Roman Medicine E-Book

Audrey Cruse

• Herausgeber: The History Press
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 442

Veröffentlichungsjahr: 2025

Beschreibung

Until the mid-nineteenth century the Western medical tradition rested firmly on the foundations established in Classical Greece and later transmitted throughout the Roman Empire. Against this long and complex background, including both religious and magical medicine, Audrey Cruse looks at the many different aspects of medicine and health in the Roman Empire, especially Roman Britain.

Leseprobe

This book is dedicated to the memory of my late husband, Ken6 th January 1925 - 19th May 2004

Front cover image: Statue of Hygea from Cos Museum

First published 2004

This paperback edition first published 2025

The History Press

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www.thehistorypress.co.uk

© Audrey Cruse, 2004, 2011, 2025

The right of Audrey Cruse to be identified as the Authorof this work has been asserted in accordance with theCopyright, Designs and Patents Act 1988.

All rights reserved. No part of this book may be reprintedor reproduced or utilised in any form or by any electronic,mechanical or other means, now known or hereafter invented,including photocopying and recording, or in any informationstorage or retrieval system, without the permission in writingfrom the Publishers.

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ISBN 978 1 80399 912 8

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Contents

Acknowledgements

Preface

Introduction

1 Greek Cult and Medicine

2 Greek Science and Medicine

3Materia Medica, or The Materials of Medicine

4 Roman Health and Hygiene: The Buildings

5 Roman Diseases and Healing I: Cult

6 Roman Diseases and Healing II: ‘Medicaments, Cauteries and Operations’

7 Meeting the Roman Patient

8 Physicians and Healers in the Roman World

Abbreviations

Acknowledgements for Illustrations, Drawings and Maps

Notes

Bibliography of Primary Texts

Bibliography of Secondary Texts

Glossary

Acknowledgements

I wish to thank Peter Kemmis Betty for bringing out a second edition of this book. Amongst other improvements, I have taken the opportunity to correct a few of the ‘false certainties’ found in the first edition, which were most kindly pointed out to me. Indeed, I am grateful for all the constructive comments which appeared in various reviews of the book and I have acted upon these as far as was possible. Furthermore, I have compiled a new index. My most heartfelt thanks, are due to Laura Perehinec, who has been a helpful editor.

When writing the book, I profited greatly from the works of others and their names are enshrined in the bibliography. I also received help, advice and many kindnesses during the time of the writing and publication of the book in 2004, and I remain greatly indebted to all those friends and colleagues who are acknowledged therein.

This third reprint gives me the opportunity to extend long overdue thanks, first to David Gilbert for his assistance from the very beginning in 1999, when I first received my contract from Tempus and then for his photograph of the hospital at Housesteads Roman Fort on Hadrians’ Wall. Second many thanks to Patty Baker, Martin Henig, Ralph Jackson, Helen King and Grahame Soffe who have always been readily available with ideas and information. Third, I am grateful for the encouragement and support that I have received from Douglas Talintyre. Finally I thank my editors, for their assistance throughout the working of the fourth reprint January 2025.

Preface

This book seems to have lasted well through three decades and, although there have been advances in knowledge for example in osteology and some new finds of medical paraphernalia, as well as research by classicists in medical texts, the basis of our understanding has remained the same. But there have been losses in good friends who have helped me so much in the past, especially Dr Ralph Jackson.

Others, I am glad to say, continue to provide inspiration, namely Dr Helen King and Dr Vivian Nutton.

In this new edition I am grateful to Martin Henig for help with work on Roman Inscriptions of Britain and Douglas Talintyre who has provided essential support and sustenance. I extend warm thanks to both.

In addition, I thank my editor at The History Press for her assistance.

Audrey Cruse2024

Introduction

Injury and disease have afflicted the human race since earliest times. Although when unwell many animals instinctively know how to make themselves feel better, the search by human beings for knowledge of their illnesses, of ways to cure and prevent them and for an understanding of their bodily processes, was as much an imperative in the past as it is today. This search defines what medicine is. But medicine is more than this. According to Hippocrates (c.460-370 BC) medicine is an art,1 and ‘the medical colossus of the Roman era,’2 Galen (c.AD 129-216?), insisted that the good doctor is a philosopher. Medicine is also a skill in that it is the result of practice and knowledge, particularly knowledge of science; thus science is an intrinsic part.

Medicine, therefore, is concerned with the prevention of disease and the art and science of healing. It is as ancient as the human race itself. Healing and bodily health are brought about by the search for, and the application of, remedial substances and the regulation of diet and personal habits. Medicine has only recently been confined to professional, regulated bodies. Today it is a subject of high importance in the politics of church and state; art and philosophy have been translated into medical ethics.

Medicine changes through time. Although basic similarities remain, in many ways ancient medicine bears no resemblance to its modern counterpart. The purpose of this book is to attempt to explain how medicine was practised in the Roman world, to seek out Roman medicine as it was, not how we would like it to have been, nor how close it came to the medicine of today. Neither is the book about ‘how nearly they got it right’, by comparisons with the familiar concepts and practices of modern medicine, which today are presumed to be the proper way to practise human healing. Every ‘medicine’ is particular to the culture, time and place in which it finds itself.

