The personality of Hippocrates dominates so completely the development of ancient Greek medicine, and it is so intimately connected with the island of Cos, that it is worth while to approach the subject from the archaeologic end.
In spite of its smallness, Cos was the cradle of many physicians,¹⁰³⁰ and yet this is very puzzling. Hippocrates and his brethren seem to have practiced their art not so much in Cos as in other parts of Greece very distant from it. If we define Hellas, stricto sensu, as the islands of the Aegean sea and the lands surrounding it — Greece proper in the west, the Balkans in the north, Ionia in the east, Crete in the south — we find that Cos was near to the southeast corner of that area, and the Hippocratic physicians were exercising their skill in the northern part of it, in Thessaly, Macedonia, Thrace. Should one compile a list of the patients named in the clinical stories and of the places where cases were observed, one would find that Hippocratic experience was very largely gathered in the north (as defined above) and hardly at all in Cos. There are but two references to Coan patients in the corpus, the first to “the sister of the man of Cos” who suffered from an enlargement of the liver,¹⁰³¹ the second to Didymarchos in Cos.¹⁰³² The second case was observed in Cos, but we cannot say where the first was, for the “sister of the man of Cos” may have roamed far away from home. In another book¹⁰³³ the wine of Cos, “astringent and very black,” is twice recommended,¹⁰³⁴ but wine could be very easily exported and if it was good we may assume that it was drunk outside of the island as much as inside. Hence, we have to face a paradox: the Hippocratic physicians are spoken of as representing the school or guild of Cos, yet as far as we can locate their activities they practiced elsewhere.
In order to solve that paradox, let us consider briefly the history of Cos. We have already indicated (p. 336) that the island was rich in produce, chiefly grapes and silk, but it is well to realize that its prosperity in Hippocratic days and later was not a novelty. Cos was not an upstart among the islands of that wonderful sea. Thanks to large deposits of obsidian, it was already a commercial center in the Stone Age.¹⁰³⁵ Much of the obsidian was quarried in Cos itself, much also of a purer quality in the little island of Hyali,¹⁰³⁶placed between Cos and the Cnidian chersonese. The obsidian trade gave that district (Cos and Cnidos) a kind of supremacy; it created wealth, and made possible the efflorescence of culture and learning. We may be sure that there were already practicing physicians in Cos long before the Dorian invasion.
The Dorians came probably from Crete about the ninth century, and displaced or dispossessed the native Carians. It may be that it was the Dorians who introduced the cult of Asclepios and thus gave a new prestige to the art of healing. On the other hand, Cos was magnificently located at the crossroads of many nations, so that its commercial importance was necessarily international. The Coan merchants had business dealings with Greece and Crete, with Caria and Ionia, with Asia and Europe. Their trade relations with the Ionian cities were so intense that in spite of the Dorian overlordship Cos became to some extent an Ionian city itself. At any rate, its higher culture was Ionian, not Dorian, and the Ionian dialect was considered to be the polite language.
The prosperity of the island and the international intercourse that it enjoyed were excellent conditions for the success of any kind of scientific effort. All that was needed was such an initial fermentation as is provided by the intervention of a man of genius. One of the Asclepiad families, the family of Hippocrates, provided that opportunity. It is not surprising then that the medical school which they created, or recreated, flourished as well as it did, and it would have continued to flourish but for the calamities of war.
The Ionization of the island had probably been facilitated by the Persian conquest. Under Darios (king of Persia, 521–485) Cos was part of a Persian satrapy, and the educated people, loving their Greek brethren and hating their Persian lords, would naturally rally around the Ionian teachers and affect Ionian speech and manners, which represented then and there the highest ideals of Hellas. After the naval victory of Mycale in 479 they threw off the Persian yoke and sooner or later were persuaded by the Ionians to join an Athenian confederation against Persia. As a result, they were involved in the Peloponnesian War, on the Athenian side. Indeed, Thessalos, son of Hippocrates, took part in the ill-fated Sicilian expedition (415—413). That period was a tragic one for Cos, for the island was devastated by an earthquake ¹⁰³⁷ and a little later invaded by the Spartans.
We may assume that the youth of the Hippocratic school in Cos coincided with that half century of peace between Mycale and the beginning of the Peloponnesian War. Hippocrates was educated during that period and revealed his genius, but his work and that of his disciples had to be continued elsewhere. The tumults¹⁰³⁸ caused by the war were not auspicious for scientific research and it is not surprising that Hippocrates and the other Asclepiads left their island home and began the life of wandering exiles. This explains the paradox that the Hippocratic teachings were formulated largely outside of Cos. It may explain another paradox, the persistence of Hippocratic positivism in spite of the Asclepiadic heritage. No matter how strong and pervasive the influence of Asclepios was, the Hippocratic doctors escaped it; instead of their allowing themselves to be subverted by magic rites the opposite happened, and the temple of Asclepios in Cos eventually capitalized on the fame of Hippocrates for its own religious purposes.
