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)

 

 

THE TREASURE OF HIPPOCRATES

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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

 

 

The Art of Medicine and Writing

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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)

 

“From Hippocrates to 21st Century Nutritional Medicine”

You are invited to an event organised by the Hellenic Medical Society UK, on Friday 19th of October at the Hellenic Centre in London:  

The 2012 Hippocratic Oration:  

“From Hippocrates to 21st Century Nutritional Medicine” 

The President of the Hellenic Medical Society UK Dr Dimitris Paschos & the HMS Committee will honour:

  Prof Joe Millward PhD, DSc RPHNutr, Emeritus Professor of Human Nutrition,  Institute of Biosciences and Medicine, University of Surrey, Guildford, UK 

 who will deliver his lecture with 

 Dr Eleni Tsiompanou MD, MSc Nutritional Medicine, Researcher in History of Medicine, Physician 

 7pm: Friday 19th October 2012

At the Great Hall of The Hellenic Centre,  16-18 Paddington Street, London W1U 5AS

 The event is open to the general public  

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Health – the greatest of human blessings

More than 50 people attended my talk last Friday, organised by the Stuart Low Trust.

The audience wanted to know how by their own efforts they could improve their health.

Food, physical activity, singing, music, the arts, lifestyle habits and having a spiritual practice, were some of the Hippocratic practices that I explored as ways to restore ‘balance’ and hence a more healthy condition in the body.

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Honey – a Food for Life

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DIET (δίαιτα) in the ancient Greek language meant ‘way of life’ encompassing food, exercise, massage, baths and other aspects of everyday life activities.

It has been known since Ancient times that food, exercise and lifestyle in general, plus the external environment in which people live, have a definite influence on their health. 

 Hippocrates changed the diet of his patients to help them get better. He advocated a number of foods, but he believed that honey and wine are the two most important foods for health.

A story found in a famous ancient book, the ‘Deipnosophists’ (translated as the ‘Banquet of the Philosophers’) and written by Athenaus in the early 3rd century AD, gives us an idea of the nourishing power of honey.

According to it, Democritus of Abdera who was often called the ‘Laughing Philosopher’, was coming to the end of his life, at the great age of 104. His food intake had gradually reduced and he was expected to die. It was, however, the time of the important Thesmophorian festival and his centenarian sister who looked after him at his home, asked him not to die during the festivities so that she could take part in them. Wanting to grant her request, he asked for a pot of honey to be brought to him and was kept alive by inhaling the fumes of it, for three days. When the festival finished, the pot of honey was taken away and he passed away without any suffering. 

 

Professor Spyros Marketos (1931-2012): my inspiration

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Professor Spyros Marketos (1931-2012). Past President of the International Hippocratic Foundation of Kos (1991 to 2000)

‘Galen’ – first pointed me to Hippocrates‘Galen’, not the great physician philosopher of ancient times but a ‘modern’ version who, for me, was no less inspiring, was the pseudonym used in Kathimerini, a daily newspaper in Greece, by a Professor of the History of Medicine in Athens, Dr Spyros Marketos. Every Sunday, absorbed by his words, I found inspiration particularly about his accounts of the lives and work of great medical scientists that had shaped modern medicine; the pathologist, George Papanikolaou, DNA pioneers James Watson and Francis Crick.

In 1987, while still a medical student in Northern Greece, I wrote to ‘Galen’ asking to meet him. ‘Galen’, Professor Marketos, replied inviting me to visit him. Travelling overnight in the sleeper of a slow train from Thessaloniki to Athens, I arrived as the sun appeared on the horizon. I stayed in a small hotel near the Acropolis and walked to his office in Kolonaki, in Athens. This was to be the first of countless trips over the next few years. 

Professor Marketos had invited me to join his circle of young medical students studying the history and philosophy of medicine. And so my journey began. 

Studying the books in the Hippocratic Corpus, I discovered that Hippocrates and his followers knew how to use diet to restore health in people. Despite the fact that they did not have our anatomical, biochemical and physiological understanding, they used methods from an understanding of the needs of the human body. 