Western medicine has a historical pedigree which reaches back to the times of Homeric epic, in which disease and war-wounds are described and treated by divine will or magical incantations, or with surgery or drugs. The Iliad and the Odyssey, attributed to Homer, were transmitted by ancient oral tradition from the end of the Trojan war, at the beginning of the twelfth century BC, and written down around the eighth century. This is where the name of the paramount god of Greek medicine, Asclepius, is first found, although at this time he was not yet deified. His chief attribute, the snake, is the symbol of medical associations in Britain and abroad, while the sons of Asclepius, Machaon and Podalirius, healers also mentioned in the Iliad, are featured today in the arms of the Royal College of Surgeons in London.3

Most particularly, Western medicine is indebted to the origins of natural scientific thought in archaic and classical Greece. Hippocrates was a Greek physician born on the island of Cos and known as the ‘Father of Medicine’. Many medical treatises are collected under his name, but few, in fact, are his work. Between the seventh and fourth centuries BC, argument and debate concerning different subjects gave rise to the formulation of a variety of competing theories. Questions were asked concerning the identification of individual elements making up the human body and the cosmos, such as earth, air, fire and water. Atomic theory has its roots in this early period. Democritus (c.460 BC) thought that all things in the universe were made up of a flux of atoms in a void. Plato (427-347 BC) and his pupil Aristotle (384-322 BC) were concerned with enquiries surrounding the relationship between the body and the soul. Plato taught that the soul (mind or psyche) was immortal and independent of the body and, because the body could influence the mind, one of the duties of the doctor was to teach virtue.

Through Plato the tradition evolved in Western thought whereby an important part of medicine consisted of understanding human nature, or the psyche. Good health depended on temperance and wisdom, on self-control achieved through moderation in the consumption of food and wine, and in sex and physical exercise. Thinking good thoughts led to sophrosyne, soundness of mind.4 Aristotle also investigated the natural world and was interested in explanations concerning anatomy and physiology. He used findings from animal dissections in his research, although he did not distinguish between veins and arteries.

1 The Calf-Bearer, c.575-550 BC. From the Acropolis Museum, Athens

Thinking good thoughts was also required of those who entered the temples of Asclepius. Throughout this period, religious medicine was an important part of life. Healer deities resided at cult centres, such as those erected for Asclepius at Epidaurus, Cos or Pergamum. Here the sick would sleep in order to experience healing dreams. Another important healer-deity was Amphiaraus, found at Oropus near Boeotia. He fulfilled a similar function. However, such cult centres cannot be regarded as early types of a ‘hospital’ because the sick were not given any form of continuous therapy, nursing care or food. Another aspect of religious medicine to take place at cult centres was pilgrimage. Gifts, often including animals, (1) first-fruits, garments and anatomical models of parts of the body, would be carried to the deity, as a request either for healing or for fecundity for themselves, their animals or their crops.

Hospitals were a natural outcome of Rome’s military policy. As the Empire expanded its frontiers into distant and hostile territories, suitable places where the sick and wounded could rest and be cared for were needed. Although little is known about its foundation, the Roman military medical provision evolved from this need and hospitals, valetudinaria, were provided in forts and fortresses. Greek doctors, including Claudius’ personal physician, Caius Stertinius Xenophon of Cos, Scribonius Largus (c.AD 1-50) from Sicily, and Dioscorides (fl. c.AD 40-90) of Anazarbus, in Roman Cilicia (who may have come to Britain with Claudius’ invasion force), were among the army medical personnel.

The distinction between veins and arteries, although not discovered by Aristotle when in Athens, may have been realised at other centres of study. Some of these have already been mentioned above. Many theories came from Praxagoras of Cos (c.340 BC) and Diocles of Carystus (c.320 BC) in Euboea. Later, in the second century AD, Galen decided that blood was made in the liver where it became mixed with foods in the form of chyle. This nourishment for the extremities was carried by veins which also originated in the liver. According to Galen, arteries commenced in the heart, although full understanding of blood circulation was not to come until much later, with the work of William Harvey, published in 1628.

In 331 BC, Alexander the Great, whose tutor had been Aristotle, founded the city of Alexandria, ushering in the Hellenistic period. When Alexander died in 323, Egypt was ruled by a line of Macedonian kings, the Ptolemies, and a royal dynasty was established. The city of Alexandria became very wealthy. The library and museum were founded and a great international centre of study and research grew up. It continued at least into the second century AD and possibly lasted throughout the Roman period in Egypt (30 BC-c.AD 323). Galen is known to have studied at Alexandria, where one of the most important subjects to be researched was anatomy. According to Celsus (De Med. pref. 23-6) human dissection was performed. Two of the foremost medical scientists to travel to the great city were Erasistratus of Ceos (330-255 BC) and Herophilus of Chalcedon (c.330-260 BC). New discoveries were made in anatomy and physiology and, following the ideas of Alcmaeon of Croton and Diogenes of Apollonia, the brain and not the heart was found to be the seat of intellectual activity.

Among other subjects to be researched in the new city were pharmacology and botany. In the reign of Augustus, after his conquest of Egypt in 31 BC, strange and new ingredients became incorporated into the Roman pharmacopoeia. Later, the expansion of the Empire all round the Mediterranean basin, beyond the Euphrates to Asia, further increased the range of medicinal drugs that could be available. Three routes lay open to a rich diversity of plant-life in the Far East. First by the Black Sea, through the Oxus and by northern Bactria (modern Afghanistan, Tadzhikistan and Kirghizstan); secondly, from Syria down the Euphrates to Nisa and across Persia; finally, the route through the Red Sea and the Indian Ocean.5

In the later Empire, after the conversion to Christianity of the Emperor Constantine, the cult of Asclepius was supplanted by Christianity and the first non-military houses where the sick could be cared for were established in the Greek East. Literary and epigraphic sources refer to these as xenodocheia and nosokomeia. One of the first to be built was that of the bishop St Basil of Caesarea. He provided physicians, nurses, rehabilitation and after-care in his ptocheion. This was technically ‘a house for the poor’, although it was also used for sufferers from other misfortunes, including disease. According to St Jerome, the first hospital in the West was founded in Rome by a wealthy Christian widow, Fabiola, in around AD 350.

