OF all the Hippocratic writings the Oath, in spite of its shortness, is perhaps the most interesting to the general reader and also to the modern medical man. Whatever its origin, it is a landmark in the ethics of medicine.

Yet its exact relationship to the history of medicine is unknown, and apparently, in our present state of knowledge, unknowable. The student must, at every stage of the inquiry, confess his ignorance. What is the date of the Oath ? Is it mutilated or interpolated ? Who took the oath, all practitioners or only those belonging to a guild ? What binding force had it beyond its moral sanction ? Above all, was it ever a reality or merely a " counsel of perfection" ? To all these questions the honest inquirer can only say that for certain he knows nothing.

Such being the case it is most important to realize clearly what actually is known. In the first place, the Oath was admitted to be genuinely Hippocratic by Erotian.

As to internal evidence, the Oath, besides binding all who take it to certain moral rules of practice, makes them also promise to act in a certain manner towards co-practitioners.

The taker of the oath--

(1) Will treat the children of his teacher as though they were his brothers ;

[p. 292] (2) Will " share his livelihood" with his teacher, and, in case of necessity, relieve his financial distress ;

(3) Will teach his teacher's children " without fee or indenture" ;

(4) Will give full instruction to his own children, to those of his teacher, to students who have taken the oath and signed the indenture, and to no others.

We cannot be sure what this indenture (ς1υγγραφή) was. The word occurs again in the very first sentence, " I will carry out this oath and this indenture." One might suppose from these two occurrences of ς1υγγραφή that they both refer to the same document, and that the document is what we call the Oath. If this view be taken, our present document must be a composite piece, consisting of both oath and indenture, and that it is the second component that the students paying no fee are excused from signing, for nobody would suppose that these had not to take the oath to uphold a high moral standard.

It must be confessed that to separate ς1υγγραφή from ὅρκος2 would not be difficult, as the former would include merely those articles which concerned master and pupil, i. e. the latter's promise of financial aid to his teacher and of instruction to his teacher's children.

The difficulty in this view is that the vague promises Βίου κοινώς1ες1θαι, καὶ Χρεῶν Χρηΐζοντι μετάδος1ιν ποιής1ες1θαι, do not read like a legal ς1υγγραφή, such as is implied in the words ἄνευ μις1θοῦ καὶ ς1υγγραφῆς2. They are not definite enough, and there is no mention of a specific μις1θός2. Indeed, such clauses

[p. 293] could never be enforced ; if they could have been, and if a physician had one or two rich pupils, his financial position would have been enviable. A share in the livelihood of rich men, relief when in need of money, free education for children--these advantages would make it superfluous, not to say unjust, to require any μις1θός2 in addition.

It may well be that the ς1υγγραφή of ἄνευ μις1θοῦ καὶ ς1υγγραφῆς2 was a private agreement between teacher and taught, quite distinct from the present document, in which case ς1υγγραφὴν τήνδε will refer either to such an agreement appended to the Oath, or more probably to the Oath itself, which might be called a ς1νγγραφή in the wider and vaguer sense of that term, though it is not precise enough for the legal indenture.

Some scholars regard the Oath as the test required by the Asclepiad Guild. The document, however, does not contain a single word which supports this contention. It binds the student to his master and his master's family, not to a guild or corporation. But if the Hippocratic oath ever was a real force in the history of medicine, it must have had the united support of the most influential physicians. Whether this union was that of something approximating to a guild we cannot say.

The Oath contains a sentence which has long proved a stumbling-block. It is :--οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας2, ἐκχωρής1ω δὲ ἐργάτῃς1ιν ἀνδράς1ι πρήξιος2 τῆς1δε. If these words are the genuine reading, they can only mean that the taker of the oath promises not to operate even for stone, but to leave operations for such as are craftsmen therein. It has seemed an insuperable difficulty that nowhere in the Hippocratic

[p. 294] collection is it implied that the physician must not operate, nor is any mention made of ἐργάται ἄνδρες2 who made a profession of operating. On the contrary, as Littré points out in his introduction to the Oath, the Hippocratic writers appear to perform operations without fear or scruple. Gomperz, in a note to the first volume of Greek Thinkers, suggests that the words hide a reference to castration. A glance at Littré's introduction shows that the suggestion is by no means new, and a belief in its truth underlies Reinhold's unhappy emendation to οὐδὲ μὴ ἐν ἡλικίῃ ἐόντας2. A reference to castration would clear away the difficulty that a promise not to operate is out of place between two promises to abstain from moral offences, for castration was always an abomination to a Greek. But to leave the abominable thing to the ἐργάται is condoning a felony or worse, and, moreover, the qualification is quite uncalled for. The whole tone of the Oath would require " I will not castrate" without qualification.

