In Our Time - The Hippocratic Oath

Episode Date: September 15, 2011

Melvyn Bragg and his guests discuss the Hippocratic Oath. The Greek physician Hippocrates, active in the fifth century BC, has been described as the father of medicine, although little is known about his life and some scholars even argue that he was not one person but several. A large body of work originally attributed to him, the Hippocratic Corpus, was disseminated widely in the ancient world, and contains treatises on a wide variety of subjects, from fractures to medical ethics.Today we know that the Hippocratic Corpus cannot have been written by a single author. But many of its texts shaped Western medicine for centuries. The best known is the Hippocratic Oath, an ethical code for doctors. Celebrated in the ancient world, and later referred to by Arabic scholars, it offers medics guidance on how they should behave. Although it has often been revised and adapted, the Hippocratic Oath remains one of the most significant and best known documents of medical science - but there is little evidence that it was routinely sworn by doctors until modern times. With:Vivian NuttonEmeritus Professor of the History of Medicine at University College LondonHelen KingProfessor of Classical Studies at the Open UniversityPeter PormannWellcome Trust Associate Professor in Classics and Ancient History at the University of WarwickProducer: Thomas Morris.

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terms of use, please go to BBC.co.com.uk forward slash radio four. I hope you enjoy the program. Hello, here's a quotation purportedly from two and a half thousand years ago. Life is short and art long. The crisis fleeting. Experience perilous. And decision difficult. That famous aphorism is believed to be the work of an ancient Greek doctor often described as the father of modern medicine. His name was Hippocrates, born in the 5th century BC, and although we know little about his life, he's probably just as famous today as he was in the antique world.

Through the careful observation and logical deduction, he brought to his work, Hippocrates is credited by some with founding a new school of medical thought, but he's best known today as the supposed author of the Hippocratic Oath, which lays out an ethical code for doctors. Remarkably, this brief 300-word text continues to govern the behaviour of physicians 2,500 years after it was first written down.

With me to discuss the Hippocratic Oath are Vivian Nutton, Emeritus Professor of the History of Medicine at University College London, Helen King, Professor of Classical Studies at the Open University, and Peter Paulman, welcome Trust Associate Professor in Classics and Ancient History at the University of Warwick. Vivian Notten, Hippocrates is a school. thought of lived sometime in the fifth century

in the great classical period of Greek learning, scholarship, art and philosophy, but how much do we actually know about him? Hippocrates is one of the most mysterious figures of antiquity. We know almost nothing about him. We know he came from

a family of doctors, from the Greek island, of course, who traced their ancestry back to the god of healing, Asclepius, and tradition also says his mother's family, traced their descent from another surprising healing god, Hercules. He lived traditionally in the late 5th century BC.

He's said to be born in 460 BC, and he may have lived at the age of 80 or later than that. He was the most famous doctor of his time in Greece. He's praised as being a great teacher, But apart from that, we know nothing for certain. He may have spent part of his time in northern Greece because the town called Larissa claimed to have had his tombstone. But even that which you know seems to have been hard come by,

with needs but of intellectual archaeology. Can you tell us how you know what you know, little though it is? We have a few stories, and we have the comments by a near-contemplary. Plato, who says he is a great teacher, he is the model that you can use, and he's a man who teaches logically. What he teaches, Plato never really says. Until a hundred years ago, it was thought that he was the founder of the theory of the four humours.

But then in Egypt, a papyrus turned up, which recorded words that were written probably by a pupil of Aristotle. That's to say, 50 or so years after Hippocrates' death, in which Hippocrates is credited with an absolutely different theory, which said health and disease is dependent on residues in your body. Apart from that, we have local stories that can be shown to be demonstrably false, that he cured the plague of Athens, or that he refused to treat the king of Persia as an enemy of the Greeks,

