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On The
Moral Obligation Of The Medical Profession According to
Hippocrates
by Emile Littre (1839)
translated by Harold
Kulungian (1999)
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(Note: This is an
excerpt from Chapter XIV: "Remarks on the Medical Character and the Style of
Hippocrates", from volume I (1839) of OEUVRES COMPLETES D'HIPPOCRATES, in 10
volumes, (Paris, 1839-61) edited and translated into French by Emile Littre,
with Greek text on facing pages.
This is still
the definitive edition of the complete Hippocratic Corpus. It was undertaken
over 150 years ago when the classical tradition of Hippocratic medicine was
still alive--a monumental labor of love that took 25 years to complete--and
actually served as medical handbooks for doctors practicing
medicine.
However, before Littre's final
volume came out in 1861, Louis Pasteur had launched the Bacteriological
Revolution, beginning with his first paper in 1857, which overthrew the
Hippocratic tradition.
But, as the renowned
biologist and Pasteur scholar, Rene Dubois, wrote in 1976, in his revised
edition of LOUIS PASTEUR: FREELANCE OF SCIENCE (1949, 1976): "The germ theory
of disease has been the biggest obstacle to medical progress for over a hundred
years."
If germs exist today, they certainly
existed 2500 years ago when Hippocrates was practicing medicine and writing his
treatises. Without having a microscope by which to see minute micro-organisms,
nevertheless ancient medicine was able to treat and cure infectious diseases.
It did so by treating them as problems of internal hygiene, deriving ultimately
from one's diet and way of life, just the same as non-infectious degenerative
diseases, e.g. cancer, was treated--by addressing the internal condition of
imbalance of the diseased person.
This excerpt
is restricted to moral considerations on the practice of responsible medicine.
It can serve as a background for viewing the medical malpractice which has
become so pervasive in our time of disintegrating civilization, accelerated by
a medical establishment that preens itself on "progress" even while it cannot
heal any disease and blames most of them on Nature.)
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Hippocrates flourished in the most
brilliant epoch of Greek civilization, in the century of Pericles which has
left immortal memories. He lived with Socrates, Phidias, Sophocles, Euripedes,
Thucydides, Aristophanes; and he was not unworthy of that high
society.
He also shared in the sentiment which then suffused the
Hellenes, elated with their liberty, enthusiastic over their triumphs, taken
with their beautiful creations in the arts, in literature, and in the
sciences...
His books are strewn with reflections which show that his
mind has been constantly occupied with the memory of his own medical practice
and with the examination of the practice of other doctors. Obviously he had
meditated much on medicine. And in a good number of passages one encounters
these observations, which... are due to the reflections of those who teach, and
cause the reader to reflect.
I could cite many examples, but will
content myself with reporting one, because I will join to it the just remarks
which have been suggested to Galen by it. For his remarks develop the same idea
that I have articulated of the direction of the mind of
Hippocrates.
Hippocrates said in the first book of EPIDEMICS: "The
practitioner must have two objects in view: To be useful to the sick person or
at least DO NO HARM." Those are grave and modest words, in which one discovers,
when one digs into them, a profound meaning and a useful
teaching.
Moreover, it is necessary to allow Galen to speak, who was
struck, he also, by that remark thrown out by Hippocrates in the course of his
first book of EPIDEMICS:
"There have
been times when I regarded those few words as unworthy of Hippocrates. It
seemed to me manifestly self-evident that the duty of the doctor is to work to
relieve the sick person or at to DO HIM NO HARM. But, after having seen several
renowned doctors reproached on just this head for what they have
prescribed--blood- letting, baths, purgatives, wine, or cold water--I
understood that Hippocrates had proven similar errors, just as many others did
who practiced medicine then. Since that time, I have judged that it is
necessary not only, in prescribing an important remedy, to know to what extent
the sick person will find relief. But also I have never administered anything
without having taken guard to DO HIM NO HARM, in the case where the
prescription falls short of its aim.
