Tag Archives: ancient medicine

Ethnographic “Racism” in Ancient Philosophy

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There can be very little, except the evergreen pride of modernity, that gives us hope that our beliefs and practices are exempt from some future condemnation in a world so distant our comprehension of it could hardly be distinguished from loathing.  When it comes to our own canon of sins, foremost among them appear to be those forms of discrimination that are lodged against certain groups or classes.  As an analog to these prohibitions, social propriety has, probably correctly, identified among the chief causes stereotypes and accordingly speaking of the general characteristics of a people is deemed off-color and brutish.  There are occasional and accepted forays into the generic, though.  Despite the mild import of such thoughts as, “The French have wonderful cuisine,” it is a curious thing to distinguish what exactly it is we object to when we hear a generalism about a culture or race.  Before I ask a few questions about that, it may be helpful to look at a couple things said, by way of example, by Hippocrates and Plato.

And concerning the listlessness and cowardice of peoples, the seasons are especially the cause why Asians are less martial than the Europeans and more tame in their character,for making no dramatic shift either to the hot nor to the cold their seasons are temperate. For there are no mental disturbances nor strong change of the body, from which it is more likely that the passion is roused and indulges the senseless and high-spirited rather than when it is in a steady state.  For it is change of everything which wake the disposition of men and do not allow it to rest.  For these aforesaid reasons it seems to me that that the Asian race is weak and yet further so because of their customs.  For much of Asia is ruled by a king.  And where men do not rule themselves nor are autonomous, but are ruled by a despot, there is no reason for them to concern themselves over this.  So that they do not practice the military disciplines, but they work to seem pacifistic (Hippocrates, Airs, Waters, Places, XVI). (1)

 

For it would be absurd if someone should think that spiritedness does not occur in our cities from private citizens, who indeed have this reputation, such as those who live throughout Thrace and Scythia and nearly all the northern areas, or love of learning, which indeed someone would say is especially prevalent in the area around us, or as someone would say that the love of money is not least among the Phoenicians or Egyptians (Plato, Republic 435e3-436a3). (2)

Setting aside the accuracy of Hippocrates’ description of Asians, his explanation appealing to geographical and sociological causes is less jarring than Plato’s, whose opinion appears informed only by a cryptic Athenian prejudice.  Both cases, however, are less egregious than when a comparison is made between groups wherein one is deemed superior, one inferior, such as in the following from Aristotle.

Therefore the poets say, “It is fitting that the Greeks rule barbarians,” on the grounds that the barbarian and slave are the same in nature (Politics 1252b7-9). (3)

A few questions:

What makes the above offensive to contemporary attitudes?  Is it that a group is generalized?  Or is it that a group is generalized negatively?  (That is, a positive characterization would be acceptable.)  Or is it that a group is generalized negatively and untruly? (But this would imply that a negative generalization, if true, would be acceptable. Or on the other hand perhaps, does this mean true, negative generalizations are ruled out a priori?)

 

 

REFERENCES:

Translations mine

(1)
περὶ δὲ τῆς ἀθυμίης τῶν ἀνθρώπων καὶ τῆς ἀνανδρείης, ὅτι ἀπολεμώτεροί εἰσι τῶν Εὐρωπαίων οἱ Ἀσιηνοὶ καὶ ἡμερώτεροι τὰ ἤθεα αἱ ὧραι αἴτιαι μάλιστα, οὐ μεγάλας τὰς μεταβολὰς ποιεύμεναι οὔτε ἐπὶ τὸ θερμὸν οὔτε ἐπὶ τὸ ψυχρόν, ἀλλὰ παραπλησίως. οὐ γὰρ γίνονται ἐκπλήξιες τῆς γνώμης οὔτε μετάστασις ἰσχυρὴ τοῦ σώματος, ἀφ᾿ ὅτων εἰκὸς τὴν ὀργὴν ἀγριοῦσθαί τε καὶ τοῦ ἀγνώμονος καὶ θυμοειδέος μετέχειν μᾶλλον ἢ ἐν τῷ αὐτῷ αἰεὶ ἐόντα. αἱ γὰρ μεταβολαί εἰσι τῶν πάντων αἱ ἐπεγείρουσαι τὴν γνώμην τῶν ἀνθρώπων καὶ οὐκ ἐῶσαι ἀτρεμίζειν. διὰ ταύτας ἐμοὶ δοκεῖ τὰς προφάσιας ἄναλκες εἶναι τὸ γένος τὸ Ἀσιηνὸν καὶ προσέτι διὰ τοὺς νόμους. τῆς γὰρ Ἀσίης τὰ πολλὰ βασιλεύεται. ὅκου δὲ μὴ αὐτοὶ ἑωυτῶν εἰσι καρτεροὶ οἱ ἄνθρωποι μηδὲ αὐτόνομοι, ἀλλὰ δεσπόζονται, οὐ περὶ τούτου αὐτοῖσιν ὁ λόγος ἐστίν, ὅκως τὰ πολέμια ἀσκήσωσιν, ἀλλ᾿ ὅκως μὴ δόξωσι μάχιμοι εἶναι.

