Hippocrates of Kos (/hɪˈpɒkrətiːz/; Ancient Greek: Ἱπποκράτης ὁ Κῷος, romanized: Hippokrátēs ho Kôios; c. 460 – c. 370 BC), was a Greek physician and philosopher of the classical period who is considered one of the most influential medical doctors of all time.
  • Lived during the Athenian Golden Age alongside prominent figures such as:
    • Sophocles (ca. 496–405 BC)
    • Euripides (ca. 480–406 BC)
    • Plato (ca. 427–348 BC)
    • Aristophanes (ca. 448–380 BC)
    • Thucydides (ca. 460–401 BC)
    • Democritus (ca. 460–370 BC)
  • Received comprehensive education in philosophy and rhetoric.
  • Medicine at his time was largely philosophical, aiming to intrigue rather than explain scientific phenomena.
  • Worked during an era dominated by mysticism and magic, where logic was not commonly applied.
  • Emphasized a holistic and humanitarian approach to medicine.
  • Understood the functions and purposes of vital organs including the heart, liver, and kidneys.
  • Demonstrated detailed anatomical knowledge, evident through his copper model of the human body dedicated to Apollo at the Oracle of Delphi.
  • Introduced experimentation into medical practice, advocating experience and observation as the foundations for medical knowledge.
  • Established core methods of patient examination still used today:
    • Inspection
    • Palpation
    • Auscultation
  • Proposed a treatment algorithm prioritizing:
    • Medication first
    • Surgery second
    • Cautery third
  • Believed patients untreatable by these methods were incurable.
  • Defined the ideal physician as modest, humanitarian, presentable, and pleasant.
  • Birth and Family Background:
    • Hippocrates was born in 460 BC on the Isle of Kos.
    • Hippocrates was the son of physician Heraclides and his wife Phenarete.
    • He came from a family of medical doctors, rulers, and noblemen (father and grandfather were physicians).
    • He was initially taught medicine by his father.
    • Practiced medicine extensively in Thessaly, Abdera, and Argos.
  • Life and Death:
    • Refused an invitation from Artaxerxes, the King of Persia, who sought to appoint him as his court physician.
    • Credited with successfully controlling the plague in Athens
    • A monument was erected in Athens in his honor for this significant contribution
    • According to the biography by Soranus of Ephesus (98–138 AD), Hippocrates lived to around 90 years old.
    • Died in Larissa during the 102nd Olympiad (375 BC).
  • Notable Patients:
    • Perdiccas II, regent of Macedonia (4th century BC).
    • Democritus (460–370 BC), the philosopher.
    • Patients from neighboring regions including Persians, Paeones, and Illyrians.
  • Legendary Ancestry:
    • Linked through his father to Asclepios (Greek god of healing).
    • Connected through his mother to Hercules (known as the strongest and bravest man, who incidentally had epilepsy).
  • Influence on Medical History:
    • Marked the beginning of scientific medicine.
    • Influenced many historical physicians from Galen (131–201 AD) onward.
    • Many fundamental Hippocratic principles remain integral to medicine today.
    • Reflects the concept: "the more things change, the more they remain the same."
  • Hippocratic Corpus:
    • Consists of 72 treatises originally stored in the library of Alexandria.
    • Only some manuscripts are directly attributed to Hippocrates:
      • On Ancient Medicine
      • On Air, Waters and Places
      • On Fractures
      • Nutriments
      • On the Nature of the Child
      • Epidemics 1 and 3
      • Prognostics
      • On Injuries of the Head
      • On the Articulations
      • Aphorisms
      • On the Sacred Disease
      • On Humors
  • The Hippocratic Oath:
    • Believed to have been written by Asclepian priests sometime after Hippocrates' death.
  • Medical Philosophy:
    • Hippocrates emphasized the four fundamental elements of the universe: earth, fire, water, and air.
    • He correlated these elements to four bodily humors: blood, phlegm, yellow bile, and black bile.
  • Anatomical Knowledge:
    • Hippocrates had extensive knowledge of internal organs, nerves, muscles, arteries, and veins.
