Ancient Greek Medicine: Hippocrates & His School

Differences between Ancient & Modern Medicine

• Unlike modern medicine, there were no official medical qualifications in
the ancient world. In principle everyone could call himself a healer –
this term being more accurate than physician, which to us suggests
someone holding an official qualification.
• Training was by apprenticeship, from master to pupil.
• Except for midwives, healers were generally male.
• Healers were often itinerant, moving from place to place trying to make
a living from their art. They generally asked for a fee both to provide
instruction to apprentices and to cure the sick. The late Hippocratic text
Precepts, however, states that healers should treat the sick for free,
when the circumstances seem appropriate.
• There were different sects holding different views about health and
disease, often in competition among themselves.
 This Roman
marble relief
shows a vivid
birth scene
with only
women in
attendance.
The woman on
the left holds
the newborn,
while the
woman next to
her is either
cleaning the
mother or
perhaps
helping her
deliver the
placenta.
• Hippocrates (about 460 – 370
BCE) traveled extensively
from his native Kos across the
Greek world practicing
medicine.
• The Hippocratic Corpus
consists of about 60 texts
(written in ancient Greek)
discussing many medical
matters and diseases.
• Their doctrine is attributed to
Hippocrates, though none can
be attributed with certainty
and in its entirety to
Hippocrates himself.
• The Hippocratic Corpus is a collection of
texts used as a medical handbook, modified
& expanded over two centuries.
• The Hippocratic Oath is the most famous
work of the corpus. The manuscript
reproduced here shows a 12th-century copy
(over 1500 years later!) of the Oath in the
(Christianized) form of a cross. The
Hippocratic Oath is a foundational text to
medical ethics: in some variant it is still used
today as a basis for medical students
entering their profession.
• Other major texts include On the Sacred
Disease, the Aphorisms, and Epidemics.
• On the Sacred Disease (epilepsy) presents a
physical account of disease, as opposed to a
religious or superstitious one.
 Features of the Hippocratic Corpus
• Given their origin, it is not surprising that the texts of the Hippocratic
corpus are not entirely consistent, but there are common features.
• Hippocratic doctrines provide a causal explanation of health and
disease based on the four humors (blood, yellow bile, black bile, and
phlegm), though this is not always the case.
• It is not clear what black bile was, possibly coagulated blood due to
malaria, but having four humors went well with the four elements (air,
water, earth, and fire), four qualities (hot, cold, moist and dry) and the
four seasons of the year (spring-blood; summer-yellow bile; fall-black
bile; winter-phlegm).
• The elaborate connections among humors, elements, qualities, and
seasons, point to the strong philosophical and causal framework
within which notions of health & disease were formulated.
• Generally, diseases result from the
imbalance of the humors due to an
individual constitution (balance of
the humors) & regimen (way of life,
as for food, exercise, sleep, etc.)
• At times it was necessary to take into
account that some diseases were
unrelated to the constitution and
regimen of individual patients,
because they affected everyone at
the same time, as in epidemics. In
such cases, disease was attributed to
bad air.
• At the time there was no sense of
infectious diseases transmitted by
germs (the germ theory dates from
the late 19th century).
Hippocratic Corpus, Nature of Man,
section IX
Diseases arise, in some cases from regimen, in other cases from the air by
the inspiration of which we live. The distinction between the two should
be made in the following way. Whenever many men are attacked by one
disease at the same time, the cause should be assigned to that which is
most common, and which we all use most. This it is which we breathe
in. For it is clear that the regimen of each of us is not the cause, since the
disease attacks all in turn, both younger and older, men as much as
women, those who drink wine as much as those who drink only water,
those who eat barley cake as much as those who live on bread, those
who take much exercise as well as those who take little. For regimen
could not be the cause, when no matter what regimen they have
followed all men are attacked by the same disease.
• The Hippocratic Corpus has attracted
interest for over two millennia not only for
historical motives, but also as a living
medical legacy. This 1588 edition includes an
extraordinary title page with figures
illustrating different aspects of medicine.
• This apocryphal (=fictitious) story shows
Hippocrates in the center starting a fire to
purify the air in order to avoid a plague.
• The vignettes refer to ancient medicine,
including a time after Hippocrates. At top
center is diet; along the left column are
various surgical procedures, including head
trepanation; along the right column are
vignettes related to pharmacy, with
medicinal plants and chemical apparatus.
 A
devastatin
g “plague”
hit Athens
in 430
BCE, killing
~100,000
people, as
shown in
this 17th-
century
painting.
We do not
know the
cause of
the disease
in modern
terms.
 Historian Thucydides (ca. 460-ca.400 BCE) witnesses
the Athenian plague, caught the disease, but survived
It struck the city of Athens suddenly. People in the Piraeus caught
it first, and so, since there were not yet any fountains there, they
actually alleged that the Peloponnesians had put poison in the
wells. Afterwards, it arrived in the upper city too, and then deaths
started to occur on a much larger scale. Everyone, whether
doctor or layman, may say from his own experience what the
origin of it is likely to have been, and what causes he thinks had
the power to bring about so great a change. I shall give a
statement of what it was like, which people can study in case it
should ever attack again, to equip themselves with
foreknowledge so that they shall not fail to recognize it. I can give
this account because I both suffered the disease myself and saw
other victims of it.
Thucydides’s Tragic Account of the Athenian Plague

