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Balkan Military Medical Review 14, 52-65 (2011) Review Article Ancient Greek medicine before and after Hippocrates: the scientification of medicine Emmanouil MAGIORKINIS BSc, MD, PhD, Apostolos BELOUKAS Bsc, PhD, Aristidis DIAMANTIS, MD, PhD * Office for the Study of History of Hellenic Naval Medicine, Naval Hospital of Athens, Greece Corresponding author: Captain Aristidis. DIAMANTIS, MD, PhD, HN 2 Karaiskaki, 15562 Cholargos Athens, Greece Tel: +30-210-7261154, mobile: 6944-323722 e-mail: [email protected] Abstract adventures and life of gods, godesses, The path of Greek Medicine is heroes and heroins. The purpose of this lost through the centuries between myth article is to present the evolution of and history. The Greek mythology medicine before and after the era of flourishes Hippocrates with stories about the and to stress the Magiorkinis E. et al: Ancient Greek Medicine before and after Hippocrates 53 contribution of Hippocrates in the the word “μύθος” which literally means scientification of medicine. A thorough “on the side of myth” or alternatively “a study of ancient texts of the Greek and story very close to that of myth” (“παρά το Roman literature, revealed that Greek μύθον”). During prehistory, what was mythology abounds in examples of Gods unable to be explained by reason, was such as Apollo, semi-gods such as attributed to transcendental entities, which Asclepius and had either a human or animal form. In that creatures such as Centaur Chiron who way, diseases were thought to be of divine practiced and taught medicine in pre- origin and, therefore, their final outcome- historical times in Greece. Hippocrates either cure or death- was bestowed upon will be the first to nominate medicine as the will of God. The innate inability of the a science rejecting the influence of Luck individual as a unit or within the family or and the the tribe led man to device different means chronological order of the appearance of with the superior, invisible deities, giving those figures in Greek mythology depict birth, in that way, to Magic and Ritual. the of and Gods. course of Amphiaraus, In general, transformation of Medicine from divine gift to practical Medicine in Ancient Greek Mythology art. Ancient Greeks believed that Gods Keywords: mythology, medicine, sent disease and provoked death, punishing “Ύβρις” (hubris) and injustice. All disease Hippocrates, Ancient Greece. could be healed by the process of propitiation of the Gods through sacrifices and other rituals. Only the chosen ones Introduction could communicate with the Gods; they Greek were people who were worshiped after mythology depicts a series of events which their death as deities and were undertaking are rather allegorically narrated than totally the task to mediate between the patient and fictitious. The word “μύθος” (mythos) in the God for the sake of the first. The world of Ancient Greek is totally different by the word The first figure in Ancient Greek “παραμύθι” (fairy-tale): the second is a mythology connected with Medicine is the compound word of the word “παρά” and healer of Gods “Παιών” (Paeon or Paion) 54 Balkan Military Medical Review Vol. 14, No 1, January 2011 who treated the wounds of Mars and Ades using various ointments and remedies [1]. His name comes from the word “παίω” which means “heal the disease by a magic hit”, whereas the word “Παιάν” was used to name the military lied of victory, connecting the music and healing properties of Paion. During the classic years, the word Paean became a synonym of Asclepius and, in many cases, he was considered as a deliverer from any evil or calamity [2]. Examining the Dodekatheon, Apollo (Figure 1), the God of Light and Music, was also connected to Medicine; he Figure 1. Apollo was considered to be the inventor of the art of «θεραπεύειν» (healing). According to is doctor and prophet- and “ιατρός” (iatros) Hesiod [3] Apollo was the son of Zeus and since he is referred by Hippocrates as the Leto, the son of spiritual Light, of Music, first doctor ever. Apollo was worshiped in of Poetry and of Vaticination. Apollo is the considered to be the god who wards off characterization “λοξίας” (loksias), but evil and offers help; different names have also as a healer in various places in been used to describe this property such as: Ancient Greece such as Lindos, Tegea, “αλεξίκακος” (aleksikakos) - a Greek word Sparta, Athens, Oropos, Sicyon and Thraca that means the one who prevents evil- in various oracles. Other characterizations “λοίμιος” (limios) - another Greek word for Apollo include “ακέσιος”, “ακέστωρ”, for the one who provokes epidemics “σώτερ”, (“λοιμός”). Other characterizations for “επικούριος” (akesios, akestôr, alexikakos, Apollo regarding his medical dexterities sôtêr, apotropaios, epikourios, iatromantis) was “υπερδέξιος” (hyperdeksios)- the one [4-6]. who uses the right hand in order to heal-, “ιατρομάντις” (iatromantis) – the one who Oracle of Delphi “αποτρόπαιος”, by the and Magiorkinis E. et al: Ancient Greek Medicine before and after Hippocrates 55 “χείρων” originates from the ancient greek