Communicating disease, care and healing. The role of medical inscriptions and patient reports in temple medicine from classical antiquity to the roman imperial age

Abstract The use of the term “irrational”, when interpreting ancient and contemporary medical systems, is generally based on a bipolar, perhaps two-party, ideological systematization. This is a perspective behind which there is a reifying ideology that defines medical knowledge based on divination and symbolic practices as “irrational”. Moreover, they are seen as systematized “beliefs”. However, this approach neglects the extent to which rituals permeate all practices, including those of contemporary biomedicine. Even in the case of ancient medicine, concepts of the natural and the spiritual are not, therefore, connoted as a clear watershed between the rational and the irrational in the reductive sense described above. On the contrary, they are conjugated in a manner that coexists within the same medical system. Starting from this interpretative foundation, it is possible to trace practices of rational medicine in the temples of Asclepius, in accordance with the late testimonies of Hippocratic medicine. Consequently, this paper focuses on demonstrating the continuity between temple medicine and “rational medicine” through the communication strategy of the iamata (sanationes) as well as the reports of special patients, such as Aelius Aristides. In addition, the article highlights the political role of writing as a way to regulate the healing not only of the body but also of the civic body. This approach is perfectly consistent with the ancient wisdom and philosophical tradition of overlapping state and body, politics and medicine, lawgivers and physicians.

The elevation of Asclepius from healing hero (Gorrini, 2015) to god of medicine is a relatively recent fact when compared to the origins of the Greek Pantheon.However, despite this timing, his cult quickly overshadowed that of the other local healing heroes-specifically that of Apollo as a deity traditionally linked to the sphere of health and disease, with the exception of the city of Cyrene.Both Apollo and Asclepius had the centaur Chiron as master, one of divination, the other of medicine, two practices closely linked to the role reserved for prognosis.From an archaeological point of view, it is no coincidence that the sanctuary of Apollo Maleatas and the great Asklepieion of Epidaurus are also so close to each other and similar from a cultural perspective (mid-8 th century BCE).Starting from the 5th century BCE, there are clear distinctions regarding the skills of the deities of these shrines: Apollo, united in worship to the Delphic Muses, is assigned divination, and Asclepius medicine (Melfi, 2007, pp. 23-27).The importance of shrines to Asclepius as places for the treatment of diseases through the practice of temple medicine is tangibly demonstrated by their proliferation, the processes of monumentalisation, to which many Asklepieia are subjected, and by inscriptions.Through proxeny decrees and theorodokia (See Melfi, 2007, p. 27 note 49), these inscriptions attest to a strong internationalisation of worship.The medical role of the Asklepieia became a defining feature of the Hellenization inn Mediterranean that would persist during the Imperial Age.The literature and epigraphy testify to the fortune of the cult that entrusts to the inscriptions of healing, iamata or sanationes, the account of the medical practices put in place in the sanctuary.
The language of sanationes would remain unchanged through the centuries.The propagandistic and apologetic value that defines sanationes -and which the inscriptions resort to-give value to the healing and therapeutic strategies of temple medicine, also had a profound influence on the report of a patient of excellence such as Aelius Aristides.The archaising culture of the Hadrian age, the noteworthy process of Hellenisation that characterised the age of the Antonines, the pagan revival of Julian the Apostate, as well as the importance given to the medicine of the sanctuaries of Asclepius in the recovery of pre-Christian cultural identity, made the testimonies on the healing of the temple rather homogeneous in intention, even if chronologically belonging to different eras.The aforementioned aspects are the reason behind how and why this work intends to explore the dialogue between temple medicine and Hippocratic medicine, or simply their coalescence through the centuries, precisely because of the continuity of their language and their intentions.It is of little importance whether the propaganda of the effectiveness of temple care was read in inscriptions of the classical or imperial age or heard in the public oration of a brilliant lecturer.The public edition of sanationes and their goal, both through inscriptions and rhetorical speech, consecrate Asclepius' strategy for the care of the body just as the written laws for the good government of a state.Health of the body and of the civic body, or disease of the body and of the civic body consequently find a strong parallelism not only in the sapiential, medical and philosophical traditions, starting from Alcmaeon of Croton, but also in the communication strategies used to regulate the εὐκρασία (humoral balance) and the δυσκρασία (humoral imbalance) of the body as well as of the state (See Sirianni, 2020, pp. 141-155).

The salvation narrative of Aelius Aristides and the iatromantic practices of the healing sanctuaries
However, the practices of temple medicine within the Asclepieia also provide us with an exceptional witness, namely Aelius Aristides, a well-renown rhetorician born in Mysia under the Antonine dynasty from a rich and politically relevant family.The author, fearing that he was close death, tells us about the experience of devotion and salvation that the god Asclepius granted him during ten years of stay in his sanctuary of Pergamum in order to cure the state of psychological and physical prostration that afflicted him after returning from Rome in 144 CE.From this moment on Aristides obeys Asclepius' will as the patient obeys the doctor.
