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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.

Aristotle’s Categories: 10-Fold Division of Being

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(See here for the previous posts on the Categories: Chapter 1, Chapter 2, Chapter 3)

In this fourth chapter of the Categories Aristotle introduces a second division of being, classifying “things said without combination.”  When considered in their most elemental form, if they can be, on Aristotle’s view things will be organized into these 10 types of categories.  In J.A. Ackrill’s considered opinion Aristotle arrived at these categorial classifications, “by observing that different types of answer are appropriate to different questions.” [2]  However he discovered this system of classification, he introduces them very briefly by exampling them with 2 or 3 instances.

Each of the things said without combination signify either substance (ousia)[1], or quantity (poson), or quality (posos), or relation (pros ti) or where (pou) or when (pote) or being in a position (keisthai) or having (echein) or doing (poiein) or being affected (paschein). And substance is, to speak generally, for example a man, a horse; and quantity for example, two cubits long, three cubits long; and quality is for example, white, grammatical; and relation is for example, double, half, greater; and where is for example, in the Lyceum, in the market; and when for example is yesterday, a year ago; and being in a position for example, reclining, sitting; and having for example, having shoes on, being armored; and to do for example, cutting, burning; and to be affected for example, to be cut, to be burnt.

In any affirmation though, none of the things mentioned is said by itself; rather in the combination of these with each other an affirmation comes about. Each affirmation seems either to be true or false, but none of the things said without combination is true or false, for example man, white, runs, wins (translation mine, Categories, 1b25-2a10). [3]

So we have rather straightforwardly, a classification that looks like this:

Substance (ousia) example: horse, man
Quantity (poson) example: two cubits long, three cubits long
Quality (posos) example: white, grammatical
Relation (pros ti) example: double, half, greater
Where (pou) example: in the Lyceum, in the market
When (pote) example: yesterday, a year ago
Being in a position (keisthai) example: reclining, sitting
Having (echein) example: having shoes on, being armoured
Doing (poiein) example: cutting, burning
Being affected (paschein) example: to be cut, to be cut

It should be noted that when Aristotle both earlier and in this chapter spoke of “things said without combination,” he must have intended this to mean the objects to which the words refer.  We can be confident of this because he gives as an example of one his categories, which are by definition said without combination, “in the Lyceum” which is two words in Greek.  Yet, on the supposition that Aristotle was referring to linguistic terms alone, of course using two words is an example of combination.  Thus, Aristotle must be referring to the concrete items for which these terms are merely used as designations.

It is mnemonically suggestive that 8 of the 10 categories begin with the letter p (Greek π).  This might be similar to the journalistic admonition to remember the “W questions,” i.e. who, when, why, where, what.  If so, this might cynically incline us to believe that these categories were chosen because they were easily accessible to Aristotle.

In the second half of this passage, Aristotle wants to emphasis that while these categorial uses are building blocks, they are not of any use when discussing truth or falsity.  We cannot discover the truth value of “horse.” In order to make it truth-evaluable we must say, “horse is white” or “horse is grammatical,” for example.

Some interpretative questions:

Is “in accordance with no combination” κατὰ μηδεμίαν συμπλοκὴν used by Aristotle as a circumlocution to avoid adding another predicate, i.e. things that are without combination are either, etc.?

Why does Aristotle preface his introduction with “to speak generally” ὡς τύπῳ εἰπεῖν about substance (or maybe all the categories, it seems ambigious)?  Is this just to say the examples he is about to give are not exhaustive, typical, or that we should refrain from inferring too much from limited examples?

Does Aristotle want us to understand, in the second paragraph, translating more literally, “In no affirmation is each of the things mentioned predicated of itself?”  Viz. “Horse is horse”  If this is so, what does this mean for how he intended his theory of predication to be employed, since we are excluding this meaning?

 

REFERENCES:

[1] Could be translated ‘being.’
[2] Aristotle’s Categories and De Interpretatione, Oxford, 1963, pg. 79
[3] Τῶν κατὰ μηδεμίαν συμπλοκὴν λεγομένων ἕκαστον ἤτοι (25)
οὐσίαν σημαίνει ἢ ποσὸν ἢ ποιὸν ἢ πρός τι ἢ ποὺ ἢ ποτὲ ἢ
κεῖσθαι ἢ ἔχειν ἢ ποιεῖν ἢ πάσχειν. ἔστι δὲ οὐσία μὲν ὡς
τύπῳ εἰπεῖν οἷον ἄνθρωπος, ἵππος· ποσὸν δὲ οἷον δίπηχυ,
τρίπηχυ· ποιὸν δὲ οἷον λευκόν, γραμματικόν· πρός τι δὲ
(2a.) οἷον διπλάσιον, ἥμισυ, μεῖζον· ποὺ δὲ οἷον ἐν Λυκείῳ, ἐν
ἀγορᾷ· ποτὲ δὲ οἷον χθές, πέρυσιν· κεῖσθαι δὲ οἷον ἀνάκειται,
κάθηται· ἔχειν δὲ οἷον ὑποδέδεται, ὥπλισται· ποιεῖν δὲ οἷον
τέμνειν, καίειν· πάσχειν δὲ οἷον τέμνεσθαι, καίεσθαι.

