Medicine holds an extensive and important history, as it has been an important task for Gods and healers to treat illnesses and heal injuries since the beginning of civilization. Early references to medicine were made by Homer, who described Machaon treating wounded warriors by removing arrows and applying drugs and bandages to wounds. The ancient Greeks originally believed it was Asclepius, the God of Medicine, who was responsible to heal and treat any injuries or illnesses. Hippocrates was a physician who identified as an Asclepiad – a member of a family that claims to be descendant from the God of Medicine. Hippocrates is one of the most important physicians from ancient Greek time due to his contributions of the Hippocratic Oath, development of clinical observation, and the treatises in the Hippocratic Corpus. As time progressed, so did the Greeks’ rational thought when it came to medicine and treating illnesses and injuries. Eventually, the Greek methods of medicine were brought to Rome, where Galen was instrumental in the progression of medicine from Hippocrates’ time and how he has shaped the medical field today with his studies in vivisection, dissection and expansion of the Hippocratic thought. Galen held Hippocrates in high regard and much of his work is influenced by his predecessor. In this essay, I will discuss how Hippocrates and Galen were the largest contributors to modern day medicine.
Before Hippocrates, thoughts on medicine were very irrational, people believed that the gods were responsible for disease. For example, Zeus would set loose a fever or plague to punish a community for sinning. Hippocrates was born in 460 BC and was an influential physician in the 5th century, he is often regarded as the father of medicine. Some of Hippocrates’ greatest accomplishments include the Hippocratic corpus, the development of clinical observation via diagnosis and prognosis, and the creation of the Hippocratic Oath.
The Hippocratic Corpus is made up of approximately 60 treatises written in the Ionic dialect of Greek. All writings in the corpus come from the period of 420-350 BC, roughly corresponding to the active lifetime of Hippocrates. It is debated whether the treatises were all written by Hippocrates himself, as it is often thought that most were written by his students. Nutton refers to this debate in Ancient Medicine: “one author in the time of Galen believed that at least part of the collection was written down by Hippocrates to preserve the oral doctrines of the family of Asclepiads that were in danger of disappearing because they were handed down only by word of mouth.” Nevertheless, the writings in the Hippocratic Corpus are inspired and influenced by Hippocrates and that is why it is an important contribution. Hippocrates believed that illness in one part of the body could only be explained by looking at the body as a whole, rather than in pieces. He often prescribed diet and exercise to help treat and prevent different ailments. The Hippocratic Corpus provides a logical explanation for disease that is independent of divine intervention and provides new ideas about the physical body, it also reflects the importance of empirical information that as we will see is used in diagnosis and prognosis.
The steps of clinical observation include observing the patient to determine a diagnosis for their ailment, as well as providing a prognosis. Prognosis is important because it gives the patient a general timeline of their recovery or, in the worst case, their death. Prognosis also protects the doctor from blame in the case of the latter. Hippocrates believed that it was important to cover all aspects of the health of the patient, body as well as mind. We see how Hippocrates goes about his determining a prognosis of a diseased man in Longrigg’s Greek Medicine from the Heroic to the Hellenistic Age: A Source Book:
A sign that the patient is going to recover: if the pus is white and pure and there are strands of blood in it, the patient generally recovers; but, if, for example, it flows out on the first day like pease-pudding, or, n the next day, thick, greenish and smelly, these patients die.
Hippocrates often used diet as his prescription to treat illness as disease was often thought to be linked with an imbalance of the four humours. The four humours are blood, yellow bile, black bile, and phlegm. Each is linked to a different season and set of elements. For example, blood was associated with spring and wet, warm elements and yellow bile with summer and warm, dry elements. Black bile was cold and dry, associated with fall, and phlegm, cold and wet, was paired with winter. Hippocrates mentions the four humours in the treatises of the Hippocratic Corpus, as seen in Jouanna’s Greek Medicine From Hippocrates to Galen: Selected Papers, “the body of man contains blood, phlegm, yellow bile, and black bile. This is what constitutes the nature of the body; this is the cause of disease or good health.” The treatise titled The Regimen in the Hippocratic corpus touches on how diet can influence health. The Greek word diatia is used in this treatise to encompass all intake of food, drink (wine), water, and exercise. The Hippocratic Corpus contained many treatises on prognosis and diet, as well one titled Oath.
The Hippocratic Oath was created for physicians in ancient Greek time to abide by to ensure proper treatment of patients and is still taken by today’s physicians and practised in modern medical schools. The oath was originally written as a religious statement, as it has no legal binding and references the gods. The oath consists of two parts, the first outlines obligations of the swearer in receiving and transmitting medical knowledge, while the second discusses the obligations of the physician with regard to medical practise and their patients. As written in Craik’s The ‘Hippocratic’ Corpus: Content and Context, the oath states: “I will use treatment to help the sick according to my ability and judgment; but never with a view to their injury and detriment.” Some parts of the oath are not in the modern version, such as the promise not to provide abortion or euthanasia, as these are practises that are performed, but still debated today. The original oath also promises “… not use the knife, even on sufferers from stone…”. Obviously, that practise has also been removed from the today’s version as surgery is a staple for modern day medicine. There are however, many statements in the oath that are relevant to today’s physicians. These statements include promising to do no harm, as stated above, but also to protect patient confidentiality as well as not engaging in any inappropriate activity, such as sexual conduct, with patients or their relatives.
Galen was another influential physician who was inspired by Hippocrates’ and uses him as his basis for medicine. Galen was born in 129 AD and was a Greek-born physician for the Roman empire. He is responsible for bringing much of Greek medicine into Rome during ancient times. One of Galen’s famous works is the Commentary on Hippocrates’ Aphorisms, in which he quotes Hippocrates’ writings and adds his own commentary in afterwards. For much of the writings, he agrees and expands on some ideas. For the statements he did not agree with, such as Hippocrates’ deceitful treatment of ear aches, he writes, “It is better to suppose that this sentence was not written by Hippocrates.” These commentaries have been very important in the progression of medicine in that scholars were able to take a look at the original idea, Galen’s interpretation of it, and then make their own assumptions and propose new ideas.
In Galen’s commentary regarding the four humours, he expands on the presence of the four humour on the four stages of life. He links blood, spring, and infancy together, as well as yellow bile, summer and youth. Black bile and autumn are dominant in maturity, and phlegm, winter are in old age. He also proposes a link between the four elements, earth, air, fire, and water, to the four humours. These linkages inspired the four temperaments, which also line up with the four humours and life stages, as we see in Jouanna’s book:
Man is comprised of four elements, blood, phlegm, yellow bile and black bile…
1. Those who are composed of pure blood are always joyous, joke and laugh; and they have a flowery complexion and nice skin.
2. Those who are composed of yellow bile are passionate, courageous, quick-tempered and have hair that changes color.
3. Those who are composed of black bile are indolent, pusillanimous, sickly, hesitant and cowardly.
4. Those who are composed of phlegm are despondent and also cold, forgetful with a short memory, sleep a lot and have white skin.
These four temperaments are, from the top, sanguine, bilious, melancholic, and phlegmatic. Sanguine temperament being dominant in infancy, bilious in youth, melancholic in maturity, and phlegmatic in old age. This expansion of the four humours dominated ancient medicine for centuries post-Galen.