The role of spirituality in Hippocratic medicine.

To anyone studying the role of spirituality in Western medicine, the first few lines of the Hippocratic Oath should be of interest: ‘‘I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant.’’ The Oath continues to be uniquely respected among practitioners of Western medicine, and the emphasis that the Oath seems to place on spirituality from its onset stimulates inquiry into the nature of spirituality in Hippocratic medicine. The original Oath, as we have it preserved today in Greek, was almost undoubtedly not written by Hippocrates, but the work is traditionally included in the Corpus Hippocratum, a collection of medical writings attributed to Hippocrates of Cos (469Y399 BCE), written between the fifth and fourth century, BCE. Celsus, writing nearly four hundred years later, said that Hippocrates was the first to separate medicine from philosophy. The Corpus Hippocratum illustrates the unique transformation of the Western medical/healing tradition from a system that relied upon external and often divine influences as both the cause and remedy of disease, to a system where causes of diseases were less often divine and more often controllable by the sufferer. For example, dietetics was a central premise of Hippocratic medicine, where the substances we eat may cause, prevent, or treat disease. This concept excluded direct influence of any of the various gods, and placed the onus of health back on the patient and physician. This ‘‘cause-and-effect’’ observational system may very well have found its origin in Greek thought in Homer’s The Iliad, a body of work with which all successors in Western medicine and philosophy would have been intimately familiar. In The Iliad, for example, significant time and interest are dedicated to detailing the various injuries and wounds sustained by the epoch’s characters. These stories must have certainly stirred the Greek mind to understand in a cause-and-effect paradigm that, for example, death eventually followed coma, which followed fever, which followed a purulent wound, which started with a battle injury caused by another mortal Greek. At the same time, the luxury of attributing the battle injury to the will of the gods who controlled these Homeric battles was preserved, at least initially, in the Greek thought process. There gradually emerged in Greek thought a dichotomy in which some actions, mostly those well understood by the philosophers and scientists of the time, were considered wholly physical phenomena ripe for human study and exploration, whereas other phenomena were considered wholly divine. Socrates held that both classes of phenomena existed and espoused essentially two methods of investigationVone scientific and one divine. Interestingly, Socrates considered physics and astronomy as belonging to the divine class, impenetrable to human study, and Plato thought the fields could be studied, to an extent, although the sun and stars should be held as divine and the investigator ran the risk of blasphemy with such investigations. Nevertheless, at the same point in Greek history, Hippocrates clearly denied Socrates’dichotomy. Hippocratic medicine was quicker to embrace a physical model of biomedicine, although it did not abandon the divine. Again, different parts of the Corpus Hippocratum are contradictory on this point, likely the result of mixed authorship. Because Galen saw such contradiction in Hippocrates’ statement that all diseases were divine, he argued that he meant that they were all related to the state of the atmosphere. This particular hypothesis seems unlikely, but it does demonstrate that even the ancients thought that Hippocrates had abandoned ideas that were increasingly believed to be superstitious in favor of biomedical concepts. Rather, it appears that the Hippocratic author was espousing a concept put forward more famously by Anaxagoras, that of divine agency. In this idea, the gods were connected to physical phenomena from their instigation, but were not necessarily involved in the day-to-day execution of physical From the Department of Obstetrics and Gynecology, East Tennessee State University, Johnson City, TN.