Herodicus, and to have been taught philosophy by Gorgias, the Sophist,

and by Democritus, whom he afterwards cured of mental derangement.



There was a very famous medical school at Cos, and the temple there held

the notes of the accumulated experience of his predecessors, but

Hippocrates visited also, for the purpose of study, various towns of

Greece, and particularly Athens. He was a keen observer, and took

careful notes of his observations. His reputation was such that his

works are quoted by Plato and by Aristotle, and there are references to

him by Arabic writers. His descendants published their own writings

under his name, and there were also many forgeries, so that it is

impossible to know exactly how many of the works attributed to him are

authentic; but by a consensus of opinion the following books are

considered genuine: "Prognostics," seven of the books of "Aphorisms,"

"On Airs, Waters and Places," "On Regimen in Acute Diseases," the first

and third books of "Epidemics," "On the Articulations," "On Fractures,"

the treatise on "Instruments of Reduction," and "The Oath"; and the

books considered almost certainly genuine are those dealing with

"Ancient Medicine," "Surgery," "The Law," "Fistulae," "Ulcers,"

"Haemorrhoids," and "On the Sacred Disease" (Epilepsy). The famous

Hippocratic Collection in the great libraries of Alexandria and Pergamos

also comprised the writings of Pythagoras, Plato and Aristotle.



The genius of Hippocrates is unsurpassed in the history of medicine. He

was the first to trace disease to a natural and intelligible cause, and

to recognize Nature as all-sufficient for healing, and physicians as

only her servants. He discussed medical subjects freely and without an

air of mystery, scorning all pretence, and he was also courageous enough

to acknowledge his limitations and his failures. When the times in which

he lived are considered, it is difficult to know which of his qualities

to admire most, his love of knowledge, his powers of observation, his

logical faculty, or his courage and truthfulness.



The central principle of belief of Hippocrates and the Dogmatists was

that health depended on the proper proportion and action in the body of

the four elements, earth, water, air, and fire, and the four cardinal

humours, blood, phlegm, yellow bile and black bile. The due combination

of these was known as crasis, and existed in health. If a disease were

progressing favourably these humours became changed and combined

(coction), preparatory to the expulsion of the morbid matter (crisis),

which took place at definite periods known as critical days. Hippocrates

also held the theory of fluxions, which were conditions in the nature of

congestion, as it would now be understood.



In his time public opinion condemned dissection of the human body, but

it is certain that dissections were performed by Hippocrates to a

limited extent. He did not know the difference between the arteries and

the veins, and nerves and ligaments and various membranes were all

thought to have analogous functions, but his writings display a correct

knowledge of the anatomy of certain parts of the body such as the joints

and the brain. This defective knowledge of anatomy gave rise to fanciful

views on physiology, which, among much that is admirable, disfigure the

Hippocratic writings.



The belief that almost all medical and surgical knowledge is modern,

though flattering to our self-complacency, is disturbed by the study of

the state of knowledge in the time of Hippocrates. To him we are

indebted for the classification of diseases into sporadic, epidemic,

and endemic, and he also separated acute from chronic diseases. He

divided the causes of disease into two classes: general, such as

climate, water and sanitation; and personal, such as improper food and

neglect of exercise.



He based his conclusions on the observation of appearances, and in this

way began a new era. He was so perfect in the observation of external

signs of disease that he has never in this respect been excelled. The

state of the face, eyes, tongue, voice, hearing, abdomen, sleep,

breathing, excretions, posture of the body, and so on, all aided him in

diagnosis and prognosis, and to the latter he paid special attention,

saying that "the best physician is the one who is able to establish a

prognosis, penetrating and exposing first of all, at the bedside, the

present, the past, and the future of his patients, and adding what they

omit in their statements. He gains their confidence, and being convinced

of his superiority of knowledge they do not hesitate to commit

themselves entirely into his hands. He can treat, also, so much better

their present condition in proportion as he shall be able from it to

foresee the future."



