Torofy Blog

Depression and Heart Disease

2. Classical Views of Disease: Hippocrates, Galen, and Humoralism

Prof: Without more ado,
then, we’ll turn to our topic of the morning,
which is about the first embodiment of a rational
scientific medicine, which is rather an
extraordinary one because it lasts from the fifth century
B.C. down to the nineteenth century
as a dominant–not exclusive–but a dominant
medical scientific paradigm. It was associated with this
idea of the first form of a rational,
secular, naturalistic form of medicine,
with ancient Greece in the fifth century,
and in particular with the so-called father of medicine,
Hippocrates, who lived from about 460 to 377
B.C. Now, there’s some debate about
whether he was one person or a school, a group,
of people. There is a corpus of
Hippocratic writings that consists of about sixty works,
perhaps by multiple hands. But that issue won’t really
concern us. We’re concerned with
Hippocrates as either this composite or single figure,
and with the various schools that followed in his name.
The sixty works,
some of them are very famous to you already.
You know about the Hippocratic
Oath. We’ll be talking about such
other works as On the Sacred Disease, On Human
Nature, Epidemics, On Airs, Waters,
Places; and he also had a collection of
aphorisms. One would note the variety of
the Hippocratic corpus. It consists of a whole series
of things. He/they invented case
histories, and they’re included. There are lecture notes.
There are memoranda of all
sorts; writings on every form of
medical practice at the time: surgery, obstetrics,
diet, the environment, therapeutics.
All of that forms part of the
Hippocratic corpus. So, enormous variety.
In terms of what Hippocrates
accomplished, I’d like to make a contrast,
and that is with the supernatural view of disease.
And the first form we could
think of that, in drawing our contrast–the
contrast to what Hippocrates accomplished–
we can see it in terms of the breakthrough from something that
preceded it and went alongside it,
down to our own day, and this would be first of all
the supernatural view of disease;
that epidemics and pestilence are divine punishment sent by an
angry god for sin and disobedience.
You can see this in many parts
of our culture. It’s embodied in the Bible,
for example. In Genesis, you know that Adam
and Eve lived happily and enjoyed eternal life in the
Garden of Eden, until they committed the sin of
eating of the forbidden tree of the fruit of knowledge of good
and evil, and as a result this was
original sin and they were kicked out of the Garden of
Eden. From then on for things they
had to work. They also became subject to
disease and to death. They were immortal until that
time. So, we see in Genesis the
embodiment of this idea that diseases are a punishment of
sin. This was also clear–you can
read further in the Bible, in the book of Exodus,
where you learn about the bondage of the Israelites in
Egypt and God asking for Moses and Aaron for the Pharaoh to
release his chosen people. But the Pharaoh’s heart was
hardened and so the Egyptians were punished with this series
of terrible plagues that are all in Exodus.
Another way of embodiment of
this was in Psalm 91, and this is of particular
importance to us–let’s move to share this with you.
This is the text of Psalm 91.
This is particularly important
because it embodies the idea of plague and pestilence as a
punishment by God. But also in terms of our
historical experience, as you’re reading Daniel Defoe,
you’ll realize that it’s Psalm 91 that was read out from the
Christian churches during times of epidemic.
This was the great plague psalm.
It embodies hope and an
interpretation of what the experience of plague was all
about. Let me read part of it here.
“Thou shalt not be afraid
for the terror by night, nor for the arrow that flieth
by day, nor for the pestilence that
walketh in darkness, nor for the destruction that
wasteth at noonday. A thousand shall fall at thy
side, and ten thousand at thy right hand, but it shall not
come nigh thee. Only with thine eyes shall thou
behold and see the reward of the wicked.
Because thou hast made the
Lord, which is my refuge, even the most high by
habitation. There shall no evil befall thee;
neither shall any plague come nigh thy dwelling.”
So, if you renounce sin,
the pestilence won’t come near you.
Let me turn also to another
embodiment in culture, our Western culture,
and this is the opening scene of Homer’s Iliad,
which as you know is all about the Trojan War,
and it begins just before this scene with Achilles’ anger.
That is to say,
Achilles was the greatest of the Greek warriors,
but the Greek King Agamemnon had taken his concubine for his
own, and as a result,
enraged, Achilles withdrew from combat and sulked in his tent.