And these were later invented to give a picture of Hippocrates as the great diastician, the great philosopher, and the great patriot. Maybe in such a time as that the sort of strength of the legend and the power of the myth is a substitute for the facts scattered around. And that is how Hippocrates has come, in fact, to exist today. It's a series of, if you like, myths around very little, which tell you more about the people, who are actually talking about the Hippocratic Oath today,

then they do about the Hippocratic Oath itself. I'm enjoying this, Vivian, but so that our listeners don't feel that we're reducing the Trade Descriptions Act, there was a Hippocrates. There was a Hippocrates. He was a doctor. He did exist. It's classical Greece and words of some sort or other

stemmed from him or through him or by him. And what complicates the matter is that we have something which is called the Hippocratic Corpus, which is a large number of words. and all of which in some way have been attributed to Hippocrates. How did you get that, how did that corpus come together briefly? I know we are talking about a sort of archaeology because the whole thing didn't really come together massively

until the Middle Ages, really, after the Middle Ages. So we're talking about 2,000 years on. Did people find a bit there were they determined to search, to put a corpus to the word talk Hippocrates? Many people in antiquity when they wrote books didn't sign their names. And so there's a mass of medical literature which comes together. Some people believe in Alexandria in 250 BC,

and which then begins to circulate under the name of Hippocrates. But some of the things that circulated in antiquity under the name of Hippocrates don't survive to us, and some of the things that seem to have been unknown in antiquity almost become part of what modern scholars call the Hilary. Hippocratic corpus, which was first printed in that form, only in 1526. Helen King, can I turn to you now? Can we just develop that, how this corpus came together?

I'm going to ask you also what the range of it is. I'm just trying to talk about how these documents from so far back are coming together to form something that you can spend a lot of your life studying. How did they bring it together? Well, Vivian's given the date of around 250 BC as a possible place where that starts to happen. That's in Alexandria when Alexandria is being ruled by the Greeks after the death of Alexander the Great. And what's happening there seems to be that as part of a big interest in learning,

not just science but also literature and the arts, people are getting much more interested in collecting materials. So the great library of Alexandria comes into being. And it's been suggested that in that library, the librarian was just so overwhelmed with the amount of medical stuff that came in that they simply put it all under Hippocrates because he was a famous doctor. Once again, it's supposition.

It's interesting that the supposition keeps being Hippocrates, that the power of the name, perhaps because of the reference in Plato? Who knows? I think that's right. Is it Plato who's giving him his dynamic? Yes, I think it is. And he's also mentioned in Aristotle,

so he's in the sort of big philosophers. The two big ones. Two big ones. And he's known as a great doctor, but no one's really sure what he wrote. The only thing in Plato that talks about what the content of his work is is where it's something about knowing the parts and knowing the whole.

You can't understand the whole without the parts. To understand the whole, you have to divide it into parts, something like that. And there's no text in the Hippocratic corpus that instantly makes you think, ah, that's the one Plato's talking about. So the corpus is brought together in this magnificent doomed lives of Alexandria, which is just burnt down to tantalise the rest of us for the whole of civilisation, isn't it? Exactly. Exactly. And Galen tells us, in the Roman Empire,

So 700 years or so after Hippocrates is supposed to have written, Galen says back in Alexandria, they had a method of getting books for their library, which could be quite popular today if someone thought of it, which is that anyone arriving at the port who had a book with them, the library would take it away from them, copy it, give back the copy to the owner, and keep the original. So that's how Galen says the library was built up.

It's a very interesting idea. Whether it's true, again we don't know, But given that was burnt down, Helen, and I like all this fudging around. Sorry about that. If that was burnt down, what happened next? So it's all carefully got together by the brilliant librarian's Alexandria. And then it's burnt down. So what happens?

We know that copies of these works survived outside the library. So, for example, we have papy, much later, third century AD papy, of the oath. And we have a little fragment of the oaths. We know these things were copied. But what we don't know is what was lost. it's not as if we've got a catalogue of what they had in Alexandria to know exactly what they classified as by Hippocrates and what else they might have had that was medical.

So this is rumours and later report? Rumours and later report, yes. Now then can you give us some idea of the range that was in that corpus? Did that corpus survive in any way? Did it have to be reconstructed and if so, how is it reconstructed? The range is enormous. It's got everything in it. The way you're talking from now, it's burnt down in Alexandria

which is kept somewhere else, is it? It wasn't kept somewhere else, is it? It wasn't kept somewhere else, but copies of these things survived in manuscript later on, and papari also survived. So there's a copying process going on because anything associated with Hippocrates tends to get copied. So what you've got in there is a range of different types of text. So case histories, individual named patients, and a case day-by-day study of what happened to them and whether they died or recovered. So that's the texts called the epidemics. Close observation there.

