PART FOUR
‘Wherever the art of medicine is loved, there is also a love of humanity.’
Hippocrates
Medicine – the practice of diagnosing, preventing and treating disease – has existed for thousands of years, although its nature has changed markedly over that period. Where once we looked at illness as the judgement of the gods, or a manifestation of the natural cycles of the world, we now look to science to free us from its shackles. Moreover, it not only offers a reflection of humanity’s increasing pool of knowledge and skills, but speaks of more fundamental changes in our conception of ourselves. The revered medical historian Fielding Hudson Garrison once observed:
The history of medicine is . . . the history of humanity itself, with its ups and downs, its brave aspirations after truth and finality, its pathetic failures. The subject may be treated variously as a pageant, an array of books, a procession of characters, a succession of theories, an exposition of human ineptitudes, or as the very bone and marrow of cultural history.
Whereas ancient civilizations had a tendency to seek supernatural explanations for medical conditions, modern medicine looks for answers in science and nature. The Greek physician Hippocrates (c. 460–370 BCE) is perhaps the key figure in establishing many of what are now the central tenets of modern medical practice and theory.
The first identifiable physician in history is Imhotep, who worked in Egypt in the third millennium BCE. In this period, much medical practice was ritualistic and spiritual in nature. Remedies often took the form of plants, animal parts or minerals perceived as having magical restorative properties. It wasn’t until Hippocrates that there was a fundamental change in approach – one that established medicine as a profession rooted in rationalism.
Hippocrates looked for natural causes of disease, rather than relying on mystical explanations. Ill health, he suggested, was caused by an individual’s diet, habits and environment, rather than by affronting the gods. In particular, he held with the idea that disease was caused by an imbalance of the body’s four humours (bodily fluids): blood, yellow bile, black bile and phlegm. Rather than aiming for precise diagnoses (see next entry here) and targeted medication, he sought instead to follow more generalized and passive schemes of treatment aimed at rebalancing the humours. He recommended that patients combine exercise with rest, keep themselves clean and regulate their intake of food and drink. He also introduced the idea of illnesses being either acute or chronic, as well as pioneering the concepts of endemic and epidemic conditions.
In terms of professionalizing medicine, he insisted that the physician should be kind, calm, honest and serious – not to mention well presented. Other innovations included taking patients’ medical histories, making clinical observations (for instance, recording the pulse, noting areas of pain and checking on the bodily functions) and keeping clear records that might be shared with other professionals.
The Hippocratic Oath
Hippocrates’ most celebrated contribution to medicine was the Hippocratic Oath, a pledge that still forms the basis of many modern-day medical oaths and laws. Among its most important clauses is that which is often summarized as ‘to do no harm’:
I will use treatment to help the sick according to my ability and judgement, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course . . . Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bound or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.