Hippocrates Timeless Still

My article in the Journal of the Royal Society of Medicine 

J R Soc Med. 2013 Jul;106(7):288-92

can also be read in full here in the James Lind Library online

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The special interest in each person’s particular characteristics distinguishes Hippocratic medicine significantly from modern medicine. Hippocrates put the person at the center of his attention, while modern medicine focuses on the disease. Hippocrates was first and foremost interested in finding out what led to the development of the symptoms experienced by the person. He distinguished lifestyle patterns and personal characteristics that predisposed to certain conditions. Although modern medicine is increasingly accepting the importance of lifestyle in the development of chronic diseases, it continues to give priority to examining the illness and treating the symptoms. Hippocratic therapies involved primarily changes in food, exercise and other lifestyle patterns while modern medical treatments concentrate on pharmacological and surgical interventions.

In The Art, the writer gives general advice on how a patient should be treated. He explains that medical treatment consists of much more than drugs:

The most famous doctors cure by changing the diet and lifestyle of their patient and, by using other substances. Such capable doctors have the knowledge and ability to use 
the therapeutic properties of most natural or man-made products (The Art 2.6; Jones 1923)

 

 

“Food as Medicine” – Hippocratic Ancient Mediterranean Diet

Food as Medicine copy

“Food as Medicine: Exploring Nutritional Knowledge in Hippocrates Books”. My published thesis on the Hippocratic Ancient Mediterranean Diet.

Abstract

The Hippocratic writings are the first written evidence of the significance that ancient doctors placed on nutrition for maintenance and restoration of health. The views of the Hippocratic doctors on health and disease and their nutritional interventions influenced medical practice and shaped medical views on the role of diet in the prevention and treatment of illness, for more than 2,500 years.

The Hippocratic writers advocated the use of diet to treat illnesses. They also paid great significance to the factors that maintained health, amongst which nutrition was one of the most important. By taking a broad view on life they advocated preventative (prophylactic) medicine.

The aim of my study was to assemble, critically appraise and produce a synthesis of nutritional guidelines and views found in the Hippocratic books. I did so by searching and reviewing the primary source: the Hippocratic Corpus. I also put the Hippocratic ideas under the light of modern nutritional knowledge, in order to assess the factual value and effectiveness of dietetic approaches and treatments proposed in the Hippocratic books.

Were the Hippocratic physicians the first to practise Nutritional Medicine in a scientific way? We all know the famous saying ‘Let Food be thy Medicine and Medicine be thy Food’. Were they right in saying that food can be used as medicine? What are the nutritional principles that they promoted? Can Hippocratic hypotheses/observations be validated with what research has found today?

The Hippocratic doctors weren’t aware of the human genome, but they understood that each person is different and should be treated as such. They therefore advocated the use of a meticulous medical history, which included the individual’s previous state of being, health and illness, their environment and their previous known reaction to foods. Could we then argue that they were practicing the equivalent of modern nutrigenomics? Lastly, could the review of the observational data and views concentrated in the Hippocratic books help us plan further research and ask new questions, opening new possibilities into our therapeutic approach?

All these themes are explored in detail in my book.

THE TREASURE OF HIPPOCRATES

Delphi
An Invitation to Book Club at PENNY BROHN CANCER CARE
in BRISTOL

 

 THURSDAY 21 MARCH 2013, 4.30 p.m. – 6.00 p.m.

 

“THE TREASURE OF HIPPOCRATES:
Ancient knowledge on health and medicine
applied in the 21st Century”

 

Speaker: Dr ELENI TSIOMPANOU

 

 

 

2,500 years ago Hippocrates said ‘Health is the greatest gift given to man’. Starting as an itinerant physician, he travelled from his home on the Greek island of Cos, through Greece and Asia Minor practising the gentle art of physical observation, using his medical knowledge to show that disease was the product of environment and lifestyle. He believed that the body contained within itself the benign power of nature to rebalance and heal. His medical ethics included the instruction to treat the whole, not just the afflicted part in order to help, and to do no harm.

 

Here in the 21 century, Dr Eleni Tsiompanou also bases her medical practice on such ethics: ‘my job is to inspire, empower, support, rebalance and help patients to rediscover a quality of life’ she says. The writer of many books and articles, with a special interest in nutrition for the health-compromised, she has worked in palliative medicine, integrative oncology and general medicine. Living in London, she regularly makes her way to Bristol to work as one of Penny Brohn Cancer Care’s doctors. Her interest in the history and philosophy of medicine originates from her native Greece. ‘ I believe that food, exercise, lifestyle and the environment all contribute to health’ she says ‘and I have seen how spiritual practice, music, the arts, singing and harmonious living can restore balance. Health is much more than the absence of disease: it can be vibrant, dynamic and long lasting when we live in harmony with our true nature’.

 

I am sure that this Book Club will be fascinating and informative. In bringing the date forward to 21st of March to avoid clashing with Easter, I hope that as many of you as possible will come and bring your friends.

 

Pat Pilkington
Co-Founder, Penny Brohn Cancer Care
Bristol BS20 0HH

 

 

Google Effects on Memory and the Art of Medicine

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On the occasion of an interesting article published in Science in July 2012:

‘Google Effects on Memory: Cognitive Consequences of

Having Information at Our Fingertips’

(Betsy Sparrow, Jenny Liu and Daniel M. Wegner; 15 July 2011: Vol. 333 no. 6040 p. 277).

Two thousand five hundred years ago, Plato wrote that reading had created

a generation of pedants who believe they know everything but master nothing:

“For this <the art of writing> will cause forgetfulness in the minds of those who have learned,

because they will neglect their memory.

