Hippocratic and Ideological Medicine (Part I)

by Angelo Fiori

Hippocratic and Ideological Medicine

---

The Hippocratic Oath

I SWEAR BY APOLLO THE PHYSICIAN and aesculapius—and health—and all—heal—and all the gods and goddesses—that according to my ability and judgment—I will keep this oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents —to share my substance with him—and relieve his necessities if required—to look upon his offspring in the same footing as my own brothers—and to teach them this art—if they shall wish to learn it—without fee or stipulation—and that by precept—lecture—and every other mode of instruction—I will impart a knowledge of the art to my own sons —and those of my teachers—and to disciples bound by a stipulation and oath according to the law of medicine—but to none others—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—I will give no deadly medicine to anyone if asked—nor suggest any such counsel—and in like manner I will not give to a woman a pessary to produce abortion—with purity and with holiness I will pass my life and practice my art—I will not cut persons labouring under the stone—but will leave this to be done by men who are practitioners of this work—into whatever houses I enter —I will go into them for the benefit of the sick—and will abstain from every voluntary act of mischief and corruption —and further—from the seduction of females or males—of freemen and slaves—whatever—in connection with my professional practice—or not in connection with it—I see or hear—in the life of men—which ought not to be spoken of abroad—I will not divulge as reckoning that all such should be kept secret—while I continue to keep this oath unviolated—may it be granted to me to enjoy life and the practice of the art—respected by all men—in all times —but should I trespass and violate this oath—may the reverse be my lot.

---

The legislation to liberalize abortion which is spreading like wildfire marks a victorious phase of ideological medicine over Hippocratic medicine. The political authority, presuming that it can intervene even in the sacred area of life, applies the play of majorities and consequently assumes, in the name of all, decisions which actually are not in its sphere of competence, in view of the nature of the interest in question.

As if that were not enough, it claims to entrust the material execution of sentences of abortion to one category of citizens alone, physicians, deeply distorting the purposes of a professional activity born for life. Conscientious objection is granted, it is true, but through bureaucratic mechanisms which, whatever their inspiration may be, tend in actual fact to discourage it, putting the doctor in the disagreeable position of one who refuses to carry out what is unilaterally declared to be a "social duty".

It is impossible to understand what this event means nor can a line of resistance and an ideal programme be drawn up unless we examine the nature of Hippocratic medicine, as opposed to ideological medicine.

The history of medicine is rich in complex counterpoints, often coexisting in the same period, in the same medical school and sometimes even in the same physician. Only the necessity of a scholastic schematization can inspire classifications aimed at pinpointing within it precise movements of thought that do not concern the purely scientific aspects but embrace medical science in its multiform aspects. Since it opposes a Hippocratic medicine—an expression which alludes to medical practice of ancient "good" inspiration—to an ideological medicine—an expression which, on the contrary, alludes transparently to a medicine that is negatively conditioned—it is an operation which already runs the risk of superficial dogmatism.

It cannot be denied, however, that the history of medical science, as always happens in history, moreover, contains in the flow of the vicissitudes and men that have been its protagonists, the seeds and developments of trends, which if not always conflicting are at least divergent and can be determined.

Physicians have consciously referred to these trends throughout the ages, causing, as a result of the temporary prevalence of one tendency over the other, considerable differences in the content of medical art and even giving it very different rates of development.

Two trends

"Hippocratic medicine" and "Ideological medicine" wish to be, obviously, significant expressions and claim to condense trends, by means of the use of two adjectives, one of which refers to a "father" of rational and individual medicine, while the other is derived from a noun (ideology) in common use, the meaning of which is well known.

It is with these trends that we intend to deal. We shall try to clarify, in the first place, with more details what their features are. Subsequently we shall try to establish if actually, in the course of the history of medical science, these trends are always present and in what forms, to what extent one prevails over the other, for what reasons, and with what consequences; to ascertain if this dualism is still present today and if there are rational and ethical reasons to operate an alternative choice between the two trends, or else a choice that disregards both: in particular to ascertain if this choice is justified also by the present juridical, political and social context...

By Hippocratic medicine can be designated a trend of thought and medical practice which finds not only in the oath attributed to Hippocrates, but also particularly in the scientific and professional approach of the great Greek physician, one of the most ancient and complete representations. It is characterized substantially by Galileo's principle of free and not preconceived observation, of equally free and independent evaluation, and of a consequently logical practice: everything in so far as historical contingencies and the laws of society allow.

This line can be considered opposed, as has been said, to another one that is even more ancient, but still re-emergent. This latter cannot be attributed particularly to any ancient or modern physician and is characterized by scientific, and even professional, approaches that are strongly conditioned by ideology of any type.

