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Friday, March 13, 2015

460-370 B.C.: Why was Hippocrates dubbed 'the father of medicine?'

A depiction of Hippocrates writing. 
Hippocrates might possibly be the most important figure in the history of medicine, and our history of asthma and respiratory therapy. His Hippocratic Corpus became the most essential medical document of all time. But, did he work alone, and did he deserve such an honor?

In the ancient world only a few people, called scribes, had the ability to write.  To garnish credibility for a document, the person given credit for writing it was usually a king. The reason for this was that most kings were believed to have the ability to communicate with the all-knowing gods. The document, therefore, contained the wisdom of the gods.  

This changed somewhat in ancient Greece, particularly in Athens. The Greeks liked to give credit for any important works. Still, in many cases, the author was some person who would garnish respect for the document. For instance, a document written by a group of unknown physicians at Cos may not garnish the respect as a document written by Hippocrates, the most famous physician in Greece.  

For this reason, and because many of the writings in the Hippocratic documents are suspected of being written by some hand other than that of Hippocrates, it is believed the Corpus Hippocraticum was a collaborative effort between various physicians of ancient Greece.  However, for posterity purposes, Hippocrates is most often given credit for the medical information it contains. Most medical writers after Hippocrates credit the document to Hippocrates.

Who actually wrote the Corpus Hippocraticum may probably never be known, although most modern experts on the subject would attest to the fact that most of the writings do not appear to be written by one person.  In fact, some experts suspect some were written prior to his birth, some during his lifetime, and some after his death.  So, chances are, he did not write the whole thing.

Max Neuburger, in his 1910 history of medicine, said: 
The wide range of opinion is shown by the fact that the number of "authentic writings (of which the commentator Erotianus at the time of Nero's time recognized thirty one and Galen thirteen) has sunk to two or even to nil, whilst modern criticism admits no more than six." (8, page 122)
So now we must ask: if Hippocrates did not write the whole thing, then who helped him out? Considering most of what we know about Hippocrates was written after his lifetime, we have no choice but to refer to speculation from the various experts on the subject.

In the ancient world there were a variety of diseases that plagued mankind, or that made their way through the cities killing hundreds, if not thousands, of people along its path.  Ancient physicians did not have knowledge of germs, so they simply referred to such epidemics as plagues.

Supposedly, sometime during the life of Hippocrates word got out that there was a plague in nearby city-states, and the people were, perhaps, in an all out panic. The leaders of the city-state must have approached the physician to see if he was privy to wisdom that might stop the plague from reaching the city.

Perhaps based on what he learned from his father, or from his teachings at the school of Cos, or by his travels to the school of Alexandria, he believed that strong winds could bring about disease, Hippocrates came up with an ingenious idea.

Of this, medical historian Edward Meryon wrote in 1861: (1, page 25-26)
Thucydides informs us that he kindled fires to neutralize the infection of a pestilence which broke out on two successive occasions in Attica, when the skill of the physicians could do nothing else to mitigate it."  (1, page 25-26)
Medical historian Thomas Bradford wrote in 1898:
He rendered a great service in stopping a plague which broke out in Athens in the time of Pericles, for which he was given a golden crown and the privilege of Athenian citizenship. (2, page 23)
So maybe such an act of heroism made him worthy of such fame.  

Medical historian Plinio Prioreschi said said in 1995 that there were many medical schools when Hippocrates walked the earth, the two most relevant to our history being the school of Cos and the school of Cnidian, which were near each other (about 20 miles apart) and were competing "in knowledge and effectiveness in curing disease." (3, page 28) 

Prioreschi mentions one theory where each school was stuck in it's own paradigm about diseases and its treatment. The Corpus Hippocraticum was the result of a koinon, or an association between the two schools.  It is thus Treaties whereby the two schools compromised on how to treat medical conditions.  (3, page 208-209)