Reliable historical and literary sources can reconstruct the distribution of these sacred places of healing, as well as their history, their structure, their arrangement on the territory, and the practices that the faithful underwent in search of health (Blinkenberg, 1894, pp. 153-178).Aelius Aristides represents a preferential source, albeit late, testifying to the "psychological" experience of healing in the temple (Gourevitch, 1968, pp. 897-902).He describes how Asclepius works essentially through dreams, offering his therapy and cures directly or through symbolic mediation.Moreover, this god needs a host of interpreters who are able to connect his order with the use of the correct remedy.These interpreters sometimes deserve the appellation of iatroi and in general the interpretation of the dream conforms to a widespread medical practice, linked to precise cultural aspects of that time.
Asclepius orders Aelius Aristides to write down his healing experience, so that the orator's work, once it has seen the light, does not take the form of a simple act of devotion and thanks, rather this work takes on the much more structured character of a public testimony.This paper raises the question-and also attempts to answer it, at least partially-concerning the specific nature of this process of recognition.What value or importance is intended to be conveyed by the apology that Aristides makes of himself and the god he lives in close contact for ten long years?
Based on initial analysis, there are three possible answers: (a) The dialogues are an exaltation of a technique, that of oneirocriticism, also attested in medical sources, already in the IV book of the Hippocratic treatise On regimen (whose author only creates a distinction between medical dreams and divine dreams) and then in the tradition up to Galen (who complicates the classification of dreams, on the one hand, while on the other admits the validity of Asclepius' suggestions, which he tested personally) and to Artemidorus.
(b) Aelius Aristides' work constitutes a source of study of a successful therapeutic strategy, based on the use of medication and on the changes to living conditions.
(c) The path towards recovery also marks the resumption of Aristides' rhetorical activity that places his art under the patronage and service of the god Asclepius (Israelowich, 2012).No wonder, then, that the therapeutic pathway promoted Aristides to the rank of therapeutes, as the rhetorician defines himself in the dream that sees him refuse the bow in the presence of emperor Marcus Aurelius as therapeutes of Asclepius.If we exclude the term indicating a generic devotional role-yet actually refer to the group of "devoted experts" who in Asclepieion put themselves at the service of the patient as mediators between the sphere of the sacred and the one more properly connected to the cure-we can then interpret the testimony of Aristides precisely as a service rendered to the god as therapeutes.
Regarding point C above, a sacred law of the II century CE offers testimony to a quasi-hierarchical distinction between those who visit the sanctuary for the first time and those who return to continue their dialogue with the deity.This distinction is measured in a less onerous sacrificial request, in access to a reserved environment to repeat the incubation experience and in carrying out the rite of perithyein with priests.According to Habicht's interpretation (Habicht, 1969, p. 8), this rite is the same as three inscriptions for three special theoroi who can be recognized as therapeutai of the god.Aristides offers a significant testimony on the role of therapeutai in the interpretation of dreams sent by the god and how they translate the god's indications on the therapeutic level (Petridou, 2017, pp. 185-213).In essence, Aristides' account turns into a formalisation of a genre, the literary ennoblement of the iamata/sanationes tradition.As a form of public writing, this account represents a significant change from oral tradition to written works.This "genre" is defined by a rather extraordinary persistence-due to the fact that it is still vividly seen in the chronicles of the saints-and therefore well beyond the time when the pagan voice of Aelius Aristides would be heard (Angeletti, 1992, pp. 71-82).

Pinakes and Sanationes
Inside the sacred enclosure there are (some) stelae, more numerous in ancient times, but in my time only six.In them are engraved the names of the men and women treated by Asclepius and also indicate the disease from which each one suffered and how he was healed.The inscriptions are in Doric dialect (Guarducci, 1978, p. 149).
With these words, in the II century CE, Pausanias describes the stelae containing the catalogues of sanationes of the temple of Epidaurus, a result of the systematic transcription from the gods' pinakes and votive stelae in marble.These were a sign of deeper devotion, left in the sanctuary by the faithful who believed they had received a healing in response to their pleas.These long catalogues, which are the product of collective writings from priests and engraved on marble tables, on stelae, or directly on the walls of the temple, represent a sort of proto-archiving of lesser important artefacts.On the other hand, the clay or wooden tablets were engraved directly by sick faithful or by those who, in their stead, asked for healing.The tablets can be partly considered the result of the personal elaboration of the suitor, although some were likely revised by the priests themselves, or corrected by them in some way.Moreover, some are also certainly "false", in the sense that they tend to magnify the power of the god and the miraculous effects of the cure.As a matter of fact, they represent the "objective correlative" of the apology Aelius Aristides wrote, and a sort of sophisticated response to Artemidorus who still warns in his work on the interpretation of dreams: In fact, there are some who argue that the art of medicine is derived from these cures.But I am of the opinion that even people who have a very low degree of common sense may realise that medical prescriptions through some writer's dreams are indeed quite ridiculous, because these writers do not record dreams that actually occurred, but rather dreams that they invent themselves. . .However, I think that the very gods, to whom these writers attribute the nonsense they themselves fabricate, are in all likelihood indignant to them.(White, 1975, pp. 323-344) Finally, a small part of the iamata, which are late and come from the eastern provinces, has the religious form of the admission of the guilt that brings with it the disease as a punishment-these are generally indicated as propitiatory inscriptions (Chaniotis, 1995, pp. 6-26).