From ‘Galen’ and my own interest in Hippocrates, I went on to study for an MSc in Nutritional Medicine at the University of Surrey, the first university-level, evidence-based Masters degree course in this subject in the UK.

Recently, on a visit to Kos, continuing my research into the life of Hippocrates, my journey has, in a sense also brought me back to ‘Galen’.

I feel truly indebted to Professor Spyros Marketos who inspired me at the beginning of my medical career. 

 

Kos – the Island of Hippocrates, the Father of Medicine

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I just returned from a trip to Kos, the birthplace of Hippocrates, the father of Medicine.

This is an exceptional island which is blessed with the most extraordinary flora.

Some of the plants and trees are unique and rare.

Kos has a mild climate, rich soil and amazing sea and surroundings, which not only feed the people with nutritious food but also provide beautiful sights to nurture their soul. 

It is not perhaps by coincidence that Hippocrates developed his medical theories and practice on this place. 

Walking in the centre of the town of Kos, near the plane tree under which Hippocrates allegedly taught his students, I discovered and photographed many edible plants that also have great nutritional power and healing properties. A few of them are seen in the slide above.

 

The Therapeutic Power of Food – From Hippocrates to Modern Science

The Greek Society of Ethnopharmacology is organising a conference dedicated to ‘Hippocratic Medicine’, on Saturday the 28th of April, at the island of Kos, Greece

I will present some of my research findings on the Hippocratic approach to food and diet and how modern science can help us understand further its therapeutic value.

More details (in Greek) here:

http://bit.ly/Iw3m5r 

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Nutrition in Palliative Care – More than just ‘Tea and Sympathy’

Food, exercise, lifestyle and the external environment

We’ve known since Ancient times that food, exercise and lifestyle plus the external environment in which we live, have a definite influence on our health. This has now been verified beyond any doubt through epidemiological research and experiments. Good nutrition helps us to have a feeling of well-being, preserve and increase our strength and energy, maintain a healthy weight and retain adequate stores of useful nutrients, tolerate treatment related side effects, decrease the risk of infection and heal and recover quickly.

Nutrition in palliative care

In palliative care, good nutrition can enhance recovery, when healing is possible. Poor nutrition on the contrary results in poor resistance to infections, impaired wound healing, increased susceptibility to pressure ulcers and fatigue. Good, nutritious food can also contribute to the patient’s overall sense of wellbeing. A drop in essential amino acids or glucose can adversely affect the nervous system and behaviour. Last but not least, food has a major psychological and social significance.

Personalised nutritional advice

Each one of our patients is an individual and so they need to have personalised advice. If they live alone they will need practical advice on how to prepare nutritious food when, at the same time, they can experience overwhelming fatigue. Practical advice on where to get good ‘meals on wheels’ can be extremely important for them. Their individual preferences need to be taken into account: if they like eating meat and two vegetables, they may ignore dietary advice to eat, for example, fish. On the other hand, a serious illness often leads people to make radical changes to their lifestyle in an attempt to become stronger.

A patient’s story

When Phil who was only 45 found out he had metastatic lung cancer, he turned overnight from a successful consultant physician to a patient with a life-limiting condition. During an admission to hospital for a severe infection, he lost 2 stones of his body weight. He was started on chemotherapy, which resulted in severe nausea and vomiting. These symptoms were made worse by anxiety and fear, which also affected his appetite. More than a year later, he was strong and receiving treatment for disease recurrence to the mediastinal lymph nodes.

He talks openly in this video about the physical and emotional impact the disease had on his life. One of the most significant pieces of advice he said he received during the period that chemotherapy had changed his sense of taste and smell and wiped out his appetite was, to eat porridge with honey and bananas. For a while, this was what he had for breakfast, lunch and dinner.

Furthermore, exercise played a significant role in his rehabilitation. Armed with his scientific background and inquisitive mind, he sought additional ways to support himself, increase his chances of survival and improve his quality of life.

