Part 2

In his medical doctrines Hippocrates starts with the axiom that the body is composed of the four elements--air, earth, fire, and water. From these the four fluids or humours (namely, blood, phlegm, yellow bile, and black bile) are formed. Health is the result of a right condition and proper proportion of these humours, disease being due to changes in their quality or distribution. Thus inflammation is regarded as the passing of blood into parts not previously containing it. In the course of a disorder proceeding favourably, these humours undergo spontaneous changes in quality. This process is spoken of as coction, and is the sign of returning health, as preparing the way for the expulsion of the morbid matters--a state described as the crisis. These crises have a tendency to occur at certain periods, which are hence called critical days. As the critical days answer to the periods of the process of coction, they are to be watched with anxiety, and the actual condition of the patient at these times is to be compared with the state which it was expected he ought to show. From these observations the physician may predict the course which the remainder of the disease will probably take, and derive suggestions as to the practice to be followed in order to assist Nature in her operations.

Hippocrates thus appears to have studied "the natural history of diseases." As stated above, his practice was to watch the manner in which the humours were undergoing their fermenting coction, the phenomena displayed in the critical days, and the aspect and nature of the critical discharges--not to attempt to check the process going on, but simply to assist the natural operation. His principles and practice were based on the theory of the existence of a restoring essence (or {physis}) penetrating through all creation; the agent which is constantly striving to preserve all things in their natural state, and to restore them when they are preternaturally deranged. In the management of this vis medicatrix naturæ the art of the physician consisted. Attention, therefore, to regimen and diet was the principal remedy Hippocrates employed; nevertheless he did not hesitate, when he considered that occasion required, to administer such a powerful drug as hellebore in large doses.

The writings which are extant under the name of Hippocrates cannot all be ascribed to him. Many were doubtless written by his family, his descendants, or his pupils. Others are productions of the Alexandrian school, some of these being considered by critics as wilful forgeries, the high prices paid by the Ptolemies for books of reputation probably having acted as inducements to such fraud. The following works have generally been admitted as genuine:--

1. On Airs, Waters, and Places. 2. On Ancient Medicine. 3. On the Prognostics. 4. On the Treatment in Acute Diseases. 5. On Epidemics [Books I. and III.]. 6. On Wounds of the Head. 7. On the Articulations. 8. On Fractures. 9. On the Instruments of Reduction. 10. The Aphorisms [Seven Books]. 11. The Oath.

The works "On Fractures," "On the Articulations," "On Injuries to the Head," and "On the Instruments of Reduction," deal with anatomical or surgical matters, and exhibit a remarkable knowledge of osteology and anatomy generally. It has sometimes been doubted if Hippocrates could ever have had opportunities of gaining this knowledge from dissections of the human body, for it has been thought that the feeling of the age was diametrically opposed to such a practice, and that Hippocrates would not have dared to violate this feeling. The language used, however, in some passages in the work "On the Articulations," seems to put the matter beyond doubt. Thus he says in one place, "But if one will strip the point of the shoulder of the fleshy parts, and where the muscle extends, and also lay bare the tendon that goes from the armpit and clavicle to the breast," etc. And again, further on in the same treatise, "It is evident, then, that such a case could not be reduced either by succussion or by any other method, unless one were to cut open the patient, and then, having introduced the hand into one of the great cavities, were to push outwards from within, which one might do in the dead body, but not at all in the living."

His descriptions of the vertebræ, with all their processes and ligaments, as well as his account of the general characters of the internal viscera, would not have been as free from error as they are if he had derived all his knowledge from the dissection of the inferior animals. Moreover, it is indisputable that, within less than a hundred years from the death of Hippocrates, the human body was openly dissected in the schools of Alexandria--nay, further, that even the vivisection of condemned criminals was not uncommon. It would be unreasonable to suppose that such a practice as the former sprang up suddenly under the Ptolemies, and it seems, therefore, highly probable that it was known and tolerated in the time of Hippocrates. It is not surprising, when we remember the rude appliances and methods which then obtained, that in his knowledge of minute anatomy Hippocrates should compare unfavourably with anatomists of the present day. Of histology, and such other subjects as could not be brought within his direct personal observation, the knowledge of Hippocrates was necessarily defective. Thus he wrote of the tissues without distinguishing them; confusing arteries, veins, and nerves, and speaking of muscles vaguely as "flesh." But with matters within the reach of the Ancient Physician's own careful observation, the case is very different. This is well shown in his wonderful chapter on the club-foot, in which he not only states correctly the true nature of the malformation, but gives some very sensible directions for rectifying the deformity in early life.

When human strength was not sufficient to restore a displaced limb, he skilfully availed himself of all the mechanical powers which were then known. He does not appear to have been acquainted with the use of pulleys for the purpose, but the axles which he describes as being attached to the bench which bears his name (Scamnum Hippocratis) must have been quite capable of exercising the force required.

