- The making of the man: 19 generations of healers and 3 first-rate legends
- Milestone #1 Getting real: diseases have natural causes
- Milestone #2 Its the patient, stupid: the creation of clinical medicine
- Milestone #3 A code of ethics that stands the test of time
- Milestone #4 Acting the part: professionalizing the practice of medicine
- Milestone #5 The enigmatic Corpus: 60 books and a wealth of medical firsts
- Milestone #6 Where the two worlds meet: a holistic approach to medicine
- Hippocrates for yesterday, today...and tomorrow
The Greek island of Kos, located in the crystal clear waters of the Aegean Sea and bordered by 70 miles of golden beaches, might be one of the best spots on the planet to fall ill—or to simply remain well.
Part of a 12-island archipelago, Kos is 200 miles southeast of Athens and just a few miles off the southwest coast of Turkey. Long, narrow, and verdant with lush foliage, the island is flat except for two low mountains along its southern coast. But it is in the town of Kos, an ancient village on the northeastern coast of the island, where the magic and medicine of this island begin.
It is tempting to speculate that the legendary history of Kos arises from its nurturing rich soil and abundant groundwater: Visitors entering the village are greeted by a lush landscape of tall palms, cypresses, pine trees, jasmines and, for an added splash of color, the bright reds, pinks, and oranges of the hibiscus. But if you want to locate the true pulse of Kos and its 2,500-year-old legacy, you must continue your journey...
First, face west and walk two and a half miles out of the village. There, amidst more lush landscape, you will approach a sloping site. Hiking up this slope, you pass an extensive complex of ancient ruins that rise around you in a series of terraces. Put aside your curiosity and continue to climb. Before long, you will arrive at a pinnacle. Gazing out from this high point, you stop flat in your tracks: The world has split apart.
Spread out before you is a breathtaking view of the Aegean seacoast. Inhaling the fresh coastal air, you feel the stirrings of the true spirit of this small island, the mystery of where two worlds meet. One, the “inner” world, is simply you: the tightly wrapped sac of blood and bone, emotion and mind, which is your body. The other “outer” world is merely every other thing in the physical universe surrounding you.
If you ponder for a moment the possibility that two such worlds not only exist, but co-exist in a place we may not yet fully understand, then congratulations. You have finally begun to arrive, physically and metaphysically, on the island of Kos. For this is the place where, in the view of the world’s first “rational physician,” all life, death, health, and disease—and hence the practice of medicine and healing itself—begins.
This ancient site is known as the Asklepieion, the generic Greek word for any “healing temple.” But the Asklepieion of Kos is a temple like no other. Although today a crumbling ruin of broken walls, roofless chambers, and lonely columns supporting only air, in its heyday this was a bustling center of healing. Here patients in all stages of sickness and injury sought the best treatment they could find.
If you were suffering from disease or injury and arrived here in the fifth century BC, over the course of days and weeks you would have progressively ascended each of the four terraces that scale these grounds, each level dedicated to a different stage of diagnosis, counseling, and healing. Apart from simple relaxation, your treatment might have included bathing in large pools, being massaged with perfumes, oils, and ointments, following a regimen of mental and physical exercise, receiving diet counseling, herbs and other oral drugs, and commiseration with the ancient spirits.
Oh, and one more thing. If you happened to check in sometime between 490 and 377 BC, you might have received one more benefit: a visit from the world’s “first” physician, a man not only credited with inventing the practice of medicine, but whose insights have remained influential for well over two thousand years.
Most of us have a distinct yet vague impression of who Hippocrates was. The phrase “Father of Medicine” often (and accurately) jumps to mind. And of course, there is the Hippocratic Oath, which we know has something to do with doctors behaving nicely. On the other hand, it should be noted that Hippocrates bears no connection to the similar-sounding “hypocrisy.” Though also Greek in origin, hypocrisy is from hypokrisis, which means “playing a part” or, as commonly used today, someone who is a phony.
Which Hippocrates certainly was not.
Who was Hippocrates, and how did earn the mantle of “Father of Medicine” as well as credit for the “Invention of Medicine”?
Perhaps one measure of an individual’s greatness is when the question is not so much how their “breakthrough” compares to another, but rather, which of their many breakthroughs one should select to make the comparison. For Hippocrates, the list is substantial and includes being the first physician to
- Recognize that diseases have natural causes, rather than their arising from supernatural or evil forces
- Invent “clinical medicine” and the “doctor-patient relationship”
- Create an oath of conduct that has remained influential for 2,500 years
- Elevate the practice of medicine to an honored profession, rather than a conventional trade like plumbing or roof repair
- Achieve many other medical breakthroughs, including recognizing that thoughts and emotions arise in the brain rather than the heart
Some time around 440 BC a young physician eager for knowledge crossed the narrow body of water separating his island home from what we know today as southwestern Turkey. Reaching land, he made his way 50 miles north to an area known as Ionia. Entering the city of Miletus, he met with the well-known philosopher Anaxagoras. Famed for introducing philosophy to the Athenians, Anaxagoras was also the first person to recognize that the moon’s brightness is due to reflected light from the sun. The ensuing conversation must have been interesting. On the one hand, Hippocrates was a reputed descendent of Asklepius, the god of healing and son of Apollo. On the other hand, Anaxagoras was likely unimpressed by religious tradition: In 450 BC he had been imprisoned for insisting that the sun was not a god. While this outrageous claim may have raised the hackles of any other healer from Kos, more likely it set a twinkle in the eye of young Hippocrates. And an invitation to sit down for a chat...
