Hippocrates and humours: medicine in ancient Greece

Modern medicine was born in ancient Greece as physicians like Hippocrates began to seek a more scientific approach. Writing for BBC History Revealed, Emma Slattery Williams gives her diagnosis on the developments and some of the Greeks' more unusual beliefs

An image of Hippocrates from the 14th century, sitting and holding a book open in front of him

Early medicine in ancient Greece borrowed numerous ideas from ancient Egypt, with many people seeking supernatural explanations for their ailments, such as curses and the judgment of the gods. If someone became unwell, they would typically end up in an asclepeion – a temple dedicated to the god of medicine, Asclepius. The patient would sleep there and hope to be visited by Asclepius overnight, who would tell them their cure.

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Upon waking the next day, the patient would report their dreams to priests, who would prescribe them a treatment – usually based on prayer, exercise, bathing and herbal remedies. If they were cured, the grateful worshippers would leave behind a model of their affected body part in the temple as an offering of thanks. However, a desire to seek more pragmatic explanations for people’s ailments grew as time went on.

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One of the most notable physicians to advocate science and reason was Hippocrates (c460–c375 BC), who helped further the theory of the four humours, and was one of the first doctors to accurately describe conditions such as epilepsy. Whereas some people believed that the disorder was a result of demonic possession, the Kos-born physician instead determined that the cause lay inside the human brain.

Thanks to the work of Hippocrates and his adherents down the generations, distinctions now also began to be made between acute (short and sudden) and chronic (long-lasting) diseases, while emphasising the importance of observation.

Physicians would also regularly take checks of their patient’s progressing symptoms, as well as their pulse, temperature and excretions. In addition, the Hippocratic school pioneered important new techniques: a collection of writings attributed to the physician’s followers (known as the Hippocratic Corpus) features the earliest known reference to an endoscopy using a rectal speculum.

What was the theory of the four humours?

Humourism was a prevalent concept in ancient Greece. Though the theory is believed to have originated much earlier, Hippocrates is often credited with refining and popularising it.

The core belief was that the human body was made up of four fluids – blood, yellow bile, black bile and phlegm – and that these corresponded with the four elements of earth, fire, wind and water. If any of these became imbalanced, you could become ill.

The humours were also believed to be connected with temperature and weather. Blood was associated with moisture and warmth; if you suffered from redness, perspiration and swelling, you were said to have too much blood in your body.

To solve the problem, doctors would practise bloodletting, achieved by cutting the skin or by using leeches. Fainting was usually seen as a sign that the treatment was working, but death could occur if too much blood was drained.

The four humours theory did not die out with the ancient Greeks. In fact, humourism would remain part of western medicine until as late as the 19th century, when germ theory (the idea that pathogens cause disease) and other medical discoveries took hold.

As medicine was still a developing field, physicians were often viewed with suspicion. Hippocrates, however, developed a code of ethics that helped turn medicine into a respected profession, and ensured that physicians came to be seen as important members of society.

The so-called ‘Hippocratic Oath’ laid out basic ground rules for a doctor’s bedside manner, as well as text on the importance of honesty, compassion, confidentiality, cleanliness, and careful noting of a patient’s symptoms (which could then be used by other physicians).

Taking the oath

Indeed, more than 2,300 years after Hippocrates’ death, much of the oath still resonates today:

I swear by Apollo the physician, and Asclepius, and Hygieia and Panacea and all the gods and goddesses as my witnesses, that, according to my ability and judgment, I will keep this Oath and this contract… I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them… Into whatever homes I go, I will enter them for the benefit of the sick, avoiding any voluntary act of impropriety or corruption, including the seduction of women or men, whether they are free men or slaves.

Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private. So long as I maintain this Oath faithfully and without corruption, may it be granted to me to partake of life fully and the practice of my art, gaining the respect of all men for all time.

However, should I transgress this Oath and violate it, may the opposite be my fate.

A fifth-century BC marble relief showing a Greek physician treating a woman
This fifth-century BC marble relief shows a Greek physician treating a woman (Photo By DEA / G. DAGLI ORTI/De Agostini via Getty Images)

While Hippocrates is perhaps the most famous of the ancient Greek physicians, he certainly wasn’t the only doctor to have had an important impact on medical thinking.

Herophilus (c330–c280 BC), for instance, is believed to have been one of the first to perform human dissections during a time when a ban on the practice (for religious reasons) was temporarily lifted in Alexandria. Through his careful studies of the body, Herophilus deduced that veins only carried blood (it was previously thought they also carried a mixture of water and air), and devised a method for measuring the pulse.

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A fertile imagination

Despite their pioneering ideas, the ancient Greeks still had some unusual beliefs when it came to conditions like pregnancy, including the notion that a baby’s gender could be determined through the complexion of the mother – the appearance of freckles was thought to be a sign that she was carrying a girl, while a clear complexion indicated that a boy was due instead.

If a couple wanted to increase the likelihood of having a boy, the man could tie up his left testicle before intercourse; according to contemporary thinking, the right testicle was believed to be ‘superior’ and would therefore conceive a stronger (and more desirable) male heir.

Another medical technique that the ancient Greeks utilised was trepanation – drilling a hole into the skull. While earlier civilisations may have adopted the procedure to allow evil spirits to escape, it’s possible that Greek physicians had other ideas as to the benefits of the procedure. According to some historians, trepanation may have been used as a way of treating head fractures, on the basis that recovery was more likely if pieces of dead bone could be removed before infection set in.

Regardless of how strange some of their methods may seem today, however, the work of ancient Greek physicians had an undeniable impact on the western world. The teachings of ancient Greece were adopted by ancient Rome, and – as the Roman empire expanded – those ideas spread further afield. Together, they would influence medicine for many centuries to come.

An ancient Greek vase depicts animal sacrifice of a cow by two women
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This article first appeared in BBC History Revealed’s essential guide to ancient Greece