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Lessons from History

Hippocrates and the Hippocratic Oath

Saurabh K. Gupta
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

Abstract
For a long‑time men had a philosophic view of health and disease, and this lasted till almost 2500 years back. Hippocrates, the great Greek
physician, is believed to have seperated the “art of healing” and philosophy. An astute observer, Hippocrates during his practice employed
principles that laid the foundation of modern medicine. The medical fraternity worldwide unanimously bestowed the title of “father of
medicine” to this great man. Apart from being a physician, he was instrumental in bringing about the concept of ethics in the realm of medicine.
The famous document “Hippocratic Oath” while being respected by almost all has generated a great amount of debate among historians.
Nonetheless, almost all medical schools across the world have the Oath ceremony where medical graduates agree to the commandments of
the Hippocratic Oath, either in its original or modified form. Although a statement of promise this Oath does not have any legal implications
as might be seen by a person outside the medical community. This article outlines the contributions made by Hippocrates to the medical world
with an emphasis on the Hippocratic Oath.

Key words: Hippocrates, Hippocratic Oath, Oath

Introduction prescriptions dates back to 3000 BCE in the Kingdom of

Sumeria. The codes of conduct were laid by Hammurabi,
Five and half years after I joined the medical college, during
well‑acclaimed ruler of Babylon, approximately 2000 years
the convocation ceremony, I undertook the Hippocratic Oath
before the Christian era. These rules are testimony to the fact
in the presence of hundreds of medical professionals. Although
that the concept of medical ethics was well formulated early
I have indelible memories of this landmark day of my career, in the history of mankind.
I have only a faint recollection of the great Hippocratic Oath.
So fascinating has been the journey in the field of medicine Medicine in ancient Egypt
that I never ventured in this important aspect of medicine. Egypt was an epicenter for the development of medicine in
However, a recent discussion on medical ethics revived my ancient times. Like the Greeks, various gods were believed to
interest. The discussion that was otherwise casual had lasting preside over the arts and sciences. Horus, the God of the health,
effect on my psyche and prompted me to learn more about lost his eye in a fight that was miraculously restored. This eye
Hippocrates, the father of medicine. of Horus is believed to have an appearance similar to the sign
“Rx,” a common representation for prescription. This sign
Historians have done a commendable job in recreating the “Rx” is otherwise known to represent the Latin word “recipe”
extremely complicated sequence of the development of medicine. meaning “to take.” Unfortunately, we have scant information
[1]
No one statement can define the boundaries of ever increasing regarding medicine in ancient Egypt. Nonetheless, two persons
field of medicine. Instead, modern medicine is an amalgamation of need special mention. Sekhet‑eanach is considered as the first
knowledge acquired over thousands of years of human civilization physician in the history of mankind by some scholars. Imhotep
and is a source of learning in itself. In this article, however, I shall was the other well‑known physician and was worshipped as the
restrict myself to Hippocrates and the Oath he is credited with. god of medicine, until well in the Christian era. Few researchers
even suggest that Imhotep, rather than Hippocrates, should be
History of Medicine regarded as the father of medicine.
There are ample evidences to support the fact that primitive Medicine in ancient India
man practiced medicine. The earliest evidence of medical Rig‑Veda and later Ayurveda laid the foundation of Indian
Access this article online
medicine which was successfully carried forward by Charaka,
Quick Response Code:
Sushruta, and other physicians. Like other historical aspects
Website: exact timing of Charaka Samhita and Sushruta Samhita,
www.j-pcs.org
Address for correspondence: Dr. Saurabh Kumar Gupta,
Department of Cardiology, Room No. 23, 7th Floor, CT Centre,
DOI:
10.4103/2395-5414.157583 All India Institute of Medical Sciences, New Delhi ‑ 110 029, India.
E‑Mail: [email protected]

