Let’s get back into this. A story from Galen on how not to talk to patients, and how to use Hippocrates to get them on your side.

“The comforts for those who are ill, e.g. doing things in clean way when it comes to drink, food, and whatever they may see; with softness in whatever they touch. [There are other measures as well]. What does no great harm, or that is easily borne [or easily gotten?], like something cold, when it is needed. Entrances, words, posture, clothing, for the patient, haircut, nails, smells.”

Αἱ τοῖσι κάμνουσι χάριτες, οἷον τὸ καθαρίως δρῇν ἢ ποτὰ ἢ βρωτὰ ἢ ἃ ἂν ὁρᾷ, μαλακῶς ὅσα ψαύει· [ἄλλαι·] ἃ μὴ μεγά[λα] βλάπτει, ἢ εὐανάληπτα, οἷον ψυχρὸν, ὅκου τοῦτο δεῖ· εἴσοδοι, λόγοι, σχῆμα, ἐσθὴς, τῷ νοσέοντι, κουρὴ, ὄνυχες, ὀδμαί.

Epidemics 6.4.7, 5.308L

Galen’s comments

All of the words obviously refer to the doctor, but the phrase, “for the patient,” inserted in between them raises a question; consequently, some have entirely removed it and pretended not to have found it written at all. However, the ancient interpreters are aware of this reading. Maybe we’ll find some plausible solution for it if we first examine each of the things mentioned individually. [1]

Τούτων τὰ μὲν ἄλλα πάντα προφανῶς ἐπὶ τὸν ἰατρὸν ἀναφέρεται, μεταξὺ δ' αὐτῶν παρεγκείμενον τὸ «τῷ νοσοῦντι» παρέχει τινὰ ζήτησιν, ὅθεν ἔνιοι παντάπασιν ἐξελόντες αὐτὸ προσεποιήσαντο μηδ' ὅλως εὑρηκέναι γεγραμμένον. ἀλλ' οἵ γε παλαιοὶ τῶν ἐξηγητῶν ἴσασι καὶ ταύτην τὴν γραφήν. ἴσως δ' ἄν τινος εὐπορήσαιμεν εἰς αὐτὴν πιθανοῦ προεπισκεψάμενοι τῶν εἰρημένων ἕκαστον ἰδίᾳ.

Entrances. And first, he spoke about the doctors’ “entrances” to the patient, and how they may occur in a pleasing manner. For some patients find it annoying when doctors check on them frequently, while others enjoy this very much. There are some doctors who behave so foolishly as to intrude upon sleeping patients with the noise of their feet or a loud voice; the patients, sometimes woken up by this, are aggravated with them and say they have been caused greatest harms. Therefore, a doctor must consider all these things ahead of time in order not to appear at an inappropriate time, or rush in headlong with a lot of noise and a loud voice, or an awkward gait or look, or anything of this sort at all.

καὶ πρώτας γε ἔλεγε τὰς πρὸς τὸν κάμνοντα τῶν ἰατρῶν «εἰσόδους» ὅσαι κεχαρισμένως αὐτοῖς γίνονται. τινὲς μὲν γὰρ ἐνοχλεῖσθαι νομίζουσιν ὑπὸ τῶν πολλάκις αὐτοὺς ὁρώντων, ἔνιοι δὲ πάνυ τούτῳ σφόδρα χαίρουσιν. ἰατροὶ δέ τινές εἰσιν οἳ μέχρι τοσούτου μωραίνουσιν, ὡς καὶ τοῖς κοιμωμένοις ἐπεισιέναι μετὰ ψόφου ποδῶν ἢ φωνῆς μείζονος, ὑφ' ὧν ἐνίοτε διεγερθέντες οἱ νοσοῦντες ἀγανακτοῦσί τε πρὸς αὐτοὺς καὶ βεβλάφθαι τὰ μέγιστά φασι. ἅπαντ' οὖν ταῦτα προορᾶσθαι χρὴ τὸν ἰατρόν, ὡς μήτε κατὰ καιρὸν ὃν οὐ χρὴ παραγίνεσθαι μήτε προπετῶς μετὰ ψόφων πολλῶν καὶ φωνῆς μεγάλης ἢ βαδίσματος ἀσχήμονος ἢ βλέμματος ἢ ὅλως οὑτινοσοῦν τοιούτου.

Conversation. This is one of the greatest issues regarding whether patients are being treated appropriately or inappropriately by their doctors. Some of them are utterly witless, the sort of people Zeuxis says Bacchius described in his Memoirs of Herophilus and his House regarding Callianax the Herophilean. For once, when a patient said to Callianax, “I am going to die,” they say he responded with this verse:

“Unless Leto of the Fair Children gave birth to you.” [2]

And to another who said the same thing, he said:

“Patroclus died as well, who was much better than you.” [3]

Some doctors today, even if they are more moderate than Callianax, are still rough on patients, so that they are hated. Others, conversely, who flatter in a slavish manner, are despised for this very reason. Just as the doctor should not appear worthy of hatred to the patient, neither should he be easily despised; rather, he should maintain his dignity while being humane, moderate, and pleasant. For unless the patient admires the doctor like a god, he will not be obedient; and if he is not willingly obedient, it is better not to flatter him to the point of being despised, nor to be boorish and rough like Callianax. This will happen if the doctor maintains dignity in his look, speech, and the posture of his whole body, while instructing the patient to obey his orders.

