Probably edited later at Alexandria, the body of medical works that has come to be known as the Hippocratic Corpus includes about 70 works, all originally in the Ionic dialect, of differing rhetorical and teaching styles, most likely stemming from a variety of different authors during the last decades of the 5th century B.C. and the first half of the 4th century B.C.. By tradition, they are attributed to the most renowned physician of the classical era, Hippocrates of Cos. These works established medicine as a discipline with its own methods and practices (particularly observation and experimentation) that were distinct from religion and philosophy. Hippocratic medicine saw illness as a natural process, an imbalance of the four “humors” or fluids of the body—blood, phlegm, yellow bile, and black bile—and recognized that factors like diet, weather, and stress could influence health. In a famous passage in The Art, medicine is defined “in general terms” as “to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their diseases, realizing that in such cases medicine is powerless.”
Very little is known about Hippocrates. Now revered as the “Father of Medicine,” he was born around 460 B.C. and lived on the Aegean island of Cos (Kos). By the time of Plato’s Phaedrus, written in the early 4th century B.C., Hippocrates’ fame had been established as a model physician: he was said to have been learned, humane, calm, pure of mind, grave, and reticent. The remains of the school and clinic attributed to Hippocrates are still visible on Cos. However, although he has at times been credited with authorship of most or all of the treatises forming the Corpus, none have been proven to be his. He is almost certainly not the author of the oath still bearing his name or of the short treatise on maidens.
In its original form, presented here, the “Hippocratic Oath” invokes the gods of healing, specifies the duties of the pupil toward his teacher and his teacher’s family, and makes explicit the pupil’s obligations in transmitting and using medical knowledge. It asserts a central principle: the physician shall come “for the benefit of the sick,” that is, for the sake of the patient rather than to serve the interests of other parties. This and the companion principle “do no harm” are still understood as the normative core of the Oath, which also articulates a variety of specific rules concerning medical practice: it mandates the use of dietetic measures only (or what would now be called drug therapy); it prohibits the use of surgery (reserved for another profession); it prohibits abortion; and, central to the issue of suicide, it prohibits supplying lethal drugs to one’s patients or to others.
Twentieth-century scholars like Ludwig Edelstein and Danielle Gourevitch have argued that the stringent ethics of this document do not accurately reflect the practice of medicine in 5th-century Greece, and are more likely a result of a later inclusion of differing philosophical ideals, principally Pythagorean religion. According to Edelstein (though not all scholars accept this view), at the time Hippocrates was writing, elective death, including both voluntary active euthanasia and physician-assisted suicide, was widely accepted and practiced in Greek society as an option for those diagnosed as terminally ill. Taking poison was the most usual means of ending life in these circumstances. It was thought to be the responsibility of the physician, who was typically his own apothecary, to supply an appropriate and effective poison to a patient whose prognosis was irremediably dim; it is said that hemlock was developed for this purpose. Such a step involved consultation between the patient and the physician, or between the patient’s family or friends and the physician; if the case was found to be hopeless, the physician might directly or indirectly suggest suicide. Whether to act upon such a suggestion, however, was left to the discretion of the patient. Thus the supplying of lethal poisons to patients upon request was not generally considered a violation of medical ethics; the Hippocratic Oath’s prohibition of this practice represents, in Edelstein’s view, the distinctive influence of Pythagoreanism.
“About Maidens” (peri parthenion), one of several gynecological treatises in the Hippocratic Corpus and a diatribe against marginal religious healers, is an early attempt to formulate a physiological explanation of suicide. It also represents an early medical attempt to identify risk groups. The text is based on the clinical observation that women strangle (or hang) themselves more often than men if faced with the “sacred disease” (epilepsy) or paranoid forms of mental illness, a fact attributed to feminine cowardice (“the female nature is more fainthearted”). It focuses particularly on disturbances in the parthenos or “maiden” who is childless and unmarried but at the age for marriage, not long after menarche; the symptoms described in this text would now be called premenstrual dysphoric disorder. The Hippocratic writer offers a therapeutic recommendation: quick intercourse and pregnancy (rather than offerings to Artemis, called “The Strangled,” the eternally virginal goddess). In this largely physiological explanation of suicide put forward in “About Maidens,” however, there is little exploration of psychosocial factors associated with the social conditions of sequestration under which girls in ancient Greece lived.