In most of these documents, the fact is clearly mentioned that they were written at the behest of the god, who expressly asks that they be first compiled and then made public.
The collections of clinical cases that come to us through this temple witnesses have quite variable dates, ranging from the oldest collection, which is that of Epidaurus, dated to the IV century BCE, to the most recent ones, from the temples of Phrygia and Lydia, which can be dated around III century CE.Among these, the inscriptions bear a clear preponderance, testifying to a decisive resurgence of the concept of disease understood as a punishment that follows a sin committed or an impurity in some way contracted.
Contrary to what one might be led to believe, none of them represent evidence of the existence of a real contrast between the use of rational medicine and temple practices (Corazza, 2018;Longrigg, 1993;Nicosia, 2009;Perilli, 2006).On the contrary, the inscriptions, like Aelius Aristides' report, even when narrating cases of obscure interpretation and imaginative theophanies, depict the god as a sort of expert doctor, who knows and suggests the remedies in order to eliminate the evil through surgical procedures or to restore a correct balance of humors, with dietary, pharmacological and hygienic prescriptions: the god cooked some kind of medicine, the god opened her breast with a knife and removed her abscess, a young man of majestic appearance placed a pharmakon on his tongue, the god took a herb and injected its juice into the eye, the god led him out of the sanctuary to one very cold water source and ordered him to bathe there, the god placed a cup on her belly and commanded her to leave quickly (Herzog, 1931, p. 14, 17, 40, 37).
Specifically, the collections of Epidaurus and Lebena, which date back to the IV century BCE, provide us with a large number of medical prescriptions and use terms of current use in medicine (Chaniotis, 1995, p. 330).Moreover, this is a fairly common attitude also in other contexts, which is that of simulating procedures documented by the rational medical tradition.Historical criticism has long discussed the logic of the proposed treatments and their congruence with the dictates of contemporary "rational" therapy, proposed by Hippocratic medicine starting from the V century BCE.Although some historians believe that some of the prescriptions are characterized by a clearcut irrationality, none are actually conceived entirely outside the "scientific" spirit that defines contemporary medicine (Oberhelman, 1981).
Moreover, the pharmacopoeia of sanationes changes with the development of new approaches in official pharmacopoeia, consequently adopting most of its vegetable principles as well as animal and mineral substances.The therapy to which the Roman Publius Granius Rufus is subjected in Lebena, in the I century BCE, for his cough, with hemoptysis and with pain in a shoulder, provides a good example of a complex and articulated approach to care that certainly cannot be dismissed as a simple fruit of the practices of worship.As a matter of fact, Lebena's prescription meets three requirements, which are namely religious, climate and dietary requirements.The first can be identified in the mixture of ash and sacred water that come respectively from the altar of sacrifices and from the spring that in the Asclepieia provides the waters for ritual ablutions.The location of the sanctuary near the sea and its exposure to the South on routes to Libya and Egypt makes the place climatically suitable for treating respiratory diseases.Finally, Granius Rufus disease is due to an imbalance of the humoral krasis so that, in perfect harmony with the indications of CH, he is prescribed foods that have nutraceutical properties capable of purging and tempering the excess of certain humors at the origin of respiratory infection (Cilione et al., 2022a, p. 4;Rivoli, 2019, pp. 191-198).This aptitude for rational care is based on stimulants, emollient foods, medical plants such as arugula and iris.Pliny, among others, prescribed these ingredients, in association with honey, in the treatment of lung diseases: To Asclepius Publius Granius Rufus, by (his) order.The god took care of me after I had been coughing continuously for two years, so as to emit infected and bloody phlegm all day long.He gave me to eat some rocket on an empty stomach, then to drink Italian peppery (wine), then flour with hot water, then a mixture of holy ash and holy water, then an egg and resin, and then liquid pitch, then iris with honey, then, boiled a quince with peplis, drink the decoction and eat the apple [. ..] lots of blood.(Oberhelman, 1981) Moreover, both Aelius Aristides and Plutarch are well acquainted with the texts of Corpus Hippocraticum, and the work of the first, in which the god also advises the hypochondriac patient from placing his trust in the work of doctors, abounds with suggestions and healing practices directly modelled on Hippocratic skills.Artemidorus himself expressly urges his son to become an expert in the principles of medical art, if he wants to read dreams correctly: Whenever you stumble upon a cure through dreams, whether you have interpreted it yourself or learned the results from others, you will discover through investigation that the prescription will be so much better in medical terms and not outside of medical theory . . .therefore, I have often warned you, work hard to acquire as much understanding as possible of medical theories and practices (Oberhelman, 1981) Moreover, the iamata often have the same logical form as medical texts, due to the fact that they report a symptomatology, a prescription-often of a surgical or pharmacological nature-and are alien to other forms common to sacred healing rites, which find their fundamental expression in enchanting ceremonies, prayers and a complex set of rituals.
The permeability between the medical practices adopted in the temple and the Hippocratic clinical approach is confirmed not only by the aforementioned "technical" terms used in some of the inscriptions (Cilione, 2016, pp. 19-38), but also by the direct quotation that some make of the activity of iatroi inside the sacred enclosure.In fact, Aelius Aristides himself speaks of doctors working inside the enclosure of the temple.
