Top image: Asclepius, the Greek god of medicine, and the Asclepian centers which existed across Greece, Asia Minor and Judea for almost 1000 years, achieved world renown. But why were they so popular? And what can they teach us today?

Doctors the world over take the Hippocratic oath swearing to do no harm to patients. In doing this, to quote the words of the oath itself, they “call upon Apollo the physician and Asclepius, Hygeia and Panaceia and all the gods and goddesses as witnesses, that [they] will fulfil this oath and this contract according to [their] ability and judgment.” Moreover, most people will be familiar with the rod of Asclepius, a symbol representing medicine and healthcare which depicts a serpent coiled around a staff. In this way Asclepius, the Greek god of medicine, and the Asclepian centers that sprund up in his name have achieved world renown.

The rod of Asclepius, a symbol representing medicine and healthcare.

The celebrity of Asclepius

In the past it was not just the man, but also the renowned Asclepian centers that flourished in the ancient world. From the 6 th century BC to the 4 th century AD there were around 400 sites across Greece, Asia Minor and the Levant. The most famous were at Olympia, Corinth, Kos, Epidaurus and Pergamum, with Epidaurus and Pergamum having theaters that could seat up to 14,000 and 10,000 people respectively.

These numbers far exceed the capacity of London’s Royal Albert Hall (5,272), New York’s Metropolitan Opera House (3,800) or even the Sydney Opera House (5,748). What was it that attracted these multitudes? The answer is simple. Asclepian temples existed at a time when state-funded medical care was absent. The record of success of these religious-medical institutions saw their human founder elevated to the ranks of the demigods and mythologized as the son of Apollo, the god of healing.

The Lure of Asclepian Temples

What specifically drew so many people to the Asclepian centers? According to a doctor from the 1940s, Asclepian medicine “was based on miracles and not upon medical arts”. More recent commentators have continued to play down the physical basis to Asclepian medicine, with Bragazzi (2019) referring to it as “magic-ritual.” Commentators discussing the special incubation sleep experienced by patients ascribe the benefits as arising from the dreams triggered in patients. Are they correct, or could there also have been a physical basis to the cures? A good place to begin any investigation into Asclepian medicine is with the medical constructs that underpin it.

Asclepian centers flourished in the ancient world, and their theaters attracted up to 14,000 people at a time. What was the allure? In the image, the ancient theater of Epidaurus in Greece is located to the southeast end of the sanctuary dedicated to the

The Asclepian Family: Asclepiads and Their Unique Specialisms

Asclepian centers emphasized the Asclepian family, including the sons and daughters of Asclepius.  These so-called Asclepiads were each endowed with their own unique medical specialism. Panaceia was the goddess of universal remedy, Hygeia was goddess of health and sanitation, Laso the goddess of recuperation from illness, and Aceso was known as the goddess of the healing process. Amongst his sons, Podalirius was a skilled diagnostician, Machaon a master surgeon, and Telesphorus the god of vegetation with an understanding of herbal remedies.

What we find when assessing the combined skills of the Asclepian family, real or imagined, is a systematic approach to healthcare which was rooted in accurate diagnosis, good sanitation, appropriate remedies (including herbal remedies and surgery) and recuperation. This fact suggests that there is more to Asclepian medicine than a purely psychological model, but that it was also rooted in physical factors. For a closer understanding, we should analyze each of these elements, starting with the area associated with his son Podalirius, “diagnosis”, before moving on to the province of his daughter Hygeia, namely “sanitation”.

Diagnosis

The so-called “Father of Medicine,” Hippocrates, was born in Kos (in circa 460 BC) and learned his medical knowledge at the Asclepian center there, with Plato describing him as “Hippocrates of Kos, the Asclepiad.” The terminology of diseases he used, on which diagnosis must have rested, is still applied in medicine today. It included terms such as diabetes, gastritis, enteritis, arthritis, nephritis, cholera, herpes, pleurisy, apoplexy, melancholy, carcinoma, tetanus, eclampsia, coma, paralysis, haematuria, mania, panic, hysteria, epilepsy, hepatitis, pneumonia and oedema. So, we have to assume a systematic rather than “magical” approach to understanding and diagnosing illness. The same applies to the next stage of the cycle, hygiene, associated with Asclepius’ daughter Hygeia.

