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Scribonius Largus and the Oath of Hippocrates

"Hippocrates, before he will teach his pupils, makes them take an oath and compels them to swear fealty to him. He binds them over to silence, and prescribes for them their language, their gait, their dress, their manners. How much more reason have we to whom the medicine of the soul has been committed to love the houses of all Christians as our own homes."

Jerome, Epistles (LII.15)

Claudius was accompanied on the British campaign of AD 43 by Scribonius Largus, a physician and pharmacologist, probably at the instigation of Caius Julius Callistus, an influential freedman who was the secretary in charge of petitions. He also commended his Latin medical writings to the emperor and, in appreciation for this patronage, Largus addressed and dedicated to him the Compositiones, a collection of drug compounds or recipes, written, as is related in the Preface, when he was abroad, with only a few books at his disposal.

Nothing is known of Largus beyond what can be inferred from the Compositiones. He may have been born in Sicily at the beginning of the first century and wrote in both Greek and Latin, given that he refers to his work in Latin being presented to the emperor and that Galen, a century and a half later, quotes prescriptions in Greek that are not in the surviving Latin text. Although Largus did treat members of the imperial household, he probably was not Claudius' personal physician. That role was held by Xenophon, who also had gone on the British expedition and later, as Tacitus relates in the Annals (XII), was induced by Agrippina (Claudius' fourth wife) to murder the emperor by means of a poisoned feather.

Most prescriptions in the Compositiones, if not all, seem to have been culled from teachers and connections at court. There is an antidote against poison favored by Augustus, a drug against colic prepared for Tiberius, an ointment used by Claudius' mother (Antonia) and grandmother (Livia), as well as dentifrices used by Augustus' sister (Octavia), Livia, and Messalina, Claudius' third wife. It is the mention of Messalina (LX), in fact, that allows the book to be dated some time after Callistus succeeded to his post in late AD 47 and before the execution of Messalina for adultery late the next year.

Two hundred and seventy-one compounds are described, arranged from head to toe, according to the site of the disease; antidotes against poisons, bites, and stings; plasters, dressings, and salves; as well as references to aconite (CLXXXVIII) and to an early form of electroanalgesia, in which the shock of the torpedo ray was used to manage both headache (XI) and gout (CLXII)the latter when a freedman of Tiberius, standing on the shore, allowed the repeated shocks of a ray placed beneath his feet to numb the pain.

The name of the ray comes from torpere, "to be stiff or numb, torpid." Indeed, Meno, in speaking to Socrates in the dialogue of the same name, says "And if I may venture to make a jest upon you, you seem to me both in your appearance and in your power over others to be very like the flat torpedo fish, who torpifies those who come near him and touch him, as you have now torpified me, I think. For my soul and my tongue are really torpid, and I do not know how to answer you" (trans. Jowett).

As to the torpedo ray, itself, Oppian calls it the cramp-fish, saying that "in its loins it hath a piece of craft, its strength in weakness: even two rays planted in its sides, one on either hand. If one approach and touch these, straightway it quenches the strength of his body and his blood is frozen within him and his limbs can no longer carry him but he quietly pines away and his strength is drained by stupid torpor" (Halieutica, II.56ff). Later, He relates how, if caught, the shock runs through the line and rod to the hand of the fisherman, causing him to drop the tackle because "Such icy numbness straightway settles in his hand" (III.149ff). Claudian says much the same thing. "The dread paralysing force rises above the water's level and climbing up the drooping line, passes down the jointed rod, and congeals, e'er he is even aware of it, the blood of the fisherman's victorious hand. He casts away his dangerous burden and lets go his rebel prey, returning home disarmed without his rod" (Carmina Minora, XLIX).

Largus also recommends plasters for the treatment of wounds suffered by gladiators (CI), but remedies against epilepsy (XVII) that involve drinking the blood of a gladiator or consuming a portion of the liver are condemned as falling outside the professio of medicine. Celsus does promote such a cure, however, admitting that "Some have freed themselves from such a disease by drinking the hot blood from the cut throat of a gladiator: a miserable aid made tolerable by a malady still most miserable" (III.23.7; also Pliny, XXVIII.4).

Here, professio mean a public declaration by which the doctor imposes upon himself the duties and obligations of the profession and commitment to it. In the Preface, Largus expounds on what it means to be a physician, whose heart should be "full of mercy (misericordia) and humanity" (humanitas). There is a solemn obligation (sacramentum) to heal and show compassion for the patient; indeed, this beneficence is specific to the role of the physician and supersedes even civic duty. The doctor, for example, should know about poisons, if only to recognize and combat them, but never to compound or use them, even on an enemy in war. Drugs are like "divine hands" and their effect like "divine intervention." To deny the efficacy of drugs because of ignorance is negligent; even worse, is not to use them when they are known to work.

