FROM EPIDAUROS TO GALENOS THE PRINCIPAL CURRENTS OF GREEK MEDICAL THOUGHT* By A. P. CAWADIAS, O.B.E., M.D. DURH., AND PARIS, M.R.C.P., LOND. LONDON HE object of this paper is to that unites the irrational medicine of show the evolution of Greek the ancient Eastern people to the medical thought from the scientific medicine of the Greeks. practices of religious medi- In the scientific medicine of the cine, as symbolized by the Faith-healGreeks- four periods can be distin- Ting of Epidauros, which forms the guished. Every period is based on link with the pre-Hellenic or irra- physiological work, and it is in part tional medicine, to the death of the application of this physiological Galenos which marks the end of the work to medicine, and its develop- creative period of Greek medicine. ment through special clinical methods For the understanding of this im- of diagnosis and treatment that char- portant period of the history of acterizes the medical work of every medicine, the history of the Greeks, in period. Physiology, taken in its large general, must be taken into considera- sense, that is, including anatomy, is tion; and principally the work of the the scientific basis of medicine, and physiologists and philosophers, who thus the only way to understand the mark the various stations of Greek evolution of Greek medical thought thought, must be studied. Greek medi- will be to place distinctly at the cine bound with Greek thought, in beginning of each period, the physio- general, shows a remarkable progres- logical work on which this period is sion, from the first conceptions of based. nature, of life, of disease due to the The first period can be called the physiologists, philosophers and physi- physiological period. The physiolog- cians of the seventh and sixth cen- ical work on which the practice of turies b .c . to the complete knowledge these early physicians is founded is of physiology found in Galenos. that of the ancient Ionian philosophers Medicine is a creation of the Greek called in Greek Physiologists, such as intellect. Before the advent of the Thalles of Miletus. To this period of Greeks the people who had preceded Greek medicine belong the old schools them in the history of the world had of Magna Graecia, that is of the an attitude towards disease which did Greek colonies of the south of Italy not correspond to real medicine, which and Sicily. During this period the basic is based on science. Medicine before concepts of medicine are founded, the Greeks was mostly religious, magi- diagnosis is introduced, on the basis cal, irrational. Epidauros, and in gen- principally of physiological deduction eral the cult of Asclepios represents controlled by a rudimentary clinical the religious medicine of the Greeks, examination, and treatment begins and constitutes therefore the link on the basis of a combination of * Paper read before a meeting of the Royal Soeiety of Medicine at the Wellcome His- torical Museum, on January 30, 1930. On the occasion of the 18th Centenary of Galenos. deductions from physiology and of ritus and Diogenes of ApoIIonia, and clinical control. This period com- is represented by the late Italo-Sicilian prises the seventh and the sixth physicians and the famous schools of Cos and Cnidos. The conception of the mechanism of disease becomes more precise and the clinical method of diagnosis and treatment reaches its zenith, from the combination of the nosographical method introduced by the physicians of Cnidos, and that of the individual diagnosis developed by the physicians of Cos. This period comprises the fifth and the fourth centuries b .c . The third period receives a great impulse from the physiological work of Aristotle. It is characterized by a tendency to base diagnosis and treat- ment on rational lines, that is on deductions from physiology. This tend- ency does not succeed completely, and that is why many physicians remain faithful to the clinical methods of the previous period, while others fall into an exclusively physiological dogmatism, which brings as a reac- tion, as another dogmatism, the devel- opment of the school of the Empirics. The fourth period is represented by the work of Galenos. He is the physiologist on whom the medical work of the period is based and he is at the same time the physician who applies that medical work. The physi- ology of Galenos marks a great prog- ress over that of Aristotle and of the Alexandrians, on account of the intro- duction by Galenos of the experi- mental method. From a medical point of view this Galenic period is charac- terized by the predominant role the centuries and the early fifth century physiological method plays in diagno- B.C. sis and treatment. The second period begins with the The fifth period is the period of work of the physiologists of the fifth compilation and transmission of Greek century b .c ., Anaxagoras, Democ- medicine to the West. Epidaur os As a form of religious medicine Epi- The study of the principal currents dauros represents also the Hellenic of Greek medical thought begins with spirit regarding religion. There were Epidauros for two reasons. Epidauros, no inscrutable mysteries, no magical being the most celebrated shrine of the procedures, no manifestations of theoc- God of Medicine, of Asclcpios, sym- racy in the practice of Epidauros. bolizes Greek medicine. It is in the Those who came there were simply neighborhood of this famous temple, put into a good condition, so as to that according to some beautiful receive the effects of the religious legends, Asclcpios was born as son of suggestion. They came into a beautiful Apollo the God of Art and of the country, where they forgot all the beautiful Koronis, and it is on the worries of life, by listening to Mount Tithion, that is near the actual theatrical representations given in sanctuary, that the child Asclepios that marvelous theater of Polyclctos, was kept by a shepherd and nourished which remains today the masterpiece with the milk of a goat. of Greek theatrical architecture. They Apart from that, Epidauros is inter- visited the musical places, watched esting because it is the most important the athletic games at the Stadium, place of Greek faith-healing, and and conversed about politics or philos- represents a sort of transition between ophy with the people who had come the pre-Hellenic medicine, which was from all parts of Greece. At the cor- nearly exclusively religious, at all ners of the shady alleys, they could events magical and irrational, and read the steles on which were written the Greek medicine which was rational the miraculous cures of the God of and scientific. It may appear curious Medicine. that in the ultra-rational Greece religi- When they were thus well prepared, ous medicine, as has been demon- they were put to sleep in the Abaton, strated by the work of P. Cawadias, and the God appeared in their dream played such a great role. But this is acting as a physician, manipulating easily understood when one remem- their diseased limbs, applying an bers the marvelous sense of proportion ointment on their sore eyes, and the ancient Greeks brought into all pushing the similarity to the physi- their work. The Greek physicians cian so far as to recommend to the knew that the power of mind over patient not to forget to pay his fee to body was very great, and they knew the priests. When the patient awoke, also that nothing could have such a he was cured. power over the mind as religion, and One sees that there was a great thus they did not do anything to hin- difference between the religious medi- der the evolution of religious medicine. cine of Epidauros and the religious On the other hand the priests of medicine of the Egyptians, the Assyr- Asclepios realized that there were ians, the Babylonians and the Jews. limits in the action of mind over body, The patients who came to Epidauros and that their God could not do every- were not considered as possessed of thing, and they were probably very gods or demons, but as suffering from careful to send to the physicians disease explained by the laws of phys- who had their schools near the tem- ical nature. There was no practice of ples of Asclepios, the organic cases. magic, no manifestations of theocracy, but pure, one could say, rational century did not experiment in the psychotherapy. There was no exclu- actual sense of the word, but it is not siveness, and the collaboration of the experimentation but the critical con- scientific physicians was often de- sideration of facts of observation and manded. The Greeks had in the experimentation that constitute the matter of religion ideas explained in science of Physiology. Thus these the story of the man who while drown- Greek physiologists were really the ing was invoking Pallas Athene, and first physiologists. They did not study to whom one of his companions man or animals or plants alone, but said, “continue to invoke Athene, all nature, because it was the only but try also to swim.” Zup ’Adr)v& method through which the place of [xai x^pcr pivec. man in Nature could be ascertained. First Per iod of Gre ek Medi cine (Sev en th , Thales of Miletos believed that water Sixth and Earl y Fift h Cent ury , was the primary element from which The Fir st Phys iologi sts (Seventh all matter was formed, and Anaxi- Centu ry ). Scientific medicine be- mander of Miletos explained the origin gins with the first physiologists who of man by various transmutations.