Asklepios, Hippocrates and their followers: some aspects of healing and physicians in the Ancient World

This paper deals, in a very general perspective, with the relationship between religious medicine and the everyday task of physicians in the Greek world, paying attention not oniy to some of the rnedical texts but mainly to the epigraphical evidences.

The god could even heal at a distance. Heraclotes from Troezen, suffered from an abcess (Peek,n. 48): "While this man was asleep at Troezen, before being cauterized by the local doctors, he dreamt of the god standing over him urging him not to have the cauterization done, but to sleep in the temple of the Epidaurians. When the time had passed which the god had prescribed, the abcess disappeared and he departed healthy." 'ILvo other texts insist on the revenge of the god who sends the illness back when the patient does not pay what he had promised or what the godor the priestshad asked for. The following story illustrates this perfectly (Herzog, n. 22): "Hermon of Thasos. He was blind and the god healed him. After that, as he didn't deliver the fees for the treatment, the god made him blind again. But when he came back (to Epidaurus) and slept (in the dormitory) again, the god healed him once and for all". AU these miracles celebrate Asklepios' power; the god also healed 11 blind, 10 lame and 3 mute people as well as many others from various iiinesses. People carne from all around the Greek world to consult the god, showing the success of the Asklepieia and of divine healing.
It is most probable that people tumed to the god as a last hope, having tried human healers in vain. But it seems that it was not always the case, as indicated by the story of Prepousa who dedicated a stele to the local divinity, Men Axiottenos, in Phrygia, during the Hellenistic period (Varinlioglou,n,2): "Because Prepousa [...I had made a vow for her son Philemon, that if he became healthy without wasting money on doctors, she would have it written it on a stone, and although her request had been fulfilled, she did not keep her promise; (therefore) the god now demanded that the promise be kept and punished her father Philemon; she fulfills her vow for her son and from now on, she praises the god." Prepousa's way of thinking is revealing of the mentality of the time; the cost, the risk, the uncertainty, the discomfort or sheer pain of ancient medical treatment on the one hand and the belief in the ornnipotence of the gods on the other explain why people tumed to healing deities for help. Prepousa's priority was certainly her son's life, but if she had gone to a doctor, even a famous and expensive one, she could not have been sure that her son would have recovered and she would have wasted her savings. Therefore, making a deal with the god Men Axiottenos seemed more appealing; the god would take his reward only if he succeeded; in the worst case, Prepousa would lose her son, but not her money as well! The success of this sort of miraculous healing lasted throughout the centuries right into the Christian period at which time healing saints took over from the pagan healing gods.
Within the healing sanctuaries which attracted a lot of sick people, physicians, leamed in their art, were also present. They practiced it with skill, and succeeded in saving numerous patients from death! The most famous of these physicians was most certainly Hippocrates, the "Father of medicine", bom in Cos, off the Cnidian peninsula, on the Asian coast in 460 BC.
His family on his father Thessalos' side, belonged to the Asclepiads, an aristocratic genos composed of the decendants of Asklepios, the prince of Tricca in Thessaly. Men of this genos were not necessarily physicians, but Hippocrates, his two sons, Thessalos and Dracon, his own father, Thessalos, as well as his grand-father, also named Hippocrates, were. His ancestors had been famous and one of them had helped in the famed Sanctuary of Delphi during the First Sacred War in the sixth century BC. On his mother's side, Hippocrates was, so the ancient biographers say, a descendant of Herakles, thus being twice of noble lineage.
Hippocrates travelled to the north of Greece, to Thessaly, Thracia and Macedonia and practiced his art on the island of Thasos. He also went to Delphi and died in Larissa, in Thessaly, between 375 and 35 1. After his death, he became the object of a cult as a healing deity.
But Hippocrates was not only a practitioner, he was also a teacher and a writer. He taught medicine to his sons and, for a salary, to other young men. Those who did not belong to the "genos" of the Asklepiades were supposed to pronounce, before they began their studies, the very famous oath physicians still revere, -though slightly modified -: "I swear, by Apollo Physician, by Asklepios, by Hygieia (Health) and Panakeia, by a11 the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath, and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his farnily as my own brothers and to teach them this art, if they want to leam it, without fee or indenture; to impart precepts, oral instructions and a11 other instruction to my own sons, the sons of my teacher and to indentured pupils who have taken the physician's oath, but to nobody else. I will use treatment to help the sick, according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers frorn stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrongdoing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession, in the intercourse with men, if it be what should not be published abroad, I will never divulge, holding such This oath is a sign that the transmission of medical knowledge in Cos was extended to "outsiders" at the time of Hippocrates and, for centuries, made of this island a reference for medical care, building the basis for medica1 deontology. Hippocrates left Cos but his son-in-law Polybios continued to practice and the Hippocratic school lasted until the Roman period.
