Hippocratic Method

Ancient Period, Feature

A Greek Physician Proves, Centuries Before his Time, that it is the Patient who should be Treated, Not the Disease

“The factors which enable us to distinguish between diseases are as follows: First we must consider the nature of man in general and of each individual, and the characteristics of each disease. Then, we must consider the patient, what food is given to him and who gives it, for this may make it easier for him to take or more difficult, the conditions of climate and locality both in general and in particular, the patient’s customs, mode of life, pursuits, and age. Then we must consider his speech, his mannerisms, his silences, his thoughts, his habits of sleep or wakefulness, and his dreams, their nature and time. Next, we must note whether he plucks his hair, scratches, or weeps. We must observe his paroxysms, his stools, urine, sputum, and vomit. We look for any change in the state of the malady; how often such changes occur, and their nature, and the particular change which induces death or a crisis. Observe, too, sweating, shivering, chill, cough, sneezing, hiccough, the kind of breathing, belching, wind, whether silent or noisy, hemorrhages, and hemorrhoids. We must determine the significance of all these signs.”

These words, which might well have been written in the middle of the twentieth century, were in fact set out by the Greek physician Hippocrates in the fifth century B.C. They are words no doctor can afford to forget. Hippocrates knew that a disease cannot be treated as a thing by itself: the human being, the soul harboring it, must be considered, in its entirety. The same disease, in two different bodies, might run two very different courses, the same disease need TWO very different treatments.

The order in which Hippocrates set out his examination is interesting. First, we “consider the nature of man in general”: then, and then only, do we consider his food, customs, and mode of life. After that, and not before, we consider the more obviously “medical” attributes of the patient, his sputum, urine and so on.

We view the whole man. Not his disease.

This advice, though well over two thousand years old, has never been bettered. Much of what Hippocrates wrote, and he wrote and taught a great deal, in a long and crowded life, is a present-day guide, a bible, to a conscientious doctor. The whole ethic of medicine is based on his Oath; and some of his shorter “Aphorisms” sum up the whole of a doctor’s work, with its successes, its failures, its risks. “Life is short, science is long: opportunity is elusive, experiment is dangerous, and judgment is difficult.” Probably no more embracing, penetrating remark has been made about the profession, in so few words.

But the words for which this remarkable man, who lived centuries before his time, will be most remembered are those of the Hippocratic Oath, the greatest of his moral texts. Some universities still require doctors, upon qualifying, to take this Oath, in one form or another, and although the words may differ, the content is much the same:

“I swear by Apollo the healer, by Asclepius, by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this Oath and Promise, to the best of my ability and judgment.

“I will pay the same respect to my master in the Science as to my parents, and share my life with him and pay all my debts to him… I will regard his sons as my brothers and teach them the Science, if they desire to learn it, without fee or contract. I will hand on precepts, lectures and all other learning to my sons, to those of my master, and to those pupils duly apprenticed and sworn and to none other.

“I will use my power to help the sick to the best of my ability and judgment; I will abstain from harming or wronging any man by it.”

“I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing. Neither will I give a woman means to procure an abortion.”

“I will be chaste and religious in my life and in my practice.”

“I will not cut, even for the stone, but I will leave such procedure to the practitioners of that craft.”

“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 or slaves.”

“Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one.”

“If, therefore, I observe the Oath and do not violate it, may I prosper both in my life and in my profession, earning good repute among all men for all time. If I transgress and forswear this Oath, may my lot be otherwise.”

Hippocrates was born in 460 B.C. on the island of Cos, a Greek island which had been colonized by Dorians, but whose civilization and dialect were Ionian. He was an exact contemporary of Democritus and Thucydides. In those days, as we can gather from the words of the Oath, medicine tended to be a family affair, and the family of Hippocrates, the Asclepiadae, all of whom practised it, were believed descendants of Asclepius (Aesculapius, to give him his more common, Latin, name), Homer’s “Blameless Physician”. Homer’s legend has it that the sons of Asclepius became physicians in the Greek Army; and, in fact, it was only after Homer’s death that Asclepius came to be held in reverence, as a god. The family of Hippocrates claimed descent from him, and their knowledge of medicine was handed down, in the terms of the Oath, from father to son, from master to pupil. It was a sacred trust, one that might not be abused. The seat of the Asclepiadae was the island of Cos, and here the young Hippocrates grew to manhood, gained grounding in the science of medicine.

