As­cle­pieia, the sa­cred hos­pi­tals of an­cient Greece

Ded­i­cated to the god of heal­ing, these sanc­tu­ar­ies func­tioned as cen­ters of re­li­gious wor­ship but also pop­u­lar en­ter­tain­ment

Kathimerini English - - Focus - BY JOHN LEONARD *

Health­care was a pri­mary con­cern for peo­ple in the an­cient world, just as it is to­day, but un­til the 6th and 5th cen­turies BC heal­ing was rooted mostly in re­li­gion and magic. When peo­ple be­came ill or suf­fered in­juries, they did not visit hos­pi­tals or clin­ics, but of­ten sought out treat­ment and com­fort from priests, of­fered sac­ri­fices and prayers to cer­tain gods, or con­sulted learned prac­ti­tion­ers who might pre­scribe the use of medic­i­nal herbs or the fol­low­ing of other, some­times more mys­te­ri­ous, tra­di­tional rit­u­als.

With the emer­gence of the divine healer As­cle­pius, first men­tioned in the 7th6th cen­tury BC texts of Homer and He­siod, the in­firm found a new cham­pion, a fig­ure usu­ally de­picted as bearded, ma­ture and fa­therly, like his grand­fa­ther Zeus, and highly knowl­edge­able in medicine, like his fa­ther Apollo, but more or­di­nar­ily hu­man, more ap­proach­able and seem­ingly more gen­uinely con­cerned with the hu­man con­di­tion. He usu­ally car­ried a staff or walk­ing stick and kept around him a snake and a dog as com­pan­ions or sa­cred sym­bols.

Where deities in­clud­ing Eilei­thyia (the Cre­tan/Mi­noan god­dess of child­birth and mid­wifery), Apollo and his sis­ter Artemis, or myth­i­cal crea­tures such as the cen­taur Ch­i­ron (Apollo’s foster son, As­cle­pius’ teacher) had pre­vi­ously been main myth­i­cal sources of med­i­cal skill and so­lace, As­cle­pius came to rep­re­sent the new gen­er­a­tion, at a time in Clas­si­cal Greek his­tory when knowl­edge of medicine and the prac­tice of health­care were be­com­ing more sci­en­tific en­deav­ors. It was only with As­cle­pius that more for­mal “hos­pi­tals” were es­tab­lished. As his cult spread, sanc­tu­ar­ies ded­i­cated to the heal­ing god sprang up through­out many ar­eas of the known Mediter­ranean world.

As­cle­pius orig­i­nally ap­peared in an­cient Greece at an­cient Trikka (mod­ern Trikala) in Thes­saly. Trikka was con­sid­ered his birth­place, from which, ac­cord­ing to Homer, his sons Machaon and Po­dalir­ius trav­eled with the Greek army to fight at Troy. The Ro­man ge­og­ra­pher Strabo re­ports that Trikka was the site of As­cle­pius’ old­est, most fa­mous sanc­tu­ary. Two other big cen­ters were Ep­i­dau­rus and the is­land of Kos. The cult of As­cle­pius may have reached Ep­i­dau­rus by c. 500 BC and a later local tra­di­tion sug­gested he had been born there, rather than Trikka. Ep­i­dau­rus be­came the main, highly in­flu­en­tial base from which other As­cle­pieia were founded – usu­ally through a rit­ual in which a statue of the god or one of his sa­cred snakes was cer­e­mo­ni­ally trans­ported to the prospec­tive site and be­queathed to the new sanc­tu­ary dur­ing its ded­i­ca­tion rites. Kos, too, be­came known for As­cle­pius in the 5th c. BC. His fa­mous mul­ti­tiered sanc­tu­ary there be­gan to rise af­ter the mid-4th c. BC.


The 5th and es­pe­cially 4th cen­turies BC were a time of great ex­pan­sion for As­cle­pius, as his sanc­tu­ar­ies also ap­peared at sites in­clud­ing Athens, Corinth, Si­cyon, Tegea, Me­ga­lopo­lis, Ar­gos, Sparta and Messene. As­cle­pieia were also founded on the is­lands of Paros, Aegina and Crete (at Leben, a port of Gortyn), at Perga­mum in Asia Minor, Alexan­dria in Egypt and Cyrene in Libya, as well as in the West at Rome – where the god oc­cu­pied Tiber Is­land and was called Aes­cu­lapius. Al­to­gether, hun­dreds of large and small As­cle­pieia were es­tab­lished in an­cient Greek and Ro­man times, with al­most ev­ery big town seek­ing to pro­vide what was es­sen­tially a health­care fa­cil­ity for its res­i­dents and neigh­bors. As­cle­pius’ cult spread usu­ally thanks to the well-in­tend­ing ac­tions of in­di­vid­u­als and be­came in­creas­ingly pop­u­lar be­cause it ap­pealed to in­di­vid­u­als and re­flected a grow­ing in­ter­est in more rea­soned, hu­man­is­tic ap­proaches to medicine.

