Epidemics in Western Society Since 1600

HIST 234 - Lecture 2 - Classical Views of Disease: Hippocrates, Galen, and Humoralism

Chapter 1. Diseases as Supernatural [00:00:00]

Professor Frank Snowden: Without more ado, then, we'll turn to our topic of the morning, which is about the first embodiment of a rational scientific medicine, which is rather an extraordinary one because it lasts from the fifth century B.C. down to the nineteenth century as a dominant — not exclusive — but a dominant medical scientific paradigm. It was associated with this idea of the first form of a rational, secular, naturalistic form of medicine, with ancient Greece in the fifth century, and in particular with the so-called father of medicine, Hippocrates, who lived from about 460 to 377 B.C. Now, there's some debate about whether he was one person or a school, a group, of people. There is a corpus of Hippocratic writings that consists of about sixty works, perhaps by multiple hands. But that issue won't really concern us.

We're concerned with Hippocrates as either this composite or single figure, and with the various schools that followed in his name. The sixty works, some of them are very famous to you already. You know about the Hippocratic Oath. We'll be talking about such other works as On the Sacred Disease, On Human Nature, Epidemics, On Airs, Waters, Places; and he also had a collection of aphorisms. One would note the variety of the Hippocratic corpus. It consists of a whole series of things. He/they invented case histories, and they're included. There are lecture notes. There are memoranda of all sorts; writings on every form of medical practice at the time: surgery, obstetrics, diet, the environment, therapeutics. All of that forms part of the Hippocratic corpus. So, enormous variety.

In terms of what Hippocrates accomplished, I'd like to make a contrast, and that is with the supernatural view of disease. And the first form we could think of that, in drawing our contrast — the contrast to what Hippocrates accomplished — we can see it in terms of the breakthrough from something that preceded it and went alongside it, down to our own day, and this would be first of all the supernatural view of disease; that epidemics and pestilence are divine punishment sent by an angry god for sin and disobedience. You can see this in many parts of our culture. It's embodied in the Bible, for example. In Genesis, you know that Adam and Eve lived happily and enjoyed eternal life in the Garden of Eden, until they committed the sin of eating of the forbidden tree of the fruit of knowledge of good and evil, and as a result this was original sin and they were kicked out of the Garden of Eden. From then on for things they had to work. They also became subject to disease and to death. They were immortal until that time.

So, we see in Genesis the embodiment of this idea that diseases are a punishment of sin. This was also clear — you can read further in the Bible, in the book of Exodus, where you learn about the bondage of the Israelites in Egypt and God asking for Moses and Aaron for the Pharaoh to release his chosen people. But the Pharaoh's heart was hardened and so the Egyptians were punished with this series of terrible plagues that are all in Exodus. Another way of embodiment of this was in Psalm 91, and this is of particular importance to us — let's move to share this with you. This is the text of Psalm 91. This is particularly important because it embodies the idea of plague and pestilence as a punishment by God. But also in terms of our historical experience, as you're reading Daniel Defoe, you'll realize that it's Psalm 91 that was read out from the Christian churches during times of epidemic.

This was the great plague psalm. It embodies hope and an interpretation of what the experience of plague was all about. Let me read part of it here. "Thou shalt not be afraid for the terror by night, nor for the arrow that flieth by day, nor for the pestilence that walketh in darkness, nor for the destruction that wasteth at noonday. A thousand shall fall at thy side, and ten thousand at thy right hand, but it shall not come nigh thee. Only with thine eyes shall thou behold and see the reward of the wicked. Because thou hast made the Lord, which is my refuge, even the most high by habitation. There shall no evil befall thee; neither shall any plague come nigh thy dwelling." So, if you renounce sin, the pestilence won't come near you.