He believed that ‘good food’, regular exercise, meditation, Qigong, hypnotherapy, laughter and love, combined together will help him. And I had no reason to doubt that. I supported him through his decision to change his habits and to follow ‘an anti-cancer diet and lifestyle’.

Hippocrates and our responsibilities

We approach each person with an understanding that they are not just body, but also mind, emotions and soul; they bring their personal history, belief system, hopes and cultural background. As healthcare practitioners we seek to help the individual patient, showing compassion and care. 

To use Hippocrates’ words:

Life (ours and our patients’) is short, the Art of Healing is long, the Opportunity to help our patients is fleeting, Experiment is sometimes treacherous and Judgement can be difficult

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‘Health, the most precious gift: pearls of wisdom from Hippocrates’

When times are difficult and everything around us seems to be falling apart it is important to take special care of our health. Greece is currently in turmoil and people are facing tremendous difficulties, being exposed daily to negative news. This is the time to help each other and support our Greek friends in any way we can.

I am giving a talk in my hometown Kozani in Northern Greece, to a lay audience. I hope to convey a number of useful, practical ideas that can be found in the wise words of the father of Medicine Hippocrates. These can help each one of us improve our health in a simple, straightforward way.

Ὠφελέειν ή μη βλάπτειν – ‘To help, or at least, to do no harm’

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Ὠφελέειν ή μη βλάπτειν - ‘To help, or at least, to do no harm’ Hippocrates proclaimed 25 centuries ago. 

 This expression was passed on, like a batton, from Hippocrates to Galen, to Thomas Sydenham, to Florence Nightingale and across the oceans to the United States, Japan and other countries, while along the way was transformed to contemporary and trendy languages, becoming the famous injunction in Latin: “primum non nocere”.

Hippocrates, the originator of this quote, was not only an inspiring physician and teacher of the medical school of Kos that he founded. Neither was he just the most famous doctor of his time and the one who is still now considered by most physicians, historians and philosophers to be the Father of Medicine. He did something no-one else had done before: he systematically wrote down and passed on to future generations his research observations, teachings, theories, philosophy, ethics and regimes for health and illness. 

His teaching continues to be of great significance to us today and deserves to be studied by the modern physicians and other healthcare professionals.

‘Food and Exercise as Medicine’ – From Hippocrates to Modern Times

This was the title of my poster presented earlier this year at the biannual conference of the International Hippocratic Foundation of Kos, in Kos, Greece

In researching the Hippocratic writings, my aim was to add an objective argument to the authority of Hippocrates and collect and systematise evidence from the written body of Hippocratic tradition which was used by later doctors and scientists, including Galen and upon which much of modern medicine has been built.

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 it then be argued that they were practicing the equivalent of modern nutrigenomics?

More research may bring to light the scientific background behind the lifestyle modification  treatments used by the ancient doctors. 

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A Good Physician Is Half a Cook (and vice versa)

A Good Physician Is Half A Cook. This is a paraphrase from Andrew Boorde’s 1547 medical book ‘Breviary of Health’ in which he writes: “a good cook is halfe a physycyon”.

 2000 years earlier, Hippocrates wrote in The Art (of Medicine) that highly skilled physicians treat their patients, using not only drugs, but also the right diet and lifestyle, to assist the human body in the healing process: ‘The physicians of greatest repute obviously cure by regimen and other substances…’  

 

In my thesis for an MSc in Nutritional Medicine I wrote about ‘Food asMedicine: Exploring Nutritional Knowledge in the Hippocratic Corpus’. I examined a number of books in the Corpus, in which Hippocrates emphasises the importance of physicians’  knowledge of nutrition and dietetics.

