七、医德及结语

罗马时代医生的水平可以从当时的史料中得知，但是不同作者之间的说法却各不相同。在关于医生的故事中，评论家的评价、他们之间的关系以及当时的传统都有影响。例如，赛尼加（Seneca）认为医生是聪明的伙伴，品德高尚，能力出众。84

然而反面意见也很可观。例如，老普利尼认为：“医生在我们的危机中实践他们的知识，在生病的皮肤上做实验，医生是唯一不必受刑的屠杀者。实际上，他们还会因病人没有尊重这种待遇而指责他们。” 85盖伦则说很多医生只是谈论医学，但从未展现他们的技巧。86

实际上，古代史料提到医生正在走向腐败，追逐利益，不再为了提高技巧而努力学习，忘记了希波克拉底的誓言。皇帝也想方设法与医生的名利之欲斗争，阻止功名利禄控制更多的医生，让他们放弃自己的技艺。当时的铭文也提到良医不从穷人身上获利（a medicus ingeniosus, pru[dens pau]peribus non cupidus）87以及医术最高（artis medicine doctiss[imus]）。88医生的墓志铭中屡屡提到这些品德，暗示着这一行中实际上有很多利欲熏心行为失当的人。

盖伦指出医生的道德堕落现象遍布整个社会。医学行业堕落的影响之一是向宗教医学的回归，而科学的医学则大受损害，这一现象在社会上层阶级也同样发生。89

不过，因为认识到了这一行业的必要性，罗马皇帝增加并巩固了医生的豁免权。史料表现出皇家病人和他们的私人医生之间有固定关系，且非常紧密。与其他的僧侣相比，医生与皇帝的关系更为密切，盖伦曾拒绝参加马库斯·奥勒留（Marcus Aurelius）组织的一次征服战，而且他是唯一一位享有自由进入宫廷禁区特权者，以便提供医疗服务。90

富有的名医，不但能够享受由于其能力得到承认所带来的利益，更能获得社会的尊敬。宫廷医生和那些在上层社会享有名望的人并不多。大多数医生为各种各样的病人服务，这更多的是出于经济原因，但也可能是因为医生的原则：任何病人都应该得到同等治疗。

在希腊化罗马社会，有一个非常具有说服力的例子。一件碑铭中提到一位医生，Hyrcanis的Menophantes，铭文中指出他“平等对待每位病人”91，Lacedemonia的Damiadas则被评价为“潜心工作”，平等待人，“不分穷富，无论贵贱”。92可以想象，这些行为之所以被提出来专程表彰，是因为大多数医生无法这样做，所以做到的人值得被专门提出。Medici publici，即被社团雇用的医生，接受公共支付的薪水，有义务“治疗社团中的穷人，这种义务更超过治疗富人” 93。这一位于文末的建议，明显是出于经济考量，因为富人有能力支付去看医生的钱。

关于医生的劳酬，除了作为公共医生（medici publici）接受来自社团的薪水之外，他们也会挣私人咨询的钱。从铭文和文献资料中无法得知每次看诊诊费多少，或每月能够挣多少诊金。作为交换，有时候医生会免费看诊，有时候因为病人无力支付诊金，有时候因为医生想要提高社会名望或者吸引重要的客户。在第一种情况下，希波克拉底书中的一个章节中认为医生不应要求高额诊费，因为要考虑病人的经济条件。94

根据医生的成功程度，医患关系的质量也非常重要。医生因诊治失败而受到责难的情况不是太多，但也并非没有。如果病人在治病的过程中花费了大量钱财，这种矛盾就更为尖锐。一位男孩的碑铭中提到他死于一次外科手术，这很能说明问题。95我们还有一系列诅咒碑铭（defixione），表现出某些病人对医生没有给予他们合适治疗的怨愤，不过这也可能因为报复的心态而非仅仅出于专业态度。96

另一方面，也有很多例子中，被治愈的病人使用无数溢美之词赞颂他们的医生，同时赞颂保佑他们的上帝，以表示感谢。97

值得一提的是，这种赞美和感激较少给予某个医生，而更多的是致以医疗之神，如：阿斯克勒庇俄斯、海吉亚、阿波罗、帖利斯弗洛斯等。文献中多处记载“被神的善念”治好的善男信女们在埃皮达鲁斯（Epidaurus）98、科斯和特利卡（Trikka）99的阿斯克勒庇俄斯神庙立起石碑。

同行之间为了争夺病人，或者不如说是争夺地位，两名医生之间发生斗争这种事颇为常见。不管在真实事件还是在文学虚构中，病人常常被操控。在罗马有一个很有名的驱逐事件。被驱逐的是一名医生昆图斯（Quintus），他的同行因为嫉妒而以一种不公平的方式控告他毒杀病人。100

最后我们要问自己，医患关系是否随着医学本身的发展，随着技术的进步和医学领域不断出现的新发现而不断变化，还是从来就未改变过？

关于医学技术的进步，在数个世纪中，随着不断研究，知识的更新令人震惊。另一方面，对于医生的信任或不信任，接受医生所采用的方法或以例如神佑的名义损害治疗拒绝医生，批评或过誉某名医生，传颂成功和讳言失败，这些在任何时代都一样，基本没有什么改变。

人之间的关系超越了历史成为共性，永久地保留下去。医疗的目的是健康，而医生就是那个想方设法达到这一目的的人，正如Galenus，这位古代最重要的医生所说的。这一点贯穿所有历史时代，几乎从未改变。

缩略语

铭文

AE—L’Année épigraphique, Paris.

CIG—Corpus Inscriptionum Graecarum, Berlin.

CIL—Corpus Inscriptionum Latinarum, Berlin.

IDR II—Inscripţiile Daciei romane, II, Oltenia şi Muntenia, culese, însoţite de comentarii şi indice, traduse în româneşte de G. Florescu şi C. C. Petolescu, Bucureşti, 1977.

SEG—Supplementum Epigraphicum Graecum, Leiden, Amsterdam, 1923- ... .

百科全书、字典和其他工具书

ANRW—Aufstieg und Niedergang der römischen Welt. Geschichte und Kultur Roms im Spiegel der neueren Forschung, H. Temporini, W. Haase (eds.), Berlin-New York.

期刊

Archäologisches Korrespondenzblatt—Archäologisches Korrespondenzblatt, Mainz.

BJ—Bonner Jahrbücher des Rheinischen Landesmuseums in Bonn und des Vereins von Altertumsfreunden im Rheinlande, Bonn.

Britannia—Britannia. A Journal of Roman, British and Kindred Studies, London.

Bull. N. Y. Acad. Med.—Bulletin of the New York Academy of Medicine, New York.

Classica et Christiana—Classica et Christiana, Journal of “Al. I. Cuza” University, Iaşi.

JRA—Journal of Roman Archaeology, Portsmouth (RI).

Michmanim—Michmanim. Hecht Museum Journal, University of Haifa, Haifa.

Starinar—Starinar. Organ Srpskog arheološkog društva, Belgrad.

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