not qualify as philosophy, but as an observational science challenged by specific diseases arising from specific natural causes, the challenges met only by detailed observation leading to cumulative knowledge undergirded by rational reasoning.
"Whoever having undertaken to speak or write on Medicine, have first laid down for themselves some hypothesis to their argument, such as hot, or cold, or moist, or dry, or whatever else they choose (thus reducing their subject within a narrow compass, and supposing only one or two original causes of diseases or of death among mankind), are all clearly mistaken in much that they say…. Wherefore I have not thought that it stood in need of an empty hypothesis, like those subjects which are occult and dubious, in attempting to handle which it is necessary to use some hypothesis; ; as, for example, with regard to things above us and things below the earth; if any one should treat of these and undertake to declare how they are constituted, the reader or hearer could not find out, whether what is delivered be true or false; for there is nothing which can be referred to in order to discover the truth." —Hippocrates, Ancient Medicine [11] |
In my view, there is no beginning in the body; but everything is alike beginning and end. For when a circle has been drawn, its beginning is not to be found. And the beginning of ailments comes from the entire body alike. . . . Each part of the body at once transmits illness one to the other, whenever it arises in one place or another; belly to head, head to flesh and to belly, and all other parts thus analogously, just as belly to head and head to flesh and to belly. For when the belly fails to make proper evacuation, and food goes into it, it floods the body with moisture from the ingested foodstuffs. . . . .This moisture, blocked from the belly, travels en masse to the head. When it reaches the head, not being contained by the vessels in the head, it flows at random, either around the head or into the brain through the fine bone. Some penetrates the bone and some the region of the brain through the fine bone. And if it returns to the belly, it causes illness in the belly; and if it happens to go anywhere else, it causes illness elsewhere; and in other cases similarly, just as in this case, one part causes illness in another. . .. The body is homogeneous (lit. the same as itself) and is composed of the same things, though not in uniform disposition, in its small parts and its large; in parts above and parts below. And if you like to take the smallest part of the body and injure it, the whole body will feel the injury, whatever sort it may be, for this reason, that the smallest part of the body has all the things that the biggest part has. —Hippocrates, Places in Man; [12] |
Hippocrates’ life overlapped that of the great Greek natural philosophers Empedocles (ca. 495-435 BCE), Socrates (469–399 BCE), Plato (429-347 BCE) and Aristotle (384-322 BCE). Thus he lived during the Golden Age of Greece (c. 500 – 300 BCE). Disease, so central a continuing problem in human lives, not surprisingly would come under scientific scrutiny in the environment of such thinkers. Historians know that Hippocrates observed keenly ("infinite in faculty"), reasoned rationally ("noble in reason"), and taught and practiced a holistic ideal of medicine ("what a piece of work is Man")[13] [14] that regarded health and disease as manifestations of body and mind as a whole — though centuries later Margagni would offer a qualification. An excerpt from one of the Hippocratic Treatises, Places in Man, aptly illustrates the Hippocratic holistic view.[12] See sidebox at lower right.
"Why do modern day researchers keep going back to Hippocrates?....although ancient, some notions expressed in the Hippocratic works are still applicable today. What is more important though, is a reason easily recognized to anyone familiar with Hippocratic descriptions of infection: the clarity of presentation of the clinical course and the astute inclusion of infection in a broader environmental and social context are still unparalleled by modern thinking." —Georgios Pappasa, Ismene J. Kiriazea, and Matthew E. Falagas[15] |
Hippocrates founded a school of medicine known by his name, and advocated a basic approach to the diagnosis and treatment of disease that still has applications in modern medicine. [For example, see Pappas et al.[15], Chang et al.[16], and Ghaemi[17]]
History gave his name to an oath of medical ethics called the Hippocratic Oath. "The code of conduct for doctors outlined in the Hippocratic Oath, a vow commonly taken by modern doctors", remains an ethical guideline in medicine.[18] One can begin to appreciate the influence of Hippocrates to the present day by his presence in the World Wide Web since the year 2000, where the scientific search engine, SCIRUS, reveals 74,523 entries, and Google search reveals ~172,000 entries for the twelve months preceding April 2008.