(2)
γελοῖον
γὰρ ἂν εἴη εἴ τις οἰηθείη τὸ θυμοειδὲς μὴ ἐκ τῶν ἰδιωτῶν
ἐν ταῖς πόλεσιν ἐγγεγονέναι, οἳ δὴ καὶ ἔχουσι ταύτην τὴν
αἰτίαν, οἷον οἱ κατὰ τὴν Θρᾴκην τε καὶ Σκυθικὴν καὶ σχεδόν
τι κατὰ τὸν ἄνω τόπον, ἢ τὸ φιλομαθές, ὃ δὴ τὸν παρ’ ἡμῖν
μάλιστ’ ἄν τις αἰτιάσαιτο τόπον, ἢ τὸ φιλοχρήματον τὸ περὶ
τούς τε Φοίνικας εἶναι καὶ τοὺς κατὰ Αἴγυπτον φαίη τις ἂν
οὐχ ἥκιστα.

(3)
διό φασιν οἱ ποιηταὶ
βαρβάρων δ᾿ Ἕλληνας ἄρχειν εἰκός,
ὡς ταὐτὸ φύσει βάρβαρον καὶ δοῦλον ὄν.

Against Empiricism: Galen’s Arguments

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Galen’s Rationalism, properly understood and practiced, involves an appropriation of experience, in that by taking hold of and building upon phenomena the doctor-philosopher achieves a superior type of knowledge, an art of medicine.  Insofar as this is the case then, Rationalism is inarguably a more robust theory of knowledge compared to Empiricism, which in fact is subsumed into this Galenic Rationalism.  On the other hand, however, if Empirical phenomena are not incorporated into the superior methods of Rationalist understanding, then to this same degree they are deficient and wanting.  This naked kind of Empiricism is exactly the target of Galen’s criticism, of which I present two arguments below.

The first of these criticisms can be subtle on a first reading, and deals with argument itself.  Galen says,

For it is not their view [the Empiricists] that one can judge the truth of the matters in question in these accounts, since they believe that evident perception and memory suffice for the constitution of all arts.  But, to judge such matters it is necessary to suppose that there is some power in us which is able to consider and to judge what is incompatible and what follows.  If, then, there is no such power in us, we should not endeavor either to produce arguments ourselves or to refute those arguments which have been argued badly (Outline of Empiricism 44 trans. Walzer, Frede).(1)

Galen is not here saying that Empiricists recuse themselves from the dispute about the role of reason in medicine; rather he is forcing the point that the Empiricists have no standing when it comes to arbitrating any dispute because they have nothing to arbitrate by, except inert experience.  In order to appeal to the superiority of Empiricism over Rationalism, one has to make use of reason itself, but this would appeal to something beyond experience and memory, a resource which Empiricism does not have.  In fact, Galen implies that Empiricists are unable to be consistent in their adherence to Empiricism, since even it requires “some power in us which is able to consider and to judge what is incompatible and what follows.”  Thus, even on a strictly Empiricist program, there must be judgments about what is similar or dissimilar, compatible or incompatible, consistent or inconsistent concerning the phenomena under investigation, if one is expected to categorize or understand the information.  In summary, to argue at all is to enter into the Rationalist camp.(2)

