CHAPTER IV. Greek Medicine At the Dawn of History

GREEK MEDICINE AT THE DAWN OF HISTORY

It is from Greece and from Greece alone, says Daremberg, that our modern medicine derives its origin.

It has come down to us, in a direct line, through the sheer force of its inherent excellence, and with little or no aid from outside sources. Harvey, Bichat and Broussais are as much the legitimate heirs of Hippocrates, Herophilus, Galen, Berenger de Carpi and Vesalius, as Hippocrates is the heir of Homer, and as this divine singer of the anger of Achilles is himself the product of a civilization that existed before his day and that was in all probability the creation of Hindu influences.

It is to the development of medical knowledge in Greece, therefore, that our attention should next be directed, and more particularly to that period which belongs to the dawn of history--the pre-Homeric period.

The pre-Homeric Period of Medicine in Greece.--The poems of Homer, the Iliad and the Odyssey, furnish us with the earliest and almost the only written evidence of the state of medicine in Greece during that period of time. They were probably written, according to the authority of the Earl of Derby, somewhere about 800 B. C., and modern investigations show that the siege of Troy, the theme of the Iliad, occurred between the years 1194 and 1184 B. C. These investigations also show that in this region, and especially in the Island of Crete and in Mycenae on the neighboring mainland of Asia Minor, at this time and probably several hundred years earlier, there existed a high degree of civilization. Specimens of a written language, for example, were found among the objects recovered from the ruins of the palace of King Minos at Cnossus in Crete, but hitherto no interpreter of this unknown language has been found. It is reasonable to expect, however, that in due time these Minoan records will be translated, that still other records belonging to this remote age will be discovered, and that much valuable information regarding the condition of medical knowledge in Greece during this long period will then be revealed to us. Strange as it may appear, the classical Greek writers seem to have possessed very little knowledge concerning this highly developed civilization at Cnossus. And yet, if we stop to consider the matter, their silence will appear less strange for the following reasons. Some great calamity (war, an earthquake, or a conflagration) must have destroyed many of the evidences of Minoan civilization besides those which are now being brought to light; then, also, several hundred years elapsed between the occurrence of this disaster and the classical period of Greek culture; and, finally, there is the fact that the knowledge of past historical events, when kept alive simply by tradition, slowly vanishes, until finally it becomes so vague as to possess very little value. The discoveries made in the Island of Crete and at Mycenae were not known to Daremberg when he wrote the lines quoted above, but he felt perfectly sure, from his knowledge of the laws of development in general, that a product so highly cultured as Homer could not have suddenly sprung into existence out of the apparent darkness and ignorance of the centuries immediately preceding his time.

The State of Medical Knowledge at the Time of the Siege of Troy.--It is from Homer’s Iliad and Odyssey that our authoritative knowledge of the most ancient Greek medicine is derived. In the former work mention is made of Aesculapius and his two sons, Machaon and Podalirius, both of whom accompanied Agamemnon and the Greek host in their expedition against Troy. According to this author’s account they served in the double capacity of surgeons to the army and valiant leaders of troops. In order that the reader may judge for himself just what is the nature of the evidence furnished by Homer with regard to the medical knowledge of that period, it seems desirable to introduce here a few of the more characteristic references which the poet makes to spear, javelin and arrow wounds, to the injuries caused by fragments of rocks hurled by the assailants, and to various remedial measures, both surgical and medical, employed for the relief of the wounded or sick warriors. There are at least one hundred such passages in the Iliad alone, but the few which are here cited will serve as adequate examples of Homer’s familiarity with anatomy and with some of the methods of treating spear and arrow wounds,--a familiarity which indicates that the poet must have had some medical training.

Thus he; and not unmoved Machaon heard: They through the crowd, and through the widespread host, Together took their way; but when they came Where fair-hair’d Menelaüs, wounded, stood, Around him in a ring the best of Greece, And in the midst the godlike chief himself, From the close-fitting belt the shaft he drew, With sharp return of pain; the sparkling belt He loosen’d, and the doublet underneath, And coat of mail, the work of Arm’rer’s hand. But when the wound appeared in sight, where struck The stinging arrow, from the clotted blood He cleans’d it, and applied with skilful hand The healing ointments, which, in friendly guise, The learned Chiron to his father gave. (Book IV. of the Iliad, Lines 221–259.)

