The Greek Island of Kos is forever associated with its most famous son, the physician and Priest of Asclepius, Hippocrates, known as “The Father of Medicine.”
He made such an impression on medical history that his name is still very much associated with medicine today. All newly qualified doctors take what is called the ‘Hippocratic Oath’ and some see Hippocrates as the father of modern medicine even though he did most of his work some 430 years before the birth of Christ.
Greek doctors had started to look at the issue of poor health and disease by using a process of reasoning and observation. The most famous of these was Hippocrates. He is thought to have been born in Kos in 460 BC. In fact, we know very little about Hippocrates as a person but his fame was such that Plato and Aristotle wrote about him.
Hippocrates and other Greek doctors believed that the work done by a doctor should be kept separate from the work done by a priest. They believed that observation of a patient was a vital aspect of medical care. Ancient Greek doctors did examine their patients but Hippocrates wanted a more systematic period of observation and the recording of what was observed. Today, we would call this ‘clinical observation’. Such ideas have lead to Hippocrates being called the ‘Father of Medicine’.
The Temple and Sanctuary of Asklepion is situated on the slopes of Mount Dikeos some 5km from Kos Town. Set among natural springs backed by fragrant pine woods, cooled by balmy breezes and overlooking the narrow straits to the Bodrum Peninsula in Turkey it still has the power to inspire. For in the ancient world this strait was a great maritime crossroad criss crossed by galleys from Egypt, Rome, Syria, Persia and many more and the straits which look upon modern Bodrum then looked on the great city of Halicarnassus, capital of Caria, birthplace of Herodotus, the father of History, and site of one of the Seven Wonders of the Ancient World, the Tomb of Mausolus, (Μαύσωλος) King of Caria, which gives us the English word, mausoleum.
Looking at the view today it is not difficult to envisage this ancient galley filled sea and the fertile island of Kos where the ancient people up to Roman Times and beyond stopped on their journeys. Here they stocked up on the fertile produce of this island, took on fresh water and salt and recovered from their voyages in the Gymnasia and Thermae whose ruins can still be seen on the island. And their sick and infirm were offloaded and taken to this famous Temple of Healing whose name was renowned in antiquity, The Asklepion of Kos.
It is impossible to overstate the influence that the Asklepion has had on the world for it is here that modern medicine was developed, a medicine based on logic and analysis of symptoms, a medicine based on holos, treating the whole person, ensuring they had good food, fresh water and air, stimulation and respect. A medicine that recognised the importance of a person’s psychiatric condition as part of their overall well being. This was done in a place which was a Temple, a spa, a sanatorium and a hospital dedicated to the Greek God of healing, Asclepios which is the prototype of all modern hospitals.
And it was also here that a priest of Asclepios laid down the principles of medicine. The principles which were lost in the Dark Ages, rediscoved, preserved and adopted by Arab practitioners in the City of Alexandria and by the Hospitaller Knights of St John. It is here that this priest of the Cult of Asclepios laid down the foundation of medical ethics that a Doctor must do no harm, treat all according to need and keep a patient’s details confidential. This priest laid down the Oath which is still taken by all doctors when they qualify. That oath is named after him “The Hippocratic Oath” and the priest of Asclepios was Hippocrates, known to history as “The Father of Medicine.”
Hippocrates was born around 460 BC on the island of Kos, Greece. He became known as the founder of medicine and was regarded as the greatest physician of his time. He based his medical practice on observations and on the study of the human body. He held the belief that illness had a physical and a rational explanation. He rejected the views of his time that considered illness to be caused by superstitions and by possession of evil spirits and disfavour of the gods.
The cult of Asclepios originated on the island of Kos (some sources also state the city of Trikala in the Greek region of Thessaly) and gradually spread throughout the whole of Greece and Asia Minor. In the classic Hellenistic period, shrines to Asclepios could be found in many small towns and also larger cities – around three hundred are known to date. The most important are to be found in the cities of Epidaurus and Trikala on the Greek peninsula, in Pergamon in Turkey, in Lebena in Crete and of course on the island of Kos in the Aegean Sea. Large numbers of pilgrims gathered at each of these healing shrines over the centuries from all corners of the ancient Greek world.