Early Greek medicine operated as a supernatural, magical art. The god of healing, Asclepius (Aesculapius in Roman terminology), [19] whose priests and temples flourished in ancient Greece at least from the Homeric era, appeared in the dreams of the sick who came to the temple for 'sleep therapy'. Asclepius gave advice to the dreamer, which the priests interpreted. The priests prescribed baths, diets, exercises, changes in occupation or living locales, and other routines, and those prescriptions received credit when cures occurred. The cult of ‘therapeutic dreaming’ persisted in various places even into Christian times.[20]
Hippocratic medicine developed as the "naturalistic counterpart" of the Asclepian supernaturalistic tradition.[21] By the 6th century BCE (the 500s BCE) Greek philosophers emerged and began to theorize about the natural causes of the way the world worked. Empedocles (ca. 495-435 BCE), characterized as a physician and philosopher, postulated earth, air, fire and water as the primordial elements of which everything in the world consisted, in differing combinations and kinds of combinations, including the human body.[22] [23]
- "The development of Hippocratic medicine, its [Aesculapian medicine’s] naturalistic counterpart, is considered a turning point in the history of the healing arts although, as we have seen, at about the same time, naturalistic medical paradigms were developing in other ancient civilizations as well. The importance of Hippocratic medicine rests on the fact that it is the first comprehensive naturalistic medical system of the Western world and therefore the source from which scientific medicine would eventually originate." —Plinio Prioreschi[21]
Indeed, the development of Hippocratic medicine may have influenced changes in the persisting Asclepian practice.[24]
For its objectives of seeking classification, causes and remedies of disease, medicine requires reason, but not only reason. Considering that knowledge emerges from information processed by reason, not only does the quality of reason count, but also does the quality of the information fed into reason count. Reason will yield a formally valid conclusion, but if fed flawed information, it will not yield a reliable conclusion. For the latter, reason requires information ultimately based on empirically sound observation. If based on wishful thinking, imagination, unquestioned assumptions, ybelieved revelation by deities, guesswork and the like, reason yields at best dubious knowledge and at worst false knowledge. Hippocrates appears to have understood that, and as a physician considered to epitomize the art of medicine, as Socrates did, he inspired many likeminded and knowledge-seeking followers.
Likely inspired by Empedocles’ concept of four elements making up natural things,[25] the concept of four humours (blood, yellow bile, black bile, phlegm) as constituent elements of the human body emerged as part of the Hippocratic tradition, the individual humours in various combinations determining state of health and personality:
- excess blood makes a person ‘sanguine’, full of energy, optimistic, ruddy complected
- excess yellow bile makes a person ‘bilious’, ‘choleric’, bad tempered, quick to anger, irritable
- excess black bile makes a person ‘melancholic’, deeply and long-lastingly sad
- excess phlegm makes a person ‘phlegmatic’, unemotional, temperamentally slow, calm
Historians have not identified an individual who originated the four humours theory, nor have they excluded the possibility that the theory emerged into a formal theory only gradually. [26]
The medical corollary of Empedocles' theory is the identification of the traditional humours with constituent elements: what made this possible was the presence, in the traditional view of humours, of positive characteristics. Because of these characteristics it was easy to conceive the humours as the ingredients of man, upon which his normal or healthy state, as well as his very existence, depended….It is not the recognition of this or that humour as existing which counts, but the theoretical use to which that humour is put. One would therefore also have to find evidence….that the humours were regarded as constituent parts of the human body. There seems no a priori reason why this should not have been the case, in any writer working after say 450. But in the absence of such evidence, the question of the precise originator of the four-humoral theory is formally insoluble….What is perhaps of more interest is the way in which the theory of four humours exemplifies the stimulating effects of Greek philosophy on Greek medical science. It may be described in this way: the philosopher provides the categories within which the medical scientist can order his experience. (Page 61.)[26] |
The Hippocratic physician: scientist or craftsman?
H.J.F. Horstmanshoff argues that the Hippocratic physicians qualify as craftsmen, and not as scientists:
Ancient physicians did not receive scholarly, scientific training. The intellectual attitudes and social status which we are inclined to attribute to them are anachronisms nourished by the Hippocratic tradition from Galen to Littre. Physicians who had scholarly ambitions steered toward philosophy and rhetoric rather than to empirical disciplines. As a consequence of the prevailing social and economic outlook, the image of the rhetor [teacher of rhetoric, or orator] and of the philosopher were considered to be far better than that of the engineer or of the artisan, or that of those devoted to applied knowledge in general. Ancient physicians were above all craftsmen. Nevertheless the more ambitious among them cloaked over the manual aspects of their art and explained away the remuneration for their services with the help of rhetoric [persuasive public speaking].[27]
....
