What were the attitudes of other ancient physi- cians and
philosophers
about these issues?
Voices of Ancient Greece and Rome_nodrm
) consists of a long conver- sation about the nature and causes of boulimos, including the notion that it is a cold-weather affliction.
Scythians: A nomadic people who lived in the Black Sea region, expert equestrians, as would be expected of a people who were often on the move.
? ? ? ? ? Although the date of Aulus Gellius's essay is unknown, the fate of his friend Favorinus is more certain. As mentioned earlier, Favorinus had somehow offended the emperor Hadrian (ruled 117-138 CE). As a result, statues of him that had been set up in Athens were
removed by the Greeks. Nonetheless, he willed his extensive library, and his mansion in Rome, to the Greek rhetorician Herodes Atticus.
ASK YOURSELF
1. It makes sense that gorging oneself with food would destroy feelings of hunger, but why does Erasistratus claim that fasting can have the same effect?
2. How did the Scythians prevent hunger? Do you think their method would work?
TOPICS TO CONSIDER
e AulusGelliusdoesnotdirectlyrevealtothereaderwhetherheagreeswith the descriptions of Favorinus (and by extension, Erasistratus) on the mat- ters of stomach constriction and bulimia, but is it possible to read between the lines and speculate on his views?
Controlling Appetite and Curbing Weight Gain
? ? ? ? APICIUS'S COOKBOOK
The early first-century CE gourmand Apicius wrote extensively on foods, cooking, and recipes. These writings were later collected and published under the title De Re Coquinaria (On Cooking). The book is divided into 10 chapters and encompasses a wide variety of culinary themes, including wines; spices; minces; puddings; veg- etables (such as asparagus, squash, beets, carrots, peas, and beans); duck, pheasant, goose, and chicken dishes; meats (including wild boar, venison, beef, veal, and hare); and seafood dishes (including shellfish, oysters, sar- dines, and mussels).
Several writers, including Seneca and Martial, report that Apicius spent 100,000,000 sesterces on fancy foods and other extravagances. When Apicius took an inventory of his finances and discovered a balance of "only" 10,000,000 sesterces, he reputedly poisoned himself (at a banquet, of course) because he believed that no gourmet worth his salt could possibly live appropriately on such a paltry sum.
? ? ? ? ? ? ? ? ? ? A DIFFERENT KIND OF RAVENOUS HUNGER
The Greek historian Xenophon, when describing the hardships of a military march that he helped to lead and that he detailed in a famous historical work entitled Anabasis (The Expedition), relates a slightly different account of excessive hunger:
[T]hey marched . . . through snow, and many of the men fell ill with hunger-faintness [the boulimia referenced in the document, and confirming the statement that this disorder tends to occur more often in cold weather]. And Xenophon . . . [in the rear] . . . did not know what the trouble was. But as soon as a person who was acquainted with the disease had told him that they manifestly had hunger-faintness, and if they were given something to eat would be able to get up, he went around among the baggage animals, and wherever he saw something that was edible, he would distribute it among the sick men, or send [here and there] people who had the strength to run along the lines, to give it to them. And when they had eaten something, they would get up and continue with the march. [Xenophon. Anabasis 4. 5; tr. Brownson. ]
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e TheEnglishword"bulimia"derivesfromtheGreekwordboulimos,which is generally defined in Greek-English lexicons as "extreme hunger" or "rav- enous hunger. " However, John C. Rolfe, the translator of the Aulus Gellius essay, renders boulimos as "ox-hunger," which is the literal meaning of the Greek word. Can you discover what the connection might be between extreme hunger and oxen?
e Why do you think that boulimos was more common in cold weather than in warmer weather?
Further Information
Holford-Strevens, Leofranc. Aulus Gellius: An Antonine Scholar and His Achievement. Oxford, 2003.
Vehling, Joseph Dommers (ed. /trans. ). Apicius: Cookery and Dining in Imperial Rome. Chicago, 1936.
Website
Aulus Gellius. Biography. http://www. bookrags. com/biography/aulus-gellius-dlb/
Bibliography for Document
Brownson, Carleton L. (tr. ) Xenophon: Anabasis. Volume III. [LCL. ] London and Cambridge, 1922.
Matz, David. Ancient World Lists and Numbers. Numerical Phrases and Rosters in the Greco-Roman Civilizations, Jefferson, NC, 1995.
Rolfe, John C. (tr. ) The Attic Nights of Aulus Gellius. Volume I. [LCL. ] Cambridge and London, 1927.
HEALTH CARE
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18. HIPPOCRATES AND THE ETHICS OF THE MEDICAL PROFESSION
INTRODUCTION
The most famous name in the history of ancient medicine is undoubtedly Hippocrates, from the island of Cos, off the coast of modern-day Turkey. Hippocrates (ca. 460-370 BCE) came from a family of physicians; both his father and his grandfather practiced medicine, and his father served as one of his instructors in the medical arts. Hippocrates is generally associated with a voluminous output of medical treatises, perhaps 60. However, modern scholars doubt that he himself wrote all, or even any, of these; rather, it is thought that the works attributed to him were probably authored by a consortium of later physicians and then collected together in an anthology today known as the Hippocratic Corpus. Some of the major topics in this collection of medical writings include air, wind, and water, and their effects on health; epidemics; nutriments; the art of prognosis; epilepsy; fractures and dislocations; medical aphorisms; and treatments for various diseases and disorders.