Situated west of Kos Town, Asklepion is the most significant archaeological site on the island. The excavations here began in 1902, by Iakovos Zaraftis from Kos and Hertsok from Germany. Asklepeio was built in a green area full of cypress trees. During the ancient years, it served as a sanatorium and it was dedicated to Asclepios, son of Apollo, protector of health and medicine. Many significant people taught and worked here including Hippocrates. Due to the steep ground, Asklepeio consist of four connecting levels, called “andira”. The first is characterised by ruins of Roman constructions of the 1st century AD. The second, where the medical school is said to have been housed, is known for its arches and statues. The spas were here and they were watered from the spring of King Halkon and the spring of Vournika on Mount Dikeos. The third level is where the Temple of Asclepios of Kiparissios Apollo (4th century BC) used to be. Excavations in the surrounding area brought to light an invaluable treasury for visitor’s offerings, a semi-circular platform and a small Roman temple dedicated to Neron. The fourth level was constructed in the 2nd century BC and included a large temple of Doric style along with the chambers of the patients.
For a man considered by many to be the “Father of Medicine”, little is actually known about Hippocrates of Kos. He lived circa 460-380 BC, and was the contemporary of Socrates as well as a practising physician. Historians have suggested that Hippocrates might have been an Asclepiad, a member of a guild of physicians whose origins trace back to Asclepios, the god of healing. He was certainly held to be the most famous physician and teacher of medicine in his time. Over 60 treatises of medicine, called the Hippocratic Corpus have been attributed to him; however, these treatises had conflicting content and were written sometime between 510 and 300 BC, and therefore could not all have been written by him.
However it appears he recognised and wrote about the treatment of psychiatric conditions;
“Men ought to know that from the brain, and from the brain only arise our pleasures, joys, laughter and jests, as well as our sorrows, pains, grief’s and tears. Through it, in particular, we think, see, hear and distinguish the ugly from the beautiful, the bad from the good the pleasant from the unpleasant. It.. makes us mad or delirious, inspires us with fear, brings sleeplessness and aimless anxieties … In these ways I hold that the brain is the most powerful organ in the human body.”
Hippocrates, From “THE SACRED DISEASE”
Asclepios was the God of medicine and healing in ancient Greek mythology, according to which he was born a mortal but was given immortality as the constellation Ophiuchus after his death. His name means “cut up,” and (perhaps incidentally) shares a root with the word scalpel. He represents the healing aspect of the medical arts, while his daughters Hygeia, Meditrine, and Panacea symbolise the forces of cleanliness, medicine and healing (literally, “all-healing”), respectively.
Occasionally he is also linked to his son Telesforos, who represents the powers of recuperation. He was worshiped throughout the Greek world but his most famous sanctuary was located in Epidaurus which is situated in the north-eastern Peloponnese. The main symbol of Asclepios is a physician’s staff with an Asclepian snake wrapped around it; this is how he was distinguished in the art of healing, and his attribute still survives to this day as the symbol of the modern medical profession.
The cult of Asclepios became very popular during the 300s BCE and the cult centres (known as an Asklepion) were used by priests to cure the sick. Invalids also came to the shrines of Asclepius to find cures for their ailments (in the same fashion pilgrims visit Lourdes today.) The process of healing was known as incubation. The patient would spend the night in a dormitory. During the night they would supposedly be visited by the god in a dream. Priests would interpret the dreams and then recommend a remedy or give advice on how they could be cured with perhaps a recommended visit to the baths and gymnasiums. There were many centres and schools of medicine, from Trikkis in Thessaly to the island of Kos.
The Asklepion of Kos seems to have been established in the 4th century BC on the sides of a low hill with a view towards the sea of Asia Minor. It was located close to the ancient city of Kos in an open area with running water, close to the springs of Bourinnas and Red Waters. It was surrounded then, as today, by fragrant pine woods. The Asklepion of Kos is connected to the works of one of the most important representatives of medical science, Hippocrates (460-380 BC). Hippocrates established the Medical School of Kos as well as the other Asclipia. Initially he followed the traditional therapy of the times. A priest would come and examine the patient in detail and then they would cleanse the patient and then offer sacrifices.
