natural treatment for the disease cystic disease

prof: without more ado,then, we'll turn to our topic of the morning,which is about the first embodiment of a rationalscientific medicine, which is rather anextraordinary one because it lasts from the fifth centuryb.c. down to the nineteenth centuryas a dominant--not exclusive--but a dominantmedical scientific paradigm. it was associated with thisidea 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 377b.c. now, there's some debate aboutwhether he was one person or a school, a group,of people. there is a corpus ofhippocratic writings that consists of about sixty works,perhaps by multiple hands. but that issue won't reallyconcern us.

we're concerned withhippocrates 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 hippocraticoath. we'll be talking about suchother works as on the sacred disease, on humannature, epidemics, on airs, waters,places;

and he also had a collection ofaphorisms. one would note the variety ofthe hippocratic corpus. it consists of a whole seriesof things. he/they invented casehistories, and they're included. there are lecture notes. there are memoranda of allsorts; writings on every form ofmedical practice at the time: surgery, obstetrics,diet, the environment, therapeutics.

all of that forms part of thehippocratic corpus. so, enormous variety. in terms of what hippocratesaccomplished, i'd like to make a contrast,and that is with the supernatural view of disease. and the first form we couldthink of that, in drawing our contrast--thecontrast to what hippocrates accomplished--we can see it in terms of the breakthrough from something thatpreceded it and went alongside

it,down to our own day, and this would be first of allthe supernatural view of disease;that epidemics and pestilence are divine punishment sent by anangry god for sin and disobedience. you can see this in many partsof our culture. it's embodied in the bible,for example. in genesis, you know that adamand eve lived happily and enjoyed eternal life in thegarden of eden,

until they committed the sin ofeating of the forbidden tree of the fruit of knowledge of goodand evil, and as a result this wasoriginal sin and they were kicked out of the garden ofeden. from then on for things theyhad to work. they also became subject todisease and to death. they were immortal until thattime. so, we see in genesis theembodiment of this idea that diseases are a punishment ofsin.

this was also clear--you canread further in the bible, in the book of exodus,where you learn about the bondage of the israelites inegypt and god asking for moses and aaron for the pharaoh torelease his chosen people. but the pharaoh's heart washardened and so the egyptians were punished with this seriesof terrible plagues that are all in exodus. another way of embodiment ofthis was in psalm 91, and this is of particularimportance to us--let's move to

share this with you. this is the text of psalm 91. this is particularly importantbecause it embodies the idea of plague and pestilence as apunishment by god. but also in terms of ourhistorical experience, as you're reading daniel defoe,you'll realize that it's psalm 91 that was read out from thechristian churches during times of epidemic. this was the great plague psalm.

it embodies hope and aninterpretation of what the experience of plague was allabout. let me read part of it here. "thou shalt not be afraidfor the terror by night, nor for the arrow that fliethby day, nor for the pestilence thatwalketh in darkness, nor for the destruction thatwasteth at noonday. a thousand shall fall at thyside, and ten thousand at thy right hand, but it shall notcome nigh thee.

only with thine eyes shall thoubehold and see the reward of the wicked. because thou hast made thelord, which is my refuge, even the most high byhabitation. 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 anotherembodiment 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 hisown, and as a result,enraged, achilles withdrew from combat and sulked in his tent.

now, he had a friend who was apriest of the god apollo, and this friend tried tointervene and beseeched agamemnon to write the wrong andreturn the woman. but agamemnon rebuffed apollo'spriest; or as we might say,he dissed him. and, so, what we have here isthis tremendous and terrifying scene at the beginning of theiliad. let me just quote from thebeginning then. "over and over the old manprayed 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 thedanaans pay for my tears shed.' so he spoke in prayer,and phoebus apollo heard him, and strode down along thepinnacles 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 thebow of silver. first he went after the mulesand the circling hounds, then let go a tearing arrowagainst the men themselves and struck them. the corpse fires burnedeverywhere and did not stop burning." so, that was apollo punishingthe greeks on behalf of his

priest. or let me also mentionsomething, an example, that's more recent and closerto home; that is, i want to talk for aminute about a yalie. and this is our friend herejohn 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 anda group of his friends decided that they were going to renouncesin all together, and they called themselves theperfectionists. and they founded an idealcommunity, 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 inharmony and peace,

forever, as eternal people. and every morning began with amutual criticism in which they pointed out each other'sfaults-- this must have been a lot offun--in order that they not fall by the wayside and lapse onceagain into sin. well, i'm sorry to tellyou--this was the 1840s-- by the 1890s the idealcommunity had become instead a joint stock company,and you still have oneida pottery and silverware.