The noted Roman natural scientist Pliny the Elder certainly seemed to accept the his- torical reality of a physician named Hippocrates. He credits Hippocrates, during the time of the Peloponnesian War (431-404 BCE), with having revived the practice of medicine after a period of dormancy. He notes that Hippocrates hailed from the island of Cos, sacred to Asclepius, the god of medicine. In the temple dedicated to Asclepius there, it was customary for "patients recovered from illness to inscribe in the temple of that god an account of the help that they had received, so that afterward, similar remedies might be enjoyed [thus form- ing a sort of medical casebook]. Accordingly, Hippocrates . . . wrote out these inscriptions and . . . founded that branch of medicine called 'clinical. ' " [Pliny the Elder. Natural History 29. 5; tr. Jones. ]
KEEP IN MIND AS YOU READ
1. The Hippocratic Oath is perhaps one of the most famous writings in all of ancient Greek literature, but a number of thorny questions surround the oath. Its date, for example, is unknown. Nor is it known whether all ancient physicians took the oath, or even subscribed to its principles. It is not certain whether physicians who violated one or more of the oath's injunctions would be punished in some way.
2. The oath is very short--only 250 words in Greek.
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? Document: The Hippocratic Oath
I swear by Apollo Physician, by Asclepius, by Health [Hygiea], by Panacea and by all the gods and god- desses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my liveli- hood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a [suppository] to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even on suf- ferers from stone, but I will give place to such as are craftsmen therein. Into whatever houses I enter, I will enter to help the sick, and I will abstain from all inten- tional wrongdoing and harm, especially from abusing the bodies of man or woman, [slave] or free. And what- soever I shall see or hear in the course of my profes- sion, as well as outside my profession in my [dealings with individuals], if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art. But if I transgress it and forswear myself, may the opposite befall me. [Tr. W. H. S. Jones. Hippocrates (11, 12). LCL, 1924. ]
AFTERMATH
The impact of Hippocrates's work is well summarized by the entry in the Oxford Classical Dictionary (s. v. Hippocrates): "If one asks what Hippocrates meant to the Greeks, the Middle Ages, the Renaissance, what he means even today, the answer is that by a complicated historical process he has become the embodiment of the ideal physician. "
? ? ? ? ? ? ? ? ? Apollo Physician, Asclepius, Health [Hygiea], Panacea: An invocation to the family of "healer deities" of Greek mythology: Apollo, the father of Asclepius, who was the god of medicine. Hygiea and Panacea, whose names mean "health" and "all-curing" respec- tively, were daughters of Asclepius.
indenture: The exact application or meaning of this word in the medical context is uncertain. The Greek word syngraphia (here translated as "indenture") literally means "a writ- ing together," and is generally understood to refer to a contract. It may here denote an agreement between teacher and student: the student's main responsibilities are to respect the teacher and to be will- ing to share his medical knowledge with other students; the teacher's responsibility is to instruct the stu- dent, possibly free of charge.
partner: This probably refers to a con- tinued sharing of knowledge and expertise, rather than a more nar- rowly defined, shared professional medical practice.
stone: Presumably bladder or kidney stones.
And whatsoever I shall see or hear:
The translator of the passage, W. H. S. Jones, comments: "This remarkable addition is worthy of a passing notice. The physician must not gossip, no matter how or where the subject matter for gossip may have been acquired; whether it be in practice or in private life makes no difference. "
? ? ? ? ? 90
Hippocrates and the Ethics of the Medical Profession
? ? ? ? HIPPOCRATES WAS NOT THE ONLY NOTABLE GREEK PHYSICIAN
The fifth-century BCE historian Herodotus relates a story about the powerful and much-feared (by the Greeks) Persian king Darius (sixth century BCE). It seems that Darius was out hunting one day, when he dismounted awkwardly from his horse and badly sprained his ankle. The Egyptian physicians who were called in to treat him only made matters worse by their inept methods. But someone in the royal entourage knew of a Greek cap- tive by the name of Democedes, from the city of Croton, and that this Democedes was a skilled medical practi- tioner. Democedes was summoned, and, after some cajoling, he agreed to attend to the king, who soon recovered, thanks to the care he had received from his Greek doctor. According to Herodotus, "it was chiefly because of Democedes' success [not only in treating Darius, but in his medical practice on the islands of Aegina and Samos] that Crotoniate doctors came to have such a high reputation. Darius' accident happened during the period when the physicians of Croton were considered the best in Greece, and those of Cyrene the next best. " [Herodotus. The Histories 3. 131; tr. de Selincourt. ] An interesting side note: Democedes married the daughter of Milo of Croton, who was the finest Olympic athlete of his era and one of the best in all of ancient Olympic history.
? ? ? ASK YOURSELF
1. What differences do you notice between the ways in which ancient and modern physicians viewed the practice of medicine?