There are many “conversations”, and I will not hesitate to provide you with one as an example. The doctor, in a persuasive introduction, can review with the patient what Hippocrates wrote about these matters: first in the Aphorisms, saying, “One must not only do what is necessary oneself, but also make the patient, the attendants, and the externals cooperate” (Aph. 1.1); then in the first book of Epidemics: “The art has three factors: the disease, the patient, the physician. The physician is the servant of the art. The patient must cooperate with the physician in combating the disease” (Epid. 1.2.5). And since there are three factors, doctor, disease, and patient, if the patient leaves the doctor to fight the disease alone, or goes over to the disease and opposes the doctor, the doctor will be defeated by the disease. But if the patient leaves the disease and becomes an ally to the doctor against it, there is great hope of victory with two men fighting one disease. Conversely, it provides no hope if the patient joins the disease and opposes the doctor; for he, being isolated, would be defeated by the two.

This example is sufficient for you, who are capable of understanding that many similar things happen to the patient in relation to doctors. Not only should the intention of the <words> spoken by doctors to patients be appropriate, but the volume of the voice, the tone, and the whole delivery should correspond to the thought behind the words. And even if one is speaking to an educated man, one should take care not to commit solecisms or barbarisms. [4] For doctors appear contemptible to patients due to such things.

<λόγοι.> τῶν μεγίστων ἐστὶ καὶ τοῦτο πρὸς τοὺς κάμνοντας ὑπὸ τῶν ἰατρῶν ἤτοι προσηκόντως ἢ οὐ προσηκόντως τι γινόμενον. ἔνιοι μὲν γὰρ αὐτῶν ἐσχάτως εἰσὶν ἀβέλτεροι τοιοῦτοί τινες ὄντες, οἷον ὁ Ζεῦξίς φησιν ὑπὸ Βακχείου γεγράφθαι Καλλιάνακτα γεγονέναι τὸν Ἡροφίλειον ἐν τοῖς Ἀπομνημονεύμασιν Ἡροφίλου τε καὶ τῶν ἀπὸ τῆς οἰκίας αὐτοῦ· νοσοῦντος γάρ τινος, εἶτ' εἰπόντος τῷ Καλλιάνακτι «τεθνήξομαι», φασὶν αὐτὸν ἐπιφωνῆσαι τόδε τὸ ἔπος·

«εἰ μή σε Λητὼ καλλίπαις ἐγείνατο».

ἑτέρῳ δὲ ταὐτὸ τοῦτ' εἰπόντι φάναι·

«κάτθανε καὶ Πάτροκλος, ὅπερ σέο πολλὸν ἀμείνων».

ἔνιοι δὲ τῶν νῦν ἰατρῶν, εἰ καὶ μετριώτεροι Καλλιάνακτός> εἰσιν, ἀλλὰ τραχέως καὶ αὐτοὶ προσφέρονται τοῖς νοσοῦσιν ὡς μισηθῆναι, καθάπερ ἄλλοι τινὲς ἐξ ὑπεναντίου δουλοπρεπῶς κολακεύοντες ἐξ αὐτοῦ τούτου κατεφρονήθησαν. ὥσπερ δὲ οὐ χρὴ μίσους ἄξιον φαίνεσθαι τῷ κάμνοντι τὸν ἰατρόν, οὕτως οὐδ' εὐκαταφρόνητον, ἀλλ' ἐν τῷ φιλανθρώπῳ καὶ μετρίῳ καὶ ἡδεῖ τὸ σεμνὸν φυλάττειν. εἰ μὴ γὰρ ὥσπερ θεὸν αὐτὸν ὁ κάμνων θαυμάσειεν, οὐκ ἂν εὐπειθὴς γένοιτο, εἰ δὲ μὴ ἑκὼν εὐπειθὴς γένοιτο, βέλτιόν [οὖν] ἐστι μήτε κολακεύειν εἰς τοσοῦτον ὥστε καταφρονεῖσθαι μήτ' ἄγροικόν τε καὶ τραχὺν ὁμοίως εἶναι τῷ Καλλιάνακτι. γενήσεται δὲ τοῦτο φυλάττοντος μὲν ἔν τε τῷ βλέμματι καὶ τῷ φθέγματι καὶ τῷ παντὶ τοῦ σώματος σχήματι τὸ σεμνὸν τοῦ ἰατροῦ, ἐκδιδάσκοντος δὲ τὸν κάμνοντα πείθεσθαι τοῖς προσταττομένοις ὑφ' ἑαυτοῦ.