He wrote about the history of Medicine, a study which is much neglected

at the present time. There is no generation of men so wise that they

cannot with advantage adopt some ideas from the remote past, or, at

least, find the teaching of their predecessors suggestive. Hippocrates

was one of the first to recognize the vis medicatrix naturae, and he

always aimed at assisting Nature. His style of treatment would be known

now as expectant, and he tried to order his practice "to do good, or, at

least, to do no harm." When he considered interference necessary,

however, he did not hesitate even to apply drastic measures, such as

scarification, cupping and bleeding. He made use of the narcotics

mandragora, henbane, and probably also poppy-juice, and as a laxative

used greatly a vegetable substance called "mercury," beet and cabbage,

and cathartics such as scammony and elaterium! He was able to diagnose

fluid in the chest or abdomen by means of percussion and auscultation,

and to withdraw the fluid by the operation of paracentesis, and he

recognized also that the fluid should be allowed to flow away slowly so

as to minimize the risk of syncope. He operated also for empyema. In

regard to the methods of Hippocrates for the physical examination of the

chest it is reasonable to suppose that the Father of Medicine indirectly

inspired Laennec to invent the stethoscope. Hippocrates prescribed fluid

diet for fevers, allowed the patients cold water or barley water to

drink, and recommended cold sponging for high fever. In his writings

will be found his views on apoplexy, epilepsy, phthisis, gout,

erysipelas, cancer and many other diseases common at the present day.



In the province of Surgery, Hippocrates was surprisingly proficient,

although he lived before the Anatomic Period. He had various lotions for

the healing of ulcers; some of these lotions were antiseptic and have

been in use in recent times. His opinions on the treatment of fractures

are sound, and he was a master in the use of splints, and considered

that it was disgraceful on the part of the surgeon to allow a broken

limb to set in a faulty position. He resected the projecting ends of the

bone in the case of compound fracture. He had a very complete knowledge

of the anatomy of joints, was well acquainted with hip-joint disease,

and could operate upon joints. Accidents were no doubt common in the

gymnasia, and practice in the treatment of fractures and dislocations

extensive and of a high order of excellence. Hippocrates used the sound

for exploring the bladder, and understood the use of the speculum for

examining the rectum, and in operations for fistula and piles. He

understood the causation of club-foot, and could cure cases of this

deformity by bandaging. He was skilful also in obstetric operations. He

trepanned the skull, which appears to have been a common operation in

his day. He had clear and sound views in reference to wounds of the

head, recognizing that trivial-looking wounds of the scalp might become

very serious. Hippocrates gave directions as to the indications for

using the trepan, and warned the operator against mistaking sutures of

the cranial bones for fracture.



He did not describe amputations as generally understood, but removed

limbs at a joint for gangrene. When necessary he made use of mechanical

appliances for reducing dislocations, and recommended doctors to furnish

their surgeries with an adjustable table, fitted with levers, for

dealing with the reduction of dislocations, and for various other

surgical manipulations. Excision of tumours was not a common operation

of Hippocratic surgery, although it had been a part of Hindu practice in

very ancient times. On the subject of Obstetrics, Hippocrates wrote a

great deal, and although many of his theories seem absurd at the present

day, yet, on the whole, the treatment he recommends is efficacious.

Regarding Gynaecology, in his treatise on "Airs, Water and Places," it

is interesting to observe that he says that the drinking of impure water

will cause dropsy of the uterus. Adams, commenting on this, has in mind

hydatids, but it is evident that both Hippocrates and his translator and

critic have mistaken hydatidiform disease of the ovum for hydatid

disease of the womb. In the books which are considered genuine the

references to diseases of women are meagre, and it is likely that the

author had little special knowledge of the subject. That part of the

Hippocratic collection which is not considered genuine deals rather

fully with the subject of gynaecology.[5] In it are described sounds

made of wood and of lead, dilators and uterine catheters. Sitz baths

were in use, and fumigations were very extensively employed in

gynaecological practice. Pessaries were made by rolling lint or wool into

an oblong shape, and were medicated to be emollient, astringent or

purgative in their local action. The half of a pomegranate was used as a

mechanical pessary, and there are also references to tents, and to

suppositories for the bowel.



In dealing with Dietetics, Hippocrates displays close observation and

sound judgment. The views held generally at the present day coincide

closely with his instructions on food and feeding. In the treatise on

Ancient Medicine, he states that men had to find from experience the

properties of various vegetable foods, and discovered that what was

suitable in health was unsuitable in sickness, and that the accumulation

of these discoveries was the origin of the art of medicine.



The Sydenham Society initiated, and Dr. Adams brilliantly accomplished,

a noble work in the publication in 1849 of "The Genuine Works of

Hippocrates," from which "The Law," and "The Oath" are here quoted. The

former is the view of Hippocrates of the standards which should govern

the practice of medicine; the latter is that by which all the

AEsculapians were bound.





