Welcome to another text where we continue our journey through the philosophers who developed the ideas that inspired most of our own at present. Today we are going to explore a name that may not be as obscure as the ones before: Hippocrates.
Giving some justification to my personal interest in philosophy, in ancient Greece, philosophy and medicine were tightly bound, as it happened with many other fields of present-day science, both having an influence on each other (Adamson, 2014). Hippocrates is originally from an island of the coast of Ionia (where the Milesian school was) name Kos. We don’t have full certainty, but the available evidence suggests that Hippocrates is younger than Socrates and a likely contemporary of Plato and possibly Aristotle, placing him between late 4th century BC and early 3rd century BC with Hippocrates’ works being influential to them (Adamson, 2014).
Hippocrates is famously hailed as the father of medicine (Adamson, 2014; Kleisiaris et al., 2014) for both his great achievements in ancient Greek medicine as well as being credited with developing a lot of the ideas that still function as the philosophical core of modern medicine. One of his most famous, and still influential to present day, ideas is what is considered the fundamental precept of medical ethics: “Primum non nocere”, “First of all, do no harm” (Adamson, 2014). This idea first originated in one of Hippocrates’ texts, the Epidemics, which interestingly analysed the disease outbreaks at the time (Adamson, 2014). This text is one of many that composes a whole body of texts commonly known as the Hippocratic Corpus. These texts would cover a range of topics ranging from different diseases, drugs and medical ethics even (Adamson, 2014).
Within its records we find that when the Greeks first started organising the Olympic Games, some people started specialising in the care of athlete’s health and the prevention of injuries, under the title of “paidotrivai”(Kleisiaris et al., 2014), being the first to use massage oils, specifically olive oil, with the aim of warming up athletes and avoid sport injuries (Kleisiaris et al., 2014). I consider the fact that a lot of this practices still prevail not as a sign of the genius of Hippocratic medicine, but of how outdated some of present-day practices are. In the Hippocratic corpus we also find the first descriptions of treatment of traumatic wounds, fractures and surgeries such as amputation to stop gangrene, which were used until at least the Middle Ages (Kleisiaris et al., 2014).
Despite bearing his name, not all these texts were written by Hippocrates, but also by other physicians who learned from him or followed in his teachings (Adamson, 2014). There were forms of archaic medicine before this, but the Hippocratic corpus is where we found the earliest surviving systematic texts on medicine (Adamson, 2014). Another common trend between medicine and philosophy at the time was the separation from religious practices and beliefs, instead seeking to have a basis on rationality and science (Adamson, 2014; Kleisiaris et al., 2014). Thus, the underlying philosophy of Hippocratic medicine is that medicine should be seen as a scientific discipline that bases itself on the natural sciences when diagnosing, preventing and treating diseases (Kleisiaris et al., 2014). However, this separation was not complete. While the overall belief at the time was that diseases were caused by the gods, in the Hippocratic corpus it is stated if diseases were in any way sacred, was because they were caused by forces of nature that were themselves sacred, such as the sun or wind (Adamson, 2014). The idea that gods would just randomly curse individual mortals was argued against, but there was still room for belief in gods and the divine (Adamson, 2014).
Still, Hippocrates contributed to the first steps of modern medicine, arguing that diagnosis, prognosis and treatment should be based on detailed observation, reason and the accumulation of observed experience (Kleisiaris et al., 2014). In other words, medicine should be based on knowledge obtained from the available empirical evidence (Kleisiaris et al., 2014).
However, the bigger influence to Hippocratic medicine came from the philosophical and scientific theories of the pre-socratics, such as Empedocle’s theory of the four elements that I covered previously. You should read the previous text for further details on Empedocle’s theory, but put simply, everything in the universe is made of four elements: air, earth, fire and water (Adamson, 2014). This will thus include human bodies, leading to our link between this theory and medicine. If we got ill, it was because the elements in our body are not in the proportion they should (Adamson, 2014; Kleisiaris et al., 2014). Also utilising the same theory of balancing the four elements and how hot, cold, dry or wet our body to explain how they worked, Hippocratic doctors would already utilise certain drugs as part of their treatment (Adamson, 2014).
This type of theory may seem non-sensical to us, but it’s not that far-fetched when you consider the observations that could be made at the time such as being quite common to develop a fever when you’re ill or that when people die they stop breathing (Adamson, 2014). Still, it was insisted by the Hippocratic doctors that the practice of medicine isn’t as simple as memorizing a few theoretical principles and applying these automatically, being more akin to a form of art (Adamson, 2014). I personally don’t like this phrasing without proper contextualisation, as it opens the door for a lot of esoteric quackery to be accepted into medicine and healthcare. What is meant by art here is a non-rigid, holistic approach to medicine, one where we treat the whole body, not just the symptomatic body part, and we consider the individual circumstances of each patient (Adamson, 2014). Still relating to this theory and within the writings found in the Hippocratic corpus, was the first mention of the four-humour theory (Adamson, 2014; Kleisiaris et al., 2014). According to this theory, for us to be and remain healthy, there has again to be balanced proportions within our body, not of the elements, but of certain types of fluids called the bodily humours: blood, phlegm, yellow bile, and black bile (Adamson, 2014). Based on this, Hippocratic doctors had also started using bloodletting and cupping (Adamson, 2014). They would, however, advise against using this often and displayed an overall reluctant stance against any type of “invasive” procedures (Adamson, 2014). Interestingly, even though I like to think no one with a minimal level of knowledge of biology and ability to think critically nowadays would take the four-humour seriously, a lot of these interventions are still greatly used and advertised presently even amongst healthcare providers. This is not due to shown effectiveness in quality critical trials, so I do wonder what makes people still commonly utilise outdated practices such as cupping if the theory explaining its acting mechanism is not supported by biology? Why have certain sectors and agents of healthcare failed to move from 400BC? I’ll explore this more below when I highlight what I consider to a very pertinent text from the Hippocratic corpus. But first I want to discuss what was actually the principal and most common of the treatments prescribed by Hippocratic doctors: the right diet and amount of exercise (Adamson, 2014; Kleisiaris et al., 2014).