Plagues cause social upheaval and change. The chronological framework of the book is bounded by the three most devastating pestilences, known from literary sources, to have occurred in the ancient world. First, the plague in Athens (430-426 BC) which brought about the end of the Athenian Empire; secondly, the ‘Antonine Plague’, brought back to the Roman Empire by troops returning from campaigns in the Near East. This plague raged for fifteen years and claimed the lives of two emperors. Lastly, in late antiquity, c.AD 542, the plague of Justinian lasted for more than fifty years. Recorded by Procopius, the Greek historian, it may have been one of the factors that contributed to the ultimate failure of Justinian’s schemes for reviving the Roman Empire.

It is generally accepted that ‘rational medicine’ describes the type of medical practice which looks for the cause of a disease before prescribing its treatment and ‘irrational’ describes magic and superstition. However, when viewed alongside the manifest deficiencies of early healing systems, it is possible to construe the use of magic as ‘rational’. The question rests on an attitude of respect regarding the beliefs of other peoples. These are aptly juxtaposed by King when she writes6 that ‘the Greeks believed in the wandering womb, whilst we believe in hormones’. ‘Scientific’, although used to describe the work of the ‘natural scientists’ and Hippocratic and Galenic medicine, is better used when applied to modern medicine. Finally, ‘classical’ is used to describe the medicine of the classical period, which embraces most of the fifth and fourth centuries BC.

To conclude, Roman medicine did not arise out of a vacuum, neither is it a single discipline that can be neatly packaged into a linear narrative. On the contrary, Roman medicine is a complex and wide-ranging subject. Its research involves not only older systems of medicine, such as those of the archaic (before 500 BC), classical (500-300 BC), and hellenistic (after 300 BC) periods of the Greek world, but also many of the different cultures which became incorporated into the Roman Empire. These include the medicine of Ancient Egypt, particularly that of the Graeco-Roman period, during which the centre at Alexandria flourished. In Italy, Roman medicine incorporated Etruscan technical achievements and certain aspects of Etruscan magico-religious healing. Following discussions of these, many of the brief references included in this introduction will be expanded upon, and Roman medicine, as practised during the Roman Republic and Empire, will be discussed in more detail. Sources available are archaeological, for example skeletal evidence, anatomical votive objects and finely-made surgical instruments. Sources are also architectural, in the form of buildings such as baths, aqueducts, sewers and traces of possible military hospitals. Evidence for herbal remedies is discussed, in addition to epigraphy and documentary and literary sources.

1

Greek Cult and Medicine

In the ancient Greek world religion was based on myths and legends which reached back into earliest times. Some myths were already ancient before dramatists such as Aeschylus, Sophocles, Euripides and Aristophanes reworked the old stories as drama in order to reflect contemporary issues and as vehicles for their art. Myths embody truths, differing mythologies demonstrate the possibility for more than one single view on a question. For the Greeks and Romans, myths and legends were traditional ways of explaining the mysteries of life and the uncontrollable forces of Nature.

Although Greek myth supposes that diseases were absent at the moment of creation, no time is lost in introducing Pandora and her dowry to the human race. Several myths reflect contemporary ideas about the beginnings of Greek medicine and the origins of disease. The poet Hesiod (c.late eighth century BC) describes the ills that await men and women in times to come. ‘Sicknesses visit men by day, and others by night, uninvited, bringing ills to mortals, silently …’. Hesiod also tells of the myth of Pandora who, on opening her jar, ‘let loose harsh toils and grim sickness upon mankind’.1 Nevertheless, ‘Hope’ was allowed to remain clinging under the lid, allowing for the development of medical enquiry. The poet Aeschylus (fl. 525-456 BC), in his play Prometheus Bound uses a myth which tells how Prometheus gave man medicine: ‘I showed them how to mix mild healing herbs / and so protect themselves against all maladies’.2 Another myth which attempts to account for the origins of herbal medicine is that of Cheiron the centaur in Homer. Such myths, reflecting the anxieties of ancient peoples concerning disease, disability and misfortune, were already ancient when used by early writers.

The earliest evidence for the practice of medicine in ancient Greece is met in prehistory with the Mycenaeans, whose proficiency in the skills of healing is attested archaeologically on settlement sites and in tombs. The use of opium, known mainly from ritual, is seen in the Gazi goddess3 (colour plate 1), dating from 1350-1250 BC, into whose diadem-headdress are tucked stalks of poppy-seed heads; coincidentally, according to tradition, this is the time of the Trojan wars.4 Moreover, the Homeric poems, which tell the story of those wars, and which also emerged in prehistory, bear witness to the care of the sick and wounded, many of whom were treated with medicinal herbs either mixed with wine or applied directly to wounds. It is noteworthy that more than sixty plant varieties are named in Homer.5

Medicine has an important place in Homer’s epic world and reference to disease occurs early, in the plague cast by Apollo on the Greek army at Troy. Apollo, striking from afar, drives ‘the foul pestilence along the host and the people perished’ (Iliad I.10). Apollo was a healing deity and the most important divine supporter of the Trojans. He inflicted the plague upon the Greek army before Troy as punishment for the abduction of Chryseis, daughter of his priest Calchas. Later, after Agamemnon has surrendered the girl, Apollo is appeased. Healed of his anger, he causes the plague to cease. Homer includes a doctor among the following: ‘… one who works for the people, either / a prophet, or a healer of sickness, or a skilled workman, / or inspired singer, or one who can give delight by his singing’. The idea that healers were ‘journeymen’ is also shown here (Odyssey XVII.383-5). The inclusion of the ‘healer of sickness’ with community workers and skilled workmen, is the first reference to an important aspect of ancient medicine – that it was regarded as a techne, a craft or a skill, comparable to other technai, such as the work of a sculptor,6 or a builder.