Social and economic roles of the Hippocratic physicians
The Hippocratic Corpus records a wealth of information about classical Greek medicine, yet records little details about the lives of the Hippocratic physicians. In part to remedy that gap, or compensate in a way for it, classical scholar, Hui-hua Chang studied the Greek cities in the northern regions of the Aegean where the Hippocratic physicians spent time, as recorded in the Hippocratic treatise, Epidemics.[28] The express purpose of the study, according to Professor Chang, “…is to determine how such places may help us define the social and economic roles of Greek physicians in the Classical period.”
Professor Chang's analysis reveals that the Hippocratic physicians were not mere aimless itinerants, as sometimes implied by writers. Rather, more objectively, Chang characterizes them as physicians visiting targeted towns and villages to seek employment and financial support as opportunity presented. They found more job opportunities in the larger urban centers where division of labor accompanied by specialization of occupation had evolved. Moreover, such centers housed wealthy individuals and families who could support the renown Hippocratic physicians of burgeoning repute.
Professor Chang provides detailed descriptions of the cities visited by the Hippocratic physicians, their location on trade routes, their chiefs sources of trade, their resources for their daily lives — revealing most of them as wealthy commercial centers or the major cities in the region. He describes:
- Cyzicus on the southern coast of Propontis (now the Sea of Marmara) — visible upper right on the accompanying map south of Thrace and North of Asia Minor (Anatolia) — acquiring its wealth from its location on the trade route between the Black Sea to the northeast and the Aegean Sea to the west, its exports of wine, fish and marble, and it supply of wheat to the Aegean from Russia.
- Perinthis on the northern coast of Propontis, also depicted on the map, a trade city with abundant territory to produce corn, cattle and timber.
- Abdera and Ainos, on the Thracian coast near the island of Thrasos in the north Thracian Sea. Ainos acquired its wealth from its location at the mouth of the major river in the northern Aegean, supplying the Aegean with the products fertile Thracian fields in return for Greek merchandise. Abdera — home of the geometer and atomist, Democritus, whom legend has it Hippocrates visited because of accusations of mental dysfunction and declared Democritus the sanest man in town — became “the emporium of the silver trade”.
- Thrasos, the island and its Thracian mainland colonies, wealthy from gold and silver mining and producing wine considered the finest in Greece. The Hippocratic physicians spent much time there.
- Olynthus, the largest city on the peninsula of Chalcidice, visible on the map in the southern part of Macedonia, destroyed after Hippocrates’ death because Phillip II considered it a threat to his rule of Macedonia. The Hippocratic physicians practiced their art there prior to its destruction, when its large population displayed their wealth and power.
- Larissa, in Thessaly, south of Macedonia and left of center on the map, shows up in Epidemics with many descriptions of medical cases. It had much fertile land and control of the mountain passes to Macedonia.
Possibly the Hippocratic favored those cities both because their wealth and the undoubted wealth of patients in cities with dense populations of people living luxuriously. Large populations also usually meant labor division and thus opportunities for physicians to concentrate on practicing medicine. Professor Chang closes thus:
It was in such places as those described above, where wealth was concentrated and people with open minds resided, that they [the Hippocratic physicians] would find clients and patrons who were ready to accept untraditional [non-supernatural] ideas and who would support the art of the Hippocratic doctors.[28]
The Hippocratic treatises
This listing as in Jouanna's Appendix 3.[6] Jouanna states: "The principal editions given here are based on the Greek-French edition of Émile Littré (10 vols., 1839-1861).[6]
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....
Aphorisms
The first aphorism
"....the First Aphorism is medicine’s whole law; the rest is commentary." |
Of the more than 400 aphorisms attributed to Hippocrates, the first has received the most attention. In the Francis Adams translation,[31] it reads:
Life is short, and the Art long; the occasion fleeting; experience fallacious; and judgment difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and the externals cooperate.[31]
Another 19th century translation:[32]
Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.>[32]
The same aphorism as translated in the Hippocratic Writings edited by G. E. R. Lloyd reads:[33]
Life is short, science is long; opportunity is elusive, experiment is dangerous, judgement is difficult. It is not enough for the physician to do what is necessary, but the patient and the attendants must do their part as well, and circumstances must be favourable.[33]
In the Adams translation, the "Art", always with an capital 'A', refers to medicine — the art of medicine. In the Lloyd text, the 'Art of medicine' becomes 'science'. In either case, the first clause of the first aphorism seems to say that the lifespan of a physician does not suffice for learning the Art of medicine, all of its science. The implication would seem to exhort awareness to physicians that they cannot expect learn all of medicine in a lifetime, an exhortation to humility and avoidance of overconfidence. Can any physician even two and a half millenia later deny the aphorism, especially in respect of the enormous amount and intricate complexity of the knowledge base of medicine in the early 21st century. Perhaps the complete Art of medicine will always overwhelm any one physician's lifetime of learning and practice.