Now, he had a friend who was a
priest of the god Apollo, and this friend tried to
intervene and beseeched Agamemnon to write the wrong and
return the woman. But Agamemnon rebuffed Apollo’s
priest; or as we might say,
he dissed him. And, so, what we have here is
this tremendous and terrifying scene at the beginning of the
Iliad. Let me just quote from the
beginning then. “Over and over the old man
prayed as he walked in solitude to King Apollo.
‘Hear me Lord of the silver bow;
bring to pass this wish I pray for.
Let your arrows make the
Danaans pay for my tears shed.’ So he spoke in prayer,
and Phoebus Apollo heard him, and strode down along the
pinnacles of Olympus, angered in his heart,
carrying across his shoulders the bow and the hooded quiver,
and the shafts clashed on the shoulders of the god,
walking angrily. He came as night comes down,
and knelt then apart and opposite the ships,
and let go an arrow. Terrible was the clash from the
bow of silver. First he went after the mules
and the circling hounds, then let go a tearing arrow
against the men themselves and struck them.
The corpse fires burned
everywhere and did not stop burning.”
So, that was Apollo punishing
the Greeks on behalf of his priest.
Or let me also mention
something, an example, that’s more recent and closer
to home; that is, I want to talk for a
minute about a Yalie. And this is our friend here
John Humphrey Noyes of the nineteenth century,
who was at the Yale Divinity School,
and he read the pieces we’ve just talked about,
and thought about disease as a punishment for sin,
and decided well there was a remedy.
And, so, in all modesty he and
a group of his friends decided that they were going to renounce
sin all together, and they called themselves The
Perfectionists. And they founded an ideal
community, first in Putney,
Vermont, and then in Oneida in New York State–
it’s part of the history of American utopian communities–
in which they renounced sin and were going to live together in
harmony and peace, forever, as eternal people.
And every morning began with a
mutual criticism in which they pointed out each other’s
faults– this must have been a lot of
fun–in order that they not fall by the wayside and lapse once
again into sin. Well, I’m sorry to tell
you–this was the 1840s– by the 1890s the ideal
community had become instead a joint stock company,
and you still have Oneida pottery and silverware.
And I’m very sorry to report
that all of the members of the community have been buried.
I don’t know if that was
because they couldn’t stick the pace, or if the concept was
wrong from the outset. In any case,
this was an embodiment, then, of the idea of disease as
a punishment for sin. But if we view this view of
pestilence as divine punishment, it does at least imply a
law-governed cosmos. Disease exists for an
intelligible reason, and it implies a rational
therapeutics, which is repentance:
propitiation of God, amendment of conduct,
and renewed obedience to the laws.
There’s another variation of a
supernatural view, which is more capricious,
and let’s call that the demonic theory of disease.
This postulates that the world
is populated by powerful arbitrary and evil spirits who
cause disease through their malign influence.
These may be evil persons,
such as witches or poisoners, the disembodied spirits of the
dead, superhuman beings, or the devil himself.
We’ll see this view throughout
the course, the idea that epidemic diseases are diabolical
plots, not natural events. There’s some occult secret
crime caused by the poisoning of witches or scapegoats,
and this gives rise to witch-hunts,
to hunt down and punish the guilty.
We know this famously in the
seventeenth century and in our own country at Salem.
But the idea was clearly
expressed in Europe by Martin Luther who declared,
“I would have no pity on the witches.
I would burn them all.”
Alternatively–that was a good
therapeutic idea– alternatively a person could be
deemed to be inhabited or possessed by an evil spirit,
and in that case the cure was to cast out the devil through
exorcism. And this cosmology survives in
our own language when we talk today about someone acting
“like someone possessed,”
or “out of his mind.” And healers pursuing these
sorts of ideas would invoke magic, or have incantations.
They’d prescribe special
concoctions, chants, sacred rites and spells.
And in European history,
a relatively recent illustration of that idea was
the idea of the healing power of the royal touch.
Charles II of England,
for example, administered this treatment in
the seventeenth century to about 100,000 people.
So, healers could do that.