The language used by the patients, who were saved by the healing god, or by the priests who interpret their story, is clear and free from aspects regarding symbolism that the connection with the dream context could suggest.Artemidorus expressly states that ease of expression is the main characteristic of the god's language: I think, my son, that you will discover that the prescriptions of the god through dreams are simple, and without enigmas.Indeed, when the god prescribes applications, poultices, food and drink, he uses the same names we use, and even when the god speaks in symbols, their meaning is very clear indeed.(Oberhelman, 1990) Moreover, not even in its treatise did the Corpus Hippocraticum fiercely oppose to the use of magical practices in the treatment of diseases, more radically inspired by a natural interpretation of their causes, that is On the Sacred Disease, contrasting temple medicine with so-called rational medicine.The tried and true contrast concerns the practices of wizards and charlatans that limit the cure to a question of enchantments and purifications, invoking the gods improperly (Marcone, 2006, pp. 26-54).According to the author, however, the sick should be taken to the temples of the gods who cannot contaminate humans as nothing is purer than divinity.Perhaps, right behind this statement by the author of Sacred Disease, there is a hidden awareness that the temple environment operates in a way that is not incompatible with those that are properly medical.
In short, with their echoing of "secular" knowledge and proposing common lifestyles and treatments, albeit in synthetic and simplified prescriptions compared to those elaborated in the texts of official medicine, the gods' advice is "surprisingly reasonable" (Oberhelman, 1993, p. 152).
This apparently bizarre correspondence with rational Hippocratic medicine is mutually confirmed, although only in part, by the same medical texts.The IV book of the Hippocratic treatise On Regimem presents, for example, dreams as seed, trustworthy indicators of a humoral imbalance (Haselswerdt, 2019, pp. 1-21).In the treatise On Diagnosis from Dreams, Galen associates humoral imbalance with very distant images from the reality of waking life, especially cosmic images, due to the fact that the body is the microcosm that reproduces balances and imbalances in harmony with the macrocosm.The only moment when the dialogue between body and cosmos becomes explicit is when the soul in sleep detaches from the body and speaks the metaphorical language of the dream.According to Galen, the physician is the only person who can interpret the analogical language of this type of dreams (Walde, 2013, pp. 129-157).Artemidorus explicitly mentions the analogy in the aforementioned work on dreams, also recalling that the methods of interpreting dream activity adopted by popular practices and "official" medicine are, if not the same, certainly based on the same strategies.This is likely the reason why, unlike his contemporary Galen, Artemidorus does not distinguish between medical dreams and dreams that predict diseases: oneiroi and enhypnia are identical from a qualitative point of view and distinct only for the meaning of their content.However, only an example can be mentioned: the analogical method, which allows to explain the nocturnal visions of the sea, water and drowning as a signal that indicates the excessive presence of blood in the dreamer's body, blood that must be evacuated through bloodletting (CH, Vict.4.90).
In short, regardless of the cataloguing of dreams in general, "There is no real conflict between rational attitude and not rational towards dreams" (Oberhelman, 1993, p. 152), as also attested by philosophical literature.For example, Plato classifies them as the lowest form of perception, yet at the same time admits to the existence of those inspired by the god.Likewise, there is generally no definitive gap between the world of the rational and that of the irrational in Greek and Roman culture.
Therefore, these inscriptions represent an "alternative" form of transmission of knowledge and attested practices, despite their different depth and extension, by the same culture-based medicine that was first put in writing by Hippocrates.They constitute the primitive form of a true kind of communication (Dorati & Guidorizzi, 1994, p. 345), characterised by the persistence of modules and formulas and by a language and verbal motifs common to very different eras and cultural situations.If the iamata were long believed to be an expression of a form of "popular" culture (typical of the lower middle class that certainly thrived in the world of healing temples), it is equally certain that they can be placed in a transversal dimension.Intellectuals of the time developed their work: Aelius Aristides and his companions in life and conversation in Pergamum; Demetrius Phalereus, who collected, according to Artemidorus, chronicles of healings and sacred prescriptions in five books; and, Publius Granius Rufus, adorned with proxeny, protagonist of the two inscriptions of Lebena.They are far from exclusively linked to an uncultivated feeling that they converged in the Hellenistic period in real books, which-if we set aside the outdated cult of Asclepius-testify to the fortunate activity of late divinities, such as Serapis (Dorati & Guidorizzi, 1994, p. 346).

Hypothesis by way of conclusions
In historical-medical literature, there is a well-documented hypothesis on the interpretation of these epigraphic texts.This idea concerns the role of iamata within healing temples, regarding sickness warding rituals (Dillon, 1994, p. 251).According to this belief, the sanationes, above all, would have had an "educational role", highlighting that their main purpose would have been to attest to the popularity of the cult.Consequently, many report the places of origin of the believers, which vary a great deal.They also offer evidence, as in the case of Epidaurus, not only of the survival of a temple activity that lasted for many centuries, but above all the involvement of pilgrims.These people were attracted by this "Panhellenic" fame, coming from even very distant regions-and perhaps areas provided with their own sanctuary of healing-although these faithful judged their own temples to be less effective.
