Nearly all medical schools incorporate some form of professional medical oath into their graduation ceremo- nies. The oldest and most popular of these oaths is the Hippocratic Oath, composed more than 2,400 years ago. In modern times, especially during the twentieth century, the Hippocratic Oath has had its content changed and its authorship challenged. This article discusses the history of the Hippocratic Oath from its traditional form to its modern adaptations. Additionally, this article seeks to explain the Hippocratic Oath’s endurance despite these challenges, based upon the historical importance of Hippocrates and the Hippocratic tradition in Western medicine.

Hulkower, Raphael

Albert Einstein College of Medicine, Yeshiva University: Open Journal Systems

Einstein J. Biol. Med. (2009/2010) 25/26:41-44  41
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COMMENTARY
Covenant with deity:  
“I swear by Apollo the physician…”
Covenant with teachers:  
pledge of collegiality and financial support. 
Commitment to students:  
promise to teach those who swear the Oath.
Covenant with patients:  
pledge to use “ability and judgment.”
Appropriate means:  
use of standard “dietary” care. 
Appropriate ends:  
the good of the patient not the physician.
Limits on ends:  
originally proscribed abortion and euthanasia.
Limits on means:  
originally proscribed surgery for renal stones, by 
deferring to those more qualified.
Justice:  
“avoiding any voluntary act of impropriety or 
corruption.”
Chastity:  
originally proscribed sexual contact with patients. 
Confidentiality:  
not to repeat anything seen or heard.
Accountability:  
Prayer that the physician be favored by the gods if the 
Oath is kept, and punished if it is not kept. 
Historians do not know for sure who wrote it. Its exact 
age is uncertain, but it has been widely accepted that 
it was composed in the fourth century B.C.E. by the 
renowned Greek physician Hippocrates, often referred 
to as the “father of Western medicine.” As little is known 
about the original Oath, it remains unclear what weight 
it carried in its own time or how widely it was used. In 
fact, some scholars speculate that there may have been 
other oaths at that time, of which the Hippocratic Oath 
is the sole surviving text (Miles, 2004).
The Oath’s evolution into modern medical ethics was 
a slow process. There is little mention of the Oath in 
Raphael Hulkower
Albert Einstein College of Medicine
Bronx, New York 10461
The History of the Hippocratic Oath: Outdated, 
Inauthentic, and Yet Still Relevant
ABSTRACT
Nearly all medical schools incorporate some form of 
professional medical oath into their graduation ceremo-
nies. The oldest and most popular of these oaths is the 
Hippocratic Oath, composed more than 2,400 years ago. 
In modern times, especially during the twentieth cen-
tury, the Hippocratic Oath has had its content changed 
and its authorship challenged. This article discusses 
the history of the Hippocratic Oath from its traditional 
form to its modern adaptations. Additionally, this article 
seeks to explain the Hippocratic Oath’s endurance 
despite these challenges, based upon the historical 
importance of Hippocrates and the Hippocratic tradi-
tion in Western medicine. 
THE HISTORY AND EVOLUTION OF THE “OATH”
Medical school is filled with a variety of ceremonies. 
There are white-coat ceremonies, stethoscope ceremo-
nies, and cadaver-related convocations. Perhaps the 
oldest rite of passage is the recitation of the Hippocratic 
Oath that many medical schools across the globe have 
incorporated into their graduation ceremonies over the 
past 500 years (Miles, 2004). 
The modern Hippocratic Oath is an oath or declara-
tion taken by many graduating medical students or 
physicians stating their intentions to practice medicine 
justly and ethically. Ceremonial and nonobligatory, the 
Hippocratic Oath can be compared to that taken by a 
judge, president, or other politician when he or she is 
sworn into office. Nevertheless, many schools consider 
it a rite of passage for physicians, and the vast majority 
of U.S. medical schools incorporate some oath into their 
graduation ceremonies, about half of which use some 
version of the Hippocratic Oath (Orr et al., 1997).
