j-r

A CLUSTER ANALYSIS

OF THE

HIPPOCRATIC OATH

Paul A. Fritz

A Dissertation

Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

August 1978

Approved by Doctoral Committee

MUNG GREEN SIKIE JlflllMf “W*1 ''",’7 © 1978

PAUL ALVIN FRITZ

ALL RIGHTS RESERVED li

ABSTRACT

The Hippocratic Oath appears to dictate moral rectitude and

altruism of motive to a physician. This research examined the Oath

as it appeared in the Greek Hippocratic Corpus to determine if this

motive actually was present in the original Oath.

Kenneth Burke's cluster analysis was applied to the Oath to

analyze motive. An index of terms was constructed by comparing key words in the Oath with the usage of those words in the twenty-six books of the translated corpus. A concordance of those terms was con­

structed from the index which showed the contexts of the key terms.

If an author's motives can be detected in the symbols that he uses to describe his scene, then an examination of the contexts of those symbols will give an indication of the author's motives.

The chief motives found by this analysis were not variations of altruism, but a desire to perpetuate a specific methodology of med­ ical treatment, a desire to dissociate the Hippocratic physician from quacks and religious healers, and a desire to win high repute from the patient.

Though altruism is not the chief motive in the original Oath, the key cluster terms are ambiguous enough to allow new meanings to be applied to the motives in the document as the Oath moved through history. These new motives were: devotion to duty, identification with divine healing, and moral rectitude. Ill

ACKNOWLEDGMENT

My beautiful and loving wife Margaret deserves most of the

credit for this research by putting up with me during the past three

years of study. In a world where a wife's role is in perpetual re­

definition, she proves that there are still some women who know the

traditional skills of not allowing a husband to be consumed by his own delusions.

My dear friend and professional colleague in the Church, Pastor

T. David Morgan also deserves special thanks for asking the reality producing question, "What good is this research for the parish pastor?" and who rescued me from the blizzard of '78. In a world of shifting definitions about the role of the clergy in society, he proves that there are still shepherds left who are smart enough to ask the laity accurate questions that make us squirm in our intellectual concupiscence.

My advisor, Dr. Donald Enholm, deserves not only thanks but a

Te Deum. In a world of strange new academic skills and practitioners, he proves that there are still a few professors left who know how to cure student paranoia by a dose of library time and a spelling dictionary

I wish to thank the other members of my dissertation committee:

Dr. James Wilcox, Dr. Thomas Rickey, and Dr. Richard Lineback. In a large state university, they prove that there are still men of good will who gladly spend the time necessary to rescue a student from his own research errors. I would like to thank the "off-campus” member of this committee, Dr. Paul Andrews of Capital University, Columbus, Ohio. He has checked the Greek used in this analysis for error and taught me IV

the modern relevance of a language of antiquity. These persons have all shared their separate skills with me to help me learn that intel lect can be sanctified only in concert and never in solo. V

TABLE OF CONTENTS Page CHAPTER I: OVERVIEW OF THE RESEARCH ...... 1

Medical Critics: The Hippocratic Oath as Clarity • • 2

The Oath and Status...... 3

The Oath and the Ideal Man...... 4

The Oath: Religion and Ethics ...... 5

The Oath and Responsibility...... 7

Medical Critics: The Hippocratic Oath as Ambiguity . • 9

The Oatha nd Paternalism...... 9

The Oatha nd Disease...... 10

The Oatha nd Ends...... 11

The Oath and EconomicG ain...... 13

Rhetorical Critics: The Hippocratic Oath as Artifact • 14

Rhetoric and Persuasive Stratagems ...... 14

Rhetoric and Psychological Constructs .... 16

Rhetoric and Textual Analysis ...... 17

Rhetoric and Choice Situations ...... 18

Method of Investigation ...... 19

Cluster Analysis: Extrinsic Data and Motive . . 21

Cluster Analysis: Research Goals ...... 24

Cluster Analysis: An Example . 24

Cluster Analysis: The Author ...... 26

Cluster Analysis: Identification ...... 28

Cluster Analysis: A Grid for Analysis .... 29

Hypotheses...... 31 VI

Review of Literature ...... 32

Justification ...... 37

Organization ...... 38

CHAPTER II: CLUSTER ANALYSIS ...... 40

Cluster Analysis and Burke's Symbolic Theory .... 42

Basic Schema for Clusters...... 43

Theory Behind Clusters ...... 47

Goal of Cluster Analysis ...... 52

The Method of Cluster Analysis ...... 53

Progression Forms ...... 53

Cluster Analysis Forms ...... 54

Dramatistic Interpretations ...... 56

Justification of Cluster Analysis ...... 57

Lack of Extrinsic Data...... 57

Calculus of Persuasion ...... 59

A Rhetoric of Motive...... 60

Burkean Examples of Cluster Analysis ...... 62

An instrument for the Analysis of the Oath .... 64

CHAPTER III: THE ARTIFACT...... 67

What Is Known About the Oath...... 69

Religion, Science, and Medicine ...... 70

Hippocrates: Life and Science...... 75

Hippocrates: Corpus and Oath...... 81 Vll

What Documents Transmitted the Oath...... 88

Questions That Remain...... 91

CHAPTER IV: CLUSTER ANALYSIS APPLIED TO THE ARTIFACT ... 94

The Data ...... 95

The Index...... Ill

The Concordance...... 117

What the Oath Appears to Say...... 118

Cluster Identification ...... 118

Cluster: Art...... 118

Cluster: Physicians ...... 123

Cluster: Patients ...... 127

Dramatic Alignments ...... 130

Functional Features ...... 130

Stages of Development ...... 131

Beginnings and Endings ...... 132

Points of Furthest Internality ...... 132

Expressions of Secrecy ...... 133

Striking Expressions ...... 133

What Motives Are Present In The Oath...... 134

What Stratagems Are Identified...... 136

Summary Calculus ...... 137

The Translations...... 137

CHAPTER V: CONCLUSIONS AND FUTURE RESEARCH 143 vili

The Motive...... 146

Vocational Differentiation ...... 147

PhilosophicalD ifferentiation ...... 152

The Method...... 155

The Effect...... 159

Future Research ...... 164

BIBLIOGRAPHY ...... 166

APPENDIX 171 LIST OF TABLES

TABLE I: Page Significant Words and Phrases in the Hippocratic Oath 97

TABLE II: Index of Significant Terms in the Hippocratic Oath Appearing in the Hippocratic Corpus ...... 99 CHAPTER I

OVERVIEW OF THE RESEARCH

Statement of the Problem

The Oath of Hippocrates^-

I swear by Apollo Physician, by Asclepius, by Health, by Panacea and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him,- to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician's oath, but to nobody else. I will use treatment to help the sick according to my ability and'judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on suffers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain forever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me.

The Hippocratic Oath written in the Fifth Century, B. C., is a medical code which should clarify the responsibilities of a physician to his patient. By swearing to uphold the moral dicta in this code,

!w. H. S. Jones, tr., Hippocrates, Vol. I (Cambridge, Massachusetts: Harvard University Press, 1957), pp. 299-301. -2-

the patient may assume that his doctor intends: 1) to do what is in

the patient's best interest; 2) to do no intentional harm to the pa­

tient; and 3) to keep what the patient tells him in confidence.2 For

many centuries, the clarity of the code appeared to assure beneficent

medical motive from doctors toward their patients.

Today however, medical ethics is being examined by critics within and without the medical profession. In an era of startling medical advances and shifting value orientations, medical commenta­ tors appear divided as to the effectiveness of the Oath to describe the doctor's responsibility to the patient and to assure the patient that the doctor's motives are altruistic. Scholastic and popular writers argue either that the Oath places the doctor's motives above doubt, or, that the Oath generates doubt about a physician's motives.

It would make good research sense, in the face of this divisiveness, to examine the motives of the original writer of the Hippocratic Oath.

Once the original motives were learned, current interpretations of the

Oath could be compared to the first Oath to learn if they conform or diverge from it.

Below will be described first, commentators who argue that the

Oath assures a doctor's positive motive toward his patient. Second, will be cited, sources which deny the positive motive. Third, a source of criticism which should supply insights into the original Oath will be explained.

2M. Jellinek, "Erosion of Patient Trust in Large Medical Centers," Hastings Center Report, 6:3 (June 1976), 16-19. -3-

Some popular and scholastic critics argue that by taking the

Oath, the patient may be assured that the doctor's medical motives

are altruistic. These critics claim that the Oath: 1) Gives the med­

ical profession high status. 2) Gives practitioners ideal moral qual

ities. 3) Sanctions a doctor's activities with religious overtones.

4) Underscores the physician's "total commitment" for the well-being of his patient.

1. The Oath And Status

According to some sources, taking the Oath allows the physi­ cian to enjoy eminence above other professions. As medical historian

G. E. Gask states: "This little document [the Oath] is a priceless possession. Here we have committed in writing these noble rules, loy­ al obedience to which has raised the calling of a physician to the highest of all professions."-^ Apparently the traditional oath of pov­ erty, chastity, and obedience of Religious Orders is outranked by "I will use treatment to help the sick according to my ability and judg­ ment but never with a view to injury or wrong-doing." J. Goodfield, another medical critic, points out that the Oath permits the taker to join a type of social/medical aristocracy. The sentiment of the

Oath "... carries overtones of nobility, sublimity, and aspiration."

3g. E. Gask, "Early Medical Schools: The Cult of Aesculapius and the Origin of Hippocratic Medicine," Annals of Medical History, 1 (1939), 128-157.

4j. Goodfield, "Reflections on the Hippocratic Oaths," Hastings Center Studies, 1 (1973), 84. -4-

It is true that the first third of the Oath establishes a community bond with other practitioners and requires that the art of healing be taught only to members who have committed themselves to the goals of the medical community. The motives here seem obvious: to estab­ lish an organization which will be viewed with respect by the rest of the society by the dedication of its members to high moral conduct.

2. The Oath And The Ideal Man

The Oath appears to give doctors an extra quality of goodness which ordinary men with ordinary moral standards do not have. K. R. S

Murthy, another medical historian states: "Great men on medicine of present times like Pavlov, Osler, Schweitzer, Carrel, were equally philosopher-scientists who substantiated the ancient truth that sci­ ences should merge with ethics and philosophy to bring peace and hap­ piness to man. It is strict adherence to medical ethics that can make an efficient physician, an ideal man as well."5 Thus the doctor is one who both knows the technique of his art and who applies it wisely to his patients. This idealized man/physician was popularized in

ABC's television series "Marcus Welby, M. D." The audience was shown how the ideal doctor could balance the dicta for secrecy and public leadership with such difficult cases as venereal disease56 contracted

5K. R. S. Murthy, "Professional Ethics in Ancient Indian Medicine," Indian Journal of the History of Medicine, 18:1 (1973), 49.

6S. Thompson, "Is Dr. Welby A Menace To Women?" New York Times September 2, 1973, II, p. 11, col. 1. -5-

by a married woman during an affair, a respected father who is also a homosexual,7 and even a pedophil who is a science teacher in a jun­ ior high school.® In each of these cases Dr. Welby confronted the dicta of his Oath: "And whatsoever I see or hear in the course of my profession . . . if it be that which should not be published abroad,

I will never divulge, holding such things to be holy secrets." And in each of these cases, Dr. Welby, without breaking professional con­ fidences, convinced the patient to admit his condition and to seek to restore order to his life. Apparently swearing to administer treat­ ment with the best of ability and judgment extends beyond biology in­ to persuasive tasks. The word "judgment" takes on social connotations in the polis of the modern hospital. Thus the motives of the ideal man/doctor are those committed not only to restore man's body, but to restoring his place in society as well.

3. The Oath: Religion and Ethics

The Performance of healing, apparently, is a duty which ordin­ ary people are not able to do because of the possibility of impure mo­ tive. The doctor, on the other hand, by taking the Oath, seems to be able to do what ordinary men are not—treat other men as an end in themselves. F. 0. Smithies states: "This word [ethics] carries with

7j. j. O'Connor, "Pressure Groups Are Increasingly Putting The Heat On TV," New York Times, October 6, 1974, II, p. 19, col. 1.

8A. Krebs, "Welby Is Scored by Gay Activists," New York Times, February 17, 1973, p. 63, col. 4. -6-

it the idea of a moral law mingling with the performance of one's

duty: a sort of fervid, soul-borne adherence to what is purely the ab­

stract principle of duty to a professional man—not doing one's duty

because it is a duty, but acting rightly from higher motive, and there­

by exhibiting true 'God-like' qualities. It is in the deontologic

sense then, that the medical neophyte pledged himself."9 It is assum­

ed that the dicta of the Oath are timeless. They are effective not

only for Greek physicians but also for modern doctors. The moral

qualities of the dicta transcend changes in cultural value systems.

The patient may depend on them because of their categorical nature as

W. F. May states: "These various professional obligations have a reli­

gious reference, as the physician declares, 'In purity and holiness

I will guard my life and my art.' The rules are categorical, univer­

sal, and to this degree ahistorical: they do not receive their authority

from particular events by which they are authorized or legitimated.

They remain operative categorically on all similar occasions: never

assist patients in attempts at suicide or abortion; never break a con­

fidence . . . ."10 This medical omnipotence is implied by current phy-

siciansll who appear to make reference to specific dicta in the Oath.

9F. 0. Smithies, "On The Origin and Development of Ethics in Medicine and the Influence of Ethical Formulae Upon Medical Practice," Annals of Clinical Medicine, 3 (1924-25), 583.

10w. F. May, "Code, Covenant, Contract, or Philanthropy," Hastings Center Report, 5 (December 1975), 29.

Hr. C. Yeager, "Doctoring Isn't Just For Doctors," Reader' s Digest, 111 (December 1977), 242. -7-

Thus the doctor is omnipresent in medical crisis ("use treatment ac­ cording to ability"). Here the tense of the verb in Greek indicates that the doctor will continue always to use his treatment. The doc­ tor does no intentional wrongl2 and can be "confessed to" without fear of reprisal.13 Further, the loving trust relationship is so valuable to the physician that he will allow no social institution—not even government—to disrupt that bond between doctor and patient.14 clear­ ly these sources argue that the doctor's motives can be trusted be­ cause he strives toward perfection in obeying them with religious zeal

4. The Oath And Responsibility

Finally, if the Oath gives the doctor highest professional status, ideal manliness, and religious zeal, then it follows that the physician must be totally responsible to the sick to use his skills.

M. B. Rock, associate dean, college of arts and sciences, University of Rochester, speaking to pre-medical students named the consequences of the Oath's dicta to heal: "Do I [speaking for the medical student] have a total, committed interest in healing people? Am I willing to endure the long hours spent in keeping records, reading journals, at­ tending rounds, and continuing self-education in order to keep up with

12w. A. Nolen, "Ten Questions Your Doctor Should Answer," McCalls, 104 (July 1977), 96.

13m. Fox, "Why People Are Mad At Doctors," Newsweek, 89 (January 10, 1977), 4.

14m. H. Parrott, "American Medicine 1976," Vital Speeches, 43:1 (October 15, 1976), 15. -8-

the perpetual demands of more and more people with illnesses to be

cured? ... Do I have the right to assume a profession that knows

no time or closure to responsibility?"-'-® This responsibility is

sounded by other physicians who will risk great dangers of life for

the patient in the surgical suite,*1 8 and disregard staggering costs

in administering complex electronic care1^ in order to save the life of the patient. The doctor demands much of himself because the com­ munity expects much from him as he tries to follow the implications of the Oath. Dr. S. C. Scheiber assistant professor of psychiatry at the University of Arizona Medical School states: "The doctor al­ ways knows what's best. He knows what's best for his patients, what's best for the community, what's best for himself. 'The Doctor says' has got to be the ultimate authority. That's the image society ex­ pects of him, that his colleagues expect of him, that he expects of himself."18 Surely, argue the critics above, the Oath inspires the highest of moral behavior from the doctor. The doctor's motives could be only positive toward the patient if the physician is willing to vow to follow such stringent dicta in the Hippocratic code.

18M. B. Rock, "Advisor Speaks to Aspiring Physicians," Intellect, 106 (August 1977), 76.

18A. Trafford, "Crisis in the Operating Room," U. S. News And World Report, 84:19 (May 15, 1978), 39-42.

3-^A. T. Brett, "America's Doctors: A Profession in Trouble," U.S. News and World Report, 83 (October 17, 1977), 52.

18"The Doctors Who Are Sick," Arizona Republic, in Newsbank (Stamford, Connecticut: Arcata Microfilms, April 1976), "Health," 40: A 12-B 1. -9-

Another group of popular and academic writers disagrees.

They argue that the mere swearing of the Oath in no way assures the

patient that his doctor's motives are altruistic. In fact, says this

group of critics, the physician may be motivated to heal the patient

by reasons which directly appear to contradict the obligations in the

Oath. Indeed, say these critics, the doctor may be motivated 1) by paternalism; 2) by his own fears about the nature of disease; 3) by a desire to treat the patient as a means to an end; and 4) by a desire

for economic gain. These critics argue that the doctor only uses the

Oath to further these private motives which are anything but altruistic

1. The Oath And Paternalism

The Oath's dicta against doing intentional harm has expanded to "prevent harm." The doctor tries to prevent anything which would cause the patient distress. Now it would appear that the doctor be­ comes a caretaker and guardian of the patient. This role encourages the doctor to keep unpleasant information from the patient as in the case of terminal disease,I9 bizzare side-effects of medication,20 and even the qualifications of the surgeon who may be performing an oper­ ation on the patient in a teaching hospital. Often in large teach­ ing hospitals, a resident doctor instead of the family surgeon will

19d. Robinson, "Medical Secrecy," Ladies Home Journal, 92 (March 1975), 91-92; 70; 72.

20a. M. Schmidt, "Better Medicine Through Better Information," Vital Speeches, 43:5 (December 15, 1976), 146. -10-

perform a patient's surgery.21 This switch in personnel is not us­ ually told to the patient.

The doctor encourages the patent-child relationship by urging the patient to do as he is told without questions.22 The doctor can reinforce this cast of relationship by fits of anger if the patient does not comply with his orders. Dr. R. Cook states: "More than once I have seen physicians become enraged because a patient refused to submit to a particular operation—and incidents in which the phy­ sician blew up because the patient refused to get well on the treat­ ment prescribed."23 The physician assumes that all problems have a medical solution and if the patient would only entrust his entire care to the physician, the patient could find relief.24 Critics in this group argue that the doctor does not want to heal as much as he wants to take over the decision process for his patient. "Doing no harm" as a motive is replaced by—keeping from harm.

2. The Oath And Disease

Critics in this group argue that the doctor does not practice

21t. Cohen and M. N. Levin, "Ghost Surgery," Philadelphia Inquirer, in Newsbank (Stamford, Connecticut: Arcata Microfilms, June 1976), "Health," 58: B 14.

22j. h. Perkins, "Business Looks At Health Care Costs," Vital Speeches, 43:7 (January 15, 1977), p. 212.

23r. Cook, "New Doctor's Dilemma," Newsweek, 81 (May 14, 1973), 25.

24t. Boyce and M. Michael, "Nine Assumptions of Western Medicine," Man and Medicine, 1 (Summer 1976), 311-335. -11-

his art to help the sick as much as he practices his art because of

his own personal or troubling questions about sickness. The doctor

views sickness not as a physical condition, but as an enemy. Here

he views disease that moves quickly toward a terminal condition, not

as a natural process, but as something which makes a mockery of his professional skills.25 some critics maintain that it is the doctor's own fear of disease which drives him to try desperate healing tech­ niques. It is this same fear of disease which causes a doctor to be a poor patient when he himself is sick. Many physicians seldom follow the advice they give to their patients 26 and are reluctant to accept advice from counselors and peers concerning their own health.27 They fear to admit to themselves they they too are susceptible to the same ills that their patients suffer. The motive here is not to heal, but to deny sickness' effects by healing.

3. The Oath And Ends

Closely related to the "doubts" group, the critics of this

"ends" group argue that the physician does not heal for the benefit of the patient—thus treating the patient as an end in himself. On

2®"The Doctors Who Are Sick," 40: A 14-B 1.

26g. Levoy, "Physicians Maintain Their Advice Means More Than Vices," Cincinnati Inquirer, in Newsbank (Stamford, Connecticut: Arcata Microfilms, February 1978), "Health," 28: A 1.

27m. Burke, "C. R. Doctor Sets Up Referral Service for Troubled Doctors," Cedar Rapids Gazette, in Newsbank (Stamford, Connecticut: Arcata Microfilms, November 1977), "Health," 152: E 5. -12-

the contrary, say these critics, the physician heals in order to dis­

cover greater techniques of conquering diseases—thus the patient is

treated as a means to a greater end. To this end doctors disregard religion's role in healing since it explains illness by irreducible metaphores.28 instead, the doctor focuses on scientific technology and the cure of disease by the application of instrumentation.29 The vast medical instrumentation used in the modern healing scene has the effect of intimidating the patient to the point where he becomes de­ pendent upon medical technology for his recovery and forgets the pow­ erful contributions that his own desire to recover may play in the healing effort.20 Doctors become associated with technology and pa­ tients begin to assume that the wonderous machines of the modern hos­ pital are doing all the healing. Soon the patient becomes a symptom instead of a person.21 The motive in healing is not to cure the indi­ vidual patient so much as it is to advance knowledge so that a cure can benefit a larger number of patients. Thus the patient becomes a means to an end. In reality the doctor is not working for the patient but the patient is working for the doctor.

28e. R. MacCormic, "Scientific and Religious Metaphors," Religious Studies, 11:4 (1975), 401-409.

29j. Grange, "Magic, Technology, and Being," Religious Humanism, 8:2 (1974), 88-91.

20i. niich, Medical Nemesis: The Expropriation of Health (New York: Pantheon Books, 1976), p. 41.

21r. m. Veatch, Death, Dying and the Biological Revolution: Our Last Quest For Responsibility (New Haven: Yale University Press, 1976), p. 20. -13-

4. The Oath And Economic Gain

A few critics claim that doctors are motivated toward healing

more by the desire for material wealth than by a pure desire to see

sick men restored to health. Dr. W. Beechman points to the difference

in motives and the consequences of this double motive when he states:

"I think too many doctors drink too much and work harder than they have

to—and more for the love of the almighty buck than the human condition."32

A survey of 205 Utah physicians appears to underscore the economic mo­

tive. 33 The surveyed doctors were asked to rank 80 criteria that might

predict a physician's performance. They indicated that the size of pro­

fessional income was a primary factor by which they would evaluate the

effectiveness of another doctor's skills. The bigger the income, the

bigger the practice, interprets the research, thus the more patients

the doctor must be satisfactorily serving. It would appear that these

motives stand out in bold contrast to the clause of the Oath to keep

one's life and art pure and holy.

The critics of this section argue that the Oath has lost its

prescriptive virility in today's healing scene, because the doctor's

motives in healing are in variance to the dicta of the Oath. Swear­

ing to the Oath does not assure the patient that his doctor's motives

are altruistic. Indeed, he may heal motivated by paternalism, by his 3

32G. Levoy, 28: A 1.

33c. W. Taylor, E. G. Lewis, D. E. Nelson, G. C. Loughmiller, and P. B. Price, "Synthesis of Multiple Criteria of Physician Perfor­ mance," Journal of Medical Education, 44:11 (November 1969), 1063-1069. -14-

own doubts, by a desire for utilitarian ends, and by a desire for econ­

omic gain. In short, most professional and popular critics appear to

be divided as to whether the Oath assures positive motivations for the

good of patients or whether the Oath hides private motivations which

may be at variance to the patient's good. As a third alternative, this

research asks, which critics have evaluated motives which may arise

from the text of the original Oath itself.

One group of critics who could do this type of analysis has

remained silent. Rhetorical critics who offer rich evaluations and

analyses of significant topics in American culture8^ have yet to pro­

vide analysis of motives that may affect American culture as those

motives emerge from the author of the original Oath. This silence is

difficult to understand especially since rhetorical critics have par­

ticular skills in analyzing persuasive stratagies, interpreting psy­

chological constructs, examining textual and manuscript data, and de­

scribing choice situations. Thus the rhetorical critic could pro­ vide valuable insights into the Oath from the following perspectives.

1. Rhetoric and Persuasive Stratagems

The Hippocratic Oath appears to convey powerful persuasive meaning for physicians who publically swear to abide by it and for patients who trust that their doctors believe in the moral constraints

34l. f. Bitzer and E. Black, The Prospect of Rhetoric: Report of the National Developmental Project (Englewood Cliffs, New Jersey: Prentice-Hall, 1971), p. 236. -15-

within it. As an artifact, the Hippocratic Oath conveys meaning for

doctor and patient transcending the simple biology of the healing

scene. The patient may assume that not only is the physician able

to cure all illness with his vast arsenal of modern wonder drugs and

electronic procedures, but that he also will want to cure the patient

regardless of the'doctor's resources in time and interest. The pa­

tient may view the Oath as a license for the doctor to bring every

available means of healing to his bedside with little regard for the

financial expediency of such procedures. The doctor may view the Oath

as a moral directive which tells him that all healing is good and

that sustaining life is better than allowing death to overcome a pa­ tient. The Oath then makes medical choice situations very simple: allowing death is evil and maintaining life is a virtue. If the doc­ tor follows the popular perceptions of the Oath he will seek to pro­ long a patient's life even if this increases the patient's suffering in extreme cases where the natural course of the disease has been in­ terrupted by extraordinary technological procedures. The Oath con­ veys a moral transcendency to those who swear to it and a moral moor­ ing for those who believe that their doctor adheres to it.

Silence among rhetorical critics on the Hippocratic Oath in particular and on the medical profession in general is perplexing since the Oath is a piece of discourse. Most rhetorical critics25 would claim as their task of work, the description, analysis, and evaluation

25k. K. Campbell, Critiques of Contemporary Rhetoric (Belmont, California: Wadsworth, 1972), pp. 4 and 12. -16-

of the discourse of man who is both persuader and capable of being

persuaded. The Oath thus would appear as an appropriate piece of work

for the rhetorical critic.

2. Rhetoric and Psychological Constructs

The Oath should interest the rhetorical critic not only for

the persuasive stratagems implicit in the brief document, but for the

strange psychological construct that emerges from the Oath today: trust between doctor and patient. Patients and physicians assume that a moral ideal can be achieved within the medical profession if the doctor follows the three apparent dicta within the Oath. 1) The phy­ sician promises to do only that which is in the patient's best in­ terest. 2) He promises to do no harm to the patient. 3) He promises to keep in confidence all information given to him by the patient.35

It is strange that the rhetorical critic has not asked the question,

"How came the doctor so to be trusted?" Can the patient trust the doc­ tor by virtue of moral integrity received by some type of Apostolic

Succession from Hippocrates—the doctor who started it all in the hum­ ble Fifth Century Greek village of Cos? Does trust arise because the patient is willing to be persuaded and the doctor willing to persuade his patient? Or does trust arise from the very act of making prom­ issory statements?37 or does trust arise because the patient assumes

36m. Jellinek, 16-19.

37m. H. Robins, "Promissory Obligations and Rawls's Contractarianism," Analysis, 36:4 (June 1976), 190-198. -17-

that his physician has medical skills that will cure him?

3. Rhetoric and Textual Analysis

Further, the Oath would be a suitable subject for rhetorical

criticism because it is in trouble at both ends of its historical evo­

lution. Textual critics of the Greek language attack the Oath by ar­

guing that Hippocrates never wrote the short statement of obligation.

A quick examination of the Oath found in the Hippocratic corpus tells

the textual critic that the Oath in its primitive form deals first

with financial and family obligations of the medical student with his

instructors. Only in the second part of the Oath are the topics of

moral responsibility and patient trust treated. At the modern end of

the Oath's evolution, ethical critics in medicine argue that the Oath

no longer has prescriptive vitality in a technologically sophisticated

era when a doctor may or may not choose to extend a life by extra­

ordinary means. Thus the dictum to do no harm to the patient gives

little guidance to the physician who may be faced with the medical di­

lemma of extending his patient's life and causing him additional suffer

ing or electing to "harm" the patient by withdrawing treatment and

ending the patient's suffering. The Oath appears to generate moral ambiguity in this era if it is assumed that today's technology- oriented doctors are morally obligated to a behavior model written by a primitive medical artisan in a scientifically artless era. Can a physician be bound to dicta to extend life made by early doctors who could not know the life-extending skills of modern medicine? -18-

4. Rhetoric and Choice Situations

Rhetorical critics could clarify the ethical basis of the

Oath since they have particular skills at tracing the progression of

arguments and evaluating the extent to which the first principles of moral philosophy are made clear to an audience in discourse.28 Thus,

the rhetorical critic would not ask the question that theological, political, ethical and medical critics ask—how came the physician here. Rather, the rhetorical critic would ask—how did the Oath bring the doctor here. The rhetorical critic would look not only at the physician as persuader but also would examine the Oath as competitor with other forms of the Oath as the spirit of the document was trans­ lated through history to this present era. The rhetorical critic also would look at the patient and doctor as audience. Both are objects of medical/moral persuasion: the doctor as audience to the descriptive pleadings of the patient, and the patient as audience to the argu­ ments created by the physician. Rhetorical criticism may ask the fol­ lowing questions of this artifact. 1) How does this oath function as persuasive discourse? 2) What caused the Oath to become overlayered with the myth of moral infallibility? By what process did this

38First principles of ethics answer the questions: From whence do decisions about human behavior arise? Are humans influenced more by their environment or by the exercise of rational free will? Pamela Huby in Greek Ethics (London: Macmillan, 1967) notes that Greek sophists of the Fifth Century first named these principles in the nomos-physis debate. The two sides of the debate are sounded again by Kant's Foundations of the Metaphysics of Morals and by contemporary ethicians John Rawls' A Theory of Justice (Cambridge, Massachusetts: Belknap, 1971) and Robert Nozick, Anarchy, State, and Utopia (New York: Basic Books, 1974). -19-

overlayering take place? 3) Does the original Oath provide justifi­

cation for this overlay to begin? 4) Have these overlays inhibited or

stimulated human choice as the Oath evolved throughout history?