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Gupta: Hippocrates: The Father of Medicine

two landmark manuscripts of Indian medicine are speculative Hippocrates must be credited for separating medicine from
at best, although the majority of historians believe that they philosophy. He was instrumental in bringing scientific methods
practiced before Hippocrates. of careful observation and logical reasoning. He declined that
the disease is the result of punishment by the God. Instead,
Medicine in ancient Greek he believed that the human body possessed four fundamental
Till well into the early Greek era, the disease was believed to
qualities, the hot and the cold, the dry and the moist and that
be an act of magic and society largely depended on magicians
it was composed of four humors – blood, phlegm, yellow bile
and “witch doctors.” This pattern continued well into the
and black bile. Further, he envisaged that disturbance of the
Greek civilization and continues to have some effect even
relative predominance of the humors caused disease, and it is
today. The presence of personalities in the likes of Socrates
the physician’s duty to bring this balance back in a person who
and Pythagoras, the great philosopher of Greek civilization
is sick. In one of his books, he mentioned about the effect of
provided apt environment for unparalleled growth in the field
food, occupation and climate in causing disease. He advised
of medicine.
physicians to observe the prevailing winds, the water supply,
nature of the soil and habit of the people to be able to deduce
Hippocrates and Hippocratic Medicine what diseases are more prevalent or likely to become prevalent
Hippocrates was born in 460 BC in the Island of Cos, close in their region of work. By indicating these aspects of disease
to the then Asia minor. He is said to be the direct descendant causation, he was the first to introduce epidemiology.
of Aesculapius, the Greek God of healing. Hippocrates He was an astute observer of clinical signs and believed in
traveled extensively during his lifetime and after an illustrious systematic assessment. He said that the examination should
professional career, died in Larissa in 355 BC. He is believed begin from the face of the patient. “Hippocratic facies” to
to have taught his pupils and run an open‑air clinic under a describe a patient with “nose sharp, eye hollow, temples
gigantic oriental plane tree (Platanus orientalis). This plane shrunken, ears cold and with their lobes turned outward, the
tree, the largest in Europe exists even today standing tall in skin of the parched face and tense, the color yellow or very
the town of Cos. However, some scholars believe that this tree dusky” to describe impending death is a testimony to his
is only 500 years old, and, therefore, unlikely to be the one wisdom in providing a vivid description of what we know
related to Hippocrates. The derivatives of the tree have been today as “low cardiac output state.” Similarly, his portrayal
taken to various academic centers of excellence across the of “the breathing was rare and large” is an apt description for
globe, including Yale University, University of Glasgow and Cheyne–Stokes respiration. This vividness of the depiction
National Library of Medicine in the United States [Figure 1]. was the hallmark of Hippocrates. Further, he was able to
Very little is known about the man himself; most of his forecast how symptom would develop and whether a fatal
reputation as a physician comes from the study of Corpus issue is likely. An extract from one of his greatest works
Hippocraticum, a collection of more than 100 books. They “prognostic” summarizes it well. It says, “I hold that it is an
varied in style, tone, and medical doctrine and therefore it is excellent thing for the physician to practice forecasting… he
very likely a work of more than one author. Although much of it will carry out treatment best if he knows beforehand from the
is obsolete, the principles of teaching described are surprisingly present symptoms what will take place later.”
modern. This monumental work was first published in 1526 Hippocrates made little use of drugs in the treatment. He
and was later translated in English. Irrespective of incomplete probably knew that most of the diseases have a tendency of
knowledge and lack of relevance of most of the writing, natural cure and believed that “the natures are the physicians
of our diseases.” Nevertheless, he did not refrain from even
surgical treatment when it was needed. His description of
surgical practices ranged from the use of tar for wounds as an
antiseptic method to the instructions for trainee surgeons. In his
short book entitled “In the surgery,” he wrote “the nails neither
to exceed nor come short of the finger tips. Good formation of
fingers, with thumbs well opposed to forefinger. Practice all
the operations, with each hand and with both together.” While
he had an illustrious career as a physician and surgeon, he was
courageous enough to report his successes and failure with
equal ease. He did not refrain from reporting high mortality of
60% out of 42 cases that he described in the book “epidemics.”
Thus, he set an example of record keeping.
In addition to many firsts in the field of medicine, Hippocrates
is credited with the use of aphorisms (Greek aphorismos) ‑ an
Figure 1: Plaque situated at National Library of Medicine stating the gift original thought presented in a concise and memorable
of tree of Hippocrates from Island of Cos. fashion. One such aphorism worth mentioning is “do not