According to the traditional religious therapy, God would then appear in the patient’s dreams and cure their worries and their illnesses. As compulsory payment the patient had to sacrifice a rooster. The practice was followed during the early Greek period but later the Asklepion and its cadre of priests developed a methodology based on systematic diagnosis and examination of symptoms. They thoroughly examined and observed the patient relying on autopsia, “to see for oneself”, derived from αυτος (autos, “oneself”) and όψις (opsis, “eye”). If a patient died then their body and organs would be systematically examined in a procedure autopsia cadaverum, which gives us the modern meaning of autopsy. From their observations and examinations the Medical School of Kos recorded cancers, tuberculosis and many other diseases. These and the treatment of them were recorded in the Hippocratic Corpus which is the foundation of modern medicine based on systematic diagnosis.
Research to find the Asklepion began at the end of the 19th century and was discovered at the beginning of the 20th century by the German archaeologist Rudolf Herzog aided by the Kos historian Jacob Zarrafti. Zarrafti noticed that one of the small Byzantine temples was dedicated to the Tarsou Virgin Mary. He assumed that the name Tarsou was a word used for “woods” and was referring to the “woods of pine trees” which were adored by Kiparisios Apollon. In combination with the ancient springs it indicated the possible position to Herzog and in 1901 excavations began, which then continued till 1905. The excavation continued in the 1930’s under the Italian Archaeological Mission which led to further reconstructions which still stand today. In the area which later became a sanctuary, there was initially an area of worship for the curing expert Peionas and Apollo, Asclepios’s father. Other gods were worshipped at the Asklepion such as Zeus, Ikesios, Athena Fatria and Apollo Karnios, while in the 4th century BC the worship of Asclepios was also included and an altar was constructed in his honour.
The worship of Asclepios proved to be one of the most important public worships of Kos during the 3rd and 2nd century BC, especially after 242 BC the year when Kos declared the Asklepion a sanctuary which protected from attacks or interference of any kind. They also established the Great Asclipia, a celebration where musical and gymnastic competitions were held in which all Greek cities took place. During this period the sanctuary was developed as a unified group of buildings with the aim of promoting the worship of Asclepios and it gradually expanded into three smaller buildings, the lowest of these (93 x 47 metres) which was surrounded by arcades. The centre of worship initially consisted of the altar of Asclepios, his son Mohoana and Igeia. South of the temple a square building was added, the Avaton, this may have functioned as a cemetery for the patients. In the eastern part of the altar an arcade was constructed (length 17m and depth 6.5m) where votives were placed towards the North in a semi-circle for outdoor gatherings.
At the beginning of the 2nd century BC the Asklepion was placed under the protection of King Eumeni the second of Pergamou and gained the appearance it has today. It developed into three successive smaller buildings which contained an entrance, arcades, temples, altars, sacred woods, and other smaller different items of worship and buildings, while monumental stairs connected the different levels. The entrance to the group of buildings was through a monumental four column gateway around 11,5 metres wide. The wooden arcades of the lower building were replaced by Doric style stone arcades which were gathering points for the many pilgrims. In the 1st century AD the first level was built which contained toilets, known as Vespasian’s, springs and a library. At the same time a small chapel was built belonging to the Kos doctor Gaiou Stertinou Xenofontos, who lived in Rome and was the personal physician of the Roman Emperor’s Tiberius, Claudius and Nero. The springs, the water supply and the library were endowed by him.
In the 3rd century AD a large group of springs were added to the eastern side of the lowest buildings. In the second building an area was transformed and decorated with statues and fountains necessary for the ceremonial therapies. In the 2nd century AD during the Antonian Age another temple using Corinthian design was added and was dedicated to Apollo. Finally a bigger and more impressive central area was reconstructed. It led to the last building where a large Doric temple was built and dedicated to Asclepios, which was a copy of the temple of Epidaurus, the other great centre of healing in the Peloponnese.
A monumental area which led to the higher building was surrounded by arcades of Doric design in a Π shape with a Doric temple in the centre. During the Byzantine period, possibly the 11th century, a church was built, Panagia Tarsou, which was part of the Patmos monastery. The area continued to function for some time as is shown by the coins found during the 4th century AD. It was abandoned after the earthquakes which occurred in 469 to 554 AD. In the 15th century the Asklepion suffered the indignity and great damage by the Knights Saint John of Jerusalem who treated what they considered as a pagan temple as a quarry to build their 4 fortresses which protected the Island of Kos from the Turks who overran Byzantium. Across on the mainland of Asia at Halicarnassus (Bodrum) the great tomb of Mausolus suffered a similar indignity providing the dressed stone for their fortress of St. Petrium.
