1911 Encyclopædia Britannica/Hippocrates
HIPPOCRATES, Greek philosopher and writer, termed the “ Father of Medicine,” was born, according to Soranus, in Cos, in the first year of the 80th Olympiad, i.e. in 460 B.C. He was a member of the family of the Asclepiadae, and was believed to be either the nineteenth or seventeenth in direct descent from Aesculapius. It is also claimed for him that he was descended from Hercules through his mother, Phaenarete. He studied medicine under Heraclides, his father, and Herodicus of Selymbria, in philosophy Gorgias of Leontini and Democritus of Abdera were his masters. His earlier studies were prosecuted in the famous Asclepion of Cos, and probably also at Cnidos. He travelled extensively, and taught and practised his profession at Athens, probably also in Thrace, Thessaly, Delos and his native island. He died at Larissa in Thessaly, his age being variously stated as 85, 90, 104 and 109. The incidents of his life are shrouded by uncertain traditions, which naturally sprang up in the absence of any authentic record, the earliest biography was by one of the Sorani, probably Soranus the younger of Ephesus, in the 2nd century; Suidas, the lexicographer, wrote of him in the 11th, and Tzetzes in the 12th century. In all these biographies there is internal evidence of confusion, many of the incidents related are elsewhere told of other persons, and certain of them are quite irreconcilable with his character, so far as it can be judged of from his writings and from the opinions expressed of him by his contemporaries; we may safely reject, for instance, the legends that he set fire to the library of the Temple of Health at Cnidos, in order to destroy the evidence of plagiarism, and that he refused to visit Persia at the request of Artaxerxes Longimanus, during a pestilential epidemic, on the ground that he would in so doing be assisting an enemy. He is referred to by Plato (Protag. p. 283; Phaedr. p. 211) as an eminent medical authority, and his opinion is also quoted by Aristotle. The veneration in which he was held by the Athenians serves to dissipate the calumnies which have been thrown on his character by Andreas, and the whole tone of his writings bespeaks a man of the highest integrity and purest morality.
Born of a family of priest-physicians, and inheriting all its traditions and prejudices, Hippocrates was the first to cast superstition aside, and to base the practice of medicine on the principles of inductive philosophy. It is impossible to trace directly the influence exercised upon him by the great men of his time, but one cannot fail to connect his emancipation of medicine from superstition with the widespread power exercised over Greek life and thought by the living work of Socrates, Plato, Aeschylus, Sophocles, Euripides, Herodotus and Thucydides. It was a period of great intellectual development, and it only needed a powerful mind such as his to bring to bear upon medicine the same influences which were at work in other sciences. It must be remembered that his training was not altogether bad, although superstition entered so largely into it. He had a great master in Democritus, the originator of the doctrine of atoms, and there is every reason to believe that the various “ asclepia ” were very carefully conducted hospitals for the sick, possessing a curious system of case-books, in the form of votive tablets, left by the patients, on which were recorded the symptoms, treatment and result of each case. He had these records at his command; and he had the opportunity of observing the system of training and the treatment of injuries in the gymnasia. One of his great merits is that he was the first to dissociate medicine from priest-craft, and to direct exclusive attention to the natural history of disease. How strongly his mind revolted against the use of charms, amulets, incantations and such devices appears from his writings, and he has expressly recorded, as underlying all his practice, the conviction that, however diseases may be regarded from the religious point of view, they must all be scientifically treated as subject to natural laws (De aëre, 29). Nor was he anxious to maintain the connexion between philosophy and medicine which had for long existed in a confused and confusing fashion. His knowledge of anatomy, physiology and pathology was necessarily defective, the respect in which the dead body was held by the Greeks precluding him from practising dissection; thus we find him writing of the tissues without distinguishing between the various textures of the body, confusing arteries, veins and nerves, and speaking vaguely of the muscles as “ flesh.” But when we come to study his observations on the natural history of disease as presented in the living subject, we recognize at once the presence of a great clinical physician. Hippocrates based his principles and practice on the theory of the existence of a spiritual restoring essence or principle, φύσις, the vis medicatrix naturae, in the management of which the art of the physician consisted. This art could, he held, be only obtained by the application of experience, not only to disease at large, but to disease in the individual. He strongly deprecated blind empiricism, the aphorism “ ἡ πεῖρα σφαλερή, ἡ κρίσις χαλεπή ” (whether it be his or not), tersely illustrates his position. Holding firmly to the principle, νούσων φύσιες ἰητροί, he did not allow himself to remain inactive in the presence of disease; he was not a merely “ expectant ” physician; as Sydenham puts it, his practice was “ the support of enfeebled and the coercion of outrageous nature.” He largely employed powerful medicines and blood-letting both ordinary and by cupping. He advises, however, great caution in their application. He placed great dependence on diet and regimen, and here, quaint as many of his directions may now sound, not only in themselves, but in the reasons given, there is much which is still adhered to at the present day. His treatise Περὶ ἀέρων, ὑδάτων, καὶ τόπων (Airs, Waters, and Places) contains the first enunciation of the principles of public health. Although the treatises Περὶ κρισίνμων cannot be accepted as authentic, we find in the Προγνωστικόν evidence of the acuteness of observation in the manner in which the occurrence of critical days in disease is enunciated. His method of reporting cases is most interesting and instructive; in them we can read how thoroughly he had separated himself from the priest-physician. Laennec, to whom we are indebted for the practice of auscultation, freely admits that the idea was suggested to him by study of Hippocrates, who, treating of the presence of morbid fluids in the thorax, gives very particular directions, by means of succession, for arriving at an opinion regarding their nature. Laennec says, “ Hippocrate avait tenté l'auscultation immédiate.” Although the treatise Περὶ νούσων is doubtfully from the pen of Hippocrates, it contains strong evidence of having been the work of his grandson, representing the views of the Father of Medicine. Although not accurate in the conclusions reached at the time, the value of the method of diagnosis is shown by the retention in modern medicine of the name and the practice of “ Hippocratic succession.” The power of graphic description of phenomena in the Hippocratic writings is illustrated by the retention of the term “ facies Hippocratica,” applied to the appearance of a moribund person, pictured in the Prognostics. In surgery his writings are important and interesting, but they do not bear the same character of caution as the treatises on medicine; for instance, in the essay On Injuries of the Head, he advocates the operation “ of trephining” more strongly and in wider classes of cases than would be warranted by the experience of later times.
