Hippocrates as Historian and Philosopher of Ancient Medicine
As there were many pens and voices making up the Hippocratic corpus, there existed a great many Hippocrates-es.
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Hippocrates, the widely acclaimed “Father of Medicine”, is a historical paradox: he was both someone and no one. Someone in the sense that there was indeed one doctor named Hippocrates who radically shaped medical thought in Ancient Greece; subsequently the world. And no one in the sense that the works associated with Hippocrates cannot be just the work of one person, but of many. Authorship of the sixty-plus texts with his name on the byline, collectively known as the Hippocratic corpus, is still up for debate with no clear consensus. For ease and consistency, all contributors to the corpus shall be from hereon subsumed under the umbrella Hippocrates.
As there were many pens and voices making up the Hippocratic corpus, there existed a great many Hippocrates-es. If there’s Hippocrates the doctor, then, surely, there could well have been a Hippocrates who was not just a doctor, but also, say, a geologist or a cartographer. However intriguing these incarnations are, we can’t be sure of either as there are many Hippocratic texts lost in antiquity, forever withholding their secrets from modern eyes. But what we can be sure of, based on the treatise On Ancient Medicine, is that there was both a Hippocrates the historian and philosopher of ancient medicine.
A few words of caution before we move forward. An examination of the Hippocratic corpus demands two things from the reader. First, an appreciation of the text with respect to its own historical milieu. There are plenty of wrong conclusions in ancient medical suggestions, for example the gynaecological findings attributed to Hippocrates. It’s imperative that we criticise them for being wrong, for being exactly that, but that also stipulates an understanding of the culture that shaped their ideas. Hippocrates lived and wrote in a world that was highly misogynistic, so it shouldn’t come as a surprise or an attack on our modern sensibilities that resemblant views on women underlie his gynaecological tracts. The ancients accepted them for the most part, for the way they saw it such claims represented the best science of their time (this applies not just to the Hippocratic corpus, but to many ancient documents in general). The problem lies not in them, but in us if we continue to hold such views knowing that they’re wrong. Secondly, the disputed authorship of the corpus shouldn’t demean the prestige of Hippocrates the individual. On the contrary, it amplifies it. Many writers of the Hippocratic corpus wrote with the intention of using Hippocrates’ reputation to seek recognition and support for their works. This alone tells us one important thing: invoking Hippocrates granted you attention and audience, regardless whether the result benefited or bedeviled the invoker. Such was the power of Hippocrates’ rank.
The above suggestions will help guide us as we search and recover the historian and philosopher in On Ancient Medicine. But before diving into the text, we need to know a few things about who Hippocrates was as a historical individual.
A brief biography of Hippocrates
The famed doctor was born in the Greek island of Kos around 460 BCE. Like many physicians at that time, his supposed lineage can be traced back to the Greek god of healing, Asclepius. True to their dynasty’s destiny, Hippocrates’ father, Heraclides, was also a physician.
Plato mentions Hippocrates’ alleged ancestry in Phaedrus, calling him “of the Asclepiad family”. Whether that meant Hippocrates being a temple attendant to Asclepius or him belonging to a sect of doctors who were considered descendants of the healing god, we can’t exactly be sure. But textual evidence points to the latter as Hippocrates was wont to detach diseases from divine sources (but he was open to the possibility as shown in Prognostic). The folk-clerical therapies employed in Asclepius’ temples by its stewards also contradict with Hippocrates’ largely materialist medicine. Plato also tells us in Protagoras another important social function that Hippocrates fulfilled, that of a medical instructor, a role that he performed for an unspecified price.
Of his stature as a physician, we read from Aristotle a glowing endorsement of his medical abilities. In Politics, Aristotle uses the doctor as a comparative standard for what a well-functioning institution should be like:
“For a state like other things has a certain function to perform, so that it is the state most capable of performing this function that is to be deemed the greatest, just as one would pronounce Hippocrates to be greater, not as a human being but as a physician, than somebody who surpassed him in bodily size.”
Acclaim wasn’t limited to his homeland either, so it seems. News of his extraordinary talents had reached the neighbouring kingdom of Persia, where the king Artaxerxes was listening attentively. Artaxerxes later ordered the governor of the Hellespont to bribe Hippocrates with extravagant gifts, hoping that the allure of riches would convince the doctor to ditch Greece for Persia. Unfortunately for Artaxerxes, the offering only managed to elicit Hippocrates’ defiance and nonchalance over worldly riches, for the doctor promptly refused the offer. This story is largely a legend with only a few kernels of truth in it; it was probably first concocted as a political parable peddled by the Greeks to bolster anti-Persian prejudice.
