Hippocratic oath

Developments in ancient medicine

Hippocrates, the so-called ‘Father of Medicine', was born on the island of Kos around 460 BCE and lived until around 370 BCE. Little is known about his life for certain, but he seems to have led the way in the attempt to get the study of medicine on to something like a scientific footing.

Till then, medicine in most cultures had been practised by priests, following ritual traditions handed down over generations. Their treatments did sometimes work, but since no systematic study had been made they were inevitably rather hit-and-miss in their effectiveness.

Modern relevance

To this day, when doctors qualify they take what is known as the ‘Hippocratic Oath' – their version of a vow first made by Greek practitioners almost 2,500 years ago. It takes its name from Hippocrates, though we have no way of knowing for sure whether he was actually its originator.

In the centuries since the oath was first taken, the practices of medicine have changed beyond recognition, but many of the moral challenges facing doctors remain the same. The Hippocratic Oath is the first known formulation of the moral duty of the medical practitioner: an early framework for the study of what we would now call medical ethics.

A solemn promise: ‘Never do harm ...'

The oath was sworn to the classical gods of medicine, including Asclepius and Apollo the Physician, and it began with an undertaking to respect the sacred bond between the medical student and his teacher. ‘I swear ...', the student said:

At the heart of the oath was the promise that, even if the doctor could not help his patient, he would be sure to do no harm:

The doctor taking the oath also swore that he would:

In other words he would never use his skills to make himself an accessory to murder:

• ‘Whoever should ask me to' was presumably a reference to people of great power and authority – a wealthy client or king, for example
• It has taken on a new relevance today when the person asking may be the doctor's patient, hoping for release from some painful and irreversible condition
• Some doctors see this part of the oath as prohibiting euthanasia.

Professional conduct

One of the most strikingly ‘modern' aspects of the oath was its recognition that the doctor's responsibility extended beyond the immediate area of medical treatment, that the doctor's powers as healer gave him a strong psychological hold over his patients which might easily be abused. Hence the promise that:

Ambiguities

Most doctors find it inspiring to think that they belong to such a long and honourable tradition, swearing the same oath their predecessors have taken for centuries. But, clear as it is in many of its clauses, the oath is ambiguous in others – and sometimes it is most ambiguous when it seems most clear.

One example is the undertaking ‘never to give a woman any drug which will assist abortion':

• The obvious interpretation of this clause is that it prohibited abortion outright
• However this does not sit well with the evidence from other classical sources which suggests that there was no moral stigma attached to abortion at the time
• It seems more likely, in fact, that the doctor was here promising not to trespass on to the professional territory of the female midwives who customarily dealt with these matters.

In the same way, in a later clause, doctors undertake ‘not to cut into a patient to remove a stone, even where it is clear that this is necessary, but to leave this operation to a specialist surgeon'.

The four elements of creation the body

Modern chemistry recognizes 117 different elements, the basic ingredients out of which everything must be made. The Greeks understood things differently, but they too assumed that the world and everything in it was composed of certain elements: different combinations, in different proportions, made different things. They had just four elements: earth, air, fire and water. One way or another, anything you might think of was made of these.

The four elements of the body

The elements making up the physical environment were represented in a living body by what were called the ‘humours': black bile, yellow bile, phlegm and blood. These were the bodily versions of the physical elements: black bile was based on earth; yellow bile was a sort of fire in the body; phlegm was largely water and blood was associated with the air.

How these elements were proportioned in the individual body could affect his or her temperament. Too much of one element or another was a bad thing:

• A ‘bilious' person, with too much earth in his or her make-up, was likely to be melancholic – down in the dumps
• Someone with an excess of yellow bile would have a fiery temper and be described as ‘choleric'
• A ‘phlegmatic' person would be passive and easy-going – perhaps too much so
• A ‘sanguine' person was liable to be cheerful. Again, this is a positive quality in itself, but whilst today the word has connotations of being calm and reasonable, for the Greeks it was possible to be unhealthily sanguine – ‘away with the fairies' maybe, or ‘hyper': they were firm believers in the Golden Mean.

Good health depended on these elements being maintained in a sensible balance. The main focus of classical medicine (and, indeed, the discipline as it was practised into early-modern times) was upon achieving this, by the use of drugs, diets, exercise and other treatments.

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