FROM ASKELEPIOUS TO HIPPOCRATES

Innominate Lecture
December 1997

INTRODUCTION

·         Medical Roots Trip.  Charles Rush the Apostle Paul.

·         Show Map Slides.

·         Sulfur drugs 1939. PCN 1946.  Biological revolution.  We could significantly affect death.  This was the first time in history that this was possible.

·         The last fifty years has been a period of innovation that society recognizes as good.  This is a progressive attitude.  Not always true.  Long periods of conservatism, with stagnation.  Example the Dark Ages and Middle Ages in Europe when people suspect of innovation were regularly tortured and put to death for heretical ideas.  Our current period of innovation is similar to what happened 2500 years ago in Greece, except this current one is technologic and subject to a reduction to absurd levels, but during the great period of Greek enlightenment ideas were broad in scope.

·         Part II of this talk will develop HIPP as a personality.

·         Part III will develop ASK as a personality.

·         Part IV will show how these two live together.  Introduce briefly the challenge of 1st and 2nd century church fathers and the threat of the ASK cults and HIPP.

Section II - HIPP

·         Born 1460 BC 18, August.  Lived to be about 99 years old.  Probable death 361 BC in the city of Larissa in Thessaly.  From the slides we see that he was a short stocky man and rather homely in appearance.  No literary descriptions are available.

·         HIPP lived in the Golden Age of Greece.  He knew Socrates, Sophocles.  He is mentioned in two of the dialogs of Plato and one of Aristotle's writings.  So most scholars feel that HIPP was indeed a real historical entity.  Otherwise, everything else is conjecture.

·         His father Heraclids was a physician and belonged to the hereditary ASK family.  As time passed this mortal hero was made semi-divine.  He is said to have descended from Hercules on his mother's side and ASK on his father's side.

·         He was born on the island of Kos and educated at Kos and left sometime between age 20 and 30 for Athens where he worked as a physician.

·         Early life.  His mother and a female slave would have raised him.  His mother responsible for his meals and the care of the children.  A house would have been a two-story stucoed brick house with painted floor and walls.  Rugs and tapestries, gold, silver and bronze cups.

·         Three meals a day.  The evening meal was for the entire family to eat together.  They would have used plates.  Spoons for soup and fingers for all other foods.  The men sat on a couch, the women and children at a low table.

·         At age seven HIPP would have been given over to a man servant who took him to school.

·         Primary school for nine years where he studied physical education, reading, spelling, poetry, music and played the flute and           .

·         Age 16.  His parents, if they had money, and his had enough because his father was a physician, went to study under a philosopher.  If parents were poor, they went to work as an apprentice.  From age 16 to 18 went to gymnasium where they studied sports, music, literature and oratory and were prepared to become a citizen.

·         The study of medicine was under his father as an apprentice.  There were no real medical schools.  At the end of his apprenticeship with his father which was somewhere between the age of 20 and 30, he left home.  Probably closer to 20, where he traveled throughout the Agiaan Island, the mainlands of Greece, Egypt and Libia to learn and study with various physicians, looking at varying medical systems.

·         What was the life of a Greek physician?

·         Greek doctors traveled, visited places and went from city to city.

·         If they had an office in a town, it was a professional office.  Roomy, direct and indirect light, surgical instruments, drugs, scrolls of medical books.  It was neat and clean, perfumed and surgery was performed there.  Interested citizens and other physicians would come and watch a physician perform his treatments in surgery.

·         The average Greek physician was a craftsman.  That is, he belonged to the craftsman level of society.  No license was needed, anyone could do it, no examinations and there was no governing authority.  He was basically classified as a businessman.  In modern times, a doctor is put in a higher social class, even though he receives payment for services like other craftsman.

·         The town physician had a shop as we discussed.  Not a hospital, but more like a consulting room and visited the patient's home.

·         The tenured physician visited the patient's home and had a booth in a marketplace.

·         In our modern physician, the patient defers to the physician's special knowledge and education, but in ancient Greece, a physician had to prove he knew his business and was eager to work and that's where the people in his shop who were observing and discussing, came into play criticizing other physicians and their treatment.  The patient's family gathered around the doctor as well as his pupils.  It was a communal event, not a private event, as we think of medicine now.  The doctors would advertise by knocking on doors, talking to passersby, would hire a town crier and go to other doctor's shops to show that he was better.

·         However, some physicians were trained as well in philosophy, and this is where HIPP rose above the level of craftsman.  HIPP was a genius and was the first physician to clearly annunciate the moral precepts of medicine, precepts that hold until this day.

·         Also, his was the first clear insight into the scientific nature of medicine.  Up until that time, disease was felt to be at the whim of the gods so called religious medicine, but HIPP said that "all disease is from natural cause and cannot arise without a natural cause."  This very fundamental insight changed everything from then on and is the basis of medicine into the modern era.