ἕκαστον δὲ τῶν εἰρημένων αὐτὸ μὲν καθ’ αὑτὸ ἐν οὐδεμιᾷ κατα- (5)
φάσει λέγεται, τῇ δὲ πρὸς ἄλληλα τούτων συμπλοκῇ
κατάφασις γίγνεται· ἅπασα γὰρ δοκεῖ κατάφασις ἤτοι
ἀληθὴς ἢ ψευδὴς εἶναι, τῶν δὲ κατὰ μηδεμίαν συμ-
πλοκὴν λεγομένων οὐδὲν οὔτε ἀληθὲς οὔτε ψεῦδός ἐστιν,
οἷον ἄνθρωπος, λευκόν, τρέχει, νικᾷ. (10)

Aristotle’s Categories: Predication with Genus and Differentiae

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(See here for the previous posts on the Categories: Chapter 1, Chapter 2)

Aristotle’s philosophical writing, often opaque in style as well as content, can also venture into extended periods of intricate simplicity, innovating complexity and depth from a rather limited set of fixed, technical terms.  This is the case for much of the Categories, and chapter 3 certainly fits this description as well.  In this post, I will be continuing my quasi-commentary on Aristotle’s Categories, now arriving at chapter 3.

Whenever one thing is predicated of another as of a subject (ὑποκειμένου), as many things as are said of the thing being predicated, all of these will also be said of the subject. For example human is predicated of an individual human, and animal is predicated of a human. Therefore animal will be predicated of an individual human also. For an individual human is both a human and an animal.

 

Of the things differing in genus and not being subordinated to one another there are differentiae different in kind (τῷ εἴδει), for example, there are [distinct] differentiae of animal and of knowledge: footed, winged, water-dwelling, two-footed, and none of these is [a differentia] of knowledge. For [one kind] of knowledge does not differ from [another] knowledge by having two feet. Yet nothing prevents there being the same differentiae of the genera subordinate to each other. For the higher genera are predicated of the things said under them, so that as many differentiae as there are of the thing being predicated there will be of the subject as well (Translation mine, Categories 1b10-24). [1]

Aristotle begins this section with the confusingly worded, “Whenever one thing is predicated of another as of a subject (ὑποκειμένου), as many things as are said of the thing being predicated, all of these will also be said of the subject.”  Now the example that follows makes the concept he is addressing here rather clear.  If an individual human is a human, and if a human is an animal, then an individual human is an animal.  In this instance, using Aristotle’s terminology, the subject and the thing being predicated of is “the individual human,” while the thing being predicated is “human.”  (Keep in mind that I use quotation marks not to designate a mere linguistic term, but to clarify and distinguish the objects to which they refer.)

Aristotle next invokes language about genus and differentia (plural, genera and differentiae.)  Assuming that there are such entities we may roughly think of as “kinds of things,” designated as genera, then it follows that these things must be organized and distinguished from each other in some way.  For example, taking animal as a real genus, we can say that there are (at least) two “kinds”: birds and fish.  These two kinds of things, birds and fish, are each a species of the genus animal, and although they belong to the genus animal, birds and fish are distinguished from each other by differing in some salient way.  Possession of this differing property or properties, such as scales or feathers, is what makes the one animal (fish) differ from the other (bird).  Thus these properties are called differentiae.  Since this usage of genus is not to be confused with our modern classifications in biological nomenclature, we can freely apply the term genus to whatever level of kinds of things we wish.  With confidence in being philosophically consistent, in other words, we can also say that in addition to animal, fish is also a genus, with the differentiae of salt-water or fresh-water picking out two other species based on the difference of the type of water inhabited.  What Aristotle warns against in the second half of this text is being sloppy when it comes to distinctions made in one genus that do not apply to another, viz. knowledge and animal, where one applies two-footedness to knowledge.

 

REFERENCES:

[1] Ὅταν ἕτερον καθ’ ἑτέρου κατηγορῆται ὡς καθ’ ὑποκει- (10)
μένου, ὅσα κατὰ τοῦ κατηγορουμένου λέγεται, πάντα καὶ κατὰ τοῦ ὑποκειμένου ῥηθήσεται· οἷον ἄνθρωπος κατὰ τοῦ τι-
νὸς ἀνθρώπου κατηγορεῖται, τὸ δὲ ζῷον κατὰ τοῦ ἀνθρώπου·
οὐκοῦν καὶ κατὰ τοῦ τινὸς ἀνθρώπου τὸ ζῷον κατηγορηθήσε-
ται· ὁ γὰρ τὶς ἄνθρωπος καὶ ἄνθρωπός ἐστι καὶ ζῷον. (15)
τῶν ἑτερογενῶν καὶ μὴ ὑπ’ ἄλληλα τεταγμένων ἕτεραι
τῷ εἴδει καὶ αἱ διαφοραί, οἷον ζῴου καὶ ἐπιστήμης·
ζῴου μὲν γὰρ διαφοραὶ τό τε πεζὸν καὶ τὸ πτηνὸν καὶ τὸ
ἔνυδρον καὶ τὸ δίπουν, ἐπιστήμης δὲ οὐδεμία τούτων· οὐ γὰρ
διαφέρει ἐπιστήμη ἐπιστήμης τῷ δίπους εἶναι. τῶν δέ γε (20)
ὑπ’ ἄλληλα γενῶν οὐδὲν κωλύει τὰς αὐτὰς διαφορὰς εἶναι·
τὰ γὰρ ἐπάνω τῶν ὑπ’ αὐτὰ γενῶν κατηγορεῖται, ὥστε
ὅσαι τοῦ κατηγορουμένου διαφοραί εἰσι τοσαῦται καὶ τοῦ
ὑποκειμένου ἔσονται.