331 B.C- 619 A.D..: The School of Alexandria

Figure 1 --Alexander the Great had a vision of creating
a great city, and compiling all the science and wisdom of
the world in one place.  He died before he was 32, thus
not living to see his dream come true. 

The evolution of medicine was slow moving through most of history.  One of the reasons for this was that it was illegal to touch a human corpse except in preparing it for burial or cremation.  This was one of the main reasons Galen's ignorant explanations of the human body were worshiped as the medical Bible for over a thousand years after his death.  This created a roadblock for learning about diseases like asthma and allergies.

This roadblock made it so it was nearly impossible for there to be any major advancements in medicine.  If someone learned something about the human body by dissecting, it was usually done by stealing a corpse from a graveyard, or from a prison, and performed illegally.  And the information learned was kept secret from a monarchy that might kill you, or at least throw you in prison, for learning something that opposed the view of the establishment. So even if something was learned, it was probably never published.  And if it was published, it was so posthumously. 

Thankfully, however, there were a few places scattered around the world where it was legal to perform autopsies.  It was at these places where physicians would flock to obtain medical knowledge, and patients would flock to get the best treatment.  Among the first such place was the great city of Alexandria in Egypt. (1)

Alexander the Great is considered one of the greatest military leaders of all time.  Born in 356 B.C. in Macedonia, a city just north of Greece (Macedonia was not a city-state like Athens and Sparta).  He spent his childhood watching his father, Phillip II, build Greece into a great military power, winning battle after battle. (1)

When he was 13 Aristotle was hired to be his personal tutor.  Like other Greeks, he learned about science, medicine, and philosophy.  (1) Aristotle taught him to read and speak Greek, and taught him to respect philosophy the way the Greeks did.  He loved Greece, it's gods, it's history, and he dreamed of teaching it's culture to people all over the world. (2)

Figure 2 -- A rendering of Ancient Alexandria.  The lighthouse
you see depicted here was one of the seven wonders of the
ancient world.  This was one of the most beautiful cities ever.

His father, Phillip, conquered most of the Greek city-states, and when his father died, Alexander went on to conquer many nations, including Egypt.  As he did in other places he conquered, he championed Greek culture.

As noted by historian John Watson:  "The rapid extension of Grecian arms under Alexander the Great, lead to the diffusion of taste and learning among the surrounding nations.  Pergamus and the new capital of Egypt (Alexandria), became points of scientific attraction second only to Athens; and with the spread of general knowledge, the study of medicine extended to these cities."  (4, page 74)

The Asclepion of Pergamus was surrounded with architecturally amazing structures that "were occupied as places of public instruction and scientific intercourse. Here the orators, sophists, and philosophers of the city held their daily conferences, and sometimes amused themselves in expounding to the sick the vaticinations of the priests. As a school of medicine, the Asclepion of Pergamus enjoyed a long continued celebrity." (4, page 74)

Alexander died in 323 B.C. of a mysterious illness in the palace of Nebuchadrezzar II of Babylon.  He was only one month shy of his 32nd birthday.  At this time the Egyptian portion of Alexander's empire was given to Ptolomy Soter (367-282 B.C.), the brother of Alexander. 

Figure 3 -- The library of Alexandria was one of the largest libraries
in the ancient world.  Physicians came from all over the world
to study here.  Unfortunately it was destroyed by barbarians.
Can you just imagine if this was never destroyed?  Perhaps medical
knowledge would have been advanced faster, and there would be
better asthma and allergy knowledge today, and maybe even better
medicine, or a cure.  If I could go back in time, I'd want to go to the
City of Alexandria during its glory days and peruse ancient writings

Like Alexander, Ptolomy loved arts and sciences, and he formed the great library of Alexandria, and he placed Aristotle in charge of it.  (3, page 33) The flow of knowledge through this city was so abundant its great library "rendered Alexandria the great repository of science and wisdom." Some estimate that by the reign of Ptolomy Philadelphus (36-29 B.C.) the library had accumulated a collection "about two hundred thousand rolls of papyrus, equal to about ten thousand of our modern printed volumes." (4, page 79)

Ptolomy also started Museum of College of Philosophy, or the school of Alexandria, in 331 B.C., which was described best by John Watson in 1856:

It's chief apartment was a lecture room and place of general concourse.  Around the main building, on the outside, was a covered walk or portico.  And connected with it was an Exhedra, in which the philosophers sometimes sat in the open air... This noble institution was originally designed to serve in part as a school for the training of  youth in the higher walks of learning, and in part as a retreat within which men of genius and acquirements, free from the necessary and providing for their daily wants, might have leisure and opportunity, each in his own way, for extending the domain of science, or for increasing the enjoyments of improving the condition of their fellow beings. (4, pages 77-8)

Figure 4 -- Ptolomy

By the time of Ptolomy Philadelphus, the school "had already risen to the highest rank among the Greek schools. (4, page 79)