2. Why do you think there seemed to be such a strong link between medicine and reli- gion in the ancient Greek world?
TOPICS TO CONSIDER
e AlthoughtheHippocraticOathisveryshort,itcontainsafairlylargenum- ber of principles relating to the practice of medicine. Which of these prin- ciples would still be doable by modern physicians? Which ones do you think that many modern physicians might avoid or even outwardly oppose?
e How many medical schools today still require graduating students to take the Hippocratic Oath? If this information is not readily available, try doing a random survey of select medical schools to see which ones require it.
e ItwasmentionedintheintroductionthatHippocratesmaynothavewrit- ten all of the entries in the Hippocratic Corpus, and that he perhaps did not author any of them. What evidence leads modern scholars to these conclu- sions? Does it seem likely that there never existed an ancient physician named Hippocrates, and that the medical texts bearing his name were actually written by a consortium of now-unknown doctors?
e The document contains fairly straightforward condemnations of both euthanasia and abortion.
What were the attitudes of other ancient physi- cians and philosophers about these issues? In particular, find out what Plato, Socrates, and Aristotle might have written.
Further Information
Cantor, David, ed. Reinventing Hippocrates. Burlington, VT, 2002. Jouanna, Jacques. Hippocrates. Baltimore, 1999.
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Levine, Edwin Burton. Hippocrates. New York, 1971. Smith, Wesley D. Hippocratic Tradition. Ithaca, NY, 1979.
Website
Hippocrates. http://www. notablebiographies. com/He-Ho/Hippocrates. html
Bibliography for Document
de Selincourt, Aubrey (tr. ); revised by A. R. Burn. Herodotus: The Histories. Baltimore, 1954. Jones, W. H. S. (tr. ). Pliny: Natural History. Volume VIII. [LCL. ] London and Cambridge,
1963.
Jones, W. H. S. (tr. ). Hippocrates. Volume I. [LCL. ] Cambridge and London, 1923.
19. A MEDICAL MIRACLE MAN WHO DECLINED TO GIVE AN ENCORE PERFORMANCE
INTRODUCTION
This document comes to us by way of the second-century CE Greek satirist and essayist Lucian, who authored works on rhetoric, literature, and philosophy, as well as numerous satirical dialogues. He was born in Syria, but as a young man, he immigrated to the Greco-Roman world, where he traveled widely, both in Greece and Italy. Eventually, he gave up his travels, settled in Athens, and focused on his literary career.
KEEP IN MIND AS YOU READ
1. Lucian wrote over 60 dialogues and sketches; The Disowned Son is one of these. The narrator is a young man who, after being disowned by his father, studied medicine and became a physician. Meanwhile, his father fell ill with a mental disease that puzzled the doctors who were summoned to treat him. The disowned son, however, was able to cure his father, who, in gratitude, revoked his son's expulsion from the family. But in a cruel twist of fate, the young man's stepmother (his father's wife) was also victimized by some sort of mental ailment. When the father commanded his son to work another miracle cure, the son refused, saying that in his medical opinion, his stepmother's illness was different than the one suffered by his father, and likely incurable. For that refusal, the father disowned his son a second time.
2. This fictitious sketch is cast in the form of a legal action, with the son pleading his case in court that his disownment is unjust. As far as is known, no formal disown- ment case ever reached Athenian law courts, but the philosopher Plato writes that provisions for such an action did exist: "Between fathers and their children, and children and their fathers, there arise differences greater than is right, in the course of which fathers, on the one hand, are liable to suppose that the lawgiver should give them legal permission to proclaim publicly by herald, if they so wish, that their sons have legally ceased to be their sons . . . " [Plato. Laws 11. 928D; tr. Bury. ]
3. In the modern world, the mantra to which the medical profession seems to pay homage is "medicine by template": each disease has certain symptoms, courses, and outcomes and must be treated in much the same way, regardless of the specific circumstances of the individual patient. The disowned son refused to be bound by such restrictions. He realized that there were subtle differences in the afflictions of
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Voices of Ancient Greece and Rome
his father and stepmother, and that the remedies that worked in his father's case would be ineffectual in treating his stepmother.
Document: No Physician--Not Even a Miracle
Worker--Can Cure All Ills
There is . . . something of a novelty in my present plight [i. e. , his second disown- ment], in that I am under no personal charge, but am in jeopardy of punishment on behalf of my profession because it cannot in every particular obey [my father's demands]. But what could be more absurd than to give treatment under orders, in accordance, not with the powers of the profession, but with the desires of my father? I could wish, to be sure, that medical science had a remedy of such sort that it could check not only insanity but unjust anger, in order that I might cure my father of this disorder also. As things are, his madness has been completely assuaged, but his anger is growing worse, and (what is hardest of all) he is sane to everyone and insane towards me alone, his physician. You see, therefore, what fee I receive for my attendance. I am disowned by him once more and put away from my family a second time, as if I had been taken back for a brief space merely that I might be more disgraced by being turned out of the household repeatedly.
