HIPPOCRATES

hippocrates, greek philosopher and writer, termed the "father of medicine," was born, according to soranus, in cos, in the first year of the 80th olympiad, i.e. in 460 b.c. he was a member of the family of the asclepiadae, and was believed to be either the nineteenth or seventeenth in direct descent from aesculapius. it is also claimed for him that he was descended from hercules through his mother, phaenarete. he studied medicine under heraclides, his father, and herodicus of selymbria; in philosophy gorgias of leontini and democritus of abdera were his masters. his earlier studies were prosecuted in the famous asclepion of cos, and probably also at cnidos. he travelled extensively, and taught and practised his profession at athens, probably also in thrace, thessaly, delos and his native island. he died at larissa in thessaly, his age being variously stated as 85, 90, 104 and 109. the incidents of his life are shrouded by uncertain traditions, which naturally sprang up in the absence of any authentic record; the earliest biography was by one of the sorani, probably soranus the younger of ephesus, in the 2nd century; suidas, the lexicographer, wrote of him in the 11th, and tzetzes in the 12th century. in all these biographies there is internal evidence of confusion; many of the incidents related are elsewhere told of other persons, and certain of them are quite irreconcilable with his character, so far as it can be judged of from his writings and from the opinions expressed of him by his contemporaries; we may safely reject, for instance, the legends that he set fire to the library of the temple of health at cnidos, in order to destroy the evidence of plagiarism, and that he refused to visit persia at the request of artaxerxes longimanus, during a pestilential epidemic, on the ground that he would in so doing be assisting an enemy. he is referred to by plato (_protag._ p. 283; _phaedr._ p. 211) as an eminent medical authority, and his opinion is also quoted by aristotle. the veneration in which he was held by the athenians serves to dissipate the calumnies which have been thrown on his character by andreas, and the whole tone of his writings bespeaks a man of the highest integrity and purest morality. born of a family of priest-physicians, and inheriting all its traditions and prejudices, hippocrates was the first to cast superstition aside, and to base the practice of medicine on the principles of inductive philosophy. it is impossible to trace directly the influence exercised upon him by the great men of his time, but one cannot fail to connect his emancipation of medicine from superstition with the widespread power exercised over greek life and thought by the living work of socrates, plato, aeschylus, sophocles, euripides, herodotus and thucydides. it was a period of great intellectual development, and it only needed a powerful mind such as his to bring to bear upon medicine the same influences which were at work in other sciences. it must be remembered that his training was not altogether bad, although superstition entered so largely into it. he had a great master in democritus, the originator of the doctrine of atoms, and there is every reason to believe that the various "asclepia" were very carefully conducted hospitals for the sick, possessing a curious system of case-books, in the form of votive tablets, left by the patients, on which were recorded the symptoms, treatment and result of each case. he had these records at his command; and he had the opportunity of observing the system of training and the treatment of injuries in the gymnasia. one of his great merits is that he was the first to dissociate medicine from priest-craft, and to direct exclusive attention to the natural history of disease. how strongly his mind revolted against the use of charms, amulets, incantations and such devices appears from his writings; and he has expressly recorded, as underlying all his practice, the conviction that, however diseases may be regarded from the religious point of view, they must all be scientifically treated as subject to natural laws (_de aere_, 29). nor was he anxious to maintain the connexion between philosophy and medicine which had for long existed in a confused and confusing fashion.[1] his knowledge of anatomy, physiology and pathology was necessarily defective, the respect in which the dead body was held by the greeks precluding him from practising dissection; thus we find him writing of the tissues without distinguishing between the various textures of the body, confusing arteries, veins and nerves, and speaking vaguely of the muscles as "flesh." but when we come to study his observations on the natural history of disease as presented in the living subject, we recognize at once the presence of a great clinical physician. hippocrates based his principles and practice on the theory of the existence of a spiritual restoring essence or principle, [greek: physis], the _vis medicatrix naturae_, in the management of which the art of the physician consisted. this art could, he held, be only obtained by the application of experience, not only to disease at large, but to disease in the individual. he strongly deprecated blind empiricism; the aphorism "[greek: he peira sphalere, he krisis chalepe]" (whether it be his or not), tersely illustrates his position. holding firmly to the principle, [greek: nouson physies ietroi], he did not allow himself to remain inactive in the presence of disease; he was not a merely "expectant" physician; as sydenham puts it, his practice was "the support of enfeebled and the coercion of outrageous nature." he largely employed powerful medicines and blood-letting both ordinary and by cupping. he advises, however, great caution in their application. he placed great dependence on diet and regimen, and here, quaint as many of his directions may now sound, not only in themselves, but in the reasons given, there is much which is still adhered to at the present day. his treatise [greek: peri aeron, hydaton, kai topon] (_airs, waters, and places_) contains the first enunciation of the principles of public health. although the treatises [greek: peri krisimon] cannot be accepted as authentic, we find in the [greek: prognostikon] evidence of the acuteness of observation in the manner in which the occurrence of critical days in disease is enunciated. his method of reporting cases is most interesting and instructive; in them we can read how thoroughly he had separated himself from the priest-physician. laennec, to whom we are indebted for the practice of auscultation, freely admits that the idea was suggested to him by study of hippocrates, who, treating of the presence of morbid fluids in the thorax, gives very