One of the main reasons for this was that for the first time in the ancient world, dissection was legal in Alexandria.  This was significant, because religion made even touching a human corpse illegal in Ancient Egypt, Greece and Rome.  Now, for the first time in history, the human body could be studied, and it was.  In this way Aristotle was able to describe the insides of the human body by actual dissection. (3, page 33)  

The school was also a place for public lectures and readings, which were very important in Alexandria, as in all ancient civilizations.  This was because books were expensive and few could read.  Great minds would orally educate about the common wisdom of the day, and readers, or orators, would "familiarize" people with the writings of Homer and other great authors of the day. (4, page 82) Watson explained:

Among the Greeks this had been the common mode of enlightening the people, of amusing them, and of molding their opinion.  Most of the poetry, and much of the written history of the nation, were prepared for public recitation.

Placed in charge of medicine at the school were Erasistratus and Herophilus.

Erasistratus (304-250 B.C.) was from the Isle of Chios, and was the grandson of Aristotle.  He was the founder of the school of anatomy at the school of Alexandria, performing many autopsies.  Herophilus (335-280 B.C.) was a native of Chalcedon and was educated at the school of Cos. He also performed many autopsies at the school. (4, page 85) 


Figure 5 -- Aristotle

Along with Aristotle, they both made stunning observations from their inspections of the internals of the human body, and postulated various hypothesis based on these observations.  For instance, Erasistratus discovered that the trachea was a passageway for air (pneuma) to the lungs, and he discovered veins and arteries both originate from the heart.  Only he, like Aristotle,  believed the arteries were filled with air not blood, and hence the name 'arteries.'  And the passage of pneuma from the veins to arteries was the cause of disease(3, page 35-6, 4, page 86))

He disregarded the four humors of Hippocrates and the four elements of Empedocles, and instead postulated that fevers were caused by inflammation.  He was not a believer in purgatives and most medicine, and instead preferred a good diet and gymnastics.  Some believe he was the first to recommend exercise as a means to stay healthy and for healing.  (4, page 86)

Herophilus was among the "first of the Hippocratic school to distinguish himself as an atomist."  He was the first to use the pulse as an "index of varying conditions of health and disease."(4, page 84)

He properly attributed the pulsations of the arteries to the heart. 




Figure 6 -- Herophilus

Of interest is that Herophilus was charged with opening "the bodies of living criminals, to discover the secret springs of life."  (3, page 35)

Unlike Erasistratus, he was a believer in the hypothesis that imbalances of the four humors cause most diseases.  (4, page 85)

He revered Hippocrates to the point that "when obliged to contradict him he always avoided mentioning his name."   Also, unlike his counterpart, he placed a "high value on drugs, which he called, 'the hands of the gods,' and used them in great variety.  (5, page 62-3)

Erasistratus was an empiracist.  Herophilus was a rationalist. In this way, "the same rivalry which existed in Greece between Cos and Cnidos arose also between Alexandria and Pergamus, in which later place Galen was born, and Aesculapius was held in great respect as one of its most celebrated divinities."  (3, page 36-37)

Regardless, anyone who wanted to be a physician in the ancient world was eager to learn at the school of medicine in Alexandria, as "to have studied medicine at Alexandria, was everywhere considered a passport to the confidence and patronage of the public."  (4, page 92)

The school continued "its celebrity as a seat of learning and as a school of medicine, until it was taken by Saracens in 638 of the Christian era."  (3, page 36)

Figure 7 -- 1532 woodcut showing Herophilus (L) and Erasistratus (R)

Alexandria would fall in 619 A.D., and that ended whatever medical wisdom came out of it.  Many of it's wonders were destroyed by barbarians, including it amazing library.  As the library went up in flames, so to did all medical wisdom except for random scrolls scattered here and there.  (6, page 150-2) (7, page 28)

Until the  School of Salerno was established in the 10th century, there were no known autopsies performed, and medicine was left in limbo, or what historians like to refer to as the dark ages of medicine.  (6, page 150-2) (7, page 28)

References:

1. "Alexander the Great Alexander of Macedon Biography: King of Macedonia and Conqueror of the Persian," historyofmacedonia.org, http://www.historyofmacedonia.org/AncientMacedonia/AlexandertheGreat.html
2. "Alexander the Great: Ancient Greece for kids," mrdonn.org, http://greece.mrdonn.org/alexander.html
3. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861,
4. Watson, John, "The medical profession in ancient times," 1856, Baker and Godwin, New York
5. Withington, Edward Theodore, "Medical history from the earliest times,"
6. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, Philadelphia, W.B. Saunders Company
7. The John Hopkins Hospital bulleton," (volume XV 1904), "From the epoch of the Alexandria School (300 B.C.)"

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106-48 B.C.: Greek medicine migrates to Rome

In order for the medical ideas of Greece to stand the test of time, this "key of medicine" would have to make it's way to other cultures.  This is exactly what happened through the course of many years as Grecian medicine migrated to ancient Rome.

