Why You, Hippocrates?

I know that most people wouldn’t even ask the question, but did you ever wonder why Hippocrates is considered to be the “Father of Medicine”, especially considering his oath?

Over the centuries, the oath became the basis of professional ethics and morality of the healing arts. It is a solemn obligation dedicated to how physicians are to interact with their teachers and their families, their colleagues and their kin, and the families of the physicians themselves. Today, we would call this “professional courtesy”. Then it goes into how the physician is to interact with patients.

There are, however, some interesting things here that would seem to contradict the actual practice of medicine as it is today.

Let’s take a look at the oath and see what it says. I’ll make some comments along the way.

I swear by Apollo the physician, and Aesculapius, and Hygeia, and Panacea, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation:

To reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

As we all know from Greek Mythology, Apollo was the god who dragged the Sun across the sky, but he was also the god of all of the Arts, including music, poetry, prophesy and the art of healing. Aesculapius, the Roman name for his son, was also considered the god of healing. His two daughters, Hygeia, and Panacea, came to represent “personal cleanliness or health” and “cure-alls”; which is why we use derivatives of their names to express those concepts today.

You don’t want to screw around with Apollo, his son or his grand-daughters because one of the most powerful weapons in his arsenal to do harm to humanity is “pestilence”! He could kill you in the most painful and prolonged ways.

I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

Here, “regimen” means a rational course, as of diet, exercise, or life style, intended to preserve or restore health or to attain some result.

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.

Firstly, the Greek word that was interpreted here as “medicine” in the original text was “φάρμακον” (pharmakon) and not “ιατρική” (iatrikì), the Greek word for “medicine”. Pharmakon literally means “poison”. The Romans translated this word as “venenum” in Latin, which is where we get the word “venom” in English.

This line obviously indicates a refusal to commit euthanasia and abortion. On the subject of abortion, medical professionals who perform this procedure have justified themselves by suggesting that what Hippocrates was actually saying is that abortion was within the practice of obstetrics which fell under the purview of the midwives and was not within their competence or that, in ancient Greece, since a woman was the property of either her father or her husband, she had no inherent right without their consent to abort. In other words, their opinion is that if a male had asked for the pessary, it could be provided, since the unborn child was his alone.

Pretty slick; no? I mean, leave it to a profession to look at a direct, unambiguous statement and interpret it to mean the complete opposite of what it says. Now, look at the next line and consider where it is positioned in the oath.

With purity and with holiness I will pass my life and practice my Art.

This line, since it comes after the abstention from carrying out euthanasia and abortion, seems to be declaring the reason for not engaging in the those acts. We may assume this because the next line deals with surgery, another non-medical practice performed by the surgeon or “chierurgos” (χειρουργός) and not the doctor or iatròs (ιατρός). The practices of medicine and surgery were two, distinct professions. In fact, they remained so all the way until the beginning of the 20th century.

By the way, chierurgos in Greek means, “he who does by hand”. This could be interpreted to be from manipulation and bone setting all the way to general surgery and trepanation (boring holes into a person’s skull).

I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work.

“Laboring under the stone” refers to either suffering from gall stones or kidney stones.

Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves.

Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.

These two lines are self-explanatory and deal with maintaining a clinical detachment from the patient, abstaining from sexual relationships and keeping their information privileged.

While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

To summarize, the oath is the basis of what is called the “deontology” of the professional. The deontology means that the practitioner is bound to follow science, his conscience and the law when performing his duties. This is one of two distinguishing characteristics that make a profession different from a trade. Professions, being based upon a philosophy, cannot guarantee an outcome, but must guarantee that their adherents will follow their deontology; trades, having no philosophical basis, must guarantee an outcome by contractual agreement.

The oath also clearly defines Hippocrates’ thoughts on practice as being non-pharmacological, non-surgical (excepting manipulation) and based more upon proper life-style, proper diet and physical exercise.

So, why would medical doctors and surgeons consider him to be the father of their profession?

