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On The Moral Obligation Of The Medical Profession According to Hippocrates
by Emile Littre (1839)
translated by Harold Kulungian (1999)

(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.)

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.

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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