The term ideology came into being in 1798 with the "Memoire sur la faculte de penser" by Antoine Louis Claude Destutt de Tracy, read at the "Institut National des Sciences et des Arts" in the section dedicated to the "Analysis of sensations and ideas". It was seen to be necessary at that time to find a new name to designate the "science of thought", and the author thought of substituting a science of the effects of thought—ideas and their expressions—for a science of thought as formal cause. These were the intentions, but the author himself, in his "Elements d'ideologie", published between 1803 and 1805, brought up again what he had endeavoured' to suppress, the problem of the first and absolute cause.

This is certainly not the place to retrace the ground which, from philosopher to philosopher and from age to age, was covered by the term "ideology". All we need, in fact, is to ascertain its present meaning, often characterized by disparaging tones, of an "abstract doctrine not founded on practice", "collective ideas of a party" or better, according to Mannheim, "system of ideas of a group or an age". Less used, on the other hand, is the Marxian meaning of "masking of interests".

If the term is, therefore, comparatively recent, the meaning it has assumed at present is such as to make it possible to apply it to very ancient situations in the history of man and the history of sciences, especially of medicine and biology, in which ideology has played an essential role, often as a cause of error in doctrine and in practice.

It seems to us useless, as they are so well known, to recall the innumerable errors committed by medicine in the course of its now long life... What is interesting is to consider some of the causes of these errors.

There obviously figure among them gaps in knowledge and in technique, which have been filled to an appreciable extent only in the last two centuries. It is equally true that there are others which are not identified in those gaps, but go back to preconceived approaches in doctrine and method which are in themselves limitative, capable of pushing into the background and sometimes even neutralizing the scientific and practical goals already reached.

These approaches were often borrowed uncritically from other sectors of human thought. We are alluding to the negative influences that have always been exercised on medicine in all ages by the dominant ideologies: philosophical, political and even scientific—obviously pseudoscientific—ideologies.

Along the way

A short survey of some outstanding moments of the history of medicine will make it easier to prove the reality of this supposition.

In the millennia that cover the span of the civilizations best known to us, two sufficiently distinct periods can be determined. The first stretches approximately from the beginning of known civilization, that is from the dawn of medicine, up to the end of the eighteenth century; the second one from the beginning of the nineteenth century to our own days.

In the first, of these periods the conflict between Hippocratic medicine and ideological medicine concluded with the domination of the latter, often prolonged for many years. An effect consisted in the arrest, sometimes for centuries, of medical scientific development, although ideological medicine was not the only cause of this effect.

In the following more recent period, Hippocratic medicine, drawing advantage from the impressive development of all sciences, especially in physics, chemistry and technology, shook off in the most strictly technical and scientific fields the shackles of ideological medicine. Ideology, on the other hand, ousted from the mainstream of medical development. has appeared again arrogantly in those areas of medicine that are most closely connected with the ethical foundations of medical thought and practice: just think of the problems of abortion, contraception, experimentation on man. euthanasia.

That does not represent, of course, anything new and is, in fact, the repetition of ancient models of influence of ideology. These today are more or less skilfully camouflaged and updated in the ways and in the purposes declared. Ideology. on the other hand, has not exhausted its influence even in the more specifically scientific sector and even today it is important in those restricted areas of medicine in which there is still space for its action, as, for example, psychiatry.

In the long period that we took as ending at the beginning of the nineteenth century, medicine went through phases that varied considerably, more or less closely connected with those phases that determined man's thought as it took shape in the different cultures and civilizations. Medical progress was irregular, interrupted by long, barren periods of stagnation, marked by an interminable series of attempts and withdrawals, successes and failures.

Archaic medicine

Archaic medicine which has lasted up to our time in certain populations (and which flourishes again perennially in the civilized world through magicians and healers) was identified everywhere with magic and religions. Illness was considered a possessive manifestation, extraneous to man, inflicted as a sanction by evil genii. So recovery inevitably required the intervention of personages who declared they were capable of having contact with supernatural powers; magicians, soothsayers, "priests". Pathology and therapy were, therefore, only aspects of mythology, even though the marginal principle of recourse to elementary empirical means was accepted. We are, therefore, in the absolute predominance of ideological medicine.

A subsequent phase witnessed the desacralization of medicine. This phase corresponds in the Graeco-Roman world, to the six centuries that separate the innovating work of Hippocrates from that of Galen. Passive but intelligent observation of the facts takes the place of blind mythological beliefs. Illness is humanized, it stops being extraneous to the person who is ill and is identified with him.