Method of Investigation

Basically there are three models of rhetorical criticism. The

first method is called touchstone. Here the artifact is compared to an idealized form. The critic evaluates the artifact as to how far

it falls short of this ideal form. Thus a poetry critic may compare a poem to his ideal that poetry must be crystallized prose. The second method of rhetorical criticism is analog-genre. The critic evaluates an artifact by comparing it to other artifacts belonging to the same genre. Thus the critic would compare two speeches in the same genre and explicate factors from the speeches which give the genre its distinctive character. Here commonalities are attri­ buted to the conventions of the genre and differences are attributed to the artistry of the speaker.39 However both these methods de­ mand an abundance of biographical and historical data be available to the critic as he analyzes the specific piece of discourse. Since very little data of this type about the Oath has endured through the centuries, the use of these methods here would be inappropriate.

39a lucid explanation of touchstone criticism is given by W. M. Parrish, "The Study of Speeches," W. A. Parrish and M. H. Nichols, eds. American Speeches (New York: Langmans, 1954). L. W. Rosenfield in "The Anatomy of Critical Discourse," Speech Monographs, 25:1 (March 1968), 50-69, explains analog-genre methodology. -20-

A third method, cluster analysis, is a portion of Kenneth

Burke's dramatistic perspective of rhetoric. This method looks in

detail at the artifact itself and asks what is the artifact doing by

its formal structure, its stratagems of argument, and the choices pre­

sented to the audience. Cluster analysis is essentially descriptive.

It makes an index and concordance of word usage in the artifact. Fur­ nished with the concordance the critic may make a series of equations from the literature before him. The critic draws equations from these clusters of what goes with what and why.4® Examples of clusters and equations will be given below.

Cluster analysis has been selected as the method to be used in this study of the Oath because of certain conditions present in the Oath. The purpose that the Oath served both for the original author and for audiences that followed it in history needs to be ex­ amined as well as the message or discourse found in the Oath. It may be discovered that the purpose may be in wide variance to the message.4!

The diversity of public opinion about what the Oath is supposed to mean, would indicate that at least there is a good chance that a troublesome difference between Hippocrates' purpose for writing the

Oath and modern culture's understanding of the Oath exists. Below will be described cluster analysis relevant to extrinsic data, motive,

40w. H. Rueckert, Kenneth Burke and the Drama of Human Relations (Minneapolis: University of Minnesota Press, 1963), pp. 84 and 85.

41e. Black, Rhetorical Criticism: A Study in Method (New York: Macmillan, 1965), p. 15. -21-

and research goals. An illustrative example of cluster analysis will

be cited. Cluster analysis will also be discussed as it relates to

an author of an artifact as is seen in Burke's concept of identifi­

cation. Last, an evaluative grid for the study of the Oath will be presented.

1. Cluster Analysis: Extrinsic Data and Motive

The most obvious condition present in the Oath which dictates the use of cluster analysis is the poverty of biographical and his­ torical data about the Hippocratic corpus, Hippocrates, or the med­ ical school at Cos. The Oath and a few related medical texts are all the researcher has to examine for his analysis. If there is little or no extrinsic material for the analysis of an artifact, Burke assumes that it was once there and now is buried within the artifact. The critic is urged to look for all that should be there and all that must be there. Burke argues that if the act (artifact) was caused by the author's historical scene, his personal bias, and his purpose, then the artifact is equal to the scene, bias, and purpose of the author.

The reductive or synecdochic logic is thoroughly characteristic of

Burke: since "caused by" therefore "equal to."^2 Burke's cluster analysis reduces the things to look at in analysis of an artifact, but it also increases the ways of looking for motive in a piece of discourse

Since the act (Oath) contains the scene in which it was written,

42w. H. Rueckert, p. 82. -22-

economic, social, political, and theological coordinates may be used to examine the artifact.43 Since the act also contains the agent

(Hippocrates), coordinates from neurology, biology, and psychology may be used in the analysis.44 since the Oath is a verbal act, the coordinates of semantics, rhetoric, and grammar may be brought to the analysis.45 since the Oath also contains its purpose (function) and since Burke argues that the function of all literature is purgative redemptive, the coordinates of ethics, anthropology, comparative re­ ligion, and decision theory may be used in the analysis.46 since so little extrinsic data is available for the analysis of the Oath, the critic must use everything available to him in the artifact itself.

Needed is a methodology that would attribute meaning to what is already present in the document itself : motives for the structur­ ing of the environments in which the medical community found itself, whether at Cos, Rome, or in the modern American hospital. Kenneth

Burke's range of critical works gives the researcher a vocabulary for discussing motives. For Burke, language orders experience be­ cause it creates the forms which make possible the communication of experience. Where there is evidence of language,47 there is also a

43w. H. Rueckert, p. 82.

44w. H. Rueckert, p. 82.

45w. H. Rueckert, p. 83.

46w. H. Rueckert, p. 83.

47r. l. Ivie, "Presidential Motives For War," Quarterly Journal of Speech, 60 (October 1974), 338. -23-

record of the author's motives in writing. Language thus tells the researcher how it does what it says it does. A Burkean perspective would focus on the symbols present in the Oath and would spin analy­ sis and interpretation from the textual evidence. The textual form is a synecdochial representation of the structure that the author super­ imposes on his world. The dramatistic method examines all data re­ presented in the artifact and from that textual evidence, recon­ structs the historical/social situation in which the author wrote— the same situation that gave rise to the artifact. If this method describes what the artifact is doing for the author, then it can be learned what the artifact is also doing for the present day readers and interpreters. By the use of universals, which are psychological predispositions of persuasion, the author shows his audience how he identifies with or rejects the artifact. The audience, using the same universals, may be led to identification with or rejection of the arti­ fact. If this methodology shows what the artifact is doing for the present audience, then it may give some orderly account for the un­ usual array of popular opinion cited above. The advantage of using this methodology would be that it allows the researcher to examine doctors and patients not as an audience that reacts to the dicta of the Oath in unquestioned obedience, but as an audience in a much larger sense: a group which manipulates the message of the Oath for its own ends. The dramatistic methodology would examine the symbolic structures within the Oath which either facilitate or delimit the ethical choices of the modern medical scene. -24-

2. Cluster Analysis: Research Goals

If Burke's dramatistic perspective is to be employed in an

analysis of the Hippocratic Oath, the goals of the research must be

decided at the outset by asking two questions: Is the goal of the re­

search to discover attitudes and motives found in the artifact, or is

the goal of the research to describe attitudes. Two Burkean methods

of investigation are open to the researcher corresponding to his goals

of research. For Burke, discovery is prior to description. Cluster

analysis is Burke's method of "getting into" the artifact and re­

vealing symbolic loci of private vs. public motives.48 on the other

hand, if the goal of the research is description489 of attitudes as

they evolve from the artifact, then the pentad and its ratios are

available for an analysis of the Oath. Though it is tempting to em­

brace both goals, this research will focus on cluster analysis and

attitude discovery because of the detailed textual evidence available

in the Hippocratic corpus has not been analyzed from a rhetorical

perspective.

3. Cluster Analysis: An Example

Cluster analysis is elegantly simple. It asks—what is

48K. Burke, The Philosophy of Literary Form: Studies in Symbolic Action (Berkeley, California: University of California Press, 1973), p. 24.

49B. L. Brock, "Rhetorical Criticism: A Burkian Approach," in Methods of Rhetorical Criticism: A Twentieth-Century Perspective, R. L. Scott and B. L. Brock, eds. (New York: Harper and Row, 1972), pp. 315-327. -25-

connected with what, and why.88 on a cursory examination of an arti­

fact the reader may discover what he thinks are obvious literary

features which are "obviously" associated with good or evil. Such

analysis tells the reader little about the author's stratagems for manipulating good and evil. The Book of Job uses the devil figure.

A careless reader may assume that here the devil is responsible for

the evil things that befall Job. But in close examination of the work, the reader sees that the devil is associated with the interro­ gation of Job's value system. The devil plays the role of prosecutor

—not the source of evil. In any literary work the structural fea­ tures may show to what they are related. This is not a clear dialec­ tical role identification where Job is all white and the devil is all black, but in the examination of all the activities of the structural features, the critic may see relationships and stratagems emerge that perform certain functions for the author. In Job, sometimes the devil may be associated with questions of faith; at other times, with words of consolation to sway Job's value foundation; at other times, one who confronts Job angrily. By fitting these clusters together the critic sees that the devil's stratagems emerge to label him as "one who tests."

Each of the roles he plays fits under the main cluster of prosecutor

—one who tests the strength of argument in others. Thus, anger, con­ solation, and questions, fit together in a whole which gives a picture of what the character of the devil is doing for the author. In the

50k. Burke, Philosophy, pp. 58-60. -26-

case of Job, the devil represents ambivalent themes none of which in

combination with each other or examined separately resembles the pop­

ular image of devil as an overpowering, evil force so marketable in

the current cinema trade (Exorcist or The Heretic).

A piece of discourse may retain public popularity over cen­

turies and the meanings once attached to figures in the work may shift

with new audiences. Thus "prosecutor" may shift to "unscrupulous law­

yer" to "insidious lawyer" to "Inquisitor" to "executioner." Buried

within the original figure are the seeds of motive which allow the

figure to dissociate from its original mooring, and which also point

the way back to unity with its original meaning. In this research on

the Hippocratic Oath, cluster analysis may show what "seeds" of mean­

ing were present in the original document from which modern interpre­

tations of the Oath could grow. Thus through these shifts in meaning,

the critic may detect where the audience has taken the artifact and

what the artifact is doing for each new generation of readers.

4. Cluster Analysis: The Author

Cluster analysis examines an author's private motives and de­

tects equations in his public discourse by which he identified with his audience and by which he persuades them. A chart5! of the author's motives is contained in each piece of discourse. The term "chart" must be understood together with the other two levels of analysis in

51k. Burke, "Comments," Western Speech, 32:3 (Summer 1968), 181 -27-

any act of symbolic discourse.22 "Dream" is the subconscious factor

in a piece of literature. It is the author's prior disposition to

the situation. He may hate flowers and so his work will show flowers

always as weeds. Though not a conscious word choice, dream is still

evidence of the author's motivation. "Prayer" is the communicative,

public aspect of the literary work. By the use of prayer, the author

communicates universals or norms. By exploiting these norms the au­

thor gains identification with his audience. These norms are univer­

sal conditions of appeal by which the audience allows itself to be persuaded and by which the author can persuade. They act as psycho­

logical common ground between author and audience.53 "chart" is the

ritualistic sizing up of a situation that an author does. Sometimes

this is explicit, sometimes it is implicit. By means of this sizing up, the author decides how he will shape the scene to his own pur­ pose. 54 The critic is able to look at the clusters and examine the relationships to read the motives of the author. The author was de­ scribing his situation by the clusters. The clusters thus become his situation and situation is another word for motive.55 Literary images, characters, types of discourse, and other devices are synecdochial in­ dicators of what the discourse is doing for the author in his private

52k. Burke, Philosophy, pp. 5 and 6.

53w. H. Rueckert, p. 27.

54k. Burke, Philosophy, p. 6.

55r. Burke, Philosophy, p. 20. -28-

life: a house lived in could be synecdochic of the woman loved and

the breaking of a window in the house, an equation of rape.88 When

it is learned what the equations are doing for the author, it may be learned what the equations are doing for all readers. By the use of universals, the author has unified the audience and his work as well as persuaded the audience to think that the internal movement of the work

(the stratagems for encompassing a situation) are their own. The au­ dience gains from the work in two ways. First their tensions are re­ duced somewhat by identifying with the author’s stratagems and watch­ ing him effect a solution to the situation. Second, the audience be­ nefits from the work because each audience member persuaded himself that his experience with the work has unburdened him.87

5. Cluster Analysis: Identification

Motives are thus discovered by cluster analysis that move the author toward or away from identification with his situation. The mo­ tives are seen in the terms the author selects to respond to his scene/ environment. He may use positive terms (those describing the actual data—father); dialectical terms (those which are defined by their op­ posite and which invite forensic fencing between men—does father mean enemy or friend); and ultimate terms (which allow the audience and au­ thor to choose a meaning they both can live with—choosing the best 88

88K. Burke, Philosophy, p. 29.

57w. H. Rueckert, p. 27. -29-

meaning to the term arising from the debate at the dialectical level.

Thus the ultimate term "benevolent dictator" might fit both require­

ments for father).58 The stratagems by which these terms are manipu­

lated show the transformation of terms, the motivation for change of

terms and the ethical weight of the author's rhetorical manipulation.

The transformation employs a scapegoat (a symbolic vessel to carry

off unwanted meanings) and a rebirth of meaning. Socialization is

the normal mode of this symbolic expiation: the author ceases to live

in one style of life and adopts another style of living.Physicians

in antiquity discarded the meaning given to their profession in the

public opinion, by joining in group membership. This need for strong

group identity was seen early in the medical profession as physi­

cians at the medical school in Cos tried to divide themselves from

the religious healing Cult of Asclepius.50 They stopped being priests

who took money in offering to the gods for healing, and began to be

craftsmen who earned money for services rendered to their patients.

The physicians' earning power dissociated from religious sanctions and

associated with commercial norms of free trade.

6. Cluster Analysis: A Grid For Analysis

In order to isolate cluster stratagems in the Hippocratic corpus,

58t. f. Mader, "Agitation Over Aggiornamento: William Buckley vs. John XXIII," Today's Speech, 17:4 (November 1969), 5.

59k. Burke, Philosophy, p. 50.

50g. e. Gask, 128-157. -30-

this researcher will use the following grid for textual analysis.

1) The original text delivered by W. H. S. Jones will be examined in the Greek language. 2) Key words will be compared. 3) Word contexts will be indexed. 4) Dramatic alignments will be catalogued: the phy­ sician with the philosopher; the physician with rhetor.61 5) Equations will be noted that reinforce opposing forces: god terms and devil terms

6) Quotations will be extracted to back up the equations—the quanti­ tative test. 7) The equations will be observed for changes as they appear in the corpus—the qualitative test.62 8) Names will be no­ ted as they indicate essence. Example: Peter used by the Pope does not mean "apostle," but "infallible." 9) Bridges used by the author will be indexed: dialectic pairs like the hero, the villain. 10) In­ ternal forms will be indexed. 11) Points of furthest internality will be noted: what forms will balance each other; what forms compen­ sate each other.63 12) Expressions denoting guilt, secrecy, power, silence, mystery, and marvel will be indexed. 13) Moments when the work comes to fruition will be noted: watershed moments.64

The Greek text will be analyzed in the following order:

1) An index will be constructed by searching the corpus for the in­ stances where words of the Oath appear. 2) A concordance will be

61r. Burke, Philosophy, p. 68.

62k. Burke, Philosophy, p. 71.

62r. Burke, Philosophy, p. 74.

64k. Burke, Philosophy, p. 78. -31-

composed by examining frequently used words in the index. 3) Ex­

amination of the ambiguous terms in the concordance will help to

describe the private motives that Hippocrates may have held in writ­

ing the Oath. 4) Examination of these ambiguous terms will also show the stratagems of persuasion Hippocrates used to gain his purpose.

5) The Oath will be contrasted to the translations of the Hippocratic

Oath during the unfolding of European and American medical history.

The Oath will be contrasted to the document drafted at the conclu­ sion of World War II by the World Health Association and to the doc­ ument drafted in 1957 by the American Medical Association.88

Hypotheses

1) The application of the Burkean cluster analysis to the

Hippocratic corpus and Oath will reveal private and public motives ex pressed in the Oath and in the medical writings of the medical school at Cos. Private motives known to have been present in medical soci­ eties in antiquity include: the need for professional differentiation of medical arts from the "arts" of the athletic trainer; the need for financial security gained from the practice of medical arts; and the need to avoid public ridicule. The Oath shows public motives prior to cluster analysis: the need for academic integrity in the study of medicine; the need for financial security of medical faculty members; and the need to be identified with society dedicated to

88H. K. Beecher, Research and the Individual: Human Studies (Boston: Little, Brown and Company, 1970). -32-

certain moral precepts. 2) The cluster analysis will also identify

what stratagems were used to gain the private medical ends by the pub­

lic means of persuasion in the Oath. 3) Cluster analysis will also

identify the means used to transform terms as the Oath endured through history. 4) Cluster analysis will describe the manner in which those private motives have gained or lost persuasive power by

shifting perspectives in medical history.

Review Of The Literature

What rhetorical critics have dared to demythologize revered historical figures, what methods did they use, and have any critics known enough Greek to perform such acts on persons of antiquity?

Parsons88 used a Burkean cluster analysis to examine the

America First Committee. He asked why the Committee failed to gain strong public support prior to the start of World War II. In this study, the private motives of the Committee were examined. Parsons shows that these private motives were given a halo in order to win the audience's acceptance. The Committee tried to gain identification with the audience and public acceptance by making the private motive appear as if it were altruistic and had no self-serving character.

This analysis of the hidden motive in persuasion is consistent with

Burke's theory of motive and situation. For Burke, motives do not

w. Parsons, "The Rhetoric of Isolation: A Burkian Analysis of the America First Committee," (Ph.D. Dissertation, University of Minnesota, 1964). -33-

arise from needs dictated by man's scene but from strategic moments

—ways man manipulates his scene. Man is not only subject to his

scene but makes his scene subject to him. For Burke, an author man­

ipulates his scene by his symbol-using skills. Thus a thorough ana­ lysis of an author's symbolic useage in a piece of discourse will give the researcher a record of how the author viewed his scene and how he intended to encompass that scene. Parsons traces these motives through the short history of the Committee and concludes that the failure of the Committee to gain wide public acceptance was not due to Pearl Harbor which ended debate about America's participation in the war, but to the failure of the strategies of the Committee to gain identification with its audience.57

An elegant analysis of Sam Houston was done by Davidson.58

By cluster analysis Davidson concludes that Houston's halo-attitude toward American Indians given to him in history was in stark contrast to what Houston actually thought about Indians. The equations

Houston used in his speeches were romantizations about a West that never was because he knew such strategies would be successful per­ suasion devices. Methodologically elegant for Davidson's study is the single biography which gives Houston the popular aura of folk hero. Davidson can then easily contrast Houston's private motives against the public image and the public discourse to show the

67d. w. Parsons, p. 15.

68w. c. Davidson, "Sam Houston and the Indians: A Rhetorical Study of the Man and the Myth," (Ph.D. Dissertation, University of Kansas, 1971) -34-

dispairity between the public and the private man.

Mader88 conducted a humerous cluster analysis of the 1961 feud between William F. Buckley's conservative National Review and the lib­ eral Catholic America magazine. Pope John XXIII had issued Mater et

Magistra which the liberal America hailed as a papal nod toward soc­ ialism, and which Buckley labeled as trivial with the quip: "Mater, si; Magistra, no." Mader identified four clusters in the course of the journalistic feud: obedience, humor, leadership qualifications, and mystery terms. Among these four clusters Mader focuses his analysis on Buckley's use of humor as a means for identifying public vs. pri­ vate motives. Buckley represents conservative Catholicism. Instead of embracing the socialistic encyclical, the conservative magazine stalls for time by the use of humor. The encyclical had placed con­ servative Catholicism in a double-bind: how does a conservative

Catholic reject a papal encyclical and yet continue to claim that he is a loyal son of the Church. Buckley addresses this ambivalence by rejecting the encyclical in the words of Cuban nationals: "Liberty, si; Yankee, no." The implication is both clear and humorous: the

Pope cast as imperialist, should not dictate financial policy to his

"poor struggling colonies" in America. The liberal America wanted to embrace the socialism of the encyclical and interpreted Buckley's quip as a sign of disobedience and disloyalty to the Pope. America's private motive: acceptance of the encyclical without reservations;

69t. F. Mader, pp. 4-15. -35-

Buckley's private motive: rejection of the encyclical without re­

jecting the right of the Pope to issue it. Mader concludes from his analysis of the clusters that neither side used terms which would allow them to transform positive terms to dialectical terms.70 In order to make such a transformation, there must be an accompanying transformation of motive. No motive transformation was found since

America demanded complete obedience to the Pope and Buckley demanded qualified obedience.

Ivie^l located recurring patterns in selected presidential calls for war. He showed how the individual president's terministic screens determined how he perceived war: as crisis, as cause for crisis, or as solution for crisis. The index was not given in the article and Ivie also attempted a pentadic analysis of the numerous speeches.

Macksoud and Altman72 did a cluster analysis of Shaw's Saint

Joan to determine the dramatic alignments that would allow Shaw to make the link between fifteenth-century France and post-World War I

England. The authors conclude that Shaw gave Joan a halo of sympathy, equated Joan's God-messages with common sense, and gave her a sexual/ asexuality that persuaded his audience to see that their orthodox be­ liefs were once heresy. Shaw's private motive was to lead his audience

70t. f. Mader, p. 14.

7lR. L. Ivie, p. 339.

72s. J. Macksoud and R. Altman, "Voices in Opposition: A Burkian Rhetoric of Saint Joan," Quarterly Journal of Speech, 57:2 (April 1971), 140-146. -36-

to see that England’s nationalism was once a heresy in France, and

that heresies are nothing more than the orthodoxies of a future age.

Here the rhetorical trail ends. None of the critics above have actually shown an index of the terms of the artifact. The ab­ sence of the index makes their studies difficult to replicate. Also, it appears that Burkean critics either do not know enough Greek to carry their craft to literature of antiquity, or they find ancient topics in medicine lackluster. In the case of Hippocrates, this re­ luctance is difficult to understand because excellent textual spade work has already been done by Jones73 in a four volume edition of the major works of the Hippocratic corpus with rich introductory notes on the major writings of the corpus. Further, Levine has eased the difficulty of this exacting research by surveying all the known works in the corpus.74 Calhoun has shown how these texts have changed as they were transmitted in history,75 as does Edelstein76 and Etziony.^7

Clearly an abundance of translated textual aids stand ready to help the rhetorical critic who wishes to analyze Hippocrates.

73w. H. S. Jones, Hippocrates, 4 Volumes (Cambridge, Massachusetts: Harvard University Press, 1957).

74e. b. Levine, Hippocrates (New York: Twayne, 1971).

75q. Calhoun, Annotated Bibliography of Medical Oaths, Codes, and Prayers (Washington, D. C.: Kennedy Institute, 1975).

76l. Edelstein, Ancient Medicine (Baltimore: Johns Hopkins University Press , 1967).

77m. B. Etziony, The Physician's Creed (Springfield, Illinois: Charles C. Thomas, 1973). -37-

Justification

The Oath is unexamined territory for research in speech-

communication. The studies in medical scenes that existas in speech-

communication focus on the immediate process of communication pathol­

ogies as they appear in the doctor-patient relationship. No studies

have been done to discover some of the powerful meaning-generating

artifacts that affect the doctor-patient relationship prior to the

beginning of a medical encounter. This study seeks to answer questions

about one item that is brought into the drama between patient and

physician—the Hippocratic Oath.

The artifact is brief enough for thorough investigation by

means of cluster analysis. One standard text for the artifact is

easily obtained for research. It appears that cluster analyses in

the past have attempted to examine too large a work. The Oath has

only eighty-six isolated terms. The corpus has a representative sample

of translated works in English. The brief nature of both the Oath and

the corpus should allow for thorough analysis with the many coordi­ nates prescribed by Burke. The researcher has demonstrated skills in the Greek language and is able to analyze the document from the grammatical, philosophical, and rhetorical perspectives expressed in the Greek text.

Little research has been generated about Hippocrates and

78k. Adler, "Doctor-Patient Communication: A Shift to Problem-Oriented Research," Human Communication Research, 3:2 (Winter 1977) , 179-190. -38-

his oath. A new perspective on the Oath is needed by physicians and

professional people dealing with the sick and dying patient. This

research would be a part of a continuing interest in bioethics which

plays an important role in this researcher's communication studies.

This project is his twelfth study in bioethical topics during the

past three years.

In a pluralistic world, the prize for leadership will go to

those persons in rhetoric, philosophy and religion who are able to

name a third alternative to the barren polarities of science vs.

mystification. Rhetorical studies encourage healthy self-criticism

—a topic the health profession has often overlooked. Rhetorical

studies can help to answer the question—how came the doctor here?

Organization

The research will be developed in the following order. Chap­ ter One: Statement of the problem, method, hypothesis, review of the

literature, and justification of the research will be discussed. Chap ter Two: An explication of the Burkean cluster analysis will include an introduction to Burke’s rhetorical theory and a detailed survey of this method as it appears in Burke's various works. Major interpre- • ters of Burkean theory will be cited. Burke's illustrations of how the methodology may be applied to an artifact will be included in this chapter. Chapter Three: The Hippocratic corpus will be ex­ amined. A description of the social setting of the Greek medical pro­ fession will be followed by a biographical sketch of Hippocrates. A -39-

discussion of the corpus as well as a survey of the documents which transmitted the ©ath will be included in this chapter. Chapter Four

The cluster analysis will be applied to the Oath to locate evidence of private vs. public motives as cited in the hypotheses. Chapter

Five: Conclusions will be drawn from the cluster analysis. The mo­ tives arising from the Oath will be compared with the changes in the

Oath as it was translated in evolving medical history. A suggestion for additional research will be given in this chapter. Ho

CHAPTER II

CLUSTER ANALYSIS

The method of study should be appropriate to the artifact

studied. One test of appropriateness is to ask what types of ques­

tions does the researcher wish to ask of the artifact—what are the

goals unique to this research. In the previous chapter, this research

has already described the types of questions it wishes to ask of the

Oath. Those questions seek to describe and interpret the meaning

that was originally intended in the Oath by the medical scene of an­

tiquity and ancient physicians. Thus the research must adopt a method

of rhetorical criticism which would allow the original meaning of the

Hippocratic Oath to emerge instead of a method which would test the

meaning that the current medical scene imposes upon the the Oath. The

four questions asked of the Oath are: 1) How does the Oath function as persuasive discourse? 2) What overlays of moral infallibility have

surrounded the Oath over the centuries and how did this process occur?

3) Are these overlays justified by motives which may have been present

in the original Oath? 4) Do these overlays inhibit or stimulate hu­ man choice in the modern healing scene? There is no way to learn the answers to these questions unless the research investigates the

Hippocratic Oath with a method that would allow the Oath to speak for itself. A method and instrument for study of the Oath must be se­ lected which would allow the researcher to break the code of the Oath and learn what motives the original author had in mind for medical -41-

ethics when he wrote the document in the first place. Thus if the

Oath dictated certain behaviors, the researcher must find a critical

instrument for analysis which would have appropriate skills in de­

tecting those dicta.

To this end cluster analysis was chosen as the methodology

to be used in this study because it would allow close examination of

what the Oath itself was saying to the original audience of Greek

medical men, and would provide an interpretation of why the Oath gen­

erates the ambiguity of meaning in the modern healing scene as was

previously cited by sources in the popular and professional press.

Kenneth Burke introduces and explains cluster analysis in his crit­

ical work, The Philosophy of Literary Form (Berkeley: University of

California Press, 1973). Here he provides numerous illustrations of

how cluster analysis may be used to uncover public and private mo­

tives of an author in a literary artifact. Further, two Burkean in­

terpreters, W. H. Rueckert! and D. Fogarty2* have refined the Burkean cluster schema for application to an artifact. The discussion of method in this chapter will draw much from all three of these authors.

Burke's style is often uninviting.2 His intricate arguments frequently

!w. H. Rueckert, Kenneth Burke and the Drama of Human Relations (Minneapolis: University of Minnesota Press, 1963).

2D. Fogarty, Roots For A New Rhetoric {New York: Columbia University, 1959).

2h. Slochower, "Kenneth Burke's Philosophy of Symbolic Action," in W. H. Rueckert, ed., Critical Responses to Kenneth Burke, 1924-1966 (Minneapolis: University of Minnesota Press, 1969), p. 131. -42-

omit intermediate steps, operating as complex enthymemes which the

reader is expected to fill. Thus it is often helpful to draw ex­

planations of cluster analysis from expert Burkean interpreters who

make explicit what is implicit in Burke. The following chapter will

discuss cluster analysis as a methodology with the following parts.

First Burke's theory of persuasion relevant to cluster analysis will

be described. Second, a detailed description of cluster analysis will

be made. Third, an argument of justification for cluster analysis will be given. Fourth, examples of cluster analysis used by Burke will be cited. Finally, a design of a specific instrument appropriate

for the study of the Oath will be given.

Cluster Analysis and Burke's Symbolic Theory

Some ethical and philosophical critics point out that

Kenneth Burke's methodology has no evaluative core.4 They argue that

Burke does not focus cleanly on the first principles of ethics as he determines whether discourse is right or wrong. He appears to begin with the benchmark that moral discourse should be the exercise of free and rational choice. But he appears to end with his argument for right or wrong discourse in a type of utilitarianism. He pro­ motes rhetoric as a means of obtaining the good life for the great­ est number of people enjoying the greatest good. This criticism may

4h. Kuhn, "A Review of 'The Philosophy of Literary Form"' in W. H. Rueckert, ed., Critical Responses to Kenneth Burke, 1924-1966 (Minneapolis: University of Minnesota Press, 1969), 140. -43-

be valid, but Burke seems to prefer to focus on the language by

which he reaches this contradiction in metaethics, instead of on

the exercise of reason that brought him there. For Burke, words

are instruments an author uses to "encompass a situation." How

successfully the author accomplishes this task appears to be the

only way of judging whether an author was right or wrong: a kind

of shallow relativism—the roots of utilitarianism.