·         On any given day HIPP would, while living on the island of Kos in particular, get up early in the morning and made rounds in the patient's home or in the state hospital.  Then had a mid day lunch, met with his students who came from all over the world to be with him.  And then in the afternoon, he would see more patients who came to him and do his writing.

·         One final word.  HIPP did not appear out of a vacuum.  There were major schools of medicine in Crotone, Italy, at Cyrene in North Africa and on the island of Cnidos near HIPP's Kos.  Their ideas however were premature and religiously based.  There was a great deal of astrology, that is looking at the sun, the moon and the stars.  It was HIPP who had the moment of insight about the natural causes of disease.  However, he also believed in the gods.

·         Existing in his time were some basic concepts of anatomy and physiology that read in Aristotle and in the dialogs of Plato.  A concernable amount of knowledge was known about anatomy and some basic surgical skills and orthopedic knowledge.  In the dialogues of Plato there are several mentions of many medical books available at the time.  None of these have come down to us.  So, HIPP brought to us his theory of ethics, the scientific approach to medicine.  He combined these by saying that the patient was more important than the disease combining both the ethics and the scientific aspects of his thoughts and he felt that a person could not be a complete physician unless philosophical training was part of the physician's education.  Again, a revolutionary concept.

·         The love of humanity - the love of the craft, is what sets the physician apart.  Nothing has changed that's fundamental to revolutionary thought of the Greek's.  The physician puts the welfare of the patient before his fee.  Plato and Socrates attest this to.

Section III - ASK

·         Who is this mortal - god figure?

·         First comes into scene in Homer's ilius with his sons Macohon and Podilarios.  They are the sons of ASK who is a mortal physician and a chieftain who is in Agamendon's army in the Invasion of Troy.  This is in the 12th century BC resighted by Homer in the 8th or 9th Century.

·         The ASK myth made comments about Tricca in the north and Thessaly and then the movement south into Epiduras ultimately to Athens and approximately 400 other sites around the Mediterranean.  This mortal physician who was worshiped with local hero worship in the 12th century eventually becomes deified and has his own genealogy most thoroughly developed at Epiduras.  In this we learn that ASK was the daughter of a mortal Coronis who was the daughter of a Thessilian King Phlyagas.  Her father had arranged for her to marry a royal prince.  But when he finds out that she is pregnant with Apollo, she is killed and placed on her funeral pier.  At the last moment, Apollo extracts his son ASK from her belly and takes him to a mountain near Epiduras where he is raised by the half-man, half-horse, centaur Chiron who is knowledgeable in medicine.  There follows, a series of miracle cures and individuals being brought back from the dead and ASK is worshiped throughout the Mediterranean world.

·         What we see beginning in Trica is just a small cult, worshiped around the grave of a famous physician, grows into the Greek god ASK who is given a complete genealogy and related to all the great Greek gods including his father Apollo who is the god of healing, sun, light and music.

·         The Epiduran site is the primary Aesculapian but many arose throughout the Mediterranean area and there have been 207 authenticated sites approximately three to four hundred are thought to have existed and a 161 have been identified on coins alone.

·         ASK is associated with certain symbols, the most important being the serpent, which is one of his essential attributes.  This is an ancient symbol associated with earth worship and healing because the snake sheds it's skin, lives in the earth, comes out and has the power to renew life and contributes to healing.  He also, since he lives in the earth, knows about plants and herbal medicines and since he is involved with the living and the dead there is the symbol of the soul.

·         A dog is also part of ASK symbolism because he was used in the temples of healing.  The staff is a Cyprus limb, knotted, knarled and crooked used by royalty as a ceptor in ancient Greek societies and also by physicians who wandered about from city to city as a walking stick.

·         How did these ASK centers develop and what did they consist of?

The ASK sites were flourishing in Greece in the 5th and 6th century BC.  But reached their zenith several centuries after the death of HIPP during the Roman Empire in the 1st and 2nd centuries AD.  And finally died out with the ascendancy of Christianity in the 5th and 6th centuries AD.

·         Spend a few moments discussing what an ASK center consisted of.  Namely a temple, the ASK area where there was a spring with clear, healthy water, trees, a breeze, and usually in a mountainous area.  The incubation area or abiton where the people slept, gymnasiums, sports arenas, stadiums, amphitheaters and other assorted temples.

·         Discuss what the patient did when he came in.  Was bathed, went to the temple ASK made an offering and then met the priest and was taken into the abiton for the dream therapy.  There he was probably given a sedative.  His dreams were interpreted by the priest and said a dog or a snake often licked him.

These miraculous cures are mentioned in Stelly carved in place outside the temples and many of them have been found.

·         For the slides I will show in a few minutes we will demonstrate the archaeology and architecture of the Aesculapian centers.

