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Sleep and Dreams: From Myth to Medicine in Ancient Greece
Sleep and Dreams: from Myth to Medicine in Ancient Greece Helen Askitopoulou MD, PhD, FRCA, DA PII: DOI: Reference:
S2352-4529(15)20010-2 doi: 10.1016/j.janh.2015.03.001 JANH 23
To appear in:
Journal of Anesthesia History
Received date: Revised date: Accepted date:
5 January 2015 16 February 2015 9 March 2015
Please cite this article as: , Sleep and Dreams: from Myth to Medicine in Ancient Greece, Journal of Anesthesia History (2015), doi: 10.1016/j.janh.2015.03.001
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Sleep and Dreams: from Myth to Medicine in Ancient Greece
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Helen Askitopoulou§
§MD,
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Address for correspondence: Helen Askitopoulou 31 Stefanou Nikolaidi str Heraklion GR 71305 Greece Tel: +302810319166 Email: [email protected]
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PhD, FRCA, DA, Professor Emeritus of Anesthesiology, Faculty of Medicine, University of Crete, Greece.
The author has no actual or potential conflict of interest related to the present work.
received.
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No financial support for the conduct of the research and/or preparation of the article was
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Abstract (247 words)
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Starting from the epic poems of Homer and Hesiod in the 8th century BCE, the significance
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attributed to sleep and dreams by Greek antiquity is traced in myths referring to the god of sleep, Hypnos, and the dream-gods, the Oneiroi. Hypnos was related to very ancient deities of darkness; his mother Nychta (Night), his twin brother Thanatos (Death) and his sons the Oneiroi (Dreams)
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who dwelled “past the gates of the dead”. Early in the 6th century BCE, induced sleep, “enkoimesis” or dream incubation, became an established healing practice in the sanctuaries of
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AsklepiosI. Later, starting in the 4th century BCE, sleep and dreams were among a series of biological phenomena that became an integral part of the Greek physician's practice. Several Hippocratic treatises explore the medical significance of sleep and dreams, as symptoms of disease. The treatise On Regimen IV uses dreams as prognostic and diagnostic signs of normal or abnormal internal conditions. This treatise distinguishes two types of dreams, those sent by the gods and
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those sent by the soul. The soul observes the body during sleep and informs on any impending problem manifested by dreams. By interpreting patients' dreams, the Hippocratic physician made a
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prognosis about the condition of the patient's body, the effects of diet and physical exercise and adjusted the regimen to prevent deterioration of disease. It is the study of sleep and dreams in
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to medicine.
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ancient Greece that provides us with knowledge on the evolution of these notions from mythology
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In this article the Greek name Asklepios will be used instead of the Latin transliteration Asclepius.
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Highlights Hypnos and Oneiroi, gods of sleep and dreams, were associated to oblivion and pain
The sorceress Medea was the first to induce pharmaceutical sleep in ancient Greece
Sleep induction, enkoimesis, was a healing practice in the sanctuaries of Asklepios
“Euthanasia”, as voluntary permanent sleep, was known in ancient Greece
Greek physicians considered sleep and dreams as biological phenomena
Hippocratic physicians used sleep and dreams for medical prognosis and diagnosis
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Keywords:
History of medicine, Greek, ancient, dream incubation, euthanasia; Hippocrates, sleep,
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dreams, prognosis, diagnosis; Mythology
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Introduction
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The earliest references to medicine in ancient Greece can be traced to the second half of the th
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8 century BCE and the Homeric epics, the Iliad and the Odyssey, assumed to be the oldest written work of Western literature. Before the 8th century BCE there are no historical writings, only record tablets and labels exist.II At the end of the 8th century BCE, the epic poet Hesiod is also a major
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source of Greek mythology. It is in the various allegorical myths about Hypnos, the god of sleep, that the first recorded notions about sleep are found in the epic poems of Homer and Hesiod. These
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myths reflect, among other things, the ancient Greeks’ awareness of the relationship of sleep to oblivion and pain.
A few centuries later, the practice of dream healing during sleep became prominent in Greek theurgic ( the work of a god) medicine in the sanctuaries of the god Asklepios, where the ritual of “enkoimesis” (dream incubation) was widely practiced. Sleep healing was an imitation of decay,
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death and rebirth. Sleep resembles a temporary death since we remain motionless and unconscious during sleep, while waking up includes the element of rejuvenation, a new life [1].
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Hippocrates (460 to circa 375 BCE), the central historical figure in ancient Greek medicine, and his disciples of the school of Cos were the first to provide systematic information about sleep
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and dreams from a medical point of view. In contrast to Homer and Hesiod, both of whom connected Hypnos with death and darkness, the Hippocratic physicians considered sleep necessary
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for the maintenance of human health. The interpretation of dreams was also used as a tool for diagnosis and cure of conditions derived from internal sensations. The great significance attributed to medical dream interpretation by ancient physicians was later evidenced in Aristotle’s (384-322 BCE) essay On Prophecy in Sleep, which explored the physiology of dreams, as cause or result [2].
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These tablets were written in the Linear A and Linear B. These linear forms of writing attributed to Aegean civilizations from the 2nd millennium BCE, either remain undecoded (Linear A), or those decoded (Linear B) refer exclusively to trade.
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The study of sleep and dreams in ancient Greek medicine provides us with knowledge of the evolution of these notions from mythology to medicine. Ancient Greeks often used information
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The God of Sleep, Hypnos, and his sons, the Dreams
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gained from their myths to bridge the gap between metaphysical phenomena and reality.
Accomplishments and Attributes of the God Hypnos
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In the Iliad, Homer closely associates sleep with the deities of darkness. Homer refers to Hypnos as the son of darkness (Night) and, most importantly, as the twin brother of death
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(Thanatos). However, he placed the home of Hypnos in pleasant surroundings, on the island of Lemnos, near Troy [3a]. The god resided there without his brother Thanatos, although the two brothers sometimes worked in collaboration to carry young, dead or wounded warriors to Hades, the underworld. The most well known scene is described in the Iliad, in which they carried the fatally wounded hero Sarpedon, son of Zeus, away from the battlefield of Troy to his homeland
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Lycia in an unconscious state, but not yet dead [3b,4]. In Hesiod’s Theogony (The Origin of the Gods), Hypnos is also the son of night and twin
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brother of death [5a]; he has as brothers and sisters Ponos (Pain), Lethe (Oblivion) and Algea (Sufferings) [5b]. In contrast to Homer, Hesiod, and much later the Roman poet Ovid (43 BCE to
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circa 17 CE), placed the home of Hypnos and his brother Thanatos in the underworld, an area associated with death [5c,6a], in front of which flows the stream of the river Lethe. The ancient
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traveler Pausanias (circa 2nd CE) in his book on Boeotia explains that souls on their way to the underworld had to drink from the waters of Lethe to forget their past lives [7a]. The connotation of death residing in such a place is obvious. What is not apparent is why the ancient Greeks also consigned sleep to the same place. It is plausible that ancient Greeks associated sleep with death because they were aware of the detrimental effects of sleep inducing plants [4]. The association of Hypnos with death reappears in the well known myth of Endymion, cited by many ancient writers. According to the version by Apollodorus (circa 180 to 110 BCE), Endymion was a young man of surpassing beauty with whom the goddess Selene (Moon) fell in love. Zeus allowed him to choose between Hypnos and Selene. Endymion chose to sleep forever and therefore to remain with the immortal goddess “untouched by either age or death” [8]. Endymion’s
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eternal sleep connotes an idiosyncratic way of defeating death, human aging and decay. Plato (427347 BCE), in the Socratic dialogue Phaedo, objected to this eternal sleep as a means of achieving immortality. Socrates argued that if the state of sleep prevailed, all things would have the same
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form, act in the same way and nothing would be created.
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“For example if the process of falling asleep existed, but not the opposite process of waking from sleep, in the end, you know, that would make the sleeping Endymion mere nonsense; he would be nowhere, for everything else would be in the same state as he, sound asleep... And in the like manner, if all things that have life should die, and, when they had died, the dead should remain in that condition, is it not inevitable that at last all things would be dead and nothing alive?[9]
The idea that sleep could be interpreted as a means of cheating death, or as a way of reaching
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a separate kind of immortality, is highlighted by the personal qualities of Hypnos himself, as a kind of rescuer, a savior of those who have been injured by life's adversities, who are in need of a period of rest. These properties suggest that the true purpose of sleep is to promote physical and psychic healing, not allowing the individual to avoid life, but to embrace it. Homer, referring to Hypnos, mainly uses adjectives which associate the god with pleasant sweetness, especially that of honey. In
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fact, he calls him nidymos (sweet) [10a], meliedes (sweet like honey) [10b], melifron (pleasant like honey) [11a], and ambrosial (divine, heavenly) [11b]. In addition to these kind hearted and gentle
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attributes, Hypnos is constantly recognized as pandamator (the one who conquers everything) [3c]; an appraisal confirmed by the address used by the almighty goddess Hera “sleep, lord of all gods
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and of all men” [3d].
These connotations persist as well in the way Greek Tragedy portrayed Hypnos. A most
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telling example is the one found in Sophocles’ (circa 497 to 406 BCE) text Philoctetes. The hero, suffering from chronic pain, was left on the island of Lemnos by his comrades on their way to Troy. In this major tragedy sailors appeal to Hypnos as a “healer” of suffering and pain. "Sleep, ignorant of anguish [odynas], ignorant of pains [algeon], come to us with gentle breath, ... Come come, Healer!” [12].