Let me turn also to another embodiment in culture, our Western culture, and this is the opening scene of Homer's Iliad, which as you know is all about the Trojan War, and it begins just before this scene with Achilles' anger. That is to say, Achilles was the greatest of the Greek warriors, but the Greek King Agamemnon had taken his concubine for his own, and as a result, enraged, Achilles withdrew from combat and sulked in his tent. Now, he had a friend who was a priest of the god Apollo, and this friend tried to intervene and beseeched Agamemnon to write the wrong and return the woman. But Agamemnon rebuffed Apollo's priest; or as we might say, he dissed him. And, so, what we have here is this tremendous and terrifying scene at the beginning of the Iliad. Let me just quote from the beginning then.

"Over and over the old man [that is, the priest] prayed as he walked in solitude to King Apollo. 'Hear me Lord of the silver bow; bring to pass this wish I pray for. Let your arrows make the Danaans pay for my tears shed.' So he spoke in prayer, and Phoebus Apollo heard him, and strode down along the pinnacles of Olympus, angered in his heart, carrying across his shoulders the bow and the hooded quiver, and the shafts clashed on the shoulders of the god, walking angrily. He came as night comes down, and knelt then apart and opposite the ships, and let go an arrow. Terrible was the clash from the bow of silver. First he went after the mules and the circling hounds, then let go a tearing arrow against the men themselves and struck them. The corpse fires burned everywhere and did not stop burning."

So, that was Apollo punishing the Greeks on behalf of his priest. Or let me also mention something, an example, that's more recent and closer to home; that is, I want to talk for a minute about a Yalie. And this is our friend here John Humphrey Noyes of the nineteenth century, who was at the Yale Divinity School, and he read the pieces we've just talked about, and thought about disease as a punishment for sin, and decided well there was a remedy. And, so, in all modesty he and a group of his friends decided that they were going to renounce sin all together, and they called themselves The Perfectionists. And they founded an ideal community, first in Putney, Vermont, and then in Oneida in New York State — it's part of the history of American utopian communities — in which they renounced sin and were going to live together in harmony and peace, forever, as eternal people. And every morning began with a mutual criticism in which they pointed out each other's faults — this must have been a lot of fun — in order that they not fall by the wayside and lapse once again into sin.

Well, I'm sorry to tell you — this was the 1840s — by the 1890s the ideal community had become instead a joint stock company, and you still have Oneida pottery and silverware. And I'm very sorry to report that all of the members of the community have been buried. I don't know if that was because they couldn't stick the pace, or if the concept was wrong from the outset. In any case, this was an embodiment, then, of the idea of disease as a punishment for sin. But if we view this view of pestilence as divine punishment, it does at least imply a law-governed cosmos. Disease exists for an intelligible reason, and it implies a rational therapeutics, which is repentance: propitiation of God, amendment of conduct, and renewed obedience to the laws.

There's another variation of a supernatural view, which is more capricious, and let's call that the demonic theory of disease. This postulates that the world is populated by powerful arbitrary and evil spirits who cause disease through their malign influence. These may be evil persons, such as witches or poisoners, the disembodied spirits of the dead, superhuman beings, or the devil himself. We'll see this view throughout the course, the idea that epidemic diseases are diabolical plots, not natural events. There's some occult secret crime caused by the poisoning of witches or scapegoats, and this gives rise to witch-hunts, to hunt down and punish the guilty. We know this famously in the seventeenth century and in our own country at Salem. But the idea was clearly expressed in Europe by Martin Luther who declared, "I would have no pity on the witches. I would burn them all."

Alternatively — that was a good therapeutic idea — alternatively a person could be deemed to be inhabited or possessed by an evil spirit, and in that case the cure was to cast out the devil through exorcism. And this cosmology survives in our own language when we talk today about someone acting "like someone possessed," or "out of his mind." And healers pursuing these sorts of ideas would invoke magic, or have incantations. They'd prescribe special concoctions, chants, sacred rites and spells. And in European history, a relatively recent illustration of that idea was the idea of the healing power of the royal touch. Charles II of England, for example, administered this treatment in the seventeenth century to about 100,000 people. So, healers could do that. They could also recommend magic practices, offerings and sacrifices; magic charms to ward off the evil spell; or they could recommend escaping by taking flight; or invoking the power of a powerful ally, as in the Christian cult of saints that we'll be talking about later.