word “χείρ” which means hand. Chiron’s name implied that he was "skilled with the hands”, and, therefore, could heal by the use of magic through his hands. The name was also closely associated in myth with “χειρουργός» (kheirourgos or surgeon). Except from Medicine, Chiron was an adept in the use of herbs [10-11], the augural art, music, astronomy, law, hunting and the art of war ; therefore he was a brilliant teacher. His students were heroes that excelled in battles and in the field of Medicine and many of them participated in the Argonautic campaign Figure 2. Centaur Chiron teaching with Jason [12-13]. Chiron was “the wild archery to Achilles. centaur who ruled in the glens of Pelion” who bred “Asclepius, the gentle artificer of Another important figure in the Greek freedom-from-pain, that strengthens the mythology connected with Medicine was limbs, the demi-god that wards off Centaur Chiron (Figure 2), son of the diseases” and the “most just of all father of the gods, Cronos, and of a centaurs” [14]. He was worshiped in nymph, Philyra [7]. Cheiron lived in Magnesia, and, according to Propertius, he Mount Pelion, until his forced expulsion to healed the blindness of Phoenix, whereas the forest of Laconia by Lapithae, decents he was the one that converted medicine of Lapithes who was son of Apollo and from Stilbe. Centaurs was a tribe of half-horse therapeutics [15,16] men. Mount Pelion in Ancient times was a desolate region full of caves magic to a practical art of Asclepius (Figure 3), the son of the and Trikkaian princess Koronis or Arsinoe and impenetrable thickets [8]. Centaur Chiron of Apollo, was taught the art of Medicine was considered to be the founder and the by Chiron [17, 18]. His mother died in first teacher of Medicine [9]; his name labour and was laid out on the pyre to be 56 Balkan Military Medical Review Vol. 14, No 1, January 2011 a new-born child, was to be sacrificed along with his mother to the vengeance of Gods, and Apollo took him out of the funeral pile the last moment and transferred him to a cave in Mount Pelion where Chiron lived, in order to learn how to treat illnesses that afflict the mortals [19]. According to the myth, Asclepius’ art reached in such a high level that he managed imprudently to raise up from the dead mortals. There were many theories about how Asclepius obtain his power to resurrect the dead. According to Apollodorus, he had received from Athena the blood which had flowed from the veins of Gorgon, and the blood which had Figure 3. Statue of Asclepius flowed from the veins of the right side of consumed, but his father rescued the child, cutting him from her womb, performing the first caesarean section in the history of medicine. There are many theories about the origin of his name. Some believe that he received his name from the fact that he was born with a caesarean section and that the name Asclepius means "to cut open”. Others believe that his name “Ασκληπιός” comes from the word “Αίγλη” which means brilliance or “Άσκλης”- the name of a king whose eyes were ill and was subsequently healed- and the word “Ήπιος” which means calm. Asclepius, as her body possessed the power of restoring the dead to life. According to the other tradition, Asclepius on one occasion was shut up in the house of Glaucus, whom he was to cure, and while he was standing absorbed in thought, there came a serpent which twined round the staff, and which he killed. Another serpent then came carrying in its mouth a herb with which it recalled to life the one that had been killed, and Asclepius henceforth made use of the same herb with the same effect upon men. When he was exercising this art upon Glaucus, Zeus killed Asclepius with a flash of lightning, as he feared lest men might Magiorkinis E. et al: Ancient Greek Medicine before and after Hippocrates gradually contrive death Hygeia, Panacea, Iaso and Akeso. Hygeia altogether, or, according to others, because was the goddess of good health, whereas in Pluto Asclepius one of the Orphic Hymns, she is also diminishing the number of the dead too called the wife of Asclepius. Iaso was much [19-21]. Asclepius, after his death, considered to be the goddess of recovery, was worshipped all over Greece, and many Panacea was the “all-healing” goddess of towns claimed the (honor) of his birth.; cures and of “πανάκειας” (panaceas), many magnificent temples- over 300- were whereas Akeso was the goddess of wound built in his honor in Cos, Knidos, and healing and curing of illnesses. had Epidaurus, to escape 57 complained of the so-called «Ασκληπιεία» Asclepius sons, Machaon and Asclepieia, which were, in the same time, Podalirius, according to Homer’s Iliad, the first Hospitals in Ancient Greece. The participated in the siege of Troy as doctors Asclepieia, to (chief medical officers) attached to the patients from all over the Greece from the Greek forces from Thessaly and warriors beginning of sixth century B.C. till the and were brilliant doctors and excellent advent of Christianity in Greece in the men. Machaon and Podalirius, thus, were fourth century A.D. All founders of the the first doctors who practiced medicine in