particular directions, by means of succussion, for arriving at an opinion regarding their nature. laennec says, "hippocrate avait tente l'auscultation immediate." although the treatise [greek: peri nouson] is doubtfully from the pen of hippocrates, it contains strong evidence of having been the work of his grandson, representing the views of the father of medicine. although not accurate in the conclusions reached at the time, the value of the method of diagnosis is shown by the retention in modern medicine of the name and the practice of "hippocratic succussion." the power of graphic description of phenomena in the hippocratic writings is illustrated by the retention of the term "facies hippocratica," applied to the appearance of a moribund person, pictured in the _prognostics_. in surgery his writings are important and interesting, but they do not bear the same character of caution as the treatises on medicine; for instance, in the essay _on injuries of the head_, he advocates the operation "of trephining" more strongly and in wider classes of cases than would be warranted by the experience of later times. the _hippocratic collection_ consists of eighty-seven treatises, of which a part only can be accepted as genuine. the collection has been submitted to the closest criticism in ancient and modern times by a large number of commentators (for full list of the early commentators, see adams's _genuine works of hippocrates_, sydenham society, i. 27, 28). the treatises have been classified according to (1) the direct evidence of ancient writers, (2) peculiarities of style and method, and (3) the presence of anachronisms and of opinions opposed to the general hippocratic teaching--greatest weight being attached to the opinions of erotian and galen. the general estimate of commentators is thus stated by adams: "the peculiar style and method of hippocrates are held to be conciseness of expression, great condensation of matter, and disposition to regard all professional subjects in a practical point of view, to eschew subtle hypotheses and modes of treatment based on vague abstractions." the treatises have been grouped in the four following sections: (1) genuine; (2) those consisting of notes taken by students and collected after the death of hippocrates; (3) essays by disciples; (4) those utterly spurious. littre accepts the following thirteen as absolutely genuine: (1) _on ancient medicine_ ([greek: peri archaies ietrikes]); (2) _the prognostics_ ([greek: prognostikon]); (3) _the aphorisms_ ([greek: aphorismoi]); (4) _the epidemics_, i. and iii. ([greek: epidemion a' kai g']); (5) _on regimen in acute diseases_ ([greek: peri diaites oxeon]); (6) _on airs, waters, and places_ ([greek: peri aeron, hydaton, kai topon]); (7) _on the articulations_ ([greek: peri arthron]); (8) _on fractures_ ([greek: peri agmon]); (9) _the instruments of reduction_ ([greek: mochlikos]); (10) _the physician's establishment, or surgery_ ([greek: kat' ietreion]); (11) _on injuries of the head_ ([greek: peri ton en kephale tromaton]); (12) _the oath_ ([greek: horkos]); (13) _the law_ ([greek: nomos]). of these adams accepts as certainly genuine the 2nd, 6th, 5th, 3rd (7 books), 4th, 7th, 8th, 9th and 12th, and as "pretty confidently acknowledged as genuine, although the evidence in their favour is not so strong," the 1st, 10th and 13th, and, in addition, (14) _on ulcers_ ([greek: peri helkon]); (15) _on fistulae_ ([greek: peri syringon]); (16) _on hemorrhoids_ ([greek: peri haimorrhoidon]); (17) _on the sacred disease_ ([greek: peri hieres nousou]). according to the sceptical and somewhat subjective criticism of ermerins, the whole collection is to be regarded as spurious except _epidemics_, books i. and iii. (with a few interpolations), _on airs, waters, and places_, _on injuries of the head_ ("insigne fragmentum libri hippocratei"), the former portion of the treatise _on regimen in acute diseases_, and the "obviously hippocratic" fragments of the _coan prognostics_. perhaps also the _oath_ may be accepted as genuine; its comparative antiquity is not denied. the _aphorisms_ are certainly later and inferior. in the other non-hippocratic writings ermerins thinks he can distinguish the hands of no fewer than nineteen different authors, most of them anonymous, and some of them very late. the earliest greek edition of the hippocratic writings is that which was published by aldus and asulanus at venice in 1526 (folio); it was speedily followed by that of frobenius, which is much more accurate and complete (fol., basel, 1538). of the numerous subsequent editions, probably the best was that of foesius (frankfort, 1595, 1621, geneva, 1657), until the publication of the great works of littre, _oeuvres completes d'hippocrate, traduction nouvelle avec le texte grec en regard, collationnee sur les manuscrits et toutes les editions, accompagnee d'une introduction, de commentaires medicaux, de variantes, et de notes philologiques_ (10 vols., paris, 1839-1861), and of f. z. ermerins, _hippocratis et aliorum medicorum veterum reliquiae_ (3 vols., utrecht, 1859-1864). see also adams (as cited above), and reinhold's _hippocrates_ (2 vols., athens, 1864-1867). daremberg's edition of the _oeuvres choisies_ (2nd ed., paris, 1855) includes the _oath_, the _law_, the _prorrhetics_, book i., the _prognostics, on airs, waters, and places, epidemics_, books i. and iii., _regimen_, and _aphorisms_. of the separate works attributed to hippocrates the editions and translations are almost innumerable; of the _prognostics_, for example, seventy editions are known, while of the _aphorisms_ there are said to exist as many as three hundred. for some notice of the arabic, syriac and hebrew translations of works professedly by hippocrates (ibukrat or bukrat), the number of which greatly exceeds that of the extant greek originals, reference may be made to flugel's contribution to the article "hippokrates" in the _encyklopadie_ of ersch and gruber. they have been partially catalogued by fabricius in his _bibliotheca graeca_. (j. b. t.) footnote: [1] "hippocrates cous, primus quidem ex omnibus memoria dignus, ab studio sapientiae disciplinam hanc separavit, vir et arte et facundia insignis" (celsus, _de medicina_). hippocrene (the "fountain of the horse," [greek: he hippou krene]), the spring on mt helicon, in boeotia, which, like the other spring there, aganippe, was sacred to the muses and apollo, and hence taken as the source of poetic inspiration. the spring, surrounded by an ancient wall, is now known as _kryopegadi_ or the cold spring. according to the legend, it was produced by the stamping of the hoof of bellerophon's horse pegasus. the same story accounts for the hippocrene in troezen and the spring peirene at corinth.