LECTURE No. 3. Hippocrates and his contribution to the development of medicine

In the history of the development of medicine, one can hardly find another name with which almost the birth of medicine would be associated. We will talk here about Hippocrates II the Great, who went down in history as Hippocrates. This great healer lived about 2500 thousand years ago at a time when Hellenic culture reached the apogee of its development. Temporal periodization dates this period to the V-IV centuries. BC e. Then not only medicine flourished, almost every branch of human activity moved forward by leaps and bounds and had its representatives who went down in history: the outstanding politician of that time was Pericles (444-429 BC), universally recognized then and subsequently as philosophers Democritus, Anaxagoras, Gorgias, Socrates, Empedocles, in poetry Aeschylus, Sophocles, Aristophanes stood out, in the field of architecture Praxiteles, Phidias, Polykpetes became famous, in history it was the era of Herodotus and Thucydides. Euryphon and Praxagoras became the great colleagues of Hippocrates, and Herophilus and Erasistratus became his followers.

However, no matter how they praised the contribution of Hippocrates to medicine, very limited information has reached our days about Hippocrates himself, which does not even allow us to accurately determine the date of his birth and death: some data indicate that he died at the age of 104 years, others - about that he died at the age of 83.

It is assumed that he was born in the first year of the XX Olympiad. The place of his birth was the island of Kos (later on, the flourishing of the Kos medical school is associated precisely with the name of Hippocrates). Translated from Greek, the name of the great healer is translated as "horse tamer". For a long time after his death there was not a single source containing information about the biography of Hippocrates. Only more than 600 years after the death of Hippocrates, the doctor Sorans Fr. Kos (around the XNUMXnd century AD) first recorded the biography of the healer, and his work was continued by the lexicographer Svida (XNUMXth century) and the prose writer, philologist I. Tsetse (XNUMXth century). Since they could not conduct a complete analysis of his activities and works, their stories bear the imprint of legend and mystery that surrounded the personality of Hippocrates. From the most reliable sources it is known that he was a descendant of the great Asclepius in the seventeenth generation on his father, and on his mother belonged to the genus of Heraclides (i.e., descendants of Hercules). In addition, he is credited with family ties with the rulers of Thessaly and the Macedonian court.

Hippocrates' teachers in the medical art were his grandfather Hippocrates I and father Heraclid. When he left his native home and finished home schooling, he continued his further knowledge of the medical art in Cnidus, and later with Herodicus and the philosopher-sophist Gorgias. Hippocrates received a wide field for applying and improving his knowledge by becoming a wandering doctor. The fame of him quickly spread along the coast of the Eastern Mediterranean. After long wanderings, already in his old age, he stopped in Larissa (Thessaly), where he spent the rest of his life, dying in the same year as Democritus (about 370 BC). The inhabitants of Thessaly honored the tomb of Hippocrates, on which were written poems by an unknown poet dedicated to the great doctor:

Here is buried Hippocrates, a Thessalian born on Kos, Phoebe, he was the very root of the immortal branch. He healed many diseases, erected trophies to Hygiea, He deserved many praises - knowledge is not an accident. The name of Hippocrates was repeatedly mentioned in the writings of his contemporaries: he was mentioned by Plato, Diocles from Carista, Aristotle. In their works, comparisons of Hippocrates with the great sculptures and politicians of Ancient Hellas were found. Not just like that, Aristotle even wrote about it as a state that can be considered strong, unlike others, not in terms of its size, but in terms of the state tasks it performs, just like Hippocrates himself, not as a person, but as a doctor, is greater than any other, even many times its body size.

Hippocrates chose the path of medicine for himself not by chance, for all his predecessors, starting from Asclepius himself, were doctors. In total, seven Hippocrates are known in history, one of which - the grandson of Hippocrates II, the son of his heir Dragon - treated the wife of Alexander the Great, Roxana. All seven Hippocrates left behind works on the art of medicine, just like many other healers of that time, but history does not know of a single work that would definitely belong to the pen of Hippocrates II the Great. This uncertainty is explained by the fact that all doctors of that time wrote anonymously, because knowledge was initially transferred only within family medical schools, that is, from father to son and to a few who wished to study the medical art. Thus, these works were intended "for home use", their author was known by sight.

