Hippocrates

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Contents

Introduction

The Oath of Hippocrates

On Ancient Medicine

On the Sacred Disease (Epilepsy)  

Functions of the Brain

The Diaphragm and the Heart

Source

 

Introduction

Hippocrates is believed to have lived between 460 and 380 BCE. He was born on the Island of Cos, which contained a famous health resort and medical academy. It is not clear how much of the large amount of medical writings attributed to him by Plato and Aristotle came actually from his hand (even the Hippocratic Oath may have been of Pythagorean origin). However, they show that the Greeks had learned to describe the details of a disease and to grasp its whole course. The likelihood that several authors were involved in the Hippocratic works is indicated by the variety of explanations: theories involving from one to four humors, causes of disease attributed air or food and drink, and treatments that involved differing changes in regimen. 

Nevertheless, the beginning of scientific method can be seen as magical explanations are increasingly discarded and material explanations sought. Hippocrates’ description of the causes of epilepsy is inaccurate, but because it is couched in verifiable physical terms it is a step towards finding the true cause. Hippocrates recognized the brain as the organ of the senses, knowledge, and wisdom. Furthermore, there was clearly an emerging humanistic and ethical perspective that was beginning to focus on the individuality of the patient.

 

   

The Oath of Hippocrates

  1    I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his of offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work.

Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

   

On Ancient Medicine

  2     Whoever having undertaken to speak or write on Medicine, have first laid down for themselves some hypothesis to their argument, such as hot, or cold, or moist, or dry, or whatever else  they choose (thus reducing their subject within a narrow compass, and supposing only one or two original causes of diseases or of death among mankind), are all clearly mistaken in much that they say; and this is the more reprehensible as relating to an art which all men avail themselves of on the most important occasions, calling on the good operators and practitioners that they hold in special honor. For there are practitioners, some bad and some far otherwise, which, if there had been no such thing as Medicine, and if nothing had been investigated or found out in it, would have been indistinguishable, for all would have been equally unskilled and ignorant, and everything concerning the sick would have been directed by chance. 

    But now it is not so. In all the other arts, those who practice them differ much from one another in dexterity and knowledge. So it is with Medicine. Therefore I have not thought that it stood in need of an empty hypothesis, like those subjects which are occult and dubious ant attempt to explain things by reference to things above us and things below the earth. If any one should discuss these and undertake to declare how they are constituted, the reader or hearer could not find out whether what is delivered is true or false; for there is nothing that can be referred to in order to discover the truth.

   

  3     But all these considerations belong to ancient Medicine, since that era, a starting point and way have been found out, by which many and elegant discoveries have been made over time, and others will yet be found out, if a person possessed of these discoveries and the proper ability should proceed from them to carry out his investigations. But whoever, rejecting and despising all these, attempts to pursue another course and form of inquiry, and says he has discovered anything, is deceived himself and deceives others, for the thing is impossible. And for what reason it is impossible, I will now endeavor to explain, by stating and showing what the art really is. From this it will be manifest that discoveries cannot possibly be made in any other way. 

    It also appears appears to me that whoever discusses this art should deal with things that are familiar to the common people. For such a person will have nothing to diagnose and treat but of the diseases under which the common people have labored. The origin and passing of these diseases, their increase and decline, illiterate persons cannot easily find out themselves. But still it is easy for them to understand these things when discovered and expounded by others. For it requires nothing more than that every one is put in mind of what has happened to himself. But whoever does not communicate with the illiterate vulgar, and fails to make them listen to him, misses his mark. 

 4     For the art of Medicine would not have been invented at first, nor would it have been made a subject of investigation (for there would have been no need of it), if when men are indisposed, the same food and other articles of regimen which they eat and drink when in good health were proper for them, and if no others were preferable to these. But now necessity itself made medicine to be sought out and discovered by men, since the same things when administered to the sick, which agreed with them when in good health, neither did nor do agree with them.  . . To such a discovery and investigation what more suitable name could one give than that of Medicine? since it was discovered for the health of man, for his nourishment and safety, as a substitute for that kind of diet by which pains, diseases, and deaths were occasioned.

  5     Let us investigate then what is admitted to be Medicine, namely, that invented for the sake of the sick, which possess a name and practitioners, and see whether it seeks to accomplish the same objects, and what its origin is. To me, then, it appears, as I said at the beginning, that nobody would have sought for medicine at all, provided the same kinds of diet had suited with men in sickness as in good health. In fact, even now, such races of men as make no use of medicine, namely, barbarians, and even certain of the Greeks, live in the same way when sick as when in health; that is to say, they take what suits their appetite, and neither abstain from, nor restrict themselves in anything for which they have a desire. But those who have cultivated and invented medicine, having the same object in view as those of whom I formerly spoke, in the first place, I suppose, diminished the quantity of food that they used. This alone would be sufficient for certain of the sick, and be manifestly beneficial to them. However, it would not be beneficial to all, for there would be some so affected as not to be able to manage even small quantities of their usual food, and as such persons would seem to require something weaker, they invented soups, by mixing a few strong things with much water, and thus abstracting that which was strong in them by dilution and boiling. But such as could not manage even soups, laid them aside, and had recourse to drinks, and so regulated them as to mixture and quantity, that they were administered neither stronger nor weaker than what was required.