first schools of Medicine in Knidos, Kos, the battlefield. In Iliad, in the second book, Cyrenea and Rhodes in Ancient Greece both of them were marshals of the tribes of were students of the Asclepieia’s. His Trikka, Ithome and Oechalia who dwelt in marriage with Epione gave him many Thessaly [25]; in that way, they were not children; his sons Machaon and Podalirius, only military doctors but also brilliant were his disciples who propagated his art leaders who fought bravely. The name of in [22]. Machaon is named 11 times in Iliad, to whereas the name of Podalirius appears he founded only one time [26]. Notably, in the fourth sons Alexanor, the offered whole Machaon Asclepieia Sphyrus, Ancient moved Peloponnesus, with their from where his Nicomachus, services Greece Thessaly Gorgasus and book of Menelaus, Iliad, the Homer king of narrates that Sparta, was Polemocrates [23, 24]. Podalirius, on the wounded by an arrow from the bow of other hand, founded Asclepieia in Karia, in Alexander, and Agamemnon, his brother Aegean islands and in Apulia in Italy. and king of Mycenae, addressed for help to Epione gave birth to four daughters, Talthybius, the divine herald. Talthybius, 58 Balkan Military Medical Review Vol. 14, No 1, January 2011 in turn, called for Machaon who removed incompetence of Iphiclus by the use of iron the arrow and healed the wound saving rust [31]. Menelaus from death [27]. Podalirius, Amphiaraus, son of Oicles (Oecles) specialized especially in internal medicine, or Apollon and Hypermnestra [32,33], on the other hand, according to Homer, daugther of Thestius, participated in the could heal wounds using a miraculous hunting of the Calydonian boar, which he cure, whereas he was the first to diagnose is said to have deprived of one eye, and Ajax’s insanity by the glittering of his eyes also was as one of the Argonauts [34]. and the depression of his spirits [26]. Amphiaraus was a descedant of the According to Virgil’s Aeneid, he was one Melampus on his father’s side and was of the soldiers hidden in the wooden horse thought to have acquired the skill of of Troy [28]. The reports on the death of therapeutics the two brothers differ. According to grandfather. By his participation in the Quintus Smyrnaeus, Machaon was killed Argonautic campaign, it is our firm belief during the siege of Troy by Eyrypylus son that Amphiaraus was the first naval doctor. of Telephus [29], whereas Podalirius Amphiaraus was a hero of the war of the married the daughter of King Damethus, ‘Seven Against Thebes’; he died during a after healing her wounds when she fell off battle, when he sought to flee from her horse [26]. Periclymenus, son of the divine Poseidon and augury from his Melampus, son of Amythaon and [19], who wanted to kill him, but Zeus ruler of Argos, was considered to be a threw his thunderbolt, and the earth opened healer and name to swallow Amphiaraus together with his (‘Μελάμπους’) literally means the one who chariot transforming him into an oracular has black foot whereas his father’s name, daimon (spirit) [35]. After his death, he “Αμύθεος” means the “ineffable” or was worshiped and a sanctuary at Oropos, “unspeakably great”. Melampus practiced the so-called Amphiaraeion, was built. a type of primitive psychiatry; according to Amphiaraus was considered to be a healer Herodote, he healed Pritos’ daughters of and a oracle who was associated with their madness by the use of helebore [30]. divine Later, according to Apollodorus, healed relationship with Melampus. After making the mania of the women in Messinia, a sacrifice of a few coins, or sometimes a whereas ram, at the temple, a petitioner slept inside he a soothsayer. His also treated the sexual Asclepius, as result of his Magiorkinis E. et al: Ancient Greek Medicine before and after Hippocrates 59 and received a dream detailing the solution attention paid to observing and evaluating to the problem. the physical findings. In Knidos, diseases Agamede was princess of Elis, are categorized according to the the daughter of King Augeias and wife of affected organ, a system resembling the Mulius, and a practitioner of the art of practice in the Mesopotamian lands east of mixing medicinal herbs (the so called Knidos. pharmakeia). According to Homer, she was acquainted with the healing powers of all the plants that grow upon the earth [36]. Hippocratic medicine: the transformation of medicine into science Medicine during the ‘Classical Period’ in Greece was practiced by physicians, who have been trained by renowed tutors or in medical schools, by medical assistants, by empirical doctors, and by charlatans who employed filters and other magical therapies. During this period, two medical schools dominate in Greece: the Medical School of Knidos, with his main representative Euriphon, and Figure 4. Hippocrates of Kos. the Medical School of Kos, with his main representative Hippocrates (Figure 4). Physicians of the School of Knidos The Hippocratic corpus represents the focused on the detailed recording of first scientific recording of the ancient symptoms and consider each variation of greek medicine. Consisting of 60 ancient the