The work called "The Aphorisms," which was probably written in the old age of Hippocrates, consists of more than four hundred short pithy sentences, setting forth the principles of medicine, physiology, and natural philosophy. A large number of these sentences are evidently taken from the author's other works, especially those "On Air," etc., "On Prognostics," and "On the Articulations." They embody the result of a vast amount of observation and reflection, and the majority of them have been confirmed by the experience of two thousand years. A proof of the high esteem in which they have always been held is furnished by the fact that they have been translated into all the languages of the civilized world; among others, into Hebrew, Arabic, Latin, English, Dutch, Italian, German, and French. The following are a few examples of these aphorisms:--

"Spontaneous lassitude indicates disease."

"Old people on the whole have fewer complaints than the young; but those chronic diseases which do befall them generally never leave them."

"Persons who have sudden and violent attacks of fainting without any obvious cause die suddenly."

"Of the constitutions of the year, the dry upon the whole are more healthy than the rainy, and attended with less mortality."

"Phthisis most commonly occurs between the ages of eighteen and thirty-five years."

"If one give to a person in fever the same food which is given to a person in good health, what is strength to the one is disease to the other."

"Such food as is most grateful, though not so wholesome, is to be preferred to that which is better, but distasteful."

"Life is short and the art long; the opportunity fleeting; experience fallacious and judgment difficult. The physician must not only do his duty himself, but must also make the patient, the attendants and the externals, co-operate."

Hippocrates appears to have travelled a great deal, and to have practised his art in many places far distant from his native island. A few traditions of what he did during his long life remain, but differences of opinion exist as to the truth of these stories.

Thus one story says that when Perdiccas, the King of Macedonia, was supposed to be dying of consumption, Hippocrates discovered the disorder to be love-sickness, and speedily effected a cure. The details of this story scarcely seem to be worthy of credence, more especially as similar legends have been told of entirely different persons belonging to widely different times. There are, however, some reasons for believing that Hippocrates visited the Macedonian court in the exercise of his professional duties, for he mentions in the course of his writings, among places which he had visited, several which were situated in Macedonia; and, further, his son Thessalus appears to have afterwards been court physician to Archelaus, King of Macedonia.

Another story connects the name of Hippocrates with the Great Plague which occurred at Athens in the time of the Peloponnesian war. It is said that Hippocrates advised the lighting of great fires with wood of some aromatic kind, probably some species of pine. These, being kindled all about the city, stayed the progress of the pestilence. Others besides Hippocrates are, however, famous for having successfully adopted this practice.

A third legend states that the King of Persia, pursuing the plan (which in the two celebrated instances of Themistocles and Pausanias had proved successful) of attracting to his side the most distinguished persons in Greece, wrote to Hippocrates asking him to pay a visit to his court, and that Hippocrates refused to go. Although the story is discarded by many scholars, it is worthy of note that Ctesias, a kinsman and contemporary of Hippocrates, is mentioned by Xenophon in the "Anabasis" as being in the service of the King of Persia. And, with regard to the refusal of the venerable physician to comply with the king's request, one cannot lose sight of the fact that such refusal was the only course consistent with the opinions he professed of a monarchical form of government.

After his various travels Hippocrates, as seems to be pretty generally admitted, spent the latter portion of his life in Thessaly, and died at Larissa at a very advanced age.

It is difficult to speak of the skill and painstaking perseverance of Hippocrates in terms which shall not appear exaggerated and extravagant. His method of cultivating medicine was in the true spirit of the inductive philosophy. His descriptions were all derived from careful observation of its phenomena, and, as a result, the greater number of his deductions have stood unscathed the test of twenty centuries.

Still more difficult is it to speak with moderation of the candour which impelled Hippocrates to confess errors into which in his earlier practice he had fallen; or of that freedom from superstition which entitled him to be spoken of as a man who knew not how to deceive or be deceived ("qui tam fallere quam falli nescit"); or, lastly, of that purity of character and true nobility of soul which are brought so distinctly to light in the words of the oath translated below:--

"I swear by Apollo the Physician and Æsculapius, and I call Hygeia and Panacea and all the gods and goddesses to witness, that to the best of my power and judgment I will keep this oath and this contract; to wit--to hold him, who taught me this Art, equally dear to me as my parents; to share my substance with him; to supply him if he is in need of the necessaries of life; to regard his offspring in the same light as my own brothers, and to teach them this Art, if they shall desire to learn it, without fee or contract; to impart the precepts, the oral teaching, and all the rest of the instruction to my own sons, and to the sons of my teacher, and to pupils who have been bound to me by contract, and who have been sworn according to the law of medicine.

"I will adopt that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and will protect them from everything noxious and injurious. I will give no deadly medicine to any one, even if asked, nor will I give any such counsel, and similarly I will not give to a woman the means of procuring an abortion. With purity and with holiness I will pass my life and practise my art.... Into whatever houses I enter I will go into them for the benefit of the sick, keeping myself aloof from every voluntary act of injustice and corruption and lust. Whatever in the course of my professional practice, or outside of it, I see or hear which ought not to be spread abroad, I will not divulge, as reckoning that all such should be kept secret. If I continue to observe this oath and to keep it inviolate, may it be mine to enjoy life and the practice of the Art respected among all men for ever. But should I violate this oath and forswear myself, may the reverse be my lot."

FOOTNOTES:

Grote's "Aristotle," vol. i. p. 3.

Grote's "History of Greece," vol. i. p. 358.