EARLY MEDICAL SCHOOLS THE CULT OF AESCULAPIUS AND THE ORIGIN OF HIPPOCRATIC MEDICINE By G. E. GASK, C.M.G., D.S.O., F.R.C.S., (Hon .) F.A.C.S. LONDON N COMMENCING a study divine beings, and so it came about that of medical education in when sick of soul or body men turned Greece and the early Greek to the gods of healing for help and guid- medical schools, one is con- ance. fronted immediately by a serious diffi- Even to-day such beliefs do not strike culty. In writing of the early medical us as strange for since childhood we schools, the more important of which have heard of the dreams of Pharoah are those of Cos and Cnidos, the diffi- and Nebuchadnezzar and the stories culty arises of disentangling the associa- connected with their interpretation. tion of temple-medicine as practised in the Aesculapium of Cos and of the lay Aesculapius, the God of Healing medicine described in the Corpus Hip- From the earliest times there have pocraticum. been gods specially associated with heal- Writers in the past have believed that ing and in Greek mythology one of the Hippocrates received his training in the earliest is Apollo. As the son of Zeus, Aesculapium and derived his great Apollo appears as the god of light, the knowledge from this source. It becomes god of spring, the giver of crops, the therefore imperative to examine this averter of ills, the promoter of health. question critically and to dispose of it His fame grew and his worship became before attempting to describe the school established, the two chief centres of of Cos. which were his birthplace, Delos, and This article contains a description of Delphi with its far-famed oracle. the Cult of Aesculapius, related, it is Now according to common account hoped, without prejudice, and is fol- Apollo had a son by Coronis, the daugh- lowed by arguments intended to refute ter of Phlegeas, prince of Thessaly, and definitely the possibility of temple- it is interesting to note that it was in medicine having been the source of the Thessaly tradition states that the cult of Hippocratic inspiration. Aesculapius arose. Coronis is supposed to have been THE CULT OF AESCULAPIUS killed by Artemis, twin sister of Apollo, The origins of healing cults are for unfaithfulness, and Aesculapius, her buried deep in the mists, fancies and son, was brought up by Chiron, the make-believes of the infancy of man- Centaur, who taught him the art of kind, when dreams were thought to be healing. Aesculapius profited so well warnings or revelations of things to from his teaching that he is said to have come. In sleep, it was thought, the soul been able to bring dead men to life. could slip the body and soar into the In Homer Aesculapius is represented realm of spirits, there to commune with as a hero not yet a god, and he had two sons, Machaon and Podaleirius, skilled cent proportions that they compel our in medicine and surgery, who fought at wonder and admiration to this day. Troy. The ritual of the proceedings of the Later, we do not know just when, cult were somewhat as follows: Aesculapius becomes a god. He was a The patient who was about to be a wonder worker, a healer, a saviour from suppliant was first prepared by absten- trouble and disease and one who could tion from certain forms of food and be propitiated by gifts and worship. So drink, or by absolute fasting, for with- his cult grew and temples for his wor- out such due preparation no person ship were established far and wide, in might enter the temple. On entrance to Greece, in the islands, and in the coastal the temple the patient would be met by regions of Asia Minor. the priest, who was often accompanied Aesculapius is generally represented by his daughter, for the purpose of re- with a staff in his hand and accompa- calling, one may imagine, that Aescu- nied by a snake. From very early times lapius was assisted by his daughters snakes have been associated with medi- Hygieia and Panaceia. The patient cine and life. Sir James Frazier suggests would then be told stories of wonders that the snake became the emblem of effected by the god and everything done immortality, for it seems to renew its to excite the imagination and raise the youth yearly by shedding its skin. expectation of a cure to the highest It will be recalled that in the wilder- pitch. Next came prayers and some form ness Moses made a serpent of brass and of ceremonial purification by washing. put it up on a pole so that all those who Then came the offering in the shape of had been bitten by the fiery serpents a cake, a cock, a ram or an ox, according were cured. to the wealth of the patient. The offer- ing was placed on an altar before the The places devoted to the worship of statue of the god, and apparently it or Aesculapius were called Aesculapia, the a portion of it became the perquisite of most famous of which were Tricca in the priest. Next followed the ceremony Thessaly, Epidaurus, Cos, and Perga- of incubation (literally lying-in) or mos.1 temple-sleep, the most impressive part The sites chosen for the temples were of the ritual. generally beautiful places, commonly The patients lay side by side in a long on wooded slopes and close to a pure open-air portico, or abaton, covered at and bountiful supply of fresh water or the top and open at the side. Lights a medicinal spring. In addition to the were put out by the attendants and all temple or shrine of the god there were were told to go to sleep. inns or hostels for the reception of the Here the suppliants spent the night sick and their friends, as well as abatons and during sleep dreams came to them or sleeping places in which the sick by which they were cured or a means of passed the night and where they re- cure revealed. But about the sleeping ceived the dreams or revelation or treat- places there came at night tame snakes, ment which was to effect their cure. or in some instances dogs, who licked Closely associated with the temple the sore places or the blind eyes and buildings were ample facilities for ex- aided in the cure. ercise and recreation, including stadia In many instances a cure did follow, and open-air theatres of such magnifi- in which case the will of the god had been obeyed, but if no cure ensued then his bonds. Straightway he departed cured, the patient had omitted to do some- and the floor of the abaton was covered thing that should have been done. with blood. In the case of a cure it was a custom Many more instances could be cited, to consecrate a votive offering to the some of them dealing with affections of god or present a model of the diseased the eyes. But these are a fair sample of part or limb, made perhaps of gold or the votive inscriptions. They mostly re- silver, which could be hung up in the late immediate and miraculous cures, temple. It was common also to adorn and some of them are even more fan- the walls with votive tablets describing tastic than those quoted. Any medical cures for the benefit of future patients. man reading them would agree at once In Epidaurus a number of such inscrip- that they do not bear the slightest evi- tions have been discovered, done on dence of rational diagnosis or rational large stone stelae. treatment. Cure is by miraculous inter- Here are three such inscriptions:2 vention of the god following propitia- 1. Kleo was with child for five years. tion by gifts, aided by the use of sugges- After these five years of pregnancy, she tion and perhaps also by drugs. came as a suppliant to the god and slept Exception might be taken to this in the abaton. As soon as she left it and judgment in the case of the third exam- got outside the temple precincts, she bore ple quoted—the man with the abscess. a son who, immediately after birth, Professor Singer thinks that the man was washed himself at the fountain and walked given a powerful narcotic and that, about with his mother. In return for this while he was under its influence, the favour, she inscribed on her offering: “Ad- mire not the greatness of this tablet, but priest, in the guise of the god, opened the divine power, in that Kleo was with the abscess with a knife “and the floor child for five years, until she slept in the of the abaton was covered with blood.” Temple and the god cured her.” The Rev. John Todd thinks it was 2. A man had his toe healed by a ser- merely an advertising stunt to impress pent. He was suffering dreadfully from a the patients with the power of the god. malignant sore in his toe, when the ser- In 388 b .c . Aristophanes exhibited vants of the Temple took him outside and his play “Plutus” in Athens, probably sat him on a seat. When sleep came upon in the theatre of Dionysus, which is him, a snake came out of the abaton and alongside of the Aesculapium. In this healed the toe with his tongue, and there- after went back to the abaton.