Here, Hypnos is associated not only with the relief of somatic pain (algos), but also with the relief of strong psychic pains (odynas) and of mental suffering [13].
Oneiroi, the Dream-Gods In the Odyssey we learn that the Oneiroi (Dreams) dwelled on the dark shores of the western Oceanus, past the gates of the sun and the kingdom of the dead [10c]. Dreams were sent out to men
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in their sleep passing through one of two gates. Deceitful dreams came through the gate of ivory “bringing words that find no fulfillment”, while through the gate of horn passed true dreams which “bring true things” [10d]. On some occasions these very Oneiroi create dream forms, or appear
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personified under different shapes. As when Zeus sends to Agamemnon a “destructive Dream” in
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the likeness of the wise old Nestor, to encourage him to attack Troy without delay to sabotage the Greek army.
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“‘Up, go, destructive Dream (Oneiro), to the swift ships of the Achaeans, and when you have come to the hut of Agamemnon, son of Atreus, tell him everything exactly as I charge you’. ... So, he spoke, and the Dream set out, ... Quickly he came to the swift ships of the Achaeans, and went to Agamemnon, ... So he stood above his head, in the likeness of the son of Neleus, Nestor, whom above all the elders Agamemnon held in honor;” [11c]
Much later, Ovid described Hypnos as the father of Oneiroi and above all of the three dreamgods. Morpheus, who was named after the Greek word morphe (shape), as he used to take different human appearances in dreams to deliver messages from the gods [6b]. Icelos or Phobetor the one who was supposed to bring nightmares, and Phantasus the one who brought dreams of inanimate
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things [4]. It is not by chance that morphine, the active ingredient of opium, was named after Morpheus [13]. These three sons of sleep together with their father ruled in the sphere of dreams of
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ordinary people and kings alike, creating opposite sensations like euphoria or dysphoria [4]. The connection of sleep with dreams is also confirmed by Pausanias in the description of an
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actual statue of Hypnos lying inside the sanctuary of Asklepios at Sikyon, near Corinth. In the inner room of the sanctuary Pausanias saw “an image of the Dream-god and Sleep surnamed Epidotes
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(Bountiful) lulling to sleep a lion” [7b].
Sleep Induction in Greek Antiquity Sleep Induction in Mythology The first reference to sleep induction by the administration of a soporific substance is found in the myth of the Golden Fleece [14]. The sorceress Medea, daughter of the king of Colchis helped Jason to steal the Golden Fleece by lulling into a state of deep sleep the vigilant dragon that guarded it [15a]. For that purpose she used a so far unknown potent substance, simultaneiously asking the god Hypnos for help. Thus, one of the first references concerning induced sleep is associated not with a human being, but with a monster. The scene of Medea putting the ever-alert dragon to sleep
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is illustrated in art [14]. It is also described by Apollonius Rodius (3rd century BCE) in the epic poem Argonautica, which depicts the expedition of the Argonauts to Colchis.
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"And as he [the dragon] writhed, the maiden came before his eyes, with sweet voice calling to her aid Hypnos, highest of gods, to charm the monster;... the serpent, already charmed by her song, was relaxing the long ridge of his giant spine ... But she [Medea] with a newly cut spray of juniper, dipping and drawing untempered charms from her mystic brew, sprinkled his eyes, while she chanted her song; and all around the potent scent of the charm cast sleep; and on the very spot he let his jaw sink down” [16].
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Medea learned “all the powers which drugs possess” [15b] from her mother Hecate, the queen of the underworld, and from her sister, the sorceress Circe. Hecate is referred to as the first person
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to discover the poisonous properties of many plants, from which she prepared therapeutic as well as lethal potions. In her garden in Colchis she grew the black poppy and mandragoras, together with the “white hellebore and monks-hood and many other baneful plants that grow upon the ground” [17].
Among these baneful plants, the most widely known in antiquity as inducing tolerance to pain
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is the poppy, a typical symbol of the god Hypnos. The word ancient Greeks used for the poppy capsules of the plant Papaver somniferum is mekon (mekones in plural) [13]. The poppy capsule
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also functioned in certain contexts as a symbol of the sleep of nature and also as a symbol of fertility, wealth and immortality [18]. It represented one phase in the natural cycle that leads to
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sleep and awakening, analogous to death and rebirth, a reference to the idea of the cyclical process of nature. The symbolism of euphoria, voluptuous ecstasy, and also sleep and death are closely
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related to the specific pharmacological properties of opium. The most convincing evidence concerning mekon, and its use in the whole of the Greek world, comes from the Cretan goddess of mekones, “patron of healing” (Figure 1), a terracotta figurine dated from the Post Palatial Minoan period (circa 1200 BCE) [19,20]. Several scholars have argued that opium was probably used in the cult ceremonies of the goddess either for its healing properties or perhaps to cause hallucinations and dreams in connection with healing [18], as in the cult of Asklepios at a later date. [Insert Figure 1 here]
“Enkoimesis”, Sleep Induction in the Temples of Asklepios With regard to induced sleep, special reference should be made to a particular ritual
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exclusively practiced in the temples of Asklepios. The cult of Asklepios, a physician-hero at first and a god later, was at the same time a religious system and a practice of therapeutics. Beginning in the 6th century BCE, his sanctuaries, known as Asκlepieia, sprang up all over the Mediterranean area,
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where “enkoimesis”, meaning sleeping in the temple or dream incubation, was practiced [13,21].
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After preparation with purifying baths and sacrifice to the god, patients would spend the night in the god’s precinct or temple to wait for the god. While patients “slept” or “were in a strange state between sleep and waking” the god revealed himself nightly [22a]. Patients in their dreams believed
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that the god succeeded in healing them miraculously by “laying on of hands”, or by giving medical advice, or even by curing them with salves and drugs, or finally even by surgery (Figure 2)
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[21,22b]. In the morning the priests, usually trained in medical practice, would interpret the dream and explain the god’s instructions in accordance with rational procedures [22c]. The patients would then leave healed and healthy. [Insert Figure 2 here]
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Whether “enkoimesis” was facilitated by the administration of soporific substances is still debatable. However, there are indications that “enkoimesis” does not refer to natural sleep, but to
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induced sleep. Pausanias reports that inside the enclosure of the famous Asclepieion of Epidaurus there was an imposing circular building of white marble, called Tholos (Round House), ornamented
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by poppy coffers. Inside this building, where the patients slept there was a picture of a deity called Methe (Drunkenness) who was “drinking out of a crystal cup” [7c,21]. The description of Methe together with the poppy coffers suggest that in the inaccessible inner area of this building, called
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abaton, the patients slept while waiting for the god to appear [21]. In this area the process of healing took place on two stages: the dream one of “enkoimesis”, and the “actual” one of treatment, as depicted in a votive relief from the sanctuary of Amphiaraos, a divine figure related to Asklepios (Figure 2) [1]. However, the exact facts concerning the use of soporific substances during “enkoimesis” evade us probably because priests concealed, under a thick veil of secrecy and mysterious glamour, any information about the alleged use of soporifics or the cures practiced. Nevertheless, inscriptions discovered in Asκlepieia certify that real surgical cures were practiced there; these cures point towards the administration of potent analgesic and soporific substances or opium to the sufferers before dream therapy [21]. Today, more than two thousand years later, we still combine sleep and the alleviation of pain as the two basic components of modern anesthesia,
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reversible medicinal sleep induced pharmaceutically.
“Euthanasia” the Permanent Sleep
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Another case where sleep and death were associated in ancient Greece was “euthanasia”, the
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permanent sleep. The word “euthanasia” is derived from the Greek words “eu” (good) and “thanatos” (death) and it means “good death”, “gentle and easy death”. According to the Greek philosopher Heraklides Lembus (circa 2nd century BCE), on the island of Kea aged persons
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voluntarily put an end to their life by drinking poison after a ceremonial banquet; thus they avoided the illnesses and suffering of old age.
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“Since the island is healthy and the population lives to a ripe old age, especially the women, they do not wait until they are very old for death to take them, but before they grow weak or disabled in any way, take themselves out of life, some by means of the poppy, others with hemlock.” [2]
This is the reason why “euthanasia” in ancient Greece was called the “Keian custom”. Yet, this same practice was in use in other areas as well, as implied by Theophrastus (circa 372 to 287 BCE) in his account about a Mantineian herbal healer, Thrasyas; the latter could bring an easy and
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painless death by using “... the juices of hemlock, poppy and other such herbs, so compounded as to
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make a dose of conveniently small size, weighing only one drachma” [24].