Furthermore, the inscriptions testify to the totipotency of the god, who is able to treat almost all possible diseases, from blindness to parasites, from paralysis to stones, from headaches to sterility, from abscesses to tumours.
According to this interpretative key, the iamata would perform a multiplicity of functions at the same time: (a) The patient uses them as "memento" of the offer he made to the god, in exchange for which he expects healing: the tablet must function as a reminder in case Asclepius forgets that the request for pardon for a sick wife has already been duly accompanied by the payment of what was due (to chreos) (Dillon, 1994); then, the pinax will have to act as a witness (marturìen).
(b) The god, through his priests, uses them, in turn, as a form of convincing sceptics, as proof of his power even over those who have no faith, as well as a reminder that no one forgets to offer even a minimal sign of homage to his capacity.The sacrifice of a single rooster can also be considered a sufficient form of thanks.Roosters, although they were well-known through the famous request of the Platonic Socrates, is a poor gift, whose offering on the altar of the god constitutes the minimum form of gratitude.The importance is to believe and not deride the care given by the god: A man who had a paralyzed hand except one finger came suppliant to the god.Examining the temple votive tablets, he doubted the cures and laughed at the inscriptions.When he fell asleep he had a vision and thought he was playing dice at the temple; and he was already about to throw the dice when the god appeared and took his hand and stretched out its fingers.When the god was gone, he dreamed of taking his hand and stretching each finger.
When he had straightened all his fingers, the god asked him if he still doubted the inscriptions on the temple tablets.He answered no, and the god said: before you did not believe incredible things, for the future your name will be Incredulous.When the day dawned, he went away healed.(Pifferi, 1963, pp. 35-47) How the god aims to "console the afflicted and confound the unbelievers" (Guarducci, 1978, p. 152) is testified by the fact that he works in any kind of impossible intervention, including that of restoring a vase broken by the negligence of a foolish servant, despite the fact that he was confident in the extraordinary abilities of the Asclepius of Epidaurus (Guarducci, 1978, p. 154)who even manages to make Hermodice of Lampsacus, paralyzed, cured during his sleep, drag the largest stone that his strength allows him to lift in front of the temple.The attestation of gratitude becomes a public expression.In this case, we can point to the grandiose engraved stone placed in front of the abaton and, in another geographical context, in the obligation imposed on the healed person to publicly profess his faith in the healing god before the gathered assembly, along the banks of the Tiber: To Lucius, pleuritic and passed off by everyone, the god ordered by oracle to go and take some ash from the Tribomos and mix it with wine and apply it to the chest.And he was saved, and publicly given thanks to the god, and the people rejoiced with him.(Guarducci, 1978, p. 158;Moretti, 1968, p. 158) (c) The god, again through priestly mediation, orders the writing as pure aretalogy, as a record of virtue and power, which constitutes an encouragement for the sick present and provides instructions for the sick who would come.
In all three cases cited above, the iamata cannot be seen as simple statements of "received grace", but rather constitute a clear warning to the people about the real powers of the god.Therefore, they would be the result of an instruction carried out by the temple authorities on the faithful-learners, in order to introduce them to the "documented" knowledge of the powers of Asclepius, while also leading them to publicly admit that they had fulfilled the "expectations" that existed within the same religious place.In short, the god demands that he be offered a gift not to receive thanks, but rather to have a public attestation of his effectiveness and ability to carry out healing.
This view, which is certainly valid along general lines, has the only limit of settling on an evident level.This level implies the pressing need to disseminate a healing practice, more or less close to the theory and techniques of Hippocratic rational medicine, to make it accessible to the greatest number of people, to set up, in the end an effective advertising campaign to promote itself.Could there be further levels of reading that welcome this thesis and incorporate it into a more defined dimension?
The reading and interpretation of the texts of the inscriptions suggests some other elaboration, which can be presented in the form of a hypothesis articulated in two further points: a.The writing can testify to a medical "claim of legitimacy" of the healing that is derived from the unique and simplified dimension of magic and temple practices.Later on, the distinction between temple medicine and magic, as defined in the Hippocratic treatise On the Sacred Disease, can also be expressed through the contrast between public use and the secret and hidden use of writing.In fact, magical inscriptions in general and therefore either magical-medical inscriptions of amulets created either to protect health or to put curses on others, are designed to be hidden from view either because they are buried in the depths of the earth.This also occurs with defixiones, or because they are encapsulated in a container that makes them invisible.An alternative level of invisibility can also be represented by the use of cryptic writing, i.e. a paralinguistic code that constitutes the privileged channel of communication with the invoked magical forces (Vallarino, 2010, pp. 87-136).Inscriptions relating to the prodigious healings of Asclepius, on the other hand, are publicly exhibited and in some cases made in very regular characters, almost with decorative function, as seen with the stoichedon style.This cultural and anthropological path can be translated into a simple question: do the priests who wrote the catalogues write them in order to be similar to "real" medicine and convey the sense of the growing distance of their therapeutic practices from the schemes of magic?
