HISTORY OF UROLOGY Of gods and men BY JONATHAN CHARLES GODDARD n this series of articles I am going to show a healing temple was founded you some of the exhibits contained in the there in his name. Museum of Urology, hosted on the BAUS According to legend, Apollo Iwebsite (www.baus.org.uk). had a son with the mortal One of the most fascinating aspects of Coronis, the daughter of early Ancient Greek culture is the fluid Phlegyas, Prince of Thessaly; mingling between history and myth. Deep this son was Aesculapius. in the mists of time, names appear in the Unfortunately, Coronis was history of medicine of healers who may unfaithful to Apollo (or was have been real people, or not; may have rumoured to have been) and for been based on real people or indeed several this, Artemis, Apollo’s twin sister, people; or even just based on an idea or murdered her. With her dying school of thought. Some, and this is what I breath, Coronis told Apollo she love about the Ancient World, we are told, was carrying his child and he were related to, or were actually, gods. cut Aesculapius from her womb, Aesculapius is a name closely associated saving him; a caesarean section with medicine in Greece. It is unclear if a prior to Caesar! man with that name, who practised healing, The orphaned Aesculapius ever walked the earth. His name is linked was adopted and brought up by with a ‘school’ of medicine and religious Chiron the centaur (a mythical healing. His symbol, a snake wound around half man, half horse) who was Figure 2: Hippocrates, as depicted on a small modern plaster bust. a staff, remains one of the emblems of skilled in medicine and taught modern medicine today (Figure 1). the young Aesculapius all he knew. developed in his name. Healing temples Aesculapius is mentioned in Homer’s epic were built called Aesculapia. Here, the sick poem the Iliad and his sons Machaon and came to see the priests (not doctors) and Podalirius were also skilled healers and are to sleep in the temple overnight. During said to have taken part in the Trojan War. their sleep, they hoped to dream of the god Machaon was wounded by Paris, Prince of who would come to them and heal them, or Troy, but survived to be one of the Greek tell them how they could be healed. If they heroes who hid inside the Wooden Horse. improved, the god had healed them, if not, He was said to have healed Philoctetes, maybe they were just not pious enough. the archer and owner of Hercules’s bow, There is some extant evidence of these of his appalling snakebite, thus allowing episodes in Greek poems and plays and Philoctates to return to Troy, slay Paris some stories were carved into stone stelae and help win the war. Machaon was at the Aesculapia at Epidaurus. subsequently killed at Troy. For example, a man came to the Homer also recorded an incident of Aesculapia with an abscess in his abdomen. urological trauma in the Iliad. Harpalion, This is an unusual description and one fighting for the Trojans, attacked Meneleus, wonders if it was a renal abscess pointing younger brother of Agamemnon, but into his loin. He dreamt that the god came Figure 1: Aesculapius, as depicted on the medal of the 16th International Medical Congress, held in Budapest, 1909. was unable to break his shield. As he to him and commanded his servants to hold retreated, he was shot with a bronze arrow him down and drain the abscess. When Aesculapius was said to be the son of by Meriones. The arrow pierced the right he awoke his pain had gone, his abscess Apollo. Apollo was a god, the son of Zeus, buttock, passed through the greater sciatic was drained and there was blood on the king of all the gods. He was the god of light, notch rupturing the bladder to exit under floor. If one were disinclined to believe the springtime and crops, and the god of the pubis. The wound was fatal. in the divine healing of Aesculapius, one healing. It is said Apollo was born at Delos; Podalirius, Aesculapius’s other son, may think he was perhaps sedated and survived the Trojan War but his ship was the priests did indeed drain the abscess, wrecked on the coast of Caria. There he maybe for the good. healed Syrna, the daughter of the king, and The descendants of Podalirius, son of subsequently married her, establishing the Aesculapius, settled in Rhodes, Cnidus “The writings of city of Syrnus (named after his wife); more of and Cos. On the latter two islands, great Podalirius’s family later. medical schools emerged. The most Hippocrates contain many At some point, Aesculapius was deified famous doctor of the school of Cos was early references to urology” and became a god and a healing cult Hippocrates. Hippocrates is thought to have urology news | JULY/AUGUST 2020 | VOL 24 NO 5 | www.urologynews.uk.com HISTORY OF UROLOGY been born around 460BC into a medical Cos was Herophilus of Chalcedon (c.335 Unfortunately, I’m not able to tell you family (Figure 2). He was described by his – c.280BC). He became a doctor at the that all urologists are directly descended contemporary, Plato, as Hippocrates of Cos, great school of medicine in Alexandria in from gods. But Hippocrates does allow the Aesculepiad. Some felt this implied that the C3rdBC. It appears he studied human us to claim that we work in the oldest he and his family were medical priests of anatomy, very likely by dissection of human surgical specialty and when we do remove the temple of Aesculapius, but this doesn’t as well as animal corpses and possibly bladder stones we are carrying out the fit with his subsequent works, which were by vivisection of criminals. It has been oldest elective operation, one that was not based on magic and religion. The suggested he gave the first description of the done on the shores of the Aegean Sea other theory suggests that Hippocrates prostate: “glands which poured a humor into under the watchful gaze of the gods was of the family of Aesculapius, via the the urinary passages of the male to excite of Mount Olympus. line of Podalirius, one suggestion being the sexual act.” Herophilius called these that he was the 17th direct descendent of glands parastatai adenoeides or glandular Aesculapius himself. assistants. It is more likely Herophilus was The writings of Hippocrates contain describing the seminal vesicles. many early references to urology. He Although the Greeks may not have been notes that wounds to the bladder, like truly aware of the prostate gland as an SECTION EDITOR that of poor Harpalion, were always fatal. anatomical concept, the presence of some This statement, adhered to for centuries, soft tissue mass at the base of the bladder probably delayed the use of the suprapubic and urethra must have been appreciated approach for bladder stones by hundreds by the Greco-Roman surgeons as they of years. Although Hippocrates advised attempted to pass catheters or dilators to against opening the abdomen, the drainage relieve bladder outflow obstruction. of pointing renal abscesses was encouraged, The prostate would also have been like our patient who dreamed his cure in the encountered as surgeons cut for the stone Aesculapia at Epidaurus. via the perineum. This procedure, perineal Hippocrates also noticed that, “Diseases lithotomy, also appears in Hippocrates, in Jonathan Charles Goddard, about the kidneys and bladder are cured fact in the Oath. The phrase, “I will not cut Curator of the Museum of Urology, hosted by BAUS; with difficulty in old men” indicating some for the stone,” has been interpreted to mean Consultant Urological Surgeon, Leicester General recognition of the effects of the enlarged general physicians and surgeons should Hospital, Leicester, UK. prostate and ageing bladder we see so not attempt this difficult and dangerous E: [email protected] commonly now. Interestingly, one product procedure, but refer it to specialist stone of the Hippocratic School of medicine at surgeons, now known as urologists. urology news | JULY/AUGUST 2020 | VOL 24 NO 5 | www.urologynews.uk.com.