One might be tempted to say that the promise not to operate was intended to hold only during the noviciate of the learner were there anything in the text to support this view. But although the oath would have been stultified if it had not been taken at the beginning of the medical course,1 there is nothing in the text implying that any of its clauses were only temporarily binding. So the historian is

[p. 295] forced back upon the view that the clause, even if not strictly speaking an interpolation, applied only to a section of the medical world, or only to a particular period, when it was considered degrading to a master physician to operate with his own hands, and the correct course was to leave the use of the knife to inferior assistants acting under instruction.

Knowing as little as we do, it is perhaps permissible to use the constructive imagination to frame an hypothesis which in broad outline at least is not inconsistent with the data before us.

From the Protagoras we learn that Hippocrates himself was ready to train physicians for a fee, and there is no reason to suppose that the practice was unusual. Some sort of bond between teacher and taught would naturally be drawn up, and a set form of words would evolve itself embodying those clauses which had as their object the maintenance of medical probity and honour. These might well contain promises to the teacher couched in extravagant language if taken literally, but which were intended to be interpreted in the spirit rather than in the letter.2 Such may have been the nucleus of the Hippocratic Oath, and a copy would not unnaturally be found in the library of the medical school at Cos. But there is nothing in the evidence to lead us to suppose that a stereotyped form was universal, or that clauses were not added or taken away at various places and at various times. One writer in the Corpus, the author of the work Nature of the Child, unblushingly violates the spirit, if not the letter, of the Oath by attempting to produce abortion in a

[p. 296] singular and disgusting manner.3 So some physicians did not feel bound by all the clauses, and some may not have felt bound by any. We may suppose, however, that no respectable physician would act contrary to most of the Oath, even if he were ignorant of its existence. The clause forbidding operative surgery may be an addition of late but uncertain date.4

But the interest of the Oath does not lie in its baffling problems. These may never be solved, but the little document is nevertheless a priceless possession. Here we have committed to writing those noble rules, loyal obedience to which has raised the calling of a physician to be the highest of all the professions. The writer, like other Hippocratics, uses to describe the profession a word which, in Greek philosophy, and especially in Plato, has a rather derogatory meaning. Medicine is " my art" (τέχνη) in the Oath ; elsewhere, with glorious arrogance, it is " the art." " The art is long ; life is short," says the first Aphorism. Many years later, the writer of Precepts declared that " where the love of man is, there is the love of the art." That medicine is an art (the thesis of The Art), a difficult art, and one inseparable from the highest morality and the love of humanity, is the great lesson to us of the Hippocratic writings. The true physician is vir bonus sanandi peritus.

The chief MSS. containing the Oath are V and M.

[p. 297] The chief editions are--

Serment d'Hippocrate précédé d'une notice sur les serments en médecine. J. R. Duval. Paris, 1818.

Hippocrate : Le Serment, etc. Ch. V. Daremberg. Paris, 1843.

See also--

Super locum Hippocratis in Iureiurando maxime vexatum meditationes. Fr. Boerner, Lips. 1751.

1 Of course an ancient physician did not graduate in the modern sense of the term. The distinction between a qualified practitioner and one unqualified was not a well-defined line. A man was an ἰητρός2 as soon as he had learnt enough to be of any use at all.

2 Compare modern interpretations of marriage vows.

3 13, Littré, vii. 490.

4 It is possible that the degradation of surgery did not take place until Christian times (see Galen x. 454, 455), and the sentence of the Oath may well be very late indeed. The μὴν in οὐὅὲ μὴν λιθιῶντας2 will strike scholars as strange.

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