They could also recommend magic
practices, offerings and sacrifices;
magic charms to ward off the evil spell;
or they could recommend escaping by taking flight;
or invoking the power of a powerful ally,
as in the Christian cult of saints that we’ll be talking
about later. So, if you hold that up–those
two views, then, of supernatural
interpretations of disease– then you can understand the
breakthrough that was made in fifth century Greece.
This was in contrast to the
supernatural divine and demonic theories, and it’s in contrast
to them that we can see the importance of a new idea;
the idea that disease instead is a naturalistic event that can
be understood by natural causes. Examples of this new,
naturalistic, secular view abounded in the
fifth century. You can see it in Thucydides,
in his account of the Peloponnesian War,
the famous Plague of Athens that may have been typhus,
or more recently it was thought to have been typhoid.
But in any case it was a
natural event, and is described as such by
Thucydides, with no reference to the occult or the supernatural.
You can see it in Hippocrates’
discussion on epidemics in which diseases, epidemic diseases,
are caused by a corruption of the air.
But let me talk about this very
famous example, and dramatic one,
of Hippocrates, On the Sacred Disease.
By the sacred disease he meant
epilepsy, and it looks–I guess if you wanted any disease–it
looks like a possession by a demon.
It is epilepsy.
And Hippocrates wants to tell
us that this is not a supernatural event,
or a possession. He says instead something
extremely different. What he tells us is that:
“It is thus with regard to the disease called sacred.
It appears to me to be no wise
more divine or sacred than other diseases, but has a natural
cause, like other afflictions. Men regard its nature and cause
as divine, from ignorance and wonder.
And this notion of its divinity
is kept up by their inability to comprehend it.
Neither truly do I count it as
a worthy opinion to hold that the body of man is polluted by
God; the most impure by the most
holy. For were the body defiled,
it would be likely to be purified and sanctified,
rather than polluted. Those who first referred this
malady to the gods appear to me to have been just such persons
as the conjurers, mountebanks and charlatans are.
Such persons then,
using the divinity as a pretext and screen for their own
inability to afford assistance, have given out that the disease
is sacred.” This was a very major
breakthrough conceptually, the beginning of the foundation
of a scientific medicine. So, therapeutics then got rid,
in a naturalistic view, of chance, potions,
spells and sacrifices; and exorcism,
appeasement of the gods. The importance of this
momentous step in human consciousness was expressed by a
Yale professor of epidemiology in the 1940s,
Charles-Edward Winslow, who wrote–and let me quote a
sentence or two from him. “If disease is postulated
as caused by gods, daemons or demons,
scientific progress is impossible.
If it is attributed to
hypothetical humors, the theory can be tested and
improved. The conception of natural
causation was the essential first step.
It marks incomparably the most
epochal advance in the intellectual history of
mankind.” That perhaps is putting it a
little strongly, but you certainly get the
point. Now, why perhaps was there a
rational scientific medicine in fifth century Greece?
Here I think the main part of
the answer has to be imponderable factors such as the
inspiration of Hippocrates himself, and his associates.
But there were influences we
could point to as important: The absence of a priestly
bureaucracy, with the power to sanction heretics;
the centralized city states; the legacy of Greek natural
philosophy, the work of Plato and Aristotle in particular;
a culture of individualism. And I think we also need to
remember the Hippocratics’ positions.
Although they were known to
treat the poor and slaves, their care was not by and large
available to the masses. The primary clientele consisted
of educated, prosperous elites in ancient Greece and ancient
Rome, and this was a medical philosophy that suited them.
The educated doctor and the
educated patient spoke the same language,
and the therapies that the physician proposed,
such as a special diet or rest, were remedies the wealthy could
afford. We should say that Hippocratic
medicine is still with us. We can see it in the return to
holistic medicine. We can see it also in the
Muslim world, and you can still be treated in
Unani medicine by a Hippocratic style medicine.
And you can see it in certain
popular cultural precepts, such as “feed a cold and
starve a fever.” Well, if that’s its importance,
let’s look at its content. What was the content of this
first embodiment of scientific medicine?
And it was humoralism.
Here let’s talk about what that
is. The fundamental assumption was
that there’s a correspondence between the macrocosm of the
universe and the microcosm of the individual body.
Both are composed of the same
materials, subject to the same laws, and disorder can occur in
one and be followed by disease in the body.