Sherwin Nuland puts it this way:
Although life expectancy is currently well more than twice what it was during the golden age of Greece, it will never be endowed with years enough for anyone to master the vast expanse of medical knowledge, or even that part of it sufficient for an individual doctor to care for all of his patients.[30]
The aphorism continues with the occasion fleeting, alternatively opportunity is elusive, generally interpreted as indicating the need for timely diagnosis to achieve the best results of treatment — a narrow window of opportunity.
[E]xperience fallacious, or experiment [in the sense of experience] is dangerous, seems to warn of misinterpreting the patient's symptoms and signs by relying on experience that might apply generally but not to the specific patient at hand owing to that patient's particular circumstances, internal or external, physiological or psychological. Sherwin Nuland applies that to the non-personal 'experience' that statistics offers, unless it takes into consideration individual variability and the factors that go into generating it.
[J]udgment is difficult seems to follow give that life is short and the art, and that experience of other cases cannot always be counted as reliable when applied to an individual patient at hand.
21st century scholarly interest in and diversity of views of Hippocrates
- Some Abstracts paragraphed or otherwise reformatted for ease of reading
- Grammaticos PC, Diamantis A. (2008) [From Emeritus professors, Thessaloniki, Macedonia, Greece] [34]
“Hippocrates is considered to be the father of modern medicine because in his books, which are more than 70. He described in a scientific manner, many diseases and their treatment after detailed observation. He lived about 2400 years ago. He was born in the island of Kos and died at the outskirts of Larissa at the age of 104. Hippocrates taught and wrote under the shade of a big plane tree, its descendant now is believed to be 500 years old, the oldest tree in Europe-platanus orientalis Hippocraticus- with a diameter of 15 meters. Hippocrates saved Athens from a plague epidemic and for that was highly honored by the Athenians. He considered Democritus-the father of the atomic theory- to be his teacher and after visiting him as a physician to look after his health, he accepted no money for this visit. ome of his important aphorisms were: "As to diseases, make a habit of two things -to help or at least to do no harm". Also: "Those by nature over weight, die earlier than the slim.", also, "In the wounds there are miasmata causing disease if entered the body".He used as a pain relief, the abstract from a tree containing what he called "salycasia", like aspirin. He described for the first time epilepsy not as a sacred disease, as was considered at those times, but as a hereditary disease of the brain and added: "Do not cut the temporal place, because spasms shall occur on the opposite area". According to Hippocrates, people on those times had either one or two meals (lunch and dinner). He also suggested: "...little exercise...and walk...do not eat to saturation". Also he declared: "Physician must convert or insert wisdom to medicine and medicine to wisdom". If all scientists followed this aphorism we would have more happiness on earth.” |
- Totelin LM (2007) [From: Department of History and Philosophy of Science, University of Cambridge, Cambridge, UK.] .[35]
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- Smith CM. (2005) [From School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York] [36]
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- Ventegodt S, Clausen B, Omar HA, Merrick J. (2006) [From: the Nordic School of Holistic Health and Quality of Life Research Center in Copenhagen, Denmark; Nordic School of Holistic Medicine; the Kentucky Clinic University of Kentucky in Lexington.; Center for Multidisciplinary Research in Aging, Zusman Child Development Center, Division of Pediatrics and Community Health at the Ben Gurion University, Beer-Sheva, Israel] .[37]
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References and notes cited in text
- Links in blue font-color.
- ↑ Note: Also referred to as "Hippocrates the Asclepiad"
- ↑ Sigerist HE. (1934) On Hippocrates. Bulletin of the History of Medicine 2:190-214.
