On the Hippocratic Sources of Western Medical Practice

One of the key figures in Western medicine is the fourth century Greek physician, Hippocrates. The Hippocratic Oath binds new physicians to the ethos and profession of medicine, while the Western tradition of scientific medicine traces its roots to the Hippocratic corpus. We will not attempt an exhaustive historical or philosophical analysis of the thinking of Hippocrates and his followers, but rather describe the most important Hippocratic influences still bearing on contemporary medicine in the West. We will highlight some of the major ideas found in notable quotations contained in the Hippocratic corpus, describing their centrality to and continuing life within the foundations of Western scientific medicine, and speculate briefly on other matters of some current importance. Hippocrates and His Time Hippocrates is thought to have lived from 460 to 370 B.C.E., during the great age of Greek cultural dominance. He was a contemporary of Aristotle and Plato, may have been friends with Democritus, and died a decade or so before the birth of Alexander the Great. He taught medicine on the Island of Kos, as had his father and grandfather before him, it is thought. One can postulate that the achievements of his long life were built on foundations laid by a long line of physicians. Indeed, scholars have had much difficulty in identifying with certainty which parts of the large Hippocratic corpus were written by Hippocrates himself and which may have been written by predecessors or by innumerable followers in the centuries after his death. The great anthropologist Margaret Mead points out that prior to the Hippocratic tradition, the physician and the sorcerer tended to be the same person, and she credits the Greeks of the fourth and fifth centuries with forever making clear the distinction between the two.1 The pre-Hippocratic practitioners of medicine were empiricists who used treatments indiscriminately or mystics who claimed control over nature through magic and ritual. Hippocratic medicine for the first time introduced a new approach based on reason in the natural order of things and a framework of scientific knowledge. As Pedro Lain-Entralgo characterizes it, Hippocratic doctors needed to know the illnesses they were treating, what remedy would cure the illness, and why the remedy worked. Along with this historic transition in the practice of medical skills evolved the concept of medicine as a technical a body of scientific study to be mastered, taught, expanded, and documented.2 Hippocrates insisted on careful observation and the keeping of notes. He believed that the interaction of nature, the patient, and the physician determined the outcome of the illness. Contrary to what became central Judeo-Christian belief, Hippocrates did not believe that God placed the earth and nature at humanity's disposal or that humans were lords of the earth. Rather, he felt deeply that humanity worked within the confines of nature and must collaborate with it to achieve the best health and to avoid disease. He had in fact a remarkably broad concept of health and disease that is not now widely appreciated.3 The collected writings of the Hippocratic corpus comprise a kind of running textbook of medicine, carefully describing diseases and known treatments. Hippocrates detailed his treatment failures so that others would not repeat them. He followed his patients until the disease had run its course, even if it took months. He treated all comers, whether free or in bondage, and he describes the need to treat each person with dignity and the diseased body as still sacred. Instead of incantations or prayers, the physician's art, his technique, required careful observation, clear thinking, and useful intervention without doing harm. In fact it is the prohibition against medical harm that particularly sets the Hippocratic tradition apart. Certain injunctions are specifically spelled out in the oath (abortion, euthanasia, use of poisons). …