ASCLEPIA AND THE ASCLEPIADES.
Many asclepia, or temples of health, were in time established throughout
Greece and her colonies and elsewhere. A recent writer states that at
least three hundred and twenty are known “to have existed in antiquity;
so that every town of importance must have had its sanctuary.”[60] In
success and length of existence they, of course, varied greatly. The
one at Epidaurus has been spoken of, and others of great celebrity were
those of Tricca, Cnidus, and Cos, to say nothing of some only a little
less deserving of mention, such as those at Rhodes, Pergamus, Carthage,
Athens,[61] and Rome.
The asclepion at Tricca, in Thessaly, was probably started by the sons of
Æsculapius, Machaon and Podalirius. At any rate, according to Homer, they
were attendants there. This was enough to bring it into repute, but its
situation in the mountains was much in its favor as a popular sanatory
resort.
The Coan and Cnidian asclepia were favorably located; the former on the
island of the name, which Pliny speaks of as “flourishing and powerful in
the highest degree and consecrated to Æsculapius,”[62] and the latter not
far distant, on a site decidedly maritime, in Asia Minor. These temples
were both very distinguished, and a degree of rivalry prevailed between
them. In them there was undoubtedly much highly creditable medical
knowledge in exercise. The same was probably the case in most, or perhaps
all, others, especially in later times; but it is in respect to those
only that we have indubitable evidence of the fact. Of the two schools,
the adherents of the Cnidian paid special attention to the symptoms of
individual cases, and avoided, as much as possible, powerful cathartics,
bleeding, and other active means of cure.
Whatever may have been the success of the various asclepia, institutions
which were finally blotted out in the early part of the fourth century by
Constantine, the first Christian emperor,[63] that of Cos was destined
to make the greatest impress on the medicine of the future. It was the
good fortune of this institution to have in connection with it, at the
acme of its career, a great author as well as physician. Hippocrates, a
native of the island, rendered the fame of the Coan school imperishable,
and gave to his fellow-men throughout the world, in all time to come, a
legacy of incalculable value. Through this early and great medical writer
his _alma mater_ has been made, in a manner, that of the medical man of
all ages. From Cos sprang forth at the touch of a humble man, afterward
called appreciatively “the divine old man,” a mass of medical knowledge,
wonderfully pure and good, which constitutes the main body of the real
medical science of our own day.
An asclepion[64] consisted essentially of a building with a more or
less hygienical site, usually in the country and near a fountain,[65]
sometimes a mineral one, in which the arts of healing were practiced
by priests or disciples of Æsculapius, called asclepiades. In all, the
influence of the god was generally believed to be an essential factor;
and hence in each an image of him was to be found. But the fully-equipped
institution had many appliances, as has been shown in the account given
of the one at Epidaurus. Arrangements for exercises, baths, and other
means which were brought to bear to restore people to health were duly
provided and were in many instances elaborate.
The asclepiades claimed that they were descended directly from the god of
whom they were the disciples. They were not, at any time, mere priests;
that is, ministers of religion. Indeed, it has been asserted that “there
is no sign in the Homeric poems of the subordination of medicine to
religion.”[66]
The asclepiades constituted a special class, and they were oath-bound
to preserve the mysteries of the art from the uninitiated. The oath is
preserved in the Hippocratic Collection,[67] and is usually called by his
name. It begins thus: “I swear by Apollo, the physician, and Æsculapius,
and Health, and All-Heal,[68] and all the gods and goddesses that,
according to my ability and judgment, I will keep this oath and this
stipulation.” In it occurs this passage: “I will follow that system of
regimen[69] which, according to my ability and judgment, I consider for
the benefit of my patients, and abstain from whatever is deleterious and
mischievous.” Here is another: “With purity and with holiness I will pass
my life and practice my art.” Cutting for the stone is left to those who
make a special business of it. What is learned about patients, in the
exercise of the art, which should be kept secret is not to be divulged.
Mr. Adams well says that it is most honorable to the profession that
so ancient a document pertaining to it as this, “instead of displaying
narrow-minded and exclusive selfishness, inculcates a generous line of
conduct, and enjoins an observance of the rules of propriety and of the
laws of domestic morality.”[70]
It has been said, in a learned article[71] on ancient medicine, that “the
asclepiadæ of Greece were the true originators” of scientific medicine.
This claim might be questioned, but it is, doubtless, in the main just.
Certainly all physicians were not connected with asclepia; and in later
times the asclepiades proper were avoided by the more intelligent and
rational.
