University of Texas Health Science Center - IATRO Yearbook (Houston, TX)

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Later myths are different and picture the miraculous birth of a god. One sees, by the fact that Zeus slew Asclepius for resuscitating a dead man, that, even in Antiquity, physicians were not to take their position for granted. It was not a god-given right for the physi- cian to interfere with the laws of nature by keeping people alive beyond their allotted time. The physi- cian, therefore, has great moral obligations (Sigerist, p. 53). Thus, in the beginning, Asclepius was a physician praised by Homer and eventually became the patron of physicians. Physicians were craftsmen, united and revered because they belonged to a guild founded in the assumption that physicians were descendants of Asclepius. He did not cure people but protected the physicians, who practiced, above all, a secular craft. Physicians of Antiquity travelled from town to town, and, soon, word spread about their patron hero, who, with time, became singularly identified with medicine and healing, ultimately renowned as the chief healer. Through the years, Asclepius, in fact, became less a patron to the physician and more the competitor. His deification occurred toward the end of the sixth century BC and the cult of Asclepius began immediately in Epidaurus and soon spread over all the Known world with Epidaurus, Cos (home of Hippocrates), and Pergamum (home of Galen) the Bx ait me chief centers of the cult. As the cult spread to Africa, Hippocrates, as envisioned by a 14th cent. Byz Asclepius became identified with the local deities =° % oly Bae (eg., Imhotep in Egypt), who were then worshipped together. Asclepius was pivotal in the struggle be- tween Christianity and paganism and his cult was the last to die, surviving well into the sixth century AD (Sigerist, pp. 56-61). It is clear, although once thought otherwise, that rational and religious medicine developed along parallel courses. Thus, mythology is not the origin of Greek medicine but, rather, one finds the roots of Greek medical science in the observations and thoughts of the early philosophers. In fact, for the true origins of the ‘Hippocratic Oath,’ one must look at the tenets of the school and cult of Pythagoras (Castiglioni, p. 126). The school of Pythagoras probably exerted the deepest influence on medicine. Pythagoras lived dur- ing the sixth century BC and he took part in the great religious movement that swept Greece during that time, making possible the development of the cult of Asclepius. People were no longer satisfied with the primitive Homeric gods and were seeking something more meaningful and representative of their lives. Although Pythagoras investigated nature and made obvious scientific contributions, his primary aim was religious. He sought the redemption of man from the +; cycle of reincarnations, attainable through the pompeian wall painting depicting Aeneas attended by a “Pythagorean way of life.’’ Since the cult of physician. Pythagoras was aristocratic in character, intellectual activities were most important. 8 Hippocratic Oath “a antine artist. a pg Sa

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Let oh quart 4 ee ae Ag j eee i pius and his family depicted on votive tablet (c. 370-270 BC) Ascle — ee . Asclepius shown on a metope from the Temple of Asclepius at Epidaurus (c. 4th cent. BC). PM Be My SERMON hewn, SURES Bas-relief (c. 400-350 BC) depicting Asclepius and daughter Hygeia and symbolic snake curing patients during sleep. In fact, religious medicine has been present in the initial stages and throughout the course of every civilization. As there have always been individuals who would rather go to a priest than a physician for treatment of an illness, so too, have there been physicians from Antiquity to more modern times who relegated their incurable patients in need of miracles into the hands of the gods (Sigerist, p. 44). Greece, certainly, was no exception. Religious medicine was cited in the Homeric poems, and, in fact, it is in Homer’s Iliad, where one finds the origin of perhaps the most enduring of the ancient healing cults, the cult of Asclepius, one of the gods invoked in the ‘Hippocratic Oath.” In the liad (Book Il, line 731), Asclepius is mentioned as a minor chieftain and physician, who, with the help of his sons, Pol- daleirios and Machaon, treated the Greek wounded at Troy. Although the Greek gods had the ability to protect mortals against evil and to treat the sick, it was Apollo who became the god of medicine. Asclepius became important and eventually replaced Apollo as god of medicine when legend made him the son of Apollo. Hesiod’s Theogony, written around 700 BC, contains, perhaps, the first legend of Asclepius: In the Boebian lake, the lake of Phoebus, the beautiful maiden, Coronis, daughter of the Lapithian king, Phlegyas, was bathing her feet when Apollo (Phoebus) saw her and desired her. She became pregnant with the god’s child but her father had promised her to her cousin, Ischys. The day of the wedding came and all the preparations had been made, when the raven, a white bird until then, brought the evil news to Delphi, Apollo’s seat. The god, in his wrath, first punished the messenger of the evil tidings, who then on exhibited the black color of mourning and was feared as the herald of disaster. He then killed Ischys, shooting his darts at him, while his sister, Artemis (Diana), hit Coronis and her innocent compa- nions. But when the god saw the body of his beloved on the funeral pyre, he felt pity for the unborn child, removed him from the mother’s womb, and brought him to the cave of Chiron (demigod and Centaur) on Mount Pelion. There, Asclepius grew up, instructed by Chiron in the treatment of diseases with incantations, herbs, and the knife. He became a famous physician, sought by many from far and wide and became so self-assured that he even resuscitated the dead (Pin- dar later changed this to have Asclepius resuscitate a dead man for money), whereupon Zeus slew him with his thunderbolt (Gordon, p. 437). Hippocratic Oath 7