Medical historian John Watson wrote in 1855 of Mercuriali, who suggested:
"Not more than fourteen treaties out of the whole collection were published by Hippocrates himself.  Five others... may have been left by him unfinished to be completed either by his son in law and successor, Polybius, by his sons Thessalus and Draco, by his grandson Hippocrates, or by other members of his family." (4, page 49)
Watson also noted the following:
"A third portion, including about 22 treaties, though perhaps not even begun by Hippocrates, is in strict accordance with his doctrines, and is believed by Mercuriali to have emanated from the immediate descendants of Hippocrates or other disciples of the school of Cos.  The remaining portion of the collection, according to the same authority, consists of spurious writings, and as such as contains opinions not in accordance with the doctrines of Hippocrates, though published as his."
(4, page 49)
Another theory is that as many as seven Hippocrates worked on the documents. We know that his grandfather was named Hippocrates. In additionNeuburger said:
In addition to his two sons Thessalos and Dracos, who also undertook journeys, his son in law Polybos, with Apollonios and Dexipos of Cos, probably also Praxagoras of Cos, ranked as his most famous pupils. It has been shown that Polybos took part in the formation of the Collection and acted as deputy in the school. Amongst the successors, there were five who bore the name of Hippocrates and represented themselves as medical authors. (8, page 125)
Prioreschi said that some parts of the Corpus may even have been written by physicians from the school of Cnidron. He said this may be evident in some of the passages that do not use theory to describe medicine.  He said  physicians of Cnidron tended to be more rational in their approach to medicine, compared to the speculative approach by the Con. (3, page 209-210, 214)

Whether or not parts of the corpus were written by Cnidron physicians may never be known. What is known is that, according to Neuburger:
"...the Hippocratic collection was brought together and edited in the beginning of the third century B.C. by a commission of Alexandrian scholars under order from the book loving Ptolomy. Even at that time doubt existed as to which of the writings could with certainty be ascribed to the great Hippocrates, and hardly one of the books had remained free from alterations and additions." (8, page 121)
So while they had the documents, they had no proof Hippocrates wrote them all. It's possible they attributed it to the great physician named Hippocrates.  However, it is also possible they ascribed the document to Hippocrates because this was a common name among the family of physicians at the School of Cos.

Medical historian Henry E. Sigerist suggested the entire treaties may be credited to Hippocrates because of his hard work, method of teaching, and skillful medical technique. It may have had nothing to do with Hippocrates being the superior physician at all, and mainly because later historians sought to credit someone for such important documents. (2, page 266)

Some historians speculate that Greek medicine had reached a point where a significant figure was needed to lift medicine to the next level, and the man born into, or raised into, this job was Hippocrates II.

It was, thus, his job to free medicine from the "fetters of oriental dogmatism... the leading-strings of the priestly caste... to rational science and moral dignity... (to) transition from the guild of the Asclepiads into the free profession of medicine." (8, pages 128-129)

Sigerist mentions another theory which postulates that Hippocrates was not superior to, but respected equally among his fellow physicians, with Hippocrates being the most senior.  With later Alexandrian physicians viewing these anonymously written medical texts as extremely important, they sought to give someone credit, and Hippocrates seemed the most logical choice.  (5, page 266)

Meryon goes as far to suggest that perhaps Hippocrates himself stole the best ideas of Cnidron. He said:
It has been stated, that having extracted all the information which the records contained in the temple of Cnidros could yield him, he set fire to it, in order that he alone might enjoy a monopoly of knowledge. (1, page 25)
Regarding this, Meryon stated in his notes:
The above calumy is attributed to Andreas, but Tzetstates said that it was the library of Cos, and not that of Cnidos, that was burnt. (1, page 25)
So was Hippocrates so selfish to earn credit for the documents that he was willing to destroy the information used in creating it?  Once again, there is no evidence to support this claim, so it is left to us as just another theory.

Meryon suggests Hippocrates was simply the benefactor of the era he was born into.  He was, after all, the son of a family of physicians who were all taught at the School of Cos.  Meryon said:
Much of the information contained in his writings, and which has been transmitted to us, appears to have been the accumulated knowledge of his immediate ancestors; and it is supposed by competent judges in the matter, that many, if not most, of the numerous treaties which are commonly attributed to him, were simply collected and written by him; for he had the great advantage, which can scarcely be appreciated, since the introduction of printing, of acquiring a thorough knowledge of the observations of his predecessors; and having, moreover, access to all the records and votive tablets in the temple of Cos, he had peculiar facilities to achieve the honour which is universally accorded to him. (1, page 22)
Watson, likewise, credited the era he was born into for his fame. He said:
"He lived in an age of progress, and while other arts and sciences were thus springing into life, and rising at once to maturity, it is not surprising that some man of genius should appear in the ranks of medicine, to give to it's principles from the utterance. This man was Hippocrates." (4, page 47)
So it appears that Hippocrates probably didn't work alone in creating the Hippocratic Corpus.  What will never be known with any certainty is who helped him.  

Another question one might ask is: does Hippocrates deserve credit for the Corpus?  

Considering that the document attributed to Hippocrates became the most significant document in Greek medicine, and that Greek medicine became the key to all medical wisdom, then I think we're fine with giving Hippocrates credit for the whole thing.