In the centre of Kos Town in what would have been the Colacchio, the walled town of the Knights ironically built with the stone from the desecration of the Asklepion on top of the Roman Agora stands the famous plane tree of Hippocrates in front of the Castle of the Knights. It is a huge tree, with a perimeter of twelve meters, which is considered to be the largest in Europe. The inhabitants claim that it was planted by Hippocrates, the greatest doctor in antiquity, who used to teach his students who travelled from all over the ancient world under its shade. According to tradition, the Apostle Paul also taught there. On this site, cultural festivals are held each summer. Most probably the tree which stands on the site was seeded from Hippocrates tree as it is around 700 years old. This place and the connection with Hippocrates was treasured by the Ottomans who ruled Kos from 1522 to 1912 as it was beautified with the Loggia (Hassan Pasha) Mosque, and an ablution font and drinking fountain.
Hippocrates and his followers were first to describe many diseases and medical conditions. He is given credit for the first description of clubbing of the fingers, an important diagnostic sign in chronic suppurative lung disease, lung cancer and cyanotic heart disease. For this reason, clubbed fingers are sometimes referred to as “Hippocratic fingers”. Hippocrates was also the first physician to describe Hippocratic face in Prognosis. Shakespeare famously alludes to this description when writing of Falstaff’s death in Act II, Scene iii. of Henry V.
Hippocrates began to categorize illnesses as acute, chronic, endemic and epidemic, and use terms such as, “exacerbation, relapse, resolution, crisis, paroxysm, peak, and convalescence.” Another of Hippocrates’ major contributions may be found in his descriptions of the symptomatology, physical findings, surgical treatment and prognosis of thoracic emphysema, i.e. suppuration of the lining of the chest cavity. His teachings remain relevant to present-day students of pulmonary medicine and surgery. Hippocrates was the first documented chest surgeon and his findings are still valid.
Perhaps the most enduring – certainly the most quoted – tradition in the history of medicine is the Hippocratic Oath. Named after Hippocrates, this oath was written as a guideline for the medical ethics of doctors. Although the exact words have changed over time, the general content is the same – an oath to respect those who have imparted their knowledge upon the science of medicine, and respect to the patients as well as the promise to treat them to the best of the physicians’ ability.
The question is – why has such an old bit of writing, descended from ancient times, so profoundly influenced the practice of medicine throughout the history of medical science? Anthropologist Margaret Mead wrote:
“For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and the sorcerer tended to be the same person. He with the power to kill had power to cure, including specially the undoing of his own killing activities. He who had the power to cure would necessarily also be able to kill…With the Greeks the distinction was made clear. One profession, the followers of Asclepios, were to be dedicated completely to life under all circumstances, regardless of rank, age or intellect – the life of a slave, the life of the Emperor, the life of a foreign man, and the life of a defective child…”
G E R Lloyd said of Hippocratic medicine: ‘In the Western world, the name Hippocrates has always stood for an ideal.’ And this is what the oath is all about – an ideal gold ethics standard representing a clear dividing line separating healers and killers, a commitment that physicians make to protect life, and never to take life away deliberately. In a world where society is always attempting to put the blame on physicians when things go wrong, this oath, when upheld, would protect not only physicians and their patients, but also their families and the society as a whole.
THE OATH OF HIPPOCRATES
“I swear by Apollo the healer, by Aesculapius, by Hygeia and Panacea and by Health and all the powers of healing, and call to witness all the gods and goddesses that I may keep this Oath and Promise to the best of my ability and judgement.
I will pay the same respect to my master in the Science as to my parents and share my life with him and pay all my debts to him. I will regard his sons as my brothers and teach them the Science, if they desire to learn it, without fee or contract.
I will hand on precepts, lectures and all other learning to my sons, to those of my master and to those pupils duly apprenticed and sworn, and to none other.
I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it.
I will not give a fatal draught to anyone if I am asked, nor will I suggest any such thing. Neither will I give a woman means to procure an abortion.
I will be chaste and religious in my life and in my practice.
I will not cut, even for the stone, but I will leave such procedures to the practitioners of that craft.
Whenever I go into a house, I will go to help the sick and never with the intention of doing harm or injury. I will not abuse my position to indulge in sexual contacts with the bodies of women or of men, whether they be freemen or slaves.
Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one.
If, therefore, I observe this Oath and do not violate it, may I prosper both in my life and in my profession, earning good repute among all men for my time.
If I transgress and forswear this oath, may my lot be otherwise.”
Imagine you are the Centurion Fabius Valens who was embarked on a galley with wounds and feeling ill at Alexandria in the Roman Province of Egypt. Four weeks later after a rough voyage and developing a fever you are disembarked near to death’s door at Kos. You are taken to the most famous place of healing, where the Emperor’s own physician worked. There, midst fresh air and health giving springs, the priests of Asclepios examine you and bind your wounds, lower your fever and anoint you with healing balms. You are fed well with the freshest produce from this fertile island with its kind climate and lack of disease causing insects. You are bathed in and drink the health giving waters rich with minerals and oxides and the priests of Asclepios treat your nerves and put your mind at rest. Eventually you have recovered from death’s door and are healthy again to walk to the Temple of Asclepios on the top level of the Asklepion of Kos to sacrifice a rooster and make a burnt offering, holos caustos, to the Gods in thanksgiving for your deliverance. In Kos while waiting for your galley you are once again well enough to indulge in the Thermae, Gymnasia and even the brothels for which this Island of Health was famous in Roman times. Before embarking on a galley for Rome you buy your wife, who hasn’t seen you for four years, some of the translucent silk “Coan Draperies” which were Ancient Rome’s saucy gifts and some well crafted gold piece for which the Island was also renowned. Back in Rome you tell family and friends that you, Fabius Valens, were smiled upon by the Gods who brought you to the shrine, sanatorium and hospital of The Asklepion of Kos to be treated by the priests of Asclepios in one of the greatest centres of healing in the ancient world. The fame and reputation of this fabled place would only increase in the minds of Fabius’s audience.
The Asklepion you see today was restored by the Italians in the 1930’s who built the modern retaining wall and the stairway to connect the levels but also to give a sense and feel of the ancient structure. The Greek contribution since has been entirely slight with the facilities largely provided by a private cafe at the entrance and the staff who take you five Euros entrance fee largely disinterested. The municipality of Kos provides a mini-train service from the harbour which is an entirely pleasant way to make the trip through the Muslim village of Platani (Kermetes) past the Jewish and Muslim cemeteries to the Asklepion. The site is crying out for an interpretative centre, proper signage, disabled toilets and access and maybe (although the lazy Archaeological Ministry will consider this hyperactive) guides on each level to engage with visitors and explain the site – there are plenty of talented multi-lingual young people in Greece who would relish the task unlike the indolent present staff who have their jobs because of who they know. So what was they response of the great centralised Greek heritage bureaucracy in Athens to visitor needs? Why, with EU grants, they have installed at great expense electronic card operated gates (which don’t work) and electronic “information” screens (which also don’t work). It reminds me that “Idiotis” is also a Greek word. The sooner the stranglehold of the Hydra of the Ministeros Idiotis on visitor attractions is broken and they are given to somebody actually interested in visitors and capable of running them, the better for Greece and its visitors.
It is impossible to overstate the influence that the Asklepion of Kos has had and continues to have on all our lives. It is here that modern medicine was developed based on diagnosis and recording whether and how treatments worked. It is here that disease was understood to be the result of logical factors which could be treated rather than the random whims of the Gods. It was here that this information was recorded for posterity and taught to future generations to build on this understanding. It was here that the handmaidens of Asclepios, Hygeia and Panacea, were incorporated into cleanliness which stopped the spread of disease and pain relief which lessened the suffering. It was here that the physicians treated the Holos, the whole person, guided by the teachings of the Father of Medicine who said “Let food be thy medicine and medicine be thy food.” It is here that they put into practice his teaching that the mind can be diseased and can also cause disease. It was also here with the Oath of Hippocrates that the first profession emerged. Men, who must keep themselves apart and set an example, do no harm, never exploit their patients or their position, pass on their knowledge and whose duty of care was to their patients whose details they must keep secret.
Every hospital and clinic in the world is based on the teachings of the Asklepion of Kos; every Physician who qualifies takes an Oath which is still based on the principles outlined by Hippocrates and everybody who has been a patient is treated according to the principles of respect for their personal integrity developed here. It can only be summed up in two words we get from the Greeks; Logic and Ethics.
See also Kos Town;
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