and i'm very sorry to reportthat all of the members of the community have been buried. i don't know if that wasbecause they couldn't stick the pace, or if the concept waswrong from the outset. in any case,this was an embodiment, then, of the idea of disease asa punishment for sin. but if we view this view ofpestilence as divine punishment, it does at least imply alaw-governed cosmos. disease exists for anintelligible reason,

and it implies a rationaltherapeutics, which is repentance:propitiation of god, amendment of conduct,and renewed obedience to the laws. there's another variation of asupernatural view, which is more capricious,and let's call that the demonic theory of disease. this postulates that the worldis populated by powerful arbitrary and evil spirits whocause disease through their

malign influence. these may be evil persons,such as witches or poisoners, the disembodied spirits of thedead, superhuman beings, or the devil himself. we'll see this view throughoutthe course, the idea that epidemic diseases are diabolicalplots, not natural events. there's some occult secretcrime 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 theseventeenth century and in our own country at salem. but the idea was clearlyexpressed in europe by martin luther who declared,"i would have no pity on the witches. i would burn them all." alternatively--that was a goodtherapeutic idea-- alternatively a person could bedeemed to be inhabited or

possessed by an evil spirit,and in that case the cure was to cast out the devil throughexorcism. and this cosmology survives inour own language when we talk today about someone acting"like someone possessed,"or "out of his mind." and healers pursuing thesesorts of ideas would invoke magic, or have incantations. they'd prescribe specialconcoctions, chants, sacred rites and spells.

and in european history,a relatively recent illustration of that idea wasthe idea of the healing power of the royal touch. charles ii of england,for example, administered this treatment inthe seventeenth century to about 100,000 people. so, healers could do that. they could also recommend magicpractices, 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 talkingabout later. so, if you hold that up--thosetwo views, then, of supernaturalinterpretations of disease-- then you can understand thebreakthrough that was made in fifth century greece. this was in contrast to thesupernatural divine and demonic

theories, and it's in contrastto them that we can see the importance of a new idea;the idea that disease instead is a naturalistic event that canbe understood by natural causes. examples of this new,naturalistic, secular view abounded in thefifth 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 anatural event, and is described as such bythucydides, 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 veryfamous example, and dramatic one,of hippocrates, on the sacred disease.

by the sacred disease he meantepilepsy, and it looks--i guess if you wanted any disease--itlooks like a possession by a demon. it is epilepsy. and hippocrates wants to tellus that this is not a supernatural event,or a possession. he says instead somethingextremely different. what he tells us is that:"it is thus with regard to the disease called sacred.

it appears to me to be no wisemore divine or sacred than other diseases, but has a naturalcause, like other afflictions. men regard its nature and causeas divine, from ignorance and wonder. and this notion of its divinityis kept up by their inability to comprehend it. neither truly do i count it asa worthy opinion to hold that the body of man is polluted bygod; the most impure by the mostholy.

for were the body defiled,it would be likely to be purified and sanctified,rather than polluted. those who first referred thismalady to the gods appear to me to have been just such personsas the conjurers, mountebanks and charlatans are. such persons then,using the divinity as a pretext and screen for their owninability to afford assistance, have given out that the diseaseis sacred." this was a very majorbreakthrough conceptually,

the beginning of the foundationof 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 thismomentous step in human consciousness was expressed by ayale professor of epidemiology in the 1940s,charles-edward winslow, who wrote--and let me quote asentence or two from him. "if disease is postulatedas caused by gods,

daemons or demons,scientific progress is impossible. if it is attributed tohypothetical humors, the theory can be tested andimproved. the conception of naturalcausation was the essential first step. it marks incomparably the mostepochal advance in the intellectual history ofmankind." that perhaps is putting it alittle strongly,

but you certainly get thepoint. now, why perhaps was there arational scientific medicine in fifth century greece? here i think the main part ofthe answer has to be imponderable factors such as theinspiration of hippocrates himself, and his associates. but there were influences wecould point to as important: the absence of a priestlybureaucracy, with the power to sanction heretics;the centralized city states;

the legacy of greek naturalphilosophy, the work of plato and aristotle in particular;a culture of individualism. and i think we also need toremember the hippocratics' positions. although they were known totreat the poor and slaves, their care was not by and largeavailable to the masses. the primary clientele consistedof educated, prosperous elites in ancient greece and ancientrome, and this was a medical philosophy that suited them.

