Abstract
^Humanism and Ethics in Roman Medicine: Translation and Commentary on a Text of Scribonius Largus* Edmund D. Pellegrino and Alice A. Pellegrino It is only when we, as members of a later society, with the gifts of hindsight and differing ideals, attempt to define Roman medicine in modern terms that it falls short. One should recall the basic humanity of Celsus, Aretaeus, and Galen as one assesses the worth of medicine in the Empire. —John Scarborough, Roman Medicine, p. 148 In the closing words of his last public address—his presidential oration before the British Classical Association in 1919—William Osier summarized his philosophy of medicine and life in two words—philotechnia and philanthropia—"love of the art" and "love of humanity."1 He was quoting from a well-known Hippocratic text that many physicians before him, and since, have taken as the inspiration for those humanistic qualities that have characterized the best physicians in all ages. Osier's view has long been the standard account of the origins of medical humanism and especially its ethical expression. In 1955, however, Ludwig Edelstem, a distinguished humanist and authority on ancient medicine, disagreed. In his Osier oration, he suggested instead that a fuller and perhaps loftier expression might be found in the writing of an obscure Roman of the first century A.D.—one Scribonius Largus.2 Edelstein expanded upon the opinions of several German classicists whose * Presented in abbreviated form before the Washington Society for the History of Medicine, 30 April 1983, and the American Osier Society, Minneapolis, 3 May 1983. Literature and Mediane 7 (1988) 22-38 © 1988 by The Johns Hopkins University Press Edmund D. Pellegrino and Alice A. Pellegrino 23 commentaries on a text of Scribonius—the preface to his Compositiones— pointed to a humanistic strain not generally attributed to Roman medicine .3 Edelstein's commentary emphasized several distinctive humanistic features of Scribonius's professional ethics—the grounding of the physician 's moral obligations in the special nature of his social role, the compassion intrinsic to that role, and its status as a moral imperative. Taken together these created a humanistic ethic in which compassion for the sick person shapes the moral obligations of the physician. These features of Scribonius's preface merit careful reflection today when both ethics and humanism are foci of public and professional concern . The humanistic strain in medicine is being threatened by some of the same forces that are weakening the ancient edifice of medical ethics— the commercialization and industrialization of medical care, specialization and technology; and moral pluralism. As a result, the physician's technical and professional moral obligations are becoming progressively disengaged from each other. Osier's hope for a fusion of philotechnia and philanthropia seems less possible now than ever. Equally sincere and dedicated physicians differ sharply on most of the prescriptions and proscriptions of the Hippocratic ethic.4 Many recognize only competence and nonmaleficence as moral obligations, denying any obligation to efface self-interest in the interests of the sick. The physician as professional is giving place to the physician as entrepreneur, proletarian, or corporate employee. Compassion is increasingly depredated as unrealistic and ancillary in the face of medicine's technologic prowess. Given the likely continuation of these trends, a central question is whether it is still possible to define some set of moral commitments common to the profession that can transcend the deep philosophical differences that divide it. If such commitments are to be found, they will reside in the one medical reality that does not change with time—the need of the sick person for the physician's help and the promise the physician makes when he or she offers to provide that help. Scribonius Largus illuminates the humane and ethical nature of that relationship in a unique way. In a few pregnant words embedded in a treatise devoted to pharmacotherapeutics, he defines precisely what it is to te a physician. He writes squarely in the Hippocratic tradition but adds dimensions drawn from the ethics of the middle Stoa that enlarge that tradition significantly. J. S. Hamilton recently provided the first English translation of Scribonius 's preface.5 Ours differs in emphasis but not in substance. In...