Unfortunately, the records of the practice of the asclepiades have been
almost entirely lost. This is to be regretted, and more especially
because what is preserved is of a decidedly high order of merit.[72]
However, it is probable that at least the _crême_ of the whole has been
handed down to us by Hippocrates.
It seems certain that in the first “Prorrhetics” and the “Prænotiones
Coacae,” which are transmitted to us in the Hippocratic Collection, we
have fragments and excerpts from the histories of diseases and cures
which were formerly found on the votive tablets of the Coan Temple. From
these records Hippocrates drew largely in composing his highly valuable
“Book of Prognostics.” In reference to the matter Adams says: “It is
as clear as the light of day that Hippocrates composed this work from
them.”[73]
It is more than probable that, except for a short time at first, the
system of treatment pursued by the asclepiades varied within wide limits;
and it is equally certain that the superstitious element lessened as time
passed. Between the principles of practice of Æsculapius and those of
Hippocrates[74] there is a very wide difference. Those of the former will
be given later; but of those of the latter I may say here that they were
essentially scientific.[75] To Hippocrates every disease had a natural
cause, and was to be cured by natural means. He was wont “to consult
Nature herself about Nature,” as Bacon has somewhere wisely advised.
He did not attribute any morbid condition to any spiritual power, good
or bad, and hence in his practice did not resort to conjuration or any
related means of cure. Even of epilepsy, the so-called “sacred disease,”
he said: “It is thus with regard to the disease called sacred: It appears
to me to be nowise more divine nor more sacred than other diseases, but
has a natural cause from which it originates like other affections.” And
again: “Men regard its nature and cause as divine, from ignorance and
wonder.”[76] As regards holding disease to be divinely inflicted, he very
properly remarks: “I do not count it a worthy opinion to hold that the
body of man is polluted by God.”[77]
Not only in the principles of medicine, but in its practice, Hippocrates
was wonderfully sound, even when judged from the stand-point of the art
in our day. In truth, for extent and profundity of medical knowledge and
philosophy, between him and what modern would one think of instituting
a comparison? Sydenham has been likened to him; but, although I am an
admirer of the English physician, I do not hesitate to say that he was
neither in breadth nor depth any such man as the Coan. As a writer on the
prevention and cure of disease, Hippocrates remains _facile princeps_.
Let it not be hastily supposed that my admiration for Hippocrates is
unreasonably great. His works are truly a surprise to even the well-read
modern. Very many of the so-called discoveries of recent times may be
learned by turning to them. I speak advisedly. I will cite instances:—
Thus, of the treatment of open sores, he says: “In these cases no part
is to be exposed to the air.” Dressings of “wine and oil” and “pitched
cerate[78]” are directed to be used.
Again, in treating fractures, in connection with certain splints, he
advises that “a soft, consistent, and clean cerate should be rubbed
into the folds of the bandage;”[79] and he says, “If you see that the
bones are properly adjusted by the first dressing, and that there is no
troublesome pruritus in the part, nor any reason to suspect ulceration,
you may allow the arm to remain bandaged in the splints until after the
lapse of more than twenty days.”[80]
Still again, in regard to the reduction of a dislocation at the
hip-joint, he says, “In some the thigh is reduced with no preparation,
with slight extension, directed by the hands, and with slight movement;
and in some the reduction is effected by bending the limb at the joint
and making rotation.”[81]
In the three preceding paragraphs we have the practical side of the germ
theory of disease, the permanent dressing of fractures, and the reduction
of dislocations by manipulation.
I might go on and recount numerous other matters alleged to be new, and
of which we hear much; but it is not necessary. I may add, however, a few
items of interest:—
“Bleed,” says the old Greek, “in the acute affections, if the disease
appears strong, and if the patients be in the vigor of life, and if they
have strength.” Has any modern spoken more wisely on the subject?[82]
Here is a statement worthy of the attention of unbalanced theorists
of our day: In fevers and pneumonia, heat “is not the sole cause of
mischief.”[83]
He gives directions for the use of effusions with “water of various
temperatures” in “cases of pneumonia,” of “ardent fevers,” and of
other diseases. This treatment, he thinks, “suits better with cases of
pneumonia than in ardent fevers.”[84]
In that inimitable book, his “Aphorisms,” it is said: “In general,
diseases are cured by their contraries.” There is no exclusive allopathy
or homœopathy, or dogma of any kind, in that statement; it is the
sentiment of a scientific physician.
Medicine was evidently far advanced in the days of Hippocrates;[85] and
he was certainly a learned and sensible practitioner of it, even the
“Prince of Physicians,” as Galen, I think, somewhere characterizes him,
as well as one who did much to make it what he pronounced it himself to
be, namely, “of all arts the most noble.”[86]