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Milestone #5 The enigmatic Corpus: 60 books and a wealth of medical firsts

  • “Men ought to know that the source of our pleasures, merriment, laughter, and amusements as well as our grief, pains, anxiety and tears is none other than the brain.”
  • Hippocrates, On the Sacred Disease, 420-350 BC

Much of what we know of the medicine of Hippocrates comes from the Hippocratic Corpus, a collection of about 60 manuscripts that covers virtually every aspect of health, from the inner (mind and body), to the outer (environment), to where the two worlds meet (diet and breathing). Although the Corpus as we know it today dates back to 1526, a mere 500 years ago, accounting for its whereabouts in the preceding 2,000 years is a bit more problematic. Some historians believe that the manuscripts were initially assembled in the Great Library at Alexandria around 280 BC, possibly after they were recovered from the remains of the medical school library at Kos.

What else do we know about these manuscripts? On the perplexing side, their hodge-podge of mixed content, writing styles, chronology, and contradictory viewpoints suggests that they were written by multiple authors who lived before and after Hippocrates. On the other hand, though none of the writings can be definitively linked to Hippocrates, most were probably written around 420 BC to 350 BC, corresponding to his lifetime. Most intriguing, despite a pervasive lack of inner unity, the manuscripts share one crucial theme: a belief in rationality and a scorn for magic and superstition.

To get an idea of why historians are vexed in their attempts to make any generalizations about the Corpus, one needs only to consider the curious diversity of their titles, which include: Nature of Man; Breaths; Nutriment; Aphorisms; Dentition; Airs, Waters, and Places; Affections; Joints; On Diseases, Decorum; Head Wounds; The Nature of the Child; Diseases of Women, and so on. And the content ranges wildly in form and content, from a series of easily memorized sentences (Dentition), to insightful medical observations (On the Sacred Disease), to simple lists of ailments (On Diseases).

Nevertheless, from these texts we can gather that Hippocrates and his followers had a remarkably accurate understanding of anatomy—perhaps derived from their observations of war wounds and animal dissections—given that at the time, human dissections were deemed unacceptable, if not forbidden. True, at times the descriptions tended to lean a bit heavily on analogy and metaphor—for example, the eye was compared with a lantern and the stomach to an oven. But in other cases their anatomical and clinical observations were so accurate that they have earned the admiration of physicians and surgeons throughout history, up to and including the twenty-first century.

Some of the most fascinating observations from the Corpus come from facts that we take for granted today but were quantum leaps of insight at the time. One of the best examples is Hippocrates’ descriptive assertion in On the Sacred Disease that thought and emotion arise from the brain and not the heart, as others believed at the time:

  • “Men ought to know that the source of our pleasures, merriment, laughter, and amusements, as well as our grief, pains, anxiety, and tears, is none other than the brain. It is by this organ that we think, see, hear, and distinguish between the ugly and the beautiful... By this same organ, too, we become mad or delirious, and are assailed by fears and panics, by insomnia and sleepwalking...”

Among the anatomical and clinical descriptions that continue to impress physicians today are those describing head injuries and joint deformities. For example, some claim that Hippocrates’ treatise On Injuries of the Head helped set the stage for modern-day neurosurgery. The treatise begins with an impressively detailed discussion of the anatomy of the skull, including cranial structure, thickness, and shape, and differences in texture and softness between the skulls of adults and children. Hippocrates then describes six specific types of cranial trauma, including fissured fractures (caused when a weapon breaks the bone), depressed fractures, and wounds above cranial sutures. Other details reveal his clinical experience in treating head injuries, such as his description of certain cranial fractures that are “so fine that they cannot be discovered...during the period in which it would be of use to the patient.”

Similar details of medical acumen are seen in the manuscript On Joints, in which Hippocrates describes techniques for managing spinal diseases, including correction of curvatures of the spine and spinal injuries. Particularly interesting is the Hippocratic table, which was developed to treat spinal injuries. In fact, this table—to which patients were strapped so that physicians could apply pressure and thereby correct the deformity—is still in use today and is considered by many to be the forerunner of the modern orthopedic table.

But one of the most intriguing facets of Hippocrates’ medicine was his view that to preserve health or cure disease, it was necessary to understand the nature of the body and its environment. In other words, the body had to be treated as a whole, not simply a collection of unrelated parts. This view, in turn, was closely related to the concept of balance. While Hippocratic writings describe balance in differing ways, the basic view was that good health arose when forces in the body were in balance, while disease occurred when internal or external forces upset this balance. The physician’s goal in treating patients, therefore, was to identify and correct any imbalance.

One of Hippocrates’ best-known—but medically inaccurate—theories arose from the concept of balance. According to this theory, four humors, or fluids, circulate in the body: phlegm, bile, black bile, and blood. A person’s state of health or disease arises from the degree of balance or imbalance among these fluids, along with their relation to the four seasons (winter, spring, summer, and autumn) and the four elements of nature (air, water, fire, and earth).

Although humoral theory is notably absent from modern text books of human pathophysiology, it can be argued that within this view lies the metaphysical roots of something deeper than modern medicine can fully explain.

Acknowledging Hippocrates’ invitation to discuss his philosophy, Anaxagoras nodded silently and picked up a stick. Slowly and deliberately he began to speak, sketching out his thoughts in the dirt with a series of circles and lines...

“Things in the one universe are not divided from each other, nor yet are they cut off...” He paused to see Hippocrates was following along.

Indeed he was.

“Thus also,” continued the philosopher, “all things would be in everything...and all things would include a portion of everything... Nothing could be separated, nor yet could it come into being of itself, but as they were in the beginning so they are now, all things together...”

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