According to Aristotle and
natural philosophy, the macrocosm consisted of four
elements that you can see here. They were earth,
water, air and fire. And each of the elements is
associated with four qualities, which can be dry and hot like
fire; or dry and cold;
or cold and wet; or wet and hot.
So, the elements embody also
four qualities, in different proportions,
of course. And this went on over the
centuries, and there were four seasons, four winds,
later on four evangelists. The point for us is there was
also a microcosm, and one can see the theory
expounded on human nature in which there are four humors,
which are phlegm, black bile, yellow bile and
blood. And each of those–also the
body is composed of these–and each has qualities of as being
wet and cold, or hot and dry.
This also determines–the
balance of these humors in the body–the four temperaments:
whether you’re melancholic, phlegmatic, choleric or
sanguine. Those words survive in our
culture. There are four ages of man,
four principal organs of the body: the spleen,
the brain, the liver and heart. You see the importance of four.
And the system is axiomatic.
It’s based on deductive
reasoning from first principles. Central, of course,
to all of it was the climate of Greece, with its seasonal
patterns and its specific patient population.
Many were malarial victims with
the complications of pneumonia. And Hippocrates,
indeed, was the world’s first malariologist.
Now, health consisted–was
called eucrasia, which meant a balance or
equilibrium of the humors, and therefore the qualities.
And variations are possible,
up to a certain threshold, and at various times in your
life–or from one person to another–
the balance among the four humors can change.
But once you cross a certain
threshold in variation– that is, one humor becomes
overly dominant, or one humor is lacking in
sufficient supply– that’s an imbalance.
That’s dyscrasia;
an excess or deficiency of one of the humors,
and that is disease. So, we know what disease is
then. It’s an imbalance of the humors.
Note that there is no
single–that is to say there aren’t discrete individual
diseases, as in modern medicine; that is, disease is classified
as typhoid, cancer, pneumonia, and all the rest.
Disease instead was a holistic
phenomenon of body equilibrium. There was, in a sense,
only one disease. Now, what were the causes?
The causes were said to be,
what we might call in modern jargon, environmental insults;
that Galen later on was to codify as the six non-naturals.
The human body and constitution
then had contact with the air, which might be corrupted,
or “miasmatic,” as it was called later.
Motion, or what we might call
exercise, was the second–or its lack–non-natural.
Sleep or wakefulness;
excretion or retention of whatever was ingested;
and the passions of the soul, these were the non-naturals
that could tip the body into disease.
Restoring health was based in
part on nature itself; that is to say,
there’s a teleology of the body, embodied in the phrase
vis medicatrix naturae;
which is the healing power of nature.
And the means to restore–the
body, in other words,
strives to restore equilibrium, through its innate heat or
through the elimination of excess humors,
when you sweat, you sneeze or you vomit;
for all of that is your body’s attempt to get rid of the humor
that’s making you sick because of its excess.
So, this led then to humoral
therapeutics. And let’s talk about that.
The basis of medical strategy
was that the physician was the ally of nature,
and of the body. The body was trying to restore
itself to health, and the physician would join it
in doing battle against disease. He would read the signs to
decipher the underlying process; would take a case history;
would practice close observation, taking the pulse,
listening to the body; and would examine the urine,
its color, its density. He would smell it and taste it,
and see whether it contained blood or was frothy,
as all of those were worrying prognostic signs.
It was a holistic treatment
where you didn’t treat individual symptoms,
but the whole constitution. And it also had an idea of the
individualism of the patient. Treatment should be tailored to
the constitution of the individual.
There are no disease entities,
because disease is not a thing but a process.
This was a medicine that was
rather indifferent to diagnosis or classification.
What it stressed instead was
the answer to the patient’s eternal question,
“Am I going to be all right doc?”
Prognosis was what really
mattered to the Hippocratic physician.
The therapeutic principle was
that opposites treat opposites. So, if you have an excess of a
dry and cold humor, like a black bile,
if that’s the humor that’s causing your illness,
then you would like perhaps to give the patient a food to
ingest that would be wet and hot;
and hot in this case, think of it not simply as the
touch. We think of it when we talk
about spicy food as being hot. All the elements that you have
also have qualities, and so diet is very important
to this therapeutics. The tools available to the
physician, then, are first of all diet.