The “Hippocratic Oath” itself has had an erratic history. Although it was apparently used during ancient times, it was preserved primarily by Arabic scholars and not rediscovered in the West until translations of the Hippocratic Corpus appeared in the 11th century. Revised versions of the Oath are now administered in most U.S. medical schools (though fewer Canadian and British schools) upon the conferring of a medical degree. With very few exceptions, contemporary versions of the Oath taken by graduate physicians do not contain the original Greek version’s explicit prohibitions of taking fees for teaching, abortion, providing lethal drugs to dying patients, or surgery, though provisions concerning justice, social responsibility, and respect for life have often been introduced instead.
Sources
“The Hippocratic Oath,” ed. and tr. Ludwig Edelstein, in Ancient Medicine: Selected Papers of Ludwig Edelstein, eds. Owsei and C. Lilian Temkin, tr. C. Lilian Temkin, Baltimore, MD: Johns Hopkins Press, 1967, p. 6. “About Maidens” (peri parthenion), text 8.466-70 Littre, tr. Nancy Demand (Greek deleted), in Nancy Demand, Birth, Death, and Motherhood in Classical Greece. Baltimore and London: Johns Hopkins University Press, 1994, pp. 95-97. Quotation in introductory passage from “The Art,” III.3-10 in W.H.S. Jones, ed. and tr., Hippocrates. Cambridge, MA: Harvard University Press, 1952, p. 193. Also see Danielle Gourevitch, “Suicide Among the Sick in Classical Antiquity,” Bulletin of the History of Medicine 43(1969):501-518. Material concerning “About Maidens” in introductory passage also from Helen King, “Bound to Bleed: Artemis and Greek Women,” in Averil Cameron and Amélie Kuhrt, eds., Images of Women in Antiquity (London and Canberra: Croon Helm, 1983), pp. 109-127.
THE HIPPOCRATIC OATH
I swear by Apollo Physician and· Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this .oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art – if they desire to learn it-without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else.
I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.
from ABOUT MAIDENS
The beginning of medicine in my opinion is the constitution of the ever-existing. For it is not possible to know the nature of diseases, which indeed it is [the aim] of the art to discover, if you do not know the beginning in the undivided from which it is divided out.
First about the so-called sacred disease, and about those who are stricken, and about terrors, all that men fear exceedingly so as to be out of their minds and to seem to have seen certain daimons hostile to them, either in the night or in the day or at both times. For from such a vision many already are strangled more women than men; for the female nature is more fainthearted and lesser. But [maidens] for whom it is the time of marriage, remaining unmarried, suffer this more at the time of the going down of the menses. Earlier they do not suffer these distresses, for it is later that the blood is collected in the womb so as to flow away. Whenever then the mouth of the exit is not opened for it, and more blood flows in because of nourishment and the growth of the body, at this time the blood, not having an outlet, bursts forth by reason of its magnitude into the kardia [heart] and phrenes [diaphragm]. Whenever these are filled, the kardia becomes sluggish then from sluggishness comes torpor; then from torpor, madness. It is just as when someone sits for a long time, the blood from the hips and thighs, pressed out to the lower legs and feet, causes torpor, and from the torpor the feet become powerless for walking until the blood runs back to its own place; and it runs back quickest whenever, standing in cold water, you moisten the part up to the ankles. This torpor is not serious, for the blood quickly runs back on account of the straightness of the veins, and the part of the body is not critical. But from the kardia and the phrenes it runs back slowly, for the veins are at an angle, and the part is critical and disposed for derangement and mania. And whenever these parts are filled, shivering with fever starts up quickly; they call these fevers wandering. But when these things are thus, she is driven mad by the violent inflammation, and she is made murderous by the putrefaction, and she is fearful and anxious by reason of the gloom, and strangulations result from the pressure around the kardia and the spirit, distraught and anguished by reason of the badness of the blood, is drawn toward evil. And another thing, she addresses by name fearful things, and they order her to jump about and to fall down into wells and to be strangled, as if it were better and had every sort of advantage. And whenever they are without visions, there is a kind of pleasure that makes her desire death as if it were some sort of good. But when the woman returns to reason, women dedicate both many other things and the most expensive feminine clothing to Artemis, being utterly deceived, the soothsayers ordering it. Her deliverance [is] whenever nothing hinders the outflow of blood. But I myself bid parthenoi, whenever they suffer such things, to cohabit with men as quickly as possible, for if they conceive they become healthy. But if not, either immediately in the prime of youth, or a little later, she will be seized [by this illness], if not by some other illness. And of married women, those who are sterile suffer this more often.