And yet among the many “firsts” commonly attributed to Hippocrates, one breakthrough at the core of his teachings is often forgotten or overlooked today. Perhaps this lapse is due to its paradoxical nature, the fact that it both opposes yet resonates with the way medicine is often practiced today. What was this additional breakthrough? Before answering, we need to learn more about this man and his place in history.
The making of the man: 19 generations of healers and 3 first-rate legends
In today’s high-tech world of CAT, MRI, PET, SPECT, and other cryptic visions, of the increasing specialization and molecularization of medicine, of all manner of pharmacopeia from the fitful to the fatal, we put a certain amount of trust in the rituals of modern medicine. We are comforted by hospital rooms where patients are anchored to their sanitized beds by the wires and tubes of modern technology. If for some reason then, you were to succumb to an illness and wake up in the fifth century BC in a dim, oil-lamp-lit chamber to the sound of a priest moaning incantations over your hurting body, chances are you would be overcome by a distinct lack of confidence, if not terror.
Hippocrates may well have felt the same.
Yet, born on Kos in 460 BC, this was the world in which he was raised. Like many doctors today, Hippocrates came from a line of physicians who had been practicing “medicine” for generations. For starters, he was trained in medicine by his father, Heracleides, his grandfather, and other famous teachers of the time. But this is being too modest. In fact, his family also claimed that the tradition of medicine had been in their lineage for no less than 19 generations, dating back to Asklepieios, the demi-god of healing. Deities aside, Hippocrates’ early view of medicine was probably influenced by a long, long ancestry of religious healers and priests.
If you’re thinking that claiming to be the nineteenth-generation descendent of the god of healing on your medical school application might strain the limits of credulity—or, conversely, that it might be just the edge you need for acceptance—several caveats are in order. First, surprisingly few undisputed details are known about the life of Hippocrates. Although a large body of writings attributed to Hippocrates have survived—some 60 works collectively known as the Corpus Hippocraticum, or simply Hippocratic Corpus—there is considerable debate as to which are genuine works of Hippocrates versus the embellishments of the many admirers who expanded on his school of thought decades and even centuries after his death. Nevertheless, by comparing and analyzing the documents, historians have patched together a reasonably credible account of Hippocrates and his accomplishments.
To be honest, three of the most colorful stories about Hippocrates are probably rooted as much in legend as they are truth. But even if only partly true, they provide insight into the man Hippocrates may well have been, a man whose reputation was sufficiently formidable to spread beyond his own small island to the distant lands of his own enemies.
The first and perhaps best known story is set in 430 BC during the Peloponnesian War. Shortly after being destroyed by the Spartans, a plague broke out in the city of Athens. Hippocrates and his followers traveled to Athens to help. Observing that the only people not affected by the plaque were iron smiths, Hippocrates made an astute deduction: Their resistance must somehow be related to the dry, hot atmosphere in which they worked. He promptly wrote up his prescription. The citizens of Athens were to light fires in every home to dry the atmosphere, to burn corpses, and to boil all water before consumption. The plague retreated, and Athens was saved.
The second story is often cited to highlight Hippocrates’ remarkable diagnostic skills, which ranged from the physical to the psychiatric. Shortly after the Athenian plague, King Perdiccas of Macedonia, aware of Hippocrates’ growing reputation, requested the physician’s help when no other doctor could diagnose his vexing symptoms. Hippocrates agreed and traveled to Macedonia to see the king. During the examination, Perdiccas blushed whenever a beautiful girl named Phila—who was his father’s concubine—was nearby. Hippocrates took note. Upon further inquiry, he learned that Perdiccas had grown up with Phila and dreamed of one day marrying her. This dream was shattered when his father took the girl as his concubine. However, the recent death of his father reawakened Perdiccas’ conflicted feelings of love for Phila, causing him to fall ill. After subsequent counseling by Hippocrates, the king was cured.
The third story, a testament to Hippocrates’ loyalty, took place when Greece was at war with Persia. By this time, Hippocrates’ reputation was so great that Artaxerxes, the enemy king of Persia, requested that Hippocrates travel to Persia to save its citizens from a plague. Despite the king’s offer of gifts and wealth “equal to his own,” Hippocrates politely declined. Although sympathetic, it was against his scruples to assist the enemy of his country. The king gracefully responded with a vow to destroy the island of Kos—a threat that was put to rest, figuratively and literally, when the king suffered a stroke and died.
Legends aside, our investigation into the invention of medicine may be better served by looking at the achievements of Hippocrates as documented in the more scholarly writings of the Corpus. While historians continue to debate the authenticity of even these documents, said caveats having been acknowledged, we can venture into the territory where Hippocrates’ “Invention of Medicine” can be attributed to six major milestones.
While there is no record of the conversation between Hippocrates and Anaxagoras in that ancient city of Miletus, it’s not hard to imagine that the young physician was beginning to question the medical tradition of his own family, with its lineage of demi-gods, superstitions, and priest healers. It wasn’t that Hippocrates completely rejected their theocratic approach; he simply felt that in medicine and health, other truths were to be found. Thus, the reputation of Anaxagoras and his philosophy, which had reached even the small island of Kos, brought Hippocrates here to question and learn. Settling down in the shade of a tree outside the city, Hippocrates proffered a simple invitation. “You know of my background and tradition, Anaxagoras. Now tell me of yours...”