Greek relief at the National Museum in Athens showing Asclepius with his sons Podalirius and Machaon and three daughters.

Hygeia: Prioritizing Sanitation and a Clean Environment

Talk of a clean medical environment brings to mind Florence Nightingale, whose famous Notes on Nursing (1859) focused extensively on cleanliness due to the low levels of hygiene she saw in hospitals. It’s important to remember, however, that Asclepian centers were prioritizing sanitation two thousand years before Nightingale.

How did this priority manifest itself in practice? Well, the first step on arriving at the Asclepian center at Kos was to take cleansing baths before being examined by priests-therapists. At Epidaurus, the Asclepius baths were located next to the abaton, the building where special incubation sleep took place and quite possibly surgery too. Meanwhile, at Corinth and Oropos a wash basin and baths (respectively) were located adjacent to the abaton. These are striking examples of the way in which cleanliness was built into the system. There were four main remedies which took place in the abaton. These surgeries included water therapy, plant remedies, incubation sleep and finally recuperation. What does a close look reveal?

Aerial view of tourists snorkeling above the old sunken city of Epidauros in Greece.

(i) Miraculous Waters: The Therapeutic Effect of Water at Asclepian Centers

Sources of water were abundant at Asclepian centers and visitors could use them in one of two ways: externally, through immersion (either total or partial) or internally, through drinking. Each allowed for different effects. Immersion, for example, allowed the absorption of minerals, especially in total body immersion. At high temperatures, the skin and the peripheral lymphatic and capillary circulation were most directly affected. On the other hand, drinking water allowed the digestive, metabolic, nutritional and growth aspects of the body to be affected.

One patient who took advantage of the waters was the orator Aelius Aristides Theodorus (117–181 AD) who, dogged by decades of illness, frequented several Asclepian centers and then recorded his experiences. Here he is describing the miraculous character of the water at Epidaurus:

“The god uses this well as a kind of co-worker… for just as the servants of physi­cians and miracle workers are trained to ministrations, and, working with their superiors, astonish those who behold them and ask their advice, so is this well the discovery of the great miracle worker who does everything for the salvation of men ” ( Oratio XXXIX, 14).

He goes on to describe the effects of these apparently miraculous waters:

“Many have regained their sight by bathing in it; many, by drinking it, have been cured of chest disease and recovered the breath we need for life ” ( ibid, XXX1X, 15).

Aristides was a famous orator, which begs the question of whether this is fact or the workings of an overactive imagination? Modern analysis has, in fact, revealed that many of the waters at Asclepian sites are rich in minerals. At Corinth, for example, balneological analysis has revealed that the six thermal springs are slightly radioactive with a very high mineral content. At Kos, in the Aegean, all the water troughs are fed by iron and sulfur springs and at Lissos in Crete the spring water is dominated by a calcium-magnesium-oxycarbonate (Ca-Mg-HCO3) mineral complex.

At Epidaurus, the Relia and the Hagia Anna springs have the same mineral content as the alkaline spring waters at Evian, and are therefore effective with conditions relating to the liver, urinary or digestive organs. Strangely, the locations where the cures took place in Epidaurus have recently been covered over, but inscriptions on the mouth of a well provide information on the type of cures that took place.

