As the Greeks believed that all diseases were the consequences of the anger of the gods, it was in their temples that cures were most likely to take place. Faith was the sine quâ non in the patient, and everything about the temple and its ceremonies was calculated to excite religious awe and to stimulate faith. Preliminary purifications, fasting, massage, and fomentations with herbs, were necessary parts of the initiatory ceremonies, and the imagination was excited by everything that the sufferer saw around him. He heard the stories of the marvellous cures which had taken place at the sacred fane. Tablets round the walls, placed there by grateful worshippers who had been cured in the past,372 served to fill the mind with hope, when, as was the practice, the patient lay down in the holy place by the image of the healing god, that in the incubatory sleep the remedies which were to cure him might be revealed. Sometimes no such revelation was vouchsafed, then sacrifices and prayers were offered; if these failed, the priests themselves would appear in the mask and the dress of the healing god, and in the darkness and mystery of the night reveal the necessary prescriptions. To interpret the dreams was the task of the priests at all times, just as it was in the temples of ancient Egypt. Divination, magic, and astrology largely assisted in the work of discovering the requisite remedies. If all failed, it was due not to any defect on the part of the divinity or his servants, but simply to the want of faith on the part of the patient. The festivals of Æsculapius were called Asclepia, and the presiding priests of the healing god were named Asclepiades. The schools of the Asclepiades were a sort of medical guild, and their doctrines were divided into exoteric and esoteric. They naturally became possessed of a great body of medical teaching, which was preserved as a precious secret and handed down from generation to generation. The Asclepiadæ thus became the hereditary physicians of Greece. Medicine at this period was not a science to be taught to all comers, but was a mystery to be orally transmitted. These men pretended to be descendants of Æsculapius, just as now the imitators of medicines, perfumes, etc., which have become celebrated, give out that they belong to the family of the inventor, and thus know the secrets of the preparation.373
This professional class was quite distinct from the priests of the Æsculapian temples, though many writers have confused them. Probably the truth is this:—Certain students from reading the votive tablets in the temples, and examining the persons who came to be cured, gave their attention to the art of medicine, and established themselves as physicians in the neighbourhood of the temples; for it does not appear that the priests themselves pretended to medical skill. They were the instruments of the divine revelation, the mediums of the healing power of the god; they suggested remedies, but did not attempt their application or the treatment of cases. In process of time the pilgrims to the temples would require human aid to supplement the often disappointing divine assistance, and this the Asclepiadæ were appointed to supply. Hypnotism was probably practised; music, and such drugs as hemlock were also employed which soothe the nervous system and relieve pain. The Asclepiadæ took careful notes of the symptoms and progress of each case, and were particular to observe the effect of the treatment prescribed; they became, in consequence, exceedingly skilful in prognosis. Galen says that little attention was paid to dietetics by the Asclepiads; but Strabo speaks of the knowledge which Hippocrates derived from the documents in the Asclepion of Cos.374 Exercise, especially on horseback, was one of the measures used by the Asclepiads for restoring the health.375
The three most famous schools of the Asclepiades were those of Rhodes, Cos, and Cnidos. There were also that of Crotona, in Lower Italy, established by Pythagoras, and the school of Cyrene, in the North of Africa. Famous temples of Æsculapius existed at Titanæ, Epidaurus, Orope, Cyllene, Tithorea, Tricca, Megalopolis, Pergamus, Corinth, Smyrna, and at many other places.376
A spirit of healthy emulation existed in these different schools, which was most advantageous for the progress of medical science. The tone existing at this early period amongst the different medical societies at these institutions is shown in the famous oath which the pupils of the Asclepiadæ were compelled to subscribe on completing their course of instruction in medicine. It is the oldest written monument of the Greek art of healing.377
“I swear by Apollo, the physician, and Æsculapius, and Health, and Panacea,378 and all the gods and goddesses, that, according to my ability and judgment, I will keep this oath and this stipulation—to reckon him who taught me this art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patient, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practise my art. I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work.379
“Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen or slaves. Whatever, in connection with my professional practice, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this oath, may the reverse be my lot!”