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Members led an aesthetic, pure life, maintaining a “perfect’’ physical and mental balance, achieved through observance of various food taboos. For in- stance, they were not allowed to kill animals, for sacrifice or food since they believed in the transmigration of the soul. Destruction of animals was as objectionable as that of humans. They strove for purity by avoiding all luxuries, through total con- trol of emotion, and asexuality (sex was solely for procreation and not pleasure) (Castiglioni, pp. 126-135). If one now looks critically at the “Hippocratic Oath,”’ one finds that it clearly falls into two parts — the first specifying the duties of the pupil toward his teacher, the teacher’s family, as well as his obliga- tions in transmitting medical knowledge; the second io. summarizes medical ethics, outlining rules to be BS. observed in the treatment of disease. It becomes ob- ae “s m™ vious that the “Hippocratic Oath’ is, in fact, a — Pythagorean document. Calyx-crater (c. 455-450 BC) showing Apollo and Artemis The first part of the Oath, known as the ‘“‘Cove- shooting arrows that brought disease to mankind nant,”’ establishes the closest, almost sacred rela- ee ey ea tionship between pupil and teacher, equivalent to father and son, for the expressed purpose of instruc- ting the pupil in the art. One might surmise that this Oath is taken to join a family guild of physicians. However, the Oath does not speak of a guild of physicians, but refers solely to pupil and teacher. In- deed, all crafts in most civilizations were originally restricted to family guilds, which, in time, became trade unions, admitting outside practitioners of the craft. One is reminded of the artisan guilds during the Middle Ages and Renaissance, and this was no less true in Antiquity. The gradual move from guild to trade union was marked by the adoption of outsiders by families for apprenticeship, and these adoptees were then treated as natural children of the family. Looking at the Pythagoreans, one sees that this is, in fact, how people were admitted to their order. It comes, then, as no surprise that the pupil is asked to share his life with his teacher. To support his father was the son’s duty, and this obligation was even more binding for the Pythagoreans, who were taught Teed i ee RECS NOMS ANY to honor their parents above all others. Acceptance Fooamnticec of the teacher’s family as one’s own as well as their | responsibility to educate is also a Pythagorean ethic, Greek physician palpating patient's abdomen, especially the for the Pythagoreans were encouraged to turn to liver. their brothers first and even referred to their fellow members as brothers. Finally, the pupil is instructed not to teach everyone. The knowledge is to be im- parted to a closed circle of a selected few. This is without question in agreement with the principles of how Pythagorean doctrine was to be transmitted. The Pythagoreans differed from all other philosophical sects in that they did not divulge their teaching to everyone (Edelstein, pp. 40-48). Hippocratic Oath 9