Very close observation, exactly. And that seems to have survived because people liked close observation and wanted to copy those because they showed how to do it, really, how to observe a case. But also the aphorisms, which Vivians mentioned, the aphorisms are very much about individual little nuggets of medical wisdom, which you could perhaps learn off by heart. And these were certainly used in training in the later antique period. So, say, 6th century AD, people would be learning from some of these texts.

They were still being copied. Oh, my favourite one would be a nosebleed is a good thing when the menstrual period is suppressed. That's it. No explanation why, no explanation what you do. Is you right? Is that right? No. But it's interesting idea.

But it's memorable. It's memorable, exactly. And it gives you an insight into the theory that might be behind it. Another one is a woman cannot be ambidextrous. Absolutely. And that's obviously right. It's absolutely. So these little nuggets like that.

But also some lists of treatments, lists of drugs you could give, lists of dietary advice, how to eat in health, how to eat in disease, what to do to stop getting sick in terms of keeping your diet adjusted to the climate and the situation you find yourself in. So quite a range, but also surgical texts, texts on anal fistula and haemorrhoids and all sorts of delightful subjects. It's a remarkable raking over, isn't it? It's huge. A big territory. It's huge. stage, when we think it's sort of primitive prodding about

with a few blunt instruments hoping for the best and a little philosophy thrown in. Yes, it's an extremely impressive range. And in terms of time, the range goes over several centuries, so there's no way it will be written by one person. You can tell from the style of the Greek this is written in different places, different periods,

and also conflicting models between different texts. So one sort of theory of how the body is made up in one, totally different in another. And Peter Porman, one treaty in the corpus that was particularly influential, I'm told, and was called On the Sacred Disease. What's that? And why was it thought to be so important? Well, the sacred disease is the falling sickness.

It is epilepsy. And the author of this treaty basically sets out to debunk some religious or magical ideas or superstitious ideas about epilepsy. So people claimed that the gods sent down epilepsy or because of impurity you would suffer from epilepsy. And the author tries to find a physiological explanation for this disease and sets out to argue against those who claim that this particular disease has been sent down by the gods.

Why, if I may interrupt you, why in the first place was it called the divine disease? Because it's sent by the gods. But why did they think it was, this particular disease? I'm thinking this particular disease is... Well, because it's so mysterious. You know, in epilepsy, basically, one day you walk the next thing, you fall down, you behave very strangely. The physical effects, of course, if you see about epilepsy, are quite disturbing. And so this was a prime candidate, so to speak, for a disease being sent down by the gods.

So this is why some people called it the divine, or it was generally called the divine disease, the disease sent by the gods. and the author argues against it. It's not an atheist text, so he doesn't say the gods don't exist. He just says all diseases in a way are sent by the gods and none are. I mean, obviously the whole universe is inspired by gods, but what we as physicians need to do is recognize certain physiological processes, such as humors, phlegm is, for instance, mentioned in the brain,

and because of this phlegm in the brain, you know, you get epilepsy. So he tries to find a physiological explanation, not an explanation based on divine intervention. How far does it get in your, it's cruel to compare it in modern day. I mean, we've got to keep the things in context to give it in a sense. And obviously within the conditions and the circumstances that they had, we're talking about extraordinary, brilliant people. But what was your view of the explanation given by the investigating physician?

So certain arguments are interesting. For instance, he says he talks about Libya, he talks about goals and makes certain, comparison and debunks arguments. He can't say this disease is sent by goats because we know of people living with goats and they don't suffer all from epilepsy. So certain type of arguments seem to us to be well-based, well-founded. But other explanations from a modern perspective, of course, are wrong. We don't think that epilepsy, for instance, is caused by phlegm in the brain on excess of phlegm. But there were also certain observations which are correct. For instance, that children, when they suffer from epilepsy,

we will be cured, but once epilepsy settles down a bit more, later in life and continues, then it's rare that a cure is affected. Just to pick out another part of that corpus, there's one on human nature. That's quite a big subject. What do they say then?

