University of Chicago, Chicago, IL (Spring 2016)
|Jean-Baptiste-Raphael-Urbain Massard – Hippocrates refusing the gifts of Artaxerxes
Public domain courtesy of via Wikimedia Commons
Hippocrates once asserted that while “many admire, few know,” a truth that would come to cast a long shadow over his own legacy. Eager to connect themselves to a famous name, if not to the practices or ideology he espoused, a multitude of schools across the ancient Greek world have hailed themselves as Hippocratic, and it is under this designation that their works were left to history. This amalgamation is however a forced and uneasy one as a close analysis of the disparate conduct and dogmas presented as “Hippocratic Writings” reveals a house very much divided against itself. The splintered nature of the work renders the search for a unified Hippocratic doctrine futile; each treatise must instead be studied in its unique context.
The Hippocratic Oath, arguably the most famous document to bear the great physician’s name, provides a perfect lens through which to examine some of the most prominent schisms between the groups who co-opted his reputation. Among the oath’s most famous assertions is that a physician “will not cut even for the stone,” but will “leave such procedures to the practitioners of that craft.”[ii] Despite the clarity and definitiveness of this statement, many who called themselves Hippocratic physicians placed no such restrictions upon themselves. In “Airs, Waters, Places,” the author urges his reader not “to cauterize or cut any part of the belly” until at least ten days after a change in weather patterns and asserts that “the most dangerous times” to perform surgeries are “the two solstices…and the equinoxes.” [iii] These assertions imply that the author himself conducts surgery in his career.
The oath’s indictment of those willing to “give a woman means to procure an abortion” [iv] helps to further emphasize the ideological divides between the groups under the Hippocratic umbrella. The author of “The Seed and the Nature of the Child” clearly has no compunction about acting against this tenant. Hearing that a valuable servant of one of his relatives had become pregnant he instructed the young woman “to jump up and down, touching her buttocks with her heels at each leap” until “the seed fell upon the ground.” [v] From these diametrically opposed views on what in our modern era are considered central Hippocratic tenants we see that those who lay claim to the great physician’s legacy were united only in their common name, in practice each sect deferred to its own unique code.
In addition to their ideological divisions, the various Hippocratic schools fail to form a consensus on how to best study the human animal. Ancient Greek medicine was dominated by two major theories of how best to understand the nature and health of humans. The first of these theorizes that the best method to learn about humans is to study them. The second theory claims that one must first understand all of nature. The author of “The Seed and the Nature of the Child” espouses the former worldview. This allegiance is manifested through his emphasis on direct experimentation and his personal experiences with human reproduction including having observed “a six day old embryo” with his own eyes. [vi] It is through his careful study of this structure which he describes as looking “as though someone had removed the shell from a raw egg so that the fluid inside showed through the inner membrane” that he derives the majority of his conclusions. [vii] Even in his studies of animal models, the human is his eternal frame of reference. The value of chickens in the study of embryos therefore stems from the fact that “all the phenomena …in the human child are to be found in the chicken’s egg.” [viii]
The author of “Airs, Waters, and Places” by contrast holds that to know humans one first ought to study nature. He urges those wishing to succeed in the medical profession to “consider the effect of each of the seasons…the warm and cold winds…the effect of water on the health” and “lastly the life of the inhabitants themselves.”[ix] Holding environment to be the primary influencer of human health, the author believes that a careful survey of the land allows the studied physician to determine the diseases that most afflict various locales. In considering regions “sheltered from the northerly winds but exposed to the warm ones,” the author notes how a studied physician can expect and prepare for “diarrhea, dysentery, ague and in winter…prolonged fever.”[x] While the two authors are united by the importance they place on observation, their dichotomous views on what observations merit the greatest consideration demonstrate the lack of a common way of observing and understanding their subject of study, the hallmark of a united philosophical school.