For my part, in cases which can be cured, I do not wait to be summoned. On the previous occasion, for instance, I came to his relief uncalled. But when a case is perfectly desperate, I am unwilling even to [take it on]. And in respect to this woman I am with good reason even less venturesome, since I take into consider- ation how I should be treated by my father if I were to fail, when without having so much as begun treating her, I am disowned. I am indeed pained . . . at my stepmother's serious condition (for she was a good woman), at my father's dis- tress on her account, and most of all at my own apparent disobedience and real inability to do the service which is enjoined upon me, both because of the extraordinary violence of the illness and the ineffectiveness of the art of healing. I do not think, however, that it is just to disown a man who declines at the outset to promise what he cannot perform . . .
In the case of the medical profession, the more distinguished it is and the more serviceable to the world, the more unrestricted it should be for those who practice it. It is only just that the art of healing should carry with it some privilege
in respect to the liberty of practicing it; that no compul- sion and no commands should be put upon a holy call- ing, taught by the gods and exercised by men of learning; that it should not be subject to enslavement by the law, or to voting and judicial punishment, or to fear and a father's threats and a layman's wrath . . . The physician ought to be persuaded, not ordered. He ought to be willing, not fearful. He ought not to be hailed to the bedside, but to take pleasure in coming of his own accord. Surely his calling is exempt from paternal com- pulsion in view of the fact that physicians have honors, precedence, immunities, and privileges publicly
? ? ? ? ? ? ? ? ? ? a holy calling, taught by the gods:
According to the Roman natural scientist Pliny the Elder, "to its pioneers, medicine [is] assigned a place among the gods and a home in heaven, and even today medical aid is in many ways sought from the oracle. " [Pliny the Elder. Natural History 29. 1; tr. Jones. ]
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A Medical Miracle Man Who Declined to Give an Encore Performance
bestowed on them by states. [Tr. A. M. Harmon. Lucian. (1-2; 23. ) Volume V. LCL, 1936. Page numbers: 477, 479, 511, 513. ]
AFTERMATH
The son concludes his case by stating that there is no cure on the horizon for his stepmother, not even if "she takes medicine a thousand times," and that therefore, it is imprudent to embark upon a course of treatment. He also pledges that if his father should have a relapse, that he (the son) would once again attempt to effect a cure, despite the one, and possibly two, disownments inflicted upon him by his father. Further, he reminds his father that it was through shouting, arguments, anger, and hatred that his first bout of insanity was trig- gered, and by continuing to display those maladaptive character traits, he might well bring on a second one.
Lucian does not reveal whether the disownment action was upheld by the court.
ASK YOURSELF
1. Do you think the disowned son was right to refuse treatment to his stepmother, or should he have at least tried to administer a remedy, in the hope that it might work?
2. If you were sitting on the jury in this case, would you have supported or denied the
father's case for disownment? Why?
TOPICS TO CONSIDER
e Inthemodernworld,itmightbeconsideredinappropriateorevenuneth- ical for a physician to deliver health care services to an immediate family
? ? ? ? ? ? ? ? ? ? DIVINE HEALING FOR A BATTLE WOUND
The connection between the gods and the art of medicine is illustrated by the two physicians who accompanied the Greek forces during the Trojan War: Machaon and Podalirius, both sons of Asclepius, god of medicine. In Book 4 of the Iliad, the Greek warrior-king Menelaus has been shot by an arrow and is bleeding profusely; Machaon is hurriedly summoned:
And gaining the place where red-haired Menelaus nursed his wound and a growing ring of warlords pressed around him, striding into their midst
the godsent healer reached the captain's side
and quickly drew the shaft from his buckled belt -
he pulled it clear, the sharp barbs broke back.
He loosed the glittering belt and slipped it off
and the loin-piece and the plated guard below it,
gear the bronzesmiths made. When he saw the wound
where the tearing arrow hit, he sucked out the blood
and deftly applied the healing salves that Chiron,
friend of Asclepius, gave his father long ago. [Homer. Iliad 4; tr. Fagles. ]
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Voices of Ancient Greece and Rome
96
member. This does not appear to have been the case in the ancient world.
Why not, do you suppose?
e Weknowverylittleaboutwhatmighthaveconstitutedmedicalmalpractice
in the ancient world, but there seems to have been a tradition to hold physi- cians blameless in the event that their treatments failed. The disowned son apparently hints at that idea when he proclaims that the practice of medi- cine "should not be subject to enslavement by the law, or to voting and judicial punishment [i. e. , no medical malpractice lawsuits should be allowed! ], or to fear a father's threats and a layman's wrath. " In the same sec- tion, the son argues that the medical profession should be "unrestricted . . . for those who practice it. " Research ancient Greek law and judicial pro- cedure, to see if you can find any examples of the prosecution of physicians for real or perceived incompetence.
Further Information
Baldwin, Barry. Studies in Lucian. Toronto, 1973.
Branham, Bracht. Unruly Eloquence: Lucian and the Comedy of Traditions. Cambridge, MA,
1989.
Jones, Christopher P. Culture and Society in Lucian. Cambridge, MA, 1986.
Website
Bibliography to Lucian: A Select and Evolving Guide. http://classics. uc. edu/~johnson/ Lucian/bibliography. htm
Bibliography for Document
Bury. R. G. (tr. ). Plato. Laws. Volume II. [LCL. ] London and Cambridge, 1926.
