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York, George K. III MD

The Accidental Historian

Practicng neurologists, among many others, are amazed to see the re-emergence of expressly religious values in our national discourse. We conduct our practices in secular splendor, and though our patients often invoke the Almighty, we usually respond with anatomy, physiology, and chemistry. We completely reject the assertion that disease is the result of the wrath of God, that people get sick because of divine retribution. Stigmatizing the sick as sinners, miscreants who deserve supernatural punishment, violates our principles as physicians and humanitarians. For the accidental historian, things haven't changed since 400 BCE.

The sight of a seemingly normal person falling to the floor, stiff and jerking, foaming at the mouth and biting his or her tongue, then returning to his or her usual life is disconcerting to the casual observer.

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In pre-Hippocratic times, people thought that epilepsy was sent by the gods in retribution for some imagined slight. They believed that the Olympians controlled all aspects of human existence, not excluding health and disease. Epilepsy, as broadly defined, was called the sacred disease, and the afflicted sought treatment in the temples rather than the physician's shop. The standard treatment in 400 BCE was purification and incantation.

Our knowledge of classical Greek medicine comes from a collection of writing known collectively as the Hippocratic corpus, though none of the works can be reliably attributed to Hippocrates the man. One of the earliest works in the Hippocratic corpus is a work entitled The Sacred Disease, which scholars believe was written by a younger contemporary of Socrates, who died in 399 BCE. You can read the Greek version with an English translation in Hippocrates II (Harvard University Press, 1923).

The Greeks did not share our modern definition of epilepsy, and it is anachronistic to expect them to do so. The symptoms describes in The Sacred Disease include what we would call epilepsy, but also a variety of presumably psychiatric disorders.

The Hippocratic author states categorically that epilepsy is no more sacred or divine than any other disease, that it has a natural cause. He says that its supposed divine origin is due to human inexperience and puzzlement at its curious nature. He excoriated the magicians, purifiers, charlatans and quacks that infested medicine in classical Athens, who treated disease in all manner of irrational ways.

Even 2,400 years ago, fantastic treatments evoked outrage among those who thought of health and disease in concrete, naturalistic ways. The unknown author of The Sacred Disease is simply one of the oldest extant exponents of what we call naturalistic, or rational, or scientific medicine.

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It would be pleasing to report that, once rational medicine appeared in ancient Greece, it immediately and completely supplanted religious medicine, but that is not the case. The two co-existed for many centuries; you could argue that it is still the case. The ancient Greek medical temples, the Asclepieions, housed both Hippocratic practitioners and religious healers. People believed that the blood of executed criminals would cure epilepsy, a practice that was active less than a hundred years ago. There are still places in the world where epilepsy is treated by applying hot objects to the plantar surfaces.

Modern physicians see religious and scientific medicine as inherently opposed, as did the author of The Sacred Disease, but this attitude would have astonished many physicians in antiquity and the Middle Ages. We must not confuse our patients' religious belief with error or irrationality. Our challenge is to find ways to give our patients the benefit of our science while understanding the power of their beliefs. We often hear neurology described as an art as well as a science, and the sacred disease tests both parts of our practice.

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