Chapter 2. Humoralism [00:13:50]

So, if you hold that up — those two views, then, of supernatural interpretations of disease — then you can understand the breakthrough that was made in fifth century Greece. This was in contrast to the supernatural divine and demonic theories, and it's in contrast to them that we can see the importance of a new idea; the idea that disease instead is a naturalistic event that can be understood by natural causes. Examples of this new, naturalistic, secular view abounded in the fifth century. You can see it in Thucydides, in his account of the Peloponnesian War, the famous Plague of Athens that may have been typhus, or more recently it was thought to have been typhoid. But in any case it was a natural event, and is described as such by Thucydides, with no reference to the occult or the supernatural. You can see it in Hippocrates' discussion on epidemics in which diseases, epidemic diseases, are caused by a corruption of the air.

But let me talk about this very famous example, and dramatic one, of Hippocrates, On the Sacred Disease. By the sacred disease he meant epilepsy, and it looks — I guess if you wanted any disease — it looks like a possession by a demon. It is epilepsy. And Hippocrates wants to tell us that this is not a supernatural event, or a possession. He says instead something extremely different. What he tells us is that: "It is thus with regard to the disease called sacred. It appears to me to be no wise more divine or sacred than other diseases, but has a natural cause, like other afflictions. Men regard its nature and cause as divine, from ignorance and wonder. And this notion of its divinity is kept up by their inability to comprehend it. Neither truly do I count it as a worthy opinion to hold that the body of man is polluted by God; the most impure by the most holy. For were the body defiled, it would be likely to be purified and sanctified, rather than polluted. Those who first referred this malady to the gods appear to me to have been just such persons as the conjurers, mountebanks and charlatans are. Such persons then, using the divinity as a pretext and screen for their own inability to afford assistance, have given out that the disease is sacred."

This was a very major breakthrough conceptually, the beginning of the foundation of a scientific medicine. So, therapeutics then got rid, in a naturalistic view, of chance, potions, spells and sacrifices; and exorcism, appeasement of the gods. The importance of this momentous step in human consciousness was expressed by a Yale professor of epidemiology in the 1940s, Charles-Edward Winslow, who wrote — and let me quote a sentence or two from him. "If disease is postulated as caused by gods, daemons or demons, scientific progress is impossible. If it is attributed to hypothetical humors, the theory can be tested and improved. The conception of natural causation was the essential first step. It marks incomparably the most epochal advance in the intellectual history of mankind." That perhaps is putting it a little strongly, but you certainly get the point.

Now, why perhaps was there a rational scientific medicine in fifth century Greece? Here I think the main part of the answer has to be imponderable factors such as the inspiration of Hippocrates himself, and his associates. But there were influences we could point to as important: The absence of a priestly bureaucracy, with the power to sanction heretics; the centralized city states; the legacy of Greek natural philosophy, the work of Plato and Aristotle in particular; a culture of individualism. And I think we also need to remember the Hippocratics' positions. Although they were known to treat the poor and slaves, their care was not by and large available to the masses. The primary clientele consisted of educated, prosperous elites in ancient Greece and ancient Rome, and this was a medical philosophy that suited them. The educated doctor and the educated patient spoke the same language, and the therapies that the physician proposed, such as a special diet or rest, were remedies the wealthy could afford.

We should say that Hippocratic medicine is still with us. We can see it in the return to holistic medicine. We can see it also in the Muslim world, and you can still be treated in Unani medicine by a Hippocratic style medicine. And you can see it in certain popular cultural precepts, such as "feed a cold and starve a fever." Well, if that's its importance, let's look at its content. What was the content of this first embodiment of scientific medicine? And it was humoralism. Here let's talk about what that is. The fundamental assumption was that there's a correspondence between the macrocosm of the universe and the microcosm of the individual body. Both are composed of the same materials, subject to the same laws, and disorder can occur in one and be followed by disease in the body.