Fagles, Robert (tr. ). Homer: The Iliad. New York, 1990.
Harmon, A. M.
Scythians: A nomadic people who lived in the Black Sea region, expert equestrians, as would be expected of a people who were often on the move.
? ? ? ? ? Although the date of Aulus Gellius's essay is unknown, the fate of his friend Favorinus is more certain. As mentioned earlier, Favorinus had somehow offended the emperor Hadrian (ruled 117-138 CE). As a result, statues of him that had been set up in Athens were
removed by the Greeks. Nonetheless, he willed his extensive library, and his mansion in Rome, to the Greek rhetorician Herodes Atticus.
ASK YOURSELF
1. It makes sense that gorging oneself with food would destroy feelings of hunger, but why does Erasistratus claim that fasting can have the same effect?
2. How did the Scythians prevent hunger? Do you think their method would work?
TOPICS TO CONSIDER
e AulusGelliusdoesnotdirectlyrevealtothereaderwhetherheagreeswith the descriptions of Favorinus (and by extension, Erasistratus) on the mat- ters of stomach constriction and bulimia, but is it possible to read between the lines and speculate on his views?
Controlling Appetite and Curbing Weight Gain
? ? ? ? APICIUS'S COOKBOOK
The early first-century CE gourmand Apicius wrote extensively on foods, cooking, and recipes. These writings were later collected and published under the title De Re Coquinaria (On Cooking). The book is divided into 10 chapters and encompasses a wide variety of culinary themes, including wines; spices; minces; puddings; veg- etables (such as asparagus, squash, beets, carrots, peas, and beans); duck, pheasant, goose, and chicken dishes; meats (including wild boar, venison, beef, veal, and hare); and seafood dishes (including shellfish, oysters, sar- dines, and mussels).
Several writers, including Seneca and Martial, report that Apicius spent 100,000,000 sesterces on fancy foods and other extravagances. When Apicius took an inventory of his finances and discovered a balance of "only" 10,000,000 sesterces, he reputedly poisoned himself (at a banquet, of course) because he believed that no gourmet worth his salt could possibly live appropriately on such a paltry sum.
? ? ? ? ? ? ? ? ? ? A DIFFERENT KIND OF RAVENOUS HUNGER
The Greek historian Xenophon, when describing the hardships of a military march that he helped to lead and that he detailed in a famous historical work entitled Anabasis (The Expedition), relates a slightly different account of excessive hunger:
[T]hey marched . . . through snow, and many of the men fell ill with hunger-faintness [the boulimia referenced in the document, and confirming the statement that this disorder tends to occur more often in cold weather]. And Xenophon . . . [in the rear] . . . did not know what the trouble was. But as soon as a person who was acquainted with the disease had told him that they manifestly had hunger-faintness, and if they were given something to eat would be able to get up, he went around among the baggage animals, and wherever he saw something that was edible, he would distribute it among the sick men, or send [here and there] people who had the strength to run along the lines, to give it to them. And when they had eaten something, they would get up and continue with the march. [Xenophon. Anabasis 4. 5; tr. Brownson. ]
? ? 85
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e TheEnglishword"bulimia"derivesfromtheGreekwordboulimos,which is generally defined in Greek-English lexicons as "extreme hunger" or "rav- enous hunger. " However, John C. Rolfe, the translator of the Aulus Gellius essay, renders boulimos as "ox-hunger," which is the literal meaning of the Greek word. Can you discover what the connection might be between extreme hunger and oxen?
e Why do you think that boulimos was more common in cold weather than in warmer weather?
Further Information
Holford-Strevens, Leofranc. Aulus Gellius: An Antonine Scholar and His Achievement. Oxford, 2003.
Vehling, Joseph Dommers (ed. /trans. ). Apicius: Cookery and Dining in Imperial Rome. Chicago, 1936.
Website
Aulus Gellius. Biography. http://www. bookrags. com/biography/aulus-gellius-dlb/
Bibliography for Document
Brownson, Carleton L. (tr. ) Xenophon: Anabasis. Volume III. [LCL. ] London and Cambridge, 1922.
Matz, David. Ancient World Lists and Numbers. Numerical Phrases and Rosters in the Greco-Roman Civilizations, Jefferson, NC, 1995.
Rolfe, John C. (tr. ) The Attic Nights of Aulus Gellius. Volume I. [LCL. ] Cambridge and London, 1927.
HEALTH CARE
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18. HIPPOCRATES AND THE ETHICS OF THE MEDICAL PROFESSION
INTRODUCTION
The most famous name in the history of ancient medicine is undoubtedly Hippocrates, from the island of Cos, off the coast of modern-day Turkey. Hippocrates (ca. 460-370 BCE) came from a family of physicians; both his father and his grandfather practiced medicine, and his father served as one of his instructors in the medical arts. Hippocrates is generally associated with a voluminous output of medical treatises, perhaps 60. However, modern scholars doubt that he himself wrote all, or even any, of these; rather, it is thought that the works attributed to him were probably authored by a consortium of later physicians and then collected together in an anthology today known as the Hippocratic Corpus. Some of the major topics in this collection of medical writings include air, wind, and water, and their effects on health; epidemics; nutriments; the art of prognosis; epilepsy; fractures and dislocations; medical aphorisms; and treatments for various diseases and disorders.
