The hippocratic oath: a code for physicians, not a pythagorean manifesto

: Metical Hy, D Ponoc cer (14995) 44, 447 402 Prufessiona) Lus 1995 7 | 29 >© Ca pl Hippo mate? Ae \aas psi bd | The Hippocratic Oath: a Code for Physicians, not ? Pythagorean Manifesto P, PRIORESCHI School of Medicine, Creighton University, California Plaza, Omaha, NE, 68178-0001, USA Abstract — The Hippocratic Oath is to be considered a code of conduct for all physicians and 4 not a Pythagorean manifesto, in spite of the view of Edelstein. In fact, it can be shown that the 4 prohibitions and requirements on which the Pythagorean hypothesis rests (the prohibition against helping suicide, inducing abortion, performing surgery, and having sex with patients 3 or with members of their household and the rules of confidentiality and collegiality) do not necessarily link the Hippocratic Oath to the Pythagoreans. Edelstein affirms that only the # Pythagoreans condemned suicide, whereas it can be shown that Plato, Aristotle, the Epicureans, and several authorsin antiquity opposed it. Similarly, induced abortion was by no means universally accepted in antiquity. Soranus, for example, clearly states that many "physicians opposed it in all cases. The passage of the oath concerning surgery can be shown 2 to refer only to lithotomy (as others have underlined). As for sexual relations with patients or 3 members of their household (male or female), the existence of laws against promiscuity (homo- or heterosexual), and other evidence, indicates that it was usually condemned. à Finally, confidentiality and collegiality were virtues that the Pythagoreans were not alone in upholding. In addition, many of the principles upheld by the Oath are found in other 4 documents unrelated to the Pythagoreans. SSH Ethan a 2 jmauval nypotneses For the half century since Edelstein, in a well-known and, for this reason, ‘far centuries ancient physicians, pu: (1), proclaimed that the Hippocratic Outh ‘in in opposition to the demands made by the Oath, put poison in the hands of thuse among their patients who intended to commit suicide; they administered abortive remedies; they practiced surgery (6).' The purpose of this paper is to suggest: a) that the Oath was what it had traditionally been considered to be before the publication of Edelstein's work, namely a code of conduct for physicians which reflected commonly accepted ethical principles; ci spirit and in letter, in form and content ... is u “+ Pythagorean manifesto (2),' it has been widely accepted, in spite of dissenting voices (3), that the Oath ‘È i indeed a Pythagorean document (4). As a result, it & ls also been held that as the Oath ‘originated in a 3 group representing a small segment of Greek opinSton,’ ie, the Pythagoreans, it did not reflect ethical ; principles commonly accepted in classical times (5) À Date received 21 October 1994 3 Date accepied 28 December 1994

© Pearson Professional Ltd 1995 The Hippocratic Oath: a Code for Physicians, not a Pythagorean Manifesto P. PRIORESCHI School of Medicine, Creighton University, California Plaza, Omaha, NE, 68178-0001, USA Abstract — The Hippocratic Oath is to be considered a code of conduct for all physicians and not a Pythagorean manifesto, in spite of the view of Edelstein. In fact, it can be shown that the prohibitions and requirements on which the Pythagorean hypothesis rests (the prohibition against helping suicide, inducing abortion, performing surgery, and having sex with patients or with members of their household and the rules of confidentiality and collegiality) do not necessarily link the Hippocratic Oath to the Pythagoreans. Edelstein affirms that only the Pythagoreans condemned suicide, whereas it can be shown that Plato, Aristotle, the Epicureans, and several authors in antiquity opposed it. Similarly, induced abortion was by no means universally accepted in antiquity. Soranus, for example, clearly states that many physicians opposed it in all cases. The passage of the oath concerning surgery can be shown to refer only to lithotomy (as others have underlined). As for sexual relations with patients or members of their household (male or female), the existence of laws against promiscuity (homo- or heterosexual), and other evidence, indicates that it was usually condemned. Finally, confidentiality and collegiality were virtues that the Pythagoreans were not alone in upholding. In addition, many of the principles upheld by the Oath are found in other documents unrelated to the Pythagoreans. For the half century since Edelstein, in a well-known and, for this reason, ‘for centuries ancient physicians, work (1), proclaimed that the Hippocratic Oath ‘in in opposition to the demands made by the Oath, put spirit and in letter, in form and content ... is a poison in the hands of those among their patients who Pythagorean manifesto (2),’ it has been widely acintended to commit suicide; they administered abortive cepted, in spite of dissenting voices (3), that the Oath remedies; they practiced surgery (6).’ is indeed a Pythagorean document (4). As a result, it The purpose of this paper is to suggest: a) that has also been held that as the Oath ‘originated in a the Oath was what it had traditionally been considered group representing a small segment of Greek opinto be before the publication of Edelstein’s work, ion,’ i.e., the Pythagoreans, it did not reflect ethical namely principles commonly accepted in classical times (5) reflected Date received 21 October 1994 Date accepted 28 December 1994 447 a code of conduct for physicians commonly accepted ethical which principles;

b) that its Pythagorean traits are coincidental; c) that 5. keep confidential any information about patients; the numerous violations of it by ancient physicians 6. consider his teacher of medicine as his father and were not related to its alleged Pythagorean origin. the teacher’s children as brothers, share his own The following is Edelstein’s translation of the money with the teacher if he were to be in need, Oath: and pass his own medical knowledge to his own I swear by Apollo Physician and Asclepius and Hygieia and have signed the covenant and have taken an oath sons, the sons of the teacher, and ‘to pupils who Panaceia and all the gods and goddesses, making them my according to the medical law, but to no one else.’ witnesses, that I will fulfil according to my ability and Edelstein underlines the contradiction between, on 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 one side, ancient ethics and medical practice and, on the other, the rules and prohibitions of the Oath: ‘suicide was not censured in antiquity,’ and ‘many physicians actually gave their patients the poison for which they were asked (8)’; ‘(concerning abortion), in antiquity it was not generally considered a violation of medical ethics to do what the Oath forbade,’ have signed the covenant and have taken an oath according and ‘many physicians prescribed and gave abortive to the medical law, but to no one else. remedies (9)’; in spite of the Oath’s prohibition, I will apply dietetic measures for the benefit of the sick surgery was commonly performed by Hippocratic according to my ability and judgment; I will keep them physicians. He then notes that the principles reflected from harm and injustice. in the Hippocratic Oath were alien to all philosophi- 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 a woman an abortive remedy. In purity and cal schools of the time except to the Pythagoreans, holiness I will guard my life and my art. I will not use the knife, not even on the 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. IfI fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among ali men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot (7). who condemned abortion, suicide, and all forms of surgery. As for the injunctions about sex with the members of the patient’s household (including slaves), ‘their (i.e., the Pythagoreans’) views on sexual matters were severer than those of all other ancient philosophers’; ‘they alone condemned sodomy (10)’; and ‘free born people and slaves, for the Pythagoreans, were on equal footing (11)’. Moreover, concerning confidentiality and the teaching of medicine, “They (i.e., the Pythagoreans) did not indiscriminately impart their knowledge to others. They expected the scientist to be reticent and ready to listen. They expected silence even in daily life (12y. According to Edelstein, not only could the Oath’s prohibitions be interpreted as a reflection of the Pythagorean point of view, but the duties of the To support his thesis that the document was a Pythagorean manifesto, Edelstein focused on the following points, of which some prohibited the physician from: 1. administering or prescribing deadly drugs, even if asked by the patient; physician toward his teacher also showed an unmistakable Pythagorean imprint. He asserts that, whereas to consider the teacher a father was a practice not known ‘to have been customary in ancient scientific or practical training ... the Pythagoreans of the fourth century apparently were wont to honor those by whom they had been instructed as 2. inducing abortion; their fathers by adoption (13)’. In addition, ‘that the 3. performing surgery, ‘not even on sufferers from stone, but... withdraw in favor of such men as are engaged in this work’; 4. having sexual relations with any member (male or Pythagorean pupil shared his money with his teacher if necessary,’ he says, ‘one may readily believe brothers (15)’. Edelstein, therefore, concluded not female, free or slave) of the household where he is only that ‘in spirit and in letter, in form and content, called; is (the Oath) a Pythagorean manifesto’, but also (14)’ and ‘the Pythagoreans considered themselves that ‘all its details are understandable only (our italics) and others required that the physician: in connection with Pythagoreanism (16)’.