6   Certain sophists and physicians say that it is not possible for any one to know medicine who does not know what man is and how he was made and how constructed, and that whoever would cure men properly, must learn this in the first place. But this saying rather appertains to philosophy, as Empedocles and certain others have described what man in his origin is, and how he first was made and constructed. I think whatever has been said or written by sophist or natural philosopher concerning nature has less connection with the art of medicine than with the art of painting. And I think that one cannot know anything certain respecting nature from any other quarter than from medicine. Furthermore, this knowledge is to be attained when one comprehends the whole subject of medicine properly, but not until then. I say that the history of medicine shows what man is, by what causes he was made, and other things accurately. Therefore it appears to me necessary to every physician to be skilled in the ways of nature, and strive to know, if he would wish to perform his duties, what man is in relation to the articles of food and drink, and to his other occupations, and what are the effects of each of them to every one.

7   And it is not enough to know simply that cheese is a bad article of food, as disagreeing with whoever eats to satiety. One must know what sort of disturbance it creates, and why, and with what principle in man it disagrees; for there are many other articles of food and drink naturally bad that affect man in a different manner. Thus, to illustrate my meaning, undiluted wine drunk in large quantity renders a man feeble; and everybody seeing this knows that the cause is the power of wine. We know, moreover, on what parts of a man's body wine principally exerts its action; and I wish the same certainty to appear in other cases. For cheese (since we used it as an example) does not prove equally injurious to all men, for there are some who can take it to satiety without being hurt by it in the least; on the contrary, it is wonderful what strength it imparts to those it agrees with. But there are some who do not bear it well. Their constitutions are different, because what in their body is incompatible with cheese is roused and put in commotion by such food. And those in whose bodies such a humor happens to prevail in greater quantity and intensity, are likely to suffer the more from it. But if the thing had been pernicious to the whole nature of man, it would have hurt all. Whoever understands these things will not suffer from it.

  8     During convalescence from diseases, and also in protracted diseases, many disorders occur, some spontaneously, and some from certain things accidentally administered. I know that the common herd of physicians, like the vulgar, if there happen to have been any special event on that day, such as the bath being used, a walk taken, or an unusual food eaten—all which were better done than otherwise—nevertheless attribute the cause of these disorders, to some of these things, being ignorant of the true cause but proscribing what may have been very proper. Now this ought not to be so; but one should know the effects of a bath or a walk unseasonably applied. For then there will never be any mischief from these things, nor from any other thing, nor from repletion, nor from such and such an article of food. Whoever does not know what effect these things produce upon a man, cannot know the consequences which result from them, nor how to apply them.

   

On the Sacred Disease (Epilepsy)

9    It is thus with regard to the disease called Sacred; it appears to me to be nowise more more sacred than other diseases, but has a natural cause from which it originates like other affections. Men regard its nature and causes as divine from ignorance and wonder, because it is not at all like to other diseases. And this notion of its divinity is kept up by their inability to comprehend it, and the simplicity of the mode by which it is cured, for men are supposedly freed from it by purifications and incantations.

    But if it is reckoned divine because it is wonderful, instead of one there are many diseases which would be sacred; for, as I will show, there are others no less wonderful and prodigious, which nobody imagines to be sacred. The quotidian, tertian, and quartan fevers, seem to me no less sacred and divine in their origin than this disease, although they are not reckoned so wonderful. And I see men become mad and demented from no manifest cause, and at the same time doing many things out of place. And I have known many persons in sleep groaning and crying out, some in a state of suffocation, some jumping up and fleeing out of doors, and deprived of their reason until they awaken, and afterward becoming well and rational as before, although they be pale and weak; and this will happen not once but frequently. And there are many and various things of the like kind, which it would be tedious to state particularly.