- ↑ Longrigg J. (1998) Greek Medicine From the Heroic to the Hellenistic Age: A Source Book. Routledge, New York. ISBN 0415920876. Table Of Contents
- ”Three legends, in particular, seem to have been invented to illustrate particular virtues attributed to Hippocrates; his eradication of the Athenian plague was created to illustrate his brilliance as a doctor [see X.lO]; his refusal to work for Artaxerxes, king of the Persians, to show his patriotism as a Greek [IV.3], and his cure of King Perdiccas's love-sickness to show his diagnostic skill [IV.4l.” [Citations (e.g., IV.3) found in Longriggs’ source book.]
- ↑ The Project Gutenberg Etext of Protagoras, by Plato.
- Note: Socrates, in speaking to a man by chance named Hippocrates wonders why the man exhibits excitement over the impending visit of a famous Sophist, Protagoras. In the dialogue, he reveals the existence of the physician, Hippocrates of Cos, the Asclepiad, implying that the latter’s fame as a physician and teacher had reached Athens during his lifetime:
- “Tell me, Hippocrates, I said, as you are going to Protagoras, and will be paying your money to him, what is he to whom you are going? and what will he make of you? If, for example, you had thought of going to Hippocrates of Cos, the Asclepiad, and were about to give him your money, and someone had said to you: You are paying money to your namesake Hippocrates, O Hippocrates; tell me, what is he that you give him money? how would you have answered?”
- “I should say, he replied, that I gave money to him as a physician.”
- “And what will he make of you?”
- “A physician, he said.”
- Note: Socrates, in speaking to a man by chance named Hippocrates wonders why the man exhibits excitement over the impending visit of a famous Sophist, Protagoras. In the dialogue, he reveals the existence of the physician, Hippocrates of Cos, the Asclepiad, implying that the latter’s fame as a physician and teacher had reached Athens during his lifetime:
- ↑ The Project Gutenberg Etext of Phaedrus, by Plato.
- Note: Socrates, in dialogue with Phaedrus, confirms the existence of Hippocrates the Asclepiad, indicating Hippocrates’ holistic approach to medicine, and implying that Hippocrates’ thought relating to medicine influenced philosophical thinking about such things as the nature of the soul:
- SOCRATES: And do you think that you can know the nature of the soul intelligently without knowing the nature of the whole?
- PHAEDRUS: Hippocrates the Asclepiad says that the nature even of the body can only be understood as a whole.
- SOCRATES: Yes, friend, and he was right:--still, we ought not to be content with the name of Hippocrates, but to examine and see whether his argument agrees with his conception of nature.
- PHAEDRUS: I agree.
- ↑ Jump up to: 6.0 6.1 6.2 6.3 Jouanna J. (1999) Hippocrates. Translated by M.B. DeBevoise. The Johns Hopkins University Press. ISBN 0-8018-5907-7 Cite error: Invalid
<ref>
tag; name "jouanna1999" defined multiple times with different content - ↑ Regarding Ionia:
- Note: Because of its large population of Greeks who called themselves Ionians, the western area along the coast of Asia Minor and the adjacent islands in the Aegean Sea the ancient geographers gave it the label Ionia. The Ionian Greeks traced their ancestor to Ion, an illegitimate son of Apollo, who achieved noble status, according to a play by the ancient Greek playwright, Euripedes. The Ionians had emigrated from the Greek mainland and colonized the area shortly after the Trojan War, thought to have occurred in the 1200s or late 1100s BCE. A dozen main cities comprised a cooperative Ionic League. In the 600s and 500s BCE, the Ionians made major contributions to Greek culture, especially in art, literature and philosophy.
- ↑ Osler W (1913) The Evolution of Modern Medicine: A Series Of Lectures Delivered At Yale University On The Silliman Foundation In April, 1913. Project Gutenberg's The Evolution of Modern Medicine, by William Osler. Produced by Charles Keller and David Widger.
