On the Medical Art

In his work on the medical art, Hippocrates defined medicine as freeing the sick of their suffering, dulling the vehemence of diseases, and not attempting to cure those who have been overwhelmed by their ailments, knowing that the medical art cannot always restore health.  An alternative definition: the medical art brings about health in people’s bodies. An alternative definition: medicine is the art of adding and subtracting, adding what is missing, and subtracting what is excessive. An alternative definition, according to Herophilus: medicine is the art that deals with those who are well and those who are sick and those who are neither well nor sick. But most people define medicine as the art of dietetics for the healthy and of healing for the sick (Pseudo-Galen, Medical Definitions 19.351Κ).

The art of medicine admits hardly any universally applicable principles (Celsus, On Medicine Preface 63).

In medicine, even if there is universal agreement on the procedure to be followed, there is nothing universal about the result obtained (Celsus, On Medicine 7.12).

There are many wonderful things, but nothing is more wonderful than man. … He is not helpless in facing any challenge. An escape from death is the only thing he will not be able to devise, but he has thought out ways to escape from unmanageable diseases (Sophocles, Antigone 332-364).

Some medical discoveries were made accidentally. For example, the couching of cataracts was devised when a goat with a cataract recovered its sight after being stabbed in the eye by a sharp reed, and drenching with clysters was devised thanks to the ibis’s habit of filling up the skin round its neck like a douche bag with water from the sea or the Nile and injecting it into itself through its beak from behind (Pseudo-Galen, Introduction or The Doctor 14.675K).

Herbal remedies make the most significant contribution to medical treatment. Assuming that it is true that people long ago treated illnesses with plants and their roots, this is the longest established part of our discipline, and therefore the first to be commended and promoted. The reason for this is that the human race was initially fearful of putting its trust in surgery and cautery. To this day, there are still many people who resort to these other types of treatment only in dire necessity; without the hope that such procedures may cure them, they cannot face an ordeal that would be almost unbearable even if they were physically fit (Scribonius Largus, Prescriptions Preface).

In times long past, sick people were set down where passersby could see them and, if anyone knew of any cure that might be of help, either through having suffered from the same illness, or through caring for someone else who was suffering from it, they gave their advice to the sick person who needed it. They say that a great amount of medical expertise, based on experience, was gathered by this method. It would be good if diseased lives and sicknesses of the soul were exposed publicly this way, with everyone probing and inspecting them, and giving his opinion on their condition: “Are you angry? – take this precaution”, “Are you jealous? – do this”, “Are you in love? – so was I once, but I thought better of it”. What actually happens is that, by living in denial, hiding their sickness, and covering it up, people let it sink deeper into them (Plutarch, Is “Live Unknown” a Wise Precept? 1128e).

“When a case has reached the incurable stage, why should we spend any more time investigating it?” This is definitely not the correct approach, for understanding the incurable stage is part of the same process as the earlier stages, and it is not possible to separate them from each other. We have to devise ways of ensuring that curable cases do not become incurable, through understanding how best they can be prevented from progressing to that stage, but we should also take notice of incurable cases so as to avoid causing unnecessary harm (Hippocrates, On Joints 58).

Hippocrates thought that the first thing a medical student should practice is bandaging. This can best be done on wooden models carved in the shape of a human being, but, failing that, you can practise on children’s actual bodies (Galen, On Hippocrates’s In the Surgery 18b.629K)

When someone told Diocles the physician that, since he had bought a medical book, he did not need any further medical education, Diocles replied, “Books are reminders for those who have learned, but a mere memorial for the ignorant” (Diocles, frg. 6).

There are some doctors and intellectuals who maintain that it is not possible for anyone to know medicine until he knows what man is, and that anyone aspiring to give people proper medical care has to gain a good knowledge of this. … But I believe that anything that any intellectual or doctor has said or written about nature along these lines has less to do with the art of medicine than with the art of painting. I believe that it is impossible to learn anything for certain about nature from any source other than medicine. And I maintain that it is possible to acquire this knowledge only when one has come to understand every aspect of medicine, and not before (Hippocrates, Ancient Medicine 20).

It is both cruel and unnecessary to dissect the bodies of the living, but the dissection of corpses is essential for medical training. Beginners need to know about the position and the order of body parts, and these are illustrated better in a corpse than in a living and wounded person. Other information that can only be gathered from living bodies will be picked up rather more slowly but much more gently through practical experience in treating wounded people (Celsus, On Medicine Preface 74).

It is not cruel, as most people maintain, that remedies should be sought for innocent people’s ailments in all future ages through the sufferings of just a few criminals (Celsus, On Medicine Preface 26).

Medical writings in any language other than Greek lack prestige even among the uneducated who do not know Greek. When it comes to health matters, people have less confidence if they know what is going on. That is why, by Hercules, anyone who claims to be a doctor is trusted straightaway. Medicine is the only profession in which this happens, even though there is no other profession in which falsehood is more dangerous. But we pay no heed to that danger, for everyone finds the sweetness of wishful thinking so seductive. Moreover, there is no law to punish ignorance that costs lives, and no precedent for redress. Doctors learn through endangering our lives, conducting experiments that lead to people’s death. Only doctors have total immunity if they kill people. In fact, the criticism is transferred to the patient, who is faulted for self-indulgence: those who die are actually held to have brought their death upon themselves (Pliny, Natural History 29.17).

Just as Romans were impressed by doctors speaking Greek, Greeks themselves were impressed by Greek spoken by doctors in non-local dialects. In a fourth-century BC comedy (Alexis, frg. 146), a character remarks that “If a doctor born in Athens says ‘Give the patient a bowl of gruel in the morning’, we despise him immediately, but, if he says ‘gruel and a bowl’, we are amazed.” The general point is clear, though the specific humor, if there is any, is lost.

Philosophers were not the only Greeks that Cato hated. He was also suspicious of Greeks who practiced in Rome as doctors. He had probably heard about how the Great King of Persia had invited Hippocrates to come to his court for a fee of many talents, and how Hippocrates had replied that he would never made his services available to barbarians who were enemies to the Greeks. Cato used to say that all the Greek doctors had sworn an oath to this effect, and he urged his son to be wary of them all. He had written a collection of treatments and regimens which he followed in tending those in his family who fell sick. He never required anyone to fast, and fed them on vegetables and morsels of duck, pigeon, or hare. (He claimed that hare meat was light and suitable for sick people, the only side effect being that those who ate it often had dreams.) He boasted that, by observing such methods in treatment and regimen, he himself was healthy and he kept his family healthy. But such boasting evidently did not go unpunished, for he lost both his wife and his son. He himself, however, stayed physically fit and robust, maintaining his vigor so well that, even as an old man, he frequently had sexual intercourse, and he actually married again when he was past the age for such things (Plutarch, Life of Cato the Elder 23).