Thank you very much. Count Benidot, Nobel laureates, ladies and gentlemen, it is a great pleasure to be present on this occasion

and an honor to have received an invitation to participate. That someone who is only a physician with severely limited classical as well as scientific background should venture to bring once more to your attention

the time-honored theme of Hippocrates and history is the result not so much of new discoveries concerning Hippocrates as it is of certain new and massive and to some extent rather frightening trends

that we find in present-day physical and biological affairs, including medicine. What I shall try to show is, first, the position originally taken by Hippocrates regarding man and nature. Second, how this position has waxed and waned

in its validity and acceptability over vast centuries of time. And third, the urgency now for a new consideration of what may fairly be called Hippocratic doctrine. We need to know about Hippocrates himself as well as his ideas and must first establish

that he was a man and not a fable. Like every great man, all kinds of fables gathered around and about him, but these must be recognized and discarded. There are two clear references by Plato, Hippocrates' contemporary. In the Protagoras, one of Plato's characters,

also named Hippocrates, is going to Hippocrates, of course, the Asclepiad, to be instructed in medicine. An Asclepiad was a term apparently used to describe the general guild of physicians. In the Phaedrus of Plato, it is recorded that Hippocrates, the Asclepiad, teaches

that an understanding of natural events is the necessary approach, not only to medicine, but to all knowledge. Aristotle, in his politics, has an interesting comment. When one says, the great Hippocrates, he writes, one means not the man, but the physician.

From this brief but authoritative statement, one can deduce that Hippocrates was a man, that he was well known to Aristotle, and that then, a generation after his death, he was already a great figure. Some have even thought that there is here an implication that Hippocrates was a man of small stature,

but this seems debatable. The pertinent question is raised, however, what indeed did Hippocrates look like? This question has occupied archaeologists for more than three centuries. The first evidence that was found, early in the 17th century, was a Roman coin of the first century AD, on which were depicted

a head in profile, the Greek letters, Iota Pi, hip, and a serpent's staff. Could I have my first slide, please? He begins to show. The head was rounded, bald, with a short beard, the nose large, with broad nares.

The design is, of course, crude, but gives a definite idea of the kind of head and countenance the man had. There was much interest through the latter 18th and 19th centuries in finding an antique sculptured head or other portrait, which would be sufficiently like that on the coin so as to call the head Hippocrates.

On the next slide, I might have the next slide, is one familiar in the Capitoline Museum in Rome, and the next slide, please, here of the same person that in the British Museum. The fit, as you will see, is not good,

the face being much narrower than that on the coin. Half a century or so ago, with much additional evidence, this head was identified as that of the stoic philosopher Chrysippus, and not Hippocrates. There was then, at this point, no accepted representation of Hippocrates except the coin.

In 1940, in the excavation of a burying ground near Ostia Antica, the ancient seaport of Imperial Rome, there was found within the family tomb of a distinguished Greco-Roman physician of the first century AD, a pedestal on which was an inscription, beginning, life is short.

Near the pedestal on the ground was the sculptured head or herm of an elderly bearded man, the right side with a face much damaged. The contour of the head and details of the face were found to correspond closely with those on the old Roman coin of Kars.

This with the inscription, life is short. Could I have the next slide, please? This with the inscription, life is short, and other evidence have led most archaeologists to believe, with some confidence, that the head is indeed an ancient representation of Hippocrates, a fine Roman copy

of an earlier Greek original. This is the side view. Could I have the next slide? This is from one side and the next, and this from the other. It is seen to be a head and confidence of great power. Its expression a curious blend of strength and sorrow.

The Hellenistic style places the Greek original at about 280 to 300 BC. Or somewhat less than 100 years after Hippocrates' death. Could I have the lights, please? What were the enduring creations

that came out of the life of this remarkable man? As in all history, there are not many certainties, and we must deal with records of greatly varying probability. One certainty is the Hippocratic corpus. The whole mass of medical treatises, some 70 or 80 of them still surviving, that were gathered over a period

probably of some 400 years, and that have survived over a period of 24 centuries. This in itself is an astonishing product. We have, of course, writings on religion collected over much longer periods, and still with us. But where else in either ancient or modern times

have we a collection of objective and interpretative writings in a scientific field assembled in one man's name, so sedulously protected and so earnestly studied and used over so great a span of time. Plato, Aristotle, and of course Galen

wrote more extensively, but within one or two generations they and their schools had completed their work. The Stoics continued teaching and writing for centuries, but their works were scattered, never held together by one dominating personality, and in great part, lost. It is fairly certain that there existed

a school of medicine at cost before Hippocrates the Great. His biographer, Siranus, mentions his grandfather, Hippocrates I, and at least two of the writings in the corpus have been dated before Hippocrates. What were the truly fundamental contributions

to medicine of Hippocrates himself? The evidence is largely internal, and authorities naturally vary as to which treatises are genuine, meaning by this, either written by himself or his immediate students or associates. I believe that by reference to a few of these,

one can reach the primary features of his teaching. One of the sevearer critics, Dichreiber, admits only one, The Epidemics, books one and three, as surely by Hippocrates himself. These, as I suppose everyone knows, are simple in form. They consist first of a brief discourse on constitution,

that is, the meteorological conditions and the kinds of disease occurring in a particular season. And second, three series of most detailed and exact descriptions of individual clinical cases. These are, moreover, complete.

