Hippocratic Oath, 21st Century

Hippocratic Oath was first promulgated in 400 BC. Since then it became mandatory to take this oath for any medical profesional who practices medicine. The Oath envisaged all the important guidelines required to be possessed before the medicine is practiced. Recently there had been debates over the traditional oath and various revisionist versions were recommended. The enormous available literature compells us to think and revisit the status of orignal oath vis a vis the practice of medicine in 21st Century.     

The Hippocratic Oath: source of medical ethics

The Hippocratic Oath is twenty-five centuries old. Probably drawn-up by Hippocrates himself, it intervenes in a particular cultural, political and religious context: that of Greece at the time of Pericles. It guaranteed the Asclepiad doctors of the continuity of their knowledge within their community. Medicine was highly esteemed because of it. The Oath, more than any other work of the Hippocratic collection, has outlived the centuries. It still remains one of the symbols of the medical profession. Despite its age, it provides insight into some of the questions of medical ethics even today. Its topicality is, without doubt, due to the transcendent nature of the values it proclaimed.     

A brief history of medicine's Hippocratic Oath, or how times have changed

Medicine has experienced many changes over the last three thousand years and surprisingly, the good and the bad of these changes can be found in the evolution of the wording of the Hippocratic Oath. This commentary reveals why the original Oath became a part of modern medicine's rite of passage and how society is now changing the very reason that the Hippocratic Oath was brought into the world of medical ethics. By examining the modern language of the Oath, it is possible to understand how these words have diluted its meaning and intent. The long-term consequences of these changes cannot be foreseen, but history has shown what can happen without a strong oath to guide the practitioner.     

The prohibition of lithotomy within the Hippocratic Oath: historical and ethical considerations on the history of surgery

A passage with one of the most contradictory interpretations of the so-called Hippocratic Oath, which was presumably created between 500 and 300 before Christ, is the prohibition of lithotomy. The oldest handwritten traditions of the Hippocratic Oath are dating back to the 11th-12th century. However the section of the prohibition of lithotomy is missing in the oldest preserved tradition (Codex Urbinas gr. 64), which led to some authors interpretation of being added later on. Beyond all doubt the analysis of the texture of the Hippocratic Oath leads to the conclusion that the prohibition of bladder stone lithotomy must have been an integrative part of the oath from the very first beginning. The author could have been inspired by the following reasons to have a non oath related doctor let done the medical operation: the removal of a bladder stone by an operation, which was outfitted with many complications, was one of the most difficult surgical interventions in the antique. Celsus (1st century A. D.) mentioned "severe fever, urine fistula and deadly inflammations" after lithotomy. Since the operation was done perineally, presumably a negative sexual potency was feared. No doctor engaged to help and not to harm his patients was allowed to make this kind of operation, which was often followed by many complications. Nevertheless sometimes patients were "tantalised to death by suffering dreadful pain" through those bladder stone diseases. Consequently "practising men" (the term "surgeon" was created at a later date), those who had been specialised in that operation and had not been linked to the oath, were allowed to make this kind of dangerous operation. Due to a greater experience of those specialists (named as "Lithotomos" by Celsus ih the 1st century A. D.) the danger of this kind of operation was reduced. The prohibition of lithotomy could be interpreted as a commitment to realize the limits of ones own medical actions.     

Treatment of Eye Diseases in the Hippocratic Era

For the treatment of eye diseases, Hippocrates described the application of ointments, administration of herbs, implementation of surgical interventions and the use of phlebotomy and cauterization along the “ancient vessels”.The Hippocratic use of bleeding and cauterization as a medical treatment has significant similarities to traditional Chinese medicine. The “ancient vessels” described by Hippocrates are not related to human anatomy, but are similar to the meridians of traditional Chinese medicine. The points chosen for cautery are similar to those described in ancient Chinese texts. The treatment of ophthalmic diseases with phlebotomy and cauterization during the Hippocratic period can undoubtedly be considered as alternative medicine.