"Some doctors, similarly to those
who lauched out since then, prescribe treatments which, if they miscarry, are
very deadly to the sick persons. Those who begin the study of medicine believe,
of this I am certain, as I had believed formerly, that this advice "TO BE
USEFUL OR AT LEAST DO NO HARM", is unworthy of Hippocrates. But the
practitioners, of this I am no less sure, in comprehending all the significance
of those words, if it ever happens to them to cause harm to their patients by
the untimely administration of some active remedy, it would be especially then
that they understand the meaning and the gravity of the warning that
Hippocrates has bequeathed to them." The
chief of the school of Cos frequently reminds the doctors of the duties that
they have to fulfill, and the rules of attention, of care, of prudence which
their profession imposes on them with regard to sick people. Hippocrates has
completely expressed his feeling on this important subject in a few words: "The
medical art has three terms: the sickness, the sick person, and the doctor. The
doctor is the servant of the art; and, with the doctor, the sick person must
combat the sickness." (EPIDEMICS I)
In addition he said: "The first
consideration to hold in all medicine is to heal the sickness." This feeling is
natural in a man who loves his profession, who feels the value of it, and
consequently the obligations and the moral responsibilities. The love of the
profession of medicine is manifested by Hippocrates in a good many passages.
The word which serves him to designate the profession is "the art". Anything
which could compromise or diminish its credit in the opinion of the public,
wounds it.
He has his eyes constantly fixed on this point. And he
signals it forcefully to his colleagues. When the doctors of that remote epoch
contradict one another in their prescriptions and their advice, Hippo- crates
tells them that they discredit the profession to the point of making people
believe that there is no art of medicine. And that of a sort they resemble the
diviners who each interpret in a contrary sense the flight, to the right or to
the left, of birds (REGIMEN IN ACUTE DISEASES, VIII).
And, in searching
to establish upon solid foundations the doctrine of "Regimen in Acute
Diseases", he aims to prevent, on an essential point, the divergences contrary
to the honor of the medical art. One of the reasons why he recommends doctors
to familiarize themselves with the study of prognostic signs is that they
thereby acquire the advantage of the confidence of the sick person, who then
decides to put himself into their hands (PROGNOSTIC, I).
Also Galen has
made the remark: "Hippocrates occupied himself not only with sick people, but
moreover with the doctor, to the end that he be always irreprehensible in the
practice of his art, and that he obtain consideration and respect."
The
recommendations of this sort which are found frequently repeated in the works
of Hipocrates are so much in accord with the HIPPOCRATIC OATH that they form a
new argument in favor of the authenticity of that piece. The same spirit
breathes in it. The same feeling dominates it.
And, if the reasons which
I have adduced further back for granting acceptance to the legitimacy of the
OATH, do not have all the rigor that one could desire, they acquire, it seems
to me, much force when one has under his eyes gathered into a single sheaf all
that Hippocrates has disseminated in his works on the duties of doctors and
upon the consideration that they carry, in practicing these duties, to make
their profession attractive.
Celsus has praised the scientific probity
of Hippocrates in a brilliant phrase which is engraven in all the
recollections. I will not authorize myself to make use of this testimony. For
the fact which Celsus invokes is in the fifth book of the EPIDEMICS (V, 27: "I
was unaware that I should trephine because I did not notice that the sutures
had the injury of the weapon right on them, since it became obvious only
later." -Loeb ed., VII, 1994, p. 179). This book forms a collection of notes
which one cannot attribute to Hippocrates with some surety.
But the very
list of observations which he has transmitted in the 1st and 3rd books prove
that he did not try to hide his wrong side and cite only his successes. He has
recorded with candor the disasters which he experienced. The number of deaths
that he reports is a faithful fact. It is the same feeling of probity which
inspired in him the most lively repugnance for all that he perceived to be
charlatanism.
This reprobation rings out in a good many passages. I will
not cite but one, because it remains applicable to all times and to all
countries. Hippocrates, after having said that the interest of the sick person
must come before everything else, adds: "When there exists several procedures,
one must employ that which is the least ostentatious, that which does not
pretend to dazzle the eyes of the vulgar by a vain show, perceiving that such
must be the conduct of a man of honor and of a true doctor."
The hatred
which Hippocrates felt and expressed in regard to the charlatans is very
comparable to the hatred which animated Socrates, his contemporary, against the
sophists. The doctor and the philosopher pursue with an equal reprobation men
who abuse popular credulity, those with false medicine, the others with false
wisdom.
Not only does Hippocrates blast the manoeuvres of the
charlatans. Not only does he warn the public against the artifices of the men
who make them their dupes. But he also cautions with all his strength the true
doctors against all the temptations that they could have of allowing themselves
to employ a charlatanism more or less innocent.
