Healing and Medicine: Healing and Medicine in Greece and Rome

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HEALING AND MEDICINE: HEALING AND MEDICINE IN GREECE AND ROME

In the ancient world there were four models of disease causation. The first viewed disease as retributive, caused directly by a divinity, usually a god or gods. The second postulated a demonic force as being responsible for inflicting disease on individuals. The third explained disease as the result of magic, often brought by sorcerers or magicians. Finally, the ancients ascribed some disease to natural causes. These etiological models were not mutually exclusive. In most ancient societies, in fact, they were complementary. But the treatment prescribed differed according to the perceived causative factors. When gods were assumed to be responsible, a religious response (e.g., prayer, sacrifice, or purification) was required. When demonic causation was assumed, exorcism or divine healing was called for. If illness was attributed to magical forces, counter-magic was expected to be efficacious. If disease was thought to be the result of natural causes, medical treatment was ordinarily sought. Throughout the period of classical antiquity (c. 800 bce–c. 500 ce), one finds all four models manifesting themselves in different times, often in a harmonious or complementary relationship, as they reflected the changing spirit of the age.

Greece

The earliest Greek literary works that have come down to modern readers are the Iliad and Odyssey, traditionally ascribed to Homer, who probably lived between about 750 and 650 bce. Although the historical setting of these epic poems is that of the Trojan War, which the Greeks dated to about 1200 bce, it is widely held that much of the social and cultural backdrop is that of the Dark Age in Greece (c. 1200–800 bce). In the Homeric epics the gods play an active role in every area of life, including health and sickness. Apollo sends arrows that cause disease and death (Iliad 1.9–52), whereas daimones (unseen supernatural powers) might cause them as well (Odyssey 5.394–97). The early Greeks regarded disease as retributive, the result of having offended a god or violated a sacred taboo. Only after the offense was removed, the community purified, and the gods propitiated would the disease be averted. Hesiod (eighth century bce), an epic poet who was perhaps a late contemporary of Homer, offers an alternative explanation. Diseases are daimones that escaped from Pandora's box and move of their own accord throughout the world (Works and Days 100–104). Greeks sought healing of supernaturally caused diseases from iatromanteis, shaman-like healers. Iatromanteis traveled from city to city and purified communities from divine pollution, as in the early sixth century bce did the Cretan Epimenides, who purified Athens, thus ending a plague that had fallen on the city because a magistrate had committed a sacrilege when he killed several men who had taken sanctuary in an Athenian temple.

But the Homeric epics speak also of an empirical approach to medicine. According to the Odyssey a group of physicians existed called demiourgoi, who were itinerant members of a medical craft. They relied on their experience and skill to treat wounds, broken bones, and diseases symptomatically by employing traditional treatment that was passed on by apprenticeship. In the sixth century bce, groups of physicians began to assemble in several cities throughout the Mediterranean. Although they did not train physicians, they offered apprenticeship to aspiring doctors. Associated with one of the best known of these medical "schools," that of Cos, off the coast of Asia Minor, was the physician Hippocrates (c. 460–c. 380 bce). Although he acquired the reputation as the father of medicine, little is known about Hippocrates. There exist only two contemporary references to him (both by Plato), but he became the subject of much idealized legend after his death.

In the fifth century bce, Greek medicine began to develop beyond mere craftsmanship into a science that possessed a body of theoretical knowledge. The craftsman or empiric was often skilled in practical knowledge and the application of traditional methods. However, the addition of theory to practice actually created scientific medicine. The physician (iatros ) attempted to understand disease and its causes in terms of natural processes. To do so he turned to philosophy, from which he borrowed the ability to frame universal formulations. The Hippocratic Corpus is the earliest attempt to provide a theoretical basis for medicine. The collection consists of about seventy treatises, most of which were written in the fifth and fourth centuries bce. The treatises eschew magical or divine factors in accounting for disease, rather employing naturalistic theories of disease that were taken over from the pre-Socratic philosophers. The best known is the theory of the four humors, which was borrowed from Empedocles.