The doctor's duty is to heal, not to harm and, in this admonition, Largus provides the earliest reference to the Hippocratic Oath, when he appeals to the provision that forbids a woman being given an abortive pessary. It is Hippocrates, "the founder of our profession" who "handed on to our discipline an oath by which it is sworn that no physician will either give or demonstrate to pregnant women any drug aborting a conceived child." Then "how much more abominable will those men judge it to do harm to a fully formed human being who consider it wicked to injure the uncertain hope of an unborn child" (trans. Hamilton).

Soranus, a Greek practicing in Rome in the early second century AD, refers to the Oath in the Gynecology. There, he sides with the opposing position of the controversy. Rather than prohibit all abortions, Soranus understands the Oath to prohibit only abortive suppositories and that abortion is permitted if the life of the mother is in danger.

"For one party banishes abortives, citing the testimony of Hippocrates who says: 'I will give to no one an abortive'; moreover, because it is the specific task of medicine to guard and preserve what has been engendered by nature. The other party prescribes abortions, but with discrimination, that is, they do not prescribe them when a person wishes to destroy the embryo because of adultery or out of consideration for youthful beauty; but only to prevent subsequent danger in parturition if the uterus is small and not capable of accommodating the complete development" (I.19.60).

A more suspicious view of the Oath (and Greeks in general) was held by Cato the Elder.

"It was not only Greek philosophers that he hated, but he was also suspicious of Greeks who practised medicine at Rome. He had heard, it would seem, of Hippocrates' reply when the Great King of Persia consulted him, with the promise of a fee of many talents, namely, that he would never put his skill at the service of Barbarians who were enemies of Greece. He said all Greek physicians had taken a similar oath, and urged his son to beware of them all" (Plutarch, Life of Cato, XXIII.3-4).

Neither Largus, Soranus, nor Jerome quote the Oath exactly. Attributed to Hippocrates, who flourished in the fifth century BC, here is the second section, which concerns the obligations of the physician.

"I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot" (trans. Edelstein).

Finally, an example of one of Scribonius' potions (LXX) for inflammation of the tonsils, which was suffered by Antonia (Minor), the mother of Claudius.

"For Treatment of a Choking Quinsy: And the following has proven beneficial for many patients, and is certainly quite powerful and quite effective: 2 drachmas each of costus, celery seeds, anise seeds, oil of camel grass, and cinnamon-cassia, one-half drachma of cardamom, 2 drachmas of the wild rue (two-thirds of which is the seed), one-half ounce of fissile alum, 5 medium-sized ground-up oak galls, 2 drachmas of saffron, one-half drachma of the refined residue of the oil of saffron, one-half drachma of myrrh, 4 drachmas of Cretan birthwort, 3 drachmas of cinnamon, one ounce of the ashes of a young wild swallow, and one-half drachma of spikenard. All these ingredients are to be conjoined and either pounded or otherwise produced separately each having been skimmed in Attic honey. And whenever the compound is to be used, a sufficient amount of the same honey should be added to it. The Augusta always has this compound at hand" (trans. Scarborough).

The ingredients do have biologically active compounds and, insists Scarborough, comprise an effective analgesic.

The fragment above is from the Oxyrhynchus papyri (P.Oxy. 2547) and is in the Wellcome Library for the History & Understanding of Medicine (London). Dating from the third century AD, it contains a fragment of the Hippocratic Oath.

References: "Scribonius Largus, the Unknown Pharmacologist" (1995) by Vivian Nutton, Pharmaceutical History, 25, 5-8; "Scribonius Largus on the Medical Profession" (1986) by J. S. Hamilton, Bulletin of the History of Medicine, 60, 209-216; "Humanism and Ethics in Roman Medicine: Translation and Commentary on a Text of Scribonius Largus" (1988) by Edmund D. Pellegrino and Alice A. Pellegrino, Literature and Medicine, 7, 22-38; "The Career and Works of Scribonius Largus" (1992) by Barry Baldwin, Rheinisches Museum für Philologie, 135, 74-82; Ancient Medicine (2004) by Vivian Nutton (which is critiqued by John Scarborough in Bryn Mawr Classical Review, 2005.07.74); "The Hippocratic Oath: Text, Translation and Interpretation" (1943) by Ludwig Edelstein, The Bulletin of the History of Medicine, Supplement 1; A Select Library of Nicene and Post-Nicene Fathers of the Christian Church, Series II (1890-1896) edited by by Philip Schaff and Henry Wace; Soranus' Gynecology (1991) translated by Owsei Temkin; Celsus: On Medicine (1938) translated by W. G. Spencer (Loeb Classical Library); Claudian: Shorter Poems (1922) translated by Maurice Platnauer (Loeb Classical Library). The standard edition is Scribonii Largi Compositiones (1983) edited by Sergio Sconocchia. Aside from the preface, the Compositiones has not been translated into English.

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