The noted Roman natural scientist Pliny the Elder certainly seemed to accept the his- torical reality of a physician named Hippocrates. He credits Hippocrates, during the time of the Peloponnesian War (431-404 BCE), with having revived the practice of medicine after a period of dormancy. He notes that Hippocrates hailed from the island of Cos, sacred to Asclepius, the god of medicine. In the temple dedicated to Asclepius there, it was customary for "patients recovered from illness to inscribe in the temple of that god an account of the help that they had received, so that afterward, similar remedies might be enjoyed [thus form- ing a sort of medical casebook]. Accordingly, Hippocrates . . . wrote out these inscriptions and . . . founded that branch of medicine called 'clinical. ' " [Pliny the Elder. Natural History 29. 5; tr. Jones. ]
KEEP IN MIND AS YOU READ
1. The Hippocratic Oath is perhaps one of the most famous writings in all of ancient Greek literature, but a number of thorny questions surround the oath. Its date, for example, is unknown. Nor is it known whether all ancient physicians took the oath, or even subscribed to its principles. It is not certain whether physicians who violated one or more of the oath's injunctions would be punished in some way.
2. The oath is very short--only 250 words in Greek.
? ? ? ? 89
Voices of Ancient Greece and Rome
? Document: The Hippocratic Oath
I swear by Apollo Physician, by Asclepius, by Health [Hygiea], by Panacea and by all the gods and god- desses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my liveli- hood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrongdoing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a [suppository] to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even on suf- ferers from stone, but I will give place to such as are craftsmen therein. Into whatever houses I enter, I will enter to help the sick, and I will abstain from all inten- tional wrongdoing and harm, especially from abusing the bodies of man or woman, [slave] or free. And what- soever I shall see or hear in the course of my profes- sion, as well as outside my profession in my [dealings with individuals], if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art. But if I transgress it and forswear myself, may the opposite befall me. [Tr. W. H. S. Jones. Hippocrates (11, 12). LCL, 1924. ]
AFTERMATH
The impact of Hippocrates's work is well summarized by the entry in the Oxford Classical Dictionary (s. v. Hippocrates): "If one asks what Hippocrates meant to the Greeks, the Middle Ages, the Renaissance, what he means even today, the answer is that by a complicated historical process he has become the embodiment of the ideal physician. "
? ? ? ? ? ? ? ? ? Apollo Physician, Asclepius, Health [Hygiea], Panacea: An invocation to the family of "healer deities" of Greek mythology: Apollo, the father of Asclepius, who was the god of medicine. Hygiea and Panacea, whose names mean "health" and "all-curing" respec- tively, were daughters of Asclepius.
indenture: The exact application or meaning of this word in the medical context is uncertain. The Greek word syngraphia (here translated as "indenture") literally means "a writ- ing together," and is generally understood to refer to a contract. It may here denote an agreement between teacher and student: the student's main responsibilities are to respect the teacher and to be will- ing to share his medical knowledge with other students; the teacher's responsibility is to instruct the stu- dent, possibly free of charge.
partner: This probably refers to a con- tinued sharing of knowledge and expertise, rather than a more nar- rowly defined, shared professional medical practice.
stone: Presumably bladder or kidney stones.
And whatsoever I shall see or hear:
The translator of the passage, W. H. S. Jones, comments: "This remarkable addition is worthy of a passing notice. The physician must not gossip, no matter how or where the subject matter for gossip may have been acquired; whether it be in practice or in private life makes no difference. "
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Hippocrates and the Ethics of the Medical Profession
? ? ? ? HIPPOCRATES WAS NOT THE ONLY NOTABLE GREEK PHYSICIAN
The fifth-century BCE historian Herodotus relates a story about the powerful and much-feared (by the Greeks) Persian king Darius (sixth century BCE). It seems that Darius was out hunting one day, when he dismounted awkwardly from his horse and badly sprained his ankle. The Egyptian physicians who were called in to treat him only made matters worse by their inept methods. But someone in the royal entourage knew of a Greek cap- tive by the name of Democedes, from the city of Croton, and that this Democedes was a skilled medical practi- tioner. Democedes was summoned, and, after some cajoling, he agreed to attend to the king, who soon recovered, thanks to the care he had received from his Greek doctor. According to Herodotus, "it was chiefly because of Democedes' success [not only in treating Darius, but in his medical practice on the islands of Aegina and Samos] that Crotoniate doctors came to have such a high reputation. Darius' accident happened during the period when the physicians of Croton were considered the best in Greece, and those of Cyrene the next best. " [Herodotus. The Histories 3. 131; tr. de Selincourt. ] An interesting side note: Democedes married the daughter of Milo of Croton, who was the finest Olympic athlete of his era and one of the best in all of ancient Olympic history.
? ? ? ASK YOURSELF
1. What differences do you notice between the ways in which ancient and modern physicians viewed the practice of medicine?
