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HIPPOCRATES.

His life and works--His influence on Medicine.

Hippocrates, the Father of Medicine, was born at Cos during the golden age of Greece, 460 years before Christ. He belonged to the family of the Asclepiadæ, and, according to tradition, could trace his ancestors on the male side to Æsculapius, and on the female side to Hercules. He is said to have received his medical education from his father and from Herodicus, and to have been taught philosophy by Gorgias, the Sophist, and by Democritus, whom he afterwards cured of mental derangement.

There was a very famous medical school at Cos, and the temple there held the notes of the accumulated experience of his predecessors, but Hippocrates visited also, for the purpose of study, various towns of Greece, and particularly Athens. He was a keen observer, and took careful notes of his observations. His reputation was such that his works are quoted by Plato and by Aristotle, and there are references to him by Arabic writers. His descendants published their own writings under his name, and there were also many forgeries, so that it is impossible to know exactly how many of the works attributed to him are authentic; but by a consensus of opinion the following books are considered genuine: "Prognostics," seven of the books of "Aphorisms," "On Airs, Waters and Places," "On Regimen in Acute Diseases," the first and third books of "Epidemics," "On the Articulations," "On Fractures," the treatise on "Instruments of Reduction," and "The Oath"; and the books considered almost certainly genuine are those dealing with "Ancient Medicine," "Surgery," "The Law," "Fistulæ," "Ulcers," "Hæmorrhoids," and "On the Sacred Disease" (Epilepsy). The famous Hippocratic Collection in the great libraries of Alexandria and Pergamos also comprised the writings of Pythagoras, Plato and Aristotle.

The genius of Hippocrates is unsurpassed in the history of medicine. He was the first to trace disease to a natural and intelligible cause, and to recognize Nature as all-sufficient for healing, and physicians as only her servants. He discussed medical subjects freely and without an air of mystery, scorning all pretence, and he was also courageous enough to acknowledge his limitations and his failures. When the times in which he lived are considered, it is difficult to know which of his qualities to admire most, his love of knowledge, his powers of observation, his logical faculty, or his courage and truthfulness.

The central principle of belief of Hippocrates and the Dogmatists was that health depended on the proper proportion and action in the body of the four elements, earth, water, air, and fire, and the four cardinal humours, blood, phlegm, yellow bile and black bile. The due combination of these was known as crasis, and existed in health. If a disease were progressing favourably these humours became changed and combined (coction), preparatory to the expulsion of the morbid matter (crisis), which took place at definite periods known as critical days. Hippocrates also held the theory of fluxions, which were conditions in the nature of congestion, as it would now be understood.

In his time public opinion condemned dissection of the human body, but it is certain that dissections were performed by Hippocrates to a limited extent. He did not know the difference between the arteries and the veins, and nerves and ligaments and various membranes were all thought to have analogous functions, but his writings display a correct knowledge of the anatomy of certain parts of the body such as the joints and the brain. This defective knowledge of anatomy gave rise to fanciful views on physiology, which, among much that is admirable, disfigure the Hippocratic writings.

The belief that almost all medical and surgical knowledge is modern, though flattering to our self-complacency, is disturbed by the study of the state of knowledge in the time of Hippocrates. To him we are indebted for the classification of diseases into sporadic, epidemic, and endemic, and he also separated acute from chronic diseases. He divided the causes of disease into two classes: general, such as climate, water and sanitation; and personal, such as improper food and neglect of exercise.

He based his conclusions on the observation of appearances, and in this way began a new era. He was so perfect in the observation of external signs of disease that he has never in this respect been excelled. The state of the face, eyes, tongue, voice, hearing, abdomen, sleep, breathing, excretions, posture of the body, and so on, all aided him in diagnosis and prognosis, and to the latter he paid special attention, saying that "the best physician is the one who is able to establish a prognosis, penetrating and exposing first of all, at the bedside, the present, the past, and the future of his patients, and adding what they omit in their statements. He gains their confidence, and being convinced of his superiority of knowledge they do not hesitate to commit themselves entirely into his hands. He can treat, also, so much better their present condition in proportion as he shall be able from it to foresee the future."