·         We must make the following points: First of all, ASK centers of healing were religiously oriented.  This was miracle medicine.

·         You had to be pure to enter; that is, you could not be pregnant or terminally ill.  They very carefully selected the patients.  Many of them were psychological and functional illnesses.

·         People usually came to the ASK centers when all else failed.  They were not competition for the official medicine but doctors "always ask for assistance in difficult cases and ASK were extremely helpful”.  They actually integrated with the craftsman physician to create a whole system of medicine for society.  The reason this was possible is because most of the physicians did believe in the gods and in the official Hippocratic oath they swear allegiance to ASK.  HIPP himself says prayer is good and "the gods are the real physicians."

·         People flocked to the ASK early on because there was no surgery or caudery.  They could relax on holy soil, take in beautiful scenery, listen to hymns, go to plays, listen to music and then at night they would have their dreams interpreted.  The god ASK appeared in person or as in the form of a snake or dog.  We must remember that the Greek's thought dreams were reality, not the imagination as we assume now.  Most commonly seen contemporary          society.  It is only late in the Roman period that the ASK centers performed surgery.  This is known from a few votive inscriptions.

·         Since most Greeks thought illness was due to divine cause, that is by the gods, so ASK was made a divine god so cure was possible.  This of course was true for the Japanese, Chinese, Indian, Hebrew and Egyptian cultures of which we are all very familiar.

·         The miracle cure is that the ASK are very similar to those that occur in Christian Centers of the Middle Ages.  They use the same phasiology and are a direct continuity from Aesculapian Centers.

·         The relation of the couch in modern psychiatric office to the couch in the Abiton is more than a coincidence.

·         Ancient cults and modern psychotherapy have much in common.  The ancient Greeks believed that anyone dedicating himself to the cult, for example ASK, was called a therapist.  This is what we modern physicians claim to be.  This follows what Young says, that the human psyche has a hidden and deep religious function.  Young said that no patient in the second half of his life could be cured without getting in touch with this religious function.  In contrast, Freud who said this was rooted in infantile conflicts.  So, Young is closer to the Aesculapian concept than Freud, however Freud used couches.  So both of these great, modern, medical thinkers had their roots deep in Aesculapian and Greek medicine.  ASK as well as HIPP believed in care for both body and mind.  Today we say body and soul.  Ancients felt bodily sickness and psychic defects were inseparable unites.  The ASK never had however, the insight of HIPP about the natural causes.  The ASK cults remain a religious mystic medical phenomenon.

PART IV - CONCLUSION

·         The ASK cult died out when Christianity became the religion of the Roman Empire.  The early Christian fathers, especially in the 1st and 2nd Centuries, had to combat the ASK centers because there was so much in common between Christ and ASK.  The similarities include:

·         Healing of the sick; soul and body.

·         Call Savior.

·         Physician; early gospel says Christ was a physician.

·         Resurrected the dead.

·         Fought no battles.

·         No heroic deeds.

·         Blameless life.

·         Patients came to them or they traveled to them.

·         Man and God are         .

·         Son of a god and a mortal woman.

·         Rose to heaven though God.

·         Immortality because of virtues.

·         ASK acted as son of Apollo, Christ as Son of God.

·         The differences are important and explain why Christianity won the day.  To enter an ASK temple one had to be pure, but Christ accepted sinners and the down trodden.  Of all the ancient          gods however, ASK was closest to Christ in moral attributes and teaching and persisted after all the other gods had lost their hold.

·         What I have tried to show, is that during this ancient period, that although the mystical religious ASK centers existed in parallel with Hippocratic medicine after the 5th century BC they both used each other.  The ancient physicians kept in touch with the ASK centers and used them in their oath.  The temple priest did not scorn secular knowledge, they could learn from lay practitioners.

We remember in the iliod that ASK was a physician whose sons were surgeons and internists in the Agamendon’s Army and not divine people.  Eventually ASK becomes synonymous with Imhotp the Egyptian genus who was the architect for the step pyramid of Zoser at Sakkora in Egypt who eventually became deavied as a physician at the time of the tolimies during the Hellenistic period in the 3rd century BC.  He starts 3300 BC of course in the second dynasty.  Early in Homer there was the idea that the mind can be controlled through the body.  In Egypt the same idea existed with the use of drugs such as the Lotus flower to control the mind through the body.  However, the ASK priest did not stop here.  They supplemented this notion that the unsound mind can be controlled with the body.  A sound mind can and should completely control a sound body.  This was the beauty of these ASK centers.  This idea was of course used by HIPP as well as we discussed a few moments ago.

Empedocles, a philosopher who was dying after a long, painful illness asked HIPP for a poison to end his life.  HIPP's answer "my task as a physician is to save life, not to end it."