1. Poison for suicide It is the easiest possible step thou urgest, wretched man, and one that any man may take, this dying; and dost thou The passage in the Oath concerning poison most likely refers to patients wanting to commit suicide because of intractable and incurable illnesses. It is well known that suicide was condoned by many in the classical world and that it was often considered think thyself brave when thou art making a flight more shameful than the one preceding it? . . . He who in the face of toils and hardships, or of the censorious judgments of men, gives up the fight, is vanquished by his own weakness. . . For it is shameful to die, as well as to live, for one’s self alone. And yet it is this that thou now invitest me an honorable way to terminate an existence that, in thine eagerness to be rid of present troubles, though for whatever reason, had become intolerable (17). This, however, does not mean that ‘among all Greek beyond that thou wilt effect nothing that is honorable or thinkers the Pythagoreans alone (our italics) outlawed suicide and did so without qualifications (18). In fact, according to Plato, this is how Socrates felt about suicide: useful (24). Epicurus, according to Diogenes Laertius, did not approve of suicide; (Epicurus says that) even when. . . (the wise man) has lost Tell me then, Socrates, what are the grounds for saying that suicide is not legitimate? I have heard it described as wrong before now, as you suggested, both by Philolaus (19), when he was staying with us, and by others as well, but I have never yet heard any definite explanation for it. (Socrates answers)... no doubt you will feel it strange his sight, he will not withdraw himself from life (that is, commit suicide) (25). Lucretius, the Roman Epicurean, scorns the suicide who (as one affected by an incurable disease could do) kills himself for fear of death: that this should be the one question that has an unqualified And often, for fear of death, men are seized by hatred of answer (or: that this alone of all laws is without life, by hatred of seeing the light, and with anguish they exception”), . . And it probably seems strange to you that it inflict death on themselves, forgetting that this fear is the should not be right for those to whom death would be an origin of their distress (26). advantage to benefit themselves, but that they should have to await the services of someone else. . . All the same, Cebes, I believe that this much is true, that the gods are our Examples of physicians who refused to furnish help in suicide, although rare (27), are not unknown: keepers, and we men are one of their possessions. Don’t when the emperor Hadrian wanted to end his life, his you think so? physician, in order not to be obliged to furnish the Yes, I do, said Cebes. Then take your own case. If one of your possessions were to destroy itself without intimation from you that you wanted it to die, wouldn’t you be angry with it and punish it, if you had any means of doing so? poison, preferred to kill himself (28); in The Golden Ass, the physician who was asked for poison states in court ‘nec meae sectae crederem convenire causa ulli praebere mortis, nec exitio sed saluti hominum Certainly. So if you look at it in this way I suppose it is not unreasonable to say that we must not put an end to ourselves until God sends some compulsion like the one which we are facing now (i.e. his death sentence). That medicinam quaesitam esse didicissem (29, 30)’. In fact, the Pythagorean, far from being the only seems likely, I admit, said Cebes (21). condoned it (31). Aristotle expresses contempt for the suicide who school to condemn suicide, was just one of several: the Academic, Peripatetic, and Epicurean schools opposed suicide and only the Cynic and the Stoic Yet, Edelstein asserts that the Oath’s prohibition ‘did not echo the general feeling of the public’ and that ‘suicide was not censured in tries to escape suffering by killing himself: antiquity (32)’. If we consider laws as reflecting beBut to die to escape from poverty or (the sorrows of) love liefs generally held by a given society at a given time, or anything painful is not the mark of a brave man, but we must, however, conclude that the ‘general feeling rather of a coward; for it is softness to fly from what is of the public’ was against suicide because, in Greece, there were laws against it (33) and, in Athens, suicides troublesome, and such a man endures death not because it is noble but to fly from evil (22). were buried with their right hands amputated (34,35). He also states that suicide is contrary to the ‘right Seif-destruction was also condemned in early Roman religious law and tradition: Servius says that, accordrule of life’: ing to Cassius Hemina, the ignominy of suicide dates And he who through anger voluntarily stabs himself does this contrary to the right rule of life, and this the law does not permit; therefore he is acting unjustly (23). According to Plutarch, Cleomenes, had hanged himself should be left unburied; the ignothe son of Leonidas, gave the following answer when Therycion proposed suicide: from the time of Tarquinius Superbus, and that the Libri Pontificales prescribed that the body of one who miny of the hanged, he also says, is mentioned by Varro as well (36). It must also be underlined that, in the Hippocratic

Corpus there is not a single case in which suicide hopes, his name of continuity, his family of its support, his is suggested, let alone encouraged, although there is a house of an heir, and the Republic of a citizen-to-be (45). passage which could be interpreted as meaning that, at least sometimes, suicidal attempts were discouraged: Others who (after fasting seven days) were persuaded to eat and drink and not to let themselves die of starvation ... (37). We may therefore conclude that, in spite of the assertion of Edelstein mentioned above, the Pythagoreans were not alone in opposing suicide (38) and, therefore, that the Oath’s prohibition concerning poison was not necessarily of Pythagorean origin. In other words, the assumption of a necessary Pythagorean origin of the prohibition is unwarranted. Juvenal (early 2nd century A.D.) decries abortion as the murder of human beings within the womb: So great is the skill and so powerful the drugs of the abortionist who murders human beings within the womb (46). Ovid, not known for puritanical principles concerning sexual mores, laments the practice of abortion: Ah, women, why will you thrust and pierce with the instrument (literally: why do you dig with shafts at your vitals from below) and give dire poisons to your children yet unborn?. . . This neither the tigress has done in jungles of Armenia, nor has lioness had the heart to destroy her unborn young; yet tender woman does it — but not unpunished; oft she who slays her own in her bosom dies 2. Abortion herself. She dies herself, and is borne to the pyre with hair unloosened, and all who behold cry out: ‘Tis her desert’ (47). In antiquity, abortion was not universally accepted. As Edelstein has shown, one can find many ancient authors who considered it acceptable; it is not difficult, however, to find authors supporting the opposite view as well: Galen mentions that Lycurgus and Solon promulgated laws against abortion and asserts that their laws were based on the fact that the fetus is a living being (39). Some historians believe (although the record is not clear) that in at least some parts of the Greek world there were laws against abortion (40). The passage is of particular interest because it underlines that not only Ovid himself condemned abortion but ‘all who behold’, that is, the people who are present at the cremation as well. Seneca wrote with pride about his own mother: ... never, as it was common among other women. . . did you hide, almost as it were an indecent burden, the tumescent uterus, nor did you tear out from your viscera the conceived hopes of children . . . (48). The most important evidence against general Aristotle distinguishes abortion allowed and not allowed (‘to gar osion kai to me’), the difference acceptance of abortion, however, is given by Soranus resting on whether the fetus is alive and sentient gynecologists, in fact, clearly states that some physior not (41). cians opposed abortion in all cases because ‘it is the In the Commentary of Sopater (fourth century A.D.) there is reference to a work about abortion that may have been written by Lysias (c.460—c.370 B.c.) (42): has been engendered by nature’, and that even those There are, in fact, medical and philosophical problems. A medical problem, for example, is the one that Lysias also considered: if he who caused a woman to abort committed homicide. First of all, it is necessary to know if, before the expulsion, (the fetus) was alive. This kind of thing is for physicians and natural philosophers (to decide) . . . (43). Cicero (106-43 B.c.) describes with contempt a case of abortion motivated by greed: Having taken the money and many gifts, overcome by greed, she sold the promise in her womb that was entrusted to her by the husband (44). He also reports a case that occurred in Miletus: I remember a case . . . how a certain woman of Miletus, (98-138 A.D.). The greatest of the ancient specific task of medicine to guard and preserve what who were not opposed to it had ethical qualms and would allow it only to preserve the health of the mother: But (concerning abortion) a controversy has arisen. For one party banishes abortives, citing the testimony of Hippocrates who says: ‘I will give no one an abortive (49)’; moreover, because it is the specific task of medicine to guard and preserve what has been engendered by nature. The other party prescribes abortives, but with discrimination, that is, they do not prescribe them when a person wishes to destroy the embryo because of adultery or out of consideration for youthful beauty; but only to prevent subsequent danger in parturition. . . And they say the same about contraceptives as well, and we too agree with them (50). who had accepted a bribe from the alternative heirs and Obviously Soranus, while recognizing the necessity procured her own abortion by drugs, was condemned to of performing death: and rightly, for she had cheated the father of his the mother, abortion to protect the health acknowledges the moral problem by

asserting that it is to be condemned if performed for It is evident that, only if the sentence is translated trivial reasons (51). For our purpose, it is of interest Edelstein’s way (65), does it mean that the physician that he indicates that there were two factions among physicians and that one of the two felt that abortion had to be rejected in all cases (52). should not practice surgery at all. It is difficult to see, however, why the author of the Oath would have chosen such a cumbersome way to express himself. Finally, in the entire Corpus Hippocraticum, there If the idea was that the physician should not practice is but one prescription for aborting a healthy fetus. The case concerned a danseuse (owned by a procuress simply say ‘I will not use the knife’? As the operation surgery, why add ‘not even for the stone’? Why not who was a relative of the author) who allegedly was for the stone is not mentioned in the Hippocratic pregnant for 6 days. The author of the Hippocratic Corpus except in this passage (66), it could not have treatise advised the girl to expel the ‘seed’ by leaping occupied a particularly important place in Hippocratic so that the heels touched the buttocks — the so-called ‘Lacedaemonian leap’ (53). It is of interest that, in it were not to single it out as the only operation that antiquity, at least by some, this was not considered an abortion: medicine. Why mention the operation at all then, if was forbidden? It seems logical, therefore, to choose the alternate translation, mentioned as possible by And an ‘expulsive’ some say is synonymous with an Edelstein himself, and to conclude that the physician abortive; others, however, say that there is a difference taking the Oath simply promises not to operate for the because an expulsive does not mean drugs but shaking and leaping. . . For this reason they say that Hippocrates, although prohibiting abortives, yet in his book On the kinds of surgery. Nature of the Child employs leaping with the heels to the for the operation of lithotomy, the physician ‘will buttocks for the sake of expulsion (54). All the other prescriptions in the Hippocratic Corpus stone while, it is understood, he will practice other The point that remains to be clarified is why, withdraw in favor of such men as are engaged in this work’. It seems evident that the passage means that for emptying the pregnant uterus are for the expulsion of a dead, paralysed or half-developed fetus, in other the operation was to be performed by specialists (67), words, for the termination of an irreparably compromised pregnancy (55). operation and were therefore better able to perform i.e., by individuals who were experts in this specific it with less risk for the patient. Edelstein says that It would appear that, in classical times, there were ‘such an explanation . . . leads into great difficulties”, those who did not object to abortion, others who because ‘lithotomy as performed in antiquity was not felt it to be justified only in certain circumstances, a more daring operation than many other which the and others who were against it in all cases. In other general words, there was a body of opinion, unrelated to Pythagorean philosophy, that condemned abortion (68)’. (56), unfamiliar ground, did not appreciate the risks that and we believe that the Hippocratic Oath reflected this point of view (57). This being the case, the Pythagoreans do not need to be called into the picture and, once again, the assumption that the prohibition necessarily reflects their philosophy is unwarranted. practitioner undertook without hesitation It would appear that Edelstein, treading here on such surgery involved. Here is how the operation was described by Celsus: Two strong men should be put on the sides, and they by standing there prevent the man or men who are holding the boy (i.e., the young patient) from slipping. Then the surgeon having carefully pared his nails and anointed his 3. Surgery left hand, gently introduces two fingers, the index and the middle . . . into the anus . . . and the stone is first sought for about the neck of the bladder . . . if the stone is not found at The crucial sentence of the Oath concerning surgery, the neck of the bladder . . . the fingers are placed against ‘ou temeo de oude men lithiontas’, is translated the base of the bladder, while the surgeon’s right hand too by Edelstein as ‘I will not use the knife, not even on is placed above the stone and gradually follows it sufferers from stone,’ but he himself acknowledges downward. When the stone has been found, and it must fall that it can also be translated as ‘I will not use the between his hands, it is guided downward with special care knife either on sufferers from stone (58)’. Others, in the smaller and the smoother it is, lest it escapes ... When fact, have rendered it ‘I will not cut persons laboring under the stone (59)’, or ‘I shall not practice the operation for the stone (60)’, or ‘I shall not operate the stone has now got there (at the neck of the bladder), then the skin over the neck of the bladder next to the anus should be incised . . . then a second cut is to be made under the skin . . . to open up the neck of the bladder until the those who suffer from the stone (61)’, or ‘I will never urinary passage is open so that the wound is a little larger cut patients who suffer from stone (62)’, or ‘Also, I than the stone . . . Now when the urethra has been laid will not operate for the stone (63, 64)’. open, the stone comes into view . . if it is small, it can be