Only in the III century. BC e. in the Alexandria Manuscript Depository, which was founded by the first ruler of Ancient Egypt, Ptolemy I Soter (323-282 BC) - the diadocho of Alexander the Great, writers, philologists, historians and doctors of that time compiled the first collection of ancient Greek medical writings. The work was then carried out colossal, since manuscripts from all over the world were brought to Alexandria. The total number of papyrus scrolls subject to further processing and translation soon exceeded 700 thousand. Among this huge number of works, 72 compositions on a medical theme were found. All of them were written in Greek, or rather, in the Ionian dialect around the 1525th-XNUMXth centuries. BC e. None of these writings had the signature of the author. It was practically impossible to distinguish from them those that could have belonged to the pen of Hippocrates: not a single work matched the rest in terms of writing style, depth and style of presentation, philosophical and medical position. Moreover, open disagreements were found in the discussion of many issues up to directly opposite opinions. This once again confirmed that they all belonged to different authors. Having lost hope of establishing the authorship of the works, historians combined all these medical texts into one collection and called it "Hyppokratiki sil-logi" or "Hippocratic collection" in honor of the great Greek physician. Later, the title and text of the collection were translated into Latin, and it became better known as "Corpus Hippocraticum". So that this great work would not be lost in the abundance of other literary treasures of that time, it was repeatedly copied, not only in Greek, but also in Arabic, Latin and Italian and many other languages ​​​​of the world. And only eighteen centuries later, in XNUMX, when printing was invented, it was first published in Rome in Latin. The publication immediately gained immense popularity a year after its release in Greek in Venice, after which it became almost the most famous and widely read work in all of Europe.

The work existed for a long time unchanged, and in the XIX century. the French encyclopedist and philologist Emile Litre engaged in a deep analysis, but did not find out which works included in the collection may belong to Hippocrates.

Scientists involved in the study of the collection came to the conclusion that no more than 3-4 works can be attributed to the authorship of the great doctor. First of all, they decided that these were "Aphorisms", "Epidemics", "Prognostics", "About air, waters, localities".

First of all, it is worth mentioning the "Aphorisms". Perhaps, only in relation to this work there is practically no doubt that it belongs to Hippocrates. "Aphorisms" (from the Greek. aphorismos - "complete thought") were not only on medical, but also on universal, philosophical topics. The beginning of the composition already foreshadows the significance of this work in the scientific world: "Life is short, the path of art is long, opportunity is fleeting, experience is deceptive, judgment is difficult." Undoubtedly, a person who so accurately and briefly was able to state the essence of human life in general and the meaning of medical practice in particular, must have had a remarkable mind, wisdom, subtle attention and had many years of experience behind him. And even if this saying was the only one in his life and he did nothing else either in the practical or in the scientific fields of medicine, people would already have to admit that he was a great doctor and thinker.

Another work of the Hippocratic Collection, which became the basis for diagnosing diseases, is Prognostics (from the Greek prognosis - "initial knowledge"). This is the first work on ancient Greek therapy. The book provides detailed descriptions of the prognosis of various diseases, diagnosis, methods of examination, questioning the patient, monitoring him, as well as methods of "treatment at the patient's bedside." It was from this work that some diagnostic signs that have survived to this day have entered the centuries. For example, the "face of Hippocrates" (named not for external resemblance, but in honor of Hippocrates). This is a classic description of the face of a dying person, and now it is also applied to people with certain certain diseases (metastatic cancer of the gastrointestinal tract, etc.).

This description in the “Hippocratic Collection” reads as follows: “...the nose is sharp, the eyes are sunken, the temples are sunken, the skin on the forehead is hard, tense and dry, and the color of the whole face is green, black, or pale, or leaden...” This and many other descriptions are still widely used in medical practice.