* * * * *

He said: the spear, by Pallas guided, struck Beside the nostril, underneath the eye; Crashed through the teeth, and cutting through the tongue Beneath the angle of the jaw came forth: Down from the car he fell; and loudly rang His glittering arms: aside the startled steeds Sprang devious: from his limbs the spirit fled. Down leaped Aeneas, spear and shield in hand, Against the Greeks to guard the valiant dead; And like a lion, fearless in his strength, Around the corpse he stalk’d, this way and that, His spear and buckler round before him held, To all who dar’d approach him threatening death, With fearful shouts; a rocky fragment then Tydides lifted up, a mighty mass, Which scarce two men could raise, as men are now: But he, unaided, lifted it with ease. With this he smote Aeneas near the groin, Where the thigh bone, inserted in the hip, Turns in the socket joint; the rugged mass The socket crushed, and both the tendons broke, And tore away the flesh: down on his knees, Yet resting on his hand, the hero fell; And o’er his eyes the shades of darkness spread. (The Iliad, Book V., Lines 333–356.)

* * * * *

He said, and passing his supporting hand Beneath his [Eurypylus’] breast, the wounded warrior led Within the tent; th’ attendant saw, and spread The ox-hide couch; then as he lay reclined, Patroclus, with his dagger, from the thigh Cut out the biting shaft; and from the wound With tepid water cleans’d the clotted blood; Then, pounded in his hands, a root applied Astringent, anodyne, which all his pain Allayed; the wound was dried, and stanch’d the blood. (The Iliad, Book XI., Lines 958–967.)

* * * * *

But Jove-born Helen otherwise, meantime, Employed, into the wine of which they drank A drug infused, antidote to the pains Of grief and anger, a most potent charm For ills of every name. Whoe’er his wine So medicated drinks, he shall not pour All day the tears down his wan cheeks, although His father and his mother both were dead, Nor even though his brother or his son Had fallen in battle, and before his eyes. (Book IV. of the Odyssey, Lines 275–284.)

In former years and down almost to the present time, it was the custom among English medical writers to speak of Aesculapius only as the “God of Medicine,” thus conveying to the minds of many readers that he was a mythological character, not a real personage. To-day, and especially since Schliemann has demonstrated, by his excavations at the site of ancient Troy, that Homer’s Iliad is not merely a beautiful creation of his poetic fancy, but a narration of events that actually occurred about 1200 B. C., it is quite generally acknowledged that Aesculapius is an historical character, an individual whose memory should receive due honor from the physicians of modern times. Neither Homer nor Pindar speaks of him as a god. In Athens he was publicly deified in 420 B. C.

When Daremberg, as quoted above, expressed the belief that Hippocrates was the product of an earlier civilization, he undoubtedly gave due weight to other circumstances beside those which are narrated in Homer’s poems--circumstances, for example, which are referred to casually by several of the classical Greek authors, and to which fresh importance has been given by a number of recent discoveries. Thus, there is an abundance of evidence showing that the Greeks, both before and after Homer’s time, held the memory of Aesculapius in the very highest honor. So great, as they believed, was his power over disease, so wonderful were the cures which he accomplished, and so noble and pure was his character, that they made him a god and erected temples in his honor--not mere places where a barren worship might be carried on, but veritable sanatoria--termed Asclepieia--where the extraordinary healing powers of him whom they had made a god might be perpetuated for the benefit of succeeding generations. While, on the one hand, the ancient Greeks may have been full of superstitious beliefs, they were at the same time as kindly disposed toward their fellow men, as generous in their spending of money for this purpose, and as practical in their selection of suitable methods as are the benefactors of to-day all over the world. In course of time these so-called temples became the prototypes of our hospitals, sanatoria and schools of medicine, and it therefore seems only proper that they should here be described somewhat in detail.