It is opportune to meditate on these historical events and above all on the work of Hippocrates, whom we have taken as the emblem of a movement of medical thought, successful in the end, but threatened again today. We intend to refer not so much to the de-ontological aspects but rather to the more specifically scientific, and, in particular, methodological aspects of the work of Hippocrates, as it has come down to us.

Desire to know

Hippocrates is now traditionally the personified expression of medicine which, having emerged from the empiricism-ideologism of the school-temples, becomes "rational" and takes its place in the wide movement of the "philosophy of nature". In this case what is meant by philosophy is the "desire to know": the whys and wherefores of illnesses, their cure, of the effects of the therapy and so on. Because of this series of "whys", it can be stated that for Hippocrates it represents the very necessity of medicine that it should assert itself in that dimension that is characteristic of it, a necessity that has no age and which is more valid than ever today.

Hippocrates, in making the great effort to free medicine as a science from "priestly" influences, did not neglect philosophy, however, and in fact used it widely: but related to experience, not outside it. To investigate is recognized as a fundamental part of medical art, and investigation is carried out both through passive observation of phenomena and through the observation of provoked phenomena. From the study of particular cases, conclusions of general significance are reached in a rational way.

The technical insufficiencies of the Hippocratic age are obviously enormous and inevitably limit the field of investigations. But Hippocrates knows his fallibility and is aware of the insufficiencies. This is the essence of modern science, which arrives at the truth because it is ready to recognize its mistakes.

The work of Hippocrates was soon suffocated by a powerful movement of ideology. No sooner had medicine freed itself from mythological beliefs than it fell under the influence, only seemingly more rational, of philosophical systems based on an arbitrary logic. Thus the acquisitions of empiricism were put in the service of preconceived theories formulated in such a way as to furnish a systematic justification.

In this way there began a long period of ultraconservatism, in which religious and philosophical beliefs once more dominated medicine, at least indirectly, imposing upon it unconditional respect for dogmas inherited from antiquity or borrowed from contemporary disciplines imprisoned in dogmatics.

The very works of Hippocrates, and even more those of Galen (alongside those of Aristotle) became an ideological instrument. In this long lethargy of science, instead of using what was new on the plane of methodology in the work of these and other scientists, all that was done was to ideologize the result, very often fallacious, of their researches and scientific considerations, crystallizing it and imposing it in an intolerant and apodictic way. Science itself, therefore, becomes ideology. It was another way, not a new one, of conditioning medicine and science in general to dogmatic doctrinal schemata which are imposed and which are contrary to the free development of knowledge.

Victory of the Hippocratic spirit

During this long period of immobility, which only for the sake of exposition in schematic form we have considered the domain of ideological medicine, the opposite trend, that is, true Hippocratic medicine, was not dead. It remained alive like an underground torrent not dried up, nourished on Greek thought. About the end of the Middle Ages it succeeded in bringing its fresh waters to the West: through the Jewish, Byzantine and Islamic culture, transmitted through Spain, Salerno and Montpellier.

This ancient stream, never completely extinguished, frees its energies in the Renaissance, favoured by the discovery of printing and the deep renewal of religious and philosophical thought.

The great revolution of Renaissance thought involves medicine, in fact, giving rise to a deep critical revision of method, with increasing recourse to the experimental method.

Within this line of renewal we find, it is, true, two trends coexisting for many years. One gives primacy to reasoning over the scientific fact observed and provoked. The other, which will subsequently yield the maximum results, continues research, particularly in the experimental field, with logic and patience and makes a clean sweep of all preexisting dogma; it dedicates itself to the morphological study of healthy and diseased organs, to exploration of the functions of the human body and utilization of the progress of chemistry and physics.

This line becomes evident and is emphasized particularly at the end of the eighteenth century, having been preceded, after the enthusiasms and hopes of the Renaissance, by yet another period of weakening and dogmatic dependency. It is a question of new spasms of ideological medicine in a phase of decline, made possible above all by the continuing technical insufficiencies of the age.

Revolutions are, by definition, critical moments, sudden turning-points, prepared for a long time but then condensed in events that happen quickly. For this reason also the scientific revolution of the nineteenth century had its phases of relative stagnation, its slow periods, which preceded the new leap forward that started about 1930. After that there came an age, such as the present one, in which the Hippocratic spirit. seems to have definitively overcome all the temptations of ideological medicine.

---

"L'Osservatore Romano", Via del Pellegrino, 00120, Vatican City, Europe, Telephone 39/6/698.99.390.

This item 413 digitally provided courtesy of CatholicCulture.org