Galen wrote of Hippocrates : We are indeed zealots of Hippocrates, for he has
been an excellent physician (aristos iatros) and philosopher . He surpassed
everyone and was the first to bring to light the perfect medicine (Iatriki)
of Hellenes. He is the man who gave us all the good seeds.
Adamantios Koraes, an 18th century Greek physician and scholar, from the island
of Chios, who lived in France and who edited many masterpieces of the Ancient
Greek Literature, wrote : “The life of Hippocrates is one of few who can
“hardly have a parallel. ?e resembles his contemporary Socrates. History
and his writings testify that studying and practicing Medicine had no other
purpose, but men’s benefit”
It was not just an isolated phenomenon, but the evolution and consequence of
previous ideas and practices. It was ?nly natural for the scientific Medicine
of Hippocrates to appear during the Golden Age of the Ancient Greece.
Hippocratic medicine replaced the theocratic medicine practiced by the priests,
evolving from the Minoan Medicine of Crete mentioned in the Homeric poems, and
by the prehippocratic philosophers. Before the Hippocratic School was formed,
the great medical schools of Kyrene, Kroton, Rhodes, Elaia and Knidos already
A great debate is still going on among scholars (Littré being the first)
about the books that constitute the so called Hippocratic corpus. There are
three possibilities about their author: a) as genuine works of the great Teacher,
b) as written by Hippocrates’ disciples, c) as written at a later time.
The truth is that they represent a continuum, expressing the teachings of the
Hippocratic School of Kos Hippocrates’ son in law, Polyvos is considered
by some to have played an important role similar to that of Plato for Socrates.
It is hard to summarize what the main characteristics of Hippocratic spirit
However, we can emphasize the following main points:
a) Study and description of disease with scientific accuracy, based on detailed
history , careful physical examination, inspection, palpation and auscultation.
b) The importance of the epidemiologic history completed with information about
weather and local conditions prevailing at the time of the epidemic.
c) An effort to elucidate the pathophysiology of disease, as much as the preva?ling
beliefs of the time , but also beyond them.
d) Emphasis on the importance of the “patient and his illness” and
not the illness (nosos) itself.
e) Emphasis on prevention and healthy habits. The physician should be an instructor
of the public for healthy lifestyle in the Hippocratic books we have the first
introduction to the importance of lifestyle.
f) Stress on the significance of diet.(There are 4 books on Diet).
g) Contrary to the School of Knidos, the “whole” and not the “parts”
h) Practice of humane medicine with compassion towards the suffering person.
Hippocratic terms used to this day:
Some of the diseases and terms originating in Hippocratic books are persisting
to our times, such as pneumonia, pleuritis, aphthes, amygdalitis, kynanche,
diftheria, enteritis, ileos, empyema of thorax and abdomen , dysentery, lithiasis,
nephrolithiasis, nephritis, cystitis, spondylitis, karkinos, hemeplegia, paraplegia,
lethargic encephalitis, mania, melancholia, hysteria, opisthotonos, tetanos,
epilepsy, typhos, asthma, echinococcus etc.
In the passage that follows, we can admire the exact requirements for investigating
new areas, characteristic of the Hellenes of the Golden age: “But Medicine
has long had all its means at hand, and has discovered both the principles and
the methods, through which the discoveries made over a long period are many
and excellent; full discovery will be made, if the inquirer is competent, conducts
his researches with knowledge of the discoveries already made, and makes them
his starting point. But anyone who, casting aside and rejecting all these means,
attempts to conduct research in any other way or after another fashion, and
asserts that he has found out anything , is and has been, the victim of deception”
(Ancient Medicine ,21)
To help or at least do no harm: (Ofeleein I mi blaptein):
In all dangerous cases you should be on watch …Declare the past, diagnose
the present, foretell the future, practice these acts. As to diseases, make
a habit of two things – to help, or at least to do no harm.
The Art consists of three factors, the disease, the patient and the physician.
The physician is the servant of the Art. The patient must cooperate with the
physician in combating the disease.” (Epidemics 1st, 11)
Some people say that medicine on those days was paternalistic. The last sentence
speaks to the contrary.
The science of Medicine-Need for Lifestyle Changes:
“Turning now to what is generally admitted to be the science of medicine….