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Gupta: Hippocrates: The Father of Medicine

disturb a patient either during or just after a crisis, and try no life began from birth and Plato as well as Aristotle advocated
experiments, neither with purges nor with other irritants, but abortion and infanticide, not only for medical reasons
leave him alone.” Similarly, he remarked that “it is better to but also for a variety of reasons. In this respect, the Oath
give no treatment in cases of hidden cancer; treatment causes might rather be a reflection of Pythagorean philosophy that
speedy death, but to omit treatment is to prolong life.” These argued in favor of beginning of life at conception. Further,
aphorisms may not be true in the current era of emergency if Edelstein is to be believed the separation of medical and
medicine and advanced oncology but was in probabilities surgical specialties as the Oath might suggest is also the
appropriate for physicians then. He advised the doctor to be result of Pythagorean influence. Edelstein made a rather
prepared for the right thing at the right time, in which patient, strong conclusion when he claimed that the Oath was a
attendants, and the external circumstances must co‑operate. Pythagorean manifesto and not the expression of an absolute
Thus, while he was concerned about physicians’ behavior standard of medical conduct.[5] Other historians, however, do
toward their patients, he was vigilant enough to express his not agree with this interpretation and believe that the Oath
expectations from the patients and their relatives. In summary, is in general sync with the then existing Greek philosophy.
he contributed in all aspects of medicine and laid the foundation Interestingly, contrary to the common belief the well‑known
for their growth over centuries. This is his expertise in phrase “first do no harm’’ from Latin “primum nonnocere”
preclinical, clinical as well as surgical specialties of medicine is not part of the Oath. Hippocrates wrote in Greek and not
that has earned him a title of “father of medicine.” Latin, and this phase were most likely introduced by Thomas
Inman in 1860.[6]
Hippocratic Oath Whatever may be the truth behind its composition, authorship
According to Webster dictionary, Oath is a noun that literally and its exact timing, the persistence of this Oath is impressive.
means “a formal and serious promise to tell the truth or to Ceremonial and nonobligatory, the Hippocratic Oath can be
do something.” The Oxford dictionary defines this noun compared to that taken by a judge, president or other politician
as “a solemn promise, often invoking a divine witness, when he or she is sworn into office. To understand the message
regarding one’s future action or behavior.” The Oath is embedded in the Oath, it is necessary to have a detailed analysis
emphasized so much in recent times that it seems to have of the Oath. Many historians have provided interpretations
become a reflection of the gold standards of any profession. of the Hippocratic Oath. Michael North[7] interpreted and
And why not, when in the current era moral and ethical translated the Oath [Figure 2]. According to Orr et al.[4] the
values are eroding rapidly this sacred set of promises is content of this traditional version Hippocratic Oath can be
expected to be taken equally by all the stakeholders. Almost divided into 12 items:
all medical professionals cherish the moment of their Oath • Covenant with deity: “I swear by Apollo, the physician…”
ceremony and feel proud to be associated with such a
tradition. Unfortunately, while expectations and enthusiasm This is an invocation of the Greek gods of healing. Apollo is
regarding Oaths are high this much celebrated Hippocratic invoked as a physician or healer. Asclepius is the legendary
Oath is questioned for its relevance in the current era. As father of medicine and physicians. Hygeia and Panacea were
has been mentioned before, contrary to the expectations the two most famous of Asclepius’ daughters. Medicine was
historians do not know for sure who wrote it. The notion a craft commonly passed from father to son; medical families
that this might not have been written by Hippocrates himself sometimes claim to be descended from Asclepius himself.
stems from the fact that some of its contents contradict This was true of Hippocrates, and this is probably the reason
the concepts in other text believed to be composed by why Plato called him an “Asclepiad.”
Hippocrates. As little is known about the original Oath, it
remains unclear what relevance did it have in the Greek era.
In fact, some scholars speculate that there may have been
other Oaths at that time, of which the Hippocratic Oath is the
sole survivor. There is almost no mention of the Oath during
first 1500 years after its composition. The first recorded use
of the Oath was in the University of Wittenberg, Germany, in
1508.[2] This literary silence of almost one and half century
and its resurgence in the middle age, possibly explain the
inclusion of some of the vows that seem to have reflection
of Christian ideology. The Hippocratic Oath was translated
in English in 18th century, and it is increasingly being used
in medical schools in Europe and the United States, albeit
in modified form.[3,4]
The Hippocratic Oath not only contradicts other Hippocratic
texts, but also contradicts ancient Greek practices. For Plato, Figure 2: Hippocrates oath as translated by Michael North.