One of the reasons for this reputation, is what modern scholars cal1 the Hippocratic Corpus: about seventy treatises on ancient medicine written in the Ionic dialect. They deal with internal diseases, surgery and gynecology and they offer rational physiological as well as pathological theories. The surgical therapy of dislocations and fractures is often quite modern. For internal diseases, a treatment based on heaithy habits (from diaite "way of life, regimen") stands in the foreground.
Hippocrates himself is, of course, not the only author of all these volumes and most of the texts were written by his disciples long after his death and gathered together under the general authorship of Hippocrates. This corpus is very rich and diverse. Scholars consider that, if some of the books were written at the end of the fifth century or at the beginning of the fourth, others were composed as late as the second century AD. Some of the treatises, for example Fleshes or Regimen are deeply influenced by philosophical writings. One important fact should be pointed out; some of the most ancient treatises, of the time of Hippocrates himself or of his direct pupils, consider medicine as a science, detached from religion as well as from philosophy, and give the main part to scientific observation. This is why they are considered as giving birth to medical science, or to medicine as a science (Ternkin,. The medica1 literature of the subsequent 400 years has been lost. The center of medical thinking moved from Cos and Cnidus to Alexandria and Rome; two great Alexandrian physicians of the early third century, Herophilus and Erasistratus, continued the research of the dogmatic school, which soon was nvalled by the new empirical sect that banished the search for hidden causes and referred the physician to experience and analogical reasoning in unprecedented cases. In Rome a new sect appeared: the methodists, opposing the dogmatists' scientific theories as well as the empiricists' trust in experience. They stressed what is common in diseases, considering the laxity and tenseness of the body as well as the cycles in the rhythms of the body and advocated a methodical treatment (astringents or laxatives) to restore the balance.
Dioscorides' herbal, De Materia Medica, some works by Rufus of Ephesos and by the methodist Soranos, also from Ephesos, all practitioners from the first centuries AD, still exist. Aretaeus the Cappadocian probably also wrote at that time. Then, of course, the wealth of the Galenic writings of the second century AD, allows us an insight into the medica1 practices of this scientifically creative century. , bom in Pergamon, was a careful anatomist as well as a pathologist and a true heir of the Hippocratic medicine that he discusses in length. His work, 22 volumes, representing only two-thirds of what he wrote, E. Sarnama: Asklepios, Hippocrates and their followers: some aspects of healing and physicians in the Ancient World.
was edited in the nineteenth century (1821-1833) with a Latin translation by G.C. Kuhn. Galen travelled a lot. He went to Rome where he practiced and held public conferences on anatomy with dissections of animals, such as monkeys, pigs or even an elephant.
After Galen, medica1 thinking fel1 into the "darker ages". "Centuries passed. The Roman Empire broke up. The flame of Greek medicine flickered, but never died out. Three times, it was revived. The first revival occurred in Persia, between the fifth and tenth centuries" (Majno, p. 420). which explains why some Greek works have come down to us ultimately as Latin versions from Arabic texts translated from the Syriac. The second revival took place in Europe, when the printing press first made the texts more easily available, the third, in the 18th century, when Emile Littre translated the entire work of Hippocrates into French, over a twenty-two year period. As a result, Hippocrates, assumed his still current position as a central figure of Greek medicine.
However, he was, of course, not the only physician to help his fellow citizens. The handbooks of Greek literature are replete with references to doctors and medicine. Apart from the medica1 texts such as the Hippocratic Corpus or the others already mentioned, the Greeks often wrote about their physicians. Plato uses them in his comparisons, for instance, in the famous analogy stating that law is to gymnastics what justice is to medicine (Gorgias, 464B). However, he does not allude to any physician in particular, with the exception of Hippocrates.
Aristophanes generally gives a rather bad image of the physician, saying for instance that a11 doctors are interested only in how much they will be paid, "No fees, no doctor" (Ploutos, 407-8). Historians of the period do not usually mention physicians although a few names occur in Herodotus or Plutarch. The former writes of Democedes of Crotonia who was attached to King Darius' family and healed both him and Queen Atossa (III, 125 sqq.).