    • Likely acquired through autopsies, despite being inconceivable and punishable by death at the time.
  • Neurological Diseases Recognized:
    • Apoplexy
    • Spondylitis
    • Hemiplegia and paraplegia
    • Obstetric and traumatic brachial plexus palsy
    • Lethargic encephalitis
    • Epilepsy
    • Psychiatric conditions: melancholia, mania, hysteria
  • Contributions to Neurology:
    • Authored the influential neurological treatise "On the Sacred Disease", focusing on epilepsy.
    • Identified the brain as the analyst of external stimuli, interpreter of consciousness, and the center of intelligence and willpower.
  • Anatomical Observations:
    • Described the brain as composed of two hemispheres separated by a membrane, similar to animals.
    • Observed that the brain contained fluid when dissected.
    • Differentiated between meninges layers: dura mater and pia mater, indicating detailed anatomical study.
  • Insights on Neurological Functions:
    • Defined the brain as a "phlegmatic organ" and origin of certain diseases.
    • Recognized contralateral neurological effects (injury on the right side of the head resulting in paralysis or spasms on the left side), deducing nerve crossover (documented in "On the Injuries of the Head").
    • Attributed control over the soul to the left ventricle of the heart, reflecting contemporary beliefs.
    • Identified the relationship between nerves and muscles, recognizing the peripheral nervous system and the mechanism of muscular contraction during movement.
  • Epilepsy—"The Sacred Disease":
    • Hippocrates speculated epilepsy was termed "sacred" to conceal the inability of physician-sorcerers or charlatans to cure it.
    • Boldly asserted that epilepsy was neither sacred nor divine, but rather hereditary and stemming from brain dysfunction.
  • Identified Precipitating Factors for Epilepsy:
    • Changes in wind and temperature
    • Exposure of the head to the sun
    • Emotional triggers such as crying and fear
  • Clinical Observations on Epilepsy:
    • Recognized epilepsy could occur at any age.
    • Described certain epileptic auras, including apneic crises and aphonia.
    • Documented focal epilepsy, noting temporal lobe lesions causing contralateral convulsions.
  • Hypothesized Causes of Epileptic Seizures:
    • Brain trauma
    • Impaired cerebral circulation leading to excessive production of "yellow bile" (phlegm)
  • Theory of Brain Changes in Epilepsy:
    • Believed epileptic seizures caused liquefaction of the brain tissue.
  • Knowledge of Blood Vessels:
    • Did not differentiate between arteries and veins.
    • Recognized that compression of blood vessels caused tingling sensations and changes in skin color (pallor or lividity) in the extremities.
  • Understanding of Circulation:
    • Described blood vessels originating from the heart, continuously transporting blood throughout the body.
    • Believed circulation heated the body through numerous peripheral channels.
  • Observations on Cardiac Conditions:
    • Described cases of sudden cardiac death.
  • Insights on Stroke and Related Conditions:
    • Coined the term "apoplexy", meaning "to strike down," to describe stroke.
    • Provided accurate descriptions of strokes and transient ischemic attacks (TIAs), noting symptoms like preceding paresthesia or anesthesia of limbs.
    • Recognized stroke could manifest as hemiplegia (paralysis of one side) or paraplegia (paralysis of both legs).
    • Acknowledged that lesions of the carotid artery caused contralateral hemiplegia.
  • Headache and Migraine:
    • Hippocrates recognized and described migraine headaches.
    • Proposed that migraines were caused by vapors rising from the liver to the head.
    • Although seemingly unusual, this indicates his understanding of migraines as a result of a cascade of events preceding the headache onset.
  • Meningitis:
    • Identified three forms of meningitis:
      • Epidemic meningitis
      • Meningitis resulting from middle ear infections (mastoiditis)
      • Meningitis resulting from cranial fractures
    • Recognized key symptoms:
      • Severe headache
      • Dysphagia (difficulty swallowing)
      • High fever
      • Head retraction
    • Observed that progression to a febrile comatose state indicated severe encephalitis.
    • Noted recovery was unlikely unless pus and other secretions drained externally through the nose or ears.