And they who first referred this disease to the gods, appear to me to have been just such persons as the conjurors, purifiers, mountebanks, and charlatans now are, who give themselves out for being excessively religious, and as knowing more than other people. Such persons, then, using the divinity as a pretext and screen of their own inability to afford any assistance, have given out that the disease is sacred, adding suitable reasons for this opinion, they have instituted a mode of treatment which is safe for themselves, namely, by applying purifications and incantations, and enforcing abstinence from baths and many articles of food which are unwholesome to men in diseases. Of sea substances, the sur-mullet, the blacktail, the mullet, and the eel; for these are the fishes most to be guarded against. And of fleshes, those of the goat, the stag, the sow, and the dog: for these are the kinds of flesh which are aptest to disorder the bowels. Of fowls, the cock, the turtle, and the bustard, and such others as are reckoned to be particularly strong. And of potherbs, mint, garlic, and onions; for what is acrid does not agree with a weak person. And they forbid the patient to have a black robe, because black is expressive of death; or to sleep on a goat's skin, or to wear it, or to put one foot upon another, or one hand upon another; for all these things are held to be hinderances to the cure.

All these they enjoin with reference to its divinity, as if possessed of more knowledge, and announcing beforehand other presents, so that if the person should recover, theirs would be the honor and credit; and if he should die, they would have a certain defense, as if the gods, and not they, were to blame, seeing they had administered nothing either to eat or drink as medicines, nor had overheated him with baths, so as to prove the cause of what had happened.

But I am of opinion that (if this were true) none of the Libyans, who live in the interior, would be free from this disease, since they all sleep on goats' skins, and live upon goats' flesh; neither have they couch, robe, nor shoe that is not made of goat's skin, for they have no other herds but goats and oxen. But if these things, when administered in food, aggravate the disease, and if it be cured by abstinence from them, then God is not the cause at all; nor will purifications be of any avail, but it is the food which is beneficial and prejudicial, and the influence of the divinity vanishes. Thus, then, they who attempt to cure these diseases in this way, appear to me neither to reckon them sacred nor divine. For when they are removed by such purifications, and this method of cure, what is to prevent them from being brought upon men and induced by other devices similar to these? So that the cause is no longer divine, but human. For whoever is able, by purifications and conjurations, to drive away such an affection, will be able, by other practices, to excite it; and, according to this view, its divine nature is entirely done away with.

 10  But this disease seems to me to be nowise more divine than others; but it has its nature such as other diseases have, and an originating cause, and its nature and cause are divine only just as much as all others are, and it is curable no less than the others, unless when, from length of time, it is confirmed, and has become stronger than the remedies applied. Its origin is hereditary, like that of other diseases..

11 When a person has passed the twentieth year of his life, this disease is not apt to seize him, unless it has become habitual from childhood, or at least this is very rare. For the veins are filled with blood, and the brain consistent and firm, so that it does not run down into the veins, or if it do, it does not overpower the blood, which is copious and hot. But when the disease has gained strength from one's childhood, and become habitual, such a person usually suffers attacks, and is seized with them during changes in the winds, especially in south winds, and it is difficult of removal. Then the brain becomes more humid than natural, and is inundated with phlegm, so that the defluxions become more frequent, and the phlegm can no longer be excreted, nor the brain be dried up, but it becomes wet and humid.

This you may ascertain in particular, from beasts of the flock which are seized with this disease, and more especially goats, for they are most frequently attacked with it. If you will cut open the head, you will find the brain humid, full of sweat, and having a bad smell. And in this way truly you may see that it is not a god that injures the body, but disease. And so it is with man. For when the disease has prevailed for a length of time, it is no longer curable, as the brain is corroded by the phlegm, and melted, and what is melted down becomes water. This surrounds the brain externally, and overflows it; so that they are more frequently and readily seized with the disease. And therefore the disease is protracted, because the influx is thin, owing to its quantity, and is immediately overpowered by the blood and heated all through.

But such persons as are habituated to the disease, know beforehand when they are about to be seized and flee from men. If their own house be at hand, they run home, but if not, to a deserted place, where as few persons as possible will see them falling, and they immediately cover themselves up. This they do from shame of the affliction, and not from fear of the divinity, as many suppose. And little children at first fall down wherever they may happen to be, from inexperience. But when they have been often seized, and feel its approach beforehand, they flee to their mothers, or to any other person they are acquainted with, from terror and dread of the affliction, for being still infants they do not know yet what it is to be ashamed.

    Thus is this disease formed and prevails from those things which enter into and go out of the body, and it is not more difficult to understand or to cure than the others, neither is it more divine than other diseases. 

 

 

Functions of the Brain

12   Men ought to know that from nothing else but thence [from the brain] come joys, delights, laughter and sports, and sorrows, griefs, despondency, and lamentations. And by this, in an special manner, we acquire wisdom and knowledge, and see and hear, and know what are foul and what are fair, what are bad and what are good, what are sweet and what unsavory. Some we discriminate by habit, and some we perceive by their utility. By this we distinguish objects of relish and disrelish, according to the seasons; and the same things do not always please us. And by the same organ we become mad and delirious, and fears and terrors assail us, some by night, and some by day, and dreams and untimely wanderings, and cares that are not suitable, and ignorance of present cir­cumstances, desuetude, and unskilfulness. All these things we endure from the brain, when it is not healthy, but is more hot, more cold, more moist, or more dry than natural, or when it suffers any other preternatural and unusual affliction.

