CHAPTER VIIHIPPOCRATES THE GREAT

Hippocrates was born in 460 B. C. in the city of Cos, on the island of the same name. Both his father and grandfather were eminent physicians, descendants of Aesculapius. On his mother’s side he traced his descent from Hercules. The famous painter, Apelles, also hailed from the city of Cos. To distinguish Hippocrates from an earlier individual of the same name he was called Hippocrates II., or the Great. He is said to have received his first instruction in medicine at the school of the Asclepiadae in his native city, but his frequently repeated and very favorable comments on the teachings of the Cnidian school[24]have led some to believe that he may have received a part of his medical training at the latter institution. At a later period of his life his popularity as a teacher of medicine, in the school of the Asclepiadae at Cos, attracted many pupils to that city. In accordance with a custom which prevailed among the physicians of ancient Greece, Hippocrates, at the beginning of his career, spent quite a long time in Athens, and then traveled about, from one city to another, in the character of a periodeutic or itinerant physician. In this way, as he himself reports in some of his writings, he visited Thessaly, Thrace, the Island of Thasos, Scythia, the countries bordering on the Black Sea, and even Northern Egypt. Owing largely to domestic troubles he left his home in Cos, during the latter part of his career, and removed to Thessaly. He died about 370 B. C. at Larissa, at anadvanced age. Soranus of Ephesus, the celebrated obstetrician, reported that in his time (second century A. D.) the tomb of Hippocrates was still standing, and that it had been taken possession of by a swarm of bees whose honey was far-famed for its efficacy in curing ulcers of the mouth in children.

Among the pupils of Hippocrates were his two sons, Draco and Thessalus, and his son-in-law, Polybus. Thessalus, in the capacity of a military surgeon, accompanied Alcibiades on his expedition to Sicily, and later in his career he served as private physician to Archelaus, King of Macedonia. It is also believed that a number of the writings in the Hippocratic collection are from his pen. On the other hand, it is a well-established fact that Polybus is the author of a few of these treatises. When Hippocrates gave up the work of teaching, his son-in-law, who was at that time engaged in private practice in Cos, was chosen his successor in the school.

Among the many anecdotes which are related of Hippocrates, there is one which may with propriety be repeated here:—

On the occasion of a visit to Abdera, in the northern part of Thrace, Hippocrates was requested to examine into the mental condition of the philosopher Democritus, who was thought by his narrow-minded countrymen to be insane. Hippocrates found him deeply engrossed in the study of natural philosophy and asked him what he was doing. Democritus replied that he was investigating the foolishness of men. Whereupon Hippocrates reported that he considered Democritus the wisest of men. (Pagel.)

No better evidence of the true greatness of a man can be furnished than that which is afforded by the praise of his contemporaries in the same rank or walk of life; and when the appreciation comes from such men as Plato and Aristotle, it constitutes an absolute guarantee that it is well and honestly earned. To Hippocrates belongs the singular honor of having won unstinted praise from both of these great philosophers, Aristotle giving him the title of “Hippocrates the Great,” and Plato comparing himto those famous sculptors, Polyclytus and Phidias. His writings and those of the members of his family who were associated with him in the work of promoting a knowledge of medicine were most carefully preserved by his successors. When the Ptolemies began to establish libraries at Alexandria, Egypt (285 B. C.), and manifested a decided readiness to purchase the works of the most celebrated authors, copies of the Hippocratic writings were among those which found their way to that city. This eagerness on the part of the Kings of Egypt to purchase books or manuscripts stimulated unscrupulous persons to attribute to celebrated authors not a few of these works which they offered for sale. The librarians, whose duty it was to guard against such frauds, were not sufficiently well informed to prevent them; and thus there were accepted, as genuine productions, a few books which could not possibly have been written by those to whom they were attributed. The collection of Hippocratic writings did not escape this fate, and the evil was also further aggravated by the fact that copyists and incompetent editors made all sorts of emendations and additions on their own responsibility. Thus, it is not surprising that a collection which originally contained only the writings of Hippocrates and his immediate family, should in course of time have become expanded, not only by such alterations as have just been described, but also by the addition of entire works that had been written by others. At the beginning of the third century B. C., the Ptolemies appointed a committee of learned men in Alexandria to examine carefully the treatises reputed to be the work of Hippocrates and to make a collection of those which appeared to them to be genuine. They performed this task to the best of their ability, but the result showed that they lacked the necessary critical powers; and consequently during the past 2000 years repeated attempts have been made to do what they failed to accomplish, but these efforts have only succeeded in part. The French edition prepared by Émile Littré, the distinguished member of the French Academy of Medicine, and published in the years 1839–1861, was, until quiterecently, universally accepted as embodying the best results of modern research and criticism with regard to this difficult question. But since 1861 other scholars have been busily engaged in perfecting the text of the Hippocratic writings, and their criticisms and suggestions have made it possible to publish a German version of this great work which is of more practical value to physicians than that of Littré, which forms a series of ten large volumes and is no longer easy to obtain. On the other hand, the German version by Robert Fuchs (Munich, 1895–1900), in three volumes of moderate size, while in no respect inferior to the famous French translation, is superior to it in several particulars: it is better adapted to the needs of the ordinary practitioner of medicine, it embodies the results of the excellent critical work done since 1861 (e.g., by Ermerins of Utrecht, Daremberg of France, and Ilberg and Kühlewein of Germany), and it costs very much less than its French predecessor and rival.