  • Trepanation (Trephination):
    • It remains unclear if Hippocrates himself performed trepanation.
    • Some researchers argue that the treatise On Wounds of the Head was authored by a skilled surgeon who was new to trepanation, rather than Hippocrates himself.
  • Treatment of Head Injuries:
    • Hippocrates unquestionably treated skull fractures, including those associated with subdural hematomas.
    • Recommended trepanation 1–3 days following the injury for severe cases.
    • Provided detailed descriptions of coup and contrecoup brain lesions.
    • For severe trauma exposing meninges and brain tissue, he advocated placing lint over the injury site for protection.
  • Diagnostic Approach:
    • Emphasized the importance of thoroughly inspecting the patient and taking a detailed medical history before initiating any brain injury treatment.
  • Anatomical and Pathological Exploration:
    • Hippocrates was the first physician to deeply study the anatomy and pathology of the human spine (as described in On Fractures and On Articulations).
    • Believed thorough spinal knowledge was essential for curing many diseases.
    • Identified the spine's principal function as maintaining an erect posture.
  • Division and Description of Vertebral Segments:
    • Described three main vertebral segments:
      • Above the clavicles
      • Thoracic section (12 vertebrae)
      • Keneon section (5 vertebrae between chest and pelvis), meaning "empty," containing only vertebrae.
    • Included sacrum and coccyx in his description, noting that the sacrum protects reproductive organs, rectum, and bladder.
  • Adjacent Structures and Connections:
    • Labeled adjacent tendons and ligaments as "nerves."
    • Believed a connection existed between the spine, kidneys, and male genitalia, facilitated by veins.
  • Recognition of Spinal Curvatures:
    • Identified kyphosis (spinal curvature), suggesting it resulted from aging or a reaction to pain.
    • Accurately recognized tuberculosis as a cause of spinal kyphosis, differentiating between tuberculosis occurring above and below the diaphragm (On the Articulations).
    • This description preceded Percival Pott’s (1714–1788) identification of spinal tuberculosis (Pott's disease) by approximately 2,300 years.
  • Descriptions of Spinal Injuries and Conditions:
    • Documented acute spinal shock after vertical trauma, noting symptoms:
      • Paralysis of arms and legs
      • Loss of bodily sensation
      • Urinary retention
    • Described various spinal pathologies including:
      • Concussion of the spine
      • Scoliosis
      • Vertebral dislocations
      • Spinous process fractures
      • Post-traumatic kyphosis
      • Tuberculous spondylitis
  • Innovations in Treatment:
    • Invented the ladder and board methods for managing spinal dislocations.
    • Due to these contributions, Hippocrates is recognized as the father of spinal surgery.
  • Poliomyelitis:
    • Provided one of the earliest known descriptions of epidemic paralysis of the legs, recognized today as poliomyelitis 
  • Hydrocephalus:
    • Described hydrocephalus as an accumulation of fluid beneath the skull and around the brain.
    • Identified principal symptoms:
      • Headache
      • Vomiting
      • Visual impairment
      • Diplopia (double vision)
  • Dementia:
    • Early references to senile dementia date back to Hippocrates' era, concurrent with the time of Pythagoras (c. 570–495 BC).
  • Intentional Tremor and Possible Early Reference to Multiple Sclerosis:
    • Descriptions of intentional tremors in patients may suggest an early recognition of symptoms consistent with multiple sclerosis.
    • Given his extensive observations on anatomical relationships, neurological symptoms, and disorders, Hippocrates is rightly recognized as the forefather of neurology.
"For, on this account, the brain first perceives, because, I say, all the most acute, most powerful, and most deadly diseases, and those which are most difficult to be understood by the inexperienced, fall upon the brain" - Hippocrates.

References

Breitenfeld, T., Jurasic, M. J., & Breitenfeld, D. (2014). Hippocrates: The Forefather of Neurology. Neurological Sciences, 35(9), 1349–1352.

Cover Image: Hippocrates Visiting Democritus (1636) Nicolaes Moeyaert (Dutch, 1592–1655)