2. Why do you think there seemed to be such a strong link between medicine and reli- gion in the ancient Greek world?
TOPICS TO CONSIDER
e AlthoughtheHippocraticOathisveryshort,itcontainsafairlylargenum- ber of principles relating to the practice of medicine. Which of these prin- ciples would still be doable by modern physicians? Which ones do you think that many modern physicians might avoid or even outwardly oppose?
e How many medical schools today still require graduating students to take the Hippocratic Oath? If this information is not readily available, try doing a random survey of select medical schools to see which ones require it.
e ItwasmentionedintheintroductionthatHippocratesmaynothavewrit- ten all of the entries in the Hippocratic Corpus, and that he perhaps did not author any of them. What evidence leads modern scholars to these conclu- sions? Does it seem likely that there never existed an ancient physician named Hippocrates, and that the medical texts bearing his name were actually written by a consortium of now-unknown doctors?
e The document contains fairly straightforward condemnations of both euthanasia and abortion.
What were the attitudes of other ancient physi- cians and philosophers about these issues? In particular, find out what Plato, Socrates, and Aristotle might have written.
Further Information
Cantor, David, ed. Reinventing Hippocrates. Burlington, VT, 2002. Jouanna, Jacques. Hippocrates. Baltimore, 1999.
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Levine, Edwin Burton. Hippocrates. New York, 1971. Smith, Wesley D. Hippocratic Tradition. Ithaca, NY, 1979.
Website
Hippocrates. http://www. notablebiographies. com/He-Ho/Hippocrates. html
Bibliography for Document
de Selincourt, Aubrey (tr. ); revised by A. R. Burn. Herodotus: The Histories. Baltimore, 1954. Jones, W. H. S. (tr. ). Pliny: Natural History. Volume VIII. [LCL. ] London and Cambridge,
1963.
Jones, W. H. S. (tr. ). Hippocrates. Volume I. [LCL. ] Cambridge and London, 1923.
19. A MEDICAL MIRACLE MAN WHO DECLINED TO GIVE AN ENCORE PERFORMANCE
INTRODUCTION
This document comes to us by way of the second-century CE Greek satirist and essayist Lucian, who authored works on rhetoric, literature, and philosophy, as well as numerous satirical dialogues. He was born in Syria, but as a young man, he immigrated to the Greco-Roman world, where he traveled widely, both in Greece and Italy. Eventually, he gave up his travels, settled in Athens, and focused on his literary career.
KEEP IN MIND AS YOU READ
1. Lucian wrote over 60 dialogues and sketches; The Disowned Son is one of these. The narrator is a young man who, after being disowned by his father, studied medicine and became a physician. Meanwhile, his father fell ill with a mental disease that puzzled the doctors who were summoned to treat him. The disowned son, however, was able to cure his father, who, in gratitude, revoked his son's expulsion from the family. But in a cruel twist of fate, the young man's stepmother (his father's wife) was also victimized by some sort of mental ailment. When the father commanded his son to work another miracle cure, the son refused, saying that in his medical opinion, his stepmother's illness was different than the one suffered by his father, and likely incurable. For that refusal, the father disowned his son a second time.
2. This fictitious sketch is cast in the form of a legal action, with the son pleading his case in court that his disownment is unjust. As far as is known, no formal disown- ment case ever reached Athenian law courts, but the philosopher Plato writes that provisions for such an action did exist: "Between fathers and their children, and children and their fathers, there arise differences greater than is right, in the course of which fathers, on the one hand, are liable to suppose that the lawgiver should give them legal permission to proclaim publicly by herald, if they so wish, that their sons have legally ceased to be their sons . . . " [Plato. Laws 11. 928D; tr. Bury. ]
3. In the modern world, the mantra to which the medical profession seems to pay homage is "medicine by template": each disease has certain symptoms, courses, and outcomes and must be treated in much the same way, regardless of the specific circumstances of the individual patient. The disowned son refused to be bound by such restrictions. He realized that there were subtle differences in the afflictions of
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his father and stepmother, and that the remedies that worked in his father's case would be ineffectual in treating his stepmother.
Document: No Physician--Not Even a Miracle
Worker--Can Cure All Ills
There is . . . something of a novelty in my present plight [i. e. , his second disown- ment], in that I am under no personal charge, but am in jeopardy of punishment on behalf of my profession because it cannot in every particular obey [my father's demands]. But what could be more absurd than to give treatment under orders, in accordance, not with the powers of the profession, but with the desires of my father? I could wish, to be sure, that medical science had a remedy of such sort that it could check not only insanity but unjust anger, in order that I might cure my father of this disorder also. As things are, his madness has been completely assuaged, but his anger is growing worse, and (what is hardest of all) he is sane to everyone and insane towards me alone, his physician. You see, therefore, what fee I receive for my attendance. I am disowned by him once more and put away from my family a second time, as if I had been taken back for a brief space merely that I might be more disgraced by being turned out of the household repeatedly.