I do not believe anyone would ever have looked for such a science if the same
diet (regimen) were equally good for the sick and the healthy. Even now some
people, the barbarians and some Greeks,, who have no knowledge of medicine,
go on behaving when they are ill, just as they do in health. They neither abstain
from, nor moderate the use of the things they like”. ( On Ancient Medicine
The Importance of Knowing What is Man:
“There are some physicians and sophists who maintain that no one can understand
the science of medicine unless he knows what man is. Anyone who proposes to
treat men for their illnesses must first learn that”.
“I do not believe that any clear knowledge of Nature can be obtained from
any source other than a study of medicine and then only through a thorough mastery
of this science”.( On Ancient Medicine, 20)
Master Description of Diseases:
“There was much rain in Thassos about the time of the automnal equinox
and during the season of the Pleiads…..The summer was for the most part
cloudy but there was no rain. The etisiae (winds blowing yearly in the summer
down to our days) were few and light and blew at scattered intervals……
Many people suffered from swellings near the ears, in some cases on one side
only, in others both sides were involved. Usually there was no fever and the
patient was not confined to bed. In a few cases there was slight fever. In all
cases the swellings subsided without harm and none suppurated as do swellings
caused by other disorders. The swellings were soft, large and spread widely.
They were unaccompanied by inflammation nor pain and they disappeared leaving
no trace. Boys, young men and male adults in the prime of life were chiefly
affected and of these, those given to wrestling and gymnastics were specially
liable. Few women took it. Many patients had dry, unproductive coughs and hoarse
voices. Soon after the onset of the disease, but sometimes after an interval,
one or both testicles became inflamed and painful. Some had fever, some not.
These cases were serious enough to warrant attention, but for the rest, there
were no illnesses requiring care.
“The forman of the big ship hit his index finger with the anchor (ankyra)
Inflammation followed and necrosis and fever…….Later on he complained
that he could not formulate words. The prognosis was that opisthotonos would
Mandibles were immobilized…..All the back of his body was taken by spasms
With sweats …..the third day he died’’ ( Epidemics the 5th,
74) “When Tetanos occurs, the mandibles are immobilized like wood, and
the mouth cannot be opened, the eyes are full of tears ….the spine cannot
bend, the lower extremities do not come together, the same for the hands …..and
when the patient is about to die the fluids that he is trying to swallow flow
from the nose , the same with the sputum”.
(About Diseases the 3d,12)
“ It is better not to treat those who have internal cancers since, if
treated, they die quickly, but if not treated they last a long time” (Aphorisms
“ In a woman in the town of Abdera, carcinoma developed in her breast,
and bloody fluid flowed from the nipple” (Epidemics the 5th ,101)
“Diseases caused by over-eating are cured by fasting. Those caused by
starvation are cured by feeding-up. Diseases caused by exertion are cured by
rest. Those caused by indolence are cured by exertion”. ( Nature of Man
In the book On Diet 3 (Regimen III), there is a detailed program for exercises
according to the season and in relation to the food.
“As for exercises (in summer), practice on the circular track and in the
double stade should be infrequent and short, walking should be in the shade….
After dinner walking should be restricted to a short stroll, but in the early
morning walks should be taken. One should, however, beware of the sun and of
morning and evening chills, such as are given off by rivers, lakes, or snow”.
(Diets,3 (Regimen III), 140, , 14-150)
Medicine and Physicians practicing it.
“Although the art of healing is the most noble of all the arts, because
of the ignorance both of those practicing it and of their rash critics, it has
at this time fallen into the least repute of them all.
“The chief cause for this seems to me to be that it is the only science
for which states( poleis) 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.
“Such men resemble dumb characters on the stage who, bearing the dress
and appearance of actors, yet are not so. It is the same with physicians. They
many in name, few in fact”.
“ Thus exactness is difficult to achieve and small errors are bound to
I warmly commend the physician who makes the least errors. Infallibility is
rarely to be seen. Most physicians seem to me to be in the position of ignorant
captains?. In calm wheather they can conceal their mistakes, but when overtaken
by a mighty storm or a violant gale, it is evident to all that it is their ignorance
and error which is the ruin of the ship will ruin the ship.
