Introduction
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.