manifestation of the disease as a Greek separate clinical entity. On the other hand, collection of books is strongly associated Hippocratic the with the physician Hippocrates and his patient rather than the disease with great teachings, and although attributed to medicine emphasized medical works strongly, this 60 Balkan Military Medical Review Vol. 14, No 1, January 2011 Hippocrates, most of them are of unknown when administered to the sick, which authorship. The Hippocratic Corpus agreed with them when in good health, contain textbooks, lectures, research, notes neither did nor do agree with them….. To and case histories without any particular such a discovery and investigation what order. For example Books I and Books III more suitable name could one give than of Epidemics contain case reports of which that of Medicine? since it was discovered 60% had a fatal outcome [37]. for the health of man, for his nourishment In many parts of the Hippocratic and safety, as a substitute for that kind of Corpus one can find in parallel empiricism diet by which pains, diseases, and deaths and rationalism, since the writter of the were occasioned.”[38] Hippocratic corpus medical The writter of On the Places in knowledge not only in theories but also on Man states that medicine is art (τέχνη) in experience. Ancient order to defend against opponents who Medicine , one of the oldest books of the claim it produces no better results against Hippocratic Corpus, the writter deals with disease than chance: the evolution of human diet and will stress “I think that Medicine has already that man chooses his diet based on his discovered all its sections and, at the experience of the effect that various food current stage, teaches what is necessary in exert on human health. The next step in the each cases and when circumstances are history of medicine is the separation of diet favorable. Whoever knows Medicine in this during health and ilness: way, nothing is based on luck……” [39] For bases eample, in “For the art of Medicine would not have In The Law, one can read the been invented at first, nor would it have following: been made a subject of investigation (for “Medicine is of all the Arts the most there would have been no need of it), if noble; but, not withstanding, owing to the when men are indisposed, the same food ignorance of those who practice it, and of and other articles of regimen which they those eat and drink when in good health were judgment of them, it is at present far proper for them, and if no others were behind all the other arts” [40] who, inconsiderately, form a preferable to these. But now necessity itself According to the Hippocratic texts, made medicine to be sought out and medicine draws conclusions based on facts discovered by men, since the same things which are gathered on the basis of patient Magiorkinis E. et al: Ancient Greek Medicine before and after Hippocrates interview and thorough patient examination. In that way, based on facts, 61 advice on good manners that a physician must have when visiting patients. on observation and on reason, medicine, as recorded in the hippocratic texts, becomes Conclusion a science. The writters of the Hippocratic In summary, Hippocrates, as texts agree in rejecting divine and religious depicted through the Hippocratic Corpus, causes and remedies of disease in favor of inaugurates the scientific era of medicine. natural mechanisms. For example in the In the years to come, the principles of the treatise On the Sacred Disease considers Hippocratic School of medicine formed the that epilepsy has a natural cause and its basis of medical thought and research. In supposed divine origin is due to men’s the pre-hippocratic era, Medicine mingled inability to explain its peculiar character: between “It is thus with regard to the disease called mythology is full of examples of deities Sacred: it appears to me to be nowise more and heroes who possessed the art of divine nor more sacred than other healing and practiced primitive forms of diseases, but has a natural cause from the medicine during pre-history period in originates like other affections. Men Greece. The practice of medicine from regard its nature and cause as divine from Gods, semi-gods and then from humans ignorance and wonder, because it is not at and Hippocrates could symbolize the all like to other diseases.” [41]. different stages of the rationalization of Finally, another Myth and history; Greek important medical practice in Ancient Greece from contribution of the Hippocratic school in the cult of Apollo, Amphiaraus and Medicine was the formulation of Medical Asclepius to the practice of medicine from Ethics. The Hippocratic Oath represents a Melampus, Machaon and Podalirius and landmark declaration of Medical Ethics the use of herbs, surgical operations and with various other remedies. practical projections. The and writter philosophical of On the Physician offers the ideal image – physical References and moral- of the doctor, whereas in Precepts one can read about the physician’s conduct. Decorum deals with 1. Homer: Iliad. 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