In medical history, Hippocrates (Buqraat) is the founder of medicine. He is also renowned as the father of medicine because of his significant contribution. Hippocrates was the first physician who finally freed medical science from the shackles of superstition, magic, and supernatural powers. He explained that diseases are natural processes by collecting data and conducting experiments. He explained that the human body is designed by nature in a way to self-heal and self-sustain. Any disease and illness can result from the body’s response to the disease-fighting process. Here, physicians only play the role of nature’s servant and facilitator.
Hippocrates (Buqraat) Autobiography
Hippocrates took his first breath at Cos (Kos) island (present-day Turkey) around 460 BC. That grand Greek island is present on the Aegean Sea near Turkey. At present, there is insufficient information available about the birth and childhood of Hippocrates.
According to Soranus (first biographer of Hippocrates), the father of Buqraat was Heraclides (a physician), and his mother was Praxitela (Tizane’s daughter).
Plato stated that Hippocrates had gained knowledge of medicine from his grandfather and father in the form of apprenticeship. It is also stated that he used to follow his father from patient to patient and learned various treatments through observation [1]. He lived a long life and died in the town of Larissa in Thessaly at a ripe old age in 370 BC.
The Revolution of Hippocrates in Medicine
When Hippocrates started to practice medicine, there was an established school known as Cnidian School. But this school’s approach to medicine had various flaws that began to become apparent and cause of dissatisfaction with medicine. According to the Cnidian School, the human body comprises multiple isolated parts. They used to think that diseases only affect a specific body part and that particular part needs treatment. But, their treatment method was also faulty because they only focused on the subjective signs and did not consider the objective symptoms of the disease.
Here, Hippocrates radically conflicted with the Cnidian school concept and argued that the human body is designed as a single unified organism (physis). It must be treated as one coherent, integrated organism. He also added that both subjective and objective symptoms of the patient must be considered for the accurate assessment and diagnosis of a disease. These words show Hippocrates opinion about humans and their diseases:
“The body of a man has in itself blood, phlegm, yellow bile, and black bile; these make up the nature of the body, and through these, he feels pain or enjoys health.
Hippocratic Medicine
In Hippocratic medicine, pathology and physiology were based on humor theory. For the good health of an individual, it is necessary to maintain a united confluence and sympathy. Innate heat and Pneuma (a vital force or breath) were suffused from the lungs into the blood via the heart, providing the power to the blood to sustain life.
Insight on Humor Theory
According to Hippocrates, the balance of four humors and Pepsis is essential for good health. If there is a disorder of Pepsis, it can cause the origin of many other diseases.
The knowledge of Hippocrates on anatomy was relatively scant, but no one can deny the soundness of his reasoning and insights into the physiology of humans. When it comes to the contribution of Hippocrates into the field of therapeutics, he used to think that the role of the physician is like the facilitator and servant of nature. The purpose of all medical treatments is to enable the patient’s natural resistance to prevail and provide recovery by overcoming the disease.
Insight on Unani Mode of Treatment
Hippocrates was very pragmatic, sensible, and flexible in his treatment approach and favored moderation and conservatism over extreme or radical measures. Hippocrates also employed bloodletting to cure diseases. But its use was sporadic at that time, and it is applied conservatively even today.
He emphasized the building and strengthening of the body’s inherent resistance against diseases. For the strengthening of the body’s inherent resistance, he prescribed gymnastics, diet (Ghiza), massage (Dalak), exercise (Riyazat), sea bathing, and hydrotherapy.
To treat diseases, he was a great believer in proper dietary intake (a notion of Ilaj Bil Ghiza) and implemented them. He prescribed a light and balanced diet during acute illness and crises stage. And for the wound and fever treatment, he prescribed a liquid diet.
He was focused on the treatment of the patient rather than the treatment of disease.
Hippocrates (Buqraat) Works
Hippocrates was the first physician who differentiated medicine and philosophy. He further bifurcated scientific medicine from religion. He was the first Unani physician who believed that any God or superstition does not cause diseases; instead, diseases are caused naturally. This was the turning point of medicine. Overall, this belief made him the legend of medicine. The title “father of medicine” belongs to Hippocrates because this title represents the ethical ideal and prototype of a physician who spoke about the doctor’s attitude towards disease and patient. He put the welfare and wellbeing of the patient at the priority of the treatment methodology.
