The Hippocratic Paradigm in Medicine: Origins of the Clinical Encounter
A study of Medicine in the Classical Age (fifth century B.C.) indicates that the linguistic requirement in the development of a discipline of inquiry was not merely theoretical but a practical necessity. Essential to the advancement of science, including medicine, in the Greek world was that rival schools of physicians made conflicting claims regarding diseases, treatments, and the nature of medicine itself, supporting these claims using rhetorical schemes in oral or written form.1–3 This unprecedented assembling of rational and systematic debates was marked by a transition from orality to the development of prose writing and set the stage for transforming medicine from traditional practice to a scientific discourse.4,5 Particular examples of disease led to general questions about sickness and health; questions seeking answers.2,4 These linguistic requirements bred the new language for the science (episteme) of medicine.
The Hippocratic Canon depicts the background underlying the systematic debate over medicine.6,7 It is the oldest collection of scientific and philosophical literature and thus provides a detailed view of Greek thought in its early stages. In the Canon, doctrines from different medical schools compete and occasionally conflict with each other, revealing an inconsistency of substance and style,6 acting to strengthen rather than weaken the value of the collection. Although the historical Hippocrates was not solely responsible for this upheaval, several of the texts acknowledged as genuine8,9 show that Hippocrates provided the momentum for this gradual paradigm shift10 from theoretical and religious accounts of philosophy and superstition to the evidence-based model of modern medicine.7,11,12
In this issue of Anesthesia & Analgesia, Astyrakaki et al.13 provide a wealth of information about the Classical Age origin, etymology, and use of concepts defining theory and practice in our specialty. Among others, notions and terms such as anesthesia (αναισθησια) and pain (πονοσ—ponos) are frequently encountered in the Hippocratic Canon and, either directly or through intimation, influence their modern usage by present day clinicians and scientists.
Hippocrates used the term anesthesia to denote loss of sensation as a result of disease or injury.13 In Breaths, the author* also associates seizure-induced loss of consciousness with insensibility to painful stimuli.14 Pedanius Dioscorides, a Greek physician living in Rome during the first century A.D., is recorded as the first person who, in his De Materia Medica,15 makes explicit reference to the administration of mandrake-induced anesthesia to facilitate a surgical intervention. Oliver Wendell Holmes, a Professor of Anatomy and Physiology at Dartmouth College, is credited with “coining” anesthesia in a letter to William Morton on November 21, 1846.16 In this letter, Holmes states: “The state should, I think, be called ‘anesthesia.’ This signifies insensibility, more particularly (as used by Linnaeus and Cullen) to objects of touch.”16,17 It is acknowledged that William Cullen (1710–1790), a Scottish physician and chemist, explains anesthesia in his Nosology18 as the “impaired or lost sense of touch,” whereas the stance of Carl Linnaeus (1707–1778), a Swedish naturalist, physician, and father of modern taxonomy, is less clear and comes only from indirect sources.19 Both Cullen and Linnaeus, as well as Francois de Sauvages (1706–1767) in France,20 supported definitions for the concept of anesthesia that were similar to the Hippocratic view (i.e., they regarded anesthesia as a result of disease or an injury) and definitely more limited than the direct account given by Dioscorides.