Those same critics are also quick to point out that Burke's

full moral philosophy has yet to be developed in his numerous works.

While the academic community waits for the full explanation of Burkean moral philosophy, it can focus on methodological contributions in or­ dinary language philosophy from Burke, which appear complete. One of those is the cluster analysis. Below will be discussed: 1) A basic schema of clusters; 2) The rhetorical theory that lies behind the schema; 3) The goal of cluster analysis.

1. Basic Schema For Clusters

Burke understands that words encompass a scene for an author in two ways. First, words represent the author who uses them; second, words fulfill a function for the author. Words not only reflect the personality of the author but they are a means of exercising his hu­ man choice skills. By words, an author shows his audience what he wishes to disclose about his own personality. The words that an au­ thor leaves behind him in his literature also show how the author chose to manipulate his world scene by his symbolic choices. Thus -44-

words for Burke are not just particles of literature and art, but

modes of action; a synthesis of the poetic with the practical act.

For Burke words focus on human choice. By means of words man can

transcend above his scene by sharing his emotions and thoughts with

others in socialization, or by refusing to socialize and persuading

others to refuse interaction with a specific scene.5

Burke further understands that words enable man to search

for unity and identification of the self. In Burke's concept of

identification, man molds words to perform strategies of interaction/ persuasion with the world which will amplify his own motives of self­ acceptance. These strategies may be: death-rebirth (giving new meaning

to an old term: "gay"); rejection-acceptance (what was once "fornica­ tion" is now "free love"); purification-change (the "draft dodger" through the questioning of national conscience becomes a "war resis­ ter"); disintegration-reintegration ("homemade" is not a sign of pov­ erty, but of pride in craftsmanship). By means of these strategies man creates new frames of meaning whereby he can manipulate his world.

These new frames become unified attitudes by which man can accept the world he sees.^

Burke combines man's private motive for acceptance of the scene and his public means for accomplishing these ends by the con­ cept of "commonalities" in language. Though each man experiences his

5W. H. Rueckert, pp. 46-47.

6w. H. Rueckert, p. 45. -45-

scene in a unique way, he can communicate his experience to others

by means of forms which are common to all men: loss, joy, expecta­

tion, and hate. By means of these public forms or grammars of

selves, authors draw materials which are available to all men in

order to participate in the cooperative effort of persuasion.?

Thus Burke has transformed the term persuasion from a covert desire

to get the best of others, to a new term: a desire to unify in self

and others in order to obtain the best of cooperation for global

and international living.

These materials and grammars externalize what is private

for the author and help him to alleviate the solipsism that is na­ tural to man. Man by nature withdraws into himself, thinking that only he knows what he is experiencing. By means of symbols and the strategies of persuasion, man avoids this despair to promote the possibilities of socialization and cooperation.8*

Words provide the same benefit for the reader as the author

—the persuader, as well as him who is persuaded. The reader, by means of the mateirals and commonalities that the author uses, is able to reinact, to some degree, what the author is feeling. The audience is able to get outside themselves and also avoid the same solipsism.8 Thus words show an author's ultimate strategy in creation:

?W. H. Rueckert, pp. 173-174.

8W. H. Rueckert, p. 173.

8w. H. Rueckert, p. 173. -46-

to unburden his mind and by this rhetorical "confession" to achieve

catharsis for himself. Words also become a cryptogram of an atti­

tude which may impose itself on the reader's mind.10

How are these strategies composed and how do they work?

Burke argues that these commonalities are composed either of essence

or imitations. Essence is a cluster of terms that clings together,

evolving or dissolving until unity is complete. This is much like the

sun holding its planets in unity by gravitational pull.H Thus the

cluster "family" would hold some terms within the unity—such as mo­

ther, parenting, and love. By contrast, other terms would not fit within the unity and fall naturally away from its pull: prostitute,

infidelity, and divisiveness. Imitation, by contrast,!2 is a cluster which has a unity from the fact that it employs a chronological de­ velopment of plot. Here unity is achieved by things that lead to other things. Birth leads to growth; speculated crime leads to per­ petration; violence leads to death. Thus the two basic types of

Burkean clusters: what equals what, and what leads to what.

For Burke, clusters are made up of relationships which re­ sult from the conscious or sub-conscious activity which characterizes all psychic activity. Man does not simply experience a series of discrete stimuli, according to Burke, but he seeks to show how those

10h. Kuhn, p. 138.

llW. H. Rueckert, p. 174.

12W. H. Rueckert, p. 175. -47-

stimuli are related and seeks to provide an interpretation of those relationships. Essence describes what is, and imitation describes how changes take place by the introduction of time. Thus the author can travel by his strategies from what is, to what should be, and from what is known to what is desired to be known. Thus indexing, the first step in cluster analysis, as was explained in Chapter One, is the way of learning that the essential meaning for an author is equal to the sum of whatever it is associated with in the context.!21

"... such clusters can be found in the work of any poet because no one is ever completely conscious of why he does certain things, writes of certain subjects, uses certain images, sounds, and rhyth­ mical patterns over and over again in different contexts. In such clusters, the poet not only personalizes an essence but portrays him self; the structure of interrelated images, terms, and sounds sym­ bolizes the structure of his psychic and physical self. This is what Burke means when he says that 'in the depths of his images a poet cannot lie' . . . each poet puts words together according to im­ pulses generated by his own unique personality."14

2. The Theory Behind Clusters

Here will be discussed Burke's theory of abstraction, the negative, and identification. Burke's theory of abstraction has

12W. H. Rueckert, p. 175.

14w. H. Rueckert, p. 177. -48-

classical roots. For Burke, the thought is real. The mind has an

ability to classify and separate objects on a choice basis. For

Burke, the logos is not an external referant by which objects are

measured, but is a quality in the objects themselves.H as Burke

states: "Empiricist reduction of idea to image is particularly de­

ceptive because of the ways in which it conceals the social animus

contained in sensations. And 'dramatism' aims always to make us

sensitive to the 'ideas' lurking in 'things' which might even as

social motive seem reducible to their sheerly material nature, un­

less we can perfect techniques for disclosing their 'enigmatic' or

'emblematic' dimension."I® For Burke motive in language does not only arise from man's interactions with his scene. The motive em­ bodied in language also allows man to rise above his environment/

scene. The skill of describing the motive in symbols that other persons can understand is man's unique skill beyond his animal counter parts.17 as Burke states:18

When we call attention to the rudiments of generalization, specification, classification, and abstraction, in the con­ ditioning and adaptations of non-linguistic organisms, we do not mean to derive "rational" human language by a simple "graded series" from the "behavioristic pre-language" of sensation and gesture. On the contrary, we subscribe to the view that there is a "qualitative leap" between the

■15d. Fogarty, p. 64.

16k. Burke, "A Dramatistic View of the Origins of Language, Part One," Quarterly Journal of Speech, 38:3 (October 1952), 259.

17d. Fogarty, p. 65.

1®K. Burke, "Dramatistic View," 257. -49-

motives of pre-language and those of language. . . . Once a qualitative leap has been made, even those ingredients ta­ ken over from the previous structure have a new nature be­ cause of their place in a new motivational cluster. Hence to say that the principles of abstraction, classification, generalization, and specification (or division) are pre­ sent in pre-linguistic behavior is not the same as saying that their linguistic analogues are "nothing but" more com­ plicated variants of the pre-linguistic.

At the deepest root of language for Burke lies the concept

of the negative. Every idea may be abstracted from a concrete image

of the thing, except the negative. The negative is the only idea

without a concrete picture. The negative fulfills two functions.

It is the tool whereby concrete images are split apart and it is

the choosing and sorting process that enables language.18 For Burke,

the essential difference between verbal and nonverbal is the fact

that language adds the peculiar possibility of the negative. Burke's dramatistic theory would insist that the negative functions in ad­ monitory or pedagogical sense. "For if sensation is the realm of motion, idea is the realm of action. And action is possible only insofar as the rational agent transcends the realm of sheer motion

—sensory image."28 Thus the negative enables man by his symbol use to transcend his scene. The negative used in society promotes co­ operation since it encourages other men, as well as just the author, to transcend their scenes.

The negative and abstraction concepts lead naturally to

18D. Fogarty, pp. 65-67.

20k. Burke, "Dramatistic View," 260. -50-

Burke's theory of identification. The author seeks unity with his

audience aided by the use of ambiguities. These allow for a small

measure of identification to arise between people because the term-

names have wide meanings. Ambiguities arise in these ways. 1) They

arise by contextual definitions where the individual is defined by

his scene. Thus a man may be defined as a New Yorker; a Fifth

Avenue fashion expert. 2) Ambiguities arise from derivational de­

finitions where the term is abstract enough to allow different mean­

ings: two different men are both fathers. 3) Ambiguities arise

from circumference shifting where one person picks up new meanings

and drops off others until the agents are not even talking about

the same thing. "Street" for a New York city resident does not mean

the same thing as "street" for a Vermont farmer. 4) Ambiguities arise from scope-reduction-deflection where broad terms may mean entirely different things to different people: West to the President of the United States means something different than west to a farm­ er.2! Using ambiguities allows the author to get away from meanings that do not fit his motivations. "It is part of the fortunate rich­ ness of language that makes it possible for people to adjust them­ selves to reality."22

Through the use of ambiguities, motivations become short­ hand terms for explaining to others and ourselves, in the midst of

21d. Fogarty, pp. 69-71.

22p. Fogarty, p. 71. -51-

conflicting stimuli, why we went the way we did. They act as bridges between what man wants to be and what others will allow him to be.21

Though a speaker and his audience may initially appear to be at an impasse, both can transcend the conflict by naming the terms ambig­ uously that caused the impasse. Motive is not "covert plan" but

"game plan." Through motive men explain what they see in their scene that they desire to change and how they are going to change it. Thus for Burke, identification is the acting together (consub­ stantiation) that men do from one common factor (a desire for unity) in spite of the differences between men.24 Division between men provides the need for identification and unity and ambiguities make identification possible.25 The aim of identification is to enable the person to live in hierarchy—the patterns of striving where the individual living in concert with the group obtains the big­ gest slice of the good life possible for himself and the group.26

In hierarchy, the individual recognizes the strivings of those who are weaker than he is and those who are stronger. In man's need for hierarchy and order he continually strives to treat the weak with dignity and the strong with respect in order to achieve stability for himself and his community.

23d. Fogarty, p. 72.

24d. Fogarty, p. 75.

25d. Fogarty, p. 76.

26d. Fogarty, p. 77. -52-

3. The Goal of Cluster Analysis

Clusters are the result of identification. They are spon­

taneously or deliberately generated by the strategies of identifi­

cation. By indexing the clusters in a literary work, the research­ er gains a picture of the stratagems of sociation that underlie all human activity.2? Thus in cluster analysis, the critic treats a piece of discourse not just as an object of art, but as a large sen­ tence that must be diagramed to show "what goes with what,"2*8 in order to understand the author's motives for manipulations of his scene. One goal of cluster analysis is thus to underscore the author's motive and not just the audience's understanding of the artifact.

Another goal of cluster analysis is reductionistic. For

Burke all symbolic action can be reduced to its essence: purgative- redemptive ethical drama. And all ethical drama can be reduced to ritual drama. All linguistic action is to be found in ritual drama.

"In typical fashion, Burke reduces the many to the one . . . all verbalization is reduced to symbolic action; symbolic action is then reduced to its most perfect or ideal form, which is poetic symbolic action; all poetic symbolic action is then reduced to its essence, which is the purgative-redemptive ethical drama; ethical drama is then reduced to its most perfect or ideal form, which is ritual drama. Burke then takes the final step and equates the point of

27W. H. Rueckert, p. 178.

28W. H. Rueckert, p. 179. -53-

departure—linguistic action, with the terminal point of ritual drama—and ends up with the proposition that the essence of all linguistic action is to be found in ritual drama."2® Burke then strives to show that conflict is resolved symbolically instead of materially and thus bridges the gap between those who regard sym­ bols as reflections of subjectivity and those environmentalists who argue that symbols are only the reflections of a basic objectivity.30

By performing this reductionist function, cluster analysis generates a schema for ambiguities. Thus ambiguities do not obscure truth, but careful manipulation of them insures the emergence of a "truth" with which the author and his audience can live.

The Method of Cluster Analysis

Now that the rhetorical theory underlying cluster analysis has been briefly explored, it would seem appropriate to examine the actual method Burke prescribes for cluster analysis. Below will be discussed: 1) The progression forms that give rise to cluster analy­ sis. 2) The forms used in cluster analysis. 3) The dramatistic interpretation that follows from cluster analysis.

1. The Progression Forms Determined by Cluster Analysis

The critic begins cluster analysis with a structural analysis

29w. H. Rueckert, p. 128.

30h. Slochower, p. 132. -54-

what follows what and why. Here he identifies plot (sequence of ex­

ternal events); action (spiritual movement or sequence of internal

action); pattern of experience (conflict between the agent and oth­ er agents); spatial movement (up, down, east, west); tonal pro­ gression (from dark to light); chronological progression (historical change); scenic progression (where does the action move to); qual­ itative progression (from innocence to correption).31 The struc­ tural analysis simply puts the critic in touch with the author's mode of manipulation. As yet the author's code of motives is un­ known—the critic is only laying out the format of the coded message

2. Cluster Analysis Forms

Before he can interpret the forms, the critic must identify synecdocic forms of motive in the artifact.32 The house lived in could be synecdocic for the woman love. This is a recognition of another type of form than the progression forms mentioned above.

This is what goes with what.33 Here the goal is to understand the author's motive, not only his mode of discourse. In order to under­ stand this type of structure first an index is formed of high in­ tensity terms (sex, love, or other terms charged naturally by the

31w. H. Rueckert, pp. 83-84.

32r. Burke, The Philosophy of Literary Form: Studies in Symbolic Action (Berkeley, California: University of California Press, 1973), pp. 29-30.

33w. H. Rueckert, p. 84. -55-

author—rose garden, or a tavern), or of frequently repeated terms.34

Next, a concordance is made of every context in which these terms ap­ pear. Each frequently used or charged word context is catalogued not only in the artifact under examination, but in other artifacts composed by the author. This exhaustive concordance shows linkages of what words are linked to what meanings and contexts. The con­ cordance may show also variances of meaning.35 At some places in the author's works, the rose garden may be linked to a lover, and at other times it may be linked to a grave. Thus loving and dying for the author may have terminal overtones of ultimate self- disclosure. The concordance also shows pivotal terms for the author such as society, nature, justice.36 The pivotal terms are repre­ sentations of large institutional or psychological constructs around which may cluster a variety of terms, such as were mentioned in the

Job-Devil illustration in Chapter One.

In a private interview with Fogarty, Burke gives the follow­ ing hints for concordance construction: 1)Search for stages of de­ velopment in the artifact and name those stages of development.

Where names are already given in the artifact, such as in chapters of books or acts of plays, the critic is purged to suggest alterna­ tive names for the parts. 2) Note striking terms. 3) Note

34w. H. Rueckert, p. 84.

35w. h. Rueckert, p. 84.

36w. H. Rueckert, p. 85. -56-

oppositions. 4) Note beginnings and endings of sections. 5) Note

names for persons that indicate essence. 6) Note properties in one

character present in other characters. 7) Note internal forms.

8) Note parts of the scene where the character will complete him­

self. 9) Note expressions of secrecy, marvel, guilt, mystery, power, silence. 10) Note points of furthest internality. 11) Note

fruition and water shed moments.37 12) Look for dramatic align­ ments and note equations and quotations that back up those equa­ tions. 13) Note shifts in the meaning of the equations. 14) Look for what the work is doing for the author's private life. 15) Look for functional features. 16) Look for underlying imagery.35

3. Dramatistic Interpretations

Though no attempt beyond cluster analysis will be made in this research on the Hippocratic Oath, it would be helpful for fu­ ture researchers to point to additional areas that might be inves­ tigated by additional models suggested by Burke. After a cluster analysis has been done, the critic may employ an Agon analysis in which the author uses the main character of the plot as a central character representing the self in search for identity. Here the agent transcends his literary scene and takes the reader's part in overcoming ambiguities. This is a full interpretation of the human

37p. Fogarty, pp. 84-85.

38k. Burke, Philosophy, pp. 71-78. -57-

drama unfolding from the cluster analysis. Protagonist and antag­

onist are pictured in the drama of conflict resolution.39

Justification of Cluster Analysis

Why is cluster analysis particularly suited for an analysis of the Hippocratic Oath? Below will be described: 1) Lack of ex­ trinsic data; 2) Cluster analysis as a calculus of persuasion;

3) Cluster analysis as a rhetoric of motive description.

1. Lack of Extrinsic Data

When little biographical data is available for analysis, the critic must focus directly on the artifact for his interpretations.

Cluster analysis allows this close scrutiny.40 Thus if there are seven ingredients in a cluster, one of them could represent the oth­ er six in a synecdochic function.41 The critic looks at the whole work and describes the words not only on the literary merit of the work, but by what the symbols are doing for the artist (function).

The critic looks at what function the poem has for the poet as the artist interacts with the scene to accomplish the artist's purpose.42

Even if there is no extrinsic data, Burke assumes there once was,

39w. H. Rueckert, p. 86.

40k. Burke, Philosophy, p. 24.

41k. Burke, Philosophy, p. 27.

42w. H. Rueckert, p. 67. -58-

and thus he makes everything extrinsic, intrinsic;4*8 "caused by" becomes "equal to."44 If the scene is focused upon, then social and economic coordinates can be used:48 since agent, then biology; since act, then literature and rhetoric; since purpose, then ethics.

Burke reduces the number of things to look for in a poem, but at the same time increases the ways to look for them.48 with a lack of extrinsic data and interpretation to tell the critic what the author had in mind in a particular piece of discourse, the critic, by cluster analysis, has the chance to discover what the author him­ self had in mind as motive in his works. A surprising difference between what the public has assumed the author meant and what pri­ vately motivated the author can be detected by this method. Burke shows in his analysis of Freud's writings that the primary motive of human rescue in the father-child cluster emerged—not the com­ petition motive that the popular press often attributes to Freud.47

It is popularly assumed that Freud cast the father-child relation­ ship in terms of envy, competition, jealousy, and covetousness.

Thus the father's motive for disciplining the child was to prevent the child from competing with the father for love from the mother.

43w. H. Rueckert, p. 82.

44w. H. Rueckert, p. 82.

48w. H. Rueckert, p. 82.

48W. H. Rueckert, p. 83.

4?k. Burke, Philosophy, p. 260. -59-

Burke's cluster analysis on selected works of Freud however shows a

different motive in discipline: rescue. By discipline, the father

rescues the child from error and the consequences of error that the

father knows will affect the child's later life. The father disci­

plines the child, so that the child can be free from the bondage of

bad choices in his adult life.

2. A Calculus For Persuasion

If it is discovered what the work is doing for the author, it

may be discovered what the poem or artifact is doing for everyone.

Thus common loci of meaning are identified.48 These loci arise from

patterns of expectancy in human reason. These are what Burke calls

"internal forms." These forms may be stages of growth, contrasts of

opposites, or unfoldings of emotions.49 These forms arouse expec­

tancy and answer that expectancy by satisfying it.50 Burke identi­

fies five internal forms. 1) Syllogistic progression in a well-

constructed argument. 2) Qualitative progression—the quality of

one character preparing the way for another character. For example,

Duncan's murder prepares the audience for the comedy porter scene.

3) Repetitive forms such as a series of repeated themes. 4) Con­ ventional forms such as the sonnet or the soliloquy. 5) Minor forms

48k. Burke, Philosophy, p. 73.

49p. Fogarty, p. 78.

50p. Fogarty, p. 78. -60-

such as metaphor or figure of speech.51 For Burke the symbol be­ comes a parallel to experience that clarifies a problem, favors ac­ ceptance of one side over another, acts as compensatory corrective, and emancipator of principles and values which the reader would not think of doing.Thus ideologies can arise from a general belief pattern that the author knows that the audience already holds.88

The author uses these patterns that are strategically arranged to produce a saliency effect between artist and audience, "... be­ cause of the quasi-universality of the experience pattern they

[idiologies] are built upon. Symbolic intensity arises when the artist uses subject matter 'charged' by the reader's situation out­ side the work of art."8*^ Thus symbol power is reduplicated by the power of ideology.

3. A Rhetoric of Motives

By counting the equations the critic can detect what is made to stand for what. The author describes his situation by the clus­ ters. Thus situation becomes another word for motive.88 No matter how consciously he structures the relationships, there are thousands

81D. Fogarty, p. 79.

82d. Fogarty, p. 80.

53d. Fogarty, p. 80.

54d. Fogarty, p. 81.

88K. Burke, Philosophy, p. 20. -61-

of relationships of which he is not aware and these too comprise his motive. As Burke explains: "Like a man with an eye tic—if you kept a list of the topics that made his eye tick, you would know what the tic was 'symbolic' of."56 By cluster analysis, the critic can describe the author's rationalizations—how he is naming a par­ ticular kind of scene that made the agent act in the way that he did.57 Thus, an author lifts a problem out of a context where there is no answer and places it into a situation where there are answers close at hand. This cannot be done without a shift in circumference58

—a desire on the part of both artist and audience to transcend their present scene. Thus Burke's works are really an attempt to chart laws in the realm of normative judgments.59 This methodology allows description of the full weight of opposing perspectives without hos­ tility.88 The scientific model Burke concludes is inadequate to describe the universal strategies that men have always used in cop­ ing with scenes, because it does not promote the cooperative and non-combative aspects of symbolic action. The three threats to any situation or scene are disorder, division, and disintegration.

These threats to disorder a scene are met by the symbolic strategies

56k. Burke, Philosophy, p. 20.

57d. Fogarty, p. 86.

58d. Fogarty, p. 86.

59h. Slochower, p. 131.

60h. Slochower, p. 134. -62-

which unite men.®! In order to change circumference often a scape­ goat is used. A vessel is employed to carry off unwanted meanings and to allow for a rebirth of meanings.82 The scapegoat does not need formal appointment but may be the vessel of our own tempta­ tions and vices: the bad father who would not give his children toys is used as a scapegoat by the good father who gives his chil­ dren toys.63 Socialization is the normal mode of scapegoating: the community excludes from membership a member who does not measure up to the norms, in order to strengthen the group.64

Burkean Examples of Cluster Analysis

Below will be cited both examples of the cluster analysis applied to an artifact and some deficiencies in cluster analysis found in Burke. The most outstanding example of cluster analysis was used by Burke as he analyzed Hitler's Mein Kampf in "The Rhetoric of 'Hitler's Battle.'"65 Remarkable in this analysis was Burke's picture of the dictatorial menace prior to the eruption of World

War II. In this analysis Burke showed the cluster of Hitler's inner voice that unified leader and people. Thus unity = Reich = the

61w. H. Rueckert, p. 42.

62k. Burke, Philosophy, p. 41.

63k. Burke, Philosophy, p. 45.

64k. Burke, Philosophy, p. 50.

65k. Burke, Philosophy, p. 191. -63-

Mecca of Munich = plow = sword = work = war = army = responsibility

= sacrifice = German democracy = absolute obedience = love = ideal­

ism = obedience to nature = race/nation.88 Burke showed that Hitler by identifying with the norms of the nation, completely identified with the people making their aims his own.

Burke has also done a cluster analysis on James Joyce's

Portrait of the Artist as a Young Man and many of Freud's writings in The Philosophy of Literary Form. Also in Philosophy of Literary

Form Burke uses cluster analysis in his interpretation of Coleridge's poems, particularly The Ancient Mariner in which he identifies five clusters.87 The aesthetic cluster illustrated by the Eolian Harp

—the unity of the player and the being-played-upon. The poet's ex­ ultation in his creative process is characterized by a total self­ giving to the art. The marriage cluster is characterized by asso­ ciations with rot and punishment. Biographical data substantiates the fact that Coleridge had an unhappy marriage but the intrinsic data of the Ancient Mariner also shows this private fact of the poet's life. The political cluster is seen in his vision for a

Utopia. Coleridge believed that given a proper structure, virtue would emerge in any society. His dream was to found a "pantisocracy" communistic society in America. This dream never materialized. The disintegration of structure is obvious in the character of the mariner

88K. Burke, Philosophy, p. 207.

87K. Burke, Philosophy, pp. 93-100. -64-

himself who is beaten by the sun. The drug cluster is seen in the

mariner's blessing of the serpents, where the snakes are transformed

from malign to benign creatures. Here the snakes are synecdochic

representatives of the author's drug addiction. The metaphysical

cluster is seen in Coleridge's attempt in the poem to recreate evil

into good. He views himself as a dim analogue of creation.

A methodological weakness of cluster analysis as it appears in Burke and other rhetorical critics, is the complete lack of an actual index cited in the text by the various critics. This lack of an index makes replication of the research impossible. A form of cluster analysis is used in Scriptural analysis with manuscripts of antiquity (see J. Jeremias, Rediscovering The Parables, New York:

Scribner's, 1966, and C. Westermann, The Praise of God in the Psalms,

Richmond, Virginia: John Knox Press, 1961). In these expositions, the critics have included the actual index which invites academic scrutiny

This research will include an index in Chapter IV of the pivotal terms found within the Hippocratic Oath.

An Instrument for the Analysis of the Oath

The Oath will be analyzed by the following steps. 1) The

Oath will be examined using the text delivered by W. H. S. Jones.

Major books of the corpus of Hippocrates have been translated by

Jones and his index system for line counting will be used through­ out: each line in the Oath will be identified as HO 1; HO 2. The other works are identified in the Jones translation by title, chapter -65-

and line: AWP 3.21 = Airs, Waters, Places, Chapter Three, line

twenty-one. Where relevant, the Greek words will be included in

the discussion. 2) A translation of the Oath will be made and a

preliminary identification of important terms to be studied will

also be made. These terms will be isolated for comparison of use

later in the corpus. Each term will be written on a card and each

time an instance of the word occurs in the corpus, an additional

card bearing the term and its context will be made. 3) After the

index has been made, the contexts will be molded into a concordance

with the following divisions: a) What words in the Oath are used

frequently enough to be called important vehicles of meaning.

b) What dramatic alignments arise out of these comparisons: phy­

sician with community; physician with rhetor; physician with philosopher

c) Identification of cluster equations. From the contexts, the re­

search may determine that when the term "physician" is used, it may

be associated with the terms "brother," "stability," and "secrecy."

d) Once equations are identified, quotations will be catalogued to

back up those equations in order to ease replication of the study.

e) A separation in the corpus of those works that can be attributed

to Hippocrates and those that cannot, will not be done since phil­

ological debate still has not resolved this issue. The equations

will be drawn from the manuscripts that represent the earliest dates with the best Greek. If equations can be identified from this analy­

sis, then there is additional evidence for the work of one author or the contributions of one editor among the many traditions of the -66-

corpus. f) The evolution of the Oath will be traced historically to show which equations are kept in later generations of physicians and which equations were dropped. This survey will be brought to the present position in history to learn if there is justification for the present equations of current documents, from the "seed" equations present in the original document. CHAPTER III

THE ARTIFACT

The purpose of this chapter will be to examine some of the

extrinsic and intrinsic data of the Hippocratic Oath prior to the

application of cluster analysis. First, some of the significant

cultural details of the ancient world out of which the Oath grew

will be examined. As was stated earlier, it is a goal of this re­

search not to neglect important purposes and functions that the

Hippocratic Oath may have served for the Hippocratic medical com­

munity. These functions can only be appreciated after an analysis

of the social influences directed at medicine during its formative

years. Here these influences are discussed as they arise from re­

ligion, superstition, and cultic life-styles prevalent in Fifth

Century Greece. These are labeled non-empirical forces because they

attempted to attribute the condition of man—his health and his dis­

eases—to extra-worldly sources. Also, within this same perspec­

tive, influences from the investigations of the Ionian nature phi­

losophers will be discussed. These influences are labeled empirical

forces because they attempted to explain the conditions of man by

the objects present in the visible world. Instead of promoting mystery, these currents of philosophical/social thought negated mystery in the life of men.

Second, what is known about Hippocrates himself will be

examined. Though biographical data about Hippocrates is limited, -68-

a few details may be drawn from classical historians, Roman med­

ical cataloguers, and contemporaries of Hippocrates, which will allow

a brief sketch of the Coan physician's life. Also examined here will

be the features of Hippocrates' life which gave indication of how he

as a physician responded to his scene: the school, its particular

style of medical treatment, medical societies that insured medical

norms in the classical world, types of students that the school at­

tracted in concrast to student-types attending rival medical schools,

and the philosophy of medicine taught at the Cos medical school.

Third, the immediate context of the Oath will be examined.

Here will be discussed what is known about how oaths in general

functioned in antiquity, the authorship of the Oath, its relation

to other documents in the Hippocratic corpus, the approximate age

of the documents, a short analysis of the form of the Oath, and

textual problems present in the Oath. These topics are stated in

order to provide a data base for Chapters IV and V. In Chapter IV,

the cluster analysis will be applied to the Oath. Here the details

of the index and the concordance will confuse the reader unless he

has an introduction to oaths in antiquity. In Chapter V, the con­

clusions will be drawn from the cluster analysis and an introduction

to the medical world from which the Oath emerges may form a helpful

background for the reader as the documents which transmitted the

Oath are discussed.

