Hippocrates

Hippocrates of Kos was a Greek physician of the fifth and fourth centuries BCE, traditionally called the father of medicine. Very little is known for certain about his life, and none of the roughly sixty to seventy medical treatises that carry his name can be proved to be his own work. What his name stands for is clearer: the idea that disease has natural causes and should be understood through careful observation of the patient, not explained by the anger of the gods.

Hippocrates was born around 460 BCE on Kos, an island in the eastern Aegean off the coast of Asia Minor. He belonged to a family of physicians known as the Asclepiads, who claimed descent from Asclepius, the god of healing. He was reportedly trained by his father and grandfather and by Herodicus of Selymbria, a physician known for prescribing exercise, and he is said to have known the sophist Gorgias.

He was famous in his own lifetime. Plato, writing in the early fourth century BCE, mentions him twice as a well-known doctor who took fee-paying pupils and who believed the body could only be understood as a whole. Aristotle refers to him as the great Hippocrates, meaning great as a physician though not tall. These brief references are the only near-contemporary evidence.

Most other details come from a Life attributed to Soranus of Ephesus, written some five centuries later, and from Byzantine reference works. According to these, he taught on Kos, travelled widely in Thessaly, Thrace and around the Sea of Marmara, and died at Larissa in Thessaly at a great age, given variously as 83, 85, 90 or over 100. A traditional date of death is around 370 BCE. His sons Thessalus and Draco and his son-in-law Polybus were said to have carried on his work.

Many stories grew up around him that historians regard as later inventions. One claims he ended the plague that struck Athens in 430 BCE, during the Peloponnesian War and in the time of Pericles, by lighting fires throughout the city. Thucydides, who caught the plague himself and described it in detail, does not mention him. Another has him refusing gold from the Persian king Artaxerxes, ruler of the Achaemenid Empire, out of loyalty to Greece, a story popular in later art. A body of letters said to be his, including an exchange about treating the philosopher Democritus for madness, is also spurious.

The Hippocratic Corpus is a collection of medical writings in the Ionic dialect of Greek, assembled in the third century BCE, probably at the great library of Alexandria in the Ptolemaic Kingdom. The texts differ in style, date and opinion, sometimes contradicting one another, and were clearly written by many authors over a long period, some probably before Hippocrates and some after him. Ancient scholars already argued over which were genuine. It is likely that the librarians filed medical works under the most famous physician's name.

The collection covers a remarkable range. On Airs, Waters and Places argues that climate, water supply and way of life affect health, and that a doctor arriving in a new town should study them. On the Sacred Disease attacks the idea that epilepsy is sent by the gods, arguing that it has a natural cause in the brain like any other illness and that those who call it sacred are hiding their ignorance. The Prognostic teaches the physician to predict the course of an illness from the patient's signs. The Epidemics records individual case histories day by day, including many that ended in death. The Aphorisms condense medical advice into short sayings, the first of which begins: life is short, the art is long. Other treatises deal with fractures and dislocations, wounds of the head, diet and the diseases of women.

The physicians of the Hippocratic tradition looked for natural explanations. They paid close attention to the patient's face, breathing, pulse, temperature, urine and sleep, and they took account of age, diet, occupation and surroundings. The writers described the appearance of a dying patient's face, still called the Hippocratic face, and the clubbing of the fingers seen in chronic lung and heart disease. They classified illnesses as acute or chronic and as epidemic or endemic, and believed that many diseases reached a crisis on predictable days, after which the patient would either recover or die.

Treatment was usually cautious. The body was thought to have its own power to heal, and the physician's job was to support it with rest, diet, cleanliness, exercise and simple remedies, using drugs and surgery sparingly. The surgical texts nonetheless describe setting bones with traction, reducing dislocated shoulders and draining pus from the chest.

The best-known theory associated with the Corpus is that of the four humours: blood, phlegm, yellow bile and black bile. Health was a balance between them, and illness came from an excess or deficiency of one. The fullest statement, in On the Nature of Man, was attributed in antiquity to Polybus rather than Hippocrates. Humoral theory was wrong, but it gave a coherent natural framework that lasted until the nineteenth century.

Kos was one of two rival medical centres in the region. The other, at Knidos on the mainland opposite, concentrated on identifying and naming distinct diseases, while the Koan tradition stressed prognosis and the care of the whole patient.

The Oath is the most famous text in the Corpus. It begins with an invocation of Apollo, Asclepius, Hygieia and Panacea, and binds the physician to honour his teacher, to act for the benefit of the sick, to give no deadly drug, to avoid sexual relations with patients and to keep secret what he learns in their homes. Most historians date it after Hippocrates and think it came from a particular group of physicians rather than Greek medicine as a whole. The phrase "first, do no harm" is not in the Oath; the closest ancient wording, in the Epidemics, tells the doctor to help, or at least not to harm.

The Hippocratic writings became the foundation of Greek medicine. Galen, the second-century physician who worked in Rome under the Roman Empire, revered Hippocrates and built his own vast system on the humoral theory, which then dominated medicine for well over a thousand years. Translated into Arabic, the Corpus was studied by physicians of the Islamic Golden Age such as Avicenna, and from the Renaissance European doctors returned to the Greek texts directly, reviving the practice of recording careful case histories. Versions of the Oath, much modified, are still sworn by medical graduates in many countries.