- Osler writes: "No god made with hands, to use the scriptural phrase, had a more successful "run" than Asklepios—for more than a thousand years the consoler and healer of the sons of men. Shorn of his divine attributes he remains our patron saint, our emblematic God of Healing, whose figure with the serpents appears in our seals and charters. He was originally a Thessalian chieftain, whose sons, Machaon and Podalirius, became famous physicians and fought in the Trojan War. Nestor, you may remember, carried off the former, declaring, in the oft-quoted phrase, that a doctor was better worth saving than many warriors unskilled in the treatment of wounds. Later genealogies trace his origin to Apollo,(10 = W. H. Roscher: Lexikon der griechischen und romischen Mythologie, Leipzig, 1886, I, p. 624.)] as whose son he is usually regarded. "In the wake of northern tribes this god Aesculapius—a more majestic figure than the blameless leech of Homer's song—came by land to Epidaurus and was carried by sea to the east-ward island of Cos.... Aesculapius grew in importance with the growth of Greece, but may not have attained his greatest power until Greece and Rome were one."(11 = Louis Dyer: Studies of the Gods in Greece, 1891, p. 221.)]"
- ↑ Jump up to: 9.0 9.1 9.2 Longrigg J (1993) Greek Rational Medicine: Philosophy and Medicine from Alcmaeon to the Alexandrians. Routledge. New York. Full-Text Online with Subscription. Cite error: Invalid
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tag; name "longrigg1993" defined multiple times with different content - ↑ The Persian Letters. Page 18. In. Hippocrates: Pseudoepigraphic Writings. Translated with an Introduction by Wesley D. Smith. E.J. Brill Leiden, New York, Kobenhavn, Koln. 1990.
- ↑ Hippocrates. (~400 BCE) On Ancient Medicine Directory of Classic Literature. Full-text of the treatise.
- ↑ Jump up to: 12.0 12.1 Craik EM. (editor and translator) (1998) Hippocrates: Places in Man.Oxford: Clarendon Press. Cite error: Invalid
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tag; name "craik1998" defined multiple times with different content - ↑ Regarding parenthetical quotes:
- Note: From Shakespeare's "Hamlet", Act I. Scene II.
- ↑ Ventegodt,S.; Kandel,I.; Merrick,J. (2007) A short history of clinical holistic medicine. ScientificWorldJournal 7:1622-1630.PMID 17982604
- Abstract: Clinical holistic medicine has its roots in the medicine and tradition of Hippocrates. Modern epidemiological research in quality of life, the emerging science of complementary and alternative medicine, the tradition of psychodynamic therapy, and the tradition of bodywork are merging into a new scientific way of treating patients. This approach seems able to help every second patient with physical, mental, existential or sexual health problem in 20 sessions over one year. The paper discusses the development of holistic medicine into scientific holistic medicine with discussion of future research efforts,
- ↑ Jump up to: 15.0 15.1 15.2 Pappas,G.; Kiriaze,I.J.; Falagas,M.E. (2008) Insights into infectious disease in the era of Hippocrates. Int.J.Infect.Dis. PMID 18178502
- Abstract: Hippocrates is traditionally considered the father of modern medicine, still influencing, 25 centuries after his time, various aspects of medical practice and ethics. His collected works include various references to infectious diseases that range from general observations on the nature of infection, hygiene, epidemiology, and the immune response, to detailed descriptions of syndromes such as tuberculous spondylitis, malaria, and tetanus. We sought to evaluate the extent to which this historical information has influenced the modern relevant literature. Associating disease to the disequilibrium of body fluids may seem an ancient and outdated notion nowadays, but many of the clinical descriptions presented in the Corpus Hippocraticum (Hippocratic Collection) are still the archetypes of the natural history of certain infectious diseases and their collective interplay with the environment, climate, and society. For this reason, modern clinicians and researchers continue to be attracted to these 'lessons' from the past - lessons that remain extremely valuable.
- ↑ Chang A, Lad EM, Lad SP. (2007) Hippocrates' influence on the origins of neurosurgery. Neurosurg.Focus. 23:E9 PMID 17961056
- Abstract: Hippocrates is widely considered the father of medicine. His contributions revolutionized the practice of medicine and laid the foundation for modern-day neurosurgery. He inspired several generations to follow his vision, by pioneering the rigorous clinical evaluation of cranial and spinal disorders and combining this approach with a humanistic and ethical perspective focused on the individuality of the patient. His legacy has forever shaped the field of medicine and his cumulative works on head injuries and spinal deformities led to the basic understanding of many of the fundamental neurosurgical principles in use today.