Inscriptions serve as a vital source of information concerning the everyday physician and ancient medicine. Epigraphy does not provide any information relative to the organization of studies, or precise treatments or on how to practice surgery, but different types of inscriptions give, here and there, some details about a physician's daily life.
Inscriptions mentioning the medica1 professions are numerous and, above all, varied, such as epitaphs, i.e. funerary inscriptions, dedications to gods or to physicians, decrees, lists and catalogs of different kinds. The origin of these inscriptions is quite varied. They have been found a11 over the Greek World which includes not only Greece and the Islands, but also Asia Minor, the Eastern Mediterranem, Africa, Italy and the West. A wide chronological period corresponds to this great spatial extension.
Physicians are mentioned in Greek in engravings on stones dating from the sixth century BC to the sixth century AD. One of the most ancient testimonies is a statue, a 1.19 m. tal1 marble kouros, from about 550 BC found in Megara Hyblaea in Sicily (Dubois, p. 28). It is now in the Museo Archaeologico of Syracuse. Unfortunately the statue is headless but the inscription, on his right thigh, can be read without any problem; it is engraved from the top to the bottom, but backwards and says "Somrotida to hiatro to Mandrokleous", meaning "[I um the monument] of Sommtidas, physician. son of Mandrokles". Considering the two names, the origin of his family was probably Ionian. Sombrotidas means "descendant of men's saviour" which perhaps indicates that his name was based on a family tradi-tion of medicine or on his profession.. . At any rate, he must have been a very important man to have been offered such a big statue. It is probable that the city granted him the kouros in gratitude for his medica1 services.
Even during Roman times, Latin-speaking authors like Sextus Niger or Julius Bassus made an effort to write in Greek on medica1 topics. Medecine was considered a Greek science, therefore, any professional who wanted to establish an evident link between himself/herself and the great Hippocrates used his languageeven sometimes the specific Ionic dialect in which the Hippocratic Corpus is written! As far as epitaphs are concerned, the farnily emphasized the medical competence of the deceased by using this noble language. It is also important to note that very many physicians had Greek names; either they were of Greek origin, or they wanted their name to sound Greek in order to seem more competent. Two dedications found in Chester, the Roman Deva, now in Chester's Grosvenor Museum, engraved during the second century AD, serve as examples: "To the all-mighty saviour gods, I, Hermogenes, physician, have consecrated this altar" (Collingwood, n. 461); "Antiochos, the physician in honour to the erninent saviours of men among the immortals: to Asklepios with a healing hand, to Hygieia and Panakeia . . ." (Wright,p. 285

n. 3).
These two physicians, possibly of Greek origin considering their names, were, it would seem, employed by the Roman army (the twentieth legio Valeria Vicrix was based in Deva). Although in Roman surroundings, they chose to have their dedication engraved in Greek and addressed to the healing gods listed in the same order as in the Hippocratic Oath2.
A funerary stele from about 480 BC represents a doctor, identifiable because of the cupping glasses which are placed on the ground near him (Berger, 1970). They are symbolic of the medica1 profession and are often found on bas relief related to doctors. The long stick which he is holding in his hand perhaps indicates that he was a travelling physician.
The t e m "medica1 profession" covers a relatively wide field: physicians iatroi, official or chief physicians archiatroi, women physicians iatrinai, archiatrinai (found on one stele), midwives maiai, "masseurs" iatraleiptai, and even veterinarians hippiatroi. The funerary stele of a woman named Mousa who lived in Byzantion during the second or the first century BC serves as an excellent example. The text reads "Mousa, daughter of Agathokles, physician (iatreine)" (Firatli-Robert p. 96 n. 139)3. She is represented on this bas-relief, carrying a roll. It is rare for a woman to be represented with this attribute; they generally are shown with mirrors, make-up accessories or objects referring to female occupations like a spinning wheel. So Mousa, the "intellectual", carries a sign of her sophia, to indicate that her knowledge was wide. She was learned in the medical art as well as in other arts, and this is reinforced by her name, probably a surname, based on the Muses; in other words, Mousa is familiar with a11 the arts. The two little dogs on the right symbolize her medica1 competence as this animal is associated with Asklepios. E. Samama: Asklepios, Hippocrates and their followers: some as-of healing and physicians in the Ancient World.
