Hippocrates and Galien, portraits from "Oeuvres" by Ambroise Pare (1582).

Hippocrates was of Dorian origin.  His family came from Thessaly which is confirmed by several clues:  his name, which means “horse trainer” (Thessaly was the only region of Greece where horses were bred), the fact that he named one of his sons “Thessalos” and that his father was called Heracleid, a Dorian name.  More important, and also more delicate, is the question of knowing how Hippocrates elaborated his revolutionary conception of the medical art.  He received diverse influences from his family, Babylonian influences but also Indo-Germanic and Indo-Aryen.  From this, he kept a whole “magico-empiric” tendency.  Delving further into the question of the origins of Hippocratic Medicine, Charles Lichtenthaeler observes that Hippocrates could not have neglected the contributions of the pre-Socratic philosophers, and that he in fact took certain fundamental notions from them.  For example,

“the spiritual father of fluxion and catarrh is not Hippocrates but Empedocles of Agrigente (around 495-435) and one has the right to think that the four humours defined by Hippocrates – blood, phlegm, bile and atrabile – are born from the analogy with Empedocles’ four elements:  air, water, fire, earth”.

Like all innovators of genius, Hippocrates dipped into his immediate environment.  He observed the doctors who looked after the gymnasium athletes;  he interested himself in the specialists who had to draw up healthy, balanced menus for both well and sick people.  After having carefully studied the therapeutic actions of his time, he questioned them and proposed his own.  He begins by taking into consideration the patient’s environment, by studying the geology, the configuration, the cardinal orientation of the place;  then Hippocrates determines the type of climate to which his patient is submitted;  he then connects the illness and the seasons, the volume of precipitations and the temperature.  It is like this that he concludes that epidemics are ruled by the rhythm of the seasons.  But Hippocrates’ great contribution is to have demonstrated the existence of four primary temperaments in the human species:  the sanguine, the flegmatic, the coleric and the melancolic.  Once the patient’s temperament is recognized, Hippocrates is able to guess how the illness will evolve.  This is how he makes morale intervene in medical prognosis, with, for the first time, this affirmation which has not been refuted since:

“He who wants to heal gets better faster, he who loses all hope worsens the prognosis.”

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Using the Egyptian and Mesopotamian contributions, Hippocrates draws up a systematic table – a nosology – of the illnesses which he repertories starting from their clinical symptoms.  But, by removing all magical and demonic intervention, Hippocrates is the first to look at the malady from the point of view of its external clinical signs.  Unfortunately, the Hippocratic pathology is less commendable and, visibly, the roles of the brain, lungs, heart, liver and kidneys are perfectly unknown.  Which doesn’t prevent Hippocrates from being right when he attempts to treat catarrh, rhumatisms and malaria.

However, the most admirable thing about Hippocrates is his humanity, his infinite patience, his attitude toward the patient.  This attitude is not only the fruit of ethical reflection, it also obeys the wish to make the attending doctor more efficient.  It is by minute observation that the process of treatments, and healing where possible, begins.  Hippocrates therefore observes all his patients, notes the symptoms and then tries to draw synthetic conclusions which he groups together in his works.  Here is how he reports the evolution of a malignant fever in a certain Philistes:

“At Thasos, Philistes had had a headache for a long time, sometimes he even fell into a carus [coma];  he went to bed.  After drinking, a continuous fever having been lit, the headache became worse.  Firstly, he felt the heat during the night.  On the first day, he vomitted bilious matters in small quantities, firstly yellow, then eruginous [rust-coloured] and in greater abundance.  He then rendered solid excrements.  Difficult night.  The second day, deafness, high fever, right hypocondra tense and retracted, urines scarce, diaphanous […]  He had a furious delirium around the middle of the day.  The third day was difficult.  The fourth day, spasms;  everything was exasperated.  The fifth day in the morning, he died.” (Epidemics III, from the French translation by C. Daremberg).

Hippocratic therapy reposes on four fundamental principles which are still worthy of meditation:

  –  “be useful or at least do not harm”;

  –  “combat the ill by its contrary”;

  –  “measure and moderation”;

  –  “each thing in its time”.

Hippocrates had no illusions about his capacities and did not claim to heal all illnesses.  His precept:  “be useful or at least do not harm” even appears rather discouraging, and in its time scandalised the most gifted of Hippocrates’ successors, Galien of Pergamo, who lived in the IInd Century of our era.  But Littre, proceeding to the modern edition of Hippocrates’ writings, estimed that these were

“grave and modest words where one discovers, when one penetrates them, a deep sense and useful teaching”.

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The Romans, who had no serious medical tradition – old Roman Medicine took its remedies from the Etruscans, visibly more gifted in divination and magic than in a clinical approach -, greatly appreciated Greek doctors.  As early as the Ist Century before the present era, a certain Aesclepiade acquired great celebrity by treating his rich clients with massages, hydrotherapy and dietary advice, but it is Galien who gave all its brilliance to the Hippocratic teaching, on which he delivered a very prolix and very scholarly commentary.  What survives of this work contains no less than nineteen thousand pages.  It is difficult to separate his personal observations from those attributed by him to Hippocrates.  But, as they are, his reports constitute a highly colourful description of the Roman medical universe.  One learns the effects of wine on sleep, how to get rid of an elephantiasis, how to treat gladiators’ wounds, what sort of colics were suffered by the Emperor Marcus-Aurelius and how Galien cured them…  Only one regret:  that he had succeeded in treating the tonsilitis of the young Commodus, son of Marcus-Aurelius, for if he had not survived the operation, he would have spared the Antonius Dynasty from ending in bloody buffooneries.

Not very inventive in comparison to the Greeks, the doctors of the Roman epoch at least had the merit of generalising the use of anaesthetics when operating.  They mostly used mandragora.

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The Greek or Roman Medicines, or even more ancient ones, have not disappeared.  Kept in the memories of the monasteries of the High Middle Ages or transmitted by the Byzantines and the Muslims, they came down to us, and still serve for medical reflection.

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