Apollo was the father of Asclepius. Although Homer refers to Asclepius only once by name (Iliad II.731), his presence in the poem is important, for medicine as taught and practised by him in a later period was certainly not a creation out of nothing. When the Greeks sailed against Troy they invited two heroes, the sons of Asclepius, who were also respected doctors, to join the army. Machaon and Podalirius were pupils of Cheiron the centaur, who was a wise and kind friend (Iliad IV.219; XI.831); an unusual thing in a centaur. Asclepius, too, had been a pupil of Cheiron.

As an inspired singer, the healer could use an incantation (epode) as an haemostatic, like the sons of Autolycus (Odyssey XIX.457-458):

The dear sons of Autolykos were busy to tend him,

and understandingly they bound up the wound of stately

Odysseus, and singing incantations over it

stayed the black blood,…

Incantation may have been as appropriate in Homer’s time as ‘music therapy’ is today – regarded by some people as questionable, even though many claims have been made for positive results. The poet’s narrative is a skilful interweaving of realistic detail and the imagined world. Allusions to things medical in Homer vary from realistic descriptions of wounds, attesting a certain degree of understanding of anatomy, to the treatment of these by means of medicinal plants. Although reference is made in only two places to bandaging, this does not necessarily mean a lack of knowledge or use. It could also indicate that the dry scab was well known to be a natural ‘bandage’.7

Both the Iliad and the Odyssey speak of fearful injuries suffered in battle, caused by weapons such as arrows, spears, swords, jagged rocks or stones. Homeric heroes know where to strike in order to finish off the enemy quickly. The result of a blow depends more on the region and the organs involved than the weapon used. The descriptions of woundings attest knowledge of the anatomical positions of the major organs and of the most likely consequences of injuries to each. For example, Aeneas is struck by a huge rock on the hip at a place called the cup-socket. The blow ‘breaks the two tendons’ and crushes the cotyloid socket. Aeneas falls to his knees and faints from the pain. Aphrodite, his mother, Apollo and Artemis all protect him and his cure is so rapid that he returns to fight the same day. (Iliad V.297-317; 431-70; 514-18.) Another example where anatomical detail is shown is at the death of Diomedes (Iliad XVI.480-1): ‘Patroklos … with the brazen spear, the shaft escaping his hand was not flung vainly / but struck where the beating heart is closed in the arch of the muscles’.

Eye conditions were a great concern in the ancient world and the theme of blindness all too frequently occupied the Greek mind (colour plate 2). It is used by the Muses in the Iliad (II.595-600), when, enraged by his boasts, they desired to punish the Thracian bard, Thamrys when, at the same time, he was deprived of his voice. The gods themselves blinded the Theban seer Tiresias (Odyssey X.492-5). On the other hand, the bard Demodocus was blind as a result of the special affection of the Muses, ‘She reft him of his eyes, but she gave him the sweet singing art’ (Odyssey VIII.63-64), perhaps a reference to Homer himself. Blindness could also have been an affliction from birth. In Greek thought, physical blindness could suggest psychic or spiritual insight. In Sophocles’ Oedipus, King Oedipus is said to ‘see better’ after he is blinded. Blindness is rationalised as a gift, or a punishment, bestowed by the gods. Such a rationalisation would go a long way towards helping the sufferer to accept the disability.

At the Iliad XVI.28 ‘Healers skilled in medicine are working to cure their wounds’, and at the Iliad XI.514-5, Homer tells us that ‘A healer is a man worth many men in his knowledge / of cutting out arrows and putting kindly medicines on wounds’. The wounded are carried off the battlefield and tended on nearby ships (Iliad XI.824-5). After the wounding of Machaon, the first attentions he received were a seat, story-telling and a cup of ‘Pramnian wine, and grated goats-milk cheese into it / with a bronze grater, and scattered with her hand white barley into it’ (Iliad XI.638). Later, Machaon’s wound was washed with warm water by the same woman, ‘Hekamede the lovely-haired’, (Iliad XIV.6). The only remedy in Homer for haemorrhage, apart from the dry scab already mentioned, was the epode refered to above and the application of a pounded unnamed root (Iliad XI.841-7). This may have been an onion, or achillea (woundwort) or aristolochia, a herb used for the relief of birth-pangs. Moreover, Homer shows much confidence in speaking of medicine when Patroclus is described removing an arrow from the thigh of Machaon:

Patroklos laid him there and with a knife cut the sharp tearing arrow out of his thigh, and washed the black blood running from it with warm water, and, pounding it up in his hands, laid on a bitter root to make the pain disappear, one which stayed all kinds of pain. And the wound dried, and the flow of blood stopped.

