Origins of Nephrology, Greece and Byzantium

Am J Nephrol 1997;17:205-208

Spyros Marketos
Department of History of Medicine, Athens
University Medical School and International Hippocratic Foundation of Kos, Athens, Greece

In memoriam Gregory Vosnides

Abstract

At the end of the 20th century, Hippocratic medicine - which developed at the crossroads between the occidental and oriental civilisations - acts as link, bridge and a symbol for the need to combine both the experience of traditional (Eastern) and the trends of modern (Western) medicine. Hippocratic medicine is one vital pathway to the proper study of the evolution of the medical art. Not only is it the beginning of the art and science of medicine, but modern medicine can still learn from the Hellenic medicine of ancient Greece. Hippocratic medicine is both an antidote to an overconcentration and overemphasis on medical technology and stimulus to more humane technical achievements. Hippocratic bedside examination has not died, but is merely pushed aside temporarily by modern technology. The fact that ancient Hellenic medicine was based on the coexistence of both Asclepian (traditional) and Hippocratic (rational) medicine on the island of Kos reveals and symbolises the necessary coexistence and co-operation of both systems, synthesis of their concepts being essential to solve the problems threatening the future of humankind. Hellenic medicine serves to highlight that the parallels between Asclepian and Hippocratic medicine are closer than medical historians usually realise, and that alternative medicine may function in complementary way to conventional primary medical care.

Introduction

Medicine has existed on earth - either in the form of primitive medicine and/or magicoreligious medicine - from the first day that humans appeared on the planet. Religion and medicine, priest and doctor worked towards the same end: the defence of the individual against evil forces [1]. Ancient Greece during the pre-Hippocratic period was the time of the priestly Asclepian medicine. To Asclepios - or Aesculapius in Latin the god of the healing art were dedicated many therapeutic centres-temples around the Mediterranean Sea, the so-called Asclepieia. Pre-Hippocratic medicine was based on religious belief on surgery and on regimen. The physician was closely connected with religion and, predominantly, herb gatherer. Hippocratic medicine (5th century BC) was based on right way of thinking (rationalism) and on whole, humane approach to the patient [2]. The Hippocratic physician treated the whole patient, not only the organs of the body. It is obvious that when sick patient was not cured by the rational medicine, then an attempt was made to find healing in religious and/or alternative types of medicine, as occurs even today.

Ancient Greek medicine (Hellenic medicine) is based on the coexistence of both the Asclepian art and Hippocratic medicine and comprises part of the history of general culture. The fact that the priestly Asclepian medicine, which relied on dreams and faith, and rational Hippocratic medicine occurred together from the 5th century BC reveals that alternative medicine is nothing new [3]. Although there is no evidence to support co-operation between the Hippocratic physicians and the priests of Asclepieia, there is no proof of hostility between them. Although the medical work of Hippocrates had little in common with that of the priests of Asclepieia, the parallels between creativity in the Asclepian art and Hippocratic medicine were closer than medical historians usually realise, since the rise of rational medicine did not exclude a parallel rise in religious medicine in Greece. Asclepios' followers respected the tradition, did not reject the old divine status, claimed that they were the descendants of Asclepios and were loyal to the Hippocratic oath [2]:

I swear by Apollo Physician, by Asclepios, by Hygeia and Panacea and by all the gods and goddesses, making them my witnesses, that I will cam out, according to my ability and judgement, this oath and this indenture...

I will keep pure and holy both my life and my art.

The Asclepian Medical Art

Ancient Greek medicine had its origins in primitive medicine and took a magicoreligious form. Throughout antiquity, the roles of religion, magic and medicine were confused because they used different methods for the same purpose: the treatment of diseases, supposed to be caused by the supernatural forces of evil divinities, often called spirits or demons [1].

According to Greek mythology, Orpheus was probably the first Greek medicine man-shaman. He was a healer, he loved music, he prophesied and, above all, he fulfilled the best traditions of shamanism: he was sent by god to protect humans from diseases. As an inspired bard, seer and healer, Orpheus wandered over Greece, and the power of his words, sung to the strains of his lyre, bewitched humans, beasts and plants and moved even the rocks, while the rivers halted in their courses to listen to him. Here is a clear indication of supernatural orientation, which was the fundamental element in primitive medicine.

