Many of the early Greek philosophers and medical writers have been largely forgotten, but the name Hippocrates (ca. 460-360 b.c.e.) has become synonymous with the phase ''Father of Medicine.'' The establishment of medicine as an art, a science, and a profession of great value and dignity has been associated with the life and work of Hippocrates. Yet surprisingly little is known about his life. Indeed, some historians insist that Hippocrates was neither the author of the Hippocratic collection nor even a real person. For the sake of simplicity and tradition, we shall use the name Hippocrates as the exemplar of the ideal physician of antiquity and for any of the authors of the medical texts attributed to Hippocrates. Presumably, these texts were written by physicians who practiced medicine in accordance with the principles known to us as Hippocratic medicine.
Although Hippocrates was widely praised and respected in antiquity, many of the most fascinating biographical details were supplied several centuries after his death. Historians note that, in response to changing cultural and social circumstances, the idea of Hippocrates and Hippocratic medicine have been subjected to cycles of construction, reconstruction, and transformation ever since antiquity. It was probably during the Renaissance that the modern picture of Hippocrates emerged. Today, the image of Hippocrates is invoked as a model for the ideal physician and the philosophy of humanistic holism.
According to ancient biographers, Hippocrates was born on the island of Cos, lived a long, exemplary life, and died in Larissa when 95 or perhaps 110 years old. In genealogical tables constructed by his later admirers, Hippocrates traced his ancestry back to Asclepius on his father's side and to Hercules on the maternal side. Plato and Aristotle spoke of Hippocrates with respect, despite the fact that he taught medicine for a fee. Not all ancient writers praised Hippocrates. The Father of Medicine was accused of burning down the medical library at Cos in order to eliminate competing medical traditions. An even more unflattering story accused Hippocrates of plagiarizing the prescriptions of Asclepius before destroying the god's temple and claiming clinical medicine as his own invention. Another legend says that the great doctor
never thought about collecting fees and was always ready to admit his errors.
Whatever uncertainty there may be about Hippocrates himself, the collection of some fifty to seventy essays and texts attributed to him is undoubtedly the foundation of Western medicine. Ironically, as scholars gained more information about the writings of the ancients, they had to admit to less and less certainty about distinctions between the ''genuine'' and the ''spurious'' works of Hippocrates. Nevertheless, throughout Greek, Roman, and medieval times, the texts that had made their way into the Hippocratic collection remained authoritative and worthy of study, interpretation, and commentary. In Western history, Hippo-cratic medicine is revered for its emphasis on the patient instead of the disease, observation rather than theory, respect for facts and experience rather than philosophical systems, ''expectative therapy'' (rather like ''watchful waiting'') as opposed to ''active intervention,'' and the Hippocratic motto: ''At least do no harm.''
One of the most important and characteristic expressions of Hippocratic medicine is found in the text known as On Ancient Medicine. A major thesis of this work is that nature itself has strong healing forces. The purpose of the physician, therefore, was to cultivate techniques that would work in harmony with natural healing forces to restore the body to a harmonious balance. Other characteristics of the Hippocratic texts are perceptive descriptions of the symptoms of various diseases, insights into medical geography and anthropology, and explorations of the idea that climate, social institutions, religion, and government can affect health and disease.
By assigning explanations for the phenomena of health and disease to nature and reason, the Hippocratic physician rejected superstition, divination, and magic. In other words, if the world was uniform and natural, all phenomena were equally part of nature. If the gods were responsible for any particular phenomenon, they were equally responsible for all phenomena. Thus, nature was everywhere both natural and divine. While Hippocrates ridiculed the deceptions practiced in the name of religious healing, he was not opposed to prayer and piety. ''Prayer indeed is good,'' Hippocrates conceded, ''but while calling on the gods one must oneself lend a hand.'' Skepticism was also appropriate with respect to the claims of philosophers, because, according to Hippocrates, one could learn more about nature through the proper study of medicine than from philosophy alone.
The true physician understood that disease was a natural process, not the result of possession, supernatural agents, or punishment sent by the gods. Disease could be interpreted as punishment only in the sense that one could be punished for transgressing against nature by improper behaviors. Thus, to care for his patient, the physician must understand the constitution of the individual and determine how health was related to food, drink, and mode of life.
In a fundamental sense, dietetics was the basis of the art of healing. According to Hippocrates, human beings could not consume the rough food suitable for other animals; thus, the first cook was the first physician. From such crude beginnings, the art of medicine developed as people empirically discovered which diets and regimens were appropriate in sickness and in health. As medicine became more sophisticated, physicians became skilled and knowledgeable craftsmen. As knowledge about human beings and nature accumulated, philosophers propounded theories about the nature of human life and derived therapeutic systems from their theories. Medicine and philosophy interacted to their mutual benefit, but Hippocrates refused to be bound by any rigid medical dogma, or therapeutic system, such as treatment by ''similars'' or ''opposites.'' The experienced physician knew that some diseases were cured by the use of opposites and others by the use of similars. That is, in practice, the physician discovered that some ''hot'' diseases in some patients could be cured by cooling medicines, while others might require warming remedies.
