Bodily Reverence in the Hippocratic Oath

More recently the study of ancient medicine has gained attention, not from merely antiquarian curiosity about the developmental history of the healing arts, but from its illumination on kindred concepts arising in and influenced especially by philosophy and science, yet also inclusive of the wider Mediterranean culture.  Of particular interest to me today is the Hippocratic Oath, which many believe to apply to a small group of practicing medics due to the parochial constraints it imposes on its adherents, thus necessarily limiting the scope of its practice.  However, let’s take a look at this document in full:

I swear by Apollo the healer, by Asclepius, by Health (Hygeia), and Panacea and by all the gods and goddesses, making them witnesses, to bring to completion this oath and written contract in accordance with my ability and judgment:

To revere the man who taught me this art as equally as my ancestors, and to share my living with him, and to share with him when he lacks money, and to esteem his progeny equally as my brothers, and to teach this art, if they wish to learn it, without a wage or written contract, and to share the precepts and lectures and all other instructions both with my own sons and those of the one who taught me, and to no one else.

And I shall make use of a regimen for the help of patients in accordance with my ability and judgment, but not to act for injury or a wrongful act.  And I shall not give a deadly drug to anyone, though he ask for it, nor will I offer up such counsel.  In a like manner, I shall not give any abortifacent (lit. destructive pessary) to a woman.  But I shall observe my life and my art in a holy and reverent manner.  I shall not cut even one suffering from the stone, but I shall give way to the practitioners of this deed (i.e. surgeons). As many houses as I enter into I shall proceed for the benefit of the patients, standing afar from every willing and destructive harm, and especially from sexual acts with both female bodies and male, free and slave alike.  Whichever things I hear or see in my practice or outside my practice in the course of daily life, things which are unnecessary to ever blurt out, I shall consider such things unspeakable.  If I complete this oath, and do not violate it, may there be a gain of reputation because of my life and art from all men forever.  But if I transgress and forswear, may there be the opposite (Translation mine, Hippocratic Oath). [1]

I want to draw out a plausible interpretation as to the theoretical guidance of this oath, sworn to not only the four physician gods, but of such gravity that all the gods and goddesses are invoked as witness.  My idea is that a reverence for the body guided this guild (for this seems an apt description for this dedicated association) in all its interactions with patients.  There may have been some religious motivation for this precept or more likely, it was merely a central, refining filter through which medical practices could be easily guided instead of the alternative of detailed and cumbersome rules, such as the nitpicking “best practices” I imagine hinders modern day medical ethics.

Here are some examples that make me suspect a cult of the body.  Now of course, just as today, the physician is sworn not to give any poison to a man, and “in a like manner” (ὁμοίως) he is also not to give an abortifacent to any woman.  The “in a like manner” is intriguing because, if we are to draw an analogy, in the first instance it is the man’s body that is injured by being drugged.  Thus, in the second instance, we may infer that the woman’s body is injured by being drugged by the abortifacent. [2]  Also of note then, is that the preservation of the child is not primarily in view.  More intriguing is the proscription on surgery, telling physicians that they cannot “cut” even if the patient is suffering from stones, one of the most painful maladies. [3]  The patient must be given a referral instead.  It is tempting to think that a ban on cutting is due to an overzealous adherence to preserve or improve not the state of the patient’s health, but rather to have the physician impose even a temporary harm for a greater long-term good.  Alternatively, though, given the last line of the oath, perhaps we can consider that the physician has his good reputation in mind, and that if word gets around that he “cuts” people, even for the better, patients will be hesitant to visit him.  One need only reflect on how skittish moderns are towards doctor visits, even with drugs, anesthesia and centuries of knowledge.  Lastly consider the strange wording of the prohibition on sleeping with patients: abstain “especially from sexual acts with both female bodies and male, free and slave alike.”  This is the literal translation, it is does not say abstain from females and males, but female and male bodies  (γυναικείων σωμάτων καὶ ἀνδρῴων).  The relationship of patient and doctor requires and must respect the solemn vulnerability of the nude body, and what better way to further this than with a principled, philosophical reverence for the body?

