Medical Reader

Hippocrates: A Rational Profession 460–370 BCE

Physical diagnosis had its origins in Grecian medicine.

Clinical medicine flourished before the Greeks, especially in Egypt, Crete, and Babylonia, and undoubtedly the Greeks were influenced by these earlier physicians. But writings from these countries did not become part of the mainstream of Western civilization, as did those of the Greeks. They took a careful history and practiced direct auscultation. They were masters of observation: their descriptions of patients could fit modern texts without much change.

Greek medicine flourished early. Homer in the Iliad (ca 1200 b.c.) described 141 wounds and used 150 anatomic terms. Hippocrates (ca 460—370 b.c.) lived during the Golden Age of Greece. His contemporaries included Plato, Socrates, Aeschylus, Sophocles, Euripides, Aristophanes, and Pericles. Medicine “became in his hands an art, a science, a profession”. The Hippocratic writings are probably a collection from a number of individuals, including the master, from the period during which he was the dominant medical figure. They were collected after the death of Hippocrates and stored in Alexandria. From there, they were disseminated to all parts of the civilized world. The surviving collection contains 42 clinical cases, the likes of which are not encountered again for 1700 years. These cases demonstrate a high level of medicine that included a careful history, inspection, palpation, direct auscultation, and examination of the sputum and urine.

An enduring contribution of the Hippocratic school was the conviction that disease is natural and not divine. Consider the remarks about epilepsy: “It is thus with regard to the disease called Sacred: It appears to me to be no wise more divine nor more sacred than other diseases, but has a natural cause from which it originates like other affections”. This was a major conceptual leap. Natural phenomena can be studied and their course predicted. This concept was a necessary prerequisite to the development of physical diagnosis.

The Greeks did not develop an accurate knowledge of human anatomy and pathology. Dissection of human bodies did not occur except for a brief time at Alexandria in the third century b.c. The Greeks had no concept of nosology. They felt that disease was caused by an imbalance of the four humors of the body; blood, yellow bile, black bile, and phlegm. Developments on these three fronts—anatomy, pathology, and the nosology of disease—did not begin to occur until the thirteenth century.

The next great Greek physician after Hippocrates was Galen (ca a.d. 130–201), who was born in Pergamum. He spent most of his professional life in Rome, becoming physician to the Emperor Marcus Aurelius. He was a prolific author. Many of his works have been lost; the surviving ones fill twenty-two volumes. He studied and wrote extensively about anatomy based upon pigs and monkeys. He was the first experimental physiologist. He supplemented his findings by speculation. His written work was accepted as the ultimate truth until the time of Vesalius. This enshrinement of knowledge, much of which was incorrect, hampered medical progress for the next 1500 years.

Source: Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.

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