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The controversial origin of the Hippocratic oath

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An excerpt from White Coat Ways: A History of Medical Traditions and Their Battle With Progress.

So, who wrote this immortal Hippocratic oath: Hippocrates or one of his Hippocratic followers? Though no one knows for certain, the answer is potentially neither. The most compelling evidence for this argument is that the ideals expressed in The Oath do not reflect those in works genuinely attributed to Hippocrates.

Ludwig Edelstein was a professor at Johns Hopkins during the early 20th century and a primary contributor to the understanding of Hippocratic works. He argued that The Oath was likely Pythagorean in nature. (If you are suddenly reminiscing about geometry class – yes, the name comes from the same Pythagoras that developed the Pythagorean Theorem.) Although there is no direct evidence that The Oath was written by Pythagoras, it was possibly written by one of his later followers. The unique ideals expressed in The Oath are compellingly consistent with the ideals of Pythagorean followers and frequently vary from the practice of Hippocratic physicians. Pythagorean ideals were strict. They believed one should only have sex to produce children, even within the union of marriage, and were opposed to abortion, suicide, and surgery, which weren’t generally opposed by Hippocratic physicians. Edelstein’s argument is compelling, but some scholars disagree that The Oath’s true authorship is Pythagorean in nature.

Even conceding this point, Edelstein’s observation that the principles in The Oath are contrary to Hippocratic methods still argues for varying authorship. Though The Oath was written around 400 BCE, there is no copy from that time. The origin date is estimated from later copies and references. The first known reference to The Oath was in the first century BCE by Scribonius Largus, referencing the section on abortion by writing, “Hippocrates, the founder of our profession, handed on to our discipline an oath by which it is sworn that no physician will either give or demonstrate to pregnant women any drug aborting a conceived child.” The Oath didn’t appear as copied text until the third century CE. So, there is essentially no direct text of The Oath from the era of Hippocrates, leaving centuries open for other beliefs to be interpolated into The Oath. William Henry Samuel Jones, an early twentieth-century British author and renowned analyst of Hippocratic works, believed just that. Jones suspected that the section of The Oath forbidding surgical interventions for stones (likely bladder stones) was interpolated into the text from the Roman era. He argues that surgical interventions for bladder stones weren’t even conceived during the era of Hippocrates, and a procedure can’t be banned if it doesn’t exist.

No one knows for certain if Edelstein’s and Jones’s arguments are correct, but these are just a sample of contentions that question the authorship of The Oath. It is tempting to attribute The Oath to Hippocrates, making it an ancient and sacred text handed down by the father of western medicine himself. But when this idealistic view is put aside, and the actual text of The Oath is analyzed, it seems unlikely that Hippocrates wrote The Oath in its entirety.

Brian Elliott is an internal medicine chief resident and author of White Coat Ways: A History of Medical Traditions and Their Battle With Progress.

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