What does the corpus say, though? So on the nature of man, or on human nature, is a treatise where you have this theory of the four humors first developed, I mean, Vivian alluded to this theory. It's the theory that flam blood, yellow bile and blackbile,

when in balance, result in health. And when this balance is disturbed, a disease occurs. So basically, the author of this treaty, is thought to be from the 4th century BC, sets out this theory, which becomes the dominant theory in medicine for the next 2,000, maybe 3,000, 300 years or something like that.

So it continues for a very, very long time. So that's some kind of context for inside which, outside which is Hippocrates, inside which is the Hippocratic Oath, which we're coming to now. It's the most famous document, Vivian Notton. Could you describe it for us? Because it's, I've read, obviously, translation of it. Didn't tell me long. It's only 300 words long. It's quite remarkable.

It's a very short document. It amounts to little more than three quarters of a page in a normal, modern book. It's written in an unusual form of Greek. It's rather as if we today were writing something up in the language of Shakespeare or Robert Burns. And this caused problems even in antiquity because people couldn't quite understand the language of the Greek. Why do you think it was written in Ionic Greek, wasn't it? It's probably the language

of Greek science at the time and it may be because we have other types of Greek. or that type of Greek in documents from that area of the Eastern Eegean. So for them, just like Robert Burns, it was his normal language. But of course later on, people couldn't really understand some of the words. As a document, it's a strange combination, unique combination, of a religious document with an apprenticeship contract. It begins with an invocation. to the gods. It ends with, if you like, an implied appeal to the gods to reward or punish you

if you fail to keep that oath. And in between are sentences so succinct and concise and in the bullseye that we'll take several of them one by one. But can you tell me why was it thought necessary? Was it aping an oath that people had to pay to the army or to the gods of war or to the state. Was it was the oath fever around the place? There were lots of oaths in Greece, but there was no other medical oath. There were lots of documents in the

Hippocratic corpus saying how a doctor should behave, but they're general, they're not personal. This is the Hippocratic oath. I shall do this. It is my life. Helen King, there's a feeling I got from the papers that read from each of you and so on, that this might well be tracked back to Hippocrates himself

and that's a sort of are we taking that I feel like an auctioneer are we taking that as the basis for the next stage of discussion taking that as a possibility no no right I think we're agreeing on that well now the mothership has left the land the earth is sailing across

can you tell us it begins with an invocation to the gods yes can you describe that for us just that first paragraph this is where the The person taking the oath swears by Apollo and Asclepius, who's the son of Apollo, as well as being God of Medicine, and then by Asclepius's children, who include Hugiaiaa, the goddess of healing, panacea, which means all heal, and so on. And then by all the gods and goddesses. So it's got the whole range of ancient Greek deities in there, all of them. And this is typical in a way. He only does that in one sentence, so he doesn't name all the other gods and goddesses.

Just the four you've mentioned. It's a throwaway line, really, to add all the others. So it's not just by the gods you necessarily associate with medicine. What happens in an oath in the ancient world is that you take usually just one divine power, but maybe more, and you make them the guarantor of what you're saying. So you may be taking an oath that you didn't do something in the past, or you did, or an oath about the present situation, or an oath about your actions in the future. And the Hippocratic Oath is about your actions in the future.

And what you say at the end, which is the sort of matching clause, is that if you do the things that you say you'll do, or if what you say about the past is true, then the gods will look after you, prosper you, whatever. And if you don't, if you don't keep your oath, then the reverse. So in a sense, it's a typical Greek oath. It starts with invocation of divine powers. It ends with what's called a conditional self-curs. If I don't do these things, then may bad stuff. happened to me. But it's an odd one because I think there's only one other oath I've found that mentions Asclepius, the god of healing. And that's not doctors swearing by Asclepius. It's a slave in a fragment of a lost Greek comedy saying, by Asclepius, I prefer dessert to dinner. So he's making an oath-type statement about a current situation. I like dessert, not the rest of the meal. It's a jokey oath. So swearing by Asclepius is itself. Quite odd, but he's the god of healing. That's who a doctor would swear by.

