The Hippocratic "oath"
(Some further reasonable hypotheses)
Research 2014; 1:733 (25
Although 65 treatises - either preserved or lost, but quoted by ancient
authors like Bacchius (3rd century B.C.), Erotian (1st century A.D.) and
Galen (c. 129-199 A.D.) - are ascribed to Hippocrates (c. 469-c. 399 B.C.)
and consist of nearly 83 books, nonetheless there is no doubt that none of
them was written by Hippocrates himself. This being the fact, we cannot help
agreeing with Ulrich von Wilamowitz Möllendorf (1848-1931), who maintained
that Hippocrates is a name without writings!
Indeed the most of the treatises of the "Corpus hippocraticum" are not
the collection of Hippocrates' works, but were likely the "library" of the
Medical School of Kos. The fact that it contains some treatises that
represent the theories of the Medical school of Cnidos (most probably
founded by a certain Euryphon, almost contemporary with Hippocrates), with
which it seems that Hippocrates entered into a relentless debate, is an
Moreover, we must confess that, although Celsus (1st century B.C.-1st
century A.D.) (De medicina, I, Prooemium) writes that "Hippocrates of
Kos…separated this branch of learning (i.e. Medicine) from the study of
philosophy", we have nothing to learn from the hippocratic treatises under
the scientific point of view.
However, whatever its origin, the "Oath" is a real landmark in the ethics
of medicine and we can say - with Thuchydides (460/455-400 B.C.) (Histories,
I, 22, 4) - that it is "an achievement for eternity".
Suffice it to remember that every graduand in Medicine is generally still
bound to take an oath that is a more or less modified and more or less
updated text of the "Hippocratic oath" and that even the modern concept of
bioethics has its very roots in the Hippocratic medical ethics.
"The art is long; life is short; opportunity fleeting; experiment
treacherous; judgment difficult: The physician must be ready, not only to do
his duty himself, but also to secure the co-operation of the patient, of the
attendants and of externals, " says the first "Aphorism" and the latest
author of "Precepts" (chapter VI) writes: "where there is love of man, there
is also love of the art", and the "art" par excellence is medicine! These
precepts go surely back to Hippocrates's moral teaching.
Nonetheless, the preserved text of the marvellous "Oath" raises many
1) which is the date of it"?
2) Is it mutilated or
3) Who took the oath, i.e. all the practitioners or only those
belonging to a guild?
4) What binding force had it beyond its moral
5) Last but not least: was it a reality or merely a "counsel of
In this article we have gathered and discussed all the available and most
important sources, but do not presume to have solved all these problems and
confine ourselves to proposing some reasonable hypotheses and letting the
readers evaluate the positive and negative points of our proposals.
Although we must agree with W.H.S. Jones that about the so-called
"Hippocratic Oath", as well as about nearly all the treatises of the "Corpus
Hippocraticum" the honest inquirer can only say that for certain he knows
 nonetheless we can at least propose some reasonable hypotheses.
There cannot be any doubt that:
1) Hippocrates (469-399 B.C) was an "Asclepiad", i.e. a member of
something like a medical "guild";
2) he trained physicians for a fee, as the following passage of the
platonic dialogue "Protagoras" (311 b-c) proves:
Socrates: Should you want to go to your namesake Hippocrates of Kos, the
member of the guild of the Asclepiads, and to give him money as a fee
and should anyone ask you: "Tell me, Hippocrates, who is the Hippocrates
to whom you are on the point of giving a fee?", what would you answer?
Hippocrates: I would say that he is a physician.
Socrates: In order
to become what?
Hippocrates: A physician!
3) He did not begin teaching any disciple unless he swore an "Oath", as
the following passage of Aristophanes' (c.450-c.385 B.C.) comedy "Thesmophoriazoúsai" (vv. 269-274) proves:
Euripides: Go then!
Mnesìochos: No, by Apollo!, unless you swear!
Euripides: What must I swear?
Mnesìlochos: To save me with all means,
if I would suffer from any damage!
Euripides: Well then! I swear by
the ether, the house of Zeus!
Mnesìlochos: Is it not better to swear
the oath of the guild of Hippocrates?
Euripides: So I swear by all
the supreme Gods!
As Aristophanes' comedy was written and staged in 411 B.C., that is when
Hippocrates was about 58 years old, and therefore at the height of his
activity as both a physician and a master of medicine in Kos, the Greek
comedian could not avoid knowing very well both his behaviour towards his
disciples, the rules of his School and his teaching programme.
