Six centuries ago, the Italian humanist and poet Petrarch remarked that if a hundred, or a thousand, people of the same constitution and illness were divided into two groups, one under medical care and one entrusted to nature, the latter would show more cases of recovery. For many years, popular wisdom held that “there is much difference between a good and a bad physician, but not any between a good physician and none at all”. In fact, L. J. Henderson, the famous Harvard biochemist, maintained that it was not until around 1910 that “a random patient, with a random disease, consulting a doctor chosen at random had, for the first time in the history of mankind, a better than fifty–fifty chance of profiting from the encounter”.

Such observations invite a range of responses. A cynic might remark that Henderson's favourable odds have yet to be achieved even today, but a more benevolent view of medicine's past would attribute much to sensible advice, pastoral care, a few good remedies and the placebo effect. Whatever one's view, however, the puzzle remains of how medicine survived as a social institution despite centuries of therapeutic impotence, incompetence and pernicious meddling.

The Hippocratic physicians identified one potential answer: the healing power of nature. Doctors, they taught, are merely nature's servants. They took their diagnostic and therapeutic cues from what they could observe at the bedside — sick people, especially patients suffering from acute illnesses, often sweat, vomit, have diarrhoea, are pale, flushed or jaundiced, cough up phlegm or blood, lose their appetites, and develop pustules or rashes. The Hippocratics interpreted these signs and symptoms as evidence that the body is a marvellous mechanism with an innate capacity to restore the natural humoral balance that constitutes health. Their ministrations were generally aimed at assisting and encouraging these natural processes.

This doctrine of the vis medicatrix naturae provided a rationale for much of the Hippocratics' activity. Inflamed limbs and fevered bodies turn red, clear evidence of too much blood. Why not therefore remove some through phlebotomy? Similarly, cathartics, emetics, sudorifics, diuretics and errhines were given to stimulate purging, vomiting, sweating, urination or nasal discharge, all frequent phenomena at the sickbed and presumably, therefore, part of the body's natural defences. To the Hippocratics, the art of medicine consisted of knowing when, and how much, to help — as well as when to stop.

Hippocratic humoralism dominated Western medical thinking until the eighteenth century. The doctrine of nature's healing power enjoyed reasonable assent, although its theoretical basis was reconceptualized by several doctors. In the seventeenth century, Jean Baptiste van Helmont saw healing as a manifestation of the workings of the archaeus, a vital principle that he located in the stomach. Johann Wepfer visualized it as a function of the 'president' of the nervous system, whereas Georg Stall believed that it was diffused throughout the whole body.

Running through much of this debate was the anxious suspicion that the doctrine rather minimized the role of the expert in the treatment of illness within an unregulated medical market-place. If nature knows best, why bother to consult a doctor? A typical attitude was that of John Conolly, who in 1859 acknowledged the power of natural healing, yet concluded that neither doctors nor their patients should ever “trust entirely to the vis medicatrix naturae, except in the case of the most trifling injuries, where a process of very small extent is all that is required for the cure”.

By Conolly's time, both the authority of Hippocrates and the doctrine of vis medicatrix naturae were being appropriated by several sectarian challenges to what Samuel Hahnemann, the founder of homeopathy, had called the allopathy (treatment by opposites) of traditional Western medicine. Most nineteenth-century medical sectarians — practitioners of homeopathy, chiropractic, hydropathy, osteopathy and naturopathy — called upon Hippocrates, the 'father of Western medicine', to sanction their endeavours. The originator of modern naturopathy, Benedict Lust (his modern followers are at pains to point out that his name is pronounced 'Loost'), was inspired by “natural therapies used successfully since ancient times” to create his own philosophy of health and the treatment of disease. Search the Internet for vis medicatrix naturae and you will find yourself in the land of what we now politely call 'alternative' or 'complementary' medicine.

Hippocrates has thus become the patron saint of virtually all occidental medicine, scientific or otherwise. This status rests squarely on the Hippocratic insight dubbed “the wisdom of the body” by W. B. Cannon. Readers of Nature may well seek the source of that wisdom in the biological mechanisms of evolutionary adaptations. Indeed, the modern scientific custodians of the Hippocratic doctrine are the advocates of darwinian medicine, who question whether it is wise to provide symptomatic relief for the multitude of self-limited illnesses to which our flesh is heir.

FURTHER READING

Neuburger, M. The Doctrine of the Healing Power of Nature Throughout the Course of Time (New York Homeopath. Coll., New York, 1932). Warner, J. H. The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820–1885 (Harvard Univ. Press, Cambridge, Massachusetts, 1986). Nesse, R. M. & Williams, G. C. Evolution and Healing (Weidenfeld & Nicolson, London, 1995).