Jason (or Iason) practised in Athens during the second century AD (IG IIAII 45 13 & Brit. Mus., Cat. Sculpt. 629). His epitaph says: b'Jason, called also Decimos, from the deme of Achamai, physician" and below, lists the other persons in the grave, his adopted son and son-in-law, Dionysios, his daughter Eirene, his grand-son Theomnestos and Theomnestos' wife Philostrate. Jason, a bearded figure, sits on a chair and examines the visibly i11 naked patient standing in front of him. An enormous cupping glass on the right-hand side indicates without a doubt Jason's occupation, already stated by the inscription.
The material from which the stele was made and the extent of its embellishment are both silent witnesses to the social status of the members of the medical profession. As a matter of fact, in the Greek cities, slaves, freedmen and citizens could practice rnedicine, of course not with the same competence nor in the sarne conditions. In general, Greek physicians were free men, even if they did not practice in their native city. On the contrary, in the Westem regions during the Roman Republic and the early Empire, physicians were often freedmen or slaves of foreign, and frequently Greek, origin. In the Eastem Provinces, on the other hand, numerous physicians belonged to very wealthy families during the 2nd and 3rd century AD, and formed a group of prominent citizens. These families often formed a type of medica1 dynasty which handled the training of future doctors as well as the healing of the sick.
In the "Golden years" of the genos of the Asclepiads, things were simpler. Knowledge was transmitted from father to son for generations. This continued to be the way of leaming after the fifth century BC and spread beyond the genos of the Asclepiads. As the Hippocratic Corpus states, in the Law "He who is going truly to acquire an understanding of medicine must enjoy natural ability, teaching, a suitable place, instruction from childhood, diligente, and time." (ii, ed. & transl. H.S.W. Jones, LCL, 1981). Many inscriptions insist on this fact as well.
From the time of Hippocrates, physicians could learn from a master if they paid. A very long inscription found in 1905, but published only in 1991 (Pugliese Carratelli, p. 135 sqq.), provides the cursus of a Coan doctor, Onasandros, who, obviously, did not belong to a family of physicians: "Considering that the physician Onasandros, son of Onesimos, has learnt his art from Antipater, son of Dioscouridas, and has gone with his master dunng the time when he was a public physician in our city and behaved properly towards everyone, and spontaneously offered the service of his art to those of the demotes (citizens of the deme) who asked for it; seeing that, promoted assistant, he gave, during many years, the evidence of his professionnal competence and of his exemplary life, sparing neither energy nor his own money to help many of the demotes; seeing that, when his master was chosen for the public service of the city of Cos, Onasandros decided to collaborate too, first in assisting his master and then in helping personnally a11 the demotes who carne to ask him, because they knew his professional competence and his attitude towards them, and he healed many of them. Seeing that he decided afterwards to open a center for medical care of his own and to offer private surgery, some of his patients helped him financially butalthough he could have done it, regarding the favors he had done to them, how serious were the illnesses he had cured and with what exceptional remedieshe didn't ask any of the demotes to lend him some money, though he could have gathered a considerable capital. [ . . . I w The inscription goes on underlining how disinterested Onasandros remained during a11 those years. What is important to note is the progression in this text between the simple pupil (mathetes) of a master (didaskalos) and the assistant (huperetes), who already has some responsibility and may take some initiative in the treatrnent he prescribes. The pupils chose the master they wanted to learn from according to his reputation. Since no diplomas existed, the only way of getting serious qualifications and ultimately having a brilliant career, was to follow a good master. His name served as a guarantee for the patients and may have helped as a recommandation in getting the coveted official jobs. During the Hellenistic period (Jaeger, 1944), some cities possessed what could be called medica1 centers where the students could learn from different teachers gathered in places like the Mouseion in Ephesos or in Alexandria (Fraser, 1972).
Three options were therefore open to those who wished to learn the medica1 art (iatrike techne): learning in the family, with a master, or in a school. The inscriptions show the different possibilities, for instance, young Orestes, from a wealthy family living in the Pisidian Adada during the second century AD, went to study in Alexandria where he unfortunately died in obscure circumstances (IGRR 111,374). After their studies, the physicians had to settle down in a city and establish a clientele. The period of learning was not fixed. Some sources indicate that it lasted as long as 4 or 5 years, which make the following resume of an epitaph a11 the more startling: Asiaticus, who died in Xanthos (Lycia) in the first or second century AD, aged 18, was already recognized as a "wise physician" (TAM 11,369). Either he began his studies at an extremely tender age or he completed them in less than four years.