According to Aristotle and natural philosophy, the macrocosm consisted of four elements that you can see here. They were earth, water, air and fire. And each of the elements is associated with four qualities, which can be dry and hot like fire; or dry and cold; or cold and wet; or wet and hot. So, the elements embody also four qualities, in different proportions, of course. And this went on over the centuries, and there were four seasons, four winds, later on four evangelists.

The point for us is there was also a microcosm, and one can see the theory expounded on human nature in which there are four humors, which are phlegm, black bile, yellow bile and blood. And each of those — also the body is composed of these — and each has qualities of as being wet and cold, or hot and dry. This also determines — the balance of these humors in the body — the four temperaments: whether you're melancholic, phlegmatic, choleric or sanguine. Those words survive in our culture. There are four ages of man, four principal organs of the body: the spleen, the brain, the liver and heart. You see the importance of four. And the system is axiomatic. It's based on deductive reasoning from first principles. Central, of course, to all of it was the climate of Greece, with its seasonal patterns and its specific patient population. Many were malarial victims with the complications of pneumonia. And Hippocrates, indeed, was the world's first malariologist.

Now, health consisted — was called eucrasia, which meant a balance or equilibrium of the humors, and therefore the qualities. And variations are possible, up to a certain threshold, and at various times in your life — or from one person to another — the balance among the four humors can change. But once you cross a certain threshold in variation — that is, one humor becomes overly dominant, or one humor is lacking in sufficient supply — that's an imbalance. That's dyscrasia; an excess or deficiency of one of the humors, and that is disease. So, we know what disease is then. It's an imbalance of the humors. Note that there is no single — that is to say there aren't discrete individual diseases, as in modern medicine; that is, disease is classified as typhoid, cancer, pneumonia, and all the rest. Disease instead was a holistic phenomenon of body equilibrium. There was, in a sense, only one disease.

Now, what were the causes? The causes were said to be, what we might call in modern jargon, environmental insults; that Galen later on was to codify as the six non-naturals. The human body and constitution then had contact with the air, which might be corrupted, or "miasmatic," as it was called later. Motion, or what we might call exercise, was the second — or its lack — non-natural. Sleep or wakefulness; excretion or retention of whatever was ingested; and the passions of the soul, these were the non-naturals that could tip the body into disease. Restoring health was based in part on nature itself; that is to say, there's a teleology of the body, embodied in the phrase vis medicatrix naturae; which is the healing power of nature. And the means to restore — the body, in other words, strives to restore equilibrium, through its innate heat or through the elimination of excess humors, when you sweat, you sneeze or you vomit; for all of that is your body's attempt to get rid of the humor that's making you sick because of its excess. So, this led then to humoral therapeutics. And let's talk about that.

The basis of medical strategy was that the physician was the ally of nature, and of the body. The body was trying to restore itself to health, and the physician would join it in doing battle against disease. He would read the signs to decipher the underlying process; would take a case history; would practice close observation, taking the pulse, listening to the body; and would examine the urine, its color, its density. He would smell it and taste it, and see whether it contained blood or was frothy, as all of those were worrying prognostic signs. It was a holistic treatment where you didn't treat individual symptoms, but the whole constitution. And it also had an idea of the individualism of the patient. Treatment should be tailored to the constitution of the individual. There are no disease entities, because disease is not a thing but a process.

This was a medicine that was rather indifferent to diagnosis or classification. What it stressed instead was the answer to the patient's eternal question, "Am I going to be all right doc?" Prognosis was what really mattered to the Hippocratic physician. The therapeutic principle was that opposites treat opposites. So, if you have an excess of a dry and cold humor, like a black bile, if that's the humor that's causing your illness, then you would like perhaps to give the patient a food to ingest that would be wet and hot; and hot in this case, think of it not simply as the touch. We think of it when we talk about spicy food as being hot. All the elements that you have also have qualities, and so diet is very important to this therapeutics.