"About the air, waters, localities" - an essay that has, rather, an ecological and geographical name, in fact, the first work on the harmful effects of environmental factors on the human body. The work details various "types of people" depending on the locality in which they live. As a person who traveled to a large number of countries, he could draw some generalizing conclusions about the occurrence of certain diseases in people inhabiting, for example, sea coasts, high mountain regions, and desert territories. He was also able to link the frequency of occurrence of certain diseases with the time of year and even with biological and circadian rhythms. Thus, Hippocrates determined that "different types" of people had different susceptibility to diseases, and therefore looked for both treatments that could be applied to all people, and different types of approach to treating the same disease that arose in people of different types. He also for the first time made an assumption about four bodily juices and, according to the predominance of one of them in the body, about dividing people into different types. This theory formed the basis of the much later formed doctrine of the four temperaments. This was already in the Middle Ages. The teaching said that if mucus predominates in the body (from the Greek phlegma - mucus), then a person has a phlegmatic temperament, if blood predominates (from the Greek sanguis - blood), then a person is sanguine, if bile predominates (from the Greek chole - bile), then the character of a person is choleric, and if there is a lot of black bile in the body (from the Greek melaine chole - bile), then the type of temperament will be melancholic. The basis of this system is erroneously attributed to the merits of Hippocrates, since even if he tried to divide people into types, it was not by temperament, but by predisposition to diseases. In addition, the names of temperaments are not contained in the work "On Airs, Waters, Localities", because some words (such as sanguis) are of Latin origin, and therefore they could not be used by Hippocrates. In the future, only the names of various "types of people" were preserved from the theory of temperaments. I. P. Pavlov connected them with the predominance of the processes of excitation and inhibition, as well as with possible body types.

In such a work as "Epidemics in Seven Parts" one can find a description of 42 different diseases, which were the most studied, since the observations of patients with these diseases were carried out separately and all data were recorded as a kind of case history. Unlike modern concepts, then epidemics were understood not as infectious diseases, but as diseases that were most widespread among the population. Such diseases included consumption, paralysis, marsh fevers, eye, catarrhal, skin, venereal and other diseases. Here the origins of the clinical approach to the treatment of diseases have been described.

The ancient Greeks thought not only about treatment, but also about the causes of diseases, that is, about their possible prevention. The reasons were divided into general, depending on the quality and conditions of the environment in which the inhabitants of a particular area lived (something most common that everyone uses, that is, something that enters the body with breathing), and individual, which depended on the lifestyle, working conditions, nutrition and living of each individual person. Particular attention in ancient Greece was paid to physical education, hygiene, hardening. This was especially applicable to men, in whom love for the Motherland and readiness to defend it at any moment were brought up from the cradle. The most severe methods of education were in Sparta, where children from the age of 7 were in the care of the state and were educated in military units.

Among the medical texts of that time, works on surgery were found (from the Greek cheir - hand, ergon - business). The main focus was on studying methods for treating fractures, wounds, dislocations, and skull injuries. It was then that devices for straightening dislocated joints, for example, the “Hippocratic bench,” were described for the first time. Much has been written about bandages (from the Greek desmurgia - the study of bandages). The types of dressings described in the “Hippocratic Collection” are still used today, for example, the “Hippocrates cap”.

The ancient Greeks also studied diseases of the teeth, gums, and oral cavity. Even then, they tried to eliminate bad breath, and local remedies were also used to treat diseases of the oral cavity: narcotic analgesics, herbal infusions and decoctions, astringents, etc. The ideas of ancient Greek doctors about the internal structure of the human body were rather scarce, because they did not open corpses . In this field they lagged far behind the Indian physicians, who, already several centuries before Hippocrates, introduced the autopsy of corpses into practice in order to study internal diseases. However, the advantage of the Greeks was that they achieved great success in the diagnosis and treatment of internal diseases, based on the data of examination, questioning, and physical methods of research.

"Hippocratic Collection" contains information on pharmacology, it contains a description of more than 250 herbal medicines, as well as preparations of animal and mineral origin.

In general, the "Hippocratic Collection" is a collection of all information from the field of medicine of Ancient Greece, created by doctors of the XNUMXth-XNUMXrd centuries. BC e.

The foundations of modern medical ethics and deontology are also rooted in the ancient period. Then there were five main treatises, which contained information about what moral, physical, spiritual qualities a real doctor should have.

