Ancient oaths for medical students
All of us have heard of the so-called “Hippocratic Oath“. It is an oath, attributed in its origin to the ancient Greek physician Hippocrates of Kos (460-370 B.C.), which binds the physician who swears it to keep with certain ethical precepts concerning the conduct of his medical art. But few might know that this oath in his original ancient version charges the physician taking it to abstain from two practices which unfortunately are already wide-spread in the Western world today or about to find more and more “acceptance“, facilitated by ever more “liberal“ laws allowing or even promoting them: abortion, and euthanasia or assisted suicide.
“I will neither give a deadly drug to anybody who 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.“
Oath of Hippocrates
It is interesting to see that these are the passages one often does not find in modernized versions of the Hippocratic Oath. But Hippocrates would have thought of a physician who contributes to taking life instead of preserving it not as an honorable doctor, but a killer. Societies and cultures, both pagan and Christian, throughout human history seem to have understood this – except the one we live in today, deeming that one could be a doctor and a hitman at the same time.
The lesser known “Oath of Asaph and Yohanan“ is a Jewish version of the Hippocratic Oath several hundred years later (probably between the 3rd and 7th century A.D.) contained in the first medical book written in Hebrew, the Sefer haRefuot – “the Book of Medicines“. The physicians Asaph ben Berechiah, also known as Assaf haRofeh (Asaph the Physician), and Yohanan ben Zabda made their students swear this oath with the following words:
“We will do all that you exhorted and ordered us to do, for it is a commandment of the Torah, and we must do it with all our heart, with all our soul and with all our might, to do and to obey, not to swerve or turn aside to the right hand or the left.“
Oath of Asaph and Yohanan
Looking at this answer the students had to give to their medical teachers after having received their ethical exhortations and before obtaining their blessing “in the name of God Most High, maker of heaven and earth“, we can already identify the source of the instructions of this pact: the Torah, the Law given by God through Moses. This is, of course, the crucial distinction between the pagan Oath of Hippocrates and the Jewish one. But let us first look at everything the two pacts have in common.
It cannot surprise us that the Jewish physician‘s oath is in accord with Hippocrates‘ rejection of harming human life:
“Do not attempt to kill any soul by means of a potion of herbs. Do not make a woman who is pregnant as result of whoring take a drink with a view to causing abortion. (…) You shall not incline after lucre so as to help a godless man in shedding innocent blood. You shall not mix a deadly drug for any man or woman so that he or she should kill their fellow-man. You shall not speak of the herbs out of which such drugs are made. You shall not hand them over to any man. And you shall not talk about any matter connected with this.“
Oath of Asaph and Yohanan
Besides that, both pacts oblige the physician to keep all the patient‘s secrets to himself:
“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.“
Oath of Hippocrates
“Do not divulge the secret of a man who has trusted you.“
Oath of Asaph and Yohanan
There also is an agreement between the pagan and the Jewish ethical precept for doctors, that a physician should never give in to any form of lust and covetousness in regard to one of his patients:
“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.“
Oath of Hippocrates
“Do not covet beauty of form in women with a view to fornicating with them.“
Oath of Asaph and Yohanan
But unlike the Hippocratic Oath, the Oath of Asaph and Yohanan contains a specific commandment regarding the treatment of the poor who might not be able to pay for the medical service they stand in need of, urging the physician to be mindful of them:
“Do not harden your heart and turn it away from pitying the poor and healing the needy.“
Oath of Asaph and Yohanan
As Mike Aquilina in his book The Healing Imperative. The Early Church and the Invention of Medicine As We Know It recalls, the poor and needy and the seriously ill were on the edge of society during Greek and Roman antiquity, excluded from participating in civilization‘s benefits:
“But it was also part of Hippocratic ethics to know when to give up on a hopeless case. After all, in an age before official licensing, a physician’s living depended on his reputation, and his reputation depended on success stories. A patient who wasn’t likely to recover could only embarass the physician who treated him, so (said Hippocrates) he should be refused treatment. (…) If you could afford it, you could get very good medical care from well-trained physicians. But that highfalutin medicine was for the rich – and most people weren‘t rich. (…) Epidemics often raged through the slums. Physicians attributed epidemics to something unhealthy in the place itself, and they were the first to flee the city when they saw one coming – as Galen himself did when an epidemic hit Rome. There also wasn‘t much sympathy for the sick. Illness was your own fault for not taking care of yourself, or it was a punishment from the gods. Health was a virtue – which was one of the reasons for the obsession with medicine in Greek and Roman times. Your health and appearance were indicators of your inward strength: in Greek, the same word means both ‘beautiful‘ and ‘good.‘ So if you were chronically ill, blind, or otherwise imperfect, you had a miserable life ahead of you. Parents commonly left children with birth defects on the rubbish heap. (…) Beggars were contemptible, and classical writers keep reminding us that giving them handouts only encourages them. They should just crawl off and die and make room for the good people – that is, the beautiful people.“
Mike Aquilina, The Healing Imperative. The Early Church and the Invention of Medicine As We Know It, Emmaus Road Publishing, p. 6-10
The physician Galen mentioned by Aquilina is the famous Roman doctor Galen of Pergamon (129-200 A.D.), after Hippocrates the most known physician of antiquity whose medical findings remained authoritative throughout hundreds of years.