Furthermore, Hippocrates believed that diseases are natural phenomena and human beings are also a part of nature. So, natural means can treat disease. He also thought that physicians treat the patient, not the disease. He was also the first doctor who asked a patient how they felt. Hippocrates has left various valid treatment methods for the present world. He pioneered the humoral theory, medical therapy, medical ethics, and medical propaedeutic [2].
The Temperament Theory of Hippocrates
Hippocrates was the pioneer of temperament theory (nazaria-e-mizaj) or humoral theory (nazaria-e-akhlat). He observed that human body functions, actions, and illness variations depend on fluids (humors) present in the human body [3]. On these observations, he introduced the concept of humorism. Based on these concepts, Hippocrates introduced and described human temperaments with distinguishing emotional, physical, and bodily characteristics [4]. In addition, he also explained that the overall health of a patient depends on temperaments [5].
Hippocrates believed that we could classify human illness, moods, variation in behaviors, and emotions based on their body fluid proportion. He explained four humors that were part of medieval medicine and science [6]. These humors (Akhlat) were black bile (Sauda), yellow bile (Safra), phlegm (Balgham), and blood (Dam). He defined dry (yabis), moist (ratab), hot (har), and cold (barid) temperaments. He further explained that the overall good health of an individual depends on the balance of these four body fluids (humors). So, any adverse condition or disease was attributed to the imbalance of any key humor [7].
The Forefather of Neurology
Hippocrates had been considered the forefather of neurology due to his outstanding work in this field. He has detailed knowledge of nerves, internal organs, arteries, muscles, and veins. It is possibly due to his autopsy practice that it was considered a punishable and inconceivable act at that time [8]. Among all diseases he was familiar with, many disorders were neurological such as spondylitis (Warm-e-faqra), paraplegia (Adharang), apoplexy (Margi, Sakta), lethargic encephalitis, hemiplegia (Falij), traumatic and obstetric brachial plexus palsy (Laqua, Qafeef falij). He was also familiar with hysteria (Ikhtinaq-e- Rahem), mania, melancholia (Malquliya), and epilepsy (Sara, Margi) [9, 10]. It was Hippocrates whose ideas have started today’s neurology. Most significantly, he explained that the human body’s brain is the analyst and stimulus of the outside world. It serves as the consciousness interpreter as well, as the brain is the center of willpower and intelligence.
While explaining the brain anatomy, he explained that the human brain is divided into two halves by a membrane just like animals, and when we cut the brain and open it, it fills with fluid. His explanations on the differences between pia and dura meninges proved that he was used to performing an autopsy. In addition, he stated that the brain is a phlegmatic organ, and certain diseases originate from the brain. He also observed that any injury on the right side of the head causes spasms or palsy (Laqua) on the left side of the body [11].
Epilepsy (Sara, Margi)
It was Hippocrates who first speculated that epilepsy was considered sacred to hide the incapability of charlatans and other physician-sorcerers to treat the disease. He explained that epilepsy was neither divine nor sacred. It was most likely due to brain malfunction, or it could be inherited. He further explained the participating factors of epilepsy (Sara, Margi), such as head exposure to harmful solar radiations, changes in temperature and wind, fear, and crying [12]. He observed that this disease could also occur due to aphonia or apneic crisis at any age. For determining the causes of convulsion, Hippocrates isolated only impaired cerebral circulation or brain trauma in damaged areas causing yellow bile (Safra) to be overproduced [13]. He firmly believed that due to epileptic seizures, the brain (Demagh) was liquefied.
Headache and Migraine (Shaqeeqa)
In explaining headache and migraine (Shaqeeqa), Hippocrates stated that it is a direct consequence of rising vapors from the liver (Jigar, Kabad) to the head. At first glance, this explanation feels strange, but from his observation, he made it clear that a sequence of events is responsible for the onset of migraine and headaches [14].