Although they didn't know it at the time, the Latins had picked the perfect spot to build their village.  It was one of many built around the seven hills along the Tiber River in the Italian Peninsula somewhere around 750 B.C.  (1, page 112)

It was in the lowland, as compared with other Italian villages.  While close to the sea it was built on a mountain side "where there was lava flow with a dominant position over the sea and the river Sarno."  (2)

Due to its volcanic origins, the "soil is naturally rich in water springs and minerals.  The hills were made of tufa rock, "a soft hardened rocky sponge," which the Romans were later able to use to make large buildings and monuments.  (2) The village grew into a city.

At first the Romans were peaceful farmers and herders, but around 600 B.C. the Etruscans from up north along the Tiber decided to conquer the other villages.  For the next 100 years Rome was ruled by the Etruscans.  In 509 B.C. the people of Rome rebelled and set up what became the world's first republic. (1, page 112)

The people of Rome didn't forget what had happened, and they continued to build a mighty military. Many of the people became skilled soldiers, and they decided to fight for more land.  By 270 B.C. they took over the entire Italian Peninsula, and then after 23 years of Punic wars, in 146 B.C., the Romans conquered the city of Carthage along the north coast of Africa, where the Phoenicians settled. (1, 113-114)

There were three wars with Carthage, called the Punic wars, and in the second one, Macedonia, the strongest city-state in Greece at that time, decided to help Carthage.  Romans didn't forget this either, and when Carthage was defeated, the Romans conquered Greece and took many Grecians back to Rome.

Of course many of these people were philosophers and physicians, and thus Rome was introduced to Greek adaptations to these arts. (1, page 114-15) As the Roman Empire spread, so to did Grecian culture.

Grecians taken to Rome became Roman slaves, and many were better educated than their new Roman masters.  So it "became customary for the well-to-do to select for the child's nurse a Greek slave, that a child might acquire the Greek language as naturally as its own," according to historian Harold Johnston.  (7, page 71)

Johnston explains that: (7, page 78)

The Greek language came to be generally learned and Greek ideas of education were in some degree adopted. Schools were established in which the central thing was the study of the Greek poets, and these schools we may call Grammar Schools because the teacher was called grammaticus. Homer was long the universal text-book, and students were not only taught the language, but were instructed in the matters of geography, mythology, antiquities, history, and ethics suggested by the portions of the text which they read. The range of instruction and its value depended entirely upon the teacher, as does such instruction to-day, but it was at best fragmentary and disconnected. There was no systematic study of any of these subjects, not even of history, despite its interest and practical value to a world-ranging people like the Romans.

Of course we must understand that after doing battle against many Greeks during the Punic wars, a prejudice developed among the Romans regarding Greek culture. This might explain Pliney the Elder's statement that Rome "got along for 600 years without physicians." (5, page 72)

He said that while knowing full well Rome had physicians, as he later contradicted himself by claiming the first physician came to Rome in 535 B.C. (3, page 81)

This prejudice might also explain why the Greeks were often disparagingly referred to as "graeculus esuriens of Juvenal," which means "hungry young Greek"  (5, page 72)

We must also understand that the Romans, as might be expected, had their own gods that they believed were responsible for health and sickness.  They had incantations and prayers they'd been using for hundreds of years.  They also saw Greek remedies as harsh, and the fact Greeks kept snakes in their "private houses in pursuance of the esculpian cult, did little to make medicine respectable in the eyes of the austere Romans." (5, page 97).

But the medical profession of Rome had it's problems. For one thing, the medicine was primitive in nature, and based mainly on incantations and prayers.  In describing the flaws of the Roman medical system of the time, Bradford quotes medical historian Pierre-Victor Renouard:

In the midst of this overflowing of charlatanism, the health of the citizens was given over to the first imposter who called himself a doctor; for how could the cheat and usurper of the title be distinguished from the man of knowledge and probity, who had acquired it by study? No examination, no legal proof was imposed on any one who wished to practice medicine; there was no security for the sick.''

These weaknesses may have left the door open ever so slightly to the curiosities of some of those who yearned for a remedy that Roman physicians were not providing. Regardless, as Grecian physicians and teachers migrated to Rome, they did so with little encouragement from the Romans. (4, page 96)

Yet as what usually happens, time heals all wounds.  When a person is really sick, when he realizes that incantations and prayers don't heal pain and suffering, he becomes eager to accept new ideas.  And it must have been in this way the Romans were gradually exposed to Grecian medicine, and slowly grew to respect and gain confidence in Grecian physicians.  (4, page 96)

One of the best ways to change the mindset of a people is to impress the king. Even kings are human, and even kings get sick. And kings have the ability to change the mindset of a nation. And it must have been in this way Caesar was exposed to the benefits of Grecian medicine, because in his travels he started taking physicians with him.(4, page 97)

Perhaps it was for this reason that Roman philosopher and orator Cicero (106-43 B.C.) "declared the duty of all men -- a duty particularly incumbant of himself -- to support the dignity of the healing art." (4, pages 96-97)

A Greek physician named Archagathus was among the first to escape the wars of Greece by emigrating to Rome.  When he was born no one knows, although what is known is he was born in Sparta and was later adapted by the Romans, becoming a Roman citizen in the year 219 B.C., around the time that Ptolomy Philopater in Egypt.  He was among the first physicians to emigrate to Rome.