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Hippocratic Prognosis and Diagnosis It was in 460 BCE, on the small Aegean island of Cos, where Hippocrates was born, the most outstanding figure in the history of ancient medicine, the person who freed medicine from magic,
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superstition and religion. Sixty medical treatises, written mainly in the 5th and 4th centuries BCE, are ascribed to the name of Hippocrates. These texts were compiled and edited by the scholars of the famous Alexandrian library under the name Corpus Hippocraticum or Hippocratic Collection during the third century BCE [25]. Only about seven of these treatises Epidemics I and III, Regimen in Acute Diseases, Prognostic, Aphorisms, Airs-Waters-Places, On Joints and On Fractures are considered to be written with some degree of certainty by Hippocrates himself [26,27a]. The greater part of the Corpus was written by Hippocrates’ disciples; it records the doctrine and the tradition of the Hippocratic medical school of Cos. Several of these treatises introduced the concepts of prognosis and diagnosis, which mark the distinction of the scientific from the empiricist approach as well as from the arbitrary practical treatment [28]. Clinical
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observation of the symptoms of the patient was a main characteristic of Hippocratic medical practice; sleep and insomnia were not considered anymore as god sent phenomena but as basic elements of prognosis and diagnosis.
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Sleep and Sleeplessness
The Hippocratic author of Epidemics VI identifies sleep as one of the six prerequisites that are beneficial to maintain health [29]. On the other hand, the author of Aphorisms agrees on the
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importance of “measure” in both normal sleep and sleeplessness.
“Sleep and sleeplessness, in undue measure, these are both bad symptoms” [30a].
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“Both sleep and sleeplessness, when beyond measure, constitute disease” [30b].
Deviations in the quality, nature, amount and time of sleep were used as prognostic and diagnostic signs of disease. The relationship between sleep and diet was used for “prodiagnosis” of a patient's current condition, with the aim of altering his regimen to prevent the onset of illness [31a]. By interpreting these symptoms, the physician would find out what kind of excess existed
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that was likely to cause disease. The famous Aphorisms record and reveal with accuracy the diagnostic significance of sleep in disease states.
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“A disease in which sleep causes distress is a deadly one; but if sleep is beneficial, the disease is not deadly” [30c]
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“When sleep puts an end to delirium it is a good sign” [30d].
The reversal of the normal hours of sleep, from nocturnal to diurnal, is a deviation from normality with damaging effects. In the treatise Prognostic, the author asserts that insomnia, as lack
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of sleep during the night or day, is a very bad sign, caused by either pain or discomfort, or a sign of impending mental disorder. “As for sleep the patient has to follow the natural custom of being awake during the day and asleep during the night. Should this be changed it is rather a bad sign. ... For either it will be pain and distress that cause the sleeplessness or delirium will follow this symptom” [32a].
To re-establish a normal sleep-waking cycle and combat insomnia the Hippocratic physicians advized soporifics, but without revealing details about their use. “A medication that brings about sleep must provide the body with calm” [33]. Hippocratic practitioners approached the occurrence of sleep and dreams from a physiologist’s perspective. However, although the proposed explanation was wrong, they were the
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first to suggest that the locus of sleep was the brain. In the treatise On Breaths it is explained that sleep causes a drop of body temperature that slows blood circulation in the brain. This cooling alters the intelligence, enabling “certain fancies” ─the dreams─ to appear.
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“When sleep comes upon the body the blood is chilled, as it is of the nature of sleep to cause chill. ... the body grows heavy and sinks; … the eyes close; the intelligence alters, and certain other fancies linger, which are called dreams” [34].
The Hippocratic author of On Regimen clarifies the connection between the things the soul
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brings up during sleep and those the person sees in his dreams. “For as the experiences of the body are, so are the visions of the soul when sight is cut off” [31b]. As there is no sense perception
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during sleep, the body cannot perceive external stimuli, neither can sensations reach the body from the outside [35a]. It is the soul, the unconscious state, which not only keeps its functions but also it even takes over the functions of the body during sleep [36]. While the body is at rest during sleep, the soul is active and “performs all the acts of the body”. It is aware of everything ─“has cognizance of all things”─ and on its own performs all the acts it would perform in the daytime
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together with the body, such as seeing, hearing, walking, touching, feeling and thinking.
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“For the body when asleep has no perception [aesthanetai]; but the soul when awake has cognizance of all things—sees what is visible, hears what is audible, walks, touches, feels pain, ponders. In a word, all the functions of the body and of soul are performed by the soul during sleep” [31c].
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Sleep and insomnia in Hippocratic medicine were among the symptoms the physician inquired about; whether the patient was sleeping or not, what his habits were with respect to sleep and wakefulness, whether the patient had any visions or dreams. Based on patient’s answers, the
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physician determined the course of action. “The following were the circumstances attending the diseases, from which I framed my judgments ... sleep or absence of sleep, the nature and time of dreams ... From these things must we consider what their consequents also will be” [37].
In “acute diseases” the physician conducted his inquiries starting from the patient’s face and then if he could not arrive on a prognosis from the other symptoms, he went on “to inquire whether the patient has been sleepless” [32b]. It is worth noting that Hippocratic physicians introduced the words “hypnikon” and “hypnoticon”, to describe sleep induction by soporific substances in patients with toothache or for the treatment of female diseases [38]. The contemporary term “hypnotic” is derived from these
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words [36].
Dream Interpretation and Medicine
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Beside sleep Hippocrates, and the physicians who followed his medical beliefs and practice,
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also used dreams as a tool for diagnosis and treatment of illness. They believed that the symbolism in dreams was derived from internal sensations. Dreams were considered to be signs of internal conditions, a belief that is consistent with modern medical concepts.
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The Hippocratic author of Regimen IV ─also referred to as Dreams─ strongly emphasizes the role of dreams as a significant indicator of the dreamer's physical condition. He provides a
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theoretical basis for the use of dreams as a source of information about the condition of the body and gives dreams the most prominent status in his “prodiagnostic” theory [31a,35b]. “He, who has learnt aright about the signs that come in sleep, will find that they have an important influence upon all things” [31d].
The same author distinguishes between two types of dreams: those sent by the gods and those
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sent by the soul. The divine dreams “foretell to cities or to private persons things evil or things good” [31e]. Their interpreters “only recommend prayers to the gods”. On the contrary, only a
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skilled physician is able to interpret the dreams caused from humoral imbalances (dyskrasias) in the body, as portrayed through the visions of the soul [39]. In these non-divine dreams the soul speaks
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to the dreamer and forewarns him of any impending bodily problems: of physical factors such as food, and the patient's habits and state of mind. According to the Hippocratic physicians, the most
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important factor is humoral imbalance in the body [39]. “All the physical symptoms foretold by the soul, excess, of surfeit or of depletion, of things natural” are interpreted by professional physicians who have the skills to restore the dreamer’s health [31f]. Both types of dreams, the divine and the symptomatic, were employed in the formation of medical diagnosis and prognosis as well as in the prescription of regimens and cures. By interpreting a patient's dreams, the Hippocratic physician learned a lot not only about the condition of the patient's body, but also about the effects of diet and physical exercise [32a]. The author of On Regimen IV introduces one of the most basic principles in the medical interpretation of dreams, when he asserts that similarity of dream images to reality is good, while dissimilarity is bad [31e,35a]. The soul relives the deeds or thoughts of the previous day, unless it is distracted by some
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abnormality within the body. When “dreams repeat in the night a man’s actions or thoughts in the day-time” it is considered that they are true representations of the experiences and thoughts of the dreamer and they “signify health” [31g]. However, when something is wrong the soul is disturbed
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and the images dreamt of are of things other than the thoughts and experiences of the previous day
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[35b]. Then, the physician does “advise treatment of the body” to adjust the balance between physical exercise and food, so that the effects of surfeit, as indicated by the dream, are
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compensated. An “emetic” accompanied by “a light diet for five days” and gradually increasing physical exercise are suggested [31h].
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Dream interpretation often determined a course of treatment both in established secular practice and at religious healing sanctuaries. This was usually based on the generally accepted importance of dreams, generated by the widespread belief of their divine origin. Hippocratic physicians did not express any sort of opposition between the rational and the divine that is between reason and religion [27b]. They accepted the validity of the curative suggestions revealed in god sent dreams, in particular those concerning the treatments the suppliants received from Asklepios
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during “enkoimesis” at his sanctuaries [22d,39]. For many centuries the cult of Asklepios coexisted with Hippocratic medicine. The latter never challenged the religion of the great sanctuaries [27b]. It
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did not oppose it nor was it antagonistic. The first lines of the Hippocratic Oath are revealing.
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“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant” [40].
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Conclusions
The knowledge about sleep and dreams gained from ancient Greek myths provides us with the first reference of their importance in the well being of gods and humans as well. The interpretation of dreams occurring during sleep healing ─“enkoimesis”─ in the sanctuaries of Asklepios can be considered as an early form of theurgic medicine. This kind of early knowledge about sleep and dreams opened the way to the rational use of these notions in Hippocratic medicine. It is worth noting that several Hippocratic treatises explore the medical significance of sleep and dreams, as symptoms of disease, as well as necessary factors for the maintenance of human health. The long road of these notions about sleep and dreams marked their evolution from mythology to medicine.
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This transition must be mainly attributed to Hippocrates and his disciples who laid the foundations
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for scientific, modern medicine.
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Acknowledgements
I wish to express my sincere appreciation and thanks to Professor Eva Kalpourtzi and Ms
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Iliana Antonakopoulou for their most constructive help with the editing of the manuscript.
References 1.
Lambrinoudakis VK. Theurgic Medicine. In: Stabolidis NC, Tassoulas Y, eds. Hygeia: Health, Illness, Treatment: from Homer to Galen. Athens: Museum of Cycladic Art Hellenic Ministry of Culture and Sports; 2014. P. 17-31.