The tools available to the physician, then, are first of all diet. In some sense the Hippocratic physicians thought we are what we eat, and all foodstuffs had qualities — hot, cold, moist, dry — to balance an opposite defect or excess in the human body. Exercise was also important. A change of environment; in modern terms, going to a spa or a sanatorium. Moderation in the emotions, moderation in sex. And medication was important, because they did practice, Hippocratic physicians, internal medicine. Examples were to promote evacuation by providing emetics, sudorifics, purgatives or diuretics. And most important perhaps was a primacy of venesection — by which I mean bloodletting or phlebotomy — that became the hallmark of the orthodox physician.

Medicine, in other words, was conceived as a process of addition and subtraction, adding what is wanting and subtracting what is in excess. Now, you may have your doubts about venesection. Let me just mention some of its advantages in the eyes of Hippocratic physicians. It was systematic, like disease itself. Its effects were immediate and you could control them. It was speedy. Its limits were also self-evident to the experienced doctor. Perhaps the patient fainted, the pulse disappeared, or the color of the blood altered. There were however, of course, contraindications to bloodletting: old age and efficiency of blood; the summer heat; evacuation already occurring by other means; or extreme cold. So, the lancet, the instrument for bloodletting — there we have real lancets — became the symbol of the orthodox physician, down through the nineteenth century.

Chapter 3. Galen as Interpreter of Hippocratic Medicine [00:30:14]

Now, note that there is no real humoral physiology, no idea of the circulation of the blood. The heart is not a pump but a furnace, drawing air from the lungs, heating it and distributing it as innate heat in the body. So, this was the first embodiment of scientific medicine. I want to talk about an alteration that it went through, through the second father of medicine. And this is another Greek physician, who lived however in ancient Rome, and that is Galen. And that's a picture. Now, his personal — he lived in the second century A.D., from 130 to about 201, with his formative years being lived out in Rome. His personal qualities are important. He was very different from Hippocrates.

Hippocrates was a great observer, an empiricist. Galen instead prided himself above all on his knowledge of the texts of Hippocrates. He almost worshipped Hippocrates, but regarded himself as the authorized interpreter of Hippocratic works, which he turned into a dogma. Now, in Rome, Galen was physician to the gladiators. His personal position helps explain his influence. He then became private doctor to the emperor. And he regarded himself as the ideal physician, philosopher and scientist. He was a man of over-weaning self-confidence, who had nothing but withering scorn for his opponents and colleagues, whom he called "murderers, amateurs, unversed in Hippocratic wisdom." He called them "more ignorant than animals."

It was true also that Galen had an encyclopedic knowledge, and we can only understand his influence if we remember that he was a man of immense knowledge of all branches of the medicine that existed at his time. And only half of his written works survive, but they alone fill twelve volumes of about a thousand pages each. In other words, he was extraordinary in his productivity, and that too is important on his influence. Now, Galen had a view that was foreign to us of the meaning of scientific progress. To him Hippocrates was the permanent foundation of medical science, and the main tenets of that science could never be overturned or revised. Instead, there was no room in his thinking for scientific revolutions. The writings of Hippocrates were valid forever. They could only be completed and perfected. And, in fact, that was Galen's view of himself. He was the person who perfected Hippocratic ideas. So, in fact, further progress was probably unnecessary and perhaps impossible.

So, Galen became the authoritative interpreter of Hippocrates. This is what we might call Galenism. And in his hands, Hippocrates became a cult figure, an object of veneration and almost worship. Hippocrates, about whom so little was known in his personal life, was now endowed with all manner of apocryphal virtues. He was idealized as a model of wisdom, courage, temperance, humanity and honesty. Mythologies developed about his religious piety, his heroism and his hard work. There was a legend that he was descended, on his father's side, from the god Asclepius, and on the maternal side from Hercules. He was said to be a great patriot who saved Athens from the plague, a man who scorned money and was perfectly wise and perfectly just. So, he became one of the greatest cultural figures of antiquity, an equivalent, in a different way, of Socrates, Plato and Aristotle.