Meningitis (Sarsaam)
It is the inflammation of the membranes surrounding the skull and the brain. Hippocrates observed three forms of meningitis (Sarsaam) and distinguished them. He stated that meningitis could be due to cranial fracturing, mastoiditis (middle ear infection), and epidemic variation. The main symptoms were dysphagia, headache, and high fever (Hararath) with head retraction. He observed that the patients with high fever and unconscious state are the suitable examples of the most severe cases of encephalitis. He explained that the patients with this condition would not recover from the madness and chills unless the pus (peep) and other secretions came out through the ears and nose [15].
Trepanation
The evidence about whether Hippocrates performed Trepanation is unclear. Few authors believe that the treaties on Wounds of the Head, which are linked with the Hippocrates, are not his original thoughts; instead, the author of that book was new in the field of trepanning but was a skilled surgeon [16]. However, there is evidence that Hippocrates treated subdural hematoma fractures and suggested trepanation after 1-3 days of injury. In addition, he described contrecoup lesions and brain coup in detail [17]. He used to place lint on the defective part for protection in patients with severe brain damage or trauma. Most significantly, Hippocrates suggested that before treating any brain injury, a physician needs to inspect the patient’s medical history [18, 19].
Spine
In the exploration of pathological and anatomical features of the human spine, the name of Hippocrates comes first place. He believed that if a physician wants to cure various diseases, he should have the knowledge of the basic spine structure of a human being. Well, he also stated that the primary purpose of the spine is to uphold the erect position.
He explained three principal vertebral segments: the thoracic section that involves 12 vertebrae, above the clavicle level section, and the keneon section that involves five vertebrae between the pelvis and the chest. In the detailed description of simple spinal curvature, he included coccyx and sacrum, aware that the sacrum normally protects the generative organs, the bladder (Masana), and the rectum (Amme-e-mustaqim, Seedhi Anth).
Other vertebral pathologies that he mentioned were based on scoliosis, concussion, fractures of the spinous process, dislocation of the vertebrae, post-traumatic kyphosis, fractures, and tuberculous spondylitis (Warm-e-faqra). As Hippocrates devised a board and ladder to treat a spinal dislocation, he is known as the father of neurology or spinal surgery (Jarahat) [20-22].
Hydrocephalus, Poliomyelitis, Dementia
Epidemic leg paralysis (Falij) is one of Hippocrates’ most popular neurological diagnoses that today is known as poliomyelitis [23]. He also describes hydrocephalus as a fluid collection around the brain and under the bones. He indicated common symptoms of hydrocephalus that were vomiting, headache, diplopia, and visual impairment [24]. It is also believed that the earliest explanation of senile dementia disease dates back to Hippocrates and Pythagoras [25].
Concerning all the explained neurological disorders, symptoms, and anatomical relations, Hippocrates is justly be known as the forefather of neurology.
Writings of Hippocrates on the Heart
Writing of the Hippocrates on heart and cardiovascular diseases contains some of the recorded clinical descriptions. Description of the blood vessels, the heart, examination method, cardiac risk factors, coronary artery disease, congestive heart failure, valvular heart disease, arrhythmias, pulse, circadian rhythm, and sudden death are available in the clinical history. Various therapeutic modalities such as thoracic and abdominal paracentesis and acupuncture show that different Greek physicians, including Hippocrates, had the experience of dealing with multiple heart disorders [26].
The Hippocratic Corpus is a collection of 70 works of Hippocrates that were written in the ancient Greek language, and it is thought that the book was compiled in 250 BC in the Library of Alexandria. There is a complete description of medicine and various philosophical texts. But no one exactly knows how many of these texts are actually written by Hippocrates [27]. It has also been reported that several books are distinguished due to the detailed descriptions and recorded histories of the diseases.
According to the classification of Jones, Regimen in Acute Diseases, On the Sacred Disease (Epilepsy), Prognostics, The Hippocratic Oath, Aphorisms, and Epidemics I and III books are the genuine works of Hippocrates. In contrast, Aphorisms, On Fractures, wounds in the head, and Airs, Waters, and Places are closely linked with the thoughts of Hippocrates, if not his genuine work.
