Descriptions of treatment in the hippocratic collection with special reference to surgery, particularly for urinary stones

Abstract

(Purpose) I analyzed mentions of treatment in the Hippocratic Collection. (Materials and Methods) I examined quantitatively mentions of treatments in the Hippocratic Collection (Roeb edition, Otsuki edition, and Kon edition) to compare preferences for therapy between the Kos and Knidos schools. (Results) Treatments, mentioned in 2,687 passages, were medical in 2,319 (86%), and surgical in 368 (14%). These 2,687 descriptions included 1,023 (38%) from the Kos, 1,261 (47%) from the Knidos school, and 403 (15%) from unspecified schools. Of the 2,319 descriptions of medical treatment, 560 (24%) referred to medicines and 466 (20%) to diet, followed by baths, vapor baths, exercise, running, walking, warm applications, and others. The 368 surgical descriptions involved traction and adjustment for treating fractures of bones or dislocation of joints in 166 (45%) and surgery using knife or fire in 202 (55%). Of the latter 202 mentions, 87 (43%) referred to incision with knife, 74 (37%) to cauterization and 73 (37%) to bloodletting. Diet, exercises, running, walks, traction, adjustment and bloodletting were mentioned more frequently by the Kos school than the Knidos school, while medicines, baths, vapor baths (for gynecological diseases) and incision were mentioned more frequently by the Knidos school (chi-squared test, p<0.01). Medicines, diet, baths, warm applications, and incision over the kidney were mentioned among treatments for urinary stones, but cystolithotomy was not. Hippocates stated in "Aphorisms" that diseases that medicines do not cure can be cured by the knife. He also, stressed that any one intending to practice surgery for wounds arising in military service must serve in the army. (Conclusions) A large number of medical treatments were mentioned in Hippocratic Collection, while surgical treatments also were emphasized. Hippocrates warned beginning doctors not to used unproven treatments for urinary stone in the introduction to the "Oath", but did not forbid surgical treatments.