Medical Writings

Overview

There is no such thing as a book by Hippocrates. What survives is a collection of about sixty treatises in Ionic Greek, written by different people between roughly 430 and 350 BCE, gathered under one name probably at the library of Alexandria. They disagree with each other about physiology, about method and about treatment, and no modern scholar will say with confidence that any one of them is by Hippocrates of Cos.

That is not a problem for reading them, provided you stop expecting a system. The collection is a snapshot of Greek medicine at the moment it was trying to become a craft with standards, and the arguments inside it, between those who want theory and those who want observation, between the school of Cos and the school of Cnidus, are the interesting part.

Standard selections run to about three hundred and eighty pages and include the Oath, Ancient Medicine, Airs Waters Places, the Sacred Disease, Prognosis, Regimen in Acute Diseases, Aphorisms, the case histories from Epidemics I and III, and the surgical works on fractures and joints.

A word about the humours. The four-humour theory, blood, phlegm, yellow bile and black bile, comes from one treatise in the collection, On the Nature of Man, and is not assumed everywhere else. It became the whole of medicine later, largely because Galen built on it.

The argument

The Oath. Three or four hundred words, sworn by Apollo, Asclepius, Hygieia and Panacea. Most of it is about the guild: the physician will treat his teacher as a parent, support him financially, teach the art to the teacher’s sons and to sworn pupils and to nobody else. Then the clinical undertakings: to use regimen for the benefit of the sick and never for injury, to give no deadly drug nor suggest one, to give no woman an abortive pessary, not to cut for the stone but to leave it to those who practise it, to enter houses for the benefit of the sick and abstain from seduction of the free or the enslaved, and to keep silent about anything seen or heard.

Two things are usually misremembered. First do no harm is not in the Oath; the nearest formulation is in Epidemics I, where the physician is told to help, or at least to do no harm. And the Oath’s prohibitions do not obviously mean what modern debates take them to mean; the ban on cutting for the stone, for instance, is most likely a demarcation between physicians and surgeons rather than an ethical point at all.

The Sacred Disease. The most intellectually radical text in the collection. Its subject is epilepsy, which was called sacred because a seizure looked like possession. The author opens by denying it: this disease is no more divine than any other, it has a natural cause, and those who first called it sacred were magicians and purifiers with nothing to offer, who took refuge in the divine to conceal that they could not treat it. He adds, sharply, that they are the ones being impious, since they claim to compel the gods.

He then argues that the brain is the cause, and in doing so states the most important proposition in ancient neurology: that from the brain and from the brain alone come our pleasures, joys, laughter and jests, and our sorrows, griefs and tears, and that by it we think and see and hear. Madness, terror and delirium are brain conditions. Aristotle, a century later, still put the seat of thought in the heart.

Airs, Waters, Places. A handbook for a physician arriving in an unfamiliar town: study the seasons, the prevailing winds, the water supply, the aspect of the site, and the habits of the inhabitants, because these determine which diseases you will meet. The second half extends the method to whole peoples, arguing that climate and terrain shape physique and character, with a long passage on the Scythians. It is the founding text of environmental medicine and also of a long and unfortunate tradition of explaining national character by weather.

Epidemics I and III. Not epidemics in the modern sense but the constitutions of particular seasons in particular places, followed by individual case histories. These are extraordinary. A named patient, a location, and then a day-by-day record: fever, urine, sweat, sleep, what the patient said, when the crisis came. Many end in a single word noting the death. Nobody is blamed, no treatment is defended, and there is no attempt to make the physician look good.

On Ancient Medicine. A polemic against doctors who base practice on philosophical postulates about hot, cold, wet and dry. The author’s case is that medicine already has a method, developed over generations from observing what diets and regimens do to sick people, and that importing a hypothesis you cannot test is a step backwards.

Aphorisms and the surgical works. The Aphorisms are several hundred compressed clinical observations, beginning with the famous one about life being short and the art long. On Fractures and On Joints are practical, detailed, and in places still recognisable; the description of reducing a dislocated shoulder was used for centuries.

How to read it

Read the Oath, the Sacred Disease, Airs Waters Places, and a dozen case histories from Epidemics I. That is perhaps sixty pages and it gives you the whole character of the collection.

Read the case histories slowly and notice what is absent: no theory, no excuses, no divine causation, and no flinching from the deaths.

Do not look for consistency across treatises. They were written by different people who disagreed, and the disagreements are more informative than any summary of Hippocratic doctrine.

Read the Sacred Disease next to Thucydides on the plague at Athens. Both are attempts, in the same decades, to describe a disaster in natural terms and record what was observed, and the resemblance is not a coincidence.

Then read Galen, who built on this and closed it down for fourteen centuries, and then Harvey, who reopened it. The three together are the clearest available story of how a science starts, hardens and is broken.

Questions it raises

• The Sacred Disease insists illness has natural causes and then offers an explanation that is wrong. Which matters more, the commitment or the content?
• Prognosis is valued above diagnosis. Is that good science, or good business for a physician who cannot cure much?
• The Oath is a professional code sworn to gods, largely about obligations to a guild. What is left of it once the guild and the gods are gone?
• On Ancient Medicine attacks the importing of hypotheses into medicine. Where is the line between a hypothesis and a theory a science needs?
• The case histories record deaths without comment. What does that restraint do, and why is it so rare afterwards?
• Airs Waters Places explains character by climate. What makes that kind of explanation so attractive, and so consistently wrong?