“This sycamore tree, graciously given to the University of Florida College of medicine by the minister of agriculture of Greece was taken as a cutting from the tree on the island of Cos under which Hippocrates, according to legend, taught students of medicine. Hippocrates is remembered as a keen observer of the natural history of disease and as one who founded and practiced the guiding principles of modern clinical medicine. He is remembered also as a man who shared his knowledge of the art with aspiring students in a creative, forceful, and inspirational manner. In keeping with these Hippocratic ideals of teaching the medical class of 1969 now initiates an award to recognize each year that teacher who has most enriched the minds of students, thereby bringing excellence to his profession and distinction to himself.”To resemble Hippocrates is thus the highest praise a physician at Florida can receive.
This award was established by the medical school class of 1969 in order to recognize and honor those teachers who were recognized as the ideal role model for the class. This class then acquired saplings from a sycamore tree growing on the Greek island of Kos, home of Hippocrates, because legend and history have it that Hippocrates taught while seated underneath the parent tree. Six saplings arrived, and the one planted in front of Shands Hospital has flourished as the list of names on the plaque at its foot has grown. Why did the class select this physician, and the symbolic site of his teachings, as representing the best that medical practice can offer?
Because Hippocrates and his teachings have an important place in Western biomedical history and training, and there are elements of Hippocratic practice that underlie today’s medical practice and research principles.
Hippocrates was a real person about whom little is known- he was born on the Greek island of Kos around 460 BCE, and died around 370BCE. He traveled widely teaching medicine and the Hippocratic School grew up around his teachings and writings. Separating the man from the myth can be difficult, however.
So deeply does the mythos of Hippocratic medicine enter into the collective consciousness that an ancient Greek oath ranks among the most important promises that doctors make in regards to professional behavior. Physicians of the past swore to practice using the words from the Hippocratic Oath. Now many schools graduate using an updated variant of this oath, binding physicians to a standard of professionalism, which outlines how to practice, how to treat patients and respect other practitioners, how to pass on the privileged information of the guild… It has long been seen as the most solemn promise a physician can make.
It is, however, probably not an oath sworn by ancient Greek physicians practicing Hippocratic medicine. Many aspects of this oath- the initial call to the gods, the prohibition against abortion and surgery do not represent Hippocratic practice or most Greek practitioners but instead describe the medical beliefs of a group of Pythagoreans. The Pythagoreans, however, represented only one of the ancient Greek medical traditions, which also included the temple medicine associated with Asclepius.
So, if there were many Greek traditions, why is there an association of the non-Hippocratic oath with Hippocrates?
Because Hippocrates was so important and his teachings so revered that any ancient oath associated with Greek medicine has stature and mystique.
And while Hippocratic medicine differed from these other Greek traditions it also stands out as having special relevance to the present day. Hippocrates was the first western practitioner who gave medicine independent professional standing while defining professional conduct for medical practitioners.
And what was the nature of Hippocratic practice that aligns it with western medicine? In addition to standards of professionalism, Hippocratic physicians also understood illness to have a natural cause, rather than to be due to supernatural phenomena such as possession by demons. They viewed healing as part of natural processes, rather than requiring divine intervention, and took exception to other teachings of the time that saw disease as having a supernatural cause. For instance, Greek priests believed that epilepsy was caused by the gods. Hippocrates believed that with all other illnesses it had a natural cause, "Men believe only that it is a divine disease because of their ignorance and amazement." From ‘The Sacred Disease’.
The Greek understanding of illness in individuals was somewhat different from causes of disease in the 20th century. It represented an adaptation of the four elements in Greek science and their properties to correspond with four humors in the body. Illness was thought to result from an imbalance of the humors- blood, phlegm, yellow bile, and black bile. Certain types of humoral imbalances supposedly predominated in certain seasons. Epidemic disease was thought to result from the development of poisonous miasmas, perhaps associated with swampy land, or earthquakes, or filth.
Still, if disease etiology differed for Greek practitioners, to the Hippocratic school the workings of disease also corresponded to careful observation. So even if our explanations vary we can see that they were clearly aware of the seasonal illnesses such as malaria that were common in the Mediterranean world. Too, epidemic disease was associated with major catastrophic events- a problem today recognized and feared after the cataclysmic wave in the Indian Ocean this past winter. Or disease was associated with mosquito-ridden swamps- even if mosquitoes were not recognized as the source of disease.
The Hippocratic corpus thus includes instructions for careful observation and diagnosis. It also includes description of treatments that included diet, exercise or rest, fresh air, drugs only if other methods of healing were not appropriate, with surgery as a last resort, and physicians treated individuals differently depending on age, gender, physical condition and other considerations.
The formalized training of new physicians also marked Hippocratic medicine. The real or mythical Hippocrates trained future physicians beneath a sycamore tree, imparting in them a body of knowledge that included a particular code of ethics as well as definite responsibilities to the patient.
Importantly, too, with a patient focus came an understanding of the relationship between the art and science of medicine. The idea that practicing medicine was part art and part science dates back to Hippocrates, who said, “Life is short, the Art is long, opportunity fleeting, experience delusive, judgment difficult.” The art of medicine is the relationship between physician and patient, the way the physician brings knowledge to bear in diagnosing and treating but even more important, in establishing a relationship with the patient that opens the way for trust and understanding, the way a physician listens to the patient and practices a humanistic, ethical, and selfless art passed down from Hippocrates.
Thus, Hippocratic medicine included professionalism, a focus on natural rather than supernatural causes of disease, empiricism with careful observation of phenomena rather than theoretical systems as well as professional training and a focus on ethical patient care. While almost all else in medicine changed, the practice is still, at base, a physician talking and listening to a patient, observing, and bringing to bear knowledge based on natural understandings of disease causation and careful observation with a written body of collected data, imparted with great care to future generations.
* Images courtesy of: National Library of Medicine's, Images from the History of Medicine collection
