BMJ No 7123 Volume 315
Education and debate Saturday 20/27 December Christmas 1997 issue
Medicine as a profession
Hip, Hip, Hippocrates: extracts from The Hippocratic Doctor
 | What do doctors know of Hippocrates? Many have seen a
presumed likeness of "the father of medicine" - a sharp eyed,
balding Greek in a toga, often under a tree. Some may remember taking
the Hippocratic Oath, which contains the laudable injunction to
"first do no harm." (In fact, it doesn't, just as nobody says:
"Play it again, Sam" in "Casablanca".) Those who have checked
the oath recently will know that it takes an unfashionable stance on
abortion, euthanasia, and women in medicine.
For a man who influenced 2,500 years of medical practice the
historical record is very hazy. Historians have now decided that the
great body of writings that bears his name is better known as the
Hippocratic Corpus, having being wr |
|
Unsurprisingly, these multiauthor volumes have their internal
inconsistencies, abrupt changes of style and tone, and incompatible
world views.
But much sounds very modern, and this forms the basis of
John Fabre's new book, "The Hippocratic Doctor: Ancient Lessons
for the Modern World". In writing it, Fabre found it necessary to
scour virtually the entire corpus to put together Hippocratic thinking
on a particular issue. He has grouped extracts from 50 treatises
under eight main themes. What f
Tony Delamothe,
BMJ |  |
The Hippocratic doctor
On Fractures (chapter I) - "In fact the treatment of a fractured arm is not difficult, and is almost any practitioner's job, but I have to write a good deal about it because I know practitioners who have got credit for wisdom by putting arms in positions which ought rather to have given them a name for ignorance. And many other parts of this art are judged thus: for they praise what seems outlandish before they know whether it is good, rather than the customary which they already know to be good; the bizarre rather than the obvious."(1)
On Joints (chapter LXXVII) - "What you should put first in all the practice of our art is how to make the patient well; and if he can be made well in many ways, one should choose the least troublesome. This is more honourable and more in accord with the art for anyone who is not covetous of the false coin of popular advertisement."(1)
Physician (chapter I) - "The dignity of a physician
requires that he should look healthy, and as plump as nature intended
him to be; for the common crowd consider those who are not of this
excellent bodily condition to be unable to take care of others. Then
he must be clean in person, well dressed, and anointed with
sweet-smelling unguents that are beyond su
Precepts (chapter IV) - "Should you begin by discussing
fees, you will suggest to the patient either that you will go away and
leave him if no agreement be reached, or that you will neglect him and
not prescribe any immediate treatment. So one must not be anxious about
fixing a fee. For I consider such a worry to be harmful to a troubled
patient, particularly if the disease be acute. For the quickness of the
disease, offering no opportunity for turning back, spurs on the good
p
Precepts (chapter VI) - "I urge you not to be too unkind,
but to consider carefully your patient's superabundance or means.
Sometimes give your services for nothing, calling to mind a previous
benefaction or present satisfaction. And if there be an opportunity of
serving one who is a stranger in financial straits, give full
assistance to all such. For where there is love of man, there is also
love of the art."(3)
Precepts (chapter VIII) - "A physician does not violate
etiquette even if, being in difficulties on occasion over a patient and
in the dark through inexperience, he should urge the calling in of
others, in order to learn by consultation the truth about the case, and
in order that there may be fellow-workers to afford abundant
help."(4)
Laws (chapter I) - "Medicine is the most distinguished of
all the arts, but through the ignorance of those who practise it, and
of those who casually judge such practitioners, it is now of all the
arts by far the least esteemed. The chief reason for this error seems
to me to be this: medicine is the only art which our states have made
subject to no penalty save that of dishonour, and dishonour does not
wound those who are compacted of it. Such men in fact are very like the
supernumeraries in tragedies. Just as these have the appearance, dress
and mask of an actor without being actors, so too with physicians; many
are physicians by repute, very few are such in
reality."(4)
Ancient Medicine (chapter IX) - "For most physicians seem
to me to be in the same case as bad pilots; the mistakes of the latter
are unnoticed so long as they are steering in a calm, but when a great
storm overtakes them with a violent gale, all men realise clearly then
that it is their ignorance and blundering which have lost the ship. So
also when bad physicians, who comprise the great majority, treat men
who are suffering from no serious complaint, so that the greatest of
blunders would not affect them seriously - such illnesses occur very
often, being far more common than serious disease - they are not shown
up in their true colours to laymen if their errors are confined to such
cases; but when they meet with a severe, violent and dangerous illness,
then it is that their errors and want of skill are manifest to all. The
punishment of the impostor, whether sailor or doctor, is not postponed,
but follows speedily."(3)
Precepts (chapter I) - "Healing is a matter of time, but it
is sometimes also a matter of opportunity. However, knowing this, one
must attend in medical practice not primarily to plausible theories,
but to experience combined with reason."(3)
Precepts (chapter II) - " ... conclusions
which are merely verbal cannot bear fruit, only those do which are
based on demonstrated fact. For affirmation and talk are deceptive and
treacherous. Wherefore one must hold fast to facts in generalisations
also, and occupy oneself with facts persistently, if one is to acquire
that ready and infallible habit which we call 'the art of
medicine.' "(3)
Epidemics VI (section 5, chapter I) - "The body's nature
is the physician in disease. Nature finds the way for herself, not from
thought . . . Well trained, readily and without instruction, nature
does what is needed."(5)
Regimen in Acute Diseases (chapter VII) - "And it seems to
me worthwhile to write on such matters as are not yet ascertained by
physicians, though knowledge thereof is important, and on them depend
great benefit or great harm. For instance, it has not been ascertained
why in acute diseases some physicians think that the correct treatment
is to give unstrained barley-gruel throughout the illness; while others
consider it to be of first-rate importance for the patient to swallow
no particle of barley, holding that to do so is very harmful, but
strain the juice through a cloth before they give it."(4)
Regimen IV (chapter LXXXVI) - "He who has learnt aright
about the signs that come in sleep will find that they have an
important influence upon all things. For when the body is awake the
soul is its servant, and is never her own mistress, but divides
her attention among many things, assigning a part of it to each
f
The Sacred Disease (chapter XVII) - "Men ought to know that
from the brain, and from the brain only, arise our pleasures, joys,
laughter and jests, as well as our sorrows, pains, griefs and tears.
Through it, in particular, we think, see, hear, and distinguish the
ugly from the beautiful, the bad from the good, the pleasant from the
unpleasant."(4)
John Fabre The Hippocratic Doctor:
Ancient Lessons for the Modern World by John Fabre is published
this month by the Royal Society of Medicine Press, price £9.95 (ISBN
1-85315-339-7), and may be ordered through the BMJ Bookshop.
References
1 Withington E T. Hippocrates, Volume
III. London: Loeb Classical Library, Harvard University Press,
1928.
2 Potter P. Hippocrates, Volume VIII. London:
Loeb Classical Library, Harvard University Press, 1995.
3 Jones W H S. Hippocrates, Volume I. London: Loeb
Classical Library, Harvard University Press, 1923.
4 Jones W H S. Hippocrates, Volume II. London: Loeb
Classical Library, Harvard University Press, 1923.
5 Smith W D. Hippocrates, Volume VII. London: Loeb
Classical Library, Harvard University Press, 1994.
6 Jones W H S. Hippocrates, Volume IV. London: Loeb
Classical Library, Harvard University Press, 1931.
The Hippocratic tradition of rational medicine
Hippocratic approaches to therapy
Dreams, haemorrhoids, and other miscellaneous points
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