The disparate worldviews that pervade the Hippocratic groups come into direct conflict in the various writers’ treatment of pregnancy and childbirth. As anticipated from an adherent of the philosophy that the focused study of man himself is the best way to comprehend that organism, the author of “On the Seed” places the responsibility for fetal health solely on physiological events. “The health or disease of the child corresponds to that of the mother,” therefore deformed children are the result either of a contusion engendered by the mother having “received a blow in the part where the embryo is” or “some constriction of the womb in that part which is contiguous to which the embryo is deformed.” [xi] Spontaneous abortion or miscarriage then is simply the consequence of either of these factors occurring to such a degree that the child is unable to survive. The author of “Airs, Waters, Places” as a subscriber to the theory that to understand humanity one must first know nature absolves the mother of much of the blame in regards to miscarriage or fetal weakness. For him, spontaneous abortion is a factor not of maternal health but simply the conditions in which the mother lives. In a district where the water supply is “hard, cold and usually brackish” “miscarriage is rare”, while where it consists “chiefly of brackish surface waters, warm in the summer and cold in the winter”, “miscarriages are common.” [xii] While ideological differences and different approaches to knowledge can exist within a cohesive group, it is difficult to argue that a medical “school” so starkly divided against itself on the root causes of the same disease can be classified as a single unit.
In the centuries since his death Hippocrates has been elevated from an ingenious itinerant physician to the paragon of medical ethics and compassion, making the right to claim his name not simply a matter of medical history but a battle for the art’s very soul. As doctors strive to define their profession in a healthcare system rapidly transitioning from one designed to heal and treat to one where “you are paid to do things to people,” questions about who or what is a Hippocratic have never been more relevant. Making this careful analysis all the more germane is the ease with which many of the Hippocratic texts can be selectively interpreted, as Leon Kass demonstrates in Toward a More Natural Science: Biology and Human Affairs in a chapter entitled “Is there a medical ethic?” Kass seeks to convince us that the father of medicine backs him up on a number of the most contentious issues of our era. Concerning doctor assisted suicide for example he claims Hippocrates’s tacit approval of his theory that to be a doctor is to “protect life, to maintain and support it …and certainly not to destroy it” and casts doubt on whether those willing perform such actions are “truly physicians.” [xiii]
Be they ideological or practical, the gaping schisms between the various writers whose works are compiled under the blanket designation of “Hippocratic writings” make it readily apparent that there is not set criteria that defines a practice or theory as Hippocratic and subsequently no way of classifying a treatise as such. The major consequence of this is that each of the texts must be considered in its unique historical and ideological contexts rather than as the products of a united school of thought, a false conclusion reinforced by compiling the works into a single volume. This understanding of the each text as distinct is vital for our own proper understanding of the “Hippocratic writings” and also for more critically engagement and evaluation of texts like Kass’s that seek to manipulate them. “Is there a Medical Ethic” is based almost entirely on the Hippocratic Oath which an informed reader is aware was penned by a sacred brotherhood dwelling in Greece’s Italian colonies decades after Hippocrates’s death. Placed in its proper context the oath allows us to place the nails in the coffins of many of the central tenants of Kass’s arguments. Passages where he critiques the morality of surgery and abortion, when properly examined, are revealed to be nothing more than artful misinterpretations of the brotherhood’s bans on blood pollution. In conclusion by understanding the divisions within those hailed collectively as Hippocratic we may admire the many groups who contributed to medicine’s growth and advancement and count ourselves among the few who know to whom the acclaim for their respective deeds truly belongs.
[i] Hippocrates, G. E. R. Lloyd, John Chadwick, and W. N. Mann. Hippocratic Writings. Harmondsworth: Penguin, 1983. Print. 67
[iii] Hippocratic Writings, 159
[iv] Hippocratic Writings, 67
[v] Hippocratic Writings, 325
[vi] Hippocratic Writings, 326
[vii] Hippocratic Writings, 326
[viii] Hippocratic Writings, 341
[ix] Hippocratic Writings, 149
[x] Hippocratic Writings, 149
[xi] Hippocratic Writings, 323
[xii] Hippocratic Writings, 149-150
[xiii] Kass, Leon. “Chapter Nine: Is There a Medical Ethic?” Toward a More Natural Science: Biology and Human Affairs. New York: Free, 1988. N. pag. Print.
Adil Menon is currently a fourth year student at the University of Chicago. His major is the History, Philosophy, and Social Science of Science and Medicine (HIPS) with a concentration in medical history and bioethics. Adil serves as an editor for the Triple Helix undergraduate research journal, and mentors adolescents affected by sickle cell disease for the STRIVE program where he serves as program coordinator in addition to his roles as GHU coordinator for Globemed and TA for the biological sciences division. Adil’s academic credentials include authorship of Joseph Goldberger: Epidemiology’s Unsung Hero in the medical humanities journal Hektoen International, acknowledgements in the journal Future Oncology and an American Heart Association award for undergraduate research. He will be attending Harvard University to earn a Master’s in Bioethics starting this fall.