In some sense the Hippocratic
physicians thought we are what we eat,
and all foodstuffs had qualities–hot,
cold, moist, dry–to balance an opposite
defect or excess in the human body.
Exercise was also important.
A change of environment;
in modern terms, going to a spa or a sanatorium.
Moderation in the emotions,
moderation in sex. And medication was important,
because they did practice, Hippocratic physicians,
internal medicine. Examples were to promote
evacuation by providing emetics, sudorifics, purgatives or
diuretics. And most important perhaps was
a primacy of venesection– by which I mean bloodletting or
phlebotomy– that became the hallmark of the
orthodox physician. Medicine, in other words,
was conceived as a process of addition and subtraction,
adding what is wanting and subtracting what is in excess.
Now, you may have your doubts
about venesection. Let me just mention some of its
advantages in the eyes of Hippocratic physicians.
It was systematic,
like disease itself. Its effects were immediate and
you could control them. It was speedy.
Its limits were also
self-evident to the experienced doctor.
Perhaps the patient fainted,
the pulse disappeared, or the color of the blood
altered. There were however,
of course, contraindications to bloodletting:
old age and efficiency of blood;
the summer heat; evacuation already occurring by
other means; or extreme cold.
So, the lancet,
the instrument for bloodletting–
there we have real lancets–became the symbol of
the orthodox physician, down through the nineteenth
century. Now, note that there is no real
humoral physiology, no idea of the circulation of
the blood. The heart is not a pump but a
furnace, drawing air from the lungs, heating it and
distributing it as innate heat in the body.
So, this was the first
embodiment of scientific medicine.
I want to talk about an
alteration that it went through, through the second father of
medicine. And this is another Greek
physician, who lived however in ancient Rome,
and that is Galen. And that’s a picture.
Now, his personal–he lived in
the second century A.D., from 130 to about 201,
with his formative years being lived out in Rome.
His personal qualities are
important. He was very different from
Hippocrates. Hippocrates was a great
observer, an empiricist. Galen instead prided himself
above all on his knowledge of the texts of Hippocrates.
He almost worshipped
Hippocrates, but regarded himself as the authorized
interpreter of Hippocratic works, which he turned into a
dogma. Now, in Rome,
Galen was physician to the gladiators.
His personal position helps
explain his influence. He then became private doctor
to the emperor. And he regarded himself as the
ideal physician, philosopher and scientist.
He was a man of over-weaning
self-confidence, who had nothing but withering
scorn for his opponents and colleagues,
whom he called “murderers, amateurs, unversed in
Hippocratic wisdom.” He called them “more
ignorant than animals.” It was true also that Galen had
an encyclopedic knowledge, and we can only understand his
influence if we remember that he was a man of immense knowledge
of all branches of the medicine that existed at his time.
And only half of his written
works survive, but they alone fill twelve
volumes of about a thousand pages each.
In other words,
he was extraordinary in his productivity,
and that too is important on his influence.
Now, Galen had a view that was
foreign to us of the meaning of scientific progress.
To him Hippocrates was the
permanent foundation of medical science, and the main tenets of
that science could never be overturned or revised.
Instead, there was no room in
his thinking for scientific revolutions.
The writings of Hippocrates
were valid forever. They could only be completed
and perfected. And, in fact,
that was Galen’s view of himself.
He was the person who perfected
Hippocratic ideas. So, in fact,
further progress was probably unnecessary and perhaps
impossible. So, Galen became the
authoritative interpreter of Hippocrates.
This is what we might call
Galenism. And in his hands,
Hippocrates became a cult figure, an object of veneration
and almost worship. Hippocrates,
about whom so little was known in his personal life,
was now endowed with all manner of apocryphal virtues.
He was idealized as a model of
wisdom, courage, temperance, humanity and
honesty. Mythologies developed about his
religious piety, his heroism and his hard work.
There was a legend that he was
descended, on his father’s side, from the god Asclepius,
and on the maternal side from Hercules.
He was said to be a great
patriot who saved Athens from the plague, a man who scorned
money and was perfectly wise and perfectly just.