Fourth, a brief historical listing of the documents that play a prominent role in the transmission of the Oath will be -69-

discussed. No attempt will be made here to provide rich historical

data that surround this transmission. This study will examine the portions of the Hippocratic Oath which were emphasized or deleted as medical history progressed. Certainly rhetorical interpretation cannot neglect historical data, but the aim of the research is to

identify and give reasons why certain stratagems or arguments used in the Oath endured historically while others did not or were trans­ formed.

Fifth, since the steps above have been done by essentially every critic who has analyzed the Oath, the questions that remain unanswered by this type of analysis will be stated and examined.

One obvious unanswered question is the reason why the first part of the Oath is shortened or is missing in subsequent translations of the Oath. The original document spends the first third of its lines binding the oath-taker to the medical peer community. Another ques­ tion that arises from this analysis is what words are not mentioned in the original Oath, and why did subsequent Oaths feel free to im­ plant words such as "death," or "disease," within their texts. This chapter will discuss the extrinsic and intrinsic data mentioned above under the headings: What is known about the Oath? What is known about transmission of the Oath? And what remains to be known about the Oath?

What Is Known About The Oath?

This section will discuss first, the world of religion and -70-

science as it influenced medicine in the Fifth Century. Second,

biographical data known about Hippocrates will be stated. Third,

the textual data known about the Hippocratic corpus and the Oath it­

self will be given.

1. Religion, Science, and Medicine

The Hippocratic Oath emerges from Greek culture during the

Fifth Century. The world at that particular time displayed a re­ markable struggle between the influences of religion and philosophy.

Prior to the Fifth Century, men chiefly attributed their physical situation to the gods. When man prospered, his behavior somehow pleased the gods and when misfortune befell him, this was evidence that man had displeased the central powers of the universe. Zeus was regarded in terms of fatherhood, and earth was naturally the mother. Divine power and greatness of the Olympic deities were contrasted to human smallness and the moral need for submission to, if not models of moral rectitude, then powers which could threaten punishment if norms were not followed. This subjection is seen in the fragments of Xenophanes: "God is one, supreme among gods and men not at all like mortals in body or in mind . . . without effort he sets everything in motion by thought of his mind. "3

The healing arts were affected by this religious mind-set.

If a man was in need of healing, he turned to the healing gods in

3-P. Wheelwright, ed., The Presocratics (New York: Odyssey, 1966), p. 26. -71-

Greece during this period. Zeus' son Apollo, who was associated

with healing, had a son: Asclepius. Chiron the centaeur reared

Asclepius and taught him healing techniques. Homer shows Asclepius

not only as a skilled physician, but as a valerous warrior fighting at Troy with Machaon and Podaleirius.2 Asclepius was represented in the popular art forms of the day by a staff (protection) around which a snake twined (immortality, since the snake sheds its skin).

If man needed to approach the healing god he did so at public wor­ ship sites. Temples were dedicated to Asclepius at Tricca in

Thessaly, Epidaurus, Pergamos, and in what will prove to be sig­ nificant later in this study, the island of Cos. At these temples,

Asclepius is assisted by his two daughters, who also play a sig­ o nificant role in the analysis of the Oath: Hygea and Panacea.

The actual practice of the cult of Asclepius shows the power of suggestion and the non-empirical quality of this popular syndrome. The temples were located in beautiful wooded settings and were equipped with exercise grounds, medicinal springs, an inn, and of course, the temple. The patients were told to fast for a day by the priest before being received by Asclepius. The priests also raised the expectations of the patients with stories of past cures that had happened in the temple. After fasting, toward evening,

2G. E. Gask, "Early Medical Schools, I: The Cult of Aesculapius and the Origin of Hippocratic Medicine," Annals of Medical History, I (1939), 128.

8G. E. Gask, "Early Medical Schools, I," 129. -72-

the patient was told to sleep in the temple and was also told that

during the night, he would experience a dream of his cure. During

the night, dogs would lick the sores or wounds of the patients. In

the morning the suppliant was told that he could show his gratitude

of cure to Asclepius by making an offering of money or a statue of

his diseased part now cured. Aristophanes describes this cure pro­

cedure in his play, "Plutus."4 sites of these temples still exist to­

day at Epidaurus and Pergamos, both of which even have theatres, and

at St. Bartholomew's Island in the Tiber near Rome.

Incubation (temple sleep-healing) was not unique to Greece because Egyptian influence also contributed to the non-empirical roots of Greek medicine. The Oxyrhynchian papyrus collection tells of the Egyptian healer god, Imhotep, whose cultus included temple sleeping, votive tablets, and models of diseased organs.5 What ap­ pears to be a religious practice which emphasized the need of the suppliant to surrender himself to the capricious mercies of an un­ seen deity, were really exercises in self-healing. High motiva­ tion to recover and robust self-confidence were needed from a pa­ tient if these cultic cures were to be effective. This positive attitude toward self-healing is consistent with the characteristic desire of early Greeks and Romans for self-sufficiency and inde­ pendence in treating their own physical ailments. This characteristic

4g. E. Gask, "Early Medical Schools, I," 131.

5G. E. Gask, "Early Medical Schools, I," 135. -73-

attitude probably accounted for much of the cult's popularity in

Greece and Rome.8

Over against the non-empirical religious strain in world­

view and in medicine, grew an opposing world-view. Ionian nature

philosophers who appeared to ignore the gods and ask not what is the

source of behavior, but what is the source of being, signaled the

end of the Olympic power to control men's behavior. Thales of

Miletus claimed that water, not Zeus, was the source of all matter.

Anaximander claimed that man evolved from sea creatures. Anaximenes

claimed that the source of life was pneuma (air). Diogenes of

Apollonia, was a pioneer physiologist who studied the actions of the heart and vascular system by vivisection. He looked to scientific investigation to find answers for diseases—not the gods.

The Ionian "school" of nature philosophers was aided in its search for the ground of being by similar interests in the Italo-

Sicilian school of philosophy. The Fifth Century migration to the western Mediterranean gave medicine and philosophy some valuable contributions. Pythagoras of Samos proposed the doctrine of the four humours which Hippocrates would later adopt. Health resulted from a correct balance of those humours—not the gods. Democedes of Croton,7 a contemporary of Pythagoras set up a clinic on the

Island of Aegina south of Athens and eventually became the court

6j. Scarborough, Roman Medicine (Ithaca, New York: Cornell University Press, 1969), pp. 15-18.

7G. E. Gask, "Early Medical Schools, I," 150. -74-

physician for Darius I. Thus the nature philosophers influenced

the policy-setters: kings and royalty. Alcmaeon of Croton distin­

guished himself by his discovery of the optic nerves and his pro­

posal that the brain was the seat of all sensation. Hippocrates

later agrees also with this proposition. The chief contribution of

the Coan school was its association of earthly elements—fire, earth,

water, and air, with the four humours: hot, cold, moist, and dry.8

It is assumed that a medical school of some type was estab­

lished at Cyrene because the city exported large quantities of a drug cure-all called silphium which cured gout, dropsy, baldness, and dog bites.9 It was also used as a relish to be eaten with cheese according to the plays of Aristophanes. Treatment by doc­ tors in this scientific school, as well as that in Alexandria put emphasis on cure of the symptom. Specialists in gynecology, phy­ siology, and orthopedics developed unusual drugs and cures based on catalogued information gained from experimentation and practical ex­ perience. Vitruvius, an early Roman doctor even correlated geo­ graphy with types of health: the right site for a city promoted the best health.10 .

Both empirical and non-empirical schools of medicine en­ joyed degrees of popularity in the classical world, but the

8G. E. Gask, "Early Medical Schools, I," 155.

9G. E. Gask, "Early Medical Schools, II: Cyrene, Cos, and Cnidos," Annals of Medical History, II (1940), 15.

10J. Scarborough, p. 58. -75-

non-empirical religious specialists were trusted by the general pop­

ulation more than were the skilled technicians. These two schools

were undoubtedly an influence on Hippocrates as his particular med­

ical theories began to evolve. Thus in examination of motive as a

product of scene in this research, it would be unwise to ignore what

types of medicine were competing for public acceptance in this era.

Choice situations in medicine began to emerge even in this primi­

tive era. Does the patient trust the gods and treat himself or does

he trust science and let others heal him.

2. Hippocrates: Life and Science

From an examination of the medical environment in the world around Hippocrates, attention is now turned to Hippocrates himself.

He was probably born at Cos around 460 B. C. His lineage was dis­ tinctly medical. His father (Heracleides), grandfather (Hippocrates), great-uncle (Aineius), and great-great-grand father (Nebrus) were all physicians.1! It would not be surprising if this clan-membership factor should not emerge in the cluster analysis of the Oath. If

Hippocrates were part of a select family of physicians, would he wish to associate or dissociate from other types of doctors? Jones!2 points out that Hippocrates belonged to a medical guild called the

Asclepiadae. The evidence is unclear as to whether this guild was

!!w. H. S. Jones, Hippocrates, Volume I (Cambridge, Massachusetts: Harvard University Press, 1957), p. xliii.

!2W. H. S. Jones, p. xliii. -76-

associated with the Cult of Asclepius or whether it used the name

simply as a term of professional heritage in the same way that phy­

sicians use the term "doctor" when in reality they do not properly

belong to the academic community. It is interesting that the term

in Greek can mean "the family of" and parallels for this usage can be found in Pindar, Nemeans II.1 where poets who memorized Homeric verse are called "Homeriadae."33 Little is known biographically of Hippocrates except that he traveled a great deal and his medical help was sought by Perdiccas, King of Macedonia, and by Artaxerxes,

King of Persia.34 He is mentioned in Plato's Protagoras which calls him a Coan and a trainer of medical students. Plato's Phaedrus also cites Hippocrates for his principle of physiology which states that a knowledge of the human body is impossible without a knowledge of nature as a whole.35 Aristotle refers to Hippocrates as the great

Hippocrates (Politics, VII.4 [1326]).36 it is difficult to date

Hippocrates exactly because it is impossible to carry his name back further than the early half of the Fifth Century.

Aside from what is known about Hippocrates' life, what is known about his medical science? Fortunately researchers may rely on the Hippocratic corpus for this information where they may not * 3

33w. H. S. Jones, p. xlvi.

14w. H. S. Jones, p. xliii.

38w. H. S. Jones, p. xliii.

36w, h* S. Jones, p. xliv. -77-

for biographical information. From historians in antiquity, it is

known that two medical colonies flourished in Ionia. A medical

school at Cnidos was oriented toward practicum. The physicians

there divided diseases into catagories and treated only the symp­

toms. By contrast, the Cos medical colony took a more philosophical

view of medicine. Those doctors studied the natural history of dis­

eases and the effects of diet and climate on combating disease.

The Coan school studied disease inductively. This method, of

course, demanded the gathering of large amounts of data about every case and disease. The presence of a close rival medical community with contrasting medical philosophy would substantiate further

Hippocrates' desire and motive to separate himself from his scene.

While the rival school focused narrowly on the evidence of disease, the Hippocratic school looked for a social dimension in illness: how men elected to live as the cause of their condition; what, cloth­ ing did the sick men wear; what prevailing winds reached the town where the sick men lived; what foods were eaten.

Additional social and topographical differences between the cities where the schools were located may further substantiate a desire on Hippocrates' part to differentiate himself from the scene of his rival medical school. Cos was insular, provincial, agri­ cultural, and famous only for its exported wine. By contrast,

Cnidos was a cosmopolitan and commercial city with harbors. It was

17G. E. Gask, "Early Medical Schools, II," 17. -78-

situated on the main trading lanes with Persia, Babylonia, and India.!8

These foreign influences could be a source of identification or rejec­

tion for Hippocratic medicine. Portions of Hippocrates' "Peri

Hebdomadon" may have been taken from the Persian Avesta.!®

Indian influence may have also reached Hippocrates. Moral

dicta similar to the Oath are found in the Ayurvedic literature com­

posed in the era just after the Upanishads (800 - 600 B. C.). The

Upanishads emphasized service to man rather than gods and forced

each profession to design a code of conduct. The doctor is told

that ". . .if you [the doctor] desire success, wealth, and fame as a physician in this life and heaven after your death. . ."he will

follow the seventeen dicta of the code.28

The bulk of Hippocrates' theory of medicine is contained in the Hippocratic corpus. This collection of literature may have been part of the medical library at Cos.2*! Tradition says that Hippocrates burned the library in order to prevent its manuscripts from being used by rival schools. Similar libraries were known to have existed at Ephesus and Pergamos.22 It is known, however, that the Alexandrian library took many copies of Hippocratic manuscripts for its own

1®G. E. Gask, "Early Medical Schools, II," 17.

!®G. E. Gask, "Early Medical Schools, II," 18.

2®K. R. S. Murthy, "Professional Ethics in Ancient Indian Medicine," Indian Journal of the History of Medicine, 18:1 (1973), 47.

21W. H. S. Jones, p. xxix.

22G. E. Gask, "Early Medical Schools, II," 20. -79-

collection. Ptolemy Philadelphus wanted to establish the Alexandrian

collection as superior to that at Pergamos, so many books of the

Aristotelian collection were brought to Egypt along with medical

scholars who would develop a medical school on the site. Many

Hippocratic documents found their way to Alexandria in this way.23

This medical center produced a kind of bookish doctor—long on the­

ory and short on practice. The Cnidian school was probably much

older than the Alexandrian or the Coan school. The writings of

this school are all lost, but it is known that students who attend­

ed this school tended to be specialists.24 Though a search of the

Hippocratic corpus shows no evidence of a medical school in Cos, ex­ cept in the Oath, it is known that students of this school traveled from town to town and set up stalls that would support their craft, in the market places of various communities. If the amount of his medical practice was large enough, the Coan doctor may have stayed in a town for several years before moving to a new location. These facts are known through the biographers of Hippocrates, Soranus of

Ephesus (Second Century, A. D.), and Tzetzes, a historian (Twelfth

Century, A. D.).2®

The chief theoretical orientation of Hippocratic medicine was the fact that he considered the body as a whole and that a sickness

23j. Scarborough, p. 31.

24jj. o. Taylor, Greek Biology and Medicine (New York: Cooper Square Publishers, 1963), p. 146.

28g. E. Gask, "Early Medical Schools, I," 139. -80-

in a part of the body might disorder the rest of the body. To oper­

ationalize this complex concept of dependency he adopted the doctrine

of the humours and increased its reliability by practical field ob­

servations. The body was composed of four factors which must be in

correct balance before health could be achieved: warm-moist (blood), warm-dry (yellow bile), cold-dry (black bile), and cold-moist

(brain).28 The genius of this concept was that the doctors of the

Coan medical school were able to make prediction and prognosis of disease by a careful catalog of the symptoms. By observing climate,

they could predict the ailment most likely to affect the patient. A hot dry climate for example, would most directly affect the cool-moist humours. Treatment, thus, was easy to prescribe since the cause of the ailment was known.

A further accomplishment of the Hippocratic school was its ability to advance argument for the cause-effect relationship of medi­ cine in culture. Thus Hippocrates was able to define medicine as techne and make the qualitative leap from empirical evidence to c z medical generalization.2' Techne ( *’1 Ttxv'*« ) was a skill or art for devising something according to rules. This skill in craftsman­ ship was the opposite of spontaneous creation in art that followed no plan and was haphazard. A techne had rules of creation and those rules could be seen in numerous creative vocations in antiquity: a

28h. O. Taylor, p. 18.

27g. E. R. Lloyd, "Aspects of the Interrelation of Medicine, Magic, and Philosophy in Ancient Greece," Aperion, 9:1 (1975), 11. -81-

sculptor followed the "rules" of ideal body proportions; the archi­

tect followed "rules" about column height and width. The Hippocratic physician also had a techne which described the right relation

(proportion) between environment and regimen for a healthy body.

This techne followed rules gained by observation and did not make treatment haphazard.

In this perspective Hippocrates was able to show a relation between medicine, philosophy, and magic. How a man decides to live will affect his health. The way a man decides to live is determined in some part, by the value he places on his scene. For Hippocrates, health was life in balance and his motive for perpetuation of this perspective can be found within the persuasive stratagems found with­ in the corpus, and within the Oath. Hippocratic medicine was the result of this process of cataloging, not the result of one man's success with treatment or the result of one school's scientific experimentation.28 Hippocrates valued his patients' belief systems and attempted to give evidence of this supportive desire by the manner in which he persuaded them to correct an ailment.

3. Hippocrates; Corpus and Oath

Now that the social and biographical evidence of Hippocrates' world have been examined, the textual evidence of the Hippocratic corpus and the Oath itself will be studied. First will be discussed

28G. E. Gask, "Early Medical Schools, I," 156. -82-

the role of oaths in antiquity. Next, a short description of some

features of the corpus will be given. Finally the text of the Oath

itself will be discussed.

With the discovery of the Mari tablets in 1935, modern re­

search has learned how oaths functioned in the ancient world. The

"conditional oath" with a long string of obligations in the oath is

typical of the legal obligation made between persons of unequal power.29

This is the type of oath represented in the corpus under study. Usu­ ally the blood of a sacrificial animal bound the parties together by illustrating the consequences of breaking the oath. The oath had three factors. 1) A relationship between parties of unequal power was begun by an oath. 2) Communication between the parties was in­

sured by the taking of the oath. 3) The oath's obligations became laws or new norms of conduct which signify that the relationship is still in effect.30 if the oath is viewed with its classical genre, then the first part of the Hippocratic Oath is the most important part. The first part of the oath establishes the relation between the two parties, on which the other two parts of the oath hinge.

Aristotle would seem to echo this concept because he states that some oaths depend on perceptions that the audience has of the oath-maker.31

29b. W. Anderson, Understanding the Old Testament (Englewood Cliffs, New Jersey: Prentice-Hall, 1957), p. 54.

30e. Jacob, Theology of the Old Testament (New York: Harper and Row, 1958), p. 211.

31l. Cooper, tr., The Rhetoric of Aristotle (Englewood Cliffs, New Jersey: Prentice-Hall, 1932), p. 84. -83-

The credibility of an oath, for Aristotle, varies with him who wrote

it.32

The Hippocratic Oath is not a legal instrument as would be

used in a court setting. Since it appeals to the gods it must be

viewed as an artistic proof since the gods belonged to opinion rather

than fact.33 The Hippocratic Oath does not belong to the legal

scene where an oath was an inartistic proof. With its list of dicta,

it is obvious that the Oath belongs to the "conditional oath" genre

and its scene is relationship formation between parties of unequal

status. The scene is the medical community and not the court setting.

The Oath is addressed to other doctors; the "moral" dicta are the

conditions that show that the relationship among the doctors is still in effect.

Clearly for the classical medical world, the Oath was not a series of laws promised to be obeyed, as much as it was an artistic

32oaths may be both artistic (proof by argument) and inartistic (proof by demonstration). In order to determine whether an author is using an oath as artistic or inartistic proof, the researcher must look at which verb the author uses to describe the taking of the oath. Aristotle in Rhetoric describes oath-taking as "deferre" with the verb S*. Sov*.e ( ) - The oath is used here as an inartistic proof because the taker offers to surrender himself to the judgment of the court—his wit­ ness will rest on demonstration and not argument. Hippocrates, however, in the corpus, describes oath-taking with —to join, to agree, to be "seized" as in a hand-clasp. Here the focus is on "recipere"—a trust relationship which implies ethos, an artistic proof. With Hippocrates' (3* vcxv , the focus is on function (what makes one person trust another); Aristotle's SkS"/«-1- focuses on use (how oath-taking demonstrates the existence of a condition without ethos). See E. M. Cope's Introduction to Aristotle's Rhetoric (London: Macmillan, 1867), p. 202, note 1. The verb is the key to proof differentiation.

33l. Cooper, p. xxxiv. -84-

proof of perceived credibility. This view is echoed by medical

historian H. E. Sigerist who claims that the Oath was the only way

a primitive doctor could gain professional credibility and pro­

fessional credentials: "... and this he acquired through his

learning, skill, conscientiousness, correct prognosis, finding out

things the patient did not tell him, and in a general way, leading

a worthy and dignified life."24 The Oath was the only way the doc­

tor had to differentiate himself from quacks and charlatans. When

the Oath is viewed within the context of its classical scene, the researcher must look for a motive in its creation beyond medical altruism.

The Greek in the corpus suffers from an unusual mixture of

Ionic and Attic forms. As Ionic dialect gradually was accepted as the language of science, the writings of the corpus were circulated to a wider audience in the ancient world. Later scribes, thinking that some forms were intended to be Attic, took the liberty of cor­ recting the forms. Thus the translator should be alert for changes between Attic and Ionic form which may appear within the same sentence

The corpus is composed of fifth-eight books. These are listed in the appendix. Littré's edition attributes Hippocratic authorship to only twelve of these books.35 Textual debate continues concerning this claim. Cluster analysis in future research may

34h. e. Sigerist, A History of Medicine, volume II (New York: Oxford University Press, 1961), p. 305.

35e. b. Levine, Hippocrates (New York: Twayne, 1971), p. 20. -85-

substantiate Littré*s thesis. The Oath is known by early editors

of the corpus from the time of Nero: Erotian, Bacchius, Celsus,

and Galen.36

The Oath appears to be divided into two parts. The first part speaks of a medical student's relation to his teacher and the

teacher's relation to the student. The second part deals with moral

codes of behavior in public and private acts for the doctor.27 Be­

low, the Oath is divided into its twelve dicta.88

1. I solemnly swear by Apollo the Physician, by Asclepius, Hygea, and Panacea, and by all the gods and goddesses, whom I call upon to wit­ ness this oath, that I shall to the best of my ability and judgment carry out the intent of this oath and this agreement.

2. I shall consider my teacher in this art as the equal of my parents, I shall share my livelihood with him and even share my substance with him if need be.

3. I shall consider the male members of his family as my own brothers, and I will teach them this art if they wish to learn it, without payment or written agreement. 4. I shall impart both written and oral instruction as well as practical instruction to both my own sons and those of my teacher, and to those students who have signed the agreement and sworn to abide by the physician's rule, but to no other person.

5. I shall use treatment for the good of the sick to the best of my ability and judgment, and I shall refrain from using it for either * 3

36w. H. S. Jones, p. xl.

37e. b. Levine, p. 57.

38e. B. Levine, pp. 57-59. -86-

harm or wrongdoing.

6. I shall not prescribe a deadly drug to anyone even if I am asked to do so, and I shall not suggest or advise the taking of such a drug.

7. Likewise, I shall not prescribe for any woman the use of a pessary to induce abortion.

8. I shall conduct my life and the practice of my profession in a pure and holy manner.

9. I shall not do surgery even on those suffering from stones, but I shall yield to practitioners who specialize in this work.

10. Whatever houses I go into, I shall enter for the good of the sick, avoiding all malicious or distructive wrongdoing, including es­ pecially sexual misconduct with persons of either sex, free or slave

11. Whatever I see or hear in the course of my ministrations or even beyond the professional sphere of my activities in the society of others, I shall not reveal what ought never to be repeated, as I am convinced that such matters are strictly confidential.

12. Accordingly, if I carry out the provisions of this solemn oath, and if I do not violate any of them, may it be my reward to enjoy life and the practice of my profession, honored always by all men; but if I transgress any provision or falsely swear to this oath, may I suffer the opposite fate.

Though this translation suffers from incredible liberties with

the original text, it has been reproduced to illustrate the twelve sti­ pulations of the Oath. On the surface it may appear that this divi­ sion of the meaning of the Oath may be possible: A) Formal stipula­ tions of oath-taking: 1 and 12. B) Obligations to peers: 2, 3, and

4. C) Professional dicta: 5, 6, 7, and 9. D) Personal conduct dicta: -87-

8, 10, and 11.

However, if the classical genre of oaths is followed (rela­

tionship, communication, and dicta), then the following order is dic­

tated: A) Relationship: 2, 3, 10, 12; B) Communication: 1, 4, 11;

C) Dicta indicating the relationship: 5, 6, 7, 8, 9. From this ar­

rangement, it is obvious that the emphasis of the Oath lies with pro­

fessional peer relationship and communication; not with the patient.

Jones has posited that the Oath was intended to be obey­

ed in spirit instead of letter, and that any student would be taught medicine for a fee. There are also violations of the let­ ter of the Oath in Nature of the Child where an abortion is describ­ ed. Indeed, the Oath may have been written differently for each stu­ dent who entered the school. Sentences could have been inserted or deleted according to the value system of the student.

There are sixteen existent manuscripts of the Hippocratic corpus varying in degrees of completeness and age. The earliest manuscript is Vendobonesis which dates from the Tenth Century. The latest manuscript is Barberinus (Fifteenth Century). The Oath is found in Vaticanus Graecus 276 (Twelfth Century) and in Marcianus

Venetus 269 (Eleventh Century). The chief edition containing the

Oath is J. R. Duval's Serment d'Hippocrate Precede d'un Notice sur les Serments en M/decine, Paris 1818.88 The English W. H. S.

Jones edition will be used in this research.

88W. H. S. Jones, p. 296. -88-

What Documents Transmitted the Oath?

Now the vehicles that transported the Oath into modern times

will be examined. No historical analysis of the conditions which

surrounded the Oath will be given here. In this section the aim is

not to show what was kept of the original Oath and what was deleted

as the Oath moved into the modern era, for these stratagems will be

discussed in Chapter V. It is the purpose of this section to intro­

duce the documents that will be used in the concluding chapters to

drawn conclusions for the cluster analysis. The purpose of this

research is to determine if the stratagems employed in the orig­

inal Oath remain intact or if they are altered as the Oath moves into

history. Thus the emphasis will not be on historical data that may

surround the Oath but on the actual documents that transmit if not

the words then the implications of the Oath. Here will be named

the sixteen documents which build on the Oath. These documents are

reproduced in the appendix in the order in which they are discussed below.

During the Third Century, the growing Christian community

rewrote the Hippocratic Oath by removing the pagan references and

including a Trinitarian salutation. Certain moral dicta and the length remain about the same as the original document.40

Next, the Hippocratic influence is stated in a short letter

40s. J. Reiser, A. J. Dyck, and W. J. Curran, Ethics in Medicine: Historical Perspectives and Contemporary Concerns (Cambridge, Massachusetts: MIT Press, 1977), p. 10. 89-

by St. Jerome in the Fourth Century to a priest names Nepotian, in

northern Italy.4! Here the author discusses how the clergy should

conduct themselves when visiting the sick in their parish. Jerome

alludes to Hippocrates and states several dicta of the Oath.

Legal interests began to influence medical practice in the

Fifth Century and the next document which will be cited is a frag­

ment of the Germanic Code laws of the Visigoths as they were given

shape in Spain.4*2 * In the Sixth Century, Cassiodorus writing to a

doctor of the royal court at Ostrogoth in northern Italy again

states the Hippocratic ideals.42 In the Eighth Century, medical

handbooks flourished on how doctors should conduct themselves with patients. In this era, the Hippocratic ideals were transmitted by an artifact called the Bamberg Document which appeared in Germany and joined Christian to classical ideals.44 *The largest collection of Hippocratic writings is gathered in a corpus simply titled Paris

11219. This Ninth Century collection written in central France deals with a number of medical topics. The Oath is found in the section entitled Liber Epistolarum.42 Another Ninth Century document

41Li C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 3.

42L. C. MacKinney, 4.

42l. C. MacKinney, 4.

44L. C. MacKinney, 5.

42l. C. MacKinney, 7. -90-

is called "Epistle of Hippocrates." This document has heavy man­

uscript verification for it is reproduced in Brussels 3701-15; Rome

Vatacanus Regina 1443, and Parish BN 6988A.46 A Tenth Century docu­ ment Monte Cassio 97 deals with medical morals of the doctor's bed­

side manner.4? Constantine's work, Liber Pantegni (1100) expands

Hippocratic doctrine and contains a medical treatise in the pro­

logue. 48 The Oath was translated into Arabic in the mid-Thirteenth

Century, and it is contained with Ibn Usaybia's Lives of the Physicians.49

In the Twelfth Century, the Salernian manuscript (Breslau 1302) again

attempts to invoke God's aid and the classical ideals to create an excellent moral example for the physician.50

A serious break with Christianity appears to surface in 1306 with Henri de Mondeville's "Code of Ethics For Surgeons," a group not highly esteemed by society in this period. The subtitle of the work is: On The Morals and Etiquette of Surgeons.51 a further break with religion is seen in 1791 when Thomas Percival was asked to draw up a code of ethics for the disputing staff of Manchester

Infirmary in England. No research has been done on what sources * 48

46l. c. MacKinney, 23.

47L. C. MacKinney, 24.

48l. C. MacKinney, 27.

48J. Goodfield, "Reflections on the Hippocratic Oaths," Hastings Center Studies, 1 (1973), 82.

50l. C. MacKinney, 24.

51s. J. Reiser, et al. , p. 15. -91-

Percival used for his large document but the Hippocratic ideals are

clearly imbedded within the body of the statement.52 go influential

was this statement that the newly-formed American Medical Association

in 1846 used much of Percival's work as a base for the American Code

of ethics.53 in 1948, at the conclusion of World War II the

Declaration of Geneva was established by the World Medical Association

as an ethical guide to the profession.54 in 1957 the American Medical

Association adopted a shorter version of its original code.55 Though both the Nuremberg Code56 and the Declaration of Helsinki57 deal in­ directly with the Hippocratic Oath, they will not be discussed in

this research because these documents deal with moral dicta concern­

ing human experimentation. Such documents focus more on the legal rights of a patient/medical subject in extraordinary empirical re­

search than with the ordinary relationship between a patient and a general practitioner.

Questions That Remain

Philologists have done thorough analyses on the Oath from

52c. D. Leake, Percival's Medical Ethics (Baltimore: Williams and Wilkins, 1927), p. 28.

53s. J. Reiser, et al., p. 26.

54s. J. Reiser, et al., p. 37.

55s. j. Reiser, et al., p. 38.