Historian Thomas Lindsley Bradford, in his 1898 book "Quiz questions on the history of medicine," discussed the influence of Archagathus the Executioner upon Greek medicine.

He was the first of all the Greeks who attempted to introduce their kind of physic (medicine) into Italy. At first his coming was very agreeable to them, and many marked distinctions were paid him, but when he came to the cutting and burning part they changed their opinion, and conceived such an aversion to him that he was compelled to leave the city. He was called executioner on account of the too frequent use of the actual cautery and the knife. He was also called Vulnarius and Carnifex. He was honored by the Senate." (8, pages 27-28)

Bradford must have obtained much of his wisdom about Archagathus from the writings of Pliny the Elder, who wrote about 150 years later:

He obtained Roman citizenship and was extraordinarily popular on his arrival, but very soon, gained the nickname of the "executioner." (9)

Greek physicians ultimately did gain the respect and confidence of the Roman people, and the man given credit for this was Asclepiades of Bithynia.  He was born in Rome at the time of Pompey in 106 B.C., and then was educated at the school of Alexandria and practiced in Athens before moving back to Rome.  (4, page 99-101)  Despite his name, Asclepiades has no ties with the Asclepiade temples that rose in Ancient Greece and Rome. (8, page 28)

His opinions and remedies were based on the Atomist philosophy of medicine devised by Democritus, and were the opposite of the Hippocratic doctrine.  Since he believed in a different hypothesis as Hippocrates, he also had different remedies which included fresh air, light diet, hydrotherapy, massage, clysters, local application of some external medicines, and sparing use of internal medicine.  (5, page 72)(8, page 28-29)

This new medical philosophy, coupled by his "good bedside manner," made Asclepiades a very popular physician in Rome.  He was so well accepted that after his death other physicians took on his name hoping to take advantage of his fame.  (6, page 83)

Asclepiades basically believed Romans had a negative view of Greek medicine because their dogmatic remedies appeared to make a patient worse before he got better.  He believed it was perceived as a "crude and unfeeling practice."  He took advantage of this and smoothed out the edges by not using medicine that "offended the stomach" and using hygienic remedies instead.  His techniques were so well accepted he became famous and wealthy.  He wrote a book on General Remedies, and started the first school of medicine in Rome. (4, page 99)

Bradford said that:

He does not seem to have followed any course of medical study, but owing to his fashion of catering to the patient and avoiding everything that was painful and disagreeable, he soon gained a large practice.  He eschewed emetic and purgatives, though he practiced blood-letting.  He also relinquished the religious ceremonies which had held so large a place in medical practice...  His treatment was mainly dietetic and hygienic.  He advocated exercise, bathing, music, and even declamation as a means of curing disease." (8, pages 28-29)

He was revered by some as the greatest physician ever, aside from Hippocrates. Others claimed he was no more than a philosopher and charlatan. Even Galen "charged him with many absurdities, and with having but little knowledge of the great fathers of the profession, whom he affected to ridicule." (4, page 98)

Yet Caesar liked him and approve of his work, and that may have been all that was needed.  Asclepiades died in 48 B.C. "and is said to have been killed by a fall from a ladder in his extreme old age." (4, page 101)

So perhaps more so than the physicians themselves, it was a combination of both the politics, philosophy and public relations of the physicians, coupled with the approval of various emperors, who improved respect and confidence in Grecian medicine.  It is because of them Grecian medicine survived the test of time.

As John Watson said: (4, pages 97-98)

Caesar, after reaching the summit of his power, in order to attract men of science to the capital, and to improve the condition of those already there, decreed that all who practiced physic at Rome, and all the masters of the liberal arts therin residing, should enjoy the privilege of citizenship.  And Augustus, after having been relieved of a dangerous illness by his freedman, Antonius Musa, loaded this physician with wealth; raised him, by consent of the Senate, to the equestian rank; erected a bronze statue to his honor near that of Aeslepius; and, at his instigation, conferred important privileges on the whole body of the profession then residing in the city... These privileges afterwords confirmed by... later emperors." (4, pages 97-98)

Of Roman medicine, Bradford said:

Before the consolidation of the Roman empire in 31 B.C. there were no established medical laws.  The Greek system of training seems to have been in vogue.  Everyone who was liberally educated was instructed in philosophy of medicine. which explains why all the philosophers of the old days were also to some extent teachers of medicine. But the physician was expected, in common with his medical knowledge, to be familiar with the grammar of his own language, with rhetoric, arithmetic, geometry, dialectics, moral philosophy, astronomy, and even architecture. (8, page 53)

The benefactors of all this education were, of course, all those who became sick or injured. It was in this way that Greek medicine, the key to medicine, migrated from Greece to Rome, and perhaps was saved.