The Hippocratic Collection consists of eighty-seven treatises, of which a part only can be accepted as genuine. The collection has been submitted to the closest criticism in ancient and modern times by a large number of commentators (for full list of the early commentators, see Adams's Genuine Works of Hippocrates, Sydenham Society, i. 27, 28). The treatises have been classified according to (1) the direct evidence of ancient writers, (2) peculiarities of style and method, and (3) the presence of anachronisms and of opinions opposed to the general Hippocratic teaching—greatest weight being attached to the opinions of Erotian and Galen. The general estimate of commentators is thus stated by Adams: “ The peculiar style and method of Hippocrates are held to be conciseness of expression, great condensation of matter, and disposition to regard all professional subjects in a practical point of view, to eschew subtle hypotheses and modes of treatment based on vague abstractions.” The treatises have been grouped in the four following sections: (1) genuine; (2) those consisting of notes taken by students and collected after the death of Hippocrates; (3) essays by disciples; (4) those utterly spurious. Littré accepts the following thirteen as absolutely genuine: (1) On Ancient Medicine (Περὶ ἀρχαίης ἰητρικῆς); (2) The Prognostics (Προγνωστικόν); (3) The Aphorisms (Ἀφορισμοί); (4) The Epidemics, i. and iii. (Ἐπιδημιῶν α' καὶ γ'); (5) On Regimen in Acute Diseases (Περὶ διαίτης οξέων); (6) On Airs, Waters, and Places (Περὶ ἀέρων, ὑδάτων, καὶ τόπων); (7) On the Articulations (Περὶ ἄρθρων); (8) On Fractures (Περὶ άγμῶν); (9) The Instruments of Reduction (Μοχλικός); (10) The Physician's Establishment, or Surgery (Κατ' ἰητρεῖον); (11) On Injuries of the Head (Περὶ τῶν ἐν κεφαλῇ τρωμάτων); (12) The Oath (Ὄρκος); (13) The Law (Nόμος). Of these Adams accepts as certainly genuine the 2nd, 6th, 5th, 3rd (7 books), 4th, 7th, 8th, 9th and 12th, and as “ pretty confidently acknowledged as genuine, although the evidence in their favour is not so strong,” the 1st, 10th and 13th, and, in addition, (14) On Ulcers (Περὶ ἐλκῶν); (15) On Fistulae (Περὶ συρίγγων); (16) On Hemorrhoids (Περὶ αἰμοῤῥοΐδων); (17) On the Sacred Disease (Περὶ ἱερῆς νούσου). According to the sceptical and somewhat subjective criticism of Ermerins, the whole collection is to be regarded as spurious except Epidemics, books i. and iii. (with a few interpolations), On Airs, Waters, and Places, On Injuries of the Head (“ insigne fragmentum libri Hippocratei ”), the former portion of the treatise On Regirnen in Acute Diseases, and the “ obviously Hippocratic ” fragments of the Coan Prognostics. Perhaps also the Oath may be accepted as genuine; its comparative antiquity is not denied. The Aphorisms are certainly later and inferior. In the other non-Hippocratic writings Ermerins thinks he can distinguish the hands of no fewer than nineteen different authors, most of them anonymous, and some of them very late.
The earliest Greek edition of the Hippocratic writings is that which was published by Aldus and Asulanus at Venice in 1526 (folio); it was speedily followed by that of Frobenius, which is much more accurate and complete (fol. Basel, 1538). Of the numerous subsequent editions, probably the best was that of Foesius (Frankfort, 1595, 1621, Geneva, 1657), until the publication of the great works of Littré, Œuvres complètes d'Hippocrate, traduction nouvelle avec le texte grec en regard, collationnée sur les manuscrits et toutes les éditions, accompagnée d'une introduction, de commentaires médicaux, de variantes, et de notes philologiques (10 vols., Paris, 1839–1861), and of F. Z. Ermerins, Hippocratis et altorum medico rum veterum reliquiae (3 vols., Utrecht, 1859–1864). See also Adams (as cited above), and Reinhold's Hippocrates (2 vols., Athens, 1864–1867). Daremberg's edition of the Œuvres choisies (2nd ed., Paris, 1855) includes the Oath, the Law, the Prorrhetics, book i., the Prognostics, On Airs, Waters, and Places, Epidemics, books i. and iii., Regimen, and Aphorisms. Of the separate works attributed to Hippocrates the editions and translations are almost innumerable; of the Prognostics, for example, seventy editions are known, while of the Aphorisms there are said to exist as many as three hundred. Forsome notice of the Arabic, Syriac and Hebrew translations of works
- " Hippocrates Cous, primus quidem ex omnibus memoria dignus, ab studio sapientiae disciplinam hanc separavit, vir et arte et facundia insignis ” (Celsus, De medicina).