The need for cleanliness was also recognised. It is seen in the use of fire and brimstone, ‘the cure of evils … to sulphur the hall’, after the slaughter of the suitors (Odyssey XXII.480-495). There is also an element of ritual purification here. Odysseus then cleaned his ‘palace, house and courtyard alike, with the sulphur’. In some ways the ‘ritual cleansing’ of the ancient world can be seen as hygiene. We know that certain bacteria are ‘polluting’, or ‘infectious’, but for the ancients pollution could come from wrong actions as well as from the physical events of birth, death and sex.8

Arrowheads were made of iron or bronze. Some were tricuspids, with three barbs (Iliad V.393), but most had two. These were thin enough to break off when pulled through a leather belt (Iliad IV.210-19). The damage to human tissue may be easily imagined; ‘as they were pulled out the sharp barbs were broken backwards’. Macheon, called to treat Menelaus, ‘sucked out the blood and in skill laid healing medicines on it / that Cheiron in friendship long ago had given his father’. One of these arrow-heads was found in Troy VIIa, lying in the rubble in the middle of the street.9

Although opium is not mentioned in Homer it would have been easy to come by. Jewellery and clay objects in the shape of opium poppy-heads, like the headdress of the Gazi goddess described above, attest the availability of the drug from Asia Minor to Greece. Sometimes the poppy-heads in these objects are artificially slit, demonstrating the way that the latex could drip out to be collected. Book IV of the Odyssey (lines 220-35) finds Helen in Egypt with Menelaos and Telemachos. The conversation turns on sad memories of Troy. Helen, in kindness, casts a medicine into their wine ‘of heartsease, free of gall, to make one forget all sorrows’. This was probably opium, for ‘in Egypt, the fertile earth produces the greatest number of medicines and every man is a doctor there and more understanding than men elsewhere’; they belong to the race of the healer-god Paion (later identified with Apollo). It was Paion who healed the wound of the violent Aries when he applied a soothing medicine to it (Iliad V.900-4), ‘since he, Aries, was not one of the mortals’. Thus it is also demonstrated that the Gods require the services of a divine doctor. However, the juice of a fig tree, although it could curdle white milk rapidly, as described in the simile in the Iliad V.902, has been shown by Majno in his laboratory tests, to actually prevent the clotting of blood.10

2 Achilles binds the arm of Patroclus

Sources

The value of literary sources has been demonstrated above. However, some Homeric medical scenes are interpreted by iconographical representation on works dating to the Greek and Roman periods. The blinding of the lyre-player, Thamrys, is figured on an Attic hydria of the fifth century BC, seen in the Ashmolean Museum, Oxford (No.530). Therapies practised in the ancient world are also seen in art from both classical Greece and the later Roman period. An illustration by Sosias on a vase of c.500 BC depicts Achilles binding the forearm of Patroclus (2). Wounds were sometimes treated with iron-scrapings. This is illustrated in a Roman bas-relief from Herculaneum which depicts another scene from the myths of the Trojan wars, in which Achilles applies scrapings from his lance to the injury of Telephus.

In contrast to poetry, which could be more easily remembered and was transmitted verbally through many generations, written prose developed slowly in the Greek world. Once it appeared, medical writers, historians and writers of speeches and aphorisms were quick to make use of it. This happened simultaneously in different areas. Herodotus (c.490-c.425 BC) was one of the first to use the new medium. He was also interested in physicians and medicine. Although records were made on stone, writing in ink on papyrus was predominant by the classical period. Egypt, of course, had the monopoly on papyrus. Other archaeological sources are also available, particularly with reference to cult centres.

Healer-gods and their sanctuaries

Many sanctuaries in Greece date back at least to Mycenean times and some continued through the Roman period and beyond. Healing deities occupied natural sites, ranging from rivers and mountain springs to peak sanctuaries (3). Nymphs of Artemis, according to literary sources, were found in brooks and streams. They cured, among other maladies, eye diseases. These ideas were deeply rooted in ancient belief. Apart from Apollo, who possessed other interests besides that of health, the two best-known powers of healing in ancient Greece belonged to Apollo’s son, Asclepius, and the demi-god Amphiaraus of Oropus. Although the cult of Asclepius was to spread throughout the Greek world as far as Cilicia, and then to Rome and the West, that of Amphiaraus remained centred on his sanctuary at Oropus, situated on the borders of Attica and Boeotia.

3 Votive figurines from the Middle Minoan peak sanctuary of Prinias, Siteia

4 The sanctuary of Apollo at Delphi

Apollo

In Greek mythology Apollo (colour plate 3) was twin brother to Artemis. Whilst he was god of the plague and the healing hymn, Artemis was the goddess of childbirth and fertility. The nature of Apollo is complicated. Although he was subject to the human passions of lust and jealousy, this was balanced by testimonies at his shrine at Delphi (4) to another aspect of his nature, that of moral excellence. In the fifth century, proverbs engraved on his temple – the method used for the dissemination of wisdom at the time – fully expressed this particular attribute. Among the many epigrams discovered were two which today continue to be regarded as useful: ‘nothing in excess’ and that other famous Greek injunction, ‘first know thyself’. Oracles and healing sanctuaries are often found on the same site; one example is the sanctuary of Amphiaraus of Oropus. However, at Delphi, there is no direct evidence for a healing cult, although Apollo was first and foremost a healing deity and this was his major shrine. In Roman times, Apollo retained his Greek name and other major sanctuaries; for example Delos, also sacred to Apollo, became just as important as Delphi.

Asclepius

The conception of Asclepius was straightforward. Apollo, seeing Coronis, a mortal nymph and daughter of King Phylegys of Thessaly whilst she was bathing, desired her and seduced her and the violent birth of Asclepius followed in due course. However, before this could happen, her father arranged a marriage with a mortal prince and the god felt slighted. Apollo was told of the marriage arrangements by a raven which at the time possessed white plumage. As a punishment for bearing the bad news Apollo cursed the bird and turned his plumage black (colour plate 3). Because of Coronis’ forthcoming marriage and her apparent adultery, jealous Apollo tore his unborn son out of her womb and gave the prematurely-born infant for parenting to Cheiron the centaur, by whom he was nurtured and taught the art of medicine on Mount Pelion. Because of his mixed parentage, controversy has always existed as to whether Asclepius (colour plate 4) was a god or a hero.