As­cle­pieia func­tioned as sa­cred hos­pi­tals, nurs­ing homes, cen­ters of re­li­gious wor­ship and pop­u­lar en­ter­tain­ment, as well as gath­er­ing places for teach­ers and stu­dents, es­pe­cially those in­ter­ested in be­com­ing doc­tors. Fol­low­ers of the pi­o­neer­ing physi­cian Hip­pocrates (c. 460370 BC) taught medicine at Kos, while the Ro­man doc­tor Galen (AD 129-200) re­ceived train­ing at Perga­mum be­fore as­sum­ing his du­ties as per­sonal physi­cian to the em­peror Mar­cus Aure­lius.

Sanc­tu­ar­ies of As­cle­pius shared many com­mon char­ac­ter­is­tics. In ad­di­tion to As­cle­pius, other health-re­lated deities were also reg­u­larly wor­shipped in or near these places, in­clud­ing his fa­ther Apollo, his “aunt” Artemis, his sons Machaon and Po­dalir­ius, and his daugh­ter Hy­gieia – the per­son­i­fi­ca­tion of health, clean­li­ness and hy­giene. The 2nd cen­tury AD trav­eler Pau­sa­nias records that, as a child, As­cle­pius was nur­tured by a goat and pro­tected by a dog – thus ex­plain­ing why no goat sac­ri­fices were al­lowed at Ep­i­dau­rus, but dogs were a com­mon sight gen­er­ally in As­cle­pieia.

Be­sides al­tars and tem­ples, an­other dis­tinc­tive, colon­naded build­ing of cen­tral im­por­tance (the Aba­ton) was pro­vided, in which pa­tients ar­riv­ing at the sanc­tu­ary would un­dergo enkoime­sis (incu- ba­tion), spend­ing the night there and wait­ing for the god to come to them in their dreams with a pro­posed course of ther­apy. At the ex­em­plary site of Ep­i­dau­rus, vis­i­tors also had ac­cess to bath com­plexes, a large dor­mi­tory-like hos­tel (Kat­a­go­gion), cer­e­mo­nial din­ing rooms, a sta­dium, a palaes­tra, a large gym­na­sium and a the­ater that would even­tu­ally seat more than 12,000 spec­ta­tors.

A dis­tinc­tive cir­cu­lar struc­ture (Tho­los or Thymele) near the colon­naded Aba­ton and the Tem­ple of As­cle­pius may have housed the god’s sa­cred snakes, which em­bod­ied ideas of re­birth and re­ju­ve­na­tion. In some As­cle­pieia, non-ven­omous snakes were al­lowed to slither about freely on the floors of the vis­i­tors’ ac­com­mo­da­tions, while at Ep­i­dau­rus the ser­pents, in­clud­ing a pe­cu­liar yel­low­ish va­ri­ety, were tame, ac­cord­ing to Pau­sa­nias. The snakes in the As­cle­pieion at Alexan­dria were said by Aelian (c. AD 175-235) to be gi­gan­tic, some reach­ing 6-14 cu­bits (about 3-6 me­ters) in length.

Springs, wells and reser­voirs were also com­mon fea­tures in As­cle­pieia. A sa­cred well in­side the Aba­ton at Ep­i­dau­rus served in the vis­i­tors’ pu­rifi­ca­tion process, prior to in­cu­ba­tion. Fol­low­ing these two ini­tial stages of treat­ment, ac­tual med­i­cal ther­a­pies were of­ten pro­vided. Tes­ti­mo­ni­als de­scrib­ing the fre­quent mirac­u­lous cures achieved at Ep­i­dau­rus were in­scribed on a se­ries of stone slabs pub­licly dis­played in the sanc­tu­ary. These fas­ci­nat­ing ac­counts, which record the names of spe­cific pa­tients, their ill­nesses and the method of their cure, were read some 1,800 years ago by Pau­sa­nias and can still be ex­am­ined by vis­i­tors to­day in the ar­chae­o­log­i­cal site’s mu­seum.

One such in­scrip­tion reads: “Arata, a Spar­tan, suf­fer­ing from dropsy [oedema, the re­ten­tion of wa­ter in the body]. On her be­half, her mother slept in the sanc­tu­ary while she stayed in Sparta. It seemed to her that the god cut off her daugh­ter’s head and hung her body with the neck down­ward. Af­ter a con­sid­er­able amount of wa­ter had flowed out, he re­leased the body and put the head back on her neck. Af­ter she saw this dream, she re­turned to Sparta and found that her daugh­ter had re­cov­ered and had seen the same dream.” In more re­cent times, Jun­gian schol­ars have sug­gested the dream heal­ing ther­apy prac­ticed at Ep­i­dau­rus and else­where rep­re­sents the early fore­run­ner of mod­ern psy­cho­anal­y­sis and psy­chother­apy.


Con­cern­ing Kos and other ma­jor As­cle­pieia, it was not ac­ci­den­tal that they were lo­cated in the open coun­try­side, among beau­ti­ful, clean sur­round­ings, where the cli­mate was healthy and the wa­ter pure. In­deed, these sanc­tu­ar­ies pro­vided a holis­tic, in­no­va­tive ap­proach to health and the pre­req­ui­sites for phys­i­cal, psy­cho­log­i­cal, so­cial and spir­i­tual well-be­ing.

