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Saturday, January 31, 2015

800 B.C Asclepius will heal your asthma, part 2

Medical historian Pierre-Victor 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 (the 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)

Some historians say that there were probably non-poisonous snakes that crawled around the floors of the temples.  Usually the sick did not mind this because they knew the snakes were part of the healing ceremony.

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)

Renouard transcribed 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 (of a snake, perhaps?), which indicated the arrival of the god, he should not move in the slightest manner.  So 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 said 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," described 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 complaints of 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 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 were 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 M├ędicine 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, however, 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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