Well, there’s still a little more to the picture to see in order to understand this.

In Hippocrates’ time, they were in the process of separating the physician from the priest. The healing arts were, historically, in the hands of devotees of the gods, in particular, Apollo. Then, some Greeks began to think about nature (“φύση” or physi).

On the one hand, one group, the “Theologoi” (θεολόγοι), believed that the gods were causal in all activities and events effecting humanity, on the other, the “Physiologoi” (Φυσιολόγοι) believed that things occurred because of their inherent nature and the reaction of their natures to outside influences.

These two philosophies wound up being manifested in two different, competing schools of healthcare with two differing approaches to the art. The former was centered in the City of Knidos and the latter on the Island of Kos. Hippocrates was a follower of the Kosian School of Aesklapios. It is for this reason that his oath reflects that view.

The two views, and the practices upon which they were based, were in startling contrast from one another.

The Knidian opinion was that ill-health was the result of demonic possession, of a sort. They would give the patient a “pharmakon” or poison, in the belief that the demon, seeing that the host was about to die, would flee the body. This was the professional objective of this school of thought. The idea was then to try and bring the patient back to health. If the patient died as a result of their treatment, they were still considered successful, because the demon, in any event, was cast out.

It was from this practice that Hippocrates, and later Galen of Pergamum in the first century after Christ in Rome, declared:” First, do no harm!” (Primum non nuocere!). Those of the Kosian school recognized that their counterparts were killing more patients with their treatments than many of the illnesses themselves, if left to follow their natural courses.

The Kosian view of health and illness was centered around a concept of “balance”. They believed that illness was a consequence of imbalances between the patient and himself, his family, his society, the cosmos and so on.

Now, I won’t get into the Humoralist philosophy in detail because it is not germane to this post. Suffice it to say that the professional objective of the Kosians was to bring their patients into equilibrium or, as we would call it today, homeostatic balance.

Okay, so now we know that Hippocrates was not of the schools that we would generally associate with medical or surgical practice. We also know that he didn’t share the same philosophy of health and disease. So, why do they consider him the Father of their practices?

Well, it all has to do with knowing what you’re treating!

Every 5 years or so, doctors from all over the Greek-speaking Mediterranean would come together in different locations to discuss their experiences with patients. These congresses were called a “Lykeion” (Λύκειον) or “Lyceum” in Latin. It was at these gatherings that Hippocrates noticed that the nomenclature for transmitting information was not standardized and clinical observations of the same phenomena were described differently and named differently in different locations. He set about the task to facilitate communication between practitioners for the purpose of eliminating confusion and the spreading of accurate knowledge. He did this by categorizing “symptoms”, that is, the subjective complaints of the patients, and “signs” or the objective observations of the examiner. By grouping these into a clinical picture and giving them a “name”, each practitioner would know precisely what the other one was discussing.

This process was called “diagnosis” (διάγνωση); literally meaning “for knowledge”.

It was for his development of the diagnostic basis of treatment that Hippocrates is now called the Father of Medicine.

Incidentally, drugs and medicines were not introduced into the practice of medicine until the first century after Christ. As was mentioned above, Galen of Pergamum, another Greek, came to Rome to revolutionize the practice.

It was Galen who mixed “drogue”, a Gallic word for “dried barks and spices”, along with “medicinae” or “dried legumes” in Latin, into precise mixtures according to the Theories of Pythagoras. These concoctions were referred to as “Galenicaliae”. By eliminating the pharmakon from his protocols, he had far fewer patients die under his care. We can’t know if his treatments actually had an effect on the conditions he treated, but we can say that he may have simply humored his patients and gave them enough time to recuperate on their own.

One thing we do know is that he was extremely successful and his fame and renown throughout the empire is an historical fact.

One more thing, as was mentioned above, medicinae in Latin means “dried legumes”, so whenever you hear the title, “Doctor of Medicine”, you are actually hearing “Teacher of Dried Beans”.

We have come a long way!