2 – THE HIPPOCRATIC OATH
Welcome back to The Doctor's Bag, our monthly look at 19th century medicine, and how aspects of it compare to the profession today. This time we'll take a look at that famous oath that binds all doctors, and has done throughout the millennia - apart from when the actions of various unscrupulous or unethical doctors have demanded that it be updated.
THE
OATH
‘I SWEAR by Apollo the
physician, and Aesculapius, and Hygieia, and Panacea, and all
the gods and goddesses, that, according to my ability and judgment, I
will keep this Oath and this stipulation …….’
A code rather than an oath
Hanging on the office wall of countless
frontier doctors, according to western movies and novels, would be a copy of
the Hippocratic oath. It may even have been in Latin, for that was the language
of medicine for centuries. In reality, most frontier doctors probably had no such adornment to their surgery wall,
on account of the fact that they were probably not medically qualified at all.
And those that were may have merely held a diploma qualification that certified
that they had attended a series of lectures at some sort of medical college.
No formal
educational qualifications were needed to enter a medical school. Indeed, even the famous Harvard Medical School in 1870 had no written examinations, because
apparently most of the students at that time could not write well enough.
But that is not to
say that these early doctors did not serve their communities well. Some were superb,
while others were at the most, better than nothing. Still others didn’t stay around too long. Yet
all of them would have had an awareness of a code of practice, the Hippocratic
code. Basically, it was to do the best for your patient through hell and high
water, and not to betray a confidence. That would have been the code that
governed their professional life.
The Hippocratic oath
Everyone associates the Hippocratic
oath with medicine. It is one of the most popular
selections of ancient literature, even though the original Oath is now rarely
read or recited. Hippocrates himself almost certainly did not write the original
oath, but the work is traditionally included in the Corpus Hippocratum,
a collection of medical writings attributed to him, written between the fifth
and fourth century, BC.
Aesculapius was the Greek god of healing,
and Hygieia and Panacea were his two daughters. Hygieia was the goddess of
cleanliness and sanitation, while Panacea was the goddess of Universal remedy.
It is said that of the two, he preferred Hygieia.
Nowadays we would agree with that, since
‘hygiene’ is probably one of the most important measures that benefits the
health of a community. And of course,
there is no such thing as a panacea – a cure-all!
Hippocrates of Kos (460-370 BC) was an
ancient Greek physician, who really brought medicine out of the religio-magical
practice of his forefathers and who laid the foundations for the practice of
clinical medicine.
Aphorisms
It is generally accepted that we must thank the Classical
Greeks for the aphorism, as we know it, that short segment of distilled wisdom
that is designed to express a general truth. They are like proverbs and adages;
essentially they are rules of thumb. Sometimes they will be discrete packets of
wisdom; at other times they are building blocks, which link up with other
aphorisms to make a greater whole.
In the Aphorisms of Hippocrates, one of
the books of the Hippocratic Corpus that is regarded by philologists as having
been genuinely written by Hippocrates himself, the aphorism is seen as an ideal
vehicle for passing on the wisdom of experience. In reading these today one can
almost imagine the father of western medicine sitting under the famed plane
tree on Kos and delivering his nuggets of wisdom to his eager pupils. Indeed, they were an ideal way of handing on the oral tradition of medicine.
The plane tree on Cos, under which Hippocrates reputedly sat and taught his pupils
The first aphorism of
Hippocrates
In this first aphorism, which is often abbreviated to ‘Life
is short, the Art is long,’ we see a remarkable piece of advice, which is
highly relevant to the practice of any form of medicine.
‘Life is short, and Art
long; the crisis fleeting; experience perilous, and decision difficult. The
physician must not only be prepared to do what is right himself, but also to
make the patient, the attendants, and externals cooperate.’
Hippocrates is telling us that it takes a
lifetime to truly learn the art or practice of medicine, and that no one can
truly master it. The crisis or opportunities for learning are quickly over, so
must be grasped. Experience is not always reliable, so it is important not to
base knowledge exclusively upon experience. And finally, judgement is always
difficult, because of the complexities of the discipline.
Know a few aphorisms
Doctors in Britain, before the time of any sort of regulation
of their practice, could impress by trotting out the odd aphorism in Latin or Greek. About ninety-five per cent of all
medical terms are based on Latin or Greek or a mixture of the two. In general,
anatomical terms and the names of micro-oragnisms (which of course were not
discovered or known about back in the days of the Civil War and the decade or
so after) were derived from Latin. The names of conditions and pathological
states, on the other hand, come from the Greek.
Most doctors
would know this Latin aphorism:
Ubi pus, ibi evacua.
Which means, ‘where there is pus, let it out.’ It is a great surgical maxim, especially in pre-antibiotic days.
And, this one:
And, this one:
Res in cardine est.
Which means, ‘the next 24hours will tell.’ Again, without modern drugs, often 24 hours could be critical.
Taking the oath
The swearing of the Hippocratic oath is something that is
done when you graduate from a university or a medical school. I remember taking
my oath, many moons ago, along with my fellow students in our class of 100. It
was a proud moment that made one conscious of the long history of oath-taking
in our profession.
For several centuries now, doctors upon
qualification have taken modified versions of the oath containing the essence
of its message. It is the code by which
doctors agree to live by and the fact that doctors take it, is essential in
allowing patients to put their trust in the individual doctor.
There are four main variations:
The Oath of Maimonides written by Moses Maimonides (1135-1204 AD), a rabbi, philosopher
and physician in the 12th century. He was the court physician to Sultan
Saladin. Apparently he had declined an invitation to become personal physician
to King Richard the Lionheart.
The Declaration of Geneva adopted by the World Medical Association at Geneva in 1948. This
arose from the Nuremberg Code formulated in 1949, after the trials in which 23
Nazi doctors were found guilty of breaching the medical code by performing
horrific operations on prisoners in concentration camps.
There were other amendments to the
Declaration in 1968, 1984, 2005 and 2006, to deal with various issues as they
have arisen, including euthanasia, torture of prisoners and so on.
The Oath of Lasagna was written in 1964 by Louis Lasanga,
the Dean of Tufts Medical School. It stresses the importance of dealing with
patients as human beings, not just as medical cases.
The Restatement of
the Hippocratic oath in 1995. Again, slight variation, which was drawn up
by 35 eminent US physicians, the ‘Value of Life Committee. This is the commonest one taken in medical schools today.
The Oath today
In 1989 a survey was done of 126 US
medical schools. It was found that three still used the original Hippocratic
oath, 33 used the Declaration of Geneva, 65 used the restatement and 4 used the
Oath of Maimonides.
Dr Logan Munro of Wolf Creek
The town doctor of Wolf Creek
graduated from Edinburgh University in Scotland in 1853 and took his
Hippocratic oath at the graduation ceremony. To him it is a solemn principle
that guides him in both his professional and his personal life. And nothing will make him break it! You will find out in the forthcoming Wolf Creek novels 4 and 6.
