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Volume 38:

The Oath of Hippocrates (full text)

Like Yogi Berra, Hippocrates may never have actually said the line for which he's most famous. First, do no harm, appears nowhere in the Hippocratic Oath -- or the rest of Hippocrates' extant writings. The closest we get here is, I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. Which is sensible, but not nearly as catchy. On the other hand, he did write Ars longa, vita brevis -- life is short, art is long -- which is catchy, and often attributed to Seneca or Horace.

The belief in medicine as an art, one requiring more than a lifetime to learn, pervades Hippocrates' writing. For this reason, he directs a physician's responsibilities towards his fellow practicioners -- especially his teachers and students -- before his patients. The first stipulation of the Oath is to reckon him who taught me this Art equally dear to me as my parents.Reading the Oath and the Hippocratic Law, which is included in the Classics with it, one gets above all the sense of an esoteric cult whose lessons aren't to be spread among the uninitiated. Those things which are sacred, are to be imparted only to sacred persons, Hippocrates writes; and it is not lawful to impart them to the profane until they have been initiated in the mysteries of the science.

Journeys in Diverse Places (full text) by Ambroise Pare

In keeping with the conventional separation of the time, Hippocrates forbade physicians from performing surgery of any kind: I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. A physician was an artist, a surgeon was a craftsman: Hippocrates would never have spoken of medicine as work to be practiced. This distinction was still upheld almost two thousand years later. When Ambroise Pare became a barber-surgeon in the early sixteenth century, Church law forbade physicians from shedding blood.

Pare's Journeys in Diverse Places is a memoir of his travels with the French army, mostly in battle against the Spanish. He was a kind of freelancer, not employed directly by the army or the state. In Brittany he is given a diamond for performing an autopsy on a wrestler. In Perpignan, he is offered a purse wherein might be an hundred or sixscore pieces of gold to dress the head of a soldier who has been struck for cheating at a dice. Eventually, he finds his way into the King's service.

There isn't much to be learned about surgery here, but there are some wonderful battle descriptions:

They went forth always an hundred or six score men, well armed with cutlasses, arquebuses, pistols, pikes, partisans, and halbards; and advanced as far as the trenches, to take the enemy unawares. Then an alarum would be sounded all through the enemy’s camp, and their drums would beat plan, plan, ta ti ta, ta ta ti ta, tou touf touf. Likewise their trumpets and clarions rang and sounded, To saddle, to saddle, to saddle, to horse, to horse, to horse, to saddle, to horse, to horse. And all their soldiers cried, Arm, arm, arm! to arms, to arms, to arms! arm, to arms, arm, to arms, arm:--like the hue-and-cry after wolves; and all diverse tongues, according to their nations; and you saw them come out of their tents and little lodgings, as thick as little ants when you uncover the ant-hills, to bring help to their comrades, who were having their throats cut like sheep. Their cavalry also came from all sides at full gallop, patati, patata, patati, patata, pa, ta, ta, patata, pata, ta, eager to be in the thick of the fighting, to give and take their share of the blows. And when our men saw themselves hard pressed, they would turn back into the town, fighting all the way; and those pursuing them were driven back with cannon-shots, and the cannons were loaded with flint-stones and with big pieces of iron, square or three-sided. And our men on the wall fired a volley, and rained bullets on them as thick as hail, to send them back to their beds; whereas many remained dead on the field: and our men also did not all come back with whole skins, and there were always some left behind (as it were a tax levied on us) who were joyful to die on the bed of honour. And if there was a horse wounded, it was skinned and eaten by the soldiers, instead of beef and bacon; and if a man was wounded, I must run and dress him.

I was reminded while I read Pare how many of the best volumes of the Classics have been memoirs of this sort, works whose interest rests not in their historical significance but in their narrative energy and descriptive verve.

On the Motion of the Heart and Blood in Animals (full text) by William Harvey

The Three Original Publications on Vaccination Against Smallpox (full text) by Edward Jenner

The Contagiousness of Puerperal Fever (full text) by Oliver Wendell Holmes

On the Antiseptic Principle of the Practice of Surgery (full text) by Joseph Lister

Scientific Papers (full text) by Louis Pasteur

Scientific Papers (full text) by Charles Lyell

The rest of the works in this volume are more strictly scientific than Pare's Journeys, but they're all memoirs of a sort. At least, they all draw their arguments out of personal experience. William Harvey's essay On the Motion of the Heart and Blood in Animals begins:

When I first gave my mind to vivisections, as a means of discovering the motions and uses of the heart, and sought to discover these from actual inspection, and not from the writings of others, I found the task so truly arduous, so full of difficulties, that I was almost tempted to think, with Fracastorius, that the motion of the heart was only to be comprehended by God.

The modern reader is likely to be repelled at least a little by the very idea of vivisection. This feeling isn't likely to lessen over the pages that follow, mostly given over to descriptions of cutting open the chests of living animals, watching their hearts beat, poking and prodding their arteries and veins. But the more historically significant point is the effort to learn about the body from actual inspection, rather than through reading Aristotle. Every assertion Harvey makes about blood, the heart, and circulation is bolstered by his personal experience. The same holds true for the works that follow. Jenner's publications on his smallpox vaccine aren't theoretical arguments for inoculation, but records of its practice in rural England. Holmes' essay is a collection of case studies. Pasteur actually refers to his works as Memoir, and like Harvey he grounds every assertion in experience. To this reader, at least, all these experiences on the operating table, on the farm, in the maternity ward and in the lab weren't as riveting as Pare's experience in battle, but taken together they've saved millions of lives.


--CRB, October 23, 2007

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