We pass from myth to the opening of history. The central historical figure in Greek medicine is Hippocrates. The events of his life are shrouded in uncertainty, yet tales of his ingenuity, patriotism, and compassion made him a legend. He provided an example of the ideal physician, after which others, centuries after, patterned their existence.
He was associated with the Asclepium of Cos, an island off the coast of Asia Minor, near Rhodes, and with a group of medical treatises known collectively as the Hippocratic Corpus. Hippocrates was the first to give the physician an independent standing, separate from the cosmological speculator, or nature philosopher. Hippocrates confined the medical man to medicine. At the same time that he assigned the physician his post, Hippocrates would not let him regard the post as sacrosanct. He set his face against any tendency toward sacerdotalism. He was also opposed to the spirit of trade-unionism in medicine. His concern was with the physician’s duties rather than his “rights.” Hence, the greatest legacy of Hippocrates: the Hippocratic Oath.
The Hippocratic Oath
The so-called Hippocratic Oath was unquestionably the exemplar for medical etiquette for centuries, and it endures in modified form to this day. Yet uncertainty still prevails concerning the date the oath was composed, the purpose for which it was intended, and the historical forces which shaped the document. The date of composition in modern debate varies from the sixth century BCE to the fourth century CE.
In antiquity, it was generally not considered a violation of medical ethics to do what the Oath forbade. An ancient doctor who took the Oath was by no means in agreement with the opinion of all his fellow physicians; on the contrary, he adhered to a dogma which was much stricter than that embraced by many, if not by most, of his colleagues.
I swear by Apollo the Physician and Asclepius and Hygeia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parent and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it—without fee and covenant; to give share of precepts and oral instruction and all other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.
I will apply dietetic measure for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give a woman an abortive remedy. In purity and in holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite be my lot.
—Translated by Ludwig Edelstein
The organization of the Hippocratic Oath is clearly bipartite. The first half specifies the duties of the pupil toward his teacher and his obligations in transmitting medical knowledge; the second half gives a short summary of medical ethics. Because the second half of the Oath is inconsistent with Hippocrates’s own principles and practices, we must assume he was not its sole contributor, if one at all.
One immediate inconsistency is the Oath’s prohibition against abortion. The Hippocratic Corpus contains a number of allusions to the methods of abortion and the use of pessaries. The Oath’s prohibitions did not echo the general feeling of the public either. Abortion was practiced in Greek times no less than in the Roman era, and it was resorted to without scruple. In a world in which it was held justifiable to expose children immediately after birth, it would hardly seem objectionable to destroy the embryo.
A second discrepancy between the Oath and general Hippocratic principles is the ban on suicide. Suicide was not censured in antiquity. Self-murder as a relief from illness was regarded as justifiable, so much so that in some states it was an institution duly legalized by the authorities. Nor did ancient religion proscribe suicide. It did not know of any eternal punishment for those who ended their own lives. Law and religion then left the physician free to do whatever his conscience allowed.
Pythagoreanism is the only dogma that can possibly account for the attitude advocated in the Hippocratic Oath. Among all the Greek philosophical schools, the Pythagoreans alone outlawed suicide and abortion and did so without qualification. The Oath also concurs with Pythagorean prohibitions against surgical procedures of all kinds and against the shedding of blood, in which the soul was thought to reside. Again, this interdiction against the knife is especially out of keeping with the several treatises in the Hippocratic Corpus that deal at length with surgical techniques and operating room procedures.
It is little wonder that this Oath, although incorrectly attributed to Hippocrates, has remained steadfastly the symbol of the physician’s pledge. The prohibition against abortion and suicide were (and remain) in consonance with the principles of the Christian Church. The earliest reference to the Oath is in the first century CE, and it may have been appropriated soon after to fit the religious ideals of the time. The substitution of God, Christ, and the saints for the names of Asclepius and his family was easy enough. It is ironic that the Hippocratic Oath, in its present form with its religious subtext, is associated with Hippocrates, the man who first separated medicine from religion and disease from supernatural explanations.