References:

1. Suter, Joanne, "Fearon's World History," 1994
2. "Ancient Rome Geography,"  mariamilani.com, http://www.mariamilani.com/ancient_rome/Ancient%20Rome%20Geography_.htm
3. Watson, John, "The Medical Profession in Anciet Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855, New York, Baker and Godwin
4. Watson, ibid, pages 97-98, in reference to Seutonius, Octav, August, cap. lix.
5. Garrison, Fielding Hudson, "An introduction to the history of medicine: with medical chronology, Bibliographic data and test questions," 1913, Philadelphia and London, W.B. Saunders company
6. Withington, Edward, "Medical history from the earliest times: a popular history of the healing art," 1994, London
7. Johnston, Harold, "The Private Life of the Romans," 1908
8. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
9. Pliney the Elder, "Natural History,

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800 B.C Asclepius will heal your asthma, part 2

Buck explains that the person would lie down, usually wrapped in coat of a Ram , and then drift off to sleep. (8, page 62)  The god Asclepius would then enter the hostel, remove your skull , and take out the demons.  When you woke up you'd either have an epiphany regarding the cure, or the priest would tell you the cure the god recommended.

Actually, Garrison said that once the patient fell asleep the priests would dress like the god.  If the patient was asleep the remedy would occur to the patient.  If necessary the patient would tell the priests what he dreamed of, and the priests would interpret them, thus relaying the cure.  Some patients would not sleep, and they would come face to face with the god, who would directly relay the cure. The god may either appear as a vision, or he may have actually been one of the priests in disguise.  (7, page 76)

Watson said the temples were:

"Always filled with patients; and along their walls the tablets (votive tablets) were suspended upon which were recorded the history and treatment of the individual cases of disease." (5, page 27)

Neuburger said the votive tablets were made of wood or stone, "and hung up on posts or pillars." (13, page 95)

As the patient's slept, the priests would review the complaints of the patients, and perhaps assess them vaguely.  This information was then used for divination purposes, where the priests would make both a diagnosis and prognosis.  The priests would then refer to the votive tablets for the cure.  (2, page 57)

In looking at the votive tablets, the priests would look for similar diseases. enouard explained the reasoning behind this system:

These persons have constantly in their mouths these words: “ I have seen a disease similar to this cured by such a remedy.” Their reasoning, however gross it appears to us, is based on an incontestable principle, that may be stated as follows: Remedies which have cured a disease, must be equally efficacious in curing analogous cases. (9, page 70)

As noted by Neuburger above, this was mainly done to offer hope to the sick.

Renouard said this was a system similar to that of the ancient Egyptians.  He said the votive tablets "showed the names of the patient, the kind of disease with which he was attacked, and the manner of the cure." (9, page 67)

Renouard said that one votive tablet was found in Rome on the island of Tiber, the site of an ancient Asclapion temple.  He quoted the following from one of these tablets:

"Lately a certain Carus, who was blind, came to consult the oracle. The god required that he approach the sacred alter to perform adorations; at once he passed from the right to the left, and having rested his fingers on the altar, he raised his hand and applied them to his eyes. He recovered his sight immediately, in the presence of the people, who rejoiced to see such marvels accomplished under the reign of our august Antonius." (9, page 67)

“Lucius was attacked with a pleurisy, and every one despaired of his life. The god ordered that the ashes of the altar be taken, mingled with wine and applied to his side. He was saved, and gave thanks to god before the people, who congratulated him.” (9, page 67)

“Julian vomited blood, and appeared lost beyond recovery. The oracle ordered him to take the pine seeds of the altar and eat them for three days, mingled with honey. He did so, and was cured. Having solemnly thanked god, he went away.”

“The god gave this direction to a blind soldier named Valerius Aper: Take the blood of a white cock, mingle it with honey, and make acollyrium, which you are to apply to the eyes for three days. The soldier having fulfilled the direction of the oracle, was restored to sight, and returned to make a public thanksgiving to God.”

The tablets were reviewed by the priests when their memories did not allude to a similar case and a cure. (9 page 67).

These tablets were studied by the priests, particularly when they were in training, and were later studied by students of philosophy in schools (gymnasiums) that were attached to the Asclepions.

Neuburger said:

Asclepios enjoined mostly natural cures, such as diet, exercise... hunting, or fencing, also physical means -- listening to song, seeing a play -- less often bleeding or purgatives, at times seemingly ridiculous but really suggestive measures. Success was always ascribed to the credit of the god, failure to the fault of the patient."