pushed outward with the fingers . . . if large, we must put Hippocratic injunction against operating for the stone, over the upper part of it the scoop made for the purpose but it would appear that the Oath, in this case, goes against Pythagorean tenets because the members (there follows a lengthy description of the complicated maneuvers to extract the stone with the scoop and of the dangers associated with it)... When the stone has been extracted, if the patient is strong . . . it is well to let the bleeding go on... . but if again the bleeding does not cease of the sect were against all kinds of surgery, as Edelstein himself has so clearly shown. of its own accord . . . (a very lengthy discussion of possible 4. Sexual behavior in the house of the sick complications and their treatment follows) (69). It is evident that the difficulties were great and The Hippocratic oath enjoins the physician to refrain, many, and that, under the conditions prevalent in in the house of the sick, from injustice and mischief ancient and from indulging in sexual contact with members of surgery (no asepsis, no antibiotics, no anesthesia), the incidence of serious complications the household. It is not clear why it is necessary to must have been high indeed. Celsus himself describes invoke a particular philosophical doctrine to support the operation as extremely risky, in fact, reckless such elementary rules of decency, which can be (‘temeraria medicina’), full of all sorts of dangers (‘in quo plura ... genera... periculi sunt”), usually disapexpected to be part of common morality. The Oath protects all members of the household, pointing (‘saepius utique ... fallat”) (70), and says men and women, free and slaves, against the amorous that it was to be used as ‘a last resource’ when ‘the desires of the physician. Edelstein, to make his case disease is so bad that it cannot be relieved by medicafor the Pythagorean origin of the Oath, underlines that ments or endured by the patient without shortly bringing his life to a close (71)’. women (and) they alone condemned sodomy’ (our ‘The Pythagoreans upheld the equality of men and In view of the above, it is reasonable to conclude italics). ‘Besides’, he continues, ‘in the performance that the Hippocratic physician did not want to perform of moral duties, they did not discriminate between the operation because it was too dangerous (72), and social ranks. In that respect free-born people and that he left it to the specialist because the risk for slaves, for the Pythagoreans, were on equal footing’. the patient would have been less if it was performed He then concludes that ‘everything, then, that the by somebody with a great deal of experience. At a time when theoretical background knowledge was with the tenets of Pythagorean ethics, in fact with Oath stipulates in regard to sexual continence agrees purely speculative and of little help, practical experithe ideals of these philosophers alone’ (our italics) ence was, in fact, all-important. As for the other operations that Edelstein assumed (77). Besides noting the suggestion that, to be as daring and that the general practitioner Greece, ‘the individual who was known to value his ‘undertook without hesitation’, in ancient they consisted in own sexual satisfaction highly was regarded with reduction of fractures and dislocations, resection of suspicion as a potential lawbreaker and an unreliable bone splinters in compound fractures, thoracenteses, paracenteses, operation of fistulas and hemorrhoids, the physician is condemned in the non-Pythagorean friend (78)’, and that concupiscence on the part of catheterizations, extraction of dead fetuses from the On Decorum (79), it is to be underlined that the uterus, and cauterizations (73). It is evident that none Pythagoreans were not alone in condemning sodomy. of these even approaches the complexity and dangers For example, Athenian law refers to sodomy as of lithotomy (74). The Hippocratic physician also making traffic of the shame of one’s body and debars practiced cranial trephining, of course, but, as we any citizen who practiced it from the exercise of his have operation, civil rights because ‘the man who has made traffic of practiced from prehistoric times, was not very danthe shame of his own body . . . would be ready to sell discussed elsewhere (75), this gerous if one took care, as the Hippocratic physician the common interests of the city also (80)’. The text of did (76), not to pierce the dura mater. the law is as follows: We may therefore conclude that, contrary to Edelstein’s view, the Oath did not forbid surgery in If any Athenian shall have prostituted his body, he shall not general but only the cutting for the stone. In addition, the Oath tells us that lithotomy had to be performed by specialists; the reason for this is not spelled out but the fact that it was a most dangerous operation be permitted to become one of the nine archons, nor to discharge the office of priest, nor to act as an advocate for the state, nor shall he hold any office whatsoever, at home or abroad, whether filled by lot or by election; he shall not take part in debate, nor be present at the public sacrifices; seems to be most logical explanation. when the citizens are wearing garlands, he shall wear none; In view of these considerations, not only is the position of the Pythagoreans irrelevant to the been purified for the assembling of the people. If any man and he shall not enter within the limits of the place that has

NOT A PYTHAGOREAN MANIFESTO who has been convicted of prostitution act contrary to these It is evident, therefore, that the Pythagoreans were prohibitions, he shall be put to death (81). not alone in condemning pederasty; nor can the Although the laws against it constitute perhaps the most important evidence indicating that homosexuality was neither accepted nor condoned by all in Athenian society, other evidence is found in the writings of several authors (82). Plato and Aristotle, in some passages, indicate that they considered homosexuality as being against nature: Hippocratic Oath be said to agree with the ideals of the Pythagoreans alone in regard to sexual continence. It would appear more logical to conclude that the Oath reflected, in this case, commonly held beliefs that, even if not espoused by everyone, were sufficiently widespread to be incorporated into the laws. This being the case, the assumption that the Oath’s prohibitions concerning sexual behavior in the pa- Whether these matters are to be regarded as sport, or as tient’s house could only be of Pythagorean origin earnest, we must not forget that this pleasure (i.e., sexual seems unwarranted. pleasure) is held to have been granted by nature to male and female when conjoined for the work of procreation; the crime of male with male, or female with female, is an outrage on nature and a capital surrender to lust of pleasure (83). Besides those things however which are naturally pleasant 5. Confidentiality The Oath enjoins the physician to keep to himself all that he may ‘see or hear in the course of the treatment ... there are other things, not naturally pleasant, which or even outside of the treatment in regard to the life of become pleasant either as a result of arrested development men, which in no account one must spread abroad.’ or from habit, or in some cases owing to natural depravity Edelstein finds the last part of the sentence (‘which . in no account one must spread abroad’) Other morbid propensities are acquired by habit, for instance . .. sexual perversion. These practices result in some cases from natural disposition, and in others from habit, as with those who have been abused from childhood (84). In Polybius we find: Agathocles in his early youth was a common prostitute, ready to yield himself to the most debauched, a jackdaw, a buzzard (lit., ‘very lecherous’), who would right about face to anyone who wished it (lit., ‘place his behind in front of anyone who wanted it’) (85). And Aristophanes says: He never was found in the exercise-ground, corrupting the boys: he never complied With the suit of some dissolute knave, who loathed that the vigilant lash of the bard should chide His vile effeminate boylove (86). strange (‘the latter phrase in particular has always seemed strange’) and thinks that it can be explained by the fact that the Pythagoreans were secretive and taciturn. He then concludes, ‘certainly if the doctor who promises not to talk about anything that he may see or hear is to be placed in any philosophical school, it must be the Pythagorean (88)’. The point is that we do not need to place physician confidentiality in any philosophical school. Confidentiality is simply what one expects from a physician. In fact, advice to this effect is found not only elsewhere in the Hippocratic Corpus (in The Physician, it is stated that the physician should be ‘silent (89)’; in On Decorum, that he should not ‘gossip to laymen, but say only what is absolutely necessary (90)’, but also in the physicians’ code of other ancient cultures as well (in the ‘Oath of Initiation’ of the As for the fact that, for the Pythagoreans, free-born Caraka Samhita (91), and, arguably, in the profiles people and slaves were on equal footing and that, of the good and bad physicians in Aztec medicine therefore, this would explain the language of the Oath (92) — see below). It is evident that, in classical times, that protects also the slaves of the household from the average patient in Greece expected physician conthe lecherous physician, Athenian law offered protecfidentiality as the ancient Hindu or Aztec patient did. tion from sexual abuse to slaves: It would appear, therefore, that the physician’s obligation to keep secret his knowledge about his If any Athenian shall outrage a free-born child, the parent patients did not derive from any particular philosophior guardian of the child shall prosecute him before the cal school; accordingly, to insist on a Pythagorean Thesmothetae, and shall demand a specific penalty. If the court condemn the accused to death, he shall be delivered to the constables and put to death the same day. If he be derivation of the Oath’s injunction concerning confidentiality seems to be unwarranted. condemned to pay a fine, and be unable to pay the fine immediately, he must pay within eleven days after the trial, and he shall remain in prison until payment is made. The 6. Relation with teachers same action shall hold against those who abuse the persons of slaves (our italics) (87). Even if the principles supporting the special relation