Ancient authorities differ as to the respective order in which the schools of the Asclepiads should be esteemed. Rhodes, Cos, and Cnidos continually disputed for the pre-eminence, Cos and Cnidos acquiring great fame by their conflicting opinions. According to Galen, the first place must be conceded to Cos, as having produced the greatest number of excellent disciples, amongst whom was Hippocrates; he ranks Cnidos next. Cos (B.C. 600) was the objective school, and devoted its studies chiefly to symptomatology. It asked, what can we see of the patient’s disorder? of what does he complain? what, in fact, are his symptoms? This is practical medicine, though not so much in accordance with modern scientific medicine as the method of Cnidos, the subjective school. There the aim was to make a correct diagnosis; to find out what was behind the symptoms, what caused the morbid appearances; what it was that the sensations of the patient indicated; and its aim was not to treat symptoms so much as to treat vigorously the disorder which caused them. Auscultation, or the art of scientifically listening to the sounds of the chest, those of the lungs in breathing, and of the heart in beating, was to some extent understood and practised at Cnidos. The medical school of Crotona was in the highest repute 500 B.C., probably on account of its connection with the Pythagoreans. The school of Rhodes does not seem to have had a long life.
That of Cyrene was famous on account not only of its medical teaching, but from the fact that mathematics and philosophy were industriously pursued there. The teaching in all these schools must have been of a very high order; for, though unfortunately little of it has descended directly to us, we have sufficient evidence of its importance in such fragments as are to be found incorporated with the works of Hippocrates, such as the Coan Prognostics and the Cnidian Sentences; the former, a miscellaneous collection of the observations made by the physician of Cos, and the latter, a work attributed to Euryphon, a celebrated physician of Cnidos (about the former half of the fifth century B.C.).
Experiment and observation were insisted upon in the study of anatomy and physiology. Galen tells us in his second book, On Anatomical Manipulations: “I do not blame the ancients, who did not write books on anatomical manipulations; though I praise Marinus, who did. For it was superfluous for them to compose such records for themselves or others, while they were, from their childhood, exercised by their parents in dissecting, just as familiarly as in writing and reading; so that there was no more fear of their forgetting their anatomy than of their forgetting their alphabet. But when grown men, as well as children, were taught, this thorough discipline fell off; and, the art being carried out of the family of the Asclepiads, and declining by repeated transmission, books became necessary for the student.”
The method of the Asclepiadæ was one of true induction; much was imperfect in their efforts to arrive at the beginning of medical science. They had little light, and often stumbled; but they made the best use of what they had, and with all their deviations they always returned to the right path, and kept their faces towards the light. Hippocrates was of them; and Bacon of Verulam, in the centuries to come, followed and developed the same method. Dr. Adams remarks the assiduous observation and abundant rational experience which led them to enunciate such a law of nature as this: “Those things which bring alleviation with bad signs, and do not remit with good, are troublesome and difficult.”
Ctesias, of Cnidus, in Caria, was a physician at the court of King Artaxerxes Mnemon. He may be called a contemporary of Herodotus. It is possible that, according to Diodorus, he was a prisoner of war while in Persia, though the well-known fact that Greek physicians were in great request, and were always received there with favour, is quite sufficient to account for his presence in that country. He wrote a history of Persia and a treatise on India, containing many statements formerly considered doubtful, but now proved to be founded on facts.
The persons who anointed the bodies of the athletes of ancient Greece, preparatory to their entering the gymnasia, were called Aliptæ. These persons taught gymnastic exercises, practised many operations of surgery, and undertook the treatment of trifling diseases. The external use of oil was intended to close the pores of the skin, so as to prevent excessive perspiration. The oil was mixed with sand, and was well rubbed into the skin. After the exercises, the athletes were again anointed, to restore the tone of the muscles. The aliptæ would naturally acquire considerable knowledge of the accidents and maladies to which the human body was subject; accordingly, we find that they not only undertook the treatment of fractures and dislocations, but became the regular medical advisers of their patrons. Iccus of Tarentum devoted himself to dietetics. They were probably a superior class of trainers. Herodicus of Selymbria, a teacher of Hippocrates, treated diseases by exercises. He is said to have been the first to demand a fee in place of the presents which were given by patients formerly to their doctors.380 The gymnasia were dedicated to Apollo, the god of physicians.381 The directors of the institutions regulated the diet of the young men, the sub-directors prescribed for their diseases.382 The inferiors, or bathers, bled, gave clysters, and dressed wounds.383