So, he became one of the
greatest cultural figures of antiquity, an equivalent,
in a different way, of Socrates,
Plato and Aristotle. Now, probably some of you are
wondering– we’ve talked about humoralism
and its advocates, and you want to know,
“well, that’s all very fine;
did it work?” I’d like to say that humoralism
had a number of strengths. It was a quantum leap from
magical thinking to naturalistic explanations of disease.
It appealed because it was
accessible to educated laymen. Contemporaries with an
education understood everything that Hippocratic and Galenic
doctors said and prescribed. It was consonant with
contemporary understandings. We also need to know that
Hippocratic and Galenic physicians practiced therapeutic
modesty. They did not participate in
surgery except, for example,
for setting bones, lancing abscesses and
practicing venesection; but the internal cavities of
the body they knew were off limits.
It was based on observation.
They took case histories.
And we ought to remember,
in terms of medical effectiveness,
that–my wife, for example,
who is a primary care physician,
says that about seventy-five percent of patients who present
themselves in a clinic have self-limiting illnesses,
or psychosomatic ones, and mostly need reassurance
that everything will be all right.
So, the point about Hippocratic
medicine was that experienced physicians,
accustomed to seeing ill people, would be pretty good at
prognosis and reassurance. They would refuse to treat
cases they regarded as hopeless, and hopeless cases,
they also had a referral system–
we’ll refer to in a minute–which was to temples.
I’ll come back to that in just
a second. There were, however,
a number of weaknesses. So, Hippocratic/Galenic
medicine had a number of powerful strengths.
It provided a lot in terms of
reassurance and prognosis, and the answer to that eternal
question, “Will I be all right
doc?” and the other question,
“What can I do to help myself?”
There were a number of
weaknesses. It was a closed system.
It was based on deductive
reasoning, and came to be bound up in the authority of the
ancients, with empiricism fading away;
and indeed in later centuries it comes to be called
“library medicine.” It was anchored in a cult of
personality– the cult of Galen,
and through him of Hippocrates–
and practiced a cult of antiquity, with knowledge almost
becoming a form of revealed truth.
So, Galenism involved authority
and tradition, an elite medicine of
university-trained physicians who were involved,
particularly in their training, in studying the classics.
How do you train a physician?
You have them read Hippocrates
and Galen, in the original languages.
I don’t want to say,
however, that there were no challenges.
It’s extraordinary to reflect
that humoralism, as a dominant medical
philosophy, persists into the nineteenth century.
But I don’t want to think that
it was unchallenged. We know there were demonic and
religious views that ran alongside.
But in addition,
there were a series of scientific challenges that
occurred in a number of major shocks to the system that slowly
weakened its hold and gave rise to doubters,
but did not thoroughly dismantle humoralism until the
late nineteenth century; and even then it persists in
popular culture and some forms of alternative medicine.
What were some of these
challenges? I don’t expect you to remember
these at this point; we’ll come back to them later
in the course. But just so that you’ll
understand that it wasn’t as though this system never had
challenges. Protestantism was a challenge,
with a challenge to authority and established texts.
And Paracelsus,
whose dates are on your handout,
was called the Martin Luther of medicine,
who rejected Galenic and Hippocratic medicine all
together. William Harvey discovered the
circulation of the blood, which overthrew or challenged
Galen’s anatomy and his physiology,
which were proved not to correspond to the observed
results of dissection and pathology.
So, the discovery of the
circulation of the blood was a major blow;
although, oddly enough Harvey himself never rejected
humoralism, Hippocrates and Galen.
Then there was the scientific
revolution. And in particular one can think
of the chemical revolution associated with men like Joseph
Priestly and Antoine Lavoisier. They destroyed the Aristotelian
notion of elements. Earth and air,
for example, were found themselves to be
composed of a great number of modern elements that go to make
up what we know as the periodic table.
And more generally,
the scientific revolution marked a democratic turn from
authority to empirical evidence, and it envisioned scientific
and medical knowledge as infinitely expandable and not
bounded by set texts. And then, from the point of
view of our course, the experience of epidemic
disease, as we’ll see,
made the idea of dyscrasia improbable as a mechanism needed
to explain epidemic disease, because it’s fairly flimsy as a
basis for explaining why so many people,
in a single place, at a single moment of time,
had their equilibria all unbalanced at the same moment.