In this case, the god would act as a skilled physician, a lithotome expert and surgeon, a proper pharmacopola, for the fundamental purpose of protecting himself from decline (Gordon, 1995, pp. 363-376).Nothing, in the narration of his deeds, is in fact the result of chance or accumulation.With their intervention, the priests select the testimonies, for example-as a part of medical historiography claims-giving preference to therapies practiced on men over those made on women, so that "The number (of testimonies) could have been higher, because the iamata were selected by the male authorities of the temple" (Calloway, 2018, pp. 332-350).Therefore, writing as a competitive form, justified by the fact that, then as now, especially in the absence of a strong opposition, or rather of a declared incompatibility, the patient tends to prefer a multi-approach to the disease, the use of multiple strategies at the same time.
This procedure is clearly revealed if we examine the opposite attitude.In this case, doctors, for example in the case of dreams, place themselves as the only interpreters authorised to explain their meaning to the layman.Obviously, other categories were well consulted by patients in order to interpret the meanings of one's dream.The doctor must exercise a form of control that allows him to keep clients from resorting to Asclepius, or even worse, from interpreting the dreams concerning their illness on their own.On the contrary, the "writers of Asclepius" must use means to conquer and maintain their market, in the forms of competition mentioned above, because medicine, albeit quite simplified, is always the same.
Moreover, Greek and Roman medicine "is the result of a complicated cultural construct in which [we find] science, magic, folklore, philosophy and rhetoric" (Oberhelman, 1993, p. 152).Defining it the simply as "ancient scientific medicine" is an unacceptable simplification that seems to derive from a specific tendency towards categorisation that is quite typical of our current mentality.In ancient times, we find a more complex flow of data, a ground that is in some respects uncertainthe god uses the method of iatriké téchne and creates his own specific knowledge.The proof of this is that in official medicine, which at this point had already severely condemned magicians, charlatans and swindlers, there is no explicit condemnation of resorting to the healing powers of Asclepius.Indeed, they are "reused" by medicine even late as a construct borrowed from these more ancient and popular practices.We can remember once again Galen who does not hesitate to profess his faith in the healing powers of Asclepius who healed his hand and allowed him to make it an instrument in the service of rational medicine (Brockmann, 2013, pp. 51-67).
A second, and conclusive, hypothesis could be formulated in the following terms: b.In addition to having an attested role of teaching and learning, the iamata could be interpreted as the tools of a publicist or advertising.In other words, a form of early "advertising" of health could be found in them, structured in analogy to what occurred, around the V century BCE (and therefore in a dating prior to that of the first known and organic collections of epigraphs) mainly in temples dedicated to divinities who, before the establishment of the cult of Asclepius, also dealt with the management of health and illness.Here we are discussing gods such as Apollo and Artemis, in whose temples the early "advertising" of the law is documented through writing and public posting (Detienne, 1997, pp. 1-49).Detienne studied the role that the practice of writing plays in the "invention of political space" -it seems equally legitimate to ask ourselves what role writing has played in the invention of healthcare and above all in its spread to a wide audience, to whom the values on which the practice itself is based must be transmitted.
The period that Detienne takes into consideration is between 600 and 450 BCE, and is therefore useful for identifying a period in which temple medicine had not yet completely undergone the crisis stemming from the impact of the rational theory proposed by Hippocratic medicine.
In this context, the Solonian laws are engraved "on a machine made of rectangular wooden beams, three or four faces mounted on vertical frames and movable around an axis" (Detienne, 1997, p. 7).Therefore, writing provides a tool, which is placed at the centre of the polis, in the Prytaneum, in order to allow the public vision of the laws.Similar procedures for the notification of the law, although it is the expression of an oligarchic government, are attested by Strabo in Marseille and then in Chios, between 575 and 550, where a red trachyte stele engraved on all faces is used for this purpose.
Consequently, writing is in itself inextricably linked to the "advertising" process, because writing is nothing more than making something known through its display in a common space.And it is precisely the law that uses, since its structuring as entrusted to a transmission no longer only oral, a metaphorical tool which, shortly afterwards, would constitute one of the workhorses of Plato's political philosophy.It would also become one of the most successful topoi used in moral literature up to the imperial era, as the example provided by Seneca clearly attests.Detienne reminds us that, during a social crisis, the term loimos is used-the same one that inaugurates the Iliad with the image of the pestilence that devastates the Achaean camp in front of Troy.If there is loimos, that is, violent political disorder, abrupt tearing of the civil make-up, it is necessary to resort to medicine, and this is represented by none other than the work of the legislator (Detienne, 1997, p. 9).
The domains are often also common.Epimenides, the soothsayer expert in contamination in Athens, lended his service to the god Apollo, the same god who triggers epidemics of punishment.This is due to the belief that contaminations have a religious origin, yet also affect aspects regarding society and health.In this case, the problem is to counteract a metaphorical disease, which derives from the unjust killing of the partisans of Cilone, slaughtered on the altar of the Eumenides by the Alcmeonides, and the spilled blood has a character of impurity that Epimenides eliminates with publicly celebrated rituals.However, this was not yet based on written rules.The same blood, if corrupted, is the cause of a long series of diseases-the blood that is shed as a result of a violent and unjust act contaminates the city, as well as, in a mutual process, the guilt of Orestes who crosses the town can cause problems for pregnant women, invited not to leave the enclosure of the houses (Parker, 1990).
