Wednesday, June 10, 2015

The Hippocratic Oath for Hypocrites


The Hippocratic Oath is an oath historically taken by doctors swearing to practice medicine ethically.  The Greek physician, Hippocrates, from the 5th Century B.C., is the author.  Adopted about 26 centuries ago it withstood the test of time for nearly 2,500 years before changes in 1948 and 1964, the last 67 years, effectively destroyed the original intent.

From the website Greek we learn the following.


Father of Medicine

Medical historians generally look to Hippocrates as the founder of medicine as a rational science.  It was Hippocrates who finally freed medicine from the shackles of magic, superstition, and the supernatural.  Hippocrates collected data and conducted experiments to show that disease was a natural process and that the signs and symptoms of a disease resulted from the natural reactions of the body to the disease process.  He also believed that the chief role of the physician was to aid the natural resistance of the body to overcome the metabolic imbalance and restore health and harmony to the organism.

Hippocrates was born on the island of Cos, off the southwest coast of Asia Minor, or present-day Turkey, around 460 B.C.  His father was a physician-priest in the Asclepion at Cos, and his family could trace its lineage back to the legendary Asclepius.  Hippocrates lived a very long life and died at a ripe old age in the town of Larissa in Thessaly.

The Hippocratic Revolution

When Hippocrates began to practice medicine, the established school of medicine was the Cnidian School, but this school's approach to medicine had several serious flaws, which were already becoming apparent and starting to cause a general dissatisfaction with the art of medicine.

The Cnidian School considered the body to be merely a collection of isolated parts, and saw diseases manifesting in a particular organ or body part as affecting that part only, which alone was treated.  Their system of diagnosis was also faulty, relying exclusively on the subjective symptoms related by the patient, while totally ignoring the objective signs of the disease.
Hippocrates radically disagreed with the Cnidian School, countering that the human body functioned as one unified organism, or physis, and must be treated, in health and disease, as one coherent, integrated whole.  In diagnosis, not only the patient's subjective symptoms, but the objective signs of the disease must also be considered to arrive at an accurate assessment of what was going on.

As his unifying theory for the holistic understanding of the human organism, and how it functions in health and disease, Hippocrates used the concept of the Four Humors.  Building on the groundwork of humoral physiology and pathology laid by his predecessors, Hippocrates finally brought the theory of the Four Humors into its classical form.

Health is a harmonious balance of the Four Humors.  Disease results from their disharmony and imbalance.  The physician's job is to restore health by correcting the imbalance and restoring harmony to the humors.

To quote Hippocrates:

"The body of man has in itself blood, phlegm, yellow bile, and black bile; these make up the nature of the body, and through these he feels pain or enjoys health.  Now, he enjoys the most perfect health when these elements are duly proportioned to one another in respect to compounding, power and bulk, and when they are perfectly mingled.  Pain is felt when one of these elements is in defect or excess, or is isolated in the body without being compounded with all the others."

The Nature of Man

Hippocrates took his band of renegade physicians with him to the island of Cos.  There, they set about to revolutionize the art of medicine and put its theory and practice on a truer, sounder footing.

Hippocratic Medicine

Physiology and pathology in Hippocratic medicine was based on the Four Humors.  A united confluence and sympathy between all four humors working together was necessary for good health.  Pneuma - the Breath or Vital Force, and the Innate Heat, which were suffused into the blood from the lungs via the heart, gave the blood the power to sustain life.
Hippocrates saw pepsis, or an orderly, balanced, harmonious digestion and metabolism of the Four Humors as being essential to all good health.  In disorders of pepsis Hippocrates saw the origin of most disease.

Hippocrates' anatomical knowledge was rather scant, but this is compensated for by his profound insights into human physiology and the soundness of his reasoning.  But even so, his surgical techniques for dislocations of the hip and jaw were unsurpassed until the nineteenth century.