Several myths surround the nativity of Asclepius. They are attempts to account for both his mortality and his divine status. In Homer a few indirect references appear but there is no special mention of his epiphany as in Hesiod and Pindar, where his death caused by Zeus is described. The reason for Zeus’ action was that, in answer to a plea from Artemis, Asclepius restored her favourite, Hippolytus son of Theseus, to life. Zeus was further angered when Hades, god of the underworld, complained about the unequal numbers of souls or persons inhabiting the two different worlds, due to the miraculous interventions of Asclepius. In his anger Zeus slew the healer with a thunderbolt. Later Apollo, son of Zeus, raised Asclepius from the dead and rewarded him with divine status. Asclepius’ wife was Epione and their two daughters were Hygea and Panacea; their sons, Podalirius and Machaon, are already referred to above. In art Asclepius is also frequently seen with Telesphorus (colour plates 5 and 6), god of convalescence, usually depicted as a small hooded figure, similar in appearance to the so-called genii cucullati found in Britain and Gaul. Other sanctuaries belonging to Asclepius, known through texts and archaeological excavation, are found at Athens, Corinth, Piraeus, Pergamum and Cos. An important feature in all those mentioned is the proximity of a theatre. At Corinth, votive limbs from the sanctuary are exhibited in the site museum (5).

5 Votive limbs from Corinth

Originally Asclepius was known as a Thessalian king and a mortal healer. His sons, Podalirius and Machaon, came from Trikka in Thessaly where they already worked as doctors. However, in the Iliad, Homer merely refers in passing to the hero Asclepius. It was later, in classical times, that he was deified. He then became the focus for a healing cult in temples through the Greek and Roman world. His serpents were held to be sacred and sometimes assumed the functions of Asclepius himself. Furthermore, in their annual shedding of the old skin and the growing of a new one, snakes were symbols of renewal (6, 7 and 8).11

6 Snakes, the chief attribute of Aesclepius featured on a stone altar at Butrint, Albania

Epidaurus: The Archaeology

Epidaurus was the first and most important shrine of Asclepius. The area is known to have been associated with a healing cult since the sixteenth century BC. At first it was the shrine of the hero-deity Malleatus who was god of the hunt, hence the association with hounds. Sometime later this deity was conflated with Apollo who was then known as ‘Apollo Malleatus’. His cult was centred on Mount Kynortion which rises above the sacred precinct of Epidaurus (9). In Greek, the name reflects the hound epithet.12 The remains of sacrifices performed during the seventh century BC have been discovered by archaeologists, in addition to vestiges of much later temples and other buildings. These could have been guest-houses for pilgrims visiting the shrine and in many instances the finds confirm that the cult of Asclepius at Epidaurus continued at least until the imperial period.13

7 Snakes featured on Left a) a funerary stelae; Below b) a votive plaque showing Hygea standing behind the god. From the National Archaeological Museum, Athens

Writing in the second century AD during and after the reigns of Hadrian and Antoninus Pius, Pausanias, a Greek doctor (according to Levi, 1971) and a travel-writer, was personally devoted to Asclepius. He provides many references to the god concerning his birth and background. In his ‘Guide to Greece’14 Pausanias records statuary and works of art depicting Asclepius, some of which are shown in contemporary or later coinage. He writes of the territory of the Argolid: ‘this whole land is especially sacred to Aesculapius’,15 such was his devotion to the god. Pausanias records that the Emperor Antoninus Pius was responsible for many kindnesses here, one of which was, whilst yet a senator, to build a house for women in labour: ‘here a man can die and a woman bear her child without sacrilege’16 (childbirth was regarded as potentially polluting). It is not known exactly when the god arrived at Epidaurus and took over from Apollo but the general opinion is that Apollo was venerated from the seventh century and the cult of Asclepius arrived in the sixth or fifth century.

8 A statue of Asclepius, from Epidaurus

9 Mount Kynortion rises above the sanctuary of Asclepius at Epidaurus; the theatre is in the foreground

The site has been under excavation by Greek archaeologists since 1881 until the present time. Buildings within the sanctuary have been located and identified. These include the temples of Asclepius and Artemis, the stadium, hotel (katagogion), banqueting hall, baths, gymnasium and tholos (thymele). The most complete building is the theatre, a building of great beauty and magnificence; the original orchestra remains. The fifty-five tiers of seats are restored and the theatre is used today for the performance of the Greek plays for which it was originally built. A small museum houses many sculptures and artefacts rescued from the site itself. No anatomical votives were found at Epidaurus. Stone slabs, iamata, bear inscriptions recording case-histories and cures received by pilgrims to the shrine; four of them were found during excavation and two are virtually intact. Pausanias writes:

In my day there are six left of the stone tablets standing in the enclosure, though there were more in antiquity. The names of men and women healed by Asclepios are engraved on them, with the diseases and how they were healed.

A few of the cures seen by Pausanias appear below:17

Ambrosia of Athens, blind of one eye. She came as a suppliant to the god. As she walked about in the Temple she laughed at some of the cures as incredible and impossible, that the lame and the blind should be healed by merely seeing a dream. In her sleep she had a vision. It seemed to her that the god stood by her and said he would cure her, but that in payment he would ask her to dedicate to the Temple a silver pig as a memorial of her ignorance. After saying this, he cut the diseased eyeball and poured in some drug. When day came she walked out sound.