We have to take it on board that the people are swearing this earth believed in the strength of the earth and the dire consequences if they fail to keep it. Yes, it's an extremely serious one. And the fact it's got all the gods and goddesses mentioned after the obvious healing ones, all the divine powers are making sure that you do what you say you're going to do. Peter Pornman, the earth goes on to deal with medical teaching. It starts by the first paragraph, first full paragraph, again, it's three, hundred words long. I'm tremendously impressed by that. And it's like the first

America's kind of shorter the better, isn't it? Anyway, so it starts with how to be a good doctor, how you teach a good doctor, who you're going to teach. Can you say what that says? And then we'll talk about that. Well, it's really a pledge to one's teacher. So basically

saying that one will teach the children of one's teacher and one will teach those who have taken this oath. So, I mean, basically, one gets this impression from the second part there

that there was some sort of medical community, which was very closely knit, which was bound together through this oath, and that medical knowledge would be passed on, I mean, free of charge, to those from whom one has received instruction, but that one

would also only give it to those who take this oath and pledge it. It's very much a closed system. You, you, you deeply respect your teacher, his children will be treated like your siblings, if they want to learn medicine, you will teach them free of charge and look after them. And the implication that they will look after you

as you're looking after their father and your children, if they want to do it, you will teach them. But it seems almost Masonic in its closeness, though. Yes, and this is where we get this idea that perhaps this oath was taken in a Pythagorean community. I mean, modern scholarship no longer really adheres to this doctrine, but Ludwig Edelstein,

a German classicist who fled to America from the Nazis, developed this idea that there was this closely knit community, and since we know about the Pythagorean as being very closely knit communities, maybe this is where this oath originated. Just because of

the Pythagorean by being close knit or because any idea over the other? Oh no, there are others. I mean, in a pure and holy way, for instance, I will keep my life and my art is another sentence in that oath which comes right afterwards. So this idea of Hagnos and Horsios in a pure and holy way,

this respect for life, for instance, not to kill, not to give water for Mets and all these things appeal to Edelstein and to make him think that, well, the Pythagorean, you know, they are vegetarians, they don't eat beans, they try to keep themselves pure and holy. So he finds a number of overlapping themes, and this is why he put forward this. this idea, again, which nowadays is maybe no longer

adhere to. Can I turn to you, Vivian, about one of the injunctions? He talks about diet. I will use those dietary regiments which will benefit my patients. But the next one is, I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan. Now, that has been interpreted in different ways, isn't it? The whole of that, almost every sentence in the oath has been interpreted in different way.

We take them one at a time, Vivint. Let's take the diet one, because the Greek word may mean diet, or it may mean the way in which you recommend lifestyles. I think it does mean diet, and we start off with, I will give you the proper diets to help you. And then we move on to dealing with the second aspect, which is drugs. diet is the normal food stuff, the way of life. Then we move on to drugs, and I shall not give you a dangerous drug, even if I'm asked, and that would include not only euthanasia, but being asked to poison somebody, to be involved in murder, and then we move on to the next part, which is the destructive pesire.

We're going to come to the pesire in a moment. let's stay with this drugs and the relationship to euthanasia because there seems to be a contradiction in that euthanasia apparently was an acceptable form of ending life it was called the good ending wasn't it? Yes, it's a good... That's a translation, the good ending. And yet it appears at first sight that he's saying,

Hippocrates or whoever he was or the man and women group he inspired are saying I'm not going to be part of that. Is that the way to interpret it? Yes, that's the way in which many scholars have interpreted it. He isn't saying he's against it. He's saying that doctors shouldn't be a part to it. Doctors should not

be a part of it. And it's related to that again, this clause we're going to come on to look at, which is in a pure and holy way, which is a very mysterious religious sentence which follows. Helen.