As for Plato's (c.429-347 B.C.) statement, one can say the same, because
"Protagoras" is one of his earliest dialogues and therefore it was written
at most few decades after Hippocrates' death, when his Medical School was at
the top of its booming. In this connection it is worth remembering that the
foundation of the great "Asclepieum" of Kos at the middle of the 4th century
B.C. was due largely to disciples of Hippocrates. These being the facts, we
are presented with two problems: is the text of the "Oath" preserved in the
"Corpus hippocraticum" just the original text of the "Oath" requested by
Hippocrates to accept any new disciple in his school?
If not, when and why was it reviewed, corrected and possibly
The extant text reads as followsn3:
I swear by Apollo Physician, by Asclepius, by Health,
2] by Panacea,
and by all the gods and goddesses, making
3] them witnesses that I will
carry out, according to my ability
4] and judgement, this oath and this
indenture. To consider my
5] teacher in this art as equal to my parents;
to make him partner in my
6] livelihood, and when he needs money to
share mine with
7] him; to consider his offspring equal to my brothers;
8] them his art, if they require to learn it, without any fee
9] covenant; and to impart precepts, oral instruction, and all
10] the other learning to my sons, to the sons of my teacher, and
disciples, who have signed the indenture and sworn obedience
12] to the
physicians' Law, but to none other. I will use treatment
13] to help the
sick according to my competence and my judgement,
but I will keep away all treatment which is
intended to cause
15] injury or wrong.
not give poison to anyone even if asked
16] to do so. Neither will I
give a pessary to a woman to cause
But I will guard my life
and my art in purity and in holiness.
I will not use the knife even
on sufferers from stone,
but I will give
19] place to such as are
craftsmen therein. Into whatever house I enter,
I will enter to help
the sick, keeping myself free from all intentional
21] wrong-doing and
harm, and most of all from sexual intercourse
22] with women or men, free
or slave. Whatsoever I see or hear in the
23] course of practice, or even
outside my practice in social intercourse,
24] that ought never to be
published abroad, I will not divulge, but consider
25] such things to be
holy secrets. Now if I keep this oath and break it not,
26] may I enjoy
honour in my life and art, among all men and for all time;
27] but if I
transgress and forswear myself, may the opposite befall me.
It begins (lines 1-5) with the words "I swear by Apollo Physician, by
Asclepius, by Hygeia and Panaceia and all the gods and goddesses, making
them my witnesses, that I will fulfil, according with my ability and
judgement, this oath and this indenture (as Jones translates the Greek word
"syggraphé"), or "this covenant" (as Edelstein translates the same Greek
The content of the "indenture / covenant" (lines 5-12) follows this
to consider my teacher in this art as equal to my parents and to make him
partner in my livelihood, and when he needs money, to share mine with him;
to consider his offspring as equal to my brothers; to teach them this art -
should they desire to learn it - without any fee and any covenant; and to
impart precepts, oral instruction, and all the other learning to my sons, to
the sons of my teacher and to disciples, who have signed the indenture and
have sworn obedience to the physician's Law, but to none other.
This means that a person, who wanted to benefit from the teaching of
Medicine at the school of Kos must first of all "sign" a contract; second
take an "Oath" (or most probably vice versa, as we shall see later which was
just the guild), becoming a member of a restricted group characterized by an
 of the
"Asclepiadae". As for the "syggraphé"(which literally means "a written contract signed by both the parties", i.e. the future disciple
and the master) it was something like our school enrolment and, at the same
time, something like our school regulation.
On the basis of the order of the words "this oath and this indenture (or
"covenant") one would expect 1) the text of the "Oath"; 2) the text of the "indenture / covenant".
A) there is a clear contradiction between "this oath (a) and this
indenture (b)" and the following "who have signed the covenant (b) and have
taken the oath (a)";
B) moreover why the "signature" of an "indenture /
covenant" would follow the initial "I swear by Apollo Physician, etc"? In
fact the real oath does not precede the terms of the "indenture / covenant"
but follows them, as the lines 5-15 concern the "indenture / covenant",
whilst the real commitments (prohibitions and commands) only begin at line
16 and consist of:
- a) a first positive pledge (lines 12-13): "I will use treatment to
help the sick according to my competence and my judgement";
- b) a first prohibition (lines 14-15): "I will keep away all
treatment which is intended to cause injury or wrong";
- c) a second prohibition (line 15): "I will not give poison to
- d) a third prohibition (lines 15-16): " [I will not give poison]
even if asked to do so";
- e) a fourth prohibition (lines 16-17): "I will not give a pessary to
a woman to cause abortion";
- f) a second positive pledge (line 17): "I will guard my life and my
art in purity and in holiness";
- g) a fifth prohibition (line18 ) : "I will not use the knife, eve,
on sufferers from stone";
- h) a first particular command (lines 18-19): "I will give place to
such as are craftsmen therein";
- i) a second particular command (line 20): "I will enter to help the
- j) a third particular command (lines 20-22): "I will keep myself
free from all intentional wrong-doing and harm, and most of all from
sexual intercourse with women or men, free or slave";
- k) a fourth particular command (lines 22-25): "I will not divulge" "whatsoever I see or hear in the course of practice , or even outside my
practice in social intercourse...consider such things to be holy
- l) a final vow (lines 25-27): "If I keep this oath and break it not
it, may I enjoy honour in my life an art among all men and for all time;
but if I transgress it and forswear myself may the opposite befall me
As everybody sees, four prohibitions follow the first positive pledge and
four particular commands follow the second one.