We cannot tell when the cult of Asclepios began in Cos, but the remains of the oldest temple there date back only to the third century, or say the end of the fourth. The site was thoroughly excavated in 1898 and the following years by members of the Archaeological Institute of Germany; after the first World War, when the Dodecanese was in Italian hands, new excavations were made by Italian archaeologists (Fig. 75). The sanctuary was not in the walled city of Cos, but about 1½ miles west of it on the slope of a hill. It was laid out on three artificial terraces. On the top, one may still see the remains of the Doric temple of Asclepios, with six columns on its short and eleven columns on its long sides. On the middle terrace there were smaller temples. The lower terrace was a promenade bounded by porticoes and there was a sacred well. Near the well was a little temple dedicated to Nero (emperor, 54–68), in the character of the god Asclepios, by a physician, C. Stertinius Xenophon.¹⁰³⁹
The earliest mention of the temple is relatively late, in the Geographica ¹⁰⁴⁰ of Strabon (I–2 B.C.). It reads: “In the suburb [of Cos] is the Asclepieion, a temple exceedingly famous and full of numerous votive offerings among which is the Antigonos of Apelles.” Many of the inscriptions, of which the temple was full, have been preserved; they memorialize rites of purification, invitations to the festivals, decrees in honor of physicians of Cos, many of whom had obtained distinction in foreign service, and so forth. The “votive offerings” to which Strabon refers and which were probably far more abundant than the other inscriptions, represent another group of monuments, common enough in the sanctuaries of all countries and ages. The people who were sorrow-laden because of disease, infirmities, or other calamities appealed to the god and made vows; if they were healed and their troubles were removed they expressed their gratitude by means of an ex-voto. These monuments vary considerably in size, value, and contents. They may represent the god Asclepios, the snakes that were his attributes and the instruments of his grace, or the patient or, more specifically, the part of his body that had been cured. Among the old medical offerings there are some that represent a pregnant woman, babies, eyes, womb and bladder, cancer of the breast, a dropsical body, hernia of the bowels.¹⁰⁴¹ One of the most beautiful medical ex-votos known to me is here reproduced (Fig. 76). It shows an old man holding in his arms an enormous leg with varicose veins. Votive offerings are so common everywhere that we may consider them characteristic of human nature; they are especially abundant in the Catholic churches, and the pilgrims to Lourdes can easily imagine how the Asclepieion of Cos looked, say, in Strabon’s time. I call them characteristic of human nature, for imitation is almost certainly excluded: a grateful patient gives a pair of crutches to the sanctuary of Lourdes in the same spirit as he would have given them to the temple of Cos or Epidauros (Fig. 77).
We have definite ideas concerning the methods of treatment followed by the Hippocratic physicians; as shown in previous chapters, those methods were astoundingly rational. On the other hand, we know nothing except what votive offerings tell us (and that is negligible) about the medical cures effected in the Asclepieion of Cos. It is probable, however, that that Asclepieion was somewhat controlled and its priests restrained by the lay practice flourishing in their neighborhood and by the Hippocratic ideals, that their methods were more rational (or less irrational) than those obtaining in other asclepieia, that they used more common sense and less magic, or that they used the latter less blatantly.¹⁰⁴² One cannot repeat too often that the essence of the temple practice (incubation, rest, and confidence) was rational and excellent; the irrationalities of Epidauros and other places were accretions caused by the credulity of the people and the greed of the priests.
Fig. 75. Plan of the Asclepieion made by the German archaeologists in 1904. The three successive terraces are shown, the highest one being at the top of the figure. Italian archaeologists have excavated later a fourth terrace, which would be represented below the bottom part of this figure. [From Schazmann, Asclepieion (Berlin, 1932), pl. 37.]
Fig. 76. Ex voto. A man holding in front of him a gigantic leg with varicose vein. [Mitt. krl. deut. Archaeol. Inst., Athenische Abt., 18 (Athens, 1893), pl. 11.] The original is preserved in the National Museum, Athens.
All we can say is that no votive tablets have been excavated in Cos that are comparable to those that have been discovered in Epidauros. Here are three of these Epidauros inscriptions:
Cleo was with child for five years. After she had been pregnant for five years she came as a suppliant to the god and slept in the Abaton.¹⁰⁴³ As soon as she left it and got outside the temple precincts she bore a son who, immediately after birth, washed himself at the fountain and walked about with his mother. In return for this favor she inscribed on her offering: “Admirable is not the greatness of the tablet, but the Divinity, in that Cleo carried the burden in her womb for five years, until she slept in the Temple and He made her sound.”