Edelstein, 1945, stele 1-4

Euphanes, a boy of Epidaurus. Suffering from stone he slept in the Temple. It seemed to him that the god stood by him and asked: ‘What will you give me if I cure you?’ ‘Ten dice,’ he answered. The god laughed and said to him that he would cure him. When day came he walked out sound.

Edelstein 1945, stele 1-8

A man with an abscess within his abdomen. When asleep in the Temple he saw a dream. It seemed to him that the god ordered the servants who accompanied him to grip him and hold him tightly so that he could cut open his abdomen. The man tried to get away, but they gripped him and bound him to a door knocker. Thereupon Asclepius cut his belly open, removed the abscess, and, after having stitched him up again, released him from his bonds. Whereupon he walked out sound, but the floor of the Abaton was covered with blood.

Edelstein, 1945, stele 11-27

Cleinatas of Thebes with lice. He came with a great number of lice on his body, slept in the Temple, and saw a vision. It seemed to him that the god stripped him and made him stand upright, naked, and with a broom brushed the lice from off his body. When day came he left the Temple well.

Edelstein, 1945, stele 11-28

Gorgias of Heracleia with pus. In a battle he had been wounded by an arrow in the lung and for a year and a half had suppurated so badly that he filled sixty-seven basins with pus. While sleeping in the Temple he saw a vision. It seemed to him the god extracted the arrow point from his lung. When day came he walked out well, holding the point of the arrow in his hands.

Edelstein, 1945, stele 11-30

The Cult of Asclepius

In order to receive healing dreams, it was necessary for the patient to sleep in the abaton. Asclepius would appear during the dream to give his instructions. These would be interpreted by specially trained priests. Before approaching the god, the patient was required to follow a prescribed ritual. In the temples of Asclepius this procedure was not at all arduous or unpleasant. Nothing unkind or grasping is found in his ministry. Asclepius charged no entrance fee and made few requests of his patients; he merely required that the suppliant should purify their body by washing and have good thoughts. Many of the testimonies show that the god especially cared for such qualities. He only refused to help those who came to him in dishonesty, or who had a high regard for great personal wealth. Testimonies found both at the temple at Epidaurus and at Lambaesis carried the inscription: ‘Pure must the person be who goes inside the fragrant temple, purity means to think nothing but holy thoughts’.18

Sacred Sleep, Dream Oracles, Incubation, The Abaton

To prepare for sacred sleep, the patient’s mind should be cleared of all worldly thoughts and domestic concerns. The prescribed ritual, which first included personal cleansing, was followed by the performance of an animal sacrifice. The patient would then lie down in the appropriate part of the sanctuary, either in the abaton or, in the case of the Amphiareion at Oropus, the stoa. The god would appear to the patient in a dream and would give specific advice. For a graphic presentation of such a dream, see the stele of Archinos of Oropus, (10a). Here the incubation as it was practised in the domain of the healing gods is depicted. The relief is dated to the fourth century BC. It represents the healing of the injured shoulder of a young man, Archinos of Oropus, by the god, through the lick of a snake during a dream. Two or three scenes from the episode are shown at once and it is difficult to interpret their proper sequence and meaning with certainty. However, the god’s resemblance to the iconography of Asclepius is quite striking, possibly representing the ‘type’ of a healer rather than a portrait. The following lines (649-732) from Aristophanes’ play Wealth, or Plutus, are informative:

Anyway, the temple servant put out all the lamps and told us to go to sleep, warning us to remain silent if we heard any noise. So we all lay there quietly; but I could not sleep. There was an old woman with a pot of wheat broth lying near her head, and I was struck by this and I had a consuming desire to creep up on that pot. So I looked up, and what did I see but a priest taking the cheese-cakes and figs off the holy table; after which he went all round the altars seeing if anyone had left a cake there, and he consecrated all of them by putting them into his bag. Well, that assured me that what I intended to do was an act of the highest piety, so I got up and made for the pot of broth.

10 Left a) A fourth-century BC votive relief depicting the god Amphiaraus curing a young man, Archinus of Oropus; right b) A votive relief is offered to a deity of healing. From the National Archaeological Museum, Athens

As described by Aristophanes, the offerings placed on the god’s altar consisted of such simple things as cakes, bakemeats and figs. When the god appeared, ceremonies were performed. Asclepius would prescribe the therapy, whether herbal medicine, exercise or hot and cold baths. He would also name the sacrifice required. This was rarely onerous or expensive but at each sanctuary the sacrifice was different. In Cyrene goats were offered19 but at Epidaurus these were banned.20 Oxen and stuffed pigs are recorded.21 Cockerels were also allowed: note the last words of Socrates after swallowing the hemlock – ‘send a cock to Asclepius’.22 When the patient was healed, he was expected to offer the promised sacrifice in thanksgiving and to fulfil any other vows he had made. This may well have been to present a model of the affected part. In Greece examples of such limbs may be seen in the museum at Corinth. Asclepius was known from testimonies carved in stone at his sanctuaries, for his ability to cure all diseases. Physicians were also present at the temples.

The Amphiareion of Oropus

A further healing sanctuary of interest with roots in Greek myth and a long history of pilgrimage and use by the sick and disabled is found at Oropus, situated in a pleasant wooded valley thirty miles from Athens (11 and 12). During the fifth and fourth centuries BC the Amphiareion at Oropus would have been a site to equal in popularity the sanctuary of Asclepius at Epidaurus. Pausanias relates the story from Greek myth of the seer and divine healer, Amphiaraus.23 He was a Greek hero of the generation earlier than the Trojan wars, who took part in the expedition of the Seven against Thebes. In the legend, as Amphiaraus was fleeing from a predicted certain death, Zeus cast out a thunderbolt, opening a cleft in the earth in which the hero sheltered with his chariot. As a result of this divine favour, Amphiaraus (the name means twice-holy), became a chthonic deity and functioned in two capacities, as both a divine healer and a prophet. The god performed miraculous cures over several centuries. The sanctuary at Oropus was founded in the last quarter of the fifth century BC and was at once an oracular shrine and a health spa. Under Roman state patronage, it attained added importance, particularly in the first century BC when the games flourished, encouraged by money supplied by Sulla.24 The statue bases of Brutus and an equestrian portrait statue of Marcus Agrippa provide evidence for the continuation of the site into the very end of the Republic and beyond.