Asclepius acquired the reputation of being “one who could charm back the dead man.” Could this be due to the covert use of anesthetic drugs at the Asclepian centers? In the image, a mosaic depicting Asclepius in the center and being greeted by Hippocrates

Of course, none of this should come as a surprise since Aristotle, Hippocrates, the Roman Celsus and the Roman Vitruvius all documented the healing powers of water. Here, for example, is Vitruvius, the first century BC Roman architect and engineer, on the optimum location for temples:

"…for all temples, the most healthy sites (must) be chosen and suitable springs of water in those places in which shrines are to be set up, for Asclepius in particular and for Salus and for those by whose medical power a great many of the sick seem to be healed.  For when sick persons are moved from a pestilent to a healthy place and the water supply is from wholesome fountains, they will recover more quickly " ( On Architecture, 1.2.7). 

Hippocrates observed that waters were either rain fed (as in lakes or marshes) or from subterranean aquifers (as in mineral springs emerging from rocks), and he theorized that their curative properties derived from their mineral content. So, not surprisingly, the classic Airs, Waters and Places, probably written by Hippocrates, not only mentions the therapeutic effect of water, but also those of air and microclimate: “climatotherapy” in today’s language.

To appreciate how advanced this understanding was, we need to realize that it is not until the nineteenth century, with Bradshaw’s 1882 Dictionary of Mineral Waters , a book with an eight-fold categorization of water types and their cures, that we find a similar focus on the healing properties of water. Today, the scientific knowledge is available to appreciate the power of mineral-rich waters and the way that these can be used to supplement the body’s natural supply of minerals, whether of iron, lithium, manganese, lead, copper, sulfur, chlorine, potassium, sodium and calcium. This knowledge shows how the absence or deficiency in one or more of these minerals can trigger an illness and how the use of water, externally and internally (through bathing or drinking water), can reverse illness. (Moss, 2010)

Telesphorus, son of Asclepius, is the god of plant-life and recovery from illness.

(ii) Plant-Based Medicines: Gifts from Telesphorus, the God of Plant Life

As we saw earlier, Aristides frequented Asclepian centers over a long period, describing his experiences in his Orations. There, we learn that one of Asclepius’s remedies was balsam juice, a medicine described as the gift of Telesphorus, the god of plant-life and recovery from illness, as well as being another of Asclepius’ sons. Interestingly, Telesphorus is occasionally shown in art holding a roll with medical prescriptions. Aristides also mentions the “king ointment” used for throat disease and containing the juice of the balsam tree and spikenard. The description also explains that Asclepius prescribed medicines he made himself, as well as medicines obtained on the market. This shows the wide range of herbal remedies available at the Asclepian centers.

This should not come as a big surprise since Asclepius was said to have been brought up by Chiron, the centaur, known for his healing skills. Chiron lived on Mount Pelion, which was referred to as the “healing mountain” on account of the medicinal plants grew there, including meadow saffron, hemlock, henbane, nightshade, mandrake, St. John’s wort, mullein and yarrow. Corroboration comes from the Greek author, Theophrastus (371-287 BC), who mentioned Asclepius’ use of herbal medicines in his Enquiry into Plants .

Dioscorides (40-90 AD), the Greek physician who travelled as a surgeon with the armies of the Roman emperor Nero, described the medical attributes of balsam and spikenard in his compendious work on herbal medicines, De Materia Medica , the leading pharmacological text until the 15th century. According to herbalist Christopher Robbins, “many of its recommendations have been verified today.”

Patients sleeping in the temple of Aesculapius at Epidaurus, Ernest Board.

(iii) Incubation Sleep and Surgery: Did They Use Anesthetics?

A further remedy was the form of sleep known as incubation sleep, something that patients would experience during the day or evening in a building known as the abaton, waking up to find themselves cured. Clues as to what was involved come from inscriptions, with case histories ranging from the cutting of a diseased eyeball, the removal of an abscess after cutting open the belly (with the floor of the abaton covered in blood), to the removal of an arrow point from a lung. One inscription describes how Asclepius appeared to patients in their dreams as a surgeon. Although some interpret the incubation sleep as operating at a purely psychological level, the reference to surgery may actually hold the key to what was really happening.