I was just going to say there that the whole idea of good death is really tricky here because in the 5th century BC the good death, the O, the the good death is really the young man dying in the prime of life in battle to defend his city. That's the death you're aiming for. And that's what euthanasia means originally. The idea of using drugs to help someone die when they're suffering from a serious disease

is really not a very 5th century BC idea. So you've immediately got a problem there that I will not give a drug to anyone if asked for it, a deadly drug, could be much more likely, I think, to mean, as Vivian says, I won't give poisons to someone. Because if you're known to be a doctor, you're known to have access to drugs, someone might come up to you and say,

look, got this trouble with the mother-in-law, got a deadly drug I could use? And the answer is no. So it could be about control of dangerous substances, however they're being used. Chucking out the mother-in-law, I preferring, joking about.

People could use it, where Socrates decided to take his own life, and he personally took Hemlock. There's no evidence there of a doctor being used. He went and got hold of it one way another. Nobody around him law-abiding Greek citizens, as one imagines, seemed to object at all. There's no

sense of objection. He took his own life in that way. And at the same time, there's this go, so he wants doctors to be apart from that. That's what I get from. I think that's right. Because deadly drugs could be available in other ways. You could go to the marketplace. You could go to drug sellers to get drugs. The doctors trying to be separate from that.

Can I take the second half of that sentence, Helen? And similarly, I will not give a woman a pestry to cause an abortion. Yes. That's all he says about it, but that set off debates galore. Huge debates, and not only in the ancient world, but in the modern world too. Up to 1973 in court in America. Groh versus Wade, exactly.

He was quoted there, yes. He was quoted in Roe versus Wade, and what they were saying was actually it's okay to permit abortion in the first three months of pregnancy, despite the Hippocratic Oath, because the Hippocratic Oath is a contested document. So the fact that we don't fully understand what these clauses mean means you can simultaneously have some people saying, oh the Hippocratic oath mustn't do it and others saying yeah but the Hippocratic oath really hard to interpret so you can go both ways

and within the Hippocratic corpus there is a description of a girl being advised to jump up and down so that she brings on an abortion and that's clearly acceptable there are drugs being recommended herbs being recommended in some of the gynecological treatises which would have the effect of causing abortion

and that's okay seems to be the peccary that's the problem and I wonder whether that's because that was seen as a very dangerous method of administration. So it's back to the deadly drugs that this is maybe a more dangerous way of causing an abortion than the other ones that would be available in the ancient world.

Okay, let's move on. Peter Porman, again, a simple sentence. I will not use the knife even upon those suffering from stones but I will leave this to those who are trained in this craft. Yes, I mean, basically it seems to say that there's no surgery for physicians. Now, again, there was a debate. Does this just mean that there's a bladder stone operation,

which is left specifically for those who are expert in it, and physicians perhaps performed other kinds of surgery? After all, in the Hippocratic corpus, we have treatises which deal with surgery. And, you know, so that's one solution for this problem. But beyond this... But if we're sticking to the oath, which we're trying to do,

the relentlessly. If we're trying to do, he doesn't say that, is it? He's being specifically saying, I am swearing, I'm going to be a doctor, I will not use them enough, I will not commit surgery. I leave it to people who are surgeons. Yes, but as I... Why is you doing that? Oh, well...

I think you get to the point now, why is the oath written in the first place? Yes. Is it a specific group of doctors with a specific social problem where perhaps too much cutting's been going on and they feel it's a good idea to say, well, we don't cut? it doesn't seem to be an oath that's sworn throughout the ancient world.

Far from it. It seems to be quite a small group of people who at some point chose to produce this oath, which then got into the Hippocratic corpus. Yeah, and even, I mean, as I say, there's even a debate about what exactly this one line means, where we have to put the comma, you know, does it just preclude bladder stone operations, as one something very specific, just as with the passery that we say we won't use the passery, but other forms of abortions are all right, or does it include all surgery?

And in fact, even today, there was a sentence added in some English translations, which I think was added in the 1940s, which talks about the, which says, I will not cut for the stone, even in those in whom the diseases is manifest. And I think that was added in the 1940s in America to distinguish the doctor

from the quack. this lithotomist. And again, Helen King, with brilliant concision, he, the oath talks about how a doctor should behave with regard to when he enters into the house. His personal behaviour, with regard to him, he mustn't sexually molested anyone, but also he must keep everything confidential.

