The application of Hippocratic principles to pediatric radiology

Hippocrates of Kos, universally acknowledged as the “father of western medicine,” and his writings have largely become the province of scholars of classical Greece and the history of medicine. The millennia-old Hippocratic Oath is often replaced in medical schools by more contemporary substitutes or done away with. One can reasonably ask if Hippocrates has any relevance to medicine in the age of molecular imaging, gene-based therapy and other remarkable advances in the modern medical world. That a widely known and admired physician named Hippocrates lived in the 5 Century, B.C., is assured by mention of him in the writings of Plato (Protagoras 311B, Phaedrus 270 C-E) [1] and Aristotle (Politics 1326a) [2], among others. He was a member of the family of Asklepiades [3] and, as legend has it, was in the 16 lineal generation of descent from the classical physician-god, Asklepius. He was taught medicine by his father and grandfather in the classical tradition of medical apprenticeship and he became the leadingmedical educator of his day, legendarily teaching dozens of students in the shade of a great plane tree on Kos until he moved to mainland Greece in middle age. Hippocrates’ great contribution to medicine, however, was bringing the field out of the supernatural world into the natural one. He taught that disease was not caused by the gods but by natural phenomena nor was its treatment to be found in prayer and sacrifice. Because his diagnostic armamentarium was necessarily limited to his five senses, hewasmuchmore interested in the course and treatment of disease than in its specific causes. He did subscribe to the widely accepted classical theory that disease was primarily due to an imbalance in the four humors (blood, phlegm, yellow bile, black bile) and in their relationships to the four elements (earth, air, water, fire) that made up the natural world and also to naturally occurring celestial phenomena. The substantial body of medical writings that has survived to the present time, known as the Hippocratic Corpus, comprises an unknown but probably small number of the genuine works of Hippocrates and numerous contributions by several generations of his disciples. Even the famed Hippocratic Oath is thought to have been composed no less than a century after Hippocrates himself flourished. More to the point, however, is what possible relevance Hippocrates and the Hippocratic Corpus have to the practice of 21-Century pediatric radiology. As noted above, Hippocrates showed little interest in diagnostics as we understand the concept but concentrated on course, therapy and prognosis. The theory and practice of Hippocratic medicine can be found today only in the ministrations of some practitioners of holistic and alternative medicine. The corpus, however, contains the thoughts of the Hippocratic school on what we might call the philosophy and ethics of medicine and, indeed, pediatric radiology. Throughout the writings, Hippocrates showed great respect for the individual patient whose welfare was the means and end of Hippocratic practice. Perhaps of most importance is that Hippocrates established the earliest extant code of medical ethics. Ethical teachings are found in several Hippocratic treatises, notably Epidemics I and the Hippocratic Oath. Within the corpus is the repeated admonition to do no harm to the patient. The ethical issues frequently dealt with fees charged by the physician, but issues of equality and patient privacy played a prominent role. Of particular note is that there is a responsibility to “treat slaves as one would the master,” i.e. that all should be treated equally regardless of ability to pay. This latter concept may have been practiced more in the breach than in the observance in that it is likely that citizen-physicians treated citizens and slave-physicians treated slaves [4]. This paper was presented at the 49th Annual Meeting of the European Society of Pediatric Radiology, Athens, Greece, June 1, 2012.