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

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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

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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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The Pythagorean influence is equally evident in the “Ethical Code,”’ the second part of the Oath. The first rule concerns the administration of poisons and pessaries for suicide and abortion. The enigma, as one first studies the Oath, is the origin of this rule in relation to accepted Greek daily life. In Antiquity, suicide and abortion were completely acceptable. If the ill felt that the pain they suffered was intolerable and no help could be offered them, they put an end to their lives. In fact, poison was the usual means of committing suicide. It is not surprising that it was the physician, who was also the pharmacist, who was most likely to have poisons as well as the knowledge of those which caused a fast, painless death. Of course, Suicide was the last recourse after the pa- tient had exhausted all other avenues of treatment, a decision the physician made as well. The fact re- mains that throughout Antiquity many people pre- ferred voluntary death (euthanasia) to endless agony. Abortion, also, was felt to be an acceptable method of birth control, but not for hiding adultery. Since it was acceptable to expose infants at birth, destroying the fetus also was not objectionable. If ancient Greek ethics did not include the dogma of an immortal soul or had any comprehension of eternal punishment for those who committed suicide or feticide, then how did it become part of the Oath? (Edelstein, pp. 9-16). Again, the answer lies in Pythagorean doctrine. Pythagoreans were the only cult to unequivocably outlaw suicide without qualification. To the Pythagoreans, man is given a position in life by the gods which he must hold and defend. Thus, suicide is a sin against the gods and punishment awaits those who disobey the divine command to live. Thus, for any physician accepting this dogma, it becomes a crime to assist in a suicide. The same holds true for abortion. All other philosophers, Aristotle included, advocated abortion before the fetus attained “animate life.’’ The Pythagoreans held that the em- bryo was animate from the moment of conception. Therefore, when the physician forswears to give poisons and pessaries, it is in “purity and holiness’’ that he guards his life and art. Indeed, he dedicates himself to the purity and holiness of the ‘Pythagorean way Of life.’’ (Edelstein, pp. 17-20). The remaining tenets of the ‘‘Ethical Code” are no less Pythagorean. The Pythagoreans felt that the se- quence of the healing art was dietetics first, followed by pharmacology and surgery. Dietetics not only referred to proper nourishment, but it was also a regimen of life, guided by one’s actions. Treatment % .- of disease, according to the Pythagoreans, first “=== — pes y begins with alteration in the patient's regimen. The Gorgon Medusa, from the pediment of the Temple of Surgery is prohibited in the Oath because it was held Artemis at Corfu (c. 600-580 BC). beneath the dignity of the physician. 10 Hippocratic Oath