In Delphi, Thaletas carried out his work.He is an expert in paean-based music therapy, which he generally used in the treatment of madness in women.Again, it was Apollo who summoned him to eliminate this time a real disease, which is a loimos that brings fever and death to the city (Detienne, 1997, p. 12).
In both cases, we find the skills of non-rational healers of the soul and the body.They restore peace to the torn city, as well as health to feverish bodies, eliminating the impurity which is the common cause of social malaise and disease.They are both experts in ritual practices, commissioned by the god.This is the embodiment of the powers that he himself carries out, together with his son, during the night in the rites of incubation.If not legislators, both are recognised by the true legislators, Lycurgus and Solon, as predecessors of their activity as public operators, disseminators in a common space of healing practices, testifying to an early link between legislation as a cure of the state and medicine as a cure for the body (See Plato, Laws 720a; Botter, 2019, pp. 35-64;Cilione et al., 2022b, pp. 31-44).
Laws would later determine an extensive use of writing, no longer relegated in the form of graffiti in limited inscriptions on commonly used objects.At the turn of the VI and V centuries, they find a space for writing, which is very similar to that of sanationes.These are marble stelae, large stone blocks, white painted wooden tablets, destined to be placed in public places where they can be seen and read by many.
Around 550, the polis even invents a style -Stoichedòn -which, with its ordered and aligned letters, allows easier readability of the rule, through the creation of a tried and true engraved writing grid (Guarducci, 1970).The city appropriates, by means of the stylus, the concept of public enjoyment of the common good, and not only regarding far-reaching assumptions (the law, in fact), but also in smaller aspects of the daily life, contracts, marriage, commerce and family life (Guarducci, 1970).Moreover, there is also the public aspect of healing, which is testimony to the activity of the god for the city, the Asclepius of Epidaurus is all the more active than that of another city.Even the divinity has a sort of social belonging, even the god is a full member of a polis and representative of a social group.The close interaction between politics and that of healing is highlighted, early on, by the presence of the same opening formula ("god good fortune") both in the healing inscriptions and in the normative provisions.In an interesting testimony from Epidaurus, dated to the III century BCE, Isillus proposes Asclepius and Apollo, together, as guarantors of the new constitution of the city, because they are able to guarantee "ygieian, eunomian, eiranan", meaning health, good governance and peace.Much later, again the Annales of Tacitus speak of an "ancient" right of political asylum inside the temples of Asclepius for those who request it (Tacito, pp.1-2).
On the other hand, according to Detienne, more than a mere transmission of information, from the very beginning advertising becomes a "political act", and epigraphy becomes a form of public offering for all those who wish to use it.
And what place is more public than the house of god, where intellectuals and servants, writers and pregnant women, soldiers and the mute children go together to ask for the grace of healing?This aspect is so true that neither the laws nor the iamata are posted only in the adynaton, the area of the temple accessible only to the sick and priests.Furthermore, the same is true for the room where the anatomical votives are deposited, another sign, however, of the attendance and success of the temple, but often in the enclosure, where they are necessarily placed in good view.There is no need for special access to read the story they testify.
Not only that, but in the inscriptions, it has been said, the request to "make public" the activity of the god often appears, or the mention of the fact that the patient gives thanks in front of an audience, to a real social assembly: About Julian spitting blood.He was the despair of every man; the god revealed to him that he had to go and take a pine cone from the altar, covered three times and eat it with honey for three days.And he was saved and returned and publicly gave thanks before the people.(Edelstein & Edeltein, 1945, p. 251) And again, in Epidaurus, in the II century CE, an individual inscription, certainly revised by the priests: Under the priesthood of Publius Aelius Antiochus I, Marcus Julius Apella Idrieus of Milasa, was sent to call by the god, because I often fell sick and suffered from indigestion also to put in writing these things.Grateful and healed, I left.(Girone, 1998, p. 58) or in Lebena, between the II and I centuries BCE: . . .and a woman gives thanks to Asclepius the saviour, having developed a terrible ulceration on her little finger, and being healed, (after the god had ordered her) to apply (the shell) of an oyster -after having burned and ground it (together with) a rose ointment -and to grease (finger) with mallow together with oil; and so he healed her.Having seen further prodigies (of the god in a dream) the god ordered (me) to transcribe my visions.(Girone, 1998, p. 147) or again in Pergamum, in the II century CE, the voice of Publius Elio Theon, perhaps a stomach patient: To Asclepius, the loving god of men, (I) Publius Aelius Theon, (son) of Zenodotus and Zenodota, of Rhodes, after one hundred and twenty days in the morning of each day I did not drink and ate fifteen and a half grains of white pepper onion, by order of the god, having been manifestly saved from many and great dangers, I have dedicated -also for the nephew Publius Aelius Callistratus, called Plankion, (son) of Antipater -the paidikon as a vow.(Girone, 1998;Mueller, 1987, pp. 193-233) This marks the birth of what would later become a topos of sacred literature (Festugière, 1950), precisely the activity of Serapis as that of the God of the righteous of Israel, to whom the Lord often orders that the vision in which he appears and his own orders be transcribed by engraving on a tablet.