between teacher and pupil mentioned in the Oath cultural differences, the expression ‘or slave or a were found only among the Pythagoreans, ‘one would supplicant’ is also introduced. hesitate’, as Edelstein recognizes, ‘to claim Pythago- As for the financial help that the pupil was to prorean origin for the covenant by reason of one feature vide to the teacher, it may have been, as pointed out only, even if it be the main feature of this document by Jones, one of the promises that were couched in (93)’. It can be shown, however, that we do not need ‘extravagant language . .. but which were intended to to invoke a Pythagorean derivation even in this case. be interpreted in the spirit rather than in the letter The elements defining the teacher-pupil relation according to the Oath are the following: (102)’. It is of interest that the same notion that the teacher must be helped, financially if necessary, by the pupil, is also mentioned in the Caraka Samhita as a. the pupil must consider the teacher equal to his parents; b. the pupil is asked to share his life with the teacher and to support him with money if need be; c. the pupil vows to hold the teacher’s children as brothers; d. the pupil will teach medicine to his own sons, to those of the teacher, and to pupils ‘who have signed the covenant and have taken the oath according to medical law, but to no one else.’ As pointed out by Jones (94), we know from Plato that physicians taught medicine to their sons (95), and this could have encouraged the development of a father-son relation between teacher and pupil when, later, the teacher was no longer the biological father of the pupil. Galen reports that the Asclepiads (96) were for generations the sole possessors of medical knowledge and that they taught only members of their clan (97); it is likely that, to reinforce the feeling of belonging to the clan, the pupils would be encouraged to consider the teacher as a father. Later, the Asclepiads also taught pupils who did not belong to the clan (98) and it is logical to think that the same attitude toward their teachers would be requested from them (99). In addition, it has been stated that no consider the teacher as a father was part of the Western cultural tradition at least until the time of the Sophists (100). Moreover, the fact that the same concept that the teacher should be considered as a father is likewise found in the Caraka Samhita also suggests that the notion is not so unusual that only the Pythagorean origin of the Oath could explain it: The teacher then should instruct the disciple in the presence of the sacred fire, Brahmanas and physicians (saying): ... Thou shalt dedicate thyself to me and regard me as thy chief. Thou shalt be subject to me and conduct thyself for ever for my welfare and pleasure. Thou shall serve and dwell with me like a son (our italics) or a slave or a supplicant ... Acting either at my behest or otherwise, thou shalt conduct thyself for the achievement of thy teacher’s purpose alone, to the best of thy abilities (101). It is evident that the Caraka Samhita reflects the same notion of dependence and of father-son relation between pupil and teacher although, because of shown above (‘Thou shalt . . . conduct thyself for ever for my welfare . . .”). The commitment of the pupil to regard his teacher’s sons as his brothers, as Edelstein acknowledges, ‘naturally follows from the fact that the disciple acknowledges his master as his father’. The fact that the Pythagoreans ‘considered themselves brothers and were believed, like brothers, to have divided their earthly goods among themselves (103)’, appears to be irrelevant for the question at hand. Finally, the promise of the pupil concerning the way he would in turn teach medicine is simply in conformity with the way medicine was taught at the time, when physicians, as mentioned above, usually taught their own sons (104) as well as pupils who did not belong to the clan or guild (105). It would appear, therefore, that, the relations between pupil and teacher do not need a Pythagorean explanation and, therefore, that the assumption of a necessary Pythagorean origin of the precept is unwarranted. Discussion It is evident that, in antiquity, independently of Pythagorean philosophy, there was a considerable body of opinion upholding the tenets of the Hippocratic Oath. As the main thrust of Edelstein’s argument was that only the Pythagoreans held the beliefs reflected in the Oath, his conclusion that the document could only be Pythagorean is unjustified. There is no doubt that, as Edelstein has shown, many beliefs were shared by the Pythagoreans and by the author of the Oath but this does not prove direct derivation any more than the existence of beliefs shared by Pythagoreanism and Christianity proves the derivation of the latter from the former. In addition, the fact that the physician who took the Oath, although promising to abstain from doing lithotomies, fully intended to practice surgery (which was in violation of Pythagorean tenets), suggests that the Oath could not be a Pythagorean document. This point alone would be sufficient, in our opinion, to call into question the Pythagorean origin

of the Oath, but there are others as well. As it has with the wife of another, whether a free woman or a been pointed out (106), the Pythagorean concern for married slave, or with a boy, or with a virgin, or to counsel secrecy this to another. . . Let no woman or man who do the and ascetism supports the assertion that the members of the sect were not interested in personal renown and yet the Oath says that ‘If I fulfil this Oath and do not violate it, may it be granted to me ... (to be) honored with fame among all men for all time to come’. In addition, according to aforementioned acts come into this shrine; for in it are enthroned mighty deities, and they observe such offenses, and will not tolerate those who transgress their commands . - - These commands were set up by the rule of Agdistis, the most holy guardian and mistress of this shrine. May she put good intentions in men and women, free and slave Diogenes Laertius, Pythagoras ‘advised his disciples alike, that they may abide by what is here inscribed; and ... not to call the gods to witness’, in other words, not may all men and women who are confident of their to take oaths, ‘man’s duty being rather to strive to make his own word carry conviction (107)’. commandments of the god, at the monthly and at the annual uprightness touch this writing, which gives the In spite of this, the student (allegedly Pythagorean) sacrifices in order that it may be clear who abides by them not only would have taken the Oath (108), but would and who does not. O savior Zeus, hear our words, and give have started by calling the gods as witnesses. Therefore, as the evidence adduced by Edelstein us a good requital, health, deliverance, peace, safety on land and sea (115). does not warrant the assumption that the Oath is a If such principles applied to the worshippers of the Pythagorean document and the points just discussed goddess, it is evident that they must have applied also contradict such an assumption, we must conclude that to physicians, at least to those among them who the Oath was not a Pythagorean document and that the worshipped Agdistis (116). features common to it and to Pythagorean philosophy Other ethical codes for physicians, not necessarily are coincidental. If the Oath was not a Pythagorean manifesto, then in the form of an oath, are found in other cultures and what was it? First of all, there is no need to believe Hippocratic Oath although, as is to be expected, they that it had to be the expression of any particular philosophical school. The Oath simply reflected a common example, in the Caraka Samhita, the following text ethical standard, a popular morality (109) that the is the first part of an ‘Oath of Initiation’: they also contain many of the elements of the also differ in many respects. In Hindu medicine, for physician was expected to follow (110); in other words, it reflected the common morality of the patients (111) and not the moral tenets of any particular philosophical school, and surely not of the Pythagorean (112). Because of the special access that the physician has 13. (1) The teacher then should instruct the disciple in the presence of the sacred fire, Brahmanas and physicians (saying): (2) Thou shalt lead the life of a bachelor, grow thy hair and beard, speak only the truth, eat no meat, eat only pure to patients’ secrets and to the most intimate parts of articles of food, be free from envy and carry no arms. There shall be nothing that thou oughtest not do at my their bodies, it is logical to think that they would behest except hating the king or causing another’s expect him to behave in accordance with certain death or committing an act of great unrighteousness or commonly held ethical standards and ideals. The Hippocratic Oath simply reflects this fact. We have examples of similar oaths and codes. One of them, which does not apply only to physicians and, as far as we know, has no relation to Pythagorean doctrine, contains several of the principles upheld by the Oath. It was found in an inscription, of around 100 B.c., at Philadelphia, in Lydia (113), in the shrine of the goddess Agdistis (114): acts leading to calamity. (3) Thou shalt dedicate thyseif to me and regard me as thy chief. Thou shalt be subject to me and conduct thyself for ever for my welfare and pleasure. Thou shall serve and dwell with me like a son or a slave or a supplicant. Thou shalt behave and act without arrogance and with care and attention, and with undistracted mind, humility, constant reflection and with ungrudging obedience. Acting either at my behest or otherwise, thou shalt conduct thyself for the achievement of thy teacher’s purpose alone, to the best of thy abilities. Let men and women, slave and free, when coming into this (4) If thou desirest success, wealth and fame as a physician shrine swear by all the gods that they will not deliberately and heaven after death, thou shalt pray for the welfare plan any evil guile, or baneful poison against any man or of all creatures beginning with the cows and woman; that they will neither know nor use harmful spells; that they will neither turn to nor recommend to others nor Brahmanas. (5) Day and night, however though mayest be engaged, have a hand in love-charms, abortives, contraceptives, or thou shalt endeavor for the relief of patients with all thy doing robbery or murder; that they will steal nothing but will be well-disposed to this house, and if any man does or heart and soul. Thou shall not commit adultery even in purposes any of these things they will not keep silence but possessions. Thou shalt be modest in thy attire and will reveal it and avenge. A man is not to have relations appearance. Thou shouldst not be a drunkard or a sinful thought. Even so, thou shalt not covet other’s

