In his business dealings the physician, like a genuine philosopher, should not display a greed for money, he should assume a modest and dignified attitude, he should appear quiet and calm, and his speech should be simple and straightforward and free from all superstition.
For their knowledge of human anatomy the physicians of that period were obliged to depend on the dissection of animals. Specimens of human bones were of course easily accessible, and consequently the descriptions which are given of these structures are quite accurate, even as regards many of the finer details.
It would be a very difficult matter to furnish here, within a limited space, a reasonably clear exposition of the views held by Hippocrates with regard to human physiology and pathology. Empedocles, a Greek physician and high priest of Agrigentum, in Sicily, who was born about 490 B. C., founded a system of philosophy on the theory that the universe is made up of four elements—fire, air, earth and water; and he maintained that fire is the essence of life, the other elements forming the basis of matter. It was upon this system that Hippocrates founded his own theories of life, death and disease, but he disagreed with Empedocles in regard to the manner in which the four elements are united, his own belief being that they form together a genuine mixture, whereas Empedocles maintains that their union represents merely a mechanical aggregation of separate atoms. He also held that these original four elements, to which he gave the names of heat, cold, dryness and moisture, were represented in the human body by the following four cardinal fluids or “juices”: blood, mucus or phlegm, black bile and yellow bile.[25] He maintained, further, that when these elements are mingled harmoniously so as to produce a state of perfect equilibrium, health resulted; but that when some deficiency of one or more of them, or some lack of harmony between them in other respects, occurs, disease is produced. At a later date, a fifth element—wind or air (pneuma)—was added to the other four; and when Hippocrates was unable to account satisfactorily for certain phenomena of disease, he was wont to refer the phenomenon observed to divine interference.
This brief exposition of the physiological and pathological views held by Hippocrates, incomplete and superficial as it is, will have to suffice. Those who wish to acquire a more profound knowledge of the subject should consult some of the larger treatises like those of Daremberg, of Max Neuburger, and of Pagel, as well as the sections devoted to these subjects in the French (Littré) and the German (Fuchs) versions of the Hippocratic writings. At every step in such a study, the modern physician will encounter ideas and individual terms which he will have great difficulty in comprehending; and later on, as he reads the sections which deal with the more practical matters of the medical art, he will be astonished to find that Hippocrates was a most acute and trustworthy observer of the phenomena of disease, a remarkably clear writer, and a standard-bearer of very high aims.
In the examination and treatment of the sick the physicians of ancient Greece were highly trained. They paid very close attention to the patient’s account of his symptoms, but it was to the physical examination of the diseased body that they attached the greatest importance. They noted with extreme care the color and other peculiarities of the skin and mucous membranes, the condition of the abdomen, and the shape and movements of the thorax; they tested the patient’s temperature by placing the hand upon the body; and all the excretions were subjected to the closest scrutiny. By means of palpation they were able to determine not only the size of the liver and spleen, but also the changes which occur in the form of these organs in the course of certain diseases. They utilized succussion both as an aid to diagnosis and as a means of favoring the breaking through of pus into the bronchial tubes. They were familiar with the pleuritic friction sound and with the finest râles, which they compared to the creaking of leather or “the noise of boiling vinegar.” In their descriptions of these sounds it is distinctly stated that the examiner’s ear was kept tightly pressed against the patient’s chest.
In speaking of the accounts of individual diseases which appear in the Hippocratic writings, Puschmann says that they are evidently based on cases actually observed in practice, and that they are admirably written. It is in the laws which they have laid down with regard to the treatment of disease, however, that the Hippocratic writers have gained their chief distinction, a distinction which will belong to them through all time.
The physician should be the handy man of Nature, and he should strive to aid and to imitate her efforts to effect a cure. His first care should be to remove, so far as is possible, the causes of the disease; and then, in the conduct of the treatment, he should keep in view at all times the special circumstances of the case, giving closer attention to the patient than to the disease itself. In short, he should aim at being useful, or at least he should be careful not to do any harm.
CHAPTER VIII
BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS
The statements which have thus far been made in these pages with regard to Hippocrates are only of a general character, and it may therefore be interesting for the reader to have placed before him a few selected extracts from the writings which have formed the basis of these statements. The English text here used is a translation of the German version of Robert Fuchs, to which reference has already been made. It would have been a pleasure to use for this purpose the admirable English translation of Frederick Adams, published in 1849 under the auspices of the Sydenham Society of Great Britain; but, unfortunately, this version contains only a part of the Hippocratic writings, and, besides, this writer did not at that time have the advantage of consulting the French and German versions which have been published since 1849.
It seems almost unnecessary to state here, by way of preface, that the small amount of space which may properly be devoted to these extracts renders it necessary to present many of them in a very fragmentary and disconnected form, merely enough text being furnished to give the reader some slight idea both of the manner in which Hippocrates and those associated with him handled certain medical topics, and also of the views which they entertained with regard to the same subjects.