There is an equally clever, perhaps sophistic, argument against Empiricism which was mentioned earlier in the treatise as well, but gets it full narrative force in On Medical Experience.  Galen is attempting to use a traditional sorites-type argument and apply it to medical practice.  The puzzle is summarized as follows: if it is agreed that the art of medicine is constituted only by a number of experiences, at precisely what number of experiences do we say that a doctor has acquired the art of medicine?  He pesters the Empiricist to respond as to why a certain number of experiences is not sufficient to guarantee this art: is it 12, 40, 100 times?  No matter the number, though, says Galen, it will be a finite number.  He can then ask why it is that one less than this critical number is not sufficient to constitute the art.  More importantly though, he has shown a point of inconsistency in the Empiricist’s method which cannot be solved by experience.  The inconsistency is that the Empiricist’s initial position was that one experience was insufficient for the acquisition of the art.  But now when say the critical number is 50, in the process of passing from 49 to 50 experiences, that is, the addition of one experience, then the Empiricist claims that this single experience makes all the difference.  I take it this sorites argument appeals to Galen’s earlier contention that Empiricism, in its very nature, is not equipped to deal with arguments, since these lay outside the realm of phenomena.  Yet it also seems that Galen is pointing out something about the very nature of experience.  Experience, as the Empiricist wishes to have it in the medical art, is deeply limited in Galen’s view, because, were it not for the addition of something else at a given point during the procedure of induction, induction would blithely continue on ad infinitum with, quite literally, no reason for it to pause in its course.  The impetus for experiences to coalesce into an art cannot come from experiences themselves, no matter how numerous, but from some guiding rational principle that orders and arranges the information into a comprehensible whole.  This rational principle, of course, if it is discerned by a faculty specially designated to identify this rationality, need only be exposed to the faculty a single time for it to be properly identified.  This efficacy, a singular identification from a single exposure, is Galen’s point, and he is here forcing the Empiricist to concede it, whether it be Galen’s explanation of a Rationalist faculty or under the conditions of Empiricist induction, as this sorites argument would have it.

 

Footnotes:

(1) This text is extant only in a Latin translation by Nicolaus of Reggio in 1341.  I unfortunately do not have access to this text.

(2) There is not only an appeal to rational argument, but further, to a faculty, perhaps analogous to that between experience and the senses.  Thus there is both reason and the faculty of reason, neither of which the Empiricist can appeal to.  This argument plays right into Galen’s second objection as well, as I show.

References:

Galen. “An Outline of Empiricism.” Three Treatises on the Nature of Science. Trans. Richard Walzer and Michael Frede. Indianapolis, IN: Hackett Pub., 1985.

Galen. “On Medical Experience.” Three Treatises on the Nature of Science. Trans. Richard Walzer and Michael Frede. Indianapolis, IN: Hackett Pub., 1985.

Bodily Reverence in the Hippocratic Oath

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More recently the study of ancient medicine has gained attention, not from merely antiquarian curiosity about the developmental history of the healing arts, but from its illumination on kindred concepts arising in and influenced especially by philosophy and science, yet also inclusive of the wider Mediterranean culture.  Of particular interest to me today is the Hippocratic Oath, which many believe to apply to a small group of practicing medics due to the parochial constraints it imposes on its adherents, thus necessarily limiting the scope of its practice.  However, let’s take a look at this document in full:

I swear by Apollo the healer, by Asclepius, by Health (Hygeia), and Panacea and by all the gods and goddesses, making them witnesses, to bring to completion this oath and written contract in accordance with my ability and judgment:

To revere the man who taught me this art as equally as my ancestors, and to share my living with him, and to share with him when he lacks money, and to esteem his progeny equally as my brothers, and to teach this art, if they wish to learn it, without a wage or written contract, and to share the precepts and lectures and all other instructions both with my own sons and those of the one who taught me, and to no one else.

And I shall make use of a regimen for the help of patients in accordance with my ability and judgment, but not to act for injury or a wrongful act.  And I shall not give a deadly drug to anyone, though he ask for it, nor will I offer up such counsel.  In a like manner, I shall not give any abortifacent (lit. destructive pessary) to a woman.  But I shall observe my life and my art in a holy and reverent manner.  I shall not cut even one suffering from the stone, but I shall give way to the practitioners of this deed (i.e. surgeons). As many houses as I enter into I shall proceed for the benefit of the patients, standing afar from every willing and destructive harm, and especially from sexual acts with both female bodies and male, free and slave alike.  Whichever things I hear or see in my practice or outside my practice in the course of daily life, things which are unnecessary to ever blurt out, I shall consider such things unspeakable.  If I complete this oath, and do not violate it, may there be a gain of reputation because of my life and art from all men forever.  But if I transgress and forswear, may there be the opposite (Translation mine, Hippocratic Oath). [1]

I want to draw out a plausible interpretation as to the theoretical guidance of this oath, sworn to not only the four physician gods, but of such gravity that all the gods and goddesses are invoked as witness.  My idea is that a reverence for the body guided this guild (for this seems an apt description for this dedicated association) in all its interactions with patients.  There may have been some religious motivation for this precept or more likely, it was merely a central, refining filter through which medical practices could be easily guided instead of the alternative of detailed and cumbersome rules, such as the nitpicking “best practices” I imagine hinders modern day medical ethics.