The doctors were unable to cope, since they were treating the disease
for the first time and in ignorance: indeed, the more they came into
contact with sufferers, the more liable they were to lose their own lives.
No other device of men was any help. Moreover, supplication at
sanctuaries, resort to divination, and the like were all unavailing. In the
end, people were overwhelmed by the disaster and abandoned efforts
against it. […] There was not a single remedy, you might say, which
ought to be applied to give relief, for what helped one sufferer harmed
another. No kind of constitution, whether strong or weak, proved
sufficient against the plague, but it killed off all, whatever regime was
used to care for them.
 Problems in the study of Disease
• Understanding disease changed greatly over time. Diseases that for us
are one entity (tuberculosis) due to one agent, may take different
forms; but were seen as separate in the past (consumption, scrofula).
• Conversely, diseases that for us constitute different entities, may be
lumped together: in the past gonorrhea was seen as the first stage of
syphilis, and generally diseases were seen as forming a continuum.
• Often historical descriptions can be very different from those we
would give today: they may appear incomplete or wildly inaccurate
from a modern standpoint, though they would have been adequate at
the time from the perspective of those who provided them.
• On some occasions, verbal descriptions, images, and more recently
also DNA studies, have enabled scholars to study past diseases in a
new way and to identify the disease from our perspective.
• Some texts provide case histories describing
the course of illnesses based on critical days,
namely days numbered from the onset of the
disease when a crisis occurs, or healing
ensues.
• There is a lot of empirical observation in the
Hippocratic corpus, but even observations are
framed within a theoretical framework
inspired by the theory of the four humors.
• Famous statements from the Corpus include:
“First, do no harm”; “Nature is the Healer of
Disease”; “Ars longa, vita brevis”.
• For the most part, the Hippocratic tradition
avoided surgery, but it included the ladder
(shown here) for treating dislocations.
 Anatomy and the Hippocratic
Corpus
• The ancient Greeks did not perform human dissection; knowledge of the
human body relied on superficial anatomy, occasional war wounds, but it
was not systematic. Ancient Greeks did not know the nervous system
and did not distinguish between arteries and veins. Both findings date
from late Antiquity, after the Hippocratic corpus. [The circulation of the
blood was discovered only in 1628].
• Not surprisingly, the Hippocratic corpus does not show a deep
knowledge of anatomy. The one exception dealing with human
dissection is The Heart, a late work (possibly 3rd Century BCE).
• Some essays in the Hippocratic Corpus refer to animal dissections in
order to investigate healthy and diseased states. Animal dissections were
carried out in order to investigate the cause or location of diseases such
as epilepsy and also consumption. Animal dissection offered the basis for
(problematic) generalizations to humans.
 Different Medical Traditions
The Hippocratic tradition was just one among many rival ancient sects.
• According to the methodists, disease is caused by the obstruction or
excessive opening of pores; therefore, cures consist in opening or closing
them in order to restore a proper flow of atoms. One of the most
prominent figures was Asclepiades of Bithynia (1st century BCE).
• According to the empirical sect, anatomy and theory were useless and
the nature of illness and disease were unknowable. Disease was cured
by relying only on experience and observation, comparing cases and
testing remedies to check which worked and which did not. A prominent
figure was Sextus Empiricus (2nd century CE).
• The rationalists believed that theory and especially anatomical
knowledge should guide medical practice. They were looking for rational
causes and explanations of health and disease.