He holds them on guard
against this peril. He does not want their conduct to have the slightest
appearance of it. He recommends to them, above all, to use that which is
simple, right and honest. It was truly necessary that Hippocrates had been
outraged by the spectacle of effrontry given by the charlatans and by the
credulity of the public, in order to insist, in the service of the doctors, his
students, with so much force, not only against the use of scandalous
charlatanism, but also against all conduct of which exclusive care would not
let deviate even slightly into the shade.
The war against the sophists
waged by Socrates, the war against the spirit of charlatanism waged by
Hippocrates, are of the same epoch and bear the same
character.
Hippocrates presents to us the first example that we know of
medical polemics. The book ON ANCIENT MEDICINE is a polemical book for the most
part. His treatise on REGIMEN IN ACUTE DISEASES opens with a discussion against
the book of CNIDEAN SENTENCES. I have given elsewhere the history of that
debate, and I will expound the points of medical philosophy on which it
touches. It is an interesting subject of study to take account of the divisions
in science which have occupied our predecessors. The quarrel between Cos and
Cnidus, between Hippocrates and Euryphon, is important because it is the first
that we know, and by the very foundations which it constitutes.
One
finds in the writings of Hippocrates a good many passages where he criticizes
the particular procedures employed by the doctors of his time, in the treatment
of different affections. He has sufficiently reflected upon those things to not
accept without judgement the traditions of the past, or the examples of his
confreres. He had enough experience personally to form an independent opinion
upon the principal points of medicine. And he expressed himself with a just
authority on what he approved and what he condemned.
Hippocrates is
essentially a practitioner. If in medicine he knows but the art, at least he
wants the art to be treated scientifically, that is to say that on all
occasions one apply attention and judgement to it. When he recommends to search
for the solution of certain problems of medicine, these are the problems
relative to the type of diet [genre de regime] which it is advisable to
prescribe to sick people with acute diseases.
And if he praises the
second edition of the CNIDEAN SENTENCES as being a little more medical than the
first, it is because it contains more regarding practice, and the additions are
more appropriate for the usage of a doctor. For him, medicine is always the
art; what he wants is to convey its light into the observations that have been
collected. The art is thus to seize the general principles which guide the
practice of medicine, and give to the art a scientific foundation. That way he
raises it to a science.
His merit is great for knowing how to confine
himself within this order of ideas. The art was still too near the empiricism
from which it had issued, to have pretensions much higher than what Hippocrates
attributed to it. And this doctor had a mind too judicious to regard as a sure
guide the physiological speculations which occupied all the philosophers of his
time, and so threw himself into the field devoid of hypotheses...
Much
has been written about Hippocrates, and one could write much more yet. The
capital compositions which antiquity has bequeathed to us have the
characteristic that the study of them never can be exhausted. Science, at each
progress that she makes, perceives them from a new point of view and under
another day. The labors of our predecessors on these old monuments does not
exempt us from examining them on our own account. Because for us there is also
an abundant harvest of facts, of thoughts, of indications that will be useful
to better understand present-day medicine.
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Postscript by the translator:
Coming back to Emile Littre's exposition of Hippocrates has been just as
inspiring as when I did the translation initially a year ago. There is much
food for thought in it, especially his closing exhortation that the study of
Hippocratic medicine can shed much light on the crisis of Western Medicine in
our time. Not a few critics of modern medicine have urged in recent years "a
return to Hippocratic holism," as the phrase
goes.
However, the Hippocratic Corpus is
virtually totally unintelligible to medical-school minds, because there has
been a complete severance of modern medicine from its fountainhead in
Hippocratic classical medicine.
That's the
down side. The up side is that intellectual access to the sealed books of
Hippocrates is possible through the practice and study of Macrobiotics. Indeed,
as Michio Kushi points out visually on page 27 of THE BOOK OF MACROBIOTICS
(1977, 1986 Rev. ed.), Hippocrates is the ultimate source of
Macrobiotics--followed by Hufeland, Ishizuka, and Ohsawa--as well as the Father
of Western Medicine!
If that is the true
historical fact, then why should Western Medicine let Macrobiotics steal the
mantle of Hippocrates, while he remains unknown in medical
schools?
I have a much lengthier piece,
Littre's chapter XIII: "Summary Exposition of the Medical Teaching of
Hippocrates" (1839), that I hope to post also in the near future.
-Harold
Kulungian 15 Nov. 2000 |
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EAT
YOUR WAY TO HEALTH
Harold Kulungian