“Doctors who cut and burn and torture their patients in every way complain that they do not receive the reward they deserve.” (K 73, Cp. R, S D 58, W 107, L&M D57)
On first reading one might think Heraclitus doesn’t have great regard for medicine. However, against the backdrop of Heraclitus’ view of the unity of opposites, the text can be seen as highlighting that the same thing that is harmful in one context is healing in another. A cut or burn, on the face of it, is bad. Yet, in the context of medicine a cut or a burn is part of a treatment. It may be necessary. This fragment makes sense in the context of Heraclitus’ more general statements that there is variation in what is good or bad, desirable or undesirable, in various contexts, especially, for example, for animals and people. Just as garbage or straw is more valuable to a donkey than gold, so some act, normally bad, like a laceration or burn, can in another context be needed and good. Our valuations must be context specific. The primae facie bad can at one and the same time be the de facto good.
Given the inexact art of medicine, especially Ancient medicine, an addendum to the quote from numerous translations also can make sense.
As rendered by Lak and Most, the entire text reads (D 57): “Doctors, Heraclitus says, cutting, cauterizing, badly mistreating their patients in every way, complain that they do not receive an adequate payment from their patients — and are producing the same effects, benefits and diseases.” The addition of “benefits and diseases” is of questionable legitimacy, so not included by many. Yet, it too makes sense given that treatments do not always work. Sometimes the cutting and cauterizing do not heal. The treated do not gain the benefits but only the harms of the treatment. Medicine is an inexact art (or science). That is true today. It was more true in Ancient Greece. Doctors of course practice their craft with good intent. But especially in the ancient context, the results were not always those hoped for. The patients were surely less than grateful.