13  And we become mad from humidity [of the brain]. For when it is more moist than natural, it is necessarily put into motion, and its sensitivity being changed, neither the sight nor hearing can be at rest, and the tongue speaks in accordance with the sight and hearing. As long as the brain is at rest, the man enjoys his reason, but disorder of the brain arises from phlegm and bile, either of which you may recognize in this manner: Those who are mad from phlegm are quiet, and do not cry out nor make a noise; but those from bile are vociferous, malignant, and will not be quiet, but are always doing something improper. If the madness be constant, these are the causes of it.

But if terrors and fears assail, they are connected with derangement of the brain, owing to its being heated. And it is heated by bile when this is diverted to the brain along the blood vessels running from the trunk. And fear is present until it returns again to the veins and trunk, when it ceases. 

He is grieved and troubled when the brain is unseasonably cooled and contracted beyond its wont. This it suffers from phlegm, and from the same affection the patient becomes oblivious. He calls out and screams at night when the brain is suddenly heated. The bilious endure this. But the phlegmatic are not heated, except when much blood goes to the brain, and creates an ebullition. Much blood passes along the aforesaid veins. But when the man happens to see a frightful dream and is in fear as if awake, then his face has a greater glow, and the eyes are red when the patient is in fear. And the understanding meditates doing some mischief, and thus it is affected in sleep. But if, when awakened, he returns to himself, and the blood is again distributed along the aforesaid veins, it ceases.

     

14   In these ways I am of opinion that the brain exercises the greatest power in the man. This is the interpreter to us of those things which emanate from the air, when it [the brain] happens to be in a sound state. But the air supplies sense to it. And the eyes, the ears, the tongue and the feet, administer such things as the brain cogitates. For inasmuch as it is supplied with air, does it impart sense to the body. It is the brain which is the messenger to the understanding. For when the man draws the breath (pneuma) into himself, it passes first to the brain, and thus the air is distributed to the rest of the body, leaving in the brain its acme, and whatever has sense and understanding. . .        Therefore, I say, that it is the brain which interprets the understanding. 

 

 

The Diaphragm and the Heart

 

15  The diaphragm has obtained its name [as interpreting the understanding] from accident and usage, and not from reality or nature, for I know no power which it possesses, either as to sense or understanding, except that when the man is affected with unexpected joy or sorrow, it throbs and produces palpitations, owing to its thinness, and as having no belly to receive anything good or bad that may present themselves to it, but it is thrown into commotion by both these, from its natural weakness. It then perceives beforehand none of those things which occur in the body, but has received its name vaguely and without any proper reason, like the parts about the heart, which are called auricles, but which contribute nothing towards hearing.

Some say that we think with the heart, and that this is the part which is grieved, and experiences care. But it is not so; only it contracts like the diaphragm, and still more so for the same causes. For veins from all parts of the body run to it, and it has valves, so as to perceive if any pain or pleasurable emotion befall the man. For when grieved the body necessarily shudders, and is contracted, and from excessive joy it is affected in like manner. Wherefore the heart and the diaphragm are particularly sensitive, they have nothing to do, however, with the operations of the understanding, but of all these the brain is the cause. 

      

16  And the disease called the Sacred arises from causes as the others, namely, those things which enter and quit the body, such as cold, the sun, and the winds, which are ever changing and are never at rest. And these things are divine, so that there is no necessity for making a distinction, and holding this disease to be more divine than the others, but all are divine, and all human. And each has its own peculiar nature and power, and none is of an ambiguous nature, or irremediable. And the most of them are curable by the same means as those by which they were produced. For a thing may be food to one, and injurious to another. Thus, then, the physician should understand and distinguish the season of each, so that at one time he may attend to the nourishment and increase, and at another to abstraction and diminution. And in this disease as in all others, he must strive not to feed the disease, but endeavor to wear it out by administering whatever is most opposed to it, and not that which favors and is allied to it. For by that which is allied to it, it gains vigor and increase, but it wears out and disappears under the use of that which is opposed to it. But whoever is acquainted with such a change in men, and can render a man humid and dry, hot and cold by regimen, could also cure this disease, if he recognizes the proper season for administering his remedies, without minding purifications, spells, and all other illiberal practices of a like kind.

   

Source

    

Adapted from The Genuine Works of Hippocrates, translated from the Greek by Francis Adams, Robert E. Krueger Publishing Co, Huntington, N.Y. 1972 (from 1946 reprint of 1849 original).

      

Web Site:  On Ancient Medicine by Hippocrates translated by Francis Adams

 Selection and adaptation Copyright © Rex Pay 200, 2005.