Tuesday, December 11, 2012

800 B.C: Asclepius will heal your asthma

This is a statue of Asclepius from the National
Museum at Athens.  The staff of Asclepius
appears to be missing. (2, page 44)
If you lived with asthma ancient Greece around 800 B.C., chances were pretty good you worshiped the god Asclepius for health and healing.  He became the most proficient of all the Greek gods of medicine.

You didn't have to worship him, however, as nearly all the Greek gods had the ability to cause injuries and disease and the power to heal, especially Hermes, Paeon, Apollo, Hercules and Athena.

Yet these gods had other interests they had to concentrate on, so they may not have the time to help you. Their temples were dedicated not only to the sick, but to others who might need help improving their lot in life. (13, page 92)

About the time of Homer "the cult of a special god of healing arose, on whose sole office was the cure of sickness and the preservation of health. This was the cult of Asclepios, whose temples formed the chief and laterally the only seat of theurgic medicine, and were held in such estimation that they survived the Olympian fall," said medical historian Max Neuburger in his 1910 book "History of Medicine."  (13, page 92)

So the god who would become the ultimate god of health and healing was Asclepius, the son of Apollo. He would become "the chief healing god," according to Henry E. Sigerist in his book "A History of Medicine."  (1, page 45-6)

Of Asclepius, Sigerist said:
The rise of Asclepius was possible only because the legend made him the son of Apollo.  In Delphi, Apollo had his famous oracle.  He was seer but also physician...  He (Apollo) is the first deity invoked in the Hippocratic Oath, where he appears as Apollo the Physician. (1, page 45-6)
Neuburger said Apollo was the founder of medicine, but he was also known to bring on "pestilence and death on man by his far-reaching darts (sun rays), who was early identified with Paeon, physician of the gods."  He said Apollo may have taught his son medicine, although more likely this job was left to the Chiron, the son of Saturn.  (13, page 92-93)

Chiron was the only immortal centaur.  He he is
showing Apollo how to shoot arrows with a bow.
He was also the teacher of Apollo's son, Asclepius.
Chiron was another legendary figure whose significance arose the same time as did the Asclepions, after the time of Homer. He was a half horse, half god called a centaur who, according to Sigerist:
"dwelt in a cave on Mount Pelion, in Thessaly, like the other centaurs, deeply skilled in the arts of hunting, music and medicine.  In the history of mythologic founders of medicine, he was considered the discoverer of medicinal properties of many herb... (mastered them), and passed it (his medical wisdom) on to his pupils." (1, page 50)
Chiron obtained his knowledge from Apollo and Apollo's sister Artemis.  Chiron became a skilled surgeon, an excellent musician, and well versed in lore.  These skills made him a gifted and entertaining story teller with the ability to share knowledge of the past and present.  (7, page 76)

Apollo, who some speculate may have been an actual physician around 1200 B.C., wanted to make sure his son was the most proficient physician of all time, and so he sent him to Chiron to be educated.

Sigerist explained that around 700 B.C. Hesiod described one version of the story of the birth of Asclepius:
This statue of Asclepius is from
the National Museum as Saples.
It depicts Asclepius with his staff.
(2, page 45)
In the Boebian Lake, the lake of Phoebus, the beautiful maiden Coronis... was bathing her feet when Apollo saw her and desired her.  She became pregnant with the god's child but her (Corois's) father had promised (Coronis) to her cousin Ischys.  The day of the wedding came when the raven, a white bird until then, brought the evil news to Delphi, Apollo's seat.  The god in his wrath first punished the messenger of evil tidings, who from then on exhibited the black color of mourning and was feared as a herald of disaster.  He then killed Ischys, shooting his darts at him, while his sister hit Coronis and her innocent companions.  But when the god saw the body of his beloved in the pyre, he felt pity for the unborn child, removed him from the mother's womb, and brought him to the cave of Chiron on Mount Pelion (in Thessaly). There Asclepius grew up, instructed by the Centaur in the treatment of diseases with incantations, herbs, and the knife.  He became a famous physician, sought by many far and wide, and became so self-assured that he even resuscitated the dead, whereupon Zeus slew him with his thunderbolt. (1, page 52)
Asclepius and Achilles were the two most famous pupils of Chiron.  However, Sigerist said that Homer never referred to Achilles as a physician hi the Illiad.  Perhaps it was for this reason that Asclepius eclipsed even Apollo himself as the most significant healing god, and Asclepius was worshiped many places around the world, including Ancient Rome where he was referred to as Aesculapius.