This being the fact, the fifth prohibition concerning the "use of the
knife" on the one hand is absolutely out of place and does not correspond to
a fifth particular command; on the other hand one would expect it not after
the second pledge but before it, as well as one would obviously expect a
fifth particular command corresponding to this fifth prohibition. But we
shall deal with it later.
At any rate Aristophanes' words "I swear by all the supreme Gods" seem
something like a summary (or an abbreviated paraphrase) of the first lines
of our text, and mainly seem repeating the entry "I swear...by all the Gods
and Goddesses making them witnesses".
Therefore the legitimate suspicion arises that
A) these first lines ("I
swear by Apollo...that will carry out, according to my ability and judgement
this oath") represent the "introduction" to the real "Oath";
B) "and this
indenture" is a later interpolation inserted into it when the "indenture"
itself was joined with it;
C) the original text of the "Oath" was most
probably: "I swear by Apollo...and by all the Gods and Goddesses...that I
will use treatment to help the sick,... holding such things to be holy
secrets", followed (as in many of our prayers) by the final vow: "if I carry
out this oath, and break it not, may I gain forever reputation among all men
for my life and for my art; if I transgress it and forswear myself, may the
opposite befall me", which seems approximately corresponding to our "Amen /
So be it".
We cannot be sure whether was the "indenture / covenant" signed before or
after taking the "Oath", but can reasonably suppose that
- one thing was the "indenture / covenant", and quite another thing
was the "Oath"
- most probably the novice was asked to take the "Oath" before signing
the "written contract" and therefore before becoming a fully entitled
member of the guild of the "Asclepiads".
At this point we can confidently answer to the first question:
extant text of the so-called "Hippocratic oath" isn't at all the original
2) It is the result first of all of the insertion of the text of the "indenture - covenant" into the original
33) there cannot be any
reasonable doubt that the prohibition of "using the knife" is a very late
interpolation, as maintained by Jones and by us in two former articles
, all the more so because the command :
"I will give place to such as
are craftsmen therein" is clearly alluding to specialized "lithotomists",
whom none of the hippocratic treatises deal with and Celsus' passages in De
Medicina, VII (26, 3, B in particular) do not speak about "specialized
lithotomists" prior to Ammonius (or Hammonius), who lived and was active in
the III century B.C., that is to say during the great Hellenistic period.
Moreover the "Prooemium" of book VII proves that Celsus himself thought that
"surgery" - which he calls "the third part of the Art of Medicine" - was a
very recent "specialization" that started just in the Hellenistic period. In
fact after having quoted Hippocrates as if it were a sort of "historical
duty", he writes:
Later it was separated from the rest of medicine, and began to have its
own professors; in Egypt it grew especially by the influence of
Philoxenus (flourished in Alexandria in the 1st century B.C.), who wrote
a careful and comprehensive work on it in several volumes, Gorgias
(flourished in Alexandria in the 3rd century B.C.) and Sostratus
(flourished in Alexandria in the 1st century B.C.)and Heron (flourished
in Alexandria in the 3rd century B.C.) and the two Apollonii (flourished
in Alexandria in the 3rd - 2nd century B.C.) and many other celebrated
men, each found out something.
It is clear that Celsus is implying that the real "History of Surgery"
started only with the Alexandrian school of medicine, which flourished just
from the 3rd century B.C.! All the more so because he confines himself to
quoting some of the "surgical" treatises of the Corpus hippocraticum (Head
wounds, Surgery, Fractures, Joints, Mochlikon) - that is to say treatises
dealing with fractures and orthopaedic surgery - in the 8th book just at the
beginning of which Celsus states that
The remaining part of my work relates to the bones; and to make this
more easily understood, I will begin by pointing out their position and
shapes and tells nothing at all about urological surgery!