Now, probably some of you are wondering — we've talked about humoralism and its advocates, and you want to know, "well, that's all very fine; did it work?" I'd like to say that humoralism had a number of strengths. It was a quantum leap from magical thinking to naturalistic explanations of disease. It appealed because it was accessible to educated laymen. Contemporaries with an education understood everything that Hippocratic and Galenic doctors said and prescribed. It was consonant with contemporary understandings. We also need to know that Hippocratic and Galenic physicians practiced therapeutic modesty. They did not participate in surgery except, for example, for setting bones, lancing abscesses and practicing venesection; but the internal cavities of the body they knew were off limits. It was based on observation. They took case histories.

And we ought to remember, in terms of medical effectiveness, that — my wife, for example, who is a primary care physician, says that about seventy-five percent of patients who present themselves in a clinic have self-limiting illnesses, or psychosomatic ones, and mostly need reassurance that everything will be all right. So, the point about Hippocratic medicine was that experienced physicians, accustomed to seeing ill people, would be pretty good at prognosis and reassurance. They would refuse to treat cases they regarded as hopeless, and hopeless cases, they also had a referral system — we'll refer to in a minute — which was to temples. I'll come back to that in just a second. There were, however, a number of weaknesses.

So, Hippocratic/Galenic medicine had a number of powerful strengths. It provided a lot in terms of reassurance and prognosis, and the answer to that eternal question, "Will I be all right doc?" and the other question, "What can I do to help myself?" There were a number of weaknesses. It was a closed system. It was based on deductive reasoning, and came to be bound up in the authority of the ancients, with empiricism fading away; and indeed in later centuries it comes to be called "library medicine." It was anchored in a cult of personality — the cult of Galen, and through him of Hippocrates — and practiced a cult of antiquity, with knowledge almost becoming a form of revealed truth. So, Galenism involved authority and tradition, an elite medicine of university-trained physicians who were involved, particularly in their training, in studying the classics. How do you train a physician? You have them read Hippocrates and Galen, in the original languages.

I don't want to say, however, that there were no challenges. It's extraordinary to reflect that humoralism, as a dominant medical philosophy, persists into the nineteenth century. But I don't want to think that it was unchallenged. We know there were demonic and religious views that ran alongside. But in addition, there were a series of scientific challenges that occurred in a number of major shocks to the system that slowly weakened its hold and gave rise to doubters, but did not thoroughly dismantle humoralism until the late nineteenth century; and even then it persists in popular culture and some forms of alternative medicine. What were some of these challenges? I don't expect you to remember these at this point; we'll come back to them later in the course. But just so that you'll understand that it wasn't as though this system never had challenges.

Protestantism was a challenge, with a challenge to authority and established texts. And Paracelsus, whose dates are on your handout, was called the Martin Luther of medicine, who rejected Galenic and Hippocratic medicine all together. William Harvey discovered the circulation of the blood, which overthrew or challenged Galen's anatomy and his physiology, which were proved not to correspond to the observed results of dissection and pathology. So, the discovery of the circulation of the blood was a major blow; although, oddly enough Harvey himself never rejected humoralism, Hippocrates and Galen.

Then there was the scientific revolution. And in particular one can think of the chemical revolution associated with men like Joseph Priestly and Antoine Lavoisier. They destroyed the Aristotelian notion of elements. Earth and air, for example, were found themselves to be composed of a great number of modern elements that go to make up what we know as the periodic table. And more generally, the scientific revolution marked a democratic turn from authority to empirical evidence, and it envisioned scientific and medical knowledge as infinitely expandable and not bounded by set texts. And then, from the point of view of our course, the experience of epidemic disease, as we'll see, made the idea of dyscrasia improbable as a mechanism needed to explain epidemic disease, because it's fairly flimsy as a basis for explaining why so many people, in a single place, at a single moment of time, had their equilibria all unbalanced at the same moment.