At the Asclepian center of Kos, twenty-four surgical instruments were found and several bronze medical instruments, including a saw and several scalpels. In fact, the evidence of both the inscriptions and the surgical instruments strongly suggests that surgery was carried out at Asclepian centers. There are three other clues which point in the same direction. First, as we saw earlier, one of Asclepius’ sons known as Machaon, was a specialist in surgery. Since dedications were made to family members at the centers, it would be strange if use had not been made of his skills. Secondly, the name Asclepius means “to cut open” and this epithet may have been applied to Asclepius because of his surgical skills and not simply, as some think, because he was the product of a Caesarean birth.

The name Asclepius means “to cut open.” Could this epithet may have been applied to Asclepius because of his surgical skills?

Thirdly, could it be possible that incubation sleep was brought about by the covert use of anesthetic drugs? If the public was unaware of anesthesia, they might assume that someone waking from a deep, death-like sleep was actually resurrecting from the dead. This would explain how Asclepius acquired the reputation of being “one who could charm back the dead man” (Aeschylus) and “heal any illness and resurrect the dead” (Pausanias in 2 AD). So widespread was this point of view, that Asclepius was credited with resurrecting not only King Tyndareus, but also Glaucus the son of Minos, Lycurgus the son of Pronax, and most famously perhaps, Hippolytus, son of Theseus and Capaneus.   That’s quite a list!

Of course, the $64,000 question is whether a suitable anesthetic existed during the lifetime of Asclepian temples? The answer is an unequivocal “yes”. The narcotic substances of opium and mandrake were described by ancient authors including Theophrastus (371-287 BC) and Dioscorides (40-90 AD). In terms of access to these plants, we have already seen that mandrake grew on Mount Pelion, the area in Thessaly where Asclepius learned the art of healing. Could it be that an understanding of mandrake was perhaps a part of this education?

Interestingly enough, elaborate legends sprung up around mandrake, with one warning of death to whoever uprooted the plant. As herbalist Christopher Robbins has written (1995), this may have been a strategy to keep people away from the plant and to enhance the reputation of the person using it. Of course, the ultimate way to enhance a person’s status was to keep mention of the use of anesthetic drugs under wraps and attribute the miraculous sleep and recovery to Asclepius. This example of medical wizardry is not a million miles from that of a professional who keeps the tricks of his trade to himself, declining to reveal the relatively simple methods used. In the case of Asclepius, the covert use of soporific substances would leave patients with the impression that the effect was achieved by the physician independently of any drug.

(iv) Recuperation: A Systematic Approach to Healthcare

Many Asclepian centers were situated on elevated sites with verdant surroundings, and included libraries, theaters and gymnasia. Canton has even written eloquently on the way that the trees, breezes and these other amenities facilitated recovery.

The elements that made up medical care at Asclepian centers created, collectively, a systematic approach to illness that embraced physical as well as psychological cures. All of these began with a physical diagnosis of the illness. It is this combination that explains the great success of Asclepian centers and their role as medical schools as well as hospitals, disseminating their systematic approach far and wide. Hippocrates based his medical school at the Asclepian center at Kos and Galen, the celebrated 2 AD Roman physician/surgeon, learned medicine at the Asclepian center at his birthplace, Pergamon.

Asclepian healing centers enjoyed renown for almost 1000 years, and their remains can be found across Greece, Asia Minor and Judea. Modern commentators have assumed that the methods used worked at a purely psychosomatic level, but an examination of the evidence reveals a range of physical treatments as well, including the use of herbal plants, balneotherapy and surgery, all rooted in used in a clean and hygienic environment. It also reveals the covert use of anesthesia.

This new analysis restores a sense of the rich offerings of ancient healing centers. However, it leads us to ask why this information has been kept from us for so long. As Voltaire said, “history is the lie commonly agreed upon.” Now it’s up to us to ask what other secrets are concealed by medical and religious establishments both past and present.