man nor shouldst thou associate with the abettors of moderate in his acts. He provides health, restores people, crime. Thou shouldst speak words that are gentle, pure provides them splints, sets bones for them, purges them, and righteous, pleasing, worthy, true, wholesome and gives emetics, gives them potions; he lances, he makes moderate. Thy behavior must be in consideration of incisions in them, stitches them, revives them, envelopes them in ashes. The bad physician is a fraud, a half-hearted worker, a killer with his medicines, a giver of overdoses, an increaser time and place and heedful of past experience. Thou shalt act always with a view to the acquisition of knowledge and fullness of equipment. (6) No persons, who are haters of the king or who are haters of the public shall receive treatment. Similarly, those that are very unnatural, wicked and miserable character and conduct, those who have not vindicated their honor and those that are on the point of death and similarly women who are unattended by their husbands or guardians shall not receive treatment. (7 Ne, No offering of presents by woman without the behest of her husband or guardian shall be accepted by thee. While entering the patient’s house, thou shalt be accompanied by a man who is known to the patient and who has his permission to enter, and thou shall be wellclad and bent of head, self-possessed, and conduct thyself after repeated consideration. Thou shalt thus properly make thy entry. Having entered, thy speech, mind, intellect and senses shall be entirely devoted to no other thought than that of being helpful to the patient and of things concerning him only. The peculiar customs of the patient’s household shall not be made public. Even knowing that the patient’s span of life has come to its close, it shall not be mentioned by thee there, where if so done, it would cause shock to the patient or to others. (8) Though possessed of knowledge one should not boast very much of one’s knowledge. Most people are offended by the boastfulness of even those who are otherwise good and authoritative (117). In the Sushruta Samhita, we find that the physician was to follow these principles: Thou shall renounce lust, anger, greed, ignorance, vanity, egotistic feelings, envy, harshness, niggardliness, falsehood, idleness, nay all acts that soil the good name of a man. In proper season thou shall pare thy nails and clip thy hair and put on the sacred cloth, dyed brownish yellow, live the life of a truthful, self-controlled anchorite and be obedient and respectful toward thy preceptor... . Thou shall help with thy professional skill and knowledge, the Brahmanas, thy elders, preceptors and friends, the indigent, the honest, the anchorites, the helpless and those who shall come to thee (from a distance), or those who shall live close by, as well as thy relations and kinsmen (to the best of thy knowledge and ability), and thou shall give them medicine (without charging for it any remuneration whatever), and God will bless thee for that (118). (of sickness); one who endangers others, who worsens sickness; who causes one to worsen. (He pretends to be) a counselor, advised, chaste. He bewitches; he is a sorcerer, a soothsayer, a caster of lots, a diagnostician by means of knots. He kills with his medicines; he increases (sickness); he seduces women; he bewitches them (199). The Aztecs also developed profiles of the good and bad woman physician: The physician (is) a knower of herbs, of roots, of trees, of stones; she is experienced in these. (she is) one who has (the results of) examinations; she is a woman of experience, of trust, of professional skill: a counselor. The good physician is a restorer, a provider of health, a reviver, a relaxer —- one who makes people feel well, who envelopes one in ashes. She cures people; she provides them health; she lances them, she bleeds them — bleeds them in various places, pierces them with an obsidian lancet. She gives them potions, purges them, gives them medicine. She cures disorders of the anus. She anoints them; she rubs, she massages them. She provides them splints; she sets their bones — she sets a number of bones. She makes incisions, treats one’s festering, one’s gout, one’s eyes. She cuts (growths from) one’s eyes. The bad physician (pretends to be) a counselor, advised, a person of trust, of professional knowledge. She has a vulva, a crushed vulva, a friction-loving vulva. (She is) a doer of evil. She bewitches — a sorceress, a person of sorcery, a possessed one. She makes on drink potions, kills people with medications, causes them to worsen, endangers them, increases sickness, makes them sick, kills them. She deceives people, ridicules them, seduces them, perverts them, bewitches them, blows (evil) upon them, removes an object from them, sees their fate in water, reads their fate with cords, casts lots with grains of maize, draws worms from their teeth. She draws paper - flint — obsidian — worms from them; she removes these from them. She deceives them, perverts them, makes them believe (120). It is possible that codes for physicians existed in other ancient societies and that they have not reached us. Conclusions And these are the profiles of the good and bad male physicians according to the Aztecs: The physician (is) a curer of people, a restorer, a provider of health. The good physician (is) a diagnostician, experienced — a knower of herbs, of stones, of trees, of roots. He has (results of) examinations, experience, prudence. (He is) The evidence suggests that the Hippocratic Oath was an ethical code for physicians that reflected common morality, i.e. the ethical principles that, without necessarily belonging to any philosophical school, were accepted by the patients. As all moral codes, it was a target to approach, a goal to aspire to, an aim

not always, perhaps rarely, reached. It is a description of the ideal behavior of the ideal physician. Because, that ‘Edelstein’s thesis is tempting and, in my opinion, the most convincing so far advanced’, although he adds, ‘The Pythagorean origin of the Oath, however, should not be however, ideals always collide with the realities of everyday life, we may expect that many physicians, considered proved’. R. H. Feen (Feen R H. Abortion and even among those who took the Oath, did not live Abortion and the Status of the Fetus. Dordrecht/Boston: D. up to its principles. We have no reason to be astonished by this and we do not have to try to find an explanation except in the weakness of human nature. In addition, most probably, not all physicians took the Oath or agreed with its principles and it is possible that there were current several forms of it and that only by accident did the text that we know become the Hippocratic Oath (121). The first certain reference exposure in ancient Greece. In: Bondeson W B et al, eds. Reidel, 1983: 283-300) says that Edelstein ‘may not be too far off in his analysis’. . It would seem therefore that the ethical principles in the Oath were atypical of the medical profession and the moral values of ancient society as a whole’ (Feen R H. Abortion and Exposure in Ancient Greece. In: Bondeson W B et al, eds. Abortion and the Status of the Fetus. Dordrecht/ Boston: D. Reidel, 1983: 283-300); ‘it is reasonable to say with absolute certainty (our underlining) that the Oath, taken of as a whole, is an esoteric document that is often inconsonant with the larger picture of Greco-Roman medical ethics’ Hippocrates outside the Corpus is found in Scribonius (Amundsen D W. The Physician Obligation to Prolong Life: to the Oath Largus, a Roman physician who lived in the first half of the first century A.D., who states: A Medical Duty without Classical Roots. Hastings Center Report 1978; VIII (4): 23-30. . Edelstein L. op. cit., p. 62. . Edelstein L. op. cit., p. 6. Hippocrates, founder of our profession, to inspire human . Edelstein L. op. cit., p. 13. feelings in the minds of the students, began his instruction . Edelstein L. op. cit., p. 14. with an oath in which it was decreed that no abortifacient . Edelstein L. op. cit., p. 35. be given or revealed to a pregnant woman by any physician . Edelstein L. op. cit., p. 35. (122). . Edelstein L. op. cit., p. 38. It is of interest that Scribonius Largus felt that the Oath was written ‘to inspire human feelings in the mind of the students’, i.e. that it was an ethical code for the physician. The Pythagoreans are not mentioned. . Edelstein L. op. cit., p. 43. . Edelstein L. op. cit., p. 45. . Edelstein L. op . cit., p. 46. . Edelstein L. op. cit., p. 53. . Gourevitch D. Suicide Among the Sick in Classical Antiquity. Bull Hist Med 1969; XLIII: 501-518. . Edelstein L. op. cit., p. 17. . Philolaus of Croton or Tarentum (b. c. 470 8.c.), a Pythago- References and notes rean contemporary of Socrates. . This is how W. R. M. Lamb translates the sentence. See: Plato. 1. Edelstein L. The Hippocratic Oath: Text, Translation and Interpretation, Suppl. to the Bull Hist Med, No. 1. Baltimore: The Johns Hopkins Press, 1943. (Siegerist called the work ‘epoch-making’ (Siegerist H E. A History of Medicine. Oxford: Oxford University Press, 2 vols, II: 99). Phaedo, translated by W R M Lamb. The Loeb Classical Library. London: William Heinemann, 1913: 215. . Plato. Phaedo, 61e, 62b-c. In: Hamilton E, Cairns H, eds. The Collected Dialogues of Plato. Princeton: Princeton University Press, 1961: 44, 45. (Translation by Hugh Tredennick). The 2. Edelstein L. The Hippocratic Oath: Text, Translation and position of Plato concerning suicide was that it was justified Interpretation, Suppl. to the Bull Hist Med, No. 1. Baltimore: only in extreme circumstances but not if done because of The Johns Hopkins Press, 1943, reprinted in: Temkin O, ‘sloth and unmanly cowardice’. (See: Plato. Laws IX: 873C). Temkin C L, eds. Ancient Medicine, Selected Papers of 22. Aristotle. Nicomachean Ethics 1116a, 12ff. (Translated by Ludwig Edelstein. Baltimore: The Johns Hopkins Press, 1967: 53. David Ross). In: The Nicomachean Ethics of Aristotle. London: Oxford University Press, 1925: 67. 3. For example: Kudlien F. Medical Ethics and Popular Ethics in 23. Aristotle. Nicomachean Ethics 1138a, 9ff. (Translated by Greece and Rome. Clio Medica 1970; V: 91-121; Nickel D. David Ross). In: The Nicomachean Ethics of Aristotle. Ärztliche Ethik und Shwangerschaftsunterbrechung bei den London: Oxford University Press, 1925: 134. Hippokratern. NTM 1972; IX: 73-80; Harig G, Kollesch J. 24. Plutarch. Lives, Agis and Cleomenes XXXI: 4—5. (Transla- Der Hippokratische Eid: Zur Entstehung der antiken medizinischen Deontologie. Philologus 1978; CXXII: 157-176; tion by Bernadotte Perrin) The Loeb Classical Library. Cam- Lichtenthaeler C. Der Eid des Hippocrates: Ursprung und 25. Diogenes Laertius X, 119. (Translation by R. D. Hicks) The Bedeutung. Köln: Deutscher Ärzte-Verlag, 1984: 279-286. Loeb Classical Library. London: William Heinemann, 1931. 4. For example: Singer C. An Early Parallel to the Hippocratic Oath. Gesnerus 1951; VIII: 177-180; Siegerist H E. bridge, M A: Harvard University Press, 1921. A 26. Lucretius. De Rerum Naturae III: 79-83. Et saepe usque adeo, mortis formidine, vitae/percipit humanos odium lucisque History of Medicine. Oxford: Oxford University Press, 2 vols, videndae,/ut sibi consciscant maerenti pectore letum/obliti II, 1961: 303; Phillips E D. Greek Medicine. London: Thames and Hudson, 1973: 116; Nutton V. Museum and Medical fontem Schools, in Classical Antiquity. History of Education 1975; curarum hunc esse timorem. (Translation by P. Prioreschi). 27. The rarity may be explained, at least in part, by the fact that, IV (1): 3-15. For a very recent example, see: Magner L N. A in the Roman world, slave-physicians were common, and History of Medicine. New York: Marcel Dekker, 1992: 69. for them to refuse to obey an order of the master, even if it Darrel W. Amundsen (Amundsen D W. Physician concerned a request for poison for his own destruction, A Medical Duty without Classical would have been very difficult. ‘The contempt with which, for Roots. Hastings Center Report 1978; VII (4): 23-30.) says the most part, Romans regarded their physicians, because the Obligation to Prolong Life:

latter were either slaves or Greeks and present to carry out Lipsiae, in aedibus B. G. Teubneri, 3 vols., 1884, I, p. 626, orders, may sometimes explain the ease with which they exacted this very special service from them’. (Gourevitch D. Suicide among the Sick in Classical Antiquity. Bull Hist Med 1969; XLIII: 501-518). commentary of verse 602 of Aen. XII. 37. On Flesh IX. Littré VII: 612. 38. Edelstein, after having acknowledged the opposition to suicide of Aristotle and, possibly, Epicurus, says: ‘It is... 28. Hadrian. Scriptores Historiae Augustae XXIV: 13. The slaves important to stress that Aristotelian and Epicurean opposition of Marcellinus also refused to help him to commit suicide but it would appear that they refused not for moral scruples but to suicide did not involve moral censure. If men decided to because they were afraid of being accused of murdering their master (Seneca. Ad Lucilium epistulae morales LXXVII: 7). masters 29. take their lives, they were within their rights as sovereign of themselves. The Aristotelian and Epicurean schools condoned suicide’ (Edelstein L. op. cit., p. 17). The ‘I considered that it was not consonant with my code to cause passage is unclear. It is not readily apparent why it should anybody's death, and I was taught that medicine was to be used to heal men rather than cause their death’. (Apuleius. be important that the Aristotelian and Epicurean opposition The Golden Prioreschi). not spell out either on which ground the prohibition rests). Edelstein (Edelstein. op. cit., pp. 13 and 14, footnotes 23 and It is not readily evident, in the context, what the second 24) seems to dismiss this episode by pointing out that the sentence is supposed to convey. Finally, the third sentence same physician had not previously rejected the request for does not seem to agree with the first nor with at least some Ass X:11) (Translation by P. to suicide ‘did not involve moral censure’ (the Oath does poison on general grounds (Apuleius. The Golden Ass X: 9). It is evident, however, that the fact that he made such a stateof the evidence (e.g., Lucretius’ quotation). 39. Galen. An animal sit quod in utero geritur v, K ment in a court of law indicates that it reflected commonly accepted beliefs. XIX: 179-180, The work is of uncertain authenticity. 40. For a discussion on this subject, see: Moissidés. Contribution 30. Concerning murder, sometimes physicians refused to particia l’étude de l’avortement dans l’antiquité grecque. Janus pate in poisoning schemes even at the risk of their lives. Herodian (III: 15) tells us that Caracalla tried to persuade 41. Aristotle. Politics VII, xiv, 1335b: 24-26. In Generation of 1922; XXVI: 58-85. the doctors of his father Severus to hasten his demise. They refused and, when the old man died, Caracalla had them Animals, it is stated that the fetus is alive and that it acquires the ‘sentient Soul’ during its development (See: Aristotle. Generation of Animals II (iii): 736a—b). killed. 31. Encyclopedia of Religion and Ethics. Hastings J, ed. 42. Whether the passage can be attributed to Lysias is de- Edinburgh: T. & T. Clark, 13 vols., 1908-1926, XI: 30. batable, but the text is nevertheless of interest because it suggests (together with other references to the existence of 32. Edelstein L. op. cit., p. 13. 33. ‘This is why the state exacts a penalty; suicide is punished such a document by Lysias) that, in Lysias’ time, there were by certain marks of dishonor, as being an offence against discussions about abortion. For a review of the pertinent the state’ (Aristotle. Nichomachean Ethics V (xi) 3-4). (Translation by H. Rackham. The Loeb Classical Library. Cambridge MA: Harvard University Press, 1934. That there were laws concerning rites of purification and of burial of suicides is also mentioned by Plato (Plato. Laws IX: 873D). 34. ‘And when a man kills himself, the hand that did the deed is buried apart from the body’ (Aeschines. Against Ctesiphon 244. (Translation by C. D. Adams. The Loeb Classical Library. London: William Heinemann, 1919). See also: Cooper J M. Greek Philosophers on Euthanasia and Suicide. In: Brody B A, ed. Suicide and Euthanasia: Historical and Contemporary Themes. Dordrecht: Kluwer Academic, 1989: 9-38 (24). 35. Edelstein dismisses the importance of Athenian laws against suicide because they ‘have been rightly explained... as directed against those who committed suicide when still able to bear arms’ (Edelstein L. op. cit., p. 15, footnote 29). Even if suicide was condemned because it was a way to escape obligations toward the state, it is not farfetched to think that it could have been forbidden also because it was an escape from obligations toward family, city, creditors, etc., whether the suicide was sick or not. In fact, in Thebes suicide for any reason was forbidden (Hirzel R. Der Selbstmord. Archiv fiir Religionswissenschaft 1908; XI: 75-104; 243-284; 417-476; (268); Edelstein asserts that this was because Philolaus, a Pythagorean, lived there for some time, and ‘it seems probable that the well-known theory of the famous philosopher was projected into the legislation of Thebes’ (Edelstein L. op. cit., p. 20, footnote 49). There is no evidence that this was the literature on this passage see: Nardi E. Procurato aborto nel reason for the law. In any case, the crucial point for our discussion is that, for whatever reason, there were laws against suicide, in other words, for whatever reason, suicide was condemned. 36. Servii Grammatici qui feruntur in Vergilii carmina commentarii, recenserunt Georg Thilo et Hermann Hagen, mondo greco romano. Milano: Giuffré, 1971: 82-116. 43. Quoted by: Nardi E. Procurato aborto nel mondo greco romano. Milano: Giuffré, 1971: 86-87. (Translation by P. Prioreschi). . Cicero. Pro Cluentio XII. ‘Quo illa pretio accepto multisque praeterea muneribus ... spem illam, quam in alvo commendatam a viro continebat, victa avaritia . . . vendidit’. (Translation by P. Prioreschi). The condemnation could be considered as due to the betrayal of the husband’s trust more than to the abortion itself, but, by calling the fetus ‘spem’ (that is, hope, prospect, promise of future achievements), Cicero seems to indicate condemnation of abortion per se. For a discussion about the designation of the baby to be born as ‘spes’, see: Nardi E. Procurato aborto nel mondo greco romano. Milano: Giuffré, 1971: 354-360. 45. Cicero. Pro Cluentio XI. (Translation of H. Grose Hodge) The Loeb Classical Library. London: William Heinemann, 1927. 46. Juvenal. Saturae VI: 595-597. ‘Tantum artes huius, tantum medicamina possunt/quae steriles facit atque homines in ventre necandos/conducit.’ (Translation by P. Prioreschi). 47. Ovid. Amores II (xiv): 27-28, 35-40. (Translation by Grant Showerman) The Loeb Classical Library. London: William Heinemann, 1921. 48. o numquam abscondisti more quasi aliarum ... indecens onus, tumescentem nec intra uterum viscera tua conceptas spes liberorum elisisti . . .’. Seneca. Dialogues, Ad Helvetiam matrem de consolatione II (xvi): 3. Quoted by: Nardi E. Procurato aborto nel mondo greco romano. Milano: Giuffré, 1971: 247. (Translation by P. Prioreschi). 49. The Hippocratic Oath reads, literally: ‘I shall not give a woman an abortive pessary.’ 50. Soranus. Gynecology XIX: 60. (Translated by Owsei Temkin with the assistance of Nicholsons Eastman, Ludwig