11 Temple site at Oropus and the remains of the stoa

12 The remains of the cult statue at Oropus

The Archaeology

The sanctuary was first excavated by the Greek archaeological service between 1884 and 1929. After a period of inactivity, sporadic restorations were resumed in 1960.25 Amphiaraus is believed to have emerged from the underworld through the sacred spring. In ancient times it was forbidden to use this for such mundane, or impure, purposes as personal washing. However, the water was thought to possess medicinal properties which pilgrims were permitted to drink. According to Pausanias, when a person was cured of a disease, or was in receipt an oracular pronouncement, they would drop gold and silver coins into the spring in thanks. Lower down the valley, the water fed into a stream where it could be freely used. Today the remains of the colossal cult statue still lie among the ruins of the temple in which it once stood (12).

A large part of the fourth-century theatre, which could accommodate some 3,000 spectators, is also preserved. Five marble thrones with scroll ornaments are present, as well as the proscenium arch. Contests were held in poetry and music and plays. It is known from inscriptions that people wishing to consult the god followed a ritual. First personal purification was necessary and then a ram was sacrificed. Afterwards the patient slept on the fresh skin of the animal to receive either the god’s oracular advice, or a direct cure.

The difference between Asclepius, the god of medicine, and Amphiaraus lies in the origins of their therapeutic techniques. Asclepius was taught the art of herbal medicine by the centaur Cheiron through the medicinal plants that grew on Mount Pelion, symbolising the curative powers of nature which he practised. Dream interpretation was undertaken by priests at the sanctuaries of Asclepius (13) but this was not the same as the dream therapy practised at Oropus. Here the patient was expected to undergo a ‘heightened’ experience. As a seer and a prophet, the god interpreted dreams but he also gave oracular pronouncements concerning matters other than health, in such subjects as military or athletic events.

13 Asclepius healing a young girl. The stele demonstrates dream therapy. Marble votive relief, from the Piraeus Asklepieion, early fourth century BC

Asclepius was different from other gods in the Greek pantheon. He was hardly ever depicted in company with them. Unlike his father, Apollo, his nature was not dualistic; he was benign and kindly and his concern was only with healing. Annual festivals were held in his honour. These were not only serious religious events, they were also occasions of great fun, attended by enormous crowds of people who would participate in games and in theatrical productions, as well as in religious ceremonies and processions. A further attraction would have been the stalls where birds and animals, souvenirs and other items could be bought and sold. According to the Roman writer, Celsus (De Medicina, Prooenium 2), ‘Asclepius is celebrated as the most ancient authority, and because he cultivated this science (medicine), as yet rude and vulgar, with little more than common refinement, he was numbered among the gods’. The cult of Asclepius continued for more than a thousand years, to be ousted, eventually, by Christianity.

2

Greek Science and Medicine

The origins of European thought can be traced to the intellectual movement which began in the Ionian Greek city of Miletus in the sixth century BC. Situated on the west coast of Asia Minor, Miletus was possessed of a wide range of personal and trading contacts with other lands and cultures and, as a result, many of the people were prosperous and self-confident.

Initially three Milesian philosophers are important. First, Thales (fl. c.600 BC), who astonished the Greek world by predicting an eclipse of the sun in the year 584 and who, after visiting Egypt, originated the art of geometry. Next, Anaximander (fl. c.610-545 BC), the author of the earliest known prose work on nature, in which he attempted to explain the origins of the world and of humankind, perhaps in an attempt to substitute science for myth’.1 Anaximenes (fl. c.546 BC) postulated that air, as opposed to water (contrary to the theory of Thales), was the ultimate constituent of the universe. Furthermore, he saw the universe as disc-like, supported on a cushion of air. Hecataeus (c.500 BC), a prominent statesman and geographer, later wrote a work entitled Genealogies, perhaps another critical attempt to rationalise the Greek myths.

However, most important is the historian Herodotus (c.490-c.425 BC). In his great work, The Histories, he demonstrates the influence of Homeric oral tradition, in that his sources were mainly verbal and his work was based on witness, on what he could see and what he had heard. Herodotus had a keen eye and ear for marvels and strange customs. Although he was, deservedly, known as the ‘Father of History’, detractors have called him the ‘Father of Lies’. Later accounts from travellers in the sixteenth century, telling their own stories of the wonders of distant places, have partially dispelled that negative view.

The Pre-Socratic Philosophers

Coinciding with the rise of democracy, the formation of the city-states and the expansion of the polis, the new intellectual movement converged upon Athens. The arrival of philosophers from widely different backgrounds and areas of interest inevitably brought about a period of great enlightenment. Theories originated concerning science, philosophy and medicine, which quickly became separate fields of inquiry and study. The ‘atomists’, Leucippus (fl. c.435 BC) and Democritus (fl. c.460 BC) from Abdera, on the Thracian coast, claimed that the essence of the universe was a flux of atoms in a void, an idea which was later embraced by Epicurus (341-271 BC) from Samos. A further interest of Epicurus was in the elimination of superstition. Heraclitus (fl. c.