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Gupta: Hippocrates: The Father of Medicine

When on one hand, they are credited with incorporating trustworthy from the untrustworthy. These paragraphs of the
science in place of philosophy in the understanding the health Oath also stress the importance of passing on the knowledge
and disease invocation of the Gods seems contradictory. In all of medicine and of ethical practice to the next generation. In
probabilities, prominent physicians are invoked as patrons, the current days of institutions, formal education and statutory
witnesses and judges who will determine whether the contract exams this is no longer a part of the relationship of a physician
is ethically followed and not as Gods. The invocation of the and his apprentice. However, the importance of passing on
gods, like swearing on the Bible in a court of law, brings a medical knowledge and of impressing upon students the
solemnity and supernatural sanction to the Oath, which is importance of standards of behavior and of competence cannot
precisely what makes it an Oath (as opposed to a promise or be overemphasized.
a declaration). If they have been fulfilled, the gods will grant • C ovenant with patients: Pledge to use “ability and
fame and honors, but if they have been transgressed, the gods judgment.”
will ensure ill fortune and disgrace. • Appropriate means: Use of standard “dietary” care.
The very concept of inviting Gods is not in line with the • A ppropriate ends: The good of the patient, not the
Christians and Muslims philosophy, as it seems to involve physician.
worshipping or at least acknowledging the existence of This section is the soul of the Oath. It immediately follows the
false gods. This problem might explain delayed acceptance section on the structures of medical education and sets out the
of Hippocratic Oath nearly 2000 years after its composition. fundamental role of medicine. The physician promises to use a
Furthermore, this portion of the Oath has undergone treatment for the benefit of those who are sick, according to his
greatest degree of alteration over the ages. Nevertheless, it or her ability and judgment. The physician is also directed to
is remarkable that the Oath was adapted and used both by refrain from doing harm or injustice. The typical Hippocratic
Christians and Muslims. One of the many versions has not method of treatment was to prescribe a particular regime of
only replaced the pagan gods with Christ, but also adapts diet and exercise with or without change in the environment.
the Oath to become a declaration; there is no “I swear” but it Only if this failed, there was a need of drugs. The role of
begins instead by saying “Blessed to God the Father of our the physician was to assist nature in restoring this balance.
Lord Jesus Christ, who is blessed for ever and ever; I lie not.” “Nature is the physician of diseases.”
Other newer versions of the Oath simply allow one to swear
by “whatever I hold sacred.”[3,8] • L
 imits on the ends: Originally proscribed abortion and
euthanasia.
Similarly, the Islamic translators rendered the Oath safe and
acceptable by putting it in the mouth of Hippocrates and also The paragraph which immediately follows concerns the
by making a number of subtle changes to the Oath. One of provision of deadly drugs and of abortive pessaries. This
such Oath begins by saying “Hippocrates said: I swear in the paragraph is placed here because these actions are seen as
name of God, the Master of life and death, the giver of health archetypal acts of transgression, betraying the aim or meaning
and creator of healing and of every treatment, and I swear in of medicine as outlined in paragraph 4. These prohibitions are
the name of Aesculapius, and of all the holy ones of God, male thus central to the very understanding of medicine. Giving a
and female, and I call them to witness, that I will fulfill this lethal drug or in lethal doses, for whatever reason, contradicts
Oath and these conditions.”[9] the meaning of medicine, understood as the fostering of
physical health. Destroying the body (either of the sick patient
• C ovenant with teachers: Pledge of collegiality and financial or of the fetus) is contrary to the very nature of medicine.
support. Thus since these actions in some way contradict the most
• Commitment to students: Promise to teach those who swear fundamental aim of medicine and rather than assisting nature
the Oath. and bringing health, they bring death and destruction, these
These two paragraphs are controversial. When used in its actions are prohibited by Hippocrates.
near original form, this section is often omitted as it seems The debate on the use of abortifacients is not new. Although
obsolete in the current era. According to Edelstein, the practice it invokes death and destruction of the fetus it brings health
of quasi‑adoption of the pupil was again a pointer toward to the mother immediately and in times to come especially if
Pythagorean influence. It seems difficult to understand as it is associated with ill health of the mother or is an unwanted
to why the teaching of medicine is confined to those who pregnancy. The relief of physical and mental sufferings of the
take the Oath? This could be a way to protect the power and mother then should be the first goal as a physician. Therefore,
exclusivity of the medical elite. The exclusion of those who will taking a balanced view this statement must be taken as a guide
not abide by the physicians’ law is, of course, a sociological to use harmful drugs with caution.
method of control, and a means to establish the reputation
• L
 imits on means: Originally proscribed surgery for renal
and prestige of those within the fellowship of the Oath. Such
stones, by deferring to those more qualified.
mechanisms once again are not unique to the ancient world.
Like any other method of control or licensing it must have The paragraph about surgery (paragraph 7) is obscure, but it is
been a way to separate the reliable from the unreliable and the at least clear that it does not involve the same sort of objection

