Hippocrates

In Greek antiquity, medicine was second to mathematics. Ancient Greek Civilization was at its peak during the 400's BC. During this period of time, sick people went to the temples dedicated to Asclepius, the Greek god of healing. At this time, a man named Hippocrates began teaching that every disease had only natural causes. He is known as the great ancient Greek physician. In medicine, doctors still refer to the Hippocratic oath, instituted by Hippocrates, who is also credited with laying the foundations of medicine as a science.

Galen built on Hippocrates' theory of the four humors, and his writings became the foundation of medicine in Europe and the Middle East for centuries. The Greek physicians Herophilos and Paulus Aegineta were pioneers in the study of anatomy, while Pedanius Dioscorides wrote an extensive treatise on the practice of pharmacology.

Hippocrates was the first physician known who actually considered medicine to be a science, and to be separate from religion. He wrote the Hippocratic oath, an oath that every new doctor-to-be still says to this day. It reflected Hippocrates high ideals.

Hippocrates of Kos (c. 460 BC­. 380 BC) was an ancient Greek physician. He has been called "the father of medicine", and is commonly regarded as one of the most outstanding figures in medicine of all time. He was a physician trained at the Dream temple of Kos, and may have been a pupil of Herodicus. Writings attributed to him (Corpus hippocraticum, or "Hippocratic writings") rejected the superstition and magic of primitive "medicine" and laid the foundations of medicine as a branch of science. Little is actually known about Hippocrates's personal life, but some of his medical achievements were documented by such people as Plato and Aristotle.

The Hippocratic writings introduced patient confidentiality, a practice which is still in use today. This was described under the Hippocratic Oath and other treatises. Hippocrates recommended that physicians record their findings and their medicinal methods, so that these records may be passed down and employed by other physicians.Other Hippocratic writings associated personality traits with the relative abundance of the four humours in the body: phlegm, yellow bile, black bile, and blood, and was a major influence on Galen and later on medieval medicine.

The Hippocratic Corpus is a collection of about sixty treatises, most written between 430 BC and AD 200. They are actually a group of texts written by several different people holding several different viewpoints erroneously grouped under the name of Hippocrates, perhaps at the Library of Alexandria. None of the texts included in the Corpus can be considered to have been written by Hippocrates himself, and one of them at least was written by his son-in-law Polybus. The best known of the Hippocratic writings is the Hippocratic Oath; however, this text was most likely not written by Hippocrates himself. A famous, time-honoured medical rule ascribed to Hippocrates is Primum non nocere ("first, do no harm"); another one is Ars longa, vita brevis ("art is long, and life short").

The Hippocratic face is the change produced in the countenance by death, or long sickness, excessive evacuations, excessive hunger, and the like. The nose is pinched, the eyes are sunk, the temples hollow, the ears cold and retracted, the skin of the forehead tense and dry, the complexion livid, the lips pendent, relaxed, and cold. The Hippocratic face is so called because it was first described by Hippocrates.

In medicine, clubbing (or digital clubbing) is a deformity of the fingers and fingernails that is associated with a number of diseases, mostly of the heart and lungs. Idiopathic clubbing can also occur. Hippocrates was probably the first to document clubbing as a sign of disease, and the phenomenon is therefore occasionally called Hippocratic fingers. Medical astrology is an ancient medical system that associates various parts of the body, diseases, and drugs as under the influence of the Sun, Moon, and planets, along with the twelve astrological signs. Hippocrates, the Greek physician who is regarded as the father of medicine, insisted his students study astrology, saying, "He who does not understand astrology is not a doctor but a fool." Each of the astrological signs (along with the Sun, Moon, and planets) are associated with different parts of the human body. Also, many plants are referred to in old herbals as being "under the influence of" some planet. This was used as a codification of the plants properties and used to create mixtures specific to different diseases.The associations of the signs with the parts of the body are as follows:

1. Aries - head, face, brain, eyes

2. Taurus - throat, neck, thyroid gland, vocal tract.

3. Gemini - arms, lungs, shoulders, hands, nervous system

4. Cancer - chest, breasts, stomach, alimentary canal

5. Leo - heart, chest, spine, spinal column, upper back

6. Virgo - digestive system, intestines, spleen, nervous system

7. Libra - kidneys, skin, lumbar region, buttocks

8. Scorpio - reproductive system, sexual organs, bowels, excretory system

9. Sagittarius - hips, thighs, liver, sciatic nerve

10. Capricorn - knees, joints, skeletal system

11. Aquarius - ankles, calves, circulatory system

12. Pisces - feet, toes, lymphatic system, adipose tissue

The Hypocratic bench or scamnum was a device invented by Hippocrates (c. 460 BC­380 BC) which used tension to aid in setting bones. It is a forerunner of the traction devices used in modern orthopedics, as well as of the rack, an instrument of torture. The patient would lie on a bench, at an adjustable angle, and ropes would be tied around his arms, waist, legs or feet, depending on the treatment needed. Winches would then be used to pull the ropes apart, correcting curvature in the spine or separating an overlapping fracture.