πολλοὶ δ' εἰσὶ λόγοι, καί σοι παραδείγματος ἕνεκεν οὐκ ὀκνήσω παραθέσθαι τινά. δυνήσεται γὰρ ὁ ἰατρὸς ἐπὶ προοιμίῳ πιθανῷ μετὰ ταῦτα πρὸς τὸν κάμνοντα διελθεῖν, ὅσα περὶ | τῶν τοιούτων Ἱπποκράτης ἔγραψε, πρῶτον μὲν ἐν τοῖς Ἀφορισμοῖς εἰπών· «Δεῖ δὲ οὐ μόνον ἑωυτὸν παρέχειν τὰ δέοντα ποιέοντα, ἀλλὰ καὶ τὸν νοσέοντα καὶ τοὺς παρεόντας καὶ τὰ ἔξωθεν», εἶτ' ἐν τῷ πρώτῳ τῶν Ἐπιδημιῶν· «Ἡ τέχνη διὰ τριῶν, τὸ νόσημα, ὁ νοσέων, ὁ ἰητρός· ὁ ἰητρὸς ὑπηρέτης τῆς τέχνης. ἐναντιοῦσθαι τῷ νοσήματι τὸν νοσέοντα μετὰ τοῦ ἰητροῦ χρή».

καὶ ὡς τριῶν ὄντων, ἰατροῦ καὶ νοσήματος καὶ κάμνοντος, ἐὰν ὁ νοσῶν ἐάσῃ μόνον πολεμεῖν τῷ νοσήματι τὸν ἰατρὸν ἢ καὶ πρὸς αὐτὸ μεταστὰς ἐναντιώσηται τῷ ἰατρῷ, συμβήσεται νικηθῆναι τὸν ἰατρὸν ὑπὸ τοῦ νοσήματος. ἐὰν δὲ καταλιπὼν τὸ νόσημα σύμμαχος κατ' αὐτοῦ γένηται τῷ ἰατρῷ, μεγάλην ἐλπίδα τῆς νίκης ἔσεσθαι δυοῖν ἀνθρώπων πρὸς ἓν νόσημα μαχομένων, ὡς τό γε ἐναντίον ἔμπαλιν οὐδεμιᾶς ἐλπίδος ἔσται παρεκτικόν, ἐὰν ὁ κάμνων μετὰ τοῦ νοσήματος γενόμενος ἐναντιῶται τῷ ἰατρῷ· μονωθεὶς γὰρ ἂν οὗτος ὑπὸ τῶν δυοῖν νικηθείη ἄν.

ἀρκεῖ δέ σοι τὸ παράδειγμα τοῦτο νοῆσαι δυναμένῳ κατὰ τὸ παραπλήσιον ἕτερα πολλὰ τοιαῦτα τῷ νοσοῦντι γίνεσθαι πρὸς τῶν ἰατρῶν. οὐ μόνον δὲ τῶν λεχθησομένων λόγων τοῖς κάμνουσιν ὑπὸ τῶν ἰατρῶν τοιαύτην εἶναι προσήκει τὴν διάνοιαν, ἀλλὰ καὶ τὸ μέγεθος τῆς φωνῆς καὶ τὸν τόνον καὶ τὴν ὅλην ὑπόκρισιν ἀνὰ λόγον εἶναι τῇ διανοίᾳ τῶν λόγων. εἰ δὲ καὶ πεπαιδευμένῳ διαλέγοιτό τις ἀνδρί, † καὶ μετὰ τοῦ μὴ σολοικίζειν τε καὶ βαρβαρίζειν. καὶ γὰρ ἐκ τῶν τοιούτων εὐκαταφρόνητοι τοῖς κάμνουσιν οἱ ἰατροὶ φαίνονται.

Galen, Commentary on Epidemics VI 4.10, 17B.145-148K = 202-205 Wenkebach

Notes

[1] The Epidemics passage is usually taken as a checklist of things that affect how a sick person feels. On the modern reading (e.g. Smith), τῷ νοσέοντι (“for the patient”) is taken as a dative of reference. Everything that follows belongs to the patient’s world: what they eat and drink, what they see and touch, the general atmosphere, and even practical details like clothing, hair, nails, and smells. It’s classic Epidemics: observe, adjust, don’t make things worse.

Galen (and maybe others at the time) reads the list very differently. For him, it’s about the doctor’s own behavior and grooming: speak politely, dress sensibly, keep your hair and nails neat, don’t smell of wine or garlic. A kind of ancient bedside-manner code. He takes τῷ νοσέοντι to mean “for the sake of the patient.”

Grammar probably favors the simpler view, and Galen has to do some gymnastics to make his reading work. His interpretation is fun, and great evidence for later medical etiquette, but it probably tells us more about Galen’s world than about what this Hippocratic text originally meant.

[2] Leto, goddess, mother of Apollo and Artemis.

[3] Iliad 21.107, what Achilles says to Lykaon just before he kills him.

[4] Technical terms. “Solecism” is incorrect grammar/syntax; “Barbarism” is the use of non-Greek words.