The writer of On the Sacred Disease argues that epilepsy, commonly attributed to divine possession, is not more sacred than any other disease but has a natural cause. He writes, "There is no need to put the disease in a special class and to consider it more divine than the others; they are all divine and all human. Each has a nature and power of its own; none is hopeless or incapable of treatment" (On Sacred Disease, ch. 21). Although the Hippocratic treatises generally espouse a naturalistic explanation of disease, there is no evidence that this approach was regarded as atheistic. Hippocratic writers regarded nature as divine and medicine as a gift of the gods. Nor did they reject appeal to the gods for healing. "Prayer indeed is good, but while calling on the gods a man should himself lend a hand" (Decorum 87).

Hippocratic medicine spread rapidly in the late fifth and fourth centuries bce. But alongside this rational or speculative medicine, which assumed natural causes of illness and sought to heal by natural means, there existed a tradition of religious healing. Those suffering from illness sought divine healing from gods, demigods, and heroes. Initially cures might be sought at the temple of any god or at the shrines of local heroes, but in the fifth century Asklepios emerged as the chief healing deity of Greece. In the Iliad Asklepios is the "blameless physician" to whom the centaur Chiron taught medicine. He is said in later legend to have been a god. His cult initially came from Tricca in Thessaly (in northern Greece), but it spread to Epidaurus (in the Peloponnese), which became the most important cult center of Asklepios. It was carried throughout the Mediterranean world to Athens, Pergamum in Asia Minor, Crete, Cyrene in North Africa, and Rome in 291 bce, where the god was worshiped as Aesculapius.

The temples of Asklepios, known as Asclepieia, attracted large numbers of the sick who sought miraculous healing. At Epidaurus those seeking healing underwent a rite of ritual purification before offering simple sacrifices of cakes or fruit. The focal point of the pilgrimage was incubation, in which pilgrims spent a night in the abaton (inner sanctum) at the center of the temple. Lying on a couch, they would await a dream or vision from the god, who appeared with a caduceus (a staff around which a snake was coiled), which later became the symbol of modern medical healing. The healing process was varied to suit the pilgrim. Asklepios might merely touch the patient, or he might perform surgery or administer a healing drug. Sometimes a serpent or dog would bring healing by licking the wound. Whatever the means, when the incubants awoke the next morning, they expected to have been healed.

That many were cured of their illnesses or physical disabilities is evident from the several tablets, called iamata, that were posted at the temple site at Epidaurus, which recorded case histories of pilgrims who had been healed. These testimonials were doubtless meant to encourage pilgrims to trust that they too might experience the god's favor. Some of the testimonials were fictional or based on significant misunderstandings (such as that of a woman who delivered a baby that she thought she had carried for five years), whereas others were convincing. At this distance in time, to explain fully how pilgrims were healed is impossible; rationalistic approaches are unconvincing. Perhaps many of the pilgrims suffered from chronic diseases that doctors could not successfully treat. Others probably suffered from hysteria that was susceptible of psychotherapy. The Asclepieion at Epidaurus grew over time to become a complex of buildings that included guest houses for pilgrims, gymnasiums, theaters, stadiums, and baths—all of which provided a sanatorium-like setting that offered a peaceful retreat and therapeutic environment for physical healing and recuperation.

Asklepios was both the dispenser of divine healing through incubation and the patron of physicians. Galen (129–c. 210 ce), the great physician and polymath, referred to himself as a servant of Asklepios, who had healed him when ill with a life-threatening abscess. Physicians did not doubt the god's ability to heal in any way he wished, whether miraculously or by natural means. They viewed religious healing as complementary to medicine. When they could offer no further medical help to their patients, they had no objection to their seeking supernatural healing at the shrine of Asklepios. Because Asklepios was their patron, who blessed their efforts as medical practitioners, physicians saw no conflict with his healing supernaturally in temples. They regarded both secular and temple medicine as legitimate means of healing, and they existed in relative harmony, but probably with little contact. The rapid spread of the cult of Asklepios in the fourth century bce coincided with the decline of the older civic religions, and the cult appealed to the growing individualism of Greek religion. He was regarded as a philanthropic god and had an appeal to ordinary individuals that the great Olympian deities lacked. The poor, who could not afford physicians' fees, sought treatment at his temples. So popular was the worship of Asklepios that more than four hundred temples and shrines were devoted to his worship in the Greco-Roman world.

