Hippocrates c. 460–370 BCE
c. 460–370 bce
Hippocrates of Cos was a semi legendary physician who traveled widely in Greece and gained an exceptional degree of fame. Some modern scholars, such as Ludwig Edelstein, have held that it is a "name lacking even any accessible historical reality." Few scholars go that far, although none believe that Hippocrates wrote all the works attributed to him. Nonetheless, most authorities seem to think that the legends associated with Hippocrates are based on a real person. He certainly was the best-known physician of his time, and the writings attributed to him indicate a profound investigator and an acute observer.
Hippocrates was the head of the most flourishing medical school of his time, situated in Cos, and had many pupils. His teachings spread throughout the Greek world and beyond. He held that disease is a natural process, that symptoms are the reactions of the body to a disease, and that the chief function of the physician is to aid the natural forces of the body in overcoming disease. Both Aristotle and Plato wrote about Hippocrates, and Galen commented extensively on him. Attributed to him is the so-called Hippocratic Corpus, a collection of about sixty medical works (the number depends on the editor), the great majority of which were written in the last decades of the fifth century bce and the first half of the fourth, when Hippocrates was believed to have lived. Some of the writings attributed to Hippocrates apparently were written after he died and some were produced before he was born, but most are contemporary with his time. Scholars believe that the collection was compiled at Alexandria in the third century bce, a hundred years or so after his death.
HIPPOCRATES'S THEORY OF DISEASE
The Hippocratic writings, also known as the Coan writings, hold that the body is formed of four elements—air, earth, water, and fire—that unite in the composition of the individual parts of the organism. As each of the four elements possesses its own particular quality—cold, hot, dry, or wet—the single parts of the organism also possess their essential qualities. The essential factor in life is heat, but because it pervades the entire body, it is essential that equilibrium be maintained by the continuous infusion of pneuma (vital element often translated as air). The nature of the body is made up of four humors: phlegm, blood, yellow bile, and black bile.
Generally these humors operate in harmony with one another, and the individual enjoys good health in his or her body. However, when one of the elements is in excess or in insufficient supply, the individual feels pain. Disease is caused by fluxes of indigestible humors, and cure is dependent on the restoration of equilibrium and the normal bodily properties. Air, location, climate, and season all effect disease, as do diet, the psychology of the patient, and the effect of the psyche on the organism.
The followers of the Coan school believed they had established medicine on a scientific basis, and they attacked magic relentlessly. For them medicine was a rigorous rational technique. Practitioners were advised to examine the body through the use of sight, hearing, smell, touch, taste, and reason. From this process came a synthesis that would provide the treatment. Each disease had its own nature, and no disease came without its natural cause. Hippocratic medicine held that the purpose of the medical practitioner was to help or at the least to do no harm. The ethics of a caregiver should be unquestioned. In the Hippocratic Oath, th would-be physician is instructed to swear that:
In whatever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrongdoing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession in my intercourse with men, if it be what should be published abroad, I will never divulge, holding such things to be holy secrets.
One of the handicaps of Hippocratic medicine was that its practitioners lacked any real knowledge of anatomy, physiology, and pathology; that knowledge began to develop only in the sixteenth century. Instead, it relied on observation, essentially founded on bedside experience, that was combined with philosophical reasoning. In a sense, with the writings of Hippocrates the development of "scientific" medicine began, to be added to gradually by others.
IDEAS ABOUT REPRODUCTION AND GENDER
Ideas about generation were derived from observations of animals mixed with speculation. The Hippocratic writers held that the uterus is always bicornate; that is, it has two hornlike projections. Males are conceived on the right side, and females on the left; this meant that males were superior and females inferior because the right side was superior to the left. In mixed twins both sides of the uterus were involved, with the female child on the left and the male on the right. There is no mention of what happens when the twins are both of the same sex, but clearly they must come from the same horn of the uterus. In single births the male fetus is in the warmest and most solid place: the right side of the womb. Males are formed earlier than females and move about earlier, although they grow more slowly later in the pregnancy. They are more solid, more passionate, and more full-blooded because the part of the womb where they take form is hotter. The writer of the Hippocratic work on conception made pregnancy a joint matter between male and female that results from a mixture of two kinds of seeds: the male semen and the vaginal secretion. Both the male and the female seeds had coagulative power and receptive capacity for coagulation, but the first was stronger in the male and the second was stronger in the female. Menstruation was considered a normal bodily function of the female and was thought to be important in procreation.
Some of the writings of the Hippocratic corpus discussed the possibility of gender change, something the Greeks reported as being common among the Scythians. According to the writers of the corpus, the Scythians lived in a region where the atmosphere is always humid and spring lasts for many months, with mists covering the land for many days. Animals are small and reproduce infrequently. Plants are scarce and vegetation is poor, yet the inhabitants are fat, although they are weak and have poor musculature. Masculine impotence was reported to be common among them. Many of those impotent men did women's work, they often spoke like women, and some, known as anaries, lived as women. Those men were honored because they were believed to have elements of divinity. Other men prostrated themselves before the anaries for fear that the gods might punish them similarly. The author of the description speculated that the condition was due to the fact that the Scythians spent so much time on horseback; this caused many men to become temporarily impotent. If the impotency persisted, the men believed they had committed a sin against the gods. To expiate that sin they put on women's clothing and devoted themselves to feminine occupations. Hippocrates reported that the illness usually attacked only the most powerful and richest men, and when they changed their role, they also became powerful shamans.
The Hippocratic writers not only marked the beginning of modern medicine, they also set forth the ideas that dominated medical and philosophic thinking about sex and gender into the twentieth century.
Edelstein, L. 1967. Ancient Medicine, ed. O. Temkin and C. L. Temkin. Baltimore: Johns Hopkins University Press.
Ellinger, Tage U. H. 1952. Hippocrates on Intercourse and Pregnancy: An English Translation of On Semen and On the Development of the Child. New York: H. Schuman.
Hippocrates. 1923. The Oath; Precepts and Nutriment, ed. and trans. W. H. S. Jones. Cambridge, MA: Harvard University Press.
Hippocrates. 1923. Of the Air, XXI, in Collected Works, trans. and ed. W. H. S. Jones. London: William Heinemann.
Needham, Joseph A. 1959. History of Embryology. 2nd edition. New York: Abelard-Schuman.
Vern L. Bullough