Considering how dogmatic people can be when considering new ideas, it must have been many years in the workings to transform medicine from the primitive mindset to the ancient mindset.  The fact that it eventually happened at all can be considered a revolution of sorts.

What matters most is that Hippocrates, or the Hippocratic writers, helped transform medicine away from the primitive world to the ancient world. Or, as Meryon put it, Hippocrates helped transform medicine from a profession of superstition to one of speculation by 'vague hypothesis.'  (6, page 21)

Of this, Watson said: 
"According to Celsus (a physician of the 2nd century), his (Hippocrates) principle credit is removing the teaching of medicine from the schools of philosophy, where it had always received some attention, and treating it as a distinct department of practical knowledge.  Pliny the elder supposes he was the first to institute clinical instruction."  (4, page 46, also see 3 page 42)
Withington said: 
It has been well said that great men illuminate the world by gathering into a focus the rays emanating from itself, and this is well seen in Hippocrates' third great service to medicine -- his rejection of supernatural heroes of disease.  The age was one of transition, and the simple faith in the old mythology was giving way in all direction."  (6, page 50)
Garison said:
Instead of attributing disease to the gods or other fantastic imaginations, like his predecessors, Hippocrates virtually founded that bedside method which was afterword employed with such signal ability by (later physicians).  (7, page 87)
Bradford said:
So great was his influence on medicine that it was no longer called the art of Aesculapius, but the science of Hippocrates." (2, page 23)
Chances are, however, that he did not work alone.  If it were possible to jump into a time machine and travel back to the age of Hippocrates, we'd probably find him, along with many other physicians, writing the passages that would end up in the Corpus.

Regardless, Hippocrates was referred by his contemporaries, including Plato, as "The Great." (6, page 48) He was also referred to as "the Great" when Aristotle walked the earth. The great second century Greco-Roman physician Galen referred to him as "the divine." The rest of history knows him as the father of medicine, and medicine as the "Hippocratic art." (8, page 125)

Max Neurburger, in his 1910 history of medicine, said:
The achievements of Hippocrates' family, of the Coan (Con) school, of many of his predecessors and immediate successors, all these were placed to the credit of the one man, whilst the historic personality was more and more veiled by the nimbus of homage. (8, page 126)
Yet through most accounts of the historians he earned this honor by his hard work and gentle approach. While he may not have written the Corpus, his name made it famous.  Perhaps for that reason alone he is deserving of honor as the father of medicine.

Over time, said Neurburger:
The mysticism of the Asclepiads diminished on the one hand in proportion to the admission of strangers into their fraternity, whereby the preservation of professional secrets were relaxed, on the other through intercourse with physicians (particularly Pythagorean), who had derived a more extended outlook from the schools of philosophy or who by empirical capacity had earned the confidence of the people." (8, page 100)
Neuburger also said that physicians like...
...Pythagoras, Empedocles, and their pupils, who were not without medical knowledge and dexterity, proved that healing was to be found even remote from the Asclepion shrines. Philosophically educated physicians aroused by their speculative and theoretical writings -- and considerable medical literature was in existence long before Hippocrates -- general scientific interest. (8, pages 100-101)
Hippocrates expounded upon this literature, setting up a system of medicine that made medical wisdom available to all who wished to become physicians.

This was all made possible by the physician of Cos, and, more particularly, by the the Hippocratic writers.  Although, through it all, it was made possible by the greatest physicians of all time: Hippocrates.

Legend has it he died in Thesally at the ripe old age of 80 or 85 or 90 or 105, depending on the source of reference.  Perhaps the longevity of his life was due to his mythical legacy; the fact he was essentially deified by later physicians.

  1. Meryon, Edward, "The History of Medicine," Volume I, 1861, London, (6)
  2. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey (7)
  3. Prioreschi, Plinio, "A history of medicine: Primitive and ancient medicine," volume 1, 1995, NE, Horatius Press, (1)
  4. Watson, John, "The Medical Profession from the Earliest Times: an anniversary discourse delivered before the New York Academy of Medicine November 7, 1855," 1856, New York, Baker & Godwin (4)
  5. Sigerist, Henry, "A History of Medicine," volume 2, 1961, Oxford University Press  (2)
  6. Withington, Edward Theodore, "Medical History from the Earliest Times: A Popular History of the Art of Healing," 1894, London, The Scientific Press. (3)
  7. Garrison, Fielding Hudson, "An introduction to the history of medicine, 1922, (9)
  8. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press
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