Following the conquest of the Persian Empire by Alexander the Great (356–323 bce; ruled 336–323 bce), foreign cults poured into Greece from Egypt and Asia, brought back by soldiers returning from his campaigns. The Greek world itself was enlarged and now comprised the eastern Mediterranean, including the Hellenistic kingdoms of Macedonia, Egypt, and the Seleucid Empire in Asia. The mystery religions, as they have been called, offered a sense of personal union with the deity that was often formalized in a rite of initiation. Enormously popular during the Hellenistic period (323–30 bce), they supplemented the official cults that were maintained by the Greek city-states as the focal point of public worship. Many of them offered healing, which adherents of almost any Greek or foreign deity, demigod, or hero might expect. Incubation was the most common means of temple healing, but other forms existed as well. The use of magical practices in Greek medicine, common in Homeric and archaic Greece, did not play a major role from the middle of the fourth century bce until the second century ce. Although some physicians might resort to chants, amulets, or sympathetic magic, in general magical practices were the preserve of magicians, not of physicians. Indeed Greek medicine differs significantly from Mesopotamian and Egyptian medicine, which routinely incorporated magical practices.

Rome

For the first six centuries of their history (Rome was, according to tradition, founded in 753 bce), the Romans lived without either rational medicine or physicians. They used native folk remedies, which they supplemented with magic and divination that they inherited from the Etruscans. The paterfamilias (the eldest male member of the household, which included slaves and up to three generations) administered folk remedies to his household. A well-known example of such a family practitioner was Cato the Elder (234–149 bce). According to Plutarch (before 50–after 120 ce),

[Cato] compiled a book of recipes that he used for the treatment of members of his household who fell ill. He never made his patients fast, but allowed them to eat herbs and morsels of duck, pigeon, or hare. He maintained that this diet was light and thoroughly suitable for sick people, apart from the fact that it often produced nightmares, and he claimed that by following it he kept both himself and his family in perfect health. (Plutarch, Life of Cato 23)

Cato relied on folk remedies, together with prayers, sacrifices, magical incantations, and rituals, to protect his family, crops, and herds. He was renowned for his advocacy and use of cabbage in medicinal recipes and for his contempt of Greek medical theories and practitioners.

The Romans initially worshiped spiritual powers without defined personalities that they called numina. Under the influence of the Etruscans, they came over time to represent numina as gods, many of whom they identified with Greek gods of similar characteristics, but animistic elements remained. Roman religion was a state cult, staffed by unpaid priests who carried out formal observances that maintained the pax deorum (peace of the gods) and guaranteed the continuing divine favor to the city and its fortunes. The Romans believed that if they neglected to observe formal religious obligations, the gods would send disasters. Hence public disasters like epidemics, droughts, and defeats in battle were explained as being sent from the gods, and great care was taken to propitiate them to avert their anger. The earliest Romans had no specific gods associated with disease or healing, although specific deities might be appealed to if they were thought to be especially concerned with bodily parts or functions. Sometimes, if prayers to Roman gods had failed to produce the desired effect, the Romans introduced foreign deities. Thus in 433 bce the Romans built a temple to the Greek god Apollo, whom they credited with ending a plague that had lasted for two years. They worshiped him as Apollo Medicus (Apollo the Physician). In 293 bce, during a pestilence, the Romans consulted the oracular Sibylline Books, which directed them to send a mission to Epidaurus to bring the god Asklepios to Rome. Two years later they did so. According to the legend, Asklepios took the form of a serpent and boarded the Roman ship, which carried him to Rome, where he disembarked onto the Tiber Island. The Romans built a temple for him and he came to be worshiped as Aesculapius.