They are no single visits to a prestigious patient by a prestigious consultant. The physician here sees every kind of patient, from the wealthy aristocrat to the artisan, the domestic, even the slave. And he follows the patient from the beginning of his disease to its end, whether recovery or death,

and whether the disease lasts two days or four months. He is concerned about the patient's mental and emotional state, as well as the physical strains or excesses that led up to his illness. I venture to state that this kind of exact description was new.

Here is an exact and accurate observer of natural events. Here is no philosopher proving a system. As Hippocrates himself insists over and over again, he is a practitioner of his technae, or craft. And craft is probably a better name for Hippocratic medicine than the traditional word art.

What further does he think and do in the broad field of medicine? There are a number of other works which are considered by most authorities to have been written by Hippocrates or one of his colleagues associated in contemporary practice and teaching.

The treatise, Regimen in Acute Diseases, indicates the broad principles of therapy, using the means then available, diets, purges, emetics, bleeding, and general daily regimen. The prognostics gives the evaluation of symptoms and signs favorable and unfavorable.

The surgical treatises on fractures, dislocations, and wounds of the head are an extraordinary group, detailing most accurately the anatomy and signs of these various injuries. When to use the knife, how to reduce the fracture or dislocation, precisely how to dress or bandage the injury,

what will happen on succeeding days, and how to deal with these events. Significant here is that Hippocrates included all branches of medicine and surgery on the same terms. There was no downgrading, for example, of surgery. This came centuries later. In the chapter on airs, waters, and places,

Hippocrates reaches out further and endeavors to place man in relation with his environment. Man and nature, as it were, together. What kind of human beings develop in such and such a climate or ecologic state, as well as what diseases they will have?

While he describes accurately malarial climates and the chronic malarial state in man, other sections are wide of the mark, as we would interpret them now. But the point here is the breadth of Hippocrates' conception of medicine and the identification of man, both in health and disease, as a part of nature.

Hippocrates' attitude, his philosophy, at the foundation of his medical art or craft, is perhaps best set forth in a very early chapter called Ancient Medicine. In this, he begins by stating that medicine has no need of hypotheses.

Here, one must distinguish, as WHS Jones notes, the ancient from the modern notion of hypothesis. In the modern, an hypothesis is a postulate which, once stated, can be investigated. Not so in ancient times. Then, an hypothesis was a thesis,

a declaration of underlying truth, to be accepted and thereafter used to explain phenomena but never questioned. To such an hypothesis, Hippocrates was opposed. He does not accept, for example, empedocles' proposition that in order to know nature, one must first know the origin of man,

how he came into being and out of what elements. Medicine is concerned, says Hippocrates, with the sufferings of ordinary folk and does not require ultimate cosmologic theory. He admits of certain general processes and forces which can be derived from the study and observation of man himself.

As one would expect, these are not especially original but relate to a number of philosophic generalities current in the fifth century B.C. The state of health is one of harmony or balance of forces. An acute disease, for example, with sharp acrid discharges is caused by an imbalance of forces

to be restored by coction, the Greek word pepsis, into thicker, more purulent secretions that lead to healing, and this through mixture or blending, the Greek word crassus. The so-called humors in this early era were recognized but numerous and of various kinds. The fixed doctrine came later.

In all cases, the basis of medical care is to understand nature, the Greek word phusis, that is the natural order. The function of medicine is to assist nature, to restore this balance of forces which is the state of health. It is necessary now to define our terms

even more precisely if we are to know what Hippocrates is talking about. The Greek word phusis, or nature, comes from phuo, to grow, spring forth, come into being. And so phusis as Hippocrates uses it means both nature and the natural order in the large, and also the nature or constitution of man himself.

The term differs from the Aristotelian episteme, which is to know how or understand and thus denotes man's own definition of scientific knowledge. Neither one includes the notion of experimentation as a planned action to demonstrate a process. It should be noted, however, that Hippocrates

was very much aware of the experimental aspect of medicine. The word pera, or trial, which he uses in the first aphorism, shows that for him, every therapeutic effort in medicine is an experiment, as indeed it is. The other word of importance is iatricae,

medicine or the art of healing, and this too is very broad. In Hippocrates' conception, it signifies the guidance of man by the physician in health and disease, and in all man's relations with nature. In this same treatise, that is ancient medicine, Hippocrates makes the boldest

and most inclusive statement of all. I hold, says he, that clear knowledge about nature can be obtained from medicine and from no other source. This is presumptuous indeed. It may be no more than a naive statement by a craftsman trying to advance the prestige

of his own trade, perhaps. But I believe that it is more than this. Since man and nature are one, we must seek this knowledge through the study of man and man in nature. This is medicine or iatricae in its broadest sense. It is in fact humanism also in the broadest sense.