“In AD 162, Galen moved to Rome, where he showed a genius for publicity. He gave public anatomy shows. He debated other physicians (and won the debates). He cured the rich and famous. Pretty soon he was the world’s foremost celebrity doctor.
Mike Aquilina, The Healing Imperative. The Early Church and the Invention of Medicine As We Know It, Emmaus Road Publishing, p. 8
Galen revered Hippocrates, and thought of himself as continuing Hippocrates‘ tradition. But part of that tradition was not relying on authority for medical knowledge. Like Hippocrates, Galen made many medical experiments and investigations of his own. He dissected animals to learn about how all the parts of the body fit together, and he did medical trials on willing patients. Although he came to some wrong conclusions, he was definitely a scientist, even in the modern sense of the term. (…) The Arabic-speaking world later embraced Galen wholeheartedly, so he remained the basis of medicine both in the Arab world and in Europe into the Renaissance.“
Galen began studying medicine at the age of 16 at the local Asclepieon – a healing temple dedicated to the Greek god of medicine Asclepius – in Pergamon, Turkey. The cult of Asclepius began around the time of Hippocrates who made his students swear the Oath by the whole pantheon of the Greek gods and goddesses:
“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant.“
Oath of Hippocrates
And here we find, of course, the sharpest contrast between the Hippocratic Oath and the Oath of Asaph and Yohanan. The Jewish version warns the medical students of all the practices that would at times be part of the pagan way of doing medicine:
“Do not adopt the ways of the sorcerers using as they do charms, augury and sorcery (…). You shall not seek help in any idolatrous worship so as to heal through a recourse to idols, and you shall not heal with anything pertaining to their worship. But on the contrary detest and abhor and hate all those who worship them, put their trust in them, and give assurance referring to them, for they are all naught, useless, for they are nothing, demons, spirits of the dead; they cannot help their own corpses, how then could they help those who live? Now then put your trust in the Lord, your God, who is a true God, a living God, for it is He who kills and makes alive, who wounds and heals, who teaches men knowledge and also to profit, who wounds with justice and righteousness, and who heals with pity and compassion. No designs of His sagacity are beyond His power and nothing is hidden from His eyes, who causes curative plants to grow, who puts sagacity into the hearts of the wise in order that they should heal through the abundance of His loving-kindness, and that they should recount wonders in the congregation of the many; so that every living being knows that He made him and that there is no savior other than He. For the nations trust in their idols, who are supposed to save them from their distress and will not deliver them from their misfortunes, for their trust and hope is in the dead. (…) The Lord is with you, while you are with Him.“
Oath of Asaph and Yohanan
Asaph and Yohanan simply repeat the constant testimony of the Torah and the prophets to their students, demanding from them obedience to the commandments of God.
The “rod of Asclepius“, and Christ crucified
The contrast between the pagan and the Jewish understanding of health and healing on the backdrop of differing worldviews can also be shown by comparing the cult of Asclepius with the significantly more ancient story about the children of Israel plagued by poisonous serpents in the wilderness, which is reported in the book of Numbers, chapter 21.
Asclepius was the Greek god of medicine, being the son of Apollo – the god of light, the sun, music, poetry, as well as of healing and diseases, who in turn was regarded as the son of Zeus. The “rod of Asclepius“, which is used as a medical symbol to this day – a snake coiled up around a staff – , stems from the cult of Asclepius in antiquity. The healing temples dedicated to Asclepius – the Asclepeions – were one of the treatment options for sick people. They were some kind of ancient “wellness resorts“. After the “katharsis“ – purification rites consisting of baths and a cleansing diet – one would be admitted to the temple. In the temple one would lapse into the “incubatio“ – the temple sleep – while non-venomous snakes would crawl around in the dormitories of the sick, being part of the healing ritual. The expectation was to be visited by Asclepius or by one of his children in one‘s dream. The dream was told to a priest who was responsible for interpreting it, which would then lead to the prescription of a certain therapy.