He wrote about the history of Medicine, a study which is much neglected at the present time. There is no generation of men so wise that they cannot with advantage adopt some ideas from the remote past, or, at least, find the teaching of their predecessors suggestive. Hippocrates was one of the first to recognize the vis medicatrix naturæ, and he always aimed at assisting Nature. His style of treatment would be known now as expectant, and he tried to order his practice "to do good, or, at least, to do no harm." When he considered interference necessary, however, he did not hesitate even to apply drastic measures, such as scarification, cupping and bleeding. He made use of the narcotics mandragora, henbane, and probably also poppy-juice, and as a laxative used greatly a vegetable substance called "mercury," beet and cabbage, and cathartics such as scammony and elaterium! He was able to diagnose fluid in the chest or abdomen by means of percussion and auscultation, and to withdraw the fluid by the operation of paracentesis, and he recognized also that the fluid should be allowed to flow away slowly so as to minimize the risk of syncope. He operated also for empyema. In regard to the methods of Hippocrates for the physical examination of the chest it is reasonable to suppose that the Father of Medicine indirectly inspired Laennec to invent the stethoscope. Hippocrates prescribed fluid diet for fevers, allowed the patients cold water or barley water to drink, and recommended cold sponging for high fever. In his writings will be found his views on apoplexy, epilepsy, phthisis, gout, erysipelas, cancer and many other diseases common at the present day.

In the province of Surgery, Hippocrates was surprisingly proficient, although he lived before the Anatomic Period. He had various lotions for the healing of ulcers; some of these lotions were antiseptic and have been in use in recent times. His opinions on the treatment of fractures are sound, and he was a master in the use of splints, and considered that it was disgraceful on the part of the surgeon to allow a broken limb to set in a faulty position. He resected the projecting ends of the bone in the case of compound fracture. He had a very complete knowledge of the anatomy of joints, was well acquainted with hip-joint disease, and could operate upon joints. Accidents were no doubt common in the gymnasia, and practice in the treatment of fractures and dislocations extensive and of a high order of excellence. Hippocrates used the sound for exploring the bladder, and understood the use of the speculum for examining the rectum, and in operations for fistula and piles. He understood the causation of club-foot, and could cure cases of this deformity by bandaging. He was skilful also in obstetric operations. He trepanned the skull, which appears to have been a common operation in his day. He had clear and sound views in reference to wounds of the head, recognizing that trivial-looking wounds of the scalp might become very serious. Hippocrates gave directions as to the indications for using the trepan, and warned the operator against mistaking sutures of the cranial bones for fracture.

He did not describe amputations as generally understood, but removed limbs at a joint for gangrene. When necessary he made use of mechanical appliances for reducing dislocations, and recommended doctors to furnish their surgeries with an adjustable table, fitted with levers, for dealing with the reduction of dislocations, and for various other surgical manipulations. Excision of tumours was not a common operation of Hippocratic surgery, although it had been a part of Hindu practice in very ancient times. On the subject of Obstetrics, Hippocrates wrote a great deal, and although many of his theories seem absurd at the present day, yet, on the whole, the treatment he recommends is efficacious. Regarding Gynæcology, in his treatise on "Airs, Water and Places," it is interesting to observe that he says that the drinking of impure water will cause dropsy of the uterus. Adams, commenting on this, has in mind hydatids, but it is evident that both Hippocrates and his translator and critic have mistaken hydatidiform disease of the ovum for hydatid disease of the womb. In the books which are considered genuine the references to diseases of women are meagre, and it is likely that the author had little special knowledge of the subject. That part of the Hippocratic collection which is not considered genuine deals rather fully with the subject of gynæcology.[5] In it are described sounds made of wood and of lead, dilators and uterine catheters. Sitz baths were in use, and fumigations were very extensively employed in gynæcological practice. Pessaries were made by rolling lint or wool into an oblong shape, and were medicated to be emollient, astringent or purgative in their local action. The half of a pomegranate was used as a mechanical pessary, and there are also references to tents, and to suppositories for the bowel.

In dealing with Dietetics, Hippocrates displays close observation and sound judgment. The views held generally at the present day coincide closely with his instructions on food and feeding. In the treatise on Ancient Medicine, he states that men had to find from experience the properties of various vegetable foods, and discovered that what was suitable in health was unsuitable in sickness, and that the accumulation of these discoveries was the origin of the art of medicine.

The Sydenham Society initiated, and Dr. Adams brilliantly accomplished, a noble work in the publication in 1849 of "The Genuine Works of Hippocrates," from which "The Law," and "The Oath" are here quoted. The former is the view of Hippocrates of the standards which should govern the practice of medicine; the latter is that by which all the Æsculapians were bound.