- ↑ Ghaemi SN. (2008) Toward a Hippocratic Psychopharmacology. Canadian Journal of Psychiatry 53:189-196. PMID 18441665
- Abstract: OBJECTIVE: To provide a conceptual basis for psychopharmacology. METHOD: This review compares contemporary psychopharmacology practice with the Hippocratic tradition of medicine by examining the original Hippocratic corpus and modern interpretations (by William Osler and Oliver Wendell Holmes). RESULTS: The Hippocratic philosophy is that only some, not all, diseases should be treated and, even then, treatments should enhance the natural healing process, not serve as artificial cures. Hippocratic ethics follow from this philosophy of disease and treatment. Two rules for Hippocratic medicine are derived from the teachings of Osler (treat diseases, not symptoms) and Holmes (medications are guilty until proven innocent). The concept of a diagnostic hierarchy is also stated explicitly: Not all diseases are created equal. This idea helps to avoid mistaking symptoms for diseases and to avoid excessive diagnosis of comorbidities. Current psychopharmacology is aggressive and non-Hippocratic: symptom-based, rather than disease oriented; underemphasizing drug risks; and prone to turning symptoms into diagnoses. These views are applied to bipolar disorder. CONCLUSIONS: Contemporary psychopharmacology is non-Hippocratic. A proposal for moving in the direction of a Hippocratic psychopharmacology is provided.
- ↑ "Hippocrates of Cos" in Scientists: Their Lives and Works, Vols 1–7. Online Edition. U*X*L, 2004. Reproduced in Biography Resource Center. Farmington Hills, Mich.: Thomson Gale. 2007. Document Number:K2641500095.
- ↑ Greek Medicine. History of Medicine Division, National Library of Medicine, National Institutes of Health
- Note: From the website” “Asclepius did not begin as a god, however. It is now thought that he was an actual historical figure, renowned for his healing abilities. When he and his sons, Machaon and Podalirios, are mentioned in The Iliad in approximately the 8th century B.C.E., they are not gods. As his "clan" of followers grew, he was elevated to divine status, and temples were built to him throughout the Mediterranean world well into late antiquity .”
- ↑ Osler W. (1913) The Evolution of Modern Medicine: A Series Of Lectures Delivered At Yale University On The Silliman Foundation In April, 1913. Project Gutenberg's The Evolution of Modern Medicine, by William Osler. Produced by Charles Keller and David Widger.
- Osler writes: "One practice of the temple was of special interest, viz., the incubation sleep, in which dreams were suggested to the patients. In the religion of Babylonia, an important part was played by the mystery of sleep, and the interpretation of dreams; and no doubt from the East the Greeks took over the practice of divination in sleep, for in the AEsculapian cult also, the incubation sleep played a most important role. That it continued in later times is well indicated in the orations of Aristides, the arch-neurasthenic of ancient history, who was a great dreamer of dreams…. There are still in parts of Greece and in Asia Minor shrines at which incubation is practiced regularly, and if one may judge from the reports, with as great success as in Epidaurus. At one place in Britain, Christchurch in Monmouthshire, incubation was carried on till the early part of the nineteenth century. Now the profession has come back to the study of dreams,(19 [=Freud: The Interpretation of Dreams, translation of third edition by A. A. Brill, 1913.]) and there are professors as ready to give suggestive interpretations to them, as in the days of Aristides."
- ↑ Jump up to: 21.0 21.1 Prioreschi P. (1996) The History of Medicine. Volume II: Greek Medicine. 2nd ed. Horatius Press, Omaha. ISBN 1888456027
- ↑ Scoon R. (1928) Greek Philosophy before Plato. Princeton University Press. Princeton, NJ.
- ↑ Parry, Richard, "Empedocles", The Stanford Encyclopedia of Philosophy (Spring 2005 Edition), Edward N. Zalta (ed.), URL = <http://plato.stanford.edu/archives/spr2005/entries/empedocles/>.
- ↑ Pettis JB. (2006) Earth, Dream, and Healing: The Integration of Materia and Psyche in the Ancient World. Journal of Religion and Health, Vol. 45, No. 1
- Excerpt: "Hippocrates’s concerns himself specifically with the study and treatment of the human body, thus separating medicine from philosophical speculation about the natural world such as atomic theory in the thought of Epicurus (371–270 BCE). Apparently, Hippocrates had direct association with the Asclepius temple at Cos, and according to A. J. Brock, he revitalized the Asclepius temple system of his time ([cites] Brock 1916, x)."
- ↑ Longrigg J. (1993) Greek Rational Medicine: Philosophy and Medicine from Alcmaeon to the Alexandrians. Routledge. New York. Full-Text Online with Subscription.