One of the more astonishing aspects of the various Hippocratic writings is that, though so many of them apply to our present age, they were composed in an age of almost total ignorance of the workings of the human body. Hippocrates knew less about the contents of the body and its mechanism than many a twentieth-century child (the veins, for example, carried air, and it was not until the time of the physician Galen, six hundred years later, that the movement of blood began to be accepted, albeit inaccurately), but despite this ignorance, his method, his approach to the subject, has never been bettered.

He travelled a great deal, in Greece and abroad, learning from Ms Travels and in the course of them curing men and women from all corners of the ancient world. He would settle, for brief periods, in the regions he visited, healing the sick and studying the people and their customs, before moving on. From these years of travel and healing he sifted and compiled his teachings, and, in the course of them, achieved great and justified fame during his own lifetime. We believe he died in 375 B.C., at the age of eighty-five; yet there are legends that he lived to the age of one hundred and thirty.

However long he lived, we do know that he devoted his life to (he care of the human mechanism, body and mind, and to the sing on of his knowledge, his methods and his attitude to others. He wrote a great deal, though as with other famous men there are writings ascribed to him which we have reason to believe he never wrote. Through them all, one is struck with the vast appetite for knowledge, for information. Not for him the snap decision, the hasty diagnosis based on a symptom: the whole man must be studied, and not only in the Present Tense. We must know what has gone previously; we must predict, to the best of “our abilities and judgment”, what will happen: History, Diagnosis, and Prognosis.

Like other physicians of the period, Hippocrates had a high rate of failure, which is hardly surprising in view of the confused state of medical knowledge at the time, a confusion which reigned for many hundreds of years. Even after Galen had established the movement of blood from the heart, it was not until the seventeenth century A.D. that William Harvey proved its circulation: in Greek times, blood was pumped to the extremities of the body and miraculously used up.

What was remarkable about Hippocrates was his method. The system of diagnosis set out at the beginning of this article can scarcely be improved on to-day: yet this was written at a time when men believed in magic, would rush to oracles, make sacrifices, gifts to gods and goddesses, to cure themselves; and when everyone, apart from a precocious few like Hippocrates, believed in this. While others were calling on Zeus and Apollo to help them, Hippocrates was teaching that “the examination of the body is a serious business, requiring good sight, good hearing, and sense of smell and touch and taste, and power of reasoning”. All this is important, but the last three words, which were nonsense to many, are the most vital. At a time when every sort of healer—well-intentioned or charlatan, was making an exhibition of driving out bad gods, propitiating good ones, Hippocrates could write and teach that no methods of an ostentatious, boastful kind should be used: the physician must be quiet, calm and modest in his actions. It would be shameful Hippocrates wrote, “If, after so much noise and exhibition and so many words, he in the end achieved nothing useful”.

An important point in the teaching of Hippocrates is that the physician must give equally of his skill and comfort to all men. This included slaves. It established the tradition, still adhered to, that no doctor can be privately employed to the exclusion of other healing. Hippocrates, we teach, treated cooks, tavern-keepers, schoolmasters, stonemasons, miners, gardeners, vine-growers, cobblers, carpenters, to name a few, and many of these were slaves. “Particular care”, he emphasized, “should be taken of the sick man who is a stranger and poor.”

The ignorance of the body’s working in Hippocrates’ time was perpetuated by a custom which forbade dissection of corpses, and this ignorance hung like a mist over all his work. Yet his teachings somehow transcended the way of life and thought of his age and survived to our day. Much of this teaching, with its inter-relation of body and mind, is only now, in the middle of the twentieth century, being fully understood. Despite the tremendous advances in medical science and technique during the last two hundred years, the discovery of the blood’s circulation, of anaesthetics, antisepsis, antibiotics, more and more physicians are realizing that the human body is not just a machine. It may be kept going in a tent of oxygen, restored with penicillin, made mighty with hormones, but this is only half the story.

We must study the whole man, see why he becomes ill. Nowadays we are learning that, far, far more often than was believed likely or even possible, the mind is the cause of illness. To take an everyday example: emotion or a sudden fright may make us lose our voices. If we have a sore throat and worry about it, we can lose our voices altogether, for weeks on end. If we can be made to forget we had a sore throat, our voices return, miraculously. Our minds and our bodies are one.

We are learning what Hippocrates taught, two and a half thousand years ago, that it is more important to prevent the patient’s illness than to cure him. There are better things to do with life than recover.