These were such works as "The Oath", "On the Doctor", "Law", "Instructions", "On Causal Behavior". These works mainly spoke about the need for a doctor to educate himself in such qualities as determination, neatness, aversion to vice, contempt for money, an abundance of thoughts, a denial of fear of the gods, for a good doctor himself is equated with God.

A true healer had to comprehend knowledge not only from the field of medicine, but also all those that are useful and can be useful, and also be able to keep in mind all the information known to him and apply them as needed.

However, the excessive application of this knowledge in practice, when they could cause harm, was condemned, because the first law of healing was the law "first of all, do no harm."

In addition, the doctor should not have paid special attention to monetary rewards, especially if the patient is in serious condition or poor (helping the poor was a holy deed).

Along with knowledge of his business, a person involved in medicine had to look neat and dignified so that people would have no doubts about his professional qualities.

A special place in the medical practice of Ancient Greece was occupied by the "Hippocratic Oath" or "The Oath of the Future Doctor", which was given by everyone who completed their training in the medical profession. The "oath" was not invented by Hippocrates, he only summarized in a single text all its main features that existed long before his medical practice. She first received the same literary design in the same Alexandrian library in the XNUMXrd century BC. BC e.

Any oath of that time assumed the support of the gods, who were supposed to be the first punishers in the event of perjury. The medical oath contained references to the gods who were directly related to the medical art and those who practiced it. These were Apollo, Asclepius, Hygieia, Panacea. There are suggestions that the Hippocratic Oath got its name also because it mentions Asclepius, the ancestor of Hippocrates II the Great in the seventeenth generation.

By giving the "Oath" at the end of his training, the doctor secured the trust of society and provided a guarantee of a high level of professionalism. The “oath” translated from ancient Greek is as follows: “I swear by Apollo the doctor, Asclepius, Hygiea and Panakea and all the gods and goddesses, taking them as witnesses, to fulfill honestly, according to my strength and my understanding, the following oath and written obligation: to consider the one who taught me medical art on an equal footing with my parents, to share with him my wealth and, if necessary, to help in his needs; to consider his offspring as his brothers, and this art, if they want to study it, teach them free of charge and without any contract; instructions, learned lessons and everything else in the teaching to communicate to his sons, his teacher and students, bound by obligation and oath according to medical law, but to no one else.

I direct the regimen of the sick for their benefit, according to my ability and my understanding, refraining from causing any harm and injustice. I will not give to anyone the deadly plan asked of me, and I will not show the way for such a plan; likewise, I will not hand any woman an abortion pessary.

Purely and undefiled shall I conduct my life and my art. In no case will I make sections in those suffering from stone disease, leaving it to people involved in this matter. Whatever house I enter, I will enter there for the benefit of the sick, being far from everything intentional, unjust and harmful, especially from love affairs with women and men, free and slaves.

Whatever, during treatment - and also without treatment - I see or hear about human life from what should never be divulged, I will keep silent about it, considering such things a secret. To me, who inviolably fulfills the oath, may happiness be given in life and in art and glory among all people for all eternity, but to the one who transgresses and gives a false oath, let it be the opposite of this.

All the norms set forth in the "Oath" and other works on medical ethics were strictly observed, because people feared not only the wrath of their compatriots and reprisals from the government, but also the punishment of the gods.

In the modern world, each state has its own doctor's oath, which reflects the level of development of medicine, national and religious traditions, but they all retain common features with the ancient Greek oath.

Thus, the "Hippocratic Collection" contains quite a few works whose authorship can be attributed to Hippocrates, and the names mentioned there - "Hippocratic Oath", "Hippocratic Bench", "Hippocratic Medicine" - did not appear because were what Hippocrates invented directly, but because many discoveries of that time were associated with the name of Hippocrates as the name of the then most famous doctor.

These names simultaneously glorified the era in which certain innovations appeared. Therefore, Hippocrates is more of a legend of Ancient Hellas, but a beautiful and noble legend. In no case should we belittle his merits in the formation and development of world medicine.

Author: Bachilo E.V.

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