- Excerpt:: Empedocles also exploits the four element theory with similar skill to account for physiological processes like digestion and nutrition....
- Simplicius tells us that he held that food was first cut and ground up in the mouth by the teeth (In phys. 371. 33 D.K.31B61); it was then digested in the stomach, i.e. it was broken down into its constituent elements by a process of putrefaction (sêpsis), [footnote here] presumably under the action of the innate heat of the body. [footnote here]
- Once this digestive process had been completed, the nutriment was then carried to the liver, where it was turned into blood, [footnote here] itself a compound of all the elements in (more or less) equal proportions (In phys. 32-3 D.K.31B98) and thence distributed through the blood vessels (Soranus, Gynaec. I 57, 42. 12 Ilb. D.K.31A79) and assimilated by the body by a process of ‘like to like’ (Aëtius, V 27, 1 D.K.31A77).
- Empedocles apparently considered flesh to be a thickening and secondary formation of the blood since both are composed essentially according to the same formula (cf. B98 last line and Aëtius, V 22, 1 D.K.31A78)—although, presumably, blood would contain a somewhat larger proportion of water than flesh. [footnote here]
- Excerpt reformatted for ease of reading; see Longrigg's book for items in parentheses and footnotes.
- ↑ Jump up to: 26.0 26.1 Lonie IM. (1981) The Hippocratic Treatises; "On Generation"; "On the Nature of the Child"; "Diseases IV": A Commentary. Walter de Gruyter, Berlin & New York. ISBN 3110079038
- ↑ Horstmanshoff HJF.
- ↑ Jump up to: 28.0 28.1 Chang H-h. (2005) [http://www.ncbi.nlm.nih.gov/pubmed/17144070 The Cities of the Hippocratic Doctors. Stud Anc Med. 31:157-171. PMID 17144070. And : In, Hippocrates in Context: Papers read at the XIth International Hippcrates Colloquium, University of Newcastle upon Tyne, 27-31 August 2002. Ed., Philip J. Van Der Eijk. Leiden: Brill. Series: Studies in Ancient Medicine. Vol. 31 ISBN9004144307
- ↑ Jones WHS. (1923) Greek Medical Etiquette. (Free Full-Text PDF download) Proc R Soc Med. 16(Sect Hist Med): 11–17. PMCID PMC2103580
- ↑ Jump up to: 30.0 30.1 Nuland SB. 2008. The Uncertain Art: Thoughts On A Life In Medicine New York: Random House. ISBN 978-1-4000-6478-6.
- ↑ Jump up to: 31.0 31.1 Adams F. (1886) The Genuine Works of Hippocrates, Translated from the Greek with a Preliminary Discourse and Annotations by Francis Adams, LL.D., Surgeon. In Two Volumes. New York: William Wood and Company. 56 & 58 LaFayette Place. [Click ‘Gallery’ tab to view title page.]
- ↑ Jump up to: 32.0 32.1 Hippocrates. The Genuine Works of Hippocrates Edited by: Charles Darwin Adams (trans.). New York: Dover 1868.
- ↑ Jump up to: 33.0 33.1 Lloyd GER. (1983). Hippocratic Writings. Edited with an introduction by G. E. R. Lloyd. Translated by J. Chadwick and W. N. Mann, I. M. Lonie, E. T. Withington. Penguin Books. ISBN I3: 978-0-14-04445I-3. Table of Contents; Most Pages of Introduction
- ↑ Grammaticos PC, Diamantis A. (2008) Useful known and unknown views of the father of modern medicine, Hippocrates and his teacher Democritus. Hell J Nucl Med. 11(1):2-4. PMID 18392218
- ↑ Totelin LM. (2007) Sex and vegetables in the Hippocratic gynaecological treatises. Stud.Hist Philos.Biol.Biomed.Sci. 38:531-540. PMID 17893063
- ↑ Smith CM. (2005) Origin and uses of primum non nocere--above all, do no harm! J.Clin.Pharmacol. 45:371 PMID 15778417
- ↑ Ventegodt S, Clausen B, Omar HA, and Merrick J. (2006) [http://dx.doi.org/ 10.1100/tsw.2006.337 Clinical holistic medicine: holistic sexology and acupressure through the vagina (Hippocratic pelvic massage). ‘’TSW Holistic Health & Medicine’ 1:114–127.
- Note: This article includes a general discussion of the concept and practice of holistic medicine.