460-370 BC

Hippocrates was a Greek physician born on the island of Cos in Greece. He is known as the father of medicine and regarded as the greatest physician of his time. His practices were based on his theory of humors as well as on his observations of the human body. His humor theory was a departure from theories of his time that saw illness as being caused by the gods.

The humor theory that Hippocrates subscribed to and furthered saw disease as originating in an imbalance of four humors of the body: blood, black bile (made in the spleen), yellow bile (made in the liver) and phlegm (made in the brain and lung).

These four humors were seen as having parallels in the universe, which was made up of four basic properties: heat, cold, moisture, and dryness. The properties, in turn, combined to produce air, earth, water, and fire. The combinations went as follows:

Among his contributions to diagnosis and theorizing about the body were the following:

In his books Epidemics and Prognostic, are detailed investigations of disease symptoms. Epidemics reads like a set of case notes in which students reporting on the symptoms of individual patients. Included in Epidemics are descriptions of the patient’s temperature, excretions, movements, sleep history, and appetite. Also included are notes about the disease, history of the community and climate changes. The second book, Prognostic, lists the particular symptoms that a doctor should pay attention to in order to diagnose the cause and prognosticate the course of the person’s disease.

Hippocrates is perhaps best known today for the Hippocratic Oath, a code of ethics for physicians. A revised form of the oath is still taken by medical students when they are inducted into the professions. The oath includes patients’ right to privacy, pledges the physician to an honorable personal and professional life, and requires that doctors do no harm.

Hippocrates saw the goal of medicine as building a patient’s strength through diet and hygienic measures. He prescribed therapies of rest, a good diet, fresh air and cleanliness. Only after the patients did not respond did he resort to more drastic treatments. He noted that there were individual differences in the severity of disease symptoms and that some individuals were better able to cope with their disease and illness than others.

Hippocrates and those in his school were prolific writers, creating an influential body of work, called the Hippocratic Corpus. The corpus consists of 70 or so treatises mostly written between 430 BC and AD 200. Its contents were written by several different people holding several different viewpoints. The most frequently cited book in the corpus contains a set of aphorisms that contain Hippocrates’ deductions about different aspects of medicine.

Hippocrates had a number of things to say about the brain and speech production. In his treatise on glands, Hippocrates portrayed the brain as a gland. “The head,” he said, “has glands; the brain itself resembles a gland. It is white, it is separated in small masses, like other glands. It possesses the same advantages…The brain is large and lodged in the cranium where it occupies much space... When the brain is irritated, consciousness is lost, the brain becomes convulsed, and involves the whole body. Man can no longer speak. He becomes suffocated and falls into a condition called apoplexy.”

Speech, according to Hippocrates, was an expression of the soul.

Aphorism 32, section 6 is on misarticulations:

The traulos (misarticulation) is very often struck by a lengthy diarrhea.

This aphorism, according to Wollock (1997, p. 191) is based on the idea emerging from humor theory that an excess of certain humors will lead to particular diseases. In this case misarticulations are due to the same humor imbalances as is diarrhea, both being associated with of too much moisture in the body. (For more on this see Wollock, 1997, chapter 5).

Another collection of aphorisms derived by those of the Hippocratic school has to do with using symptoms to predict outcomes. Here are a few involving communication and speech:

35. Aphasia in fever is bad.

51. A sharp retort from a polite person, in a high-pitched voice, is bad; in such cases, there is retraction of the hypochondrium.

65. When a febrile patient becomes demented and keeps silent although he has not lost the power to speak, it is fatal.

77. When patients suffering from a continued fever lie speechless with their eyes closed but for an occasional flicker of the eyelids and then, after a nose bleed and vomiting, begin to speak and regain their wits, it is a sign they will recover. If these signs do not occur, they become dyspnoeic and soon die.

98. Wandering of the mind, a strident voice, spasm of the tongue and tremulousness indicates insanity. Stiffening is a fatal sign in these cases.

191. Those who suffer from deafness with heaviness of the head, distension of the hypochondrium and photophobia, have a haemorrhage.

193. To be hard of hearing, to show tremor in picking up anything, to have a paralyzed tongue, to be sluggish—is bad.

240. Aphonia is of the most serious significance if accompanied by weakness.

242. Those who develop aphonia while febrile but not at a critical time, die with tremor.

243. Aphonia during a fever in the manner of that seen in a seizure associated with a quiet delirium, is fatal.

244. Pain, then aphonia—a hard death.

245. Aphonia with a seizure is fatal.

246. A cracked voice after purging—is this bad? More patients in this case have slight sweating and their bellies become relaxed.

247. In cases of aphonia, the presence of that type of breathing seen in suffocation is bad—is it also a sign of delirium?

248. Aphonia, following headache accompanied by sweating, fever, incontinence of the stools, and then remitting, denotes a prolonged illness. A rigor supervening in such cases is not a bad sign.

249. Cases of dementia accompanied by aphonia prove fatal.

250. Aphonia in patients who have rigors is a sign of death; they usually suffer from headache.

251. Aphonia accompanied by weakness in an acute fever is a sign of death in the absence of sweating, but is of less serious significance if sweating be present, when it denotes a long illness. It may be that these signs are safest when they are seen during a relapse; those are most likely to die who have epistaxis and those who have diarrhea.

252. A shrill whining voice and dimness of the eyes denote a spasm; pains in the lower parts of the body in such cases show that they will get over it.

253. Unexpected diarrhea accompanied by a quavering voice is a fatal sign in complaints which have lasted a long time.

254. Frequent attacks of aphonia with slight stupor foretells a consumptive condition

341. Do those who palpitate all over die with aphonia?

353. When a convulsion is attended by prolonged aphasia, it is a bad sign; if such aphasia be short-lived, it is associated wither with paralysis of the tongue, or of the arm and right side of the body. The trouble is ended by the sudden passage of a large quantity of urine at one time.

474. An attack of madness may resolve itself into hoarseness and cough.

Hippocrates explained that the voice is formed by the lungs and trachea and that it is:

articulated by the lips and the tongue…Man speaks by means of the air which he inhales into his entire body and particularly into the body cavities…The tongue articulates by striking; it gathers the air in the throat (pharynx) and pushes it against the palate and the teeth, thereby giving the sound a definite shape. If the tongue did not articulate each time by means of striking, man would not speak clearly and would only be able to produce a few inarticulate sounds (Hippocrates, De Carnibus, viii, 606 Lit). (Tr by Wollock, p. 21, 192)

Hippocrates thought that stuttering was due to dryness of the tongue. He prescribed blistering substances to drain away the black bile that is responsible for dryness.

Works by Hippocrates and others in the Hippocratic school

Adams, Francis (translator) (1939). The genuine works of Hippocrates. Baltimore, MD: Williams and Wilkins.

Hippocratic aphorisms can be found at http://classics.mit.edu/Hippocrates/aphorisms.html

References on the work of Hippocrates.

Chadwick, J. & Mann, W. (1950). The medical works of Hippocrates. London: Blackwell Scientific Publications.

Rieber, R. & Wollock, J. (1977). The historical roots of the theory and therapy of stuttering.Journal of Communication Disorders, 10, 3–24.

Wollock, J. (1997). The noblest animate motion: Speech, physiology and medicine in the pre-Cartesian linguistic thought. Philadelphia, PA: John Benjamins Publishing Co.