Hippocratic therapy

A drawing of a Hippocratic bench from a Byzantine edition of Galen's work in the 2nd century AD.

Hippocratic medicine was humble and passive. The therapeutic approach was based on "the healing power of nature" ("vis medicatrix naturae" in Latin). According to this doctrine, the body contains within itself the power to re- on simply easing this natural process. To this end, Hippocrates believed "rest and immobilization [were] of capital importance". In general, the Hippocratic medicine was very kind to the patient; treatment was gentle, and emphasized keeping the patient clean and sterile. For example, only clean water or wine were ever used on wounds, though "dry" treatment was preferable. Soothing balms were sometimes employed.

Hippocrates was reluctant to administer drugs and engage in specialized treatment that might prove to be wrongly chosen; generalized therapy followed a generalized diagnosis. Potent drugs were, however, used on certain occasions. This passive approach was very successful in treating relatively simple ailments such as broken bones which required traction to stretch the skeletal system and relieve pressure on the injured area. The Hippocratic bench and other devices were used to this end. One of the strengths of Hippocratic medicine was its emphasis on prognosis. At Hippocrates's time, medicinal therapy was quite immature, and often the best thing that physicians could do was to evaluate an illness and induce its likely progression based upon data collected in detailed case histories.[ Professionalism A number of ancient Greek surgical tools. On the left is a trephine; on the right, a set of scalpels. Hippocratic medicine made good use of these tools. Hippocratic medicine was notable for its strict professionalism, discipline and rigorous practice.

The Hippocratic work On the Physician recommends that physicians always be well-kempt, honest, calm, understanding, and serious. The Hippocratic physician paid careful attention to all aspects of his practice: he followed detailed specifications for, "lighting, personnel, instruments, positioning of the patient, and techniques of bandaging and splinting" in the ancient operating room. He even kept his fingerails to a precise length. The Hippocratic School gave importance to the clinical doctrines of observation and documentation. These doctrines dictate that physicians record their findings and their medicinal methods in a very clear and objective manner, so that these records may be passed down and employed by other physicians. Hippocrates made careful, regular note of many symptoms including complexion, pulse, fever, pains, movement, and excretions. He is said to have measured a patient's pulse when taking a case history to know if the patient lied. Hippocrates extended clinical observations into family history and environment."To him medicine owes the art of clinical inspection and observation". For this reason, he may more properly be termed as the "Father of Clinical Medicine".

Direct contributions to medicine Clubbing of fingers secondary to pulmonary hypertension in a patient with Eisenmenger's syndrome. First described by Hippocrates, clubbing is also known as "Hippocratic fingers" Hippocrates and his followers were first to describe many diseases and medical conditions. He is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as "Hippocratic fingers". Hippocrates was also the first physician to describe Hippocratic face in Prognosis. Shakespeare famously alludes to this description when writing of Falstaff's death in Act II, Scene iii. of Henry V. Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, "exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence." Another of Hippocrates's major contributions may be found in his descriptions of the symptomatology, physical findings, surgical treatment and prognosis of thoracic empyema, i.e. suppuration of the lining of the chest cavity. His teachings remain relevant to present-day students of pulmonary medicine and surgery.[41] Hippocrates was the first documented chest surgeon and his findings are still valid.[41]

Humorism and crisis

The Hippocratic school held that all illness was the result of an imbalance in the body of the four humours, fluids which in health were naturally equal in proportion (pepsis).[ When the four humours, blood, black bile, yellow bile and phlegm, were not in balance (dyscrasia, meaning "bad mixture"), a person would become sick and remain that way until the balance was somehow restored. Hippocratic therapy was directed towards restoring this balance. For instance, using citrus was thought to be beneficial when phlegm was overabundant.

Another important concept in Hippocratic medicine was that of a crisis, a point in the progression of disease at which either the illness would begin to triumph and the patient would succumb to death, or the opposite would occur and natural processes would make the patient recover. After a crisis, a relapse might follow, and then another deciding crisis. According to this doctrine, crises tend to occur on critical days, which were supposed to be a fixed time after the contraction of a disease. If a crisis occurred on a day far from a critical day, a relapse might be expected. Galen believed that this idea originated with Hippocrates, though it is possible that it predated him.

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The Hippocratic Oath

The Hippocratic Oath is an oath traditionally taken by physicians, in which certain ethical guidelines are laid out. It is thought to be written by Hippocrates by some scholars, but this is disputed and instead thought to be written by the Pythagoreans. One traditional version is below but there are others.

Several parts of the Oath have been removed or re-worded over the years in various countries, schools, and societies but the Oath still remains one of the few elements of medicine that have remained unchanged. Most schools administer some form of oath, but the great majority no longer use this ancient version, which praises pagan gods, advocates teaching of men but not women, and forbids cutting, abortion, and euthanasia. Also missing from the ancient Oath and many modern versions are complex, new ethical landmines such as dealing with HMOs, living wills, and whether morning-after pills are technically closer to prophylactics or an abortion.

I swear by Apollo the physician, and Aesculapius, and Health, and All-heal, 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.

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.

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

I will 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!