There were actually many theories as to why Asclepius became such an important healing god. Some say he was an actual physician who was so skilled that, like his father Apollo, his legend turned him into a god.

How Asclepius really died may never be known, but legend has it he was "destroyed by a thunderbold of Zeus," said medical historian Fielding Hudson Garrison in his 1922 book "An introduction to the history of medicine."   (7, page 76)

Some speculate that Zeus may have done this because he was afraid the healing methods of Asclepius might make immortals of all the humans.  The result was that Asclepius became the most significant god of health and healing of all time.  (11, page 3)

He even became "so powerful that when Christianity entered the world as a religion that promised healing and redemption, he (Asclepius), of all pagan gods, was the only serious competitor of Christ," according to Sigerist.  (1, page 51)

He was such a significant figure that William Osler, the so called father of modern medicine, said of him during a lecture at Yale University in April of 1913:
No god made with hands, to use the scriptural phrase, had a more successful 'run' than Asklepios -- for more than a thousand years the counsoler and healer of the sons of men.  Shorn of his divine attributes he remains our patron saint, our emblematic God of Healing, whose figure with the serpents in our seals and charters. (2, page 43)
Osler was referring here to the seal of medicine.  Asclepius was such a significant figure that his symbol, of a rod with two snakes wrapped around it, continues to be the symbol (although modified slightly) of medicine to this day.

This symbol probably comes from the many busts and statues of Asclepius that depict him as a sagacious middle aged man with curly hair and beard, and he's usually carrying a staff with a serpent (perhaps the deadly type) wound round it with the head close to the hands of Asclepius, according to Albert Henry Buck in his 1917 book "The growth of medicine from the earliest times to about 1800."  (8, page 62)  

Buck explained that despite the deadly serpent's head being ready to strike, the face of Asclepius is calm and "unconcerned," perhaps representing his ability to remedy things that are known to be a threat to life.  (8, page 62)

Buck said:
"In the estimation of the Ancient Greeks this fearlessness was undoubtedly attributed to the supernatural power which they believed Aesculapius to possess over dangerous serpents as well as over diseases of all kind. "  (8, page 62, 63)
Some speculate the snakes represent the two opposing forces of medicine, sickness and health.  Some speculate the rod is a symbol of authority.  The serpent and the staff were not unique to Greece, as they became symbols of medicine throughout the ancient world.  An evolved version continues to be a symbol of medicine to this day.

Most of the gods had temples dedicated to them at various locations around Greece.  Osler said that it was around the 5th century B.C. that some of these temples were turned into places of learning.  While Asclepius was the most significant healing god at this time, his temples became the most significant of all these medical schools.  (2, page 39)

His temples became known as Asclepions. Garrison said that most of these Asclepions were set into mountainsides, with the most famous being the Asclepions at Cos, Cnidus, Epidaurus, and Pergamus (7, page 76)(13, page 94)

John Watson, in his book 1856 book "The Medical Profession in Ancient Times." said these temples would:
"Serve as schools of instruction, and as asylums for the sick.  They furnished the nucleus for which, in process of time, were developed other institutions and organizations.  As schools, the most ancient of them is said to have been Titane, near Sicyon." (5, page 26)
Neuburger said Asclepius introduced music and gymnastics into medicine. Built near the temples were gymnasiums. He said:
It is remarkable that the Asclepios cult flourished mostly in places which, through climate or hygienic advantages, were natural health resorts. Those favoured spots on hill or mountain, in the helter of forests, by rivers or springs of pure flowing water, were conducive to health. The vivifying air, the well cultivated garden surrounding the shrine, the magnificent view, all tended to cheer the heart with new hope of cure. Many of the temples owed their fame to mineral or merely hot springs. To the homely altars, erected originally by sacred fountains in the neighborhood of healthy-giving mineral springs, were later added magnificent temples, pleasure-grounds for festivals, gymnasia in which bodily ailments were treated by physical exercises, baths and inunctions (rubbing ointment on the skin), also, as in proved by excavations, living rooms for the patients (hostels)."
Renouard said that at some point:
"The gymnasium were no longer, as formerly, places devoted entirely to bodily exercise; they were surrounded by halls and porticos where philosophers, rhetoricians, artists and physicians assembled to hold their schools and dispute on questions of art." (9, page 80)
So Asclepius "became one of the most popular of the gods.  By the time of Alexander it is estimated that there were between three and four hundred temples dedicated to him."  (2, page 49)