The Romans also personified forces like Febris (Fever), which came to be represented as a goddess whose anger might be propitiated for remedies from disease. The Romans believed that every natural function was under the protection of a particular deity. Hence every stage of life, including conception, gestation, and birth was subject to a numen, and the protection of the appropriate spirit or deity was sought. Given the dangers of childbearing, which claimed the lives of many women, a Roman matron might appeal to any number of Roman goddesses in childbirth, although through a process of syncretism Juno Lucina and Diana came to replace most of the others. Incantations and magical formulas were often recited, together with the laying on of hands, which was thought to transfer the power of a deity and provide safety in childbearing or healing.

The first physician to practice medicine in Rome was Archagathus, a Greek who settled in Rome in 219 bce. Although he was initially well received, he relied heavily on surgery and cautery, which damaged his reputation and gained for him the title of carnifex (the executioner). Many subsequent Greek physicians were attracted to Rome, where they enjoyed great popularity in a city that had never before had professional medical practitioners. Yet some Romans, like Cato the Elder and the encyclopedist Pliny the Elder (23/24–79 ce,) distrusted physicians and relied on popular folk medicine long after the introduction and widespread acceptance of rational Greek medicine. Pliny included many folk and magical remedies in his influential Natural History.

As Rome conquered the Mediterranean world in the second and first centuries bce, Roman culture underwent many rapid changes owing to Eastern influences and Greek thought. Some Romans abandoned traditional religion for philosophy or skepticism, whereas others supplemented the mechanical and formal civic religion with Eastern religions. The influence of foreign beliefs, such as astrology and magic, spread throughout Italy as soldiers returned from foreign campaigns and slaves were brought to Italy. Although amulets had always been worn to ward off disease and personal disaster, magicians now abounded, selling charms and incantations to exorcize demons or to heal diseases. The belief that certain animals, plants, and precious stones possessed occult properties, which released magical forces through manipulation, influenced healing practices. Astrologers, too, had become popular in Rome by the first century ce, and some physicians began to integrate astrology into their medicine. Galen, for example, held that the condition of patients was affected by the course of the moon and the planets.

However, it was the popularity of mystery religions that more than any other factor produced new forms of popular religious belief. From Egypt and Asia Minor came many cults that offered a personal satisfaction not found in the formal religion of Rome. They were often modified and Westernized by their contact with the Greeks. The most prominent were those of Isis and Serapis from Egypt, Mithra from Persia, and Magna Mater (the Great Mother) from Asia Minor. These cults sometimes offered healing in a supernatural fashion, most commonly by means of astrology, magic, divination, or the use of herbs. Although the cult of Asklepios was introduced into Rome in 291 bce, it was not until the first century ce that his temple on the Tiber Island came to be a popular healing site. By the second century ce Pergamum in Asia Minor had replaced Epidaurus as the center of healing by Asklepios. Moreover, the nature of the cures performed by Asklepios underwent change. Miraculous healing by the god was replaced by therapeutics that were not in many respects very different from those that a physician might prescribe. Instead of supernatural cures through incubation, Asklepios's priests often recommended practical regimens of exercise, swimming, diet, and purgatives to incubants.

Among the Eastern influences that became prominent in the imperial period was belief in the power of demons. In ancient Middle Eastern cultures like Mesopotamia and Egypt, demons had been an important part of the religious framework, and diseases were often attributed to them. In Greek and Roman culture, belief in the demonic etiology of disease, although always present, was less common, especially after the advent of rational medicine with its naturalistic understanding of disease. But in the mid-second century ce, the mood began to change. Diseases were attributed to demons by an increasing number of people, who believed that they consequently could be cured only by supernatural means. For example, the Gnostics believed that diseases themselves were demons that might be expelled by the use of magical formulas (Plotinus, Enneads 2.9.14), a view that was widely held in the late Empire. Hence ritual purification, on which the mystery religions placed much importance, was used to exorcize evil spirits.