What are the origins of this time-honored ritual? What 
is the history of the Hippocratic Oath? The original 
Hippocratic Oath is an ancient Greek document simply 
titled “Oath” and is the oldest and most well known 
medical oath. Many versions with slight variations exist, 
and the translation listed on the National Institutes of 
Health webpage on the Hippocratic Oath can be found 
at the end of this article. According to Orr et al. (1997), 
the content of the traditional Hippocratic Oath can be 
divided into 12 items:
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4Commentary
The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant
as we know it may actually be the work of the followers 
of Pythagoras of Samos, who lived a generation before 
Hippocrates (Orr et al., 1997).
THE ENDURANCE OF THE HIPPOCRATIC OATH
Despite all of this criticism, the Hippocratic Oath has 
endured. It remains the most commonly administered 
medical oath and has retained its original title despite 
the work of Professor Edelstein. If it is outdated, inap-
propriate, and historically misnamed, why have most 
schools not chosen to do away with it? What is it about 
the Hippocratic Oath that still appeals to the medical 
community? The answer lies not only in an understand-
ing of the Oath itself, but in an appreciation of who 
Hippocrates was and what he still stands for.
Hippocrates is still regarded as the father of Western 
medicine. Despite his modern notoriety, surprisingly 
little is known about his life. In fact, some historians 
have gone so far as to state that Hippocrates was not 
an individual person and that the Hippocratic collection 
was composed by a group of physicians. Still, many his-
torians believe he was a single man. 
Most information about the life of Hippocrates comes 
from legends circulating after his death. According to 
his admirers, Hippocrates could trace his ancestry back 
to Asclepius, the god of medicine and healing, and to 
Hercules, Zeus’s half-mortal son. Other legends are less 
complimentary, accusing Hippocrates of burning down 
the medical library in Cos in order to eliminate compet-
ing medical traditions. Yet, both Plato and Aristotle 
spoke of Hippocrates with great respect and it appears 
that he was widely praised and renowned even during 
his own lifetime (Magner, 2005; Bulger, 1973). 
The true greatness of Hippocrates emerges not from his 
biographical information, but rather from his works. 
Fifty to seventy essays and texts are attributed to 
Hippocrates, and these documents have become widely 
accepted as the foundation of Western medicine. These 
texts contain vast amounts of medical information, but 
more importantly, they display a new attitude towards 
the practice of medicine—one that emphasizes nature 
over philosophy, observation over theory, and the 
patient over the physician’s self-interest. 
Before Hippocrates, Greek philosophers had shown an 
interest in the study of medicine, but most approaches 
included some strong shamanistic, religious, or philo-
sophical aspects at the foundation of their understand-
ing of the body and the healing processes. Rarely based 
upon empirical observations, most of the practice of 
medicine was based upon an underlying theory or 
philosophy. For example, Pythagoras of Samos (ca. 530 
B.C.E.) believed that pairs of opposites were the first 
principles of existence. Health was the balance between 
any capacity for the first 1,500 years after its composi-
tion. The Oath was rediscovered in the Middle Ages by 
church scholars who began modifying or interpreting 
the Oath to conform to medieval Christian doctrines. 
The first recorded use of the Oath outside of Greece 
was at the University of Wittenberg, Germany, in 1508 
(Smith, 2008). Finally, in the eighteenth century, the 
Oath was first translated into English, and medical 
schools in both Europe and the United States began 
to use various versions of the Oath in their graduation 
ceremonies (Miles, 2004; Orr et al., 1997). 
The pagan religious content at the opening of the Oath 
may have been a primary cause in its delayed popular-
ity. Swearing by Apollo and Asclepius probably did not 
appeal to Western monotheists, even if they agreed 
with the statements that followed. In fact, the opening 
line of the Oath is the portion that has seen the greatest 
degree of transition over the ages. Versions of the Oath 
that replace Apollo with the Christian God have existed 
for more than a thousand years, and in recent times 
more pluralistic versions simply allow one to swear by 
“whatever I hold sacred” (Daikos, 2007; Miles, 2004). 