A reasonable answer to the second question (when and why was it reviewed,
corrected and possibly mended?) needs at least three important premises.
First of all neither Plato, nor Aristotle (384-322 B.C.) asked the
disciples of the Academy and the Lyceum (that can be considered the
ancestors of our Universities) either to sign any "indenture - covenant" or
to take any "Oath", let alone to pay any fee. Neither any disciple of the
Alexandrian Museum (the first real University in the modern sense of the
word  ) was ever asked the signature of an indenture or the taking of any
"Oath", or the payment of any fee. Galen (c.129-199 A.D.) states that he
studied anatomy at the famous Medical School of Alexandria and urges the
novices to go to Alexandria to study anatomyn8, but never speaks
of either an "indenture" to be signed, or an Oath to be taken, let alone of
any fee to be paid. In fact the about 100 research scholars and teachers
housed in the Museum were supported by generous salaries granted first by
the Ptolemies, then by the Roman emperors and therefore they could easily,
or better they must teach for free.
Second: it seems likely that none of the books of the so-called "Corpus
hippocraticum" is to be ascribed to Hippocrates himself. It is rather
probable that the writings came to Alexandria as the remnants of medical
literature which had circulated in the fifth and fourth centuries as
anonymous works, like technical literature commonly was in that era./p>
Third: although Erotian (a grammarian and physician, who flourished in
the age of the emperor Nero (54-68 A.D.) in his "Hipporatic glossary"
admitted the "Oath" to be genuinely Hippocratic, neither Celsus (1st century
B.C.-1st century A.D.) nor Galen ever quote or refer to it, although
Aristophanes' passage quoted above makes sure that an "Oath" had to be taken
by those, who wanted to join the Medical School of Kos. After having taken
the "Oath" the disciple had to sign the "indenture-covenant".
Well then: as the Alexandrian scholars knew that no "indenture-covenant"
was requested to any disciple at their times (and - as said above - since
Plato and Aristotle), it is likely that they considered the text as a
fragment of the "Oath" and therefore inserted it just at the beginning, as
well as they added books II, IV, V, and VI of the treatise "Epidemics" to
the original books I and III, not to say a lot of more or less ample works
that are surely spurious
. But we think that it is worth observing that although more or less
abbreviated Latin translations of the "Oath" can be found in a lot of
mediaeval manuscripts , in all of them both the text of the
"indenture-covenant" and the
prohibition of "using the knife" are missing, few Latin manuscripts and a
printed edition of their text excluded, as we shall state later.
WWe agree with H.E.Sigerist and W.H.S. Jones
n10 that the first
gap may be due to the fact that the aristocratic exclusiveness its text
represented was in sharp contrast with the Christian idea of universal
As for the second we must confess that it is rather astonishing: why the
prohibition of "using the knife" could ever be eliminated in a period when
the final divorce of "Medicine" from "Surgery" had taken place at least
since the 5th, not to say - on the basis of one of Galen's statements -
since the 2nd century A.D.? In fact Galen maintains in "De medendi methodo"
(On therapeutic method), VI, 2, K, X, 454-455 that:
mmust know the doctrines that teach us which is the
human nature, which are its particular qualities, which is unhealthy
state of the humours, and which is plethora; moreover he must be able to
distinguish acute and dull senses; and which may be the suitable
medicaments according to the nature of each patient; when he must have
recourse immediately to coagulants in case of fresh wounds and when to
other kinds of medicaments. Thessalus of Tralles († 79 A.D.)
neglected all this previous knowledge and revealed his puerility and his
ignorance by relying on what even the populace knows. Indeed knowing
what must be done is not important; it is important knowing how it must
be done! However it seems that Thessalus ignores everything and while he
thought that every bloody wound was to be treated by the same method, he
smeared a pierced nerve with the drug he had often had a successful
recourse to in cases of very severe wounds. By contrast he caused the
formation of a phlegmon and undertook its treatment by a poultice made
of wheat flour. The result was that the wound became gangrenous and he
murdered this as well as many other patients in the space of six days.
We think that it is possible that the mediaeval authors had at their
disposal a text of the "Oath" where this prohibition was still missing.