Conclusion

Throughout the history of Greek and Roman cultures, a medical pluralism prevailed. There were always healing cults of various gods and heroes available, including both indigenous and foreign deities. The most significant was Asklepios. The extent of belief in magic, astrology, and demonic activity varied over the centuries of classical antiquity. At all times natural healing, whether by empirics or by practitioners of rational medicine, was an accepted, but not an exclusive, means of healing. Beginning in the fifth century bce, physicians appropriated constructs of natural philosophy to provide a theoretical understanding of health and disease. Although many physicians considered Asklepios their patron, the medicine they practiced was devoid of religious or magical elements. Many sources besides medical authors attest—usually indirectly but sometimes directly—to this expectation in classical antiquity. For example, the tragedian Sophocles (496–406 bce) makes one of his characters say, "No good physician (iatros ) chants incantations over a malady that needs the knife" (Ajax 581–2).

Over six centuries later, the greatest Roman jurist, Ulpian (d. 228 ce), when discussing the qualifications necessary to sue for unpaid remuneration for services, says regarding physicians (medici ), "But one must not include people who make incantations or imprecations or, to use the common expression of impostors, exorcisms. For these are not branches of medicine, even though people exist who forcibly assert that such people have helped them" (Digest 50.13.1.3). Neither Sophocles nor Ulpian was implicitly denying that alternative healing practices may have proven efficacious under some circumstances. Furthermore, both make it evident that those who called themselves physicians were not effective physicians or even physicians at all if they engaged in the practices specified. One of the greatest legacies of classical culture was a scientifically based medicine that, irrespective of the enormous changes and developments in its theoretical and practical aspects over the past two and a half millennia, has been the expectation of those in Western cultures who have chosen to consult a physician or surgeon rather than an alternative healer.

Bibliography

On Greek medicine, religion, and magic, see Ludwig Edelstein, "Greek Medicine in Its Relation to Religion and Magic," in Ancient Medicine, edited by Owsei Temkin and C. Lilian Temkin, pp. 205–46. (Baltimore, Md., 1967); Jacques Jouanna, Hippocrates, translated by M. B. DeBevoise, pp. 181–209 (Baltimore, Md., 1999); Antje Krug, Heilkunst und Heilkult: Medizin in der Antike (Münich, 1985); Vivian Nutton, Ancient Medicine, pp. 103–114, 273–91 (London, 2004); and Owsei Temkin, Hippocrates in a World of Pagans and Christians (Baltimore, Md., 1991).

On medicine and magic, see H. C. Kee, Medicine, Miracles and Magic in New Testament Times, pp. 112–16 (Cambridge, U.K., 1986) and Georg Luck, Arcana Mundi (Baltimore, Md., 1985). On the religious views of Galen, see Fridolf Kudlien, "Galen's Religious Belief," in Galen: Problems and Prospects, edited by V. Nutton, pp. 117–30 (London, 1981). Pierre Bonnechere, Trophonios de Lébadée: cultes et mythes d'une cité béotienne au miroir de la mentalité antique (Leiden, Netherlands, 2003) is essential reading on incubation.

On the cult of Asklepios, see Emma J. and Ludwig Edelstein, Asclepius: Collection and Interpretation of the Testimonies (New York, 1975; repr., 1998) and Charles A. Behr, Aelius Aristides and the Sacred Tales (Amsterdam, 1968). On other gods of healing, see Samuel Angus, The Religious Quests of the Graeco-Roman World, pp. 414–38 (New York, 1929). On the healing cult of Isis and Serapis, see H. C. Kee, Miracles in the Early Christian World, pp. 105–45 (New Haven, Conn., 1983), 105–45.