Sachs M
Klinik für Allgemein- und Gefässchirurgie, Johann Wolfgang Goethe-Universität, Frankfurt am Main.
Zentralbl Chir. 2003 Apr;128(4):341-7. doi: 10.1055/s-2003-38802.
A passage with one of the most contradictory interpretations of the so-called Hippocratic Oath, which was presumably created between 500 and 300 before Christ, is the prohibition of lithotomy. The oldest handwritten traditions of the Hippocratic Oath are dating back to the 11th-12th century. However the section of the prohibition of lithotomy is missing in the oldest preserved tradition (Codex Urbinas gr. 64), which led to some authors interpretation of being added later on. Beyond all doubt the analysis of the texture of the Hippocratic Oath leads to the conclusion that the prohibition of bladder stone lithotomy must have been an integrative part of the oath from the very first beginning. The author could have been inspired by the following reasons to have a non oath related doctor let done the medical operation: the removal of a bladder stone by an operation, which was outfitted with many complications, was one of the most difficult surgical interventions in the antique. Celsus (1st century A. D.) mentioned "severe fever, urine fistula and deadly inflammations" after lithotomy. Since the operation was done perineally, presumably a negative sexual potency was feared. No doctor engaged to help and not to harm his patients was allowed to make this kind of operation, which was often followed by many complications. Nevertheless sometimes patients were "tantalised to death by suffering dreadful pain" through those bladder stone diseases. Consequently "practising men" (the term "surgeon" was created at a later date), those who had been specialised in that operation and had not been linked to the oath, were allowed to make this kind of dangerous operation. Due to a greater experience of those specialists (named as "Lithotomos" by Celsus ih the 1st century A. D.) the danger of this kind of operation was reduced. The prohibition of lithotomy could be interpreted as a commitment to realize the limits of ones own medical actions.
关于所谓的《希波克拉底誓言》，其中一段有着最矛盾解读的内容是禁止膀胱结石手术。该誓言大概创作于公元前500年至300年之间。《希波克拉底誓言》最古老的手写传统可追溯到11至12世纪。然而，在现存最古老的版本（《乌尔比诺抄本希腊文64号》）中，禁止膀胱结石手术的部分缺失了，这导致一些作者认为这部分是后来添加的。毫无疑问，对《希波克拉底誓言》文本的分析得出结论，禁止膀胱结石手术从一开始就必定是誓言的一个组成部分。作者可能受以下原因启发，让与誓言无关的医生进行该医疗手术：通过手术切除膀胱结石，这种手术存在诸多并发症，是古代最困难的外科手术之一。塞尔苏斯（公元1世纪）提到膀胱结石手术后会出现“严重发热、尿瘘和致命炎症”。由于手术是经会阴进行的，可能担心会导致性功能丧失。没有承诺帮助且不伤害患者的医生被允许进行这种常伴有诸多并发症的手术。然而，有时患者会因膀胱结石疾病“被剧痛折磨致死”。因此，那些专门从事该手术且与誓言无关的“行医者”（“外科医生”一词是后来才出现的）被允许进行这种危险手术。由于这些专家（公元1世纪塞尔苏斯称其为“膀胱结石手术者”）经验更丰富，这种手术的风险降低了。禁止膀胱结石手术可被解释为一种对认识自身医疗行为局限性的承诺。
