Hippocrates: Epidemiology, Environmental Health, & Occupational Health

Introduction

Hippocrates of Kos (c. 460 – c. 370 BC), often considered the “Father of Medicine,” was a highly influential Greek physician during the classical period. His significant contributions to medicine include the establishment of prognosis and clinical observation practices, disease classification, and the development of humoral theory. As the founder of the Hippocratic school of medicine, he played a crucial role in distinguishing medicine from other disciplines like theurgy and philosophy. The Hippocratic Oath, still in use today, and the Hippocratic Corpus, a collection of medical knowledge and guidelines, are both attributed to him.

In this article, we will explore Hippocrates’ treatise “Airs, Waters, Places,” which examines how environmental factors impact health and disease. This work can be seen as an early precursor to modern public health and environmental health fields. We will also discuss the claim that Hippocrates made the first recorded mention of an occupation-related illness.

Airs, Waters, Places

“Airs, Waters, Places,” a treatise attributed to Hippocrates, offers guidance to traveling physicians on the effects of the environment on health. The text examines factors like climate, water supply, and topography to predict the strengths and vulnerabilities of populations in various locations.

For example, Hippocrates wrote the following:

“The next to them in badness are those which have their fountains in rocks, so that they must necessarily be hard, or come from a soil which produces thermal waters, such as those having iron, copper, silver, gold, sulphur, alum, bitumen, or nitre (soda) in them; for all these are formed by the force of heat. Good waters cannot proceed from such a soil, but those that are hard and of a heating nature, difficult to pass by urine, and of difficult evacuation by the bowels.”

Despite the admirable attempt to create a rational basis for understanding endemic diseases, the work contains generalized theories, confused and contradictory statements, and influences from mythology, traveler accounts, and ethnography. But then again this was over 2,000 years ago so I think we can cut Hippocrates a little slack.

The treatise establishes a connection between “ethos” and “locus,” linking people’s appearances, behaviors, and thoughts to their environment. This connection was later used by orators to argue the character of individuals based on their origins. The work assigns positive and negative associations with different locations and forms early stereotypes of East and West. Its importance lies in its contributions to argumentative techniques and the examination of the environment’s impact on human characteristics.

This text is interesting, and it is certainly a fun way for a textbook or a lecture to introduce the topic of epidemiology or environmental health, but the text must be placed within the context of the times.

Hippocrates and the First Recorded Occupation-Related Illness?

Some have argued that Hippocrates was the first to document an occupation-related illness, specifically lead colic. This illness, associated with lead poisoning, was common among miners and causes symptoms like abdominal pain and constipation. This claim appears to have been repeated many times in textbooks, blog articles, and informative articles hosted on government websites. However, this claim is not supported by evidence.

James Grout from the University of Chicago traces the claim’s origin to a 1983 article in the New England Journal of Medicine by geochemist Jerome Nriagu. Nriagu’s article, which argued that lead poisoning contributed to the decline of Rome, faced criticisms from scholars such as Scarborough and Waldron, who pointed out flaws in Nriagu’s use of evidence and challenged the idea that lead poisoning alone could explain Rome’s decline.

And I think it’s important we point out Nraigu’s flawed reasoning by quoting Grout. Several claims made by Nraigu have been repeated, verbatim, by authors and experts in the field of occupational health and safety, often and without any examination or thought:

One reads that Hippocrates (died c. 370 BC) was the first to describe lead colic in a metal worker. Although a primary source almost never is provided, the Encyclopaedia Britannica Online does say, in its entry on Occupational Disease: The Preindustrial Era, that “The first recorded observation of an occupational disease may be a case of severe lead colic suffered by a worker who extracted metals. It is described in the third book of Epidemics, attributed to Hippocrates.”

In fact, the reference is from Epidemics IV.25, where there is brief mention of a man “from the mines” who, among his other symptoms, was pale. And, indeed, miners often were described as pallidus. Vitruvius remarks on the pallid color of lead workers. Lucan (Pharsalia, IV.298), Silius Italicus (Punica, I.233), and Statius (Silvae, IV.7.15) all comment on the pallor of gold miners, especially those from Asturias in northern Spain, the mining operations which Pliny may have witnessed for himself (XXXIII.xxi.66ff).

But it is facile to assume that, because Romans reported symptoms concomitant with lead poisoning, they necessarily were caused by lead—or, to phrase it another way, that if lead poisoning has certain symptoms, the same symptoms can be attributed to it—as Waldron comments in his review of Nriagu. While Hippocrates may have known about lead poisoning, Waldron cautions that he “did not describe it in any of the books which have come down to us.”

Conclusion

Hippocrates’ treatise “Airs, Waters, Places” serves as an early example of examining the relationship between environmental factors and health. Although the work contains significant limitations, it remains an important contribution to the field of medicine and its understanding of the environment’s impact on human characteristics. As for the debated claim that Hippocrates documented the first occupation-related illness, the evidence is insufficient to support this assertion. Nevertheless, Hippocrates’ influence on medicine, particularly through the establishment of the Hippocratic school and the creation of the Hippocratic Oath and Corpus, is undeniable and remains an important part of the history of medicine.

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