Having put their trust in writing, they will recall to memory things from outside,

by means of external marks; not from inside themselves, by themselves.

You have invented a pharmakon not for memory, but for reminding” (Totelin, 2009).

In Ancient times, doctors did not have the luxury of easy access to information, as we do today.

Before the 5th century BC no book on medicine really existed.

This meant that oral tradition was very important.

People had to pay attention and remember what they heard.

A good memory was necessary and, when combined with experience in the practice of medicine,

it distinguished a good from a bad doctor.

As Plato said, if you experience something, know it from within yourself,

then you have a memory of it. 

 The art of medicine can be acquired through practicing it,

not through reading about it. 

This is even more relevant today with the available technology and information overload. 

 

 

 

The Art of Medicine and Writing

Hippocratic_corpys_lugdunum_1665

A doctor’s aim, Hippocrates argues, should be to push medicine forward, taking what has already been discovered and improving it further, to advance the Art of Medicine:

In my opinion, however, to discover what was unknown before is the ambition and task of intelligence, and so is to bring to completion what was already accomplished in part (The Art 2.1; Jones 1923).

Hippocrates called for physicians to engage with research in health and disease, as today. Every new discovery opens up another level of inquiry that goes deeper into understanding how the human body functions.

An aspect of Hippocratic Medicine that was innovative at the time relates to the practice of collecting detailed records of the patients Hippocrates cared for. This practice marked a significant shift from the then traditional oral transmission of knowledge. Plato commented on this new movement of the written word, in his work Phaedrus:

For this [the art of writing] will cause forgetfulness in the minds of those who have learned, because they will neglect their memory. Having put their trust in writing, they will recall to memory things from outside, by means of external marks; not from inside themselves, by themselves. You have invented a pharmakon not for memory, but for reminding (Plato, Phdr. 275a; Totelin, 2009).

Perhaps these records were used for teaching purposes. We do not really know what their purpose was. Hippocrates challenged the then oral tradition, by recording his observations. When a person came to see him about their illness, he examined details about their habits, lifestyle, food intake and their symptoms and signs of disease. With his companions and disciples, he recorded his findings, analysed them and later developed his theories. Through this system, which was based on clinical observation, he drew original conclusions and pushed medicine forward to a new era, influencing physicians more than anyone else before him.

The case histories written in some of the books, such as the Epidemics, are only epigrammatic recollection of certain patients. It is possible that the information presented was only a summary of the actual cases and its purpose was primarily for teaching. Yet, what these writings show is a discrimination of cases and a search for understanding of what determines disease progression and prognosis:

The most acute diseases, the most severe, difficult and fatal belong to the continuous fevers. The least fatal and least difficult of all, but the longest of all, is the quartan… It is necessary also to consider the person’s mode of life and to take it into account when prescribing. Many other important symptoms there are which are akin to these… These must be duly weighed when considering and deciding who is suffering from one of these diseases in an acute, fatal form, or fatal illness, or one from which he may recover… (Epidemics I 1.XXIV-V; Jones 1923).

The woman suffering from angina who lay sick in the house of Aristion began her complaint with indistinctness of speech. Tongue red, and grew parched. First day: Shivered, and grew hot. Third day: Rigor; acute fever; a reddish, hard swelling in the neck, extending to the breast on either side; extremities cold and livid, breathing elevated; drink returned through the nostrils –she could not swallow- stools and urine ceased. Fourth day: general exacerbation. Fifth day: Death (Epidemics III, 1.Case VII; Jones, 1923).

Bibliograpy

Chalmers I (2007) The lethal consequences of failing to make full use of all relevant evidence about the effects of medical treatments: the importance of systematic reviews. In: Rothwell P, ed. Treating individuals: from randomised trials to personalised medicine. London:Elsiever, pp 37-58. 

Jones WHS (1923). Hippocrates. Volume I. With an English Translation by WHSJ. Cambridge, Mass & London: Loeb Classical Library. 

 Plato, Phaedrus 275a. In: Totelin LMV (2009) Hippocratic Recipes: Oral and Written Transmission of Pharmacological Knowledge in Fifth- and Fourth-Century Greece, Leiden: Brill, p 1.

 

 

 

Hippocrates and Darwin

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In 1868, Charles Darwin, already famous for his radical theory on evolution, made a surprising admission, acknowledging the similarities between his theories and those of Hippocrates, the famous Greek physician of the 5th century BC. In reply to a letter, now unfortunately lost,  sent by Dr William Ogle (Superintendent of Statistics to the Registrar-General) Darwin declares the following:

…I wish I had known of these views of Hippocrates before I had published, for they seem almost identical with mine – merely a change of terms – and an application of them to classes of facts necessarily unknown to the old philosopher. The whole case is a good illustration of how rarely anything is new.

…Hippocrates has taken the wind out of my sails, but I care very little about being forestalled. I advance the views merely as a provisional hypothesis, but with the secret expectation that sooner or later some such view will have to be admitted.

…I do not expect the reviewers will be so learned as you otherwise, no doubt, I shall be accused of wilfully stealing Pangenesis from Hippocrates, for this is the spirit some reviewers delight to show (Darwin 1887, p 82).

Having grown up in a family of doctors and having attended medical school only to drop out after a couple of years, Darwin may have had some knowledge of the Hippocratic writings. He however denies it in his letter, leaving us only to guess whether he had read any of the books in the Corpus. 

Darwin F (ed) (1887). The Life and Letter of Charles Darwin, Vol II. (John Murray Publ., London)