Medical Ethics in the Renaissance (review)

The author, a professor of English at the University of California (Davis) and a skilled Latinist, has produced a well-researched analysis of certain ethical concerns of physicians from the early sixteenth to the mid-seventeenth century. The principal topics are the ethics of lying in medical practice, the genital treatment of hysteria, and the prevention of syphilis. To provide the societal context for these issues, the influence of Jewish physicians on the predominantly Catholic medical philosophy is portrayed particularly well. The Hippocratic oath is cited, but its role is not a major focus.

Important consequences flow from the Catholic belief in the soul-body dichotomy. It is acceptable to lie to the patient to make him more optimistic, as long as one does not believe that influencing the imagination can heal the body. Of the numerous physicians who are cited, Rodrigo a Castro (1546–1627) receives the most attention. A Portuguese Jew, he was educated in Spain and because of persecution emigrated to Hamburg. He wrote “possibly a milestone in the history of medical ethics” (p. 50) and an “important book on women’s diseases that went through many editions” (p. 109). Jewish ethics taught that physicians should focus on the body, rather than primarily on saving the soul (this is an explanation for their popularity despite their official persecution, particularly in Catholic countries). Furthermore, the withholding of treatment is not justified by a poor prognosis. It is justified, however, if the circumstances may impair the physician’s objectivity: he should not treat family or friends, nor should he treat enemies, to avoid being accused of malfeasance should such a patient succumb.

“Suffocation of the mother” (hysteria) consumes the longest of the six chapters. This ailment was attributed to toxins that were formed from retained menstrual fluid and/or retained semen. There was consensus that cure required the expulsion of the toxin, and that this could be achieved only by stimulating the genitalia—but how this could be accomplished without causing sinful sexual arousal was an unresolved quandary, even though midwives usually were the delegated therapists.

Syphilis became the leading public health issue during the period under consideration and was a paradigm for the limits of ethical medical practice (this chapter is a revision of Schleiner’s article in Bull. Hist. Med., 1994, 68: 389–410). Although prophylactic measures were soon devised, opinion predominated that, whether or not they were actually effective, they should not be publicized because such knowledge would encourage sinning. Schleiner points out the similarity to this of some contemporary attitudes to AIDS, but in general he avoids drawing modern parallels.

Schleiner has brought together a great deal of interesting information pertaining to the early development of medical ethics. However, the book would have benefited from more aggressive editing. Embellishing obscure passages with comments such as “Rhodiginus’s well known chapter” (p. 131) or “An essay oft quoted” (p. 132) is not helpful, nor is Schleiner’s predilection for obscure terms mixed with colloquialisms such as “covering his flank” (p. 67) or”lightweights in medicine” (p. 94). There is a lot of unnecessary repetition, such as the identification of Sennert as a Protestant in consecutive sentences (p. 149) and of Sanchez as a “moral casuist” twice in one paragraph (p. 128). Schleiner decided not to consider Paracelsian works despite his opinion of their “requirement of high ethics and godliness in the medical practitioner” (p. 37). The illustrations are frontispieces of cited books, except for an eighteenth-century depiction of masochism that appears on the dust jacket and twice in the text.

Nevertheless, Schleiner has assembled a valuable addition to the history of medical ethics. Each chapter is completed with extensive annotations, including the Latin originals of passages that he has translated.