The so-called Aesculapian Temples and their Chief Purpose.--The first of these temples, or Asclepieia, were established at Trikka, in Thessaly; at Cnidus, on the coast of Caria in Asia Minor, opposite Cos; at Epidaurus, in Argolis, Greece; at Cyrene on the northern coast of Lybia, Africa, opposite the Island of Crete; at Crotona, on the southeastern coast of Italy; and, finally, at Athens. It is said that traces of as many as eighty of these Asclepieia have been found in different parts of the ancient world. One of them, for example, is known to have existed on the small island (Isola San Bartolommeo) in the Tiber, at Rome. Their management was intrusted, in the earlier years of their existence, to men who were descendants of Aesculapius--i.e., the sons and grandsons of Machaon and Podalirius. They were both priests and physicians, and are mentioned in history as the Asclepiadae. With the progress of time it became necessary, as one may readily understand, to intrust the temple service to individuals who were not members of the family of Aesculapius. The original Asclepiadae guarded as valuable secrets the methods of treatment and the pharmaceutic formulae which had been handed down to them by the head of the family. It was therefore natural, when these newly adopted members were installed in office, that they should be made to promise, under oath, not to “divulge these secrets to any but their own sons, the sons of their teachers, or the pupils who were preparing themselves to become regular physicians.” (Neuburger.)

The divulging of these secrets, it may be assumed, would gradually entail upon the organization of priest-physicians a serious money loss. As will be seen further on, the oath known as “the Hippocratic Oath” omits these mercenary features, and thus places the vocation of physician upon a much higher level.

It is an interesting fact, as noted by Hollaender, of Berlin, that Homer does not make the slightest mention of temples dedicated to Aesculapius; from which circumstance it may be inferred that a long time--perhaps several hundred years--elapsed, after his death, before his countrymen realized fully his greatness and the value of the services which he had rendered in his rôle of physician. Of the temples which were then built in his honor, all have long since fallen into ruins, but in recent years excavations have been made at some of the more important of these sites and under the guidance of competent scholars, and as a result our knowledge of the state of medicine in Greece between the time of Homer and the appearance of the Hippocratic writings has been greatly enlarged. The facts revealed by these excavations and the statements which are to be found in classical Greek literature, but which previously did not receive all the consideration that they deserved, have now been pieced together and we have thus been furnished with a fairly satisfactory picture of the relations of the different chambers and spaces in these temples, and with a more or less complete account of the manner in which affairs were conducted by those in charge. The following short description which is based on the account recently published by Professor Meyer-Steineg of Jena, Germany, will put the reader in possession of all the more important facts.

As it must have appeared to the traveler, in the third century B. C., on his approach by sea to the port of that island.

Reconstitution based upon recent photographs and upon surveys by Herzog (Koische Forschungen, 1904).

(Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.)]

There were two principal types of Asclepieia--one, like that of Epidaurus, in Argolis, which occupied an inland situation, that had clearly been chosen from religious motives alone, viz., because it was believed, in accordance with an ancient tradition, that at this spot Aesculapius had been born--and a second, like that of Cos, on the island of the same name in the Aegean Sea, which situation without doubt had been chosen chiefly because the locality was exceptionally healthful. Of the first of these two types of temples, the sites of both of which have been most carefully studied, very little need be said in this brief sketch. The purely medical aspects of this Asclepieion, to which at the height of its celebrity crowds flocked from all parts of Greece, are of minor interest. The temple and its accessory buildings, which appear to have been very extensive, were located in a narrow valley, not far distant from the seaside village which still to-day bears the name of Epidaurus. Then, also, the locality is deficient in one important respect--it has an insufficient supply of good drinking water; and, finally, it is only slightly elevated above the sea-level. Dr. Meyer-Steineg remarks that the patients who visited this temple must have owed whatever benefit they derived from the visit to other influences than those of a purely medical or hygienic character. Doubtless suggestion played an important part in any relief which they may have obtained, and the so-called temple-sleep was also doubtless a very effective factor in this direction. The Asclepieion at Cos, on the other hand, occupied a most healthful position on the northern slope of the ridge of mountains which extends throughout the entire length of the island and attains a maximum height of about 3000 feet. (See Fig. 1.)