Osler said the priests "did not neglect the natural means of healing.  The inscriptions show that great attention was paid to diet, exercise, massage and bathing, and that when necessary, drugs were used."  (2, page 57)

Most of the drugs used were generally to cleanse and purify the body.  Garrison said some common drugs were cathartics (purgatives), emetics, or bleeding.  (7, page 76) Other drugs that may have been used were diaphoretics, stimulants, and sedatives.  

Most drugs consisted of a variety of herbs prepared into pills made of dough that were taken orally or through the rectum.  Some remedies were made into drinks such as wine.    

Sigerist said the rich gave expensive gifts and sacrifices, and the poor gave what they could. Some slept in the temples and some in nearby hostels hoping to be cured by the god in the night.   If you had asthma perhaps you were among the crowd sleeping on the floors.  Or, in your case, slumped over a chair yearning to fall asleep to learn how to get your breath back. (1, page 73 and 3)

Neuburger said the "hostels (shelters) were "undertaken by the keepers of inns and boarding-houses in the neighbourhood." (13, page 94)

Garrison said if you did get better, an offering of thanks, which often included a wax model of the "diseased part," was presented to the god, and the story recorded on the votive tablets for future priests to reference.  (7, page 76)

Some speculate that at some point during the life of the Asclepions medicine was transformed in Greece from mythology and theology to natural philosophy and reason (an early form of science), but at exactly what point this occurred, and how many cases were seen prior to this transformation, are unknown. (9, page 68, 76)

That medicine was practiced at the Asclepions, as opposed in some remote location among the populace, is what allowed medicine to advance.  It is only out of this system, as Renouard quotes Louis Philippe Auguste Gauthier from his 1844 book "Recherches Historiques sur l’Exercice de la Médicine dans les Temples,”

It must be agreed, that in those barbarous times, medicine could make more progress in the hands of a corporation like the Asclepiadae, than if it had been merely a domestic or popular art.  It is not probable that, at a period so remote, when the arts and sciences were still in their infancy, a man of genius could be suddenly raised up, who could elevate medicine to the rank of a science... It is probable that the reading of the inscription in the temples, and the habit of seeing a great number of sick, gave, in the end, a certain amount of medical instruction to the priests." (9, page 76)

Initially this knowledge was esoteric to only the priests of the Asclepions, although, over time, the priests at Cos preferred a more rational approach to medicine. This rational medicine ultimately gave rise to the physicians who worked outside the Asclepions.  (13, page 96)

Sometimes around 400 B.C. a famous physician named Hippocrates, the so called man of genius, transcribed the votive tablets at the temple of Cos into the infamous Hippocratic Corpus, or so some speculate. 

By writing the Corpus, Hippocrates not only helped complete the transformation of medicine in Greece, he also made this knowledge available to the public.  It was for these reasons, as we will learn later, why Hippocrates will forever be known as the father of medicine.

In the meantime, many historians have noted that ancient Greece was well ahead of other ancient societies in regards to medicine.  The best evidence of this is the accumulated knowledge obtained from the votive tablets stored in the Asclepions. Of this, Meryon said:

"And this opinion appears to be supported by the fact that from the earliest time of which any historic record exists, the Hellenic physicians were in high repute at the court of Babylon; so that, although the origin of Grecian medicine is involved in the most profound obscurity, the resources at the Asclepiades were obviously appreciated over and above the appliances of the Persians, which were chiefly derived from astrology and magic." (6, page 20)

While some may think of such "asylums" as the first hospitals, Watson notes this wasn't necessarily true.  He said:

"The temples bore no inapt resemblance to the hospitals and infirmaries of modern times; into which, in fact, some of them were ultimately converted. (5, page 26)

Thomas Bradford, in his 1898 book "Quiz questions on the history of medicine," said the Asclepions were, however, converted into hospitals when Constantinople made Catholicism the official religion of Rome in 312 A.D.  It was Helena, the mother of Constantine, who was the primary champion for this conversion. (12, page 49)

Even after their demise, even after the glorious physicians of the Grecian era were long gone, the sick could still travel to the Asclepions for health and healing. Even as the medicine was transformed from philosophy back to theology, at least the sick were offered the best mode of treatment in the ancient and primitive worlds, and that was hope.