Edelstein, and Alan F. Guttmacher) Baltimore: The Johns Hopkins University Press, 1956: 63. 51. Discussing the characteristics of the good midwife, he says: ‘She must not be greedy for money, lest she give an abortive wickedly for payment’ (Soranus. Gynecology I (ii): 4. (Translated by Owsei Temkin with the assistance of Nicholsons J. Eastman, Ludwig Edelstein, and Alan F. Guttmacher) Baltimore: The Johns Hopkins University Press, 1956: 7). 52. Curiously enough, Edelstein reads in this passage that Soranus ‘had little patience with these colleagues of his’, that is, with those who rejected abortion under all circumstances, and that ‘he resorted to abortion whenever it seemed necessary, much as he deprecated it if performed for no other reason than the wish to preserve beauty or to hide the consequence of adultery’ (Edelstein L. op. cit., p. 14). It is evident that, in this passage, Soranus neither shows ‘little patience’ with those condemning abortion, nor shows evidence that ‘he resorted to abortion whenever it seemed necessary, much as he deprecated ... etc.’ What he says is that abortion should not be performed except when the safety of the mother requires it. The condemnation in other cases is clear. 53. On the Nature of the Child XIII. Littré VII: 490. For a discussion of this case see: Prioreschi P. Quandoque bonus dormitat Hippocrates: Induced abortion and embryos’ age in the Hippocratic Corpus. Acta Belgica Historiae Medicinae 1992; V (4): 181-184. 54. Soranus. Gynecology I (xix): 60. (Translated by Owsei Temkin with the assistance of Nicholsons J. Eastman, Ludwig Edelstein, and Alan F. Guttmacher) Baltimore: the Johns Hopkins University Press, 1956: 62. Undoubtedly, to us the Lacedaemonian leap seems to be a prescription for abortion. 55. For a discussion of this topic, see: Nardi E. Procurato aborto nel mondo greco romano. Milan: Giuffré, 1978: 72-82. 56. For the position of other ancient authors on the question of abortion, see: Nardi E. Procurato aborto nel mondo greco Quellenstiicke is ‘toxic (or damaging, or abortive) pessary’ presumably because of the ulcerations that they may have caused (Riddle J M. Oral Contraceptives and Early-term Abortifacients during Classical Antiquity and the Middle Ages. Past and Present No 132: 3-32, August 1991). In this context, however, it is quite evident that phtorion means abortive and it has been so interpreted since antiquity (see, for example, the quotation from Scribonius Largus reported at the end of this Hippokrates bis Galen mit der 1962: 9). . Others have translated the passage in a similar way: an Arabic translation of around the tenth century renders it: ‘I will not operate on those who have stone in the bladder’; a Latin translation of the sixteenth century says: ‘laborantis lapillo haudquaquam Doctor’s Oath: excisurum'. An Essay in the (Jones W H S. The History of Medicine. Cambridge: At the University Press, 1924: 33, 35). Jones, in spite of his translation for the Loeb Library (see below), acknowledges, in The Doctor’s Oath, that the sentence could mean ‘As to operating, I, furthermore, will not operate for stone’. (Jones W H S. The Doctor’s Oath: An Essay in the History of Medicine. Cambridge: At the University Press, 1924: 47). For a discussion on the translation of the sentence see: Kudlien F. Zwei Interpretationen zum Hippokratischen Eid. Gesnerus 1978; XXXV: 253-263. 65. It must be underlined that Edelstein is not the only one to translate the sentence in a way that indicates the forbidding of the practice of surgery. For example, W. H. S. Jones, in his translation for the Loeb Library, renders it ‘I will not use the knife, not even, verily, on sufferers from stone’. (Hippocrates (translated by W. H. Jones) The Loeb Classical Library. Cambridge MA: Harvard University Press, 1923 - see above for his translation in The Doctor’s Oath); J. Chadwick et W. N. Mann render it ‘I will not cut, even for the stone’. (Hippocratic Writings. Lloyd G E R, ed. Harmondsworth: Penguin Books, 1978: 67); Nittis translates it ‘I will not cut, indeed not even sufferers from stone’. (Nittis S. The Hippocratic Oath in Reference to Lithotomy: A New Interpretation With Historical Notes on Castration. Bull Hist Med 1939; VII: 719-728); also, a Latin translation of the fourteenth century reads: ‘non incidam autem neque lapiditatem patientes’. (Jones W H S. The Doctor’s Oath: An Essay romano. Milano: Giuffré, 1971, passim. 57. It has been suggested that, in reality, the Hippocratic Oath does not prohibit abortion but only pesson phtorion, that von Übertragung ins Deutsche. München: Ernst Heimeran Verlag, in the History of Medicine. Cambridge: At the University Press, 1924: 37). 66. In the Corpus there are several references to bladder calculus (e.g., Diseases I, VI; Diseases IV, LV; Airs Waters Places IX) but lithotomy is mentioned only in the Oath. 67. We do not know anything definite about the existence of Specialists in the classical period but, as Edelstein says, ‘it is hard to believe that in the Hippocratic period specialization was unknown’ (Edelstein L. op. cit., pp. 28-29, footnote 86). In addition, that specialization existed in antiquity is shown by the passage of Herodotus: ‘The practice of medicine is so divided among them (that is, Egyptian physicians), that each paper). 58. Edelstein L. op. cit., p. 29. The alternate translation is by W. H. S. Jones, who, however, in a footnote says: ‘Perhaps, “I will not use the knife even on sufferers from stone,”’ Physician is a healer of one disease and no more. All the country is full of physicians, some of the eye, some of the see: Jones W H S. The Doctor’s Oath: An Essay in the History of Medicine. Cambridge: At the University Press, teeth, some of what pertains to the belly, and some of the hidden diseases’. (Herodotus II: 84). (Translation by A. D. Godley. The Loeb Classical Library. London: William 1924: 11. See below for Jones’ translation for the Loeb Heinemann, 1920). The tradition of the operation of lithotomy Library. being performed by non-physicians, that is, by ‘such men as 59. Adams F, The Genuine Works of Hippocrates. London: The are engaged in this work’, seems to have survived until Sydenham Society, 2 vols., 1849, II: 780. 60. ‘Je ne pratiquerai pas |’ opération de la taille’. Littré IV: 631. 61. ‘Non opererö colorö che soffrono del male della pietra’ modern times: up to the middle of the XIXth century, in the (Pazzini 62. A, Baffioni G. ‘Ancora per una più precisa countryside of France, there were still itinerant charlatans operating for the d’Hippocrate: Analyse stone (Lichtenthaeler d’ensemble. C. Rev Le serment Med Suisse traduzione e interpretazione del “Giuramento’ d'Ippocrate””. Romande 1980; C: 1001-1011), and Adams, in 1849, could Pagine di Storia della Medicina 1972; XVI: 83-89). ‘Ich werde niemals Kranke schneiden, die an Blasestein write that in leiden’ (Deichgriber K. Der hippokratische Eid: Text formed by non-professional persons’. (Adams F. The Genuine griechisch und deutsch — Interpretation — Nachleben. Stuttgart: Hippokrates Verlag, 1983: 15). 63. “Auch werde ich den Blasenstein nicht operieren’ (Müri W. Der Arzt im Altertum: Griechische ind lateinische Scotland ‘not perhaps much more than a hundred years ago, it was common for lithotomy to be perWorks of Hippocrates. London: The Sydenham Society, 2 vols., 1849, II: 778). 68. Edelstein L. op. cit., pp. 28, 29. 69. Celsus. De Medicina VII: 26. (Translated by W. G. Spencer)

Loeb Classical Library. Cambridge MA: Harvard University Press, 1938: 431 ff. Cambridge MA: Harvard University Press, 1938: 428. Classical Library. Cambridge MA: Harvard University Press, 1938: 427, 429. Aretaeus (Chronic Diseases II: iv) also describes the dangers of lithotomy. 72. Koelbing H tionen zum M. Zu Fridolf Kudliens Hippokratischen XXXVI: 156-158; Ch. Rogers) The Loeb Classical Library. Interpreta- Gesnerus Lichtenthaeler. Harvard University Press, 1919. 88. Edelstein L. op. cit., pp. 37, 38. . The Physician I. Littré IX: 204. Edelstein dismisses the importance of the passage by saying that the statement serves “Zwei Eid’. 87. Aeschines. Against Timarchus 16. (Translation of Charles Darwin Adams) The Loeb Classical Library. Cambridge MA: 71. Celsus. De Medicina VII: 26. (Translated by W. G. Spencer) Loeb Bickley Cambridge MA: Harvard University Press, 1924. 70. Celsus. De Medicina VII: 26. The Loeb Classical Library. The Benjamin Le 1979; serment d’Hippocrate: Analyse d’ensemble. Rev Med Suisse Romande 1980; C: 1001-1011. Adams says: ‘in the whole compass of ancient medical literature, there is not a single a utilitarian purpose whereas the Oath ‘insists on secrecy not as a precaution but as a duty’. (Edelstein L. op. cit., p. 37). 90. On Decorum VII. (Translation by W. H. S. Jones) The Loeb Classical Library. Cambridge MA: Harvard University Press, 1923. description of the operation by a person who had actually performed it... Galen... never once hints that he meddled 91. The Caraka Samhita, the Sushruta Samhita, and the Bhela with the operation ... the descriptions of the operation given medicine. The first two were probably written soon after the by Celsus and Paulus Aegineta are evidently Samhita are the three main texts of Hindu naturalistic copied’. beginning of our era but reflect a much earlier oral tradition. (Adams F. The Genuine Works of Hippocrates. London: The See: Prioreschi P. A History of Medicine, Vol I, Primitive and Sydenham Society, 2 vols., 1849, II: 777). Ancient 73. Littré IV: 617. In Internal Affections (XIV, XV, and XVII) are Medicine. Lewiston: The Edwin Mellen Press, 1991: 244ff. mentioned renal operations associated with renal calculi, but 92. In these the bad physician ‘pretends to be a counselor’ but of it is evident that the author describes incisions of peri-renal course (or she) is not. It seems justified to assume that one of or para-renal abscesses. the virtues lacking in somebody who pretends to be a 74. For a discussion of the dangers, difficulties, and risks of lithotomy as practiced in ancient times, see: Petrequin J E. Chirurgie d’Hippocrate. Paris: Imprimerie Nationale, 2 vols, 1877, I: 195-198. 75. Prioreschi P. Possible Reasons for Neolithic Skull Trephining. Perspectives in Biology and Medicine 1991; XXXIV (2): 296-303. . Edelstein L. op. cit., p. 35. . Plato. Laws IV: 720b. Although, in this passage, the word paidas is often translated as ‘pupils’ or ‘disciples’ so that it Cambridge MA: Harvard University Press, 1926), the most co- Aristotle. Berkeley: University of California Press, 1974: 209. 79. On Decorum, V. mmon acception of pais is ‘child’ or ‘son;’ the passage, therefore, should read ‘the free-born doctors. . . instruct their sons’. 96. The Asclepiads, apparently, were a family (or clan) so called Against Darwin S. The Doctor’s Oath: An Essay in the History of Medicine. Cambridge: At the University Press, 1924: 56. ((Translation by R. G. Bury) The Loeb Classical Library. 78. Dover K J. Greek Popular Morality in the Time of Plato and Charles . Jones W H reads ‘the free-born doctors... instruct their own disciples’ 76. On Wounds in the Head, xxi. . Aeschines. counselor is confidentiality. . Edelstein L. op. cit., p. 44. Timarchus, Adams) The 29-30. Loeb (Translation Classical of because they asserted that they were descendants of Asclepius Library. through his son Podalirius. See: Jouanna J. Hippocrate de Cambridge MA: Harvard University Press, 1919. 81. Aeschines. Against Timarchus 21. (Translation of Charles Darwin Adams) The Loeb Classical Library. Cambridge MA: Cos et le sacré. Journal des Savants Janvier-Juin 1989: 3-22; Harvard University Press, 1919. 82. For a review of this subject, see: Prioreschi P, Brehm E Kallen H M. In: Aristole: Politics and Poetics (Translated by Benjamin Jowett and S. H. Butcher) Norwalk, CT: The Easton Press, 1979 (reprint of 1964 edition) p. IX; Jones J. W HS. The Doctor’s Oath: An Essay in the History of Male Homosexuality in Classical Greece. Proceedings of the XXXIIIrd International Congress on the History of Medicine. Medicine. Cambridge: Cambridge University Press, 1924: 44; Granada, 1992, in press. 83. Plato. Laws 636c. (Translation by A. E. Taylor) In: Hamilton E, Cairns H, eds. The Collected Dialogues of Plato. Princeton: Princeton University Press, 1963. The same passage is translated by R. G. Bury (Loeb Classical Library) as follows: ‘Whether one makes the observation in earnest or in jest, one certainly should not fail to observe that when male unites Jones W H S. Hippocrates. Cambridge MA: Harvard University Press, 4 vols, 1923 xliv—xlvi. 97. Galen. De anatomicis administrationibus II (i) K IL: 280. . Hippocrates taught outside pupils for a fee; see: Plato. Protagoras: 311b. Medical fraternal societies may have later replaced the clan and it is possible that many physicians may have joined them. For a discussion of this possibility see: Nittis S. The Authorship and Probable date of the Hippocratic with female for procreation the pleasure experienced is held Oath: to be due to nature, but contrary to nature when male mates with male or female with female, and that those first guilty of xyngraphe with a Short History of Greek Fraternal Societies. such enormities were impelled by their slavery to pleasure.’ Ethics and Popular Ethics in Greece and Rome. Clio Medica 84. Aristotle. Nicomachean Ethics VII (v): 1-3. (Translation by H. Rackham) The Loeb Classical Library. Cambridge MA: Harvard University Press, 1939. The Greek text on aphrodision tois arresin, translated by Rackham as ‘sexual perversion’, literally means ‘sexual pleasure with males’. Linguistic and Philological Considerations of the Bull Hist Med 1940; VIII: 1012-1021; Kudlien F. Medical 1970; V: 91-121. 99. Because Galen “does not mention that they were made members of the family or forced to share any obligation”, Edelstein, with an argument ab absentia, declares that Galen’s passage cannot be taken as supporting the position 85. Polybius. The Histories XII (15): 1-3. (Translation by W. R. that in Greece, especially in the early centuries, ‘medicine Paton) The Loeb Classical Library. Cambridge MA: Harvard like all other arts was passed from father to son in closed University Press, 1925. family guilds’ and that ‘what at a certain time these organiza- 86. Aristophanes. The Wasps 1024-1027. (Translated tions began to receive outsiders into their midst, they ...