A man of Torone with leeches. In his sleep he saw a dream. It seemed to him that the god cut open his chest with a knife and took out the leeches, which he gave him into his hands, and then he stitched up his chest again. At daybreak he departed with the leeches in his hands and he had become well. He had swallowed them, having been tricked by his stepmother who had thrown them into a potion which he drank.
A man had his toe healed by a serpent. He, suffering dreadfully from a malignant sore in his toe, during the daytime was taken outside by the servants of the Temple and set upon a seat. When sleep came upon him, then a snake issued from the Abaton and healed the toe with its tongue, and thereafter went back again to the Abaton. When the patient woke up and was healed he said that he had seen a vision: it seemed to him that a youth with a beautiful appearance had put a drug upon his toe.¹⁰⁴⁴
Fig. 77. Ex voto to Amphiaraos. Healing scene (National Museum, Athens). [From Maxime Gorce and Raoul Mortier, eds., Histoire générale des religions (Paris: Quillet, 1944), vol. 2, p. 137.]
Fig. 78. Asclepios with his main attribute, a snake entwined around his staff; bronze in Berlin Museum. [From W. H. Roscher, Ausführliches Lexikon der griechischen und römischen Mythologie (Leipzig, 1884–1890), vol. 1, p. 636.]
The snakes that were kept in the Asclepieia have already been mentioned thrice (chiefly p. 332). The presence of snakes and their medical use is a proof of the antiquity of the cult. The main attributes of the god Asclepios were a staff and a serpent, the latter generally entwined around the former. We need not worry about the exact meaning of those attributes, because the ancients did not agree in their explanations, and modern scholars cannot do better than pile up a series of guesses. It just happened that way. A dignified old man, with a full beard, holding a heavy staff around which a serpent seems to be gliding–that is unmistakably Asclepios, and don’t ask any more questions (Figs. 78 and 79).¹⁰⁴⁵
The Asclepieion of Cos was famous in Hellenistic and Roman days, but it suffered at the hands of Christian iconoclasts in the fourth century and was destroyed in the earthquake of 554.
To the archaeologic evidence may be added two local traditions, which we are willing to accept, if not literally, at least as symbols of the gratitude and devotion of the sons of Cos to the most illustrious of their countrymen.
The first concerns the ancient plane tree that stands in the market place of the chief town of the island.¹⁰⁴⁶ It is claimed that Hippocrates taught under its shade. The tree is certainly very old and its branches spread over the whole agora; it is supported by marble columns taken from the Asclepieion. It may be contemporary with Hippocrates, or it may be the offshoot of another tree that existed at the same place in Hippocrates’ time. Who could tell? Remember the old trees in the Garden of Gethsemane which the Franciscan fathers say were contemporary with Christ. It is true, the Cos tree would have to be at least four centuries older than the olive trees of Jerusalem.
Fig. 79. Homage to Asclepios’ snake (Berlin Museum). [From Gorce and Mortier, Histoire générale des religions, vol. 2, p. 135.]
There is an islet off the southeast coast of Cos called Palaionisi; it is told that Hippocrates composed some of his writings in its seclusion.¹⁰⁴⁷
In short, the neighboring places, Cos and Cnidos, were the cradles of scientific medicine; thanks to the fact that the Asclepiad family of Hippocrates belonged to Cos, the island became more famous than its continental neighbor and almost eclipsed it. Hippocratic medicine began in Cos but developed chiefly in the north of the Greek area. It is possible that members of the family remained in Cos and continued the glorious tradition begun by Hippocrates. In the third century, the building of an Asclepieion (or of a new one vaster than the preceding) increased the prestige of religious healing. Scientific medicine and religious healing may have coexisted in Cos as they do in Boston.
The students of Greek medicine are more fortunate than those of Greek poetry, for they can see the place where Hippocrates grew up and dreamed, they can sit in the shade of an old plane tree and fancy that the master sat there twenty-five centuries ago, while it is impossible to visualize Homer’s immediate surroundings.
For the study of Coan history and archaeology I have made use of the following publications:
F. H. Marshall, Discovery in Greek lands (Cambridge, 1920), pp. 82–84 [Isis 4, 59 (1921–22)];
Karl Sudhoff, “Cos and Cnidos,” Ann. Medical History 2, 13–19 (1930) [Isis 15, 199 (1931)];
Archäologisches Institut des deutschen Reiches, Kos. Ergebnisse der deutschen Ausgrabungen und Forschungen, vol. 1, Paul Schazmann, Asklepieion (folio, 110 p., 57 pl., 1 map; Berlin, 1932);
Aldo Neppi Modona, L’isola di Cos nell’antichità classica (Rhodes: Memorie dell’Istituto storico di Rodi, 1933), vol. 1 (folio, 240 pp., 18 pls., 2 maps);
Emma J. and Ludwig Edelstein, Asclepius. A collection and interpretation of the testimonies (2 vols.; Baltimore: Johns Hopkins University Press, 1945) [Isis 37, 98 (1947)].