Hipocrates' theories are considered some of the earliest approaches to what, almost 20 centuries later, becomes a new science: psychology (Sánchez, 2020). This is one of the youngest sciences, yet it has been developed for centuries, or even millennia (Triglia, n.d.). In fact, some of the big questions it seeks to answer began generating theories over two thousand years ago. An example of this is the theory of the four humors, which is related to the different types of personality that can be found in humans (Triglia, n.d.). According to Sánchez (2020), the history of Hipocrates and the theory of the essential humors dates back almost four centuries before the present time.
Biography
Hippocrates of Cos was born on the Island of Cos, located in Greece, in the year 460 BC (Figueroba, n.d.). He was a highly respected physician and teacher during his lifetime (Smith, 2018). His father, Heracleides, and paternal grandfather, Hippocrates I, were also physicians, and it is said that he taught the profession to his two sons and son-in-law (Figueroba, n.d.). According to Sanchez (2020), he is known as the father of medicine for being the first person in the West to systematize existing knowledge about health and disease.
Hippocrates was also the first to describe the symptoms of many diseases and medical conditions, as well as to systematize criteria for their diagnosis (Figueroba, n.d.). Additionally, he created relevant medical terms, such as convalescence and paroxysm, and medical categorizations, such as the distinction between chronic and acute diseases. However, Figueroba (n.d.) indicates that some of his approaches have been refuted by the scientific method, especially regarding the causes of disorders.
Hippocrates traveled to different cities to treat the sick from an early age (Cajal, 2019). It is said that during these travels he learned from other famous physicians of the time and further developed his skills in the field of medicine. During these travels, Hippocrates also began to build a reputation as a physician, which eventually made him known in the field. After these travels, he returned to the island of Cos and founded his first medical school. Later, according to Cajal (2019), he traveled to Larissa in Thessaly, where he established a second medical faculty.
The death of Hippocrates is estimated around 377 BC in Larissa, although his work in the field of medicine led him to travel extensively to other cities such as Thrace and Thessaly (Cajal, 2019). Cajal (2019) and Figueroa (n.d.) mention that, although historical sources vary, it is believed that he was between 90 and over 100 years old at the time of his death.
The Theory of Essential Humors
The Theory of Essential Humors In ancient Greece, during the 5th century BC, theories began to emerge about human behavior and why we do what we do (Triglia, n.d.). In fact, according to Triglia (n.d.), this region was special because knowledge was more freely disseminated than in other places, such as the Persian Empire, where lessons were mainly used for trade and administration. This explains why in just three centuries, ancient Greece became the benchmark for the development of philosophy and science (Triglia, n.d.). However, Greek science, like in other parts of the world, was mixed with ancient religions and myths. According to Triglia (n.d.), this was how the theory of the four humors emerged.
The Hippocratic theory, or the theory of essential humors of Hippocrates, was adopted and applied by most physicians until the mid-19th century (Sánchez, 2020). In fact, certain assumptions of the theory are still cited today. This theory states that the human body consists of four basic substances, called humors (Sánchez, 2020). Each person has the four humors, but in different proportions, and one is always more relevant than the others (Cajal, 2019). To maintain health, these humors must maintain a perfect balance, as loss of balance can lead to diseases in both the body and the mind (Sánchez, 2020). Therefore, the way to face illness was to find a way to restore the lost balance.
Later authors in Western Europe, who adopted and adapted classical medical philosophy, believed that each of these humors would increase or decrease depending on the individual's diet and level of activity (Amezcua, 2016). Therefore, many treatments consisted of changing the patient's diet to balance the levels of humors by ingesting specific foods (Triglia, n.d.). In some cases, according to Triglia (n.d.), bloodletting was performed so that the patient would lose fluid and thus balance the humors.
The theory of the four essential humors asserts that the substances that make up the human body are black bile, yellow bile, blood, and phlegm (Sánchez, 2020). Each of these humors is related to an element of the universe and an atmospheric quality. According to Sánchez (2020), black bile is related to earth and has properties of dryness and coldness; yellow bile is related to fire and has properties of dryness and warmth; blood is related to air and has qualities of moisture and warmth; and finally, phlegm is related to water and has qualities of moisture and coldness.