56s. j. Reiser, et al., p. 272.

57s. J. Reiser, et al., p. 328. -92-

a grammatical perspective. Yet in spite of these efforts, certain

questions about the Oath remain. Yet to be explained is why cer­

tain words do not appear within the text: disease, death, or "patient"

as such. They are freely mentioned throughout the corpus in a variety

of the Hippocratic works. Could it be that the Oath was not designed

for prescriptive moral dicta that the patient could understand?

There has been no analysis of motive behind the Oath. Why

was the Oath administered? Did it fulfill a need for the patient

or for the doctor to be differentiated from his scene? For whose

benefit was the Oath administered? Why was there a need for differ­

entiation from society when cooperation between citizens was thought

to be the ideal of Greek culture? The motive analysis is easy to accomplish with cluster analysis and it seems strange that the very method Hippocrates used to catalog the various conditions of climate

should be neglected by those who are equipped to study this content of the Oath.

Another question that remains unanswered is why did the dictum to do no intentional harm evolve in history to become the first prin­ ciple of medical ethics (Primum Non Nocere).58 Why is the mone­ tary emphasis, that is prominent in the original Oath, so diminished in later versions of the Oath? Why was the concept of peer-community stressed in the original Oath and gradually deemphasized to a nod in the modern versions. Clearly the Oath has never been analyzed

58S. F. Spicker, and H. T. Engelhardt, eds., Philosophical Medical Ethics: Its Nature and Significance (Boston: D. Reidel, 1977), p. 27. -93-

from the perspective of what motives were present and expressed originally. Needed is an instrument that will show what motives have replaced the original symbolic encompassments. These questions the cluster analysis will address in Chapters IV and V. CHAPTER IV

CLUSTER ANALYSIS APPLIED TO THE ARTIFACT

The purpose of this chapter will be to apply Burke's cluster

analysis to the artifact of the Hippocratic Oath as an original doc­

ument of the Hippocratic corpus. The goals of this application are

three-fold: first, to obtain a picture of the stratagems and mo­

tives present in the original Oath; and second, to observe which of

those stratagems remained intact during the many translations of

the Oath and which ones were altered. A third purpose of this chap­

ter is to provide the reader with an actual index and concordance of

terms found within the works of the corpus in order to aid additional

research on this topic. No studies of cluster analysis reviewed by

this researcher have contained these reference steps.

In order to reach the goals stated above, the present chap­

ter will discuss the artifact in five divisions. First, the data will be described. Here will be stated the details of how the data was gathered, total number of books examined, how the Oath was pre­ pared for analysis, reasons why certain books were eliminated from the study, and the total number of ambiguous terms examined.

Second, the index itself will be presented. Frequently used words will be cited together with the divisions for each word as groups of meaning emerged during the collection of the total number of ambiguous terms.

Third, a concordance will be provided. The discussion of the -95-

concordance will have three parts: 1) What the artifact appears to

be saying: what structural and functional features are present in

the artifact—clusters, dramatic alignments, stages in development,

beginnings and endings, points of furthest internality, oppositions,

expressions for secrecy, and striking expressions will be discussed.

2) The private motives of the author of the Oath which may be in

opposition to what the Oath appears to say will be noted. Here will

be discussed the author's private life, underlying imagery he may

have used, and parts where the author appears to complete himself

will be discussed. 3) What stratagems were present that the author

used to identify his motives with the motives of his audience. Here will be discussed the internal forms of argument present within the corpus, the names that indicate essences, the properties of one character present in other characters, shifts in meaning, and water­

shed moments.

Fourth, a summary calculus of the motives found within the

Oath will be presented in order to show what was argued originally by the Oath.

Fifth, the translations and examinations of later Oaths will show what Hippocratic ideals and original stratagems persisted, and which stratagems were altered.

The Data

Of the eighty-six known books of the corpus, twenty-six have been edited by W. H. S. Jones in his four volume work found -96-

within the Loeb Classics mentioned above. Jones' criterion for

selection of the books to be included within his edition was strength

of manuscript evidence. In the cases where books did not appear

within the earliest manuscripts or in cases where many variant read­

ings among the manuscripts would have made a translation suspect,

those books were not included within the Jones edition. Thus, with­

in the Jones edition, the researcher is given the Hippocratic works

with the strongest manuscript replication and the widest mention

from classical authors. Since the translated corpus contains only

the strongest textual evidence, research may draw conclusions with reasonable confidence in the quality of textual foundations.

The analysis of the Oath and corpus was conducted with the

following procedure. The Oath was translated into English. After examining both the Greek and English versions of the Oath, a table of words and phrases was made which might prove significant in the index. This table (see Table I) labeled each word and phrase for future reference as HO 1, HO 2, HO 3 . . . HO 86.

After the table was composed, the entire text of the corpus in the Jones edition was examined in order to construct an index of terms. Each time one of the words or phrases from the Oath appear­ ed in the corpus, it was recorded on a separate note card together with the sentence context in which the word was found. The work, chapter, and location in the Greek text was cited also on each card.

A total of 344 citations were gathered in this way. Next, the cita­ tions were gathered under the phrases as they appeared in the Oath -97-

TABLE I

Significant Words and Phrases in the Hippocratic Oath

HO 1 I swear HO 44 neither will I administer HO 2 Apollo HO 45 a poison HO 3 physician HO 46 to anybody when asked to do so HO 4 Asclepius HO 47 nor will I suggest such a course HO 5 health HO 48 similarly I will not HO 6 all the gods and goddesses HO 49 give to a woman HO 7 making them my witnesses HO 50 a pessary HO 8 that I will carry out HO 51 to cause abortion HO 9 according to my ability HO 52 but pure HO 10 my judgment HO 53 and holy HO 11 this oath HO 54 I will keep my life HO 12 this indenture HO 55 and my art HO 13 to hold HO 56 I will not use the knife HO 14 my teacher HO 57 not even, verily, on HO 15 in this art suffers from stone HO 16 equal to HO 58 but I will give place HO 17 my own parents HO 59 to such as are craftsmen therein HO 18 to make him partner HO 60 Into whatever houses I enter in my livelihood HO 61 I will enter HO 19 when he is in need HO 62 to help the sick of money HO 63 and I will abstain HO 20 to share mine with him HO 64 from all intentional wrong doing HO 21 to consider his family HO 65 and harm HO 22 as my own brothers HO 66 especially from abusing HO 23 and teach them HO 67 the bodies of man or woman HO 24 this art HO 68 bond or free HO 25 if they want HO 69 And in the course of my profession HO 26 to learn it HO 70 and whatever I see and hear HO 27 without fee HO 71 as well as that outside HO 28 or indenture my profession HO 29 to impart precept HO 72 in my intercourse with men HO 30 oral instruction HO 73 if it be what should not be HO 31 and all other instruction published abroad HO 32 to [make a share of] HO 74 I will never divulge HO 33 my own sons HO 75 holy secrets HO 34 the sons of my teacher HO 76 holding such things to be HO 35 and to indentured pupils HO 77 now if I carry out this oath HO 36 who have taken the HO 78 and break it not physician's oath HO 79 may I gain HO 37 but to nobody else HO 80 for my life and art HO 38 I will use treatment HO 81 reputation HO 39 to help the sick HO 82 among all men HO 40 according to my ability HO 83 forever HO 41 and judgment HO 84 But if I transgress it HO 42 never with a view to injury HO 85 and forswear myself HO 43 and wrong doing HO 86 may the opposite befall me. -98-

to determine frequency of use of significant terms. In effect, this

index contained eighty-six cells. Those cells with the greatest num­

ber of cases would be judged as the most significant symbols of mean­

ing and carriers of meaning in the Oath and corpus. Next, each cell

was examined and a short catalog of meanings of the words in each cell

was made. For example, in cell 56 ("I will not use the knife"), the

cases were arranged either under the heading "encourages surgery" or

"discourages surgery" according to the context in which the word

"knife" appeared in the corpus. The index (see Table II) will be in­

cluded within this chapter instead of within the appendices, for easy

reference during the discussion. Words with few instances of use or

those that appeared so infrequently that it was impossible to give

meaningful classifications to them are listed in the index as [no

cases].

After the index was constructed, the concordance and cluster

identification was made by examining the contexts of the most fre­

quently used words and terms. Here generalizations could be made about how the terms were used. For example, the term "art" is used with associated terms such as: wisdom, whole man, mistakes of the practitioner, and communicative skills. Clearly the concordance of contexts will show that the "physician's art" is clustered more with method of medical analysis than with the dicta about the moral de­ livery of medical service. After the concordance was constructed, a summary calculus of identification was drawn from the examined con­ texts. This calculus serves to explain what the Oath was doing for -99-

TABLE II

Index of Significant Terms in the Hippocratic Oath Appearing in the Corpus

List of Abbreviations

AM = Ancient Medicine LAW = Law AO = Aphorisms NOM = Nature of Man ART == The Art NUT = Nutriment AWP = Airs, Waters, Places OJ = On Joints BR = Breaths OWH = On Wounds in the Head DEC = Decorum PHY = Physician DEN = Dentition PG = Prognostic EP = Epidemics PRE = Precepts FRC = On Fractures R = Regimen HO = Hippocratic Oath RAD = Regimen in Acute Diseases HUM = Humours RH = Regimen in Health I OR = Instruments of Reduction SD = Sacred Diseases SUR = In the Surgery

HO 1: I SWEAR [no cases] HO 2: APOLLO [no cases] HO 3: PHYSICIAN [see HO 36] HO 4: ASCLEPIUS [no cases] HO 5: HEALTH A condition to be achieved: AWP 2.20 AM 3.48 A prior achievement: AWP 7.80 AM 10.4 AM 11.16 AM 14.12 AM 16.13 R 3.69.1-4 Biological state - impersonal: R 1.1.2 NOM 4.4 AWP 7.6 The ideal condition: NUT 34.4 -100-

PG 221 PRE 6.11-13 PRE 9.13 NUT 28.1-2 AWP 5.8 AWP 10.10 AWP 10.4 EP 3.15.10 HO 6: ALL THE GODS AND GODDESSES Gods as objects of human knowing: AWP 22.45 AWP 22.9 DEC 6.1 R 1.5.2 Gods as actors: AWP 22.6 R 4.87.14 SD 4.46 Gods as guarantee of man's word: PRE 5.5 PRE 13.6 HO 7: MAKING THEM MY WITNESSES [no cases] HO 8: THAT I WILL CARRY OUT [no cases] HO 9: ACCORDING TO MY ABILITY [no cases] HO 10: MY JUDGMENT Ino cases] HO 11: THIS OATH PRE 8.15 HO 12: THIS INDENTURE [no cases] HO 13: TO HOLD [no cases] HO 14: MY TEACHER [no cases] HO 15: THIS ART [same cases as appear also under HO 24] Theory received from the teacher: general ART 2.11 AM 5.1 DEC 4.4 ART 5.31 AM 1.9 AM 12.8 AM 2.14 Theory received from the teacher: medical AM 14.19 RAD 4.1-2 -101

PRE 2.12 AM 8.19 PRE 8.12 PRE 6.7 AM 2.11 AM 3.52 R 1.15.7 HO 16: EQUAL TO [no cases] HO 17: MY OWN PARENTS [no cases] HO 18: TO MAKE HIM PARTNER IN MY LIVELIHOOD [no cases] HO 19: WHEN HE IS IN NEED OF MONEY [no cases] HO 20: TO SHARE MINE WITH HIM [no cases] HO 21: TO CONSIDER HIS FAMILY [no cases] HO 22: AS MY OWN BROTHERS [no cases] HO 23: AND TEACH THEM [no cases] HO 24: THIS ART [Same cases also appearing under HO 15] Practicum owed to the student: aims of methodology ART 12.1 PRE 2.7 AM 13.1 EP 3.16.4 LAW 1.1 LAW 1.4 ART 10.1 PG 1.18 ART 4.4 AM 3.1 Practicum owed to the student: ancient methodological roots AM 12.11 AM 1.9 Practicum owed to the student: practitioners BR 1.1 OJ 78.1-6 PRE 9.2 ART 8.10 AM 1.17 Practicum owed to the student: detractors PRE 12.3 PRE 7.2 ART 1.14 ART 1.1 -102-

HO 25: IF THEY WANT [no cases] HO 26: TO LEARN IT [no cases] HO 27: WITHOUT FEE PRE 4.7 HO 28: OR INDENTURE [no cases] HO 29: TO IMPART PRECEPT [no cases] HO 30: ORAL INSTRUCTION [no cases] HO 31: AND ALL OTHER INSTRUCTION [no cases] HO 32: TO[ MAKE A SHARE OF] [no cases] HO 33: MY OWN SONS [no cases] HO 34: THE SONS OF MY TEACHER [no cases] HO 35: AND TO INDENTURED PUPILS [no cases] HO 36: WHO HAVE TAKEN THE PHYSICIAN'S OATH Physicians - discipline - personality LAW 2.1 Physicians - vocation - art AM 12.9 AM 2.1-2 Physicians - vocation - philosophy AM 20.1 DEC 5.4 NOM 2.3 AM 20.2 AM 20.9 Physicians - vocation - science NOM 2.2 AWP 2.24 AM 20.18 AM 20.13 Physicians - practice - communicative skills AM 1.11 PRE 9.6 RAD 44.9 RAD 8.1 AWP 22.18 AM 9.23 AO 1.2 EP 1.11.12-15 ART 5.3 ART 7.8 DEC 7.1 PHY 1.1 Physicians - practice - prognosis RAD 5.1-4 HUM 17.4 RAD 1.8 PG 25.1-8 PG 1.1 Physicians - practice - plus and minus BR 1.34 RAD 43.1 AM 21.5 PRE 8.3 Physicians - practice - regimen and seasons EP 1.25.14 EP 1.23.3 RAD 28.1 RAD 41.1 AM 7.2 AWP 2.2 AWP 1.1 AWP 1.12 NOM 8.11 ART 6.4 SD 21.13 Physicians - practice - orthopedics OJ 37.27 FRC 1.20 FRC 3.1 FRC 31.1 OJ 1.15 OJ 2.6 OJ 9.24 Physicians - quacks - general AM 9.30 AM 1.11 OJ 46.38 SD 2.1 Physicians - quacks - ethics PRE 7.4-9 PRE 7.12 PRE 1.29 ART 8.29 HO 37: BUT TO NOBODY ELSE [no cases] HO 38: I WILL USE TREATMENT Treatment that should be done PG 1.8 -104

RAD 2.1-3 RAD 6.6 DEC 7.7 NOM 9.36 EP 3.16.14 PRE 3.1-5 AWP 2.7 Treatment that was done OWH 15.1 FRC 5.1 FRC 29.1 IOR 33.3 PRE 1.2 AM 16.51 HO 39? TO HELP THE SICK Sick - patients - relationship with physician AM 2.15-17 PHY 1.21 ART 5.22-27 PG 1.2 ART 3.3 PRE 9.10 PRE 6.8 PRE 5.1 Sick - patients - illustration of disease - food and habits AM 8.1-2 AM 9.3-4 EP 1.1.20 R 2.66.67 AO 2.32.2 RAD 19.1 RAD 46.1 SD 13.25 Sick - patients - illustration of disease - diagnosis AM 1.16 AM 16.39 EP 1.19.2 NUT 28.6 EP 1.26.171 EP 3.6.3 EP 3.17.1 EP 3.17.37 EP 3.17.72 EP 1.20.31 EP 1.23.1 EP 1.21.1 NOM 12.14 IOR 37.14 OJ 77.18 -105

OJ 41.51 PG 3.1-5 PG 9.5 Sick - patients - illustration of disease orthopedics OJ 30.46 OJ 14.26 OJ 4.4 OJ 3.2 FRC 41.8 OWH 4.11 HO 40: ACCORDING TO MY ABILITY [no cases] HO 41: AND JUDGMENT [no cases] HO 42: BUT NEVER WITH A VIEW TO INJURY [no cases] HO 43: AND WRONG DOING [no cases] HO 44: NEITHER WILL I ADMINISTER AM 5.29 AM 24.11 HO 45: A POISON AM 13.20 AWP 7.23 OWH 20.15 DEC 9.1 HO 46: TO ANYBODY WHEN ASKED TO DO SO [no cases] HO 47: NOR WILL I SUGGEST SUCH A COURSE [no cases] HO 48: SIMILARLY I WILL NOT [no cases] HO 49: GIVE TO A WOMAN [no cases] HO 50: A PESSARY EP 1.26.135 EP 1.26.106 HO 51: TO CAUSE ABORTION AWP 10.37 HO 52: BUT PURE [no cases] HO 53: AND HOLY [no cases] HO 54: I WILL KEEP MY LIFE NUT 38.1 NUT 32.2 HO 55: AND MY ART [no cases] HO 56: I WILL NOT USE THE KNIFE -106

Knife - encourage surgery AO 7.87.1-4 SUR 4.9 BR 1.16 IOR 34.1-4 OWH 21.10 OWH 14.5 OJ 12.13 Knife - prohibit surgery FRC 43.7 AWP 11.6 HO 57: NOT EVEN, VERILY, ON SUFFERERS FROM STONE AWP 9.53 AWP 9.2 NOM 12.31 HO 58: BUT I WILL GIVE PLACE [no cases] HO 59: TO SUCH AS ARE CRAFTSMEN THEREIN FRC 8.23 OWH 13.42 AM 1.11 HO 60: INTO WHATEVER HOUSES I ENTER DEC 12.1 DEC 11.1 HO 61: I WILL ENTER [no cases] HO 62: TO HELP THE SICK [see 39] HO 63: AND I WILL ABSTAIN [no cases] HO 64: FROM ALL INTENTIONAL WRONG DOING [no cases] HO 65: AND HARM [no cases] HO 66: ESPECIALLY FROM ABUSING [no cases] HO 67: THE BODIES OF MAN OR WOMAN Bodies - illustration of health AWP 19.34 AM 20.45 SD 19.1 BR 3.1 IOR 23.11 NOM 7.49 NOM 3.13 AWP 14.20 AM 22.6 AM 16.3 AWP 20.12 -107

AM 20.42 Bodies - illustration of sickness AO 4.38.1 AO 2.36.1 NOM 4.9 EP 1.26.125 EP 3.13.30 AWP 10.21-22 AM 6.6 AM 10.18 AWP 23.27 Men - the art AM 14.17-18 AM 14.30 ff AM 15.23 AM 19.27 AM 20.3 NOM 1.2 NOM 1.23 NOM 1.32’ R 1.2.2 R 1.6.6 R 1.11.1-6 R 1.12.1-8 FRC 13.10 AM 1.5 Men - laymen DEC 17.7 RAD 6.1-3 RH 1.1 AM 2.23-25 AM 4:1-4 Men - inhabitants of regions AM 21.17 AWP 24.49 AWP 22.58 AWP 22.63 AWP 21.19 AWP 21.2 AWP 13.16 AWP 13.10 AWP 12.31 AWP 12.13 AWP 12.10 AWP 1.25 Men - illustration of disease AM 11.15 AM 12.5 AM 13.8 -108

AM 15.28 AM 16.25-29 AM 17.7 AM 20.16 AM 20.36 AM 20.20 AWP 16.13 AWP 15.24 AWP 14.28 AWP 12.35 AWP 10.48 AWP 10.19 AWP 8.14 AWP 4.29 AWP 3.24 AWP 3.16 AWP 1.19 EP 3.1.43 NOM 1.5 NOM 5.1 HUM 16.1 R 1.33.11 OJ 71.1 OWH 2.34 SD 12.1 Men - general AM 6.17 AM 6.7 AM 9.8 AM 9.30 AM 20.7 AWP 24.45 AWP 22.46 AWP 16.31 AWP 16.18 AWP 7.96 SD 17.1 Women - general AWP 10.30-31 AWP 10.40 Women - life style AWP 16.25 AWP 17.5 AWP 17.10 AWP 22.35 AWP 22.28 AWP 22.2 AWP 18.19 Women - diseases -109

AO 3.11.4 EP 3.17.318 EP 3.17.235 EP 3.1.182 EP 3.1.160 EP 1.19.6 EP 1.16.1-2 EP 1.1.22 Women - childbirth AWP 3.19 AWP 7.35 EP 3.17.303 EP 3.1.213 EP 3.1.201 EP 3.1.191 EP 1.26.311 EP 1.26.262 EP 1.26.129 EP 1.19.17 EP 1.12.13 AWP 4.35 AWP 5.27 AWP 7.45 AWP 21.8-9 HO 68: BOND OR FREE [no cases] HO 69: AND IN THE COURSE OF MY PROFESSION [no cases] HO 70: AND WHATEVER I SEE AND HEAR [no cases] HO 71: AS WELL AS THAT OUTSIDE MY PROFESSION PRE 2.16 HO 72: IN MY INTERCOURSE WITH MEN [no cases] HO 73: IF IT BE WHAT SHOULD NOT BE PUBLISHED ABROAD [no cases] HO 74: I WILL NEVER DIVULGE EP 3.1.157 PRE 14.19 HUM 9.5 HO 75: HOLY SECRETS LAW 5.1 HO 76: HOLDING SUCH THINGS TO BE DEC 18.6 HO 77: NOW IF I CARRY OUT THIS OATH [no cases] HO 78: AND BREAK IT NOT [no cases] HO 79: MAY I GAIN [no cases] -no

HO 80: FOR MY LIFE AND ART [no cases] HO 81: REPUTATION LAW 4.1 DEC 1.10 PRE 4.11 DEC 18.1 PG 1.22 HO 82: AMONG ALL MEN [no cases] HO 83: FOREVER [no cases] HO 84: BUT IF I TRANSGRESS [no cases] HO 85: AND FORSWEAR MYSELF [no cases] HO 86: MAY THE OPPOSITE BEFALL ME [no cases] -111-

its author and his audience. By applying the calculus to the trans­

lated versions of the Oath as they followed in history, the research

could identify shifts in identification stratagems in the evolving

medical profession.

The Index

By cataloging each significant instance of words used in the

text the following index of terms was obtained. A brief description

of the cells of the index will be given here. The word classifica­

tions in the cells are not arbitrary. After thorough reading of the

corpus and listing of each instance of a word within the Oath, the

entries in each cell were analyzed in respect to their context, word

usage, and grammatical structure. Though the terms were all analyzed

in Greek, very little actual use of the Greek language can be permit­

ted in this discussion because the emphasis of the research is rhe­

torical instead of philological. After review of the cases, fac­

tors could be drawn from the cells with higher populations of en­

tries. These classifications of the cells conform to what is known

about Greek syntax. For example if the word "love" were examined,

it would be classified under the headings: ideal love; brotherly

love, and erotic love which are lexicographically valid.

The first large cell was the term "health." The Oath names

Hygea along with Apollo and Asclepius as guarantors of the fact

that the Oath would be kept by the Oath-taker. Hygea and Asclepius were the focus of cultic worship activities among the Asclepiadae. -112-

Though Hygea is not mentioned again in the corpus to any significant

degree, the condition of man which bears her name (health) is men­

tioned many times. Examination of the four ways the term "health"

is used in the corpus would give an indication of how men of antiquity

viewed this goddess who was the guardian of the beautiful temples

mentioned in the previous chapter.

In very few instances is health used as an impersonal topic of study (Rl.1.2). More often, health is used to describe the ideal,

superior condition of man that is ranked above all other states of being. For Hippocrates health is the body in perfect harmony with

scene (NUT 34.4).

In another sense of the word, health is a condition given to all men and maintained by one's own judgment (AM 3.48). In still another sense, physicians brought health by careful evaluation of what sick men were doing wrong in their daily lives (AWP 7.80). The first thing the Hippocratic physician analyzed when called to minister to a sick man was the climate in which he lived and the natural compo­ nents of his scene. Obviously for a Greek, health was something naturally obtained—a birth right of his personhood. Physicians only corrected what was already supposed to be present in man's life.

This timeless presence would naturally be thought of as a gift of the gods and not a condition to be achieved solely through the work­ ings of the medical science of the day.

The "gods" mentioned in the corpus and the Oath show three major usages. 1) They are objects of human knowing (AWP 22.45). -113-

They exist and are known as persons by man. The gods are pleased

with the condition of health because its euphoria must be similar

to the condition of perfection and immortality they themselves en­

joy. Since the gods are capable of giving good gifts to man, it

was thought that this gift of health certainly was from the gods.

2) The gods were viewed as actors and causes for illness only among

the peasant classes (SD 4.46). Obviously then, gods were not view­

ed seriously as the cause of illness, but respect was paid them as

a person tried to find his way back to health if he were sick.

3) The gods were considered politely as the guarantors of a man's

word (PRE 5.5). The divine forces were respected because he who

broke an oath was considered to be guilty of hubris or self-pride

that shut out the higher authority of the gods and made him a law

unto himself. In the high social ethic of the emerging polis, gods

assured the audience of an oath-taker that hubris was not about

to occur.

The term "art" or techne, properly describes the status

of medicine in this era. The Oath reflects two basic understand­

ings of the term: 1) Art as theory received from a physician's

teacher (AM 5.1). In this first definition in the corpus is found

rich components of the term. Art is focused on the visible world

—not the metaphysical. It is the practice of observing some part of the final end by observing each of many particulars. Where there is love of man, there is love of art. The art has an end in health and health has as its end the goodness of the whole man. A by-product -114-

of the techne is the doing away with pain as the doctor helps his

patients search for health.

A second meaning of "art" is practicum-oriented: 2) Art that

is owed to the student (LAW 1.1). Obviously the new, and inexperi­

enced medical student cannot be expected to grasp the wisdom neces­

sary to understand the over-all concept behind medical theory, but he

can grasp the practical steps of his craft which will give his practice

foundation until his mind begins to broaden with wisdom. The stu­

dent is urged to grasp hard onto facts which enable him to know both

diseases whose cures are visible and those whose cures are hidden.

Cures are not attributed to luck but to a thorough understanding of

man's regimen: food, weather, air, water, and temperament. The pro­

fession is traced back to its ancient roots—those practitioners who

cured only by physical exercise and diet—much like athletic train­

ers. This discipline, though sturdy, was faulted because of poor

method: these practitioners learned their art only by trial and er­

ror treatment of the symptom and not by examination of the facts

that may have led to the illness. The student is urged not to ex­ pect too much from the art because it is not an exact science and he is urged not to make extravagant claims about the success his art can accomplish on the sick.

The term "physician" also discloses interesting degrees of meaning in the corpus. The practitioner is to have natural abil­ ity and cannot expect divine intervention to provide both the princi­ ple and the method of returning men to health. The doctor must know -115-

first what man is and must not be a stranger to wisdom. He must know

natural science and best of all, must know weather and climatic con­

ditions. An important in-service skill of the doctor is his commu­

nicative strengths, for the doctor must not only know his art but be

able to secure the cooperation of his patient (AO 1.2). Added to these

skills, the doctor must know forecasting: know when a patient will re­

cover, the things that will contribute to that recovery, and those

things that will mean his demise (PG 25.1-8). Thus the art of medi­

cine is ultimately one of addition and subtraction: adding those

things in which the patient is deficient and removing those things

which a patient has in excess (BR 1.34). The basic practical skills

of the doctor are diet analysis and the reduction (relocation; setting)

of bones. Surgery is given one slim book but the vocabulary appears

to be from a later period as indicated by the advanced medical skills

shown in this volume. The chief practical dicta will be cited under

"knife" later in the chapter. The description of doctors as a term belongs in the cluster analysis discussed later in the chapter and

in Chapter V. Here brief mention will be made of the doctor's re­

lation to quacks. The chief objection to the quack is that he does not desire to belong to the medical fellowship and engage in consul­ tations with other Hippocratic physicians. The quack thus separates himself from the medical polis created by doctors who recognize the complex amounts of knowledge necessary to analyze both climate, diet, and temperament of a patient.

The term "treatment" is prescriptive and descriptive. Treatment -116-

on one hand is the body of knowledge with which a physician enters

a sick man's scene. By this body of knowledge, the physician defines

the scene before him. Here, treatment is very much like the canon

of oratory: inventio (how a subject matter is organized and is di­

vided, is determined by how one views the world.)! This is the ap­ plication of system to a world of inexact meanings. Treatment can

also mean the methods and products that were applied to a particular

sickness. Rich details are given in the corpus for setting bones, cor

recting postpartum depression, and the types of bandages for various wounds.

The descriptions around the word "patient" or "him who is

ill" is not as rich as one would like to imagine. In fact, the word patient is not used in the corpus. The participle of the verb form

"to be sick or ill" is used throughout the corpus and this is the form of the word found within the Oath. A few instances are given of the patient-doctor relationship which must be characterized by "fairness" in the corpus. The majority of instances show the patient as an illustration of illness: types of disease, ways to analyze diseases, and ways to analyze the climate and regimen of a patient.

"Knife" as symbol is neither rich nor striking in term mean­ ing variance. Skills of manual dexterity are encouraged so the patient may not suffer extensively during an operation. Surgery is

lBurke adds interesting illustration to this canon in Philosophy of Literary Form (p. 145) where he states that one can view an ant as vegetation-plus through the poetic characterization of progressive encompassment. -117-

not encouraged among those patients who are not physically strong or

among those patients who will die as a result of the surgery.

Though massive in number, the terms for "bodies," "man" and

"woman" are not as varied as one would assume. "Bodies" are used to

illustrate health or sickness. There appears to be no special con-

notation to <■ (soma) except that it serves to illustrate the

Hippocratic precepts of balance and inductive diagnosis. The term

is used to illustrate the "art” of medicine, as illustration of the

types of laymen with whom the doctor must converse, and as illustra­

tion of disease cases. "Woman" as a term is used chiefly to describe

female diseases and the conditions of childbirth. Clearly from a

frequency perspective, the largest numbers of terms will cluster

around the words "art," "physician," "bodies of man and woman." These

clusters will be discussed in detail in the next section.