"THE LAW.



"(1) Medicine is of all the arts the most noble; but, owing to the

ignorance of those who practise it, and of those who, inconsiderately,

form a judgment of them, it is at present far behind all the other arts.

Their mistake appears to me to arise principally from this, that in the

cities there is no punishment connected with the practice of medicine

(and with it alone) except disgrace, and that does not hurt those who

are familiar with it. Such persons are like the figures which are

introduced in tragedies, for as they have the shape, and dress, and

personal appearance of an actor, but are not actors, so also physicians

are many in title but very few in reality.



"(2) Whoever is to acquire a competent knowledge of medicine, ought to

be possessed of the following advantages: A natural disposition;

instruction; a favourable position for the study; early tuition; love of

labour; leisure. First of all, a natural talent is required, for, when

Nature opposes, everything else is vain; but when Nature leads the way

to what is most excellent, instruction in the art takes place, which the

student must try to appropriate to himself by reflection, becoming an

early pupil in a place well adapted for instruction. He must also bring

to the task a love of labour and perseverance, so that the instruction

taking root may bring forth proper and abundant fruits.



"(3) Instruction in medicine is like the culture of the productions of

the earth. For our natural disposition is, as it were, the soil; the

tenets of our teacher are, as it were, the seed; instruction in youth is

like the planting of the seed in the ground at the proper season; the

place where the instruction is communicated is like the food imparted to

vegetables by the atmosphere; diligent study is like the cultivation of

the fields; and it is time which imparts strength to all things and

brings them to maturity.



"(4) Having brought all these requisites to the study of medicine, and

having acquired a true knowledge of it, we shall thus, in travelling

through the cities, be esteemed physicians not only in name but in

reality. But inexperience is a bad treasure, and a bad friend to those

who possess it, whether in opinion or reality, being devoid of

self-reliance and contentedness, and the nurse both of timidity and

audacity. For timidity betrays a want of powers, and audacity a want of

skill. There are, indeed, two things, knowledge and opinion, of which

the one makes its possessor really to know, the other to be ignorant.



"(5) These things which are sacred are to be imparted only to sacred

persons; and it is not lawful to impart them to the profane until they

have been initiated in the mysteries of the science."





"THE OATH.



"I swear by Apollo, the physician, and AEsculapius, and Health, and

Panacea, 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 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 anyone 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 practise my Art. I will not cut persons

labouring 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 freedmen 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 inviolate, 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 or violate this oath, may the

reverse be my lot!"



It would be a great task to attempt anything like a full review of the

writings of this great doctor of antiquity, but enough has been written

to reveal the great powers of his mind, and to show that he was far in

advance of his predecessors, and a model for his successors. In the

island of Cos, made illustrious by the name of Hippocrates, it is

strange to find that he has no fame now other than that of being

regarded in the confused minds of the people as one of the numerous

saints of the Greek Church.[6]



"When," says Littre, "one searches into the history of medicine and the

commencement of science, the first body of doctrine that one meets with

is the collection of writings known under the name of the works of

Hippocrates. The science mounts up directly to that origin, and there

stops. Not that it had not been cultivated earlier, and had not given

rise to even numerous productions; but everything that had been made

before the physician of Cos has perished. We have only remaining of them

scattered and unconnected fragments. The works of Hippocrates have alone

escaped destruction; and by a singular circumstance there exists a great

gap after them as well as before them. The medical works from

Hippocrates to the establishment of the School of Alexandria, and those

of that school itself, are completely lost, except some quotations and

passages preserved in the later writers; so that the writings of

Hippocrates remain alone amongst the ruins of ancient medical

literature." Sydenham said of Hippocrates: "He it is whom we can never

duly praise," and refers to him as "that divine old man," and "the

Romulus of medicine, whose heaven was the empyrean of his art."



Hippocrates died in Thessaly, but at what age is uncertain, for

different authors have credited him with a lifetime of from eighty-five

to a hundred and nine years. By virtue of his fame, death for him was

not the Great Leveller.



Hippocrates had two sons, Thessalus and Draco; the former was physician

to Archelaus, King of Macedonia, the latter physician to the wife of

Alexander the Great. They were the founders of the School of Dogmatism

which was based mainly on the teaching and aphorisms of Hippocrates. The

Dogmatic Sect emphasized the importance of investigating not the obvious

but the underlying and hidden causes of disease and held undisputed sway

until the foundation of the Empirical Sect at Alexandria.