However the legitimate suspicion arises that it was still present at least
in one of the Greek manuscripts, whose text was the same we read today,
because the prohibition of "using the knife" and the command of "giving
place to such as are craftsmen therein" is still present in 5 Latin
manuscripts n7 containing a Latin translation of the Oath made by
Niccolò Perotto (1429-1480)n11 and printed in Basel in 1538, as
well as in the Arab translation by Ibn abī Uşaybi 'ah (1203/1204-1269/1270),
whilst it is already missing in the Greek cross-shaped text of the Vaticanus
Urbinates 64 (fol. 116) (Fig. 1), of the Ambrosianus B 113 sup. (fol. 203)
and of the Bononiensis 3632.
In this connection it is worth observing that all the authors of surgical
treatises, from Lanfrancus of Milan († c.1315) to Fabricius Hildanus
(1560-1634) recommend the surgeon to have recourse to the advice of a
"physician" in cases of exceptionally dangerous and risky surgeries.
On the contrary the insertion of the text of the "indenture - covenant"
goes most probably back at least to a period between the second half of the
3rd and the 2nd century B.C., i.e. when the "Corpus Hippocraticum" formed
and it too was eliminated in Christian times, i.e. between the 4th and the
5th century A.D. for the above mentioned motives.
We are well aware that these are nothing but hypotheses. Nonetheless we
believe that they may be considered as supported enough by both internal and
external evidences, although we cannot avoid agreeing with Jones that "the
interest of the "Oath" does not lie in its baffling problems" and that
although "these may never be solved... 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".
1. - History Office, European Association of Urology. I dedicate also this
article to the memory of my adored son Giulio, who was killed y a criminal
river, who did not observe a STOP sign, on 14/05/2012.
2. - MD University of Milan - Casualty Ward and Emergency Medicine -
St.Anna Hospital, Como, Italy
3. - We quote the lines of the Greek text of Jones' edition. Cf. reference
4. - We feel bound to express our gratitude to Prof. Dr. Rainer Engel, who
has let us have Jones' and Edelstein's fundamental contributions at our
5. - Cf. H. E. Sigerist, A History of Medicine, New York, Oxford Unversity
Press, 1961, II, p. 304.
6. - Cf. W.H.S. Jones, Hippocrates, etc (cf. reference n. 1); I, 296; S.
Musitelli, Comment on the article "Operative Urology and the Hippocratic
Oath", in De Historia Urologiae Europaeae Drukkerij Gelderland, Arnhem, IX
(2002), p. 163 ff.; S. Musitelli & J.F. Felderhof, Castration from
Mesopotamia to the XVI century, in De Historia Urologiae Europaeae ,
Drukkerij Gelderland, Arnhem, X (2003), p. 112 ff.
7. - Laurentianus 73,40 ; Leydensis B.P.L. 156; Bernensis 131;
Vindobonensis 4772 and Basileensis E III 15.
8. - Cf. Anatomicae admnistratuiones (Anatomical procedures), I, 2, K. II,
9. - He was the founder of the School of the so-called "Methodists"
10. - Cf. H. E. Sigerist, A History of Medicine, etc. II, 304; W.H.S.
Jones, The Doctor's Oath, etc. Cambridge, 1924, p. 23.
11. - The text has been, so to say, "Christianized": in the Latin
translations the pagan Gods have disappeared and the first lines read as
follows: "From the Oath according to Hippocrates in so far as a Christian my
swear it. Blessed God the Father of our Lord Jesus Christ, who is blessed
for ever and ever. I lie not". Cf. Hippocrtes, etc, I, 296.
"Hippocrates with an English translation by W.H. Jones, William
Heinemann ltd, London - Harvard University Press, Cambridge
Massachusetts, 1957, I, 291.
W. H. S. Jones, The Doctor's Oath - An essay in the History of
Medicine, Cambridge, at the University Press, 1924.
L. Edelstein, The Hippocratic Oath, Baltimore, The John Opkins
H.E. Sigerist, A History of Medicine, New York, Oxford
University Press, 1961, II, p.304.
S. Musitelli, The first Universities, in Europe - the cradle of
Urology, History Office of the European Association of Urology,
S. Musitelli: Comment to the article "Operative Urology and the
Hippocratic Oath" in De Historia Urologiae Europaeae, Drukkerij
Gelderland, Arnhem, IX (2002), 163 ff.
S. Musitelli & J.F. Felderhof: Castration from Mesopotamia to
the XVI century, in De Historia Urologiae Europaeae, Drukkerij
Gelderland, Arnhem, X (2003), 112 ff.
L. Edelstein, in The Oxford Classical Dictionary, Oxford, at the
Clarendon Press, 1953, entry Hippocrates.
Cf. S. Musitelli, Hippocratic Oath during the Middle Ages, in
IHFK Bulletin, Vol.3, 1994, p. 3 ff.