Hello everyone and welcome to this week's blog post. This week, I will be exploring the life of a man often referred to as the "Father of Medicine", who also happens to be the namesake for this website - Hippocrates of Kos. Hippocrates of Kos, an Ancient Greek physician who lived between 460 BC to 370 BC, had a huge impact on medicine, especially through his teachings and books. In this article, I will discuss his works, including the Hippocratic Oath, the ethical guidelines that he inspired and his teachings.
The Hippocratic Corpus was a set of around 60-70 ancient Greek medical works that were written by Hippocrates and his colleagues. It contains numerous notes, essays and other research on medical subjects aimed at a wide audience, from other physicians to average people. Interestingly, while the set of documents is named after Hippocrates, historians agree that the Corpus could not have been entirely written by him. Instead, it is more likely that the Corpus was accidentally named after him when a librarian in Alexandria, Egypt recorded all medical works as Hippocrates'.
The most famous document contained in the Hippocratic Corpus is arguably the Hippocratic Oath, which is still used in modern-day medicine today. The Hippocratic Oath is an ethical statement that was historically taken by doctors and other physicians, requiring them to swear by the ancient greek gods of healing (including Apollo, Asclepius, Hygieia and Panacea) that they would be held to certain medical standards, As such, the Hippocratic Oath is widely accredited to be the earliest declaration of medical ethics, and has established many of the principles of modern-day medical ethics.
"Do no harm" is the most famous of these ethical principles, perhaps because it underlines the belief that doctors should always act for the good of their patient. This principle is outlined in the original version of the Hippocratic Oath with the words "I will abstain from all intentional wrong-doing and harm", however, the exact words 'primum non nocere' (which translates as 'do no harm') actually belong to another of his works called 'Of the Epidemics'.
The principle of doing no harm, which in modern-day use is often referred to as 'non-maleficence', is the most important for a doctor to remember. This is because doctors with the best intentions often use treatments that do good without considering the negative effects or harm caused by the treatment.
For example, while surgery on a broken leg could heal the leg and allow the patient to walk again, one must still consider the risks of surgery when deciding treatment. Equally, when prescribing aggressive medication may give the best chance of curing the disease, "do no harm" dictates that the medication should not be prescribed if it causes harm to the patient.
The principle of non-maleficence is often counter-balanced with the principle of beneficence which states that a doctor has the moral duty to act in the best interests of their patient. This principle is incredibly important, especially when considering how vulnerable many patients are. Doctors often treat people who are in lots of pain or mentally deprived in some other way. As such, it would be very easy for an unscrupulous doctor to trick patients, perhaps by putting them through unnecessary pain or charging them for unnecessary medication or treatment.
In addition, it is important to note that acting in the best interests of the patient is not the same as doing good. For example, while amputation after a leg injury would do good, it's not in the best interest of the patient as they would have a much worse quality of life afterwards. Therefore, the possible good that would come out of treatment must also be compared with other possible treatments. This action should also be counter-balanced with the principle of non-maleficence to ensure the best possible outcome for the patient.
Today, most doctors do not swear to the original Hippocratic Oath. Nevertheless, the majority of doctors do take an oath when they graduate from medical school. For example, graduates of the Bristol Medical School take an oath called the Bristol Promise. Moreover, following the Holocaust, during which doctors in Germany participated in experiments and other atrocities against prisoners in concentration camps, the world realised that there was a large disparity between the medical ethics of different countries.
Consequently, the Declaration of Geneva was adopted by members of the World Medical Association in 1948. According to the WMA themselves, this declaration was intended to be a form of the Hippocratic Oath, modified to fit better with modern practices. Following multiple amendments to this declaration in recent years, this declaration now forms the foundation of the international code of medical ethics.
Hippocrates is also very well-known for setting up the Hippocratic School of Medicine. In this school, medical terms such as acute, chronic and relapse were coined and several diseases were documented (such as Hippocratic fingers). Nonetheless, this school is most well known for its effectiveness. At the time in Ancient Greece, there were two rival schools on Knidos and Kos island respectively. Hippocrates' school on Kos had better results than the Knidian medical school focusing on patient care and addressing the symptoms of a disease, rather than the Knidian school which focused on diagnosis. Moreover, it is important to note that the effectiveness of school was limited as dissections were not allowed in Ancient Greece, resulting in very poor anatomical knowledge.
Before the teachings of Hippocrates, almost everyone living at the time believed that disease was caused by the gods, however, Hippocrates was one of the first people to reject this idea of divine intervention. Instead, he proposed that disease, in fact, originated from a combination of internal factors and environmental factors. Indeed, this is most evident in his book 'On the Sacred Disease', in which he writes that disease is not 'divine' nor 'sacred' but rather has 'a natural cause from [which it] originates like other affections. This idea of his was important to medicine, as it marks the first shift away from the divine in medicine, however, unfortunately, his ideas of medicine were based on wrong ideas, such as the theory of humours.
Hippocrates of Kos is also widely accredited as being the first person to apply the ideas of humorism to medicine. Humorism, which is also known as the theory of the four humours, is the idea that there are four humours that exist as liquids in the human body, which were linked to the four fundamental elements (earth, air, water and fire). These liquids were blood, phlegm, yellow bile and black bile. The theory then went on to state that disease was caused by an excess of one of these liquids. As such, the disease could be treated by restoring the balance of humours. While Hippocrates himself did not invent this theory, he was the first to implement it in the medical profession. Indeed, his teachings and arguments about this theory were so effective that they remained central to medical treatment until the 19th century.
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