 


REFERENCES:

[1] Ὄμνυμι Ἀπόλλωνα ἰητρὸν καὶ Ἀσκληπιὸν καὶ Ὑγείαν καὶ Πανάκειαν καὶ θεοὺς πάντας τε καὶ πάσας, ἵστορας ποιεύμενος, ἐπιτελέα ποιήσειν κατὰ δύναμιν καὶ κρίσιν ἐμὴν ὅρκον τόνδε καὶ συγγραφὴν τήνδε· ἡγήσεσθαι μὲν τὸν διδάξαντά με τὴν τέχνην ταύτην ἴσα γενέτῃσιν ἐμοῖς, καὶ βίου κοινώσεσθαι, καὶ χρεῶν χρηΐζοντι μετάδοσιν ποιήσεσθαι, καὶ γένος τὸ ἐξ αὐτοῦ ἀδελφοῖς ἴσον ἐπικρινεῖν ἄρρεσι, καὶ διδάξειν
10 τὴν τέχνην ταύτην, ἢν χρηΐζωσι μανθάνειν, ἄνευ μισθοῦ καὶ συγγραφῆς, παραγγελίης τε καὶ ἀκροήσιος καὶ τῆς λοίπης ἁπάσης μαθήσιος μετάδοσιν ποιήσεσθαι υἱοῖς τε ἐμοῖς καὶ τοῖς τοῦ ἐμὲ διδάξαντος, καὶ μαθητῇσι συγγεγραμμένοις τε καὶ ὡρκισμένοις νόμῳ ἰητρικῷ, ἄλλῳ δὲ οὐδενί. διαιτήμασί τε χρήσομαι ἐπ᾿ ὠφελείῃ καμνόντων κατὰ δύναμιν καὶ κρίσιν ἐμήν, ἐπὶ δηλήσει δὲ καὶ ἀδικίῃ εἴρξειν. οὐ δώσω δὲ οὐδὲ φάρμακον οὐδενὶ αἰτηθεὶς θανάσιμον, οὐδὲ ὑφηγήσομαι συμβουλίην
20 τοιήνδε· ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω. ἁγνῶς δὲ καὶ ὁσίως διατηρήσω βίον τὸν ἐμὸν καὶ τέχνην τὴν ἐμήν. οὐ τεμέω δὲ οὐδὲ μὴν λιθιῶντας, ἐκχωρήσω δὲ ἐργάτῃσιν ἀνδράσι πρήξιος τῆσδε. ἐς οἰκίας δὲ ὁκόσας ἂν ἐσίω, ἐσελεύσομαι ἐπ᾿ ὠφελείῃ καμνόντων, ἐκτὸς ἐὼν πάσης ἀδικίης ἑκουσίης καὶ φθορίης, τῆς τε ἄλλης καὶ ἀφροδισίων ἔργων ἐπί τε γυναικείων σωμάτων καὶ ἀνδρῴων, ἐλευθέρων τε καὶ δούλων. ἃ δ᾿ ἂν ἐν θεραπείῃ ἢ ἴδω ἢ ἀκούσω, ἢ καὶ ἄνευ
30 θεραπείης κατὰ βίον ἀνθρώπων, ἃ μὴ χρή ποτε ἐκλαλεῖσθαι ἔξω, σιγήσομαι, ἄρρητα ἡγεύμενος εἶναι τὰ τοιαῦτα. ὅρκον μὲν οὖν μοι τόνδε ἐπιτελέα ποιέοντι, καὶ μὴ συγχέοντι, εἴη ἐπαύρασθαι καὶ βίου καὶ τέχνης δοξαζομένῳ παρὰ πᾶσιν ἀνθρώποις ἐς τὸν αἰεὶ χρόνον· παραβαίνοντι δὲ
36 καὶ ἐπιορκέοντι, τἀναντία τούτων.

[2] One source (definitely Oxford University Press) I read, though I can not find it now, claimed that only 1 in 10 women survived an abortion.

[3] Aulus Cornelius Celsus (c. 25 BC – c. 50 AD) divided medicine into precisely three areas: dietetic, pharmacology and surgery.  This division is believed to extend much further back into antiquity however.