Roman Medicine

Introduction

Injury and disease have afflicted the human race since earliest times. Although when unwell many animals instinctively know how to make themselves feel better, the search by human beings for knowledge of their illnesses, of ways to cure and prevent them and for an understanding of their bodily processes, was as much an imperative in the past as it is today. This search defines what medicine is. But medicine is more than this. According to Hippocrates (c.460-370 BC) medicine is an art,1 and 'the medical colossus of the Roman era,'2 Galen (c.AD 129-216?), insisted that the good doctor is a philosopher. Medicine is also a skill in that it is the result of practice and knowledge, particularly knowledge of science; thus science is an intrinsic part.

Medicine, therefore, is concerned with the prevention of disease and the art and science of healing. It is as ancient as the human race itself. Healing and bodily health are brought about by the search for, and the application of, remedial substances and the regulation of diet and personal habits. Medicine has only recently been confined to professional, regulated bodies. Today it is a subject of high importance in the politics of church and state; art and philosophy have been translated into medical ethics.

Medicine changes through time. Although basic similarities remain, in many ways ancient medicine bears no resemblance to its modern counterpart. The purpose of this book is to attempt to explain how medicine was practised in the Roman world, to seek out Roman medicine as it was, not how we would like it to have been, nor how close it came to the medicine of today. Neither is the book about 'how nearly they got it right', by comparisons with the familiar concepts and practices of modern medicine, which today are presumed to be the proper way to practise human healing. Every 'medicine' is particular to the culture, time and place in which it finds itself.

Western medicine has a historical pedigree which reaches back to the times of Homeric epic, in which disease and war-wounds are described and treated by divine will or magical incantations, or with surgery or drugs. The Iliad and the Odyssey, attributed to Homer, were transmitted by ancient oral tradition from the end of the Trojan war, at the beginning of the twelfth century BC, and written down around the eighth century. This is where the name of the paramount god of Greek medicine, Asclepius, is first found, although at this time he was not yet deified. His chief attribute, the snake, is the symbol of medical associations in Britain and abroad, while the sons of Asclepius, Machaon and Podalirius, healers also mentioned in the Iliad, are featured today in the arms of the Royal College of Surgeons in London.3

Most particularly, Western medicine is indebted to the origins of natural scientific thought in archaic and classical Greece. Hippocrates was a Greek physician born on the island of Cos and known as the 'Father of Medicine'. Many medical treatises are collected under his name, but few, in fact, are his work. Between the seventh and fourth centuries BC, argument and debate concerning different subjects gave rise to the formulation of a variety of competing theories. Questions were asked concerning the identification of individual elements making up the human body and the cosmos, such as earth, air, fire and water. Atomic theory has its roots in this early period. Democritus (c.460 BC) thought that all things in the universe were made up of a flux of atoms in a void. Plato (427-347 BC) and his pupil Aristotle (384-322 BC) were concerned with enquiries surrounding the relationship between the body and the soul. Plato taught that the soul (mind or psyche) was immortal and independent of the body and, because the body could influence the mind, one of the duties of the doctor was to teach virtue.

Through Plato the tradition evolved in Western thought whereby an important part of medicine consisted of understanding human nature, or the psyche. Good health depended on temperance and wisdom, on self-control achieved through moderation in the consumption of food and wine, and in sex and physical exercise. Thinking good thoughts led to sophrosyne, soundness of mind.4 Aristotle also investigated the natural world and was interested in explanations concerning anatomy and physiology. He used findings from animal dissections in his research, although he did not distinguish between veins and arteries.

