The Hippocratic Oath: Background information when reading Cutting For Stone

The Hippocratic Oath

This article relates to Cutting For Stone

The title, Cutting for Stone, refers to a line in the Hippocratic Oath, and to the last name of the three main characters, all of them surgeons. As Abraham Verghese quotes it, the line from the Oath reads "I will not cut for stone, even for patients in whom the disease is manifest. I will leave this operation to be performed by practitioners, specialists in this art." While this line refers specifically to surgery for bladder stones (which were quite prevalent in the 4th century BC), it's also a directive against surgery of all kinds. Ancient Greek physicians did not practice surgery, instead referring their patients to trained surgeons. Surgery was then considered a secondary skill, and surgeons were not trained in theoretical medicine as physicians were. Dissection was forbidden, and without precautions against contamination or the ability to anaesthetize, surgery was almost always deadly and certainly unbearably painful.

It's believed that The Hippocratic Oath was written in the 4th century BC, influenced by the doctrines of Pythagorean philosophy. It probably has several authors, one of which may or may not be Hippocrates. Considered the father of modern medicine, Hippocrates is credited with separating medicine from magic, religion and superstition, and planting it firmly in a systematic and rational school of thought. His thoughts and writings still form the basis of modern medicine's ethical tenets, and continue to be adapted and debated as science and medicine progress.

First do no harm is probably the most famous tenet most often quoted from The Hippocratic Oath - but erroneously so. The phrase doesn't appear in any of the many translations or adaptations of the Oath, and is likely adapted from a phrase in Hippocrates' Epidemics, though its exact origins are often debated.

Medical schools around the world recite oaths upon graduation, most of them based on The Hippocratic Oath. Over time, schools have adapted and modernized the oath, but the idea remains the same: to bind physicians to the art and moral responsibilities of their practice and their patients, and to affirm a commitment that the care of their patients is their first consideration.

Abraham Verghese is a surgeon, and Professor for the Theory and Practice of Medicine at Stanford, and every year he joins his graduates as they stand and take the oath. In an interview he remarks, "When the new graduates take stand and take the oath, all the physicians in the room are invited to rise and retake the oath. You see many physician parents and physician siblings standing as their son or daughter or brother or sister takes the oath. It chokes me up every time. Not only am I renewing my faith, but I am bursting with pride in seeing my students graduate."

• A translation of The Hippocratic Oath
• A modern adaptation by Dr. Louis Lasagna
• The Stanford Affirmation from the Stanford School of Medicine

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This "beyond the book article" relates to Cutting For Stone. It originally ran in February 2009 and has been updated for the January 2010 paperback edition. Go to magazine.

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