References:

1. Sigerist, Henry E, "A History of Medicine," 1961 edition, Volume II: Early Greek, Hindu, Persion Medicine," Oxford University Press, page 44
2. Osler, William, "The Evolution of Modern Medicine: A series of lectures at Yale University on the Silliman Foundation in April, 1913," New Have, Yale University Press, 1921,
3. Templesuk.org, "Asclepius," http://healing.templesuk.org/asclepius.htm
4. Withington, Edward Theodore, "Medical History from the Earliest Times," 1894, London
5. Watson, John, "the Medical Profession in Ancient Times," 1856, New York, 
6. Meryon, Edward, "The History of Medicine: Comprising a narrative of its progress from the earliest ages to the prestne and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861
7. Garrison, Fielding Hudson, "An introduction to the history of medicine," 1922, 3rd edition, Philadelphia and London, W.B. Saunders and Company
8. Buck, Albert Henry, Williams Memorial Public Funds, "The growth of medicine from the earliest times to about 1800," 1917, London, Oxford University Press
9. Renouard, Pierre-Victor, "A History of Medicine from its origin to the nineteenth century," 1867, Philadelphia, Lindsay and Blakiston
10. Bradford, Thomas Lindsley, "Quiz questions on the history of medicine: form the lectures of Thomas Lindsley Bradford, M.D," 1898, Philadelphia
11. Strathern, Paul, "A Brief History of Medicine from Hippocrates to Gene Therapy," 2005, U.K. Avalon Publishing
12. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey
13. Neuburger, Max, writer, "History of Medicine," 1910, translated by Ernest Playfair, Volume I, London, Oxford University Press

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225 - 200 B.C. Dogmatism is challenged

Even while the dogmatic school of medicine (rational medicine) was being formed at the school of Cos by Hippocratic writers, so too was forming the emperical school of medicine at the school of Cnidos, about 20 miles away. (1, page 29)

In other words: "By the side of dogmatic philosophies Skepticism slowly arose," said Norman Maccoll in 1868.  (6, page 10, 18-19).

What is skepticism?  It is a branch of ancient Greek philosophy thought to have been created by Pyrrho.  Who was he?

Pyrrho lived lived 360-270 B.C., and was among the first of the skeptics, or philosophers who doubted that all wisdom could be learned.  (Skeptic comes from the ancient Greek term "skepsis," which, according to Meriam-Webster, means examination or doubt).

He is often considered as the father of skepticism. His followers were called Pyrrhoneans.  His philosophy was called Pyrrhonism, his school called the Pyrrhonean School. (6, page 13)

However, as was normal for the ancient world, many believe ideas contributed to him arose prior to his lifetime and were merely attributed to him later on.  (6, page 13)

Of his disciples or pupils, Maccoll said the one most important to historians of philosophy was Timon, who lived from 320-230 B.C.  While Pyrrho is known to have written only one poem addressed to Alexander, Timon wrote voluminously. Therefore, it "was through him that Pyrrho's doctrine became first generally known." (6, page 27, 28, 30)

Maccoll wrote that it was Timon who said that a philosopher should ask the following questions:

1. How are things constituted?  Our conclusions should not come from our opinions or senses because answers derived from them are neither true nor false.  Answers must be derived from empirical evidence. (6, page 21, 22)
2. In what relation should we stand to them?  We cannot form opinions on things that are beyond our knowledge.  In other words, "We cannot distinguish the false from the true, for both to the senses and the reason all things are alike: they possess no criterion of truth: we must not hazard those decided judgments, in which the dogmatist indulges: we must incline neither to the right hand nor to the left: we must remain unmoved." (6, page 21, 22)
3. What will result to us from our relation to them? "What effect on our happiness will our attitude to Things have ? This attitude has already been determined to be suspension of judgment. If therefore we are to make a rule of abstaining from all judgments, our happiness must be dependent on this abstinence, and consist in regarding everything external with undisturbed tranquillity of mind; for there is no certainty with regard to what is external, and, where there is no certainty, there can be no happiness. The soul must retire upon itself, looking upon all outside itself as indifferent, and striving to become neither the slave nor the mistress of circumstances, but separate from, and independent of, them." (6, page 21, 23)

Of this third question, Maccoll said: 

The answer to the third question shows the aim of Pyrrho's doubt: like all his contemporaries he searched for a summum bonum: he was not a sceptic in the modern sense of the word : he doubted because doubt appeared to give him the most secure promise of happiness. (6, page 24)

Of the three questions, Maccoll said:

They relate of course to the old points: " Is knowledge absolutely relative ? Is there any objective truth ? Can we have any knowledge of Things as they are in themselves ?" (6, page 31)

The quest of Pyrrhonism was to find the summum bonum, or the highest good. In this regard, Pyrrhoneans were considered eudaemonistic (eudaemonism), which, according to Merriam-Webster, was a theory that the highest goal is happiness and personal well being. (6, pages 8-9,24)

Skepticism died out after the death of Timon, only to be re-established by later philosophers.  (6, page 69)

However, it was from the skeptics, or Pyrrhoneans, that arose the empirical school.  It was the empirics who would ultimately counter dogmatism.  