Below is a portion of an early 19th-century depiction of Hippocrates’ refusal by Ann-Louis Girodet-Trioson.
An incomplete yet already coherent picture of Hippocrates emerges out of these few reports. With Plato and Aristotle’s accounts, we can be certain that there was indeed a Hippocrates whose medical talents overshadowed others, which was reason enough for aspiring physicians to pay tuition to study under his tutelage. Moreover, the use of Hippocrates as propaganda against the Persians affirms his salutary stature within the greater Mediterranean.
As a doctor of elite acclaim and a medical teacher of great repute, we can safely assume that Hippocrates fostered within and around him an academic culture that especially focused in, but wasn’t limited to, medicine. In a time when specialisation was alien to intellectual life, Hippocrates and his students would have welcomed insights from other fields if it improved medical treatments. This openness wasn't unique to the Hippocratics, but it was quite common in ancient Greece. An earlier school, that of Pythagoras of the famous theorem, mixed medical treatments with music and a strict regimen of vegetable diet. Aristotle’s Lyceum, which opened decades later after Hippocrates’ death, also followed a similar schema, especially embodied by its founding headmasters. While Aristotle busied himself with zoological research—culminating in the multi-volume Historia Animalium which garnered him the accolade of being the “father of biology”—his chosen successor as headmaster of the Lyceum, Theophrastus, set his eyes on another living kingdom. As a sort of complement to Aristotle’s compendium, Theophrastus wrote a comprehensive botanical study called Historia Plantarum. Because of this work, Theophrastus was later granted custody of his kingdom and named “father of botany”.
An eye for medicine buttress the works of these two. Implicit in Aristotle’s work is the importance of understanding the reciprocal relationship between anatomical form and physiological function when it comes to the well-being of the organism, that is, of its health. Theophrastus, meanwhile, devoted portions of his anthology to herbal lore and used this as a segue to discuss illnesses and their respective cures. Given Aristotle’s high praise of the doctor, it’s plausible that Hippocrates had significant influence on both their works.
The fact that Hippocrates found an audience within the philosophical community is a testament to the intellectual quality of the corpus. In fact, there is enough reason to suppose that Hippocrates was a more direct spiritual and intellectual forerunner to Aristotle, as many of the “modern” and “scientific” elements espoused by the philosopher were already developed in many Hippocratic texts. Especially consonant with Aristotle’s science was Hippocrates’ pursuit of a correct method in On Ancient Medicine which showcased the doctor’s best attempt at a philosophy and history of medicine.
A tale of two Hippocrates
Hippocrates starts On Ancient Medicine with a polemic against those “who narrow down the causal principle of diseases and of death among men” to a mere accounting of “heat, cold, moisture, dryness, or anything else that they may fancy”. This aggressive opening stems from Hippocrates’ concern that “some practitioners are poor”. It is clear, then, that the chief aim of this text is to correct contemporary medical malpractices and misunderstandings.
The opening reprimand acts as a reminder to physicians and the public alike that there exists a flourishing medical tradition which stands in contrast to those who he castigates. Medicine, Hippocrates says, “has discovered both a principle and a method, through which the discoveries made during a long period are many and excellent”. The method Hippocrates mentions here is of utmost importance to his whole philosophy, because it is the beacon that guides correct medical practice. And it is through this method that Hippocrates believes “full discovery will be made, if the inquirer be competent, conduct his researches with knowledge of the discoveries made, and make them his starting point.” A fork begins to form here, where Hippocrates slowly splits into a philosopher and a historian. For Hippocrates the historian, there is no question that modern medical discoveries are built upon the foundations of the past. And it should be like that because according to Hippocrates the philosopher, medicine is a cumulative treasury that grows from the collective empirical efforts of its practitioners. Both paths serve to heighten the patented Greek irony present in this formulation: the way forward is to look back and see what works.
Because there is already a standard for the correct conduct of medical research, fresh progress in medicine, Hippocrates claims, can only be attained by engaging in this empirical tradition, saying that anyone who “attempts to conduct research in any other way or after another fashion, and asserts that he has found out anything, is and has been the victim of deception.” It’s as if Hippocrates is issuing a philosophical prescription bearing the medical message, “this is what you should do and this is what you should avoid doing.”