the educated doctor and theeducated patient spoke the same language,and the therapies that the physician proposed,such as a special diet or rest, were remedies the wealthy couldafford. we should say that hippocraticmedicine is still with us. we can see it in the return toholistic medicine. we can see it also in themuslim world, and you can still be treated inunani medicine by a hippocratic style medicine.

and you can see it in certainpopular cultural precepts, such as "feed a cold andstarve a fever." well, if that's its importance,let's look at its content. what was the content of thisfirst embodiment of scientific medicine? and it was humoralism. here let's talk about what thatis. the fundamental assumption wasthat there's a correspondence between the macrocosm of theuniverse and the microcosm of

the individual body. both are composed of the samematerials, subject to the same laws, and disorder can occur inone and be followed by disease in the body. according to aristotle andnatural philosophy, the macrocosm consisted of fourelements that you can see here. they were earth,water, air and fire. and each of the elements isassociated with four qualities, which can be dry and hot likefire;

or dry and cold;or cold and wet; or wet and hot. so, the elements embody alsofour qualities, in different proportions,of course. and this went on over thecenturies, and there were four seasons, four winds,later on four evangelists. the point for us is there wasalso a microcosm, and one can see the theoryexpounded on human nature in which there are four humors,which are phlegm,

black bile, yellow bile andblood. and each of those--also thebody is composed of these--and each has qualities of as beingwet and cold, or hot and dry. this also determines--thebalance of these humors in the body--the four temperaments:whether you're melancholic, phlegmatic, choleric orsanguine. those words survive in ourculture. 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 deductivereasoning from first principles. central, of course,to all of it was the climate of greece, with its seasonalpatterns and its specific patient population. many were malarial victims withthe complications of pneumonia. and hippocrates,indeed, was the world's first

malariologist. now, health consisted--wascalled eucrasia, which meant a balance orequilibrium of the humors, and therefore the qualities. and variations are possible,up to a certain threshold, and at various times in yourlife--or from one person to another--the balance among the four humors can change. but once you cross a certainthreshold in variation--

that is, one humor becomesoverly dominant, or one humor is lacking insufficient 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 isthen. it's an imbalance of the humors. note that there is nosingle--that is to say there aren't discrete individualdiseases, as in modern medicine;

that is, disease is classifiedas typhoid, cancer, pneumonia, and all the rest. disease instead was a holisticphenomenon 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 constitutionthen had contact with the air,

which might be corrupted,or "miasmatic," as it was called later. motion, or what we might callexercise, 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-naturalsthat could tip the body into disease. restoring health was based inpart on nature itself;

that is to say,there's a teleology of the body, embodied in the phrasevis medicatrix naturae;which is the healing power of nature. and the means to restore--thebody, in other words,strives to restore equilibrium, through its innate heat orthrough 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 humorthat's making you sick because of its excess. so, this led then to humoraltherapeutics. and let's talk about that. the basis of medical strategywas that the physician was the ally of nature,and of the body. the body was trying to restoreitself to health, and the physician would join itin doing battle against disease. he would read the signs todecipher 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 treatmentwhere you didn't treat individual symptoms,but the whole constitution. and it also had an idea of theindividualism of the patient.

treatment should be tailored tothe constitution of the individual. there are no disease entities,because disease is not a thing but a process. this was a medicine that wasrather indifferent to diagnosis or classification. what it stressed instead wasthe answer to the patient's eternal question,"am i going to be all right doc?"

prognosis was what reallymattered to the hippocratic physician. the therapeutic principle wasthat opposites treat opposites. so, if you have an excess of adry 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 toingest that would be wet and hot;and hot in this case, think of it not simply as thetouch.

we think of it when we talkabout spicy food as being hot. all the elements that you havealso have qualities, and so diet is very importantto this therapeutics. the tools available to thephysician, then, are first of all diet. in some sense the hippocraticphysicians thought we are what we eat,and all foodstuffs had qualities--hot,cold, moist, dry--to balance an oppositedefect 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 promoteevacuation by providing emetics, sudorifics, purgatives ordiuretics.

and most important perhaps wasa primacy of venesection-- by which i mean bloodletting orphlebotomy-- that became the hallmark of theorthodox 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 doubtsabout venesection. let me just mention some of itsadvantages in the eyes of hippocratic physicians.

it was systematic,like disease itself. its effects were immediate andyou could control them. it was speedy. its limits were alsoself-evident to the experienced doctor. perhaps the patient fainted,the pulse disappeared, or the color of the bloodaltered. there were however,of course, contraindications to bloodletting:old age and efficiency of

blood;the summer heat; evacuation already occurring byother means; or extreme cold. so, the lancet,the instrument for bloodletting--there we have real lancets--became the symbol ofthe orthodox physician, down through the nineteenthcentury. now, note that there is no realhumoral physiology, no idea of the circulation ofthe blood.