The second one particularly led to a lot of, again, entered into many debates, many court cases and so on. Yes, the confidentiality clause is very interesting because it's not just whatever I hear in treatment, but what I hear outside treatment. So even gossip that you hear down the marketplace, as a doctor, you must never pass on. And that was used, most notably for me,

in the 1860s when Isaac Baker Brown was performing clitoridectomies in Victorian London, and one of the things he was accused of was doing this without the consent of the husbands of the women he operated on. And his defence was, that's what the Hippocratic Oath says, that you should not talk about anything you hear or do in treatment.

So it's okay to do this operation on women without telling their husbands because to tell their husbands would be to break the Hippocratic Oath. It's very interesting that we rattle right through to the present with this thing that was written so many years ago. Can we go back so many years now, Vivian, when did this Hippocratic Oath come into what could be called risking a generalisation, general use in antiquity? When did it start to grip people's behaviour?

Well, the first evidence we have for somebody talking, about the oath is actually in the second century of BC when it's seen as a part of a conspiracy on the part of doctors against their patients. It's seen as a mark of these nasty doctors ganging up because oaths have often seen in a very dubious light. What's the ganging up about what you've been saying? Well, anybody who swears an oath is wanting to do something in secret.

And it's part of this, the Roman, this light. Conspiratorial academic therapy. These were nice people. Exactly. But we now have evidence from the first century of our era of somebody, if you like, cutting out a piece of the oath, almost a stick on the wall and saying this is the thing you should take at the beginning of your medical training.

And by the time we get to the 4th, 6th century, it seems to have been taken by doctors, by some doctors at any rate, at Alexandria in Egypt, in late antiquity, in the famous medical centre, and from then it passes with modifications into the Christian world, into the Arab world. And the first modification is you replace the gods by the Christian god or the Muslim god, and indeed in 19th century France by the supreme being. We're going ahead of our horse to market here, but we've got to just come back a bit. it seems to me

that Galen, the Greek-born Roman surgeon, who doctor, who had an influence, second century AD, was it? Yeah, had an influence for the next 1,500 years. He took Hippocrates as it were, as his mentor. He said, yes, this is the man, this is, it is his oath, and pushed forward Apocrates' ideas and gave it tremendous authority and force,

which he sort of helped Hippocrates through. Maybe it was the other way around as well. Galen certainly gives Hippocrates the big boost. He makes Hippocrates, as Wesley Smith as argues, in his own image. So that whatever Galen wants, that's what Hippocrates was. And Galen's the one who really gives the for-humour theory that we've talked about already, the big push to make it that that is the genuine work of Hippocrates. And Galen's very interested in trying to divide within the Hippocratic corpus

to the bits Hippocrates wrote and the bits that someone else must have written like his sons or his sons-in-law or something else. but Galen doesn't really give the oath the sort of primacy you might expect. He writes a commentary on the oath. But he doesn't say, every doctor should swear it, I've sworn it, it's really important that we swear this oath. So it's in there, but for him, in his image of Hippocrates, isn't really the oath as primary.

It's the four humours, and it's Hippocrates's connecting philosophy and medicine. But in a way, it's strange, isn't it, that this oath has peddled its way into the tumour. 20th, 21st century, more than the, as it were, greater doctors around. Peter Paulman, it went into the, it went into Islamic scholarship, very importantly, because when Islam

scholarship got underway, 7th century it added things, it translated things, it pushed things forward in medicine, as well as many other ways. Can you just give us a bit of details how that happened and what the consequence were? Yes. So Galen is very important for this. The commentaries of Galen were

translated in the 9th century in Honan Ibn Ishak's circle, so a translator who lived from roughly 800 to 870. And during this massive translation movement, many of these

Galanic commentaries were translated from Greek into Arabic, and these texts became available, the oath among them, and other Hippocratic texts on which Galen did not write commentaries also were translated into Arabic. So, all this

material becomes available all of a sudden. And obviously Vivian alluded to this through this translation or in the process of this translation's ideas were adapted and adopted and also changed. So the beginning of the

oath for instance, you know in the Greek it says, I swore by Apollo and Asclepius and Health and all heal and all the goddesses and gods. Now that becomes something like I swore by God, oxymu'llahe, the