Due to the fact that we know, even after the advent of Asclepius, that some "previous" divinities continued to play a role of interest in the healing processes.These gods were often involved in publicising or announcing the law and the reacquisition of health.More specifically, once again, this regards the major deities of the pantheon, Apollo and Artemis, sometimes in the form of Ilithyia (Eileithya), who relieves the pains of childbirth.Apollo himself continues to "serve" in the temples dedicated to his son Asclepius even when the cult of the latter was consolidated and widespread throughout the Hellenic territory.Moreover, his name is engraved, in a prominent position, in the heading formulas of epigraphs, up to quite advanced times (Guarducci, 1978, p. 147).This happens in Miletus, Argos, Eretria, Lato, places where the laws are exhibited in the temple of gods to whom the pre-Asclepiadean tradition attributes powers of healing and dealings in life and death.Even in Rome, the incubation practice is attested, as well as on island of Tiber starting in 291 BCE, at the temple of Apollo which stands on Palatine hill.
Consequently, we find analogous and similarly spread management of the "things of the gods" and of the "things of men".We also see how their mediation lies in the practices of writing (Detienne, 1997, p. 37), as a technical means, which become the instrument with which the polis defines its limit of action and articulates it on the two different registers of the sacred and the profane, the world of the gods and the world of men.And what domain, more than that of sacred medicine, of religion, best identifies the meeting point, the intersection of the two dimensions?What better point is that of human materiality, the management of one's body, suffering and illness, and that of supervision divine, which regulates and puts order in the balances of the body as well as in the complex systems of public affairs, and the "body of the city"?Disease, along the lines of social deviance, destroys "an order or an aspect of it ".Healing, much like the intervention of the legislator, restores that order, in part with therapeutic aids, in part by trying to reconstruct a certain balance through the creation of a rule.In this sense, the inscriptions are the "simplified" mirror of Hippocratic therapy, and the reflection of the analogous procedures that the legislator assumes for the reorganisation and control of polis.
As Plato would describe, and as long before him Alcmeon had stated, the vision of disease as a counterpart to the unjust prevailing of one over many: Who is unhappier between two sick people in body and soul, the one who gets treated by the doctor and frees himself from evil, or the one who does not seek treatment and continues to keep this evil? . ..But the liberation from the greatest evil, that is, from wickedness, was it not perhaps serving the sentence? . ..In fact, justice in a certain sense makes us feel better and more righteous and is a sort of medicine against wickedness.(Reale, 1998, p. 323)

Conclusions
The contemporary perception of the act of care as a private fact is the result of an approach that has, at the same time, quite ancient as well as very recent roots.In addition to the principle of confidentiality already enunciated in the Hippocratic Oath and in general by the deontological treatises of the Corpus Hippocraticum, confidentiality is reaffirmed in the Geneva Declaration of 1948 as a contravening the aberrant experience of the National Socialist ethical state that had denied individual identity even on the level of health.However, if the Geneva Declaration restores the balance with respect to a totalitarian excess, the oldest roots of care as a private and individual fact must be sought in Christianity that separates the individual destiny from the community destiny because the soul is principium individuationis and it is with respect to the individualizing soul that the otherworldly parable of man is defined.This also applies to the body, if it is true that Christianity associates the concept of health with that of salvation and if it is true that the risen body is a healthy body.The Greek world, on the other hand, conceives of the individual only within a community network.Belonging to a thiasus, to an haeteria, to a class homogeneous by census or by geographical origin is nothing more than the different declination of the political dimension of the Greek man.However much, therefore, the relationship of care is played between the vertices of the triangle, doctor, disease, sick, this triangle must be placed on the broader level of the Community dimension.The votive anatomicals and the iamata, together with rhetorical reports, are the tool through which the healing deity and his hypostasis publish and share the experience of the disease and its cure, they are the channel through which the addresser (the god) and the addressee (the community) participate in the message (the healing path).The material nature of the object and epigraphic writing gives social weight and legitimation to a communicative act that is played out in the private situation of the enkoimeterion and in the individual and impalpable dimension of iatromantic sleep (Cilione et al., 2019).In this inscription, the message of God takes shape exactly as it occurs when upon awakening the patient's soul rejoins the body.In this way, writing becomes a sort of borderland of communication.In the same way, the inscriptions of the Orphic foils guide the soul of the initiate on the otherworldly journey to the lake of Mnemosyne, so the iamata tell the diagnosis and care of the god with whom the soul of the sick person came into contact during the small death of sleep.Only the direction of origin of the message and the mode of its edition change: secret and therefore hidden in one case, intentionally public in the other.This communication takes place through the shared code of alphabetic writing that represents a real revolution in the communicative habit of ancient civilizations.It shifts the sharing of knowledge from an oral-aural modality to a more markedly visual one, passing through an intermediate phase of written orality.In the case of the iamata, seeing the words of the god makes the patron of the temple witness to the authority of the care and the success of healing by way of the temple.The high sociological value of epigraphic writing in the ancient world, moreover, is expressed both in the sense of its recognized and widespread educational value, as in the sense of its normative and legitimizing value.The religious autobiography of Aelius Aristides ends up pursuing the same goal.The solicitation of friends to tell the path of salvation and temple healing superimposes the author's apologetic intent on the testimony of the medical successes of the Asklepieion of Pergamon which benefits on a propagandistic level from the communicative narcissism of the brilliant lecturer.