Correct practice, he argues, can only be attained by following correct methods - ones that are rooted in empiricism. To stray from what works is to deceive and be deceived. There is, therefore, an acute understanding in Hippocrates of the delicate web that binds doctors and patients together that makes medicine possible and necessary. The patient depends on the care given by the doctor, so it is of great importance that whatever the doctor prescribes and does spring from an empirically-proven source.
It is tempting to conclude that Hippocrates is denying theoretical thinking any role in medicine in these passages. This is all the more beguiling given that his views were further fleshed by the later Empiricist school who championed the superiority of sensory experience over theory in diagnostics and treatments. However, the locus of Hippocrates’ concern is not in the supposed incompatibility of medical practice with philosophical thinking, rather it is in the crucial episode of acquiring knowledge, on the event of knowing. Medicine requires an intimate knowledge of the workings of the body, thus precluding the need for actual hands-on experience in dealing with sick and injured patients. Of course, one can know a thing or two about medicine from books. But since medicine happens in the social relationship between a doctor and a patient, merely knowing medical facts without confronting their physical incorporation doesn’t lead to a realisation of medicine. Sensory experience, in this regard, only becomes superior because it manifests in the same physical realm where the social character of medicine exists. Doctors can hardly conjure living patients out of hypotheses - and bodies are more than just the site of idealised humoural confluence. However, this doesn’t belittle the value of theory.
Because Hippocrates puts a premium on what works, theory enjoys a paramount, albeit secondary, place in medicine. The concept of what works is dependent on established practices that produce consistently effective results and theories that best explain why such practices work. So it is not enough for a doctor to prescribe an expectorant for incessant coughs, but the doctor should also know how it loosens phlegm and eases its expulsion. Knowledge of the dual character of what works will enable the doctor to easily communicate whatever concerns there are with their patient. Hippocrates viewed this information transmission as a key component of medical practice:
“But it is particularly necessary, in my opinion, for one who discusses this art [medicine] to discuss things familiar to ordinary folk. For the subject of inquiry and discussion is simply and solely the sufferings of these same ordinary folk when they are sick or in pain. Now to learn by themselves how their own sufferings come about and cease, and the reasons why they get worse or better, is not an easy task for ordinary folk; but when these things have been discovered and are set forth by another, it is simple. For merely an effort of memory is required of each man when he listens to a statement of his experiences. But if you miss being understood by laymen, and fail to put your hearers in this condition, you will miss reality.” (Emphasis mine)
We can conclude from the above paragraph that Hippocrates easily escapes the modern convention of lumping complex thinkers into diluted categories: Hippocrates wasn’t an empiricist nor was he a rationalist as we mean by them today. He transcended both. The emphasised portion of the paragraph shows Hippocrates’ keen understanding of how sensory experience (via empiricism) and theory (via rationalism) interact to form a medical reality - so the more correct conclusion is to say that he embodied a fluctuating balance of both.
The starting polemic finally reaches maturation in the form of an epistemological aphorism: sensory experience makes medicine possible, theory makes medicine necessary. It is at this point where the philosopher Hippocrates slowly steps away from the podium to let his historian duplicate take the stage, because the philosophical position just articulated finds its greatest support from the region of history explored in On Ancient Medicine.
As mentioned above, the Hippocratic view sees medicine as being built from empirical accumulation, and continues to be so. What we know today we owe to the many physicians and patients of the past. There’s an important presupposition here, of course, that of varying tempos of development. Human societies undergo frequent fluxes that have drastic effects on the activities of its scholars. Progress can either go slowly or rapidly, depending on the many factors that affect its process. Or it can altogether halt and stagnate. Whatever the case may be, the truism that medical knowledge is built from past foundations still rings true. A complete rundown of the respiratory process would’ve been impossible had we failed to understand even the rudiments of nasal breathing.
Since medicine is a continuous human project with an origin that can be traced back to a certain point in the past, medicine therefore has a history. Its probable genesis is what preoccupies historian Hippocrates. Because he believes that medicine happens within the connection between patient and doctor, he draws a few scenarios when this bond first started showing signs of life, when ideas of health and healing were still in their primordial forms but were already close to boiling in people’s minds.
Similar to what I discussed in my previous article, The History of Medicine Starts in Our Animal Lineage, Hippocrates draws our attention back to an imagined past when our ancestors were still making sense of their new alien worlds, acquainting themselves with the new flora and fauna surrounding them. New natural vistas necessitated novel modes of nutrition and lifestyle, leading to early attempts at differentiating what sustained and restored good health.