In addition to the opening proclamation, many insti-
tutions have modified the remaining content of the 
Hippocratic Oath. The most common changes are the 
removal of the proscription of sexual contact with 
patients, the ban against using abortive agents, the ban 
against euthanasia, and the agreement to be account-
able for keeping the Oath. While close to 50% of 
schools have chosen to continue to use the Hippocratic 
Oath with some modification or modernization substi-
tuted to make it more consistent with their own values, 
other institutions have chosen to administer a different 
medical oath. Other professional medical oaths being 
used include the Declaration of Geneva, written in 
1948—and revised in 1983—in response to the medical 
crimes committed during the Nazi regime in Germany, 
and the oath written in 1964 by Louis Lasagna, academ-
ic dean of the School of Medicine at Tufts University. 
Other schools have composed their own oaths—at times 
allowing the student body itself to arrange its text, or 
even instructing each student to write his or her own 
personal oath (Orr et al., 1997).
Although the twentieth century saw a dramatic increase 
in medical oaths administered at graduation, the tradi-
tional Hippocratic Oath has been subjected to serious 
criticism and revision. Some argue that its content is out-
dated, indicated by the many modifications schools have 
made. Others believe that the Oath fails to incorporate 
many new ideals that are held dear to medical practice, 
such as societal or legal responsibilities, research ethics, 
and accountability in collaborative patient-care models 
(Loewy, 2007). Finally, the authenticity of the Oath itself 
was undermined when the research of Ludwig Edelstein 
(1902-1965), a history of medicine professor at Johns 
Hopkins University, indicated that the Hippocratic Oath 
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4Commentary
The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant
led to the well-known Hippocratic motto: “At least do 
no harm” (Magner, 2005). 
With this history in mind, it becomes quite clear why 
the Hippocratic Oath has endured. The Hippocratic 
Oath has endured not because of its specific guidelines 
and proscriptions but because it represents one’s com-
mitment to the Hippocratic tradition—a tradition based 
upon sound scientific investigation combined with 
patient-oriented care.
THE TRADITIONAL HIPPOCRATIC OATH, TRANSLATED 
BY MICHAEL NORTH :
I swear by Apollo the physician, and Asclepius, and 
Hygieia and Panacea and all the gods and goddesses 
as my witnesses, that, according to my ability and judg-
ment, I will keep this Oath and this contract: 
To hold him who taught me this art equally dear to me 
as my parents, to be a partner in life with him, and to 
fulfill his needs when required; to look upon his off-
spring as equals to my own siblings, and to teach them 
this art, if they shall wish to learn it, without fee or 
contract; and that by the set rules, lectures, and every 
other mode of instruction, I will impart a knowledge of 
the art to my own sons, and those of my teachers, and 
to students bound by this contract and having sworn 
this Oath to the law of medicine, but to no others.
I will use those dietary regimens which will benefit my 
patients according to my greatest ability and judgment, 
and I will do no harm or injustice to them.
I will not give a lethal drug to anyone if I am asked, nor 
will I advise such a plan; and similarly I will not give a 
woman a pessary to cause an abortion.
In purity and according to divine law will I carry out my 
life and my art.
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.
Into whatever homes I go, I will enter them for the 
benefit of the sick, avoiding any voluntary act of impro-
priety or corruption, including the seduction of women 
or men, whether they are free men or slaves.
Whatever I see or hear in the lives of my patients, 
whether in connection with my professional practice or 
not, which ought not to be spoken of outside, I will keep 
secret, as considering all such things to be private.
So long as I maintain this Oath faithfully and without 
corruption, may it be granted to me to partake of life 
fully and the practice of my art, gaining the respect of 
opposites, such as moist and dry, hot and cold, or bitter 
and sweet. Disease, Pythagoras believed, was caused 
by an imbalance in one of these pairs of opposites 
(Magner, 2005). 