Here are some examples that make me suspect a cult of the body.  Now of course, just as today, the physician is sworn not to give any poison to a man, and “in a like manner” (ὁμοίως) he is also not to give an abortifacent to any woman.  The “in a like manner” is intriguing because, if we are to draw an analogy, in the first instance it is the man’s body that is injured by being drugged.  Thus, in the second instance, we may infer that the woman’s body is injured by being drugged by the abortifacent. [2]  Also of note then, is that the preservation of the child is not primarily in view.  More intriguing is the proscription on surgery, telling physicians that they cannot “cut” even if the patient is suffering from stones, one of the most painful maladies. [3]  The patient must be given a referral instead.  It is tempting to think that a ban on cutting is due to an overzealous adherence to preserve or improve not the state of the patient’s health, but rather to have the physician impose even a temporary harm for a greater long-term good.  Alternatively, though, given the last line of the oath, perhaps we can consider that the physician has his good reputation in mind, and that if word gets around that he “cuts” people, even for the better, patients will be hesitant to visit him.  One need only reflect on how skittish moderns are towards doctor visits, even with drugs, anesthesia and centuries of knowledge.  Lastly consider the strange wording of the prohibition on sleeping with patients: abstain “especially from sexual acts with both female bodies and male, free and slave alike.”  This is the literal translation, it is does not say abstain from females and males, but female and male bodies  (γυναικείων σωμάτων καὶ ἀνδρῴων).  The relationship of patient and doctor requires and must respect the solemn vulnerability of the nude body, and what better way to further this than with a principled, philosophical reverence for the body?

 

REFERENCES:

[1] Ὄμνυμι Ἀπόλλωνα ἰητρὸν καὶ Ἀσκληπιὸν καὶ Ὑγείαν καὶ Πανάκειαν καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ συγγραφὴν τήνδε· ἡγήσεσθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖς, καὶ βίου κοινώσεσθαι, καὶ χρεῶν χρηΐζοντι μετάδοσιν ποιήσεσθαι, καὶ γένος τὸ ἐξ αὐτοῦ ἀδελφοῖς ἴσον ἐπικρινεῖν ἄρρεσι, καὶ διδάξειν
10 τὴν τέχνην ταύτην, ἢν χρηΐζωσι μανθάνειν, ἄνευ μισθοῦ καὶ συγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοίπης ἁπάσης μαθήσιος μετάδοσιν ποιήσεσθαι υἱοῖς τε ἐμοῖς καὶ τοῖς τοῦ ἐμὲ διδάξαντος, καὶ μαθητῇσι συγγεγραμμένοις τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί. διαιτήμασί τε χρήσομαι ἐπ᾿ ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμήν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν. οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην
20 τοιήνδε· ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω. ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν. οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσιν ἀνδράσι πρήξιος τῆσδε. ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ᾿ ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων. ἃ δ᾿ ἂν ἐν θεραπείῃ ἢ ἴδω ἢ ἀκούσω, ἢ καὶ ἄνευ
30 θεραπείης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτε ἐκλαλεῖσθαι ἔξω, σιγήσομαι, ἄρρητα ἡγεύμενος εἶναι τὰ τοιαῦτα. ὅρκον μὲν οὖν μοι τόνδε ἐπιτελέα ποιέοντι, καὶ μὴ συγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰ πᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον· παραβαίνοντι δὲ
36 καὶ ἐπιορκέοντι, τἀναντία τούτων.

[2] One source (definitely Oxford University Press) I read, though I can not find it now, claimed that only 1 in 10 women survived an abortion.

[3] Aulus Cornelius Celsus (c. 25 BC – c. 50 AD) divided medicine into precisely three areas: dietetic, pharmacology and surgery.  This division is believed to extend much further back into antiquity however.