So from its earliest inception, medicine had already been charged by the dual power of experience and theory. Continued consumption of the usual food items, everyday habits, and endurance from environmental conditions all coalesced to form nascent ideas of health. Corollary to this was concern of its absence.
It was the failure of customary diet and lifestyle to restore health among the sick that prompted initiatives to try novel regimens for recovery and healing. “For the art of medicine would never have been discovered to begin with, nor would any medical research have been conducted,” says Hippocrates, “if sick men had profited by the same mode of living and regimen as the food, drink and mode of living of men in health, and if there had been no other things for the sick better than these.” Its nascence was not born out of a carefully deliberated consensus, nor the commencement of a preordained genetic programme, rather it was “sheer necessity” that “has caused men to seek and to find medicine.”
These impromptu beginnings can be best understood when contextualised with our global dispersal after the earliest Homo sapiens marched beyond the frontiers of their original African habitat. If what Hippocrates claims is true, then we should expect to find a variety of unique healing practices among early human societies. And this is exactly what current archaeological and paleontological finds tell us. While all early medical attempts are expected to operate under the auspices of a common theme, the diversity of materials scattered all over the world provided the many isolated pockets of early human societies with enough substances to experiment with and utilise, giving every iteration a uniqueness enriched by their local environments.
And again, the fossil and archaeological records all concur. Trepanning, the surgical boring of the skull to relieve the brain of stress, was almost ubiquitous in prehistory. However, the rituals, incantations, drugs, tools, and personnel involved in the operation differed from culture to culture by varying degrees. Patients who underwent trepanning all had their skulls opened, and all felt the agony, but their overall experience wasn’t similar - while coconuts were said to have been used as skull dressings among Polynesian patients, a different type of cover was used for those who underwent the procedure in Switzerland, unless of course tropical coconuts did migrate to Europe (with the help of swallows according to Monty Python).
Hippocrates embraced the many early attempts to kindle medical thought and considers them vital in the overall development of medicine. “I declare” he starts:
“...that we ought not to reject the ancient art as non-existent, or on the ground that its method of inquiry is faulty, just because it has not attained exactness in every detail, but much rather, because it has been able by reasoning to rise from deep ignorance approximately perfect accuracy, I think we ought to admire the discoveries as the work, not of chance, but of inquiry rightly and correctly conducted.” (Emphasis mine)
Reason prevails as a vital ingredient in the “discovery” of medicine for Hippocrates. It wasn’t just mechanical impulses that led early humans to, say, bore skulls of their comrades, but antediluvian considerations of health and sickness were products of careful thought, of reason tempered by experience and experience informed by reason.
Now we can fully appreciate our conjured Hippocratic aphorism: experience makes medicine possible insofar as it is in the physical and actual interaction with patients where medicine happens; and reason makes medicine necessary insofar as it is in the realm of careful thought where experience gets processed to form new ideas for possible development, without which our modes of treatment and understanding health would’ve decayed by interminable ignorance.
And since Hippocrates wants what is right, his appeal to reason is predicated on correctness, which is why his opening tirade is aimed at what he sees as an erroneous trend in humoural analysis. This is also the reason why his rebuke is not a total admonition of the humoural theory, instead, it is a critical scrutiny of its conduct and content. Where experience calls for reason to expand and accommodate “more” humours into consideration, reason should follow. In fact, in the last third of On Ancient Medicine, Hippocrates emphatically recommends that “we must examine the powers of humours, and what the effect of each is upon man, and how they are related to one another.” There is no mention of the definitive amount of humours, be it four, five, or even eleven as Praxagoras claims. But what he highlights are their powers, their effective quality upon the body.
Hippocrates wouldn’t have been able to arrive at these conclusions had he not had a trenchant appreciation of history and philosophy. Had he limited himself to medicine, perhaps progress in the field would’ve been hampered and much slowed. We cannot know for sure, perhaps other thinkers would’ve taken the task. But thankfully Hippocrates did, and his contributions substantially helped medicine grow from its outset. And at the end of On Ancient Medicine, Hippocrates invites us all to follow his lead so we could all do our part in making medicine better for all:
“If a man can in this way conduct with success inquiries outside the human body, he will always be able to select the very best treatment.”
(All images taken from the Wellcome Collection.)
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