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

Page 15 text:

This is easily understandable when one realizes that the Pythagoreans were elitist and aristocratic. It was equally held in Antiquity and the Middle Ages that any work done with hands was menial and, therefore, delegated to the lower classes. The Pythagoreans abhorred adultery as much as violence. They upheld the equality of men and women and did not discriminate between classes in the performance of their moral duties. Thus, the Oath’s prohibition of sexual relations with the pa- tient, patient's family or slaves is an outgrowth of the Pythagorean doctrine. The promise of silence and strict confidence at the end of the Oath is not a precaution but a duty, a moral obligation observed by the Pythagoreans in everyday life. They swore not to tell everyone everything (Edelstein, pp. 21-38). Thus, one sees clearly that the ‘Hippocratic Oath” is hardly the expression of common Greek attitudes howing a man vomiting. toward medicine, nor does it represent the natural TT ap es YL we duties of the physician. This document reflects the i ue é ‘ o Tas ; . E VW, ; “S MG. 222 «opinions and beliefs peculiar to a small, isolated ' ; ae 4; » % group which reached the peak of its importance in the fourth century BC, the same era when the ‘‘Hip- pocratic Oath” was written. This Oath was an obliga- tion then, as it is now, but it was not enforced then by any ruling organization. Instead, the physician freely accepted the obligation. It is also not a legal docu- ment but a solemn promise given and honored only by the conscience of the swearer. It is interesting to note that this, too, is in strict adherence with Pythagorean ethics. Pythagoras insisted that all in- struction must be based on the willingness of teacher and pupil, through voluntary rule and volun- tary obedience. Pythagoras’ aim, after all, was religious — to instill in man a desire to lead a better, purer, holier existence through stimulation of his conscience (Edelstein, p. 61). It is remarkable that in : ) 2 a civilization characterized by the pursuit of Bas-relief (c. 4th cent. BC) showing Asclepius and his daughter knowledge as well as decadence, there should Hygeia. evolve a small cry in a vast wilderness which | developed parallel to the larger voice of Judaic Artwork is reproduced from Lyons’ and morality, later to become the Judeo-Christian ethic. | Petrucelli's Medicine, An Illustrated History One cannot help but wonder how cumbersome the | (Abrams, 1978) and Marti-lbanez’s The Epic of development of modern-day medical ethics would | | Interior medallion of a cup (c. 490-480 BC) s' | Medicine (Potter, 1962). have been without this important Pythagorean | document. — Michael A. Weitzner | Castiglioni, A. A History of Medicine. NY: Alfred A. | Knopf, 1947. Gordon, B. Medicine throughout Anti- quity. Phil: FA Davis Co., 1949. Sigerist, H. A History of Medicine, vol Il. NY: Oxford University Press, | 1961. Temkin, O. and CL Temkin, ed. Ancient | Medicine: selected papers of Ludwig Edelstein. Balt: Johns Hopkins Press, 1967. Hippocratic Oath 11

Page 14 text:

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

Page 16 text:

Vv VA. IBL EXTANT DELINEATIO. ; } ERA ANATOMIA. LUGDUNO-BATAVA, CUM SCELETIS ET RELIQVIS ARCHIVUN INS’TRE MENT ANATOMICOR We Dr Wi MOG ‘ VY a WF £ SS a ee Gens te as po Aod|| Eaca j : SRO ONT MIG RA SSC SNE 8 ai 1p Sn . Oe pets ANAN CAANRANRAAARAN: AANNAAAAARAAARY § . me ee ee ; 12 Features