Renouard said that aspiring Greek physicians traveled to Egypt and Mesopotamia to learn about medicine, once the schools at the great Asclepions had been established.  He said that "soon the sages of Greece ceased their journeys in search of light in foreign countries, for their own country became in its turn a center of illumination for all nations." (9, page 80)

Potential physicians traveled from near and far to be instructed at these temples, and they were probably sworn to secrecy. Likewise, the sick and injured traveled from near and far to learn the recommended cures of Asclepius.  These patients would participate in a treatment called incubation (process of the god Asclepios revealing the cure).

Watson said the temples "were sacred from intrusion, and accessible to the sick only after suitable preparation. The invalid, on his arrival, submitted to purification, by fasting, ablution, and inunction." (5, page 27)

Garrison said the patient was first cleansed in a nearby spring.  (7, page 76)

Neuburger said pregnant women were kept away, as well as the "mortally afflicted." He said those allowed in were "submitted to careful purification, to bathe in the sea, river or spring, to fast for a prescribed time, to abjure wine and certain articles of diet, and they were only permitted to enter the temple when they were adequately prepared by cleansing, innunction and fumigation." (13, page 94)

Watson said the patient would then lie on the stone floors, or sit in the corners, or in some cases sit on couches that were arranged on the floors of the "Hicetas, or common-hall of the temples, said Watson.  They would be entertained by the priests with stories of healing by Asclepius. (5, page 27)

Neuburger said the sick were entertained with stories of patient's with similar symptoms being cured.  Such miraculous stories were told in order to incite hope. (13, page 95)

Buck said that a sacrifice was made, and usually it might be a cock, which was a symbol of "watchfulness," a sign  for the physician to be vigilant.  An owl might symbolize "clearsightedness," the eagle of long life, the hawk skilled in medicine, the ram a symbol of dreams and divination.  These animals were also often depicted near statues of Asclepius.  (8, page 62)

Dr. P.V. Renouard, in his 1867 book, "History of Medicine," transcribes a quote from a comedy of Aristophanes that shows what an incubation may have been like:  (9, page 64)
"The Priests of the temple of Esculapius, after having extinguished all the lights, told us to go to sleep, adding, that if any one should hear a hissing, which indicated the arrival of the god, he should not move in the slightest manner.  Se we all laid down without making any noise; but I could not sleep, because the odor of an excellent broth, that an old woman held near me, agreeably excited my olfactories.  Desiring most ardently to slide along to it, I raised my head very quietly, and saw the sacristan, who took away the cakes and figs from off the sacred tables, going the round of the altars, putting into his sack every thing he could find.  I believed that I had a right to follow his example, so I raised to go to the old woman's pot"  (9, page 64)
Neuburger said the believers thought the god was affecting the cure. But, as was shown by the comedy of Aristophanes, the priesthood "actually performed cures which the half-sleeping or half-intoxicated patient imagined to be dreams." (13, page 95)

Renouard this comic was obviously one of the doubters.  Most people, however, believed in the healing powers of Asclepius.  Although, over time, it must have become quite puerile.  Of this, Neurburger said:
In later times Asclepios refrained from these manual services and only indicated the cure, either clearly or symbolically, to the dreamer of his accepted proxy.  (13, page 95)
Neuburger said that doubting priests may have become the first physicians of Greece. They were taught at the Asclepions and later would travel to the homes of the sick in order to treat them.

Edward Withington, in his book "Medical History from the earliest times," describes the incubation this way:
"The sick person after sacrifice and purification lay down to sleep near the alter of the god, and the mode of treatment was revealed to him either in a dream, or more directly by the priest himself, dressed as to represent the deity. On recovery he presented thank offerings, sometimes including models of the affected part in wax, silver or even gold, and a tablet was put up describing his illness and it's treatment." (4, page 40)
Buck explains that the person would lie down, usually wrapped in coat of a Ram , and then drift off to sleep. (8, page 62)  The god Asclepius would then enter the hostel, remove your skull , and take out the demons.  When you woke up you'd either have an epiphany regarding the cure, or the priest would tell you the cure the god recommended.