Aristotle. On Prophesy in Sleep. In: Parva Naturalia. Vol. VIII. Hett WS, transl. Cambridge,
ED
2.
MA: Harvard University Press; 2000. Lines 463a.3-5. Homer. Iliad. Vol. II, Books 13-24. Wyatt W, Murray AT, transl. Cambridge, MA: Harvard
PT
3.
4.
CE
University Press; 2001. Books (a) 14.230, (b) 16.671-673, (c) 24.5 (d) 14.233. Askitopoulou H, Astyrakaki E, Papaioannou A. Significance of Sleep in Greek-Roman Antiquity: Versions of Myth, Aspects of Reality. In: The History of Anaesthesia. Proceedings of
5.
AC
the Eighth International Symposium on the History of Anaesthesia. Sydney; 2015. In Press. Hesiod. Theogony. In: Homeric Hymns, Epic Cycle, Homerica. Evelyn-White HG, transl. Cambridge, MA: Harvard University Press; 1977. Verses (a) II.116-122, (b) II.226-7, (c) II.758-761. 6.
Ovid. Metamorphoses. Melville AD, transl. Oxford: Oxford University Press; 1986. Books (a) XI.605-606, (b) XI.633-638.
7.
Pausanias. Description of Greece. Jones WHS, transl. Cambridge, MA: Harvard University Press; 1978-1979. Books (a) Boeotia, 9.xxxix.8, Vol IV, (b) Corinth, 2.10.2, Vol. I, (c) Corinth, 2.27.3, Vol. I.
Page 15 of 20
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8.
Apollodorus. The Library of Greek Mythology. Hard R, transl. Oxford: Oxford University Press; 1998. P. 38-39.
9.
Plato. Phaedo. Vol. I. Fowler HN, transl. Cambridge, MA: Harvard University Press; 2005
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T
(Stephanus 72 C).
10. Homer. The Odyssey. Vol. II, Books 13-24. Murray AT, Dimock GE, transl. Cambridge, MA: Harvard University Press; 1998. Books (a) 13.79, (b) 19.551, (c) 24.11-14, (d) 19.563-565.
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11. Homer. Iliad. Vol. I, Books 1-12. Wyatt W, Murray AT, transl. Cambridge, MA: Harvard
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University Press; 2001. Books (a) 2.34, (b) 2.19, (c) 2.8-21. 12. Sophocles. Philoctetes. Vol. II. Lloyd-Jones H, transl. Cambridge, MA: Harvard University Press; 1998. Verses 827-832.
13. Askitopoulou H, Ramoutsaki IA, Konsolaki E. Analgesia and Anesthesia. The Etymology and Literary History of Related Greek Words. Analg Anesth 2000;91:486-91.
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14. Astyrakaki E, Askitopoulou H. Medea: the first Greek Pharmacist to administer a hypnotic. In: Drury PME, ed. The History of Anaesthesia. Proceedings of the Sixth International Symposium
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on the History of Anaesthesia. Reading, Berkshire: Conservatree; 2007. P. 81-85. 15. Diodorus Siculus. Library of History. Vol. II, Books 2.35-4.58. Oldfather CH, transl.
CE
Cambridge, MA: Harvard University Press; 1935. Books (a) 4.47.1, (b) 4.46.1. 16. Apollonius Rhodius. Argonautica. Seaton RC, transl. Cambridge, MA: Harvard University
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Press; 1967. Book IV.146-161. 17. Dottin G. Les argonautiques d'Orphée. Paris: Les Belles Lettres; 1930. Lines 914-923. 18. Kritikos PG, Papadaki PS. The history of the poppy and of opium and their expansion in antiquity in the eastern Mediterranean area. Part I. Bulletin on Narcotics 1967;19(3):17-38. 19. Askitopoulou H, Ramoutsaki IA, Konsolaki E. Archaeological Evidence on the Use of Opium in the Minoan World. In: Diz JC, ed. Proceedings of the Fifth International Symposium on the History of Anaesthesia. Amsterdam: Elsevier Publishers; 2002. P. 23-30. DOI: http://dx.doi.org/10.1016/S0531-5131(02)00769-0. 20. Dimopoulou - Rethemiotaki Nota. The Archaeological Museum of Herakleion. Athens: John S.
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Latsis Public Benefit Foundation; 2005. P. 132-133. 21. Askitopoulou H, Konsolaki E, Ramoutsaki IA, Anastassaki Μ. Surgical Cures under Sleep Induction in the Asclepieion οf Epidauros. In: Diz JC, ed. The History of Anaesthesia.
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T
Proceedings of the Fifth International Symposium on the History of Anaesthesia. Amsterdam: Elsevier publishers; 2002. PP. 11-18. DOI: http://dx.doi.org/10.1016/S0531-5131(02)00717-3. 22. Edelstein EJ, Edelstein L. Asclepius. Vol. II. Interpretation of the Testimonies. Baltimore: The
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John Hopkins University Press; 1998. PP. (a) 149-151, (b) 152-153, (c) 142-144, (d) 139-141. 23. Heraclides Lembus. Excerpta Politiarum. Greek, Roman and Byzantine Monographs 5. Dilts
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MR, ed. Durham: Duke University Press; 1971. P. 29.1-3.
24. Theophrastus. Enquiry into Plants. Hort A, transl. Cambridge, MA: Harvard University Press; 1977. Chapter IX, 9.16.8.
25. Miles SH. The Hippocratic Oath and the Ethics of Medicine. Oxford: Oxford University Press;
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2005. P. 40-41.
26. Jones WHS. General Introduction. In: Hippocrates. Vol. I. The Oath. Loeb Classical Library.
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Cambridge, MA: Harvard University Press; 2004. P. XIV-XXI. 27. Jouanna J. Hippocrates. DeBevoise MB, transl. Baltimore: The John Hopkins University Press;
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1999. P. (a) 58-65, (b) 195.
28. Littré E. Oeuvres complètes d' Hippocrate. Vol. 1, Paris: JB Baillière; 1839-1881. P. 454.
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29. Hippocrates. Epidemics. Vol. VII. Smith WD, transl. Cambridge, MA: Harvard University Press; 1994. Book 6.8.23. 30. Hippocrates. Aphorisms. Vol. IV. Jones WHS, transl. Cambridge, MA: Harvard University Press; 2005. Sections (a) II.iii, (b) VII.lxxii, (c) II.i, (d) II.ii. 31. Hippocrates. Regimen. Vol. IV. Jones WHS, transl. Cambridge, MA: Harvard University Press; 2005. Books (a) III.lxix.14-16, (b) III.lxxi.14-15, (c) IV.lxxxvi.12-18, (d) IV.lxxxvi.1-3, (e) IV.lxxxvii.1-4, (f) IV.lxxxvii.5-15, (g) IV.lxxxviii.16-25, (h) IV.lxxxviii.1-6. 32. Hippocrates. Prognostic. Vol. II. Jones WHS, transl. Cambridge, MA: Harvard University Press; 1998. Chapters (a) X.1-10, (b) II.12-15.
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33. Hippocrates. Affections. Vol. V. Potter P, transl. Cambridge, MA: Harvard University Press; 1988. Chapter 36. 34. Hippocrates. Breaths. Vol. II. Jones WHS, transl. Cambridge, MA: Harvard University Press;
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1998. Chapter XIV.10-19.
35. Hulskamp MAA. Sleep and Dreams in Ancient Medical Diagnosis and Prognosis. Newcastle: Newcastle University eTheses; 2008. P. (a) 156-177, (b) 256-272,
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http://hdl.handle.net/10443/1577 [Accessed 2nd November 2014].
36. Astyrakaki E, Papaioannou A, Askitopoulou H. References to anesthesia, pain, and analgesia in
10.1213/ane.0b013e3181b188c2.
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the Hippocratic Collection. Anesth Analg 2010;110(1):188-94. DOI:
37. Hippocrates. Epidemics I and III. Vol. I. Jones WHS, transl. Cambridge, MA: Harvard University Press; 2004. Book I.xxiii.
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38. Hippocrates. Epidemics 2 and 4-7. Vol VII. Smith WD, transl. Cambridge, MA: Harvard University Press; 1994. Section 6.6.13.
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39. Oberhelman SM. Galen, On Diagnosis from Dreams. J Hist Med Allied Sci 1983;38 (1):36-47. 40. Edelstein L. The Hippocratic Oath: Text, Translation, and Interpretation. In: Ancient
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CE
Medicine. Baltimore: The John Hopkins University Press; 1987. P. 6.
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Legends for FIGURES
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Figure 1. The Minoan goddess of mekones with upraised arms (78-cm height), wearing a unique tiara on her head with three hairpins of beautiful and well slit poppy capsules, called mekones, (circa 1200 BCE). In the Archaeological Museum of Herakleion, Crete [20].
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Figure 2. Votive relief of white marble in the shape of a temple found in the sanctuary of Amphiaraos at Oropos (4th century BCE). It depicts the two stages of healing through “enkoimesis” of a young patient, named Archinos. On the left the god himself performs surgery on the patient’s upper arm with a small curved knife, while the young man supports his injured right arm [1]. On the right side the same patient is depicted having a vision while he slept during “enkoimesis”. The sacred animal of Asklepios, the snake, is licking the sleeping patient’s affected shoulder, while a priest is overlooking. The votive inscription under the representation denotes that Archinos dedicated the relief to Amphiaraos. In the National Archaeological Museum of Athens.