The Concordance

From the analysis of the index, it can be seen that the Oath represents a desire to establish a covenant relationship among mem­ bers of a medical community.2 The ethics in this choice situation have more to do with the practitioners themselves than with the patients

2Rueckert (Kenneth Burke and the Drama of Human Relations, p. 45), argues that Burke sees human relations very much like the Christian drama of covenant, temptation, fall, sacrifice, and redemp­ tion. Rueckert further illustrates this drama in the same work (pp. 133 134), that Burke in Rhetoric of Religion sees all men beginning life in a "fallen" state brought on by their distinctive trait: language. By use of symbols and the negative, man can do no other than act to build or destroy his socio/political scene. -118-

they contact. Below will be discussed: 1) What the Oath appears to

say by its clusters and structure; 2) What motives emerge from this

study of the Oath that are not immediately discernible in the text;

3) What stratagems for identification with the audience are pre­

sent in the Oath and toward what audience are they directed.

1. What the Oath Appears To Say

Cluster Identification:

Below will be discussed the clusters of "art" or techne;

"physicians;" and "bodies-men-women-illness." The designation of

cluster is not arbitrary since it must grow out of the index and must trace cleanly through the contexts with which the author as­

sociates each term. As the author associates terms in his scene, the researcher obtains not only a picture of that scene but a de­

scription of how the author manipulates that scene to maximize his own needs and ends.

1. Cluster: Art

The Oath discusses art as both theory and practicum, both of which are difficult enough to insure the fact that the uninitiated will not understand the subject matter.

First, the medical art is associated with the gods. The techne is reason applied to the world of man—an art worthy to be ascribed to the gods (AM 14.19). The gods are noble ones: Apollo,

Asclepius, and Hygea. By associating with these particular gods, -119-

the medical community immediately associates with the quality of self-

healing popular in Greece and with the cultus which stressed exercise,

diet, mild baths, and rest as forms of treatment. For the takers of

the Oath, the medical gods are benevolent, if distant, and do not en­

ter the body to work harm or to punish. "A god is more likely to pu­

rify and sanctify a body. . ." than he is to cause harm (EP 4.46).

Though the doctors are mildly agnostic, "prayer indeed is good, but

while calling on the gods a man should himself lend a hand"(R 4.87.14),

and suspicious of "flowery language" of those who invoke the gods

(PRE 13.6), they, however, do attribute the wisdom (DEC 6.1) necessary

for medicine as coming from the gods. They bow slightly to the

Olympiads by urging that he who shows respect to the gods may be re­

paid with favors from the gods (AWP 22.45). In a few instances, the

gods are called the source of the art, yet this is little more than

saying they are the source of common sense (R 1.11.1-6).

The doctors associate the art with wisdom and align them­

selves against the skeptics who would say that wisdom can be taught

(DEC 4.4). The art is not a spiritual revelation but a subject mat­ ter filled with the harsh realities of the real world (ART 2.11 and

BR 1.1). Still the motive apparent in the Oath is announced immediately as: "Where there is love of man, there is love of the art" (PRE 6.7).

This phrase is not as altruistic as it sounds for the word linkages used here point to the alliances that men make with each other, and in par­ ticular, the alliances that men who are in the medical profession make with each other. In this phrase the word (filos) is used to -120-

describe love: brotherly-alliance-making love—not the altruistic

» / f love (agape). This word choice and interest in alliances

is further substantiated by (PRE 7.4-9) when a doctor is called a

e t brother of the art (oykotexvoi )—a kinsman of the profession,

over against quacks who do not belong to the profession by prac­

ticing the art in the manner prescribed below. They are called

fellow workmen: men who belong to the same "trade union." In

(PRE 5.5) the doctor is described as a brotherly doctor;

a part of a clan of brothers in medicine. Clearly the love of man

and the love of the art are slanted toward the physician and his kin,

not the patient.

The art as theory is further explained as the ability to under­

stand the concept of wholeness of the conditions in which man finds him­

self. The true brother-doctor will be able to observe some part of the

final end in each of many particulars and then combine all into a single

whole (PRE 2.12). If this type of inductive diagnosis and prognosis

is followed in the art, then the cause of all diseases can be discovered

(AM 8.19). By following his analysis by means of the art, the doctor reaches the end of the art (the telos) which is restoration of health

(AM 3.52) by the reduction of pain (R 1.15.7).

Now clearly the art has been linked with health, but not be­

fore it was clearly linked to the brotherhood of physicians. When the art is linked with health it is seen that health is not something a- chieved only by a medical profession, but something already naturally present in man (PRE 9.13) which medicine takes the haphazardness out -121-

of maintaining and achieving (R 3.69.1-4). Health is the natural

state of man, but medicine is the way of maintaining the superiority

of that natural state when man is foolish or too ignorant to care

for himself (NUT 34.4). By maintaining a perfect, proportioned bal­

ance of environment, temperament, diet, and personal habits, man can

achieve health himself (NOM 4.4). In this light, the doctor is not

the savior of all those who suffer, but the doctor is the one who ap­

plies a system to an area where no system is apparent. The doctor or­

ganizes the topics of his craft so that order may lead to better pre­

diction about the consequences of man's various life-styles.

How theory of the art breaks into the actual delivery of the

art is the practicum side of medicine and here is where the Oath shows

some interesting linkages of meaning. The doctor must be prepared for

two dimensions of this craft as it is actually applied to man's con­

dition: 1) that it is not an exact science and 2) that in order for it

to be successful, it must be communicated successfully to the patient.

The doctor must recognize the wide number of variables that

may contribute to a man's condition and thus be prepared for the art being inaccurate or inexact in prescription (AM 12.8). The doctor

also must realize that his art alone may not cause a man to regain health—he may do so from luck (ART 4.4). The practitioner's real

skills however, lie in his ability to make accurate diagnosis and prog nosis about even unseen conditions in every case of sickness. "The art must be a match for the open diseases; it ought however not be helpless before the diseases that are more hidden" (ART 10.1). The -122-

doctor is also urged on in this inexact science by a strange first

principle that puts a halt to extraordinary treatment and altruistic

stop-at-nothing-to-save-the-patient attitude: "What you should put

first in all the practice of our art is how to make the patient well

and if he can be made well in many ways, one should choose the least

troublesome" (OJ 78.1-6). The first principle is not to heal the sick,

but to know how to heal the sick. This dictum demands organization of

medical knowledge, not delivery of medical knowledge. Altruism is not

a thrust in this argument. By stressing complete knowledge of the art

of medicine, the brotherhood of doctors assures itself that it will

maintain high academic and practical standards for its members so they

can be distinguished from other doctors who administer treatment by

chance. From the beginning it appears that those within the medical profession do not feel comfortable with ambiguities and wish to iden­

tify themselves with those who rule out chance.

Knowing the art is not enough. Those within the art will also know how to present the art to the sick in simple language: "It is necessary for one who discusses the art to discuss things familiar with ordinary folk" (AM 2.14). A doctor must not raise a patient's expectations beyond the ability of the cure because the reality of the art causes hope to arise in patients when they do not know the limits of the cure (PRE 9.2). The power of the art is the fact that it can cure the sick and this ability can easily be misinterpreted by the patient (ART 12.1). If communication with the patient is done without fostering false expectations in the patient, it can be the most 123-

distinguished of professions, (LAW 1.1). Clearly the author is re­

jecting the methods of quacks who make promises for their cures that

cannot be realized.

Since each cluster is complex, a summary of the cluster will

be given at the end of each analysis. Here in the case of "art" the

term clusters: with the gods who sanctify by a desire to improve the

body; with brother-clan love whose members differentiate themselves

from other doctors by a desire to know the system of medicine, not

just the cure; with wholeness of all particulars of the scenic state

of man; with health as a condition where chance is removed from its

maintenance; with limits set by the inexactness of the craft; with

limitless acquisition of the knowledge of medical conditions; and

with communication of those skills to the layman so that false ex­ pectations about the cure are not aroused.

2. Cluster: Physician

The cluster of physician falls into three parts: the doctor and his art; the doctor and his errors; the doctor and his relation­

ship to the community and with quacks.

The doctor and his art are summed under the sentence "... for medicine is both principle and method; that is why it is not hap­ hazard" (AM 2.12). This statement connects cleanly with HO 29 and

HO 30 "precept and oral instruction." To understand the principle and method, the research needs to discover: 1) What linkages the pro­ fession makes with other professions; 2) What is the unique skill -124

of the medical profession and how is it conceptualized. First, the

doctor's art is associated with philosophy in order to know the na­

ture of man (AM 20.1) because ". . . between wisdom and medicine

there is no gulf fixed" (DEC 5.4). The doctor must also be associa­

ted with science for knowledge of climate (AWP 2.24) so that he

knows what he should prescribe for treatment in different countries

(AM 20.18), and of what the body is composed (AM 20. 13). Thus

chance is to be limited in treatment (ART 5.3).

On the practical side, the physician must realize that his

art is one of careful analysis of balance among many variables:

"Medicine in fact is subtraction and addition—subtraction of what

is in excess; addition of what is wanted. He who performs these

acts best is the best physician; he who is farthest removed there­

from is also farthest removed from the art" (BR 1.34). "Remission

and aggravation of a disease require respectively less or more med­

ical assistance" (PRE 8.3). The object of analysis of this balance

is to enable the physician to forecast accurately the condition of

the patient: "I hold that it is an excellent thing for the physician

to practice forecasting" (PG 25.1-8). Here the physician takes into account the patient's mode of life (EP 1.25.14), the nature of the

individual (EP 1.23.3-5), and regimen (RAD 28.1). All this is to

increase the physician's skill at observing symptoms (HUM 17.4) and the avoidance of casual or incomplete diagnosis (AM 21.5).

The art has two goals: 1) To make the art portable so that

it can be of use to the practitioner as he travels from town to -125-

town in search of business. In fact these skills are more valuable

only when the physician actually experiences the patient's total

scene, (AWP 1.12 and AWP 2.2). 2) Another more curious motive for

insisting on accurate diagnosis skills emerges in AM 7.2. Here the

doctor is urged to be proficient in these skills so that he may

divide himself from dietitions and athletic trainers. The doctor

knows not only how to cure the ailments before him as a trainer would

do, but he also knows the cause of those ailments. Thus, by insist­

ing on these skills, physicians divide themselves from others in the

public eye with skills the dietitions and trainers do not have.

The doctor and his mistakes is another important dimension

of the physician cluster. There appears to be built into the corpus

a large number of phrases which show a physician how to understand

his professional fallibility. Since medicine is an inexact science,

the physician is given "rationalizations," to use the Burkean term,

for viewing the mistakes and errors he is sure to encounter. Though many areas of medicine are exact (AM 12.9), it is difficult to ac­

count for the patient who does contrary to the doctor's orders and

still recovers. The doctor thus becomes the laughing stock in the town (RAD 44.9). The doctor is prepared for this ridicule in the event he has given inexact orders or made faulty diagnosis. The physician is also prepared for the fact that he will probably ex­ ercise the worst judgment in times of highest crisis: "Most physi­ cians are like bad pilots—one does not notice their mistakes on smooth seas, but only in times of storm" (AM 9.23). The doctor is -126-

also prepared for breakdowns in communication: "While the physician

may give wrong instructions; patients can never disobey orders"

(ART 7.8)—the customer is always right. He is further prepared for

strong dispute from fellow physicians (OJ 1.15); with unfair gossip

(OJ 46.38); for the consequences of associating with inexperienced

practitioners who make deadly mistakes with patients (PRE 1.29); and

for the pressure to take on a desperate case where the doctor knows

that the patient will die and knows that he will be blamed for the

death (ART 8.29).

A third factor in the physician cluster is his relationship

with the community and with quacks. The doctor is urged instead of

languishing in error, to set an example of good health leadership by

his ethos in the community (PRE 9.6). He is urged to ask questions

about the scene (RAD 8.1); to ask about those things that the pa­

tient may not tell him freely (RAD 1.8); to urge self-cure as the

basis of health (AWP 22.18); to encourage cooperation among patients

as they are urged to try his treatments (AO 1.2); and to have a

ready wit (DEC 7.1)—to be healthy-looking himself (PHY 1.1). By

good example, the doctor separates himself in the public eye from

charlatans who attribute all diseases to sacred sources (SD 2.1) and

from inexperienced trainers who shun the alarming case that may on

first sight appear hopeless (PRE 7.12).

In summary, the physician cluster shows the doctor associated with wisdom and science in order to equip himself with a concept of balance that exists between the patient and the scene. This knowledge -127

equips him with forecasting skills which are both portable and which

differentiate him from dietitions and trainers. He is warned about

his medical fallibility and shown that the best way to avoid low

credibility in the community is to provide good example of what med­

icine can mean for the practitioner himself. Thus he will be dis­

tinguished in the public eye from quacks and given high regard by

the community.

3. Cluster: Patients

The patient cluster has many cases but few variations in

meaning. Obviously the writers of the corpus preferred to speak of

the doctor and his craft rather than those who would purchase the

services of the doctor. The cluster has five sub-clusters: 1) body

conditions; 2) diet and scene as they affect man; 3) the art of med­

icine treating man. Here lie the additional clusters at HO 38 (treat

ment); HO 39 (the sick); and HO 44 (administer). 4) Diseases are

classed by examples and 5) man's ability to discern between good and

bad treatment is discussed.

Bodies are used as examples of various treatment methods:

"But when they [the patients] have been cauterized, the excess of moisture dries up from their joints and their bodies become more braced, more nourished, and better articulated" (AWP 20.12). Age,

sweat, coma, weakness, twitching, and flabbiness are discussed and their instances show little beyond simple illustration.

"Man" is also used as illustration of a variety of illnesses. -128-

However "man" is equated more often with the term "strength" (AWP 12.35)

"Uniformity among men fosters slackness while variation [in weather] fosters endurance" (AWP 23.27 ). "Men should be well nourished and very tall, differing from one another but little in either physique or stature" (AWP 12.35). Men by contrast are equated usually with childbirth and female diseases in a significant majority of the cases mentioned in the corpus.

Environment, as would be expected from the stress placed on regimen, is given wide exposure in the corpus. Obviously

Hippocrates felt the account of his travels to be of benefit to his students as they began their own practices. Types of diseases, cli­ mate conditions, names of countries and attitudes of the inhabitants are given detailed attention.

Interesting variation in meaning however is found within the third classification of the cluster: the art of medicine applied to man. "By means of the visible, the invisible is understood ... by the present, knowledge of the future; by the dead, knowledge of the living; and by means of those who understand not, man has under­ standing" (R 1.12.1-8). This balance theme is seen again from the cluster of the physician and here it is given further articulation.

"Men saw a log; the one pulls, and the other pushes; but herein they do the same thing; and while making less, they make more. Such is the nature of man. One part pushes, the other part pulls; one part gives, the other part takes" (R 1.6.6).

Diseases are most interesting when seen in relation to manner -129

of treatment. Treatment without justification of method or art is

the chief reason quacks are called physicians (RAD 6.6). The quack

treats only the disease without knowing the consequences of the dis­

ease. In fact the mark between a true doctor and the quack is the

quack's need to gossip with others about the treatment he has ad­

ministered (DEC 7.7). The Hippocratic doctor by contrast, consults

only with peers who under stand the disease.

The most interesting dimension of the man cluster is a sub­

group dealing with the nature of man and communication skills. Pa­

tients must praise or blame remedies for their worth (RAD 6.1-3).

Treatment must be justified and the Hippocratic doctor is suspicious

of those who would argue for a remedy with quick words and sophisticated

method (NOM 1.23).

Another dimension of treatment is the quality of understanding

that the author holds about laymen in a few textual cases. The doc­

tor is urged to try to explain treatment in terms that the layman can

understand (AM 2.23-25). The sharpest example of this patronizing

attitude is: "Never put a layman in charge of anything, otherwise if

a mischance occur the blame will fall on you" (DEC 17.7).

In summary, the man-woman-body cluster does not yield the

rich variations that the first two clusters did. Here man is equated with body types, with environment, with the balance theme by illus­

tration from the physician cluster; with gossip arising from treat­ ment; with poorly argued cases for or against remedies; and with ig­ norance and inability to understand the treatment. -130-

Dramatic Alignments

The dramatic alignments are easy to detect in the corpus and from the Oath. The largest alignment is physician with brother-family

From the word choice and syntax, it is obvious that a clan of prac­ titioners is being formed by bond with the oath/indenture. The Oath represents then, an induction into family membership of those who are committed to the propriety of the art as method. To further am­ plify this alignment and give it credibility, the gods are drawn into the pact, as are‘philosophers, workers in science and practitioners of common sense in the person of dietitions who really understood the importance of regimen but who had no method for its application. The combination of sources, divine, academic, professional and athletic- dietetic, increases credibility.

The clan is aligned against sophists. Why division was thought to be necessary will be discussed below. The sophists were often accused of teaching an art without content. Thus the medical clan is careful to differentiate from this indictment against the sophists and is also careful to cast suspicion on those with skilled speaking techniques as is seen above.

Functional Features

Oaths in antiquity must, as stated by both Anderson and

Jacob in Chapter III, serve three functions: establishing a rela­ tionship; starting communication with parties of the indenture; and citing conditions and consequences of the relationship. In the case -131-

of the Oath, with its heavy emphasis on the definition of the art,

the relationship is not directed toward the patient but toward other

practitioners. Thus what appears to be moral dicta for the benefit

of the patient are only evidences of how the art will function with

other practitioners and with patients.

Stages of Development

This relationship between practitioners is seen in the man­

ner in which the Oath is developed. The following pattern shows

from an analysis of the content of the Oath: 1) Ability to recog­

nize authority with a bow to the Olympic dieties (HO 1-7). 2) Abil­

ity to recognize the practical and theoretical skills that colleagues

have in the art and the respect owed not only to peers but offspring

of peers (HO 8-29). 3) The ability to recognize the need to per­

petuate skills of the art to the student's own offspring on a prac­

tical level (HO 29-37). 4) The creation of a language based on the

relationship by means of specific modes of practice of the art. Thus

others know the doctor's skills and they know that these skills make

him a member of the medical clan (HO 38-76): Treatment prescribed

after an examination of a patient's total environment (HO 39-51);

Practice that recognizes skill limitations (HO 52-59) ; Practical de­

corum which avoids association with quacks who gossip or those who

do not take the time to learn the method (HO 60-76). The functional dicta (those clauses which will show if the relationship is being met)

are not phrases about treatment, but the final sentences of the Oath: -132-

(HO 77-86). The way one knows if this is an effective indenture is

if the physician enjoys high regard among men. Thus in summary, the

power of the art will be seen in the regard that its practitioners

are given by men. Thus the patient has only an illustrative role

in the Oath: by the way the patient is treated, other physicians will

know if a practitioner is faithful to the art.

Beginnings and Endings

The structure of the Oath has definite balance when viewed

from the perspective of the art. It begins with the gods to whom

are owed respect and ends with the physician who will gain respect.

The Oath arranges the topics in descending order of importance: Gods,

to medical clan, to teachers, to practical considerations, to quacks,

to sophists, to laymen. Again, by observing the way the Oath is

structured, the importance of the patient can be seen in the perspec­

tive in which it was intended. Here can be seen the seeds of "divinity"

which make later transformations possible. The gods are owed respect,

but in the Christian transformation of the Oath, the gods are re­

placed by the God, to whom is not only given respect, but obedience

and honor as the source of life.

Points of Furthest Internality

Here only topics which have a wide range of meaning can be

discussed. The image of the physician would be a ready starting point. There is strong evidence to show the extremes of what a physician -133-

should be from the corpus. The physician by his knowledge of the art is free to associate on one end of the spectrum with philosophy and science, and the ideal nature of man. He who loves the art also knows the nature of man (AM 20.1), and takes on a god-like quality for this ability to understand both man and the products of his mind (DEC 5.4). Here again are seeds for the subsequent transfor­ mations. At the other end of the spectrum lie the doctors who know neither man nor wisdom. Evidence of this ignorance is seen by how far from the art those doctors have strayed: they are alarmed by scenes of suffering (PRE 7.12) and persuade gullible patients to try extraordinary cures (OJ 46.38).

Expressions of Secrecy

What appears to be phrases of secrecy are nothing more than restrictions against the profligation of the whole doctrine of

Hippocratic medicine to those who would only utilize part of art: method and not theory (HO 37; HO 75). Only when both data (practicum) and theory (precepts) are applied together (PRE 2.12) can a healing be realized. Thus, theory depends on the correct gathering of data by those committed to the art and not on those who will only use the fruits of the art for the cure of disease.

Striking Expressions

Beside the terms mentioned above, one expression returns many times in the corpus: a patient is "seized by a disease." The -134-

verb used is : take hold of; grasp; understand; make one's own; seize. The same word is used by those who take oaths: under­ standing the import of the Oath, they make it their own and become one with it. The doctor identifies the power of his art with the power of disease. It is interesting that both the Oath and the majority of verbs used to describe disease would use this word choice in the medical scene. Obviously the Oath is not a mere formality in the eyes of the ancients, but something (the belief and dedication to the art) which consumes their whole interest in the practice of their profession.

2. What Motives Are Present In The Oath

Here will be discussed the author's private life; the under­ lying imagery used in the text; and the parts where the author com­ pletes himself.

The most obvious segment of the Oath which would equate with private life would be HO 60, 69, 70, 71, and 72. It is known that both Hippocrates and graduates of his school traveled from town to town. Knowing that first impressions are often the most lasting, the ancient doctors needed to establish credibility quickly or else be subject to identification with sophists who also traveled from town to town. From the corpus, there is evidence of the author be­ ing the laughing stock of quick-tongued word smiths who probably de­ rided his skills and method (RAD 44.9); (OJ 1.15). The only way to avoid this personal ridicule was by fashioning the art into a ready -135

body of workable knowledge which could easily distinguish between diseases and win repute by concrete evidence. Where the sophists could only accomplish abstract victories by winning argument—the doctor could, by his art, win health victories over sickness (LAW

4.1; PG 1.22). The motive to establish himself may have led to the firm establishment of the method as a means of gaining that end.

The underlying image used in the corpus and the Oath is

"plus and minus." This image fits cleanly into the private life segment of the analysis because it is a means of explaining the core theory of the art. The goal of the art is to detect what is in excess in man's environment and what is less than symmetry. The modes of treatment in the Oath are examples of excesses in judgment.

Examples of balance are displayed in the beginning of the Oath: clan membership brings balance. This good judgment (krisis) (HO 10), enables the doctor to distinguish between excess and privation. When a proper balance is achieved, then the author and those who swear by the Oath also complete their search for meaning of the self: "More gracious is wisdom that has been fashioned into an art; provided that it can be an art directed toward decorum and good repute" (DEC 1.10).

The art of medicine is worthless unless it wins the practitioner credibility and repute. These are strange words to modern ears ac­ customed to hearing medicine and mercy and altruism in the same theme

But the words are not strange when the Oath is viewed as a formal statement of belief by men who were defining a profession, which in its early days could have easily been mistaken for the casual -136-

advice-giving of the sophists.

The motive is obvious when the Oath is examined by cluster method. Hippocrates and his clan wished to differentiate themselves in a world of competing disciplines, from sophists, and distinguish themselves from those who would deride their craft.

3. What Stratagems Are Identified

The formal stratagem is an oath with a qualitative progression of terms: the most important to the least important. The Oath is also a familial document—a clan membership in a medical polis that answered the questions of inhabitants of new towns where the doctors wandered. Given the fact that strangers who were not citizens were treated with suspicion, the Oath and its tacit bond to a method of medical treatment became a passport—a set of credentials of citizen­ ship for the doctor in a new location. The Oath was a respected form of proof in the ecclesia and it was used as a form of proof in the informal ecclesia—the sickroom where credentials and competencies were demanded.

Thus the term physician was quickly equated with the essence

"He who does not make rapid and unwise judgments." This physician would heal by a scientific system applied to the scene where he found the sick man. The term physician brought trust to the sickroom be­ cause it assumed that the physician had carefully observed all the available symptoms and causes of the condition in which the patient finds himself and knows what treatment to prescribe. If the essence -137-

of careful observation and adherence to the art shifts, the physician will be quickly classified with sophists who do not really know the conditions of man's scene which brought him to his place on the sick bed

Summary Calculus

The calculus shows what stratagems must be present before the Oath can function as persuasive discourse in its original scene.

The art must be linked with the gods or some divine source of credi­ bility; with peer as brother; with art as the diagnostic process of understanding the whole from the parts of the case; with health as as end aided by the application of the system; with an understanding of the inexactness of the art; and with a desire to communicate the virtues of the art to a layman. The physician must be linked with wisdom, science, and a theoretical frame of restoring balance to the human constitution; with ability to forecast the effect of disease; with the humility to be prepared for fallibility, and with a desire to start a relationship with the community in which he practiced.

This understanding of man must be linked to a huge catalogue of body types, scenes, diseases, and natures, to a focus on the importance of non-radical prescriptions and treatments and to a wary respect for man's communication skills which could both destroy a physician or win him respect.

The Translations

Below will be examined the sixteen documents of translation -138-

of the Oath. The calculus will be applied to each of the translations to determine what stratagems of the original Oath were transformed or deleted. All documents are displayed in the appendix.

The "Oath of Hippocrates In So Far As A Christian May Swear

It" of the Third Century eliminates most references to the art. Thus the reader is not given an idea of where the skills for moral behavior are based. In the last three lines, God is asked to be the physician's

"helper" in life and art. Notice that the art has been relegated to a secondary spot in the ranking. Thus the reader is told what will be done, not who will do it, or what scientific or methodological cre­ dentials the doctor has. This transformation is possible because of the original "bow" to the Olympic dieties.

Jerome's Epistle of the Fourth Century broadens the description of how one will recognize the doctor/clergyman. However the reader is told that the original Oath was sworn to Hippocrates and not to the art. The result is techne description without ethos credentials

(the definition of magic) and a marriage of the Christian religion somehow with the medical motive. Now practitioners of the "art" of

Christianity can wed their motives to those of the doctor because both professions focus on the same God.

The Visigoth document (Fifth Century) completely ignores the art function of the Oath and focuses on sexual opportunities that may present themselves to the doctor. The fact that this dicta is prior to the fact of patient encounter, assumes that a doctor would want to make sexual advances if no prohibitory norms existed. Now art is -139

ignored and sexual motives rise to the fore. It will be observed that the sexual motive was not present in the original Oath, yet the seeds of possible sexual interpretation are present in HO 66—the

"abuse" passage.

In Cassiodorus (Sixth Century) an emotion theme is stated:

". . . new strength to the weak; certain hope to the weary." The highly Biblical stratagem assures the continuation of the clergy/ doctor medical practitioner. This theme fits cleanly with the truth telling dicta in the same document. Now the art, as a peer evalua­ tion technique is completely ignored and now, how the physician com­ municates with the patient is the criterion of the competence of the doctor.

Bamberg (Eighth Century) broadens the religion theme and now the doctor is equated with Jesus Christ. Obviously Christ's techne has replaced that of Hippocrates' and the patient recognizes a good doctor by how nearly he molds himself after Jesus.

Paris 11219 (Ninth Century) returns cleanly to the original

Oath with dicta urging the student to know "the art of medicine and the science of nature" as well as rhetoric so he may defend that art

There are also warnings about knowing the consequences of taking the

Oath and urgings to know the balance between knowledge and communi­ cation of that art to the patient.

The Epistle of Hippocrates (Ninth Century) returns to re­ ligious and methodology themes. The emphasis is on etiquette. This document gives rationalizations of how the doctor may accept money, -140-

be identified with God, and still win high regard from men.

Monte Cassino 97 (Tenth Century), focuses strictly on diagno­ stic skills. The doctor is not really urged to converse with the pa­ tient, but is engaged in a question and answer liturgy that is a good example of a doctor making a decision by the art described in

Hippocrates: parts to the whole. Here the pateint assumes a secondary role and the art is the primary focus of the encounter.

Constantine's Liber Pantegni (1100 A. D.) shows the clear altruism theme. A doctor must not expect money from the treatment of his patients, nor can he refuse to treat the sick. In view of

Constantine's formative role in the emerging Church in the western world, it is not surprising that this altruistic theme remained in­ tact as the medical profession continued to evolve. The theme of sexual propriety is reintroduced in this document. Apparently the

Christian translators wanted to stress altruism, but also knew how this motive could be misinterpreted by the patient.

The Arabic Oath (1200 A. D.) is remarkably similar to the original Oath. Yet it suffers from imprecise definition and elabo­ ration of each theme of the Oath. It appears as if the translator was making glosses in the text to make sure Hippocrates will be understood by the reader. These glosses allow extraneous themes to enter the interpretation: "I will strive for the benefit of the patients;"

"I will not contemplate administering any pessary to cause abortion."

These glosses go beyond the Greek in the text and they also call needless attention to clauses of the Oath which were probably not part -141

of the original document. It is easy to see how ethical confusion

could result in the modern era around the interpretation of these

phrases when such liberties were taken with the text.

The Salernitan Treatise (1100 A. D.) shows some charming

details of how a physician actually communicated with a patient.

Here the emphasis is on communication skills, or lack of them.

These skills are linked with divine benedition: the physician

is the helper of God and God is his guide. The seeds for this trans­

formation are present in the original document.

Henri de Mondeville (1306 A. D.) focuses the duties of a physician squarely on techne and reintroduces a common sense rational ization to the earning of money in medical treatment.

Percival (1791) expands medical etiquette and is responsible for the confusion between ethics and etiquette in modern medicine.