In ancient Greece, the art of healing and the relief of suffering derived from Asclepios whose oracles are found everywhere around the Mediterranean. In Homeric times (12-8th centuries BC), the period of the famous Minoan and Mycenaean civilisations, the physicians were respected and skilful craftsmen. In the Iliad, the greatest epic in any European language, Machaon and Podaleirius, surgeons and noble-warriors, are the sons of the king of Tricca. The two noble Greek physicians gave their attention to the treatment of wounds and treated diseases by dietetics. Both were Asclepiads, in fact sons of Asclepios the blameless physician, as the poet says.

Asclepios was the son of Apollo (fig. 1), the god of the sun, the leader of the muses and the patron of physicians, worshipped at Delphi, a centre for medical advice. Asclepios was taught the art of medicine by the famous centaur Chiron. Chiron was the first to institute the medical art of surgery and then of herbs. The sage Chiron trained physicians, guided musicians and made righteous men.

Asclepios (fig. 2) had a large family, all of whose members were connected with health care activities. His wife Epione soothed pain, his daughter Hygeia (fig. 3) provided preventive medicine, another daughter, Panacea (fig. 3), represented treatment and cure for everything; his son Telesphorus, always represented as a child, cared for convalescence. It is important to note that every member of Asclepios' family presided over a different form of health care or specific medical services.

During the next ten centuries (6th century BC-5th century AD), temples dedicated to Asclepios, cults of temple healing associated with his name (Asclepieia), developed into therapeutic centres, where, besides his adoration, medical care was given by the priests. The establishment of the Asclepieia in specially selected places took account of the influence of climate, water supply and situation to offer a naturally healthy environment to patients. At the Asclepieion of Kos the balance of air, water and earth is perfect!

Asclepios was worshipped in magnificent temples throughout the Aegean islands, more than 400 temples all over the Greek world and further, from Rome to Asia Minor and from Africa to Scythia. It is important to emphasise that the ancient Greek origins of the Western tradition of medical care are rooted in the pattern of the physician-god Asclepios [4] and that in antiquity there was neither competition nor enmity between the physician and the healer god.

Rational Hippocratic Medicine

Hippocrates (460-377 BC) worked on the island of Kos before the founding of the Asclepieion. He came from an old, local, priestly family and travelled extensively before dying in Lairs, Thessaly. His pupils established a centre of healing on Kos after his death, using the old Hippocratic methods (anamnesis, diagnosis, therapy), and the Hippocratic oath has become he ethical nucleus of the medical profession.

The Greek `father of medicine' (Hippocrates the Koan; vg. 4) is connected with the most creative period of scientific medicine in antiquity. He was the one most able to assimilate he accumulated knowledge of the previous centuries for the transition from empiricism to rational medicine [5, 6]. This progress in cosmology and human physiology was acquired by the physical or pre-Socratic philosophers, who played the role of a bridge between the Asclepian and the Hippocratic physician. The latter inaugurates a new approach to all the natural phenomena, attempting to offer scientific explanations.

Early Greek philosophy flourished on the periphery of the Greek world and Hippocratic medicine mirrored this geographical localisation. The intellectual background of Hippocratic medicine was pre-Socratic philosophy. Hippocrates was born m the island of Kos very close to the coast of Asia Minor, and vas a contemporary of Pericles and his `Golden Age'. His name s mentioned in the works of the two greatest philosophers of ancient Greece, Plato and Aristotle. `Asclepiad', the former ailed him [7], and `leader of the Asclepiads', the latter [8]. He vas taught the first principles of medicine by his father Heralides, a direct descendant of the god Asclepios, according to a widespread legend.