Thus, the theory of the four humors was not isolated from the way reality was understood in ancient Greece but was linked to the belief about the origin of the planet and the cosmos in general (Triglia, n.d.). The ancient Greeks believed that everything in reality was a combination of four different elements, and from there, the theory of the four humors emerged. These four elements manifested in the four humors that, according to Hippocrates, flowed through the human body (Triglia, n.d.). Javier (2014) mentions that it was believed that the four humors followed a cycle according to the seasons and constellations, which reflected the strong influence of astrology on the theory of humors.
Humors and Personality
Hippocrates and his followers did not consider illness as exclusively physical, but maintained the idea that the mind and body were a single reality (Sanchez, 2020). Therefore, in correspondence with Sanchez (2020), what happened in the psyche had an impact on the body, and vice versa.
On the other hand, the Peripatetic school added a new element to the theory of essential humors (Sanchez, 2020). They speculated that the dominance of one of the humors produced a specific temperament in people (Sanchez, 2020). Although this idea is related to personality studies in psychology, Hippocrates' focus was on the relationship between humors and diseases that affect the body (Cajal, 2019). According to Cajal (2019), each humor had a physical representation in the human body that triggered a certain type of personality.
Hippocratic Oath
From a historical perspective, although it is attributed to Hippocrates, there is no conclusive evidence that he was the author of the Hippocratic Oath (Iglesias, 2007). However, it is one of the most famous medical texts that exists (Figueroba, n.d.). This oath establishes the fundamental principles of medical ethics and guides healthcare professionals in their performance (Figueroba, n.d.). According to Cajal (2019), this document describes the characteristics that a physician should possess, emphasizing the importance of humility and simplicity with patients, equity in service, and discretion in the lives of patients.
The Hippocratic Oath was greatly influenced by the work of Pythagoras, especially his contributions to philosophy (Figueroba, n.d.). For this reason, emphasis is placed on solidarity, privacy, justice, and respect for authorities. Figueroba (n.d.) mentions that, according to the magical-religious beliefs and practices of the time, the Hippocratic Oath invites new physicians to swear before various healing gods to meet ethical standards.
The Hippocratic Oath connects students and physicians with the community, making them almost members of families (Figueroba, n.d.). Therefore, this oath is considered one of the most important precursors to medical professionalization. Its relevance was such that it was rewritten and adapted to the values and requirements of each era. Today, according to Figueroba (n.d.), the Hippocratic Oath is still used as a public oath taken at the end of medical school, although it is not mandatory.
Transforms Medicine into a Discipline
Towards the 5th century BC, medicine was not considered a worthy discipline of study as it was associated with superstition, legend, and magic (Cajal, 2019). However, Hippocrates drastically changed the landscape of medicine by approaching it in a more rational way, moving away from legends and starting to investigate the causes of diseases. Hippocrates explained that the diseases that humans suffered from depended more on the environment, habits, and diet. Additionally, according to Cajal (2019), he implemented techniques and methods to treat some diseases, including diagnosis and preventive measures, which initiated the art of medicine and spread to various parts of the world.
The set of approaches and descriptions of Hippocratic medicine is currently known as the Hippocratic Corpus, which is a compilation of the most important findings for medicine in the 4th and 5th centuries (Boylan, n.d.). Figueroba (n.d.) mentions that although it is believed that most of the writings in the Hippocratic Corpus are the work of several different writers, this is why sometimes we refer to Hippocratic treatises, Hippocratic works, or the Hippocratic Corpus, and not just Hippocrates.
Anatomy
Among the various writings saved from this period, some drawings of human anatomy were discovered (Cajal, 2019). At that time, doctors treating war wounds had experience in anatomy (Gill, 2019). Similarly, according to Gill (2019), during the Hellenistic period, there was a great cultural exchange with the Egyptians, who had embalming techniques that involved the removal of organs. However, knowledge of human anatomy was largely based on analogies with animals, inferences of externally visible structures, natural philosophy, and function (Gill, 2019). Despite the limited information available about human anatomy at that time, in correspondence with Cajal (2019), these writings contained the first impressions about this field.
Surgery
Another great contribution to modern medicine was the possibility of surgery (Cajal, 2019). Hippocrates was one of the first recorded surgeons a long time ago. Despite the technological limits of the time, they used methods that were completely suitable for their time (Cajal, 2019). The Hippocratics not only studied and practiced medicine, but also established the medical and surgical standards of their time (Toledo, 2014). Toledo (2014) explains that the Hippocratics defined surgery as the specialty that required the participation of a physician who sutured wounds, controlled bleeding sites, and detected and treated fractures, dislocations, and empyemas of the thoracic cavity.