“ So it is with the majority of doctors. They treat men who are only slightly
ill…such diseases are many and more common than the serious ones. When
physicians make mistakes over such cases, their errors are not perceived by
the layman, but when they have to treat a serious case, a mistake or lack of
skill is obvious to all, and vengence not long delayed”. (On Ancient Medicine,
Prerequisites for Becoming a Physician
“For a man to be truly suited to the practice of medicine, he must be
possessed by a natural disposition for it, undergo the necessary instruction,
under favorable circumstances, have education, industry and time. The first
prequisite is a natural disposition, for a reluctant student renders every effort
“ The growth of plants forms an excellent parallel to the study of medicine.
Our characters (?????) resembles the soil, our masters’ precepts the seed.
Learning from childhood is the sowing of the seed in season and the circumstances
of teaching resemble the climatic conditions that control the growth of plants.
Dilligence is the working of the soil. Time strengthens all these things, so
that nurture is perfected” (Hippokrates,Law or Canon).
Evidence based Medicine:
“ But conclusions which are merely verbal cannot bear fruit; only those
do which are based on demonstrated facts ( evidence, endeixis). For affirmation
and talk are deceptive and treacherous. Wherefore one must hold fast to facts
….if one is to acquire that ready and infallible habit, which we call
“I urge you not to be unkind, but consider carefully your patient’s
Sometimes offer your services for nothing, calling to mind a previous benefaction
or present satisfaction. And if there be an opportunity of serving one who is
a stranger in financial straits, give full assistance to all such , for where
there is love of man, there is also love of the Art” (Parangeliai 6, (Precepts
The so called Hippocratic Oath is actually older than Hippocrates. How older
though is not possible to define. The Hipoocratic School has accepted and perfected
It is remarkable that in a text of not more than a page long, a code of medical
is presented that survived so many centuries, being accepted and valid to our
days. Initially the first christian physicians did not want to recite the oath
swearing by the idolatric gods, but eventually they ommitted the heading and
kept the text, or changed it to swear by the Holy Trinity.
“I will use my power to help the sick to the best of my ability and judgement.
I will abstain from harming or wronging any man by it”
In this phrase the ethics of the practice of the medical profession are concentrated.
The physician pledges to use all his means, knowledge, and abilities to help
the sick, to the best of his judgement. It is implied that he should keep abreast
of the current knowledge and that he will decide to the best of his judgement.
This has served as the basis of the medical authority and responsibility.
“ I will not give a deadly (thanassimon) medicine ( pharmakon) to anyone
, if I am asked,
nor will I suggest any such a thing. Neither will I give a woman means to procure
It is surprising that such a statement is made against euthanasia and abortion,
showing respect for the beginning and the end of life.
“Whenever I go into a house, I will go to help the sick and never with
the intention of doing harm or injury. I will not abuse my position to indulge
in sexual contacts with the bodies of women or of men, whether they be freemen
“ Whatever I see or hear, professionally or privately ,which ought not
to be divulged, I will keep secret and tell no one”.
The confidentiality, which is so much stressed in the oath, nowadays becomes
problematic with the type of medicine that is increasingly applied worldwide.
It is impossible to keep a medical secret anymore. The data bases are accessible
non medical authorities
As an extension of the principles of the Oath, there are passages describing
humane medicine to be one of the main hippocratic heritages. We encounter concepts
that have been propounded in the Christian era. The great Greek fathers of the
Church have called such concepts the “thyrathen paedeia”, or the
In the book of “Peri Physon” (About Breaths), one of the oldest
books, which deals with the air and its influence on the disease, (Physa is
the inner air, pneuma is the outer air and has been translated in latin as spirit),
the reader is astonished to see the following passage, with which the book begins:
“There are some arts which to those who possess them are painful, but
to those “who use them are helpful, a common good to laymen, but to those
who practice them grievous. Of such arts there is one which Hellenes call Iatriki
“For the physician (iatros) sees terrible sights, touches unpleasant things,
and the “misfortunes of others bring a harvest of sorrows that are peculiarly
“But the sick by means of the art rid themselves of the worst of evils,
disease, “suffering, pain and death, for Medicine proves for all these
evils a manifest cure”.
References for future reading:
- Hippocrates 1923-1995 Loeb Classical Library, Harvard University Press; vol
- Hippocratic Writings 1983 Penguin Classics, (ed) G.E.R. Loyd, London.
- Marketos SG 1997 The medical school of Kos, Hippocratic Medicine, Human Sciences,
Forum, Trends in Experimental and Classical Medicine; vol 7, pp, 313-324.
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