Actually, Garrison said that once the patient fell asleep the priests would dress like the god.  If the patient was asleep the remedy would occur to the patient.  If necessary the patient would tell the priests what he dreamed of, and the priests would interpret them, thus relaying the cure.  Some patients would not sleep, and they would come face to face with the god, who would directly relay the cure.  The god may either appear as a vision, or he may have actually been one of the priests in disguise.  (7, page 76)

Watson said the temples were:
"Always filled with patients; and along their walls the tablets (votive tablets) were suspended upon which were recorded the history and treatment of the individual cases of disease." (5, page 27)
Neuburger said the votive tablets were made of wood or stone, "and hung up on posts or pillars." (13, page 95)

As the patient's slept, the priests would review the complains the the patients, and perhaps assess them vaguely.  This information was then used for divination purposes, where the priests would make both a diagnosis and prognosis.  The priests would then refer to the votive tablets for the cure.  (2, page 57)

In looking at the votive tablets, the priests would look for similar diseases. enouard explained the reasoning behind this system:
These persons have constantly in their mouths these words: “ I have seen a disease similar to this cured by such a remedy.” Their reasoning, however gross it appears to us, is based on an incontestable principle, that may be stated as follows: Remedies which have cured a disease, must be equally efficacious in curing analogous cases. (9, page 70)
As noted by Neuburger above, this was mainly done to offer hope to the sick.

Renouard said this was a system similar to that of the ancient Egyptians.  He said the votive tablets "showed the names of the patient, the kind of disease with which he was attacked, and the manner of the cure." (9, page 67)

Renouard said that one votive tablet was found in Rome on the island of Tiber, the site of an ancient Asclapion temple.  He quoted the following from one of these tablets:
"Lately a certain Carus, who was blind, came to consult the oracle. The god required that he approach the sacred alter to perform adorations; at once he passed from the right to the left, and having rested his fingers on the altar, he raised his hand and applied them to his eyes. He recovered his sight immediately, in the presence of the people, who rejoiced to see such marvels accomplished under the reign of our august Antonius." (9, page 67)
“ Lucius was attacked with a pleurisy, and every one despaired of his life. The god ordered that the ashes of the altar be taken, mingled with wine and applied to his side. He was saved, and gave thanks to god before the people, who congratulated him.” (9, page 67)
“ Julian vomited blood, and appeared lost beyond recovery. The oracle ordered him to take the pine seeds of the altar and eat them for three days, mingled with honey. He did so, and was cured. Having solemnly thanked god, he went away.”
“ The god gave this direction to a blind soldier named Valerius Aper: Take the blood of a white cock, mingle it with honey, and make acollyrium, which you are to apply to the eyes for three days. The soldier having fulfilled the direction of the oracle, was restored to sight, and returned to make a public thanksgiving to God.”
The tablets, which were attached to the walls and columns of the temples, were reviewed by the priests when their memories did not allude to a similar case and a cure. (9 page 67).

These tablets were studied by the priests, particularly when they were in training, and were later studied by students of philosophy in schools (gymnasiums) that were attached to the Asclepions.

Neuburger said:
Asclepios enjoined mostly natural cures, such as diet, exercise... hunting, or fencing, also physical means -- listening to song, seeing a play -- less often bleeding or purgatives, at times seemingly ridiculous but really suggestive measures. Success was always ascribed to the credit of the god, failure to the fault of the patient."
Osler said the priests "did not neglect the natural means of healing.  The inscriptions show that great attention was paid to diet, exercise, massage and bathing, and that when necessary, drugs were used."  (2, page 57)

Most of the drugs used were generally to cleanse and purify the body.  Garrison said some common drugs were cathartics (purgatives), emetics, or bleeding.  (7, page 76) Other drugs that may have been used are diaphoretics, stimulants, and sedatives.  

Most drugs consisted of a variety of herbs prepared into pills made of dough that were taken orally or through the rectum.  Some remedies were made into drinks such as wine.    