1 The Calf-Bearer, c.575-550 BC. From the Acropolis Museum, Athens

Thinking good thoughts was also required of those who entered the temples of Asclepius. Throughout this period, religious medicine was an important part of life. Healer deities resided at cult centres, such as those erected for Asclepius at Epidaurus, Cos or Pergamum. Here the sick would sleep in order to experience healing dreams. Another important healer-deity was Amphiaraus, found at Oropus near Boeotia. He fulfilled a similar function. However, such cult centres cannot be regarded as early types of a 'hospital' because the sick were not given any form of continuous therapy, nursing care or food. Another aspect of religious medicine to take place at cult centres was pilgrimage. Gifts, often including animals, (1) first-fruits, garments and anatomical models of parts of the body, would be carried to the deity, as a request either for healing or for fecundity for themselves, their animals or their crops.

Hospitals were a natural outcome of Rome's military policy. As the Empire expanded its frontiers into distant and hostile territories, suitable places where the sick and wounded could rest and be cared for were needed. Although little is known about its foundation, the Roman military medical provision evolved from this need and hospitals, valetudinaria, were provided in forts and fortresses. Greek doctors, including Claudius' personal physician, Caius Stertinius Xenophon of Cos, Scribonius Largus (c.AD 1-50) from Sicily, and Dioscorides (fl. c.AD 40-90) of Anazarbus, in Roman Cilicia (who may have come to Britain with Claudius' invasion force), were among the army medical personnel.

The distinction between veins and arteries, although not discovered by Aristotle when in Athens, may have been realised at other centres of study. Some of these have already been mentioned above. Many theories came from Praxagoras of Cos (c.340 BC) and Diocles of Carystus (c.320 BC) in Euboea. Later, in the second century AD, Galen decided that blood was made in the liver where it became mixed with foods in the form of chyle. This nourishment for the extremities was carried by veins which also originated in the liver. According to Galen, arteries commenced in the heart, although full understanding of blood circulation was not to come until much later, with the work of William Harvey, published in 1628.

In 331 BC, Alexander the Great, whose tutor had been Aristotle, founded the city of Alexandria, ushering in the Hellenistic period. When Alexander died in 323, Egypt was ruled by a line of Macedonian kings, the Ptolemies, and a royal dynasty was established. The city of Alexandria became very wealthy. The library and museum were founded and a great international centre of study and research grew up. It continued at least into the second century AD and possibly lasted throughout the Roman period in Egypt (30 BC-c.AD 323). Galen is known to have studied at Alexandria, where one of the most important subjects to be researched was anatomy. According to Celsus (De Med. pref. 23-6) human dissection was performed. Two of the foremost medical scientists to travel to the great city were Erasistratus of Ceos (330-255 BC) and Herophilus of Chalcedon (c.330-260 BC). New discoveries were made in anatomy and physiology and, following the ideas of Alcmaeon of Croton and Diogenes of Apollonia, the brain and not the heart was found to be the seat of intellectual activity.

Among other subjects to be researched in the new city were pharmacology and botany. In the reign of Augustus, after his conquest of Egypt in 31 BC, strange and new ingredients became incorporated into the Roman pharmacopoeia. Later, the expansion of the Empire all round the Mediterranean basin, beyond the Euphrates to Asia, further increased the range of medicinal drugs that could be available. Three routes lay open to a rich diversity of plant-life in the Far East. First by the Black Sea, through the Oxus and by northern Bactria (modern Afghanistan, Tadzhikistan and Kirghizstan); secondly, from Syria down the Euphrates to Nisa and across Persia; finally, the route through the Red Sea and the Indian Ocean.5

In the later Empire, after the conversion to Christianity of the Emperor Constantine, the cult of Asclepius was supplanted by Christianity and the first non-military houses where the sick could be cared for were established in the Greek East. Literary and epigraphic sources refer to these as xenodocheia and nosokomeia. One of the first to be built was that of the bishop St Basil of Caesarea. He provided physicians, nurses, rehabilitation and after-care in his ptocheion. This was technically 'a house for the poor', although it was also used for sufferers from other misfortunes, including disease. According to St Jerome, the first hospital in the West was founded in Rome by a wealthy Christian widow, Fabiola, in around AD 350.

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