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S2352-4529(15)20010-2 doi: 10.1016/j.janh.2015.03.001 JANH 23
To appear in:
Journal of Anesthesia History
Received date: Revised date: Accepted date:
5 January 2015 16 February 2015 9 March 2015
Please cite this article as: , Sleep and Dreams: from Myth to Medicine in Ancient Greece, Journal of Anesthesia History (2015), doi: 10.1016/j.janh.2015.03.001
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Sleep and Dreams: from Myth to Medicine in Ancient Greece
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Helen Askitopoulou§
§MD,
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Address for correspondence: Helen Askitopoulou 31 Stefanou Nikolaidi str Heraklion GR 71305 Greece Tel: +302810319166 Email: [email protected]
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PhD, FRCA, DA, Professor Emeritus of Anesthesiology, Faculty of Medicine, University of Crete, Greece.
The author has no actual or potential conflict of interest related to the present work.
received.
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No financial support for the conduct of the research and/or preparation of the article was
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Abstract (247 words)
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Starting from the epic poems of Homer and Hesiod in the 8th century BCE, the significance
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attributed to sleep and dreams by Greek antiquity is traced in myths referring to the god of sleep, Hypnos, and the dream-gods, the Oneiroi. Hypnos was related to very ancient deities of darkness; his mother Nychta (Night), his twin brother Thanatos (Death) and his sons the Oneiroi (Dreams)
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who dwelled “past the gates of the dead”. Early in the 6th century BCE, induced sleep, “enkoimesis” or dream incubation, became an established healing practice in the sanctuaries of
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AsklepiosI. Later, starting in the 4th century BCE, sleep and dreams were among a series of biological phenomena that became an integral part of the Greek physician's practice. Several Hippocratic treatises explore the medical significance of sleep and dreams, as symptoms of disease. The treatise On Regimen IV uses dreams as prognostic and diagnostic signs of normal or abnormal internal conditions. This treatise distinguishes two types of dreams, those sent by the gods and
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those sent by the soul. The soul observes the body during sleep and informs on any impending problem manifested by dreams. By interpreting patients' dreams, the Hippocratic physician made a
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prognosis about the condition of the patient's body, the effects of diet and physical exercise and adjusted the regimen to prevent deterioration of disease. It is the study of sleep and dreams in
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to medicine.
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ancient Greece that provides us with knowledge on the evolution of these notions from mythology
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In this article the Greek name Asklepios will be used instead of the Latin transliteration Asclepius.
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Highlights Hypnos and Oneiroi, gods of sleep and dreams, were associated to oblivion and pain
The sorceress Medea was the first to induce pharmaceutical sleep in ancient Greece
Sleep induction, enkoimesis, was a healing practice in the sanctuaries of Asklepios
“Euthanasia”, as voluntary permanent sleep, was known in ancient Greece
Greek physicians considered sleep and dreams as biological phenomena
Hippocratic physicians used sleep and dreams for medical prognosis and diagnosis
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Keywords:
History of medicine, Greek, ancient, dream incubation, euthanasia; Hippocrates, sleep,
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dreams, prognosis, diagnosis; Mythology
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Introduction
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The earliest references to medicine in ancient Greece can be traced to the second half of the th
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8 century BCE and the Homeric epics, the Iliad and the Odyssey, assumed to be the oldest written work of Western literature. Before the 8th century BCE there are no historical writings, only record tablets and labels exist.II At the end of the 8th century BCE, the epic poet Hesiod is also a major
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source of Greek mythology. It is in the various allegorical myths about Hypnos, the god of sleep, that the first recorded notions about sleep are found in the epic poems of Homer and Hesiod. These
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myths reflect, among other things, the ancient Greeks’ awareness of the relationship of sleep to oblivion and pain.
A few centuries later, the practice of dream healing during sleep became prominent in Greek theurgic ( the work of a god) medicine in the sanctuaries of the god Asklepios, where the ritual of “enkoimesis” (dream incubation) was widely practiced. Sleep healing was an imitation of decay,
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death and rebirth. Sleep resembles a temporary death since we remain motionless and unconscious during sleep, while waking up includes the element of rejuvenation, a new life [1].
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Hippocrates (460 to circa 375 BCE), the central historical figure in ancient Greek medicine, and his disciples of the school of Cos were the first to provide systematic information about sleep
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and dreams from a medical point of view. In contrast to Homer and Hesiod, both of whom connected Hypnos with death and darkness, the Hippocratic physicians considered sleep necessary
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for the maintenance of human health. The interpretation of dreams was also used as a tool for diagnosis and cure of conditions derived from internal sensations. The great significance attributed to medical dream interpretation by ancient physicians was later evidenced in Aristotle’s (384-322 BCE) essay On Prophecy in Sleep, which explored the physiology of dreams, as cause or result [2].
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These tablets were written in the Linear A and Linear B. These linear forms of writing attributed to Aegean civilizations from the 2nd millennium BCE, either remain undecoded (Linear A), or those decoded (Linear B) refer exclusively to trade.
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The study of sleep and dreams in ancient Greek medicine provides us with knowledge of the evolution of these notions from mythology to medicine. Ancient Greeks often used information
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The God of Sleep, Hypnos, and his sons, the Dreams
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gained from their myths to bridge the gap between metaphysical phenomena and reality.
Accomplishments and Attributes of the God Hypnos
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In the Iliad, Homer closely associates sleep with the deities of darkness. Homer refers to Hypnos as the son of darkness (Night) and, most importantly, as the twin brother of death
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(Thanatos). However, he placed the home of Hypnos in pleasant surroundings, on the island of Lemnos, near Troy [3a]. The god resided there without his brother Thanatos, although the two brothers sometimes worked in collaboration to carry young, dead or wounded warriors to Hades, the underworld. The most well known scene is described in the Iliad, in which they carried the fatally wounded hero Sarpedon, son of Zeus, away from the battlefield of Troy to his homeland
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Lycia in an unconscious state, but not yet dead [3b,4]. In Hesiod’s Theogony (The Origin of the Gods), Hypnos is also the son of night and twin
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brother of death [5a]; he has as brothers and sisters Ponos (Pain), Lethe (Oblivion) and Algea (Sufferings) [5b]. In contrast to Homer, Hesiod, and much later the Roman poet Ovid (43 BCE to
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circa 17 CE), placed the home of Hypnos and his brother Thanatos in the underworld, an area associated with death [5c,6a], in front of which flows the stream of the river Lethe. The ancient
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traveler Pausanias (circa 2nd CE) in his book on Boeotia explains that souls on their way to the underworld had to drink from the waters of Lethe to forget their past lives [7a]. The connotation of death residing in such a place is obvious. What is not apparent is why the ancient Greeks also consigned sleep to the same place. It is plausible that ancient Greeks associated sleep with death because they were aware of the detrimental effects of sleep inducing plants [4]. The association of Hypnos with death reappears in the well known myth of Endymion, cited by many ancient writers. According to the version by Apollodorus (circa 180 to 110 BCE), Endymion was a young man of surpassing beauty with whom the goddess Selene (Moon) fell in love. Zeus allowed him to choose between Hypnos and Selene. Endymion chose to sleep forever and therefore to remain with the immortal goddess “untouched by either age or death” [8]. Endymion’s
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eternal sleep connotes an idiosyncratic way of defeating death, human aging and decay. Plato (427347 BCE), in the Socratic dialogue Phaedo, objected to this eternal sleep as a means of achieving immortality. Socrates argued that if the state of sleep prevailed, all things would have the same
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form, act in the same way and nothing would be created.
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“For example if the process of falling asleep existed, but not the opposite process of waking from sleep, in the end, you know, that would make the sleeping Endymion mere nonsense; he would be nowhere, for everything else would be in the same state as he, sound asleep... And in the like manner, if all things that have life should die, and, when they had died, the dead should remain in that condition, is it not inevitable that at last all things would be dead and nothing alive?[9]
The idea that sleep could be interpreted as a means of cheating death, or as a way of reaching
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a separate kind of immortality, is highlighted by the personal qualities of Hypnos himself, as a kind of rescuer, a savior of those who have been injured by life's adversities, who are in need of a period of rest. These properties suggest that the true purpose of sleep is to promote physical and psychic healing, not allowing the individual to avoid life, but to embrace it. Homer, referring to Hypnos, mainly uses adjectives which associate the god with pleasant sweetness, especially that of honey. In
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fact, he calls him nidymos (sweet) [10a], meliedes (sweet like honey) [10b], melifron (pleasant like honey) [11a], and ambrosial (divine, heavenly) [11b]. In addition to these kind hearted and gentle
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attributes, Hypnos is constantly recognized as pandamator (the one who conquers everything) [3c]; an appraisal confirmed by the address used by the almighty goddess Hera “sleep, lord of all gods
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and of all men” [3d].
These connotations persist as well in the way Greek Tragedy portrayed Hypnos. A most
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telling example is the one found in Sophocles’ (circa 497 to 406 BCE) text Philoctetes. The hero, suffering from chronic pain, was left on the island of Lemnos by his comrades on their way to Troy. In this major tragedy sailors appeal to Hypnos as a “healer” of suffering and pain. "Sleep, ignorant of anguish [odynas], ignorant of pains [algeon], come to us with gentle breath, ... Come come, Healer!” [12].