Sigerist said the rich gave expensive gifts and sacrifices, and the poor gave what they could. Some slept in the temples and some in nearby hostels hoping to be cured by the god in the night.   If you had asthma perhaps you were among the crowd sleeping on the floors.  Or, in your case, slumped over a chair yearning to fall asleep to learn how to get your breath back. (1, page 73 and 3)

Neuburger said the "hostels (shelters) were "undertaken by the keepers of inns and boarding-houses in the neighbourhood." (13, page 94)

Garrison said if you did get better, an offering of thanks, which often included a wax model of the "diseased part," was presented to the god, and the story recorded on the votive tablets for future priests to reference.  (7, page 76)

Some speculate that at some point during the life of the Asclepions medicine was transformed in Greece from mythology and theology to natural philosophy and reason (an early form of science), but at exactly what point this occurred, and how many cases were seen prior to this transformation, are unknown. (9, page 68, 76)

That medicine was practiced at the Asclepions, as opposed in some remote location among the populace, is what allowed medicine to advance.  It is only out of this system, as Renouard quotes Louis Philippe Auguste Gauthier from his 1844 book "Recherches Historiques sur l’Exercice de la Médicine dans les Temples,”
It must be agreed, that in those barbarous times, medicine could make more progress in the hands of a corporation like the Asclepiadae, than if it had been merely a domestic or popular art.  It is not probable that, at a period so remote, when the arts and sciences were still in their infancy, a man of genius could be suddenly raised up, who could elevate medicine to the rank of a science... It is probable that the reading of the inscription in the temples, and the habit of seeing a great number of sick, gave, in the end, a certain amount of medical instruction to the priests." (9, page 76)
Initially this knowledge was esoteric to only the priests of the Asclepions, although, over time, the priests at Cos preferred a more rational approach to medicine. This rational medicine ultimately gave rise to the physicians who worked outside the Asclepions.  (13, page 96)

Sometimes around 400 B.C. a famous physician named Hippocrates, the so called man of genius, transcribed the votive tablets at the temple of Cos into the infamous Hippocratic Corpus, or so some speculate

By writing the Corpus, Hippocrates not only helped complete the transformation of medicine in Greece, he also made this knowledge available to the public.  It was for these reasons, as we will learn later, why Hippocrates will forever be known as the father of medicine.

In the meantime, many historians have noted that ancient Greece was well ahead of other ancient societies in regards to medicine.  The best evidence of this is the accumulated knowledge obtained from the votive tablets stored in the Asclepions.  Of this, Meryon said:
"And this opinion appears to be supported by the fact that from the earliest time of which any historic record exists, the Hellenic physicians were in high repute at the court of Babylon; so that, although the origin of Grecian medicine is involved in the most profound obscurity, the resources at the Asclepiades were obviously appreciated over and above the appliances of the Persians, which were chiefly derived from astrology and magic." (6, page 20)
While some may think of such "asylums" as the first hospitals, Watson notes this wasn't necessarily true.  He said:
"The temples bore no inapt resemblance to the hospitals and infirmaries of modern times; into which, in fact, some of them were ultimately converted. (5, page 26)
Thomas Bradford, in his 1898 book "Quiz questions on the history of medicine," said the Asclepions were converted into hospitals when Constantinople made Catholicism the official religion of Rome in 312 A.D.  It was Helena, the mother of Constantine, who was the primary champion for this conversion. (12, page 49)

Even after their demise, even after the glorious physicians of the Grecian era were long gone, the sick could still travel to the Asclepions for health and healing. Even as the medicine was transformed from philosophy back to theology, at least the sick were offered the best mode of treatment in the ancient and primitive worlds, and that was hope.

References:
  1. Sigerist, Henry E, "A History of Medicine," 1961 edition, Volume II: Early Greek, Hindu, Persion Medicine," Oxford University Press, page 44
  2. Osler, William, "The Evolution of Modern Medicine: A series of lectures at Yale University on the Silliman Foundation in April, 1913," New Have, Yale University Press, 1921,
  3. Templesuk.org, "Asclepius," http://healing.templesuk.org/asclepius.htm
  4. Withington, Edward Theodore, "Medical History from the Earliest Times," 1894, London
  5. Watson, John, "the Medical Profession in Ancient Times," 1856, New York, 
  6. Meryon, Edward, "The History of Medicine: Comprising a narrative of its progress from the earliest ages to the prestne and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861
  7. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, 3rd edition, Philadelphia and London, W.B. Saunders and Company
  8. Buck, Albert Henry, Williams Memorial Public Funds, "The growth of medicine from the earliest times to about 1800," 1917, London, Oxford University Press
  9. Renouard, Pierre-Victor, "A History of Medicine from its origin to the nineteenth century," 1867, Philadelphia, Lindsay and Blakiston
  10. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia
  11. Strathern, Paul, "A Brief History of Medicine from Hippocrates to Gene Therapy," 2005, U.K. Avalon Publishing
  12. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
  13. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

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