The Heart and Blood Vessels
One of the outstanding collections of Hippocrates writings is “The heart,” which deals with the anatomic subject. The first explained treaty mentions the four heart valves and chambers, the pericardium, and the blood vessels [28].
It was Hippocrates who recognized that in coronary heart disease, obesity is a risk factor. In his Aphorism 44, Hippocrates explained the short life span of obese compared to slim individuals.
He also condemned overeating in Aphorisms 1 as “Repletion that is carried to an extreme is perilous” [29].
In addition, he also warned fat people against exercise after eating and said that “obese who want to reduce weight should take exercise before eating on an empty stomach.”
For heart failure treatment, Hippocrates also suggested dietary therapy and venesection. One of the Hippocrates aphorisms is that: starving should be indicated for people with moist flesh as starving dries bodies. In addition, the term ‘pulse’ was first used by Hippocrates. The reference of this is available in the Corpus Hippocraticum, such as “if a person is suffering from acute fever, his veins pulsate with greater frequency and strength, around the umbilicus.
Seasonal Variation & Circadian Rhythm
In recent years, the seasonal variation and circadian rhythm that affect many biochemical and physiological body parameters have been well recognized in cardiology – in acute coronary syndromes, in acute myocardial infarction, in thrombotic stroke, and sudden cardiac death. However, nearly 2500 years ago, Hippocrates theorized that the seasons affected humans’ physiologic functions and constitution.
According to Hippocrates theory, every disease occurs at all seasons, but some disorders can occur with great severity and more frequently at certain times. This theory clearly indicates an early precursor of the recent world idea of seasonal variation and circadian rhythm of diseases. Long ago, Hippocrates also postulated that the hormone releases autonomic nervous system modulation. Various other pathways present a mechanism through which chronobiological rhythms controlled by the suprachiasmatic nucleus could disturb cardiovascular events and cause sudden cardiac death [30].
Contribution of Hippocrates in the Understanding of Various Other Diseases
From the historical point of view, medicine is divided into three periods: the pre-Hippocratic period, the Hippocratic period, and the post-Hippocratic period. The most critical period was the Hippocratic one, where the medicine was formulated under the great Greek (Unani) physician Hippocrates (Buqraat).
Manual Methods for Repositioning
Hippocrates had suggested the manual methods for repositioning shoulder fracture and gleno-humeral dislocation. These methods are well known and explained in his writing “On fractures.” The technique suggested that the upper arm is fixed under load and in extension while sitting. After returning the humerus to the normal position, the fracture is bandaged after dipping the bandages in the oil. After the bandage, the patient’s arm remains fixed for 40 days, and the patient needs to follow the diet therapy.
From these observations, it is clear that the Hippocratic school students were well aware of the articulation and its dynamics [31]. The school students also observed that urinary tract diseases are due to the swelling in the semen (Madda munviya). It is also considered that both women and men can suffer from this problem, and the possible cause could be sex. However, they faced difficulty distinguishing between urinary tract diseases and sexually transmitted diseases.
In his writing “On joints,” he talked about nasal injuries and described the procedures of nose repositioning [32]. In addition, as proposed by Hippocrates, scoliosis traction therapy is still used in the modern medicine system. Hippocrates also prescribed the clubbed fingers and fingertips and lower jaw dislocation treatment.
He considered the urine as a blood filtrate that passed from the kidney. He also explained in the aphorisms that if you find bubbles in the urine, it indicates a long-term kidney infection. And if there are sediments in the urine, it means a long-term fever.
In Peri Adenoma, Hippocrates tried to elaborate lymphatics as a complex and branched network. He also associated claudication with sciatica and observed that it was more common in the hot summer season, so he prescribed diet and rest to the patient.
It was Hippocrates who established a line of differentiation between preventive and therapeutic medicine. He considered the environment as one of the causes of seasonal disorders and diseases in his book “Airs, Waters, and Places.” This book is regarded as a milestone in social and preventive medicine. In the book, Hippocrates explained the relation of health with cloth, house, water, and dietary habits.