Here, Hypnos is associated not only with the relief of somatic pain (algos), but also with the relief of strong psychic pains (odynas) and of mental suffering [13].
Oneiroi, the Dream-Gods In the Odyssey we learn that the Oneiroi (Dreams) dwelled on the dark shores of the western Oceanus, past the gates of the sun and the kingdom of the dead [10c]. Dreams were sent out to men
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in their sleep passing through one of two gates. Deceitful dreams came through the gate of ivory “bringing words that find no fulfillment”, while through the gate of horn passed true dreams which “bring true things” [10d]. On some occasions these very Oneiroi create dream forms, or appear
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personified under different shapes. As when Zeus sends to Agamemnon a “destructive Dream” in
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the likeness of the wise old Nestor, to encourage him to attack Troy without delay to sabotage the Greek army.
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“‘Up, go, destructive Dream (Oneiro), to the swift ships of the Achaeans, and when you have come to the hut of Agamemnon, son of Atreus, tell him everything exactly as I charge you’. ... So, he spoke, and the Dream set out, ... Quickly he came to the swift ships of the Achaeans, and went to Agamemnon, ... So he stood above his head, in the likeness of the son of Neleus, Nestor, whom above all the elders Agamemnon held in honor;” [11c]
Much later, Ovid described Hypnos as the father of Oneiroi and above all of the three dreamgods. Morpheus, who was named after the Greek word morphe (shape), as he used to take different human appearances in dreams to deliver messages from the gods [6b]. Icelos or Phobetor the one who was supposed to bring nightmares, and Phantasus the one who brought dreams of inanimate
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things [4]. It is not by chance that morphine, the active ingredient of opium, was named after Morpheus [13]. These three sons of sleep together with their father ruled in the sphere of dreams of
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ordinary people and kings alike, creating opposite sensations like euphoria or dysphoria [4]. The connection of sleep with dreams is also confirmed by Pausanias in the description of an
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actual statue of Hypnos lying inside the sanctuary of Asklepios at Sikyon, near Corinth. In the inner room of the sanctuary Pausanias saw “an image of the Dream-god and Sleep surnamed Epidotes
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(Bountiful) lulling to sleep a lion” [7b].
Sleep Induction in Greek Antiquity Sleep Induction in Mythology The first reference to sleep induction by the administration of a soporific substance is found in the myth of the Golden Fleece [14]. The sorceress Medea, daughter of the king of Colchis helped Jason to steal the Golden Fleece by lulling into a state of deep sleep the vigilant dragon that guarded it [15a]. For that purpose she used a so far unknown potent substance, simultaneiously asking the god Hypnos for help. Thus, one of the first references concerning induced sleep is associated not with a human being, but with a monster. The scene of Medea putting the ever-alert dragon to sleep
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is illustrated in art [14]. It is also described by Apollonius Rodius (3rd century BCE) in the epic poem Argonautica, which depicts the expedition of the Argonauts to Colchis.
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"And as he [the dragon] writhed, the maiden came before his eyes, with sweet voice calling to her aid Hypnos, highest of gods, to charm the monster;... the serpent, already charmed by her song, was relaxing the long ridge of his giant spine ... But she [Medea] with a newly cut spray of juniper, dipping and drawing untempered charms from her mystic brew, sprinkled his eyes, while she chanted her song; and all around the potent scent of the charm cast sleep; and on the very spot he let his jaw sink down” [16].
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Medea learned “all the powers which drugs possess” [15b] from her mother Hecate, the queen of the underworld, and from her sister, the sorceress Circe. Hecate is referred to as the first person
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to discover the poisonous properties of many plants, from which she prepared therapeutic as well as lethal potions. In her garden in Colchis she grew the black poppy and mandragoras, together with the “white hellebore and monks-hood and many other baneful plants that grow upon the ground” [17].
Among these baneful plants, the most widely known in antiquity as inducing tolerance to pain
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is the poppy, a typical symbol of the god Hypnos. The word ancient Greeks used for the poppy capsules of the plant Papaver somniferum is mekon (mekones in plural) [13]. The poppy capsule
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also functioned in certain contexts as a symbol of the sleep of nature and also as a symbol of fertility, wealth and immortality [18]. It represented one phase in the natural cycle that leads to
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sleep and awakening, analogous to death and rebirth, a reference to the idea of the cyclical process of nature. The symbolism of euphoria, voluptuous ecstasy, and also sleep and death are closely
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related to the specific pharmacological properties of opium. The most convincing evidence concerning mekon, and its use in the whole of the Greek world, comes from the Cretan goddess of mekones, “patron of healing” (Figure 1), a terracotta figurine dated from the Post Palatial Minoan period (circa 1200 BCE) [19,20]. Several scholars have argued that opium was probably used in the cult ceremonies of the goddess either for its healing properties or perhaps to cause hallucinations and dreams in connection with healing [18], as in the cult of Asklepios at a later date. [Insert Figure 1 here]
“Enkoimesis”, Sleep Induction in the Temples of Asklepios With regard to induced sleep, special reference should be made to a particular ritual
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exclusively practiced in the temples of Asklepios. The cult of Asklepios, a physician-hero at first and a god later, was at the same time a religious system and a practice of therapeutics. Beginning in the 6th century BCE, his sanctuaries, known as Asκlepieia, sprang up all over the Mediterranean area,
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where “enkoimesis”, meaning sleeping in the temple or dream incubation, was practiced [13,21].
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After preparation with purifying baths and sacrifice to the god, patients would spend the night in the god’s precinct or temple to wait for the god. While patients “slept” or “were in a strange state between sleep and waking” the god revealed himself nightly [22a]. Patients in their dreams believed
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that the god succeeded in healing them miraculously by “laying on of hands”, or by giving medical advice, or even by curing them with salves and drugs, or finally even by surgery (Figure 2)
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[21,22b]. In the morning the priests, usually trained in medical practice, would interpret the dream and explain the god’s instructions in accordance with rational procedures [22c]. The patients would then leave healed and healthy. [Insert Figure 2 here]
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Whether “enkoimesis” was facilitated by the administration of soporific substances is still debatable. However, there are indications that “enkoimesis” does not refer to natural sleep, but to
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induced sleep. Pausanias reports that inside the enclosure of the famous Asclepieion of Epidaurus there was an imposing circular building of white marble, called Tholos (Round House), ornamented
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by poppy coffers. Inside this building, where the patients slept there was a picture of a deity called Methe (Drunkenness) who was “drinking out of a crystal cup” [7c,21]. The description of Methe together with the poppy coffers suggest that in the inaccessible inner area of this building, called
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abaton, the patients slept while waiting for the god to appear [21]. In this area the process of healing took place on two stages: the dream one of “enkoimesis”, and the “actual” one of treatment, as depicted in a votive relief from the sanctuary of Amphiaraos, a divine figure related to Asklepios (Figure 2) [1]. However, the exact facts concerning the use of soporific substances during “enkoimesis” evade us probably because priests concealed, under a thick veil of secrecy and mysterious glamour, any information about the alleged use of soporifics or the cures practiced. Nevertheless, inscriptions discovered in Asκlepieia certify that real surgical cures were practiced there; these cures point towards the administration of potent analgesic and soporific substances or opium to the sufferers before dream therapy [21]. Today, more than two thousand years later, we still combine sleep and the alleviation of pain as the two basic components of modern anesthesia,
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reversible medicinal sleep induced pharmaceutically.
“Euthanasia” the Permanent Sleep
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Another case where sleep and death were associated in ancient Greece was “euthanasia”, the
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permanent sleep. The word “euthanasia” is derived from the Greek words “eu” (good) and “thanatos” (death) and it means “good death”, “gentle and easy death”. According to the Greek philosopher Heraklides Lembus (circa 2nd century BCE), on the island of Kea aged persons
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voluntarily put an end to their life by drinking poison after a ceremonial banquet; thus they avoided the illnesses and suffering of old age.
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“Since the island is healthy and the population lives to a ripe old age, especially the women, they do not wait until they are very old for death to take them, but before they grow weak or disabled in any way, take themselves out of life, some by means of the poppy, others with hemlock.” [2]
This is the reason why “euthanasia” in ancient Greece was called the “Keian custom”. Yet, this same practice was in use in other areas as well, as implied by Theophrastus (circa 372 to 287 BCE) in his account about a Mantineian herbal healer, Thrasyas; the latter could bring an easy and
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painless death by using “... the juices of hemlock, poppy and other such herbs, so compounded as to
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make a dose of conveniently small size, weighing only one drachma” [24].
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Hippocratic Prognosis and Diagnosis It was in 460 BCE, on the small Aegean island of Cos, where Hippocrates was born, the most outstanding figure in the history of ancient medicine, the person who freed medicine from magic,
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superstition and religion. Sixty medical treatises, written mainly in the 5th and 4th centuries BCE, are ascribed to the name of Hippocrates. These texts were compiled and edited by the scholars of the famous Alexandrian library under the name Corpus Hippocraticum or Hippocratic Collection during the third century BCE [25]. Only about seven of these treatises Epidemics I and III, Regimen in Acute Diseases, Prognostic, Aphorisms, Airs-Waters-Places, On Joints and On Fractures are considered to be written with some degree of certainty by Hippocrates himself [26,27a]. The greater part of the Corpus was written by Hippocrates’ disciples; it records the doctrine and the tradition of the Hippocratic medical school of Cos. Several of these treatises introduced the concepts of prognosis and diagnosis, which mark the distinction of the scientific from the empiricist approach as well as from the arbitrary practical treatment [28]. Clinical
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observation of the symptoms of the patient was a main characteristic of Hippocratic medical practice; sleep and insomnia were not considered anymore as god sent phenomena but as basic elements of prognosis and diagnosis.