It now remains for me to describe, as best I may within the limited space which is at my command, the results of the excavations and surveys that have been made in recent years on the Island of Cos. Professor Meyer-Steineg’s article on this subject is the source from which I have derived the information contained in the following account.

The temple and its associated buildings stood at an elevation of three hundred feet above the sea-level and at a distance of a little more than two miles from the city of Cos. The heights behind the temple were in former times covered with forests and afforded ample protection against the debilitating and much-dreaded south wind. A brook of considerable size and of very pure water passed through the temple grounds; the spring (Burinna) from which it took its origin being located about 300 feet higher up on the side of the mountain. Not far off, in the same neighborhood, is a mineral spring, the water from which contains both iron and sulphur. All the physical conditions of this site were, therefore, very favorable to the restoration of both mental and bodily health. Professor Meyer-Steineg declares that it is scarcely possible to determine accurately the age of the Cos Asclepieion,--i.e., of the structures which the present ruins represent,--but he believes that some of them date no farther back than the third century B. C., at which time extensive structural alterations were made. Then, at a still later date (first century A. D.), in consequence of the damage done by an earthquake, C. Stertinius Xenophon (at the instigation of the Roman Emperor Claudius, whose private physician he was) carried out some very radical changes. Not only were the separate buildings well supplied with running water, but even many of the individual rooms (of which there were a large number) were equipped with the same conveniences. Hydropathy evidently formed an important part of the treatment in the reconstructed temple. (See Fig. 2.)

As has been shown above, the climate, the freedom from disturbing factors of all kinds, the existence at that spot of a plentiful supply of pure water, the character of the structures composing the temple group, and the widespread belief among the people that the Asclepiadae were able, with the assistance of the god Aesculapius, to effect cures which were obtainable nowhere else--all contributed to make the temple at Cos one of the greatest sanatoria of ancient times.

As they appeared in the third century B. C.

(Copied by permission from a model made by Prof. Dr. Meyer-Steineg for the Medico-historical Museum of the University of Jena, Germany.)]

As Ascertained by the Researches of Dr. Herzog.

The different structures are arranged as nearly as possible in the same positions which they occupied in the third century, B. C.

A, main entrance to Asclepieion; B, B, B, gallery, 6 metres broad, with colonnade on one side; C, open space or court, on the southern side of which is a structure composed of recesses provided each with a bathing basin (D); H, staircase leading to intermediate terrace; a, massive series of steps leading to the upper terrace; b, b, b, broad gallery similar to that shown on the lower terrace; d, the temple proper.

(From Prof. Dr. Meyer-Steineg’s Medizinisch-historische Beiträge.)]

The buildings which constituted what is commonly termed the “Temple of Aesculapius” at Cos were located on three artificially prepared terraces. The principal entrance to the group, as the excavations conducted quite recently by Herzog show, was on the lower terrace, and faced north--that is, toward the sea. From this lower level a broad staircase led to the second or intermediate terrace, which, in turn, was connected with the upper one by means of a very broad and massive series of steps. The southern limit of this upper terrace ended abruptly at the slope of the mountain. The arrangement of the buildings on the three different terraces may, in harmony with the account given by Professor Meyer-Steineg, be briefly described as follows: That which stood on the lower terrace occupied three sides of a parallelogram (Fig. 3), the open part of which faced south. The longer side of the building measured about 120 metres (390 feet) in length, and the two shorter sides each 55 metres (180 feet). The supply of running water in every part of this great building, which appears to have been devoted mainly, if not entirely, to therapeutic purposes, must have been most abundant. The source from which the water came was the Burinna spring, situated higher up on the mountain at a spot far beyond all possibility of contamination. It is not yet clear, says Dr. Meyer-Steineg, whether or not there were any buildings devoted to therapeutic purposes on the intermediate terrace. (Figs. 2 and 3.) On the other hand, the great halls, contained in the large building which surrounded the temple on the upper terrace, appear to correspond very closely to the rooms that constituted the main portion of the building on the lower terrace, and it is therefore probable that this upper building also served some useful purpose in the general scheme of the Asclepieion. It is Herzog’s opinion--according to Meyer-Steineg--that the central idea around which everything in this assemblage of fine buildings revolved, was a clinic conducted by the Asclepiadae. The means chiefly employed at first for the restoration of health were such simple agents as sunlight, pure air, pure drinking water, dietetic measures, massage, physical exercise, etc., and yet, when the patient’s condition seemed to require their use, there was no hesitation in resorting to the rational employment of drugs, and even surgical operations were performed. The numerous instruments which Dr. Meyer-Steineg collected at the site of the ruins when he visited Cos in 1910, furnish ample corroborative evidence of the correctness of this last statement.