Hippocrates is also famous as an epidemiologist because of his work on epidemic diseases. He was the physician who distinguished between epidemic and endemic diseases. He thoroughly observed water, climate, diet, clothing, eating habits, and their possible effects on producing various diseases. His concept of health and diseases focused on the relationship between humans and the environment. He also explained the impact of seasons and cold and hot winds. He examined diseases in relation to season, time, environmental conditions, and place.
Hippocrates also explained that every individual has a unique humeral constitution that represents a healthy state of an individual. He described that Medicatrix’s self-preservation power (Quwate mudabbrah) maintains a correct balance of humor. In addition to medicine, Hippocrates explained the concept of immunity (Quwat e Mudafiat) and the concept of physics (Tabiat) [33].
Hippocrates Famous Oath
The most important reason for remembering Hippocrates even today is his famous Oath. Hippocrates first writes the Oath that physicians take before starting their practice of medicine. In the Oath, he set high standards of ethics for future physicians that they have to follow. But when it comes to compliance with these standards in the past and now, it is less than perfect.
Some provisions of the Hippocrates oath were accepted without a single question. These provisions protected patient-doctor confidentiality, meddling in the patients’ lives, and forbidding sexual involvement. He also forbade abortion and the use of deadly or poisonous drugs. From these provisions, it is clear that Hippocrates favored the right to life and against euthanasia. One other Oath provision was that the physician should offer the teaching of the art of medicine to any male relative or offspring of his family, free of cost. But today, no physician accepts this provision while taking the Oath [34].
The Oath:
I swear by Apollo, the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction.
I will impart a knowledge of the art to my own sons, and those of my teachers, and to disciples bound by a stipulation and Oath according to the law of medicine, but to none others and will follow that system of regimen which, according to my ability and judgment, I consider for my patients’ benefit and abstain from whatever is deleterious and mischievous.
I will give no deadly medicine to anyone if asked, nor suggest any such counsel, and in like manner, I will not give a woman a pessary to produce abortion. With purity and with holiness, I will pass my life and practice my art. I will not cut persons laboring under the stone but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and enslaved people.
Whatever, in connection with my professional practice or not, in connection with it,
Conclusion
It has been stated that what Plato and Socrates did for philosophy, Hippocrates did the same for medicine [35]. From Plato’s work, we can get information about the status of physicians and medicine in his time. It is also stated the profession of medicine was developing a long time before the work of Hippocrates in this field. But the development of medicine as a science was started by Hippocrates.
On broad lines, the foundation of modern medicine was laid by the Hippocratic School by its skeptical attitude and critical sense. He left his mark in history, and in the present time. a great deal can be learned by following his examples and studying his works. Many teachings and works are attributed to him but were originally not written by him. His followers wrote these works, and they are nonetheless substantial because they described the various procedures and treatments of disease used by Hippocrates.
Perhaps, Hippocrates was the first known physician to follow a rational method in therapy and diagnosis. In Hippocrates’ time, Priests were also used to practice medicine, but they considered it as a magical art rather than science. However, Hippocrates said that “gods rule in the Earth and heaven, but their fateful influences are remote. Natural causes directly prevail in medicine, and diseases are also natural events. Therefore, they must be inspected, followed, and cured naturally. So, the place of any physician is not in any temple but at it is besides” [36]. He knew that if the art of medicine did not come in front of people and kept secret, it could not benefit the people and make progress. Therefore, he publicized all the medical aspects used to keep secrets and established clinical practices by considering human values.
Consequently, practitioners developed medicinal theories and methods in the following centuries by following his examples. Because of this, Celsus in Rome and AD Galen in Greece were popularly considered as the “Roman Hippocrates” and the “second Hippocrates,” respectively. Similarly, Ibn Sine (Avicenna) was famous as “Persian Hippocrates,” in the 10th century. Sydenham was also known as “English Hippocrates,” in the 17th century. While Lannec was known as “French Hippocrates,” in the 19th century, and Osler was famous as the “Canadian Hippocrates” in the 20th century.
Heart diseases were identified almost 2500 years ago, considering all the facts and references confirmed. It was the time when knowledge of pathophysiology and anatomy was fragmentary and non-existent.