In summary, in correspondence with Cajal (2019) and Toledo (2014), surgery is an important contribution to modern medicine and the Hippocratics were pioneers in establishing surgical standards of their time, which included the care of wounds, bleeding, fractures, and empyemas of the thoracic cavity.
Preventive Medicine
This was an important part of the writings of Hippocrates (Cajal, 2019). Hippocrates developed a methodology for the diagnosis of diseases through the observation and description of symptoms and possible complications. He also considered the patient's diet and lifestyle, as he believed they were relevant aspects for the prognosis of diseases. Similarly, according to Cajal (2019), he believed that a person's habits and environment influenced their diseases.
Hippocrates’ Ideas in Today’s World
The theory of humors was the first attempt to classify different types of temperaments (Sánchez, 2020). Hipocrates, Galen and their followers developed this theory through observation, although they did not rely on any scientific method. With the emergence of formal sciences, the theory was forgotten, although it is considered a historical reference point (Sánchez, 2020). Currently, when doctors prescribe an antibiotic, they are trying to restore balance to the patient's body.
In the modern world, there are many professional codes of conduct, such as the American Medical Association Code, the American Bar Association Code, among others (Boylan, n.d.). However, the Hippocratic Oath established the standard of what a professional code is (Boylan, n.d.). After discovering the atrocities committed in the name of medicine during World War II and the growing interest in bioethics in the following decades, taking the oath began to play an increasingly important role in graduation rates.
The Hippocratic Oath balances very specific prohibitions, such as not administering poison or having sexual relations with patients, with more general principles, such as caring for the patient's well-being (Boylan, n.d.). Therefore, many current oaths include vows not to change medical practice on grounds of race, nationality, religion, gender, socioeconomic status or sexual orientation (Iglesias, 2007). They also guarantee accountability and patient protection, autonomy and informed consent, and assistance with decision-making. According to Iglesias (2007), all these changes are helping to make this oath a process of constant change to adapt to changing views of medicine and society.
References
Amezcua, M. (2016). Teoría Hipocrática de los Humores. Fundacionindex.com. Recuperado 8 April 2021, a partir de https://www.fundacionindex.com/gomeres/?p=1990
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Cajal, A. (2019). Hipócrates: Biografía, Obras y Aportes. Lifeder. Recuperado 8 April 2021, a partir de https://www.lifeder.com/aportaciones-de-hipocrates/
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Gill, N. (2019). The Seasons and Elements of the Four Bodily Humors. ThoughtCo. Recuperado 12 April 2021, a partir de https://www.thoughtco.com/four-humors-112072
Iglesias, J. (2007). El Juramento de Hipócrates ¿Aún vive?. Medigraphic.com. Recuperado 12 April 2021, a partir de https://www.medigraphic.com/pdfs/meduni/mu-2007/mu074l.pdf
Javier, H. (2014). The Four Humours Theory. Core.ac.uk. Recuperado 12 April 2021, a partir de https://core.ac.uk/download/pdf/33196432.pdf
Sánchez, E. (2020). Hipócrates y la teoría de los humores esenciales en el ser humano. La Mente es Maravillosa. Recuperado 8 April 2021, a partir de https://lamenteesmaravillosa.com/hipocrates-y-la-teoria-de-los-humores-esenciales-en-el-ser-humano/
Smith, W. (2018). Hippocrates | Biography, Works, & Facts. Encyclopedia Britannica. Recuperado 12 April 2021, a partir de https://www.britannica.com/biography/Hippocrates
Toledo, L. (2014). Cirujanos en su siglo. De Hipócrates y su Escuela. Elsevier.es. Recuperado 12 April 2021, a partir de https://www.elsevier.es/es-revista-revista-medica-del-hospital-general-325-articulo-cirujanos-su-siglo-de-hipocrates-X0185106314927295
Triglia, A. La teoría de los cuatro humores, de Hipócrates. Psicologiaymente.com. Recuperado 8 April 2021, a partir de https://psicologiaymente.com/personalidad/teoria-cuatro-humores-hipocrates
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