For my part, in cases which can be cured, I do not wait to be summoned. On the previous occasion, for instance, I came to his relief uncalled. But when a case is perfectly desperate, I am unwilling even to [take it on]. And in respect to this woman I am with good reason even less venturesome, since I take into consider- ation how I should be treated by my father if I were to fail, when without having so much as begun treating her, I am disowned. I am indeed pained . . . at my stepmother's serious condition (for she was a good woman), at my father's dis- tress on her account, and most of all at my own apparent disobedience and real inability to do the service which is enjoined upon me, both because of the extraordinary violence of the illness and the ineffectiveness of the art of healing. I do not think, however, that it is just to disown a man who declines at the outset to promise what he cannot perform . . .
In the case of the medical profession, the more distinguished it is and the more serviceable to the world, the more unrestricted it should be for those who practice it. It is only just that the art of healing should carry with it some privilege
in respect to the liberty of practicing it; that no compul- sion and no commands should be put upon a holy call- ing, taught by the gods and exercised by men of learning; that it should not be subject to enslavement by the law, or to voting and judicial punishment, or to fear and a father's threats and a layman's wrath . . . The physician ought to be persuaded, not ordered. He ought to be willing, not fearful. He ought not to be hailed to the bedside, but to take pleasure in coming of his own accord. Surely his calling is exempt from paternal com- pulsion in view of the fact that physicians have honors, precedence, immunities, and privileges publicly
? ? ? ? ? ? ? ? ? ? a holy calling, taught by the gods:
According to the Roman natural scientist Pliny the Elder, "to its pioneers, medicine [is] assigned a place among the gods and a home in heaven, and even today medical aid is in many ways sought from the oracle. " [Pliny the Elder. Natural History 29. 1; tr. Jones. ]
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A Medical Miracle Man Who Declined to Give an Encore Performance
bestowed on them by states. [Tr. A. M. Harmon. Lucian. (1-2; 23. ) Volume V. LCL, 1936. Page numbers: 477, 479, 511, 513. ]
AFTERMATH
The son concludes his case by stating that there is no cure on the horizon for his stepmother, not even if "she takes medicine a thousand times," and that therefore, it is imprudent to embark upon a course of treatment. He also pledges that if his father should have a relapse, that he (the son) would once again attempt to effect a cure, despite the one, and possibly two, disownments inflicted upon him by his father. Further, he reminds his father that it was through shouting, arguments, anger, and hatred that his first bout of insanity was trig- gered, and by continuing to display those maladaptive character traits, he might well bring on a second one.
Lucian does not reveal whether the disownment action was upheld by the court.
ASK YOURSELF
1. Do you think the disowned son was right to refuse treatment to his stepmother, or should he have at least tried to administer a remedy, in the hope that it might work?
2. If you were sitting on the jury in this case, would you have supported or denied the
father's case for disownment? Why?
TOPICS TO CONSIDER
e Inthemodernworld,itmightbeconsideredinappropriateorevenuneth- ical for a physician to deliver health care services to an immediate family
? ? ? ? ? ? ? ? ? ? DIVINE HEALING FOR A BATTLE WOUND
The connection between the gods and the art of medicine is illustrated by the two physicians who accompanied the Greek forces during the Trojan War: Machaon and Podalirius, both sons of Asclepius, god of medicine. In Book 4 of the Iliad, the Greek warrior-king Menelaus has been shot by an arrow and is bleeding profusely; Machaon is hurriedly summoned:
And gaining the place where red-haired Menelaus nursed his wound and a growing ring of warlords pressed around him, striding into their midst
the godsent healer reached the captain's side
and quickly drew the shaft from his buckled belt -
he pulled it clear, the sharp barbs broke back.
He loosed the glittering belt and slipped it off
and the loin-piece and the plated guard below it,
gear the bronzesmiths made. When he saw the wound
where the tearing arrow hit, he sucked out the blood
and deftly applied the healing salves that Chiron,
friend of Asclepius, gave his father long ago. [Homer. Iliad 4; tr. Fagles. ]
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member. This does not appear to have been the case in the ancient world.
Why not, do you suppose?
e Weknowverylittleaboutwhatmighthaveconstitutedmedicalmalpractice
in the ancient world, but there seems to have been a tradition to hold physi- cians blameless in the event that their treatments failed. The disowned son apparently hints at that idea when he proclaims that the practice of medi- cine "should not be subject to enslavement by the law, or to voting and judicial punishment [i. e. , no medical malpractice lawsuits should be allowed! ], or to fear a father's threats and a layman's wrath. " In the same sec- tion, the son argues that the medical profession should be "unrestricted . . . for those who practice it. " Research ancient Greek law and judicial pro- cedure, to see if you can find any examples of the prosecution of physicians for real or perceived incompetence.
Further Information
Baldwin, Barry. Studies in Lucian. Toronto, 1973.
Branham, Bracht. Unruly Eloquence: Lucian and the Comedy of Traditions. Cambridge, MA,
1989.
Jones, Christopher P. Culture and Society in Lucian. Cambridge, MA, 1986.
Website
Bibliography to Lucian: A Select and Evolving Guide. http://classics. uc. edu/~johnson/ Lucian/bibliography. htm
Bibliography for Document
Bury. R. G. (tr. ). Plato. Laws. Volume II. [LCL. ] London and Cambridge, 1926.
Fagles, Robert (tr. ). Homer: The Iliad. New York, 1990.
Harmon, A. M.