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Sleep and Sleeplessness
The Hippocratic author of Epidemics VI identifies sleep as one of the six prerequisites that are beneficial to maintain health [29]. On the other hand, the author of Aphorisms agrees on the
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importance of “measure” in both normal sleep and sleeplessness.
“Sleep and sleeplessness, in undue measure, these are both bad symptoms” [30a].
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“Both sleep and sleeplessness, when beyond measure, constitute disease” [30b].
Deviations in the quality, nature, amount and time of sleep were used as prognostic and diagnostic signs of disease. The relationship between sleep and diet was used for “prodiagnosis” of a patient's current condition, with the aim of altering his regimen to prevent the onset of illness [31a]. By interpreting these symptoms, the physician would find out what kind of excess existed
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that was likely to cause disease. The famous Aphorisms record and reveal with accuracy the diagnostic significance of sleep in disease states.
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“A disease in which sleep causes distress is a deadly one; but if sleep is beneficial, the disease is not deadly” [30c]
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“When sleep puts an end to delirium it is a good sign” [30d].
The reversal of the normal hours of sleep, from nocturnal to diurnal, is a deviation from normality with damaging effects. In the treatise Prognostic, the author asserts that insomnia, as lack
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of sleep during the night or day, is a very bad sign, caused by either pain or discomfort, or a sign of impending mental disorder. “As for sleep the patient has to follow the natural custom of being awake during the day and asleep during the night. Should this be changed it is rather a bad sign. ... For either it will be pain and distress that cause the sleeplessness or delirium will follow this symptom” [32a].
To re-establish a normal sleep-waking cycle and combat insomnia the Hippocratic physicians advized soporifics, but without revealing details about their use. “A medication that brings about sleep must provide the body with calm” [33]. Hippocratic practitioners approached the occurrence of sleep and dreams from a physiologist’s perspective. However, although the proposed explanation was wrong, they were the
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first to suggest that the locus of sleep was the brain. In the treatise On Breaths it is explained that sleep causes a drop of body temperature that slows blood circulation in the brain. This cooling alters the intelligence, enabling “certain fancies” ─the dreams─ to appear.
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“When sleep comes upon the body the blood is chilled, as it is of the nature of sleep to cause chill. ... the body grows heavy and sinks; … the eyes close; the intelligence alters, and certain other fancies linger, which are called dreams” [34].
The Hippocratic author of On Regimen clarifies the connection between the things the soul
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brings up during sleep and those the person sees in his dreams. “For as the experiences of the body are, so are the visions of the soul when sight is cut off” [31b]. As there is no sense perception
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during sleep, the body cannot perceive external stimuli, neither can sensations reach the body from the outside [35a]. It is the soul, the unconscious state, which not only keeps its functions but also it even takes over the functions of the body during sleep [36]. While the body is at rest during sleep, the soul is active and “performs all the acts of the body”. It is aware of everything ─“has cognizance of all things”─ and on its own performs all the acts it would perform in the daytime
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together with the body, such as seeing, hearing, walking, touching, feeling and thinking.
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“For the body when asleep has no perception [aesthanetai]; but the soul when awake has cognizance of all things—sees what is visible, hears what is audible, walks, touches, feels pain, ponders. In a word, all the functions of the body and of soul are performed by the soul during sleep” [31c].
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Sleep and insomnia in Hippocratic medicine were among the symptoms the physician inquired about; whether the patient was sleeping or not, what his habits were with respect to sleep and wakefulness, whether the patient had any visions or dreams. Based on patient’s answers, the
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physician determined the course of action. “The following were the circumstances attending the diseases, from which I framed my judgments ... sleep or absence of sleep, the nature and time of dreams ... From these things must we consider what their consequents also will be” [37].
In “acute diseases” the physician conducted his inquiries starting from the patient’s face and then if he could not arrive on a prognosis from the other symptoms, he went on “to inquire whether the patient has been sleepless” [32b]. It is worth noting that Hippocratic physicians introduced the words “hypnikon” and “hypnoticon”, to describe sleep induction by soporific substances in patients with toothache or for the treatment of female diseases [38]. The contemporary term “hypnotic” is derived from these
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words [36].
Dream Interpretation and Medicine
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Beside sleep Hippocrates, and the physicians who followed his medical beliefs and practice,
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also used dreams as a tool for diagnosis and treatment of illness. They believed that the symbolism in dreams was derived from internal sensations. Dreams were considered to be signs of internal conditions, a belief that is consistent with modern medical concepts.
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The Hippocratic author of Regimen IV ─also referred to as Dreams─ strongly emphasizes the role of dreams as a significant indicator of the dreamer's physical condition. He provides a
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theoretical basis for the use of dreams as a source of information about the condition of the body and gives dreams the most prominent status in his “prodiagnostic” theory [31a,35b]. “He, who has learnt aright about the signs that come in sleep, will find that they have an important influence upon all things” [31d].
The same author distinguishes between two types of dreams: those sent by the gods and those
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sent by the soul. The divine dreams “foretell to cities or to private persons things evil or things good” [31e]. Their interpreters “only recommend prayers to the gods”. On the contrary, only a
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skilled physician is able to interpret the dreams caused from humoral imbalances (dyskrasias) in the body, as portrayed through the visions of the soul [39]. In these non-divine dreams the soul speaks
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to the dreamer and forewarns him of any impending bodily problems: of physical factors such as food, and the patient's habits and state of mind. According to the Hippocratic physicians, the most
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important factor is humoral imbalance in the body [39]. “All the physical symptoms foretold by the soul, excess, of surfeit or of depletion, of things natural” are interpreted by professional physicians who have the skills to restore the dreamer’s health [31f]. Both types of dreams, the divine and the symptomatic, were employed in the formation of medical diagnosis and prognosis as well as in the prescription of regimens and cures. By interpreting a patient's dreams, the Hippocratic physician learned a lot not only about the condition of the patient's body, but also about the effects of diet and physical exercise [32a]. The author of On Regimen IV introduces one of the most basic principles in the medical interpretation of dreams, when he asserts that similarity of dream images to reality is good, while dissimilarity is bad [31e,35a]. The soul relives the deeds or thoughts of the previous day, unless it is distracted by some
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abnormality within the body. When “dreams repeat in the night a man’s actions or thoughts in the day-time” it is considered that they are true representations of the experiences and thoughts of the dreamer and they “signify health” [31g]. However, when something is wrong the soul is disturbed
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and the images dreamt of are of things other than the thoughts and experiences of the previous day
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[35b]. Then, the physician does “advise treatment of the body” to adjust the balance between physical exercise and food, so that the effects of surfeit, as indicated by the dream, are
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compensated. An “emetic” accompanied by “a light diet for five days” and gradually increasing physical exercise are suggested [31h].
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Dream interpretation often determined a course of treatment both in established secular practice and at religious healing sanctuaries. This was usually based on the generally accepted importance of dreams, generated by the widespread belief of their divine origin. Hippocratic physicians did not express any sort of opposition between the rational and the divine that is between reason and religion [27b]. They accepted the validity of the curative suggestions revealed in god sent dreams, in particular those concerning the treatments the suppliants received from Asklepios
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during “enkoimesis” at his sanctuaries [22d,39]. For many centuries the cult of Asklepios coexisted with Hippocratic medicine. The latter never challenged the religion of the great sanctuaries [27b]. It
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did not oppose it nor was it antagonistic. The first lines of the Hippocratic Oath are revealing.
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“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant” [40].
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Conclusions
The knowledge about sleep and dreams gained from ancient Greek myths provides us with the first reference of their importance in the well being of gods and humans as well. The interpretation of dreams occurring during sleep healing ─“enkoimesis”─ in the sanctuaries of Asklepios can be considered as an early form of theurgic medicine. This kind of early knowledge about sleep and dreams opened the way to the rational use of these notions in Hippocratic medicine. It is worth noting that several Hippocratic treatises explore the medical significance of sleep and dreams, as symptoms of disease, as well as necessary factors for the maintenance of human health. The long road of these notions about sleep and dreams marked their evolution from mythology to medicine.
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This transition must be mainly attributed to Hippocrates and his disciples who laid the foundations
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for scientific, modern medicine.
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Acknowledgements
I wish to express my sincere appreciation and thanks to Professor Eva Kalpourtzi and Ms
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Iliana Antonakopoulou for their most constructive help with the editing of the manuscript.
References 1.
Lambrinoudakis VK. Theurgic Medicine. In: Stabolidis NC, Tassoulas Y, eds. Hygeia: Health, Illness, Treatment: from Homer to Galen. Athens: Museum of Cycladic Art Hellenic Ministry of Culture and Sports; 2014. P. 17-31.
Aristotle. On Prophesy in Sleep. In: Parva Naturalia. Vol. VIII. Hett WS, transl. Cambridge,
ED
2.