Not the least important part which this famous Asclepieion played in the history of medicine was the splendid opportunity which it afforded to those who were preparing themselves to engage in the practice of the healing art, for acquiring the necessary familiarity with the different diseases and for learning how they should be treated.

The manner of conducting the preliminary treatment was probably not the same in every particular in all the different Asclepieia, and yet in the main the plan of procedure followed in Epidaurus, in Cos and in Athens undoubtedly resembled closely that which Pagel furnishes in his Geschichte der Medizin. It may be briefly described as follows:--

In the first place, moribund persons, the unclean, and women about to be confined were not admitted into the temple enclosure. The management of the latter class of patients was left entirely to women nurses, and, when it became evident that a person was likely to die, the individual was thereafter cared for outside the enclosure. In short, everything possible was done to keep out of sight all such objects as might produce an unpleasant impression upon applicants for treatment. After preliminary bathing and dieting, the patient was conducted into the temple enclosure and encouraged to make offerings and to pray to the god Aesculapius, an imposing statue of whom in marble was one of the first things that confronted him. As he was led about by the priest or an attendant, his imagination was wrought upon by the sight of numerous votive offerings exposed to view on the walls or columns of the buildings, by the singing of hymns in adoration of the god, and by the reading of the records of earlier cases inscribed on tablets or on the columns. After his mind had thus been worked upon, he was asked to furnish to the priest a detailed history of his own case and to submit to some sort of physical examination. As a final and most important step in this first stage of the treatment he was subjected to what was termed “the temple-sleep,” during which the suggestion of the proper remedies to be employed was supposed to be communicated to him by the god himself.

In our day it is difficult to understand how persons of a fair degree of intelligence could for so long a period have continued to believe in the efficacious interference of the deified Aesculapius in their behalf. But that this belief really did exist is well known, and it was only after the lapse of many centuries that the faith of the public began to weaken, doubtless through the influence of several factors. Perhaps the most important of these was the discovery of an increasing number of instances of humbuggery or trickery, of which the officiating priests, in some of the temples, had been guilty. The satirical writer, Aristophanes, who flourished in Athens about 400 B. C., describes an incident of this nature in his play entitled “Ploutos.” The following extracts furnish an account of the doings observed by the slave Karion on the occasion of his passing a night in the temple enclosure at Athens:--

The Scene throughout is laid at Athens, in front of the house of Chremulos.

* * * * *

Blepsidemos: Ought n’t we then to bring in some doctor?

Chremulos: Prythee, what doctor is there now in the city? For their pay is no longer anything worth, nor their art.

Blep.: Let us cast about.

Chrem.: Nay, there is not one.

Blep.: I believe there is not.

Chrem.: Nay, by Zeus, the best plan is to do what I have been long preparing--(to conduct him [Ploutos]) to the temple of Asklepios make him lie down [there].

* * * * *

Chrem.: Karion, my man, you must bring out the bedclothes and lead Ploutos himself in the usual way, and carry everything else that is ready within.

(Exeunt omnes.)

* * * * *

Chorus of Farmers. What is the matter, Oh thou best friend of--thyself? For you seem to have come as a messenger of some good news.

Karion. My master has fared most prosperously, or rather Ploutos himself. For, instead of being a blind man, he has been made to see again, and his pupils are clear-sighted, as he has met with a kindly friend in Asklepios the Healer.

Chorus. You give me reason for joy, reason for shouts of triumph.

Karion. Ye have reason to rejoice whether ye wish it or not.

