Dear Marion,

As I reread our most recent correspondence, I notice that
I neglected to take the opportunity to comment, expand,
pontificate about the issues you raised concerning Hippocratic
medicine in general, as well as Hippocratic epistemology
and Hippocratic ethics in particular.

By way of introduction, I would point out that my philological
experience with the Hippocrartic writings is very limited.
I have read only fragments of what has been published and
translated, and of these fragments I've latched onto what
seems of special interest and significance to me. I've 
neglected to accept responsibility for even trying to ascertain
to what extent the phrases that I extol, and the notions I
distill from them, are in fact representative of the entire
corpus. Subject to that caveat, I see no harm in trying to
untangle the threads of my ideas and subject to the disclaimer
of historical authenticity, use them to weave a new fabric.

My hypothesis is that the theories which were impugned by 
by Hippocratic physicians were Pythagorean mathematics schemes
which derived a spurious plausibility from intrinsic esthetic
and or logical qualities, schemes that were proposed to be
engrafted onto medical diagnosis and therapy in the absence
of all empirical justification. A modern analogy might cite
diagnosis or treatment by the criteria of astrology.

In my own medical practice, I've been impressed by the importance
of listening to the patient, of examining the patient and of
experiencing vicariously the details of this particular patient's
medical, social, and psychic history in the context of my clinical
experience with other patients and in the context of what I have
learned from books, periodicals and lectures. I remember with
embarrassment the "clinical conferences" in which the treatment
of patients desperately ill with glaucoma was determined by ballot,
by the votes of inexperienced physicians who had memorized and
internalized textbook wisdom, but who had never conversed with,
never examined and never perused the medical records of the human
being whose future they were then adjudicating with self-satisfied
glibness. I was poignantly aware, even at the time, that the true
purpose of these conferences was not to winnow the most effective
treatment from competing possibilities, but to establish a social
consensus which would appear to justify the selected course of 
action that was more likely than not destined ultimately to fail.

Of course the modern physician must rely on second hand information 
that comes from beyond his own experience. Often this information
will be inconsistent or contradictory, and the optimal course of
action will be obscure. I review in my own mind the diagnoses and
therapies which in the course of my sixty years of exposure to
medical lore have been promoted as essential truth, only to fall
into disfavor and to be abandoned years later. Is it rational to
assume that each new day we step across a threshold which separates
an admittedly faulty past froma perfect present and an equally 
perfect future? In some instances I remember even now my scepticism
and incredulity at stupidity of the moment. I'm also much aware of
the mistakes I myself have made, albeit in good faith and with the
best of intentions.

It is extraordinarily difficult to confront ones ignorance in more
than a perfunctory manner. Consider that the successful physician's
most important function is to create and to maintain the patients'
confidence in his competence. The pressure to pretend that one
knows what one cannot know is irresistable. It's only when I have
retired, or almost retired from practice, that I can contemplate
the range and depth of what I don't know.

In the wake of this confession, I'm sure you won't want me for
your ophthalmologist.

Jochen