The Hippocratic diagnostic system [2], based on logical reasoning, observation and belief in the `healing power of Nature', armed the basis of medical practice. Hippocrates was one of he most significant figures in the history of science because he released the healing art from demons, superstition and magic, rid established the ethical and moral rules of the medical profession [5]. Diseases had a logical interpretation, they were no roger a curse of the gods or a punishment due to divine wrath. Sharing the human suffering, he adopted an attitude summarised in the phrase `the place of a physician is at the bedside of is patient'.

The Hippocratic physician is basically a craftsman, accompanied into his workshop by an audience of pupils and other bystanders, who discusses the diagnosis and treatment of every case. When he goes to the patient's home he has the duty to persuade not only the patient but the relatives as well. He follows the more communal character of life in antiquity, which does not permit any special discretion or intimacy in his behaviour. His authority is related to his education (usually philosophical and medical) and to his therapeutic abilities. If he makes a reputation for himself, then this extends beyond his town and he probably attracts patients from other regions or is invited to visit other cities. If he is called to undertake the treatment of a serious disease, he may refuse or accept, explaining the slight prospects of a cure. Certain situations, with a predictable fatal outcome, where intervention was prohibited, justified the Hippocratic dogma `to help or at least not to harm'.

The Hippocratic physician must also possess the oratorical skill to express his ideas about human nature and the structure and composition of the body as well as to answer the medical questions of the people, or simply for the better handling of human relations. Some theories can only be proved by dialectics and logical argumentation. This aspect of medical science is accessible only to those educated in philosophy and rhetoric. The healing art, according to Hippocrates, is linked to three conditions: the disease, the patient and the physician; the latter is needed to be, moreover, a servant of the art (the `techne'). Every patient is a different case and this individuality makes a fixed dogma for curative methods impossible. Hippocrates was, above all things, both a practitioner and philosopher-physician, who took care of his patients from prognosis to treatment.

Hellenic (Asclepian and Hippocratic) Medicine

Ancient Greek medicine combines rationalism and empiricism but it is also influenced by religious ideas. God is a power reckoned into the theories and practice of the physicians. At first glance, the medical texts do not usually mention magic or religious healing. If a miracle occurs, it is accepted because philosophy acknowledges this possibility. Hippocratic writings recognise the divine influence but only as a factor like nature, which is a power of its own. In the treatise On Sacred Disease, Hippocrates concludes that there is no need to put the disease in a special class, to consider it more divine than the others: they are all divine and all human. Each has a nature and power of its own. He also attacks those who attribute epilepsy to the direct influence of a god or demon and calls them magicians, faithhealers, quacks and charlatans.

On the other hand, Asclepios, almost throughout antiquity, was the ancient hero of medical care [4] and the main representative of divine healing in his cult centres, a form of medical treatment never opposed by ancient physicians. Moreover, the worship of the God of Medicine, beyond its medical significance, came to play a significant role in the religious life of later centuries, in the final stage of paganism. While Galen's rational and experimental medicine [9] was still preserved in the encyclopaedias, the new and prevailing spirit of medicine was that of religion and magic. A significant historian calls Galen `the last Greek medical scientist of antiquity', and declares, `Man's mind had moved from a scientific toward a religious and magical view of the universe' [ 10, 1 1 ]. This explains the survival of Asclepian medicine, because scientific medicine was worsted in the rivalry and gradually degenerated from rational treatment to wild speculation and even quackery.

In the period in which rational and religious medicine coexisted, they had equal value. The latter, performed in the Asclepieia, adopted scientific elements, changing its character. Yet an influence of religious ideas on science is also conceivable. It is possible that the physicians recognised the practice of priests and magicians as an activity parallel to but separate from theirs, an alternative healing method.

Conclusion

From the preceding discussion, we may draw five conclusions. (1) Ancient Greek medicine (Hellenic medicine) has a scientific and cultural orientation throughout its history. (2) Asclepian medicine reflects some of the virtues and the duties of contemporary society for providing care to the underserved. (3) Hippocratic medicine developed in close company with philosophy and cannot be separated from that of pre-Socratic philosophy. (4) Hellenic medicine highlights the coexistence of traditional and rational medicine. (5) Alternative medicine may function in a complementary way to conventional primary medical care.

References

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