the heart is not a pump but afurnace, drawing air from the lungs, heating it anddistributing it as innate heat so, this was the firstembodiment of scientific medicine. i want to talk about analteration that it went through, through the second father ofmedicine. and this is another greekphysician, who lived however in ancient rome,and that is galen. and that's a picture.

now, his personal--he lived inthe second century a.d., from 130 to about 201,with his formative years being lived out in rome. his personal qualities areimportant. he was very different fromhippocrates. hippocrates was a greatobserver, an empiricist. galen instead prided himselfabove all on his knowledge of the texts of hippocrates. he almost worshippedhippocrates, but regarded

himself as the authorizedinterpreter of hippocratic works, which he turned into adogma. now, in rome,galen was physician to the gladiators. his personal position helpsexplain his influence. he then became private doctorto the emperor. and he regarded himself as theideal physician, philosopher and scientist. he was a man of over-weaningself-confidence,

who had nothing but witheringscorn for his opponents and colleagues,whom he called "murderers, amateurs, unversed inhippocratic wisdom." he called them "moreignorant than animals." it was true also that galen hadan encyclopedic knowledge, and we can only understand hisinfluence if we remember that he was a man of immense knowledgeof all branches of the medicine that existed at his time. and only half of his writtenworks survive,

but they alone fill twelvevolumes 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 wasforeign to us of the meaning of scientific progress. to him hippocrates was thepermanent foundation of medical science, and the main tenets ofthat science could never be

overturned or revised. instead, there was no room inhis thinking for scientific revolutions. the writings of hippocrateswere valid forever. they could only be completedand perfected. and, in fact,that was galen's view of himself. he was the person who perfectedhippocratic ideas. so, in fact,further progress was probably

unnecessary and perhapsimpossible. so, galen became theauthoritative interpreter of hippocrates. this is what we might callgalenism. and in his hands,hippocrates became a cult figure, an object of venerationand 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 ofwisdom, courage, temperance, humanity andhonesty. mythologies developed about hisreligious piety, his heroism and his hard work. there was a legend that he wasdescended, on his father's side, from the god asclepius,and on the maternal side from hercules. he was said to be a greatpatriot who saved athens from the plague, a man who scornedmoney and was perfectly wise and

perfectly just. so, he became one of thegreatest cultural figures of antiquity, an equivalent,in a different way, of socrates,plato and aristotle. now, probably some of you arewondering-- we've talked about humoralismand its advocates, and you want to know,"well, that's all very fine;did it work?" i'd like to say that humoralismhad a number of strengths.

it was a quantum leap frommagical thinking to naturalistic explanations of disease. it appealed because it wasaccessible to educated laymen. contemporaries with aneducation understood everything that hippocratic and galenicdoctors said and prescribed. it was consonant withcontemporary understandings. we also need to know thathippocratic and galenic physicians practiced therapeuticmodesty. they did not participate insurgery except,

for example,for setting bones, lancing abscesses andpracticing venesection; but the internal cavities ofthe 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 presentthemselves in a clinic have self-limiting illnesses,or psychosomatic ones, and mostly need reassurancethat everything will be all right. so, the point about hippocraticmedicine was that experienced physicians,accustomed to seeing ill people, would be pretty good atprognosis and reassurance. they would refuse to treatcases 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 justa second. there were, however,a number of weaknesses. so, hippocratic/galenicmedicine had a number of powerful strengths. it provided a lot in terms ofreassurance and prognosis, and the answer to that eternalquestion,

"will i be all rightdoc?" and the other question,"what can i do to help myself?" there were a number ofweaknesses. it was a closed system. it was based on deductivereasoning, and came to be bound up in the authority of theancients, with empiricism fading away;and indeed in later centuries it comes to be called"library medicine."

it was anchored in a cult ofpersonality-- the cult of galen,and through him of hippocrates--and practiced a cult of antiquity, with knowledge almostbecoming a form of revealed truth. so, galenism involved authorityand tradition, an elite medicine ofuniversity-trained physicians who were involved,particularly in their training, in studying the classics.

how do you train a physician? you have them read hippocratesand galen, in the original languages. i don't want to say,however, that there were no challenges. it's extraordinary to reflectthat humoralism, as a dominant medicalphilosophy, persists into the nineteenth century. but i don't want to think thatit was unchallenged.