MA: Harvard University Press; 2000. Lines 463a.3-5. Homer. Iliad. Vol. II, Books 13-24. Wyatt W, Murray AT, transl. Cambridge, MA: Harvard
PT
3.
4.
CE
University Press; 2001. Books (a) 14.230, (b) 16.671-673, (c) 24.5 (d) 14.233. Askitopoulou H, Astyrakaki E, Papaioannou A. Significance of Sleep in Greek-Roman Antiquity: Versions of Myth, Aspects of Reality. In: The History of Anaesthesia. Proceedings of
5.
AC
the Eighth International Symposium on the History of Anaesthesia. Sydney; 2015. In Press. Hesiod. Theogony. In: Homeric Hymns, Epic Cycle, Homerica. Evelyn-White HG, transl. Cambridge, MA: Harvard University Press; 1977. Verses (a) II.116-122, (b) II.226-7, (c) II.758-761. 6.
Ovid. Metamorphoses. Melville AD, transl. Oxford: Oxford University Press; 1986. Books (a) XI.605-606, (b) XI.633-638.
7.
Pausanias. Description of Greece. Jones WHS, transl. Cambridge, MA: Harvard University Press; 1978-1979. Books (a) Boeotia, 9.xxxix.8, Vol IV, (b) Corinth, 2.10.2, Vol. I, (c) Corinth, 2.27.3, Vol. I.
Page 15 of 20
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8.
Apollodorus. The Library of Greek Mythology. Hard R, transl. Oxford: Oxford University Press; 1998. P. 38-39.
9.
Plato. Phaedo. Vol. I. Fowler HN, transl. Cambridge, MA: Harvard University Press; 2005
RI P
T
(Stephanus 72 C).
10. Homer. The Odyssey. Vol. II, Books 13-24. Murray AT, Dimock GE, transl. Cambridge, MA: Harvard University Press; 1998. Books (a) 13.79, (b) 19.551, (c) 24.11-14, (d) 19.563-565.
SC
11. Homer. Iliad. Vol. I, Books 1-12. Wyatt W, Murray AT, transl. Cambridge, MA: Harvard
MA NU
University Press; 2001. Books (a) 2.34, (b) 2.19, (c) 2.8-21. 12. Sophocles. Philoctetes. Vol. II. Lloyd-Jones H, transl. Cambridge, MA: Harvard University Press; 1998. Verses 827-832.
13. Askitopoulou H, Ramoutsaki IA, Konsolaki E. Analgesia and Anesthesia. The Etymology and Literary History of Related Greek Words. Analg Anesth 2000;91:486-91.
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14. Astyrakaki E, Askitopoulou H. Medea: the first Greek Pharmacist to administer a hypnotic. In: Drury PME, ed. The History of Anaesthesia. Proceedings of the Sixth International Symposium
PT
on the History of Anaesthesia. Reading, Berkshire: Conservatree; 2007. P. 81-85. 15. Diodorus Siculus. Library of History. Vol. II, Books 2.35-4.58. Oldfather CH, transl.
CE
Cambridge, MA: Harvard University Press; 1935. Books (a) 4.47.1, (b) 4.46.1. 16. Apollonius Rhodius. Argonautica. Seaton RC, transl. Cambridge, MA: Harvard University
AC
Press; 1967. Book IV.146-161. 17. Dottin G. Les argonautiques d'Orphée. Paris: Les Belles Lettres; 1930. Lines 914-923. 18. Kritikos PG, Papadaki PS. The history of the poppy and of opium and their expansion in antiquity in the eastern Mediterranean area. Part I. Bulletin on Narcotics 1967;19(3):17-38. 19. Askitopoulou H, Ramoutsaki IA, Konsolaki E. Archaeological Evidence on the Use of Opium in the Minoan World. In: Diz JC, ed. Proceedings of the Fifth International Symposium on the History of Anaesthesia. Amsterdam: Elsevier Publishers; 2002. P. 23-30. DOI: http://dx.doi.org/10.1016/S0531-5131(02)00769-0. 20. Dimopoulou - Rethemiotaki Nota. The Archaeological Museum of Herakleion. Athens: John S.
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Latsis Public Benefit Foundation; 2005. P. 132-133. 21. Askitopoulou H, Konsolaki E, Ramoutsaki IA, Anastassaki Μ. Surgical Cures under Sleep Induction in the Asclepieion οf Epidauros. In: Diz JC, ed. The History of Anaesthesia.
RI P
T
Proceedings of the Fifth International Symposium on the History of Anaesthesia. Amsterdam: Elsevier publishers; 2002. PP. 11-18. DOI: http://dx.doi.org/10.1016/S0531-5131(02)00717-3. 22. Edelstein EJ, Edelstein L. Asclepius. Vol. II. Interpretation of the Testimonies. Baltimore: The
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John Hopkins University Press; 1998. PP. (a) 149-151, (b) 152-153, (c) 142-144, (d) 139-141. 23. Heraclides Lembus. Excerpta Politiarum. Greek, Roman and Byzantine Monographs 5. Dilts
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MR, ed. Durham: Duke University Press; 1971. P. 29.1-3.
24. Theophrastus. Enquiry into Plants. Hort A, transl. Cambridge, MA: Harvard University Press; 1977. Chapter IX, 9.16.8.
25. Miles SH. The Hippocratic Oath and the Ethics of Medicine. Oxford: Oxford University Press;
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2005. P. 40-41.
26. Jones WHS. General Introduction. In: Hippocrates. Vol. I. The Oath. Loeb Classical Library.
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Cambridge, MA: Harvard University Press; 2004. P. XIV-XXI. 27. Jouanna J. Hippocrates. DeBevoise MB, transl. Baltimore: The John Hopkins University Press;
CE
1999. P. (a) 58-65, (b) 195.
28. Littré E. Oeuvres complètes d' Hippocrate. Vol. 1, Paris: JB Baillière; 1839-1881. P. 454.
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29. Hippocrates. Epidemics. Vol. VII. Smith WD, transl. Cambridge, MA: Harvard University Press; 1994. Book 6.8.23. 30. Hippocrates. Aphorisms. Vol. IV. Jones WHS, transl. Cambridge, MA: Harvard University Press; 2005. Sections (a) II.iii, (b) VII.lxxii, (c) II.i, (d) II.ii. 31. Hippocrates. Regimen. Vol. IV. Jones WHS, transl. Cambridge, MA: Harvard University Press; 2005. Books (a) III.lxix.14-16, (b) III.lxxi.14-15, (c) IV.lxxxvi.12-18, (d) IV.lxxxvi.1-3, (e) IV.lxxxvii.1-4, (f) IV.lxxxvii.5-15, (g) IV.lxxxviii.16-25, (h) IV.lxxxviii.1-6. 32. Hippocrates. Prognostic. Vol. II. Jones WHS, transl. Cambridge, MA: Harvard University Press; 1998. Chapters (a) X.1-10, (b) II.12-15.
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33. Hippocrates. Affections. Vol. V. Potter P, transl. Cambridge, MA: Harvard University Press; 1988. Chapter 36. 34. Hippocrates. Breaths. Vol. II. Jones WHS, transl. Cambridge, MA: Harvard University Press;
RI P
T
1998. Chapter XIV.10-19.
35. Hulskamp MAA. Sleep and Dreams in Ancient Medical Diagnosis and Prognosis. Newcastle: Newcastle University eTheses; 2008. P. (a) 156-177, (b) 256-272,
SC
http://hdl.handle.net/10443/1577 [Accessed 2nd November 2014].
36. Astyrakaki E, Papaioannou A, Askitopoulou H. References to anesthesia, pain, and analgesia in
10.1213/ane.0b013e3181b188c2.
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the Hippocratic Collection. Anesth Analg 2010;110(1):188-94. DOI:
37. Hippocrates. Epidemics I and III. Vol. I. Jones WHS, transl. Cambridge, MA: Harvard University Press; 2004. Book I.xxiii.
ED
38. Hippocrates. Epidemics 2 and 4-7. Vol VII. Smith WD, transl. Cambridge, MA: Harvard University Press; 1994. Section 6.6.13.
PT
39. Oberhelman SM. Galen, On Diagnosis from Dreams. J Hist Med Allied Sci 1983;38 (1):36-47. 40. Edelstein L. The Hippocratic Oath: Text, Translation, and Interpretation. In: Ancient
AC
CE
Medicine. Baltimore: The John Hopkins University Press; 1987. P. 6.
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Legends for FIGURES
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Figure 1. The Minoan goddess of mekones with upraised arms (78-cm height), wearing a unique tiara on her head with three hairpins of beautiful and well slit poppy capsules, called mekones, (circa 1200 BCE). In the Archaeological Museum of Herakleion, Crete [20].
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Figure 2. Votive relief of white marble in the shape of a temple found in the sanctuary of Amphiaraos at Oropos (4th century BCE). It depicts the two stages of healing through “enkoimesis” of a young patient, named Archinos. On the left the god himself performs surgery on the patient’s upper arm with a small curved knife, while the young man supports his injured right arm [1]. On the right side the same patient is depicted having a vision while he slept during “enkoimesis”. The sacred animal of Asklepios, the snake, is licking the sleeping patient’s affected shoulder, while a priest is overlooking. The votive inscription under the representation denotes that Archinos dedicated the relief to Amphiaraos. In the National Archaeological Museum of Athens.
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