In therapeutics, Hippocrates saw the physician as the servant and facilitator of Nature.  All medical treatment was aimed at enabling the natural resistance of the organism to prevail and overcome the disease, to bring about recovery.

In the treatments he prescribed, Hippocrates was very sensible, pragmatic and flexible in his approach, favoring conservatism and moderation over radical or extreme measures.  Bloodletting, which was much abused at other times in medicine's history, was used only rarely by Hippocrates, and even then, only applied conservatively.

Hippocrates placed great emphasis on strengthening and building up the body's inherent resistance to disease.  For this, he prescribed diet, gymnastics, exercise, massage, hydrotherapy and sea bathing.

Hippocrates was a great believer in dietary measures in the treatment of disease.  He prescribed a very slender, light diet during the crisis stage of an acute illness, and a liquid diet during the treatment of fevers and wounds.  

Hippocratic medicine was constitutionally based, so its approach to diagnosis and treatment was quite flexible.  As a holistic healing system, Hippocratic medicine treated the patient, and not just the disease.

Hippocrates was the first physician to systematically classify diseases based on points of similarity and contrast between them.  He virtually originated the disciplines of etiology and pathology.  By systematically classifying diseases, Hippocrates placed their diagnosis and treatment on a sounder footing.

The Hippocratic Corpus

The Hippocratic Corpus is a collection of over 60 works.  Although all of them are attributed to Hippocrates, the Corpus is of a heterogenous character, and many, if not most, of its works may actually have been written by his students.
Still, we can be fairly certain that Hippocrates actually did author many books in the Corpus, including many original, groundbreaking works.

These include:
Airs, Waters and Places - the first major work on medical meteorology, climatology, geography and anthropology.
Aphorisms - a collection of wise, pithy sayings giving advice on practical matters of diet, prognosis and therapeutics.
Ancient Medicine - a defense of the empirical study of medicine against one biased by preliminary axioms and assumptions.  Also deals with the Four Humors.

The Legacy of Hippocrates

Hippocrates was the personification of the ideal physician - wise, caring, compassionate, and honest.  His Hippocratic Oath, which set high ethical standards for the practice of medicine, is his most remembered achievement.  His exemplary life has been a constant and enduring source of inspiration for doctors and healers down through the ages.

The Hippocratic Oath

Contrary to popular myth, the phrase "First do no harm" (Latin: Primum non nocere)) is not part of the Hippocratic oath. Strictly speaking, the phrase does not appear in the oath, though an equivalent phrase is in Epidemics, Book I, of the Hippocratic school: "Practise two things in your dealings with disease: either help or do not harm the patient".  The exact phrase may have originated with the 19th-century surgeon Thomas Inman.

There were several modifications to the oath, with a significant revision in 1948 by the World Medical Association (WMA) called the Declaration of Geneva.  During post World War II and immediately after its foundation, the WMA showed concern over the state of medical ethics in general and over the world. The WMA took up the responsibility for setting ethical guidelines for the world physicians. It noted that in those years the custom of medical schools to administer an oath to its doctors upon graduation or receiving a license to practice medicine had fallen into disuse or become a mere formality". In Germany during the Third Reich, medical students did not take the Hippocratic Oath, although they knew the ethic of "nil nocere" - do no harm.

In the 1960s, the Hippocratic Oath was changed to require "utmost respect for human life from its beginning", making it a more secular obligation, not to be taken in the presence of God or any gods, but before only other people. When Louis Lasanga, Academic Dean of the School of Medicine at Tufts University, rewrote the Oath in 1964, omitted the prayer, and that version has been widely accepted and is still in use today by many medical schools.

Following are the Classic (original) version of the Oath, and the modern version resulting from the Lasanga revisions in 1964.  Note in the original version content in red represents sections altered in the modern version.

The Hippocratic Oath (Classic Version)

I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.

I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.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

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of 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 myself holding such things shameful to be spoken about.

If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

The Hippocratic Oath (Modern Version)

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of over treatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

The Modern Version, written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, is used in many medical schools today.

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