we know there were demonic andreligious views that ran alongside. but in addition,there were a series of scientific challenges thatoccurred in a number of major shocks to the system that slowlyweakened its hold and gave rise to doubters,but did not thoroughly dismantle humoralism until thelate nineteenth century; and even then it persists inpopular culture and some forms of alternative medicine.

what were some of thesechallenges? i don't expect you to rememberthese at this point; we'll come back to them laterin the course. but just so that you'llunderstand that it wasn't as though this system never hadchallenges. 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 alltogether. william harvey discovered thecirculation of the blood, which overthrew or challengedgalen's anatomy and his physiology,which were proved not to correspond to the observedresults of dissection and pathology. so, the discovery of thecirculation of the blood was a major blow;although, oddly enough harvey

himself never rejectedhumoralism, hippocrates and galen. then there was the scientificrevolution. and in particular one can thinkof the chemical revolution associated with men like josephpriestly and antoine lavoisier. they destroyed the aristoteliannotion of elements. earth and air,for example, were found themselves to becomposed of a great number of modern elements that go to makeup what we know as the periodic

table. and more generally,the scientific revolution marked a democratic turn fromauthority to empirical evidence, and it envisioned scientificand medical knowledge as infinitely expandable and notbounded by set texts. and then, from the point ofview of our course, the experience of epidemicdisease, as we'll see,made the idea of dyscrasia improbable as a mechanism neededto explain epidemic disease,

because it's fairly flimsy as abasis 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 epidemicdisease is important, and we'll see the physician,fracastoro, came up with the idea ofcontagionism many centuries ago. in the nineteenth century we'llsee also, with the development of pathology,the idea of disease

specificity;and finally in the late nineteenth century the germtheory of disease, which offers an entirelydifferent paradigm for disease. so, that's the journey we'll betaking, to the time when humoralism isreplaced, and we'll look at variousembodiments along the way of what people considered to bescientific medicine. but here a number of you willbe thinking that i've involved myself in an importantcontradiction,

and you'll be thinking aboutasclepius and the fact that i talked about temples and a god. and in particular let's lookat--that's the god asclepius, and this is the--i'll talkabout who he is. hippocrates and galen were bothpious 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 mightcall the world's first referral

system. asclepius, who was he? he was first a moral hero whobecame half human and half divine, and then entirely a god. he was thought to be thekindest of the gods; the one who loved humanityenough to sacrifice himself for their sake. his father was the god apollo. his daughters wereinterestingly named the

goddesses panacea and hygieia. and physicians in the ancientworld might call themselves asclepiads, meaning the sons ofasclepius, who regarded their father as a patron saint. by the time of alexander thegreat, greece possessed three to four hundred temples dedicatedto asclepius. asclepius was said to have beenkilled by zeus because he taught mortals the art of healing andzeus feared that men and women would compete with him in nolonger being subject to death.

but asclepius never practicedmagic. he was merely the most skilledof physicians, using the same principles thatasclepiads, 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 withchristianity for a number of centuries. and like christ,after death he was said to have

risen and to be presenteternally in the temples. so, the temples were shrines toasclepius, 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 atpergamon. 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 ofidentifying yourself with asclepius was that there was--itprovided physicians with a badge of identity, a source ofauthority. they were wandering peripatetichealers, but now they're recognizable as members of thesame guild. this gave them a collectivepresence and authority, and asclepius also vouched fortheir ethical conduct. remember, these are peripateticphysicians whom you invite into your home.

and, so, they needed to havesomeone vouch for them, and he vouches that they'regood doctors and that they have special care for the poor whocan't pay him. but again, there is nocontradiction with naturalistic the temples were precursors,in a way, to health spas, sanatoria or hospitals. there they provided care forthe poor and the seriously ill. patients could enter them,the precincts of these compounds, after a period ofpreparation in which they

bathed, fasted,prayed and offered sacrifice. but the therapeutic strategycomes 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 atnight you'll have a dream. this is the incubation,and the god asclepius will appear to you and tell you thestrategy you should pursue in

order to become well again. but the strategy was nothingother than what a skilled physician would have prescribed,had he been skillful and wise enough to have known. there was never a treatmentprescribed by asclepius by magical means or miracles,or by practices that weren't accessible to the ordinarydoctor. 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 usedas a lens to view the experience of terrible epidemiccatastrophes. and we'll look also at the wayin which the experience of bubonic plague and otherepidemics challenged or raised major questions about humoraltheory, and helped propel thescientific medical elite towards a different view of disease andwhat it was. so, we'll see epidemics,beginning next time,

as a process. and we'll also want then toexplain it, and we'll look at bubonic plague as the first ofour major epidemics in our course.