Lessons on the Art of Medicine From Hippocrates Part One: Observe All

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AUTHOR:
Richard Colgan, MD
University of Maryland School of Medicine

Medicine is of all the Arts the most noble; but, owing to the ignorance of those who practice it, and of those who, inconsiderately, form a judgment of them, it is at present behind all the arts.
—Hippocrates (460 BCE–?356)

Even 2000 years ago physicians struggled to learn about the art of medicine, and philosophers contributed much to its interpretation. Although he is highly recognized as the Father of Medicine, little is known about Hippocrates of Cos, also known as Hippocrates the Great (460 BCE–?356). Two hundred years after his death the Greeks founded the Library of Alexandria, with the aim to compile and organize thousands of medical writings provided by many medical, religious, and spiritual philosophers. Works attributed to Hippocrates stood out for the detailed nature in which the author described those sufferings from diseases. All writings that seemed to follow this unique style were thereafter noted as having been written by Hippocrates and represent the Corpus Hippocraticum—the bodies of work that followed his distinguished theories about health and humanity. Although all of the texts of the Corpus Hippocraticum follow his spoken philosophies and detailed style of analysis, experts agree that many of the works attributed to this collection were certainly not penned by Hippocrates.¹

Throughout my career, the majority of medical students I have encountered are unable to cite much more about Hippocrates than the famously quoted “Primum non nocere” or “First do no harm.” If you had to remember only one line attributed to Hippocrates, this is undoubtedly the most important one to remember, and it is a theme that spans the entirety of medical practice, yet there is so much more that is learned from Hippocrates as one explores his life, personal experiences, and teachings.

Hippocrates was renowned for his power of observation, thought by many to be his greatest skill. In a collection of his writings entitled Aphorisms there are over 200 observations of medical practice, disease process, and pathological theory. Many of these are still relevant today, and those that are not as applicable to modern medical practice are of great interest as they provide insight into the evolution of medicine. Furthermore, although some of his conclusions have been shown to be made without current standards of scientific validation, it is important to recognize the value Hippocrates placed on the physician’s skill of observation and its application to the patient. This is as important today as it was over two millennia ago. A few of Hippocrates' observations from Aphorisms follow:

Life is short and the art long, the occasion fleeting, experience fallacious, and judgment difficult. The physician must not only be prepared to do what is right himself but also to make the patient, the attendants, and externals cooperate.

For extreme diseases, extreme methods of cure, as to restrictions, are most suitable.

Spontaneous lassitude indicates disease.

Persons who are naturally fat are apt to die earlier than those who are slender.

In whatever part of the body heat or cold is seated, there is disease.

If erysipelas of the womb seizes a woman with child, it will probably prove fatal.

Pneumonia coming on pleurisy is bad.

When bubbles settle on the surface of urine, they indicate disease of the kidneys and that the complaint will be protracted.

Sleep and watchfulness, both of them when immoderate, constitute disease.

Some aphorisms may make you laugh, such as:

Drinking strong wine cures hunger.

If you wish to stop the menses in a woman, apply as large a cupping instrument as possible to the breasts.

A woman does not become ambidextrous.

Eunuchs do not take the gout nor become bald.

Hippocrates urged us to “Observe all”. A more contemporary “Philosopher” by the name of Yogi Berra apparently agreed. He is quoted as saying “You can observe a lot by just watching”.  All healers do this; some do it better than others.

Next Blog: Lessons On the Art of Medicine from Hippocrates Part Two: Prognosticate When You Can 

¹One of the most frequently cited English translations of Hippocratic texts was written by the Scottish surgeon, Francis Adams in 1849 . The reader is referred to this text to learn more about the veracity of different treatises ascribed to Hippocrates. Suffice it to say that for the remainder of the discussion on Hippocrates I will refer to these writings as being by Hippocrates, with the understanding that it can not be proven that he actually wrote what has been attributed to him.

Richard Colgan, MD, is associate professor of family and community medicine at the University of Maryland School of Medicine in Baltimore, Maryland. He was the School's nominee to the Association of American Medical Colleges for its Humanism in Medicine Award, the recipient of numerous faculty teaching awards including the School's Golden Apple Award for excellence in teaching. Dr Colgan is the author of Advice to the Young Physician: on the Art of Medicine. For more information, go to www.advicetotheyoungphysician.com