#7. Hippocrates and his legacy

Before you read this, consider the period. In its glorious canvas. Socrates is in his full avatar, Plato a young man philosophizing, as Hippocrates is writing his Hippocrates Corpus. And Aristotle is entering his teens as Hippocrates is breathing his last.

These were the times that Hippocrates, the father of modern medicine wandered with his healing power and guidance from the shores of the Aegean and inland to where today Bulgaria and Turkey stand. Some 2500 years back. (c, 460-c.370BCE).

The Hippocrates Corpus is a document of around 60 documents some of which may not have been written by the author. Notes. Detail histories and records, ailments and treatments. It is so assumed because the subject range is wide, opinions varied from strong scientific arguments in some to no so in some and because the styles differ such widely between documents. From fever to fractured bones to epidemics to infertility to teeth to epilepsy (the sacred disease).

Hippocrates is believed to be a man of many qualities – a poet, a musician, a mathematician and an athlete. No wonder that he wandered such distances. But above all he was a torchbearer of science. A story runs that Hippocrates refused to agree with dignitaries who believed they had the last word in the society on the issue of cause of illness being deities and spirits. The result, he was imprisoned for around 20 years.

But why is Hippocrates considered the Father of Medicine? For many things. For he prescribed guidelines on clinical practice, for he first emphasized on medical ethics and for he wrote a set of rules that a physician must abide by for him to be respected as a physician by the Society.

He first described the critical terms of today’s diseases, Acute and chronic. Endemic and epidemic. Relapse and remission. He pioneered a systematic approach to patient care through clinical observation, examination, recording and analysis of the patient’s condition. Principles and techniques that every medical student is taught today.

On a mandatory daily observation of the patient he writes “I believe that it is an excellent thing for a physician to practice forecasting. He will carry out the treatment best if he knows beforehand from the present symptoms what will take place later.’ And what was it to observe that Hippocrates chronicled? Pulse, breathing, temperature, skin colour, appearance of mouth and eyes, palpitation of internal and external organs and excretion. Every element a twenty first century physician shall observe.

Hippocrates paid particular importance to two elements- urine and faeces. Famous is his guidance “It is better that flatulence should be passed that that it should be retained”.

But it is the principles that he set. Particularly on medical recording. All records to be written in clear, objective and uncluttered fashion so that the treating physician could follow the course of disease well or a different physician than the treating physician could understand the issues better.

With all of above scientific approach, Hippocrates’ approach to treatment was very pragmatic. His most famous quote “First, do no harm”. He advised much reliance on elements non-invasive – peace, cleanliness; comfort; nutrition and a keen observation of the patient.

And his remedies included honey, olive oil, vegetables and herbs – figs, garlic, onion, poppy and such many – in whole or extracts.

Some disease conditions he described well. For example, Hippocratic fingers where clubbing of fingers and nails occur due to lung or heart conditions.

Hippocrates could have been a chapter in the History of Medical Science for the above. The rationale that he brought in medical examination, his scientific principles, his clinical acumen and his focus on “harmless” treatment,

But more than all of these Hippocrates did something for which he is the first and the most important chapter in medical history. He wrote the Hippocratic Corpus “On the Physician” that clearly set guidelines on what an ideal doctor should be. With this not only did he lay out a guidance for doctors through generations but also increased the social standing ever after.

So, what does an ideal doctor look like? An upright, honest, stable, beyond reproach or corruption, attending the patient with curiosity and consideration, take care of the patient’s position and note his symptoms meticulously.  

And the doctor’s clinic? Tidy, Clean. Inspiring confidence; organized with each equipment laid out methodically.

(I am so much reminded of my father, the Physician and his small clinic in Howrah truly as I write this).

And finally, so important. On issue of patient confidentiality. Every aspect of the patient’s condition should remain private and confidential only to the treating physician(s)’

And all of this result in what all of medical students have taken our oath on as Physicians. The Hippocrates Oath,

“I swear by Apollo the Healer, Asclepios, Hygiea and Panacea….Witness all the Gods, all the Goddesses, to keep according to my ability and my judgement, the following oath…..I will prescribe regimes for the good of my patients, in accordance with my ability and my judgement…I will never do harm to anyone…….I will give no deadly medicine if asked…..I will preserve the purity of my life and arts…..In every house I will enter only for the good of my patients, keeping myself away from all intentional ill-doing and all seduction and especially from the pleasures of love with women or men, be they slaves or free….All that may come to my knowledge in the exercise of my profession or in daily commerce…..I will keep to myself , holding such things shameful to be spoken about , and will never reveal…..’

But Hippocrates was not God, He was a human. And therefore, lives on with a controversy – for some a height of a patriotic act and for some defying the principles of a physician’s act. According to a legend, troops of Artaxerxes, the Persian Kind who was an enemy to the Greeks, were being ravaged by Plague. The King offered huge sums and gifts to Hippocrates to treat his troops, Hippocrates refused to treat for he would not treat the enemy. This is a legend and for a doctor to consider whether his call of duty as a Physician is more or his call of duty to patriotism.

(A bust of Hippocrates of Cos gifted to me by my dear friend Dr Amresh Kumar)

Reference: A Short History of Medicine by Steve Parker; Internet Encyclopedia of Philosophy https://www.iep.utm.edu/hippocra/

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