The ghost of Hippocrates looms over every encounter between a doctor and a patient. To the medic, he is a pioneer, who persuaded the Western world to abandon primitive superstitions in favour of systematic enquiry into human health and disease. He is the reason doctors can ask ‘do you get any burning or stinging when you go for a wee?’ and other such impertinent questions. To the patient, he is the guarantor of their doctor’s integrity; the benevolent authority who holds physicians to their promise that they will “first, do no harm.” And for both, he is the emblem of a compassionate and holistic style of medicine, the death of which is often lamented in waiting rooms and staff rooms around the world.
But is it really justified to place such a heavy burden of hopes and fears on the shoulders of one man? Seeing as I’ve named my blog about him, I probably ought to have a think about it.
Facts, or fake news?
We can’t actually pin down a great number of facts about Hippocrates’ life. We know he was born around 460 BC, on the Greek island of Kos, and became a physician of great renown, to the extent that he was name-checked as such by Plato in his dialogue Protagoras. But this is one of only a handful of extant contemporary references to Hippocrates, and even the Hippocratic Writings (or Corpus) are not in a single person’s hand. It’s therefore impossible to reliably ascribe all the achievements of Hippocratic medicine to one man .
But this is perhaps to overlook the point. The Ancient Greeks handed down names like Homer, Lycurgus and Solon through the centuries in order to enhance the origin-myths of their social and cultural institutions. It can be debated to what extent we can identify these individuals as real people, and which supposed achievements are truthfully theirs, though we have little evidence to actually base the debate on. In a similar way to the poet and the lawgivers, Hippocrates’ name has been useful to societies throughout history, as a repository of ideals about practising medicine. This melting pot of qualities has been dipped into by various people through the ages to serve their own ends.
Dirty work
It’s vital to recognise that Hippocratic medicine was not the dominant mode of healthcare in Ancient Greece; physicians were competing with charlatans, bone-setters, priests and others for their livelihoods. The Hippocratic Writings are a hodgepodge of treatises, written in different styles by different authors with different views. But one thing they all have in common is that they seek to glorify the discipline of medicine while disparaging other healthcare practitioners. In the Writings we can see a great effort not only to disparage quacks but also to carve out a niche for medicine as a noble exercise of the mind, and an inquiry into nature itself. Here is one example, from The Canon:
The art of healing is the most noble of all arts, yet…it has at this time fallen into the least repute of them all…it is the only science for which states have laid down no penalties for malpractice. Ill-repute is the only punishment and this does little harm to the quacks who are compounded of nothing else.
Hanging onto coat-tails
If we now fast-forward five hundred years, to the career of Galen, we can see how Hippocrates’ name became invoked for his authority on physiology. Galen, born in 129 AD, was a Greek physician born in the time of the Roman Empire. He wrote many commentaries on various Hippocratic treatises, but he also made them the centre of his own framework of health and disease. He built his reputation and theories on the indisputable authority of Hippocrates’ doctrines; this is an excerpt from On the Natural Faculties:
I have shown elsewhere that these opinions were shared by Hippocrates, who lived much earlier than Aristotle. In fact, [of] all those known to us who have been both physicians and philosophers, Hippocrates was the first who took in hand to demonstrate that there are, in all, four mutually interacting qualities…and at least the beginnings of the proofs to which Aristotle later set his hand are to be found first in the writings of Hippocrates.
For various reasons, Galenic theory became the supreme, unquestionable truth in Western medical thinking for over one thousand years, and as it did, the name of Hippocrates was carried along too. In the sixteenth century, Andreas Vesalius, one of the first modern anatomists, struck a major blow to Galen’s reputation by demonstrating that much of his anatomical teaching was incorrect. Further blows rained down on Galen’s physiology in the Scientific Revolution of the seventeenth century. But the versatility of Hippocrates ensured his name would fight another day.
Liberation from the lab
During the seventeenth and eighteenth centuries, the fields of anatomy and physiology grew ever stronger, and dissection of corpses and experimentation in laboratories became de rigueur. Hippocrates’ name now began to stand for the somewhat quaint notion of meticulously observing patients at the bedside, which is perfectly seen in this extract from Epidemics, a treatise of the Writings:
Heropythus at Abdera had a headache; he remained up for a while but eventually went to bed with it. He lived near the upper highroad. He showed a fever of the causus type. At first he vomited much bilious matter and suffered from thirst and much distress. His urine was thin and dark; sometimes, but not always, it contained suspended matter. An uneasy night. The fever showed paroxysms at varying intervals, for the most part quite irregular.
About the fourteenth day, he complained of deafness and the fever increased; the urine remained as before.
Twentieth and following days: much delirium.
Fortieth day: a large epistaxis and became more lucid. The deafness was still present but more severe. The fever abated. Small epistaxis occurred frequently on the following days
Thomas Sydenham (1624-89), an English physician who was regarded as something of a maverick in his time, was so renowned for this approach that he became known as the “English Hippocrates.” He famously told a young student “all that [anatomy and botany] is stuff, you must go to the bedside, it is there alone you can learn disease.” He in turn was admired by Herman Boerhaave, professor at Leiden University from 1702. Boerhaave maintained that “nobody after Hippocrates had shown such exactitude in observation as Sydenham,” and in his first public address after taking up his position, he exhorted his students to return to the ideals of Hippocrates.
Boerhaave was nicknamed the “medical instructor of the whole of Europe,” such was Leiden’s pre-eminence as a centre for learning. It was under his influence that Leiden became a pioneer in bedside teaching, with two wards of a local charity hospital earmarked for this purpose. Bedside teaching might be a common experience for patients these days, but back then it was a major innovation. And through it, the echoes of Hippocrates’ name began to reach patients’ ears for the first time since antiquity.
Echoes of ourselves
Phaedrus: “Hippocrates the Asclepiad says that the nature even of the body can only be understood by the whole”
Plato: Phaedrus
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.”
The point of all these examples is to show that what we think about Hippocrates says as much about us as it does the man himself. Medicine and society don’t exist inside their own separate bubbles; the relationship between doctors and patients is much more complicated than that. By examining medicine through the lens of history and the arts, I think there is a lot that we can all learn about ourselves, and that’s what this blog will keep trying to explore.
Postscript
This is supposed to be a blog, rather than a formal essay, believe it or not. That’s why I didn’t reference my sources as I went along. But you might like to know whose work I have leaned on, and you might like to see for yourself some of the materials I’ve spoken about. So here is a list of resources I have used, and where you might find them on the internet.
Hippocratic Writings, edited by G.E.R. Lloyd. Penguin Classics, 1978.
You can also find some online translations here
The Greatest Benefit to Mankind, Roy Porter. Fontana Press, 1999.
You will probably never find an article on the history of medicine that doesn’t reference Roy Porter in some way
What is History? E.H. Carr. Penguin Modern Classics, 2018.
Galen: On the Natural Faculties, translated by Arthur John Brock. Medicina Antiqua, UCL. Available online here
Boerhaave and Great Britain, G.A. Lindeboom. 1974.
Excerpts (hand on heart, the only bits I’ve been able to read myself) available online here
Images courtesy of the Wellcome Collection. You can look through their extensive catalogue here