From a Hebrew perspective, not only the dedication of such a temple to Asclepius but also the presence of serpents signals the presence of demons – the attempt to heal with the help of demonic powers. Let us remember that Satan appeared as a serpent in the garden of Eden, bringing sin into the world. There is a connection between serpents, the demonic, and sin. And now let us look at the Hebrew counter-story in the book of Numbers:
“They travelled from Mount Hor along the route to the Sea of Reeds in order to go around the land of Edom. The spirit of the people became impatient along the way. The people spoke against God and Moses: ‘Why have you brought us from Egypt to die in the wilderness, because there is no bread, no water, and our very spirits detest the despicable food?‘ So ADONAI sent poisonous serpents among the people, and they bit the people and many of the people of Israel died. The people came to Moses and said, ‘We sinned when we spoke against ADONAI and you! Pray to ADONAI for us, that He may take away the snakes!‘ So Moses prayed for the people. ADONAI said to Moses, ‘Make yourself a fiery snake and put it on a pole. Whenever anyone who has been bitten will look at it, he will live.‘ So Moses made a bronze snake and put it on a pole, and it happened that whenever a snake bit anyone and he looked at the bronze snake, he lived.“
Numbers 21: 4-9
Unlike as in the cult of Asclepius, the snakes in this story are definitely not part of a healing ritual – they are a plague to which Israel is given over on account of their sin of murmuring against their God and His prophet, as they doubt God‘s character and providence. The snakes are “poisonous“ and their bites lead to death. They are a punishment for Israel‘s sin – or we could even say, they are the deadly poison of sin itself. The way for Israel to be healed and freed from the plague is to confess their sin before Moses and ask him for his intercession. While in the pagan healing ritual, the temple priest – and not the god visiting one in a dream – is eventually the final authority deciding about the appropriate remedy, the man Moses is only the intercessor, mediator, and messenger between the people of Israel and their God, and the Lord Himself is the author and source of healing, of restoring health and shalom – Asaph and Yohanan try to impress this very same truth upon their students. Moses shall put a bronze snake on a pole – does it not remind us of the “rod of Asclepius“? Looking at this snake on a pole helps everyone among the Israelites when bitten by a snake – when bitten by sin or harassed by the demonic. The apostle Saint John reports in his gospel the following saying of Jesus of Nazareth, the Messiah, as he is discoursing with the Pharisee Nicodemus:
“Just as Moses lifted up the serpent in the desert, so the Son of Man must be lifted up, so that whoever believes in Him may have eternal life.“
John 3: 14-15
The serpent on a pole in the desert – the Hebrew version of the “rod of Asclepius“ – is therefore a type of Christ nailed to a tree. Of course no analogy is established in this image between the serpent and Christ – the analogy pertains to being bound to and lifted up on a pole and to the life-giving and saving effect of looking at this crucifix. But thinking of Saint Paul‘s verses in his letter to the Colossians, we notice the semblance of the bronze image of a serpent on a pole with the record of sins nailed to the cross:
“He wiped out the handwritten record of debts with the decrees against us, which was hostile to us. He took it away by nailing it to the cross. After disarming the principalities and powers, He made a public spectacle of them, triumphing over them in the cross.“
Colossians 2: 14-15
Both sin with its deadly consequences and the demonic powers are disarmed by the Son of Man lifted up. Looking at and believing in Christ crucified, Savior and Divine Physician, saves from demons, from sin, and from death – saves from every plague.
All throughout Sacred Scripture it is made clear that there is a close and inseparable connection between body and soul in human beings and thus between their physical and their spiritual infirmities, and that the God of Israel is the Savior and Healer of both body and soul. The word “soul“ is mentioned not a single time in the Hippocratic Oath, but several times in the Oath of Asaph and Yohanan.
“And the soul of every living being is in His hands to kill and to make live, and there is none that can deliver out of His hand.“
Oath of Asaph and Yohanan
This Jewish understanding of God and man and of man‘s physical and spiritual weakness, which are closely intertwined, is present in the Church‘s practice of the Sacrament of the anointing of the sick, about which we read the following in the epistle of Saint James:
“Is any man sick among you? Let him bring in the priests of the church, and let them pray over him, anointing him with oil in the name of the Lord. And the prayer of faith shall save the sick man: and the Lord shall raise him up: and if he be in sins, they shall be forgiven him. Confess therefore your sins one to another: and pray one for another, that you may be saved. For the continual prayer of a just man availeth much.“
James 5: 14-16