Empiricism arose through the wisdom of the following triad:  (1, page 29) (3, page 68)(4, page 91)

• Herophilus:  He lived 325-280 B.C., and came up with many of the theories followed by the the empirical school of medicine
• Philinus: He was a pupil of Herophilus around 250 B.C., and started the empiric school of medicine
• Serapion: He was successor of Philinus around 225 B.C., and supported empiricism

This Empirical School of Medicine was basically established to counter the "extravagances" of the Dogmatic School of Medicine at the School of Cos.  (3, page 69)

A common saying of the empiracist was:

"It is not the cause but the cure of disease that concerns us; not how we digest, but what is digestible." (5, page xiii)

The major differences between these schools were as follows:  (1, page 29)(3, page 69) (4, page 68-9)

Dogmatists/ Rationalists/ Hippocratic Dogmatic School of Medicine	Empiricists/ Emperics Empirical School of Medicine
Supported ideas of the physician Hippocrates	Supported ideas of the philosopher Pyrrho
Were in search for causes of disease	Were not concerned with causes.  A person was ill is all they needed to know
Speculated on possible causes and remedies	Did not speculate
Created theories to explain causes and why a remedy will work.  Generally, diseases were caused by the body as a whole.	Did not create theories to explain anything.  If something was unknown, it was left at that
Cures were based on the theory postulated.	Cures were based on experience.  If something worked in the past, it will work today.  Medicine not based on experience could injure
They had few remedies, many of which were harsh, such as bleeding, purging, and vomiting	They had many remedies, and they were generally friendlier than dogmatist remedies and probably worked better
They believed anatomy was important to understand the physiology of disease	They despised anatomy and physiology.

Serapion was the most outspoken of the empirics, and "he wrote with great vengeance  (1, page 29), as he said:

"What is the use of  knowing the shape and position of the brain and liver, or whether there are such things as brains or livers at all."  (4, page 68)

Another common saying of the empirics was:

"It is not the cause, but the cure of diseases that concerns us; not how we digest, but what is digestible." (4, page 68)

Galen wrote about Serpion the empirist in his Outline of Empericism: (2, page 161)

Of the ancients, however, Hippocrates, Erasistratus, and Herophilus have stated nothing about the treatment suffering from the disease (i.e. lethargy).  But Serapion the Empericist, in Book 1 of his treaties Against the Haireseis, gave some instructions (about this) which are, however, too obscure to be reported here.

Serapion thus became an experimentalists.  He experimented to see what drugs worked best for said disease.  He recorded and made conclusions based on his own observations and experiments, as opposed to coming to speculative conclusions.  (1, page 30)

As described by Edward Withington:

"In short, they (empiricists) reduced the whole art and science of medicine to a system of therapeutics.  A person is ill, that is, he has certain unpleasant feelings or symptoms; surely the first thing to do is to find something which will remove them, and the whole duty of the physician is to discover what particular treatment, and especially what drugs, will get rid of particular sets of symptoms."  (3, page 68-9)

The way to do this is based on the "tripartite foundation" (1, page 30) of the following three methods:  (3, page 69)

1. Experience:  His own experience and observations
2. History:  Learning from the experience and observation of his contemporaries and  predisessors
3. Analogy:  Drawing conclusions based on similar situations to find remedies for new and strange cases

 And thus was formed the Empirical school of medicine.

The empirics were essential to this time because they created an important alternative to the dogmatists, some of whom (see Erasistratus) performed autopsies on live convicted criminals to see what organs did during life.  Hopefully, as some reports suggest, many such victims were given a large dose of morphine before the procedure.  Yet still it was considered inhumane and irrational by the empiricist, and reasonably so.

While the dogmatists based their remedies on speculation, the empiricists used only remedies that were shown by experience to work. This was a viable alternative to the extreme remedies of bleeding and purging used by many dogmatists.  The empiricist also added quite an array of new remedies, including opium and sulpher.

The dogmatists became known as rationalists due to their desire to rationalize diseases and their remedies.  They believed "everything must have a sufficient reason for its existence," Empirics believed what can be observed by experience is known, and what is not known is not to be speculated upon.

References

1. Meryon, Edward, "History of Medicine: comprising a narrative of its progress from the earliest ages to the present and of the delusions incidental to its advance from empericism to the dignity of a science," volume I, London, 1861,
2. Eijk, Philip J., editor, "Ancient Histories of Medicine: essays in medical doxography and histeriography in classical antiquity," 1999, Boston,
3. Withington, "Medical History from it's Earliest Times: a popular history of the healing art," 1894, London, The Scientific Press
4. Watson, John, "Medical Profession in Ancient Times: an anniversary discourse delivered before the New York Accademy of Medicine November 7, 1855," 1856, New York, Baker and Godwin
5. Brock, John, "Galen on the natural faculties," 1916, London, New York, William Heinemann, G.P. Putnam's Sons
6. Maccoll, Norman, "The Greek Skeptics from Pyrrho to Sextus: An Essay which obtained the Hare Prize in the Year 1868," 1868, London and Cambridge, Macmillan and Co.
7. "Ancient Greek Skepticism," Internet Encyclopedia of Philosophy, http://www.iep.utm.edu/skepanci/, accessed 6/20/14

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