Asclepiades of Bithynia

Roman physician

• Born: 124 b.c.e.
• Birthplace: Prusa (Cios), Bithynia (now Bursa, Turkey)
• Died: c. 44 b.c.e.
• Place of death: Rome (now in Italy)

Asclepiades was the first physician to establish Greek medicine in Rome.

Early Life

Asclepiades (as-klee-PI-uh-deez), whose father was probably Andreas, a noted physiologist of the time, was born in Prusa, also called Cios, in Bithynia, Asia Minor. A widely read man, he seems to have had a liberal education in his youth. Apparently, there was enough money for him to be able to travel and study.

After studying rhetoric and medicine in Athens and Alexandria, he practiced medicine, first in Parion, a town on the Hellespont (Dardanelles), and later in Athens. After extensive traveling, in the year 91 b.c.e. he settled in Rome, where he may have become a Roman citizen. A man of amiable manners, good fortune, and worldly prosperity, Asclepiades formed friendships with such prominent individuals as Cicero and Marc Antony.

Preferring the freedom of a solitary life in a suburban villa, Asclepiades refused the invitation of King Mithradates of Pontus to join his court. Though he did not participate in public debates, he was not afraid to disagree with others. He condemned all those who thought that anatomy and physiology were the foundation of medicine. He was responsible for introducing Democritus’s atomistic philosophy to Rome.

His daily routine included three basic activities: visiting and treating the sick throughout the city, giving written advice, and writing books. Although he was a prodigious author, little remains of the twenty or more treatises he prepared. Specific dates of his works are not known; the fragments that remain have been assigned English titles according to their subject matter. He wrote one book of definitions, one commentary on some of the short and obscure works of Hippocrates, one treatise on fevers, and three on febrile, inflammatory, and acute diseases. He also wrote Common Aids, a precursor of modern guides to healthy living; On Enemas, which was frequently quoted by Aulus Cornelius Celsus in De medicina (c. 30 c.e.; English translation, 1830); and On the Use of Wine.

Asclepiades also offered public lectures on medicine and had a large number of students. Applying many of his principles, these students, led by Themison of Laodicea, later founded the Methodist school, which emphasized diet and exercise in the treatment of illness.

By the age of thirty, Asclepiades was already famous. Some of that fame had grown from a story about him that circulated in Rome. According to this story, one day Asclepiades encountered a funeral procession. Just as the corpse was placed on the pyre and the fire was about to be lit, he ordered the ceremony stopped, had the body taken down and delivered to his home, administered restoratives, and soon revived the man.

A statue excavated in Rome in 1700 was assumed to be a correct likeness of Asclepiades. From this, it would appear that he was a man of slender stature who possessed a rather tranquil countenance.

Life’s Work

Asclepiades was one of the foremost physicians of his century, exhibiting rich practical and philosophical attainments, versatility of mind, and an ability to make rapid diagnoses. Opposing the Hippocratic idea that morbid conditions resulted from a disturbance of the humors of the body, he held that nothing happened without a cause and that the causes of events were always mechanical—that is, dependent on matter and motion.

The medical practice that Asclepiades founded was based on a modification of the atomic, or corpuscular, theory of Democritus, the Greek philosopher, according to which disease resulted from an irregular or inharmonious motion of the corpuscles of the body. Asclepiades believed that these masses were in continual motion, splitting into fragments of different shapes and sizes that then re-formed to create perceptible bodies. These particles were separated by invisible gaps, or pores. Friction between the particles created normal body heat; jamming the pores, or obstruction, was the cause of fever and inflammatory disorders. Fainting, lethargy, weakness, and similar complaints were attributed to an abnormal relaxation of the pores. Because disease was attributed to either constricted or relaxed conditions of the body’s solid particles, Asclepiades founded his therapy on the efficacy of systematic interference, as opposed to the healing power of nature. The regimens that he prescribed incorporated such therapies as fresh air, light, appropriate diet, hydrotherapy, massage, clysters or enemas, local applications, and, occasionally, very small amounts of medication.

For those complaints that he believed to be caused by obstruction, he proposed various kinds of exercise to relax the pores; in this way, the free transmission of the interrupted atoms or molecules would be facilitated. For pain, localized venesection might be cautiously practiced but only for instant relief, because bleeding tended to draw off the finer, more vital atoms first and leave the coarser atoms behind. Rigor, or rigidity of the body, might result.

He believed that dropsy, an excessive accumulation of fluid in the tissues, resulted from an infinite number of small holes in the flesh that converted all the food received into water. How such a conversion might occur, however, he did not explain. To illustrate that the brain was the seat of the finest atoms, he performed decapitation experiments on animals such as eels, tortoises, and goats.

Asclepiades condemned purgatives, emetics, and drugs. Instead, he relied greatly on changes in diet, accompanied by friction, bathing, and exercise. He paid special attention to the patient’s pulse. His remedies were directed to the restoration of harmony, based on the fundamental principle that treatments should be given promptly, safely, and pleasantly. For relaxants, he used wine and massage; to stimulate patients, he used wine, cold water, vinegar, and narcotics. He taught that patients tolerated diseases differently. Exercise, in his view, was unnecessary for healthy people. In cases of dropsy, he recommended making small cuts near the ankles to release the fluid. He advised that, when tapping was done to remove fluid, the opening be made as small as possible.

