Saturday, December 15, 2007

hippocrates gets dissed

In my never-ending search for truth and wisdom, I decided that as an Internet Medical Doctor, I should take some Continuing Medical Education credits. Since I have absolutely no medical training whatsoever, I decided to start at the beginning, kinda like opening the Bible at Genesis. I decided to start with the Works by Hippocrates. He’s that Oath guy, so if people swear an oath towards or about him, I figured he must be somebody.

He was a pretty important guy, so it seems. They called him the Father of Medicine, and he lived from about 460 BC to 370 BC. Ninety years is impressive for a time before flushing toilets and Dyson vacuums.

Turns out he wrote a lot, and his works are collected into something called the Hippocratic Corpus. I figure strolling through his writings should be worth a handful of CMEs.

I picked one called, Aphorisms. It is presented in Roman-numeral section and then numbered paragraphs within each section. Let’s stroll …

I.21. Those things which require to be evacuated should be evacuated, wherever they most tend, by the proper outlets. (“Evacuated … by the proper outlets.” Man, starts right in with the anal bit. Just remarkable. How did I know that was coming?)

II.11. It is easier to fill up with drink than with food. (This sounds like a proverb. “There is no ‘I’ in teamwork.” “‘Gullible’ is not in the dictionary.” “Orville Redenbacher’s brother is a colonel in the Air Force.”)

II.21. Drinking strong wine cures hunger. (“I’m hungry!’ “Shut up! Get blasted – you won’t think about it as much!”)

II.24. [Concerning acute disease] The fourth day is indicative of the seventh; the eighth is the commencement of the second week; and hence, the eleventh being the fourth of the second week, is also indicative; and again, the seventeenth is indicative, as being the fourth from the fourteenth, and the seventh from the eleventh. (Where’s my slide rule? I know I left it around here somewhere …)

II.48. In every movement of the body, whenever one begins to endure pain, it will be relieved by rest. (“Doc, it hurts when I move.” “Then stop moving.” Brilliant!)

III.10. Autumn is a bad season for persons in consumption. (Back in his day, Consumption/Tuberculosis was characterized by coughing up blood, fever, and was almost always fatal. Seems to me, Hippo, the time of year isn’t dispositive.)

V.3. A convulsion, or hiccup, supervening on a copious discharge of blood is bad. (Good rule. Got it. Thank you.)

V.34. When a pregnant woman has a violent diarrhoea, there is danger of her miscarrying. (“Dear Diary, about two months ago I got pregnant with Spyro’s child. Last week, I began to feel a quivering in my toes that worked its way the entire distance of my legs. I thought it would result in a real howitzer of an orgasm. Alas, to my dismay, the result was explosive flatulence. Now, the flatulence has given way to violent diarrhoea. What could be next? Methinks I am not well. I must stop eating hummus as very often.”)

V.72. Persons disposed to jaundice are not very subject to flatulence. (Um, OK. “Johnny, I haven’t heard you fart lately, and you look a little yellow under the gills. I think your liver is failing. I could be wrong.”)

VI.9. Broad exanthemata are not very itchy. (“Not very”? Rather loose language for a doc, eh? If it’s a rash and it was itchy when it was little, you can be damn sure it will be itchy when it spreads. “Itch” isn’t proportioned to a condition, like you only get so much “itch” per condition. The broader the condition, Hippo, the more it frickin itches.)

VI.13. Sneezing coming on, in the case of a person afflicted with hiccup, removes the hiccup. (Yes, and if you read a few posts below, sticking your fingers in his ass will also “remove the hiccup.” Surprised you didn’t come up with that.)

VI.17. It is a good thing in ophthalmy for the patient to be seized with diarrhoea. (Let’s see … “ophthalmy” is an inflammation of the membranes or coats of the eye or of the eyeball. “I can’t see nothing, doc. My eyes are all inflamed. Big time.” “Yes, they are, Spartacus, I can see that. How’s your butt?” “Hunh?” “I said, ‘how’s your butt?’” “Um, OK, I guess. I could lose a pound or two. You know it is.” “I think we need to aid in the evacuation through the proper outlets.” “Doc, it’s my eyes. My eyes are weirding out on me.” “I know, Sparty. Trust me on this one. We’ll ream you out a good one, give you a tonic to induce violent diarrhoea, and in a few days you’ll be good as new! You aren’t pregnant, are you?”)

VI.28. Eunuchs do not take the gout, nor become bald. (Now here is news you can use! The heck with that Propecia or the Gessippi Whoever with the Beverly Hills salon that hugs all his customers while he charges them $500 for the same product you can now get for $19.99 but wait order now and we’ll give you a second bottle for free who has time for all that nonsense look I don’t own the company in fact I don’t know anything about them they just agreed to give my 20% of gross if I would do this commercial so I am and stop staring at that zit above my right eyebrow I am fully aware the pancake didn’t cover it completely just buy the product you bovine freak. You want to stop hair loss or jumpstart re-stimulation or re-growth? Easy – cut your nuts off! And as an added bonus, if you chop the mud flap off within the next 15 minutes, we’ll guaranty that you’ll never get gout! “Honey, where’s the hedge clippers?”)

VI.46. Such persons as become hump-backed from asthma or cough before puberty, die. (And if it happens after puberty, people will just spend a lifetime being pointing at you and hiding their children from your view. Man, how hard do you have to cough to create a hump on your back?)

VI.53. Delirium attended with laughter is less dangerous than delirium attended with a serious mood. (“How is he, doctor?” “He’ll be fine, Ma’am. Just keep him laughing. Whatever you do, keep him laughing.”)