Lord over life and death, I swear, by him who gives cure, who gives all treatment. I swear by Asclepius, he stays, and then he says, I swore by the friends of God, Aulia, Allahi, and both men and women, all

of them together. So you see this, all the gods, I mean, of these four gods mentioned there, they're reduced to just the one, Esclep, and God, the supreme being, such a speaker, is mentioned with this very acceptable phrase, you know, the Lord over life and death. So this author then is not sworn in general by Islamic physicians or anything like that, but Hippocrates himself becomes a figurehead, a symbol for the right clinical practice

and also for moral probity. And if I can just develop these two points a little bit. So case notes, the epidemics, for instance, were very important. And then Islamic physicians, for instance, in the 9th and 10th century, but also beyond, look to Hippocrates as somebody who took clinical observations, and they will then develop this genre of case histories themselves and push medicine forward in that sense. On the other hand, the right behavior for the doctor is linked to Hippocrates.

So, for instance, a physician in the third. 13th century, Abdel Atif al-Bardadi would look back to a mystical time in Byzantium or Greece where all doctors had to swear this Hippocratic oath. I mean, we know that it didn't happen like that. But for him, there was this wonderful time when people would take this oath and he says, I look around doctors nowadays and they do all sorts of tricks and they're ill-educated and so on and so forth. But the oath, you know, we should bring this back, so to speak.

Continues to recur as an inspirational figure. Vivian Nuttan, the Hippocratic Corpus was much studied in the Renaissance. Where was the oath in that study in the Renaissance? It's actually in the Renaissance that we get the first introduction of the oath as such into Western European universities. First in Basel and then in universities like Heidelberg, where in the 16th century they go back to a curriculum

based on the original, so they think, the works of Galen and Hippocrates. And that's when you get the oath reappearing in a formal university context for doctors to swear. Can I just, we're coming to an end here, I'm a bit rusty first program, a bit mismanish here, Helen. I really haven't, I want to get in the fact that it continued until the last century in many ways. But let's just take how it affected, how it played, in a Nuremberg trial at the end of the Second World War. Can you manage to condense that level? I can try.

1947, 20 doctors being tried. Both the defence, the Nazi defence, and the American prosecutors use the oath. So the argument was it's okay, on the Nazi side, it's okay to have done human experimentation because it's not covered by the oath. The oath may sound like it doesn't allow that sort of thing, but it's a pagan document,

it's an aristocratic document, it's not appropriate for national socialism. We don't need to go there. And anyway, they argued, there's an alternative hypocritees in, which Vivians alluded to, the hypocrities of the letters that are attributed to him around the third century BC, in which he says he won't heal barbarians, he won't help barbarians. So you don't actually have to help everyone under the oath. But as the US was arguing that the oath is the gold standard,

that you simply can't say that. And the Germans were also saying you can't use those discussions of hypocritees, not helping barbarian kings because they're spurious. But they didn't say, and the oath isn't by him either. So it was being played out in a number of ways. That's a rather brief summary. But it appears to come from you, Vivian. And of course, the people who were on trial themselves

strongly believed that they had always abided by the Hippocratic Oath. They had always stood by their patience. And of course, other people aren't mentioned in the Hippocratic Oath except tangentially. It seems to be as powerful now as it's ever been, Peter. Yes, absolutely. I mean, all these things, euthanasia, keeping one's silence, I mean, keeping confidences and so on and so forth,

these things are still with us today. And what is amazing with this author is it's a short document, and obviously it's open to interpretation. And having all these interpretations inside it makes it possible to read it and reread it and apply it for every single century again. and again and again. Well, thank you very much, Peter Porman, Vivian Nodden and Helen King.

Next week we'll be talking about the Japanese religion Shinto thought of struggle into life or burst into life in the 8th century. Thank you very much for listening. If you've enjoyed this BBC podcast, why not try others such as the Forum, the discussion programme about global ideas? To find out more, visit BBCworldservice.com slash forum.