Dur­ing its hey­day in Hel­lenis­tic and Ro­man times, Kos’ elab­o­rate As­cle­pieion must have been a stun­ning sight, set 100 m above sea level on the east­ern slopes of Mount Dikeos, about 4 kilo­me­ters out­side the town of Kos. Ris­ing in three ar­ti­fi­cial ter­races above the ground, the sanc­tu­ary was adorned with mon­u­men­tal gate­ways and stair­cases, U-shaped stoas (colon­naded, roofed walk­ways/shel­ters), Doric, Ionic and Corinthian tem­ples, al­tars, foun­tains, stat­ues dis­played in wall niches, and even­tu­ally a large Ro­man bath com­plex (3rd cen­tury AD).

Kos was a head­quar­ters for the closeknit pri­estly or­der of the Asklepi­adai, sup­posed de­scen­dants of As­cle­pius, who guarded their se­crets of medicine and ad­vo­cated the treat­ment of pa­tients not through dreams but in ac­cor­dance with the teach­ings of Hip­pocrates.

On the South Slope of the Athe­nian Acrop­o­lis, a small As­cle­pieion was es­tab­lished in 420/419 BC, dur­ing the Pelo­pon­nesian War, when Athens’ in­hab­i­tants were largely penned in­side their de­fen­sive city walls and dis­ease was ram­pant. Plague had bro­ken out in 430 BC and claimed as one of its first vic­tims Pericles, the city’s great leader. To stem the ris­ing tide of ill­ness, a pri­vate cit­i­zen, Telema­chos of Ar­chanes, took the ini­tia­tive of hav­ing a sa­cred ser­pent rep­re­sent­ing As­cle­pius brought across the Sa­ronic Gulf by boat to Pi­raeus, then up to the Acrop­o­lis. A diminu­tive sanc­tu­ary was es­tab­lished that in­cluded the main com­po­nents of the mother site at Ep­i­dau­rus: a sa­cred spring, al­tar, tem­ple ded­i­cated to As­cle­pius and Hy­gieia, two-sto­ried Doric stoa/aba­ton, cer­e­mo­nial din­ing room and a mon­u­men­tal gate­way (propy­lon).

Pau­sa­nias writes that the Athe­nian As­cle­pieion “is worth see­ing both for its paint­ings and for the stat­ues of the god and his chil­dren.” He also de­scribes an un­usual vo­tive of­fer­ing dis­played in the sanc­tu­ary: a mil­i­tary/hunt­ing breast­plate pro­duced by Sau­ro­matae crafts­men (from western Scythia), con­sist­ing of a linen gar­ment cov­ered with snake-like scales made from horses’ hooves. Mar­ble kouros stat­ues were also brought to As­cle­pieia as ded­i­ca­tions to the heal­ing god, a large ex­am­ple of which, from the sanc­tu­ary in Paros, is now in the Lou­vre. In the 1st c. AD, the Ro­man em­peror Domi­tian sent locks of his hair, a mir­ror and a jew­eled box as vo­tive gifts to As­cle­pius at Perga­mum.

The prac­tice of trans­fer­ring the power and cult of As­cle­pius through the con­veyance of sa­cred ser­pents was not unique to Athens, but also re­ported at sites in­clud­ing Sikyon, where, ac­cord­ing to Pau­sa­nias, “the god was car­ried to them from Ep­i­dau­rus on a car­riage drawn by two mules… in the like­ness of a ser­pent.”

The es­tab­lish­ment of the As­cle­pieion at Rome was also trig­gered by an on­set of plague (293 BC), al­though the cult of As­cle­pius/Aes­cu­lapius had pre­vi­ously be­gun spread­ing into the Ital­ian penin­sula dur­ing the 5th c. BC. In the face of ris­ing ill­ness in the city, a del­e­ga­tion was dis­patched to bring a ser­pent from Ep­i­dau­rus – which, upon its ar­rival at Rome, le­gend holds, slith­ered off the ship and swam onto the small is­land in the midst of the Tiber River. There, the Ro­mans founded an As­cle­pieion safely re­moved from the crowded city. Later, the is­land’s Traver­tine sea­walls were con­fig­ured to re­sem­ble the bow and stern of a Ro­man ship – a trib­ute to the orig­i­nal ves­sel that had ar­rived from Ep­i­dau­rus. To­day, the wa­ter-worn traces of a re­lief carved on the is­land’s down­stream “bow” still de­pict Aes­cu­lapius’ snake-en­twined staff. * This ar­ti­cle first ap­peared in the free press mag­a­zine Greece Is Health. To view more con­tent, visit, a Kathimerini pub­lish­ing group ini­tia­tive.

The As­cle­peion at the site of an­cient Messene, in the Pelo­pon­nese. The 5th and es­pe­cially 4th cen­turies BC were a time of great ex­pan­sion for the As­cle­pieia.

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