During the Classical and the Hellenistic period, Greek physicians travelled a great deal. Some of them died more than a thousand kilometers from their native country; most of them practised in foreign towns. One of the treatises of the Hippocratic Collection, Airs, Waters, Places notes for the newly arrived physician what should be noticed concerning the geographic situation and the climate in order to help the physician in his first weeks of practice (Jouanna, 1996, introd.). The length of time that physicians chose to stay in a town was entirely up to them. Some stayed for a short while, and others for longer periods. Menocritos of Samos, for example, stayed on the small island of Karpathos for twenty years. Others were called to and by the cities in case of epidemics or wars, when the need for physicians was urgent. Hermias, a famous physician from Cos, is mentioned in three inscriptions: two from Creta, Cnossos and Gortys, and one from Halicamassos. He helped the people of Cnossos during a "civil war" (219-217) where many were wounded. Thanks to his efficient competente, he saved a lot of men which is why the citizens of Cnossos voted a decree honouring Hermias in their assembly and sent a copy of it to Cos, where it was found (Syll. 528). Hermias is the only known physician whose medica1 skills were thus recognized on three separate occasions by three different cities. As there is no concrete evidence of the existence of hospitais at this time in the Greek cities, it seems logical to conclude that either the physician went directly to visit the sick in their home or received them in his office, the iatreion. The latter is depicted on a small fifth century vase, called aryballos where a doctor is beginning a blood-letting on his patient's right arm4. A container placed on the floor is to receive the blood. The presence of the cupping glass on the wall serves as an ultimate proof that this is indeed a doctor's office.
The iatreion (described in two treatises of the Hippocratic Corpus: The Physician and the Physician ' s ofice) was generally composed of two or three mms. The presence of the physician, his assistants, the patients, the farnily and the public made these iatreia into crowded places. One room was used to receive the patients and the other(s) to keep the instruments, and the ingredients for drugs and eventually, to perform some surgery, with a bed to keep the wounded for a day or two. This place had to be sheltered from the wind, not too sumy, and yet, bright. The physician, says the Hippocratic text Peri Ietmu (The Physician), must be "clean in person, well dressed, and anointed with sweet-smeiiing unguents that are not in any way suspicious. This, in fact, is pleasing to patients." (ed. & transl. H.W.S. Jones, LCL, 198 1).
Conceming the fees, no inscription gives any precise indication. But they mention that some of the physicians healed their patients for free. One important characteristic of the Greek medical system was the existence of public physicians (Cohn Haft, 1956). These were hired by a city after an interview before the demos, in the Assembly, for a one year conuact that could be renewed. During the audition, the physician was supposed to explain where and from whom he had leamed his art, eventually present some witnesses (mainly healed patients), or letters of recomrnandation from other cities. To get this highly sought after job, some physicians offered to treat their patients without pay for a certain time, for exarnple, six months. The pubiic physician was paid by the city to take care of the population; the salary he received was probably variable, dependiig on the need, the number of candidates for the job and the reputation of the aspirant. Herodotus reports that the famous Democedes of Croton, installed in Egina, was paid one talent (i.e. 6000 drachmai) during his first year as a public physician; the year after, the Athenians sought him and offered him a hundred mines (10000 drachmai) and the third year, Polycratos of Sarnos hired him for two talents (Herodotus, iii, 13 1). Concerning salaries, misthoi, inscriptions are very discreet. The only mention is on an old tablet found in Idalion (Masson, n. 61). Cyprus, presenting the contract between king Onasikypros and the physician Onasilos and his brothers, according to which they would receive one talent and take care without additional payment of a11 the wounded in the war (478-470). In any case, this official salary did not hinder the physician from accepting a voluntary reward by satisfied patients if they so wished! With the money he received from the city, the public physician was supposed to pay for the manufacture of instruments, the rent of the Mtreion and the preparation of drugs and remedies. Such surgical and medical instruments have both been pictured on stone and found by archaelogists in various graves. To pay the public physician, the cities raised a special tax, caiied iatrikon, that the citizens and probably the metoikoi were supposed to pay.
If the physician, public or private, had helped the city, an honorary decree was voted to honour him. In this official text, voted by the Assembly, the merits and the good deeds of the physician towards the city and the inhabitants were proclaimed in very general and conventional terms. The honorary decree for the physician Asclepiades, found in 1914 in