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as the prohibition of poisoning or abortives‑for in the case of

surgery the physician is allowed to make way for a specialist
physician, the surgeon to carry out these actions. Although it
may be a reflection of an element of self‑protection, it also
emphasizes the role of specialization. Interpreted very broadly
as a prohibition against practicing beyond the limits of one’s
competence, this is probably more relevant today.
• Justice: “Avoiding any voluntary act of impropriety or
corruption.”
• C hastity: Originally proscribed sexual contact with
patients.
• Confidentiality: Not to repeat anything seen or heard.
• Accountability: Prayer that the physician be favored by the
gods if the Oath is kept, and punished if it is not kept.
In these paragraphs, emphasis is broadly on the physician‑patient Figure 3: Oath being pledged at All India Institute of Medical Sciences,
relationship that is becoming more and more talking point in New Delhi, India.
the current era of modern medicine. The Oath is an ethically
acute and thoughtful document in this regard. It is this ethical an Oath, in 1958 this had risen to 72% and by 1989, the
aspect of the Oath that has made it relevant in a long history proportion had reached a staggering 98%. Of these medical
of more than two centuries. schools, nearly half use some version of the Hippocratic
In addition to the opening proclamation, many institutions have Oath and a quarter uses the declaration of Geneva.[2,11,12]
Similar to the trend worldwide, there is no uniformity of
modified the remaining content of the Hippocratic Oath. The
the Oath in India. The Oath being used at All India Institute
most common changes are the removal of the proscription of
of Medical Sciences, New Delhi is believed to be written
sexual contact with patients, the ban against using abortive
by Charak [Figure 3].
agents and the agreement to be accountable for keeping
the Oath. While close to 50% of schools have chosen to Nevertheless, while the number of schools using an Oath or
continue to use the Hippocratic Oath with some modification declaration has risen consistently through the twentieth century,
or modernization substituted to make it more consistent with albeit with more and more changes in the original content of
their own values, other institution have chosen to administer the Hippocratic oath. In short, more and more medical students
a different medical Oath. were swearing to do less and less with the concerns during
the Oath ceremony shifted from physician’s behavior to the
Medical Oath in Current Era requirement to respect the stated wishes of patients.
There are many modern versions of the Oath. The declaration
of Geneva that was written by the World Medical Association Conclusion
in 1948 after World War II is most popular of these. This The contributions made by Hippocrates are immense in every
was later amended in 1968, 1984, 1994 and underwent field of medicine. The Hippocratic Oath although controversial
two editorial revisions in 2005 and 2006. Unlike the Oath, in some aspects is still relevant to modern day physicians and
the declaration of Geneva does not invoke the presence forms the basis of a majority of the medical Oaths being sworn
of Gods and is only a statement of promise. However, it in medical schools across the globe.
is not a pact between individuals nor is it agreement to
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