Hippocratic Writings

"Whenever you start thinking about a subject, I’ve always found it a good principle to go back to the very beginning of what has been written about it. The Hippocratic writings were collected in the library in Alexandria around 300 to 200 BC, maybe even later. Essentially they are writings on medicine from across the Greek world that were deemed to have reached a certain standard. They are very varied, and from all sorts of different authors. I am no classical scholar, and I cannot make any comment on the translations, or even the cultures that they come from, but I really enjoy looking through them because you can see how intellectual curiosity was already working hard. Some of the Hippocratic writers are intensely trying to figure things out. One, for example, is confused about whether all the liquid you swallow goes down your oesophagus or whether some goes into your lungs. So he restricts a pig from water until it is very thirsty and then he gives it water with blue dye in it. And then he does something any butcher would be familiar with, but not many doctors: he slits its throat. He reports that if you follow what he has done, you will notice that some of the blue water goes down the trachea. And he has a whole theory as to why that is, what that tells us about the mechanism of swallowing. Yes he’s genuinely interested where that water goes and there is proper method. You can see constantly as you go through the Hippocratic writings how they’re reaching for answers. This is from a passage about the heart: In shape the heart is like a pyramid, in colour deep crimson. It is enveloped in a smooth membrane. In this membrane there is a smooth fluid rather like urine, giving the impression that the heart can move in a kind of bladder. The purpose of the fluid is to protect the pulsation of the heart, but there is just about sufficient of it to alleviate the heat as well. Amazing! it’s a completely perfect description of the pericardium, whose purpose is to lubricate the beating of the heart within its sac — though not to draw off heat. The writing can be extraordinarily poetic as well. Here, for example, the author has just opened up the ventricles of the heart and looked deeply into its chambers: These are the springs of Man’s existence. From them spread throughout his body those rivers with which his mortal habitation is irrigated, those rivers which bring life to man as well for if ever they dry up, the Man dies. Beautiful and completely straightforward! Not at all. That doesn’t come until 1628, although Galen was getting close to it. But there is an enormous amount in these writings about the effect of the environment on your health, and how the humours within the body are affected by the climate within which you live. It’s written, for example, that drought is more healthy than rain, and less likely to provoke fatal illness. The diseases usually peculiar to rainy periods are chronic fever, diarrhoea, gangrene. You can see they’re trying to reach out and put together some sensible ideas about malaria, diarrhoea in places without adequate sanitation and so on. Yes! The precepts, for example, recommend that you not overawe your patients with splendour of your dress. Be sombre and sober in your style. Use a cheap case, don’t wear a fancy hat. And then there’s a wonderful line: you must not force payment from a patient unable to pay, because your reputation will be higher for treating a patient who cannot pay you. Your dedication and devotion to the art is more important than whether you get paid. Beautiful! “Before there was even a profession such as medicine, there is writing with a scientific appreciation of the body and how to make it better” So right there at the beginning, before there was even a profession such as medicine, there is some writing with a scientific appreciation of the body and how to make it better. There’s no dogma here, because they’re constantly asking, try this for yourself, prove me wrong! And there is also the beginning of a professional ethic about a group of people who should hold each other to high moral and clinical standards. A few of the writings complain about quacks, who rip people off, and don’t pay attention to the high standards. There’s another ancient text I could have mentioned: Galen’s That the Best Physician is Also a Philosopher . It’s essentially a call to arms for doctors to concentrate on the perfection of their clinical skills and to give up on ideas of attempts to get rich through their art. It shows all the ways in which he doesn’t trust those doctors who use their talents for a gain other than the benefit of their patients. It is short and elegant."