I am inclined to think that Hippocrates had this large concept in mind, though the language was not then available to give it more precise expression. I should mention the Hippocratic aphorisms. These terse statements, some 400 of them, are of variable quality and origin,

many brilliant clinical observations, many obscure and hard to interpret, many of post-Hippocratic and some of pre-Hippocratic origin. They were revered and memorized in later ages by scores of generations of Greek, Roman, Hebrew, Arabic, and medieval physicians.

We must examine one more Hippocratic or early post-Hippocratic treatise, that on the sacred disease or epilepsy in which he contrasts medicine with religion and magic. The name sacred disease for epilepsy came out of the tradition of some past age.

But why this, asks Hippocrates, more than any other. All diseases are divine, he insists, and all are human. Each has a nature and proceeds according to its natural order. Hippocrates is opposed to non-rational magic, but not at all opposed to religion in and for itself.

Bring the sick man to the sanctuary, he says. At least it is Godhead that purifies and cleanses us from the greatest of our sins. While thus not denying religion, he holds as absolutely to the mechanical order in his description of nature as Democritus himself.

Incidentally, while there is multiple evidence that Hippocrates and Democritus of Abdera were friends over many years, Hippocrates did not use or appear to need atomistic theory in all its detail. He might have been interested in Aristotle's biology, but not his cosmogony.

Plato's idealism was the opposite of Hippocrates' primary concern with objective living events. Least of all would he have accepted the Judaic belief of man under a beneficent Jehovah as lord and master of created beings, both living and non-living.

Man belongs to nature according to Hippocrates, but nature does not belong to man. We shall come back to this later. So much for Hippocrates, the man and the physician and his teaching. It has been a long introduction. Now to pursue the adventures, misadventures, and distortions of himself and his doctrines

through the course of history. We must keep separate at all times two main features of this teaching. One is the actual clinical instruction in practical medicine. The other is the larger philosophical scheme of man in nature because they have very different histories. Let us examine first the course of Hippocratic medicine

within his school itself as more and more medical writings came to be added to the collection. These were from many sources and with many different philosophic backgrounds. Pythagorean, Aristotelian, Epicurean, and so forth. The whole as we have it now is actually probably a part of the library

of the Hippocratic school. As is so often the case with the leader of thought, the wide ranging philosophy of Hippocrates became increasingly restricted and dogmatized as time went on to end eventually and unhappily in that rigid rubric which continued down the ages

as the Hippocratic doctrine of the four humors combining these with the four elements and four forces or powers. These as we have noted Hippocrates himself had been at much pain to denounce as the wrong way by which to approach

the art and science of medicine. Could I have the last slide please? This figure familiar I suppose to all of you gives the pattern. We have the four elements, fire, earth, water, and air and associated with them the Hippocratic humors,

yellow bile, black bile, phlegm, and blood and acting upon them the four dunamis or forces or hot, dry, cold, and moist. Like so many theories it is so neat that it ought to be true even if it is not

and therefore was thought worthy to be perpetuated. Even more, could I have the lights slide off please? Even more perhaps than his scientific attitude, Hippocrates as a man was stripped of his human qualities and made into a figurehead if not a semi-deity.

He was solemnly pronounced 19th in lineal descent from Asclepius and 20th in lineal descent from Hercules. He was set up as an actual disciple of Asclepius as for example in the so-called Hippocratic actually post-Hippocratic oath when in his life he scorned the use of magic in medicine and in his own writings

never once mentioned Asclepius name. In the later works of the corpus if one leaves aside the medical philosophy and looks only at the medical and surgical observations one finds that there is much of value and of the widest range. This solid foundation of practical clinical medicine

is what continued to be valued by successive generations of physicians and what therefore held the corpus together as a sort of textbook on a grand scale. The long list of commentators provides abundant proof of this. Aristotle comments on one. His student Menon lists a number of the writings.

Herophilus, the anatomist of the Alexandrian school around 300 B.C. was a commentator and more extensively his student Pacius. Erotian in the time of Augustus listed the works known to him. To complete our story the Renaissance compiler and editor Annutius Phoecius assembled over 250

commentators on the works of Hippocrates most of them Greek, Roman, Hebrew or Arabic but it was of course Galen. At the end of the second century A.D. who truly and authoritatively brought to life again the major writings of the Hippocratic school.