The second sentence of the document sounds an altruistic theme that continued into American medical practice. Section 23 shows that membership in the medical clan has been reduced to form: the object of living up to medical norms is not to harm the repute that doctors already have.

The American Medical Association Code (1846) built its own set of dicta on Percival's Code and clearly gave monetary rationaliza­ tion as a reason to conform to medical norms. The World Medical

Association Code (1948) takes up the religious-priest-physician theme in the first sentence: "... consecrate my life to the service of humanity." The health of the patient is the first consideration. -142-

Now art has completely disappeared and the need of the patient ranks as first priority in the doctor's oath.

The American Medical Association Code (1957) returns slight­ ly to a more realistic picture of the physician. The code is a set of standards by which a physician may determine the propriety of his conduct. This assumes that there is a right way to conduct oneself.

The ancient Oath would say—the art will dictate the behavior. When working with the sick by the methodology of the art, there is little chance for misbehavior to occur. Clearly the concept of medicine as art has been neglected. This concept will be examined in the next chapter. CHAPTER V

CONCLUSIONS AND FUTURE RESEARCH

At the beginning of this research it was stated that the

Hippocratic Oath appeared to be a medical code that assured a rela­ tionship of trust between a physician and his patient by dictating that the doctor would: 1) Do only that which is in the patient's best interest; 2) Do him no intentional harm; 3) Keep everything that was said by the patient confidential.! The Code appears not only to dictate behavior to the doctor but also seems to imply that the doctor's motive for treating the patient is altruistic.

Two groups of critics have analyzed this apparent altruism.

One group of critics argues that the Oath assures a physician's mo­ tive of altruism. These critics argue that this unselfish motive can be seen by the high status that the medical profession has at­ tained in the public eye;2* 3 b4y the moral superiority of doctors as ideal men;2 by their total devotion to medical duty;4 and by their

!m. Jellinek, "Erosion of Patient Trust in Large Medical Centers," Hastings Center Report, 6:3 (June 1976), 16-19.

2G. E. Gask, "Early Medical Schools: The Cult of Aesculapius and the Origin of Hippocratic Medicine," Annals of Medical History, 1 (1939), 128-157.

3K. R. S. Murthy, "Professional Ethics in Ancient Indian Medicine," Indian Journal of the History of Medicine, 18:1 (1973), 49

4F. 0. Smithies, "On the Origin and Development of Ethics in Medicine and the Influence of Ethical Formulae Upon Medical Practice, Annals of Clinical Medicine, 3 (1924-25), 583. -144-

own recognition of their responsibility to heal the sick with all their available skills.5

Another group of critics, however, argues that the Oath of

Hippocrates does not insure the altruistic motive of the physician.

Indeed, they argue, it can be seen in the way that physicians con­ duct themselves toward their patients, that their motives are any­ thing but altruistic. Physicians are often paternalistic;8* they often practice medicine only because they have a psychological dread of death and have professional doubts about their own scientific skills;7 and they often use the patient as a means to an end either to discover new cures for diseases;8 or for their own financial gains.8

Rhetorical critics represent a third group of analysts who hopefully could resolve this impasse. Instead of assuming that the

Oath should assure a motive of altruism or its opposite, the rhe­ torical critic would rather look at the Oath itself to learn what motives were intended by the original author.

8m. B. Rock, "Advisor Speaks to Aspiring Physicians," Intellect, 106 (August 1977), 76.

8A. M. Schmidt, "Better Medicine Through Better Information," Vital Speeches, 43:5 (December 15, 1976), 146.

7T. Boyce and M. Michael, "Nine Assumptions of Western Medicine," Man and Medicine, 1 (Summer 1976), 311-335.

8i. Illich, Medical Nemesis: The Expropriation of Health (New York: Pantheon Books, 1976), p. 41.

8C. W. Taylor, et al., "Synthesis of Multiple Criteria of Physician Performance," Journal of Medical Education, 44:11 (November 1969), 1063-1069. -145-

By examining the Hippocratic Oath by the method of cluster analysis, the rhetorical critic should be able to determine what private and public motives gave rise to the original document. Rhe­ torical critics, through cluster analysis, would examine the Greek text of the Oath and describe motives which may have gone undetec­ ted as the Oath evolved with medical history over the centuries.!8

Thus the rhetorical critic would examine the Oath as an act of per­ suasion instead of a set of laws concerning moral behavior.!! Also the critic would determine in this textual analysis what method and what stratagems the author used to persuade the audience of this oath.!2 Once the stratagems were identified, then an explanation could be made of how trust evolved from the original Oath by the taking of the Oath by the doctor. Other questions that could be answered would be: What function did the Oath fulfill in the pri­ vate life of Hippocrates? How did the notion of medical infalli­ bility arise surrounding the physicians that took the Oath? Were these overlays of infallibility justified on the basis of the stra­ tagems present in the original Oath? Have these overlays stimula­ ted or inhibited the physician's or the patient's choice alterna­ tives in the medical scene?

10w. H. Rueckert, Kenneth Burke and the Drama of Human Relations (Minneapolis: University of Minnesota Press, 1963), pp. 84 and 85.

!!r. K. Campbell, Critiques of Contemporary Rhetoric (Belmont, California: Wadsworth, 1972), pp. 4 and 12.

12m. H. Robins, "Promissory Obligations and Rawls's Contractarianism," Analysis, 36:4 (June 1976), 190-198. -146-

Thus instead of assuming that the Oath dictates behavior

motivated from altruism, the rhetorical critic would examine the

motives that were actually present in the original Oath and would

compare them with behaviors seen in the medical profession today to

judge their altruistic or selfish motives. To this end, four hypo­

theses were proposed by this research. Hypothesis I: By cluster

analysis, Hippocrates' private motives will be detected in the Oath.

Hypothesis II: Cluster analysis will show what stratagems of per­

suasion Hippocrates used to gain these private ends. Hypothesis

III: Cluster analysis will show what transformations of the motives

from the original Oath took place in subsequent documents . Hypo­ thesis IV: Cluster analysis will show by what processes this shift

in motives took place. Below Hypothesis I will be discussed under the title of "motive;" Hypothesis II, under "method;" and Hypothesis

III and Hypothesis IV under "effect." Following discussion of these sections, a suggestion for future statistical research will be given.

The Motive

Hypothesis I was confirmed. Cluster analysis does reveal private motives even in literature without an abundance of biograph­ ical data available about the author for the critic to use in his analysis.!3 The two main private motives identified were: the desire to divide the medical profession both vocationally and philosophically

!3W. H. Rueckert, p. 82. from the social and intellectual climate of antiquity.

1. Vocational Differentiation

In order to observe the private motive of an author in his literature, one must first crack the code in which the author cloaks his motive.34 in the case of the Oath, the code is: Art-Physician-

Man-Addition and Subtraction. By means of the code, Hippocrates was able to set his profession apart from not only other medical persua­ sions, but also to insure the fact that his practitioners would not be equated with quacks and charlatans, Since a significant part of man's self-image is tied to what he does vocationally, it is easy to understand the author's motive in wanting to create positive and per suasive retionalizations about his profession that would be accepted by his peers and his public.

For Hippocrates, it would have been easy to merge his medi­ cal community with religious influences since the thriving cultus of the Asclepiadae could have folded these medical experts into the diverse temple staff which appears to have existed in many major cities at the time. Yet such a move would have restricted the doc­ tor's independence for travel and would have demanded that patients come to him at the temple site. Further, the Coan medical commu­ nity could have merged with the Alexandrian or Sicilian medical schools where the emphasis was on theory and not on practicum. Yet

14k. Burke, The Philosophy of Literary Form (Berkeley, California: University of California Press, 1973), p. 20. -148-

here again, the physician would be restricted to "laboratory" con­ ditions where the infinite variables of climate and scene could not be studied.

What the Coan doctor needed to differentiate his craft from other practitioners of antiquity was a techne that could be applied anywhere and which was portable. Needed was a techne by which he could be assured of accurate diagnosis and prognosis of a patient's condition in order to gain respect from persons who were sick, wher­ ever he met them. The Hippocratic concept of medical art proved to be this techne which would not only divide the ancient Hippocratic doctor from other medical practitioners, but would persuade acceptance of the doctor among the laity. The techne becomes a means of both rejecting competitive medical idiologies and transcending the social scene.15 gy the techne the Hippocratic doctor encompassed his scene from another perspective.

The genius of the Hippocratic techne was its theoretical overview. The art was both precept and oral instruction: theory and practice. Its theory demanded that the doctor assume that a per­ fect balance between environmental and ecological factors was not only possible but the normal state of affairs for man in the condition of health. Thus the Coan doctor was not prone to quick judgments in diagnosis as were other medical practitioners, since so many factors needed to be considered before a judgment could be made. "Wherefore

15w. H. Rueckert, pp. 46-47. -149-

one must hold fast to facts in generalizations also and occupy one­ self with facts persistently, if one is to acquire that ready and infallible habit which we call the art of medicine" (PRE 2.7). This ability to recognize the theory behind the art rewarded the doctor in the positive way the physician was regarded by the patient who was cured: "The man who has learned these things [the art] and uses them will not, I think, make great mistakes in the art" (EP 3.16.4). The

Hippocratic doctrine of the four humours assumed that all environ­ mental and physiological factors must be in correct balance before health can be maintained or restored.

Hippocratic medical art was not only theory, but also prac­ ticum. Since he understood the art, the doctor could communicate clearly with his patient. The art was a practicum which the layman could easily understand and which coincided with the desire for self- healing prevalent in Greece. If a man fell ill from an unusual and novel activity, he stopped the activity and assumed that he had heal­ ed himself. The Hippocratic medical art, by its system of analysis of the scene could explain to the patient why the activity caused his sickness and knowing why, could restore the balance he enjoyed prior to the illness. "Through these considerations and by learning the times beforehand, he [the doctor] will have full knowledge of such particular cases, will succeed best in securing health, and will achieve the greatest triumphs in the practice of his art" (AWP 2.20).

The motive in this concept of the art is clear: purgative- redemptive. The Hippocratic doctor separates himself from his -150-

competition by being the only doctor who explains how disease is a dis­

integration of the healthful balance that was naturally present in man, and the only doctor who explains how the medical treatment he prescribes will bring a reintegration of out-of-balance elements in the patient.

Thus disease is viewed not as an outside force striking man down, but as the natural parts of man and his world out of synchronization. By the art, the Hippocratic physician is urging a cure upon man with the powers that the patient already has within him. This method and its mode of explanation was a tool by which the practitioners of the Coan school could separate and differentiate themselves from other doctors and quacks who treated only the visible symptoms of the disease and who did not bother to give the patient a total picture of the causality of his disease.

The motive for division in vocation is further amplified by the taking of an oath to adhere to the Hippocratic medical art. The verb for swearing to an oath () and the verb for being seized by a disease are the same word. The author is saying in ef­ fect—just as the patient is fully seized by a disease, so is the doc­ tor "seized" by his conviction of the efficacy of his method of cure.

The art was a total encompassment of the analysis of the condition of man: the total answer. As sure as the patient was that he was sick, so sure also was he who had sworn the Oath, that his art was the cure.

This is the death-birth motive.36 Death, was the total sum of man's

36q. Fogarty, Roots For A New Rhetoric (New York: Columbia University, 1959), p. 73. -151-

neglect of his condition (under normal circumstances—without ac­

cident) , while life and cure through the Hippocratic method was the

total analysis of the environment/scene of man that can lead to life.

If the patient is committed to neglect of his health, death will re­ sult. But if the doctor is committed to the art (seized by it), life will result.

The purgative-redemptive motive for the Oath is further am­ plified by the fact that not many doctors would swear to abide by it.

The code of meaning "adding and subtracting" comes into play here. The

Coan medical community could be increased with competent men because the restriction of swearing to the method would eliminate those who were not totally convinced of the superiority of the art. By subtraction, the school would be adding; by decreasing numbers, the art increased quality of practitioners. "Medicine in fact is sub­ traction and addition: subtraction of what is in excess; addition of what is wanted. He who performs these acts best is the best physi­ cian; he who is farthest removed therefrom is also farthest removed from the art" (BR 1.34).

The Oath and its focus on techne/art thus becomes a type of identification for members of a profession who wished to differentiate themselves from those who refused to examine the long range effects of environment and regimen on the human condition. The way non-member physicians could recognize the Coan doctor was by the theoretical method that he swore to follow; the way the patient could recognize the Coan physician was by the way the physician fit the patient's -152-

disease or illness into the schema of nature and explained how the

condition could be cured to restore the natural balance of health.

Thus for the Greek audience Hippocratic physicians were equated with

the method of their profession, not their mercy or their altruistic

motives.

The Oath focuses on creating a brotherhood of physicians who

were convinced that the Hippocratic understanding of the art was

theoretically and practically sound. Thus the Oath is not a list of

moral obligations to the patient. The private motive in the Oath is

to insure vocational prominence in an era when the doctor could be

easily mistaken for a priest, a scientist, or a charlatan. Thus the

seeds of what would appear to be altruism were planted. Contemporary

critics who argue that the Oath assures altruism can build their case

at this point because the oath-taker devotes himself to his art. The

original oath-takers had no idea that their art could cure every ill­

ness. Thus critics who argue that altruism was present from the start

of the Hippocratic tradition would confuse the unlimited pledge with the

limited scope of the art. Today, with extraordinary medical advances

credited to the art, the unlimited pledge can easily be linked with

if not "limitless cure" then "high probability of cure." The seeds

for this transformation were present in the original Oath, if not used in the original document.

2. Philosophical Differentiation

Apart from vocational differences, another pergative-redemptive -153-

motive that emerges from the cluster analysis is a desire to differ­

entiate from philosophical trends which existed in this era. Any per­

son who traveled from town to town and taught on topics of popular

concern (government, trade, wars, the power of the gods) was suspect

of being a sophist. The sophists taught a type of humanistic rela­

tivism which easily led to skepticism: the gods were dead; no standard

of public morals existed save those man created for himself. The

sophists appeared to be a threat to conservative citizens because

they represented an end to governmental order centered in a ruling

class. They promised to teach a techne for wisdom. This perspective

was a liberal threat to those who wished to cling to conservative ideals.

The sophists were further viewed as a threat because they had

no citizenship rights and privileges in the polis where they taught.

If they had no rights, they also exercised no responsibilities toward

maintaining that polis. Thus their teaching and training for govern­

mental leaders, while theoretically sound, may not have endured actual

practice. By not living as a citizen in the polis where he taught, the

sophist did not need to stay in the city and see the effect of his bad

teaching. When public opinion became too hostile about a bad sophist's

theory, he could move on to another polis.

In one sense, the Hippocratic physicians were like the sophists because they also taught a techne but they were quick to dissociate

from the sophistic philosophical perspective. They dissociated not only by their insistence on the regularity and predictability of nature but by their insistence that wisdom was not taught. Wisdom came from 154

the gods; only krisis (judgment) could be shaped to better use by

thorough analysis of the facts pertinent to the medical case. Every

man has the ability to make judgments; only the properly educated man,

who opened his mind to wisdom could make sounder and sounder judgments.

Thus the physicians of the Coan school quickly divided themselves from

those who appeared to destroy the old order of society and government

and those who did so with the promise of a techne available to all.

The private motive for this separation from those who were philosophically hostile to the natural order of things was two-fold.

The sophists were often urged to get out of a polis on pain of death.

If a physician were mistaken for a sophist, this sudden ejection from his practice would mean the disruption of his total study of the scene where his patients lived. The other reason for dissociation from the sophists was the fact that the Hippocratic techne was not built on relativism. In the public eye, relativism was often associated with faddish thought and foolish exercise of supposition. The Hippocratic physician was not interested in gaining the reputation for his art of a passing curiosity becuase the rules of science that he had carefully established by study of the scene applied to all cases as an absolute standard. His explanation of the cause of things and disease was built on scientific system, not on glib exercise of oratorical skill. From an examination of the Oath, it is obvious that the art was not available to any person, as the sophists often taught, but only to him who could distinguish between precept and practicum.

Further, the doctor wished to differentiate himself from -155-

superstition that attributed the cause of all disease to the gods.

To cling to this superstitious perspective would demand that man be

limited in his exercise of reason. He is subject to divine whim. The

Coan community did not appear to be devout enough for this complete

submission of will to unseen powers. The gods, as perceived by the

Hippocratic doctor, were mildly benevolent, but man exercised his

true telos by applying his judgment to discern between things in his

world, not by being overawed by the powers outside the world. Thus

the Coan medical community divided from the Asclepiadae not only in

practice but in philosophical perspective. Man does not need the gods

to be complete, say the Hippocratic physicians—he needs only the ex­

ercise of reason that is his gift.

The Hippocratic private motive can thus be seen in the doctor1s desire to identify with conservative men in the town he visited by his art so that he would not be associated with liberal trends of dis­ respect for the ruling classes. This would mean that his art was as­ sociated with the status quo of orderly life and dissociated from the disruption of a belief in gods who handed down punishment by whim.

The Method

Hypothesis II was confirmed. Cluster analysis showed what means were used to gain private ends. By merging to form a medical community, the Coan practitioners increased their credibility. This credibility was accomplished by flooding the medical/healing scene with ambiguities. The Oath not only established a relationship -156-

between members of the Hippocratic school and assured communication among members of the same medical school, but the Oath became the representative anecdote for a kind of medical polis—a community with­ out geographic boundaries, but with methodological boundaries. In order to make this professional isolation come about, the Hippocratic doctor needed to make something new out of what would appear to be very old. In order not to be perceived as some foreign nation that floated from city to city, the practitioners needed to identify with something that was traditionally Greek, and transform it into new meaning both for themselves and for their audience. If the members of this community pledged their support to each other in the practice of medicine, the patients of these practitioners could identify with that bond of professional excellence because in times of sickness the patient could assure himself of his doctor's skills. The medical community successfully identified the need of the layman—to be assured that the doctor had demonstrated competencies. The best way to demon­ strate medical competence was to be able to explain disease and sick­ ness from a natural origin, and to be able to cure the disease. The

Oath bound the practitioner to these goals of explanation and cure through the art, and the patient knew of this bond. The Oath assured uniform medical method and also increased credibility by its method of argument. By the richness of the ambiguities, the new meanings could arise for terms that the patient and the doctor understood.

This is seen by circumference shifting. "Sickness" for the doctor and for the patient meant two different things. For the patient, sickness -157

meant symptom; for the doctor, sickness meant out of balance. The

Oath allows a new term to be fixed as a bridge between these two points.

Now "art" is a means of identifying sickness for the doctor and a means

of cure for the patient. The Oath is a stratagem for arguing for this

new term. How is this done?

First, the Oath gathers up.all the highest forms of credibility

and places them at the beginning of the Oath as guarantors of the in­

tegrity of the oath-taker: the gods, love of family, pedagogical respect,

pledges to practice only the best judgment. The doctor will heal and

not be disrespectful of the social and spiritual "realities" of the

scene. The patient was likely to hold these things in high regard

and by hearing them at the beginning of the Oath, he knew that the

doctor was dedicated to the best of the paidea.

Next, the physician states in effect, that the art is so

valuable that he will not teach it to the casual student. Further,

the art is so valuable that it will only be used for the sick. The

art is so valuable that turly worthy persons who are able to make dis­

cerning judgments will respect its value.

Further the art is distinguished by one characteristic that

stands above the rest and acts as a key to the whole Oath: the art is practiced by the doctor who knows how to avoid excesses in treatment:

"the best of by ability and judgment." The words "ability and judg­ ment" are not parallel terms. Ability is practical skill; judgment

is theoretical/discernment skill. Thus the patient treated by the

Hippocratic doctor can be assured of the fact that no rash or unwise -158-

decisions will be made in his case: no irresponsible prescription of drugs (those things that the doctor knows to be deadly but which the patient may not know); no administration of a pessary (vaginal sup­ pository) for casual abortion such as in the case of birth control or protection of beauty. (The interpretation of these two dicta is justified on the basis of parallel Greek construction in the Oath.

Both dicta are pointed toward prudent administration of treatment rather than toward prohibition.) Further, the doctor will not use surgery as treatment, even if asked to do so by the patient, who may not be aware of the dangers involved with surgery. Further, the doctor promises not to abuse the bodies of men or women. No sexual connotation is given here. Yet the seeds of a sexual interpretation are present. The main thrust of this line is: the doctor will not treat the body simply as an interesting experimental subject on which he may try any casual new idea or treatment. Further, he promises to keep his art holy (set apart) by not associating with gossips and those who would treat only the symptoms of the sick and brag about their success. He knows that the art is an inexact science and if he succeeds in curing the patient, he must not brag about his accomp­ lishment for failure may happen as quickly as success.

Thus after the powerful witnesses of credibility are mention­ ed, and the means by which peer doctors and patients can tell if the physician is behaving in accord with the art, finally the last test of credibility is given: peers will know that the doctor has been faithful to the art if his reputation is good among laymen. Adherence -159-

to the dicta of the art will insure that men will give the doctor

public acclaim. Thus, the public may think that there is no ulterior

motive in the Oath, for the doctor appears to be saying—the patient

must be the judge of medical quality and competence. If the doctor

is not faithful to the art, the public will reward him with a bad

reputation. In summary, the argument takes the following form: If I

[the physician] value the gods, and my follow practitioners which I

treat like family, and the art they promote, and if I follow that art,

I will not subject the patient to extreme treatments, and thus I will

be judged a competent physician. The method or art is the first priority of the Oath, not the patient. The argument is the best of persuasion devices: to persuade without appearing to persuade—to let the customer make up his own mind. The Hippocratic doctor has flood­

ed the term sickness with a new ambiguity which helps him gain his private end: health is equated with art. When art is rightly prac­ ticed, good repute will be the result. Thus healing has a new artistic proof: the Hippocratic doctor.

The Effect

Hypotheses III and IV are not confirmed. In order to de­ termine how the transformations in the Oath came about during its historical development, a cluster analysis would need to be run on each document and its translator. However, an examination of these stratagems in the existing documents does tell the researcher which of the arguments of the original Oath persisted through history and -160-

which were deleted. The cluster analysis has shown what must be in

the argument in order to achieve the end of the Hippocratic motive.

Do all these stratagems remain intact as the Oath moves through

history?

The first version of the Oath (As A Christian May Swear It)

had the effect of changing the focus of the art as expressed in the

original Oath. In this version, by stating that all healing comes

from a source outside of man, the art looses its techne as an invention of man. Here the gods are not just bowed to, but are made an inter­ vening source of healing. Now the doctor becomes an instrument of divine healing, not just a craftsman. Here a different set of gods are irivolked than the ones in the Hippocratic Oath. The God of this oath is not just a benevolent diety; he is creator and savior. Ob­ viously he alone gives the power for healing. Cassiodorus sides with this new God and even gives the doctor Biblical duties (strength and hope—Matthew 11:28: Come unto me all ye who are weary and heavy- laden) . Bamberg shows the doctor created by God and his art is e- quated with the Gospel. Bamberg even introduces new credibility in the form of ancient prophets. Epistle of Hippocrates goes so far as to say God is the only physician. Salernitan Treatise makes the doctor an assistant to God. American Medical Association, 1847 now associates the profession with the most supreme effort of man and makes its members "sinless." World Medical Association (Declaration of

Geneva) introduces the priestly theme and duty of the doctor in

"consecrating" the lives of its members to humanity. The stratagem -161-

of medicine as a man-invented art has now transcended the world scene

and entered the spiritual realm.

Another strange item that emerges as the Oath is translated

is the theme of sexual promiscuity. In many versions of the Oath, the

sexual theme is given vivid detail: "fornication" in As A Christian

May Swear It; "beauty" in Jerome; "secret conduct" in the Visigoth

Code; "chastity" in Epistle of Hippocrates; "lust" in Liber Pantegni;

"mischief-making" in the Arabic Version; "lecherous eye" in Salernitan

Treatise; and "occasional indulgences" in Percival. This theme attributes a motive to the doctor that was not in the original Oath, although the seeds for this shift were present in the Hippocratic document. It suggests that if a doctor is acquainted with the inti­ mate details of the human body, then he would want to take advantage of his patients. This would suggest that the doctor had completely lost the art as was suggested by Hippocrates because he refused to put his sexual interests below his desire for high repute among his patients. This excess is far removed from the art that Hippocrates described where the doctor knows how to make balanced judgments. The

"abuse of bodies" passage in the Oath refers to temperance in treat­ ment, not sexual activity.

Another concept that emerges in the translations of the Oath is the dicta that the medical profession owes all its attention to the healing of the sick. Primum non Nocere is translated into "don't let any harm happen to the patient." This motive was never present in the original document (though again, the seeds for this shift were -162-

present) and such dicta strap the modern physician with impossible

dilemmas of treatment. Obviously, identification of the healing

arts with God requires that the physician heal everyone "who calls

on His name." Later versions of the Oath pick up this divine theme

and infer this total responsibility to duty. American Medical

Association, 1957 uses "rendering to man a full measure of service

and devotion" and "improving the health and well-being of the indi­

vidual and the community."

Versions of the Oath which stressed techne ended with Percival.

Before him, Henri de Mondeville, Salernitan Treatise, Monte Cassino,

and Paris 11219 indicate some examples of balanced techne. Apparently

they did not argue their cases well enough to be included in later

versions of the Oath, since the later versions preferred divine motives

to practicum.

Prom the examination of the Oath, the ancient physician pre­

sumed little of himself but prized highly his art and method. He

assumed that he was fallible and knew that only if he relied on medical

judgments that restored balance of health in his patients could he be able to overcome the errors that he was bound to make. The end of the method was the gaining of high public regard and self-achievement

The modern physician, however, has a long tradition of being associated with divine healing. If he is associated with divine heal­ ing, then the healer also becomes divine and can make no mistakes.

The translations of the Oath would indicate that the physician does not make decisions as other men would make them. As soon as an -163-

over-emphasis on infallibility occurs, the art is lost, for it is

an inexact science. When infallibility is stressed, the physician

becomes something different from his Greek brothers in the profession.

To expect infallibility from a man with the ancient professional cre­

dentials expressed in the Oath, causes him to labor under undue pressures

which neither his profession, nor the exercise of good reason will al­

low. Careful examination of the Oath shows that it was only intended

to be a means of identification, marvelously constructed to con­

vince people of the credibility of the profession. To make the Oath

something beyond that in this modern era, is making a transformation

beyond the intentions or motives of the original writer.

The Hippocratic Oath is a document that is best interpreted

from the perspective of the art as defined by the corpus and as men­

tioned within the Oath. Though the art is mentioned very little in the

Oath, cluster analysis shows that it has a powerful meaning for the

writer of the Oath. To neglect the art/techne cluster makes the dicta

about surgery, abortion, bodily abuse, and administration of drugs,

take on extravagant meanings never intended by the author and mean­

ings which cause needless ambiguity as to the Oath's dicta today.

Tracing to the core of the Oath clears not only the Oath of its

strange tone of mixed dicta, but also clears the way for modern phy­

sicians who have labored under false assumptions about the duties of

their profession. The rhetorical critic asks—how came the doctor here?

He came by cooperation and invitation of practitioners within the

Church. By identification of medical motive with religious motive -164-

the physician not only changed the focus of his art, but moved easily into the modern era in league with another powerful yet newer profession.

Future Research

Future research could examine the wide variances of meaning given to the Oath today by physicians, through the use of multivariate statistical models. Just as cluster analysis was used on this ancient artifact, modern research could ask the question—what clusters of meaning are arising today from the way physicians in this era under­ stand and use the Oath? In order to answer this question, research would need to examine a larger "artifact:" that of the members of the medical community itself. Future research could ask those people what meaning the Oath has for them.

A systematic plan for obtaining the answer from this popula­ tion would require that the "art" of statistical analysis be applied to a large medical environment. First a team of judges trained in verbatim technique would interview a representative sample of doctors in the nation (N=100). These judges would ask each doctor to discuss what he thought about the Hippocratic Oath in a series of open-ended questions. These judges would record the conversations and collate the data by drawing out common factors which a significant number of the doctors stated.

After a taxonomy of factors had been established, then a test instrument could be constructed which asked the subject to evaluate the statements by a semantic differential. Questions would be included -165-

on the instrument such as: "The Hippocratic Oath is useful to me when

making ethical judgments about telling a patient if he has a terminal

condition;" or "The Hippocratic Oath is a guide for my personal con­

duct in the community." This instrument could be sent to a large

number of physicians throughout the country for a larger sample of

opinion (N=1,OOO). From the results, a FACAN could be run to de­

termine statistically where significant factors lay in meanings at­

tributed to the Oath. From the FACAN, a MANOVA would determine if

there was a significant difference between the factors and of course,

a DISCRIM would locate the source of these differences in the groups.

Canonical correlation (Rc) would determine the degree of overlap be­

tween groups: if a person held one belief about the Oath, how strong­

ly is that belief associated with other beliefs. Thus FACAN, coupled

with Rc would be valuable in locating and differentiating salient be­

liefs about the Oath from external beliefs. In the same manner that

cluster analysis showed the desire to differentiate was the prime mo­

tive of the original Oath, and not a desire to operationalize altru­

ism, so might Rc show that doctors have obscure beliefs about the Oath which have not yet come to light in modern research. -166-

BIBLIOGRAPHY: BOOKS

Anderson, B. W. Understanding the Old Testament. Englewood Cliffs, New Jersey: Prentice-Hall, 1957.

Beecher, H. K. Research and the Individual: Human Studies. Boston: Little, Brown, and Company, 1970.

Bitzer, L. F. and E. Black. The Prospect of Rhetoric : Report of the National Developmental Project. Englewood Cliffs, New Jersey Prentice-Hall, 1971.

Black, E. Rhetorical Criticism: A Study in Method. New York: Macmillan, 1965.