In Ancient Medicine, he talks about the required fields of study for physicians. A good physician, he says, should have knowledge of the properties of each food, of their differences according to variety, conditions of growth and processing and of their uses for restoration of health and healing of the sick. He, however, should learn much more than a list of foods and their effect on the body. He must also have an understanding of the particular characteristics of individuals and, of the mechanisms by which each food affects different people:

 

Required Fields of Study for a Physician,  according to Hippocrates

·      Anatomy and Physiology of the Human Body

·      Properties of foods and drinks, in their natural form and after processing and cooking

·      Natural and artificial exercises

·      Laws of the Universe – Astronomy

 

As more and more evidence emerges on the importance of food and lifestyle for our health, many modern doctors choose to get more knowledge and education on Nutrition. At the same time, the best medical journals around the world, increasingly publish studies that research dietary influences on health and disease.

A shift in the focus of healthcare is apparent. Food is becoming again an essential therapeutic tool, a medicine!

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JEWELLED PORRIDGE – AN ANCIENT RECIPE MADE NEW

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Porridge is a traditional Scottish food. I took this nutritious dish and added a Mediterranean twist to it with some extra beneficial, fragrant and colourful ingredients.  

Saffron is a precious spice with numerous health benefits, including anti-tumour activity and anti-depressive effects, which are currently being researched. You can find good quality saffron in a Persian or Middle Eastern shop where it is often cheaper than the high-street supermarkets.

The ingredients in this recipe go back to Antiquity, although perhaps Hippocrates would have used barley instead of oats. If you choose the Hippocratic version, then soak the barley overnight and follow the steps below:

Ingredients:

1 cup rolled oats

2 cups milk (goat’s, soya or rice) or 1 cup milk and 1 water

3 green cardamom pods

1 cinnamon stick

1/3 tsp ground saffron (or a small pinch of saffron threads roughly cut with your fingers). Alternatively, make ‘saffron water’ the previous day by adding 1 cup boiling water to the saffron threads and leave overnight.

1 tbsp raisins

1 tbsp goji berries or other dried fruit

For the sprinkling on top:

1 tsp cinnamon powder

1 tbsp freshly ground mix of poppy, flax and sunflower seeds

1 tbsp pumpkin and sesame seeds

fresh berries or pomegranate seeds, when in season

1-2 tbsp good quality, cold-pressed honey (avoid heated honey as the process of heating destroys its healing nutrients)

Directions: 

Bring the milk and water (or saffron water) to a boil in a non-stick pan.

Add the oats, raisins and goji berries and mix well.

Add the cinnamon stick, cardamom pods and ground saffron.

Cook slowly on low heat.

Simmer until the mixture reaches a creamy consistency.

Spoon the porridge into individual serving bowls.

Sprinkle the ground seeds, cinnamon powder and berries.

Serve hot with milk and honey.

Enjoy the smell and the colours.

Taste it and appreciate the textures.

It will give you energy to start your day.

 

 

 

JUST HONEY

Hippocrates, who lived 2,500 years ago, helped people maintain or restore their health by changing their DIET (ΔΙΑΙΤΑ). The word diet in Ancient Greek means ‘way of life’ and encompasses food, physical activity, massage, baths, sleep and other aspects of everyday activities.

We’ve known since ancient times that food, exercise and lifestyle, as well as the external environment, influence our healthFor this and many other reasons, food has always been a subject of interest for lay people, writers and philosophers alike. In the famous ancient cookery book ‘Deipnosophists’ (which means the ‘Banquet of Philosophers’) written by Athenaus in the 3rd century AD, we read the interesting story of the death of Democritus of Abdera, the ‘Laughing Philosopher’.

Feeling quite old at the age of 104, he had decided that his time had come to die. He had gradually reduced his food intake and was expecting to leave this life soon. It was however the time of a very important womens only festival, the Thesmophoria, dedicated to the goddesses Demeter and Persephone. His sister, who looked after him at his home and, who was herself more than 100 years old, asked him not to die during the festivities because she wanted to take part in them. Democritus, wanting to grant her wish, asked for a pot of honey to be brought to him. He kept himself alive for three days just by inhaling the fumes from the honey. When the festival had finished, the pot of honey was taken away and he passed away without any suffering.

This story from Ancient Greece graphically depicts many elements of nutritional care which we encounter in our modern medical practice and which we categorise as physical, cultural, social, ethical and emotional.

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