More Hippocratic Aphorisms
Aphorism is a short, pithy statement of an evident truth concerned with life or nature. Hippocrates wrote a series of aphorisms on medical practice. They became handy hints for the physicians of the time (400 BCE). Perhaps they represented a tool analogous to what medical interns have carried around in their pockets—the Merck Manual. Many aphorisms dealt with the art of purging since very few other treatments were available then. Prognostication between curable and incurable conditions was a common issue in the aphorisms. The first Hippocratic aphorisms was the topic of the last posting. Here are some more aphorisms of a general nature as extracted from http://classics.mit.edu. To read a translation of them all go to the link.
Aphorisms by Hippocrates and translated by Francis Adams
Section II-19.-In acute diseases it is not quite safe to prognosticate either death or recovery.
Section II-33. In every disease it is a good sign when the patient's intellect is sound, and he is disposed to take whatever food is offered to him; but the contrary is bad.
Section II-44. Persons who are naturally very fat are apt to die earlier than those who are slender.
Section II-52 When doing everything according to indications, although things may not turn out agreeably to indication, we should not change to another while the original appearances remain.
Section VII-43. A woman does not become ambidextrous.
Section VII-87. Those diseases, which medicines do not cure, iron (the knife?) cures; those which iron cannot cure, fire cures; and those which fire cannot cure, are to be reckoned wholly incurable.
Any comments on your interpretation of the significance of these views of Hippocrates? ..Maurice.
posted by Maurice Bernstein, M.D. @ 7:30:00 PM
2 comments
2 Comments:
“In acute diseases it is not quite safe to prognosticate either death or recovery.”
This certainly has not changed! The mystery of the arrival of death is both awe inspiring and terrifying. Patients, their families, and the medical system want doctors to prognosticate life expectancies for a variety of reasons. Not only that, they want the doctors to be correct in this prognosis, even when we all know quite well that just because you have a diploma in medicine does not mean that you are also omniscient. I have heard MDs discuss this issue of prognosticating death for their patients. It is a fence that they all have to ride. If you predict that the patient will die and he lives, then it is because you/the hospital/medicine did a good job and that makes you and the profession that surrounds you heroes. However, if the patient dies when you thought he would not, then you are a liar/bad doctor/etc. If you don’t give any indication of what you think, then you leave the patient in the dark. If you, the doctor, can’t give her a ballpark answer, is she expected to predict herself? Is she forced to live as if everyday is her last? Her son will graduate from high school in two months. Will she be around to attend? She and her husband have been fighting. Do you think she will have a chance to apologize for things she regrets saying? Will her sister have time to fly in and see her before she loses consciousness from her progressing disease? We feel an obligation to give a timeline, even though it is “not quite safe.”
I cringed when I sat in consultations when families would use the phrase “If my loved one dies” in referring to their terminally ill or injured patient. It is not a matter of if, but when. Not to mention the fact that in the cases of many of those families, death was already well on its way. The patient had already begun to die. Sometimes this is because the healthcare team is not ready to admit it, but other times, it is because the family is not ready to hear it.
When I was assessing patients for ethical consultations, I came to know some of the signs of coming death. I wish that I had kept a chart on how I felt when I read those charts. I would predict what I thought the outcome would be for each person I followed. Very often, I was right, but there is nothing satisfying in “knowing” someone will die soon. However, I was deeply humbled when I was wrong. There are people who truly surprised me when they bounced back from what appeared to be sure death. And then I remembered, who am I to think I can see death coming and going?
Touche, Hippocrates. Touche.
Touche, Alyssa, touche. Thanks for posting this wise and realistic commentary. Fortunately, unlike in Hippocratic times, physicians now have some literature about the course of some diseases which can be helpful to talk to the patient or family about, if they want this information. And unfortunately, of course, this data may be meaningless in terms of prognostication regarding the patient at issue. So we have to guess but be vague and at the same time being supportive and comforting to them while trying to understand what is going through their minds. It's a tough job. ..Maurice.
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