Brock, B. L. "Rhetorical Criticism: A Burkian Approach," in Methods of Rhetorical Criticism: A Twentieth-Century Perspective, R. L. Scott and B. L. Brock, eds. New York: Harper and Row, 1972.

Burke, K. The Philosophy of Literary Form: Studies in Symbolic Action. Berkeley, California: University of California Press, 1973.

Calhoun, C. Annotated Bibliography of Meàical Oaths, Codes, and Prayers. Washington, D. C.: Kennedy Institute, 1975.

Campbell, K. K. Critiques of Contemporary Rhetoric. Belmont, California: Wadsworth, 1972.

Cooper, L. tr. The Rhetoric of Aristotle. Englewood Cliffs, New Jersey: Prentice-Hall, 1932.

Edelstein, L. Ancient Medicine. Baltimore: Johns Hopkins University Press, 1967.

Etziony, M. B. The Physician's Creed. Springfield, Illinois: Charles C. Thomas, 1973.

Fogarty, D. Roots For a New Rhetoric. New York: Columbia University, 1959.

Illich, I. Medical Nemesis: The Expropriation of Health. New York: Pantheon Books, 1976.

Jacob, E. Theology of the Old Testament.. New York: Harper and Row, 1958. -167-

Jones, W. H. S. Hippocrates,. Four volumes. Cambridge, Massachusetts: Harvard University Press, 1957.

Kuhn, H. "A Review of 'The Philosophy of Literary Form'" in Critical Responses to Kenneth Burke, 1924-1966, W. H. Rueckert, ed. Minneapolis: University of Minnesota Press, 1969.

Leake, C. D. Percival's Medical Ethics. Baltimore: Williams and Wilkins, 1927.

Levine, E. B. Hippocrates. New York: Twayne, 1971.

Reiser, S. J., A. J. Dyck, W. J. Curran. Ethics in Medicine: Historical Perspectives and Contemporary Concerns. Cambridge, Massachusetts: MIT Press, 1977.

Rueckert, W. H. Kenneth Burke and the Drama of Human Relations. Minneapolis: University of Minnesota Press, 1963.

Scarborough, J. Roman Medicine. Ithaca., New York: Cornell University Press, 1969.

Sigerist, H. E. A History of Medicine, two volumes. New York: Oxford University Press, 1951 and 1961.

Slochower, H. "Kenneth Burke's Philosophy of Symbolic Action," in Critical Responses to Kenneth Burke, 1924-1966, W. H. Rueckert, ed. Minneapolis: University of Minnesota Press, 1969.

Spiker, S. F. and H. T. Engelhardt, eds. Philosophical Medical Ethics: Its Nature and Significance. Boston: D. Reidel, 1977.

Taylor, H. A. Greek Biology and Medicine. New York: Cooper Square Publishers, Inc., 1963.

Veatch, R. M. Death, Dying and the Biological Revolution. New Haven: Yale University Press, 1976.

Wheelwright, P. ed. The Presocratics. New York: Odyssey, 1966.

BIBLIOGRAPHY : PERIODICALS

Adler, K. "Doctor-Patient Communication : A Shift To Problem-Oriented Research," Human Communication Research, 3:2 (Winter 1977), 179-190. -168-

Boyce, T. and M. Michael. "Nine Assumptions of Western Medicine," Man and Medicine, 1 (Summer 1976), 311-335.

Brett, A. T. "America's Doctors: A Profession in Trouble," U, S. News and World Report, 83 (October 17, 1977), 50 & 58.

Burke, K. "A Dramatistic View Of The Origins of Language, Part One," Quarterly Journal of Speech, 38:3 (October 1952), 251-264.

Burke, M. "C. R. Doctor Sets Up Referral Service For Troubled Doctors," Cedar Rapids Gazette, in Newsbank (Stamford, Connecticut: Arcata Microfilms, November 1977), "Health," 152: E5.

Cohen, T. and M. N. Levin, "Ghost Surgery," Philadelphia Inquirer, in Newsbank (Stamford, Connecticut: Arcata Microfilms, June 1976), "Health," 58: B11-C2.

Cook, R. "New Doctor's Dilemma," Newsweek, 81 (May 14, 1973), 24-25.

Fox, M. "Why People Are Mad At Doctors," Newsweek, 89 (January 10, 1977), 4.

Gask, G. E. "Early Medical Schools: The Cult of Aesculapius and the Origin of Hippocratic Medicine," Annals of Medical History, 1 (1939), 128-157.

______. "Early Medical Schools, II,: Cyrene, Cos and Cnidos," Annals of Medical History, 2 (1940) , 15-21.

Goodfield, J. "Reflections On The Hippocratic Oaths," Hastings Center Studies, 1 (1973), 79-92.

Grange, J. "Magic, Technology, and Being," Religious Humanism, 8:2 (1974), 88-91.

Ivie, R. L. "Presidential Motives for War," Quarterly Journal of Speech, 60 (October 1974), 337-345.

Jellinek, M. "Erosion of Patient Trust in Large Medical Centers," Hastings Center Report, 6:3 (June 1976), 16-19.

Krebs, A. "Welby Is Scored by Gay Activists," New York Times, February 17, 1973, p. 63, col. 4.

Levoy, G. "Physicians Maintain Their Advice Means More Than Vices," Cincinnati Inquirer, in Newsbank (Stamford Connecticut: Arcata Microfilms, February 1978), "Health," 28: Al. -169-

Lloyd, G. E. R. "Aspects of the Interrelations of Medicine, Magic and Philosophy in Ancient Greece," Apeiron, 9:1 (1975), 1-16.

MacCormic, E. R. "Scientific and Religious Metaphors," Religious Studies, 11:4 (1975), 401-409.

MacKinney, L. C. "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 1-31.

Macksoud, S. J. and R. Altman, "Voices in Opposition: A Burkian Rhetoric of Saint Joan," Quarterly Journal of Speech, 57:2 (April 1971), 140-146.

Mader, T. F. "Agitation Over Aggiornamento: William Buckley vs. John XXIII," Today1s Speech, 17:4 (November 1969), 4-15.

May, W. F. "Code, Covenant, Contract, or Philanthropy," Hastings Center Report, 5 (December 1975), 29-38.

Murthy, K. R. S. "Professional Ethics In Ancient Indian Medicine," Indian Journal of the History of Medicine, 18:1 (1973), 45-49.

Nolen, W. A. "Ten Questions Your Doctor Should Answer," McCalls, 104 (July 1977), 96 & 170.

O'Connor, J. J. "Pressure Groups are Increasingly Putting the Heat on TV," New York Times, October 6, 1974, II, p. 19, col. 1.

______. "Doctor's Hospital," New York Times, September 10, 1975, p. 88, col. 6.

Parrott, M. H. "American Medicine 1976,” Vital Speeches, 43:1 (October 15, 1976), 13-15.

Perkins, J. H. "Business Looks At Health Care Costs," Vital Speeches, 43:7 (January 15, 1977), 211-215.

Robins, M. H. "Promissory Obligations and Rawls's Contractarianism," Analysis, 36:4 (June 1976), 190-198.

Robinson, D. "Medical Secrecy," Ladies Home Journal, 92 (March 1975), 91-92; 70 & 72.

Rock, M. B. "Advisor Speaks To Aspiring Physicians," Intellect, 106 (August 1977), 76-77.

Rosenfield, L. W. "The Anatomy of Critical Discourse," Speech Monographs, 25:1 (March 1968), 50-69. -170-

Schmidt, A. M. "Better Medicine Through Better Information," Vital Speeches, 43:5 (December 15, 1976), 145-148.

Smithies, F. 0. "On The Origin and Development of Ethics in Medicine and the Influence of Ethical Formulae Upon Medical Practice," Annals of Clinical Medicine, 3 (1924-25), 573-603.

Taylor, C. W., E. G. Lewis, D. E. Nelson, G. C. Loughmiller, and P. B. Price, "Synthesis of Multiple Criteria of Physician Performance," Journal of Medical Education, 44:11 (November 1969), 1063-1069.

"The Doctors Who Are Sick," Arizona Republic, in Newsbank (Stamford, Connecticut: Arcata Microfilms, April 1976), "Health," 4O:A12-B1.

Thompson, S. "Is Dr. Welby A Menace To Women?" New York Times, September 2, 1973, II, p. 11, col. 1.

Trafford, A. "Crisis In The Operating Room," U.S. News And World Report, 84:19 (May 15, 1978), 39-42.

Yeager, R. C. "Doctoring Isn't Just For Doctors," Reader's Digest, 111 (December 1977), 237-242.

BIBLIOGRAPHY: DISSERTATIONS

Davidson, W. D. "Sam Houston and the Indians: A Rhetorical Study of the Man and the Myth, " (Ph.D. Dissertation, University of Kansas, 1971).

Parsons, D. W. "The Rhetoric of Isolation: A Burkian Analysis of the America First Committee," (Ph.D. Dissertation, University of Minnesota, 1964).

BIBLIOGRAPHY: REFERENCE TOOLS

A Lexicon Abridged From Liddell and Scott's Greek-English Lexicon. Oxford: Clarendon Press, 1958.

Cope, E. M. An Introduction to Aristotle's Rhetoric. London: Macmillan, 1867. -171

APPENDIX A

Hippocratic Corpus

1. Adenography 30. Hebdomads 2. Airs 31. Hemorrhoids 3. Airs, Waters, Places 32. Human Anatomy 4. Anatomy 33. Illness 5. Ancient Medicine 34. Illnesses in Young Females 6. Angiology 35. Infant Nature 7. Aphorisms 36. Instruments of Reduction 8. The Art of Medicine 37. Internal Medicine 9. Body Fluids 38. Joints 10. The Clinic 39. Letters 11. Coan Prognoses 40. Medical Education 12. Crises 41. The Nature of Man 13. Critical Days 42. Nutrition and Digestion 14. Dentition 43. The Oath 15. Diseases I, II,I II, IV 44. The Physician 16. Dreams 45. Precepts 17. Eight Months Foetus 46. Professional Conduct 18. The Emissary Speech 47. Prognostic 19. Epidemics, I - VII 48. Prorrhetic I, II 20. Epilepsy, The "Sacred Disease" 49. Regimen I, II, III 21. Excision of the Foetus 50. Regimen in Acute Diseases 22. Female Nature 51. Regimen in Health 23. Female Sterility 52. Seven Months Foetus 24. Fistulas 53. Speech at the Altar of Athena 25. Fractures 54. Sperm 26. General Physiology 55. Superfetation 27. Gynecology I, II 56. Ulcers 28. Head Injuries 57. Use of Fluids 29. The Heart 58. Vision -172-

APPENDIX B

The Hippocratic Oath Insofar As A Christian Could Swear It*

Blessed be God the Father of our Lord Jesus Christ, who is blessed for ever and ever; I lie not. I will bring no stain upon the learnings of the medical art. Neither will I give poison to anybody though asked to do so, nor will I suggest such a plan. Similarly I will not give treatment to women to cause abortion, treatment neither from above nor from below. But I will teach this art, to those who require to learn it, without grudg­ ing and without indenture. I will use treatment to help the sick ac­ cording to my ability and judgment. And in purity and in holiness I will guard my art. Into whatsoever houses I enter, I will do so to help the sick, keeping myself free from all wrongdoing, intentional or unintentional, tending to death or to injury, and from fornication with bond or free, man or woman. Whatsoever in the course of practice I see or hear (or outside my practice in social intercourse) that ought not to be published abroad, I will not divulge, but consider such things to be holy secrets. Now if I keep this oath and break it not, may God be my helper in my life and art, and may I be honored among all men for all time. If I keep faith, well, but if I forswear myself may the opposite befall me. >

4 *J. Goodfield, "Reflections on the Hippocratic Oaths," Hastings Center Studies, 1(1973), 81-82. -173-

APPENDIX C

Jerome, to Nepotian, Priest*

It is a part of your [clerical] duty to visit the sick, to be acquainted with people's households, with matrons, and with their children, and to be entrusted with the secrets of the great. Let it therefore be your duty to keep your tongue chaste as well as your eyes. Never discuss a woman's looks, nor let one house know what is going on in another. Hippocrates, before he will instruct his pupils, makes them take an oath and compells them to swear obedience to him. That oath exacts from them silence, and prescribes for them their language, gait, dress, and manners. How much greater an obligation is laid on us [clergymen]. .

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 3. -174-

APPENDIX D

Visigoth Code*

No physician shall presume to bleed a [freeborn] woman in the absence of [some of] her relatives. . .; the father, mother, brother, son, uncle, or some neighbor. ... On such occasions scandals multiply. . .

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 4. -175

APPENDIX E

Cassiodorus*

Let your visits bring healing to the sick, new strength to the weak, certain hope to the weary. Leave it to clumsy [practitioners] to ask the patients they are visiting whether the pain has ceased and if they have slept well. Let the patient ask you about his ailment and hear from you the truth about it. Use the surest possible informants. To a skillful physician the pulsing of the veins reveals the patient's ailment while the urine analysis indicates it to his eye. To make things easier, do not tell the clamoring inquirer what these symptoms signify. . . .

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 4. -176-

APPENDIX F

Bamberg Document*

. . . Wherefore one ought not to spurn earthly medicine since he knows it is advantageous rather than harmful and since it has not been held in contempt by holy men. . . . Wherefore let us honor the physicians so that they will help us when sick, remembering that wise one "Honor the physician of necessity for the Most High created him." And do not hesitate to take what potions he gives you. That same wise one said, "The Most High created medicine from the earth and the prudent man will not reject it." Therefore he who does not seek medicine in time of necessity deserves the name of stupid and imprudent. I say that it is wise to do well by the physician while you are well so that you will have his services in time of illness. . . . God wishes to be honored by his miracles performed through man. According to Isaiah whatever good is done by man is effected by God; he said, "The Lord does all of his works through us." Christ himself in the Gospel said, "Without me you can do nothing." . . . Aid the sick, your reward coming from Christ, for whoever gives a cup of cold water in His name is assured of the eternal kingdom where with Father and Holy Spirit He lives and reigns for eternity. Amen.

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 6. -177-

APPENDIX G

Paris 11219 On Giving The Sacred Oath And What Sort of Books One Should Read*

He who wishes to begin the art of medicine and the science of nature ought to take the oath and not shrink in any way whatsoever from the consequences. And then by this process of oath-taking let him take up the teachings. Let him learn the art of grammar to the point where he can understand and expound the sayings of the ancients, omitting all artificialities of speech. Also let him learn rhetoric so as to be able to defend with his own words those who are carrying on medical teaching; also geometry so that, just as one knows the measuring and numbering of fields, so also he may recognize the ailments called typi [fevers] and the crises which are produced by periodici [fevers]. He must also know the science of the stars so as to recognize their rising, setting, and other movements, and the seasons of the year, since our bodies change along with these, and since human illnesses are affected by their normality and abnormality.

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 15. -178-

APPENDIX H

Paris 11219 Concerning Those Who Are Starting In The Art Of Medicine*

We begin concerning him who is starting training in the art of medicine. Let him be of that transitional age, between boyhood and manhood, that is a youth of fifteen which is an apt age for taking up the sacred art of medicine. Let him be neither very large nor very small in size, and such that he may live his youth freely and his old age usefully and easily. In character and spirit let him be zealous and talented, in­ deed keen so that he may understand readily and be teachable; also strong so that he may be able to endure the recurring labor and the terrible sights that he encounters. He should make the cases of others his own sorrow. Let him be less concerned with other disciplines, but careful about his manners. According to Erasistratus, the greatest felicity is to keep things in balance so that one is both accomplished in the art and also endowed with the best of manners. If either one is lacking, better to be a good man without learning than a skillful practitioner with depraved manners. If indeed the lack of good manners in the art seems to be compensated by [professional] reputation, greater is the blame, for professional knowledge can be corrupted by blameful manners. But if both of these are faulty, I adjure you who are aware of it to withdraw from the art. He who takes up the art of medicine ought also to have knowledge of the nature of things so that he will not seem to be inexperienced therein. And he should be well endowed and wise, indeed adorned with all good characteristics.

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 14. -179-

APPENDIX I

Epistle of Hippocrates*

Meanwhile I warn you, Physician, even as I was warned by my master. You ought always to read, and to shun indolence. Visit with care those whom you accept for treatment, and safeguard them. (Hold fast to the cures that you know. Never become involved knowlingly with any who are about to die or who are incurable. Do not take up with the daughter or wife of your patient). Cherish modesty, follow chastity, guard the secrets of the homes [you visit]. If you know anything derogatory con­ cerning a patient, keep quiet about it. Do not detract from other [physicians]; if you praise the character and cures of others you your­ self will have a better reputation. (At the outset, accept at least half of the remuneration without hesitation, for he who wishes to buy [your services] is disposed to pay and to beg [for treatment]. Get it while he is suffering, for when the pain ceases, your services also cease). You will win more thanks if you do all these things, and no physician will be greater than you [in reputation]. Read felicitously, be pro­ gressive, fare well, and God's grace be with you, in the practice of medicine and [your other] undertakings. Let healing come from God, who alone is the physician. Amen.

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 23-24. -180-

APPENDIX J

Monte Cassino 97 In What Manner You Should Visit A Patient*

You do not visit every patient in the same manner. If you wish to learn all, heed [the following]. As soon as you approach the patient ask him if he has any pain. If he says he has, then ask if the pain is severe and constant. After this take his pulse and see if he has fever. If he is in pain you will find the pulse rapid and fluid. Ask if the pain comes when he is cold; also if he is wakeful, and if his bowels and urine are normal. Inspect both parts and see if there is perchance any serious danger. If the ailment is acute inquire as to the beginning of the illness. If it is chronic you will not recognize it at all, for the beginning of such illness is at a time when the patient begins to feel a lesion when performing accustomed functions, as if he could not perform them. After this ask what former physicians said when they visited him, whether all of them said the same. Inquire concerning the condition of the body, whether it is cold or otherwise, whether the bowels are loose, sleep interrupted, the ailment constant, and if he has ever had such ailment before. Having made these inquiries you will easily recognize the causes of the illness and the cure will not be difficult.

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 24. -181-

APPENDIX K

Constantine's Liber Pantegni What Sort Of Person A Student Of Medicine Should Be*

He who wishes to obtain the mantle of medicine ought [so to act] that he is an honor to his master, is praised [by him] and is subject to him just as to his own parents. . . . The master should be honored so that [his disciples] may learn how to handle difficult situations. Whomso­ ever the master takes for instruction should see to it that he is a worthy disciple. He should teach [only] worthy disciples without pay or expectation of future emolument; and he should be sure to keep un­ worthy persons from entering this learned profession. The physician should work for the healing of the sick. He should not heal for the sake of gain, nor give more consideration to the wealthy than to the poor, or to the noble than the ignoble. He should neither teach, nor ac­ quiesce in teaching anyone how to give a harmful potion, lest some ignorant person should hear of it and on his authority give a death potion. He should not teach anyone to bring about abortion. Moreover, when he visits patients, he should not set his heart on the patient's wife, maidservant, or daughter; they blind the heart of man. He ought to keep to himself confidential information concerning the ailment, for at times the patient makes known to the physician things that he would blush to tell his parents. The physician should flee luxury and avoid worldly pleasures and drunkenness. These things upset the spirit and encourage the vices of the flesh. He should devote himself with assiduous zeal to the healing of the body and should not neglect reading, so that his memory may aid him when books are not at hand. He should never refuse to visit the sick for thus, by experience, he may become more efficient. He should be pious, humble, gentle, likeable, and should seek divine assistance.

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 27. -182-

APPENDIX L

The Arabic Version Of The Oath Of Hippocrates*

Hippocrates said: I swear in the name of God, the Master of life and death, the Giver of health and Creator of healing and of every treatment, and I swear in the name of Aesculapius, and of all the holy ones of God, male and female, and I call them to witness, that I will fulfill this oath and these conditions. I will regard my teacher in this art as my father, I will share with him my means of livelihood and I will make him my partner in my wealth, and I will give him my wealth whenever he may be in need of it. As for his descendents, I regard them as my brothers, and I will teach them this art without any remuneration or condition, should they desire to learn it. And I associate together (i.e. regard as equal), in the injunctions and in the sciences and in all else contained in the art, my own children, the children of my teacher, and the disciples on whom the oath has been imposed, and who have sworn to observe the medical code of honor. And I will not do so for any other than these. In all my treatment, I will strive so far as lies in my power for the benefit of the patients. And I will restrain myself from things which are injurious to them, or are likely in my opinion to do them harm. And I will not give them any poisonous drug if they ask for it, nor will I advise them thus. Nor will I contemplate administering any pessary which may cause abortion. And in my treatment and in the practice of my art I will keep myself pure and holy. And I will not operate on those who have stone in the bladder; rather I will leave it for those whose profession it is. And I will enter every abode into which I may go only for the benefit of the sick, being in a state devoid of (all deliberate intention of) wrong-doing, injustice, mischief-making, such as might be intended in other transactions, or in respect of sexual relations with woman or man, whether free or slaves. And as for the things which I may see or hear during the time of treating the sick, or at times other than those in which I am so engaged, about such behavior of men as should not be talked of outside, I will keep silence, considering that such thing should not be discussed. He who fulfills this oath and does not violate any part of it, to him will it be granted to carry out his treatment and his art under the most excellent and favorable conditions, and to be praised by all men in future for ever; while the contrary will be the portion of him who transgresses it.

*J. Goodfield, "Reflections on the Hippocratic Oaths," Hastings Center Studies, 1 (1973), 82-83. -183-

APPENDIX M

The Salernitan Treatise Concerning The Physician's Approach To The Patient*

Therefore, 0 physician, when you call on a patient, be a helper in God's name. Let the angel who accompanied Tobias be your spiritual and phy­ sical companion. On entering the home try to find out through the mes­ senger how sick the patient is and what sort of an ailment he has. This is necessary so that you will not seem to be entirely ignorant of the ailment when you approach him. ... [Detailed instructions follow: e.g., ask whether the patient has confessed to a priest; pretend that the case is serious; thus, whether he survives or dies, your reputation is safe; in the sick room greet those present and pay compliments con­ cerning the household before turning to the patient]. Make him feel secure and quiet his spirit before you take the pulse. Take care lest he lie on his side or have his fingers over-extended or drawn back into his palm. Support his arm with your left [hand] and consider the pulse beat at least to a hundred. Also take note of the different kinds of pulses. . . . [Inspect the urine for color, substance, and quantity; on leaving tell the patient that he will get well but tell the servants that he is very sick; do not look with lecherous eyes on women of the household; if invited to dine, do not be officious or overly fastidious; during the meal, inquire about the patient; on leaving, show your appreciation; etc., followed by advice concerning diet, cupping, digestion, etc., on later visits during the patient's convalescence, the physician is advised to be cheerful and to promise the patient a speedy recovery. Finally] with as much as possible of honest promises go in peace, Christ your guide.

*L. C. MacKinney, "Medical Ethics and Etiquette in the Early Middle Ages: The Persistence of Hippocratic Ideals," Bulletin of the History of Medicine, 26:1 (1952), 26. -184-

APPENDIX N

from Henri de Mondeville: The Morals And Etiquette Of Surgeons*

. . . A surgeon ought to be fairly bold. He ought not to quarrel before the laity, and although he should operate wisely and prudently, he should never undertake any dangerous operation unless he is sure that it is the only way to avoid a great danger. His limbs, and especially his hands, should be well shaped with long, delicate and supple fingers which must not be tremulous. He ought to promise a cure to every patient, but he should tell the parents or the friends if there is any danger. He should refuse as far as possible all difficult cases, and he should never mix himself up with desperate ones. He may give advice to the poor for the love of God only, but the wealthy should be made to pay well. He should neither praise himself nor blame others, and he should not hate any of his colleagues. He ought to sympathize with his patients in their dis­ tress and fall in with their lawful requests so far as they do not inter­ fere with the treatment. Patients on the other hand, should obey their surgeons implicitly in everything appertaining to their care. ...

*S. J. Reiser, et al., Ethics in Medicine: Historical Perspectives and Contemporary Concerns (Cambridge, Massachusetts: MIT Press, 1977), p. 15. -185-

APPENDIX O

From: Thomas Percival's Of Professional Conduct In Private Or General Practice*

1. The moral rules of conduct prescribed towards hospital patients should be fully adopted in private or general practice. Every case com­ mitted to the charge of a physician or surgeon should be treated with at­ tention, steadiness, and humanity; reasonable indulgence should be grant­ ed to the mental imbecility and caprices of the sick; secrecy and delicacy, when required by peculiar circumstances, should be strictly observed; and the familiar and confidential intercourse, to which the faculty are admitted in their professional visits, should be used with discretion, and with the most scrupulous regard to fidelity and honor. 2. The strictest temperance should be deemed incumbent on the faculty. ... 3. A physician should not be forward to make gloomy prognostica­ tions because they savour of empiricism, by magnifying the importance of his services in the treatment or cure of the disease. 4. Officious interference in a case under the charge of another should be carefully avoided. 7. Consultations should be promoted in difficult or protracted cases, as they give rise to confidence, energy, and more enlarged views in practice. 13. Visits to the sick should not be unseasonably repeated; because when too frequent, they tend to diminish the authority of the physician, to produce instability in his practice, and to give rise to such occasional indulgences, as are subversive of all medical regimen. 21. The use of quack medicines should be discouraged by the faculty as disgraceful to the profession, injurious to health, and often destructive even to life. 23. The espirit du corps is a principle of action founded in human nature, and when duly regulated, is both rational and laudable. Every man who enters into a fraternity engages by a tacit compact not only to submit to the laws, but to promote the honor and interest of the association, so far as they are consistent with morality and the general good of mankind. A physician therefore should cautiously guard against whatever may injure the general respectability of his profession and should avoid all contumelious representations of the faculty at large, all general charges against selfishness or improbity, and the indulgence of an affected or jocular scepticism concerning the efficacy and utility of the healing art.

*S. J. Reiser, et al., Ethics in Medicine: Historical Perspectives and Contemporary Concerns (Cambridge, Massachusetts: MIT Press, 1977), p. 24. -186-

APPENDIX P

From: American Medical Association First Code Of Medical Ethics 1847 Duties Of Physicians To Each Other And To The Profession At Large*

1. Every individual on entering the profession, as he becomes entitled to all its privileges and immunities, incurs an obligation to exert his best abilities to maintain its dignity and honor, to exalt its standing, and to extend the bounds of its usefulness. 2. There is no profession, from the members of which greater purity of character, and a higher standard of moral excellence are re­ quired, than the medical; and to attain such eminence, is a duty every physician owes alike to his profession, and to his patients. 3. It is derogatory to the dignity of the profession, to resort to public advertisements or private cards or handbills, inviting the attention of individuals affected with particular diseases — publicly offering advice and medicine to the poor gratis, or promising radical cures 4. Equally derogatory to professional character is it for a physician to hold patent for any surgical instrument, or medicine; or to dispense a secret nostrum, whether it be the composition or exclusive property of himself or of others. For, if such nostrum be of real efficacy, any concealment regarding it is inconsistent with beneficence and professional liberality; and if mystery alone give it value and im­ portance, such craft implies either disgraceful ignorance, or fraudulent averice. It is also reprehensible for physicians to give certificates attesting the efficacy of patent or secret medicines, or in any way to promote the use of them.

*S. J. Reiser, et al., Ethics in Medicine: Historical Perspectives and Contemporary Concerns (Cambridge, Massachusetts: MIT Press, 1977), p. 31. -187-

APPENDIX Q

World Medical Association: Declaration of Geneva*

I solemnly pledge myself to consecrate my life to the service of humanity I will give to my teachers the respect and gratitude which is their due; I will practice my profession with conscience and dignity. The health of my patient will be my first consideration: I will respect the secrets which are confided in me; I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers; I will not permit considerations of religion, nationality, race, party politics or social standing to inter­ vene between my duty and my patient. I will maintain the utmost respect for human life, from the time of conception; even under threat, I will not use my medical knowledge contrary to the laws of humanity. I make these promises solemnly, freely and upon my honor.

* s. J. Reiser, et al., Ethics in. Medicine: Historical Perspectives and Contemporary Concerns (Cambridge, Massachusetts: MIT Press, 1977), p. 37. -188-

APPENDIX R

From: American Medical Association Principles Of Medical Ethics (1957)*

Preamble. These principles are intended to aid physicians in­ dividually and collectively in maintaining a high level of ethical con­ duct. They are not laws but standards by which a physician may determine the propriety of his conduct in his relationship with patients, with colleagues, with members of allied professions, and with the public. 1. The principle objective of the medical profession is to render service to humanity with full respect for the dignity of man. Physicians should merit the confidence of patients entrusted to their care, rendering to each a full measure of service and devotion. 3. A physician should practice a method of healing founded on a scientific basis; and he should not voluntarily associate professionally with anyone who violates this principle. 5. A physician may choose whom he will serve. In an emergency, however, he should render service to the best of his ability. Having undertaken the care of a patient, he may not neglect him; and unless he has been discharged he may discontinue his services only after giving adequate notice. He should not solicit patients. 8. A physician should seek consultation upon request; in doubt­ ful or difficult cases; or whenever it appears that the quality of medical service may be enhanced thereby. 9. A physician may not reveal the confidences entrusted to him in the course of medical attendance, or the deficiencies he may observe in the character of patients, unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or of the connunity. 10. The honored ideals of the medical profession imply that the responsibility of the physician extends not only to the individual, but also to society, and these responsibilities deserve his interest and participation in activities that have the purpose of improving both the health and well-being of the individual and the community.

*S. J. Reiser, et al., Ethics in Medicine: Historical Perspectives And Contemporary Concerns (Cambridge, Massachusetts: MIT Press, 1977), p. 39.