While the physician must not be bound by philosophical systems, neither should a practitioner of the healing art ever act as an unthinking technician. The true physician understood the principles guiding his course of action in each case, as related to the nature of man, disease, diagnosis, remedies, and treatment. Moreover, this display of medical knowledge and proper behavior helped win the trust of the patient.
In the absence of legally recognized professional qualifications and standards, virtually anyone could claim to be a physician. Thus, to secure his reputation and compete with quacks and magicians, the physician had to prove that medicine was an art and a science that could promote health and cure disease. Complaints about ignorant physicians and outright quacks appear in many Hippocratic texts, suggesting that the profession was already plagued by impostors who were bringing disrepute to the art.
The related problems of professional recognition, standards of practice, and ethical obligations are addressed in several Hippocratic texts. However, the well-known formula known as the ''Hippocratic Oath'' may have been composed and popularized long after the death of Hippocrates. There is little doubt that the Oath was originally Greek, as indicated by various ancient manuscripts and inscriptions on Greek temples. There are many uncertainties about the origins, usage, purpose, and meaning of the Oath, but there is considerable evidence to suggest that the text honored as the nucleus of Western medical ethics was actually a ''neo-Pythagorean manifesto.'' During the Roman era, Greek physicians like Scribonious Largus, personal physician to the Emperor Claudius, cited the Hippocratic Oath as proof of their good intentions and reliability. However, the Oath apparently had limited influence until it was essentially adopted as a useful bridge between antiquity and Christianity.
Although the Oath includes the promise to practice medicine for the benefit of the patient, a prohibition against giving anyone a lethal drug, or using medical knowledge to cause the sick any danger or injury, it was primarily a private contract between a new physician and his teacher, not, as commonly assumed, a promise from practitioner to patient. Indeed, the Greeks had no official medical practice act to enforce such contracts. Presumably, it was love of the art, joined with love of man and fear of dishonor, more than the swearing of oaths that made the Hippocratic physician conform to the highest standards of medical ethics.
The fact that the Hippocratic Oath prohibits prescribing a ''destructive pessary'' may be the most compelling evidence that the Oath represents the precepts of the Pythagoreans rather than Greek physicians in general, because this prohibition was essentially unique to that sect. The ancients generally accepted abortion and infanticide as means of population control. Surgical abortions were condemned because they were more dangerous than childbirth, not because they were necessarily immoral. Moreover, unwanted infants could be ''exposed.'' Generally, midwives dealt with normal childbirth, abortion, and assorted ''female complaints,'' but the physician could prescribe appropriate fumigations, fomentation, washes, and pessaries. Although the Hippocratic texts discuss the diseases of women in some detail, Hippocrates acknowledged that women were often so reluctant to discuss their problems with physicians that simple illnesses became incurable. According to some calculations, gynecological texts make up about a quarter of the Hippocratic collection.
Within the ethical framework of antiquity, very different patterns of medical treatment were considered appropriate to the rich and the poor. For the rich, the aesthetic pursuit of health was far more significant than the mere absence of disease. Striving for optimum health required a complex, time-consuming regimen and presupposed that the patient could assign complete control over food, drink, exercise, rest, and other aspects of life to the most skillful physician. Patients who were free but poor could expect an intermediate kind of pragmatically designed medical care, without the benefits of individualized regimens. Remedies that acted swiftly were appropriate for patients lacking time and money, because the poor must either recover quickly and resume their work or die and so be relieved of all further troubles. The Hippocratic texts indicate that the physician did not necessarily refuse to treat slaves, or to adapt dietetic therapy to the needs of the poor. But various sources suggest that, for the most part, the treatment of slaves was rather like veterinary medicine and was carried out by the doctor's servants.
Ideally, the Hippocratic physician did not practice medicine merely for the sake of money, but like other craftsmen who had perfected their skills, the physician was entitled to a fee for his services. The ethical physician was expected to consider the status of the patient in determining the size of the fee. He was not to argue about fees before treating a patient, especially in acute illnesses, because extra worries might interfere with the patient's recovery. Patients without money who hoped to acquire the services of the ideal physician described in the Hippo-cratic texts were well advised to remember the Greek proverb ''There is no skill where there is no reward.''
Many noble sentiments about the practice of medicine and the relief of suffering are found in the Hippocratic texts, but the limits of the art were sharply defined. Knowing that it was impossible to cure all patients, the physician had to determine which patients would die in order to avoid blame. Thus, the injunction against treatment in diseases that were necessarily fatal was a fundamental principle of Hippocratic medicine. Unlike the temple priest, who had the authority of the gods to protect and excuse him, the secular physician was in a peculiar, highly vulnerable position. Only skill, success, and a rigorous commitment to the ethical standards of the profession protected the physician. Ultimately, the physician was a craftsman, who was judged by his patients—not by a peer review committee—according to the results of his art.
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