VII.4. A chill supervening on a sweat is not good. (I know. This happens every time I drink myself into oblivion and evacuate through all the proper outlets. I always hear this voice, “This is not good.” Voice sounds familiar. I think it is me.)

VII.14. Stupor or delirium from a blow on the head is bad. (OK. How long did it take to figure this one out? Did you use live subjects?)

VII.34. When bubbles settle on the surface of the urine, they indicate disease of the kidneys, and that the complaint will be protracted. (I always make bubbles. It’s fun!)

VII.43. A woman does not become ambidexterous. (Whew! Is the next line, “burn the witch!”?)

VII.55. When the liver is filled with water and bursts into the epiploon, in this case the belly is filled with water and the patient dies. (I think you got a little off track here, Hippo. It seems to me that the patient died because of the burst liver. I really do think the water in the stomach is secondary. You may want to look over your data again.)

Interesting guy.

So I figure since “real” docs take the Hippocratic Oath, maybe I should read it. Good rule: Always start with the original text when doing research. Then, silly me and somewhat to be shock and awe, I wanted to find the modern version, and found instead a bunch of “modern” versions. I have three of them following the original.

Here is the original version (yes, translations differ, but that is your problem, not mine).

“I SWEAR by Apollo (wasn’t he a god or sumptin?) the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses (smile. Pagan!), that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents (mentor = daddy. Interesting concept. Sounds like a blood oath, Kemo Sabe.), to share my substance with him (are you selling Amway?), and relieve his necessities if required (mentor = sex daddy?); to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation (getting whored out just to learn a trade. Wow.); and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others (was there a secret handshake? I picture Fred Flintstone with his big blue hat while at the Loyal Order of Water Buffalos Lodge). I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous (OK). I will give no deadly medicine to any one if asked (OK), nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion (WHAT?!? You will NOT induce an abortion? Um, wait a minute … roughly 45MM abortions since 1972 in the US and the original text of the Oath includes a prohibition? Oh, it is to laugh.). With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work (Ewww! What pray tell is behind this crack? Cutting the tendons so they cannot escape?). Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males (and since docs were all guys, here’s a little gay reference.), of freemen and slaves (don’t go banging the patient – good rule). Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot! (whew, it ends like a spell. Eerie!)

Well, old Hippo didn’t support abortion, did he? He’d get on all fours and let his teacher bang him doggy-style, but wouldn’t do his patients. Gotta draw lines somewhere, I guess. Interesting world.

Let’s see how the Oath was updated. Here’s the first modern version:

“I SWEAR in the presence of the Almighty (down to one god) and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

“TO RECKON all who have taught me this art equally dear to me as my parents (but you’re not going to sleep with them, right?) and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations (all?), so long as (funny, didn’t take long for the “but” to come in)the treatment of others is not compromised thereby (well, cowpoke, there is only so much of “you,” so in order to not compromise this fee-paying patient over here …), and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient (the origins of the referral system).

“I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous (tip of the hat to Hippo). I will neither prescribe nor administer a lethal dose of medicine to any patient (… any patient …) even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization (oh my, methinks a prohibition against abortion has reared its head) to natural death and reject abortion that deliberately takes a unique human life (Oh! I should have read ahead, eh? “Reject abortion” coupled with previous reference of “life = fertilization” seems very clear. How interesting. I wonder how fully this position lies with Aristotle’s delayed ensoulment.).

“WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient. (There’s that “seduction” bit again! Must’ve been a real problem. Something just dawned on me – in all the usages, it is the doc seducing the patient. Always that form. So if she (or he!) starts it … weird demarcation. Why not just prohibit sexual relations with patients?)

“WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

“WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.”

Alright, substantially intact. Added a few bits about human research and informed consent. Good issues. Let’s see another “modern” version. Methinks the Indians are discussing leaving the reservation.

“I swear to (now down to zero gods) fulfill, to the best of my ability and judgment, this covenant:

“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. (A little soft around the edges, but still very Fred-like.)

“I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. (But sometimes the exact appropriate amount of treatment is nihilistic. How do you handle that?)

“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. (Oh man. How many docs do you know that skipped this paragraph?)

“I will not be ashamed to say "I know not," (ditto) nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery (share the wealth).

“I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life (in theory); this awesome responsibility must be faced (application) with great humbleness and awareness of my own frailty. Above all, I must not play at God. (Capital G? But you axed Him in the opening. Odd.)

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. (No comment.)

“I will prevent disease whenever I can, for prevention is preferable to cure.

“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

“If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”

That was an interesting shift in the treatment of abortion – from clear to cryptic. Still present, in some carnival mirror sort of way. Notice what is missing entirely? Docs can now nail their patients – male and female – regardless of who initiates it!

Last and, yes, least I found the AMA approved version. The reservation is now devoid of human inhabitants.

“You do solemnly swear, each by whatever he or she holds most sacred (Hunh? “whatever”? Good lord, talk about politically correct): That you will be loyal to the Profession of Medicine and just and generous (read, “make referrals early and often”) to its members. That you will lead your lives and practice your art in uprightness and honor.

“That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice. (Is this code for boning patients?)

“That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it. (Cure = good; criminal = bad. Silent on preventing abortion. Silent on assisted suicide. But neither “cure” do they?)

“That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret.

“These things do you swear. Let each bow the head in sign of acquiescence. And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.”

The AMA sucks. Remarkable how much they changed from Hippo’s first writing. Why do they even continue to use the name?

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