The study of medical history has vanished from most U.S. medical schools. Is this a surprise? The number of discoveries in molecular biology has exploded. The field of biochemistry grows relentlessly. Newly defined diseases are described in detail. Medical technology demands greater knowledge in interpreting its findings. These expanding fields and others compete for time in the curriculum. Why keep what has no practical value today or for tomorrow?
A case for medical history in the curriculum cannot be made easily by arguing that it will give medical students a better grasp of modern medical science or of modern practice. Is there a case to be made for medical history at least in the self-education of students and physicians? In 1941, Alan Gregg suggested a way to look at this question ("Humanism and Science." Bulletin of the New York Academy of Medicine 1941;17:83-99). He commented that "the humanist is not interested in the past merely because it is past. As the statistician likes a long series, not a short one, the humanist similarly likes the long accumulations from the past to illustrate the nature of man.... `Plus ca change; plus ca reste."'
If we assume that Gregg, who was in the field of medicine himself, is speaking of physicians as humanists, he implies that there may be aspects of medical knowledge and practice that are much the same today as in the past, unless "the nature of man" has changed radically. He also seems to imply that we can learn from medical history whether what we believe today about the essence of the practice of medicine -- the qualities needed in a physician, the needs of patients, the relation of patient and physician, the finding of evidence, and the basic methods of practice -- can be confirmed by a long view of medicine's past. If any aspects of what was seen in the practice of medicine 2000 years ago are still seen today, then these aspects are enduring foundations of practice. Here lies the main value of Jouanna's Hippocrates for medical readers.
The title Hippocrates is far from describing what Jouanna covers. A subtitle such as "Hippocratic Medicine in Ancient Greece" could have made clearer the scope of his book. Hippocrates (460-c. 375 b.c.) is the subject of only the opening three chapters. Here Jouanna assesses the historical evidence relevant to identifying the physician and teacher named Hippocrates, whom we associate with the island of Cos and the Hippocratic oath. Next comes a chapter that considers who probably wrote which documents among those that, as a group, are titled the Hippocratic Collection.
Jouanna then moves into three chapters on the Hippocratic knowledge of medicine in the fifth, fourth, and third centuries b.c. and how it was applied in practice.
One might ask how so much can be known of physicians' knowledge and beliefs and of the day-to-day conduct of practice from such a distance in time. It is clear that much in Jouanna's descriptions is inference, but the inferences are indeed reasonable. They are based in part on the surviving Hippocratic literature itself but also on such sources as Aristophanes, Euripides, Plato, Socrates, and the later Galen. All of this documentation is cited, and full references are given in the Notes section that follows Appendix 3. In these chapters, the reader can compare the nature of medical knowledge and practice in ancient Greece with our knowledge and practice. This will be the most valuable part of Jouanna's book for medical readers who wish to see what in medicine has endured from the Hippocratic era to our times. They will see that despite radical changes in medical science, much in medical practice and ethics has remained constant.
From this focus on Hippocratic medicine, Jouanna goes on to consider the place of Hippocratic concepts in the wider sphere of contemporary Greek science and philosophy. Finally, he returns to the influence of Hippocratic medicine and its associated documents on medicine in the following centuries. This influence, in its scientific aspects, persisted for almost two millennia, into the 18th and early 19th centuries.
This English edition will be notably valuable as a guide for all Anglophone medical students and physicians who wish to read for themselves any of the documents in the Hippocratic Collection. As Appendix 3, "The Treatises of the Hippocratic Collection," makes clear, these documents cannot all be considered to have come from the hand of a historical person named Hippocrates. But that is irrelevant to the question of the value of reading them. This appendix describes their content, their probable authorship and date, and where they can be found in authoritative sources. One source not mentioned is that most likely to be found in U.S. medical-school libraries: the collection translated into English by Francis Adams, which was published in 1849 and has been reprinted at least twice since World War II. Mention of the Adams collection was omitted probably because it includes only 17 documents and because its introduction by Emerson Crosby Kelly does little more than discuss probable authorship.
The Notes section lists the English translations in the Loeb Classical Library set of eight volumes (published by Harvard University Press, Cambridge, Mass.). The many quotations from Hippocratic works in the English edition of Hippocrates were taken by the translator from the Loeb editions.
By now I hardly need to say that I unreservedly recommend Jouanna's highly readable, thoroughly documented survey of Hippocratic medicine in pre-Hellenistic Greece -- its origins, concepts, and influence. The influence of Hippocratic medicine on desiderata in practice and, especially, on medical ethics persists today, even though today's practitioners may be unaware that at least some of what they believe is Hippocratic. This survey should be read by all who would like to understand the foundations, laid more than two millennia ago, of today's medicine.
Reviewed by Edward Huth, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
--This text refers to an out of print or unavailable edition of this title.
Jouanna boldly cuts through controversy to present a lucid and highly readable narrative.
(E. M. Craik
Social History of Medicine 2002)
Jouanna's acquaintance with the text is probably unsurpassed.
(Anthony Preus
Religious Studies Review )
The book is refreshing in that Jouanna seems to feel almost on personal terms with Hippocrates, and it is a good introduction to the subject in terms of the number of issues he addresses and the breadth of citation from the primary sources.
(Lesley Dean-Jones
Journal of the History of Medicine and Allied Sciences )
A beautiful and rich study.
(
Le Monde )
If one is searching for a beginning book on Hippocrates and Greek medicine as a whole, Jacques Jouanna's work is a splendid introduction.
(
International Journal of the Classical Tradition )