As regards the question of authenticity of the treatises contained in the work known as “The Hippocratic Writings” the most important thing to be determined is, not whether this or that book or chapter in the collection was really written by Hippocrates, but whether the work in its totality gives a correct and fairly complete picture of the best medical thought and practice of the period during which Hippocrates lived; and to this question a decided answer in the affirmative may be given. As to the broad question of authenticity, Max Neuburger, the distinguished Viennese author of the latest and most authoritative history of medicine, thus expresses himself:—

Notwithstanding the extremely small quantity of evidence which the so-called “Hippocratic Writings” themselves furnish as to who were the writers of the individual treatises and as to what Hippocrates himself actually did or thought; and although it is true that portions of the collection often contradict one another both in regard to questions of theory and also in regard to methods of treatment, one fact stands out conspicuously, viz., that the peculiar character of these writings both as a collection and taken separately, not only gives them a unique position in medicalliterature, but reveals plainly that they owe their origin directly or indirectly to the powerful influence of a single commanding personality.

As to the manner of teaching medicine, the Hippocratic writings show that, at the time which is here under consideration, the mystical features had almost completely disappeared. The science was now taught by regular instructors, who agreed for a stipulated fee to take charge of the pupil’s entire training from the beginning to the end of the course. Candidates who were in delicate health were discouraged from entering upon the career of a physician, and those who had completed the regular course of instruction were sent out into the world equipped with certain general principles for their future guidance in actual practice. Some of these bear a close resemblance to the principles of a similar nature which had been established at a much earlier period in India. For example, the importance of cleanliness of the person is strongly emphasized. Reticence, as well as courtesy, is classed as one of the virtues of a good physician.

He who acts hastily and does not take sufficient time for consideration is sure to be criticised unfavorably. If he breaks out too readily into laughter he will be thought uncultivated.

In another of the Hippocratic writings the physician is urged not to indulge in too much small talk, but to confine his conversation as much as possible to matters relating to the treatment of the disorder.

In his business dealings the physician, like a genuine philosopher, should not display a greed for money, he should assume a modest and dignified attitude, he should appear quiet and calm, and his speech should be simple and straightforward and free from all superstition.

For their knowledge of human anatomy the physicians of that period were obliged to depend on the dissection of animals. Specimens of human bones were of course easily accessible, and consequently the descriptions which aregiven of these structures are quite accurate, even as regards many of the finer details.

It would be a very difficult matter to furnish here, within a limited space, a reasonably clear exposition of the views held by Hippocrates with regard to human physiology and pathology. Empedocles, a Greek physician and high priest of Agrigentum, in Sicily, who was born about 490 B. C., founded a system of philosophy on the theory that the universe is made up of four elements—fire, air, earth and water; and he maintained that fire is the essence of life, the other elements forming the basis of matter. It was upon this system that Hippocrates founded his own theories of life, death and disease, but he disagreed with Empedocles in regard to the manner in which the four elements are united, his own belief being that they form together a genuine mixture, whereas Empedocles maintains that their union represents merely a mechanical aggregation of separate atoms. He also held that these original four elements, to which he gave the names of heat, cold, dryness and moisture, were represented in the human body by the following four cardinal fluids or “juices”: blood, mucus or phlegm, black bile and yellow bile.[25]He maintained, further, that when these elements are mingled harmoniously so as to produce a state of perfect equilibrium, health resulted; but that when some deficiency of one or more of them, or some lack of harmony between them in other respects, occurs, disease is produced. At a later date, a fifth element—wind or air (pneuma)—was added to the other four; and when Hippocrates was unable to account satisfactorily for certain phenomena of disease, he was wont to refer the phenomenon observed to divine interference.

This brief exposition of the physiological and pathological views held by Hippocrates, incomplete and superficial as it is, will have to suffice. Those who wish to acquire a more profound knowledge of the subject should consult some of the larger treatises like those of Daremberg,of Max Neuburger, and of Pagel, as well as the sections devoted to these subjects in the French (Littré) and the German (Fuchs) versions of the Hippocratic writings. At every step in such a study, the modern physician will encounter ideas and individual terms which he will have great difficulty in comprehending; and later on, as he reads the sections which deal with the more practical matters of the medical art, he will be astonished to find that Hippocrates was a most acute and trustworthy observer of the phenomena of disease, a remarkably clear writer, and a standard-bearer of very high aims.

In the examination and treatment of the sick the physicians of ancient Greece were highly trained. They paid very close attention to the patient’s account of his symptoms, but it was to the physical examination of the diseased body that they attached the greatest importance. They noted with extreme care the color and other peculiarities of the skin and mucous membranes, the condition of the abdomen, and the shape and movements of the thorax; they tested the patient’s temperature by placing the hand upon the body; and all the excretions were subjected to the closest scrutiny. By means of palpation they were able to determine not only the size of the liver and spleen, but also the changes which occur in the form of these organs in the course of certain diseases. They utilized succussion both as an aid to diagnosis and as a means of favoring the breaking through of pus into the bronchial tubes. They were familiar with the pleuritic friction sound and with the finest râles, which they compared to the creaking of leather or “the noise of boiling vinegar.” In their descriptions of these sounds it is distinctly stated that the examiner’s ear was kept tightly pressed against the patient’s chest.

In speaking of the accounts of individual diseases which appear in the Hippocratic writings, Puschmann says that they are evidently based on cases actually observed in practice, and that they are admirably written. It is in the laws which they have laid down with regard to the treatment of disease, however, that the Hippocratic writers havegained their chief distinction, a distinction which will belong to them through all time.

The physician should be the handy man of Nature, and he should strive to aid and to imitate her efforts to effect a cure. His first care should be to remove, so far as is possible, the causes of the disease; and then, in the conduct of the treatment, he should keep in view at all times the special circumstances of the case, giving closer attention to the patient than to the disease itself. In short, he should aim at being useful, or at least he should be careful not to do any harm.

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