So, the experience of epidemic disease is important, and we'll see the physician, Fracastoro, came up with the idea of contagionism many centuries ago. In the nineteenth century we'll see also, with the development of pathology, the idea of disease specificity; and finally in the late nineteenth century the germ theory of disease, which offers an entirely different paradigm for disease. So, that's the journey we'll be taking, to the time when humoralism is replaced, and we'll look at various embodiments along the way of what people considered to be scientific medicine. But here a number of you will be thinking that I've involved myself in an important contradiction, and you'll be thinking about Asclepius and the fact that I talked about temples and a god. And in particular let's look at — that's the god Asclepius, and this is the — I'll talk about who he is.

Chapter 4. Ascelpius [00:42:32]

Hippocrates and Galen were both pious and devout; that is to say, although they believed in a naturalistic medicine, it wasn't that they didn't also believe in the gods, and through the gods they found in temple medicine what we might call the world's first referral system. Asclepius, who was he? He was first a moral hero who became half human and half divine, and then entirely a god. He was thought to be the kindest of the gods; the one who loved humanity enough to sacrifice himself for their sake. His father was the god Apollo. His daughters were interestingly named the goddesses Panacea and Hygieia. And physicians in the ancient world might call themselves Asclepiads, meaning the sons of Asclepius, who regarded their father as a patron saint.

By the time of Alexander the Great, Greece possessed three to four hundred temples dedicated to Asclepius. Asclepius was said to have been killed by Zeus because he taught mortals the art of healing and Zeus feared that men and women would compete with him in no longer being subject to death. But Asclepius never practiced magic. He was merely the most skilled of physicians, using the same principles that Asclepiads, like Hippocrates and Galen, would use as well. Note, of course, there are similarities to the story of Christ, and Asclepius was in fact a major competitor with Christianity for a number of centuries. And like Christ, after death he was said to have risen and to be present eternally in the temples. So, the temples were shrines to Asclepius, at places like Athens.

I'll show you, I hope, a couple of examples. That's Chios, where Hippocrates was from, and this is the temple at Pergamon. I just want to — there, it's a whole — this is more than just a temple, although it is a temple. It's almost a compound. Now, the usefulness of identifying yourself with Asclepius was that there was — it provided physicians with a badge of identity, a source of authority. They were wandering peripatetic healers, but now they're recognizable as members of the same guild. This gave them a collective presence and authority, and Asclepius also vouched for their ethical conduct. Remember, these are peripatetic physicians whom you invite into your home. And, so, they needed to have someone vouch for them, and he vouches that they're good doctors and that they have special care for the poor who can't pay him. But again, there is no contradiction with naturalistic medicine.

The temples were precursors, in a way, to health spas, sanatoria or hospitals. There they provided care for the poor and the seriously ill. Patients could enter them, the precincts of these compounds, after a period of preparation in which they bathed, fasted, prayed and offered sacrifice. But the therapeutic strategy comes to them in a particular way, which is called an "incubation"; which is to say that at night, after you've prepared yourself carefully, in the way I just mentioned, when you — then the priest will help you — and when you fall asleep at night you'll have a dream. This is the incubation, and the god Asclepius will appear to you and tell you the strategy you should pursue in order to become well again. But the strategy was nothing other than what a skilled physician would have prescribed, had he been skillful and wise enough to have known.

There was never a treatment prescribed by Asclepius by magical means or miracles, or by practices that weren't accessible to the ordinary doctor. So, this is humoral medicine, the first embodiment of scientific medicine. And I want us to look, for the next several sessions, at the way in which it was used as a lens to view the experience of terrible epidemic catastrophes. And we'll look also at the way in which the experience of bubonic plague and other epidemics challenged or raised major questions about humoral theory, and helped propel the scientific medical elite towards a different view of disease and what it was. So, we'll see epidemics, beginning next time, as a process. And we'll also want then to explain it, and we'll look at bubonic plague as the first of our major epidemics in our course.

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