Hippocrates, however, refused to be bound to any 
rigid medical dogma or therapeutic system based on 
philosophy. Medicine should be based upon empiri-
cal observations and studies, he argued, not a priori 
systems. Hippocrates believed that the human body 
was controlled by natural forces, and as such, an astute 
physician is one who is keenly observant. Hippocrates’ 
case write-ups are known for being detailed observa-
tions of medical phenomena, not philosophical treatises. 
Furthermore, although Hippocrates did subscribe to 
the doctrine of the Four Humours, he denounced the 
idea that diagnoses must fit rigidly into this system. For 
him, the Four Humours—Blood, Phlegm, Black Bile, and 
Yellow Bile—were a systematic way of explaining how 
disease is not a localized problem, but rather a distur-
bance of the entire body (Harrison, 2004; Bulger, 1973). 
Hippocrates was also opposed to the idea of practicing 
medicine based upon religious systems. While he still 
believed in religion, his entire approach to medical prac-
tice was based upon nature. This is most clearly demon-
strated in his work on epilepsy, On the Sacred Disease. 
In the ancient world, epilepsy, with its unpredictable 
seizures, was seen as a disorder beyond the scope of 
nature—a “sacred disease.” Hippocrates declared that 
even this “sacred disease” is no more sacred or divine 
than any other illness. Consequently, Hippocratic physi-
cians regarded the practice of treating epilepsy with 
purifications and incantations as deceptive practices, 
both medically improper and sacrilegious (Magner, 
2005). Interestingly, Dr. Roger Bulger in Hippocrates 
Revisited notes that Hippocrates’ opposition to religion-
based medical practice is perhaps one of the clear-
est indications that the traditional Hippocratic Oath, 
which begins by swearing to the gods of medicine, is 
unlikely to have been composed by Hippocrates himself 
(Bulger, 1973).
Aside from this novel, natural approach to medicine, 
the Hippocratic writings are also known for the impor-
tance placed on practicing patient-oriented medicine. 
Hippocrates believed that each patient should be 
treated individually, for his or her own benefit and 
not the glory of the practicing physician. In one essay, 
Hippocrates writes, “It is especially necessary in my 
opinion for one who discusses this art to discuss things 
familiar to ordinary folk. For, the subject of our inquiry 
is simply and solely the sufferings of these ordinary 
folk when they are sick or in pain” (Bulger, 1973). 
Throughout his writings, Hippocrates emphasizes that 
physicians should take the least damaging approach 
to treatment, not the one that will give them the most 
fame. The humble belief that medicine is a “craft” that 
a physician practices on behalf of his patients is what 
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4Commentary
The History of the Hippocratic Oath: Outdated, Inauthentic, and Yet Still Relevant
Magner, L.N. (2005). A history of medicine. 2nd edition. Boca Raton: Taylor & 
Francis Group.
Miles, S.H. (2004). The Hippocratic Oath and the ethics of medicine. New York: 
Oxford University Press.
North, M. “I swear by Apollo physician”…: Greek medicine from the Gods 
to Galen. Exhibition website, History of Medicine Division, National Library 
of Medicine and National Institutes of Health. http://www.nlm.nih.gov/hmd/
greek/greek_Oath.html. 
Orr, R.D., N. Pang, E.D. Pellegrino, and M. Siegler. (1997). Use of the 
Hippocratic Oath: A review of twentieth century practice and a content 
analysis of oaths administered in medical schools in the U.S. and Canada in 
1993. J Clin Ethics 8:377-88.
Smith, L. (2008). A brief history of medicine’s Hippocratic Oath, or how times 
have changed. Otolaryngol Head Neck Surg 139:1-4.
all men for all time. However, should I transgress this 
Oath and violate it, may the opposite be my fate.
REFERENCES
Bulger, J.B. (1973). Hippocrates revisited. New York: MEDCOM Press.
Daikos, G.K. (2007). History of medicine: Our Hippocratic heritage. Int J 
Antimicrob Agents 29:617-20. 
Harrison, M. (2004). Disease and the modern world. Malden: Polity Press.
Loewy, E.H. (2007). Oaths for physicians—Necessary protection or elaborate 
hoax? Med Gen Med 9:7. 


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