Chorus. I will shout aloud for Asklepios of the goodly children, the great light to mortals.

* * * * *

Karion. Well, as soon as ever we came to the god, leading a man then, indeed, most miserable, but now blessed and fortunate, if any other is so, first we led him to the sea, and then we bathed him.

Wife of Chremulos. By Zeus, then the old man was fortunate, bathing in the cold sea.

Karion. Then we went to the sacred enclosure of the god. And when on the altar the cakes and offerings were dedicated by the flame of murky Hephaistos, we laid down Ploutos, as was proper; and each of us made up from little odds and ends a bed for himself.

Wife. Then were there certain others beside yourselves wanting the god?

Karion. Yes, Neokleides, for one, and he is blind; but in stealing has far overshot those who can see; and there were many others with all sorts of ailments. But when the minister of the deity put out the lights and told us to go to sleep and said that we were to keep silent, if any of us perceived a noise, we all lay down in an orderly manner. And I was unable to sleep, for my attention was arrested by a certain pitcher of porridge a little way off from the head of a certain old woman, and I strangely desired to creep over to that pitcher. Then I looked up and saw the priest making a clean sweep of the cakes and dried figs from the sacred table. After this he went round all the altars in a circle to see if any cakes were left anywhere. Then he consecrated them into a certain wallet; and I, believing that there was great holiness in this proceeding, rise up to go to the pitcher of porridge.

Wife. Oh you most miserable of men, were you not afraid of the god?

Karion. Yes; by the gods I was afraid lest he with his fillets should reach the pitcher before me; for the priest had already given me a lesson. But, as soon as ever the old woman perceived the noise I made, she lifted up her hand over the pitcher (to protect it). Then I hissed and seized (her hand) by the teeth as if I were a reddish-brown snake. But she at once drew back her hand again and lay down peacefully, rolling herself up. And then I at once gulped down a lot of the porridge; and then, when I was full, I jumped up again.

Wife. And didn’t the god come up to you?

Karion. Not up to that time. After this I at once covered myself up, being afraid; but he made a complete circuit examining all the ailments in a most orderly fashion; and then a slave set by him a little mortar and box of stone.

Wife. Of stone?

Karion. No, by Zeus, certainly not,--at least, not the box.

Wife. To the deuce with you, how did you see since you say you were covered up?

Karion. Through my old cloak; for, by Zeus, it had holes not a few. First of all, he took in hand to pound a plaster for Neokleides, and he threw in three cloves of Tenian garlic. Then he bruised them in the mortar, mixing therewith the acid juice of the fig-tree and squill; then, having diluted it with Sphettian vinegar, he turned his eyelids inside out that he might feel more pain, and then applied the mixture. But he, squalling and bawling, jumped up and was running away, when the god said with a laugh:--“Sit down there now, smeared with thy plaster, that I may stop thee from going to the Assembly, having for once a real excuse.”

Wife. What a patriot and sage the god is!

Karion. After that he sat down by the side of Ploutos, and first he touched his head, and then, taking a clean towel, he wiped his eyelids all round, and Panakeia covered his head and all his face with a cloth of purple dye; and the god then whistled. Thereupon two snakes of monstrous size darted forth from the temple.

Wife. Dear Gods!

Karion. And these two (snakes) having quietly glided under the crimson cloth, licked his eyelids all around, methought. And before you could drink ten cups of wine, my mistress, Ploutos stood up and was able to see: and I clapped my hands with delight and awoke my master. And the god suddenly took himself off from our view with the snakes into the temple.

If one examines carefully the facts connected with the Aesculapian temple treatment, so far as they are known to us, one cannot fail to be impressed with their strong resemblance to what has been the experience of similar semi-religious movements in more recent times, not only in European countries but also in the United States. In all of them there may be found a kernel of true religious belief, and no candid observer can deny the fact that many persons have been benefited thereby both in body and in mind. But, sooner or later, the method has fallen into disrepute, either because it was employed in the vain hope that it might accomplish a cure which surgical means alone could effect, or else because unscrupulous persons, taking advantage of the credulousness of those associated with the movement, utilized it for their own selfish advantage.