Asclepiades was particularly interested in psychiatric cases. He placed these patients in brightly lit, well-ventilated rooms, used occupational therapy, prescribed exercises for improving the memory and increasing attention, soothed them with music, and used wine to induce sleep.

According to Pliny the Elder, the Roman naturalist and writer, Asclepiades had three principal modes of cure. The early stages of illness often called for “gestation,” which consisted of being transported in some way, such as a boat or litter, to exhaust the patient’s strength and cause fever. Asclepiades also used suspended beds that could be rocked, as well as hanging baths and other forms of hydrotherapy. He firmly believed and taught that one fever was to be cured by another. The second mode was friction, or massage. The third mode was wine, which he gave to febrile patients and used as a stimulant in cases of lethargy. He believed that it was necessary to force a patient to endure thirst. All patients were required to fast during the first three days of illness. In later stages, wine and moderate amounts of food were allowed.

Asclepiades showed great accuracy in distinguishing among various diseases, describing and dividing them into acute and chronic classes. For example, he gave a correct description of malaria; he also observed the psychic complications that occurred in cases of pneumonia and pleurisy. His special attention was devoted to chronic diseases, conditions that had been somewhat neglected by Hippocrates.

Asclepiades wagered that he would never die of disease; indeed, he is not known ever to have fallen ill. His death, at an advanced age, was the result of an accidental fall down a flight of stairs.

Significance

Asclepiades of Bithynia may be ranked as the first physician to introduce Greek medicine to Rome. A full assessment of his merits cannot be made because most of his writings have been lost. The fragments of them that have surfaced in later literature deal with subjects such as the pulse, respiration, heart disease, ulcers, climate, drugs, and the preparation of remedies.

By the fourth century, Asclepiades was almost forgotten. His critics had characterized him as a man of natural talents acquainted with human nature and possessed of considerable shrewdness but little scientific or professional skill. Galen strongly opposed him because Asclepiades had been the first to attack and repudiate the humoral teachings of Hippocrates. Pliny also disliked him and regarded him as a charlatan.

On the other hand, Celsus, the first compiler of medical history and procedures, admitted that he learned much from Asclepiades. Galen grudgingly credited Asclepiades as having pioneered two surgical procedures, laryngectomy and tracheotomy. As has been noted, his ideas were influential in the development of the Methodist school, with its emphasis on diet and exercise. Furthermore, Asclepiades was a pioneer in the humane treatment of mental patients.

Bibliography

Allbutt, Sir Thomas C. Greek Medicine in Rome: The Fitzpatrick Lectures on the History of Medicine Delivered at the Royal College of Physicians of London in 1909-10. Reprint. New York: B. Blom, 1970. This series of lectures presents a complete medical history of the period, with extensive commentary on all major figures but only one brief chapter on Asclepiades. Includes excellent illustrations, bibliography, and chronology.

Cumston, Charles Greene. An Introduction to the History of Medicine: From the Time of the Pharaohs to the End of the Nineteenth Century. 1926. Reprint. London: Dawsons, 1968. This volume, which contains only one brief chapter on Asclepiades, is a compilation of numerous essential contributions to the general subject of a history of medicine. Written for the general reader.

Gordon, Benjamin Lee. Medicine Throughout Antiquity. Philadelphia: F. A. Davis, 1949. Gordon’s book contains only a very brief section on Asclepiades, along with scattered page references. Includes brief reference notes and a few illustrations but no chronology or bibliography.

Green, Robert M., ed. and trans. Asclepiades, His Life and Writings: A Translation of Cocchi’s “Life of Asclepiades” and Gumpert’s “Fragments of Asclepiades.” New Haven, Conn.: Elizabeth Licht, 1955. Green has prepared a complete translation of Discorso primo di Antonio Cocchi sopra Asclepiade (c. 1740) and of selections from Christian Gumpert’s Fragmenta (1794), a compilation of extant writings of Asclepiades. This volume contains detailed information available in English for the general reader, although it lacks reference notes and a bibliography.

Major, Ralph. “Medicine in the Roman Empire.” In A History of Medicine. Springfield, Ill.: Charles C Thomas, 1954. This chapter includes a brief section on Asclepiades. There is no presumption of background knowledge about medical history.

Rawson, Elizabeth. “The Life and Death of Asclepiades of Bithynia.” Classical Quarterly 32, no. 2 (1982): 358-370. Rawson presents a critical analysis of the information known about Asclepiades. It presumes extensive background knowledge concerning Asclepiades as well as the period in which he lived.

Vallance, J. T. The Lost Theory of Asclepiades of Bithynia. New York: Oxford University Press, 1990. Examines how Asclepiades of Bithynia reformed traditional Hippocratic practice with his own physical theory.