So, the experience of epidemic
disease is important, and we’ll see the physician,
Fracastoro, came up with the idea of
contagionism many centuries ago. In the nineteenth century we’ll
see also, with the development of pathology,
the idea of disease specificity;
and finally in the late nineteenth century the germ
theory of disease, which offers an entirely
different paradigm for disease. So, that’s the journey we’ll be
taking, to the time when humoralism is
replaced, and we’ll look at various
embodiments along the way of what people considered to be
scientific medicine. But here a number of you will
be thinking that I’ve involved myself in an important
contradiction, and you’ll be thinking about
Asclepius and the fact that I talked about temples and a god.
And in particular let’s look
at–that’s the god Asclepius, and this is the–I’ll talk
about who he is. Hippocrates and Galen were both
pious and devout; that is to say,
although they believed in a naturalistic medicine,
it wasn’t that they didn’t also believe in the gods,
and through the gods they found in temple medicine what we might
call the world’s first referral system.
Asclepius, who was he?
He was first a moral hero who
became half human and half divine, and then entirely a god.
He was thought to be the
kindest of the gods; the one who loved humanity
enough to sacrifice himself for their sake.
His father was the god Apollo.
His daughters were
interestingly named the goddesses Panacea and Hygieia.
And physicians in the ancient
world might call themselves Asclepiads, meaning the sons of
Asclepius, who regarded their father as a patron saint.
By the time of Alexander the
Great, Greece possessed three to four hundred temples dedicated
to Asclepius. Asclepius was said to have been
killed by Zeus because he taught mortals the art of healing and
Zeus feared that men and women would compete with him in no
longer being subject to death. But Asclepius never practiced
magic. He was merely the most skilled
of physicians, using the same principles that
Asclepiads, like Hippocrates and Galen, would use as well.
Note, of course,
there are similarities to the story of Christ,
and Asclepius was in fact a major competitor with
Christianity for a number of centuries.
And like Christ,
after death he was said to have risen and to be present
eternally in the temples. So, the temples were shrines to
Asclepius, at places like Athens.
I’ll show you,
I hope, a couple of examples. That’s Chios,
where Hippocrates was from, and this is the temple at
Pergamon. I just want to–there,
it’s a whole–this is more than just a temple,
although it is a temple. It’s almost a compound.
Now, the usefulness of
identifying yourself with Asclepius was that there was–it
provided physicians with a badge of identity, a source of
authority. They were wandering peripatetic
healers, but now they’re recognizable as members of the
same guild. This gave them a collective
presence and authority, and Asclepius also vouched for
their ethical conduct. Remember, these are peripatetic
physicians whom you invite into your home.
And, so, they needed to have
someone vouch for them, and he vouches that they’re
good doctors and that they have special care for the poor who
can’t pay him. But again, there is no
contradiction with naturalistic medicine.
The temples were precursors,
in a way, to health spas, sanatoria or hospitals.
There they provided care for
the poor and the seriously ill. Patients could enter them,
the precincts of these compounds, after a period of
preparation in which they bathed, fasted,
prayed and offered sacrifice. But the therapeutic strategy
comes to them in a particular way, which is called an
“incubation”; which is to say that at night,
after you’ve prepared yourself carefully,
in the way I just mentioned, when you–
then the priest will help you–and when you fall asleep at
night you’ll have a dream. This is the incubation,
and the god Asclepius will appear to you and tell you the
strategy you should pursue in order to become well again.
But the strategy was nothing
other than what a skilled physician would have prescribed,
had he been skillful and wise enough to have known.
There was never a treatment
prescribed by Asclepius by magical means or miracles,
or by practices that weren’t accessible to the ordinary
doctor. So, this is humoral medicine,
the first embodiment of scientific medicine.
And I want us to look,
for the next several sessions, at the way in which it was used
as a lens to view the experience of terrible epidemic
catastrophes. And we’ll look also at the way
in which the experience of bubonic plague and other
epidemics challenged or raised major questions about humoral
theory, and helped propel the
scientific medical elite towards a different view of disease and
what it was. So, we’ll see epidemics,
beginning next time, as a process.
And we’ll also want then to
explain it, and we’ll look at bubonic plague as the first of
our major epidemics in our course.

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