In general, Hippocratic doctors were firm supporters of preventative medicine, (Adamson, 2014) and argued the importance of environmental causes and natural treatments of diseases, the importance of psychological factors, nutrition and lifestyle, independence of mind, body and spirit, and the need for the harmony between the individual and the social and natural environment as both causes and treatment of health problems (Kleisiaris et al., 2014). Ancient Greeks in general believed that mental and physical health were connected, with the phrase “healthy mind in a healthy body” came from this belief (Kleisiaris et al., 2014). In this sense, it appears they were ahead of us in their understanding of health, as amongst the general public and health care practitioners, the importance of psychosocial factors remains underrecognized (Haslam et al., 2018). This shows a view that aimed to treat the individual as whole, addressing the psychosomatic entity that is a disease, instead of treating symptoms (Kleisiaris et al., 2014). In line with this, the assessment performed by Hippocratic doctors included noting geographical location, climate, age, gender, habits, diet, rational moods swings, duration of sleep, appetite, thirst, nausea, location and severity of pain, chills, coughing, sneezing, and menstrual changes (Kleisiaris et al., 2014). A lot of these details remain part of modern medical history taking. Based on this information and examination of symptoms, Hippocratic doctors would diagnose patients and treat them, establishing the basis of medicine for the present day (Kleisiaris et al., 2014). Not only this, but the Hippocratic corpus also introduced many of the medical terms still used today such as symptom, diagnosis, therapy, trauma, sepsis, diabetes, arthritis, cancer, coma, paralysis, epilepsy, among others (Kleisiaris et al., 2014).
One particular text in the corpus I want to highlight is the famous Oath (Adamson, 2014) which focuses on professional integrity, benevolence and human dignity (Kleisiaris et al., 2014) In particular, I want to highlight some of the points from the Modern version of the Hippocratic Oath, that were already present in Hippocrates’ arguments: (Harris and Buchbinder, 2021):
- Medicine should be based on and respect the evidence produced through the scientific method.
- Overtreatment and overdiagnosis should be avoided.
- Understanding of natural history of symptoms and reassurance of patients takes precedence over medical interventions.
- Doctors should be honest about the actual limited effectiveness of certain medical interventions.
- Treatment should be based on individual patient circumstances and presentation as opposed to scans and other investigations.
- The focus on medicine should be on public health measures focused on healthy lifestyle as opposed to more passive and sometimes invasive interventions.
I find it astonishing that despite these values being present since Hippocrates and doctors the oath being considered the code of conduct for medical doctors even in present day, a lot of the current problems in healthcare stem from these ideals not being adhered to. Some examples are unnecessary imaging, opioids, and surgery for non-serious back pain; arthroscopic surgery for knee osteoarthritis; subacromial decompression surgery for shoulder pain; platelet-rich plasma injections for tendinopathies and osteoarthritis. (Harris and Buchbinder, 2021). I will also point the finger at my own profession of physiotherapy and highlight other problematic examples such as offering “diagnoses” that are no more than natural anatomical variations, also overestimating the effectiveness of interventions such as massaging, manipulating and sticking needles in people’s bodies, disregard for patients’s individual environment and circumstances. Why do healthcare professionals behave in this way? Curiously because of the following trait that they appear to have in common with many practitioners of alternative “medicines”: reluctance to admit that they don’t know and seeing not testing or treating a patient as a failure to care (Harris and Buchbinder, 2021).
This, however, is not entirely their fault. Just like patients are part of an environment that has an effect in their health, so do healthcare professionals work in a system that propagates the expectation from both clinicians and patients that there is always a need to exclude or provide a diagnosis or a treatment, where diagnoses and diseases are created to treat measured values or other findings independently of how these correlate to symptoms, and treatments “need” to be tried instead of choosing advice, reassurance and simply waiting while monitoring (Harris and Buchbinder, 2021).
This is way I think we need to again create a better link between philosophy and healthcare. I’ll go even as far as arguing that we need to bring back philosophy into most aspects of our quotidian. We have so much to learn from exploring how ideas came to be over the ages. I hope this journey through the philosophers of history has started to make you aware of this. I will continue this journey at another time. Thank you for reading through and as always, if you learned something and/or found this text interesting, please share it all over social media so you can help others learn. See you in the next one.
References:
Adamson, P. 2014. Classical Philosophy: A history of philosophy without any gaps, Volume 1. 1st edition. Oxford University Press: Oxford.
Harris, I. A., & Buchbinder, R. (2021). How doctors are betraying the Hippocratic oath. The BMJ, 375. https://doi.org/10.1136/bmj.n2807
Haslam, S. A., McMahon, C., Cruwys, T., Haslam, C., Jetten, J., & Steffens, N. K. (2018). Social cure, what social cure? The propensity to underestimate the importance of social factors for health. Social Science and Medicine, 198, 14–21. https://doi.org/10.1016/j.socscimed.2017.12.020
Kleisiaris, C. F., Sfakianakis, C., & Papathanasiou, I. v. (2014). Health care practices in ancient Greece: The Hippocratic ideal. In J Med Ethics Hist Med (Vol. 7).
The Physiolosopher 