demanded from them full participation in the responsibilities of the ‘real’ children (Edelstein L. op. cit., pp. 40, 41). For a we must assume that Plato felt that physicans, in view of their professions, were bound to ethical standards more rigid than criticism of Edelstein’s position on this point, see: Pazzini A, Baffioni G. Ancora per una più precisa traduzione e those of ordinary citizens. 111. It interpretazione del ‘Giuramento’ d’Ippocrate. Pagine di Storia della Medicina 1972; XVI: 83-89. is of interest that the mistaken idea persists that suicide and abortion were universally accepted in ancient Greece and that, therefore, the Oath, even if not of Pythago- 100. E. Hoffmann. Kulturphilosophisches bei den Vorsokratikern. Neue Jahrbiiker fir Wissenschaft und Jugendbildung 1929; rean derivation, was against the prevailing morals. See: Koelbing H M. Zu Fridolf Kudliens ‘Zwei Interpretationen zum Hippokratischen Eid’. Gesnerus 1979; V: 2-24. See also: Lichtenthaeler C. Der Eid des Hippocrates: Ursprung und Bedeutung. Kéln: Deutscher Arzte-Verlag, XXXVI: 156-158. 112. Kudlien F. Zwei Interpretationen zum Hippokratischen Eid. 1984: 79-110, 285. 101. The Caraka Samhita. Translated by the Shree Gulabkunverba Gesnerus 1978; XXXV: 253-263; Harig G, Kollesch J. Der Ayurvedic Society, Jamnagar, India, 6 vols, 1947-49, V, Hippokratische Eid: Zur Entstehung der antiken medizinip. 326. schen 102. Hippocrates. The Loeb Classical Library. Cambridge MA: Harvard University Press, VI vol., Deontologie. Philologus 1978; CXXII: 157-176; Triebel-Schubert C. Bemerkungen zum Hippokratischen Eid. 1923-1987, I, p. 295. Midizinhistorisches J 1985; XX: 253-260; Lichtenthaeler C. Jones adds in a footnote: ‘Compare modern interpretations of Der Eid des Hippocrates: Ursprung und Bedeutung. Köln: Deutscher Arzte-Verlag, 1984: 287-292. marriage vows.’ 113. The city had been founded only fifty years earlier and was 103. Edelstein L. op. cit., p. 46. 104. Plato. Laws IV: 720b. part of the Attalid Empire based on Pergamum as capital. It 105. Plato. Protagoras: 311b. 106. Lichtenthaeler C. Le shared the Pergamenian culture as a remote provincial town’ serment d’Hippocrate: Analyse (Singer d’ensemble. Rev Med Suisse Romande C: 1001-1011. 107. Diogenes Laertius VIII: 22. Translated by R. D. Hicks. The Loeb Classical Library. London: William Heinemann, 1925. 108. Edelstein says concerning this point: ‘Still this C. An early Parallel to the Hippocratic Oath. Gesnerus VII: 177-180. hardly 114. ‘Agdistis was a mother-goddess whose cult was widely spread in Anatolia, Egypt, and even in Attica, from the third century B.c. onward. Such a mother-goddess, under means that the Pythagoreans intended to ban all oaths and all various titles, is characteristic of the numerous Anatolian invocations of divine witnesses. No Greek could ever have cults of the time. She is often associated with a male deity, gone that far’. In addition, he mentions that Diodorus Siculus sometimes as (with?) Asclepios, but more often under other (X, 9, 2) ‘expressly states (that), in the opinion of the school, names. an oath should be sworn only on rare occasions’ and that the sometimes Agdistis is associated with Zeus’ (Singer C. An Pythagoreans took an oath of allegiance when they became Early members of the society. (Edelstein L. op. cit., p. 53). Because VII: 177-180). According to the myth, Agdistis was origithe Hippocratic Oath, however, mentions another oath and a covenant (‘... who have signed a covenant and have taken Generally Parallel to her the consort Hippocratic is subordinate Oath. Gesnerus but 1951; nally androgynous. 115. Singer C. An Early Parallel to the Hippocratic Oath. Gesnerus an oath. ..’) to be taken and signed by pupils who were not 1951; sons of teachers (Edelstein L. op. cit., p. 48, footnote 158), the given in Dittenberg W. Sylloge Inscriptionum Graecarum, 3rd Pythagorean pupil who was not the son of a teacher and edn., No 985, and that the English translation is from Nock who decided to become a physician would have had to take at A D. Conversion: The Old and the New in Religion from VIII: 177-180. The author states that the text is least three oaths (one as a Pythagorean, one as a pupil who Alexander the Great to Augustine of Hippo. Oxford: Oxford was not the son of a teacher, and the third the Oath itself) and, in addition, to sign a covenant. This does not seem to University Press 1933: 216. 116. Curiously enough, although such code of non-Pythagorean agree either with Diogenes Laertius’s or with Diodorus origin Siculus’s passages. Hippocratic Oath can be explained only in Pythagorean 109. Kudlien F. Medical Ethics and Popular Ethics in Greece and Rome. Clio Medica 1970; V: 91-121; concerning Greek obviously undermines the assumption that the terms, Sigerist considered it a confirmation of Edelstein’s theory and says: ‘This (Edelstein’s) theory of the origin of the popular morality in general, see: Dover K J. Greek Popular Oath is confirmed still further by . . . (the following) document Morality in the Time of Plato and Aristotle. Berkeley CA: ... (the text of the Agdistis inscription follows). I do not think University of California Press, 1974 (for a definition of poputhat there is any direct relation between this oath and the lar morality, see pp. 1-5; for a discussion of Greek popular Hippocratic Oath, but the document is very important neverattitudes toward suicide see pp. 168-169; for a discussion of theless, for it shows what ethical rules prevailed in certain attitudes toward sexual continence see pp. 208-209 and religious circles’. (Sigerist 212-213). 2 vols, Oxford: Oxford University Press, 1951 and 1961, 110. Plato, in his Laws, proposes the following concerning poison and poisoning: II: 303, 304). 117. The Caraka Samhita. Translated by the Shree Gulabkunverba Ayurvedic Any man administering a poison to another, or to persons employed by him . . . and convicted of the offense of poisoning shall, if a physician, suffer death, and if a layman, such penalty or fine as the court shall impose. (Plato. Laws XI: 933c--d. In: Hamilton E, Cairns H, eds. The Collected Dialogues of Plato. Princeton: Princeton University Press, 1961: 1483-1484. (Translation by A. E. Taylor)). Because the penalty is more severe in the case of physicians, H E. A History of Medicine, Society, Jamnagar, India, 6 vols, 1947-49, V: 326-327. 118. An English Translation of The Sushruta Samhita. Translated by Kaviraj Kunjalal Bhishagratna, Varanasi, India, 3 vols, 1963, I: 18, 19. 119. Florentine Codex. Translated by Charles E. Dibble and Arthur J. O. Anderson, The University of Utah, Book 10, 120. Florentine Codex. Translated by Charles E. Dibble and Arthur J. O. Anderson, The University of Utah, Book 10, 1061: 53.

121. Jones W H S. The Doctor’s Oath: An Essay in the History of 122. aut demonstretur a quoquam medico, longe praeformans Medicine. Cambridge: Cambridge University Press, 1924: 18. animos discentium ad humanitatem. Quoted in: Jones W H S. ‘Hippocrates, conditor nostrae professionis, initia disciplinae The Doctor’s Oath: An Essay in the History of Medicine. ab iureurando tradidit, in quo sanctum est, ne praegnati quidem medicamentum, quo conceptum excutitur, aut detur Cambridge: Cambridge University Press, 1924: 39. Translation by P. Prioreschi.